Category Archives: behavior therapy

I could tell you, but you’re not going to like it: Anxious Youth

As you know, this column isn’t intended as psychotherapy or professional advice. It’s information and entertainment, and, I hope, the spark for some conversation with someone who can help with a problem. The problem here is anxiety in all its forms.

According to the Anxiety and Depression Association of America, about 31.9% of youth have some sort of anxiety disorder.  This would include diagnoses such as generalized anxiety, separation anxiety, panic disorder, and trauma disorders. It’s hard to believe this is accurate; if it is, then as a culture, things have gone horribly wrong. 

We know a lot about what works, and what doesn’t work for anxiety.  Isolation, the vortex of doom the internet can be, the misguided or malevolent support of random strangers online, endless social networking, and a sedentary, sleep-starved, junk-fed existence don’t work.  Overscheduling doesn’t work. Avoidance doesn’t work. Irresponsibility doesn’t work. So do the opposite.

Get off the devices except for schoolwork.

Get enough sleep. Go to bed at a set time, get up at a set time. Every day, even weekends.

Cut down on activities.

Read real books. Learn about other people’s interior lives via good fiction (that’s a primary reason that we read classic literature in school; to understand more about how other people think, feel, and respond to life’s events). Then talk about them. That means parents should read them, too.

Get physical activity.  A healthy young person needs at least two hours of activity a day, and ought to be standing, moving around, and active a big chunk of the rest of the time.  

Learn useful skills.  For example, everything it will take to manage one’s own money, car and home.

Socialize in person, often while doing something purposeful (whether that’s a sport, volunteering, or other activity).

Spend a lot of time in nature. If it can’t happen just about every day, plan a four- or five-hour chunk on the weekend.

Have chores and responsibilities for young people.  No, “school is not their job” and therefore nothing else is to be done around the house. How are they going to learn necessary life skills? Plus, who wants a spouse or roommate who thinks going to work covers them for any contribution to home and family life?

Learn mindfulness meditation skills, to slow down the stress response and “step back” from anxiety-provoking thoughts. This facilitates the cognitive restructuring of cognitive-behavioral therapy, in which new ways of thinking and behaving are identified and rehearsed.

…and try cognitive behavioral therapy (CBT), preferably with at least one parent learning, too, to be coach and to help the parent. Anxious parents tend to teach their children fear-fueled ways of thinking and behaving, and anxious parents are apt to facilitate avoidance.  Avoidance is like jet fuel for anxiety. Find a licensed mental health professional who will work with you as a family to teach the skills. Keep in mind that CBT will work much better if the other parts of life are in healthy, working order – proper sleep, nutrition, exercise, etc.

To expand on an earlier point: parents, often your anxiety feeds your child’s anxiety. If you are behaving as if the world is a terrible, dangerous place, do not be surprised if your child responds the same way.  Making changes together to have a healthier, less anxious lifestyle will help the whole family.

I could tell you: Bryce Canyon Therapy

I could tell you, but you’re not going to like it…there’s no way to defeat fear without going through it

I am afraid of heights.

Not, “Eew, a little squeamish standing on the observation deck at the Empire State Building” afraid of heights. I mean, heart-pounding, sweaty-handed angst when faced with the open stairs in your typical outdoor, three-story-ish observation tower. I come by it honestly; I apparently took a few hard tumbles down long flights of stairs as a toddler. Hence the reality that “falling can and does happen, and it’s bad,” is hardwired in.

The thing of it is, avoidance works perfectly if by works you mean, never feel that afraid. It also means missing out on things, standing around at the bottom of things feeling slightly foolish when everyone else goes up and looks out over scenic vistas that I will see as a thumbprint on their cell phone screens.  The only way to reduce it, or at least have the experience that fear will not be what kills me, is to go through it.

Enter our long-planned, long-saved for vacation earlier this year to Utah, where we joined a small group tour hiking and camping and taking in five of the national parks: Arches, Bryce Canyon, Capital Reef, Canyon Lands and Zion.  The first day, we set up camp nearby and drove over to Bryce Canyon to see the canyon at sunset and see the trail we would take on the next morning just past sunrise – a narrow path down the cliff walls, through the varying terrain of the bottom, and back up the narrow path along the cliff walls.  I spent half the night in turmoil, crying with fear, and woke up knowing if I did not do that hike, I would regret it for the rest of my life. Meanwhile, of course, my amygdala were trying to convince me that the rest of my life would be short because I would certainly fall off a cliff and die.

I did hike the trail, sometimes in tears, sometimes trying to melt into the cliff face away from the edge (sorry, everyone who had to pass me; I disobeyed the rules of foot traffic on that).  By the end of vacation, I was navigating through elevations with much less fear. I am not a fan of heights, and probably never will be, but I know I can feel afraid and still do reasonable things.

Sharing this tale with friends, one shared that he, too, is afraid of heights and that’s why he decided to apply to and go through jump school in the military (as in, jump out of perfectly good airplanes). He didn’t expect it to cure his fear of heights – it didn’t – but it did do what he hoped, which was convince him he could handle scary things, something he wanted in his pocket before being deployed to war.

The purpose of this rambling set of tales is to illustrate what’s happening when we therapists annoyingly insist people face their fears, even one small step at a time, if the fear is keeping them from doing the normal, necessary things of life and/or barring them from their goals. Whether it’s elevators, public speaking, or driving over bridges, only taking the small, often agonizing steps forward works. Thinking about it, waiting until you’re magically not afraid, or postponing only convince your emotional, instinctive brain parts that the situation in question merits that level of fear. In other words, avoidance doesn’t reduce fear, it increases it. Every time I started up an observation tower, freaked out and sat down on the steps and then crept back down before reaching the top, I didn’t accomplish anything except making my fear worse.

So when, as the therapist, I encourage you to plan out, with me, and begin taking small steps towards conquering the fears that block you from living as enthusiastically as you’d like, I am not being mean or insensitive. I am not failing to understand how gut-wrenching fear can be. I get it. Really. As in fear-sweat drenched, heart-pounding, climbing that narrow path in and out of Bryce Canyon on a hot day getting it.