Anxiety in School

Anxiety is a normal emotion in reaction to danger or to stressful situations perceived as threatening to a person's survival, even though we may not be consciously aware of the threat. Anxiety disorder and panic attacks occur when that normal reaction is exaggerated. Although a stressful event can trigger an anxiety or panic attack, sometimes they seem to occur for no obviously apparent reason. However, it is important to remember that for every effect there is always a cause.

Psychiatry suggests that abnormalities in the balance of some brain chemicals (neurotransmitters) may play a role in anxiety and panic. This theory is supported by evidence that antidepressant and anti-anxiety medications are useful in the treatment of anxiety for some patients. However these "chemical imbalances" are themselves effects of more fundamental causes that are not usually investigated or treated in general psychiatric practice. Anti-depressant medications (SSRIs) work for around 40% of people, while around 30% of people respond just as well to a placebo (harmless sugar pill which they think is medication).

A typical day at school provides endless potential stressors. From the peer interactions on the morning bus ride to the timed test situation to a low grade that may halt a season of sports or other school activity, a child has many opportunities to test the “fight or flight” response. The “fight or flight” response is controlled by the adrenalin system. When this system is on, one feels stress or anxiety.

At the extreme end, excess anxiety might result in a panic attack.  Effectively a panic attack is a warning that something is wrong either in the environment of in the body. The interpretations of the physiological sensations as catastrophic triggers a massive release of adrenaline which exaggerates the sensations and further reinforces the idea that something is very wrong, which of course makes matters even worse.

Anxiety in childhood is problematic in many arenas. Children with anxiety at school may act out with disruptive behaviors. The disruptive behavior is typically an action that helps the child avoid the anxiety-producing stimulus. This can include talking, skipping class, “forgetting” assignments, fighting, and even substance abuse to produce an altered state of mind. Obviously, the disruptive behavior is not helpful in solving the problem, but at the moment it can be an acceptable alternative to that dreadful anxious feeling.

Teaching the child appropriate tools to decrease the anxiety is paramount.  Teaching appropriate responses for anxiety and questioning belief systems is a key component of cognitive behavioral therapy (CBT).  CBT is the most effective add-on to treatment of the underlying causes for anxiety. Studies show that CBT on its own it works well for over half of people with panic disorder (and agoraphobia) by reducing the catastrophic feeling and subsequent severity of attacks.