“If [your teen] wanted to go to in-person college one day, if they want to have a job, be involved with in-person interactions, have friends, and make connections, in my mind it’s really important, even if it’s more comfortable online in that home, to still practice putting ourselves out there and tolerating some feelings of anxiety,” says Dr. Abigail M. Stark, Ph.D., a licensed clinical psychologist who treats adolescents with anxiety at McLean Hospital, a major teaching hospital for Harvard Medical School. This week, we chat about teenage anxiety during back-to-school times.
- Why short-term avoidance of in-person school is okay, but long-term avoidance is harmful
- Signs that your teen has anxiety beyond the typical anxiety we all feel
- Her expert advice to parents helping their teens navigate school and test anxiety
Thank you so much for joining us, today! Can you tell us about your work in adolescent mental health?
I am a licensed clinical psychologist working in Boston, Massachusetts. I’m spread across four different clinics right now. The main two that I’m working at are most relevant to this conversation. I work at an intensive outpatient program for children with severe anxiety and OCD disorders, and we’re an exposure-based program where kids come in four days a week to work on anxiety, avoidance, and OCD. And then I’m also at a program called the 3East Program at McLean Hospital, which is a dialectical behavior therapy program for teens with something called borderline personality disorder.
Many teenagers are experiencing anxiety returning to school, realizing that they missed a year or more of in-person instruction, and seeing college on the horizon. What have you been noticing as a clinical psychologist?
One of the things that we’ve seen is an increase in severity in terms of children and teen anxiety and level of depression. The way we often think of anxiety disorders and depression developing is through avoidance.
Can you share what avoidance looks like?
When kids feel afraid of something — let’s say that they’re really afraid of germs or getting Covid — the natural response when you’re afraid is to avoid. This makes total sense in the short-term, like if you avoid and stay inside, don’t go outside, don’t see friends, that can be really helpful in bringing down anxiety, because you feel safer, you’re in a safe place.
It sounds like avoidance of something scary, like getting Covid, makes sense in the short-term, but not the long-term. Why not?
What tends to happen is in the long term, your brain learns that it’s dangerous. It’s something I can’t handle. And it becomes harder and harder to do different things, and your worlds become smaller and smaller. For kids who naturally had more genetic predisposition to anxiety or depression, we were seeing that all the natural avoidance that we had to do due to Covid — being inside, staying away from other people, not connecting as much, not playing sports, not having in-person school — has led to some increases of depression and anxiety symptoms, from what I’ve noticed through my own experience, absolutely.
How have you seen this increase of depression and anxiety also affect teenagers’ performance in school?
For a lot of the teens that I work with, because they haven’t had the chance in the past year to be in-person, taking the SAT or tests in situations with a lot of people around them, their brain has basically learned something. The amygdala, the small almond-shaped structure in our brain that goes off like a smoke alarm when there is danger, tends to create that fight-or-flight response.
What happens when a teenager at school or at an SAT test center is in fight-or-flight mode?
Your heart is pounding, sweating, breathing increases, and you’re not meant to be thinking through Shakespeare or logic or philosophy or math problems when you’re in fight-or-flight mode. Basically, the higher-order parts of our brain, the frontal lobe, tends to go offline when that smoke alarm is going off.