Teens and stress: When it’s more than worry


Stress—and sometimes feeling anxious—is a natural and normal experience for everyone, including children and teenagers. But when those feelings last a long time or occur frequently, that’s cause for concern.

According to Krystal Lewis, Ph.D., a licensed clinical psychologist in the National Institute of Mental Health Intramural Research Program, it’s important to know the difference between stress and anxiety.

Stress is the body’s reaction to danger or excitement, including positive things such as an upcoming party or a vacation. Stress causes the body to release hormones that can raise blood pressure, heart rate, or blood sugar.

Anxiety is the body’s or mind’s response to stress, even when there are no current stressors. Dr. Lewis said this often comes from the fear of a future outcome that may not even happen. For example, you may be worried about getting into college or an important exam: “You already had the test, but you’re still feeling anxious…You’re worried about the next test now.”

She said it’s important to remind adolescents that it is normal to feel pressure to be perfect or perform well. However, failure is a part of life. If a teen is so concerned with not making mistakes that anxiety gets in the way of them enjoying life or causes prolonged physical symptoms, that could become a clinical problem.

Physical symptoms of stress and anxiety include headaches, trouble sleeping, digestive issues, or muscle pain. If left untreated, these symptoms can damage the body and lead to other mental health issues, including anxiety disorders.

A mental health professional can diagnose an anxiety disorder, which may require treatment such as therapy or medication.

We don’t know what causes anxiety disorders, but risk factors include a family history of the condition or other mental illness and a person’s brain biology and chemistry. Some physical health conditions, such as thyroid problems or arrhythmia, can also lead to anxiety disorders. Experiencing traumatic events is a risk factor as well.

For adolescents, stress and anxiety can be hard to talk about. Some signs that a teen is struggling may include noticeable changes in appetite and sleep, aggression, irritability, difficulty concentrating, avoiding social activities, and engaging in self-harm or having thoughts of suicide.

If you think a teen is experiencing a mental health crisis, the 988 Suicide & Crisis Lifeline is a national, 24/7 hotline that can connect you with a trained crisis counselor by phone or online chat. TTY users can contact the Lifeline via their preferred relay service or by dialing 711, then 988.

At-home stress coping strategies for teens

A teen’s environment can contribute to them developing an anxiety disorder, so in addition to exploring treatment options, it’s important to take simple steps to decrease their risk.

  • Sleep. Make sure they are getting enough! Eight to 10 hours of sleep per night are recommended for teens ages 13 to 18. Stick to a regular bedtime and make their sleep space as calm as possible.
  • Physical activity. This can be gentle, such as yoga or walking, or more intense, like running or playing team sports. Exercise causes the body to release endorphins, which are hormones that can relieve pain and reduce symptoms of anxiety. It also helps take their mind off whatever is causing them stress.
  • Balanced diet and hydration. Eating regular, healthy meals and drinking plenty of water can improve energy and focus throughout the day. They may want to limit caffeinated beverages such as soft drinks or coffee and other foods that can cause physical symptoms of stress or discomfort.
  • Meditation and breathing exercises. These don’t have to be complicated or take a lot of time. They can spend a few minutes being still and quiet, listening to their breathing, and letting their mind clear. They can also download a mobile app or listen to meditation playlists to guide them in a relaxation exercise.

Having a schedule or routine is also important for adolescents. Sometimes it’s less about creating a schedule and more about modifying the schedule you already have.

“Schedules are useful in that they help create a routine, and it gives them something to look forward to,” Dr. Lewis said. “When you’re able to create a schedule and you know what’s upcoming, that can help you to manage stress and anxiety by minimizing the unknown.”

Just make sure that schedule also includes time for fun and relaxation!


Resources and hotlines for teen mental health

  • TrevorSpace. Online chat community, forums, and resources for LGBTQ+ youth, moderated by The Trevor Project nonprofit staff. The organization’s website has a “quick exit” safety feature: Users can press their ESC key three times and it will exit the site as well as erase it from their browsing history.
  • Disaster Distress Helpline. Operated by the Substance Abuse and Mental Health Services Administration, this helpline provides disaster crisis counseling for experiences such as natural disasters, health emergencies, incidents of mass violence, and the anniversaries and trigger events of those experiences. Users can call toll free or text 800-985-5990. This service is confidential and multilingual.

NIH fact sheets on mental health for families

Alternative accessible version (pdf)

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