Anxiety is a universal human emotion that we all experience, both children and adults alike. In fact, it is normal to experience some anxiety and worry at times, as anxiety can be adaptive in nature and serve both as a motivator and as a means of keeping us safe. For example, anxiety can indicate to our brain that there may be something important to address in the future (i.e., studying for an upcoming test or preparing for a job interview), or it may be alerting us to a possible threat that we need to prepare for to maintain our safety (i.e., a flash flood warning).
However, both children and adults can experience excessive anxiety that becomes maladaptive and rises to the level of an anxiety disorder. In fact, the National Institute of Mental Health highlights via the National Comorbidity Survey Adolescent Supplement that the lifetime prevalence rate of anxiety disorders among adolescents in the U.S. aged 13-18 was 31.9% (Merkangas K.R., et al., 2010). Meanwhile, the prevalence data via the National Comorbidity Study Replication indicated that about 31.1% of adults in the U.S. experienced an anxiety disorder in their lifetime (Harvard Medical School, 2007).
It is important to note that there are different anxiety disorders that children and adults can experience and knowing the differences and which one is affecting an individual can help determine the support and treatment needed. Some of the common anxiety disorders and their core features that are listed in the Diagnostic and Statistical Manual of Mental Disorders 5th edition, text revised (DSM-V-TR), include the following (American Psychiatric Association, 2022):
- Separation Anxiety Disorder: excessive fear or anxiety about separation from home or from a major attachment figure (i.e., a parental figure)
- Specific Phobia: excessive fear or anxiety about certain objects or situations (i.e., heights, dogs, elevators, vomiting, etc.)
- Social Anxiety Disorder: excessive fear or anxiety about social situations where an individual is exposed to possible scrutiny or judgment from others (i.e., common social situations may include public speaking, asserting oneself, starting or maintaining conversations, being observed)
- Panic Disorder: excessive fear or anxiety about experiencing re-occurring panic attacks
- Agoraphobia: excessive fear or anxiety about being in a setting where escape or accessing help might be difficult (i.e., settings may include public transportation, enclosed places such as stores or open spaces such as bridges)
- Generalized Anxiety Disorder: excessive anxiety or worry about a variety of events (i.e., responsibilities at work or school, one’s health, finances, being on time, etc.)
Ways Anxiety Can Manifest Across the Lifespan
While the primary concern varies across the different anxiety disorders, a common theme is excessive fear or anxiety. You may be thinking, “What is considered excessive anxiety?” Individuals affected by anxiety disorders are frequently overestimating the likelihood of feared outcomes occurring and how bad it would be if they did occur or face them AND often underestimating their ability to cope with the perceived threat. In other words, their worries about the feared object/situation are usually persistent and often unlikely to occur or be as catastrophic in nature as one assumes. In turn, the persistent and unhelpful worries usually result in significant distress and often times lead to avoidance of the feared situation, (i.e., avoidance of social situations, dealing with responsibilities, going to places where one may be concerned about being separated from a parental figure such as school, avoidance of an object such as dogs or a place where one believes they may experience a panic attack, etc.). When these maladaptive patterns of thinking and coping repeat for both children and adults, one can find themselves in the anxiety cycle, and the anxiety can begin to interfere with daily life, such as in school, at work, in social life/relationships, or in managing responsibilities.
In addition to persistent worries and avoidance of feared situations being common signs of anxiety in both children and adults, additional cognitive, emotional, physical, and behavioral signs of anxiety can include the following:
- Difficulties controlling one’s racing thoughts/worries and thus concentrating
- Various somatic complaints, such as muscle tension, upset stomach, headaches, difficulties breathing, racing heart, fatigue, restlessness/fidgety behavior
- Changes in sleep (i.e., trouble falling asleep, staying asleep, tired upon waking up, nightmares, sometimes difficulties sleeping alone for children)
- Changes in appetite (i.e., minimal appetite or excessive appetite)
- Irritability
- Excessive crying or clinginess in children
- Sometimes school refusal for children
- Disruptive behavior in children, such as outbursts or tantrums
While children and adults can experience any of the aforementioned symptoms of anxiety, it’s important to realize that children may have a more difficult time expressing their fears and worries to others compared to adults given their developmental stage, thus, it’s often helpful for adults to pay close attention to changes in a child’s emotional, physical, and behavioral functioning that are persistent and interfering in their daily life.
Undoubtedly, anxiety disorders can be overwhelming for both children and adults to experience. Fortunately, there are effective, evidence-based treatments that can be pursued regardless of age that can help individuals manage their anxiety and lessen the impact on one’s day-to-day life.
Treatment of Anxiety and Worry Across the Lifespan
Cognitive Behavioral Therapy (CBT) offers a structured and evidenced based approach to help individuals more effectively manage anxiety and worry. While treatment across the lifespan shares many core components, treatment is tailored to each person’s age, cognitive ability, and developmental stage.
One of the initial steps in treatment is building trust and assessing motivation. Because anxiety is uncomfortable and often frightening, people naturally want to avoid situations that trigger it. Therapy helps individuals identify what matters most to them. Identifying goals and values they can pursue even when anxiety is present. Treatment is not something done to a person but rather a collaborative process, working together to reach agreed upon goals that the individual is committed to. Instead of allowing fear to dictate behavior, therapy encourages individuals to focus on how they want to live their lives and let their values guide them.
Psychoeducation is another early and essential step. Many people enter therapy hoping their anxiety will simply “disappear,” but this expectation can lead to disappointment and treatment dropout. As highlighted, anxiety is a natural and necessary emotion that helps protect us from danger and achieve success. Reflecting on a time when anxiety helped achieve a goal can shift one’s perspective on the body’s fight or flight response. Recognizing that innocuous events can trigger this response can help us identify the “false alarms” that signal danger. Giving a presentation, taking public transportation, going on a school bus, attending social events, driving a car, being near someone vomiting, hearing thunder, going to school, and feeling a racing heart may indicate danger to someone with an anxiety disorder. This in turn can lead to further physical symptoms and an assessment of heightened risk. Treatment can help individuals identify “false alarms” and reframe their reactions.
A common pattern in anxiety disorders is the feedback loop between anxious thoughts and physical symptoms. For instance, someone may feel their heart race before a presentation and believe their mind will go blank or they may faint and embarrass themselves which then spirals into further anxiety. CBT teaches strategies to interrupt this cycle and better manage symptoms.
Treatment plans in CBT vary based on diagnosis, age, and cognitive level but often include:
- Psychoeducation about anxiety
- Relaxation and breathing retraining to manage physical symptoms
- Cognitive restructuring, which involves challenging anxious thoughts
- Gradual exposure to feared situations, sensations, or thoughts
- Values clarification, helping individuals focus on what matters most
As part of CBT, individuals are taught to notice their thoughts and recognize when they are catastrophizing or overestimating risks. Individuals learn to face their fears with support and gradually learn that the feared outcomes either do not happen or can be managed. This process builds confidence in handling these situations and builds resilience.
Adults refer themselves to therapy, indicating potential readiness and motivation for change. Still, it can be daunting to learn that reducing the intensity of anxiety involves first feeling anxious while facing feared thoughts and situations. Once individuals understand the nature of anxiety and learn coping tools, through a collaborative process with the therapist, a hierarchy of feared situations is developed. Therapy starts with less distressing fears and gradually moves up the ladder, allowing individuals to build confidence. These exposure exercises are often practiced during sessions, with the therapist encouraging, supporting, and guiding throughout.
Motivating children and teens can be more challenging, as they are often brought to therapy by adults. Young clients may be less inclined to face fears, especially if parents or caregivers have enabled avoidance. For instance, if a child is allowed to skip school on test or presentation days, is driven to school instead of riding the bus, does not go to friends’ houses or avoids going to the doctor, they may lack motivation to confront their fears. If the child/teen must engage in activities that induce anxiety, motivation to participate in therapy may increase. Additionally, if the child/teen understands that therapy involves facing anxiety in a structured, collaborative way and they have power as to the pace and order of therapy, motivation tends to improve.
Caregivers and teachers play a crucial role in the treatment process. They must be aware of how they may be unintentionally reinforcing avoidance. For example, giving attention to fear rather than acts of bravery can maintain anxiety. Shifting this attention toward encouraging bravery while approaching feared situations helps reinforce positive change.
The key message is that the goal of treatment is not to eliminate anxiety, but to learn how to live without being controlled by it. Therapy empowers individuals to make choices based on their values rather than their fears. With motivation, effort, effective strategies, and support, individuals and families can learn to manage anxiety and lead fulfilling lives.
Debra Salzman, PhD, and Hongmarie Martinez, PsyD, are licensed psychologists in New Jersey and New York and work at Behavior Therapy Associates in Somerset, New Jersey. Dr. Salzman and Dr. Martinez also have the authority to practice interjurisdictional telepsychology (APIT) from the PSYPACT commission, allowing them to provide telepsychology to clients in many states. To learn more, please visit behaviortherapyassociates.com or call (732) 873-1212. Email inquiries can be sent to dsalzman@behaviortherapyassociates.com and hmartinez@BehaviorTherapyAssociates.com.
