The Riggs Blog

Navigating Turbulent Adolescent Years

by Elizabeth Weinberg, M.D.

The New York Times this past Saturday featured an excellent editorial about anxiety disorders in adolescents by Dr. Richard Friedman, a professor of psychiatry at Weil Cornell Medical College. 

To briefly summarize some of his points, Dr. Friedman explains that emerging developments in neuroscience help to clarify why adolescence often is a difficult, anxiety-ridden developmental period.  It appears that the deep brain structures that produce the experience of fear develop well before the parts of the brain that support rational decision making and impulse control.  Unfortunately, cognitive-behavioral therapy, (CBT) which is often recommended for anxiety disorders, may not be the best fit for many adolescents.  The goal of CBT for anxiety disorders is for the patient to learn to be less anxious, but it may be that changes in processing of fear don’t happen as readily among adolescents as among children and adults

These are important points, and helpful to all of us who try to help adolescents and young adults with their difficulties.  It would be a mistake, however, to conclude that adolescents are simply crazy, and that their anxiety is irrational and without meaning.   Actually, Dr. Friedman’s points suggest that heightened anxiety and risk taking are actually pretty normal conditions of adolescence, perhaps serving developmental goals. 

So, if behavioral therapy might not help, what does?  When I think about my own adolescence, and times when I felt afraid or confused, I remember relationships that helped me find a path I could walk, and feelings of connection and meaning.  Of course, most adolescents don’t go on to develop anxiety disorders; the resolution of normal adolescent anxiety comes through successful attainment of the developmental transition to adulthood, both in the brain and in establishing a sense of confidence in one’s abilities and relationships.  There can be many relationships to support the developing adolescent—with parents, teachers, coaches, members of the clergy, and so on.  Sometimes a supportive relationship with a skilled therapist also helps.   Perhaps how we can help adolescents most is by simply being with them, with respect for their very real fears and the developmental tasks they are working to accomplish.     

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