Emotional health

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 Steele’s 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 requesting them.

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 performance. In 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 us.”

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.