Rodney A. Fry, MA, MDIV, MS, LPC-S, RPT-S™

If you are the parent of a teenager struggling with anxiety, you may find yourself asking:

Is this normal teenage stress?
Should I be worried?
Why does my teenager seem overwhelmed by things that did not bother them before?
Can therapy actually help?

The short answer is yes. Therapy can be an effective treatment for anxiety in children and adolescents.

Anxiety is a common concern during childhood and adolescence, and evidence-based treatments are available. Cognitive behavioral therapy (CBT), in particular, has substantial research support for treating anxiety disorders among children and adolescents (Walter et al., 2020; Walkup et al., 2008). The American Academy of Child and Adolescent Psychiatry (AACAP, n.d.) also identifies psychotherapy as an important treatment option for young people experiencing anxiety. At Natural State Counseling Centers (NSCC), we believe teenagers need more than someone telling them to “calm down,” “stop worrying,” or “just get over it.” They need a safe and supportive environment where they can begin understanding what they are experiencing, learn practical coping skills, strengthen their confidence, and discover healthier ways of navigating life’s challenges.

What Does Anxiety Look Like in Teenagers?

Anxiety does not always look like fear.

Parents sometimes expect an anxious teenager to appear visibly nervous or afraid. However, anxiety can present in many different ways.

A teenager experiencing anxiety may show:

• Constant worrying or overthinking
• Irritability or anger
• Difficulty sleeping
• Trouble concentrating
• Frequent headaches or stomachaches
• Fear of making mistakes
• Perfectionism
• Avoidance of school or social situations
• Frequent requests for reassurance
• Panic symptoms
• Procrastination
• Withdrawal from friends or family
• Difficulty separating from parents or caregivers
• Excessive concern about grades, friendships, appearance, sports, or the future

Anxiety can involve emotional, behavioral, cognitive, and physical symptoms. Anxiety disorders also do not have one single cause. Biological factors, temperament, life experiences, family and environmental influences, and other individual factors may contribute to their development (American Academy of Child and Adolescent Psychiatry [AACAP], n.d.).

Some anxiety is a normal part of adolescence. Teenagers are facing new responsibilities, relationships, expectations, and developmental changes.

The question is often not simply, “Does my teenager have anxiety?”

A more helpful question may be:

“Is anxiety beginning to interfere with my teenager’s ability to live their everyday life?”

When anxiety begins interfering with school, friendships, family relationships, sleep, activities, responsibilities, or overall emotional well-being, it may be time to consider professional support.

Why Are Teenagers Experiencing Anxiety?

There is rarely one simple reason a teenager struggles with anxiety.

Adolescence is a significant developmental period. Teenagers are simultaneously trying to develop independence, understand who they are, build relationships, navigate increasing responsibilities, and prepare
for adulthood.

They may also be managing:

• Academic expectations
• Social pressures
• Family stress
• Friendships and dating relationships
• Athletic or extracurricular expectations
• Social media
• Bullying
• College or career decisions
• Changes within the family
• Trauma or significant life experiences
• Questions about identity and belonging
• Fear about their future

What seems relatively small from an adult perspective can feel enormous to a teenager.

Understanding the teenager’s experience does not mean reinforcing every fear or removing every difficult situation. Instead, understanding creates an opportunity for adults to respond with both compassion and healthy guidance.

That is one area where counseling can help.

How Can Therapy Help a Teen With Anxiety?

Therapy can provide teenagers with a confidential and supportive environment where they can begin identifying what contributes to their anxiety and develop healthier strategies for responding to it. Research and professional treatment guidelines support psychotherapy particularly CBT as an effective treatment for many childhood and adolescent anxiety disorders (Walter et al., 2020).

Here are several ways counseling may help.

1. Therapy Can Help Teens Understand Anxiety

Sometimes one of the most frightening parts of anxiety is not understanding what is happening. A teenager may experience racing thoughts, physical tension, rapid heartbeat, difficulty breathing, stomach discomfort, restlessness, or overwhelming fear without understanding why their body is reacting that way.

Therapy can provide psychoeducation about anxiety and help teenagers understand the relationship between their thoughts, emotions, behaviors, and physical responses.

Instead of thinking:

Something must be wrong with me.

They can begin learning:

My body is reacting to something that it believes may be threatening. I can learn how to respond differently.

Understanding anxiety can reduce some of the mystery surrounding it and help teenagers develop a greater sense of control.

2. Therapy Can Help Teens Identify Their Triggers

Sometimes teenagers know exactly what makes them anxious.

Other times, they simply know that they feel overwhelmed.

A counselor can help a teenager identify patterns and possible triggers involving areas such as school, friendships, family relationships, performance expectations, social situations, trauma, perfectionism, or uncertainty.

Once those patterns become clearer, the teen and therapist can work together to develop healthier ways of responding.

3. Therapy Can Help Challenge Anxious Thinking

Anxiety often makes the worst possible outcome feel like the most likely outcome.

A teenager might think:

Everyone is judging me.

If I fail this test, my future is ruined.

If my friend doesn’t text me back, they must be angry with me.

If I embarrass myself, everyone will remember it forever.

If something feels uncomfortable, I need to avoid it.

Cognitive behavioral therapy helps young people recognize connections among thoughts, emotions, and behavior and learn to identify and challenge distorted or unhelpful patterns of thinking (AACAP, 2019).

The goal is not to convince teenagers that nothing difficult will ever happen.

Life will contain disappointment, uncertainty, rejection, mistakes, and uncomfortable moments.

A healthier goal is helping a teenager develop the confidence to say:

“Even when something difficult happens, I can handle it.”

4. Therapy Can Teach Practical Coping Skills

Good counseling should provide skills teenagers can use outside the therapy office.

Depending on the teen and the therapeutic approach, counseling may include learning:

• Grounding techniques
• Relaxation strategies
• Emotional regulation skills
• Healthy problem-solving
• Mindfulness skills
• Communication strategies
• Ways to identify and challenge anxious thoughts
• Strategies for managing panic symptoms
• Healthy sleep and self-care routines
• Gradual ways of confronting feared situations

Avoidance can sometimes decrease anxiety temporarily while strengthening anxiety over time. Evidence-based anxiety treatment therefore may involve gradually helping young people approach appropriate situations they have been avoiding while developing their ability to tolerate uncomfortable emotions (AACAP & American Psychiatric Association, 2020).

The purpose is not to overwhelm the teenager.

The purpose is to help them discover:

“I can experience anxiety without allowing anxiety to control everything I do.”

Therapy With Teens Should Be More Than Just Talking

Parents sometimes picture counseling as their teenager sitting on a couch and talking about feelings for an hour.

Effective adolescent counseling can look very different.

Psychotherapy with children and adolescents can incorporate different therapeutic approaches and interventions depending on the young person’s developmental level, personality, concerns, and treatment needs (AACAP, 2019).

Depending on the teenager, therapy might incorporate:

• Traditional conversation
• Cognitive behavioral strategies
• Expressive activities
• Games
• Creative interventions
• Experiential exercises
• Relaxation or grounding activities
• Problem-solving activities
• Family involvement
• Developmentally appropriate therapeutic interventions

Some teenagers communicate easily through conversation.

Others need time to become comfortable enough to discuss difficult emotions.

A therapist working with adolescents should seek to meet the teenager developmentally rather than expecting every teen to communicate like an adult.

What If My Teen Does Not Want Counseling?

This is one of the most common concerns parents have.

Some teenagers are ready for counseling.

Others may respond:

“I’m fine.”

“I don’t need therapy.”

“You’re the one who thinks something is wrong with me.”

“I’m not talking to some stranger.”

That initial reaction does not necessarily mean counseling will be unsuccessful.

One of the most important early components of therapy with adolescents is developing a therapeutic relationship in which the teenager feels respected, heard, and emotionally safe.

Parents can often help by presenting counseling as support rather than punishment.

Instead of saying:

“You’re going to therapy because your behavior is out of control.”
Consider something more like:

“You’ve been carrying a lot lately. We want you to have another adult in your corner who can listen, support you, and help you figure out what might make things easier.”

The way therapy is introduced can make a significant difference in how a teenager approaches the experience.

What Role Do Parents Play?

Parents and caregivers remain incredibly important in the emotional lives of teenagers.

At the same time, adolescents typically need an appropriate level of privacy in counseling so they can develop trust with their therapist.

The exact level of parental involvement will depend on the teenager’s age, clinical needs, treatment goals, safety concerns, circumstances, and applicable ethical and legal requirements.

In many cases, treatment may include a combination of individual sessions with the teenager and collaboration with parents or caregivers.

Family involvement may also be helpful because anxiety does not occur in isolation. Family patterns, communication, accommodations, expectations, and responses to anxiety can sometimes influence how anxiety is maintained or reduced.

Parents may therefore benefit from learning how to support their teenager without unintentionally strengthening avoidance.

For example, if a teenager experiences anxiety about a particular situation, a parent’s natural instinct may be to protect them by allowing them to avoid it completely.

Sometimes temporary support is appropriate.

However, repeatedly avoiding safe but uncomfortable situations can reinforce anxiety over time. Evidence-based treatments frequently help children and adolescents gradually confront appropriate feared situations while developing coping skills (AACAP & American Psychiatric Association, 2020).

The goal is to find a healthy balance between:

Compassion + Support + Healthy Boundaries + Growing Independence

Does Research Show That Therapy Works for Teen Anxiety?

Yes.

Clinical practice guidelines from the American Academy of Child and Adolescent Psychiatry support cognitive behavioral therapy for children and adolescents experiencing several common anxiety disorders (Walter et al., 2020).

One major randomized clinical trial involving children and adolescents with anxiety disorders found that CBT and the medication sertraline were each associated with improvement, while combined treatment produced an even higher response rate for participants in the study (Walkup et al., 2008).

This does not mean every teenager requires medication.

Treatment should be individualized. For some young people, psychotherapy alone may be appropriate. In other circumstances, particularly when symptoms are more severe or have responded only partially to psychotherapy, consultation with a qualified medical provider regarding medication may also be appropriate (AACAP, n.d.).

Parents should discuss medication questions with a physician or other appropriately licensed prescriber who works with children and adolescents.

How Long Does Therapy Take?

There is no universal number of counseling sessions that works for every teenager.

The length of treatment may depend on:

• The severity of the anxiety
• How long symptoms have been present
• The type of anxiety being experienced
• Family and environmental factors
• The presence of trauma
• Depression or other mental health concerns
• The teenager’s participation in treatment
• Treatment goals
• How consistently skills are practiced outside therapy

Some teenagers may demonstrate significant progress during relatively brief treatment.

Others may benefit from longer-term counseling.

It is also important to remember that progress is rarely a perfectly straight line.

A teenager might have several good weeks followed by a difficult week.

That does not necessarily mean counseling is failing.

The larger goal is helping teenagers develop skills and confidence that continue serving them long after counseling ends.

When Should Parents Seek Professional Help?

Parents do not have to wait until their teenager reaches a crisis before seeking counseling.

Consider contacting a mental health professional when anxiety begins significantly interfering with the teenager’s daily functioning or quality of life.
You may especially want to seek professional support when you notice:

• Significant school avoidance
• Frequent panic attacks
• Major changes in sleeping or eating
• Increasing isolation
• Sudden changes in behavior or personality
• Declining academic performance
• Anxiety interfering with friendships or activities
• Persistent physical complaints
• Increasing anger or emotional outbursts
• Significant avoidance
• Persistent feelings of hopelessness
• Statements about self-harm or suicide

If your teenager expresses suicidal thoughts, engages in self-harm, or indicates that they cannot remain safe, seek immediate crisis or emergency assistance rather than waiting for a routine counseling appointment.

Your Teen Does Not Have to Navigate Anxiety Alone

The teenage years involve learning how to become increasingly independent while still needing guidance, safety, connection, and trusted adults.

Sometimes one of the most helpful things parents can provide is another safe person for their teenager to talk with.

At Natural State Counseling Centers, our counselors work with children, teenagers, adults, couples, and families. Our goal is to provide a supportive and nonjudgmental environment where teens can better understand themselves, develop healthier coping skills, improve relationships, and build confidence in their ability to navigate life’s challenges.

Anxiety may be part of your teenager’s story right now.

It does not have to control the rest of their story.

Looking for a Teen Therapist in Northwest Arkansas?

Natural State Counseling Centers provides counseling services in Bentonville and Fayetteville, Arkansas, as well as telehealth counseling for clients throughout Arkansas.

If anxiety is beginning to control your teenager’s decisions, relationships, school experience, or everyday life, counseling may be an important next step.

Contact Natural State Counseling Centers to learn more about our therapists, availability, and counseling options.

References

American Academy of Child and Adolescent Psychiatry. (n.d.). Anxiety disorders resource center.
https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Anxiety_Disorder_Resource_Center/Home.aspx

American Academy of Child and Adolescent Psychiatry. (2019). Psychotherapy for children and adolescents: Different types.
https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Psychotherapies-For-Children-And-Adolescents-086.aspx

American Academy of Child and Adolescent Psychiatry, & American Psychiatric Association. (2020). Anxiety disorders: Parents’ medication guide. American Academy of Child and Adolescent Psychiatry.

Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., Ginsburg, G. S., Rynn, M. A., McCracken, J., Waslick, B., Iyengar, S., March, J. S., & Kendall, P. C. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. The New England Journal of Medicine, 359(26), 2753–2766. https://doi.org/10.1056/NEJMoa0804633

Walter, H. J., Bukstein, O. G., Abright, A. R., Keable, H. B., Ramtekkar, U., Ripperger-Suhler, J., & Rockhill, C. (2020). Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 59(10), 1107–1124.
https://doi.org/10.1016/j.jaac.2020.05.005