Anxiety in childhood and adolescence: cognitive behavioural therapy, psychoanalysis and the limits of comparison

Abstract

Anxiety in childhood and adolescence has become an object of growing demand in mental health services, and with it the question of which therapeutic orientation offers the better response. This article comparatively examines what cognitive behavioural therapy (CBT) and psychoanalysis each maintain regarding anxious suffering in this age group, and argues that direct comparison between the two approaches meets limits that are conceptual rather than technical. Through a narrative review of a theoretical and conceptual nature, each model is reconstituted in its own terms: on one side, the cognitive formulation of anxiety disorder as a product of threat schemas and maintaining avoidance; on the other, the Freudian elaboration of anxiety as a signal of the ego before an internal danger, and its developments in clinical work with children. A distinction is drawn between angústia, a structural concept of psychoanalysis, and anxiety disorder, a diagnostic category of the DSM-5 and the ICD-11. It is argued that the two traditions diverge not only in method but in the outcome each considers relevant, which renders the comparison of results less informative than the comparative literature tends to assume. This article does not constitute treatment guidance.