All about Anxiety at College

Today I’m talking about college student anxiety. I’m going over some basics of anxiety disorders, what they look like from a clinical perspective and, most importantly, what can be done to treat college students. For more information, check out this episode’s show notes and visit my blog at robdanzman.com. I also have a whole chapter on anxiety in my first book Insider’s Guide to Parenting: How to Solve Messy Problems and Build a Great Family. You can find it on amazon.

https://www.youtube.com/channel/motivatecounseling
https://robdanzman.com/

Transcript

In this podcast episode, Rob Danzman, a licensed clinical mental health counselor and national expert in college student mental health, explains the different types of anxiety, treatments, and actionable things parents can recommend for their college student.

All about Anxiety at College

Today I’m talking about college student anxiety. I’m going over some basics of anxiety disorders, what they look like from a clinical perspective and, most importantly, what can be done to treat them. For more information, check out this episode’s show notes and visit my blog at robdanzman.com. I also have a whole chapter on anxiety in my first book Insider’s Guide to Parenting: How to Solve Messy Problems and Build a Great Family. You can find it on amazon. 

Talking about anxiety has changed over the last decade since so many more college students have symptoms related to or actual diagnosed anxiety disorder. 

It’s scary to put so much freedom and responsibility into the hands of your son or daughter when you suspect they’ve got substantial worry and fear around social interactions, academic progress or career decisions. Before I discuss what to do about anxiety, I think it’s important to review some details about what anxiety is.

Everyone feels uneasy or anxious occasionally like when we are running late for a meeting or got caught doing something we’re not supposed to. It's normal. Our brain does a great job of scanning our environment for threats. But sometimes, our brain goes into overdrive and can’t differentiate between actual risks and perceived risks.

Anxiety disorders are different from regular, situational anxiousness. This group of mental illnesses are characterized by intensity, duration, origin and how they impact life domains like work, school, relationships, and health.

For college students struggling with an anxiety disorder, worry and fear may be constant and overwhelming, and often feel disabling. With the correct treatment, most can overcome the anxiety disorder and lead a fulfilling life.

Now, let’s take a look at the specific diagnoses. You’ve probably heard of most of these but may not have a solid understanding of the specific criteria for each. Let’s

Let’s start with 

• Panic Disorders. This is when we feel an overwhelming sense of terror or dread that seemingly strikes randomly. During a panic attack, the person may sweat, have chest pain, and feel unusually strong or irregular heartbeats. Sometimes they may feel like they’re choking or having a heart attack. Panic attacks rarely last more than 20 minutes. Some can last up to 30 minutes. Most of the students I work with report having an episode for about 5 minutes. 
• Social Anxiety Disorder. Also known as Social Phobia, this is when someone feels overwhelming worry or judgment while in social situations. They may obsess over others' judgment or have a fear of feeling embarrassed or ridiculed. 
• Specific Phobias. This is when someone has a very specific fear of something such as spiders, heights or flying. The fear goes beyond what’s appropriate based on actual risk and may cause them to avoid regular situations. I see this most often materialize as a fear of failing a class, fear of something related to social media or fear of experiencing depersonalization.
• Generalized Anxiety Disorder. This is what I see most when working with college students. They describe having excessive, unrealistic worry and tension with little or no reason. It’s not that they’re making it up, it’s more that their brain is saying “Hey, there’s something scary and dangerous out there. I don’t know what it is or what I’m afraid will happen but I know I’m scared.” 

Risks

Early signs of anxiety are super subtle and include distractibility, avoidance and sleeplessness. Students with anxiety disorders often report to me that semesters generally start fine but as papers, tests and social pressures mount, their anxiety builds to the point where they start to consider drastic changes like dropping out of school. Untreated anxiety can lead to sleep problems, academic issues, depression, severe drug use and in some instance, suicidal thinking or attempts. Anxiety and depression seem to be best friends, often presenting together in college students I’ve worked with. 

What to Do

Though anxiety disorders can make someone feel hopeless, there are very effective treatments and interventions we can implement to get life back on track or at least make things easier. Here are the seven most effective things parents can encourage their college students to implement.

1. Counseling

Right out of the gate, the first thing parents should do is link their child with a) campus health services (often called Counseling and Psychological Services or CAPS) and b) a therapist or counseling like me specializing in college student anxiety in the community close to campus. Ideally, find a therapist/counselor that uses Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT). Waiting until the first big meltdown isn’t necessary. Loads of freshman fail to share their struggles with their parents until Thanksgiving and Christmas which, by then, is too late in their minds and they end up not returning for their Spring semester. Invest the time on the front end.

2. Scheduling

Anxiety is a disorder of fear and is fed by fear. Fear is often the by-product of lack of predictability about social events, academic outcomes, and career opportunities. One solution is increasing predictability. I accomplish this with students by teaching them to download the semester schedule onto their phone or laptop calendars before the semester starts. Next, after they receive their syllabi, I coach them to put in every single date for every single assignment/test possible. This also includes social events and any non-academic events they know about. This may sound like it could be overwhelming, but I’d rather have them feel a wee bit overwhelmed when looking at the calendars on the front end rather than freaking out anxious about remembering when that next big thing is due later on.

3. Resources

Not the most used suggestion but one we have to put here – make sure your son or daughter has a list or access to resources that can help them reduce stressors or mitigate things when they’re already starting to spiral down. These resources could include the academic supports found at nearly every university or within the community. Universities have a vested interest in making sure your son or daughter doesn’t bail at semester’s end. Another form of ‘resource’ is the on-call list. Create a formal or informal list of people they can call/text when they are starting to feel overwhelmed. I am on-call for all of my clients and often receive texts from students the night before big tests asking for help in quiet their brains down. I call them or text back strategies and remind them to call if they want to talk through things in more detail. Just knowing there is a safety net and team of support can have a dramatic reduction effect on anxiety.

4. Medication

I am super conservative with medication use and recommendations for students I work with around the country. But, with that said, I recognize that some students simply need a bit more support than what counseling and academic support can provide alone. If your college does not have a psychiatrist on staff, I highly recommend finding one in the local community. I rarely encourage use of primary care physicians or nurse practitioners for medication management since they are not specifically trained to diagnose and medically treat those suffering from anxiety. You also want your college kid to work with someone who genuinely understands the risk of some medications that have the potential for addiction. Good students get hooked on meds too. It’s also important to avoid illegal or non-prescribed drugs (like the roommate’s Xanax). Talking about medication, the potential benefits and risks, is important if your student wants to check out that option.

5. Meditation

I recommend to nearly every student I work with to start participating in weekly yoga, meditation or mindfulness classes (or at least a practice on their own). This is an evidence-based approach with only positive side-effects. Nearly every college offers some sort of mindfulness practice in their wellness programs so encourage your kid to take advantage and put it into the calendar. There are also a bunch of solid apps that are also evidence-based and easier to access for students with really busy schedules. I’ve listed a few in the show notes for this episode. Meditation, counseling and medication are an incredibly complementary approach to combating anxiety. 

6. Sleep

It’s not always easy for parents to encourage better sleep habits but nudging your college student on this has pretty high return-on-investment. The ideal for anxiety reduction is a steady sleep pattern so that bedtime and wake time are pretty standard every day. Staying up late on Thursday, Friday and Saturday, sleeping in till 1:00pm and then dragging out of bed Monday morning for an 8:50am class is terrible for anxiety. Sleep meds only make things worse and really should only be taken with the psychiatrists oversight. Lastly, sleep apps can be helpful for students who need data to monitor and modify their sleep habits. Some of these apps are listed in the show notes. I also have a whole lot of blog posts, chapters in my two books and another podcast episode where I go into more detail on sleep but for our purposes here, the important stuff if you get a chance to encourage your student to sleep better - the ideal formula for the best sleep is consistency (waking up and falling asleep), making the room as cool and dark as possible, and avoiding devices or food an hour or two before (and while they’re in) bed. 

7. Exercise

Exercise is one of the most effective behavioral changes at combating anxiety and works through stimulation of different brain regions. Both aerobic and resistance exercise have been shown to improve anxiety. The three easiest ways for students to get enough exercise to quiet their brain down are walking to class, signing up for club team sports, and setting up a routine at the school’s gym. Distraction and flow experience are essential in helping him or her focus on non-academic activities. The team sports and gym routine are also a great way for them to be social without needing a drink in their hand. Exercise’s value can come from single episodes but the consistency over weeks is where students will find the greatest benefit. 

That’s the list of what can be added to the life of a college student to improve anxiety. There are also a few things that the research shows is best reduced or flat out removed from their life to also improve anxiety. Basically, weed and stimulants are the two biggest problems I see in college students’ that make anxiety way worse. The research on weed has exploded in the last few years as more states have legalized it. The results have become more nuanced and sometimes contradictory but for our purposes today, I tell students that weed ultimately is a net loss. Weed at small doses can have an antianxiety effect but long term use of greater concentrations is linked to increased anxiety. Also - weed messes with several receptors like dopamine and serotonin which, through a complicated series of interactions, ultimately decreases drive, memory and motor function. Stimulants like caffeine, amphetamines (Adderall), and methylphenidate (Ritalin) have been shown to increase anxiety though there are some studies that show use of methylphenidate might actually decrease certain types of treatment-resistant anxiety which turn out to be more related to ADHD.  

So in summary, anxiety, if addressed early on, doesn’t have to ruin the semester. Just like attending to a medical issue that requires some modifications, treating anxiety with intentional practice and moderate lifestyle changes can significantly help just about any student.

Ok everyone. I hope this helps you figure out the best way to help that college kid who may be struggling away from home. For more information about college student anxiety, check out my blog and sign up for my newsletter at motivatecounseling.com or my two books on amazon - just search my name Rob Danzman. 

Show Notes

Evidence-based mindfulness apps - Moodfit, Headspace, iBreathe, MindShift, Happify

Sleep Apps - CBT-i Coach