STANDARD CBPT PROTOCOL
What Is Cognitive Behavioral Play Therapy (CBPT)?
Cognitive Behavioral Play Therapy (CBPT) is a developmentally sensitive approach that combines the principles of cognitive behavioral therapy with the natural language of children: play. Through plays, stories, drawings, role-play, and symbolic play, children learn to recognize emotions, understand the links between situations, thoughts, feelings, and behaviors, and practice new coping skills in a safe and engaging way.
CBPT is structured and goal-oriented, but remains flexible and child-centered. The therapist uses play materials not only to build a trusting relationship, but also to explore the child’s difficulties, co-construct a shared formulation, and rehearse new ways of thinking and behaving. Parents and caregivers are typically involved as partners in the process, supporting the generalization of skills across home, school, and peer contexts.
How the Standard CBPT Protocol Works
1) Assessment, engagement, and case formulation
In the first step, the therapist gathers information about the child’s difficulties and context, and creates a collaborative understanding of the problem.
Clinical assessment and play observation: The therapist explores the onset, frequency, intensity, and impact of symptoms, while observing the child’s play themes, interaction style, and regulation capacities.
Parent and caregiver meetings: Parents provide developmental history, family patterns, educational practices, and current coping strategies. School information is included when relevant.
Child-friendly case formulation: Using drawings, puppets, cards, or stories, the therapist and child build a simple model showing how situations, thoughts, emotions, body sensations, and behaviors influence each other.
Goal setting: Together with the family, the therapist defines clear, observable goals (e.g., fewer anger outbursts, more participation in activities, reduced avoidance, better toilet routines).
2) Psychoeducation and emotional literacy
This step focuses on helping the child and family understand the presenting problem and learn the basic language of emotions and CBT.
Normalizing and externalizing: Difficulties are presented as understandable and changeable, often using metaphors (e.g., “worry monster,” “anger volcano,” “bossy thoughts”) to reduce shame and blame.
Emotional vocabulary: Through plays and stories, children learn to differentiate emotions, recognize intensity levels, and link feelings to events.
Understanding the CBT model: The therapist shows, in playful ways, how thoughts, feelings, body reactions, and behaviors are connected, preparing the ground for later interventions.
3) Skill building through play
In this step, CBPT uses play to teach and practice specific cognitive and behavioral skills tailored to each disorder.
Cognitive skills: Children learn to notice unhelpful thoughts, test them, and create more flexible alternatives, often via comic strips, thought-bubble games, and puppet dialogues.
Behavioral and regulation skills: The therapist introduces concrete tools such as breathing plays, relaxation, positive self-talk, problem-solving steps, and communication skills, practiced within play scenarios.
Exposure and behavioral experiments: When anxiety, OCD, phobias, or mutism are present, graded, play-based exposure is used so the child can face feared situations while using new coping strategies.
Reinforcement and strengths: Progress is supported through token systems, reward games, and explicit recognition of the child’s strengths and efforts.
4) Parent work, environment, and generalization
Parental involvement is central in CBPT, especially for behavioral and anxiety-related disorders.
Parent guidance: The therapist shares the formulation and skills, helps parents respond more consistently, and addresses interaction patterns that may maintain difficulties (e.g., overprotection, harsh discipline, accommodation of rituals).
Home and school plans: Skills learned in session are translated into simple weekly “missions” and routines, often involving teachers when needed.
Monitoring change: Parents and children may use charts, logs, or simple scales to track behaviors, emotions, and the use of new strategies.
5) Consolidation and relapse prevention
The final step aims to stabilize gains and prepare the child and family for future challenges.
Review of goals and progress: The therapist and family compare the initial situation with the current one, highlighting changes and helpful strategies.
Relapse prevention stories: Together they create stories, games, or “future movies” showing how the child can handle upcoming difficulties using their CBPT tools.
Closure and transition: The end of therapy is marked with a meaningful ritual (e.g., certificate, “CBPT toolbox,” or booklet summarizing skills), reinforcing the idea that difficulties may reappear, but the child now has resources to face them.
Application of CBPT to Specific Childhood Disorders
Childhood anger and irritability
CBPT for childhood anger focuses on emotional regulation, awareness of triggers, and alternative responses to provocation or frustration.
Typical difficulties: Frequent outbursts, aggression, irritability, difficulties accepting limits, and conflicts with adults and peers.
CBPT focus: Identifying anger triggers and early body signals, understanding thoughts like “It’s not fair” or “They never listen,” and replacing aggressive responses with more constructive strategies.
Childhood depression
CBPT for childhood depression emphasizes behavioral activation, restructuring negative self-beliefs, and strengthening hope and connection.
Typical difficulties: Persistent low mood or irritability, loss of interest, withdrawal, reduced energy, negative self-perception, and feelings of hopelessness.
CBPT focus: Helping the child reconnect with enjoyable and meaningful activities, identify negative thoughts about self, world, and future, and build a sense of competence.
Evacuation disorders (e.g., encopresis, enuresis)
CBPT in evacuation disorders addresses shame, anxiety, avoidance, and family dynamics surrounding toileting, in coordination with medical care.
Typical difficulties: Involuntary soiling or wetting, avoidance of toilets, embarrassment, conflicts about hygiene and routines.
CBPT focus: Normalizing the problem, reducing anxiety and shame, supporting adherence to medical or behavioral routines, and improving communication around accidents.
Generalized anxiety disorder (GAD)
CBPT for GAD involves externalizing worry, modifying catastrophic thinking, and increasing tolerance of uncertainty.
Typical difficulties: Excessive, pervasive worries, restlessness, somatic complaints, reassurance seeking, and difficulty relaxing.
CBPT focus: Helping the child identify worry patterns, challenge “what if” thoughts, and practice doing valued activities despite uncertainty.
Oppositional defiant disorder (ODD)
For ODD, CBPT integrates emotion regulation, problem-solving, and parent training to change unhelpful interaction cycles.
Typical difficulties: Frequent arguing, defiance, refusal to follow rules, deliberate provocation, and resentment.
CBPT focus: Helping the child notice emotions and thoughts that precede oppositional behavior, and teaching alternative ways to express needs and handle frustration, while parents modify their responses.
Obsessive–compulsive disorder (OCD)
CBPT for OCD adapts exposure and response prevention (ERP) to a play-based format that children can understand and tolerate.
Typical difficulties: Intrusive thoughts, images, or urges; repetitive rituals; strong distress when unable to perform compulsions; significant interference in daily life.
CBPT focus: Helping the child understand how rituals maintain anxiety, externalizing “bossy thoughts,” and practicing gradual exposure while resisting compulsions.
Selective mutism
CBPT for selective mutism supports gradual, safe increases in verbal communication, respecting the child’s pace and sensitivity.
Typical difficulties: Consistent inability to speak in specific social situations (e.g., school) despite speaking in other contexts, high anxiety when expected to talk, social withdrawal.
CBPT focus: Reducing anxiety around speaking, strengthening nonverbal communication first, and then moving step-by-step toward verbal expression in targeted settings.
Specific phobia
CBPT for specific phobia centers on playful, graded exposure and the development of coping skills.
Typical difficulties: Intense fear and avoidance of a specific object or situation (e.g., animals, darkness, medical procedures), disproportionate to actual danger.
CBPT focus: Helping the child approach the feared stimulus step-by-step while managing anxiety, and updating beliefs about danger and coping ability.
Attention-deficit/hyperactivity disorder (ADHD)
In ADHD, CBPT enhances self-regulation, planning, and frustration tolerance using highly engaging, structured activities.
Typical difficulties: Inattention, hyperactivity, impulsivity, difficulty waiting, disorganization, academic and social problems.
CBPT focus: Strengthening the child’s capacity to pause, think, and choose actions; improving routines; and reshaping the child’s self-image from “problematic” to “capable with support and strategies.”
