Learn about adolescent anxiety, including risks, warning signs, how anxiety can affect the body and well-being, and how cognitive behavioral therapy (CBT) can help your child better cope with life's stresses.

1. Managing Teenage Anxiety
Presented by:
Jennifer Ginsberg, MSW, LCSW
& Kristin Cole, MSW, LCSW

2. Agenda:
●What is stress?
●How does it present itself in my teenager?
●What is anxiety?
●How do I help my teenager manage anxiety from a cognitive behavioral
standpoint?
●Questions

3. What is Stress:
● Stress is a normal component of the body’s response to demands that
are placed on it.
● When demands are in balance with your coping abilities and resources
you do not feel anxiety.
● When demands are greater than your coping abilities you feel fatigue,
somatic difficulties, anxiety, depression and any number of other
psychological reactions.
STRESS IS A NORMAL PART OF
EVERYDAY LIFE. ANXIETY
DOESN’T HAVE TO BE.

4. Teen Stress Reactions:
Worried & Anxious
Depressed
Negative thoughts and feelings
Lose vitality and self-confidence
Argumentative
School avoidance
Experimenting with drugs and alcohol
APA, 2013
Normal verses Abnormal?

5. Sources of Stress in Teens
The Good, Bad and Ugly: Perception Matters!
Promotion to the next grade
Graduation
Getting into collegeMeeting new friends
Having a boyfriend/girlfriend
Working a job
Leadership
Overscheduled
Tough classes
Moving
Sibling rivalry
Peer pressure
Peer pressure
Teachers
Family verbal/physical abuse
violence
Sexual abuse
Death of family member/friend
Divorce
Bullying
Social Situations

6. The stress response is the body’s 911 system:

7. Fight or Flight reaction: Normal stress response
Productive if you are in a situation in
which you need to protect yourself:
External Event seen
as a threat
Fight or Flight Response activated
Adrenaline, noradrenaline
and cortisol released
 Heart rate increased
 Breathing increased
 Fats and glucose released
for energy
 Blood flow diverted from
non-essential body areas to
muscles and brain
 Perception increased
 Immune system suppressed
Threat Removed
Acetylcholine
released
Adrenaline,
noradrenaline
and cortisol
levels lower
Body returns to normal

8. Causes/Triggers are a matter of perception:
Stress and its associated physical reactions is your body preparing itself for a
threatening situation. When we perceive threat we prepare ourselves for action
(survival). When we aren’t in threatening situations; common threats to teens
include:
●Social
●Emotional
●Familial
●Financial
●Academic

9. Stress has a mixed reputation: Stress can be good…
Stress is good in small doses:
● Gives you a burst of energy
● Increases motivation to complete tasks
● Protects you from harm
– Thinking twice before walking alone down a dark alley at night Little Johnny is
managing his
stress…

10. Stress can be bad when not managed well and when
misinterpreted
leading to
anxiety and
other disorders

11. So what is anxiety?
An overestimation of a
situation and an
underestimation of my
ability to handle the
situation…

12. Types of anxiety in adolescence
Generalized anxiety disorder
Panic disorder
Social Anxiety disorder
Separation Anxiety disorder
Specific Phobias
Closely related to Anxiety Disorders and can sometimes co-occur with
anxiety disorders:
Obsessive Compulsive Disorder
Post Traumatic Stress

13. Cycle of Anxiety

15. ADOLESCENCE
● Begins at puberty, ends with assumption of adult roles
● Physical, Cognitive, Social/Emotional Development
– Lets expand upon these
● Stress and anxiety can be problematic on each of these
domains

16. Physical Challenges
● Puberty onset age 10-12girls, 13boys
● Idealized body image
● Emerging sexuality
● Awkward development
● Curiosity of alcohol and other drugs

17. Healthy vs. Unhealthy
● Thoughts, expressions of
concern about body
type/shape/size/physical
features
● Desire, taking steps to improve
physique, eating habits
● Chronic self-critical thoughts
regarding appearance.
● Interference with social/academic
life.
● Extreme, abrupt changes in
eating/exercise habits.
● Sudden weight loss or gain
● Diet pills, steroids

18. Social/emotional and sexual development
• More complex identity
• Increased peer influence
• Self-esteem challenges
• Gaining skills for independence: academic/social
• Emerging sexuality and curiosity
• Exploring and experimenting with alcohol
(sometimes begins in high school and sometimes
in college)

19. Healthy Stress/Concern vs. Unhealthy Stress/Concern
• Questioning: Values, career,
religion
• Seeking peer approval over
parental approval
• Moodiness
• Exploration of styles, friends,
interests
• Dating
• Sexual orientation and
expression
• Learning responsibilities of
alcohol and drugs
• Chronic arguing
• Chronic negative self talk
• Withdrawal/isolation from friends
• Interfering with social or academic
performance
• Risky Sexual behaviors
• Panic attacks
• Separation anxiety

20. Cognitive Development
● Imaginary Audience: “Everyone’s watching
me”
● Personal Fable: “nobody feels like I do”
● Idealism
● Argumentative
● Over/underachievement

21. Healthy Cognitions vs. Unhealthy Cognitions/Behaviors
● I feel uncomfortable with a pimple
● Nobody understands me
● You’re such a hypocrite
● I want to do my best at all things
● Why do I have to do my best at all
things
● This is too much I need to scale
back
● Withdrawal from activities & peers
● Depressive symptoms
● Obsessive worrying, excessive
reassurance-seeking
● Incessant arguing
● “I must excel at everything and it is
awful if I don’t”
● “I don’t care whether or not I do
well”

22. Cognitive-behavioral Therapy (CBT) Treatment
The way we feel is influenced by the way we view and think about our
experiences, and by our behavior.

23. Cognitive-behavioral Therapy (CBT) Treatment
Collaborative, short-term, goal-oriented, self-talk, teaching therapy
● Treatment for anxiety problems includes:
– cognitive restructuring;
– exposures;
– developing coping strategies;
– increasing tolerance for distress; and
– intervening with parents who may be inadvertently
maintaining/increasing anxiety.
• Practice makes progress!!

24. Cognitive Restructuring
Evaluate your negative thoughts and learn to think in more adaptive and/or
accurate ways
● Identify automatic thoughts (AT)- come up rapidly, may not be aware of
them but they can effect emotions & behavior:
– Situation = School refusal
● AT= “I’m going to fall apart and I can’t handle that”
● Emotion= Fear, Sad

25. Testing Automatic Thoughts
with Socratic Questioning
● What is the situation?
● What am I thinking or imagining?
● What makes me think this thought is
true?
● School refusal
● “I’m going to have a panic attack at
school and I can’t handle that”
● I’ve been having panic attacks
lately, people at school can be
judgmental, sometimes people can
tell that I’m panicking

26. Testing Automatic Thoughts
with Socratic Questioning
● What makes me think this thought is
not true or not completely true?
● What’s another way to look at this?
● What could happen if I change my
thinking?
● What would I do if my thinking was
true or somewhat true?
● I have skills to manage my panic attacks,
maybe its not that obvious when I’m
distressed, I don’t have panic attacks all
the time, panic attacks don’t last more
than 10 minutes.
● Even though it would be uncomfortable
and upsetting to have a panic attack at
school, I know how to manage it and they
don’t last that long.
● I could get back to school and decrease all
the worry associated with falling behind.
• I can use strategies to handle the panic
attack; If people notice my panic attack, I’ll
just tell them that sometimes I have panic
attacks but I’m dealing with it; If they judge
me negatively for it, I guess that’s their
problem.

27. Exposures
● The goals of exposures are to decrease avoidance behavior by
positioning teens in a previously feared or challenging situation.
● Educate teens about avoidance cycle (storytelling clips)
● Identify exposure “ladder” of steps (early success before
attempting greater challenges)
● Initiate exposures, with careful attention to anxiety pre- and
post-exposure, and using relaxation/coping during exposure
itself

28. Coping Statements
• Building our estimation of ability “to handle it.”
• When rational self-talk is practiced and learned, the brain takes over
and it begins to automatically occur.
• With such gentle conditioning, our brain changes as a result of new
thinking habits.
• “I can handle this”; “This is temporary”; “I can calm myself down”

29. Tolerating Distress
• We don’t get rid of uncertainty completely, rather we learn to manage
our response to uncertainty
• Teaching teens to discover and acknowledge their ability to handle
discomfort
• “I prefer being anxious to avoiding school/people/challenges
altogether.”

30. Family Therapy
● Provide psycho-education about anxiety
● Identify family’s existing problem solving skills
● Identify and change destructive patterns & BE CONSISTENT
(hard due to natural instinct to nurture)
● Increase helpful communication strategies

31. Other tools
● Anxiety timeline
● Wise brain vs Worry brain
● False Alarm/Real Alarm
• Breathing & Meditation
• Mindfulness

32. Resources
For parents:
Freeing Your Child from Anxiety, T. Chansky
Anxious Kids, Anxious Parents, R. Wilson & L. Lyons
For teens:
My Anxious Mind: A Teen’s Guide to Managing Anxiety & Panic, by M.A. Tompkins
& K. Martinez
The Anxiety Workbook for Teens: Activities to Help You Deal with Anxiety & Worry

33. ?