​Parenting a Teen Who Struggles with Anxiety

If your teen is struggling with anxiety, chances are you might be feeling exhausted. What likely started off as small worries early on, may have escalated to something that feels unmanageable. Over the years, parents have shared their stories with me as they struggle to help their anxious teen:

•  It’s so hard to know when to push and when to let her avoid certain things that I know are really triggering. Sometimes my partner and I are on the same page about how to help our son/daughter cope, but sometimes it gets real heated and we just can't agree on our approach.
• She/he started out occasionally skipping on birthday invites because they felt nervous, but now they're missing out on so much more (e.g., sports practices, field trips, sleepovers) because he/she feels so nervous.
• I see other teens having fun with their friends at school and involved in different sports or activities, but she can’t seem to relax. She’s always thinking about what could go wrong. 
• No matter how much I try to convince him that everything will be okay, he gets so stuck on his worries. Sometimes I can distract him, but it doesn't last - and then he's right back to worrying.  

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If these struggles sound familiar, you are not alone.

But rest assured: There are effective treatments that can help your teen learn to manage anxiety.
Let's get started on this difficult but worthwhile journey.

​Finding Effective Treatment for Anxiety

Finding the right therapist in South Florida might feel overwhelming because (thankfully!) there are so many options across Broward, Miami-Dade, and Palm Beach. But how do you know which therapist will work best with your teen? Will he/she feel comfortable with the therapist and be willing to talk to them about their challenges?
 
 It is crucial that your teen have a connection to their therapist – to feel that the therapist “gets them.” And if your teen is struggling with anxiety, it is also critical to find a therapist who specializes in the treatment of anxiety in children & teens. Based on lots of research, we know that what works best in helping teens manage anxiety is Cognitive Behavioral Therapy (CBT).

​​What is Cognitive Behavioral Therapy (CBT)?

​Cognitive Behavioral Therapy (CBT) is a type of treatment that will help your teen change the way he or she thinks, and as a result, helps them change how they behave in different situations. In therapy, I will work with you and your teen to hone in on exactly what kinds of thoughts are going through his or her mind at different times throughout the day. Anxious thoughts can take on a variety of flavors, such as: I’m not good enough. This needs to be perfect. Something terrible is about to happen.
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Once we have a good sense of what your teen's anxiety is saying (Spoiler alert: Anxiety usually LIES!), your teen will practice different strategies to help him or her challenge those nagging, anxious thoughts. In other words, they will learn how to “talk back” to anxiety and check the accuracy of those worries.

The most important component of treatment is having them learn to gradually face their fears. Psychologists refer to this process of facing your fears as “exposures” because you are gradually exposing yourself to situations that make you feel anxious, and then using the tools learned in therapy to cope with this anxiety. Facing your fears is not easy, but your teen CAN learn to do this with the right coping tools, a good relationship with their therapist, and support from parents that makes them feel validated and empowered. 

​CBT for Anxiety with Dr. Penela

Once your teen has CBT tools in their back pocket, anxiety doesn’t disappear. Instead, they will begin to feel confident that when they encounter potentially triggering situations, he or she will know exactly how to handle it. With the right therapy, their worry or anxiety will no longer be something that holds them back in their everyday lives.​

​Over the last decade, I’ve helped many children, teens, and adults face and overcome their challenges with anxiety using CBT tools. I have received specialized training in using CBT and enjoy using this approach with teens and families for one simple reason: it helps most people feel better. I tailor the treatment to meet each family’s specific needs, and as needed will incorporate other approaches, such as mindfulness, family systems, and acceptance-based techniques.

Including Parents in Anxiety Treatment

Although some therapists work almost entirely with children in therapy and simply keep parents updated occasionally, I firmly believe that although I may be an expert in anxiety treatment, YOU are the expert on your child. So as your child learns helpful CBT skills in therapy, it is critical that you (and other primary caregivers) learn them, too! Anxiety can disrupt the parent-child relationship and cause so much distress for the whole family. ​

Throughout the course of therapy, it is vital that parents learn the same CBT tools that their teen is learning in therapy. Keeping you (and other primary caregivers) in the loop is essential to your child's success in therapy!  

When your teen feels anxious - they may be turning to you for help, or because they want to altogether avoid certain situations. In therapy, I teach parents how to respond in these tricky situations - not just so that you help your teen feel some relief in the moment - but so that your teen is feeling more confident and empowered in the long run. 

​Starting Therapy to Help Your Anxious Teen

​If you're considering starting the challenging but rewarding journey toward helping your teen beat anxiety, let's get started. In a warm and empowering environment, we will work together to help your teen learn to effectively manage his or her anxiety and lead a full and meaningful life.

I am Ready to Help My Teen Beat Anxiety

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What if my Teen Does Not Want To Go To Therapy?

Sometimes teens don't want to get involved in therapy - maybe because they don't think there's anything wrong. Or maybe they know something is off, but they're just not ready to face it. A big one I hear from parents is: my teen doesn't believe that therapy can actually help.

Other times, your teen knows there is a problem - but they just don't have the time to face it!  Between academically rigorous classes, extra-curricular activities, sports practices, and maintaining a social life - the thought of squeezing in an hour per week for therapy for anxiety just seems too overwhelming. 

I understand how frustrating and hopeless this can feel as a parent! If your teen is refusing to attend therapy, here are the three things I would do: 
1. Maintain open communication about what's keeping them from therapy. Have respectful discussions where you try to understand each other's viewpoints.
2. Consider evidence-based self-help resources for your teen (books, podcasts). I hope to have a curated resources list on my site soon - but ADAA is a great places to start for now!  
​3. Last (and perhaps most important!) - educate yourself as a parent on how you can best support your anxious teen. 

One of the best ways you can support your teen is by learning science-backed tools about how to respond to your anxious teen. We can do this parent-focused work in therapy using an effective treatment: Supportive Parenting for Anxious Childhood Emotions (SPACE). Using SPACE, I help parents learn the tools needed to consistently respond to their teen so that their teen will learn to cope with anxiety over the long-term. 

Research has shown that this treatment can be just as effective in reducing anxiety symptoms, as me working directly with your teen.  Yes!  You read that correctly, sometimes by working only with parents in therapy, we can help your teen just as much as if I were working with your teen in therapy. You can check out those study results here. ​

Learn More about SPACE Therapy for Parents

Social Anxiety

Worry Talking Back Exposure

• Identify worry thought:

  If I make a mistake while ordering my food at a restaurant, I’ll look so stupid.

• Talk back to the worry with facts/evidence:

  I’ve been to this restaurant before, and the waiters are usually friendly, so even if I fumble over my words, he/she probably won’t think much of it.

• Gradual exposure:

  • Go with a friend, and have him/her order my food. I might order my drink.
  • Go with a friend. Order both my food and drink order on my own.
  • Go to restaurant alone, and order both my food and drink.

Panic Attacks

Worry Talking Back Exposure

• Identify worry thought:

  I notice that my heart is beating a little faster than usual, so I should probably leave this situation in order to prevent a panic attack.

• Talk back to the worry with facts/evidence:

  My heart could be beating faster than usual because I’m walking quickly. I’ve had this sensation before and it does not usually lead to a panic attack. If I do have a panic attack, it will be very uncomfortable, but it will pass quickly.

• Gradual exposure:

  • Do activities that lead to the experience of a fast heart beat (e.g., run vigorously or do jumping jacks for a minute)
  • Do these activities in situations where it might be difficult to leave quickly

Obsessive Compulsive Disorder

Worry Talking Back Exposure

• Identify worry thought:

  I’m not sure I did that quite right (e.g., a task, a conversation), and that makes me feel very anxious/uncomfortable. I will [insert compulsion] to help myself feel better

  Compulsions are quite varied and can include: mental rituals (counting or repeating a phrase in your mind), reordering/arranging, hand-washing, etc.

• Talk back to the worry with facts/evidence:

  Even though I feel uncomfortable about messing up, the compulsion will not actually fix anything, it’ll just help me take the edge off or now.

• Gradual exposure and response prevention (ERP):

  In OCD treatment, the focus is on reducing the compulsive responses and learning to manage the obsessions in a more effective manner. To engage in ERP in the current example, you might start with purposefully doing something not quite right (e.g., mess up on a minor task) and experiencing feeling some anxiety/discomfort. Then, you would gradually work on the response prevention component:

  • Allow myself to engage in the compulsion minimally (e.g., repeat phrase in mind only two times rather than ten times).
  • Delay the compulsion: wait one minute before repeating the phrase
  • Do the compulsion differently: Say the phrase, but only part of it or say it backwards.
  • Do not engage in the compulsion

Separation Anxiety (child)

Worry Talking Back Exposure

• Identify worry thought:

  After Mom drops me off at school, I will miss her too much and will have a long, terrible day at school. So I’m going to try to stay with her as long as possible.

• Talk back to the worry with facts/evidence:

  Even though I will miss Mom while I’m at school, there are some things that I could do, like talk with my friends or go to the playground.

• Gradual exposure:

  • Spend time separate from Mom in fun places (e.g., at a friend’s house).
  • At school drop-off time, walk with Mom into the classroom and stay with her for a few minutes before she leaves.
  • At school drop-off time, walk with Mom to the school entrance and say goodbye there.

Specific Phobia: Vomit (also known as emetophobia)

Worry Talking Back Exposure

• Identify worry thought:

  My stomach feels a little queasy, which means I might throw up. If I throw up, I will feel terrible/disgusting/very nervous. Others might notice, and think I am gross.

• Talk back to the worry with facts/evidence:

  Since my stomach is feeling queasy, there’s a small chance that I may throw up. I’ve thrown up before and it is uncomfortable, but it is not harmful and I can handle it.

• Gradual exposure:

  • Read stories about vomiting
  • Look at pictures and watch videos of people vomiting
  • Engage in activities that could lead to nausea (e.g., spin in chair to get dizzy, shake head quickly from side to side for a full minute, eat foods that may have been previously avoided due to fear of vomiting)