In the last decade, rates of anxiety-related disorders in teenagers have steadilyrisen, particularly in girls. Researchers and psychologists posit severalhypotheses about why these rates are on the rise -- from digital hyperconnectivity to heightened external pressures to simply a greater awareness, and therefore diagnosis, of mental health concerns.
Whatever the causes, Dr. Lisa Damour has hopeful news for parents and teens: first, some degree of stress and anxiety is not only normal but essential for human growth. And if those levels become untenable, there are tested strategies for reining anxiety back in.
Damour, a psychologist and author of the new book "Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls," has spent decades working with adolescent girls and their families. In recent years, she has noticed a change in how society views stress. “Somehow a misunderstanding has grown up about stress and anxiety where our culture now sees both as pathological,” said Damour. “The upshot of that is that we have adults and young people who are stressed about being stressed and anxious about being anxious.”
Anxiety is a normal and healthy function, according to Damour, and much of the anxiety that teenagers express is a sign that they are aware of their surroundings, mindful of their growing responsibilities, and frightened of things that are, in fact, scary. Adults can make a difference simply by “reassuring them that, a great deal of time, stress is just operating as a friend and ally to them.”
Change and stress go hand in hand -- even if a change is positive. Teenagers' lives are filled with change: Their bodies and brains are transforming, they usually switch schools at least once between grades 5 and 12, their academic workload is increasing, and social relationships are constantly evolving. The anxiety that comes with stretching to face these and other challenges is part of how humans develop strength, said Damour.
When she talks with teenage girls, she uses the metaphor of exercise: To develop physical strength, you have to slowly push your levels of physical endurance, building up strength through resistance training. Similarly, said Damour, “you should see [a challenge] as an extraordinary weight training program for your mind. You are going to walk out of it tougher and stronger than you have ever been.”
Stress, Emotion and the Teenage Brain
Sometimes anxiety and stress reach levels that impede a girl’s ability to navigate life effectively. That said, Damour cautions that an emotional outburst -- in and of itself -- is not a reliable indicator of mental health. “If you are raising a normally developing teenage daughter, she will have meltdowns. And there’s nothing you can do to prevent that,” said Damour.
Of course, when it’s your daughter who is sobbing on the bathroom floor, it’s hard to keep this in perspective. “When it’s your kid, it’s terrifying,” Damour said. “A lot of parents are frightened and paralyzed in that moment. They wonder: Is this a sign that something is really wrong or that my kid is really out of control?”
This is where a little neuroscience might be helpful, said Damour. “The adolescent brain is very gawky and vulnerable to emotion.” That gawkiness stems from the extraordinary brain development that happens in adolescence. “The brain is upgrading, but in the same order as it initially developed,” said Damour, from the more primitive regions that house emotions to the more sophisticated regions that regulate perspective and problem-solving.
The result? “When she’s calm, a teenage girl can outreason any adult. When she’s upset, her primitive regions can hijack the whole system and take it down.”
When your daughter is emotionally overwhelmed, give her a little time. Damour said it’s easy to see a meltdown as a fire that’s about to turn into a conflagration. But a storm is a more accurate metaphor. “You can’t stop a storm,” she said. “You have to wait it out. But these storms do pass. The brain will reset itself. Don’t try to stop the storm or fix it in the moment.”
Instead, sit with her, go on a walk together, watch a funny show, or offer her a cup of tea, advised Damour. After weathering a few storms successfully, “parents and teenagers get to discover that -- all by itself -- the storm will pass. At that point, either the problem completely evaporates and she moves on, or the girl can now look at the problem with clear eyes, assess it with her prefrontal lobe back online, and figure out what she wants to do.”
Responding Instead of Reacting
Teenage girls are particularly sensitive to the cues they receive from parents and teachers – from words to facial expressions. How adults respond to teens’ emotional reactions matters a lot, said Damour. When adults become anxious in response to a teen’s anxiety, it exacerbates the situation.
Helping girls weather stress storms can be “excruciating for parents,” and Damour said she understands the almost primal desire to alleviate the pain, solve the problem for them or remove the stressor -- such as letting them stay home from school if they are anxious about a test. But avoidance feeds anxiety. Girls often feel stressed because they overestimate the difficulty of a situation and underestimate their ability to deal with it, said Damour. When they avoid a situation, they miss the opportunity to correct that perception and recognize their own strength.
Damour has found two words helpful in helping keep teens in the driver’s seat: “stinks” and “handle.”
“ ‘That really stinks’ is a very simple phrase that cuts right through it. It says, ‘I hear you and I’m just going to sit here for a moment and acknowledge that what you are up against isn’t that great,’ ” said Damour, “Empathy goes very, very far in helping them contain what is upsetting them.”
Often, there is no simple solution to a stressor, so “the next step may simply be acceptance – acceptance of the situation and of their strength to persist through it. It’s the ability to say to yourself, ‘This stinks, but this is something I can handle.’ ”
Damour said the word “handle” is empowering. Girls learn that “by enduring this, I’ll be able to endure more down the line. I’ll build up my capacity to handle unpleasant situations.”
Build in Recovery Time
In strength training, “you can’t just lift weights day after day after day,” said Damour. “In order to get the full benefits from the workout, your muscles need a chance to recover and repair.” The same holds true for the brain.
If teens accept that some level of stress is inevitable, they can spend less time worrying about stress and more time focusing on how they can build in recovery time.
“The good news is your mind recovers a lot faster than your muscles do. But you need to restore yourself so you can go right back in for another workout. Your job is to figure out how you like to recover. What’s the system that really works for you?” For some teens, playing sports gives them the reboot they need to focus on academics. Another student might benefit from a watching a 22-minute episode of a sitcom, playing with a dog, going on a walk or listening to a favorite music playlist.
Having conversations with stressed-out teens about this type of downtime redirects the attention away from the stress and toward the recovery. Students can’t always control the stressors in their life, said Damour, but they can have a say over how they choose to restore themselves.
The Restorative Power of Sleep
Sleep deprivation is one of the simplest explanations for the rise in anxiety-related concerns, Damour said. “Sleep is the glue that holds human beings together.”
The research is unambiguous: When we are sleep-deprived, we are less emotionally resilient. According to Damour, the first question many clinicians ask teens who come in for anxiety is, “How much sleep are you getting?”
If they are consistently getting less than seven or eight hours, that’s the first line of intervention. “Teenagers need nine hours a night, middle-schoolers need 10, and elementary students need 11. Caffeine doesn’t make up for that.”
When it comes to sleep, she says, small changes can make a big difference, including completing as much homework as they can during the schoolday, making judicious choices about how much time they spend on any given assignment, and monitoring social media use in the evening.
“Technology is very hard on sleep,” said Damour. “I’m not anti-social media, but it makes a tremendous difference for teens to not have a phone and computer in the bedroom at night. Teenagers have texts waking them up.”
Because of the melatonin-suppressing effects of blue light emitted from smartphone screens and other devices, Damour encourages teens to turn off social media notifications well before going to sleep. But it’s not just the blue light. “Girls will often see something on social media that will keep them up at night -- and if you ask them, they’ll usually admit this.”
Growing Up Brave
According to Damour, the most powerful force for good in a teenager’s life is a “caring, working relationship with at least one loving adult.” Within that context, adults can offer teenagers empathy, grounded perspective and a vote of confidence as they work through challenges -- helping them aim for courage, not avoidance.
“Brave is a positive word -- it’s something we aspire to be,” said Damour. “Built into the word is the understanding that the person is scared and yet they are doing something anyway. Scared is here to stay. Anxiety is part of life. It’s not our job to vanquish these feelings. It’s our job to develop the resources we need to march forward anyway.”