Effectiveness of Cognitive Behavioral Therapy in Managing Anxiety Symptoms Among Adolescents in High-Stress Environments: A Randomized Controlled Trial

Abstract

Background: Anxiety disorders affect up to 30% of adolescents globally and are particularly prevalent in those exposed to high-stress environments such as socioeconomic disadvantage, academic competition, and family dysfunction. These conditions often disrupt psychosocial development and academic performance, underscoring the need for effective, context-appropriate interventions. Cognitive Behavioral Therapy (CBT) is an established first-line treatment for anxiety, but evidence in adolescents from resource-constrained, high-stress settings remains limited. Objective: To evaluate the effectiveness of CBT in reducing anxiety and depressive symptoms and improving overall functioning among adolescents living in high-stress environments. Methods: A randomized controlled trial was conducted at Therapy Plus Clinics, Lahore, Pakistan, including 42 adolescents aged 12–18 years diagnosed with anxiety disorders. Participants were randomly allocated to 12 weekly CBT sessions (n = 21) or standard care (n = 21). Primary outcome was anxiety (Beck Anxiety Inventory, BAI), with secondary outcomes of depression (Beck Depression Inventory-II, BDI-II) and functioning (Global Assessment of Functioning, GAF). Assessments were conducted at baseline, post-intervention, and three-month follow-up. Results: CBT resulted in significant reductions in anxiety (–52.3%) and depression (–55.5%) and improvement in functioning (+31.2%) compared with minimal changes in controls (≤6%). Between-group differences were statistically significant (p < 0.001), with large effect sizes (Cohen’s d > 1.0). Conclusion: CBT is a highly effective intervention for adolescents in high-stress environments, producing sustained improvements across mental health outcomes. Larger-scale trials are warranted to confirm these findings and guide implementation.