TEEN HEALTH: Coping with Stress
by Dr. Ann L. 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
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
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
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
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?
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
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.
teens discover that sports, friends, talking to parents,
listening to music, exercise, and sleep are helpful stress
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.
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
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
Thick Nhat Hanh. The Miracle of Mindfulness, 1999.
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
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.
Ask a Teen Health Question:
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