Reflecting on Lisa Damour’s New Book About Stress and Anxiety in Girls
By Deborah Offner (National Association of Independent Schools)
April 29, 2019
As I read Lisa Damour’s latest book,
Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls, I felt as if she had swooped into my counseling office and the schools
where I consult to speak candidly about the girls I know. As a psychologist
who specializes in adolescent girls, I counsel some patients whose symptoms—shortness
of breath, sweating, shaking, rapid heartbeat, migraine headache, abdominal
discomfort—are so debilitating they often spend extended periods
in the nurse’s office or miss school altogether.
If you teach, advise, coach, or live with adolescent girls, then you are
familiar with their unprecedented levels of stress and anxiety. According
to Damour, 31% of girls and young women experience anxiety compared with
13% of boys and young men.
Under Pressureputs anxious girls’ otherwise perplexing behavior in context. It
is a pertinent sequel to the 2016 bestselling
Untangled: Guiding Teenage Girls through the Seven Transitions into Adulthood. This time around, Damour—who is consulting psychologist at Laurel
School (OH) and executive director of Laurel’s Center for Research
on Girls—integrates her deep understanding of girls’ inner
lives from her counseling work and immersion in school life with her facile
knowledge of empirical literature on adolescent psychology.
After reading her book and seeing her speak about it, I noted some key
takeaways for educators and school leaders.
Stress and anxiety. Stress is necessary for growth. And school, Damour notes, is actually
supposed to be stressful, in the healthy way; it challenges students in order to
facilitate their intellectual and emotional development. Pushing students
beyond their comfort zones—academically, athletically, and socially—is
what the most thoughtful independent schools do well.
“Stress becomes unhealthy,” Damour says, “when it exceeds
what a person can absorb or benefit from.” The point at which that
occurs is different for everyone. “Whether stress becomes unhealthy
depends upon two variables: the nature of the problem and the person upon
whom the problem lands,” she writes. This explains to all of us
who work with students why some whose lives seem so privileged and secure
might struggle emotionally while others in “objectively” difficult
personal situations may seem calm and content.
She also describes how anxiety can serve as an important signal or warning
sign. Damour tells a story of a patient who found herself inexplicably
anxious at an ill-fated house party. In response to her nervous feelings,
she (uncharacteristically) accepted a shot of liquor along with the beer
she was already drinking, as she thought it would help her calm down.
She ended up getting so drunk she landed in the emergency room. Damour
explains how she helped the girl see that her anxiety at the party was
acting as an ally, not an enemy, signaling to her that she was not in
a good environment and needed to find an excuse to go home.
I’ve found that teen and even tween girls are remarkably good at
understanding what might be driving their anxiety. But to use their anxiety
as a friend and informant, girls need adults to be curious with them and
to assume there’s probably a reason for their feelings. Using health
class or advisory time to help girls reframe stress as important information
encourages them to listen to themselves and restores them some control.
Coping strategies. Damour notes that while girls should avoid some situations that are truly
dangerous, running away from situations that simply make them anxious
is not helpful. She explains, “Everything we know in academic psychology
tells us that avoidance only makes anxiety worse.”
My advice to schools is that when students have panic attacks, they should
be given a space (the nurse’s office or infirmary, an advisor’s
office) to let the physical symptoms such as racing heart, shaking, sweating,
and dizziness subside. Once that’s happened, students should move
right back into their usual routines. Otherwise, their avoidance of the
place where the attack happened—a classroom, the gym, or cafeteria—can
turn into habit. The fear of having another attack can become a reason
to stay out of class, off the playing field, or away from school altogether.
At one school where I consulted, we assumed it best to send one student
home when her panic attacks wore her out physically and emotionally (and
distracted her friend group from their studies). After speaking with her
outside psychologist, however, I learned that their treatment plan prescribed
staying in school after panic attacks. We quickly reversed the school’s
practice, and the therapist’s advice worked.
Negative stereotypes. Sometimes when members of a particular social group perform poorly on a
task, it isn’t because they lack proficiency or knowledge but because
they’ve internalized a negative stereotype about their group’s
abilities. For example, if girls believe that they are, by virtue of their
gender, not strong in math or science, they may undermine their own performance
out of fear of confirming this negative stereotype. Girls often don’t
know they’ve internalized the stereotype. Naming the phenomenon,
Damour says, and even sharing ample evidence that contradicts the stereotype,
can reduce its power over female students.
Sharing scientific evidence debunking this myth with faculty (and parents)
can be useful as well. I encourage schools to assign psychologist Claude
Whistling Vivaldi as a faculty summer reading book and to structure some conversations about
how Steele’s research and concept of “stereotype threat”
apply within the school community. I also recommend that schools offer
a parent forum on the topic, with attention to how it affects girls and
students of color in particular.
Sexuality. Damour encourages parents and teachers to talk candidly with girls about
their sexuality. Talking to girls about their wishes and needs makes them
less, rather than more, vulnerable to sexual coercion, she says.
High school (and some middle school) girls in my own practice describe
boys requesting nude photos and sending unsolicited ones of themselves
as a routine occurrence. Damour challenges schools to create technology
policies that prohibit students from sending nude photos and
I also recommend that schools include substantial technology training in
a health and wellness class or advisory. This unit should detail the interpersonal
and sexual aspects of digital communication and must be updated regularly,
as this is a rapidly shifting and complex landscape. Keeping these conversations
grounded in the complex dynamics of peer-to-peer relationships is important.
According to Damour, “Experts note that adolescents aren’t
enthralled by the technology—they’re enthralled by the peers
at the other end of the technology they happen to be using.” I often
remind parents and educators that students’ daily lives remain every
bit as complex and challenging as they were before Instagram or cell phones existed.
Acknowledging that widespread anxiety affects at least one-third of female
students’ ability to learn, work, and play can seem overwhelming
for students and school administrators alike. Gaining a basic understanding
of its mechanisms and effects can help school leaders support anxious
students more effectively. Schools are uniquely positioned to help girls
confront their fears and anxieties and to ensure they can utilize the
stress they encounter to enhance their self-protection, motivation, and growth.
Don’t worry about your child’s everyday stress. It may be helping.
By Jennifer Breheny Wallace (The Washington Post)
With reports of adolescent stress reaching epidemic proportions, concerned
parents are left searching for ways to prevent or minimize pressure. But
a growing number of psychologists are pushing back against the modern
view that stress is wholly unwanted and unhealthy. While chronic or traumatic
stress can be damaging, psychologists say normal, everyday stress —
in the right dose and viewed through the right lens — can be helpful,
pushing adolescents to grow beyond their limits and setting them up to thrive.
Ask any great performer on the field or stage, and they’ll tell you
a healthy dose of stress is key to reaching peak performance — but
too much of it can make you choke. Researchers say it’s often how
a person interprets a high-pressure situation, rather than the load itself,
that influences how they experience stress.
Healthy stress is motivating, focuses attention, and primes our minds and
bodies to face new challenges, be it taking a test, speaking in front
of an audience or standing up to a bully at school. Stress turns unhealthy
when it feels bigger than our ability to cope with it, fills our minds
with worries and hijacks important cognitive resources that could be better
spent mastering the challenge at hand.
“Anything that asks us to work at the edge of our current capacity
is stressful, but that’s how we learn and grow,” says child
psychologist Lisa Damour, author of “Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls.”
“It’s easy for kids and adults to fall into the assumption
that if it doesn’t feel good, it’s bad for you,” she
says. “But as anyone who has exercised knows, that’s not true.
Stress, even healthy stress, doesn’t feel good in the same way that
lifting weights doesn’t usually feel good.” Parents need to
be at ease with the idea that their child will be uncomfortable, and that
it doesn’t necessarily mean something is wrong.
In fact, a growing body of research finds that how students view their
stress — as helpful or harmful — can influence their academic
a study published recently in Proceedings of the National Academy of Sciences,
researchers set out to explore whether a 10-minute stress-reducing exercise
performed before an exam could help students improve their scores, especially
those from lower-income backgrounds who have been found to have particularly
high levels of stress and anxiety regarding tests.
Researchers studied nearly 1,200 freshmen at a large, diverse high school
in the Midwest. Before their midyear and final biology exams, one group
of students was given a “writing intervention” and asked to
spend 10 minutes writing about their worries about the coming test. (Previous
research has shown that writing about one’s anxieties helps to diminish
their intensity and frees up cognitive resources.)
Another group was given a “reappraisal intervention,” where
they were taught how to reinterpret their anxiety as a beneficial, energizing
force. (Past studies have found that re-framing stress to a more positive
view boosts performance.)
A third group of students was taught both interventions, while a control
group was asked to simply ignore their stress.
The researchers found that using one of the three interventions (writing,
reappraisal or both) helped anxious students better regulate their stress
and significantly improved their test scores.
Study co-author Sian Beilock, president of Barnard College, says that,
at home, parents can help adolescents reinterpret signs of stress in positive
ways. For example, your pounding heart is not a sign that you’re
about to fall on your face, but a way of delivering blood to your brain
to help you better focus. Humans are “limited capacity systems,”
she says, meaning we can’t really do two things well at once. By
reappraising your stress and focusing on the positive, rather than spending
energy ruminating on the negative, you’re able to free up the cognitive
resources needed to meet the challenge.
A powerful thing a parent can do to help a student diminish unhealthy stress
is to keep things proportional — talk about what is being asked
of them in proportion to what it actually means, Damour says. She says
it’s helpful to be explicit about putting tests into context by
saying, “This test is a measure of how well you know this material
today, not how well you’ll do in the future, not how much your teacher
likes you or how much you like her, and not how much you are loved by
To help an adolescent distinguish between helpful and harmful stress, Damour
says, ask your teen to visualize life events in three buckets: things
that I like, things that are a crisis and all the other things in between
— these are the things they can handle. For example, if a child
is having four quizzes in one week, that’s a moment a parent can
say: “I understand why you don’t like this. It’s uncomfortable,
but it’s not a crisis,” Damour says. “This falls into
the category of being something you can handle, and I’m here to
help you handle it.”
At its best, stress not only energizes us to hit challenging goals, but
it can build up a store of psychological resilience that can be accessed
to meet future challenges. Adolescents can build up a tolerance to stress,
what researchers call stress inoculation, the way marathon runners build
up their endurance: by gradually pushing themselves beyond comfortable
limits, Damour says. Think of it as the difference between bringing home
your first and second child. “You’ve already been stressed
in this way, built up this muscle, so the second child doesn’t overwhelm
you the same way,” she says.
The next time your adolescent comes home complaining about the stress she’s
under, listen, validate her concerns, and then offer a more positive,
adaptive view. Help her see that stress isn’t the enemy. In fact,
it may be one of our most undervalued natural resources, one worth preserving
to help us grow, rise to the challenges that lie ahead and push us to
reach our full potential.