Author: Dr. Delaney Ruston
"The power of emotional stories" — that is the phrase that just popped into my head as I sit here on a plane reading Scott Stossel's book, My Age of Anxiety.
Tears just filled my eye as I read these sentences from Stossel's life:
" One night, when I was fourteen, I woke up at three in the morning with one of my bouts of screaming panic. Hearing my cry, my father lost control. He stormed into my room, trailed by my mother, and started hitting me repeatedly, telling me to shut up."
Stossel's psychiatrist once said about Stossel's father, "He didn't have a lot of tolerance for anxious behavior. Your anxiety would make him blow up with anger."
My heart aches for Stossel, and I want to do all I can help people of all ages remember. As humans don't choose to have anxious feelings, we don't choose to have depressive feelings.
My heart also feels for Stossel's father. He needed help and was not getting it — in part because his mind hindered its ability to see outside of his mindset. But I am confident that if he was asked: "Are you happy? Are you proud? Are you content with your feeling the need to get angry and violent with your son when he is experiencing anxiety?" — His answer would have been no.
Knowing how to lovingly and effectively be with our kids and teens as they experience difficult emotions and display challenging behaviors is immensely complicated. But there are lots of solutions — knowing strategies and sharing these with our friends, colleagues, parent groups, and on and on, is crucial so we can stop stories like Stossel's.
Today I want to share some solutions around anxiety, including some points that came up in an interview I did last week on the NPR station KUOW with Bill Radke on The Record. He also had Laura Kastner, a clinical psychologist for teens who is the author of five books, is in Screenagers and Screenagers NEXT CHAPTER…and who I greatly respect.
Here is the link (once there scroll down the page to the 3rd paragraph) to hear the full interview, which would be a great way to spark conversations with your kids or teens during a car ride or after dinner. Not only does it discuss anxiety, but also topics around screen time.
Part of what I talk with the host Radke about is how, as a physician, I assess anxiety in teens and adults in my clinic.
I ask everyone who comes into the clinic at some point in the visit, "Are you experiencing any anxiety or depression?" The incidence of anxiety and depression is significantly higher in a medical setting than in the general population, so it is important that I ask about these things. And, so often, I see how relieved they are that I asked.
I shared with Radke that when I see people in my clinic, and I have identified a concern about anxiety, the number one question I then ask is, "Are you avoiding things?" Their eyes light up and often respond, "How did you guess that?"
When I talk with my patients, we work to see how much avoidance is preventing them from achieving goals like meeting people, talking to a boss about a work issue, etc. I then ask how much is their avoidance shrinking their world? Making them feel worse about themselves? Making them feel hopeless? From there, I do a brief intervention to think of a small step to counteract the avoidance, and we also talk about getting behavioral health counseling.
In the radio interview I talk about how surprised I was to learn in my research for Screenagers NEXT CHAPTER that "…on MRI scans if you give an anxious teen and non-anxious teen a scenario, you will actually see the anxious teen have more firing in the amygdala, the emotion center of the brain. The good news is, as the teen does these exposures, as they step into the discomfort of getting scaffolding and support, you can actually see changes in the brain scans of the amygdala. It is no longer as hyperactive as it was before to that stimuli."
I go on to tell Radke about a wonderful family in the film, with a girl who was very socially anxious:
"Part of what she needed to do was go to a shopping mall and ask for sushi at a pizza place — practice being embarrassed. When you do something like this, it makes real-life situations that much more tolerable. I'm not saying we have to do that for everyone, but sometimes it's just calling that friend you don't like to call, you practice doing that. You just do baby steps."
Laura Kastner makes these really important points in the interview:
"A lot of what they have is anxiety about anxiety. So they have this dread in their minds. They already have this scenario in their mind, and their anxiety shoots up, maybe have an amygdala hijack, and then they will, of course, want to avoid that stimulus. So, part of what you're doing is listing these challenges like going to school when you didn't want to or facing the homework. That's what I call the panther in the day pack because just homework raises their anxiety, the anticipation of opening the day pack.
Part of it is just chunking it up with little challenges so that you scaffold, or you have an exposure kind of profile where you go through small things like going in and asking for condiments at Burger King or big stuff like returning something to Nordstrom. So, you literally can write up a list of small, medium, and large challenges. As they go there and they have the shooting up of their anxiety, if they're in the presence of the difficult thing, the anxiety will go down, and they go, 'Oh, this was innocuous.'…So, you need lots of those experiences of going toward things."
I make another point in the interview with Radke about screen time, our teens, and anxious feelings:
"What really concerns me is that so often teens tell me that the number one way of coping with challenging emotions is to turn to screens— looking at YouTube, finding ways to escape the hard emotions. I often think it's like me eating a chocolate chip cookie. That's my go-to. It feels great at the moment, but has it gotten me to where I really want to be?"
Here are a few questions to get the conversation started:
Do you ever feel anxious?
When you are feeling in a low mood, does going on social media provoke anxious feelings? Give examples.
Does avoiding the thing you feel anxious about make you feel better or worse?
Do you have ways to help yourself when you start to recognize anxiety coming on?
Who in your life would you go to help you through some of these feelings?