Living with a family member who has an anxiety disorder can be a challenge in itself. Many times, family members will focus all their support to the adolescent with the disorder and consequently neglecting other members of the household, leading to resentment or feelings of rejection. Often parents will develop a sense of guilt or blame themselves, and wonder if they had a part to play in the development of the disorder.
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Research suggests that family boundaries are reevaluated when a family member is struggling with an anxiety disorder (Dikec, Ergun & Gumus, 2018). For example, an adolescent with severe panic attacks is unlikely to care for themselves and other family members may in turn accumulate additional responsibilities in the home. When the change in responsibilities occur in an unnegotiated manner, this can cause strain in the form of stress, tension and further resentment (Dikec, Ergun & Gumus, 2018).
There are two common approaches families take to help cope when their adolescent develops anxiety: the overbearing, intrusive parent or the uninvolved, get over it parent. Very rarely does a supportive and empathetic family who is supportive of treatment come along. The majority of the time, families who are open to treatment usually identify as White American; they will seek treatment and expect the therapist to fix their child. These families are cooperative yet not involved in treatment. Contrary to the overbearing family, the get over it family, commonly linked to Hispanic Americans and African Americans, rejects the idea that the adolescent has developed the disorder and acknowledges the symptoms as a phase (Bettis et al., 2018).
There are numerous Evidenced-Based Interventions such as Attachment-Based Family Therapy (ABFT), acceptance commitment therapy (ACT), and exposure therapy that help reduce symptoms of anxiety disorders. However, research has demonstrated that despite the newly integrated evidenced based practices, individual cognitive behavioral therapy (CBT), has proven to be one of the most effective treatments not only in treating the symptoms but addressing the underlying reasons for the excessive fears (Sheets et al., 2013). Cognitive Behavioral Theory suggests that our cognition (how we think) affects how we feel and in turn affecting our behavior which then impacts our thoughts, creating a never-ending cycle if left unaddressed. The psycho-social intervention aims at addressing all three components to reduce the maladaptive behaviors the youth have engaged in to reduce their thoughts. CBT is individually tailored to the adolescents’ needs and can be utilized across cultures (Alegria, Atkins, Farmer, Slaton, & Stelk, 2010).
The long-established therapeutic approach is the most widely used treatment for individuals with anxiety disorders (Thompson, May, & Whiting, 2013). Challenging cognitive distortions is CBT’s key component in reducing maladaptive behaviors. The name itself suggest two vital elements: cognitive, which focuses on how negative thoughts induce anxiety, and behavioral which focuses on the behavior the youth engages in when in an anxious situation. Family upbringing, attitudes, individual expectations and beliefs all influence thoughts thus the same situation can lead to completely different cognitive distortions in different people. The main objective of CBT is to recognize thought distortions and challenge them, ultimately replacing them with accurate thoughts. This process is also known as cognitive restructuring.
Cognitive restructuring involves three key steps. The first step is to identify the pattern of negative thoughts. Once the negative thoughts are identified, the second step requires challenging the distortions by questioning the evidence which involves past experiences and weighing the pros and cons. Lastly, once the irrational thoughts are challenged the final step is to replace them with accurate and realistic thoughts. By changing the thought process, we can change the negative emotions associated with those thoughts and eventually reducing the avoidance behaviors (Young, et al, 2012). Although cognitive restructuring is a critical component, CBT improved emotional regulation by implementing mindfulness techniques and developing coping strategies that target anxious symptoms (Young et al., 2012).
CBT’s strengths lie within the therapeutic approach’s ability to be researched and measured for effectiveness. Despite its structured sessions, it’s flexibility in approach allows for the evidenced based practice to be implemented across different cultures, races, ethnicities, social classes and identified gender. Its limitations focus on whether the negative thoughts are a result of the anxiety rather than the cause (Wong et al., 2018). Aside from the cause, the CBT approach is narrow minded as it concentrates on cognition and ignores other factors such as family influence (Wong et al., 2018).
There are over four decades of research that provide support for the effectiveness of CBT among adolescent youth struggling with anxiety (Cohen, Mannarino, & Deblinger, 2012). The extensive clinical studies all conclude that the integrative technique is the gold standard of treatment for mental health disorders. Meta-analysis conclude that CBT interventions have the lowest relapse rates of any psychological treatment. Even the new evidenced-based interventions designed to target anxiety are CBT based approaches (Cohen, Mannarino, & Deblinger, 2012).
Pedro, a 19-year-old identified male, was referred by his county clinician after developing symptoms of agoraphobia. Approximately 3 months ago, Pedro’s panic attacks increased from his normal frequency which resulted in an inability to work, inability to continue college and impaired his interpersonal relationships. Pedro received and ACE score of 9.
Despite the various physical examinations, Sebastian’s anxious symptoms are not linked to a physical illness. Pedro is physically healthy emerging adult with no history of illness aside from the occasional flu.
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