General practitioners (GPs) can play an important role in helping young people cope with anxiety, delegates heard at The Primary Care Show 2025.
Although anxiety is a normal response to many situations in life, GPs can guide young people to understand this and reframe their angst, according to Fiona Smith, a GP at Eaglescliffe Medical Practice in Stockton-on-Tees, England.
“There are ways that we can use language within the consultation — and use youth-friendly consulting — to help young people and families manage the anxiety,” she said.
Smith founded the Footsteps Youth Wellbeing service in 2018, offering support for 11- to 19-year-olds.
She acknowledged the importance of access to cognitive-behavioural therapy. However, she also shared some practical ways in which GPs can address anxiety during 10-minute consultations.
Why Anxiety?
“I’ve heard from a lot of my colleagues locally about the surge in anxiety issues in this generation of young people, and there’s lots of debates about why that might be,” Smith said.
She noted that anxiety is not only just about neurodevelopment but also about the pressures being put on young people by their parents, school, society, and social media.
Teenagers often compare themselves with others online but only see the highlights of others’ lives, Smith said.
Research has found that the peak time for mental health problems to emerge in young people is around 14.5 years. While not all young people who experience anxiety will develop a chronic anxiety-related disorder in adulthood, identifying people earlier can have an important impact on their later mental well-being, “and that’s what we’re really hoping,” said Smith.
“Even if their initial presenting complaint is not feeling anxious and is feeling low in mood or even self-harming or feeling suicidal, there’s always anxiety somewhere within the problem list,” she said.
Normalising Anxiety
Smith said that a good starting point during a consultation might be to ask the young person to describe what they think anxiety is and whether it is good or bad.
“We’re looking to normalise and reduce the stigma,” she said. “Anxiety is a helpful thing if it fits into the situation.”
Being anxious is a natural instinct, but a young person lacks the life experience and limbic system response that can quell levels of anxiety before they get out of proportion to the situation. Smith uses the metaphor of a smoke alarm. “If your limbic system is your smoke alarm, and your smoke alarm at home is going off all the time, but there’s no smoke, then that’s a faulty alarm.”
However, “If your smoke alarm goes off when you have burned the toast, it’s working well. So, that’s one way of helping them to understand when their anxiety is out of proportion with the situation.”
Shifting to Positive Thinking
According to Smith, overthinking and negative thinking can feed anxiety, which is a common problem among young people. Moreover, worrying about physical symptoms such as nausea or vomiting, which may be brought on by anxiety, can also exacerbate the problem.
A key element of the consultation process involves changing the language used and helping young people reframe negative thoughts in a positive way. She also recommended explaining to parents that it can be beneficial for children to express their emotions.
Problems can become worse when they are given too much attention. Simple strategies include setting aside time to talk about worries at the end of the day or visualising the mind as a TV with channels that can be changed to switch to more enjoyable topics.
It is important to encourage young people to step out of their comfort zones, as fear and anxiety are often necessary for growth. “Anxiety can be uncomfortable, but it’s rarely harmful,” said Smith.
Consultation Tools and Techniques
How can primary care professionals help? First, they should “connect” with the young person by being there to talk and listen, said Smith. Second, advise them to “be active” — do what they can, enjoy what they do, and try to “move your mood.” Third, encourage them to “take notice” and remember the simple things that bring joy. Fourth, encourage them to “keep learning” and embrace new experiences and opportunities and “surprise yourself.” Finally, give your time, your words, and your presence.
Smith recommended using two tools for consultations:
RULER, a self-assessment tool that gauges emotional literacy. The acronym stands for:
R: Recognising emotions in oneself and others.
U: Understanding the causes and consequences of emotions.
L: Labelling emotions accurately.
E: Expressing emotions appropriately.
R: Regulating emotions effectively.
The other tool is STOPP, which helps young people take a step back and reassess their situation. The acronym stands for S, stop; T, take a breath; O, observe what’s happening; P, pull back; and P, practise what works for you.
Smith also suggested square breathing: Breathe in, hold, breathe out, and hold again — each for four counts — to regulate the nervous system.
Involving Parents
Parents play a key role in supporting their children. “We shouldn’t overlook parents in terms of the support and the guidance they need in supporting their young people,” Smith said. “We often respond as parents to our young people’s anxiety or children’s anxiety by being anxious ourselves, and that then just reinforces it.”
Smith gives young patients the option to include or exclude their parents or guardians during consultations. She always asks young people if they would like their parent or guardian to be present during the consultation, and if so, they can ask them to leave at any time.
Explaining different parenting styles can also help. With a “helicopter-type parenting style,” when a young person comes to their parent with a problem, “the parent wants to immediately fix it,” Smith explained. “So, the young person never actually builds their own resilience or builds their own tools, or ways, of fixing the problem for themselves — and they always then turn to the parent.”
She suggested the concept of “lighthouse” parenting: Steady support that is there when needed to provide reassurance while allowing the young person to solve their own problems as appropriate. This involves offering encouragement and understanding rather than being the one to fix problems immediately.
The GP Perspective
Michael Dixon, a GP at Culm Valley Integrated Centre for Health in Devon, England, welcomed Smith’s approach.
“There’s an awful lot we can actually do simply by talking to the child, validating and explaining, and giving some very simple methods they can use to reduce their anxiety,” he told Medscape News UK. “I think it’s a message that needs to get out, not only to doctors and nurses but also to schools.”
Dixon said that parents often ask GPs for a diagnosis of conditions such as attention-deficit/hyperactivity disorder, behavioural disorders, and autism spectrum disorders. However, this has a downside. “People wait a year or 2 before they get a diagnosis, and then another year or 2 before they get help,” he noted. “Giving them labels they can’t do anything else with” could do more harm than good.
Dixon praised Smith’s message that it’s okay for young people to live ordinary lives and not constantly strive for perfection or compare themselves with others. “You don’t have to be the cleverest in the class, the fastest runner, or anything else. I feel our whole virtual world is continually making us feel inadequate for not being the happiest, the loveliest, the most beautiful, the thinnest,” he said.
Adolescent-Friendly Consultations
Separately, Ichechim White, a GP at Aplos Health Primary Care Network in London, England, said youth consultations should be “trauma-informed, neurodevelopmentally appropriate, and held in collaboration with the young person, as well as with outside partnerships and organisations.”
White, who is the adolescent health clinic lead for the network, encourages GPs to use the HEADSSS psychosocial screening tool, which explores:
Home
Education/employment
Activities
Drugs/alcohol
Sexuality
Suicidality/self-harm
Safety, including online behaviour
Consultations should be “strength-based, rather than deficit- or negative-based,” she told Medscape News UK.
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