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Stress & College Students

A Guide for SMU Faculty and Staff: Identifying and Referring the Distressed Student

• Signs of Stress
  • Stated Need for Help
  • Unusual Changes in Behavior
  • Rapid Onset of Illness
  • Traumatic Changes in Relationships
  • Alcohol & Drug Abuse/Dependence
  • References to Suicide
• Crisis Procedures
• Faculty & Staff Intervention
• How to Help a Student Under Stress
• Means of Coping with Stress
• How to Refer a Student for Further Help
• Referrals to Counseling & Psychiatric Services
• Campus Resources

Stress seems to be an especially common feature of college student life, particularly at highly competitive colleges and universities. In addition to surviving academically and preparing themselves for further graduate or professional training, students are involved in becoming unique and independent adults, deciding on career alternatives, creating personal value systems, and developing significant relationships. Usually minimal degrees of stress motivate individuals into productive action; maximum degrees of stress, on the other hand, often result in little or no productive outcomes.

Our purpose is to share with you, from the experience of the staff of SMU Counseling and Psychiatric Services, the following information that we hope will be of value to you as you work with students. This information is not intended to be an exhaustive treatment of the topic, however, we think it will be of considerable value regardless of the perspective from which you work with students.

Please call us at 214-768-2277 or come to Counseling and Psychiatric Services if you would like to discuss any general or specific student stress situations. We are located on the 2nd floor of the Memorial Health Center at 6211 Bishop Boulevard.

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Signs of Stress

The following signs, depending on their severity, usually indicate that a student is under some degree of stress and may need help. A single sign in a pronounced state, or a cluster of signs appearing about the same time, would probably indicate the need for a referral to Counseling and Psychiatric Services.

A Stated Need for Help

The need may be stated directly or indirectly, strongly or modestly. It is important not only to hear what the student is saying, but also to notice how he or she is saying it.

Unusual Changes in Behavior and/or Mood

• Withdrawal from usual social interactions
• Decreased productivity
• Increased mistakes
• Noticeable absence from class
• Emotional outbursts and crying
• Loss of interest or apathy
• Exam time "jitters"
• Increased or decreased sleep
• Exaggerated irritability
• Depression
• Excessively blaming others
• Excessive hostility, anger or resentment
• Obsessions (unwanted thoughts)
• Excessive worrying or expression of fears
• Increased forgetfulness
• Confusion
• Thought disorders (the student’s conversation does not make sense)
• Compulsive disorders (ritualistic ways of acting, such as twitches, repeated words, excessive handwashing)

Rapid Onset of Physical Illness

• Elevated blood pressure
• Chronic digestive problems/stomach pains
• Increased muscle tension
• Severe and frequent headaches
• Dizziness
• Elevated pulse and respiration
• Ulcers
• Moist or sweaty palms
• Increased frequency of urination
• Questions about sexually transmitted diseases and/or pregnancy (referral to the University Health Center and/or to the Planned Parenthood Center off campus are appropriate in such cases)

Traumatic Changes in Personal Relationships

• Death of a family member, partner or close friend
• Difficulties in marital or dating relationships
• Difficulty in family relationships

Alcohol and Drug Abuse/Dependence

You may call either Counseling and Psychiatric Services at 214-768-2277, or the Center for Alcohol & Drug Abuse Prevention at 214-768-4021.

IN CASE OF A DRUG OVERDOSE, CALL 911 IMMEDIATELY AND THEN CALL THE SMU POLICE DEPARTMENT AT 214-768-3388. SMU PD WILL SET IN MOTION THE EMERGENCY RESPONSE TEAM.

References to Suicide

If you listen carefully, it is often possible to distinguish between a "theoretical" discussion of suicide and the personal anguish of "not knowing if life is worth the hassle." IMMEDIATE referral is necessary if the conversation includes the how, the when, and/or the where of the suicide. During the hours of 8:30 a.m. until 5:00 p.m., please call 214-768-2277, Counseling and Psychiatric Services for emergency assistance. For after hours assistance, call 214-768-2277, and the phone call will be forwarded to the professional on call for that day. Appropriate care can be provided by either department.

IN CASE OF ATTEMPTED SUICIDE, CALL 911 IMMEDIATELY AND THEN CALL SMU POLICE DEPARTMENT AT 214-768-3388. SMU PD WILL SET IN MOTION THE EMERGENCY RESPONSE TEAM.

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Crisis Procedures

Southern Methodist University has identified staff trained to respond in a crisis situation. The Crisis Management Team may be used in cases such as student, spouse, or dependent death, sexual assault, attempted suicide, or major trauma affecting students’ lives.

IF A SITUATION REPRESENTS AN IMMEDIATE THREAT TO PERSONAL HEALTH AND SAFETY, CALL SMU POLICE DEPARTMENT AT 214-768-3388. SMU PD OR OTHER DEPARTMENTS IDENTIFIED BY THE EMERGENCY MANAGEMENT PLAN WILL ASSUME CONTROL AND DIRECT THE UNIVERSITY’S RESPONSE TO THE EMERGENCY.

In the event of a crisis as defined above, the Dean of Student Life should also be notified immediately at 214-768-4564. The Dean will notify the members of the Crisis Management Team and will coordinate their response.

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Faculty and Staff Interventions

1. Emergency Situation – Imminent Threat of Harm

   If a faculty or staff member has knowledge of or observes very unusual behavior, including, but not limited to:

   • student talks about harming self or others;
   • student engages in any type of self-destructive behavior; or
   • student exhibits overdose, tissue damage, vomiting and/or fluctuating levels of consciousness due to severe intoxication.

   Actions to Take

   1. Call 911 and ask for paramedics who will determine the appropriate response.
   2. Stay with the student until he or she is evaluated by paramedics or a mental health professional
   3. Notify the Dean of Student Life, 214-768-4564.

   When medically stable, Counseling and Psychiatric Services (CAPS) staff will meet with the student, request the student to authorize a release of information and arrange transport to the hospital or determine a plan of transport. Prior to returning to the Residence Hall, the student must meet with a staff member from CAPS to determine his or her suitability to return to the Residence Hall. The Dean of Student Life, in consultation with Counseling and Psychiatric Services staff, makes other notifications as appropriate. CAPS will conduct a follow-up with the person(s) who reported the student.

2. Emergency Situation – Recent Threat of Harm

   If a faculty or staff member learns that a student has been talking about harming himself, herself, or others, and/or engages in any type of self-destructive or psychotic behavior, he or she should consult with Counseling and Psychiatric Services (CAPS) about mandating a referral for an evaluation. If necessary, the Dean of Student Life can assist in this process. The Counseling and Psychiatric Services (CAPS) staff will request that the student sign a release of information authorization, conduct an assessment, and arrange transportation to the hospital if necessary.

3. Non-Emergency – No Imminent Threat of Harm

   If a faculty or staff member has knowledge of or observes the following behavior by a student:

• bizarre behavior;
• sleeping in excess;
• evidence of an eating disorder or depression; or
• drug use, including serious alcohol use.

Such behavior should be reported to the Dean of Student Life. The Dean of Student Life will meet with the student and may require the student to meet with the Counseling and Psychiatric Services (CAPS) staff or the Center for Alcohol and Drug Abuse Prevention as appropriate. If the student refuses to make such an appointment and the situation is serious enough to warrant it, the Dean may initiate disciplinary action and removal from the University.

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How to Help a Student Under Stress

1. Be available.
2. When you talk with a student, put aside all other work in order to give him or her 100% of your attention.
3. Listen with care, attention and acceptance from the student’s perspective, rather than your own. Develop an "adult-adult" approach rather than a "superior-subordinate" approach. Use reflective statements, i.e., share with the student what you hear him or her saying.
4. Help the student define what is causing the stress, the effects of the stress, what he or she is doing to cope and how effective the coping skills are.
5. Before offering suggestions or advice, encourage the student to think of coping methods he or she has found effective in the past or which might be effective in dealing with the current stressors. Doing so empowers the student to rely on his or her own judgment and to assume responsibility.
6. After the previous items have been discussed, you can suggest alternative ways of viewing the situation and other ways of coping with or minimizing the stress. (See the "Means of Coping with Stress" part of this material.)
7. Take the time to follow up with the student, i.e., asking generally how the student is getting along. Do so in an interested, concerned and adult-adult manner, not in a paternal manner.
8. If it seems that the student has made little or no progress with resolving the stress situation or employing various coping mechanisms, refer the student to Counseling and Psychiatric Services (CAPS) or to other appropriate resources on or off campus.
9. Don’t hesitate to call one of us at CAPS or another referral source to discuss a student’s situation. In that way, not only will you help the student deal more effectively with the problem, but you will also prevent the possibility that you will become part of the student’s problem. It is more beneficial to the student if you are aware of your limitations and, thus, know when and how to appropriately access referral sources.

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Means of Coping With Stress

1. Eat a balanced diet, get a good night’s rest, and exercise regularly. Get regular physical examinations. When we feel "good," we not only are able to deal with problems more effectively, but also to interpret problems as less severe.
2. Set realistic academic and personal priorities, and reevaluate them periodically. Don’t overload yourself with unimportant responsibilities or tasks. Be flexible!
3. Do as much as you can appropriately and effectively each day about the stress-producing situation. Then, consciously discipline yourself to believe the fact that you have done your best today and stop worrying about the future which you can no longer affect this day.
4. Don’t wait until the last minute to do things! Plan your day and week so that you are able to accomplish the necessary tasks and comprehend all the responsibilities and activities that lie before you.
5. Consider alternative ways of viewing your situation. Sometimes it is not the situation but the particular way you interpret it that creates undue stress. This is essential if you happen to be the "catastrophizing" type of individual, i.e., one who often interprets events or problems as crises.
6. Try at various times each day to "get outside yourself," i.e., listen to and concentrate on others and think about other external events. Constant preoccupation with oneself is sometimes quite counter-productive.
7. Balance your social time with some alone time. Experience what it means to feel good about being yourself.
8. Engage in prayer or meditation.
9. Read self-help books that address the area of life that is causing you stress. Counseling and Psychiatric Services (CAPS) can recommend books that are used in conjunction with counseling.
10. Learn effective relaxation exercises through books, tapes or classes.
11. Learn more productive reading and study skills. Call the Altshuler Learning Enhancement Center at 214-768-3648 or visit Counseling and Psychiatric Services.
12. Engage in individual activities that are pleasurable and provide a diversion, such as TV, hobbies, reading, exercising, going to a movie, play, or concert, listening to or playing your favorite music, hiking, eating out for a change, etc.
13. Be aware of you support system: friends, family members, professors, counselors, etc., and be willing to ask them for help.
14. Attend the church or synagogue of your choice, or talk to a minister, priest, or rabbi.
15. Get involved in volunteer work or do something helpful for someone you know.
16. Learn about the campus resources that are available to you. Refer to the student handbook, consult with fellow students, or visit the office of the Dean of Student Life to learn about each service.
17. Be careful not to fall into the trap of thinking and feeling that you are "all right" only when everyone else "approves" of you.
18. Engage in social diversionary activities like athletics, dancing, participating in social, special interest, or religious groups, taking short trips, playing games, etc.
19. Be selective about the people with whom you choose to share your concern. Talk to trusted, mature, and experienced people who may have dealt with concerns similar to yours, or who can offer honest, responsible feedback. They can sometimes give tips and perspectives that can help you accomplish a task or deal with a situation, thus, reducing the stress and anxiety you feel.
20. When given advice, always remember that you are not obligated to follow it; after all, you are ultimately responsible for yourself, and what happens to you. Learn to rely on your own judgment and remember this takes practice and patience with yourself.

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How to Refer a Student for Further Help

1. When to Refer

   1. When a student presents a problem or a request for information that is beyond your level of competency.
   2. When you feel that personality differences (which cannot be resolved) between you and the student will interfere with his or her effective progress.
   3. If the problem is personal and you know the student on other than a professional basis (friend, neighbor, etc.,).
   4. If the student is reluctant to discuss his or her problem with you for some reason.
   5. If, after a period of time, you do not believe your work (communication) with the student has been effective

   Don’t wait until it is too late for anyone to help! Anyone able to identify situations that need specialized counseling or advising deserves commendation.

2. To Whom to Refer

   Knowledge of persons, offices and agencies that can be of service to you and the student is of primary importance. You’ll want to be sure to refer the student to the persons or office that will best serve the student. We all know how discouraged we get when we are passed along from office to office without a real effort on anyone’s part to determine where we can receive the help we need. If you are not sure where to refer the student, find out before you send the student off with assurance that he or she will find help.

3. How to Refer

   1. Build rapport with the student. Let the student express his or her feelings, and if necessary, calm down. This step may include a statement of your intention to help and observation and identification of his or her feelings (e.g., "You seem afraid. Your voice is trembling and you hands are shaking.").
   2. Determine the problems, how long they have existed, which problem is most pressing, and the student’s resources, (e.g., the student’s success in resolving similar problems, the availability of friends, family, etc.,). If the problem appears serious and longstanding and the student does not have or want to use his or her human resources, a referral is appropriate.
   3. Making the Referral
      1. Ask the student what he or she sees as a solution to the problem. He or she may come up with an acceptable solution or suggest the need for outside help. The latter makes the process of referral easier, while the following steps are suggested if the student has not considered a referral or seems reluctant to access outside help.
      2. Re-summarize the problem, noting its magnitude and duration.
      3. Raise the issue of seeking outside help.
      4. Assess the student’s reactions to this suggestion.
      5. Ask the student which outside source he or she sees as most appropriate for dealing with this problem.
      6. If the student is unaware of sources of help, suggest in a caring, concerned, and forthright manner the most appropriate service or person. Describe what the agency is like.
      7. Observe the student’s reactions to the referral, and answer questions he or she may have about the referral. Convey positive but not exaggerated expectations of help from the referral, and deal with their fears about contacting this helping source.
      8. Specify the procedures involved in contacting the agency, including the who, when and how of making the referral, or allow the student to use your phone to arrange the appointment. Making his or her own appointment reinforces the student’s sense of self-responsibility.
      9. If you have information about the student that you feel is important to share with the counselor, don’t share it in front of the student. Always secure the student’s permission before passing information about the student on to the counselor.
      10. Solicit agreement from the student to follow through on the referral.
      11. Encourage the student to act upon the referral.
      12. Check with the student to see if the referral was followed up, and is working out. Don’t pump the student for information. If you inquire as to whether or not the student kept the appointment, the student will volunteer whatever information is necessary to continue your relationship.
      13. The person making the referral cannot expect to be provided with the details of treatment, or share the confidences given by the student to the counselor. You can expect to receive consultation on how best to interact with the student in future relationships if this information is so desired or necessary. Always feel free to call the counselor for this consultation.
      14. Don’t expect the immediate resolution of particular symptoms or problems. It may be a process that moves slowly.
      15. Finally, respect the individual. The basic approach to all counseling and referral is one of fundamental respect for the individual, and the belief that it is best for that person to work out his or her problems in an individual way. You and the counselor are helpers in this process by providing a variety of alternatives for assistance on the student’s own terms. He or she may choose to ignore or accept the help available. Your role is to see that the student becomes aware of this help and has the maximum opportunity to utilize it.

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Referrals to Counseling and Psychiatric Services (CAPS)

Here is some information about CAPS that may help you when making referrals. CAPS, located at 6211 Bishop Boulevard, on the 2nd floor of the Memorial Health Center, offers individual, couple and group counseling as well as psychiatric services for SMU students with personal or educational concerns.

CAPS also coordinates the on-campus administration of tests such as the SAT, GRE, MAT, LSAT, CLEP and various placement exams. The Center is staffed by Ph.D. psychologists and psychiatrists. The Center is open weekdays from 8:30 until 5:00, and the phone number is 214-768-2277. Please do not hesitate to call CAPS to determine if a referral is appropriate. We are here to help!

The following information should be explained to students when you are referring them to CAPS:

1. Counseling services are free to all full-time SMU students.
2. Confidentiality is strictly observed to the limits provided by the law.
3. No record of a student’s use of the Center is made on a transcript or in a job placement file.
4. Information cannot be released without the student’s permission (the usual exception being in cases of imminent harm or danger to the student or others).
5. Except in cases of emergency, each student is asked to complete two short forms before an appointment is scheduled.

If you know a particular counselor to whom you would like to refer the student, please contact the receptionist first with your request (214-768-2277), since they will know about each counselor’s availability. If you consider the situation to be a serious one warranting immediate intervention, then tell the receptionist that this is a crisis situation. Such crises are responded to immediately.

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Campus Resources

SMU is fortunate in having a number of counseling and mental health professionals available to assist students, faculty and staff. You may contact any of the following offices to learn more about services that are available and to discuss the needs of any particular student.

COUNSELING AND PSYCHIATRIC SERVICES………………214-768-2277

CENTER FOR ALCOHOL & DRUG ABUSE PREVENTION…214-768-4021

SERVICES FOR STUDENTS WITH DISABILITIES.………… 214-768-4557

WOMEN’S CENTER……………………………………………..214-768-4792

UNIVERSITY CHAPLAIN………………………………………...214-768-4502

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