Effective Evidence-Based Interventions for Anxiety in High School Students

August, 2018

Effective Evidence-Based Interventions for Anxiety in High School Students

Students everywhere suffer from stress in school, but for some stress goes beyond what a person can handle and becomes anxiety.  In cases of frequent overwhelming stress, a student may have an anxiety disorder or OCD. 

In casual speech, stress and anxiety may be used interchangeably but they indicate very different things.  Stress is something that everyone experiences and almost everyone can manage to a certain degree.  Stress tends to deal with realistic fears and does not interfere with a person’s daily activities very much.  If a person begins to feel overwhelmed, reassurance from family and friends can help.  Anxiety, on the other hand, is far more intense, pervasive, and unrealistic.  Those experiencing anxiety cannot manage it alone and reassurance from family or friends does not result in lasting relief. 

Anxiety disorders and OCD can vary greatly in severity and form.  For example, symptoms can present as high or low emotions.  High emotion anxiety is the stereotypical anxiety where it’s highly evident that the person is upset.  During exposure to stressors, high emotion students and adolescents may throw temper tantrums, cry profusely, and worry excessively.  Students specifically may frequently ask to go to the nurse, go home, or even refuse to go to school.  This set of symptoms contrasts with low emotion anxiety, which is far less apparent.  Those suffering from low emotion anxiety may, at first glance, seem to be introverted or shy.  In reality, they are just as distressed as someone with high emotion anxiety but do not show it outwardly.  Students with low emotion anxiety may skip lunch, be perfectionistic, or abuse drugs and alcohol. 

A common characterizing symptom of anxiety is pain.  People who show this symptom, may exhibit anything from a headache or gastrointestinal distress, to muscle pain.  The pain ranges in severity from a mild nuisance to debilitating pain.  This happens because the part of the brain that controls the fight or flight reflex cannot distinguish between someone being anxious about a test and someone being anxious about a realistic threat such as being attacked.  The fight or flight reflex treats these two scenarios the same and triggers a set of physical changes including increased muscle tension. Although these physical changes may help someone escape from an attack, chronic muscle tension results in pain for the anxious test taker.

When a student is suffering from anxiety or OCD it is not uncommon to refuse school.  It is important to note that this is not truancy.  A student who refuses school does so not because of laziness, but because of avoidance of anxiety triggers.  Anxious students often get their work done and isolate themselves at home.  This contrasts with truant students, who typically leave home and shirk their responsibilities.  The parent of an anxious school refuser is aware of the student’s school refusal and typically calls the student in sick for the day. Parents of truant students may not be aware of their student’s truancy, therefore school absences typically are unexcused.

Decades of clinical research trials support Cognitive-Behavioral Therapy (CBT) with Exposure with Response Prevention (ERP) as the most effective treatment for the anxiety disorders and OCD, producing more longstanding benefits than medication alone.  Providers in the general community are not widely trained in this treatment. Effective treatment lowers anxiety and creates a higher tolerance of fear and of distressing stimuli.

In order to maximize the effectiveness of CBT with ERP, treatment goals are applied consistently within the family and in the school of a student with an anxiety disorder or OCD.  For the family of the student this might include maintaining appropriate behavioral expectations with an effective incentive plan and providing helpful responses to the student’s anxiety.  Schools typically provide accommodations to students with disorders, such as a separate testing room or excusing absences.  It is imperative that neither the family nor school be too rigid or too permissive with the student since both can undermine treatment.

The level of anxiety that students with anxiety disorders or OCD experience goes above and beyond normal, healthy, levels. It is imperative to utilize effective treatments so that the student receives the help they need to manage and overcome their anxiety, and live a healthy, fully-functional life.