How To Treat Anxiety Disorder In Teenager

Understanding Anxiety In Children And Teens

As parents, we always desire the best for our children. We want them to be healthy, happy, and resilient when faced with lifes challenges. This is often easier said than done with the daily demands and parenting responsibilities. Anxiety is a common issue in children, adolescents, and teens, often experienced at different phases of development. Anxiety disorders can be first diagnosed in children between the ages of four and eight, while a recent survey found that about 32% of adolescents in the U.S. have an anxiety disorder, a number that has substantially increased over the years. The study also revealed that one in four to five adolescents has a severe disability related to their anxiety disorder.

The COVID-19 pandemic has heightened anxiety in children and teens, with the disruptions in their normal routines in school, family life, and relationships with peers. Its not always easy to recognize the difference between normal worries and anxiety disorders in children and teens, particularly in these stressful times. For example, young people often worry about their schoolwork or taking exams, but this is usually temporary once the immediate stressor has passed. However, if worrying becomes constant and interferes with a childs daily functioning, it can negatively affect their overall quality of life.

How Can I Help My Child

If your child has an anxiety disorder, here are some ways you can help:

• Find a trained therapist and take your child to all the therapy appointments.
• Talk often with the therapist, and ask how you can best help your child.
• Help your child face fears. Ask the therapist how you can help your child practice at home. Praise your child for efforts to cope with fears and worry.
• Help kids talk about feelings. Listen, and let them know you understand, love, and accept them. A caring relationship with you helps your child build inner strengths.
• Encourage your child to take small steps forward. Don’t let your child give up or avoid what they’re afraid of. Help them take small positive steps forward.
• Be patient. It takes a while for therapy to work and for kids to feel better.

Evidence Based Treatment For Teens With Anxiety Disorders

Research shows the best way to treat anxiety disorders in teens is with a combination of therapy and medication.

There are three primary modes of psychotherapeutic treatment for anxiety:

1. Cognitive-Behavioral Therapy

• CBT helps teens with anxiety connect their patterns of thought to their behaviors. Teens who participate in CBT learn to identify the patterns of thought that are life-interrupting and replace them with patterns of thought that are life-affirming. Then, they learn to align their behaviors with what they know helps them, and reduce behaviors that interfere with their participation in family, school, and social life.

2. Dialectical Behavioral Therapy

• DBT helps teens understand the connection between emotion to thought, and identify the influence of emotion-driven thoughts on their behavior. DBT is particularly effective for teens who are highly reactive and feel overwhelmed by their anxiety. Teens who participate in DBT learn to observe their emotions without judging them, which helps them get perspective. Then, they learn to separate their extreme emotions from the thoughts and behaviors they cause and replace those emotion- or anxiety-driven thoughts and behaviors with those that help them maintain balance and like CBT return to full participation in family, school, and social life.

3. Exposure Response Prevention Therapy

There are two types of medications commonly used to treat anxiety in teen and adults:

1. Anxiolytics, a.k.a. anti-anxiety medications

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How To Help Your Anxious Child

If your child is having problems with anxiety, there’s plenty you can do to help.

Above all, it’s important to talk to your child about their anxiety or worries.

Read more about how to help an anxious child, including self-help tips for parents of anxious children.

Many children at different ages may have anxieties that will go away after a while, with your reassurance.

However, it’s a good idea to seek professional help or reassurance yourself if your child is constantly anxious and:

• it’s not getting better, or is getting worse
• self-help is not working
• it’s affecting their school or family life, or their friendships

Repeated Exposure And Reduction Of Avoidance

Exposure to feared stimuli is arguably the central component in most CBTs for child anxiety. In fact, Chorpita and his colleagues found exposure based treatments for anxiety disorders in youth to be associated with the largest effect sizes . Early exposure therapies guided by a reciprocal inhibition hypothesis paired feared stimuli with a response incompatible with anxiety – often muscle relaxation . In such an approach the child would be trained in relaxation techniques and a hierarchy of feared stimuli would be developed. Systematic exposure to the feared stimuli would proceed with the child engaging in relaxation procedures. Any symptoms of anxiety would be countered with relaxation, as the goal would be to avoid the experience of anxiety in order to condition an association between the once-feared stimuli and relaxation. However, such an approach has largely fallen out of favor, in part because it has been found that the relaxation training component of the treatment was often not necessary and in part because of updated theories regarding the mechanisms responsible for change in exposure therapies . Today exposure-based treatments generally have four basic phases instruction, hierarchy development, exposure proper, generalization and maintenance.

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Key Points About Gad In Children And Teens

• Generalized anxiety disorder is a serious mental health problem. A child with GAD has a lot of worry and fear that seems to have no real cause.

• A child with GAD may worry about things such as future events, past behaviors, and family matters.

• The child may not realize his or her worry is more intense than the situation calls for

• GAD is caused by both biological and environmental factors.

• A mental health evaluation is needed to diagnose GAD.

• Treatment includes therapy and medicines.

• Untreated, chronic anxiety can lead to other serious problems such as depression, substance abuse, and self-harm.

• Treatment and family involvement can help reduce GAD symptoms and improve your child’s quality of life

Developmental Epidemiology And Course Of Pediatric Anxiety Disorders

Accumulating dataâfrom both retrospective and prospective studiesâsuggest that anxiety disorders are both the most frequent psychiatric disorders in children and adolescents and represent the âearliest of all forms of psychopathologyâ . Mostly due to the frequent, early emerging specific phobias, the onset of the first or any anxiety disorder is usually in childhood, and thus, considerably earlier than the onset of depressive or substance use disorders . However, there is considerable heterogeneity in the onset of the specific anxiety disorders with GAD, agoraphobia, panic disorder, and obsessive compulsive disorder mostly emerging in adolescence . Overall, anxiety disorders are more prevalent in girls compared to boys, although it is noteworthy that sex differences are accentuated by development, with prevalence ratios reaching 2-3:1 by adolescence .

The age of onset distribution of anxiety, depressive and substance use disorders and specific anxiety disorders at age 33, and estimated cumulative incidence rates at age 33

Data from the Early Developmental Stages of Psychopathology Study. Adapted from .

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Common Causes & Risks Of Anxiety

While anxiety disorders have been studied extensively, not everything is known about the disorder. Some potential causes include:

• Traumatic Events anxiety can be the result of a specific traumatic event or might be due to a preponderance of stressful life situations
• Medical Problems or side-effects of specific medications unpredicted anxiety can be the symptom of a larger medical issue . In addition, certain medications can cause unexpected anxiety.
• Genetics some studies show that there is a genetic link to certain anxiety disorders. A young person might be predisposed to anxiety if they have a family history of anxiety.
• Family patterns or stressors anxiety might be a reaction to long-held family systems and disfunction. Anxiety disorders can develop as a reaction to upbringing.
• Drug or alcohol use substance use can add to feelings of anxiety. People who struggle with anxiety can turn to substance use to mask their symptoms. Yet, this use can add to worsening feelings of stress and anxiety.

How Much Anxiety Is Too Much

Here are some of the signs of excess anxiety:

• You feel anxious, worried, or afraid for no reason at all. Normally, teens feel anxiety because of something specific — like a test or going out on a date. But if there’s no obvious reason for your feelings, your anxiety level may be too high.
• You worry too much about everyday events or activities. Some worry is normal. But if you’re constantly worrying about things that are not unusual, or if you worry so much about those events you avoid them, your anxiety level is too high.
• You continually check whether you did something right. While it’s normal to check something you did to make sure it’s right, continuing to check it again and again is a sign that you have way too much anxiety.
• You’re so panicky that you are unable to function in certain specific situations — like taking tests or socializing with friends.

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Have A Drink Itll Take Your Mind Off Of It

A favorite soft drink might be a welcome distraction for an adolescent or teen, but when you are dealing with anxiety disorders, there are other issues to consider. Caffeine in soda pop or coffee, and other stimulants, found in popular energy drinks, can have the opposite effect. Humphreys says most people assume that if someone has a refreshing beverage it will take their anxiety away. In the short term, yes, perhaps it will, but in the long term it can be a gateway for addiction. Its dangerous in the long term because those substances can be reinforcing the anxiety.

Sometimes, doing nothing for your teen is best thing you can do. Humphreys stresses that its important to remember panic and anxiety disorders stem from something larger than just one particular or minor instance. Accept that you cannot control another persons emotions, he explains. If you try to control their emotions, you will feel frustrated, your loved one suffering may feel rejected and youll resent each other. Its important not to take their anxiety personally.

How To Help At Home

It is impossible, and often counterproductive, to remove all sources of anxiety from a childs life.

A better approach is to help a child learn effective and productive ways to cope with the situations and activities that make them anxious. This will lower their levels of anxiety over time.

When talking to a child about their anxiety, the way a person poses their questions is key. Some phrasing may lead a child to dwell on their anxiety.

Instead of asking whether they are anxious about a situation, a person can ask an open-ended question about how they feel.

A child may also benefit from someone talking through the situations with them. This can help some children feel more in control of the situation and their responses to it.

It may also help to:

Modeling good coping mechanisms at home can also teach a child how to deal with their own anxiety. It is not necessary for parents or caregivers to hide all of their anxiety from a child by managing stress and anxiety in healthy ways, they can lead by example.

It may be a good idea to seek advice from a doctor if a child is showing symptoms of anxiety that are not eased with anxiety-management techniques at home.

If anxiety is affecting the childs school life or relationships, a doctor or therapist can help.

Possible treatment options for childhood anxiety include:

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How Are Anxiety Disorders Treated

Most often, anxiety disorders are treated with cognitive behavioral therapy . This is a type of talk therapy that helps families, kids, and teens learn to manage worry, fear, and anxiety.

CBT teaches kids that what they think and do affects how they feel. In CBT, kids learn that when they avoid what they fear, the fear stays strong. They learn that when they face a fear, the fear gets weak and goes away.

In CBT:

• Parents learn how to best respond when a child is anxious. They learn how to help kids face fears.
• Kids learn coping skills so they can face fear and worry less.

The therapist helps kids practice, and gives support and praise as they try. Over time, kids learn to face fears and feel better. They learn to get used to situations they’re afraid of. They feel proud of what they’ve learned. And without so many worries, they can focus on other things like school, activities, and fun. Sometimes, medicines are also used to help treat anxiety.

Build Your Childs Coping Skills

Rather than avoiding your childs anxiety triggers, you can help them develop effective coping strategies. Giving frequent positive feedback will encourage your child to feel more capable and self-confident. Set small goals that are both realistic and achievable. Each time a goal is reached, you can say Im so proud of the way you handled the situation and worked through your anxiety.

Make a point of praising your childs effort whenever they exhibit any type of resilience or face their fears. If a setback occurs, reassure your child that this is not a failure but a learning experience that will help them overcome future obstacles. Talk to them about what they could change the next time around to have a better outcome. Theyll feel more empowered as they take control of the situation.

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Symptoms Of Anxiety In Children

Signs to look out for in your child are:

• finding it hard to concentrate
• not sleeping, or waking in the night with bad dreams
• not eating properly
• quickly getting angry or irritable, and being out of control during outbursts
• constantly worrying or having negative thoughts
• feeling tense and fidgety, or using the toilet often
• complaining of tummy aches and feeling unwell

is common in younger children, whereas older children and teenagers tend to worry more about school or have social anxiety.

Predictors Of Treatment Response

Accumulating evidence suggests a constellation of âpredictorsâ of treatment response in children and adolescents with anxiety disorders. These predictors include demographic characteristics, clinical characteristics and family-system factors. In one study of youth aged 7-17 years with triad anxiety disorders who were treated with fluoxetine , having a first-degree relative with an anxiety disorder was associated with poorer functional outcomes at endpoint . In the CAMS, increased caregiver strain, a measure of the effect of caring for a child with emotional problems on the primary caregiver , predicted higher endpoint PARS score. Additionally, Ginsburg and colleagues noted that older age predicted a decreased likelihood of remission in CAMS , which was defined as the absence of all study entry diagnoses. Additionally, being Caucasian predicted an increased likelihood to enter remission . Finally, the long-term, follow-up study of CAMS participants suggests that males as well as participants with better family functioning are more likely to be in remission approximately 6 years post-randomization .

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Things You Should Never Say To Teens With Anxiety Disorders

Fortunately, there are ways to be supportive that wont cause more distress for your teen or adolescent. Bea and other psychologists have developed, as a guideline, a list of comments that you should learn to avoid. They also offer suggestions for different approaches that might help you reduce your childs anxiety. Here are 6 of their tips, with a dont and a do for each.

Common Forms Of Anxiety In Teens

Some forms of anxiety disorders are more common than others. The most common forms of anxiety in teens include:

• Generalized anxiety disorder Characterized by difficulty concentrating, being easily fatigued, feeling irritable or restless, having sleep issues, and more. GAD includes consistent, long-lasting feelings of anxiety that affect a teens daily life.
• Social anxiety disorder Being easily embarrassed, blushing, having a hard time talking to others, making eye contact, speaking up, and more. As the name suggests, social anxiety shows up mainly in social situations.
• Panic disorder Symptoms may include having repeated, unexpected feelings of extreme fear, racing heart, dizziness, trembling, shortness of breath, and more. A panic attack can be caused by a certain trigger in their environment or at random.
• Specific phobias Intense fears about specific things or situations that arent really dangerous: dogs, heights, flying, etc. Teens can have specific phobias of death, deep water, and many other things.

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Build Your Teens Self

Highlight your teens strengths instead of their weaknesses. Rather than focusing on their anxiety, you can emphasize their positive attributes. It can be as simple as complimenting your teen on their thoughtfulness, kindness, or consideration of others. Your teen may also have strong intellectual or character traits that make them stand out as individuals. Point out that their uniqueness is something to be celebrated as opposed to feeling as if they dont fit in.

• Building resilience and self-confidence can help your teen recognize their ability to problem-solve on their own. If they do well on an exam or school assignment, you can do more than just praise them. You can also remind them about the amount of time they devoted to study and preparation. This will show them the value of their effort to succeed rather than always worrying about the outcome.
• If your teen has a particular interest or aptitude, such as art, music, or athletics, you can use this to help sustain their motivation. Showing how proud you are and acknowledging the rewards of their dedication will bolster their confidence. Mastering any type of skill will build self-esteem and divert attention away from their anxiety. Remember, this is not about trying to be perfect the goal is to extend their best effort to succeed based on their abilities.