Anxiety

School Nurse’s Mental Health Toolkit

Everyone experiences anxiety. Anxiety is a common emotion and can be helpful or harmful.

Past or present trauma can provoke anxiety symptoms.

Students with severe anxiety can have self-harming behaviors or suicidal thoughts.

Anxiety is Helpful

To protect us when there is a
real threat.

To alert us to a stressful situation.

To help us face new challenges.

Anxiety is Harmful

When we see threats everywhere.

When we overestimate threat so that most situations are stressful.

When we avoid daily activities and new challenges.

Immediate Strategies

Listen and support

Let the student know that you hear how they are feeling and that you are there to help.

Communication Tips

  • Validate the student’s feelings: “It sounds like you’re worried about… That must be very hard.” Avoid saying “Everything is fine,” “Don’t worry,” or “That’s not a big deal.”
  • Check your feelings. Be calm, so you can calm the student.

Gather information without judgment. Be curious.

Do you know why you’re feeling worried?

What challenges are you having at home or school?

How are your worries affecting your sleep and concentration?

How do your worries make it hard to do what you normally do?

How often does this happen?

Explain anxiety. Let the student know that everyone gets anxious. Anxiety is helpful when there is a real danger or true alarm. Sometimes, we get a false alarm and overestimate the threat.

Signs of Anxiety

Academic signs:

  • Frequent trips to the nurse.
  • Leaving school early or arriving late.
  • Skipping school activities (e.g., gym, lunch, or recess). Excessive absenteeism.

Sleeping in class. Student might report:

  • Physical complaints (stomach aches, headaches, chest pain, racing heart, trouble breathing, feeling dizzy)
  • Excessive worry or fears.
  • Trouble concentrating.
  • Feeling afraid as if something awful might happen.

Trouble sleeping. Signs others might see:

  • Restlessness.
  • Irritability or acting out.
  • Using marijuana or other drugs to ease distress
  • Change in participation in normal activities.
  • Not wanting to engage with friends or activities.

Review the Cognitive Behavior Triangle

Visit the Depression section in this guide (page 9). Students with severe anxiety can be treated with therapy or medication or both. Changing one piece of the triangle (e.g., improving selftalk/thoughts) affects feelings and behavior. For example, changing a thought from “I’m going to fail this test” to “I studied and I’ll do my best” can decrease anxiety (feeling) and improve concentration (behavior). Changing behavior (deep breathing exercises) can improve anxiety (feeling) and help thoughts become more positive.

Panic Attacks

A panic attack is a period of intense fear or discomfort during which at least four symptoms of anxiety develop quickly and usually reach a peak within 10-20 minutes.

Students may experience panic attacks out of the blue or in response to a feared object or situation (e.g., a spider, taking a test, giving a presentation).

Signs and Symptoms

During a panic attack, a student will experience at least four of the following symptoms intensely:

  • Pounding heart or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Shortness of breath
  • Feelings of choking Anxiety/Panic Attack
  • Chest pain
  • Nausea or stomach pain Strategies
  • Pounding heart or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Shortness of breath
  • Feelings of choking Anxiety/Panic Attacks
  • Chest pain
  • Nausea or stomach pain Strategies

Strategies

Panic attacks are scary to experience and witness. You can help a student having a panic attack by:

Staying calm

Students are overwhelmed during a panic attack and may think they are going to die. By staying calm and speaking to the student in a soothing voice, you can help them to relax more quickly.

Providing reassurance

Let the student know that they are experiencing a panic attack, it is scary, but harmless and will pass. They are going to be fine. Reassure them that the symptoms will usually stop in 10-20 minutes and you can help them feel better.

Gathering information

Once the student is calm, you can be curious and non-judgmental to find out if this is happening frequently, and connect them with resources via your school protocols.

Patient Instruction

Showing the student how to slow down their breathing. A lot of the symptoms of panic are triggered by over breathing (hyperventilating). Encourage the student to try to slow down their breathing by taking slow, quiet, belly breaths in through their nose with their mouth closed and then out through their mouth. The greater the panic, the more time it will take for a student to be able to slow down their breathing.

Helping the Student

Helping the student feel more grounded. A variety of mental and physical grounding techniques can help a student shift their focus away from the symptoms of panic. For example, try the 54321 technique (page 19) or apply cold water or an ice pack to the face and hands.

Help them connect.
Always follow your school’s crisis protocols.
all or text 24/7. 988 for the Suicide & Crisis Lifeline.