May 6, 2020
Anne Marie Albano, PhD, professor of medical psychology and
psychiatry at Columbia University, New York, and director of the
Youth Anxiety Center at New York–Presbyterian Hospital, discusses
strategies for treating childhood, youth, and young adult anxiety
with Nick Andrews.
who also is director of Modern
Minds, an anxiety and depression program in Charleston, S.C.,
spoke with Nick (@Nick_Andrews_)
Dr. Albano has no conflicts of interest.
- Early identification of activity avoidance is essential because
it is difficult to reverse the cycle of escape and avoidance, and
this is all the more difficult with school avoidance.
- Parents should validate that facing anxiety is difficult and
that the child might be afraid. The parental role is to help
problem-solve ways to manage anxiety, continue to provide
exposures, and help the child cope with their fears rather than to
accommodating and enabling.
- In 2008, Dr. Albano and colleagues published a randomized,
controlled trial in the New England Journal of Medicine showing
that sertraline, cognitive-behavioral therapy, or a combination of
both are all more effective treatments for anxiety than placebo.
The treatment effect degrades over time as the developmental
challenges change, so children will need booster sessions or must
return to treatment.
- Young adults sometimes misinterpret “normal” emotions of
apprehension with overwhelming anxiety that disincentivizes them to
engage in activities. Therapy teaches children to “ride the wave”
of anxiety and continue to move toward new experiences.
- Dr. Albano is currently developing a program that uses virtual
reality to role-play difficult developmental experiences that cause
anxiety and help young adults learn how to advocate for themselves
and problem-solve through anxiety.
- Dr. Albano noticed that, when parents do not push children to
participate or let them get out of activities, this can exacerbate
the child’s anxiety. Early identification of avoidance is essential
because it is difficult to reverse the cycle of escape and
avoidance, and this is all the more difficult with school
- As a strategy, parents can offer children a choice of
activities and push for the child to choose one of them. Parents
should validate that facing anxiety is difficult and the child may
be afraid. The parental role is to help problem-solve ways to
manage anxiety, continue to provide exposures, and help the child
cope with their fears instead of accommodating and enabling.
- The psychotherapy treatments focus on “riding the wave” of
emotions that come with new or intimidating experiences and pushing
toward exposures. Young adults sometimes misinterpret “normal”
emotions of apprehension with overwhelming anxiety, and this
confusion disincentivizes engaging in activities.
- Dr. Albano has always integrated parents into treatment.
Working with parents means finding the balance between the parents
swooping in to help or rescue the child with coaching, setting
limits, and pushing children toward experiences that will be
exposures to anxiety.
- The biggest challenge is the extent to which technology tethers
parents to children and builds dependency.
- More research needs to be done on what types of children
progress with specific types of treatment, how long to stay in
treatment, how to transition out of treatment, and when to offer
booster sessions. Dr. Albano wants to expand treatment out of
clinics and to the places in the community where anxiety happens
and is at risk of hindering child development.
Walkup JT et al.
N Engl J Med. 2008 Dec 25;359(26):2753-66.
Kagan ER et al. Child Psychiatry Hum Dev. 2020 Apr 6. doi:
Hoffman LJet al. Current Psychiatry Rep. 2018 Mar 27. doi:
Chen A. For kids with anxiety, parents learn to let them face
NPR. Morning Edition. 2019 Apr 15.
McGuire JF et al. Depress
Anxiety. 2019 Aug;36(8):744-52.
Show notes by Jacqueline Posada, MD, who is associate producer
of the Psychcast and consultation-liaison psychiatry fellow with
the Inova Fairfax Hospital/George Washington University program in
Falls Church, Va. Dr. Posada has no conflicts of interest.
For more MDedge Podcasts, go to
Email the show: email@example.com