Reflecting on Lisa Damour’s New Book About Stress and Anxiety in Girls

April 29, 2019

By Deborah Offner

As I read Lisa Damour’s latest book, Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls, I felt as if she had swooped into my counseling office and the schools where I consult to speak candidly about the girls I know. As a psychologist who specializes in adolescent girls, I counsel some patients whose symptoms—shortness of breath, sweating, shaking, rapid heartbeat, migraine headache, abdominal discomfort—are so debilitating they often spend extended periods in the nurse’s office or miss school altogether.

If you teach, advise, coach, or live with adolescent girls, then you are familiar with their unprecedented levels of stress and anxiety. According to Damour, 31% of girls and young women experience anxiety compared with 13% of boys and young men. Under Pressure puts anxious girls’ otherwise perplexing behavior in context. It is a pertinent sequel to the 2016 bestselling Untangled: Guiding Teenage Girls through the Seven Transitions into Adulthood. This time around, Damour—who is consulting psychologist at Laurel School (OH) and executive director of Laurel’s Center for Research on Girls—integrates her deep understanding of girls’ inner lives from her counseling work and immersion in school life with her facile knowledge of empirical literature on adolescent psychology.

After reading her book and seeing her speak about it, I noted some key takeaways for educators and school leaders.

Stress and anxiety. Stress is necessary for growth. And school, Damour notes, is actually supposed to be stressful, in the healthy way; it challenges students in order to facilitate their intellectual and emotional development. Pushing students beyond their comfort zones—academically, athletically, and socially—is what the most thoughtful independent schools do well.

“Stress becomes unhealthy,” Damour says, “when it exceeds what a person can absorb or benefit from.” The point at which that occurs is different for everyone. “Whether stress becomes unhealthy depends upon two variables: the nature of the problem and the person upon whom the problem lands,” she writes. This explains to all of us who work with students why some whose lives seem so privileged and secure might struggle emotionally while others in “objectively” difficult personal situations may seem calm and content.

She also describes how anxiety can serve as an important signal or warning sign. Damour tells a story of a patient who found herself inexplicably anxious at an ill-fated house party. In response to her nervous feelings, she (uncharacteristically) accepted a shot of liquor along with the beer she was already drinking, as she thought it would help her calm down. She ended up getting so drunk she landed in the emergency room. Damour explains how she helped the girl see that her anxiety at the party was acting as an ally, not an enemy, signaling to her that she was not in a good environment and needed to find an excuse to go home.

I’ve found that teen and even tween girls are remarkably good at understanding what might be driving their anxiety. But to use their anxiety as a friend and informant, girls need adults to be curious with them and to assume there’s probably a reason for their feelings. Using health class or advisory time to help girls reframe stress as important information encourages them to listen to themselves and restores them some control.

Coping strategies. Damour notes that while girls should avoid some situations that are truly dangerous, running away from situations that simply make them anxious is not helpful. She explains, “Everything we know in academic psychology tells us that avoidance only makes anxiety worse.”

My advice to schools is that when students have panic attacks, they should be given a space (the nurse’s office or infirmary, an advisor’s office) to let the physical symptoms such as racing heart, shaking, sweating, and dizziness subside. Once that’s happened, students should move right back into their usual routines. Otherwise, their avoidance of the place where the attack happened—a classroom, the gym, or cafeteria—can turn into habit. The fear of having another attack can become a reason to stay out of class, off the playing field, or away from school altogether. 

At one school where I consulted, we assumed it best to send one student home when her panic attacks wore her out physically and emotionally (and distracted her friend group from their studies). After speaking with her outside psychologist, however, I learned that their treatment plan prescribed staying in school after panic attacks. We quickly reversed the school’s practice, and the therapist’s advice worked.

Negative stereotypes. Sometimes when members of a particular social group perform poorly on a task, it isn’t because they lack proficiency or knowledge but because they’ve internalized a negative stereotype about their group’s abilities. For example, if girls believe that they are, by virtue of their gender, not strong in math or science, they may undermine their own performance out of fear of confirming this negative stereotype. Girls often don’t know they’ve internalized the stereotype. Naming the phenomenon, Damour says, and even sharing ample evidence that contradicts the stereotype, can reduce its power over female students.

Sharing scientific evidence debunking this myth with faculty (and parents) can be useful as well. I encourage schools to assign psychologist Claude Steele’s Whistling Vivaldi as a faculty summer reading book and to structure some conversations about how Steele’s research and concept of “stereotype threat” apply within the school community. I also recommend that schools offer a parent forum on the topic, with attention to how it affects girls and students of color in particular.

Sexuality. Damour encourages parents and teachers to talk candidly with girls about their sexuality. Talking to girls about their wishes and needs makes them less, rather than more, vulnerable to sexual coercion, she says.

High school (and some middle school) girls in my own practice describe boys requesting nude photos and sending unsolicited ones of themselves as a routine occurrence. Damour challenges schools to create technology policies that prohibit students from sending nude photos and requesting them.

I also recommend that schools include substantial technology training in a health and wellness class or advisory. This unit should detail the interpersonal and sexual aspects of digital communication and must be updated regularly, as this is a rapidly shifting and complex landscape. Keeping these conversations grounded in the complex dynamics of peer-to-peer relationships is important. According to Damour, “Experts note that adolescents aren’t enthralled by the technology—they’re enthralled by the peers at the other end of the technology they happen to be using.” I often remind parents and educators that students’ daily lives remain every bit as complex and challenging as they were before Instagram or cell phones existed.

Acknowledging that widespread anxiety affects at least one-third of female students’ ability to learn, work, and play can seem overwhelming for students and school administrators alike. Gaining a basic understanding of its mechanisms and effects can help school leaders support anxious students more effectively. Schools are uniquely positioned to help girls confront their fears and anxieties and to ensure they can utilize the stress they encounter to enhance their self-protection, motivation, and growth.

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