School refusal can be a deeply distressing experience for both teens and their families. Cognitive Behavioural Therapy (CBT) offers valuable insights into the thoughts, feelings, and behaviours that may contribute to this issue. By identifying and addressing these patterns, teens can begin to regain control and confidence in facing school-related challenges.
Let’s explore the common cycles of behaviour—called "maintaining processes" in CBT—that often contribute to school refusal and how they can be addressed.

Common Maintaining Processes in Teen School Refusal
Safety Behaviours
Safety behaviours are strategies teens use to avoid or minimise fear in situations they find overwhelming, like school. For example, a teen might sit at the back of the classroom, avoid eye contact with teachers, go to a quiet room/ mental health break room, or refuse to speak in group discussions. While these behaviors can provide temporary relief, they often reinforce the fear, making it harder to confront school-related challenges in the future.
Breaking the Cycle: Acknowledge the fear, but practice small, manageable exposures to the feared situation. For instance, start with attending one class or sitting closer to the front. The longer the safety behaviour is practiced, the more the individual is believing that they need to do it to feel better.
Escape/Avoidance
Avoiding school altogether or leaving early when anxiety builds is a common response. While it may feel like a solution, avoidance often exacerbates the underlying anxiety. It prevents teens from testing whether their fears—such as being judged or failing—are truly justified.
Breaking the Cycle: Gradual reintroduction to school, supported by a plan that includes coping strategies like mindfulness or relaxation techniques, can help rebuild confidence over time.
Reduction in Activity
When school refusal occurs, teens often withdraw from other activities they previously enjoyed, such as sports, hobbies, or socialising. This can lead to feelings of isolation, reinforcing negative thoughts about their ability to cope or fit in.
Breaking the Cycle: Encourage small, enjoyable activities outside of school to rebuild a sense of accomplishment and connection. These can act as stepping stones to more challenging tasks.
Catastrophic Misinterpretation
Teens with school refusal may misinterpret their feelings of anxiety as signs of failure, rejection, or something catastrophic happening if they attend school. For example, they may think, “If I give the wrong answer in class, everyone will think I’m stupid” or "They all look at me as if I am weird"
Breaking the Cycle: Challenge these thoughts by examining the evidence. For instance, ask, “Has anyone ever reacted like that before?” Mindfulness techniques, such as observing thoughts without judgment, can also help.
Scanning/Hyper-vigilance
Teens experiencing school refusal often become hyper-aware of potential threats, such as a teacher calling on them unexpectedly or peers judging them or a boistrous student misbehaving in class. This heightened vigilance can increase anxiety and make school seem more intimidating than it is.
Breaking the Cycle: Teach teens to focus on the present moment rather than "what if" scenarios. Mindfulness practices, like grounding exercises, can reduce the intensity of hyper-vigilance.
Self-Fulfilling Prophecies
Teens who believe they will be judged, fail, or be disliked at school may act in ways that inadvertently elicit these reactions. For example, avoiding group work may lead peers to see them as unfriendly, reinforcing the belief that “nobody likes me.”
Breaking the Cycle: Encourage teens to experiment with small changes in behavior, such as smiling or initiating a brief conversation. Positive feedback from peers can help shift their perspective. Using Imagination therapy is a technique to rehearse anxiety inducing situations in a calm therapy room and manage the reactions to them.
Perfectionism
Teens with perfectionistic tendencies may fear going to school unless they feel completely prepared, which can lead to procrastination and avoidance. They may believe, “If I can’t be perfect, there’s no point in trying.”
Breaking the Cycle: Emphasise progress over perfection. Helping teens set realistic goals and celebrate small wins, such as completing part of an assignment or participating in one class builds self-efficacy.
Recognising and Addressing These Patterns
Acknowledging these cycles is the first step toward breaking them. If your teen is struggling with school refusal, encourage them to reflect on their thoughts and behaviours. Consider these tips:
Track Patterns: Help your teen notice when and where their anxiety peaks. Understanding triggers can make it easier to address the underlying issues.
Challenge Thoughts: Gently question negative beliefs and replace them with more balanced perspectives.
Practice Mindfulness: Encourage your teen to use mindfulness to manage overwhelming emotions and stay grounded.
Support is Key
Breaking these cycles takes time and patience. If you have questions about CBT or how to support a teen struggling with school refusal, don’t hesitate to reach out. Remember, change is a process, but with understanding and effort, teens can build the confidence they need to face school with resilience which sets them up to facing college, university or their first job.
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