Abstract
The purpose of this study was to determine whether differing stress reduction interventions could alter stress levels experienced by male and female college students from the beginning to the end of a semester. Components of stress examined included overall perceived stress, test anxiety, and personal burnout. Participants (N = 531) were part of courses that during the course of a 16-week semester focused specifically on cognitive–behavioral stress management, cardiovascular fitness, generalized physical activity, or a control with no intervention. In addition to gender differences, both the stress management and physical activity groups had significantly lower levels of perceived stress, test anxiety, and personal burnout at the end of the semester. The fitness group scored significantly lower on perceived stress and personal burnout, but there was no difference in scores for test anxiety. The important ramifications of reducing stress in college students are discussed, including the pros and cons of implementing differing physical and psychological intervention modalities.
Stress is an inevitable aspect of a college student’s life, and its sources are numerous and diverse (Brown, 1992). This is in part due to society’s tendency to consider college entrance as the demarcation to the onset of adulthood; thus, it is assumed that a sudden increase in one’s level of maturity has taken place, enabling students to easily handle the college experience (Ferrante, Etzel, & Lantz, 2002). However, developmental specialists consider the age range from 18 to 24, categorized as “late adolescence,” to be fraught with issues such as autonomy from parents, leaving home, self-sufficiency, gender identity, internalized moral reasoning, and career choice (Newman & Newman, 2003). Regardless of the perspective taken, college students are moving into and through a major developmental period of transition (Darling, McWey, Howard, & Olmstead, 2007). Any or all of these factors can lead to students feeling as if they do not have enough time or energy to cope with the responsibilities associated with the collegiate experience. Thus, as they grapple with increased academic, personal, social, and moral pressures in their lives, these stressors may lead to increased anxiety, loneliness, depression, hopelessness, headaches, sleep disturbances, colds, and sometimes suicidal ideations (Kelley, 1993; O’Donovan & Hughes, 2008). Evidence shows that some college students are able to adjust to the overwhelming challenges that arise from this new life experience, whereas others struggle with the escalating stress. This article addresses research on health promotion education interventions for stress reduction among college students, and the implications for health promotion practice in postsecondary education settings are identified.
The Stress Process
Stress comes in many forms, and college students are not immune. It is a process whereby a stressor creates a demand and an individual must respond or react to its demands. It is a transaction between the environment or situation and the person, which results in the perception or cognitive appraisal that the demands of the situation exceed the individual’s resources available to meet or cope with those demands (Kelley, 1994; Lazarus, 1990). Life stressors may be transient, such as annoying everyday hassles, or more long term and potentially traumatic.
Response to such stressors is influenced by both the way in which events are appraised and an individual’s effective response capacity. People who sense that they have the ability and the resources to cope are more likely to take stressors in stride and take action constructively. However, experiences that consistently lead to a negative stress appraisal can cause both physical and psychological problems over time (Kelley, 2007; Pretzer, Beck, & Newman, 2002).
Stress and College Students
Stress is commonly experienced by college students and can negatively affect their overall health and wellness through a number of ways (e.g., Abouserie, 1994; Chang, 2006; Dwyer & Cummings, 2001; Everson, Tobias, Hartman, & Gourgey, 1993; Gan, Shang, & Zhang, 2007; Giesecke, 1987; Hall, Chipperfield, Perry, Ruthig, & Goetz, 2006; Hudd et al., 2000; Jacobs & Dodd, 2003; Labbe, Murphy, & O’Brian, 1997; Misra & McKean, 2000; Nathan, 2006; Rayle & Chung, 2007; Weidner, Kohlmann, Dotzauer, & Burns, 1996).
Cognitive interpretation or perception of stress in a person’s life will generally have both physiological and psychological effects. Some of the negative physiological consequences of ongoing stress include hypertension, high levels of muscle tension, and lowering of immune system defenses (e.g., Friedman & Berger, 1991; Kelley, 1994; Methany, Aycock, Pugh, Curlette, & Silva Cannella, 1986). Psychological effects such as anxiety, depression, interpersonal problems, and ineffective cognitive processes may also be manifested (e.g., Berger, Friedman, & Eaton, 1988; Kelley & Gill, 1993).
Psychological Interventions and Stress
Researchers have examined the effectiveness that stress inoculation and skill development training has on stress levels, concluding that meditation and relaxation along with many other psychological variables can be as effective in reducing stress as exercise (Bahrke & Morgan, 1978; Bruning & Frew, 1987; Decker & Russell, 1981; Deckro et al., 2002; Hains & Szyjakowski, 1990; Long, 1988; Long & Haney, 1988; Quick, 1979; Macan, Shanani, Dipboye, & Phillips, 1990; Misra & McKean, 2000; Russell, 1992; Schwartz, Davidson, & Goleman, 1978; Winstead, Derlega, Lewis, Sanchez-Hucles, & Clarke, 1992; Yorde & Witmer, 1980). Thus, in general, any training designed specifically to improve skills that might mediate, buffer, and lower stress has the potential to be successful. However, whether one strategy is more successful than another has not been well tested.
Physical Activity and Stress
Physical activity is one simple, yet effective means to reduce stress. For example, Brown (1992) reported that physical activity and fitness helped mediate the effects of negative stress in a sample of college students, whereas leisure time physical activity was enough to decrease the effects of daily stressors in undergraduate college students (Carmack, Bourreaux, Amaral-Melendez, Brantley, & de Moor, 1999; Nguyen-Michel, Unger, Hamilton, & Spruijt-Metz, 2006). It is interesting to note that exercise participation can be positively influenced by knowledge concerning the benefits of exercise, which include stress reduction (Katz, Davis, & Findlay, 2002; Makrides, Veinot, Richard, McKee, & Gallivan, 1998). This suggests that education and dissemination of the relationship between physical activity and stress would be beneficial for college students.
Although physical activity is important to well-being, cardiovascular exercise (here defined as vigorous physical activity) can be more effective in reducing the effects of physiological and psychological stress (Berger & Owen, 1988; Crews & Landers, 1987; Long & Haney, 1988; Norris, Carroll, & Cochrane, 1990; Schwartz et al., 1978). For example, early research studies (e.g., Keller & Seraganian, 1984; Sinyor, Schwartz, Peronnet, Brisson, & Seraganian, 1983) found that fit participants were able to recover more quickly from a stressor. It was posited that those fit participants may have developed a physical conditioning that allowed them to more quickly cope with the emotional stressors. A meta-analysis by Crews and Landers (1987) reported that aerobically fit subjects were more immune to the psychosocial stress response. Thus, exercise may act as a coping strategy that reduces the physiological response to stress and may also function as a protector by helping to create more effective responses to psychosocial and emotional stress. More recently, VanKim and Nelson (2013) found that among a large sample of almost 15,000 students, those who met vigorous physical activity guidelines had lower levels of perceived stress and were less likely to report poor mental health than those students who were not meeting guidelines for vigorous physical activity.
Combination Treatments and Stress
Unfortunately, very few research studies have attempted to determine whether one treatment is more effective than another within the same study. This highlights the importance of the present research study in delineating between which method or strategy might be the most effective stress reducer. In one of the very few experiments with college students, Berger et al. (1988) compared exercise, relaxation response, social interaction, and a no-treatment control group. Exercise and relaxation groups were found to reduce stress better than the social interaction group. However, all three treatment techniques were significantly more effective than no treatment at all.
Silvestri (1987) found that an experimental intervention consisting of both exercise and relaxation was more effective in reducing stress than exercise on its own. When examining the effects of the psychological intervention of stress inoculation training and the physiological intervention of exercise, Long (1988) found that stress inoculation training coupled with exercise was the best combination for reducing the effects of stress than either intervention alone.
Most recently, in their meta-analysis of interventions used to reduce stress among university students, Regehr, Glancy, and Pitts (2013) reported that a myriad of interventions could be successful in reducing anxiety, depression, and cortisol production. Interestingly, it was reported that stress reduction strategies have been focused more on females than males, and further research on stress reduction strategies for males is warranted.
Purpose for Present Research
Stress is a process, not a static moment in time, and a person’s appraisal of it may fluctuate, necessitating more than one coping strategy be engaged to reduce the magnitude of a negative stress appraisal (Folkman, & Lazarus, 1985; Kelley, 2007). Thus, stress reduction using only one technique may not be sufficient to elicit true reductions in negative perceptions of stress, and having a large repertoire of coping behaviors may lead to employing different strategies that may have both long- and short-term benefits. Therefore, the purpose of this study was to examine the effect of the intervention approaches of stress management, cardiovascular fitness, and physical activity on the stress levels of college students over the course of a 16-week semester. Participants were assessed on the stress variables Perceived Stress, Test Anxiety, and Personal Burnout. It was hypothesized that stress levels (perceived stress, test anxiety, and burnout) would (1) show the greatest reduction in the Stress Management group, (2) be lower at the end of the semester compared to the beginning for all treatment groups, and (3) be higher at the end of the semester compared to the beginning for the Control group.
Method
Participant Characteristics
Participants were 531 male (n = 293) and female (n = 238) college students of all levels (freshman, sophomore, junior, and senior) from a large Midwestern university. Participants were from existing courses within the university curriculum in the major areas of Stress Management (SM), Physical Activity (PA), and Cardiovascular Fitness (CV). An additional Control group (C) was compiled from various academic courses (history, sociology, and geography) with no emphasis on stress, fitness, or activity. The Control group was not assessed for any self-selected activity that they may have participated in during the study.
For participants to be included in the study, they had to have completed survey packets at both data collection periods (beginning and end of the semester) and not be enrolled presently or previously in any of the intact treatment courses. Participants that did not meet all inclusion criteria were dropped from the study (n = 70). The final participation rate was 88% for the SM (n = 124), CV (n = 131), PA (n = 144), and C (n = 132) groups for a total of 531 students.
Measures
Perceived Stress
Overall perceived stress was assessed via the Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983). The PSS measures perceived stress including items assessing control, overload, as well as thoughts and feelings of stressful events and experiences. The scale assessed responses to items with respect to how respondents “usually felt over the past 3 weeks” or thought about each item. Students used a Likert-type scale (1 = never to 5 = very often) to estimate “how often” they thought or felt a certain way for each of the 14 items, and then a total score was calculated from these responses. The PSS is a short-term assessment of stress perception (e.g., “In general, how often have you felt that you were unable to control important things in your life?”). Good reliability for the PSS (.85) has been found in previous research (Kelley, 1994), and validity was established with a strong correlation between the PSS (r = .89) and the trait portion of the State-Trait Anxiety Inventory Form Y (Spielberger, 1983). In the present study alpha coefficients were .91 and .93 for the beginning and end of the semester, respectively, well above the .70 criterion suggested by Nunnally (1978).
Test Anxiety
The Test Anxiety Survey (TAS) was modified from the 15-item Sport Competitive Anxiety Test (Martens, Vealey, & Burton, 1990) to assess the anxiety students experience as a result of having to perform in a test- or exam-taking situation in class. The word test was substituted for compete and competition to increase face validity for the participants (Kelley, 1996). Students also responded to statements on a 5-point Likert-type scale from hardly ever to often, rather than the original 3-point scale in order to be synonymous with scoring of other scales. This helps eliminate selection errors by the participants that are often caused by making the cognitive shift back and forth between different Likert-type–formatted surveys (Kelley, Hoffman, Gill, & Kang, 1988).
The survey focused on “How often do you feel this way when you take a test?” For example, one statement was, “Before I take a test I feel uneasy.” Similar to the measures for perceived stress, the individual items were summed together to obtain a total. The survey was designed to draw on the work of Martens et al. (1990) in identifying personal trait anxiety in association with the role of a student in a performance and competitive task of test taking. The TAS had an alpha coefficient of .79 and .81 for the beginning and end of the semester, respectively.
Personal Burnout
The Personal Burnout Scale (PBS; Kelley, 2007) is a 10-item scale designed as an applied measure of a general sense of burnout. Items in which “work” or “work-related” factors were the focus were modified to emphasize a “class-” or “coursework”-related focus (e.g., “I am becoming increasingly frustrated with class related responsibilities”) to increase the face validity of the instrument for college students. Participants were asked to rate how characteristic each statement was in describing how they were feeling right now or have felt recently on a 5-point Likert-type scale of not very characteristic at all to very characteristic. The PBS has demonstrated good reliability (Kelley, 2007), and alpha coefficients were .82 and .84 for the two data collection periods.
Treatment Groups
There were some predetermined commonalities between all groups. Recruited participants were enrolled in three credit hour classes that could be applied toward fulfilling the general education requirements of the university. All classes met 3 days a week for 50 minutes on a Monday, Wednesday, and Friday schedule. All instructors agreed to provide the incentive of extra credit for those students that agreed to participate in the study. To avoid any coercion, each instructor also provided an alternative means to obtain the same extra credit value. Groups were randomly assigned to a treatment.
Stress Management
The SM groups divided their time between lectures (25%); cognitive–behavioral exercises, concepts, and hands-on participation (25%); mental and physical relaxation strategies, techniques instruction, and practice (25%); and exercise and wellness participation (25%). Each student was provided with a 170-page workbook titled “Exploring Your Stress: An Introductory Program” designed specifically for the study and used as the course textbook. It comprised 13 chapters and 164 exercises and activities. The chapters in the workbook were: (1) Introduction to Stress, (2) Stress and Burnout Assessment, (3) Health and Well-Being, (4) Thought Management, (5) Coping, 6) Communication, (7) Psychological Needs and Social Support, (8) Values and Time Management, (9) Goal Setting, (10) Lifestyle Balance, (11) Stress Ideas and Suggestions, (12) Fifteen Ways to Relax and Control Emotions, and (13) Reassessment and Future Planning. They also received a professionally developed and produced narrated guidance over a music background for Progressive Muscle Relaxation and Autogenic Relaxation. Various handouts, brochures, and cartoons related to the course content were handed out as supplemental material. In addition, students were encouraged to bring in articles they found in magazines, newsletters, or other literature not used in the course.
Physical Activity
The PA groups spent approximately 25% of their time in lectures and 75% in activities. Lectures contained informational facets that covered an introduction, history, biomechanics, technique, strategy, and safety of that particular activity. Classes were offered for a tremendous array of sports and games, and individuals signed up based on the activities they wanted to participate in. The activities that were represented included basketball, volleyball, badminton, table tennis, martial arts, tennis, racquetball, softball, bowling, soccer, and touch football. The purpose of the physical activity classes was to provide students with an opportunity to learn a new sport or activity that they might wish to pursue as a lifelong activity. Although there was an imbedded fitness component, skill development was the primary objective.
Cardiovascular Fitness
The CF groups also spent approximately 25% of their time in lectures and 75% in activities. Lecture content included pre and post fitness assessments, exercise physiology, biomechanics, exercise psychology, personal program development, and safety. Both aerobic and anaerobic fitness were emphasized, and the focus was improving physical fitness over participating in a sport, which distinguishes this group from the PA Group.
Procedures
Following institutional review board approval, participants were recruited from university courses that fit the intervention parameters needed for the study. All courses were scheduled for the full 16-week semester. For all groups, the course instructors were contacted and permission requested to come to their class and recruit participants. During the first week of the class, an investigator attended and addressed the class members at the beginning of the class period. Participants were read a statement of the general purpose of the study, requirements of participation, and informed consent. Survey packets contained the following: (1) cover letter, (2) demographic survey, (3) PSS, (4) TAS, (5) PBS, and (6) informed consent form. Participants completed the survey during that class, and this process was repeated at the end of the semester during the last week of classes before finals.
For the SM courses, a cognitive–behavioral workbook curriculum was developed in which participants completed the designated surveys at the beginning and end of the semester as part of their workbook assignments for the course. An investigator attended the classes at the end of the semester and collected the completed pre–post surveys from their workbooks.
Except for the SM class, an instructor attended each of the selected classes during the second week of the semester and gave a 30-minute stress management and test anxiety reduction presentation. At the end of the presentation, a packet of materials was provided with information from the presentation with additional information and exercises. There was no follow-up presentation, and students were left to read and practice the material on their own.
Results
Descriptive Analyses
Prior to analyses, data were screened for missing values and violation of assumptions. There were no missing data. All regression assumptions were examined for these data, including linearity, normality, and homogeneity of variance. At baseline, students were equally grouped with respect to gender, race, and age.
Of the male (n = 220) and female (n = 311) students who participated, 25% were freshmen, 18% sophomores, 19% juniors, and 38% seniors, with a mean age of 21.4 years. Participants were primarily Caucasian (78%) and African American (15%) by ethnicity. Most reported that they were single (91%). Almost half (47%) participated in a regular program of exercise, and 45% reported using exercise as a means of reducing their stress.
Demographic Variables
Correlation analyses were used to examine relationships between the demographic variables of race, age, class in school, living arrangement (e.g., dorm, apartment), number of roommates, participation in a regular exercise program, whether they exercised to reduce stress, and strength of religious beliefs to the three stress indices (perceived stress, personal burnout, test anxiety). Compared to nonexercisers, those participating in a regular exercise program were lower in their perceived stress levels and burnout at the beginning (r = −.13, p < .01; r = −.12, p < .01) than at the end (r = −.10, p < .01; r = −.08, p < .05). Furthermore, those who exercised specifically to reduce stress were higher in test anxiety (r = .10, p < .01; r = .10, p < .01) than those using exercise not for stress reduction but for fitness and enjoyment. Although relationships were present, multiple regression analyses revealed that the demographic variables, most notably gender and participation in an exercise program, accounted for only minimal variance in perceived stress, F(8, 531) = 3.81, p < .01, R2 = .06, and test anxiety, F(8, 459) = 3.51, p < .01, R2 = .06, at the beginning of the semester, and similarly small amounts in perceived stress, F(8, 531) = 2.67, p < .01, R2 = .04, and test anxiety, F(8, 531) = 2.75, p < .01, R2 = .04, at the end of the semester.
Group by Time of Semester Differences
A 4 × 2 Group (SM, PA, CF, C) by Time (beginning, end of semester) repeated-measures multivariate analysis of variance was conducted with perceived stress, test anxiety, and personal burnout as the dependent measures. Results (see Table 1) indicated significant main effects for Group, Wilks’s Λ = .94, F(3,531) = 16.13, p < .01; Time, Wilks’s Λ = .91, F(1, 531) = 16.99, p < .01; and Group × Time interaction, Wilks’s Λ = .99, F(1, 531) = 18.04, p < .01.
Overall Means and Standard Deviations for Stress, Management, Physical Activity, Cardiovascular Fitness, and Control Groups on Stress Variables
NOTE: Higher scores indicate a greater level of stress.
p < .05.
Group Main Effect
Examination of the univariate F revealed significant differences in the overall means for perceived stress, test anxiety, and personal burnout when groups were compared to each other. In reference to perceived stress, the C group (M = 38.6) was higher than all other groups (SM, M = 35.9; PA, M = 35.0; CF, M = 35.3). The SM group (M = 33.9) was higher than the PA (M = 25.9) and CF groups (M = 28.2) on test anxiety, and the PA group was also lower than the C group (M = 31.6). The SM (M = 30.4) and PA groups (M = 28.8) were lower than the CF group (M = 33.9) on personal burnout.
Time Main Effect
Inspection of the univariate F showed a significant difference in the overall mean for perceived stress. Students were not significantly higher in perceived stress at the end of the semester (M = 35.0) than at the beginning (M = 37.4); however, this mean is moderated by an increase in perceived stress for the C group but decreases in the other three groups. Test anxiety and personal burnout were not significant (Table 2).
Means and Standard Deviations for Stress Management, Physical Activity, Cardiovascular Fitness, and Control Groups on Stress Variables for the Beginning and End of the Semester
NOTE: Higher scores indicate a greater level of stress.
p < .05.
Group × Time Interaction Effect
Review of univariate F values for Group by Time interaction showed that the SM and PA groups demonstrated significant decreases in perceived stress, test anxiety, and personal burnout from the beginning to the end of the semester. The CF group showed a significant decrease in perceived stress also but had a significant increase in personal burnout. The C group showed a significant increase in perceived stress but had no significant increase or decrease on test anxiety or personal burnout.
Discussion
Stress is a complex and multifaceted construct affected by a wide number of factors (Nguyen-Michel et al., 2006) and can be particularly evident throughout the collegiate experience (Ferrante et al., 2002). Thus, the purpose of this study was to determine whether differing stress reduction interventions could reduce the stress levels experienced by male and female college students from the beginning to the end of a semester.
With respect to our first hypothesis, it was predicted that stress levels for perceived stress, test anxiety, and burnout would show the greatest reduction over the semester in the SM group, which we classified as a comprehensive, global intervention. Interestingly, both the SM group and the PA group demonstrated significant decreases in all three variables; however, as hypothesized, the reduction in stress indices was greater, if only slightly, in the SM group. This finding is supported by previous research indicating that broad, universal interventions with a strong cognitive–behavioral component can be highly effective in reducing stress indices (Bahrke & Morgan, 1978; Berger et al., 1988; Deckro et al., 2002).
Interestingly, the PA group also significantly reduced their stress indices and only marginally less than the SM group. Physical activity has been established as an effective means of stress reduction (e.g., Carmack et al., 1999; Nguyen-Michel et al., 2006). Thus, practitioners should consider which method would be the most effective. For example, the intensive SM course in addition to the provision of a stress reduction workbook could be time-consuming and impractical if a stress reduction program was to be implemented university-wide. Rather, the provision or requirement of physical activity during a semester would assist in student stress reduction without the contact time necessary to deliver a stress management program.
In our second hypothesis, it was predicted that stress levels for perceived stress, test anxiety, and burnout would be lower at the end of the semester compared to the beginning for all treatment groups. All stress indices were lower in both the SM and PA groups at semester’s end, but the CF group yielded mixed results. Although the group participants significantly decreased levels of perceived stress, text anxiety did not change, and levels of personal burnout significantly increased.
Cardiovascular fitness is a frequently used strategy to reduce stress (e.g., Keller & Seraganian, 1984; Sinyor et al., 1983). However, our findings suggest that is it less effective than other methods. This is somewhat contradictory to the findings of VanKim and Nelson (2013), who found that students who met vigorous physical activity recommendations reported lower perceived stress. Although the goals and expected participation outcomes for the courses in our study were to achieve these recommendations, it was not measured, and may explain differences in findings to those of VanKim and Nelson.
However, results may have differed due to the varied exercise preferences of individuals with respect to motivation, style, activity, and environment (Brue, 2002). It may be that the focus on fitness rather than physical activity may be a contributor to personal burnout in some, who may have viewed the high intensity nature of cardiovascular fitness as a stressor rather than a stress reducer. This could account for the mixed results, and therefore practitioners should consider whether cardiovascular exercise is the best method for lowering stress, particularly if the client is inexperienced or unfamiliar with vigorous physical activity.
Last, the third hypothesis stated that stress levels for perceived stress, test anxiety, and burnout would be higher at the end compared to the beginning of the semester for the C group. This hypothesis was confirmed, and the outcome was in contrast to the treatment groups who experienced less stress by semester’s end. For the C group there was no significant increase or decrease on test anxiety or personal burnout. Although we could not account for participants in this group that already employed stress reduction strategies, it did not appear that the strategies, if used at all, were particularly effective.
Several limitations in the present study must be noted. First, we did not ascertain how important the classes chosen were to the participants. For example, a student may have been heavily invested in cardiovascular exercise, or he or she may have been trying to merely pass a class for credit. Some form of assessment could have been included with the aim of determining that level of investment. Second, because the classes were taught by a variety of instructors, the investment and outcome in a particular class may have been dependent on instructor attributes or how well the class was taught. For example, the perception of instructor physique can positively or negatively affect a student’s learning and opinion of both instructor and class (Baghurst & Bryant, 2012). A future study might consider limiting the number of instructors for greater consistency. Third, this study’s participants were limited to one large Midwestern university, and it would be interesting to see whether similar findings occur in smaller universities in other parts of the United States and world.
In sum, a combination of stress reduction strategies may be the most effective means of reducing stress indices in male and female college students. This study did not attempt to examine the long-term or lasting effects of the various interventions on stress; however, this would seem a necessary and logical extension of this preliminary work. Although all treatment groups were found to reduce one or more indicators of stress, the combination of psychological stress management strategies significantly reduced all stress indices the most.
From a practitioner’s perspective, it is evident that stress reduction strategies do have an impact on reducing stress variables in students over the course of a semester, and those working in the field should be encouraged that such strategies can be effective. However, although psychological skills training may be marginally more effective, implementation of such training campus-wide may not be as practical as physical activity opportunities. That physical activity classes are almost on par with psychological skills training in reducing stress is very important to note, as colleges are increasingly reducing or eliminating physical activity requirements from undergraduate programs (Cardinal, Sorensen, & Cardinal, 2012). Thus, although academic institutions may be streamlining the degree plan, they may be doing so to the detriment of their students’ health.
