What Every College Student Needs to Know

Anxiety in College by the Numbers

College is a time of major changes, so it’s no wonder it is also a time when many students experience anxiety. When you know what you’re dealing with, know how to cope and can find the right help, you can manage anxiety.

A survey that asked college counselors about anxiety issues found that anxiety is the top issue for college students (41.6 %). About 25% of college students were taking medications to treat mental health issues.

Another study done by Penn State found that more than 60% of college students report anxiety as one of their major health concerns. College students struggling with anxiety cuts across all sexes and races. One study found that the rates of anxiety disorders reported by US college students doubled from 2008 to 2016. During this time, the rates for anxiety disorders rose by 65% for transgender students, 67% for male students, and 92% for female students.

College Students Treated for Anxiety by Race

  • Asian or Pacific Islander 10%
  • African American 14%
  • Hispanic or Latino 15%
  • White 23%

Students of color were half as likely to report a diagnosis or treatment of anxiety disorders compared to white college students.

anxiety vs. stress

Stress and anxiety may seem the same at first glance. While both can be touched off by the same things and signal the body to be on alert, anxiety has the additional element of fear and sometimes a feeling of doom.

Another difference is that anxiety is not the same as stress, but rather a reaction to stress. When anxiety happens frequently, it can become a problem because it interferes with college life.

Video: College Anxiety and Depression

Symptoms of Anxiety in College Students

Anxiety affects students’ physical well-being, emotions, how they think, and how they behave. Let’s take a closer look at each of these areas.

Physical Symptoms

Anxiety can have negative physical impacts on the body, both in the short- and long-term. Short-term effects include rapid breathing rate, elevated heart rate, and muscle tension, which are normal responses that help prepare you for facing intense situations.

But if the anxiety is continuous or extreme, it can have crippling effects on your body, including:


Nausea / Upset stomach

Leads to alcohol or drug abuse



Dry mouth

Loss of sex drive

Muscle aches / Body pains



High blood pressure

Emotional Symptoms

Prolonged anxiety can affect your emotions to the point where panic attacks happen. When anxiety and stress get intense and it causes a panic attack, you can experience symptoms like you’re having a heart attack, your tongue swells, or you feel like you are choking.

Fortunately, a panic attack doesn’t last long, but it can be such an intense experience that you change your life to avoid situations you think can lead to attacks. Anxiety can also lead to other mental health issues, such as depression. You may also start to isolate yourself socially to avoid other people so you won’t be judged. You may worry that you are going crazy.

Cognitive Symptoms

Cognitive thinking is the mental processes that you use to learn, reason, understand and concentrate. Anxiety can negatively affect these thinking processes. Research suggests that anxiety overpowers the brain and greatly changes nervous system activity. Anxiety can slowly weaken your thought processes. Your ability to make rational decisions can degrade. Anxiety can blacken your thoughts, making you feel fearful of what is going to happen. Feelings of not being good enough and memory problems can also happen as cognitive effects of anxiety.

Behavioral Symptoms

When your thinking processes change from anxiety, it leads to changes in the ways you behave. Common effects anxiety are behavior that is feeling “out of it,” unhappy or bored. This can lead to a life where you want to be alone with your thoughts and deal with your anxiety. You also don’t want the help of others and shy away from enjoying the activities you like.

When you have anxiety, these behaviors may seem like good choices because you are tired. You feel that being alone helps you recuperate. While recuperating in isolation seems like a good choice, it’s not the best one. Isolation without distractions can lead to you becoming lost in your own thoughts. When you are struggling with anxiety, too much time with nothing but your own thoughts will likely cause more anxiety. Spending too much time alone can lead to agoraphobia, where you become fearful of leaving your home or dorm. When you avoid situations where a panic attack or anxiety episode can occur, it can result in an overall feeling that the only safe place is home.

Things to Avoid when Anxious


Avoid drinking too much coffee. Caffeine can make you jittery and increase anxious feelings. Drinking large caffeine doses of 200 mg or more can produce negative effects. Increased anxiety, nervousness, and jitters can all happen. Too much caffeine can also produce withdrawals if you try to stop abruptly. Keep your caffeine intake low or slowly wean yourself from it.

Keep in mind coffee isn’t the only thing that contains caffeine. Certain teas, sodas, yogurts, ice creams, chocolates, candy and over-the-counter medicines contain caffeine. At the end of this article in the resource section, there is a link for a list of foods and drugs and their caffeine content.

Drugs and Alcohol

It may be tempting to try and relieve anxious feelings by taking drugs or drinking. In the long run, they will make things worse instead of better. At first, drugs or alcohol may help you feel better. They mask anxious feelings, but as soon as they wear off, you’ll feel anxious once again. It’s better to get to the root of your anxiety rather than temporarily mask it. Many drugs and alcohol will build a tolerance in your system if you keep taking them to cope with anxiety. Tolerance means that you will gradually need more to get the same effects from before. This results in taking larger quantities, which can lead to dependence and addiction. Instead of dealing with just anxiety, you’ll be dealing with a substance abuse disorder as well.

You may try alcohol or drugs to relieve your anxiety, but when you’re anxious, this can worsen anxiety instead of making it better. A drink or drug may hit you the wrong way; then you may find yourself dealing with an unstable frame of mind and a dangerous situation.

Focusing Too Much on the End Result

When you focus too much on the end result, it can be exhausting. Overthinking can overwhelm you as it consumes your time, energy and thoughts. Continuous anxiety puts you in a state of high alert all the time. You will be looking for pitfalls, dangers, and worries at every turn.

Overthinking can take the form of racing thoughts about what you should do or say. It’s also about creating endless worst-case scenarios. Moreover, you may worry all the time about how you look to others and if you measure up. After a while, this kind of thinking can become disordered and cloud your mind. Stop yourself when you think, what if? Turn to a relaxation technique for a much-needed break from jumbled thoughts.

How to Fight Anxiety

The good news is that there are positive ways you can deal with anxiety to keep its effects to a minimum.

Get Enough Sleep

College students typically have hectic schedules. School demands include classes, homework, studying and exams. Finding time for activities outside of school may be difficult. Many students cut into their sleep time to fit it all in. But lack of sleep can cause anxiety because of the fatigue that results.

If you’re running on empty, everything suffers, including maintaining your mental health. Be sure to get about 8 hours of sleep every night. Take naps if you need them, and don’t pull all-nighters.

Make sure the sleep you do get is restful, quality sleep. Don’t sleep with the TV on, because the TV light and sound will prevent you from reaching deeper levels of sleep.

Deep Breathing

When you find yourself becoming anxious, take several deep breaths. Deep breathing from your diaphragm is a powerful way to reduce stress because it starts up the body’s relaxation response. Deep breathing helps your body go from the fight-or-flight response to a relaxed response within the nervous system.

Slowly inhale to a count of 4, filling your stomach area first and then your chest. Hold your breath while you count to 4, then slowly exhale while you count to 4. Repeat a few times or more if needed. The fantastic advantage about deep breathing is you can do it anywhere at any time to reap its calming benefits.

Talk to Someone

You could talk to friends and family about your anxious feelings, but sometimes it’s better to talk to someone who is not in your inner circle. A therapist or peer counselor from the college student center can be good sources for advice. Talk about what is troubling you and how to handle it. An online resource that can help called College Confidential is a forum that allows you to talk about anything with other college people.

Stay in the Here and Now

When you feel anxiety building, stop and use your deep breathing technique. At the same time, focus on what is around you at the present moment. By focusing on the present moment, you’ll be able to better manage what is going on around you.

Eat Healthy

Proper eating habits help you maintain a healthy brain and body while you tackle college life. It’s tempting to eat junk food on the run when you have a busy school schedule, but food that isn’t nutritious will harm you in the long run. Be sure to eat plenty of fresh fruits and vegetables. Eat breads, grains and protein for energy boosts. Also, always drink lots of water to stay hydrated.

Think Positive

The power of positive thinking can be tremendous when preventing or dealing with anxiety. If you are stuck in dark thoughts, it increases anxious feelings. More anxious feelings make for more negative thoughts; it’s a vicious cycle.

When you think positive, you are conditioning parts of your brain that control thinking and behaviors to work better. These brain improvements can help you perform better when you’re dealing with difficult tasks or negative emotions.

Take Part in Relaxing Activities

Anxiety is filled with tension and fear, so relaxation can be the perfect way to tackle these feelings. Take a mental health day to unwind from your fast-paced college life. Do things you enjoy in your spare time. Yoga classes can go a long way in helping you control stress and anxiety. Go for a walk or practice deep breathing. You can repeat a silent prayer or mantra. These are all simple, easy to do ways of relaxing without spending a lot of time or money.

Create an Independent Study Routine

It’s smart and helpful to develop a study routine. Set aside time on a regular schedule to study. Be sure to stick to your schedule. By having a regular routine, you’ll avoid having your studying activities build-up. When studying builds up, it can easily lead to you pulling an all-nighter. Cramming lots of studying into small windows of time can cause or worsen anxiety and stress. A routine can help prevent cramming from happening.

It can help to talk with your academic advisor early to find out how to get tutoring and other academic support if needed.

Video: College Life & Social Anxiety

Ok, wow really good to be here.
I don’t actually need to share like the first half of what I was going to share
because Terry already told you, but
my name is Dr. Russ Morfitt and the work that I do is treatment of anxiety problems
and there are a lot of anxiety problems out there and I’m really privileged to be able to spend
my time helping people who suffer with problems ranging from social anxiety, to general anxiety, to obsessive compulsive disorder
Some people have panic attacks – there’s a problem called panic disorder.
Post-traumatic stress disorder. Those are the sorts of things that I do.
And I do it two different places.
I wonder if I’m going to be able to operate this thing here.
Ok, so I do it two different places. One is right across the street over at Hutchinson Health.
And I’ve been privileged to be there for something like 16 years
and along the way I’ve been able to develop my skills to focus on treatment of anxiety and its been really a privilege to be there.
But the new thing I’m doing apart from Hutchinson Health
is to help people really around the world by the new website
that we created called Learn to Live.
It’s just extremely exciting to me.
Really the problem being that most people who suffer from social anxiety related problems never ask for help.
They just never ask for help.
So all the people who I never see in my practice because they never ask for help, we’re able to help
because its a lot easier to start off by going to a website
than it is to actually work up the courage
to do what it takes
to actually meet with a provider
and if you’re not somebody
who’s dealt with this personally,
if you can imagine what its like
So for example I’ll ask you a general question
How many of you would say
“you know, I think I know the difference
between a psychologist and a psychiatrist”
If you feel like “yeah I confidently know that.”
Ok, just a handful of people.
So if I’m someone who’s suffering from social anxiety or another kind of anxiety
and I think, “OK, I’m fed up with this, I really want to get some help now.”
But, where do I even start?
Phone book? I mean, what do I even do?
All these barriers and hurdles to really asking for help.
That’s why I’m doing Learn to Live
But really I’m here to talk about big picture how social anxiety affects people in college.
So let’s talk about an example. Let’s say Marie – Marie is a 2nd year student who’s studying Biology.
She’s 19 years old. She’s from good old Hutch. Umm and she’s in some of your classes.
But you don’t notice her.
She kind slips into class quietly. She slips out of class quietly. Lectures and labs – there she is, there she’s gone.
You hardly notice her. At one point you say hi to her, but she doesn’t say hi back.
And so you think, “Well how stuck up is she?” But maybe not – maybe its not an issue of being stuck up.
Luke, he’s a first year student studying generals. He’s signed up for several classes. He mysteriously withdraws from Intro to Communications
Then he withdraws from general chemistry. He’s still in another class or two but if you notice him at all you notice he’s just always with that one guy.
That one guy who he rides to campus with. And if you are also from Litchfield you might have noticed, “Hey, that was the same kid that Luke always spent time with in Litchfield as well.
Maybe Luke and that friend are just really good friends or maybe there is more to it than that.
Peyton is a PSEO student. She blends into the woodwork. You hardly notice her. She takes the trailblazer over then right after class she finds her way back to the bus.
When she drives she finds a way back to the car right away after class. Where’d she go?
In the hallway it’s occurred to you to maybe say Hi to her cause she’s in a class or two of yours, but she’s always on the phone.
Always on the phone for some reason. Then after three weeks she disappears.
These are some examples of people who suffer from social anxiety. And as I say social anxiety, I’m talking about problem social anxiety.
We’ll get to the idea that social anxiety itself is not an unusual thing, but that social anxiety is actually a very normal and useful thing.
But when I’m talking about social anxiety i’m talking about serious problematic social anxiety.
So what happens when people suffer from social anxiety disorder and some of those others I mentioned at the beginning that I treat?
Studies of students who have left school – who have left college – and gone back and said, ” Hey, time-out, stop, what contributed to you leaving college?”
64% said they had a mental health related concern. They were depressed, they were anxious, they had another problem.
A mental health related concern that contributed to them leaving college. So they’re not here. Here we are in the middle of this year, and they’re gone.
These are issues that really do affect college students. With Learn to Live we do a lot with Facebook and Twitter and social media.
We found this was Tweeted to us on Twitter.
Hearing people laugh near you. Not talking because you are afraid that what you say will be judged.
Keeping quiet in a conversation with three people. Not being able to go anywhere alone. Staying inside all day.
Hating when the teacher asks you a question in class. Eye contact. Eating in front of people. Counting money before you pay.
Not leaving voicemails. Paying for things at a shop. Asking for help. Always preparing what to say. Bumping into people you know. Feeling embarrassed all the time.
Social Anxiety. That’s what we’re talking about with social anxiety.
People who have problematic social anxiety – this is the kind of story that I hear over and over and over again. It can affect every little area of your life.
Because, we’re around people so often. Two numbers – 8% and 12% – 8% is at any given time in the general population, 8% of the population is diagnosable with social anxiety disorder.
Meaning, their problem with social anxiety is so great that they are diagnosable with this disorder that because it causes them so much impairment, they are missing out on things in life.
They are suffering so much by experiencing the discomfort when they do go places, when they do things.
When they do come to college 12% are diagnosable with social anxiety at some point during their lifetime. So – that’s one out of 8.
DO you know more than 8 people? Then there’s a good chance you know someone who suffers or will suffer at some point from serious social anxiety or social phobia in their life.
Another tweet – I’m actually not listening to anything, I just really like it when people don’t talk to me.
How many have suspected that there’s somebody who you have encountered or somebody you know or somebody you’ve interested with when you’ve walked past them and they seem to be busy and you wondered, “they might be uncomfortable
and might just be covering up some discomfort. They might just be trying to avoid things a little bit – have you ever suspected that?
So Barbara on our Facebook page – we now have 5,000 members on our Facebook page, but back in September she said
“ugh, social anxiety, just another disorder for therapists to get rich curing. Whatever happened to just shyness?”
We’ll you’ll not that Barbara didn’t get any likes on that comment. So two problems with Barbara’s comment –
One of them was addressed by Anna hear who says, “shyness and anxiety are two very very different things. And unless you have severe social anxiety as I do, you wouldn’t understand.”
And that’s the life of many people who suffer from anxiety. Whether its social anxiety or some of the other anxieties that I have mentioned earlier.
Family members and if someone is lucky enough to have some friends really have a hard time understanding that – it seems so unnecessary – there’s no really threat here.
Why are you struggling I don’t get it? The family or friend might say – might feel – but in reality its a story of someone really either suffering or just feeling like they can’t do it
whatever the “it” is. That’s the one problem with Barbara’s comment. The other problem is about therapists getting rich. I don’t know if any of you are thinking about becoming a therapist or psychologist or whatever…yeah, therapists don’t get rich.
Barbara is in error there. So treatment – treatment for social anxiety. Most people never seek it. But those who do – here are three main kinds of treatment a person can encounter for social anxiety:
Number one is supporting counseling. Number two would be medications. Number three would be Cognitive Behavioral Therapy.
That’s the kind of work that I do across the street, and that’s what we’ve built into Learn to Live and there are some other online programs as well in different countries that use online CBT as well.
So those are the three main kinds of treatment for social anxiety.
As somebody that spends my career devoted to helping others I want to make sure that the type of work that I do really is helpful.
And so I pay close attention to what the research about social anxiety says.
Most people who go to seek counseling whether is is for social anxiety or for other things (but we’re talking about social anxiety here) will receive supportive counseling
Provided by compassionate counselors, therapists, who are well-trained – but what does our research say about how that impacts social anxiety?
To meet with a provider, and process your week, and get that empathy and support and encouragement – that doesn’t help for social anxiety very much.
So supportive counseling is less effective. Many people get medications –
and our research shows that that is more effective though there are side effects that apply for some people, but many people are helped.
Cognitive Behavioral Therapy, whether its face-to-face…well with face-to-face our research shows that it is more effective,
and I’ll be defining what Cognitive Behavioral Therapy is as, because, frankly, if you suffer from social anxiety, or if you have someone you care about who does, I would hope that you would seek out cognitive behavioral therapy for yourself or them.
Because it’s more effective, but its often unavailable because we have far too few providers who do this kind of work
Or online, the reason we do it is, as Terry mentioned, to make it more available. And our research shows, low and behold, its just as effective as face-to face therapy.
So what is CBT? What have I been talking about?
So CBT is Cognitive Behavioral Therapy. We use a really long name with lots of syllables so that we all feel very smart.
But really the cognitive part relates to the fact that our thoughts affect how we feel. We want to get the head knowledge for starters – that’s the cognitive part.
Of Cognitive Behavioral Therapy. So how do we do that? With education, people begin to challenge their thoughts.
So, education. We start off with education about the idea that actually anxiety can be a useful thing as I mentioned earlier.
So how can anxiety be useful? Well lets say you are that skier – if you are just really laid back like the stereotypical skier is
(but I would suggest that the champion skiers probably aren’t as laid back as the stereotype)
But if I’m just really laid back like I have no anxiety at all – how hard am I going to work? really?
The champion skiers, they’re in the weight room, and they’re running and they’re skiing and they’re working hard.
And they’re working out and they’re focused and they are feeling a certain amount of anxiety because the competition is stiff.
And so that anxiety can drive us in to work harder.And anxiety can be a signal to us that there is danger and we should do something about it.
So either it’s a little bit of anxiety to tell me, “OK work at this” or anxiety that is higher that says, “Danger – act! Do something!”
If you are hearing the first one – how many of you know what the Yerkes-Dodson Law is?
Ok, so I’m a psychologist. And psychology is a field of study that has been around about 100 years.
Lots of research. Thousand and thousands of studies and ideas that have been generated, but we’ve only generated on idea that has been so compelling that it has ever been declared a law, and that’s the Yerkes-Dodson Law.
Which is this idea that for any given task that I do, that my performance on that task (let’s think about the skier) that my performance on that task is related to how much stress that I feel.
If the idea were (and stress and anxiety are close cousins) that having no anxiety means I’m at my best, then my peak performance would be right here, right?
When my stress is really low, my performance would be really high. But in reality the Yerkes-Dodson Law has found over the years that, no, it’s like this
That there is some level of stress (not zero) that is going to give me my peak performance.
Sot hey skier who has a certain amount of stress is going to try harder – same with people in any other occupation.
Welders are going to do a better job welding if they feel a little bit of pressure.
Now what about social anxiety? Can social anxiety be useful?
We have our group here and this is their intro to Lit class and they’re talking about Beowulf and you think, “Well, is her contribution to their conversation going to be better if she has no anxiety?”
Or will it be better if she has just a little bit of anxiety? Yes – so if she feels a little bit of anxiety she is going to put in a bit more effort.
She’s probably going to care more about how the other person feels, who she’s talking to. She’s probably going to want to put a little bit more thought into what is happening.
Let’s say that our other person on the bottom is interviewing for a job.
Well, interviewing for a job can produce a ton of anxiety. Who’s interviewed for a job before?Multiple jobs?
Well, if you think about it, if I’m interviewing for a job I want to put my best foot forward, right? And so I don’t want to be here, and have no anxiety.
But sometimes it can be really hard – who thinks they have ever been here when interviewing for a job? So sometimes when the anxiety is really high it’s difficult to think as clearly as you could and to think of all the great things to tell the person who is interviewing you.
But she wants to have some level of anxiety so that she can really be engaged – put effort into it.
You would want me to feel somewhat nervous and feel some anxiety about talking to you, right?
Or else you’d totally get (silence), which is OK for me. So – no anxiety, and you don’t put forth effort, and we don’t want that.
So, here’s somebody who’s applying for the job at Ikea…
It’s not always easy to apply for the job.
Ok, I’m going to pause here because I’m going to check my watch.
Any questions so far?
“How would you describe the difference between shyness and social anxiety?”
Really good question – so the question was, “How would you describe the difference between shyness and social anxiety?”
“Actually that was a question I was going to bring up earlier, is that I struggle with anxiety, and to my knowledge, the difference between shyness and anxiety is such that shyness is a quality you have
versus anxiety being something that is debilitating and keeps you from participating fully in life or keeps you from doing things or makes it very difficult to do things that you feel you need to do.”
That was a great answer – that was a very good answer. Could everyone in the back hear his answer?
So yea it really is a story of impact on our life. So people who are shy have a temperament towards introversion.
So if I’m introverted, um, my batteries get recharged when I’m by myself. And if I’m introverted, I’m kinda timid, kinda nervous about meeting other people.
Not all introverts are nervous about meeting new people, they just want to get their batteries recharged by themselves,
But if I am introverted and I’m also somewhat timid, somewhat nervous about encountering new people, I’m shy.
So when I was little I hung onto moms leg when she was talking to somebody at the church or a meeting or wherever – the store.
Social anxiety when it gets to the level that we are talking about here really causes significant suffering and it prevents me from doing what I want to do.
We call that impairment in health care. Impairment.
Yes? “Is it emotional or neurological?” So the question was is social anxiety emotional or neurological.
Good question that I’ll give a very brief answer to – so short shrift to that answer. My friends the psychiatrists who are treating people with medications – I asked you who knew the difference between a psychiatrist and a psychologist…
The short answer is psychiatrists tend to treat with medication and psychologists tend to do evaluations or do therapy and treat with therapy – talk treatments like I do.
But my friends who are psychiatrists or other physicians who are prescribing medications, they use a model (and I’m not sure I get to this in my slides) they view it as being a chemical imbalance
so maybe many of you have heard – a person has anxiety or depression because they have a chemical imbalance in their brain.
And that’s their perspective. My perspective is (well, because I have no chemicals) but the research shows that Cognitive Behavioral Therapy which I do is one of our most effective treatments
without any chemicals directly involved. We know that if I change my thoughts (as we are starting to talk about here) and then change my behaviors, that my anxiety gets better.
So they’re treating things biologically, I’m treating things by changing behavior and thoughts, both are impacting the anxiety, so does that tell us what the problem is?
I think it really tells us it depends on what lens you are looking through. We know that if we do a brain scan of somebody who has a severe anxiety problem
while they’re doing certain activities (sometimes a PET scan or a SPECT scan) we’re able to see hot spots in the brain that tend to be active that aren’t active in the same way with someone that doesn’t have an anxiety problem.
And then if that person is successfully treated with medications, we see changes in the PET scan or SPECT scan. It looks different.
And what if they’re treated with therapy? Same thing. The same kind of improvement happens in those scans of the brain.
So it’s strange and we don’t really have a good answer to your question.
Ok. So I indicated that the cognitive part of Cognitive Behavioral Therapy is about your thoughts and the idea that your thoguhts produce your feelings.
And so, I call this the STEP model. Where we say, “wait a second, even though most people would say that my situation causes how I feel.” (most people talk that way)
Who say, “I’m really stressed because of that job interview.” Well, stress (emotion right?) and what was my explanation? Job interview.
Like the situation causes the emotion. To which you might say, “well duh! Job interviews cause stress.”
But let me ask you – what if somebody’s thoughts were, “That interviewer – I just know they are going to like me. I just really think they are – I saw them in the office before when I dropped off my application and I just think they are going to like me.”
Vs. if my thought is, ” I am not going to know what to say. They are going to think I am so stupid and boring. I’m gonna freeze up. I’m gonna drool.”
Different thoughts, right? Who thinks that having those different thoughts could impact how comfortably we feel?
So this is not rocket science – how comfortable I feel brings different emotions and all I did was change the thoughts.
And so a big part of my job in providing people with CBT is helping them learn to change their thoughts.
And along the way they learn to inspect thoughts. So we identify the thought that goes in the diamond, and then we say, “Let’s take a closer look at that.”
Now we call them automatic negative thoughts – we call them automatic thoughts because they are automatic and we often don’t notice them.
If I’m angry – so different emotion – if I’m angry I might not notice that I’m also thinking when somebody cut me off in traffic – I might not notice that I’m thinking, “That person thinks they’re better than me. They think they can push me around. They don’t care how I feel. they are trying to put me down.”
But I might be thinking those, and that’s why i might be feeling angry at that time. And so we help them slow it down and think, “what were my thoughts?”
And maybe it was something like that for the anger and maybe for that job interview its something like those thoughts I was saying.
“They might think I’m boring. They might think I’m stupid. They might think I’m nervous.”
“They might think I’m nervous” is really a big one for people with social anxiety. I don’t want you to think I’m nervous. Cause if you think I’m nervous that would be awful.
And so why am I on my cell phone? Why am I grabbing the chair bracing myself, why am I slipping out of the room?
I want to cover it up, I want to get out of there because right now I feel like I am in the spotlight. If I have social anxiety I feel like I’m in the spotlight.
I actually am in front of the spotlight. But if in this moment I am suffering from a high level of social anxiety I’m seeing myself as in the spotlight and viewing you as an audience looking at me.
And I’m fully anticipating that you are going to be judgmental, that you are going to have hostile thoughts towards me. That you are going to be highly critical.
In truth, there may be some of you who are kind of highly critical, there may be some of you in this room who tend to judge people harshly, but not all of you.
I have no doubt that there are many people in this room who are really willing to cut a lot of other people slack and really accepting of other people.
If there are people in this room (and if I’m suffering from social anxiety and I’m realizing that I might have been miss-judged by a judgmental person) I might chose to say, “I’m just not going to let that person vote.
In my own mind I’m not gonna let them vote on whether I’m OK or not.”
So as we inspect the thoughts we might identify the automatic negative thought – so let’s say I figure out the thought and I’m having thoughts like “oh your are going to think I’m stupid, you are gonna think I’m boring, or a bad psychologist or a bad presenter.”
And then we might say , well, there are certain groups of categories of problems with automatic thoughts, one of them is fortune telling.
Well, I just predicted what you might think, so I was fortune telling. Right?
Mind reading – I was pretty sure I knew what you were thinking about me, and I was pretty sure I knew why you turned away and whispered to that person next to you.
I was reading your mind.
“Feeling makes fact” – the idea that I feel something so strongly it must be true. Because I felt it in my gut – so it much be true.
“disaster making” – that’s when I say, “if this thing happens its not just bad, it’s really, really bad. Like what if you thought I was nervous?”
And you might. You might think that. But there’s two things happening in my mind. One is that I’m predicting – I’m fortune telling that you’re going to think this a second from now, right?
And then i’m also thinking of it as something that would be really horrible if it were to come true.
Well wait a second – two problems here, right? One is that you may not think that.
And the other thing is I can’t please everybody and it’s not practical to care deeply about what everyone thinks
and so maybe it isn’t as disastrous if you think bad things about me.
We have 12 minutes.
Ok – Socratic questioning – that’s when I have this thought, (and some of you have probably studied philosophy more than I have) but my understanding is that Socrates back in the day didn’t just tell people stuff.
He taught people how to ask the right questions, or he would ask them questions and then it was their job to answer the question
then in the course of answering the question, they would gain knowledge. So Socratic questioning is the process where I say, “OK I’m having this thought so I’m predicating
that I’m going to shake.” Social anxiety – I don’t want to shake in front of you. 20% of alcoholics have social anxiety disorder. 20% or all alcoholics have social anxiety disorder.
So what’s going on? In part they are medicating that anxiety.
And everybody knows that alcohol is a depressant which is a problem mood wise and adjustment wise, but some people are using it to try to manage their anxiety.
It works out very poorly for people who do because they’re much more likely to become addicted and much more likely to have serious problems.
But it might be that I am drinking to cover up the shake. Because again if I care deeply about how you think that I’m anxious right now, it’s really important to me that you don’t see me shake.
And so I don’t want to write a check in front of you – checks are these paper things we used to use – anyway, I don’t want to write a check in front of you.
I don’t want to do other things in front of you that might cause you to see me shake. I might not want to drink from a glass in front of you.
Because you might see me shake – and why am I shaking? Because I’m nervous and when I’m nervous, my body is preparing for action.
And so my muscles are tense right? And when my muscles are really tense, then they shake.
You’ve seen the weight lifters in the olympics – its not just all smooth – gahhhhh! They’re shaking right?
So Socratic questioning is when I ask myself questions about the thought. You know, “has this happened before?” Because I’m predicting the shake.
Questions like, “Does it happen to others? What do logic and science and common sense suggest about whether it is likely?”
“How bad would it be if it happened?” Then we try to identify a new thought. What is a thought that is going to work better?
It could be that changing my thoughts and changing my behaviors – in the case of this penguin – changing my behaviors can change my outcomes.
“We just haven’t been flapping them hard enough.” Low and behold, we could have been doing this all along.
So one kind of knowledge is the head knowledge and we’ve been talking about that. So again, Cognitive Behavioral Therapy. The cognitive part relates to my thoughts – and my thoughts produce my emotions.
And that give me that kind of head level knowledge that I don’t need to be afraid of you, maybe, I might think this through and end up concluding
“now wait a second – yeah I might shake, or you might think I’m boring or you might think I’m nervous, but maybe it’s not that bad if you do.”
And so then maybe in my head I know, “I don’t really need to be afraid of you.” But in my gut I still fear it.
How many people have ever been afraid of something that you really knew you didn’t need to be afraid of, but you were afraid anyway?
Ok, so a little confession about my profession is that even though we say Cognitive Behavioral Therapy is demonstrated to be very effective for social anxiety
often it stops with the head knowledge, but it really shouldn’t, and the research says it shouldn’t , and its important that we get that gut level knowledge.
Well how do we get that? Well, we do behavior experiments.
where we go out there and we do things and check out what our outcomes are.
I go out there and do I shake like I think I will? Maybe I will, maybe I won’t. But I want to find out – sometimes we predict things will happen and they don’t.
I want to reduce my precautions – I know that I have that written in the same sized font as everything else, but it should be a giant font.
It should be enormous. Reducing precautions – our recent research is showing us that the most powerful thing that we can do to get past an anxiety problem that we have is to quit being so careful.
Now, your parents told you to be careful. They told you that, and in some areas of life you really should be careful.
But if I suffer from anxiety problems, and we’re talking about social anxiety, it might be that in that area I’m being too careful.
Well what kind of precautions might I do? Well, it might be that if I do a presentation, if I have to do a talk, I’m going to practice, practice, practice
so it’s perfect, cause there’s no chance that you can judge me if every word comes out just right.
Or it might be that I’m just going to read word for word here and then I wont forget what I was going to say
because I might be predicting I’m going to predict what I was going to say. Well public speaking is a place where social anxiety happens a lot.
How many of you have ever felt nervous when you are public speaking? “All the time” Yeah, I hear ya.
And so public speaking for example we might take precautions like reading word for word, over-preparing, I might stare at the wall so I don’t have to look at you.
And I might go really fast to just get it over with because its really uncomfortable talking in front of you so I just want to get this done.
And yet, at the end – let’s say it goes OK – let’s say it goes OK and I survive this semester at school
but I know that all the way I was walking through the hallways faking phones calls and getting in and out of class really fast
I could draw two conclusions: my conclusion could be “it really isn’t that threatening of a situation, and I’m, really up to the task. I don’t have any reason to be afraid.”
Or I could conclude, “Phew, that was one near miss after another – good thing I did all of those precautions. I’m going to keep that phone handy. I’ll get a second phone.”
And so job one is to really reduce these precautions, so if the ceiling caves in before I finish my presentation and all you got from this was
for a person to reduce their social anxiety over time, the most powerful thing they can do is to be less careful.
That would be the message I would want you to take home.
And the other thing we do is fear facing, where I put myself in situations that are uncomfortable deliberately. Deliberately.
The idea is that anything worth doing is difficult to do, and there’s no easy way to get past fears except to face them.
So I’ve deliberately put myself in the spotlight. I’ve deliberately put myself in the situation. So if i’m facing my fears I’ve deliberately put myself in situations where you can see me up close
or I might – having a conversation with you might make me really uncomfortable so it might be that I’ll make a plan that I’m going to make small talk with that cashier.
And in fact I might even plan it so that I can have interactions with several cashiers over the next half hour and one after another I’m going to make some small talk.
Even though I’m uncomfortable with the idea that I’m facing my fears, and there’s something powerful that happens when I face my fears.
It might be that the telephone is really uncomfortable for me so I might decide that I’m going to make phone calls, one after the other.
You know, “How much is milk?” right? Ummm Ummm Ummmm, I might pause, I might “ummm” in front of you because I might be afraid that you might judge me
if I look nervous or uncertain. It’s even possible that I’ve been doing that throughout our discussion today. Or it could be that I naturally “ummm”.
I might make deliberate mistakes because on some level – remember the “disaster making” issue?
I might think, “It’d be awful if you judged me. It might be awful if I make a mistake.” So I might make mistakes on purpose.
So I might deliberately, when I go talk to the cashier, I might deliberately mispronounce words. I might deliberately do other things imperfectly.
I might deliberately-ly stutter. Why? Because I’m so sick and tired of being caged in by this fear that’s kept me from potentially completing my college education.
Or having the kind of life that I want to live. That is is worth doing. It’s worth doing these things that are awkward and uncomfortable.
And its the people who have become really fed-up with the problem enough to cross that threshold that they’re willing to suffer a little bit by facing fears
Those are the people who really get a big win. I might even inconvenience others on purpose as well.
That actually is one of the – I won’t even get into that. But sometimes it’s funny to deliberately inconvenience other people
I mean, you’re not trying to make them really suffer, but if you are going to deliberately slow someone down for a second or two
If you have trouble with social anxiety, it is excruciating at first.
Like if the light turns green – one one thousand, two one thousand – if you suffer from social anxiety your veins will be swelling.
But, because facing fears typically results in (by the end of my fear facing, if I stick with it a long time) I get to be less afraid.
You know, after I’ve done that to 40 cars, I’m less afraid. My anxiety drops, like that graph shows.
Here are some safety behaviors that we discussed.
Terry, I said I would talk about test anxiety. Same basic principles.
I worry too much about if I am going to fail the test or if I will do poorly, and so i want to do the same thing.
I want to change my thoughts – is it really the end of the world if I get a bad grade on this particular test?
Really? Maybe it’s not. Maybe I even want to face my fears – maybe I want to deliberately put the wrong answer on a couple of quizes or on a couple of papers so I get less afraid of imperfection.
So the key is noticing the problem. Noticing the people who are trying to conceal that they have the problem. Acknowledging it in yourself if you are the one that suffers.
And then seeking good help.
Thank you very much!

Signs You May Need Help

Everyone gets anxious now and then. So how do you tell if you need help with anxiety? The following signs may mean you need to find help.


Social Isolation

Anxiety and isolation can be a dangerous trap. You may go into seclusion to avoid situations that may cause anxiety, or you may isolate yourself to avoid people from judging you. This can add up to a lonely life.

A lot of time spent alone can worsen your anxiety. You’re alone with your thoughts without any social support. This creates an isolated cocoon filled with disordered anxiety thoughts. You may start to question who you are and what your purpose is in life. You’ll only have your anxious thoughts to keep you company.


Emotional Outburst

Anxious feelings that are with you most of the time can make you feel stressed out. It’s like you are living in a pressure cooker that’s ready to blow. If you’re having angry outbursts, it might be due to emotional overheating from built-up anxiety.


Physical Signs

Many people with an anxiety disorder also abuse or are dependent on drugs and alcohol.

Abuse/Dependent on Alcohol 35%
Abuse/Dependent on Drugs 30%

Anxiety can produce mild and intense physical symptoms, including:

Muscle Tension

Sometimes, a long day can cause tight muscles and pain for just about anyone. Anxiety-related muscle tension is different. Over the long term, it’s aches and pains that won’t go away in the back, neck, shoulders and jaw muscles. Muscle tension causes restlessness, fidgeting or teeth grinding.

Fatigue and Sleeplessness

When you worry all the time, it is an exhausting way to live that makes you tired. Anxious thoughts can make it hard to go or stay asleep.

Shortness of Breath

Anxiety can make you feel like you are having trouble breathing. It can also make you feel like you’re not getting enough air. When your heart is racing, your blood pressure is rising. You’ll feel dizzy and shortness of breath can develop.

Difficulty Swallowing

Emotional distress from anxiety can make you feel like you have food stuck in your throat. It can also feel like it is hard to swallow.


Sweating due to anxiety happens from feeling fear and worry. Anger or nervousness can play a part as well.

Chest Pains

When anxiety is too much to handle, it can cause chest pain unrelated to the heart. Other chest-related symptoms can include a pounding or racing heart.

Headaches and Lightheadedness

Anxiety can give you headaches or migraines. It can also make you feel dizzy, unsteady or lightheaded. These symptoms can make it hard for you to maintain your balance. Feeling light-headed a lot without any other symptoms is often due to anxiety.


Always feeling anxious can put you on edge. It can also make you feel irritated at even the slightest of events. If your irritability is persistent, it could be due to anxiety.

Numbness, Hot, and Cold Flashes

Numbness or tingling in your extremities can be an anxiety-related physical symptom. Flashes of heat or chills in your upper body can result from anxious thoughts.

Substance Use/Abuse

Many people with an anxiety disorder also abuse or are dependent on drugs and alcohol. 30% to 35% of people with anxiety disorders also abuse or are dependent on alcohol, while 25% to 30% of people with anxiety disorders abuse or are dependent on drugs.

Stomachaches and Digestion Issues

Your digestive system holds and shows anxiety. This can happen in different ways, like an upset stomach or stomach pain. Other ways are throwing up, moving your bowels too much or too little, and IBS (irritable bowel syndrome). Digestive problems can have a big impact on your everyday life.

Anxiety and Substance Abuse

Which Comes First

Figuring out which came first (the substance abuse or anxiety) is a bit more complicated and depends on the person. Anxiety may cause a person to use drugs or alcohol due to several possible reasons, such as to escape anxious feelings and/or thoughts and to feel normal. Anxious feelings also increase impulsive reactions to take drugs and alcohol.

Substance-Induced Anxiety Disorder

In other cases, drinking or drugs lead to anxiety. This is called substance-induced anxiety disorder. Sudden anxiety can happen in a person who is intoxicated. Anxiety can also develop when a person is not using drugs or alcohol and discomfort sets in. Many times, people don’t make the connection between drugs or alcohol and anxiety. This is because they don’t associate drugs or alcohol with feeling bad.

Substances that can induce anxiety are alcohol, marijuana, hallucinogens, inhalants, amphetamines, cocaine, and other stimulants. Many different prescription medications can cause substance-induced anxiety. Check with your doctor to see if your prescriptions could be causing issues.

Suicidal Thoughts

Anxiety can also lead to suicidal thoughts when there is also depression. Hopelessness, low self-worth, and no motivation to have fun can lead someone down the dark path to suicide. Though anxiety signs are most noticeable, suicide thoughts from depression can be lurking. See the section below entitled “Are You in Crisis?” to get help fast for suicidal thoughts.

(Get Help Now 911) 1-800-273-8255

If you are having suicidal thoughts, get help now.

Finding Help On- and Off-Campus

On-Campus Counseling

Finding help for anxiety, stress, or panic attacks on campus may take a little research. You can likely easily find resources at school for your concerns.

Student Center: Visit or call the student center for names of counselors available on campus that you can speak with. Your student center may be called the campus health or counseling center or student wellness center. Contact them to ask about their services. Don’t let lack of money stop you from seeking help. Many colleges provide counseling sessions free of charge.

Psychiatry/Psychology Department: Contact the psychiatry or psychology department at your school. Ask if they offer sessions with graduate students.

School Chaplain: Many private colleges with religious views have school chaplains. If one is available, visit your chaplain to see about counseling.

Residential Assistant: Talk with a friend or your resident assistant (RA). Ask the individual to help you seek professional help, or to go with you on your first visit.

Off-Campus Resources

Many counseling centers have limited resources, so you may have to seek help off-campus.

Insurance Company: Check with your healthcare insurance company about what mental health services they cover. Look over their list of counseling and therapy providers. Make an appointment with one of them.

Keep Your Options Open: Not every professional is a good fit for every client. If you don’t like the first one, try another. Keep trying until you find someone you are comfortable with and have confidence in.

Primary Care Physician: See your primary care physician who may be able to give you a referral for a mental health professional.

Support Groups: Find a local support group that meets off-campus. Check with the local counseling centers and community centers. Hospitals and places of worship may also host or run support groups.

See “Additional Resources” at the end of this article. There are several listings on how to locate low cost and confidential mental health services.

Additional Support for Anxiety

See Your Doctor to Rule Out a Medical Cause for Anxiety

For some people, physical anxiety signs can have medical causes. Go to your doctor for a checkup. Some medical conditions can cause anxiety-like symptoms. Certain drugs and supplements can also cause anxiety. Medications for asthma, cold remedies, antidepressants and ADHD medications can all cause anxiety. Talk to your doctor about any OTC drugs, prescriptions, supplements and other drugs you are taking.

Group Sports and/or Exercise Classes

Group sports or exercise classes are excellent ways to stay in shape. Group sports and classes are both good ways to get out of the house to make friends. They also help to get your body working and release some of those feel-good brain chemicals. Baseball, football, soccer and basketball are popular group sports choices. Exercise classes, kickboxing, cardio and yoga are some classes many colleges offer their students.

Visit the College Gym

Many college gyms are also health centers for students. They help students face the challenges that stress and anxiety can bring. It can be the perfect place for you to foster healthy habits and focus on self-care. If your gym has health coaches, get one for yourself. Together, you can work out a plan that improves your mental and physical well-being.

Meditation Area/Prayer Rooms

Meditation and prayer rooms at colleges help faith- and non-faith-based students. Students can visit a quiet and safe setting where they can meditate, pray or reflect. They are welcoming environments that are safe and secure. If you are feeling anxious, visit the meditation and prayer room at your school. Prayer rooms are sometimes called chapels.

Substance Abuse Support

Alcohol and drug abuse are major issues on college campuses.  22.5% of college students meet the criteria for drug addiction. 49% of full-time college students abuse drugs and/or alcohol, and 95% of violence on college campuses is alcohol-related.

Most schools know these numbers. They have responded by providing drug and alcohol abuse services and support for students. They also provide education about drugs and alcohol to help prevent abuse from starting.

Some on-campus substance abuse centers partner with treatment centers. These partnerships provide much-needed help to students struggling with serious drug and alcohol problems. Certain colleges also host outpatient programs. Students can attend both classes and rehab without leaving the campus.

Online Resources


A five-minute anxiety test that is based on the DSM-IV (Diagnostic and Statistical Manual of Mental Health Disorders – Fourth Edition).

A two-minute screening test to see whether or not you have anxiety.

Anxiety and Suicide

Help is available around the clock 7 days a week for people in distress or in crisis. Trained workers can also provide mental health referrals.

A comprehensive look at the relationships between anxiety and suicidal thoughts.

Learn more about the fleeting and long-term thoughts and plans that can lead to suicide.

A WebMD article about young people and mental health issues. It’s a bigger issue than most people realize.

An article by Boston University that explains the difference between “normal” anxiety vs. anxiety that becomes an issue needing further help.

A searchable directory of mental health providers by address and the disorders they treat. The list of disorders enables you to choose anxiety.

Managing Anxiety

An article on 12 ways to find help for anxiety both on and off-campus.

A list of 50 of the best meditation spaces on college campuses across the United States with summaries and a picture of each.

The author interviewed therapists and developed a comprehensive list on dealing with anxiety.

Learn how mindfulness, meditation and yoga can help college students relax and improve their health.

A quick and easy read on how to control your stress and ways to relax when you’re feeling overwhelmed.

A guide for college students on coping with anxiety due to leaving home for school.

A guide for people who know college students who are dealing with anxiety and the best ways to help them.

Many college students have limited budgets. This article explains how to eat healthy on a budget.

The Mayo Clinic’s step by step guide to reducing stress by using relaxation techniques.

A detailed analysis of how to use your time each day to allow for studying.

A guide from Harvard Health on coping with anxiety for students.

Anxiety Support Groups

A confidential and anonymous website where you can find information about treatment facilities in the United States for addiction, substance use, and/or mental health issues such as anxiety.

An online directory of anxiety support groups that you can search by disorder and state. Some states have on-campus listings.

A list of ways college students can get the help and support needed and how to get someone to talk to.

More About Anxiety

A comprehensive look at why deep breathing is healthy and deep breathing techniques.

An article about 10 ways you can use to develop a different relationship with your thoughts and feelings.

A comprehensive look at anxiety disorders that coexist with drug and alcohol abuse.

A look at the physical symptoms that are related to anxiety and panic disorders.

A handy guide to the caffeine content of foods and drugs so you can keep track of your intake and avoid consuming too much caffeine. Table 1 with the caffeine dosage information appears on page 75.

A detailed look at how positive thinking helps to rewire the brain and help combat anxiety.

A comprehensive overview of anxiety including signs, symptoms, risk factors, treatments and therapies.

A quick and easy read on why you should avoid alcohol as a way to cope with anxiety.

A research article that does a deep dive into the relationships and consequences from the combination of drug abuse and anxiety.

An article that discusses overthinking, why it can be unsafe, and ways to stop it.

Are You in Crisis?

The second leading cause of death in young people ages 10-24 is suicide. If you need immediate help or have thoughts of suicide, call or visit the website of the National Suicide Prevention Lifeline (1-800-273-8255). Trained crisis workers are there to talk 24/7 and your call is kept confidential. You can get crisis counseling and mental health referrals from them. If you are in a possible life-threatening situation, call 911 or go to the closest emergency room.