Depression is a disturbance in mood, thought, and body characterized by varying degrees of sadness, disappointment, loneliness, hopelessness, self-doubt, and guilt. Most people tend to feel depressed at one time or another; some people may experience these feelings more frequently or with deeper, more lasting effects. In some cases, depression can last for months or even years. The most common type of depression, "feeling blue" or "being in a bad mood" is usually brief in duration and has minimal or slight effect on normal, everyday activities. In the next level of depression, symptoms are more intense and last for a longer period of time. Daily activities become more difficult but the individual is still able to cope with them. However, feelings of hopelessness can become so intense that suicide may seem the only solution. In severe depression a person may experience extreme fluctuations in moods or even a complete withdrawal from daily routine and/or the outside world.

Symptoms of Depression

Changes in Feelings and/or Perceptions

• Crying spells or at the other extreme, lack of emotional responsiveness
• Inability to find pleasure in anything
• Feelings of hopelessness, worthlessness and/or helplessness
• Exaggerated sense of guilt, self-blame or failure
• Loss of sexual desire
• Loss of warm feelings toward family or friends
• Pessimism about self, the world, the future

Changes in Behavior and Attitudes

• Lack of interest in prior activities
• Withdrawal from others
• Neglect of responsibilities and appearance
• Irritability, complaints about matters previously taken in stride
• Dissatisfaction about life in general
• Impaired memory, inability to concentrate
• Indecisiveness and confusion
• Reduced ability to cope on a daily basis
• Thoughts of death or suicide, suicide attempts

Physical Complaints

• Chronic fatigue and lack of energy
• Loss of appetite, or at the other extreme, compulsive eating
• Insomnia, early morning wakefulness, or excessive sleeping
• Unexplained headaches, backaches, and similar complaints
• Digestive problems including stomach pain, nausea, indigestion, and/or change in bowel habits

Causes of Depression

When the source of depression is readily apparent, the individual can expect the reaction to lessen and then fade away within a reasonable amount of time. In cases where feelings of depression exist with no apparent source, the depression may get worse because the person is unable to understand it. This sense of loss of control may add to the actual feelings of depression. Any number of stressors may be involved in depression. This can include personality, or environmental factors such as loss of a loved one, an unhealthy relationship, excessive criticism and negativism, unrealistic expectations and difficulty in expressing feelings. Biochemical factors, such as illness, infection, certain drugs (including alcohol and even prescribed medications) and improper diet and nutrition can create chemical imbalances which play a significant role in some depressions. In general, depression is a withdrawal from physical or psychological stress. Identifying and understanding underlying causes of the stress is necessary in learning to cope with depression.

Helping Yourself

Being honest with yourself about changes in mood or the intensity of negative feelings as they occur will help you identify possible sources of depression or stress. Examine your feelings and try to determine what is troubling you -- relationships with family or friends, financial responsibilities, and so forth. Discussing problems with the people involved or with an understanding friend can sometimes bring about a resolution before a critical stage of depression and stress is reached. Even mild depression should be dealt with if it interferes with your effectiveness. You might also try to :

• Change your normal routine by taking a break for a favorite activity or something new-even if you don't feel like it
• Exercise to work off tension, help you relax, and perhaps improve your ability to sleep
• Avoid known stressors
• Become more positive and active rather than criticizing and waiting for others to act
• Learn to be specific, not vague about your feelings and to express them constructively
• Delay making long-term commitments, decisions or changes that make you feel trapped or confined

See a physician, especially if physical complaints persist

Helping a Depressed Friend

Since severely depressed individuals can be very withdrawn, lethargic, self-ruminating, and possibly suicidal, a concerned friend can provide a valuable and possibly life-saving service. Talking candidly with the individual regarding your concern for his or her well-being will often help bring the problems out into the open. As you talk with your friend, share your concern and willingness to help.

• Acknowledge the pain and suffering
• Do not try to "cheer up" the individual
• Do not criticize or blame as feelings of depression cannot be helped
• Do not sympathize and claim that you feel the same way as he or she does
• Try not to get angry with the depressed individual

If the depression appears to turn to thoughts of suicide, urge the individual to seek professional help. If the person resists such a suggestion and you feel that suicide is likely-contact a professional yourself, so you will know how to best handle the situation.

When Professional Help is Necessary

Depression is treatable and needless suffering can be alleviated. A mental health professional should be consulted when an individual experiences any of the following circumstances:

• When pain or problems outweigh pleasures much of the time
• When symptoms are so severe and persistent that day-to-day functioning is impaired, and/or
• When stress seems so overwhelming that suicide seems to be a viable option

Qualified mental health professionals can help identify the causes and sources of depression and can help the individual find ways to overcome them.

University students typically encounter a great deal of academic, personal, and social stress during their educational experience. While most students cope successfully with the demands of college life, for some the pressures can become overwhelming and unmanageable.

Faculty and staff are often in the direct position to identify students in distress. Moreover, faculty and staff are often perceived by students as the first point of contact in obtaining advice and support. Your expression of interest and concern may be critical in helping a student reestablish the emotional equilibrium necessary for academic success.

This guide is designed to assist you in working with students in distress. Counseling Center staff members are available to offer further consultation.

Recognizing Distressed Students

At one time or another, everyone feels depressed or upset. However, when some of the following signs are present the student is probably in distress.

Unusual Behavior

• withdrawal from usual social interaction
• unwillingness to communicate
• inability to sleep or excessive sleeping
• loss of appetite or excessive appetite
• unexplained crying or outbursts of anger
• irritability, aggressiveness, agitation, nonstop talking
• poor personal hygiene
• excessive or irrational worrying (at odds with reality or probability)
• poor communication (garbled and slurred speech; disjointed and unconnected thoughts
• loss of contact with reality (seeing/hearing things that aren't there, beliefs or actions at odds with reality or probability)
• suspiciousness, irrational feelings of persecution
• feelings of shame, guilt, poor self-esteem

Changes in Personal Relationships

• death of a family member or close friend
• difficulties in family or marriage relationships
• dating and personal relationship difficulties

Drug and Alcohol Abuse

• indications of excessive drinking or drug abuse
• loss of interest and motivation, decreased school performance, class absences
• changes in physical appearance and behavior
• decline in interactions with peers
• reduced memory, concentration, and attention span

Undecided or Uncommitted About Educational Direction

• lack of alternative goals when failing
• dissatisfaction with academic major
• unrealistic educational aspirations
• confusion about interests, abilities, or values
• chronic indecisiveness or choice conflict

Learning Problems

• decline in course work and class participation
• deficient reading speed or comprehension
• poor study habits
• incapacitating and irrational test anxiety
• repeated requests for special considerations
• increased absences from class
• disruptive behavior in class
  

What Can You Do?

The options you choose depend upon the urgency of the situation. For students who are having difficulty but seem able to cope fairly well, you may choose not to intervene, to limit your interaction to the classroom issue, or to deal with it on a more personal level. If you judge a situation to be more urgent or an emergency, you might decide that more active and timely involvement on your part is appropriate.

If you choose to approach a student, or if a student seeks you out for help with personal problems, here are some suggestions that might make the situation more comfortable for you and helpful for the student.

• Talk to the student in private when both of you have time. Give the student your full attention.
• Listen to the thoughts and feelings in a sensitive, non- threatening way. Let the student know you hear by repeating back the gist of what the student has told you.
• Be specific regarding the behaviors that have raised your concerns, and avoid making generalizations, criticizing, or judging (e.g., "I noticed you've been absent from class lately and I'm concerned" rather than "Where have you been lately? Goofing off? Being lazy?").

Work with the student to clarify options and the costs and benefits of each option.

When Should You Make a Referral?

Even though a student asks for help with a problem and you are willing to help, some circumstances may indicate that you should suggest that the student use other resources. For example: The problem or request is one you know you can't handle...you believe that personality differences will interfere with your ability to help...you know the student personally (as a friend, neighbor, relative) and think you could not be objective enough to help...the student is reluctant to discuss a problem with you...after working with the student you find that little progress has been made...you feel overwhelmed, pressed for time, or at a high level of stress yourself.

What Happens at the Counseling Center?

Once the student contacts the Counseling Center, an appointment is made for an initial interview. This is usually within a few days from the time of contact. In an emergency, the student is seen that day.

During the student's first visit to the Counseling Center, information forms are completed. These can be waived in emergencies. During the first appointment, a counselor assesses the student's needs and the ways the Counseling Center might be able to help. Options the counselor considers include individual counseling, groups or workshops, or referral to private or community counseling services. Some students may leave the initial appointment feeling able to handle their concerns without further assistance.

If the student and counselor agree that individual counseling is appropriate, a series of appointments may be scheduled. The Center offers up to twelve individual sessions per academic year to students. Typically, students need four or five sessions with a counselor. At busy times of the year, it may be two weeks or so before regular appointments begin. Students are encouraged to keep in touch if their level of distress increases prior to scheduled appointments.

Students need to know that services provided at the Counseling Center are free and confidential. Information is released only with a student's written permission. This means that a counselor cannot discuss the student's situation with the faculty member unless the student provides written permission. Faculty are encouraged to contact the student and ask them if they saw a counselor and how it went. Exceptions to confidentiality may occur if there is of clear danger to self or others or in the case of court-ordered subpoenas.

How Do You Make a Referral?

When you have decided that a student might benefit from professional counseling, it is usually best to express your recommendation in a straightforward, matter-of-fact manner. Make it clear that this recommendation represents your best judgment based on your observations of the student's behavior. Be specific regarding the behavior that has raised your concerns and avoid making generalizations or attributing anything negative to the individual's personality or character.

Except in an emergency, the option must be left open for the student to accept or refuse counseling. If the student is skeptical or reluctant for whatever reason, simply express your acceptance of those feelings so that your own relationship with the student is not jeopardized. Give the student room to consider alternatives by suggesting that perhaps you can talk after the student has had some time to think it over. If the student emphatically says "No," respect the decision and again leave the situation open for possible reconsideration later.

Once the student has agreed that counseling might be useful, there are several possible steps to take, depending on the urgency of the situation and how committed the student is to following through on the referral.

• Give the student information about the Counseling and Student Development Center and urge the student to call for an appointment.
• Offer to let the student call from your office right then so that a public commitment will have been made.

Accompany the student yourself to ensure that the student arrives at the Center and to provide the necessary information. The Center would appreciate your calling ahead if a student is being brought over or sent directly in an emergency, so that plans can be made to have a counselor available.

Additional Consultation Is Available to You

If you have concerns and questions about a student, staff members at the Counseling Center are available to help you:

• Assess the situation, its seriousness, and potential referral.
• Learn about resources, both on- and off-campus, so you can suggest the most appropriate help when talking with the student.
• Learn the best way to make a referral if appropriate.
• Clarify your own feelings about the student and consider the ways you can be most effective.

What Is Anxiety?

Anxiety is a physiological state which calls you to action, motivating you to engage in productive behaviors such as studying for a test, finishing a project, asking someone out.

When Is Anxiety a Problem?

When it affects your daily life such as you . . .

• Can’t do regular activities at all or as well as you usually do
• Avoid regular activities
• Worry excessively without any apparent reason
• Occasionally become immobilized with fear
• Can’t cope with the fear and know it is irrational
• Can’t get the anxiety symptoms to go away

Anxiety which disrupts your life may fit one of these disorders

Generalized Anxiety Disorder

Recurring fears, worries or persistent sense of something bad happening. The reason for the intense feelings may be hard to identify.

Panic disorder

Sudden, intense, unprovoked feelings of terror or dread which often lead to concern about when another attack will occur; one frequent way of coping is to restrict activities in hopes of limiting the possibility of another attack.

Phobias

Intense fears about certain objects or situations. Specific phobias involve things such as certain animals or flying in airplanes. Social phobia is fear of social settings or public places.

Obsessive-compulsive disorder

Persistent, uncontrollable, unwanted feelings or thoughts and routines in which individuals engage to try to prevent or rid themselves of these thoughts. Examples include excessive hand washing or house cleaning for fear of germs or excessively checking something for errors.

Post-traumatic stress disorder

An individual who experienced severe physical or emotional trauma such as a natural disaster, an accident, a crime may experience anxious thoughts, feelings and behaviors when reminders of the traumatic event are encountered.

While anxiety disorders can begin at anytime, they often begin in adolescence or early adulthood. In some disorders, there is evidence of a genetic or family predisposition.

How Can You Manage Your Anxiety?

Managing anxiety means practicing the thoughts, feelings and behaviors of good self-care. The following areas need to be part of a comprehensive anxiety management program. For managing high anxiety all these areas need to be considered. If your anxiety is more intermittently a difficulty for you, you may want to pick and choose some areas to focus on.

Physical Level

Physiological responses of body tension, poor breathing, and bodily reactions to cumulative stress as well as dietary and nutritional factors. Do you:

• Practice deep breathing when feeling anxious?
• Use relaxation strategies such as deep muscle relaxation, meditation or biofeedback?
• Exercise regularly, particularly doing aerobic exercise?
• Exclude from your diet stimulants and substances that stress the body such as excess caffeine, sugar, nicotine, salt or alcohol?

Emotional Level

Handling feelings in a healthy way keeps anxiety levels down.

• Do you tend to ignore feelings?
• Are you able to identify your feelings?
• Do you hesitate or refuse to express your feelings rather than take the risk of hurting someone or being hurt yourself?
• Do you avoid anger at just about any cost?

Mental Level

What you say to yourself about a situation determines your feelings and behaviors in that situation. Managing anxiety often involves changing the messages you give to yourself to be more positive. Do the messages you give yourself :

• Include excessive "what-if" thinking in which you imagine the worst possible outcome before facing the situation?
• Judge and evaluate you in very critical ways?
• Say you are supposed to be perfect, that what you do is not good enough?
• Say you cannot change the situation and you are helpless to have any impact?
• Show worry about how others respond to you or what they think of you?

Behavioral Level:

Phobias and panic can be very frightening when they occur. You can learn to anticipate them and how to respond when they occur. Can you . . .

• Keep a perspective that it is just a reaction of your body and not a serious health problem, i.e. deflate the perceived danger.
• Learn to talk gently and calmly to yourself, using your repertoire of skills developed in above areas such as more productive self-talk, deep breathing and muscle relaxation.
• For phobias, learn about imagery desensitization and how to use it for yourself.

Interpersonal Level

Assertiveness in your interactions with others will help to decrease feelings of helplessness and anxiety. Do you . . .

• Assert yourself, ie. Ask for what you want and stand up for your rights?
• Say no to some things you do not want to do?
• Feel you avoid being manipulated by others?

Medical Level

Continued difficulty with anxiety interfering with your daily life may be addressed by using medication. An assessment by your physician or a psychiatrist can help to decide if medication would be helpful for you.

Where Is Help Available?

Managing anxiety requires the development of new skills, behaviors and thinking processes. While you may be able to learn some of these on your own, you may find it helpful to seek the assistance of professionals who are trained to deal with anxiety issues.

Counseling Services on campus, offers several options to assist you in addressing anxiety concerns:

• Workshops on anxiety management, stress management, biofeedback, procrastination, assertiveness, and communication in relationships are some of the programs available to assist you in developing new management skills. See our brochure for specific programs.
• The Self-Development Program offers many materials that you can use on your own or in conjunction with counseling. A self instructional guide describing these materials and others on-campus is available.
• Individual counseling is available to assist you in assessing your concerns about anxiety and how to address them.
• Referrals for services in the community, including psychiatric assessments for medication.