Treatment of Anxiety in Children and Adolescents

There is no single cause for anxiety disorders in children and adolescents, and no one-size-fits-all treatment to address the full range of these conditions.  At The Midtown Practice, we recognize that effective treatment must be individualized for a specific family and child, and is determined by both clinical recommendations and familial culture and circumstances. After a thorough assessment by one of our skillful clinicians, we are likely to recommend a comprehensive approach that might include psychotherapy (“talk therapy”), behavioral and lifestyle modifications, family psychoeducation, coping strategies, and at times pharmacological interventions. Although medication is almost never our initial step, there are instances when it can be helpful, even if only on a temporary basis, until a child is able to resume normal activities and functioning.

Psychoeducation

Psychoeducation involves teaching children and caregivers about their anxiety symptoms and providing an overview of how they are affected by their conditions. At The Midtown Practice, we believe knowledge is power, and a diagnosis does not determine life course, but is rather a guide for treatment and return to normal function. Emphasis is placed on understanding the causes of anxiety, removing blame from the individual and guilt-ridden caregivers, and moving towards a more positive view of the future. We work with you and your child to normalize the anxiety symptoms, focusing on the relationship between anxiety and avoidance and on the role avoidance plays in perpetuating negative behavioral patterns. Everyone can learn, for example, that while the sensation of anxiety is a completely natural response to unfamiliar situations, it does not need to impair friendship, academics, or participation in other activities. Identifying your specific symptoms of anxiety and learning to self-monitor is a powerful tool in gaining awareness and applying tools to minimize distress.

Behavioral and Lifestyle Modifications

Through self-monitoring of daily lives and reactions, your child can learn to identify specific triggers, physical sensations, and thoughts that signal and perpetuate anxious emotions. Perhaps your child can benefit from greater structure, more exercise, or avoidance of certain foods. Your clinician might also teach certain techniques, such as diaphragmatic breathing or progressive muscle relaxation. Multiple studies have shown that these methods ease the nervous system, and effectively manage subjective and objective symptoms of anxiety.

Diaphragmatic breathing involves breathing slowly and deeply from the diaphragm to facilitate a relaxation response. Sometimes we combine this type of breathing with mindfulness exercises, such as counting your breaths, intentionally making your exhalation longer than your inhalation. Progressive muscle relaxation involves tensing and relaxing muscles throughout the body, beginning with the lower extremities and moving upward the length of the body. Other mindfulness exercises, such as focusing on the senses, mindful walking which involves paying attention to how your body moves when you walk slowly, or taking a 3-breath hug with your child can also help them regulate their emotions. Our skillful clinicians can teach specific tools adapted to your child’s age, symptoms, and temperament in order to achieve the highest level of success.

Psychotherapy

Psychotherapy, or talk therapy, is a general term for treating emotional struggles by talking to an experienced clinician, such as a Therapist, Psychiatrist, or Psychiatric Nurse Practitioner (PMHNP.) At The Midtown Practice, our experienced clinicians can help you and your child learn about their moods, feelings, and behaviors, and minimize the suffering associated with anxiety. Psychotherapy can help your child or adolescent feel less alone, and help them to respond rather than react to challenging situations with healthy coping skills and self-awareness.

There are many types of psychotherapy, each with their own philosophy and approach. At The Midtown Practice, we employ a variety of strategies, drawn from evidence-based practice, and tailored to your child’s age, life experience, and personality. The goal of psychotherapy is to reduce discomfort, learn to manage unhealthy or unproductive behaviors, recover from trauma, resolve conflict, and return to a normal productive life. Our clinicians are trained in various specialties such as Dialectical Behavioral Therapy, Cognitive Behavioral Therapy, Psychodynamic Therapy, Supportive Therapy, Acceptance and Commitment Therapy, and Cognitive Processing Therapy.

Generally, there is little risk in engaging in psychotherapy, however, it is possible when exploring and/or learning how to manage difficult emotions to be emotionally uncomfortable at times. We work hard at the Midtown Practice to find a clinician well matched with you and your child, who can provide you with a trustworthy and safe environment to achieve the best results possible.

Psychopharmacology

 At The Midtown Practice, our general philosophy is that although less medication is better, especially in the pediatric setting, there are instances when medication can be a safe and sometimes wonderfully effective treatment for those suffering from anxiety disorders. Rarely do we recommend medication as a singular treatment course, but rather in combination with psychotherapy and/or the other treatments described above. The decision to prescribe medication depends on the severity of your child’s anxiety, the extent it interferes with their schoolwork, social life, and everyday functioning or if your child is experiencing thoughts of harming themselves. At times, medication is recommended when psychotherapy or another treatment alone is ineffective. Oftentimes, medication is prescribed similar to training wheels on a bicycle. In these instances, the medication can be used to temporarily relieve symptoms while a child learns to manage their emotions within the context of therapy, and then later tapered off once a child achieves adequate progress.

There are several types of medication that can help with symptoms of anxiety. Although they often have confusing names, they generally fall into discrete categories. These include antidepressants such as Selective Serotonin Reuptake Inhibitors (such as Zoloft, Prozac, and Celexa), Antidepressants called Selective Serotonin and Norepinephrine Reuptake Inhibitors (such as Effexor XR or Cymbalta), Anti-Anxiety medications called benzodiazepines (such as Ativan or Klonopin), Atypical Antipsychotics (such as Abilify or Latuda), Alpha agonists (such as Intuniv), and finally Antihistamines and Atypical Anti-Anxiety medications (such as Vistaril or Buspar.) After thoroughly discussing and weighing the risks and benefits with you, your clinician at The Midtown Practice will make a recommendation best suited for your child and support you and your family, constantly reevaluating to make sure progress is being made.

At The Midtown Practice, we know how important it is to include you and your child in all treatment decisions, and spend whatever time is necessary to ensure success. We are dedicated to helping young people early and comprehensively, so that they can mature into healthy, well-adjusted adults living the full and meaningful lives of their own making.