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Abstract

Background:

Higher education students often face stress, academic pressure, and limited mental health support in low-resource settings. Although brief cognitive-behavioral therapy (CBT)-based interventions are scalable, their impact is often measured solely by mental health outcomes. This study explored the broader outcomes of a CBT-based Anxiety Toolbox Workshop on students’ mental well-being, academic functioning, social support, and help-seeking attitudes.

Design and methods:

The study employed a retrospective qualitative design using open-ended self-report questions administered at the workshop’s conclusion. Fifty-four first year undergraduate students (M = 19.3 years, SD = 0.8) from a major public university in Kosovo participated. A deductive thematic analysis was conducted based on predetermined themes aligned with the objectives.

Results:

Participants reported reduced stress, emotional overload, and academic anxiety following the workshop. These improvements were supported by practical coping tools, including mindfulness techniques, cognitive reframing, and peer discussions. The workshop also enhanced time management, study routines, and academic focus, particularly through structured strategies and daily planning. Beyond academic benefits, participants expressed increased confidence in career decisions and perceived social support. The workshop also helped reduce internalized stigma, challenge stereotypes around psychological help, and improve readiness to seek support.

Conclusion:

The findings suggest a brief CBT-informed intervention can enhance students’ emotional well-being, academic performance, and prosocial attitudes. This study demonstrates the potential of low-intensity, structured programs to meet student needs and reduce barriers to support in a real-world academic setting. Future research should investigate the long-term impacts and cross-cultural adaptability of such interventions.

Keywords

CBT brief intervention university students mental well-being barriers to seeking psychological help social support study skills career confidence

Introduction

Youth experience a transformative phase during higher education, as they encounter personal and academic growth opportunities. However, this period also presents significant challenges that affect their mental well-being and academic performance.¹ Research has consistently highlighted high levels of stress, anxiety, and depression among higher-education students worldwide.² Factors such as academic demands, social and familial pressures, financial constraints, poor time management, inadequate study skills, and difficulties adapting to the expectations of higher education contribute to these challenges.^3
–5 For students, these issues can undermine motivation, decrease academic efficiency, and disrupt academic trajectories, underscoring the critical importance of prioritizing mental health as a core component of youth and student success.⁶

The COVID-19 pandemic exacerbated existing mental health challenges, causing unprecedented disruptions in education, social interaction, and career planning.⁷ Even in the post-pandemic period, students have continued to report elevated stress, academic and career-related anxiety, and financial difficulties, reflecting the long-term psychological toll of the crisis.^8
–12 The pandemic also exposed systemic vulnerabilities in mental health support systems globally. Poor access to services, inefficient regulatory frameworks, and fragmented policies have left many individuals, particularly youth and students, without adequate support during critical life transitions.^13,14

Although gaps in mental health services persist worldwide, these challenges are especially pronounced in resource-limited settings, such as Kosovo, where this study was conducted. In Kosovo, institutional limitations amplify these issues, including the absence of professional mental health services in many educational institutions and the high costs of private care.¹⁵ Large class sizes relative to a limited number of professors pose additional difficulties, particularly for first-year students at public higher education institutions.¹¹ This group faces significant challenges in transitioning from the structured environment of secondary education to the self-directed demands of university life. Globally, first-year students are considered especially vulnerable to academic stress, anxiety, and feelings of isolation and are less likely to access supportive services compared to their more advanced peers.¹² Furthermore, a lack of tailored individual support exacerbates academic struggles, prevents the development of effective study habits, and heightens anxiety, ultimately affecting students’ mental well-being and academic performance.^11,16 Cultural stigma surrounding mental health remains a significant barrier in Kosovo and the surrounding regions. Thus, fear of judgment and shame discourage students from accessing psychological support.¹⁷

To address the gaps in student mental health services, brief and scalable interventions, including peer-to-peer support models, have gained prominence.¹⁸ Evidence shows that brief interventions grounded in cognitive-behavioral therapy (CBT), particularly those implemented in educational settings, can significantly reduce anxiety and depression within short timeframes.¹⁹ Mindfulness-based approaches rooted in CBT principles have also been effective in alleviating anxiety, improving working memory, and enhancing cognitive performance in high-stress situations, such as examinations.²⁰ Similarly, brief mindfulness and psychoeducational interventions have demonstrated the ability to reduce test anxiety among pre-university students in Kosovo.¹¹ These programs are often cost-effective and can be delivered by professionals with less formal training, thereby increasing their scalability.²¹ Peer-to-peer support models further expand access by providing avenues to increase emotional resilience and enhance perceived social support, particularly in resource-limited settings.^22
–24

Despite this growing body of evidence, research on the outcomes of brief CBT interventions has continued to focus on anxiety and depression reduction among university students.²⁵ Consequently, broader psychosocial and academic outcomes remain underexplored.²⁶ This study addresses this gap by exploring multiple perceived outcomes of the Anxiety Toolbox Workshop, a brief CBT-informed intervention, among first-year undergraduate students at a major public university in Kosovo. This study examined changes in students’ emotional well-being (e.g. stress and anxiety reduction), academic functioning (e.g. academic anxiety, study skills, and career confidence), and psychosocial domains (e.g. social support, stereotypes, barriers to seeking help, and help-seeking-related attitudes). Furthermore, by exploring factors that influence well-being, attitudes, and support-seeking, this study aimed to understand how brief interventions can potentially foster self-awareness, adaptive coping, and openness to psychological help in educational contexts with limited mental health infrastructure.

The Anxiety Toolbox Workshop, originally developed by Dr. Elizabeth Poloskov and widely implemented at university counseling centers across the United States,^27,28 was translated into Albanian and adapted for use in Kosovo. In this context, and without structured psychological services at the university level, the workshop was integrated into student support services for the department of psychology, providing both psychological and academic support to students at the largest public university nationwide. The workshop has also been implemented with high school students in Kosovo, demonstrating benefits in emotional regulation, particularly cognitive reappraisal, and study skills. The program comprises three weekly group sessions and one individual follow-up session lasting approximately 60 min.

Grounded in CBT, the Anxiety Toolbox Workshop introduces students to foundational strategies for identifying and managing anxiety-related thought and behavior patterns. It integrates psychoeducational content, guided discussions, and experiential learning to support both an understanding of the concepts and the development of coping skills.^29,30 In line with CBT, each session includes structured homework tasks, which, beyond their contribution to emotional well-being,^31,32 are intended to promote habit formation and self-regulation, consistent with active learning principles.³³

In addition to CBT, this study incorporates resource and social exchange theories to examine the group-based mechanisms underlying the workshop’s effects. Resource theory highlights the value of interactions that can foster empathy and reduce social isolation, such as the exchange of emotional support, validation, and information in group settings.^34,35 Social exchange theory provides a lens for exploring how mutual interactions foster trust, build relationships, and create a sense of belonging,^36,37 potentially contributing to reduced stigma, improved help-seeking attitudes, and increased self-efficacy.

Therefore, the findings of this study, conducted in a real-world academic setting, may offer valuable preliminary insights into the potential of brief, low-intensity mental health interventions for higher education students, particularly in contexts that have received limited research attention. Although such programs are common in high-income countries, their adaptability and relevance in settings with limited psychological support and persistent stigma remain underexplored, with most evidence coming from systems in which mental health services are well integrated into universities.²⁵

Furthermore, this study aimed to shift attention toward the broader academic and psychosocial relevance of brief mental health interventions, an area that remains underrepresented in CBT literature. By examining perceived outcomes beyond symptom reduction, we aim to deepen understanding of how structured, low-intensity programs may foster academic engagement, promote help-seeking behaviors, and strengthen social support. These insights offer a foundation for destigmatizing mental health services and advocating for more holistic and scalable student support systems in educational settings with limited resources. Ultimately, our findings may guide the development of low-threshold, context-sensitive interventions tailored to the needs of students in under-resourced environments, in line with growing calls to promote such approaches as effective and scalable solutions for supporting students’ mental health.^11,38

Design and methods

Study design

This study utilized a retrospective qualitative approach, which is well-suited for exploring perceived intervention outcomes. Such an approach allows participants to reflect on their experiences and describe perceived changes in knowledge, attitudes, and behaviors through a consistent internal frame of reference, thereby minimizing response-shift bias.³⁹ A retrospective approach was also chosen for its practicality in early-phase, resource-limited support programs and for its appropriateness in addressing culturally sensitive issues such as mental health. Conducting a single post-intervention reflection can encourage more openness, especially in contexts where pre-intervention surveys may hinder engagement.⁴⁰

Intervention and research team

The intervention and research team consisted of seven individuals with complementary academic backgrounds and clearly defined roles. The Anxiety Toolbox Workshop was implemented by three Master’s-level students—two from the School Psychology and Counseling program and one from the Clinical Psychology and Community program. These student facilitators were mentored and supervised by two PhD-level psychologists: one associate professor from the university’s Department of Psychology and one external collaborator with advanced training in mindfulness-based interventions. All facilitators had academic training in cognitive-behavioral therapy (CBT) and completed preparatory sessions on workshop delivery, group facilitation, and ethical conduct.

Both the intervention and research teams were part of the university’s student support services initiative at the time of the study. The data collection and analysis were conducted by a separate team of volunteers from the same initiative, who had not participated in workshop delivery. This team included one MA student in School Psychology and Counseling and one MA in Clinical Psychology, alumni of the Department of Psychology. Their work was supervised by the same associate professor, who ensured methodological rigor and adherence to ethical standards. All members of the research team had prior academic preparation in qualitative research methods, particularly deductive thematic analysis. All research and intervention team members were female, with no preexisting personal relationships between the researchers and participants.

All research and intervention team members were female, with no preexisting personal relationships between the researchers and participants.

Ethical procedures

Ethical approval was obtained from the Ethics Committee of the Faculty of Philosophy at a major public university in Kosovo (nr. 03.40351/1). Prior to data collection, all participants were informed about the purpose of the intervention and the data collection, the voluntary nature of their participation, and their right to withdraw from the study at any time without consequences. Written informed consent was obtained from each student. Participants were assured that their responses would remain confidential and anonymous throughout the research process.

Intervention

The Anxiety Toolbox Workshop consisted of three group sessions and one individual session, delivered over 4 consecutive weeks during the first semester (October to November 2024). Each session lasted approximately 60 min, and group sessions involved up to 10 students. The workshop was conducted with first-year undergraduate students at a major public university in Kosovo.

The workshop sessions were interconnected and designed to progressively build participants’ understanding of anxiety and strengthen their coping skills. In addition to the content and structure outlined in the original workshop manual, which includes specific tasks and activities, this intervention incorporated brief mindfulness-based practices delivered during sessions and as take-home assignments. These activities included guided breathing exercises, visualizations to reduce test anxiety, self-affirmation practices to boost confidence, and mindfulness-based relaxation techniques, each lasting no more than 5 min. Participants were also provided with Albanian-language video recordings of the exercises, made available through the official YouTube channel of the student support program at the Department of Psychology. These resources were intended to encourage at-home practice and reinforce students’ ability to manage anxiety in their daily lives, in line with the original manual’s recommendations (Table 1).

Table 1.

Workshop structure and content.

Session	Focus	Core activities	Homework/Practice
Session 1 Understanding anxiety	Foundations of anxiety: causes, symptoms, and differentiation from stress	Psychoeducation; identification of cognitive distortions and behavioral patterns; discussion of how anxiety manifests in daily life; introduction to CBT framework; brief mindfulness exercise	Cross-sectional formulation worksheet (analyzing a personal anxiety situation); practice one mindfulness activity and one sleep hygiene technique
Session 2 Triggers and coping strategies	Identifying emotional, cognitive, and environmental triggers and their role in the anxiety cycle	Mapping the anxiety cycle; exploration of anxiety triggers; practice of adaptive coping strategies including relaxation and behavioral techniques; guided visualization	Trigger identification worksheet; continue mindfulness and sleep hygiene routines
Session 3 Skill consolidation	Reflection and integration of learned strategies; development of personal coping plans	Sharing progress; evaluation of strategies; creation of personalized anxiety management plans; self-affirmation practice, and breathing exercises	Finalize coping plans; Continue practicing sleep hygiene and mindfulness
Session 4 Individual follow-up	Personalized support and application of skills	One-on-one session with facilitator; review of coping plans; discussion of individual challenges and goal setting	Implement the finalized management plan in daily life, ensuring long-term application of learned techniques.

Participant selection and sampling

Eligible participants for the intervention were first-year undergraduate students enrolled in the psychology program at a major public university in Kosovo. Recruitment followed a purposive sampling strategy based on predefined criteria: enrollment in the program, availability to attend all four workshop sessions, and expressed interest in participation. Students were invited to apply through public announcements shared via the university’s student support program social media channels. These described the workshop’s purpose, format, and peer-facilitated structure under the department’s student support services. Seventy students initially enrolled; of these, 60 completed all four sessions. Non-completion was primarily due to academic workload or scheduling conflicts.

Following the final session, students who attended all four workshops were invited to participate in the post-intervention evaluation. They were informed that their feedback would contribute to the program’s ongoing evaluation and improvement. Interested students provided written consent with their name and email address. Of the 60 eligible students, 54 completed the survey. The remaining six either declined or did not provide a reason for non-response.

Data collection procedures

Participants were contacted via email, sent from the official address of the student support program, following the final workshop session and invited to complete an online questionnaire. This program is managed by the Department of Psychology, which also coordinates workshop logistics and conducts follow-up evaluations of its student services.

The survey comprised two sections. The first section included demographic questions regarding participants’ age, gender, ethnicity, region and urbanicity of permanent residence, year of study, and prior experience with psychological support services or online mental health tools.

The second section consisted of seven open-ended questions designed to examine perceived changes across psychological, academic, and social domains. In addition to assessing general stress levels, academic anxiety, and study skills pre- and post-intervention, the questions explored shifts in career confidence and attitudes toward social support and help-seeking. The survey aimed to understand students’ initial perceptions or stereotypes about individuals who seek psychological help, personal barriers to accessing support, and which workshop components facilitated change.

A typical item in this section was: “How would you describe your levels of stress or anxiety before and after participating in the workshop? How did the workshop contribute to any changes you experienced?” Each item was phrased to elicit reflective, narrative responses and capture both pre- and post-intervention perspectives. The questionnaire was pilot tested with two non-participating students to ensure clarity, accessibility, and alignment with the intervention’s learning objectives.

Responses were collected through the Google Forms platform, and participants were not required to provide their identities within the form. No repeat interviews were conducted. The average time to complete the survey was 20–30 min.

Data processing and analysis

This study used deductive thematic analysis guided by Braun and Clarke’s six-phase framework.⁴¹ A set of a priori themes aligned with the workshop’s core learning objectives directed the initial coding and interpretation process. The analysis proceeded through six stages: (1) becoming familiar with the data through repeated readings, (2) generating initial codes based on predetermined themes, (3) identifying subthemes within each main theme, (4) reviewing and refining the themes for internal coherence and consistency with the dataset, (5) articulating the scope and meaning of each theme and naming relevant subthemes, and (6) reporting the results by integrating illustrative excerpts with interpretive commentary. To reflect the workshop’s outcomes, coded responses under each theme were organized into two subcategories: participants’ reported challenges, attitudes, or perceptions before the workshop and their reflections on how the workshop influenced change in each domain.

To ensure intercoder consistency, two researchers independently analyzed a subset of responses and resolved discrepancies through discussion. Data saturation was reached when no new codes or subthemes emerged during the final rounds of coding, confirming that key patterns in the data were fully captured. Qualitative data were analyzed and managed using NVivo 14 (QSR International) and Atlas.ti 23 (ATLAS.ti Scientific Software Development GmbH), facilitating systematic coding, data organization, and identification of patterns across themes. These software programs were used in accordance with the software providers’ terms of use.

Results

Participants

The sample included 54 participants aged 18–20 years (M = 19.3, SD = 0.8), of whom 90.7% (49) identified as women and 9.3% (5) identified as men. All participants were first-year undergraduate students enrolled in their first semester of the 2024/25 academic year at Kosovo’s largest public university.

All participants were of Albanian ethnicity. The participants represented all seven regions of Kosovo, residing in municipalities within the Prishtina, Mitrovica, Peja, Prizren, Ferizaj, Gjilan, and Gjakova regions. Regarding their living environments, 65% reported residing in urban areas, whereas 35% reported living in rural areas. Most participants had no prior experience with mental health services. Only 4% reported using digital mental health services, such as MindSpace, before attending the workshop.

The following themes illustrate key insights into participants’ experiences and attitudes and the perceived influence of the Anxiety Toolbox Workshop on various domains based on the study objectives.

Theme 1: Factors influencing students’ mental well-being and the role of the workshop

This theme explores how participants experienced anxiety and stress as persistent barriers to their mental well-being, largely because of academic pressures, social expectations, and feelings of isolation. These challenges not only affected students’ emotional functioning but also limited their ability to fully engage in academic and social environments. The workshop helped participants build emotional awareness and coping strategies while simultaneously creating a supportive peer environment that reduced isolation and reinforced a sense of validation.

Participants commonly reported symptoms such as difficulty concentrating, physical tension, trouble sleeping, and overwhelming emotions. These manifestations often undermined their confidence in academic or social situations. For many students, the workshop offered structured tools such as relaxation exercises, mindfulness practices, and cognitive strategies, which provided new or reinforced methods for managing stress and anxiety in daily life. As one participant stated, “I struggled with constant racing thoughts, especially regarding school deadlines. The mindfulness exercises helped me slow down and focus.” (Participant 12)

Participants frequently mentioned their ability to identify and regulate stress triggers as an outcome. They described gaining a clearer understanding of their emotional patterns, allowing them to feel better equipped to respond constructively. One student explained, “I now understand my emotions better and am more aware of what triggers my anxiety. This has helped me manage it more effectively.” (Participant 10)

In addition to individual skill development, the group dynamic played a key role in participants’ experiences. Several participants highlighted how the shared space allowed them to connect with others facing similar challenges, thereby reducing their feelings of isolation. As one participant reflected, “After connecting with others, I realized I wasn’t the only one struggling. That support made a huge difference.” (Participant 48)

Theme 2: Factors influencing academic anxiety and the role of the workshop in anxiety reduction

This theme focuses on academic anxiety among participants and how the workshop helped mitigate it by normalizing their concerns and offering practical strategies to increase academic confidence.

Participants frequently cited performance pressure, fear of failure, and internalized negative thought patterns as central sources of academic anxiety. Furthermore, their limited familiarity with university demands often magnified these concerns. Several students described feeling anxious even before taking their first exam, indicating pervasive anticipatory stress. One participant explained, “I felt anxious thinking about final exams, even though they hadn’t started yet. The workshop taught me how to manage those thoughts and approach them calmly.” (Participant 12)

The workshop helped reduce students’ anxiety by validating their emotions and emphasizing that this type of stress is a common part of academic adjustment. Participants learned to manage their anxious thoughts and regain a sense of control using structured techniques such as breathing exercises, progressive muscle relaxation, and cognitive reframing. These methods helped them feel more composed and capable when faced with academic challenges. As one student stated, “I thought my academic anxiety was really high, but after the workshop sessions, I realized it was just my thoughts making me believe it was worse than it really was.” (Participant 2)

Beyond immediate stress management, the workshop also appeared to foster long-term academic resilience. Participants noted that the techniques they had learned could be applied not only in their current situation but also in future high-pressure contexts. Even those who did not report experiencing high levels of anxiety at the time of the workshop found value in the skills provided, describing a sense of preparedness and confidence. For example, one participant shared, “I used to feel paralyzed before speaking in class, but now I feel much more confident after using the reframing techniques we learned.” (Participant 22)

Theme 3: Outcomes of the workshop related to study skills

This theme highlights how the workshop contributed to participants’ development of study-related competencies, especially in terms of time management, routine formation, and academic focus. Several first-year students started the workshop, feeling overwhelmed by the academic demands of university life and uncertain about how to organize their responsibilities. Through practical strategies and peer engagement, the workshop provided participants with a greater sense of structure and self-discipline, thus supporting both academic performance and overall well-being.

Participants commonly described how they had struggled to manage their time efficiently before attending the workshop, often feeling disorganized and stressed by academic tasks. After the workshop, most students reported improving their ability to engage in daily planning and prioritization. Some mentioned that developing a daily routine and allocating specific times for study enabled them to approach coursework with greater clarity and focus. One participant noted, “The workshop helped me improve my time management. I now plan my day better and have learned how to prioritize tasks.” (Participant 25)

In addition to better time management, participants adopted study techniques that enhanced their engagement and information retention. Several noted that they had previously found it difficult to remain attentive during lectures or remember important material. Students also mentioned improvements in self-care, particularly in sleep hygiene, as contributing to their academic focus.

Even among participants who reported only minor changes in their learning strategies, several emphasized the indirect benefits of the workshop, such as connecting with peers and exchanging academic insights. According to one participant, this sense of community offered a valuable space for sharing challenges and adopting new perspectives: “While my learning skills didn’t change much, the workshop helped me connect with others and get new perspectives.” (Participant 52)

Theme 4: Career insecurity and the influence of the workshop on confidence development

This theme explores participants’ reflections on career uncertainty and how the workshop contributed to building or reinforcing their confidence in their chosen academic and professional paths. Many first-year students experience concerns about whether they have selected the right field, accompanied by anxiety and self-doubt. The workshop addressed these concerns by helping participants manage anxiety, normalize uncertainty, and engage in reflective peer discussions that validated their aspirations.

Several participants were unsure whether psychology was the right field for them at the beginning of the workshop, expressing hesitations about their long-term goals. However, after completing the workshop, several students reported increased clarity and reassurance regarding their decisions. One participant shared, “Before the workshop, I wasn’t very sure about my decision to choose psychology as a field of study, but after the workshop, I realized I made the right decision.” (Participant 20)

An important contributor to this growing confidence was the intervention’s focus on managing anxiety, which enabled participants to confront self-doubt more constructively. The techniques learned in the workshop helped reduce internal barriers, while group discussions encouraged participants to reflect on their career goals in a supportive context. One participant explained, “Before the workshop, I had a lot of self-doubt, but these sessions taught me to believe in myself and that I can achieve my career goals.” (Participant 44)

The workshop served as reinforcement for those already confident in their career paths. The space for open dialog and shared reflection allowed them to articulate and affirm their goals. As one student expressed, “I have always been certain about my career choice, and the workshop served as a reinforcement for the belief I had in my future career.” (Participant 41)

While most participants reported increased career confidence, some still required more time and experience to feel fully secure in their choices. Nevertheless, the workshop was considered an important first step in reducing doubt and supporting career-related self-efficacy.

Theme 5: Factors influencing perceived social support and the role of the workshop in social connections

This theme examines how participants’ perceived social support evolved through their engagement in the workshop. For several students, the group-based format and peer interactions created a space in which they could reflect on the value of supportive relationships, particularly in the context of stress and anxiety management. The workshop served not only as a tool for self-development but also as a social bridge that fostered connections and mutual understanding among students.

Several participants described experiencing a shift in awareness as they realized that social support could play a key role in maintaining mental well-being and reducing feelings of isolation. One participant noted, “My levels of social support were relatively low before, but after participating, they increased. It made me realize that my mental state and that of my peers are a concern for others.” (Participant 8)

For others, the workshop reinforced the importance of community, even if their perceived support did not change significantly. These students appreciated the opportunity to reflect on their existing relationships and explore new ways to strengthen them. In some cases, the workshop also prompted participants to take a more active role in offering emotional or practical support to others. As one student shared, “During this workshop, I had the opportunity to meet new colleagues, which I hadn’t been able to do before. This made me more social, and I’m now offering more support than I did before.” (Participant 40)

Overall, the participants considered the group dynamics of the workshop to be a catalyst for greater social engagement. They felt more comfortable in social situations, empathetic toward their peers, and willing to seek and provide support. These shifts contributed to a broader sense of belonging and community within the university environment.

Theme 6: Challenging stereotypes about others who seek psychological help

This theme explores how the workshop prompted participants to question and reframe social stereotypes about others seeking psychological help. Several students initially believed that mental health services were appropriate only for individuals with serious psychological disorders. These views were often influenced by cultural expectations, limited prior exposure to psychological services, and underlying discomfort with the idea of needing help. The workshop discussion offered the students an alternative framework that presented help-seeking as constructive, preventive, and empowering.

Participants described how their perspectives began to shift during group sessions, particularly as they listened to their peers share personal challenges and discuss the importance of emotional well-being. These conversations provided new insights into how others viewed and experienced support. One participant shared, “Before, I thought you needed to have serious problems to ask for help, but now, I know it’s necessary to seek help whenever you feel the need.” (Participant 2)

Several participants emphasized that learning about stress and anxiety as common and manageable experiences helped them view psychological support as something relevant to everyone, rather than only those in crisis. This was further reinforced by the workshop structure, which presented coping strategies and cognitive techniques not as treatments but as skills anyone can use. Engaging in these activities allowed participants to experience the usefulness of such techniques firsthand.

Empathy also emerged as a key dimension of change. Reflection and peer interaction allowed participants to better understand the emotional effort required to seek help. One student noted, “The workshop taught me how hard it is for that person to decide to ask for help.” (Participant 8)

Theme 7: Barriers to seeking help and the role of the workshop in intentions to seek help

This theme explores the personal, social, and cultural barriers previously preventing participants from seeking help and how the workshop influenced their readiness to overcome them.

Participants cited fear of judgment, stigma, and the internalized belief that they should manage challenges independently as key deterrents to help-seeking. Several students expressed concerns about how others would perceive them if they admitted to needing psychological support. One participant stated, “The main barrier was the fear of being judged by others.” (Participant 8)

In addition to social stigma, several participants noted having never felt comfortable or safe expressing emotional struggles in academic settings. They did not view the university environment as appropriate for discussing personal issues. This sense of disconnection between academic life and emotional support further reinforced their silence.

The workshop helped to address these barriers by creating a validating environment in which participants could hear from their peers facing similar challenges. This normalization process reduced shame and self-stigma. One student noted, “Mostly social norms and stigma. The workshop helped me understand that there are people who are willing to help us.” (Participant 11)

Beyond shifting attitudes, the workshop also strengthened participants’ sense of self-efficacy in seeking help. Several students reported that, after the workshop, they felt more confident and emotionally prepared to reach out for support in the future.

Table 2 provides a concise overview of the main themes, highlighting key barriers, attitudes, and psychological challenges participants reported, along with the perceived benefits of the Anxiety Toolbox Workshop. Each theme is accompanied by selected codes and representative quotes illustrating the participants’ experiences.

Table 2.

Overview of themes, codes, and illustrative quotes from the anxiety toolbox workshop.

Theme	Codes: Challenges/initial attitudes	Illustrative quotes (challenges//initial attitudes)	Codes: Role of the workshop	Illustrative quotes (Workshop)
Theme 1: Factors influencing students’ mental well-being and the role of the workshop	- Academic pressure - Social expectations - Emotional overload - Physical tension - Sleep issues - Isolation - Difficulty concentrating	“Sometimes I couldn’t concentrate at all, especially before academic tasks.” (Participant 34) “I often felt like I was the only one dealing with this.” (Participant 17)	Emotional awareness Identification of triggers Mindfulness strategies Coping skills Peer connection and support Shared experience/validation Confidence in expressing emotions	“The mindfulness techniques helped me reduce anxiety in stressful situations.” (Participant 27) “But after connecting with others, I realized I wasn’t the only one struggling.” (Participant 17)
Theme 2: Factors influencing academic anxiety and the role of the workshop in anxiety reduction	Academic transition stress - Performance pressure - Fear of failure - Anticipatory anxiety - Classroom-related anxiety	“Hearing others talk about their struggles with adapting to university life made me realize I wasn’t alone.” (Participant 48)	- Practical tools for anxiety - Cognitive understanding of anxiety - Preparedness for future challenges Psychoeducation and skill-building	“Before the workshop, I had a medium level of anxiety, but afterward, I felt it drop significantly. . .” (Participant 1) “The workshop helped me classify my anxiety and understand it better.” (Participant 5) “I didn’t have any anxiety during this period, but I learned techniques I can use in the future.” (Participant 40)
Theme 3: The outcomes of the workshop on study skills	- Poor time management - Lack of routine - Academic overload - Difficulty staying focused - Disorganization	“Before the workshop, I didn’t have a daily routine.” (Participant 22) “Studying felt overwhelming, and I couldn’t stay focused during lectures.” (Participant 31)	- Improved time management - Daily planning and prioritization - Self Care - Increased academic focus - Adoption of study strategies - Self Discipline - Peer academic exchange	“I’m now managing my time better and focusing on learning new things.” (Participant 27)
Theme 4: Career insecurity and the influence of the workshop on confidence development	- Career uncertainty - Self-doubt - Anxiety about future goals - Lack of clarity about academic direction	“Before the workshop, I had a lot of self-doubt. . .” (Participant 50)	- Increased career confidence - Affirmation of academic path - Reduction of self-doubt - Supportive peer reflection	“As I started to manage anxiety, I began feeling more secure in my chosen field of study.” (Participant 39)
Theme 6: Challenging stereotypes about others who seek psychological help	Belief that psychological help is only for severe disorders; Associating help-seeking with weakness or failure	“I always had the perception that mental health support is not meant for ‘ordinary’ stress.” (Participant 33)	Reframing help-seeking as a preventive and empowering step Normalization through shared peer experiences Increased empathy and understanding of others’ struggles Realization that support is applicable to daily stressors	“The workshop taught me how hard it is for that person to decide to ask for help.” (Participant 8)
Theme 7: Barriers to seeking help and the role of the workshop in intentions to seek help	- Fear of judgment - Internalized stigma - Belief that one should manage alone - Discomfort with seeking help in academic settings - Perception that university is not a place for emotional vulnerability	“I didn’t feel like the university was the place to talk about this. . .” (Participant 28)	- Normalization of help-seeking - Creation of a validating peer environment - Reduction in self-stigma - Increased readiness and emotional confidence to seek support	“I wasn’t ready at all before, but now I feel more prepared to express myself freely and seek help.” (Participant 19)

Discussion

This study’s findings demonstrate how brief group-based interventions such as the Anxiety Toolbox Workshop can address the interconnected psychological, academic, and social challenges facing students in higher education. Participants frequently attributed their stress to academic pressure and social expectations, reporting symptoms such as disrupted sleep, overwhelming emotions, and difficulty concentrating.^3,12 The workshop provided practical tools, such as cognitive reframing, mindfulness practices, and stress management techniques, which enabled participants to better regulate their emotions and manage stress triggers.^29,32 These findings reinforce the value of CBT-based interventions in fostering resilience and equipping students with strategies to navigate both academic and personal challenges.²⁰

Group-based interactions were crucial in shaping the participants’ experiences, particularly by reducing their feelings of isolation and fostering a supportive environment. By connecting with peers who shared similar struggles, participants developed trust and empathy, contributing to a sense of belonging and emotional validation. Resource theory underscores the importance of these exchanges by highlighting how emotional and informational support within groups fosters mutual understanding and reduces social isolation.³⁶ Simultaneously, social exchange theory emphasizes the reciprocal nature of these interactions, in which participants both offered and received validation to create a collaborative and affirming group dynamic.³⁷ These group discussions not only assisted in normalizing help-seeking behaviors but also reframed them as proactive steps toward mental well-being.

In addition to normalizing help-seeking, the workshop reduced internalized stigma and changed participants’ views on who could benefit from psychological support. Several students reported abandoning the belief that mental health services were only for severe cases, instead developing a more open and accepting attitude toward psychological help. This shift contributed to participants’ greater willingness to seek support when needed, highlighting the workshop’s potential role in destigmatizing help-seeking in educational contexts where mental health services are often underutilized.

The collaborative nature of the workshop also extended its influence to career confidence. Reflecting on career aspirations within a group setting allowed participants to address self-doubt and gain reassurance from peers facing similar uncertainties. This peer validation provided a foundation for increased confidence in their career trajectories, although some participants reported needing more time and experience to solidify their decisions. The combination of emotional support and shared reflections highlights the workshop’s role in addressing broader professional and social challenges beyond immediate academic concerns.

Improved study skills were also a prominent outcome, particularly in terms of time management, focus, and task organization. Structured discussions on routines and academic strategies offered participants practical insights into managing their responsibilities, while self-care practices, such as improved sleep hygiene, supported these changes. These outcomes align with the dual emphasis of CBT-based interventions on the emotional and behavioral aspects of mental well-being, illustrating their potential to enhance students’ academic performance and psychological resilience.^19,32

Practical implications

The findings of this study offer practical insights into enhancing mental health interventions in higher education, particularly in resource-limited settings. The Anxiety Toolbox Workshop exemplifies how brief group interventions can effectively address students’ psychological, academic, and social challenges when transitioning to university life. By integrating CBT principles, such workshops provide practical tools for managing stress, regulating emotions, and building resilience, reflecting essential skills for both academic and personal success.

A notable implication of this study is the value of incorporating peer-supported group dynamics into mental health initiatives. Universities should promote peer-led models as a cost-effective approach to bridging gaps in mental health support while also strengthening social connections among students. These models can complement formal counseling services, thereby creating a more holistic mental health framework.

The influence of the workshop on study skills underscores the broad applicability of CBT-based interventions for academic support. Universities can integrate similar psychoeducational modules into orientation programs or first-year courses to equip students with essential skills, such as time management, goal setting, and stress management. These efforts can enhance academic performance while simultaneously addressing psychological well-being.

Career-related uncertainties also emerged as an area that requires attention. Although the workshop improved students’ career confidence, additional targeted support is needed to help them solidify their career aspirations. Universities could expand career services to include group discussions and mentoring programs that encourage self-reflection, peer validation, and exploration of career pathways.

The success of the workshop in normalizing psychological help and challenging mental health stigma highlights the need to cultivate environments in which discussions of mental health are encouraged. Universities can extend this effect by establishing accessible counseling services, follow-up programs, and psychoeducation initiatives. Combining peer-led interventions with professional mental health services will ensure a comprehensive approach to students’ mental well-being.

Conclusion

This study’s findings suggest the potential of brief CBT-informed interventions to support students beyond mental health by enhancing academic functioning and increasing openness to seeking help, particularly in educational settings with limited access to formal psychological services and where cultural stigma influences attitudes toward support. The multiple outcomes identified highlight the importance of integrating such programs into higher education to foster supportive environments that not only safeguard students’ mental well-being but also strengthen academic confidence and peer connections.

In addition to the reported benefits, the students’ concerns highlighted persistent emotional and structural challenges, emphasizing the need for more comprehensive and accessible support systems. Thus, the Anxiety Toolbox Workshop may serve as a feasible model for institutions aiming to promote students’ mental well-being and help them realize their full potential, especially by easing transitions in higher education. This is particularly relevant for low- and middle-income countries, where scalable context-sensitive mental health strategies are urgently needed.

Limitations and future directions

Although this study and its findings can serve as a starting point for further promoting the potential of brief interventions, the results should be interpreted with caution owing to certain limitations. First, the small sample size, which consisted mostly of women from a single university, as well as participants primarily from the Albanian ethnic community (the major ethnicity in the Kosovar context), limits the generalizability of the findings to a broader student population. Future studies should include more diverse samples to better understand how such interventions affect students across genders, academic backgrounds, and demographic groups. Second, although the retrospective qualitative approach was feasible in the given context, provided insight into perceived changes, and helped minimize response-shift bias, its interpretive power remains limited. The absence of a control or comparison group, the reliance on self-reported data which introduces the possibility of social desirability bias, and the lack of objective measures of change restrict the ability to attribute outcomes directly to the intervention or to draw causal inferences about its impact. Future studies could strengthen the evidence base by employing true experimental designs. Finally, although the study highlighted the role workshops can play in addressing multiple challenges students face, the long-term effectiveness remains unclear. Follow-up studies are recommended to assess sustained changes in participants’ well-being, attitudes, academic performance, and career confidence.

Footnotes

Acknowledgements

We thank the students who participated in the Anxiety Toolbox Workshop and shared their reflections and experiences.

ORCID iDs

Zamira Hyseni Duraku

Besarta Buqaj

Consent to participate

Informed consent was obtained from all participants in the study.

Author contributions

Z.H.D. led the conceptualization and overall study design, supervised both the intervention and research teams, and ensured methodological rigor. S.N. provided expert input on intervention design and implementation the overall quality of the manuscript. M.J., F.B., and V.G. facilitated the implementation of the intervention. F.Rr. and B.B. conducted data collection and analysis under the supervision of Z.H.D. All authors contributed to the writing and revision of the manuscript and approved the final version.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was conducted as part of the project “Advancement and Measurement of the Effectiveness of Psychological and Academic Support Services for Students,” implemented by the Department of Psychology at the University of Prishtina with institutional financial support. This support did not cover publication costs.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Outcomes of a CBT-based anxiety workshop on higher education students’ mental health,stigma,learning,and career certainty

Abstract

Background:

Design and methods:

Results:

Conclusion:

Keywords

Introduction

Design and methods

Study design

Intervention and research team

Ethical procedures

Intervention

Participant selection and sampling

Data collection procedures

Data processing and analysis

Results

Participants

Theme 1: Factors influencing students’ mental well-being and the role of the workshop

Theme 2: Factors influencing academic anxiety and the role of the workshop in anxiety reduction

Theme 3: Outcomes of the workshop related to study skills

Theme 4: Career insecurity and the influence of the workshop on confidence development

Theme 5: Factors influencing perceived social support and the role of the workshop in social connections

Theme 6: Challenging stereotypes about others who seek psychological help

Theme 7: Barriers to seeking help and the role of the workshop in intentions to seek help

Discussion

Practical implications

Conclusion

Limitations and future directions

Footnotes

Acknowledgements

ORCID iDs

Consent to participate

Author contributions

Funding

Declaration of conflicting interests

Data availability statement

References