One of the most common reasons that teenagers come to counseling is because they are struggling with anxiety. Over the past year I have worked as a therapist at a high school and seen over 40 teenage clients. Although they come to counseling for many different reasons, the number one reason these clients come is because of stress or anxiety. Whether it’s daily stress or anxiety when trying to sleep, it’s a common experience among adolescents. My experience is not without merit; according to the NIH roughly 31.9% of adolescents ages 13-18 in the US have an anxiety disorder. Of course, not everyone who comes to counseling has an anxiety disorder. There are also many more teenagers who seek help due to family or school stress. Regardless of the source of the anxiety, it is clear that many young people are trying to get help for this difficulty.
Common Types of Anxiety in Teens
In order to work with teenagers who are struggling with anxiety it is important for me to find out where that anxiety is coming from. I often spend the first few sessions asking clients about the history of their anxiety, the story of it, and what the experience of it is like for them. When working with teens it is important to understand what their subjective experience of the problem is like and how it is impacting them.
One of the most common types of anxiety for teenagers is social anxiety. On the most severe end of social anxiety, teens might experience a social anxiety disorder. When teenagers have a social anxiety disorder they are caused severe discomfort and even panic in social situations.
Some of the symptoms of social phobia include:
- Anxiety in peer settings
- Fear that you will be negatively evaluated
- Social situations almost always provoke fear or anxiety
- The fear and anxiety lasts for more than 6 months
- The fear or anxiety causes significant distress or impairment in functioning
On the most mild end of social anxiety, teens might present with self-consciousness or worries about what their friends or adults think of them. Even when this type of social anxiety does not rise to the level of a disorder, it can still be uncomfortable. This might lead teens to present themselves in a way that they think will make people like them more. When working with teens I like to ask them how much they worry about what people think of them.
Among many of the teenage girls I work with, this type of anxiety can lead them to dress a certain way or wear a lot of makeup. It is important to understand that how kids dress and how much makeup they wear might be related to worry about how they will be evaluated by peers. When I work with teenagers I always try to tease out what they are doing for themselves and what they are doing for others.
Another common type of anxiety I see when working with teenagers is panic attacks. Whenever I hear that a student has run out of class crying I begin wondering if they had a panic attack. In order to figure this out, when I see teenagers I try to ask them about how their body feels when they experience anxiety. If I can help them get in touch with what is going on in their body, we can start to tease out if panic attacks are present. When working with panic, it is important to remind teens that even though it is uncomfortable they have tools they can use to cope.
Some of the symptoms of Panic Disorder include:
- Palpitations, pounding heart, or fast heart rate
- Trembling or shaking
- Shortness of breath
- Feeling like you are choking
- Chest pain or discomfort
- Nausea or stomach pain
- Feeling dizzy
- Fear of dying or losing control
It is important to remember that when teenagers experience panic attacks it is often an overwhelming and scary experience. There might be feelings of embarrassment depending on where they were when it happened. Also, they don’t always know what is happening so there can be confusion and fear.
Anxiety from Interpersonal Problems
A huge source of anxiety for teenagers is interpersonal problems. These problems might come up in relationships with their parents, friends, or teachers. Most often in my work, teenagers report having conflicts with their parents. These conflicts can cause teens to have significant distress when they come to school or even when they are with their friends. They sometimes say they are anxious when they have to get in the car or go home at the end of the day because they know they will argue with parents.
Teen years are a time where young people are creating more independence while still being very dependent on the people around them. So, it is no wonder that it is also a time where they get into struggles with authority figures and even peers. When working with anxiety that comes from interpersonal conflicts, it is important to offer tools for reducing both the conflicts and the anxiety.
Another source of worry for teens is school stress. There is sometimes a misconception that all school stress comes from student’s high expectations or even parents high expectations for their kids. This isn’t always the case. Often students experience anxiety about actually just getting the work done. Many young people find themselves overworked with little or no time for friends and fun.
When working with teenagers I address all areas of school that might be causing stress. I assess how much time they are spending on homework each night, how much they are care about grades, if there are worries about the future or jobs. In addition to all of these thing that might cause anxiety, there are other school related issues teens worry about. Recently, I have noticed more and more teens are concerned about their financial futures. Sometimes this shows up as concerns about the cost of living, paying taxes, or loans for college. Often, there is a concern that school is not preparing them for these future realities.
Counseling for Teens
When working with teenagers there are a number of different interventions or approaches I use in order to help the reduce feelings of anxiety. Both individual therapy and group therapy are helpful for anxiety. While many of the same interventions can be used with adults, there are some key differences in my work with teens. The most important thing is that I am not there to be another adult telling them what to do. I am there to listen and to help but not necessarily give advice.
When someone walks in the door for a therapy session I know that whatever is going on will be told to me in story form. When working with teenagers it is all about listening to the story and drawing out the feelings and stressors.
One of the most important things I do is validate feelings. Teenagers often feel invalidated by parents, teachers, or peers. As a therapist, my role is to validate the feelings someone has. People often fall into the trap of thinking that the response to the stressor is out of proportion. While this might be true, the feelings that fueled the response are completely valid. It is always my goal to make teenagers feel safe and heard and to let them know that their problems matter.
Mindfulness and Distress Tolerance
Once someone knows that I care about their subjective experience I can work with them to help them recognize what is going on. The ability to be aware of what is happening and do something with that information is called mindfulness. I work with teenagers by stopping them when they are telling a story to ask how it felt when that happened. I might ask “what did you feel in your body?” or “how did your chest and stomach feel?”.
I try to work with people until they get the the point where they are able to be mindful of both the triggers that cause them anxiety and how their mind and body feel when they have anxiety. Once they are able to do this they can learn distress tolerance. This skill teaches people that even though a feeling is uncomfortable, they have the ability to sit through it until it passes. Rather than teaching people to get rid of anxiety, I teach them to cope with it in a healthy way.
Breathing and Self-Soothing
The next technique I use when working with teenagers is to teach them breathing or other self-soothing techniques. This portion of work might sometimes include psychoeducation about our bodies and how we can use things like slow breathing to reduce the physical symptoms of anxiety. As adults, we sometimes forget that teenagers don’t know this stuff!
There are many different breathing techniques I use but one of the simplest is to have them breathe out for longer than they breathe in. Also I might have them self-soothe by placing their hand on their chest or pressing their feet into the ground.
Planning and Goal Setting
For people who are struggling with worries about the future I always offer that we can plan and set goals. For some people the idea of doing this actually causes more stress, but for some it is comforting to know they have an adult to do these things with. I have worked with students on writing resumes, practicing job interviews, and creating monthly budgets.
Creating this concrete plans or practicing these skills can reduce worry about the future. When doing this type of work I am careful to take it slow and create goals for my clients that are small and manageable. Likewise if there is stress about grades and school I talk with students about study techniques, taking breaks, and planning out the work.
If someone comes to me with anxiety as a result of interpersonal problems, I will often work with them on communication skills. Creating clear and open communication is a great way to reduce the number of conflicts someone has with their parents or friends. Often I work with teenagers of how to use I statements. I ask them if they could tell someone what is going on by saying “I feel ____ when you ____”.
I always use some humor when doing this and tell them that I know it seems silly and forced. However, people often can’t really hear what we are saying when we attack them. I try to teach teenagers that people are more likely to listen if we play to their sense of sympathy. Often if they can start communicating in this way it reducing the conflict they have. When they have less conflict with others they often feel less anxious.
Client Centered Advocacy
The final piece of my work with teenagers involves a great deal of client centered advocacy. Yes, therapists are often advocate on behalf of their clients but this is especially true when the clients are teens. Sometimes this means helping them navigate complicated school processes like getting a 504 plan or and IEP. I have had many meetings with students, administration, and parents so that we can all get on the same page and help someone get extra resources when it is needed.
Sometimes advocating g for my clients means talking to their parents with or for them. As much as possible I ask clients to bring their parents in for a conjoint session so we can talk to them together. But there are times when I speak to parents on my clients behalf if they ask me to. Finally, I advocate for clients by trying to change the systems (like excessive punishment or too much homework) that create more anxiety.
So many young people struggle with anxiety. The good news is that there are many effective ways to work with teenagers in order to reduce their anxiety. If you or someone you know is struggling with anxiety, please feel free to reach out for help. As a therapist it is always my goal to put my client first and help them to live happier lives. I work with teens in California both in person an online on whatever they are facing.