Adolescence

Adolescence is the time of great development between childhood and adulthood (Call et al., 2002). Although the World Health Organisation describes adolescence as being between ten and nineteen years old, many agree that adolescent development continues in to the mid-twenties (Arnett, 2000;  World Health Organisation, 2021a). The proportion and number of adolescents present in each country differs due to cultural demographics (Petersen et al., 1992). Globally however, the proportion of adolescents is rising as young people are provided more time and opportunity to develop skills necessary to perform their new adult role in industrialised society (Patton, 2018). Children must adaptively progress through a number of physical, psychological and social changes during this maturation process (Call et al., 2002). Those who are not able to adaptively navigate these changes are at higher risk of developing mental health problems (World Health Organisation, 2021a).

Anxiety

Anxiety is the most common mental heath issue in Australia and it is seen in many forms (Beyond Blue, 2022a). People with a generalised anxiety disorder suffer from a persistent sense of worry across most situations (Beyond Blue, 2002b). This has a great impact on daily life as there is no specific source or trigger for this form of anxiety (Beyond Blue, 2022a). As small issues which are encountered in safe environments can become the focus of anxiety, greater issues in larger contexts can become even more overwhelming (Beyond Blue, 2022a). Within the context of adolescence, anxiety disorders can affect normal daily functioning in a number of ways. Commonly identifiable symptoms include irritability, tiredness, restlessness, tension and difficulty sleeping and concentrating (Beyond Blue, 2022a). These physical symptoms make it difficult for adolescents to perform in a number of settings, affecting their ability to work, study and socialise (Beyond Blue, 2022a). This increases the likelihood of school avoidance which can make the situation worse (Carsley et al., 2017). As individuation is a social process, anxiety disorders can therefore have a negative effect on adolescent development.

Anxiety can also surface in a number of other presentations. People may have specific phobias which affect their ability to perform in specific situations (Beyond Blue, 2022a). Social anxiety is also common, where people have an intense fear of negative social consequences (Beyond Blue, 2022b). Anxiety can also physically materialise in the form of panic attacks (Beyond Blue, 2022a).

Evidence of Symptoms 

A number of cognitive, behavioural and social factors are implicated in the development and continuance of a generalised anxiety disorder (Hazlett-Stevens, 2008). The underlining view held by those with a generalised anxiety orders is that the world is dangerous and that they do not have the physical, social or emotional skills necessary to adaptively navigate it (Hazlett-Stevens, 2008). Worrying then becomes the primary strategy used to cope with an increased sense of threat (Hazlett-Stevens, 2008). People with underdeveloped emotional regulatory skills therefore avoid situations that cause an increased sense of worry (Hazlett-Stevens, 2008). As perceived threats are catastrophised, those suffering from a generalised anxiety disorder can live in a state of hypervigilance (Hazlett-Stevens, 2008). If not corrected this hypervigilance contributes to the development of muscle tension, restlessness, fatigue, irritability, sleep disturbances and difficulties concentrating (Nutt et al., 2002). When the aforementioned symptoms are experienced for a significant period or time or cause functional impairment a generalised anxiety disorder is diagnosed (Nutt et al., 2002).

As brain size and function improves markedly during adolescence, so does the adolescent’s ability to think critically and abstractly (Steinberg, 2005). This increase in cognitive ability is necessary for individuation, as the adolescent must self-construct an individual identity necessary to assume a role in adult society (Steinberg, 2005). Adolescents that do not meet cognitive milestones in line with their peers may therefore experience stress (Luna et al., 2004). Adolescents that do not possess the cognitive and social skills necessary to address this stress may develop avoidance strategies (Hazlett-Stevens, 2008). Although stress avoidant strategies may reduce the immediate stress experienced by the adolescent, social withdrawal can consolidate social dysfunctional and reduce the opportunity for the adolescent to build protective cognitive, social and behavioural skills (Steinberg, 2005).

Impact on the Individual and Interactions

Generalised anxiety disorders are chronic and prevalent (Wittchen & Hoyer, 2001). Individuals who suffer from a generalised anxiety disorder are very likely to develop other functional impairments on top of their social dysfunction (Wittchen & Hoyer, 2001). For example, adolescents that are diagnosed with a generalised anxiety disorder are up to five times more likely to develop a drug or alcohol abuse problem (Stewart & Conrod, 2007). In addition to negative health outcomes, adolescent anxiety is also associated with poor peer and family relationships (Bögels & Brechman-Toussaint, 2006; Vernberg et al.,1992).

Anxiety disorders are also associated with an early school dropout (Van Ameringen et al., 2003). One study investigating the reasons for students leaving school prematurely determined that anxiety was the primary concern for twenty-four percent of students (Van Ameringen et al., 2003). It was also determined that those adolescents who left school prematurely were more likely to have a life time diagnosis of anxiety and likely to develop extra maladaptive coping strategies such as alcohol and drug abuse.

On a societal level, workers with anxiety disorders often exhibit reduced performance levels and are more prone to accidents (Haslam et al., 2005). Also, as there is a stigma attached to mental health disorders, workers are less likely to disclose their condition which reduces their ability to seek help and increases the likelihood company performance levels reducing (Haslam et al., 2005).

Suggested Interventions

There are a number of different intervention strategies that can be implemented to address generalised anxiety disorders. A variety of drug therapies have been determined effective and may be appropriate depending on an individual’s specific context (Fisher, 2006). Applied relaxation, cognitive therapy and cognitive behaviour therapies however have been identified as the most effective treatment options for generalised anxiety disorder (Fisher, 2006).

Within the school context Guidance Officers should focus on developing relaxation strategies with students with anxiety so that they have the skills necessary to self-regulate and continue social engagement (Jerath et al., 2015). Specific breathing techniques, grounding strategies and mindfulness activities can assist adolescents to refocus and self-regulate (Jerath et al., 2015). Guidance Officers should also co-develop an action plan with anxious adolescents that builds upon their protective strengths and mitigates risk factors. Anxious adolescents should be supported in approaching previously anxiety inducing situations in a manner that restories anxiety induced narratives (Jonas et al. 2014).

As generalised anxiety disorders increase the likelihood of further functional impairments, early identification and treatment is vital for community health (Wittchen & Hoyer, 2001). Due to this Guidance Officers should advocate for, develop and implement preventative measures within their school contexts (Seligman et al., 1999).