Harvard Educational Review
  1. Under Pressure

    Confronting the Epidemic of Stress and Anxiety in Girls

    Lisa Damour

    New York: Ballantine Books, 2019. 288 pp. $27.00 (cloth).

    In Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls, Lisa Damour challenges readers to reframe the way they think about stress and anxiety in order to alleviate the rise of anxiety in girls. According to Damour, stress is a healthy stimulus for achieving personal growth, and capacity for stress is built when overcoming challenges. The key to building this capacity is helping girls find and embrace reasonable levels of stress and anxiety. Damour leverages her extensive knowledge of clinical psychology and her research in the field, her role as executive director of Laurel School’s Center for Research on Girls, her private psychotherapy practice, and her own experience as a parent to address different domains in a girl’s life that can be sources of toxic stress and anxiety.

    Initially, the framing of stress and anxiety as healthy may seem surprising for a book that provides evidence that stress and anxiety are on the rise for girls. Damour draws on research by the American Psychological Association to make the case that teenagers today are more stressed than their parents were a generation ago. Alarmingly, in study after study, more girls than boys report experiencing the symptoms associated with anxiety. Girls between the ages of twelve and seventeen are also three times more likely than boys to suffer from depression. This gender imbalance continues into adulthood. Damour cites an American College Health Association study which found that women undergraduates are 43 percent more likely to feel anxious than men undergraduates. Drawing on these statistics to convincingly outline the problem, Damour contends that an in-depth look at stress and anxiety can provide readers with some insights into how to start to help girls cope with anxiety.

    Damour explains that the point at which healthy stress shifts to unhealthy stress varies from person to person and is dependent on two factors. First, the type of problem and, second, the person and the resources this person has to cope with the problem. She notes, “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” (p. 5). Once she defines the scope of the problem and provides convincing evidence of the stress epidemic in girls, she walks the reader through the mechanics of stress and anxiety. She defines stress as “the feeling of emotional or mental strain or tension” (p. 11) and anxiety as “the feeling of fear, dread, or panic” (p. 11), and she uses the terms interchangeably throughout the book. She dedicates a chapter to each of the major facets of girls’ lives that can be sources of stress, including home life, other girls, interactions with boys, school, and the broader culture.

    One of the book’s strengths is its description of how education can be a source of anxiety and stress and its provision of actionable steps to help girls reduce their academic stress. Damour uses cases from her own practice to illustrate sources of stress and academic patterns that are not serving girls well, at least not in the long term. This is a bit of a paradox, because girls are doing well in school; on average, they are doing better than boys. Girls tend to get better grades, to take more Advanced Placement courses, and to enroll in college in higher numbers, according to the evidence Damour provides. Contrary to stereotypes, girls are also performing better than boys in science and math. However, informed by her professional practice, Damour argues that girls generate too much unhealthy stress in their quest for success. Her patients have punishing schedules, they are early to rise and late to go to sleep. The long days are due in part to ineffective and untargeted study strategies, Damour illustrates. For example, girls tend to treat all subjects equally if they are not encouraged to channel their enthusiasm and strengths for some topics and not others. And they want to perform perfectly in all topics. They highlight, underline, and color code. Using research from the learning sciences about effective learning strategies, Damour points out how ineffective study strategies can be linked to toxic stress.

    Damour argues that passive study strategies are pernicious because they are largely ineffective, though they do alleviate some anxiety by giving girls the feeling that they are adequately prepared. This “slavish overpreparation” can also yield good grades early on in school. Once girls make a link between overpreparing and good grades, it is very difficult to change their ways, even though this practice is not sustainable long term. Damour suggests that parents recommend and explain why effective study strategies work before girls are in the high-stakes environment of high school. For example, instead of long cram study sessions, girls should use spaced practice. Rather than passive study strategies like highlighting, underlining, and color coding, girls should use sample testing. Sample testing helps girls identify where they need to focus their study time rather than spending equal (and unnecessary time) on all concepts. These active study strategies are a part of a more general effort to help girls become “academic tacticians” (p. 151) who figure out how much work is necessary to earn the grade they want and do no more than is required. Damour’s recommendations in favor of targeted and active approaches to studying are sound and supported by the learning sciences (Sawyer, 2014).

    While coaching girls to become academic tacticians may sound instrumental, it is part of a larger goal to get girls to recognize and rely on their strengths. Damour argues that when girls spend their efforts cultivating a strong work ethic, they get fewer opportunities to rely on their talent. An inclination toward overpreparation means that girls have fewer opportunities to see how they perform based on their aptitudes and talents, without hours of preparation. Damour links this idea with the study by Kay and Shipman (2014) that investigated Hewlett-Packard’s management and found that women applied for top positions when they fulfilled all the qualifications, while men applied when they fulfilled 60 percent of the qualifications. Damour contends that “by the time they enter the professional world, [men] feel self-assured, because they have literally spent years testing the limits of their native abilities, constantly calibrating their sense of how much work they have to do to be successful. Our daughters should arrive in the professional world having done the same” (p. 156). She argues that we should help girls learn when hard work is necessary and when relying on their talents will do, because when girls have a more precise sense of their strengths, they exert their effort more efficiently, can feel more confidence in their abilities, and will feel less uncertainly about their ability to succeed.

    Although the book is targeted to parents of school-aged girls, it also has the potential to help adult women. Perhaps it was Damour’s comforting tone or the care with which she writes about her patients, but I easily related to the girls in her book and found connections to my own journey with anxiety. A couple of years ago my therapist asked me, “Can you think about times when stress and anxiety have been helpful?” This single question surprised me and catalyzed what would become the reframing of my stress and anxiety. And while I still have to manage my stress and anxiety, I no longer stress about the stress itself. I have also started sharing with others, when appropriate, that no, what I experience is not just normal nerves. Sometimes, I cannot breathe; I feel like I might just die, and yet I know I will be okay. Sharing my experience with anxiety has been possible only after reframing stress and anxiety as a necessary biological mechanism—or as Damour puts it, “these mental states are essential catalysts for human growth and development” (p. 3). After my therapist asked me to consider the potential productive aspects of stress, much like Damour asks readers to do early in the book, I was able to confront my anxiety directly and keep from going deeper into a rabbit hole where stress about my anxiety spiraled into greater anxiety. It was reassuring to read Damour’s description about how stressing out about stress can indeed lead to more anxiety. Her positive framing of and openness about stress and anxiety is necessary to begin thinking about solutions to the stress epidemic in girls.

    Under Pressure provides both a helpful understanding of stress and anxiety and practical guidance for both parents and educators in the face of this epidemic.

    Isaura J. Gallegos

    Kay, K., & Shipman, C. (2014). The confidence code: The science and art of self-assurance—what women should know. New York: HarperBusiness.

    Sawyer, R. K. (Ed.). (2014). The Cambridge handbook of the learning sciences. New York: Cambridge University Press.
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