Anxious Students Strain College Mental Health Centers
ORLANDO, Fla. — One morning recently, a dozen college students stepped out of the bright sunshine into a dimly lit room at the counseling center here at the University of Central Florida. They appeared to have little in common: undergraduates in flip-flops and nose rings, graduate students in interview-ready attire.
佛罗里达州奥兰多——近日的一个早晨，十几名大学生从明媚的阳光中走入中佛罗里达大学（University of Central Florida, U.C.F.）心理咨询中心所在的昏暗房间。乍一看，这些学生身上完全没有共同点：本科生踢拉着人字拖，穿着鼻环；研究生则衣着正式如同正准备参加面试。
But all were drawn to this drop-in workshop: “Anxiety 101.”
As they sat in a circle, a therapist, Nicole Archer, asked: “When you’re anxious, how does it feel?”
“I have a faster heart rate,” whispered one young woman. “I feel panicky,” said another. Sweating. Ragged breathing. Insomnia.
Causes? Schoolwork, they all replied. Money. Relationships. The more they thought about what they had to do, the students said, the more paralyzed they became.
Anxiety has now surpassed depression as the most common mental health diagnosis among college students, though depression, too, is on the rise. More than half of students visiting campus clinics cite anxiety as a health concern, according to a recent study of more than 100,000 students nationwide by the Center for Collegiate Mental Health at Penn State.
目前，焦虑症已经超越抑郁症成为大学生中最常见的心理健康问题（不过抑郁症也在增加之中）。宾夕法尼亚州立大学的大学生心理健康中心（Center for Collegiate Mental Health at Penn State）近期的一项研究调查了全美的10万多名大学生，发现一半以上的学生到校园诊所就诊时提到了焦虑问题，并视其为健康隐患。
Nearly one in six college students has been diagnosed with or treated for anxiety within the last 12 months, according to the annual national survey by the American College Health Association.
美国大学健康学会（American College Health Association）的年度全国调查显示，近六分之一的大学生在过去的12个月内曾被诊断为焦虑症或因焦虑症接受过治疗。
The causes range widely, experts say, from mounting academic pressure at earlier ages to overprotective parents to compulsive engagement with social media. Anxiety has always played a role in the developmental drama of a student’s life, but now more students experience anxiety so intense and overwhelming that they are seeking professional counseling.
As students finish a college year during which these cases continued to spike, the consensus among therapists is that treating anxiety has become an enormous challenge for campus mental health centers.
Like many college clinics, the Center for Counseling and Psychological Services at the University of Central Florida — one of the country’s largest and fastest-growing universities, with roughly 60,000 students — has seen sharp increases in the number of clients: 15.2 percent over last year alone. The center has grown so rapidly that some supply closets have been converted to therapists’ offices.
中佛罗里达大学拥有约6万名学生，是全美最大、也是发展最快的大学之一。与许多校园门诊一样，该校的心理咨询和服务中心（Center for Counseling and Psychological Services）的客户数量也在急剧增加：仅去年一年就增加了15.2%。由于发展太过迅速，该中心的一部分储物间都被改造成了治疗师的办公室。
More students are seeking help partly because the stigma around mental health issues is lessening, noted Stephanie Preston, a counselor at U.C.F.
Ms. Preston has seen the uptick in anxiety among her student clients. One gets panic attacks merely at the thought of being called upon in class. And anxiety was among a constellation of diagnoses that became life-threatening for another client, Nicholas Graves.
Two years ago, Mr. Graves, a stocky cinema studies major in jeans, a T-shirt and Converse sneakers, could scarcely get to class. That involved walking past groups of people and riding a bus — and Mr. Graves felt that everyone was staring at him.
He started cutting himself. He was hospitalized twice for psychiatric observation.
After some sessions with Ms. Preston, group therapy and medication, Mr. Graves, 21, who sat in an office at the center recently describing his harrowing journey, said he has made great progress.
“I’m more focused in school, and I’ve made more friends in my film courses — I found my tribe,” he said, smiling. “I’ve been open about my anxiety and depression. I’m not ashamed anymore.”
Anxiety has become emblematic of the current generation of college students, said Dan Jones, the director of counseling and psychological services at Appalachian State University in Boone, N.C.
阿帕拉契州立大学（Appalachian State University，位于北卡罗来纳州布恩市）心理咨询与服务中心的主任丹·琼斯（Dan Jones）说，焦虑已成为当代大学生的典型标志。
Because of escalating pressures during high school, he and other experts say, students arrive at college preloaded with stress. Accustomed to extreme parental oversight, many seem unable to steer themselves. And with parents so accessible, students have had less incentive to develop life skills.
“A lot are coming to school who don’t have the resilience of previous
generations,” Dr. Jones said. “They can’t tolerate discomfort or having to struggle. A primary symptom is worrying, and they don’t have the ability to soothe themselves.”
Social media is a gnawing, roiling constant. As students see posts about everyone else’s fabulous experiences, the inevitable comparisons erode their self-esteem. The popular term is “FOMO” — fear of missing out.
社交媒体是一个折磨人的、令人不安的存在。当学生看到其他人发布的讲述自己精彩经历的帖子时，不可避免的攀比心理会削弱他们的自尊。对此，流行的说法叫做“社交控（FOMO, fear of missing out）”。
And so personal setbacks that might once have become “teachable moments” turn into triggers for a mental health diagnosis.
“Students are seeking treatment, saying, ‘I just got the first C in my life, my whole life just got shattered, I wanted to go to medical school and I can’t cope,’” said Micky M. Sharma, president of the Association for University and College Counseling Center Directors and head of Ohio State University’s counseling center.
美国大学校院心理辅导中心主任协会（Association for University and College Counseling Center Directors）主席，俄亥俄州立大学（Ohio State University）心理咨询中心的负责人米基·M·夏尔马（Micky M. Sharma）说：“学生们来寻求治疗时说着：‘我刚得了这辈子的第一个C，整个人都不好了，我想进医学院啊怎么办，我受不了了。”
Anxiety is an umbrella term for several disorders, including social anxiety disorder and agoraphobia. It can accompany many other diagnoses, such as depression, and it can be persistent and incapacitating.
焦虑症是几种疾病的总称，包括社交焦虑障碍（social anxiety disorder）和广场恐怖症（agoraphobia）等。它可伴有抑郁症等许多其它疾病，并可能持续存在并使患者丧失正常的行动能力。
Students who suffer from this acute manifestation can feel their very real struggles are shrugged off, because anxiety has become so ubiquitous, almost a cliché, on campus.
Alexa, 18, has been treated for an anxiety disorder since middle school, when she was still feeling terrorized by monsters under the bed. She has just finished her freshman year at Queens College in New York.
If she had a severe episode during a test, afterward she would try to explain to her professors what had happened but they would dismiss her. “They’d say, ‘Your mind isn’t focused,’ or ‘That’s just an excuse,’ ” said Alexa, who wrote her college application essay about grappling with the disorder. She asked not to be fully identified for privacy reasons.
More often, anxiety is mild, intermittent or temporary, the manifestation of a student in the grip of a normal developmental issue — learning time management, for example, or how to handle rejection from a sorority.
Mild anxiety is often treatable with early, modest interventions. But to care for rising numbers of severely troubled students, many counseling centers have moved to triage protocols. That means that students with less urgent needs may wait several weeks for first appointments.
“A month into the semester, a student is having panic attacks about coming to class, but the wait list at the counseling center is two to five weeks out. So something the student could recover from quickly might only get worse,” said Ben Locke, associate director of clinical services at Penn State University and the lead author of the Penn State report.
“开学一个月后，一个学生准备去上课的时候恐慌发作，但心理咨询中心的候诊名单已经排到二到五周之后了。结果该学生本来很快就可以摆脱的一些阴影可能就进一步恶化了，”宾夕法尼亚州立大学（Penn State University）临床服务部的副主任，宾州州立大学报告的主要作者本·洛克（Ben Locke）说。
By necessity, most centers can only offer individual therapy on a short-term basis. Ms. Preston estimates that about 80 percent of clients at U.C.F. need only limited therapy.
“Students are busting their butts academically, they’re financially strapped, working three jobs,” she said. “There’s nothing diagnosable, but sometimes they just need a place to express their distress.”
Even with 30 therapists, the center at U.C.F. must find other ways to reach more students — especially the ones who suffer, smoldering, but don’t seek help.
Like many college counseling centers, U.C.F. has designed a variety of daily workshops and therapy groups that implicitly and explicitly address anxiety, depression and their triggers. Next fall the center will test a new app for treating anxiety with a seven-module cognitive behavioral program, accessible through a student’s phone and augmented with brief videoconferences with a therapist.
It also offers semester-long, 90-minute weekly therapy groups, such as “Keeping Calm and in Control,” “Mindfulness for Depression” and “Building Social Confidence” — for students struggling with social anxiety.
The therapists have to be prepared to manage students who present a wide array of challenges. “You never know who is going to walk in,” said Karen Hofmann, the center’s director. “Someone going through a divorce. Mourning the death of a parent. Managing a bipolar disorder. Or they’re transgender and need a letter for hormone therapy.”
治疗师必须做好准备以应对学生五花八门的问题。“你永远不知道走进咨询室将会是怎样一个人，”该中心的主任卡伦·霍夫曼（Karen Hofmann）说。“有人正在办离婚，有人沉浸在丧父/丧母的悲痛中，有人正接受躁郁症（bipolar disorder）治疗，又或者，来者是个变性人，需要你开个证明以进行激素治疗。”
Indeed, Dr. Locke and his colleagues at Penn State, who have tracked campus counseling centers nationwide for six years, have documented a trend that other studies have noted: Students are arriving with ever more severe mental-health issues.
Half of clients at mental health centers in their most recent report had already had some form of counseling before college. One-third have taken psychiatric medication. One quarter have self-injured.
The fundamental goal of campus counseling centers is to help students complete their education. According to federal statistics, just 59 percent of students who matriculated at four year colleges in 2006 graduated within six years.
Studies have repeatedly emphasized the nexus between mental health and academic success. In a survey this year at Ohio State’s center, just over half of the student clients said that counseling was instrumental in helping them remain in school.
Anxiety-ridden students list schoolwork as their chief stressor. U.C.F.’s center and after-hours hotline are busiest when midterm and final exams loom. That’s when the center runs what has become its most popular event: “Paws-a-tively Stress Free.”
深受焦虑症之苦的学生们将课业列为首要的压力源。U.C.F.的心理咨询中心及其非工作时间热线都是在期中和期末考试迫近时最为繁忙。在这种时候，该中心就会开展他们最受欢迎的活动：“治疗犬减压法（Paws-a-tively Stress Free）”。
The other afternoon, just before finals week, students, tired and apprehensive, trickled into the center. The majority were not clients.
At a tent outside, their greeter was the center’s mascot and irresistible magnet: a 14-pound Havanese, a certified therapy dog whom many clients ask to hold during individual sessions, stroking his silky white coat to alleviate anxiety.
“Bodhi!” they called, as he trotted over, welcoming them to his turf with a friendly sniff.
For the next two hours, some 75 students visited the center, sitting on floors for a heavy petting session with therapy dogs.
在接下来的两个小时中，约75名学生参观了中心，并坐在地板上与治疗犬们共同完成了“亲密爱抚疗程”（heavy petting session）。
They laughed at the dogs’ antics and rubbed their bellies. They remarked on how nice it was to get a study break.
On the way out, the students were handed a smoothie and a “stress kit,” which included a mandala, crayons, markers, stress balls and “Smarties” candy.
Also tucked into the kit was a card with information about how to contact the center, should they ever need something more.