First Steps in Helping Your Teen with Anxiety

By David A. Clark, PhD, author of The Anxious Thoughts Workbook for Teens

Often anxiety first emerges during the teen years with approximately one-third of adolescents experiencing an anxiety disorder sometime during their teen years. Many more have briefer and less severe experiences of anxiety. Usually, teens first disclose their struggle with anxiety to parents, teachers, an older sibling, or a trusted friend or confidant. If you find yourself in this position, you may be wondering how to respond when your teen discloses a problem with anxiety. The first step is helping your teen understand anxiety. Two features are especially important to highlight when educating young people about anxiety.   

Anxiety Is a Normal Emotion 

When talking to a teen about anxiety, start with some reassurance that feeling anxious is normal. Explain that everyone feels anxious from time to time, so there is no need to feel ashamed or to think you’re weak and inadequate because of anxiety. In fact, it is impossible to go through life anxiety-free.  Anxiety is a negative emotion like sadness, anger, frustration, or guilt. These emotions are distressing and can reduce happiness and well-being. That’s why it’s important to learn how to manage negative emotions like anxiety. 

Talking to your teen about anxiety should never feel like a lecture.  Instead, you’ll want to involve them in the discussion by asking about their anxiety experience. Do they feel tense, keyed up, on edge, or have “butterflies” in their stomach? Do they have a lot of other physical symptoms like chest tightness, heart palpitations, difficulty breathing, lightheadedness, and the like? In your discussion, explain that anxiety occurs when we think our self-worth is threatened by failure, embarrassment, rejection, or the like. You can mention things that make most people anxious, such as exams, competitions, meeting new people, or doing something new that could be dangerous. You could give some examples of things that have made you anxious. As your teen talks about their anxiety, emphasize that they’re experiencing an emotion that can be managed just like other emotions such as sadness, fear, anger, and guilt.   

There is one other thing to consider when having a conversation about anxiety. You’ll want to determine if the anxiety is sufficiently problematic to involve a mental health professional. Some of the signs for professional consultation include: having elevated distress over several days or weeks, poor emotional control, suicidal ideation, sudden drop in school performance or other activities, increase in social withdrawal or isolation, presence of panic attacks, sleep disturbance, acting out, or onset of substance abuse. 

Deal with the Outside/Inside Fallacy 

In this initial conversation, it’s also important to teach your teen about the origins of their anxiety. When we’re anxious, its natural to search for its cause. We tend to look for the answer outside ourself, to our circumstances, and think this is the cause of our anxious feelings. You may think it’s a difficult boss, heavy traffic, going to the dentist, crowds, traveling out of town, and the like that makes you anxious. Your teen will be no different. They’ll think that comments on social media, being liked and accepted by peers, school grades, or performance in sports or the arts is what makes them anxious. But looking to our circumstances is not the key to success in managing anxious feelings.   

As explained in The Anxious Thoughts Workbook for Teens, it’s how we think about our circumstances that determines whether our anxiety is mild or severe. When we think that a situation will have catastrophic consequences and that we’re helpless to deal with the situation, our anxiety will be greater than if we think the situation is difficult but there are ways to cope with it. In other words, it’s not so much what happens to you that causes anxiety, but how you think and act that’s most important. This is a hard lesson for anyone to accept, especially teens who are learning how to deal with their emotions. There are several ways you can help your teen focus on their thoughts and behavior rather than their circumstances when dealing with anxiety. 

• Start with some common unpleasant situations and ask your teen to consider why some people get anxious and others don’t. For example, most people have dental appointments and occasionally undergo a painful procedure like getting a tooth filled, a root canal, or worse. People with high dental anxiety might think, I can’t stand the pain, I feel like I’m suffocating, I hate needles, I’m trapped, and then they avoid dental appointments. People with low dental anxiety think, the pain is momentary and disappears once my mouth is frozen, it’s uncomfortable but I can breathe through my nose, I can always ask the dentist to pause until I catch my breath, better to have a little pain now and get the tooth fixed. Thinking this way enables them to endure the appointment and maintain their dental hygiene. Examples like this help the teen realize that anxious thoughts are the biggest cause of anxious feelings. 
• Ask your teen about a situation that doesn’t make them anxious, but does make one of their friends anxious. Explore with them how they think about the situation in a non-anxious way, and how their friend thinks about it in an anxious way. For example, maybe your teen is not anxious about trying out for a school sports team. Ask how they think about the tryouts and their chance of making the cut, versus their friend who gets really anxious and nervous about tryouts. 
• Finally, explore with your teen how someone else might think about and cope with their anxiety-provoking situation or problem to feel less anxious. This is the most therapeutic part of the interaction. You are now getting to the heart of cognitive behavioral therapy (CBT) for anxiety. 

Anxiety is a difficult emotion to manage. The first step is to help your teen understand anxiety. They’ll need to focus on changing how they think before using other CBT strategies to reduce anxiety. 

David A. Clark, PhD, is a clinical psychologist, and professor emeritus at the University of New Brunswick. He is author or coauthor of several books on depression, anxiety, and obsessive-compulsive disorder (OCD), including The Anxiety and Worry Workbook with Aaron T. Beck (founder of cognitive therapy), The Anxious Thoughts Workbook, The Negative Thoughts Workbook, and Cognitive-Behavioral Therapy for OCD and Its Subtypes. Clark is a founding fellow and trainer consultant with the Academy of Cognitive and Behavioral Therapies, and fellow of the Canadian Psychological Association. He is author of the blog, The Runaway Mind, on www.psychologytoday.com.