1. Introduction
Adolescence is characterized by important psychological and psychosocial changes as the transition to adulthood is characterized by a heightened vulnerability to stress
[1]
. Adolescents have weaker compensation mechanisms and coping strategies than adults
[2]
[3]
. A growing number of adolescents are entering adult life equipped with maladaptive coping strategies.
Therefore, adolescents face a heightened risk of physical and mental symptoms later in their lives. Coping strategies should be offered as early as possible, ideally during school years
[4]
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[6]
.
According to WHO depression, anxiety and behavioural disorders are among the leading causes of illness and disability among adolescents. Globally, it is estimated that one in seven (14%) of 10 - 19-year-olds experience mental health disorder. The 2022 National Healthcare Quality and Disparities Report World revealed that this has been major driver of the increase in the rate of suicide, which now ranks as the fourth leading cause of death among the 15 - 29-year-olds.
The failure to address mental health disorders among adolescents impairs both physical and mental health in adulthood, thus limiting the prospects for a fulfilled adult life. Various authors are unanimous in their opinion, that one reason for mental health problems in young people is increased stress
[7]
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[9]
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Multiple factors have been identified as affecting mental health among adolescents. The more risk factors they are exposed to, the greater the potential impact on their mental health in adult life
[10]
.
Typical factors that contribute to stress during adolescence include exposure to adversity, pressure to conform with peers and exploration of identity Media influence and gender norms can exacerbate the disparity between an adolescent’s lived reality and their perceptions or aspirations for the future. Other important determinants include the quality of their home life and relationships with peers. Violence (especially sexual violence and bullying), harsh parenting and severe and socioeconomic problems are also recognized risks to mental health in this age group
[11]
.
The most common mental illnesses include depression, anxiety disorders, eating disorders and ADHD (attention deficit hyperactivity disorder). Symptoms can range from mood swings, sleep disorders, social isolation to self-harm or suicidal thoughts
[12]
[13]
.
Prevention and early intervention are recognized as key strategies for minimizing the impact of any potentially serious health condition. It should be emphasized that this does not necessarily fall within the responsibility of mental health professionals alone. Research evidence suggests that health researchers and professionals such as teachers and youth workers as well as health service institutions and governments should join forces to deliver integrated and multidisciplinary actions in mental health, especially in the early steps of the prevention chain. This should include a common effort to reduce stressful events in school and to implement coping strategies aiming to increase the resilience of adolescents
[14]
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[16]
.
A number of research reports describe the effects of stress management programs for schoolchildren and students interacting with teachers/parents, from peer pressure, from school/leisure conflict as well as compulsive behaviours. With respect to resilience, the intervention improved the adolescents’ individual skills and resources, relationships with primary caregivers, and the quality of environmental factors all of which facilitated a better sense of belonging
[17]
[18]
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Other interventions aimed at reducing stress and improving health by focusing on relaxation techniques and cognitive-behavioural strategies, which helped to identify and change maladaptive thinking and behaviour
[19]
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In order to analyse the effectiveness of different relaxation methods in young people, we recruited adolescents and performed different meditation programs (mindfulness training, autogenic training, muscle relaxation according to Jacobson, singing bowl massage). The participants assessed their preference for the respective relaxation method and the overall outcome of the respective mediation program by questionnaire.
4. Discussion
We aimed to test various forms of relaxation methods offered to schoolchildren in order to investigate their effects. According to UNICEF, analysis based on estimates from the IHME, Global Burden of Disease Study, 2019 average prevalence of psychological distress among young people amounts to 15% - 20% in different European Countries. Experts interpret the occurrence of psychological disorders as the cause of increased chronic stress among young people. Some authors have pointed to intensified demands of everyday school life, the social pressure to which young people are exposed in a performance-oriented society and to family circumstances as a possible source of this problem
[24]
.
The isolation of adolescents in the Corona crisis during school shut-downs may also have intensified stress among adolescents, creating a feeling of uncertainty and fear about the future
[25]
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While mental illnesses among adolescents are subject to a clear medical definition, the recognition of their continuous stress level as a possible precursor is difficult to calculate and measure. Given this background, the provision of successful stress relaxation programs to adolescents is a major challenge.
We studied the stress relaxation in a random sample design with students (11 female and 1 male) from two schools in Kreuzlingen (Thurgau Switzerland) at the pubertal age of 13 - 15 years (
Table 1
). In general students at this school level are particularly exposed to school stress.
We used a questionnaire for the self-assessment to quantify the participants’ perception and interpretation in 10 items (
Table 2
), while being aware of the fact that this may have led to subjective assessments. When conducting the intervention programs, we were not able to rule out influencing the students. In order to minimise the feedback influencing, the evaluation was performed anonymously. Despite that we cannot rule out possible weakening of our results. Still, this remains well within accepted practice of other authors, who also used self-surveys to obtain relevant data in this area of research
[26]
.
The assessments differed between the age groups only in the two items “excitement and tension” and “feeling of stress”. Here older participants showed stronger effects. This suggests that stress management should be applied early in puberty and should not be reserved for half-adult adolescents. In this regard, we proved our hypothesis, that even young people at this age are amenable to relaxation exercises. In most categories of the relaxation program participants reported a feeling of relief afterwards. Although these effects were not statistically significant (p > 0.05) we saw a positive trend after the relaxation in the items “feelings of stress” and related symptoms it “headache, vertigo and sweating”. It is noteworthy that the item “fears for (or about?) the future” had a significant effect. The relaxation exercises were obviously able to influence the participants’ perspectives regarding the future in the long term positively (
Table 2
;
Figure 2
; p < 0.001).
The power of the four relaxation programs offered was demonstrably equal. However, the relaxation with ancient sound bowls was rated with the best score in the cohort (
Figure 2
).
Results from investigations with adults cannot be directly transferred to younger age groups However, our results are consistent with reported achievements in adult groups
[27]
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We could show that stressed schoolchildren benefit from relaxation exercises (
Table 5
). In particular, since our research indicates that relaxation exercises can ameliorate stress, we have established that there are readily available effective methods of avoiding the long-term damage of ongoing stress in adolescents.
Besides the use of the singing bowls, our relaxation measurements were implemented without any special hardware. Evidently, it is unlikely that the success of these interventions was tied to the intellectual abilities of the young people. It has been shown that relaxation exercises modifies the neurovegetative functions.
Under parasympathetic control, sympathetic stress symptoms such as increased blood pressure, faster pulse, etc. can be ameliorated
[28]
. Adolescents are generally susceptible to sound and tones. The perception of sounds and active muscle tension influences the minds vegetatively and can trigger relaxation reactions
[29]
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To a certain extent, we observed the same effect also in cognitively focused methods such as mindfulness exercises and autogenic training. For the implementation in everyday routine, we hypothesize that the selection of relaxation methods should primarily depend on the setting and the needs of the young people individually as there may be individual preferences for different methods.
We assume that the implementation of relaxation methods in daily school life routine can reduce stress tension among schoolchildren. However, to increase success, the relaxation program should be offered regularly, as it is unlikely to have any particular side effects.
The pedagogical educational mission must also accompany the successful transition of young people into adulthood and ensure the psychological health of those who mature. A previous study with adolescents had shown that perceived social support may buffer the effects of academic stress on psychological wellbeing
[30]
[31]
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Young people suffering from mental health problems during early adolescence may be too psychologically impaired to positively contribute to social life as adults, as they carry their problems from youth to adulthood. It follows, that the problems of today’s youth can easily become problems of tomorrow’s society
[32]
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The rise in the prevalence of mental disorders among young people in Europe is an alarming signal. Health policy aspects must therefore be incorporated into educational policy of European countries.
Finally, we are in agreement with other authors who have identified stress management techniques for children and adolescents as an important tool for improving social skills and reducing anxiety, as well as preventing from depressive symptoms.