Exposure is the ingredient that carries child anxiety treatment
A fifty-year evidence base update across 111 treatment studies
Reviewed by Sian Trombley, CCCFounder, Thrive Family Company
Strong confidence
Source citation
Higa-McMillan C. K., Francis S. E., Rith-Najarian L., Chorpita B. F. (2015). Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety. Journal of Clinical Child & Adolescent Psychology. https://doi.org/10.1080/15374416.2015.1046177
Published 1 January 2015 · Added to Thrive 26 July 2026 · Reviewed 26 July 2026
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Anxiety treatment for children has many brand names. This review identified the component they share.
Published research findings
The study
Higa-McMillan and colleagues reviewed 111 treatment studies for child and adolescent anxiety across fifty years.
What researchers examined
Which treatment approaches met criteria for well-established status, and which components appeared in effective treatments.
What they found
Cognitive behavioural therapy, with and without parent involvement, and exposure-based treatments met the highest evidence standards. Exposure appeared in nearly every effective protocol.
Thrive editorial interpretation
What this may mean for families
If a treatment plan for anxiety contains no gradual approach to feared situations, it is missing the active ingredient.
What this doesn't tell us
Important limitations
Trial samples are often less complex than families seen in routine services.
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
Ask any therapist how they use exposure. The answer tells you a great deal.
Practical family considerations
Effective anxiety treatment involves gradually approaching what is feared.
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.
The landmark trial that showed therapy, medication and both together all help — and what each one costs
2008 · Randomized controlled trial
Strong confidence
Why it matters
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.