The following information is from my Thesis. The Lived Experience of Adolescents with Social Anxiety.

The Effectiveness of Cognitive Behavioral Therapy Treatments with Adolescents who suffer from Anxiety Disorders

This literature review will summarize recent articles on the effectiveness of cognitive behavioral therapy with adolescents who experience anxiety disorders. Adolescence is a difficult phase of development that we all must pass through. Hall (1904) described adolescence as a cascade of instinctual passions, a phase of growth so turbulent that it resembled the period in which human beings evolved from savages into civilized beings. This biologically oriented view of adolescence would appear to be greatly exaggerated as the environmental perspective points out. Although teenagers encounter difficulties that should not be ignored, emotional turbulence is not necessarily a common attribute during this developmental stage (Berk, 1993). A common attribute found during this developmental stage, as identified by this literature review, is anxiety disorders. This literature review will examine articles that describe the use and effectiveness of cognitive behavioral therapy when treating the aforementioned problem experienced by adolescents.

Social Phobia

Adolescents have the ability to reflect on their thoughts. Adolescents often appear to be egocentric beings, which means they are wrapped up in their thoughts, appearance and behaviors. Elkind and Bowen (1979) describe the experiences of young teenagers as being on stage. They believe that they are the focus of everyone's attention. Being the focal point results in the adolescent feeling extremely self-conscious and therefore avoiding situations that may cause embarrassment (Berk, 1993).

The cognitive-behavioral approach is based on the assumption that social phobia is maintained by two factors. The first is a pattern of thinking broadly referred to as faulty self-talk. Faulty self-talk is an illogical and maladaptive style of thinking that serves to persuade us that anxiety-eliciting social situations are more serious or more imminent than they really are. It is treated with cognitive restructuring. The emotional response a person has is a result of the perception or thought that a person has about the situation and this will influence how that person feels. The cognitive model hypothesizes that people's emotions and behaviors are influenced by their perception of events. It is not a situation in and of itself that determines what people feel but rather the way in which they construe a situation (Beck, 1995). 

The second factor that maintains social phobia is a lack of opportunity for the socially phobic person to learn that they have nothing to fear, resulting from escape and/or avoidance of anxiety provoking situations. It is treated by giving exposure treatments that involve presenting the person with a hierarchy of progressively more anxiety-eliciting social situations, until distress is extinguished (Cook, 1996).

Velting, Setzer, and Albano (2004) focus on three common anxiety disorders: separation anxiety disorder, social phobia, and generalized anxiety disorder. They discuss the importance of selecting an effective treatment approach such as cognitive behavioral therapy and provide practical examples of assessment and treatment techniques for clinical practice.

The past 20 years have advanced our understanding of the psychopathology, course, and disability associated with anxiety disorders in youth. These advances are occurring concurrently with the development of scientifically sound assessment and treatment techniques focused specifically on children and adolescents (Velting, Setzer, & Albano, 2004, p. 42).

School Phobia

Excessive fears, which become uncomfortable, can have social drawbacks for an adolescent who is extremely self-conscious. This cognitive distorted awareness of self may result in adolescents avoiding situations that are uncomfortable, such as school. Kail and Wicks-Nelson (1993) describe the phenomenon of avoiding school as School Phobia. This involves an irrational fear of the school situation that may lead to a resistance to going to or remaining in school. Most adolescents do not avoid school all together but once they arrive at school they avoid situations that may draw attention to them or that may embarrass them in any way.

Schoepp (2005) addresses the issue of school phobia by discussing strategies such as relaxation, and the four steps to challenging anxious thoughts.  When adolescents are feeling anxious or afraid it may be useful to employ relaxation strategies to try and alleviate the physical reactions being experienced. Some strategies notes by Schoepp (2005) include the robot/rag doll exercise, progressive muscle relaxation, deep breathing, and visualization. 

Another strategy that may be utilized is the four steps to challenging anxious thoughts. The first step is to identify the thought behind the emotion. This can be done by having the student state what they are worried about, (i.e., I’ll make a mistake and people will laugh at me). The second step is to look for evidence by using questions with the adolescent. The student could be asked about past experiences, alternative possibilities, general knowledge, and exploring a different perspective. The third step is to evaluate thought on the basis of the evidence, (i.e., how likely is it that the bad thing I’m expecting will actually happen?). Percentages or descriptors such as “not likely” could be used during this step.  The fourth and final step in challenging anxious thoughts is to examine and challenge the consequences of the feared event, (i.e., what is the worst thing that could happen here?). At this point coping strategies could be discussed to deal with the worst case scenarios revealed by the adolescent.

It would appear that regardless of the theory or techniques employed by caring professionals the most important factors in effectively treating children and adolescents with anxiety disorders include a thorough and accurate assessment of the individuals and the rapport built between the counselor and client. A counselor should possess the desire to accurately diagnose and select appropriate intervention techniques to meet the needs of their clients’.  This coupled with compassion, empathy, and a willingness to listen should ensure that children and adolescents are given the appropriate treatment required.

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