Mental health awareness week:Teenage anxiety during exams – how to help

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Being a teenager can be challenging enough and in this article I cover some major issues that teens today often face.

However, this time of year -exam time is a particular time of angst and stress and can tip teens over the edge with anxiety and worry and it is the time I see a surge of appointments for teenagers in my clinical practice. So I would like to offer some information,and strategies for parents and teens to help manage anxiety and stress at this important time and throughout adolescence.

Here are some main points to consider:

  • Often parents can feel disconnected as children transition into adolescence and begin to stretch their boundaries.
  • Life is very different to how it was even 20 years ago and mental health in teens is beginning to take centre stage as we see headline news about anorexia ,increased risk of suicide, cyber bullying through social media, and the increased pressure at school and college with the ever – demanding educational systems. This is overwhelming for both parents and their children but there is much we can do!
  • Adolescence is a tough time-

And let’s not forget- there is nothing new about adolescence we were all teenagers once- pushing the boundaries, taking risks, and developing our sense of self in the world, finding our own tastes in music and developing relationships with peers and other adults outside of the family home.

What is new though is the speed in which technology has overtaken human input and whilst this has many upsides it does have its downsides and we are increasingly aware of what these re through the media

  • Adolescence is a time of great change and transition in every culture.
  • Teens are meant to push the boundaries – to find new and novel ways of solving problems as we continue to grow and evolve and continue as the human race- a species that is socially connected in order to survive. Hence the dopamine surges which increase risk-taking behaviour

The current generation have much to contend with:

Peer pressure- this is not new but how it plays out comes in new formats through social media and online communication.

Exam pressure- the pressure seems to increase year on year for schools and pupils to get higher grades and to exceed and excel through the likes of Ofsted.

Social media confounds the boundaries between home and the world outside.


By design

Teens are designed to be creative, to take risks ,and to eventually ‘fly the nest’ procreate and continue the evolvement of our species.

Dopamine and hormonal surges increase this awareness of the pull towards independence- when they are not yet ready to fly the nest completely.

Teens take more risks as they put more value on excitement than the chance of something going wrong, and don’t have the wisdom of adult experience.

What does the developing teenage body and mind need?

  • The developing brain and body needs routine to create balance and a sense of well-being -our bodies like routine and constancy and follow natural rhythms- this is especially important during growth spurts.
  • Good food is important to balance mood-foods high in omega 3 and 6 fatty acids will help with this.
  • Plentiful amounts of fruit and vegetables ,and protein as whole foods to obtain essential vitamins and minerals required for healthy growth.
  • Good fluid intake for mood, energy, and brain development.
  • Sleep is key to well-being during this time of phenomenal growth spurts and in my clinical practice I regularly see exacerbated parents -trying to support their teen’s transition to independence, yet at the same time keep them safe with their wealth of experience and knowledge as adults – Quite often teens are on social media until the early hours of the morning- so I encourage them to enjoy the benefits of switching their phones off until morning – something I know parents already do!

Some common causes of stress and anxiety in teens

  • Fear of not fitting in
  • Fear of failure in exams
  • Fear of being judged
  • Bullying
  • Constant social media overload
  • Not enough sleep!
  • Developing a sense of who they are and their place in the world
  • Risk taking behaviours such as experimenting with drugs and alcohol
  • Violence and aggression – from any source
  • Undeveloped cognitions leading to faulty beliefs such as I am not good enough, I am unlovable etc


Depression and anxiety are increased a great deal during adolescence

Some Signs to look out for:

  • Retreating more often into their room
  • Poor appetite/ changes in appetite
  • More aggression than usual
  • Lack of personal hygiene and care in their appearance – more than normal!
  • Not wanting to socialise with the family
  • Not engaging with activities they once found enjoyable
  • Not engaging with peers
  • Indifference and apathy
  • Tiredness and lethargy
  • Physical symptoms such as unexplained headaches and migraine, stomach aches, back pain, joint aches and pains.
  • Giving up on school and friendships that are important
  • Changes in sleeping patterns
  • Self-isolation
  • Self- harm



Some tips and techniques to support your teen

  • Positive reward and feedback when they do well at school or with their hobbies/sport etc
  • Listen mindfully – when they come to you for advice or open up- it’s important to listen openly and mindfully- be fully present and available as much as is possible without too much interference- remember teens need their space to grow and develop their own personality, views, interests, likes and dislikes, and way in the world.
  • Be there to comfort and support not just to criticise or advise
  • Help them connect with other teens outside of school and through hobbies and interests
  • Encourage mindfulness and meditation practices and exercise as these have been shown to be effective in lifting mood. May be do this with them as a family.
  • Assuring them that everything they feel is ok and valid and that you are there for them.
  • Help them to acknowledge their achievements and find something good in every day that you can comment and feed back on.
  • Let them know its ok to make mistakes
  • When they act out or behave badly – reassure them first of all that they are loved unconditionally and then help them to understand the behaviour is harmful to themselves and others – we are not talking about tolerating bad behaviour – we are looking to change that behaviour in a way that the teen will understand.
  • Don’t over fuss or interfere – allow them space to grow and evolve and know that what may be normal behaviour to them might not always be to us so trust a little when they say things are fine but keep and eye on them in conjunction with other signs you might notice that they may suffering in some way.


  • Remember- we were teens once! They need to have their needs met and experiences validated just as we did.
  • If we can show the benefits of making healthier-less risky choices rather than a raised voice saying “ Because I say so” they are more likely to respond and our accept the benefit of our experience and wisdom as adults who have walked their path before. The aim is to keep communication open and constant criticism and challenge will only serve to shut down communication – teens need to understand why and how.
  • A better stance when addressing negative behaviour would be to adopt where possible, is empathic understanding and respectful communication.


  • The physical, biological, and social changes adolescents go through can be overwhelming to them. It is an important and necessary period of transformation and we can learn from them also.


  • It is a question of finding some middle ground -firm but fair, available yet not intrusive or suffocating with our own fears and worries.


  • Encourage hobbies and exercise that promotes healthy sleep and encourage a routine of switching their phones of a t a regular time before bed

Even though it is a challenging time for both parents and their teens; managing the ups and downs of creativity, physical change, risk taking and rebellion, are all natural.

  • Keep communication open- teens pick up on ‘our stuff’ and can internalise and misinterpret our own stress and adult concerns as their fault and when we’re tired its so easy to push back  and the need for our own space is important too. However, be mindful that  this can feel like complete rejection to a teen who does not yet have a fully developed sense of self or where they fit in the world, and not enough life experience to challenge a faulty belief system that is still developing and  can lead to  ingrained into adulthood issues.
  • Be mindful and fully present-tolerant and forgiving – It is useful to remember that we all make mistakes -it’s how we learn – and this continues throughout the whole of life.
  • Be there as a family so they have a strong base whilst they grow and fall, and grow and fall- building resilience and transitioning towards adult independence
  • Know the resources available such as GP, Therapists, the school and college, Organisations such as Anxiety UK
  • We can start with our own self-compassion, meeting our needs, managing our own wellbeing.


References and recommended reading:

“Brainstorm” Dr Daniel Segal

“Conquer negative thinking for teens” Mary Karapetian Alvord and Anne McGrath

“ The self- compassion workbook for teens” Dr Karen Bluth


Useful websites



Useful on the spot mindfulness practices and helpful techniques for anyone suffering from anxiety


Soles of the feet

This is a very effective way to anchor your awareness in body sensation, especially when you’re upset and can’t calm yourself down.

  • Stand up and feel the soles of your feet on the floor. Rock forward and back a little, and side to side. Make little circles with your knees, feeling the changes of sensation in the soles of your feet.


  • When you notice your mind has wandered, just feeling the soles of your feet again.



  • If you wish, you can begin to walk slowly, noticing the changing sensations in the soles of your feet. Noticing the sensation of lifting a foot, stepping forward, and placing the foot on the floor. Doing the same with both feet as you walk.


  • As you walk, perhaps also noticing for a moment how small the surface area of your feet are, and how hard your feet work to keep your body off the ground. See if you can notice that with appreciation or gratitude.



  • When you are ready, returning to standing.



Three- minute breathing space

A helpful meditation to practice is called ‘the three- minute breathing space’


The 3 x minute meditation or 3 x minute breathing space (as it is often called):

This 3 x minute breathing space meditation was developed within the practice of Mindfulness-Based Cognitive Therapy for Depression (Williams et al 2002) and is an extremely useful practice when time is limited but can also be used at any time during the day simply to bring ourselves back to the present moment of our experience and back to our mindful practice. The meditation is structured as follows:

1st minuteAWARENESS – Paying attention to our present moment experience. Noticing with awareness how our minds are, how we are emotionally, how our bodies are here and now paying attention to any particular sensations that may be present.

2nd minuteGATHERING – Paying attention to our breath as a means of gathering our awareness and being ‘present’ in each moment, each in-breath and each out-breath

3rd minuteEXPANDING – Opening up our awareness from the focus on the breath to the whole of our bodies and the environment that surrounds us.