Children’s CBT skills, metacognition, empathy, and theory of mind
| Published date | 18 March 2019 |
| Date | 18 March 2019 |
| DOI | https://doi.org/10.1108/JCS-12-2017-0052 |
| Pages | 16-26 |
| Author | Jonathan Jones,Céline Souchay,Chris Moulin,Shirley Reynolds,Anna-Lynne Adlam |
| Subject Matter | Health & social care,Vulnerable groups,Children's services,Sociology,Sociology of the family,Children/youth,Parents,Education,Early childhood education,Home culture,Social/physical development |
Children’s CBT skills, metacognition,
empathy, and theory of mind
Jonathan Jones, Céline Souchay, Chris Moulin, Shirley Reynolds and Anna-Lynne Adlam
Abstract
Purpose –Cognitive Behavioural Therapy (CBT) is an evidence-based treatment for common mental health
problems that affect children, young people and adults. The suitability of CBT for children has been
questioned because it requires children to think about their thoughts, feelings and behaviours. The purpose
of this paper is to investigate which cognitive and affective capacities predict children’s ability to relate
thoughts, feelings and behaviours.
Design/methodology/approach –A total of 59 typically developing children aged between 8 and 11 years
took part in the study. CBT skills were assessed on a story task that required children to relate the character’s
thoughts to their feelings and behaviours. Children also completed an assessment of IQ, a feeling-of-knowing
metamemory task that assessed metacognition, and a higher-order theory of mind task. Furthermore,
parents rated their child’s empathy on the children’s empathy quotient.
Findings –The findings suggest that CBT is developmentally appropriate for 8–11 year old children;
however, young children and children with mental health problems may have impaired metacognition and
CBT skills. Metacognition and empathy may moderate the efficacy of child CBT and warrant further
investigation in clinical trials.
Originality/value –This study provides evidence for the cognitive and affective skills that might predict the
outcome of CBT in children. Metacognition and empathy predict children’s ability to relate thoughts, feelings
and behaviours, and therefore may moderate the efficacy of CBT.
Keywords Cognitive Behavioural Therapy, Metacognition, Empathy, Theory of mind,
Development, Children
Paper type Research paper
Introduction
Cognitive Behavioural Therapy (CBT) seeks to address maladaptive behaviours and
psychological distress by altering the cognitive processes and behaviours that sustain them.
During therapeutic sessions, patients are required to participate in complex dialogue about their
thoughts and feelings. To make this accessible to children, abstract concepts may be conveyed
using concrete examples, stories and visual imagery (e.g. Stallard, 2002a). Reviews have
concluded that CBT is an effective treatment for childhood and adolescent depression
(Arnberg and Öst, 2014; Watanabe et al., 2007) and anxiety ( James et al., 2015). However,
approximately 40 per cent of children with anxiety ( James et al., 2015) and 50 per cent of
children with depression (Watanabe et al., 2007) still meet diagnostic criteria following treatment.
This may partly be because some children’s cognitive and affective abilities are not sufficiently
developed to fully engage with the therapeutic exercises (see Grave and Blissett, 2004, for a
discussion). Further, when therapies have been shown to be effective, concerns have been
raised over whether this is due to behavioural components and increased parental involvement,
rather than cognitive restructuring (see Stallard, 2002b, for a review).
To engage with cognit ive restructurin g, children must ha ve developed the cap acity to think
about their thoughts, feelings and behaviours, and how they are related. Quakley (2001)
designed two tasks that imitate the activities given to children receiving CBT.
The “discriminatio n task”requires pa rticipants to sort s entences contain ing a thought,
Received 6 December 2017
Revised 10 September 2018
Accepted 29 October 2018
Jonathan Jones is based at the
Department of Psychology,
University of Exeter,
Exeter, UK.
Céline Souchay is based at the
Université Grenoble Alpes,
Saint-Martin-d’Heres, France.
Chris Moulin is Professor at the
Université Grenoble Alpes,
Saint-Martin-d’Heres, France.
Shirley Reynolds is Professor at
the Faculty of Arts Humanities
and Social Science, University
of Reading, Reading, UK.
Anna-Lynne Adlam is based
at the Department of
Psychology, University of
Exeter, Exeter, UK.
PAG E 16
j
JOURNAL OF CHILDREN'S SERVICES
j
VOL. 14 NO. 1 2019, pp. 16-26, © Emerald Publishing Limited, ISSN 1746-6660 DOI 10.1108/JCS-12-2017-0052
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