Anxiety and Academics: Tools for Teen Well-being

This Ask an Expert segment features Alana Cooperman, a senior social worker at the Child Mind Institute's Anxiety Disorders Center. Alana has worked in school settings to provide individual and group therapy to children and adolescents for over 15 years. She has experience in delivering evidence-based treatment to children and families with various anxiety disorders, including generalized anxiety, social anxiety, selective mutism, and phobias. Her work also extends to individuals with ADHD, autism spectrum disorder, and emotional regulation issues.

What are some of the most effective strategies you found for helping teenagers manage generalized anxiety and social anxiety in their daily lives?

So I currently work at the Anxiety Disorder Center at Child Mind Institute, and we use an approach using the cognitive behavioral therapy model. The idea is to help teenagers and all patients learn to understand the connection between our thoughts, feelings, and actions, and that we can change how we feel and act if we can change our thoughts. And it takes a lot of work since it requires increasing our self-awareness of our thoughts. Because when we learn what anxiety is, and that anxiety is often led by negative thinking, it takes the ambiguity around it away and helps us feel empowered. When I work with teenagers around that, it feels good knowing there is something we can do, which is first learning that awareness of when my anxious thoughts arise, and learning that there is something we can do when they're present.

Anxiety tricks us into thinking and making us feel like a danger or risk is being posed in front of us when there typically is not. Therefore, that triggers our anxious thoughts, feelings, and physical sensations, resulting in changing how we act. If we think something's dangerous, or we think something's a threat, whether it be social anxiety, or just in general, we act a certain way, resulting in high alertness. So, we do cognitive behavioral therapy, where we use strategies to help teenagers learn how to catch their awareness of their anxiety. We call these thinking traps, which is learning that there are different negative patterns and ways of thinking.

First, we teach acknowledging that a person has dysfunctional thinking, causing them anxiety. Then, we teach how to challenge the thought. We ask ourselves, "What can I do to see that this thought isn't 100% true?" "How do I know it's not true?" "Do I have evidence?" At first, we think "Yeah it's true." But when we slow down that thought process, we realize there isn't any evidence, so we seek other options to help alleviate this thinking. One strategy I like to teach is using the opposite what-ifs. So instead of a negative what-if statement, we teach a positive, what-if statement. For example, we'll ask questions to ourselves such as, "What if it goes better than I think?" "What if they're not looking at me, they're looking behind me and laughing?" "What if we have a great time?" Anxiety is an anticipatory feeling, making us think an event will result badly.

Therefore, another common strategy that we recommend for all patients is exposure practice, which is facing our fears, but gradually and purposefully. For example, if the fear is going to a party, then we would implement exposure practice by starting out in a small group, then over time adding more people to the group to increase that group size. Another example could be having a fear of public speaking. By using exposure practice, you would first record yourself. Then, you would gradually increase that fear by showing it to one friend, then two friends, and finally in front of a group of friends. So we use what's called a hierarchy, which increases the intensity of the fear every time you go up a level. So you might be thinking, "You're making me do what I'm afraid of, why would that help?" But this process builds distress tolerance, and it helps us understand that the more we face our fear, the more we realize that it's not as bad as our anxiety is telling us it's going to be. This challenges the dysfunctional thoughts, leading to a positive restructure of our thoughts. It lets an individual handle the uncomfortable feeling more and more, rather than avoiding it.

Avoidance is a natural way for us to react when there's an anxious, uncomfortable, or worrisome thought. However, avoidance keeps the problem present or even worsens it. So, exposure practice is facing our fears, even if it's hard, because then you show yourself, "Oh, I can do this. I can do this hard thing." Instead of teaching yourself I" always avoid it so it's good." However, that good feeling is a short-term relief, so in the end, it doesn't feel good, because you're not getting past that fear. Avoiding the fear doesn't allow that resilience of if you sit with discomfort, eventually, it feels better and it calms down. So, exposure practice and cognitive skills are the most effective strategies that help with anxiety.

How do you see the school environment influencing the mental health of teenagers, particularly those dealing with ADHD and ASD? What role can schools play in supporting these students?

Especially these days, the increase in stress plays a huge role in mental health. I think schools should normalize stress. It's important for them to normalize mental health, offer services, and make it known in general. Those resources should be accessible to everyone, such as having more counselors available or mental health hotlines. Schools should help educate students about the services they're offered. Whether or not they have a learning disability, ASD, or ADHD, offering different services to meet their learning styles is beneficial.

For example, one person might need an extended testing time, a special chair that can move more, or scheduled breaks throughout the day. This is especially helpful with individuals who become dysregulated, meaning their emotions can go from zero to 100 fast, or they become overwhelmed by their environment. Another way of helping is allowing fidgets or earphones to manage overstimulation. Overall, I think the best thing that a school can help with is educating students about the services they can offer and offering them.

How do you tailor your therapeutic approach to help adolescents better understand and manage their emotions?

Especially during adolescence, there's a lot that's confusing and overwhelming in life. The number one thing I have found helpful is helping adolescents and teens know that they're not alone. Learning the thinking traps, like we mentioned earlier is one way where we help them see that these are not things that you are solely struggling with. Everyone has them, every human being has a thinking trap. However, some people who have more anxiety or depression have them more often.

A lot of adolescents and teens who have social anxiety are worried about what people think of them. However, these other people are so worried about what you're thinking about them that they don't have time to think about what you're you're doing. Therefore, everyone in the room is worried about what everyone else is thinking about them. But we don't realize this because we can't see that, since dysfunctional thinking is cognitive, and anxiety is not always as visible. So, it's mostly important to know you're not alone. Other people are going through the same challenges. Many strategies are universal, research-based, and evidence-based that we teach to everyone.

How do you work with students to create a healthy balance between school responsibilities and self-care practices? What resources would you recommend for teens who may be struggling to prioritize their mental health alongside academic expectations?

The first thing that comes to mind is working with everyone together. For example, working with your family, working with school, etc. I know a lot of adolescents and teens are against working with their families, but the ones I've worked with, who've had success, have realized there's a benefit of being able to self-advocate for your needs and knowing what you need in terms of learning to challenge dysfunctional thoughts. It's important to have the mindset of, "I need this to help make my learning better, but I might need a break and it's okay to have boundaries." And it's important to be able, especially with friends, to use those boundaries. For example, it's okay to say "I can't go out right now" or "I don't want to go out right now." Or to say to your family, "I need a break."

It's also okay to ask for help and tell your friends what you're experiencing, even though there's a lot of stigma around that. Many times I've seen when adolescents or teens tell their friends about their problem, those friends relate to that problem when they least expect it. For example, a friend might respond with "I suffer from depression too" or "I get panic attacks too." It's a relief to find someone to tell. So it's important to ask for help, tell people what you're experiencing, and advocate for what you need. I also think it's important to be flexible with the options that you're given. It might not always work for you, or there may be no choice. It's important to talk to your school, your family so that they're aware of what you're going though. The Child Mind Institute website also has a lot of resources, so you can always find many articles on there as well.