It was nearly 8 p.m. and she’d been standing for hours testing slide after slide of fish cells.
It was just another night in lab. Then, as suddenly as always, the intrusive thoughts came.
“You can’t do this anymore.”
She tried to shake it off. Blinking, she stared harder at her notebook.
“This will never stop.”
She flipped a page, her hand shaking.
“It’s terrible. You’ll have to do it again.”
She ran through her list of coping techniques. She couldn’t stop and breathe with the experiment going. She couldn’t call friends to talk her through it – her phone was nearly dead.
When she tried to send messages through her computer no one answered.
Her brain screamed a broken record of abuse. Her breaths were quick and shallow as her body shook. Her heart pounded with fear, sweat beading on her skin.
She curled up on the laboratory floor and sobbed until the worst of the anxiety attack had passed.
When she could breathe again, she stood up and continued the experiment, tears dripping down her face.
She knew she had to hide it.
“Quiet, now, or they’ll see,” she thought. “This is normal. This is fine.”
Taylor Dole, 23, has been living with anxiety for about a decade. A graduate student studying food science at the University of Florida, she learned the hard way to deal with her anxious mind.
There was an emotionally abusive boyfriend. There was pressure from her parents to do well academically. There was the constant fear of failure.
It all affected her daily life.
“It really did become all-encompassing which was the worst part,” she said. “It felt like there was no way out.”
Unfortunately, Dole’s situation is not uncommon. In the 2013 American Psychological Association survey of college counseling directors, 70 percent said they believe the number of students with severe psychological problems has increased in the past year.
The survey also found that anxiety is the top presenting concern among college students at 41.6 percent. This is closely followed by depression (36.4 percent) and relationship problems (35.8 percent).
Dole began visiting UF’s Counseling and Wellness Center in 2013 and has continued off and on ever since. Specialists described her as having anxious and depressive tendencies.
She hasn’t been diagnosed with a specific disorder, but the patterns are there. The worries about her friendships, existential crises, panic attacks, night terrors and episodes of depression were regular.
Dole learned to wrestle with her brain to override the poisonous thoughts. She knew most of the time her worries were unrealistic. But the cycle can be hard to break.
“Paranoid me says, ‘No, you’re stuck like this,’” she said. “The rest of me says, ‘It has to get better. It has to.’”
College students experience stress, but the difference between everyday anxiety and an anxiety disorder is important. Nervousness helps people stay safe and prepare for important events like tests and interviews.
But when anxiety starts interfering with everyday activities, it can be a sign something more serious is lurking. Recent studies show anxiety disorders are the most common psychiatric illnesses affecting children and adults.
Generalized anxiety disorder is the most common out of the many types of anxiety disorders. It affects nearly 7 million adults — 3.1 percent of the U.S. population — yearly, according to the Anxiety and Depression Association of America.
Women are twice as likely as men to be affected.
The ADAA says those with generalized anxiety disorder experience constant and unfounded worry, often about work, family, health or money.
The worry is daily, sometimes disrupting their ability to eat, sleep and focus.
This, certainly, Dole is all too familiar with.
“If it’s something small like, ‘I have a paper due next week I haven’t started yet,’ normal people would be like, ‘Okay, I’ll work on this,’” she said. “But for me it just becomes overwhelming: racing heart rate, nausea, headache. Absolutely anything stressful – it’s the same response.”
A friend described it best, she said: There’s no proportional response. Just a trap door into adrenaline. It’s exhausting.
Quality Of Life
According to a 2009 University of Houston psychological study, people with anxiety disorders can have a lower quality of life than non-anxious adults.
Mental illnesses are difficult to test objectively. This test did what most avoid: It asked its patients subjective questions and applied them to a scale.
“Behavioral changes take practice and work,” said Dr. Brian Ess, a psychologist at the UF Counseling and Wellness Center. “People with that lower quality of life, it’s their main motivator to come in for help.”
But because it can be hard to identify the difference between healthy levels of anxiety and serious problems, students often don’t ask for help until they’re absolutely desperate.
Dole recognized that her anxiety was out of control. People with average anxiety levels, she said, don’t go through mental checklists before every conversation and decision. Part of her knows she will be fine but she can’t quite believe it.
“It’s doubting everything, being concerned about every little thing — my future, my relationships with people, day-to-day communication,” she sighed. “Pure doubt. Some days it is just easier to lay in bed with my cats.”
Her worries about academia are even worse. Dole equates her academic excellence with her self-worth. One mistake in school means she’s damaged her future.
This is not an abnormal worry. Ess said grades and social anxiety are the most common pressures plaguing anxious students at the wellness center.
The wellness center’s annual reports show that UF students are seeking help for anxiety more than any other psychological problem.
Last year, 14.3 percent of college students were diagnosed with or treated for anxiety problems, according to the American College Health Association.
Why mental illness seems to be rising among college students is unclear. It is likely a combination of many factors. Increased outreach means more students are aware of the existence of anxiety disorders and can recognize the need to seek help.
“It can be challenging to make the adjustment here, with 50,000 students,” Ess said. “It feels overwhelming. But I want people to know that this is something that can be treated. We have a lot of different tools for helping anxiety.”
The Counseling and Wellness Center offers individual, group and online therapy. Medication, biofeedback and classes, such as “Taming the Anxious Mind,” are also available.
The class focuses on a technique quite helpful to those who can’t calm their thoughts: mindfulness.
“I find a lot of anxiety takes place in the future or the past,” Ess said. “Things like mindful walking and looking internally can help shift focus to the present. We can understand what’s going on. The present is the only time we can do anything about anything.”
Inhale for seven seconds. Exhale for 11.
Or inhale for four seconds, exhale for four.
Or perhaps start inhaling for one second and exhaling for one, then slowly increase the length of each breath.
There are many different breathing techniques taught in mindfulness classes. The reason why is simple: Slowing one’s breathing slows one’s heart rate. Calming the body is the first step toward calming the mind.
“Nine out of 10 times now, it works,” Dole said. “The one time it doesn’t, I call someone. But I have to be self-reliant. I can’t get to a point where I can’t handle something if I’m alone.”
She’s tried many techniques. For those with anxiety, relaxing is not an easy task. Yoga, exercise and meditation can slow some of the constant, whirling laps an anxious mind runs. The techniques are proven to be relatively successful. The most effective remedy, however, is cognitive behavioral therapy.
“Our thoughts and behavior certainly have an impact on our emotions, and vice versa,” said Dr. Joe McNamara, the co-director of the UF Health Medical Psychology Clinic at Springhill. “It’s amazing how much of an impact we can make using CBT (cognitive behavioral therapy) with exposure response prevention for people struggling with the vast majority of anxiety disorders and OCD.”
McNamara and his team work with people whose anxiety has severely crippled their ability to function. They accompany patients in anxiety-provoking situations and coach a different response to stimulus. When the bad things don’t happen, it disconfirms the fear and the anxiety decreases over time.
The therapeutic techniques matched with exposure response prevention are effective because they target elements of anxiety, according to McNamara. There’s a cognitive component, a behavioral component and the emotional attachments to both.
“Basically, our brain doesn’t do a very good job of communicating with our brain,” he said.
An anxious brain can’t differentiate between a dangerous situation and a safe one. So a little trickery is needed to challenge the hyper arousal: diaphragmatic breathing mantras, medications.
Eighty percent of people who go through cognitive behavioral therapy have a 50 percent decrease in their symptoms by their 15th session, McNamara said. Many can decrease their anxiety from extreme clinical conditions to something they can then handle.
“Unhealthy anxieties generally don’t just stay where they are,” McNamara said. “They normally either get better or they get worse. The main thing for people struggling is that there definitely is hope out there. There are evidence-based treatments that people can get that really help turn things around.”
The Sum Of The Parts
On a Sunday in April, Taylor Dole felt good.
She pounded a clove of garlic into paste, and she scraped it with steady hands from the cutting board into a pan on the stove.
Taylor Dole, 23, bakes chocolate chai biscotti to distract her nerves the day before her thesis defense. Dahlia Ghabour / WUFT
“I don’t think about my issues when I cook,” she said as she peeled an onion. “I just cook. I’m creating something.”
She enjoys putting together a bunch of ingredients that would not work on their own. Even if it doesn’t look perfect on the outside – even if the cake is sloppy, or the pasta doesn’t stick right – the food tastes the same.
“Even in cooking, I’m self-critical,” she said. “But no matter how bad I think I do, people say I’m amazing. And then yes, I’m amazing.”
Dole cooks to relieve stress. It’s her litmus test.
When she’s especially anxious, she stops cooking. That’s when she knows it’s time to take a break, bake something and invite a friend over to try it.
School is stressful but she knows she is capable of handling the workload.
Relationships can also incite anxiety, but she is aware she is a good girlfriend. She is aware that she is now in a healthy relationship, one that can build her up instead of tear her down.
Dole wiped her hands on a towel. The roasted vegetarian meal was ready.
“I know the anxiety is built out of fantasy,” she said. “So I have to go to an idealized fantasy. You’re not as bad as you think you are. You have to be greater than you think you are, too. I guess it’s kind of the sum of the parts.”