Anxiety

College and Mental Illness

By Katie S. Frauenfelder, MA, LPC, NASM CPT

College Student asking for help — Young people entering college are at higher risk for mental health challenges.

Now that fall is in full swing, many teens have flown the coop in pursuit of what will hopefully be some of the best four (or five) years of their lives. While the idea of college for many young adults includes newfound freedom, football games, frat parties, (and oh yeah, those pesky classes), many teens have yet to discover the reality of the stress that comes along with it.

While the aforementioned is part of the college experience for many, it also comes with less structure, a demanding workload, and comparison to peers. Because of this, college can often be a perfect breeding ground for mental health issues. According to the American Psychological Association, “Over one-third of first-year college students are impacted.” Mental health issues can take many forms, but they most commonly include depression, anxiety, eating disorders, and addiction. It is important to recognize the risks and warning signs, and familiarize yourself with the resources available before it’s too late.

Depression

Many new college students have moved away from home for the very first time in their lives. Missing friends and family back home, late nights studying, and adjusting to a new lifestyle can be challenging and stressful. So how can students tell the difference between typical college stress, or something more serious? Recognizing signs of depression can be tricky. It is common to have days where you feel “off” or overwhelmed with life. However, when these days occur more frequently, and daily tasks or even getting out of bed becomes a struggle, this is cause for concern. Here are a few signs that might indicate depression is present:

persistent feelings of sadness
lack of interest in things once enjoyed
guilt
feeling tired or having little energy
isolation
mood swings
feelings of hopelessness
changes in appetite
difficulty concentrating
thoughts of hurting oneself

Anxiety

It goes without saying that college isn’t exactly a breeze. Whether it be meeting new people or realizing that classes are probably going to be tougher than they were in high school, many students will notice themselves experiencing some sort of anxiety. It is important to note that a certain amount of anxiety is acceptable, and can even be helpful. If you weren’t at least a little anxious about your anatomy final, you wouldn’t feel the need to pull an all-nighter studying. However, it is important to recognize when the appropriate amount of anxiety is escalating into something more harmful. While every person experiences anxiety in their own way, here are some general symptoms that might indicate help is needed:

trouble concentrating
sweating
stomach aches
insomnia –
shortness of breath
irrational fears –
ruminating thoughts
stomach issues

Eating Disorders

There is no doubt college life is hectic. Due to this it can be easy to skip the occasional meal, or mindlessly consume half of a pizza during a late night study session. But what differentiates erratic eating patterns from an eating disorder? A question I frequently ask my clients as it relates to food and behaviors is “What are your underlying motivations?” Let’s use the “skip the occasional meal” scenario from above. A person with normalized, non-disordered eating patterns might occasionally become so wrapped up in what they are doing that something like missing a meal is an honest oversight. (What? I’ve been gazing at my crush from across the library, er, I mean studying for three hours and missed lunch?) Once this person realizes they skipped a meal and recognizes they are hungry, they often head off to the food court or dining hall to grab something to eat. However, a person with an eating disorder might use studying at the library as an excuse to avoid eating. This can be due to a host of underlying issues, and rarely is it about the food.

Eating disorders are extremely unhealthy and sometimes life-threatening coping skills. Research on the causes of eating disorders is constantly evolving, and we continue to gain more insight as to what the risk factors are which may contribute to the illness. Many of the reasons are multi-faceted, and are the product of biopsychosocial factors that differ from person to person. Several major risk factors for eating disorders include: genetics, temperament, biology, trauma, lack of positive coping skills, sociocultural ideals, and dieting.

Eating disorders can take on many forms, a variety of types exist. With that being said, I will only touch on the three most common disorders, and their characteristics.

Anorexia Nervosa

There are two common types of Anorexia. They include: Binge/Purge Type and Restrictive. Though two classifications of this eating disorder exist, both types exhibit similar symptoms, such as abnormal eating patterns and an irrational fear of gaining weight. Other common symptoms include:

Chronic restrictive eating or dieting
Dressing in layers to hide weight loss or to stay warm
Amenorrhea
Depression or lethargy
Ritualistic eating patterns
Lanugo
Preoccupation with weight, food, nutrition info, and dieting
Dry hair
Distorted body image
Dramatic weight loss
Body image struggles
Lanugo
Compulsive exercise

Bulimia Nervosa

Bulimia is characterized by bingeing – consuming a large quantity of food in a short period of time – and then purging. During a binge, a person often feels a lack of control over eating during the episode (ie feelings that one cannot stop eating or control how much one eats). This is often followed by engaging in compensatory behaviors in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, fasting, or compulsive exercise. Common warning signs/symptoms include:

Preoccupation with weight
Food rituals
Extreme weight fluctuations
Excessive/rigid exercise patterns
Repeated episodes of eating abnormally large amounts of food in one sitting
Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of laxatives or diuretics.
Calluses on the back of hands from self-induced vomiting
Swelling of cheeks/jaws
wearing baggy clothes

Binge Eating Disorder

Until recently, Binge Eating Disorder (B.E.D.) wasn’t classified as an eating disorder. Those who engaged in bingeing behaviors were thought of as lacking willpower or being lazy. We have come to find that B.E.D. is a real medical condition, and is increasingly more common. B.E.D. is characterized by the repeated inability to control the consumption of large amounts of food at one time, often followed by feelings of guilt, shame, and remorse. Signs and symptoms of B.E.D. include:

Eating unusually large amounts of food in a specific amount of time, such as over a two-hour period
Frequently dieting
Eating even when you are full or not hungry
Eating rapidly
Eating to the point of discomfort
Eating alone or in secret

Unlike a person with Bulimia, after a binge one doesn’t typically compensate for extra calories eaten. A person may attempt to diet or eat regular meals, but restricting often leads to more binges. Causes of the disorder are unknown, but genetics, biological factors, history of dieting, and psychological issues increase your risk.

Addiction

College is often a time for experimentation. The temptation to do drugs is strong because college students often find it makes socializing easier or helps them study harder. Of course, not all college students start abusing drugs or binge drinking right from the start, but regular use of these substances can lead many down the road to addiction. And while the type of drug a student may abuse can differ, the most consistent are alcohol, marijuana, hallucinogens, and prescription pills such as Adderall.

College students turn to drugs for a variety of reasons. These can include academic or peer pressure, relieving stress, and as an escape from their problems. Results of a CASA survey on 2,000 students showed the majority of them took drugs and drank alcohol to be “part of the group”. In many cases, people are exposed to illicit substances in college for the first time. Students succumb to the pressure so they aren’t seen as the “odd one out”.

Signs and symptoms of addiction can vary based on the drug, but common signs and symptoms include:

dilated pupils, red eyes
mood swings
drop in grades
irritability
loss of interest in activities once enjoyed
reckless behavior
shift in sleeping patterns
financial problems

Resources

While admitting you are struggling can be difficult, it is important to know you are not alone. Tens of thousands of college students suffer from mental health issues, and the sooner you seek help, the more likely you are to recover successfully. There are a number of accommodations available, and often don’t require you to look much further than your college campus. Many colleges have health and counseling centers with services such as individual and group counseling, medication management, and urgent care.

Groups such as the National Alliance on Mental Illness maintain campus clubs at hundreds of colleges throughout the country and provides an array of services. In addition to offering a space where students with mental health issues can meet, the group also strives to reduce the stigma associated with mental illness. This is done by bringing mental health awareness to campuses and educating faculty, staff and students.

If your college isn’t able to provide resources to students, or you just feel uncomfortable utilizing on-campus support, there are online, phone, and usually local resources available to fit your needs. Your college’s health and counseling center can help you find local resources, as can a simple Google search. With more focus than ever on mental health, help is always available. You just need to be proactive about seeking it.

Mental health challenges can be difficult to tackle, but recognizing you need help is the first step. Shame and guilt may cause you to be apprehensive about beginning your journey toward recovery, for we have spent years believing mental illness is a sign of weakness, and something we should be able to just “get over”. However, in a society where we have so many pressures and demands put on us, particularly during our college years, it is truly a sign of strength to take the time to take care of yourself. Remember, you are worth it.

Could Your New Year’s Resolutions Actually Be Harmful to Your Health?

By Katie S. Frauenfelder, MA, PLPC, NASM CPT

It’s that time of year again. The time where once the clock strikes midnight on January 1^st we bid adieu to the previous year and all of its shortcomings, and welcome the new year with open arms.

The new year is synonymous with a fresh start, one that we are only given once every 365 days, so we best take advantage. Most of us have become a bit redundant with our resolutions over the years, and although we are logically aware that our track record of sticking with them is less than stellar, this year we delusionally believe will be different. This is the year we will follow through with our pledge to hit the gym more, eat healthier, spend less money, and thanks in part to the new Netflix show “Tidy Up,” will become more organized.

But there’s a good chance making these resolutions could do more harm than good. Many of the goals we set for ourselves are unreasonable, and when we fail to meet them our self-worth plummets, and our anxiety skyrockets. This is why it is so important we remain true to ourselves and refrain from this repeated trap that can prevent us from reaching our full potential. The following are reasons why making New Year’s resolutions can be toxic to your health:

They are rooted in negativity

Many of us put so much focus on how we are “flawed”, and the things we would like to change about ourselves. Doing so can bring about emotions associated with shame and can actually set us back rather than motivate us. For example, making a resolution to “cut out sugar” is just as self deprecating as it is unrealistic. Instead, reframe this goal to “eat more vegetables.” This shift not only makes your resolution more optimistic, but can help you stay motivated.

They are too definitive

People make the mistake of declaring absolute statements, leaving little room for error. This can lead to polarized or black and white thinking. In polarized thinking, things are either black or white — all or nothing. We have to be perfect or we are a complete and utter failure — there is no middle ground. A popular resolution is to hit the gym a certain amount of times per week. While this can absolutely be a positive and healthy goal, it will only be effective if you give yourself some grace. For example, many people set a rigid, often arbitrary number of times they must exercise per week. While they may be able to follow this schedule for a while, inevitably life circumstances arise that can disrupt your plans. This is when that polarized thinking can creep in causing you to think “Well, if I can only work out once this week instead of three times, why even bother?” Instead, promise yourself to fit exercise into your life, but eliminate the rigidity surrounding it.

They ignore the process and only focus on the outcome

In our fast paced society, many of us desire instant gratification. If we do not immediately achieve the results we are so desperately seeking, we are tempted to throw in the towel. But what if we try to adjust our mindset, and instead of focusing so much on the result we turn our attention to the process? By focusing on the process, it helps eliminate distractions. It is important to identify what is significant, and what is wasting your time. This allows for the proper steps to be made toward advancing to your goals. Focusing on the process gives you the ability to engage more deeply with the present, and will allow yourself to experience it more fully. In addition, an outlook focusing on results is mainly an outlook focused on external factors. Doing so gives up much of the control you could have.

An internal focus of control leads to higher self-esteem, builds confidence, and is empowering. Finally, once you take the time to really put in the work, focusing on each step at a time, you will appreciate the results so much more. Results earned by taking shortcuts are often taken for granted. Instead, being able to handle failures and setbacks allows us to relish in our success once it finally presents itself.

Katie is leading two new groups at The Center for Mindfulness & CBT for teens and young adults. Healthy Coping Skills for Stress, Relationships, and Life and Establish Balance and Freedom from Disordered Eating both start January 31^st and are enrolling now.

Does My Child Have Anxiety?

By Erin Magee, MSW, LMSW, Child and Adolescent Therapist

Worrying about things is normal and even helpful at times. It allows children to be safe and cautious while experiencing new things. However, when a child worries excessively, avoids fun activities, or refuses to go to school because they are fearful, anxiety can become a major problem in their lives.

Anxiety in children can show itself in many forms, which include physical, emotional, and behavioral symptoms. Some symptoms or signs of anxiety in children include the following:

Physical symptoms:

Frequently tensing muscles
Trouble falling or staying asleep
Only using the bathroom at home or excessively using the bathroom
Complaining of headaches or stomachaches that do not have a medical cause
Shaking or sweating in new situations or when they’re the center of attention

Emotional symptoms:

Worried or upset about making a mistake
Extreme nervousness about taking tests
Panic attacks (spike in anxiety with physical symptoms such as increased heartrate, trouble breathing, hyperventilating, sweating, feeling hot or cold, shaking, etc)
Anger or tantrums without any clear reason, or in excess of the situation
Fears of dogs, the dark, storms, etc.
Oversensitivity or overreactions to things

Behavioral symptoms:

Asking “what if” questions a lot. (For example, “What if a tornado comes?” “What if you are in a car accident?”)
Refusing to go to school
Frequent trips to the office or school nurse
Staying inside or alone at lunch and/or recess
Avoiding social situations with peers, such as, birthday parties, field trips, extracurricular activities, etc.
Saying “I can’t do it!” without a real reason
Regularly seeking approval or reassurance from parents, teachers, or friends

No one symptom alone signifies anxiety, and it is common and normal for a child to experience temporary anxiety, such as a child having trouble sleeping after watching a scary movie. However, when the anxiety becomes severe and/or consistent, or when it interferes with daily activities, such as going to school, sleeping, or hanging out with friends, your child may be suffering from an anxiety disorder.

Seeking support from a qualified child therapist can help both you and your child in many ways. Cognitive behavior therapy (CBT) has been shown to be very effective in treating anxiety disorders in children and adolescents. CBT for children who suffer from anxiety usually consists of education about anxiety and how to recognize when its occurring, learning relaxation and other coping skills to manage it, facing fears gradually to resume normal functioning, and parent training in how to best respond to and support your anxious child without making the anxiety worse.

If you think your child may be suffering from anxiety, we have several child and adolescent therapists who are taking new clients, and can help you determine whether individual or group therapy would be beneficial for your child. If you’re unsure, it never hurts to come in for one session to have a professional evaluate your child to see if he or she meets the criteria for an anxiety disorder, and to learn what treatment would look like for your child should you choose to pursue it.

Efforts to Reduce Anxiety That Actually Increase It

Most people do not want to experience anxiety, yet I see people regularly doing things in an effort to reduce their anxiety that are actually making it worse. Here are three of the most common culprits, and what we can do instead.Reassurance seeking, or asking others to tell you that you look okay or that whatever you’re worried about is not going to happen is a common response to anxiety; however, it actually makes anxiety worse, in the long run. Because seeking reassurance temporarily reduces anxiety, the next time you worry about something, you will feel like you need reassurance in order to cope with it. This seemingly innocent behavior often becomes a pattern that is very hard to break, and, for some people, makes their anxiety significantly worse.

Reassurance seeking is a common compulsion done by those with Obsessive Compulsive Disorder, but seeking reassurance can also be a major factor in anxiety disorders and in those with a level of anxiety that isn’t clinical significant.Instead of asking for reassurance, it is much healthier to sit with the anxiety and not get reassured from anyone, even yourself. This may be very difficult at first, but it will get easier over time. By sitting with the anxiety you will find that it passes on its own, and you will eventually become less dependent on reassurance.

Another common way to make anxiety worse is by fighting or resisting it. It is natural to dislike anxiety and want to get rid of it. However, when we try so hard to get rid of an unpleasant emotion, it often sticks around longer. Think about when you’re trying to fall asleep. Often the harder you try to to sleep, the more difficult it becomes. Instead if you just accept that you are not asleep yet but that you will be eventually, you will actually fall asleep more quickly. The same is true with anxiety. By allowing it to be as it is, the tension is released and the anxiety is able to pass naturally. Panic Disorder is basically a product of the effort to control or stop the symptoms of a panic attack, such as a racing heart, shortness of breath, and hyperventilating. The more you try to make a panic attack stop, the worse it becomes because your brain believes that the threat is greater than it actually is. If you are able to recognize that the symptoms are actually just a false alarm and not truly harmful, they will pass much more quickly.

Finally, our natural tendency to avoid situations or people who make us anxious is another way that we make anxiety worse. It seems like a good idea to avoid things that make us uncomfortable, doesn’t it? Unfortunately, avoidance often makes anxiety stronger by reinforcing the idea in our minds that there is something really scary about this situation or person. If the situation or person really is dangerous, avoiding them is probably the best course of action; but, when the situation is not dangerous, like public speaking or going on a date, avoidance is problematic in two ways.

When you avoid something that you want to be able to do, you get in your own way of reaching your goals.
Secondly, avoidance makes it less likely that you will face that fear or a similar one in the future because avoidance intensifies the anxiety and makes the distorted thoughts feel truer. For instance, if you tell yourself that you cannot go to a job interview because you will never be able to handle that much anxiety and will never get a job, and then you avoid job interviews because of this fear, you will never learn that you will probably be able to handle it and get a job. So the distorted beliefs that you cannot handle anxiety and that you cannot get a job feel even more true.

To overcome a fear, it must be consistently faced gradually in order to reduce your anxiety. So with the job interview example, you could start writing out answers to common interview questions, then practice reading the answers aloud, then practice answering them with a close friend or family member, and finally have a less familiar person perform a mock interview. Every time you master one of these smaller steps you will be teaching yourself that you can handle the anxiety and that you are capable of going on an interview.

This confidence will then help you take the final step toward facing this fear by going on a real job interview. Whether you do well and get the job or not, you will have learned that you can handle the associated anxiety, which you will never learn if you continue to avoid. Over time, and with repeated practice of facing fears, your anxiety will decrease and you will not be held captive by your fear any longer.

Break Free of Anxiety and Depression with MBCT

Research has shown that Mindfulness Based Cognitive Therapy (MBCT) can reduce by half the risk of future depressive episodes in those who have already had several depressive episodes. The effects of MBCT have been proven as effective as antidepressant medications. Research has also demonstrated MBCT’s success in managing stress, anxiety, anger, and other unwanted mood states. So why is this therapy so effective?

Mindfulness involves a specific way of paying attention, which, when practiced daily, trains our brains to become aware of what is going on around us and within us in the present moment. When you are depressed or anxious your mind is likely focused on the past or future, not the present. The five senses – sight, sound, touch, smell, and taste – are always in the present moment. So, one way to practice this present-moment awareness is to bring your attention to one or more of your five senses. This can be practiced through informal mindfulness exercises such as mindful eating or mindful showering. After regular practice of these exercises, you will be better able to redirect your attention to the present moment when you feel caught up in spiraling thoughts and feelings.

Another way to practice this present moment awareness is through mindfulness meditation. Mindful meditation (referred to as “meditation”) is different from other types of meditation in that it is not religious-based, does not involve clearing your mind, and is usually guided by a mindfulness instructor. Meditation is an exercise that transforms your brain, similar to how physical exercise transforms your body. Meditation is the most important type of mindfulness practice, and when practiced daily will result in profound changes in your brain by strengthening neuropathways related to calmness, focus, and joy.

Mindfulness training teaches us to be aware not only of our five senses, but also our thoughts, feelings, physical sensations, and external triggers that lead to unwanted mood states. Becoming aware of our triggers is the first step toward learning how to respond differently to them. Once we realize that we are having an anxious thought, then we are able to choose how we respond to that thought and the feeling that accompanies it.

Our typical response to unwanted thoughts, feelings, and physical sensations is to avoid or change them. This is a natural human response, and makes sense when there’s an easy solution such as removing your hand from a hot pan. However, often our efforts to get rid of our thoughts and feelings make them worse. For instance, worrying about all of the things that are troubling you and trying to figure out how to feel better usually increases the intensity of the anxiety and depression. This is because thinking things through is helpful in solving problems at work, but this strategy is not effective when it comes to our emotions. Rumination, worry, overthinking, and other forms of avoidance of our thoughts and feelings actually increase our distress. You may have heard the equation, Pain X Resistance = Suffering, used to explain this phenomenon. This means our resistance to pain (physical or emotional) multiplies our level of suffering. Since you cannot often directly change your level of pain, the only thing you have control over is how you respond. You can choose to continue to resist it by trying to make that feeling go away, or you can choose a new way to respond that has the power to release you from the unhealthy cycles in which depression and anxiety keep you stuck.

Mindfulness teaches us a new way of responding to our thoughts and feelings. By accepting our thoughts and feelings as they are and letting them pass in their own time, we learn that they are temporary. Acceptance does not mean that we like what we are experiencing, and it doesn’t mean that we never get ourselves out of a bad situation. It just means that when we are feeling something that we don’t like and cannot change it, we take a breath and lean into the feeling, allowing it to be as it already is. This is not easy to do, and most people require several weeks of mindfulness training in order to get to this level of acceptance. That’s why MBCT is taught as an eight-week course. Just as you can’t train for a marathon in one week, you can’t train your brain by meditating a few times or every so often. In order to be effective, mindfulness must be practiced daily, and the strongest effects will come from a structured course taught by a trained mindfulness instructor.

Dr. Laura Chackes, Licensed Psychologist and Founder of The Center for Mindfulness & CBT, teaches 8-week MBCT courses for adults and older teens, as well as a modified MBCT program for children and younger teens and their parents (Family Mindfulness Program) at her center in St. Louis. For information on upcoming courses, check the Courses and Group Therapy.tab above, or visit our Facebook page, @mindfulstl, to stay up to date as soon as new courses are announced.

Depression

Anxiety

Eating Disorders

Anorexia Nervosa

Bulimia Nervosa

Binge Eating Disorder

Addiction

Resources

They are rooted in negativity

They are too definitive

They ignore the process and only focus on the outcome

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