An estimated one in 10 teenagers have mental health problems and there is a high prevalence of anxiety and depression. In this five-article series, Dr Stephanie Thornton advises schools and teachers. In part four, she advises on how we might students who suffer from anxiety

Anxiety of one sort or another is one of the earliest, and most common of mental health problems in the young (Beesdo et al, 2009), especially among girls (Craske, 2003).

Research suggests that as many as 1 in 6 teenagers may suffer from anxiety – so in a class of 30, there may be five individuals struggling with this problem (Beesdo et al, 2009).

And NHS figures show that 12.8 per cent – roughly one in eight – five to 19-year-olds had at least one mental health disorder when assessed in 2017. This figure rises to 16.9 per cent of 17 to 19-year-olds. Furthermore, of these, emotional disorders were the most common, affecting 8.1 per cent of five to 19-year-olds in 2017. And of these, anxiety-related disorders were the most common – 7.2 per cent (see SecEd, 2018).

Anxiety is intrinsically distressing; it undermines school success, both academic and social, and is associated with increased risk of substance abuse, self-harm, suicidal behaviour and other adverse developmental outcomes (Woodward & Fergusson, 2001).

Anxious teenagers are at risk of suffering mental health problems throughout life (Gregory et al, 2007). So it is really worth doing all we can, to help the young cope with and hopefully overcome anxiety.

There are many different triggers for anxiety, from life experiences to mental disorders of various kinds, and there are many different degrees of anxiety. This means that there can be no one-size-fits-all solution that will fully resolve the problem, and no classroom teacher can be expected to cover that range.

 

Anxiety and depression: A five-part series by Dr Stephanie Thornton

Part 1: Anxiety and depression: The new normal? March 2020: https://bit.ly/2wE3Bye
Part 2: Anxiety and depression: Are they co-morbid? April 2020: https://bit.ly/3blzR7u
Part 3: Anxiety and depression: When should we intervene: May 2020: https://bit.ly/2T0KlTr
Part 4: Anxiety and depression: Managing anxiety in the classroom: June 2020: https://bit.ly/2XJXiUu
Part 5: Anxiety and depression: Managing depression in the classroom: July 2020: https://bit.ly/2YJ9DJ0

 

So what practical support can teachers feasibly provide in the face of teenage anxiety? Whatever the cause, all anxiety tends to have some common features which we can potentially address in the classroom:

  • The anxious are generally wrapped up in thoughts that exacerbate their fears (focusing, for example, on whatever the trigger for the anxiety might be: fear of failure, social rejection, bullying, a situation outside school, even the anxiety that there might be a giant spider in the corner, and so on).
  • The anxious notice, and worry about, the physical signs of fear: rapid pulse, shallow breathing, clamminess (am I ill, having a heart attack?).
  • What kinds of things might make a person anxious? The more ideas students come up with here, the better. And it is helpful for students to realise that anxiety is not necessarily either pathological or embarrassing: there are situations in which anxiety is the healthy and helpful response, so long as one uses that anxiety effectively to address problems, rather than letting it overcome you.
  • What does anxiety feel like? It may be useful to pick some situation that any normal person would feel anxious about, but which is unlikely to be the source of anxiety for anyone in your classroom. For example, ask students to imagine engaging in that “trust” exercise where one must throw oneself backwards, trusting peers to catch you before you hit the floor (there is no need to actually do this). Ask students to pay attention to the tension in their bodies, their breathing, etc. Where is the anxiety located? Throat? Chest? Racing pulse? Balled-up hands? What does it feel like?

What can we do?

First aid

First aid when a teenager is overwhelmed by anxiety, or even a panic attack, is to remove bystanders, especially those who may exacerbate the situation by ridiculing or becoming anxious themselves. A companion exuding calm can be effective in relieving distress.

Reassure: the physical symptoms are not dangerous. Encourage the teenager to talk, preferably about something distracting: talking helps to regulate breathing, reducing the fear induced by struggling for breath. And distraction interrupts the thoughts fuelling the anxiety.

Once the main crisis is passed, a teenager who has experienced a panic attack will need a quiet place to recover, with a calm companion offering reassurance and help. Do not leave them alone.

Foster resilience

Foster resilience by teaching all young people to recognise and understand anxiety. Surprisingly often, sufferers do not really understand what anxiety is, or why they are anxious. Group discussion (talking only in general terms – do not let individuals be too self-revealing in a group discussion) can help the anxious to recognise anxiety and name it, providing a key foundation for learning to manage it.

In addition, learning to understand anxiety can create resilience in others who have not yet felt serious anxiety (but probably will, life being what it is). Such shared understanding may foster a classroom culture that is supportive, rather than judgemental. Practical advice for structuring such discussions includes:

Communication

Reacting effectively to anxiety involves communication. Sometimes, and generally with minor anxieties, there is a practical solution that we can immediately enact. But for those with problematic, unresolving or serious causes for anxiety, no “fix” may be either apparent or possible. The effective practical support is to encourage the young to ask for help. Communicate. Talk to a trusted person. The message the anxious student needs to hear is that there is someone to confide in, someone who will not judge, but only try to help.

So make sure there is such a trusted person in your school – and that all your students know who that is, and how to access them. And of course, that person must be able to triage anxiety: when to cope locally, when to call in expert help?

Cutting off anxious thoughts in the classroom

Whatever the cause, constant rumination on those issues exacerbates anxiety. Expert opinion agrees: finding ways to disrupt anxious thoughts is a very practical and helpful intervention.

One popular solution here is to encourage the practice of mindfulness, a shift to focus only on the immediate. Many of our schools are now teaching this practice. However, a major meta-review of research (Hofmann et al, 2010) reports that though mindfulness practices do offer some benefit to some individuals, the benefit is at best “modest”, and that overall, research in support of mindfulness is of poor calibre.

Mindfulness practices are by no means the powerful panacea that is often suggested. Worse still, there is research that suggests that a mindful focus in the moment can have damaging effects in some kinds of anxiety (Lustyk et al, 2009). And in fact, anything that distracts an individual from ruminating on anxiety-provoking thoughts works just as well as any meditative practice: getting involved in a non-threatening task, sport or game, for example. Physical exercise can be very effective here. The crucial thing is that anxious thinking is disrupted. Whatever works for the individual is the thing to encourage.

Physical tensions

Counter the physical tensions of anxiety. Teach the young to recognise, and counter anxiety as it starts to create physiological effects. There is considerable benefit from taking charge of breathing: long, slow, deep breaths are intrinsically calming.

Noticing areas of tension in the body and face, and systematically relaxing the muscles is also very effective. Everyone can benefit from learning these strategies, whether they have problematic levels of anxiety or not: we all experience moments of tension, and learning to recognise and deal with them effectively is an important life-skill for us all.

Discussing such strategies may benefit the whole class, rather than just the anxious – but they should help the anxious in particular.

  • Dr Stephanie Thornton is a chartered psychologist and former lecturer in psychology and child development. To read Dr Thornton’s previous articles in SecEd, including in this series, go to http://bit.ly/2o1BVxK

Further information & references

  • Beesdo, Knappe & Pine: Anxiety disorders in children and adolescents: developmental issues and implications for DSM-V, The Psychiatric Clinics of North America, 2009: http://bit.ly/2sRmcFf
  • Craske: Origins of phobias and anxiety disorders: Why more women than men? Elsevier, 2003.
  • Gregory et al: Juvenile mental health histories of adults with anxiety disorders, American Journal of Psychiatry, February 2007.
  • Hofmann, Sawyer, Witt & Oh: The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review, Journal of Consulting and Clinical Psychology, April 2010: http://bit.ly/2R3hYST
  • Lustyk et al: Mindfulness meditation research: Issues of participant screening, safety procedures, and researcher training, Advances in Mind Body Medicine, March 2009.
  • SecEd: One in eight students have a mental health disorder, official NHS figures confirm, November 2018: http://bit.ly/2QbgUi3
  • Woodward & Fergusson: Life course outcomes of young people with anxiety disorders in adolescence, Journal of the American Academy of Child and Adolescent Psychiatry, September 2001.