Mahbobeh Chinaveh* Department of Psychology, Arsenjan Branch, Islamic Azad University, Iran

Transcription

1 Available online at Procedia - Social and Behavioral Scienc es 84 ( 2013 ) rd World Conference on Psychology, Counselling and Guidance (WCPCG-2012) The Effectiveness of Multiple Stress Management Intervention on the Level of Stress, and Coping Responses Among Iranian Students Mahbobeh Chinaveh* Department of Psychology, Arsenjan Branch, Islamic Azad University, Iran Abstract This study examined the effects of multiple stress management intervention (MSMI) on coping responses, and stress symptoms among Iranian students. Sixty students with high scores for avoidance responses, stress and low scores for approach responses were randomly assigned to one of two groups: the experimental group or the control group. During the 8-week period, sixteen 2-hour session interventions were conducted for the experimental group. Both groups responded to a measures) was conducted to determine the effect of the MSMI on the dependent variables. Significant differences were 2 To examine the durability (stability) of MSMI effectiveness, repeated measure analyses of variance were performed on the stress, and coping response variables. The results showed that the effects of MSMI are stable over time. These findings indicate that multiple stress management intervention has a positive effect on coping responses, and stress The Authors. Published by Elsevier Ltd. Open access under CC BY-NC-ND license. Selection 2013 Published and peer-review by Elsevier under Ltd. responsibility Selection and of peer Prof. review Dr. Huseyin under Uzunboylu the responsibility & Dr. Mukaddes of Dr. Melehat Demirok, Halat Near East University, Cyprus Keywords: Stress management; stress; coping responses 1. Introduction correlate or predictor of psychological and health outcomes (Cohen, Kessler, Gordon, 1995; Dougall & Baum, 2001). Psychological stress has been found to be associated with a variety of ailments and health outcomes in adolescents, including poor general physical health (Baldwin, Harris, & Chambliss, 1997), depressive symptoms (Unger et al., 2001), and smoking initiation, continued smoking, or relapse into smoking following smoking cessation treatment (Byrne & Mazanov, 2001; Wills, Sandy, & Yaeger, 2002). Associations have been found between stress, coping variables and aspects of health in a variety of populations (e.g., Kolen, Hartly &and Murdock, 1990; Ryan & Twibell, 2000; Henderson, 2003; Hicks, & Miller, 2006; Dolbier, Smit & Steinhardt, 2007). Many studies have indicated that large percentages of college students are feeling overwhelmed, sad, hopeless, and so depressed that they are unable to function (e.g., Veeser, Blakemore, 2006; the National Alliance for mental Health, 2005; Ryan & Twibell, 2000; Hicks & Miller, 2006). Iranian students are, of course, among those suffering from such concerns (Gholamzadeh, Passyar & Haghshenas, 2008; Moeini, Birashk, & Allahverdipour, 2008). According to Rostami and Bahrainian, (2001) 16.3% of freshman students have been diagnosed with mental - Corresponding author name: Mahbobeh Chinaveh; Tel: E mail address: chinaveh@iaua.ac.ir The Authors. Published by Elsevier Ltd. Open access under CC BY-NC-ND license. Selection and peer-review under responsibility of Prof. Dr. Huseyin Uzunboylu & Dr. Mukaddes Demirok, Near East University, Cyprus doi: /j.sbspro

2 594 Mahbobeh Chinaveh / Procedia - Social and Behavioral Sciences 84 ( 2013 ) disorders. Additionally, 37.6% of college students reported emotional disorders, and 27.5% of them reported experiencing anxiety disorders during (Ferdusi, 2004). Successfully handling these events can help students acquire new tools for everyday life. However, continued struggles can result in more persistent signs of anxiety, depression, and isolation that need treatment. The ability to manage and control stress is a useful skill for student life but also for life beyond the university. 2. Theoretical Framework of Study The Multiple Stress Management Intervention (MSMI) framework is underpinned by a transactional model of stress and coping (Lazarus and Folkman,1984), a model of the interaction between context, coping and adaptation (Moos& Hallahan, 2003), and the multimodal transactional model of stress (Palmer& Dryden, 1995). Lazarus and Folkman (1984) stated that whether or not stimuli are stressful depends on a person's "cognitive appraisal," a process that translates objective events into perceptual experiences. When a person appraises an objective event as harmful, he or she may still attempt to cope with it; that is, he or she may make behavioral efforts to reduce and master related internal and/or external demands. A person who fails to cope with harmful stimuli might suffer from mental or physical exhaustion or disease. The model by Moos and Hallahan, (2003) stipulates that (a) ongoing environmental and personal factors foreshadow transitory conditions, such as new life events and participation in intervention and treatment programs; and (b) these three sets of factors shape cognitive appraisal and coping skills. In turn, appraisal coping skills influence individual health and well-being. The framework emphasizes the key role of cognitive appraisal and coping skills in the stress and coping process. The working model of stress used by Palmer and Dryden, (1995) that has been adapted for stress counseling is known as "transactional." This model provides a simple but realistic explanation of the complicated nature of stress as it addresses the interrelationship between the internal and external worlds of individuals. Palmer and Dryden (1995) modified the transactional Lazarus believes that the entire range of personality can be covered within seven specific modalities (Lazarus 1981, 1989): Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal, and Drugs/Biology. This helps the therapist to achieve a holistic understanding of an individual. The MSMI based on these three models attempts to change and correct cognitive appraisal and responses to stress. The goals of the intervention are: (a) to help students understand the components of stress and how stress operates in their lives; (b) to provide a structured opportunity for students to learn, practice, and apply management techniques and strategies for change to their lives; and (c) to promote healthy methods of managing stress. 3. Method 3.1. Design This study employed an experimental design of experimental and control groups with pre- and post-tests. The subjects of this study were sixty students selected from four academic majors: Human Science, Natural Science, Medical Science and Engineering. Participants were assigned to the experimental and control groups by random assignment and were given University stress student (USSI), Coping responses (CRI) and Type-A behavior (TABI) inventories as a pretest on dependent variables, Y1. Multiple stress management was only conducted for the experimental subjects over an eight-week period of time from May until June of The dependent variables for the two groups were measured by the three inventories mentioned above, after they finished the treatment. The average difference between the pre-test and post-test (Y2 Y1) was found for each group, and then these average difference scores were compared in order to ascertain whether the experimental treatment produced a greater change than the control situation.

3 Mahbobeh Chinaveh / Procedia - Social and Behavioral Sciences 84 ( 2013 ) Participants Sixty students with high scores for avoidance responses, stress level, and low scores for approach responses were selected to participate in the following experiment. Consequently, these students were randomly assigned to one of two groups: thirty undergraduate students were recruited to participate in the multiple stress management programs (17 males and 13 females), and thirty students were recruited as a control group (17 males and 13 females). The mean age for students in the MSMI was 21.3 years (19-34), and that for students in the control group was 21.7 (19-34). For both groups, the questionnaires were administered twice, before and after the intervention Instruments The Coping Responses Inventory (CRI) developed by Moos (2004) was selected to assess participant coping responses. The coping responses inventory assessed two different types of coping responses related to responses into approach and avoidance responses and each of two categories reflects cognitive and behavioral coping strategies. For example, "Did you think of different ways to deal with the problem" and "Did you try to forget the whole thing". When responding to the CRI, individuals select a four-point scale varying fro The University Student Stress Inventory (USSI) was designed to identify and assess specific sources of intra/inter-personal (eg. I am confident in my ability to make choices consistent with my value) and academic stress (eg. I am able to organize my time effectively) that affects mental health in association with poor health and physical -item USSI, checking items that made t them (from not at all to always) The MSMI was administered for an eight-week period with two 2-hour sessions per week, and there was typically a 15-person limit per session. The MSMI involved didactic teaching components as well as learning exercises and homework assignments. The objective of the MSMI is to ensure that the client develops the capacity to effectively execute coping responses. The coping skills that are taught vary with the specific population and with the goals of the training. The coping techniques to be taught include what Moos (2004) called Approach and Avoidance Coping Responses. Approach Coping Responses include techniques such as information-gathering, problem-solving, communication and social skills training, time management, and life-style changes used to adjust to environmental demands or to alter stressful situations and transactions. The techniques fall into five categories, so the MSMI includes five modules. Module A The Nature of Stress: defined stress and introduced the causes and implications of stress. This module also attempted to help students to become aware of the signs and symptoms of stress early, prevent stress, identify potential sources of stress, develop an awareness that they could cope with stress, and learn how such responses can become maladaptive. Moreover, this module helped students to identify their own optimal level of stress. Module B Relaxation training: The procedure for relaxation training was as follows. On the first day of relaxation training, the instructor explained and practiced breathing exercises. Breathing exercises have been found to be effective in reducing generalized anxiety disorders, panic attacks and agoraphobia, depression, irritability, muscle tension, headaches, and fatigue. These exercises are used in the treatment and prevention of breath-holding, hyperventilation, shallow breathing, and cold hands and feet (Davis, et al. 1995). This part was divided up into four sections: (a) breathing for awareness and relaxation, (b) breathing to release tension, (c) breathing to stimulate alertness, and (d) breathing for symptom control. Most people do not realize which of their muscles are chronically tense. Progressive relaxation provides a way of identifying particular muscles and muscle groups and distinguishing between the sensations of tension and deep relaxation. Four major categories were covered: (a) progressive muscle relaxation, including tensing and relaxing muscles of the legs and arms, shoulders, face, and whole body; (b) abdominal respiration; (c) meditation, including imagining a special place where one can relax; (d) stretching arms

4 596 Mahbobeh Chinaveh / Procedia - Social and Behavioral Sciences 84 ( 2013 ) and getting up. Calm instrumental music was used as the background. Relaxation exercises were started in session 5, and then repeated at each session for 20 minutes, until the end of the sessions (session 16). Module C Cognitive Skills: The first of the cognitive interventions was cognitive restructuring. The cognitive second was refuting irrational ideas. Albert Ellis (1975) developed a system to attack irrational ideas or beliefs and replace them with realistic statements about the world. The third was problem-solving. As in the case of cognitive therapy, much has been written about the use of problem-solving training as a means of enh problem solving can serve as a useful alternative to worry. Focusing on solving problems step-by-step can help participants realize that they do not have to use worry to ensure successful outcomes. The final technique used in this module was thoughts that help cope with stress. Coping skills training taught students to relax away anxiety and stress. The basic procedures were formulated by Suinn and Richardson in 1971 as outgrowths of Wolpe's work with deep muscle relaxation and systematic desensitization. Module D Affect skills: This module focuses on identifying feelings, which are an important part of any problem. Anger is a perfectly normal emotion or feeling that everyone experiences, but it becomes a problem when it is poorly managed. This module introduced anger and anxiety management techniques, which have been shown to be effective in reducing both anger and anxiety. Module E Behavioral skills: In this module, students were trained in assertiveness, time management and selfmonitoring. These sessions were experimental and were designed to simulate a college student's day. Students were forced to decide what to include and what to eliminate from their daily activities. The sessions concluded with a discussion of the methods that students used to complete the task and how approaches to time management may minimize or increase stress. The last session reviewed the stress management techniques presented in the class. The trainer provided a summary of how the different techniques impact the interaction response modalities and of their effects on mental health. This activity was conducted using the psycho-educational technique. Table 1 contains an overview of the session topics, all of which were facilitated by the same therapist. Table1. Contents of the multiple stress management intervention. Session Activity Module 1 Understanding Stress A: The nature of stress 2 How you React to Stress 3 Body Awareness 4 Breathing B: Relaxation training 5 Progressive Relaxation 6 Cognitive restructuring C: Cognitive Skills 7 Refuting Irrational ideas 8 Problem solving training 9 Thought stopping 10 Identifying feeling D: Affect Skills 11 Anxiety management 12 Anger management 13 Assertiveness training E: Behavioral skills 14 Goal setting and time management 15 Self-monitoring and Self reward 16 Health education, Review of the stress management intervention 3.4. Procedure During the spring term of 2007, we administered a battery of questionnaires (see above) at ten universities in the Fars province of Iran in order to assess the validity and reliability of the questionnaires. From the initial sample of 578 (after the measures had been scored), 60 students who had high scores for stress, type-a behavior, avoidance

5 Mahbobeh Chinaveh / Procedia - Social and Behavioral Sciences 84 ( 2013 ) responses, and mental health and low scores for approach responses were selected and invited to attend weekly stress management sessions for eight weeks. From April to June (2008), intervention was administered without a break and students were again asked to complete the second set of questionnaires. After one month, a third set of questionnaires was distributed. 4. Results The participants were 34 male and 26 female university students (for both the experimental and control groups). Normality and homogeneity, which underlie MANOVA, were obtained. Table 2 shows the findings of Box's M test, which we can use to see the homogeneity of the co-variance matrices of the dependent variables. The findings show that the covariance matrices of dependent variables are equal. This is shown by the F value= and p=.087>.05. These results allowed the MANOVA to be used to analyze the level differences between the experimental and control groups for stress, approach and avoidant responses. In order to analyze the effect of stress management training, gain scores for the differences between pre- and post-scores were computed (gain score = post-score prescore). Then, a mu determine the effect of the MSMI on the gain scores of the three dependent variables. The preliminary results of the MANOVA test as shown in Table 2 yielded the resul in the dependent measures were found between the two groups. The experimental group analysis not only indicates 2 approach response levels, but also indicates a lower level of avoidance response affected coping responses, stress. The results also indicated significant interactions between groups and variables Table2. MANOVA Conducted on Groups and Dependent Variables. Effect N Wilks' F DF1 DF2 sig Groups Experimental Control 30 Table3. Interaction Effect of Groups and Variables Source Df F Sig Variable group To examine the durability (stability) of MSMI effectiveness, repeated measure analyses of variance were performed on the stress, and coping response variables. Group (experimental vs. control) served as the betweengroups variable and time (pretest, posttest1 and postest2) as the within-groups variable. Table 7 shows the mean and standard deviation of pre-test, post-test 1 and post-test 2.The results showed that the main effects of the stress management training were significant. There were significant differences between the experimental and the control group in post-test 1 (F (1, 58) = , p=.000) and post-test 2 (F (1, 58) = , p=.000), but there was no significant difference in the pre- -test vs. post-test 1 interaction in terms of approach responses -test 1 vs. post-test 2 interaction was not significant. The interaction was not significant. The -A behavior was

6 598 Mahbobeh Chinaveh / Procedia - Social and Behavioral Sciences 84 ( 2013 ) posttest2 interaction was not significant. Figure 3 shows the interaction effects of group, pretest, posttest1 and posttest2. Simple main effects tests indicated that approach response scores significantly improved from pretest to decreased from pretest to posttest1 in the experimental group. However, there were no significant differences between posttest1 and posttest2 for any measures in this study. 5. Conclusion This study showed that multiple stress management intervention influenced stress, coping responses. Multivariate results indicated that significant interaction did occur between these dependent variables and the treatment. In comparison with the control group, students who received the MSMI had higher scores for approach responses and lower scores for avoidance responses, stress. These findings are consistent with those from worksite stress management in adult organizations (e.g., Hirokawa, Yagi & Miyata, 2002; Romano, 1984; Bond & Bunce, 2000). Even though this study showed that MSMI reduced stress and type-a behavior, the fact that different mechanisms mediate such effects suggests that this intervention worked on a number of different, possibly independent, levels. If, as was found in the current study, reductions in stress and type-a behaviors occur via different mechanisms, it would be interesting to determine which aspects of the intervention reduce stress and which affect type-a behavior. If the current results are reliable, then they have a number of theoretical and practical implications. The analysis of the data showed that the MSMI is brief and has positive effects. It confirms that the strategies work and those students can continue any of these activities. On a more practical level, if MSMI can help students to manage stress better and be more mentally healthy, it is likely that students will get more out of their education. These findings are unique in that they examine the effectiveness of MSMI in Iranian students. Thus, this program is suggested as coursework for Iranian students, as an instructional classroom intervention that has been designed, implemented, and evaluated to help adults learn strategies to alter potentially harmful life-style habits. Because college students are forming adult life-styles, this coursework would be particularly appropriate for them. Baldwin, D. R., Harris, S. M., & Chambliss, L. N. (1997). Stress and illness in adolescence: Issues of race and gender. Adolescence, 32, Acknowledgements The author would like to thank the Islamic Azad University-Arsanjan Branch for financial support. The author is grateful to the all of students and staff who participated in this study. References Beck, A. (1984). Cognitive approaches to stress. In R. Woolfolk & P. Leher (Eds.), Principles and practice of stress management. New York: Guilford Press. Bond, F. w., & Dryden, W. (Eds.) (2002). Handbook of brief cognitive behavior therapy. Chichester: Wiley. Bond, F. w., & Bunce, D. (2000). Mediators of change in emotion-focused and problem-focuse worksite stress management interventions. Journal of Occupational Health Psychology, 5, Brantly, P. J., & Ames, S. C. (2001). Psychology of health and disease. In P. B. Sutker & H. E. Adams (Eds.), Comprehensive handbook of psychopathology (pp ). New York: Plenum. Byrne, D. G., & Mazanov, J. (2001). Self-esteem, stress and cigarette smoking in adolescents. Stress and Health, 17, Chinaveh, M., Noriah, I. (2008). Coping Responses as a Mediator to Type-A Personality in Promoting General Health: A Path Analysis of Predictive Factors. XXIX International Congress Psychology, July, Berline.

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