Running head: Overview of best practices

Overview of Best Practice Treating Adolescents with Anxiety

Monte Ritchey
University of Southern Indiana

Overview of best practices

Clinical Presentation of Anxiety in Adolescents

Adolescents can experience excessive distress, fear and worry for the health and safety of
themselves or parents when away from home with Separation Anxiety Disorder. This can be
expressed with somatic problems (headaches, gastrointestinal issues) that stem from the thoughts
of harm to their family if they are separated from them. This can lead to the adolescents refusing
to go to school, having inappropriate tantrums, as well as wanting to do everything they can to
not be separated from their parents. With Generalized Anxiety Disorder difficulties in their
ability to control their worry in relation to school performance and interactions with friends and
family. This can lead the adolescents to trying to be perfect in everything they do and if they do
something that falls short of this they believe they are failures and will depreciate their selfworth. The adolescent will seek constant reinforcement of their activities and experience fatigue,
headaches and body tension as a result of over preparing for activities (sports events, tests)
(Connolly & Nanayakkara, 2009).
Course of Anxiety in Adolescents
One of the most common disorders that can affect adolescents is the anxiety disorders.
Anxiety Disorders can develop at any age or stage of development (Fisher, Tobkes, Kotcher &
Masia-Warner, 2006). Anxiety in adolescents has a prevalence rate of 10-20%. Anxiety disorders
is undertreated and not as recognized in adolescent patients. Anxiety development in adolescents
is a predictor to anxiety and depression in adults and is a risk factor for inpatient hospitalization
and/or suicidal ideation (Walkup, Albano, Piacentini, Birmaher, Compton, Sherrill & Kendall,
2008). There is also a high rate of comorbidity with substance abuse disorders, depression, and
personality disorders (Wolgensinger, 2015). Three-Quarters of anxiety disorders have their
development in adolescents start between the ages of 11 and 21 years old (van Starrenburg,

Overview of best practices

Kuijpers, Hutschemaekers, & Engels, 2013). Anxiety will affect about 40% of adolescents
population before the age of 18 and without treatment could lead to other mental health
conditions when they are adults (Seager, Rowley, & Ehrenreich-May, 2014).
Recommended Course of Treatment
Cognitive Behavioral Therapy (CBT)
CBT is a very common therapeutic approach to use with individuals of all ages. The main
focus of CBT is to teach the patients to change the way they think/feel so as to change negative
behaviors (anxiety). Using CBT to treat adolescents with anxiety disorders has been shown to be
effective in group as well as individual settings. Group settings have been the most effective
because it allows peer support, positive reinforcement and modeling of positive behaviors
(Wolgensinger, 2015). CBT in an individual or group setting involved teaching coping skills that
would allow the individual to learn how to manage their anxiety as well as to expose the
individuals to situations that evoke anxiety so they are able to apply the new techniques in a
controlled but real life way. At all times patients should be closely monitored by a trained
therapist that would be able to intervene if the patient becomes overwhelmed (Walkup, Albano,
Piacentini, Birmaher, Compton, Sherrill & Kendall, 2008). Parental involvement in the CBT
process has a reinforcing quality outside of the treatment setting. When out of the treatment
setting parents are able to continue to reinforce positive coping skills (using a reward system)
and be able to problem solve with their children to help them be able to control their anxious
behaviors. Overall CBT either individual, group or including parents has been demonstrated to
be effective in reducing anxiety symptoms over no treatment (Fisher, Tobkes, Kotcher & MasiaWarner, 2006).

Overview of best practices

Psychopharmacology
The first line of psychopharmacology for the treatment of anxiety disorders is Selective
Serotonin Reuptake Inhibitors (SSRI). These anti-depressants have been shown to be effective
for short term use among adolescents. These medications may be more positive than when used
to treat depression. The most common SSRIs used with adolescents is Sertraline and Fluoxetine.
A black box warning was issued by the Food and Drug Administration (FDA) because
antidepressant use in adolescents has a chance to increase suicidal thoughts with this population
(Connolly & Nanayakkara, 2009). Sertraline has been shown to be very effective in the treatment
of anxiety either alone or in combination with CBT as well as being more tolerated. Studies have
shown that the best possible outcome for the treatment on anxiety with adolescents is the
combination of CBT along with Sertraline (Walkup, Albano, Piacentini, Birmaher, Compton,
Sherrill & Kendall, 2008). The other most commonly used medication for adolescents is
Fluoxetine and it has shown to be as effective as Sertraline in reducing anxiety symptoms but
most commonly side effects can include an increase in activity or gastrointestinal discomfort
(Fisher, Tobkes, Kotcher & Masia-Warner, 2006). Other medications used as an alternative to the
treatment of anxiety with adolescents include Buspirone because higher doses are more tolerable.
Benzodiazepines are used in conjunction with SSRIs to help reduce symptoms but should be
closely monitored because of the risk of dependence and abuse. Tricyclic Antidepressants (TCA)
should be avoided being used with adolescents because of adverse side effects (overdose,
Suicidal Thoughts) unless there has been several treatment failures with SSRI medications
(Connolly & Nanayakkara, 2009).

Overview of best practices

5
References

Connolly, S. D., & Nanayakkara, S. D. (2009). Anxiety Disorders in Children and Adolescents.
Psychiatric Times,

26(10), 40-50.

Fisher, P. H., Tobkes, J. L., Kotcher, L., & Masia-Warner, C. (2006). Psychosocial and
pharmacological treatment for pediatric anxiety disorders. Expert Review of
Neurotherapeutics, 6(11), 1707-19. doi:http://dx.doi.org.libproxy.usi.edu/10.1586/14737175.6.11.1707
Seager, I., Rowley, A. M., & Ehrenreich-May, J. (2014). Targeting common factors across
anxiety and depression using the unified protocol for the treatment of emotional disorders
in adolescents. Journal of Rational - Emotive & Cognitive - Behavior Therapy, 32(1), 6783. doi:http://dx.doi.org.lib-proxy.usi.edu/10.1007/s10942-014-0185-4
van Starrenburg, M.,L.A., Kuijpers, R. C. W. M., Hutschemaekers, G. J. M., & Engels, R. C. M.
E. (2013). Effectiveness and underlying mechanisms of a group-based cognitive
behavioural therapy-based indicative prevention program for children with elevated
anxiety levels. BMC Psychiatry, 13, 183. doi:http://dx.doi.org.libproxy.usi.edu/10.1186/1471-244X-13-183
Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., & ...
Kendall, P. C. (2008). Cognitive Behavioral Therapy, Sertraline, or a Combination in
Childhood Anxiety. New England Journal Of Medicine, 359(26), 2753-2766.
doi:10.1056/NEJMoa0804633

Overview of best practices

Wolgensinger, L. (2015). Cognitive behavioral group therapy for anxiety: recent developments.
Dialogues in Clinical Neuroscience, 17(3), 347351.