Owen feels compelled to make himself tiny, standing small in the corner with his arms folded while the family watches a movie.
And he apologizes — a lot.
This summer, as the 12-year old and his little brother Craig, 10, were gathering fallen apples near their home in the Salt Lake suburb, Craig decided to count: Owen said “I’m sorry” 266 times.
Owen has battled disruptive levels of anxiety since he was 9, but it got worse this past summer. Now the possibility of hurting people or things — even apples — has been added to his already-long list of worries.
"Adolescence is a critical period for the onset of mental health disorders," according to the latest report from New York-based Child Mind Institute, which says more than 17 million American youths have or had a serious mental health impairment before age 18. And nearly one-third of adolescents "will meet criteria" for an anxiety disorder diagnosis by age 18. So Owen’s in good company.
Alone or coexisting with other mental health conditions like depression or obsessive-compulsive behavior, which Owen started exhibiting in 2015, anxiety impacts 1 in 4 teens severely enough to be life-altering.
For a year, the Deseret News has explored how anxiety is increasingly taking a debilitating toll on teens, a research journey that drew us into families’ living rooms, doctors’ offices, therapy sessions, school programs, college quads and community meetings. We’ve talked with dozens of teens and young adults across the country, their parents and families, teachers, friends and the experts who counsel them.
We’ve shared findings about why anxiety is on the rise, what to expect with medication, how boysand girls react differently to stressors, why anxious college students flourish or falter and how anxiety interacts with faith.
Yet as we wrote about unprecedented rates of anxiety among youths, we also found reasons to be hopeful and ways to be helpful.
Helping teens overcome anxiety takes place in three distinct but overlapping arenas: At home, in schools and through community resources like churches, doctors and therapists. Each uses techniques that can be learned and shared so teens who struggle with anxiety feel heard, supported and, in time, flourish.
“I think back 20 years ago, and I was here to teach — everything else was the responsibility of the community, parents, churches,” says Larry Madden, principal of Bryant Middle School in Salt Lake City. “Really, it’s all of our jobs; it’s all of us.”
While Owen has the diagnosis, his family — dad Matt, mom Lorraine, Craig and sisters Ella, 17, and Clara, 15 — are all impacted, too. Conquering his highly anxious behavior is a family affair and each one is part cheerleader, part therapist, guiding him through what counselors call “exposure therapy,” which means doing the very thing that ratchets up his anxiety, and is one type of cognitive behavioral therapy, which is the industry's gold standard.
The “it takes a village” approach has helped Owen. He’s been reading through workbooks at home with his mom and dad and recently completed an outpatient stint at The OCD & Anxiety Treatment Center in Bountiful. School’s structure helps, too.
Small Owen is slowly expanding, his laugh returning in unexpected bursts that delight the entire clan.
Not too long ago, Owen asked his dad if he’d always be anxious. “I think so,” Matt said. “But we’ll get better at managing it.”
Anxiety doesn’t just affect a teen — it affects the entire family, from parents who aren't sure how to react or where to get help, to siblings who may find themselves drifting out of focus as the suffering child’s needs take center stage.
Many parents feel overwhelmed by the depth of emotion and stress exploding in their home.
“I wasn’t prepared for how physically draining it is for him and for our whole family,” says Molly, a mother of three children who struggle to varying degrees with anxiety, though it’s most severe for her oldest son, Luke, 18, who also has OCD. “When Luke is anxious then everybody feels it.”
Wading through the family’s anxiety is so rough some mornings that by the time Molly gets the kids off to school in Murray, Utah by 7:15 — an epic battle — she sits down and cries. Other days, she feels calm and capable as she cares for her kids, and still has energy for yoga or book club to relieve stress.
She checks in frequently with supportive family members and friends who will listen and love, and tell her it’s OK that she’s feeling stressed, angry or anxious herself.
“Some of the mightiest work of parenting is emotional self-awareness so you can teach emotional self-regulation,” says John Duffy, a clinical psychologist near Chicago and author of “The Available Parent.”
The ability to acknowledge emotions, name them and then deal with them positively are among the most important ways parents support their anxious teens — not to mention their anxious selves.
Yet, many parents believe their role is to “always be perceivably stable,” says Jenny Howe, a therapist with practices in Utah and California. “And that does a disservice to our children. They’re watching that, and in their eyes, they think, “I have to be stable, too. This is what mom and dad do; I better do this as well.”
That doesn’t mean stable parents aren’t important, Howe says, but it means parents need to embrace the idea that it’s OK to feel emotions, it’s OK to talk about them and it’s OK to not always be OK.
When kids understand that their parents can handle tough emotions and yet be resilient, it gives them permission to do the same thing. It also breaks down the idea that “anything other than happy is unacceptable,” says Duffy.
Parents can demonstrate through direct conversations like: “Today at work I felt frustrated, so I did some deep breathing and watched a YouTube clip,” or “I felt disappointed, so I took a walk to refocus.”
Other times, it may mean apologizing to a child for mismanaged emotions or even just silently modeling healthy coping, because “kids are always watching,” Duffy says.
Shari and her three daughters have learned to embrace their emotions by meditating together.
Each morning at 6:30, they gather in the living room to read scripture, write in their journals and breathe deeply to clear their minds, which are often clouded with anxious thoughts.
The daily exercise has brought them closer and given them permission to have and express big feelings.
It’s also removed the “should” from the equation, says oldest daughter Samantha, 20, meaning there’s no expectations that they feel or not feel a certain way. Rather, meditation allows “everybody to work out their own emotions in a way that they feel is best,” she says.
It’s made a noticeable difference. They fight less, listen more.
Instead of peppering her daughters with questions about their day or homework load, Shari asks them instead, “What have you done today for self-care?”
“When we’re meditating,” says 17-year-old Nikolette, “when everyone knows we’re taking care of ourselves, it’s easier to want to take care of other people.”
The ability to be mindful about emotions isn’t limited to in-home meditation.
A growing number of schools are weaving social-emotional learning and mental wellness practices into their classrooms, recognizing that next to the home, kids spend the most time at school — and they always bring their anxiety with them.
When Katy Stinchfield, a senior program manager at School-Based Health Alliance in Washington, D.C., worked with Teach for America in New Mexico early in her career, she quickly realized her high expectations needed adjustment.
“My kids (had) so much other stuff going on, they couldn’t even do math or reading,” she says. “If you want kids to be successful, you have to meet these basic needs.”
Instead of jumping into the curriculum each morning, she’d start with an informal check-in and ask the kids how they were feeling — have them name their emotions. Some kids were fine, others reported serious concerns.
Over time, the kids began to feel both safe and heard in her classroom and could then focus on learning.
At Albion Middle School in Sandy, Utah, mindfulness is official and schoolwide. Students spend the first 10 minutes of second period at their desks with their eyes closed. They listen to a guided meditation that focuses on breathing, and perhaps a body scan, head to toe, noting physical feelings, but not reacting to them. Then each day’s exercise veers gently into a different social-emotional learning focus.
Teachers even use the meditation as a reset when kids are rowdy, says Albion school counselor Cathy Nelson of the pilot project Canyons School District is testing there and at Corner Canyon High School.
When students feel mentally healthier, they’re more ready to learn and more likely to enjoy school.
Stanford Senior Lecturer Denise Pope has heard from teens who excitedly tell her she’s the reason they now have time for breakfast or the reason they practice meditation.
Her program, “Challenge Success,” encourages primary and secondary schools to reduce the pressures on kids by adjusting schedules and expectations — encouraging overall well-being through later start times, project-based learning, mindfulness practices in the classroom, changes in grading and parent buy-in.
As rates of anxiety and depression, bullying and teen suicide rise, the nonprofit — which has worked with over 450 schools all across the country though none in Utah, yet — now has a wait list.
Bryant principal Madden knows a student’s frame of mind at school “dramatically affects their learning,” he says. “The safer a kid feels in school, the better they do academically. If you want to raise test scores, make sure everyone feels safe at school.”
To that end, he’s invited University of Utah assistant professor of school psychology Aaron J. Fischer and his “Well-Being Team” of inexpensive, but devoted psychology grad students to offer mental health counseling inside the school.
Each week, teachers present a brief lesson on a social-emotional concept — like values and friendships, emotions or goals — to benefit every teen, anxious or not.
Students who need more support are invited to join graduate-student-led groups to talk about concerns, including anxiety, depression or self-harm.
If their need is greater, they can talk one-on-one with a counselor — all during school hours, with parental consent, for no cost and only if the student chooses.
Historically students were expected to “behave” and “absorb,” says Pamela A. Cornejo, a doctoral candidate in counseling psychology who manages the individual therapy at Bryant. But unaddressed mental health issues can prevent that and manifest as truancy, fighting, underperformance or even shyness.
The Well-Being Team is helping Bryant teachers recognize what is typical for adolescents versus red flags that need intervention, Cornejo says.
And just feeling noticed means a lot to a teen.
Cornejo says students sometimes cry when she tells them someone was worried about them.
Students will tell her they’ve experienced suicidal thoughts, or that they’re tired of adults not hearing them. Their depth of feelings tells her that intervention at this age is crucial and makes a difference.
“To have at least one person on their side, listening, monitoring and helping boost their development,” she says, “it changes everything.”
In the community
After she lost her son James to an overdose when he was 23, Trisa McBride vowed she would do all she could to help other anxious teens and parents avoid the same heartache.
She started an anxiety clinic in his name, the James Mason Centers for Recovery in Taylorsville, Utah, where anxious teens learn skills to prevent their anxiety from running rampant and leading them to drugs to numb their pain — as it did for James.
Through therapeutic crafts, schoolwork, games and ropes courses, students learn they can do hard things. And through family therapy sessions, parents and teens work through mental health struggles and family conflict.
“It’s tough to be a parent because as much as we love our kids ... we seem to have less influence on them because of the nature of the teen (years),” McBride says. “The gift is having other adults that can guide and assist a teen, because they’ll listen to someone else.”
Teaching folks in the community how to provide that guidance is the goal of the “Everyday Strong” program out of United Way of Utah County.
It’s built on the notion that beside basics like food, sleep and shelter, humans, especially teens, need to feel safe and secure. They must feel a strong sense of belonging and believe in their own value — and responsive adults can help them develop those feelings.
The program offers a free, educational downloadable booklet on resilience and provides speakers for schools, community groups and others on request.
Before adults fully buy in, though, they must accept anxiety as a problem in their own community. In Utah County alone, the number of highly anxious kids has gone from 17 percent in 2013 to 25 percent in 2017.
It’s not a matter of how researchers asked the question, either. The wording in the SHARP survey is clear: “During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities?”
"Everyday Strong" hopes to curb anxiety before it becomes so rooted it derails young lives. “Kids are experiencing something really hard,” says Michaelann Bradley of United Way of Utah County. “We want to stop it.”
Ultimately, anxiety is fear of the unknown, says Luke Henke, a clinical psychologist at the University of Michigan who sees a lot of anxious students every year. Those who would tame anxiety have two basic choices. Reduce the fear piece, or reduce the unknown piece. But stop avoiding what makes you anxious.
At St. George, Utah-based Life Launch Centers, kids tackle their anxieties by speaking to each other face-to-face during group therapy about the “stuff that really matters, like how anxiety affects them,” says Joe Newman, director of business development.
Instead of texting side-by-side, they’re learning to look someone in the eye and communicate, which “builds resilience,” he says.
DOWNLOAD: Our toolkit for dealing with anxiety
“There is more risk of rejection in face-to-face interactions,” says Newman. “Kids today just aren’t building that ‘thick skin’ as they constantly choose easier modes of communication like texting.”
The Centers teach kids distress-tolerance tools like self-affirming touch or how to use “box breathing” (see interactive graphic for more.) The point is to develop self-management “rather than having a teacher say, ‘You need to calm down.’” Which, by the way, he adds, usually just makes things worse.
Counseling sessions, day-treatment or even in-patient treatment can be lifesavers for some teens and families, yet finding a therapist who’s available, affordable AND compatible isn’t always easy.
Too few therapists work with those who are highly anxious, especially teens, and even with insurance, wait times can be long, says Bradley.
Knowing that, her organization has partnered with relevant community groups: Intermountain Healthcare, Wasatch Mental Health, Family Support and Treatment Center, Utah Valley University and Brigham Young University all bring unique expertise to the program’s advisory board.
It's crucial that churches know about their community mental health resources because struggling families will likely turn to their pastor before they turn to their psychiatrist, says Stephen Grcevich, a clinical associate professor of psychiatry at Northeast Ohio Medical University and president and founder of Key Ministry, which promotes connection between churches and families of children with “hidden” disabilities — like mental illness, trauma or developmental disabilities.
Studies from Child Trends and Harvard are among many finding religion is a protective factor, shielding people from mental illness, as well as providing support for those who struggle. But that finding is only true for those who attend church and participate in related activities — which may be exceptionally hard for someone with anxiety.
Imagine what’s going through someone’s anxious mind as they think about going to church: Will they be dressed appropriately or will they stand out? Will they be asked to pray? Sing? Comment? Introduce themselves in front of a large group of people? What if no one sits by them? What if someone sits by them?
Yet, because mental illness is so often hidden, it may be difficult to know whether attempts to fellowship and befriend are appreciated gestures or triggers to panic.
Grcevich’s recent book “Mental Health and the Church: A Ministry Handbook for Including Children and Adults with ADHD, Anxiety, Mood Disorders, and Other Common Mental Health Conditions” explains that supporting fellow worshippers is more a “mindset than a program.”
It requires learning about mental illness and how it may interfere with church attendance, then practicing inclusion strategies that can benefit everyone — like talking about mental health from the pulpit, going with a friend to church, and taking casseroles to families whose kids have mental health disorders, not just families whose kids have cancer.
“When you look at the explosion of ... common mental health conditions in the U.S., particularly anxiety and ADHD, there’s a role for everybody to play,” Grcevich says.
Back in Utah, Owen’s dad Matt says learning ways to help his son has helped him deal with his own quirks and emotions. The shared effort to help one has helped them all, in fact, and drawn the family closer.
So when Owen starts tiptoeing across the carpet, Matt gently steers him back to the starting point. “Do it again, Owen,” he says.
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