How to manage stress in Dominican teenagers?

• Psychiatrist Gene Beresin of Mass General Brigham explains the causes of stress in teenagers and how families can help them as they go back to school.

SANTO DOMINGO:– Ask any of the millions of preteens and teenagers going back to school this month and they will confirm it: school stress in 2024 extends far beyond class timetables, homework and a lack of time with friends.

“Preteens and teenagers are going through a perfect storm,” explains Gene Beresin, a child and adolescent psychiatrist at Mass General Brigham. “They’re worried about viruses. They’re worried about new strains of COVID. They’re worried about polio. They’re worried about monkeypox. They worry that another viral outbreak will lead to another lockdown. They worry about climate change, the economy and whether their families can afford things. They worry about mass shootings. Many are worried about the plight of underserved populations,” he adds.

According to UNICEF, around 15% of adolescents aged 10 to 19 in Latin America and the Caribbean have a diagnosed mental disorder, representing nearly 16 million young people. This gives the region the highest rates in the world.

Why can adolescence be a stressful time for many teenagers?

Adolescence is an incredibly stressful stage of life. In adolescence, children’s brains are maturing. They are seeking (and developing) independence. Their relationships and social experiences start to stand out in the context of their lives. And all these changes lead them to think about and worry about different issues in more complex ways.

“A school-age child is more concerned with being liked and fitting in,” explains Dr. Beresin. “A teenager is grappling with questions like, ‘How do I fit in while still being independent and autonomous, and being myself?’ When you can see all the nuances, as teenagers can at their stage of development, you can get tangled up. They need time and valuable experiences with peers, teachers, parents, caregivers and others to work out their identity and the role they play with others.”

According to Dr. Beresin, teenagers’ fears and anxieties about the state of the world, their families and their lives are the main contributors to the mental health conditions students face today.

Going back to school is an especially stressful time for teenagers. As Dr. Beresin explains, “for most young people, the backdrop of their life is mainly school, family, friends and recreation. And their recreation is largely based at school, or at least that’s the setting where recreation happens. So most of their life is embedded in school.”

“School is very important because it’s not only where students learn but also where they build friendships,” says Dr. Beresin. “It’s where they develop sporting skills and do extracurricular activities. They learn how to navigate classroom settings. And it’s also the basis for how they develop a sense of belonging, identity and autonomy… and it’s where they face how they are treated. They also learn, sometimes the hard way, to resolve the conflicts that naturally occur in their lives.”

Common cognitive stressors for teenagers

Teenagers face a long list of stressors, including: pressure to do well at school, after-school and extracurricular activities, community service demands and public health and safety issues.

Social stressors: changes in platonic and romantic relationships, bullying, for some, pressure to engage in substance use and risky behaviour; pressure to change or control physical appearance, and the need to focus constantly on digital and social media.

Family and home stressors: family stress, such as conflict, illness, financial difficulties and/or divorce, changes in family relationships, jobs and career decisions, and a lack of free time.

“Students are going back to school in this era of uncertainty, division and polarisation,” says Dr. Beresin. “And they’re worried: ‘Am I going to fit in? Will other kids like me? Will I be able to keep up with the work, or have I fallen too far behind? Am I still as good as I used to be at sports and other activities?'”

And it’s not just academic stress; extracurricular activities and social standing also affect teenagers. Many of today’s students also face fears about their lives and their families’ wellbeing.

Dr. Beresin says: “I don’t have a single conversation with a young person without talking about concerns about the planet, concerns about the world they’re inheriting, viruses, climate change, economic recession, discrimination, shootings or assaults.”

Many parents wonder whether digital and social media are stressors for teenagers. According to Dr. Beresin, while these devices and apps certainly need better management, they are not solely to blame.

“We are hostages to digital media,” says Dr. Beresin. “And we haven’t learned to use it productively and in moderation. It’s complicated, and it complicates our lives. Does it cause more stress, anxiety, depression and loneliness? Sure. But it’s just one of many factors contributing to the back-to-school situation.”

How does stress affect teenagers?

Back-to-school stress can be overwhelming for teenagers. And they may not be able to recognise or express their needs.

Teenagers who are stressed may show some of the following signs: moodiness and irritability; increased anxiety and worry; sometimes oppositional or defiant behaviour, or shutting down and withdrawing; trouble sleeping; reduced interest in activities they used to enjoy; reduced energy or more tiredness than usual; difficulty concentrating and falling grades; lack of motivation; avoiding friends or favourite activities; reduced or increased appetite; headaches, stomach aches, jaw tension and/or teeth grinding.

What are some good coping techniques for teenagers?

There is no easy way to adjust to the demands and stressors that today’s preteens and teenagers face. But there are ways for them to manage their emotions so that stress does not become unbearable.

Dr. Beresin says preteens and teenagers can manage stress in several ways. “I think students can and should be activists. I want them to look, with guidance from teachers, at their curriculum and extracurricular activities.”

He explains that activism is not only an excellent way for teenagers to establish an identity and connect with a group but also a creative outlet, a positive form of rebellion and a channel for abstract thinking. Most importantly, it is a means of bringing about change in the system that is causing such serious mental health problems.

But activism alone will not help manage stress. “It doesn’t replace good sleep hygiene, exercise, diet and meditation, which all children should do; yoga and the use of cognitive behavioural therapy; and the same self-care process should be practised by parents.”

Additional coping skills include self-care, such as setting boundaries, choosing activities that energise or relax you, changing your surroundings, doing a calm activity, yoga and/or meditation.

How can parents help?

This is how parents can help their children manage stress: manage your own anxiety by taking care of yourself.

You are in the best position to help if your state of mind is calm. Ask them what is worrying them: “What bothers you most?”, “What are you worried about?” Open questions are always better, as they can provide key information on how to address young people’s problems.

Listen to and validate their feelings, talk often and encourage them to use the creative arts to express themselves. Talk to them about family stories and how we have got through difficult times before. Let them know: we can handle this. Watch media with them and use it to discuss important issues.

Support others in your community who may be struggling. Send them an upbeat note or a YouTube video, or cook them a meal. Giving to others always feels good, and it is better than receiving.

According to Dr. Beresin, “parents and caregivers could advocate for more free time, fewer demands, less teaching to the test, changes to the school system and policies, seeing what works, and more social-emotional learning.”

Several resources are available to help parents and students looking for support with back-to-school stress and mental health. These include:

Massachusetts General Hospital’s Clay Center for Young Healthy Minds : a free, practical online educational resource dedicated to promoting and supporting the mental, emotional and behavioural wellbeing of children, adolescents and young adults.

Newton-Wellesley Hospital’s Resilience Project: an innovative community initiative designed to promote the mental health and wellbeing of teenagers.

McLean Hospital website, which offers support to parents and caregivers of teenagers struggling with mental health problems.

CASEL: The Collaborative for Academic, Social and Emotional Learning.