Why extreme anxiety is at an all-time high among American students

Teenagers in America are increasingly suffering from severe anxiety—but few are receiving one of the most helpful forms of treatment, Benoit Denizet-Lewis writes for the New York Times.

According to the National Institute of Mental Health, about one-third of adults and adolescents suffer from anxiety disorders, making them the most common mental health condition in the country. And young people in particular have reported a substantial increase in the rate of anxiety, Denizet-Lewis writes.

The American College Health Association found the rate of undergraduates reporting "overwhelming anxiety" increased from 50% in 2011 to 62% in 2016. Anxiety has also "overtaken depression as the most common reason college students seek counseling services," Denizet-Lewis writes.

Multiple issues could be spurring the increase of anxiety, Denizet-Lewis writes.

For example, according to Denizet-Lewis, anxiety might be a very rational response among young people who live in abusive homes or in violent or impoverished neighborhoods. But young people from privileged homes have also reported a substantial spike in anxiety, with many saying their primary stressor is the feeling they will "never get to the point where they can say, 'I've done enough, and now I can stop,'" according to Suniya Luthar, a professor of psychology at Arizona State University.

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According to experts, sources of stress among both disadvantaged and privileged young people include concerns about how they are perceived by others, a fixation on family conflicts, and a focus on events in the media, such as terrorism.

But one consistent source of stress among youth is social media, Denizet-Lewis writes. Stephanie Eken, a psychiatrist and regional medical director for Rogers Behavioral Health, explains that young people are using social media to compare themselves with their peers—and they constantly perceive themselves to be falling short.

The threat is double-edged, because even though many of the teenagers with whom Denizet-Lewis spoke with identified social media as a source of anxiety, they also admitted it was a helpful avoidance tactic, a distraction from school, family, and other stressors.

Research has shown exposure therapy—in which patients are incrementally exposed to their fears—is often highly successful in treating anxiety, Denizet-Lewis writes. He cites a 2008 study in the New England Journal of Medicine which found more anxious youth reported improvements with cognitive behavioral therapy that features exposure therapy (60%), than with Zoloft, a medication treatment (55%), although the study found a combination of medication and therapy had the highest rate of success (81%).

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Researchers at UCLA's Anxiety and Depression Research Center more recently found that the more anxious someone feels about exposure therapy, and the more surprised he or she feels at the result of the therapy, the more effective it is at treating anxiety when compared to the patient's originally reported traumatic memory or negative situation.

But while exposure therapy has proven successful, few teenagers receive it, Denizet-Lewis writes.

"We're much more likely to medicate kids than to give them therapy," Stephen Whiteside, director of the Child and Adolescent Anxiety Disorders Program at the Mayo Clinic, said. "And when we do give them therapy, it's unlikely to be exposure. With a few exceptions, we're not treating people with what actually works."

As Whiteside explained, the problem is two-fold: Anxious people are reluctant to engage in therapy designed to make them feel more anxious, and therapists are often reluctant about "helping [anxious people] feel uncomfortable." Whiteside added, "It's much easier to sit in a therapist's office and talk about feelings."

According to Denizet-Lewis, therapists are working to address those problems, such as by exploring how to incorporate exposure therapy into office-based work via virtual reality. Whether exposure therapy happens in person or virtually, the point remains the same, according to Bryan Randolph, a therapist at Mountain Valley, a residential treatment facility that provides care for acutely anxious adolescents. Patients in exposure therapy learn that regardless of whether "exactly what you think will happen happens" or the "exact opposite of what you think will happen happens… it's all manageable" (Denizet-Lewis, New York Times, 10/11).

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