Best way to get timely help for anxiety focused around writing?
September 3, 2014 3:36 PM   Subscribe

I need to get documentation for issues that have been significantly impacting my studies. I would like that documentation to reflect an appropriate diagnosis and helpful help. What's the best way of accomplishing these two goals?

I'm a mature student with past issues with anxiety that have resurfaced. For one course, I turned a paper in a week late, which brought down the final grade down to a level that will assuredly put the kybosh on my long-term plans. (Did not disclose previously diagnosed anxiety to this professor, hoping I could rise to the occasion. That and, honestly, she seemed like a tough one and I just didn’t feel comfortable.)

Work for another course remains outstanding, after extensions. I obviously did disclose to this (amazingly supportive) professor, but have not communicated with her over the past month (idiot, fool, it's true), because I have been waiting until I produced some damn thing I could show her to demonstrate that I have not been abusing her patience. That is not happening, because I’ve gone right off the wagon / rails / road / whatever travel metaphor is appropriate and am in full-on ostrich mode. (When I am not in ostrich mode, I am in panic or anxiety mode.)

I saw my GP for help in the spring. She cracked open the DSM, found a diagnosis and offered the top-line recommended script inside of five minutes. I did not agree with this diagnosis, and quite frankly, I do not want to go through the trial and error of SSRIs again. (Or if I did think about it, I would want past symptoms and experiences to be taken into account when choosing the meds, not just whatever the algorithm spits out. I tried to broach this; she shrugged and said, “well you’ve got x, and drug y is for x”.)

In the end, for the purposes of the form, she was amenable to putting it all down to GAD (which came from a past provider and was in my files). She didn’t insist I take the prescription (but strongly recommended I should) and facilitated a treatment plan, which was 5 sessions with an NP that veered to general life issues and blarghy conversation, and away from the issues at hand.

These are: perfectionism; anxiety and panic that is pretty much solely focused on writing; and issues with organization and focus that, on the face of it, to me, look a bit like ADHD. I kick butt at taking tests or exams under timed conditions (including ones that involve writing). I struggle to the point of incapacitation with prioritizing and synthesizing research, and with organizing my writing. I would like to reiterate that I only experience panic symptoms when it comes to writing (which is why I felt my GP’s diagnosis of “panic disorder” was inappropriate).

Those five sessions with the NP are what was available from our system; further help would be limited to group CBT sessions oriented around general help for anxiety and depression. I do not feel those would necessarily help with my particular issues.

As far as the courses go -- I did get extensions for the one course, based upon documentation arising from the above, but I haven’t registered with the disabilities office. To do that, I would need to provide a diagnosis and evidence of a treatment plan. I would like a valid diagnosis and a treatment plan that will work. I get that I have to tick the boxes, but I also need real help. Finding appropriate help on the timelines required to support my studies is going to be a bear, I am pretty sure.

How should I be approaching this? Should I be looking for a new GP? Asking for a referral (she doesn’t much like doing this either)? Try my chances with a walk-in doctor? I have some money but not enough for a full neuropsychological assessment. As mentioned, I’m cagey about meds and would only go with this if I felt they were chosen with care, and there were at least ‘good’ communication with the provider. My batting average with providers is so far 2/8 -- the good ones (different time/place) were great; the others not so much. Honestly, I’m a little cagey about this too.

My self-esteem is good (I like who I am and can talk to people etc.); I don’t feel hopeless (except I’m terrified I’m ruining my life); I have friends (although I haven’t seen most of them in four months because I’ve put myself on lockdown to wrestle with these damn papers). I have particular issues that largely manifest in the context of my studies.

Advice from mental health care providers, students who have been through something like this, or academics or university staff is very much welcome. I would be grateful if people who do not have first-hand experience in these capacities, or whose comments would amount to “suck it up, stop fooling around and get a job”, perhaps refrain from sharing thoughts this time. I want to do what I can to salvage this degree, at least.
posted by cotton dress sock to Education (19 answers total) 11 users marked this as a favorite
I have some similar first-hand experience.

My first thought it to check with resources at your college/university. Is there a student health center? Or, even better, an office for support for students with disabilities? (Don't worry about labels -- that's exactly what that office is for: getting students the accommodations they need to be successful.)
posted by pantarei70 at 3:48 PM on September 3, 2014 [1 favorite]

Thank you -- there is a disability office :) but in order to access support, I need to bring them a firm diagnosis and evidence of a treatment plan. The health centre is a walk-in clinic; they've recommended I go through my GP.
posted by cotton dress sock at 3:49 PM on September 3, 2014

If you want your professors to be required to accommodate your disability you will need to get certified by your school's office of disability services. This will probably involve some tests to get an official diagnosis. Without an official letter of accommodation, you can ask your professors for extensions or whatever else you need, but they wouldn't be required to accommodate you.
posted by MsMolly at 3:49 PM on September 3, 2014 [1 favorite]

Your school can and will evaluate you.
posted by Ruthless Bunny at 3:53 PM on September 3, 2014 [1 favorite]

Sorry, will sit out after this: they will, but I'd need to borrow money to fund it; I'm not eligible for loans or assistance. But I suppose you're right, it might have to come to that.
posted by cotton dress sock at 4:07 PM on September 3, 2014

I'm sorry that you are suffering, but I'm not sure that the solution to your problems will be found through accommodations.

I'm an academic. I will only modify the requirements of my course if my student is registered with the office of disability. At my current school, and every school I've ever taught at, these are the kinds of relevant accommodations that can be provided:

--extra time for exams
--using a computer to take in-class exams
--having an assigned note taker
--providing audio recordings of lectures

Of course, for visually impaired, deaf, and other students there are a range of different accommodations that can be provided, but none of them would be relevant to your situation.

You don't say exactly what kind of accommodations you seek, but I've never heard of any that could address your specific complaint: focused anxiety over writing papers. Of course, every school is different, and perhaps some universities do offer the kind of accommodations you want, but I have not personally heard of it. If your primary aim is accommodations, then I would suggest spending the money on testing through the disabilities office. They are your allies in this, and I imagine that they may have some programs that could help defray the costs of testing.

My own personal take (in real life I just do whatever the office of disability tells me to do): think about what you are struggling with and what university services could help you. It may turn out, unfortunately, that there is nothing specific that your school or your professors can do to help with your anxiety over writing papers.

As you yourself have noted, and my many years teaching experience confirms, extra time does not help people with anxieties about writing papers. I swear to you, in the vast, vast majority of cases, it only makes things worse. When I have given Incompletes to anxious students in the past, whatever anxieties they have had are just increased: the extra time gives them more time to ruminate and it also tends to ramp up their own performance expectations. In most cases, the paper turned in a month after the deadline is a worse paper than one turned in on the deadline.

Perhaps you have another sort of accommodation in mind, but I can't think of what it could be. In any event, your next stop really does need to be with the office of disability--I don't see any way around that.
posted by girl flaneur at 4:36 PM on September 3, 2014 [5 favorites]

Quick follow up to my post above: If the office of disability cannot offer you any accommodations that address your issue, then I would encourage you to approach your professors at the beginning of them term and simply tell them that you have anxieties about writing papers, and ask if they can work with you to address this issue.

If a student came to me and said that, I would be happy to set up one-on-one meetings with the student to brainstorm possible topics, look over an outline, and maybe have the student talk through the first draft with me.

While I would not be inclined to offer extensions for the reasons given above, I would do what I could to help the student succeed. I don't think this kind of guidance is something that can be guaranteed through the disabilities office, but I suspect this is something most professors would be willing to provide so long as the request is made early in the term and the student follows through and shows up to the meetings.
posted by girl flaneur at 5:44 PM on September 3, 2014 [2 favorites]

In my experience as a TA, albeit not in the US- you won't receive any accommodations for anxiety specifically around test-taking because that, in and of itself, is not a disability, it's something everyone experiences. If you have a diagnosable learning disability that results in anxiety, take evidence of that to your uni's disability office otherwise yeah, anxiety around tests and assignments is 100% a normal part of being a student and I would find it highly weird if you didn't experience it.
posted by goo at 5:45 PM on September 3, 2014 [3 favorites]

You may have difficulty getting formal accommodations from your school's disability services, as other posters have mentioned, because your symptoms and difficulties may not fall under a straightforward diagnosis with relevant accommodations. And, as girl flaneur mentioned, many schools do not provide extended time for papers, regardless of diagnosis.

If I were you, I'd get assessed and seek exposure/behavioral therapy as soon as possible. Following the assessment, see what accommodations are available through disability services. If they can't help, explain your difficulties to your professors, and tell them that you have been assessed and are in therapy specifically for this issue. They may be willing to help, even if they are not required to by disability services. If neither of those things work, at least you'll be on the way to getting through this, and have a much better chance of salvaging your degree.
posted by MrBobinski at 6:01 PM on September 3, 2014 [2 favorites]

girl flaneur and goo, thank you for your considered responses. So sorry to jump in again, but just to clarify, what I am after in the first instance is medical or mental health assistance in accurately identifying and managing whatever it is that's stopping me up. So, getting this kind of help is really the main thing, I guess, here.

I experience some, but minimal stress with timed assessment; on the contrary, I'm highly focused under those constraints, and typically score in the top 1%. It's mostly a 'charged' feeling that accompanies exams.

What I think is that the anxiety with writing might come from from unaddressed issues with organization, which I do suspect could be related to ADHD. (This goes back to childhood and has run all through my education. I was assessed and identified as 'gifted' as a child [a label that's no gift to anyone, imo], but routinely failed to deliver on expectations. I muddled through. As an adult, I've compensated, somewhat, although always with difficulty whenever tasks lean on organization. It's maybe not so much that it's 'just writing'; I've mostly lived my life in such a way that I've managed to get by, in my view, through underachievement, basically.)

I feel that if the underlying problems were addressed, I'd be better placed to profit from the more ordinary help with organization and writing available at my university (some through the disabilities office). I think that addressing my issues, while (re)learning to write, might take some time. And you're right, I suppose time to do this is what I'd be after from my university. I'd like to graduate this year.

Sorry, again.
posted by cotton dress sock at 6:02 PM on September 3, 2014

I suggest going to your school's writing center and sitting down with someone to have them help you break down your remaining work into discrete chunks that you can get DONE so that whatever anxiety you have about writing for this coming semester isn't compounded by papers hanging over your head. They may also be able to help you with techniques for managing projects and papers so that you can minimize your anxiety and make things seem more manageable while you are seeking help through other venues. My university's writing center website is here - they have some resources online you might also find helpful. They're great - they'll often go through papers from receiving the assignment to writing a final draft with you, and are full of a variety of useful bits and pieces of information.
posted by ChuraChura at 6:10 PM on September 3, 2014 [3 favorites]

So sorry to jump in again, but just to clarify, what I am after in the first instance is medical or mental health assistance in accurately identifying and managing whatever it is that's stopping me up. So, getting this kind of help is really the main thing, I guess, here.

OK, but you saw your GP and rejected her diagnosis.

It seems that you are left with the following options:

-1 Overcome your objections and try the treatment plan suggested by your GP
-2 Get tested through disability services and see what they say
-3 Get an independent evaluation from a psychologist or psychiatrist

The office of disability service is going to be focused on testing and accommodations, not care (though they may be able to refer you to care).

I'm not sure how large your school is or what kind of insurance you have, but you could probably see a decent psychologist or psychiatrist by going through student health, so, if time is of the essence, maybe that would be your best bet. From what I understand, the doctors on staff regularly assess and treat students for these kinds of issues.

Alternatively, you could ask your GP for a referral. I imagine that this will take more time than going to student health, but you may be able to get a more established practitioner.
posted by girl flaneur at 6:40 PM on September 3, 2014 [1 favorite]

Well, even though you don't feel that the GP's diagnosis is correct, you do have a diagnosis and treatment plan that you could provide the disability centre with if you do want to go through them. Just because you give them a piece of paper from the GP that says "panic disorder + prescription + 5 NP sessions" or whatever, doesn't mean that you have to necessarily follow it. Just taking the prescription doesn't mean you have to fill it.

But that's if there are accommodations that would help. At this point it sounds like maybe the only thing the disability people could do for you would be to retroactively get the lateness penalty for your last assignment removed. I don't know if they can do that, but it's worth asking since it sounds like that grade is really going to screw things up.

In terms of getting the right help, if your university has a counselling centre, writing anxiety is something they will deal with all the time. I guarantee you. Sign up to see a counselor there and see what they suggest. If your university doesn't have one on-campus, maybe the disability office can give you recommendations for one nearby who deals with students often. I am sure that if you can find the right person, they could be very helpful, with or without medication as an second line of defense. They may also be able to help guide you through the process of getting evaluated for ADHD if that seems to be appropriate.

Finally, you may find that you can socially engineer yourself to write. Can you set up a writing group with other students who are struggling? When I needed to do that I had no problem at all finding a bunch of likeminded people. Seriously, mentioning anxiety about writing to anyone opened the floodgates to them talking about similar experiences. If you can then book a room at the library, or even just arrange to meet at a coffee shop with your laptops and work together in the same space for timed periods, that may help you pull the trigger on getting something done. And then I find it spirals (in a good way). If you've done a little work, you feel less stressed and more capable, and then it is possible to do more work, and then you feel even better, and so on.
posted by lollusc at 7:22 PM on September 3, 2014 [1 favorite]

You don't sound like you want a diagnosis and a treatment plan; you want a diagnosis you think is correct and a treatment plan you think will help. Which is totally fine, but it's separate from getting some quick documentation.

I think you should go see a psychiatrist, in whatever way your current health insurance will allow. They're the experts at mental-health diagnoses and medication, so that's where I'd start.
posted by jaguar at 7:48 PM on September 3, 2014 [1 favorite]

Read up on Dysgraphia and see if that sounds right. It can cause a tremendous amount of anxiety when you have to write something.
posted by Mr. Yuck at 9:08 PM on September 3, 2014 [1 favorite]

This isn't what you are looking for at the moment, but might be helpful in thinking about your big picture stuff.

I have a degree from a well-known university and a PhD from the same university. Almost all my college friends are academics now and teaching at top universities. I was heading the same way. During my PhD, I discovered that big, open-ended writing projects send me into a spiral of despair, anxiety, self-hatred and paralyzing perfectionism leading to insomnia, panic attacks and severe difficulties in my studies. I only got the thing done when I had four months before my university would no longer consider my degree.

After much soul searching, I realised that I could never be happy in academia because it would be choosing to do the thing that was most harmful to my mental health on a daily basis. This was sad and I spent a long time being sad about my life plans and feeling inadequate to my peers.

I used to work for a university disability office for students with mental health disorders and I have seen so many people struggle and be miserable about writing - it seems to focus and magnify anxiety. With more advanced degrees, particularly if you are aiming at research, this is only going to get worse.

Now I am a clinician working in a fast-paced hospital with my focus firmly on what I can do for that patient at that moment and a lot of my anxiety has magically melted away. I am generally successful and seem to be good at my job.

I would urge you to look at this as something that isn't going to go away. You might treat it and cope with it better, but it's likely always to be an issue for you. Think about how you want to spend your one life.
posted by kadia_a at 10:31 PM on September 3, 2014 [3 favorites]

kadia_a, thank you so much for sharing your experience. I fully, completely agree with you -- if I had any residual desire to pursue academic (or even applied) research, it's been burnt to ash. The long-term plan was to gain entry to a professional program in allied health, actually, and to spend my days doing something not unlike what you do. But that's in question unless I can get a grip on this for long enough to get through the hoops.

Thank you to everyone -- I really appreciate the time each of you has taken to read through my wall of text and offer such thoughtful advice.

Taking everyone's comments together, then, would it make sense to work with my GP to get documentation quickly, and simultaneously pursue more in-depth investigations with a psychiatrist?

(I do want to say that I did actually attend those five appointments with the NP; I just didn't take the prescription. If I were to put that on an application for support from the disability centre, I'd have already mostly fulfilled my treatment plan despite not being any nearer to addressing the issue. My barrier to independent evaluations is financial; I'm not eligible for those supports, but can't quite pay out of pocket. I blew what my insurance would allow for psych help on physiotherapy for a foot injury. But I will review all possibilities again, and will go private if I have to.)

Thank you all, again.
posted by cotton dress sock at 12:00 AM on September 4, 2014

I would definitely seek a referral to a psychiatrist and/or a therapist to deal with these issues more in depth. If your GP refuses to accommodate your (very reasonable) desire to see a specialist for these problems, then yes, I would get a new GP. But for now, since time is of the essence, your best bet is probably to work with your current provider to get through this immediate situation.

Also, although IANAD or any kind of mental health professional, I just want to chime in to say that your struggles sound so much like what I went through, and I have had tremendous relief from getting treatment for ADHD, including taking a prescription stimulant (which I got from a psychiatrist). What especially rings true to me is the fact that you do really well on exams but struggle with papers. I'm not exaggerating when I say that every paper I scraped through writing in college made me utterly miserable. I still get sick thinking about my many tortured all nighters, and the days leading up to the due date where I would desperately try to get started and never actually get anywhere. It was particularly frustrating since I've always done very well on written assignments (if/when I actually finish them). I tried everything I could possibly think of on my own and never got anywhere.

Looking back now, it seems so clear to me, though, that writing papers shouldn't make you paralyzed with fear. I don't mean "should" in the sense that you need to pull yourself up by your bootstraps and get on with your life. I just mean that you don't have to suffer like this.

I'm not saying you necessarily have ADHD, but I would highly encourage you to continue pursuing treatment until you find a treatment plan that works for you, no matter what diagnosis you are given. One of my big regrets is that I didn't get help for this until after I graduated from undergrad.

Getting a correct diagnosis can be kind of tricky sometimes, but when you do get in to see a therapist or psychiatrist, I would be sure to include what you said here. Specifically, that this intense anxiety is limited to when you have to write papers, that you excel under the pressure of time limited exams, and that you have other struggles with organization and other executive function type tasks. It would probably be most helpful if you can give specific examples of these problems. You might find it helpful to write an outline of all of this before your appointment.

The last thing I'll say is that I would recommend not writing off medications. I was very weary of trying meds at first, but taking a low dose stimulant has made such a huge difference for me. I still am doing a lot of work separate from the medication to deal with these issues, but I do think taking the medication has made it possible for me to actually succeed when I implement these new skills.

Hang in there and good luck!
posted by litera scripta manet at 10:39 AM on September 4, 2014 [1 favorite]

Oh man, do I know where you're coming from. I struggled through university because I kept failing classes that I had otherwise perfect grades in when I just couldn't turn a paper in on time. When I did create something, it was great, but the process was torturous. These aren't direct answers to your question (I thought lollusc's points were all good, though), but here are some things that helped me, and might help folks reading this later:

--Talking to professors ahead of time. I know it's hard. I know that this time it's going to be different, that you'll be able to just write this paper and won't have to make a fuss, that it's awkward because you're not even sure what you want them to do about it, but just tell them. Take two weeks from the first day of class to become a real person in their eyes, show that you're a good, attentive student, and then take a deep breath after class and just say something like, "Professor, I wanted to let you know that I have this weird anxiety about writing papers that has tripped me up in the past. I wanted to let you know in advance in case this problem comes up with your assignments, but I'm doing my best to work on it."

They might have something to suggest, like having you turn in outlines or first drafts ahead of the official deadline, or having you come in during office hours to get over the first hump of writing. If they don't suggest anything themselves, bring one of these options up yourself. It shows you're trying, and it might help. Maybe I've had an unusually good experience, but even really scary professors have responded sympathetically, even if they weren't able to make any accommodations. The worst that can happen is they'll say that they can't do much about it, or don't have time to help -- then you're exactly where you started, except now the anxiety of disappointing the professor is a little alleviated, because they're in the loop.

--Creating manageable chunks. Make a list of what's necessary to write a paper, and then only look at one thing on that list at a time. Do not even think about the rest of the list. It might look something like this: "1. Make a list of what to do. 2. Think about list of paper topics for 15 minutes. 3. Choose paper topic. 4. Go to the library. 5. Find 10 sources that might be helpful. 6. Read 5 of the sources and take notes. 7. Read the rest of the sources and take notes. 8. Reread notes and think about them for 30 minutes," and so on. "10. Title and format a word document." "15. Write a thesis sentence."

When you are writing the list, do not think about the implications -- pretend you are writing instructions for somebody else, even. When you are going to the library, do not think about what you're going to do there. Just think about how when you get to the library, you will get to cross off step 4 (wow, you're on step 4 already! way to go!), and then you will see what the next step is. The idea is not to break up the steps into even amounts of time, but into non-threatening pieces. Since starting is often the hardest part, the beginning might be broken down into lots of extremely tiny chunks, eventually getting up to something like, "30. Write for 45 minutes."

-- Holding Productivity Times with friends. Pick a friend that also has several hours of tasks to do (updating their website, working on their freelance projects, taking notes on a novel) -- you can have one friend with ongoing tasks for repeat Productivity Times, or multiple friends that you cycle through one on one times with. Productivity Time is when you meet up with a friend at some location that is conducive to your tasks (library, their house, coffee shop, etc.), chitchat for 20 minutes, then tell eachother what your goals are for that Productivity Time, and commence working. Periodically ask each other, "So how is it going?" (especially when you see the other person looking like maybe they got distracted on the internet), and be honest with your answers -- "Ugh, I haven't even been able to start. Okay, I'm opening the document right now, I'm starting now." Share progress, even small progress.

This achieves a temporal breaking down of your papers into small chunks -- all you have to do is show up and sit in front of your friend for three hours. You don't need to set yourself goals like "I will get through list numbers 5 through 10" -- your goal is just to be actively working on your paper for, say, 2.5 of those hours. And if you do that, no matter how "far" you get, you get to feel good about yourself. It's also harder to just not do that chunk of work that day, because you would be letting your friend down if you don't show up. Once you show up, you are supporting your friend in doing their work by working on your paper. It's not about turning that paper in later -- it's about being there and doing work so that your friend can do their work, too.

-- Catch upswings. If there are ever times that working on your paper doesn't seem like the absolute worst thing in the world, if sometimes it seems possibly manageable, drop whatever you're doing and start working. Cancel your plans, skip dinner, take a pad of paper out right there on the bus, and just start making your list, or your outline, or writing down a few sentences, or drawing idea diagrams -- whatever comes easiest. Take advantage of the moments when the barrier to writing is smallest.

I can't say that it ever gets better; but when you do struggle through the briars and get out to a completed paper on the other side, that pride in overcoming is bright enough to stay with you for a long while.
posted by Pwoink at 11:59 AM on September 4, 2014 [4 favorites]

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