STRESS: The Growing Teen Epidemic

Why Are Teens So Stressed?

Teens routinely say that their school-year stress levels are far higher than they think is healthy and their average reported stress exceeds that of adults, per an annual survey published by the American Psychological Association (APA).[i] On average, teens reported their stress level was 5.8 on 10-point scale, compared with 5.1 for adults.

The most common reported sources of stress were school (83 percent), getting into a good college or deciding what to do after high school (69 percent), and financial concerns for their family (65 percent). In another survey on youth stress, the sources were school work (78 percent), parents (68 percent), romantic relationships (64 percent), friend problems (64 percent) and younger siblings (64 percent).[ii]

How Is Stress Impacting Them?

The APA’s Stress in America survey found that 30 percent of teens reported feeling sad or depressed because of stress and 31 percent felt overwhelmed. Another 35 percent of teens reported that stress caused them to lie awake at night and 26 percent said that they are overeating or eating unhealthy foods in the past month.

The pressures of schoolwork, family life, social life, sports or other activities, combined with a relentless media culture, result in young people being more stressed than ever before. As indicated, stress is also impacting teen’s sleep. They reported sleeping on average 7.4 on school nights and 8.1 hours on non-school nights, less than the 8 to 10 hours recommended by The National Sleep Foundation.[iii]

Teens who sleep fewer than eight hours on a school night are more likely to report experiencing symptoms of stress such as irritability, nervousness, sadness and/or feeling overwhelmed. It becomes a vicious cycle, lack of sleep makes teen’s more susceptible to stress, stress makes teens more vulnerable to lack of sleep.

This process can also easily lead to overeating. Research shows that there is a direct correlation between sleeping habits and weight gain.[iv] With a lack of sleep, it disrupts the functioning of chemicals referred to as ghrelin and leptin, that are known to control appetite.

Stress and lack of sleep increases teens appetite, makes them hold onto fat and interferes with their ability to be mindful of thoughts and feelings that sabotage their decision making regarding food. With stress the body releases adrenaline, CRH, and cortisol. This launches their bodies into a stress response called the “fight or flight” response. In the short-term this works well, because it allows them to feel less hungry and blood flows away from internal organs to their large muscles. The issue becomes how the body handles chronic stress over a prolonged period.

Once the adrenaline wears off, cortisol, the “stress hormone,” signals the body to replenish the food supply. Typically, teens don’t work off the energy it requires to deal with the stressor and they’re stuck with a brain that commands them to continue to replenish. That comes with intense urges to automatically reach for calorie dense foods to make sure that they have enough energy to cope with the next bout of stress. All too often those foods include chips, cookies, pizza, among other things. Overtime, the excess cortisol is also known to slow down their metabolism, makes them prone to carry an extra layer of fat in their abdomen, which puts them at a higher risk of future heart disease and diabetes.

The stress response also activates impulsivity and an inhibition of the prefrontal cortex which is the evolved part of the brain that allows teens to resist temptation. That part of the brain allows them to process information and carry out cognitive processes such as executive decision making.[v] Eating mindlessly and impulsively impacts on their food choices, being aware of how much they’re eating and being aware of physiological cues that informs them when they’re physically satiated.

Stress can also be the impetus for emotional eating. In a survey by the American Psychological Association, regarding stress in America, 40% of respondents reported dealing with stress by overeating. Younger people prefer snack-related foods when compared to older people.[vi] The release of cortisol due to stress, may cause them to crave more fat and sugar which is why they would be highly enticed by sugary and high fat comfort foods. Over time, a strong association gets created encouraging teens to become dependent on comfort foods in order to help cope with their emotions.

Chronic stress can additionally impact teen’s mood. The cortisol that gets released during the stress response, can lead to a reduction of “feel-good” neurotransmitters such as serotonin. It can eventually lead to unstable moods (impacting motivation, level of anger and anxiety, etc.), somatic complaints (abdominal pain, headaches, muscular pain, etc.) and disrupted sleeping and eating patterns.

What Can We Do To Help?

It’s important for teens to build adaptive coping skills to stress and manage their stress on a continual basis. Mechanisms to accomplish this is through exercise, engaging in mindfulness, learning social, problem-solving, and conflict resolution skills, implementing healthful eating and sleep habits, and receiving emotional support.

Besides improving mood, decreasing anxiety,[vii] and increasing self-confidence, exercise stimulates serotonin and endorphins that leave teens feeling more positive and energetic. It also reduces perception of pain (what’s personally challenging and emotionally uncomfortable), which directly impacts mood.[viii] It positively affects body image, the belief in one’s ability to successfully complete tasks and accomplish goals (self-efficacy), and coping skills.[ix]

Per the CDC and the US Department of Health and Human Services, children ages six to seventeen should do an hour or more of physical activity each day.[x] Aerobic activity should make up most of this time each day. Even though the CDC and US Department of Health have given their recommendations, kids and teens are still not getting nearly the amount of physical activity that they need. In 2013, only 17.7 percent of female high school students and 36.6 percent of male students were participating in at least sixty minutes of physical activity a day. Only 24 percent of females and 34.9 percent of males were attending physical education classes daily.[xi]

On the APA survey, teens who exercised once a week or more reported lower average stress levels in the past month than their peers who exercised less than once a week or not at all (4.4 vs. 5.1 on a 10-point scale). As indicated, exercise is an effective way to manage stress, manage weight, as well as affords teens with many other health and mental health benefits, but their schedules and many other factors currently prohibit their engagement in it.

Getting teens in touch with mindfulness, meditation and stress management resources is also extremely helpful. In 2012, there were 477 scientific journal articles verifying the effectiveness of mindfulness and meditative practices. It has been proven as an effective method with kids and teens and assists with focusing and attention, executive functioning, sleep, emotional regulation, stress reduction, aggressive behavior, anxiety, and social skills/behaviors.[xii] I highly recommend Transcendental Meditation (TM), the apps “Insight Timer,” “Take a Chill,” and “Stop, Breathe, and Think,” 10 teen meditations at: http://www.doyouyoga.com/10-cool-meditations-for-pre-teens-and-teens-67578/ and the book “The Mindful Teen” by Dr. Dzung X. Vo.

To manage sleep, parents should consider their child’s early school start time, their exorbitant amount of homework, whether they are being overscheduled, and their screen time. Adding to teen’s shift in circadian rhythm due to developmental changes, are myriad electronic distractions that cut further into sleep time, like smartphones, iPods, PC’s and televisions. A stream of text messages, tweets, snapchats, Instagram messages, etc. keep many teens awake. Another factor is the light from a screen which can suppress melatonin, the hormone in the brain that signals sleep. Consideration and effort made toward managing these factors is essential.

Schools can do a better job at implementing policy and create programmatic changes addressing school start times, homework, health, exercise and nutrition curriculum, and life skills including social, problem-solving, and conflict resolution skills.

Teens can also work with a therapist or coach to help them identify adaptive coping strategies to manage their stress (other than drugs or alcohol and/or overeating which can be maladaptive), learn social, problem-solving, and conflict resolution skills, and work on specified and manageable goals where they can readily note progress. My book “Free Your Child from Overeating: A Handbook for Helping Kids and Teens. 53 Mind-Body Strategies for Lifelong Health” (https://www.amazon.com/Free-Your-Child-Overeating-Handbook/dp/1615192700) can assist with overeating and lifelong health management.

Teens will vary in how expressive and emotionally available they are. There also needs to be careful attention paid toward reaching teens where they’re at and taking strong consideration of their gender, age, racial, religious, and socio-economic composition.

Periodically checking in with teens and asking directly how they want to be supported and following through by helping them connect to those viable resources can be helpful. Parents can ask teens how they’re coping emotionally. They can express, “I know you’re managing a lot, I’m thinking of you and am wondering how you’re doing?” or “I know you have a lot on your plate, how are you feeling about it all?”

Our teens are stressed. It’s negatively impacting them in many fundamental ways. We can’t just idly stand by as witnesses but must be proactive at creating impactful sustaining changes. We are powerful conduits in making the lives of our teens more manageable and significantly less stressful.

References:

[i] American Psychological Association. (2014). Stress in America: Are Teens Adopting Adults’ Stress Habits? Stress in America Survey. 1-38.

[ii] Center for Adolescent Health, John Hopkins Bloomberg School of Public health, “Confronting Teen Stress, Meeting the Challenge in Baltimore City.” http://www.jhsph.edu/research/centers-and-institutes/center-for-adolescent-health/_includes/_pre-redesign/Teen_Stress_Guide.pdf.

[iii] National Sleep Foundation. (2016). Recommendations for Appropriate Sleep Durations. Sleep Health: The Journal of The National Sleep Foundation. 2(4).

[iv] Patel, S.R., and Hu, F.B. (2008). “Short Sleep Duration and Weight Gain: A Systematic Review.” Obesity, 16, 643–53.

Reilly, J.J., Armstrong, J., Dorosty, A.R., et al. (2005). “Early Life Risk Factors for Obesity in Childhood: Cohort Study.” BMJ, 330, 1357.

Gillman, M.W., Rifas-Shiman, S.L., Kleinman, K., et al. (2008). “Developmental Origins of Childhood Overweight: Potential Public Health Impact.” Obesity, 16, 1651–56.

Taveras, E.M., Rifas-Shiman, S.L., Oken, E., et al. (2008). “Short Sleep Duration in Infancy and Risk of Childhood Overweight.” Archives of Pediatrics and Adolescent Medicine, 162, 305–11.

Bell, J.F., and Zimmerman, F.J. (2010). “Shortened Nighttime Sleep Duration in Early Life and Subsequent Childhood Obesity.” Archives of Pediatrics and Adolescent Medicine, 164, 840–45.

Landhuis, C.E., Poulton, R., Welch, D., and Hancox, R.J. (2008). “Childhood Sleep Time and Long-term Risk for Obesity: A 32-Year Prospective Birth Cohort Study.” Pediatrics, 122, 955–60.

[v] Siddiqui, S. V., Chatterjee, U., Kumar, D., Siddiqui, A., and Goyal, N. (2008). “Neuropsychology of prefrontal cortex.” Indian J Psychiatry, Jul-Sep, 50(3): 202-208.

[vi] Wansink, B., Cheney, M.M., and Chan, N. (2003). “Exploring Comfort Food Preferences Across Age and Gender.” Physiology and Behavior, 79(4–5), 739–47.

Wansink, B., and Sangerman, C. (2000). “Engineering Comfort Foods.” American Demographics, July 2000, 66–67.

[vii] Martikainen, S., Pesonen, A.K., Lahti, J., et al. (2013). “Higher Levels of Physical Activity Are Associated with Lower Hypothalamic-Pituitary-Adrenocortical Axis Reactivity to Psychosocial Stress in Children.” Journal of Clinical Endocrinology and Metabolism, 98(4), E619–27.

[viii] WebMD (2014). “Exercise and Depression.” webmd.com.

[ix] Baker, C.W., and Brownell, K.D. (2000). “Physical Activity and Maintenance of Weight Loss: Physiological and Psychological Mechanisms.” In Bouchard, C., ed., Physical Activity and Obesity, Champaign, IL: Human Kinetics, pp. 311–28.

[x] Centers for Disease Control and Prevention. “How Much Physical Activity Do Children Need?” cdc.gov.

US Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans. Washington, DC: US Department of Health and Human Services. health.gov/PAguidelines/guidelines/default.aspx.

[xi] Centers for Disease Control and Prevention (2014). “Youth Risk Behavior Surveillance – United States, 2013.” Morbidity and Mortatlity Weekly Report (MMWR), 63(4).

[xii] Pickert, K. (2014). “The Art of Being Mindful: Finding Peace in a Stressed-Out, Digitally Dependent Culture May Just Be a Matter of Thinking Differently.” Time, February 3, 2014.

Black, D.S., Milam, J., and Sussman, S. (2009). “Sitting-Meditation Interventions Among Youth: A Review of Treatment Efficacy.” Pediatrics, 124(3): e532–41.

Broderick, P.C., and Metz, S. (2009). “Learning to BREATHE: A Pilot Trial of a Mindfulness Curriculum for Adolescents.” Advances in Social Mental Health Promotion, 2(1), 35–46.

Burke, C.A. (2009). “Mindfulness-Based Approaches with Children and Adolescents: A Preliminary Review of Current Research in an Emergent Field.” Journal of Child and Family Studies, published online June 27, 2009.

Greenberg, M.T., and Harris, A.R. (2011). “Nurturing Mindfulness in Children and Youth: Current State of Research.” Child Development Perspectives, published online October 31, 2011.

Harrison, L.J., Manocha, R., and Rubia, K. (2004). “Sahaja Yoga Meditation as a Family Treatment Programme with Attention Deficit-Hyperactivity Disorder.” Clinical Child Psychology and Psychiatry, 9(4), 479–97.

Meiklejohn, J., Phillips, C., Freedman, M.L., et al. (2012). “Integrating Mindfulness Training into K–12 Education: Fostering the Resilience of Teachers and Students.” Mindfulness, March 14, 2012.

Rosaen, C., and Benn, R. (2006). “The Experience of Transcendental Meditation in Middle School Students: A Qualitative Report.” Explore, 2(5), 422–25.

Sibinga, E.M., Kerrigan, D., Stewart, M., et al. (2011). “Mindfulness-Based Stress Reduction for Urban Youth.” Journal of Alternative and Complementary Medicine, 17(3), 213–18.

Singh, N., Lancioni, G.E., Singh Joy, S.E., et al. (2007). “Adolescents with Conduct Disorder Can Be Mindful of Their Aggressive Behavior.” Journal of Emotional and Behavioral Disorders, 15(1), 56–63.

Wall, R.B. (2005). “Tai Chi and Mindfulness-Based Stress Reduction in a Boston Public Middle School.” Journal of Pediatric Health Care, 19(4), 230–37.

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