Teens lead exciting yet stressful lives.  Anxiety symptoms may pop up at any time during the teenage years.

 

As a parent, be sure to look for these symptoms of anxiety in your teen.

 

Sleep Issues

 

Teens with anxiety symptoms find it hard to fall asleep, stay asleep, or both.  They can’t seem to turn their brains off for the night.

They will toss and turn and sometimes come to their parents for help with sleep.  They say when they don’t have anything to do (cell phone, Netflix) they start overthinking or worrying.

 

Excessive Worrying

 

Teens with anxiety symptoms will worry about anything and everything.  They have a hard time finding joy in life.

 

They fear the worst may happen.  Their worries may be tied to performance (tests, sporting events, theatre).

 

Catastrophic Thinking

 

Teens worry about future negative events/experiences.  For example, they may have the thought “if I am late to school I will fail this class and have to drop out.”  

 

The worries lead to negative thoughts that pile on one another.

 

Panic Attacks

Teens with panic attacks can experience all or some of the following: shortness of breath, crying, flushed faces, sweaty palms, chest tightness, racing heart, dizziness, and fainting.

 

Adults have been rushed to the hospital believing they are having a heart attack only to be told by a doctor it was a panic attack.

 

Teens may start worrying about having future panic attacks.  During a panic attack, the body believes you are in danger.

 

Your teen’s sympathetic nervous system is turned on and they may fight, flee, freeze, or faint.

 

Panic attacks may result from trauma, phobias, or anxiety disorders.

 

Avoidance of events/people/places

 

Teens avoid people, places, or events that may cause a panic attack.  Teens may be absent from school due to performance anxiety.

 

Teens may sit out of athletic events or creative endeavors like school plays.

 

Teens that avoid social engagements may have social anxiety.  Exposure therapy can be very helpful for social anxiety and phobias.

 

Appetite Changes

 

Teens may stress eat especially around final exams.  They may have a loss of appetite.

Teens go through growth spurts and may have times where they eat you out of house and home or pick at their food.

 

If you notice drastic changes in your teen’s weight please get them to their doctor for an evaluation.

 

*Eating Disorders:  Teens that deliberately restrict food, overeat and throw up, or binge eat to the point of making themselves sick need to be evaluated for an eating disorder.  Anxiety may exist in conjunction with an eating disorder.

 

Trauma

 

Teen survivors of trauma may experience panic attacks.  Teens may have both PTSD and anxiety symptoms.

 

Trauma is based in the body and treatment involves identifying triggers and using body-based interventions to calm down an overactive sympathetic nervous system.

 

Trauma survivors are at higher risk of developing an anxiety disorder.

 

Conclusion

 

I have touched on some common anxiety symptoms in teens.  If you notice your teen experiencing one or more of these signs please get them evaluated by a mental health professional.

 

You may be tempted to dismiss your teen’s symptoms as hormonal or the normal teenage experience.  It’s better to be safe than to be sorry.

 

Trust me, anxiety treatment will do wonders for your teen.

 

Anxiety treatment in teens can involve therapeutic interventions, medications, or both.  I will discuss the interventions I enjoy using the most with teens.

 

Somatic Interventions

 

Anxiety lives in the body.  Panic erupts often without a warning.  For example, I feel panic when flying in small airplanes.

 

Flight anxiety is a type of phobia however I only experience panic in small planes and not commercial jets.  When my body feels turbulence I immediately start to sweat, my heart races, and my breath quickens.

 

There are no thoughts that spark this reaction.  My body believes I am in danger and initiates my fight or flight system.

 

I use deep breathing and feeling my feet, in particular, to calm down.  I focus on feeling my feet on the floor of the airplane.  I push my toes into the ground.  

 

This somatic exercise literally grounds my overacting nervous system.  I begin to feel calmer.

 

I teach teens this exercise along with sighing, stretching, and progressive muscle relaxation (PMR).  PMR means you go from head to toe or vice versa tensing and then relaxing body parts.

 

PMR is a great intervention to use when trying to fall asleep.

 

Cognitive Behavioral Therapy (CBT)

 

CBT posits that negative thoughts result in difficult emotions and then behaviors.  

 

For example, a teen may have the thought, “I am going to fail this test” followed by the emotion of fear and resulting in a panic attack.  Teens may avoid test-taking in the future.

 

CBT works by having teens identify negative thoughts, test the validity of those thoughts, ultimately modifying those thoughts.  

 

Teens can get stuck in negative thinking spirals.  I help them to end those spirals earlier or to not engage in them in the first place.

 

Existential Theory

 

Existential Theory states that anxiety is normal and not something to be feared.  We have death anxiety for instance.  

 

Our society is death-phobic and often does not want to think about our impending demise.  Everyone dies and it is not something we can prevent.

 

I have teens look at anxiety as a messenger rather than something to fear and avoid.  Teens gain acceptance around anxiety and feel less helpless when they have anxious feelings.

 

Attachment Theory

 

Attachment Theory states that we have an attachment style with our primary caregivers.  The following styles exist:  secure, anxious, avoidant, and disorganized.

 

Teens with an anxious attachment style may have a difficult time facing challenges.  They cling to loved ones when they feel stressed.

 

Teens that are securely attached can encounter challenges and check-in with their secure base when they feel stressed.  They feel comforted and ready to face the next challenge.

Teens with an avoidant attachment style avoid challenges.  They fear they have no one to turn to when stressed so avoidance is the best survival strategy.

 

I develop secure attachments with teens to help them wade challenges better.  They feel less anxious due to the relationship.

 

Family Systems

Bowenian Therapy addresses anxiety that has been passed down from generation to generation.  Teens focus on which family members have had anxiety and the coping methods used.

 

Family Systems helps teens to gain insight into the origins of anxiety and ineffective coping by family members.  Teens use that insight to choose to engage in healthier coping.

 

Parents can be taught about anxiety in order to provide more support for their teens.  They can be allies for their teens and a source of emotional support.

 

Medications

 

The major medications used to treat anxiety are SSRIs (Celexa) and Benzodiazepines (Ativan).  SSRIs are very effective for long-term anxiety such as Generalized Anxiety Disorder.  Benzos work great as a short-term intervention for panic attacks.

 

Benzos can be addictive so a family history of substance abuse needs to be explored as a possible risk factor.

 

Medication use is a big decision given teens’ brains are still developing.  It is a great solution in conjunction with talk therapy if a teen is really struggling on a daily basis.

 

Teens can wean off the medications and use techniques learned in therapy to better manage their anxious feelings.

 

Conclusion

I have discussed a few of the many anxiety treatments for teens.  I will describe symptoms and signs of anxiety in my next post.

 

If your teen is struggling with anxiety don’t hesitate to email me at sarahlauterbach.lmft@gmail.com.

 

How do parents tell if their teen is depressed?  Here are depression symptoms you may notice in your teen.

Sleep Disturbance

 

Teens may be sleeping too little or too much.  Teens have a biological clock that runs differently than children and adults.  Teens are wired to stay up late and sleep in in the morning.  

 

If you notice your teen has low energy, bags under their eyes, and needs to nap often those might be signs of sleep disturbance.

 

Appetite Changes

 

Teens may be eating too much or too little.  Again, teens go through growth spurts so it may be difficult to tell if they are depressed from this one sign alone.  If you notice drastic weight changes it’s time to investigate for mental health issues.

 

Anhedonia

 

Teens may not feel joy with things that once brought them pleasure.  If they used to love to play basketball and then all of the sudden stop playing ask them what changed.  

 

If they say “I love to play but I just don’t get any happiness from it anymore” ask some follow-up questions.  They could be legitimately bored with the activity or experiencing anhedonia.

 

Depressed Mood

 

Teens have rapid shifts in mood normally but if you notice your teen seems down in the dumps more than usual it could be a sign of depression.  They may have a negative attitude, low energy, or be more irritable than usual.

 

Lethargic/Low Energy

Teens may move slowly just to piss off their parents especially when they have to be somewhere on time.  However, if your teen appears to resemble a sloth on more days than not it may be a symptom of depression.

 

 

Social Isolation

 

Teens love hanging out with their friends.  Teen relationships can be like riding a rollercoaster.  They may be besties one day and mortal enemies the next.

 

If you notice your teen hiding in their room and not hanging out with their friends as much that 

could be a sign of depression.

 

Family/Sibling Fighting

 

Teens often fight with parents and siblings.  If your teen seems more on edge than normal and picks fights with others often that may be a sign of depression.

 

Teens may also be fighting with peers and other adults (teachers) more often as irritability increases in depressed folks.

 

Alcohol and Drug Use

 

Teens experiment with drugs and alcohol.  Teens drink in social situations due to peer pressure.  Teens may abuse alcohol in order to numb their feelings.  Alcohol is a depressant and can make a depressed mood worse.

 

Teens that smoke pot on a regular basis may be self-medicating for a depressed mood.  Teens that may struggle with alcohol and substance abuse need an intervention by mental health professionals asap.

 

Suicidal Thoughts or Self Harm

 

Teens may have thoughts of ending their lives or choose to hurt themselves such as cutting.  Teens with these kinds of thoughts and behaviors definitely should be evaluated for depression.

 

Teens self-harm in order to feel when they feel numb, to prevent completing suicide, or to feel relief when they are overwhelmed.

 

Teens with a history of suicide attempts are at high risk for ending their lives.  If your teen has attempted suicide in the past and they are experiencing suicidal thoughts get them treatment asap.

 

Marginalzed Community

 

If your teen identifies as LGBTQIA they are more likely to experience depression symptoms.  They may exhibit the above-mentioned symptoms combined with the trauma of being bullied or not fitting in with peers.

 

LGBTQIA youth are at risk for completing suicide at a higher rate than their non-LGBTQIA peers.

 

Academic Disengagement

 

Teens with symptoms of depression have more difficulty concentrating and focusing on school work.  Parents may notice a shift in academic achievement which could indicate depression.

 

Other teens have struggled for years with academics due to untreated depression.  Academics are a great barometer for checking how your teen is doing socially and emotionally.

 

Conclusion

 

These are some of the most prominent depression symptoms in teens.  Some teens may show several symptoms while others only report one.  Parents should contact a mental health professional for an evaluation if their teens seem to be depressed.

 

National Suicide Hotline:  1-800-273-8255

 

You have a teen and they may be depressed.  So how is depression treated in teens?

I use a variety of psychological theories when treating depression in teens.  I use Cognitive Behavioral Therapy (CBT) to attack negative thoughts and core beliefs (negative beliefs of the Self such as I am not good enough).

 

CBT seeks to identify negative thoughts, test the validity of those thoughts, and then modify or change those thoughts.  For example, your teen gets a bad grade on a test.  

 

They may have the following automatic negative thoughts:  ‘I’m an idiot, I really messed up this time, I will never learn this, etc.”  Those thoughts result in emotions such as shame, disappointment, and sadness.  

 

Emotions lead to behaviors.  Your teen may choose to not study for the next test believing it is pointless.  

 

I work to help teens identify the negative thoughts (I will never learn this) and use questions to ask if that thought is 100% true.  Teens are great at finding faults lol so they enjoy this exercise of challenging negative thoughts.

 

I have them come up with other reasons they may have bombed the test.  Over time they get good at identifying and modifying these thoughts.  

 

They feel better emotionally, too.  They are able to encounter another stressful situation and ride it out with less angst and taking it out on themselves.

 

I also use Attachment Theory when treating depression in teens.  Attachment theory believes human beings need a secure attachment to caregivers in order to feel safe when navigating a challenging world.  

 

Teens explore the world and have a “safe base” to return to when they feel overwhelmed.  I hope to provide that safe base with the client-therapist relationship.

 

Teens can disclose to me their thoughts and feelings without fear of judgment.  They may be scared to share dark thoughts such as wanting to end their lives with their parents.  

 

They learn they can trust and depend on me to accept them, dark thoughts and all.  They are open to my guidance and start to take steps to come out of their depression.

 

I use behavioral therapy to assist teens in “faking it until they make it.”  I advise them to set up routines, get daily exercise and sunlight, better monitor social media use and abuse, abstain from alcohol or other depressants, and develop a healthy social network.

 

I focus on sleep hygiene because teens are known to get too little sleep.  Sleep deprivation has a myriad of negative effects on the mind and body,  There’s a reason the military uses it as a torture device!

 

Finally, I speak with parents about seeing a psychiatrist for medication options.  Most parents are hesitant to place their teens on medications.  I believe anti-depressants can be helpful in the short term in combination with psychotherapy.

 

I understand parents’ and teens’ concerns with using anti-depressants.  Both believe dependence may occur or the drugs may hurt brain development.

 

This decision is not to be taken lightly and I hope to provide a safe space to discuss the pros and cons of using this option to treat depression.

 

There are many ways to treat depression in teens.  My next post will discuss signs of depression in teens so parents feel more prepared with identifying these signs before teens experience severe symptoms.  

 

 

Let’s talk about transitions.  Transitions can be hard for some teens.  Teens enjoy sleeping in on the weekends, hanging out with friends (virtually or in person), and not thinking about school.  Monday morning rolls around and they have trouble getting up on time, seem more irritable than usual, and say things like, “I hate school!”  Parents also have to transition to work or getting teens ready for school.  Parents may be grumbling about their own transition and tempers are hot.

 

How do we help our teens to have a smoother transition?  I would give warning the night or afternoon before.  I would say something like, “I know you’ve had a blast sleeping in and playing video games with your friends and you will need to get up earlier tomorrow for school.”  I would empathize with any complaints about how school is prison and there’s no point in going to school.  As a parent I would share my own thoughts and feelings around Mondays.  I would say, “I also have a hard time getting up earlier and I feel annoyed when I think about work again after a relaxing weekend.”  We are modeling for our teens that transitions are not all rainbows and unicorns but they are something everyone has to contend with.  

 

There are many different kinds of transitions.  One is the transition from the weekend to the weekday.  Other major ones are preschool to Kindergarten, 5th grade to middle school, 8th grade to highschool, and highschool to college.  During my assessments of teen clients I often inquire about these transitions to get a sense of how my clients encounter and handle challenges.  One of the first books I read in graduate school was called Transitions:  Making Sense of Life’s Chances by William Bridges.  That book introduced me to the important concept of growth.  As I say to my clients, growth hurts.

 

I believe transitions are excellent practice for growth.  If teens can handle transitions more smoothly they can deal with challenges better.  As adults we need to help our teens learn how to cope with changes but we don’t need to do everything for them.  We can validate their feelings around transitions without feeling like we need to take their pain away.  Life is painful at times and one of the best things we can offer our teens is to be present during their pain rather than trying to resolve it.

 

Last weekend I spent six hours going through bags and boxes of my kids’ toys.  We had been culling the herd so to speak for years but still had so much stuff.  I felt overwhelmed when filling bag after bag or either trash or goodwill donations.  Why when we transition into parenting do we have to accumulate so much crap?!

 

When my children were babies and toddlers I bought stuff to alleviate my anxiety around entertaining small children all day.  My oldest never really played with toys and used us (her parents) as her favorite play things.  I breathed a sigh of relief when she was able to pay attention to shows and video games.  Playdates also helped to take the pressure off me to be her playmate all the time.  

 

My youngest plays with anything and everything.  He took a pair of hangers and entertained himself for 30 minutes the other day.  So why the hell did I buy that expensive Paw Patrol Tower?!  I am going to make a concerted effort to choose Christmas toys that are not “fixed” which means they can only be played with in one way.  I want to find open ended toys for my youngest and creative activities for my oldest.  I am also going to make a huge effort to not over buy this year.

 

I try to remind myself that when we play with our children it’s about connection and not the actual toy.  I really dislike board games but I will play one with my children if their underlying need is connection.  You can also set limits on play with your children as well.  I will often tell my children after a play session that I need a break.  We were never meant to be an endless supply of entertainment for our children.  Boredom is a good thing and can jumpstart creativity.  

 

In returning to my initial topic, stuff, I am going to try to be better about acquiring stuff.  As parents we need to model the behaviors we want from our kids.  Do I really need that latest fitness gadget?  Probably not.  Could I check-out a book from the library (if they are open during a pandemic) or do I really need to buy another one?  Our kids are soaking in our behaviors unconsciously and consciously all the time.  

 

If you do want to buy stuff for your teens or older children try to make it something the whole family can play together.  Play alleviates stress in families and can be one of the few ways to stay in connection with teens.  We need less stuff and more being with one another.

Well the holidays are approaching for many different faiths and people’s spirits are lifting despite the ongoing global pandemic.  This time of year brings fond memories of past holidays, anticipation of joy brought to loved ones through gift giving, and eating way too many scrumptious holiday treats.  Through this haze of good cheer resides a stress monster sitting on the shoulders of those of us who bring holiday magic into our homes.  I’m looking at you, moms.  

 

I don’t know where the idea of the perfect holiday arose from, possibly that highly addicting site called Pinterest, but it has been causing moms inordinate amounts of stress every season.  I start to feel the warm and fuzzy feelings associated with this magical time of year and then the stress monster rears its ugly head.  My thoughts keep me up at night wondering will I be able to pull off another successful holiday for my children?  I have so many gifts to buy, wrap, and hide from my kids.  I want to make holiday treats but even those can be labor intensive and exhausting.  I cannot stand decorating Christmas cookies after the first tray!  I enlist the help of my children but they make more of a mess which I end up cleaning up.  If you are feeling the stress of this season I have some tips that may make this “gasp” an enjoyable time of year.

 

Delegate, delegate, delegate.  I often ask my husband to help purchase gifts and wrap said gifts.  I am a terrible gift wrapper and it only stresses me out more.  If you have teens they can certainly get their bake on which builds life skills and family connection.  They can also help with gift wrapping which enlists creativity and empathy.  If you write Christmas cards they can stuff envelopes.  Young children love using a stamp wetter to close the envelopes.  You also can have the entire family decorate the tree.  You may need to let go of perfection regarding the look of the tree, gifts, and cookies.  You have to ask yourself who are you trying to impress?

 

Moms make the magic happen but it doesn’t always have to be a one woman show.  Practice self compassion, let go of unrealistic standards of perfection, and try to relax during this special time of year.  If you are super bold you can take a year off and make your partner or another family member be in charge.  Single moms have an even more difficult task because there may not be another adult to delegate tasks to and they often have financial stress.  If you are reading this and you know of a single mom(s) volunteer to help her out but only after you have had a relaxing bubble bath!  The same goes for single dads as well.  I hope this is helpful to you and please take little moments just to be present during this time of year.

We survived another daylight savings time indicating Fall is officially here.  You may notice a longing for light, feeling lethargic, and craving comfort foods.  Fall is a time of slowing down for all living things including humans.  Before artificial light humans slept for 16 hours a day in the fall and winter.  We stored food for the winter and feasted in celebration of light returning.  I believe we need to honor those ingrained behaviors from our ancestors.  We should not feel shame for sleeping more or wanting high calorie foods.  

 

However, if you notice your mood really takes a hit during this time there are things you can do.  I recommend using a light box (at least 10,000 lux) which tries to mimic sunlight.  You want to use it for at least 15 minutes every day.  You need it to be positioned at eye level because UV light enters through the iris (black part of the eye) and travels to the brain.  If you believe you suffer from SAD (seasonal affectiveness disorder) please see a psychiatrist for an evaluation.

 

You also need to exercise, preferably in the early morning when UV light is strongest.  I know getting up early is not for everyone, especially teens, but you can develop a habit.  Some people sleep in workout clothes or lay them out the night before.  It usually takes 30 days to form a habit so keep that in mind when embarking on a morning exercise routine.

 

You can also focus on the holidays.  I find having something exciting to look forward to helps to improve mood.  You can engage in a new holiday tradition or learn something new like baking holiday treats.  Distraction is a great technique to help with feelings of boredom, loneliness, sadness, etc. that are associated with low mood.

  

Altruism is also a mood booster because it increases feel good hormones in our brains.  We need to give back to those less fortunate than ourselves.  Community service is a great empathy builder for teens.  

 

I believe holding an awareness and gratitude for this time of the year will help alleviate mood issues.  We are wired to slow down and that’s a good thing.  In the spring many people feel renewed energy to tackle new challenges.

 

*Teenagers have a biological cycle to go to sleep late and wake up late.  If you notice your teen sleeping for inordinate amounts of time (12+ hours a day) and it’s not from an environmental cause (sleepover, studying for a big exam, athletic competition, etc.) please see your primary care doctor for a referral to a psychiatrist to evaluate for mood disorders.