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Grades. Roommates. Relationships. Competition. Decisions. Obligations. Finances. College and university life is filled with stress generators. Stress is normal, but it can cause anxiety, and sometimes that anxiety becomes severe enough to interfere with your daily life and functioning. Left unchecked, it can lead to emotional illness, social isolation, academic failure, dropping out of school, and other unhappy outcomes.

If you—like so many students—are experiencing anxiety, you can find help. “Anxiety disorders are treatable,” says Mary Compton, Mental Health Consultant at the Centre for Innovation in Campus Mental Health in Ontario. Avoiding the issue does not work long-term, say experts. “You get more stuck, miss out on valued activities, and inevitably suffer more. Facing the problem is much scarier, and uncomfortable, but you get to reclaim your life and well-being,” says Dr. Eric Goodman, Clinical Psychologist at the Coastal Center for Anxiety Treatment in California.

Is all stress bad?

Stress is a natural and sometimes useful response to life’s demands, experts point out. “Not all stress is bad. There’s an optimal level of stress,” says Robert Mann, Senior Scientist at the Centre for Addiction and Mental Health’s Institute for Mental Health Policy Research in Ontario. “Stress can help performance; it can motivate you to get a term paper done or study for an exam.”

But once you exceed that optimal level, stress impairs performance, says Mann, and leads to mental, emotional, or physical strain. We often use the words “stress” and “anxiety” interchangeably, but they describe different states of mind. Understanding that difference can help you recognize when and how to take better care of yourself.

When does stress become anxiety?

If your stress is leading you toward unrealistic thinking, and fear of a threat that is not immediate or clear, you could use an anxiety check. That unrealistic thinking may be related to a specific situation or trigger, or it could be generalized and manifesting in various situations. See Students’ stories: Got anxiety?

When does anxiety become a disorder?

Anxiety becomes a disorder when it interferes with your daily life and you can’t free yourself from the intense physical sensations or worry.

  • There are many kinds of anxiety disorder; they include generalized anxiety, panic, social anxiety, phobias, obsessive-compulsive disorders, and post-traumatic stress disorder.
  • Anxiety disorders can coexist with other emotional health conditions; these include depression, substance abuse, eating disorders, and body dysmorphic disorder (when someone ruminates constantly over what they consider their physical flaws).

Who’s anxious in post-secondary?

  • Anxiety is common among students: Nearly two out of three students (65 percent) said they felt overwhelming anxiety at some point during the past year, according to a national survey by the American College Health Association (National College Health Assessment, Canadian reference group executive summary, spring 2016).
  • Students are open to seeking help but may not recognize that they need it:
    Three out of four of students said in a national survey that if they needed help with anxiety, they would seek it (ACHA, spring 2016). And anxiety is the most common concern among students seeking counselling, according to the Anxiety and Depression Association of America (ADAA). Interventions such as counselling can help students develop resilience skills that support their success through college and university and other life changes. Seeking help requires that students recognize their anxiety as a valid and treatable issue, however, and this is often a barrier.
  • Students’ anxiety is partly about demographics:
    Anxiety disorders are the most common mental illness in Canada, according to the Anxiety Disorders Association of Canada; young people aged 15–24 are more likely to experience mental illness than any other age group (Centre for Addiction and Mental Health).
  • Anxiety appears more common among first-year students:
    New students facing difficulties in academic and social transitions may be more likely than experienced students to have problems and less likely to know how to reach out, according to a 2014 study in Health Psychology and Behavioral Medicine.
  • Anxiety can hurt students academically:
    Anxiety was the second most common factor that students felt hurt their academic performance in the past 12 months (the first was stress), according to the ACHA (2016). Students reporting both depression and anxiety ranked around the 23rd percentile in GPA, according to researchers at the University of Michigan (2009).

Is it stress, anxiety, or an anxiety disorder? And is it specific or general?

Stress

Stress

Your challenges exceed your resources.
Example Your exam is in two hours and you need another day to study.

Anxiety

Anxiety

Your thinking becomes less rational and somewhat catastrophic.
Example Your significant other is losing interest and you worry that you’ll be alone for the rest of your life.

Anxiety Disorder

Anxiety Disorder

Your life and functioning becomes negatively affected by this “brain noise.”
Example Your academic and social life take a serious hit and it’s more difficult to function.

Generalized Anxiety

Generalized Anxiety

Your worry persistently, excessively, and unrealistically about everyday situations and demands.
Example When your friend isn’t there on time to meet you, you worry that they got into an accident.

Situation-specific anxiety or phobia

Situation-specific anxiety or phobia

You worry excessively about a particular situation or demand.
Example You’re so worried about an approaching test that you can’t study effectively.

I didn’t seek help willingly, but it was one of the best decisions I made

A student’s experience with general anxiety

By Stefan* second-year student, University of Victoria, Alberta
(*Name changed)

What my anxiety looked and felt like
I was putting in long days without weekends; I slept every second night for only a few hours. Toward the second week of this schedule, I had a total breakdown. I was driving home. I felt my heart rate rising, breathing quicken, and intense claustrophobia. I slammed on the brakes. My world was spinning, and I lay in the road for two hours. That semester, as my schedule got less manic, my feelings of anxiety remained. I often woke up in the night, my heart racing. Some of my relationships were falling apart. I felt like nothing had changed, but everyone else seemed to know something was wrong.

Why I sought help
A number of my friends, my parents, and my girlfriend really encouraged me to see a counsellor. I told them I was fine, that I was doing better in school and at work than I ever had. Eventually, about four months after that panic attack, I went just to shut them up. I didn’t go willingly, but it turned out to be one of the best decisions I made that year.

What happened when I went to counselling 
Our conversation had two really important parts. First, we broke down my experience of anxiety, identifying the physical phenomena, like an elevated heart rate, shallow breathing, breaking out into a sweat, and extreme claustrophobia. One of the most important things I took away was an understanding that anxiety and panic are largely biological. My job is not necessarily to stop these feelings from occurring, but to change the way I relate to them. This type of thinking is how I continue to cope with anxiety.

We also tried to find some of its roots. We talked about the way I had set up my schedule and my priorities. Success professionally and academically easily topped the list, then a need to be liked by my peers. In the past, I always felt like happiness was something that could come after. However, this focus was starting to control and cripple me. It might sound trite, but I realized I needed a work-life balance. Now I set aside Saturday as a work-free day, and maintain mental distance from stress by activities like reading or running.

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Is it time to seek help with anxiety?

By Dr. Carol Lucas, Director of Counselling and Support Services at Adelphi University, New York and Mary Compton, Mental Health Consultant at the Centre for Innovation in Campus Mental Health, Ontario

Anxious about whether or not to seek support with anxiety? Here’s how to know:

  1. Listen to your friends Often, others will see symptoms or signs before you do. If a friend recommends that you check in at the campus counselling centre, take that seriously.
  2. Look closely at your own feelings and beliefs about seeking help Probably the number-one barrier to students’ getting help is their own internalized attitudes about what it means to ask for help. “It’s important for us to recognize the stigma that exists around these issues and try not to let that interfere with our own ability to most effectively deal with our issues,” says Robert Mann, Senior Scientist at the Centre for Addiction and Mental Health’s Institute for Mental Health Policy Research in Ontario.
  3. Use this checklist If you answer yes to even one or two of these questions, it’s worth discussing your symptoms and experiences with a health professional.
  • Are you feeling intense worry or anxiety about things, even when there isn’t an event that precipitates it?
  • Are you experiencing physical symptoms, such as trouble catching your breath or excessively fast heartbeat?
  • Do you have an intense feeling that you’ll do or say something that will be embarrassing to the point you avoid seeing people or going out?
  • Are you starting to take substances to control your worry or anxiety?
  • Do you ruminate, running over things again and again in your mind so that it interferes with sleep?
  • Are you having a hard time concentrating?
  • Are you isolating yourself?
  • Are you experiencing unusual anger, irritability, or sadness?
  • Have you stopped functioning normally?
  • Have you experienced changes in your eating, sleeping, and socializing behaviours?
  • Are these overwhelming emotions taking control of your life to the point that you’ve stopped functioning like you ordinarily would?

How does getting help early make a difference?

Early action on anxiety keeps life manageable

“The sooner you get help, the better,” says Mary Compton, Mental Health Consultant at the Centre for Innovation in Campus Mental Health in Ontario. “Not addressing it can lead to other problems, like dropping out of school or trying to manage it with the use of substances.”

Early action can prevent an anxiety disorder

“Ideally, we try to reach students before the stress rises to the level where it’s an anxiety disorder,” says Dr. Carol Lucas of Adelphi University, New York.

“For a lot of students, their way of coping with stress and anxiety is through rumination and intense worry and has been habituated for many, many years. Sometimes the work (in counselling) is helping them to think differently and find very effective practices to tolerate and manage anxiety and feelings,” says Dr. Lucas.

Is stigma about anxiety still a thing?

All names have beeen changed

Anxiety can be mistaken for the post-secondary experience
“Students face a unique stigma against reaching out to health professionals, because entering college comes with the expectation that you will be stressed most of the time and that you will work late into the night. I am less willing to reach out to professionals because I am under the impression that all my peers are going through what I am going through, even if that isn’t actually the case.”
—Dai, second-year undergraduate, University of California, Los Angeles

For everything else in life, we get help from a professional
“It’s crazy that there is stigma about this. I know I felt it though; I didn’t want to go to a counsellor. But, when you’re sick, you see a doctor. When your car breaks, you go to a mechanic. When your sink’s plugged, you call a plumber. We are not all experts on the way our bodies and brains work, and that’s why there are some people who are. You don’t have to do everything yourself. Help is there and will save you time in the long run.”
—Stefan, second-year student, University of Victoria, Alberta

Ignorant opinions should be discounted
“I’d argue that it is fairly legit to hold it in. In the end, though, you have to put yourself first, and the opinions of others second. You can’t let society tell you how to feel or be. Putting yourself up to get help feels unnatural. Learning about what drives anxiety and depression in a person can sometimes lead to some tough discoveries. None of the people who judge me or anyone else are paying my bills, so opinions are a dime a dozen. I’ve learned to be strong, and put negative or ignorant opinions to the side. People have to earn my trust. I don’t tell them what I am really feeling right out of the gate.” 
—Anna, third-year graduate student, University of Regina, Saskatchewan

Truly anxious people don’t make light of anxiety
“The term ‘anxiety’ is thrown around loosely. Everyone gets nervous and stressed out sometimes, but having an anxiety disorder is different. I’ve seen shirts around that say, ‘Stressed, depressed, but well dressed.’ I don’t think someone with anxiety or depression would feel comfortable enough to wear a shirt like that. The nature of anxiety makes it hard to come out and say to someone, even a medical professional, ‘I don’t think that it’s normal to feel this anxious so often.’”
—Debbi, third-year undergraduate, Elizabethtown College, Pennsylvania


Anxiety can be a normal reaction to a screwed up situation

A student’s experience with social anxiety

Lucia*, third-year graduate student, University of Regina, Saskatchewan
(*Name changed)

“Social situations are difficult. It’s overwhelming. That doesn’t mean I’m special; I have many friends who experience similar things. Anxiety is part of life for many people. If you’re having a bad day, take care of yourself. Talk to someone you trust, remove yourself from the stimulus if you can, and know that you don’t have to justify your need to take care of yourself to anyone.”

Lucia’s* story

“Anxiety can be a normal reaction to a screwed up situation”
A student’s experience with social anxiety

By Lucia*, third-year graduate student, University of Regina, Saskatchewan
(*Name changed)

What my anxiety looked and felt like
Anxiety makes it very hard for me to engage with my peers. My field is full of socialization opportunities, some of which are mandatory. I get paranoid and want to leave. I don’t know how to explain what it feels like, which is why I make art instead of talking about it. I do well in school because I study and work hard, but also because I am able to spend lots of time on my own. I have bad days and good days.

What makes sense about chronic anxiety
Many of us come from dysfunctional places, and what people sometimes call depression or anxiety is actually a normal reaction to a screwed up situation, which remains part of one’s neurology. Some of it is biological as well. Some of the patterns are ones we learn in order to survive. Unlearning them takes a long time and can only happen in places where we feel safe. And unfortunately, feeling safe when you have mental illness isn’t always easy, because of judgmental people and attitudes, and plain ignorance.

How I took better care of myself
Counsellors are the safest people to talk to. They know how to help; my friends want to, but don’t have the resources. So, even if that little voice inside you tells you no, don’t reach out, do it anyway. Without professional help, I wouldn’t have been able to develop coping skills. When you eat properly, and exercise every day or two, you can raise the serotonin levels in your brain, which in turn makes it easier to cope. Also, I have learned to recognize the times when I need to be alone. That’s just my personality. With the general populace, there seems to be this preoccupation with outward happiness, that if I’m not smiling and bouncing around, being friendly, that there must be something wrong. Not really, I’m just a selective people person.

How can I make college manageable?

By Dr. Carol Lucas, Director of Counselling and Support Services at Adelphi University, New York

  • Keep your expectations realistic “You might try to cram as much into your schedule in [post-secondary] as you did in high school, without factoring in that you’re in a different situation.”
  • Think seriously about what you can drop “For economic reasons, many students today have a heavy workload outside of school. You have to sit down and say, is this realistic that you can work 30 to 40 hours and go to school full time? A lot of times we have to talk to students about giving something up.”  
  • Consciously build your time management skills “Realize that all the ‘free time’ in your schedule isn’t really ‘free,’ it’s just unstructured—which means you have to make choices on how to manage your demands and your fun, before it all backs up into stress and anxiety. Check your syllabi, plan your work, don’t leave things until the last minute. Realize there’s no efficient way to multitask. For best results, organize your work one chunk of time at a time.”

For evidence-based strategies to manage your time, read Student Health 101.

How can I prevent or manage anxiety?

Get the mind-soothing benefits of movement

Get regular physical activity
People who are regularly active are less prone to anxiety, according to numerous studies. “Exercise can be a powerful addition to the range of treatments for depression, anxiety, and general stress,” said Dr. Michael Otto, Professor of Psychology at Boston University, Massachusetts, in a report by the American Psychological Association. A single workout can help alleviate anxiety and depression symptoms, according to the ADAA. Physical activity appears to be protective against anxiety disorders (Depression and Anxiety, 2008).

How to be active when your feelings are blah
Focus more on the immediate mood-boosting benefits of physical activity and less on its long-term effects (such as weight management and warding off chronic disease). This works, because the immediate effects are more motivating. “Usually within five minutes after moderate exercise you get a mood-enhancement effect,” said Dr. Otto, who is co-author of Exercise for Mood and Anxiety: Proven Strategies for Overcoming Depression and Enhancing Well-Being (Oxford University Press, 2011).

For tools and resources, see Find out more today.

Prioritize your sleep, wellness, social support, and self-awareness

  • Prioritize your sleep Inadequate sleep is associated with anxiety and depression, studies show. Research suggests that sleep deprivation amplifies anticipatory anxiety (for example, fear of an upcoming test or social event), especially in people who are anxious by nature (Journal of Neuroscience, 2013). Focusing on improving your sleep may protect you from anxiety.
  • Take advantage of wellness programming Many schools offer meditation, aerobic fitness activities, support with managing your academic workload, and other relevant services and resources.
  • Take some time for yourself each day “Give yourself time to relax, to be able to put away the worries of the day,” says Mary Compton, Mental Health Consultant at the Centre for Innovation in Campus Mental Health in Ontario. Focus on activities that relax the mind and body, such as yoga, meditation, or listening to music.
  • Check in with a support group Support groups for people with some emotional and behavioural health issues can improve outcomes, according to a review of studies (PsychCentral). Sharing problems with others sometimes helps, says the National Institute of Mental Health, but use internet chat groups mindfully, since you don’t know the other participants.
  • Assess your own behaviours candidly Are you responding to stress and anxiety in unhealthy ways? These may include the excessive use of caffeine or alcohol, using other drugs, gambling, or obsessively playing video games. These are behaviours that need attention.
  • Notice when anxiety prevents you from doing something. Being aware of triggers and tuning in to them early helps you take preventive action.

For tools and resources, see Find out more today.

Seek professional support

Anxiety disorders are usually treated with counselling, medication, or both. “Talk therapy” helps you identify your problems and figure out ways to address them. A variety of approaches can help, depending upon the problem. You and your therapist will decide which approach is best for you.

Your campus counselling centre is a good place to start. Here’s how that might go:

“One of the effective strategies that a counsellor will work on with a student is taking a look at the things you’re telling yourself, and beginning to refute those. If we can change the way we’re thinking about something, it will change the way we feel about something.”

“By going to counselling, you’re taking that step to not only tell someone what’s going on, but working with someone on assessing what’s going on, because it’s treatable.”
—Mary Compton, Mental Health Consultant, Centre for Innovation in Campus Mental Health, Ontario

For tools and resources, see Find out more today.

If necessary, consider medication

If counselling is not enough or you are in a state of crisis, talk with your counsellor and other health care providers (such as your primary care physician) about additional resources and options.

A combination of psychotherapy and medication may produce better outcomes than either alone, according to research. For example, a review of 21 studies suggests that combined treatment improves outcomes for panic disorder and obsessive-compulsive disorder (World Psychiatry, 2014).

A range of medications is available to help with anxiety:

  • Many antidepressants also treat anxiety. 
  • Beta-blockers mitigate certain physical symptoms of anxiety, such as a rapid heartbeat or trembling.
  • Short-term anti-anxiety medications can help with severe episodes of anxiety or panic.

For tools and resources, see Find out more today.

Student stories: Got anxiety?

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Article sources

Eric Goodman, PhD, clinical psychologist, Coastal Center for Anxiety Treatment, San Luis Obispo, California.

Carol Lucas, PhD., LCSW, director, counseling and support services division of Student Affairs; adjunct professor, School of Social Work, Adelphi University, New York.

Laura Richardson, MD, MPH, interim director, division of adolescent medicine, Seattle Children’s Hospital, University of Washington.

American College Health Association. (2015, Spring). National College Health Assessment. Retrieved from http://www.acha-ncha.org/docs/NCHA-II_WEB_SPRING_2015_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf

Anderson, E., & Shivakumar, G. (2013). Effects of exercise and physical activity on anxiety. Frontiers in Psychiatry, 4(27).

Anwar, Y. (2013, June 25). Tired and edgy? Sleep deprivation boosts anticipatory anxiety. University of California, Berkeley. Retrieved from http://news.berkeley.edu/2013/06/25/anticipate-the-worst/

Anxiety and Depression Association of America. (2016). Generalized anxiety disorder. Retrieved from https://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

Anxiety and Depression Association of America. (2016). Facts. Retrieved from https://www.adaa.org/finding-help/helping-others/college-students/facts

Brunes, A., Augestad, L. B., & Gudmundsdottir, S. L. (2013). Personality, physical activity, and symptoms of anxiety and depression: The HUNT study. Social Psychiatry and Psychiatric Epidemiology, 48(5), 745–756.

Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., et al. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: A meta-analysis. World Psychiatry, 13(1), 56–67.

Eisenberg, D., Golberstein, E., & Hunt, J. (2009). Mental health and academic success in college. BE Journal of Economic Analysis & Policy, 9(1), 1935–1682. Retrieved from
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Goldstein, A. N., Greer, S. M., Saletin, J. M., Harvey, A. G., et al. (2013). Tired and apprehensive: Anxiety amplifies the impact of sleep loss on aversive brain anticipation. Journal of Neuroscience, 33(26), 10607–10615.

Kyrouz, E. M., & Humphreys, K. (2015). Research on self-help and mutual aid support groups. PsychCentral.com. Retrieved from http://psychcentral.com/library/support_groups.htm

National Institute of Mental Health. (n.d.). Anxiety disorders: Definition. Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

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http://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-adults.shtml

Penn State. (2015). Center for Collegiate Mental Health (CCMH) Annual Report. Retrieved from http://ccmh.psu.edu/wp-content/uploads/sites/3058/2016/01/2015_CCMH_Report_1-18-2015.pdf

Student Health 101 survey, September 2016.

Vidourek, R. A., King, K. A., Nabors, L. A., & Merianos, A. L. (2014). Students’ benefits and barriers to mental health help-seeking. Health Psychology and Behavioral Medicine, 2(1), 1009–1022. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346065/

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Suzanne Allard Levingston is a freelance health writer whose work has appeared in The Washington Post, Bloomberg Businessweek, Bloomberg Government, and US News & World Report. She has researched projects for NOVA, the History Channel, Discovery Education, and Time Inc. She reported on medicine and science for “The MacNeil/Lehrer NewsHour.” She earned her BA with honors in English from Brown University, Rhode Island, and an MA in journalism from Stanford University, California.


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Charlotte Ottaway is a freelance writer and journalist whose work has been published in Canadian Business, Zoomer magazine, The Globe and Mail, and the Huffington Post Canada. She is the founder of Web of Words, where she helps solopreneurs and small business owners create real human connections online through blogging and social media. Find her at charlotteottaway.com and follow her on Twitter @charlottaway.