When considering the success of any particular treatment, it is useful to discriminate between efficacy and effectiveness. The former refers to the outcomes associated with a treatment when it is delivered in its optimal form. The latter refers to the outcomes associated with the treatment in the real world, and thus includes consideration of many factors such as resources needed, skills of the clinicians in the community, and acceptability of the treatment to consumers, as well as the efficacy of the treatment. While psychodynamics and family therapies have been used in the treatment of childhood anxiety disorder, the lack of controlled studies prohibits conclusions about their efficacy or effectiveness. In contrast, a wealth of evidence is available about the efficiency and, to a lesser extent, the effectiveness of cognitive-behavioral and pharmacological interventions.
Cognitive-behavioral treatments incorporate a range of treatment strategies, and most clinicians recommend a combination of procedures based on conditioning/exposure, reinforcement, physiology, and cognition. Common to all learning-based treatments in the premise that anxious patients can, through learning, minimize the threat value of the things they fear and learn to regulate their emotions and psychological reactions more comfortably as they explore life. Exposure techniques involve having the patient, under the support and guidance of a therapist, face the fear in order to learn that the feared stimulus is not in fact so threatening,thereby breaking the cycle of avoidance. Often, some exposure is undertaken in imagination prior to exposure in the real world. The underlying mechanism that account for the success of exposure based procedures are still controversial. Originally Joseph Wolpe explained it as the inhibition of anxiety through relaxation learned as part of the exposure treatment. More recent views emphasize changes in thinking processes that occur during exposure. David Clark and his colleagues use exposure treatments that help the sufferer to rethink and devalue the threat associated with the things they fear as they face them.
Psychological strategies for dealing with anxiety include muscle relaxation skills and breathing techniques to help patients manage uncontrollable arousal, especially during exposure exercises. Most of this techniques were developed with anxious adults but can be used with children and adolescents. A number of other strategies have been developed more specifically for children. Modelling procedures often include the use of films, whereby the child learns to devalue the threat of the fear after watching other people confidently handle the feared situations. Modelling is an important procedure with children who may be manifesting a fear that is shared by other family members. The child is prompted to imitate the performance of the model who is demonstrating nonfearful behaviours and is reinforced for coping behaviour. The efficacy of modelling procedures is both the treatment of childhood phobias and in the preparation of children for stressful events has been supported.
Treatments for anxious children often incorporate reward-base programs, especially in the treatment of school refusal, socially avoidant children, and specific phobias. In general, therapeutic success is enhanced when these programs are combined with other techniques such as exposure and cognitive reappraisal.
Some evidence has emerged to indicate that the provisions of learning programs (scheduled as part of the school curriculum) for anxious children can assist in preventing the development of anxiety disorders in a significant proportion of children.