Loyola University Maryland

Counseling Center

Anxiety

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Anxiety is the most common problem for which students come to the Counseling Center.  This page describes the kinds of anxiety we see most often, and how we help students learn to handle it.

Anxiety can be caused by stress.  By relatively brief stresses, like exams, and by longer and longer lasting ones like having a loved one with a serious illness, or feeling you don't fit in because of the way you look, or because of your sexual orientation. Anxiety can also develop without obvious stress.  It can “run in the family.” Regardless the cause, if anxiety is interfering with your life, counseling will help you.

What is anxiety?

Anxiety is troubling thoughts and physical sensations. Sometimes you need some anxiety, to motivate and get you focused. But sometimes it becomes problematic.  If anxiety permeates your daily mood and interferes with your functioning, it would be good to learn better ways to cope with it.

These are the kinds of anxiety that most often bring students to us:

• “Stressed out”
• Panic attacks
• Shyness
• Public speaking anxiety
• Test anxiety
• Excessive worrying
• Obsessions and compulsions

“Stressed out”: This is the most common kind of anxiety.  Students describe feeling nauseous, on the verge of tears, and without their normal self-confidence.  They feel indecisive, irritable, “on edge” and “ready to snap.”  They’re often having trouble concentrating and sleeping.  Headaches and other physical problems are typical.

If this kind of anxiety lasts very long or is recurrent, it would be a good idea to get treatment.  Brief counseling focusing on one’s specific situation, plus education about anxiety and help with things like relaxation, time-management, assertiveness, etc., is usually enough to give major relief.  For more complicated or stubborn cases, longer-term counseling almost always helps.

Panic attacks: This is one of the most common issues we see.  About 10% of students will experience panic attacks at some point, usually starting in college. For some, these attacks become chronic.

A panic attack (or “anxiety” or “adrenaline” attack) is an episode of intense fear and dread, along with physical symptoms not normally experienced in the absence of physical exertion or sudden fright.  Usual physical symptoms include rapid heartbeat, shortness of breath, chest discomfort, nausea, sweating, flushing, shaking, and lightheadedness, among many others. These symptoms can fade away after a few minutes or linger for hours.

The fear experienced during these attacks is triggered by the physical symptoms, which can mimic a heart attack or other serious condition.  Often, especially for young people, the fear is not so much of dying but of a potentially embarrassing event, like “panicking in front of everybody,” or fainting, or “going crazy.”

The physical symptoms, in turn, that trigger the fearful thoughts, are caused by excess adrenaline (or excessive sensitivity to adrenaline), which is usually the result of a long build-up of stress, like in the months preceding college, or preceding graduation, or after a death, or while trying to adjust to a new environment or culture, especially if it is very different from the one you’re coming from.

Treatment for panic attacks, especially if they have not lasted for years and years, is usually brief, simple and successful.  It involves education about the causes of panic, that attacks are in no way dangerous, and that “allowing” or “accepting” them, rather than resisting them, is the key to managing them. In more complicated case, longer counseling and sometimes medication are usually sufficient.

For some people, panic attacks lead to “agoraphobia.” This is the avoidance of situations or places where attacks have occurred, under the mistaken belief that it is the place or situation that is causing the attacks. Like panic attacks themselves, agoraphobia is also very treatable.  It must, though, be addressed very early on in college, as it can otherwise lead a student to avoid classes or drop out of school entirely.

Shyness: Extreme shyness (also known as “social anxiety” or “social phobia”) is also common at this stage of life. It is characterized by intense anxiety and self-consciousness in social situations, enough to make a person regularly avoid or really strain to endure such situations. Panic attacks in, or in anticipation of, such situations are common. Physical symptoms like blushing, trembling, nausea, shortness of breath, lightheadedness, and sweating are common. In some cases, the person is afraid of one or a few types of situation, like making conversation, speaking in class (see below), or eating in public, but usually the anxiety is more general. The common fear, though, is that one will somehow embarrass oneself or be negatively evaluated by others.

Of all the kinds of anxiety, social anxiety is especially problematic, particularly in the college setting. This is because it can and often does lead easily to substance abuse. It is deceptively easy to develop a habit of using alcohol or drugs to relieve social anxiety.

The ideal treatment for excessive shyness is specialized group counseling. Most years, we have enough students to form a Shyness and Public Speaking Phobia Workshop. Otherwise, we can refer students to a group in the community. These groups alternate instruction with sessions in which newly learned skills are jointly practiced. Once the initial terror at this prospect is passed, group members settle down and get a lot out of the group.  (They often say they enjoy and look forward to it.)  As with the other kinds of anxiety, further individual counseling and/or medication can be very helpful if needed.

Public speaking anxiety:  This kind of anxiety often appears earlier in adolescence but is not a major problem until college, when more public speaking is required.  Students speak of "blanking out," freezing, feeling like they’re "talking gibberish,” or that they’re visibly trembling, sweating, etc.

Unfortunately, students sometimes drop classes or change majors to avoid public speaking. As with shyness, the ideal treatment is a specialized group or workshop (see above). For the occasional student who makes insufficient progress in such groups, we can recommend evaluation by the Center's psychiatrist, who might offer specific medication.

Test anxiety: Some amount of anxiety around testing is of course normal.  Without it, you might not study or concentrate adequately. However, when excessive, such anxiety can interfere with test-taking. As with any kind of anxiety, test anxiety involves distressing levels of physical symptoms, like rapid heartbeat, sweating, trembling, nausea and lightheadedness. It also involves cognitive interference, like "blanking out," difficulty understanding questions, and trouble 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, there are a couple issues you might consider before seeking counseling. First, is your anxiety due mostly to insufficient studying? If so, you’re right to be anxious and should take it as a welcome signal that you need to study better next time. (Also, ask yourself if you are avoiding or delaying studying because it makes you too anxious—another form of test anxiety.) Second, if caffeine or other substance might be causing your anxiety, try cutting back or stopping it.  (And if that is too difficult, consider contacting 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:

• 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. Visit our relaxation page for more suggestions.

• Change your attitude.

Positive thinking can be very helpful. Try catching yourself when you are thinking negatively ("I'll never be able to study enough. I'm sure to fail"), and replace those thoughts with more realistic ones ("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", etc.)

• Plan to take a few minutes at the start of the test to do the following: 
 
1. Read the directions. Scan the entire test, and then re-read the directions.
2. 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.
3. For essay questions, outline. Then begin with a good summary sentence.
4. For short answers, stay short.
5. For multiple choice, read all the options, then eliminate the least likely and go with your first impression.
6. Promise yourself a reward when you finish the test (something you'll really enjoy, like a movie or time with a good book, a special ice cream treat, 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.

• De-stress during the test.

If you are beginning to panic, break the cycle by interrupting it. Take a deep breath, suck in more, hold it 3-4 seconds, then let it all out, pushing out the last little bit. If it's allowed, get a drink or go to the bathroom. Think of the reward you've promised yourself.

• Finally, consider other resources.

Do you need to speak with your professor? Study with some friends? The Study, on the 3rd floor of Jenkins Hall, can be very helpful with time management, study skills, test-taking tips to counter anxiety, tutoring and much more. Call 410-617-2104 to make an appointment. And, of course, there’s us.  With even the worst test-anxiety, a few sessions here can help a lot.

Excessive worrying: This is worrying that takes up too much time or is too intense considering the situation. For some students, excessive worrying becomes a habit and gets in the way of functioning.  These students expect the worst. They worry endlessly about money, health, family, their relationships, grades, etc., even when there are no signs of trouble. Insomnia, poor concentration, fatigue, headaches, and feeling keyed-up or irritable are common symptoms.

Excessive worrying sometimes responds very well to brief counseling, especially when one can see that they’ve developed a habit, which can be changed.  In other cases, longer-term counseling off-campus and/or medication can be very helpful.

It is important, though, to distinguish excessive worrying from realistic worrying about an ongoing situation. The person prone to excessive worrying will find something to worry about regardless of their real circumstances.
This is very different from the person with ongoing real worries—for instance, the student concerned about financial strains on their family, or about fitting in at Loyola as someone with less money than other students, or as a member of an under-represented race or ethnicity. With such worries, counseling might well be appropriate and helpful, but it would be focused on managing a real situation, not on a habit of excessive worrying.

Obsessions and compulsions: Obsessions are highly persistent thoughts, impulses or images that one realizes, at least initially, are senseless or exaggerated. They are unpleasant and intrusive, causing guilt, fear or other negative feelings. Some typical obsessions are exaggerated fears of contamination with germs, doubts whether you’ve done something correctly (“did I really lock the door?”), or thoughts of harming someone you don’t really want to harm, and might even love. Compulsions are rituals or repetitive behaviors performed in response to an obsession, to ease or neutralize it. Typical compulsions include counting (like, counting one’s steps for fear that not counting will cause something bad to happen), checking (like repeatedly checking to be sure the door is locked), and excessive hand-washing to ease fears of contamination. When these rituals interfere significantly with one's functioning, they are called "obsessive-compulsive disorder" (OCD). As with most anxiety disorders, susceptibility for developing OCD is thought to be inherited genetically, although there is evidence that a small number of cases might arise from infection, as with streptococcus bacteria (strep throat).

Treatment for OCD typically involves a type of cognitive-behavioral therapy called Graduated Exposure and Response-Prevention. This involves first developing a personal 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 relatively low anxiety, but using the bathroom as high anxiety). These situations are then gradually attempted, easiest first, with the aid of various techniques, and without the habitual rituals. Progress can be surprisingly quick and lasting. As with other forms of anxiety, when progress is limited, additional counseling and/or medication might be recommended.

For more information about these and other anxiety issues, see related topics under depression and stress management or visit RelaxOnline or our other Relaxation Resources. If you would like to discuss anxiety, or any other issues, please call or stop by the Counseling Center for an appointment.

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