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Anxiety: Supporting pupil mental health in practice

Written By: Victoria Cook
5 min read
Vic Cook, Education and Research Project Specialist, Chartered College of Teaching

 

Anxiety can be a normal, temporary and productive reaction to things we find stressful. Research suggests that from a young age, children commonly experience certain fears at different ages, such as a fear of ghosts at the age of six (Seven, 2008). However, when anxiety is constant, overwhelming or out of proportion it shouldn’t be ignored.  

Anxiety disorders are the most common mental health disorders experienced across the lifespan (Kessler et al., 2005) and the most common mental health disorder in children and adolescents (Packer and Pruitt, 2010). Furthermore, several studies have demonstrated the impact of COVID-19 on feelings of anxiety amongst young people, with young people with pre-existing mental health difficulties, special educational needs, and neurodevelopmental disorders particularly affected (Waite et al., 2022). Children with anxiety disorders are more likely than their peers to experience ongoing anxiety problems and other serious mental health disorders and have reduced educational and employment opportunities (Copeland et al., 2013).

Teachers have a role to play in supporting children and adolescents to understand anxiety as part of the new Relationship, Sex and Health Education (RSHE) curriculum. It is also important that teachers feel confident that they can recognise the impact it may have on the students they work with. This research review contains practical suggestions on how to recognise signs of mental health concerns, and strategies for coping with anxiety.

What is anxiety? 

Anxiety can be described by using a simple formula: ‘Add up all the things that cause us stress, and then subtract all of our abilities to cope. The net result is our anxiety level’ (Cohen, 2013, p. 2). Anxiety is typically associated with a range of cognitive, physiological and behavioural symptoms (Table 1). 

Cognitive symptoms Physiological symptoms Behavioural symptoms
Lack of focus

Lack of concentration

Inability to make decisions

Catastrophic thinking

Headaches

Stomach aches

Nausea

Heart palpitations

Sweatiness

Dizziness

Fainting

Chills

Muscle tension

Insomnia

Fatigue

Weakness

Trembling

Blushing

Avoidance

School refusal

Classroom disruption

Trouble developing relationships

Trouble maintaining relationships

Inability to relax

Table 1: Symptoms of anxiety (Moran, 2016, p. 29)

 

Anxiety is both a very normal and useful emotion. It is our body’s natural reaction to perceived danger, focusing our attention and giving us a rush of adrenaline to react. This is sometimes called the ‘fight or flight’ response. A certain amount of anxiety may also have a beneficial impact on academic performance. Test anxiety, in the form of emotional apprehension or tension but without intrusive cognitive worries, has been found to have a positive influence on test performance (Chin et al., 2017). However, when anxiety becomes constant, overwhelming or out of proportion, it may be classified as an anxiety disorder.

There are different anxiety disorders that share many characteristics (APA, 2013). The two most frequent anxiety disorders in middle childhood and adolescence are generalised anxiety disorder (GAD) and social anxiety disorder (Packer and Pruitt, 2010). ‘GAD manifests itself as a hard-to-control, excessive worry, about many different aspects in students’ lives’ (Moran, 2016 p. 28). These students tend to be perfectionists, doubt their abilities, and seek outside approval (Packer & Pruitt, 2010). Social anxiety disorder can best be described as a ‘Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others’ (APA, 2013, p. 202). Students with social anxiety tend to appear shy, withdrawn, and avoid eye contact (Keeley and Storch, 2009). 

The importance of coping strategies 

An individual may respond to stress by implementing different coping strategies (Brouzos et al., 2019). There are three major categories of coping strategies: active coping, passive coping and avoidance (Sahler and Carr, 2009). Coping strategies can be further differentiated as adaptive or maladaptive. Adaptive strategies decrease the perceived level of stress and increase functioning, whereas maladaptive strategies provide temporary relief from stress but decrease functioning. For example, if an adolescent with social anxiety chooses not to attend a party, their anxiety is reduced in the short term but in the long term such avoidance interferes with their ability to overcome their fear (Brouzos et al., 2019). Indeed, it is a common myth that it is helpful to avoid situations that make a child anxious, because although a child experiences relief in the short term, in the long term they don’t get an opportunity to learn what happens if they go into that anxiety-provoking situation (Chessell, 2022). Passive and avoidance coping strategies are both maladaptive strategies. 

Developing effective coping strategies with children 

One study has investigated whether teaching adaptive coping strategies was associated with fewer social anxiety symptoms in adolescents transitioning into secondary school (Brouzos et al., 2019). The study involved 82 Year 6 (11-12 years of age) Greek students from two schools in north-western Greece. Fifty-six students participated in the intervention, which consisted of 45 minutes sessions over five consecutive weeks, and 26 students were in the no-intervention control group. In the intervention, students developed coping strategies to solve both academic and social problems and applied these skills to hypothetical vignettes. No further information on the specific coping strategies developed is given by the authors. The findings suggest that the intervention encouraged the use of active coping strategies and had a positive effect on participants’ self‐reported social anxiety symptoms. Female participants with higher initial social anxiety symptoms benefitted the most, although the authors do not hypothesise why. While the intervention did not appear to significantly reduce the use of passive/avoidant coping, the authors speculate that habitual coping styles will gradually be replaced with more active coping strategies over time. 

Children and adolescents can be taught coping skills to help develop effective strategies to minimise anxiety. Active coping strategies include listening to music, reading a book, drawing, talking to someone and apologising or telling the truth (Moran, 2016; Brouzos et al., 2019). Providing time in class for students to relax and practice these coping strategies is important. Highlighting the importance of positive self-talk, in particular how students talk about themselves and their abilities, can also be influential in reducing anxiety (Moran, 2016). 

Interventions such as mindfulness, meditation and relaxation techniques are also becoming increasingly popular in schools. However, a recent meta-analysis of mindfulness-based interventions (MBIs) on anxiety in children and adolescents suggests that the effect of such interventions may be limited, particularly amongst Western youth populations (Odgers et al., 2020). It is not clear why this is the case, although the authors suggest that MBIs may offer less opportunity for proactive exposure to feared external stimuli that is necessary to facilitate learning (Waters and Craske, 2016).

The Association for Child and Adolescent Mental Health has information on how to involve a child in creating a step-by-step plan to help them learn new information as they gradually face their fears (Chessell, 2022). The NHS website gives further tips for coping with anxiety, including understanding and challenging anxious thoughts.

Key takeaways

  • Anxiety can be a normal, temporary and productive reaction to things we find stressful.
  • Anxiety is typically associated with a range of cognitive, physiological and behavioural symptoms.
  • Children and adolescents can be taught coping skills to help develop effective strategies to minimise anxiety.

 

This research review has been developed as part of the ‘Pedagogy in practice‘ series.

References
  • American Psychiatric Association (APA) (2013) Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  • Brouzos A, Vassilopoulos S and Vlachioti A et al. (2019) A coping‐oriented group intervention for students waiting to undergo secondary school transition: Effects on coping strategies, self‐esteem, and social anxiety symptoms. Psychology in the Schools. 57. 10.1002/pits.22319.
  • Chessell C (2022) Myth Busting Anxiety. Available at: Myth Busting Anxiety recording - ACAMH (Accessed 08 June 2022).
  • Chin ECH, Williams MW and Taylor JE et al. (2017) The influence of negative affect on test anxiety and academic performance: An examination of the tripartite model of emotions. Learning and Individual Differences 54: 1-8.
  • Cohen LJ (2013) The drama of the anxious child. Available at: https://ideas.time.com/2013/09/26/the-drama-of-the-anxious-child/ (accessed 16 May 2022).
  • Copeland WE, Angold A and Shanahan L et al. (2013) Longitudinal patterns of anxiety from childhood to adulthood: The great smoky mountains study. Journal of the American Academy of Child and Adolescent Psychiatry 53(1): 21–33.
  • Keeley ML, and Storch EA (2009) Anxiety disorders in youth. Journal of Pediatric Nursing 24(1): 26–40.
  • Kessler RC, Berglund P and Demler O et al. (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry 62: 593–602.
  • Moran K (2016) Anxiety in the classroom: Implications for middle school teachers. Middle School Journal 47 (1): 27–32.
  • Odgers K, Dargue N and Creswell C et al. (2020) The limited effect of mindfulness-based interventions on anxiety in children and adolescents: A meta-analysis. Clinical Child and Family Psychology Review 23(3): 407-426. doi: 10.1007/s10567-020-00319-z. PMID: 32583200.
  • Packer LE and Pruitt SK (2010) Challenging kids, challenged teachers: Teaching students with Tourette’s, Bipolar disorders, Executive dysfunction, OCD, ADHD, and more. Bethesda, MD: Woodbine House.
  • Sahler OJ and Carr JE (2009) Coping strategies. In WB Carrey (ed.) Developmental‐Behavioral Pediatrics. Philadelphia, PA: W.B. Saunders, pp. 491–496.
  • Seven S (2008) Child Mental Health. Turkey: Pegem Academy.
  • Waite P, Pearcey S and Burgess LCH et al. (2022) How the COVID-19 pandemic affected young people’s mental health and wellbeing in the UK: A qualitative study. https://doi.org/10.31234/osf.io/xmpw3
  • Waters AM and Craske MG (2016) Towards a cognitive-learning formulation of youth anxiety: A narrative review of theory and evidence and implications for treatment. Clinical Psychology Review 50: 50–66. https://doi.org/10.1016/j.cpr.2016.09.008.
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Lucy Bishop

Thank you for this. We have a lot of parents raising concerns about anxiety in their children and this provides some concrete guidance. I liked the guidance on different types of coping strategies and the consequences. For example the temporary relief of avoidance can lead to further anxiety.