ANXIETY DISORDERS College is stressful, so you figure you're going to be anxious sometimes. Anxious about leaving friends and family, about making new friends, making class presentations, taking exams, deciding on a major, even deciding when to go to dinner -- there's no shortage of stressors. Usually, you manage to carry on despite your anxiety, and do fine. Ideally, you continue, during these first years away from home, to learn your own best ways to RELAX, find SUPPORT for yourself, and generally BALANCE your life-so that, looking back on a few years of college, one can often see how one has grown in one's ability to handle stress and anxiety. Occasionally, though, anxiety can become overwhelming despite such efforts. At these times, counseling can be very helpful. This site will describe the kinds of anxiety that most often bring students to come see us in the Counseling Center, and how we try to help them learn to cope better. But first:
WHAT EXACTLY IS ANXIETY? Anxiety is a psychological state (duh!), made up of both physical sensations and thoughts. It can seem to occur suddenly and "out of the blue," or be more ongoing, or it can come up only in specific situations. Of course, certain situations (like finals) should generate a level of energy and anticipation. When this type of anxiety is strong enough to keep you alert, motivated and focused, and not so strong as to get in the way of your doing well, it's a good thing (not exactly pleasant, but necessary). It's when anxiety starts to seem out of proportion to the situation at hand, and begins permeating your ongoing mood and making you lose focus and concentration, that we start to call it problematic.
WHAT DOES PROBLEMATIC ANXIETY FEEL LIKE? Physically, the sensations are the same as those belonging to "healthy fear," "reasonable trepidation," "necessary anxiety," or whatever -- except that they have gotten exaggerated psychologically, to the point that they are getting in the way of your functioning. This heightened state tends to promote a vicious cycle, in which frightened thoughts lead to increased physical sensations of anxiety, which in turn cause more frightened thoughts, and -- you get it. When such a cycle of anxiety has gotten started, things can start to feel really awful. Whether the anxiety is coming in sudden surges -- called "PANIC ATTACKS" or "anxiety attacks" -- or is more of a day-in, day-out kind of thing, the physical sensations typically include some of the following, among others: nausea or "butterflies in the stomach," trembling, headaches, chest pain, diarrhea, shortness of breath, numbness/chilling of the extremities, rapid heartbeat, dizziness, achiness of the big muscles, sweating, and even blurred vision and distortions of hearing. (Note: The type of anxiety involving obsessions and compulsions can be somewhat of an exception to the above. See below.) The more "psychological" symptoms (those that are more immediately wrapped up with thoughts) can include: feelings of impending doom, derealization (a transitory feeling that the world or self is unreal), confusion, "freezing up," "blanking out," the sense that one is going crazy, and even (these feel weird) urges to scream, swear, run, hit, etc. From one perspective, these "psychological" symptoms can be seen as overreactions to heightened physical sensations. But, what is most important is that all of these symptoms can be seen as natural reactions that, while unpleasant at best and intensely frightening at worst, are essentially harmless -- they cause no physical damage and no one actually "goes crazy" from anxiety.
HOW DOES PROBLEMATIC ANXIETY GET STARTED? There is some debate as to whether some people are genetically more prone to problematic anxiety. (Studies indicate that it tends to run in families.) Regardless of this question, it is the case that problematic anxiety of the most general type usually starts very gradually, almost imperceptibly. Very typically, the person has been under increased stress for several months (like after a major loss, or around the time of starting or finishing college, etc.) before obvious symptoms begin to occur. This is called "sensitization," a period during which not-necessarily-conscious perceptions of stress cause gradual changes in muscle tension, leading to changes in breathing (it gets tighter, shallower -- usually without your noticing), which in turn trigger changes in adrenaline function, along with a host of other subtle but accumulating physiological changes -- all of which gradually lead to the emergence of "symptoms" like those described above.
WHAT CAN BE DONE ABOUT PROBLEMATIC ANXIETY? Given the above, it makes sense that one of the keys to keeping anxiety from becoming problematic lies in recognizing when one is becoming sensitized. This is why we speak of using anxiety as a "signal." In counseling, this signal, or "warning light" function is one of the tools that we teach you to use, so that the earliest, subtlest signs of anxiety can be recognized, when it's easiest to prevent their becoming problematic. Other tools we work with include learning how to "under-react" to anxiety, understanding how best to "go with" the sensations (rather than fighting or trying to avoid them, which only makes them worse), improved breathing, relaxation exercises, and other healthy ways of living. Often, these "generic" tools are enough. Sometimes we need also to work with you more individually to understand the specific reasons why you have become so anxious. Still, even when this is the case, students usually notice that they are starting to feel better within a few sessions -- often after just one or two.
TYPES OF ANXIETY Anxiety can take many different forms. Some of the most common kinds of problematic anxiety that we encounter through the Counseling Center are described below. All have much in common. Some of them correspond to what are termed clinically as "anxiety disorders." Fortunately, one thing they all have in common is that they tend to be highly treatable, so that the treatment success rate with anxiety is quite high. 1. Just plain stressed out.
2. Panic attacks
3. Shyness
4. Public speaking anxiety
5. Test anxiety
6. Excessive worrying
7. Obsessions and compulsions 1. JUST PLAIN STRESSED OUT This pretty much fits the "sensitized" state described above. Not surprisingly, it is probably the most common anxiety-type problem we see -- especially around three times of year. (Want to try to guess before we tell you? Take a second -- you'll probably get at least one.) OK: As you probably figured, one is the period leading into and during finals; the other two are a little less obvious: the roommate selection period and, basically, October (Midterms? Can't call it just a "rough start" anymore? There are probably several reasons for October). "Stressed," "burned out," and "freaked" are some of the words we hear at these times, along with "can't concentrate," "having trouble sleeping," "super irritable," "crying all the time," and "just feel on edge all the time." Headaches, stomach distress, muscle aches and other physical problems are also common. Overall, not an outstanding set of feelings. Treatment for this kind of thing depends partly on what's going on for each person at that point in their lives, but in general we would recommend some individual counseling that includes a focus on specific individual issues, probably along with such things as relaxation training, time-management, help with prioritizing responsibilities, etc. In some cases, group counseling might also be recommended. 2. PANIC ATTACKS Large surveys have established that about one in ten people will experience panic attacks (or "anxiety attacks," "adrenaline surges," etc.) at some point in their lives. Very typically, these attacks will first appear during the college years. A panic attack is defined simply as an unexpected episode of intense fear, accompanied by some combination of physical symptoms -- symptoms such as rapid heartbeat, shortness of breath, dizziness, etc. These symptoms sometimes begin to fade away after a few minutes, but just as often they linger, maybe rising and falling in intensity, sometimes for many hours. Some of the other most common physical symptoms are abdominal distress, chest pain, coldness/numbness in the extremities, trembling, sweating, flushing, rubbery knees, visual/aural distortions, and choking or smothering sensations -- and there are many others. Unfortunately, panic symptoms often mimic symptoms of a heart attack or other life-threatening medical condition -- which naturally creates more anxiety, per the "anxiety cycle" described above. These sensations can also generate fears of a more embarrassing, if less life-threatening, nature, like the sense that one is about to lose control of their bowels, vomit or pass out (events which probably never occur). Probably most frequently, though, given the spacey, racey, out-of control feelings that typically occur, the fear is that one is going crazy, or will do something extreme, like bolt from the room in a panic, or start screaming. Given all of this, it is therefore surprising that most panic attacks are virtually invisible to others. (A note on AGORAPHOBIA: Naturally, many people with panic attacks develop anxiety between episodes, worrying when and where the next one will strike. This often leads to avoidance of situations or places, or extreme distress about encountering such situations, under the mistaken belief that it is the place, or whatever, that is causing the attacks. This condition of avoidance is called "agoraphobia," and it too is very treatable through counseling, especially when treated early on.) Treatment for panic attacks is in most cases fairly simple, involving education about panic symptoms (especially about how while they can be extreme and unpleasant, they are in fact natural bodily sensations that are in no way dangerous); relaxation and breathing exercises; and new ways of thinking about the panic sensations that make them easier to live with. In those cases where underlying conflicts, habits of thinking, or ongoing stresses seem relevant, additional counseling around those issues usually allows for further progress. In more stubborn cases, medication is usually helpful. 3. SHYNESS Extreme shyness, or "social anxiety," or "social phobia," is probably the most common ongoing anxiety problem of all. It is characterized by intense anxiety and self-consciousness in social situations -- enough so that the person regularly avoids or really strains to endure such situations. Panic attacks are not uncommon. Physical symptoms include blushing, trembling, lightheadedness, nausea, shortness of breath and sweating. In some cases, the person is afraid of one or a few specific types of situation, such as speaking in class (see below), making conversation, or eating in public, but usually the anxiety is more general. The common fear, though, is that one will somehow be negatively evaluated by others. Most often, this fear has emerged during the mid-teens, but it is not uncommon for it to emerge more clearly as a problem during the college years. Shyness, of all the kinds of problematic anxiety, is especially problematic in that it is so frequently linked with alcohol and drug abuse: It is deceptively easy to develop the habit of drinking or using drugs to relieve social anxiety, maybe especially in the college setting. The ideal treatment for extreme shyness is specialized group counseling. Most years, we have enough students to form our "Shyness and Public Speaking Phobia Workshop." If we don't, we can refer students to a nearby group in the community. These groups operate similarly: instructional sessions alternating with sessions in which the newly learned skills and techniques are practiced in mock situations, with and in front of the group. (After the initial hurdle of terror at this prospect is passed, group members settle down and generally get a lot out of the group. Usually it's even fun!) As with the other kinds of problematic anxiety, further individual counseling and/or medication, if necessary, can be very helpful. 4. PUBLIC SPEAKING ANXIETY This is probably best understood as a variant of shyness (see above). It typically appears in adolescence, but very often is not a major problem until college -- probably because there are then more situations in which public speaking might be required. Students' anxiety around this varies from those who are fine giving prepared talks, but dread being called on in class, to just the opposite, or both. We have seen many students who were considering, or were already in the habit of dropping classes or changing majors to avoid public speaking. They describe intense anxiety leading up to such situations, and often during the actual speaking. Students speak of "blanking out," "freezing," "beginning to just talk gibberish," or feeling that they are very obviously trembling, blushing, sweating, etc. As described above, the ideal treatment is in a specialized group or workshop, which we usually run, given enough interest. Otherwise, we can refer you to an excellent local group that has been ongoing for many years. For the occasional student who makes insufficient progress in such groups, we can also, in certain situations, through evaluation by the Center's psychiatrist, offer specific medication that can be taken shortly before speaking events, which dampens the physical symptoms of nervous arousal. 5. TEST ANXIETY Some amount of anxiety is normal in test-taking, and lower to moderate levels are generally helpful: without an adequate level of anxiety, you might not prepare enough beforehand or be fully concentrating during the test. But, when such anxiety becomes excessive, it can interfere with functioning. As with the other types of anxiety, excessive test anxiety involves distressing levels of physical symptoms, such as rapid heartbeat, sweating, trembling, intestinal distress and lightheadedness. It also involves cognitive interference, such as "blanking out," forgetting important information, trouble reading and understanding questions, and difficulty organizing one's thoughts. It can also lead to panic attacks, and the feeling that one must leave the room. If you experience such symptoms, you must first ask yourself if your anxiety is connected mostly to the fact that you have not studied adequately. If so, then you are right to be anxious, and need to take it as a signal that you must prepare better in the future. However, if you are adequately prepared and still excessively anxious, the cause is probably one of the following: a. Past experiences of high anxiety in such situations.
b. A general predisposition to high anxiety.
c. Over-sensitivity to normal levels of anxiety.
d. Excessive caffeine, alcohol, and/or drug abuse. If caffeine or other substance use is the cause, the cure is obvious. (It is not, however, always easy to stop or cut back on these habits. Consider contacting one of the counselors at the Alcohol and Drug Education and Support Services, at ext. 2928, for help.) Otherwise, you can probably alleviate your test anxiety by trying some of the following: 1. Let yourself relax: If your anxiety is mostly in anticipation of the test, try breaking your studying into manageable chunks, and focusing on relaxation techniques during your breaks. These might include simple breathing and muscle-relaxation exercises, meditation and/or visualization (see our RELAXATION page). 2. Change your attitude: Positive thinking can be very helpful. Try catching yourself when you are thinking negatively (e.g., "I'll never be able to study enough," "I'm sure to fail"), and replace those thoughts with more realistic ones (e.g., "It's only one test," "I'll see where I am after tonight, and get help if I need it," "If I don't do well on this one, I'll study more next time"). 3. Use test-taking skills: Plan to take a few minutes at the start of the test to do the following:
- Read the directions; review the entire test; then re-read the directions.
- Organize your approach; start with the easiest parts of the test; plan how much time you'll spend on each part, and keep track of the clock.
- For essay questions, outline; then begin with a good summary sentence.
- For short answers, stay short.
- For multiple choice, read ALL the options, then eliminate the least likely, and go with your first impression.
4. Promise yourself a reward: Choose something you'll really enjoy (a movie, a sundae, buying yourself a book or sweater, etc.). Be specific, and really visualize this reward. You will do this for yourself no matter how you do on the exam, preferably that same day. Then flash to this image when you are feeling most stressed. 5. De-stress during the test: If you are beginning to panic, break the cycle by interrupting it. Break your pencil lead, and then go sharpen it. Ask a question. If it's allowed, get a drink or go to the bathroom. Take a deep breath, suck in more, hold it, then let it all out, puff out some more, and then take a long, deep breath. Focus for a moment on how your feet feel, or on what you can hear, smell, etc. Think of the reward you've promised yourself. Finally, consider other resources. Do you need to speak with your professor? Study with some friends? See your advisor? The Study Center can be very helpful with time management, general study skills, test taking tips, etc. (they are in Humanities Center, rooms 302 and 333; call x2063 or Leah McGinnity at x5050). And of course always consider coming to us for help.
6. EXCESSIVE WORRYING
This is basically what it sounds like: worrying that takes up too much time, or is too intense, considering what you really have to worry about. Probably most often, when we see students with this type of anxiety, it appears as part of a syndrome called "generalized anxiety disorder" (GAD). This is a condition that tends to start earlier than the other types of problematic anxiety, often in childhood, but it can emerge at any time. (It is officially termed GAD when it has lasted at least six months.) People with GAD usually expect the worst; they worry excessively about money, health, family or grades, even when there are no signs of trouble. They often are unable to relax (so, again, alcohol can be a danger), and are worrying about several things at once. Insomnia and poor concentration are common, as are physical symptoms such as muscle tension, fatigue, trembling, headaches, nausea and feeling on edge, keyed-up or irritable. As with the other kinds of problematic anxiety, treatment for GAD most often includes various cognitive-behavioral techniques, as well as relaxation and breathing exercises. Medication is often recommended. 7. OBSESSIONS AND COMPULSIONS Obsessions are recurrent, unwanted thoughts that feel beyond one's control. Some typical obsessions are fears of contamination (preoccupation with germs, filth, etc.), of making mistakes, or of doing something terribly inappropriate. Compulsions are activities that one performs repetitively, to great excess, in a way that also feels beyond one's control. Typical compulsions include counting, putting things in order, checking (for example, repeatedly checking to be sure the door is locked) and hand-washing. When these "rituals" are significantly interfering with one's functioning, they are considered to be a disorder, called, naturally enough, "obsessive-compulsive disorder." As with most of the anxiety disorders, susceptibility for developing OCD is thought to be inherited genetically, although there is evidence that some cases arise from infection with a streptococcus bacteria (strep throat). Treatment for OCD typically involves a type of cognitive-behavioral therapy called Graduated Exposure and Response-Prevention. This consists of the person developing with the therapist a list of problematic situations, graded from least to most anxiety-provoking. (For example, someone who fears contamination might rank touching the doorknob outside the Humanities Center as fairly low anxiety, but using the bathroom as high anxiety.) These situations are then gradually attempted, easiest first, with the aid of various cognitive and relaxation techniques, and without the habitual rituals. Progress can be suprisingly quick and steady. As with panic disorder, additional counseling around related conflicts or stresses might be recommended. Medication is often considered, as best results tend to be achieved with a combination of counseling and medication.
For more information about these and other anxiety disorders, see related topics under "Depression" and "Stress Management" or visit our "Other Resources" page. The Loyola College Counseling Center offers free counseling and referral service to Loyola students. Just call 617-5109 for an appointment . |
