Building ‘bravery muscles’ to combat rising youth anxiety – Harvard Gazette


Amid the ongoing mental health crisis among young Americans, the US Task Force on Preventive Services released a draft recommendation earlier this year for doctors to begin screening children for anxiety as early as 8 years old. R. Meredith Elkins, professor of psychology in the department of psychiatry at Harvard Medical School and co-director of the McLean Anxiety Mastery program at McLean Hospital, which treats children ages 6 to 19, said improved screening will help children to access proven and effective treatments, while ignoring it can worsen the condition and lead to other mental health problems. She also notes that a complicating factor in this problem, as well as the nation’s overall dilemma, is the current shortage of youth mental health providers. The interview has been edited for clarity and length.

GAZETTE: I think most people think anxiety is a problem for adults. How big is the problem among young people?

MOKS: Taken together, anxiety disorders are the most common category of mental health problems in children and adolescents. It is important to differentiate normative anxiety, which is an adaptive and natural response to threats to one’s life or well-being, from anxiety which is long standing, interferes significantly with daily life and causes distress. important. When you consider these criteria, unfortunately, many children will meet the diagnostic criteria for one or more anxiety disorders. Given how common these concerns are among young people, I definitely think screening is appropriate.

GAZETTE: Is childhood anxiety something with a relatively effective and accessible treatment?

MOKS: Absolutely. Because anxiety disorders are so common, they are relatively well studied and understood. Screening should not only help clarify which children are having difficulty, but, more importantly, should enable providers to triage them into needed care. We have evidence-based approaches to treating anxiety and related disorders across the lifespan, which provides a reasonable degree of confidence that with early identification and quality care, we can intervene in a way that should bring support and relief to troubled young people and adolescents. families.

GAZETTE: What does therapy involve?

MOKS: Cognitive-behavioral therapy, or CBT, with an emphasis on exposure therapy, is the gold standard approach to the psychological treatment of anxiety. A CBT approach addresses how thoughts and behaviors impact anxiety symptoms. We identify how a person behaves in response to anxiety – which typically involves a lot of avoidance – and examine how these behaviors might actually make anxiety worse in the long run. We then challenge the person to approach – rather than avoid – the situations they dread to learn that they can finally tolerate those circumstances. If anxiety tells you, “I’m afraid to speak in class,” the exhibit will do just that: raise your hand in class. The old adage “Face your fears” is actually quite true. We also consider how anxiety manifests cognitively and encourage reassessment of the accuracy or usefulness of anxiety-provoking thoughts, particularly if they lead us to behave in ways inconsistent with our values ​​and goals. . Thus, by intervening on both thoughts and behaviors, we can help the person regain control of their anxiety.

GAZETTE: We have heard so much about the mental health crisis in children, which started before COVID but was made worse by it. Do you see evidence of this in your clinic?

MOKS: In our program, the McLean Anxiety Mastery Program, we collect data weekly from patients and their families. Comparing data from young participants before the COVID-19 outbreak with those treated during the pandemic confirms an increase in symptom severity and functional impairment since the start of the pandemic. But, on a positive note, although our treatment transitioned to a fully virtual model in March 2020, our data also demonstrates that the youth in our program continue to do well. They join the program more impaired and sicker, on average, than their pre-pandemic peers, but they improve just as much as when the program was delivered in person. This gives us great confidence that these methods can be really useful, regardless of the format in which they are provided.

GAZETTE: How has the pandemic increased our children’s anxiety?

MOKS: I think a lot of that is yet to be unpacked. Anecdotally, the factors that were contributing to youth anxiety during the acute phase of the pandemic appear somewhat different from the challenges of today. During the pandemic, the abrupt disruption of normal routines has been a huge contributor to anxiety – social isolation, challenges with remote learning, interruption of extracurricular activities, etc. at home because their families felt them too: economic stressors, infection problems, racial injustice and social unrest, political discord. Now we see children struggling to readjust to resuming “normal life”. The kids had years when they didn’t have to deal with situations that would lead to normative anxiety, like tough classes and awkward dances in middle school, or disappointing football tryouts. Many of them haven’t had the chance to develop those anti-anxiety muscles that would have grown naturally from dealing with normal stressors. Now they’re thrown back into it, and we’re seeing a tremendous amount of anxiety and avoidance — especially academic avoidance — along with ineffective coping strategies and loss of self-confidence. And we know that avoidance, while helpful in the short term, actually fuels anxiety, so kids are stuck in a cycle of anxiety and avoidance. And – by mandate – children had to avoid many things.

GAZETTE: Is there a progression from anxiety to other types of mental illnesses, so it behooves us, from a societal mental health perspective, to really pay attention to that early on ?

MOKS: Absolutely. Research shows that untreated anxiety disorders in childhood predict long-term impairment and dysfunction, both for those with anxiety and for their families. We should catch that early, to do as much prevention and early intervention as possible. There is reason to believe that helping families and primary care providers deal with anxiety early may be helpful in alleviating longer-term problems associated with anxiety and depression. However, a major concern is the question of who treats these children once they are identified. The shortage of youth mental health care providers is a huge problem, which is compounded by limitations in insurance coverage for these services. There is an urgent need for societal investment in the availability and access to mental health care for young people.

GAZETTE: How can parents help their children?

MOKS: As early as possible, parents should try to normalize negative emotions. Communicating that “Everyone feels anxious sometimes”, “It’s okay to feel sad”, and most importantly, “I know you can handle these difficult feelings”, sends the message that just feeling these feelings is not pathological. What often ends up happening – as a parent myself, I know this – is when you see your child struggling with hard feelings, whether they are scared, sad or angry, you want to address them immediately. , you don’t want your child to suffer. But when parents show that we are truly distressed by our child’s emotions, or when we rush to “fix” them, we send the message to our children that there is something wrong when they feel sad, scared or angry. It can make children feel broken if they don’t feel happy all the time and can’t cope with difficult feelings or situations on their own. Over time, these beliefs can contribute to anxiety or depressive disorders.

So, with warmth and validation, encourage children to do difficult things, even if it causes difficult feelings. Encourage courageous behaviors, implement bravery practices, and praise distress tolerance. If your child is afraid to go to football practice, challenge them to go for the first 15 minutes, then get a treat as a reward and think about how they coped with their scared, even though it was difficult. Next week, set a goal to attend 25 minutes and start building those muscles for bravery. Stand firm with expectations and boundaries, while validating difficult emotions and providing warmth, love, and support. Paradoxically, the best way to support anxious children is often to encourage them to feel more comfortable about being uncomfortable..


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