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Academics. Relationships. Family. Finances. Competition. Decisions. Obligations. Student 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 Dr. Eric Goodman, clinical psychologist at the Coastal Center for Anxiety Treatment in San Luis Obispo, California. “Often, avoiding the problem feels better in the short term. However, in the long term, you get more stuck, miss out on valued activities, and inevitably suffer more over time. Facing the problem is much scarier, and uncomfortable, but you get to reclaim your life and well-being. You become free.”

Is all stress bad?

Stress is a natural and sometimes useful response to life’s demands, experts point out. “Stress in and of itself is not bad. Sometimes stress is a motivator,” says Dr. Carol Lucas, director of counseling and support services at Adelphi University, New York. For example, being a little stressed about your work may make you sit down and do it.

On the other hand, some stressors can create “mental, emotional, or physical strain,” says Dr. Lucas. 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 college?

  • Anxiety is common among students: Nearly six out of ten students (58 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, Fall 2015).
  • 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, Fall 2015). And anxiety is the most common concern among students seeking counseling, according to the Anxiety and Depression Association of America (ADAA). Interventions such as counseling can help students develop resilience skills that support their success through school 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 emotional health condition in the US, says the National Institute of Mental Health. Anxiety often begins in young adulthood: Three out of four people with anxiety disorders experienced their first episode before age 22, says the ADAA.
  • 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. “The rigors of college are so different from high school,” says Dr. Carol Lucas, a licensed social worker at Adelphi University, New York.
  • 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 (2015). 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 died.

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 ended up in the ER

A student’s experience with generalized anxiety disorder

Abraham*, third-year law student, Suffolk University, Massachusetts
(*Name changed)

“After my first year of law school, I ended up in the emergency room with GI problems. When you’re dealing with anxiety in general you don’t automatically assume that it’s something about your mental health but rather that it’s something you can fix physically. Then you have to take a step back and realize those two are very connected.”

Abraham’s* story

“I ended up in the ER”
A student’s experience with generalized anxiety disorder

By Abraham*, third-year law student, Suffolk University, Massachusetts
(*Name changed)

What my anxiety looked and felt like
It felt like a whirlwind. I was pushing myself and thinking of millions of different things, especially because I just moved to a new city, was entering a new academic endeavor, and was worried about the high cost of education. I had been feeling different for months. I wasn’t my usual self, and my body didn’t feel normal. I was very tired and I wanted to keep pushing myself. It was almost like running out of time but still trying to get as much as you can out of the time that you had. I didn’t have time to cook regularly because I was spending up to 14 hours a day at school. My overall health took a dive.

Why I sought help 
I lost somebody pretty significant in my second year. It was the loss of my friend that really pushed me to seek out the counselor. My mental health went to the top of my list after that. I realized I need to be in peak mental and physical condition to be able to handle the heavy load of work, school, and the cost of education. 

What happened when I went to counseling
I was really grateful to my school counselor. The counselor would ask me if anything during the day made me feel particularly tense, and then helped me identify certain triggers. The main thing was being able to step out of my bubble for a few moments—taking a break to vent and talk about what was going on. It helped me identify certain things I needed to stay away from, or get some perspective on. We kept the sessions going for over two semesters. I feel much better. I stopped smoking and cut way back on alcohol. I listen to meditation apps, eat well, and exercise regularly.

Is it time to seek help with anxiety?

By Dr. Carol Lucas, director of counseling and support services at Adelphi University, New York

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

  • Listen to your people Often, others will see symptoms or signs before you do. If a friend or family member recommends that you check in with a counselor, take that seriously.
  • 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.
  • 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.
Checklist of questions: Do you worry intensely about things that may or may not happen? 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, sadness? Have you stopped functioning normally? Are you not eating, sleeping, or socializing normally? Are you having a physical response to stress, such as fast heartbeats or clammy hands? Are you routinely turning to alcohol or other drugs as a stress-relief mechanism?

How does getting help early make a difference?

Early action on anxiety keeps life manageable

“Where young adults get into trouble is when they’ve missed a few assignments, maybe they’re failing, and they haven’t talked to anyone. And the further they get behind, the bigger the mountain they have to climb to get back to where they need to be,” says Dr. Laura Richardson, interim director of the division of adolescent medicine at Seattle Children’s Hospital and the University of Washington.

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 counseling) 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 been changed.

Empathy helps us deal with our stress
“Stress is something that you don’t really want to address. It feels like almost admitting some kind of defeat. For me, the stigma is like when you’re in a competition, you feel that if anything takes away from running toward the goal, then you won’t be able to catch up and make it. That’s where the stress comes from. Part of [the solution] is admitting that you have to pay attention to the stress, because your health suffers. Empathy is really essential [in getting away from any stigma]. Everybody is going through stress.” 
—Abraham, third-year law student, Suffolk University, Massachusetts

Uninformed opinions should be discounted
“In the end, 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. 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, Saskatechewan

Getting help was the best thing I’ve ever done
“There is no shame in admitting you’re struggling with any sort of mental illness. You wouldn’t be embarrassed having cancer, so mental illness should be no different. It can be treated. If one method doesn’t work, there are many other ways to treat it, but you have to take that first step with a health provider. A lot of people say, ‘I don’t want to take meds.’ I didn’t either, but it was the best thing I have ever done. I’m still on my medication, and it doesn’t make me a ‘zombie’ or alter my personality. I can take my meds in the morning and go to work the same day.”
—Maria, part-time student, Wake Technical Community College, North Carolina


With treatment, I was different in the best ways

A student’s experience with social anxiety

Maria*, part-time student, Wake Technical Community College, North Carolina
(*Name changed)

“It seemed to manifest in social situations. I would feel extremely hot, sweaty, and could feel this rush of blood to my face. Sometimes my heart would pound. I would turn bright red, even splotch. I felt nervous at inappropriate times. I thought this was normal, but at the same time, I didn’t understand why I was holding myself back.”

Maria’s* story

“With treatment, I was a different person in the best ways”
A student’s experience with social anxiety

Maria*, part-time student, Wake Technical Community College, North Carolina
(*Name changed)

What my anxiety looked and felt like
Everything came to a head when I went through a bad breakup a few years ago. I lost my appetite and lost about 20 lbs. in three months; I had a constant achy feeling in my chest/stomach. I couldn’t sleep because I couldn’t seem to turn my brain off. My blood pressure increased. I felt like I couldn’t go to work. I had a feeling of ‘I need to get out of here.’ I would panic and start crying for no reason.

Why I sought help
Anxiety was really interfering with every aspect of my life, and I knew this was not normal. I went to my primary care provider and talked to someone about it. I was diagnosed with depression and anxiety. She prescribed me something to manage my anxiety in the short term, and long term I went on a preventative medication as well as meeting with a counselor.

How the treatment helped me
I found that just talking and expressing myself helped. The medication took about four weeks to build into my system, and that’s when I noticed this huge difference, a light switch going on. I was a different person in the best of ways. I felt comfortable with myself for the first time I could remember. I could sleep; my appetite returned. I was much more social than I’ve ever been and wanted to meet new people. I was able to share my thoughts at work meetings in front of hundreds of people, something that had paralyzed me before. This change in me led me to believe that my anxiety had been present for a long time. Now if I’m feeling overwhelmed, I list my tasks and remind myself to take things day by day. I do breathing exercises and take a Barre class (a blend of yoga, ballet, and Pilates). I share laughs with friends and remind myself to have fun.

How can I make student life manageable?

By Dr. Carol Lucas, director of counseling and support services at Adelphi University, New York

  • Keep your expectations realistic “You might try to cram as much into your schedule as [possible], 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.

  • Check in with a support group Support groups for people with some emotional and behavioral 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 behaviors 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 behaviors 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 counseling, 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 counseling center is a good place to start. Here’s how that might go:

“Students come in when anxiety completely impacts their work. We tell them that no one has ever died of feelings, but people do die trying to control or avoid them.

“In counseling, we work with students to be able to tolerate their feelings, tolerate the stress, and take a look at what your day looks like. What are some of the things you can change? 

“What are your expectations? There is such a heavy emphasis on performance and on grades that we try to help them feel good about what they’re doing. Are you cramming or leaving papers until the last minute? We try to help them organize their days so that they’re not constantly slamming into this stress.”
—Dr. Carol Lucas, director of counseling and support services at Adelphi University, New York

For tools and resources, see Find out more today.

If necessary, consider medication

If counseling is not enough or you are in a state of crisis, talk with your counselor 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 the National Institute of Mental Health. 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

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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.