1. Emotional Wellness Kevin Joyce, LPC Priti Shah, Ph.D. Office of Counseling Services

2. Objectives Understand and identify what Emotional Wellness and Emotional/ Psychological is in students. Understand and identify what Emotional Wellness and Emotional/ Psychological is in students. Learn about some common psychological and emotional conditions among students. Learn about some common psychological and emotional conditions among students. Learn basic intervention skills in situations involving Emotional/ Psychological Distress or Crisis. Learn basic intervention skills in situations involving Emotional/ Psychological Distress or Crisis. Practice learned skills and information. Practice learned skills and information.

3. How do you know when you are emotionally well?

4. 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.).

5. 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

6. Emotional / Psychological Concerns Among College Students

7. Emotional/Psychological Concerns To Be Aware Of: Anxiety Anxiety Depression Depression Eating Disorders Eating Disorders Suicide and Self-Injurious Behavior Suicide and Self-Injurious Behavior Mental Health Crisis Situations (Immediate Self- Harm, Violent Behavior, Psychosis, etc.) Mental Health Crisis Situations (Immediate Self- Harm, Violent Behavior, Psychosis, etc.) Sexual Assault, Sexual Misconduct Sexual Assault, Sexual Misconduct Others? Others?

8. Anxiety, Panic Attack, Just Worried, or Stressed ? Anxiety Anxiety is more than “normal worry” or “stress.” Anxiety is more than “normal worry” or “stress.” Reoccuring worry over longer periods of time. Reoccuring worry over longer periods of time. Physical discomfort. Physical discomfort. Inability to function day (affecting sleep, relationships, behavior). Inability to function day (affecting sleep, relationships, behavior). May/may not include panic. May/may not include panic. May be specific to a situation or generalized May be specific to a situation or generalized –Social Anxiety –Test Anxiety –Generalized Anxiety Panic (i.e. Panic Attack) Sudden and intense episodes of fear and anxiety that occur often and without warning. Sudden and intense episodes of fear and anxiety that occur often and without warning. Difficulty breathing Difficulty breathing Heart racing Heart racing Sweating Sweating Chest pains Chest pains Flushed face Flushed face Tense feeling or tightness Tense feeling or tightness May last for 5-30 minutes May last for 5-30 minutes Cause may be unknown though could have certain triggers. Cause may be unknown though could have certain triggers. Feel like you are dying. Feel like you are dying. Fear of having more panic attack (panic disorder). Fear of having more panic attack (panic disorder).

9. Recognizing Anxiety in Students Constant worrying about many things: school work/studying, grades, social relationships Constant worrying about many things: school work/studying, grades, social relationships Avoidance of certain things: classes, speaking in public, avoiding people Avoidance of certain things: classes, speaking in public, avoiding people Person appears tense, unable to relax Person appears tense, unable to relax Problems sleeping Problems sleeping Headaches Headaches Reporting of numbness in body, heart palpitations Reporting of numbness in body, heart palpitations Racing thoughts Racing thoughts Stomach problems Stomach problems Eating problems- often can’t eat Eating problems- often can’t eat

10. Depression or Just “Sad” Getting sad is normal response to stressors or difficult life events. Getting sad is normal response to stressors or difficult life events. This sad feeling does not mean you are depressed. This sad feeling does not mean you are depressed. Depression Depression –sad most of the day –loss of pleasure in activities –physical and psychological changes –lasts for more than 2 weeks

11. Signs of Depression Core Signs of Depression: Core Signs of Depression: –Depressed Mood. –Negative Thinking –Diminished interest in friends or activities that student once enjoyed. –Change in eating. –Changes in sleeping.

12. 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 Changes: Psychological Changes: –Sadness –Apathy (lack of emotion, interest, or pleasure) –Feelings of worthlessness or excessive guilt –Hopelessness –Lack of concentration –Lack of motivation –Irritable or angry –Preoccupation with death or suicidal thinking.

13. 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.

14. Eating Disorders Eating disorder in which the individual maintains unhealthy attitudes and behaviors toward food, eating, and body image. Eating disorder in which the individual maintains unhealthy attitudes and behaviors toward food, eating, and body image. Often, there is an underlying belief that being thinner would be a solution to troubles and demonstrate proof of control in one's life. Often, there is an underlying belief that being thinner would be a solution to troubles and demonstrate proof of control in one's life. 40% of female college students have eating disorders 40% of female college students have eating disorders 91% of female college students have attempted to control their weight through dieting 91% of female college students have attempted to control their weight through dieting Estimate 1% to 7% of college males have eating disorders Estimate 1% to 7% of college males have eating disorders

15. Types of Eating Disrupted Behaviors Binge-Eating: uncontrollable, excessive eating, followed by feelings of shame and guilt; no purging Binge-Eating: uncontrollable, excessive eating, followed by feelings of shame and guilt; no purging Bulimia: binge & purge; A binge is the consumption of a large amount of food within a short period of time. Purging is forced vomiting. Bulimia: binge & purge; A binge is the consumption of a large amount of food within a short period of time. Purging is forced vomiting. Anorexia: less common; take extreme measures to avoid eating; often become abnormally thin Anorexia: less common; take extreme measures to avoid eating; often become abnormally thin Combination: Many students will diet frequently, restrict, followed by bingeing and purging Combination: Many students will diet frequently, restrict, followed by bingeing and purging

16. Signs of Disturbed Eating * 1 symptom DOES NOT means the person has a problem Avoid situations w/food involved Avoid situations w/food involved Rituals around food prep & eating Rituals around food prep & eating Recent weight loss or gain (fluctuations). Recent weight loss or gain (fluctuations). Emotional changes Emotional changes Trips to bathrooms after meals Trips to bathrooms after meals Hoarding of large quantities of food or hiding food Hoarding of large quantities of food or hiding food Excessive, rigid exercise Excessive, rigid exercise Eating in secret Eating in secret Constant dieting Constant dieting Smell of vomit Smell of vomit Social withdrawal Social withdrawal

17. Prevention in the Halls 6 Tips the RA can use: Respect privacy. Be aware of the eating disordered person’s condition and progress, but don’t make it seem as if you’re watching them like a hawk. Respect privacy. Be aware of the eating disordered person’s condition and progress, but don’t make it seem as if you’re watching them like a hawk. No one needs a food monitor. Don’t be “helpful” by pointing out which foods are healthier and which aren’t. No one needs a food monitor. Don’t be “helpful” by pointing out which foods are healthier and which aren’t. Talk about other things. We are much more then our illnesses, and discussing other things not only helps remind the resident that life is more than food and weight. Talk about other things. We are much more then our illnesses, and discussing other things not only helps remind the resident that life is more than food and weight.

18. Prevention Continued: Research the disease and arm yourself with knowledge - it shows the resident that you’re genuinely interested and helps you understand their struggles. Research the disease and arm yourself with knowledge - it shows the resident that you’re genuinely interested and helps you understand their struggles. Don’t be patronizing. While people with an eating disorder may not be making rational and healthy decisions due to malnutrition and the disease, they are not stupid or ignorant. Don’t be patronizing. While people with an eating disorder may not be making rational and healthy decisions due to malnutrition and the disease, they are not stupid or ignorant. Provide a good role model. Examine your own eating habits - Do you diet constantly? Do you make self-deprecating comments about your body, even in jest? Provide a good role model. Examine your own eating habits - Do you diet constantly? Do you make self-deprecating comments about your body, even in jest?

19. General Intervention with Psychological Distress 1. 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. 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. 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.

20. 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. 6. Follow up Be open to other conversations. It may be a process 7. 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.

21. Understanding Suicide and Self- Injurious Behavior Approximately 1100 college students complete suicide each year. (There are 18,248,128 college students in the U.S. in 2007; this is.006%) Approximately 1100 college students complete suicide each year. (There are 18,248,128 college students in the U.S. in 2007; this is.006%) Suicidal ideation: Thinking about suicide Suicidal ideation: Thinking about suicide Suicide Threat: Stating intent to kill yourself Suicide Threat: Stating intent to kill yourself Suicide Attempt: Actually trying to kill yourself; NOT the same as cutting Suicide Attempt: Actually trying to kill yourself; NOT the same as cutting Self-Injurious Behavior: “cutting or burning”; behavior related to self harm but absent of intent to kill yourself Self-Injurious Behavior: “cutting or burning”; behavior related to self harm but absent of intent to kill yourself

22. How to Assess for Suicide If you’re worried about the possibility of Suicide…(even if a student might be cutting). If you’re worried about the possibility of Suicide…(even if a student might be cutting). Signs: What do you look for? Signs: What do you look for? Intervention: What to ask? What do you do? Intervention: What to ask? What 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!

23. 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).

24. What do you Do? Your goal is NOT therapy; provide resources and support for the person Your goal is NOT therapy; provide resources and support for the person Be DIRECT- people who are thinking about it may not always say it. Asking about suicide DOES NOT “make” someone suicidal. Be DIRECT- people who are thinking about it may not always say it. Asking about suicide DOES NOT “make” someone suicidal. Being direct helps the person feel UNDERSTOOD- goal of the intervention Being direct helps the person feel UNDERSTOOD- goal of the intervention Ask “Are you thinking about killing yourself? Have you thought about suicide?” Ask “Are you thinking about killing yourself? Have you thought about suicide?”

25. If they say “Yes” to considering suicide… Try to follow up with other important questions to get a better assessment Try to follow up with other important questions to get a better assessment (1) How often and how soon are you thinking about it? (1) How often and how soon are you thinking about it? (2) Have you attempted suicide in past- when? (2) Have you attempted suicide in past- when? (3) Are you considering a plan/method at this time? If so, what is it? (3) Are you considering a plan/method at this time? If so, what is it?

26. Intervention (Cont.) Remain CALM and don’t panic. You might be caught off guard, but in most cases you have plenty of time to gather this type of information. Remain CALM and don’t panic. You might be caught off guard, but in most cases you have plenty of time to gather this type of information. Do not advise, interpret/explain, assure “it will be ok” Do not advise, interpret/explain, assure “it will be ok” LISTEN and REFLECT how they are feeling. how they are feeling. They will feel understood. LISTEN and REFLECT how they are feeling. how 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 SUPPORTS. Ask about SUPPORTS.

27. Intervention (cont.) State you are concerned and glad they are willing to share this w/you State you are concerned and glad they are willing to share this w/you DO NOT agree to secrecy or confidentiality about their suicidal thinking. DO NOT agree to secrecy or confidentiality about their suicidal thinking. Persuade: Validate their courage in speaking w/you and seeking help- Encourage to speak with professional. Persuade: Validate their courage in speaking w/you and seeking help- Encourage to speak with professional. Notify and consult with an RD who will contact the Counselor on Call. Notify and consult with an RD who will contact the Counselor on Call. If you believe there is an immediate risk of a suicidal attempt, DO NOT leave the person alone. Get help (RD, CNU PD immediately). If you believe there is an immediate risk of a suicidal attempt, DO NOT leave the person alone. Get help (RD, CNU PD immediately).

28. Crisis Response for RA’s Immediate physical or psychological harm to self or others. Immediate physical or psychological harm to self or others. –Immediate Suicide or Self Harm –Violent or threatening behavior –Psychosis –Others

29. 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.

30. Consulting with OCS: When You’re Not Sure… If you are ever unsure about how to approach a concern with one of your residents, you can and should consult your RDs, other RAs, and OCS. If you are ever unsure about how to approach a concern with one of your residents, you can and should consult your RDs, other RAs, and OCS. You can contact OCS and make a Consultation Appointment. You can contact OCS and make a Consultation Appointment. Unless we are concerned about anyone’s safety, your information as well as the residents will remain confidential. Unless we are concerned about anyone’s safety, your information as well as the residents will remain confidential.

31. Making Referrals to OCS 1) Share your concern w/student- cite your observations & avoid labeling behaviors. 2) 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 counseling that it’s just a conversation. Let them know they don’t need to commit to counseling that it’s just a conversation. Can make call w/them or can come to appointment with them to offer more support. Can make call w/them or can come to appointment with them to offer more support. 3) Follow up with the student

32. Questions?

33. Practice Examples & Clips