Psychological and Physiological Response of Students to Different Types of Stress Management Programs

Purpose.

To design, implement, and examine the psychoneuroendocrine responses of three different types of stress management programs.

Design.

Randomly assigned. A pre/post experimental design comparing variables between three different programs and a control group. The first program included training in deep breathing, relaxation response, meditation, and guided imagery techniques (RRGI). The second program included training in cognitive behavioral techniques (CB). The third program included both RRGI and CB (RRGICB).

Setting.

The study was conducted at Buenos Aires University.

Subjects.

Participants (N = 52) were undergraduate students.

Measures.

Anxiety, anger, hopelessness, neuroticism, respiration rate, and salivary cortisol levels were assessed.

Analysis.

Wilcoxon signed rank test was used to investigate differences in pre and post variables.

Results.

Subjects in the RRGI group showed significantly lower levels of anxiety (p < .011), anger (p < .012), neuroticism (p < .01), respiratory rate (p < .002), hopelessness (p < .01), and salivary cortisol (p < .002) after the treatment. Subjects in the CB group showed significantly lower levels of anxiety (p < .018), anger (p < .037), and neuroticism (p < .03) after the treatment. Subjects in the RRGICB group showed significantly lower levels of anxiety (p < .001), anger (p < .001), neuroticism (p < .008), hopelessness (p < .01), respiratory rate (p < .001), and salivary cortisol (p < .002) after the treatment. Subjects in the control group showed only one variable modification, a significant increase in cortisol levels (p < .004).

Conclusions.

The combination of deep breathing, relaxation response, meditation, and guided imagery techniques with CB seems to be effective at helping people to deal with stress.

Emotional and symptomatic reactivity to stress in individuals at ultra-high risk of developing psychosis

BACKGROUND

The stress-vulnerability model of psychosis continues to be influential. The aim of this study was to compare emotional and symptomatic responses to stress in individuals at ultra-high risk (UHR) of developing psychosis, in age- and gender-matched healthy controls, and in patients with non-affective psychosis.

METHOD

A total of 27 UHR, 27 psychotic and 27 healthy individuals completed the experience sampling method, an ambulant diary technique, where they were required to fill in self-assessment questions about their emotions, symptoms and perceived stress at semi-random times of the day for 6 days. Quesionnaire and interview assessments were also completed.

RESULTS

Multilevel regression analyses showed that individuals at UHR of developing psychosis reported greater negative emotions in response to stress than the healthy individuals. Against the initial hypotheses, the UHR individuals also experienced greater emotional reactivity to stress when compared with the patient group. No significant differences were observed between the patients and the non-clinical sample. Stress measures significantly predicted the intensity of psychotic symptoms in UHR individuals and patients, but the extent of this did not significantly differ between the groups.

CONCLUSIONS

Individuals at UHR of developing psychosis may be particularly sensitive to everyday stressors. This effect may diminish after transition to psychosis is made and in periods of stability. Subtle increases in psychotic phenomena occur in response to stressful events across the continuum of psychosis.

Differential effects of well-being promoting and anxiety-management strategies in a non-clinical school setting

The aim of the present study was to examine the differential effects of strategies for promotion of psychological well-being (Well-Being Therapy, WBT) and removal of distress (Anxiety Management, AM) in a non-clinical school setting.162 students attending middle schools in Northern Italy were randomly assigned to: (a) a protocol derived from WBT; (b) an anxiety-management protocol (AM). The students were assessed immediately before and after the interventions, and after 6 months using: Psychological Well-Being Scales (PWB), Symptom Questionnaire (SQ) and the Revised Children's Manifest Anxiety Scale (RCMAS). In school children, well-being and symptom focused interventions produced slightly different effects on psychological dimensions. WBT, by facilitating progression toward positive and optimal functioning, may integrate symptom-centered strategies.

Cognitive and behavioral treatments for anxiety and depression in a patient with an implantable cardioverter defibrillator (ICD): a case report and clinical discussion

Implantable cardioverter-defibrillators (ICDs) are the treatment of choice for patients at risk for potentially life threatening arrhythmias. The associated stress of living with an implanted device and receiving ICD shock therapy has been noted to exert a psychological toll on the individual patient and family. Anxious and depressive symptomatology is frequently reported by these patients, thus creating a demand for tailored psychological interventions for this population. The current case report describes the components, delivery, and effectiveness of a targeted treatment approach for anxiety and depression in an individual with an ICD. Test results and interview data revealed significant improvements in multiple domains of cognitive, emotional, and behavioral functioning. Improvements in marital relations were also achieved. These treatment effects were maintained at follow-up and in the context of acute, medical stressors. Future clinical and research directions are also discussed.

Rural adolescents' coping responses: implications for behavioral health nurses

The purpose of this paper is to identify coping responses of rural adolescents. The sample included 193 students attending three high schools in southwestern Pennsylvania. Family and peer relationships were the most common stressful situations described by the adolescents. Coping responses were measured by the Coping Responses Inventory-Youth Form (CRI-Y). The results indicate that males most often report the coping response of logical analysis and females report the coping response of cognitive avoidance most often. Mental health programs, led by behavioral health nurses, may teach a variety of coping strategies to rural adolescents.

Well-being therapy in school settings: a pilot study

BACKGROUND

There is increasing interest in the psychobiological mechanisms of resilience and psychological well-being. It is conceivable that activation of such mechanisms in the school setting may entail long-term benefits, both in terms of the developmental process and of prevention of distress. This study wants to apply and test the efficacy of a school-based intervention protocol derived from well-being therapy (WBT) compared to cognitive-behavioral strategies.

METHODS

School interventions were performed in a population of 111 students randomly assigned to: (a) a protocol using theories and techniques derived from cognitive-behavioral therapy; (b) a protocol derived from WBT. Assessment before and after interventions was performed using two self-rating scales: Kellner's Symptom Questionnaire and Ryff's Psychological Well-Being Scales.

RESULTS

Both school-based interventions resulted in a comparable improvement in symptoms and psychological well-being.

CONCLUSIONS

This new well-being-enhancing strategy could play an important role in the prevention of psychological distress in school settings and in promoting optimal human functioning among children.

Can sickness absence be reduced by stress reduction programs: on the effectiveness of two approaches

OBJECTIVES

The aim of the study was to evaluate the effectiveness of two brief preventive stress reduction programs--a cognitive focused program and a combined intervention of physical exercise and relaxation--on sickness absence in stressed and non-stressed employees working in various jobs in a telecom company.

METHODS

The study was designed as an a priori randomized trial and the follow-up period for sickness absence was 1 year. Sickness absence data of 242 employees were analyzed with respect to spells of sickness (frequency, incidence rate), days (length, duration) and time between intervention and first subsequent absent spell.

RESULTS

For stressed employees this study suggests that the illness burden represented by absenteeism is not affected by the interventions. There is no substantial difference in effectiveness between the cognitive and physical interventions. However, in comparison with the physical intervention the cognitive intervention decreases the period between the intervention and the first recurrence of a sick leave period with 144 days (marginal significant).

CONCLUSION

The illness burden represented by absenteeism is effected in detail but not substantially by the interventions.

Grundlegende Persönlichkeitsmerkmale und individuelle Stressverarbeitungsstrategien als Determinanten der Mobbing-Betroffenheit

Zusammenfassung. Verschiedene Befunde weisen darauf hin, dass Mobbing-Betroffene sich in verschiedenen Persönlichkeitsmerkmalen und allgemeinen Stressverarbeitungsstrategien von Nicht-Betroffenen zu unterscheiden scheinen. In der vorliegenden Studie wurde überprüft, ob grundlegende Persönlichkeitsdimensionen, wie sie vom Fünf-Faktoren-Modell der Persönlichkeit postuliert werden, und habituelle Stressverarbeitungsweisen die Wahrscheinlichkeit, zum Mobbing-Opfer zu werden, beeinflussen können. An der Untersuchung nahmen 147 Mobbing-Betroffene und 162 Nicht-Betroffene teil. Multiple Regressionsanalysen belegten, dass die Persönlichkeitsdimension Offenheit für Erfahrung einen Varianzanteil von 5.7 % und der Einsatz von so genannten Negativ-Strategien der Stressverarbeitung einen Varianzanteil von 4.7 % der Gesamtvarianz für Mobbing-Betroffenheit erklären. Als bester Prädiktor für die Intensität des von Mobbing-Betroffenen erlebten subjektiven Leidensdrucks erwies sich - mit einem aufgeklärten Varianzanteil von 7.5 % - die Häufigkeit, mit der nicht-adaptive Negativ-Strategien zur Stressbewältigung eingesetzt wurden. Die Ergebnisse legen nahe, dass Programme zur Mobbing-Prävention und zur psychotherapeutischen Behandlung von Mobbing-Betroffenen insbesondere die Vermittlung angemessener Stressverarbeitungsstrategien bei sozialen Konflikten am Arbeitsplatz berücksichtigen sollten.

Paramedic performance in calculating drug dosages following stressful scenarios in a human patient simulator

BACKGROUND

Paramedics face many stressors in their work environment. Studies have shown that stress can have a negative effect on the psychological well-being of health professionals. However, there is little published research regarding the effects of stress on the cognitive skills necessary for optimal patient care.

OBJECTIVES

The primary purpose of this study was to investigate the effects of acute stress on the emotional response and performance of paramedics. Furthermore, the authors explored whether a paramedic's level of training or years of experience would mediate the effects of stress on performance.

METHODS

Paramedic performances in calculating drug dosages were compared in two stress conditions. In the low-stress condition, 30 paramedics calculated the drug dosages in a quiet classroom free of any stressor. In the high-stress condition, the same paramedics calculated comparable drug dosages immediately after working through a challenging scenario with a human patient simulator.

RESULTS

The paramedics obtained lower accuracy scores in the high-stress condition than in the low-stress condition [43% (95% confidence interval [CI]: 36.9-49.2) vs. 58% (95% CI: 48.6-67.1), p < 0.01 based on univariate analysis]. Neither work experience nor level of training predicted the individual differences in the stress-induced performance decrements.

CONCLUSION

These results suggest that the types of stressors encountered in clinical situations can increase medical errors, even in highly experienced individuals. These findings underline the need for more research to determine the mechanisms by which stress influences clinical performance, with the ultimate goal of targeting education or technologic interventions to those tasks, situations, and individuals most likely to benefit from such interventions.

The effect of a cognitive and a physical stress-reducing programme on psychological complaints

OBJECTIVES

To investigate the short-term and long-term effectiveness of two, brief, preventive, work stress management programmes. One programme was a cognition-focused programme, the other was a newly developed intervention in which physical exercise and relaxation were combined. It was hypothesised that the newly developed intervention would be more effective in reducing psychological complaints than the cognitive intervention. Both programmes consisted of four sessions in a period of 10 weeks.

METHODS

From a working population engaged in a periodic health check-up, employees above a minimum stress level (n=396) were invited to participate in a randomised comparative outcome study with pre-trial, post-trial and 6-month follow-up measures. After giving informed consent 130 participants entered the study (response rate 33%). Outcome measures consisted of three self-reported questionnaires on psychological complaints.

RESULTS

It was found that both interventions revealed a positive impact on psychological complaints, burnout and fatigue, both at short-term and at 6-month follow-up. No statistical interaction effects between the two interventions were found. Calculation of the clinical significance of the effects indicated that 50% of the employees with psychological complaints who participated in the physical intervention and 60% of the employees who participated in the cognitive intervention improved and returned to functioning within normal range both in the short term and in the long term at 6 months.

CONCLUSION

The data indicate that interventions were equally effective on psychological complaints, burnout and fatigue.

Effects of Stress Management Program for Teachers in Japan: A Pilot Study

The aim of this study was to examine the effects of a stress management program for teachers on their stress responses, social support, and coping. Participants (n=24) were assigned to either an intervention or a waiting list control group. A five-session program, including psychoeducation, group discussion, role-playing and relaxation training, was conducted for the intervention group at two week intervals. Eight participants from each of the groups responded to pre- and post-intervention questionnaire surveys. The positive intervention effect was significant for social support from co-workers (p=0.035), whereas the negative intervention effect was significant for proactive coping (p=0.033). No significant effect was observed for stress responses (vigor, anger, fatigue, anxiety, depression, and somatic stress responses) (p>0.05). The positive intervention effect was marginally significant for social support from co-workers (p=0.085) and anger (p=0.057) among those who at first had high stress response scores in the pre-intervention survey (n=5 and n=4 for the intervention and waiting list control groups, respectively). Furthermore, the positive intervention effect was significant for social support from co-workers (p=0.021) and marginally significant for resignation coping (p=0.070) among those who at first had high job control scores (n=4 and n=5 for the intervention and waiting list control groups, respectively). Results showed that the stress management program conducted in this study contributed to increasing social support from co-workers. This study suggests that a program that focuses on a particular subgroup (e.g., those with high stress responses or high job control) might be effective in enhancing coping skills, increasing social support, and reducing stress responses.

Developing effective helping relationships in health education practice

Health educators who interact directly with the people they serve must be able to establish effective relationships. Helping relationships are effective if they facilitate clients' progress toward health-promoting goals. Health educators are usually well versed in learning activities and spend a significant proportion of their time interacting with clients. However, many health educators have never received explicit training in how to establish effective formal helping relationships. Research on social influence processes has provided a set of empirical findings that suggest interpersonal behaviors that are likely to maximize the effectiveness of formal helping relationships. This literature indicates that formal helping relationships characterized by interpersonal behaviors that enhance client self-esteem and feelings of control are most effective in helping clients achieve specific goals. Interestingly, enhancement of self-esteem and feelings of control are consistent with many definitions of personal empowerment. Since the social influence and empowerment literatures come from very different intellectual roots and have different approaches to power and influence, their convergence is especially notable. These literatures combine to establish the bases for proposing two essential components of effective helping relationships: (1) providing unconditional acceptance and positive regard for clients, and (2) sharing power and control through participatory processes.

Comparison of Traditional and Non-traditional Baccalaureate Nursing Students on Selected Components of Meichenbaum and Butler's Model of Test Anxiety

The purpose of this study was to compare traditional and non-traditional baccalaureate student nurses on test anxiety and major contributing factors using the model proposed by Meichenbaum and Butler. Instruments used to measure the model variables were the Test Anxiety Inventory, the Effective Study Test, the Self-Concept of Academic Ability Scale, the Cognitive Interference Questionnaire and students' admission GPAs. Analysis of data revealed no significant difference between the groups on test anxiety. A significant difference was found between the two groups on knowledge of effective test-taking skills. Significant differences were found between the two groups on two correlations: 1) academic self-concept and knowledge of time management and study organization skills and 2) academic self concept and worry. Pearson correlations indicated that for both groups cognitive interference was the strongest variable associated with test anxiety.

An identification of stressors associated with student nurses in an accident and emergency department and comparison of stress levels

This study has two main focuses; comparing the experience of two groups of student nurses and identifying stressors associated with Accident and Emergency (A & E) nursing. One group was on an enrolled nurse conversion course and the other group was on a full length Registered General Nurse (RGN) course. Both groups shared the same clinical area and the study involved only one A & E department. Particular stressors associated with this type of nursing were identified and were in keeping with previously published evidence. Other causes of stress could be attributed to the working environment and quality of working relationships. An indication emerged that anticipation of stressful events, and not just actual experience, is very significant in the cognitive processes involved in the perception of stress. A correlational survey design was used and a questionnaire incorporating a stress scale was devised. No significant association between reported stress levels and the age of students was found. Place of residence as a variable also revealed no influence on student stress. However, a marked difference, of statistical significance, was shown between the stress levels of the two groups. Interpretation of the data points to prior experience as a key mediating factor in the perception and experience of stress. Following discussion, recommendations regarding further research and changes affecting both the theoretical and practical settings are made.

A stress inoculation training program for adolescents in a high school setting: a multiple baseline approach

This study examined the effectiveness of stress inoculation training with adolescents in a high school setting using a multiple baseline approach. Through this intervention procedure, youths were trained in cognitive restructuring, anxiety management, and problem solving skills. Self-reports of state and trait anxiety were gathered during baseline and each training session. Five of the six youths displayed improvement on state and trait anxiety scores with the initiation of treatment. In addition, significant improvements were noted on pre- to post-assessments of state and trait anxiety and trait anger. Non-significant decreases were evident on self-reports of total, daily, and major negative stress events. No changes occurred on measures of depression, self-esteem, and anger expression. Similar patterns were obtained at a 3 month follow-up.

Prompting and fading in the exposure treatment of compulsive checking

Compulsive checking can be treated effectively through the use of in vivo exposure with response prevention. However, the clinical application of these procedures can become quite complex. The therapist must help teach the client new coping skills for managing anxiety. However, many compulsive clients report a substantial reduction in the urge to check whenever accompanied by another adult. Therefore, the therapist must not be so intrusive as to reduce the impact of the exposure. Treatment procedures used with two clients are described to show how prompting can be useful for facilitating the early stages of exposure and how fading is essential in promoting self-control. Portable electronic communication devices were used to bridge the gap between therapist-assisted and self-controlled exposure sessions. Therapy was successful in reducing the frequency of checking behaviors and the subjective urge to check.

The occupational stress of judges

This paper reports the results of what is believed to be the first systematic survey of the Canadian judiciary about work-related stress. County and District Court judges from four provinces who were attending an educational event on two successive years (N = 104) reported in writing, anonymously, their perceptions of the most stressful aspects of being a judge. A similar survey of their spouses (N = 48) added another perspective to the findings. The overwhelming majority of respondents reported aspects of the work itself (for example, sentencing, child custody cases, judgements, decision-making, and jury trials) as being their primary source of occupational stress. This is not in keeping with the results of most studies, which find that workers view job factors such as role conflict, employer/employee relationships, and career decisions as being more stressful than the actual work they perform. Qualitative material from individual and group interviews suggests that additional preparation and training for the bench and mechanisms for reducing isolation and improving communication might alleviate the stress experienced by judges, while helping them to cope more effectively with their increasingly complex and difficult roles.