Coping with Stress in Adolescents

Indian Academy of Pediatrics (IAP)

STANDARD TREATMENT

GUIDELINES 2022

Coping with

Stress in

Adolescents

Lead Author

Swati Y Bhave

Co-Authors

Jayshree, Sandeep Kavade

Under the Auspices of the IAP Action Plan 2022

Remesh Kumar R

IAP President 2022

Vineet Saxena

Upendra Kinjawadekar

Piyush Gupta

IAP President-Elect 2022

IAP President 2021

IAP HSG 2022–2023

IAP Standard Treatment Guidelines Committee

Chairperson

Remesh Kumar R

IAP Coordinator

Vineet Saxena

National Coordinators

SS Kamath, Vinod H Ratageri

Member Secretaries

Krishna Mohan R, Vishnu Mohan PT

Members

Santanu Deb, Surender Singh Bisht, Prashant Kariya, Narmada Ashok, Pawan Kalyan

Coping with Stress in Adolescents

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Stress is a response to external or internal challenges, pressures, or events. Stress that motivates is called eustress and stress that paralyses and affects various domains of functioning is called distress. Adolescence being a period of transition from child to adulthood there are many challenges that will cause stress in normal adolescents. In specially challenged adolescents their problems will be exacerbated with challenges of adolescent period. These are outlined in Figure 1.

Fig. 1: Causes of stress.

Introduction

Assessment of Stress

Coping with Stress in Adolescents

This can be done by taking a detailed history of various factors:

; Effect on sleep (quantity/quality and duration)

; Effect on food habits (overeating/anorexia, binge eating, and emotional eating excess junk food)

; Effects on personality (withdrawn/noncommunicative/irritable/frequent temper out bursts)

; Effects on relationships (conflict at home—family or school—teachers/peers)

; Effects on academic performance (lack of interest in studying and or deterioration in marks)

; History of addictions/or unproductive ways to deal with stress (Table 1)

TABLE 1: Addictions/unproductive ways to deal with stress.

;; Alcohol

;; Tobacco

;; Internet use ;; Gaming

;; Drugs

;; Trying not to think about it ;; Avoidance

;; Isolating

;; Arguments

;; Blaming/criticizing oneself

; HEEADSSS (Goldenring and Rosen, 2004)

• Home, education, eating, activities, drugs, sexuality, suicide/depression, and safety

; SHADESS (Ginsburg, 2007b)

• This is a modification of the HEEADSSS interview

• SHADESS stands for school, home, activities, drugs/substance use, emotions/ depression, sexuality, and safety

; BATHE (Lieberman and Stuart, 1999)

• This is a brief supportive interviewing technique, adapted from psychotherapy

• BATHE stands for background, affect, troubling, handling, and empathy

Screening and Counseling Methods

for Primary Care Clinicians

Coping with Stress in Adolescents

Adults—parents and teachers can play a great role by teaching children to become resilient. This will help them deal with all adversities in life as adolescents and young adult (AYA) and adulthood and promote positive mental health.

Teaching Resilience ; This can be done by developing coping skills with programs like the World Health Organization (WHO) life skills and increasing their emotional quotient so that they take stress as a challenge to overcome and not go into anxiety and depression.

; Developing positive mindset and positive self-talk.

Lifestyle—Healthy Body

;Daily minimum 45 minutes of good physical activity/exercise. Exercise induces endorphins which promotes feeling of happiness and promotes neuronal activity.

; Focus on adequate sleep with good sleep routines. Adequate sleep generates good neurotransmitters that help deal with stress.

; Dietary habits with good breakfast, ensuring balanced diet and minimum of caffeine and junk food.

Leads to Healthy Mind

Focus on Healthy

Teaching Good Relaxation Techniques

; Practicing stress inducing scenarios to develop coping mechanism, e.g., mock exams

;Setting specific developing skills to handle various stress generating situations

; Developing ability to resist peer pressure and assertiveness to say No to situations, and actions adolescent is not comfortable with

; Mindfulness, meditation, chanting, prayers, deep breathing, Tai Chi, yoga, pranayama, progressive muscular relaxation (PMR), visual imagery, biofeed-

back, etc.

; Developing healthy stress busters such as sports, exercise, music, and art

Parents/Peers

Case Scenarios with

Practicing with

Adolescent Education/Parental Guidance (Table 2)

Adolescent Education/Parental Guidance

Coping with Stress in Adolescents

TABLE 2: What helps when you are in stress?

Situation

What happens

What it does

Results

Behavior

Severe stress

“Emotional storm”

Experience intensely difficult thoughts and feelings. They are so strong they are like a mighty storm, and they can easily overpower you

Difficult thoughts and feelings hook us, and we are pulled away from our values

Your thoughts and actions not under your control

What are the solutions

Actions

What happens

What is does

Results

Behavior

Ground yourself

Helps calms you down

Brings yourself back to stable mind

Rational thinking enabled

Emotional hijacks avoided

Practice empathy

You understand and notice pain in yourself and others

You respond with kindness

Better interpersonal relationship handling reduces stress

Calm behavior— better results

Unhooking from stress and making make room for positive thoughts

;; You notice the difficult thought or feeling with curiosity

;; You can name the difficult thought or feeling

;; Refocus on what you are doing

;; Engage fully in the activity at hand

;; Pay full attention to whoever is with you and

whatever you are

doing

;; You can rationally

analyze

You can allow the painful feeling or thought to come and go like the weather

Acting on your values

Remember the values inculcated in you. If you have responsibility for caring for others, what kind of person do you want to be

You bring out your positivity loving, wise, attentive, committed, persistent, protective, courageous

These are values which we must aspire to inculcate in yourself

More positive behavior

Source: World Health Organization (2020). Doing What Matters in Times of Stress: An Illustrated Guide. [online] Available from https://www.who.int/publications/i/item/9789240003927. [Last accessed November, 2022].

; American Academy of Child and Adolescent Psychiatry (2019). Stress Management and Teens. [online] Available from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/ FFF-Guide/Helping-Teenagers-With-Stress-066.aspx. [Last accessed November, 2022].

; Condon EM. Chronic Stress in Children and Adolescents: A Review of Biomarkers for Use in Pediatric Research. Biol Res Nurs. 2018;20:473-96.

; Vo Dzung X, Park MJ. Stress and Stress Management among Youth and Young Men. Washington, DC: American Academy of Child and Adolescent Psychiatry; 2008.

; World Health Organization (2020). Doing What Matters in Times of Stress: An Illustrated Guide. [online] Available from https://www.who.int/publications/i/item/9789240003927. [Last accessed November, 2022].