Children’s Literature on Anxiety: A Systematic Review and Content Analysis

Objective: Children’s literature can teach life lessons and effective coping strategies, and can be a way to disseminate evidence-based practices (EBPs) for mental health as a universal prevention strategy. We conducted a content analysis on the presence of EBPs for youth anxiety in children’s literature picture books about anxiety. Method: Analytic plan was preregistered on OSF. 1640 books were screened, and 191 books were coded for eight EBPs for youth anxiety: psychoeducation, labeling body sensations, relaxation, identifying/challenging anxious thoughts, problem solving, contingency management (e.g., rewards and praise), approaching-anxiety provoking situations (i.e., exposure), and post-approach processing.Results: Characters in the books modeled an average of 2.39 EBPs (SD = 1.76). The most frequently modeled EBPs were identifying/challenging anxious thoughts (60% of books), approaching-anxiety provoking situations (46%), and labeling body sensations (42%). The least commonly modeled EBP was contingency management (7%). Books written by licensed therapists were more likely to demonstrate post-approach processing. Books with self-help information at the end were more likely to model post-approach processing and relaxation skills. Books written for youth age 9-12 years modeled more EBPs than books written for youth age 8 years and younger.Conclusions: Children’s books on youth anxiety model relatively few EBPs. Although approaching anxiety-provoking situations was one of the most used EBPs, 54% of books with an anxious character do not model having that character face their fears–a key strategy for youth anxiety. Additionally, few books demonstrate use of rewards and praise by caregivers, who often read stories with their children. Clinicians, caregivers, and librarians are encouraged to purchase books written by therapists or with self-help information in the back, given that these books are more likely to model EBPs.