Play Therapy for Childhood Anxiety: What Does It Actually Look Like?
When parents hear the words play therapy, they sometimes wonder what therapy could possibly look like if their child is spending time playing.
Is the therapist just playing with my child?
Will my child actually talk about their anxiety?
How can playing help?
When I work with children who are experiencing anxiety, I use Cognitive Behavioral Play Therapy (CBPT). This approach combines the principles of cognitive behavioral therapy with play-based interventions that are developmentally appropriate for children.
Children don't always communicate the way adults do. Sitting down and talking about thoughts, feelings, and behaviors for an entire therapy session may not be realistic—or particularly helpful—for a young child.
Play gives children a way to learn, practice, and experience new skills while working toward specific therapeutic goals.
What is Cognitive Behavioral Play Therapy?
Cognitive Behavioral Play Therapy uses the principles of cognitive behavioral therapy while incorporating play into the therapeutic process.
CBPT can help children understand the relationship between their thoughts, feelings, and behaviors and recognize patterns that may be contributing to their anxiety.
Depending on the child's needs, therapy may focus on:
Understanding anxiety and how it affects them
Identifying thoughts and feelings connected to anxious situations
Recognizing avoidance and behaviors that can maintain anxiety
Learning and practicing cognitive and behavioral strategies
Increasing tolerance for uncomfortable feelings and uncertainty
Developing problem-solving skills
Practicing new behaviors in a safe, developmentally appropriate way
Applying what they learn to situations outside the therapy room
The goal isn't simply to make therapy fun.
The play has a purpose.
What does play actually look like in anxiety therapy?
There isn't one specific type of play that every child will do in therapy.
The activities depend on the child's age, developmental level, personality, anxiety, and treatment goals.
Here are a few examples of what that can look like.
The "What If?" Game
Anxiety loves what if questions.
What if I get called on?
What if I make a mistake?
What if my mom doesn't come back?
What if everyone laughs at me?
Rather than spending the entire session trying to reassure a child that these things won't happen, we can turn some of those what ifs into a game.
We might take turns coming up with increasingly silly or realistic "what if" situations and talk about what the child would do if that situation actually happened.
The important question becomes:
"If that happened, what could you do?"
We're shifting the focus from How can I make sure this never happens? to How could I handle it if it did?
The Mistake Game
For a child who is anxious about making mistakes or struggles with perfectionism, I'll intentionally build mistakes into an activity.
We might play a game where mistakes are inevitable.
We might intentionally draw something "wrong."
We might build something that falls apart and have to start again.
Instead of immediately fixing the mistake or reassuring the child that everything is okay, we can pause and notice what happens.
"You made a mistake. What are you noticing?"
"Do you want to quit, fix it immediately, or keep going?"
The goal is to give the child an opportunity to experience the discomfort of making a mistake without escaping from it.
The Uncertainty Game
Some anxious children want to know exactly what is going to happen.
What are we doing today?
Who will be there?
What happens next?
What if something changes?
We can use games involving surprise, unpredictability, or changing rules to practice tolerating uncertainty.
The child doesn't get to know every detail ahead of time.
They experience the uncertainty, notice their response, and practice continuing anyway.
The lesson isn't "Don't feel anxious."
It's:
"You don't have to know exactly what will happen in order to keep going."
Puppet Role-Play
Puppets can be incredibly useful for practicing situations that feel difficult in real life.
Maybe a puppet doesn't want to walk into a classroom.
Maybe the puppet is afraid to ask a question.
Maybe the puppet doesn't want to sleep alone.
Maybe the puppet is worried about making a mistake.
We can act out the situation and experiment with different responses.
What happens if the puppet avoids it?
What happens if the puppet asks for reassurance?
What happens if the puppet faces the situation even though it feels uncomfortable?
Role-play gives children a chance to practice before they have to do it in the real world.
The "Keep Going" Challenge
Sometimes a child wants to stop an activity the moment anxiety or frustration appears.
That's where play can create a natural opportunity to practice staying with discomfort.
We might choose a game or activity that the child finds challenging and set a goal to keep going when the urge to quit shows up.
The focus isn't on making the child feel better.
It's on helping the child discover:
"I can feel uncomfortable and keep going."
That is a very different message from teaching a child that the goal is to get rid of anxiety.
Brave Behavior Practice
Sometimes we take what we're practicing in the therapy room and turn it into a real-world challenge.
A child who is afraid to speak to unfamiliar people might practice introducing themselves through role-play before trying it outside the therapy room.
A child who avoids raising their hand might practice doing it during a game.
A child who is afraid of being away from a parent might practice short, manageable separations.
The goal is to gradually increase the child's ability to approach rather than avoid the things anxiety has been telling them to avoid.
Play Isn't Used to Distract From Anxiety
This is an important distinction.
When treating anxiety, I don't want play to become another way for a child to escape uncomfortable feelings.
If a child becomes anxious and we immediately distract them, reassure them, or remove the situation, the child may learn that anxiety is something they cannot handle.
Instead, play can give us a way to practice handling anxiety.
A child can be nervous during a game.
They can feel frustrated when they make a mistake.
They can feel uncertain when they don't know what happens next.
They can feel uncomfortable while practicing something difficult.
And they can learn that those feelings are something they can experience without allowing them to take control.
The Goal Isn't to Make Children Fearless
I don't want children to leave therapy believing they should never feel anxious.
Anxiety is part of being human.
The goal is to help children recognize when anxiety is influencing their behavior and learn that they have choices about how they respond.
Sometimes that means challenging an anxious thought.
Sometimes it means tolerating uncertainty.
Sometimes it means making a mistake and continuing anyway.
And sometimes it means doing the very thing anxiety has been telling them to avoid.
Resisting anxiety feeds it. Facing it weakens it.
Play gives children a developmentally appropriate way to practice facing those challenges.
What Parents May Notice Outside the Therapy Room
The real measure of therapy isn't whether a child had fun during a session.
It's what begins to change outside of therapy.
Maybe your child starts going into school without the same level of resistance.
Maybe they stop asking for repeated reassurance.
Maybe they can make a mistake without melting down.
Maybe they try something new.
Maybe they can tolerate not knowing what is going to happen.
Maybe they recognize that they are anxious and choose to keep going anyway.
Those are the skills that matter.
The goal isn't to raise children who never feel anxious. It's to help children become confident in their ability to handle anxiety when it shows up.
That's the heart of Cognitive Behavioral Play Therapy for anxiety.
Play is the vehicle. CBT provides the framework. And practice is what helps children take those skills into real life.