10.5 Preventing and Addressing Stress, Anxiety, Substance Use, and Bullying
Key Takeaways
In CDC's 2023 YRBS, about 40% of high school students reported persistent sadness or hopelessness and about 20% seriously considered suicide.
Tier 1 lessons on stress management, study skills, and test-taking are appropriate direct services; Tier 2 adds CBT-based groups; Tier 3 adds referral and coordinated care.
SBIRT means screening, brief intervention, and referral to treatment; CRAFFT is a validated adolescent substance-use screen.
Bullying involves intentional, repeated aggression with a real or perceived power imbalance; ASCA A.11.d requires reporting bullying, dating violence, and harassment to administration.
Effective bullying prevention is whole-school and teaches bystanders to act as upstanders; peer mediation and zero tolerance alone are not recommended.
10.5 Preventing and Addressing Stress, Anxiety, Substance Use, and Bullying
Quick Summary: ETS expects you to know methods for preventing and addressing common student concerns such as stress, anxiety, substance use, and bullying. The counselor's approach is tiered: Tier 1 prevention for all students, Tier 2 small-group and brief interventions for students at risk, and Tier 3 referral and coordinated care for intensive needs. Discipline is never the counselor's tool.
Why These Concerns Matter
CDC's 2023 Youth Risk Behavior Survey found that about 40% of U.S. high school students felt persistently sad or hopeless during the past year, about 20% seriously considered attempting suicide, and about 9.5% attempted suicide; female and LGBTQ+ students reported much higher rates. Anxiety, substance use, and bullying often occur together with these symptoms and drive absences and failing grades.
Stress and Anxiety
Nerves before a big test are normal. Anxiety needs attention when it causes avoidance (such as school refusal), panic, frequent physical complaints (stomachaches on school mornings), or impairment across settings.
| Tier | Interventions |
|---|---|
| 1 | Classroom lessons on stress management, sleep, breathing, study skills, and test-taking (the ETS study companion lists these as appropriate counselor activities); coping-skills lessons (B-SMS 7) |
| 2 | Short-term CBT-based small groups (cognitive restructuring, relaxation, gradual exposure); brief individual counseling; consultation with teachers |
| 3 | Referral to community mental health; coordination with outside therapists (with a signed release); referral to the 504 team if anxiety substantially limits learning |
Test anxiety: teach preparation (spaced practice and practice tests), in-the-moment calming (paced breathing, grounding), and cognitive reframing ("One test does not decide my future"). For a student with anxiety who is awaiting a 504 evaluation, the ETS study companion identifies short-term, goal-focused counseling on calming strategies as the counselor's most direct support; the team, not the counselor alone, decides accommodations.
School refusal: distinguish anxiety-based avoidance from truancy. Build a gradual re-entry plan with the family and teachers, use graded exposure (see systematic desensitization in 3.3), and avoid long stretches of home instruction that reinforce avoidance.
Substance Use
Risk factors: early use, family substance use, peer use, trauma and adverse childhood experiences, untreated mental health problems, and low school connectedness. Protective factors: parental monitoring, school connectedness, clear norms, involvement in activities, and developmental assets.
Alcohol, cannabis, and nicotine vaping are the substances adolescents use most often. Counterfeit pills containing fentanyl have made experimenting with pills far more dangerous, so prevention lessons now include that risk and awareness of naloxone.
The counselor's role:
- Tier 1: evidence-based prevention lessons, accurate norms ("most students do not use"), and refusal skills.
- Tier 2: screening and brief intervention—the SBIRT model (Screening, Brief Intervention, and Referral to Treatment)—using a validated screen such as CRAFFT (named for its questions about riding in a Car driven by someone using, using to Relax, using Alone, Forgetting things, Friends or family saying to cut down, and getting into Trouble), combined with motivational interviewing (8.4).
- Tier 3: referral to treatment, coordination with families and providers, and re-entry support.
- Confidentiality: substance use does not automatically require a breach, but use that creates serious and foreseeable harm (overdose risk, driving impaired) triggers parent/guardian notification (A.9). Discipline for possession belongs to administrators.
- Family influence: children of parents with substance use problems benefit from support groups (see 7.4).
Bullying
Definition: the ASCA Ethical Standards define bullying as intentional, repeated harmful acts, words, or other behavior committed by one or more children against another, where a real or perceived imbalance of power exists. CDC's uniform definition likewise requires unwanted aggression, a power imbalance, and repetition or a high likelihood of repetition.
Forms: physical, verbal, relational or social (exclusion, rumors), cyberbullying, and damage to property.
Roles: the student who bullies, the target, bystanders, and upstanders who intervene safely or report.
Effective practice:
- Whole-school programs (for example, the Olweus Bullying Prevention Program) that combine clear rules, adult supervision, classroom meetings, and individual interventions.
- Upstander education: teach safe ways to help—support the target, refuse to join in, and report.
- Avoid peer mediation for bullying and avoid relying on zero-tolerance suspensions alone.
- Report bullying, harassment, and dating violence to administration (ASCA A.11.d). Harassment based on race, color, national origin, sex, or disability can violate federal civil rights laws (Title VI, Title IX, Section 504, and the ADA), and every state has an anti-bullying law.
- Support both sides: safety plans, check-ins, and counseling for targets; skill-building and accountability (including restorative practices) for students who bully, while administration handles discipline.
Tiered Summary
| Concern | Tier 1 | Tier 2 | Tier 3 |
|---|---|---|---|
| Stress and anxiety | Coping, study-skills, and test-taking lessons | CBT-based groups, brief counseling | Community referral, 504 referral |
| Substance use | Prevention curriculum and norms | SBIRT with MI | Treatment referral and coordination |
| Bullying | Whole-school program and upstander lessons | Support groups for targets; social-skills groups | Safety plans, coordinated care, civil-rights processes |
Praxis Application
Scenario: A ninth grader tells the counselor she vapes nicotine "to calm down" before tests.
Analysis: Treat both concerns. Teach coping strategies for test anxiety, use motivational interviewing to explore her mixed feelings about vaping, and offer cessation resources. Follow district policy on notifying parents/guardians, and leave any discipline to administrators.
Which activity best represents a Tier 1 school counseling response to rising test anxiety across a grade level?
Referring every anxious student to a psychiatrist
Requiring anxious students to take tests in the counseling office
Assigning detention to students who miss tests
Classroom lessons on test preparation, calming strategies, and cognitive reframing for all students in the grade
During a brief screening, a tenth grader answers "yes" to several CRAFFT questions about alcohol use. Within the SBIRT model, what is the counselor's next step?
Report the student to the school resource officer for underage drinking
Provide a brief intervention using motivational interviewing and, if risk is high, refer the student to treatment while following policy on notifying parents/guardians
Tell the student that screening results stay confidential in every circumstance
Place the student in a peer mediation session with friends who drink
Which response to cyberbullying best follows the ASCA Ethical Standards and bullying-prevention research?
Bring the target and the students posting the messages together for peer mediation
Advise the target to delete social media and ignore the posts, without making a report
Report the bullying to administration, support the target with a safety plan and counseling, and teach bystanders to act as upstanders
Suspend the students who posted the messages
Sections you finish are checked off in the contents.