Adolescence Doesn't Just Suck: Managing Teens' Anxiety In Therapy

Anxiety: One Word That Can Mean A Whole Lot For Teens

In our therapy with teens, anxiety means a lot of different things. It can be stress, worry, OCD, trauma, panic, etc. Anxiety is, simply, one little word that means a whole lot. And just because it’s one word doesn’t mean it’s trivial. Similar to teens’ experience with depression, it’s important that anxiety isn’t trivialized during adolescence. While teenage moodiness is certainly a problematic trope, adolescent worry is another one.

Anxiety can also manifest in a variety of ways for teenagers. Many behaviors we don’t see as clearly about anxiety actually are. This can include eating issues, isolation, school avoidance, bad grades, bad relationships, exercising too much, pot and alcohol use, irritability and anger.

Adolescence Is Stressful, Yes and No

There’s no question that there is much about being 15 that sucks. Life and growing up are stressful. But that’s not the entire story of adolescence. Part of what’s important when dealing with teens is to not buy into the narrative that adolescence is just a dark phase through which children pass–only becoming human again upon full adulthood.

We’re conscious not to cast the story of teens as victims of adolescence. The narrative of waiting it out sucks and there’s a lot of fun in that time of life too. Postmodern psychologists talk about developmental psychology as socially constructed or the idea of adolescence as a socially constructed concept. This isn’t to say that it doesn’t exist or that its descriptive features are inaccurate. Rather, it avoids casting the stressors of adolescence as inevitable. The idea that being a teenager “just sucks” is passive. It leaves teens alone–a resignation to a potentially serious amount of suffering.

No matter our age, we’re all responsible for dealing with the hard stuff that’s in front of us and getting help to do so when needed. Teens, especially, need help accessing help. While stress is unavoidable (though it can exist in excess), there are powerful ways of facing stressful situations by getting help, digging deep and being creative.

Teens and Worry: Setting Teens Up To Handle The Fears Of Adulthood

Worry is frequently an attempt to control stuff that can’t be controlled. In particular, teens worry largely as a response to not feeling or being powerful. Teens often confront an awareness of the world and all sorts of worrisome features of it in advance of their emotional capacity to manage these feelings. “Don’t worry” is about the least effective thing we can say to a teen.

Rather, as therapists who work with teens and anxiety, we support teens to develop their capacity to handle the grief and fears of the adult world. It’s not that there is nothing to worry about–there’s plenty in their lives, futures and the world for teens to be concerned about. We can’t change that. What we can do is help young people grow into and see themselves as individuals who can live in awareness of these fears and be strong enough to handle them. There are endless strategies here–healthy compartmentalizing, self-talk, setting a quota on worry, precise sorting of what can and can’t be controlled and finding strength in taking action in their lives where they can.

Managing Teens’ Anxiety About Their Daily Lives and The World At Large

Often teens live in anxiety that they have created or poorly managed–being behind on assignments, getting stuck in messy relationships, alienating friends, taking on too much, getting in trouble related to drugs and alcohol, etc. The work of managing anxiety is often the work of managing these sources of anxiety. Once a therapist can establish some influence, our expertise lies with understanding what’s going on with teens, the real social consequences of certain decisions they’ve made and that certain choices are made based on a calculus that may seem absurd to an adult’s first glance. There can be some practical problem solving here (i.e. How do I get this girl to stop being mean to me and still hold onto this other girl I'm friends with but who is afraid of her? How do I tell this teacher that I'm way behind on my science project and need more time?)

Teens can also become anxious about larger issues outside of their daily lives. Living in a world with a scary president, existential threats pouring through the news from North Korea and global warming and confusing messages about the future of the American economy is a task all of us need to take on. For some, tuning out these concerns is a workable strategy and yet, others can’t or don’t care to tune out. To start with, understanding these fears as real and shared is a big deal, especially for young people. There’s power in making them ordinary, meaning helping teens understand that many, many people carry these concerns and grapple with them every day. Their impression may be that those who aren’t them don’t notice or don’t carry these concerns. In therapy, we talk about what it means to have a healthy relationship with news and social media, how to make active decisions about when to turn off these inputs and how to learn the mindful capacity of taking breaks.

The Focus of Teens’ Anxiety Isn’t Always Reflective Of The Source

While certainly all parents and adults don’t trivialize teens’ experiences with anxiety, even very loving parents can miss some concerning things going on in teens’ lives. One of the challenges with teens that can cause parents to miss some things of concern is that anxiety doesn’t always present itself at the surface in a way that is reflective of the source. A teen may feel anxious about challenges with a friend, for example, but present that as a worry over a driving test or a pimple. Parents and those who care about teens need to be able to hear these worries in a way that both respects them (having a pimple sucks), while appreciating that there might be more going on.

How? It’s not easy. Good therapists who work with teens are masterful at this and can often help parents get better at it too. The first step is to honor whatever the teen is saying that’s bothering them (again, pimples suck). But then, find a way that doesn’t come off as dismissive to say, “What’s really going on?” It’s helpful to keep in mind that this phenomenon–that of expressing anxiety about something other than the actual dominant source of anxiety–isn’t unique to kids. Under the best circumstances, there’s an opportunity to teach teens how to have this insight–to help them see what grabs their attention may be a placeholder for a worry that’s harder to name.

Anxiety Can Be Isolating: Sharing Worries With Teens

Anxiety can be incredibly isolating and it’s also true that isolation is fertile ground for anxiety. Anxiety can both fill up a lot of space, taking up room where friendship, hobbies, an active life may otherwise thrive, while the opposite is true as well: empty space can function as a vacuum where anxiety can creep in and take over. Sometimes the best thing to do for anxiety is to go for a jog, see a movie or find some friends to hang out with.

In therapy with teens, we make anxiety a more social experience by being curious about what’s really going on with them. The curiosity itself is soothing. Rather than “resolve” the anxiety (i.e. convincing someone or ourselves that the anxiety isn’t grounded in reality), we can find ways of holding it together. At times, I’ll ask a teen to let me hold onto a worry or keep it in my office. In other ways, we “share” worries, in multiple senses of share–naming them for one another, but also agreeing to have these worries as a shared experience. In the case of irrational worries, they tend to vanish in the context of a strong relationship.

A good therapist for teens also recognizes the limits of his or her importance in this process. Humans evolved socially–we are built to live our physical, economic and emotional lives together as a tribe, meaning our families and extended families. A good therapist can be part of that tribe, but can also help a teenager create and make use of (and repair) relationships with existing members of that tribe whether getting closer to parents or making and deepening friendships and relationships with teachers and coaches.