Helping Adolescents Work Through the Rising Tide of Anxiety
Article found at Fuller Youth Institute Blog
Written by Rhett Smith
Photo by Tom Sodoge
Lately I’ve noticed a growing alarm about anxiety in our culture. It seems to be wreaking havoc in our lives. I’ve seen this trend in my counseling practice, in questions I get when I’m speaking at churches and organizations, and in what I hear in my day-to-day interactions with friends and neighbors.
Anxiety feels like a virus spreading quickly through our midst. We’re now anxious about getting anxious.
As much as we see this chatter offline, there is an even more deafening presence online, as social media interaction and article after article emphasize the impact of anxiety among the American population, and more specifically among high school and college-aged young adults. In the last several months alone, multiple publications have run stories on anxiety. The New York Times Magazine prominently featured a piece entitled, “Why Are More American Teenagers Than Ever Suffering From Severe Anxiety?.” A few months earlier, the Times ran an article proclaiming that anxiety has become an “everyday argot”.  The Atlantic published articles in July, August, and September looking at anxiety, connecting it to our use of smartphones and social media.
I could list many more, but you get the point. Anxiety is on the rise, and it’s having devastating effects, not only on the American population as a whole, but more specifically among younger Americans. One author writes, “Anxiety is the most common mental health disorder in the United States, affecting nearly one-third of both adolescents and adults, according to the National Institute of Mental Health. But unlike depression, with which it routinely occurs, anxiety is often seen as a less serious problem.” 
Perhaps it’s time to pay more attention.
Anxiety in Context
It is important to gain perspective on how anxiety may impact the work you are doing in your context, whether that’s as a parent, teacher, pastor, mentor, or friend of a teenager. For example, if you are a teacher in middle school or high school and you look out at your classroom of 25 students, statistically speaking, somewhere in the neighborhood of 8 students are suffering from an anxiety disorder. If you are a youth pastor and you look out at your youth group of 50 high schoolers in a Wednesday night gathering, somewhere around 17 students are struggling with an anxiety disorder.
And what about college students? One story in Inside Higher Ed sums up anxiety’s growing impact on collegiates, “More than half of the college students who visited their campus counseling centers during the 2015-2016 academic year reported symptoms of anxiety, … This marks the seventh year in a row that anxiety has been the top complaint among students seeking mental health services.”
The average age of onset for anxiety is 11 years old, which matches my own debilitating struggle with anxiety. In 1981, my mom was diagnosed with breast cancer, and by the time she passed away in 1986, my anxiety ballooned into full effect. I began stuttering after the trauma of her death. Two weeks after she passed away, I went back to fifth grade and discovered I could no longer read out loud in class. Instead, when I was called upon I froze in an anxious panic. This continued all the way through high school and into college. It was only then that I decided to face my anxiety, and later in my thirties, through the help of a couple of therapists, I really began not only to understand my anxiety, but also to make serious progress with it.
I know from personal experience how frightening anxiety can be, and that’s why it’s a topic we must all learn to understand better in order to offer help to those who struggle.
Practical Strategies to Help Young People Face Anxiety
Through my work with anxiety both personally and as a therapist, I have found some specific responses to be helpful, so I want to pass these suggestions on to you. You have a vital role in helping teenagers who are struggling. As a first word of caution, however, there are circumstances where anxiety is so severe that someone must be hospitalized or put on medication. What I’m going to share with you here are ways to help those who are anxious but not in need of immediate medical care. As you work through this guide, hopefully the exercises will help give you the confidence to discern when you can help and when you need outside assistance.
1. Create space and give permission to talk about anxiety
When it comes to adolescents and anxiety, you may be a first responder on the front lines. How you handle anxiety when it arises may set the trajectory for how that adolescent works through anxiety, or if they choose to do so. For most teenagers, talking about their anxiety is a very scary thing, and depending on how they are being raised and the culture they inhabit, there might be all kinds of barriers to talking openly.
Here are some specific ways you can create space and give permission to adolescents experiencing anxiety:
- Start with: Begin by communicating that it’s okay to have anxiety. I encourage you to literally say to an adolescent, “I am creating a safe space for you, and giving you permission to talk about your anxiety.” This kind of permission can be a key to unlocking a lot of the negative assumptions and fears teenagers hold around anxiety.
- Advanced tactics: Normalize anxiety by sharing your own struggles or inviting others in the community to share stories about their anxiety. If you have a hard time finding someone to share, I recommend bringing in someone from outside your ministry like a local therapist to help break the silence.
2. Help identify the roots of anxiety
My mentor, marriage and family therapy pioneer and Fuller professor Dr. Terry Hargrave, helped me understand very clearly that anxiety is typically a response to a deeper underlying feeling. Anxiety is less of a feeling, and more about how we cope with feelings that we are often unclear about, or too afraid to confront.
Distinguishing anxiety as a coping behavior rather than a feeling is critical. Don’t get stuck focusing on the symptom (anxiety), but help the adolescent explore the underlying issues that may be perpetuating anxiety. It’s when you identify the root issues that true healing can begin to take place.
Here are some specific ways you can help an adolescent with anxiety identify the underlying root issues that cause them to respond with anxiety:
- Start with: Sometimes teenagers need help finding the right words to articulate what they are experiencing. Use a handout of feeling words that you can give an adolescent to look through and see if they can name more clearly what they feel. This identification helps them understand themselves better, as well as helping you understand their experience, which increases a sense of safety and trust in the relationship.
- Advanced tactics: Take a stack of 3×5 cards and write down one feeling word on each card. You will want about 20-30 cards. Lay the cards down on the ground, spread out from each other at a good distance (ideally a foot or more). Invite the adolescent to walk around and through the cards and pick up which ones they resonate with the most (i.e., which ones create the feeling of anxiety in them as they look at or walk by the word). Then use those words to help open up a conversation. The physical movement and tactile nature of this exercise can be very helpful.
3. Provide tools to help manage the anxiety
Normalizing and identifying anxiety are important first steps, but adolescents also need tools to assist them in managing anxiety. And though tools are vital, I often have found that adolescents (especially younger ones) have a hard time using tools on their own, especially if they are too complex.
Self-care is an important tool in the management of anxiety. For example, when an adolescent is doing something physically, it helps release positive chemicals in the brain, offsetting some of the more negative ones. When an adolescent is emotionally connected, they tend to feel less isolated and alone, and there is less of a chance they will have to deal with anxiety by themselves. When an adolescent finds something positive to mentally engage, this can be helpful in finding purpose and in switching focus from the negative messages of anxiety. And when an adolescent takes care of themselves spiritually, they are often able to place themselves in a larger narrative than their own, which is key to keep from being swallowed up by the focus on self that anxiety often perpetuates.
Here are some specific and easily-accessible tools you can recommend to or use with adolescents experiencing anxiety:
- Start with: Breathing exercises are probably the most underrated of all anxiety tools, and might be the most important. The Latin root for anxiety implies a “choking off,” or a “closing/shutting in,” so with anxiety it can actually feel like the person can’t breathe (i.e., a panic attack), or that their world is falling apart around them (i.e., existential crisis). So, restoring a calm breathing pattern is essential. You can help a teenager start by practicing a technique such as “box breathing.” I also highly recommend the app Headspace and its “Anxiety Pack.”
- Advanced tactics: Sit down with an adolescent and perform a self-care assessment by drawing four columns on a piece of paper. Label them from left to right: Physical, Emotional, Mental, Spiritual. One column at a time, help the adolescent identify as many things they could be doing to foster each area of their life. Look at the list together and narrow it down to just one activity or practice in each column that they feel the most excitement or energy to focus on. Meet weekly to help keep them accountable and inspired to work on self-care and soul care.
4. Reframe anxiety as an opportunity to grow
Most teenagers I work with have been raised to believe that anxiety is a bad thing, something to be avoided at all costs. Many great thinkers on anxiety from Søren Kierkegaard to Rollo May have argued that though anxiety can have debilitating effects on our lives, ultimately it can also provide us with great insight and lead to transformative change. Kierkegaard has written that “anxiety is the dizziness of freedom.” And what possibly produces more anxiety than being in adolescence and having to navigate all the freedom and choices new to a young person’s experience?
- Start with: Take an adolescent through some of the stories in the Bible where the journey through anxiety (whether implicit or explicit) seems to be a major tool for shaping and growing people (e.g., wandering for 40 years in the wilderness; Jacob wrestling with God; Mary giving birth to Jesus; Jesus praying in the garden.) You might ask the adolescent, “What anxiety has God brought you through that has really shaped and helped you grow as a person?”
- Advanced tactics: Try leading the young person in an exercise where they interview their anxiety. There is no “right” way to do this, but the act of depersonalizing anxiety away from themselves and asking questions of their anxiety like, “Why are you here?”, “What do you want from me?”, “What can I learn from you?” “Where is God in the midst of this anxiety?”, are super helpful in making it friendlier, and the process itself can sometimes lead to answers and next steps for the adolescent.
5. Practice working through the anxiety
I have come to realize more and more in my work as a therapist that insight alone is not enough. It’s not enough to simply know that we are anxious, or that a certain underlying feeling is the trigger for anxiety. We have to take that insight and put it into practice, and when we do that, I believe we will see the transformative change we are looking for. Psychologist Angela Duckworth, in her book Grit: The Power and Passion of Perseverance, describes the role “deliberate practice” plays in cultivating change. I have seen that when adolescents practice working with and through their anxiety, they experience more victory over it.[Read more about Grit from FYI, and why it may matter more than grades.]
Here are some specific ways that a teenager can practice working out their anxiety:
- Start with: Help an adolescent identify a specific area of life where they have anxiety. Then explore with them if there are some specific and tangible “baby steps” they can take to face the anxiety head on. Plan those steps out together, and encourage them to experiment with each one. For example, since anxiety can be socially isolating, I might encourage something like this: 1) Walk through a busy part of campus (hallway, cafeteria, etc.) and simply notice what they feel and think. Don’t do anything else for a couple of weeks. 2) Then I might encourage them to find just one person they know and strike up conversation with them. Try this over a few weeks. 3) Then as that friendship develops, I might encourage them to share just a little with that friend about what they are struggling with in terms of anxiety. You could go through a progression of steps like this with many topics, such as anxiety around giving a speech, or trying out for a team, or for feeling overwhelmed with homework. The more you know a teenager, the more you will be able to speak specifically into their experience. The key is to keep the teenager from isolating themselves and letting anxiety take over their day-to-day experience. Instead, look for small, achievable experiences that work in helping the adolescent face and work through their specific anxieties.
- Advanced tactics: Teach the young person to walk through these steps when they feel anxious: a) Say what you feel: e.g., “I feel inadequate.” b) Say what you normally do: e.g., “I normally become anxious.” c) Say your truth: e.g., “The truth is that I’m capable and have what it takes.” d) Say what different action you will take: e.g., “I am choosing to face my fears and have this difficult conversation/apply to that school/end this relationship/try out for this team.” This practice brings awareness to the automatic processes in our brain and body, and by bringing attention to these processes, helps us emotionally regulate and position ourselves to make a different, healthy choice. (And again, I’m indebted to Terry Hargrave’s restoration therapy model for developing this process).
Rising above the tide
I have spent a majority of my life struggling with anxiety, and it is through these key approaches that I, and those who I counsel daily, have found freedom.
It’s not that I am no longer anxious, but rather I now see anxiety as a voice within that helps give me direction when I experience anxiety. Is this anxiety here to crush me? Should I avoid it? Or can it be a tool for growth? Is there something I need to pay attention to in my current patterns? Could this anxiety act as a helpful guide to me? For example, the anxiety may simply be an indicator of fear that is keeping a student from trying out for a part in the school play. Or perhaps it is keeping a student from making new friends in school. This is where anxiety might be saying, “We need to work through these fears in order to live in freedom.”
Sometimes we do sense that anxiety requires more than the practices described in this toolkit. For example, if you encounter a young person whose anxiety is so overwhelming that you fear it may endanger their life or the lives of others. Or perhaps the adolescent’s anxiety is impeding their ability to set healthy boundaries or make wise choices. This is where anxiety may be saying that it’s time to see a therapist, to see a psychiatrist about medication, or to look for inpatient options to help treat anxiety’s debilitating effects.
Kierkegaard declared that “anxiety is our best teacher.” And it has been through the loving care of those responders in my life—a thoughtful college chaplain, two insightful therapists, a helpful mentor, a loving wife, and a faithful God—that I have been able to see anxiety as a teacher in my life, and to use it as an agent of transformation.
I believe you too can be that caregiver who helps a young person transform their anxiety for good. You can be the guide who helps an adolescent best understand the role of anxiety in their lives, and discern what to do with it. Then instead of being overcome by the drowning waves of anxiety, teenagers in our lives can see the tide when it’s rising and step to higher ground.
 Benoit Denizet-Lewis, “Why Are More American Teenagers Than Ever Suffering From Severe Anxiety?” New York Times Magazine, October 11, 2017.
 Benoit Denizet-Lewis, “Why Are More American Teenagers Than Ever Suffering From Severe Anxiety?” New York Times Magazine, October 11, 2017.
 See the American Association of Depression and Anxiety, http://www.aada.org.
 I wrote more about this in The Anxious Christian: Can God Use Your Anxiety for Good? (Chicago, IL. Moody Publishers, 2012).
 You may find this podcast episode on the Pain Cycle helpful, and here is a downloadable PDF that helps identify feeling words that often underlie anxiety. You could also utilize something like Think 2 Perform’s Feeling Word Vocabulary tool.
 You can find instructions for the box breathing technique easily in an online search.