The Deseret News is exploring why teens are more anxious than ever and how families and communities can help. This is the latest in a multi-part series.
SALT LAKE CITY —
More U.S. teens than ever say they’re feeling overwhelmed by their anxiety. Doctors and therapists are booked solid.
The trends are alarming, spurring studies, books and, here at the Deseret News, a yearlong series of stories and events.
But a reader could be forgiven for wondering: Are today's teens really overwhelmed by their anxiety like never before? Or are they less resilient and therefore more likely to describe everyday stresses as overwhelming?
Both explanations might hold some truth.
It's possible teens have a lower threshold for what they label as anxiety, yet teens have been experiencing more symptoms of anxiety, too — nonsubjective experiences such as shortness of breath, trouble sleeping and racing heartbeats.
There’s no clear consensus on why this is happening. Persuasive research connects rising anxiety to almost every imaginable factor, including air pollution, decreased religiosity, gut bacteria, vaccines and income inequality.
Source: National Institute of Mental HealthBut some of the most popular explanations might surprise you: The very things that tend to make us think life should be easier for today's teens — space-age devices, limitless opportunity and doting parents — might be stoking teen angst.
And maybe it's also that teens are viewing their anxiety, itself, as something to worry about.
Is the struggle real?
People are Googling "anxiety" twice as much as five years ago. As public schools conduct daily mindfulness exercises, an online retailer sells stigma-defying T-shirts that read “ANXIOUS AND COURAGEOUS.”
The website BuzzFeed has published four compilations of humorous anxiety-related social media posts, many of which cast anxiety as a diabolical internal voice that seeds doubts for fun.
Anxiety is trending, and Philip Kendall says it seems to have become the disorder du jour that depression, anorexia and attention deficit hyperactivity disorder were in past decades.
Kendall, director of the Child and Adolescent Anxiety Disorders Clinic at Temple University and a leader in the field of cognitive behavioral therapy for youth anxiety, says teens also use (and misuse) mental health jargon in day-to-day conversation.
On a bad day, they’re “depressed.” If they’re feeling happier the next day, they’re “bipolar.”
“These kids are defining themselves by their, quote-unquote, ‘mental health condition.’”
His clinic recently treated a girl whose legitimate phobias had prevented her from going to school and led her peers to call her “Phobia Girl.” After she was persuaded to come to the clinic — no easy task — she overcame many of those phobias. But she didn’t want to give up the nickname.
Yet Kendall and other practitioners don’t dispute that teen anxiety is on the rise — some of it pathological, like Phobia Girl’s, and some of it as a proportionate response to challenges faced by today's youths, from heightened academic expectations and campus shootings to gloomy economic projections and climate change.
Between fall 2008 and fall 2017, college students became twice as likely to have been treated for anxiety within the past year, with anxiety overtaking depression as the foremost concern at campus counseling centers. (See box for more stats.)
John Walkup, chairman of the psychiatry department at Lurie Children’s Hospital in Chicago, says diagnoses may have been fueled by a better understanding of treatment options, which includes his own seminal 2008 study about a combination of antidepressants and cognitive behavioral therapy for treatment.
But is anxiety actually increasing?
Allan Horwitz, a professor of sociology at Rutgers University and author of “All We Have to Fear: Psychiatry's Transformation of Natural Anxieties into Mental Disorders” and “Anxiety: A Short History,” said people have long claimed that anxiety is on the rise.
“You can go back centuries and find quotes that are almost identical to what we hear today,” he said. “I think back to when I was a young person and there was a possibility of a nuclear holocaust and missiles in Cuba. ... There have always been lots of things to be anxious about."
Holed up with their FOMO
Millennials grew up amid constant disruptions to the American lifestyle: Affordable and intuitive personal computers. Widespread, speedy internet. Portable phones. And, eventually, devices that combined the best of everything.
Today’s teens? They grew up not knowing anything else.
Whether you call them post-millennials, homelanders or, as San Diego State psychologist Jean Twenge proposes, iGen, many teens are tethered to their devices all day and fall asleep beside them at night.
Twenge researches generational trends, from boomers to Generation X to millennials and today’s teens. Around 2012, she began to notice that in annual surveys of college students, traits like loneliness and anxiety were spiking dramatically after decades of more gradual change.
Edward Shorter, a University of Toronto professor and author of “A History of Psychiatry,” believes social media is taking the place of face-to-face interactions, which tend to promote connectedness and reduce anxiety.
“We haven’t had technological changes of this magnitude ever,” he said.
Twenge acknowledges in her book "iGen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy — and Completely Unprepared for Adulthood" that there's a chicken/egg question: Teens may be using their devices more frequently because they’re lonely or anxious, as opposed to being lonely or anxious because they’re using their devices.
But she believes it’s more likely that devices are worsening what’s come to be known as FOMO, or fear of missing out. Social media gives teens the perception that others are having more fun without them and makes them constantly assess whether they are spending their time in the “right” way.
Barry Schwartz, a longtime psychologist and economist who wrote “The Paradox of Choice: Why More Is Less,” said a teen’s self-esteem also suffers from constant comparisons to their peers’ best selves.
“You don’t post pictures of yourself brushing your teeth or folding your laundry,” he said. “You’re seeing your friends and their perfect lives, and your life sucks.”
Washington, D.C.-area psychologist Mary Alvord, an author of “Conquer Negative Thinking for Teens,” said social media may have its pluses, too. For instance, it may give shyer kids a means to connect that they wouldn’t have had in past eras.
Alvord said after a recent Pew report found that 31 percent of teens feel social media mostly benefits them, many headlines focused on the 24 percent of teens who consider it a negative influence.
Kendall says technology has probably contributed to teen anxiety levels, “but it’s not the prime mover.” He compared the current discussion of social media and cellphones to the debate over television and child violence.
“For years, they were studying the effects of television programs on child violence,” he said. “What they found was that aggressive kids watched more aggressive television.”
The consequence of caring
Kendall believes teens have legitimate reasons to be fearful.
The Twin Towers tumbled to dust before some of them were born. They never knew an airport security line without body scanners or schools that didn’t have regular lockdown drills in case of a shooting.
But Kendall says much of their anxiety has a far less malevolent source: Mom and Dad.
A race for the “superkid” — worrying about college essays from the early stages of child development — has coincided with what experts say is a tendency for today’s parents to be overprotective and hyperinvolved.
A 2015 Pew survey found that about 3 in 5 parents felt they were sometimes overprotective. Twenge notes that parents of this generation have also become more likely to know at all times where their teens are and whom they're with.
The takeaway for youths can be that without their parents, they’re sunk. And not only can that insecurity become a source of considerable anxiety, it may also cause teens to avoid situations that would otherwise hone their coping skills, such as jobs or social gatherings.
Ian Robertson, an Irish clinical psychologist who wrote “The Stress Test: How Pressure Can Make You Stronger and Sharper,” said it’s not that today’s teens are “precious," or inherently more fragile than previous generations.
But just as one study suggests children from especially clean households are more prone to allergies and asthma, today's teens aren't building a tolerance to life's challenges.
“People with a lifetime of anxiety do less stuff,” he said. “Because they do less stuff, they get less opportunities for discovering things about themselves.”
In his book "Free to Learn," Boston College psychologist Peter Gray argues that an emphasis on schooling and adult supervision has led to a deficit of playtime. The result is that children are deprived of the “hunter-gatherer” education he received as a child in the 1950s, prowling the neighborhood and learning how to overcome boredom and adversity.
The 2015 Pew survey said today's average parent figures their child needs to be 14 before they can spend time in a public park unsupervised.
Alvord has worked with teens for nearly four decades, sometimes speaking about resilience at elite schools attended by the children of presidents and congressmen, where middle schoolers are panicking about their college applications and kindergartners focus entirely on academics.
“When I went to kindergarten, we played,” she said.
At 12, Alvord rode the New York subway unsupervised with a friend. Once, when they got off at a wrong stop in what seemed to be a less-than-hospitable neighborhood, they solicited the help of a friendly-looking stranger to find their way home. They made it home, and "that gave us confidence," she said.
The concept of exposure therapy, or facing your fears, is a cornerstone of cognitive approaches to treating anxiety. But Kendall said parents are increasingly letting their children retreat from their fears, and their children are becoming more adept at using physiological symptoms, like a stomachache, to excuse avoidance.
A majority of his patients’ parents tell him they know they should put their foot down, he said. But “it’s just so hard,” they say: “‘When he gets upset, it’s so much easier to just give in.’”
The curse of opportunity
Pennsylvania’s Swarthmore College is reliably rated as one of the nation’s top liberal arts schools, with a 10 percent acceptance rate in 2017.
And yet, about 15 years ago, many of Barry Schwartz's Swarthmore students stopped doing his assigned readings, accepting that their grades would be docked.
“What I came to realize, slowly, is it wasn’t because they were lazy or irresponsible,” he said. “It was because they were facing all these decisions about their lives that previous students didn’t have to face very much.”
They were paralyzed, said Schwartz, who has written about the anxiety-inducing effect of excessive choice in the modern era and the "too muchness" faced by today's youth.
He took pity on his students, assigning them less work. And he stopped asking seniors what they were going to do when they graduated, knowing “it was the last conversation they wanted to have.”
“They get a job at Starbucks hoping that one morning, they’ll wake up with an insight about what their future lives will be like, and it doesn’t happen,” he said.
Today’s youths feel pressure to pick the perfect college, the perfect career, the perfect spouse — all while having what experts describe as diminished faith in themselves, less life experience and worse coping skills.
And parents’ attempts to soothe their teens may have the opposite effect.
Explained Walkup: “When a parent says, ‘All I want for my kid is to be happy,’ that puts enormous pressure on that kid to be happy for their parent. In the bad old days, it was, ‘I just want you to get out of the house and get a job.’ Maybe the expectations were a little bit more concrete.”
Walkup tells parents that being happy is a byproduct of being competent and confident in your life choices, not stopping to obsess over every fork in the road.
“The other thing that modern families say is, ‘Sweetie, you can do anything you want. You are really smart and really talented,’” he said. “That sounds like an affirmation … but it also puts enormous pressure on a child.”
Walkup says a parent’s focus should be on the developmental tasks that are appropriate for a child's age — not their prospects to become president.
At age 3, for instance, that means eating, sleeping and toileting. As teenagers, they need to master their emotions and build social relationship skills. Parents should affirm those goals.
While it may seem kind to tell an aspiring young musician that she might one day play Carnegie Hall, Robertson said such feedback too often creates a “dangerous itch” that can’t be scratched.
Teens should be encouraged to judge themselves by their own values. If their passion is the violin, they should focus on the intrinsic satisfaction of improving, day by day.
Carnegie Hall may not be a legitimate possibility. But should they have to resort to duller work to pay the bills, that’s OK: At least they’ll still be fulfilled by their music.
Anxious? Try being excited, instead
The efficacy of serotonin reuptake inhibitors in treating anxiety has been so often challenged and then again supported by clinical trials that it’s nigh impossible for a Googling layperson to make heads nor tails of the drugs, which are known as antidepressants.
Their skeptics even include some psychiatrists, who’ve admitted they prescribe them without knowing for certain how well they stop anxiety, or why they would, precisely.
And there are those who believe that by marketing their drugs to mental health professionals and consumers alike, pharmaceutical companies have fueled a perception that normal emotions constitute a medical disease, and that anxiety itself is something to worry about and not — as it once was — something to push through.
Most experts who spoke to the Deseret News said severe anxiety can become a serious impediment to a teen’s well-being, and that in those cases, teens often benefit from professional treatment — whether it’s cognitive behavioral therapy (CBT), medication or the combination supported by Walkup’s 2008 study, in which 80 percent of child anxiety sufferers ages 7 to 17 saw “much improvement” after three months. For more on drugs used to treat anxiety, click here.
But some pharmaceutical skeptics decry the industry's role in creating what Ian Dowbiggin, a professor at the University of Prince Edward Island who studies the history of medicine, refers to as an “illness-breeding” and “illness-affirming” society.
“If you have to do a report in class and you get the butterflies in your stomach, you’re told that’s natural, and you’re not to blame,” Dowbiggin said. “You’re, in a sense, a victim of outside sources, and therefore it’s OK to be anxious. I think that has a lot to do with the fact that a lot of young people today report their anxiousness.”
Christopher Lane, a Northwestern University English professor and author of “Shyness: How Normal Behavior Became a Sickness,” said he was alarmed to learn how many of his students were being prescribed medications after reporting temporary stresses from things like exams.
Lane has written that the definitions in the American Psychiatric Association’s industry standard Diagnostic and Statistical Manual of Mental Disorders, or DSM, were arrived at arbitrarily and unscientifically. And pharmaceutical marketers have capitalized on the ambiguity, he said.
In a full-page Paxil ad that ran in the American Journal of Psychiatry in 2003, a woman looks downward as a floppy hat obscures the top half of her face, under the text: “Is she just shy? Or is it Social Anxiety Disorder?”
The latest DSM definition says that adults have generalized anxiety disorder when they experience three of these symptoms more days than not for six months: 1. restlessness, 2. fatigue, 3. difficulty concentrating, 4. irritability, 5. muscle tension, 6. sleep problems. For a child, only one symptom is required.
Lane said the vast gray area between normal nervousness or shyness and pathological anxiety makes it inevitable that SSRI drugs have been overprescribed, bringing with them side effects (including, in some cases, anxiety) and dependencies that partially self-fulfill the original diagnosis.
“[T]here are a great many inexpensive, harm-free ways to treat anxiety without medication,” he wrote in an email to the Deseret News. “Some leading psychiatrists prescribe walking, for centuries known to help calm the worried mind.”
Not all anxiety can be beaten with a walk in the park. But Robertson said that, physiologically speaking, most anxiety looks no different from excitement.
That beating heart, dry mouth, churning stomach and sweat? It’s how your body prepares for action. “It doesn’t really care what kind of action,” he said.
Robertson said teens will sometimes become frightened of their own anxiety, which begins a self-propelling spiral downward into avoidance and withdrawal.
The power of reframing anxiety as excitement was demonstrated in a 2014 study conducted by Alison Wood Brooks, an assistant professor at Harvard Business School with a background in psychology.
Brooks invited college-age students to complete a variety of stressful tasks. Some sang Journey’s “Don’t Stop Believin’” in a karaoke game on the Nintendo Wii. Others delivered public speeches. Others were tested on their math abilities. All were treated in ways designed to freak them out.
And there was one constant: They performed markedly better when they were told to say “I am excited” or to “Try to get excited” before the test.
(“I am calm” or “Try to stay calm,” was no help at all.)
Said Robertson: “It’s just a mental shift to say these feelings I’m having, these are the feelings of when my team’s winning. It puts you into a mindset where you’re anticipating reward instead of getting punishment.”
With an increasing awareness of teen anxiety, the optimist can see an opportunity: Instead of being known as the most anxious generation, might they become known as the most excited?
Join the Deseret News Anxiety Community Facebook group for more information.