Many teens we see here at the North Shore CBT Centre are struggling with social anxiety. They are smart, creative, and compassionate young people from great families. While most teenagers experience periods of anxiety related to developmental, situational and physiological changes that come with adolescence, those with social anxiety disorder may experience paralyzing fear that keeps them isolated from peers, avoiding school, and disengaging from extracurricular activities. For some teens, social anxiety has increased, or may have started, during the covid19 pandemic.
What is social anxiety like for your teen?
Teens with social anxiety tend to focus on themselves during social interactions and have big, loud, powerful negative thoughts about their performance such as:
“Everyone is going to laugh at me”
“They will all think I am stupid”
“They won’t like me”
“I will get anxious and others will notice”
Social anxiety can also lead to very real physical symptoms such as:
Blushing/ heat rising in the face,
Trembling and or shaky hands, weak knees
Racing heart
Upset stomach
Sweating
Dizziness
Headaches
Urge to use the washroom
Dry mouth and or shortness of breath
It is important to know that these physical symptoms are common, your teen is really experiencing these difficulties. These symptoms are a direct result of powerful negative thoughts. Don’t buy it? Try this: Close your eyes and imagine a lemon. Now imagine slowly cutting that lemon into quarters. Imagine the smell of the zest, see the juice squirting out. Imagine the taste. Notice anything happening in your physical body? Most of us will begin to salivate at the back and sides of our mouth (the first step in active digestion!) just by thinking about this lemon, or something sour! This example is something counsellors utilize in session to demonstrate to clients the power our thoughts have over our physical and emotional experiences.
Social anxiety, and the negative thoughts and physical sensations that your teen is experiencing, can lead to avoidance behaviours like:
Avoiding or trying to escape from social situations
Refusing to attend school
Isolating from peers
Trying to hide, blend in, or stay quiet, when forced to be in social situations
Drinking alcohol or using substances to cope with the situation
For teens, some of the most common fears and situations that they may be avoiding are:
Participating in class
Attending extracurricular activities
Finding a group to sit with at lunch
School performances
Sports and athletic activities
Online presence and persona
Dating
Parties
Being a teen during Covid19
Remote learning, lockdowns and pandemic uncertainty have increased anxiety and depression among adolescents and heightened concerns about their mental health. According to a meta-analysis of 29 studies, including 80,879 youth globally, the prevalence of depression and anxiety symptoms during COVID-19 have doubled, compared with pre-pandemic estimates (Racine et al., 2021).
Adolescence is a time when individuation and independence are key aspects of development. Opportunities for this development were significantly impacted during the pandemic as most teens had to stay home, and socialization became dangerous. Even for kids who have been able to attend full-time school, the school and social environments changed drastically with pandemic restrictions. Critical parts of this developmental stage were and continue to be impacted by covid19.
Feeling better
Parents might feel their kids should suck it up, and though, it may not be that easy. While getting your teen to school, activities and out with their peers is important, they need to feel safe and secure in order to build confidence and resilience. This is why working using evidence-based practices that include cognitive behavioral therapy (CBT), in collaboration with validation and psychoeducation, is the best way to set your teen up for success.
This work is best done with a clinical counsellor or psychologist who regularly works with youth. The therapeutic relationship is where social anxiety exposures begin. Additionally, this relationship has been shown throughout research to directly impact the overall success of treatment. Therefore it is essential that your teen find a clinician that is warm, engaging, accepting, and relatable!
Validation
Normalizing anxiety and connecting with your teen is an important first step. It can be helpful for parents, teachers, friends and trusted adults to also send this message. Everyone gets worried sometimes, and social anxiety, especially among teens, is common. A key phrase that can be helpful to use consistently with your teen, and encourage them to adopt themselves is “This is hard, AND you can do hard things”. We must validate their experience, that this is challenging, and also let them know that we have full confidence in their ability to overcome it.
Name it to Tame it!
Dr. Dan Siegel coined the phrase, “name it to tame it”, referring to the process of identifying troublesome thoughts and emotions that are holding us back. Psychologist David Rock states, “when you experience significant internal tension and anxiety, you can reduce stress by up to 50% by simply noticing and naming your state.”
Working with your teen to get familiar with the fears that they are facing, to identify automatic negative thoughts that are contributing to their experiences of anxiety, and to name these worries helps to take away their power.
Getting to Know Your Brain
We have the power to change our brains, to create new neural pathways, think more clearly, learn more easily, and manage reactive emotions. In order to do this, we must first learn about how the brain works. Teens managing social anxiety can specifically benefit from learning about the brain’s alarm system - the amygdala. Much like the smoke alarm in your kitchen, the amygdala does not know if the curtains are on fire, or if the toast is burning. For them, in social situations, the amygdala responds with a loud alarm signal that triggers a fight, flight or freeze reaction.
This is where detective thinking comes in. Together with your teen, we will work as detectives to look at what is really happening when they are feeling anxious. By changing our thoughts, we can also change our emotions and our behaviours.
Getting back out there
Research shows the more we avoid anxiety-provoking situations, the more our anxiety is reinforced. This is called the avoidance cycle. Teens with social anxiety will work with their counsellors to create a bravery ladder in order to incorporate small, manageable exposures that will create a greater sense of safety over time. These exposures, coupled with new learned coping strategies will create a new experience for your teen.
Teens are encouraged to recognize their feelings while understating that they are not in real danger, it is a false alarm going off in the emotional centre of their brains. The goal of exposure is not to eliminate anxiety but to learn how to tolerate it. Through this process, as teens become more confident, their anxiety tends to decrease. Teaching adolescents coping mechanisms that they can use throughout their lives will serve them well.
Social anxiety is common among teens and adolescents, and increasingly also among adults. Understanding what is happening for your teen, and how to best support them through these challenges, will bring you closer together and help them to overcome their fears.
Alicia Woods, Master's Level Practicum Student
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