Parenting Troubled Teen

Dealing with Anxiety in Teens and Young Adults: Visit to the Mountain Valley Treatment Center.

According to the National Association of School Psychologists, 1 in 11 teenagers today is diagnosed with anxiety severe enough to be considered a disorder; and girls develop anxiety disorders more frequently than boys. This is why we went to visit the Mountain Valley Treatment Center in Haverhill, NH. We wanted to use our combined knowledge of mental health, education, consulting, and evaluation to get a sense of this program and the services it provides. Located in a beautiful country site, with picturesque views of mountains and fields, the program made a strong impression on us. We were hosted by a skilled, highly credentialed team of outstanding specialists who spoke with passion about the work they do and the treatment model they have developed.

For many families, the relationship with the treatment team begins before the client steps foot in the program. The Mountain Valley team frequently travels around the country to meet clients in their homes to explain their services and to begin the process of educating potential clients and their families about disordered anxiety. Mountain Valley utilizes an evidenced treatment modality known as Exposure and Response Prevention (ERP) in which clients are gradually and thoughtfully exposed in a controlled and compassionate fashion to feared objects and situations, followed by a process of reflecting on the experience with their peers in support groups, in therapy sessions with members of the clinical team and in family therapy. The program relies heavily on the use of eight wellness modules: Farm to Table, Forest to Family, Equine Therapy, Mindfulness, Adventure, Fitness, Academics, and Art.  The Mountain Valley team also offers comprehensive post-program support planning.

We asked the Clinical Director, Dr. Francis Moriarty to write a piece on anxiety for our blog to help families of struggling teens to better understand this issue. Please, feel free to comment or ask questions.

Anxiety is universal. Everyone gets it. It is a normal, useful, and even critical emotion. It communicates to us through a sense of worry, fearfulness, and alert that danger is near or upon us. Yet sometimes anxiety becomes an exaggerated, unhealthy response.

Adolescence or the teen years are the scene of a constant barrage of pressures and uncertainties. Anxiety, for many, if not all, teens, is a constant companion lurking in the background.  For some teens, anxiety becomes a chronic state of daily life, interfering with the ability to attend school, perform to their potential, and participate in the extracurriculars that they have loved in the past. Often times, through avoidance, connections with friends and peers are sacrificed, while at home, domestic calm can be shattered by silence, withdrawal and at times aggression. Sometimes anxiety is characterized by a general, yet pervasive, sense of uneasiness. At other times, the fear and anxiety take the form of panic or fear of specific things or situations.

What to look for: Anxiety disorders take different forms and can vary widely from teen to teen. The presence of an anxiety disorder might be observed first with a general sense of uneasiness. Also, there may be the presence of excessive fears and worries, feelings of inner restlessness, and a consistent presence of apprehension, worry and hyper-vigilance.

Social settings can become occasions for great dissonance. In these situations anxious teens may appear dependent, withdrawn, ill at ease, and extremely avoidant. They may become overtaken with concern over their ability to keep it together or experience hyper-vigilant preoccupation with their ability to interact effectively.

In addition to emotional and behavioral problems, anxiety disorders can also impact a teen’s sense of physical well being. Common issues include:  muscle tension, nausea or stomach complaints, headaches, soreness in muscles and joints, fatigue and a sense of lethargy that they believe is disabling. Skin discoloration or blotching, sweating, hyperventilating, trembling and an exaggerated startle response may also be present.

Adolescence is a time of emotional turbulence and upheaval in the best of circumstances. When an anxiety disorder is emerging this turmoil can be exaggerated in many different ways.

An overwhelming sense of intense panic may arise without any noticeable cause. Previously benign situations may take on new energy becoming triggers for a full-blown panic attack, characterized by a sudden episode of intense anxiety accompanied by emotional and physical symptoms. Once an experience of this kind is endured a teen may find that they are living in fear that another such occurrence may arise and that they will be powerless to prevent it.

Research indicates that school avoidance in middle school or junior-high has increased dramatically over recent years. Inordinate worry about performance or social pressure is at the heart of this rising level of truancy. A cycle of anxiety, physical complaints, and school avoidance is thus created and maintained. The pattern becomes exacerbated by increasing frequency and severity of physical complaints followed by visits to health care providers who most often are at a loss to provide concrete medical explanations for the complaints. The longer this pattern is perpetuated the more the fear rises and the harder it becomes to return to school. This leads to a greater sense of isolation and fear resulting in a greater entrenchment of avoidance.

Much of the research has suggested that a predisposition towards shyness and anxiety is prewired from birth. Additionally, if one or both parents have a tendency towards anxiety, there’s a good chance that their child will also have anxious tendencies. The environment, albeit often very loving and supportive, communicated in a family system comprising one or more anxious parents, may compound the child’s natural sensitive inclination.  This is fertile ground for the generation of a cycle of increasing uneasiness. By the time this child reaches adolescence, his characteristic way of functioning in the world is consistently informed by a well-developed sense of anxiety. This maladaptive functioning is often supported by the entire family system through a process known as family accommodation. Family accommodation refers to ways in which family members accommodate their child’s symptoms. This can take many forms including providing reassurance, assisting or participating in the avoidance of feared objects or situations, taking over their child’s duties, and changing or modifying family routines. Family accommodation serves to reinforce a child’s anxious response and in so doing increases symptom severity and adversely impacts treatment.

Some teens with anxiety disorders can also become depressed or develop problems with eating. Evidence also suggests that persistent anxiety may lead to suicidal feelings or self-destructive behaviors. These symptoms should not be minimized and require immediate attention and treatment. Sometimes an anxious teen might self-medicate or self-soothe with the use of alcohol and drugs.

It is important to remember that the disturbance and disruption caused by the presence of an anxiety disorder can be effectively managed with education and treatment. A teen can learn skills to minimize the debilitating impact of anxiety and find the competence, skill and energy to face life with hope and confidence.