SALT LAKE CITY — When Em’s history teacher assigned a research project, the Salt Lake sophomore, 15, felt her stomach lurch. Weeks before the due date, she’s already worried about what could go wrong. Like any assignment, she’ll sketch it out repeatedly to see how it fits. But the hours researching, distilling, then mapping it will not bolster her for the class presentation, where she’s supposed to briefly explain the poster.
She expects that to be a spectacle: five minutes of misery she says she’d gladly swap for a barefoot jog on barbed wire. She’ll visibly tremble. Her voice will shake and sound reedy. Her eyes might tear up, though she tries to seem composed. Jagged breathing will make kids who don’t know her well wonder if they’re witnessing a medical crisis — and in a way, they are.
Her anxiety is ferocious.
Em takes great care with her appearance, too, rising before dawn to get ready. The wing on her eyeliner takes the most time and she sometimes has to wipe it off and start over. She constantly compares herself to peers, but doesn’t want to be noticed, so she never speaks up in class. She avoids making phone calls. If she must, she steps away and whispers.
At night, sleep eludes her as she frets over the job she may not get after college, years away. She thinks she might not get into college. That spirals into dread over school debt and whether she’ll be able to afford an apartment and ….
Her heart pounds and her head aches a lot. She’s usually tired.
Em’s not unusual.
Anxiety — the keep-you-up, leave-you-immobile variety — is this generation’s brick wall. Millions of youths struggle with it. Experts estimate one-fourth of teens — and as many as one-third of teen girls — have an anxiety disorder. That classification includes phobias, generalized anxiety disorder, panic disorder and social anxiety. These are not insignificant problems, and they often travel with depression and other mental health challenges.
Source: National Institute of Mental HealthOf the nearly 75 million children under 18 in 2015, the U.S. Census Bureau estimated more than 17 million had already experienced a diagnosable mental disorder — the equivalent of the entire populations of Utah, Idaho, Arizona and Colorado today.
While experts in clinical practice say the numbers are increasing, there are no exact counts of how many experience anxiety disorders specifically because anxiety is so under-diagnosed, medical professionals say. There are disparities in some counts and many oft-cited statistics are dated, but most experts agree crippling anxiety is growing. And the numbers experts do offer are staggering.
New York-based The Child Mind Institute says nearly half of American youths will have experienced a mental illness by age 18, more than 1 in 5 a “serious impairment.” In 2016, for the first time, most students entering college described their own mental health as “below-average,” says the Center for Collegiate Mental Health, housed at Penn State. Of 161,014 students seeking mental health services on college campuses last year, 70-plus percent listed anxiety as a concern and 24 percent called it their primary concern.
Those numbers reflect students who asked for help; 80 percent of anxiety sufferers don’t, the institute says, though anxiety is treatable.
That’s bad news for young people, their families and their futures: Untreated anxiety can play into later panic attacks, depression, separation anxiety disorder, behavioral problems, drug use, social phobias and even suicide.
“There is an attitude in the U.S. that if you have a mental illness, it’s linked to a character defect, linked to laziness, bad parenting ... it’s your fault, ” says Jeff Szymanski, executive director of the International OCD Foundation, a Boston-based nonprofit that includes individuals with obsessive-compulsive disorder, their families, mental health professionals and researchers.
We don’t ask, “‘What did you do to develop pancreatic cancer?’” he says. “People (don’t want) to be mentally ill. It’s not because they’re not trying to get better.”
Because of the stigma people may attach to mental illness, the Deseret News agreed not to use the last names of the teens interviewed for this story.
Why anxiety happens or how to manage it lack easy answers, though there are plenty of theories and strategies to explore. But experts unite on this: The costs are far too great to ignore.
Since January, Deseret News reporters have talked with dozens of experts, parents, therapists, teachers and teens, visited college and high school classrooms and pored over academic studies. They’ve sat in on treatment sessions, family conversations, meditation events, community panels and professional lectures.
Here's what we've found:
“Everybody is going to experience anxiety at some point. We expect a little bit of anxiety when a big test is coming up or it’s the first day of school,” says Torilyn Gillett, school counseling programs specialist for Utah’s Canyons School District. She says what’s troubling is anxiety that persists and inhibits one’s ability to function and meet everyday responsibilities.
Junior- and high-school teachers and counselors say overly anxious students have trouble learning and often miss school. They compare themselves to friends in social media and in person, yet struggle to build and maintain relationships. They fail to make and keep commitments. They can’t pay attention, eat or converse. Just getting out of bed is sometimes tough.
Challenges often persist into college, stalling students from launching into a fully adult future. That grown-up world does not entice anxious teens: Relationships look daunting, holding down a job seems difficult and maintaining a lifestyle that includes enough sleep and nutritious food feels overwhelming.
To dull crippling worries, many anxiety-ridden youths turn to self-harm, drugs, drinking or even suicide.
Research in the Archives of Disease in Childhood, an international peer-reviewed journal produced by The Royal College of Paediatrics and Child Health in the UK, notes a “significant public health burden associated with anxiety disorders in children and young people.”
Yet some parents, grandparents or educators dismiss those disorders — believing today’s struggles are no worse than those they faced decades ago.
David Derezotes thinks “maybe every generation thinks the one that follows had it easier than them, yet complains too much.” But he sees students battle anxiety daily at the University of Utah, where he teaches social work and directs the Peace and Conflict Studies Program. In truth, today's teens and young adults have grown up with big changes, from social media to terrorism, school shootings, environmental degradation and more.
The suffering is real.
“If they don’t get help, it stifles their growth as people because they question what’s wrong with them — why they can’t do this or that. It hurts them,” says John Ogden, licensed clinical social worker and outpatient therapist with West Ridge Academy in South Jordan. “They don’t want to feel the way they feel. It’s not fun.”
Still, experts preach hope. Parents and teens are not helpless in the face of anxiety disorders, and healing is possible, though it’s often a rough road.
Wendy, a Murray mother of four, said three of her children have struggled to varying degrees with anxiety, depression and phobias. She said talking to the Deseret News let her drop the facade of perfection and she encourages others to do the same.
She shakes her head remembering one of her children asking, “Hey Mom, why does our family have issues when everyone else doesn’t?”
“If we weren’t so afraid of being judged, maybe we would judge less,” she says. “If we stopped worrying about what people thought, (we could) start noticing what people need.”
What’s going on?
Fear is the brain’s natural, biological response to perception of a specific threat, the fight-or-flight order from the brain’s tiny, almond-shaped amygdala to the adrenal glands: “React!”
Anxiety is the sense that something’s wrong, but with fewer or no specifics, says resilience expert David Pincus, a psychology professor at Chapman University in Southern California. Instead of a clear reaction, the body gets stuck on high alert. Telling yourself not to feel anxious usually makes it worse, while avoiding what triggers it maintains the unsettled emotion.
For someone with a healthy anxiety response, an adrenaline boost motivates, allowing one to run faster in a basketball game or be alert to danger on the road.
Anxiety becomes problematic when the brain overestimates the threat, says Jonathan S. Abramowitz, clinical psychologist and professor of psychology and neuroscience at the University of North Carolina at Chapel Hill.
Things that are relatively safe feel dangerous, he says. What some would consider merely a nuisance becomes catastrophic to a highly anxious teen. Asking a teacher about an assignment is daunting; dating is nearly impossible.
Boys tend to lash out, while girls cry, according to Utah therapist Jenny Howe and other experts. Some anxious teens wear a class-clown mask or laugh all the time. Avoidance — of people, experiences, classes — is common. Others shed inhibition and hide emotions behind risky behavior like impulsive sex.
Worry unites them — usually excessive and often without reason. They fret over a mix of controllable and uncontrollable factors — everything from how they’ll do in school to natural disasters, world wars, finances, test scores, health, tardiness, how many bracelets to wear. ...
Consider what teens see and hear today — and how different it is from what previous generations faced.
Today’s teens never knew the pre-9/11 world. Kindergartners now have a song to sing while practicing active-shooter drills. Teens watch 24-hour news reports of increasing racial tension and world conflict, and witness incredible levels of incivility at the highest levels of government.
Even day-to-day adult life seems harder and more expensive. Today, the richest fifth of Americans hold 90 percent of the nation’s wealth, and teens are told they’ll be among the first who won’t outperform their parents financially. They hear that affordable housing is nearly impossible to find and experts predict Social Security won’t exist when they’re ready to retire. Higher education — touted as the key to save them — may leave them awash in debt. The Institute for College Access and Success says “average student debt at graduation in 2016 ranged from $20,000 in Utah to $36,350 in New Hampshire.”
It’s no wonder anxious college students either “withdraw and give up or they get even more desperate and work harder and harder and harder,” says Derezotes. “We call the kids that get desperate and work harder ‘healthy.’ I don’t think they’re healthier. They’re suffering.”
That’s not all that’s changed for modern teens. San Diego State University psychology professor Jean Twenge started a virtual panic attack when she raised awareness of correlative data between smartphone ownership and the rise in teen anxiety, depression and suicidality. Pew Research Center reports 95 percent of teens have a smartphone, and Common Sense Media found teens average nine hours with entertainment media daily, shaping their social sense of self and disrupting circadian rhythms because kids are Snapchatting instead of sleeping. Pew also reported that 45 percent of teens proclaim themselves online “almost constantly,” which promotes comparisons, envy and FOMO — fear of missing out.
Once online, today’s “rules for social engagement” have changed, in that “it’s OK to say almost anything to anybody at this point and call it free speech, or call it a joke,” says Lisa Feldman Barrett, University Distinguished Professor of Psychology at Northeastern University, with appointments at Harvard Medical School and Massachusetts General Hospital.
Over time, these “casually brutal” conversations, combined with a shortage of sleep, lack of exercise and nutritionally deficient food are creating people with imbalanced “body budgets,” she says.
“It’s not that surprising to me that (teens) are walking around stressed all the time; their baseline level of distress is higher than it used to be,” Barrett said. “These disruptions take a physical toll on the body, but teens don’t feel it as physical illness, they feel it as distress.”
Parenting trends don’t help, either.
A desire to protect and help children has given rise to helicopter and snowplow parents who hover over or clear the path for their kids. When kids aren’t allowed to try and fail, and try again, they don’t develop skills, resilience and self-confidence, but instead look to their parents to do the hard things, believing themselves incapable.
These same loving parents also try to isolate their kids from risk — from curbing unstructured outside playtime to running interference on even minor issues with a child’s teacher, instead of teaching kids what to do if something goes wrong. These parents may also overgeneralize, as University of Cambridge research points out that after a child abduction or a concert shooting, for example, kids are kept indoors and people avoid concerts. Compounding it, Northwestern University research showed people may “catch” fear and anxiety from seeing peers behave fearfully.
Dr. Celine Gounder believes some teenagers are more likely than others to struggle with anxiety and mental health issues, including LGBTQ youth who are more often bullied and may struggle to fit in. Deployment and moving around puts military families at risk of increased anxiety, says Gounder, an internal medicine and infectious disease specialist who hosts the In Sickness and in Health podcast. Kids in destabilized home environments have higher rates of substance abuse and are more likely to join a gang seeking a protective environment, she says.
“Dreamers,” the teens and young adults brought into America as kids without legal immigration status, have extraordinarily high levels of anxiety because their situation is so tenuous, and experts are already worried about the long-term mental-health impact of parental separation on the hundreds of young children in tender-age shelters.
Finding hope
None of that is on Christine’s radar as she sweeps a paintbrush back and forth across her canvas on a recent Friday in Murray, an inky blue sky melting into a shadowy charcoal landscape. She’s careful but her hand moves easily. White stars accent the scene, a blending of northern lights and the Milky Way galaxy.
The peaceful image is an attempt to calm her mind.
Christine, 17, third of Wendy’s four kids, has struggled with anxiety and depression since she was 9, constantly worried people judge her or just pretend to like her. She’s so fearful of not being liked that she’s willing to “bend over backward to make sure it doesn’t happen,” she says, often lending time and money and expecting nothing in return.
She was 15 when her severe panic attacks started. A trumpet player in her high school band, she’d often leave band class to cry in the bathroom. Sometimes, friends would find her huddled under the bleachers before games.
That’s when it got unmanageable, she says. “I couldn’t do the things I love.”
Christine’s anxiety stops her from ordering her own food at restaurants because she’s terrified to talk to the server. When it gets bad, her communication with everyone shuts down, while her room fills up with laundry and she stays in bed. On those days, existing plans are scuttled so the family can drag Christine to a nearby park to decompress.
These are not imagined problems or created difficulties, but real, painful experiences — stemming not from lack of motivation or poor self-control, experts say, but an overactive brain that in many cases lies to its owner.
Anxiety doesn’t just hijack the brain, it also stakes out spots in the body, leading to migraines, nausea or muscle tension. Knowing what anxiety looks like can help parents understand when a child complains of a daily stomachache before school, wakes up repeatedly at night or refuses to eat.
A youth may seem hypervigilant or sluggish. Often, an anxious teen startles readily and may hyperventilate, tremble or sweat, among other physiological responses.
Bobby, 17, gets headaches almost daily, and occasionally has what he thinks are panic attacks. He hyperventilates, starts to feel numb and either gets “loopy” or almost blacks out.
His doctor thinks his headaches might result from poor posture and pinched nerves, becoming attacks, while his therapist thinks his stress load triggers anxiety and sends him spiraling.
An incoming senior at Murray High School with a 4.0 and president of his peer leadership team, he knows he’s “definitely more stressed” than his friends.
He vacillates between moments of healthy stress that propel him to work multiple jobs and take concurrent high school/college classes and negative stress that makes him stew over one question on a math test where he may have added an unnecessary minus sign. (In English, he had a 130 percent until his teacher dropped it to 100 percent because it was “too much.”)
“I feel like with teens ... it kind of all comes down on us all at once,” Bobby says. “Some people ... have really good ways of dealing with it ... and I’m learning how to deal with it, but sometimes it’s hard.”
He’s been seeing a counselor, which has helped him talk about his emotions and his worries regarding the future, but he also de-stresses by talking to friends, spending time with his girlfriend and playing video games — his favorite is League of Legends. He’s a meticulous planner, taking notes throughout the day on his smartphone, which for him is a tool, not the source of anxiety.
“If I can just really learn to take advantage of stress management skills that I’m trying to learn, I feel like I’ll be OK,” he says. “I’ll survive.”
Treatment providers believe the first step to conquering anxiety is confronting it — “name it to tame it.”
“I don’t care if we call it ‘anxiety’, ‘fear,’ ‘the worry bug,’ ‘stupid head,’ we gotta put a name on the problem so that as parents and teachers we can talk about how to fix it, as opposed to how to fix you,” says Matt Swenson, child and adolescent psychiatrist and medical director of Utah Valley Psychiatry and Counseling Clinic in Provo.
In coming stories, the Deseret News will explore in detail how communities, families and individuals are tackling anxiety through medication, therapy, social changes and more.
But there are simple things that can help right now — like improving sleep hygiene by using an alarm clock instead of a cell phone to avoid distractions, and confronting the things that might be worrying us.
Utah therapist Howe remembers taking her daughter, 9, and her friend to an ice cream shop several years ago. The friend told Howe the flavor she wanted, and Howe’s daughter immediately countered with, “My mom is going to make you order for yourself,” then rolled her eyes and added, “She calls it ‘exposure.’”
Howe believes kids should be required to do a variety of little things that may initially seem unpleasant or uncomfortable, to learn the valuable lesson that they can do hard things.
"Avoidance is really a key piece of anxiety," she says. "We are so unwilling to be uncomfortable right now. We want food delivered to our door, we don’t even want to leave our house.”
As a therapist, she uses tough love and exposure therapy — a subset of cognitive behavioral therapy — to help anxious people confront things that trigger them, recalibrating their brain’s responses and rewiring reactions.
When someone can sit and acknowledge their anxiety for a few minutes, instead of trying to avoid it, the brain realizes it’s not really a life-or-death situation and will eventually calm down.
“You’re going to feel anxious the rest of your life, so get comfortable with this feeling,” Howe says. “We are anxious about being anxious and that just reinforces the cycle of avoidance, which has created where we’re at in our society.”
To break the cycle, experts encourage parents to consider their own behavior:
- Let kids do it. Many parents order their kids’ ice cream, e-mail their teachers, or solve their friend problems — depriving kids of experiences and conveying the unintended message that the child is incapable. Teens internalize that and thus see experiences as something to fear. “The more kids practice something, the less anxious they are going to be,” says school counselor Gillett.
- Own your own anxiety. When parents panic about their child’s future, including pushing them to get into a great college, it creates “anxiety and pressure on steroids,” says Gounder.
- Help kids learn “soft skills.” Parents may erroneously assume teens know how to do something — talk to an adult, solve problems face-to-face, label emotions — when instead teens need to be coached directly and placed in situations requiring those skills.
- Take time to be still. Everyone can benefit from mindfulness practices and stress-reduction exercises. Mindfulness should be practiced daily to accrue the research-proven benefits, but even 10 minutes will do — and there are apps for that.
- Be kind. Teaching teens positive self-talk helps curb negative self-talk. Help teens recognize failures as chances to grow, not personal weaknesses.
- Get moving. Exercise releases beneficial hormones that fight anxiety. Sports help teens exercise, make friends and learn to handle winning and losing.
- Find a higher power. Embracing spirituality provides teens a sense of something bigger than themselves.
- Limit phones. Get phones out of the bedroom and set a curfew for nightly screen use to limit blue light exposure that messes with sleep patterns.
- Get support. Maybe this means inpatient treatment, seeing a counselor once a month or confiding in Grandma. Anxiety often makes teens feel isolated, so a support network is vital.
Above all, experts encourage hope and emphasize that anxiety is not the enemy. Feeling anxious is normal — a biological function that has kept humans alive throughout history. But in moments where it rages out of control, there are people who care and interventions that work.
“People who get the appropriate help, most of them get better, it’s not something they have to live with for the rest of their life,” says Ryan Regis, safe schools clinical coordinator for Davis School District and a therapist who’s worked with children and adolescents for 23 years. “That’s what I’d like people to hear — you can get through this. You can get help.”
Christine recently graduated from a treatment center for anxiety near her home after three months of outpatient day treatment followed by several weeks of outpatient classes.
She did schoolwork and yoga, obstacle courses and pool noodle soccer with beach balls, and ate with other students at lunch to overcome the fear that no one likes her.
She learned to stop thinking in binary absolutes, or to assume people will reject a request she has yet to make. Now she puts her thoughts “on trial” and demands evidence from her brain to support or reject her worries, and she talks about her feelings, because the more she ignores something, the bigger it gets.
“The only way to get rid of an emotion is to go through it,” she says. “It’s a matter of sitting with the discomfort (and saying), ‘This is how I feel, I’m not going to die today, it’s not going to be the end of my world.’”
Her other major treatment take away? She’s not alone.
Along with that reassurance and her tools, this summer is already going better than last year’s.
Her anxiety isn’t gone, but there’s less of the terrifying variety. And now, on days she wants to stay in bed, she can talk herself into getting up.
“I feel like I’ve come far,” she continues. “At first, it was an excuse that I used, where it’s ‘Oh, I have anxiety, I can’t do this.’ (Now it’s) ‘OK, I have anxiety and I’m going to try to do this.'”
Editor's note: In coming months, the Deseret News will explore how anxiety impacts adolescents, zero in on who’s suffering and why, and highlight solutions. We’ll look at how the creation of anxiety medications changed society’s view of the disorder. We’ll share stories of unique pressures girls face and why boys may simply give up unless they have good role models. We’ll explore innovative campus and community efforts and share experts’ advice and families’ experiences. We hope readers will join the conversation in-person at a series of events and through online comments and contributions.
Correction: An earlier version incorrectly stated the type of treatment Christine attended for anxiety. She graduated after three months of outpatient day treatment and outpatient classes, not inpatient treatment.