College Student Stress Management

Client Background

Sebastian Yang, a 20-year-old junior at UC San Diego, reached out for therapy midway through fall quarter when his stress finally hit a breaking point. He was a biology major on the pre-med track, maintaining a 3.8 GPA while working 15 hours a week at the campus library to help cover living expenses. As a first-generation college student—his parents immigrated from Taiwan and ran a small restaurant in the San Gabriel Valley—the pressure to succeed was intense. Med school wasn't just his dream; it felt like the entire reason his family had sacrificed so much.

Things really started falling apart during his first semester of junior year. He was taking Organic Chemistry II (the notorious pre-med weedout course), Cell Biology, Biochemistry, and Physics—simultaneously. That's when the panic attacks started. The first one hit during a physics midterm—his heart was pounding so hard he thought something was medically wrong, his hands were shaking so much he could barely write, and he had to excuse himself to the bathroom where he just sat on the floor for ten minutes trying to breathe. He bombed that exam, got a D+, which sent him into a spiral of "I'm going to fail out and disappoint everyone."

His roommate eventually convinced him to look into therapy after finding him awake at 3 AM, surrounded by Red Bull cans and flashcards, having a complete breakdown over an upcoming O-Chem exam. Sebastian was resistant at first—therapy felt like admitting defeat, plus he'd heard the campus counseling center had month-long waitlists. His roommate mentioned that BetterHelp offered a student discount, and that you could do sessions from anywhere. The privacy part appealed to Sebastian; the last thing he wanted was to run into his Biochem TA in the counseling center waiting room.

Initial Assessment

When Sebastian filled out BetterHelp's intake questionnaire at 2 AM (because of course he did—after finishing a problem set), the results were pretty stark:

• GAD-7 Score: 18 out of 21 (severe anxiety—he was checking "nearly every day" for pretty much everything)
• PHQ-9 Score: 12 (moderate depression—he'd been feeling down and hopeless more often than not)
• PSS (Perceived Stress Scale): 29 out of 40 (high perceived stress, no surprise there)
• Academic Anxiety: Through the roof—he rated "fear of failure" as 10/10

During his first video session with his therapist (Dr. Park, who specialized in working with college students and academic anxiety), they dug into what was really going on:

• Constant worry about grades—not just wanting A's, but feeling like anything less than perfect meant he wasn't "good enough" for medical school
• Brutal perfectionism—he'd rewrite lab reports three times, spend hours making flashcards with color-coded systems, then beat himself up if he forgot something minor
• Physical symptoms piling up: tension headaches almost daily, sleeping maybe 4-5 hours a night (and not good sleep), barely eating because his stomach was always in knots
• Procrastination paradox—he'd avoid starting assignments because the anxiety was so high, then pull all-nighters in a panic
• Social life basically nonexistent—he'd bailed on his friends so many times they'd stopped inviting him out
• First-gen pressure—feeling like he was carrying his parents' dreams on his shoulders, plus guilt about them working so hard to support him
• Money stress making everything worse—every dollar spent on anything felt like it should've gone toward textbooks or MCAT prep

Treatment Approach

Dr. Park got it. She'd worked with tons of pre-med students and understood the specific hell of that environment. They put together a treatment plan that focused on both immediate crisis management (Sebastian was barely functional) and longer-term patterns that were driving his anxiety. The plan covered fall quarter through winter quarter—about 5 months of weekly sessions, with the flexibility to adjust during finals.

Weekly Video Sessions (With Built-In Flexibility)

Every Tuesday at 8 PM, Sebastian would log into BetterHelp from his favorite corner in the Price Center (a quiet spot where nobody bothered him). Sometimes he'd move sessions to Sunday afternoon if he had a big exam coming up. These weren't just "how was your week" conversations—they were working sessions. They'd pull up his anxiety thought logs, analyze his study schedule, and practice anxiety management techniques in real time. Dr. Park had him practice some breathing exercises while talking about his O-Chem exam anxiety, which felt weird at first but actually helped.

Between-Session Messaging (This Saved Him Multiple Times)

The messaging feature became Sebastian's lifeline during particularly rough weeks. At 11:30 PM before a Cell Bio exam: "Spiraling again. Convinced I'm going to fail even though I've studied for days. Can't stop thinking about how this will tank my GPA." Dr. Park would usually respond within a few hours (sometimes by morning) with a grounding question or a reminder of the cognitive distortions they'd identified. It wasn't immediate like texting a friend, but knowing he could reach out when the anxiety hit hard—rather than waiting a week to process it—made a huge difference.

Actual Strategies That Worked for His Situation

They developed a bunch of college-specific interventions that fit into Sebastian's chaotic schedule:

• Study schedule overhaul—switching from marathon 8-hour library sessions to Pomodoro technique (50 minutes on, 10 minutes off), which he hated at first but grudgingly admitted helped
• Test anxiety toolkit—breathing exercises he could do in the exam room, a pre-exam routine that didn't involve cramming until 3 AM, challenging his "one bad grade = failure" thoughts
• Course triage—accepting that Organic Chemistry was his priority class and Physics could be a B (this was HARD for him)
• Breaking down assignments—they literally calendared his 15-page Cell Bio term paper into chunks so he'd stop procrastinating until the last minute
• Professor office hours script—Dr. Park helped him practice asking for help without feeling like an imposter

Core Therapy Techniques

• Cognitive restructuring: Learning to catch his catastrophic thinking. "If I get a B in this class, I won't get into med school and I'll have wasted four years and disappointed my parents" → "Okay, is there actual evidence that one B ruins med school chances? What would I tell my roommate if he said this?"
• Mindfulness and grounding: Sebastian was skeptical about this "woo woo stuff," but Dr. Park framed it as attention training for his brain. He started using the Headspace app for 5 minutes before studying, which actually helped quiet the anxiety chatter.
• Behavioral experiments: Testing his beliefs in real life. First experiment: study for only 3 hours instead of 6 before a quiz and see what happens. He got the same grade. Mind blown.
• Self-compassion work: This was brutal for Sebastian. The voice in his head was vicious—way harsher than he'd ever speak to anyone else. They worked on talking to himself like he'd talk to a friend who was struggling.
• Time management reality check: Building a schedule that included—gasp—sleep, meals, and maybe seeing his friends once a week.
• Values work: Separating "I want to be a doctor" from "my worth as a person depends on perfect grades." This got deep.
• Boundary setting: Learning to say no to extra study group sessions when he needed rest, and having honest conversations with his parents about the pressure he felt.

Progress and Challenges

Weeks 1-4: Damage Control Mode

The first month was basically about keeping Sebastian from completely burning out. His anxiety was at crisis levels—he'd been averaging 4 hours of sleep, skipping meals, and having panic attacks weekly. Dr. Park focused on immediate coping skills: grounding techniques he could use during exams, basic sleep hygiene (no more studying in bed, cutting off caffeine after 2 PM), and creating a study schedule that wouldn't literally kill him.

The biggest challenge? Sebastian was terrified to change anything. In his mind, his brutal schedule was the only thing keeping him afloat—if he studied less, he'd fail. Dr. Park suggested an experiment: take Friday evening completely off from studying. No textbooks, no flashcards, nothing academic. Sebastian agreed reluctantly, spent the evening playing video games with his roommate, and then... aced his Biochem quiz on Monday anyway. That was the first crack in his "I must study constantly or fail" belief.

By week 4, he'd implemented a more structured study approach (Pomodoro technique, scheduled breaks), and his physical anxiety symptoms had eased up a bit. Still anxious, but not in constant crisis mode.

Weeks 5-12: Digging Into the Deeper Stuff

Once Sebastian wasn't in full panic mode, they could address the underlying beliefs driving his anxiety. Turns out he had a whole mental rulebook for academic success: "I must get an A in every class," "Any mistake means I'm not smart enough for medicine," "If I don't get into med school, I'll have failed my family," "Taking breaks is lazy." Dr. Park helped him examine where these rules came from (spoiler: a lot of it was internalized pressure from being first-gen and cultural expectations) and whether they were actually true or helpful.

The turning point came in week 8. Sebastian got a B+ on his Organic Chemistry midterm—not bad by normal standards, but devastating for him. He immediately spiraled: "This ruins everything. I'm not good enough. I should just give up on med school." But this time, instead of just drowning in the anxiety, he was able to catch himself doing it. He messaged Dr. Park, they worked through it in their next session, and he actually went to his professor's office hours to review the exam (something he would've been too ashamed to do before). Turned out he'd made some careless mistakes on reaction mechanisms but actually understood the material well. Not a catastrophe. Just... a B+.

Another breakthrough: week 10, he reconnected with his friends from freshman year. They grabbed dinner at Dirty Birds, and he realized how much he'd missed just being a normal college student instead of a stressed-out robot. He started scheduling weekly hangouts—usually Sunday dinners—and discovered that having social time actually made him less anxious, not more.

By week 12, his GAD-7 score had dropped to 11 (moderate anxiety instead of severe). He was sleeping 6-7 hours most nights, using the cognitive restructuring techniques when he started catastrophizing, and had a way more balanced approach to studying.

Weeks 13-20: Finals Gauntlet and Building Resilience

The last chunk of therapy coincided with winter quarter finals—basically the ultimate test of whether Sebastian's new skills would hold up under pressure. Dr. Park helped him create a comprehensive finals prep plan that was realistic: spreading studying across two weeks instead of cramming the night before, building in self-care (sleep! food! exercise!), and having a plan for managing anxiety when it inevitably spiked.

He used the messaging feature a ton during finals week. "Can't stop thinking about failing my Biochem final even though I've been studying consistently." "Had a panic moment during my Physics exam but used the breathing technique and got through it." "Actually asked my TA for help with a problem I didn't understand—still feels weird but it helped." Dr. Park's responses were brief but grounding—reminding him of his progress, validating that finals are stressful for everyone, encouraging him to use his toolkit.

The final exam period wasn't perfect. He had one rough night where the old patterns came back—stayed up until 4 AM cramming, had a meltdown, texted his roommate that he was going to fail everything. But the difference was, he bounced back faster. He messaged Dr. Park, got some perspective, actually slept before his next exam, and did fine.

By the end of winter quarter, Sebastian had finished strong—maintained his 3.8 GPA while feeling significantly less like he was dying. His GAD-7 score was down to 8 (mild anxiety), he was sleeping normally, eating regularly, and had even joined an intramural basketball team. He still got anxious before exams (probably always would), but it wasn't consuming his entire life anymore.

Outcomes and Results

In Sebastian's Words

"Okay so—I was super skeptical about online therapy. Like, how is talking to someone through a screen going to fix my crippling anxiety? But honestly? It was perfect for my situation. I could do sessions from wherever—the library, my dorm, that one quiet spot in Price Center. And being able to message my therapist when I was freaking out at midnight before an exam? Game changer. I'm not gonna lie, I still get stressed before big tests, but it's like... normal stress now instead of 'I'm having a full breakdown and can't function' stress. I actually got through finals without a single panic attack, which seemed impossible five months ago. The biggest thing I learned is that taking care of my mental health doesn't mean I'm weak or lazy—it actually makes me better at everything, including school. I'm still pre-med, still working hard, but I'm not destroying myself in the process anymore."

Follow-Up and Maintenance

After wrapping up weekly therapy, Sebastian switched to monthly check-ins, usually scheduled at the start of each quarter to help him plan for the semester ahead. At his 3-month follow-up (spring quarter), he reported:

• Still using cognitive restructuring when he caught himself catastrophizing—it had become pretty automatic
• Keeping up the balanced schedule: studying hard but also making time for basketball, hanging out with friends, and actually sleeping
• Going to office hours regularly without the shame spiral—he'd even become friends with a couple of TAs
• Joined a pre-med study group that was supportive instead of toxic competitive
• Way fewer physical symptoms—rare tension headaches, sleeping well, actually enjoying food again

He'd also become the therapy advocate in his friend group—when his roommate started struggling with similar anxiety, Sebastian was the one who recommended BetterHelp and helped him sign up. He mentioned that a lot of his pre-med classmates were dealing with the same stuff but suffered in silence because asking for help felt like weakness. The flexibility and privacy of online therapy made it way more accessible for the stressed-out college student lifestyle.

Key Takeaways from This Case

• Schedule flexibility is huge for students: Being able to move sessions around midterms, do them between classes, or even from a study spot made it actually sustainable—no way Sebastian would've kept up with weekly in-person appointments across campus.
• Privacy matters in competitive environments: The last thing pre-med students want is running into their Biochem TA in the counseling center waiting room. Online therapy provided confidential support without the stigma.
• Academic-specific skills make a difference: Generic stress management wouldn't have cut it—Sebastian needed strategies specifically for test anxiety, study planning, and dealing with academic perfectionism.
• Real-time messaging during crises: Being able to reach out during late-night anxiety spirals before exams—rather than waiting a week to talk about it—was crucial for skill-building and crisis management.
• Student discounts enable access: Sebastian was working 15 hours a week and budgeting carefully—without the student discount, consistent therapy would've been financially out of reach.

Platform-Specific Benefits

BetterHelp features that made treatment work for Sebastian's situation:

• Flexible scheduling that worked around his chaotic class schedule and could shift during exam periods
• Student discount program (20% off) that made weekly therapy affordable on a college budget
• Messaging feature for support during late-night study sessions and pre-exam panic moments
• Mobile app—Sebastian could do sessions from anywhere on campus with decent Wi-Fi
• Reliable video quality even on spotty university internet (mostly—there was one session that froze halfway through)
• Therapist matching connected him with Dr. Park who specialized in academic anxiety and first-gen student issues
• Digital worksheets and thought logs that integrated into his already-digital workflow (everything in Google Drive)