Helping Adolescents Cope with
Anxiety and Stress During High
School
January 7, 2014
Jonathan Dalton, Ph.D.
Center for Anxiety and Behavioral Change
Why this is so important
Children and Adolescents
 Median age of onset 11 – earliest of all
forms of psychopathology
 8 % of children between ages 13 and 18
currently have an anxiety disorder
 25% will have an anxiety disorder between
the ages of 13 and 18
 5.9% will have “severe” anxiety disorder
 Only 18 % of these teens receive treatment
Adults
 28.8 percent lifetime prevalence
 Most common category of mental health
disorders
 18 % of adults currently have an anxiety
disorder (40 million)
 $42 billion in annual health costs
Treatment Works!
“Ultimately we know deeply that on the other side
of every fear is freedom” – Marilyn Ferguson
 Treatment success rates for anxiety
disorders with CBT (exposure therapy)
range from 60% to 90%
 Tragically low utilization rates
(18% compared with 79% for ADHD)
When Does Anxiety Become
Disordered?
 Distress
 Avoidance
 Interference
 Functional Impairment
Fear, Anxiety, and Stress
 Anxiety: Future-oriented “diffuse
apprehension”
 Fear: Present-oriented defensive response
to observable threat
 Stress: Perceived environmental demands
exceed one’s perceived ability to meet them
Three Pillars of Anxiety
 Uncertainty
 Lack of control
 Perception of danger
Anxiety Reduction
 Education
 Cognitive Reframing
 Behavior Change
Basic Template for the Treatment
of Anxiety Disorders in Teens
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Assessment
Psychoeducation
Cognitive Reappraisal Strategies
Exposure
Parent Training
Relapse Prevention
Cognitive Reappraisal of
Anxious Arousal
“Don’t believe everything you think!”
 Body is doing the right thing at the wrong
time
 Perspective of “curious observer”
 “In this moment…”
 Metaphor of fire alarm
Cognitive Strategies
“Why don’t the palm trees care when the wind
blows?”
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Coping cards
Mindfulness training
Problem-solving skills training
Cognitive flexibility exercises
Coping Cards
“Just because I’m scared…”
 I am stronger than my
fear
 Scary thoughts can
never hurt me
 I know I can do this
because…
 The presence of a
thought is not
evidence to support it
 Just because I’m
scared doesn’t mean I
can’t do it
 It’s ok to be scared
 Just do it anyway
 Anxiety is temporary
and harmless
Decreasing Avoidance
“Urges do not dictate actions.”
 Metacognitive awareness of urge to avoid
or escape
 “Swatting butterflies”
 Rehearsal of self-instruction
 Building distress tolerance
Fear Reduction
Through Behavior Change
“Courage is what you do, not what you feel”
 Exposure to the feared situation in the
absence of the feared consequence produces
fear reduction
 Exposure can be conducted in a variety of
manners, but exposure always remains the
“active ingredient” (e.g., acetaminophen
comes in tablets, caplets, gelcaps, etc.)
Three Critical Variables for
Habituation to Occur
(Successful Exposure)
 Frequency
 Intensity
 Duration
Psychoeducation
for Parents
“Fear and Avoidance are Teammates”
 Parent-training is paramount!
 Begin with education regarding the negative
reinforcement of anxious behavior
 “Protection Trap”
Parent Training
“Water the seeds, not the weeds.”
Essential for treatment
Focus on “loving firmness” (kite metaphor)
Metaphor of flight attendant during
turbulence
Nuts and Bolts
“Your attention is your child’s paycheck, so be
exceptionally careful what you pay him/her for”
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Functional analysis
Positive reinforcement
Negative reinforcement
Coercive behavior cycle
Extinction
Extinction Burst
Habituation
scene from Ray
Relapse Prevention
 Problem-solving skills training
 Increase perceived social support
 Emphasis on continued self- directed
exposure
 Relaxation training
 Reframe potential recurrence of symptoms
as opportunity for future learning
 Increase self-efficacy to deal with future
fears
Jonathan Dalton, Ph.D.
Center for Anxiety and
Behavioral Change
drjdalton@gmail.com
301-610-7850