Anne Marie Albano, PhD
Associate Professor, Clinical Psychology in Psychiatry
Director, Columbia University Clinic for Anxiety and Related Disorders, Columbia University Medical Center
Classrooms are ripe for social anxiety triggers
From being called on in class to navigating the hallways, school is rife with social stressors. However, for children and teens with social anxiety disorder, school can be even more stressful, as school presents a full day of social interactions with peers and authority figures. The day can harbor countless opportunities to be embarrassed or say something humiliating. As a result, many young children with social phobia have a hard time transitioning to school and may cling to parents or have long, tearful good-byes. Older children and teens may simply refuse to go to school.
Ironically, school can also provide an ideal, natural treatment setting for children and teens suffering from social anxiety disorder. Research indicates that students are more likely to engage in school-based treatment than treatment at a mental health center. In addition, school offers a readily accessible setting for practicing social skills and confronting social fears in a supportive environment.
By increasing support and funding for school-based interventions, we improve the chances that children and teens with social anxiety disorder will overcome the crippling anxiety that diminishes their quality of life and stunts their potential.
Why schools are the right treatment setting
Twelve percent of all youth suffer from social anxiety disorder, yet very few receive treatment. Obtaining mental health services for any disorder can be a challenge, as families may not have access to providers or transportation, or may lack the financial means to pay for care. Children with social anxiety disorder are especially reluctant to engage in treatment, as interacting with authority figures is stressful.
In contrast, all young people have access to public schools and are legally required to receive an education. Providing school-based cognitive behavioral therapy (CBT) supports opportunities for children to confront anxiety-provoking situations that can’t be simulated at home or in a therapist’s office, such as
- Interacting with an authority figure
- Taking tests
- Walking through the hallway with friends
- Finding a place to eat in the cafeteria
CBT is a proven treatment method for social anxiety. Children learn different ways of thinking, behaving and reacting to situations so they feel less anxious and fearful.
Schools with successful CBT programs use screenings at the beginning of the school year to identify students or they are referred by a teacher. Once parents provide permission, the students are offered group therapy after school or during the school day. We have seen that 10 to 16 group sessions can really turn a child around.
Another more universal school-based approach is to present life-skills training and anxiety management as part of regular health classes. If we address social anxiety and worry in the course of the regular curriculum, it can normalize the behavior and help children learn to manage it. Plus, teachers can identify students who might need a little more support, enabling counselors to work with them individually.
Addressing concerns about school-based therapy
Invariably, some people will object to bringing psychiatric evaluations and screenings into the school setting. Some people have concerns that introducing more mental health services into the school setting will lead to more students being prescribed medication.
In my mind, this is a shame and wasted worry. Offering children basic skills for managing emotions such as lessons in mindfulness, and teaching children to become problem solvers rather than worriers, is fairly benign and have no other intention than to be helpful. Many teachers—good teachers who recognize the whole child—have been doing this sort of thing for a long time. If we can implement these types of lessons and group support in more schools and at earlier ages, we will likely reduce the need for more extensive therapy and medication treatment down the road.
- What services are appropriate for schools to offer to students dealing with social anxiety disorder?
- What are the down-sides of providing psychological services to students with social anxiety disorder, and do they outweigh the benefits?