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New class expectations, new living situations, and navigating newfound independence can give us all the feels—from super psyched to super stressed. Even if you’re loving your student life, dealing with all the stressors that come with college can be a lot to handle. According to experts, the best time to handle that stress is now. “If we don’t take care of our mental health, we may not be able to reach our goals, maintain good relationships, and function well in day-to-day situations,” says Dr. Chrissy Salley, a psychologist in New York who works with students of all ages. “Taking care of mental health is one of the best things someone can do.”

Now really is the time to start tuning into your mental health—the majority of mental health issues appear to begin between the ages of 14 and 24, according to a review of the World Health Organization World Mental Health surveys and other research (Current Opinion in Psychiatry, 2007). But help is available. Along with methods like mindfulness and meditation, talking to a therapist (such as a counselor, psychologist, or psychiatrist) can be a super-effective way to manage any mental health issue you may be facing or just a way to get extra support during times of stress, challenge, celebration, or change.

There’s a ton of research on how effective therapy really is—a 2015 meta-analysis of 15 studies of college students with depression found that outcomes were nearly 90 percent better for those who received therapeutic treatment than for those in control groups, most of whom received no treatment (Depression and Anxiety).

One of the most common and effective therapies is cognitive behavioral therapy (CBT), a short-term, goal-oriented therapy where a pro helps you find practical ways to deal with specific problems.

And it works. There’s strong evidence that this therapeutic technique can help you handle just about anything you might have going on, according to a 2012 analysis of over 200 studies on CBT published in Cognitive Therapy and Research. The researchers found that CBT was effective for people struggling with anxiety, bulimia, anger issues, stress, and a number of other mental health issues.

OK, so we know that therapy is an essential and effective tool for keeping your mental health at its peak, but making that first appointment can feel intimidating. It doesn’t have to be. Our experts break down the therapy basics so you can embrace whatever you need to feel your best. Here’s what the pros want you to know.

Surveys show it’s not out of the ordinary to see a therapist—55 percent of college students have used campus counseling services, according to a 2012 report from the National Alliance on Mental Illness. If you feel uncomfortable with the idea of going to see a therapist, you’re not alone—and that’s totally OK, says Zachary Alti, a licensed social worker, psychotherapist, and professor at the Fordham University Graduate School of Social Service in New York. “Few people look forward to therapy, but students should be aware that therapy exists to help them, not to judge them,” he says. The process might not always be comfortable, but that doesn’t mean it’s not worth it. “I’d encourage students to keep an open mind and try it,” says Dr. Salley.

“Many [young people] tell me they’re reluctant to participate in therapy because they don’t want to talk about their feelings,” Dr. Salley says. Again, that’s totally normal. But going to therapy isn’t just about talking about how you feel; it’s also about walking away with real tools you can use in your life. “Therapy should also be action oriented—a time to learn new skills for coping and figuring out ways to solve problems,” Dr. Salley says.

“Therapy is like physical exercise,” says Alti. Just like hitting the gym is good for everyone’s physical health—not just those with diabetes or heart disease—seeing a therapist can benefit everyone’s mental health.

But really, any time is a good time to go. While anxiety and depression are still the most common reasons students seek counseling, according to a 2016 annual report from the Center for Collegiate Mental Health, you don’t have to be in the midst of a crisis or feel like you’re nearing a breakdown to see a pro—seeing a therapist can be helpful even when things are all good. “There are a lot of pink flags before you get to red ones,” says Dr. Dana Crawford, an individual and family therapist in New York. “Keeping things from becoming extreme is always better.” In other words, don’t wait for an emergency to take care of your mental health. “When bad things do happen, mental health will protect against the impact of these unfortunate events,” adds Alti.

Student perspective

“Being able to just have someone to really listen has promoted a lot of self-discovery. I trust my therapist with everything and I feel like he genuinely cares about what I have to say. He asks me questions that make me think about why I feel and do the things that I do. Once I know where something comes from, I can change it. It’s easier said than done, but it’s not something I think I could do on my own.”
—Second-year undergraduate student, University of Alabama

Real talk: College is full of huge life changes. “Even positive changes can be stressful,” says Dr. Salley. Luckily, therapists are particularly skilled at helping their clients deal with these transitions. “Having someone to talk to can be helpful, especially as you encounter new situations and people,” she says. While you’re dealing with a new set of responsibilities and expectations (everything from picking the right major to sorting through awkward roommate issues), a therapist can help you pinpoint how all the changes are impacting you and sort through the onslaught of emotions that everyone feels during this time.

Therapists aren’t one-size-fits-all—sometimes you have to try a few before you find the right fit. Don’t get turned off if your first therapy appointment isn’t super helpful—if something feels uncomfortable, listen to your gut, but don’t give up, says Dr. Crawford. “You would never go to the store, try on a pair of jeans, and say, ‘Oh, those don’t fit, I guess I won’t wear jeans.’ You would keep trying jeans until you found the right fit,” says Dr. Crawford. Same goes for therapists.

Finding that fit with a therapist is just as important for the outcome as the actual therapeutic technique, according to findings presented in Psychotherapy Relationships That Work (Oxford University Press, 2004). The research analysis found that three key things had a measurable positive impact on the outcome of individual therapy: 1) the strength of your collaborative relationship with your therapist—aka are you on the same page and making goals for your treatment together?; 2) your therapist’s ability to empathize or see where you’re coming from; and 3) the degree to which you and your therapist outline goals and reevaluate them together.

In other words, to get the most out of a therapy session, take the time to find someone you feel like you’re on the same page with, who gets you, and who’s willing to listen to your goals for therapy and help you develop them.

“Therapy can be useful by helping people acquire a better understanding of themselves and develop healthy habits,” says Dr. Salley. For example, if you have trouble getting up in time to make that optional early-morning lecture, but then you beat yourself up about missing it, a therapist can help you identify what you really value and then help you make decisions based on that. “It can be helpful to talk to someone who’s objective and not a friend to bounce your experiences and feelings off of,” says Dr. Crawford. “A therapist’s only investment is for you to be your best self.”

Once you’ve identified what’s really important to you, a therapist can help give you the tools to make your value-driven goals a reality. “Problems that are unaddressed remain problems,” says Dr. Crawford. “When you’re ready for something different in your life, it can change. Therapy can help you create the future you want.”

You may be worried that all that talking might get out or that your therapist might tell your advisor or RA about what you’re struggling with. “A therapist isn’t allowed to do this unless the student poses a threat to themselves or others,” says Alti. “A therapist’s effectiveness is dependent on maintaining trust.” Bottom line: Unless they believe you’re in imminent danger (e.g., at risk of being seriously harmed or harming yourself or others), they can’t share what you say.

In short, everyone can benefit from talking to a therapist. “In the same way that everyone can benefit from going to the dentist, sometimes therapy is just a routine cleaning,” says Dr. Crawford. “Sometimes it’s just a time to reflect on where you are and where you want to go.” Whether you’re wrestling with anxiety and depression or mildly stressed about finding a summer internship, seeing a therapist can help—even if it’s just for a few sessions. (According to the CCMH report, the average student who uses campus psychology services attends between four and five sessions.)

Student perspective

“Therapy was a good way to talk through anything weighing on my mind. My therapist was very understanding, kind, and, of course, confidential. I’d recommend going to counseling services to everyone.”
—Third-year undergraduate student, Elizabethtown College, Pennsylvania

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Here’s something most of us know, and the research backs up: Small actions make a big difference, especially when it comes to preventing sexual harassment and assault. If we see something that doesn’t feel right, we can act. This is bystander intervention: stepping in to reinforce our community values and prevent harm when we see something that looks like disrespect or pressure. Many of us already do this, like when we disrupt a conversation that seems uncomfortable or speak up when people make hurtful comments.

Often, when we think about sexual misconduct and bystander intervention, we’re thinking about intervening in social situations, such as on the dance floor, at a party, or in a relationship. But what happens when you see this happening at your internship, on the job, or at your workplace?

While we might know that it’s equally important to take action in the workplace, we might not exactly know how to do it, especially if we’re dealing with uneven power dynamics—like a boss who’s making crude comments to an employee or an established colleague taking advantage of a new intern. The good news? The basics, which you already know, work here too.

“The skills and strategies that work in social contexts can often be applied to other settings, including professional contexts such as a summer internship or other job,” says Laura Santacrose, assistant director of the Skorton Center for Health Initiatives at Cornell University in New York, who developed Cornell’s “Intervene” project, a bystander intervention initiative for students. The knowledge and confidence that we’ve gained from intervening in other contexts make a difference. Knowing we have the skills to step in makes us more likely to do so, according to a 2014 study of college students in the Journal of Interpersonal Violence.

Besides reinforcing your own personal values, you’re also setting the bar high for the rest of the organization. And that’s important. “Employers hope to create an environment that is welcoming and inclusive for all employees. A safe and inclusive environment fosters teamwork among colleagues, greater workplace satisfaction, and higher levels of innovation and creativity on the job. Employees who are able to facilitate such an environment are highly valued by both their employers and by their clients,” says Jeanine Dames, director of the Office of Career Strategy at Yale University in Connecticut.

So how do you do it?

Before you start, consider risk

Whenever we intervene, it’s critical to consider the potential risks involved and to make a safe plan. The power dynamics between supervisors and employees may make it difficult to intervene directly, so consider subtle or indirect actions. “There may be additional supports in a professional setting that will make an intervention easier [than in a social situation], including support from a human resources department,” says Santacrose.

Start here: Stepping in on the job

• Overhear a sexist comment about the new hire’s cleavage? See a colleague’s uncomfortable face when he interacts with his overly handsy boss? Pay attention to the patterns.
• Ask yourself: How might this situation impact the individuals involved? The department or team? The broader community of the organization or company?

• Trust your instincts. It’s OK to decide to do something even if you aren’t sure there’s a problem.
• Remember that “doing something” might be shooting a quick email to human resources (HR) or chatting briefly with your coworkers to see if they’re noticing it too. Ask your fellow employees or supervisors what they’re seeing or how they might deal with the situation. HR representatives may be particularly helpful. It’s their job to make sure that the workplace is safe and respectful, so they want to know when something seems off.

• There are usually multiple ways to intervene. Play to your strengths. Not sure what those are? Take our bystander quiz here to learn more about your stepping-in style. Remember that interventions don’t have to be dramatic to be effective.
• Pay attention to power dynamics. If you are worried about the consequences of intervening, consider confidentially reporting the problem to HR.

• After you’ve intervened, follow up with the person being targeted or your colleagues.
• Think about what the organization could do to make positive outcomes more likely in the future. What structural changes would help? Can you review company policies and suggest updates? Are there employee training options that can help set community standards? Make suggestions and be willing to help put them into place if it’s an option.

How would you respond?

Now that you know the basics, or at least can refer back to them, let’s get into some examples. Use the following scenarios to think about possible intervention strategies. What strategies would you choose?

Imagine that you share an office space with several other summer interns. One of the interns, Taylor, often makes sexual jokes and suggestive comments. You and the other interns find the jokes annoying, but one of the interns, Sam, looks upset and starts to avoid the space.

Imagine that you have a part-time campus job in a lab. The professor in charge of the lab chooses a graduate student, Riley, to lead a project. A few weeks ago, Riley asked one of your coworkers, Casey, out on a date. Casey said no. Since then, Riley seems to be treating Casey differently from the other lab members. Riley often dismisses Casey’s comments in meetings and assigns all the menial jobs to Casey.

Imagine that you have a part-time job. Your supervisor makes small talk with employees as you arrive in the morning. Topics range from sports to the weather, but on several occasions, your supervisor has made comments about the appearance of one employee, Kai, such as, “You look gorgeous today!” and “That shirt looks great on you!” Your supervisor does not comment on other employees’ appearances.

See? Your bystander skills just went pro. When you break it down like this, intervening becomes a little easier, which means your workplace can be just as supportive of a community as your campus is. So remember: Your bystander skills can work in any context, at any time.

Want more bystander info? Check out Cornell University’s bystander initiative, “Intervene.” This interactive training, useful for students of all kinds, offers concrete strategies for intervening in a wide range of social, academic, and professional settings.

Strategies developed by the Communication and Consent Educator program at Yale University.

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Most of us have witnessed online harassment. For that matter, most of us report that we’ve experienced it, according to surveys. Young adults are the most likely to be abused online. That experience can make it harder for students to attend class or concentrate on learning, according to a survey by Hollaback!, a coalition to prevent harassment. Online harassment can raise the risk of suicide in adults who are already experiencing emotional or situational stress, according to a 2011 study in Educational Leadership.

How can you respond if you or a friend is harassed online? How can you make sure your own online presence is positive? The prevalence of trolling, roasting, stalking, and other forms of harassment gives us all opportunities to intervene. Online behavior is contagious, studies show. We are all well positioned to model respectful behavior on social networks, influence a comment thread that’s veering toward abuse, and help build more positive online spaces in which everyone can participate freely. Leaders in the tech industry have our backs on this as they work to make online spaces more accommodating for all. For six steps to keeping the cyber-peace, see below. For resources and tools, see Get help or find out more. For guidance on how to argue constructively online and off, see Tame the tension: Science-backed ways to talk it out in this issue.

1. Set a respectful and considerate tone and standard

The majority of our online presence is communal. Every contribution we make adds to the overall tone of the online space. Kindness is contagious. By engaging respectfully with others, you reinforce the expectation that others do the same.

2. Practice engaging constructively on difficult or contentious topics

Disagreeing with a friend’s opinion or disputing someone’s argument is all well and good—depending on how we go about it. For a guide to constructive arguing and how to influence someone’s opinion, see Tame the tension: Science-backed ways to talk it out in this issue of SH101.

3. Apologize when it’s merited, even if your slight was unintentional

If you hear that you have hurt someone, apologize. Communicating digitally can sometimes obscure the very real three-dimensional people who are reading and hearing our words. It’s important to remember that, even in the midst of heated or highly charged conversations. If the platform allows you to delete, retract, or qualify a contentious comment, do so.

4. Ask for clarification if you need it

If you don’t know why what you said was hurtful, you can ask for clarification. To the best of your ability, do so with respect and compassion. You could say something like, “I’m sorry that I upset you with my comment. Could you tell me why that word is hurtful? I want to be sure I don’t make the same mistake again.”

5. Stay chill when you feel misunderstood

Resist calling people out personally with inflammatory and divisive terms. If you think a comment has racist or sexist implications, try assuming those were unintentional and pointing them out gently. By the same token, if you see yourself as a fair person and someone says that your comment was discriminatory, try to resist getting defensive. We are all coming from our own complex places. If you’ve asked for clarification and didn’t get it, reiterate that your intention was positive, and let it go.

6. Use the reporting tools

Platforms and sites rely on their users to report abusive or disrespectful behavior that violates community standards. You can help create a safer environment by reporting harassment and abuse when you see or experience it.

7. Use your moderator powers for good

If you’re the administrator or moderator of an online group, forum, or list, take initiative to set the tone for positive, respectful interactions. You can do so by:

• Establishing community standards or guidelines (pinning a post about rules to the top of a page helps reduce trolling, according to a 2016 experiment by r/science, a Reddit community)
• Creating a clear reporting structure for harassment or abuse
• Reaching out for help and support if you run into trouble
• Being open to feedback from your community and others

8. Support people and platforms doing good work

In recent years, the tech industry has been taking a more active approach to preventing and addressing cyberbullying and harassment. There are several great initiatives you can learn from and support, including:

Facebook’s Bullying Prevention Hub
This online resource, developed in partnership with the Yale Center for Emotional Intelligence, offers information on and strategies for addressing cyberbullying. It includes detailed and practical conversation starters and step-by-step plans for students, parents, and educators looking to address a bullying incident, whether they are speaking with the person being bullied or the person inflicting the bullying. This resource also offers concrete strategies for proactively preventing online harassment and cyberbullying.

Hack Harassment
This coalition, led by Intel, Vox Media, and Lady Gaga’s Born This Way Foundation, aims to build a more inclusive and supportive online community. You can get involved and commit to building that more inclusive and supportive online community through the Hack Harassment website. There, you can sign up to be a Campus Ambassador, host a #HackHarassment hackathon, or apply for a grant to fund your own harassment-hacking project.

People who are harassed online tend to turn to trusted friends, teachers, and family members for help, according to a 2012 study in the Journal of School Violence. Receiving support, both online and off, can have a tremendously positive impact on how someone copes with and responds to online harassment. Here’s how to go about it:

1. Think about what you can potentially accomplish

“Your goal might be to approach a friend involved in a bullying incident, but you don’t know how to approach them or what to say. Or you might choose to report something that you see online that seems unsafe for one of the people involved,” says Dr. Robin Stern, associate director of the Yale Center for Emotional Intelligence at Yale University, Connecticut.

2. Reach out and offer support

You can reach out directly to the person experiencing harassment. Express your alarm at what’s happened and ask what you can do to help. Bear in mind that responding with emojis or “likes” can sometimes be misleading.

3.Add positive comments to a negative thread

If you see insults or attacks online—for example, against a writer discussing sexual violence—consider contributing some positive words. Offering encouragement and support is a simple way to mitigate the effect of online harassment. Manners (good and bad) are contagious. Modeling civility and constructive commentary online can potentially dissuade others from trolling, according to a 2017 study by researchers at Cornell University. That said…

4. Ask before you act on someone else’s behalf

If you want to confront the aggressor or request an apology on behalf of the person who’s been wronged, this is not a decision to make alone. Work with the targeted person and respect their wishes about how to proceed. They might prefer to not confront the aggressor, or to report the issue to the relevant site directly. Except for situations of acute danger, do not take action on their behalf if you have not been asked to do so.

5. Check in with your own feelings

“It is important to reflect on your own feelings before talking with someone affected by a bullying incident because you want to make sure that you are in a place where you can have that conversation,” says Dr. Stern. “If you yourself are emotionally activated, which is understandable and may well be the case, then you won’t be able to have that conversation from a place of calm. If you lower your own emotional activation, you are going to be able to more effectively help the person in the interaction regulate their own emotions.”

6. Seek support, off-line and on

“It is important to talk it through with someone you trust and who you believe is wise about this sort of thing. You might turn to a trusted peer or RA or dean who can help you think about how to approach the incident, depending on your goal,” says Dr. Stern. Tell someone you trust and who is in a position to help. Alternatively, you might report the incident to the site or platform, group administrator, or moderator. If someone is being harmed, about to be harmed, or threatening harm, take that seriously and get help immediately.

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What do you know about opioid abuse and addiction? Take our quiz to see how your knowledge compares to other students’, and find answers to questions like these:

• Is it risky to take prescription pain meds?
• Who’s at risk for addiction?
• How rare is opioid abuse among college students?
• Does opioid overdose reversal always work?

The US is experiencing a brutal opioid epidemic. In 2015, 33,000 Americans died from overdoses involving prescription painkillers, heroin, and synthetic opioids, according to the National Institutes of Health. Many opioid overdoses can be reversed with timely medical treatment, however—someday, you may be in a position to save a life. This brief guide shows you how.

The illicit use of heroin and prescription painkillers is rare among college students. Yet this epidemic is affecting demographics that were previously considered relatively immune to drug crises. “My freshman year of college, my older sister went to rehab for heroin addiction. People from all ethnicities and social classes are struggling with opioid addiction,” says a third-year undergraduate at Saint Louis University, Missouri.

In this article, “opioid” covers heroin, prescription painkillers, and synthetic opioids sold on the street. For info on getting help with abuse and addiction, see Get help or find out more.

What to do if someone may have overdosed: Call 911 immediately

• Act quickly: Most deaths occur one to three hours after the overdose, so you have a window for intervention.
• Get medical help: When people survive an overdose, it is because professional help was available. You do not need to be sure the person has overdosed on opioids (or any other substance) before calling 911. Calling 911 usually ensures quicker medical help than taking the victim to the hospital yourself.
• Tell the 911 dispatcher: Let them know if the person’s breathing has slowed or stopped and if they are unresponsive. Give the dispatcher the exact location.
• Be aware of Good Samaritan laws: In most states, people who seek help with a suspected overdose are immune from drug-related criminal charges under Good Samaritan laws (also known as 911 Immunity Laws). Your college may have similar policies (sometimes called medical amnesty). For information about your state, see Get help or find out more.

What does an opioid overdose look like?

» The signs of opioid overdose include:

• Small pupils
• Droopy arms and legs, and the inability to stand or walk
• Itching
• Slurred speech
• Shallow and uneven breathing
• Being unresponsive
• Loss of consciousness

» As the window for intervening narrows, signs include:

• Pale face
• Blue lips
• Gurgling chest sounds

Could I be at risk for opioid abuse?

Opioid addiction is difficult to treat. Avoiding illicit drug use is the safest strategy. Here’s how to look out for yourself:

• If you are using a prescription opioid medication that was not prescribed to you, seek help.
• If you are using an opioid medication prescribed to you, be self-aware about your reasons: Opioid medications are prescribed for long-term pain associated with various medical issues or for short-term pain control after surgery or an injury. If you are using opioids for other reasons—e.g., to get high or buzzed—seek help.
• If you are using opioids for pain relief, and your pain is becoming more difficult to control, discuss that with your physician immediately.
• If you have a family history of drug abuse/addiction and need medication for short-term pain, consider asking your physician for a pain medication other than opioids. Having a family history of drug abuse/addiction puts you at a higher risk for abuse/addiction.
• If you are abusing opioids or may be addicted, you will need support with your recovery. See Get help or find out more (below).

Where can I get help with opioid abuse or addiction?

• Ask your physician or other health care provider for a referral to an addiction specialist.
• If you have health insurance, check the insurance company website for addiction specialists covered by your plan.
• Ask at your student health center, counseling center, place of worship, or community center about addiction assistance.
• Call your local hospital for help finding medical professionals with addiction expertise.
• Look at community directories or online for a specialist in your area: Make sure the person is licensed or certified in mental or behavioral health, or is a licensed counselor in social work or professional counseling.
• Try Narcotics Anonymous for local, free, anonymous support groups.
• Many detox centers offer free initial consultations.
• For more key info and resources, see Get help or find out more (below).

What are the options for accessing reversal treatment?

Many opioid overdoses can be reversed with treatment. The opioid reversal medications naloxone and naltrexone can be delivered via a nasal spray, by injection, or intravenously. These reversal drugs (or antidotes) are also known by various brand names (e.g., Narcan®).

Naloxone treatment can be accessed in several ways:

• At hospital emergency rooms
• Via police departments and paramedics (ambulance responders), after calling 911
• Via some fire departments
• In most states, via some trained laypeople (not medical professionals) who may have a history of opioid abuse or family members who are abusing opioids
• Some states allow pharmacies to dispense naloxone to people meeting certain criteria without a physician’s direct involvement (this is often reported as over-the-counter availability, although that term is technically incorrect)

What exactly does “unresponsive” mean?

Here’s what being unresponsive looks like, according to the Harm Reduction Coalition:

• Not answering to their name
• Not responding to information they may not want to hear (e.g., “I’m going to call 911”)
• Not responding to physical stimulation (e.g., rubbing your knuckles into their sternum, the place in the middle of their chest where the ribs meet, or pinching their earlobes)
• If the person wakes up but their breathing seems shallow or their chest feels tight, call 911 anyway