TEEN HEALTH: Coping with Stress

by Dr. Ann L. Engelland

Dr. ENgelland(March 7, 2004) Molly, a freshman at the high school, cannot eat breakfast in the morning. Her stomach is too “nervous” to even think about food, much less to swallow anything. By the time she reaches school, she needs to go to the restroom and often throws up before her first class.

Peter, a junior, has a hard time falling asleep at night. He lies in bed, staring at the ceiling, thinking about his grades, his college applications that by now are on some admissions officer’s desk, and his girlfriend who is pressuring him to be more fun. Sleepless, he works himself into a knot, often resorting to online chat rooms for an hour or so before finally trying to get back to bed.

Rachel, in eighth grade, feels she is not doing well enough in school and is afraid that if she brings home any B’s at all her parents will send her off to private school where she knows she would be miserable, missing her friends and classmates. She and a few friends have started experimenting with alcohol on weekends, and she has found it is the one thing that relaxes her.

Since his grandfather died six months ago, David worries a lot about his own parents and how he can make things safer so nothing will happen to them. He is having second thoughts about going away to camp in the summer. He’s thinking it might just be better to stick around the house. He finds himself reaching for his cell phone during his lunch period to check in with his Dad at work.

Worry. Stress. Anxiety.

It’s no surprise that kids of all ages are feeling it. Informal polling of local mental health workers in Larchmont and Mamaroneck corroborates that more and more patients, students, and families are presenting for counseling and guidance with stress and symptoms of anxiety.

Although a minority of worried teens have diagnosable disorders such as depression, bipolar illness, anxiety disorder with panic attacks, or obsessive compulsive disorder, many more of them are under the diagnostic radar level and are leading lives that are churning with stress that affects them in a number of ways.

What stresses kids? Stress for kids comes from without—family problems, social issues, school performance, health concerns, and the state of the world—or from within—self-generated pressure to conform, to perform, or to be different.

So what happens when we experience stress?

The biological underpinnings of the human reaction to stress are what have brought us from being cavemen to “civilized” people. Running from the wild boar, fuelled by the natural drug, adrenaline, and driven to outrun and outsmart the beast is what allowed us to survive. The “flight or fight” response is programmed chemically into our brains and bodies. However, as anyone who has ever experienced “butterflies” knows, there are side effects of the adrenaline rush. These include headache, stomachache, muscle tension, difficulty breathing deeply, lack of appetite, difficulty sleeping and sweaty hands and feet. If the wild boar is behind you, there is no time to eat, and it would not be wise to stop to sleep. All of the extra blood is moved into the body’s large muscles to help it run away, so the hands and feet get cold and clammy.

How teens cope with stress.

When asked, most teens admit that they do not know how to cope with stress. They discover, by trial and error, some methods that may work for them. Procrastination, distraction, evasion, fighting, food and alcohol are some of the maladaptive methods they discover. When they look at the problem carefully, however, they realize that these techniques often intensify the stress. Other times, teens discover that sports, friends, talking to parents, listening to music, exercise, and sleep are helpful stress breakers.

What else can we teach teens about stress?

In order to maximize their use of positive stress breakers, kids need better techniques and practice using them.

Stress is inevitable in our lives. But we need to assess the sources of stress and see if some of them can be minimized. Taking stock with a friend, parent, doctor, or therapist often helps to identify the major internal and external stressors, some of which may be self-imposed. When we recognize them for what they are, change can happen.

Teach kids to change the music in their heads. Earl Hipp has written and lectured extensively on the subject, and he recommends that kids think of the low-volume music they hear at a supermarket in the same way that certain messages play in their heads. “I can’t do this.” “I hate my body” “I’m so worried.” are some of the phrases that play over and over. Kids can consciously change the tape, teaching themselves to say, “I can do it.” “People like me for who I am.” “This is going to be ok, if I only breathe through it.”

Teach kids about mindfulness. Helping kids to focus their thoughts on the present moment prevents the escalation of worry. Mindfulness takes practice. It is a combination of learning to focus on a discrete moment in time and allowing intensive thoughts, feelings and worries to float by as if on a cloud, if only temporarily.

Teach kids to breathe. The simple art of deep breathing and body-mind cleansing is an ancient technique that makes sense. It needs to be taught and then practiced on a continuing basis. It soon becomes a habit and can serve the owner well. If Molly, Peter, and Rachel knew this breathing technique, they might not be having the visceral reactions (vomiting or insomnia) or reaching for other harmful ways of coping (such as drinking alcohol).

Breathing and mindfulness are powerful tools that can be used to counteract the body’s adrenaline and all of its side effects. But the body needs to be trained to respond to the relaxation techniques. Training need not require teens to set aside time in their (too) busy days to practice. One of the best strategies, for instance, is to practice throughout the day.

At every red light, passengers and drivers can practice breathing. Before going to bed, when walking down the hall and changing classes, while sitting on the toilet, and whenever you walk up a set of stairs, mindful deep breathing will slow the heart rate, increase oxygenation to the brain and remind it to relax.

After a few weeks, there will be a reflexive relaxation in response to the breathing. And before long, you’ve internalized your own stress-breaking drug!

This is a nutshell version of the experiences of millennia of philosophers, wise people, priests, monks, and meditators of all faiths. For a slightly larger nutshell version, I highly recommend the following books:

Earl Hipp. Fighting Invisible Tigers: A Stress Management Guide for Teens, 1995. Free Spirit Publishing.

Thick Nhat Hanh. The Miracle of Mindfulness, 1999. Beacon Press.


Dr. Engelland will be leading a seminar on "Stress and Teens" at the Family University in Mamaroneck on March 25. For more information, see: Register for Family U

Dr. Engelland has a practice in Mamaroneck devoted to Adolescent Primary Care. She can be reached at 914 698-5544. Use the form below to submit a question to Dr. Engelland.

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