It’s a rare week for the school psychologist Dr Lisa Damour when a girl doesn’t knock on her office door to tell her that she is suffering from ‘‘anxiety issues’’. The figures bear this out – 31 per cent of UK girls experience symptoms of anxiety, compared with 13 per cent of boys.
The blame is often laid on social media, but Damour agrees with the latest research from the University of Oxford, which found that it was responsible for only a tiny fraction of teenagers’ unhappiness. ‘‘Social media tends to amplify what is already happening in their lives,’’ she says. ‘‘Social media is not a distinct universe.’’
So what is going on? Damour, a clinical psychologist and leading authority on teenage girls, argues in her new book, Under Pressure, that we’ve lost sight of the fact that a certain amount of stress and anxiety is normal, and can even be a good thing.
‘‘When girls say to me, ‘I have anxiety,’ they say it as if it’s a grave and permanent congenital defect,’’ says Damour, who works in a high-achieving private girls’ school in Ohio and has her own practice. She decided to write the book after realising that in the past 10 years she barely had a conversation at her practice, the school or at international speaking events that didn’t revolve around stress and anxiety.
She thinks that this has happened partly because our culture views any negative emotion as a bad thing, to be avoided, and prizes relaxation and calm above all else. ‘‘We are the first generation to think that the answer to feeling stressed is to feel as peaceful as possible,’’ she says. ‘‘I don’t think that’s necessarily a good thing. It’s not possible and aiming for it is going to lead to disappointment and stress.’’
The growing use of quasi-medical diagnostic language doesn’t help either, she argues, because it can pathologise perfectly normal emotions. ‘‘Where we used to talk about nervousness we now talk about anxiety, and where we used to talk about sadness we talk about depression,’’ she points out. We even describe children as having ‘‘social anxiety’’ when they are shy in a culture that celebrates easy-going extroverts.
‘‘I do wonder about the loss of a more garden-variety vocabulary for emotion,’’ Damour says. ‘‘I think if we’re going to use this vocabulary we have to tell teenagers that there is good and bad anxiety; healthy and unhealthy stress.’’
Knowing the difference, she says, is key. ‘‘Somewhere along the line we got the idea that emotional discomfort is always a bad thing. Although people don’t always enjoy being stretched to new limits, common sense and scientific research tell us that the stress of operating beyond our comfort zones helps us to grow. In the same way, physical exercise often doesn’t necessarily feel good, yet we fully accept it’s healthy for us.’’
In the case of a teenager faced with an exam they haven’t yet revised for, stress can be a useful thing, she says. ‘‘I ask them, ‘Have you started studying?’ and they say, ‘No,’ and I say, ‘Good, you are having the right reaction.’ When you start studying you’ll feel better.’’
Anxiety, she says, is the body’s natural alarm system, which is triggered when we sense a threat. ‘‘Just as physical pain prompts us to stop touching a hot gas ring, emotional distress alerts us to pay attention to our choices.’’
Stress and anxiety are harmful only when they are lasting. ‘‘Unhealthy stress
is when it becomes chronic and there’s no possibility of taking a break from it, and unhealthy anxiety is when the alarm goes off all the time for no reason, or it’s out of proportion to events.’’
There’s no doubt that some girls – and boys – are dealing with chronic issues, Damour says. Girls often suffer more, she believes, because they tend to take schoolwork more seriously and worry about it more. How does she work out what’s normal? ‘‘If the child feels they can’t recover, get enough sleep to feel restored and never really feel their resources are equal to the demands placed on them, that’s not healthy.’’ She recommends cognitive behavioural therapy for chronic anxiety and often psychodynamic psychotherapy when there’s a hidden reason for the anxiety.
How parents deal with normal stress and anxiety makes a huge difference, explains Damour, who has two daughters, aged 8 and 15. ‘‘What’s concerning is that sometimes our instincts as parents can make it worse. If the parent becomes just as upset as the child, that cues the child to feel they are facing a crisis. But if the parent can maintain a sense of steady calm, we can help children to feel that whatever the problem is it can be managed.’’
Here are some of her tips for how we can help:
Empathy is better than reassurance
Telling a stressed girl not to worry sounds dismissive rather than reassuring. ‘‘The child doesn’t feel you’re taking it seriously, so they become more upset in an unconscious effort to clarify that it does feel like a big deal,’’ Damour says. ‘‘Making a small adjustment from, ‘Don’t worry it will be fine,’ to, ‘This is a big deal, but I think you’re going to be OK,’ can make a big difference.’’
Play a game of worst-case scenario
‘‘Taking time to strategise seriously with girls, even about concerns we view as overblown, helps them to feel more in control,’’ Damour explains. Ask them: ‘‘What’s the worst that could happen?’’ Then follow it with: ‘‘OK, what will you do then?’’
So a girl who is worried that she has no friend to sit with at lunch might say: ‘‘I guess I could ask someone early in the day if she wants to eat lunch together.’’
‘‘You might say, ‘Good idea. And what if that doesn’t work?’ She’ll volunteer another idea, and on it goes. All the time she’s learning to handle the anxiety,’’ Damour says.
Don’t let them avoid the stressful situation
Our instinct as parents is to protect our children from the things that are causing the anxiety and let them skip it, whether that’s a test, a sleepover, or a school play.
‘‘Dodging a perceived threat actually feels good – in fact, avoidance works like an incredibly powerful and fast-acting drug,’’ Damour says. ‘‘They will be relieved in the medium term, but they will be robbed of the feeling that they could have managed the situation. I have seen young people end up with quite entrenched fears of everyday stressful experiences because of this. Help her to move towards the threat, rather than running away from it.’’
Help them to breathe through panic
What teenage girls describe as a panic attack isn’t necessarily a ‘‘true’’ attack (although no official diagnosis exists). It’s often a period of ‘‘intense nervousness’’. However, the treatment is the same.
‘‘When we are very stressed, the brain signals the lungs to speed up and shallow the breathing, so oxygenated blood can be sent to the extremities ready for fight or flight. When we override our breathing and take it slow and deep, the body detects the change and sends a signal up to the brain that everything’s OK. That can short-circuit a panic response.’’
Damour’s favourite technique is square breathing: inhale slowly for a count of three, hold that breath for a count of three, exhale slowly for another count of three, and then pause for a initial count of three before repeating the cycle a few more times.
Teach them to decode social media
Girls can need reminding that social media is not real life. It’s ‘‘one big furniture showroom’’, their news feeds a highlights reel of curated words and images, says Damour.
Offer support rather than judgment, and encourage them to take a few paces back so they can get some perspective. That means helping them to engage in some literary criticism of their friends’ online narratives.
Frame school stress as a positive
Research has shown that if you tell people stress is beneficial because it enhances creativity and helps them to succeed, their mood and self-esteem – and the quality of their work – is higher for days afterwards. One study demonstrated that by telling people that signs of stress, such as a racing heart, could improve their performance, they found a nerve-racking experience less stressful. Tell girls that their work schedules and tests are designed to help them to build endurance for life after school.
Help them to get more sleep
Adolescent girls tend to get less sleep than boys. ‘‘This is likely one of the simplest, yet most powerful explanations for girls’ high levels of anxiety,’’ Damour says. ‘‘When we get enough sleep we can handle most of what life hands us. When we don’t, we become frazzled and brittle.’’
Teach perfectionist girls to make less effort
Anxious perfectionist girls can be inefficient in their schoolwork, argues Damour. The more nervous a girl feels, the harder she’ll work (and the more we praise her for it), but ultimately it’s unsustainable, and risks burnout. It also leaves girls with confidence in their work ethic, but no confidence in their ability. It is better to tell a perfectionist girl to work more like the stereotypical boy, exerting the minimum effort to keep adults off their backs. ‘‘The way I phrase it is to get tactical in their work – figure out how much work is needed to learn the content or get the grade you want. Then stop there.’’
Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls, by Lisa Damour (Atlantic), is out now.