Teen Anxiety: Learning to Cope in Healthy Ways

About Aspen By Meghan Vivo

If your teen is exceedingly worried, afraid or nervous, the problem may be something more serious than typical teen stress. It may be an anxiety disorder.

Anxiety disorders are among the most frequently diagnosed mental health issues. The following are the most common anxiety disorders:

Generalized anxiety disorder – a disorder characterized by physical symptoms (such as chest pain, headaches, fatigue, tension and nausea), excessive worry and feelings of dread that make life feel out of control
Panic attacks – sudden and intense episodes of anxiety that can include physical symptoms and can occur for no apparent reason
Social anxiety disorder – anxiety triggered by social situations
Obsessive-compulsive disorder (OCD) – a disorder characterized by obsessive thoughts and compulsive actions to try to relieve anxiety
Post-traumatic stress disorder (PTSD) – an anxiety disorder brought on by a traumatic experience, which is characterized by flashbacks, nightmares or uncontrollable fear
Phobias – intense fears of things or situations that pose no real danger

In appropriate amounts, anxiety is normal and healthy. It helps teens prepare for tests, make big decisions and resolve problems. But when it becomes excessive, happens for no reason at all or negatively impacts their daily functioning, treatment is often necessary.

The Symptoms of Teen Anxiety

Anxiety can affect every area of a teen’s life, including their concentration at school, self-confidence, sleep patterns, appetite and perspective on life. It can also co-occur with other disorders, such as depression, teen substance abuse and personality disorders, making it difficult in some cases to recognize and diagnose.

The following are a few common signs of teen anxiety:

Uncontrollable fear
Ritualistic thoughts and behaviors (OCD)
Flashbacks or nightmares (PTSD)
Muscle tension
Sleep problems
Cold, sweaty hands
Shortness of breath
Heart palpitations
Dry mouth
Numbness or tingling in hands and feet
Nausea
Dizziness
Difficulty sitting still or being calm

“Anxiety in adolescents doesn’t always look the way people might expect,” said Kirsten Bolt, CMFTI, a therapist at Aspen Achievement Academy, a therapeutic wilderness program for teens in Utah. “Parents may worry that their child is angry or depressed, but in many cases, anxiety is underneath those feelings.”

The Causes of Teen Anxiety

The origins of anxiety aren’t fully understood. Anxiety can stem from genetics, brain chemistry, personality, traumatic life experiences or growing up in a family that demands perfection.

“Personality is the key to change,” said Bolt. “We can’t change our genetics or the things that have happened to us, but we can change how we experience, interpret and respond to anxiety. This is where learning healthy ways to cope can make a difference.”

Unhealthy Coping Mechanisms vs. Healthy Coping Skills

Because anxiety is an uncomfortable emotion, teens develop coping mechanisms to help them manage their feelings, some of which actually make the situation worse, explained Bolt.

Attempts to suppress or mask anxiety generally result in even greater suffering over time. For example, trying to suppress anger frequently leads to explosive outbursts later on, and trying to ignore traumatic experiences can have long-term repercussions such as risky sexual behavior, drug and alcohol abuse, emotional detachment and other attempts to fill the emotional void.

While defense mechanisms are natural and understandable and serve an important basic survival function, they can lead to cognitive distortions, black-or-white thinking, and feeling disconnected from self and others.

Treatment programs for teen anxiety focus on identifying these unhealthy coping mechanisms and teaching new coping skills. Using Dialectical Behavior Therapy (DBT), Cognitive-Behavioral Therapy (CBT) and other approaches, the adolescent specialists at Aspen Achievement Academy help teens recognize negative thought patterns and more effectively manage their stress.

“Teens with anxiety often are consumed by worry – worries about what they’re saying, how they’re acting and whether they’re making mistakes,” said Bolt. “They become so focused on these things, they actually make the situation worse by resorting to black-or-white thinking or over-generalizing (‘I made a mistake therefore I’m a person who always makes mistakes’).”

As a result of distorted thinking, teens lose self-esteem and may begin to act out. They end up trying harder to achieve perfection or giving up altogether. It is at this point, according to Bolt, that parents often seek treatment for their teen, unsure whether the defiance, substance abuse and other negative behaviors they’re seeing are the problem or merely a symptom of an underlying issue such as an anxiety disorder.

Treating Teen Anxiety

There are a number of approaches to treating teen anxiety, including medication, therapy and relaxation techniques. Although many parents aren’t aware of it, wilderness therapy is also a highly effective treatment for anxiety.

Because adolescents in wilderness therapy are with their field instructors and peers 24 hours a day, they are able to work on both primary components of anxiety treatment: prevention and intervention.

In an effort to prevent anxiety from taking hold, the field staff and therapists at Aspen Achievement Academy help teens learn the following:

Relaxation techniques
Coping skills that keep them grounded, calm, and connected to their bodies and minds
Mindfulness skills (connecting to their own thoughts and emotions)
Emotional regulation and expression
Cognitive restructuring (changing thinking patterns in order to change behaviors)

For teens with anxiety disorders, prevention is helpful, but insufficient on its own. Intervention is also critical so that teens can develop healthy coping skills to help them manage their symptoms.

In her work with teens, Bolt utilizes breathing techniques, positive self-talk and “I feel” statements to help young people bring themselves back to a calm place when they’re struggling with anxiety. She also teaches DBT skills, such as mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness, to help teens recognize their negative thought patterns and reshape them.

Some of the specific techniques Bolt uses include asking teens to write about and share their emotional life story, keep a journal to document what happens in their minds and bodies when an anxiety attack comes on, and restructure their thoughts by imagining the worst possible outcome and the likelihood of the worst case scenario actually happening.

“There can be a lot of shame around anxiety, which can be alleviated by opening up and talking about it,” said Bolt. “Once teens are able to start sharing, they open a window that helps us understand and address the source of their anxiety.”

When teens are suffering from PTSD and related disorders, they may not be comfortable talking about their problems. In these cases, Bolt uses alternative approaches such as art therapy.

Because the mind and body are closely connected, Bolt also believes exercise, a healthy diet and adequate sleep are particularly important for teens with anxiety. “If the body is tense, teens can’t feel anything but tense,” she explained. “Sometimes you have to change the physical body as well the emotions in order to relieve anxiety.”

Although some anxiety is normal, the feelings of dread, panic and incessant worry that are characteristic of anxiety disorders shouldn’t keep your teen from going places and doing things they enjoy. With treatment and a few new skills, teens can practice healthy ways to cope with anxiety that make the situation better, not worse.