illustrations by Anna Skalicki

Learning how to take a breath

*To encourage readers considering visiting SCS to remain open to making an appointment with any of the qualified counselors on staff, he has asked to be referred to as “M.”

After my class ended early, I finally made the call I’d been considering for two years.

“Thank you for calling the Student Counseling Service at Miami University,” answered a cheerful woman. “How can I help you today?”

I’d researched the Student Counseling Service (SCS) online. I knew that the first appointment was the initial consultation, where I would describe my problems to a counselor who would determine the best course of action.

I also knew from friends that SCS is notorious for being understaffed, inept and having a waitlist that’s weeks to months long. 

The receptionist told me to pick my “best day” so she could check available times. I almost laughed — between work, classes, dance rehearsals, my editor-in-chief role for a campus writing group and chapter meetings for my English honor society, I didn’t have a “best” day. 

I quickly penciled my 9 a.m. appointment for next Friday in my color-coded planner while the woman noted I’d be coming in to discuss my issues with anxiety. 

***

One October morning my senior year of high school, I woke up to a text that one of my friends, Sydney, had died by suicide.

With my friend’s funeral and memories of her still fresh in my mind, I visited my grandma in the hospital as her health worsened. Less than three weeks after Sydney’s death, my boyfriend at the time found out one of his friends died by suicide at 15 years old.

I watched my friends and family cry. I signed my friend’s casket. I tried to comfort my boyfriend while he talked about how unfair it all was. Bad things kept happening, and I became consumed by the fact there was absolutely nothing I could do to stop, control or predict them. 

I woke up one day and realized the voice in my head that had assured me that things would be all right had been silenced forever.

***

I was looking out the window of a Steak ‘n Shake in Troy, Ohio, when suddenly I could feel the Earth spinning beneath me. My face grew warm. My heart started racing. 

Take a deep breath. Everything is OK. Breathe.

I was losing control over my own head, and the realization made my heart beat faster. My thoughts spiraled, and I felt trapped.

I was sitting across from the guy I was dating at the time, happy and in love, and a few weeks away from the start of my second year at Miami after finishing the first with a 4.0 GPA. I was munching on shoestring fries and sipping a milkshake. 

Why can’t I just be OK? What’s wrong with me? 

“I’m feeling panicky,” I told my boyfriend. “I need to step outside.”

He knew what I meant — it had happened before.

I walked out into the parking lot and pressed three on my speed dial through tears.

“Mom?” I said. “Do you remember last summer when I started feeling anxious and panicky and how I told you sometimes I thought I could feel the world spinning?”

I felt the concrete slant upward beneath me and started crying even harder.

“I need help. Can we please get me help?”

***

I sign in at the front desk, where a lady hands me a laptop and directs me to the waiting room to fill out paperwork. One form asks me to rate how relatable I find certain thoughts or behaviors based on my experiences over the past two weeks on a scale from 0 (Not Like Me) to 4 (Extremely Like Me). “I find that I cry frequently” gets a 4, “I worry about having anxiety or panic attacks in public” gets a 3 and “I feel like no one understands me” gets a 2.

“Amanda?”

A man in a blue plaid shirt and jeans approaches me with a friendly smile. He looks young, maybe late 20s or early 30s. 

The counselor shakes my hand and leads the way to his office — a small, rectangular room with gray walls and fake grass in the windowsill. I take a seat next to a coffee table that’s offering the small comforts of a bowl of mints and a box of tissues. 

The man tells me he’s a clinical mental health counselor who has worked with college students for over four years, and this is his first semester working at Miami. 

M asks the magic question: Why am I here today?

I talk about how when I feel like I’m not in control, I start to panic and cry. I’m filled with a sudden, unnamable dread that possesses my whole body, like once when I was at the movies with my friends and was suddenly gripped by the feeling that I wasn’t getting out of the theatre alive.

“How frequently do you experience these attacks?” 

 About every other week. 

“How long do they usually last?” 

Anywhere from 10 minutes to an hour. 

“Is there a common trigger?” 

Any time I feel like I’m not in control: an insurmountable list of assignments, motion sickness, financial problems, every three months when there’s something new that’s wrong with my car that I don’t have the money to fix, any unexpected crisis. Sometimes it’s nothing at all, and then panicking over nothing reminds me how I can’t control my own thoughts, and I panic more.

Talking to my boyfriend, Carter, who is the level-headed opposite of me, usually helps me in those moments. He can say everything will be OK and believe it’s true. But sometimes, that’s frustrating to me. He doesn’t understand.

I describe how I lean on Carter when I have a bad day, and I’m afraid I’m becoming a burden. Carter can’t relate to my anxious moments. I think he gets frustrated with me; he tells me things are going to be alright, then I say I don’t believe him.

M nods and jots down some notes. He lists four options for me. First, I can seek individual counseling. Second, I can attend group therapy sessions. Third, I can meet with a psychiatrist at Student Health Service if I’m interested in medication. 

“But let me be the first to assure you that you don’t need medication to treat anxiety,” he adds. “It’s an option that helps, but it’s certainly not necessary.” 

I almost tell M how after I called my mom from the Steak ‘n Shake parking lot, we went to my regular doctor together to discuss options. My doctor said she didn’t want to write me a prescription because college students are likely to abuse anxiety medication. 

She encouraged me to seek out a therapist, but then I started another busy school year, and then I spent the next summer abroad in Spain. Life sped on, and my anxiety went along with it.

“One program I think you could really benefit from is biofeedback,” M says.

He describes a workshop where I’d be attached to sensors. I’d think about something stressful, and I’d get to see my heart rate increase, my blood pressure rise, how my body physically responds to the anxiety. Then, I’m introduced to techniques to calm me down, and I’d get to see how they affect my physiological responses. I can also combine this with individual counseling or any of the other options.

“The counselor who runs the biofeedback has actually given me permission to refer students directly to him,” M says, “so we can set up a one-on-one appointment, and then you can decide from there if it’s really for you.” 

“That would be amazing.”

Why can’t I just be okay? What’s wrong with me?

***

Dr. Fred Shueh is a licensed psychologist who has been studying biofeedback techniques since 2007. 

Biofeedback has been integrated into everyday life for many people. When your Fitbit monitors your heart rate, you get biofeedback. The trick is to use mind-body techniques alongside this feedback to learn to control heart rate, palm sweat and other bodily functions affected by anxiety to recover to a calm level.

“If you had to rate yourself on a scale from one to 10, 10 being the sky is falling and one being you’re on vacation, how would you rate your stress level over the past two weeks?” Fred asks.

My brain hastily constructs an arbitrary algorithm based on hours of homework, mental breakdowns and canceled plans.

“Six. Or seven.”

Fred wants to see how I breathe naturally. Sitting across from me, he mimics what he wants me to do: feet flat on the floor shoulder-width apart, right hand pressed just below my collar bone, left below my belly button, back resting against the chair. 

He immediately points out that my shoulders move when I breathe, a breathing style that may increase my stress and anxiety.

Great. I can’t even breathe correctly?

Fred explains that since I breathe like I’m responding to a stressful situation, this likely affects my brain chemistry and bodily responses: the secretion of adrenaline and cortisol, increased heart rate, the feeling of being in danger. 

We try again. This time, I should let out a deep sigh like I do when I’m stressed and focus on pulling my stomach in, like I’m flattening it against my back. 

After a few deep, focused breaths, I do begin to feel more relaxed.

Fred tells me that on average, it takes about 28 days for a new habit to form. Practicing this breathing exercise for even five minutes a day can make a difference.

He gives me three sensors to clip to my fingertips to measure my heart rate and palm sweat. He opens a computer program with 15 biofeedback exercises and clicks over to the first activity. The screen shows a CGI nature shot of a mountainscape at dawn. The narrator tells me to focus on making my breathing deeper, slower and more regular.

“I can tell you’re doing well. Do you know how?” Fred asks after a few minutes.

I shake my head. He gestures to the screen, where the sun is now peeking out above the mountaintops.

“The sun is rising as your body relaxes.” 

Fred asks me to rate my stress level on a scale of one to 10 again. I give myself a four.

***

A week later, M takes me back to his office promptly at 3 p.m. Everything looks exactly the same, from the position of the bowl of mints to his blue button-up.

After a few minutes of small talk, we dissect how Carter reacts when I come to him with my problems.

“From what you talked about last time, it sounds like Carter just gets really frustrated and doesn’t understand where you’re coming from. Would you say that’s an accurate description?”

I stiffen at the harsh analysis of the boy who brings me Wendy’s chicken nuggets when I’m sad.

“Well, he starts from a place of understanding. But after a while, when I’m not calming down, I think he starts to get frustrated with me.”

“How does he handle this frustration?”

“He just kind of wants to drop it,” I say. “After he tries to reassure me for a few minutes, he starts just saying, ‘I don’t know what you want me to say,’ like I’m expecting some kind of right or magical answer when I know he can’t just fix everything.”

“Right,” M nods. “And boyfriends kind of look at themselves as problem-solvers, as fixers, so if they don’t know how to fix the problem, they might just feel lost.”

I nod in agreement.

“I’m going to focus on ways you can cope with anxiety on your own, so that you don’t always have to go to Carter, or you can make it a last resort.”

We devise a three-part plan for when I have anxiety attacks:

Plan A: Breathe from my belly while listening to music. 

Plan B: Go to the place where I’m most comfortable (my bedroom) and find an outlet (freewriting).

Plan C: Talk to Carter.

Something about having concrete steps to follow gives me more control. Maybe if I can manage my anxiety more often on my own, I can stitch some part of myself back together into one piece. I might also stop feeling like a burden to the people I love.

“I like to imagine anxiety and stress as like a tower,” M says, “and the tower is made up of chunks of experiences and things that make us stressed.”

At certain moments, the tower becomes so tall that it reaches what he calls “the anxiety threshold,” where I start to panic. With anxiety, the tower consistently hovers below that threshold until something triggers a shattering point.

Neither breathing nor my three-step plan will make the pieces of my tower completely disappear. The goal is to find a way to at least bring the natural baseline for my tower further away from the anxiety threshold.

“Does that make sense?”

Yes. Things are starting to make sense.

I’m still not certain that everything will be OK. What I do know is that even if it’s not, I’m not as helpless as I felt before.

***

“Is it hard dating someone with anxiety?” 

Carter looks away from the status of his fantasy football league and takes a hard look at me.

“No.” He pushes his glasses back up the bridge of his nose.

“There aren’t any challenges?”

“There are challenges with dating anybody,” Carter says. “But it’s not like anxiety presents more or greater challenges.”

But doesn’t it frustrate him that my anxiety demands his time over and over again?

“I mean, it can be frustrating.”

I flinch.

“But it’s not like I’m frustrated with you. I’m just frustrated with the anxiety. I understand that that’s not what you want to be doing either or what you want your brain to do.”

I recall something an author who visited campus once shared, a phrase that the internet attributes to a variety of different writers: “Love is giving someone power to destroy you, but trusting them not to.” 

There’s another way to interpret this: Love is asking someone to help you, and trusting that they’ll try.

***

During my third session, M talks about how other people’s support helps anxiety and panic attacks significantly. 

“But how do you avoid feeling like a burden?” I ask.

I look down at the floor.

“I feel like I still struggle with asking people for help without feeling like a burden, because I’m always asking the same people.”

“But you know that knowing you have someone there for you helps,” he says. “And you’re not actually a burden to those people, that’s just thoughts coming from your anxiety. Anxiety breeds by telling you you’re a burden to others.” 

I don’t have much more to talk about, and we wrap up a little early.

“Before you leave, I just want to check in with you,” M says. “How has your experience with counseling been?”

I tell him the truth: my experience with counseling has been great. The breathing techniques have helped, and developing the three-step plan makes me feel like I have some degree of control in situations where I feel most helpless. I also find that speaking to someone who’s trained to converse about mental health problems gives me further comfort and stability. Even just the confirmation that I do have “mild to moderate” anxiety after years of uncertainty makes me feel like I have a better grasp of my situation.

I can’t imagine how different my college experience would have been if I had this disposition and these coping techniques from the beginning.

M informs me that the counseling center has entered its waitlist period, which they had hoped they wouldn’t hit until November. The wait is about two weeks. We can continue meeting every other week, we can lengthen the time between appointments or I can take a break from counseling to see how I’m doing on my own.

I tell M that I’d like to transition to meeting once a month now. 

I’m still not certain that everything will be OK. What I do know is that even if it’s not, I’m not as helpless as I felt before. When I walk out of the counseling center, I stand in the chilly fall air and take a deep breath.