Supporting teens with anxiety: Effective strategies for home and school

Common Anxiety Disorders in Teens

Anxiety disorders are characterized by intense levels of anxiety that have a clinically significant impact on one’s ability to live and function. The anxiety disorders that are common in teenagers are:

• Generalized anxiety disorder (GAD): GAD is frequently characterized by consistent, prolonged feelings of worry or dread. It’s not the same as being stressed about an upcoming test or worried about a sick loved one, but rather consists of significant worry about various situations or circumstances that they may or may not be in, and can make living and functioning difficult. Teens living with GAD tend to report a consistent degree of anxiety, rather than occasional spikes and regressions. Those with GAD may also experience panic attacks, which may or may not be triggered by a clearly defined event. 
• Social anxiety: Those struggling with social anxiety may be able to navigate most areas of their lives, but struggle with social situations or interactions. They may worry about how their peers will react to things or their own behaviors more than the average teenager already does. This may cause the teen to catastrophize about situations and ruminate on them. Social anxiety can make it difficult to resolve conflict, ask questions, and maintain relationships.
• Phobias: A phobia is a persistent, irrational, and intense fear of specific stimuli, such as being outside, being in a small room, heights, or even large objects. The high levels of fear associated with common or everyday stimuli can make day-to-day functioning incredibly difficult depending on the specific feared object or situation. This may make doing activities or traveling difficult, as the family would have to accommodate their teen’s fears.
• Panic disorders: This disorder is characterized by frequent panic attacks, usually with no specific fear or worry triggering them. Panic disorders look very similar to GAD—however, the difference is having a focus on the panic component and not their worries. 
• Obsessive-compulsive disorder (OCD): OCD is characterized by a cycle of uncontrollable, chronic thoughts (obsessions) and repetitive behaviors (compulsions) that severely interfere with daily functioning. Due to these obsessive thoughts and compulsions, even daily tasks like eating, drinking, and going to school can become difficult.

Anxiety disorders often have specific causes and symptoms, and therefore specific treatments. If you suspect your teen may be struggling with an anxiety disorder, it’s advisable to seek help from a mental health professional to ensure they receive the treatment that’s right for them.

Signs of Anxiety in Teens

Signs of anxiety in teens include:

• Becoming agitated, irritable, or tense quicker than usual
• Sensitivity to criticism and/or being extremely self-conscious (outside of normal developmental expectation)
• Worrying about the future, especially about things that are unlikely to happen
• Withdrawing from people and activities, especially those that they previously enjoyed
• Challenges concentrating on tasks
• Changes in sleep and eating patterns
• Chronic complaints about stomachaches, headaches, or other forms of discomfort
• Grades dropping (may or may not include school refusal)
• Consistently seeking reassurance that everything is okay
• Excessive worry about how well they do things
• Excessive worry about how others perceive them
• Excessive concerns about body image

It is important to note that the last three items listed above are normal worries for a teenager. As teens begin to individualize from their families and form their identities, it’s common for them to worry more about how they’re perceived by others. However, if these worries become all-consuming or make socializing and everyday life more difficult, they may be indicative of a mental health issue.

When Should I Be Concerned About My Child's Anxiety?

Anxiety can be a hard condition to live with and can make navigating life more difficult. A parent should become concerned about their child’s anxiety if:

• The child reports high anxiety and they feel like they can’t manage it effectively.
• The child is struggling to regulate their anxiety, they no longer engage, or they attempt to avoid things more than usual.
• The child is struggling at school. A big red flag might be having lower grades than in prior semesters. Another red flag is if the child or school reports a lot of social issues such as the child isolating themselves, conflict with peers, or bullying from peers. 
• The child is unusually irritable, struggles with concentrating on tasks, and has changes in sleep (be mindful that this is also a symptom of depression)

If you are concerned about your child or teen’s anxiety, or any aspect of their mental health, consider contacting a mental health professional. They can assess your child’s symptoms, create an individualized treatment plan for them, and teach them healthy coping strategies to help them manage their symptoms.

Recognizing Anxiety in the Classroom

Because teachers spend so much time with the children in their classrooms, they may be the first to recognize that a teen is struggling with anxiety. Common signs of anxiety at school are:

• Isolating from peers. For example, the teacher tells the class to form small groups and the teen stays put, not knowing where to go or whose group they should join.
• Difficulty concentrating on tasks.
• Forgetting to turn in work. Their work may even be complete, but the teen neglects to turn it in—or, conversely, it is turned in, but it is incomplete.
• Stuttering or forgetting information when called on by the teacher. They may then try to hide or get the teacher to call on someone else.
• Task avoidance. The teen might be spending a good part of the day in the social worker’s or the guidance counselor’s office, respectively, on a daily basis.
• Excessive worries about presentations and tests.
• Excessive time spent in the bathroom or at the nurse. They may try to avoid social interactions as much as possible by isolating in the bathroom or in the nurse’s office.
• Conflict with peers. Anxiety can cause teens to become irritable and lash out, as they feel overwhelmed and don’t know how to deal with their intense discomfort. Other students may also see their isolation or struggle to connect with others as “strange” or “weird,” causing them to pick on or belittle them.
• Frequent complaints of physical pain or discomfort. Anxiety can cause physical aches and pains as well as dysregulated emotions.
• Sleeping during class. Anxiety can disrupt sleep patterns, and because sleep is especially important for teens, sleepiness in class can be a sign.

Again, since teens spend so much of their time in school, many signs of anxiety are likely to pop up in class. If you think your teen might have anxiety or another mental health condition, consider talking to their teachers to see if they have noticed any unusual behavior. 

Supporting Teen Mental Health at School

One of the most important ways to support teens with anxiety in school is to assess if a 504 plan or a formal individualized education plan (IEP) is necessary. IEPs are plans put in place to provide appropriate accommodations for students with a variety of physical and mental health conditions, such as those with autism, ADHD, or anxiety, to give them appropriate tools and support and help them succeed in school. 

At home, you can encourage your teen to connect with their peers, whether at lunch or through a club or sports. Making friends can help them feel more connected and less isolated, allowing them to form their own community and gain confidence through improving their social skills.

You can also normalize how challenging school can be and validate their struggles. Encourage them to take little breaks throughout the day, such as getting a drink of water or going to the bathroom, and remind them that they are doing their best. 

Supporting Teen Mental Health at Home

As adolescence is a period of significant physical, emotional, and psychological changes, it’s crucial to support your teen’s mental health at home. Here are some ways you can help support your teen’s mental health:

• Help your teen recognize their triggers and body sensations as they occur so they recognize if their anxiety is starting to escalate. This can help your teen pick up on what they’re feeling and work to stop the anxiety before it begins to block them from living their normal life.
• Teach and practice grounding. Grounding techniques are cognitive exercises meant to bring focus back to the present moment. The most common form of grounding is the 5-4-3-2-1 method: naming five things you can see, four things you can hear, three things you can smell, two you can taste, and one you can feel.
• Encourage them to practice their coping skills, and model how they’re used. Help your teen identify ways to calm themselves down such as breathing techniques, looking at pictures that make them happy, and yoga. Modeling can be an incredibly helpful way of helping your teen learn coping skills—especially if you live with anxiety yourself. Telling your teen that you’re feeling anxious about a situation and following through with the task shows your teen how to work through anxiety, hopefully giving them ideas on how to work through their own.
• Encourage some physical activity (if appropriate). Physically moving around helps to produce endorphins as well as dopamine, which has been shown to help regulate mood. Even a brief walk can improve symptoms of anxiety.
• Help your teen identify ways they can gather information to help them reduce their anxieties. This can be as simple as helping them research where they’re going on vacation and what’s around them, or even just walking them through what a situation could look like.
• Be patient with your teen. Yelling at your teen to get over themselves or saying their anxiety is all in their head is not going to help them feel less anxious. A little validation and acknowledgment of what they’re feeling can go a long way in helping them work through their anxieties.
• Celebrate their victories, no matter how small. When progress is acknowledged, it lays the groundwork for larger victories by helping build momentum. 

Anxiety can be difficult to overcome, and even more so without proper support and encouragement. If you struggle to understand how best to support your teen in their journey with anxiety or how they are feeling, researching anxiety — what it looks like, how it feels to experience it, etc. — can be a helpful tool in supporting your child.

Coping Strategies for Teens With Anxiety

Learning to live with and manage anxiety can be a big challenge for a teen. Here are some strategies that can be used to help them manage their anxiety, especially when it feels out of control:

• Develop an emotional first aid kit: Put together a tote bag or a small box filled with things that help them feel good or regulate emotions that can be taken to school. It might include scented hand lotion, fidget toys, or a worry stone. When they feel anxious, they then have access to helpful tools wherever they are.
• Breathing techniques: Breathing exercises are a powerful tool to calm the rapid heartbeat or shallow breathing often associated with anxiety and can be used almost anywhere. One of the more common breathing techniques is square breathing: inhale for four seconds, hold for four, exhale for four, hold for four, and so on. Repeat at least 3-5 times or until calm.
• Break down challenging times into more manageable pieces: Instead of trying to cope with the entire situation (or situations) at once, break tasks into small, doable sections that are easier to digest. This can help prevent overwhelm and increase momentum. For example, instead of a teen thinking, “I have to get through the school day,” they could say “I’m going to focus on getting through the morning, and then I can relax at lunch,” or “I just need to get through math class, and then I’m done.” 
• Practice radical acceptance: Radical acceptance is about accepting the present moment as it is—not how it should be. In this scenario, teens aren’t fighting with themselves or ignoring what’s wrong. They don’t have to like or enjoy what is going on, but they have to work to accept the moment as it is despite how they feel about it. Radical acceptance also encourages one to identify what could make the present moment better, without focusing on changing it. 
• Grounding: Grounding exercises focus on getting neutral information into the brain. List-making can be helpful, such as naming one’s favorite albums or cities, counting something in a room or on a road (lights, cars, etc.), or naming the streets you lived on or visited. The most common form is identifying things with the senses — for example, the 333 rule, which involves naming three things you can see, three you can hear, and three you can touch or move. 
• Coping thoughts: Tell yourself a mantra that can help you deal with the situation: “It is what is,” “All actions have led up to this moment,” or “I can take all the time I need to relax.”
• Set up routines that encourage success: This means getting enough sleep, setting up the day to feel productive, and prioritizing what’s important for that day.
• Practice self-care: Self-care is what provides teens (and everyone else) the energy and peace of mind to do what they want to do and provide care that our friends and family members need. Self-care doesn’t need to be a day spent at the spa; it can be time spent with friends, engaging in enjoyable hobbies, going on a walk, or making sure to eat nourishing food.

Coping skills are important for dealing with anxiety in the moment, but preventative measures like therapy help decrease anxiety levels over time. For those with intense anxiety symptoms, consider talking with a psychiatrist to see if medication might be a necessary part of anxiety management for you or your teen.