Mental health issues can have a profound impact on school performance, with anxiety creating significant challenges in the classroom setting. As teachers work to address barriers to learning, schools must develop a system to fully address the growing needs of students with anxiety. The purpose of this study was to examine the relationship between metacognition and its use as a mental health support strategy for students suffering from anxiety. 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.