To prevent anxiety in adolescents, we need to cultivate "brave muscles"

Amid the ongoing mental health crisis among U.
S.
adolescents, the U.
S.
Preventive Services Task Force released a draft recommendation earlier this year recommending that doctors begin screening
children under 8 years of age for anxiety disorders 。 R.
Lee, lecturer in psychiatric psychology at Harvard Medical School and co-director of the McLean Anxiety Mastery Program at McLean Hospital.
Meredith Elkins said enhanced screening would give children access to treatment that has been proven effective, while ignoring it can lead to worsening of the condition and lead to other mental illnesses
.
The McLean Anxiety Control Program at McLean Hospital treats children between the ages
of 6 and 19.
She also noted that one of the complicating factors in the problem, as well as the overall plight of the country, is the current shortage
of youth mental health care providers.
For clarity and length, the interview was edited
.

Anxiety disorders are one of the most common mental health disorders
in children and adolescents.
It is important to distinguish between normative anxiety and long-term anxiety, which is an adaptive, natural response to threats to life or well-being, while long-term anxiety seriously interferes with daily life and causes severe suffering
.
When you consider these criteria, unfortunately, many children meet the diagnostic criteria
for one or more anxiety disorders.
Given how pervasive these concerns are among young people, I definitely think screening is appropriate
.

Because anxiety disorders are so common, people have studied and understood them relatively well
.
Screening should not only help identify which children are struggling, but more importantly, providers should be allowed the necessary treatment
for them.
We have evidence-based approaches to treating anxiety and associated disorders throughout the lifecycle, which gives us a fair degree of confidence that through early recognition and high-quality care, we can intervene
in a way that should provide support and relief to struggling adolescents and families.

Cognitive behavioral therapy, or CBT for short, emphasizes exposure therapy and is the gold standard approach
to anxiety psychotherapy.
The CBT approach deals with the way
thoughts and behaviors affect anxiety symptoms.
We determine how a person responds to anxiety — which often includes a lot of avoidance — and consider how these behaviors may actually worsen anxiety over the long term
.
We then asked subjects to approach — rather than run away — the situations they feared to understand that they would eventually tolerate them
.
If anxiety tells you, "I'm afraid to speak in class," then the way to be exposed is: raise your hand
in class.
There's an old saying that goes, "Face your fears.
"
We also consider how anxiety manifests cognitively and encourage a reassessment of how accurate or useful anxiety-driven thoughts are, especially when they cause us to behave in a way that is inconsistent with our values and goals
.
Thus, by intervening in thoughts and behaviors, we are able to help patients regain control of their anxiety.

In our program, the McLean Anxiety Control Project, we collect data
from patients and their families on a weekly basis.
Comparing data from youth who participated before the outbreak of COVID-19 with those who were treated during the pandemic confirmed an increase
in symptom severity and functional impairment since the beginning of the pandemic.
However, on the positive side, while our treatment shifted to a fully virtual model in March 2020, our data also shows that the young people in our program continue to perform well
.
On average, they joined the program with more severe physical impairment and illness than their pre-pandemic peers, but they improved to the same extent as
when they participated in the project in person.
This gives us a lot of confidence that these methods are very useful, regardless of the format in which they are delivered
.

I think there's still a lot to be tapped
.
Interestingly, the factors contributing to youth anxiety during the acute phase of the pandemic seem to be somewhat different from
today's challenges.
During the pandemic, sudden disruptions to normal life are a major cause of anxiety – social isolation, the challenges of distance learning, interruptions in extracurricular activities, and more
.
Add to that a feeling of uncertainty and awareness of the bigger, more frightening problems that children encounter at home because their families also feel them: economic stressors, infection concerns, racial injustice and social unrest, political discord
.
Now we see children struggling to readjust to "normal life"
.
For years, kids didn't have to deal with situations that would bring normal anxiety, such as tough classes, awkward middle school dances, or disappointing football auditions
.
Many of them don't have the opportunity to build those muscles that fight anxiety that could have developed
naturally when dealing with normal stress.
Now that they've been pushed back, we're seeing a lot of anxiety and avoidance – especially school avoidance – as well as ineffective coping strategies and a decline
in self-confidence.
We know that avoidance, while helpful in the short term, can actually exacerbate anxiety, so children get caught up in
a cycle of anxiety and avoidance.
And, according to the regulations, children have to avoid a lot of things
.
Does anxiety develop into other types of mental illness that from a socio-mental health perspective, it is necessary for us to notice this early on?

Absolutely
.
Studies have shown that for people with anxiety disorders and their families, untreated anxiety disorders in childhood are indicative of long-term impairment and dysfunction
.
We should screen as early as possible and do as much prevention and early intervention
as possible.
There is reason to believe that helping families and primary care providers address anxiety issues early can help improve long-term concerns
associated with anxiety and depression.
One major question, however, is who will treat these children once they
are diagnosed.
The shortage of youth mental health care providers is a huge problem, exacerbated
by limited insurance coverage for these services.
There is an urgent need to provide and access to mental health care for young people

Parents should normalize
negative emotions as early as possible.
The message "Everyone has moments of anxiety," "It's okay to feel sad," and most importantly, "I know you can handle these tough feelings" sends the message that just experiencing those feelings is not pathological
.
As a parent, I know that what usually happens in the end is that when you see your child struggling with a tough emotion, whether they're scared or sad or angry, you want to fix it right away, and you don't want your child to suffer
.
But when parents show that we are really bothered by their children's emotions, or when we rush to "fix" them, we send a message to our children that when they feel sad, scared, or angry, we tell them that something is wrong
.
This can lead to children feeling like they are broken, and if they don't feel happy, they can't handle difficult feelings or situations
independently.
Over time, these beliefs can lead to anxiety or depression disorders
.

So, with warmth and affirmation, encourage children to do tough things, even if it can provoke their pain
.
Encourage courageous behavior, build courageous practices, and praise the ability to tolerate distress
.
If your kids don't dare to practice football, challenge them to practice for 15 minutes and then go grab something as a reward and reflect on how they face their fears, even though it's difficult
.
Next week, set a goal of participating for 25 minutes and start exercising those brave muscles
.
Insist on expectations and limitations, while also acknowledging difficult emotions and providing warmth, love and support
.
Paradoxically, the best way to support anxious children is often to encourage them to adjust to uncomfortable feelings
.