Emotional Emotional WellnessWellness

Kevin Joyce, LPCKevin Joyce, LPC

Priti Shah, Ph.D.Priti Shah, Ph.D.

Office of Counseling ServicesOffice of Counseling Services

ObjectivesObjectives

Understand and identify what Emotional Understand and identify what Emotional Wellness and Emotional/ Psychological is in Wellness and Emotional/ Psychological is in students. students.

Learn about some common psychological and Learn about some common psychological and emotional conditions among students.emotional conditions among students.

Learn basic intervention skills in situations Learn basic intervention skills in situations involving Emotional/ Psychological Distress or involving Emotional/ Psychological Distress or Crisis. Crisis.

Practice learned skills and information. Practice learned skills and information.

How do you know when you are emotionally well?

What is Emotional Wellness

Three Criteria for Emotional Wellness/ Health:– 1. Is the person basically happy?– 2. What is the quality of his/her

relationships?– 3. Is he or she having success in school or

work? Are they functioning on a day to day basis (i.e. going to class, meetings, taking care of themselves, etc.).

Normal College Concerns v. Emotional/ Psychological

Distress “Normal” College

Concerns…– Homesickness– Breakups– Academic Stress– Difficulty making friends– Family Conflicts (Divorce,

etc.)– Financial Stress

Signs of Emotional/

Psychological Distress…– Depression– Feelings of Hopelessness– Isolating themselves– Violent towards self or

others– Not taking care of

themselves physically

Emotional / Psychological Concerns Among College

Students

Emotional/Psychological Emotional/Psychological Concerns To Be Aware Of:Concerns To Be Aware Of:

AnxietyAnxiety DepressionDepression Eating DisordersEating Disorders Suicide and Self-Injurious BehaviorSuicide and Self-Injurious Behavior Mental Health Crisis Situations (Immediate Mental Health Crisis Situations (Immediate

Self-Harm, Violent Behavior, Psychosis, etc.)Self-Harm, Violent Behavior, Psychosis, etc.) Sexual Assault, Sexual MisconductSexual Assault, Sexual Misconduct Others? Others?

Anxiety, Panic Attack, Just Worried, or Stressed ?

AnxietyAnxiety Anxiety is more than “normal Anxiety is more than “normal

worry” or “stress.”worry” or “stress.” Reoccuring worry over longer Reoccuring worry over longer

periods of time.periods of time. Physical discomfort.Physical discomfort. Inability to function day Inability to function day

(affecting sleep, relationships, (affecting sleep, relationships, behavior).behavior).

May/may not include panic.May/may not include panic. May be specific to a situation or May be specific to a situation or

generalizedgeneralized– Social AnxietySocial Anxiety– Test AnxietyTest Anxiety– Generalized AnxietyGeneralized Anxiety

Panic (i.e. Panic Attack)Panic (i.e. Panic Attack) Sudden and intense episodes of Sudden and intense episodes of

fear and anxiety that occur often fear and anxiety that occur often and without warning.and without warning.

Difficulty breathingDifficulty breathing Heart racingHeart racing SweatingSweating Chest painsChest pains Flushed faceFlushed face Tense feeling or tightnessTense feeling or tightness May last for 5-30 minutesMay last for 5-30 minutes Cause may be unknown though Cause may be unknown though

could have certain triggers.could have certain triggers. Feel like you are dying.Feel like you are dying. Fear of having more panic attack Fear of having more panic attack

(panic disorder). (panic disorder).

Recognizing Anxiety in Recognizing Anxiety in StudentsStudents

Constant worrying Constant worrying about many things: about many things: school work/studying, school work/studying, grades, social grades, social relationshipsrelationships

Avoidance of certain Avoidance of certain things: classes, things: classes, speaking in public, speaking in public, avoiding peopleavoiding people

Person appears tense, Person appears tense, unable to relaxunable to relax

Problems sleepingProblems sleeping

HeadachesHeadaches Reporting of Reporting of

numbness in body, numbness in body, heart palpitationsheart palpitations

Racing thoughtsRacing thoughts Stomach problemsStomach problems Eating problems- Eating problems-

often can’t eatoften can’t eat

Depression orDepression orJust “Sad”Just “Sad”

Getting sad is normal response to stressors or Getting sad is normal response to stressors or difficult life events. difficult life events.

This sad feeling does not mean you are This sad feeling does not mean you are depressed. depressed.

DepressionDepression– sad most of the daysad most of the day– loss of pleasure in activities loss of pleasure in activities – physicalphysical and and psychological psychological changeschanges– lasts lasts for more than 2 weeksfor more than 2 weeks

Signs of DepressionSigns of Depression

Core Signs of Depression:Core Signs of Depression:– Depressed Mood.Depressed Mood.– Negative Thinking Negative Thinking – Diminished interest in friends or activities Diminished interest in friends or activities

that student once enjoyed.that student once enjoyed.– Change in eating.Change in eating.– Changes in sleeping.Changes in sleeping.

Signs of Depression Physical Changes:

– Fatigue/ lack of energy.– Appetite/weight gain or

loss– Changes in the way a

person moves (may move slower or may be agitated).

Psychological Psychological Changes:Changes:– SadnessSadness– Apathy (lack of emotion, Apathy (lack of emotion,

interest, or pleasure)interest, or pleasure)– Feelings of worthlessness Feelings of worthlessness

or excessive guiltor excessive guilt– HopelessnessHopelessness– Lack of concentrationLack of concentration– Lack of motivationLack of motivation– Irritable or angryIrritable or angry– Preoccupation with death Preoccupation with death

or suicidal thinking.or suicidal thinking.

Depressed? Ex.) A male sophomore in

their second semester at CNU just broke up with his long-term LD girlfriend 3 weeks ago. He’s been quieter than usual, irritable, doesn’t come to hall events, hasn’t been eating with his roommates as often. He’s still goes to class and goes to parties on the weekends with a few of this friends, but not as often, though he seems to be having fun when you’ve seen him out. One of his roommates have come to you a little concerned that he might be depressed.

Ex.) A female student in her second semester begins going home each semester. Her roommates are a little concerned (but haven’t come to you officially, you’ve just “heard”), as she has also stopped eating with them, never comes out with them, but notice a little weight gain. You know that she’s interested in her spirituality and academically motivated, but for the past month, she’s had little interest in school, and seems to make it to about half her classes or no longer attends church. You have already decided to talk with her, and when you share some of your concerns, she states, “I just miss home.” and begins to cry.

Eating DisordersEating Disorders Eating disorder Eating disorder in which the individual maintains in which the individual maintains

unhealthy attitudes and behaviors toward food, unhealthy attitudes and behaviors toward food, eating, and body image. eating, and body image.

Often, there is an underlying belief that being thinner Often, there is an underlying belief that being thinner would be a solution to troubles and demonstrate would be a solution to troubles and demonstrate proof of control in one's life. proof of control in one's life.

• • 40% of female college students have eating 40% of female college students have eating disorders disorders

• • 91% of female college students have attempted to 91% of female college students have attempted to control their weight through dieting control their weight through dieting

Estimate 1% to 7% of college males have eating Estimate 1% to 7% of college males have eating disorders disorders

Types of Eating Disrupted Types of Eating Disrupted BehaviorsBehaviors

Binge-Eating:Binge-Eating: uncontrollable, excessive eating, uncontrollable, excessive eating, followed by feelings of shame and guilt; no purgingfollowed by feelings of shame and guilt; no purging

Bulimia:Bulimia: binge & purge; A binge is the binge & purge; A binge is the consumption of a large amount of food within a consumption of a large amount of food within a short period of time. Purging is forced vomiting. short period of time. Purging is forced vomiting.

Anorexia: Anorexia: less common; take extreme measures less common; take extreme measures to avoid eating; often become abnormally thin to avoid eating; often become abnormally thin

Combination: Combination: Many students will diet frequently, Many students will diet frequently, restrict, followed by bingeing and purgingrestrict, followed by bingeing and purging

Signs of Disturbed EatingSigns of Disturbed Eating**1 symptom DOES NOT means the person has a problem1 symptom DOES NOT means the person has a problem

Avoid situations Avoid situations w/food involvedw/food involved

Rituals around food Rituals around food prep & eatingprep & eating

Recent weight loss Recent weight loss or gain or gain (fluctuations).(fluctuations).

Emotional changesEmotional changes Trips to bathrooms Trips to bathrooms

after mealsafter meals

Hoarding of large Hoarding of large quantities of food or quantities of food or hiding foodhiding food

Excessive, rigid Excessive, rigid exerciseexercise

Eating in secretEating in secret Constant dietingConstant dieting Smell of vomitSmell of vomit Social withdrawalSocial withdrawal

Prevention in the HallsPrevention in the Halls6 Tips the RA can use:6 Tips the RA can use:

Respect privacy.Respect privacy. Be aware of the eating Be aware of the eating disordered person’s condition and progress, but disordered person’s condition and progress, but don’t make it seem as if you’re watching them don’t make it seem as if you’re watching them like a hawk. like a hawk.

No one needs a food monitor.No one needs a food monitor. Don’t be Don’t be “helpful” by pointing out which foods are “helpful” by pointing out which foods are healthier and which aren’t.healthier and which aren’t.

Talk about other things.Talk about other things. We are much more We are much more then our illnesses, and discussing other things then our illnesses, and discussing other things not only helps remind the resident that life is not only helps remind the resident that life is more than food and weight. more than food and weight.

Prevention Continued:Prevention Continued: Research the diseaseResearch the disease and arm yourself and arm yourself

with knowledge - it shows the resident that with knowledge - it shows the resident that you’re genuinely interested and helps you you’re genuinely interested and helps you understand their struggles. understand their struggles.

Don’t be patronizing.Don’t be patronizing. While people with an While people with an eating disorder may not be making rational eating disorder may not be making rational and healthy decisions due to malnutrition and and healthy decisions due to malnutrition and the disease, they are not stupid or ignorant. the disease, they are not stupid or ignorant.

Provide a good role modelProvide a good role model. Examine your . Examine your own eating habits - Do you diet constantly? own eating habits - Do you diet constantly? Do you make self-deprecating comments Do you make self-deprecating comments about your body, even in jest? about your body, even in jest?

General Intervention with Psychological Distress

1. Assess: How do you feel? What makes you concerned based on knowledge of the disorder and/or instinct? What do you know about the situation?

2. What is your Role in the situation? Your role is not to be a therapist. Don’t take on more than you should!

3. Share your concerns State observations “I’ve noticed that over the past several weeks you’ve been

quieter, you don’t come to hall events, and you seem sad…Is everything okay.” Or “I’m concerned about you because…” and then stating the things you’ve been seeing.

Use I statements Be Direct Share this information privately as long as you feel safe with the person.

General Intervention with Psychological Distress

4. Listen. Understand Reflect feelings, paraphrase, just be with them. Ask questions to better understand what they are thinking and feeling. Let them know that you want to understand and are here to listen. May not want to promise them confidentiality. Don’t say, “I won’t tell anyone.”

Instead, “I may need to tell those who can help you.”

5. Support. This may look different depending what is happening. Ask, “What can I do to help?” Encourage & Empower them to consider ways they have coped with stressors

in the past. Notice their resources, point them out. They may not be aware of them. Be available and attentive Sometimes support means getting them other help.

6. Follow up Be open to other conversations. It may be a process

7. Connect/ Consult. Contact your RD, other Pro-staff to support you (let the person know in

advance that you might need to do this, or you are going to be doing this). Make a referral if you feel you need to this/ it is the person’s best interest.

Understanding Suicide and Understanding Suicide and Self-Injurious BehaviorSelf-Injurious Behavior

Approximately 1100 college students complete Approximately 1100 college students complete suicide each year. (There are 18,248,128 college suicide each year. (There are 18,248,128 college students in the U.S. in 2007; students in the U.S. in 2007; this is .006%)this is .006%)

Suicidal ideation:Suicidal ideation: Thinking about suicide Thinking about suicide

Suicide Threat:Suicide Threat: Stating intent to kill yourself Stating intent to kill yourself

Suicide Attempt: Suicide Attempt: Actually trying to kill yourself; Actually trying to kill yourself; NOT the same as cuttingNOT the same as cutting

Self-Injurious BehaviorSelf-Injurious Behavior: “cutting or burning”; : “cutting or burning”; behavior related to self harm but absent of intent to behavior related to self harm but absent of intent to kill yourselfkill yourself

How to Assess for SuicideHow to Assess for Suicide

If you’re worried about the If you’re worried about the possibility of Suicide…(even if a possibility of Suicide…(even if a student might be cutting). student might be cutting).

Signs: What do you look for?Signs: What do you look for? Intervention: What to ask? What Intervention: What to ask? What

do you do? do you do? It’s NOT you’re job to be a Counselor! It’s NOT you’re job to be a Counselor! It’s NOT you’re job to know ALL the answers!It’s NOT you’re job to know ALL the answers!

What do you look for?: Warning Signs of Suicide

Tier 1: Direct statements and threats about suicide Seeking ways to kill themselves, trying to find a plan Talking, writing, discussing death frequently; seems preoccupied

with this. Tier 2: Extreme mood shifts and impulsive acting out (ex.) Sadness and crying Hopelessness; Feeling trapped; Indicating no purpose to live. Change in eating habits, weight gain/loss Giving away prized possessions Prior attempts (not burning or cutting necessarily). Other High Risk Behavior (increased substance use/abuse, self-

injurious behavior).

What do you Do?What do you Do? Your goal is NOT therapyYour goal is NOT therapy; provide resources and ; provide resources and

support for the personsupport for the person

Be DIRECT-Be DIRECT- people who are thinking about it may people who are thinking about it may not always say it. not always say it. Asking about suicide DOES NOT Asking about suicide DOES NOT “make” someone suicidal“make” someone suicidal. .

Being direct helps the person feel UNDERSTOOD- Being direct helps the person feel UNDERSTOOD- goal of the interventiongoal of the intervention

Ask Ask “Are you thinking about killing “Are you thinking about killing yourself? Have you thought about suicide?”yourself? Have you thought about suicide?”

If they say “Yes” to If they say “Yes” to considering suicide…considering suicide…

Try to follow up with other important Try to follow up with other important questions to get a better assessmentquestions to get a better assessment

(1) How often and how soon are you (1) How often and how soon are you thinking about it?thinking about it?

(2) Have you attempted suicide in (2) Have you attempted suicide in past- when?past- when?

(3) Are you considering a plan/method (3) Are you considering a plan/method at this time? If so, what is it?at this time? If so, what is it?

Intervention (Cont.)Intervention (Cont.) Remain Remain CALMCALM and don’t panic. You might be and don’t panic. You might be

caught off guard, but in most cases you have caught off guard, but in most cases you have plenty of time to gather this type of information. plenty of time to gather this type of information.

Do notDo not advise, interpret/explain, assure “it will be advise, interpret/explain, assure “it will be ok”ok”

LISTENLISTEN and and REFLECTREFLECT how they are feeling. how how they are feeling. how they are feeling. They will feel understood.they are feeling. They will feel understood.

Encourage them to talk about how they are feeling.Encourage them to talk about how they are feeling.

Ask about Ask about SUPPORTSSUPPORTS..

Intervention (cont.)Intervention (cont.) State you are concerned State you are concerned andand glad they are willing to share this glad they are willing to share this

w/youw/you

DO NOTDO NOT agree to secrecy or confidentiality about their suicidal agree to secrecy or confidentiality about their suicidal thinking.thinking.

PersuadePersuade: Validate their courage in speaking w/you and seeking : Validate their courage in speaking w/you and seeking help- Encourage to speak with professional.help- Encourage to speak with professional.

NotifyNotify and consult with an and consult with an RD RD who will contact the who will contact the Counselor on Counselor on Call.Call.

If you believe there is an immediate risk of a suicidal attempt, If you believe there is an immediate risk of a suicidal attempt, DO DO

NOTNOT leave the person alone. Get help (RD, CNU PD immediately). leave the person alone. Get help (RD, CNU PD immediately).

Crisis Response for RA’sCrisis Response for RA’s

ImmediateImmediate physical or physical or psychological harm to self or psychological harm to self or others.others.– Immediate Suicide or Self HarmImmediate Suicide or Self Harm– Violent or threatening behaviorViolent or threatening behavior– PsychosisPsychosis– OthersOthers

Crisis Response for RA’s

Remain Calm. Assess Risk:

– Are you in any immediate danger first?– Is anyone’s physical or psychological safety

at risk? Slow down the situation (breathing, pacing,

tone, etc.). This will calm others down as well. Gather Information. Contact and Consult RD You should NEVER feel alone.

Consulting with OCS: Consulting with OCS: When You’re Not Sure…When You’re Not Sure…

If you are ever unsure about how to approach a If you are ever unsure about how to approach a concern with one of your residents, you can concern with one of your residents, you can and should consult your RDs, other RAs, and and should consult your RDs, other RAs, and OCS.OCS.

You can contact OCS and make a Consultation You can contact OCS and make a Consultation Appointment. Appointment.

Unless we are concerned about anyone’s Unless we are concerned about anyone’s safety, your information as well as the safety, your information as well as the residents will remain confidential. residents will remain confidential.

Making Referrals to OCSMaking Referrals to OCS

1)1) Share your concern w/student- cite your Share your concern w/student- cite your observations & avoid labeling behaviors. observations & avoid labeling behaviors.

2)2) Suggest they meet with a counselor.Suggest they meet with a counselor.• Let them know what to expect.Let them know what to expect.• Let them know they don’t need to commit to Let them know they don’t need to commit to

counseling that it’s just a conversation.counseling that it’s just a conversation.• Can make call w/them or can come to Can make call w/them or can come to

appointment with them to offer more appointment with them to offer more support.support.

3)3) Follow up with the studentFollow up with the student

Questions?

Practice Examples & Clips