Many teens struggle with anxiety and depression related to COVID-19. Which therapy is the best?

Have you seen it before? We see all the headlines: 100,000 new COVID-19 infections per day … New infections are back to winter levels …

Everyone experiences stress, fear and anxiety, including our young people. The CDC has reported that since the pandemic, visits to pediatric emergency rooms for mental health reasons have increased across the country.

Some of our young patients are stressed that they will be infected and fear taking it home to their parents and grandparents, especially when they go back to school. Some refuse to leave their homes and have chosen distance education for another year. Overwhelming worry and fear that interferes with daily life are symptoms of an anxiety disorder. As specialists in adolescent medicine, we are seeing an increase in anxiety disorders, including generalized anxiety disorder, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).

PTSD results from exposure to trauma and involves persistent distress or fear, avoidance of things that remind them of the trauma, and mood swings. PTSD can result from watching someone die of COVID-19, or simply from experiencing the pandemic. People with OCD have persistent intrusive and unwanted thoughts, such as believing that they have or will get COVID.

Some teens can’t sleep, feel sad all the time, and stay in their rooms. One patient told us, “I quit the cross country team. … I am no longer in contact with my friends. This is not a normal teenage mood; it’s depression.

In adolescence, the body of adolescents changes and body image develops. Many gained excessive weight during the pandemic as sports were interrupted and they spent more time indoors. At the Nemours Eating Disorder Assessment and Management Program, one patient told us, “I felt really great. … I started to exercise, then I started to skip meals, then I started to purge. Nationally, eating disorders have become more prevalent during the pandemic, and phone calls to the National Eating Disorders Association have increased 70% to 80% from pre-pandemic levels.

You may not know these teens, but you may know others who are suffering, and maybe one is yours. Another heartbreaking concern: We have seen an increase in suicide attempts this year.

Mental health issues are real, not something teens can “get over”. An essential part of improvement is psychotherapy. Therapy can help teens understand their problems, solve problems, change their behaviors, and make positive changes in their lives. There are many types of scientifically supported psychotherapy that involve different approaches. Here are some options:

Cognitive Behavioral Therapy (CBT) combines cognitive and behavioral therapies and has been shown to be the most effective treatment for children and adolescents with anxiety and depression. People with these problems often have distorted thought patterns that lead to distress and dysfunctional behaviors. CBT attacks those self-defeating thought patterns that have become automatic; it helps patients correct and reframe these thoughts. In addition, CBT helps people learn to manage the symptoms of their disease and teaches relaxation techniques.

Dialectical Behavior Therapy (DBT) is often used to treat older teens who have chronic suicidal thoughts and hurt themselves. DBT helps examine how they deal with conflict and intense negative emotions and helps them develop coping skills through mindfulness and emotional regulation. DBT often involves a combination of group and individual sessions.

Family therapy (FBT) is a specific type of family therapy and is considered the gold standard in the treatment of anorexia and bulimia nervosa. FBT is based on the understanding that eating disorders take precedence over the thoughts and behaviors of adolescents and prevent them from making rational, healthy decisions about food, exercise, and their bodies. FBT allows parents to take an active role in helping their teens gain weight, externalize the disorder and normalize their eating habits. FBT is divided into three phases aimed at gradually returning control to adolescents.

Interpersonal therapy (IPT) is a brief, diagnostic-targeted treatment used to help people with depression and other psychiatric disorders. IPT focuses on how interpersonal relationships affect a person’s emotional state and address problematic relationships. IPT helps patients resolve interpersonal crises and identify their social supports to improve their symptoms and their lives.

Our tip: If you notice any changes in your teens’ mood, start by discussing these changes with their primary care provider. Sometimes psychotherapy and medication are needed. Therapy is a process; over time, it can reduce symptoms, provide insight, and improve quality of life.

Rima Himelstein is a specialist in adolescent medicine and Bailey DeLong is a master’s level social worker at the Children’s Hospital in Nemours, Delaware.

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