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Q&A: Anxiety Among Teens
When worry takes over
Destiny Smith

All of us experience anxiety. But some teens experience such extreme anxiety that they have trouble getting through everyday life. Dr. Sandra Pimentel is an assistant professor of clinical psychology at Columbia University and associate director of the Columbia University Clinic for Anxiety and Related Disorders. She spoke with us about the different types of anxiety and how to cope.

Q: What is anxiety? At what point does everyday anxiety become a problem that you should seek help for?

A: Anxiety is our response to something we perceive to be threatening or dangerous. It doesn’t have to be threatening or dangerous, but we believe it to be.

Everyone worries; you’re supposed to worry and feel anxious at times. It becomes an anxiety disorder when the worry or anxious feelings become excessive, more than the actual situation calls for. Do you avoid situations because they make you too nervous? Does it hold you back from being with your friends, or from making friends? Does it mess things up in terms of how you feel about school, or your self-esteem? If your anxiety is starting to get in the way of everyday activity, that’s a good sign that you should get help.

Q: What are the main types of anxiety disorder?

A: Anxiety disorders are the most common mental health disorders that kids and teenagers experience. One out of every eight kids has an anxiety disorder.

There are a few categories. There’s generalized anxiety disorder, where people worry a lot about everything. Social anxiety disorder is when people worry excessively about social situations, what people think about them.

Panic disorder is where people have panic attacks, with a lot of physical symptoms and the feeling that they are about to die or that something really terrible is going to happen to them. Obsessive-compulsive disorder, or OCD, is a category of anxiety where people have intrusive thoughts that compel them to do some particular behavior. Separation anxiety disorder is where a kid gets scared of separating from Mom or Dad. That’s normal for a 2- or 3-year-old, but when you see it in older kids, it’s a problem.

Then there are specific phobias. People have phobias about all different things, everything from elevators to cats, dogs, mice, flying.

The final category is PTSD, post-traumatic stress disorder, where people experience really significant anxiety after something traumatic happens to them—like if they’ve seen someone die, they’re coming back from war, or maybe they were involved in a hurricane or flood where they got very frightened. Kids who have been neglected or physically or sexually abused may also develop PTSD in response to the terrible things that happened to them.

Q: How does anxiety tend to show itself in teenagers?

A: As you go through development, you experience different phases of things that may scare you, like a kid who’s scared of monsters and the bogeyman. Social things become more important in your teens, so social anxiety disorder comes out in teen years, typically. There are different academic challenges, so kids worry more about performance in school. Panic attacks also tend to have their onset in teen years.

Q: How does anxiety affect a person’s thought processes?

A: Anxiety is meant to protect us by making us act. If you have a test or presentation you’re worried about, you’re more likely to study or prepare. But when people are stuck in anxiety, they’re not planning or coping. It’s like running in place. You’re not using the anxiety as a push to say, “What can I do about this?”

You also get stuck in a certain thought pattern. For example, if someone has a fear of being unsuccessful, they might get stuck thinking, “I did poorly on this one exam; that means I’m going to be a failure in the future.” They start to make things more negative than they actually are. That’s called “cognitive distortion.” It’s like if a radio station keeps playing that sad song, you get in a sad mood. If you’re thinking only about being unsuccessful and being rejected, jumping to only negative conclusions, these distorted ways of thinking overestimate how bad it will actually be.

With panic disorder, people get stuck in a panic cycle. If the average person feels a gurgle in their stomach or palpitations in their heart on a given day, they might not think too much about that. But someone more prone to panic attacks might think, “I’m having a heart attack.” Imagine if you have that reaction—it’s going to make the feeling worse.

Q: Does keeping anxiety to yourself make it worse?

A: We’re social people and meant to share feelings with others, whether those feelings are anxieties or happiness, anger, etcetera. It’s good to be able to talk to friends about things that make you nervous or anxious, and if they can help you problem-solve or come up with ways of coping, good. But a lot of times when people get anxious, they want reassurance that everything’s going to be OK, and we can’t over-rely on people to make us feel better. It’s about developing your own sense of how to cope with anxiety.

Q: Is anxiety linked with depression?

A: If you see someone who’s socially anxious and they start to avoid social situations and participating in activities that their peers do, you can see how that can lead to them being depressed. The “cognitive distortions” or negative thinking patterns people have with anxiety are also seen in people with depression. Kids who are anxious may avoid certain situations, and kids who become depressed may avoid and withdraw as well.

Q: How do mental health professionals treat anxiety disorders?

A: The good news is that, even if someone is at the edge with anxiety, there are treatments that can help. Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on changing thought patterns and behaviors and has been shown to work as effectively as medication in helping people cope with anxiety. It’s a short-term, structured treatment.

Sometimes medication is prescribed, depending on patient preference, severity of symptoms, and other considerations. Research shows that CBT, medication, or the combination of CBT and medication are each effective ways of treating anxiety disorders in teens.

Q: How do you recommend dealing with everyday anxiety?

A:Sometimes a teen says, “I’m worried.” I say, “About what?” and they say, “Stuff.” It’s important to think specifically about what worries you: I’m worried about what to say when I ask him or her out; about SATs; about college. Then you can break down your fears: What do you think you’re going to say wrong when you go on the date? What do you worry you’ll have trouble with on the SATs? Come up with a plan and prepare, setting realistic expectations about what you can and can’t do. That’s using anxiety in a good way.

Another thing is to eat well and get enough sleep. If you’re tired, you’re less likely to deal with stress in a good way. Exercise to give your body an outlet, even if it’s just going for a walk. Yesterday I had a day with no breaks, but I forced myself to take a five-minute break to walk around the block. It’s important to say, “OK, this is funny but I’m going to do it.”

That’s another thing: Things are much easier to deal with if you have a sense of humor about them. And talk to people. Find a friend, or talk to a parent or a counselor.

For more information on different types of anxiety disorder, coping with anxiety, and getting help to treat anxiety, visit the website of the Anxiety Disorders Association of America at, or contact the Columbia University Center for Anxiety and Related Disorders:, 212-246-5740.

Luisa Tucker
All Expert Advice articles are written by Maria Luisa Tucker, Youth Communication's Editorial Director, and based on interviews with our advisory board of mental health profressionals.
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