We are pleased to have author and Director of the Columbia University Clinic for Anxiety and Related Disorders, Dr. Anne Marie Albano, Ph.D., share some great insights with us on the differences between separation anxiety, generalized anxiety, and social phobia! Read on for great insights for how parents can help and what to expect in therapy. She is the author of “You and Your Anxious Child: Free Your Child from Fears and Worries and Create a Joyful Family Life,” and a member of the Columbia University faculty.
AiT: What is the difference between separation anxiety, generalized anxiety, and social phobias?
AA: Let’s start with this…anxiety is the common feature that runs through separation, social and generalized anxiety disorders. What makes each unique is the focus of the anxious thoughts and fear. In separation anxiety, the individual fears that something terrible will happen while he or she is away from loved ones, and they won’t be able to reunite again. In teenagers, separation anxiety prevents a teen from going to school comfortably, to sleepovers or camp, and even stops them from leaving for college. They fear that while away, a parent will die or be severely hurt, or the teen himself could be kidnapped, killed, or somehow never get home again. The teen imagines all sorts of scenarios, some taken from cases in the media, and becomes certain that “What happened to that (abductee, accident victim, etc) can happen to me!” Separation anxiety is different from social anxiety disorder, otherwise known as social phobia, where the fear is about being rejected, embarrassed, or humiliated, or of being evaluated negatively by others.
But, unlike the typical concern that we all have about fitting in and being accepted, social phobia results in such extreme anxiety that it’s nearly impossible to be comfortable around people, and the fear causes avoidance of interacting and doing things that we all need to do. And so, the idea of asking for help when needed, speaking up in class, taking tests or just going up to other teens and joining in with the crowd causes intense anxiety and at times panic attacks. Teenagers with social anxiety fear that they won’t measure up, will say or do something to appear foolish, and then they won’t be able to face other people again. And finally, generalized anxiety disorder (GAD) is characterized by worry, but it’s worry running wild. Whereas we all worry to some degree, the individual with GAD can’t turn the worry off by distracting himself or moving onto something else, or by being reassured.
In fact, no matter what other people say, she can’t stop herself from thinking “What if this goes wrong” and “What if I can’t handle that,” spinning the worst case scenario again and again, and not being able to see herself coping with anything that comes her way. Headaches, stomachaches, difficulty sleeping and muscle aches can all accompany GAD. So, all 3 of these anxiety disorder share anxiety—a fear of something bad happening—-but the focus of the fear is different. And, all anxieties also share one other feature, avoidance. When you’re anxious, whether it’s separation, social or generalized anxiety disorder, you’re likely avoiding or escaping from things that prompt your anxiety. When avoidance sets in and becomes a pattern or habit, then the anxiety flourishes and the individual feels increasingly different and apart from everyone else.
AiT: How can a parent identify if one of these issues is developing in his/her child?
AA: Parents are excellent observers of what their kids are doing. In fact, my colleague Dr. Patricia DiBartolo and I once did a study where we found that when parents described their teenagers’ social anxiety to clinicians, they were focusing on the teens’ avoidance behavior. This was key for the clinicians to understand whether the anxiety was at a significant level, because the parents gave very important information such as:
“She won’t go to any school dances”
“He hasn’t gotten together with a friend since middle school”
“She always makes me ask the teacher for missed assignments when she’s sick”
“I have to deal with store clerks for him, he won’t ask for help in finding something.”
Parents very accurately described what types of situations their adolescents were avoiding and also the various ways that their kids made excuses or accommodations because of their anxiety. “She tells other kids that I make her babysit for her younger sister every Friday night, and that’s why she can’t go to social events.” “He volunteered to serve meals at the nursing home, but that’s because the other position involved tutoring kids closer to his age in math. And, he’s good at math but won’t work with other kids!” “She won’t go away on the school trip, because she says that she misses us so much!”
And so, my advice to parents is to be on the lookout for avoidance and escape: what is it that your son or daughter is not doing that other teenagers his or her age are doing? Do you notice him skipping out on social events? Does she get stomachaches or illnesses before exams or interviews? Is your teen almost always at home and not out with kids his age?
Not that I want parents to hover and be spies on their kids, but I do want them to think about what is typical for kids to do in their hometowns and within their culture, and think about whether their teen is doing these same things. If not, then ask “Why not?” Anxiety may be at play if your teen is avoiding healthy, expected, and typical teen activities. teens’ avoidance behavior. This was key for the clinicians to understand whether the anxiety was at a significant level, because the parents gave very important information such as “She won’t go to any school dances” “He hasn’t gotten together with a friend since middle school” “She always makes me ask the teacher for missed assignments when she’s sick” “I have to deal with store clerks for him, he won’t ask for help in finding something.”
AiT: What are the next steps; what can parents expect in therapy and how to be successful there?
AA: The very next step after noticing avoidance behavior is to open a dialogue with your teenager. Again, a few words of caution…this is a conversation that needs to happen, not an inquisition and you have to be careful not to judge your child. He or she might be on the defensive no matter how you handle this, because that’s what anxiety does to a person and also, because that’s not unusual for teenagers.
But, you want to open up with some questions about how your child is feeling about the things she’s turning down. “Bonnie, I think this is the third time you’ve turned down your friends’ invitations to go to the movies. Can you tell me about that?”
Listen for excuses (“Everyone gets drunk and I don’t want to do that” “They are all mean kids, I don’t want to be around them.”) and think through whether these sound realistic or exaggerated to make you back off. After all, what parent wants their teenager hanging out with kids who drink or get into trouble? But, if you know some of these kids and if you are aware that there are other opportunities that your teen shrinks from, state your concern. “I can see that you’re staying up all night working on this homework but you never seem to be satisfied with it. Let’s talk more about that.”
Show your concern and let your teen know that whatever the anxiety—-fear of separation, fear of embarrassment, worry about failure—-you want to understand and you’re there to help, not judge. See if you can engage your teen in devising some goals for turning around the avoidance and upset feelings. Suggest some deep breathing, relaxation strategies or yoga, and encourage your teen to challenge their thinking with realistic and problem-solving thoughts. And, support your teen’s efforts to try. Success isn’t the goal, but making an attempt to push back on the anxiety and move forward into a situation that he would otherwise be doing, that is what you’re after.
If your teen doesn’t turn this around with your encouragement and support, then suggest seeing a therapist who can help in a step-by-step way that has been tried and tested: cognitive behavioral therapy, or CBT. With CBT, your teen and the therapist will work as a collaborative team to identify the anxiety and use strategies to soothe and comfort one’s self, to uncover the unhelpful thinking patterns that have evolved, and to challenge those with helpful, productive, and coping-focused thinking. And, once these self-soothing and cognitive/thinking skills are in place, to take on in a systematic way those situations that caused angst and upset.
The goal of CBT is to free your teenager from anxiety and allow him to make decisions and choices based on what he wants to do, rather than what he fears doing. The therapist will engage you in setting goals with your teenager and will direct you in how to encourage and support your teen’s exposures and reinforce his progress. And, you’ll learn to let go of your own fears….those worries that have likely developed over time from watching your teen’s struggles. You’ll also find that your teen can handle the bumps in the road that everyone encounters and she won’t crumble from them, but rather, she’ll grow with confidence and maturity because she’s taken control of her anxiety. And that will make you smile…a lot.Any specific feedback or words of hope you have for parents who are just recently identifying an anxiety issues in their child?
Know that anxiety is the most common of all the mental health problems affecting children and adolescents, ages 7 to 17. Now, while that might not be comforting, know that anxiety itself is normal, and problematic anxiety is highly treatable. Yes, with CBT by itself, or when needed, with CBT plus certain medications, anxiety disorders can be brought under your child’s control and tucked away. The main idea to keep in mind is that your son or daughter can learn skills to tackle anxiety and then use these skills going forward at each new bump along the road of development. In fact, you want your child to feel the normal butterflies and trembles that accompany life: the sweaty palms felt in giving an oral report, the trembling when asking someone on a date, the what if’s of what’s inside the envelope (or email) that just arrived from a college.
Anxiety should happen in small doses and result in not avoidance but in moving towards similar situations again and again….and that’s what we’d like every teen to experience and to learn to harness their anxiety so it’s used to motivate them and encourage their taking on new and challenging situations.
AiT: Where can we find and order your book for more information?
AA: I wrote “You and Your Anxious Child: Free Your Child from Fears and Worries and Create a Joyful Family Life” with Leslie Pepper (a great co-writer and exceptional mom) so that parents can learn from the many families who I’ve seen over the years. They have inspired me, they keep me going, and I hope they will do the same for parents who pick up the book. It’s available via Amazon.com and other bookseller on the web and published by Penguin Press.
I highly, highly, highly recommend effectivechildtherapy.com, a great website packed with free videos for parents and solid, science-based information on how to identify problems and where to (and what kind of) help to seek for your children and teenagers with anxiety, mood concerns, ADHD and the range of issues that confront kids and families.
By: Solome Tibebu, AiT Contributor