Under Pressure

Confronting the Epidemic of Stress and Anxiety in Girls



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February 12, 2019 | ISBN 9781984845962

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About the Book

NEW YORK TIMES BESTSELLER • An urgently needed guide to the alarming increase in anxiety and stress experienced by girls from elementary school through college, from the author of Untangled

Dr. Lisa Damour worked as an expert collaborator on Pixar’s Inside Out 2!

“An invaluable read for anyone who has girls, works with girls, or cares about girls—for everyone!”—Claire Shipman, author of The Confidence Code and The Confidence Code for Girls

Though anxiety has risen among young people overall, studies confirm that it has skyrocketed in girls. Research finds that the number of girls who said that they often felt nervous, worried, or fearful jumped 55 percent from 2009 to 2014, while the comparable number for adolescent boys has remained unchanged. As a clinical psychologist who specializes in working with girls, Lisa Damour, Ph.D., has witnessed this rising tide of stress and anxiety in her own research, in private practice, and in the all-girls’ school where she consults. She knew this had to be the topic of her new book.

In the engaging, anecdotal style and reassuring tone that won over thousands of readers of her first book, Untangled, Damour starts by addressing the facts about psychological pressure. She explains the surprising and underappreciated value of stress and anxiety: that stress can helpfully stretch us beyond our comfort zones, and anxiety can play a key role in keeping girls safe. When we emphasize the benefits of stress and anxiety, we can help our daughters take them in stride.

But no parents want their daughter to suffer from emotional overload, so Damour then turns to the many facets of girls’ lives where tension takes hold: their interactions at home, pressures at school, social anxiety among other girls and among boys, and their lives online. As readers move through the layers of girls’ lives, they’ll learn about the critical steps that adults can take to shield their daughters from the toxic pressures to which our culture—including we, as parents—subjects girls.

Readers who know Damour from Untangled or the New York Times, or from her regular appearances on CBS News, will be drawn to this important new contribution to understanding and supporting today’s girls.

Praise for Under Pressure

“Truly a must-read for parents, teachers, coaches, and mentors wanting to help girls along the path to adulthood.”—Julie Lythcott-Haims, New York Times bestselling author of How to Raise an Adult
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Praise for Under Pressure

“Lisa Damour offers a fresh, riveting take on the unsustainable stress girls face today, which is often fueled unintentionally by the most well-meaning parents and teachers. Damour also offers refreshing and research-based practical fixes; it’s possible to normalize pressure, in many cases, and use it in fortifying ways to build strength and confidence. Under Pressure is an invaluable read for anyone who has girls, works with girls, or cares about girls—for everyone!”—Claire Shipman, New York Times bestselling author of The Confidence Code and The Confidence Code for Girls

“Anyone who has read the beloved Untangled knows that Lisa Damour gets girls. This timely sequel brings stunning clarity to the complicated set of stressors that girls experience—in the classroom, online, with peers, and at home—and models how to show up as an ally instead of an adversary. Truly a must-read for parents, teachers, coaches, and mentors wanting to help girls along the path to adulthood.”—Julie Lythcott-Haims, New York Times bestselling author of How to Raise an Adult 

Under Pressure is exactly what parents need and, as a mother, it helped me to relax! Damour explains the difference between healthy and unhealthy stress and anxiety. She offers a detailed, comprehensive look at how to help our daughters manage naturally occurring tension, toxic stress, and anxiety. This brilliant book is a must-read.”—Norah O’Donnell, host, CBS This Morning

“Lisa Damour is my go-to resource for all things raising girls (and I often apply her wisdom to my boys as well). Under Pressure is Damour at her best, addressing issues that are challenging our girls, from sexuality and academics to the ways girls speak and present themselves. Don’t be misled by the title; even if you believe your daughter isn’t unduly anxious, this is a book that will help you to help her navigate. Under Pressure is my gift of choice for parents of teenage girls, and a gift to parents everywhere.”—KJ Dell’Antonia, former editor, The New York Times’ “Motherlode,” and author of How to Be a Happier Parent

Under Pressure provides striking insight into the inner workings of the anxious mind. Filled with tips for any parent, educator, or person interested in helping our girls live and perform up to their potential, this book is a go-to guide for understanding and dealing with stress and anxiety in girls.”—Sian Beilock, president of Barnard College at Columbia University and author of Choke and How the Body Knows its Mind

“In readily accessible and easily assimilated prose, Damour . . . [makes] common-sense suggestions to help parents help their daughters in these highly competitive times. Although few of these issues are new, Damour’s instructive book pulls them into the limelight yet again, where they can be addressed by a new generation of parents and girls. Practical solutions backed by solid research that will help many girls overcome their high levels of stress and anxiety.”Kirkus Reviews

“Clinical psychologist Damour thoughtfully and compassionately discusses the many pitfalls faced by adolescent girls today. . . . This is a remarkably thorough and accessible guide for raising girls into strong, independent women.”Publishers Weekly

“Parents of adolescent girls will find this an excellent choice for assisting their children in navigating day-to-day stress and struggles.”Library Journal

“Damour offers practical suggestions for heading off stressful encounters and counteracting their influences. Although aimed at parents, Damour’s sensible and empathetic approach will also be reassuring for teens seeking guidance.”Booklist
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Under Pressure

chapter one

Coming to Terms with Stress and Anxiety

i have good news. actually, i have two pieces of really great news. First, stress and anxiety aren’t all bad. In fact, you can’t thrive without them. Understanding the difference between their healthy and unhealthy forms will change, for the better, how you help your daughter manage the tension she feels. Second, the field of psychology has a lot to say about how to alleviate stress and anxiety if they do reach toxic levels. Indeed, if I were to take an informal survey of my colleagues, the vast majority would agree that we have come to understand the root causes and inner workings of pathological stress and anxiety as well as we understand anything in our field. As a result, we have many ways to help people rein in psychological strain when it gets out of control.

Taken together, these two happy facts mean that you can already start to worry less about how stressed or anxious your daughter feels because, to a degree, these mental states are essential catalysts for human growth and development. And if you suspect that your daughter’s unease far exceeds the healthy mark, then I’m here to reassure you that you and your daughter do not need to feel helpless. We’re going to tackle unhealthy stress and anxiety, too.

Healthy Stress

Stress gets a bad rap. Though people don’t always enjoy being stretched to new limits, both common sense and scientific research tell us that the stress of operating beyond our comfort zones helps us grow. Healthy stress happens when we take on new challenges, such as giving a speech to a large audience, or do things that feel psychologically threatening, such as finally confronting a hostile peer. Pushing ourselves past familiar limits builds our capacities in the same way that runners prepare for marathons by gradually extending the distances at which they train.

Learning to brave stressful situations is also a skill that develops with practice. Researchers actually use the apt term stress inoculation to describe the well-­documented finding that people who are able to weather difficult life experiences, such as riding out a serious illness, often go on to demonstrate higher-­than-­average resilience when faced with new hardships. I can speak for myself in saying that being middle-­aged doesn’t seem to come with a lot of advantages, but it definitely has one particular benefit: problems don’t bother me as much as they used to. Like most of my agemates, I’ve got enough life experience under my belt that I now take in stride events—­such as having a plane flight canceled—­that would have put me on the ceiling when I was younger. While the saying “What doesn’t kill you makes you stronger” almost certainly overstates the point, it’s not all wrong.

As parents, we should think of stress the way Goldilocks thought about making herself comfortable while trespassing. We don’t want our daughter’s stress level to be consistently too low or too high. But we can embrace reasonable levels of stress as a nutrient for our daughter’s healthy development that will help her to grow into the strong and durable young woman we want her to be.

Much of what our girls learn about how to manage stress comes from observing how we manage it as parents. Our daughters watch us for cues about how alarmed they should be by life’s difficulties. When we let our own inner Chicken Little take over and panic in the face of manageable challenges, we set a bad example. When we accept that stress often leads to growth—­and help our girls do the same—­we create a self-­fulfilling prophecy for ourselves and for our daughters.

Obstacles, however, only make us stronger when we can surmount them. Accordingly, Under Pressure will address in its coming chapters how you can help your daughter master the challenges she will face as she moves from childhood to adulthood. With your help and over time, your daughter can come to appreciate that stress is a positive and growth-­giving part of life.

Except for when it’s not.

How Stress Becomes Unhealthy

Stress becomes unhealthy when it exceeds what a person can absorb or benefit from. There is no single yardstick for what con­stitutes unhealthy stress, because the volume of manageable hardship differs from person to person and can even differ for a single individual from day to day. Whether stress becomes unhealthy depends on two variables: the nature of the problem and the person upon whom the problem lands.

Psychologists consider stress to be unhealthy when it interferes with well-­being in the short or long term. Whether or not a stressor harms well-­being has surprisingly little to do with the source of the stress and much more to do with whether adequate resources—­personal, emotional, social, or financial—­are available to address the problem. For example, a broken arm could be a resilience-­building hassle for a girl who writes with her other hand and has lots of friends to help carry her books. Or it could be a full-­blown crisis for one who might lose a shot at a desperately needed athletics scholarship due to the injury. In the same way, if the primary breadwinner is laid off, that feels much worse for a family without a financial cushion than it does for one with a healthy savings account.

Knowing that stress becomes unhealthy only when its demands exceed our resources helps us to better support our girls. We can’t always prevent calamities, but we can often summon reserves to help our daughter manage the challenges life puts in her path.

A terrific example comes from my work as a consulting psychologist to Laurel School, a local all-­girls’ school that runs from pre-­kindergarten through twelfth grade. I’ve spent part of each week there for the past fifteen years, and in that time I’ve watched several high school girls and their families contend with the disease of mononucleosis, a particularly tenacious stressor. The course of the virus doesn’t differ much from girl to girl, as sufferers usually miss classes for a few weeks and also need to suspend their extracurricular activities. But the illness turns out to be much more stressful for some students than for others.

Under ideal conditions, a girl’s parents can surround their daughter with loving support to make the best of a bad situation. Her folks ensure that she gets lots of rest, they coordinate effectively with the Laurel faculty to keep their daughter reasonably up to date on her assignments, and they find ways for her friends to stop by for visits. One family of a dedicated soccer player happily drove their daughter to games so she could cheer on her beloved teammates from the bench. When parents have the wherewithal to marshal resources on their daughter’s behalf, I’ve seen a bout of mono amount to nothing more than a bothersome blip in a girl’s high school career.

Other families, especially those who may already be at the limit of the stressors they can manage, can provide only minimal support. A girl who spends long hours alone at home can be inclined to choose social media over sleep, thus causing the virus to drag on longer than it should. She might fall far behind on her schoolwork or be dragged down by sadness about missing her friends or the fun parts of school. When students in this situation eventually get better, I’ve heard them ruefully remark, “Thanks to mono, my entire semester was messed up.”

The Three Types of Stress

Of course, there are girls and families who do everything in their power to address the social and academic impact of mononucleosis yet still find themselves struggling to get back on track. We can better understand their challenges when we recognize that just as stress is not all bad, it is not all the same. When psychologists study stress and its impact on health, we sort it into three distinct domains, namely life events, daily hassles, and chronic stress.

Any life event that requires adaptation, such as a teenager catching mono, is inherently stressful. Even happy occasions, such as becoming a parent or starting a new job, come with the strain of adapting to abrupt change. There aren’t many cardinal rules in psychology, but here’s one: change equals stress. The more change a life event requires, the more taxing it will be.

Moreover, life events, both good and bad, often trigger daily hassles as well. For instance, parents who rearrange their schedules to care for an unhealthy teenager may have trouble getting around to their routine errands. Or they may not be able to clean up the sink full of dinner dishes that are usually loaded into the dishwasher by the teenager felled by mono. While daily hassles seem like they shouldn’t be a big deal, they do add up. Quite remarkably, one research study found that it was the number of daily hassles triggered by a major stressor, such as the death of a loved one, that actually determined how much emotional difficulty people faced down the line. In short, the pain of losing one’s wife is amplified by the stress of trying to figure out her system for paying the household bills.

Our instinctual understanding of the burden of daily hassles explains our impulse to cook for friends with new babies. We stock the fridges of those facing major life events to spare them the added nuisance of shopping and making meals. Appreciating that our own daily hassles really do compound stress can spur us to take steps to minimize them. Eating off paper plates for a few weeks won’t cure a teenager’s mono, but it can help to reduce the level of stress overall.

Apart from life events and daily hassles, there’s also chronic stress. This is the kind that results when basic life circumstances are persistently difficult. Enduring chronic stress—­such as living in a dangerous neighborhood or caring for a relative with dementia—­has been found to take a grinding toll on both physical and emotional health. Yet even in the worst circumstances, relief can sometimes be found. Studies of how young people cope with two grave and persistent sources of stress—­ongoing cancer treatment or being raised by a severely depressed parent—­have yielded valuable lessons that apply to a wide range of chronically stressful situations.

I found myself relying heavily on what we know about helping children and adolescents manage stress, even in the context of unrelentingly difficult conditions, when working with Courtney, a bright seventeen-­year-­old whose parents were in a drawn out and contentious separation. Courtney and I started meeting weekly in the fall of her junior year after she announced to her folks that she could not bear another day of their fighting. Though they disagreed about many things, Courtney’s parents both wanted to provide their daughter with some much-­needed support.

Once we got to know each other, Courtney and I set our minds to figuring out how she could manage the problems at home. Our first step was to determine what she could and couldn’t change.

“Honestly,” she said, “I don’t think that they’ll ever get along.” With an air of exasperation she added, “They say that they won’t fight in front of me, but they can’t seem to help themselves.”

“I’m really sorry to hear that . . . and can only imagine how painful it must be to hear them go after each other.”

Courtney looked at her hands and then back at me before replying wearily, “Yeah, it sucks.”

I reflected a moment before saying, “With regard to the fighting, I think you’re stuck. Your folks are the only ones who can make it stop, and it doesn’t sound like they’re ready to do so.”

Courtney ruefully nodded her agreement.

“So, as much as I hate to say this, I think that you have to find a way to accept that reality for now.”

Indeed, for difficulties that cannot be changed, research shows that practicing acceptance is the critical first step. If your nose wrinkles at the new-­age aroma wafting from the suggestion to “practice acceptance” (true confession: that was my own first reaction), consider it pragmatically. Why expend energy fighting an immutable reality? Once we find a way to digest a hard truth, we can get on with adapting to it.

Courtney, however, was having none of it.

Simultaneously incredulous and annoyed, she replied, “How can I possibly accept their fighting? It’s awful!”

About the Author

Lisa Damour, Ph.D.
Recognized as a thought leader by the American Psychological Association, Lisa Damour, Ph.D., co-hosts the Ask Lisa podcast, writes about adolescents for the The New York Times, appears as a regular contributor to CBS News, works in collaboration with UNICEF, and maintains a clinical practice. She is the author of two New York Times bestsellers, Untangled: Guiding Teenage Girls Through the Seven Transitions into Adulthood and Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls. She and her husband have two daughters and live in Shaker Heights, Ohio. More by Lisa Damour, Ph.D.
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