How to Help Teens Weather Their Emotional Storms

A D.I.Y. snow globe full of glitter is an apt metaphor for the emotional chaos of the adolescent brain.

Trying to help a deeply upset teenager — perhaps one undone by a social slight or flipping out about an upcoming test — is among the most common and stressful challenges in all of parenting. Amid all that stress, it’s easy for well-meaning adults to make missteps.

More often than not, we jump in with earnest questions or suggestions: “Any chance you did something that hurt your friend’s feelings?” or “Would it help if I quizzed you on what you’ve studied so far?” But, despite our best intentions, these efforts often seem to only agitate our teenagers further.

Even though I’ve got years of training and experience as a clinical psychologist, for a long time I more or less muddled my way through the adolescent meltdowns that inevitably arose at my practice. Lately, however, I’ve managed to improve my approach, and I owe it all to a fateful trip to Texas.

I was chatting with the counseling team at a Dallas girls’ school a few years ago when the conversation turned to how we each handle students who become unglued during the school day.

“That,” said one of the counselors in a Texas twang, “is when I get out a glitter jar.” As I tried to conceal my immediate skepticism, she went off to retrieve one. While we waited for her to return, I sat there thinking that whatever she was bringing back, I hated it already.

First, as a parent with a neatness hang-up and kids who love art projects, I have come to loathe glitter. Second, if there was any psychology behind this, it seemed bound to be a little, well, poppy.

The counselor returned holding a clear jam jar. Its lid was glued on and it was filled with water plus a layer of sparkling purple glitter sitting at the bottom. “When a girl falls apart in my office, I do this,” she said, while shaking the jar fiercely, like an airport snow globe. Together we beheld the dazzling glitter storm that resulted. Then she placed the jar down on the table between us and continued, “After that I say to her, ‘Honey, this is your brain right now. So first … let’s settle your glitter.’”

Mesmerized, I watched the swirling glitter slowly fall to the bottom of the jar. Finally getting over myself, I was ready to acknowledge the brilliance behind this homemade device.

Sitting right there was an elegant model of the neurology of the distressed teenager. Early in adolescence, the brain gets remodeled to become more powerful and efficient, with this upgrade retracing the order of the original in utero development. The primitive regions, which are just above the back of the neck and house the emotion centers, are upgraded first — starting as early as age 10. The more sophisticated regions, located behind the forehead and giving us our ability to reason and maintain perspective, are redone last and may not reach full maturity until age 25.

While this process is underway, young people are put in a rather delicate position. Though they tend to be highly rational when calm, if they become upset, their new, high-octane emotional structures can overpower their yet-to-be upgraded reasoning capacities, crashing the entire system until it has a chance to reset.

I have enthusiastically recommended glitter jars to several parents and colleagues knowing that some teenagers will instantly benefit from having a concrete model of emotional distress. That said, I have come to appreciate that a glitter jar’s main utility is in the instructions it provides to those who are caring for the overwrought: Be patient and communicate your confidence that emotions almost always rise, swirl and settle all by themselves.

Not long after I returned from Texas, I ran into a visibly upset sophomore in the lunchroom of the school where I consult each week. She looked stricken, and her eyes were red from crying.

Urgently she asked, “Are you free?”

“Yes,” I replied, turning her toward my office.

Once there, she buried her hands in her face and broke into heaving sobs. Soon, she slowed her breathing and looked at me, even as tears continued to stream down her face. In the past, I would have taken that opening to quiz her about what had gone wrong. In retrospect, I now see this as the verbal equivalent of further shaking the mental glitter jar. Instead, I asked if she wanted a glass of water, or some time alone to let her painful feelings die down. She declined both offers, so we just sat there quietly.

Not a minute had passed before she relaxed completely. Then she volunteered that she had done poorly on a test that morning and had fallen down a rabbit hole of worries about what a bad grade might mean for her future. Now, with her glitter nearly settled and her mind more clear, she regained perspective on the situation. Within moments she decided that the low grade probably wasn’t such a big deal, and if it was, she’d figure out how to make up for it in other ways.

This is not to say that letting glitter settle is the solution to all teenage problems. But I have found it to be a better first response than any other. Every time I stop myself from trying to figure out what made a teenager upset, and focus instead on her right to just be upset, I find that doing so either solves the problem or helps clear the path to dealing with it.

It’s critical to recognize that when we react to psychological distress as though it’s a fire that needs to be put out, we frighten our teenagers and usually make matters worse. Reacting instead with the understanding that emotions usually have their own life cycle — coming as waves that surge and fall — sends adolescents the reassuring message that they aren’t broken; in fact, they’re self-correcting.

So, when you next encounter a young person in full meltdown, take a deep breath and think to yourself (Dallas accent optional), “First … let’s settle your glitter.”

Lisa Damour is a psychologist in Shaker Heights, Ohio, and the author of “Untangled: Guiding Teenage Girls Through the Seven Transitions Into Adulthood” and “Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls.”

Why more US teens are suffering from severe anxiety than ever before — and how parents can help

This story was originally published in October 2017.

Nearly one-third of American adolescents and adults are affected by anxiety, according to the National Institute of Mental Health. It’s the most common mental health disorder in the country.

And when it comes to teens, severe anxiety is becoming more crippling each year.

In fact, over the last decade, anxiety has surpassed depression as the most common reason college students seek counseling services, the New York Times reported.

The data comes from the American College Health Association’s 2016 survey of students about the previous year.

Sixty-two percent of undergraduate students in the survey reported “overwhelming anxiety,” a significant increase from 50 percent in 2011.

A separate survey from the Higher Education Research Institute at the University of California, Los Angeles, asks incoming college freshman whether they “felt overwhelmed by all I had to do” during the previous year.

In 1985, when the institute began surveying students on the issue, 18 percent said they felt overwhelmed.

By 2010, 29 percent said they did. And in 2016, the number jumped to 41 percent.

And since 2012, the Washington Post reported, the Boys Town National Hotline has seen a 12 percent spike in teens reaching out via calls, texts, chats and emails about their struggle with anxiety, depression and suicidal thoughts.

The rate of hospital admissions for suicidal teenagers has also doubled over the past decade.

Recent data from the Atlanta-based Centers for Disease Control and Prevention mirrored a national trend in suicide rates across the board.

But the research found suicide rates among 15- to 19-year-old girls doubled between 2007 and 2015, reaching a 40-year high.

That means for every 100,000 American girls in 2015, five committed suicide.

For teen boys, the rate rose by more than 30 percent.

What’s causing the rise in teenagers with severe anxiety?

Anxiety, along with depression, cuts across all demographics, including both privileged and disadvantaged teenagers.

But privileged teens are among the most emotionally distressed youth in America, Arizona State University psychology professor Suniya Luthar told the New York Times.

“These kids are incredibly anxious and perfectionistic,” she said, but there’s “contempt and scorn for the idea that kids who have it all might be hurting … there’s always one more activity, one more A.P. class, one more thing to do in order to get into a top college. Kids have a sense that they’re not measuring up. The pressure is relentless and getting worse.”

But helicopter parents aren’t always to blame. Many students internalize the anxiety and put the pressure on themselves, Madeline Levine, co-founder of Challenge Success, a nonprofit aimed at improving student well-being, told the Times.

Another expert, psychiatrist Stephanie Eken, said despite the cultural differences, there’s a lot of overlap among teens regarding what makes them anxious.

Eken mentions factors range from school, family conflicts, what food to eat, diseases, how they’re perceived by friends and notably in the last few years, Eken told the Times, to a rising fear about terrorism.

“They wonder about whether it’s safe to go to a movie theater,” she said.

A lack of close, meaningful relationships is also a major factor.

Experts have long said hormonal, mental and physical changes associated with puberty may leave teens especially vulnerable to anxiety, depression and other mental health disorders.

And social media doesn’t help, Eken said, adding that teens are always comparing themselves with their peers, which leaves them miserable.

When Times reporter Benoit Denizet-Lewis visited Mountain Valley, a nonprofit that offers teens need-based assistance for $910 a day, a college student at the facility said, “I don’t think we realize how much it’s affecting our moods and personalities,” he said. “Social media is a tool, but it’s become this thing that we can’t live without but that’s making us crazy.”

But social media can also be used to “help increase connections between people,” CDC suicide expert Thomas Simon told CNN in August. “It’s an opportunity to correct myths about suicide and to allow people to access prevention resources and materials.”

Still, Simon acknowledged that cyberbullying can greatly impact vulnerable youth.

How parents can help

Withington Independent Girls School pupil Sophia Siddiqui, aged 18, is embraced by her mother Farzana Siddiqui as Sophia reveals that she achieved three A* and two A’s in her A level exam results on August 15, 2013 in Manchester, England. (Christopher Furlong/Getty Images)

According to the Anxiety and Depression Association of America, 80 percent of kids with a diagnosable anxiety disorder are not getting treatment. And anxiety disorders are highly treatable.

While anxiety can be a normal reaction to stressful environments and situations, there are specific symptoms associated with anxiety disorders.

Generally, someone with anxiety disorder would have fear or anxiety that is out of proportion to the situation or inappropriate for his or her age.

The anxiety would also affect normal day-to-day function.

Two questions parents should ask themselves: Is my child more shy or anxious than others his or her age? Is my child more worried than other children his or her age?

According to Lynn Miller, an associate proessor at the University of British Columbia, those questions can help predict a child’s potential of developing an anxiety disorder.

If you notice overwhelming feelings of anxiety in your child, the ADAA suggests seeking help and talking to a professional.

While antidepressants and anti-anxiety medications can offer relief from symptoms, they’re not treated as cures. Instead, talk therapy is often recommended.

More tips from ADAA.org.

Here are some additional tips to manage anxiety and stress from the ADAA:

The Perils Of Pushing Kids Too Hard, And How Parents Can Learn To Back Off

NPR

Kids in elite high schools face increasing pressures from peers, teachers and parents.

Francesco Zorzi for NPR

On New Year’s Eve, back in 2012, Savannah Eason retreated into her bedroom and picked up a pair of scissors.

“I was holding them up to my palm as if to cut myself,” she says. “Clearly what was happening was I needed someone to do something.”

Her dad managed to wrestle the scissors from her hands, but that night it had become clear she needed help.

“It was really scary,” she recalls. “I was sobbing the whole time.”

Savannah was in high school at the time. She says the pressure she felt to succeed — to aim high — had left her anxious and depressed.

“The thoughts that would go through my head were ‘this would be so much easier if I wasn’t alive, and I just didn’t have to do anything anymore.’ ”

Looking back Savannah, now 23, says the pressure started early.

She told us her story as we sat at the kitchen table of her childhood home in Wilton, Conn., a wealthy community near New York. Her dad commutes to the city where he works in finance.

From the outside, Savannah’s life may have appeared picture-perfect: two well-educated, loving parents; a beautiful home; siblings and lots of friends.

From an early age, Savannah says, she was considered one of the smart kids, and when she arrived at Wilton High School, she was surrounded by many other high achievers. Lots of kids take a heavy load of Advanced Placement and honors courses. They play varsity or club sports and are involved in lots of extracurricular activities.

But by sophomore year, the high expectations began to feel like a trap. Like many kids at her school – and at elite high schools across the country – she felt compelled to push herself to get good grades and get into a top college.

“Even though I was getting A’s and B’s, mostly A’s, in all my classes — all my honors classes — I still felt it wasn’t good enough,” Savannah says.

No matter how well she did, someone else was doing better. “The pressure I put on myself was out of control,” she says. She says she felt the pressure all around her — from peers, teachers and her parents.

Newfound awareness of these kinds of struggles, has started a conversation — and new initiatives — in her community. A group of parents is trying to shift the culture to balance the focus on achievement with an emphasis on well-being. Part of the equation is freeing up kids to find their own motivation and life path. There is a growing body of evidence pointing to elevated risks of anxiety, depression, and drug and alcohol use among kids raised in privileged communities.

A wake-up call

Savannah’s mother, Genevieve Eason, feels she was partly to blame for the pressure Savannah felt.

“I know I was talking to her by eighth grade,” Genevieve recalls, “about how she needed to find out what her passions were, so she could get involved in the right activities … so that would look good on her college applications.”

But after Savannah’s problems began, Genevieve says, she backed off. She helped Savannah drop some of her tougher courses. And the family started to focus on well-being.

Tips To Dial Back The Pressure

Start a conversation — and keep it going

“Ask your kids the question ‘Am I pushing you too hard?’ ” says Colleen Fawcett, Wilton Youth Services coordinator. Don’t just ask once, she says, ask it periodically and keep the line of communication open.

Don’t supervise everything

“It’s OK to let them out of your sight,” says Lenore Skenazy, president of Let Grow, an organization that promotes childhood resilience. Let kids choose activities to do by themselves, like going to the store or walking to the park. Try this exercise from Let Grow for giving kids more control, which can buffer anxiety and foster self-confidence.

Let them play

Unlike supervised activities, Skenazy says, free play teaches kids how to negotiate, compromise, make friends and communicate. “When we deprive children of unstructured playtime, they don’t learn how to mature or deal with frustration or fear,” she says.

Underschedule

“Try to counterbalance the highly competitive culture,” says parent Vanessa Elias. Resist the temptation to overschedule your kids. Encourage them to limit their organized activities, and emphasize family time and downtime.

“Up to that point, I totally bought into the idea we’re supposed to push our kids to achieve. When they encounter obstacles, we push [them] to overcome those,” Genevieve says. But pushing too hard can backfire.

Given the pressure-cooker environment in her community, Genevieve wondered how many other teens may also be struggling.

In order to find out, she got together with some other parents and counselors — and worked with Wilton High School to do something very unusual. They hired a psychologist to come in and assess the student body.

On the day we visited, the seniors were preparing for graduation. In the main hallway, there was a bulletin board on which students have each pinned the logo of the college they plan to attend. We saw Dartmouth, Yale, Vanderbilt, Harvard — and many other highly selective universities.

Clearly, many kids here excel. But the results of the mental health assessment showed that a lot of kids struggle, too.

“The survey results definitely suggested that Wilton High School’s rates of anxiety and depression with students was higher than national averages — significantly higher,” says school principal Robert O’Donnell. He says he was surprised and concerned.

About 1,200 students — almost the entire student body — took the survey, known as the Youth Self-Report. The survey found that compared with a national norm of 7 percent, about 30 percent of Wilton High School students had above average levels of internalizing symptoms. These include feelings of sadness, anxiety and depression. It also includes physical problems that can be linked to emotional distress such as headaches or stomachaches. Often, kids may hide these feelings.

The survey also found that rates of alcohol and drug use among Wilton students were higher than average, too. We asked the psychologist who did the assessment whether she was surprised by what she found.

“This is by no means unique to Wilton. It’s a common phenomenon across high-achieving schools,” says Suniya Luthar, professor emerita at Columbia University’s Teachers College and founder of Authentic Connections, a nonprofit that aims to build resilience in communities and schools.

Luthar has been studying adolescents for more than 20 years. She has published several studies that document the elevated rates of drug and alcohol use by kids who grow up in privileged communities — where incomes and expectations are high. Surprisingly, she says, the rates rival what she has documented in low-income, urban schools.

“What we’ve found is that kids in high-achieving, relatively affluent communities are reporting higher levels of substance use than inner-city kids and levels of anxiety and depressive symptoms are also commensurate — if not greater,” Luthar says.

Her most recent study, funded by the National Institutes of Health, found that rates of substance abuse remain high among upper-middle-class kids, as they enter early adulthood. The alcohol or drugs are a form of self-medication.

Savannah’s mother, Genevieve Eason, says she is not surprised by Luthar’s findings.

“People choose communities like this to give their children opportunities, but it comes at a cost,” Eason says.

The survey findings have been a wake-up call for the community of Wilton. “A lot of people were in denial,” says Vanessa Elias. The mother of three children is the president of the Wilton Youth Council, which aims to promote the emotional well-being of the community.

“People don’t talk about these things,” Elias says. Families often struggle silently, not realizing that their friends’ or neighbors’ kids are experiencing the same struggles. “So having an opportunity to create a conversation about this was really important,” she says.

Dialing back the pressure

The community has lots of ideas about how to tackle these issues.

The high school is focused on continuing to train counselors, and student-directed initiatives are aimed at raising awareness about anxiety and depression.

Wilton is also offering a resilience training program — GoZen! — to elementary school students. It’s a research-based program that teaches coping and happiness skills. There’s a body of evidence to show that resilience training can help reduce symptoms of depressive or negative thinking among children.

At home, Elias says, she has tried to create a low-stress environment for her children. For instance, she limits the number of after-school activities her kids participate in so they don’t spend every afternoon being driven around, overscheduled. She also limits homework time in the evening for her youngest daughter — a third-grader. As a result, “there’s a lot less friction in the household,” she says.

And when she realized that the focus on standardized testing was making one of her daughters anxious in first grade — and giving her stomachaches — she opted her two youngest children out of standardized testing.

Elias says she has been influenced by the book How To Raise An Adult by Julie Lythcott-Haims, which aims to help parents break free of what the author dubs the “over-parenting trap.”

But to really change things — to dial back the focus on academic achievement at all costs — will require a culture shift, says Eason.

“We have to broaden our definitions of success and celebrate more kinds of success,” she says.

For Eason’s daughter, Savannah, this means forging a new path.

“I don’t want to work on Wall Street; that sounds miserable to me,” Savannah says.

She enrolled in culinary school, and she is training to be a pastry chef.

“I’m never going to live the same lifestyle I did growing up,” Savannah says, “I’m not going to make that much money, but that’s OK.”

She has her own set of priorities. “It’s not about how big your house is and what kind of car you drive. It’s about happiness and peace.”

This is a different kind of success, one that her parents are now celebrating with her.

“I spend hours making a cake, and my favorite part is when you cut it up and people eat it,” Savannah says. “That’s the part when you bring joy to people, and that’s what’s important to me now.”

What Parents Need to Know About Social Media and Anxiety

Learn to recognize the warning signs of anxiety disorder and help your kid keep social media use healthy and productive. By Caroline Knorr 
What Parents Need to Know About Social Media and Anxiety

From cyberbullying to FOMO to cruel comments, social media can be a land mine for kids. Issues we parents never had to worry about, such as an intimate photo texted to the entire school or Instagram videos of a birthday party we weren’t invited to, are now a risk for many tweens and teens. With kids’ digital well-being a concern, researchers are exploring potential links between social media and the rise in teen suicide ratestech addiction, and loss of real-life social skills. And many parents are wondering: Is social media causing my kid to have anxiety?

It’s an important question — and one that makes for compelling headlines for worried parents. While it’s too early to say with certainty (this is, after all, the first generation of “digital natives”), the reality is somewhat nuanced. Some research has observed a relationship between social media use and anxiety in kids, but it’s difficult to know if and when social media is causing anxiety or whether kids who are anxious are turning to social media as a way to soothe themselves or seek support. How kids use social media matters, too: Social comparison and feedback-seeking behaviors have been associated with depressive symptoms, which often co-occur with anxiety.

Of course, it’s common for kids to feel anxious sometimes. But there’s a big difference between occasional anxiety and an anxiety disorder that requires professional care. If your kid is overly self-conscious, has uncontrollable and unrealistic anxiety, is unable to make it go away, and avoids things, you may want to seek help. (Learn more about anxiety in kids at the Child Mind Institute.) For these kids, social media may act as a trigger for — though not the root cause of — their anxious feelings. There are also kids, who, for a variety of reasons, may be more sensitive to the anxiety-producing effects of social media. For example, kids with social anxiety disorder may prefer online interactions over face-to-face interactions. Bottom line: You may not know the impact of social media on your kid until issues surface.

Unfortunately, simply cutting off social media isn’t necessarily the answer. It’s such a huge part of many kids’ lives that not having access to social media could take a toll. In fact, being connected to friends through social media may counterbalance some of its negative effects.

Without conclusive research to back up claims that social media causes anxiety — and some evidence to show it’s beneficial — it’s up to you to keep tabs on how your kid’s doing. Though it adds an extra layer to your parenting duties, it’s a good idea to get a good sense of your kid’s online life. Ask kids to give you a tour of their social media world. As they’re showing you around, you might hear some of the positive stuff you weren’t expecting, as well as some of the problem areas your kid could use help with. Also, add social media to the “wellness checks” that you already do. For example, when you ask how they slept and what they ate, ask how they’re feeling about social media. Is it mostly positive, helpful, and supportive, or do they want to step back but aren’t sure how? Here are some more tips for keeping social media a positive for kids:

Encourage self-care. Seeing photos of a trip to the beach your friends didn’t invite you to can really sting. If your kid is super bummed or tired of digital drama, suggest they take a break from social media for a while. In fact, if they post a status update that they’re taking a break, their friends might be very accepting because they’ve had similar feelings.

Help kids put social media in perspective. People post stuff that makes their lives look perfect — not the homework struggles, or the fight they had with their dad, or the hours it took to look as good as possible for the camera. Remind kids that social media leaves the messy stuff out — and that everyone has ups and downs.

Encourage offline activities. In a world where kids could spend their days lying around looking at Instagram, it’s doubly important for them to feel as though they’re cultivating their inner lives. Prompt them to balance social media with soul-nourishing activities such as hobbies, exercise, reading, and helping others. Otherwise, what are they going to brag about on social media?

Talk about their feelings. Ask them what it feels like to look at other kids’ feeds. Is there a tipping point from when they feel OK to when they start to feel bad about their own lives? Encourage them to stop before that feeling sets in and do something good for themselves instead.

Let them know you’re there for them. You may not understand everything about your kid’s online social life. But recognizing it’s important to them makes your kid feel valued — and more likely to come to you when they encounter problems.

Get help. If you see any cause for concern, including mood swings that seem to result from social media, not taking pleasure in activities he or she used to enjoy, and having accompanying symptoms such as headaches and stomachaches, visit your kid’s pediatrician for a professional opinion.

The Child Mind Institute contributed to this article. Learn more at childmind.org.

75 Percent of Teen Girls Have Anxiety — What We Can Do About It

ParentMap

Author and researcher Rachel Simmons talks raising daughters in a toxic culture

PUBLISHED ON: JANUARY 17, 2018

 
anxious-teen-girl

Roughly three out of four teenage girls experience anxiety, according to the 2016 Washington State Healthy Youth Survey. Seventy-six percent of tenth grade girls have felt extremely nervous or anxious and 13 percent have attempted suicide.

What is going on and how can we as parents help? We turned to educator and researcher Rachel Simmons. Founder of Oakland-based outreach organization Girls Leadership and leadership development specialist at Smith College, Simmons believes there’s no one reason why so many young women feel anxious.

Still, there is one reason she often sees in her work: more pressure.

“We hope for girls to be smart and brave and interested in STEM fields, but we still expect them to be thin and sexually attractive and have a witty and appealing online presence,” she says. “No matter how many achievements they accrue, they feel that they are not enough as they are … We haven’t really upgraded our expectations, we’ve just added on to the old ones.”

She addresses this pressure and how parents can help their daughters thrive in her latest book, “Enough As She Is” (out Feb. 27).

It’s not a bad thing that we’re instilling more confidence in our girls, Simmons says. The problem is that we’re still raising them in a toxic culture that hasn’t caught up with those new expectations.

“That’s how girls wind up feeling something is wrong with themwhen in fact … something is deeply wrong with our culture,” she says. In the last decade alone, Simmons says she’s seen “the rise of social media, arrival of college admissions mania, and ever more ruthless pressure to be thin tighten the rules of success for girls in punishing ways.”

And that, she notes, undermines the development of their confident, authentic selves. But that doesn’t mean there’s no solution. We asked Simmons why our daughters are experiencing so much anxiety — and what parents can do to help.

WHY DOES MORE OPPORTUNITY LEAD TO INCREASED ANXIETY IN TEENAGE GIRLS?

Girls have too many roles to play and too many roles conflict with each other. Add this role overload to the fact that girls continue to need to please others first and be likable. Girls are still raised with a psychology that is trained to think about other people before themselves. This all is a real recipe for unhappiness.

My goal is to give parents tools to help girls carve out a life and a sense of self that feels authentic and important to them that isn’t fully shaped by what other people expect of them. It’s not that challenges are going to go away; it’s about how to manage these challenges. For example, I never tell girls that they are going to stop overthinking things. The question is: Do you know how to manage overthinking and how to understand it?

GOT ANY TIPS FOR HOW TO GET YOUR TEEN DAUGHTER TO ACTUALLY, YOU KNOW, TALK?

Teenagers are notorious for not wanting to talk when you want to talk. Annoyingly, they’re not interested in talking on your schedule and they want to talk when it’s not convenient for you. If they are deflecting your attempt to talk, ask yourself, ’Is this the right time for them to talk?’ Can you agree upon a different time to talk?

It’s also super important for parents to find that middle way between being authoritarian versus permissive. Kind but firm, gentle, curious and humble. Try saying, ‘There’s a lot I don’t know, and I would love to hear more about what I don’t know; here’s what I am thinking as your parent.’

Every teenager wants to have respect. I’m not talking about them getting to go out until 1 a.m. I’m talking about establishing trust in your teenager’s perspective. That’s being able to say, ‘Hey, listen. There are things you have to tell me’ while [also] standing firm with the fact that you’re the parent and the boss.

AND HOW SHOULD YOU RESPOND WHEN YOUR DAUGHTER DOES TELL YOU SOMETHING BIG?

When your child does open up and tell you something big, it’s so important to note that. You say to your kid in that situations, ‘Thank you so much for telling me that.’ Their job is not to serve you by telling you things — their job is to be secretive — so be grateful when they tell you things.

WHERE DOES THE USE OF SOCIAL MEDIA COME INTO THIS?

There’s a real trend of using fear and shame to teach about social media: ‘Your life will be ruined if you do the wrong thing online.’ But teaching through fear and shame isn’t effective for teens.

Social media in and of itself is not harmful — it’s the way in which it’s used that can be harmful. It’s important for parents to make an effort to understand why their kids love it, and to understand their kids are going to make mistakes … Parents need to be clear with their kids about parameters and expectations around use. I don’t think that means being a spy, but you must play a role in how your kids learn to be online through rules and expectations.

IN YOUR BOOK, YOU RECOMMEND CREATING A ‘FAILURE RESUME’ THAT LISTS WAYS YOU HAVE FAILED IN YOUR LIFE AND SHARING THAT WITH YOUR DAUGHTER. WHY?

If you create a failure resume and talk about it with your daughter, you’re desensitizing her to the power of failure. You’re talking about something that’s often taboo and lessening the shame around it. You’re also normalizing failure, making it fun and funny, which makes it less scary. To be comfortable with your setbacks is a muscle that you must flex again and again. It’s a skill.

A failure resume is an ingredient for the recipe [of how to deal with failure]. Essentially my whole book is about this recipe for building resilience. I talk about what is threatening girls and how to respond to it, how to be resilient. I’ve learned that what girls really need are the skills to lean inside as much as to lean in: to practice self-compassion, nourish their most important relations and seek support when needed.

Treating Anxiety in Children

Photo

CreditiStock

What does the child who can’t say goodbye to a parent without breaking down have in common with the child who is cripplingly terrified of dogs and the one who gets a bad stomach ache reliably on Monday morning?

Anxieties and worries of all kinds are common in children, necessarily part of healthy development, but also, when they interfere with the child’s functioning, the most common pediatric mental health problems. From separation anxiety to social anxiety to school avoidance to phobias to generalized anxiety disorder, many children’s lives are at some point touched by anxiety that gets out of hand.

“I often tell parents, anxiety and fears are totally a normal and healthy part of growing up,” said Dr. Sabrina Fernandez, an assistant professor of pediatrics at the University of California, San Francisco, who has written about strategies for primary care doctors to use in dealing with anxiety disorders. “I worry that it’s becoming something more when it interferes with the child’s ability to do their two jobs: to learn in school and to make friends.”

Children whose lives are being seriously derailed by their anxieties often get psychotherapy or medication, or both. And a meta-analysis published in November in JAMA looked at the two best-studied treatments for anxiety disorders, cognitive behavioral therapy and psychotropic medication. The technique of a meta-analysis allows scientists to pull in a whole range of different studies, weight the results according to the size and rigor of the research, and then consider the wider array of data gleaned from multiple investigations.

“We included panic disorder, social anxiety disorder, specific phobias, generalized anxiety disorder and separation anxiety,” said the lead author, Zhen Wang, an associate professor of health services research at the Mayo Clinic College of Medicine and Science (they did not include children with post-traumatic stress disorder or obsessive-compulsive disorder). The study looked at the effectiveness of treatments in reducing the symptoms of anxiety, and at ending the anxiety disorder state. And they also looked at any reports of adverse events associated with the treatments, from sleep disturbances to suicide.

The authors examined 115 different studies, for a total of 7,719 patients, and concluded that certain kinds of antidepressant medications — especially the selective serotonin reuptake inhibitors, or S.S.R.I.s — were effective in reducing anxiety symptoms in children; the mean age of the children in the study was 9.2 years, with a range of 5 to 16.

There were only a few studies that directly compared them, but they suggest that cognitive behavioral therapy may be even more effective at reducing symptoms and at resolving the anxiety disorders, and that the combination of medication and C.B.T. may be better than either was alone. The drugs were associated with a variety of adverse events, though they did not find the association with suicide attempts that has led to a black box warning on S.S.R.I.s. Still, they have not ruled out those dangers: “The difference may be due to underreporting and monitoring of suicide attempts in clinical trials,” Dr. Wang said.

Dr. Stephen P.H. Whiteside, the director of the Pediatric Anxiety Disorders Clinic at the Mayo Clinic, who was one of the authors of the meta analysis, said, “if your child has difficulties with anxiety, first of all, it’s treatable. There are a variety of interventions that can be helpful.”

So which of those children — the parent-clinger, the dog-fearer, the school-avoider — needs psychotherapy or psychopharmacology?

“Anxiety happens in kids,” said Dr. Christopher K. Varley, a professor in the department of psychiatry at the University of Washington School of Medicine in Seattle. “It does not always need treatment.” And it does not always look exactly like what adults think of as anxiety, he said. Kids can have physical symptoms, or become disruptive; headaches and stomachaches and tantrums can all mean that a child is anxious.

“The important questions to me are, is this a problem, is it getting in the way of functioning, is it creating stress for the child and the family, is it causing pain and suffering?” he said.

“A big thing for families is that sometimes anxiety can lead to avoidance behavior in social settings and in school,” Dr. Fernandez said. But staying away from school is only going to make the problem worse, she said. “As a parent, all you want to do is make your child feel safe and feel comfortable, and if they’re saying, I only feel safe and comfortable home with my door shut, that can only exacerbate the problem.”

The most helpful form of therapy, Dr. Whiteside said, according to the evidence, is exposure-based cognitive behavioral therapy, which involves helping kids face their fears in a supportive environment. “If they’re afraid of dogs, they have to practice petting dogs; if they’re afraid of talking to people, practice talking to people.” That seems to be of greater value for children with these problems than, for example, therapies based on changing thought patterns, or distractions, or even therapy aimed at deeper insight into the fears.

The message of exposure therapy, Dr. Whiteside said, is that the situations the child is avoiding are not as dangerous as the child’s anxiety would suggest, and that the child can cope with the anxiety. “It’s an uncomfortable feeling that you can handle,” he said, and the more the child handles it, the more proficient the child will become.

But this takes skill and experience on the therapist’s part, and an investment of time and resources by the family. “We found that C.B.T. reports the most consistent outcomes compared to placebo, but it’s time-consuming and sometimes in rural areas it’s not available,” Dr. Wang said.

The question of medication may arise for children with moderate to severe anxiety, and perhaps ideally for a child who is already getting psychotherapy. But of course, not everyone has access to the experts, or to the recommended forms of therapy. Psychotropic medications are often prescribed by primary care doctors, pediatricians or family physicians, doing their best to help their patients, sometimes getting guidance from a psychiatrist by phone.

“Even though it’s a common problem and there are treatments that work, there are still profound problems in the United States with access to psychotherapists who are versed in psychotherapy techniques that have been demonstrated to help,” Dr. Varley said. “And there clearly is a paucity of child psychiatrists.”

In an editorial accompanying the recent meta-analysis, researchers hailed the large numbers of children included, but warned that many children don’t respond fully to treatment, and that children who suffer from one form of anxiety disorder are often at high risk to develop another.

“The good news is I’ve had lots of patients who’ve had much better experiences and were able to deal with those ups and downs of life, who went to therapy and learned tools to deal, or needed a little help with medication,” said Dr. Fernandez.

The Dangers of Smart Phone and Tech Addiction

CBS 60 Minutes

What is “brain hacking”? Tech insiders on why you should care

Silicon Valley is engineering your phone, apps and social media to get you hooked, says a former Google product manager. Anderson Cooper reports

The following script is from “Brain Hacking,” which aired on April 9, 2017. Anderson Cooper is the correspondent. Guy Campanile, producer.

Have you ever wondered if all those people you see staring intently at their smartphones — nearly everywhere, and at all times — are addicted to them? According to a former Google product manager you are about to hear from, Silicon Valley is engineering your phone, apps and social media to get you hooked. He is one of the few tech insiders to publicly acknowledge that the companies responsible for programming your phones are working hard to get you and your family to feel the need to check in constantly. Some programmers call it “brain hacking” and the tech world would probably prefer you didn’t hear about it. But Tristan Harris openly questions the long-term consequences of it all and we think it’s worth putting down your phone to listen.

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Tristan Harris, a former Google product manager

 CBS NEWS

Tristan Harris: This thing is a slot machine.

Anderson Cooper: How is that a slot machine?

Tristan Harris: Well every time I check my phone, I’m playing the slot machine to see, “What did I get?” This is one way to hijack people’s minds and create a habit, to form a habit. What you do is you make it so when someone pulls a lever, sometimes they get a reward, an exciting reward. And it turns out that this design technique can be embedded inside of all these products.

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The rewards Harris is talking about are a big part of what makes smartphones so appealing. The chance of getting likes on Facebook and Instagram. Cute emojis in text messages. And new followers on Twitter.

Tristan Harris: There’s a whole playbook of techniques that get used to get you using the product for as long as possible.

Anderson Cooper: What kind of techniques are used?

“…every time I check my phone, I’m playing the slot machine to see, ‘What did I get?’ This is one way to hijack people’s minds and create a habit, to form a habit.” Tristan Harris

Tristan Harris: Tristan Harris: So Snapchat’s the most popular messaging service for teenagers. And they invented this feature called “streaks,” which shows the number of days in a row that you’ve sent a message back and forth with someone. So now you could say, “Well, what’s the big deal here?” Well, the problem is that kids feel like, “Well, now I don’t want to lose my streak.” But it turns out that kids actually when they go on vacation are so stressed about their streak that they actually give their password to, like, five other kids to keep their streaks going on their behalf. And so you could ask when these features are being designed, are they designed to most help people live their life? Or are they being designed because they’re best at hooking people into using the product?

Anderson Cooper: Is Silicon Valley programming apps or are they programming people?

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Tristan Harris: Inadvertently, whether they want to or not, they are shaping the thoughts and feelings and actions of people. They are programming people. There’s always this narrative that technology’s neutral. And it’s up to us to choose how we use it. This is just not true.

Anderson Cooper: Technology’s not neutral?

Tristan Harris: It’s not neutral. They want you to use it in particular ways and for long periods of time. Because that’s how they make their money.

It’s rare for a tech insider to be so blunt, but Tristan Harris believes someone needs to be. A few years ago he was living the Silicon Valley dream. He dropped out of a master’s program at Stanford University to start a software company. Four years later Google bought him out and hired him as a product manager. It was while working there he started to feel overwhelmed.

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Tristan Harris: Honestly, I was just bombarded in email and calendar invitations and just the overload of what it’s like to work at a place like Google. And I was asking, “When is all of this adding up to, like, an actual benefit to my life?” And I ended up making this presentation. It was kind of a manifesto. And it basically said, you know, “Look, never before in history have a handful of people at a handful of technology companies shaped how a billion people think and feel every day with the choices they make about these screens.”

“Inadvertently, whether they want to or not, they are shaping the thoughts and feelings and actions of people. They are programming people.” Tristan Harris

His 144-page presentation argued that the constant distractions of apps and emails are “weakening our relationships to each other,” and “destroying our kids ability to focus.” It was widely read inside Google, and caught the eye of one of the founders Larry Page. But Harris told us it didn’t lead to any changes and after three years he quit.

Tristan Harris: And it’s not because anyone is evil or has bad intentions. It’s because the game is getting attention at all costs. And the problem is it becomes this race to the bottom of the brainstem, where if I go lower on the brainstem to get you, you know, using my product, I win. But it doesn’t end up in the world we want to live in. We don’t end up feeling good about how we’re using all this stuff.

Anderson Cooper: You call this a “race to the bottom of the brain stem.” It’s a race to the most primitive emotions we have? Fear, anxiety, loneliness, all these things?

Tristan Harris: Absolutely. And that’s again because in the race for attention I have to do whatever works.

Tristan Harris: It absolutely wants one thing, which is your attention.

Now he travels the country trying to convince programmers and anyone else who will listen that the business model of tech companies needs to change. He wants products designed to make the best use of our time not just grab our attention.

Anderson Cooper: Do you think parents understand the complexities of what their kids are dealing with, when they’re dealing with their phone, dealing with apps and social media?

Tristan Harris: No. And I think this is really important. Because there’s a narrative that, “Oh, I guess they’re just doing this like we used to gossip on the phone, but what this misses is that your telephone in the 1970s didn’t have a thousand engineers on the other side of the telephone who were redesigning it to work with other telephones and then updating the way your telephone worked every day to be more and more persuasive. That was not true in the 1970s.

Anderson Cooper: How many Silicon Valley insiders are there speaking out like you are?

Tristan Harris: Not that many.

We reached out to the biggest tech firms but none would speak on the record and some didn’t even return our phone call.  Most tech companies say their priority is improving user experience, something they call “engagement.”  But they remain secretive about what they do to keep people glued to their screens.  So we went to Venice, California, where the body builders on the beach are being muscled out by small companies that specialize in what Ramsay Brown calls “brain hacking.”

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Anderson Cooper speaks with Ramsay Brown, the cofounder of Dopamine Labs

 CBS NEWS

Ramsay Brown: A computer programmer who now understands how the brain works knows how to write code that will get the brain to do certain things.

Ramsay Brown studied neuroscience before co-founding Dopamine Labs, a start-up crammed into a garage. The company is named after the dopamine molecule in our brains that aids in the creation of desire and pleasure. Brown and his colleagues write computer code for apps used by fitness companies and financial firms. The programs are designed to provoke a neurological response.

“A computer programmer who now understands how the brain works knows how to write code that will get the brain to do certain things.” Ramsay Brown

Anderson Cooper: You’re trying to figure out how to get people coming back to use the screen?

Ramsay Brown: When should I make you feel a little extra awesome to get you to come back into the app longer?

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Ramsay Brown

 CBS NEWS

The computer code he creates finds the best moment to give you one of those rewards, which have no actual value, but Brown says trigger your brain to make you want more. For example, on Instagram, he told us sometimes those likes come in a sudden rush.

Ramsay Brown: They’re holding some of them back for you to let you know later in a big burst. Like, hey, here’s the 30 likes we didn’t mention from a little while ago. Why that moment–

Anderson Cooper: So all of a sudden you get a big burst of likes?

Ramsay Brown: Yeah, but why that moment? There’s some algorithm somewhere that predicted, hey, for this user right now who is experimental subject 79B3 in experiment 231, we think we can see an improvement in his behavior if you give it to him in this burst instead of that burst.

When Brown says “experiments,” he’s talking generally about the millions of computer calculations being used every moment by his company and others use to constantly tweak your online experience and make you come back for more.

Ramsay Brown: You’re part of a controlled set of experiments that are happening in real time across you and millions of other people.

Anderson Cooper: We’re guinea pigs?

Ramsay Brown: You’re guinea pigs. You are guinea pigs in the box pushing the button and sometimes getting the likes. And they’re doing this to keep you in there.

The longer we look at our screens, the more data companies collect about us, and the more ads we see. Ad spending on social media has doubled in just two years to more than $31 billion.

Ramsay Brown: You don’t pay for Facebook. Advertisers pay for Facebook. You get to use it for free because your eyeballs are what’s being sold there.

Anderson Cooper: That’s an interesting way to look at it, that you’re not the customer for Facebook.

“You don’t pay for Facebook. Advertisers pay for Facebook. You get to use it for free because your eyeballs are what’s being sold there.” Ramsay Brown

Ramsay Brown: You’re not the customer. You don’t sign a check to Facebook. But Coca-Cola does.

Brown says there’s a reason texts and Facebook use a continuous scroll, because it’s a proven way to keep you searching longer.

Ramsay Brown: You spend half your time on Facebook just scrolling to find one good piece worth looking at. It’s happening because they are engineered to become addictive.

Anderson Cooper: You’re almost saying it like there’s an addiction code.

Ramsay Brown: Yeah, that is the case. That since we’ve figured out, to some extent, how these pieces of the brain that handle addiction are working, people have figured out how to juice them further and how to bake that information into apps.

Larry Rosen: Dinner table could be a technology-free zone.

While Brown is tapping into the power of dopamine, psychologist Larry Rosen and his team at California State University Dominguez Hills are researching the effect technology has on our anxiety levels.

Larry Rosen: We’re looking at the impact of technology through the brain.

Rosen told us when you put your phone down – your brain signals your adrenal gland to produce a burst of a hormone called, cortisol, which has an evolutionary purpose. Cortisol triggers a fight-or-flight response to danger.

Anderson Cooper: How does cortisol relate to a mobile device, a phone?

Larry Rosen: What we find is the typical person checks their phone every 15 minutes or less and half of the time they check their phone there is no alert, no notification. It’s coming from inside their head telling them, “Gee, I haven’t check in Facebook in a while. I haven’t checked on this Twitter feed for a while. I wonder if somebody commented on my Instagram post.” That then generates cortisol and it starts to make you anxious. And eventually your goal is to get rid of that anxiety so you check in.

So the same hormone that made primitive man anxious and hyperaware of his surroundings to keep him from being eaten by lions is today compelling Rosen’s students and all of us to continually peek at our phones to relieve our anxiety.

Larry Rosen: When you put the phone down you don’t shut off your brain, you just put the phone down.

Anderson Cooper: Can I be honest with you right now? I haven’t paid attention to what you’re saying because I just realized my phone is right down by my right foot and I haven’t checked it in, like 10 minutes.

Larry Rosen: And it makes you anxious.

Anderson Cooper: I’m a little anxious.

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A computer tracks minute changes in Anderson Cooper’s heart rate and perspiration

 CBS NEWS

Larry Rosen: Yes.

We found out just how anxious in this experiment conducted by Rosen’s research colleague Nancy Cheever.

Nancy Cheever: So the first thing I’m going to do is apply these electrodes to your fingers.

While I watched a video, a computer tracked minute changes in my heart rate and perspiration. What I didn’t know was that Cheever was sending text messages to my phone which was just out of reach. Every time my text notification went off, the blue line spiked – indicating anxiety caused in part by the release of cortisol.

Nancy Cheever: Oh, that one is…that’s a huge spike right there. And if you can imagine what that’s doing to your body. Every time you get a text message you probably can’t even feel it right? Because it’s such a um, it’s a small amount of arousal.

Anderson Cooper: That’s fascinating.

Their research suggests our phones are keeping us in a continual state of anxiety in which the only antidote – is the phone.

Anderson Cooper: Is it known what the impact of all this technology use is?

Larry Rosen: Absolutely not.

Anderson Cooper: It’s too soon.

Larry Rosen: We’re all part of this big experiment.

Anderson Cooper: What is this doing to a young mind or a teenager?

Larry Rosen: Well there’s some projects going on where they’re actually scanning teenager’s brains over a 20-year period and looking to see what kind of changes they’re finding.

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Gabe Zichermann

 CBS NEWS

Gabe Zichermann: Here’s the reality. Corporations and creators of content have, since the beginning of time, wanted to make their content as engaging as possible.

Gabe Zichermann has worked with dozens of companies – including Apple and CBS – to make their online products more irresistible. He’s best known in Silicon Valley for his expertise in something called “gamification,” using techniques from video games to insert fun and competition into almost everything on your smartphone.

Gabe Zichermann: So one of the interesting things about gamification and other engaging technologies, is at the same time as we can argue that the neuroscience is being used to create dependent behavior those same techniques are being used to get people to work out, you know, using their Fitbit. So all of these technologies, all the techniques for engagement can be used for good, or can be used for bad.

“Asking technology companies, asking content creators to be less good at what they do feels like a ridiculous ask.” Gabe Zichermann

Zichermann is now working on software called ‘Onward’ designed to break user’s bad habits. It will track a person’s activity and can recommend they do something else when they’re spending too much time online.

Gabe Zichermann: I think creators have to be liberated to make their content as good as possible.

Anderson Cooper: The idea that a tech company is not going to try to make their product as persuasive, as engaging as possible, you’re just saying that’s not gonna happen?

Gabe Zichermann: Asking technology companies, asking content creators to be less good at what they do feels like a ridiculous ask. It feels impossible. And also it’s very anti-capitalistic, this isn’t the system that we live in.

Ramsay Brown and his garage start-up Dopamine Labs made a habit-breaking app as well.  It’s called “Space” and it creates a 12-second delay —  what Brown calls a “moment of Zen” before any social media app launches. In January, he tried to convince Apple to sell it in their App Store.

Ramsay Brown: And they rejected it from the App Store because they told us any app that would encourage people to use other apps or their iPhone less was unacceptable for distribution in the App Store.

Anderson Cooper: They actually said that to you?

Ramsay Brown: They said that to us. They did not want us to give out this thing that was gonna make people less stuck on their phones.

Why Are More American Teenagers Than Ever Suffering From Severe Anxiety?

The disintegration of Jake’s life took him by surprise. It happened early in his junior year of high school, while he was taking three Advanced Placement classes, running on his school’s cross-country team and traveling to Model United Nations conferences. It was a lot to handle, but Jake — the likable, hard-working oldest sibling in a suburban North Carolina family — was the kind of teenager who handled things. Though he was not prone to boastfulness, the fact was he had never really failed at anything.

Not coincidentally, failure was one of Jake’s biggest fears. He worried about it privately; maybe he couldn’t keep up with his peers, maybe he wouldn’t succeed in life. The relentless drive to avoid such a fate seemed to come from deep inside him. He considered it a strength.

Jake’s parents knew he could be high-strung; in middle school, they sent him to a therapist when he was too scared to sleep in his own room. But nothing prepared them for the day two years ago when Jake, then 17, seemingly “ran 150 miles per hour into a brick wall,” his mother said. He refused to go to school and curled up in the fetal position on the floor. “I just can’t take it!” he screamed. “You just don’t understand!”

Jake was right — his parents didn’t understand. Jake didn’t really understand, either. But he also wasn’t good at verbalizing what he thought he knew: that going to school suddenly felt impossible, that people were undoubtedly judging him, that nothing he did felt good enough. “All of a sudden I couldn’t do anything,” he said. “I was so afraid.” His tall, lanky frame succumbed, too. His stomach hurt. He had migraines. “You know how a normal person might have their stomach lurch if they walk into a classroom and there’s a pop quiz?” he told me. “Well, I basically started having that feeling all the time.”

Alarmed, Jake’s parents sent him to his primary-care physician, who prescribed Prozac, an antidepressant often given to anxious teenagers. It was the first of many medications that Jake, who asked that his last name not be used, would try over the next year. But none seemed to work — and some made a bad situation worse. An increase in dosage made Jake “much more excited, acting strangely and almost manic,” his father wrote in a journal in the fall of 2015. A few weeks later, Jake locked himself in a bathroom at home and tried to drown himself in the bathtub.

He was hospitalized for four days, but soon after he returned home, he started hiding out in his room again. He cried, slept, argued with his parents about going to school and mindlessly surfed the internet on his phone. The more school he missed, the more anxious he felt about missing school. And the more anxious he felt, the more hopeless and depressed he became. He had long wanted to go to the University of North Carolina at Chapel Hill, but now that felt like wishful thinking.

Not every day was bad. During spring break in 2016, Jake’s father wrote: “Jake was relaxed and his old sarcastic, personable, witty self.” A week later, though, Jake couldn’t get through a school day without texting his mother to pick him up or hiding out in the nurse’s office. At home, Jake threatened suicide again. His younger siblings were terrified. “It was the depth of hell,” his mother told me.

That summer, after two more hospitalizations, Jake’s desperate parents sent him to Mountain Valley in New Hampshire, a residential treatment facility and one of a growing number of programs for acutely anxious teenagers. Over the last decade, anxiety has overtaken depression as the most common reason college students seek counseling services. In its annual survey of students, the American College Health Association found a significant increase — to 62 percent in 2016 from 50 percent in 2011 — of undergraduates reporting “overwhelming anxiety” in the previous year. Surveys that look at symptoms related to anxiety are also telling. In 1985, the Higher Education Research Institute at U.C.L.A. began asking incoming college freshmen if they “felt overwhelmed by all I had to do” during the previous year. In 1985, 18 percent said they did. By 2010, that number had increased to 29 percent. Last year, it surged to 41 percent.

Those numbers — combined with a doubling of hospital admissions for suicidal teenagers over the last 10 years, with the highest rates occurring soon after they return to school each fall — come as little surprise to high school administrators across the country, who increasingly report a glut of anxious, overwhelmed students. While it’s difficult to tease apart how much of the apparent spike in anxiety is related to an increase in awareness and diagnosis of the disorder, many of those who work with young people suspect that what they’re seeing can’t easily be explained away. “We’ve always had kids who didn’t want to come in the door or who were worried about things,” says Laurie Farkas, who was until recently director of student services for the Northampton public schools in Massachusetts. “But there’s just been a steady increase of severely anxious students.”

For the teenagers who arrive at Mountain Valley, a nonprofit program that costs $910 a day and offers some need-based assistance, the center is usually a last resort after conventional therapy and medications fail. The young people I met there suffered from a range of anxiety disorders, including social anxiety, separation anxiety, post-traumatic stress disorder and obsessive-compulsive disorder. (Though OCD and PTSD are considered anxiety disorders at Mountain Valley and other treatment centers, they were moved into separate categories in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.)

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Sharon McCallie-Steller, a therapist, during a counseling session at the Mountain Valley residential program in New Hampshire.CreditSasha Rudensky for The New York Times

Mountain Valley teenagers spend a lot of time analyzing — and learning to talk back to — their anxious thoughts. During one group session in the summer of 2016 in a sunlit renovated barn with couches, a therapist named Sharon McCallie-Steller instructed everyone to write down three negative beliefs about themselves. That’s an easy exercise for anxious young people (“Only three?” one girl quipped), but McCallie-Steller complicated the assignment by requiring the teenagers to come up with a “strong and powerful response” to each negative thought.

She asked for volunteers. First, residents would share their negative beliefs and rebuttals with the group. Then others would act those out, culminating in a kind of public performance of private teenage insecurity.

Jake raised his hand. By then, he was in his third month at Mountain Valley, and he looked considerably less anxious than several of the newcomers, including one who sat slumped on a couch with his head in his hands. “I’m free to play the part of terrible, evil thoughts for anyone who needs them,” Jake said with a smile. He had already spent weeks challenging his own thinking, which often persuaded him that if he failed a single quiz at school, “then I’ll get a bad grade in the class, I won’t get into the college I want, I won’t get a good job and I’ll be a total failure.”

At Mountain Valley, Jake learned mindfulness techniques, took part in art therapy and equine therapy and, most important, engaged in exposure therapy, a treatment that incrementally exposes people to what they fear. The therapists had quickly figured out that Jake was afraid of failure above all else, so they devised a number of exercises to help him learn to tolerate distress and imperfection. On a group outing to nearby Dartmouth College, for example, Jake’s therapist suggested he strike up conversations with strangers and tell them he didn’t have the grades to get into the school. The college application process was a source of particular anxiety for Jake, and the hope was that he would learn that he could talk about college without shutting down — and that his value as a person didn’t depend on where he went to school.

Though two months in rural New Hampshire hadn’t cured Jake of anxiety, he had made significant progress, and the therapy team was optimistic about his return home for his senior year. Until then, Jake wanted to help other Mountain Valley teenagers face their fears.

Among them was Jillian, a 16-year-old who, when she wasn’t overwhelmed with anxiety, came across as remarkably poised and adultlike, the kind of teenager you find yourself talking to as if she were a graduate student in psychology. Jillian, who also asked that her last name not be used, came to Mountain Valley after two years of only intermittently going to school. She suffered from social anxiety (made worse by cyberbullying from classmates) and emetophobia, a fear of vomit that can be so debilitating that people will sometimes restrict what they eat and refuse to leave the house, lest they encounter someone with a stomach flu.

Jillian listened as Jake and other peers — who, in reality, liked her very much — voiced her insecurities: “I can’t believe how insignificant Jillian is.” “I mean, for the first three weeks, I thought her name was Susan.” “If she left tomorrow, maybe we wouldn’t even miss her.”

At the last one, Jillian’s shoulders caved, and her eyes watered. “I don’t want to do this,” she said, looking meekly at McCallie-Steller.

“If it’s too much, you can stop,” the therapist said, but Jillian considered the offer only long enough to reject it. She straightened her back. “No, I feel like I need to do this,” she announced. “I have a week and a half left. If I can’t get through something like this here …”

Her voice trailed off, but the implication was clear: The real world would be much more anxiety producing — and much less forgiving.

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Jillian in her room in Florida.CreditSasha Rudensky for The New York Times

Anxiety is the most common mental-health disorder in the United States, affecting nearly one-third of both adolescents and adults, according to the National Institute of Mental Health. But unlike depression, with which it routinely occurs, anxiety is often seen as a less serious problem.

“Anxiety is easy to dismiss or overlook, partially because everyone has it to some degree,” explained Philip Kendall, director of the Child and Adolescent Anxiety Disorders Clinic at Temple University in Philadelphia. It has an evolutionary purpose, after all; it helps us detect and avoid potentially dangerous situations. Highly anxious people, though, have an overactive fight-or-flight response that perceives threats where there often are none.

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But sometimes there are good reasons to feel anxious. For many young people, particularly those raised in abusive families or who live in neighborhoods besieged by poverty or violence, anxiety is a rational reaction to unstable, dangerous circumstances. At the Youth Anxiety Center’s clinic in the Washington Heights neighborhood of Manhattan, which serves mostly poor and working-class Hispanic youth, teenagers would object to the definition of anxiety I heard often at Mountain Valley: “The overestimation of danger and the underestimation of our ability to cope.”

“The fears can be very real for our kids,” explained Carolina Zerrate, the clinic’s medical director. “Oftentimes their neighborhoods are not safe, their streets are not safe and their families can feel unsafe if there’s a history of trauma and abuse.” The contemporary political climate can also feel “incredibly unsafe for the community of kids we serve,” Zerrate adds, explaining that many have undocumented family members.

And yet addressing anxiety is low on the priority list in many economically disadvantaged communities. Kids who “act out” are often labeled defiant or aggressive, while those who keep to themselves — anxiety specialists call them “silent sufferers” — are overlooked or mistaken for being shy. “If you go to a public school in a struggling urban area, teachers will talk about drugs, crime, teen pregnancy, violence,” Kendall says. “When you start to talk about anxiety, they’re like, ‘Oh, those are the kids we like!’ ”

Teenagers raised in more affluent communities might seemingly have less to feel anxious about. But Suniya Luthar, a professor of psychology at Arizona State University who has studied distress and resilience in both well-off and disadvantaged teenagers, has found that privileged youths are among the most emotionally distressed young people in America. “These kids are incredibly anxious and perfectionistic,” she says, but there’s “contempt and scorn for the idea that kids who have it all might be hurting.”

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A resident taking part in equine therapy at Mountain Valley.CreditSasha Rudensky for The New York Times

For many of these young people, the biggest single stressor is that they “never get to the point where they can say, ‘I’ve done enough, and now I can stop,’ ” Luthar says. “There’s always one more activity, one more A.P. class, one more thing to do in order to get into a top college. Kids have a sense that they’re not measuring up. The pressure is relentless and getting worse.”

It’s tempting to blame helicopter parents with their own anxiety issues for that pressure (and therapists who work with teenagers sometimes do), but several anxiety experts pointed to an important shift in the last few years. “Teenagers used to tell me, ‘I just need to get my parents off my back,’ ” recalls Madeline Levine, a founder of Challenge Success, a Stanford University-affiliated nonprofit that works on school reform and student well-being. “Now so many students have internalized the anxiety. The kids at this point are driving themselves crazy.”

Though there are cultural differences in how this kind of anguish manifests, there’s considerable overlap among teenagers from different backgrounds. Many are anxious about school and how friends or teachers perceive them. Some obsess about family conflicts. Teenagers with OCD tend to worry excessively about what foods they should eat, diseases they might contract or whatever happens to be in the news that week. Stephanie Eken, a psychiatrist and the regional medical director for Rogers Behavioral Health, which runs several teenage-anxiety outpatient programs across the country and an inpatient program in Wisconsin, told me that in the last few years she has heard more kids than ever worry about terrorism. “They wonder about whether it’s safe to go to a movie theater,” she said.

When I asked Eken about other common sources of worry among highly anxious kids, she didn’t hesitate: social media. Anxious teenagers from all backgrounds are relentlessly comparing themselves with their peers, she said, and the results are almost uniformly distressing.

Anxious kids certainly existed before Instagram, but many of the parents I spoke to worried that their kids’ digital habits — round-the-clock responding to texts, posting to social media, obsessively following the filtered exploits of peers — were partly to blame for their children’s struggles. To my surprise, anxious teenagers tended to agree. At Mountain Valley, I listened as a college student went on a philosophical rant about his generation’s relationship to social media. “I don’t think we realize how much it’s affecting our moods and personalities,” he said. “Social media is a tool, but it’s become this thing that we can’t live without but that’s making us crazy.”

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A resident meditating during a yoga session at Mountain Valley.CreditSasha Rudensky for The New York Times

In his case, he had little doubt that social media made him more self-conscious. “In high school, I’d constantly be judging my self-worth online,” he told me, recalling his tortured relationship with Facebook. “I would think, Oh, people don’t want to see me on their timeline.”

While smartphones can provoke anxiety, they can also serve as a handy avoidance strategy. At the height of his struggles, Jake spent hours at a time on his phone at home or at school. “It was a way for me not to think about classes and college, not to have to talk to people,” he said. Jake’s parents became so alarmed that they spoke to his psychiatrist about it and took his phone away a few hours each night.

At a workshop for parents last fall at the NW Anxiety Institute in Portland, Ore., Kevin Ashworth, the clinical director, warned them of the “illusion of control and certainty” that smartphones offer anxious young people desperate to manage their environments. “Teens will go places if they feel like they know everything that will happen, if they know everyone who will be there, if they can see who’s checked in online,” Ashworth told the parents. “But life doesn’t always come with that kind of certainty, and they’re never practicing the skill of rolling with the punches, of walking into an unknown or awkward social situation and learning that they can survive it.”

Jean Twenge, a professor of psychology at San Diego State University who researches adolescent mental health and psychological differences among generations, used to be skeptical of those who sounded an alarm about teenage internet use. “It seemed like too easy an explanation for negative mental-health outcomes in teens, and there wasn’t much evidence for it,” she told me. She searched for other possible explanations, including economic ones. But the timing of the spike in anxious and depressed teenagers since 2011, which she called one of the sharpest and most significant she has seen, is “all wrong,” she said. “The economy was improving by the time the increase started.”

The more she looked for explanations, the more she kept returning to two seemingly unrelated trend lines — depression in teenagers and smartphone adoption. (There is significantly more data about depression than anxiety.) Since 2011, the trend lines increased at essentially the same rate. In her recent book “iGen,” and in an article in The Atlantic, Twenge highlights a number of studies exploring the connection between social media and unhappiness. “The use of social media and smartphones look culpable for the increase in teen mental-health issues,” she told me. “It’s enough for an arrest — and as we get more data, it might be enough for a conviction.”

Last fall, at a high school near the New Hampshire-Vermont border, I watched Lynn Lyons, a psychotherapist and author, deliver bad news to a packed auditorium of teachers and counselors. “We’re not getting the job done,” she said, pacing the stage at Fall Mountain Regional High School, where she had been asked to lead a professional-development training session about anxiety.

More than a decade ago, the school would have been unlikely to invite her to speak. Anxiety was barely on the radar of most educators back then, according to Denise Pope, another founder of Challenge Success, the Stanford-affiliated nonprofit. Pope remembers facing skepticism when she sounded the alarm about growing anxiety among teenagers. “We don’t have to convince them anymore,” she told me. “Schools are coming to us, eager for help.”

A gregarious speaker, Lyons kept her audience entertained by calling anxiety “the cult leader” — for its ability to convince people of falsehoods about themselves — and telling funny stories about overinvolved parents. But her main point was clear: In a seemingly well-meaning effort to help kids avoid what makes them anxious, administrators actually make anxiety worse. “Anxiety is all about the avoidance of uncertainty and discomfort,” Lyons explained. “When we play along, we don’t help kids learn to cope or problem-solve in the face of unexpected events.”

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Kids hanging out in the lounge after lunch at Mountain Valley.CreditSasha Rudensky for The New York Times

She pointed to the increasing use of “504 plans,” a popular educational tool that allows for academic accommodations for students with physical or mental disabilities. Though 504 plans for anxiety vary by student, a typical one might allow a teenager to take more time on homework and tests, enter the school through a back door — to avoid the chaos of the main entrance — and leave a classroom when feeling anxious.

Lyons believes in the necessity of 504 plans, and she is in agreement with many of the recommendations of Challenge Success, including later school start times, less homework and more project-based learning. But Lyons worries that too many 504 plans are “avoidance-based and teach zero skills.” She gave the example of a plan that allows a student to leave a classroom anytime he feels overwhelmed. Often, a teenager “can go wherever he wants and stay there for as long as he thinks he needs,” she said. Instead, she argued, a school should have a policy in place for the student to seek out a guidance counselor or nurse and do some role-playing that helps the student “externalize his worry,” similar to how Mountain Valley teenagers are taught to observe their thinking and talk back to it. Then the student should return to his regular classroom as soon as possible, Lyons said.

“If anxiety could talk, it would say, ‘You know, let’s just get out of here. We don’t have to do this!’ ” Lyons said from the stage. “But in order to retrain the brain, in order to create that message that says that even though I’m uncomfortable I can do this, we need to stop treating these anxious kids like they’re so frail, like they can’t handle things.”

Lyons sees a connection between how some schools deal with anxious students and what she worries is a generation of young people increasingly insistent on safe spaces — and who believe their feelings should be protected at all costs. “Kids are being given some really dangerous messages these days about the fact that they can’t handle being triggered, that they shouldn’t have to bear witness to anything that makes them uncomfortable and that their external environments should bend to and accommodate their needs,” she told me.

Among many teachers and administrators I spoke to, one word — “resiliency” — kept coming up. More and more students struggle to recover from minor setbacks and aren’t “equipped to problem-solve or advocate for themselves effectively,” a school counselor in suburban Oregon told me. In the last few years, the counselor said, she has watched in astonishment as more students struggle with anxiety — and as more of those “stop coming to school, because they just can’t.”

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A Mountain Valley resident doing art therapy.CreditSasha Rudensky for The New York Times

Some schools have taken drastic measures to accommodate what one administrator called “our more fragile students.” At Roxbury High School in Roxbury Township, N.J., there are two dedicated classrooms for anxious teenagers, including one next to a mural of Edvard Munch’s painting “The Scream.” These students typically avoid the mammoth school cafeteria in favor of eating lunch in one of the classrooms, as they did on the day of my visit last May. They had just finished gym class, an anxiety-producing event for some even as the school did all it could to reimagine the concept. Music blasted throughout the gym as the teenagers halfheartedly played something vaguely approximating a game of volleyball. The ball was allowed to bounce once before being struck — not that anyone was keeping score.

I couldn’t help wondering what Lyons, and other therapists I spoke to who worry that schools inadvertently worsen anxiety, would think of this approach. Some of the programs’ teenagers hoped to go to college, where no special classrooms would await them. How was this preparing them for that?

“Some will say that this feeds the monster,” concedes Patricia Hovey, director of special services at Roxbury High. “But you’ve got to start where the kids are, not where you are or where you want them to be. We’ve got to get them in the building. Many of our students simply don’t come to school if they have to spend all day in” general-education classes. Once the students are in school, Hovey explained, staff members can help them build the confidence and skills to eventually transition to Roxbury’s regular classes — and stand a chance at navigating college or a job once they graduate.

Even with the promise of a special classroom, getting anxious kids to Roxbury High each morning demands a herculean effort from the program’s teachers and therapists. During my visit, I watched them text and call several no-show students in an effort to coax them out of bed. They also regularly communicate with parents, talking them through what to say to a teenager who refuses to leave his room. Paul Critelli, one of the program’s teachers, told me that many parents feel overwhelmed trying to get two or three kids ready for school each morning, and that their instinct is often to “sacrifice the anxious kid” in order to avoid morning hysterics and keep the family train running on time.

Mostly, though, Critelli wants to talk to the anxious students. “What’s the issue today?” I heard him ask during a phone call with a sophomore boy, who had missed his scheduled bus and was presumably speaking to Critelli from underneath his sheets. The call was a “Hail Mary,” as Critelli put it, because while he suspects that the boy sleeps with the phone “right next to his face,” he rarely responds when he’s feeling anxious. “I appreciate you picking up — you don’t normally do that,” Critelli told him, mixing in positive affirmation with a call to action. The school would be sending another bus, and Critelli expected him to be on it.

Critelli looked for any opportunity to push students out of their comfort zones. During an informal study period after lunch, I watched him confiscate cellphones he said the teenagers were using to “hide from, control and avoid” their feelings; scoff at a student who claimed to be too anxious to return a book to the school library; and challenge a particularly reserved boy who said he had nothing to work on.

Critelli looked at him incredulously. “Dude, you’re failing physics,” Critelli said. “What do you mean you don’t have anything to do?”

“There’s nothing I can do — I’m going to fail,” the student mumbled.

“So you’re just accepting that you’re going to fail?” The boy looked at his hands. “Here’s an idea,” Critelli continued. “You can email your teacher and say, ‘What can I do to improve my grade? What extra work can I do?’ ”

Critelli surveyed his classroom of anxious teenagers. “I’d love to see you advocate for yourselves!”

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A Mountain Valley teenager during equine therapy.CreditSasha Rudensky for The New York Times

Jake is a remarkably minimalist emailer and texter, eschewing exclamation points and emojis in favor of an almost old-fashioned formality. It can be challenging to gauge his moods that way, so I checked in with him regularly by phone in the months after he left Mountain Valley. He usually sounded content when we spoke, an impression confirmed by his parents, who were relieved by the changes they saw in him. In the fall of his senior year, Jake was regularly attending school — on some days he “even enjoyed it,” he told me with a laugh.

While he was careful not to overschedule himself, anxiety still sometimes overtook him. One weekend, he had to leave a Model United Nations conference after he became anxious and his stomach started cramping. “That was really disheartening, but when I struggle now it doesn’t last long, and I can usually get myself out of it pretty quickly,” he said, by talking back to his negative thoughts.

Jake also confessed to some worry about his application to attend U.N.C. He had decided to be transparent with the school about his anxiety disorder, partly because it helped explain his junior-year absences and grades and partly because the months he had spent challenging his beliefs and ideas at Mountain Valley perfectly fit the application essay prompt: Reflect on a time when you challenged a belief or idea.

In 650 thoughtful and sometimes uncharacteristically dramatic words, Jake explained that in middle school he had “aced the tests and seemed to many as the bright future of the American ideal.” But then came high school and fear of failure, the debilitating worry that he might not be good enough. He explained that going to treatment helped him change his perspective on learning and life. “Just being able to type this very essay would have been impossible months ago due to my fear of judgment,” he wrote. “College is the next step in my journey to find a true sense of self, both academically and personally. The future has reopened its doors.”

The doors had not reopened quite as wide for Jillian, whom I visited on an oppressively humid spring afternoon in Florida. It was a school day, but Jillian wasn’t at school. Instead, she was on the screened-in back patio of the townhouse where she lives with her mother, Allison. A talented artist, Jillian loves theater and special-effects makeup design, and she was hard at work on an outfit for a “Walking Dead” costume contest at a local car dealership.

While she painted her costume to make it appear blood-soaked, we half-watched an episode of the Netflix series “13 Reasons Why” on her laptop. Jillian told me she could relate to many of the series’s themes, including cyberbullying. In middle school, she made a profile page on ASKfm, a social-networking site favored at the time by mean girls and their unsuspecting prey. Jillian was quickly targeted. “I’d get 30 mean questions or messages a day,” she said. “Most of them were like, ‘Just kill yourself.’ ”

Nothing like that happened at the small private high school Jillian attended after leaving Mountain Valley. Though the school is known for its flexibility and willingness to work with nontraditional students, Jillian still struggled to feel comfortable there. She didn’t want to open up and be known as “the anxious girl.” There were other students at school who had severe anxiety and depression — “It’s like the flu broke out here with anxious kids this year,” the headmaster told me — but Jillian didn’t feel comfortable hanging out with them, either. Several had yet to go to treatment, and “I don’t want to go backward,” she told me. But the end result, unsurprisingly, was that most students never got to know Jillian.

Her longtime pattern of missing school began again. She had the tools to challenge her anxious thoughts, but using them every day proved exhausting. “There’s feeling a weight on your chest, and there’s the feeling of 16 people sitting on top of each other on your chest,” she said. “As soon as I’d wake up, it was absolute dread.”

Needing to get to her job 40 minutes away each morning, Allison, who had sold her previous house in order to afford Mountain Valley, had little time to coax Jillian out of bed. They argued constantly. Jillian thought her mother — who was severely depressed during a year when Jillian was younger and especially needed support — could be insensitive. Allison struggled with when (and how hard) to push her daughter. She knew Jillian had a serious disorder, but she also knew it wouldn’t get better by letting her hide out in her room. Allison also couldn’t be sure when Jillian was genuinely paralyzed by anxiety and when she was “manipulating me to get out of doing whatever she didn’t feel like doing,” she said.

“The million-dollar question of raising an anxious child is: When is pushing her going to help because she has to face her fears, and when is it going to make the situation worse and she’s going to have a panic attack?” Allison told me. “I feel like I made the wrong decision many times, and it destroyed my confidence as a mother.”

Allison sometimes wondered how her own anxiety issues might have genetically predisposed her daughter to anxiety. Allison had done enough Google searches to know that anxious teenagers tend to come from anxious parents. Research points to hereditary genes that predispose children to an anxiety disorder, and studies have found that an overbearing or anxious parenting style can induce anxiety and risk-aversion in kids. In the parents’ workshop I attended in Oregon, Ashworth, the therapist, spent a lot of time urging family members to work on their own anxiety issues.

He also cautioned parents not to accommodate their children’s avoidance strategies. Families of children with OCD will routinely open doors for them, cook only the two or three specific foods they’ve agreed to eat and avoid saying certain words or sounds. Families of socially anxious kids will let them stay in the car while they go shopping, order for them at restaurants and communicate with a teacher because they’re afraid to. “So many teens have lost the ability to tolerate distress and uncertainty, and a big reason for that is the way we parent them,” Ashworth said.

While Ashworth can be blunt, he is also disarming and funny, with a self-deprecating sense of humor that appeals to both parents and their cynical children. Like many therapists who work with anxious teenagers, he tries to model a “let’s not take life — and ourselves — too seriously” approach. He also has an almost endless empathy for the challenges that these teenagers and their families face. He knows, for example, that raising a severely anxious child can feel counterintuitive. How, for example, do you set and enforce limits with an anxious teenager? If you send him to his room, “you’ve just made his day,” Ashworth told the parents in his workshop, who nodded knowingly.

Though Jillian had returned from Mountain Valley a more confident person with a nuanced understanding of her issues (and with her emetophobia largely under control), treatment didn’t solve her school struggles. As she fell further behind, her morning battles with her mother became increasingly untenable. In consultation with the school, Allison agreed to let Jillian drop out and study for the G.E.D. But Allison wasn’t happy about it; she considered it a momentary concession. “We basically said, ‘O.K., anxiety, you win.’ ”

Jillian was relieved never to have to set foot in another high school. “I’m just a lot more relaxed now,” she told me in her messy bedroom, where the walls were adorned with “Star Wars” posters and the bookshelf overflowed with young-adult fiction and sci-fi, as well as a worn copy of “Chicken Soup for the Teenage Soul.” Near her bed were two prescription bottles — one for Prozac and another for Klonopin, a benzodiazepine tranquilizer. Jillian had been prescribed a number of drug combinations over the years, and while none were panaceas, she believed she would be “a lot worse if I wasn’t taking them.”

Though she spoke to a therapist once or twice a week online, Jillian otherwise ignored the structured daily schedule — including yoga, studying and cleaning her room — that she had agreed to with her mother. Jillian told me she often felt lonely at home, and she spent much of her days texting friends from around the country, some of whom she met at “Star Wars” conventions or on social media.

At the same time, Jillian was trying to make new friends. I watched her joke with fellow contestants at the costume contest (where she walked away with a $250 prize), and she was practically a social butterfly at a film event she attended with her mother. Bored with our company after the screening, Jillian spotted two teenagers talking to each other in a corner.

“O.K., I’m going to go mingle,” she announced.

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A Mountain Valley teenager talking to a passer-by during exposure therapy.CreditSasha Rudensky for The New York Times

On a busy weekday morning last May, a new crop of Mountain Valley residents were discovering that a key component of their treatment would involve repeatedly making fools of themselves. On the Dartmouth College campus, eight teenagers wore hand-painted white T-shirts that read “Ask Me About My Anxiety” and “I Have OCD.” They were encouraged by the therapy team to come up with scenarios that would make them uncomfortable. One teenager considered approaching random guys on campus and saying, “You must be a Dartmouth football player.” Later that afternoon, a second group of teenagers arrived. One feigned a panic attack at Starbucks. Another ordered nonsensically at a restaurant.

“What do we need to do to make your anxiety higher?” McCallie-Steller, the therapist, asked several teenagers as they prepared for their morning of exposure therapy. First developed in the 1950s, the technique is an essential component of cognitive-behavioral therapy (CBT) for anxiety, which a vast majority of researchers and clinicians believe is the most effective treatment for a range of anxiety disorders. In a large 2008 study of anxious youth published in The New England Journal of Medicine, more improved using CBT (60 percent) than the antidepressant Zoloft (55 percent), though the most effective therapy (81 percent) was a combination of the two.

But while exposure therapy has been proved highly effective, few teenagers receive it. “We’re much more likely to medicate kids than to give them therapy,” says Stephen Whiteside, director of the Child and Adolescent Anxiety Disorders Program at the Mayo Clinic. “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 best.”

Part of the reason is that exposure work is hard. Anxious people aren’t typically eager to feel more anxious. “It’s also uncomfortable for many therapists,” Whiteside told me. “Most people go into therapy or psychology to help people, but with exposure therapy you’re actually helping them feel uncomfortable. It’s not much fun for anybody. It’s much easier to sit in a therapist’s office and talk about feelings.”

Researchers are trying to better understand how exposure works in the brain and to fine-tune its application for anxiety treatment. At U.C.L.A., scientists at the school’s Anxiety and Depression Research Center discovered that the more anxious a person feels going into an exposure exercise, and the more surprised he or she is by the result, the more effective it is at competing with an original negative association or traumatic memory. (That’s why McCallie-Steller did her best to ramp up the teenagers’ anxiety before they began their exposure work.) Other researchers are focused on virtual-reality-aided exposure therapy, which allows people to encounter the sources of their anxiety in a therapist’s office.

For two Mountain Valley 14-year-olds on the main quad at Dartmouth, the sources of their distress were numerous. One, a brown-haired boy who embarrassed easily, suffered from a dispiriting combination of social anxiety, OCD, binge-eating and depression. It was a lot to work on in three months, and he was often overwhelmed by the magnitude of the project. On this day, he had agreed to tackle his social anxiety by sitting next to a stranger on a park bench and striking up a conversation.

Earlier, another Mountain Valley teenager took part in a similar exercise, during which the stranger opened up about his own struggles with anxiety. The teenagers were sometimes surprised that others could relate to their issues. As one girl handed out fliers about anxiety on campus, she sometimes asked people, “Can I tell you about anxiety?” More than a few students — including one who looked as if he might actually be a Dartmouth football player — responded with some version of “Trust me, I know all about it.”

The brown-haired boy was highly anxious about his exposure. He bombarded the therapist, Bryan Randolph, with questions in a seeming attempt to run out the clock until they had to return to Mountain Valley. “Can I just sit on the bench for a minute?” he asked Randolph. “And can I sit down and then start talking? I mean, do I need to ask, ‘Do you mind if I sit there?’ It’s weird to just sit there, have a conversation, then get up and come running back to a group of people.”

“Even better — let’s make it weird,” Randolph told him.

The boy shook his head. “Maybe the guy’s on break and doesn’t want to be bothered.”

“Maybe,” Randolph said. “He might hate you. He might get real mad at you.”

“That’s terrifying,” the teenager confessed. “And what if we’re so close on the bench that we’re touching?”

“That would be awkward,” Randolph said with a half-smile.

The boy craned his neck to get a better look at the man. “Is he sitting in the middle of the bench?”

“I don’t know — he might be,” Randolph told him. “But are you going to ‘what if’ this to death, or are you going to do it?”

He eventually shuffled off toward the stranger, allowing Randolph to turn his attention to the other 14-year-old, Thomas, who stood sheepishly on a nearby corner holding his sign: “I’ve Been Bullied. Ask Me.” The “Ask Me” was hard to make out, because Thomas had also included many of the insults peers have hurled at him over the years, including “B*tch,” “F*ggot,” “Ur Fat” and “Kill Yourself.” Holding the sign on a busy corner had been Thomas’s idea; he thought it might ratchet up his anxiety and force him to interact with strangers, while having the potential added benefit of educating people about bullying.

Randolph and I watched dozens of students walk by, some giving Thomas’s sign a glance but most never slowing their stride. He had been bullied for years, and now he was being ignored. I felt anxious just looking at him.

Eventually, an attractive couple in their mid-20s stopped to read the sign. They smiled, Thomas beamed and after a minute or two of conversation they all hugged. “Oh, my God, that was the greatest,” Thomas announced upon his return.

I asked him what they’d talked about. “The muscular dude said he’s been bullied, too, in middle school, and that bullies get nowhere in life,” Thomas told us. “Then the girl said, ‘You’re really brave. Can I give you a hug?’ ”

“That’s not what you were expecting, huh?” Randolph said. “Instead of being mean to you, people actually treated you with compassion.”

“Yeah, it was awesome,” he said. “I feel so good!”

The brown-haired boy, meanwhile, returned from his brief visit to the bench: “It was sooooo awkward,” he reported. “The guy just kept texting. He was probably like, Why is this kid asking me questions?”

“And what if he was?” Randolph asked him. “You’re not responsible for what he’s thinking.”

The boy appeared to consider Randolph’s point as they made their way back to the van that would return them to Mountain Valley. Sometimes, Randolph told the boys, “exactly what you think will happen happens. Other times, the exact opposite of what you think will happen happens. Either way, it’s all manageable.”

The subject line of Jake’s email to me last winter read simply, “College Results.” I opened it: “Hey Benoit, I just wanted to tell you that I was accepted to U.N.C. Chapel Hill. Jake.” I emailed back to say that he could stand to sound a little bit more excited, to which he replied, “Trust me, I’m pretty excited!”

Last month, I visited him during his fourth week of college classes. It was a Sunday, and Jake met me outside his dorm wearing khaki shorts and a Carolina Panthers jersey. He looked happier than I’d ever seen him. “Let’s walk,” he said, leading me on a tour of campus and nearby Chapel Hill, where he went record shopping (he left with a Parquet Courts album) and played touch football with a few of his friends.

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Teenagers at the chicken coop at Mountain Valley.CreditSasha Rudensky for The New York Times

Since leaving Mountain Valley, Jake had prioritized his social life. “The health of my relationships with people is just as important as academics,” he told me on a bench overlooking the main quad. He had said something similar at Mountain Valley, but back then it sounded theoretical, aspirational. It felt true now. He had made new friends on campus and was keeping up with old ones from home — and some of his peers from Mountain Valley — via text and Snapchat, the only social-media platform he regularly uses these days. “My junior year, when things got really bad, I told myself that I didn’t need to hang out with my friends a lot, that all that really mattered was how well I did at school,” he said. “I don’t think like that anymore.”

That’s not to say that Jake doesn’t study. He does — usually days before he needs to. “Procrastination isn’t a good idea for me,” he said. But he was actually enjoying several of his college classes, especially Intro to Ethics, for which he was reading Plato’s “Republic.”

Jake had experienced only one intense bout of anxiety at U.N.C. For his info sciences course, he turned in an assignment online but realized days later that there had been a technical glitch and it hadn’t gone through. He said he felt “a sudden burst of anxiety” — his chest tightened, and adrenaline coursed through his body. What had he done? He sent a panicked email to his professor and told a friend who also has anxiety issues that he was “freaking out.” Then he took a nap, which had long been one of his coping strategies. When he awoke, the professor had emailed saying it wasn’t a big deal. “That ended that crisis,” Jake told me.

For the most part, Jake felt he was managing his anxiety. Over the summer, he met twice with Jonathan Abramowitz, a psychology professor who leads the university’s anxiety and stress lab, but Jake had put off finding a regular therapist for the school year. His parents kept bugging him about it. “I just haven’t felt like I need it here,” Jake told me. But then, a few beats later, he added: “I know I need to stop making excuses and just do it.”

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Carrying apples to the pasture to feed the cows on Mountain Valley’s campus.CreditSasha Rudensky for The New York Times

I was curious how much of Jake’s newfound contentment had to do with being at U.N.C., with getting into his dream school. After all, a major component of his treatment at Mountain Valley was learning to accept that his value didn’t depend solely on academic achievement. How would he have reacted if his application was one of the 74 percent that U.N.C. rejected last year?

It was clear that Jake had thought about the question. “I would have been disappointed, but I really think I would have been O.K.,” he told me. “There are other schools in the world where I would have been happy. I definitely wouldn’t have believed that a couple years ago, but a lot’s changed.”

Before walking back to his dorm, where Jake’s friends were waiting for him, we stopped at the Old Well, a campus landmark where legend has it that students who drink from it on the first day of classes will get straight A’s that semester. The old Jake might have been first in line. But the new Jake? He hadn’t bothered to show up.

Dr. Otero’s Tips For Helping Children Cope with Anxiety

Dr. Melissa Otero Psy.D.

1) Remind your child that anxiety/worries are a normal experience. If there is a scary news story, it makes sense that they would be worried. Explain to your child that when we worry in this way, this is just our body trying to protect us. Anxiety helps to keep us alert and on the lookout for danger.

2) When we see our children worry, it is a natural to reassure them, i.e. “trust me, nothing will happen.”  While this may work for some time, it’s common to see worries persist even after having given them reassurance that they will be ok. Rather than providing reassurance in this way, try to empathize with them. Validate their worry. Let them know that it makes sense given the situation, i.e. “it makes sense that you might be worried about what might happen at school if you keep hearing stories about scary people dressed as clowns going to schools.” Then, help them think about ways that they can take care of themselves in the moment (see below!)

3) BREATHE! If you notice that your child is particularly anxious, try sitting silently with them and just breathe for a few minutes. Deep breathing in particular is effective at calming the nervous system. *Tip: Make sure that exhalations are 2-3 seconds longer than inhalations.

4) Help your child think about what they can do in the moment when they are feeling worried. It can be helpful to make this list ahead of time so that they can easily refer to it in moments when they might be more anxious. If a child states that they don’t know what can help them, a good place to start is by talking with them about what they love and building from there. Some ideas: physical activity (jumping jacks!), going for a walk, yoga, stretching, having a refreshing glass of water, meditation, writing, art, talking about their feelings, thinking of a funny memory.

5) Confront the “what-ifs.”  You may hear your child say something like, “…but what if a scary clown does come to school?” Do not dismiss their concern. Rather, sit with them and help them problem-solve. What will they do if the worst-case scenario does occur? Often times, once children know that there is a concrete plan in place, their anxiety reduces significantly.

6) Remind them that the worst-case scenario usually does not occur (but if it should, they have a plan). You may reinforce this by recalling examples of times when they thought something awful was going to happen and it didn’t. Remind them of times when they coped well with a situation.

7) Be aware of your own reactions. Anxiety is contagious. Your child takes her cues from you, so try your best to stay calm and model good problem-solving for them.

8) Limit the news and social media use. Unfortunately, it seems that most of the stories that make it to the news are negative, sad, violent, or scary. This can give children the false perception that most of what happens in the world is negative, sad, violent, or scary.

9) Make time each night to talk about good things that happened at school, at home, and in the world.

10) Be aware of what kind of media your child is watching. In particular, because Halloween is fast approaching, they may see more scary images, including clowns. Remind them that clowns are people dressed in a costume.

11) Let them know that you are taking care of them and keeping them safe. Similarly, let them know that school teachers and staff are taking care of them and keeping them safe. Remind them that Sacred Heart has security measures in place to ensure that only people who are supposed to be on campus are here.

12) Mr. Olson always tells students: “Never worry alone.”  We are here to support our students and encourage them to share how they feel, no matter how big or small the worry. Concerned students can speak with their teachers, Mr. Olson, Mrs. Weinman, or Dr. Otero.

The Mindful Child

The New York Times

Photo

CreditSam Kalda
It’s long been known that meditation helps children feel calmer, but new research is helping quantify its benefits for elementary school-age children. A 2015 study found that fourth- and fifth-grade students who participated in a four-month meditation program showed improvements in executive functions like cognitive control, working memory, cognitive flexibility — and better math grades. A study published recently in the journal Mindfulness found similar improvements in mathematics in fifth graders with attention deficit hyperactivity disorder. And a study of elementary school children in Korea showed that eight weeks of meditation lowered aggression, social anxiety and stress levels.

These investigations, along with a review published in March that combed the developmental psychology and cognitive neuroscience literature, illustrate how meditative practices have the potential to actually change the structure and function of the brain in ways that foster academic success.

Fundamental principles of neuroscience suggest that meditation can have its greatest impact on cognition when the brain is in its earliest stages of development.

This is because the brain develops connections in prefrontal circuits at its fastest rate in childhood. It is this extra plasticity that creates the potential for meditation to have greater impact on executive functioning in children. Although meditation may benefit adults more in terms of stress reduction or physical rejuvenation, its lasting effects on things like sustained attention and cognitive control are significant but ultimately less robust.

clinical study published in 2011 in The Journal of Child and Family Studies demonstrates this concept superbly. The research design allowed adults and children to be compared directly since they were enrolled in the same mindfulness meditation program and assessed identically. Children between 8 and 12 who had A.D.H.D. diagnoses, along with parents, were enrolled in an eight-week mindfulness-training program. The results showed that mindfulness meditation significantly improved attention and impulse control in both groups, but the improvements were considerably more robust in the children.

Outside of the lab, many parents report on the benefits of early meditation. Heather Maurer of Vienna, Va., who was trained in transcendental meditation, leads her 9-year-old daughter, Daisy, through various visualization techniques and focused breathing exercises three nights a week, and says her daughter has become noticeably better at self-regulating her emotions, a sign of improved cognitive control. “When Daisy is upset, she will sit herself down and concentrate on her breathing until she is refocused,” Ms. Maurer said.

Amanda Simmons, a mother who runs her own meditation studio in Los Angeles, has seen similar improvements in her 11-year-old son, Jacob, who is on the autism spectrum. Jacob also has A.D.H.D. and bipolar disorder, but Ms. Simmons said many of his symptoms have diminished since he began daily meditation and mantra chants six months ago. “The meditation seems to act like a ‘hard reboot’ for his brain, almost instantly resolving mood swings or lessening anger,” Ms. Simmons said. She believes it has enabled him to take a lower dose of Risperdal, an antipsychotic drug used to treat bipolar disorder.

Whether children are on medication or not, meditation can help instill self-control and an ability to focus. Perhaps encouraging meditation and mind-body practices will come to be recognized as being as essential to smart parenting as teaching your child to work hard, eat healthfully and exercise regularly.

To learn some meditation techniques you can teach your child, readThree Ways for Children to Try Meditation at Home.