What should we do about Teenagers’ anxiety?

A few days ago I contributed some comments to an item on LBC Radio’s afternoon programme with Shelagh Fogarty. The piece was covering a news item about a study by The University of Bristol, which surveyed 1,000 secondary aged pupils in the south west of England. It concluded that the 13-14 year olds survey participants were markedly less anxious several weeks into non-school attendance than they were in the October preceding lockdown with its school closures. The lead author of the report, Emily Widnall is quoted as saying: “With the whole world in turmoil, the natural expectation would be to see an increase in anxiety,” and, “While we saw anxiety levels rise for a few of our participants, it was a big surprise to discover quite the opposite was the case for many of them.” And Dr Judi Kidger said: “Our findings raise questions about the role of school environment in explaining rises in mental health difficulties among teenagers in recent years.”

Emily Widnall was asked a few questions on the LBC programme and talked about the fact that the research methodology consisted of teenagers’ self-reported views on their anxiety levels. This is an important point that highlights the subjectivity at play when we think about mental states and this same subjectivity is very much influenced and shaped by the context in which it arises. Young people spend a huge amount of time introspecting and, as one parent said to me, “the trouble with teenagers is they only really have one thing on their mind, themselves, and they put all their time and energies into this!”. The other thing to remember is that the general public awareness of mental health and wellbeing has never been so high. Generally speaking, there is an expectation on the part of mental health professionals and those they talk to that rates of clinically diagnosed mental health disorder, such as General Anxiety Disorder (GAD) will rise as a result of the pandemic so research like the Bristol study is intriguing.

According to Skeat’s Etymological Dictionary of the English Language anxiety comes from the Latin angere, meaning to choke or distress. Other links with French and Greek terms for a particularly bad sore throat generally concur with the modern day usage that implies an uncomfortable, upsetting and even painful state of being. We all talk about anxiety a fair bit and most people regularly experience some anxiety. However, the operative word is some and this experience is not the same as a disabling clinical mental health disorder such as GAD.

Modern dictionaries largely define anxiety in three particular ways: 1. A state of uneasiness and apprehension about future uncertainties or in terms of the cause of this state, e.g.,travelling by underground train is a cause of anxiety for some. 2. A psychiatric term in which the state of apprehension, uncertainty or fear is so strong it is disabling to the extent that it interferes with a person’s day-to-day life and actions and health. 3. A descriptive word In terms of an eagerness or enthusiasm, e.g. someone being anxious to perform well in an exam or test.

By and large 1 and 3 (above) are types or degrees of anxiety that most people regularly experience but 2, being a clinically diagnosed mental health disorder, is not. Sometimes the diagnosis of an anxiety disorder might even increase a person’s anxiety, if the individual views such a diagnosis as cause for shame. As I mentioned in my last post, ‘Do we need to talk to a real person?”, social stigma about mental health and also the idea that it is a fixed and life-long state are prevalent. The Bristol Study found that 54% of girls and 26% of boys considered they were experiencing significant levels of anxiety in October of 2019 and this figure decreased to 45% of girls and 18% of boys in May of this year, 2020. Whether or not they were attending schools it appears that a huge proportion of teenagers, particularly girls, perceive themselves to be anxious and so the study’s conclusion that schools need to be active in supporting their pupils’ mental health and wellbeing is justified.

So what can schools be expected to do? In the first instance they need to be places where young people can articulate their anxiety and feel safe to do so. What an individual means by ‘feeling anxious’ varies enormously and the factors contributing to this will be many, i.e., it may concern the individual’s self image, their family situation, their physical health, perceived pressures such as academic or social demands, their financial situation and lifestyle choices to name some of the most obvious. Likewise, the possible resources and strategies they might employ to deal with their anxiety will vary as well.

In my clinical experience the schools that appear to be most effective in supporting young people’s mental health and wellbeing are able to offer a combination of the following: 1. Informed and sensitive staff across the board, from members of the school’s senior management team right through to teachers and teaching support staff, time for staff to give time to individual pupils as and when the need arises, ideally expressed by individual pupils to individual members of staff. 2. Comprehensive Relationships and Sex Education (RSE) and PSHE (Personal, Social and Health Education programmes that covers physical, relational, emotional and social health through presenting a range of healthy lifestyle choices, for example, relating to sleep, rest, exercise, finance, relationships, physical and mental health. 3. Good levels of resourcing from and links with external agencies such as local Educational Psychology Services, Child and Adolescent Mental Health Services (ACAMHS). 4. A school system that is open to new approaches, to development and to learning from its pupils and parents as well as services that have expertise in children and young people’s wellbeing and overall health. 5. Strong and positive adult models of relationship and recognising and managing emotions.

As for all complex human emotional issues, anxiety serves a purpose. Back in history when we lived in caves, hunted and gathered, and the main priority was survival, anxiety helped us to stay as safe and connected with others as possible. Nowadays we are not trying to avoid sabre-toothed tigers or other primal dangers but our nervous systems still employ the fight/flight response, frequently because of our extremely well developed brains and imaginative capacities. This is why a whole industry of therapies that employ calming techniques and approaches that harness our active minds such as mindfulness, meditation, yoga and active relaxation is thriving. There are lots of ways of helping young people and everyone else for that matter. Schools, as Michael Rutter famously said in his book ‘Fifteen Thousand Hours, Secondary Schools and Their Effects on Children’, published in 1982, do matter and can make a difference. Let’s hope they get realistically optimistic and practical support from government and their Local Authorities, and from influencers such as the media to help their young people feel less anxious and to manage the anxiety that they will still inevitably experience.

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