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Grades. Roommates. Relationships. Competition. Decisions. Obligations. Finances. College 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 college 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 college 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 college 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. “We find the most vulnerable students are first-year students. 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 become 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.


“This was no way to experience college”

A student’s experience with generalized anxiety disorder

Debbi*, third-year undergraduate, Elizabethtown College, Pennsylvania
(*Name changed)

“Part of the issue with anxiety is that it feels like it isn’t real, that you’re making it up. And nobody wants to report symptoms to the doctor that they’re worried aren’t even real. 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’s* story

“This was no way to experience college”

A student’s experience with generalized anxiety disorder

By Debbi*, third-year undergraduate, Elizabethtown College, Pennsylvania
(*Name changed)

What my anxiety looked and felt like
I’ve always been an anxious person. Being away from home, an only child very close to my parents, factored into it. My college schedule, with my course load and extracurriculars, was crazy; I left my room at 7:30 a.m. and got back at 10 p.m. I started waking up nauseous. I often didn’t sleep well because I was paranoid about missing my alarm. My morning routine became: wake up, cough so hard that it made me throw up, pretend that I was fine so that my roommate wouldn’t worry, and then go to class. During finals week I broke out in hives.

What happened when I went to counseling 
When I eventually went to counseling services at the college, that helped. They’re free, and available to help us, so why not? You fill out a survey that rates how you’re feeling. Because it’s private, it’s easy to say, “My stress level is at a 9/10 right now,” and for the counselor to reassure you that it’s valid if that’s what you are feeling, and then to talk about why that is.

How I recognized I needed more help 
In my case, counseling was not enough. My anxiety symptoms were still happening and I was just over it. This was no way to experience college. With my counselor’s blessing, I went to the doctor. I was diagnosed with generalized anxiety and seasonal affective disorder (depression in the winter months) and prescribed an antidepressant for the harder months of the year (November–May). I take long walks with my friends at night to settle my mind before bed. Being open about my feelings helps too. I’m doing much better now.

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 friends Often, others will see symptoms or signs before you do. If a friend recommends that you check in at the campus counseling center, 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 in college 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.

Why talking lightly about “anxiety” is a problem

By Debbi*, third-year undergraduate, Elizabethtown College, Pennsylvania
(*Name changed)

Truly anxious people don’t make light of anxiety  The term “anxiety” is thrown around loosely. Everyone seems to “have anxiety;” it has almost become a trend. 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,” and it bothers me, because there are people like me who have anxiety (or depression) that can really impact their ability to function. I don’t think someone with anxiety or depression would feel comfortable enough to wear a shirt like that.

I was afraid people would think I was just part of a trend I was worried people would think that I was following some bizarre trend where people use the term “anxiety attack” to describe a time where they felt stressed, or say that they have anxiety when they have no reason to seek a diagnosis.

Emphasizing “stress” may also have a downside It’s a catch-22 though, because if we present to a college campus, “Here’s what anxiety looks like, and here’s what average stress looks like,” people who are suffering from undiagnosed disorders will worry that their symptoms aren’t real enough [to be considered anxiety], like I did. 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.”


“I was afraid my life would crumble”

A student’s experience with specific (academic) anxiety

Dai*, second-year undergraduate, University of California, Los Angeles
(*Name changed)

“College 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 under the impression that all my peers are going through what I am going through, even if that isn’t actually the case.”

Dai’s* story

“I was afraid my life would crumble”

A student’s experience with specific (academic) anxiety

By Dai* second-year undergraduate, University of California, Los Angeles
(*Name changed)

What my anxiety looked and felt like
It was a lingering feeling that if I had an assignment due, I should be working on it as much as possible—that if I didn’t keep up my GPA, my life would crumble. The anxiety affected my ability to enjoy student life and my time off with friends. It was especially bad in my dorm room, so I tended to stay out late studying in the library. At times my anxiety kept me from studying; I would worry incessantly about procrastinating and how to study more. It doesn’t surprise me that anxiety is one of the most common reasons for dropping out of college. Having to juggle an academic and social life, in a new place, can be a lot more stressful than anyone can prepare for.

How I took better care of myself
It’s helpful to exercise regularly, and to focus on my extracurriculars instead of just my academics. I think of all the safety nets in my life and all the ways that I could rebound after a devastating test or quarter. For example, every time I worry about failing a test or class, I think about how I could take the next quarter off to recuperate, or how even if I had to drop out, I could still take classes at my community college and then return to four-year college.

Why I’ll seek help if it happens again
My advice to fellow students struggling with anxiety is to seek help from a health professional. I think counseling would have helped ease the burden on me and the friends on whom I relied heavily. I did not consider how taxing it could be for them to support me; they were taking my anxiety upon themselves in addition to all their own difficulties. This year, if my anxiety hinders my ability to study, I will look for someone to help me separate my anxiety about a class from my ability to study for that class.

How can I make college 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 in college 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.

  • 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

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

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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

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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.