There are several passages in the new book “Overloaded and Underprepared” that fill me with sadness for American high school students, the most driven of whom are forever in search of a competitive edge. Some use stimulants like Adderall. Some cheat.
But the part of the book that somehow got to me most was about sleep.
It’s a prerequisite for healthy growth. It’s a linchpin of sanity. Before adulthood, a baseline amount is fundamental and non-negotiable, or should be.
But many teenagers today are so hyped up and stressed out that they’re getting only a fraction of the rest they need. The book mentions a high school in Silicon Valley that brought in outside sleep experts, created a kind of sleep curriculum and trained students as “sleep ambassadors,” all to promote shut-eye.
The school even held a contest that asked students for sleep slogans. The winner: “Life is lousy when you’re drowsy.”
Sleep ambassadors? Sleep rhymes? Back when I was in high school in the 1980s, in a setting considered intense in its day, the most common sleep problem among my peers was getting too much of it and not waking up in time for class.
Now the concern isn’t how to rouse teens but how to lull them. And that says everything about the way childhood has been transformed — at least among an ambitious, privileged subset of Americans — into an insanely programmed, status-obsessed and sometimes spirit-sapping race.
Take one more Advanced Placement class. Add another extracurricular. Apply to all eight Ivies.
Lose a few winks but never a few steps.
“Overloaded and Underprepared,” published on Tuesday, was written by Denise Pope, Maureen Brown and Sarah Miles, all affiliated with a Stanford University-based group called Challenge Success, which urges more balanced learning environments. The book looks at homework loads, school-day structures and much more.
And it joins an urgently needed body of literature that pushes back at helicopter parenting, exorbitant private tutoring, exhaustive preparation for standardized tests and the rest of it. This genre goes back at least a decade and includes, notably, Madeline Levine’s “The Price of Privilege” and Paul Tough’s “How Children Succeed.”
But it has expanded with particular velocity of late. “How to Raise an Adult,” by Julie Lythcott-Haims, came out last month. “The Gift of Failure,” by Jessica Lahey, will be released in two weeks.
There’s a unifying theme: Enough is enough.
“At some point, you have to say, ‘Whoa! This is too crazy,’ ” Pope, a senior lecturer at Stanford, told me.
Sleep deprivation is just a part of the craziness, but it’s a perfect shorthand for childhoods bereft of spontaneity, stripped of real play and haunted by the “pressure of perfection,” to quote the headline on a story by Julie Scelfo in The Times this week.
Scelfo wrote about six suicides in a 13-month period at the University of Pennsylvania; about the prevalence of anxiety and depression on college campuses; about many star students’ inability to cope with even minor setbacks, which are foreign and impermissible.
Those students almost certainly need more sleep. In a study in the medical journal Pediatrics this year, about 55 percent of American teenagers from the ages of 14 to 17 reported that they were getting less than seven hours a night, though the National Sleep Foundation counsels 8 to 10.
“I’ve got kids on a regular basis telling me that they’re getting five hours,” Pope said. That endangers their mental and physical health.
Smartphones and tablets aggravate the problem, keeping kids connected and distracted long after lights out. But in communities where academic expectations run highest, the real culprit is panic: about acing the exam, burnishing the transcript, keeping up with high-achieving peers.
I’ve talked with many parents in these places. They say that they’d love to pull their children off such a fast track, but won’t the other children wind up ahead?
They might — if “ahead” is measured only by a spot in U-Penn’s freshman class and if securing that is all that matters.
But what about giving a kid the wiggle room to find genuine passions, the freedom to discover true independence, the space to screw up and bounce back? Shouldn’t that matter as much?
“No one is arguing for a generation of mediocre or underachieving kids — but plenty of people have begun arguing for a redefinition of what it means to achieve at all,” wrote Jeffrey Kluger in Time magazine last week. He noted, rightly, that “somewhere between the self-esteem building of going for the gold and the self-esteem crushing of the Ivy-or-die ethos, there has to be a place where kids can breathe.”
And where they can tumble gently into sleep, which is a gateway, not an impediment, to dreams.
Mindfulness is something I incorporate into each of my classes once a week, and it only takes four to seven minutes. After reviewing the benefits of mindfulness practices—like reduced stress, boosted working memory, and lowered emotional reactivity—it was no longer a nice-to-have, but rather a necessity.
At the beginning of each weekly session, I welcome everyone into a circle. We leave an empty chair for those who are unable to join us that day. We put our feet flat on the ground, close our eyes, and start with three deep breaths in and out. I guide students to follow where the air from their breath goes. While students are focusing on their breath, I invite them to reflect. Sometimes we reflect on the theme we’re going to discuss in class, but not always. I always spend a minute having everyone, including myself, focus on how we’re showing up to the space. Someone could show up happy from a great start to their day, angry because of an argument they just had, or stressed from an upcoming exam. We always make sure to validate how we are showing up without judgment toward ourselves.
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FACILITATING MINDFULNESS FOR THE FIRST TIME
I have found the following steps useful in introducing and facilitating a mindfulness practice:
Let the research and purpose speak for themselves. I often lead with: “It is not strictly meditation, but rather a practice in supporting your mind to take care of yourself.” I then list the benefits.
Offer an out and get visible buy-in. Students will often be hesitant. “It’s weird!” they may say. And that’s OK. When I first introduced this to students, I told them that if they could find a research-based practice that achieved the same goals, I would be happy to help them create a proposal for the group. I then asked the group to give a thumbs up if they could at least try it.
Share how developing a mindfulness practice has personally benefited you.After I get my students’ buy-in, I tell them how mindfulness has helped me, and I give one or two anecdotes. For example, the last time I had to have a very difficult conversation with a personal friend, I felt my mind racing. I got to the coffee shop a few minutes early, put my phone away, and got into position—feet flat and hands flat on my knees. I took a few deep breaths, calmed myself, and made myself aware of how I was showing up. I was able to recognize why I was showing up that way, and I asked myself how I wanted to show up. I tried to keep my focus on only that and my breathing. I then visualized how I wanted to show up, took a few breaths in, and returned to the present moment. The conversation with my friend was incredible and uplifting. None of my dialogue was colored by the anxiety, stress, or self-consciousness that cluttered my mind leading up to that conversation.
Give a reason for every direction the first few times you go through the practice. For example, I’ll begin by saying, “We’re all going to close our eyes. I’ll keep mine open to make sure that no one is being watched because that could be awkward and feel unsafe, and my job is to ensure your physical and emotional safety.”
Balance giving directions with silent time to practice the task. I will often say, “Together, we take a deep breath in [followed by a collective breath], and a deep breath out.” I then give us 40 seconds or so of just focusing. For that 40 seconds, I am silent. Before starting, I say, “Now we are going to hold that focus for a little while. We just focus on where our air is entering and exiting our body.” Then every time I have a new direction or narration, I include myself again. It must be a balance between targeted narration and silent time to practice the task.
Only directly address behaviors that are unsafe. Otherwise, like when a student laughs or tries to make silly sounds, I will often gently reinforce the mindfulness practice by saying, “And we’re taking a deep, calm breath in.” I do this in a very direct but soft tone that sounds like a parent calming a child down rather than reprimanding them.
Allow for reflection and feedback. The first few times, I had my students turn to a partner and discuss how it was for them, offered space to give me critical feedback, and also offered them space to make meaning of their experience. Often, it sounds like, “OK, now turn around to your partner, give them a high five or ask if they want a hug, and discuss how that exercise was for you. Was it annoying? Fun? Interesting? Did you find yourself thinking about things you wished you hadn’t? Whatever it is, be ready to share something that came in your conversation with the whole class at the end of 90 seconds!”
Ultimately, it takes a strong trust with your students and a set routine. At the end of the day, teaching is not about guaranteeing that students will use what we teach them. It’s about ensuring that they know how to use it, and giving them the space to practice it. Like one of my students told me, mindfulness “doesn’t help me know what to do, but it helps me recognize that I need something.”
Being able to focus helps us succeed. Whether it’s focusing inward and attuning ourselves to our intuitions and values or outward and navigating the world around us, honing our attention is a valuable asset.
All too often though, our focus and attention get hijacked, leaving us feeling frazzled, forgetful, and unable to concentrate. In my coaching work with executives, these are the kinds of statements I most often hear when they’ve lost their focus (I may have uttered a few of them myself):
“I feel completely overwhelmed.”
“My workload is insane, and there’s never enough time to get things done when I’m in meetings and dealing with urgent issues all day long.”
“I’m mentally exhausted from the pressure and constant distractions in my office. I just can’t seem to focus.”
Constant distractions and a lack of time certainly interrupt our focus, but stress also plays a major role.
Chronic stress floods our nervous system with cortisol and adrenaline that short-circuits important cognitive functions. Researchers have studied the negative effects of stress on focus, memory, and other cognitive functions for decades. The findings are consistent – short-term stress raises cortisol levels (the so-called stress hormone) for short periods and can jump-start our adrenalin and motivate us to perform more efficiently in response to impending deadlines. Long-term stress, however, can lead to prolonged increases in cortisol and can be toxic to the brain. Scientists also suspect that high levels of cortisol over a long period of time are a key contributor to Alzheimer’s and other forms of dementia.
When we can’t focus at work because of distractions, it may lead us to feel stressed about not being productive, which then causes us to focus less, further feeding the cycle. Unfortunately, most of us don’t notice our focus declining until we become completely overwhelmed. When mental and emotional exhaustion sets in, it further drains our ability to focus, concentrate, and recall information.
Fortunately, there are things we can do to break the cycle. I’ve found in my research that one of the reasons why some people get burned out and others don’t is because they use their emotional intelligence (EI) to manage their stress. You can use these same competencies, in particular self-awareness and self-management, to improve your focus. Here’s how.
Start by using your self-awareness to help you notice several things:
Why you feel stressed or anxious. Before you can deal with stress, you need to know what’s causing it. As simple as it may sound, it can be helpful to make a list of the sources of your stress. Write down each thing in your life and at work that’s causing you anxiety. You might categorize items into things you have the ability to change and things you don’t. For the stressors in the latter category, you will need to figure out how to change your attitude toward them.
How you lose your ability to focus. According to clinical psychologist Michael Lipson, you can learn to sharpen your focus, by understanding how exactly your concentration strays in the first place. By paying attention to the patterns that lead to your lack of focus, you can begin to develop your ability to dismiss distractions and stay with your original point of attention.
How you feel when you can’t focus. Does it make you anxious when you can’t recall information when you need it – perhaps during a job interview, a high-stakes presentation, or an important client meeting? Do you feel tense and dazed when you’re racking your brain trying to find just the right words for an important email? These can be clues that you’re more stressed than you may realize, and that your inability to concentrate is causing even more stress.
When you lose your ability to focus. If, for example, you find yourself worrying yourself sick over something while you’re driving 65 mph on the highway with a car full of kids, you’re putting yourself and others in real danger. This can be a wake-up call to bring your attention back to what you’re doing and make a decision to think about your concerns later.
Once you’ve increased your awareness of what’s causing you stress and how and when you lose your focus, you can use the following strategies, which depend on your self-management abilities, to make better choices that keep you focused.
Do a digital detox. In its 2017 Stress in America survey, The American Psychological Association (APA) found that “constant checkers” – people who check their emails, texts, and social media on a constant basis – experience more stress than those who don’t. More than 42% of respondents attribute their stress to political and cultural discussions on social media, compared with 33% of non-constant checkers. While it may feel impossible to take a cold turkey break from technology, the APA says that periodically unplugging or limiting your digital access can be great for your mental health.
Rest your brain. Most of us have experienced sleepless nights caused by ruminating over past events, or fears and anxieties about the future. But when you add a few of these nights together, sleep deprivation can set in, making it more difficult to focus, and more challenging to receive and recall information. Our interpretation of events and our judgment may be affected, too. Lack of sleep can negatively affect our decisions because it impairs our ability to accurately assess a situation, plan accordingly, and behave appropriately. Committing to the recommended 7 to 8 hours of sleep each night may seem impossible when you’re stressed and overworked, but the payoff is worth it.
Too many people feel like they need to work harder when they struggle to focus. But this strategy is likely to backfire. Instead, pay attention to the causes of your stress and inability to focus and then take actions that promote improvements in the specific brain functions that drive concentration and awareness
Kip Bordelon is founder of The Picardy Group, a Chicago-based educational consulting company focused on providing diversity and leadership workshops, conducting cultural assessments, and recruiting diverse educators for independent schools.
As an alumnus of an independent school, I have enjoyed reading about the increasing emphasis on teaching cooperation, teamwork, mindfulness, and empathy. As independent schools become more globally and racially diverse, the need for greater reflection, for awareness of one’s own thinking and biases, and for curiosity about the perspectives of others also grows. The ability to empathize may be the most critical need in this century, and some research suggests that mindfulness can help cultivate empathy.
The importance of the ability to see the world from the perspective of others became apparent to me when I was a somewhat lonely, out-of-place freshman at my New England boarding school. At 14, I quickly began to see and understand that I was different from most of my peers. My views and perspectives were different as a result of being a black urban kid from the often unforgiving south side of Chicago. Over the years, I learned that my approach to many issues, assignments, and problems was vastly different from those of my white friends. As a black person living in a white world, I learned to understand the white perspective, and it was strange and frustrating that white people rarely, if ever, bothered to learn or even inquire about how I saw the world.
This was most apparent in 1995 when, as a senior, I was reviled by my classmates and, more shockingly, by my teachers, dorm parents, and coaches for celebrating the O.J. Simpson verdict. While I knew that my white classmates wouldn’t understand why the black students, like most of black America, felt jubilation that day, I was disappointed that educated adults, some of whom had seen me grow and mature since my freshman year, could not be open-minded enough to look at this national issue from my point of view. As usual of course, I was supposed to see the issue from their point of view.
I had the same experience a couple of weeks later with the Million Man March on the National Mall. Why did the people with whom I interacted daily and who cared about me lack the desire to empathize with my thoughts and feelings about issues that had directly affected me, my loved ones, and other people who looked like me?
Why the Differences Matter
Although I learned a lot and have an abiding affection for the four years I spent at my independent school, I wish some things had been different. Had my school focused on mindfulness and empathy back then and incorporated them into the curriculum, my experience and those of the other black students probably would have been different. I think that it would have been more equal, more fair. My experiences would have been more like those of my white classmates: My school trials would have been limited to in-the-classroom and on-the-field challenges.
Instead, we students of color frequently were forced to address, on our own, micro-aggressions and problems that the majority of our classmates didn’t even realize existed. As a result, I felt out of place on the very campus where I lived most days over four years. I frequently felt unsupported and misunderstood because there were very few adults who truly understood my everyday challenges. My ideas were often dismissed or met with indifference. I felt like a bull living among a campus full of horses.
New Generation and New Opportunities
Today, I am not bitter; I am hopeful. My goal is to offer this perspective on the importance of sparing future generations of students of color my experience by supporting the growing movement to develop in students nonacademic abilities like mindfulness and empathy.
According to NAIS data, independent schools are heavily populated by students who increasingly come from different backgrounds and who, consequently, see the world very differently. Education experts stress that in order to offer the most substantive and meaningful education, we must embrace and teach skills that promote mutual understanding, cooperation, and respect. I couldn’t agree more. It’s a view I’ve held since the 1990s, when I realized that my own perspective-taking ability and understanding of how people operate would be critical to my success. Thanks to my school’s student diversity, I learned to expand my understanding of people who weren’t like me. Where else would a 15-year-old black kid from Chicago get to room with a Japanese student and learn Japanese customs? Where else could a hip-hop loving, urban basketball-junkie teenager find his voice and a true passion to advocate for racial understanding and multiculturalism?
Today, developing reciprocal understanding, mutual respect, and empathy among diverse populations remains our greatest challenge. The need has perhaps never been more obvious. In the last two years alone, Trayvon Martin, Michael Brown, Eric Garner, and Freddie Gray, to name just a few, have focused national attention on racial inequality and social injustice. We have heard “I Can’t Breathe” chants and seen “Black Lives Matter” signs and hashtags that raise awareness of and express dissatisfaction with the status quo. Independent schools claim to embrace missions that promise to lead the way — to create a healthier culture of cooperation and understanding. Consequently, independent schools must actively work to ensure that those missions aren’t empty abstractions.
What I have learned is that creating a culture of empathy requires a level playing field. Young people need guidance from adults who understand them, who share their background and experiences. Understanding others is more likely to occur if people first understand themselves — if they understand who they are, what they think, and why they think it. White students in independent schools have the white mentors and role models they need in order to develop this sort of self-confidence and understanding — the base from which, with further guidance, they can become increasingly understanding of others. Black and Latino students in independent schools lack sufficient numbers of black and Latino mentors.
Diversity Issues still in Deferment
I’ve recently met directly with students of color who attend independent schools. They unanimously agree that what they need most are adults who look like them and have walked the paths that they stumble along each day. Theirs is an old wish not yet realized —not yet addressed.
These students need mentors and educators of color to demonstrate to them and, equally important, to white students, that the biggest brains on campus aren’t just white teachers. Black and Latino students need teachers of color to empathize with them about issues that only they can understand because they have lived them: what it’s like to be the object of racial bigotry; what it feels like not to meet the American standard of beauty; what it’s like to carry the weight of negative stereotypes on your teenage shoulders; what it’s like to have to be courageous enough to speak out and risk either becoming a social outcast or feeling ashamed for failing to speak; even what it’s like when the hair and hygiene products you use are not available at local drugstores. Students of color need adult role models who respond thoughtfully to their ideas about current events, instead of dismissing them as “immature, idealistic, or ignorant.” That’s what I needed when I was a student, and that’s what students of color need today.
Turning the Corner with Meaningful Solutions
Creating the conditions for a more mindful, empathetic culture begins with faculty diversity. If independent schools are to truly provide a full, substantive, and meaningful education to all of their students, each institution must staff itself with educators who can provide all students firsthand experience and perspective. Schools must understand that educators of color absolutely have a critical role to play. It is they who, working with their white colleagues, will help develop empathy and understanding, while conditioning all students to understand that there are black and Latino education professionals and administrators. What better way is there to simultaneously improve the educational experience for students and faculty at independent schools, prepare students for the global society and workforce they will soon enter, combat long-standing stereotypes, and address a need that has for too long gone unaddressed?
As a black alumnus, I know firsthand that aggressively seeking and hiring candidates of color will make a significant difference. But hiring isn’t enough. Schools must do three other things. First, the administration of each school must develop a realistic, accurate sense of the particular culture in which teachers and students of color live on their campuses. That is, schools must understand how these teachers and students experience life at their schools on a daily basis. Do they feel alone? Do they have a voice? Do they feel respected?
Second, schools need to hire sufficient numbers of teachers of color so that the teachers won’t feel as though they are isolated tokens or appear like tokens to other members of the faculty or to students. Retention of good teachers of color is a constant problem, and creating a strong cohort of teachers of color can improve the chances that the teachers will stay.
Third, administrators must empower teachers of color to ensure that the dominant white culture will not indirectly or unintentionally silence them. Once schools have created the right culture and conditions, the real work of developing empathy can begin and will have the greatest likelihood of success. The key is caring enough to care.
Stress is unavoidable in modern life, but it doesn’t have to get you down. Work, money and family all create daily stress, while bigger issues like politics and terrorism contribute to our underlying stress levels. But approach it the right way, and it won’t rule your life — it can even be good for you. Here are ways to deal with stress, reduce its harm and even use your daily stress to make you stronger.
Stress is inevitable; getting sick from it is not.
THE PERCEPTION OF STRESS
While we know that stress is associated with health problems, plenty of people with high-stress lives are thriving. How is that possible? In 2012, researchers from the University of Wisconsin-Madison published looking at how 28,000 people perceived stress in their lives. People in the study answered these two questions:
During the past 12 months, would you say that you experienced:
A lot of stress
A moderate amount of stress
Relatively little stress
Almost no stress at all
How much effect has stress had on your health?
The researchers looked at death rates in the study group over nine years. The results are startling. The study found that having a lot of stress in your life was not linked with premature death. But having a lot of stress in your life and believing it was taking a toll on your health increased risk of premature death by 43 percent.
CHANGING YOUR PERCEPTION
With stress, the mind and the body are intrinsically linked. You can view stress as something that is wreaking havoc on your body (and it can) or as something that is giving you the strength and energy to overcome adversity. Here’s a quick way to think about these two very different views of stress. Read the statement, and then think about your own reaction to the biological changes that occur during times of stress.1. When I’m stressed, my body releases adrenaline and cortisol. My heart is beating faster. This means that:
Common View: Stress is increasing my risk for cardiovascular disease and heart attack.
Alternative View: My heart is working harder and my body is mobilizing its energy to get ready for this challenge.
2. When I’m stressed, my stress response is causing my breathing rate to increase. This means that:
Common View: My fast breathing is a sign of anxiety. I worry about how stress is affecting my mental and physical health.
Alternative View: I should take a deep breath. My faster breathing means more oxygen is getting to my brain so I can think more clearly.
3. When I’m stressed, my heart and circulatory system respond, causing my blood pressure to rise. This means that:
Common View: I can feel my blood pressure rising. This can’t be good for my health.
Alternative View: Circulatory changes are allowing more oxygen and nutrients to fuel my muscles. I’m feeling stronger and ready for the challenge ahead.
It’s probably clear to you that the alternative view is the better choice for thinking about stress. It may be hard to believe that such a small shift in thinking could make a difference, but that’s what when they paid 50 study subjects $25 each to take part in a lab experiment designed to induce stress. The test involves giving a talk in front of a group of unfriendly evaluators, followed by a tricky word test. (Researchers have consistently found that this formula of public speaking plus testing in front of a hostile crowd is incredibly uncomfortable and stress-inducing for the poor people who agree to take part in the study.)
Before the social stress test, one group was allowed to play video games; another was taught to simply ignore stressful feelings if they experienced them during the test. But a third group was given advice similar to the quiz above. They got a primer about the physical stress response and were told how a higher heart rate, faster breathing and internal jitters were all tools for making you strong during a stressful event. They were told how the body’s stress response evolved to help us succeed, and that the increased arousal symptoms of stress can aid your performance during times of stress. The bottom line of the lesson was this: In a tough situation, stress make you stronger.
The group that learned to rethink the role of stress in their lives did far better on the test. They gave better speeches and were rated as more confident. They smiled more and had more-positive body language. And physiological indicators showed that their bodies were also managing the stress response better than those of test subjects who were taught to ignore stress or given no advice at all.
The Stanford psychologist Kelly McGonigal has been a champion of rethinking stress, noting that the right approach can make you smarter and stronger. Her TED talk on the subject, has been viewed 14 million times.
“What I learned from these studies, surveys and conversations truly changed the way I think about stress,” Dr. McGonigal wrote in her book “The best way to manage stress isn’t to reduce or avoid it, but rather to rethink and even embrace it.”
Learn skills to better handle stress.
The best way to get better at stress is to practice it. Scientists call this “stress inoculation,” and just as exposure to a virus will inoculate you from contracting a virus a second time, regular exposure to small amounts of stress can inoculate you from the most detrimental effects of stress when you suffer a big stressful event in your life.
Stress inoculation has
1. Education: Learn what to expect. If you need chemotherapy, are experiencing a divorce or have had a setback at work, talk to people who have been through it and learn what to expect going forward so you can be prepared, rather than blindsided, by the stressors ahead of you.
2. Rehearsal: While you can’t rehearse for life’s biggest moments, you can live your life in a way that prepares you for stress. It can be a physical challenge like competing in a triathlon or conquering a mountain. It can be an intellectual stressor like reading your poetry in public or giving a speech. The point is that you need to rehearse stressful situations in order to perform your best under stress.
3. Implementation: When the stressful event hits, you are prepared. You know what to expect, and you’ve experienced stressful situations before. You’ve got this.
Think about how firefighters train. They educate themselves about fire and how it behaves in different situations. They put themselves through grueling physical training to practice carrying heavy equipment, navigating smoky, dark buildings and stairwells, and braving the heat of a raging fire. They practice running into burning buildings. The training is hard and highly stressful.
Now imagine you are out for a nightly walk and you see that a neighbor’s house is on fire. Your heart races. You panic. You fumble with your phone. You take a step toward the house. You hesitate. What do you do? Fortunately, the firefighters arrive and race into the home without hesitation. Your moment of stress and anxiety is just another day at the office for them. They know what to expect. They trained for it.
You can practice for everyday stress in similar ways, by putting yourself in challenging situations. The good news is that practicing stress can actually be enjoyable, even thrilling. The key is to push yourself out of your comfort zone. Here are some suggestions:
Run a marathon
Play in a Scrabble competition
Read an original poem at a poetry slam
Climb a mountain
Tell a story in front of a crowd
Take on a tough project at work
Kayak the Colorado rapids
Train to scuba dive
Attend a boot camp
Not only will challenging experiences give you more confidence, but the repeated exposure to stressful situations can also change your body’s biological response to stress. Your stress hormones become less responsive, allowing you to better handle stress when it comes.
Dr. Dennis Charney, a psychiatrist and the dean of the Icahn School of Medicine at Mount Sinai in New York City, notes that programs like Outward Bound and basic military training are all designed to make people uncomfortable and build their skills so that they will be better able to handle stress later on. When his children were young, he took them on adventure trips that included “a degree of anxiety” like exposure to wildlife or kayaking in remote areas as a way to build confidence and prepare them to deal with stressful events. Putting yourself or your children in difficult social situations or speaking in public can help adults and children accumulate social and intellectual skills that help in times of stress.
“Live your life in a way that you get the skills that enable you to handle stress,” says Dr. Charney. “Put yourself out of your comfort zone.”
AN RX FOR RESILIENCE
Another factor in how you handle a stressful situation is resilience. The defines resilience this way:
Resilienceis the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems or workplace and financial stressors. It means “bouncing back” from difficult experiences.
You can boost your resilience in a number of ways. In the book the authors, Dr. Steven M. Southwick and Dr. Charney, studied people who experienced great stressors — prisoners of war, men in the special forces, victims of trauma or survivors of catastrophic events. They found that people with the most resilience in the face of extreme challenges shared several behaviors and mind-sets. From that research, the duo identified 10 factors associated with resilience. You don’t need to practice all 10 behaviors to build resilience; just pick the two or three or four that speak to you.
1. Adopt a positive attitude. Optimism is strongly related to resilience.
2. Reframe the situation. Just like the stressed-out study subjects were taught to reappraise stress as their friend, people who are resilient typically reframe a negative situation as an opportunity for growth, learning or change.
3. Focus on core beliefs. People with a deeply held core belief, strong faith or a commitment to altruism often show more resilience.
4. Find a role model. Seeing someone else who has come through adversity can strengthen your own resilience.
5. Face your fears. Confronting a challenge rather than avoiding it will help you cope and build confidence.
6. Fall back on religion or spirituality. For many people, strong faith or spiritual beliefs can fuel resilience.
7. Seek social support. People who reach out to friends, family and support groups fare better during stressful times.
8. Exercise. It improves mood, relieves stress and makes you physically stronger.
9. Inoculate against stress. Challenge yourself regularly in the areas of emotional intelligence, moral integrity and physical endurance.
10. Find meaning and purpose. Having a clear purpose in life can boost your emotional strength during difficult times.
Numerous studies have shown us that exercise can improve your mood.
Exercise can channel your stress response into something constructive and distract your mind from the challenges at work or home that make you feel chronically stressed. In many ways exercise appears to be a form of stress inoculation. In studies, mice given access to running wheels and tubes to explore for just two weeks became resistant to stress compared with mice who had not exercised. They measured this by exposing the mice to an aggressive mouse. After the bullying, the exercising-mice bounced back, but the sedentary mice continued to show signs of stress. The bottom line: Exercise doesn’t eliminate stress, but it does give your body the physical conditioning it needs to recover from it.
How Much Exercise Do I Need to Manage Stress?
It doesn’t take much. Even small amounts of exercise can help you manage your stress. The key is consistency. Don’t let the stress of your day push exercise off the schedule.
Does the Type of Exercise Matter?
The exercise that is best for relieving stress is the one you will do consistently. Find something that fits your schedule and that you enjoy. For some, that will be a morning spin class or an evening run. For others, it will be a 30-minute walk at lunch time. found that people who engaged in any exercise, evan a small amount, reported improve mental health compared with people who never exercised.
What About Weight Training?
One study showed that six weeks of bicycle riding or weight training eased symptoms in women who received a diagnosis of anxiety disorder. The weight training was especially effective at .
Indeed, some research suggests that when it comes to reducing stress, you’ll get more out of exercise if you incorporate some weight training. Studies show that anaerobic or resistance exercises (working with weights) taxes muscles more than aerobic exercise like walking or running. The result is that weight training, done right, may produce more mood-boosting endorphins than cardio exercise. Exercises that stress the large muscles seem to have the biggest effect, like squats, leg presses, incline situps, military presses and bench presses.
Don’t go for a powerlifting record. The best weight training to manage stress consists of three moderate-weight sets of 10 repetitions with one minute of rest. found in a small study that this 3-10-1 moderate weight strategy produced more endorphins than using heavier weights for five reps and a longer rest.
TAKE IT OUTSIDE
Simply taking your exercise outdoors can have a significant effect on your mood.
In a volunteers who walked outdoors reported enjoying the activity more than those who walked indoors on a treadmill. Subsequent psychological tests showed outdoor exercisers scored significantly higher on measures of vitality, enthusiasm, pleasure and self-esteem and lower on tension, depression and fatigue.
A found that those who exercised outside did so longer and more often than those working out indoors. The outdoor exercisers averaged about 30 minutes more exercise each week than those who walked or otherwise exercised indoors.
A that people have lower blood levels of cortisol, a hormone related to stress, after exerting themselves outside as compared with inside. There’s speculation, too, that exposure to direct sunlight, known to affect mood, plays a role.
found that almost all the participants reported that the outdoor effort had felt less strenuous to them than their time on the treadmill. And they enjoyed it more.
from the University of Essex found that exercisers exposed to the color green found it easier to exercise and were in a better mood than exercisers exposed to gray or red. (Think green trees versus a cement-walled gym.)
Exercise your mind and let it rest to help it better process stress.
GIVING YOUR MIND A REST
For people dealing with high levels of stress, it can be hard to fathom how a few moments of meditation will help. After meditation, the stressors are still there — you’re still getting divorced, caring for an aging parent, struggling with the demands of a high-stress job. How can a few moments of deep thought possibly help your life?
It may help to think about how muscles get stronger. Unrelenting exercise simply tears down a muscle and leads to injury. Smart exercisers know the value of a day of rest — that’s when your muscles regenerate and come back stronger than before.
Now think about your mind as an emotional muscle. Unrelenting stress without a break will not make it stronger. Your emotions, your brain and your body need moments of recovery to get stronger from stress.
“It’s about stress and recovery. Just like you build a physical muscle, just like you build biceps, you have to take the same approach to life stressors,” says Jack Groppel, co-founder of the , which offers a course called “The Power of Positive Stress.“
Think of meditation like high-intensity interval training (H.I.I.T.) for the brain. During H.I.I.T., you go as hard as you can, then you give yourself a few minutes of recovery before returning to the exercise. This cycle is repeated multiple times and has been shown to be more effective for building strength than long, slow bouts of exercise.
Now imagine a high-intensity, high-stress workday. But every hour, you take two minutes to let your brain recover. “Stress is the stimulus for growth,” says Dr. Groppel. “Recovery is when growth occurs. If there is no recovery, there is no growth. That’s how we build the resilience muscle.”
has been shown to reduce stress, increase alertness and boost your immune system. For centuries yogis have used breath control, or pranayama, to promote concentration and improve vitality. The Buddha advocated breath-meditation as a way to reach enlightenment.
Science is just beginning to provide evidence that the benefits of this ancient practice are real. Studies have found, for example, that breathing practices can help reduce symptoms associated with anxiety, insomnia, post-traumatic stress disorder, depression and attention deficit disorder.
One study who were seeking work and experiencing considerable stress. All of them participated in stretching exercises, but half of them were also taught formal mindfulness meditation. After three days, everyone said they felt refreshed and better able to withstand the stress of unemployment. Yet follow-up brain scans showed differences in only those who underwent mindfulness meditation. There was more activity, or communication, among the portions of their brains that process stress-related reactions and other areas related to focus and calm. Four months later, those who had practiced mindfulness showed much lower levels in their blood of a marker of unhealthy inflammation than the relaxation group, even though few were still meditating.
To learn more about meditation, try the introductory exercise below.
WRITE IT DOWN
Another way to cope with stress: writing. It is based on the idea that we all have a personal narrative that shapes our view of the world and ourselves. But sometimes our inner voice doesn’t get it completely right. Some researchers believe that by writing and then editing our own stories, we can change our perceptions of ourselves and identify obstacles that stand in the way of better health. It may sound like self-help nonsense, but research suggests the effects are real.
Timothy D. Wilson, a University of Virginia psychology professor and author of “Redirect: Changing the Stories We Live By,” believes that while writing doesn’t solve every problem, it can definitely help people cope. “Writing forces people to reconstrue whatever is troubling them and find new meaning in it,” he said.
There are a
Journal every day. Just writing about your thoughts, feelings and experiences every day can help. Explore your thoughts and feelings about an issue. Don’t just re-live the stress in your life but try to find meaning in it or explore how well you’ve handled certain situations. Be disciplined and write at the same time every day so it becomes a habit. In a University of Texas study, students who wrote about stressful or traumatic events for four days in a row reaped the benefits for months after. For the next six months, the writing students had fewer visits to the campus health center and used fewer pain relievers than the students in the experiment who wrote about trivial matters.
Change your story. Use writing to force yourself to confront the changes you need to make in your life. On the first day, write down your goals, then write down why you haven’t achieved them (“I don’t have the time or the money,” “Too many family responsibilities,” etc.) The next day review your writing. Now ask: What is really standing in the way of your goals? Change the story so you have control. Maybe the answer is: I don’t put myself first. I don’t make exercise a priority. I let other people talk me into spending money rather than saving.
Write a mission statement. People deal with stress better when they have a strong moral compass. This means knowing what you value in life and using that as a guidepost for all decision. By creating a mission statement people can begin to identify the underlying causes of behaviors, as well as what truly motivates them to change. “A mission statement becomes the North Star for people,” says Dr. Groppel. “It becomes how you make decisions, how you lead and how you create boundaries.” To learn more, read our article
How to Meditate
Learning how to meditate is straightforward, and the benefits can come quickly.
STRESS AND YOUR APPETITE
Stress can have a huge impact on your eating habits. During acute stress (the hours after a car accident or the shock of a layoff announcement at work), the stress response can shut down appetite. The fight-or-flight response is designed to suppress hunger — you won’t be effective in battle or run that fast if you are thinking about food. But chronic stress has the opposite effect. Repeated doses of cortisol in your body due to high stress can lead to an increase in appetite.
According to the gender can play a role in how you eat during times of stress. Some research suggests women are more likely overeat due to stress while men turn to alcohol or smoking.
And the reality is that food really can make you feel better during times of stress. So-called comfort food like chocolate cake and ice cream to chronic stress. The problem with continuing to self-medicate chronic stress with comfort foods is that it will lead to weight gain and poor health.
Just as you need to reframe your view of stress and exercise and meditate to give your body a break from stress, you can also adopt strategies to use food to help you better cope with stress.
During times of stress, we can be particularly careless about what we eat and resort to mindless snacking, grabbing sweets from the office treat table or eating bags of junk food on the run. During times of stress, it’s particularly important to engage in “mindful eating,” which involves eating slowly and relishing every bite.
How to Be Mindful at the Holiday Table
Holidays are often filled with expectations. Take a moment to appreciate the present.
“The question isn’t what are the foods to eat, in my mind,” a holistic physician who oversees , a holistic-living center in Bedford, N.Y. “Most people have a general sense of what the healthy foods are, but they’re not eating them. What’s on your mind when you’re eating: That’s mindful eating to me.”
Here’s a simple exercise to try next time you are sitting down to a delicious meal:
Place a forkful of food in your mouth. Make it something you love.
Put the fork down and resist the temptation to take a second bite.
Chew slowly. Tune in to the texture of the food, the flavor, the aroma. Focus on the colors on your plate.
Be present in the moment and think only about the food in your mouth. Reflect on the effort that went into growing or producing this food; the effort it took to prepare this meal.
Savor the moment.
To learn more, read
Support and Relationships
Your friends and family can be both a cause of stress and a cure for it.
LEAN ON LOVED ONES
The pressure of family responsibilities is one of the most common forms of stress. But during times of stress, our friends and family members are most likely to give us the support we need to get through it.
One of my involved a steep hill, a heavy backpack and 34 university students. Students were fitted with a backpack full of free weights equivalent to 20 percent of their body weight. They stood at the base of a hill on the University of Virginia campus with a 26-degree incline. Wearing the heavy backpack, they had to imagine climbing that hill and guess the incline. When a student stood alone, he or she tended to guess that the hill was very steep. But when they stood next to a friend, the hill didn’t look as daunting. Overall, students in pairs consistently gave lower estimates of the hill’s incline compared with students who were alone. And the longer the friends had known each other, the less steep the hill appeared.
The lesson: The world does not look as challenging with a friend by your side.
For people who study stress, the role of friendship, family and support networks can’t be overstated. Time and again research shows that social support is a defining element in our happiness, quality of life and ability to cope with stress.
MAP YOUR SOCIAL NETWORK
During times of high stress we have a tendency to retreat. We cancel social plans and focus on the work, money crisis or trauma that is our source of stress. But friends and social support are among the best forms of therapy to help you escape stress for brief periods of time. Friends can also make you feel better about yourself, and that mountain of stress in your life won’t look so steep.
When Dr. Southwick, Yale Medical School psychiatrist, co-wrote his book on resilience, he interviewed a number of people who had shown resilience against all odds, including former prisoners of war and people who had survived trauma. One thing they had in common was social support.
“The resilient people we interviewed actively reached out for support,” said Dr. Southwick. “They don’t sit around and wait.”
Even POWs held in isolation devised a tapping method of communication with their fellow prisoners. “Most, if not all, said it was life-saving to know they weren’t alone and they were cared for,” said Dr. Southwick.
When Dr. Southwick, a psychiatrist, meets with a new patient, one of the first things he does is construct a diagram of the patient’s social network. Sometimes they just talk about it; some patients want to map it out on paper. “Who is in your life? Who can you count on?” asks Dr. Southwick. Make your own list of your social network and keep it handy when you need to call on someone for support.
DON’T JUST SEEK SUPPORT, GIVE IT
If you lead a highly stressful life, the solution may be to add one more task to your daily to-do list. Give back.
Research consistently shows that helping other people and giving social support is a powerful way to manage the stress in your life and boost your resilience. Volunteer work, mentoring, mowing your elderly neighbor’s lawn, listening to a friend who is struggling — all these can enhance your own ability to manage stress and thrive.“
Time spent helping others, sharing our knowledge and providing social and emotional support gives meaning and purpose to our lives,” said Adam Grant, a Wharton management professor and co-author of the book “Option B: Facing Adversity, Building Resilience and Finding Joy” with Sheryl Sandberg. “Getting out of yourself and helping others may be even more powerful than receiving social support.”
REACH OUT AND TOUCH SOMEONE
The simple act of touching another person — or being touched — can ease your stress. James A. Coan, an assistant professor of psychology and a neuroscientist at the University of Virginia, recruited 16 women who felt they had strong support in their relationships. To simulate stress, he subjected each woman to a mild electric shock under three conditions, all while monitoring her brain. The shocks were administered in no particular order while the woman was 1) alone, 2) holding a stranger’s hand, and 3) holding her husband’s hand.
Notably, both instances of hand-holding reduced the neural activity in areas of the woman’s brain associated with stress. But when the woman was holding her husband’s hand, the effect was even greater, and it was particularly pronounced in women who had the highest marital-happiness scores. Holding a husband’s hand during the electric shock resulted in a calming of the brain regions associated with pain similar to the effect brought about by use of a pain-relieving drug.
Coan says the study simulates how a supportive marriage and partnership gives the brain the opportunity to outsource some of its most difficult neural work. “When someone holds your hand in a study or just shows that they are there for you by giving you a back rub, when you’re in their presence, that becomes a cue that you don’t have to regulate your negative emotion,” “The other person is essentially regulating your negative emotion but without your prefrontal cortex. It’s much less wear and tear on us if we have someone there to help regulate us.”
ANIMALS CAN HELP
Spending time with your pet can offer a temporary reprieve from stress. Spending time with your dog and taking it for a walk is a twofer — you get the stress reduction of a pet plus the stress-busting benefits of a walk outdoors.
The evidence that pets are a source of comfort and stress relief is compelling. At Veterans Affairs hospitals, therapy animals including dogs and parrots have helped patients undergoing treatment for post-traumatic stress
have shown that after just 20 minutes with a therapy dog, patients’ levels of stress hormones drop and levels of pain-reducing endorphins rise.
In a controlled among patients with heart disease, researchers at the University of California, Los Angeles, found a significant reduction in anxiety levels and blood pressure in the heart and lungs in those who spent 12 minutes with a visiting animal, but no such effect occurred among comparable patients not visited by a dog.
Excessive stress can take a physical toll if it’s not managed correctly.
While some stress is essential for human function, chronic stress creates a throughout your body.
Heart: During a stressful event, — cortisol, adrenaline and noradrenaline. In some parts of the body (skin, digestive system, brain) blood vessels constrict, allowing blood flow to increase to larger systems (heart, large muscles). The body is redirecting oxygen and nutrients to the areas where they are needed most to give you the strength to fight or flee. But blood flowing to a smaller area causes blood pressure to rise. Normally the effects are temporary, but some research suggests that in people with chronic stress, the effects on the heart are unrelenting, raising the risk for high blood pressure, heart attack and stroke.
Immune System: Chronic stress can depress the immune system and make you more vulnerable to colds or more serious illnesses.
Diabetes Risk: During stress, the liver increases glucose production for a boost of energy to propel you during an emergency. Chronic stress can lead to extra blood sugar, increasing risk for diabetes, especially among those already at high risk, such as the overweight or those with a family history of the disease. According to the , learning to manage your stress can be nearly as effective at controlling blood sugar as medication.
Stomach and Digestion: Stress can affect how fast food moves through your body, stomach acid and the absorption of nutrients. Chronic stress can also lead to overeating or alcohol use. All of these factors can contribute to a number of gastrointestinal issues including acid reflux, heartburn pain, nausea, stomach pain, ulcers and diarrhea.
Sex and Reproduction: In men, chronic stress can affect testosterone levels and sperm count, and contribute to erectile dysfunction. In women, stress can create irregular menstrual cycles and painful periods and exacerbate premenstrual syndrome. Stress can also worsen the symptoms of menopause, including more frequent and more severe hot flashes. In both men and women, chronic stress can dampen sexual desire.
About the Author
Tara Parker-Pope is the founding editor of Well, an award-winning consumer health site with news and features to help readers live well every day.
The trauma and adversity that students are carrying into classrooms are changing how educators need to address learning and academic performance. Fifty-one percent of children in public schools live in low-income households, and when poverty levels exceed 50 percent, there’s a significant drop in academic performance across all grade levels. At the same time, 25 percent of all adolescents—including 30 percent of adolescent girls—are experiencing anxiety disorders.
Adversity and trauma reside in our biology, not our psychology and cognition, so we educators need to prime students’ brains for learning. This calls for a deeper understanding of how our brains develop and how they respond to adversity and trauma, and how building relationships and providing strategies that promote emotional regulation can positively affect students’ emotional, physiological, and cognitive health.
I’d like to describe some practices that not only address the stress response in the limbic brain areas, but also attend to sensory and motor systems in the brain stem area. Often these systems are compromised because of chronic stress that has neurobiologically reprogrammed how the brain of a child or adolescent responds to adversity.
Brain breaks stimulate many areas in the brain that pay attention to novelty and curiosity, sparking the motor and sensory systems while initiating emotional regulation in the more reactive and primitive areas of the brain. Here are a few brain breaks you can try in class.
Funny talk: Have students loosely touch the roof of their mouth with their tongue and begin to speak. Create a class chant to say altogether, or the teacher can address the class, modeling what he or she would like students to say.
Tongue stretch: Have students use clean hands or a Kleenex to stretch their tongue as far as it can go. This relaxes the throat, palate, upper neck, and brain stem. What could you add to this to make it funny?
Hum: There are many ways you can incorporate humming as a break or to begin class. Lead students in Simon Says or Name That Tune, or have them move their arms and legs to someone’s humming. This activity releases stress and blockages in the brain stem.
Bilateral scribbles: Have students hold a different color marker in each hand and draw or scribble to the beat of some music for 30 seconds. When they’re finished, see if the drawings turned into anything familiar or strange. Have them share with a classmate and then give their art a name.
Name scribbles: Have students write their favorite word four times with their dominant hand and then again with their other hand. Discuss how it felt, which they found more difficult and why, and what happened in their brains when they used their non-dominant hand.
Focused-attention practices calm the brain’s stress response and stimulate sustained attention and emotional regulation. A regulated and calm brain is a brain that is ready to deeply learn.
When we consciously use sensations, breath, movement, and our body’s awareness, we activate those areas in the brain that pay attention to what is happening in this moment, while supporting areas we need for learning, attention, and engagement. I’ll share four focused-attention practices here.
Ice cube: Give each student an ice cube and a paper towel or napkin to hold. As they hold the ice cube, ask them to focus on what it feels like in their hands and what the sensation reminds them of. Can they sit still and wait for the ice cube to melt?
Deep breathing: Have students scrunch their toes and cross their legs at the ankles. Then they should cross the left arm over the right arm, clasp their hands together, and—keeping their hands clasped—bring them toward their chest. Have them hold that pose for 30 seconds as they take five deep breaths, and then have them take another 30 seconds to uncurl their toes, uncross their legs, extend and unclasp their hands, and uncross their arms while taking another five deep breaths. How did that feel?
So what? As students close their eyes and sit up nice and tall in their chairs, they should visualize a golden thread that connects their hearts to their stomachs. As they breathe in, have them picture a pulse in the thread moving from their stomachs to their hearts; with each exhale, the pulse travels from the heart back down to the stomach. As the students breathe, have them say, “So what?” to themselves if a negative thought occurs.
Feeling phrases: To begin the day, have students share through a picture or description how their bodies feel. Some example phrases: cold/warm/hot; twitchy/butterflies/soft/stuck; sharp/dull/itchy; shaky/trembly/tingly; jittery/weak; empty/full; relaxed/calm/peaceful; flowing/spreading; strong/tight/tense; dizzy/fuzzy/blurry; numb/prickly/jumpy/tearful/goosebumpy.
Sensations are different than emotions in that they describe the way the body feels physically. Children who struggle with speaking can point to places on their body that hold a sensation. Sensory awareness promotes cognitive growth and self-awareness. When students can begin to identify their sensations, they begin to tap into where the negative feelings and images are. This focused-attention practice can be implemented several times a day after different experiences. Questions to ask as part of this practice:
What are you sensing? As the teacher, begin by sharing and modeling your own sensations.
Where is this in your body?
What might be the reason for these butterflies?
Can you draw what fuzzy, tingly, tight, etc. looks like?
The disintegration of Jake’s life took him by surprise. It happened early in his junior year of high school, while he was taking three Advanced Placement classes, running on his school’s cross-country team and traveling to Model United Nations conferences. It was a lot to handle, but Jake — the likable, hard-working oldest sibling in a suburban North Carolina family — was the kind of teenager who handled things. Though he was not prone to boastfulness, the fact was he had never really failed at anything.
Not coincidentally, failure was one of Jake’s biggest fears. He worried about it privately; maybe he couldn’t keep up with his peers, maybe he wouldn’t succeed in life. The relentless drive to avoid such a fate seemed to come from deep inside him. He considered it a strength.
Jake’s parents knew he could be high-strung; in middle school, they sent him to a therapist when he was too scared to sleep in his own room. But nothing prepared them for the day two years ago when Jake, then 17, seemingly “ran 150 miles per hour into a brick wall,” his mother said. He refused to go to school and curled up in the fetal position on the floor. “I just can’t take it!” he screamed. “You just don’t understand!”
Jake was right — his parents didn’t understand. Jake didn’t really understand, either. But he also wasn’t good at verbalizing what he thought he knew: that going to school suddenly felt impossible, that people were undoubtedly judging him, that nothing he did felt good enough. “All of a sudden I couldn’t do anything,” he said. “I was so afraid.” His tall, lanky frame succumbed, too. His stomach hurt. He had migraines. “You know how a normal person might have their stomach lurch if they walk into a classroom and there’s a pop quiz?” he told me. “Well, I basically started having that feeling all the time.”
Alarmed, Jake’s parents sent him to his primary-care physician, who prescribed Prozac, an antidepressant often given to anxious teenagers. It was the first of many medications that Jake, who asked that his last name not be used, would try over the next year. But none seemed to work — and some made a bad situation worse. An increase in dosage made Jake “much more excited, acting strangely and almost manic,” his father wrote in a journal in the fall of 2015. A few weeks later, Jake locked himself in a bathroom at home and tried to drown himself in the bathtub.
He was hospitalized for four days, but soon after he returned home, he started hiding out in his room again. He cried, slept, argued with his parents about going to school and mindlessly surfed the internet on his phone. The more school he missed, the more anxious he felt about missing school. And the more anxious he felt, the more hopeless and depressed he became. He had long wanted to go to the University of North Carolina at Chapel Hill, but now that felt like wishful thinking.
Not every day was bad. During spring break in 2016, Jake’s father wrote: “Jake was relaxed and his old sarcastic, personable, witty self.” A week later, though, Jake couldn’t get through a school day without texting his mother to pick him up or hiding out in the nurse’s office. At home, Jake threatened suicide again. His younger siblings were terrified. “It was the depth of hell,” his mother told me.
That summer, after two more hospitalizations, Jake’s desperate parents sent him to Mountain Valley in New Hampshire, a residential treatment facility and one of a growing number of programs for acutely anxious teenagers. Over the last decade, anxiety has overtaken depression as the most common reason college students seek counseling services. In its annual survey of students, the American College Health Association found a significant increase — to 62 percent in 2016 from 50 percent in 2011 — of undergraduates reporting “overwhelming anxiety” in the previous year. Surveys that look at symptoms related to anxiety are also telling. In 1985, the Higher Education Research Institute at U.C.L.A. began asking incoming college freshmen if they “felt overwhelmed by all I had to do” during the previous year. In 1985, 18 percent said they did. By 2010, that number had increased to 29 percent. Last year, it surged to 41 percent.
Those numbers — combined with a doubling of hospital admissions for suicidal teenagers over the last 10 years, with the highest rates occurring soon after they return to school each fall — come as little surprise to high school administrators across the country, who increasingly report a glut of anxious, overwhelmed students. While it’s difficult to tease apart how much of the apparent spike in anxiety is related to an increase in awareness and diagnosis of the disorder, many of those who work with young people suspect that what they’re seeing can’t easily be explained away. “We’ve always had kids who didn’t want to come in the door or who were worried about things,” says Laurie Farkas, who was until recently director of student services for the Northampton public schools in Massachusetts. “But there’s just been a steady increase of severely anxious students.”
For the teenagers who arrive at Mountain Valley, a nonprofit program that costs $910 a day and offers some need-based assistance, the center is usually a last resort after conventional therapy and medications fail. The young people I met there suffered from a range of anxiety disorders, including social anxiety, separation anxiety, post-traumatic stress disorder and obsessive-compulsive disorder. (Though OCD and PTSD are considered anxiety disorders at Mountain Valley and other treatment centers, they were moved into separate categories in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.)
Mountain Valley teenagers spend a lot of time analyzing — and learning to talk back to — their anxious thoughts. During one group session in the summer of 2016 in a sunlit renovated barn with couches, a therapist named Sharon McCallie-Steller instructed everyone to write down three negative beliefs about themselves. That’s an easy exercise for anxious young people (“Only three?” one girl quipped), but McCallie-Steller complicated the assignment by requiring the teenagers to come up with a “strong and powerful response” to each negative thought.
She asked for volunteers. First, residents would share their negative beliefs and rebuttals with the group. Then others would act those out, culminating in a kind of public performance of private teenage insecurity.
Jake raised his hand. By then, he was in his third month at Mountain Valley, and he looked considerably less anxious than several of the newcomers, including one who sat slumped on a couch with his head in his hands. “I’m free to play the part of terrible, evil thoughts for anyone who needs them,” Jake said with a smile. He had already spent weeks challenging his own thinking, which often persuaded him that if he failed a single quiz at school, “then I’ll get a bad grade in the class, I won’t get into the college I want, I won’t get a good job and I’ll be a total failure.”
At Mountain Valley, Jake learned mindfulness techniques, took part in art therapy and equine therapy and, most important, engaged in exposure therapy, a treatment that incrementally exposes people to what they fear. The therapists had quickly figured out that Jake was afraid of failure above all else, so they devised a number of exercises to help him learn to tolerate distress and imperfection. On a group outing to nearby Dartmouth College, for example, Jake’s therapist suggested he strike up conversations with strangers and tell them he didn’t have the grades to get into the school. The college application process was a source of particular anxiety for Jake, and the hope was that he would learn that he could talk about college without shutting down — and that his value as a person didn’t depend on where he went to school.
Though two months in rural New Hampshire hadn’t cured Jake of anxiety, he had made significant progress, and the therapy team was optimistic about his return home for his senior year. Until then, Jake wanted to help other Mountain Valley teenagers face their fears.
Among them was Jillian, a 16-year-old who, when she wasn’t overwhelmed with anxiety, came across as remarkably poised and adultlike, the kind of teenager you find yourself talking to as if she were a graduate student in psychology. Jillian, who also asked that her last name not be used, came to Mountain Valley after two years of only intermittently going to school. She suffered from social anxiety (made worse by cyberbullying from classmates) and emetophobia, a fear of vomit that can be so debilitating that people will sometimes restrict what they eat and refuse to leave the house, lest they encounter someone with a stomach flu.
Jillian listened as Jake and other peers — who, in reality, liked her very much — voiced her insecurities: “I can’t believe how insignificant Jillian is.” “I mean, for the first three weeks, I thought her name was Susan.” “If she left tomorrow, maybe we wouldn’t even miss her.”
At the last one, Jillian’s shoulders caved, and her eyes watered. “I don’t want to do this,” she said, looking meekly at McCallie-Steller.
“If it’s too much, you can stop,” the therapist said, but Jillian considered the offer only long enough to reject it. She straightened her back. “No, I feel like I need to do this,” she announced. “I have a week and a half left. If I can’t get through something like this here …”
Her voice trailed off, but the implication was clear: The real world would be much more anxiety producing — and much less forgiving.
Anxiety isthe most common mental-health disorder in the United States, affecting nearly one-third of both adolescents and adults, according to the National Institute of Mental Health. But unlike depression, with which it routinely occurs, anxiety is often seen as a less serious problem.
“Anxiety is easy to dismiss or overlook, partially because everyone has it to some degree,” explained Philip Kendall, director of the Child and Adolescent Anxiety Disorders Clinic at Temple University in Philadelphia. It has an evolutionary purpose, after all; it helps us detect and avoid potentially dangerous situations. Highly anxious people, though, have an overactive fight-or-flight response that perceives threats where there often are none.
But sometimes there are good reasons to feel anxious. For many young people, particularly those raised in abusive families or who live in neighborhoods besieged by poverty or violence, anxiety is a rational reaction to unstable, dangerous circumstances. At the Youth Anxiety Center’s clinic in the Washington Heights neighborhood of Manhattan, which serves mostly poor and working-class Hispanic youth, teenagers would object to the definition of anxiety I heard often at Mountain Valley: “The overestimation of danger and the underestimation of our ability to cope.”
“The fears can be very real for our kids,” explained Carolina Zerrate, the clinic’s medical director. “Oftentimes their neighborhoods are not safe, their streets are not safe and their families can feel unsafe if there’s a history of trauma and abuse.” The contemporary political climate can also feel “incredibly unsafe for the community of kids we serve,” Zerrate adds, explaining that many have undocumented family members.
And yet addressing anxiety is low on the priority list in many economically disadvantaged communities. Kids who “act out” are often labeled defiant or aggressive, while those who keep to themselves — anxiety specialists call them “silent sufferers” — are overlooked or mistaken for being shy. “If you go to a public school in a struggling urban area, teachers will talk about drugs, crime, teen pregnancy, violence,” Kendall says. “When you start to talk about anxiety, they’re like, ‘Oh, those are the kids we like!’ ”
Teenagers raised in more affluent communities might seemingly have less to feel anxious about. But Suniya Luthar, a professor of psychology at Arizona State University who has studied distress and resilience in both well-off and disadvantaged teenagers, has found that privileged youths are among the most emotionally distressed young people in America. “These kids are incredibly anxious and perfectionistic,” she says, but there’s “contempt and scorn for the idea that kids who have it all might be hurting.”
For many of these young people, the biggest single stressor is that they “never get to the point where they can say, ‘I’ve done enough, and now I can stop,’ ” Luthar says. “There’s always one more activity, one more A.P. class, one more thing to do in order to get into a top college. Kids have a sense that they’re not measuring up. The pressure is relentless and getting worse.”
It’s tempting to blame helicopter parents with their own anxiety issues for that pressure (and therapists who work with teenagers sometimes do), but several anxiety experts pointed to an important shift in the last few years. “Teenagers used to tell me, ‘I just need to get my parents off my back,’ ” recalls Madeline Levine, a founder of Challenge Success, a Stanford University-affiliated nonprofit that works on school reform and student well-being. “Now so many students have internalized the anxiety. The kids at this point are driving themselves crazy.”
Though there are cultural differences in how this kind of anguish manifests, there’s considerable overlap among teenagers from different backgrounds. Many are anxious about school and how friends or teachers perceive them. Some obsess about family conflicts. Teenagers with OCD tend to worry excessively about what foods they should eat, diseases they might contract or whatever happens to be in the news that week. Stephanie Eken, a psychiatrist and the regional medical director for Rogers Behavioral Health, which runs several teenage-anxiety outpatient programs across the country and an inpatient program in Wisconsin, told me that in the last few years she has heard more kids than ever worry about terrorism. “They wonder about whether it’s safe to go to a movie theater,” she said.
When I asked Eken about other common sources of worry among highly anxious kids, she didn’t hesitate: social media. Anxious teenagers from all backgrounds are relentlessly comparing themselves with their peers, she said, and the results are almost uniformly distressing.
Anxious kids certainly existed before Instagram, but many of the parents I spoke to worried that their kids’ digital habits — round-the-clock responding to texts, posting to social media, obsessively following the filtered exploits of peers — were partly to blame for their children’s struggles. To my surprise, anxious teenagers tended to agree. At Mountain Valley, I listened as a college student went on a philosophical rant about his generation’s relationship to social media. “I don’t think we realize how much it’s affecting our moods and personalities,” he said. “Social media is a tool, but it’s become this thing that we can’t live without but that’s making us crazy.”
In his case, he had little doubt that social media made him more self-conscious. “In high school, I’d constantly be judging my self-worth online,” he told me, recalling his tortured relationship with Facebook. “I would think, Oh, people don’t want to see me on their timeline.”
While smartphones can provoke anxiety, they can also serve as a handy avoidance strategy. At the height of his struggles, Jake spent hours at a time on his phone at home or at school. “It was a way for me not to think about classes and college, not to have to talk to people,” he said. Jake’s parents became so alarmed that they spoke to his psychiatrist about it and took his phone away a few hours each night.
At a workshop for parents last fall at the NW Anxiety Institute in Portland, Ore., Kevin Ashworth, the clinical director, warned them of the “illusion of control and certainty” that smartphones offer anxious young people desperate to manage their environments. “Teens will go places if they feel like they know everything that will happen, if they know everyone who will be there, if they can see who’s checked in online,” Ashworth told the parents. “But life doesn’t always come with that kind of certainty, and they’re never practicing the skill of rolling with the punches, of walking into an unknown or awkward social situation and learning that they can survive it.”
Jean Twenge, a professor of psychology at San Diego State University who researches adolescent mental health and psychological differences among generations, used to be skeptical of those who sounded an alarm about teenage internet use. “It seemed like too easy an explanation for negative mental-health outcomes in teens, and there wasn’t much evidence for it,” she told me. She searched for other possible explanations, including economic ones. But the timing of the spike in anxious and depressed teenagers since 2011, which she called one of the sharpest and most significant she has seen, is “all wrong,” she said. “The economy was improving by the time the increase started.”
The more she looked for explanations, the more she kept returning to two seemingly unrelated trend lines — depression in teenagers and smartphone adoption. (There is significantly more data about depression than anxiety.) Since 2011, the trend lines increased at essentially the same rate. In her recent book “iGen,” and in an article in The Atlantic, Twenge highlights a number of studies exploring the connection between social media and unhappiness. “The use of social media and smartphones look culpable for the increase in teen mental-health issues,” she told me. “It’s enough for an arrest — and as we get more data, it might be enough for a conviction.”
Last fall, at a high school near the New Hampshire-Vermont border, I watched Lynn Lyons, a psychotherapist and author, deliver bad news to a packed auditorium of teachers and counselors. “We’re not getting the job done,” she said, pacing the stage at Fall Mountain Regional High School, where she had been asked to lead a professional-development training session about anxiety.
More than a decade ago, the school would have been unlikely to invite her to speak. Anxiety was barely on the radar of most educators back then, according to Denise Pope, another founder of Challenge Success, the Stanford-affiliated nonprofit. Pope remembers facing skepticism when she sounded the alarm about growing anxiety among teenagers. “We don’t have to convince them anymore,” she told me. “Schools are coming to us, eager for help.”
A gregarious speaker, Lyons kept her audience entertained by calling anxiety “the cult leader” — for its ability to convince people of falsehoods about themselves — and telling funny stories about overinvolved parents. But her main point was clear: In a seemingly well-meaning effort to help kids avoid what makes them anxious, administrators actually make anxiety worse. “Anxiety is all about the avoidance of uncertainty and discomfort,” Lyons explained. “When we play along, we don’t help kids learn to cope or problem-solve in the face of unexpected events.”
She pointed to the increasing use of “504 plans,” a popular educational tool that allows for academic accommodations for students with physical or mental disabilities. Though 504 plans for anxiety vary by student, a typical one might allow a teenager to take more time on homework and tests, enter the school through a back door — to avoid the chaos of the main entrance — and leave a classroom when feeling anxious.
Lyons believes in the necessity of 504 plans, and she is in agreement with many of the recommendations of Challenge Success, including later school start times, less homework and more project-based learning. But Lyons worries that too many 504 plans are “avoidance-based and teach zero skills.” She gave the example of a plan that allows a student to leave a classroom anytime he feels overwhelmed. Often, a teenager “can go wherever he wants and stay there for as long as he thinks he needs,” she said. Instead, she argued, a school should have a policy in place for the student to seek out a guidance counselor or nurse and do some role-playing that helps the student “externalize his worry,” similar to how Mountain Valley teenagers are taught to observe their thinking and talk back to it. Then the student should return to his regular classroom as soon as possible, Lyons said.
“If anxiety could talk, it would say, ‘You know, let’s just get out of here. We don’t have to do this!’ ” Lyons said from the stage. “But in order to retrain the brain, in order to create that message that says that even though I’m uncomfortable I can do this, we need to stop treating these anxious kids like they’re so frail, like they can’t handle things.”
Lyons sees a connection between how some schools deal with anxious students and what she worries is a generation of young people increasingly insistent on safe spaces — and who believe their feelings should be protected at all costs. “Kids are being given some really dangerous messages these days about the fact that they can’t handle being triggered, that they shouldn’t have to bear witness to anything that makes them uncomfortable and that their external environments should bend to and accommodate their needs,” she told me.
Among many teachers and administrators I spoke to, one word — “resiliency” — kept coming up. More and more students struggle to recover from minor setbacks and aren’t “equipped to problem-solve or advocate for themselves effectively,” a school counselor in suburban Oregon told me. In the last few years, the counselor said, she has watched in astonishment as more students struggle with anxiety — and as more of those “stop coming to school, because they just can’t.”
Some schools have taken drastic measures to accommodate what one administrator called “our more fragile students.” At Roxbury High School in Roxbury Township, N.J., there are two dedicated classrooms for anxious teenagers, including one next to a mural of Edvard Munch’s painting “The Scream.” These students typically avoid the mammoth school cafeteria in favor of eating lunch in one of the classrooms, as they did on the day of my visit last May. They had just finished gym class, an anxiety-producing event for some even as the school did all it could to reimagine the concept. Music blasted throughout the gym as the teenagers halfheartedly played something vaguely approximating a game of volleyball. The ball was allowed to bounce once before being struck — not that anyone was keeping score.
I couldn’t help wondering what Lyons, and other therapists I spoke to who worry that schools inadvertently worsen anxiety, would think of this approach. Some of the programs’ teenagers hoped to go to college, where no special classrooms would await them. How was this preparing them for that?
“Some will say that this feeds the monster,” concedes Patricia Hovey, director of special services at Roxbury High. “But you’ve got to start where the kids are, not where you are or where you want them to be. We’ve got to get them in the building. Many of our students simply don’t come to school if they have to spend all day in” general-education classes. Once the students are in school, Hovey explained, staff members can help them build the confidence and skills to eventually transition to Roxbury’s regular classes — and stand a chance at navigating college or a job once they graduate.
Even with the promise of a special classroom, getting anxious kids to Roxbury High each morning demands a herculean effort from the program’s teachers and therapists. During my visit, I watched them text and call several no-show students in an effort to coax them out of bed. They also regularly communicate with parents, talking them through what to say to a teenager who refuses to leave his room. Paul Critelli, one of the program’s teachers, told me that many parents feel overwhelmed trying to get two or three kids ready for school each morning, and that their instinct is often to “sacrifice the anxious kid” in order to avoid morning hysterics and keep the family train running on time.
Mostly, though, Critelli wants to talk to the anxious students. “What’s the issue today?” I heard him ask during a phone call with a sophomore boy, who had missed his scheduled bus and was presumably speaking to Critelli from underneath his sheets. The call was a “Hail Mary,” as Critelli put it, because while he suspects that the boy sleeps with the phone “right next to his face,” he rarely responds when he’s feeling anxious. “I appreciate you picking up — you don’t normally do that,” Critelli told him, mixing in positive affirmation with a call to action. The school would be sending another bus, and Critelli expected him to be on it.
Critelli looked for any opportunity to push students out of their comfort zones. During an informal study period after lunch, I watched him confiscate cellphones he said the teenagers were using to “hide from, control and avoid” their feelings; scoff at a student who claimed to be too anxious to return a book to the school library; and challenge a particularly reserved boy who said he had nothing to work on.
Critelli looked at him incredulously. “Dude, you’re failing physics,” Critelli said. “What do you mean you don’t have anything to do?”
“There’s nothing I can do — I’m going to fail,” the student mumbled.
“So you’re just accepting that you’re going to fail?” The boy looked at his hands. “Here’s an idea,” Critelli continued. “You can email your teacher and say, ‘What can I do to improve my grade? What extra work can I do?’ ”
Critelli surveyed his classroom of anxious teenagers. “I’d love to see you advocate for yourselves!”
Jake is a remarkably minimalist emailer and texter, eschewing exclamation points and emojis in favor of an almost old-fashioned formality. It can be challenging to gauge his moods that way, so I checked in with him regularly by phone in the months after he left Mountain Valley. He usually sounded content when we spoke, an impression confirmed by his parents, who were relieved by the changes they saw in him. In the fall of his senior year, Jake was regularly attending school — on some days he “even enjoyed it,” he told me with a laugh.
While he was careful not to overschedule himself, anxiety still sometimes overtook him. One weekend, he had to leave a Model United Nations conference after he became anxious and his stomach started cramping. “That was really disheartening, but when I struggle now it doesn’t last long, and I can usually get myself out of it pretty quickly,” he said, by talking back to his negative thoughts.
Jake also confessed to some worry about his application to attend U.N.C. He had decided to be transparent with the school about his anxiety disorder, partly because it helped explain his junior-year absences and grades and partly because the months he had spent challenging his beliefs and ideas at Mountain Valley perfectly fit the application essay prompt: Reflect on a time when you challenged a belief or idea.
In 650 thoughtful and sometimes uncharacteristically dramatic words, Jake explained that in middle school he had “aced the tests and seemed to many as the bright future of the American ideal.” But then came high school and fear of failure, the debilitating worry that he might not be good enough. He explained that going to treatment helped him change his perspective on learning and life. “Just being able to type this very essay would have been impossible months ago due to my fear of judgment,” he wrote. “College is the next step in my journey to find a true sense of self, both academically and personally. The future has reopened its doors.”
The doors had not reopened quite as wide for Jillian, whom I visited on an oppressively humid spring afternoon in Florida. It was a school day, but Jillian wasn’t at school. Instead, she was on the screened-in back patio of the townhouse where she lives with her mother, Allison. A talented artist, Jillian loves theater and special-effects makeup design, and she was hard at work on an outfit for a “Walking Dead” costume contest at a local car dealership.
While she painted her costume to make it appear blood-soaked, we half-watched an episode of the Netflix series “13 Reasons Why” on her laptop. Jillian told me she could relate to many of the series’s themes, including cyberbullying. In middle school, she made a profile page on ASKfm, a social-networking site favored at the time by mean girls and their unsuspecting prey. Jillian was quickly targeted. “I’d get 30 mean questions or messages a day,” she said. “Most of them were like, ‘Just kill yourself.’ ”
Nothing like that happened at the small private high school Jillian attended after leaving Mountain Valley. Though the school is known for its flexibility and willingness to work with nontraditional students, Jillian still struggled to feel comfortable there. She didn’t want to open up and be known as “the anxious girl.” There were other students at school who had severe anxiety and depression — “It’s like the flu broke out here with anxious kids this year,” the headmaster told me — but Jillian didn’t feel comfortable hanging out with them, either. Several had yet to go to treatment, and “I don’t want to go backward,” she told me. But the end result, unsurprisingly, was that most students never got to know Jillian.
Her longtime pattern of missing school began again. She had the tools to challenge her anxious thoughts, but using them every day proved exhausting. “There’s feeling a weight on your chest, and there’s the feeling of 16 people sitting on top of each other on your chest,” she said. “As soon as I’d wake up, it was absolute dread.”
Needing to get to her job 40 minutes away each morning, Allison, who had sold her previous house in order to afford Mountain Valley, had little time to coax Jillian out of bed. They argued constantly. Jillian thought her mother — who was severely depressed during a year when Jillian was younger and especially needed support — could be insensitive. Allison struggled with when (and how hard) to push her daughter. She knew Jillian had a serious disorder, but she also knew it wouldn’t get better by letting her hide out in her room. Allison also couldn’t be sure when Jillian was genuinely paralyzed by anxiety and when she was “manipulating me to get out of doing whatever she didn’t feel like doing,” she said.
“The million-dollar question of raising an anxious child is: When is pushing her going to help because she has to face her fears, and when is it going to make the situation worse and she’s going to have a panic attack?” Allison told me. “I feel like I made the wrong decision many times, and it destroyed my confidence as a mother.”
Allison sometimes wondered how her own anxiety issues might have genetically predisposed her daughter to anxiety. Allison had done enough Google searches to know that anxious teenagers tend to come from anxious parents. Research points to hereditary genes that predispose children to an anxiety disorder, and studies have found that an overbearing or anxious parenting style can induce anxiety and risk-aversion in kids. In the parents’ workshop I attended in Oregon, Ashworth, the therapist, spent a lot of time urging family members to work on their own anxiety issues.
He also cautioned parents not to accommodate their children’s avoidance strategies. Families of children with OCD will routinely open doors for them, cook only the two or three specific foods they’ve agreed to eat and avoid saying certain words or sounds. Families of socially anxious kids will let them stay in the car while they go shopping, order for them at restaurants and communicate with a teacher because they’re afraid to. “So many teens have lost the ability to tolerate distress and uncertainty, and a big reason for that is the way we parent them,” Ashworth said.
While Ashworth can be blunt, he is also disarming and funny, with a self-deprecating sense of humor that appeals to both parents and their cynical children. Like many therapists who work with anxious teenagers, he tries to model a “let’s not take life — and ourselves — too seriously” approach. He also has an almost endless empathy for the challenges that these teenagers and their families face. He knows, for example, that raising a severely anxious child can feel counterintuitive. How, for example, do you set and enforce limits with an anxious teenager? If you send him to his room, “you’ve just made his day,” Ashworth told the parents in his workshop, who nodded knowingly.
Though Jillian had returned from Mountain Valley a more confident person with a nuanced understanding of her issues (and with her emetophobia largely under control), treatment didn’t solve her school struggles. As she fell further behind, her morning battles with her mother became increasingly untenable. In consultation with the school, Allison agreed to let Jillian drop out and study for the G.E.D. But Allison wasn’t happy about it; she considered it a momentary concession. “We basically said, ‘O.K., anxiety, you win.’ ”
Jillian was relieved never to have to set foot in another high school. “I’m just a lot more relaxed now,” she told me in her messy bedroom, where the walls were adorned with “Star Wars” posters and the bookshelf overflowed with young-adult fiction and sci-fi, as well as a worn copy of “Chicken Soup for the Teenage Soul.” Near her bed were two prescription bottles — one for Prozac and another for Klonopin, a benzodiazepine tranquilizer. Jillian had been prescribed a number of drug combinations over the years, and while none were panaceas, she believed she would be “a lot worse if I wasn’t taking them.”
Though she spoke to a therapist once or twice a week online, Jillian otherwise ignored the structured daily schedule — including yoga, studying and cleaning her room — that she had agreed to with her mother. Jillian told me she often felt lonely at home, and she spent much of her days texting friends from around the country, some of whom she met at “Star Wars” conventions or on social media.
At the same time, Jillian was trying to make new friends. I watched her joke with fellow contestants at the costume contest (where she walked away with a $250 prize), and she was practically a social butterfly at a film event she attended with her mother. Bored with our company after the screening, Jillian spotted two teenagers talking to each other in a corner.
“O.K., I’m going to go mingle,” she announced.
On a busy weekday morning last May, a new crop of Mountain Valley residents were discovering that a key component of their treatment would involve repeatedly making fools of themselves. On the Dartmouth College campus, eight teenagers wore hand-painted white T-shirts that read “Ask Me About My Anxiety” and “I Have OCD.” They were encouraged by the therapy team to come up with scenarios that would make them uncomfortable. One teenager considered approaching random guys on campus and saying, “You must be a Dartmouth football player.” Later that afternoon, a second group of teenagers arrived. One feigned a panic attack at Starbucks. Another ordered nonsensically at a restaurant.
“What do we need to do to make your anxiety higher?” McCallie-Steller, the therapist, asked several teenagers as they prepared for their morning of exposure therapy. First developed in the 1950s, the technique is an essential component of cognitive-behavioral therapy (CBT) for anxiety, which a vast majority of researchers and clinicians believe is the most effective treatment for a range of anxiety disorders. In a large 2008 study of anxious youth published in The New England Journal of Medicine, more improved using CBT (60 percent) than the antidepressant Zoloft (55 percent), though the most effective therapy (81 percent) was a combination of the two.
But while exposure therapy has been proved highly effective, few teenagers receive it. “We’re much more likely to medicate kids than to give them therapy,” says Stephen Whiteside, director of the Child and Adolescent Anxiety Disorders Program at the Mayo Clinic. “And when we do give them therapy, it’s unlikely to be exposure. With a few exceptions, we’re not treating people with what actually works best.”
Part of the reason is that exposure work is hard. Anxious people aren’t typically eager to feel more anxious. “It’s also uncomfortable for many therapists,” Whiteside told me. “Most people go into therapy or psychology to help people, but with exposure therapy you’re actually helping them feel uncomfortable. It’s not much fun for anybody. It’s much easier to sit in a therapist’s office and talk about feelings.”
Researchers are trying to better understand how exposure works in the brain and to fine-tune its application for anxiety treatment. At U.C.L.A., scientists at the school’s Anxiety and Depression Research Center discovered that the more anxious a person feels going into an exposure exercise, and the more surprised he or she is by the result, the more effective it is at competing with an original negative association or traumatic memory. (That’s why McCallie-Steller did her best to ramp up the teenagers’ anxiety before they began their exposure work.) Other researchers are focused on virtual-reality-aided exposure therapy, which allows people to encounter the sources of their anxiety in a therapist’s office.
For two Mountain Valley 14-year-olds on the main quad at Dartmouth, the sources of their distress were numerous. One, a brown-haired boy who embarrassed easily, suffered from a dispiriting combination of social anxiety, OCD, binge-eating and depression. It was a lot to work on in three months, and he was often overwhelmed by the magnitude of the project. On this day, he had agreed to tackle his social anxiety by sitting next to a stranger on a park bench and striking up a conversation.
Earlier, another Mountain Valley teenager took part in a similar exercise, during which the stranger opened up about his own struggles with anxiety. The teenagers were sometimes surprised that others could relate to their issues. As one girl handed out fliers about anxiety on campus, she sometimes asked people, “Can I tell you about anxiety?” More than a few students — including one who looked as if he might actually be a Dartmouth football player — responded with some version of “Trust me, I know all about it.”
The brown-haired boy was highly anxious about his exposure. He bombarded the therapist, Bryan Randolph, with questions in a seeming attempt to run out the clock until they had to return to Mountain Valley. “Can I just sit on the bench for a minute?” he asked Randolph. “And can I sit down and then start talking? I mean, do I need to ask, ‘Do you mind if I sit there?’ It’s weird to just sit there, have a conversation, then get up and come running back to a group of people.”
“Even better — let’s make it weird,” Randolph told him.
The boy shook his head. “Maybe the guy’s on break and doesn’t want to be bothered.”
“Maybe,” Randolph said. “He might hate you. He might get real mad at you.”
“That’s terrifying,” the teenager confessed. “And what if we’re so close on the bench that we’re touching?”
“That would be awkward,” Randolph said with a half-smile.
The boy craned his neck to get a better look at the man. “Is he sitting in the middle of the bench?”
“I don’t know — he might be,” Randolph told him. “But are you going to ‘what if’ this to death, or are you going to do it?”
He eventually shuffled off toward the stranger, allowing Randolph to turn his attention to the other 14-year-old, Thomas, who stood sheepishly on a nearby corner holding his sign: “I’ve Been Bullied. Ask Me.” The “Ask Me” was hard to make out, because Thomas had also included many of the insults peers have hurled at him over the years, including “B*tch,” “F*ggot,” “Ur Fat” and “Kill Yourself.” Holding the sign on a busy corner had been Thomas’s idea; he thought it might ratchet up his anxiety and force him to interact with strangers, while having the potential added benefit of educating people about bullying.
Randolph and I watched dozens of students walk by, some giving Thomas’s sign a glance but most never slowing their stride. He had been bullied for years, and now he was being ignored. I felt anxious just looking at him.
Eventually, an attractive couple in their mid-20s stopped to read the sign. They smiled, Thomas beamed and after a minute or two of conversation they all hugged. “Oh, my God, that was the greatest,” Thomas announced upon his return.
I asked him what they’d talked about. “The muscular dude said he’s been bullied, too, in middle school, and that bullies get nowhere in life,” Thomas told us. “Then the girl said, ‘You’re really brave. Can I give you a hug?’ ”
“That’s not what you were expecting, huh?” Randolph said. “Instead of being mean to you, people actually treated you with compassion.”
“Yeah, it was awesome,” he said. “I feel so good!”
The brown-haired boy, meanwhile, returned from his brief visit to the bench: “It was sooooo awkward,” he reported. “The guy just kept texting. He was probably like, Why is this kid asking me questions?”
“And what if he was?” Randolph asked him. “You’re not responsible for what he’s thinking.”
The boy appeared to consider Randolph’s point as they made their way back to the van that would return them to Mountain Valley. Sometimes, Randolph told the boys, “exactly what you think will happen happens. Other times, the exact opposite of what you think will happen happens. Either way, it’s all manageable.”
The subject line of Jake’s email to me last winter read simply, “College Results.” I opened it: “Hey Benoit, I just wanted to tell you that I was accepted to U.N.C. Chapel Hill. Jake.” I emailed back to say that he could stand to sound a little bit more excited, to which he replied, “Trust me, I’m pretty excited!”
Last month, I visited him during his fourth week of college classes. It was a Sunday, and Jake met me outside his dorm wearing khaki shorts and a Carolina Panthers jersey. He looked happier than I’d ever seen him. “Let’s walk,” he said, leading me on a tour of campus and nearby Chapel Hill, where he went record shopping (he left with a Parquet Courts album) and played touch football with a few of his friends.
Since leaving Mountain Valley, Jake had prioritized his social life. “The health of my relationships with people is just as important as academics,” he told me on a bench overlooking the main quad. He had said something similar at Mountain Valley, but back then it sounded theoretical, aspirational. It felt true now. He had made new friends on campus and was keeping up with old ones from home — and some of his peers from Mountain Valley — via text and Snapchat, the only social-media platform he regularly uses these days. “My junior year, when things got really bad, I told myself that I didn’t need to hang out with my friends a lot, that all that really mattered was how well I did at school,” he said. “I don’t think like that anymore.”
That’s not to say that Jake doesn’t study. He does — usually days before he needs to. “Procrastination isn’t a good idea for me,” he said. But he was actually enjoying several of his college classes, especially Intro to Ethics, for which he was reading Plato’s “Republic.”
Jake had experienced only one intense bout of anxiety at U.N.C. For his info sciences course, he turned in an assignment online but realized days later that there had been a technical glitch and it hadn’t gone through. He said he felt “a sudden burst of anxiety” — his chest tightened, and adrenaline coursed through his body. What had he done? He sent a panicked email to his professor and told a friend who also has anxiety issues that he was “freaking out.” Then he took a nap, which had long been one of his coping strategies. When he awoke, the professor had emailed saying it wasn’t a big deal. “That ended that crisis,” Jake told me.
For the most part, Jake felt he was managing his anxiety. Over the summer, he met twice with Jonathan Abramowitz, a psychology professor who leads the university’s anxiety and stress lab, but Jake had put off finding a regular therapist for the school year. His parents kept bugging him about it. “I just haven’t felt like I need it here,” Jake told me. But then, a few beats later, he added: “I know I need to stop making excuses and just do it.”
I was curious how much of Jake’s newfound contentment had to do with being at U.N.C., with getting into his dream school. After all, a major component of his treatment at Mountain Valley was learning to accept that his value didn’t depend solely on academic achievement. How would he have reacted if his application was one of the 74 percent that U.N.C. rejected last year?
It was clear that Jake had thought about the question. “I would have been disappointed, but I really think I would have been O.K.,” he told me. “There are other schools in the world where I would have been happy. I definitely wouldn’t have believed that a couple years ago, but a lot’s changed.”
Before walking back to his dorm, where Jake’s friends were waiting for him, we stopped at the Old Well, a campus landmark where legend has it that students who drink from it on the first day of classes will get straight A’s that semester. The old Jake might have been first in line. But the new Jake? He hadn’t bothered to show up.