Angela has missed many days of school due to frequent stomach upsets and headaches, but her family physician can’t find a physical explanation for her condition. Randy, a formerly calm child, begins to argue constantly with his family, exploding into tantrums and refusing to talk things through. His grades are suffering, and his teachers report he is “oppositional” and “unmotivated.” Steve shies away from group activities and spends much of his time worrying. He seems anxious about grades, about whether to ask girls out to a movie, and what classmates think about him. These scenarios are fictional, but they represent some of the ways typical adolescents react to stress.

Adolescence can be a highly stressful stage of life. Issues related to forming an identity and adapting to impending maturity are central to an adolescent’s anxiety. The teen years and early adulthood are times when everyone struggles with the question: “Who am I?” This struggle begins as teenagers experience physiological, psychological and psychological changes. As adults, we can be most helpful to teens by providing support and helping them make sense out of their experiences. We can also help them develop the skills to better manage their reaction to situations that trigger anxiety.

Teens will mature more happily if they know how to cope with stress. They will also be healthier. In a long-term study of alumni, Harvard researchers found markedly higher rates of physical illness in people who had difficulty managing stress during their college years. In part, stress weakens the immune system and increases the risk of a host of physical illnesses. The more we help teenagers understand anxiety and deal wisely with it, the better we prepare them to manage jobs and relationships.

Physiological changes occur quickly during adolescence. Imagine looking in the mirror each morning only to see your body stretching upward and outward. Your face seems to change shape, your skin erupts, and various body parts take on a life of their own. Meanwhile, you are developing a strong yet unfamiliar sex drive that is difficult to predict or regulate. These changes may directly affect self-image and peer relationships during adolescence. For instance, girls who reach puberty early may suddenly find themselves struggling to keep up with a new, older group of friends.

Family relationships undergo changes as well. As adolescents struggle to develop a separate identity, they also need to redefine their relationships with their parents. This creates an additional stressor: teens sense the need for adult guidance, but their quest for independence makes it difficult to ask for help. While most still worry about what their parents think, they are also keenly aware of the growing, overshadowing influence of their peers.

Both socially and academically school can be particularly stressful for adolescents. Once out of elementary school, they find their teachers putting a new emphasis on organization, deadlines and the mastery of large amounts of information. Learning differences such as attention deficit disorder may first show up in adolescence. Existing disabilities may intensify. The competitive atmosphere — social, academic and athletic – encourages adolescents constantly to compare themselves to their peers. Furthermore, to succeed in school an adolescent must be fairly savvy about dealing with teachers, counselors and other adults in their lives. Consequently, their self-image is in a continual state of redefinition. As they mature and earn more independence, decisions about the college or job, or both, can provoke a new area of anxiety. For any or all of these reasons, academic performance may suffer during adolescence, sending grades plummeting and inviting discipline at home and in school.

How can adults best help adolescents survive these stressors? First, it is important to speak to them in a non-judgmental way. For instance, teenagers often do things their parents consider wrong. But, for an adolescent, these actions represent steps toward developing a personal identity. If parents understand this, they can help their children learn from these experiences, face decisions confidently and build on their competencies.

Adults communicating with teenagers should ask themselves: “Do I appear genuine? Does my behavior reflect what I say?” “Does my child feel understood? Or does he or she feel rushed and unimportant?” “Do I show interest in my child’s whole self: the interests and relationships as well as the problems?” “Am I lecturing at him or talking with him?” “Do I help my child make sense of experiences that might otherwise be discouraging?”

Conversation with your adolescent should not be reserved exclusively for times of crisis. Talking regularly about their friends, schoolwork and outside activities lets them know you are open to their ideas and problems. There is an additional benefit to consistent communication: it helps you read an adolescent’s feelings so you can step in promptly if you sense a real problem brewing. You will know what is normal for your child, and what signs may indicate the need to seek help from a psychologist experienced in working with adolescents.

In addition to talking regularly with teenagers, it is often useful to help them learn special strategies to help them manage their anxieties. Sometimes merely having a fallback plan helps to reduce a person’s anxiety. For example, if a boy is nervous, ruminating or “feeling stuck” before a college interview, he may benefit from practicing problem solving skills. In a supportive manner, help him define the problem or source of his anxiety. Then help him generate several possible ways to intervene. From the various options, support him as he finds the plan that may best suit the situation. He may be worried about answering the interviewer’s questions or that he will say something “dumb.” In this case, part of the strategy would be to practice answering a wide variety of questions and developing a way to respond if he is unsure how to respond.

Other strategies may involve imagery or relaxation techniques. If a student is becoming sweaty and uneasy during her SAT exam, she might relax by taking a few minutes to close her eyes, breathe slowly and imagining the sights, smells and sounds of a place she finds particularly pleasant and relaxing. The strategy will not make the problem go away but it may reduce her anxiety and clear her head. Feeling more comfortable should help her relax and perform better on the exam.

Communication with adolescents is a worthwhile a challenge, especially considering the alternative. Left to their own devices, children will seek out other, possibly unhealthy solutions. To avoid constant conflicts with parents or teachers, adolescents will attempt to reduce stress by shutting you out, seeking advice only from peers, or self-medicating with drugs or alcohol. All these factors underscore the need for adults who live and work with adolescents to stay in touch with one other.

[Sidebar I: Signs that an adolescent may be feeling anxiety * Avoidance of various activities: not attending class, frequent absences * Growing sense of haziness in one’s surroundings, extreme tenseness, fear of going crazy * Lightheadedness, racing heart, fear of losing control, upset stomach, * Unusual shyness or social isolation * Physical complaints that may be direct results of anxiety: stomach upset or pains, headaches * Excessive fear of social interaction * Explosive/non-compliant behavior tantrums, etc. * Sensation seeking behavior; drug use, excessively sexualized behavior and dress * Panic attacks or excessive worrying

[Sidebar II Panic attacks are an expression of extreme anxiety. They can be frightening and are not uncommon in adolescents, but since teenagers want to be independent, they may not mention the attack to a parent or adult. Typically, they occur at social events, or under academic stress, but can also be brought on by a movie or in certain family situations. Inexperience may lead adolescents to self-treat to avoid the sense of panic, or they may try to avoid the stimulus entirely. The self-treatment is often drugs or alcohol, creating separate dangers. And when math tests are the stimulus for panic, avoidance can lead to academic failure. A parent can help by identifying the symptoms: a sense of entrapment, lightheadedness or the sense of growing haziness in one’s surroundings. Above all there is an undeniable urge to escape. The adolescent can learn various strategies to manage the panic attacks. Get fresh air — go outside if possible. Sit down if you’re standing, use muscle relaxation techniques or visual imagery of a safe, nurturing place.

Drs. Stephen and Judith Patterson are psychologists with a practice in Princeton Junction. Both work in organizational settings and private practice, providing consultative and direct services.

Polly has been restless since her youngest daughter left for college. She has had trouble sleeping and finds she has less patience with her husband Ken. Brandon and Yvonne received news last week that their fifth attempt at in vitro fertilization has failed. Mick lost his job last summer as an industry analyst and has difficulty coping with the loss. He can hardly sleep and lost all his usual energy. His wife Kay sees him getting more and more depressed and is worried. After a horrendous fight during a car ride Frank and Maxi feel discouraged and hopeless about their relationship.

Despite the varying circumstances, these hypothetical couples have much in common. One or both partners have to face an issue that is troubling the couple’s life. In those situations, it is increasingly common that couples decide to seek conjoint therapy instead of individually working with a therapist. They hope that couples therapy will increase their chances of solving their problems. Research supports their hope. Couples therapy by a psychologist trained in this modality is effective. It is usually an intensive, but short-term experience, and supportive of the couple’s own strengths and values. Working together in therapy requires courage, openness and active participation.

Couples therapy is not just advisable as a last resort before a couple might be headed toward divorce. Often a couple can revitalize a stagnant and unfulfilling relationship through intensive work with a couples therapist. In joint therapy they can become intimately involved with each other again. They can learn to listen, to understand, and acquire the necessary skills to manage their anger and their money better. As their relationship improves the partners will discover how to argue successfully toward the resolution of a conflict, how to accept the other’s limitations, to forgive an affair without minimizing it, improve their sexual relationship, and many other aspects of a long term marriage.

Relational problems are only one of many reasons that bring couples into therapy. Many personal issues, traditionally defined as individual dysfunctions or mental disorders, can be successfully addressed jointly with a therapist. Among them are depression, anxiety, addiction, eating disorders, phobias, sexual problems or life events such as illness, career shifts, sudden losses, or the need to take care of aging parents. Conjoint therapy can be the treatment of choice for all kinds of partnerships, including gay and lesbian couples or two adult siblings living together. The focus of attention in therapy is always the relationship, not the partners as individuals. The experienced couples psychologist will be able to enhance each couple’s unique features and strengths and will avoid a “one size fits all” approach. As the quality of the partnership improves, the well-being of each partner is also enhanced. Psychotropic drugs are not encouraged in couples therapy, because they perpetuate the myth that life’s challenges can be solved with chemicals.

The therapist’s task in couples therapy is to explore the dynamic forces that shape the coupleís relationship. As a rule, both partners are seen together. Individual sessions are discouraged because they tend to exclude the other partner and restrain open communication. During the sessions, the therapist observes how the couple interacts with each other and explores the roles of the partners. The therapist may guide the partners in their conversation and help them discover how one partner’s way of talking will lead to an angry response in the other.

As therapy proceeds, the partners may need to look into the implicit understanding they formed at the beginning of their relationship or marriage. A man may secretly have hoped to find a mother in his partner or a woman may have assumed that her partner will always remain the strong protector that she missed since her beloved brother’s death. The honest examination of the hidden contracts at the origin of a long-term partnership often proves to be the turning point of therapy and the beginning of a realistic and more satisfying relationship.

Many couples get stuck in conflicts that derive from differences in the cultures of their families of origin. The partners’ family cultures may have to do with a specific understanding of gender roles, the socioeconomic status of the families, religious traditions, or simply certain family styles that the other partner finds difficult to accept. A wife who grew up in a blue collar family with both parents working may find it hard to adjust to her new role as a mother who can afford to stay at home raising the couple’s children, but feeling economically dependent on her husband. Or one partner’s family background encourages emotional closeness, physical affection and open airing of opinions and hurt feelings, whereas the other is familiar with polite distance, privacy and keeping one’s feelings inside. Couples therapy allows men and women to learn from their different experiences and increases their mutual understanding.

While it is often necessary to take a historical perspective, the present should never completely move out of focus in therapy sessions. What is the current life stage of the couple? Are the partners in a moment of emotional crisis and, therefore, perhaps ready for a shift in their relationship that is more radical than usually possible? Do they have small children or did the children just leave the home? What recent losses did the couple experience?

Do all couples face the same issues? Yes and no. Clearly, money management, sex, parenting, relationship to in-laws, work and leisure time, household chores and religious affiliation, are topics that most couples have in common. Yet, couples and their relational dynamics also differ profoundly, not the least according to their ethnic background. The traditions, rituals, norms, foods, and values of a particular ethnic heritage have a powerful impact because the partners in committed relationships share their daily and intimate lives with each other. Couples therapists’ focus on relationships enables them not to lose sight of the uniqueness of each couple.

What if a couple has decided to separate and file for divorce? Couples therapy can assist in making the process much less emotionally destructive. The spouses remain in charge of their own lives. Couples often seek out a psychologist trained in mediation who can help them settle issues in a more cost-effective manner in therapy rather than through a legal battle. If children are involved, the spouses will negotiate their new relationship as divorced co-parents who need to cooperate for the benefit of their children.

Couples therapy can be very beneficial for people who want to solve pressing problems together with their partners and are at the same time committed to strengthen their union. To find a qualified psychologist, look for someone with at least two years of postgraduate training in couples therapy and a license in marriage and family therapy. For referrals, you may call the referral service of the New Jersey Psychological Association: 1-800-281-6572.

Norbert A. Wetzel, Th.D., a NJ licensed psychologist and approved supervisor in the American Association of Marriage and Family Therapy (AAMFT), is co-founder and director of training of Princeton Family Institute. He specializes in teaching and practicing families and couples therapy. Echo R. Fling collaborated with Dr. Wetzel on writing this article.

Psychologists have long recognized the importance of work in the hierarchy of human needs. Theodor Reich, a disciple of Freud, once said, “Work and love–these are the basics.” The business world however, is rapidly changing, due to the explosive dawn of the information and technology era. Today, the world of work is now recognizing the importance of psychology and human behavior in its own hierarchy of business needs in order to survive and succeed.

The landscape of the business world is rapidly changing with the onset of the Internet and technical advances. Businesses are developing new initiatives overnight and employees have become “free agents” moving from project to project and from company to company. The old notion of an employee staying 35 years with the same company and a gold watch at retirement is becoming a rarity. Issues such as employee retention and satisfaction are becoming increasingly more important as companies compete for quality individuals. Pay, parking and other tangible benefits are not as important as quality of Work/Life issues such as corporate culture. Thus, corporations are expanding their use of psychological practices in their quest to attract, develop, and retain top-notch employees.

So what’s a business to do? My answer to this question as a “business psychologist” is that businesses must attend to the “soul” of its employees. In their 1999 book, First Break All The Rules, authors Marcus Buckingham and Curt Coffman cite the results of a multi year Gallup Poll survey which concluded that a great workplace is made up of managers and supervisors who are adept in “people skills.” Great managers care about the work and their employees. The Gallup Poll survey reported that great managers provided 12 core elements, or dimensions, that made the workplace great. These include, setting clear expectations, recognizing and praising significant contributions, valuing the opinions of the employees, and taking an active interest in the professional development of their employees.

Daniel Goleman, psychologist and author of the best-selling book, Emotional Intelligence, says that personal qualities such as self-awareness, initiative, empathy, and adaptability are the more important skills to have in the work place than intelligence.

This concept is echoed in a 1999 survey conducted by The Center for the Development of Leadership Skills, of the Rider University College of Business Administration. The study found that so called “soft-skills” were the most important indicator of employment success. Those surveyed indicated that leadership, critical thinking, problem solving, and interpersonal skills were the top attributes of a successful employee. Where the focus has previously been on technical skill development, now the emphasis is placed on skills that all have roots in psychology.

The field of “business psychology” can benefit business in several ways. Business psychologists can teach managers and supervisors how to coach and mentor employees, resolve conflict, develop mission statements, and improve morale. Business psychologists, or Executive Coaches, can develop and nurture the soft skills in every employee, especially the leadership in a company. All of this leads to an increase in employee retention, productivity, customer satisfaction, and company profits.

In my 15 years of experience as a psychologist and executive coach helping corporations, I have found three action areas where companies can work to achieve these goals. These are the areas I emphasize in my workshops on Effective Management and Coaching and Mentoring.

I call the first item, self-assessment. One component of self-assessment is the mission statement and every effective organization should have one. You would be surprised how many employees report to work each day who do not really know “why” they are there; or the typical management reaction for doing things is “just because.” A mission statement answers the question “why are we here?” It sets the tone for all leadership, coaching, managing and commitment initiatives. You may recall the scene in the movie Jerry McGuire where actor Tom Cruise wrote out his mission statement. A mission statement has passion, vision, and purpose. I would recommend that companies develop a mission statement, and that each work group, and person should have one as well. There are several books in the marketplace that offer tips on mission statements. I like Tom Petersí Brand You 50 and Stephen R. Coveyís Seven Habits for Highly Effective People.

Secondly, it is critical that companies teach “soft skills” to hard people. Corporations will often find that their employees have expertise in technical (or hard) skills, yet lack interpersonal skills. These skills include empathy, active listening, honest and effective communication, tolerating and welcoming change, giving constructive feedback, and team building. In order to acquire these important skills, the employee and manager will need to experience a change in attitude and develop a new approach to work. Without the right philosophy behind it, a new skill set will be meaningless.

Finally, companies can increase their effectiveness by developing coaching and mentoring programs. Older, more experienced managers need to take younger employees under their wing. It is a way of taking an active interest in the “corporate soul” of every employee. Employees who are treated as “talent” rather simply as employees are more productive. I like to illustrate this concept by remembering the old Disney movie The Bad News Bears. The story centered around two little league baseball teams. Walter Matthau was a coach of the rag-tag team, which held little hope of success. The other team was well organized with a coach who ran his operation like a drill sergeant. Ultimately the team that was successful had a coach who took a personal interest in the well being of each individual member.

The bottom line is that research has shown that businesses who pay increased attention to the psychological needs of its employees have increased employee retention, customer satisfaction, increased productivity, and increased profitability. This is a formula where everybody wins and everybody succeeds.

Lawrence K. Straus Ph.D. is the Associate Director of the Mercer Consultation Association in Lawrenceville, and he is a Business Psychologist to State Government and local businesses. Echo R. Fling collaborated with Dr. Straus on writing this article. If you are looking for a therapist and would like a referral, you can find help through a friend or through your family physician.

You may also call the referral service at the New Jersey Psychological Association: 1-800-281-6572.

According to the Anxiety and Depression Association of America (adaa.org), Social Anxiety Disorder (SAD) affects about 15 million American adults, and 36% of people report symptoms for 10+ years before seeking help. SAD is an extremely heterogeneous condition, and no two people with Social Anxiety Disorder look alike. For example, both an outgoing businesswoman who becomes paralyzed when speaking at work meetings and a “painfully shy” man who avoids nearly all social functions could be diagnosed with SAD.

A recent meta-analysis (Mayo-Wilson et al., 2014)[1] declared cognitive-behavioral therapy (CBT) to be the initial treatment of choice for individuals suffering from SAD. CBT involves a number of components. The first step in effective CBT treatment is completing a thorough assessment of the patient’s symptoms, working to understand the cognitive, behavioral, physiological, and emotional processes that trigger and maintain social anxiety. Once all of these processes are understood, the therapist creates a case formulation for the patient, incorporating all those factors that appear to be maintaining the problem. An example of a formulation template can be found in Hofmann & Otto (2008, p. 34)[2]

This formulation is then used to create a personalized treatment plan. CBT treatment of SAD often includes several components:

Cognitive work: patients learn to identify and challenge problematic thinking patterns that tend to maintain anxiety.

Behavioral work: patients are tasked with exposing themselves, either in reality or in their imaginations, to feared/avoided situations and experiences. With consistent, repeated exposure to these situations and experiences, patients learn that they are able to tolerate these situations and manage their anxiety, and that the outcomes they fear often do not come to pass and/or are not as catastrophic as expected.

Mindfulness/acceptance work: patients learn to accept that they may be anxious at times, but that this anxiety need not limit them. Acceptance work is often accompanied by mindfulness training. Mindfulness training consists of exercises that help patients learn to fully accept their thoughts, feelings, and experiences in the present moment, without judging them.

For additional information about CBT for Social Anxiety Disorder and other anxiety disorders, please see Dr. Dobrow DiMarco’s website: http://www.njcbt.com.

Dr. Dobrow DiMarco is a licensed clinical psychologist and a Diplomate of the Academy of Cognitive Therapy specializing in cognitive-behavioral therapy for anxiety. In addition to maintaining a private practice in Summit, NJ, she is the Assistant Director of the Rutgers Anxiety Disorders Clinic.

[1] Mayo-Wilson, Dias, Mavranezouli, Kew, Clark, Ades, & Pilling (2014). Lancet Psychiatry, 1, 368-76.

[2] Cognitive Behavioral Therapy for Social Anxiety Disorder (2008). New York: Routledge.