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Anxiety disorders are mental illnesses that can affect people differently. Begin to learn about what anxiety is, what symptoms of anxiety could look like, and w...

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Inside Higher Ed | Higher Education News, Events and Jobs

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More than half of the college students who visited their campus counseling centers during the 2015-16 academic year reported symptoms of anxiety, according to a survey by the Association for University and College Counseling Center Directors.

This marks the seventh year in a row that anxiety has been the top complaint among students seeking mental health services. This year, 51 percent of students who visited a counseling center reported having anxiety, followed by depression (41 percent), relationship concerns (34 percent) and suicidal ideation (20.5 percent). Many students reported experiencing multiple conditions at once.

Since 2009, when anxiety overtook depression as the No. 1 concern among college students, the number of students experiencing anxiety has steadily increased.

This survey was conducted between September 2015 and August 2016. In total, 529 counseling center directors representing that many institutions responded to the survey, with an even split between public and private institutions. The majority of respondents came from four-year colleges, but community colleges, professional schools and art schools were also included.

In an effort to reflect the makeup of their student bodies, counseling centers have diversified their clinical staff members. Of new hires, 62.2 percent are white, 15.3 percent black, 7.5 percent Latino and 10 percent Asian. This compares to current clinical staff, who are 70.9 percent white, 10.1 percent black, 7.3 percent Latino and 7.9 percent Asian.

"Student populations have become more diverse," said Micky Sharma, president of the AUCCCD and director of counseling and consultation services at Ohio State University. "Counseling services work to create a staff that represents their student bodies."

At Ohio State, for example, the counseling center now offers clinical services in nine different languages to meet the needs of their international students, who make up about 12 percent of the student body, Sharma said.

Regardless of race, ethnicity, gender or sexual orientation, "anyone could show up with anxiety or depression or a relationship issue," Sharma said. "A university counseling center is charged with providing help for everybody."

Another key finding in the survey is that 41.6 percent of counseling centers hired additional staff members in the last academic year, compared to about 26 percent in 2011 and 36 percent in 2016.

College counseling centers continue to grow to match the demands of their students, according to David Reetz, the lead researcher and coordinator for the 2016 survey and director of counseling and psychological services at the Rochester Institute of Technology.

"More students are seeking services because we continue to be more and more aware that a student's health and well-being have a lot to do with their success in their academic programs and the quality of their student life experience," Reetz said.

In fact, of the students surveyed, about 72 percent who used counseling services said it helped their academic performance in some way.

As more students continue to seek out mental health services and campus counseling centers try to keep up with new hires, the question of student wait times becomes key.

For the first time, this year's survey asked counseling center directors about average wait times for students based on the number of business days between when the appointment was scheduled and when it occurred.

The survey team found that, on average, students waited between six and eight business days for counseling services. However, as might be expected, institutions with a lower ratio of professional staff to students saw shorter wait times.

Reetz noted that the wait-time average is a "tricky number," given that some students opt to schedule their first appointment farther out to accommodate their own schedules.

"Students don't necessarily want to be seen right away," Reetz said, adding that, generally, "the more staff a center has, the shorter that wait time is between initial contact and first appointment."

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Anxiety and depression are the primary concerns for students seeking counseling services

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Survey of campus counseling centers finds increased demand for services, as well as additional positions and more diversity in hiring.

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American Psychological Association Survey Shows Teen Stress Rivals That of Adults

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Stress in America™ survey finds similar patterns of unhealthy behavior in teens and adults, especially during school year.

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Teens are under more stress today than ever before. Sound like an exaggeration? Despite the fact that I am often prone to hyperbole, consider this: being a teenager is not easy.

Adolescence has always been a tricky developmental period defined by fundamental yet somewhat difficult changes (physical, cognitive, and social) experienced by teens as they make their way from childhood toward adulthood. These transitions trigger changes in the way the teen sees him/herself, and the way that others see and treat him or her. They are no longer children, but not yet adults, and this series of transitions not only has an impact on the individual experiencing the transitions, but also on parents, peers, and society as a whole.

Adolescence has always been an awkward stage where teens struggle to build their own identity, seek autonomy, and learn about intimacy and sexuality in relationships. These things all cause a certain level of angst, but they are not really new.

What is new is the environment that we live in, and it is this fast-paced, perpetually plugged-in society that sets the tone for the messages and expectations that teens receive every day. Due to varying pressures around school, work, families, relationships, social media, and the seemingly endless series of transitions involved in simply being an adolescent, teens today are indeed under more stress than ever before.

There are certain contexts that inevitably make being a teen even more difficult. Living in poverty, or being in an abusive home, for example. Other, more recent issues, such as society's pressures on young people to grow up fast, have their lives completely figured out by the time they start middle school, and today's technological and social innovations that have transformed family life, make the experience of teen transitions exponentially more difficult.

So, why are teens so "angsty" today?

School: Today, kids are expected to know what they want to do-where they want to go to school and in which field they'd like to work-earlier than ever before. They are also expected to do well, and are put on "success" tracks even in elementary school. They have to do well because it is assumed that all kids will/must go to college, and not just that, but they must get into the best college if they want to "succeed" and be competitive in today's job market. This is a lot of pressure on teens.

Work: Most teens work to earn money, which they like, but it takes time away from other things like academics, extra-curricular activities, volunteering, spending time with family and friends, having fun, and simply enjoying life.

Expectations: Whether it is real or not, teenagers' perceptions are that they are expected to be successful or good at everything. Teens today feel a lot of pressure from parents, teachers, coaches, other family/friends to not fail. Failure has somehow gone from being viewed as a learning opportunity to being clearly unacceptable. This puts even more pressure on teens.

Social Connections: Given the fact that the overwhelming majority of teens today are tethered to a smartphone or other device that keeps them linked on social networking sites, teens justifiably feel "on" all the time. Their every move is judged by their peers, whether their peers are their true, real live friends, or the 1,254 "friends" on Facebook or followers on Twitter. So, the pressure is always on to be cute, clever, sexy, smart, popular, etc., and because social networking sites are the modern-day hangout spot, where teens spend a huge chunk of each day, it can be exhausting.
What can parents do?

We, as parents of teens, must communicate. A recent study from the Pew Research Center asked a national sample of adults which skills are most important for children to have to succeed in the world today. The answer: communication. As parents, we should take our own advice and talk to our teens about expectations, goals, and ask teens about what they think, what they want, and how they feel.

This, of course, means that we should also be prepared to listen. Really listen. Teens need to know that although we clearly want what is best for them in their future lives, what's best doesn't necessarily have to equate to what we want. We should hear what they have to say and consider how they envision their future.

Our teens also need unconditional love, acceptance, and support, and we should be explicit in communicating this to them. We often assume that they know this (and they probably do), but they really need to hear it.

Parents should also help their teens to set realistic expectations and keep things in perspective. No, it's not the end of the world as we know it if our teen, for example, has not decided what she is majoring in during her freshman year of college. Nor does it make you a horrible parent to think that it is OK for our teens to fail at something... after all, failure presents an opportunity for growth! If we allow our children to fall, they can learn from their mistakes (called natural consequences) and pick themselves back up.

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Teens are under more stress today than ever before. Sound like an exaggeration? Despite the fact that I am often prone to hyperbole, consider this: being a teenager is not easy. Adolescence has always been a tricky developmental period defined by fundamental yet somewhat difficult changes (physical, cognitive, and social) experienced by teens as they make their way from childhood toward adulthood.

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Alarmed, Jake's parents sent him to his primary-care physician, who prescribed Prozac, an antidepressant often given to anxious teenagers. It was the first of many medications that Jake, who asked that his last name not be used, would try over the next year. But none seemed to work - and some made a bad situation worse. An increase in dosage made Jake "much more excited, acting strangely and almost manic," his father wrote in a journal in the fall of 2015. A few weeks later, Jake locked himself in a bathroom at home and tried to drown himself in the bathtub.

He was hospitalized for four days, but soon after he returned home, he started hiding out in his room again. He cried, slept, argued with his parents about going to school and mindlessly surfed the internet on his phone. The more school he missed, the more anxious he felt about missing school. And the more anxious he felt, the more hopeless and depressed he became. He had long wanted to go to the University of North Carolina at Chapel Hill, but now that felt like wishful thinking.

Not every day was bad. During spring break in 2016, Jake's father wrote: "Jake was relaxed and his old sarcastic, personable, witty self." A week later, though, Jake couldn't get through a school day without texting his mother to pick him up or hiding out in the nurse's office. At home, Jake threatened suicide again. His younger siblings were terrified. "It was the depth of hell," his mother told me.

That summer, after two more hospitalizations, Jake's desperate parents sent him to Mountain Valley in New Hampshire, a residential treatment facility and one of a growing number of programs for acutely anxious teenagers. Over the last decade, anxiety has overtaken depression as the most common reason college students seek counseling services. In its annual survey of students, the American College Health Association found a significant increase - to 62 percent in 2016 from 50 percent in 2011 - of undergraduates reporting "overwhelming anxiety" in the previous year. Surveys that look at symptoms related to anxiety are also telling. In 1985, the Higher Education Research Institute at U.C.L.A. began asking incoming college freshmen if they "felt overwhelmed by all I had to do" during the previous year. In 1985, 18 percent said they did. By 2010, that number had increased to 29 percent. Last year, it surged to 41 percent.

Those numbers - combined with a doubling of hospital admissions for suicidal teenagers over the last 10 years, with the highest rates occurring soon after they return to school each fall - come as little surprise to high school administrators across the country, who increasingly report a glut of anxious, overwhelmed students. While it's difficult to tease apart how much of the apparent spike in anxiety is related to an increase in awareness and diagnosis of the disorder, many of those who work with young people suspect that what they're seeing can't easily be explained away. "We've always had kids who didn't want to come in the door or who were worried about things," says Laurie Farkas, who was until recently director of student services for the Northampton public schools in Massachusetts. "But there's just been a steady increase of severely anxious students."

For the teenagers who arrive at Mountain Valley, a nonprofit program that costs $910 a day and offers some need-based assistance, the center is usually a last resort after conventional therapy and medications fail. The young people I met there suffered from a range of anxiety disorders, including social anxiety, separation anxiety, post-traumatic stress disorder and obsessive-compulsive disorder. (Though OCD and PTSD are considered anxiety disorders at Mountain Valley and other treatment centers, they were moved into separate categories in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.)

Mountain Valley teenagers spend a lot of time analyzing - and learning to talk back to - their anxious thoughts. During one group session in the summer of 2016 in a sunlit renovated barn with couches, a therapist named Sharon McCallie-Steller instructed everyone to write down three negative beliefs about themselves. That's an easy exercise for anxious young people ("Only three?" one girl quipped), but McCallie-Steller complicated the assignment by requiring the teenagers to come up with a "strong and powerful response" to each negative thought.

She asked for volunteers. First, residents would share their negative beliefs and rebuttals with the group. Then others would act those out, culminating in a kind of public performance of private teenage insecurity.

Jake raised his hand. By then, he was in his third month at Mountain Valley, and he looked considerably less anxious than several of the newcomers, including one who sat slumped on a couch with his head in his hands. "I'm free to play the part of terrible, evil thoughts for anyone who needs them," Jake said with a smile. He had already spent weeks challenging his own thinking, which often persuaded him that if he failed a single quiz at school, "then I'll get a bad grade in the class, I won't get into the college I want, I won't get a good job and I'll be a total failure."

At Mountain Valley, Jake learned mindfulness techniques, took part in art therapy and equine therapy and, most important, engaged in exposure therapy, a treatment that incrementally exposes people to what they fear. The therapists had quickly figured out that Jake was afraid of failure above all else, so they devised a number of exercises to help him learn to tolerate distress and imperfection. On a group outing to nearby Dartmouth College, for example, Jake's therapist suggested he strike up conversations with strangers and tell them he didn't have the grades to get into the school. The college application process was a source of particular anxiety for Jake, and the hope was that he would learn that he could talk about college without shutting down - and that his value as a person didn't depend on where he went to school.

Though two months in rural New Hampshire hadn't cured Jake of anxiety, he had made significant progress, and the therapy team was optimistic about his return home for his senior year. Until then, Jake wanted to help other Mountain Valley teenagers face their fears.

Among them was Jillian, a 16-year-old who, when she wasn't overwhelmed with anxiety, came across as remarkably poised and adultlike, the kind of teenager you find yourself talking to as if she were a graduate student in psychology. Jillian, who also asked that her last name not be used, came to Mountain Valley after two years of only intermittently going to school. She suffered from social anxiety (made worse by cyberbullying from classmates) and emetophobia, a fear of vomit that can be so debilitating that people will sometimes restrict what they eat and refuse to leave the house, lest they encounter someone with a stomach flu.

Jillian listened as Jake and other peers - who, in reality, liked her very much - voiced her insecurities: "I can't believe how insignificant Jillian is." "I mean, for the first three weeks, I thought her name was Susan." "If she left tomorrow, maybe we wouldn't even miss her."

At the last one, Jillian's shoulders caved, and her eyes watered. "I don't want to do this," she said, looking meekly at McCallie-Steller.

"If it's too much, you can stop," the therapist said, but Jillian considered the offer only long enough to reject it. She straightened her back. "No, I feel like I need to do this," she announced. "I have a week and a half left. If I can't get through something like this here ..."

Her voice trailed off, but the implication was clear: The real world would be much more anxiety producing - and much less forgiving.

Anxiety is the most common mental-health disorder in the United States, affecting nearly one-third of both adolescents and adults, according to the National Institute of Mental Health. But unlike depression, with which it routinely occurs, anxiety is often seen as a less serious problem.

"Anxiety is easy to dismiss or overlook, partially because everyone has it to some degree," explained Philip Kendall, director of the Child and Adolescent Anxiety Disorders Clinic at Temple University in Philadelphia. It has an evolutionary purpose, after all; it helps us detect and avoid potentially dangerous situations. Highly anxious people, though, have an overactive fight-or-flight response that perceives threats where there often are none.

But sometimes there are good reasons to feel anxious. For many young people, particularly those raised in abusive families or who live in neighborhoods besieged by poverty or violence, anxiety is a rational reaction to unstable, dangerous circumstances. At the Youth Anxiety Center's clinic in the Washington Heights neighborhood of Manhattan, which serves mostly poor and working-class Hispanic youth, teenagers would object to the definition of anxiety I heard often at Mountain Valley: "The overestimation of danger and the underestimation of our ability to cope."

"The fears can be very real for our kids," explained Carolina Zerrate, the clinic's medical director. "Oftentimes their neighborhoods are not safe, their streets are not safe and their families can feel unsafe if there's a history of trauma and abuse." The contemporary political climate can also feel "incredibly unsafe for the community of kids we serve," Zerrate adds, explaining that many have undocumented family members.

And yet addressing anxiety is low on the priority list in many economically disadvantaged communities. Kids who "act out" are often labeled defiant or aggressive, while those who keep to themselves - anxiety specialists call them "silent sufferers" - are overlooked or mistaken for being shy. "If you go to a public school in a struggling urban area, teachers will talk about drugs, crime, teen pregnancy, violence," Kendall says. "When you start to talk about anxiety, they're like, 'Oh, those are the kids we like!' "

Teenagers raised in more affluent communities might seemingly have less to feel anxious about. But Suniya Luthar, a professor of psychology at Arizona State University who has studied distress and resilience in both well-off and disadvantaged teenagers, has found that privileged youths are among the most emotionally distressed young people in America. "These kids are incredibly anxious and perfectionistic," she says, but there's "contempt and scorn for the idea that kids who have it all might be hurting."

For many of these young people, the biggest single stressor is that they "never get to the point where they can say, 'I've done enough, and now I can stop,' " Luthar says. "There's always one more activity, one more A.P. class, one more thing to do in order to get into a top college. Kids have a sense that they're not measuring up. The pressure is relentless and getting worse."

It's tempting to blame helicopter parents with their own anxiety issues for that pressure (and therapists who work with teenagers sometimes do), but several anxiety experts pointed to an important shift in the last few years. "Teenagers used to tell me, 'I just need to get my parents off my back,' " recalls Madeline Levine, a founder of Challenge Success, a Stanford University-affiliated nonprofit that works on school reform and student well-being. "Now so many students have internalized the anxiety. The kids at this point are driving themselves crazy."

Though there are cultural differences in how this kind of anguish manifests, there's considerable overlap among teenagers from different backgrounds. Many are anxious about school and how friends or teachers perceive them. Some obsess about family conflicts. Teenagers with OCD tend to worry excessively about what foods they should eat, diseases they might contract or whatever happens to be in the news that week. Stephanie Eken, a psychiatrist and the regional medical director for Rogers Behavioral Health, which runs several teenage-anxiety outpatient programs across the country and an inpatient program in Wisconsin, told me that in the last few years she has heard more kids than ever worry about terrorism. "They wonder about whether it's safe to go to a movie theater," she said.

When I asked Eken about other common sources of worry among highly anxious kids, she didn't hesitate: social media. Anxious teenagers from all backgrounds are relentlessly comparing themselves with their peers, she said, and the results are almost uniformly distressing.

Anxious kids certainly existed before Instagram, but many of the parents I spoke to worried that their kids' digital habits - round-the-clock responding to texts, posting to social media, obsessively following the filtered exploits of peers - were partly to blame for their children's struggles. To my surprise, anxious teenagers tended to agree. At Mountain Valley, I listened as a college student went on a philosophical rant about his generation's relationship to social media. "I don't think we realize how much it's affecting our moods and personalities," he said. "Social media is a tool, but it's become this thing that we can't live without but that's making us crazy."

In his case, he had little doubt that social media made him more self-conscious. "In high school, I'd constantly be judging my self-worth online," he told me, recalling his tortured relationship with Facebook. "I would think, Oh, people don't want to see me on their timeline."

While smartphones can provoke anxiety, they can also serve as a handy avoidance strategy. At the height of his struggles, Jake spent hours at a time on his phone at home or at school. "It was a way for me not to think about classes and college, not to have to talk to people," he said. Jake's parents became so alarmed that they spoke to his psychiatrist about it and took his phone away a few hours each night.

At a workshop for parents last fall at the NW Anxiety Institute in Portland, Ore., Kevin Ashworth, the clinical director, warned them of the "illusion of control and certainty" that smartphones offer anxious young people desperate to manage their environments. "Teens will go places if they feel like they know everything that will happen, if they know everyone who will be there, if they can see who's checked in online," Ashworth told the parents. "But life doesn't always come with that kind of certainty, and they're never practicing the skill of rolling with the punches, of walking into an unknown or awkward social situation and learning that they can survive it."

Jean Twenge, a professor of psychology at San Diego State University who researches adolescent mental health and psychological differences among generations, used to be skeptical of those who sounded an alarm about teenage internet use. "It seemed like too easy an explanation for negative mental-health outcomes in teens, and there wasn't much evidence for it," she told me. She searched for other possible explanations, including economic ones. But the timing of the spike in anxious and depressed teenagers since 2011, which she called one of the sharpest and most significant she has seen, is "all wrong," she said. "The economy was improving by the time the increase started."

The more she looked for explanations, the more she kept returning to two seemingly unrelated trend lines - depression in teenagers and smartphone adoption. (There is significantly more data about depression than anxiety.) Since 2011, the trend lines increased at essentially the same rate. In her recent book "iGen," and in an article in The Atlantic, Twenge highlights a number of studies exploring the connection between social media and unhappiness. "The use of social media and smartphones look culpable for the increase in teen mental-health issues," she told me. "It's enough for an arrest - and as we get more data, it might be enough for a conviction."

Last fall, at a high school near the New Hampshire-Vermont border, I watched Lynn Lyons, a psychotherapist and author, deliver bad news to a packed auditorium of teachers and counselors. "We're not getting the job done," she said, pacing the stage at Fall Mountain Regional High School, where she had been asked to lead a professional-development training session about anxiety.

More than a decade ago, the school would have been unlikely to invite her to speak. Anxiety was barely on the radar of most educators back then, according to Denise Pope, another founder of Challenge Success, the Stanford-affiliated nonprofit. Pope remembers facing skepticism when she sounded the alarm about growing anxiety among teenagers. "We don't have to convince them anymore," she told me. "Schools are coming to us, eager for help."

A gregarious speaker, Lyons kept her audience entertained by calling anxiety "the cult leader" - for its ability to convince people of falsehoods about themselves - and telling funny stories about overinvolved parents. But her main point was clear: In a seemingly well-meaning effort to help kids avoid what makes them anxious, administrators actually make anxiety worse. "Anxiety is all about the avoidance of uncertainty and discomfort," Lyons explained. "When we play along, we don't help kids learn to cope or problem-solve in the face of unexpected events."

She pointed to the increasing use of "504 plans," a popular educational tool that allows for academic accommodations for students with physical or mental disabilities. Though 504 plans for anxiety vary by student, a typical one might allow a teenager to take more time on homework and tests, enter the school through a back door - to avoid the chaos of the main entrance - and leave a classroom when feeling anxious.

Lyons believes in the necessity of 504 plans, and she is in agreement with many of the recommendations of Challenge Success, including later school start times, less homework and more project-based learning. But Lyons worries that too many 504 plans are "avoidance-based and teach zero skills." She gave the example of a plan that allows a student to leave a classroom anytime he feels overwhelmed. Often, a teenager "can go wherever he wants and stay there for as long as he thinks he needs," she said. Instead, she argued, a school should have a policy in place for the student to seek out a guidance counselor or nurse and do some role-playing that helps the student "externalize his worry," similar to how Mountain Valley teenagers are taught to observe their thinking and talk back to it. Then the student should return to his regular classroom as soon as possible, Lyons said.

"If anxiety could talk, it would say, 'You know, let's just get out of here. We don't have to do this!' " Lyons said from the stage. "But in order to retrain the brain, in order to create that message that says that even though I'm uncomfortable I can do this, we need to stop treating these anxious kids like they're so frail, like they can't handle things."

Lyons sees a connection between how some schools deal with anxious students and what she worries is a generation of young people increasingly insistent on safe spaces - and who believe their feelings should be protected at all costs. "Kids are being given some really dangerous messages these days about the fact that they can't handle being triggered, that they shouldn't have to bear witness to anything that makes them uncomfortable and that their external environments should bend to and accommodate their needs," she told me.

Among many teachers and administrators I spoke to, one word - "resiliency" - kept coming up. More and more students struggle to recover from minor setbacks and aren't "equipped to problem-solve or advocate for themselves effectively," a school counselor in suburban Oregon told me. In the last few years, the counselor said, she has watched in astonishment as more students struggle with anxiety - and as more of those "stop coming to school, because they just can't."

Some schools have taken drastic measures to accommodate what one administrator called "our more fragile students." At Roxbury High School in Roxbury Township, N.J., there are two dedicated classrooms for anxious teenagers, including one next to a mural of Edvard Munch's painting "The Scream." These students typically avoid the mammoth school cafeteria in favor of eating lunch in one of the classrooms, as they did on the day of my visit last May. They had just finished gym class, an anxiety-producing event for some even as the school did all it could to reimagine the concept. Music blasted throughout the gym as the teenagers halfheartedly played something vaguely approximating a game of volleyball. The ball was allowed to bounce once before being struck - not that anyone was keeping score.

I couldn't help wondering what Lyons, and other therapists I spoke to who worry that schools inadvertently worsen anxiety, would think of this approach. Some of the programs' teenagers hoped to go to college, where no special classrooms would await them. How was this preparing them for that?

"Some will say that this feeds the monster," concedes Patricia Hovey, director of special services at Roxbury High. "But you've got to start where the kids are, not where you are or where you want them to be. We've got to get them in the building. Many of our students simply don't come to school if they have to spend all day in" general-education classes. Once the students are in school, Hovey explained, staff members can help them build the confidence and skills to eventually transition to Roxbury's regular classes - and stand a chance at navigating college or a job once they graduate.

Even with the promise of a special classroom, getting anxious kids to Roxbury High each morning demands a herculean effort from the program's teachers and therapists. During my visit, I watched them text and call several no-show students in an effort to coax them out of bed. They also regularly communicate with parents, talking them through what to say to a teenager who refuses to leave his room. Paul Critelli, one of the program's teachers, told me that many parents feel overwhelmed trying to get two or three kids ready for school each morning, and that their instinct is often to "sacrifice the anxious kid" in order to avoid morning hysterics and keep the family train running on time.

Mostly, though, Critelli wants to talk to the anxious students. "What's the issue today?" I heard him ask during a phone call with a sophomore boy, who had missed his scheduled bus and was presumably speaking to Critelli from underneath his sheets. The call was a "Hail Mary," as Critelli put it, because while he suspects that the boy sleeps with the phone "right next to his face," he rarely responds when he's feeling anxious. "I appreciate you picking up - you don't normally do that," Critelli told him, mixing in positive affirmation with a call to action. The school would be sending another bus, and Critelli expected him to be on it.

Critelli looked for any opportunity to push students out of their comfort zones. During an informal study period after lunch, I watched him confiscate cellphones he said the teenagers were using to "hide from, control and avoid" their feelings; scoff at a student who claimed to be too anxious to return a book to the school library; and challenge a particularly reserved boy who said he had nothing to work on.

Critelli looked at him incredulously. "Dude, you're failing physics," Critelli said. "What do you mean you don't have anything to do?"

"There's nothing I can do - I'm going to fail," the student mumbled.

"So you're just accepting that you're going to fail?" The boy looked at his hands. "Here's an idea," Critelli continued. "You can email your teacher and say, 'What can I do to improve my grade? What extra work can I do?' "

Critelli surveyed his classroom of anxious teenagers. "I'd love to see you advocate for yourselves!"

Jake is a remarkably minimalist emailer and texter, eschewing exclamation points and emojis in favor of an almost old-fashioned formality. It can be challenging to gauge his moods that way, so I checked in with him regularly by phone in the months after he left Mountain Valley. He usually sounded content when we spoke, an impression confirmed by his parents, who were relieved by the changes they saw in him. In the fall of his senior year, Jake was regularly attending school - on some days he "even enjoyed it," he told me with a laugh.

While he was careful not to overschedule himself, anxiety still sometimes overtook him. One weekend, he had to leave a Model United Nations conference after he became anxious and his stomach started cramping. "That was really disheartening, but when I struggle now it doesn't last long, and I can usually get myself out of it pretty quickly," he said, by talking back to his negative thoughts.

Jake also confessed to some worry about his application to attend U.N.C. He had decided to be transparent with the school about his anxiety disorder, partly because it helped explain his junior-year absences and grades and partly because the months he had spent challenging his beliefs and ideas at Mountain Valley perfectly fit the application essay prompt: Reflect on a time when you challenged a belief or idea.

In 650 thoughtful and sometimes uncharacteristically dramatic words, Jake explained that in middle school he had "aced the tests and seemed to many as the bright future of the American ideal." But then came high school and fear of failure, the debilitating worry that he might not be good enough. He explained that going to treatment helped him change his perspective on learning and life. "Just being able to type this very essay would have been impossible months ago due to my fear of judgment," he wrote. "College is the next step in my journey to find a true sense of self, both academically and personally. The future has reopened its doors."

The doors had not reopened quite as wide for Jillian, whom I visited on an oppressively humid spring afternoon in Florida. It was a school day, but Jillian wasn't at school. Instead, she was on the screened-in back patio of the townhouse where she lives with her mother, Allison. A talented artist, Jillian loves theater and special-effects makeup design, and she was hard at work on an outfit for a "Walking Dead" costume contest at a local car dealership.

While she painted her costume to make it appear blood-soaked, we half-watched an episode of the Netflix series "13 Reasons Why" on her laptop. Jillian told me she could relate to many of the series's themes, including cyberbullying. In middle school, she made a profile page on ASKfm, a social-networking site favored at the time by mean girls and their unsuspecting prey. Jillian was quickly targeted. "I'd get 30 mean questions or messages a day," she said. "Most of them were like, 'Just kill yourself.' "

Nothing like that happened at the small private high school Jillian attended after leaving Mountain Valley. Though the school is known for its flexibility and willingness to work with nontraditional students, Jillian still struggled to feel comfortable there. She didn't want to open up and be known as "the anxious girl." There were other students at school who had severe anxiety and depression - "It's like the flu broke out here with anxious kids this year," the headmaster told me - but Jillian didn't feel comfortable hanging out with them, either. Several had yet to go to treatment, and "I don't want to go backward," she told me. But the end result, unsurprisingly, was that most students never got to know Jillian.

Her longtime pattern of missing school began again. She had the tools to challenge her anxious thoughts, but using them every day proved exhausting. "There's feeling a weight on your chest, and there's the feeling of 16 people sitting on top of each other on your chest," she said. "As soon as I'd wake up, it was absolute dread."

Needing to get to her job 40 minutes away each morning, Allison, who had sold her previous house in order to afford Mountain Valley, had little time to coax Jillian out of bed. They argued constantly. Jillian thought her mother - who was severely depressed during a year when Jillian was younger and especially needed support - could be insensitive. Allison struggled with when (and how hard) to push her daughter. She knew Jillian had a serious disorder, but she also knew it wouldn't get better by letting her hide out in her room. Allison also couldn't be sure when Jillian was genuinely paralyzed by anxiety and when she was "manipulating me to get out of doing whatever she didn't feel like doing," she said.

"The million-dollar question of raising an anxious child is: When is pushing her going to help because she has to face her fears, and when is it going to make the situation worse and she's going to have a panic attack?" Allison told me. "I feel like I made the wrong decision many times, and it destroyed my confidence as a mother."

Allison sometimes wondered how her own anxiety issues might have genetically predisposed her daughter to anxiety. Allison had done enough Google searches to know that anxious teenagers tend to come from anxious parents. Research points to hereditary genes that predispose children to an anxiety disorder, and studies have found that an overbearing or anxious parenting style can induce anxiety and risk-aversion in kids. In the parents' workshop I attended in Oregon, Ashworth, the therapist, spent a lot of time urging family members to work on their own anxiety issues.

He also cautioned parents not to accommodate their children's avoidance strategies. Families of children with OCD will routinely open doors for them, cook only the two or three specific foods they've agreed to eat and avoid saying certain words or sounds. Families of socially anxious kids will let them stay in the car while they go shopping, order for them at restaurants and communicate with a teacher because they're afraid to. "So many teens have lost the ability to tolerate distress and uncertainty, and a big reason for that is the way we parent them," Ashworth said.

While Ashworth can be blunt, he is also disarming and funny, with a self-deprecating sense of humor that appeals to both parents and their cynical children. Like many therapists who work with anxious teenagers, he tries to model a "let's not take life - and ourselves - too seriously" approach. He also has an almost endless empathy for the challenges that these teenagers and their families face. He knows, for example, that raising a severely anxious child can feel counterintuitive. How, for example, do you set and enforce limits with an anxious teenager? If you send him to his room, "you've just made his day," Ashworth told the parents in his workshop, who nodded knowingly.

Though Jillian had returned from Mountain Valley a more confident person with a nuanced understanding of her issues (and with her emetophobia largely under control), treatment didn't solve her school struggles. As she fell further behind, her morning battles with her mother became increasingly untenable. In consultation with the school, Allison agreed to let Jillian drop out and study for the G.E.D. But Allison wasn't happy about it; she considered it a momentary concession. "We basically said, 'O.K., anxiety, you win.' "

Jillian was relieved never to have to set foot in another high school. "I'm just a lot more relaxed now," she told me in her messy bedroom, where the walls were adorned with "Star Wars" posters and the bookshelf overflowed with young-adult fiction and sci-fi, as well as a worn copy of "Chicken Soup for the Teenage Soul." Near her bed were two prescription bottles - one for Prozac and another for Klonopin, a benzodiazepine tranquilizer. Jillian had been prescribed a number of drug combinations over the years, and while none were panaceas, she believed she would be "a lot worse if I wasn't taking them."

Though she spoke to a therapist once or twice a week online, Jillian otherwise ignored the structured daily schedule - including yoga, studying and cleaning her room - that she had agreed to with her mother. Jillian told me she often felt lonely at home, and she spent much of her days texting friends from around the country, some of whom she met at "Star Wars" conventions or on social media.

At the same time, Jillian was trying to make new friends. I watched her joke with fellow contestants at the costume contest (where she walked away with a $250 prize), and she was practically a social butterfly at a film event she attended with her mother. Bored with our company after the screening, Jillian spotted two teenagers talking to each other in a corner.

"O.K., I'm going to go mingle," she announced.

On a busy weekday morning last May, a new crop of Mountain Valley residents were discovering that a key component of their treatment would involve repeatedly making fools of themselves. On the Dartmouth College campus, eight teenagers wore hand-painted white T-shirts that read "Ask Me About My Anxiety" and "I Have OCD." They were encouraged by the therapy team to come up with scenarios that would make them uncomfortable. One teenager considered approaching random guys on campus and saying, "You must be a Dartmouth football player." Later that afternoon, a second group of teenagers arrived. One feigned a panic attack at Starbucks. Another ordered nonsensically at a restaurant.

"What do we need to do to make your anxiety higher?" McCallie-Steller, the therapist, asked several teenagers as they prepared for their morning of exposure therapy. First developed in the 1950s, the technique is an essential component of cognitive-behavioral therapy (CBT) for anxiety, which a vast majority of researchers and clinicians believe is the most effective treatment for a range of anxiety disorders. In a large 2008 study of anxious youth published in The New England Journal of Medicine, more improved using CBT (60 percent) than the antidepressant Zoloft (55 percent), though the most effective therapy (81 percent) was a combination of the two.

But while exposure therapy has been proved highly effective, few teenagers receive it. "We're much more likely to medicate kids than to give them therapy," says Stephen Whiteside, director of the Child and Adolescent Anxiety Disorders Program at the Mayo Clinic. "And when we do give them therapy, it's unlikely to be exposure. With a few exceptions, we're not treating people with what actually works best."

Part of the reason is that exposure work is hard. Anxious people aren't typically eager to feel more anxious. "It's also uncomfortable for many therapists," Whiteside told me. "Most people go into therapy or psychology to help people, but with exposure therapy you're actually helping them feel uncomfortable. It's not much fun for anybody. It's much easier to sit in a therapist's office and talk about feelings."

Researchers are trying to better understand how exposure works in the brain and to fine-tune its application for anxiety treatment. At U.C.L.A., scientists at the school's Anxiety and Depression Research Center discovered that the more anxious a person feels going into an exposure exercise, and the more surprised he or she is by the result, the more effective it is at competing with an original negative association or traumatic memory. (That's why McCallie-Steller did her best to ramp up the teenagers' anxiety before they began their exposure work.) Other researchers are focused on v irtual-reality-aided exposure therapy, which allows people to encounter the sources of their anxiety in a therapist's office.

For two Mountain Valley 14-year-olds on the main quad at Dartmouth, the sources of their distress were numerous. One, a brown-haired boy who embarrassed easily, suffered from a dispiriting combination of social anxiety, OCD, binge-eating and depression. It was a lot to work on in three months, and he was often overwhelmed by the magnitude of the project. On this day, he had agreed to tackle his social anxiety by sitting next to a stranger on a park bench and striking up a conversation.

Earlier, another Mountain Valley teenager took part in a similar exercise, during which the stranger opened up about his own struggles with anxiety. The teenagers were sometimes surprised that others could relate to their issues. As one girl handed out fliers about anxiety on campus, she sometimes asked people, "Can I tell you about anxiety?" More than a few students - including one who looked as if he might actually be a Dartmouth football player - responded with some version of "Trust me, I know all about it."

The brown-haired boy was highly anxious about his exposure. He bombarded the therapist, Bryan Randolph, with questions in a seeming attempt to run out the clock until they had to return to Mountain Valley. "Can I just sit on the bench for a minute?" he asked Randolph. "And can I sit down and then start talking? I mean, do I need to ask, 'Do you mind if I sit there?' It's weird to just sit there, have a conversation, then get up and come running back to a group of people."

"Even better - let's make it weird," Randolph told him.

The boy shook his head. "Maybe the guy's on break and doesn't want to be bothered."

"Maybe," Randolph said. "He might hate you. He might get real mad at you."

"That's terrifying," the teenager confessed. "And what if we're so close on the bench that we're touching?"

"That would be awkward," Randolph said with a half-smile.

The boy craned his neck to get a better look at the man. "Is he sitting in the middle of the bench?"

"I don't know - he might be," Randolph told him. "But are you going to 'what if' this to death, or are you going to do it?"

He eventually shuffled off toward the stranger, allowing Randolph to turn his attention to the other 14-year-old, Thomas, who stood sheepishly on a nearby corner holding his sign: "I've Been Bullied. Ask Me." The "Ask Me" was hard to make out, because Thomas had also included many of the insults peers have hurled at him over the years, including "B*tch," "F*ggot," "Ur Fat" and "Kill Yourself." Holding the sign on a busy corner had been Thomas's idea; he thought it might ratchet up his anxiety and force him to interact with strangers, while having the potential added benefit of educating people about bullying.

Randolph and I watched dozens of students walk by, some giving Thomas's sign a glance but most never slowing their stride. He had been bullied for years, and now he was being ignored. I felt anxious just looking at him.

Eventually, an attractive couple in their mid-20s stopped to read the sign. They smiled, Thomas beamed and after a minute or two of conversation they all hugged. "Oh, my God, that was the greatest," Thomas announced upon his return.

I asked him what they'd talked about. "The muscular dude said he's been bullied, too, in middle school, and that bullies get nowhere in life," Thomas told us. "Then the girl said, 'You're really brave. Can I give you a hug?' "

"That's not what you were expecting, huh?" Randolph said. "Instead of being mean to you, people actually treated you with compassion."

"Yeah, it was awesome," he said. "I feel so good!"

The brown-haired boy, meanwhile, returned from his brief visit to the bench: "It was sooooo awkward," he reported. "The guy just kept texting. He was probably like, Why is this kid asking me questions?"

"And what if he was?" Randolph asked him. "You're not responsible for what he's thinking."

The boy appeared to consider Randolph's point as they made their way back to the van that would return them to Mountain Valley. Sometimes, Randolph told the boys, "exactly what you think will happen happens. Other times, the exact opposite of what you think will happen happens. Either way, it's all manageable."

The subject line of Jake's email to me last winter read simply, "College Results." I opened it: "Hey Benoit, I just wanted to tell you that I was accepted to U.N.C. Chapel Hill. Jake." I emailed back to say that he could stand to sound a little bit more excited, to which he replied, "Trust me, I'm pretty excited!"

Last month, I visited him during his fourth week of college classes. It was a Sunday, and Jake met me outside his dorm wearing khaki shorts and a Carolina Panthers jersey. He looked happier than I'd ever seen him. "Let's walk," he said, leading me on a tour of campus and nearby Chapel Hill, where he went record shopping (he left with a Parquet Courts album) and played touch football with a few of his friends.

Since leaving Mountain Valley, Jake had prioritized his social life. "The health of my relationships with people is just as important as academics," he told me on a bench overlooking the main quad. He had said something similar at Mountain Valley, but back then it sounded theoretical, aspirational. It felt true now. He had made new friends on campus and was keeping up with old ones from home - and some of his peers from Mountain Valley - via text and Snapchat, the only social-media platform he regularly uses these days. "My junior year, when things got really bad, I told myself that I didn't need to hang out with my friends a lot, that all that really mattered was how well I did at school," he said. "I don't think like that anymore."

That's not to say that Jake doesn't study. He does - usually days before he needs to. "Procrastination isn't a good idea for me," he said. But he was actually enjoying several of his college classes, especially Intro to Ethics, for which he was reading Plato's "Republic."

Jake had experienced only one intense bout of anxiety at U.N.C. For his info sciences course, he turned in an assignment online but realized days later that there had been a technical glitch and it hadn't gone through. He said he felt "a sudden burst of anxiety" - his chest tightened, and adrenaline coursed through his body. What had he done? He sent a panicked email to his professor and told a friend who also has anxiety issues that he was "freaking out." Then he took a nap, which had long been one of his coping strategies. When he awoke, the professor had emailed saying it wasn't a big deal. "That ended that crisis," Jake told me.

For the most part, Jake felt he was managing his anxiety. Over the summer, he met twice with Jonathan Abramowitz, a psychology professor who leads the university's anxiety and stress lab, but Jake had put off finding a regular therapist for the school year. His parents kept bugging him about it. "I just haven't felt like I need it here," Jake told me. But then, a few beats later, he added: "I know I need to stop making excuses and just do it."

I was curious how much of Jake's newfound contentment had to do with being at U.N.C., with getting into his dream school. After all, a major component of his treatment at Mountain Valley was learning to accept that his value didn't depend solely on academic achievement. How would he have reacted if his application was one of the 74 percent that U.N.C. rejected last year?

It was clear that Jake had thought about the question. "I would have been disappointed, but I really think I would have been O.K.," he told me. "There are other schools in the world where I would have been happy. I definitely wouldn't have believed that a couple years ago, but a lot's changed."

Before walking back to his dorm, where Jake's friends were waiting for him, we stopped at the Old Well, a campus landmark where legend has it that students who drink from it on the first day of classes will get straight A's that semester. The old Jake might have been first in line. But the new Jake? He hadn't bothered to show up.

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Why Are More American Teenagers Than Ever Suffering From Severe Anxiety?

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Alarmed, Jake's parents sent him to his primary-care physician, who prescribed Prozac, an antidepressant often given to anxious teenagers. It was the first of many medications that Jake, who asked that his last name not be used, would try over the next year. But none seemed to work - and some made a bad situation worse.

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When I was 10, I was diagnosed with a collection of anxiety disorders. For the next three and a half decades, I hid my condition from those around me. I concocted elaborate explanations for the absences caused by my therapy appointments. I kept my medications out of sight. I generally did everything I could to project an aura of competence and confidence that was often at odds with the vulnerability, and sometimes the terror, that I felt.

Then I decided to write a book about anxiety. The dilemma: Should I reveal anything about my own struggles? Would I hurt myself professionally by doing so? Embarrass myself? Worsen my anxiety?

My psychotherapist, Dr. W., understood my concerns. But he suggested gently, on many occasions, that revealing my anxiety would perhaps dissipate the shame I associated with it. Doing so might prove therapeutic, even liberating. "You've been keeping your anxiety a secret for years, right?" he would ask. "How's that working out for you?"

He had a point. I was still terribly anxious, and often unhappy.

But I would retort that at least I was gainfully employed and not a laughingstock or an object of unwanted pity. Concealing my anxiety was in some sense working for me.

Dr. W. would counter that by sharing what I had gone through, perhaps I could provide solace to some of the millions of other people who suffer from clinical anxiety. Perhaps I could even, as he put it, "write yourself to health."

In the end, I decided, with considerable apprehension, to go ahead and reveal my own anxiety in the book. It's now been a year since my book was published. Did "coming out" help?

The short answer is: a little bit, yes. The longer answer is ... well, let me tell you a story.

My most longstanding anxiety is emetophobia, the pathological fear of vomiting. I had, at the time of my book's publication, gone some 37 years without throwing up. Given my history, the odds of my vomiting at any given moment are rather low. I know this rationally, and yet a good part of my life is still given over to worrying that I will - and moreover that I will do so at the most inopportune time.

In August, I accompanied my boss to interview Bill Clinton for the magazine we work for. My role was merely as an appendage - to provide moral support to my boss, who would conduct the interview, and to the magazine's creative director, who would be helping to superintend a photo shoot. Still, I was looking forward to sitting in.

But as the taxi to the interview site lurched its way through traffic in the August heat, I began to feel queasy. As I walked into the building where the interview was to take place, my nausea increased, which caused my anxiety to deepen, in the usual vicious cycle of heightening physiological and emotional distress, triggering my typical internal dialogue: Do I have a virus? Food poisoning?

Relax, I told myself. It's just anxiety.
But what if it's not? Oh, god: I'm going to throw up, and my non-vomiting streak is going to end - and it's going to end, as of course it would have to, right in front of, or on top of, the former president of the United States.
I tried to tell myself that wouldn't be the end of the world. After all, Mr. Clinton's predecessor in the White House, George H.W. Bush, once threw up on the prime minister of Japan. But such attempts at self-reassurance tend to be futile once my anxiety engages full throttle.

You're just anxious and a little carsick, I told myself, retreating to the men's room, where I gulped a Xanax. Hurry up, Xanax, work!

Returning to the office, I was told that Mr. Clinton was finally on his way, and I suddenly became quite certain I was going to be sick - probably just as he arrived. After 37 years of not vomiting, my streak was going to end by barfing on the erstwhile leader of the free world, and then getting shot. (In my anxiety-driven thought process, I'd concluded that my vomiting would be interpreted by the Secret Service as evidence of hostile intention.)

Bolting from the building, I crossed the street to a hotel bar where, surrounded by chatty conference attendees wearing lanyards, I gulped an emergency vodka. Within minutes, as the Xanax and alcohol kicked in, my nausea dissipated. I felt well enough to return to the office. My hope was that I'd get back in time. No such luck. Mr. Clinton was in an inner room of the suite, the interview already underway.

"Where'd you go?" the magazine's creative director asked. I told him, as I would later tell my boss, that I'd had to field a phone call from an angry author, which was a partial truth - I'd fielded such a call earlier in the day.

So, no, publishing a book about anxiety has not cured me of it.

But in important ways, publishing the book has been a kind of deliverance. During the promotional tour for my previous book, in 2004, I lived in terror of having to run off a stage, or run out of a live TV broadcast, because of a panic attack, thereby embarrassing myself and revealing my anxiety to the world. But now, having pre-emptively announced my anxiety, if I were forced to run offstage I could always yell out, "Sorry, please refer to Chapter 4!"

I had the equivalent of a get-out-of-public-appearances-free card: You signed up an anxious guy for an event, what'd you expect? This helped relax me.

More broadly, I revealed my anxiety and ... the world didn't end. Did friends and colleagues talk about me behind my back? Maybe. Probably. (O.K., definitely.) But for the most part people didn't seem to treat me any differently - and to the extent that they did, it was to express sympathy or empathy and even admiration for my "bravery" in revealing my vulnerability. (This always struck me as odd because I was being brave only in revealing my lack of bravery, which is a cheap sort of bravery indeed.)

Many people - friends, colleagues, strangers - came forward to share their own stories of anxiety, and to say that my publicly revealing my anxiety somehow made them feel more hopeful, or less alone, and sometimes less anxious. This made me feel good, though I found it ironic that my writing about my anxiety seemed to reduce other people's anxiety more than it did my own.

I'm still anxious. I still have bad episodes. I remain (lightly, for the most part) medicated. But Dr. W. was right: Coming out as anxious has helped. It has been a relief not always to have to do "impression management," as Dr. W. calls it. I don't - or don't always, anyway - feel a desperate compulsion to hide the anxiety that sometimes overtakes me.

After years of wanting to be known for the equanimity that I (mostly) managed to project to the world despite my inner churnings, I've embraced, albeit uneasily, my place in the nervous flock. I don't know exactly where we're going together, but I draw solace from our shared membership in the fellowship of the anxious. Together, perhaps, we can shuffle forward - two steps forward, one step back - toward resilience and even serenity.
Scott Stossel, the editor of The Atlantic magazine, is the author of "My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind."

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When I was 10, I was diagnosed with a collection of anxiety disorders. For the next three and a half decades, I hid my condition from those around me. I concocted elaborate explanations for the absences caused by my therapy appointments. I kept my medications out of sight.

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Addiction Treatment | Elements | Drug Rehab Treatment Centers

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Is your teen what you would call a "worry wart?" Does she experience panic attacks? Does she avoid social situations? Does she seem anxious even when you can't see anything to be worried about? If you can describe your teen with any of the above statements, it is possible that she suffers from an anxiety disorder. This is a class of mental illnesses that includes several types, such as generalized anxiety disorder, panic disorder, obsessive-compulsive disorder and social anxiety, among others.

If your teen seems as if she might be struggling with one of these disorders, rest assured that she is not alone. Anxiety disorders are the most common of all mental illnesses and affect 25 percent of all teens and 30 percent of all teen girls. In fact, many experts are seeing a rise in the level of anxiety and the incidence of anxiety disorders in both adults and teenagers, and there are many possible explanations.

The Rise in Anxiety

That one-quarter of teens will struggle with an anxiety disorder at some point in their lives seems staggering. This number has been steadily rising, though, for nearly a century. According to researchers who looked at mental health data for high school and college students from 1938 to 2007, more and more young people report symptoms of mental illness in general, and anxiety in particular.

The research looked at over 60,000 young people and read surveys of self-reported emotions and symptoms. The researchers found that over the years, teens are describing themselves in changing terms. They are seeing more descriptions of feelings such as isolation, sensitivity, being misunderstood, narcissistic, worry, sadness, low self-control and general dissatisfaction.

The Reasons for More Anxiety

So why are teens feeling more anxious than ever? Some put the blame on cultural changes. They say that our society's increasing materialism over the years has eroded personal relationships and families. We now value money and personal luxuries more than relationships. This explanation can answer the question of increased anxiety for both adults and teens.

Other experts look more closely at the teenage experience. Today, more teens stay in school longer and delay entering the workforce, which effectively extends the unstructured teenage years, often well into the 20s. More teenagers come from homes with divorced parents than ever before. More drugs are available and accessible to teens today. All of these things can contribute to increased feelings of anxiety and worry.

Some experts also point to a strong sense of narcissism and entitlement among young people today. Our teens have been raised to believe that they can do anything. In many ways this seems like a positive attitude. Young people should be free to dream and to strive to achieve their dreams. However, when a young boy without the innate skills thinks he can play in the NBA one day, he is likely to suffer serious disappointment when his dreams are not realized. Many young people are also raised by parents who devote all of their energy to child-rearing. This helps to foster the narcissistic sense that a teen is the center of the world.

Getting Help

To know for sure if your teen suffers from an anxiety disorder, you need to get a diagnosis from a professional. Start with your doctor or pediatrician for a referral. Even if your teen does get a positive diagnosis, understand that these disorders are highly treatable. With therapy and possibly medication, your teen can learn to relax and enjoy life. You should also know that anxiety often occurs alongside depression. If you notice any signs of sadness or depression in your teen, bring it up at your doctor's appointment.

The truth is that we do not know for sure why teens are feeling more anxious than ever. The arguments that cultural changes, a focus on the material, and an exaggerated sense of entitlement in young people are affecting their mental health do not seem far-fetched, though. Your child may be destined to develop an anxiety disorder, but you can still counteract some of the negative aspects of society that lead to excessive worry. Spend more quality time together as a family. Stress the importance of people and relationships over money and things. Push your child to volunteer and to help others. If we could all realize and emphasize these important aspects of life more often, perhaps many of us would worry less.

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20 Percent of Teens Suffering From Anxiety

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Is your teen what you would call a "worry wart?" Does she experience panic attacks? Does she avoid social situations? Does she seem anxious even when you can't see anything to be worried about? If you can describe your teen with any of the above statements, it is possible that she suffers from an anxiety disorder.

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For years Madeline and Eva suffered in silence. Then they shared their secret with each other: "We have depression." It was only the beginning of an unlikely story of two teens determined to shine a light on depression-by opening up to the world.

Madeline Halpert and Eva Rosenfeld were bunking together at a student journalism conference last November when they found an unexpected connection.

On their first night there, Madeline caught a quick glimpse of a prescription bottle in Eva's suitcase and recognized a very familiar name: Prozac. It was the same anti-depressant that Madeline had been prescribed the year before, when her depression took hold.

Without thinking twice, Madeline opened up to Eva, and Eva spoke freely in return, revealing that she had been suffering from depression too-since eighth grade.

"I felt so relieved," explains Madeline. "I had never talked to anybody who could relate to what I was experiencing. It made a world of difference to know that I wasn't alone."

It's true: Depression isn't something you usually discuss with your classmates, but it's definitely not rare. Approximately 1 out of every 10 teens (of every race, gender, social group, and economic status) will suffer from it by the time they graduate from high school, and a survey released by the World Health Organization earlier this year found it to be the #1 cause of illness in teens worldwide.

But if it's so prevalent, what's with the hush?

And why do depressed teens feel so alone? Those are exactly the questions that set Eva and Madeline on a mission-as Eva explains it-"to put real faces on the illness." As co-editors of their high school's newspaper in Ann Arbor, Michigan, they proposed devoting an entire issue to personal stories from their peers who were suffering from mental illness.

Their goal: honesty with no anonymity. "The stigma surrounding depression makes people feel like they can't talk about it openly-or at all," says Eva. "And in turn, those people are not getting the help they need."

But in the end, school officials blocked the issue, citing their fear that the stories would provoke bullying or trigger recurrences in recovered students. Eva and Madeline were sympathetic to their viewpoint, but also believed that this reluctance to support a frank discussion about depression teaches teens that they should be ashamed of an illness they cannot control.

Fired up, they wrote an essay about it and sent it off to big-time newspapers. To their surprise, The New York Times agreed to publish their article as an op-ed, giving them a forum for their perspective on their school's decision-but not an opportunity to share the personal stories they had worked so hard to gather.

That's why we've teamed up with Madeline and Eva, who enlisted another friend-Caroline Phillips, a 17-year-old fellow editor-to help. Together, the girls chose classmates (or former classmates) whose personal struggles with depression show the disease for what it really is: difficult, diverse, and-most important-treatable. Here are their very powerful and incredibly brave stories.

"IN DARK MOMENTS, REMEMBER: IT ONLY GETS BETTER FROM HERE"

Evan, 19, has always been passionate about soccer, from playing it and watching it on TV to volunteering with TopSoccer (a program that helps athletes with disabilities play the sport). He also loves to fish, canoe, and read-up to three books a week-and hopes to one day settle down in New Zealand.

When Evan's parents separated junior year, he felt lost, unmotivated, and-for the first time ever- extremely depressed. "My dad, [who is] such a strong guy, was upset all the time," he says. "With him emotionally compromised and my mom gone, I had to be a parent to my younger brother."

Faced with that overwhelming responsibility on top of his depression, Evan struggled. "At my worst, I felt like nothing could make me feel better-not even my girlfriend or friends," he says.

But Evan eventually found a healthy way to cope-a therapist. "Therapy keeps me open and gives me feedback about how to help myself," he says.

Still, Evan is often frustrated by what he sees as a permanent illness. "It comes in waves," he says. "Some weeks I'll be happy, and then that weekend I'll be low for no reason. It always comes back."

While Evan cannot predict when his depression will hit, he has found comfort in one hopeful piece of advice from his friend Henry.

"At my worst point, he told me, 'The darkest times are behind you,' and it's true," says Evan. "Everything always works itself out, one way or another."
-By Madeline Halpert
"MY DEPRESSION IS NOT A DISABILITY"

Diagnosed with depression and then bipolar disorder, Alice, 17, loves being outside, finding new music, and serving on the Ann Arbor Community Foundation's Youth Council, which grants money to youth organizations throughout her county.

Alice first experienced depression in seventh grade: "It felt like everything was crumbling, and I didn't even care," she says. "I thought I was weird, and that most people weren't depressed at my age."

But now, five years later-after therapy, medication, and multiple diagnoses have caused this high school senior to cycle through periods of helplessness and hopefulness-Alice accepts her illness. "If I'm listening to the people around me and listening to my therapist, I'm OK," she says. "That acceptance was really important to me and for my progress as a human."

Instead of viewing her mental illness as a disability, Alice has now transformed her viewpoint. She is open with her peers and community and is able to speak with others about her struggles with no shame. This year, she auditioned-and was chosen- to give a presentation at the local student TEDxtalks. She also participated in the school's Depression Awareness Group.

"The stigma associated with depression can be so strong that it makes the situation-and your overall outlook-so much worse," she says. "But it really is nothing to be ashamed of."

Alice still occasionally has rough days, but she also has the strength and wisdom to see the power that living openly and honestly can have. "I've been strong," she says, "and now I can be grateful."
-By Caroline Phillips
"YOU HAVE TO ACCEPT HELP"

Meet Lauren, 17, who was diagnosed with depression in sixth grade. She loves makeup, fashion, traveling, and animals-especially her bunny, Riley, and her husky, Kimba. Cool fact: She graduated from high school last year . . . a whole year early!

"You feel like you're drowning. No matter how hard you try, the waves push you down again. You feel empty and nothing seems to make you happy anymore. You're tired and done trying to be something you're not: happy."

This is how Lauren describes her darkest place-a feeling of being completely powerless: "Even though I could point out positives in my life, I still couldn't control that I wasn't happy."

While her friends, family, and therapist have helped to lift her up from these low points, Lauren says that the best coping mechanism has been talking to others who struggle with mental illness. "You can tell someone else what depression is," she explains, "but it's hard for them to understand why you're upset for no reason."

Lauren now feels like her life is stable. She knows her depression may not go away, but she has found a medication that works for her, and she is confident that she can handle the challenges her illness brings. "You have to let people help you to help yourself," she says.

- By Madeline Halpert

"TALKING HELPS ME HEAL"

Ali, 17, is a poet, guitarist, aspiring architect, and hockey fan who has had depression for over a decade. In his spare time, he likes to organize music shows at a local venue.

Losing one home at age 10 and a second at 16, Ali has adopted the mind-set that the only consistency in his life is a lack of it. Still, he has found methods for coping with his depression-and reasons to be optimistic.

"Part of me thinks nothing will ever be steady and firm," Ali says. "But part of me has a lot of hope that things will sort out too."

Ali has found talking about his depression through poetry to be instrumental in dealing with it. He wants people who are struggling to know that others are struggling as well, and he is willing to use his own story to carry that message.

"It's so easy to not be fully aware of what everybody has going for them in life-how everybody has a story about them," he says.

Despite Ali's openness, depression has proved detrimental in some areas of his life. At school, his grades and relationships with teachers have suffered. And while some friendships have been strengthened, Ali has lost some friends altogether.

"When [friends] see that I have sunk into my feelings, it agitates them," Ali explains. "I know that in their hearts they want to help, but it's really hard to help people with depression. It's not like you can just tell them it's going to be OK and they get better."

Ali tries to take life one day at a time, and he urges people not to be ashamed to tell their story-and to be accepting of others' stories too.

"Always keep an open heart," he says. "You never know what's hiding behind someone's eyes-or inside their heart."
-By Eva Rosenfeld
This article originally appeared in the November/December issue of Choices. For more information about the magazine, including how to subscribe,

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6 Remarkable Teens Who Are Crushing The Mental Illness Stigma

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For years Madeline and Eva suffered in silence. Then they shared their secret with each other: "We have depression." It was only the beginning of an unlikely story of two teens determined to shine a light on depression-by opening up to the world.

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The first time Faith-Ann Bishop cut herself, she was in eighth grade. It was 2 in the morning, and as her parents slept, she sat on the edge of the tub at her home outside Bangor, Maine, with a metal clip from a pen in her hand. Then she sliced into the soft skin near her ribs. There was blood-and a sense of deep relief. "It makes the world very quiet for a few seconds," says Faith-Ann. "For a while I didn't want to stop, because it was my only coping mechanism. I hadn't learned any other way."

The pain of the superficial wound was a momentary escape from the anxiety she was fighting constantly, about grades, about her future, about relationships, about everything. Many days she felt ill before school. Sometimes she'd throw up, other times she'd stay home. "It was like asking me to climb Mount Everest in high heels," she says.

It would be three years before Faith-Ann, now 20 and a film student in Los Angeles, told her parents about the depth of her distress. She hid the marks on her torso and arms, and hid the sadness she couldn't explain and didn't feel was justified. On paper, she had a good life. She loved her parents and knew they'd be supportive if she asked for help. She just couldn't bear seeing the worry on their faces.

For Faith-Ann, cutting was a secret, compulsive manifestation of the depression and anxiety that she and millions of teenagers in the U.S. are struggling with. Self-harm, which some experts say is on the rise, is perhaps the most disturbing symptom of a broader psychological problem: a spectrum of angst that plagues 21st century teens.

Adolescents today have a reputation for being more fragile, less resilient and more overwhelmed than their parents were when they were growing up. Sometimes they're called spoiled or coddled or helicoptered. But a closer look paints a far more heartbreaking portrait of why young people are suffering. Anxiety and depression in high school kids have been on the rise since 2012 after several years of stability. It's a phenomenon that cuts across all demographics-suburban, urban and rural; those who are college bound and those who aren't. Family financial stress can exacerbate these issues, and studies show that girls are more at risk than boys.

In 2015, about 3 million teens ages 12 to 17 had had at least one major depressive episode in the past year, according to the Department of Health and Human Services. More than 2 million report experiencing depression that impairs their daily function. About 30% of girls and 20% of boys-totaling 6.3 million teens-have had an anxiety disorder, according to data from the National Institute of Mental Health.

Experts suspect that these statistics are on the low end of what's really happening, since many people do not seek help for anxiety and depression. A 2015 report from the Child Mind Institute found that only about 20% of young people with a diagnosable anxiety disorder get treatment. It's also hard to quantify behaviors related to depression and anxiety, like nonsuicidal self-harm, because they are deliberately secretive.
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Still, the number of distressed young people is on the rise, experts say, and they are trying to figure out how best to help. Teen minds have always craved stimulation, and their emotional reactions are by nature urgent and sometimes debilitating. The biggest variable, then, is the climate in which teens navigate this stage of development.

They are the post-9/11 generation, raised in an era of economic and national insecurity. They've never known a time when terrorism and school shootings weren't the norm. They grew up watching their parents weather a severe recession, and, perhaps most important, they hit puberty at a time when technology and social media were transforming society.

"If you wanted to create an environment to churn out really angsty people, we've done it," says Janis Whitlock, director of the Cornell Research Program on Self-Injury and Recovery. Sure, parental micromanaging can be a factor, as can school stress, but Whitlock doesn't think those things are the main drivers of this epidemic. "It's that they're in a cauldron of stimulus they can't get away from, or don't want to get away from, or don't know how to get away from," she says.

In my dozens of conversations with teens, parents, clinicians and school counselors across the country, there was a pervasive sense that being a teenager today is a draining full-time job that includes doing schoolwork, managing a social-media identity and fretting about career, climate change, sexism, racism-you name it. Every fight or slight is documented online for hours or days after the incident. It's exhausting.

"We're the first generation that cannot escape our problems at all," says Faith-Ann. "We're all like little volcanoes. We're getting this constant pressure, from our phones, from our relationships, from the way things are today."

Steve Schneider, a counselor at Sheboygan South High School in southeastern Wisconsin, says the situation is like a scab that's constantly being picked. "At no point do you get to remove yourself from it and get perspective," he says.

It's hard for many adults to understand how much of teenagers' emotional life is lived within the small screens on their phones, but a CNN special report in 2015 conducted with researchers at the University of California, Davis, and the University of Texas at Dallas examined the social-media use of more than 200 13-year-olds. Their analysis found that "there is no firm line between their real and online worlds," according to the researchers.

Phoebe Gariepy, a 17-year-old in Arundel, Maine, describes following on Instagram a girl in Los Angeles whom she'd never met because she liked the photos she posted. Then the girl stopped posting. Phoebe later heard she'd been kidnapped and was found on the side of a road, dead. "I started bawling, and I didn't even know this girl," says Phoebe. "I felt really extremely connected to that situation even though it was in L.A."

That hyperconnectedness now extends everywhere, engulfing even rural teens in a national thicket of Internet drama. Daniel Champer, the director of school-based services for Intermountain in Helena, Mont., says the one word he'd use to describe the kids in his state is overexposed. Montana's kids may be in a big, sparsely populated state, but they are not isolated anymore. A suicide might happen on the other side of the state and the kids often know before the adults, says Champer. This makes it hard for counselors to help. And nearly 30% of the state's teens said they felt sad and hopeless almost every day for at least two weeks in a row, according to the 2015 Montana Youth Risk Behavior Survey. To address what they consider a cry for help from the state's teens, officials in Montana are working on expanding access to school-based and tele-based counseling.

Megan Moreno, head of social media and adolescent health research at Seattle Children's Hospital, notes a big difference between the mobile-social-tech revolution of the past 15 years and things like the introduction of the telephone or TV. In the olden days, your mom told you to get off the family phone or turn off the TV, and you did it. This time, kids are in the driver's seat.

Parents are also mimicking teen behavior. "Not in all cases, obviously, but in many cases the adults are learning to use their phones in the way that the teens do," says Moreno. "They're zoning out. They're ignoring people. They're answering calls during dinner rather than saying, 'O.K., we have this technology. Here are the rules about when we use it.'"

She cautions against demonizing technology entirely. "I often tell parents my simplest analogy is it's like a hammer. You know, you can build a house that's never existed before and you can smash someone's head in, and it's the same tool." Sometimes phones rob teens' developing brains of essential downtime. But other times they're a way to maintain healthy social connections and get support.

Nora Carden, 17, of Brooklyn, who started college in upstate New York this fall, says she's relieved when she goes on a trip that requires her to leave her phone for a while. "It's like the whole school is in your bag, waiting for an answer," she says.

School pressures also play a role, particularly with stress. Nora got counseling for her anxiety, which became crushing as the college-application process ramped up. She'd fear getting an answer wrong when a teacher called on her, and often felt she was not qualified to be in a particular class. "I don't have pressure from my parents. I'm the one putting pressure on myself," she says.

"The competitiveness, the lack of clarity about where things are going [economically] have all created a sense of real stress," says Victor Schwartz of the Jed Foundation, a nonprofit that works with colleges and universities on mental-health programs and services. "Ten years ago, the most prominent thing kids talked about was feeling depressed. And now anxiety has overtaken that in the last couple of years."

Tommy La Guardia, a high-achieving 18-year-old senior in Kent, Wash., is the first college-bound kid in his family. He recently became a finalist for prestigious scholarships, all while working 10 to 15 hours a week at a Microsoft internship and helping to care for his younger brothers.

His mom, Catherine Moimoi, says he doesn't talk about the pressure he's under. They don't have a lot of resources, yet he manages everything himself, including college tours and applications. "He's a good kid. He never complains," she says. "But there are many nights I go to sleep wondering how he does it."

Tommy admits that the past year was tough. "It's hard to describe the stress," he says. "I'm calm on the outside, but inside it's like a demon in your stomach trying to consume you." He deals with those emotions on his own. "I don't want to make it someone else's problem."

Alison Heyland, 18, a recent high school graduate, was part of a group in Maine called Project Aware, whose members seek to help their peers manage anxiety and depression by making films. "We're such a fragile and emotional generation," she says. "It's tempting for parents to tell kids, 'Just suck it up.'" But, says Alison, "I feel like it really is less realistic for you to go after your dream job today. You're more apt to go do a job that you don't really like because it pays better and you'll be in less debt."

Meanwhile, evidence suggests the anxiety wrought by school pressures and technology is affecting younger and younger kids. Ellen Chance, co-president of the Palm Beach School Counselor Association, says technology and online bullying are affecting kids as early as fifth grade.

The strain on school counselors has increased since No Child Left Behind standardized testing protocols were implemented in the past decade. Tests can run from January through May, and since counselors in Chance's county are often the ones who administer the exams, they have less time to deal with students' mental-health issues.

"I couldn't tell you how many students are being malicious to each other over Instagram or Snapchat," she says of the elementary school where she's the sole counselor for more than 500 kids. "I've had cases where girls don't want to come to school because they feel outcasted and targeted. I deal with it on a weekly basis."

Conventional wisdom says kids today are oversupervised, prompting some parenting critics to look back fondly to the days of latchkey kids. But now, even though teens may be in the same room with their parents, they might also, thanks to their phones, be immersed in a painful emotional tangle with dozens of their classmates. Or they're looking at other people's lives on Instagram and feeling self-loathing (or worse). Or they're caught up in a discussion about suicide with a bunch of people on the other side of the country they've never even met via an app that most adults have never heard of.

Phoebe Gariepy says she remembers being in the backseat of a car with her headphones on, sitting next to her mom while looking at disturbing photos on her phone on social-media feeds about cutting. "I was so distant, I was so separated," she says. She says it was hard to get out of that online community, as gory as it was, because her online life felt like her real life. "It's almost like a reality-TV show. That's the most triggering part of it, knowing that those real people were out there." It would be hard for most people to know that the girl sitting there scrolling through her phone was engaged in much more than superficial selfies.

Josh, who did not want his real name published, is a high school sophomore in Maine who says he remembers how his parents began checking on him after the Sandy Hook shooting that killed 20 children and six adults. Despite their vigilance, he says, they're largely unaware of the pain he's been in. "They're both heterosexual cis people, so they wouldn't know that I'm bisexual. They wouldn't know that I cut, that I use red wine, that I've attempted suicide," he says. "They think I'm a normal kid, but I'm not."

In the CNN study, researchers found that even when parents try their best to monitor their children's Instagram, Twitter and Facebook feeds, they are likely unable to recognize the subtle slights and social exclusions that cause kids pain.

Finding disturbing things in a child's digital identity, or that they're self-harming, can stun some parents. "Every single week we have a girl who comes to the ER after some social-media rumor or incident has upset her [and then she cut herself]," says Fadi Haddad, a psychiatrist who helped start the child and adolescent psychiatric emergency department at Bellevue hospital in New York City, the first of its kind at a public hospital. Teens who end up there are often sent by administrators at their school. When Haddad calls the parents, they can be unaware of just how distressed their child is. According to Haddad, this includes parents who feel they're very involved in their children's lives: they're at every sports game, they supervise the homework, they're part of the school community.

Sometimes when he calls, they're angry. One mother whose child Haddad treated told him that she found out her daughter had 17 Facebook accounts, which the mother shut down. "But what good does that do?" says Haddad. "There will be an 18th."

For some parents who discover, as Faith-Ann's parents Bret and Tammy Bishop did a few years ago, that their child has been severely depressed, anxiety-ridden or self-harming for years, it's a shock laden with guilt.

Bret says Faith-Ann had been making cuts on her legs and ribs for three years before she got the courage to tell her parents. "You wonder, What could I have done better?" he says. Looking back, he realizes that he was distracted too much of the time.

"Even for us as adults, you're never away from work now. Before, there wasn't anything to worry about till I got back on Monday. But now it's always on your phone. Sometimes when you're home, you're not home," Bret says.

When Bret and Tammy joined a group for parents of kids with depression, he discovered that there were many girls and some boys who were also depressed and hurting themselves, and that few parents had any idea of what was going on.

Tammy said she wishes she'd followed her gut and taken Faith-Ann for counseling earlier. "I knew something was wrong, and I couldn't figure it out," she says.

Self-harm is certainly not universal among kids with depression and anxiety, but it does appear to be the signature symptom of this generation's mental-health difficulties. All of the nearly two dozen teens I spoke with for this story knew someone who had engaged in self-harm or had done it themselves. It's hard to quantify the behavior, but its impact is easier to monitor: a Seattle Children's Hospital study that tracked hashtags people use on Instagram to talk about self-harm found a dramatic increase in their use in the past two years. Researchers got 1.7 million search results for "#selfharmmm" in 2014; by 2015 the number was more than 2.4 million.

While girls appear more likely to engage in this behavior, boys are not immune: as many as 30% to 40% of those who've ever self-injured are male.

The academic study of this behavior is nascent, but researchers are developing a deeper understanding of how physical pain may relieve the psychological pain of some people who practice it. That knowledge may help experts better understand why it can be hard for some people to stop self-harming once they start. Whitlock, the director of the self-injury research program at Cornell, explains that studies are pretty consistent in showing that people who injure themselves do it to cope with anxiety or depression.

It's hard to know why self-harm has surfaced at this time, and it's possible we're just more aware of it now because we live in a world where we're more aware of everything. Whitlock thinks there's a cultural element to it. Starting in the late 1990s, the body became a kind of billboard for self-expression-that's when tattoos and piercings went mainstream. "As that was starting to happen, the idea of etching your emotional pain into your body was not a big step from the body as a canvas as an idea," she says.

The idea that self-harm is tied to how we see the human body tracks with what many teens told me when I interviewed them. As Faith-Ann describes it, "A lot of value is put on our physical beauty now. All of our friends are Photoshopping their own photos-it's hard to escape that need to be perfect." Before the dawn of social media, the disorders that seemed to be the quintessential reflection of those same societal pressures were anorexia or bulimia-which are still serious concerns.

Whitlock says there are two common experiences that people have with self-harm. There are those who feel disconnected or numb. "They don't feel real, and there's something about pain and blood that brings them into their body," she says.

On the other end of the spectrum are people who feel an overwhelming amount of emotion, says Whitlock. "If you asked them to describe those emotions on a scale of 1 to 10, they would say 10, while you or I might rate the same experience as a 6 or 7. They need to discharge those feelings somehow, and injury becomes their way," she explains.

The research on what happens in the brain and body when someone cuts is still emerging. Scientists want to better understand how self-harm engages the endogenous opioid system-which is involved in the pain response in the brain-and what happens if and when it does.

Some of the treatments for self-harm are similar to those for addiction, particularly in the focus on identifying underlying psychological issues-what's causing the anxiety and depression in the first place-and then teaching healthy ways to cope. Similarly, those who want to stop need a strong level of internal motivation.

"You're not going to stop for somebody else," explains Phoebe, the teenager from Maine. Even thinking about how upset her mother was about the self-harm wasn't enough. "I tried making pacts with friends. But it doesn't work. You have to figure it out for yourself. You have to make the choice."

Eventually, Phoebe steered herself out of the dark, destructive corners of the Internet that reinforced her habit by romanticizing and validating her pain. She's now into holistic healing and looks at positive sites populated by people she calls "happy hippies."

Faith-Ann remembers the day her mother Tammy noticed the scars on her arms and realized what they were. By then she was a junior in high school. "I normally cut in places you couldn't see, but I had messed up and I had a cut on my wrists. I lifted my arm to move my hair, and she saw it. It was scary because the cuts were in a place that people associate with suicide." That was not what she was attempting, however.

"If she'd asked me before that if I was cutting, I would have said no. I wouldn't have wanted to put that pain on her," says Faith-Ann. But that night she said, "Yes, I am cutting, and I want to stop." Tammy cried for a bit, but they moved on. She didn't ask why, she didn't freak out, she just asked what she could do to help. "That was the exact right thing to do," says Faith-Ann.

The family got counseling after that. Her parents learned that they weren't alone. And Faith-Ann learned breathing techniques to calm herself physically and how to talk to herself positively. Recovery didn't happen all at once. There were relapses, sometimes over tiny things. But the Bishops were on the right road.

One of the most powerful things Faith-Ann did to escape the cycle of anxiety, depression and self-harm was to channel her feelings into something creative. As part of the Project Aware teen program in Maine, she wrote and directed a short film about anxiety and depression in teens called The Road Back. More than 30 kids worked on the project, and they became a support system for one another as she continued to heal.

"I had a place where I could be open and talk about my life and the issues I was having, and then I could project them in an artistic way," she says.

Bellevue's Fadi Haddad says that for parents who find out their children are depressed or hurting themselves, the best response is first to validate their feelings. Don't get angry or talk about taking away their computers. "Say, 'I'm sorry you're in pain. I'm here for you,'" he says.

This straightforward acknowledgment of their struggles takes away any judgment, which is critical since mental-health issues are still heavily stigmatized. No adolescent wants to be seen as flawed or vulnerable, and for parents, the idea that their child has debilitating depression or anxiety or is self-harming can feel like a failure on their part.

Alison Heyland's dad Neil says that initially, it was hard to find people to confide in about his daughter's depression. "I see everyone putting up posts about their family, they look so happy and everyone's smiling, everything is so perfect and rosy. I kind of feel less than," he says.

For both generations, admitting that they need help can be daunting. Even once they get past that barrier, the cost and logistics of therapy can be overwhelming.

Faith-Ann still struggles at times with depression and anxiety. "It's a condition that's not going to totally disappear from my life," she says over the phone from Los Angeles, where she's thriving at film school. "It's just learning how to deal in a healthy way-not self-harming, not lashing out at people."

Of course Bret and Tammy Bishop still worry about her. They now live in Hampstead, N.C., and at first Bret didn't like the idea of Faith-Ann's going to school in California. If she was having trouble coping, he and Tammy were a long plane ride away. How can you forget that your child, someone you've dedicated years to keeping safe from the perils of the world, has deliberately hurt herself? "It's with you forever," says Tammy.

These days, she and Bret are proud of their daughter's independence and the new life she's created. But like a lot of parents who've feared for their child's health, they don't take the ordinary for granted anymore.

For more on help for teen mental-health issues, visit time.com/teenmentalhealth

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The first time Faith-Ann Bishop cut herself, she was in eighth grade. It was 2 in the morning, and as her parents slept, she sat on the edge of the tub at her home outside Bangor, Maine, with a metal clip from a pen in her hand.

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Is your child a warrior, or a worrier?

That cute - and memorable - phrasing comes from " Why Can Some Kids Handle Pressure While Others Fall Apart?" by Po Bronson and Ashley Merryman (famous for "Nurture Shock" and now the authors of "Top Dog: The Science of Winning and Losing") in The Times Magazine. It's shorthand for a problem most of us are familiar with: some people seem born to take tests or compete. For others, the whisper of pressure can trigger the seeming disappearance of everything we ever learned.

In their magazine piece, the authors look at what lies under that difference: "how we were raised, our skills and experience, the hormones that we marinated in as fetuses."

But while understanding the causes may help promote eventual changes in standardized testing, there's no way to entirely avoid the need to perform under pressure - and no way to avoid it on behalf of our children.
For the parents of worriers, one question hovers over the topic: how can we help our children learn to both perform better, and feel that stress just a little less? I asked the magazine piece's authors to help me pull out what they learned in researching their article, and to share some other ideas and background that might help.

Embrace the anxiety. Students who read a statement declaring that recent research suggests "people who feel anxious during a test might actually do better" did, in fact, do better on tests, in the lab and outside.

Find competition that's fun. Spelling bees, chess teams, sports, science fairs: when the pressure is predictable and comes with friends and excitement, even worriers build up their tolerance for the stress that doesn't include those benefits (like the SAT exams). These competitions "give kids the chance to make that connection between feeling a little anxious and performing at their best," Mr. Bronson said.

Emphasize success. Even when competition is fun, getting through it is a victory for a "worrier." Help your child focus on the ebbs and flows of the competitive anxiety, and then remind him to celebrate the accomplishment - and think back to it the next time that anxiety rears its head. Parents comfort children when they feel insecure, but we also need to foster exploratory behavior. "By destabilizing children, pushing them, we help children be brave in unfamiliar situations, stand up for themselves, and learn to take risks."

Watch for when "stress" turns into "distress." For many children, short-term stress can be energizing. But when it goes beyond the short term into a larger problem, "parents need to try to find the triggers that change test taking from a challenge state to a threat state." The child who lost sleep for a month over standardized testing (described in the article) had heard from teachers that school funding and teacher pay is partly tied to these tests now, so he felt an enormous burden to score super high on the standardized tests, to help buoy the school's averages.

Change the story. "Right now, the story is that college spots are really hard to get," Mr. Bronson wrote in an e-mail. "Cary Roseth, assistant professor of education at Michigan State University, classifies the race to college as a 'scramble competition,' like a huge game of musical chairs - except with too few chairs. This is somewhat of an illusion. Every year, U.C.L.A. runs a national survey of incoming college freshmen; last year, they collected data from over 204,000 frosh who attend 270 different bachelor's colleges. 83 percent of them were attending their first or second choice college. U.C.L.A., all by itself, admitted almost 16,000 applicants. Over 10,000 of them turned U.C.L.A. down. Nationally, 59 percent of all admittances are turned down by the students. So who is rejecting who here? Maybe we all need to hold our tongues when we're tempted to scare the kids, 'You know, you have to study harder if you want to get into a U.C.' And maybe when we say, reassuringly, 'There's a good college for everyone,' we have to convince ourselves first."

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Is your child a warrior, or a worrier? That cute - and memorable - phrasing comes from " Why Can Some Kids Handle Pressure While Others Fall Apart?" by Po Bronson and Ashley Merryman (famous for "Nurture Shock" and now the authors of "Top Dog: The Science of Winning and Losing") in The Times Magazine.

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With the help of other journalism students, we interviewed teenagers from around our school district who shared stories of depression, eating disorders, homelessness, prescription abuse, insomnia and anxiety. Many discussed their personal struggles for the first time. All agreed to attach their full name - no anonymity or pseudonyms. Following online recommendations of the Student Press Law Center, we asked the parents of each student to sign consent forms for the articles.

As we were putting the stories together, the head of our school called us into her office to tell us about a former college football player from our area who had struggled with depression and would be willing to let us interview him. We wondered why she was proposing this story to us since he wasn't a current high school student. We declined her suggestion. We didn't want to replace these deeply personal articles about our peers with a piece about someone removed from the students. After we asked her why she was suggesting this, she told us that she couldn't support our moving forward with the articles.

From an administrative perspective, this made some sense. It is her job to protect the students to the best of her ability. She believed that the well-being of those who shared their experiences - and most important, their names - would be put at risk because of potential bullying. She also mentioned that she had consulted a mental health professional, who told her that reading about their own depression could trigger a recurrence in some of the students and that those who committed to telling their stories might regret it later.

Our school has a very tolerant atmosphere, and it even has a depression awareness group, so this response seemed uncharacteristic. We were surprised that the administration and the adults who advocated for mental health awareness were the ones standing in the way of it. By telling us that students could not talk openly about their struggles, they reinforced the very stigma we were trying to eliminate.

The feeling of being alone is closely linked to depression. This can be exacerbated if there is no one to reach out to. Though there are professionals to talk to, we feel it doesn't compare to sharing your experiences with a peer who has faced similar struggles. And, most important to us, no one afflicted with a mental illness should have to believe that it's something he should feel obliged to hide in the first place. If someone has an illness such as diabetes, she is not discouraged from speaking about it. Depression does not indicate mental weakness. It is a disorder, often a flaw of biology, not one of character.

By interviewing these teenagers for our newspaper, we tried - and failed - to start small in the fight against stigma. Unfortunately, we've learned this won't be easy. It seems that those who are charged with advocating for our well-being aren't ready yet to let us have an open and honest dialogue about depression.

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With the help of other journalism students, we interviewed teenagers from around our school district who shared stories of depression, eating disorders, homelessness, prescription abuse, insomnia and anxiety. Many discussed their personal struggles for the first time.

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Contests

One of our 2017 editorial winners wrote about China's unofficial ban on Korean cultural exports, such as the boy band Exo. Credit... Starnews, via Agence France-Presse - Getty Images

The challenge is fairly straightforward. Choose a topic you care about, gather evidence from sources both within and outside The Times and write a concise editorial (450 words or less) to convince readers of your view.

Because editorial writing at newspapers is a collaborative process, you can write your entry as a team effort or by yourself. When you're done, submit it using the contest form below by Thursday, April 5, at 11:59 p.m. Eastern. Be sure to read the rules, also below, before posting.

Our judges will then use this rubric (PDF) for selecting winners to publish on The Learning Network.

As teachers know, the persuasive essay has long been a staple of high school education, but the Common Core standards seem to have put evidence-based argumentative writing on everybody's agenda. You couldn't ask for a more real-world example of the genre than the classic newspaper editorial - and The Times publishes, on average, two of them a day.

And at a time when breaking out of one's "filter bubble" is more important than ever, we hope this contest also encourages students to broaden their news diets by using multiple sources, ideally ones that offer a range of perspectives on their chosen issue.

So what issue do you care about? Gun violence? Sexual harassment? Social media? You decide.

Good luck, and please post any questions you might have in the comments. We'll answer you there.

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Note: The submission form has been removed from this page. The contest is closed.
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Video

The New York Times's editorial page editor Andrew Rosenthal provides seven tips for writing an effective editorial.

To help with this challenge, Andrew Rosenthal, in his previous role as Editorial Page editor of The Times, detailed seven pointers in the video above. And we have published related lesson plans, including " For the Sake of Argument: Writing Persuasively to Craft Short, Evidence-Based Editorials," " I Don't Think So: Writing Effective Counterarguments" and " 10 Ways to Teach Argument-Writing With The New York Times," that offer additional teaching ideas.

We have also culled a list of 401 prompts for argumentative writing organized by category, to help inspire you - although, of course, you are not limited to those topics.

We encourage you to look at both our comments on last year's winners and the winning essays themselves. They can serve as excellent models, and they cover topics from active-shooter school lockdowns to Korean television shows in China.

In addition, you can watch our free, archived webinar, featuring the Op-Ed columnist Nicholas Kristof and Kabby Hong, a high school English teacher.

1. Use at least one Times source. You can write your editorial about any topic, as long as you use at least one source from The Times. That should pretty much open the whole world to you, as you may be surprised how much you can find in The Times.

Be advised that nytimes.com has a digital subscription system in which readers have access to five free articles each month, but after that you will be asked to become a digital subscriber. The Times also offers K-12 digital subscription plans for schools. But all Learning Network activities for students, including our daily writing prompts, as well as Times articles linked from them, are free, so you can access them without exceeding the five-article limit.

2. Use at least one non-Times source. But make sure that the source you use is a reliable one. We encourage you to find sources that offer different perspectives on an issue.

3. Always cite your sources. Our submission form contains a required field for entering your citations. We include an example as well, though you can use M.L.A. or A.P.A. styles, or just list the website URLs. Even if you use a print source or an expert interview, you must provide a citation. Readers (and judges) should always know where you got your evidence.

4. Be concise. The editorial must not exceed 450 words. Your title and list of sources are separate, however, and do not count as part of your 450-word limit.

5. Have an opinion. Editorials are different from news articles because they try to persuade readers to share your point of view. Don't be afraid to take a stand.

6. Write your editorial by yourself or with a group. If you are working as a team, just remember to submit all of your names when you post your entry. But please submit only one editorial per student. If you're submitting as part of a team, you should not also submit as an individual.

7. Be original and use appropriate language. Write for a well-informed audience, but include enough background information to give context. Be careful not to plagiarize: Use quotation marks around lines you take verbatim from another source, or rephrase and cite your source.

8. Submissions must be from students who are 13 to 19 years old, and they may come from anywhere in the world. Unlike in previous years, students can now use their entire name if they want.

9. All entries must be submitted by April 5 at 11:59 p.m. Easternusing the contest form above. If you have questions about the contest, feel free to post them in the comments section, and we'll respond to you there.

10. Follow these instructions if you need proof that you entered this contest. Within an hour of submitting your editorial, you should receive an email from "The New York Times" with the subject heading "Thank you for your submission to our Student Editorial Contest." If you don't receive the email within an hour, even after checking your spam folder, then you can resubmit your entry. Be sure your settings allow emails from nytimes.com.

After two attempts and waiting over one full day, if you still have not received a confirmation email, you can contact us at LNFeedback@nytimes.com with the email address you used in the contest form. Use the subject heading "Please send me an email confirmation for my editorial contest submission." Be sure to include your name and editorial title (or subject) in your email. You may have to wait up to a week for a reply.

11. We will use this rubric (PDF) to judge entries, and the winning editorials will be featured on The Learning Network.

" Writing an Editorial" Unit Plan, by Lindsay Thompson

" Reader Idea | He Said, She Said, I Say: A Researched Argument Essay," by Danielle Harms

" Reader Idea | Using an Op-Doc Video to Teach Argumentative Writing," by Allison Marchetti

" Reader Idea | Using Room for Debate to Teach Argumentative Writing and Discussion Skills," by Gerard Dawson and Justin Rex

" Reader Idea | An Argument-Writing Unit: Crafting Student Editorials," by Kayleen Everitt

Good luck and have fun. We welcome your questions and comments if we have omitted details that might be useful. Let us know how we can help.

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The Learning Network runs contests for teenagers all year long. See our full calendar.

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Our Fifth Annual Student Editorial Contest: Write About an Issue That Matters to You (Published 2018)

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Contests The challenge is fairly straightforward. Choose a topic you care about, gather evidence from sources both within and outside The Times and write a concise editorial (450 words or less) to convince readers of your view. Because editorial writing at newspapers is a collaborative process, you can write your entry as a team effort or by yourself.

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Contests

One of this year's winners wrote about school lockdown drills. Related Article Credit... Alec Soth/Magnum, for The New York Times

Update | Read the work of _________ this year's 10 winners here and this year's runners-up here.
For the past four years we've invited students to write short editorials about issues they care about, and each year thousands take up the challenge.

Students often start with thoughtful questions from their own lives: Why is my school's athletic program better funded than its music program? Why do we hide in the corner of our classroom during active shooter drills? Why don't my classmates stand during the Pledge of Allegiance? And they develop sophisticated, sincere and well researched answers in response.

Students look at the nation's and world's problems and hunt for solutions - to improve the plight of lesbian, gay, bisexual and transgender people in China, for example, or to reduce recidivism rates for U.S. prisons.

We really like this contest because it asks students to look closely at their world and find something, large or small, they want to change. So, if you don't like being last in line all the time because your surname starts with "Z," then take a stand. If you want more characters in books and movies to be more like you, then write about it. If you want society to be less wasteful or more tolerant, then tell the world. Change starts with noticing, thinking critically, and starting meaningful conversations - and that's what these students have done in their editorials.

But winning this contest? It's no easy task being selected as a winner out of 7,895 entries, a record. How do you make your writing stand out from the piles of other editorials submitted to our contest - especially when you have no more than 450 words to get your point across?

Here's one way: Start strong. Grab our attention in the first few sentences, but don't take too long to state your argument.

Here's another: Pick a fresh topic, or a new angle on a popular topic, and be very clear about what you are arguing. Often when students narrow in on a specific concern, their editorial becomes more persuasive.

What else? Write with an original, confident voice and avoid formulaic language and structure. And if appropriate, acknowledge, and deftly dispatch, counterarguments.

Below, we list 10 winners, 15 runners-up and 45 honorable mentions. We also include a PDF of all the finalists, including 58 who made the cut to the third round of judging, but didn't quite reach the winner's circle.

Starting May 22, we will be publishing one of the Top 10 essays each weekday in posts that we hope you will spread on social media, hang on school bulletin boards and perhaps even use as "mentor texts" for next year's contest.

Thank you for participating - and we hope you'll take part in our Summer Reading Contest, starting June 16.

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Each category below lists our favorites in alphabetical order by title. Where titles were missing, we came up with our own.
Top 10 Winners
" A Psychedelic Cure?" by Reagan Briere, age 16
" In Nothing We Trust" by Francesca Kelley, age 18
" Leave the Citizens to Their TV Shows" by Yijia Hu, age 17
" Losing the Internet" by David Scharts, age 15
" Reform the Prison, Then the Prisoner" by Katherine Leonard, age 16
" Stopping Bullets With Locked Doors and Silence Is Already Pulling the Trigger" by Daina Kalnina, age 15
" The Anguish of the Rich" by Yiqi Wang, age 17
" The Asian Misnomer: What the Affirmative Action Debate Misses" by Matteo Wong, age 16
" The Collateral Damage of Defending Democracy" by Sarah Heiland, age 18
" The Missing Anthropological Exhibit at the American Museum of Natural History " by Alec Farber, age 16
_________ Runners-Up
"America First" by Safa Saleh, age 17
"America? More Like Ameri-Can't Vote" by Gianni Carcagno, age 17
"Climate Literacy: A Critical Step Toward Climate Stability" by Ella Shriner, age 14 and Hannah Witscher, age 15
"Cultural Appropriation: A Measure of Empathy" by James Chang, age 16
"Discourse Is Democracy: Allowing Uncensored Speech on College Campuses" by Abigail Hogan, age 17
"Drone Warfare: The Failing Fight Against the Modern Hydra" by Michael Levinger, age 16
"Generation Code Red" by Grace Scullion, age 16
"Humane Human Zoo?" by Ella Ward, age 15
"Paper or Plastic? How About a Paper ON Plastic!" by Melody Markert, age 17
"The Future Disintegration of American Democracy Through Athletics" by Julianne Yu, age 16
"The Case for Teaching News Literacy" by Mary Hannah Grier, age 17
"The Unspoken Alphabet Problem" by Stephanie Zhang, age 14
"The 'War on Drugs' Will Never Work; Legalization Will" by Kristina Vakhman, age 18
"There Is No Happily Ever After Without Once Upon a Time" by Bridget O'Leary, age 17
"When Will This Class Be Useful?" by Casey Stark, age 15
_________ Honorable Mentions
"#WorldChanger" by Joyce Zhou, age 17
"A Case for Impassiveness" by Lea Marchl, age 16
"A Scoop in the Right Direction" by Emma S., age 18
"AP Tests Don't Leave Enough Room for the Human Side of History" by Tom Malmgren, age 16
"Are My Shoulders Distracting You?" by Mairi Alice Dun, age 17
"Autism: Educated and Extraordinary" by Isabella Zhang, age 17
"Bittersweet" by Rena Rachlin, age 15 "Child Labor in the U.S. Today" by Jasmine Campos, age 16 and Charlotte Principal, age 16
"China Needs Silver Lining" by Wangchen Zhou, age 17
"Colleges Should Abandon Race-Based Affirmative Action to Achieve True Diversity" by Eric Davis, age 18
"Embrace the Mess" by Chi Yu, age 14
"Fast Fashion Is Destroying Our World" by Melissa Wang, age 17
"Food Stamps Need a Change" by Patrick Meara, age 17
"Governor Cuomo Frees the Plastic Bagss" by Jiayan Chen, age 17
"Help Wanted: Moderate Politicians" by Ireland Degges, age 17
"High School Should Not Just Be About Sports" by Swathi Kella, age 16
"How Far Can Post-Truth Democracy Take Us?" by Jiahe Yang, age 18
"How to Revitalize the Public Education System" by Dhara Yu, age 18
"Last Man Standing" by Kathryn Porter, age 16
"Leave Me Alone" by Celia Silver, age 17
"More Than a Morning Kick" by Emma Cary, age 16
"Multiple Choice: Not Multiple Enough" by Yi-Mei Templeman, age 17
"Picking Cotton: An Immigrant's Perspective" by Allan Njomo, age 16
"Post-Democracy" by Nadav Ziv, age 17
"Should Juvenile Offenders Receive Life Sentences Without Parole on Their First Offense?" by Tayler Gavetti, age 16
"Should Obamacare Be Repealed?" by William Pharo, age 16
"Single Payer: A Cure for America's Healthcare Woes" by Akshay Manglik, age 13
"Streaky Friendship" by Yuxin Long, age 16
"Technology: A Hindrance to Learning" by Zachary Weiss, age 17
"Teens, Technology, and The Pursuit of Happiness" by Sam Jagolinzer, age 17
"The Bluest Note" by Nicholas Dasoveanu, age 18
"The College Conspiracy" by Serenity W., age 17
"The Cost of Health Care May Be in Your Genes" by Sophia Lo, age 16
"The Demoralizing of the Elizabethan Language" by Olivia Seymour, age 14
"The Disposable Nightmare" by Tianxin Guo, age 14
"The Education Gap" by Adam Traweek, age 16 "The Environment in the Age of Trump" by Elliot Tuttle, age 17
"The Growing Problem of Screen Addiction" by Kaitlin Craig, age 16
"The Picture of Education We Must Change" by Danielle Naidrich, age 17
"Tipping the Pay Scale" by Ruhee Damle, age 14
"Untitled" by Melinda Hartz, age 16
"We Should Be Teaching Rap Music in Schools" by Jack Zuckerman, age 19
"What Do You Call Someone That Only Speaks One Language? An American." by Paige Patton, age 16
"Where Are All the Rainbows?" by Storm Viridian Murray, age 17
"Where Trump's Ban Stands Legally" by Marcus Linde, age 16
_________ And All the Finalists, Including 58 More Great Editorials That Made It to Round 3 (PDF) Judges: Amanda Christy Brown, Shannon Doyne, Caroline Crosson Gilpin, Michael Gonchar, Annissa Hambouz, Thomas Houston, Shira Katz, Willow Lawson, Linda Leavitt, Sue Mermelstein, Anna North, Roxie Salamon-Abrams, Katherine Schulten, Matt Schwarzfeld, Natlie Shutler and Kate Spence-Ado

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A Call to Action: Winners From Our Fourth Annual Student Editorial Contest (Published 2017)

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Contests Update | Read the work of _________ this year's 10 winners here and this year's runners-up here . For the past four years we've invited students to write short editorials about issues they care about, and each year thousands take up the challenge.

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Our 100 Most Popular Student Questions for Debate and Persuasive Writing

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Here are the 100 most-commented-upon questions we’ve ever asked that call for persuasive writing.

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Google Docs - create and edit documents online, for free.

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Create a new document and edit with others at the same time -- from your computer, phone or tablet. Get stuff done with or without an internet connection. Use Docs to edit Word files. Free from Google.