The landmark trial that showed therapy, medication and both together all help — and what each one costs
CAMS: 488 children randomised across four treatment arms
Reviewed by Sian Trombley, CCCFounder, Thrive Family Company
Strong confidence
Source citation
Walkup JT, Albano AM, Piacentini J, et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753–2766. https://doi.org/10.1056/NEJMoa0804633
Published 25 December 2008 · Added to Thrive 25 December 2008 · Reviewed 26 July 2026
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This is still the most influential trial in childhood anxiety treatment, and the reason clinicians talk about options rather than one right answer.
Published research findings
The study
Children with separation anxiety, generalised anxiety or social phobia were randomly assigned to CBT alone, sertraline alone, the combination, or placebo for twelve weeks.
What researchers examined
Rates of much or very much improved anxiety across the four arms.
What they found
The combination outperformed either single treatment (about 81% improved), while CBT alone (about 60%) and sertraline alone (about 55%) both clearly outperformed placebo (about 24%).
Thrive editorial interpretation
What this may mean for families
Skills-based therapy is a genuine first-line option, not a soft alternative. Combination care is the strongest choice when anxiety is severe or when a child cannot yet engage in exposure work.
What this doesn't tell us
Important limitations
Twelve weeks is short for judging durability, the trial excluded children with several co-occurring conditions, and academic-centre delivery is more intensive than most community care.
Evidence confidence describes how much weight this study's design can carry — not how strongly the finding applies to any individual child or family.
Therapist perspective — Thrive interpretation, not a finding of the study
Therapist Perspective
I use this study to give parents permission to consider medication without feeling they have failed, and to insist that skills work continues alongside it.
Practical family considerations
Ask what each option is for: medication lowers the volume, therapy teaches the child what to do with the quiet.
This research summary is educational and does not replace individualized medical, psychological or therapeutic advice.
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Supporting children on therapy waitlists: A randomized controlled trial of a web-based parent-focused single session intervention for child anxiety
2026 · Randomized controlled trial
Moderate confidence
Why it matters
The findings suggest cLINICAL.TRIALS GOV IDENTIFIER: NCT06043271. This does not establish what will happen in any individual family.
Eight family sessions cut the rate of new anxiety disorders from 31% to 5%
2015 · Randomized controlled trial
Strong confidence
Why it matters
Prevention is feasible and brief. Families with anxiety histories do not have to wait for a child to become unwell.
Exposure is the ingredient that carries child anxiety treatment
2015 · Systematic review
Strong confidence
Why it matters
If a treatment plan for anxiety contains no gradual approach to feared situations, it is missing the active ingredient.