Children's CBT Skills, Metacognition, Empathy, and Theory of Mind

PurposeCognitive 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/approachA 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.FindingsThe 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/valueThis 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.