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Anxiety in adolescence

Anxiety disorders have been reported to affect around 10% of adolescents (Costello et al. 2003). If left untreated, anxiety can cause personal suffering and academic underperformance, and can interfere with interpersonal issues, such as relationships or socialising (Kendall et al. 2000). It can also increase a person?s risk of developing depression and of having a continuing problem with anxiety in their adult life (Pine et al. 2002).

Types of anxiety

There are several different forms that anxiety can take in young people (MUARU 2005). The two most common types in adolescents are Social Phobia and Generalised Anxiety Disorder. People with Social Phobia are often extremely shy and withdrawn and worry a great deal about what others think of them. They may avoid social situations, including parties, sporting events, buying items at shops or even answering the telephone. They often have difficulty making friends. People with Generalised Anxiety Disorder are excessive worriers. They worry about many different areas of their lives, including schoolwork, competition, family and any new situations they encounter. They often ask repeatedly for reassurance and experience physical symptoms. Other less common types of anxiety that occur in this age group are panic disorder, fear of separation, obsessive-compulsive disorder and post-traumatic stress. Many young people with anxiety show features of several of these types of anxiety and they may also have related problems, such as relationship issues, difficulties with schoolwork or depression.

Symptoms of anxiety

Anxiety becomes a problem when it is severe enough to cause interference in a person?s life. Although it can be difficult to identify, there are some common behaviours that a person with this problem may exhibit (Figure 1) (MUARU 2005).


Figure 1

Behaviours that may suggest the presence of anxiety when they are common (MUARU2005).

  • Asking many unnecessary questions and requiring constant reassurance
  • getting upset when a mistake is made or if there is a change of routine
  • being a loner or restricting themselves to a small group of safe people
  • rarely volunteering to ask questions or give comments
  • becoming sick when performances are necessary
  • having poor social skills or refusing to participate in social activities
  • expressing worries about "bad things" happening
  • having worries about school at the beginning of each term or week
  • avoiding unfamiliar situations
  • being perfectionistic
  • having difficulty getting to sleep or waking during the night
  • having regular headaches or stomach aches that have no medical cause
  • being argumentative (if trying to avoid a feared situation)
  • being pessimistic (easily identifying what may go wrong in a situation).

There are several options for young people who want advice or help. These include school counsellors, family doctors, community health centres, research centres such as MUARU, or web sites and phone lines such as Reach Out! and Kids Help Line.

CBT programs for anxiety

Cognitive behavioural therapy (CBT) is a technique used to treat various psychological conditions. It helps people to challenge and change the negative thinking (cognition) or behaviour patterns (e.g. avoidance, safety) that are often present in an anxiety disorder. Many CBT programs have been used with adolescents who have anxiety, and this method of therapy is now viewed as an efficacious treatment option (James, Soler & Weatherall 2005). CBT programs have been shown to significantly reduce symptoms (Kendall 1994; Barrett, Dadds & Rapee 1996) and the improvements gained have been shown to be maintained up to as much as six years later (Barrett et al. 2001). Although efficacious programs exist, a common problem is that they are delivered in specialised clinics and research settings not in general community settings. For several years, MUARU has been looking for better ways to disseminate validated treatments. This was done initially by reducing the duration of therapy and by using a group approach rather than offering individual face-to-face therapy (Rapee 2000). More recently a bibliotherapy (treatment delivered using books and worksheets) program was developed to allow parents to access skills to help their anxious child without therapist involvement (Lyneham & Rapee in press). However, providing accessible treatment to adolescents presents another challenge.

What stops young people getting help?

Adolescence is a time of increasing independence, and attracting this age group to traditional therapy can be difficult. Sawyer et al. (2000) report that only 29% of young people who had a mental health problem had been in contact with a professional service in a 12-month period. There are many possible reasons for this low treatment access rate, including stigma; lack of confidentiality; cost; therapy and therapist availability; appropriateness of treatment materials; geographic remoteness; and GP knowledge, attitudes to young people or understanding of their needs (NSW Association for Adolescent Health 2005; Booth et al. 2004). The Department of Health and Ageing (2004) suggests that young people may require ?treatment approaches that transcend many existing service boundaries? (p.III).

How can computer-based CBT help?

Computer-based therapy works by delivering a series of interactive sessions covering background information on the disorder, identification of problem areas, and skills and techniques to help manage these problems. Computer programs have been shown to be clinically efficacious for various forms of anxiety in adults, for example, panic disorder and phobia (Gilroy et al. 2000; Richards, Klein & Carlbring 2003; Schneider et al. 2005). In addition, two programs aimed primarily at treating depression have also been shown to have positive effects on anxiety levels: MoodGYM (Christensen, Griffiths & Korten 2002) and Beating the Blues (Proudfoot et al. 2003). However, no computer programs have yet been developed and evaluated specifically for anxiety in adolescents. We believe that computer-based delivery has major potential for use with this age group. Increasing numbers of young Australians use the Internet to seek help for mental health problems (Mission Australia 2005; Nicholas et al. 2004) and we think it is reasonable to expect that many of these people would also be receptive to a computer-based therapy option. Computerised self-help allows a degree of personal control and flexibility that is ideal for independent adolescents and it may also be able to help reduce the stigma of receiving therapy for many users. This delivery method may allow wider dissemination of therapy and may therefore be able to improve service access for many young people.

The Cool Teens CD-ROM project

Anxiety in adolescence

Anxiety disorders have been reported to affect around 10% of adolescents (Costello et al. 2003). If left untreated, anxiety can cause personal suffering and academic underperformance, and can interfere with interpersonal issues, such as relationships or socialising (Kendall et al. 2000). It can also increase a person?s risk of developing depression and of having a continuing problem with anxiety in their adult life (Pine et al. 2002).

Types of anxiety

There are several different forms that anxiety can take in young people (MUARU 2005). The two most common types in adolescents are Social Phobia and Generalised Anxiety Disorder. People with Social Phobia are often extremely shy and withdrawn and worry a great deal about what others think of them. They may avoid social situations, including parties, sporting events, buying items at shops or even answering the telephone. They often have difficulty making friends. People with Generalised Anxiety Disorder are excessive worriers. They worry about many different areas of their lives, including schoolwork, competition, family and any new situations they encounter. They often ask repeatedly for reassurance and experience physical symptoms. Other less common types of anxiety that occur in this age group are panic disorder, fear of separation, obsessive-compulsive disorder and post-traumatic stress. Many young people with anxiety show features of several of these types of anxiety and they may also have related problems, such as relationship issues, difficulties with schoolwork or depression.

Symptoms of anxiety

Anxiety becomes a problem when it is severe enough to cause interference in a person?s life. Although it can be difficult to identify, there are some common behaviours that a person with this problem may exhibit (Figure 1) (MUARU 2005). There are several options for young people who want advice or help. These include school counsellors, family doctors, community health centres, research centres such as MUARU, or web sites and phone lines such as Reach Out! and Kids Help Line.

CBT programs for anxiety

Cognitive behavioural therapy (CBT) is a technique used to treat various psychological conditions. It helps people to challenge and change the negative thinking (cognition) or behaviour patterns (e.g. avoidance, safety) that are often present in an anxiety disorder. Many CBT programs have been used with adolescents who have anxiety, and this method of therapy is now viewed as an efficacious treatment option (James, Soler & Weatherall 2005). CBT programs have been shown to significantly reduce symptoms (Kendall 1994; Barrett, Dadds & Rapee 1996) and the improvements gained have been shown to be maintained up to as much as six years later (Barrett et al. 2001). Although efficacious programs exist, a common problem is that they are delivered in specialised clinics and research settings not in general community settings. For several years, MUARU has been looking for better ways to disseminate validated treatments. This was done initially by reducing the duration of therapy and by using a group approach rather than offering individual face-to-face therapy (Rapee 2000). More recently a bibliotherapy (treatment delivered using books and worksheets) program was developed to allow parents to access skills to help their anxious child without therapist involvement (Lyneham & Rapee in press). However, providing accessible treatment to adolescents presents another challenge.

What stops young people getting help?

Adolescence is a time of increasing independence, and attracting this age group to traditional therapy can be difficult. Sawyer et al. (2000) report that only 29% of young people who had a mental health problem had been in contact with a professional service in a 12-month period. There are many possible reasons for this low treatment access rate, including stigma; lack of confidentiality; cost; therapy and therapist availability; appropriateness of treatment materials; geographic remoteness; and GP knowledge, attitudes to young people or understanding of their needs (NSW Association for Adolescent Health 2005; Booth et al. 2004). The Department of Health and Ageing (2004) suggests that young people may require ?treatment approaches that transcend many existing service boundaries? (p.III).

How can computer-based CBT help?

... (continued)