Sunday, December 30, 2012

Sleep: Protecting An Essential Life Rhythm

Many college students do not sleep well.  In fact, the typical student pattern can best be described as chaotic.  In many cases these patterns exacerbate and even trigger poor mental health outcomes.  Bipolar and other mood disorders, for example, are known to be sensitive to inadequate or unhealthy sleep rhythms.  Sometimes sleep problems are caused by factors outside their direct control, such as loud roommates, a medical condition, or living near a train track.  In these circumstances vulnerable students should consider working toward changes in their health and living situations, admittedly not always an easy thing to do.  More often than not, however, a student's sleeping problem is caused by poor "sleep hygiene", or poor choices about sleep that are within their ability to alter.

Due to their youth and general level of energy and vitality, traditional-aged students may grossly underestimate their ability to cope with chaotic life rhythms.  The average 20-year old can in fact rebound from sleep deprivation better than, say, the average 40-year old.  But this subjective feeling may mask an underlying deterioration which may be occurring, even at the cellular level.  So, students can pull off all-nighters for a time, but that habit is soon to catch up with them in the form of worsening mood, impaired ability to focus and concentrate, and diminished academic or athletic performance.

One simple set of guidelines to follow: pick and stick to a regular, reasonable rise time, avoid daytime naps, and use the bed only for sleep and other relaxing activity.  Seven to nine hours of nighttime sleep may be ideal.  But there are other tips which may be helpful.

Here is a list of practices conducive to good sleep, adapted from the American Academy of Sleep Medicine (2002):

  • Try to sleep only when you are drowsy.
  • If you are unable to fall asleep or stay asleep, leave your bedroom and engage in a quiet activity elsewhere.  Do not permit yourself to fall asleep outside the bedroom.  Return to bed when - and only when - you are sleepy.  Repeat this process of often as necessary throughout the night.
  • Maintain a regular arise time, even on days off work and on weekends.
  • Use your bedroom only for sleep and relaxing activity.
  • Avoid napping during the daytime.  If daytime sleepiness becomes overwhelming, limit nap time to a single nap of less than one hour, no later than 3 pm.
  • Distract your mind.  Lying in bed unable to sleep and frustrated needs to be avoided.  Try reading or watching a videotape or listening to books on tape.  It may be necessary to go into another room to do these.
  • Avoid caffeine within four to six hours of bedtime.
  • Avoid the use of nicotine close to bedtime or during the night.
  • Do not drink alcoholic beverages within four to six hours of bedtime.
  • While a light snack before bedtime can help promote sound sleep, avoid large meals.
  • Avoid strenuous exercise within six hours of bedtime.
  • Minimize light, noise, and extremes in temperature in the bedroom.

Sunday, December 16, 2012

Newtown

As we learn more about yet another unspeakable tragedy we also ponder in frustration over the state of mental health care in America.  While mass violence forever changes the landscapes of educational and community institutions, we look for courageous leaders who will take the reins and improve the accessibility, affordability and effectiveness of mental health services for the most vulnerable among us.


In higher education settings, the lives of every member of a campus community have been and will be deeply affected by fears of violence.  Alert systems, enhanced reporting and communication methods concerning potential threats, response teams and capable public safety operations are all now a part of daily campus life.  We have gotten better at identifying and providing initial responding to students in distress.  But what do we do after that?

The answer is a feeble one.  In many jurisdictions, there aren't enough psychiatric beds to hold all the individuals who may be of concern.  There aren't statutes which permit a mental health professional to issue an order to law enforcement to detain a threatening individual and hold him or her in a hospital   The process of petitioning for commitment in these same hospitals can take weeks, even longer.  The average stay in those hospitals may be two to five days.  For many, especially the un- and under-insured, there may be a long wait to follow up with a mental health professional after discharge.  Hospitals are closing, patients are being released into "community care", but there may be no such thing in reality.  In short, all the current incentives, intentional or not, are to block access to care.

As you see in the news, these issues occur at a time of threat and anxiety.  The families of the dead and maimed are looking for support and answers.  We are learning more about the factors behind and indicators of risk for potentially violent individuals.  But we can tell them more about that than we can about what to do with them.  This is a national travesty and it must be addressed.  Please press your legislators to take action.  Demand that they develop sound, sustainable funding models for state services.  Demand that they sponsor legislation that provides a rapid and seamless system of detainment and treatment for people who threaten our safety.  Tell them to support mental health insurance parity.  The folks in Newtown, Portland, Aurora, Oak Creek, Tucson, Blacksburg and many other past and future communities are waiting for our help. 

Friday, November 23, 2012

Down in a Hole

Depression.  Churchill aptly called it "The Black Dog", though the alcohol and tobacco he reportedly consumed may have made it blacker.  Depression is so prevalent that it has often been called the common cold of mental health problems.  As an example, in its most recent annual report, the Center for Collegiate Mental Health noted that 31.6% of some 74,000 students seeking counseling endorsed just a single symptom consistent with depression (thoughts of suicide) at any level.  Endorsement rates for other depressive symptoms are in similar ranges.  SAMHSA reports that 8.4% of college students have experienced a major depressive episode in the past year, but also notes that this rate is not statistically different from that for non-college peers.  Some claim that rates of mental illness among American college students have increased, and reports of increased severity and emotional states which are incompatible with college life abound.  These observations are not without dispute in the college mental health community itself, in large part because other data don't square with the hypothesis.  For example, in the Center where I work, adjustment issues, a category one can think of as reflecting normal stresses and strains of living, still are the most common presenting problem and diagnosis, as they have been for the more than 20 years I have worked there.  By the way, depression was formerly number two in this ranking.  It has recently been overtaken by anxiety, which as you will see below supports other possible theories of dynamics in student functioning.

That is not to say there are no recent dramatic changes in college student behavior.  There is no question that the number, frequency and intensity of crises, for example, have increased during my career.  This has also been a steadfast observation among my counterparts for many years now.  Some, myself included, suspect that the phenomena we are seeing may not be due to diseases as defined in the medical model but rather to impairment in coping skills, which is somehow being transmitted across society and culture.  What could possibly account for the apparent rise in severity of what looks like more serious mental health problems?


All things being equal, the student with impaired coping ability will look "sicker" than the student with better skills.  I recall a student who struggled when she realized she did not know anything about how to look for a job, including understanding the classified ads.  In her next breath she also told me she did not know the location of the book store.  My friends, these statements were made in late October.  I assure you, she "looked" depressed, and if I only used a checklist I could say she had "depressive symptoms".  But depression in the medical sense was not her problem, per se.  She had somehow missed out on some very basic life skills which created the breeding ground for her symptoms.  This is but one example of a great many crisis situations in which I have been involved.  The facts change, but the essential pattern remains the same: the stresses of an environment or situation, most often involving relationships, exceeds the ability to cope.  Symptoms of depression and anxiety are the result.  Taking this a step further, this is the way it is supposed to be.  It is a clarion call for change.


Therapists of the analytic or psychodynamic ilk understand that the number and quality of our defenses against life's slings and arrows are what protect us from negative mental health.  When these defenses are too few or of poor quality, depression and anxiety are the expected outcome.  College life is interesting partly because it represents a distinct moment in time in which a late adolescent or young adult leaves familiarity, to which they have adjusted most, and joins novelty, to which they often have adjusted the least.  Any lack of preparation is likely to be revealed in short order.  This is because the defenses on which they have relied will fail.  (What former college student can look back on that time and not see that some of their behavior was "disordered"?)  "Symptoms" are often the result of reliance on defenses which are no longer working well.  Faced with this scenario humans tend to keep doing what they have always done, thereby digging down into the hole even further.  Yes, one could call that depression and throw medicine at it.  And it may even help in the short term.  But only lasting change in defenses will get students out of that hole.

Seeing a problem in living as an external entity which inhabits us, and which requires an external intervention, is a facile act.  It relieves us, students and parents alike, of a more complex responsibility to self and others: changing our behavior.  It also happens to be supported by enormous economic forces in healthcare industries which can, intentionally or not, keep us in a hole.  Any person well into recovery from a wide range of mental health states will tell you that assuming responsibility and agency was the essential ingredient to success, even when external interventions are taken into account.  That is one sound way out of the hole.

Saturday, November 10, 2012

Heroic Students

Few things in my professional life have been more rewarding than to witness college students overcoming tremendous obstacles to their success and happiness.  For most of those around them, professors and administrators, friends and sometimes even family, their struggles were invisible and silent.  Working with them in the privacy and safety of therapy, college mental health professionals are privileged to nurture their strength, shore up battered psyches, and nudge them in the directions they need to travel.

I wish I had the memory banks to tell each of their stories.  Everyone can benefit from seeing how a young adult bravely confronts horrendous conditions and accomplish things that many of us never have or will.  Here are some examples, disguised and condensed for the sake of confidentiality.
  • Tyrell, 21, came from extreme poverty and at one point lived in his car on the edge of campus.  He was the first in his family to attend college, and he was determined to graduate and make something of himself.  It took unrelenting energy and conviction to rise each morning, stay awake in class, and disregard the doubts from within and without, but he got his diploma.
  • Janie, 19, saddled with a history of physical, sexual and emotional trauma at the hands of adults who were supposed to be her caretakers.  Her days were filled with intense fear and phobic anxiety; just sitting in class around other students, thinking they were judging her, took gargantuan effort.  She battled impulses to harm herself and exit her life altogether, but deep inside there was a constant, though sometimes faint, voice which told her there were other possibilities in her life.  Class attendance and grades were far from perfect, but she did not give up or quit.  She registered each semester, and worked on her goals persistently, not with great force, but like ocean waves on the shore.
  • Will, 23, lost and roaming in the grip of various addictions he brought to college with him.  He encountered many entanglements with friends, family, the legal system.  He had to face academic probation more than once.  Will sought treatment several times, each with the same outcome: relapse.  With enough support and encouragement he entered treatment one more time, and began a 12-step program.  There were ups and downs even then, but he did better in school and eventually graduated.
  • Beatrice, 18, in great distress over her gender and sexual identity.  She encountered frequent harassment and bullying from middle school forward.  Those who professed love for her rejected her emotionally, and also communicated not-so-vague threats of disowning her altogether.  The simple act of walking across campus took immense fortitude and exhausted her at times.  Through therapy, she found supportive others and got engaged in activism and justice for all students.  This empowered her and gave her confidence to be herself and interact with others respectfully and assertively.
There are so many more stories to tell.  In each case, the student clung tightly to something dim but abiding in their core: a genuine, healthier self which sought expression and release.  So many have lost this fight.  We have all known them in our lives, and we would all do well to use our powers to "see" the whole person in front of us, imagining a great struggle in which they are engaged, and facilitating their journey into being who they really are, which is always the path to emotional health.

Sunday, November 4, 2012

Experiences Shape the Brain

Much has been said and written on the subject of medication and its role in mental health care.  Perhaps too much.  Though it is growing, comparatively little has been said or noticed about other ways the brain is and can be shaped in order to improve emotional well being.  Let's take a brief look at how experiences, both positive and negative, influence brain development and functioning.

A recent study, for example, examined the transmission of anxiety from parents to children.  This research found that socially anxious parents imparted anxiety through specific parenting behaviors involving lack of warmth and affection, and criticism and doubt directed toward the child.  The role of these experiences is thought to contribute to the development of anxiety apart from genetic contributions, because the latter alone are not thought to be sufficient in the etiology of an anxiety disorder.  It does not require a tremendous leap to imagine that parental warmth and confidence provided to children reduces the likelihood of a future anxiety disorder.  The experience of warmth and confidence is more powerful, in my opinion, than any medication we would later give to the adult child to address their anxieties.  And more lasting too.

In another arena, a play-based method of teaching social interaction, called ESDM, to autistic children was shown to result in positive brain changes.  Researchers studied brain activity in both autistic and non-autistic children, after the former received the therapy for two years, and could not identity differences which are apparent otherwise.  Clearly, this behavioral intervention altered brain activity in a very desirable manner.  I'll wager that there are not many parents of children with autism who would not jump at the chance of this non-medical or intrusive intervention.  If only they were given the chance, or that such behavioral interventions were as aggressively marketed as medications are.

Currently, one has to dig deeply into the literature or perhaps be lucky enough to have an insightful and gifted care provider to access information about evidence-based psychological interventions.  The American Psychological Association does maintain resources on these interventions on their very good web site and Help Center (www.apa.org).  I encourage consumers to be educated concerning these alternatives to physiological interventions, which, in my experience are helpful at times and with some individuals, though the benefits come with cost and ultimately fade with time.

Experiences shape the brain.  Those who have experienced stress, trauma and deprivations have brains, and even appearances, which show this.  Those who have experienced positive relationships and satisfaction of needs also have brains which show that.  It would seem, given that we know this, that individuals, groups, communities and even countries would develop systems which promote the application of sound psychological principles to the advancement of human welfare.

Tuesday, October 23, 2012

A Gathering of Colleagues

This week I have been attending the annual conference of the Association of University and College Counseling Center Directors, or AUCCCD, in Newport, RI.  I have previously written about the importance of this organization to our field (see post of January 3, 2012).  It is not an overstatement to say this conference is among the professional highlights of my year.  It is a time for colleagues to understand and support each other in sometimes very difficult work, for us to learn best and innovative practices undertaken in other centers, and for us to advocate for this profession and the communities and students we serve.  It is absolutely essential for college mental health administrators to participate in this association and its main communication vehicle, its listserv.

I joined AUCCCD as a brand new and wet-behind-the-ears director in 1998, and my earliest interactions with my peers occurred on the listserv.  Though there are a few texts relating to college mental health, there are certainly no manuals, no compendium of wisdom regarding establishing, maintaining and growing a fully functional college mental health service.  Thankfully this wisdom is accessible from the board and membership of this organization.  In a relatively short time I was able to develop benchmarks for our Center, to learn about standards and accreditation processes for the field, and to understand the distance we had to travel to bring our work closer to that which we aspired.  This simply could not be found elsewhere.  Without its support many centers would not be where the are today: vibrant and essential partners in the campus community.

I can site examples of various meetings and keynotes which were helpful this year.  Learning about the developments and future of the Center for Collegiate Mental Health (also discussed previously), understanding generational differences among counseling center staff members, listening to directors of institutions the same size as my own, and hearing Patrick Kennedy address the civil rights issue of equal access to mental health care are all memorable.  But hallway and lunchtime conversations with colleagues were just as important, for one very simple reason.  These interactions help us address the hazard of professional isolation which can be endemic in the mental health professions.  Because so much of our work is private and cannot be shared with others we simply must have mechanisms which facilitate dialog in a safe and trusting environment, devoid of pettiness, posturing and politics, where everyone has the obligation of maintaining the same level of confidentiality. This ingredient or attitude, set in place by its sage founders many years ago, promotes the development of administrators and the centers they manage.  It is a priceless benefit of membership in AUCCCD.

If you are thinking of pursuing a career in college mental health, and perhaps rising through the ranks to leadership roles, you must remember and join AUCCCD when the time comes.

Saturday, October 6, 2012

Perception and Automatic Thoughts

Understanding the limits of human perception is an essential ingredient to good mental health and good communication skills.  Take any decent Psych 101 course and you will see just how limited our perceptual skills can be.  Long ago, during a lecture, I held up a plain sheet of yellow paper.  The yellow color could be described, in objective fashion, by its emitted wavelength and that would probably be well beyond dispute.  But that did not interest me.  I asked the audience to write down what they saw and any thoughts or feelings which arose from the "stimulus", the yellow paper.  There were, quite literally, as many perceptions as there were people in the room, though of course everyone "saw" the exact same thing.

How much more complex, then, are the other things we all experience in the course of our lives?  Yet all of us, often beyond our awareness, form impressions and interpretations of very complex information, and this in turn often leads to choices and actions which impact our lives and the lives of others.  Some of these make us happy, and some definitely do not.  By the time we reach early adolescence this dynamic has become like a reflex; it is lightning quick and automatic.  It is also dangerous.  You know what "they" say about assumptions.  "They" are correct.

The scale of this pattern of human behavior is enormous.  In a recent article, psychologist Jonathan Haidt discussed the science behind political and religious polarization in America, which has led to and may well lead to a great many more social conflicts and problems.  This polarization is partly borne of reflexive assumptions and automatic thoughts.  We would all do well to slow down, understand that we may be making attribution errors, and actively seek disconfirming evidence for our interpretations.  This is admittedly a difficult thing to do, given our well-researched human nature in this area.


But try we must, if we hope to have sound emotional health and positive relationships.  The recipe is actually quite simple.  Question what you think you see and understand.  Take your time, as very few things in life require instantaneous responding.  If you experience strong emotion, wait until the immediate feelings subside a little before you do the cognitive work of analyzing information.  This gives our higher cortex a chance to do its magic instead of our being controlled by the more primitive, reptilian portions of the brain.  Check out your understanding by getting feedback from others.  The payoff is tremendous: often we learn that what we thought we understood was WAY off.  Have you ever fired off an email or text and immediately wished you could suck it back through the electronic ether?  Then you know what I am talking about.

So really, it comes down to humility.  Knowing that we have a limited range of perception means knowing that we are often capable of being wrong.  It helps us exercise caution in forming conclusions about ourselves and others and the world around us.  Benefits of this practice are improved mood and self-esteem, and improved relating with individuals, groups, and cultures.  That makes it very worthwhile.

Sunday, September 16, 2012

The Silver Lining in Today's College Student

From the beginning of time, I suppose, each generation has been identified as headed to hell in a hand basket.  Or so the pundits would have us believe.  Teens and young adults are favorites for social critiquing and waxing philosophical on the demise of civilization as we know it.  Little awareness of the irony involved is apparent; what about the older adults who have a more direct role in today's events?  While the "adults" work feverishly to destroy each other in various parts of the world, for example, one group of Christian, Jewish and Muslim teenagers are hoping to better understand and communicate with each other.

This is not to say that troubling trends or themes don't exist.  In their book Generation on a Tightrope: A Portrait of Today’s College Student, Arthur Levine and Diane Dean write about such themes in young adults.  They tell us that they are at once low in resilience and high in self-confidence.  They think their grades don't actually reflect their performance.  They embrace social media extensively, yet lack actual in-person communication skills.  They see themselves as worldly, but can't identify world leaders.  And so on.  There are data to support these observations.  But do these data mean they are a hopeless, "broken generation", or just different from us older, wiser folk?  I vote for the latter.

Jonny Wakefield, himself a college student from Canada, would vote similarly, I think.  He warns of the dangers of such trendspotting in the lives of young adults.  He posits, rightly, that sweeping generational narratives are both imprecise and subject to self-fulfilling prophesies.  Which, in the case of young adult mental health, is precisely what we don't want to invoke.  Do we really want college students to see themselves as feckless and entitled losers?  I think not.

It might just be that we do not understand what we are seeing.  It may be that youth are doing what each generation did before them: doing their best, with what we gave them, to adjust to a challenging and rapidly changing world.  Sure, some of what they will do will fail.  Just as my generation did, and as my parents' generation did before me.  They will undoubtedly learn some hard lessons along the way.  But the seeds of seeing and doing things differently are already in them, and those will bear surely some fruit later on.  When I encounter young people in my work, I detect a level of energy and boundary-busting creativity that I don't see as much in my peers.  That is cause for hope, my friends.  Perhaps they will be able to make things better in the world, if we celebrate and cultivate their strengths rather than focus on their shortcomings.

Sunday, September 2, 2012

The Failure and Growth Cycle

Some view western culture, and American culture in particular, as a society which places a premium on the success and advancement of the individual.  Critics of this view argue that this premium diminishes some individuals and groups, but others say this does not necessarily have to occur; that one can promote the interests of the individual and society at the same time.  See the works of Ruth Benedict and John Kenneth Galbraith for references on that subject.  In my experience it takes an educated and enlightened individual to pursue "success" and also orient that success to higher purposes, such as benefiting larger and larger circles of human beings.

Enter typical college students and their families.  As noted elsewhere in my blog they tend to arrive being very focused on pragmatic issues such as living arrangements and choice of major.  There is a tremendous amount of energy focused on moving the late adolescent and young adult along a continuum of advancement, however that may be conceived in family ethics and values.  Getting good grades, joining the "right" organizations, and networking for future employment are, in the minds of those involved, locked in rather tightly.  Variance from this template is often frowned upon, if not met with punitive consequences.

But college life is a crucible for the formation of both individuality and responsibility or conscience.  Mistakes and failures are inevitable, and the stuff which catalyzes the higher calling of the young adult.  In his book, How Children Succeed, Paul Tough theorizes that non-cognitive skills such as persistence, resilience and fortitude are actually the bases of future success, though it is cognitive skills that often get the attention.  In this view mistakes and failures are desirable, the launching pad for growth.  In short, one gets intimately acquainted with one's self, with both talents and foibles, through a cycle of failure and growth.

Such is the process of learning who we are, what we can do, and the limitations presented by our perceptions and biases.  The process of "advancement" is much more earthy and sobering than western mythologies would have us believe.  It is very much two steps forward, one backward, a thousand blind alleys to ten workable paths.  And this is to be embraced, not belittled.  Great achievers like Newton, Edison, Einstein, and Carver all said so.

Families can be wonderful allies in the young adult's search for self by understanding this cycle, by welcoming it, and by patiently waiting for their children to learn life's lessons.  Students will succeed in their journey to self-hood by minimizing anxieties about social perfection, or, better yet, rooting them out altogether.  It takes courage to advance.  Fear won't get us there.

Saturday, August 25, 2012

Ethics and Meaning in College Life

Recently USA Today College ran a nice little piece concerning ethics in college.  The author, Miriam Schulman, assistant director of the Markkula Center for Applied Ethics at Santa Clara University, posed five simple questions for students to consider:

  1. What is college worth to me?
  2. How can I live with someone I don’t like?
  3. How far will I go to be accepted?
  4. Should I tell on someone who is doing something I think is wrong?
  5. Is casual sex going to be part of my life?
Wonderful questions.  College life offers so many rich academic and personal experiences.  So many, in fact, that it is very easy to lose sight of fundamental questions which we all must face in our lives: Why am I here, and what am I going to do with my life?  From where I sit, working closely with students, a great many issues and problems could be averted, and a great many lives enhanced, through an active search for answers to these questions.  I believe Socrates said so way back in the misty past.

Students and their families are today focused on the practicalities of college life.  They rightfully ponder over where their students will live, what they will study, how will they spend their time, how will they make friends, and of course how they are going to pay for it all.  These are questions that do in fact need responses.  But the inquiry should not stop there, and all too often it does.  Without the bigger responses to bigger questions, students often live incongruently to their genuine identities and values.  They associate with people they don't truly respect.  They engage in activities which are meaningless or even harmful to them, which may result in a resume' packed with awesomeness but reveals experiences with little or poor quality.  A competent employer will see this instantly.

Spend time, ideally well before college starts, mulling over the big questions.  Set a target, well ahead in time and space, about where you would like to land and explore your existence.  One doesn't travel to another part of the world without having some sense of how one will live after arrival.  Why in the world would we cheat our future selves by not doing the same thing before our college and career journey begins?

Sunday, July 29, 2012

No Need to Panic: The Art of Chilling Out

In addition to academic studies, many college students are learning about their limits with respect to stress and frustration.  As noted in a previous post, college is a time of new demands on many levels, which means adopting new stress management skills if one hopes to do well in life.


This learning is sometimes marked by peaks of anxiety and stress, of feeling overwhelmed, and of outright panic.  This can happen even in those for whom things are going well.  How a student manages these intense periods can make the difference between improving a situation or making it dramatically worse.  You can make things worse by impulsively acting on feelings of panic.  So let's talk about how to turn a stressful moment into an opportunity to make things better.


To manage peaks of stress one must learn to master physiological arousal, strong emotions and negative thoughts.  Most folks are aware of our body's built-in circuits of arousal, the fight-or-flight-or-freeze response in reaction to threat.  By the time someone reaches college, this system has been initiated countless times, and is so hard-wired as to be very rapid and even outside consciousness.  And therein lies the problem.  It has become a reflex for many, and their perception is they can't do anything about it.  But this is not true.  What many do not know is that our bodies also have built-in relaxation responses.  Just as our bodies and brains can mobilize against perceived threats, so too can they calm and slow down in order to access higher cortical processes or problem-solving.  This slowing down is essential for accessing our memory and use of judgment.  Panic is good for running, but horrible for higher thought.  If you've ever gone blank during an exam you know what I am talking about here.


So, here are some ways to calm down in a moment of intense stress:
  • First, manage your breathing.  Sit down somewhere, and uncross your arms and legs.  Place one hand on your abdomen.  If you are breathing correctly that hand will rise and fall as your diaphragm muscle extends downward, allowing your lungs to fill with air.  Fix your gaze on a point in front of you, or close your eyes.  Slowly inhale through your nose, and slowly exhale through pursed lips.  Depending on body size, the breaths should be around three to five seconds apart.  In order to breathe well one must concentrate on these steps, and that is part of the secret because doing so is incompatible with worry or negative thoughts.  The other part of the secret is breathing of this type delivers a higher rate of oxygen to our brains than what occurs when we panic.  And oxygen makes our brains happy.  Keep breathing all the way through the wave of stress until you notice it is diminishing.  Practice your breathing at least daily, and every time you notice your earliest warning signals for stress and anxiety.  If you get good at it, you can abbreviate some of the steps and quickly enter a deeply relaxed state anywhere, at any time.  You can also learn more about helpful breathing.
  • If you like imagery, close your eyes after your breathing and hold any image that you find peaceful, serene or relaxing in your mind's eye.  As you hold that image try to capture all the detail in the objects, sounds or smells of this place.  If you get distracted, don't worry about it, just keep going back to that image.  Another secret of stress management is taking yourself elsewhere, away from your troubles, in your own mind.  This acts like a reset button which clears the noise in our heads.
  • Stress has physical components which increases tension in our muscles.  You can address this by tensing and relaxing, in alternating fashion, muscle groups from your toes all the way up to your head and face.  Create tension, for example, by clenching your fist as tightly as you can for a few seconds.  Then let it go, letting your hand fall as loose and limp as a wet noodle. And notice the contrast, the slightly warm or tingling sensation which comes from relaxing a muscle group.  The sensations are usually quite enjoyable.
  • All of this is the easy part.  The harder part involves addressing our negative thoughts, our "stinking thinking".  Catch yourself engaging in typical thought patterns when under stress: magnification of problems, seeing problems as catastrophic, internalizing or personalizing problems, or hopelessness.  You can address these by saying to yourself "I am not thinking clearly.  I need to focus on one thing I can do today that will move me in the direction I want to go."
  • Stress management is not complete until we examine what caused us to panic in the first place.  Such reactions occur for fairly specific reasons, such as over-extending ourselves,  poor preparation or coping skills, or perhaps failing to establish or uphold our personal boundaries in some way.  Once you are in a calmer state, and thinking more clearly as a result, spend some time problem solving about what needs to change.
Once these skills are developed a sense of confidence and resilience can be achieved.  Frustration tolerance will also increase such that future stressful moments are less likely to produce intense, reflexive reactions.  Like any skill, this takes practice, and there is no shortcut.  The skills are not a "cure" for what caused panic in the first place; that must be addressed through good judgment and decision-making.  But the skills are important management tools, the building blocks of which you already possess.  They simply await your time and attention.

Sunday, July 8, 2012

College is a Trip

"We don't receive wisdom; we must discover it for ourselves after a journey that no one can take for us or spare us." -Proust


College is way cool, no doubt about it.  There are intellectual explorations and pursuits, exposures to a wide variety of people and cultures, sporting events, rich theatre and music opportunities, tons of ways to meet, socialize and party with folks from all over the world, and on and on.  The college years are a great time to learn and otherwise benefit from these experiences, and many students take full advantage of the possibilities.


At the same time, however, many students seriously underestimate the stresses and strains that result from this time in their lives.  During college there are incredible demands placed upon a student’s intellect, physical well-being, social skills, spiritual or philosophical orientation, and sense of personal responsibility.  This is true whether that student is from Manhattan or Opp, Alabama.  Every student I have ever known (including yours truly!) has had to endure an adjustment period during the crucial first semesters of college, and often during the subsequent years as well.  Some have roommate problems.  Some party way too much.  Some are overwhelmed by their new-found autonomy or freedoms.  Some struggle with isolation.  Some have to manage the negative behaviors of others.  While many students negotiate through these stresses productively, albeit fitfully, others experience meltdowns of one kind or another, and truly have trouble functioning well as a student.  Grades may suffer.  Conflicts with friends or family may emerge.  Depression or anxiety may root and take up residence in the psyche.  Though students may not realize it, college is a microcosm of the world at large, but compressed in both space and time.  What happens here can establish precedents for the future.  College is a trip, indeed.  It is a funky but delightful journey during which learning can occur in every dimension imaginable.

Some students arrive on campus with plenty of tools in their survival kit.  Caring parents.  Good health.  Sufficient funding.  Supportive friends.  Others seem to have been given tools of little value, sort of like a duffle bag with a pearl necklace, a chocolate cake, and a catcher’s mitt, and all for an excursion into the Amazon!  A few unfortunate students appear to have no tools at all.  Just as I have never yet met a student who didn’t have to adjust, so I have also not met a student who could not overcome such limitations.  I have known courageous, admirable students who were nearly homeless, or who were afflicted with a nasty medical or mental condition, or who were abandoned or abused, but succeeded nonetheless.  My hat’s off to these folks; they had more than their fair share of troubles but in the end weren’t defeated.

So college is a trip, and there are some tricks students need to know about in order to reach their destinations with sanity intact.

1.    Prepare for the adjustment.  Think ahead about what you will need, then find out where you can get it.  Manhattanites will need variety.  Oppians will need familiarity.  If you didn’t have to study in high school, well, get ready to.  If your parents did everything for you, learn how to do it yourself.  And so on.
2.    Quickly figure out the nature and source of your stress.  Are you strung out because you’re not sleeping?  Because your roommate is messy?  Because you can’t concentrate?  Because you’ve never been good at math?  Stress has origins.  Find out how it started.
3.    Get the support you need.  Every problem, and I mean every problem, has a solution.  Granted, some solutions are difficult.  But don’t freak out!  Instead, calm down, define the problem, and then learn what person or resource or service you need.  Need tutoring?  Chances are your school has it.  Need time management skills?  There is someone who can help.  Need to choose a major?  It's covered.  Need someone to talk to?  Counselors are here for ya.  Just take a look at the web or campus directories.  I’m always a little amazed at how many students don’t look for or don’t know what resources await them, or worse, choose not to use them.
4.    Don’t wait!  Do the first three steps early.  Don’t wait until your homesickness turns into depression, your public speaking anxiety becomes panic attacks, or your stress leads to insomnia or substance abuse.  If you get what you need early, chances are good it won’t take long to overcome the problem.  If you wait, it can take much, much longer.  Don’t believe the lie that it isn’t “normal” to have problems.  I have yet to meet anyone who didn’t have a few.

To take the college journey well, students need to periodically examine their survival kits.  Make sure the needed tools are in there.  If unsure, ask someone who’s been around.  Wisdom and a good deal of fun are there for the taking, if students care enough to equip themselves for the ride.

Sunday, July 1, 2012

A View Inside the Minds of College Students

Several years ago, a colleague provided a series of web postings written by college students.  The posts, if my memory is correct, were gathered in random fashion from a variety of public internet sources.  My memory definitely has failed in one important respect; I can't recall who provided these or exactly when I received them.  I apologize for that.


These snippets are simply too good, however, to not record them in some way.  They provide a glimpse, unsettling at times, into the minds of students.  The comments provide us with a sense of what their worlds are really like and therefore some guidance on how we, all of us, might assist them with their needs.  Spelling and grammatical errors are preserved as these too are a window into the state of the authors.  Here we go...


Female
I've dropped a lot of courses. I've also failed a lot of courses. I don't know my material. I feel like I haven't learned anything. I'm not competent. I've ruined my life. I don't know what I'm going to do. Maybe I will work in fast food for the rest of my life.
I feel like such a loser. I skip final exams. I waste thousands of dollars.
I'm not smart enough. I'm not hard working enough.
I have no future. I can't do anything. I may as well be dead. I'm useless.
My parents should kick me out and leave me homeless. I don't deserve all that they've given me.
I wish I could start over, from the very beginning. I've messed up big time. I've ruined my grades.
I'm getting old. I'm going nowhere. I don't want to face life, it's too scary.
I'll never graduate. Even if I graduate, I'll do nothing with my degree.
I should just die or something. :-(


Male
So, I failed my midterm. I huge 45%. The frustrating thing is I know what I'm doing. It's not like I just didn't study, or not go to class, I did all of that. My prof was even like "What happened?" I didn't do so well on my last quiz, and I'm pretty sure I didn't do well on the one we just had. For awhile now I've been feeling like school is impossible for me. Now, it feels like it is. I don't want to keep going, but I'm afraid of dropping out. I don't konw what to do...


Female
A couple students including me talked our professior into extending our test date! Heehee! Good for me! I need an extra week!


Female
i go to university and this is my last semester of classes, or at least, that's the plan, before i do my internship and then one math class in the spring. howveer, my past practice of doing the bare minimum of what's required of me as a student (even less than the bare minimum when it comes to studying for test or reading), has been doing me wrong this semester especially. i have met a guy who has been screwing with my emotions, whether on purpose or not, it doesn't matter i guess. but i am soooo scared that i won't pass some of these classes and then i'll have to stay another semester, here in this wretched town. but i have no energy again. it's like i wish i could be one of those students who can not study and get all a's, but i am not. but although i know my end goal, getting my degree, which as it turns out, again has to be put off till the end of next fall, for other reasons, i cannot seem to focus on that enough to complete my studying, or at least to put more effort into it. i have no job, so it's not time restraints. i don't have a car, so it does take convincing to get myself to walk to campus, if i need to, and i have been skipping more...and i don't know...does anyone here ever just feel like quitting school, just lie around and do nothing? but then again, that's exacly what i do anyways. i guess i am just here to conplain and ask if anyone else feels like they just do the minimum required of them as students.


Male
I'm done! My brain is full. It's really sad because the my presentation is less than 2 minutes. What do you do when you just can't stuff anymore in???


Female
I love school!  All the people, the energy, learning, the professors, and everything except the very few parking spaces. LOL I have my first exam in a week, gotta study this weekend. :-)


Female
I'm sooooooooooooooo nervous! My classes start tomorrow. What if I'm not good enough? What if I fail? What if....? (this coming with someone who has never gotten lower than an A-) uggh. I hate this feeling.


Male
Classes started up again yesterday. I only have the one class on campus, the other is online. The one class on campus is taught by the same lecturer as the summer math class I just finished. She said we could call her late last week for our grades. She told me I could come by her office and see my final exam, and get my grade.
I haven't done either of those things.
Today I finally emailed her, asking for my grade. She just emailed me back, but I'm too afraid to open it. I know it's going to be awfully close, and I can't stand to see it.
I know, and my T tells me that it's going to be OK to get a B. She says she thinks it would be very good for me to get a B.
I'm too afraid to open the damned email.
I guess it's better than finding out in person, and crying in front of her.


Male
I woke up yesterday with sore throat, nausea, aches, etc. Still feel yucky.
And I sat down in front of an exam that did not look at all familiar. Not much that looked like anything I had ever seen before. I get depressed when I'm sick anyway, but that just made it that much worse.
I'm pretty sure I won't have an A on the exam. I am currently hoping only that I did well enough to allow me to get an A in the class. I think I can miss 65 or so points, out of 200.
Of course, when I got home again, I could think of how to work out one of the problems. I did get the right answer to that problem, but I had no idea how to set up the equation. {sigh}
I really don't want this to be the time that I find out what happens if I don't get an A. I don't know that I can handle that right now.
Maybe school is too stressful for me.


Female
I was just diagnosed bipolar ultradian rapid cycling 6 weeks ago, with social phobia 1 week ago, and while I'm getting treatment, none of it is really working yet!! My psychiatrist is confident I'll be ready to go back to school in 5 weeks but I'm soooo scared!! It's like, I don't know if I can handle being in school but if I don't go what do I do? Be a college dropout? Ugh.


As you can see, most of the posts reveal a sense of being overwhelmed by academic demands, some to the point of hopelessness.  Another, perhaps more troubling, theme is that few of them wrote about seeking or asking for help.  For this and many other reasons college mental health services are an absolute necessity for students.  Ideally, these services will be well-resourced and thoroughly and repeatedly advertised across campus, in a variety of media.  Students tend to dismiss information when they perceive they will not need it, then suffer from a lack of information when troubles visit them.  Institutional support of the mission of college mental health is a vital ingredient to student success, as we see so clearly in the messages provided above.

Friday, June 15, 2012

Emotional Health in the Transition to College Life

College mental health professionals want the beginning of your college experience to be healthy and rewarding.  Incoming students with concerns about emotional health, including a history of psychological or psychiatric conditions, need to take care to preserve the progress they have made in treating those conditions.  Following some rather simple guidelines before and right after you arrive on campus can help ensure that your early days on campus are productive and enjoyable.  What follows are generic considerations only.

Health Insurance

Check your health insurance policies and make sure they are up-to-date.  If you are in the position of making decisions concerning health insurance, choose plans that provide for mental health services on a par with medical coverage.  Ideally, your plan will provide adequate coverage for therapy or counseling services, psychiatric services, and medication.  Also, before you arrive, check your plan to see what providers in your new home are covered by your plan.  If you find that there are few or none on that list, contact your insurance representative and ask for local providers to be included.  If you are unsure about which providers could be included, contact your campus mental health service.

Health Records

If possible, bring copies of your important health records with you to campus.  This may include copies of medical, psychiatric and therapy records.  In most cases, summaries of these records will suffice.  You have the right to ask any health or mental health care provider you have seen to send your records.  You can and should ask your home providers to send these records to your new campus area providers, but if possible keeping copies for yourself is a good idea.  It is very important that your local providers have this information, as it improves the continuity of the care you have received.  This is especially true of any records relating to psychological testing, even if it occurred several years earlier.  Without such records it may feel like you are starting all over again, resulting in unnecessary delays in your treatment and progress.

Referral to Local Providers

Your current providers can and should offer to assist you with a local referral.  Your campus mental health service can also assist you with such referrals.  In general we believe that students who are taking any form of psychotropic medicines, such as anti-depressants and anti-anxiety medications, should also be in therapy or counseling due to research that suggests superior results when the two are combined.  Students with a history of any serious disorder, such as chronic addictions, Bipolar Disorder, Schizophrenia, and Personality Disorders, should arrange for long-term care well ahead of their arrival on campus.  Due to the long-term nature of such conditions, treatment by private mental health professionals off campus is sometimes indicated.  Finding and securing the appropriate providers will avoid the “ping-pong” effect that some students experience if they delay treatment or seek it in a random manner.

Use and Misuse of Medication

If you have been on medication prior to your arrival on campus, it is highly important that you remain on it during the transition to college.  Make sure that your prescriptions are current and that you have an adequate supply, at least enough to last two months.  Many students have the idea that college is a “new start” and that the stresses they experience will somehow disappear when they arrive.  Many underestimate the normal stresses and strains of college life, and by the time this is apparent to them it may be very late in the first semester.  When a student discontinues medication it sometimes takes weeks or even months to recover previous gains.  For example, it is not uncommon for a student who relapses in October to not be fully functional until December or January, too late to make up for any losses that may have occurred in the fall semester.

Avoid any misuse of your and others’ medication.  Take it as prescribed to you and don’t make changes in dosages without consulting your physician or psychiatrist.  Avoid taking medication prescribed for others, or giving your own medication to others.  This can lead to problematic or even disastrous consequences including side-effects, serious medical complications, and death.  It may also be against the law.

A Word about Attention-Deficit Conditions

If you have been diagnosed with an attention-deficit disorder before your arrival on campus, follow the same guidelines as noted above.  Remember to give your local providers all past and current information about your condition.  If you have never been diagnosed with such a disorder but notice problems with attention or concentration after beginning college courses and suspect an attention-deficit disorder, please keep a few things in mind:
  • Almost all college students experience challenges to focus and concentration.
  • Other conditions or disorders can mimic an attention-deficit disorder, including anxiety disorders, acute stress disorders, some mood disorders, substance abuse disorders, and even ordinary family or relationship conflict.
  • Diagnosing an adult with an attention-deficit disorder is more complicated than diagnosing a child or early adolescent.  Ideally, a battery of psychological tests is used to confirm the diagnosis.  Simply relying on self-report or symptom checklists can result in a misdiagnosis.
  • The criteria for an attention-deficit condition include impairment in two areas of functioning prior to age seven.  If you have a history of adequate or better academic performance it may be unlikely that you have an attention-deficit disorder. 
For Parents and Family Members

In addition to observing the practices listed above, families can play an important role in monitoring loved ones on campus.  Regularly ask your student whether they are receiving treatment or taking medications.  For serious conditions, get confirmation from the providers’ offices.  Watch for early signs of adequate adjustment to college and academic performance.  If you see indications of relapsing or slippage, follow-up promptly.  This can sometimes involve making a trip to campus to check on your student.  Consult with your student’s providers, while taking care to respect their right to privacy and some degree of control over their affairs.  If their providers give you suggestions or advice about how to manage a specific issue, follow it carefully.

Conclusion

Again, these are all simple principles in the management of emotional health care of students.  Professional experience is that the time devoted to following such guidelines is small compared to that spent on rectifying problems later on.  If you have other questions not addressed here, please contact your campus mental health service for assistance.

Sunday, May 20, 2012

Time to Heal: Developmental and Medical Models of Service

Ty Cobb was once asked to describe baseball.  After a moment's pause he said "It's something like a war."  There is something like a war occurring in professional mental health communities, most recently rekindled through the debates on the development of the DSM-V, a diagnostic manual.  See a Scientific American blog series on this issue for more information.  This war has many facets, from economic if not downright mercenary (involving the coding of disorders and therefore billing of encounters), to treatment - given connections to the pharmaceutical industry, to, perhaps most broadly, a starkly contrasting view of human beings and their problems.  In this humble writer's view, nowhere is this contrast more palpable or consequential than in college mental health settings.


Late adolescents and early adults exist in the throes of a volatile period of human development.  As I have mentioned in previous posts, their psyches are roiling with energy, literally bubbling over as they experiment with identity in their search to find authenticity and manifest the real self in the world.  Anyone who remembers those years can resonate with this time marked by fear, various forms of aggression, behavioral instability, relationship turmoil, and academic or career missteps.  This volatility is quite simply inherent in, and in fact necessary to, their growth.  And as any parent knows, it takes a lot of patience for outsiders to see this process through, to support but also avoid negatively contaminating it in some way.  Contaminating development can send youth off onto an unintended and unneeded life trajectory, and this may be quite harmful indeed.  Forces which discourage or abort patience in work with youth stoke the flames of warfare between developmentally- and medically-oriented disciplines.


To address any temptation toward dichotomous thinking or polarization, which seems so rife in society today, let me be clear.  Medicine as a thoughtful profession and considered practice is a wonderful thing, capable of using its many massive powers to alleviate human suffering and facilitate human growth.  No one in their right mind can rationally argue otherwise.  But any thoughtless or unconsidered practice is capable of great harm, no matter the profession.


Recently, the former chair of the DSM-IV Task Force, Allen Francis, who is himself a physician, wrote a brief essay on the harm caused by misdiagnosing and mislabeling.  He counsels us to use caution and patience in this process, a very wise statement indeed.  Unfortunately, those individuals and entities who stand to make a great deal of money from the industry are working in the opposite direction.  Their apparent purpose is to transform medicine's grand promise into a ghastly and speedy intervention delivery system, which may result in incorrectly pathologizing, hospitalizing and/or medicating consumers.  Or worse.  In a rather breathtaking development, one vendor is advocating for the utilization of instruments to render diagnoses in three minutes, and reducing one's mental health status to a single number!


Given the complexities of college student life and development, I simply don't know how anyone, with any tool or level of experience, can accurately diagnose youth in three minutes.  Or in 10 to 15 minutes, the average duration of many medical encounters.  It takes time to understand the bubbling psyches of young and old alike.  Susie and Johnnie may meet "the criteria" others establish for disorder X, but that may not in any but the most cursory way capture the essence of what is happening with them.  This hypothesis does not compute in those who want fast and efficient delivery of products.  Susie may be caught in a cycle of fear and anger based in years of psychological torment in family dynamics, which she cannot even articulate in hours and hours of encounters.  Johnnie may have difficulty focusing due to years of exposure to video games and substance use, the latter of which he hides from others, and the anger he feels toward his father who abandoned him.


Susie and Johnnie deserve our time and attention, our best effort in creating environments which encourage them to tell their stories and be healed.  Let's support and fund those that provide such environments.

Sunday, May 13, 2012

The Essential Magic of Confidentiality

It may not be well known to those outside of higher education, but there is a tremendous amount of energy behind the search for information concerning college students.  From vendors to credit card companies to judicial networks to administrators and parents, a great many individuals and entities want the skinny on students.  Sometimes the desire is based in altruistic and other well-intentioned motives; some times it is decidedly not.  Even when the motives are healthy, a very few understand the impact of this search on the campus mental health service and, more importantly, on the student seeking mental health services.


Students are like any consumers in that they want value for their time and dollar.  They are in my experience pretty savvy customers, and fairly merciless when they are not convinced or disappointed with the service they receive.  Outfits that deign to provide those services better darn well have some magic in their goods, or the student is out the door before they know what hit them.  And therein lies the problem for college counseling centers.


One could argue that there is an enormous amount of value in mental health services.  And one would be correct.  The opportunity to learn about the self, to manifest authentic and healthy adulthood, to remedy past trauma, to have a healing relationship, and to live free of terrible symptoms are wondrous gifts provided by skilled hands.  But the average college student does not, probably can not, see this at the outset and sometimes even for awhile after that.  It's difficult for anyone to fathom life in the absence of pain, or the beauty of what it is like to be a genuine self.


Oh but what they can see is the gift of privacy, of having at least one place in their lives where they can say what they want and try out various selves until they find the one that fits.  College students can see this even before they dial the center's number or visit the office itself.  It will be clear to them in advertisement and in the physical orientation of the office.  It will be clear to them within minutes of entering the facility and of talking with a therapist.  And it will be very obvious to them as the service negotiates through requests and demands for information concerning them.  This is the essential magic of mental health services, the magic that breeds all other magic the services can provide.  Without it no other benefits accrue; it is the oxygen of therapy and change.  Even the slightest ill-considered breach of this boundary can be fatal to healing, though students generally understand when good communication is necessary.


All others in the student's life simply must understand this.  Everyone, from a police officer to a dean, must respect this fundamental truth if they have interests in the developmental goals of students.  In the overwhelming majority of situations, the goals of society and institutions are not that different from the goals of students; there is a great deal of overlap.  If you tamper with or deprive this magic, a vacuum is created and positive growth is stunted or terminated.  A very simple but oft-overlooked principle is to ask the student for the information you want.  Allow them the autonomy and self-determination which is embedded in our federal constitution, for all of us in the United States of America, in these words: life, liberty, and the pursuit of happiness.

Sunday, April 29, 2012

Test Mastery


All students have attitudes about and reflexes toward taking tests.  In the college student, these are acquired over many years' experiences with testing, leading to conditioning of thought, emotion and behavior.  If students are not aware of these factors they will influence their responses to exams and control them, sometimes unconsciously.  Fortunately, just as behavior can be conditioned so it can be unconditioned, if you will.  But it takes knowledge, practice and skill.  Anyone can learn these skills and that is the good news.


First, beware of negative attitudes such as pessimism, magnification, catastrophic thinking and fatalism.  These thought patterns will diminish performance before the test even begins.  So check yourself for "stinking thinking" well ahead of the exam, such as when you are in class and during study.


In order to manage thoughts, we must increase awareness of negative thinking and actively combat those patterns when they are detected.  Here are some examples:

  • Pessimism: these are thoughts of doom and gloom about testing or performance.  Address these by countering with “I am qualified to be in this program and if I work hard enough I will do well enough.”
  • Magnification: thoughts like this magnify the importance of an exam way beyond what is healthy.  Respond with “This is one exam among many and it is no more or less important than the others.”
  • Catastrophic thinking: this form of thought leads one to believe life as we know it will be over if we don't do well on a test.  Counter with “One way or another everything is going to work out OK.”  (This is absolutely true, by the way).
  • Fatalism: these are thoughts that we will get the same outcomes no matter what we do.  Address this with “My effort counts.  Good preparation will get good results.”


Say them aloud when you can, and to yourself when you can't.  Repeat them, over and over again, even if you question or doubt them.  Remember, you are working on reconditioning your thinking in ways that promote good performance, not dismantle your confidence.  Some find it helpful to place colored stickers in places which will remind you of positive thinking, such as a backpack, notepad, refrigerator, or mirror.  A colored bracelet can also serve the same purpose.

The second part of test mastery involves managing anxiety.  This step is highly important as anxiety interferes with higher cortical processing.  Students who "go blank" during exams often have so much anxiety that it blocks access to memory.  Negative experiences with exams sometimes condition people to have anxiety reactions before, during and after them.  But this too can be undone if you work on it.

  • The single best antidote to test anxiety is good preparation.  There are no shortcuts here!  See my earlier post on study habits and skills for more information on this topic.
  • Don’t defeat yourself through negative habits related to eating, sleeping, and partying.  You must get enough of each, but not too much!  We perform at our best when our bodies are appropriately nurtured.
  • Avoid “anxious talk” and anxiety-provoking situations.  There is no point in asking classmates last-minute questions, or in participating in hallway comparisons before the exam.  There's always someone who will say things like "I studied for 48 hours straight!", or "I'm going to ace this one just like I did the last one."  Statements like these can make us feel bad, even if there's no truth to them at all.
  • Learn to manipulate your physiological anxiety response through focused attention and controlled breathing, both before and during exams.  A psychologist can help you learn these skills.
  • Follow the principles of exposure and desensitization.  This means placing yourself in situations similar to testing, repeatedly and long enough to experience a reduction in anxiety.
  • Practice testing, engage in testing rehearsal, and engage in actual test-taking in the same or similar environments.  Many benefit from taking a practice test in the same room where the actual test will occur.  Obviously, one must have the instructor's approval for this.
  • Understand your degree of reactivity.  If it is very high, medication may be needed, but NEVER by itself.  A little therapy will maximize the benefits of the medication, and help you address issues on your own once you stop taking it.


With some effort and practice you can condition yourself to think positively and remain calm and focused during exams.  This gives your brain a good shot at accessing memory and performing well when it counts.  So go get 'em!