Brief Behavioral Therapy For Anxiety And Depression In Youth: Workbook

The Brief Behavioral Therapy for Anxiety and Depression in Youth program provides step-by-step instructions and evidence-based strategies for supporting young people experiencing depression and anxiety. A therapist guide is downloadable separately.

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Introduction – Overview of the Program

Chapter 1 – Session 1: Understanding Stress and Mood

Chapter 2 – Session 2: Relax Your Self and Your World

Chapter 3 – Session 3: Problem-Solving Plans

Chapter 4 – Session 4: Developing a Master Plan

Chapter 5 – Session 5, Onward: Implementing the Master Plan

Chapter 6 – The Final Session: Onward and Upward!

Front Matter

Overview

The Brief Behavioral Therapy for Anxiety and Depression in Youth guide presents a concise, transdiagnostic intervention for treating anxiety and depression – two of the most common internalizing disorders in young people. This evidence-based approach targets shared underlying factors such as avoidance, withdrawal, and negative mood, offering a streamlined framework that benefits both therapists and families. By integrating behavioral strategies like graded engagement – which blends exposure and behavioral activation – BBT encourages approach behaviors and promotes meaningful re-engagement with life. Supplementary tools, including stress management and problem-solving techniques, further increase its flexibility. BBT is especially suited to pediatric settings, where emotional distress often shows up as physical complaints. It has proven particularly effective for underserved groups, including racial and ethnic minority youth. As part of the Treatments That Work™ series, this guide offers clear, practical instructions, helping clinicians deliver effective, scalable, and accessible care to children and adolescents facing internalizing difficulties.

Why Use This Resource?

This program provides a step-by-step, structured approach for treating children and young people experiencing anxiety and depression. It includes:

Detailed explanations of cognitive-behavioral principles tailored to anxiety and depression.
Evidence-based interventions for overcoming anxiety and low mood.
Practical guidance for structuring sessions and implementing client exercises.
Strategies for overcoming common obstacles during treatment.

Key Benefits

Structured

Offers a clear, session-by-session outline for delivering effective therapy.

Educational

Helps clients understand the nature of their difficulties.

Effective

Supports therapists in implementing effective interventions for addressing anxiety and depression.

Trusted

Part of the Treatments That Work™ series, developed by leading experts.

Who is this for?

Anxiety

Distressing worries, persistent fearfulness, and avoidance.

Depression

Persistent low mood, loss of interest, and withdrawal.

Mixed Symptoms

Overlapping anxiety and low mood requiring an integrated approach.

Integrating it into your practice

Assessment

Explore how children and young people (CYP) experience anxiety and/or low mood.

Psychoeducation

Teach clients about mood-related difficulties and what maintains them.

Skills

Implement effective cognitive-behavioral interventions to address key symptoms.

Monitoring

Use structured worksheets to track progress and refine interventions.

Relapse Prevention

Equip clients with long-term strategies for maintaining their progress.

Theoretical Background & Therapist Guidance

Internalizing problems - encompassing feelings of sadness, worry, irritability, and fear - are among the most prevalent psychiatric concerns throughout people’s lives. In youth, nearly one in three children experiences clinically significant anxiety, and one in four undergoes a depressive episode before reaching puberty (Merikangas et al., 2010). Left untreated, these issues can lead to a range of long-term consequences, including chronic depression, poor physical health, academic difficulties, substance abuse, and increased mortality from suicide (Bittner et al., 2007; Fergusson & Woodward, 2002; Pine et al., 1998). Moreover, anxiety and depression often co-occur, with up to 70% of treatment-seeking youth presenting with both disorders, leading to worsened outcomes (Garber & Weersing, 2010).

Despite the high prevalence and significant impact of these issues, internalizing disorders in youth remain underserved in mental health systems and historically underrepresented in clinical research. The child and adolescent anxiety and mood program (ChAAMP) sought to address these gaps, focusing on community service delivery, shared mechanisms across disorders, and the development of innovative, transdiagnostic treatments. The culmination of this work is the brief behavioral therapy (BBT) model for pediatric anxiety and depression, on which this guide is based.

Unlike traditional disorder-specific CBT approaches, BBT offers a transdiagnostic framework that targets shared mechanisms underlying anxiety and depression, such as avoidance, withdrawal, and negative affectivity. Studies have shown that these approaches are effective in improving outcomes across both conditions, particularly when delivered in medical settings like pediatrics, where somatic complaints often signal underlying mental health concerns (Lynch et al., in press; Weersing et al., 2017). Moreover, the transdiagnostic approach is especially beneficial for racial and ethnic minority populations, who often face barriers to accessing effective mental health care (Weersing & Weisz, 2002).

Research consistently supports the efficacy of transdiagnostic CBT approaches for youth. For example, BBT’s behavioral focus aligns with evidence demonstrating that exposure and behavioral activation are highly effective for treating anxiety and depression (Anderson et al., 2016; Newby et al., 2016). Additionally, studies have highlighted that shared intervention strategies for internalizing disorders can simplify treatment delivery while maintaining strong outcomes, as shown by comparable improvements in anxiety and depressive symptoms (García-Escalera et al., 2016; Ehrenreich-May et al., 2017).

By emphasizing simplicity, scalability, and effectiveness, BBT equips clinicians with a powerful tool to address anxiety and depression in youth. This guide provides therapists with a clear roadmap for implementing BBT, offering hope and practical strategies for young people and families facing internalizing challenges.

Authored by leading psychologists including David Barlow, Michelle Craske and Edna Foa, Treatments That Work™ is a series of manuals and workbooks based on the principles of cognitive behavioral therapy (CBT). Each pair of books (Therapist/Clinician Guide and Workbook) contains step-by-step procedures for delivering evidence-based psychological interventions and will help you to provide the best possible care for your clients.

What's inside

A structured session-by-session guide for BBT.
Worksheets for monitoring mood, avoidance behaviors, and progress.
Problem-solving frameworks to help youth navigate challenges.
Guidance for involving caregivers in the therapy process.

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FAQs

BBT is a brief, focused intervention that prioritizes action over discussion. While traditional CBT may include extensive cognitive restructuring, BBT emphasizes behavioral activation and problem-solving to create change.

Yes, BBT was designed for flexibility and can be delivered in primary care clinics, schools, and community-based settings where access to mental health services may be limited.

Resistance is addressed through motivational strategies, collaborative goal-setting, and starting with small, manageable steps to build confidence and momentum.

Caregiver involvement is encouraged to support skill implementation outside of sessions. The program provides guidance on how caregivers can reinforce positive behavioral changes at home.

BBT includes structured methods for assessing progress. If a client is not responding, therapists can modify the intervention by adjusting exposure hierarchies, increasing support, or addressing co-occurring difficulties.

How This Resource Improves Clinical Outcomes

BBT has demonstrated strong clinical effectiveness in reducing anxiety and depression in youth. By emphasizing behavioral activation, the intervention helps clients regain engagement in meaningful activities, reducing the impact of avoidance and low mood.

Therapists benefit from:

A structured approach that ensures efficient use of session time.
Evidence-based techniques that enhance treatment effectiveness.
Clear guidance on managing avoidance and fostering engagement.
Tools that support both in-session work and out-of-session practice.

Clinicians Who Use This Resource Also Use

Brief Behavioral Therapy For Anxiety And Depression In Youth: Therapist Guide

References And Further Reading

Anderson, P., Toner, P., Bland, M., & McMillan, D. (2016). Effectiveness of transdiagnostic cognitive behaviour therapy for anxiety and depression in adults: A systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 44(6), 673-690.
Bittner, A., Egger, H. L., Erkanli, A., Jane Costello, E., Foley, D. L., & Angold, A. (2007). What do childhood anxiety disorders predict? Journal of Child Psychology and Psychiatry, 48(12), 1174-1183.
Brent, D. A., Porta, G., Rozenman, M. S., Gonzalez, A., Schwartz, K. T., Lynch, F. L., â¦ Weersing, V. R. (2020). Brief behavioral therapy for pediatric anxiety and depression in primary care: A follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 59, 856-867.
Chu, B. C., Crocco, S. T., Esseling, P., Areizaga, M. J., Lindner, A. M., & Skriner, L. C. (2016). Transdiagnostic group behavioral activation and exposure therapy for youth anxiety and depression: Initial randomized controlled trial. Behaviour Research and Therapy, 76, 65-75.
Ehrenreich-May, J., Kennedy, S. M., Sherman, J. A., Bilek, E. L., Buzzella, B. A., Bennett, S. M., & Barlow, D. H. (2017). Unified protocols for transdiagnostic treatment of emotional disorders in children and adolescents: Therapist guide. New York: Oxford University Press.
Fergusson, D. M., & Woodward, L. J. (2002). Mental health, educational, and social role outcomes of adolescents with depression. Archives of General Psychiatry, 59(3), 225-231.
García-Escalera, J., Chorot, P., Valiente, R. M., Reales, J. M., & Sandín, B. (2016). Efficacy of transdiagnostic cognitive-behavioral therapy for anxiety and depression in adults, children and adolescents: A meta-analysis. Revista de Psicopatología y Psicología Clínica, 21(3), 147.
Garber, J., & Weersing, V. R. (2010). Comorbidity of anxiety and depression in youth: Implications for treatment and prevention. Clinical Psychology: Science and Practice, 17(4), 293-306.
James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A. (2020). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, (11), CD004690.
Lewinsohn, P. M., Sullivan, J. M., & Grosscup, S. J. (1973). Behavioral therapy: Techniques and empirical findings. Annual Review of Psychology, 24, 253-278.
Lynch, F. L., Dickerson, J. F., Rozenman, M. S., Gonzalez, A., Schwartz, K. T. G., Porta, G., O’Keeffe-Rosetti, M., Brent, D. A., & Weersing, V. R. (in press). Cost-effectiveness of brief behavioral therapy for pediatric anxiety and depression in primary care. JAMA Open Access.
Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., … Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980-989.
Newby, J. M., Twomey, C., Li, S. S. Y., & Andrews, G. (2016). Transdiagnostic computerised cognitive behavioural therapy for depression and anxiety: A systematic review and meta-analysis. Journal of Affective Disorders, 199, 30-41.
Pine, D. S., Cohen, P., Gurley, D., Brook, J., & Ma, Y. (1998). The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry, 55(1), 56-64.
Spielvogle, H., McCarty, C. A., & Richardson, L. P. (2017). Brief therapy for anxiety and depression in the pediatric primary care setting: Implications and next steps. JAMA Pediatrics, 171(10), 1006-1007.
Walkup, J. T., Mathews, T., & Green, C. M. (2017). Transdiagnostic behavioral therapies in pediatric primary care: Looking ahead. JAMA Psychiatry, 74(6), 557-558.
Weersing, V. R., Brent, D. A., Rozenman, M. S., Gonzalez, A., Jeffreys, M., Dickerson, J. F., … Iyengar, S. (2017). Brief behavioral therapy for pediatric anxiety and depression in primary care: A randomized clinical trial. JAMA Psychiatry, 74(6), 571-578.
Weersing, V. R., Rozenman, M. S., Maher-Bridge, M., & Campo, J. V. (2012). Anxiety, depression, and somatic distress: Developing a transdiagnostic internalizing toolbox for pediatric practice. Cognitive and Behavioral Practice, 19(1), 68-82.
Weersing, V. R., & Weisz, J. R. (2002). Community clinic treatment of depressed youth: Benchmarking usual care against CBT clinical trials. Journal of Consulting and Clinical Psychology, 70(2), 299.

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