Evaluating the efficacy of cognitive behavioral therapy in treating anxiety disorders in children

What happens when a treatment developed in Western clinical settings is adapted for children growing up in Lagos, where family structures, spiritual beliefs, and the very language used to describe emotional distress differ fundamentally from the contexts in which cognitive behavioral therapy was conceived? This research evaluated the efficacy of a culturally adapted cognitive behavioral therapy (CBT) program for treating anxiety disorders in Nigerian children aged 7 to 12 years. A randomized controlled trial enrolled 117 children with a primary anxiety disorder diagnosis from three child mental health clinics in Lagos between June 2022 and August 2024. Participants were randomly assigned to either culturally adapted CBT (n = 63) or a 12-week waitlist control condition (n = 54). The CBT protocol comprised 12 weekly sessions adapted to incorporate Nigerian cultural values, family-inclusive practices, local proverbs, and religious coping strategies.Anxiety was measured using the Spence Children's Anxiety Scale (SCAS, Yoruba and English versions), the Screen for Child Anxiety Related Emotional Disorders (SCARED), and clinician-rated Clinical Global Impression scales. Generalized anxiety disorder was the most common subtype (31.6%), followed by social anxiety (22.2%) and separation anxiety (18.8%). At post-treatment, the CBT group showed a mean SCAS reduction of 29.7 points compared to 4.3 points in the control group (between-group difference: 25.4, p < 0.001, Cohen's d = 1.83). Remission (defined as loss of diagnostic status) was achieved by 52.4% of the CBT group versus 7.4% of controls (NNT = 2.22). Treatment response rates varied by anxiety subtype, with specific phobia showing the highest remission (66.7%) and social anxiety the lowest (42.3%). Treatment gains were maintained at 6-month follow-up. These results demonstrate that culturally adapted CBT is effective for childhood anxiety in a Nigerian context and that careful adaptation of therapeutic content and process enhances acceptability without compromising efficacy.