Counseling Children and Young Adults Who Suffer from Anxiety
Janet L. Castrignano
Messiah College
Abstract
Current research about children and young adults who suffer from anxiety and the treatment options that are available for them is discussed in this literature review. Numerous studies describe the effects that anxiety can have on a person’s educational level. Recent studies are outlined on gender differences in social anxiety disorder (SAD). Cognitive behavioral therapy (CBT) is a treatment of choice for children and youth with anxiety. The various techniques that have been developed to help patients with anxiety learn to manage strong emotions in everyday situations are also discussed. A study from mediation analyses and dismantling was conducted to examine the influence of stable medication used on anxiety during CBT and the unique contributions of mindfulness facets to stress is an important part of managing anxiety. This paper will discuss cognitive behavioral therapy and the role counselors can take on helping children with anxiety. A study done on the prevalence rates across urbanicity levels as well as barriers to mental health treatment in rural communities are outlined. Suggestions and interventions for counselors to use that may help them better understand and work with a child as well as young adults dealing with anxiety are outlined. Lastly, this paper discusses the differences between working with children with anxiety compared to young adults suffering from the same issues.
Keywords: social anxiety disorder (SAD), cognitive behavioral therapy (CBT), mindfulness-based interventions (MBIs), gender differences, prevalence
Counseling Children and Young Adults Who Suffer from Anxiety
Anxiety disorders are a very common mental condition in any age group. “Anxiety disorders affect one in eight children under 10” (Blanck et al., 2018 p.) and “6–7% of those under 18 years of age” (Bennett et al., 2013p.). According to Weaver and Himle (2017 p.), “anxiety disorders affect approximately one in four Americans over the life course”. According to Bennette et al. (2013 p.), “anxiety disorders can become chronic and interfere with how the person functions at home or at school”. They can become upset or uncomfortable and begin avoiding activities or people. “Experts believe anxiety disorders are caused by a combination of biological and environmental factors” (Blanck et al., 2018 p.). “Social anxiety disorder (SAD) is a common and debilitating psychiatric disorder” (Asher, Asnaani, & Aderka, 2017 p.). “Individuals with SAD fear they will act in a way that will be embarrassing and may lead to a negative impression by others” (Asher, Asnaani, & Aderka, 2017 p.).
Literature review
Many studies have been conducted on social anxiety disorders and the effects it has on different people. Age, gender, urbanicity level, and economical issues all have an impact on a person’s anxiety disorder. This literature review outlines some studies, treatment options, and research results found on anxiety in children as well as young adults.
Gender Differences of SAD
According to Asher, Asnaani, and Aderka (2017), “women have a higher prevalence of SAD than men. Compared to men, women are 1.5 times more likely to meet diagnostic criteria for SAD as well as seek treatment” (Asher, Asnaani, & Aderka, 2017 p.). The Epidemiologic Catchment Area study on the gender differences in SAD, found that “approximately 13,000 young adults aged 18–29 were diagnosed with SAD (Asher, Asnaani, & Aderka, 2017). Data from the National Comorbidity Survey (NCS), with a sample of over 8,000 individuals aged 15–54, also indicated a higher lifetime prevalence rate of 15.5% for women, compared to 11.1% for men with SAD” (Asher, Asnaani, & Aderka, 2017 p.). This article stated that a number of studies have demonstrated that “women with SAD endorse a greater number of social fears compared to men with SAD. Women with SAD were more likely to feel a desire to die and a desire to commit suicide compared to men with SAD” (Asher, Asnaani, & Aderka, 2017 p.). According to Asher, Asnaani, and Aderka (2017), “women with SAD reported significantly greater fear compared to men with SAD when interacting with authority figures, giving speeches in front of a large audience, and working while being observed by superiors. However, men with SAD were more likely to fear dating and social gatherings. Studies have shown that men with SAD are more likely to be employed on a full-time basis compared to women” (Asher, Asnaani, & Aderka, 2017 p.).
Treatment Options
Despite the high prevalence of anxiety disorders, only “one in three people with the diagnosable disorders seek treatment from professionals” (Weaver & Himle, 2017 p.). The study conducted by Bennett et al. (2013) stated that “anxiety that begins before age 18 often continues into adulthood and can result in a lifetime of diminished life quality characterized that include failed adult relationships, reduced income, and increased need for social welfare assistance”. Mindfulness-based interventions (MBIs) and Cognitive behavioral therapy (CBT) are two main treatment options used for anxiety.
Mindfulness-based interventions (MBIs). Mindfulness can be defined as “a specific form of attention that is focused on the present moment, is intentional, and non-judgmental” (Blanck et al., 2018). The mediation analyses and dismantling study showed a systematic review regarding the effects of stand-alone mindfulness exercises (SAMs) on symptoms of anxiety (Blanck et al., 2018). “Mindfulness-based interventions (MBIs) were also implicated to improve regulation of emotions and psychological well-being” (Medvedev et al., 2018 p.). Based on this meta-analysis, Blanck et al. (2018 p.) concluded that the “effects of mindfulness-based intervention for anxiety reduces the symptoms of anxiety”.
Cognitive behavioral therapy (CBT). “Cognitive behavioral therapy (CBT) is the psychotherapeutic treatment of choice for children and youth with anxiety and mood disorders” (Weaver & Himle, 2017 p.). Characteristics of Intervention Adaptations and Methodological Rigor of Studies Testing CBT for Depression and Anxiety Among Rural Populations or in Rural Settings were completed that reported findings regarding the influence of age on CBT treatment outcomes. The results show that “when adolescents receive CBT in efficacy research studies they benefit at a level similar to younger children. CBT uses problem-focused cognitive and behavioral strategies and work on changing behavior patterns and dysfunctional thoughts” (Weaver & Himle, 2017 p.).
CBT Intervention Studies for Depression or Anxiety Disorders was conducted on the rural population to test CBT and addressed a variety of adaptations used to enhance CBT for depression and anxiety disorders (Weaver & Himle, 2017). This study found that “CBT for depression and anxiety was effective for addressing the targeted disorder”. It also stated that CBT had a significant effect on participants’ symptoms in rural areas with different adaptations included, such as computer-based CBT” (Weaver & Himle, 2017).
Relation of Low Self-Esteem with Anxiety
Depression and anxiety can have a long-lasting effect on a person’s life. According to Sowislo and Orth (2013), “low self-esteem and depression are strongly related. One in four of those young adults who had depressive or anxiety disorders at the baseline study continued to show symptoms of the disorder over the course of the six to eight years of follow-up” (Sowislo & Orth, 2013 p.).
According to Sowislo and Orth (2013), the tripartite model states that “depression and anxiety share the feature of high negative affectivity which is a stable disposition to experience nonspecific distress and unpleasant mood. In addition, self-esteem is correlated with both positive and negative affect. The present research suggests that self-esteem shows similar structural relations with depression and anxiety” (Sowislo & Orth, 2013 p.).
Urbanicity Levels
Epidemiologic studies suggest that “almost 20% of Americans experience major depressive disorder during their lifetime and that anxiety disorders affect approximately one in four Americans over the life course” (Weaver & Himle, 2017 p.). “Rural Americans experience depression and anxiety disorders at rates similar to their urban counterparts. However, rural areas meet many barriers, and despite decades of research on psychosocial interventions for anxiety disorders rural residents are unlikely to receive mental health treatment or appropriate care” (Weaver & Himle, 2017). Barriers to mental health treatment in rural communities, including the “lack of mental health professionals, are high due to poverty rates and a high proportion of uninsured or underinsured people living in rural areas. Over 60% of rural Americans live in designated mental health provider shortage areas” (Weaver & Himle, 2017 p.).
This literature review noted in Weaver & Himle (2017) focused on the findings that have the potential to increase the understanding of factors that reduce barriers to care and influence the adequacy of treatment among rural populations. Weaver and Himle (2017 p.), found that “a single adaptation may help to overcome multiple types of barriers with rural Americans suffering from anxiety using Cognitive–behavioral therapy”.
Current Research
A study conducted by Pearson et al. (2014) used the Five Facet Mindfulness Questionnaire to investigate the relationship between depression, anxiety, and stress with mindfulness facets in nonclinical populations. This study included data from 400 New Zealand university students and the general population whose age ranged from 17 to 95 years old. The sample comprised of 93 males (23%) and 301 females (75%). Ethnic groups included 66% Caucasian, 15% Polynesian, 6% Asian, and 13% others (Medvedev et al., 2018). The sample included 52 (13%) of participants that reported regular engagement in meditation practices and 290 not practicing meditation. The results from this study demonstrated that nonjudgmental attitude was the strongest predictor for psychological symptoms and overall distress. The results indicated that lower levels of self-judgment resulted in lower scores on stress, anxiety, and depression (Medvedev et al., 2018). According to the results in Pearson et al. (2014), development of nonjudgmental attitude towards one-self should be considered as the most important factor for reduction of anxiety.
Tips for Counselors
According to the National Institute of Mental Health (NIMH) (stated in Mathewson et al., 2013 p.), “approximately 25 percent of U.S. adults struggle with depression, anxiety or some combination of both”. Counselors should be aware that “poor school performance, disrupted relationships with peers and adults, and diminished participation in the normal activities of childhood and adolescence”, according to Bennett et al., (2013 p.), are all associated with anxiety. Several scientifically proven and effective treatment options are available for children and young adults with anxiety disorders. “Cognitive behavioral therapy (CBT) is the psychotherapeutic treatment of choice for children and youth with anxiety. Medications are effective for reducing anxiety, but they can also have side effects” (Mathewson et al., 2013 p.). Counselors can develop and work on different techniques and strategies when working with children and young adults who suffer from anxiety. Technology can also play an important role for professionals working with a person suffering from anxiety.
Cognitive strategies for coping with SAD
“Cognitive-behavioral therapy, or CBT, is a type of talk therapy that has been scientifically shown to be effective in treating anxiety disorders. CBT utilizes a combination of behavioral and cognitive intervention strategies aimed at changing behavior patterns and dysfunctional thoughts” (Weaver & Himle, 2017). According to Weaver and Himle (2017 p.), “CBT is gold-standard, evidence-based care for these mental health conditions”. Specific techniques have been developed to help patients learn to manage strong emotions in everyday situations. In one strategy, “cognitive reappraisal, participants learn to interpret anxiety-provoking situations in a less negative way, in order to avoid the development of anxious feelings” (Mathewson et al., 2013 p.). “CBT teaches skills and techniques to that children can use to reduce their anxiety” (Kasteenpohja et al., 2018 p.).
In a different strategy, “expressive suppression, participants inhibit the behavioral responses caused by strong emotions after the emotional reaction has already been started. This approach is intended to lessen the possibility of rejection by others and is often a strategy that is preferred by patients before they begin therapy” (Mathewson et al., 2013 p.). Suppression is likely to “enhance subjective and physiological responses associated with distress has been associated with poor social functioning and well-being” (Mathewson et al., 2013 p.).
CBT is an evidence-based treatment for both depression and anxiety disorders. Three of the most common CBT intervention strategies for anxiety and depression include cognitive restructuring, behavioral activation, and exposure (Weaver & Himle, 2017). Cognitive restructuring involves intervention strategies to help clients recognize, evaluate, and effectively respond to negative or distorted thoughts. Behavioral activation includes strategies that encourage clients to increase the quantity and quality of positively reinforced behavior in a scheduled, monitored way, is more relevant for clients with depression. Exposure encourages clients to confront a feared stimulus in order to manage physiological anxiety and decrease fears, is utilized for clients with anxiety disorders (Weaver & Himle, 2017).
Influence of Medications
Some anxiety-lowering medications may also influence cognitive operations related to learning, memory or executive control (Mathewson et al., 2013). Medication use may have important implications for individuals with social anxiety who are learning to reappraise difficult social situations. Although, medications are effective for reducing anxiety, they are also known to affect autonomic functioning (e.g., heart rate and blood pressure), with specific, negative effects on parasympathetic activity. (Mathewson et al., 2013).
Technology Treatment
A common adaptation for CBT that counselors can incorporate in a therapy session can include technology-assisted treatment. Technology-assisted treatment, such as videoconference, was used in studies testing CBT for anxiety disorders. Computer and/or Internet-based CBT was used exclusively among studies focused on generalized anxiety disorders. Both of the studies testing computer-based CBT were found to be effective (Weaver & Himle, 2017).
Developmental Stages
There are similarities and differences when working with children and young adults who suffer from anxiety. According to Xia, Shen, and Zhang (2015), attention deficit hyperactivity disorder (ADHD) is common in children who have comorbid psychiatric disorders, particularly anxiety disorders. These disorders may also affect the educational level, such as struggling or failing in school, in children and young adults. Compared to individuals without SAD, children with the disorder are more likely to drop out of school prematurely (Asher, Asnaani, & Aderka, 2017).
Children with Anxiety
Parental anxiety is one of the strongest predictors of childhood anxiety (Waters et al., 2008). Although, a child with any family member who has an anxiety disorder has a better chance of developing anxiety as well (Anxiety Disorders, 2014). Children with a history of abuse or neglect are also more susceptible to anxiety (Anxiety Disorders, 2014). A child who has anxiety might have trouble going to school or developing relationships with peers. They may also avoid public events or extracurricular activities, like sports. Developmentally, anxiety in children may appear as tantrums or behavioral issues. Children with anxiety may also struggle concentrating in school and become distracted easily (Anxiety Disorders, 2014).
Young Adults with Anxiety
For young adults with anxiety, support from counselors to help them achieve academic or vocational goals is important (Kasteenpohja et al., 2018). Young adults suffering from anxiety have lower educational achievement which leads to having lower income and they are more likely to be unemployed. Even when young adults with SAD are employed they will often miss many work days (Asher, Asnaani, & Aderka, 2017).
Many different attributes have an impact on a person’s anxiety disorder. The gender and age as well as what area they live in can determine the best treatment options for them. Counselors and other professionals working with children and young adults who are suffering from anxiety should learn the signs, symptoms and treatments that are available for the client. Helping the person develop coping strategies and teaching them techniques to use will diminish the symptoms of anxiety.
References
Asher, M., Asnaani, A., & Aderka, I. M. (2017). Gender differences in social anxiety disorder: A
review. Clinical Psychology Review, 561-12. doi:10.1016/j.cpr.2017.05.004
Bennett, K., Manassis, K., Walter, S. D., Cheung, A., Wilansky‐Traynor, P., Diaz‐Granados, N.,
& … Wood, J. J. (2013). Cognitive behavioral therapy age effects in child and adolescent anxiety: An individual patient data metaanalysis. Depression And Anxiety, 30(9), 829-841. doi:10.1002/da.22099
Blanck, P., Perleth, S., Heidenreich, T., Kröger, P., Ditzen, B., Bents, H., & Mander, J. (2018).
Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis. Behaviour Research And Therapy, 10225-35. doi:10.1016/j.brat.2017.12.002
Kasteenpohja, T., Marttunen, M., Aalto-Setälä, T., Perälä, J., Saarni, S. I., & Suvisaari, J. (2018).
Outcome of depressive and anxiety disorders among young adults: Results from the Longitudinal Finnish Health 2011 study. Nordic Journal Of Psychiatry, 72(3), 205-213. doi:10.1080/08039488.2017.1418429
KidsHealth The Nemours Foundation, Anxiety Disorders, 2014
Retrieved April 29, 2018 from https://kidshealth.org/en/parents/anxiety-disorders.html
Mathewson, K. J., Schmidt, L. A., Miskovic, V., Santesso, D. L., Duku, E., McCabe, R. E., & …
Moscovitch, D. A. (2013). Does respiratory sinus arrhythmia (RSA) predict anxiety reduction during cognitive behavioral therapy (CBT) for social anxiety disorder (SAD)?. International Journal Of Psychophysiology, 88(2), 171-181. doi:10.1016/j.ijpsycho.2013.03.016
Medvedev, O. N., Norden, P. A., Krägeloh, C. U., & Siegert, R. J. (2018). Investigating unique
contributions of dispositional mindfulness facets to depression, anxiety, and stress in general and student populations. Mindfulness, doi:10.1007/s12671-018-0917-0
Pearson, M. R., Brown, D. B., Bravo, A. J., & Witkiewitz, K. (2014). Staying in the moment and
finding purpose: the associations of trait mindfulness, decentering, and purpose in life with depressive symptoms, anxiety symptoms, and alcohol-related problems. Mindfulness, 6(3), 645–653.
Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-
analysis of longitudinal studies. Psychological Bulletin, 139(1), 213-240. doi:10.1037/a0028931
Weaver, A., & Himle, J. A. (2017). Cognitive–behavioral therapy for depression and anxiety
disorders in rural settings: A review of the literature. Journal Of Rural Mental Health, 41(3), 189-221. doi:10.1037/rmh0000075
Waters, A. M., Craske, M. G., Bergman, R. L., Naliboff, B. D., Negoro, H., & Ornitz, E. M.
(2008). Developmental changes in startle reactivity in school-age children at risk for and with actual anxiety disorder. International Journal Of Psychophysiology, 70(3), 158-164. doi:10.1016/j.ijpsycho.2008.07.014
Xia, W., Shen, L., & Zhang, J. (2015). Comorbid anxiety and depression in school-aged children
with attention deficit hyperactivity disorder (ADHD) and self-reported symptoms of ADHD, anxiety, and depression among parents of school-aged children with and without ADHD. Shanghai Archives Of Psychiatry, 27(6), 356-367.