We have written this resource page to provide adolescents and parents / educators with the statistics behind anxiety, examples of helpful interventions and links to mental health organizations.
ANXIOUS FEELINGS
We often use the word “stressed” in our society, which can mean many different things to the person saying it. They might feel like something in their life is out of control, or they could feel overburdened, or irritated, or many other things.
Similar to the word "stressed," “anxious” can also mean a lot of different things to different people. This is where the skill of stopping to think about the core emotions behind these words is a great one to hone. Understanding leads to the most effective interventions.
It can be helpful when thinking about anxious feelings to know that often the anxious feelings are actually fear. Fear of an uncertain future, fear that you did the wrong thing (regret is a type of anxiousness), fear of what will happen if you ask someone for something, and then the fear of how that person will perceive you.
In Washington State, there is a survey of high schoolers every two years. Here are the 2021 Healthy Youth Survey results regarding anxious feelings for teens in the state:
8th-graders
- 12% reported that they sometimes "experience increased social anxiety due to internet use."
- 30% reported feeling "nervous, anxious or on edge" for several days within the past two weeks.
- 22.6% were bothered by "not being able to stop or control worrying" for several days within the past two weeks.
12th-graders
- 17.1% reported that they sometimes "experience increased social anxiety due to internet use."
- 30.4% reported feeling "nervous, anxious or on edge" for several days within the past two weeks.
- 27.2% were bothered by "not being able to stop or control worrying" for several days within the past two weeks.
There is an incredible dearth of data in this country to be able to effectively compare data about youths' anxious feelings over recent years. Often, people cite two surveys of college students.
For example, the American College Health Association surveys students from many colleges over many years. They have been asking if students "ever felt overwhelming anxiety in the past 12 months." In 2011, roughly 50% reported yes and in 2016, approximately 58% reported yes.
The other study of U.S. freshmen asked if they ever "felt overwhelmed."
CLINICAL ANXIETY
The numbers* here come from the main comprehensive study on youth mental health, called the National Comorbidity study-Adolescent Supplement. When any book or scientific paper references rates of adolescent clinical anxiety, this is the paper to which they are referring.
- By age 18, 32% of youth will have met criteria for some type of clinical anxiety, ranging from very mild to very serious.
- By age 18, 19 % of youth will have met the criteria for severe clinical anxiety — meaning it caused severe impairment and/or distress.
*The numbers here were rounded to the nearest tenth.
The prevalence of the main specific types of clinical anxiety
By Age 18...
- 19% of youth will have met criteria for having had a specific anxiety phobia (such as towards spiders). These were ranked from mild to severe, and the majority met criteria for "mild."
- 9% met criteria for social anxiety (the majority met criteria for "mild").
- 5% will have met criteria for PTSD.
- 8% will have met criteria for separation anxiety.
- 2% will have met criteria for generalized anxiety (the majority met criteria for "severe").
- 2% will have met criteria for a panic disorder (the majority met criteria for "severe").
- 2% will have met criteria for agoraphobia (the majority met criteria for "severe").
Unfortunately, the data collected for this study was done in the early 2000s and published in 2010, and there has not been a follow up study. I know this is shocking. I have spoken with the researchers, and they told me it had to do a lot with a lack of funding.
Diagnosing Clinical Anxiety
Some anxious feelings are to be expected and are even helpful. For example, anxiousness in anticipation of a test in a few days can help motivate a students study for a test.
When anxious feelings are out of proportion for the situation and the feeling is much more intense than the fact, this may indicate clinical anxiety.
For example, these two scenarios would be cause for concern:
- A teen worries all the time about tests long before they are even scheduled to happen. The teen loses sleep and has lots of intrusive thoughts about failing.
- A youth experiences significant anxious feelings when they imagine talking to other people or raising their hand in class. This has resulted in them being extremely behind in school and not having any friends. While the student desperately wants to change, they can’t move past their anxious feelings.
The main questionnaire used in health settings to help diagnose clinical anxiety is called the GAD 7.
It starts with these questions:
- Over the last two weeks, how often have you been bothered by the following problems?
- Feeling nervous, anxious, or on edge
- Not being able to stop or control worrying
If the teen answers yes to either, then they are asked the following questions...
- Trouble relaxing?
- So restless that it's hard to sit still?
- Become easily annoyed or irritable?
- Felt afraid as if something awful might happen?
The third part assesses how distressing and/or debilitating the symptoms are and asks...
If you checked off any problems:
- How difficult have these made it for you to do your work?
- How about take care of things at home, or get along with other people?
(Options are from "Not difficult at all" to "Extremely difficult")
When symptoms are ongoing, there can be real suffering that can lead to avoidance of certain situations. So, while it is common for teens to feel a bit nervous about going up to talk with a peer, a more intense nervousness that presents as avoidance and isolation could indicate a more severe problem.
Anxious feelings leading to avoidance and suffering are signs that anxiety is a clinical problem and should be addressed with professional help, such as counselors or therapists.
HELPFUL COPING SKILLS
These skills are even helpful for youth who are not diagnosed with clinical anxiety but find themselves worrying more than they'd like to be. Let's start with a skill that can help with all types of anxious feelings — not just clinical anxiety.
Exposure therapy (also referred to as exposure response prevention)
The goal of this therapy is to work towards no longer avoiding things that a person knows they are irrationally avoiding. It is about eventually doing the things the person is avoiding over and over, so they get used to the uncomfortable feelings and learn how to do actions despite anxious feelings. Meanwhile, the more times the anxiety-inducing action is repeated, the anxious feelings will begin to go down by some degree.
This technique is done in graded steps. For example, a teen is too anxious to participate in class. They might not even be able to verbalize what they are actually afraid of, but they might be able to verbalize the reasons why they are afraid. Maybe they worry that people will judge them poorly or laugh at them and not want to associate with them.
Graded steps that might work for the student.
- Schedule time to meet with a supportive teacher to practice asking questions and offering answers outside of class.
- Make plans with a teacher before a class to have an answer ready so that when the teacher asks the question, the student will raise their hand and propose the answer.
- Do the same prep work with the teacher and this time, think of a question the student could ask in class. This will reassure the student that the teacher thinks their question is valid and reasonable.
- Create a goal for how many times the student will try to raise their hand during class. Have an accountability plan with a reward for the student when they accomplish the goal.
- Eventually, the student will start to raise their hand and participate more in other classes with teachers they haven't worked on their anxiety with.
This is challenging to do, but the good news is its high success rate. As the teen does these exposures, as they step into the discomfort of getting scaffolding and support, you can actually see changes in the brain scans of the amygdala. It is no longer as hyperactive as it was before.
In Screenagers NEXT CHAPTER, Olivia, who is 15, had clinical social anxiety, and her therapeutic exposure task was to go to a shopping mall and ask for sushi at a pizza place. She needed to practice being embarrassed. Practicing uncomfortable feelings like embarrassment makes real-life situations that much more tolerable. Not everyone has to order sushi at a pizza place. Someone who gets anxious on phone calls might start by calling a friend on the phone. You take baby steps.
People need a lot of support through exposure therapy. Asking youth to face their fears and anxiety is so hard to do as a parent and even harder for the youth to take on. But if it wasn't a hard task, it would be an easy thing to get over.
It can be helpful for parents to find other parents who are going through a similar situation. Other parents are not only a source of support but also a way to find resources.
Getting counseling for the child or teen is key. It can also be helpful for parents to be part of that counseling at times. In addition, parents usually benefit from things like their own counseling, support groups or parent coaching.
Building Brain Attention Skills with Mindfulness
In Screenagers NEXT CHAPTER, we learn how Delaney's son, Chase, uses the 10% Happier app to learn mindfulness skills from George Mumford, who has taught these skills to athletes, including Michael Jordan.
Delaney says in reference to her son,
"My son, Chase, also found an online tool that has really helped him. He's had chronic pain from an accident years ago and lots of stress because of it. From his favorite online teacher he's been learning mindfulness. It's all about getting more insight into one's patterns of thinking and learning to direct attention to more helpful thoughts."
In the film, Chase talks about it in this way:
"There's the sensation of pain, but then I add the stress of being in pain and the emotional baggage of the history of the pain and the uncertainty of the future of the pain. And I recognize that I actually have a lot more control over this than I thought. So in my day-to-day when I'm in physical or emotional pain, I can be mindful of the negative layers that are building up on top of it and intervene before they themselves cause unnecessary suffering."
Mindfulness apps
(Delaney and her teens have used all of these at different times)
Dialectical Behavioral Therapy (DBT)
Provides useful skills for overcoming intense feelings, including anxiety.
The TIPP skill is an example. If a person is suddenly overcome by anxiety or other strong emotions, doing one of these strategies can change a person's physiology, which helps stop or lower their intense emotions.
T- Temperature — the person applies ice in a bag to their face for a minute or two. Many teens also talk about how useful it is to put their faces into an ice bath of water for a few seconds.
I - Intense exercise — the person uses the energy of their emotions to do some quick jumping jacks or high knees.
P - Paced breathing — the person slows their breathing by breathing in for 5 seconds in and then breathing out for 7.
P - Paired muscle relaxation — the person breaths in and tenses a body part at the same time, such as their arms. They pay attention to the feeling of the contractions and then when they breathe out, they release the contraction.
MENTAL HEALTH ORGANIZATIONS
Anxiety and Depression Association of America
This organization has information on stress and many types of anxiety conditions as well as links to find help for children, teens and adults.
The National Alliance on Mental Illness has local branches across the country and offers support groups, online resources, programs in schools and more.
The site provides many written materials and links to awareness campaigns. My Younger Self, for example, is 30 short interviews with actors, athletes, and other celebrities who discuss their past mental health challenges.
These are free day-long courses designed to help parents better understand youth mental health issues better. On the website, you can find if there are classes near you.
This organization has affiliates across the country. The website has links to information, and they also do important work in working to increase mental health access, locally and nationally. This page on their website is helpful for the nuts and bolts of finding mental health support.
This international emotional intelligence network researches and shares tools, methods and training to create a kinder, more positive world.
Born This Way Foundation was started by Lady Gaga and her mother. The organization works to build a "braver, kinder world" for youth by creating safe-spaces and promoting self-care skills.
This site is a great place find a therapist, psychiatrist or support group in your area. You put in your zip code and any specifics about the patient, such as "adolescent," and it will list many possible providers. You can then contact the provider and set up a short call in order to see if they're a good fit.
PHONE AND TEXT LINES
A free, 24/7 support for those in crisis. Text 741741 from anywhere in the U.S. to text with a trained Crisis Counselor. Crisis Text Line trains volunteers to support people in crisis. This organization is a resource that many youth and adults report using and feeling helped. People who volunteer for CT receive 30 hours of training before they start, and they volunteer several hours a month.
"My good friend is a volunteer, and we spent an afternoon together, where she showed me how Crisis Text Line's training works and examples of the work she does with people. It was powerful. A person can text about anything they are struggling with, and the volunteers are there and provide supportive interactions. Even though it is called the Crisis Text Line, the texter does not need to be in imminent crisis to get help. They get all sorts of people seeking support for things like eating issues, problems with peers and just people dealing with hard emotions." — Delaney Ruston, MD
Connects you to caring listeners for free emotional support and offers online therapy.
This online therapy resource connects people to affordable therapy with a licensed professional who is compatible with them.
1-800-448-3000. 24-hour, free, confidential hotline staffed by trained counselors for boys and girls to receive help with bullying, anger, abuse, depression, school issues and more.
211.org
A free and confidential national hotline that connects callers with resources and support in their area.
