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anxiety- maintaining behaviors and enhance motivation for change [75]. FFT-AD has yet to be tested as an adjunct to empirically supported treatments for anxiety disorders [75]. However, the treatment is promising and the strategies that comprise the intervention may be helpful for clinicians working with EAs with anxiety disorders.
Assessment and Treatment of Co-occurring Substance Use Disorders Finally, clinical management of EAs with anxiety disorders should include a thorough psy- chiatric evaluation to assess for the presence of comorbid disorders, particularly substance use disorders (SUDs). In the NCS-R, SUDs were the second most preva- lent class of disorders among EAs (after anxiety disorders), with 22.0% of EAs meeting criteria for a past-year SUD [6]. It is likely that the imbalance between developed limbic regions and immature prefrontal regions, discussed earlier, sets the stage for increased risk for SUDs during EA [79]. In addition, developmental stressors (e.g., college matriculation), reduced parental oversight, and increased environmental exposure to alcohol and drugs likely contribute to increased vulner- ability for SUDs during this life stage [79]. Data from the NCS-R indicate that individuals with anxiety disorders have higher rates of SUDs [80], so EAs with anxiety disorders may be particularly at risk for problematic substance use. Little research exists to guide treatment recommendations for EAs with comorbid anxiety and SUDs. Integrated cognitive behavioral treatments that target anxiety and sub- stance use symptoms simultaneously have been developed for adults, though evi- dence for these treatments is mixed [81, 82]. Instead, experts recommend referring EAs with comorbid anxiety and SUDs for evidence-based SUD treatment if they are willing [79]. On the other hand, if an EA expresses low readiness for SUD treat- ment, it may be useful to first engage the patient in evidence-based treatment for anxiety in order to foster awareness of the connection between emotions and sub- stance use and to build motivation for change [79].
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whether extant findings derived from studies conducted with primarily white, college-attending EAs apply to other socioeconomic and cultural groups [83].
Even more pressing is the need for research to inform the clinical management of anxiety symptoms in EA. As noted, neurodevelopment continues throughout EA. Yet despite this fact, we are aware of no studies that have explored the interplay between pharmacological treatments for anxiety disorders and neurodevelopment during this life stage. For example, it is unclear whether unfolding brain changes impact the efficacy of established pharmacological treatments for anxiety in adults.
Similarly, we are aware of no studies that have explored whether modifications are needed when delivering evidence-based interventions such as cognitive behavioral therapy to EAs with anxiety disorders. Finally, researchers should continue to develop and test prevention and early intervention programs for EAs who are at risk for anxiety disorders. Longitudinal studies with extended follow-ups are needed in order to examine whether treating subclinical anxiety symptoms during EA shifts the long-term course of anxiety disorders in adulthood.
Conclusion
EA describes the life stage that occurs from ages 18–30 in high-income countries and is a period of considerable neurobiological, psychological, and social develop- ment. These developmental changes are necessary in order to enable EAs to ulti- mately adopt adult roles and responsibilities. However, the myriad transitions during this life stage can be stressful and may precipitate the onset of mental health prob- lems, including anxiety disorders, for some individuals. Indeed, approximately 22.3% of EAs meet criteria for an anxiety disorder in the past year [6], with those who experienced childhood adversity (e.g., abuse, neglect) being most at risk.
Anxiety during EA can interfere with an individual’s ability to attain developmental milestones, such as developing an independent identity and forming intimate social relationships. Adequate treatment of anxiety disorders in EA is therefore critical.
Clinicians treating EAs with anxiety disorders should be attentive toward common issues that arise in treatment, including low treatment engagement, deleterious fam- ily factors (e.g., symptom accommodation), and comorbid substance use disorders.
More research is needed to explore additional adaptations that could improve the efficacy of empirically supported treatments for anxiety disorders in EA.
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