Therapy for High-Achieving Teens: Anxiety and Burnout

A teen can have excellent grades and still be in real trouble. Perfectionism, constant anxiety and burnout are common in high-achieving high school students, and they often stay hidden because the report card looks fine. Blackburn Clinical Services offers one-on-one therapy in our West Los Angeles office or by secure video (for clients located in California) for teens 13 to 17, with family sessions for parents, to help students keep their ambition without the cost to sleep, health and mood.

Who this is for

Parents of high school students who are doing well on paper but:

• stay up past midnight redoing work that was already good enough
• melt down, cry or shut down over a single grade, a test or a missed point
• have stomachaches, headaches or panic before tests, games, recitals or auditions
• cannot rest on weekends or breaks without feeling guilty
• have stopped enjoying activities they used to love and do them only for the resume
• seem flat, irritable or exhausted, or have started using caffeine, stimulants, vaping or alcohol to keep going

Perfectionism, anxiety and burnout: how they fit together

Perfectionism is more than high standards. It is the belief that anything short of flawless is failure, usually paired with harsh self-criticism. A review of studies of college students published in the peer-reviewed journal Psychological Bulletin found that perfectionism rose substantially among young people between 1989 and 2016, especially the sense that others expect perfection.

Anxiety is the engine that keeps it running. According to the National Institute of Mental Health, an estimated 31.9 percent of adolescents have had an anxiety disorder at some point. In high achievers, anxiety often shows up as overpreparing, reassurance seeking, procrastinating on big assignments and trouble sleeping.

Burnout is what happens when the pace never lets up. Teens describe feeling empty, numb or done. Burnout can look a lot like depression, and sometimes it is depression, which is why an assessment matters. See signs of teen depression parents miss.

What therapy at Blackburn looks like

• An assessment first. We meet with your teen and with you to understand the pressure, the habits and what is underneath them.
• One-on-one therapy in our office or by secure video for clients located in California. Approaches such as CBT, ACT and DBT help teens challenge all or nothing thinking, tolerate a B without panic, plan work realistically and protect sleep.
• Family sessions. Many high achievers come from loving, invested families. Sessions help parents and teens talk about expectations, praise effort over outcomes and decide together what to drop.
• Scheduling. Sessions are Monday to Friday, 9 AM to 5 PM, scheduled within those hours to fit around school.
• More intensive care if needed. When anxiety or burnout is severe, the Blackburn Concierge Outpatient Program offers typically 3 to 5 hours a week of one-on-one therapy, with no groups.
• Psychiatry. Psychiatric care can be arranged if an evaluation for medication would help. Learn more about anxiety treatment.

What parents can do this week

• Notice the cost, not just the results. Keep a quick note for a week of bedtimes, meltdowns, skipped meals and physical complaints.
• Name what you see without judgment. Try: “You have been working so hard, and you seem exhausted. I am worried about you, not your grades.”
• Praise process and character. Comment on effort, kindness and courage more than scores.
• Protect sleep. Agree on a consistent lights out time and keep phones out of the bedroom overnight.
• Look at the load together. If your teen is in many advanced classes and several time intensive activities, ask what they would choose to keep.
• Call for an assessment if things have not improved in a few weeks, or right away if your teen seems hopeless.

Sports can add to the load; see therapy for high school student athletes, and if worry turns into sudden surges of fear, read teen panic attacks: what helps.

When to get urgent help

If your teen is in danger right now, call 911. If your teen talks about wanting to die, is harming themselves or you are worried they might, call or text 988 to reach the 988 Suicide and Crisis Lifeline, any time of day. You can call 988 as a parent, for advice about what to do next.

Questions

My teen gets straight As. Can they really need therapy?

Yes. Grades measure output, not wellbeing. Many teens who struggle this way are top students who are anxious, exhausted or unhappy. Therapy can help them keep their goals while getting their health back.

Will therapy make my teen less motivated?

The goal is not to lower ambition. It is to replace fear driven effort with sustainable habits. Teens often do as well or better when they are not running on panic.

Is perfectionism a diagnosis?

No. Perfectionism is a pattern of thinking and behavior. It often comes with anxiety, obsessive compulsive symptoms, depression or eating concerns, which is why we start with an assessment.

Do parents join sessions?

Family sessions are available and often helpful. Your teen also has private one-on-one time with their therapist.

When are appointments available?

Monday to Friday, 9 AM to 5 PM. We work with you to find times within those hours that fit around school.

More for families: therapy for private school students, college admissions stress and ADHD and neuropsychological testing.

Get started

You can also email info@blackburnclinical.com or contact us. Parents usually make the first call; your teen does not need to be on the line.

Sources

• Curran and Hill (2019): Perfectionism is increasing over time, Psychological Bulletin
• National Institute of Mental Health: Any Anxiety Disorder
• 988 Suicide and Crisis Lifeline