Because of COVID-19, Anxious feelings are understandably very high in youth right now. My daughter is in 8th grade in middle school and gets waves of many emotions–such as anxious feelings related to not seeing friends, missing the end of year trip, or sad feelings thinking about all the things she will miss from not being able to participate on her spring sports teams. Add to this trying to learn on line with little to no guidance while wondering how she will be graded on her work. All kids have stories right now of things they are fearing, regretting, missing out on, obsessing over, and much more.

Recently while writing a grant application, I had the opportunity to read data on youth in Door County contained in the 2019 Wisconsin Department of Public Instruction (DPI), Youth Behavioral Risk Factor Survey (YBRFS), a survey given to middle and high school students. I thought about a section in the survey dealing with anxiety and how prevalent it is in our children. I thought it would be helpful to give insight into the difference between anxious feelings vs. clinical anxiety, and then to provide examples of skills and resources based on Dr. Delaney Ruston’s research.

Dr. Ruston has been talking with psychiatrists and psychologists who are finding that many teens who were experiencing a lot of anxious feelings related to things at school are doing overall emotionally better with school out. Yet they do talk about how this can change for them at any time, particularly as the pandemic and social isolation continue.

There is still a great deal that can be discussed with our kids right now that will help them when they face anxious feelings and will help them in helping their friends and others. In surveys, teens report that they are more likely to tell a peer about hard emotions rather than adults. Helping our youth gain skills can be a real asset to be able to help others in their lives, be it now or be it years from now.

First-What are Anxious Feelings?

The word “stressed” is an often used word in our society. However, it can mean many different things to the person saying it, such as feeling that something in their life is out of control, or they feel overburdened, or irritated, or many other things.

In the same way, when a person says they are feeling “anxious”, it can mean many different things—similar to the word “stressed.”  This is where the skill of stopping to think about the core emotions behind these words is a great one to develop. Only when we understand these feelings, can we better intervene.

It can be helpful when thinking about anxious feelings to know that often the anxious feelings are actually fear. Fear of an uncertain future, fear that you did the wrong thing (regret is a type of anxiousness), fear of what will happen if you ask someone if they want to video chat, and then the fear of how that person will perceive you. 

Let’s go back to the Youth Behavioral Risk Factor Survey from 2019. The results regarding anxious feelings for teens in Door County were:

  • 49% of high school & 54% of middle school students report debilitating anxiety issues over the course of the year

Our youth here are no different in what they are experiencing from the rest of the United States. In a recent survey done across the country by Mental Health America during the COVID-19 crisis, notice the increased percentages as well as the frequency of anxiety.

  • 58% of middle schoolers said they at least sometimes “felt nervous or anxious in the past two weeks”
  • 46% of middle schoolers reported that at least sometimes, they were “unable to stop or control worrying in the past two weeks

High school students reported that:

  • 69% felt nervous at least sometimes
  • 59% were unable to stop or control worrying at least sometimes

Next we will discuss what clinical anxiety is as compared to anxious feelings

What is Clinical Anxiety?

The numbers here come from the main comprehensive study on youth mental health, called the National Comorbidity study-Adolescent Supplement. When any book or scientific paper references rates of adolescent clinical anxiety, this is the paper to which they are referring. 

  • By age 18, 32% of youth will have met criteria for some type of clinical anxiety, ranging from very mild to very serious.
  • By age 18, 19 % of youth will have met the criteria for severe clinical anxiety — meaning it caused severe impairment and/or distress.

Diagnosing Clinical Anxiety

Dr. Ruston reported that some anxious feelings are to be expected and are even helpful. For example, anxiousness in anticipation of a test in a few days can help a person to study for a test. When anxious feelings are often out of proportion for the situation, and the feeling does not fit the fact, this may indicate the possibility of clinical anxiety. For example, these two scenarios would be cause for concern:

  • A teen worries all the time about tests. Long before it is even going to happen the student is so consumed by the fear. The teen loses sleep and has lots of intrusive thoughts about failing.

 

  • A youth experiences significant anxious feelings when they imagine talking to other people or raising their hands in class. This has resulted in them being extremely behind in school and not have any friends. While the student desperately wants to change, they can’t move past their anxious feelings. 

As a physician, Dr. Ruston assess anxiety in teens and adults in his clinic. He asks everyone who comes into the clinic at some point in the visit, “Are you experiencing any anxiety or depression?” The incidence of anxiety and depression is significantly higher in a medical setting than in the general population, so it is important that he asks about these things. And, so often, he sees how relieved they are that he asked. When he sees people in his clinic, and he has identified a concern about anxiety, the number one question he then asks is, “Are you avoiding things?” Their eyes light up and often respond, “How did you guess that? 

Dr. Ruston says that the main questionnaire used in health settings to help diagnose clinical anxiety is called the GAD 7. He recommends going over these questions with your kids or teens.

 It starts with these questions:

  • Over the last two weeks, how often have you been bothered by the following problems?
  • Feeling nervous, anxious, or on edge
  • Not being able to stop or control worrying
  • If the teen answers yes to either, then the following questions are asked if they have these symptoms:
  • Worrying too much about different things?
  • Trouble relaxing?
  • So restless that it’s hard to sit still?
  • Become easily annoyed or irritable?
  • Felt afraid as if something awful might happen? 
  • Then the third part assesses how distressing and/or debilitating the symptoms are and asks:

If you checked off any problems: 

How difficult have these made it for you to do your work?  

Take care of things at home, or get along with other people? 

(Options are from “Not difficult at all” to “Extremely difficult”)

When symptoms are ongoing, there can be real suffering and can lead to avoidance of certain situations. So, while it is common for teens to feel a bit nervous about going up to talk with a peer, a more intense nervousness, would indicate a more severe problem. This might present by them starting to avoid most social interactions and becoming more isolated. 

When anxious feelings lead to a lot of suffering, via constant worrying, and a lot of negative consequences, such as avoiding situations often, these are signs that anxiety is a clinical problem and should be addressed with professional help such as counselors or therapists.

In part two, we will discuss some strategies that can help with anxiety during the COVID-19 crisis and after it is over.

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