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For college students, mental health support — in any form — is key

Learn to Live, an online cognitive behavioral therapy program, is offered free to University of Minnesota students. “It’s streamlined, it’s effective, it’s quick,” says student Sawyer Boyles.

Sawyer Boyles
Sawyer Boyles: "As a man you have to come to grips with the stigma around mental health."
MinnPost photo by Andy Steiner

People are always saying that college is the time of your life, and for many young people it is — but the college years also carry their share of stress and anxiety. Sometimes that emotional pressure builds to the point where students realize they need to find help.

As he entered his senior year at the University of Minnesota, Sawyer Boyles, a busy, mostly happy strategic communications major, started to feel that worries about the future were taking over more and more of his life.

“As you get to your senior year, there is a lot of anxiety just in general that starts to build up about things like, ‘We have to move into the real world now, get a job,’ all those sort of things,” Boyles said. “I started to feel this anxiety build up, and I was trying to figure out what I could do to address that.”

Boyles wasn’t the only one of his compatriots feeling off-kilter. When they saw some of their closest companions struggling with their mental health, he and his friends made a concerted effort to talk more openly about their emotions. Checking in on each other and naming their struggles out loud felt like an important thing to do.

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“Over the past year I’ve had a lot of friends who’ve dealt with mental health issues,” Boyles said. This open approach didn’t come easy for many of the young men in his group of friends, he added: “As a man you have to come to grips with the stigma around mental health. You are told that you have to just push on, but because I have a lot of friends who are dealing with stuff, I was like. ‘We just can’t do this anymore. We have to sit down and discuss these things before they get out of hand.’”

The next step

Talking to your friends about your emotions is a great first step, but there are times when it’s important to reach out to a mental health professional. This fall, Boyles, who said he’s seen his college friends dealing with “a lot of depression that snowballed from anxiety,” decided he wanted to take care of his own mental health. When he felt his concerns over graduation and job search bubbling up, he investigated options for mental health support on campus.

“I feel like I have a strong support network,” he said, “but I also feel like friends and professionals are two different things. I think my friends are great, but I wanted to talk to someone with a more professional angle that is backed up by science and fact.”

A friend who works at the University’s Boynton Health Service told Boyles about Learn to Live, an online cognitive behavioral therapy (CBT) program that is offered free-of-charge to University of Minnesota students. Many other Minnesota colleges and universities also offer free access to online therapy programs as a benefit to their students; the University of Minnesota has been under contract with Learn to Live for just under two years.

Though he’s always been comfortable talking about his mental health with friends and family, Boyles, who grew up in St. Paul’s Como Park neighborhood and graduated from Roseville High School, had never gone to a therapy appointment.

He was open to giving online therapy a try — his natural ease with electronic communication made Boyles feel comfortable using to his phone or laptop to complete Learn to Live’s mental health programs, which focus on helping people find common-sense solutions to common issues, including social anxiety, depression, stress, anxiety and worry, and insomnia. He also appreciated the fact that, unlike a face-to-face appointment with a therapist at one of the University’s mental health clinics, there was no wait time to start a Learn to Live therapy module.

“It’s streamlined, it’s effective, it’s quick,” Boyles said of his experience with online therapy. “ You don’t have to spend an hour and a half talking to someone. You can do it on your own time in your own space.”

Learn to Live relies on modules that lead participants through a set of questions and corresponding exercises designed to offer practical strategies for coping with different mental health concerns. Boyles completed the program’s stress, anxiety and worry module. He thought the tips that the program presented were helpful, and he said he’s adopted some of them into his daily life.

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He liked having the freedom to navigate the Learn to Live site on his own and select from a variety of treatment options. “It’s nice that you can pick the program that fits you the best,” Boyles said. The step-by-step module was easy to put on hold when life got in the way, and easy to pick up again whenever he had a free moment.

“I think that the great thing about it is how low the commitment is,” he said. “When you have an online platform that you can walk through the steps and get some additional resources, it feels like low commitment. I can do it while I’m riding the bus instead of taking the whole afternoon and going over to a clinic.”

The future of therapy?

Are online therapy programs like Learn to Live, or other web-based programs like TalkSpace or BetterHelp that connect users with therapists who converse with them via text message or video chat, the preferred method of mental health therapy for young people?  

Matt Hanson
Matt Hanson
Boyles isn’t sure about that. While he appreciated the convenience of the Learn to Live format when he sought it out earlier this school year, he said he believes that there are times when face-to-face contact with a therapist would be more effective.

“I know a couple of people that have gone in for face-to-face counseling at Boynton,” he said. “Everyone has that opportunity and everyone should take that opportunity because being a student is super-stressful at times.”

If life ever starts feeling as though it’s getting out of hand, Boyles said he’d be open to scheduling in-person time with a therapist. “I think that seeing a therapist is something that everyone should do, even if you don’t have serious mental health issues going on,” he said “It is always good to have someone you can go to and talk about things.”

Matt Hanson, a psychologist and assistant director of the University of Minnesota’s Boynton Mental Health Clinic, said that there’s no shortage of students interested in meeting face-to-face with therapists.

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“We have two mental health clinics here on campus,” Hanson said. “By virtue of how many students are coming through our doors, we know that there is a lot of interest in meeting in person with providers.”

Having an online service like Learn to Live available doesn’t seem to have impacted the number of students who want to talk to someone in person, he added.

“Students don’t see at as an ‘either-or’ type of thing. I think some students see the program as a first step: They may seek out in-person services after giving this online program a try. It may ease the transition for a number of students who may be nervous about coming into the mental health clinic.”

Therapy demystified

Though online therapy has clearly taken off at the University of Minnesota, when the idea was first introduced in a survey several years ago, Hanson recalled that student response was muted at best: “At that time we discovered that students said they preferred meeting in person with someone over online therapy.”

The University of Minnesota eventually decided to add online therapy to its suite of mental health options for students. Despite early reluctance, the tool has proven popular: In its first year, more that 2,000 students used one of the Learn to Live CBT programs: In recognition of this, Blue Cross Blue Shield recognized the University as a health care “trailblazer” for its efforts to provide mental health treatments to students in an accessible manner.

Now that Learn to Live is up and running at the U of M, many members of the mental health team there have taken to using it as a tool in their face-to-face work with students.

“A lot of the therapists on staff here have been trained in the program so that they are familiar with the surveys and the modules that are used,” Hanson explained. “Some therapists will refer students to Learn to Live as an ancillary service to go along with the therapy they are receiving a the clinic. It’s something they can do on their own time.”

It’s the same at the University of St. Thomas, where online therapy has been offered as a benefit to students, faculty and staff for a number of years. Madonna McDermott, St. Thomas’ executive director of health, wellness and counseling, said that mental health and wellness staff consider programs like Learn to Live part of a their larger goal of promoting general student health.  

“For some people [an online therapy program] might be the only thing that they use for their mental health,” McDermott said. “We consider it part of a step-care model. Someone might come in to our clinic for physical health care. They might say they are experiencing some minor anxiety or depression. A provider might then make a suggestion: ‘Why don’t you take a look at this program? Next time you come in we could touch base on it.’”

McDermott thinks programs like Learn to Live democratize mental health treatment. People who are intimidated by therapy or don’t have the financial resources required for face-to-face treatment can get help on their own terms.

Madonna McDermott
Madonna McDermott
“I’m a huge advocate,” she said. “It reaches people who might not seek out traditional counseling services. Our research shows that over 60 percent of the people who use online CBT have never sought out counseling before. This shows that that this format is reaching folks we might not otherwise have reached.”

Hanson agrees. Programs like Learn to Live, he said, “demystify what therapy is.  There are a lot of preconceptions about what happens in therapy. Something like Learn to Live can provide practical examples of what really happens when you meet with a therapist.”

The only negative Hanson sees with online therapy is that it is very easy for participants to walk away when life gets busy.

“The challenge with any type of online therapy is to get participants to stay with the program,” he said. “When you are meeting face-to-face with a person you will be more inclined to follow through because you are accountable to a real human being. That’s not the case online.”

Even if no delivery method for therapy is perfect, in an environment where record numbers of young people report struggling with their mental health, it’s important to embrace any method that that can help, Hanson added.  

“We really do talk about mental health as being a serious public-health issue that commands a multi-level response and a multi-sided effort to meet students where they are,” he said. “Some of that may be individual therapy and some of that may be other forms of providing therapy and support, including platforms like Learn to Live. Anything that helps can be an important tool.”

Step into the unknown

The end of the college years is a particularly anxiety-producing time for many young people, McDermott said. It’s not uncommon for students to seek out mental health care as they see the end of their more sheltered years coming to a close.

Though Learn to Live is used by St. Thomas community members across all age groups, McDermott said that, “The highest users of the program are 21-year-olds, the ones who are getting close to graduation. You have all this support through college and the ‘adulting’ process, and then all of the sudden, the attitude is, ‘You’re an adult now. Go live your life.’”

Boyles said that’s exactly the attitude that he and his friends are coming up against.

“Looking at it from a mental health standpoint I think there are a lot of things you have to deal with mentally when you graduate that you didn’t have to deal with in the transition from high school to college,” he said. “When you go into the real world, there are all these things that no one ever tells you you’ll have to deal with. Everyone’s like, ‘You’ve got it. You’ll be fine.’”

He’s hoping that the mental health support he’s accessed so far will help him through this major transition.

“I’m not super-stressed about finding a job,” Boyles said. “The job isn’t the big stressor.  It is more just moving out and going into another environment.” The post-college transition looms large, he added: “I’ve had friends who said, ‘It takes you a full year to come to the realization that you aren’t a college student anymore.’”

Young people like Boyles and his friends seem to be more comfortable talking about their mental health than people did just a few years ago, Hanson said. He’s hoping that this comfort will help them seek out help when they need it. If that assistance comes in the form of online therapy, he’s OK with that.

“It’s a tough age,” he said. “Any support they can seek out is really important.”