Launching Anxious Young Adults: A Specialized Cognitive-Behavioral Intervention for Transitional Aged Youth

  • Lauren J. Hoffman
  • John D. Guerry
  • Anne Marie Albano
Child and Adolescent Disorders (TD Benton, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Child and Adolescent Disorders


Purpose of Review

There has been growing clinical and research attention to the unique developmental stage of emerging adulthood. This stage is a time of significant change and growth for all individuals, as it includes identity exploration, emotional, behavioral, and financial independence from caregivers, and completion of educational or vocational requirements.

Recent Findings

Anxiety disorders are the most common mental health diagnoses among emerging adults, and individuals suffering from these disorders often experience compounding functional impairments across health, financial, and social domains. While evidence-based treatments exist for both child/adolescent anxiety disorders and adult anxiety disorders, no specialized assessment or treatment methods have been established for the unique period of emerging adulthood.


Our review examines literature pertinent to anxiety disorders in emerging adulthood and describes a novel, specialized intervention to address the unique challenges faced by anxious emerging adults. The Launching Emerging Adults Program (LEAP) is a developmentally informed cognitive-behavioral treatment model that aims to simultaneously reduce anxiety symptoms and promote independence. We conclude with a discussion of lessons learned and future directions.


Emerging adulthood Anxiety disorders Cognitive-behavioral therapy Developmental transitions Young adulthood Parenting 


Compliance with Ethical Standards

Conflict of Interest

Lauren J. Hoffman and John D. Guerry declare no conflict of interest.

Anne Marie Albano is the Principal Investigator for the Child/Adolescent Anxiety Multimodal Study (CAMELS) (NIMH) cited in this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Arnett J. Emerging adulthood: a theory of development from the late teens through the twenties. Am Psychol. 2000;55:469–80. Scholar
  2. 2.
    •• Arnett J. Emerging adulthood: what is it, and what is it good for? Child Dev Perspect. 2007;1:68–73. This chapter introduces emerging adulthood and describes this unique developmental period.CrossRefGoogle Scholar
  3. 3.
    Stoep AV, Beresford SA, Weiss NS, McKnight B, Cauce AM, Cohen P. Community-based study of the transition to adulthood for adolescents with psychiatric disorder. Am J Epidemiol. 2000;152(4):352–62. Scholar
  4. 4.
    Copeland WE, Angold A, Shanahan L, Costello EJ. Longitudinal patterns of anxiety from childhood to adulthood: the Great Smoky Mountains Study. J Amer Acad Child Adolesc Psychiatry. 2014;53:21–33. Scholar
  5. 5.
    McGuire S, IOM (Institute of Medicine), NRC (National Research Council). Supplemental nutrition assistance program: examining the evidence to define benefit adequacy. Washington, DC: The National Academies Press, 2013. Adv Nutr Int Rev J. 2013;4(4):477–8.CrossRefGoogle Scholar
  6. 6.
    Lipari RN, Hedden SL. Serious mental health challenges among older adolescents and young adults. 2013.Google Scholar
  7. 7.
    Merikangas KR, He J, Burstein M, Swanson SA, Avenevoli S, Cui L, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). J Amer Acad Child Adolesc Psychiatry. 2010;49:980–9. Scholar
  8. 8.
    Auerbach RP, Alonso J, Axinn WG, Cuijpers P, Ebert DD, Green JG, et al. Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychol Med. 2016;46:2955–70. Scholar
  9. 9.
    • Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry. 2005;62:617–27. This article reviews 12-month prevalence rates from a naturally representative survey of emerging adults. Findings indicated a 12-month prevalence rate of 22.3% for any anxiety disorder. Rates for specific anxiety disorders are also provided.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R. Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Arch Gen Psychiatry. 2003;60:709–17. Scholar
  11. 11.
    Costello EJ, Copeland W, Angold A. Trends in psychopathology across the adolescent years: what changes when children become adolescents, and when adolescents become adults? J Child Psychol Psychiatry. 2011;52:1015–25. Scholar
  12. 12.
    Costello EJ, Angold A, Burns BJ, Stangl DK, Tweed DL, Erkanli A, et al. The Great Smoky Mountains Study of Youth: goals, design, methods, and the prevalence of DSM-III-R disorders. Arch Gen Psychiatry. 1996;53:1129–36. Scholar
  13. 13.
    Connolly SD, Bernstein GA. Work Group on Quality Issues: practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry. 2007;46:267–83. Scholar
  14. 14.
    Hollon DS, Beck AT. Cognitive and cognitive-behavioral therapies. In: Lambert MJ, editor. Bergin and Garfield’s handbook of psychotherapy and behavior change. 6th ed. New York: John Wiley & Sons; 2013. p. 393–442.Google Scholar
  15. 15.
    • Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med. 2008;359:2753–66. This study is the largest randomized clinical trial for youth anxiety treatment to date. Results showed that combined CBT and sertraline led to greatest response rates. CBT alone and sertraline alone were equivalent and both superior to pill placebo.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kendall PC, Peterman JS. CBT for adolescents with anxiety: mature yet still developing. A J Psychiatry. 2015;172:519–30. Scholar
  17. 17.
    •• Ginsburg GS, Becker EM, Keeton CP, Sakolsky D, Piacentini J, Albano AM, et al. Naturalistic follow-up of youths treated for pediatric anxiety disorders. JAMA Psychiatry. 2014;71(3):310–8. This article reviews long-term outcomes of youth with anxiety disorders who participated in a randomized control trial comparing CBT, sertraline, pill placebo, or combined CBT + sertraline. Results indicated that relapse occurred in almost half of participants who initially responded positively to active treatment, indicating need for ongoing development and research of treatments that extend beyond adolescence.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Ginsburg GS, Kendall PC, Sakolsky D, Compton SN, Piacentini J, Albano AM, et al. Remission after acute treatment in children and adolescents with anxiety disorders: findings from the CAMS. J Consult Clin Psychol. 2011;79(6):806–13. Scholar
  19. 19.
    Podell JL, Kendall PC, Gosch EA, Compton SN, March JS, Albano AM, et al. Therapist factors and outcomes in CBT for anxiety in youth. Prof Psychol Res Pract. 2013;44:89–98. Scholar
  20. 20.
    Albano AM, Hoffman LJ. Treatment of social anxiety disorder. In: Kendall PC, editor. Cognitive therapy with children and adolescents: a casebook for clinical practice. New York: Guilford Press; 2017.Google Scholar
  21. 21.
    Detweiler MF, Comer JS, Crum KI, Albano AM. Social anxiety in children and adolescents: biological, developmental, and social considerations. Soc Anxiety Clin Dev Soc Perspect. 2014;253–309.Google Scholar
  22. 22.
    Guerry JD, Hambrick J, Albano AM. Adolescent social phobia in clinical services. In: Ranta K, La Greca A, Garcia-Lopez LJ, Marttunen M, editors. Social anxiety and phobia in adolescents. Berlin: Springer International Publishing; 2015. p. 201–23. Scholar
  23. 23.
    Albano AM, Poznanski B, Hambrick J, et al. The Launching Emerging Adults Functioning Scale (LEAF) [unpublished]. New York: Columbia University Clinic for Anxiety and Related Disorders.Google Scholar
  24. 24.
    Wells KC, Albano AM. Parent involvement in CBT treatment of adolescent depression: experiences in the treatment for adolescents with depression study (TADS). Cogn Behav Pract. 2005;12(2):209–20. Scholar
  25. 25.
    Barlow JH, Ellard DR, Hainsworth JM, Jones FR, Fisher A. A review of self-management interventions for panic disorders, phobias and obsessive-compulsive disorders. Acta Psychiatr Scand. 2005;111(4):272–85. Scholar
  26. 26.
    Craske MG, Kircanski K, Zelikowsky M, Mystkowski J, Chowdhury N, Baker A. Optimizing inhibitory learning during exposure therapy. Behav Res Ther. 2008;46(1):5–27. Scholar
  27. 27.
    Peris TS, Compton SN, Kendall PC, Birmaher B, Sherrill J, March J, et al. Trajectories of change in youth anxiety during cognitive—behavior therapy. J Consult Clin Psychol. 2015;83(2):239–52. Scholar
  28. 28.
    Albano AM, DiBartolo PM. Cognitive-behavioral therapy for social phobia in adolescents: stand up, speak out therapist guide. Oxford: Oxford University Press; 2007.CrossRefGoogle Scholar
  29. 29.
    Hall GS. Adolescence: its psychology and its relations to physiology, anthropology, sociology, sex, crime, religion and education. D. Appleton; 1916.Google Scholar
  30. 30.
    Pattwell SS, Liston C, Jing D, Ninan I, Yang RR, Witztum J, et al. Dynamic changes in neural circuitry during adolescence are associated with persistent attenuation of fear memories. Nat Commun. 2016;7Google Scholar
  31. 31.
    Casey BJ, Glatt CE, Lee FS. Treating the developing versus developed brain: translating preclinical mouse and human studies. Neuron. 2015;86(6):1358–68.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Lauren J. Hoffman
    • 1
  • John D. Guerry
    • 2
  • Anne Marie Albano
    • 3
  1. 1.Columbia University Clinic for Anxiety and Related DisordersColumbia University Medical CenterNew YorkUSA
  2. 2.Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  3. 3.Columbia University Clinic for Anxiety and Related DisordersColumbia University Medical Center and New York State Psychiatric InstituteNew YorkUSA

Personalised recommendations