A selected topic from the approved list: The implementation of a family-based therapy for the management of anxiety disorder in adolescents 13 to 18 years of age in the primary practice clinic setting.
PICOT question: In a group of patients between the ages of 13-18 with complaints of anxiety (P), does the implementation of family based therapy program and/or behavioral therapy program (I), compared to pharmacological interventions (C), result in reported decrease in anxiety symptoms (O) within 12 weeks (T)?
The purpose of the presented project is to determine if the implication of a family based therapy program for adolescents from 13 to 18, who are diagnosed with anxiety disorders, may reduce the symptoms. The goal of the project is to encourage adolescents to go through family-oriented therapy in order to reduce negative manifestations of anxiety disorder without further pharmacological intervention. Moreover, medication and drug treatment may have considerable health consequences, hence this project may reduce the use of potentially malicious methods. The main objective is to establish a formalized framework for implementation of family based therapy in primary care. As primary care facilities are highly involved in management for anxiety disorders in adolescents, the project may provide a variety of alternative approaches to decrease the challenges these facilities face.
Background and Significance
Anxiety disorders in adolescents represent an emerging issue, which has a significant negative impact for both individuals and society. Almost 20% of young people are diagnosed with mental disorders related to anxiety. The number may be underestimated due to teenagers not willing to inform the elders about their symptoms. In many cases people who suffer from anxiety tend to be ashamed of discussing the topic with their relatives and particularly parents. Above-mentioned tendencies lead to anxiety disorders remaining undiagnosed and family members not being able to help. Approximately seventy percent of teenagers, who are suffering from anxiety disorders or mental health illnesses, do not receive any form of medical treatment at all (Mental Health First Aid, 2019). Adolescents often receive emotional support only from their friends in school, which may lead to inefficient or even harmful advice regarding the illness. Such actions may lead to use of medication, which is not suitable for anxiety disorder treatment.
New challenges related to anxiety disorders in adolescents require development and implication of new approaches in therapy. One of the latest issues regarding anxiety is closely linked with coronavirus pandemic. As the U.S. was significantly influenced by anxiety before, COVID-19 only worsened the situation. First of all, coronavirus represents a source of stress and fear for many people with anxiety disorder (Rivera & Carballea, 2020). Risk of coronavirus, product shortage and a list of specific measures may lead to development of anxiety. Moreover, the pandemic dealt a dramatic blow to the healthcare system, making it impossible to provide patients with proper care. Lack of medication and unavailability of professional therapy increases anxiety disorder rates.
There is a wide list of various factors that may lead to development of anxiety and related mental issues. It is possible to determine several reasons why more and more people tend to suffer from anxiety. One of these reasons is the establishment of modern technology and use of new means of communication. Some studies have shown that there is an interrelation between the growth of popularity of social media and the increase of anxiety disorder cases (Keles et al., 2019). Teenager use of social media is increasing with rapid rates causing higher chance of adolescent anxiety or depression development. Reasons behind the noticeable correlation between information technology use and mental illness establishment include lack of physical activity, wrongful perception of society and poor self-esteem. In addition, current pandemic restrictions as well as lockdown conditions caused a vast increase in demand for technology. As digital information becomes more valuable and significant than ever, its constant consumption makes anxiety disorders increasingly prevalent and the issue more relevant.
Diagnosing and treating adolescents with anxiety may be hampered by a number of diverse problems. One of the most significant issues is related to treatment prices. It may be financially difficult or even impossible for some individuals to afford proper therapy and medications. Moreover, people tend to not attach enough value to mental health. Another issue is that families may lack knowledge about the facilities that provide mental health treatment and seeing a primary care provider may be delayed (Salloum et al, 2016). Late attendance may lead to worsening of conditions and complication of future treatment. Furthermore, anxiety disorders may be extremely hard to diagnose as they may appear as behavioral or physical problems and there are no unambiguous indicators or symptoms. Some of these problems may be minimized by the implication of family based therapy.
Anxiety disorder treatment issues also include primary care providers (PCPs) not willing to prescribe medications for some reasons. One of these reasons is that the medications may not be particularly suitable for anxiety and require constant monitoring and precise dosage levels. In addition, medication course may be relatively time and money consuming as it may continue for up to six weeks. Some medications, including serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors may represent an efficient way of treatment, yet they need weaning off. Adolescent of benzodiazepines as a part of anxiety treatment may cause addiction and lead to further problems (Garcia & O’Neil, 2021). Anxiety may require lifelong treatment, which makes the choice of treatment approaches even more significant. Research showed that psychotherapy methods such as cognitive behavioral therapy alone may reduce anxiety symptoms. Nevertheless, combinations of pharmacy approaches and therapy were proven to be the most effective.
The social environment has a substantial impact on the development of anxiety disorders. It may also powerfully contribute to effective treatment of the disorder. Social environment is complexly structured and consists of a large number of diverse elements, which influence an individual. One of the main elements for an adolescent is family. According to various researches family and particularly parents play a significant role in anxiety treatment. Moreover, due to pandemic lockdown, family has even more impact on a child, since people spend most of their time at home. Restrictions also reduce opportunities for certified medical providers to conduct proper care and treatment. Therefore, family based therapy may become not only the most efficient, but in some cases the only available. It is crucial for parents to understand the issues behind anxiety in order to help children overcome problems and fears (Novotney, 2019). Both the child and the parents should be provided with therapy to achieve a common goal of reducing anxiety symptoms.
PICOT Formatter Clinical Projection Questions
In the process of evaluation of project’s potential effectiveness the studied population includes adolescents between the ages of 13 and 18, who complained about and were diagnosed with anxiety disorders. The program involves implications of family based and/or behavioral therapies, which include behavioral, communication and exercise recommendations. The targeted group will be compared to people provided with traditional pharmacological care for anxiety. Assessment will be made through recording of anxiety symptom exhibition rates before and after conducting the therapeutic program. The expected outcome would be to reduce expression of anxiety symptoms in the targeted group within 12 weeks.
Anxiety disorders may cause life-long difficulties for patients, their relatives, healthcare facilities and the whole society. Anxiety has a list of possible causes, which have considerable influence in the modern world. Development of social media and increasing demand for digital information as well as growing educational issues, fast changing social norms and pressures, pandemic restrictions and constant stress contribute to rising anxiety cases. As the issue becomes more and more significant, it is crucial to implement new approaches in treatment and care. Traditional methods focus on pharmacological intervention and medication, which may cause serious health problems or addiction. There is a number of alternative or complementary therapies, including family based therapy. As family plays a major role in a life of a teenager, the development of framework for such interventions may decrease unwanted manifestations of anxiety disorder.
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