Aggressive behaviours often co-occur with emotional, behavioural, academic, and social relationship problems (Özabacı 2011). Children and adolescents with aggression often exhibit increased rates of school dropout, depression, delinquent behaviour, substance abuse, and poor peer relationships. CBT is one of the most extensively researched form of psychotherapy for aggressive children and adolescents (Sukhodolsky et al. 2004; Blake and Hamrin 2007; Özabacı 2011).

Specifically, cognitive behavioural interventions do not involve a single therapeutic technique, but rather consist of multiple intervention components: (1) problem-solving and social skills education, (2) coping models, (3) role playing, (4) in vivo experiences and assignments, (5) affective education, (6) homework assignments, and (7) operant conditioning, most typically response cost (Kendall and Braswell 1993; Kendall 2006). In addition, therapeutic interventions include self-awareness training, relaxation techniques, cognitive therapy, and conflict management skill training (Deffenbacher 1999).

A meta-analysis was done by Sukhodolsky et al. (2004) on the treatment outcome studies of CBT for anger-related problems in children and adolescents. In this study, they included 21 published and 19 unpublished reports. They found medium range of mean effect size (Cohen’s d = 0.67) of CBT and it is consistent with the effects of psychotherapy with children in general. The CBT treatment for anger includes skills training, problem-solving, affective education, and multimodal interventions (differential effects d = 0.79, 0.67, 0.36, and 0.74, respectively). For reduction in aggressive behaviour and improvement in social skills, the skills training and multimodal treatments were more effective. However, for reduction in subjective anger experiences, problem-solving treatments were more effective. In addition, Blake and Hamrin (2007) found that cognitive behavioural and skills-based approaches are the most widely studied and empirically validated treatments for anger and aggression in youth.

Özabacı (2011) has reviewed the literature on the use of CBT for treating children and adolescents who demonstrate high levels of violence. Six studies were identified, and all of them indicated beneficial results of using CBT.

CBT has been shown to be highly effective in treating children and adolescent with anxiety disorders (Santacruz et al. 2002; James et al. 2005; Butler et al. 2006; Ishikawa et al. 2007). Many studies report that between 50 and 85 % of youth, who receive CBT, no longer met criteria for their primary anxiety diagnosis at the end of treatment (Kendall 1994; Barrett et al. 1996; Kendall et al. 1997) and its effectiveness maintained over time (Kendall and Southam-Gerow 1996; Barrett et al. 2001; Kendall et al. 2004; Craske et al. 2006; Garcia-Lopez et al. 2006; Saavedra et al. 2010).

CBT for children with separation anxiety disorder, generalized anxiety disorder, and social phobia is evidenced as effective as short-term treatment (Walkup et al. 2008). In addition, computer-based CBT has demonstrated positive outcomes in case studies of spider phobia (Nelissen et al. 1995) and selective mutism (Fung 2002), in randomized controlled trial of the treatment of spider phobia in children (Dewis et al. 2001) and in anxiety disorders (Calear et al. 2009; Cuijpers et al. 2009; Andrews et al. 2010; Spence et al. 2011).

In his study, Spence et al. (2006) also found positive outcomes for a CBT intervention, in which half of the sessions were presented over internet and half in the clinic. This study revealed that combined internet and clinic-based treatment produced significant reduction in anxiety symptoms as compared to non-intervention programme and there were only minimal differences between partial internet intervention and the entirely clinic-based intervention. March et al. (2009) reported that the participants in internet-based CBT group demonstrated small but significantly greater improvements in anxiety compared to the participants in the wait list. These improvements were enhanced to near about 75 % during the 6-month follow-up period.

Gearing et al. (2013) have studied the effects of booster sessions of CBT for children and adolescents with mood or anxiety disorders in case–control studies. They examined booster sessions using effect sizes (ES): pre–post and pre–follow-up (6 months). They found pre–post studies with booster sessions had a larger effect size (r = 0.58) than those without booster sessions (r = 0.45). Similarly, pre–follow-up studies with booster sessions showed a larger effect size (r = 0.64) than those without booster sessions (r = 0.48).

For post-traumatic stress disorder, American Academy of Child and Adolescent Psychiatry (AACAP) practise guidelines recommended TF-CBT as a first-line treatment for child trauma (Cohen et al. 2010). The published randomized controlled trials (RCTs) of TF-CBT have supported its effectiveness in reducing PTS symptoms and PTSD, emotional problems, shame, and trauma-related and general behaviour problems, in comparison with non-CBT interventions, e.g. supportive or client-centred therapies, waitlist control, and usual care (Cohen and Mannarino 1996, 1998, 2008; Cohen et al. 2004; Deblinger et al. 1996, 2001; King et al. 2000; Silverman et al. 2008).

The results of recent meta-analyses by Kowalik et al. (2011) and Cary and McMillan (2012) showed significant differences between TF-CBT and highly similar CBT treatments, compared with non-CBT therapies or treatment as usual, in reducing symptoms of PTSD, depression, and internalizing behaviours across 18 studies (n = 24–229). In addition, TF-CBT has also demonstrated efficacy for children experiencing other traumas, including community violence/terrorism (Hoagwood et al. 2006), childhood traumatic grief (Cohen et al. 2004, 2006), multiple traumas resulting in foster care placement (Weiner et al. 2009), and domestic or interpersonal violence (Cohen et al. 2011; Puccia et al. 2012).

Follow-up studies have also shown the positive treatment gains and evidence of sustained benefit at 6-months, 1-year, and 2-year post-treatment (Cohen and Mannarino 1997; Deblinger et al. 1999, 2006; Cohen et al. 2005).

There are a number of studies that show the effectiveness of CBT for adolescents with clinical depression (Lewinsohn et al. 1990; Kroll et al. 1996; Weisz et al. 1997; Harrington et al. 1998). Brent et al. (2002) did a meta-analytic review of 15 articles, on the efficacy of CBT with depressed adolescents. They found that CBT reliably outperforms the control conditions, such as wait list and placebo, with medium to large ES (1.27, Lewinsohn and Clarke 1999; 1.06, Reinecke et al. 1998). Butler et al. (2006) did a meta-analytic review on treatment outcomes of CBT for a wide range of psychiatric disorders. They found large ES of CBT for adolescent depression (ES = 0.84) and anxiety disorders (ES = 0.74) and moderate effect size (M = 0.62, SD = 0.11) for CBT of childhood somatic disorders. A study by Wood and Moore in 2006 included fifty-three children and adolescents with depressive disorders who were randomly allocated to brief CBT or to a control treatment, relaxation training. Results of this study showed a clear advantage of CBT over relaxation on measures of both depression and overall outcome. Klien et al. (2007) have also demonstrated the effectiveness of CBT in the treatment of adolescent depression (ES = 0.53). In addition, follow-up studies also reported that CBT for depression was strong, but still in the medium effect size range across meta-analyses (Santacruz et al. 2002).

Computerized CBT for adolescent depressive disorders via internet has the capacity to provide effective, acceptable, and practical health care for adolescents (Calear et al. 2009; Andrews et al. 2010).

CBT is known to produce larger ES and greater rates of clinically significant improvement compared to medication in OCD (Abramowitz et al. 2005). CBT, in particular, exposure and response prevention (ERP), has been reviewed and studied in children and adolescents (March 1995) and is considered the first-line treatment approach for children and adolescents with OCD (Expert Consensus Guidelines; March et al. 1997).

Several published narrative reviews of the paediatric OCD treatment are available (e.g. Grados et al. 1999; Rapoport and Inoff-Germain 2000). These reviews are informative but they do not quantify the effects of treatment across studies. In contrast, meta-analyses (Abramowitz 1997) do quantitatively determine the magnitude of treatment effectiveness but are limited in respect to paediatric OCD.

First meta-analysis of the paediatric OCD treatment was done by Abramowitz in 1997. Results of this study indicate that SSRIs and ERP are effective in reducing paediatric OCD symptoms. Specifically, ERP was more effective and associated with larger ES on OCD measures and fewer residual symptoms than SSRIs, which were more effective than placebo (p s_0.01). Thus, this meta-analytic finding, in general, supports the clinical recommendations of the OCD expert consensus.

Though, a number of studies related to intervention (pharmacotherapy and psychotherapy) for somatoform disorders in adults have showed the efficacy of CBT across several types of somatoform disorders. However, there is a lack of evidence-based treatment of somatoform disorders in children and adolescents. In children and adolescents, persistent somatoform pain disorder (recurrent abdominal pain, joints pain, and other aches and pain) and undifferentiated somatoform disorder (multiple medical unexplained symptoms) are the most common type among all variants of somatoform disorder. CBT has been found to be effective in the treatment of functional paediatric recurrent abdominal pain. It includes activity scheduling, self-monitoring of symptoms, relaxation training, distraction, coping skills, problem-solving, and cognitive restructuring etc. (Sanders et al. 1989, 1994; Janicke and Finney 1999; Robins 2005; Warner et al. 2011; Van der Veek et al. 2013).

Warner et al. (2011) studied the feasibility and efficacy of CBT (treatment of anxiety and physical symptoms—TAPS) for children experiencing somatic complaints along with anxiety disorder and found TAPS to be acceptable and superior to the waiting list in the reduction of somatic and anxiety symptoms.

Non-pharmacological treatments for headache in children and adolescents are adopted from treatment of headache in adults (Nicholson 2010; Nicholson et al. 2011) and from treatment of other forms of pain experienced by children and adolescents. Among the existing treatments, CBT focuses on both, headache experienced by children and adolescents and other mental health problems associated with headache (e.g. anxiety, depression, substance abuse, etc.). Thus, CBT has been successfully used for the treatment of paediatric headaches (Palermo et al. 2009, 2010).

Eccleston et al. (2012) have reported in their meta-analysis that CBT including cognitive pain coping skills training and relaxation training (with or without biofeedback assistance) for the management of chronic and recurrent pain in children and adolescents has shown an approximately threefold greater likelihood of clinically significant improvement in headache as compare to control conditions.

Powers et al. (2013) conducted an RCT and found superior outcomes in headache and migraine-related pain and disability, when CBT was used in conjunction with a prophylactic medication (amitriptyline) as compared to use of headache education plus amitriptyline.

In the context of ADHD, two treatments and their combination have been empirically known to be effective for ADHD: stimulant treatment (methylphenidate, etc.), psychosocial treatment (behavioural or CBT), and the combination of both (Richters et al. 1995; Kutcher et al. 2004). The existing literature reports that CBT may be more efficacious for adults with ADHD (Safren et al. 2005) as compared to those with adolescents. However, few focal studies on CBT for adolescent ADHD have been conducted, and the results are variable.

Some studies have not found CBT as beneficial for children with ADHD (Abikoff and Gittelman 1985; Dush et al. 1989; Baer and Nietzel 1991; Bloomquist et al. 1991; DuPaul and Eckert 1997). However, in a meta-analysis, Van der Oord et al. (2008) found some efficacy of CBT, though it was not superior enough as compared to medications in the treatment of adolescent ADHD.

Antshel et al. (2012) did a study to see the efficacy of manualized CBT for managing adolescent ADHD and concluded that an empirically validated adult ADHD CBT protocol can be beneficial for some adolescents with ADHD.

SUDs among adolescents have been a public health concern for decades. Adolescents with substance use disorders differ from adults in several ways. For instance, adolescents may be more susceptible to peer influences, be more vulnerable to adverse effects from substances and have smaller body size and lower tolerance levels and experience long-term cognitive and emotional damage from substance abuse (Brown et al. 2000; Tapert et al. 2004). Thus, they may have different treatment needs. The number of studies focusing specifically on the effectiveness of psychosocial interventions for adolescent substance abuse have grown over the last decade (Dennis et al. 2004; Waldron and Turner 2008; Williams and Chang 2000), with a significant rise in both the quantity and the quality of the treatment outcome studies.

The most prevalent treatment types are family therapy (Liddle and Dakof 1995; Stanton and Shadish 1997; Waldron 1997), motivational interviewing (MET) (Colby et al. 1998; Tevyaw and Monti 2004; Walker et al. 2006), and CBT (Kaminer and Burleson 1999; Waldron and Kaminer 2004).

In the context of adolescent substance use, CBT shows promise in treating adolescent substance use (Latimer et al. 2003). It includes functional analyses (identify stimulus cues–antecedents and consequences), self-regulation, coping skills (use various strategies to avoid situations that may trigger the desire to use), communication skills, and problem-solving.

A study was carried out on 32 adolescents (age range: 13–18 years) with dual diagnosis (AOD abuse and other psychiatric disorders, such as disruptive disorders (e.g. conduct disorder or attention deficit/hyperactivity disorder) or internalizing disorders (e.g. depression or an anxiety disorder). CBT or interactional group therapy was given for 12 week in an outpatient setting. The CBT sessions included didactic presentations, modelling, role playing, and homework exercises. CBT group showed significant reduction in severity of substance use (Kaminer et al. 1998).

In Kaminer et al. 2002, carried out a study again and compared CBT with psycho-educational therapy in treating adolescents with substance use disorders with dual diagnosis. The participants (n-88, aged-13–18) were randomly assigned to 8 weeks of either CBT or psycho-educational group therapy, for 75–90 min/week. Adolescents of CBT group exhibited better treatment retention and better outcomes at follow-up. However, both groups had similar relapse rates at the 9-month follow-up.

In addition, one study (Liddle et al. 2008) conducted to examine the efficacy of two adolescent drug abuse treatments: individual CBT and multidimensional family therapy (MDFT), with 12–17.5-year-old adolescents (n-224). In comparison with other randomized controlled trials testing CBT, both treatments showed approximately equivalent or larger reductions of cannabis consumption and slightly significant reduction in alcohol, both during treatment and at the 6-month follow-up (Waldron et al. 2001).

In recent years, CBT has received an increasing amount of attention in the management of obesity. It is similar to the treatment of substance use disorders involving teaching children and families to monitor for triggers. Inspite of this, researches on efficacy of CBT to treat obesity in adolescent population have provided mixed results (Mellin et al. 1987; Duffy and Spence 1993; Braet and Van Winckel 2001; Warschburger 2001; Jelalian 2006). The review studies reported that outpatient CBT often produces positive effects (Stice et al. 2006). A meta-analysis has also documented decrease in per cent overweight at follow-up by 8.9 % for outpatient CBT programmes (Wilfley et al. 2007).

Brennan et al. (2006) have found 6 % reduction in body fat relative to the control group that sustained for 12 months after the delivery of 12-week CBT programme (CHOOSE HEALTH; L Brennan, Melbourne, Australia) in adolescents. Further, Tsiros et al. (2008) examined the effectiveness of shorter version of this same CBT programme (CHOOSE HEALTH) for improving body composition, diet, and physical activity in overweight and obese adolescents. He found improvement in body composition (BMI, weight, body fat, and abdominal fat) more in CBT group as compared to controls.

Immersion CBT has also produced promising results. Kelly and Kirschenbaum (2011) did the first comprehensive review of this research (involving 22 outcome studies). They concluded that compared to results of outpatient treatments, these immersion programmes produced an average of 197 % greater reductions in per cent overweight at post-treatment and 130 % greater reduction at follow-up. Further, follow-up evaluations showed decreased per cent overweight at follow-up by an average of 30 % for CBT immersion programmes versus 9 % for programmes without CBT.

Kirschenbaum and Kristen (2013) reviewed five recent expert recommendations on the treatment of childhood and adolescent obesity and found that all of the expert committees support and advised the use of intensive dietary intervention, physical activity, and cognitive behavioural counselling.

Before looking at some of the subtle differences between various approaches of CBT in child and adolescent problems, it is necessary to get some view of the existing approaches of CBT. Followings are the various approaches of CBT:

A traditional CBT is conducted in the form of face-to-face individual CBT in which sessions are held between the patient and the therapist. It consists of 6–18 weekly sessions of around an hour each. The therapist would write a session plan with the help of patient to ensure that everything that is important will be covered in a structured way. On the other hand, group CBT is extended form of individual CBT, in which sessions are held between a group of patients and a therapist.

Self-help CBT is given through computer, internet, or a manual. Computerized cognitive behavioural therapy (cCBT) is implemented through a computer, not a human, in which a computer programme is used to deliver some of basic explanations and planning of CBT. In other words, cCBT is a generic term for delivering CBT via an interactive computer interface delivered by a personal computer, internet, or interactive voice response system, instead of face-to-face with a human therapist.

In manualized approach, the patient receives a standardized treatment method with which he can help himself without major help from the therapist. It includes workbooks, and leaflets.

Another version of CBT, telephonic CBT, has recently been developed to overcome some of the practical barriers involved in conducting face-to-face psychotherapy, for example physical impairments interfering with attending regularly scheduled appointments, transportation problems, lack of available, and appropriate services in the patient’s geographic area (Hollon et al. 2002). In telephonic CBT, therapist caters to the rising needs of the patients through telephonic conversation to target the depressogenic thoughts and behaviours.

Many studies have been conducted to see efficacy and feasibility of different approaches to assess efficiency of CBT (Face-to-face individual or group CBT, computerized CBT, telephonic CBT, reading self-help approach) in different disorders (depression, anxiety disorders, phobias, OCD, PTSD, obesity, substance use disorders, etc.). However, results of these studies are variable.

Computer-assisted/internet-based therapies have great potential to make psychological assessment and treatment more cost-effective than other approaches of assessment and treatment. These forms of therapies are also very feasible and efficacious with respect to anxiety and depressive disorders and can reduce the stigma of visiting a therapist.

March et al. (2009) found that children with anxiety disorders in internet-based CBT (NET) condition showed small but significantly greater reduction in anxiety symptoms and increases in functioning than waitlist (WL) participants. These improvements were enhanced during the 6-month follow-up period, and 75 % of NET children were free of their primary diagnosis. In addition, a meta-analysis of 23 randomized controlled studies (RCTs) performed by Cuijpers et al. (2009) in which they compared computerized psychotherapy (CP) with non-computerized psychotherapy (non-CP) in anxiety disorders (phobias (n = 10), panic disorder/agoraphobia (n = 9), PTSD (n = 3), and obsessive–compulsive disorder (n = 1). The author founds large effect size of CP compared with non-CP approach (ES = 1.08, 95 % confidence interval: 0.84–1.32) and no significant difference between CP and face-to-face psychotherapy (13 comparisons, d = −0.06). Further, a small difference between online therapy interventions and self-help accessed from static information was found in a study in the context of depression (Clarke et al. 2009).

Cornelius et al. (2011) also found long-term (2 years) efficacy of manual-based cognitive behavioural therapy/motivation enhancement therapy (CBT/MET) (in addition to the SSRI medication fluoxetine or placebo) compared to naturalistic care among comorbid MDD/AUD youth (15 and 20 years). They found that patients receiving CBT/MET demonstrated superior outcomes compared to those who had not received protocol CBT/MET therapy (41 vs. 17 %, chi-square = 5.3, p = 0.021).

Many studies comparing computerized CBT with traditional face-to-face CBT have found both modes to be equally beneficial with maintenance of gains after follow-up and good patient adherence (Andrews et al. 2010). However, CBT was found highly efficacious and feasible when minimal therapist support or therapist-guided sessions after or during the use of the web-based CBT or manual–guided or sequential self-care was incorporated (Spence et al. 2011). This is also true for other approaches of CBT. Hence, these approaches of CBT are suitable for only some individuals, having mild to moderate severity of symptoms.

A number of studies have confirmed that CBT is superior to medication and other therapies (e.g. wait list, pill–placebo, relaxation therapy, supportive therapy, family therapy, interpersonal psychotherapy, psychoanalytic therapy, etc.).

When a line of comparison was drawn with medication, in some disorders (e.g. depression, anxiety, OCD, PTSD, etc.), CBT proved to be superior to serotonin reuptake inhibitors (clomipramine and fluvoxamine) due to reduced chance of side effects and greater cost-effectiveness (Phillips 2003; Haby et al. 2004; Guggisberg 2005; Wilson et al. 2005). In addition, in comparison with other forms of psychotherapy, CBT has proven to be more effective treatment, especially in internalizing disorders. For example,

Though, CBT has established effectiveness for the management of internalizing disorders. However, CBT has limited effectiveness than other form of therapy in some disorders. For example: