Treatment for Anxiety and Stress

The descriptions of recommended treatments are intended to provide a brief introduction to treatments that are indicated for a particular behavioral health problem. While some techniques may seem straightforward, behavioral health treatment should be administered by trained providers only. There are a number of resources for parents and young people organized under Self-Help.

Anxiety

Psychotherapy In general, cognitive behavioral treatments (CBT) are frequently used to treat Anxiety Disorders in children and adolescents.¹ CBT is designed to help anxious youth change thinking patterns that contribute to anxiety. Cognitive strategies are also used to help the child or adolescent recognize anxious thoughts, manage anxiety, and cope with anxiety-producing situations. According to Division 53 of the American Psychological Association several specific forms of short-term psychotherapy have been shown to be beneficial in the treatment certain Anxiety Disorders in children and teens:

Specific Phobia
The following are well-established treatments for specific phobias in young people:

• Participant Modeling involves a model (e.g. therapist, friend, or peer) demonstrates fearlessness and coping responses when confronting a feared situation or object. Then the model assists the child in practicing approaching and confronting the feared situation or object. This is done slowly, at a pace the child is comfortable with, sometimes over many weeks.
• Reinforced Practice involves exposure, or practicing approaching and confronting a feared situation or object, and rewards when the child does so. Again, this may take some time.

The following therapies have been shown to be helpful in treating simple phobias in young people:

• Cognitive behavior therapy is designed to help anxious youth change unhealthy thinking that contributes to anxiety. Cognitive strategies are also used to help the child or adolescent recognize anxious thoughts, manage anxiety, and cope with anxiety-producing situations.
• Systematic desensitization involves having the child or adolescent imagine his/her feared object or situation while he/she is engaged in a response that is incompatible with anxiety (e.g. relaxation or play), instead of physically exposing them to the feared object or situation.

Generalized Anxiety Disorder
The following therapies have been shown to be effective for treating Generalized Anxiety Disorder in young people.

• Cognitive behavior therapy is designed to help anxious youth change unhealthy thinking that contributes to anxiety. Cognitive strategies are also used to help the child or adolescent recognize anxious thoughts, manage anxiety, and cope with anxiety-producing situations.
• Exposure, which involves practicing approaching and confronting a feared situation or object. This is hard to do initially but becomes easier and easier with continued practice. Recall how you got over some of your fears (diving boards, riding a bike, learning to drive). Each time you did it, there was less fear. And at some point, you even started enjoying the previously feared activity? Knowing this is critical to help your children face their fears and to keep doing so until the fear lessens.
• Family Anxiety Management (FAM) teaches parents to reward the child for confronting his/her feared situation or object, and ignore excessive complaining when confronted with his/her feared situation or object.
• Participant Modeling involves a model (e.g. therapist, friend, or peer) who demonstrates fearlessness and coping responses when confronting a feared situation or object. Then the model assists the child in practicing approaching and confronting the feared situation or object.
• Reinforced Practice involves exposure, or practicing approaching and confronting a feared situation or object, and rewards when the child does so.
• Relaxation training teaches young people to let go of physical and psychological tension.

Separation Anxiety Disorder
The following therapies have been shown to behelpful in treating Separation Anxiety Disorder in young people.

• Family Anxiety Management (FAM) teaches parents to reward the child for confronting his/her feared situation or object, and ignore excessive complaining when confronted with his/her feared situation or object. This treatment is useful in treating Separation Anxiety Disorder for children 7 to 10 years of age, however it appears less useful for children and adolescents 11 to 14 years of age.
• Cognitive behavior therapy is designed to help anxious youth change unhealthy thinking that contributes to anxiety. Cognitive strategies are also used to help the child or adolescent recognize anxious thoughts, manage anxiety, and cope with anxiety-producing situations.
• Exposure involves practicing approaching and confronting a feared situation or object. This is hard to do initially but becomes easier and easier with continued practice. Recall how you got over some of your fears (diving boards, riding a bike, learning to drive). Each time you did it, there was less fear. And at some point, you even started enjoying the previously feared activity? Knowing this is critical to help your children face their fears and to keep doing so until the fear lessens.
• Reinforced Practice involves exposure, or practicing approaching and confronting a feared situation or object, and rewards when the child does so.
• Systematic desensitization involves having the child or adolescent imagine his/her feared object or situation while he/she is engaged in a response that is incompatible with anxiety (e.g. relaxation or play), instead of physically exposing them to the feared object or situation.
• Relaxation training teaches young people to let go of physical and psychological tension.

Behavior Therapy and Behavioral Interventions for Children and Adolescents
A lot of problems experienced by young people can be helped or treated with behavioral interventions or a relatively quick dose of behavior therapy.

Guidelines for Choosing a Behavior Therapist

Medications

Although medications are sometimes used to treat Anxiety Disorders in children and adolescents, data supporting their effectiveness and safety with young people is limited.² According to the Academy of Child and Adolescent Psychiatry, medication should not be used as the sole intervention, but in addition to psychotherapeutic interventions. Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are most commonly used to treat pediatric Anxiety Disorder. Benzodiazepines, a class of anti-anxiety medication, may be used on a short-term basis for anxiety symptoms. Less commonly used anxiolytics include buspirone and beta-blockers.³ It is important to consider potential side-effects compared to the benefits of medications. Not all medications work the same for everyone; therefore it is important that you consult with your pediatrician or a child psychiatrist to determine which medication (if any) is best for your child. More

Questions to Ask your child's provider about psychiatric medications.

TRICARE Pharmacy Information

Treatment of Children With Mental Disorders
A booklet with answers to frequently asked questions about the treatment of mental disorders in children -- includes a medications chart.

Stress

Most reactions to stressful periods in life are considered normal and do not develop into a mental disorder. Becoming educated about stress, seeking support, and taking steps to maintain a healthy lifestyle are effective coping strategies. View Stress and Child/Adolescent Self-Care resources.

Stress-o-meter
Are you as tight as a rubber band? How about a great big ball of nerves? Questions to help determine your personal stress profile.

¹Laurent, J., & Potter, K. I. (1998). Anxiety-related dif ficulties. In. T. S. Watson & F. M. Gresham (Eds.). Handbook of child behavior therapy (pp. 239-260). New York: Plenum Press.

²Christopherson, E. R., & Mortweet, S. L. (2005).Treatments that work with children. Washington, DC: American Psychological Association.

³American Academy of Child and Adolescent Psychiatry (1997). Practice parameters for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 36 (10suppl).