Stuck on “What If?”: Why You Overthink Everything, and How to Get Unstuck

Two questions I hear all the time from teens and young adults: “Why do I overthink everything, and how can I stop?” and “Why do I worry so much about things that haven’t even happened yet?” If these sound like you, keep reading.

You are not weak, dramatic, or broken. Your brain is doing a job. It is just doing that job a little too hard. And that can change. The first half of this article explains why your mind gets stuck on “what if.” The second half, the longer half, is about what you can do today, and what the science says about therapy and medication when the worry will not let go.

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Part 1: Why This Happens

The short version: your alarm is loud, its manager is still growing, and overthinking is a habit that pays off just enough to stick around.

Why do I overthink everything?

Your brain is trying to protect you

Deep inside your brain is a threat system. Think of it as a smoke alarm. Its job is to notice danger fast and get your body ready to act. It does not wait to check if the smoke is real. It just goes off.

That alarm is fast and loud. The part of your brain that calms it down is slower. That part sits right behind your forehead. It helps you plan, weigh evidence, and say, “Wait. This is probably fine.” Here is the important detail: this “thinking manager” is still growing until your mid-to-late 20s.1 So during the teen and young-adult years, the alarm often speaks first, and the manager has to catch up.

This is not a defect. It is how every human brain is built at your age. It is also why a quiet room at 11 p.m. can suddenly fill up with “what ifs.”

Overthinking is a habit, not a personality flaw

Overthinking comes in two flavors.

• Rumination is replaying the past. Why did I say that at lunch? Did I sound stupid? Why did she look at me like that?
• Worry is rehearsing the future. What if I fail the test? What if he doesn’t text back? What if something is wrong with me?

Both feel like problem-solving. They are not. Research shows that rumination and worry are mostly a mental habit. They run on autopilot, they spin in circles, and they rarely produce a real answer.2

Here is how the habit gets stronger. You feel a spike of fear. You think and think. Nothing bad happens. Your brain quietly concludes, “Thinking hard kept me safe.” The next time, it reaches for the same tool, even faster.

Why it does not feel like a choice

Picture the loop:

1. A trigger shows up. A text with no reply. A weird look. A grade you have not seen yet.
2. Your alarm fires.
3. You overthink. For a few seconds, that feels like doing something.
4. You get a tiny bit of relief.
5. Your brain files that away as “this works.”

That tiny relief is the hook. It is why overthinking feels automatic, and why “just stop thinking about it” almost never works.

Why do I worry about things that haven’t happened yet?

Meet anticipatory anxiety

Anticipatory anxiety is fear about something that might happen. The college decision that comes out in March. The doctor’s appointment next week. The party on Saturday. The future is not here yet, but your body reacts as if it is.

Brain research helps explain why. When a threat is possible but not certain, the threat system can fire harder than it does for a threat you know is coming.3 Your brain would rather be wrong and ready than surprised. So it treats “maybe” like “definitely.” Worry becomes its way of getting ready for a danger that may never arrive.

Uncertainty is the real trigger

Look closely at your worries and you will find a pattern. They almost always involve something you cannot know yet.

• School: “What if the teacher grades harder than last time?”
• Friendships: “They left me on read. Are they mad? Did I do something?”
• Relationships: “What if she likes someone else?”
• Family: “What if my parents are fighting because of me?”
• Social media: “Why did that post get fewer likes? Do people think I’m weird?”
• Health: “This headache. What if it’s something serious?”
• The future: “What if I pick the wrong major and ruin my whole life?”

Psychologists call the discomfort behind these thoughts intolerance of uncertainty. It means “not knowing” feels dangerous, not just annoying. In children and teens, this trait is strongly linked to worry and anxiety.4 People who feel this way often try to erase uncertainty by thinking harder. But you cannot think your way to knowing the future. So the worry never gets to finish.

Why worry feels useful, even though it is not

Many people secretly believe worry works. Two hidden beliefs keep it alive:

• “If I worry, I’ll be prepared.” In reality, most worry is not planning. It is a loop of “what ifs” with no next step.
• “If I worry, bad things won’t happen.” When the bad thing does not happen (which is most of the time), worry gets the credit. It is like carrying an umbrella every day and believing that is why it did not rain.

The Worry Cycle: How It Keeps Itself Going

Overthinking and anticipatory anxiety are not just thoughts. They are a cycle with many moving parts. Each part feeds the others.

The cycle, in plain language

• Worry and rumination keep the alarm switched on and teach the brain that thinking is the answer.2
• Fear of uncertainty makes every “I don’t know yet” feel like an emergency.4
• Avoidance brings quick relief. You skip the party, drop the class, or don’t send the text. But your brain never learns that you could have handled it. Next time feels scarier.
• Reassurance-seeking works the same way. Asking “Are you mad at me?” five times, or checking your grades ten times, calms you for a minute. Then the doubt comes back, and you need a bigger dose. When parents jump in to answer every worry or remove every scary situation, the same thing happens.5
• Stress from school, family, work, or money keeps your body in high-alert mode, so the alarm trips more easily.
• Poor sleep and anxiety feed each other. Sleep problems predict more anxiety later, and anxiety makes sleep worse.6
• Screens and social media add fuel: late-night scrolling, constant comparison, and news that never turns off.7
• The brain’s threat system learns from all of this. Every avoided situation and every reassurance is a lesson: “That really was dangerous.” So the alarm gets more sensitive.

Seeing the cycle is the first step. You do not have to break every link. Weakening one or two is often enough to slow the whole thing down.

Normal Worry vs. Anxiety That Needs Care

Worry is normal. Every person on earth worries. It becomes a problem when it takes over.

Normal worry usually:

• Has a clear reason (a real test, a real conflict)
• Fades when the situation passes
• Does not stop you from doing things you want or need to do

Anxiety that may need professional care often:

• Shows up most days, for weeks or months
• Feels very hard to control, even when you know it does not make sense
• Comes with body symptoms: racing heart, stomachaches, headaches, shaky hands, trouble breathing
• Makes you avoid school, friends, activities, or sleep
• Gets in the way of grades, relationships, or daily life

When anxiety looks like this, a clinician may diagnose an anxiety disorder. Common types are generalized anxiety disorder, social anxiety disorder, and panic disorder.8 These are not rare. About 1 in 13 children and teens in the United States has an anxiety disorder at any given time. Rates are highest between ages 12 and 17.9 Anxiety disorders are also among the most treatable conditions in all of mental health. That is why national guidelines now recommend anxiety screening for every young person aged 8 to 18 at regular checkups.9

Having an anxiety disorder does not mean you are fragile. It means your alarm system needs some retraining, and there are proven ways to do that.

Part 2: What You Can Do

This half is the reason the article exists. Every tool here is something you can start today, and a therapist can help you go deeper.

Quick Wins You Can Use Right Now

These take a minute or less. They will not “fix” anxiety, but they can turn the volume down enough for you to think.

• Name it. Say to yourself, “This is my alarm going off. It is a feeling, not a fact.”
• Try a cyclic sigh. Breathe in through your nose. Then take a second, smaller sip of air on top. Now breathe out slowly through your mouth, all the way. Repeat for one to five minutes. In a research trial, five minutes a day of this breathing improved mood and calmed the body more than meditation did.10
• Ground with 5-4-3-2-1. Name 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell, and 1 you can taste.
• Move for five minutes. Walk, stretch, do jumping jacks. Movement burns off the stress chemicals your alarm just released.
• Write it down. Put the worry on paper in one sentence. Worries feel smaller outside your head.
• Ask one question: “Is this a problem I can do something about right now?” If yes, take one small step. If no, write it on a list for later and come back to it at a set time.

Cognitive Behavioral Therapy: The Best-Tested Approach

Cognitive behavioral therapy, or CBT, is the first-line treatment recommended for anxiety in children, teens, and young adults.11 A large Cochrane review of 87 studies found that after CBT, about half of young people no longer met criteria for an anxiety disorder, compared with fewer than 1 in 5 who were still waiting for treatment.12

CBT works on a simple idea: thoughts, feelings, and actions are connected. Change one, and the others shift. Here are the core skills. You can start practicing them today, and a therapist can help you go deeper.

Catch the thought

Anxious thoughts move fast. Slow them down by writing the exact words. Not “I’m stressed,” but “If I mess up this presentation, everyone will think I’m an idiot.”

Check the thought

Now play detective. Ask:

• What is the evidence for this? What is the evidence against it?
• Am I predicting the future? (Fortune-telling)
• Am I assuming I know what others think? (Mind-reading)
• Am I jumping to the worst possible outcome? (Catastrophizing)
• What would I say to a friend who had this thought?
• Has this feared thing happened before? How did I handle it?

Change it to something more balanced

Not fake-positive. Just accurate. “I might stumble over a few words. Most people won’t notice, and even if they do, they’ll forget by lunch. I’ve gotten through every presentation so far.”

Schedule “worry time”

Pick 15 minutes a day, at the same time (not right before bed). When a worry pops up outside that window, jot it down and tell yourself, “Not now. I’ll deal with you at 5:00.” At 5:00, look at the list. Most worries will feel smaller. The ones that are real problems get a plan. This trains your brain that worry has a place, and that place is not everywhere.

Run an experiment

Anxiety makes predictions. Test them. Prediction: “If I raise my hand and get it wrong, people will laugh.” Experiment: raise your hand once this week. Record what actually happened. Real data beats imagined data every time.

Climb the ladder (exposure)

This is the most powerful part of CBT.11 Make a list of things you avoid, from least scary to most scary. Start at the bottom. Stay in the situation until the fear drops on its own, usually in a few minutes. Repeat until it is boring. Then step up.

Example ladder for social worry:

1. Say “hi” to one classmate you do not usually talk to.
2. Ask a question in a small class.
3. Eat lunch at a table with people you know a little.
4. Speak up in a group chat.
5. Go to a party for 30 minutes.

Each rung teaches your brain the thing worry never lets it learn: “I can handle this.” If you want the longer version, read our guide to exposure therapy for anxiety and OCD.

Facing Uncertainty Instead of Avoiding It

Since not-knowing is the real trigger, the cure is practicing not-knowing on purpose. Small doses, done often.

• Send the text without rereading it four times.
• Order something new at a restaurant without looking it up first.
• Wait a full day before checking the grade portal.
• Leave one question unasked, and see if you can sit with the wonder.
• Set a limit on reassurance. One question per worry. If you have already asked “Are we okay?” once, the second time is for your anxiety, not for the relationship. Parents can help by answering with warmth but not with endless answers. Programs that teach parents to reduce this kind of “accommodation” work as well as CBT for childhood anxiety.5 Our OCD series explains why reassurance backfires in more detail.
• Drop safety behaviors. Things like over-preparing, rehearsing what to say, or always sitting near the exit feel helpful. Really, they tell your brain the danger was real.
• Use “maybe” sentences. “Maybe it will go badly. Maybe it won’t. Either way, I will deal with it.” This is the honest answer, and your brain can learn to live with it.
• Make a rule for health worries. If you catch yourself searching symptoms, close the tab. Write the symptom down. If it lasts more than a few days or gets worse, tell a parent or see a clinician. Searching at midnight is not medical care; it is fuel.

Grounding, Breathing, and Mindfulness

Cyclic sighing (the double inhale). Described above. Best evidence for a quick shift in mood and body calm.10

Longer-exhale breathing. Breathe in for a count of 4. Breathe out for a count of 6 or more. A long exhale is a direct signal to your body’s “brake” system.

Box breathing. In for 4, hold for 4, out for 4, hold for 4. Good for moments when you need to steady yourself before something, like a test or a hard conversation.

Progressive muscle relaxation. Tense your feet for 5 seconds, then release. Move up through your legs, stomach, hands, shoulders, and face. Notice the difference between tight and loose.

Mindfulness. This means noticing your thoughts without arguing with them or chasing them. “There’s a worry. There’s another one.” Like watching cars pass on a road instead of jumping into each one. Research on mindfulness programs for young people shows modest but real benefits, especially for stress and low mood; the effect on anxiety alone is smaller.13 It is a good tool, not a cure. Five minutes a day with an app or a guided recording is enough to start.

Sleep, Exercise, Caffeine, and Screens

The basics are not boring. They are the foundation the rest sits on.

Sleep

Teens aged 13 to 18 need 8 to 10 hours of sleep a night. Young adults need at least 7.14 Teen brains also release melatonin (the sleep hormone) later at night, which is why you may not feel tired at 10 p.m.1 Sleep loss and anxiety push each other in a loop.6 To protect sleep:

• Wake up at about the same time every day, even weekends.
• Keep your phone out of the bedroom, or at least across the room.
• Do a 20-minute wind-down: dim lights, shower, music, reading.
• Do your “worry time” hours before bed, not in bed. If worries hit in bed, write them on a notepad and say, “Tomorrow.”

Exercise

Physical activity has a moderate, reliable effect on anxiety in children and teens. The largest review to date pooled 55 randomized trials with nearly 25,000 young people.15 Strength training had the strongest effect on anxiety. And here is the good news: exercising 1 to 3 times a week worked as well as more than 3 times.15 Pick something you like enough to repeat.

Caffeine

Caffeine copies anxiety in the body: faster heart rate, jitters, restless sleep. Pediatric guidance is no more than 100 mg per day for ages 12 to 18 (about one small coffee or two cans of cola), and no energy drinks at any age.16 If you overthink and sleep badly, try two weeks without caffeine after noon and see what changes.

Screens and social media

The U.S. Surgeon General’s advisory reports that teens who spend more than 3 hours a day on social media face double the risk of depression and anxiety symptoms, and that late-night use steals sleep.7 You do not have to quit. Try:

• One hour before bed, device-free. Charge it outside your room.
• Turn off notifications for everything except real people.
• Unfollow accounts that leave you feeling worse. Follow ones that leave you feeling better.
• Notice “comparison scrolling,” where you are measuring your life against someone’s highlight reel. Close the app when you catch it.

When and How to Ask for Help

You do not have to wait until things are terrible. Asking earlier means faster relief.

Who to tell

• A parent or trusted adult. A grandparent, coach, aunt, youth leader, or family friend counts.
• A school counselor. They talk with anxious students every day. They can also connect you to outside help.
• A therapist. Look for someone who offers CBT for anxiety. Many see teens and young adults by video.
• A doctor or nurse practitioner. Your pediatrician, family doctor, or a psychiatric provider can check for medical causes (like thyroid problems), screen for anxiety and depression, and talk about all treatment options.

What to say

You do not need the perfect words. Try one of these:

• “I’ve been worrying a lot, almost every day, and I can’t turn it off. I think I need some help with it.”
• “My brain won’t stop overthinking, and it’s messing with my sleep and school. Can we talk to someone?”
• “I read about anxiety and a lot of it sounds like me.”

What treatment usually looks like

For mild to moderate anxiety, guidelines recommend starting with CBT.11 It is usually 8 to 16 weekly sessions, with practice between visits. For moderate to severe anxiety, or when therapy alone is not enough, guidelines support adding a medication, most often a selective serotonin reuptake inhibitor (SSRI).1117 In the largest study of its kind, 488 young people aged 7 to 17 were treated with CBT, the SSRI sertraline, both, or a placebo. About 8 in 10 improved with the combination, 6 in 10 with CBT alone, 5 in 10 with sertraline alone, and 2 in 10 with placebo.18

Medication: What the Science Says

This section is educational only. It is not personal medical advice and it does not list doses. Medication decisions depend on your age, history, other conditions, and other medicines, and they require evaluation and ongoing monitoring by a qualified clinician.

SSRIs: the first-choice medications

What they are. SSRIs include medicines like sertraline, fluoxetine, escitalopram, and fluvoxamine. They change how the brain handles serotonin. Serotonin is a chemical messenger tied to mood and the threat response. The American Academy of Child and Adolescent Psychiatry names SSRIs as the medication of choice for youth anxiety.11 A review that pooled the trials found SSRIs clearly beat placebo. In the short term, their effect was at least as strong as therapy.17

What they may help with. Generalized anxiety, social anxiety, panic, and separation anxiety. They often lower the “volume” on worry so that CBT skills become easier to use.

How long they take. SSRIs are not like a painkiller. Some people notice small changes within 2 to 4 weeks. The full effect usually takes 8 to 12 weeks, and clinicians typically wait that long before deciding whether a medicine is working.19 When it helps, it is usually continued for many months after you feel better, then reduced slowly with your clinician.11 For a week-by-week picture of the start, see Starting an SSRI: What Families Should Watch For in the First Few Weeks.

Common side effects. Upset stomach, headache, and changes in sleep. Some young people feel “wired” or restless. This is called activation, and it happens in fewer than 15 percent.19 Older teens and adults may notice sexual side effects. Most side effects are mild and fade in the first few weeks. Activation should always be reported.

What is FDA-approved for young people. Only two medicines are FDA-approved for anxiety in children and teens, both for generalized anxiety disorder: escitalopram, approved for ages 7 and up in 2023, and duloxetine, an SNRI, for ages 7 and up.192027 Other SSRIs, such as sertraline and fluoxetine, are widely prescribed “off-label” for youth anxiety based on strong trial evidence.1118 Off-label is common and legal; it means the company did not seek FDA approval for that specific age and condition.

SNRIs

Serotonin-norepinephrine reuptake inhibitors, like duloxetine and venlafaxine, are a related group. Their evidence for youth anxiety is a bit weaker than for SSRIs, and they may raise blood pressure slightly.19 They are more likely to cause symptoms if stopped suddenly. They are usually considered after an SSRI.

Important cautions with antidepressants

The boxed warning. The FDA requires a warning on all antidepressants. It covers a possible rise in suicidal thoughts or behaviors in children, teens, and young adults up to age 24.2021 In the trials behind the warning, about 4 in 100 young people on medication reported suicidal thoughts or behaviors. On placebo, it was 2 in 100. No suicides occurred in those trials.21 The risk is highest in the first few months and after dose changes. That is why guidelines call for close check-ins early on.1121 Families should watch for new or worse mood, agitation, or unusual behavior. If you notice any of these, tell your prescriber right away. Do not just stop the medicine on your own.

Do not stop suddenly. Stopping an SSRI or SNRI abruptly can cause discontinuation symptoms: dizziness, nausea, flu-like feelings, “brain zaps,” irritability, trouble sleeping, and a rebound of anxiety. A 2024 meta-analysis found about 1 in 6 to 7 people have such symptoms when stopping, mostly mild, with about 1 in 35 having severe symptoms.22 Always taper with your clinician’s plan.

Tell your prescriber everything. Alcohol, cannabis, nicotine, supplements (including St. John’s wort), and other medicines can interact with antidepressants.

Benzodiazepines: fast, but not a good fit for young people

Benzodiazepines (alprazolam, lorazepam, clonazepam, and diazepam) calm the nervous system within minutes. That sounds ideal, but the evidence and risks tell a different story.

• Little evidence in youth. Only a few tiny trials exist in children and teens, and they show no clear benefit.19 Guidelines do not recommend them for youth anxiety.11
• Dependence and withdrawal. The FDA’s boxed warning states that benzodiazepines can lead to misuse, addiction, and physical dependence, even when taken as prescribed for days to weeks. Stopping suddenly can cause severe withdrawal, including seizures that can be life-threatening.23
• Dangerous combinations. Mixed with alcohol, opioids, or other sedatives, they can slow breathing to dangerous levels.23
• Other problems. Drowsiness, memory trouble, poor coordination, and in some young people, disinhibition (acting out).19
• They can block learning. Exposure works because your brain learns “I handled it.” A sedative can take that lesson away.

For adults, guidelines allow short-term use only, such as a few days during a crisis, and not as a long-term anxiety treatment.24 For the brain science behind these medicines, see What Benzodiazepines Actually Do to the Brain’s Brakes.

Other medicines sometimes used

• Hydroxyzine is an antihistamine that some clinicians use short-term for situational anxiety in adults. It mainly causes drowsiness. Evidence in teens is very limited.
• Buspirone is an anti-anxiety medicine used in adults with generalized anxiety. Trials in young people did not show clear benefit.19
• Beta-blockers like propranolol are occasionally used off-label in adults for performance nerves (shaky hands, racing heart before a speech). They do not treat worry itself.

Minors vs. adults: what is different

Frequently Asked Questions

Does overthinking mean I have an anxiety disorder?

Not by itself. Everyone overthinks sometimes. The question is whether it is frequent, hard to control, and getting in the way of your life. If yes, a screening with a counselor or clinician can sort it out in one visit.

Will medication change who I am?

The goal of an SSRI is to lower the alarm, not to erase you. Most people describe feeling more like themselves, not less. If you feel flat, numb, or “not me,” that is important feedback for your prescriber, and doses or medicines can be adjusted.

Can I just wait and grow out of it?

Some anxiety does ease with time. But untreated anxiety in the teen years often continues into adulthood and can lead to depression. Early treatment tends to be faster and easier.11

Is it okay to do therapy and take medicine at the same time?

Yes. For moderate to severe anxiety, the combination often works best.1718

Your Action Plan for Today

1. Write down your top three worries in one sentence each. Mark each one “solvable now,” “solvable later,” or “not in my control.”
2. Do one cyclic-sigh session for two minutes, right now.
3. Pick one tiny uncertainty to practice, like sending a message without rereading it.
4. Set a “worry time” for tomorrow: 15 minutes, same place, not in bed.
5. Move your body for 10 minutes, any way you like.
6. Set a phone bedtime one hour before yours.
7. Tell one person what you are dealing with. Use one of the scripts above.

Signs It Is Time for Professional Help

• Worry most days for several weeks or more
• Panic attacks, or fear of having one
• Avoiding school, friends, or activities you used to enjoy
• Trouble sleeping most nights because of worry
• Physical symptoms with no medical cause (stomachaches, headaches, chest tightness)
• Using alcohol, cannabis, or other substances to calm down
• Feeling hopeless, numb, or like nothing will ever get better
• Family, friends, or teachers saying they are worried about you

Any one of these is reason enough to talk to a parent, counselor, therapist, doctor, or nurse practitioner. You do not need to “earn” help by getting worse first.

If You Are in Crisis Right Now

If you are having thoughts of suicide or hurting yourself, feel unable to stay safe, or are in severe distress, get help now. Call or text 988 to reach the 988 Suicide & Crisis Lifeline, free and confidential, 24/7.25 You can also text HOME to 741741 to reach the Crisis Text Line.26 Call 911 or go to the nearest emergency room if you are in immediate danger. Tell a trusted adult right now, and do not stay alone. If you have started a new medicine and your mood or thoughts suddenly get worse, contact your prescriber the same day. The full list of crisis resources is at the end of this page.

Related Reading on NP FADY

• Mental Health for Young Adults
• Behind the Closed Door: Depression and Anxiety in Teens Ages 13-18
• Anxiety vs. Panic Attacks: Know the Signs & Find Relief
• CBT Made Simple: How Changing Thoughts Changes Feelings
• Exposure Therapy for Anxiety and OCD: Facing Fears, Safely
• Sleep Anxiety: Tired of Being Tired? The Science of Sleeping Without Pills
• Starting an SSRI: What Families Should Watch For in the First Few Weeks
• Serotonin Is Not Your Happiness Level

References

1. National Institute of Mental Health. The Teen Brain: 7 Things to Know. Revised 2023. https://www.nimh.nih.gov/health/publications/the-teen-brain-7-things-to-know

2. Watkins ER, Roberts H. Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behav Res Ther. 2020;127:103573. https://doi.org/10.1016/j.brat.2020.103573

3. Grupe DW, Nitschke JB. Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nat Rev Neurosci. 2013;14(7):488-501. https://doi.org/10.1038/nrn3524

4. Osmanağaoğlu N, Creswell C, Dodd HF. Intolerance of Uncertainty, anxiety, and worry in children and adolescents: A meta-analysis. J Affect Disord. 2018;225:80-90. https://doi.org/10.1016/j.jad.2017.07.035

5. Lebowitz ER, Marin C, Martino A, Shimshoni Y, Silverman WK. Parent-Based Treatment as Efficacious as Cognitive-Behavioral Therapy for Childhood Anxiety: A Randomized Noninferiority Study of Supportive Parenting for Anxious Childhood Emotions. J Am Acad Child Adolesc Psychiatry. 2020;59(3):362-372. https://doi.org/10.1016/j.jaac.2019.02.014

6. Bacaro V, Miletic K, Crocetti E. A meta-analysis of longitudinal studies on the interplay between sleep, mental health, and positive well-being in adolescents. Int J Clin Health Psychol. 2024;24(1):100424. https://doi.org/10.1016/j.ijchp.2023.100424

7. Office of the U.S. Surgeon General. Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory. 2023. https://www.hhs.gov/sites/default/files/sg-youth-mental-health-social-media-advisory.pdf

8. National Institute of Mental Health. Anxiety Disorders. https://www.nimh.nih.gov/health/topics/anxiety-disorders

9. US Preventive Services Task Force. Screening for Anxiety in Children and Adolescents: Recommendation Statement. JAMA. 2022;328(14):1438-1444. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-anxiety-children-adolescents

10. Balban MY, Neri E, Kogon MM, et al. Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Rep Med. 2023;4(1):100895. https://doi.org/10.1016/j.xcrm.2022.100895

11. Walter HJ, Bukstein OG, Abright AR, et al. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders. J Am Acad Child Adolesc Psychiatry. 2020;59(10):1107-1124. https://doi.org/10.1016/j.jaac.2020.05.005

12. James AC, Reardon T, Soler A, James G, Creswell C. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2020;11:CD013162. https://doi.org/10.1002/14651858.CD013162.pub2

13. Dunning DL, Griffiths K, Kuyken W, et al. Research Review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents - a meta-analysis of randomized controlled trials. J Child Psychol Psychiatry. 2019;60(3):244-258. https://doi.org/10.1111/jcpp.12980

14. Paruthi S, Brooks LJ, D’Ambrosio C, et al. Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine. J Clin Sleep Med. 2016;12(6):785-786. https://doi.org/10.5664/jcsm.5866

15. Singh B, Bennett H, Miatke A, et al. Systematic Umbrella Review and Meta-Meta-Analysis: Effectiveness of Physical Activity in Improving Depression and Anxiety in Children and Adolescents. J Am Acad Child Adolesc Psychiatry. 2025. https://doi.org/10.1016/j.jaac.2025.04.007

16. American Academy of Child and Adolescent Psychiatry. Caffeine and Children. Facts for Families No. 131. Updated April 2026. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Caffeine_and_Children-131.aspx

17. Wang Z, Whiteside SPH, Sim L, et al. Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders: A Systematic Review and Meta-analysis. JAMA Pediatr. 2017;171(11):1049-1056. https://doi.org/10.1001/jamapediatrics.2017.3036

18. Walkup JT, Albano AM, Piacentini J, et al. Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety. N Engl J Med. 2008;359(26):2753-2766. https://doi.org/10.1056/NEJMoa0804633

19. Zugman A, Winkler AM, Qamar P, Pine DS. Current and Future Approaches to Pediatric Anxiety Disorder Treatment. Am J Psychiatry. 2024;181(3):189-200. https://doi.org/10.1176/appi.ajp.20231037

20. U.S. Food and Drug Administration. Lexapro (escitalopram) prescribing information, revised 2023 (pediatric generalized anxiety disorder indication, ages 7 and older). https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/021323s055,021365s039lbl.pdf

21. U.S. Food and Drug Administration. Suicidality in Children and Adolescents Being Treated With Antidepressant Medications. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications

22. Henssler J, Schmidt Y, Schmidt U, et al. Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis. Lancet Psychiatry. 2024;11(7):526-535. https://doi.org/10.1016/S2215-0366(24)00133-000133-0)

23. U.S. Food and Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Drug Safety Communication, September 2020. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class

24. National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management. Clinical guideline CG113. Last reviewed 2020. https://www.nice.org.uk/guidance/cg113

25. 988 Suicide & Crisis Lifeline. https://988lifeline.org

26. Crisis Text Line. https://www.crisistextline.org

27. Eli Lilly and Company. Cymbalta (duloxetine) prescribing information (generalized anxiety disorder in adults and pediatric patients 7 years and older). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2f7d4d67-10c1-4bf4-a7f2-c185fbad64ba

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This article is general education for teens, young adults, and families. It is not medical advice. Reading it does not create a clinician-patient relationship. It is not a substitute for an evaluation by a qualified healthcare professional. Medication information here is for education only. No doses are given. Decisions about starting, changing, or stopping any medication must be made with a licensed prescriber who knows your history. If you have questions about your health, talk with your doctor, nurse practitioner, or mental health provider.

If you or someone you know is in crisis

• Call 911 or go to your nearest emergency room for any life-threatening emergency.
• 988 Suicide & Crisis Lifeline — call or text 988, available 24/7. En español: marque 988 y oprima 2. Veterans: 988 and press 1, or text 838255.
• Crisis Text Line — text HOME to 741741.
• The Trevor Project (crisis support for LGBTQ+ young people) — call 1-866-488-7386, or text START to 678-678.
• National Sexual Assault Hotline (RAINN) — call 1-800-656-HOPE (4673) or text HOPE to 64673; free, confidential, 24/7. Online chat at RAINN.org/hotline.
• National Domestic Violence Hotline — call 1-800-799-SAFE (7233) or text START to 88788; 24/7, help in 200+ languages. Online chat at TheHotline.org. If your phone or computer may be monitored, calling from a safer device is an option.
• Riverside County — Inland SoCal Crisis Helpline 951-686-HELP (4357), 24/7 (Inland SoCal United Way / 211+, in partnership with RUHS-BH); Community Access, Referral, Evaluation and Support (CARES) Line 800-499-3008, 24/7.
• San Bernardino County — Access Unit (Behavioral Health Helpline) 888-743-1478, 24/7; Mobile Crisis/CCRT 800-398-0018 (24/7, all ages) or text 909-420-0560. Arrowhead Regional Medical Center (ARMC) has a dedicated walk-in adolescent psychiatric ER (ages 13–17).
• Children under 13 — call 911 for immediate danger, contact your county's mobile crisis team (they respond to all ages), or go to the nearest pediatric emergency room.
• California Peer-Run Warm Line (non-crisis — someone to talk to) — call or text 1-855-600-WARM (9276); daytime and evening hours, not a 24/7 line.
• NP Fady (non-emergency) — for routine scheduling or questions, call (909) 707-6261. This line is not monitored for emergencies.