James Wooldridge
FILE - Deseret News hosted a film screening of 'Angst' at the Jim Santy Auditorium in Park City, Utah, Tuesday, May 29, 2018.

We've taken those questions to experts to find answers and will continue to do so throughout the course of an ongoing series on teen anxiety. Below are some of the answers — in some cases, with more than one expert viewpoint. Deseret News staff will continue to update the page and we invite readers to share their own stories, tell us what they'd like to know and more by emailing anxiety@deseretnews.com.

Question: What’s the difference between depression and anxiety?

Answer: Clinical depression, specifically major depressive disorder, involves having several symptoms that last two weeks or longer. It is not simply feeling short periods of sadness, which we all do from time to time. Symptoms include depressed mood, lack of interest or enjoyment in activities, withdrawal from family and friends, feelings of hopelessness, self-criticism or worthlessness, suicide ideation, difficulty with sleep, and changes in appetite, to name a few.

Anxiety is an unpleasant emotion we all experience given certain circumstances. However, it can be useful in avoiding dangerous situations or helping us prepare adequately for upcoming, stressful events. Although clinical anxiety varies in intensity and duration, it is more severe and long-lasting than typical anxiety, and often more intense than would be typical given the circumstances. The core symptoms include excessive worry, feeling tense, racing thoughts, decreased concentration, restlessness, and irritability. Physical symptoms could include headaches, dizziness, nausea, or rapid breathing.

Some of the symptoms of anxiety and depression overlap, such as irritability, trouble sleeping, or lack of concentration. In addition, it is common for someone to experience both depression and anxiety symptoms together.

Ryan Regis, Safe Schools clinical coordinator for Davis School District; licensed marriage and family therapist who has worked with children and adolescents for 23 years.

Question: How do you tell when people are using anxiety as an excuse — they have counseling and coping skills and sometimes really have anxiety but seem to not ever try anything new? How do you help them want to try things that may cause them some anxiety, to start learning skills?

Answer: Avoidance fuels anxiety and anxiety predicates avoidance, creating a vicious cycle, so I can understand how it is difficult to differentiate between avoidance and accommodation. People don't generally want to do the things they are fearful of, so it is important for it to be experienced and measured and used as a tool, rather than a threat. Setting reasonable, incremental expectations that the child/loved one participates in creating is vital. Being specific with those expectations and stepping into them slowly but consistently will provide the best result.

—Jenny Howe, MS, clinical therapist who practices in Kaysville, Utah.

Answer: This touches on an important consideration about "willing" vs. "able" to do and feel better. I think it's risky to make assumptions about people's motivation, or believe that people would do better if they would only 'decide to,' or if we provide better rewards or firmer consequences.

Certainly it is always some combination of can't/won't, but in my experience it is much healthier in relationships and more productive toward getting unstuck to just assume that people can't, or else they would. When you assume they can't, you treat them like learners who need education, training and encouragement; if you assume they won't, you treat them like rebellious, manipulative or lazy teens.

Kids struggling in any way often need a bit of an excuse — someone or something to help take the pressure off. I say give it to them. Acknowledge and validate that some things are harder for them of no fault of their own. However, that also doesn't mean there can't be consequences for actions, or that they should be let off the hook.

You could say for example, "I'm sorry that anxiety kept you from making it to school today, that's really frustrating. We do unfortunately need to figure out how to get the schoolwork done." Or, "I know anxiety is telling you not to go, but I'm going to keep encouraging you because life isn't going to be great if we always let anxiety make the decisions for you, I want the real you calling more of the shots."

— Matt Swenson, MD, board certified adult, child and adolescent psychiatrist, medical director of Utah Valley Psychiatry and Counseling Clinic in Provo

Question: How do you know if your child needs medication?

Answer: Dependent on the mental health diagnosis, medication is not always a necessary component of treatment and there is not a clearly defined line as to when one child versus another would benefit from medication. Specific to anxiety, or Generalized Anxiety Disorder, medication can be a useful tool in tandem with therapy, but is not always necessary. It is best to seek out a mental health professional to help you navigate the clinical nature of your child's anxiety, prior to making the decision.

— Jenny Howe, MS, clinical therapist.

Question: What can educators do to help students with anxiety when they need therapy or someone to talk to, but the school doesn't have these resources?

Answer: Unfortunately, the school system is not set up for regular therapy sessions. However, there are multiple resources throughout the community that educators can refer students and parents to. It is encouraged that educators know what resources are in their area that provide services for students.

The school counseling center is a great place to begin as they may already know of resources in the area. Another great resource is www.211utah.org. You can search for resources by topic and geographical area via the website. You can identify details such as hours of operation, cost, insurance taken, and who they serve. You can also chat with someone if necessary.

If the need is emergent, the student/parent can call 911 or use the SafeUT app for help. Again, it is recommended to know what resources are in your area that you can refer students and parents to.

In addition, there are multiple resources educators can access to help reduce anxiety. Researching and implementing a mindfulness program as a daily practice has shown to reduce anxiety in students. Before implementing mindfulness practice, be sure to research multiple programs, the evidence behind them, and the appropriate ways of implementing the program for students’ developmental levels.

Books such as “Building Resilience in Children and Teens”, “My Anxious Mind”, “Helping My Anxious Teen”, and “The Formative Five” are just a few options to begin your study.

—Torilyn Gillett, M.Ed., School Counseling Program Specialist, Canyons School District

Question: If the person who has anxiety doesn't want to get help, what can a parent do?

Answer: I am not sure I have ever had someone come into my office for the first time, overjoyed and ambitious about engaging in therapy. Acceptance and awareness of one’s issues and their impact can take time, which is often very frustrating to loved ones who really just want to help.

Continued and consistent conversations that lead with empathy and address solutions to your concerns about your child are most effective. Often, parents report telling their child they only have to try a few sessions and then they can re-evaluate, which is helpful in allowing the child/teen to feel a sense of control. Typically, if the therapist and child match well, the child will feel the benefit of therapy and want to continue after a few sessions. Video Conferencing Therapy can be a useful tool for those who are resistant to leaving the home, in the beginning, as well.

—Jenny Howe, MS, clinical therapist.

Question: How can you find your core fears, because sometimes I feel it may be so subconscious, then how do you treat it?

Answer: Core fear identification is a component of cognitive behavioral therapy. It is identified by specifying fears and recognizing a pattern of associated thought connected to those fears. For example, someone may say, "I don't like dating, so I don't," when really, the issue is related to anxiety surrounding social conversation, awkward interaction and a core fear of feeling rejected. A core fear becomes apparent through reflective patterns of avoidance. Treatment of the core fear usually centers around shame.

—Jenny Howe, MS, clinical therapist who practices in Kaysville, UT.

Question: Can regular anxiety turn into clinical anxiety? If so, when and how do we address regular anxiety so it doesn't turn into clinical anxiety?

Answer: There is no hard line that separates "clinical" anxiety, depression, inattention or social deficits from what we typically think of as "normal" variations on these problems. The term "clinical" is used to designate an agreed-upon severity of both distress and functional impairment.

This is important to keep in mind for at least two reason:

1. Negative emotions are OK and normal, indeed an important part of what makes us human. Keeping this in mind allows a person to sometimes "just sit" with negative emotions, practice self-compassion and self-reflection, and remember that they will pass;

2. Our shared experience reminds us that empathy is our most important tool for helping others by getting in touch with that part of ourselves that has experienced some degree of loneliness, embarrassment, shame, fear or vulnerability and using that to stay connected to our loved ones who are struggling. In summary, people need to feel safe to feel what they feel and be who they are, and they need to feel connected to loved ones. I would recommend working on meeting those needs for safety and connection for those with all degrees of anxiety.

— Matt Swenson, MD, board certified adult, child and adolescent psychiatrist, medical director of Utah Valley Psychiatry and Counseling Clinic in Provo

Question: Should someone with anxiety be forced to go to church or Scouts?

Answer: I think understanding and specifying the fears or concerns surrounding why the person doesn't want to attend those activities is a necessary conversation. Being mindful of projecting our own anxiety about our loved one not attending those activities is also a necessary conversation within ourselves. If we are worried about how the non-attendance at those activities is being perceived in the community, we may need to take a step back and address the issue when we've acknowledged our own anxiety.

— Jenny Howe, MS, clinical therapist who practices in Kaysville, UT.

Question: I want to help kids and parents learn how to manage anxiety. What is the best pathway to take in the college system (degree) to get the education I need to be in a position to help? What bachelor's/master's program would you recommend?

Answer: The short answer is that there are many pathways possible to do what you want to do, and I am not sure that there is a “best” one.

First, there are multiple professional licenses available in Utah, for someone who wants to do counseling and psychotherapy. All of these professional roles can give you an opportunity to work with anxiety. Each has its own salary range. The Utah Division of Occupational and Professional Licensing (DOPL) provides licenses for the five professional roles: First, there is a licensed clinical social worker, which is the license I hold. The other roles include a licensed psychologist, a psychiatrist, a marriage and family counselor, and a clinical mental health counselor. You can learn more about these professional roles by contacting DOPL and/or looking at their website.

Second, you can qualify to take an examination for licensure in one of these roles by taking required coursework that corresponds to each role. In social work, for example, people enter and complete a Masters of Social Work (MSW) program, and then also need essentially two years of supervised, post-MSW experience before they can get licensed. Many people take a bachelor’s of Social Work before they enter an MSW program, although many students enter a MSW program with degrees in other fields such as psychology or sociology. One of the reasons I love social work is because we strongly emphasize the importance of economic and social justice, diversity and inclusion, and the role of culture in our practice.

If you are interested in getting an advanced degree that would qualify you to get licensed in one of the professional roles listed above, it is probably a good idea to look at the different degree programs, in social work, psychology, medicine, and related fields.

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A last piece of advice. A long time ago, I worked with some clinical social workers when I was still an undergraduate student in my early 20s. They impressed me so much with their competency and humanity that I eventually became a social worker. Perhaps you might notice what professional helpers impress you the most and ask them about their own professional paths.

— David Derezotes, LCSW, PhD, professor at University of Utah; chair of Mental Health & Director of Bridge Training Clinic, College of Social Work, director of Peace & Conflict Studies, College of Humanities; director of Transforming Classrooms into Inclusive Communities, Center for Teaching & Learning Excellence; MUSE Professor, Undergraduate Studies