Anxiety in TeensPresented by: Julia Harris, MS, NCC, LAPC

Staff Associate TherapistIntensively Trained DBT Therapist

The Summit Counseling Center

What is Anxiety?

• A feeling of unease, apprehension, nervousness, or worry about a future event or situation with an uncertain outcome.• A normal emotion that people feel prior to making an important

decision, taking a test, while dealing with relationship issues, or problem solving

Common Anxiety Words• Worried

• Discomfort

• Overwhelmed

• Concern

• Apprehension

• Uneasy

• Fear

• Agitated

• Angst

• Panic

• Nervous

• Tension

• Eagerness (an anxiety to please)

• Dismay

Helpful Anxiety vs. Harmful Anxiety

• Helpful Anxiety• Feelings of anxiety that encourages us to act in a helpful way

• Ex: Feeling nervous about a test increases the likelihood that you will study• Ex: Feeling uneasy about a conflict can encourage you to problem solve• Ex: Feeling worried about an important decision can encourage you to weigh your

options and problem solve

• Harmful Anxiety• Feelings of anxiety that create unjustified fear, reduce effective behaviors, or

cause us to over react (highly reactive) or underreact (avoidance)• Ex: Feeling fearful before a test which leads to difficulty studying and a sleepless night • Ex: Feeling anxious about how someone may respond to you, so you never ask for help • Ex: feeling overwhelmed about an upcoming event which causes you to avoid the event

Anxiety Disorders

• Types of mental illness that create constant worry, anxiety, or fear that prevents a person from living their daily life.• Feelings of anxiety, worry, or fear are persistent despite events or

triggers that would typically create these feelings• A person with an anxiety disorder may react with more intense

emotions to some situations• Example: A person with an anxiety disorder may feel fearful when meeting

new people or may become anxious about a test and become unable to focus on studying or taking the test (displays inability to tolerate distress and/or regulate emotions)

Common Types of Anxiety Disorders• Generalized Anxiety Disorder (GAD)

• Constant and excessive unjustified worry and anxiety. • Can include panic/anxiety attacks

• Obsessive Compulsive Disorder (OCD)• Persistent, repeated, unwanted thoughts (obsessions) that are followed by behaviors (compulsions) to

alleviate the thoughts.• Social Anxiety Disorder

• Worry and self-consciousness associated with interacting with others and common social interactions. Fears of being embarrassed or judged by others causes fixation on behavior and feelings.

• Panic Disorder• Terror that occurs at random causing physical sensations including tight chest, trouble breathing, rapid heart

rate, sweating, and heart palpitations• Specific Phobias

• Intense fear associated with specific objects or situations that causes you to avoid these things. The emotion experienced is not appropriate for the situation and causes ineffective behaviors.

Signs and Symptoms of Anxiety• Nervousness

• Feelings of being powerless

• Feelings of impeding danger

• Persistent and excessive worry

• Crying spells

• Increased heart rate

• Hyperventilation (heavy breathing)

• Sweating

• Trembling

• Weakness and fatigue

• Lack of concentration and focus other than the cause of worry

• Difficulty falling asleep or staying asleep

• Weight loss or weight gain

• Nausea, vomiting, stomach aches

• Frequent urination or bowel movements

• Headaches

Behavioral Symptoms of Anxiety in Teens

• Personality changes (changes in self-esteem or self confidence)• Relationship troubles• Isolation or avoidance behaviors• Fears of engaging in certain situations• Repetitive or compulsive behaviors • Health issues (IBS, headaches, heartburn, stomach aches can all be

related to anxiety but you should always see a doctor to rule out medical issues)

Risk Factors for Anxiety Disorders

• Family members• Individuals with family members with anxiety disorders are more likely to develop an

anxiety disorder due to genetics and/or learned behaviors• Trauma

• Individuals who experience traumatic events (real or perceived life threatening events) are more likely to develop anxiety disorders

• Stress• Those who experience frequent stress, regardless of the source, are more likely to

experience anxiety• Mental Health Issues

• Individuals who experience other mental health conditions are at a higher risk of developing an anxiety disorder. Pre-existing mental illness, such as depression, is the top risk factor for anxiety.

Risk Factors for Anxiety Disorders cont’d

• Substance Abuse• Continued use of alcohol or other substances can lead to anxiety disorders• Withdrawal from a substance can create anxiety disorders

• Personalities• Some types of personalities are more prone to anxiety, such as introverts.

• Gender• Females experience anxiety more frequently than males do.• This does not mean that a male cannot have an anxiety disorder, just that females

are at a higher risk for developing an anxiety disorder.• Pre-existing Medical Conditions

• Some health conditions put an individual at a higher risk for developing anxiety disorders including but not limited to: heart disease, diabetes, thyroid problems, irritable bowel syndrome (IBS), and asthma

Coping with Anxiety• Exercise

• Consistent exercise reduces stress, boosts our mood, and increases happiness

• Mindfulness• Intentionally paying attention and being aware of the present moment; internally and externally• Increases emotion identification and ability to let go of harmful thoughts• Mindful body scan to identify and release tension in the body

• Deep breathing• Taking deep breaths and paying attention to the rising and falling of your chest or the air coming in and out of your

nostrils/mouth

• Writing it out• Getting what’s on your mind onto paper and throwing the paper away

• Reality testing • Listing out facts to disprove harmful thoughts causing anxiety

• Seeking Support• Verbalize and seek support from a trusted person (friend, family, teacher, etc.)

• Thought changing

Thought changing: reframing our thoughts can change the emotion associated with our thinking!

Coping with Anxiety con’t

• Soothing with the Senses:• Use the 5 senses to self-soothe• Taste, Touch, Smell, Sight, Hearing

• Avoiding mood altering substances• Reducing caffeine intake• Creating a sleep routine that increases a good night’s sleep

• Stop use of electronics/TV prior to bedtime, getting in bed 30 minutes before you want to be asleep with no lights or electronics, maintaining a good sleep schedule

• Eating well• Eating well-balanced meals and consuming nutrient rich foods improves wellbeing.• Rule of thumb – does this food make me feel good or bad?

• Seek Professional Support from a Licensed Therapist

Managing High Anxiety in the Moment

• Intense feelings of anxiety or fear can lead to anxiety/panic attacks• For intense feelings use the following:

• TIPP• Temperature

• Cold shower• Hold nose and lower your head into a bowl of ice water for 10 sec, repeat• Cold water on your face (at school)• Ice pack on your eyes and cheek bones and deep breathing for 30 sec, repeat

• Intense Exercise• Any exercise that gets your heart rate up 75%

• Running, sit ups, jumping jacks, push-ups, wall-sits, etc.• Progressive Muscle Relaxation

• Tightening each muscle group separately for 10 seconds, release, and repeat after you have done each muscle group• Tightening all the muscle groups at the same time, hold for 10, release and repeat

• Paced Breathing • Breathing in for 5 seconds and breathing out for 7 seconds while counting, repeat• Breathing in for 4, holding for 4, breathing out for 4, holding for 4, repeat

What is Therapy?

• What is Psychotherapy?• Treatment provided by a trained and licensed professional to manage symptoms

that are creating daily stress and interfere with a person’s ability to live their life.• Involves treatment techniques that are research supported and empirically based

• What is Long Term Therapy?• Treatment with a trained and licensed professional that works to resolve presenting

mental health issues and the root cause of the presenting issues• Example: Someone who experienced a traumatic event who now struggles with an anxiety

disorder may seek treatment to first learn coping strategies and then continue treatment to process the root cause (trauma) that’s leading to the anxiety.

• Long Term Therapy can last anywhere between 12 sessions up to 18 months.• Some therapy will last longer than 18 months depending on the presenting issues.

Benefits of Long Term Therapy

• It’s common for an individual to desire to stop therapy once they have learned coping skills to manage the issues they are experiencing, but long term therapy is the most effective way to resolve mental health issues• What does long term therapy help with?

• Processing the root issue that has lead to the individual’s presenting issues• Increasing the individual’s understanding of the presenting issues• Changing behavior long-term to increase effective behaviors in school, relationships, and

future situations• Working on self-esteem and self-worth• Processing a trauma• Managing life changes and transitions• Learning to trust others which can be modeled in the therapeutic relationship• Maintaining relationships• Managing emotions long term ; being able to apply skills to other situations other than the

situation that may have brought an individual to therapy