27
Jan 25

How Long Will My Teen’s Mental Break Last?

HowLongWillItLast.jpg“Think of your teen’s recovery in three phases: crisis phase, healing phase, and recovery phase.”

Mental illness tends to emerge slowly in teens. It can be difficult to pinpoint exactly when it started and even more difficult to estimate when it will resolve. Nevertheless, it is important for parents to have an idea of what to expect so that they can plan in terms of their job, their other children, and their teen’s school year.

First, keep in mind that your child has probably been ill for a while already. Mental illness is insidious in the sense that it comes on so slowly that the victim barely notices, and the changes in the patient are so gradual that it can take a while for loved ones to notice. Recovery is equally slow and gradual.

Think of your teen’s recovery in three phases: crisis phase, healing phase, and recovery phase.

Crisis Phase: Your teen may be in a state of crisis This can be a confusing time because parents have to figure out what is going on and how to find help. It helps if everybody can remain patient and hopeful. Remember, if you cross a therapist off your list, you’ve gotten closer to finding the right person. It usually takes a month or two to find the right therapist and psychiatrist and to notify the school.

Healing Phase: Your teen will begin the process of improving, regressing, and then improving some more. Medicine trials can take weeks to months. Take comfort in the fact that your teen is receiving good care and everyone is doing the best they can. This phase of learning about the illness and stabilizing the symptoms is likely to take six months to a year. This may seem like a long time, but it may be comforting to know that your teen’s rate of progress is rather typical.

Recovery Phase: Your teen will continue to improve but may not be able to handle as much schoolwork or as many activities as in the past. They may also still be trying to deal with medicine side effects. In addition, this final recovery phase may include changes in friends, interests, and activities. This phase is likely to last a year.

Remember that these are estimates. Your child’s timeline may be different, but hopefully it will help you to plan. Don’t hold back on alerting the school about what is going on with your teen. They can be your best ally, possibly providing on-campus support and assistance with classes and scheduling. Depending upon your work situation, you may find it helpful to let your boss know what is going on. This is a decision that must be carefully weighed. It is likely that you will need to be available to your teen more in the early part of recovery than later.

Keep a weekly record of what is going on with your teen. Progress can be so slow that it feels like none is occurring. With a record, you can occasionally look back and realize how far your teen has come. In the case of something like depression, it can be useful to rate the severity of the depression on a daily basis using a scale of 1 to 5, with 1 being barely depressed and 5 suicidal. Often, the patient believes he is still depressed when, really, he is considerably improved. Watch for significant changes that indicate improvement and praise your teen for making strides. Something as simple as being willing to resume walking to school again instead of being driven is cause for celebration.


21
Jan 25

Caring for the Anxious Teen

anxiousteen.jpg“Sometimes anxious people fail to give themselves credit for what they have accomplished.”

Anxiety can be described as conscientiousness run amuck. I once heard a corporate manager point out that anxious people make wonderful employees: they’re never late for work, they rarely make mistakes, and their work is immaculate. But anxiety can be crippling, causing your teen to miss school, experience insomnia, and hide from friends.

Putting Anxiety in Perspective
During an anxious episode, start by expressing sympathy for your teen’s anxiety. This can be difficult if it seems like they are blowing the situation out of proportion. Yet, a simple acknowledgement of their discomfort can significantly reduce the anxiety immediately. We all need to feel understood.

Now that you’ve been able to get your teen to relax and trust you, ask in a calm tone if they can isolate the specific triggers that are causing anxiety. There may be several. They may recognize on their own that one of them is not really a big deal. For the remaining issues, ask a few questions. If possible, have your teen sit down with you and write their answers on a piece of paper. Seeing the words on the page can provide clarity and reassurance. Ask these questions:

  •  What is the worst that can happen? If that happens, what can you do?
  • Is there anything you can do about the problem now?
  • Can you create a step-by-step plan of action?
  • Can you forgive yourself in advance if you don’t achieve your goal?

The point of the exercise is to try to get your teen unstuck from the circular thinking typical of anxiety. Try to get them to step outside of the immediate worry by promising that every situation eventually has a resolution.

Evaluating and Reducing Anxiety
Another useful exercise for the teen who is either driven or a perfectionist, is to have them scribble down a list of their accomplishments at the end of each day. This should help them to realize that they are doing all they can. For example, if they are feeling overwhelmed about completing their college applications, have them list the things they have already finished. Sometimes anxious people fail to give themselves credit for what they have accomplished.

Help your teen learn to reduce big jobs into several small tasks. Make the first few tasks easy, and ask them to start with the first one. Note how long it takes and then tell them how quickly they completed the task. Ask f they will go through the list and assign to each task the number of minutes or hours it will take to complete. Then set up a realistic schedule for completing the entire job. If the job is going to take three days to finish, tell them to look at only the tasks for the current day. The next time they feel overwhelmed by a large job, remind them that they successfully handled it in the past, and they can successfully handle it now.

Getting Through the Worst Moments
During your teen’s most anxious moments, encourage them to take deep breaths. This advice may annoy them, but ask them to try it because it will refocus their energy. Another helpful exercise is to take a brisk, twenty-minute walk.

Ask your teen to come up with a mantra. For example, “I’m doing the best I can.” Ask them if they will allow you to say this to them when they are becoming overwrought. For example, you could say, “You’re doing the best you can” as they are getting out of the car for school. Remember, though, that you need to have their permission. Coming from you, the phrase could either soothe or irritate them, so ask in advance.

If a worry or a thought keeps intruding into your teen’s thoughts, teach them to put it on hold. They can do this by picturing a stop sign and silently saying, “Stop.” They may also choose to substitute a positive thought. For example, if they realize that they have been telling themselves, “I’m going to fail this test,” they can interrupt the thought by saying, “I’m well-prepared for this test.” The old message will pop back in, but if they keep halting it, the periods between episodes will lengthen and they will come to realize that they can control these intrusive thoughts.

Daily Pleasures
The anxious teen often neglects to indulge in a daily pleasure, preferring to torment themselves with the possibilities of future disasters. A daily pleasure means living in the moment. It might be watching a half-hour television show with you after dinner, playing a game of cards before bed, reading a mindless novel for an hour after school, or spending time each day on a craft project. As trite as it might sound to your teen, scheduling a routine activity that provides a pleasurable or creative outlet will add up to a big relief of stress.

Reducing Unstructured Time
If your anxious teen could see how many minutes a day she spends brooding, you might both be stunned. Unstructured time is an enemy to the anxious teen. If your teen is spending hours each day in their room and coming out looking stressed, it is time to take action. Get them involved in an activity outside of the house. This can include joining a club, getting a part-time job, volunteering at school, or taking lessons. At home, include a daily fun activity, chores, and some form of physical activity, such as walking the dog each day. They will probably not want to do any of these things, but start adding them one at a time. They can start dinner one afternoon a week, do their laundry another afternoon, and pick up their younger brother from football practice another day. All of these activities will keep their mind occupied with thoughts that force them to live in the present.

Anti-Anxiety Medicines
Your teen’s psychiatrist may prescribe an antidepressant or other medicine for their anxiety. Be watchful for side effects or an increase in their anxiety; if this occurs, report it to the doctor. If the doctor prescribes a quick acting, short-term medicine from the benzodiazepine family (for example, Ativan, Valium, Klonopin, Xanax), he is likely to monitor your teen closely because it can be habit-forming. If you are concerned that your teen may become dependent upon the drug, calculate how frequently they take it. For example, when you need to refill the drug, look at the date the prescription was filled and divide the number of days by the number of pills used. If they are using it once or twice a week, you can relax. If they are using it daily, you may want to bring it up to the doctor. Above all, do not have your teen quit a benzodiazepine cold turkey if they have been using it regularly because they are likely to experience serious withdrawal symptoms, including insomnia and temper outbursts. Your doctor can easily manage your teen’s titration of a benzodiazepine by gradually tapering it off. The same is true of antidepressants.

Anxiety tends to be a pervasive trait, even after the acute symptoms are under control. Help your teen recognize that their conscientiousness is a positive quality that will aid them in achieving their goals. To discern the difference, if they are fretting, they can stop and ask, “Is this helpful?” Eventually, they will learn to manage their thoughts so that they can benefit without suffering.