Anxiety in Schools by Mary E. McCormac School counselors know that there is a stress and anxiety crisis in our schools. Anxiety, a sense of fear and worry, is the most common mental health challenge facing children, teens, and adults. Undesired internalizing behavior typically includes one or more of the following: anxiety, perfectionism, cognitive rigidity, and depression. Internalizing behavior can occur in isolation or in combination with other issues like attention deficit hyperactivity disorder. This article will primarily focus on strategies school counselors can use to help students develop positive ways to cope with anxiety. Over a quarter of teens report experiencing extreme stress, a response to challenge, during the school year. Yale researchers found that high levels of stress reduce the volume of grey matter in the area of the brain responsible for self-control. Some stress and anxiety is good but extreme levels result in students feeling overwhelmed, health problems related to the release of stress hormones in the body, and sometimes even contemplating suicide. Stress is a trigger for anxiety and perfectionism. Without social emotional education and early intervention, youth often develop unhealthy behaviors and coping strategies to deal with internalizing behaviors like anxiety and perfectionism that become bad habits that can persist into adulthood. School counselors at all levels encounter students with a variety of types of anxiety and report finding those who also have cognitive rigidity and perfectionism to be among the most challenging to help. Pressure and high expectations now begins in preschool with even kindergarten students feeling anxious and stressed but without the ability to tell adults why they are distressed. More and more school counselors are being asked to manage students experiencing severe panic attacks in school or deciding if they need to be sent home from school.
Anxiety and stress needs to be looked at in context. School counselors need to advocate for there to be less pressure on students to take as many accelerated courses as possible, achieve unreasonable high grades, and perform at advanced levels on tests. This push for excellence seems to be part of the school culture in many communities rather than a focus on the mental health and wellness of children. Students today experience additional stress from the digital world that also consumes much of what in the past would have been down time. Therefore, counselors must help all students learn to function in schools that mirror the high levels of stress and anxiety in society today. Practicing stress-reduction strategies can help students rebuild the damage caused by stress to their brains and avoid damage to their bodies, relationships, and school performance. Most counselors agree that developing self-regulation skills is the primary goal of counseling students not making them anxiety-free; today many add the additional goals of making students Stress-Smart and increasing mindfulness. The two research-based counseling approaches shown to be effective in teaching positive ways to cope with anxious behavior are cognitive behavioral therapy (CBT) and mindfulness based stress reduction (MBSR). Mindfulness helps students befriend anxiety rather than see anxiety as the enemy. There is also some evidence that motivational interviewing (MI) can help reduce anxiety and in some cases cognitive rigidity and perfectionism. Because anxiety is an internalizing behavior it can remain hidden or undetected for a long time. Therefore school counselors should collaborate with students, parents, nurses, teachers, administrators, and community mental health providers to maximize the probability that students with high levels or anxiety will be identified and provided a supportive environment in which to practice new ways of coping with anxiety and stress. School nurses are often the person in a school who firsts recognizes that a student making frequent visits to the clinic does not have a
physical aliment but rather anxiety. Teachers can be taught some of the common signs of anxiety like problems concentrating, missed deadlines, decline in participation, and absenteeism, and tardy arrivals and urged to consult with the school counselor to determine if intervention is needed. Teachers can also serve as powerful models and think out loud so that students realize that adults need to be Stress Smart too. Teachers can say, Let s just all take a minute to breathe slowly and be aware of out surroundings before we begin our day. Administrators can help reduce stress by managing the demands that come from an overcrowded calendar and no down time for students (and staff). We know for example that lack of adequate sleep makes anxiety worse which is part of the argument for later start times for teens so that they have time to get the rest they need. More so than many other mental health challenges, context is key to the level of anxiety and the appropriate intervention. Counselors should address aspects of the parent-child dyad or family dynamics that often lead to increase stress and anxiety for students and the family as a whole when possible. We are not trying to blame parents, but rather help them understand the big picture and what can be done to reduce anxious behavior and increase bravery. Parents generally want their children to be happy and will initially respond to an anxious child s wish to avoid what they think as unpleasant or scary. Counselors must teach parents that the goal is to prevent avoidance and controlling safety behavior that feeds anxiety. Counselors can assist parents to reduce secondary gain (i.e., child not sick but gets to stay home from school and play on electronics because parent has to work from home). Parents can be critical to helping with systematic exposure or desensitization to the source of fear (objects, thoughts, and situations). If a child is nervous about playing a solo in orchestra in an assembly have them practice at home in front of friendly faces, then ask if they can practice at school in the same room they will perform without an audience, and get the
teacher to work out a cue that they are there for support the day of the performance instead of emailing teacher they can t do it. Parents are frequently the ones putting the pressure on their children to take all challenging courses, earn high grades, and participate in multiple extracurricular activities. Although students with a high level of perfectionism frequently put that pressure on themselves, it is frequently a learned behavior with parents reinforcing schedules that don t allow for needed down time. Parents can be taught useful communication skills like think out loud and modeling to encourage their children to be Stress Smart. I could go answer some work emails but I d rather we take a walk together. Changing the responses of others to anxious behavior, especially parent(s), is frequently critical to reducing anxiety. Finally, if parents are dealing with anxiety themselves, counselors can encourage them to reduce their own anxiety as yet another way to help the child. Most schools today have or are moving towards a multi-tiered system to support students academics and behavior. Anxiety and stress challenges can be addressed school wide through a Mental Health Awareness Day or Mental Wellness Week. Look at the school year and prepare for peak times of anxiety and stress. For example, the start of a school year or a long break from school can trigger specific behaviors which can be reinforced by the responses and outcomes that follow the behavior. Special attention should be paid to students transitioning to a new school which is a stressor. The end of the quarter when many projects are do and tests are given and when standardized tests are administered are other periods of the year when students and teachers may need distressing tips and activities. For elementary schools these activities could be done in the classroom and at the secondary level the counselors can set up a play and wellness table in the cafeteria with activities to de-stress like coloring mandalas, making stress balls, blowing bubbles, writing positive affirmations on sticky notes and posting them on a
bulletin board. Viewing anxiety behaviors as learned suggests the counselor can modifying the environmental conditions so that problem behavior is less prevalent and occurs less frequently. Schools are beginning to see the importance of having a school wide social emotional program in place that is evidence-based. Learn more about these programs at http://www.casel.org/ In order to prevent anxiety from becoming a concern, counselors should teach ALL students positive self-talk to regulate attention, thoughts, and emotions. The best way to teach these skills systematically to all students is through an evidence-based program like Second Step or MindUp. In these programs all students are taught ways to develop emotion regulation through diaphragmatic breathing, accurately identifying feelings, and problem-solving skills to handle challenge. Counselors teach all students to focus on positive emotions like happiness and that kindness and compassion makes both the giver and receiver more positive. Classroom teachers should be educated that accommodations like provide alternative modes of completing assignments, help student start assignment, play calming music in the classroom, and prompt a student by touching their shoulder rather than call out their name but each student has a unique profile. The student and significant others need to reinforce progress toward new more appropriate skills so that they will be repeated. Teachers should try some accommodations and record data on their effectiveness for at least 4 weeks before referring a student for a Tier 2 intervention. Some students will need Tier 2 levels of support to learn and implement strategies to cope with stress and anxiety. They can be identified by responses to perception surveys at the end of classroom lessons or based on other data like an increase in absenteeism or decrease in class participation. Counselors should screen referred students to determine if Tier 1 interventions have been effective and what more may be needed. Common Tier 2 interventions
for anxiety include a behavior plan, structured breaks, morning check-ins, and evidence-based skill development like social skills training and progressive muscle relaxation. Generally it is more efficient for school counselors to assist students with anxiety in small groups. Groups have the advantage of normalizing what the student is experiencing and the opportunity to gain support and learn how peers cope with stress and anxiety. The counselor must screen students because some students with anxiety may not be comfortable participating in a group and admitting there is something that needs to change. Some students may need shortterm individual counseling first to benefit from a group and others may be more comfortable with an outside referral to a community mental health provider. Counselors can help students find behavioral strategies that will lessen anxiety like writing in a journal or listening to music. Counselors can explore cognitive strategies like changing negative automatic thoughts, correcting unrealistic beliefs and interpretations, and encouraging flexible thinking. Most anxious thoughts are not factual or actual so students can be taught to ask themselves Is this really true? to keep anxiety in check. Members can also write positive affirmations like I am safe in school on an outline of a thought bubble or an index card they can keep in their pocket to read when needed. Groups offer the opportunity to do role-plays to practice new skills such as meeting and greeting new people and that mimic exposure to anxiety triggers. Counselors can teach students the benefits of mindfulness, staying in the moment without judging, to cope with stress and anxiety. Often imagery and metaphors are used with mindfulness (e.g., thoughts and feelings are like clouds that appear and float away). Many students benefit from being taught some grounding techniques like simply observing their immediate surroundings with all their senses (name 5 things you can see right now, etc.). Another helpful strategy is to self-monitor anxiety on a simple scale from 1-10 or a feeling thermometer to assess
what triggers high levels of anxiety and what coping tools help bring the anxiety to an acceptable level. Some students are helped by being taught to externalize the anxiety and name it, i.e., that is just my worry brain talking. There are many books for children and teens that offer strategies for coping with anxiety and Apps (many of which are free and students in schools that are oneto-one readily accessible) that address mindfulness, relaxation, and sleep that counselors may want to expose students to as an extension of counseling. A few students after receiving Tier 2 interventions for a period of time will still have such high levels of anxiety that it interferes with cognitive functioning and their ability to do what would be considered developmentally appropriate like come to school on time. Counselors can offer Tier 3 more intensive research-based groups like Coping Cat or A Still Quiet Place. Daily Check In Check Out (CICO) is an evidence-based intervention that consists of students daily checking in with an adult at the start of school to retrieve a goal sheet and encouragement, teachers provide feedback on the sheet throughout the day, students check out at the end of the day with an adult, and the student takes the sheet home to be signed, returning it the following morning at check in. This has been shown to be effective with anxiety but a counselor can only have a few students on CICO so another trusted adult may need to implement this intervention. If after providing Tier 1, 2, and 3 interventions for a reasonable time, do not result in the students coping with anxiety it is time to refer out for additional more intensive intervention. Research has shown that a combination of CBT and medication is an effective treatment for severe anxiety. Some students receiving multi-tiered interventions in the general education setting also have a 504 Plan because they have a diagnosed disability that significantly impacts learning or another major life activity. Counselors commonly attend 504 meetings and suggests
accommodations an individual student needs such as preferential seating, modified class participation and presentation options, small group testing, alternative location for unstructured time, warning for fire drills or changes in routine like substitutes, use of a fast break card that students simply puts on top of the desk when anxiety comes on suddenly and is too scared or unwilling to ask to leave room with a list of safe persons in school they can go to for a break. Students can receive multi-tiered support with or without a 504 Plan. School counselors see students struggling with various levels and types of anxiety and stress daily. We need many tools in our tool box so we can help the students to become Stress Smart and develop their own coping tools for anxiety that fits their unique needs.