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From Friends To School, 'Under Pressure' Helps Teenage Girls Navigate Adolescence


I live with two teenagers. Now, when I casually mention this fact to people who do not have teenagers, I'm often greeted with raised eyebrows, or even full-on horror, and then a question usually along the lines of, how's that going? Well, the honest answer is fine. They are great. But it does feel this stage requires an entirely different set of parenting skills than when they were toddlers.

Apparently, a lot of parents of teenagers feel this way, which is where Lisa Damour comes in. She's a clinical psychologist who specializes in the inner workings of teens, especially teenage girls. She's out with a new book. It's called "Under Pressure: Confronting The Epidemic Of Stress And Anxiety In Girls." Welcome to ALL THINGS CONSIDERED.

LISA DAMOUR: Thank you so much for having me.

KELLY: Start with the numbers. You write that stress and anxiety do not affect boys and girls equally - that it is the girls who suffer more. How much more?

DAMOUR: Well, there's a recent study that showed that 31 percent of girls reported suffering from symptoms of anxiety, compared to 13 percent of boys. So that's a pretty big gap.

KELLY: A certain amount of stress is not a bad thing, right? It's - we all need this in our lives to be productive, even to be healthy.

DAMOUR: The entire first chapter of my book is about how stress and anxiety are normal functions. They are normal and healthy. Anxiety is protective. Stress is what happens when we operate at the edge of our capacity.

But if we respond to all stress and all anxiety as if it were harmful, we actually run the risk of raising a generation that becomes stressed about being stressed and anxious about being anxious.

KELLY: All right. I want to get to some of the advice because you don't just write about this stuff. You have a practice. You have an office inside a school - is that right? - where you're seeing patients every day.

One of the games you describe playing with your patients is when they are wrestling with a challenge or a conflict, you ask them to think through three possible reactions, which you label as being a bulldozer, being a doormat or being a doormat with spikes. And I want you to talk us through.

The example you give in the book is an eighth-grader, who you call Liz, whose volleyball teammate told her, I'm not throwing a party. Liz finds out there was, in fact, a party, and she just wasn't invited. And this is devastating to her. And you ask her, OK, you have a range of options here. If you were going to bulldoze her, what would that look like? What's she say?

DAMOUR: Well, so she was able to very easily join in this way of thinking and to say, oh, well, then I would go up, and I would yell at her directly. I would let her know how angry I was.

KELLY: And then doormat?

DAMOUR: Doormat would be, oh, I would stay home and cry and wonder why I was left out and why nobody wants me at their party - you know, sort of a pity party of one.

KELLY: And then doormat with spikes, which is, upon reflection, the way I got through a lot of high school. What would that look like?

DAMOUR: Well, doormat with spikes is basically passive-aggressive behavior. And I will tell you you're not alone. Most humans, when they're angry, default to doormat with spikes behavior, which is where we seem on the surface to be OK with what happened, but then we find another way to punish the person we're upset with. So that might be talking about this teammate on social media or sharing with other people how angry she was but not taking it up directly.

KELLY: Like gossiping behind somebody's back - that type of thing.


KELLY: So Liz, being smarter than I was as a teenager, does not do that. In fact, she doesn't do any of these things. She didn't confront the other girl and comes back to you and is still distraught about it. And you present her with a fourth option, which was my favorite of all. Describe it.

DAMOUR: Well, so what I initially suggested is that she might act as a pillar - right? - to stand up for herself while being respectful. And that's under the headline of if you're going to have a conflict, please try to avoid the less healthy forms - the bulldozer, doormat and doormat with spikes. Try to be a pillar.

But she came back and said, I didn't even do that. And I said to her, you have another choice, and that is emotional aikido.

KELLY: Emotional aikido, OK.

DAMOUR: And this is where - this is taken from the martial arts form aikido. And I don't know a whole lot about it, but I do know it's true that the first move in aikido is that if somebody comes at you, you actually step to the side and let them go past. And emotional aikido is when we make a tactical decision to not engage a conflict.

And one of the things I have really watched happen is that in a well-meaning way, adults tend to urge girls to respond to every slight or annoyance. I think that it's sort of often in the name of empowerment - like, you need to let her know you were hurt...

KELLY: Yeah.

DAMOUR: ...Or you need to ask her what happened. And I do - I think it is with the best intentions. But no functioning adult engages every annoyance. And we need to extend to our daughters the choice of deciding, is this a conflict that I care about? Is this a relationship that I really care to repair? And if they answer, no, to all of those questions, it is not being a doormat for them to decide to just let it drop.

So I love thinking with young people about the various forms of conflict and acknowledging our first instinct isn't always so healthy. Luckily, we've got some backup options.

KELLY: This prompts me to ask you about the word, no, and learning to say, no, to everything from extracurricular commitments to sex. What you write about it - this can be a tough one for girls.

DAMOUR: It can. We want our daughters to never do something they don't want to do. We also have to recognize that they - and boys, too - care about their relationships and care about the people on the receiving end of their no.

The way I see it is that we don't want to dictate to girls how they should speak. We want to give girls verbal toolkits. And in those toolkits, they should have a hammer for when they need it, but they should also have a tweezer for when they need to be more delicate about things.

I am cautious of advice that suggests that there is one way to speak that will always work for anyone.

KELLY: I do want to ask you - a lot of the girls who we meet on these pages are privileged. They are ones who sound as though they are headed to college, who have parents who are seriously engaged, for better or worse, in their lives. I wonder, for the rest of the population that is living a different experience, do the tips, do the advice - does that translate?

DAMOUR: Without question, people who don't have the economic resources they need and deserve and who are faced with racial, ethnic, religious discrimination are dealing with an entire extra layer of stress and anxiety in their lives.

One of the things that we can start to do is think about the various forms of stress and anxiety that people have to deal with in their lives. And in truth, there are people who are dealing with chronic stress as a function of living in a dangerous neighborhood. That cannot be put on the same yardstick as the stress of trying to get into an elite college.

And so as we start to sort through stress and anxiety and its various sources, we do need to take a close look at what's under someone's control and what is outside of someone's control, and then think about what are our social obligations to people who are in stressful or anxiety-ridden situations that they can do nothing about.

KELLY: Lisa Damour, thank you.

DAMOUR: You're welcome. Thank you so much for having me.

KELLY: The new book is titled "Under Pressure: Confronting The Epidemic Of Stress And Anxiety In Girls." Transcript provided by NPR, Copyright NPR.