Helping Adolescents Manage Anxiety

EAP Ask the Expert: Khadijah Booth Watkins, MD, MPH, Associate Director, Child & Adolescent Psychiatry Residency Training Program & The Clay Center for Young Healthy Minds at MGH

The Pandemic was particularly challenging for families and kids, due to the frequent need to pivot and adapt. This comes on top of data that shows increases in depression and anxiety for the last several years, pre-dating the pandemic. According to JAMA:

• Anxiety levels for children and adolescents increased 27% between 2016 and 2019
• By 2020, 5.6 million kids were diagnosed with anxiety

On the positive side, anxiety is highly treatable and kids and families are increasingly open to discussing mental health issues. Greater awareness lessens stigma and opens pathways for help. The key is to recognize the signs and intervene as early as possible, before symptoms become debilitating or impact your child’s well-being.

The EAP is excited to partner with Dr. Khadijah Watkins from MGH Psychiatry, to help parents and other caregivers understand how to help pre-teens and teens cope with anxiety.

Common Types of Anxiety in Adolescents

• Generalized Anxiety Disorder
• Social Anxiety Disorder
• Panic Disorder

Symptoms of Anxiety in Kids

• Any major change in behavior
• Sudden changes in mood, such as being irritable
• Communicating about worries or catastrophizing
• Being more clingy
• Avoiding usual activities and time with friends
• Reluctance about attending school (especially for the socially anxious)
• Changes in sleep patterns (trouble falling or staying asleep)
• Changes in eating habits
• Being restless or fidgety
• Exhibiting physical ailments such as headaches or stomach issues
• Perfectionism and a hyper-focus on getting things exactly right
  -Over-preparing and misperceptions about work quality
  -Leaving little time for socializing and other activities
  -Poor performance and failure to complete tasks due to over-focusing on achievement

Contributing Factors

There are several things that contribute to anxiety and each child has their own unique set of triggers and reactions. Some precipitants include:

• Pressure to thrive in school, sports and other extracurricular activities
• Fitting in with peers
• Social media
• Societal/political stressors and world events

Understanding the impact of social media

Social media is particularly challenging because it is entrenched in the lives of many young people. It is where kids go for almost everything – information, entertainment and bonding with peers. Dr. Watkins breaks down how social media can contribute to anxiety and stress for kids:

• Sometimes social media has information that is not accurate or from unreliable sources
• Kids compare themselves to what they see online and are unaware that “comparison is the thief of joy.” They may:
  – Think they should be doing more
  – Feel like they are less (attractive, smart, accepted)
  – Not understand that what others post is not necessarily the complete picture
• Social media can take away the ability to be mindful in the moment
• Some kids do things with thoughts of posting it on social media, rather than just experiencing life
• It’s hard to turn it off – it’s omnipresent
  – For example, TikTok is endless-you can keep scrolling, without reaching the bottom

Helping kids navigate social media

Here are things we can do to help our kids use social media in a way that is healthy, minimizes negative impacts and doesn’t lead to feelings of low self-worth and anxiety:

• Start conversations about social media early and revisit these conversations frequently
• Educate children on how to be smart and safe online
• Teach kids how to evaluate information for validity and help them to understand that not everything they see online is real
  – People may not admit that they are not always perfect, happy or as polished as they look on social media
• Try to approach social media with kids as a shared experience
  – Ask them to help you understand social media, how to set up an account, etc.
  – Ask kids to tell you about what they are doing and seeing online. Many kids may be reluctant to allow this. You may have to reassure them that you trust them and that your goal is to keep them safe
• Model healthy social media habits and be aware of:
  -How often you log on
  -How you engage with and react to social media
  -What you focus on – outward appearance or internal traits

Understanding the Problem

Approaching Kids about Anxiety?

Dr. Watkins recommends letting kids know that there is an open door for discussing any challenges, even before any issues arise. If you sense that kids are struggling with anxiety, she suggests:

• Starting a dialogue: “I noticed that you are not sleeping well and have seemed more anxious lately.” Discussing the anxiety will not worsen or spark anxiety
• Working with your child to identify triggers
• Allowing kids to talk about what they are experiencing, without judgment
• Normalizing – It’s OK to share (within reason) that you or others get anxious sometimes as well
• Letting kids know you are here to support them and get them whatever help is needed

Engaging Others who may be Helpful

Get input from anyone who has a meaningful role in your child’s life. This may include teachers, coaches and other adult relatives. The more information you have, the better equipped you are to assist. If children get upset about this, reassure them that your intention is to help, not harm, and that you want what’s best for them.

Help for Anxiety

Self Help

Many cases of anxiety can be addressed by families and kids through using tools and developing an adaptive skill set. It’s best to find a balance between validating feelings of anxiety and helping kids to work towards conquering fears. This entails:

• Educating them about the link between thoughts, behaviors, and feelings
• Helping them to reframe, consider other perspectives and challenge incorrect thoughts
• Encouraging them to incrementally try some opposite actions
• If the inclination is to avoid, then go towards (the party, the football team, etc.) in micro-steps
• Helping them understand that engaging in things that make them uncomfortable will eventually become more tolerable

Dr. Watkins stresses that despite good intentions, parents can sometimes be too involved in the solution. Our natural inclination to “save” kids from pain and heartache can hinder their development or progress. It’s OK to provide support (the level depends on individual needs), but also important to allow kids to independently trouble-shoot, problem-solve and engage in critical thinking. If we shield kids from things that make them anxious, it can perpetuate and increase the anxiety.  Rather than doing everything for your child, consider modeling what you want your child to work on for increased well-being:

• Coping skills, self-care and resilience
• Connection to people
• Awareness of feelings
• A willingness to problem-solve, make mistakes and be vulnerable

In addition to direct approaches to managing anxiety, engaging in healthy lifestyle activities can also impact stress levels and decrease anxiety. This includes:

• Practicing mindfulness
• Exercising
• Eating well & keeping a balanced diet
• Sleeping well
• Following the healthy social media habits discussed above

When to seek professional help

Many families and children may feel stigmatized or embarrassed about seeking help. Turning to a professional for help with anxiety is no different than going to a provider about other medical issues such as diabetes or the flu. It may be helpful for kids to know that lots of people (family members, classmates and even celebrities) get help for anxiety or depression. Most importantly, communicate that this assistance can help them to find relief and enjoy their lives again.

Dr. Watkins recommends the following as a barometer for seeking outside help:

• Duration and severity of symptoms – particularly if suffering is persistent and getting worse
• Declining in school
• Avoiding activities and socializing with friends
• Being hyper-focused on issues related to personal safety or threats to harm others

How to get help

Finding a mental health provider can seem challenging, especially when it involves kids. However, there are several available resource pathways. You might have to try a few to find the best match. Here are some options:

• Primary care providers or pediatricians
• Clinicians who have treated your child before
• School resources, such as the guidance counselor
• MGB EAP
• LYRA
• Other pathways, including insurance providers

Common Treatments for Anxiety

When you get an appointment with a provider, an important first step will be an assessment of your child’s needs. This will help to determine which intervention or combination of interventions will be most helpful.

• Cognitive Behavioral Therapy (CBT) is one of the most common and successful treatments for anxiety. CBT helps us to understand how our thoughts, behaviors and feelings are all linked together, and how changing one can change our whole ability to cope. CBT provides a tool set to reframe and reset catastrophizing, and allows us to push back on negative or anxious thoughts.
• Medication may be a good option (often in combination with therapy) when symptoms are in the moderate to severe range and are persistent. Some parents or kids may be reluctant to consider or try medications. This is understandable but you can discuss any concerns you have with the provider, who will monitor side effects and make adjustments as necessary. This MGH Clay Center blog post offers some guidance on managing your child’s medication(s)

Whichever treatment regimen you try, Dr. Watkins suggests minimizing disruption to school and activities. She points out that a day in the life of a kid is significant. Even missing out on everyday life events has an impact.

Resources

General 

• Clay Center – Anxiety Resources
• Center for Parent & Teen Communication

Teen Peer Support

• Your Life, Your Voice
• Teen Line
• Give us the Floor

Suicide & Bullying Prevention for Teens & Young Adults

• EAP Website Resources
• Hotlines
  – 988 Lifeline – Suicide and Youth
  Dial or Chat
  –The Trevor Project – Suicide & LGBTQ+ Youth
  1-866-488-7386 & Chat
  Text “START” to 678-678

Help from the EAP

The EAP offers free and confidential services for employees and immediate household family members. EAP records are separate from medical and HR records. Contact the EAP at 866-724-4327 or request an appointment via our online form for confidential assistance. In-person appointments are available at the following locations.  Phone or Video (Zoom) appointments are available from all locations.