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A Cry for Help
Dateline: 03/01/00
Kids who skip school are bad. They don't respect authority. They don't care about their futures. They're lazy. They must be out doing drugs or stealing. That's what we think, right?
Kids skip school & are grounded by their parents. Kids skip school & are suspended by their schools. They're lectured & yelled at & punished. The adults in charge make assumptions about the skipping, but rarely does anyone ask why or try to get a straight answer.
Dr. Gail A. Bernstein, a researcher
at the University of Minnesota Medical School, decided to ask. Her research team discovered that about 1/2 of the teenagers
who skip school are suffering from anxiety &/or depressive disorders. The goal of the researchers'
study was to determine the best course of treatment for these teenagers.
The study compared the use of imipramine vs. a placebo, each in combination with cognitive-behavioral therapy. 63 teens, with a history of skipping school, were involved in the study.
By the final week of the study, the attendance rate for teens taking the imipramine was 70% while only 28% for
those on the placebo. The researchers did point out that by definition, remission would have to be a 75% attendance rate,
which only 54% of teens on imipramine managed to achieve.
However, one should also note that only 18% on the placebo reached the remission standard. The researchers plan
on studying the long term effects of these treatments.
The published study of anxiety (& depression) in teens is welcome. Researchers have been studying anxiety in teens & children,
but most exciting is to see the information picked up by a major newswire (Reuters) &
published on the Web site of a major news broadcasting organization (FOX).
How long has anxiety in teens not been taken seriously?
How many teens have self-medicated
with alcohol & other drugs because they don't know how to feel better & don't know how to explain their pain to adults?
How many adults with anxiety
disorders have been told that the disorders must have started in adulthood because children don't get these disorders?
While the reports on the Bernstein
study didn't go into teens' experiences with skipping school & anxiety, one might speculate that skipping school is a cry for help. Just as adults with agoraphobia may have found themselves slowly avoiding
more & more situations, teens who skip probably begin with one day of staying at home in bed before slowly working into a more obvious pattern.
It's wonderful that researchers
like Bernstein are working to determine the best ways to treat teens with anxiety &
depression. What is worrisome, though, is that there are so many teens who will never have the opportunity for treatment. They'll be
suspended from school. Maybe they'll drop out.
Parents are encouraged, these days, to discuss so many issues with their children: drugs, smoking, alcohol, sex. Perhaps it's time to add emotions to the mix. How many parents discuss self-esteem with their children? How many parents truly know how their children are
feeling emotionally?
Anxiety & depression are difficult subjects even for adults to discuss. Many adults don't seek treatment for years for such problems. Imagine
how difficult it is for teens.
Let's open some doors for
them & let them know it's OK to tell us when their emotions become overwhelming - before they decide ways in which they can handle these problems themselves.
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Teen Anxiety & Chances of Harmful Behavior Higher Than Expected
2002-07-08
Study Marked Innovative Use of Hand-Held Computer Diaries to Assess High-Schoolers' Moods
Irvine, Calif., July 8, 2002 -- Is it any surprise that
teenagers are anxious and moody? Perhaps not, but their rates of anxiety appear unexpectedly high, and their anxiety makes
them more prone to overeat and smoke, a UCI study has found.
The study, one of the first to involve teenagers' use
of hand-held computer diaries, found that high rates of anxiety led to more frequent episodes of anger, sadness and fatigue
and altered teenage behavior significantly. The findings, part of a long-term study, may also provide insight into teenage
perceptions and moods that may have changed after the terrorist attacks of Sept. 11, 2001. The study appears in the June issue
of the Journal of the American Academy of Child and Adolescent Psychiatry.
Carol Whalen, professor of psychology,
and her colleagues found that teens recorded being anxious in about 45 percent of their computerized diary entries, much higher
than expected. This anxiety, which--also surprisingly--was equal in boys and girls, led to more prevalent feelings of unhappiness
and low self-esteem. Their anxiety caused them to engage in fewer conversations and recreational activities and to eat and
smoke more.
To conduct their research, Whalen and her team issued each of 150 high school students a hand-held computer
that contained a software program in which the teens recorded their feelings and behavior during the day. The computers turned
out to be popular with the students and provided much greater insight into the adolescent mind than traditional questionnaires
and interviews.
"The teens' diaries showed us a much greater incidence of anxiety, but they also revealed behavior
patterns that had never been observed before," Whalen said. "We were able to see when this anxiety was experienced, where
and with whom. This study may help prevent adolescents from starting harmful behaviors like overeating and smoking and may
help psychologists and other health care practitioners take better care of their adolescent patients."
Teenagers with
the highest levels of anxiety tended to spend more time alone but were less anxious when they did spend time with friends,
the researchers found. High-anxiety teens were seven times more likely than low-anxiety teens to report feelings of anger
and 11 times more likely to report sadness. Moderate- and high-anxiety teens were two-to-three times more likely to smoke,
between 70 and 80 percent more likely to drink alcohol and more likely to experience urges to eat. The researchers also found
that girls were equally as anxious as boys, which was contrary to other studies on anxiety.
While the more anxious
teens were more likely to smoke, it was the less anxious teens who were most likely to experience anxiety while they were
smoking.
"Low-anxiety teenagers may be less used to anxiety, so they may smoke to ease the discomfort of anxious feelings,"
Whalen suggested. "Or smoking may actually raise anxiety levels through some physiological mechanism."
Whalen and
her colleagues continue to study the students’ electronic diary entries as they come in. Since the study began
in 1998, the researchers are in a good position to determine mood changes in adolescents that may have occurred after Sept.
11. They are now conducting new research on the effects of the Sept. 11 events on adolescents.
"This study was conducted
in the context of a secure and optimistic society," Whalen said. "All of that has changed. We may be able to use this data
as a 'baseline' with which we can compare moods and behaviors of adolescents in a peaceful society with moods and behaviors
in a society under stress."
The study was supported by grants from the National Cancer Institute, the National Institute
for Drug Abuse and the California Tobacco-Related Disease Research Program.
Whalen's colleagues in the study included
Barbara Henker of UCLA and Larry Jamner and Dr. Ralph Delfino, both of UCI. Whalen, Jamner and Delfino are also researchers
at UCI's Transdisciplinary Tobacco Use Research Center, which was established to conduct scientific studies of the different
social, cultural and biological factors that lead to smoking behavior.
UNIVERSITY OF CALIFORNIA, IRVINE:
A TOP-10 PUBLIC UNIVERSITY
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High Anxiety?
by
Amy Thomas, 03.07.03
Every day, Preeti wakes up with a sense
of dread. She feels nervous about EVERYTHING — from what to wear, to how she's going to make conversation at lunch,
to not being able to fall asleep at night. Last week she was so worried she was getting sick, she actually made herself exhausted
and sick to her stomach. She thought these feelings might go away, but last night, as she willed herself to sleep, she started
to feel chest pains, her heart was racing, and she felt like she couldn't breathe.
A Common Condition
While
lots of people experience feelings of anxiety before an important event, like a big exam, a school presentation, or a first
date, people who have experiences similar to Preeti's are usually experiencing symptoms of an anxiety disorder. Anxiety disorders
are illnesses that cause people to feel scared, distressed, and uneasy for no apparent reason. It's important to understand
anxiety disorders and recognize the symptoms because if left untreated, an anxiety disorder can tremendously affect a person's
quality of life.
Believe it or not, anxiety disorders are the most common mental illness in America — more than
19 million people are affected by anxiety disorders each year!
There are many different kinds of anxiety disorders,
including
- panic disorder
- obsessive-compulsive disorder, which involves anxious thoughts
or rituals you feel you can't control
- post-traumatic stress disorder
- social phobia (or social anxiety disorder)
- specific phobias, such as fear of being in closed in spaces
- generalized anxiety disorder
While these anxiety disorders have different symptoms, they
all produce a sense of excessive, irrational fear, and dread.
Getting Treatment
Before a person
can be treated for an anxiety disorder, a trained clinician, such as a psychiatrist, psychologist, clinical social worker,
or psychiatric nurse, must conduct a careful evaluation to determine whether the symptoms are due to an anxiety disorder and
if so, which anxiety disorder. Also, other factors, like drug or alcohol abuse, must be identified because they often contribute
to the disorder.
Preeti decided to turn to her guidance counselor for help. Her counselor made her an appointment with
the school psychiatrist. The psychiatrist diagnosed Preeti with generalized anxiety disorder (GAD) and panic disorder. The
psychiatrist explained that anxiety disorders are highly treatable.
In general, two types of treatment are available
for an anxiety disorder. Preeti can choose to talk to a psychotherapist to examine her feelings and learn to separate realistic
from unrealistic thoughts. She can also choose to take medication. Many people choose to use both methods of treatment.
Since
Preeti isn't yet 18, she'll need to consult with her parents and her therapist about which treatment would be best for her.
Anti-depressants or anxiolytics (anti-anxiety medications) are used to treat severe symptoms so that the patient feels OK
enough to go through other forms of therapy. Medication is effective for many people and can be either a short-term or long-term
treatment option, depending on the person. The choice of medication or therapy, or both, depends on the patient's and the
health care provider's preference, and also on the particular anxiety disorder.
Dr. David Carbonell, a clinical psychologist
who specializes in anxiety disorders, suggests that in addition to various medications, teens should go through a type of
therapy that "helps them find a different way of thinking about and responding to their anxiety so that they are able to gradually
lessen the effect it has on them."
Needless to say, anxiety isn't something you should try diagnosing yourself. If
you think your fear of certain situations is disrupting your daily life, talk to an adult you trust — like your parents,
a guidance counselor, or teacher. Ultimately, you should speak with a health care provider who is familiar with anxiety disorders
and can diagnose whether you have one and, more importantly, prescribe the best treatment if you do.
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In-School Talk Therapy Can Help Depressed And Anxious Teens
Main Category: Psychology / Psychiatry News
Article Date:
15 Apr 2007 - 0:00 PDT
Training school social workers to lead "talk therapy" sessions
during the school day can help teens and pre-teens recognize and begin to overcome mild depression, anxiety and anger problems,
research is showing.
A pilot study of the approach, presented earlier this year at a national meeting by a team from
the University of Michigan, suggests that in-school therapy sessions could help address some of the unmet mental-health needs
of young people. Previous studies have indicated that many students don't access or can't afford treatment in the community,
even when it's recommended to their parents by teachers and counselors.
In all, the researchers reported results from
45 students who received individual sessions, and 60 who participated in group sessions, with three social workers at two
middle schools and one alternative high school in Ann Arbor and Ypsilanti, Michigan. Each school has an in-school clinic operated
by the U-M Health System under its Regional Alliance for Healthy Schools for uninsured and low-income students.
The
therapy sessions were conducted by school social workers who were trained by the U-M experts to provide a modified form of
a well-established and proven talk-therapy approach called cognitive behavioral therapy or CBT. The U-M team, which included
members from the Department of Psychiatry, the School of Social Work and the School of Nursing who are all members of the
U-M Depression Center, developed the modified CBT approach specifically for the project.
Over all, several standardized
measuring tools showed significant improvement nearly across the board after students completed the multi-week program. Signs
of improvement included better mood and cognitive skills among the depressed students, and decreases in angry feelings toward
teachers and improvements in problem-solving ability among those who received counseling for anger issues.
But the
authors caution that even though the study yielded promising results, further research is needed. They have developed a manual
for school social workers who wish to try the approach in their own schools; it is now being shared with other Michigan schools.
The results were most recently presented at the Society for Social Work and Research Conference, but have also been presented
at meetings of national and state-level public health, school health and mental health groups.
The study, funded by
the Michigan Department of Community Health, involved young people who are uninsured or have coverage under Medicaid program
for low-income families. A sizable number of the participants were African-American or Latino.
"We're very encouraged
by these first results, and we hope that additional schools will begin to implement this strategy for their own students,
says Mary Ruffolo, Ph.D., an associate professor and associate dean at the U-M School of Social Work.
"Many studies
have shown that cognitive behavioral therapy can help young people with mood and anger issues, but this is the first time
that an adapted form of this evidence-based therapy has been shown to work in a school setting," says co-author David Neal,
M.S.W., an assistant professor in the U-M Medical School's Department of Psychiatry and former chief of the department's social
work division.
"We've also shown that once a school social worker has been trained in this form of CBT and has conducted
sessions under monitoring, he or she can go on to provide high-quality therapy within the school day to the students who need
it most," adds co-author Dan Fischer, M.S.W., an Adjunct Clinical Assistant Professor of psychiatry and clinical social worker
who led the project before taking on the role of director of the Child & Family Life Program at the U-M C.S. Mott Children's
Hospital.
As evidence of the need for in-school CBT, the authors point to the 2003 report of the President's New Freedom
Commission on Mental Health, which recommended school-based mental health interventions for children and adolescents because
of the low rate of follow-up on referrals to community-based resources.
"Children and adolescents are far more likely
to take part in a behavioral health program that's offered at their school, compared with those offered in the community,"
says Neal. "We need to bring these programs to the schools."
Neal and Ruffolo report that most school-based social
workers have the background that allows them to provide CBT, but need training in specific evidence-based techniques in order
to provide it within the school day. That's why the adapted CBT framework was developed by the U-M team.
At the national
meeting, the U-M team presented data from 60 students who took part in group therapy sessions the majority of them focusing
specifically on anger-management but some focusing on depression. The anger groups met five weeks in a row for 45 minutes
each time; the depression groups met 9 times.
A majority of the youth experienced significant decreases in depressive
symptoms, increased school engagement, and improved problem-solving skills by the end of their multi-week sessions. No differences
were noticed between students of different genders and ethnicities.
In addition to measurements from standardized behavior
surveys, the students themselves said the group sessions were helpful and that they would recommend them to other students.
Anger-management students said they got into trouble less, and were less angry at teachers. Students who had been referred
to the program for depression showed signs of better self-esteem and reported fewer negative moods.
CBT helps participants
recognize and develop strategies for dealing with or overcoming the thoughts, feelings and actions that are involved in their
depression, anxiety or anger. In addition to specific guidance from the CBT therapist, participants might keep mood diaries,
take part in role-playing, and develop their own "cognitive change" strategies to help them avoid or confront the events that
trigger their negative moods or angry outbursts.
University of Michigan Health System
2901 Hubbard St., Ste. 2400
Ann
Arbor, MI 48109-2435
United States
http://www.med.umich.edu
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