Teenagers and Anxiety Since 2020

• Why is my teen so much more anxious than before?
• How do I help without pushing them away?

By Dr. Douglas Cowan, Psy.D., MFT

The teen anxiety I see now looks different from the teen anxiety I saw before 2020. There is more of it. And it has a different shape.

I meet young people who lost one, two, sometimes three years of ordinary adolescence. They missed the hallway talk, the awkward first dance, the group project, the daily practice of being around other people. They moved into screens, and when the world opened again, everyone expected them to pick up where they left off.

They could not. Not because they are weak. Because a teenage brain grows through other people, and those people were suddenly gone.

What the research says

A 2021 analysis of 29 studies, with more than 80,000 young people, found that about one in five had clinically elevated anxiety symptoms during the first year of the pandemic, nearly double the earlier rate. Older teens and girls had the highest rates (1).

Teen mental health had been getting harder even before 2020. Studies of national survey data found rising depression and suicide-related thoughts among US teens starting around 2010, and researchers linked part of that rise to time on screens (2). Other researchers push back. They find that the average link between digital technology and teen well-being is small, and that how a teen uses a screen matters more than how long (3, 4). Both views have real data behind them.

Here is what I can say plainly. For some teens, social media makes things worse. In one national study of US youth, more time on social media was linked with more anxiety and depression symptoms (5). In one trial of college students, cutting social media to about 30 minutes a day lowered loneliness and depression over three weeks (6). For other teens, screens are a lifeline. The question to ask is, “How does my teen feel after the scroll?”

What is happening in the brain

The teen brain is under construction. The front part, which handles judgment, self-control, and calming big feelings, keeps maturing into the mid-twenties. The emotional centers run at full speed. Teens care intensely about belonging, feel rejection sharply, and have less built-in brake than an adult.

That mix makes adolescence a time of higher anxiety risk even in good times. Take away the daily peer practice that teaches the nervous system, “I can handle awkward and come out okay,” and the alarm stays sensitive.

There is one more loss I want to name: hope. A teen who cannot picture a good future carries more anxiety in the present. Rebuilding hope is part of the treatment.

Why avoidance makes it worse

When a teen stays home from school, the anxiety drops right away. That relief teaches the nervous system, “Staying away is how we stay safe.” The next morning is harder. Researchers who study school refusal describe this pattern clearly, and they emphasize early, active steps over waiting (7).

So the goal is not pressure, and it is not rescue. It is graduated movement, with support, back toward the things that are hard.

What helps

Explain the brain to your teen. Teens respond to “here is what is happening in your brain, and why it makes sense” far better than to “just push through.” When anxiety stops feeling like a personal failure, shame drops and willingness to try goes up.

Teach a first-response skill. The double sigh (a breath in, a small second sip of air, then a long slow breath out) takes seconds and nobody notices. Practice it when calm. See our guide to breathing strategies.

Make school return a plan. Meet with the school counselor and a therapist. Start with part of a day, one class, or a low-demand time. Add a little each week. Some return needs to start soon.

Protect sleep first. Teen body clocks run late, and anxiety, homework, and screens push bedtime later still. Research on adults shows a single night of lost sleep raises anxiety (8). Set a consistent wake time, keep phones out of the bedroom, and dim screens an hour before bed.

Set clear, kind screen limits. Explain your reasons. Keep devices out of bedrooms at night. Protect time for in-person friends. A rule you explain works better than a rule you only announce.

Get the right treatment. In a large trial of young people with anxiety, ages 7 to 17, cognitive behavioral therapy and the medication sertraline both helped, and the combination worked best (9). Look for a therapist who knows adolescent anxiety and involves parents.

Rebuild connection slowly. One friend. One activity. One low-pressure plan at a time.

Ask about other options. If anxiety is strong and lasting, ask your teen’s clinician whether neurofeedback or another tool might fit alongside therapy. The research in teens is still developing, so these are add-ons, not replacements.

Start today

• Have one calm conversation about what is happening in the brain, and bring curiosity, not lectures.
• Practice the double sigh together once a day.
• Set a phone-out-of-the-bedroom rule starting tonight.
• Call the school counselor this week if school is a struggle.
• Book a visit with a therapist who works with teens.
• Take our GAD-7 check-in together if your teen is willing.

Teens who are struggling are not lost. They are stuck in patterns their nervous systems learned for good reasons. Those patterns can be unlearned, and the brain at this age is wonderfully ready to change.

Keep the door open, and keep walking toward it together.

This article is for education and is not a substitute for professional diagnosis or treatment. If you or your teen are in crisis, call or text 988 in the United States.

References

1. Racine, N., McArthur, B. A., Cooke, J. E., Eirich, R., Zhu, J., & Madigan, S. (2021). Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19. JAMA Pediatrics, 175(11), 1142-1150. https://doi.org/10.1001/jamapediatrics.2021.2482
2. Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among U.S. adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6(1), 3-17. https://doi.org/10.1177/2167702617723376
3. Orben, A., & Przybylski, A. K. (2019). The association between adolescent well-being and digital technology use. Nature Human Behaviour, 3(2), 173-182. https://doi.org/10.1038/s41562-018-0506-1
4. Odgers, C. L., & Jensen, M. R. (2020). Annual research review: Adolescent mental health in the digital age: Facts, fears, and future directions. Journal of Child Psychology and Psychiatry, 61(3), 336-348. https://doi.org/10.1111/jcpp.13190
5. Riehm, K. E., Feder, K. A., Tormohlen, K. N., Crum, R. M., Young, A. S., Green, K. M., et al. (2019). Associations between time spent using social media and internalizing and externalizing problems among US youth. JAMA Psychiatry, 76(12), 1266-1273. https://doi.org/10.1001/jamapsychiatry.2019.2325
6. Hunt, M. G., Marx, R., Lipson, C., & Young, J. (2018). No more FOMO: Limiting social media decreases loneliness and depression. Journal of Social and Clinical Psychology, 37(10), 751-768. https://doi.org/10.1521/jscp.2018.37.10.751
7. Kearney, C. A. (2008). School absenteeism and school refusal behavior in youth: A contemporary review. Clinical Psychology Review, 28(3), 451-471. https://doi.org/10.1016/j.cpr.2007.07.012
8. Ben Simon, E., Rossi, A., Harvey, A. G., & Walker, M. P. (2020). Overanxious and underslept. Nature Human Behaviour, 4(1), 100-110. https://doi.org/10.1038/s41562-019-0754-8
9. Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753-2766. https://doi.org/10.1056/NEJMoa0804633