How Separation Anxiety Is Treated

Table of Contents
View All
Table of Contents

People with separation anxiety disorder feel intense fear and anxiety about being parted from the people that they are emotionally attached to, such as a parent or loved one, or from their home.

Adult-Onset Separation Anxiety Disorder

The latest update to the "Diagnostic and Statistical Manual (DSM-5)" removed the restriction that separation anxiety disorder symptoms must begin when a person is younger than 18 years old.

Research has shown that the traditional treatments for other anxiety disorders might not be as effective for adults with separation anxiety disorder but more studies are needed.

The symptoms of separation anxiety disorder are disproportionate to a person's developmental age and cause significant difficulty in their everyday life. To be diagnosed with the disorder, a mental health professional will evaluate a person's symptoms against specific diagnostic criteria and rule out other mental health conditions that could explain the symptoms.

Sad and depressed small girl with therapist sitting indoors, psychotherapy.


Halfpoint Images / Getty Images

The most common treatment for separation anxiety disorder is psychotherapy, such as cognitive-behavioral therapy (CBT). In some cases, medications are used.

Here's what you can expect from treatment for separation anxiety disorder for yourself or a loved one.

Therapies

Cognitive-behavioral therapy (CBT) is a psychotherapy approach that is commonly used to treat depression, anxiety disorders, and other mental health disorders. The goal of CBT is to teach a person different ways of thinking, behaving, and reacting to circumstances that are connected to an object or situation that provokes anxiety or fear.

Therapy can be conducted with an individual alone or with several people who have the same disorder (group CBT).

CBT has been shown to be an effective treatment for anxiety disorders, including separation anxiety disorder, in children and adolescents. It is often the preferred treatment option, as opposed to prescription medication, by both parents and children.

Exposure Therapy

Exposure therapy is the type of CBT that is most commonly used to treat anxiety disorders. Treatment usually falls into four stages.

  1. Instruction. This stage involves people with separation anxiety disorder, as well as their parents or caregivers, learning how exposure therapy works and what can be expected. This helps to put minds at ease about what exposure therapy—which can be a stressful idea—will be like.
  2. Development of a hierarchy. This stage involves gradually progressing through a series of anxiety-inducing experiences created from those that provoke the least anxiety to most. These experiences will be specific to each person.
  3. Exposure proper. This stage is where the person with separation anxiety disorder is exposed, in order, to a series of anxiety-inducing situations. Exposure can be in person (in vivo), which is the preferred option, but if this is not possible exposure may be imaginary or through the use of virtual reality.
  4. Generalization and maintenance. This is where the lessons learned in therapy are reinforced through the person with separation anxiety engaging in repeat exposures in similar situations outside of therapy. This is an important stage as it reinforces that the person with separation anxiety does not need to rely on the presence of the therapist to help them control their anxiety. 

CBT Research

A 2018 study looked at the long-term impact of CBT on children and adolescents with anxiety disorders, including separation anxiety disorder.

The study found that CBT is effective over the long-term with loss of all inclusion anxiety diagnoses in 53% of participants, loss of the principal anxiety diagnosis in 63% of participants, as well as significant reductions in all anxiety symptom measures.

The study also found that there was no meaningful difference in the effectiveness of the treatment between individual CBT and group CBT.

Emotion-Focused CBT

A new adaptation to CBT, called emotion-focused CBT (ECBT), has been developed specifically for children with anxiety disorders. As well as all the components of traditional CBT, ECBT also involves addressing the emotion-related deficits that have been recognized in children and youths with anxiety disorders.

During ECBT treatment, children are exposed to scenarios where they would be anxious, as well as scenarios where they might feel emotions they have difficulty regulating, for example, anger. They are then supported in how to manage these emotion-provoking experiences.

A 2014 randomized clinical trial that looked at the difference between group CBT and group ECBT, found no significant difference between the two approaches in reducing separation anxiety and total anxiety symptoms.

Treatment for Young Children

Children under the age of 7 lack the abilities that older children have to effectively participate in therapies such as CBT. Therefore, other types of intervention are needed to effectively treat younger children.

Parent-Child Interaction Therapy (PCIT)

The goal of Parent-Child Interaction Therapy (PCIT) is to reshape the patterns of interactions between parents and children that are associated with the maintenance of symptoms linked to disruptive behaviors.

PCIT been adapted to specifically help treat separation anxiety disorder in young children through the addition of a technique called Bravery-Directed Interaction (BDI).

As well as the creation of a bravery ladder that is similar to the techniques that are used in exposure therapy, BDI also involves teaching parents “Dos" and “Don’ts" skills that are tailored to the specific needs of children with separation anxiety disorder.

For example, parents are encouraged to save their praise until after a child begins to approach a previously avoided separation situation. Parents are also encouraged to withdraw attention when children are engaging in negative and anxiety-based behavior, such as excessive complaining or whining.

PCIT Research

A study looked at how the adapted PCIT treatment worked with 38 children between the ages of 4 and 8—all of whom met the diagnostic criteria for separation anxiety disorder.

The study found that 73% of the children who had been treated with the adapted PCIT treatment no longer met the criteria for a diagnosis of separation anxiety disorder. The results were largely maintained at a 3-month follow-up visit. The parents of the children in the study also reported significant decreases in their stress.

Prescription Medications

Medication is rarely prescribed as the first-line treatment to children with separation anxiety disorder because it can cause side effects. However, it can be part of a treatment plan if therapy alone is not effective.

Clinicians may prescribe medications off-label, meaning that they are not approved by the U.S Food and Drug Administration (FDA) for the specific treatment of separation anxiety disorder.

Certain types of antidepressants have been shown to be effective in treating anxiety disorders, including separation anxiety disorder, in children and adolescents. They are thought to be more effective when used in addition to therapy rather than on their own.

Anxiety disorders, such as separation anxiety disorder, have high comorbidity (the presence of two or more disorders) with other mental health disorders. People with anxiety disorders may also have mood disorders, such as depression, as well as substance use disorder.

It is not uncommon for people with separation anxiety disorder to be treated for other mental health conditions as well.

Children and Adolescents

Only a few medications are FDA-approved to treat anxiety disorders in children and adolescents, and they might be prescribed off-label for other conditions like separation anxiety disorder.

For example, Cymbalta (duloxetine) is a serotonin-norepinephrine reuptake inhibitor (SSNRIs) that is approved by the FDA to treat generalized anxiety disorder (GAD) in people aged 7 and over.

There are also several FDA-approved medications to treat obsessive-compulsive disorder (OCD) in children and teens.

  • Anafranil (clomipramine). A tricyclic antidepressant (TCA) approved for treatment in children aged 10 and over.
  • Prozac (fluoxetine). A selective serotonin reuptake inhibitor (SSRI) approved for treatment in children aged 7 and over.
  • Luvox (fluvoxamine). A selective serotonin reuptake inhibitor (SSRI) approved for treatment in children aged 8 and over.
  • Zoloft (sertraline). A selective serotonin reuptake inhibitor (SSRI) approved for treatment in children aged 6 and over.

A 2015 systematic review and meta-analysis of prospective, randomized, parallel-group, controlled trials of SSRIs and SSNRIs in pediatric patients found that these medications improved the symptoms of anxiety disorders and appeared to be well-tolerated.

If you child is being treated for separation anxiety disorder, talk to their doctor about the benefit sand risks of using medication.

Adults

Adults can be also be prescribed antidepressants for anxiety disorders but, as with children and adolescents, these medications are generally thought to be more effective when combined with therapy.

Studies looking specifically at the effectiveness and efficiency of traditional treatments in adults with separation anxiety disorder are limited. However, there are some indications that conventional treatments used for other anxiety subtypes might not be as effective in those with adult separation anxiety disorder.

A 2011 study found that those with panic disorder as well signs and symptoms of separation anxiety in adulthood had worse outcomes when treated with medications than those without these symptoms.

As such, other treatment options, including medications, are being investigated to see whether they can improve the treatment of adults with separation anxiety disorder.

Viibryd (vilazodone) is an SSRI and serotonin 1a (5HT1a) receptor partial agonist. A 2017 small pilot randomized, placebo-controlled trial of vilazodone in adult separation anxiety disorder did not show significant separation between drug and placebo at 12 weeks but did report some differences in other anxiety measures.

Some antidepressants have been linked to an increase in suicidal thoughts or behavior in children, teenagers, and young adults under 25, especially in the first few weeks after starting or when the dose is changed.

People of all ages should be watched closely during the first few weeks of treatment.

Alternative Treatments

The research on how complementary health approaches can help a person manage an anxiety disorder is limited.

There are some alternative treatments that may reduce symptoms of anxiety, but these should not be used as a replacement for psychotherapy and/or medications.

Meditation

Research suggests that practicing meditation may help reduce anxiety and depression. There are several techniques that can be tried, including:

  • Being in a quiet location with as few distractions as possible
  • Taking a specific, comfortable posture, such as sitting, lying down, or walking
  • Finding a focus of attention, for example, a specially chosen word or set of words, an object, or the sensations of the breath
  • Adopting an open attitude, for example, letting distractions come and go naturally without judging them

A 2012 review of 36 trials found that 25 reported better outcomes for symptoms of anxiety in the meditation groups compared to control groups.

However, it is important to note that most studies only measured improvement in terms of anxiety symptoms and not anxiety disorders as clinically diagnosed.

A Word From Verywell

Separation anxiety disorder can occur in children, teens, and adults. The symptoms can greatly affect a person's life and interfere with their day-to-day activities and relationships.

There are several options for treating separation anxiety disorder, including different types of therapy, medications, or a combination of both. Some people may find alternative treatment, like meditation, helpful in managing some of their symptoms.

If you are concerned that you or your child has symptoms of separation anxiety, talk to your doctor. They can refer you to a mental health professional for evaluation.

Was this page helpful?
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Silove D, Alonso J, Bromet E, et al. Pediatric-onset and adult-onset separation anxiety disorder across countries in the World Mental Health Survey. Am J Psychiatry. 2015;172(7):647-656. doi:10.1176/appi.ajp.2015.14091185

  2. James AC, James G, Cowdrey FA, et al. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews. 2013;(6).

  3. Seligman LD, Ollendick TH. Cognitive-behavioral therapy for anxiety disorders in youth. Child and Adolescent Psychiatric Clinics of North America. 20(2):217-238. doi:10.1016/j.chc.2011.01.003

  4. Kodal A, Fjermestad K, Bjelland I, et al. Long-term effectiveness of cognitive behavioral therapy for youth with anxiety disorders. Journal of Anxiety Disorders. 2018;53:58-67. doi:10.1016/j.janxdis.2017.11.003

  5. Afshari A, Neshat-Doost HT, Maracy MR, et al. The effective comparison between emotion-focused cognitive behavioral group therapy and cognitive behavioral group therapy in children with separation anxiety disorder. J Res Med Sci. 2014;19(3):221-227. PMID: 24949029; PMCID: PMC4061643.

  6. Lieneman CC, Brabson LA, Highlander A, et al. Parent-child interaction therapy: current perspectivesPsychol Res Behav Manag. 2017;10:239-256. Published 2017 Jul 20. doi:10.2147/PRBM.S91200

  7. Carpenter AL, Puliafico AC, Kurtz SM, et al. Extending parent-child interaction therapy for early childhood internalizing problems: new advances for an overlooked population. Clin Child Fam Psychol Rev. 2014;17(4):340-356. doi:10.1007/s10567-014-0172-4

  8. Hussain FS, Dobson ET, Strawn JR. Pharmacologic Treatment of Pediatric Anxiety DisordersCurr Treat Options Psychiatry. 2016;3(2):151-160. doi:10.1007/s40501-016-0076-7

  9. Craske MG, Stein MB. AnxietyThe Lancet. 2016;388(10063):3048-3059. doi: 10.1016/S0140-6736(16)30381-6

  10. Amray AN, Munir K, Jahan N, et al. Psychopharmacology of pediatric anxiety disorders: a narrative review. Cureus. 11(8). doi:10.7759%2Fcureus.5487

  11. Strawn JR, Welge JA, Wehry AM, et al. Efficacy and tolerability of antidepressants in pediatric anxiety disorders: a systematic review and meta-analysis. Depress Anxiety. 2015;32(3):149-157. doi:10.1002/da.22329

  12. Miniati M, Calugi S, Rucci P, et al. Predictors of response among patients with panic disorder treated with medications in a naturalistic follow-up: The role of adult separation anxietyJournal of Affective Disorders. 2012;136(3):675-679. doi:10.1016/j.jad.2011.10.008

  13. Schneier FR, Moskow DM, Choo TH, et al. A randomized controlled pilot trial of vilazodone for adult separation anxiety disorderDepress Anxiety. 2017;34(12):1085-1095. doi:10.1002/da.22693

  14. National Institute for Mental Health (NIMH). Anxiety disorders. Updated July 2018.

  15. National Center for Complementary and Integrative Health. Meditation: in depth. Updated April 2016

  16. Chen KW, Berger CC, Manheimer E, et al. Meditative therapies for reducing anxiety: a systematic review and meta-analysis of randomized controlled trialsDepress Anxiety. 2012;29(7):545-562. doi:10.1002/da.21964