Written by: Sam Mishra, Executive Contributor
Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.
I have seen an increase lately in the number of teens coming through my door who are suffering with high levels of anxiety, panic attacks, self-harm and suicidal thoughts. Having suffered with depression in my teens, having had a nervous breakdown at 19 years old when I was exhibiting harmful behaviours, and having had periods in my life when there were some suicidal tendencies, I have tried to find ways to help these teens.
Children between the ages of 10 and 19 make up around 11% of the population, and 14% of these teenagers are frequently undiagnosed for their mental health problems. Anxiety can be treated, so by becoming aware of a teen who is showing signs, we can offer them support as soon as possible to avoid institutionalisation and over-medicalization, minimise disruption to their teenage years, and reduce the likelihood of long-term mental health issues.
Some struggle with anxiety for a long time, but increased expectations placed on them in their teens can suddenly make it worse, possibly showing up as social anxiety or panic attacks, but it may be difficult to notice because teens are good at hiding their feelings. They tend to worry about themselves, what their peers think of them, their bodies, when they go through puberty, how good they are at sports, etc. Many teens will either become depressed or start smoking or drinking in an attempt to reduce their anxiety, which can lead to them becoming dependent on such substances, getting left behind educationally, or becoming socially isolated, stigmatised, or discriminated against.
Certainly, I have seen an increase in the number of teens accessing my services for anxiety since COVID, most likely due to them being isolated from their friends, not being able to participate in their usual activities, having their education disrupted, and generally experiencing additional pressure. We constantly hear of cases in the news where teens are being bullied via social media or gaining access online to inappropriate content, for example, violence, suicide, and self-harm, so possibly spending more time on social media through the pandemic has also contributed to this rise in figures. We also know that cases of domestic abuse increased during COVID, and research has shown that exposure to violence, abuse, poverty, and other forms of adversity has also increased vulnerability and a decline in mental health in teens. The more risk factors that are present, the greater the impact on mental health.
The transition from childhood to adulthood in the late teens often means that teens with mental health issues are falling through the cracks in the system, as they are too old to access CAMHS (Child and Adolescent Mental Health Services) but considered too young to access adult services.
Cognitive behavioural therapy (CBT) has traditionally been thought of as the best treatment for teen anxiety, but I am seeing improvements with the use of regular massage and breathwork for teens experiencing anything from mild anxiety to self-harm and suicidal tendencies, although I must point out that those with suicidal tendencies must also have support from other professionals.
Research statistics
Approximately 30% of 13 to 18 year olds have had some form of anxiety disorder.
It was projected in 2017 that the ratio of 5 to 16 year olds suffering from mental health issues was one in nine. In 2021, the ratio increased to one in six.
Among the most prevalent causes of teenage illness are behavioural disorders, anxiety, and depression (22% of girls and 10% of men).
A&E attendance by teens diagnosed with psychiatric issues more than tripled between 2010 and 2018–19.
83% of teens with mental health problems felt that the COVID pandemic was a contributing factor.
24% of adolescents admit to self-harm, 7% of which is with suicidal intent. The majority of these are aged 17 to 19.
Suicide is considered the main cause of death behind road accidents, violence, and drowning aged 15 to 29
Teens from disadvantaged families in the lowest 40% income bracket are 50% more likely to attempt suicide.
LGB+ teenagers are 50% more likely to experience serious mental distress and to self-harm, and three times more likely to do this with suicidal intent.
The risk of self-harm increases dramatically for boys, from 9% at age 14 to 20% at age 17, compared to girls (23% at 14 and 28% at 17).
Why are teenagers so anxious?
Research has shown that for teens, gender norms and discovering their identity, exposure to adversity and social media, and the resulting pressure to conform with peers are the main factors contributing to anxiety. Teenage perceptions and aspirations can be very different from their reality, and factors in their relationships and home life, such as socioeconomic issues, discrimination, sexual abuse, strict parents, exclusion, and bullying, can all potentially impact on mental health. Those who are particularly vulnerable (for example, those with special needs and disabilities, teenage pregnancy, chronic medical conditions, ethnic minorities, orphans, forced marriage, and issues with sexual orientation and gender) may not be able to access support and so fall further through the cracks.
Part of being a teenager is acknowledgement of how others perceive them, and they often worry about embarrassing themselves or people thinking they are stupid, and this can cause social anxiety, which can be particularly debilitating during adolescence. As teenagers, we often think that other people’s perception of us is influenced heavily by either our academic performance or our physical appearance. Even if parents don’t place pressure on their children to get top grades, teenagers naturally feel like they have to be perfect, and that extends to their appearance, particularly with so many ‘perfect’ images on social media of celebrities. This can lead to body dysmorphia and eating disorders, where their often perceived imperfections will impact on their health and ability to function. Even puberty itself can cause anxiety and self-esteem issues if it happens to occur at a different time from peers.
Signs and symptoms of teenage anxiety
Hormonal changes and self-consciousness, combined with pubertal and educational adjustments, can mean that anxiety in teens is more affective than at any other age, and fear of how their peers will perceive them can prevent highly anxious teens from admitting their thoughts and feelings or seeking support. This is why it is so important that parents are aware of possible signs, and these will often go beyond the usual physical indications of anxiety, such as sleeping problems, bed wetting, stomach and headaches, and increased breathing and heart rate.
Since the majority of a teen’s life revolves around school, this is a good place to start, whether it’s academic ability, peers, sports, or other activities. If there is a reluctance or refusal to go to school, problems concentrating on school work, or a sudden drop in academic performance, then the focus should be on why, and the answer to this could be for a multitude of reasons, but examples may be fear of having a panic attack in a lesson, fear of doing something wrong and looking stupid, or fear of being bullied for how they look.
However, school life may not only be affected by anxiety, as depression can often result from high levels of anxiety, worsening symptoms, and bringing about feelings of isolation, social withdrawal, lack of interest in activities, and avoidance of new or challenging situations. Even the usual daily tasks that are routine can induce recurring fear, resulting in the constant need to seek reassurance as well as irritability, hypersensitivity, and an inability to relax despite constantly feeling tired.
Anxiety often leads to a lack of trust in your own judgement to make decisions, and this resulting self-doubt, lack of self-confidence, and worry can lead to depression. Of course, it may just be a coincidence that anxiety and depression are presenting themselves around the same time, but the problem is that anxiety may be masked by the depression that has occurred as a result of it, particularly when low mood has persisted for weeks, so if treatment only deals with the depression, the chances of success are poor. When teens feel that nothing can help with their depression, they may turn to substance use and self-harm, which can then lead to suicidal thoughts.
Research has shown that many teenagers believe that smoking cannabis is healthier than drinking alcohol, and while use of substances such as marijuana or alcohol may cause short-term numbing, giving the impression that the anxiety has been relieved, but the problem is still there, hence teens becoming dependent.
Self-harm
Self-harm is a coping mechanism used to deal with anxiety and depression where the person intentionally inflicts injury upon themselves and, rather like substance abuse, only offers short-term relief and can become habitual. While cutting is the most common form of self-harm, injury may be caused through burning, head banging, scratching, stabbing, hair pulling, biting, self-cyberbullying, poisoning, and overdosing. The most common tools used include razors, lighters, cigarettes, and finger nails.
While all teens suffering from depression and anxiety are at risk of self-harm, it most commonly occurs in girls with low self-esteem, poor body image, and possibly eating disorders, LGBTQI+ teens, and those who have suffered from bereavement through suicide, neglect, or trauma.
Why do teens self-harm?
There are various reasons why teens will self-harm, but the greatest misconception is that teens will self-harm in order to get attention; in fact, most will self-harm privately and often feel ashamed of it afterwards, trying to hide evidence of the injuries. The main causes of self-harm are the expression of severe emotional suffering and the need to be understood, heard, and supported. Some teens don’t even understand why they self-harm, but they know they are confused or overwhelmed with feelings of sadness, and sometimes physical pain is easier than emotional pain to control or alleviate.
Self-harming teens often have low self-esteem and may even feel that they are somehow to blame for how they feel, particularly if they have been conditioned to feel shame and guilt through neglect or abuse. For someone who is experiencing such a high level of emotional distress, to punish themselves with physical pain may be the only way to cope with those feelings of guilt and shame; it’s something they can control when everything else feels so out of control. If there has been trauma and abuse, it is natural to dissociate and become numb as a protective mechanism, but by experiencing pain, they can feel present in that moment. In that moment, the body will release dopamine, a feel-good endorphin, giving a feeling of a high, but the effect is short-term and will also cause the release of adrenaline, which is already circulating at high levels in those with anxiety disorders. For every high, there will always be the comedown after, which often means sinking lower than before, and this can cause further feelings of shame and guilt.
Of course, there are times when self-harm precedes suicide, and although suicidal ideas don't always translate into acts of suicide, it's crucial to determine whether a teen intends to take their own life. Certainly if a child has self-harmed before, the chance of them becoming suicidal is much higher, as they will become desensitised to the physical pain, meaning that the prospect of suicide becomes a little easier, or they may cut a little deeper to still get that ‘high’.
When dealing with a self-harming teen, it is vital that they are met with a non-judgemental attitude to avoid more secretive behaviour, because even if their intention isn’t suicide, there is always the potential for self-harming to go wrong.
Suicide
Suicide, as some may believe, is not about seeking attention, and while there are risk factors, it is impossible to predict which teens will become suicidal. These risk factors include anxiety, bereavement through suicide, depression, trauma, relationship breakups, parents divorcing, bullying, and substance abuse. Previous suicidal thoughts or attempts will also increase the risk. It is also recognised that if a teen feels that their family isn’t supportive, particularly in challenging issues such as confusion over their sexual identity, this may also steer them towards more negative coping mechanisms.
Having non-judgemental, supportive family and friends and access to mental health services play a major role in avoiding suicide. By teaching children problem-solving skills, showing them that they are loved and supported, and by accessing prompt support for mental health issues and substance misuse, the risk of suicide can be greatly reduced. Research has shown that whether it’s financial restrictions, language barriers, or issues with transport, if there is difficulty accessing support services, teens may well feel like they have no other way of dealing with their problems. In some religions and cultures, suicide can even be viewed as an option for dealing with personal challenges.
In recent years, the use of social media by teens at an earlier stage has been correlated with higher rates of depression and suicidality. Research has shown that teens who self-harm are more active on social media than those who don't, and this may be because it is used as a means to seek support from others or because it is promoting self-harm behaviour, and teens often copy the behaviour of others. Increased time spent on social media has not only been linked with increased suicide but also with increased mental health issues in general.
According to studies conducted by the World Health Organisation in 2021, the likelihood of attempted suicides or self-harm is even higher than every suicide. The biggest risk factor for suicide is having attempted suicide before, which increases the likelihood of suicide by 50 times following self-harm, which sees around 30,000 teenagers in the UK requiring hospitalisation yearly.
How to help a teenager with anxiety
There are various ways you can help a teenager who is suffering from anxiety, whether it’s through your own actions or through coping strategies. The most important thing is talking openly with them about their feelings, which they may not be keen to do, but by asking open questions such as “What did you enjoy about your day at school? ” can be enough to get a conversation going. But physical health is just as important as mental health, and without good sleeping patterns, a healthy diet, and regular exercise, any mental health struggles are likely to worsen as their capability to cope with challenges will be reduced through low energy levels. Encouraging children to participate in positive physical health choices from early on will mean that these strategies become habits and can consequently help to keep high levels of anxiety at bay; exercise, for example, can release endorphins, which improve mood, and if done as part of a team, can even help build their social support system.
However, if negative situations do arise, such as poor academic results or bunking off school, it is important to stay calm and avoid punishing them or becoming angry, as this will cause them to withdraw further. By allowing them to have some space and then talking compassionately, it will be easier to discover how they really feel.
But what can you do when your teenager is approaching the panic attack stage? There are some strategies that can work immediately to help the nervous system regulate:
Deep breathing (boxed breath) - inhaling through the nose for four seconds, holding the breath for four seconds, and then exhaling through the mouth for four seconds, imagining any tension flowing out with the breath, followed by another holding of the breath for four seconds
Count backwards – this is a way to focus their mind on something other than the cause of the anxiety
The 5, 4, 3, 2, 1 method – this strategy also encourages them to focus their mind on something else. Ask them to state 5 things they can see, 4 things they can feel, 3 things they can hear, 2 things they can smell, and 1 thing they can taste. (This method is used in some of the downloadable meditation sessions that I am due to release soon.)
Challenge their anxious thoughts – whatever their thought or feeling is, would it be considered an opinion or a fact? If it is an opinion, then they may just need reassurance that it will pass.
Focusing on a safe or relaxing time can also divert their mind away from the cause of the anxiety.
Talking about self-harm with teenagers
If you’re worried that a teenager may be self-harming, there are some indicators that you can look out for before talking to them. Aside from the emotional changes such as mood swings, depression, feeling worthless, and irritability, there may be some physical signs such as bruising, scars, scratches and cuts, fatigue, and maybe even hair loss if they are pulling it out. There are behavioural signs, for example, avoiding activities they enjoy, such as swimming, where they have to undress, or generally not taking pride in their appearance, covering up with long sleeves, etc. These changes could potentially be due to low body confidence, so it’s important not to take those signs alone as evidence of self-harm. Other behavioural changes may include not wanting to go to school, not sleeping, changes in appetite, spending more time on social media, or hiding certain objects that would be used for self-harm.
Understanding why a teenager self-harms can be really difficult for someone who has never been in that position, but identifying the root cause behind it will enable you to support them in finding healthy coping strategies. Opening up about such a vulnerability requires a lot of trust and courage, and just because they tell one person, it doesn’t mean that they are happy for everyone else to know, as they will probably fear being judged, but the fact that they tell just one person means that they are open to getting help. Initially, they may even pretend to be asking about a friend to gauge what the reaction will be.
The important thing to realise is that it is about the teenager, not about you and how you may feel about discovering the self-harm, and the feelings of the teenager take priority over the actual self-harm itself. Maybe you can initially take an inquisitive approach, acknowledging that they seem sad or acknowledging a physical injury and making it clear that you’re happy to talk and listen. If they do actually disclose the self-harm, a good first step would be to reassure them that whatever they are feeling is just a feeling, and while it hurts, it will pass.
Once they have opened up, you can help them find healthier ways to deal with their anxiety and the urge to self-harm, such as distraction techniques, for example, breathwork, or activities that will help them release difficult emotions and find a sense of self-worth, for example, boxing classes. It is also important to maintain connections with people, whether it’s a couple of designated emergency contacts or a mental health professional. Maybe you could also give them a journal in which they can express their feelings, and once they have written those feelings down, it may feel a little easier to actually talk about them, and a regular time could be arranged to have such talks.
If the teenager becomes sad, more withdrawn, more irritable, has more difficulty sleeping, is anxious, tired, or lacks any enjoyment in the usual activities, this is a cause for concern and could indicate a suicide risk when they have already been self-harming. Sudden erratic or reckless behaviour is a warning sign, and comments like “I wish I was dead” or “You’d all be better off if I wasn’t around.” should, without question, be taken very seriously.
Treatment for anxiety
Cognitive behavioural therapy, sometimes combined with medication or exposure therapy, is currently the standard treatment for teen anxiety, offering a different way of thinking so that the anxiety reduces over time. If we can recognise and then question negative feelings such as self-criticism or guilt, then we can adapt the way we think and act in response to them, learning better strategies to cope when life becomes challenging.
Acceptance and commitment therapy may also be helpful by showing teens that their feelings are passing emotions rather than the truth, and by accepting this, they become less critical of themselves. This means that they can adapt their coping strategies to include healthier options.
Depending on why the teen self-harms, family therapy may also be useful in examining the family dynamics and any generational trauma and improving understanding by the teen family.
With an increasing number of teens coming to me for trauma massage to help with high anxiety, self-harm, and suicidal thoughts, I started to use breathwork as a way to help them manage their anxiety.
Breathwork for teens
Breathwork is a really effective and almost immediate way of regulating the nervous system in children and teenagers, as it can be done anywhere and is something that they can control, bringing more self-awareness. Our emotions can impact our breathing and vice versa, and our breathing is closely related to the nervous system, which regulates both our internal and external environment. After a stressful event, the parasympathetic nervous system is what brings us back to a calm baseline; however, if the nervous system is out of balance, we remain in the sympathetic nervous system-controlled stress response. When the sympathetic nervous system is activated, this is a protective mechanism, enabling us to survive and maintain essential bodily functions, meaning that less important functions such as our sense of reasoning or our thought processes are pushed down to the bottom of the pile.
This is why I am of the opinion that talking therapies alone often do not work for high-anxiety states. Don’t get me wrong, they absolutely have their place, but if you don’t address what is going on physiologically to help the teen feel safe, then it is unlikely that they will have the capacity to process their emotions, and the problem will continue to reoccur.
I have already mentioned boxed breath in this article, but other options include resonant breathing, ideal for use in the midst of an anxiety attack because the aim is to take just 5 or 6 deep breaths per minute, breathing in through the nose and out through the mouth for a count of 5 each.
Another service that I am currently setting up is downloadable breathwork and meditation sessions. Research has also shown meditation to be useful in reducing anxiety, but the great thing is that it can be used in conjunction with breathwork. A helpful visualisation breathwork exercise would be to imagine inhaling a warm flow of light for the count of 3, and then exhaling thick black smoke. The idea is that you exhale all your worries with the smoke until you’re breathing out clear air.
Visualisation taps into our emotional centre, helping to encourage an emotional state in certain contexts using mental imagery, and is shown by various research studies to be one of the most effective methods for managing teen anxiety.
I am also very particular about the music I use with my breathwork sessions, and given that rhythm dictates the heartbeat, our breathing, and our sleep cycles, it is easy to understand why research has demonstrated that the nervous system, and therefore, our psychobiology, can be affected by music. Studies have shown that listening to certain sound frequencies and rhythms can cause a shift in stress hormone production and brain activity, thus relaxing and bringing about a drop in the more challenging negative emotions.
One study also showed positive results in reducing the stress response through forest bathing, so why not practice breathwork and listen to music in the middle of a natural area?
Summary
We must remain vigilant for teens with mental health problems, take a non-judgemental approach when listening to their feelings, and help them access support services as soon as possible if we are to encourage healthy coping strategies.
For those in the Kent area (South-east England) you can find out more about my services at www.themedicalmassagelady.co.uk or contact me at sam@medicalmassagelady.com.
For those in other areas, my breathwork and meditation sessions will soon be available for download.
Support services
Samaritans
Call 116 123 (24 hours)
Text: SHOUT to 85258
Childline (up to 19 years old)
Call 0800 1111
Call 0800 0684141
Sam Mishra, Executive Contributor Brainz Magazine
Sam Mishra (The Medical Massage Lady), is a multi-award winning massage therapist, aromatherapist, accredited course tutor, oncology practitioner, trauma practitioner and breathwork facilitator. Her medical background as a nurse and a midwife, combined with her own experiences of childhood disability and abuse, have resulted in a diverse and specialised service. She is motivated by the adversity she has faced, using it as a driving force in her charity work and in offering the vulnerable a means of support. Her aim is to educate about medical conditions using easily understood language, to avoid inappropriate treatments being carried out and for health promotion purposes in the general public.
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