Even when we are not in a pandemic, adolescence is a time of life when most mental disorders emerge. One of the most common disorders is anxiety. Recent estimates suggest that over 30 percent of teens have an anxiety disorder. That means about one of every three teenagers is struggling with anxiety that significantly interferes with their life and is unlikely to fade without treatment. It affects nearly 1 in 3 teens between the ages of 13 and 18. The number of young people experiencing anxiety is on the rise, with a 20% jump in anxiety disorders in children and teens seen from 2007-2012. During the current pandemic, estimates of the presence of clinically significant anxiety in adolescents are increasing.
So how does teen anxiety present? The main manifestation is fear or nervousness that does not go away, even in the absence of any real threat. Teens with anxiety disorders will report that they are nervous all the time, can not relax easily, feel stressed, and are apprehensive frequently. With all the anxiety driven by the pandemic and associated issues for teens, it can be difficult to differentiate normal emotional changes in teens from a clinical disorder. Many teens without diagnosable anxiety disorders worry about what others think about them, about making friends, or fitting in with others. However, in contrast with everyday teen worries, teens with clinical anxiety disorders feel nervous all the time and their anxiety interferes with their functioning socially and at school. We discuss anxiety and stress in detail in our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056. For information about the book, authors, and stress, please visit our website at www.manageyourhealthandstress.com
For now, what is going on in the brains of teens with anxiety? Like adult brains, scientists know that connections between the limbic system involved in emotionality (particularly the amygdala and basal ganglia) and the prefrontal cortex are involved in fear and anxiety. We are learning that one of the problems for teens is that the amygdala/prefrontal cortex connections are slow to develop, continuing to develop into their early 20s. During adolescence, the brain goes through changes and the areas involved in managing emotion are in significant development during these times. This leaves teens vulnerable to stress and anxiety secondary to the changes in the areas of the brain managing emotionality. These changes are associated with anxiety, nervousness, panic attacks, physical sensations of anxiety (such as a pounding heart, shortness of breath, and racing thoughts), and a tendency to predict the worst, At its worst, anxious teens are at heightened risk for many serious comorbid problems, including depression, substance abuse and in some cases suicide.
What are other factors contributing to increased anxiety among teens? In a recent post, Dr. Daniel Amen, world renowned neuroscientist and psychiatrist, listed several areas in addition to brain changes:
1. SPENDING MORE TIME ON SOCIAL MEDIA
Teens report using the internet on an “almost constant” basis, according to statistics from Pew Research Center. Generation Z (16-20-year-olds) individuals log on average over 4 hours a day online on their mobile phones. A growing number of studies have shown a connection between time spent on social media and feelings of anxiety and depression. Effects of this level of use include feelings of shame secondary to the incessant negative comparisons teens make of themselves to others. This can generate significant levels of anxiety. Dr. Amen suggested limiting the social media time of teens. Studies have shown that teens who limit their social media use and spend time with friends even if it is face to face such as on Zoom, exercise, engage in social activities taking COVID precautions, read and even do homework are happier than those who spend most of their time on technology devices or watching TV.
2. SPENDING LESS TIME IN FACE-TO-FACE INTERACTIONS
Dr. Amen noted that as teens spend more time on social media, they spend less time with in-person connections. As they become more anxious, teens are more likely to isolate themselves from social situations in favor of scrolling through their social media feeds. This keeps them trapped in a negative emotional cycle. He recommends spending more time with humans with the additional benefit of the brain releasing the feel-good neurotransmitter oxytocin. I realize there are challenges to doing so in a pandemic but face-to-face contacts can be beneficial.
3. INCREASED PRESSURE TO PERFORM
We know that high expectations are placed on teens (and that teens place on themselves) stimulating the rise in anxiety. Teens today can be under tremendous pressure to achieve, and a growing number of them say they feel overwhelmed by everything they need to accomplish. I have written about this in other posts including the pressures leading some parents to define youth in terms of their achievements. I have suggested being aware of the expectations you place on your teen. Do not allow them to overschedule their time, allow them to relax. Give them positive reinforcement just for being the person they are. They certainly have had enough challenges lately with cancellations of social events and sports at school, having to learn via online means, etc.
4. AN INCREASINGLY FRIGHTENING SOCIETY
I also have written about this factor in past posts. Mass shootings on school campuses and the threat of terrorist attacks have added to the sense of anxiety so many teens are experiencing. Just seeing news coverage of these events can cause intense fear and contribute to anxiety or post-traumatic stress syndrome (PTSD). Teens no longer feel safe in places that used to be safe such as school, movie theaters, or outdoor concerts. Of course, now such activities are not permissible during the pandemic. However, the fear around contracting a potentially fatal illness and/or spreading it to loved ones causes increased anxiety. It is recommended to reduce teens’ exposure to the negative news cycles on television and online. Limit the exposure to pandemic news. This also is good advice for adults. Talk to them about taking what control they can by observing healthful practices such as wearing masks, keeping social distances, and frequent hand washing. In addition, teach them stress-management techniques to soothe anxiety. I have written about these in other posts but they can include diaphragmatic breathing, progressive muscle relaxation, mindfulness training, or using yoga or meditation.
5. POOR EATING HABITS
We know that food is a drug that has major effects on our moods, emotions, and behavior. Teens frequently have bad eating habits—fast food, pizza, soda, ice cream, coffee—that can increase symptoms of nervousness. Additionally, eating foods such as sugar, MSG, gluten, soy, corn, and dairy, that are potential allergens, may create a metabolic disorder that can lead to symptoms of anxiety, agitation, irritability, depression, and more. These are found in the vast majority of processed foods. So teens may not make the connection between what they’re eating and the way they’re feeling. During this time of pandemic, there is a tendency to overeat at the same time many teens and adults have reduced activity levels.
Dr. Amen recommends to feed your teen a healthy diet of small amounts of high-quality protein, fatty fish that is rich in mood-boosting omega-3 fatty acids, and pesticide-free vegetables and fruits, and minimize refined carbohydrates and junk food.
But what if your teen still is anxious? Well, there are evidence based treatments that are effective. Teens should not have to face anxiety alone. Psychotherapy and medications can both be highly effective.
Cognitive behavioral therapy (CBT) is one of the most effective and widely used psychosocial treatments for anxiety in teens. I use it regularly in my own psychological treatment practice. In CBT, among other things, therapists help individuals with anxiety to gradually and repeatedly expose themselves to the very situations that they fear. This can help lessen the power of the anxiety situation in real life. I have heard it often said, “Do the thing you fear and the death of fear is near”. Having a socially anxious teenager imagine contacting a new acquaintance, then moving on to call the acquaintance, and then initiating a conversation with someone new they meet can help reduce felt anxiety. This is done in combination with work on helping the teen identify, challenge, and create less anxiety producing thoughts.
Emerging research has shown that current treatments for anxiety directly modify the same amygdala-prefrontal connections I discussed earlier that are in development during adolescence and associated with anxiety.
Both CBT and medication treatment with selective serotonin reuptake inhibitors (SSRIs) may reduce amygdala reactivity and enhance prefrontal control. The treatments help these brain circuits regulate fear and keep them from overreacting to potentially anxiety-provoking situations. However, I would recommend using the widest range of nonpharmacological approaches first unless your teen appears to have severe and disabling levels of anxiety. Although your teen’s brain is prone to anxiety because of their developmental stage, there are many ways you can help mitigate risk factors and/or access treatment options.
Good luck on your journey.
Dr. Paul Longobardi
For information on these and related topics, please see my website at www.successandmindset.com