University Student Services for Counseling and Psychological Services maintains this Internet site as a service to the university community.

It is intended as a resource to inform and to educate. Included are direct links to other Internet sites, which we believe may be helpful.

However, this does not imply that Counseling and Psychological Services endorse all of the information provided at each of these sites. Furthermore, while we attempt to monitor and update our listings on a regular basis, the Counseling and Psychological Services can not make any claims or assume responsibility as to the reliability or functionality of the internet addresses (URL's) provided or the information contained at these sites.

Readers are encouraged to evaluate the material and to use what they find to be helpful. Information provided in our web page and at other Internet sites is not intended as a substitute for assistance from a qualified mental health professional.

Get Help
The link above is to Mental Health America for directions to providers and support groups.

Controlling Anger Before It Controls You
This site provides information regarding recognition of triggers and strategies for dealing with anger management.

Anxiety
A service of the U S National Library of Medicine and the National Institute of Health is devoted to health topics, drug info, news and other resources.

American Psychological Association's Help Center
This is an online resource for brochures, tips and articles on the psychological issues that affect your physical and emotional well-being, as well as information about referrals

SAMHSA
This site provides info about substance abuse and mental health services. Topic info ranges from children's mental health issues, bullying, school violence to a mental health dictionary.

Relaxation techniques capitalize on the connection between DIS-stress and physical responses. Consciously controlling your breath, muscle tension, and mental focus can significantly reduce both the physical and psychological symptoms of stress. See the following sites for more information, including training videos.

Stress Management and Reduction – University of Texas – Information and coping skills related to stress management. You may follow the guided program or explore the site on your own. Includes videos on deep breathing, progressive muscle relaxation, and yoga.

Online Relaxation Exercises

How Relaxation Exercises Can Help
Here you will find a variety of relaxation exercises in the form of QuickTime and MP3 audio files that you can play on your computer.

National Eating Disorders Association
This site contains info on eating disorders, programs available , how to get involved in helping, advocacy, research, and links to other related issues.

BodyPositive
BodyPositive explores taking up occupancy inside your own skin rather than living above the chin until you're thin. It's a set of ideas that may help you find greater well-being in the body you have.

HelpGuide.org
Helpguide helps you help yourself to mental and emotional health with easy-to-read, ad-free articles that offer information, hope, and effective self-help choices.

Mental Health
Mental health is how we think, feel and act as we cope with life. It also helps determine how we handle stress, relate to others and make choices.

Learn more here...

Signs and Symptoms of Abuse

General and specific signs and symptoms of drug addiction correlated to seven classes of drugs. (Adapted from the Mayo Clinic)

Although different drugs may have different effects on overall physical and mental health, the basic pattern is the same. Getting and using the drug becomes more and more important than anything else, including job, friends and family. The physical and emotional consequences of drug abuse and addiction also make it difficult to function, often impairing judgment to a dangerous level.

While not everyone who uses drugs becomes addicted, many people do. Drug addiction involves compulsively seeking to use a substance, regardless of the potentially negative social, psychological and physical consequences. Certain drugs are more likely to cause physical dependence than are others.

Breaking a drug addiction is difficult, but not impossible. Support from doctors, family, friends and others who have a drug addiction, as well as inpatient or outpatient drug addiction treatment, may help you beat your drug dependence.

Symptoms

General signs and symptoms
Drug abuse affects the brain and body directly. While high, the drug affects the entire body, from blood pressure to heart rate. Stimulants like cocaine and methamphetamine "amp up" the body, increasing blood pressure, metabolism and reducing the ability to sleep. Drugs like opiates and barbiturates slow down the body, reducing blood pressure, breathing and alertness sometimes to dangerous levels. Some physical signs of abuse and addiction include:

• Cycles of increased energy, restlessness, and inability to sleep (often seen in stimulants)
• Abnormally slow movements, speech or reaction time, confusion and disorientation (often seen in opiates, benzodiazepines and barbiturates)
• Sudden weight loss or weight gain
• Cycles of excessive sleep
• Unexpected changes in clothing, such as constantly wearing long sleeved shirts, to hide scarring at injection sites
• Suspected drug paraphernalia such as unexplained pipes, roach clips or syringes
• For snorted drugs, chronic troubles with sinusitis or nosebleeds
• For smoked drugs, a persistent cough or bronchitis, leading to coughing up excessive mucus or blood.
• Progressive severe dental problems (especially with methamphetamine)
• Feeling the need for the drug regularly and, in some cases, many times a day
• Making certain to maintain a supply of the drug
• Failing repeatedly in attempts to stop using the drug
• Doing things to obtain the drug that they normally wouldn't do, such as stealing
• Feeling that they need the drug to deal with your problems
• Driving or doing other activities that place themselves and others at risk of physical harm when you're under the influence of the drug

The particular signs and symptoms of drug use and dependence vary depending on the type of drug.

If you're worried about someone's drinking don't be afraid to bring it up. Although friends often want to protect the drinker from harm, not saying anything simply enables the behavior. Many recovering alcoholics attribute their initial awareness of their drinking problem to the intervention of a friend or family member. The following five-point formula will provide some guidelines on what to say as well as how to handle denial and what to do if nothing happens. If others who share your concern join you in this effort, there is a greater possibility for success.

The Five-Point Formula

"I Care"
Let the person know that you care about him/her and that because of the significance of the relationship you need to discuss something very important. Both starting and ending the discussion with an emphasis that you are doing this out of genuine concern, caring, and/or respect for the person sandwiches the difficult feedback between strong positives.

"I See"
Report/review actual events with your friend as you perceived them. Remember you are criticizing the behavior, rather than the person. Try to limit your statements to observable, irrefutable facts. The more you have, the stronger your presentation will be. If necessary, write them down in advance.

Examples: "Friday night you got drunk and drove to my house and did not remember it the next day."

"You got in an argument with the bartender when he said he couldn't serve you another drink. We were asked to leave and the owner told me not to bring you back in there."

"I Feel"
Tell the person your own reaction, using "I statements" to reveal your feelings. ("You have a problem" can be refuted and denied.)

Example: "It really scares me to see you get like that" or "I was embarrassed and angry when you made crude remarks my friend" or "I'm worried about what might happen to you the next time you get so drunk."

"I Want"
Tell the person what you would like to see happen.

Examples: "I would like to see you get some help for this." or

"I'd like to see you talk with someone from CAPS" or

"I would like you to agree to go to an AA meeting … and go a dozen times before you make up your mind it's not for you."

You might want to add something like:

"I may be totally off base with my perception but being right or wrong isn't important. I'm willing to be wrong but I'm not willing to leave this unsaid because I'm worried and concerned about you."

It's important to choose words that you are comfortable with and that fit your style.

"I Will"

Specify what you will or will not do.

"I value our friendship but in good conscience I cannot ignore it," or

"If you will work on this issue I will do everything I can to help, but if you don't go for help I may need to report your behavior."

Be very careful to set ultimatums only if you can stick to them.

Be prepared for a negative reaction

It's pretty common for a problem drinker to feel attacked when confronted by a friend. Defensiveness and denial can be difficult to deal with especially if you aren't expecting such a response.

Taking care of yourself

Thinking about your friend's/resident's drinking, planning what to say, and actually bringing the subject up will undoubtedly be very stressful. Although you can't make someone get better, you can take care of yourself by setting limits and getting support for your own emotions.

If your friend/resident does not respond positively to your intervention, be able to let go of some of the pain you are feeling. Accept that the person doesn't want to deal with this right now, but let him or her know what you are going to do from now on. Reassure your friend/resident that you still like him or her; it's what happens when he or she drinks that you don't like.

Setting Limits

Don't make excuses for the person, cover up for his/her problems, write papers or do homework.

Do offer to go out with your friend to places where drinking is not the main focus. Going to parties, bars and events with this friend enables him or her to keep doing what he or she has been doing all along and puts your credibility at risk.

Be willing to talk with your friend/resident, but be clear that you won't allow him or her to just show up after a bad night of drinking without a follow up discussion.

If needed, refuse to spend time with him/her when drunk or to stay at a party to take care of him/her.

Adapted from "How to talk to a problem drinker," University of Massachusetts, Amherst Health Services and "Helping Others," Virginia Alcohol Safety Action Program

There are many levels of Intoxication

If you have concerns about a student's welfare it is always acceptable to call the paramedics

You should never be responsible for monitoring a drunk/unconscious friend overnight

If your friend is to the point where they need to be monitored in order to be safe, they most likely need medical attention.

Know the signs of Alcohol Poisoning

Respiration: Should be at least 9 breaths per minute

Pulse: Should be between 50 and 140 beats per minute

Pupil Dilation: Should be evenly responsive to light.

Pain Response: Should respond to shoulder pinch.

Passed Out

Vomiting While Passed Out

Cold, Clammy or Bluish Skin

If you suspect Alcohol Poisoning contact emergency medical response

BAC can continue to rise after one stops drinking. Never leave a person alone to sleep it off.

Protect the person from injury.

Keep the person still and comfortable.

Speak in a clear, firm, soothing voice. Comfort and reassure the person.

If the person is unresponsive, get emergency medical care immediately.

If your friend is unconscious...

A person who has passed out, or is asleep, and cannot be awakened or can only be aroused for a few moments, needs urgent care. DO NOT assume he or she is "just sleeping it off". People who have made this assumption later discovered (too late) that the friend was in a fatal coma. When in doubt, check for these signs:

• breathing is very slow, and perhaps irregular
• pulse is weak, or is either very slow or very fast
• hands or feet are colder than normal

If your friend is conscious...

NEVER leave the drunk person alone. The full effects may not have kicked in yet.

Keep the drunk person from driving, biking, or going anywhere alone.

Turn the drunk person on his/her side or stomach to prevent aspiration of vomit (inhaling own vomit).

Don't give the person any drugs or medication (not even aspirin!) to try to sober him/her up. Coffee, tea, and other caffeinated beverages won't help. You'll only end up with a wide-awake, agitated drunk person.

You can't prevent the alcohol from being absorbed once it has been consumed

Giving the drunk person food will increase the risk of vomiting.

Skip the folk remedies. A cold shower could make the drunk person pass out or fall.

Exercise won't help and could cause an injury.

If your friend argues with you, don't take what is said personally.

Talk to your friend about his or her behavior later on, in a private place.

When considering a referral for a student, it is very important to remember that students may be hesitant to the idea of assistance. Unfortunately, there is still a stigma attached to mental health counseling or even academic skills assistance which prevents many students from taking advantage of the many different resources our campus offers.

Know where the counseling center is located and phone number.

Students receive counseling services at no personal expense.

If possible, offer to walk a student to the center – this shows that you care and allows you to know if the student followed through on visiting the center.

Learn more here...

Know Yourself. Remember that you cannot make someone get help or change his or her attitudes and behaviors. You can make a significant difference by sharing your concerns, providing support, and knowing where to get more information. Offer emotional support, understanding, patience and encouragement.

Take care of yourself. Be sure to take time for yourself. It is important to pay attention to your own health while helping a friend. Know your limits, don't overextend yourself.

Although you may be willing to do anything and everything to help, don't try to take over your friend's life. Offer support, but be patient.

Be prepared for all possible reactions. Your friend may deny that he or she has a problem. Sometimes people react with hopeless statements saying "there is nothing anyone can do" or with anger "leave me alone - who asked for your help". Realize that this is the depression talking, so don't become defensive or give up. If your friend won't listen to you, you may need to tell someone else. Mental health concerns do not clear up on their own. By telling someone, you are not betraying your friend, you are helping him or her. Counselors are available to talk with you about how to best help a friend.

How to Approach a Friend Who Needs Help

Helping another person involves listening, understanding, caring and planning together. The following are some guidelines that you might consider as you assume a helping role.

Helping a friend through a tough time can be really difficult. Whether your friend has a mental health difficulty or is simply going through stressful circumstances in college, chances are your friend will turn to you for support and help. Being as informed as possible about these issues is an important first step.

Signs and Symptoms of Distress

Be aware of real trouble signs. If any one of these lasts only a short time, that can be normal. But if you know a friend with several of these problems lasting more than a couple of weeks, he or she may be nearing a crisis. Your friend needs help! The warning signs can include:

• complaining of sadness or crying more often
• being irritable on most days or having unexpected angry outbursts
• losing interest or pleasure in most activities
• avoiding friends, activities, school, social events
• escaping by daydreaming or sleeping all the time
• experiencing sleep problems, such as difficulty falling or staying asleep
• feeling fatigued or exhausted
• eating much less or more than normal or having other changes in appetite
• bingeing, purging, excessive dieting or other problematic eating behaviors
• worrying or being unable to think of anything but the problem
• experiencing declining grades or other academic problems
• talking like there is no hope, even in the future
• feeling worthless or experiencing excessive guilt
• increasing use of alcohol and/or drugs
• exhibiting severe behavior change, such as a quiet person becoming wild or active
• showing greatly increased energy, decreased need for sleep, euphoria, or manic behavior
• thinking or talking about death or dying

There are other signals that should be taken particularly seriously because they are Suicide Danger Signals

• experiencing severe depression and hopelessness
• making verbal or written threats (including email) of harm to self or others
• preparing for death (giving away prized possessions, saying goodbye)
• exhibiting self-injurious or self-destructive behaviors
• having a past history of suicidal threats or attempts

Being a helping friend

It is important to remember that you cannot be responsible for other people's actions when they are stressed, depressed, or suicidal. Whether they are crying out for help or suffering silently in despair – only they can help themselves. What you can do is be the most caring and responsible friend possible during the hard times. This means listening to their concerns, supporting them, and helping them get professional help.

If you decide to help then do it with H.E.A.R.T.

• Hear – Stop what you're doing and really listen to what your friend is saying. Sometimes just letting people vent and talk about their feelings helps them to feel better.
• Empathize – Acknowledge what you have heard and let your friend know you understand. Express concern and interest. Repeat back the essence of what your friend has said. Reflect feelings and summarize your friend's concerns. Avoid criticizing or sounding judgmental. Remember, even if the problem does not seem real to you, it may be very important to your friend.
• Assess the situation – Ask your friend, "What have you thought about doing?" What are his or her options? Does your friend have the resources (skills, information, support, training, money, etc.) needed to handle the problem? Discuss the pros and cons of different courses of action. Don't expect to have all the answers to solve your friend's problem.
• Refer – Be aware of signs and symptoms that indicate your friend needs professional help.
• Be honest about your concerns. Do not agree to be secretive about his or her problem. Help your friend find appropriate help. Offer to go with him or her to talk with a professional.
• Tell – Do not ignore remarks about suicide. Suicide is the 2nd leading cause of death for college students. When people are suicidal they need immediate help. Seek professional assistance

How Can I Help a Depressed or Suicidal Person?

It is useful to listen in a manner that shows appreciation of the person's difficulties. This does not mean entering into the despair; an attitude of careful optimism is appropriate. Depressed individuals are very often wrapped up in their own concerns; advice should be simple and practical, and may have to be repeated. When there is a threat or real possibility of suicide, it is important to stay close to the individual until professional help is obtained.

Change can be slow. Putting out energy and getting no response can be frustrating. People in a helping role should try to make sure their own needs are being met. Too high a level of frustration can lead to anger and a sudden decision to withdraw. It is a good idea to seek assistance well before this point is reached.

Suicidal individuals often try to convince others that the "worst" thing would be to let anyone know of their plight. Friends put in this position should consider the possible consequences of failing to obtain professional help. It is a sign of caring to bring a person to treatment that may alleviate suffering and save a life.

What Is Depression?

Everyone feels down at times. The breakup of a relationship or a poor evaluation in class can lead to low spirits. Sometimes sadness comes on for no apparent reason. Is there any difference between these shifting moods and what is called depression? Anyone who has experienced an episode of depression would probably answer yes. The duration and depth of despondency, and the presence of characteristic symptoms, help distinguish depression from ordinary unhappiness. This is important because in severe cases depression can be life threatening. Suicide is a possible outcome. Depressed individuals may also fail to live up to their potential, doing poorly in school and staying on the social margin. Depression is frequently ignored or untreated; the condition often prevents people from taking steps to help themselves. This is unfortunate as effective help is available.

Signs of Depression

Anyone who feels down nearly every day for weeks or months may be clinically depressed. Depressed individuals may experience:

• Loss of pleasure in virtually all activities.
• Feelings of fatigue or lack of energy
• Frequent tearfulness
• Difficulty with concentration or memory
• A change in sleep pattern, with either too much sleep or too little. Some depressed people wake up often in the night and do not feel rested the next day.
• An increase or decrease in appetite, with a corresponding change in weight.
• Markedly diminished interest in sex.
• Feelings of worthlessness and self blame.
• Exaggerated feelings of guilt.
• In some cases, very unrealistic ideas and worries, for instance, the belief that one has a terminal illness or is being pursued for a past crime.
• Hopelessness about the future.
• Thoughts of suicide.

Some Misconceptions About Suicide

• "People who talk about it seldom do it."
  The truth is that few individuals are single-minded in their decision for death; many are asking for help even as they approach the final act. Suicide threats should always be taken seriously.
• "People who really want to kill themselves are beyond help."
  Fortunately, this is not the case. Suicidal impulses may be intense but short-lived. The majority of individuals who are suicidal even for extended periods recover. All can benefit from treatment.
• "Suicide is a purely personal decision."
  This argument is sometimes used to justify a "hands-off" attitude. It is a misconception because suicide always affects others. The dismissal is unfair to those who are struggling with suicidal impulses and need help in choosing to live.
• "Asking about suicide can put the idea in someone's mind."
  The idea of suicide does not originate this way. Suicidal individuals are engaged in a private struggle with thoughts of death. Talking about the possibility of suicide can alleviate the loneliness of the struggle, and can be a first step in obtaining help.

How to Help a Friend with Body Image Concerns

Eating patterns of people with eating problems can cause serious medical complications. Anorexia nervosa and bulimia are two serious eating disorders which frequently affect college students. Early recognition and referral for treatment will improve chances for full recovery.

Anorexia nervosa is a pattern of self-imposed starvation. It can be recognized by the following behavioral, emotional and physical symptoms:

Behavioral

• Unusual eating habits — preoccupation with food and dieting
• Excessive physical activity — with the goal of burning calories
• Withdrawal from friends and family because of focus on weight loss
• Overuse of laxatives to lose weight

Emotional

• Lack of self esteem, depression, thoughts about suicide
• Denial of an underweight condition and the desire to still lose more weight

Physical

• Extreme weight loss
• Absence of menstruation
• Cavities and gum disease
• Extreme sensitivity to cold
• Hair, nail and skin problems

What causes anorexia nervosa?
The causes may be psychological, biological or social. One thing that all experts agree on is that food itself is not the cause. Early detection and treatment are necessary to prevent permanent damage to the heart, reproductive organs, and other internal organs. Bulimia is an eating disorder characterized by binge eating and self-induced vomiting. Some of the same symptoms are present as with anorexia. Some people with anorexia later add symptoms of bulimia as an alternative way of controlling weight.

Having the Conversation

• Think through who the best person is to do the talking.
  Select which of you has the best rapport with this person. Be compassionate, open and informal in the discussion. Know your own limitations.
• Pick a time to talk when you (or the roommate) are feeling calm & not upset.
  It may be harder for the roommate/friend to open up if s/h fears that they may be causing you pain.
• Create a safe environment: pick a time that you know you won't be interrupted.
  A time limit can be a barrier to the person opening up.
• Consider writing down what you want to say ahead of time.
  It is inevitable that you will feel anxious or worried when you start to talk. If you decide what to say in advance, it will help you be clearer less anxious.
• Discuss your concerns with a professional who is knowledgeable about eating disorders, being careful to respect the person's confidentiality

When and how to refer

When considering a referral for a student, it is very important to remember that students may be hesitant to the idea of assistance. Unfortunately, there is still a stigma attached to mental health counseling or even academic skills assistance which prevents many students from taking advantage of the many different resources our campus offers.

Learn more here...

Recognizing Emotional Distress

Students may become distressed for many reasons. You may have the opportunity to encourage distressed students to seek help at one of the counseling services on campus. Even if a student does not directly ask for help, it is important to pay attention to indicators of possible distress.

Emotional Indicators
Sadness, dysphoria; anxiety, tension; little or no emotionality; unexpected emotional outburst (crying); extreme mood swings; unusual agitation; little or no motivation.

Social Indicators
Lack of close friendships (almost always alone); intrudes on others' conversations; little or no communication during class discussions; avoids people (isolation).

Behavioral Indicators
Appears tired and listless; sleeps during class; unhealthy appearance; lack of interaction in class; lack of concentration; misses classes or disturbs the class; hyperactivity.

Academic Indicators
Change in writing style (rambling, incoherent); drop in quality of papers, tests, projects; turning in assignments late or not at all; unusual content in writing (death, violence, suicide); drop in grades.

When To Make a Referral

Students in distress may contact instructors for assistance concerning problems they may have understanding assignments, comprehending readings, or remembering test material. It is easier for some students to come in talking about a safe issue rather than being forward and asking for help. A one-on-one meeting with the student can help you assess their need for a referral for counseling. Important nonverbal signs of distress include:

• Physical appearance (poor grooming, unkempt)
• Language (agitation, slow or hesitant speech, little or no emotions expressed)
• Body posture (eg. tense, rigid or slumped over)

A student may have experienced a recent traumatic or stressful event which may precipitate feelings of distress. For example:

• Death of friend or family member
• Disappointment in academic performance
• Break up of a relationship
• Illness or injury
• Family crisis (e.g., divorce, relocation, illness)
• Failure to achieve an important goal

If you think there may be a need for a referral, be straight-forward with the student about your observations. Express your concerns and let them know they may speak to a counselor in confidence about any problems they may have. If the need seems urgent, you or the student may call from your office to request an emergency appointment.

Learn more here...

Take Care of Yourself

For Friends

When a friend is in trouble or struggling with personal challenges it is normal and appropriate to worry and want to help. Being a friend in a time of need is one of the most important roles we can play in our lives. It is important to know and recognize our limits:

• Your Job is to Care
• You Will Not Know how to Handle it All, nor should you...
• Remember that You are Not a Counselor
• Know Your Resources
• Take Care of Yourself
• Do No Harm

Take Care of Yourself

• Get Rest and Sleep
• Exercise
• Reduce your Workload
• Learn to say "no" or "later"
• Recharge Your Battery
• Have Fun!

Helpful Communication

While you are not a counselor there are some basic skills that can help you to help your friend.

Active Listening

Active Listening is composed of two primary components, the non-verbal and the verbal. By mastering these basic skills you will be able to learn a lot more about your friend and the struggles they may be facing.

Non-Verbal Active Listening

You non-verbal listening skills indicate to your friend that you interested in them and what they have to say. They also help show that you are truly paying attention and engaged in the conversation. Some basic non-verbal skills include:

• Eye Contact
• Facial Expression
• Nodding
• Open and Attentive Posture
• Proximity/Height
• Facing the other person

Verbal Active Listening

Sometimes you have to talk (minimally) to show someone that you are listening. The easiest way to do this is with some basic verbal cues that indicate that you are still paying attention and understanding. These verbal cues also serve to encourage your friend to keep talking and sharing. Some verbal cues include:

• I see
• Go on
• Mmm
• Etc.

Open Ended Questions

Another important skill and approach to helping a friend can be to use open ended questions. Open-ended questions are important because they help to encourage dialogue and cannot be easily avoided with one word answers. Some characteristics of open-ended questions include:

• Cannot be answered simply by stating "yes" or "no"
• Encourage additional discussion and sharing
• Move the conversation forward

When to Refer

Remember that you not a mental health professional or counselor. Sometimes the best way to help your friend get help is to help them connect with someone that has expertise in the area where they are struggling. It is important that you not get in over head when trying to help a friend and that you know when and how to refer someone to campus or community resources.

Common Defenses to Referrals

There is still some stigma about receiving help for emotional and mental health concerns in our culture. Know that you may face some resistance and defensive behavior when you choose to refer a friend to help is something you should be prepared for. Below you will find several common defenses to a referral. Think about how you might respond to each of these:

• "I don't know what they could do to help."
• "I want to deal with the problem myself."
• "I don't want anyone to know."
• "I hate to call to make an appointment."
• "I feel funny about going in there and talking to a stranger."