Helping Students Manage Anxiety

Everyone experiences anxiety some of the time. In the adult world, we grapple with our worries concerning, among other things, finances, health, relationships, and frequently how our kids are doing.

Teenagers grapple with their own suite of fears, many which center around the social relationships that are central to their lives. Teens worry about acceptance and rejection, avoiding humiliation, bullying, their mistakes living in perpetuity online, academic pressures, their families, their futures, and the state of the world that they are soon going to inherit.

The pandemic was not kind to teen mental health. In 2019, prior to the pandemic, the CDC found that 9.4 percent of children had an anxiety disorder in which daily functioning was impaired. Many teens who experienced subclinical levels of anxiety prior to the pandemic, saw their anxiety levels increase to clinical levels when exposed to the isolation and dismantling of support systems during the pandemic. One medical group found that rates of depressive symptoms and anxiety have doubled since the onset of the pandemic with nearly 25% of students experiencing impairing anxiety.

The pandemic has shifted, the great isolation is thankfully behind us, but so many young people are still dealing with the aftermath of that time. As school is starting up again, teen anxiety and other mental health concerns will increase. One medical group noted a 60% increase in the rate of pediatric mental health emergency room visits when school is back in session.

Teens need to develop strategies to manage anxiety. Some anxiety is situational and will resolve when the context changes, while for others, anxiety is more pervasive and less context-dependent. Emotional self-regulation is a skill that can be developed and enhanced with practice and time.

If a teen is in crisis, it is essential to seek qualified medical support. Urgent measures may be necessary. Once a teen is stable and safe, it’s time to begin to work on the skills of self-regulation. This is a process that will take months, and potentially years. Self-regulation is a critical life skill, which students will need to revisit throughout the phases of life as the demands upon them change.

There is rarely a single magic intervention that can get us through all the hard times we will face in our teen years and throughout our lives, but a personalized recipe of interventions and tools can help us make it through.

Therapeutic interventions

Many of my colleagues teach teens self-regulation skills and anxiety reduction through the lens of Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT). Cognitive Behavioral Therapy examines the intersection of our thoughts, feelings and behaviors. One of the key takeaways from my therapeutic training was the profound importance of self-talk and inner-dialogue to sustain anxiety. The messages we tell ourselves, the dialogue that runs in the background, drives our feelings--our feelings of comfort and safety or danger and threat. When we begin to work on our inner dialogue and systematically replace anxiety-fueling thoughts with calming thoughts, our emotions and behaviors change. A helpful and highly accessible resource is the book Chatter by Michigan psychological researcher, Ethan Kross.

DBT, conceived by famed psychologist Marsha Linehan, helps to examine the intersection between self-acceptance and change. One of the principal tenets is how to enhance one’s distress tolerance, to be able to internally experience and tolerate discomfort, without immediately reaching for something, potentially harmful, to shut it down. What are the triggers and conditions which led to the discomfort, and how can I soothe, center myself, and ground myself before I do something potentially harmful?

Many potent therapeutic interventions rely upon the reframing of events, the imposing of new meaning upon the events in our lives. Events are relatively neutral, e.g., I didn’t get the part in the play, the date for prom, the teen leadership position, or the college acceptance I wanted. Or several kids said mean things about me on Snapchat.

What we make that event mean is up to us. We can dive into a shame spiral and beat ourselves up with attacks of general worthlessness, or we can reframe the events using a different lens, look with more scrutiny at the specific situation, look at the context. We all can handle some pain, and we don’t need to add shame into the equation. Our inner “wise adult” can soothe us, rather than shame or criticize us, and we can potentially integrate lessons from the event if we are looking to generate a different outcome the next time we face a similar situation.

Mindfulness

Like many powerful techniques for emotional regulation, mindfulness practice is one that arose in the East. For eons, Eastern traditions have dedicated a great deal of energy and resources into self-management, the attainment of a more composed inner state.

Some people are able to learn to quiet the mind and lower anxiety through contemplative and meditative practice. Mindfulness training is a powerful tool: to be able to watch and observe your thoughts as they emerge, from a place of curiosity and compassion. One of the few apps I subscribe to annually is the Waking Up app, which I find to be particularly helpful with structured meditations and guidance for the beginner and intermediate meditator.

Not everyone is comfortable just sitting, and there are many approaches to self-regulation that involve the body. For 20 plus years I’ve had a Qi-Gong practice, which involves repetitive focused movement and mindful attention. Others find Tai-Chi and yoga very helpful for grounding. Taking the time to slow down, to center the mind, to focus on the breath, can be powerful. We have evidence that the deep diaphragmatic breathing of contemplative practice stimulates the vagus nerve and calms the sympathetic nervous system, lowering anxiety.

Short-term approaches

Other practices to reduce anxiety don’t require the same time investment. I’ve been teaching students about the benefits of a simple intervention called tapping, AKA the Emotional Freedom Technique- a simple series of taps on selected pressure points, balanced with calming thoughts. There are dozens of good videos on how to tap online.

A simple intervention called Havening is another helpful modality that involves repetitive movements with light pressure on the face, arms and hands. I know practitioners who swear by the efficacy of this simple practice.

I became interested in the HeartMath Institute some 20 years ago and their focus on coherence, using the breath and the mind to create a coherent heart pattern. I have a little biofeedback device that I use from time to time, which measures the heart rate variability. The calmer I get, the more coherent the wave I generate on my iphone app.

General Self-Care

When we take better care of ourselves, our bodies, our physical health, this is protective of our mental health.

• Exercise is a simple and powerful intervention to lower anxiety. Exercise stimulates many good hormones and neurotransmitters, and helps suppress stress hormones. Teens who are feeling heightened anxiety need to make time for cardiovascular exercise; it’s protective.
• Good sleep is key for mental health. Anxiety disorders and sleep difficulties often go hand in hand. Anyone grappling with elevated anxiety needs to put sleep hygiene high on the list of priorities.
• A balanced diet and adequate hydration both contribute to mental health.
• Human touch helps to decrease stress hormones and lower anxiety. Many of the techniques for lowering anxiety, such as tapping and havening and HeartMath breathing with your hand on your heart, involve some form of calming touch. Hugging others, holding hands, petting your dog or cat can also lower levels of cortisol, boost oxytocin and lower feelings of anxiety.
• Spending as little as ten minutes outdoors, in a natural setting, has been shown to reduce feelings of anxiety and boost wellbeing. Nature is healing.
• Being mindful with your screens and devices. Technology is a double-edged sword: it can connect us, and it can isolate us. It can lower anxiety through meaningful contact or make us feel more alone and separate if we are passively scrolling through social media and feeling critical about our lives. It’s important to discuss with teens how their technology use impacts their sense of well-being and feelings of anxiety. For some teens, reducing the focus on digital contact and increasing in-person interactions can lower anxiety levels.
• Reflection and journaling can help us understand our patterns and see our ruminations on paper. When we journal for ourselves, not for public consumption or performance, this can help reduce levels of anxiety.

This list is far from comprehensive. There are myriad ways to help us manage our mood and affect and keep anxiety in check. If we take better care of ourselves, if we focus on self-care, our mental health gets a boost.

Teenagers who begin to focus on self-care and learning strategies to take care of their mental health will have an advantage as they move through academia and beyond. Self-regulation is a life skill, and if we invest in ourselves, at any age, it will pay dividends.

For more insights on teen anxiety and how parents can help, join my free webinar: Teens + Anxiety.