My anxious son is 16, home-schooled, and prefers ‘cyber friends’ to real ones. We want him back in school, but can he cope?

First off, it is clear that you are concerned about your son and that you are invested in his wellbeing, and I applaud you for reaching out and asking for help. Additionally, it is clear that you have come to the point where you have realized the present situation “can’t go on.” That realization is a crucial first step that will motivate you to get your son the treatment he needs.

No one likes to feel anxious and so when we’re faced with an anxiety-provoking situation, our knee jerk reaction is to avoid it so we don’t feel anxious. In your son’s case, going to mass was anxiety provoking and so when he stayed home, he felt better. While avoiding feeling anxious by staying home felt good in the moment, it actually made the problem worse for him because he never learned how to face and conquer his fears associated with going to mass.

If a system is in place to enable avoidance of anxious situations, anxiety gets worse. Parents don’t like to see their child suffer. Parents often feel helpless when they have an anxious child and will do anything to make their child’s anxiety go away. The desire to protect your child from discomfort is understandable; however, in this situation allowing him to avoid anxiety-provoking situations is not the answer. You are inadvertently teaching him that the way to deal with anxiety is to avoid it (which is not actually dealing with anxiety at all.) The more your son is allowed to avoid things that are anxiety-provoking, the more he’s going to want to stay home and the worse his anxiety will get. This can quickly turn into a vicious cycle of avoidance and it can seep into other areas of his life, such as school and friends. The basic fact is the more his anxiety goes untreated, the more reclusive he’ll be, and the harder it will be for you as a family to stop it. Not impossible, just harder.

The bad news is that anxiety can become debilitating if it’s left untreated. However, the good news is that anxiety is a very treatable illness.

My basic advice is simple: obtain a comprehensive psychological evaluation from a licensed mental health professional. Based on your description, it is likely that your son will be given a diagnosis of an anxiety disorder. Research has shown one of the most effective treatments for an anxiety disorder is cognitive behavioral therapy (CBT) in which a person learns coping skills to face and reduce his anxiety. Research has also shown that a type of CBT called exposure and response prevention (ERP) is effective in treating many types of anxiety disorders. This therapy encourages individuals to face their fears by “exposing” them to their fears in small, manageable steps. Over time they learn to master their fears with competence and confidence and move on to bigger challenges.

It is very important that you don’t make it an option to simply not see a mental health professional. It is great you tried to get him to see someone in the past, and you’ve got to keep trying! I suggest you give him choices, such as two or three different therapists, but you must be clear that he has to decide on one.

I want to draw your attention to something you said: “We want to put him back in school but know that he won’t be able to cope.” When a person goes back to school, it doesn’t happen overnight. It has to be done in sequential steps, just like any exposure, so that each step is challenging but manageable, reasonable, and tolerable. Over time, maybe he’ll go in for a half day, and then longer, and longer — all towards the goal of being a full-time student again. Don’t get caught between the extremes of where you are now and what looks like an unrealistic positive outcome. It is possible, with patience and assistance.

There is an important role for you as parents in your son’s therapy. Ask your son’s therapist to help you learn ways you can help your son face his anxiety rather than allowing him to avoid it. As parents you will have to learn how to manage your own distress as you watch him face his own anxiety. It will be uncomfortable to see your child feel anxious, but it’s an important part of the process. You can learn ways to encourage and cheerlead him rather than trying to rescue him from discomfort.

I also wanted to touch on a couple of details of your story. I don’t believe your son’s online friendships are necessarily problematic. However, if they become the only form of communication and socialization, and they interfere with other areas of life (such as not socializing face to face or not doing what he needs to do such as go to school) then it is a problem. Additionally, it is important to understand why he is spending so much time on his computer and not with his friends.

Relatedly, I wanted to note that your son doesn’t necessarily have social skills deficits—he has had friends in the past, so there is a strong likelihood that these skills are there and just need to be strengthened. It’s possible the anxiety is simply keeping him from “exercising” those social muscles. But we don’t know this until he gets an evaluation and a treatment plan that builds on his strengths and helps him where he is struggling.

Remember, it’s important to have faith and belief in your son, because you need to be his cheerleaders. Together as a family, and with the help of professionals, you can address this situation successfully.