As campuses across the nation come alive with the buzz of a new semester, it can bring with it a complex mix of emotions, including college anxiety. One-third of US college students are diagnosed with anxiety, a condition that, when left untreated, can make academic life a challenge, even untenable.Anxiety in college studentsis a prevalent issue that requires attention, and as back-to-school season begins, learn from our clinical experts on how our IOP treatment approach equips students with the tools to reclaim their college experience.
The Dorm: Cristina Escobar, LMSW, and Tina Bryant, LCSW, thank you for being willing to share your insight on this topic. As you know, over 70% of our client population is either in college or has the goal of returning in the future. Many clients are on a current leave of absence as a result of generalized anxiety disorder (GAD) or related challenges. Can you share what are early red flags that severe anxiety is becoming a problem on campus?
Red Flags that Anxiety at College is a Problem
Cristina: I always say that periods of withdrawal often precede things falling apart. If you have a loved one in college, you may notice a pattern of isolation which extends beyond academics, affecting social interactions and family connections. For individuals who have significant anxiety and are not coping well, avoidance is a powerful protective mechanism that, once set in motion, is self-perpetuating.
Tina: We avoid what makes us anxious, but that just increases the anxiety, which makes us want to avoid it even more. This might look like a student missing one deadline, perhaps over something very small, and it triggers a chain response.
Suddenly a student’s inner voice says, “Well, now it’s too late! You’ve already missed it so you can’t show your face again!”. This narrative prompts more avoidance to ‘save face.’ Soon, a student can find themselves in the middle of the semester having not gone to class for weeks. That’s the point at which it all unravels and we get a call from the family seeking professional support.
The Dorm: This situation is incredibly difficult. For young adults who have to press pause and take a step back to focus on their mental health, what can the road back to their academic life look like?
Client Case Study:
Cristina: This is obviously individual based on the unique needs and challenges that a young adult has, but I think it’s important to hear stories of hope because we see them all the time. One past client comes to mind, we’ll call her Shay*, who is a powerful example of someone who not just returned to college after great adversity, but did so with renewed strength and a sense of truly owning that personal triumph.
Background and Presenting Problem
- Shay was admitted to our program due to severe anxiety and intense panic episodes that stemmed from past trauma and a traumatic episode that took place on her college campus.
- Her anxiety symptoms had become debilitating, making it impossible for her to continue her studies.
- As someone who was very academically-driven, interrupting her education was extraordinarily difficult and while her goal was to return one day, at intake, Shay felt that this goal was an impossibility.
Treatment Plan
In addition to supported living, Shay was enrolled in a high level of care with 30+ hours of wrap-around weekly support. Early on, a big focus of her treatment plan was addressing the trauma underpinning her anxiety through individual therapy, clinical coaching and group work with an emphasis on Dialectical Behavioral Therapy (DBT) skills, and group therapy including the Seeking Safety group program, Survivors of Sexual Assault (SOSA) and Advanced Process.
Long before we could plan a return to college, we had to address the underlying trauma and develop the coping skills for managing the panic and anxiety that has overwhelmed the system. DBT is very effective at helping individuals develop skills they can immediately put into practice. For Shay, emotional regulation was a major focal point.
From the outset, Shay was very motivated, as was her family in parent coaching and therapy sessions. She was also quick to make friendships within our community which offered strong peer support and motivation.
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Clinical Progress and Turning Points
Months into treatment, as Shay stabilized and progressed clinically, conversations about her plan for a college return began.
For other clients we work with, where the clinical challenges have been academic concerns or executive function, a key part of the reentry prep will include services such as executive function skills group or The Dorm U, but for Shay, it required a different approach, and that’s the beauty of our program’s flexibility and individualized approach.
Although there was significant anxiety about returning to a campus where trauma had occurred, Shay was determined not to let this event (and the resulting anxiety) define her. She wanted to reclaim the experience and rewrite her narrative.
Our clinicians approached her care with two clinical methods: Gradual exposures and hand in hand coaching support.
- First, accommodations were made for Shay to attend one and then two virtual classes, allowing her to slowly gain confidence and personal competence in her academic capacity.
- The return to the physical environment was slower, starting with imagined exposures and then small, incremental trips. By overcoming flare-ups of anxiety and setbacks along the way, Shay gained a sense of resilience and was able to put new coping skills into practice in real-time.
- As Shay began a new semester full-time, plans and preparations were put in place to ensure she was supported with on-campus counseling resources and continued virtual support with her Dorm treatment team, especially during those initial weeks and months.
One of the great things about our model is the way in which we gradually decrease the intensity of clinical care as we increase what’s going on outside [such as school activities and course load]. This leads to a really smooth transition as it did for Shay. By the time someone is returning to school full-time, they may have tapered down to just three hours of treatment programming a week. It’s not so abrupt and it allows us to pass over the support to other providers or a school counselor without a student ever feeling like they are in freefall.
Shay Today
Today, Shay’s success is not measured by her return to a full course load, but in her ability to ‘take back’ her experience and her academic dreams. It’s inspiring to see her thriving, and being generally more open and less anxious, not just in college but in life. Her college experience has become hers to define, not the narrative of her trauma, her panic or her anxiety — it’s inspiring to see!
*Name changed to protect client’s anonymity.
The Dorm: Thank you, Cristina, that was a really powerful client story. For other students and families who resonate with Shay’s story, can you and Tina both share some responses to the below frequently asked questions (FAQs)?
Common Signs that Anxiety in College Students Might Become a Future Issue
Tina: While there are no ‘one-size-fits-all’ cases, a large majority of young adult clients we serve who struggle with college anxiety have a history of depression and generalized anxiety disorder (GAD). Severe anxiety tends to steep into most areas of a person’s life and with a milestone like college where the stakes feel especially high, the risk of there being a challenge is great.
Cristina: I agree and would add that this can be a struggle for young adults with obsessive compulsive disorders (OCD) and panic disorders as well as any individual who presents with a high rigidity in thinking and has difficulties with adaptability.
Early glimmers may begin in high school, especially among high achievers who struggle with perfectionism, managing expectations, handling performance setbacks and ‘things not going as planned.’ This can hint at potential struggles in the future as college requires a high level of mental flexibility.
What Young Adult Students Need to Know About Anxiety and College
Tina: You’re very much not alone in this! And if you’re seeking treatment, try to do it as part of a milieu that is going through something similar. It’s very helpful to navigate this with peers who ‘get it.’
Cristina: Yes, it’s more normal than you think! The benefit of our community at The Dorm is that students can see other peers who are going through similar experiences which is a counterbalance to this false notion that ‘everyone else is navigating college in the same linear way.’ In fact, there are endless examples of individuals who have taken weeks, months or years off school, changed locations, paused, tried new things, and that’s all great! As many times as a clinician or parent can say it, it doesn’t alway sink in until it’s heard by a trusted peer.
Helpful Reminders for Family Members / Parents with a Loved One Dealing with College Anxiety
Tina: Be patient, this will take a while. Don’t rush it. Sometimes families will enroll for the summer hoping that things can get fixed by fall. And unfortunately, as history and our own research outcomes suggest, three months is barely scratching the surface.
When it comes to deeply entrenched avoidance, we need to remember that it’s a survival mechanism. Someone engages in it because it is their body’s hard-wired response to avoid and escape uncomfortable situations. Reversing that wiring takes time and hard work and is often associated with their personal narrative and sense of self. That’s why, with many of my clients struggling with this, I focus on Cognitive Behavioral Therapy (CBT) in individual therapy to support them in rewriting their mental script.
Cristina: I would add managing expectations about what this journey can look like. I try to coach families through not having any one specific expectation about the return to school. The aim is to be flexible about how we return this young person to their life. Maybe it’s not going back to the school that you thought they would go to. Maybe it’s closer to home, or virtual. All of these paths are okay!
Tina: Finally, it’s essential to provide reassurance and work to minimize external pressure, as individuals with anxiety already face enormous internal pressure. Parents or family members should work with their own therapist and a Dorm parent coach to navigate and manage any feelings of grief, frustration, or worry. This helps ensure these emotions don’t cloud the therapeutic process or add pressure to their young adult.
Finally, How Does The Dorm’s Intensive Outpatient Programming Help Young Adults Return To College Campus Successfully
“As Shay’s case study illustrated above, The Dorm’s model is designed to equip young adults with a high level of support and skill-building on the outset of treatment, and then gradually taper down based on their unique goals, academic calendar, and weekly schedule.
What many of our clients don’t realize at first is that our work with them, particularly in addressing anxiety in college students,won’t always happen within the “four walls of the therapy office.” Being in New York City especially, sometimes treatment looks like accompanying our clients into situations that could be filled with triggers, and then slowly passing the torch to them to handle their weekly tasks independently after processing anything that came up during exposure therapy.
As we also touched on above with Shay’s experience, there’s incredible value to our built-in community of peers who are experiencing similar things to them on a daily basis, and who are also working towards the goal of returning to campus life after learning to navigate a clinically-complex diagnosis.
Finally, on a very practical level, our onsite College and University Support Services have been developed and honed (based on over 15 years of development and feedback) to identify and target each specific challenge that a client may be facing when it comes to navigating the college experience. Sometimes that will look like advocating for the student and their counseling center for additional support when they go back to school. Sometimes that may look like enrolling them in our simulated “DormU” Group at The Dorm so that they can gain practical executive functioning skills in a safe space. The ultimate goal, though, is always to help them gain the autonomy and confidence they need to pursue their academic goals. For clients, like Shay, who really want to prioritize their education and academic experience – flexible IOP treatment can be a life-changing stepping stone that will make the experience all the more fulfilling.
Thank you Tina & Cristina!
Disclaimer: This content is for educational and entertainment purposes only and should not be regarded as medical advice or replace the advice of a clinician/physician.
