David L. Smoot, PhD
Rising Rates of Anxiety
Psychologists and therapists occasionally find time to get together with colleagues and discuss their practices. Among those working with children and teens, the topic almost always leads to a discussion of the rising rates of anxiety in kids. In my own practice, the shift began about ten years ago. Before that, the most common problems reported by families were behavioral problems. Beginning in about 2010 and at an increasing rate, the chief problem has been anxiety. Studies show that:
About one in three teens experience severe enough anxiety to lead to diagnosis at some point in their teen years. About 80% do not receive treatment.
Over the last ten years, rates of anxiety in teens have increased 17% to 20%. Almost half with anxiety describe their symptoms as mild, but 15% describe symptoms as severe.
Stress and anxiety are the primary concerns of the majority of college students seeking mental health care. A survey done annually on incoming college students found that 41% felt overwhelmed by all they have to do in 2016, compared with 28% in 2000, and 18% in 1985.
In my practice at Wake Family Psychology, PLLC, I like to describe my two broad-level goals as to 1) help your “Sam” (fill in child’s name) be the best Sam s/he can be, and 2) help Sam live life to the full (a nod to John 10:10 “to have life and have it abundantly”). Learning to understand and cope with anxiety is often an important part of this mission.
Sometimes the anxiety kids report is a developmentally standard course. They are afraid of monsters under the bed or in their closets, of burglars breaking in, or of storms at night or even in the forecast. When I was in graduate school in the 1980s, we learned these were normal fears and most often resolve with or without therapy.
More dramatic changes have been seen in other types of anxiety, primarily social anxiety and what we call generalized anxiety. Generalized anxiety may include the “what-if” worries and worries about one’s future. The numbers of kids and families reporting these problems have been increasing rapidly and are very concerning to me and my colleagues, as well as to parents, teachers, and pediatricians. These kinds of worries may impact a child’s ability to experience the give-and-take of social experiences, the joy of a full life, and the confidence that leads to healthy self-esteem.
A natural behavioral response to fear and anxiety is to avoid or withdraw from the triggering situation or event. This avoidance and fearful experience may hinder a child from developing coping and mastery skills that impedes him or her from becoming the best version of themselves they can be. Living with fear and anxiety also hinders the curiosity and interest – and occasional joy – that comes with living life to the full.
In my conversations with colleagues, we always turn to our best guesses on why this spike in anxiety levels is happening now. For the most part, our guesses are supported by the literature.
Greg Lukianoff and John Haidt decried the role of “safetyism” in our cultural and parenting values in affecting teens and college students and their ability to deal with anxiety. Particularly in American culture, we shelter and protect teens longer than in other developed nations. The most recent generation, born between the mid-1990s and 2012, waits longer to get a job or driving license, for instance. They are less likely to structure their own time, manage their own money, or understand how to use public transportation compared with children of other societies. We can surmise that many teens have a delayed sense of autonomy and competence that may affect higher rates of anxiety.
These same authors extend the idea of safetyism to protection from our own feelings. When learning institutions and parents believe that children must be protected from distressed feelings, challenging concepts, or differing opinions we may end up inadvertently sheltering our children and inhibiting their development of resilience. Dr. Robin Berman writes that the key to raising happy children is to teach them to tolerate their unhappiness.
This generation has grown up in an America where school shootings and other mass shootings are in the news regularly. I am writing this in late 2020 in the midst of a global pandemic, virtual schooling and social distancing, and just after a brutal, divisive national election. People of color see others that look like them treated violently – often by people that look like me (an older White male). The world appears to be a dangerous, hostile place.
Our present culture stresses high-achieving, high performing-standards. Today’s teen is likely to hear from her school, from her peers, from her parents, or from her own self-set standards that she must take the toughest courses, must get the best grades, must go to the right schools, must have the best award and titles. Julie Lythcott-Haims, a former Dean of Freshman Students at Stanford, passionately describes this as the checklist childhood and notes how these demands and pressures contribute to rising levels of anxiety. Of note, she emphasizes studies showing that students who have done well yet did not get into a “dream university” make about the same income as adults as those graduating from their dream university. She also referenced Malcolm Gladwell’s argument that students who are a “big fish in a small pond” in the top 5-10% of their chosen college have better career outcomes than students who are a “little fish in a big pond” (around the 50th percentile of their prestigious university).
Lastly, many have noted that the advent of Social Media corresponds with the alarming rise in anxiety and depression among youth. This latest generation, Gen Z, has also been termed the iGeneration because of their shared lifespan with the smartphone and social media platforms from Facebook and Twitter to Reddit to Instagram, SnapChat, and Discord. Studies have shown that students who spend more than two hours daily on social media platforms are more likely to experience anxiety and depression. Moreover, students who sacrifice other face-to-face interaction with peers and others for these 2+ hours of daily online time are at the most risk of anxiety and depression. In some cases, social media has increased the scope of social bullying exponentially. For others, social media is a cruel mirror that seems to reflect others “living the life” even though we intellectually know that others post their “best moments” or even altered, filtered images designed to boost their attractiveness. Many teens suffer from Fear Of Missing Out (FOMO) or even worse, Fear of Being Left Out (FOBLO).
As with most things, any one of the above factors alone may not ignite the flareup of anxiety in our youth. Similarly, every youth experiencing higher levels of anxiety may not (at least consciously) be aware of every one of these factors. However, the fact that these factors coincide at this particular time in varying degrees for our youth, families, and communities creates a logical path toward understanding the rising levels of anxiety, stress, and depression in young people. Many of our children, teens, and young adults feel less prepared and competent to deal with life’s challenges, feel less able to handle distressed feelings, and perceive the world as a less safe, more hostile place. They may feel less broadly supported by a safety net of extended family, neighborhood and faith community, friends, etc. With all these considerations, it is no wonder our youth feel more anxious. In the next entry, Understanding and Treating Youth Anxiety, we will look at how these factors affect the individual and how treatment can help.