By Patricia Rockman, MD, CCFP, FCFP, Allison McLay, BA, CDips, M. Lee Freedman, MD, FRCP(C), coauthors of The Mindful Teen Workbook
It is relatively common knowledge that approximately one in five people will suffer from a mental health condition at some point in their lifetime. What perhaps is less appreciated is how significantly these conditions affect youth. For example, in Canada, for those between the ages of fifteen and twenty-four, “the leading disease-related cause of death is suicide.… 3.7 times more deaths…” than cancer (Silveira & Rockman, 2016, p. 958). Mental disorders and addictions account for the most years lived with disability worldwide. This is in large part because of their young age of onset, severity, and long-term impacts—particularly when they are missed or not treated effectively.
Adolescence is a time of rapid development—physically, emotionally, and mentally. Youth are also affected by many psychosocial and physical stressors, including but not limited to, their relationships, trauma, drug use, school and work demands, bullying, unsafe living conditions, negative thoughts, mental health problems, and chronic medical illness. (Iliades, 2013). Being a teenager is a stressful time, but what does this mean for teens, and what would be helpful? We can all relate to the phrase, “I’m so stressed out!”
However, what is stress exactly? And what are its long-term effects? The word stress has many definitions, and stress isn’t a specific disorder, mental or physical (National Library of Medicine, 2021). Hans Seyle, the father of stress and its study (1956), defined a stress reaction as the “nonspecific response of the body to any demand” (Tan and Yip, 2018). It may be acute or chronic, perceived as negative or positive, and an attempt to adapt to an internal or external stressor (Macpherson & Rockman, 2022 in press). Lazarus and Folkman (1984) developed stress and coping theory. They viewed stress as an interaction between a person and the environment that exceeds their ability to cope. Extreme and/or chronic stress was and continues to be correlated with many diseases (Bialkowska, Juranek, & Wojtkiewicz, 2020); however, there is no direct causal link between stress and specific illnesses or disease outcomes (Salleh, 2008). Stress is difficult to study. It is a vague, complex concept, and has myriad definitions.
We can think of stress as a lifelong concern, and it would seem prudent to develop skills to manage it earlier rather than later. Mindfulness is a way teens can develop such tools. Mindfulness-based programs are concerned with helping people to manage their relationship to, or their distressing encounters with, specific conditions or life challenges (aka stress).
While for many years mindfulness and mindfulness-based programs functioned outside the cultural mainstream, the term stress utilized by mindfulness-based stress reduction (MBSR) developer Jon Kabat Zin served as a bridge for mindfulness to cross into mainstream medicine. It moved from helping people with the suffering of life, through healthy and adaptive coping, to the sick and maladaptive reactions to environmental or internal stressors associated with illness.
Mindfulness is now used for day-to-day concerns or the stress of living. This can include such challenges as work and study pressures, financial concerns, aging, relationship problems, eating, parenting, and childbirth. Kabat-Zinn was interested in applying mindfulness as a means for working with distress arising from any source (Macpherson & Rockman, 2022 in press). While it has predominantly been applied to adults, more recently mindfulness is being applied to youth. So, what is it about this tool and way of being that could be valuable for them?
Given that being a teen is such a period of upheaval and that they are learning how to navigate their lives, it makes sense to provide them with strategies to cope with the challenges of being human. Steven Hayes (founder of acceptance and commitment therapy (ACT), a mindfulness-based empirically supported treatment) conducted a meta-analysis (2022) of psychosocial interventions and what really helps people make a change. There appear to be three areas that are most effective for positive psychotherapeutic outcomes. These are, firstly, psychological flexibility and mindfulness skills—awareness and noticing present experience—thoughts, emotions, and body sensations from a witnessing perspective. Secondly, openness: allowing challenging thoughts and emotions to be present; turning toward difficult mind and mood states; and thirdly, taking action consistent with one’s values. All of this entails being able to direct one’s attention. Self-compassion, behavioral activation, and anxiety sensitivity were also important variables for successful therapeutic outcomes. These skills are relevant to teens and are taught to greater or lesser degrees in mindfulness-based programs.
Teens may need shorter programs and practices than adults to learn mindfulness skills to manage stress. Some tips for teaching youth are as follows:
Mindfulness Tips for Teens
- Guide them to notice their experience and learn to describe it—using the senses—getting to know what is going on in any moment, whether sitting quietly, walking, or engaged in any other activities.
- Get them to pause, check in briefly and frequently, and ask: “What’s happening in my body? What sensations are present? What emotions are here (name them) and what am I thinking?” Remember, we can’t change or manage anything if we don’t know what’s happening. This can be done many times a day.
- Help them direct their attention where they want it. This can be internally or externally. Use the senses. For example, sight. Pick a natural object to investigate and get to know its qualities; or pay attention to the sensations of breathing at the belly. Ask them to see how long their attention stays with either of these activities, and, when it goes somewhere else, wake up and bring it back to seeing or breathing without making this a big deal.
- Ask: “Are you willing to have disturbing emotions like anxiety or sadness (as well as positive ones) and get to know them?” This is openness. You don’t have to like the emotions. Simply recognize and let them be present without immediately trying to fix, avoid, or change them. This builds awareness and self-efficacy
- If challenging thoughts, emotions, or sensations are present, ask the teen: “Can you watch them come and go without getting caught up? Can you take a step back, change perspective, and get some space—perhaps bring your attention to the soles of the feet or sensations of breathing while you learn to pay attention to what you might not like?” This is called decentering or defusion.
- Helping teens think about what they value can be motivating for dealing with life challenges. What’s important to them and how can they engage in actions consistent with those values? This applies to managing stress and everything else in one’s life.
- Figure out the kinds of activities they would like to engage in to take care of themselves and build resilience when stressed or distressed—healthy versus unhealthy. How might they include others as support since we know that connection is vital for well-being?
- Brief, formal meditation practices and many daily activities can be a training ground for mindfulness skills. They provide us with opportunities to practice anywhere and anytime.
Lastly, remind them to:
- Pay attention to how stress feels in the body, emotions, and thinking
- Notice when they start to feel overwhelmed
- Get to know the signs of stress reactivity
A little mindfulness can go a long way to help us manage stress more effectively, look after ourselves, maintain our mental health, and develop habits to last a lifetime.
Patricia Rockman, MD, CCFP, FCFP, is a family physician with a focused practice in mental health. She is associate professor in the department of family and community medicine at the University of Toronto; and cofounder of the Centre for Mindfulness Studies in Toronto, ON, Canada. She is a public speaker, curriculum developer, and teaches and mentors in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR).
Allison McLay, DCS, RP, is a registered psychotherapist, and faculty at the Centre for Mindfulness Studies. She teaches MBSR and MBCT, and trains health care providers to deliver these modalities. She was an author in curriculum development for the youth mindfulness program at the Centre for Mindfulness Studies.
M. Lee Freedman, MD, CM, FRCP(C), is a child, adolescent, and family psychiatrist. She is experienced in integrating mindfulness training into her therapeutic work with youth and adults in need of help with mental health challenges.