Wellness


Coping Mechanisms for Stressed-Out Teenagers

Research and support for complementary and alternative therapies like yoga and acupuncture continues to grow, and one generally overlooked population that could benefit immensely from an introduction is teenagers.

Nada Milosavljevic, M.D. (known as Dr. Milo) is a board-certified physician in psychiatry and neurology, and faculty member at Harvard Medical School, who practices both conventional and integrative medicine for varied cognitive and behavioral conditions. As part of her holistic approach, she has studied mind-body practices like acupuncture, Ayurvedic medicine, Chinese herbology, and aromatherapy, as well as light and sound therapy. (She’s also a certified tea specialist—more to come on goop—and helms a wellness sensory platform and app called Sage Tonic.)

Dr. Milo sees a need to bring mind-body practices to adolescents trying to cope with stress and anxiety. All kids, like adults, encounter stress; but for teenagers, it’s coming at a critical developmental stage when life habits are forming, and when they often don’t yet have the tools or experience to manage it. With the goal of giving teens better tools to cope with stress early on—in the moment it strikes, before stress becomes overbearing and chronic—Dr. Milo created a holistic treatment program for high schools. In 2011, she kicked off the Integrative Health Program (IHP), a collaboration between Massachusetts General Hospital and three Boston schools to evaluate the efficacy of integrative modalities—namely sound therapy, aromatherapy, and medical acupuncture—on adolescent stress, anxiety, and overall well-being. (What’s particularly compelling about the program is that Dr. Milo chose underserved teen populations and set it up so that students could test and learn about holistic methods in an accessible school setting.) Milo shares her multi-sensory therapeutic approach (outlined in her book Holistic Health for Adolescents), which seeks to engage each of the five senses for better self-regulation. She also covers some simple tools kids can use to keep stress in check (which the adults at goop are borrowing, too).

A Q&A with Nada Milosavljevic, M.D.

Q

Are kids more stressed/anxious today, or is this exaggerated in the media?

A

Kids are definitely stressed and anxious today—whether it’s exacerbated by the media or not, it is a looming issue and affecting a large group of young adults.

In some longitudinal studies looking at stress in the United States, it’s been found that adolescents are in general much more susceptible to feeling stress than their parents or grandparents. Research suggests—as we might suspect—that the perspective gained from age and experience may be crucial in helping individuals cope with stressors; and that there is a strong correlation between social interaction and mortality risk. When a teenager feels isolated or estranged from his or her peers, they are often left to encounter the stressors of life with limited outside sources of support, and sometimes limited internal coping mechanisms.

Trying to ensure that adolescents in particular can cope with acute stress and avoid chronic stress is an important public health concern with a potentially attractive payoff: Reducing stress at the life stage when people are most emotionally vulnerable—the teen years—is likely to result in a significant decrease in the mental health disorders faced in adult and elderly populations.

Anxiety disorders, a form of chronic stress and the most common mental illness in the U.S., are widespread, and costly to society. According to some of the most recent figures available, anxiety disorders may make up almost one-third of the country’s total mental health bill. Eighteen percent of the overall U.S. population is estimated to be affected by these disorders. A national survey of adolescents found that 8 percent of teens ages thirteen to eighteen reported being severely impaired by an anxiety disorder. Of these teens, only 18 percent receive mental health care. Things don’t seem to get much better as adolescents move on to young adulthood. Colleges across the U.S. report depression and anxiety as prevalent problems today.

“Reducing stress at the life stage when people are most emotionally vulnerable—the teen years—is likely to result in a significant decrease in the mental health disorders faced in adult and elderly populations.”

The teenage years are a stage of life when many challenges take place—bodily changes, relationships with friends and parents, life goals, interests, dreams, and mental changes. Sometimes, these challenges affect each other, and sometimes they have nothing to do with being a teenager. In any case, the accumulation of varied stressors (and the anxiety they produce) faced during adolescence can be a lot for many kids to handle.

Q

What are the main causes of adolescent stress?

A

Diet: As with adults, inadequate nutrient or dietary intake is a serious concern. Nutrient-deficient diets are stressful to the body and can contribute to a host of medical conditions. During mental and physical development, inadequate nutrition is especially damaging, and can have long-term, and irreversible consequences.

Social Pressures: Adolescents famously experience pressures to look or behave in certain ways, or to do things because their peers are doing them. They are often exposed to risky behaviors such as underage alcohol or drug use, and may feel trapped by social expectations. Of course, many times the peer pressures stray from what their parents recommend or demand, resulting in additional tension. Moreover, mental and or physical abuse may be impossible for an adolescent to talk about because of social pressures. Left untreated, stress can cause an adolescent to become isolated and have feelings of poor self-worth.

Illness/infection: Any illness prompts the body to mount an immune response; the resulting healing process can be stressful and place high energy demands on the body. Chronic illnesses place an increased burden on any adolescent, and can contribute to significant long-term stress.

Physical: Bodily changes that alter appearance and functionality can cause stress in many ways. Changes such as pimples, vocal shifts, height, body odors, excess body hair, and menstrual cycles can all contribute to the awkwardness an adolescent may feel about their own body. Sleep deprivation, common in the adolescent population, has been shown to elevate cortisol levels and can cause a physiologic inability to remain focused, or even to look healthy.

Psychological: Beliefs and ideals begin to change with adolescence, and often no longer align with parental ideals. Choice of religion or political ideas may change as new discoveries are made; parents may become concerned. Sexual orientation is another discovery that may not gain parental approval, which can cause the adolescent to feel unloved and misunderstood.

Other stressors: Difficulty in school, trouble meeting and making new friends, keeping up with fashion and trends, not having the funds to join in interests with others, can all further contribute to stress and anxiety.

Q

How much stress is normal—when does it become a bigger problem?

A

One of the most popular phrases in American English describes the condition of somebody who feels agitated and distracted, usually because they have too many things to do in a short amount of time: It’s the feeling of being “stressed out.”

This term is often applied to many different kinds of stimuli that can cause feelings of distraction or distress: from reactions to an unwelcome surprise, like when a student learns that her exam is coming much sooner than she had expected, or to something longer-term, as when a person’s unreasonable boss causes him to fret and worry for days, weeks, or even months at a time. Both these people might be “stressed out.”

All sorts of conditions in our lives can produce stress, and in fact, feeling stress from time to time is a symptom of being alive. Stress can be seen as a healthy adaptive response to changes in a person’s life. Stress is intimately connected to our development—like growing pains. In our bodies, as in our lives, growth requires us to adapt, and adapting to new or unusual circumstances can be very demanding. If we want to do something that requires some effort—from getting up the courage to speak in public to stretching our arms as far as possible to reach for the keys that have fallen through the floorboards of an old house—we have to ask our bodies and minds to do more than they would in a state of rest, relaxation, or equilibrium. In so doing, our bodies need extra inputs or supports to function well in those times when higher demands are put on them. Let’s call this >normal stress.

Abnormal, excessive, or chronic stress are where difficulties tend to occur. Our bodies are meant to respond to brief or acute periods of stress. But our coping capacity is diminished when we are placed under periods of extended and chronic stress—eliciting the body’s stress response and initiating a cascade of stress hormones, cytokines, and inflammatory mediators.

“When a person is experiencing chronic stress, the body attempts to develop coping mechanisms.”

Physiologically, the “fight or flight” response is triggered during a perceived threat. It allows our systems to respond, avert danger, and return to baseline. Certain chronic situations can expose the body to extended periods of excessive stress and contribute to long-term negative health effects. When a person is experiencing chronic stress, the body attempts to develop coping mechanisms. The brain, the organ that responds to stress, determines what the threat is and what type of physiological responses could be damaging. During this process, the brain communicates with cardiovascular, immune, and other systems in the body via neural and endocrine mechanisms. But, when the body is not allowed to return to baseline, other physiologic systems become dysregulated and negatively impact our health in the long-term.

Q

You associate different therapies with the five senses—how does this work, and what do you find to be most effective?

A

We use the five senses to engage people in a multi-sensory therapeutic approach. A particular sense-specific holistic modality (i.e., acupressure for sense of touch, aromatherapy essential oils for sense of smell) is used to stimulate a sensory pathway and induce a positive change—and healing. Using modalities in combination is especially useful in helping adolescents reach the goal of healthy self-regulation.

Using the senses as the pathway to therapy has three distinct advantages:

1. The senses are foundational not just to our well-being, but also to our being, our sense of self.

2. Sensory stimuli affect us every day—we need to learn how to channel these stimuli to make us feel better, not worse.

3. The senses are easy to access, requiring little or no technological gadgets or highly skilled expertise to leverage.

Q

What kind of aromatherapy do you recommend for teenagers and kids?

A

For calming effects: lavender, chamomile, and neroli to name a few. Not only do they have a pleasant aroma, but their therapeutic effects help downregulate the central nervous system, calm the mind, and induce a sense of tranquility. I formulated a lavender/neroli-blend towelette for relaxation.

For energizing effects: Essential oils such as grapefruit, lemon, lime, and peppermint can uplift the mood and invigorate the body. We use a mix of these ingredients in the Sage Tonic towelettes—like the Energy edition made with lime and grapefruit extracts.

I have used essential oils in various ways. Inhalation is the most common method. But they can also be applied topically in a carrier oil to be absorbed through the skin. There is research underway on using various essential oils internally via capsule but I would suggest seeking a healthcare provider for this type of treatment as it can be dangerous if not done properly.

Q

Can you tell us about the Integrative Health Program? How did you come to start it and how does it function?

A

I launched the Integrative Health Program (IHP) in 2011 at Massachusetts General Hospital. It utilizes a multidisciplinary approach to provide integrative services to high school students in a school-based clinical setting(Students would come down to their respective school clinic for a 30-min treatment and then head back to class, which increased convenience and decreased absenteeism). The IHP implements mind and/or body techniques to address anxiety and stress-related disorders; it’s about early intervention, preventive health, and empowerment for teens.

The program addresses stress and anxiety conditions by providing treatment, education, and self-help skills to its adolescent participants. While there are many integrative therapies, we focused on three: medical acupuncture, aromatherapy with essential oils, and sound therapy.

Q

How have kids responded to alternative treatments? What kind of results did you see?

A

It has been overwhelmingly positive, not only in terms of how readily teens adopt these techniques and incorporate them into their daily routine, but also how effective the techniques have been at countering stress.

To date, more than 130 students (male and female, ages fourteen to nineteen) have participated in the IHP from three different Boston-area high schools. On average, during the course of the eight-week treatment, students experienced a reported one-third reduction in stress and anxiety symptoms. They learned effective self-help tools to help build resiliency; many of the students involved with the IHP might not have had access to these types of therapies, which can have long-term effects.

Our IRB-approved study on the results of the program was published in the Journal of Adolescent Psychiatry.

Q

Can you talk about why you’re such a proponent of integrative therapies and particularly for underserved populations?

A

When we look at a patient as a whole person, the interconnection between body and emotions becomes clearer. For adolescents, and indeed for all of us, stresses and problems reside in the physical, emotional, and developmental realms. The integrative approach to helping teens incorporates all spheres of concern. Most important, it reinforces teenagers’ need for independence, by giving them the tools to self-administer. Ultimately it teaches them that feeling better is truly within their control. The goal is to build resiliency and support teens to become better advocates for their own health and long-term wellness.

In particular, providing these types of treatments to students in the school setting, as I have done with the IHP, has the potential to decrease barriers to accessing care, lowering treatment costs and decreasing school absenteeism by instituting care on-site. Offering a holistic approach to treatment in schools is feasible. Because utilizing these approaches involves their active participation, adolescents can acquire lifelong skills that improve their ability to cope and confront inevitable life stressors.

“Most important, it reinforces teenagers’ need for independence, by giving them the tools to self-administer. Ultimately it teaches them that feeling better is truly within their control.”

Underserved populations face additional challenges, so these therapies can be especially beneficial. Skills and self-help treatments that can be implemented where, when, and how they see fit is empowering. Having tools to use in the moment—rather than allowing symptoms of stress, poor sleep, low energy, etc. to snowball—can make it simpler to address issues with immediacy, and hopefully prevent chronicity and worsening of these conditions.

Q

How does this work connect to your company, Sage Tonic? And how can we help?

A

I launched Sage Tonic based on my research and interest in providing anyone access to these treatments wherever they are, on-the-go. All the products and mobile tech are easy to use, educational, and include teas/herb blends, essential oil towelettes, and additional treatments like acupressure, yoga, and sound therapy in the mobile app.

“We need to raise the bar in what we offer to young adults who are at a critical stage in their development and at a phase of life where long-term health habits are established.”

A portion of Sage Tonic sales is donated to schools to provide education and support for these same integrative therapies to reach the vulnerable teen population. Interested readers can also support the IHP directly through the Integrative Health Program Fund at Massachusetts General Hospital (email: info@sagetonic.com). We need to raise the bar in what we offer to young adults who are at a critical stage in their development and at a phase of life where long-term health habits are established. Many chronic illnesses are insidious and develop slowly over time; such lifestyle-related illnesses can be significantly impacted by early intervention, along with teaching life-long preventive health skills and simple self-care techniques.

Holistic Health for Adolescents, an easy-to-use, yet informative and evidence-based guide, goes further in depth on how to use these treatments with teenagers.

Nada Milosavljevic, M.D., J.D. is a board-certified physician in psychiatry and neurology, and faculty member at Harvard Medical School, who practices both conventional and integrative medicine for varied cognitive and behavioral conditions. She is the founder and director of the Integrative Health Program at Massachusetts General Hospital (a collaboration with Boston-area school clinics to treat and educate teens who suffer from anxiety and stress conditions); author of Holistic Health for Adolescents; a certified tea sommelier; and founder of the wellness sensory platform and app Sage Tonic. Prior to her career in medicine, Milosavjevic, a graduate of Notre Dame Law School, practiced law with a specialty in intellectual property.

The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of goop, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.

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