How to Manage Stress for Teens

Stress is extremely common among teenagers. The typical sources are school performance, social acceptance, social media and parental pressures all of which result in young people being more stressed than ever before. For teenagers especially, it’s essential to manage stress so it doesn’t get out of control or last into adulthood. To figure out how, we spoke with Dr. Nada Milosavljevic who practices conventional and integrative medicine for cognitive and behavioral conditions.

An interview with Dr. Nada Milosavljevic,
Double Board-Certified, Harvard-trained physician and faculty member at Harvard Medical School (prior to her career in medicine, she practiced law with a specialty in intellectual property and biotech) and author of Holistic Health for Adolescents, Boston, MA USA


Most teenagers are more stressed today than ever before. Some of them can’t even clearly identify the cause. What do you think are the top causes of stress among teenagers?

Diet: During mental and physical development, inadequate nutrition is especially damaging, and can have long-term, and irreversible consequences.

Social Pressures: Adolescents famously experience pressures to look or behave in certain ways, or to do things because their peers are doing them. They are often exposed to risky behaviors such as underage alcohol or drug use, and may feel trapped by social expectations. Of course, many times the peer pressures stray from what their parents recommend or demand, resulting in additional tension. Moreover, mental and or physical abuse may be impossible for an adolescent to talk about because of social pressures. Left untreated, stress can cause an adolescent to become isolated and have feelings of poor self-worth.

Illness/infection: Any illness prompts the body to mount an immune response; the resulting healing process can be stressful and place high energy demands on the body. Chronic illnesses place an increased burden on any adolescent, and can contribute to significant long-term stress.

Physical: Bodily changes that alter appearance and functionality can cause stress in many ways. Changes such as pimples, vocal shifts, height, body odors, excess body hair, and menstrual cycles can all contribute to the awkwardness an adolescent may feel about their own body. Sleep deprivation, common in the adolescent population, has been shown to elevate cortisol levels and can cause a physiologic inability to remain focused, or even to look healthy.

Psychological: Beliefs and ideals begin to change with adolescence, and often no longer align with parental ideals. Choice of religion or political ideas may change as new discoveries are made; parents may become concerned. Sexual orientation is another discovery that may not gain parental approval, which can cause the adolescent to feel unloved and misunderstood.

Other stressors: Difficulty in school, trouble meeting and making new friends, keeping up with fashion and trends, not having the funds to join in interests with others, can all further contribute to stress and anxiety.

Can you recommend a simple strategy on how to get out of “stress mode” while in school? Is it possible to be ambitious without stressing out all the time?

It is important for people from every age group to find that balance between body, mind, emotions, and behavior. Here are a few strategies that can help. Some can easily be used while in school:

Relaxation response – deep abdominal breathing, focus on a soothing word such as peace or calm, visualization of tranquil scenes, repetitive prayers, yoga, and tai chi are just a few of the approaches that can be used to prompt the relaxation approach. While these approaches are not a “cure-all” for everyone with severe stress, they are beneficial to many.

Physical activity – exercise is often recommended to people who complain of stress. This activity is also beneficial to children and teens. Physical exercises such as brisk walking that increase the heart rate help to relieve muscle tension caused by stress. Movement therapies including yoga, tai chi combine fluid movements with deep breathing and mental focus to create calm. For children and teens, any physical activity like after-school sports can provide exercise, as well as social support.

Social support, Peer relationships, friendships, co-worker communications, spouses, and daily companions provide necessary daily enhancements. People who have close relationships with family and friends garner emotional support that definitely helps them during times of stress.

Other therapies such as acupuncture, Traditional Chinese Medicine (TCM), Ayurvedic medicine (use of herbal diets and other compounds), massage therapy, relaxation, and music/sound therapy have shown success in stress management.

Nutrition: Research has shown that the human body depletes stores of nutrients such as protein, and vitamins B, C and A when under stress. According to HolisticOnline.com, prolonged stress can also put you at risk of hypertension and can be countered by consuming foods high in potassium (orange juice, squash, potatoes, apricots, limes, bananas, avocados, tomatoes, peaches). Other foods that can be beneficial during times of high stress include yogurt, cheese, tofu, and chickpeas.

How do you define an unhealthy level of stress?

Problems with stress begin in two circumstances. The first one occurs when a specific demand at a specific time begins to put too much pressure on the body’s short-term coping mechanisms. This is called Acute Stress. Acute Stress, which is the most common form of stress, culminates from demands and pressures of the recent past and anticipated demands and pressures of the near future. This form of stress sometimes makes us feel thrilled and excited because it sometimes involves challenges we bring on ourselves, such as trying to get a big promotion or climbing a steep hill. But because this is short-term stress, it does not do extensive damage like long-term stress. Acute Stress is very treatable and manageable.

The second kind of problematic stress is long-term, or Chronic Stress. As emphasized in the example above, the body creates “stress” as a short-term remedy for some stimulus or circumstance that places unusual demands on a person.

There are some generalized repercussions of long-term Chronic Stress. The chemicals and hormones that can be life-saving in short situations of acute stress now suppress functions that are not immediately needed. The result is lowered immunity. As a result, our digestive, excretory, and reproductive systems stop working normally. Chronic Stress can contribute to a wide spectrum of problems: high blood pressure, heart disease, metabolic disturbance, obesity, diabetes, insomnia, anxiety and depression. These kinds of symptoms of chronic stress are often difficult to treat and sometimes require extended treatment.

Can you explain the physical and mental signs and consequences of chronic stress?

Pre-teens and adolescents often find stressful situations associated with: making and keeping friendships; achieving in school; and trying to live up to perceived expectations from parents, teachers, or coaches. During times of chronic stress, emotional symptoms can appear on a person as “acting out,” agitation, depression, nervousness, anxiousness, fearfulness, or feelings of being under constant pressure. The person may suffer from “emotional breakdowns.” Symptoms of stress and anxiety can often be experienced as an ominous feeling or sense of impending doom, negative thoughts, physical illness, or behavioral actions such as restlessness or uncharacteristic aggression.

Adults are not always aware when their children or teens are experiencing overwhelming feelings of stress. Recognizing the signs of stress in a child or teen is important for parents if they are to offer guidance and support to their children. A few signs of stress may include:

1. Negative changes in behavior. These are almost always an indication that something is wrong. A parent can suspect stress if a child or teen is acting irritable or moody, withdrawing from activities that used to give them pleasure, expressing worries, complaining more than usual about school, crying, displaying surprising fearful reactions, clinging to a parent or teacher, sleeping too much or too little, or eating too much or too little. Additionally, stress may be the culprit when teens abandon long-time friendships for a new set of peers, or express hostility towards family members.

2. Physical symptoms. Physical signs of significant stress usually include stomachaches and headaches, especially if a physician previously gave the child a clean bill of health.

3. Poor Interaction with others. While a child or teen may seem just fine at home, this may not be the case in other settings. It is important for parents to network with other parents to understand how the child or teen is doing in the outside world. Communication with other parents, teachers, and coaches of extracurricular activities may help parents to understand what their children are thinking or feeling. It may also bring awareness to any sources of concern.

4. Troubling Words. These can include: “worried,” “confused,” “annoyed,” and “angry.” If you are hearing these words from your child or teen, be concerned and try to understand from your child or teen what may be happening to cause them to use these words.

5. Our emotions also get involved with stress relief. All of us face this at one point or another and we try to cope as best we can. Unfortunately, not all coping mechanisms are healthy. In some cases, negative coping responses for short-term emotional stress relief can bring on other complications that can make the patient’s overall health worse. These coping strategies — such as alcohol, drugs, caffeine, or overeating – are as unhelpful as they are popular. Because of their connection to our emotions, these bad habits can create considerable obstacles to effective therapies and, therefore, deserve some consideration.

Food, for instance, is often used as a way to comfort or distract people who are experiencing stressful situations. This phenomenon is so large that it has a popular term attached to it that most of us have heard: “emotional eating.” Some factors that contribute to bad eating habits include low self-esteem, low levels of social support, as well as stress. One unhealthy coping mechanism, “avoidant coping,” is closely associated with bad eating behaviors. And there are many unhealthy cycles that can be commenced with eating due to stress: “high fatty food consumption, decreased food and vegetable intake, and decreased breakfast consumption among adolescents.” As adolescents move to college age, one coping mechanism they often turn to is drinking alcohol. Younger adolescents can turn to drinking as well, but alcohol is much more available and easy to access as adolescents move away from living with their parents. It also becomes more central to their social lives. Like bad eating habits, drinking can be associated with avoidance coping, at least in general. One researcher has found that while there may not be a one-to-one correlation with avoidance coping and drinking, the use of avoidance coping as a strategy for dealing with stress could “[exacerbate] ongoing problems over time, leading to higher levels of negative mood, which in turn are associated with increased drinking.”

Anxiety is the most common mental-health disorder in the United States. Can you explain the differences between anxiety and depression?

Anxiety disorders, a form of chronic stress, are the most common mental illness in the U.S., are widespread and costly to society. A national survey of adolescent mental health reported that about 8% of teens ages 13 to 18 have an anxiety disorder. Of these teens, only 18% receive mental health care (National Institute of Mental Health 2014). As adolescents (defined as ages 13-19 y.o.) move on to young adulthood the issue still looms large.

Colleges across the U.S. report depression and anxiety as prevalent problems today. Depression on the other hand, in a minor form, is a type of low mood. The two conditions share a lot of the same symptoms. Symptoms of low mood and depression are very similar, but low mood can be dealt with more easily and turned back relatively quickly with the appropriate interventions. Depression occurs when low mood sets in deeply in the life and emotions of a person, thus becoming more a habit of mind than a short-term condition. Symptoms of low mood can often signal depression. While an individual’s low mood might improve if issues or concerns are resolved, some types of depression can often last longer and may require more conventional types of treatment, including psychopharmaceuticals and psychotherapy.

As we all know, stress also impacts sleep, so what would be an effective evening ritual for a good night’s sleep (to prepare for a stressful event the next day, for example)?

Several types of complementary and alternative treatments can have positive effects. Because of their ease of use and their gentleness, these therapies can have a calming and helpful effect on teens and may help them sleep better as they search for the main causes of their sleep problems. In some cases, the calming effect of these therapies may help to significantly dampen the amplitude and frequency of sleeping difficulties.

Herbal Treatments
Various herbal teas (also called tisanes) are known to create relaxation. Herbs such as chamomile, lemon balm, and passionflower are associated with the treatment of insomnia and relief of other sleep problems.

Natural oils from plants can have a calming and gently sedative effect. Lavender essential oils diffused in the air of a bedroom or on bed sheets has been effective in helping to induce sleep.

Acupuncture / Acupressure
Often used in Chinese medicine for treatment of insomnia and other sleep disorders, acupuncture is becoming more and more widely accepted in this country. The procedure uses the insertion of very fine needles into the skin at specific points to influence the functioning of the body. These same points can also be stimulated via fingertip pressure for acupressure therapy.

Relaxation and Meditation for Sleep Disorders
Quieting the mind through meditation has often been an effective treatment for insomnia. While this is not an easy thing to do right away, after several weeks of learning techniques, adolescents can often master this. Growing research and evidence-based studies continue to support the value of meditation for treating sleep disorders. Regular meditation, alone or as part of a yoga practice, often results in higher blood levels of melatonin, an important regulator of sleep. Melatonin is a hormone produced in animals and plants. It is synthesized by the pineal gland in humans and plays a critical role in the regulation of the sleeping and waking cycle.

Additional techniques for relaxation are aimed at relaxing muscles because increased muscle tension and intrusive thoughts interfere with sleep. Progressive muscle relaxation and biofeedback (teaching people how to better regulate their own natural functions, such as breathing or heart rate) are two alternative therapies that often provide positive results.

Regular exercise is recommended for everyone and especially adolescents for whom the exercise is known to deepen sleep. A recent study reported, “Chronic vigorous exercising is positively related to adolescents’ sleep and psychological functioning.” This study also reported that males with low exercise levels have a risk of increased sleep disorders and less than adequate psychological functioning.


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