This Newsletter aims to promote communication between schools and the Student Health Service of the Department of Health

Dec 2013 Issue No.61

Published by the Student Health Service, Department of Health


When under stress, we would easily become anxious. Anxiety doesn’t only happen among adults. Students nowadays are under a lot of stress. These stress come from their studies, details in their daily life and expectations from their parents & teachers. For secondary students, they have to worry about future studies and employment too. If we educate our students on how to recognize the signs and learn how to manage anxiety, then it could minimize the impact of anxiety on their lives. Therefore, in this edition of “Bridge”, our clinical psychologist will discuss with our students about anxiety and how to manage it.

Anxiety management – Self-help tips for senior high school students

Clinical Psychologist Ms. Chan Yuk Yee


Senior high school students are confronted with multiple sources of stress. For examples, further academic development, interpersonal relationship, expectations from parents, time management and economic difficulties, etc, often bring stress to them; failure to manage stress may lead to serious problems of anxiety and impairments of mental health. It is much better to prevent than to treat. The negative effects of anxiety can be greatly reduced if students can correctly understand the nature of anxiety, its signals and the effective ways of its management.

(1) Recognizing anxiety

Anxiety usually arises when our personal safety or self-esteem is threatened, or when we worry to lose something precious. Apart from subjective sensations, there are other perspectives to understand anxiety and they are: Physiological responses, Ways of thinking, and Behavioral acts. To understand the interplay of these three elements will help us to manage anxiety effectively.

Some main elements of anxiety:

  1. Physiological responses - when confronted with threats, our physical alarm system will be triggered to respond to possible danger; reactions of the body include increased heartbeat, rapid breathing, dilated pupils, increased concentration and alertness, dry mouth and sweating, etc. These reactions often bring discomforts and they may make people feel being overwhelmed in extreme case.

  2. Ways of thinking – Anxiety usually comes as a result of an individual’s negative appraisal of events and environment. There are three common ways of negative thinking: i) over evaluating the risks and threats, for example, believing that most other people would comment on ourselves in social situations, ii) assuming we cannot manage, for example, imagining we cannot join others’ conversation, and iii) expecting the worst would result, for example, guessing other people will think we are strange and foolish. We need to examine whether we often have these negative ways of thinking which produce unnecessary anxiety.

  3. Behavioral responses - uncomfortable physiological reactions come together with negative thinking are likely to foster people’s tendency to escape, avoiding the subject matter that causes anxiety. For example, those who feel anxious meeting strangers often tend to avoid social occasions and public speaking; if forced to join, they may be avoiding appropriate eye-contact with others, staying aside, or keeping silent. The problem of avoidance behaviors is that it reinforces the erroneous belief that the individuals are unable to cope with the subject matter.

(2) Common signals of anxiety:

There are common signals of anxiety. If students find themselves often come across the following experiences, they may have been suffering from undue anxiety and they should take initiative to seek help from parents, teachers or guidance personnel. Those signals are:

Academic/ Behavioral

  • Perfunctory or missing school work

  • Withdrawal from school activities

  • Indulgent in addiction

  • Deteriorating grades

  • Truancy

Personality/ Emotional

  • Being too shy

  • Feeling hard to concentrate

  • Easily irritable or losing temper

  • Often hesitate and indecisive


  • Sudden change of appetite

  • Having dizziness or nausea

  • Trembling

  • Feeling fatigue

  • Headache or stomach pain

(3) The negative and positive aspects of anxiety:

In fact, anxiety is an integral part of human nature. Severe anxiety may lead people to overreact, making a fuss or feeling apprehended long after the danger had gone, and thus undermining our performance and health. In the favorable light, anxiety works as an effective alarm to remind us to take appropriate preventive actions. For example, feeling anxious before exam will alert students to study hard to get better grades. Therefore, a fair view on anxiety is to reduce its undue harms and to get its positive use.

Ways to manage anxiety

  1. Prevention
    Stress and anxiety are closely related. Maintaining a healthy lifestyle can enhance our stress resistance and reduce anxiety. After validation, Professor LEUNG Y.K. (Professor of The Department of Psychology of The Chinese University of Hong Kong) proposes the "Seven-Well Stress Management Approach”to manage stress and anxiety. The approach states that stress and anxiety can be effectively managed by the following ways:

    1. Eat Well - maintaining nutritional balance and regular diet

    2. Sleep Well - obtaining adequate sleep

    3. Exercise Well - doing aerobic exercise regularly and this will help the brain to release "Endorphins" to ease our stress

    4. Play Well - cultivating personal interests and healthy recreational activities to enliven our busy study life

    5. Work Well - adopting effective time management and avoiding delays; positive emotions can also be derived from studying an interesting subject or working on a rewarding task

    6. Love Well – enhancing our social skills and expending our support network; expressing gratitude to our loved ones can help the brain to produce related chemicals to ease our stress

    7. Mind Well – being positive to do our best and optimistic for the future, keeping a sense of humor, and believing in taking an active role to cope with difficulties

  2. Practical skills

    1. Relaxation skills
      Anxiety keeps the body in a combat state. Relaxation exercises can ease the body and mind by systematically slowing down our heartbeat and breathing, relaxing our muscle and blood pressure, and thus alleviating stress and anxiety. We recommend students to fit regular timeslots to practice the following exercises one to two times every day; each exercise may last for about 15-20 minutes. The relaxation exercises are:

      1. A. Deep breathing relaxation:

        1. Sit or lie down on a comfortable place.

        2. Put both hands on the abdomen.

        3. Slowly and deeply inhale from the nose; imagine the hands are placed on an inflating balloon.

        4. While inhaling to the full, hold the breath and, count slowly in your heart: 1... 2... 3…

        5. Slowly exhale from the nose or mouth; imagine the inflated balloon is deflating slowly.

      2. Progressive muscle relaxation:

        1. Sit or lie down on a comfortable place where you can stretch your arms and legs.

        2. Close your eyes to focus on the body.

        3. Hold your fists tightly; feel the tension of the hands and forearms; count slowly in your heart: 1... 2... 3…

        4. Relax your fists slowly and naturally; feel the released tension of your forearms; relax and state calm for about 20-30 seconds.

        5. Bend your arms; keep your wrists close to the shoulders; tighten your upper arms; feel the tension of the upper arms; count slowly in your heart: 1... 2... 3…

        6. Put down your arms slowly; feel the released tension of your upper arms; relax and state calm for about 20-30 seconds.

        7. Tighten and relax one by one the following muscles of the body: shoulders, neck, back and feet, until the whole body is relaxed.

      3. Imagery:

        1. In practice, Imagery is the plan to enjoy "daydreaming": focus your mind in a quiet, beautiful and comfortable place.

        2. Sit or lie down in a comfortable and quiet place; close your eyes.

        3. Imagine, you go to a spacious, quiet and beautiful beach where the water is clean and the sky is blue; there are sea breezes and birds singing; you stand on fine sand and your feet are warm; you feel comfortable…

    2. Cognitive skills
      One of the main causes of anxiety is people's thoughts and understanding of the incident. We can modulate our thoughts and understanding of the environment to manage anxiety.

Three steps to modulate our thoughts

Step one: to identify your autonomic thought: What am I thinking?

Some kind of thoughts will make us feel anxious but they are so subtle that we may not be aware of them. To identify those thoughts, we need to immediately record the related time, incident, place and people when we feel anxious. To facilitate recording, we may keep a piece of paper with us to record our thoughts and related emotions timely.

Step two: to evaluate your thought: Is it reasonable? How realistic is it?

We need to evaluate those thoughts objectively to see whether they are realistic. Identifying unreasonable and exaggerated thoughts can help us to reduce unnecessary anxiety. The following questions can help us to evaluate how realistic our worries are and they may reduce unnecessary anxiety too:

  1. What is the chance for my worry to happen?

  2. Are there alternative explanations or causes of my worry?

  3. What if the worst happens? Can I manage?

  4. If it cannot be changed, how can I reduce my worry?

Step three: to change your thoughts: Can I have better ideas?

  1. list out those unreasonable or unrealistic thoughts that cause your anxiety.

  2. replace them with more reasonable and realistic ones.

  3. practice positive self-talk and positive thinking persistently.

  4. knowing that anxiety fosters negative thinking, use positive thoughts to balance and remind yourselves.

We can apply the above three steps to modulate our thoughts. When reasonable and realistic ones become dominant, we will be more cheerful and active to solve problems.


  • Feeling anxious is a natural emotional reaction when we are confronted with danger and difficulties.

  • Appropriate degree of anxiety helps us to state alert, avoid danger and enhance performance. However, excess or prolonged anxiety may undermine our physical and psychological health, study, and social lives.

  • Maintaining a healthy lifestyle is an effective way to enhance our stress resistance and prevent anxiety. We may also apply various skills, such as relaxation skills and thought modulation skills, to reduce anxiety.

  • If we suffer from undue or prolonged anxiety, we should take initiative to seek help.

Information of community resources and related hotlines:

  1. Mental health/ Counseling services:

    • Hospital Authority- 24 hours Mental Health (Hotline: 24667350)

    • Mental Health Association of Hong Kong (Hotline: 2772 0047)

    • Tung Wah Group of Hospitals (Hotline 25480010)

    • The Hong Kong Federation of Youth Groups (Hotline 27778899)

    • YWCA (Hotline: 27116622)

  2. Other websites of anxiety and mood disorders:

    • Mental Health Association of Hong Kong :

    • Hong Kong Mood Disorders center:

    • United Centre of Emotional Health and Positive Living:

    • Anxiety Disorders Association of

Bridge Blog

Anxiety is part of life and we believe that primary or secondary students would have experienced it. If we adopt a positive attitude when we are anxious, it would energize us and help us as we are growing up. In this issue, we would like to share some tips on how to deal with anxiety collected from our students :

Doing exercise

Watching movies


Chatting with friends

Seeking help from others

I shall feel good after sweating it out with a jog in the park

Be Happy and Think Positive

Listening to music

Take a deep breath, calm down and think deeply or have a drink of water

Bridge Chats

+852 1234 4321 Fai-fai

When I was going to present my project, my heart beats very fast, my palms sweat and muscle tense. I'm afraid that I might have anxiety disorder?

The Bridge

The symptoms are caused by stress arose from your presentation, resulting in a series of physiological reactions. However, such reactions allow us to fully utilize our ability and enhance the efficiency. As a result, we can meet the challenges.

+852 1234 4321 Fai-fai

But I have poor appetite the day before my presentation and could hardly sleep that night!

The Bridge

You can practice aerobic exercise, such as playing football or basketball, running, etc., which help relieving tension and stress. Besides, muscle relaxation exercise or breathing relaxation exercise, etc., will help relieving tension and aid sleeping.

The Bridge

Of course, being well prepared and plenty of practice really help. Furthermore, always motivate yourself by saying "I can do it!" and "Sure win!” Come on, you can surely do better!

+852 1234 4321 Fai-fai

Thanks! :)

Junior Health Pioneer

Momo and Gigi are very good friends. Momo felt very uncomfortable recently and he talked to Gigi about his feelings. Gigi thought he might have anxiety and made some suggestions. She was also willing to spend more time with him.

Momo: I feel very uncomfortable.Cannot sleep well and my hands sweat a lot. Sometime my heart beat very fast too. I also feel very tired as if I have not sleep at night.
Gigi: Don’t worry! You may have anxiety. Just relax, talk to your parents so that they will understand and help you to go through with it.
Momo: Will you accompany me? I am afraid of being alone. I feel restless all the time and could not settle down.
Gigi: Don’t worry, we shall do our school work and revise together. How about going to the theme park over Christmas and enjoy ourselves?

For enquiries of student's health problem, please write to "Health Box"

E-mail Address:

Editorial Board Members: Dr. HO Chun-luen, David, Ms. LAI Chiu-wah, Phronsie, Ms. CHAN Shuk-yi, Karindi, Ms. CHOI Choi-fung, Ms. CHAN Kin-pui
Tel : 2349 4212 / 3163 4600
Fax : 2348 3968

Back Top
Last Revision Date : 9 December 2014