It is normal for teenagers to feel anxious or scared at times. A little bit of anxiety can be helpful sometimes, for example it can motivate us all to study and concentrate in school, or can help us to pay close attention to our surroundings when driving.
In teenagers, unhelpful levels of anxiety can be evidenced by recurrent physical complaints (such as recurrent headaches, stomach aches, or nausea), a tendency towards excessive perfectionism (to the detriment of productivity), excessive reassurance seeking, emotional outbursts, irritability, recurrent nightmares, difficulty going to sleep or waking throughout the night. Anxiety can also be associated with lowered mood.
Brisbane Specialist Suites helps families to manage a range of anxiety disorders including:
- School Refusal
- Specific Phobias
- Generalized Anxiety Disorder
- Panic Disorder
- Agoraphobia
- Social Phobia
- Obsessive Compulsive Disorder
- Post-Traumatic Stress Disorder
Other conditions which may also be associated with anxiety include:
- Mood disorders
- Substance misuse (excessive alcohol or drug taking)
- Academic underperformance
Anxiety disorders can impact a teenager’s capacity to move through developmentally appropriate milestones, attend school, or cope with family life. Anxiety may persist into adulthood, or lead to other problematic behaviours (such as drug use) if not appropriately treated.
When do we need to seek treatment?
We recommend requesting specialist assessment when anxiety is:
- Not responsive to calm reassurance from parents, teachers or peers
- Associated with marked distress or mood disturbance
- Associated with insomnia or loss of appetite (particularly if weight loss is present)
- Associated with functional impairment i.e., the teenager in question refuses to attend school, withdraws from friends and social activities, or refuses to leave home due to anxiety
- Associated with thoughts of harming oneself or a pervasively lowered (or depressed) mood
- Causes a significant disruption to family functioning
What is involved in assessment?
Whether you see a Psychiatrist or Psychologist first, a comprehensive assessment should always involve a detailed history from your teenager’s caregivers. This will involve both parents or guardians. The involvement of both guardians is particularly important if your teenager is required to live between two households.
The first part of the assessment will focus on:
- Observations of your teenager in multiple settings (at home, at school, at extra-curricular activities)
- Family history of anxiety or other medical conditions
- Past medical history of the teenager in question (taking a “bio-psycho-social approach” including developmental and medical history)
- Interventional strategies that have been trialed to date by caregivers and professionals
Your Specialist may also request collateral information from prior treatment providers (GP, psychologist) as well as your teenager’s school (teacher, guidance officer or school chaplain) or employer.
The second part of the assessment will involve an interview with your teenager. Your teenager will be interviewed alone. Whilst taking a history, your Specialist should also screen your teenager for any co-existing learning or language disorder which might impact on their capacity to participate in day-to-day activities.
Depending on history, your Specialist may recommend blood tests to exclude possible comorbid medical conditions that can manifest with anxiety symptoms. This is particularly important if you are considering medication.
What treatment can we expect?
Good practice dictates that first line treatment consist of psychological treatment from an appropriately skilled Psychologist, Psychotherapist or Adolescent Psychiatrist with experience in the area. Psychotherapeutic sessions will generally occur weekly, and will use principles from Cognitive Behavioural Therapy initially, although other therapeutic strategies such as Dialectical Behahvioural Therapy or Interpersonal Psychotherapy may also be used.
Caregivers are encouraged to be strong participants in their teenager’s treatment. Your Specialist at Brisbane Specialist Suites will teach caregivers skills so that they may have the knowledge to reinforce strategies at home.
Medication is only considered when psychological strategies have failed, or when anxiety is of such severity that your teenager is unable to participate in psychological treatment. Medication should only be considered under the supervision of a Child & Adolescent Psychiatrist.
What is Cognitive Behavioural Therapy?
Cognitive behavioural therapy (CBT) is based upon two components:
- The “Cognitive” part focuses on helping your teenager to take notice of, and track their thought patterns when feeling anxious. Once these have been mapped out, your teenager is then taught how to challenge automatic thoughts (by replacing unhelpful thinking) and regulate their emotions (such as mindfulness and attention training, or self-management training).
- The “Behavioural” part focuses on practical behavioural strategies to manage anxiety. This may include activities to self-soothe when your teenager experiences unpleasant feelings (such as relaxation skills), but also may include strategies to challenge themselves and fight their fear (such as leaving the house, attending a social activity with friends, going to school).
It is essential that these skills are delivered in a developmentally appropriate way by an appropriately skilled Specialist.