When Lifestyle Changes Aren’t Enough to Reduce Stress

Claire was at the end of her rope and didn’t know what to do. Her boyfriend, Mark, had just broken up with her—again. Her grades were suffering because she found it incredibly difficult to concentrate in school, and her parents were on her case about it. Her little sister was a complete brat and Claire had to share a room with her. A lot of nights she couldn’t even get to sleep because her sister insisted on texting her friends until after 11 o’clock. That meant she’d be really tired again the next day, which made everything harder to

deal with. What really bothered Claire, though, was the eating thing. She tried not to, but she thought about every single thing she put into her mouth and avoided eating whenever possible. When her mother noticed that Claire wasn’t eating and forced her to finish a bowl of soup one night, Claire made herself throw up afterwards, making sure that nobody could hear her.

Claire had always considered herself to be pretty mature and capable of handling her life, but now she felt like everything was out of control. She’d tried exercising to help with her stress level, but she just didn’t feel like she had enough energy to take a run. She had really worked on making herself eat healthy meals, but she felt like she was getting fatter and fatter and she couldn’t stand how she looked. She’d tried to talk to her sister about the sleeping prob­lem, but her sister couldn’t care less about anyone but herself. She couldn’t really talk to her best friends about her situation with Mark, because they didn’t like him in the first place and were glad that he and Claire were no longer together.

Claire was getting increasingly distraught and feeling more and more that her life was out of control and she’d never be happy again. Her stress level was at an all-time high, her life felt like it was falling apart, and she was at a loss for how to deal with it all.

KNOWING WHEN IT’S TIME TO ASK FOR HELP

Stress management, Physical exercise, stress level, healthy meals,

Sometimes it’s very difficult, or even impossible, to handle a situa­tion on your own, and you’ll need to ask someone to help you. It’s not always easy to do that, because our society teaches us that it’s important to be strong and self reliant. Even though the perception has changed somewhat, there’s still a level of admiration for people who are perceived to be tough and powerful and in control.

As you get older, however, you’ll begin to understand that very, very few people make it through life without any problems, and nearly everyone reaches points in their lives when it’s wise to reach out to a trusted friend, family member, or professional for some help. Our everyday lives continue to become more and more stressful, and increasing numbers of people, like Claire, are exhibiting the results of all that stress. So, how do you know when you’ve moved past the stage where you can handle a stressful situation on your own, and it’s now time to ask someone for some help?

The lifestyle changes you made didn’t improve the situation. You stopped drinking anything with caffeine in it and you made it a point to run for two miles every day. You’ve tried hard to get on a good nighttime schedule to assure that you’d get enough sleep, and that situation has improved. All of those changes that you worked so hard to implement, though, haven’t made you feel any better. If anything, you’re feeling more stressed out, because the exercise takes time away from your homework or your down time, and you end up feeling frus­trated and overwhelmed.

You were unable to implement the lifestyle changes that you recognize as desirable. You really wanted to start eating better, because you thought that would give you more energy and then you’d be able to get some exercise every day, and maybe you’d feel better. However, the healthy eating didn’t seem to work out. You just couldn’t force yourself to eat the sandwich you’d bring for lunch because you didn’t feel in the least bit hungry. You’d just play with your food at dinner, and you never were a breakfast eater, so that wasn’t an issue. When you did get hungry, you’d just grab a soda or an energy drink and maybe a granola bar or an apple or something. You’re always feeling tired, so it’s impossible to get any exercise. You feel like a real loser because you couldn’t make the changes you wanted to, but that’s just the way it’s going right now.

The cause of your stress never lets up. No matter what kind of grades you get, your dad always yells at you and tells you they aren’t good enough. Even when you had all As and just one B, he was upset about the B and angry that you were only taking two honors courses when some other kids were taking three. When he’s not complaining about your grades he finds something else to yell at you for—a messy room, forgetting to empty the dishwasher, not taking the dog out often enough. He always finds something to upset him, and it seems like it’s always you he picks on.

The cause of your stress has subsided, but you still feel overwhelmed and anxious. You thought you’d feel so much bet­ter when your uncle, who’d been staying at your house for a couple of months, moved out. Not that you don’t love your uncle, but he really made you nervous when he was around. He always stood too close to you and he touched you a lot in ways that seemed creepy and weird. He paid too much attention to you and would come into your room while you were doing your homework and stand behind you, some­times rubbing your shoulders. You tried to talk to your mom about it, but she said you were just being silly and imagining things, even though you felt really scared and anxious. He finally moved out a couple of weeks ago, but you find that you’re still feeling on edge and uneasy. You’ve been having some bad dreams and finding it hard to get a good night’s sleep, and your grades have been slipping because you feel so distracted and fretful.

If any of those situations apply to you—if you’ve made lifestyle changes that haven’t helped, have tried but found you’re unable to make desirable lifestyle changes, are experiencing unrelenting stress, or have stress that’s subsided but you still feel anxious and uneasy—you should consider asking for some help. Someone trained in stress management can help you in a number of ways, by teaching you several tactics and strategies:

> How to better cope with common stressors

> New skills and resources that will help you deal with situa­tions that need to change

> How to implement the skills and resources that will help bring about change

> How to better deal with situations that won’t change

There is no shame in asking for help, and you and those around you will benefit once you do.

KNOWING WHO TO ASK FOR HELP

If you’re lucky, you have what’s called a support system. Simply stated, your support system is the people in your life with whom you can talk about your problems and concerns. Some people have small support systems made up of only one or two people, while others have extended support systems.

Lisa, for instance, is an only child, a 15-year-old girl who lives with her mom. Her mom and dad are divorced and she hardly ever sees her father, who remarried and moved to a different state when Lisa was just three years old. Her grandparents have either died or live far away, and she has only two cousins, both of whom live in another part of the country. Lisa’s pretty shy and it’s never been easy for her to make friends, especially because she and her mom tend to move around a lot, depending on her mom’s boyfriend and job situations.

When Lisa has a big problem, the only person she feels comfort­able approaching is her mom, who often is too busy or distracted to pay much attention to her. The situation is even more complicated for Lisa recently, because her latest problem—and it’s a big one—is that her mom’s new boyfriend made a serious pass at her and has been making inappropriate remarks. Lisa is thinking about going to see a guidance counselor at school, but she feels like she’d be intrud­ing and the counselor might get angry. Lisa, unfortunately, and for a number of reasons, has a very limited support system.

David, on the other hand, has a large support system. He’s not one of the “popular crowd,” but the 16-year-old has a lot of friends whom he trusts and with whom he’s comfortable. He’s in the marching and concert bands at school, and he and other band members hang out together all year long. David is also involved with the chess club, sings in his church’s choir and is active in the youth group, so he’s usually pretty busy and involved with others.

His mom and dad live together and get along pretty well, and, although David doesn’t agree with everything they do, he’s got to admit that they take good care of him and his brother and sister. It’s easier sometimes to talk to a friend about a problem, but David knows that his parents will help him when he needs it. He’s also friendly with a couple of adults at his church, and they’ve told him more than once to let them know if he ever needs anything. He sees his cousins pretty often because they live nearby and the families get together for picnics or trips sometimes. And David is really close to his granddad, who lives just one town over.

When David got into a situation—a friend of his stole a pair of sun­glasses from a store at the mall when David was with him and was caught on film and apprehended by store security—David was incred­ibly upset because he thought he’d be in big trouble too, even though he didn’t even know his friend had taken the glasses. David agonized over whether or not to “fess up” to his parents about what had hap­pened, and the situation became very stressful for him. Fortunately, he was able to talk to his grandfather about it, who accompanied his grandson when David explained the situation to his parents, as his grandfather had encouraged him to do.

It’s easy to see the differences between Lisa’s and David’s situa­tions concerning support systems. Most people’s support systems fall somewhere in between those examples, and, many people rely heav­ily on their friends and relatives when problems occur. Who might you turn to when you have a problem that you feel you can’t resolve on your own?

A parent or other relative. Talking to your parent, or perhaps a grandparent or aunt or uncle, is a great approach for addressing a problem that you consider serious. Sometimes, however, for whatever reasons, teens are uncomfortable discussing certain topics with par­ents and may seek out someone else.

A friend or several friends. Friends who will listen to your concerns and understand you are wonderful resources, and there’s nothing wrong with sharing your problems with them. But friends often don’t have the answers to serious problems or the resources to help you change a troublesome situation. So remember that while it might be good for you to share your problem and get it out into the open, there are times when your friends may simply not be equipped to help you.

A trusted teacher, youth group leader, or other adult. A trusted adult is a great idea for someone who will listen to you and assist you in getting additional help, if necessary. Some problems, however, require the expertise of a mental health professional who has been trained in diagnosing and treating conditions relating to stress and anxiety.

A pediatrician who you know. Many teens have been seeing the same pediatrician for a long time and have gotten to know that person. You might ask your parent to make an appointment with your pediatrician, or your parent might suggest that you see him or her. Either way, it’s a good idea, because a pediatrician can rule out a physical problem that could be presenting symptoms that mimic those caused by stress. A thyroid problem, for instance, could cause you to feel tired and depressed, much like significant amounts of stress can.

FINDING A MENTAL HEALTH PROFESSIONAL

Some stress-related conditions will require the expertise of a mental health professional who can assess the situation and provide treat­ment. Mental health professionals are trained to treat mental, emo­tional, and behavioral disorders. If you have tried talking to your friends or parents or other trusted adults and have not gotten the relief you’d hoped for, you should consider contacting a mental health professional.

Mental health is by no means a new subject or new area of study, but some people still find it to be mysterious and even threatening, which makes them reluctant to seek help for mental health issues. Some people consider asking for help to be a sign of weakness, but that couldn’t be further from the truth. Not being afraid to ask for some help is a smart and strong decision, and it indicates that you’re stepping up to the plate to take charge of a situation. So, congratulations!

If you’ve been to a pediatrician to rule out any sort of physical problem or have talked to a school counselor or a parent, one of them may have already recommended that you seek professional help and that he or she can assist you in doing so. It’s possible that your mom talked to Andrea’s mom, who recommended a psycholo­gist who helped Andrea through a rough spot a few months back, and your mom has decided to call that professional. If you’re looking for a mental health expert on your own, however, or you’re working to help your parent identify someone, you may need a little direction before making a decision about whom to call. There are various types of mental health professionals, some of which will have more experi­ence treating stress-related problems than others.

Generally, patients suffering from stress-related problems are most successful when they are treated with cognitive-behavioral therapy, a form of psychotherapy in which therapists help their clients to bet­ter manage problems by helping them to change the way they think, behave, and respond to various situations. Cognitive therapy has been proven to be useful in treating an array of disorders, including those associated with stress. Therapists who use this model are have had spe­cial training and have done extensive educational and clinical work.

To locate a thoroughly trained cognitive therapist in your area, you can check out the Academy of Cognitive Therapy Web site at http:// www.academyofct .org, which includes a state-by-state directory. Another site to try is the Association for Behavioral and Cognitive Therapies, at http://www.aabt .org.

You should be aware that there are different types of specialists who work with patients suffering from stress-related problems. You might be referred to a psychiatrist, psychologist, licensed professional counselor, or a clinical social worker. All of these professionals are licensed and certified to provide treatment. However, others, such as pastoral counselors and psychotherapists, may or may not be licensed and certified. That doesn’t mean that a pastoral counselor or a psycho­therapist (which is a general name for just about anyone who provides counseling) can’t provide valuable treatment, it’s just that those pro­fessions aren’t as closely regulated as those that require licensing.

Psychiatrist. A psychiatrist must have completed four years of med­ical school and at least three years of residency training in medicine, neurology, and general psychiatry. Psychiatrists are medical doctors who specialize in diagnosing and treating mental conditions, and are qualified to prescribe medicines. Psychiatrists must be certified by the board of psychiatry and neurology, and pass licensing tests in the states in which they will practice. With extra training, a psychiatrist can become board-certified in child and adolescent psychiatry. All psychiatrists must pass written and oral exams, and must be recerti­fied every 10 years.

Psychologist. There are several varieties of psychologists, including clinical psychologists, developmental psychologists, school psycholo­gists, and counseling psychologists. The most common type of psy­chologist in a treatment setting is a clinical psychologist—someone who has earned a doctoral degree and are qualified to diagnose and treat mental, emotional, and behavioral disorders. Psychologists in most states are not licensed to prescribe medicines, so they often work closely with psychiatrists who can provide prescriptions when necessary. Clinical psychologists help patients with both short- and long-term problems, and some specialize in certain types of problems, such as anxiety or depression, while others specialize in treating cer­tain populations, such as adolescents or the elderly.

A developmental psychologist specializes in what is going on with a person during a specific time of life, such as childhood or adoles­cence, and can measure behaviors and development as they compare to others in the same period of life. A school psychologist works with students, parents, and school personnel to address behavioral issues and other difficulties encountered in the school setting. School psy­chologists often hold master’s degrees instead of doctoral degrees. A counseling psychologist works with clients in matters of day-to-day life, helping them to find strategies to cope with problems and draw on their strengths to achieve goals.

Psychologists work in various settings, including hospitals, clin­ics, schools, and private practices. Because there are various types of psychologists, it’s important to find one who has good training and experience in the areas in which you’ll be looking for help. If you’re seeking treatment for a stress-related problem, you probably should identify a psychologist with clinical experience to help you. Look for someone who is certified and licensed in the state in which he or she is practicing.

Licensed professional counselor. A licensed professional coun­selor must hold at least a master’s degree in counseling or a related field, successfully complete supervised clinical training, and be certi­fied by the state in which he or she will practice. These counselors employ various strategies to address wellness, personal growth, and other areas of concern.

Social worker. You might think of a social worker as someone who works with poor people or families in which parents have trouble caring for their children, but some social workers—called clinical social workers—are licensed or certified to work with clients in a clinical setting to prevent, diagnose, and treat mental, behavioral, and emotional disorders. Requirements vary from state to state, but all clinical social workers must have a master’s or doctoral degree in social work, with an emphasis on clinical experience; have completed an internship; and have completed at least two years of supervised clinical social work.

Pastoral counselor. If you look in the counseling section of your phone book, you’ll probably notice the title “pastoral counselor.” A pastoral counselor has completed both theological and psychological training, and addresses problems in terms of religion and spirituality. Some pastoral counselors are licensed, but most states do not pro­vide licensing. An advantage of pastoral counselors is that their fees generally are lower than those of some other types of mental health professionals. However, most insurance plans won’t cover pastoral counseling unless the counselor is licensed.

Psychotherapist. The term psychotherapist can refer to almost anyone, licensed or otherwise, who provides counseling services. Counselors range from psychiatrists to ministers, as well as social workers, psychologists, marriage counselor, addictions counselors, and psychiatric nurses. While there is a room for all types of coun­selors, when you’re working to address a problem that’s become serious to you and is affecting your life, it’s important to know who you’re working with and be sure the person is qualified and credentialed.

Regardless of the type of professional you end up going to, it’s extremely important that you find out the person’s level of experience in treating stress-related disorders and in using cognitive therapy. Don’t be afraid to ask questions and look for information online. Ask questions about the average length of treatment for a patient with a stress-related disorder and how many people suffering from your particular problem the person has treated. Sources such as Angie’s list, which contain actual feedback about doctors from patients and others, are controversial, and you need to use those sorts of sites cautiously. However, you usually can look online to learn about a professional’s educational credentials, clinical training, years of expe­rience, licensing status, and so forth.

TAKING CARE OF BUSINESS BEFORE TREATMENT BEGINS

Once you’ve identified a mental health professional and made an appointment, it seems reasonable to expect that you’ll show up at the right time and begin treatment for your stress-related problem. If you’ve been to a new doctor any time recently, you might know that probably won’t be the scenario you’ll experience.

Some part of your first visit to the professional who will be treat­ing you is likely to be spent filling out forms. Unless you’ve made the appointment on your own and do not have the support of a family member, you’ll need to have a parent or guardian with you to sign some of the forms.

You’ll probably be asked to read information regarding the prac­tice’s privacy policy and fill out forms such as a statement of finan­cial responsibility (normally a parent completes that one), a personal history questionnaire, an authorization for release of protected health information, and possibly other forms. You’ll be asked to answer a lot of questions that are very personal, but it’s extremely important to be honest—that way, the professional who will be treating you can get an accurate assessment of what’s going on and learn what issues need to be addressed.

Some teens find it difficult to be completely truthful when they fill out personal history forms and questionnaires, which normally include questions concerning smoking, drug and alcohol use, and may contain questions about sexual history and other issues about which teens may be reluctant to share information. If you are asked to answer such questions, remember that an experienced health-care professional will have treated a great many patients, and it’s extremely unlikely that he or she will be disturbed or shocked by anything you write on the form. As a patient, it’s your responsibility to be honest in order to best facilitate treatment.

Under normal circumstances, before your treatment starts, you, your parents or guardian, and the therapist will have a conversation regarding what type of information will be shared with your parents, and what will remain confidential between you and the therapist. You might agree that parents will sit in on any sessions regarding medical problems, such as stress-related headaches, but will not be present for sessions during which you discuss situations in school that are making you feel stressed and causing problems. Joint sessions may be scheduled to deal with problems between your parents and you or other family members.

These situations vary from patient to patient and family to family, and it sometimes can be challenging to reach an agreement that suits all involved parties, but it’s important that an understanding is in place before therapy begins. You should realize that while conversa­tions between a health-care professional and a patient are generally confidential, a doctor or other mental health-care provider is obli­gated by law to report it if someone is threatening to harm himself or others. On the flip side, the same law may prevent a doctor from informing parents of issues such as repeated drug use. Much of what a doctor shares with parents will be determined by the conversation among the three parties prior to the start of treatment, so you can see that it’s important that the conversation takes place and all the parties involved share the same expectations.

WHAT TO EXPECT DURING TREATMENT

Once all the forms are filled out and everyone is in agreement regarding how and when information will be shared, you’ll have your first session with the doctor or therapist. Note that the description of treatment that follows pertains to cognitive-behavioral therapy, which was described earlier in the post. Other types of therapies will vary from what you’ll be reading about here, but, if you choose cognitive therapy, this will give you a good idea of what you can expect.

During your first session, your doctor or therapist will ask you a lot of questions in order to get to know you and to find out what’s going on in your life that is resulting in stress. It’s important for the thera­pist to understand the full context in which stress is occurring, which means he will ask you questions regarding a wide variety of issues. If you say that you’re stressed out about your grades, for instance, the therapist might ask you questions regarding the following:

> Physical problems or conditions

> Learning disabilities

> Peer relationships and pressures

> Boyfriend or girlfriend issues

> Parental relationships

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> Homework habits

> Psychological history

> Social relationships

> Other problems in school, such as bullying

> Sleeping habits

> Pressure placed on you by yourself and others

You might think that some of the questions are stupid, or that the therapist is incredibly nosy, but you should trust that he knows what he’s doing and the information he’s seeking is necessary in order to identify the real causes of stress and be able to help you make changes.

The therapist will look at how stress is occurring on several lev­els, and will ask you questions to learn how it is affecting you. For instance, he or she might ask, do you experience headaches or knots in your stomach? Do you tend to freeze up when confronted with a stressful situation? Does your mind go blank? Do you break out in a sweat, or feel nauseous, or scared, or panicky? Understanding the ways in which stress is causing you pain is necessary in order for the therapist to help you get past the pain.

After the doctor or therapist has gathered a broad range of informa­tion, he’ll begin asking you some very pointed and specific questions. And he’ll ask you to tell him about a recent experience during which you were very stressed. The conversation might sound something like this:

Doctor Willer: So, give me an example of an experience you had recently that caused you to feel really stressed out.

Rachel: We had a chemistry test last week and I knew I wasn’t going to do well on it.

Dr. Willer: Well, tell me what you were thinking when the teacher handed out the test.

Rachel: I was thinking that I was going to flunk it.

Dr. Willer: How were you feeling when she handed out the test? Rachel: I was feeling really scared.

Dr. Willer: How did you react when the test was handed out? Rachel: My mind went blank and I couldn’t concentrate.

Dr. Willer: Well, if you would flunk the test, what does that mean about you?

Rachel: It means that I’m stupid and I can’t do anything right. Dr. Miller: Okay, I see.

At this point, Rachel has revealed both her automatic thought and her core belief, both of which are very significant in cognitive-behav­ioral therapy. Rachel’s automatic thought was that she was going to flunk the test, and that triggered the emotion of feeling scared, and the behavior of blanking out and not being able to concentrate. The thought of flunking the test led her back to her core belief of being stupid and unable to do anything right.

Core beliefs are established in different ways, and they usually apply to many areas of a person’s life. Certain personality traits may make a person vulnerable to possessing a core belief that he or she is stupid and unable to do anything right, but it’s more likely that the belief is a result of what he or she has heard and experienced.

In Rachel’s case, for instance, her parents pushed her very hard and expressed serious disappointment when her grades were not at the top of her class. They did this because they want Rachel to get into a great college, graduate with honors, get a terrific job, and be highly successful. Rachel, however, perceives that they’re pushing her because they believe she’s incapable of getting good grades on her own, or doing anything else on her own, for that matter. She’s come to the conclusion that she’s stupid and can’t do anything right, and this belief affects many areas of her life and the relationships she has with others.

The job of the therapist, in a case like Rachel’s, is to help her to recognize her automatic thought and her core belief, to evaluate her beliefs and to develop alternative beliefs. Rachel and Dr. Miller would first work on replacing her automatic thought with another one.

Dr. Willer: So, you were thinking that you were going to flunk the test.

Rachel: That’s right. I was sure that I would.

Dr. Willer: How many tests this year have you already flunked? Rachel: Well, I haven’t flunked any tests.

Dr. Willer: Oh. What grades do you normally get on tests? Rachel: I almost always get As or Bs.

While evaluating her belief, Rachel realizes that her automatic thought is not consistent with her personal experiences. At this point she can work to change it. Her new thought might be something like this: “I know that I get nervous when I have to take a test, but there’s no reason to think I’m going to flunk it, because I always do quite well. I know that I studied hard for this test. I’ll do my best and it will probably work out the same as it has in the past.”

Of course, this thought won’t come automatically for a while, and Rachel will be tempted to fall back on her old automatic thought that she would flunk the test. By being aware of the situation, however, she can redirect her thoughts toward the new statement. Replacing the old automatic thought with a new one will lead to changed emo­tions and behaviors. Instead of feeling really scared when the test is handed out, Rachel will feel just a little nervous. And, instead of blanking out and not being able to concentrate, she’ll be aware of her heart beating a little faster than normal, but she won’t lose her ability to stay focused on the test. Changing her automatic thought to one based on her actual experiences will help Rachel to deal with the stress associated with test taking and build up her confidence.

Addressing and changing the automatic thought and the reactions that result from it is the first part of the cognitive therapy process. Addressing and changing the core belief is a little more difficult.

TREATING THE CORE BELIEF

Rachel’s core belief, which has resulted from a variety of factors, is that she is stupid and unable to do anything right. Her life circum­stances, however, do not support that belief. She doesn’t flunk tests; in fact, she does very well in school. She doesn’t wreck the car every time she drives; in fact, she passed her driving test on the first try and has never had a problem with the car. She doesn’t get to the grocery store and not know why she’s there; in fact, her mother often sends her out on errands. Rachel has plenty of friends who care about her, and she’s active in her church’s youth group. Generally, she’s a well-rounded individual who navigates life perfectly fine.

The work of Rachel and Dr. Miller is to identify situations that trigger Rachel’s core belief so she’s aware of when that belief is likely to nega­tively affect her, and to replace the core belief with a different one.

Rachel might realize that her core belief of being stupid kicks in when she’s confronted with taking a test, talking with her father about current events, eating dinner with her family—even, some­times, when she’s playing board games with friends. Upon closer examination, however, she also begins to realize that there is no evidence to support her core belief, and quite a bit of evidence that proves it wrong.

After that realization, Dr. Miller will help Rachel to come up with an alternate core belief, such as this: “This situation [such as taking a test or talking with her father] often triggers my core belief that I’m stupid, but a review of evidence from my life does not support my belief. The evidence suggests that I am competent at a lot of things, and if I keep that in mind, I will probably do pretty well at most of what I attempt.”

Changing a core belief doesn’t happen in one therapy session, or overnight, or in a week. It can take months of working and talking to yourself and substituting the new core belief for the old. Patients who are willing to do that work, however, very often can change the way they view their lives and themselves, and learn to more easily cope with stressful situations. If you’re working with a therapist, be prepared to continue the work on your own between sessions. Typi­cally, you’d see the therapist once a week at first. It’s very easy to for­get from one session to the next what you’d covered, and a waste of time to have to review what’s already been done. Ask your doctor for homework between sessions, and be prepared to devote a fair amount of time to your treatment—you’ll find that it’s well worth the effort.

Treatment with a cognitive-behavior therapist can last from a few months for simple issues to several years for more serious ones. Many people schedule appointments on and off after they’ve stopped therapy on a regular basis, and that can be very helpful when you’re anticipating a stressful situation. Therapy doesn’t work in the same manner for every patient, and it’s important to take your time in determining what works best for you.

MEDICINES USED TO TREAT STRESS-RELATED PROBLEMS

Many doctors recommend a combination of therapy and medication for significant stress-related problems, such as depression or anxiety. In fact, a recent study by the National Institute of Mental Health, a division of the governmental agency the National Institutes of Health, revealed that a combination of therapy and medication was more effective than either therapy or medication alone when treating teens suffering from moderate to severe depression.

If a doctor or psychiatrist prescribes medicine for you, he or she probably will suggest that you work with a psychologist or other type of counselor to determine the best course of action for your treatment. Conversely, if you begin treatment with a psychologist or other type of therapist who does not prescribe medicine, the therapist might request that a doctor or psychiatrist review the potential benefits of medicine with you.

If your doctor or therapist recommends that you take medication, it’s important to find out everything you can about the medicine pre­scribed and follow your doctor’s directions as to how to take it. Make sure the prescribing doctor knows about any other medications­ including vitamins and herbal supplements—you might be taking. If you take asthma medicine, for instance, it’s important to make that known. Ask how often you should take the medicine, if you need to take it with food or milk, if it is likely to cause any side effects, what happens if you feel better and think you no longer need the medicine, and how long you might expect to take it.

If paying for medicine is a problem for you or your family, there are some options for getting it at a reduced cost or for free. More informa­tion about that is available in this post, “Paying for Care.”

A variety of medicines are used in treating teens who suffer from stress-related disorders such as depression and anxiety. You’ll notice that some of the same meds are used to treat both of those conditions. Drugs commonly used to treat anxiety include the following:

> Selective serotonin reuptake inhibitors (SSRIs) > Tricyclic antidepressants > Benzodiazepines

Drugs commonly used to treat depression include the following:

> Selective serotonin reuptake inhibitors (SSRIs) > Tricyclic antidepressants

> Serotonin norepinephrine reuptake inhibitors (SNRIs) > Monoamine oxidase inhibitors (MAOIs)

It’s important to know that you might have to try more than one course of treatment until you find a medicine that is effective for you. Sometimes a doctor will prescribe of combination of meds, and often, dosages need to be adjusted.

If you are prescribed medicine and, as is hoped, start feeling much better, don’t stop taking your meds without consulting your doctor. And, because some studies have suggested a link between certain drugs used to treat depression and teen suicide, it’s important to tell someone right away if you begin feeling hopeless, overwhelmed, or have thoughts of harming yourself.

WHAT YOU NEED TO KNOW

> It can be extremely difficult, or impossible, to handle an ongo­ing, highly stressful situation on your own. If you feel that you’re unable to do so, the smartest thing to do is to ask for help.

> It may be time to ask for help for your stress-related problem if you’ve tried lifestyle changes and they didn’t work, if you were unable to implement the lifestyle changes you wanted to, if the cause of your stress is ongoing and never stops, or if the cause of your stress has stopped but you still feel anxious and overwhelmed.

> If you feel like you need to talk to someone about the circum­stances that are causing you great stress, look first to your sup­port system, which may include parents, grandparents, trusted neighbors or other relatives, friends, a school nurse, youth group leader, pediatrician, and so forth.

> If you don’t get the relief you’re looking for from members of your support system, consider contacting a mental health pro­fessional, who is specially trained to treat mental, emotional, and behavioral disorders, and will be able to assess your situ­ation and provide treatment.

> Cognitive-behavioral therapy, either by itself or combined with medication, has been proven to be an effective method of treating stress-related problems in teenagers.

> Mental health professionals include psychiatrists, psycholo­gists, clinical social workers, licensed professional counselors, pastoral counselors, and psychotherapists.

> Once you’ve located a mental health professional, you can usually look online to learn about his or her educational cre­dentials, clinical training, years of experience, licensing status, and so forth.

> You’ll be asked to fill out a lot of forms and provide a lot of information before actual therapy begins. It’s important to cooperate and provide accurate, complete information.

> It may seem like your doctor or therapist is incredibly nosy, but he or she needs to obtain a wide variety of information in order to be able to assess your situation and help you over­come your stress-related problems.

> A cognitive-behavioral therapist will work with patients to help them evaluate destructive automatic thoughts and to change their core beliefs.

> Various medications are available to treat stress-related prob­lems in teens. If you’re prescribed medicine, be proactive and learn all you can about it, how it works, possible side effects, and so forth.

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Many tips are based on recent research, while others were known in ancient times. But they have all been proven to be effective. So keep this website close at hand and make the advice it offers a part of your daily life.