Goals of the Session. Graduate Education. What is Coaching? STRESS. STRESS: Student Tension Related to Exams, School and Stress

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1 STRESS: Student Tension Related to Exams, School and Stress Navigating Your DPT Experience and Beyond through Coaching and Mindfulness Goals of the Session 1) Present dataon the impact of coaching techniques to reduce perceived stress levels of graduate students in a doctoral physical therapy (DPT) program 2) Each participant will identify their stressors experienced in graduate education 3) Define complementary/integrative therapies for oneself and the patient population we treat 4) Experience a mini-coaching session in small groups 5) Explore the use of mindful movement exercises, such as yoga, visualization and meditation Amanda M. Heritage, PT, DPT Virtua in Motion, Voorhees New Jersey The Richard Stockton College of New Jersey Graduate Education Benefits of a graduate degree include: Intellect enhancement Personal and professional enhancement Verbal/writing skills enhancement Accelerated career opportunities Graduates are required to: Show originality Knowledge application Awareness of critical issues on a higher level than undergraduates Graduate Education in the Health Science Field Emotional and physical symptoms related to stress is greater in medical graduate students, than those in the general college population (Mullen & Costello, 2009). Stressors related to physical therapy students (Stecker, 2004): Amount of material to learn Demand to succeed in program Financial burdens Conflict with personal activities Poor physical and emotional health Anxiety Fatigue Headache Difficulties in sleeping What s being done about DPT student stress?! A recent study, Longitudinal Impact of Coaching Stress Management for Graduate Students in a Doctorate of Physical Therapy Program was conducted in order to foster coping skills, using wellness coaching, to directly impact stress. What is Coaching? Emerging profession that began 25 years ago. Has roots in applied behavioral science and adult development, and more recently has embraced positive psychology. The relationship between a coach and client offers a profound level of support, guidance, and encouragement to making changes, without being judgmental. A coach enables change by focusing on a client's: stated needs values vision goals helping to bring out his/her personal best. 1

2 Purpose Observe the impact and sustainability of coaching techniques to reduce perceived stress levels of graduate students in a DPT program. We hypothesized that the intervention would reduce student stress and be sustained throughout the following year. A convenience cohort sample of 20 first-year graduate students were recruited from an accredited DPT program in southern NJ. Subjects Methods Coaching Sessions Participants completed pre-post surveys for each of three consecutive semesters on measures of stress and self-efficacy. Instruments included: Student Stress Scale (SSS) Perceived Stress Scale (PSS) Exercise Self-Efficiency Scale (ESES) Circle of Life Assessment Open-ended questions were completed to discern specific personal achievements. Initial Coaching Sessions Initial Semester: 75 minute sessions Total of 7 sessions Follow Up Coaching Sessions Following 2 Semesters: Small mini coaching sessions 10 to 15 minute weekly Formal and informal reminders Coaching Sessions Coaching sessions included: Visualization techniques Breathing Yoga Tai-Chi Discussion groups Defining Various Terms: Alternative, CAM and Integrative "Alternative medicine" refers to use of CAM in place of conventional medicine. "Complementary medicine" refers to use of CAM together with conventional medicine. NCCAM defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. The boundaries between CAM and conventional medicine are not absolute, and specific practices may, over time, become widely accepted. Most use of CAM by Americans is complementary. "Integrative medicine" refers to a practice that combines both conventional and CAM treatments for which there is evidence of safety and effectiveness. 2

3 Chronic LBP Depression Cancer Pre/post partum Stress Management Diabetes Arthritis Pediatric/Adolescent Application Evidence for Yoga Evidence for Tai Chi HIV/AIDS Prevention of falls in elderly Cancer Survivors Arthritis Stress Management Example of a Coaching Session Acknowledge Strength and Weakness Guidelines for your Blueprint Name something that is working for you already Name anything you are learning about in your focus area Table 1: Example of Coaching Session Health Care Topics- 55 minutes Personal health Who we are as PT students Living Will Visualization- 5 minutes Yoga/Meditation- 15 minutes Tree pose Mountain pose Discussion Details Make routine doctor appointments Why do we feel unhealthy/ stressed? Speak to parents about current living will(s) More time to improve personal health Healthy lifestyle Promote single leg stability and balance Promote strength and improved posture Something that inspires you and motivates you from within Describe the vision you want, including the feeling/experience you desire when its fulfilled Intention Set realistic goals Goals are SMART (Specific, Measurable, Achievable, Realistic, Time-based) Goals Names something that may challenge your progress Example: People in your life, lack of resources, negative habits, past experiences, beliefs Challenges Make sure your affirmation is in present tense and positive I am empowered to I am becoming Affirmation I now allow myself to Visualization Imagine yourself successfully fulfilling your goal Engage all senses and tap into what your body feels physically and emotionally, as if you have achieved you goal Results-Demographics A total of twenty students completed the coaching program over two years. 14 female and 6 male students years old (average age=23 years old) All students were naïve to wellness coaching modalities, including yoga, tai-chi, meditation. Average attendance was 80% for all students. No student dropped out of the initial coaching session Results- Student Stress Scale The SSS, showed a significant effect for pre vs. post F (1, 17) =10.57; p=.005, indicating that students stress scores declined following the intervention. An orthogonal decomposition of trend components was conducted in order to determine the form of the interaction. The linear by linear decomposition was significant F (1, 17) =4.871 p=.041 accounting for over 86% of the sums of squares of the interaction 3

4 Results-Perceived Stress Scale The PSS, showed significant effects for all the component variables semester F(2,36)=4.366; p=.02, pre-post F(1,18)=7.969 p=.011 and the semester by pre-post interaction F(2,36)=6.643 p=.004. semester by pre-post interaction term was also decomposed the linear by linear trend component F (1, 17) p=.01, accounted for over 73% of the interaction sums. There were no significant findings for the ESES. Results- Qualitative Frequent responses from open-ended questions regarding the perceived benefit of coaching included: Positive ability to manage stressors Improve physical activity Enhanced ability to relate with others. Actual reported changes and improvements included: Less stress, more exercise Healthier eating and weight loss. Discussion An initial 7-week wellness coaching program demonstrated improvements in student stress and perceived stress. The second semester decrease in pre-post stress The third semester: decreased pre-post stress scores, compared to the first 2 semesters Results suggest students had integrated the various coaching stress management techniques into their student lives. Limitations Small sample size. Lack of a control group (comparative group). Coaching in a group setting may improve student s ability to manage stress, however research has identified social support alone may confirm participant s ability to express emotions and disclose personal struggles, therefore enhancing psychological and physical well-being. Social support cannot be ruled out. Other variables that could impact stress cannot be ruled out. Conclusion A 7-week wellness coaching program based on the Circle of Life Health and Wellness Coaching System demonstrated continued positive trends: student stress and perceived stress These preliminary quantitative and qualitative results begin to identify the use of coaching for stress management. Future Research Spread awareness to professors and students navigating the challenges of DPT programs. Future research may compare mindfulness training to a traditional social support group. Further clinical trials are necessary to confirm the results of this study. Future research with carefully designed controls will efficiently study the true effect of coaching on graduate DPT. 4

5 For More Information on CAM Overall, coaching improved students abilities to identify stressors, which allowed them to decrease stress levels, ultimately having greater control of their daily lives as graduate students. The NCCAM Clearinghouse provides information on CAM and NCCAM, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners. Toll-free in the U.S.: TTY (for deaf and hard-of-hearing callers): Web site: nccam.nih.gov Office of Dietary Supplements (ODS): Web site: ods.od.nih.gov U.S. Food and Drug Administration (FDA) Center for Food Safety and Applied Nutrition Web site: Toll-free in the U.S.: Information includes Tips for the Savvy Supplement User: Making Informed Decisions and Evaluating Information and updated safety information on supplements. If you have experienced an adverse effect from a supplement, you can report it to the FDA's MedWatch program, which collects and monitors such information ( ). PubMed A service of the National Library of Medicine (NLM), PubMed contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. CAM on PubMed, developed jointly by NCCAM and NLM, is a subset of the PubMed system and focuses on the topic of CAM. Web site: CAM on PubMed : nccam.nih.gov/research/camonpubmed/ NIH National Library of Medicine's MedlinePlus: Web site: References References Bandura, A. (2006). Guide to the construction of self-efficacy scales. In Pajares, F., & Urdan, T., (Eds.), Self-efficacy Beliefs of Adolescents ( ). Greenwich, CT: Information Age Publishing. Berkman, L. (1995). The role of social relations in health promotion. Psychosomat. Med. 57: Cohen, S., Kamarck, T. & Mermelstein, R. (1983) A global measure of perceived stress. 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