Anxiety Treatment: A Guide for Health Care Providers

Pediatricians across the nation have been diagnosing anxiety with increased frequency.  

“Stress can trigger anxiety, and factors associated with the pandemic were very stressful for children and parents alike,” said Kelly Banneyer, PhD, assistant professor of pediatric psychology at Texas Children’s Hospital. “Additionally, increases in screening for anxiety and awareness of different anxiety symptoms may also contribute to increased diagnosis.” 

Both of these factors, recent psychological stress from the COVID-19 pandemic and increased awareness of and screening for anxiety, have increased the need for intervention, but there are often not enough mental health providers to meet that need. Effective treatments for anxiety in children can be life changing for affected children and their families, and primary providers can help in various ways while waiting to find an available psychotherapist. 

Medications 

Prescribing medications is appropriate for primary care providers who feel comfortable managing psychiatric medications in children, but may not be the right first step.  

“For mild presentations, we usually recommend starting with behavioral intervention since medication management may not be necessary,” said Dr. Banneyer. 

To determine if a patient is struggling with a more severe form of anxiety, Dr. Banneyer recommends looking at how it is affecting the child’s day-to-day life. Understanding how a patient’s life has changed since noticing an onset or worsening of anxiety can also be useful. 

“Generally speaking, if a child is worrying so much or avoiding so many things that it interferes with their functioning at school, in social situations or with family, there may be a significant problem,” said Dr. Banneyer. 

Involving families 

For both children and adolescents, involving parents and caregivers is an essential part of the process, and so preparing adults for being involved in treatment and educating them about a given condition is important when making the diagnosis.  

“Anxiety treatment incorporates parents so that the family understands the practices children will be doing at home, can assist in the practices and can fade accommodation over time. This is true for young children as well as adolescents,” said Dr. Banneyer. 

Understanding therapy options to make an appropriate referral 

Providers with a variety of licensures can provide therapy to children. Psychologists have a doctorate degree and will have a research background in addition to having a clinical therapy practice. Social workers, licensed marriage and family therapists, licensed professional counselors and licensed specialists in school psychology typically have masters degree and can also have an independent clinical therapy practice.  

Once a child or adolescent is in therapy, a provider may use different approaches to address the anxiety. Cognitive behavioral therapy (CBT) is a common approach that has been proved through scientific study to help ease anxiety symptoms. Other approaches, such as play therapy, are not as effective for anxiety. 

“CBT has been one of the most widely studied therapy modalities. It is based on the theory that there is a relation between a person’s thoughts, feelings and actions,” said Dr. Banneyer.  

The idea of changing a person’s approach to their psychological distress that is foundational to CBT has been applied to many specific mental health concerns. For anxiety, many pediatric providers will use CBT in conjunction with exposure and response prevention (ERP) techniques that help children and adolescents build confidence and confront situations that trigger their anxiety.  

“While ERP is the most effective strategy, ERP can be done in conjunction with other therapy techniques, such as acceptance and commitment therapy (ACT),” said Dr. Banneyer. ACT is an approach that encourages a patient to accept their negative emotions without letting those emotions remove them from a full life.  

Families may spend a significant amount of time looking for a therapist for their child and explaining the value of some of these approaches can help them make an informed and effective decision. 

Positive encouragement and hope can go a long way 

Primary providers can help children and adolescents see that relief from frequent struggles with anxiety is possible and encourage them to participate in their mental health care. Even if the steps toward progress seem tiny, being a cheerleader for children and adolescents who are making any degree of progress is important.  

“PCPs should encourage families to help their children approach (rather than avoid) feared situations in small steps,” said Dr. Banneyer. “Even when the specific fears may differ, helping children to face their fears in a step-by-step manner and learning bravery techniques remains the same.” 

Refer a patient to the Texas Children’s Pediatric Psychology program online or by calling 832-TCH-CARE (832-824-2273).