Mental health issues affect learning and performance in profound ways. Schools tend to lack a comprehensive approach to address the needs of students with anxiety, due to the limited training staff receive in mental health identification and support. As teachers work to address barriers to learning, schools must develop a system to fully address the growing needs of students with anxiety. Metacognition plays a significant role in clinical psychology and is used as a mental health intervention and support in clinical settings. The possibility of the application of a specific cognitive strategy to classroom settings in order to support elementary students with anxiety could impact how students are served appropriately for mental health issues within the school setting. The purpose of this study was to examine the relationship between metacognition and its use as a mental health support strategy for elementary school students suffering from anxiety. The study presents a critical analysis of metacognition studies in both the educational setting and the clinical setting, as well as examines teacher perceptional data about supporting students with anxiety within the classroom. Participants in the study consisted of a convenience sample from an ex post facto survey administered to school staff in a small suburban Washington school district. Results of the study showed a statistically significant relationship between the use of metacognition, self-regulation as a component of metacognition, and teacher confidence level in supporting students with anxiety. This study works to further advance the growing body of knowledge regarding the teacher's role in the support of mental health needs of students. Though the level of cognitive monitoring in children with generalized anxiety orders is not fully understood, further research linking the strategy of metacognition for students suffering from anxiety as a possible school intervention could aid the field of education in serving the social, emotional and behavioral development of students with anxiety. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com.bibliotheek.ehb.be/en-US/products/dissertations/individuals.shtml.]