Anxiety in College Students

• Why does anxiety hit so hard in college?
• What can a student do this week to feel steadier?

By Dr. Douglas Cowan, Psy.D., MFT

College is supposed to be the adventure. The wide-open stretch between who you were in high school and who you are becoming.

For a lot of students it turns into something else. A knot in the stomach before class. A mind that will not shut off at 2 a.m. A sense that everyone else has it figured out. If that is you, or your son or daughter, I want you to hear this first: you are not weak, and you are not alone.

What the numbers say

The Healthy Minds Study is one of the largest yearly surveys of college mental health in the country. Its 2023-24 report included about 104,000 students from nearly 200 campuses. About one in three screened positive for anxiety. Close to 40 percent of students with symptoms were getting no mental health care at all (1, 2).

There is encouraging news in that report. Anxiety and depression rates fell for two years in a row, after years of climbing. They are still well above where they stood in 2013 (1, 3). More students are asking for help, and that matters.

What is happening in the brain

The college-age brain is in the middle of a big building project. The front part of the brain, which handles planning, judgment, and calming big emotions, keeps maturing into the mid-twenties. The emotional centers, meanwhile, run hot. That mix makes this stage a more sensitive time for anxiety than it will be in five years, even before any stress is added.

Now add what college brings: a new place, a new schedule, no family nearby, money worries, grades that feel like your whole future, and less sleep than you need. The alarm system in the brain responds to all of it. It is doing its job in a very demanding setting.

Sleep deserves special attention. In a review of sleep-loss studies, a single night of lost sleep raised anxiety in healthy adults, and deep sleep helped calm it back down (4). A tired brain cannot settle its own alarm.

Screens deserve a fair look too. Large studies find that the link between social media and teen and young adult anxiety is real but modest on average, and it varies a lot from person to person (5). A better question than “how many minutes?” is “how do I feel after I scroll?” If the answer is worse, that is useful information.

How anxiety shows up in college

Anxiety rarely says “I am anxious.” It dresses up:

• Perfectionism is often the alarm trying to prevent mistakes.
• Procrastination is often avoidance of something that feels scary.
• Skipping class or the dining hall is often social anxiety.
• Stomachaches, headaches, and trouble sleeping are the body keeping score.

None of these are character flaws. They are an overworked nervous system doing its best.

What helps

Protect your sleep like you protect your grades. Aim for the same bed and wake times, even on weekends. Put the phone away before bed, and keep the room dark and quiet.

Move most days. A large 2023 review of 97 reviews found that exercise lowered anxiety and depression symptoms about as well as therapy or medication, with moderate to vigorous activity helping most (6). The campus gym is a mental health resource. Use it before you study, not as a reward afterward.

Practice one slow-breathing skill. In a randomized trial, five minutes a day of cyclic sighing (a deep breath in, a small second sip of air, then a long slow breath out) improved mood more than mindfulness meditation alone (7). Do it in the morning, before exams, and before hard conversations.

Get cognitive behavioral therapy (CBT). CBT has some of the strongest research support of any treatment for anxiety (8). Start with the campus counseling center. If the wait is long, ask about group sessions, peer support, and telehealth.

Take on small steps, not big leaps. Break a paper into a ten-minute start. Go to one class event. Fear shrinks when you walk toward it a little at a time.

Rebuild real connection. One real conversation a day. One in-person plan a week. Isolation feeds anxiety, and connection starves it.

Ask about other supports. For anxiety that is strong or lasting, some students also explore neurofeedback or cranial electrical stimulation (CES) with a qualified provider. CES devices such as the CalmBox are FDA-cleared for anxiety and insomnia. The research on these tools is still growing, so think of them as extras that sit on top of sleep, movement, and therapy.

Start today

1. Pick a bedtime and set an alarm to remind you to wind down.
2. Take a 20-minute walk before your next study block.
3. Try the slow-breathing practice for five minutes tomorrow morning.
4. Book one counseling or peer-support visit this week.
5. Take our GAD-7 check-in for a clear picture of where you are (9).

You are not behind. You are a capable person with a brain that is still growing, living through a lot at once. That is hard, and it can get better.

You can take the first step today.

This article is for education and is not a substitute for professional diagnosis or treatment. If you are in crisis, call or text 988 in the United States.

References

1. Healthy Minds Network. (2024). The Healthy Minds Study, 2023-2024 data report. University of Michigan School of Public Health. https://sph.umich.edu/news/2024posts/college-students-mental-health-improving-more-finding-support.html
2. Dutton, C. (2024, September 11). Fewer college students reported mental-health challenges for the first time in years. The Chronicle of Higher Education. https://www.chronicle.com/article/fewer-college-students-reported-mental-health-challenges-for-the-first-time-in-years
3. Lipson, S. K. (2023, September). College student mental health Q&A [Briefing slides]. Boston University School of Public Health and the Healthy Minds Network. https://www.bu.edu/federal/files/2023/09/MA-Congressional-Delegation-Staff-Meeting-9.15.23.pdf
4. Ben Simon, E., Rossi, A., Harvey, A. G., & Walker, M. P. (2020). Overanxious and underslept. Nature Human Behaviour, 4(1), 100-110. https://doi.org/10.1038/s41562-019-0754-8
5. Orben, A., & Przybylski, A. K. (2019). The association between adolescent well-being and digital technology use. Nature Human Behaviour, 3(2), 173-182. https://doi.org/10.1038/s41562-018-0506-1
6. Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., et al. (2023). Effectiveness of physical activity interventions for improving depression, anxiety and distress: An overview of systematic reviews. British Journal of Sports Medicine, 57(18), 1203-1209. https://doi.org/10.1136/bjsports-2022-106195
7. Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., et al. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895. https://doi.org/10.1016/j.xcrm.2022.100895
8. Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440. https://doi.org/10.1007/s10608-012-9476-1
9. Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. https://doi.org/10.1001/archinte.166.10.1092