Navigating College with Anxiety: Understanding and Utilizing Accommodations

College is a period of significant transition and growth, but for students with anxiety disorders, it can present unique challenges. Balancing academic demands, social interactions, and independent living can exacerbate anxiety symptoms, impacting academic performance and overall well-being. Fortunately, colleges and universities are increasingly recognizing the needs of students with anxiety and offer a range of accommodations to help them succeed. It is important to note that student mental health is in crisis.

Understanding Anxiety Disorders and Their Impact on College Students

"Mental illness" refers to the collection of all diagnosable mental disorders causing severe disturbances in thinking, feeling, relating, and functional behaviors. It can result in a substantially diminished capacity to cope with the demands of daily life. Anxiety disorders are mood disorders in which the individual responds to thoughts, situations, environments, or people with fear and anxiety. Anxiety symptoms can disrupt a person's ability to concentrate and focus on tasks at hand. Symptoms may be in response to real or imagined fears. Specific anxiety disorders include generalized anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, social and specific phobias, and post-traumatic stress disorder (PTSD).

More and more students are entering college with symptoms of anxiety. In fact, recent research shows that "during the 2020-2021 school year approximately 60% of college students met criteria for a mental health diagnosis." Some individuals find that the compounding effect of the adjustment and rigor in a new social environment can highlight a range of barriers to learning, including difficulty with focus and concentration, procrastination, and sometimes even the inability to access knowledge.

These functional limitations related to psychiatric disabilities may affect academic performance and may require accommodations:

Difficulty with medication side effects: side-effects of psychiatric medications that affect academic performance include drowsiness, fatigue, dry mouth and thirst, blurred vision, hand tremors, slowed response time, and difficulty initiating interpersonal contact.
Screening out environmental stimuli: an inability to block out sounds, sights, or odors that interfere with focusing on tasks. Limited ability to tolerate noise and crowds.
Sustaining concentration: restlessness, shortened attention span, distraction, and difficulty understanding or remembering verbal directions.
Maintaining stamina: difficulty sustaining enough energy to spend a whole day on campus attending classes; combating drowsiness due to medications.
Handling time pressures and multiple tasks: difficulty managing assignments, prioritizing tasks, and meeting deadlines. Inability to participate in multi-task work.
Interacting with others: difficulty getting along, fitting in, contributing to group work, and reading social cues. Fear of authority figures: difficulty approaching instructors or TAs.
Responding to negative feedback: difficulty understanding and correctly interpreting criticism or poor grades. May not be able to separate person from task (personalization or defensiveness due to low self-esteem).
Responding to change: difficulty coping with unexpected changes in coursework, such as changes in the assignments, due dates or instructors. Limited ability to tolerate interruptions.
Severe test anxiety: the individual is rendered emotionally and physically unable to take an exam.

The Legal Basis for College Accommodations

Under the Americans with Disabilities Act (ADA) of 1990 and 2008 amendments and Section 504 of the Rehabilitation Act, colleges are legally obligated to provide reasonable accommodations for students with documented disabilities, including anxiety disorders. These laws ensure that students with disabilities have equal access to educational opportunities. The goal of accommodations is to level the playing field, allowing students to demonstrate their knowledge and skills without being hindered by their disability.

It is important to recognize that accommodations are about access, not outcome. They provide students with equal access to the content and activities of a course, but do not guarantee success. Students are still responsible for meeting the academic requirements of the course.

Differences Between High School and College Accommodations

Students with anxiety in high school may utilize a 504 or IEP to receive support. The 504 or IEP is the "guiding document" which lists supports your student has been given by their high school team. In college, the 504 / IEP is not the guiding document. Instead, your student will receive an accommodation letter. The accommodation letter states that your student has registered with their campus Disability Support Office and has been found eligible to receive support, also known as accommodations. The accommodations your student will receive are listed on the accommodation letter.

It is important to note that accommodations for anxiety your student received in high school will not necessarily be the same accommodations they receive in college. You can submit documentation that shows accommodations your student received in high school, but colleges and universities have discretion to determine 'reasonable accommodations' once your student becomes a student on their campus.

Types of College Accommodations for Anxiety

Colleges offer a variety of accommodations to address the diverse needs of students with anxiety. These accommodations can be broadly categorized into academic adjustments, classroom accommodations, mental health resources, environmental adjustments, and technology-based solutions.

Academic Adjustments

Academic adjustments and accommodations are designed to reduce stress and give students the time and space they need to do their best. Examples include:

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Extended time on tests and assignments: This allows students to manage their anxiety during exams and complete assignments without the added pressure of time constraints.
Alternative testing formats: This may include exams in alternate format (e.g., from multiple choice to essay; oral, presentation, role-play, or portfolio).
Substitute assignments in specific circumstances.

Classroom Accommodations

Classroom accommodations can help create a learning environment that allows students to absorb information comfortably and participate in ways that feel manageable. Examples include:

Preferential seating: Sitting near a door to allow leaving class for breaks.
Assigned classmate as volunteer assistant.
Beverages permitted in class.
Prearranged or frequent breaks.
Tape recorder use.
Notetaker or photocopy of another student's notes.
Early availability of syllabus and textbooks.
Availability of course materials (lectures, handouts) on disk.
Private feedback on academic performance.
Recording lectures: Access to recorded lectures can help students review material at their own pace and reduce anxiety about missing important information.

Mental Health Resources

Colleges offer a range of mental health resources designed to help students cope with stress and maintain their well-being. Examples include:

Counseling services: Many colleges provide free or low-cost counseling services for students struggling with anxiety, depression, and other mental health challenges.
Peer support groups: Peer support groups provide a safe and supportive environment for students to connect with others who share similar experiences.
Peer mentorship programs: Some schools offer mentorship programs to connect students with other students or alumni who have been in their shoes.

Environmental Adjustments

The college environment can significantly impact a student's anxiety levels. Adjustments to the physical surroundings can make a big difference. Examples include:

Single dorm room: Students that need space to decompress when feeling anxious or that need a quiet environment due to sensory issues can request a single dorm room. This accommodation may be called a "single room for medical reasons."
Seating arrangements: Sitting near a door or toward the front of the class can make it feel less stressful and more manageable.
Low-stress spaces on campus: Some colleges offer designated quiet spaces where students can relax and de-stress.

Technology-Based Solutions

Technology can be a powerful tool for managing anxiety and staying on top of academic responsibilities. Examples include:

Assistive computer software: Use of assistive computer software (e.g., Optical Character Recognition, allowing scanned text to be read aloud by the computer's sound card; or speech recognition for converting the spoken word to printed word on the computer screen).
Note-taking apps and programs: Many note-taking apps and programs can record class lectures and allow students to listen to the recording after class at their own pace.

How to Request Accommodations for Anxiety

Advocating for yourself can feel intimidating, but itâs a crucial step in getting the help you need. Many colleges have a formal process for requesting accommodations, and knowing the steps you need to take ahead of time can make the process smoother.

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Contact the Disability Services Office: This office is your go-to resource for accommodations. Some schools will allow you to submit requests online, while others may require an in-person meeting. This process should begin as soon as you accept a college's offer of admission. First, contact your campus' Office of Disability Support. You will be asked to complete a Registration Form that asks you to share your basic contact information, disability diagnosis, how your disability affects you in academic and social settings and accommodations that have been helpful for you in the past.
Provide Documentation: Your school may require a letter from a qualified mental health professional explaining how your anxiety affects your academic performance. Not all licensed professionals are able to provide a formal anxiety diagnosis, so itâs important to check with your school about their specific requirements. The next step is to submit documentation and lastly you will have a conversation with a member of the Disability Office staff.
Articulate Your Needs: Be prepared to explain specific challenges you face and how certain accommodations will help you overcome them. Think about situations where anxiety has impacted your ability to complete assignments, participate in class, or take exams. Your student's conversation with a Disability Office staff member is their opportunity to articulate their needs and how their diagnosis impacts them inside and outside of the classroom.
Discuss Implementation with Professors: Once your accommodations for anxiety are approved, you may need to talk with your professors about how they will be implemented. You donât have to disclose personal details â just let them know what accommodations youâll be using.
Follow Up and Request Changes: Accommodations are meant to support you, so if something isnât working, donât hesitate to request changes. Follow up with the disability office or your professors if you need modifications.

Beyond Accommodations: Comprehensive Support for Anxiety

While accommodations are essential, they are just one piece of the puzzle. A comprehensive approach to managing anxiety in college also includes:

Professional Therapy: Online therapy platforms like Talkspace provide accessible treatment options designed for students dealing with anxiety, depression, and other mental health challenges. Cognitive Behavioral Therapy (CBT) is a great modality, to help reframe anxious negative thoughts in order to harness insight and self-awareness that can help empower students. CBT offers practical tools to move past anxiety and towards improved self-esteem, confidence, and optimism.
Lifestyle Adjustments: Regular exercise, a healthy diet, sufficient sleep, and mindfulness practices can all help reduce anxiety symptoms.
Building a Support System: Connecting with friends, family, and campus organizations can provide a sense of belonging and support.

The Importance of Self-Advocacy and Early Intervention

It is crucial for students with anxiety to advocate for their needs and seek help early on. Delaying treatment can lead to academic difficulties, social isolation, and a decline in overall well-being. By understanding their rights, utilizing available resources, and actively participating in their own care, students with anxiety can thrive in college and achieve their academic and personal goals.

A Word of Caution: Avoidance vs. Accommodation

It's important to distinguish between accommodations that support learning and those that enable avoidance. While it's natural to want to eliminate stressors, research suggests that eliminating whatever makes students nervous is making the problem worse. Academic accommodations for anxiety convey two harmful messages: First, they imply that the feared situation is truly dangerous. Second, they suggest that the student canât withstand the distress. By contrast, when students take on what theyâd rather avoid, they learn that worst-case scenarios rarely materialize, that discomfort is survivable, and that anxiety diminishes with practice. Accommodations built on avoidance donât help a student perform despite their anxiety; it exacerbates the anxiety itself.

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