by

Michael Nelson Olpin

B.S., Brigham Young University, 1988

M.S., Brigham Young University, 1993

A Dissertation Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Philosophy

Health Education in the Graduate School

Southern Illinois University at Carbondale

May, 1996

Copyright by Michael N. Olpin 1996

All Rights Reserved

Dissertation approval form goes here

AN ABSTRACT OF THE DISSERTATION OF

Michael N. Olpin, for the Doctor of Philosophy degree in Health Education, presented on March 29, 1996, at Southern Illinois University at Carbondale.

Title: Perceived Stress Levels and Sources of Stress Among College Students: Methods, Frequency, and Effectiveness of Managing Stress by College Students

Major Professor: Dale O. Ritzel, Ph.D.

This study had several purposes. The first purpose was to assess perceived levels of stress experienced by college students. A second purpose was to detect the primary sources of perceived stress among college students. A third purpose was to find out the activities students routinely participate in to reduce stress, relax, unwind or cope with individual pressures and how often they participate in these types of activities. The fourth purpose was to find out how effectively these preferred relaxing, stress managing, coping activities reduce perceived stress. A final purpose was to find out if any differences exist among selected variables (gender, year in school, race, and age) for perceived stress levels, sources of stress, and methods for managing stress.

Results were obtained from a survey of 559 students enrolled in sections of Healthful Living 201 at Southern Illinois University at Carbondale. The subjects for this study were predominantly white and black males and females between the ages of 18-23. The representation of freshmen, sophomores, juniors, and seniors was fairly even with the largest proportion of subjects being sophomores. Survey packets were distributed to sections during November of 1995.

Subjects responded to a questionnaire that gathered information regarding perceived levels of stress, sources of stress and type and frequency of preferred methods of dealing with individual stress. The instruments used to gather this data included the Perceived Stress Scale (PSS), The Inventory of College Students' Recent Life Experiences (ICSRLE) and The Relaxation Frequency Inventory (RFI).

The chief stressors that these students experience had to do mainly with their academic life. These stressors included many responsibilities, struggling to meet academic standards, time and money management worries, and concerns over grades. As the number and intensity of these hassles go up, so do individual levels of stress.

Students of this survey use social activities, watching television, and leisure activities more than other methods for managing stress. They tended to use methods that are specifically designed to reduce stress much less than other activities that had, as a byproduct, relaxation or management of stress. The subsequent analysis of the effectiveness of stress managing activities suggested that the methods that the students commonly use to manage stress are not particularly effective at doing so.

Women reported higher levels of stress than men, although at the same time, they did not report higher scores on the hassles scale. Few other difference showed up between the demographic variables for stress levels, hassles, and relaxation techniques used. One age group, 24-25 year old students, reported higher hassles scores as well as greater amounts of time using the dysfunctional stress managing activities to manage their stress.

ACKNOWLEDGMENTS

I would like to express my heart felt gratitude to several people for their assistance, encouragement, and support in the development of this dissertation. I am quite certain that without the help of all these people over the past year or two, this project would never have come together as nicely as it did. This really was a team effort from the very beginning. Initially, I was going to use the metaphor of a sports related ball team as a way of acknowledging the way that all the people helped me in this endeavor, but I couldn't make the parallels fit just right. Dr. Ritzel, as head coach, seemed appropriate, but I couldn't decide where my wife and kids fit into the scenario. Maybe the cheerleaders or trainers. So I will remain traditional one last time and give thanks in the usual way.

My thanks must go first to my wonderful mom and dad without whom I would not be here today, in every sense of the word. Their lifelong guidance and support have enabled me to arrive at this point as a very happy and content young man. They have brought me up in the way I should go and they should be proud of their wonderful family.

Similarly, my wife and soulmate, Shan has been the person who has stood by me during every step of this work. It was a scary thing to leave our comfort zones of the beautiful mountain west and brave the rapids of new everything here in Carbondale. One-hundred degrees and 95 percent humidity is not my idea of a warm welcome to a new home. She has been very courageous and extremely selfless hanging in there while I do the work of getting this degree. I love her and the girls, Analise and Erica, dearly.

I also extend my greatest thanks to my creator and Heavenly Father for creating me in the first place. He has continued to answer my prayers throughout this process and has supported me in seemingly miraculous ways. I do recognize his omnipotent hand every step of the way.

Academically, my thanks go first to my chair, (the coach) Dr. Ritzel. I have truly enjoyed working with him. I have felt fully supported every step of the way by him as I have worked on this degree and dissertation. Despite all the work he does, I always felt that he put the students first and I hope I can emulate his example when I take similar positions in my professional career.

I thank Dr. Kittleson for his advice and ideas. A veritable plethora of ideas spew forth from his mouth on every meeting. I only wish I would have had my note pad a few more times.

I extend my thanks and recognition to guru Bob, Dr. Russell. Thank you very much for putting the right brain back into the academic world. Or better said, thank you for putting the soul back into the science. I have greatly appreciated your support and love. (If only I drank, I could have tried the home brew.)

I also appreciate the assistance of the other members of my committee, Dr. Lawrence Dennis, (What an inspiration. I hope to be so culturally refined, yet similarly ride and swim the miles, when I grow into my seasoned years.) and Dr. Poppen (A clear expert in a fascinating field) for working with me through this process.

A warm thanks goes to Dr. Drolet and the Graduate Teaching Assistants for allowing me to borrow the students of the GEE-201 classes to gather data for this study. Their cooperation was incredible as they took time out of their busy schedules to accommodate my needs. None of them had time to fit me in, yet they all did, willingly. I am forever grateful for their wondrous assistance.

I also must extend thanks to Dr. Elaine Vitello for taking me under her wise wings and being my friend and mentor. I appreciate the way she sees me as potential and possibilities, more than current manifestations. Thanks for helping me clarify my vision of myself and what I can become.

Many thanks are additionally extended to the rest of the fine people in the department: Phyllis McCowen, Dr. Ogletree, Dr. Welshimer, Dr. Glover, Angie Randolph and the rest of the staff in the office. I have always felt welcome among you all. For this I am immensely grateful.

I also thank all the folks at the Carbondale hospital for keeping me alive during that very bad weekend in late October and early November. I really am glad to still be around to do what I still have to do in this space-time continuum.

Finally, I wish to give a blanket thanks to all those graduate and undergraduates that I have worked with here at SIU in and out of the department. If I were to name names, I would miss some. I really appreciate all the fun, and not so fun, times we have spent together doing what we do here. I will cherish the memories of my experience at SIU as some of the greatest of my life. I am also altogether thankful that I am done. I think I have had enough schooling for a while. It's high time I receive a real paycheck and live in a place where I don't have to do the dishes by hand.

CHAPTER 1 1

Introduction 1

Statement of the Problem 5

Purposes of the Study 8

Research Questions 9

Delimitations 9

Limitations 10

Assumptions 10

Data Analysis 11

Definitions 11

Summary 12

CHAPTER 2 13

Review of the Literature 13

Introduction 13

Definitions of Stress 14

Eustress, Positive Stress 16

Perceived Stress 17

Hassles 19

The Stress Response 20

General Adaptation Syndrome 20

Physiology of the Stress Response 21

Autonomic Nervous System 21

Endocrine System 23

Psychoneuroimmunology 26

College Student Measures of Perceived Stress 28

Stress Management 29

Relaxation Among Populations 30

Internet References to Relaxation 38

Textbooks on Relaxation 39

Scientific Literature on Relaxation 46

Breathing 47

Meditation 49

Transcendental Meditation (TM) 50

Mindfulness Meditation 51

Yoga Meditation 52

Massage 54

Hypnosis/Hypnosuggestion/Self-Hypnosis 55

Visualization 56

Exercise 57

Biofeedback 60

Autogenic Training 64

Progressive Relaxation 65

Music 67

Humor 69

Stress Buffers 70

Religion/Spirituality/Sense of Purpose 70

Leisure 71

Social Support 72

Relaxation Recommendations 73

Stress Management Among College Students 74

Methods of Measuring Stress 74

Summary 76

CHAPTER 3 77

Methods 77

Research Questions 77

Research Design 78

Population and Sample 78

Instrumentation 79

Perceived Stress Scale 79

Inventory of College Students' Recent Life Experiences; (ICSRLE) 81

The Relaxation Frequency Inventory 82

Readability 84

Human Subjects 86

Pilot Test 86

Data Collection 87

Data Analysis 89

Summary 91

CHAPTER 4 92

Results of the Study 92

Purpose of the Study 92

Sample Demographic Results 92

Summary 121

CHAPTER 5 124

Summary 126

Discussion 126

Conclusions 131

Recommendations 132

Epilogue 136

REFERENCES 138

APPENDICES 160

Appendix A: Cover Letter 161

Appendix B: Perceived Stress Scale (PSS) 163

Appendix C: Inventory of College Students' Recent Life Experiences 165

Appendix D: Relaxation Frequency Inventory 167

Appendix E: Demographics 170

Appendix F: Human Subjects 172

Appendix G: Approval for GEE-201 Students as Subjects 174

Appendix H: Approval Letter From Dr. Drolet 176

Curriculum Vita 178

Table 1. Autonomic Effects of Various Organs of the Body 22

Table 2. Research Questions, Methods, and Statistical Analysis 89

Table 3. Gender, Age, Race, and Year in School of Students Who Responded to the Survey 94

Table 4. Ranked Mean and Standard Deviation Scores from Inventory of College Students' Recent Life Experiences 96

Table 5. Relationship Between Major Sources of Stress, As Measured by Inventory of College Students' Recent Life Experiences, and Levels of Perceived Stress, As Measured By Perceived Stress Scale Among College Students 98

Table 6. Mean, Standard Deviation, and Range Scores for Relaxation Frequency Inventory 100

Table 7. Ranked Scores from RFI based on Activities Used by Respondents to Relax 101

Table 8. Ranked Mean and Standard Deviation Scores for Functional Stress Management Activities 102

Table 9. Ranked Mean and Standard Deviation Scores for Dysfunctional Stress Management Activities 102

Table 10. Ranked Mean and Standard Deviation Scores from OTC, prescription, and recreational drug use 103

Table 11. Frequency and Percentage Distribution for Stress Managing Activities 106

Table 12. Relationship between Perceived Stress Scale Scores and Relaxation Activities: Functional, Dysfunctional, and Drug Use 115

Table 13. Results of Differences Analyses for PSS by Gender, Age, Race, and Year in School 116

Table 14. Results of Differences Analyses for ICSRLE by Gender, Age, Race, and Year in School 117

Table 15. Results of Differences Analyses for RFI by Gender, Age, Race, and Year in School 118

Table 16. Results of Differences Analyses for Functional Methods of Managing Stress by Gender, Age, Race, and Year in School 119

Table 17. Results of Differences Analyses for Dysfunctional Methods of Managing Stress by Gender, Age, Race, and Year in School 120

Table 18. Results of Differences Analyses for Drug Use for Managing Stress by Gender, Age, Race, and Year in School 121

CHAPTER 1

INTRODUCTION

It is recognized that stress is a normally occurring part of life. Selye was the first to describe the term "stress" as a state produced within an organism subjected to a stimulus perceived as a threat (Selye, 1957, p. 52). He spoke of stress as a condition that occurs commonly in response to any adaptive response within the body. He defined stress as ". . . a state manifested by a specific syndrome which consists of all the non-specifically induced changes within a biologic system" (Selye, 1950, p. 27). In other words, stress can refer to a wide range of physiological changes caused by physical or psychological components or a combination of these.

Whatever the type or cause, the effect of stress on the body results in a very specific physiological response that Selye coined the "stress response" (Selye, 1976, p. 125). This response involves many physiological changes within the systems of the body.

Several researchers define stress (Selye, 1983, p. 2; Lazarus & Folkman, 1984; Asterita, 1985; Chopra, 1987, p. 59). Benson and Stuart concluded that "Stress is the perception of a threat to one's physical or psychological well-being and the perception that one is unable to cope with that threat" (Benson & Stuart, 1992, p. 180). They also defined stress as the negative effects of life's pressures and events (Benson & Stuart, 1992, p. 177).

Selye explained that, to a certain point, stress is challenging and useful. However, when stress becomes chronic or excessive, the body is no longer able to adapt and cope with the pressures placed upon it. The analogy of a violin string is useful. When the string is too tight or too loose, it will not play appropriately. When the violin string tension is "just right" the violinist plays the notes in a pleasant way. An optimal level of stress is characterized by high energy, mental alertness, high motivation, calmness under pressure, thorough analysis of problems, improved memory and recall, sharp perception, and a generally optimistic outlook (Forbes, 1979, p. 43). The point is not to eliminate stress: such a task is not possible or desirable. The current problem is the levels of stress that most of the people in our society experience are hardly optimal.

In 1979, Paul Rosch, the physician who headed the American Institute of Stress noted the following:

It is difficult to pick up a newspaper, magazine, or medical journal today without reading about the role of stress in causing hypertension, heart disease, ulcers, cancer, and emotional illness. We are told that "stress has surpassed the common cold as the most prevalent health problem in America" and that "stress-related conditions" are responsible for $10 to $20 billion annually in loss of industrial productivity (Rosch, 1979, p. 427).

A study in 1980 of patient needs in primary-care centers found that the most common health care requests involved psychological problems (Goode et al., 1983). The Center for Disease Control survey for the Healthy People 2000 goals found that 53.5 percent of people aged 18 and older had experienced adverse health effects from stress within the past year (U.S. Department of Health and Human Services, 1990, p. 214). Researchers at the American Institute of Stress estimate that 75-90 percent of all visits to health-care providers result from stress-related disorders (Kiev, 1987; see also Cummings & VandenBos, 1981).

Before World War II the leading causes of death were illnesses caused mainly by infectious diseases (e.g., polio, rubella, tuberculosis, typhoid, and encephalitis). These diseases have since been eradicated or brought under relative control. In contrast, the leading causes of death in our society today are diseases of lifestyle. Research has detected that stress is a contributing factor to many of these diseases: cardiovascular diseases, cancers, chronic obstructive lung diseases, hypertension, gastrointestinal disorders, tension and vascular headaches, low-back pain, and decreased immunological functioning (with its implications for susceptibility to disorders ranging from colds and flus to cancer and AIDS) (Pelletier & Lutz, 1988).

Even before these more serious diseases that result in death or serious disability, stress participates in the development of a host of less serious, yet just as widespread problems. Some of these include headaches, insomnia, mild depression, anxiety, skin disorders, peptic ulcers, hay fever, hyperthyroidism, amenorrhea, migraine headache, impotence, general sexual dysfunctions, sleep-onset insomnia, muscle pain, constipation, and a whole range of neurotic and psychotic disorders (Sherman, 1994; Pelletier, 1992, p. 7).

Many of these maladies are, for the most part, preventable or correctable by altering the habits and behaviors that contribute to their etiology. Although stress is not the direct cause of these diseases, the ongoing influence of stress has the capacity to weaken the immune system, damage organ and organ systems, and render the body less able to fight off diseases (Brannon & Feist, 1992, p. 100).

If nothing is done to alleviate the stress that we experience, we may unknowingly shorten the length of our lives. A long-term investigation of more than 600 people over a period of twelve years, measured the effects of stress on longevity. Researchers tested all study subjects at the beginning of the period, asking if they suffered from high amounts of stress. At the end of the twelve years, they discovered that the existence of high levels of stress at the study's beginning was a significant predictor of who would die during the twelve-year period of the study. Even when these researchers vigorously controlled for factors such as smoking, cholesterol levels, obesity, and high blood pressure, the outcomes were still the same (Somervell, Kaplan, & Heiss, 1989).

At a societal level, we see continual and alarming rises in the rates of homicides, suicides, drug addiction, alcoholism, and other violence related incidences. These may also be symptoms of a society that is having difficulty adapting to the personal and social changes that take place over the course of their lives. As an example, Sheahan and Latimer (1995) concluded that "An individual with a high stress level is approximately 15 times as likely to be a smoker as a person with low stress."

Reports have also placed very high price tags on the effects of stress in our society individually, culturally, and economically. Rosch (1991) said in an editorial in The American Institute of Stress Newsletter that "job stress is considered by some authorities to be the nation's leading adult health problem and its costs to industry have recently been pegged at 200 billion dollars annually" (p. 5). It is estimated that over 30 billion dollars are spent each year on lifestyle and stress-related diseases (Seaward, 1994). The American Heart Association says that more than half of all Americans who die in our society succumb to heart disease. More than 50 million workdays a year, adding up to $8 billion, are lost annually to heart-related diseases (Kiev, 1987). Just among the nation's executives, approximately $10 to $20 billion is lost each year through absence, hospitalization, and early death--much of it because of stress (Kiev, 1987).

The National Council on Compensation Insurance says that stress-related claims account for almost one-fifth of all occupational diseases (Brodsky, 1989). The study also noted that one-fourth of all workers compensation claims are for stress-related injuries. They estimated that 60 to 80 percent of all industrial injuries are related to stress. Stress-related symptoms and illnesses are causing industry a conservatively estimated $150 billion a year in absenteeism, company medical expenses, and lost productivity (Brodsky, 1994). In a study completed at New Mexico State University, a strong relationship between stress and absenteeism was found. The author noted that stress accounts for more that 20 percent of the costs associated with high job turnover, strikes, work stoppages, absenteeism, and decline in productivity (Wallis, 1983).

We, as a society, do not feel particularly good. Papp and Gorman (1993) report that anxiety disorders are the most common psychiatric illnesses in the United States. Use and abuse of various drugs continues to be a big concern. Inaba and Cohen (1993, pp. 14-15) report that such mood altering drugs as psychedelics, inhalants, heroin, marijuana, alcohol and tobacco have shown no decrease in their use over recent years. We have not learned how to effectively deal with our pains and fears in perhaps the most economical of means. For example, the nation loses approximately $20 billion in potential worker production because of alcoholism. The two most frequently prescribed drugs in this country are Valium and Librium, both tranquilizers. The three best-selling drugs in the country are an ulcer medication (Tagamet), a hypertension drug (Inderal), and a tranquilizer (Valium) (Hafen, Frandsen, Karren, & Hooker, 1992, p. 50). Childre (1994, p. 38) reported that eight of the top ten selling prescription drugs are for stress-related problems, such as ulcers, hypertension, depression, and anxiety. Typically, our pattern for overcoming stress, pain or discomfort is to reach for the aspirin or some medication that will miraculously shoot the magic bullet at the pain or tension, and by that, eliminate it. Unfortunately, the deeper sources of the stress and pains may be left untouched.

Statement of the Problem

A large amount of adult Americans report having a great deal of stress in their lives (U.S. Department of Health and Human Services, 1990, p. 216). More than one-fourth of those who suffer from a great deal of stress say they do not consciously take steps to control or reduce it (Taylor & Kagay, 1985). For those who do take steps, it appears that emotional denial, physical exercise, and stress avoidance are the most popular means for doing so (Taylor & Kagay, 1985). Yet, a wide array of techniques effectively reduces stress and produces positive results toward feeling better. We have a certain degree of control over the debilitating effects of stress. Through appropriate and persistent coping and stress management techniques, many harmful effects of stress can be greatly reduced (Hafen, Frandsen, Karren, & Hooker, 1992, p. 89).

Making the adjustment from stress to rest is not an easy task for some people as Stoyva and Carlson (1993) summarized:

Patients with psychosomatic or stress-linked disorders are likely to show signs of high physiological arousal in one or more systems; they are strongly or excessively engaged in the active coping mode. They also tend to be deficient in the ability to shift from the coping to the rest mode. It can be hypothesized that this defect in the ability to shift to a rest condition is the principal reason why various relaxation procedures have so often proved useful in the alleviation of stress-related symptoms.

College students are no strangers to varying degrees of stress (Kohn, Lafreniere, & Gurevich, 1991; Cinelli & Ziegler, 1990; Margiotta, Davilla, & Hicks, 1990; Jasnoski, & Kugler, 1987). Reports suggest that the university environments are different from other settings, yet levels of stress are no less serious (Burks & Martin, 1983; Sarason, Johnson, & Siegal, 1978).

Ramsey, Greenberg, and Hale (1989) surmised that the college experience may be the most stressful years in one's life. A needs assessment at the University of Maryland (Downey, 1983) found that stress and tension was the second greatest health concern of college students following fitness. Very little research has been done to find out what college students are doing about these high levels of stress. An equally modest amount of research has been done to learn how effective are the techniques used by college students to reduce stress levels.

Benson (1994) discussed the view that there are essentially four aspects to personal wellness or well-being: (1) proper nutrition, (2) proper exercise, (3) proper psychology (using our thoughts and feelings effectively to enhance our state of well-being), and (4) proper relaxation.

Many guidelines have been given regarding the frequency and intensity of regular aerobic exercise in our daily activity. The physiological and mental benefits of regular activity are well documented. Cooper (1982), for example, described a few of these known benefits of aerobic exercise such as more personal energy, more effective digestion, bones of greater strength, more restful sleep, a better self-image and more self-confidence. Other reports have maintained that aerobic exercise is a good way to strengthen and improve the cardiovascular system (Fisher & Jensen, 1990) and enhance immune function (Niemann, 1992). In like manner, nutritional guidelines have been suggested as necessary requirements to maintain optimum health (Rosenberg, 1992). Recommended guidelines for regular activities designed to reduce stress, similar to those dealing with nutrition and exercise, have not been widely set or publicized.

Part of this lack of clarity regarding a recommended daily requirement of relaxation may be due to what Stephen Covey calls the "urgency addiction." He describes a normal lifestyle as one that emphasizes constantly running around putting out fires (Covey, Merrill & Merrill, 1994, p. 35). He points out that in our society we have come to believe that if we're busy, we're important; if we're not busy we're almost embarrassed to admit it. Relaxing, or taking time to unwind from daily pressures, has not been considered as an option, by many. As an example, during a recent discussion in a college health class on stress, one student raised her hand and politely responded that she did not know that there were ways to relax. It was her understanding that the inordinate stress she feels while she pursues her college degree was something she can do nothing about and that she had no other choice than to learn to live with it.

In the report issued by the U.S. Department of Health and Human Services in 1990 (p. 216), we read that one goal for the nation was established regarding stress and its management. The objective is to "Decrease to no more than 5 percent the proportion of people aged 18 and older who report experiencing significant levels of stress who do not take steps to reduce or control their stress." Few studies have been done to detect how closely our society is to achieving this objective. There has been little research that examines the more common methods that people in the general population or on college campuses, employ to reduce stress or relax, the frequency that such methods are employed, or the efficacy of such methods.

Stress on college campuses is high, but students may not be aware of more effective ways to reduce stress. For example, in a recent review of literature of substance use and abuse Prendergast (1994) reported that "college students are more likely to drink and to drink at high levels than are young adults who are not in college." The means for relaxing may be temporarily effective for reducing stress levels, but there are consequences associated with regular drinking that are not always desirable (Fromme & Rivet, 1994; Prendergast, 1994).

Existing research provides limited information on stress and its management among college students. Accurate information regarding stress, its primary sources and effective ways to deal with it specific to college students would allow university health educators, counseling centers, and student wellness centers to target specific need areas more effectively on campuses across the country.

Purposes of the Study

This study had several purposes. The first purpose was to assess perceived levels of stress experienced by college students. A second purpose was to detect the primary sources of perceived stress among college students. A third purpose was to find out the activities students routinely participate in to reduce stress, relax, unwind or cope with individual pressures and how often they participate in these types of activities. The fourth purpose was to find out how effectively these preferred relaxing, stress managing, coping activities reduce perceived stress. A final purpose was to find out if any differences exist among selected variables (gender, year in school, race, and age) for perceived stress levels, sources of stress, and methods for managing stress.

Research Questions

The following questions were considered for analysis in this study:

1. What do college students perceive to be the major source(s) of stress?

2. Is there a relationship between the major sources of stress and the levels of perceived stress among college students?

3. What methods do college students actively participate in to reduce stress?

4. Is there a relationship between the amount of stress perceived by college students and the amount of time they spend involved in stress reducing or relaxing activities?

5. What differences exist by gender, by age, by race, and by year in school for perceived levels of stress, sources of stress and for methods of managing stress?

Delimitations

This study was delimited in the following ways:

1. The scope of this study was narrowed to students of a Midwestern university.

2. The study was confined to those students who volunteered to participate in the study.

3. Analysis of individual levels of perceived stress is limited to the responses measured by the Perceived Stress Scale (PSS).

4. Analysis of individual sources of stress is limited to the responses measured by the Inventory of College Students' Recent Life Experiences (ICSRLE).

5. Analysis of individual methods for reducing stress is limited to the responses measured by the Relaxation Frequency Inventory (RFI).

Limitations

The following limitations exist in this study:

1. The study used a sample of convenience and consisted of volunteers.

2. Participants who responded to the questionnaire did so voluntarily, by that self-selecting as research subjects.

3. Conclusions regarding this study can only be generalized to the population of the students in the selected university and may not typify other populations in other universities.

4. Use of a written rather than an oral survey technique may have limited the responses given by the subjects.

5. Responses given by the subjects were self-reported responses.

Assumptions

For purposes of this study the following assumptions were made:

1. Subjects in the study could answer all questions honestly and to the best of their knowledge.

2. Subjects in the study understood how to fill out the questionnaire properly, when given appropriate directions.

3. The instruments used for this study appropriately measured perceived levels of stress, sources of stress, and frequency of participating in relaxing or stress reducing activities as defined for this study.

Data Analysis

Methods of data analysis selected for this study were descriptive statistics, Pearson r correlation, t-test and ANOVA.

Definitions

The following terms are defined to help in understanding this research:

Distress: events that cause debilitative stress and strain (Selye, 1976).

Eustress: stress that presents positive opportunities for personal growth (Selye, 1976).

Health: a combination of the physical, mental, emotional, social, and spiritual components of life that can be balanced to produce satisfaction and happiness (Donatelle & Davis, 1993).

Homeostasis: a physical state in which all the body's systems function smoothly or are in balance; a state of physiological calmness, once a threat is gone (Seaward, 1993).

Psychoneuroimmunology: "the connections between the central nervous system and the immune system -- and the bodily system that operates to defend an organism against disease." (Solomon, 1985)

Relaxation response: the body's ability to enter a "scientifically definable state" of relaxation. (Benson, 1987, p. 6)

Stress: the negative effects of life's pressures and events (Benson & Stuart, 1992, p. 177).

Stressor: a life event that requires changes and adjustments in an individual's daily life (Lechner, 1993); the demand that causes stress (Selye, 1976).

Wellness: "fostering life habits that prevent illness, promote faster healing when we do get sick and enhance vitality whether we're ill or not" (Benson, 1994).

Summary

This study sought to analyze how much stress college students perceive that they are experiencing and what are the most common sources of stress within this group. It also analyzed the methods college students use to relax and with what frequency. Finally, it looked at the effectiveness of chosen methods of relaxation to reduce perceived stress levels.

CHAPTER 2

REVIEW OF THE LITERATURE

In this chapter, the review of literature has been divided into eight sections: A brief introduction, current definitions of stress, the stress response, physiology of the stress response, levels of perceived stress among college students, stress management techniques, stress management among college students, and an overview instruments selected for use in this study.

Introduction

Modern living is stressful. According to figures from New York's American Institute of Stress, 90 percent of all American adults experience high stress levels one or two times a week and a fourth of all American adults are subject to crushing levels of stress nearly every day (Brodsky, 1989).

The National Center for Health Statistics (NCHS) in 1990 conducted the National Health Interview that included several questions regarding stress. Data were published in a report entitled "Health Promotion and Disease Prevention" (United States, 1990). The report said that more than half (57 percent) of adults experienced a moderate amount of stress. Persons with higher education and income were more likely to feel stress than persons with lower education and income. Four in ten adults (41 percent) reported that stress had at least some effect on their health, with women (47%) more likely than men (34%) to have reported this. The survey also noted that only 13 percent of adults had sought help to reduce their stress from either a professional or nonprofessional.

Society is changing rapidly causing changes in values, life styles, career patterns, family expectations and so on. Over the past few years, popular and professional books, magazines and journals have focused increasingly on stress and its impact on people. In any bookstore one can find books on stress and how to escape from it. Professional publications in the behavioral sciences are dealing with the same issue. Many different disciplines are trying to discover more about how people cope with the pressures of daily living. While reviewing the vast amounts of literature, it became quite clear that stress is a very complex problem in our day. Most likely, it is a problem that will not soon leave us if our lifestyles continue in the hectic paces we have chosen. Given that no two people are alike in the way they handle tension, pressure and pain, clearly there is no particular way to deal with stress that works the best for each person. Fortunately, as this review of literature will point out, there are things that people can do to actively reduce the amounts of stress they are feeling and by that, handle life in a more healthy and happy way.

We, as a species, survive on this planet because we can maintain a normal, balanced internal environment, called homeostasis. Any threat to the system, perceived or real, which may disrupt this homeostasis will produce many physiological reactions in several systems of the body. The purpose of these reactions is to resist these changes from taking place (Asterita, 1985, p. 4). These threats or stressors may be physical, psychological or psychosocial.

Stressors are different for different people, that is, what may be stressful to one person may be perceived as no threat whatever to another person. Additionally, what may be stressful for a person at a particular point in time may not be perceived as stressful at another (Asterita, 1985, p. 5).

Definitions of Stress

Stress is a term that has become associated with many things. It is much like the word health or love. It is hard to pinpoint exactly what it means, yet we have an idea of how we feel when we are experiencing it at various levels. We are quite certain we are feeling it when things get tense. Nevertheless, our understanding of stress has come a long way in the last four or five decades. Stress researcher Hans Selye, whose work in the early half of the twentieth century was recognized as one of the first to identify stress and its effects on the body, defined stress as a "nonspecific response of the body to any demand" (Selye, 1983, p. 2). Selye separated stress into two categories: eustress and distress (1976). He mentioned that "During both eustress and distress the body undergoes virtually the same nonspecific response to the various positive or negative stimuli acting upon it. However, the fact that eustress causes much less damage than distress graphically demonstrates that it is 'how you take it' that determines, ultimately how one can adapt successfully to change" (p. 74). Much of the stress we experience has to do with how we perceive the stimulus that surrounds us and the degree to which we perceive it as threatening.

Lazarus and Folkman defined stress as a "relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being" (Lazarus & Folkman, 1984; Pelletier 1992a, p. xl-xli). This definition suggests that not only the stressor but the person's perception of her ability to adapt to the stressor are important in the perception of stress.

Benson and Stuart refer to stress as the negative effects of life's pressures and events (Benson & Stuart, 1992, p. 177). Their reference in this context was to distress, as when the body becomes unable to adapt and cope with ongoing pressures.

Asterita (1985) defined stressors as "Any stimuli which an organism perceives as a threat" (p. 4). She explained that these stressors may be physical, psychological, or psychosocial in nature.

A physical stressor may include such conditions as environmental pollutants or other environmental pressures such as an extreme change in temperature or an electrical shock. Other physiological stressors may include a decrease in oxygen supply, prolonged exercise, hypoglycemia, injuries, and other trauma to the body.

Psychological stress results from reactivity within oneself to one's own thoughts or feelings about perceived threats, real or imagined. Psychosocial stress may result from intense social interactions, or their lack, or other variables associated with relationships.

Eustress, Positive Stress

Much has been written regarding the negative aspects of stress, but researchers have done work on the more positive aspects as well. Most notably of these researchers is Suzanne Kobasa. Dr. Kobasa is well known for her research on hardiness. She studied business executives, lawyers, bus drivers, telephone company employees and other groups of people who lead high-stress lives. In every group she found some people who were much healthier than others experiencing the same amount of stress. Her research led her to believe that perhaps the healthier people had some personality characteristic in common that might be protecting them from the negative effects of high levels of stress. The hardier individual, she found, tended to get sick less often regardless of the environments (Schafer, 1992, pp. 47-48).

According to Kobasa (1979), stress hardy individuals show high levels of three psychological characteristics: control, commitment, and challenge. People who are high in control have a strong belief that they can exert an influence on their surroundings, that they can make things happen. They believe that they can influence events instead of becoming a victim. This is the opposite of feelings of helplessness. Psychologists define control as "a belief that one has at one's disposal a response that can influence the aversiveness of an event" (Thompson, 1981).

People who are high in commitment tend to feel fully engaged in what they are doing from day to day and are committed to giving these activities their best effort. They have an attitude of curiosity and involvement in what is happening around them. Its opposite, according to Borysenko (1988) is alienation. People who are high in challenge see change as a natural part of life that affords at least some chance for further development. They believe that change brings a chance for growth instead of fear that change is threatening (Justice, 1987; Kabat-Zinn, 1990; Borysenko, 1988; Hafen, Frandsen, Karren, & Hooker, 1992). When potentially stressful experiences happen in the lives of people with the hardy psychological pattern they are physically more resistant to disease and illness (Hannah, 1988).

Perceived Stress

Hans Selye, who spent 50 years doing stress research, came to the conclusion that it is not what stresses us that counts, it is the way we react (Selye, 1976, p. 450). Selye tells an interesting story of what happens if you pass a helpless drunk who showers you with insults. If you pass on by, ignoring the drunk, you are not likely to experience any physiological consequences of significance. However, if you choose to fight back, verbally or otherwise, "you will discharge adrenaline that increases blood pressure and pulse rate, while your whole nervous system becomes alarmed and tense in anticipation of combat. If you happen to be a coronary candidate, the result may be a fatal heart accident." Selye would then ask: "What caused your death? The drunk? His insults? No. Death was caused by choosing the wrong reaction" (Selye, 1976, p. 450).

Lazarus (1966) has emphasized the importance of individual perceptions or appraisal of the environment. "The meaning we give events and the satisfaction we find profoundly influence the stressful effects of changes we make in our lives." Rosch likens stress to a ride on a roller coaster. "There are those at the front of the car, hands over head, clapping, who can't wait to get on again," he points out, "and those at the back cringing, wondering how they got into this and how soon it's going to be over" (Schafer, 1987, p. 310). Put differently, one roller coaster passenger has his back stiffened, his knuckles are white, his eyes shut, jaws clenched, just waiting for it to be over. The wide-eyed thrill-seeker relishes every plunge, can't wait to do it again (Cooper & Payne, 1988, p. 9).

The identical circumstance creates vastly different experiences based upon individual perceptions and interpretations. Interestingly, Chopra and Dyer (1993) describe the differences in internal activity between the two who go on the roller coaster ride. When the thrill seeker goes on the ride and experiences it as a wonderfully exciting time, she produces certain chemicals, interleukins and interferons, which are very powerful anti-cancer drugs. The person who abhors roller coaster rides, although it is the same experience, secretes chemicals such as cholesterol, triglycerides, norepinephrine, ACTH (adrenocorticotrophic hormone) and insulin. The body needs high levels of adrenaline, and these other chemicals when it is physically threatened and it must physically fight or flee. However, when we chronically invoke reactions that produce these chemical responses, the excesses can turn against us (Justice, 1987, p. 33). Again, it is the perception, the interpretation of the situation that determines the internal activity.

Kobasa, in her research on hardiness, studied a group of 200 business executives at Illinois Bell Telephone Company who had experienced an especially large number of stressful events when AT&T was breaking up its near monopoly of the phone system. One hundred of the managers and officers reported many symptoms of sickness, but the other 100 had few signs of diagnosable illness though the circumstances were similar for all these executives (Kobasa, 1984; Kobasa, 1979).

In another study Kobasa (1982) studied lawyers because of their image as people who thrive on stress. Kobasa pointed out that lawyers are taught to perform best under a great deal of pressure by learning, in law school, to work at a strenuous pace. She found that many lawyers live long lives without major illnesses. She concluded that many attorneys may have conditioned themselves to work well and stay healthy despite enormous stress simply because lawyers are expected to thrive under pressure.

This information suggests that much of the stress we experience in our lives may have little to do with what is happening in our environment, our circumstances, and much more to do with our interpretation of what is going on. The meaning we give to situations is based upon the type of cognitive appraisal we make. Our appraisal begins with looking at what we are faced with and asking ourselves: "Am I okay or in trouble?" If the answer is, "in trouble" then a second question quickly follows: "What can I do about it?" (Folkman, Schafer, & Lazarus, 1979).

Our physiological reactions are related to how much of a threat we perceive ourselves to be in and how much control we believe we have over the situation. When we perceive our trouble as more threatening than challenging, or our capacity to cope as more hopeless than promising, the physiological changes that result may lead to illness (Justice, 1987).

Hassles

Lazarus and Folkman (1984) defined hassles as "daily interactions with the environment that were essentially negative." Kohn, Lafreniere, and Gurevich (1992) called hassles mundane irritants or mild stressors. The feeling of these researchers and others (Wolf, Elston, & Kissling, 1989; Burks & Martin, 1985; Kohn, Lafreniere, & Gurevich, 1990) is that it is the accumulation of small rather than large negative events that wear the individual down mentally and physically (Schafer, 1992, p. 352). Kohn and MacDonald (1992) reviewed the literature on hassles and concluded that hassles or mundane irritants and stressors adequately predict measures of negative physical and mental well-being.

The Stress Response

Walter B. Cannon of Harvard university was the first to describe the "fight or flight" response (Cannon, 1911; Cannon, 1914). This response is designed to prepare the body to react to a threat or danger. The response prepared the body for heightened muscle activity to either fight or flee from some current threat. It is both physiological and psychological. When the body becomes stressed, no matter the source of the stress, it undergoes what scientists now recognize as the fight or flight response used by primitive people as they faced the various threats in their environment. When facing one of their enemies -- a bear or a tiger, for instance -- the body reacted in a very specific way that prepared them to either fight the bear or run for their life.

Our bodies still react in the same manner to threats we come upon, be they real or imagined. Usually, the stressor, however, does not require us to fight or flee. Harvard Cardiologist Herbert Benson remarked, "The fight-or-flight emergency response is inappropriate to today's social stresses" (Benson, 1994).

General Adaptation Syndrome

When a stressor is perceived, the body goes through a process that Selye has termed the general adaptation syndrome (GAS). A summary of this syndrome follows:

1. Alarm reaction. In the first stage, or the alarm reaction, the body immediately responds to the stress. Various physiological changes occur that enable the body to combat stress. A change that occurs almost immediately during the alarm reaction is depression of the immune system; normal resistance is lowered, and the victim becomes more susceptible to infection and disease. If the stress is brief, the body's response is limited to that of the alarm reaction. When the stress ends, so does the reaction.

2. Resistance. In stage two, resistance, the body makes physiological changes that enable it to adapt to long-term stress. Coping with the stressor becomes the specific job of the particular systems best suited to the task. During this second stage, resistance to the stressor is usually high, but because resources are diverted away from other areas, general resistance to disease may be low.

3. Exhaustion. The body eventually loses the ability to keep up with the demands that stress puts on it, and it enters the third stage, exhaustion. The organ systems or processes handling the stressor becomes worn out and breaks down

This whole process functions to maximize the body's ability to resist stressors. Even after the exhaustion phase has occurred in one area, the burden may be shifted to another system equally capable of dealing with the situation (Pelletier, 1992a; Golizsek, 1987, Chopra, 1987).

Physiology of the Stress Response

There are two primary physiological systems in the body that are triggered when a stressor is perceived. One is the autonomic or involuntary nervous system, and the other is the endocrine system.

Autonomic Nervous System

The autonomic nervous system controls many basic life functions such as breathing, heartbeat, reproductive activities, digestion, and blood pressure among others. These

Table 1

Autonomic Effects of Various Organs of the Body (Asterita, 1985, p. 23)

systems are maintained without the need to consciously control the way they function. Yet this system is responsible for many changes that occur in the body during a perceived threat.

This autonomic nervous system is divided into two subsystems called the sympathetic and parasympathetic nervous system. These two systems usually run a reciprocal balance with each other. The sympathetic system is responsible for a more aroused, active state: blood vessels constrict, the endocrine system is activated, eye pupils dilate and many other changes immediately take place to arouse the system to fight or flee (See Table 1). If someone perceives that a problem can be controlled by fighting, running or some other similar activity, then the sympathetic nervous system mobilizes a flood of activity designed for an increased state of arousal and activity.

The parasympathetic system induces a state of general relaxation and repair with an almost opposite reaction, throughout the body, to the sympathetic nervous system. If we feel it is necessary to disengage, to unwind from activities, then the parasympathetic nervous system dominates (Pelletier, 1992a, p. 54-55; Asterita, 1985, p. 22; Justice, 1987, p. 218-219).

Endocrine System

The second major system involved in the stress response is the endocrine system. Its function is to secrete hormones. When the body is under stress, the pineal gland, pituitary, thyroid, parathyroids, thymus, adrenals, pancreas, ovaries and testes all respond with the secretion of hormones designed to help in either fighting or fleeing. To date, over 30 neurotransmitters and neurohormones have been identified as being involved in this stress response (Locke & Douglas, 1986, p. 73).

Of these, two main hormone groups lead the process: the catecholamines and the corticosteroids. The two catecholamines, epinephrine and norepinephrine, cause the heart to beat faster, the blood vessels to constrict, the muscles to tense up, the respiratory system to work more rapidly, and the blood to thicken and clot in case of injury. They cause an increase in blood pressure, increased tension in the muscles, more shallow, rapid breathing, depression of sexual desire and hunger, cessation of hunger, hyperalertness of the brain and the senses turns clear.

The corticosteroids include cortisone and cortisol. Cortisone is an anti-inflammatory. This helps raise blood sugar levels and modulate the body's immunological responses. Cortisol works to increase the supply of glucose and fatty acids in the blood stream. This stimulates the liver to produce and release glucose and stimulates the fatty tissue to release fat. Suddenly, instant energy stores become available to the muscles as they may need them.

The hypothalamus sends a chemical message through a small network of blood vessels to the pituitary gland (known as the master gland) which in turn sends two chemicals into the bloodstream. One, thyrotropic hormone (TTH) is designed to activate the thyroid gland, which then secretes thyroxine, another hormone, into the bloodstream. Thyroxin speeds metabolism throughout the cells of the body.

The pituitary gland also secretes ACTH (adrenocorticotropic hormone) into the bloodstream. This stimulates the adrenal cortex to secrete gluco-corticoids which in turn, stimulate the liver to produce more blood sugar along with the signal for more fats, from fat stores, to be released into the blood for more available energy. ACTH also causes the release of aldosterone and other hormones called corticoids. These inform the kidney to retain salt and by that, increase vascular blood pressure (Locke, 1986; Schaffer, 1992; Pelletier, 1992a; Justice, 1987; Chopra, 1993)

Each phase of the stress response, both the neurological and the hormonal, carried with it benefits for the primitive man or woman who faced physical dangers. Usually those dangers were short term followed by a period of rest. The parasympathetic system was allowed to restore balance to the other systems of the body.

Those same benefits have become drawbacks for the modern day man or woman who faces the social stresses of our day. It is common for people to perceive current circumstances as threatening. The mind, however, does not easily distinguish between a real and an imaginary threat (Talbot, 1991, p. 84). The neurological and hormonal response will be the same. If, however, there is no time allowed for the parasympathetic system to restore balance, the result is hormones circulating in the system causing various degrees of damage. Some of these problems due to chronic conditions of stress aroused hormonal activity include: fatigue; muscle destruction; diabetes; stress-induced hypertension; ulceration; psychogenic dwarfism; impotence; interruption of menstruation; increased risk of disease; neuron damage; diverted blood away from any wounds; the blood coagulates; the heart beats more quickly; cholesterol is released into the bloodstream, mostly from the liver; sugar (glucose) is released into the bloodstream, followed by a boost in insulin to metabolize it; the entire digestive tract shuts down; blood is diverted to the muscles; sex hormones (progesterone in the female and testosterone in the male) are reduced; the hypothalamus releases endorphins--powerful natural painkillers that enabled people to fight or flee even when injured; cortisone and catecholamines destroy the body's resistance to cancer, infections, illness, and the complications of surgery; and the immune response weakens (Hanson, 1986; Pelletier, 1992a; Lock & Douglas, 1986; Lamb, 1989; Chopra, 1993).

In summary, stress hormones serve a very useful purpose in times of danger, when there is an evident need for extra strength and energy. The fight-or-flight reaction kicks in even when there is no life-threatening situation facing us. It is sufficient for us just to feel threatened (Kabat-Zinn, 1990, p. 254). If not allowed to restore to prestress levels, they can wreak havoc on the internal systems of the body.

Psychoneuroimmunology

One area of stress research that has received much attention in the past ten to fifteen years is the relationship between stress levels and immunocompetence. There is a large and growing body of research that shows that levels of stress can decrease the immune system's ability to fight disease (Rogers, Dubey, & Reich, 1979; Jemmott & Locke, 1984; Borysenko & Borysenko, 1983; Dantzer & Kelley, 1989; Leclere & Werhy, 1989; Keicolt-Glaser & Glaser, 1988; Pelletier & Herzing, 1988; Pelletier, 1992b).

For example, in studies on the bereaved, Bartrop (1977) and his colleagues found that bereaved spouses had lower lymphocyte production within eight weeks of the loss of a spouse. This would suggest a decrease in immune levels by that time.

In another study (Parkes, Benjamin, & Fitzgerald, 1969) it was found that there may be a link between death resulting from heart disease and the recent death of a spouse. The finding was significantly more the case with widowed men than women.

Similarly, persons with marriages that are disruptive or have continuous problems are known to suffer more from dysfunctional immune systems (Keicolt-Glaser, 1987a). These researchers also found that women who had recently (within the previous six years) divorced or separated from their husbands showed reduced immunocompetence compared to a control group of married women (Keicolt-Glaser, 1987b).

Stress has been studied in research on sleep deprivation where subjects were kept awake for 48-77 hours at a time. It was found that many aspects of immune function change occurred during those sleep deprived periods (Palmblad et al., 1976).

In another study, Keicolt-Glaser and her colleagues (1984) reported a decreased level of immune function in Ohio State University medical students during their first day of exams, as compared with samples taken before and after the exam period.

Unemployment, if prolonged has been shown to increase both morbidity and mortality (Brenner, 1979). A similar study found that women who had lost their jobs but were being adequately supplemented by unemployment benefits for nine months showed decreases in immune functioning (Arnetz, 1987).

David McClelland and his colleagues at Harvard have done research on personal power and the need to exert power over others and how this relates to illness and immune function. McClelland & Jemmott, (1980) found that college students who needed power, meaning a strong need to influence others, but were inhibited from experiencing it, reported more frequent illness. They found similar results with male prisoners (McClelland, Alexander, & Marks, 1982).

McClelland and Kirshnit (1989) did another study where subjects were shown two films. One was designed to arouse power motives. Its theme revolved around the justification of America's entry into W.W.II built mainly upon dominance and aggression. The second film portrayed Mother Theresa ministering to the impoverished and ill in India. It was designed to arouse the affiliation (love and service) response from the subjects that viewed it. Of those who watched the films, immune function, measured by Salivary IgA, increased for all except those who watched the war film and exhibited a motivation for power. In these, Salivary IgA decreased. These studies suggest that there may be a strong relationship between emotional responses and the biochemical changes they produce within the immune system.

In summary, stress affects the systems of the body in a variety of ways. In the short run, these processes provide for greater levels of survival and adaptation. Prolonged stress, however, can have many deleterious effects. A thorough review of how stress can affect health was important to explain some of these effects. Through greater awareness, those who begin to experience some of these early effects may start to take steps to reduce stress levels before they lead to damage that is more difficult to correct.

College Student Measures of Perceived Stress

Existing research provides limited information on stress among college students. A study in a northern California community (Schafer & King, 1990) found that 37% of college students of this community reported feelings of great stress more than once or twice a week. Twenty-nine percent of non-students of this community reported great stress more than once or twice a week.

Another study (Toews, Lockyer, Dobson, & Brownell, 1993) compared levels of perceived stress among residents, medical students, and graduate students at a major medical university in Calgary, Canada. They found stress levels were similar for all three groups and were described as "elevated," although the graduate level (MSc/PhD) students showed slightly higher levels of stress than the other two groups. Women reported higher levels of stress than men. The three groups had similar stressors, as well, including preparing for and taking examinations and evaluations, quantity of work required, time available, and self-expectations.

Hoalt (1991) found that among graduate students, moderate amounts of stress were reported by 76 percent of the respondents. The results of this study suggested men report feeling less stressed than women and blacks report feeling more stressed than whites among those who participated in this survey.

Another study (Frazier, & Schauben, 1994) assessing stress among female college students found that many of those surveyed have experienced major stress in their lives. The primary sources of stress for these students were test pressure, financial problems, being rejected by someone, relationship breakups, and failing a test. They also found that Asian American female college students reported a greater number of stressors and a higher degree of stress than European American female college students.

Students in a journalism and mass communication program were asked the degree of stress they felt they experienced during a particular semester (Endres, 1992). Of those who responded, 42 percent indicated feeling high stress levels, 52 percent indicated moderate stress levels and 7 percent low. The subjects reported the primary sources of stress were concerns about passing the course, personal desire for perfection, status of grade in the course, concern over what friends might think about their performance, and having to learn new technology.

Finally, a needs assessment at the University of Maryland (Downey, 1983) found that stress and tension was the second greatest health concern of college students following fitness. As Ramsey, Greenberg, and Hale (1989) mentioned in 1989, the college experience may be the most stressful years in one's life.

Stress Management

Relaxation is the direct negative of nervous excitement. It is the absence of nerve-muscle impulse (Edmund Jacobson in Seaward, p. 347). The word "relax" comes from the Latin word laxus which means to be loose. To relax simply means to regain a natural feeling of looseness and ease (Miller, 1990, p. 4). In its physiological sense relaxation is the lengthening of muscle fibers, whereas tension is the contraction of muscle fibers (Jacobson, 1938 p. 220).

As I researched this area of the study, it became evident that there are many methods that people use to relax, to reduce their perceived levels of stress. There is no final word about which single method achieves the relaxation or stress reduction that people are seeking. However, some methods of increasing relaxation have been more scientifically examined than others. One thing that is clear is that people deal with stress in a wide variety of ways.

I decided to review the information on stress reduction and relaxation in three ways. The first involved a general population review of those things people do to effectively relax. Next I looked through textbooks designed for college health classrooms to see what they had to say regarding relaxation techniques. Finally, I reviewed the scientific literature to analyze studies done with various relaxation techniques to find out their effectiveness for increasing relaxation or reducing stress.

Relaxation Among Populations

I decided to ask people, in a specific population, what they do to relax, what they do to deal with the stress they experience in their day to day lives. The quickest way to do this, for me, was through the Listserve system presently available through E-mail on the internet. I used two specific lists that have many people accessing it. The first one was called HOLISTIC. The second was called FIT-L. My single question was, "What types of things do you do that are either conventional or unconventional to reduce stress levels or increase relaxation?"

Within three days I received many responses from people who were delighted to inform me about what they do to unwind. The responses were from both men and women. The following is what I received in response to my query:

I once took a written stress test and realized that I was extremely stressed, which is strange because I am a Homemaker. When I looked into it, I found I was getting stressed at silly things, like waiting in line, getting stuck in traffic, etc. I tried meditation for a while which did help. But I learned from meditation to recognize when I was getting stressed, and to relax my facial muscles first and then the rest was easy. I am much more tuned in to feeling stressed, and it really is interesting that if I consciously relax my facial muscles, my whole body follow easily. Things go a lot more easily too, if I remember "What's the worst that can happen?" Being late is not an excuse for being stressed.

Hi! I love responding to questions like this--it makes me smile which is the first step towards relaxation for me. Anyway, my relaxation exercises are as follows:

--Daily Yoga which always ends in the corpse pose. Lately, I've started sitting meditations but this hasn't become a habit as of yet. I notice a huge difference in my mental attitude on the days that I meditate. Yogic

breathing is also a good relaxation technique.

--Gardening!!!! This is so amazing and a wonderful way to relax for me. A bad day is wiped away by just a few minutes in the garden.

--Exercise. Running and cycling always makes me feel wonderful.

--Being with a friend who I can be totally myself with.

--Warm weather relaxes me, too--especially if I'm on a Caribbean island!

Well I know you will probably hear from lots of people who do lots of soothing things to relax like meditation, go to the beach, etc. For me exercise is my best form of relaxation. I start out everyday exercising. I have heard that there is a form of exercise meditation. That is what I need. I started to study yoga this year, which I loved, and I heard that some people do meditation while moving and doing yoga.

My husband and I have used music a lot with our children.

I have a really hard time dealing with stress, and it often reflects on my home/school life. The two things that I have found help me better deal with my stress are exercise, and aromatherapy. The latter I usually do before an exam, or if I can't sleep at night. It is really helpful.

I meditate daily for stress, about 10 minutes with headphones on and listening to Gregorian chants. During the rest of the day if I feel the stress level rising, I just take a deep sigh, count to 10 or so while breathing deeply. This helps me.

Well, I've used deep muscle relaxation and now I just 'feel' which parts of my body are tense and let them relax. I also was given (as a gift) one of those 'mind machines' that you listen to a tape (can be sounds or words) and wear glasses that have flashing lights (supposed to take you to a deeper level - alpha?) I really enjoy using it and it can relax me!

Stress is often a frame of mind, result from being attached to the results of our labor, the feeling that we need to be in control. When we are not in control, it causes stress.

Stress is caused by one's ego. The ego causes us to take offense, to be attached to the fruits of our actions, to need security, attention, to have the "what about me" taken care of.

Stress is a mental condition in which the mind/ego is out of sync. with the rest of our mind.

I meditate and I chop wood to relieve stress, but most importantly, I try not to need to always be in control. I try not to get attached to those things I have not control over. I try to accept what I can't control. I recently posted a poem, "Letting Go". If we can learn to take it to heart and live it, we will go a long way in reducing stress in our lives. Blessings,

Other than the basic proper nutrition and frequent exercise elements, I like to use visualization as a stress releaser. It may sound kind of strange, but I visualize the situation and then visualize my options and how I would handle the situation in a calm and relaxed manner. It's almost a "day dreaming-type" state that I put myself in. I can generally come out of it much more relaxed and armed with a solution to my problem.

As with every other person, I hate stress and I don't have a place in my life for it. Life's too short to worry about the little things. When we really boil it down, most of our daily stress is the little things that in the bigger picture don't really amount to a hill of beans. I've watched people I love die, and never once on their deathbeds did they comment about wishing they could have "gotten a proposal into their boss a little earlier!"

My number one source of stress relief is exercise. Since it isn't healthy (for me at least) to "work out" all the time, I have a few other stress reducers. Picking up a good book and letting myself become totally engrossed in it is always relaxing and fun. I also have a garden, where I can work my stress into beautiful floral arrangements and tasty salads. Bubble baths are also great. When all else fails, I set the alarm for sometime after everyone else is sound asleep (2:00 in the morning) and get up. I go into the kitchen, brew myself some herbal tea, and deal with my problems. Then I go back to bed and wake up with a plan to combat the hassles I will face.

Stress to me comes in many forms, and I have to deal with it in myriad ways to be centered.

Sometimes I deal with fear of the future, I need to gain courage. Sometimes the past grabs me, and I have to try to make it right, or deal with the problem. Sometimes it is because of things not going my way, I need to realize that I don't run the show. Sometimes it is because life just handed me a problem, and I need to accept it, and do what needs doing. In all, stress is relieved in me by action. Until that action gets done, or I have found acceptance, there are only 2 things that help, talking to a good friend and sharing my dilemma, or exercise.

I swim ..... and swim ..... and swim .... And after about an hour of going up and down and up and down, I'm a complete zombie. My theory is that it is the endless repetition of the same rhythmic motion, and the counting of how many strokes it takes me to get to the end each time (eleven breast stroke, 13 front crawl) that puts me in a state of self hypnosis. Also, being suspended in warm water is extremely soporific (back to the womb?).

Your recent posting was noted in the Holistic list. No doubt you will get many responses that suggest meditation, exercise, vacations, Tai Chi, etc. Don't forget to consider Hypnosis. Being hypnotized and in a trace [sic] is about the least stressful, most relaxing (legal) thing you can do! As an added sidelight, a therapist may be able to help a person with chronic stress problems. Stress usually is defined as a physical and mental reaction to given circumstances. Actually, it makes no sense to try to separate the two; the Mind and Body always act and react together.

Often times an unhealthy physical stress reaction results from a mental reaction to conditions at hand. Obvious examples are anxiety attacks and phobias. These major maladies are frequently amenable to treatment by hypnosis.

Perhaps many societally induced stress reactions are merely subtle or less acute forms of the above problems. (Exclude stress caused physical phenomenon, e.g. a nearly avoided accident on the freeway. (Though such events could trigger stress reactions in later unrelated circumstances!)) Possibly, people that exhibit unhealthy stress responses have mild underlying mental triggers, perhaps a complex array of them.

I use the Feldenkrais Method, a very useful medium for retraining the nervous system. This method works by accessing unconscious habitual contractive patterns and teaching the client to make them conscious and then have the ability to choose what is more comfortable or efficient.

I started taking lessons about 5 years ago, was quite surprised to find how much more thorough the sense of physical relaxation was. I felt a depth of comfort in my body that I hadn't gotten from anything else. Jacqueline Freeman

Faculty, Hellerwork Institute

The Feldenkrais Method is based on principles of physics, biomechanics and an empirical understanding of learning and human development. By expanding the self-image through movement sequences that bring attention to the parts of the self that are out of awareness, the Method enables people to include more of themselves in their functioning movements. Students become more aware of their habitual neuromuscular patterns and rigidities and expand options for new ways of moving. By increasing sensitivity the Feldenkrais Method assists people to live their lives more fully, efficiently and comfortably.

The improvement of physical functioning is not necessarily an end in itself. Such improvement is based on developing a broader functional awareness which is often a gateway to more generalized enhancement of physical functioning in the context of one's environment and life.

Who Benefits from The Feldenkrais Method(r)?

Anyone--young or old, physically challenged or physically fit--can benefit from the Method. Feldenkrais is beneficial for those experiencing chronic or acute pain of the back, neck, shoulder, hip, legs or knee, as well as for healthy individuals who wish to enhance their self-image. The Method has been very helpful in dealing with central nervous system conditions such as multiple sclerosis, cerebral palsy, and stroke. Musicians, actors and artists can extend their abilities and enhance creativity. Many Seniors enjoy using it to retain or regain their ability to move without strain or discomfort.

People who receive the work enjoy greater ease of movement, an increased sense of vitality, and feelings of peaceful relaxation. Clients after a session often feel taller and lighter, breathe more freely and find that their discomforts have eased. They experience relaxation, and feel more centered and balanced.

What is a Functional Integration Lesson?

As Feldenkrais practitioners can guide people through movement sequences verbally in ATM lessons, they also guide people through movement in Functional Integration lessons with gentle non-invasive touching.

Functional Integration is usually performed with the student lying on a table or with the student in sitting or standing positions. At times, various props (pillows, rollers, blankets ) are used in an effort to support the person's body configuration or to facilitate certain movements. The learning process is carried out without the use of any invasive or forceful procedure.

Functional Integration is a hands-on form of tactile, kinesthetic communication. The practitioner communicates to the student how he/she organizes his/her body and, through gentle touching and movement, conveys the experience of comfort, pleasure and ease of movement while the student learns how to reorganize his/her body and behavior in new and more expanded functional motor patterns.

In Functional Integration the practitioner/teacher develops a lesson for the student custom-tailored to the unique configuration of that particular person at that particular moment. The lesson will relate to a desire, intention or need of the student. Through rapport and respect for the student's abilities, qualities and integrity, the practitioner/teacher creates an environment in which the student can learn comfortably.

...a warm mug of chamomile tea with a little honey, a scented candle, some good jazz, & my cat.

I've found that prevention is the best medicine. Deep breathing really helps relax my body. First, breathe out all of your air through your mouth. Then, slowly, inhale through your nose. Hold it a few seconds and then breathe out through your mouth. If you practice this at home, then you can often get relief at work with two or three deep breaths. I also visualize a healing substance/spirit going into my tight muscles as I breathe in. When I breathe out, I visualize breathing out all of the tension through my mouth and through my skin.

We're all prone to stress. The recent discussions have been very enlightening in helping us all find a way to deal with it more successfully. It's important to take it one day at a time and sort through and resolve each problem one at a time.

"There are two days in the week about which and upon which I never worry. Two carefree days, kept sacredly free from fear and apprehension. One of these days is Yesterday... And the other day I do not worry about is Tomorrow." (Robert Jones Burdette)

I discovered recently that ballet is a really great stress reliever for me. And this is coming from someone who would get stressed out from other types of exercise because I hated aerobics so much. I think the difference is, that ballet requires so much thought about each part of the body (from position of the head to what your arch of the foot is doing) that it is very meditative for me. I find myself really concentrating on my body for that 1.5-2 hour class, and I feel extremely refreshed after. I'm not sure how aerobic this is though, so I might have to *force* myself back into regular aerobic exercise after my next cholesterol test. Oh well, at least I like walking :)

Yes, the hard part is recognizing that you are in a stressful state. I have found a way to overcome this that works FOR ME. Practice! When I know that I am going into something that is difficult or will be stressful I let my face muscles relax and then put on a great big smile! I have done this while struggling to go uphill on a challenging run or before going into/during a lecture when I know I have a tough audience. I use the smile technique because it reminds my psyche that I have a feel good/things are all right response mode that can take over during a stressful situation, and because it usually rubs off on others. (snowball effect) So next time you think you might be going into a stressful situation practice smiling!

I get soreness in my neck and headaches. Sometimes, I don't even feel the tightness/soreness in my neck until I have the headache. I went for a massage not too long ago (which helped incredibly) and the guy told me of a simple stretching exercise, which I have used since and it's been highly successful. All you do is, while standing or sitting, lean your head to one side, as close to the shoulder as possible and hold for about a minute. Then, do it on the other side. Finally, do it leaning your head forward (down, not pushing your chin into your chest). Repeat, if necessary, which often is. I find this helps the most when done BEFORE the pain starts. When the tightness starts, I do this every hour or so until it relieves it, which might take two or three times. I told one of my roommates about it and she said that those five or ten minutes are worth their weight in gold.

Internet References to Relaxation

As I searched around on the internet, specifically the World-Wide-Web, to see what other information exists regarding relaxation techniques I found an even more interesting list of methods including: advertisements for music designed to put people into deep levels of relaxation; relaxing and then visualizing going through a feared experience; slow deep breathing; biofeedback; exercise three to four times a week (moderate, prolonged rhythmic exercise is best, such as walking, swimming, cycling, or jogging); eat well-balanced, nutritious meals; maintain your ideal weight; avoid nicotine, excessive caffeine, and other stimulants; mix leisure with work; take breaks and get away when you can; get enough sleep; be as consistent with your sleep schedule as possible; develop some mutually supportive friendships/relationships; pursue realistic goals that are meaningful to you, rather than goals others have for you that you do not share; expect some frustrations, failures, and sorrows; always be kind and gentle with yourself -- be a friend to yourself; Dynamic Meditation; Kundalini Meditation; Qi Kung; Shiatsu; Tai Chi; Reiki; Pranayama; Yoga; Bhakti Yoga; Journaling; Stress Busting Thoughts; slow rhythmic breathing; simple touch massage; visiting health resorts; foot reflexology; sauna massage; whole body massage; aromatherapy; a short walk; pelvic tilt; transcendental meditation; sex; laugh; be tactful; know what is expected of you; set goals and make a list; to help track progress, start by noting everything you did in the past week or so and then check back to see what is helping to achieve those goals; talk over problems and share thoughts with colleagues; to avoid the frustration that comes from losing things or not being able to find something quickly when it's needed, keep a neat work space without being obsessive about it; at the end of the workday, prepare a list of things to do the next day. It can prevent feeling disorganized and overwhelmed; don't take work home too often to avoid having workplace tension intrude on your private life; stress at home can be handled better if there is a calming-down period after work, perhaps exercising or spend time with colleagues; drink herbal teas; go fishing.

After many hours of searching, it remained evident that many people have a very wide variety of ways to relax. The effectiveness of these varied techniques remains to be detected. Subjectively, however, they appear to have benefit for those who are reporting them.

Textbooks on Relaxation

Next, I reviewed several textbooks commonly used in college courses on stress management. At the end of the review of the texts, a brief explanation of some of the techniques will be added for clarification.

The first manual was by Davis, Eshelman, and McKay, (1988), called The Relaxation & Stress Management Workbook. Chapter by chapter it focuses on the following methods for increasing levels of relaxation: body awareness; progressive relaxation; self-hypnosis; meditation; autogenics; refuting irrational ideas; nutrition; breathing; visualization; thought stopping; coping skills; assertiveness training; time management; job stress management; biofeedback; and exercise.

Another textbook (Seaward, 1994) divided the means for managing stress into two sections: Coping strategies and relaxation techniques. The coping strategies include the following: dealing with toxic thoughts; acceptance; cognitive restructuring; behavior modification; assertiveness; journal writing; art therapy; humor (comic relief); creativity; communication skills; time management; social-support groups; hobbies; forgiveness; dream therapy; prayer.

The relaxation techniques in this text included the following: several breathing techniques; concentration; visualization; transcendental meditation; the Benson method of relaxation; Zen and other types of meditation; hatha yoga; conscious breathing; mental imagery; color therapy; music therapy; visualization with music; massage therapy including shiatsu, Swedish massage, rolfing, sports massage, and other touch therapies; t'ai chi ch'uan; progressive muscular relaxation; autogenic training; clinical biofeedback; physical exercise; nutrition.

Additionally, Seaward devotes an entire section of the book to the subject of stress and spirituality. He focuses on many popular writers of man's more spiritual nature such as Carl Jung, Lao tzu, Albert Einstein, Scott Peck, Black Elk, Chief Seattle, Matthew Fox, Joan Borysenko, Jesus, Larry Dossey, Itzhak Bentov, Dave Bohm, Randolph Byrd, and Fritjof Capra. His reason for doing this is to emphasize a more spiritual foundation for man and the need to develop a more holistic balance, and therefore a less stress filled life, by finding and living by that inward, more spiritual nature. These people all spoke clearly of just such an aspect of a person.

Phillip L. Rice wrote a textbook called Stress & Health (1992). Some ways he outlines for increasing levels of relaxation and reducing stress includes the following: coping skills such as social support, increasing self-efficacy, cognitive restructuring such as positive self-talk, problem solving techniques, and increasing communication skills; positive diversions such as hobbies, music, exercise; self-disclosure; seeking information; monitor levels of stress; avoidance; denial; and addictions. He outlines ways to physically reduce stress and tension by: progressive muscle relaxation; using a mantra; guided imagery; autogenics; systematic desensitization; cognitive restructuring; stress inoculation; transcendental meditation; yoga meditation; the Benson method of meditation; biofeedback; time management; nutrition; and exercise.

Another text (Brannon & Feist, 1992) describes the following as methods of reducing stress: increasing personal control over situations; set up a social network of support; hypnosis; progressive relaxation; biofeedback; behavior modification; cognitive therapy; and stress inoculation.

A final manual found in this review was written by Walt Schafer (1992) called Stress Management for Wellness. In it are listed a variety of methods designed to reduce stress levels. The sections are broken into three parts. The first is titled Coping Options and considers the following methods: exercise; situational self-talk skills; positive beliefs such as a sense of coherence, hardiness, and optimism; problem-solving skills; communication skills; social support; material resources; community services; and sleep. The second section considers ways of coping considered by the author as "maladaptive reactions to stress." These include the following: alcohol abuse; smoking; drugs; overeating; escapism; spending sprees; physical and verbal abuse; blaming others; overworking; denial; magnification (making a mountain out of a molehill); and martyrdom. Next, he reviews "adaptive reactions" to stress: medications; solitude; music; play; prayer; intimacy; massage; professional assistance; hobbies; hydrotherapy; humor; exercise; nutrition; sleep; deep relaxation; health pleasures such as feeding animals, enjoying pets, conversations with family, sitting in a recliner chair, reading the newspaper, taking a hot tub under the stars, kayaking down a river.

An entire chapter of this book is devoted to how we talk to ourselves and the beliefs that we carry around that motivate that internal dialogue. Techniques for turning that negative self-talk into positive are discussed. Another chapter is devoted to relaxation techniques such as breathing techniques; standing relaxation techniques; mental techniques such as thought stopping, mental diversion, positive affirmations, and desensitization; meditation; biofeedback; autogenic relaxation; hypnosis and self-hypnosis; and visualization.

The review of textbooks was not exhaustive but rather, representative of texts available. Some relaxation/stress reducing/coping techniques from the texts are self-explanatory such as optimism. Others are not well known to everyone. I, therefore, will include a brief explanation of some techniques noted in the textbooks:

Art Therapy: Exploring the individual's "internal landscape" through paintings, pictures, drawings, and doodles as a process of self-discovery, self-healing, and self-realization (Seaward, p. 178).

Autogenics: While sitting or lying down "emphasis is placed on making specific body regions warm and heavy through passive self-suggestions" (Seaward, p. 357). For example, the subject would say to repeatedly say himself, "My right arm is warm and heavy." After several minutes of this phrase, he would say the same thing about the left arm and the legs. Other phrases such as "My heartbeat is calm and regular" may be used as well.

Behavior Modification: Actively changing behaviors through a five-step process: (1) Awareness: Becoming aware that something is less than ideal or unhealthy. (2) Desire to Change: Becoming committed to the idea that something must change now. (3) Cognitive Restructuring: Catching oneself in the act of the undesirable behavior and thinking of a new and suitable alternative. (4) Behavioral Substitution: A healthy or stress-reducing behavior consciously replaces the undesired behavior. (5) Evaluation: A determination is made to analyze whether the new behavior worked or is what was desired (Seaward, p. 160, 162).

Biofeedback: "A process or technique for learning voluntary control over automatic reflex-regulated body functions" (Davis, p. 204). Biofeedback machines include electromyogram (EMG) which measures skeletal muscle tension; Thermograph that measures minute fluctuations in body temperature, usually in the finger, hand or foot; Galvanic Skin Response (GSR) measures the electrical conductance or electrical potential in the skin and monitors tiny changes in the concentration of salt and water in the sweat gland ducts. As a person relaxes or tenses, the machines detect the changes and "feed back" to the subject what she did to cause that change. Over time, the subject is able to induce those changes more and more consciously.

Body Awareness: A process of consciously becoming aware of the sensations that one is feeling throughout the body; noticing which areas of the body are more tense than others; identifying sensations in the body associated with various thoughts or feelings (Davis, 1988, p. 15).

Breathing: Consciously modifying the inhalation and exhalation of one's breath. This may be slowing one's breath; moving the breath on the inhalation all the way down into the abdomen; inhaling and holding the breath and then exhaling very slowly or in another modified way; inhaling while occluding one nostril and exhaling while occluding the other. There are many, many variations of breathing techniques that increase levels of relaxation (Seaward, 1994, p. 260-265).

Cognitive Restructuring: An ongoing process of making changes through cognitive processes. It is done in four steps (1) Awareness: becoming more aware of what is going on in the mind including all frustrations and worries; identify why what emotions are attached to these; acknowledge the feeling physical feeling associated with the frustration or worry. (2) Reappraisal of the situation: generate a different viewpoint of the situation. (3) Adoption and substitution: Implement the new frame of mind from the different viewpoint; create new habits based on the new point of view. (4) Evaluation: Determine if this new attitude is effective (Seaward, 1994, pp. 149-150).

Color Therapy: Exposure to colors or colored lights or mentally visualizing different colors to promote desired feeling states (Seaward, 1994, pp. 306-308).

Hatha Yoga: Physical postures integrated with breathing techniques designed to balance the mind, body and spirit (Seaward, 1994, pp. 282-293).

Increasing self-efficacy: Increasing one's perception of one's capability, the belief that one possesses the personal skills and performance abilities that will enable tone to act correctly and successfully in given situations (Bandura, 1977, 1989).

Journal Writing: "A series of written passages that document the personal events, thoughts, feelings, memories, and perceptions in one's journey . . . " (Seaward, p. 165). The process of opening up, disclosing feelings, perceptions, opinions and the like on paper.

Massage: Shiatsu: Acupressure; applying force through finger pressure on locations over the body. Swedish Massage: "The total body massage" using oils. The Swedish massage consists of long rhythmic strokes, light strokes along the spine, rolls and squeezes made with either the finger tips or palm of the hand; deep kneading action of muscle tissue between the fingers and thumbs; percussive karate chop strokes; and vibration of the targeted muscles. Rolfing: Deep muscular penetration by "digging" into soft tissue, often separating layers of muscles and stretching and lengthening them with the hands, elbows and sometimes the entire body weight of the massage therapist. Sports massage: A hybrid of shiatsu and Swedish massage with emphasis on both compressive and rhythmic-pumping movements to remove the buildup of lactic acid in the muscles because of repeated contractions (Seaward, p. 333).

Meditation: The process of uncritically attempting to focus your attention on one thing at a time (Davis, Eshelman, & McKay, 1988, p. 37) for a brief period of time. This focal point may be internal such as repeating a mantra (a specific sound, word, or phrase passively repeated silently to oneself over and over) or focusing on one's breathing as it inhales and exhales. The focal point may be external such as setting one's gaze upon a candle flame. This is usually done for ten to twenty minutes with a very passive, nonjudgmental attitude.

Mental Imagery: While in a relaxed state, with the eyes closed, actively imagining a scene that is relaxing such as at the beach, in the mountains, or by a lake near a forest. The variations are limitless. Some include merely seeing colors, hearing music, finding your inner guide, creating an inner workshop, etc., (Schaffer, 1992. pp. 312-314).

Music Therapy: Listening to music to promote desired feeling states (Schaffer, 1992. p. 212).

Progressive Relaxation (Active): Sequentially tightening and relaxing each area of the body. First, tighten all the muscles in the feet for a few moments, clenching as tightly as possible. Then allow it to relax and notice the sensation of relaxation that occurs with the release. Move up the legs and do the same process and so on through the rest of the body (Seaward, 1994, p. 349).

Self-hypnosis: Inducing deep states of relaxation through suggestions designed to produce such a state. For example, "You are feeling calm and relaxed" . . . "Deep peace flows calmly and gently through every muscle organ, and cell of your body" . . . etc., until the body and mind are very relaxed (Davis, 1988, p. 65-80.

Stress Inoculation: Imagining worst-case scenarios that might induce high levels of stress. Once one has anticipated one's worst fears and thought about strategies for managing them, one will manage the situation better when it happens (Rice, 1992, p. 326).

Systematic Desensitization: While in a relaxed state, thinking of a very mild form of a feared or stressful experience. Successively, from there, thinking of closer approximations to that feared or stressful experience while in the relaxed state neutralizes the threat of that experience (Rice, 1992, p. 319).

T'ai chi ch'uan: "Moving Meditation" A series of movements that act to help unify the life force energy with that of the person. Over 100 positions reinforce the notion of consciously moving with, rather than against, perceived stressors in everyday life (Seaward, 1994, p. 339).

The Benson Method: Putting oneself in a quiet environment; focusing one's inner attention on a mental device such as a mantra (like the word "one" or "ohm"), or one's successive inhalations and exhalations; using the word "no" to refocus the mind if it wanders; maintain a passive attitude; place oneself in a comfortable position, either sitting or lying down (Schaffer, 1992. pp. 306).

Transcendental Meditation: While sitting, with the eyes closed, silently and passively repeating a special mantra for ten to twenty minutes (Seaward, 1994, p. 270).

Visualization: While in a relaxed state, with the eyes closed, actively imagining a scene that is relaxing such as at the beach, in the mountains, or by a lake near a forest. The variations are limitless. Some include merely seeing colors, hearing music, finding your inner guide, creating an inner workshop, etc., (Seaward, 1994, p. 295).

Scientific Literature on Relaxation

Several relaxation/stress management techniques have received a fair amount of scientific scrutiny. This section describes those techniques that have been more scientifically analyzed to determine their effectiveness at reducing stress and shown to be successful in doing so.

Breathing

For centuries, breathing exercises have been an integral part of mental, physical, and spiritual development in the Orient and India. There are two basic ways of breathing; the first is diaphragmatic, or abdominal breathing; the second is chest, or thoracic breathing. Normal breathing is usually a combination of the two. Chest breathing is relatively shallow. The chest expands and the shoulders rise as the lungs take in air. In the fight-or-flight response, a person tends to breathe more in this way, even to the point of holding the breath or exhaling incompletely. Breathing thoracically can cause symptoms such as shortness of breath and tightness in the chest (Benson, 1993, p. 40).

Abdominal diaphragmatic breathing involves inhalations that cause the diaphragm to contract and move down, drawing air into the lungs. When air moves down into the lungs at the lower levels, the tummy tends to distend slightly. On exhalation, the diaphragm relaxes and moves upward and the tummy moves back in.

Nearly every stress management technique includes some kind of exercise involving the breath. Diaphragmatic breathing is commonly used with techniques including progressive muscular relaxation, autogenic training, and mental imagery, for a combined relaxation effect (Seaward, 1994, p. 261).

Diaphragmatic breathing exercises are probably the easiest type of relaxation exercises to learn and usually involve bringing the attention to the inhalation and exhalation of the breath, sometimes briefly holding the breath, or varying the length of the inhalation or the exhalation. One way of practicing abdominal breathing is to place one hand on the stomach, approximately over the bellybutton, and the other on the lower part of the sternum just over the heart. Then by noticing which hand is moving more, the upper or the lower hand, during inhalation and exhalation, adjustments can be made. By making the hand over the stomach move out with the inhalation and in with the exhalation, while the top hand remains still, the exercise of diaphragmatic breathing takes place.

The primary purpose of breathing is to supply the body with oxygen and to remove excess carbon dioxide. The body's ability to produce energy, to complete the various metabolic processes depends upon sufficient and efficient use of oxygen. Oxygen is necessary to help us repair and regenerate our bodies. An average human breath contains about 10 sextillion or 10²² atoms (Dossey, 1982, p. 77). People who breathe primarily from their chest only move about 500 cubic centimeters of air in and out with each breath. A full diaphragmatic breath or abdominal breath moves eight to ten times that volume (Borysenko, 1988, p. 64). The exchange of oxygen from the lungs into the bloodstream toward the cells is far greater in the lower portion of the lungs when a person is in an upright position (Patel, 1993). Relearning (babies all breathe diaphragmatically) to breathe through the abdomen helps bring air predominantly into the lower parts of the lungs and by that, increase beneficial oxygenation throughout the various cells and systems of the body.

Slow, rhythmic breathing can turn an anxious mental state into one of relative tranquillity and release the body from many other adverse effects of anxiety. "Practicing proper breathing techniques is one of the most vital techniques we have at our disposal, not only as a treatment of respiratory disease, but to reduce the anxiety associated with all psychosomatic illness" (Pelletier 1992a, p. 185).

Studies show deep abdominal breathing to be effective in reducing levels of stress (Forbes & Pekala, 1993; Prerost, 1993; Kim & Tennant, 1993); coping with stressful situations (Toivanen, Lansimies, Jokela, & Hanninen, 1993); and reducing blood pressure (Latha & Kaliappan, 1991; Aivazyan, et al., 1988).

Meditation

Members of many Eastern religions have long realized the benefits of meditation, but most Westerners have approached the practice with a skeptical eye. In 1968, Dr. Herbert Benson and his colleagues at Harvard Medical School decided to look more deeply into this eastern method that was gaining popularity in the West. Volunteer practitioners of Transcendental Meditation were tested to see if meditation really could counter the physiological effects of stress. Benson proved that during meditation heart beat and breathing rates slow down, oxygen consumption falls by 20 percent, blood lactate levels, which are known to rise with stress and fatigue, drop, and EEG rating of brain wave patterns indicate increased alpha activity, another sign of relaxation.

Benson (1975, 1981) went on to show that any meditation practice could duplicate these physiological changes as long as four factors were present: a mental device (constant and repetitive attentional focus), a passive attitude, decreased muscle tonus (facilitated by a comfortable position) and a quiet environment. In research on meditation and its affects on anxiety, results have shown reductions in anxiety levels after beginning regular practice of meditation (Carrington, 1977; Glueck, 1973; Leserman, Stuart, Mamish, & Benson, 1989; Domar, Noe, & Benson, 1987).

Many stress-related illnesses have also responded favorably to meditation. Meditation has been correlated with improvement in the breathing patterns of patients with bronchial asthma (Honsberger & Wilson, 1973); with decreased blood pressure in both pharmacologically treated and untreated hypertensive patients (Benson, 1977; Patel, 1973, 1975; Hafner, 1982; Friskey, 1984); with reduced premature ventricular contractions in patients with ischemic heart disease (Benson, Alexander, & Feldman, 1975); with reduced symptoms of angina pectoris (Tulpule, 1971; Zamarra, Besseghini, & Wittenberg, 1978); with reduced serum cholesterol levels in hypercholesterolemic patients (Cooper & Aygen, 1979); with reduced sleep-onset insomnia (Miskiman, 1978; Woolfolk, Carr-Kaffashan, McNulty, & Lehrer, 1976); with amelioration of stuttering (McIntyre, Silverman, & Trotter, 1974); with lowered blood sugar levels in diabetic patients (Heriberto, 1988); and with reductions in the symptoms of psychiatric illness (Glueck & Strobel, 1975). Thus, meditation can be seen as a useful and effective intervention in a both reducing stress and dealing with wide variety of stress-related illnesses (from Carrington, 1993).

Transcendental Meditation (TM)

Wallace and Benson were the first to study the physiological effects of TM (1972, 1976) as it relates to stress management. Using subjects who had learned the technique, they found that there occurred within the systems of the body what they termed a "hypometabolic state." This state "represented quiescence rather than hyperactivation of the sympathetic nervous system," and was opposite, in nearly every respect, to the "fight-or-flight response.

This hypometabolic response that occurred during meditation has been shown to be associated with a decrease in oxygen consumption, respiratory rate, and cardiac output; a marked decrease in arterial blood lactate concentration, which is known to be associated with anxiety; an intensification of slow alpha waves and occasional theta waves in the EEG; and in increase in electrical resistance of the skin, associated with a decrease in sweat gland activity (Patel, 1993).

Goleman and Schwartz (1976) of Harvard studied TM to determine if it was superior to merely sitting with eyes closed and afterwards watching a film designed to be stressful. Results indicated that, in comparison to the group that just sat with eyes closed, the meditating group experienced significantly less subjective anxiety to the stressor film.

Early research projects on TM demonstrated that meditation is psychologically and physiologically more refreshing and energy restoring than deep sleep (Wallace, 1970; Pelletier, 1992, p. 197). Sothers and Anchor found TM to be effective in the reduction of hypertension (1989).

Evidence of the effectiveness of TM on anxiety and stress related illnesses are similar to those mentioned in the earlier discussion of meditation (Carrington, 1993).

Mindfulness Meditation

Kabat-Zinn described mindfulness as being different from meditation in that practitioners "attend to a wide range of changing objects of attention while maintaining moment-to-moment awareness (mindfulness), rather than restricting one's focus to a single object such as a mantra" (Kabat-Zinn et al., 1992).

Kabat-Zinn pointed out that with mindfulness meditation, emphasis is not placed on distinguishing thought as positive, negative, or faulty, as in cognitive therapy. Rather, the emphasis is on identifying thoughts as "just" thoughts and acknowledging the potential inaccuracy and limits of all thought, and not just thoughts that produce anxiety (Kabat-Zinn, 1992). The emphasis, in mindfulness meditation is on meditation as a way of being, as a way of living one's life, and as a way to develop alternative "generic" strategies for coping with stress, rather than as a technique for coping with a specific problem such as panic (Kabat-Zinn, 1992). One of these strategies is summarized by Trunnell and Braza (1995). They emphasize the importance and value of maintaining one's attention on the immediate moment rather than the future or the past:

Learning to focus on the moment offers a temporary respite from the stress at hand. Instead of worrying about the quality of yesterday's performance and all the projects yet to complete, coming back and working on the project at hand may offer multiple rewards.

In his study on the effectiveness of mindfulness with patients diagnosed with anxiety disorders, he found that subjects showed significant reductions in anxiety scores after going through the eight-week stress reduction and meditation program. A three month and a three year follow-up were conducted for the patients. The researchers reported that the decreased anxiety scores, as a result of the program had been maintained.

Yoga Meditation

The term "yoga" means union. According to Wallace and Benson (1976) it also implies "a higher consciousness achieved through a fully rested and relaxed body and a fully awake and relaxed mind."

Swami Rama (1972) described yoga as an attempt to take into account all three sides of human life--the body, the mind, and the soul, or to put it differently, the physical side, the social side, and the spiritual side. A healthy body is necessary to house the inner soul. Unfortunately, a physically health person may lack spiritual awareness, and even those who are both physically fit and spiritually aware may be lacking in their proper relationship with others. Yoga philosophy teaches us ways of establishing harmony among the various sides of life.

There are several ways of practicing yoga (Patel, 1993) but the one that is probably the most designed for reducing stress is hatha yoga. Hatha yoga consists of (1) regulation of the mind and body through 14 different breathing exercises (pranayamas); and (2) over 200 balanced physical postures (asanas) developed to exercise and lengthen all the muscles in the body (Patel, 1993). Chopra describes a hatha yoga routine that takes far less time and still combines to produce the results of reducing stress, through several postures and breathing techniques along with meditation (1990, pp. 267-301).

The physical postures (asanas) involve learning to control, regulate, and become aware of one's physical existence. The emphasis is to give complete mental attention to each movement, to the exclusion of everything else. With practice, different body functions become more integrated with one another. Energy from within is awakened, and the person practicing yoga feels radiant with vitality and energy (Patel, 1993).

An early study (Bagchi, & Wenger, 1959) with Indian yogis, most of whom practiced Hatha yoga, found that in ninety-eight meditation sessions, the following characteristic pattern of physiological alterations occurred during meditation: (1) an extreme slowing of respiration to 4 to 6 breaths per minute; (2) more than a 70 percent increase in electrical resistance (GSR), indicating a state of deep relaxation; (3) a predominance of alpha brain-wave activity; and (4) a slowing of heart rate to 24 beats per minute from the normal rate of 72 beats per minute. Each of these alterations in physiology indicates deep levels of relaxation.

Dean Ornish probably stands out as using a yoga-based therapy the most scientifically. In his most recently published study (Ornish et al., 1990a) he and his colleagues randomly assigned 48 middle-aged male and female outpatients with coronary artery disease to experimental and usual-care control groups. The patients in the experimental group were prescribed an extremely low-fat vegetarian diet and moderate exercise; were given training in stress management including enhancement of social support among the group members to increase compliance; and were advised to stop smoking. The stress management training included yoga-based stretching exercises, breathing techniques, meditation, relaxation, and visual imagery. The patients were asked to practice these at least 1 hour per day, and were given 1-hour audiocassette tapes to help them practice. The patients in the control group were not asked to make any similar lifestyle changes but were free to do so.

In the experimental group, compared with the control group, there was a significantly greater fall in total cholesterol (24.3%) and low-density lipoprotein cholesterol (37.4%); high-density lipoprotein cholesterol did not change significantly. Patients in the experimental group reported a 91% reduction in the frequency of angina, a 42% reduction in the duration of angina, and a 28% reduction in the severity of angina pain. In contrast, the control group reported a 165% rise in frequency, a 95% rise in duration, and a 39% rise in severity of angina pain. The investigators assessed 195 coronary artery lesions in both groups by quantitative coronary angiography at baseline and after about 1 year. For the experimental group, constriction of coronary arteries decreased from 40% to 37.8%. For the control group, coronary artery constriction increased from 42.7% to 46.1%. The authors commented that coronary artery disease is progressive and the control group's results demonstrate that the usual advice to change lifestyle and medications are not sufficient to halt progression. The results of the experimental group give early indications that, for heart disease, radical changes in lifestyle, including yoga-based therapy may be a potent alternative (Patel, 1993; Ornish, 1990b; Heilbronn, 1992).

In a study conducted in Japan with female college students, hatha yoga was compared with progressive relaxation and their effects on heart rate, blood pressure, physical self-efficacy, and self-esteem. Results showed both treatments were effective in lowering heart rate, and blood pressure and in improving self-esteem (Cusumano & Robinson, 1993).

Massage

A recent survey published in the New England Journal of Medicine (Eisenberg, Kessler, & Foster, 1993) found that among unconventional therapies used in our society, one of the top three is massage, along with relaxation techniques and chiropractics. Meeks, (1993) reported on the use of a slow stroking massage among hospice clients. She found that massage was associated with decreases in systolic blood pressure, diastolic blood pressure, decrease in heart rate, and an increase in skin temperature, all indicative of a relaxation response.

In another study (Field et al., 1992) a 30-minute back massage was given daily for a 5-day period to 52 hospitalized depressed and adjustment disorder children (aged 7-18 yrs.). Compared with a control group of 20 subjects who viewed relaxing videotapes, the massaged subjects were less depressed and anxious and had lower saliva cortisol levels after the massage. The nurses also rated the subjects as being less anxious and more cooperative on the last day of the study, and nighttime sleep increased over this period.

Hypnosis/Hypnosuggestion/Self-Hypnosis

In therapy as part of an eclectic approach the therapists may be found saying some version of the following words to a client to achieve deep relaxation:

Close your eyes and take a deep breath...Breathing slowly and deeply...and as you breathe out slowly, you may feel more at ease, calm, relaxed, letting go of tensions worries, frustrations...Breathing slowly and gently and calmly...letting go of bothers and concerns...more serene, relaxed, at ease, at peace, tranquil...Peaceful, quiet, deeper and deeper relaxed. Mind calm and body relaxed...Warm and comfortable...Deeper and deeper, deeper and deeper relaxed...(Barber, 1993).

Any type of deep relaxation is an attempt to promote the relaxation response (Benson, Beary, & Carol, 1974). Barber (1993) reports that this deep relaxation has been achieved by hypnotherapists for over a century to reduce stress and tension, especially in individuals with stress-related or psychosomatic ailments such as migraine, headache, asthma, insomnia, or hypertension. He noted that Wetterstrand's (1897) method of hypnotherapy consisted solely of suggesting over and over to the hospitalized patients continually every few hours for days or even weeks that they would remain deeply relaxed, calm, and at peace. The patients would get up to eat and to relieve bodily needs, but otherwise they stayed in bed while receiving continual suggestions to deeply relax. Weterstrand reported that this prolonged hypnotic deep relaxation had marked effects in relieving a wide variety of illnesses.

Hypnotherapists do not use Wetterstrand's prolonged relaxation treatment today, but they commonly use a more brief hypnotherapy through suggestion to produce this state of deep relaxation (Barber, 1993).

Experimental or clinical research has indicated that hypnotherapy and/or self-hypnosis has been used not only in the reduction of stress or relaxation (Torem, 1994; Master, 1992; Green & Shellenberger, 1991) but also in reducing migraine headaches (Anderson, Basker, & Dalton, 1975; Basker, Anderson, & Dalton, 1978; Basker, 1970); tension headaches (Barber, 1993; Field, 1979); Asthma (Collison, 1978); insomnia (Wilson & Barber, 1981, 1983); pain (Klienhauz, 1991; Sokol, Devane, & Bentovim, 1991); sleep-terror (Kohen, Mahowald, & Rosen, 1992) and hypertension (Deabler, Fidel, Dillenkoffer, & Elder, 1973; Friedman & Taub, 1977, 1978).

Visualization

Braybrooke (1991) reported a case study of a 57 year old woman who had suffered from chronic back pain or 31 years. In therapy she began a relaxation technique that comprised of a progressive relaxation exercise, a color vapor technique, and actively visualizing a mineral hot spring in which she mentally soaked herself. Using these techniques, within two years her pain fully subsided.

Among college students, Russell (1992) found that combined with familiar sedative music, mental imagery was the most effective technique in reducing university students' state anxiety compared to a music only group, a cognitive intervention group and a control group.

Exercise

Studies conducted with animals suggest a beneficial effect of exercise on autonomic and neuroendocrine stress responsivity (Birrell & Roscoe, 1978; Cox, Hubbard, Lawer, Sanders & Mittchell, 1985; Mills & Ward, 1986).

Steptoe, Moses, Edwards, and Mathews (1993) reported that moderate levels of aerobic training led to significantly greater improvements in their perceived ability to cope with stress than did a control group.

Norvell and Belles (1993) found that a four month program of circuit weight training, which combines aerobic exercise with weight training, for state law enforcement officers proved effective in decreasing anxiety, depression, and hostility compared with a control group.

Another report on depression (Thayer, Newman, McClain, 1994) concluded that exercise is the most effective mood-regulating behavior. The researchers found that the best general strategy for changing a "bad mood," increasing personal energy, and reduce tension is a combination of relaxation, stress management, cognitive techniques, and exercise.

A similar study among female nursing students found a significant increase in self-esteem along with a decrease in depression and anxiety when the students participated in a 6-week program that combined exercise with nutrition information, progressive relaxation, cognitive control, and time management skills (Godbey & Courage, 1994).

Linden and Chambers (1994) conducted a meta-analysis of the clinical effectiveness of treatments of essential hypertension comparing pharmacological treatments with non-pharmacological treatments. Their findings showed that of the non-drug approaches, weight reduction and physical exercise proved to be as effective as drug treatments for controlling hypertension. Bosscher (1993) also found exercise to be effective in treating depression, increasing self-esteem, and general body satisfaction.

Debenedetter (1988), Carlucci (1991), and Allsen (1993) have noted the following theories to explain the reasons why exercise moderates stress: Exercise reduces the intensity of the stress response because of a reduction in blood pressure and heart rate; exercise shortens the time it takes for a person to recover from stress; from exercising, a person develops a better attitude about one's life due to increased self-esteem, thus stress is reduced; exercise usually elevates a person's mood perhaps due to hormonal changes or muscle relaxation; exercise acts as a distraction from stressful stimuli and channels repressed anger and frustration into physical activity; a release of endorphins during exercise may alleviate stress.

Exercise has been called the buffer of stress (Roth & Holmes, 1985; Brown & Siegel, 1988). The ability of exercise to buffer stress has also had mixed results. In Germany (Kirkcaldy & Cooper, 1993a), a study explored the interaction between some aspects of physical leisure and work stress among 123 British and 132 German managerial and executive personnel. They found that subjects who exercised regularly were not significantly different in their occupational stress profiles compared with managers who did not exercise. The authors of this study alluded to the notion that other factors such as the culture may have a balancing influence on worker's stress.

Another study (Norris, Carroll, & Cochrane, 1990) was done to measure the training effects, both aerobic and anaerobic, on perceived stress. The study used a control group that was not involved, for a 10-week period, in any type of training activity. The study not only looked at perceived levels of stress, but also included a measure of perceived quality of life, a general health questionnaire as well as physiological measures of heart rate, systolic blood pressure and diastolic blood pressure. The researchers were testing the hypothesis that exercise buffers the negative impact of naturally occurring stressful life events and has positive implications for health and well-being. In comparison to the control group, the aerobic training group scored "substantially improved scores on all three measures." They noted that the anaerobic group had improved scores on the quality of life scale and the general health measure. Levels of perceived stress, however, were not significantly different for this group compared with the control group.

A similar study (Norris, Carroll, & Cochrane, 1992) found that adolescents who went through a 10 week high intensity aerobic training program had significantly less perceived stress than subjects who were in groups of only moderate intensity aerobic training, flexibility training or a control group.

Holmes and Roth (1985) assessed the aerobic fitness of 72 females using a submaximal cycle ergometer test, and compared the heart rate and subjective arousal responses to a memory test of the 10 least and 10 most fit subjects. They found that the most fit subjects showed a smaller increase in heart rate during the memory task than the least fit subjects. The study also found that fitness had no effect on subjective response. In a similar study Holmes and McGilley (1987) found that less fit subjects had heart rates that are nearly 30 beats higher than the heart rates of highly fit subjects during stressful mental tasks.

Hull, Young, and Ziegler (1984) found that diastolic blood pressure responses to a cognitive task were smaller for fit subjects of 40 years of age than for their same-age unfit counterparts. These authors also reported less subjective anger and depression in fit subjects following an unpleasant film. Light, Obrist, James, and Strogatz (1987) categorized subjects based on self-reported exercise habits and found that "cardiovascular reactivity (pre-ejection period, heart rate, and systolic blood pressure) to a reaction time task was greater in subjects reporting lower levels of exercise." In a similar study, Van Doornen and De Geus (1989) reported that highly fit subjects (as determined by a maximal exercise test) showed smaller increases in heart rate, diastolic blood pressure, and total peripheral resistance than low-fitness subjects during a reaction time task.

In a classic study to determine the effectiveness of aerobic exercise on coping with emotional stress, Sinroy, Golden, Steinert, and Seraganian (1983) found that compared with a control group and another group involved with meditation, a group of subjects that exercised 4 times per week for 30 minutes each, over a period of ten weeks, demonstrated a faster recovery of heart rate and autonomic system response related to a battery of stressful mental tasks than did the control group. The authors reported that a faster recovery implies that the body is coping with stress more efficiently.

A meta-analysis of studies considering the relationship between fitness levels and stress levels, was conducted by Crews and Landers (1987). They reported that subjects who were more aerobically fit had lower levels of psychosocial stress response regardless of the stressor.

It appears from the research that exercise provides a process of adaptation to stressors in general. The body seems to be able to more adequately adjust to other stressful experiences as the body responds to stressors placed upon it from exercise.

Biofeedback

Pelletier (1992a, pp. 264-265) says that biofeedback relaxation training is composed of three principles: (1) any neurophysiological or other biological function which can be monitored and amplified by electronic instrumentation and fed back to a person through any one of his five senses can be regulated by the individual; (2) "every change in the physiological state is accompanied by an appropriate change in the mental emotional state, conscious or unconscious, and conversely, every change in the mental emotional state, conscious or unconscious, is accompanied by and appropriate change in the physiological state" (Green, Green & Walters, 1970); and (3) people can be taught to control their autonomic nervous systems to influence these physiological changes directly. He pointed out that a simple process, such as heart rate, can be seen as very volatile. The simple processes of changing the posture, moving an index finger, or changing breathing patterns can have a profound effect on the heart rate. By tuning in to the effects of changes, the person begins to gain some control by emphasizing activities that generate relaxation. After some practice, the person soon learns that merely thinking about something pleasant or peaceful can create a decrease in heart rate, or alternately, merely thinking about something like a recent argument with someone, tends to cause an acceleration of the heart rate.

Biofeedback systems work by detecting changes in the biological environment and, through visual or auditory signals, the person is informed of these changes. On the basis of trial-and-error strategy, using this precise and immediate information, the person quickly learns how to control the biological systems generating the biofeedback signals (Stoyva & Budzynski, 1993). As an example, in one instance where biofeedback was used with children, Rice (1992) reported that a toy train wired to a machine provided feedback by moving only when the subjects were completely relaxed.

Stoyva and Budzynski (1993) report the inception of the biofeedback method:

In 1966, Kamiya's technique of controlling the alpha electroencephalographic (EEG) rhythm by means of a feedback tone to indicate the presence of the alpha rhythm was already stirring interest on the West Coast. Later that year, we built an alpha EEG feedback device. It had occurred to us that the pleasant and tranquil characteristics of the "alpha state" as reported by Kamiya (1969) could be used to counter anxiety in the behavior therapy procedure known as "systematic desensitization." We reasoned that with the feedback device we could first teach patients to produce more alpha. Then we could ask them to visualize themselves in anxious or stressful situations. As the percentage of alpha diminished, we could stop the visualization and allow the patients to "recover" the (relaxed) alpha state using the feedback tone. This approach did in fact result in the highly successful desensitization of a patient suffering from a severe death-related phobia (Budzynski and Stoyva, 1973). Desensitization was completed in four sessions. A follow-up 14 years later indicated no return of the anxiety. To our knowledge, this was one of the first applications of electronic biofeedback in a psychotherapy setting.

There are several types of biofeedback devices that are available and useful in monitoring autonomic nervous system activity. The electromyograph (EMG) is designed to monitor electrical impulses produced by muscle tissue. Electrodes are placed on the skin over specific muscles that are prone to tension such as the jaw, lower back, neck, or shoulders. For overall relaxation, the frontalis muscle on the forehead is used, as this muscle has no direct connection to bone. Through the EMG, the patient first becomes aware of the current level of muscle tension by watching visual feedback or hearing auditory feedback. With the aid of an assistant, the subject is then taught to relax the muscles that are diagnosed as tense, and to sense the difference between tension and relaxation while monitoring the visual and/or auditory data produced by the machine (Seaward, 1994, p. 369).

The electroencephalogram (EEG) monitors electrical activity close to the surface of the brain. It has been observed that the brain produces different electrical rhythms, or wavelengths, during different states of consciousness. For example, while in an active waking state, the beta rhythms (greater than 15 cycles per second) are seen on an EEG monitor. When someone is in a relaxed or altered state of consciousness, the alpha waves (7-14 cycles per second) are the most common. Theta brainwaves (4-7 cycles per second) and delta waves (between .5 and 4 cycles per second) are associated with unconscious and sleeping states (Seaward, 1994, p. 370).

Each type of brainwave is represented by a unique pitch or sound that comes from the EEG. Using this method, the person is taught to decrease the pitch associated with beta waves and increase the alpha sound. This would indicate a decrease in cognitive stimulation (Seaward, 1994, p. 370).

Electrodermal (EDR) biofeedback, or more commonly known as galvanic skin response (GSR) measures electrical conduction on the skin. Under stress, the hands and fingers tend to perspire. Using the water as a conductor of electricity, the electrodes are able to determine electrical impulses produced by the skin that are activated by the sympathetic nervous system. In biofeedback training, the person is taught to decrease sympathetic activity by monitoring GSR levels through relaxation techniques. Interestingly, this is the same technology that is used in polygraph (lie detector) tests (Seaward, 1994, p. 370).

The purpose of any biofeedback device is to help the person learn how relaxation feels and then learn to induce the relaxation response consciously. Biofeedback machines are designed to facilitate this process. Pelletier describes the process of how this learning to relax takes place:

A single example of the learning process involved in biofeedback can provide a model which is applicable to virtually all instances of autonomic regulation. During the initial stages of electrocardiogram (ECG) or heart-rate feedback, patients are surprised to see how volatile their heart rates really are. At first the pattern seems random, since the heart rate appears to increase and shortly afterward decrease for no easily discernible reason. After a relatively short time, the patient realizes that minor changes in his physical posture--even flexing an index finger, or changes in his breathing pattern--have a profound effect upon the heart. Breathing in a slow or regular manner or sitting in an upright posture helps to decelerate the heart rate, whereas slouching or breathing shallowly and quickly tends to accelerate it. This recognition is a first step in establishing the link between the mind and body as their interaction affects the heart. After the initial stage, during which these rather obvious connections are made, the patient begins to realize that a more subtle level of regulation is possible. When thinking of a pleasant or relaxing vacation, he notes that his heart rate begins to decelerate. Conversely, when he thinks about a perplexing or stress-inducing situation like his income tax or an argument with a close friend, heart rate accelerates. Exploration of the interaction between psychological events and physiological changes are at first fascinating to the individual, and can preoccupy him for long periods of time. After this second stage has been investigated fully, the individual graduates to a still more sophisticated understanding of mind/body interaction. At this point, he begins to realize that feelings of heaviness and warmth in the area of the heart will allow the heart rate to decelerate, while feelings of lightness and constriction in the same area will actually produce acceleration. This is a very important step in the learning process, because the individual is able to remember and duplicate these sensations at any time throughout the day. Once this link between internal sensations and their effects upon the cardiovascular system is established, the individual has a means of regulating the critical autonomic function. This progression from unconscious physiological process to a conscious awareness of psychosomatic interaction, followed by a decreased reliance on the instrumentation is a fundamental process in clinical biofeedback (Pelletier, 1977, pp. 265-266).

Clinical research has found biofeedback to be effective in decreasing levels of stress (Karnes, Oehler, & Jones, 1985); reducing tension headaches (King, 1992) reducing blood pressure (Blanchard, 1990; Aivazyan, et al., 1988); reducing chronic pain (Middaugh, Woods, & Kee, 1991); reducing anxiety (Fahrion & Norris, 1990);

Autogenic Training

The purpose of autogenic training is to reprogram the mind to override the stress response when physical arousal is not appropriate (Seaward, 1994, p. 356). The creator of Autogenic Training, Johannes Heinrich Schultz, was a firm believer in the self-regulatory capacities and ultimately the self-healing powers of the body if it was only left alone to do its work (Linden, 1993).

Autogenics involves first putting oneself either in a position lying on one's back or seated in a chair. Once situated, the participant begins focusing internally. Two approaches may then be used. One approach involves putting one's attention on a specific area of the body and while taking slow deep breaths, repeating over and over (about six times each) such phrases as "My arms and hands feel heavy," "My legs and feet feel warm," "My heart is calm and relaxed." "My stomach area is calm and relaxed," or "My forehead is calm and relaxed."

The other approach, which is more direct, involves first being fully relaxed, then, rather than merely repeating statements of warmth, or heaviness, or calmness, the person follows the flow of blood and internally senses its flow to specific areas of the body, such as the arms and hands, or the legs and feet, and throughout the body. Occasionally, during this process, suggestions of breathing, heaviness, calmness, and relaxation are included. One such instruction would sound like this: "Think to yourself that when your muscles are saturated with blood, they become very relaxed and pliable like a wet sponge. Now become consciously aware that you desire to recreate that feeling of relaxation in the muscles of your legs and feet."

Common physiological responses to autogenic training include decreases in heart rate, respiration and muscle tension; increases in hemispheric alpha waves indicating of mental calmness; and decreases in serum cholesterol levels have also been clinically observed (Greenberg, 1993).

The autogenic relaxation technique has been used successfully in the treatment of several signs of physical stress including insomnia (Coates & Thoreson, 1978), tension headaches (VanDyck, Zitman, Linssen, & Spinhoven, 1991); migraines (Blanchard, Andrasik, Evans, & Hillhouse, 1985), muscle tension (Keefe, Surwit, & Pilon, 1980) and hypertension (Silver, 1979). Norris and Fahrion (1984) summarized that autogenic training has also been effective in dealing with anxiety, phobic disorders, and hysteria.

Progressive Relaxation

Edmond Jacobson, a Chicago physician, published the book "Progressive Relaxation" in 1929, In this book he described his deep muscle relaxation technique, which he asserted required no imagination, willpower, or suggestion. His technique is based on the premise that the body responds to anxiety-provoking thoughts and events with muscle tension. This is so because the initial neural response to stress initiates muscular excitation to prepare the body to move for its physical survival. This physiological tension, in turn, increases the subjective experience of anxiety. Jacobson reasoned that it is not possible for the body to be tensed and relaxed at the same time. Deep muscle relaxation reduces physiological tension and is incompatible with anxiety: The habit of responding with one blocks the habit of responding with the other.

One thing Jacobson discovered, with the majority of his patients, was that they had one symptom in common: muscle tension. He created progressive muscular relaxation to increase physical neuromuscular awareness. He found that 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 sensations of tension and deep relaxation. Jacobson felt that once the body achieved a state of neuromuscular homeostasis, the mind would follow suit, allowing for a complete state of relaxation and rejuvenation (Seaward, 1994, p. 349)

Studies to determine the effectiveness of progressive relaxation have been done (Belar & Cohen, 1979; Hayes, 1975) with the use of biofeedback machines. Electrodes were attached to various muscle sites including the forehead, jaw, neck, shoulder, and lower back to determine neuromuscular tension. Results indicated this method was significantly effective in decreasing muscle tension.

Long and Haney (1988) found progressive relaxation to be as effective as aerobic activity in decreasing anxiety and increasing self-efficacy among working women. Progressive relaxation has been found, in controlled studies, to be effective in reducing the effects of other maladies that are stress related including reducing headaches (Wisniewski, Genshaft, Mulick, Coury, & Hammer, 1988; Blanchard et al., 1988; Attanasio, Andrasik, & Blanchard, 1987; Blanchard et al., 1985; Teders et al., 1984; Blanchard et al., 1982; Blanchard et al., 1991; Blanchard et al., 1990); depression (Broota & Dhir, 1990); aversion to chemotherapy (Lyles, Burish, Krozely, & Oldham, 1982; Carey & Burish, 1987; Burish & Lyles, 1981; Burish, Carey, Krozely, & Greco, 1987); low back pain (Turner, 1982) depression (Halonen & Passman, 1985; Reynolds & Coats, 1986) and hypertension (Hoelscher, Lichstein, & Rosenthal, 1986; Chesney, Black, Swan, & Ward, 1987; Hoelscher, Lichstein, Fischer, & Hegarty, 1987; Southam, Agras, Taylor, & Kraemer, 1982; Agras, Taylor, Kraemer, Southam, & Schneider, 1987).

Progressive relaxation can be practiced lying down or in a chair with one's head supported. Each muscle or muscle grouping is tensed from five to seven seconds and then relaxed for twenty to thirty seconds. This procedure is repeated at least once. If an area remains tense, one can practice up to five times.

After one has mastered the procedure, it may be useful to keep the eyes closed and focus one's attention on one muscle group at a time. The practice of successively tensing each of these muscle groups has been found to aid in such tension related symptoms as muscular tension, anxiety, insomnia, depression, fatigue, irritable bowel, muscle spasms, neck and back pain, high blood pressure, mild phobias and stuttering.

Created initially by Dr. Edmond Jacobson, and modified by Joseph Wolp, the most common form of progressive relaxation involves "progressively" flexing and relaxing each successive set of muscles throughout the body, usually beginning at the feet and moving up to the head. Progressive relaxation usually requires a facilitator or a taped recording of the process.

Music

Maranto (1993) writes:

It appears that music elicits physiological responses; these can be used to support a rationale for the use of music in stress management. However, it is not always possible to predict the direction of physiological responses to music, because of the complexity of the musical stimuli and the complexity of individual differences in responses to music.

Much earlier, Kwalwasser (1955, p. 162) said:

That music has a calming or exciting influence on the hearer is common everyday experience; that we enjoy the recreation that music affords is axiomatic. But do we realize that we enjoy music not so much for what it is but for what it does? The accelerated breathing rate, the increased blood pressure, the heightened bodily tonicity, the feeling of power and the reserve of strength make us supermen as we react to music...not only is music a tonal treat but a regenerative force psychologically and physiologically. Blood composition, blood chemistry, blood distribution, blood pressure are all influenced by music. Equally important and extensive respiratory changes also take place under musical stimulation. Without these physiological reverberations music would be quite ineffectual, physically and mentally.

Music has been used as a method of treatment for many centuries (Maranto, 1993). Clearly music does something to us when we hear it. For example, music has been shown to alter one's mood. Pignatiello, Camp, and Rasar (1986) significantly altered subjects' moods to correspond with a 20-minute music tape progressing from neutral to either elating or depressing. Fried noted that he has "personally observed, on numerous occasions, right/left EEG changes with hemisphere synchronization during breathing training, in which clients reported deep relaxation and alteration in conscious experience" (Fried, 1987). More recently (1990) he has been able to obtain similar results more rapidly with attention focused on music.

Maranto (1993) completed an exhaustive review of the research that has been done on music in relation to stress management. Some of the findings from related studies indicate that, with respect to stress management, music has been shown to decrease physiological tension and anxiety scores; enhance imagery capability; enhance recovery from a stressful situation; enhance biofeedback assisted relaxation training; reduce anxiety associated with stage performance; reduce stress and anxiety with various medical procedures; improve mood and comfort of adult patients in general hospitals as well as for patients in medical reception rooms; reduce pain and anxiety during pregnancy, labor, and delivery; significantly reduce stress behaviors, initial weight loss, and hospital stay, and significantly increase average weight, volume of formula intake, and caloric intake, among premature and low-birth-weight neonates; reduce stress in hospitalized infants and toddlers; reduce stress hormone levels during surgery; reduce pulse rates and stabilize blood pressure in postoperative patients; reduce postoperative pain, the need for pain medication, and the need for sedatives during regional anesthesia; reduce patient anxiety in dentist offices, as well as reduction in heart rate, blood pressure, and stress hormones.

In her review of studies on music in comparison to other stress management techniques, Maranto (1993) found that in some cases music enhances the efficacy of other treatments such as imagery or autogenic relaxation, however in some cases it does not; in some cases music is not as effective as other modes of treatment such as biofeedback, and progressive relaxation, in other cases it is as effective, and in other cases, music is more effective than other modes of treatment.

Maranto (1993) concludes that despite the uniqueness of each individual's experience with music, its uses for stress reduction continue to be widespread and successful.

Humor

A recent report (American Demographics, 1993) said that half the audience for the Cartoon Network are adults. One frequent cartoon viewer remarked "Sometimes after a hard day at the office, the depressing newscasts, sorting your mail and finding mostly bills, it is refreshing to turn to the Cartoon Network and see toons like 'Josie and the Pussy Cats that take me back to a more carefree time in my life."

White and Winzelberg (1992) found that among college students, watching a humorous videotape was not as effective as relaxation training. However, in comparison to a control group, it was significantly more effective in reducing physiological measures of stress.

Prerost (1993) reports a method of reducing stress among the elderly by first encouraging relaxation through breathing exercises. Then subjects are instructed to visualize events in their lives that have been stressful. The third step involves changing the stressful images into less stressful images by infusing the images with humor. This is done by changing the mental scenes into images that are absurd, incongruous, and exaggerated. The author points out that "laughter can counter a depressed mood while reviving a person's sense of worth."

Stress Buffers

Wheeler & Frank (1988) identified 22 different variable that may be seen as potential "buffers" of stress and found 7 strong buffers of stress (coherence, sense of purpose, effectence, social relations, sleep, control locus, and coping) and 7 moderate buffers of stress (health control, time perspective, leisure, eating, exercise, growth, and health practice). After further statistical analysis, these authors concluded that there were only 4 "true" buffers of stress: sense of competence, exercise pattern, sense of purpose and leisure activity.

Religion/Spirituality/Sense of Purpose

Schafer & King (1990) found no association among four measures of religiousness and perceived stress among college students. Williams, Larson, Buckler, Heckmann, and Pyle (1991) found that "although religious attendance does not directly reduce psychological distress, it does buffer the impact of stressful life events and physical health complaints on psychological well-being." They commented that they are uncertain if this buffering effect is linked to anything intrinsically religious. It may have as much to do with socioeconomic status as anything else. It may be compared to participation in other community organizations (Goode, 1966).

Leisure

Some researchers (Caldwell & Smith, 1988; Iso-Aloha & Weissinger, 1984; Weissinger & Iso-Aloha, 1984) have argued that the feelings and emotions associated with leisure experience tend to reduce the negative effects of stress on health. However, according to Coleman and Iso-Aloha (1993) the reasons for this are not clear. They speculate that leisure tends to be highly social in nature. Social support is commonly available during leisure pursuits. They note that "companionship in shared leisure activities appear to provide effective relief for people as they deal with excesses of daily life stresses." Additionally, the authors pointed out that feelings that reflect self-determination (e.g., hardiness, locus of control) may also contribute to people's coping capacities and health. They added that perceptions such as freedom, control, competence and intrinsic motivation that are all common to leisure activities may generate these feelings of self-determination.

In a study conducted in Australia (Griffith, 1993), the researchers found that perceived freedom in leisure was related to health in the way that it was able to reduce the usual detrimental impact of high levels of life stress.

Another study (Kirkcaldy, Shephard, & Cooper, 1993) found among police officers that regular exercisers were more likely to report better physical health and demonstrated a lower Type A (coronary prone) behavior than non-exercisers although these differences were not statistically significant. They found a negative correlation between type A behavior and the amount of time invested in leisure pursuits (hours per week). The results from this particular study showed little evidence that leisure time served as a buffer in the stress-health linkage.

Ragheb and Mckinney (1993) found, among college students, a negative correlation between perceived academic stress and frequency of participation in recreational activities. That is, the more frequently they participated in recreational activities such as hobbies, sports activities, social activities, cultural activities, outdoor activities or mass media activities, the less stress they sensed in their lives.

Social Support

The idea of social support has been described as the knowledge of a person to believe that he or she "is cared for and loved, to believe that he or she belongs to a network of communication and mutual obligations" (Cobb, 1976). House (1981) expanded this view to what other researchers (Jung, 1984; Leavy, 1983) consider to be the most comprehensive framework of social support. It includes (1) social support (esteem, affect, trust, concern, listening); (2) appraisal support (affirmation, feedback, social comparison); (3) informational support (advice, suggestion, directives, information); and (4) instrumental support (aid, money). Cohen and Willis (1985) point out that "in naturalistic settings they are not usually independent" (p. 313).

Several studies claim social support mediates or buffers the effect of stress on well-being (Cohen & Wills, 1985; Kessler & McLeod, 1985; Thoits, 1982). The findings of these studies showed that social support is a buffer while others suggested that the stress buffering aspect of social support is overstated. Kessler & McLeod (1985) reviewed 25 studies that neither show clear positive results or clear negative results of the stress buffering effect of social support. The found evidence for buffering in two-thirds of the studies. They conclude that emotional support has a buffering effect, while membership in "affiliative networks" does not (p. 233). Heller & Swindle (1983) found similar conflicting results regarding the buffering of effect of social support on stress. In their study, only 6 of 15 frequently cited studies on social support and stress demonstrate a clear buffering effect.

In the study noted earlier, (Griffith, 1993) contrary to other research, leisure based social support was not related to health. Reifma, Biernat, & Lang, (1991) similarly found that among married professional women with children aged 1-6 years, social support rendered no stress buffering effects.

Relaxation Recommendations

Most of the literature (Patel, 1993; Benson, 1992; Kabat-Zinn, 1990; Borysenko, 1988; Seaward, 1994) indicates that relaxation techniques are most beneficial if they are carried out twice a day with at least 3-4 hours and preferably 8-10 hours between sessions. If only one time per day is possible, then mid to late afternoon is best. It is best to not postpone it until late in the evening or you may fall asleep. It is not a good idea to practice immediately after a meal. Better to wait until about an hour or so afterward. Relaxation techniques should optimally last anywhere from ten to thirty minutes in length.

Additionally, the writers indicate that relaxation techniques are best if done in a place that is quiet without distractions or blaring lights. Interruptions should be completely avoided. A relaxation exercise is usually done lying on the floor, or on a firm bed. It may also be done sitting in a comfortable armchair with a high back or in a reclining chair that supports the back, neck and head. The clothes should be comfortable and loosely fitting. Every effort should be made to insure comfort and serenity, otherwise the exercise will not result in the relaxation that is intended.

In summary, a thorough review of the many ways to reduce stress and relax, both empirical and anecdotal, was necessary to gain a greater understanding of how many ways there really are to relax. If college campuses are places with high stress levels, and if students are not taking appropriate steps to reduce stress levels, it is clearly not a result of lack of good methods, but rather, a lack of awareness.

Stress Management Among College Students

The review of literature revealed no studies that had looked at methods that college students use, in general, to relax, unwind, cope, or reduce stress.

Methods of Measuring Stress

Brannon and Feist (1992) mentioned that there are several approaches that have been used to measure stress, the most frequently used falling into three broad categories: performance tests, physiological measures, and self-reports, especially those that measure life events or daily hassles. Among health psychologists and health educators, self-report questionnaires are the most common approach to measure stress. For the purposes of this study, a self-report questionnaire was used.

There are several questionnaires that could have been used for this study. The one that was chosen was the Perceived Stress Scale (PSS) (Cohen, Kamarck, & Mermelstein, 1983). The Perceived Stress Scale (PSS) measures the degree to which situations in one's life are appraised as stressful (Cohen, Karmarck, & Mermelstein, 1983). It was designed to determine how unpredictable, uncontrollable, and overloading subjects find their lives (Cohen, Tyrrell, & Smith, 1993). In one study, the Perceived Stress Scale proved to be a very strong predictor of burnout and stress induced consequences (Hills & Norvell, 1991). The PSS adequately measures the degree to which situations in one's life are appraised as stressful with substantial reliability and validity.

Other scales that could have been selected for this study included the widely used Social Readjustment Rating Scale (SRRS) developed by Holmes and Rahe (1967). It measures the amount of change, using Life Change Units, a person is required to adapt to in the previous year. It was designed to predict the likelihood of disease and illness following exposure to stressful life events. Richard Lazarus followed this line of reasoning but speculated that it was the little annoyances or "hassles" that, over time, lead to ill health. He and his colleagues developed a Hassles Scale (Kanner, Coyne, Schaefer, & Lazarus, 1981; Delongis, Coyne, Dakof, Folkman, & Lazarus, 1982; Lazarus & Folkman, 1984) to assess the small yet potentially stressful events and their affect on health. The Ways of Coping Inventory (Folkman & Lazarus, 1980) is another tool that assesses the appraisal of stressors and possible coping styles.

The Hassles Scale created by Kanner and his colleagues (1981) was assessed by Kohn, Lafreniere, and Gurevich (1990) who said it is "contaminated by items and a format which imply distressed physical and mental responses to stress as well as exposure to daily hassles." They went on to develop The Inventory of College Students' Recent Life Experiences (ICSRLE). The ICSRLE was designed to identify individual exposure to sources of stress or hassles and allow for an identification of the extent to which those stressors are experienced over the past month. It was developed uniquely for college students, as the sources of stress in a university environment are reported to be different from other settings (Burks & Martin, 1983; Sarason, Johnson, & Siegal, 1978). The ICSRLE was found to have a .59 correlation (p < .0005) against the PSS with an alpha reliability of .88. For the purpose of this study, the ICSRLE was used primarily to assess sources of stress among college students.

Summary

Chapter 2 presented a brief summary of the vast amount of information that is currently known about stress, its management and reduction. I pointed out that among the many definitions of stress, the critical factor appears to be the personal interpretation or perception of situations that cause the stress reactions that were described in the chapter. In my search for relaxation techniques, I discovered a wide variety of methods that people use to unwind. Many of these methods have not undergone the scientific scrutiny to determine their effectiveness, yet, they appear to create a relaxation-type response, based upon individual reports. A few relaxation techniques such as breathing, meditation, massage, hypnosis, visualization, exercise, biofeedback, autogenic training, progressive relaxation, music, and humor have been analyzed and determined to be quite effective in reducing stress. At the same time, many of these methods have been found to reduce many of the coexisting maladies that accompany the chronic stress response.

CHAPTER 3

METHODS

This study had several purposes. The first purpose was to assess perceived levels of stress experienced by college students. A second purpose was to detect the primary sources of perceived stress among college students. A third purpose was to find out the activities students routinely participate in to reduce stress, relax, unwind or cope with individual pressures and how often they participate in these types of activities. A fourth purpose was to find out how effective these preferred relaxing, stress managing, coping activities are at reducing perceived stress. A final purpose was to determine if any differences exist among selected variables (gender, year in school, race, and age) for perceived stress levels, sources of stress, and methods for managing stress.

In this chapter, I describe the methods and procedures that were used to conduct this research. This discussion includes: (a) research questions, (b) research design, (c) population and sample, (d) instrumentation, (e) human subjects review, (f) pilot test, (g) data collection, and (h) data analysis.

Research Questions

The following research questions were addressed:

1. What do college students perceive to be the major source(s) of stress?

2. Is there a relationship between the major sources of stress and the levels of perceived stress among college students?

3. What methods do college students actively participate in to reduce stress?

4. Is there a relationship between the amount of stress that is perceived by college students and the amount of time they spend involved in stress reducing or relaxing activities?

5. What differences exist by gender, by age, by race, and by year in school for perceived levels of stress, sources of stress and for methods of managing stress?

Research Design

A survey research design was selected for this study. According to Isaac and Michael (1990):

Surveys are the most widely used technique in education and the behavioral sciences for the collection of data. They are a means of gathering information that describes the nature and extent of a specified set of data ranging from physical counts and frequencies to attitudes and opinions. This information, in turn, can be used to answer questions that have been raised, to solve problems that have been posed or observed, to assess needs and set goals, to determine whether or not specific objectives have been met, to establish baselines against which future comparisons can be made, to analyze trends across time, and generally, to describe what exists, in what amount, and in what context (p. 128).

Sarvela and McDermott (1993) indicate that "by taking a cross-section or sample of the individuals from the population to which we would like to make inferences, we can obtain a great deal of information, and learn much about the characteristics of the group" (p. 119). Isaac and Michael (1990) conclude that a survey generally describes "what exists, in what amount, and in what context (p. 128). For these reasons, a survey design proved to be an appropriate choice for addressing the questions that were considered in this study.

Population and Sample

The target population for this study was defined as all undergraduate students attending Southern Illinois University at Carbondale. A sample of convenience was selected from sections of the Healthful Living 201 course during the Fall semester of 1995. GEE201 Healthful Living consists of students from all majors from the university. It is a required class and is recommended as a freshman course, however, a relatively large percentage of sophomores, juniors, and seniors also enroll in the class because they did not take it their freshman year. Healthful Living covers a broad spectrum of health topics and is taught by graduate students from the department of Health Education and Recreation. A particular limitation of using this sample is that students may, or may not have received instruction, during the course of the semester, on stress and stress management. The actual amount of in-class instruction customarily is limited to no time spent on stress management whatsoever, to two days of actual instruction during the semester, depending upon the instructor. Five-hundred fifty nine students completed the survey. More than 559 questionnaires were turned in but some were discarded because they were not finished sufficiently to gather adequate information. In some cases, the demographic data was missing. In other cases, the student had filled in the bubbles on the scantron in such a random way that he or she clearly had not read the questions and given them appropriate answers.

Approval for using the GEE-201 students as subjects for this study, per department policy, was required from Dr. Drolet. Dr. Judy Drolet is the faculty member responsible for the graduate assistants who teach the GEE-201 courses. A letter was given (Appendix G) to Dr. Drolet on August 23, 1995, to obtain this approval. Approval was received on August 29, 1995 (Appendix H).

Instrumentation

Perceived Stress Scale

After reviewing the literature for an appropriate instrument to assess levels of perceived stress, I chose the Perceived Stress Scale (PSS) developed by Cohen (1985). It is designed to measure the degree to which respondents found their lives "unpredictable, uncontrollable, and overloading" (Cohen & Williamson, 1988, p. 34). The scale also includes a number of direct queries about current levels of experienced stress. It was designed for use in communities whose samples have at least a junior high school level of education. The items are easily understood and are of such a general nature that they are free of content specific to any subpopulation groups.

The original PSS is a 14-item scale that can be administered in just a few minutes and is easy to score. The questions asked in the PSS, inquire about feelings and thoughts during the last month that answer levels of perceived stresses over that time. In each case, respondents are asked how often they felt a certain way.

Initial reliability coefficients, obtained by Cohen, Kamarck, and Mermelstein (1983) ranged from .84 to .86. Test-retest correlation was .85. In 1988, the psychometric properties of the PSS were again explored. Cronbach's alpha coefficient for the internal reliability of the PSS14 was .75.

As a result of factor analysis, a shorter version of the PSS scale was developed (Cohen and Williamson 1988) by the authors of the original PSS (Appendix B). The PSS10 was derived by dropping four items from the original scale. Cronbach's alpha coefficient for the PSS10 was .78. According to Cohen and Williamson (1988) the PSS10 "allows the assessment of perceived stress without any loss of psychometric quality (actually a slight gain) over the longer PSS14" (p. 34). In this study, the scale used was the PSS10 because it was in an acceptable format, it has adequate internal reliability, a "somewhat tighter factor structure" (Cohen & Williamson, 1988, p. 61) and for the purpose of this study, it assesses stress in a way that is ideal for this type of study. The Cronbach's alpha coefficient for the PSS10 portion of this study was .87.

PSS10 scores are obtained by reversing the scores on the four positive items (e.g., 0=4, 1=3, 2=2, 3=1, 4=0), and then summing across all items. Items 4, 5, 7, and 8 are the positively stated items. Individual scores on the PSS can range from 0 to 40 with higher scores indicating higher perceived stress. Scores ranging from 0-13 would be considered low-stress. Scores ranging from 14-26 would be considered moderate stress. Scores ranging from 27-40 would be considered high perceived stress levels. Cohen (1988) found that elevated PSS scores were associated with: (1) shorter periods of sleep, (2) infrequent consumption of breakfast, (3) smoking cigarettes, (4) decreased frequency but increased quantity of alcohol consumption, (5) less frequent physical exercise, and (6) increased frequency and variety of licit drug use. On the other hand, perceptions of stress were not associated with total hours of sleep per day or number of packs of cigarettes smoked per day.

Inventory of College Students' Recent Life Experiences (ICSRLE)

The Inventory of College Students' Recent Life Experiences (ICSRLE) (Kohn, Lafreniere, & Gurevich, 1990) is an instrument that measures exposure to recent hassles and was tailored specifically to a college population (Appendix C).

The developers of the ICSRLE (Kohn, Lafreniere, & Gurevich, 1990) describe the process for the development of the instrument. Initially, 85 items describing hassles were generated from a pool. Final item selection involved retaining only the items that correlated positively and significantly with the Perceived Stress Scale. Forty-nine items correlated significantly with the PSS ranging individually from .17 (p < .05) to .48 (p < .0005).

The alpha reliability of the ICSRLE was .89 in an initial item selection sample, and its correlation against the PSS was .67 (p < .0005). In a subsequent sub-sample, to correct for possible inflation of the estimates, the alpha reliability of the ICSRLE was .88, and its correlation against the PSS was .59 (p < .0005) (Kohn, Lafreniere, & Gurevich, 1990). These findings support the reliability and validity of the ICSRLE. The Cronbach's alpha coefficient for the ICSRLE portion of this study was .92.

For the purpose of this study, the ICSRLE solidly identifies individual exposure to sources of stress or hassles, and allows for an identification of the extent to which those stressors are experienced over the past month: (a) not at all part of my life, (b) only slightly part of my life, (c) distinctly part of my life, or (d) very much part of my life. Scoring for the ICSRLE can range from 0 to 3 for each item (a=0; b=1; c=2; d=3). Higher scores indicate higher levels of exposure to hassles. Two scores can be derived from this scale. A frequency score is derived by summing the total number of hassles reported by each respondent (responses of b, c, or d). An intensity score is the sum of the severity ratings for each hassle reported.

The instrument was developed distinctively for college students, as the sources of stress in a university environment are reported to differ from other settings (Burks & Martin, 1983; Sarason, Johnson, & Siegal, 1978). Although the listing of stressors yields useful information, the same stressors affect individuals differently. It is important, therefore, to indicate the degree of stressfulness of each event for them, as well as whether it occurred (Frazier, & Schauben, 1994). The ICSRLE gathers this useful information.

The Relaxation Frequency Inventory

In my search through the literature, I found only one referece to questionnaires that satisfactorily addressed the topic of frequency and type of relaxation employed by people (Endres, 1992). This study asked subjects in a college setting how they cope with stress. It described fourteen possible responses for methods they use to cope with stress. Therefore, I initially created an inventory that considered all the possible ways that college students perceive that they are dealing with their individual stress. It gathered information about the extent that subjects are presently participating in ways to cope, ways to unwind, methods of relaxing, or ways of managing stress.

Subjects are asked, "Thinking back on the past few weeks, on average, list all the things you do regularly to cope with stress, relax, unwind or otherwise manage stress in your life and how much time you spend doing them." Subjects will list all methods that they employ to manage stress. Next to each response the subject answers the frequency that they participate in each activity. Responses range from (a) less than one hour per week, (b) 1-2 hours per week, (c) 2-4 hours per week, (d) 4-6 hours per week, (e) 6-8 hours per week, or (f) more than 8 hours per week.

A total score is given at the bottom of the table to determine the total amount of time spent in relaxation activities. This questionnaire finds out not only the total amount of time that students participate in activities they perceive to be relaxing, but it also assesses the types of activities in which the subjects participate.

After lengthy discussion with the members of my committee, it became evident that a more appropriate method of gathering information regarding the extent that college students participate in relaxing activities would be by categories. The members of the committee and I decided that a list of categories that, according to the literature, summarizes the most common methods of reducing stress would be a better way of gathering this information. Therefore, according to the information in my review of literature, nineteen categories were named to describe the common methods of relaxation (Appendix D). Further discussion with the committee resulted in lumping these many categories into three broad categories. These categories included both functional and dysfunctional methods of managing stress and also the use of prescription and OTC drugs and recreational drugs to manage stress. Drug use was measured using the guide: (a) Never, (b) About once per month, (c) About 23 times per month, (d) Once per week, (e) 3-5 times per week, (f) Daily, (g) Several times daily. The other 17 categories were measured using the guide: (a) Not at all (b) Less than 1 hour per week, (c) 1-2 hours per week, (d) 3-4 hours per week, (e) 5-6 hours per week, (f) 7-8 hours per week, (g) More than 8 hours per week. Finally, an open-ended question, which could be responded to using an additional blank piece of paper was worded in the following manner:

There may be other activities that you do to help you relax, cope, unwind, or deal with stress that do not fit into any of the categories (60-77) listed above. We are very interested in knowing anything else you regularly do and for what amount of time you do them, during a typical week. Please use the accompanying blank sheet of paper to list these activities. Also, write the approximate amount of time that you participate in each activity that you list. There are no right or wrong answers.

Where applicable, I placed the responses in one of the 17 categories if I felt they fit. If they did not fit into any category, they were added separately in the data analysis. For example, one student listed that she "writes in journal -- less than one hour per week." This can easily go into one of the categories "Spiritual or Religious Development" so I added this to her scantron score for that category. Total amount of time involved in stress reducing activity was derived by analyzing the amount of time from each category and summing across all the categories to arrive at a total score. The Cronbach's alpha coefficient for the Relaxation Frequency Inventory portion of this study was .70.

Readability

There are formulas available that can measure the ease of reading a piece of written work. Some formulas are quite involved and difficult to use, some can be computed by hand, and others can be determined with various computer software programs (Kennedy, 1985). In this study, the grammar checker CorrecText®, which accompanies the Microsoft Word, word processing program, was used to determine three measures of readability: the Flesch Reading Ease, Flesch Grade Level, and the Flesch-Kinkaid index. The Flesch reading ease is based on the average number of words per sentence and the average number of syllables per 100 words. "Standard" writing averages approximately 17 words per sentence and 147 syllables per 100 words. The lower the score, the more difficult the information is to read. For example: 90-100 very easy (4th grade); 70-90 easy (5th or 6th grade); 60-70 standard (7th or 8th grade); 50-60 fairly difficult (some high school); 30-50 difficult (secondary school, some higher education; 0-30 very difficult (higher education). The Flesch-Kinkaid also assigns a grade level. A Flesch-Kinkaid index of 7 or 8 is roughly equivalent to a Flesch Reading Ease score of 70-80 or 7-8th grade (Microsoft Word, 1991, p. 275-76).

Readability tests were conducted on the PSS survey. A readability test was also run on the Relaxation Frequency Inventory but because of the small sample size, the statistics were invalid. The scores on the PSS were:

Flesch Reading Ease: 77.8 (6th or 7th grade level)

Flesch Grade level: 7.2

Flesh-Kinkaid: 6.9 (Fairly easy reading level)

These statistics are designed to help measure the efficacy of the writing. Interpretations of these scores indicate that the readability level of the PSS is acceptable for the selected population.

Similar evaluation on the ICSRLE yielded the following scores:

Flesch Reading Ease: 77.7 (5th or 6th grade level)

Flesch Grade level: 7.2

Flesh-Kinkaid: 6.2 (Fairly easy reading level)

An evaluation on the Relaxation Frequency Inventory yielded the following scores:

Flesch Reading Ease: 80.7 (5th or 6th grade level)

Flesh-Kinkaid: 6.2

Flesch Grade level: 6.9 (Fairly easy reading level)

Human Subjects

An application requesting permission to conduct this study was submitted to the Carbondale Committee for Research Involving Human Subjects before conducting the pilot test. Approval was granted on October 17, 1995 (Appendix F).

Pilot Test

Babbie (1990, p. 220) maintains that it is important for every researcher to "conduct some form of testing of the research design" and data collection tools "prior to the major research effort." This should be done to find out if an instrument is a valid and reliable one in the population of interest even if it has been proven reliable and valid in other populations. Running a pilot test is a way to "shape future research and to generate hypotheses; your pilot is exploratory and inductive, not confirmatory and deductive" (Light, Singer, & Willet, 1990, p. 216). Isaac & Michael (1984, p. 96) suggest a sample size "between 10 & 30" is adequate for a pilot test.

The pilot for this study was conducted on October 17, 1995 and consisted of 20 students from HED 335 Emotional Health. Each person was given a questionnaire and completed it on a strictly volunteer basis.

One function of a pilot test is to find out reliability of the instrument. One test for reliability is to establish internal-consistency reliability that examines the average correlation among items on the instrument. Internal consistency reliability measures the degree to which the items "hang together," or the degree to which they relate to each other (Sarvela & McDermott, 1993, p. 57). The coefficient that measures this relation ranges from a value of zero (no relationship or reliability) to one (perfect reliability). There is no specific cutoff level that shows acceptable reliability, but there are suggestions for appropriate reliability coefficients for various uses. According to Sarvela and McDermott (1993) the least accepted reliability score is .60, with .80 preferred for applied research. A Cronbach alpha of at least .60 was wanted for this study.

The Cronbach's alpha was used to measure internal-consistency reliability for the pilot test and again on the actual study. The pilot study alpha for the entire questionnaire was .86 and was within the acceptable range.

Data Collection

The primary method of data collection was self-report questionnaires. The PSS profile, the ICSRLE, the Relaxation Frequency Inventory, and a demographics questionnaire were used in this study. The Perceived Stress Scale (PSS10) was used to measure the degree to which situations in one's life are appraised as stressful (Cohen & Williamson, 1988). The ICSRLE was used to determine the sources of stress, or hassles in the lives of college students (Kohn, Lafreniere, & Gurevich, 1990). The Relaxation Frequency Inventory (RFI) was used to measure the frequency, in general, that people participate in activities designed to reduce stress or increase relaxation. The RFI also determined the type and frequency of specific relaxation activities. The four parts of the questionnaire were combined into one data packet with a cover page that included instructions on completing the questionnaire (Appendix A).

Once approval was received by Dr. Drolet, contact was next made with the graduate assistants (GA) who are teaching the Healthful Living GEE-201 courses. A visit was made to the regularly scheduled Friday morning class where the GA's meet with Dr. Drolet to discuss their teaching experiences. I visited this class on September 1, 1995. During this class I presented to all the GA's the scope and sequence of the study and the way in which they would be able to support me. I indicated clearly that their support was voluntary, as would be the participation of their students. Every one of the GA's agreed to allow me to use their classes which added up to 27 sections of GEE-201 with a potential sample of roughly 900 subjects. I did not use all 27 sections to gather the data as scheduling conflicts made it impossible to go to every section. Data collection occurred during the month of November, 1995 which time period was the later portions of the semester.. On the days that I visited each of the classes, not everyone enrolled was present. Additionally, of those who filled out the scantron, some had not completed the demographic data and others had completed the scantron in such a way as to indicate they had not read the questions or taken any time to answer them meaningfully. The actual number of students who appropriately participated in this study was 559.

Visits to each of the scheduled sections were arranged individually with the GA's who volunteered. The instructions to the students in each of the classes consisted of the following:

1. Participation was entirely voluntary; they were under no obligation to complete any part of the survey.

2. All information will be both confidential and anonymous.

3. Responses to the questions should be made fairly rapidly, that is, do not spend too much time thinking about the most appropriate answer. Rather, answer with the first response that comes to mind.

4. Use the accompanying scantron to answer all the questions except for the response in the Relaxation Frequency Inventory. These responses are to be written on the a separate blank sheet of paper which they were given.

5. When the Data Packet is complete, remain seated until everyone who participates has finished. At this point the Data Packets will be gathered.

Data Analysis

All data, except one response on the Relaxation Frequency Inventory, were coded from the Data Packet onto scantron sheets. The Statistical Analysis System (SAS), a computerized system for data analysis, was used to analyze the data for this study. The research questions, methods, and appropriate statistical design for this study are presented in Table 2. ANOVA, t-test, Pearson's r correlation and descriptive statistics were used to answer the research questions.

Table 2

Research Questions, Methods, and Statistical Analysis

Research Question #1

What do college students perceive to be the major source(s) of stress? To answer this question, descriptive statistics such as ranking and mean scores were used based upon individual responses from ICSRLE. Ranking was determined from the mean scores for each hassle from highest level of severity to the lowest. No responses were given a score of "a" or 0 for that hassle.

Research Question #2

Is there a relationship between the major sources of stress, the hassles, and the levels of perceived stress among college students? For example, do people who experience higher scores on the hassles scale correspondingly experience more stress. Individual stress levels were assessed using the PSS. The sources of stress or hassles were assessed using the ICSRLE. Pearson r product moment correlation was used to answer this question. According to Hinkle, Wiersma, and Jurs, (1988, p. 114) the Pearson r product moment correlation coefficient "is an index of the linear relationship between two variables." A PSS score was determined for each subject. This score was correlated with the hassles score for each subject.

Research Question #3

What methods do college students actively participate in to reduce stress? The instrument used to answer this question was the Relaxation Frequency Inventory. Descriptive statistics were used to analyze individual responses. Categories were ranked for levels of frequency according to mean scores for amount of time spent participating in each category.

Research Question #4

Is there a relationship between the amount of stress perceived by college students and the amount of time they spend involved in stress reducing or relaxing activities? The Pearson r product moment correlation was used to determine the relationship between the subject's score on PSS and the three frequency mean scores, functional, dysfunctional and drug use, derived from the Relaxation Frequency Inventory. In other words, do students who report less stress tend to spend more time participating in activities perceived to be relaxing?

Research Question #5

What differences exist by gender, by age, by race, and by year in school for perceived levels of stress, sources of stress and for methods of managing stress? Independent t-test and ANOVA were used to determine differences between the subject's score on PSS, sources of stress from ICSRLE, and frequency of methods of relaxation across the demographic variables.

Summary

This study was quantitative in nature. The research design sought to measure what things tend to increase stress in the lives of college students and how much stress college students are experiencing. It also analyzed the ways that college students attempt to reduce stress and with what frequency. It surveyed the effectiveness of their preferred methods of reducing stress toward perceived levels of stress. Finally, it sought to find out if significant differences exist for the chosen demographic variables for stress levels, sources of stress, and the methods and effectiveness of managing stress. Chapter 3 described the means for doing this. Chapter 4 presents the findings of the study.

CHAPTER 4

RESULTS OF THE STUDY

Chapter four presents an analysis of the data collected according to the methods and procedures described in chapter three. This analysis includes a reiteration of the purpose of the study and the results of the demographic data collected on the sample of undergraduates at Southern Illinois University who responded to the survey. Next, each of the five research questions will be answered with relevant statistical data. Chapter four will be completed with a brief summary of the results.

Purpose of the Study

This study had several purposes. The first purpose was to assess perceived levels of stress experienced by college students. A second purpose was to detect the primary sources of perceived stress among college students. A third purpose was to find out the activities students routinely participate in to reduce stress, relax, unwind or cope with individual pressures and how often they participate in these types of activities. A fourth purpose was to find out how effectively these preferred relaxing, stress managing, coping activities reduce perceived stress. A final purpose was to determine if any differences exist among selected variables (gender, year in school, race, and age) for perceived stress levels, sources of stress, and methods for managing stress. These determinations were based on self-reports.

Sample Demographic Results

Frequencies and percentages were calculated as appropriate for gender, year in school, race and age as follows:

Gender

Five-hundred fifty-nine students completed the survey for this study. Fifty-five percent (305) of the students who responded to this survey were male, while 45 percent (254) of the students who responded were female. These results are shown in Table 3.

Age

Forty-nine percent (274) of the students who responded to the survey were age 18-19. Thirty-one percent (174) of the students was age 20-21. Eleven percent (60) of the students were aged 22-23. Three percent (16) of the students were aged 24-25. Six percent (35) of the students who responded were 26 or above (see Table 3).

Race

Seventy-four percent (415) of the students who responded to the survey were white, not of Hispanic origin. Fourteen percent (80) of the students were black, not of Hispanic origin. Three percent (17) of the students were Hispanic. Less than 1 percent (3) of the students was American Indian or Alaskan Native. Five percent (29) of the students were Asian or Pacific Islanders. Three percent (16) of the students listed their race as other (see Table 3).

Year in School

Twenty-five percent (142) of the students who responded to the survey were freshman. Thirty-seven percent (204) of the respondents were sophomores. Twenty-two percent (121) of the students were juniors. Seventeen percent (92) of the students were seniors (see Table 3).

Table 3

Gender, Age, Race, and Year in School of Students Who Responded to the Survey

Research Question One

What do college students perceive to be the major source(s) of stress?

The Inventory of College Students' Recent Life Experiences (ICSRLE) had a total of 49 hassles or experiences found to be stressful. There were four response options with numerical values of 0, 1, 2, and 3. A zero response meant that item was not at all part of one's life. A "1" response meant only slightly part of one's life. A "2" response indicated distinctly part of one's life and a "3" response meant very much part of one's life. "A lot of responsibilities" had the highest mean (2.07) followed closely by "Struggling to meet your own academic standards" (2.03), "Too many things to do at once" (2.00), and "Important decisions about your future career" (1.98) "Conflict with teaching assistant(s)" had the lowest mean (.46) of all the items. Table 4 gives an individual item response analysis in rank order, means, and standard deviations.

Research Question Two

Is there a relationship between the major sources of stress and the levels of perceived stress among college students?

Levels of perceived stress were measured using the Perceived Stress Scale (PSS). Each item on the scale consisted of five response options with numerical values from 0 to 4. Individual total scores on the PSS can range from 0 to 40 with higher scores suggesting higher perceived stress. Scores ranging from 0-13 would be considered low-stress. Scores ranging from 14-26 would be considered moderate stress. Scores ranging from 27-40 would be considered high perceived stress levels (Cohen, 1988).

The low PSS score was 0 and the high score was 37. The mean score calculated on the Perceived Stress Scale was 18.96 with a standard deviation of 6.76 (see Table 5).

Frequency and intensity of stressors were measured using the Inventory of College Students' Recent Life Experiences (ICSRLE). Each item on the scale consisted of four response options with numerical values from 0 to 3. Individual total scores on the ICSRLE can range from 0 to 147 with higher scores indicating greater intensity from sources of stress. The low score was 4 and the high score was 132. The mean score calculated on the

Table 4

Ranked Mean and Standard Deviation Scores from Inventory of College Students' Recent Life Experiences

0=Not at all, 1=only slightly, 2=distinctly, 3=very much part of my life

Inventory of College Students' Recent Life Experiences was 57.81 with a standard deviation of 21.64 (see Table 5).

Table 5

Relationship Between Major Sources of Stress, As Measured by Inventory of College Students' Recent Life Experiences, and Levels of Perceived Stress, As Measured By Perceived Stress Scale Among College Students

P < .001

The Pearson Product Moment Correlation was used to determine the relationship between the Perceived Stress Scale (PSS) and Inventory of College Students' Recent Life Experiences. Statistical analysis resulted in a significant positive correlation r = .59 (p < .001).

Research Question Three

What methods do college students actively participate in to reduce stress?

This question was answered using the Relaxation Frequency Inventory (RFI). The Relaxation Frequency Inventory had a total of twenty items that were categories of activities that may be used to manage stress. Each item was scored from one 0 to 6. A "0" score indicated no participation in that activity during a typical week. A "1" score indicated less than one hour of participation in that activity during a typical week. A score of "2" indicated participation in that activity from 1-2 hours per week. A "3" score indicated participation for 3-4 hours per week, and so on through "4" and "5". A reported score of "6" indicated that the subject participated in that activity for more than 8 hours per week.

During analysis, items were also placed in one of three categories. These categories consisted of either functional, dysfunctional, or drug use activities. The functional category consisted of 12 activities designed to manage stress: biofeedback; body relaxation exercises; exercise; hobbies or leisure activities; massage, acupressure, or shiatsu; meditation; mental activities; naps; social activities; spiritual or religious development; talking with family, friends or other supportive people; and time management activities. The dysfunctional category consisted of 6 types of activities that people also use to manage stress: drinking; eating; sex; smoking; shopping or spending money; and watching television. The third category consisted of two questions regarding the use of over-the-counter and/or prescription drugs and recreational drugs. These two categories were scored from 0 to 6 also. The possible responses were "0" = Never, "1" = About once per month, "2" = About 2-3 times per month, "3" = Once per week, "4" = 3-5 times per week, "5" = Daily, and "6" = Several times daily.

The RFI, therefore, yielded four scores for each subject: a total score and three category scores. The range of scores for the RFI was 0-108. The obtained low score for the RFI was 6 and the obtained high score was 74. The mean score for RFI was 33.55 (n=559) with a standard deviation of 11.39 (see Table 6).

The range of scores for the functional activities was 0-72. The obtained low score was 2 and the obtained high score was 54. The mean score for functional activities was 20.22 (n=559) and the standard deviation was 7.47 (Table 6).

The range of scores for the dysfunctional activities was 0-36. The obtained low score was 0 and the obtained high score was 30. The mean score for dysfunctional activities was 11.79 (n=559) and the standard deviation was 5.94 (Table 6).

The range of scores for the drug use activities was 0-12. The obtained low score was 0 and the obtained high score was 9. The mean score for drug use activities was 1.54 (n=558) and the standard deviation was 1.98 (Table 6).

Table 6

Mean, Standard Deviation, and Range Scores for Relaxation Frequency Inventory

For the subjects of this study, the item "Social Activities" had the highest mean score of 3.54 among all the items. This was followed by "Television" with a mean score of 3.51. The item with the lowest mean score was "Biofeedback" with a mean score of 0.22. Table 7 gives a summary of the mean scores for each item and a ranking of the frequency of the use of each activity based upon the mean scores.

Tables 8, 9, and 10 summarize the ranked mean scores for each of the categories. The average scores for each of the categories were 1.69 for functional activities, 1.97 for dysfunctional activities, and .77 for drug use activities.

Of the functional methods of managing stress (see Table 9), Social Activities, Hobbies & Leisure Activities (3.54), and Talking with family, friends or other supportive people (3.11) showed to have the highest mean scores. Biofeedback (.22), Body Relaxation Exercises (.54), and Meditation (.55) showed to have the lowest mean scores.

Of the Dysfunctional methods that students commonly used to manage stress (see Table 9), Watching Television (3.51) had the highest mean score followed distantly by

Table 7

Ranked Scores from RFI based on Activities Used by Respondents to Relax

0 = not at all, 1 = one hour per week, 2 = 1-2 hours per week, 3 = 3-4 hours per week, 4 = 5-6 hours per week, 5 = 7-8 hours per week, 6 = more than 8 hours per week

Drinking Alcohol (2.20). Shopping/Spending Money (1.12) had the lowest mean score for dysfunctional methods while smoking was next lowest (1.58). Drug use for managing stress showed higher mean scores for over the counter drugs (1.00) than recreational drugs (.54) (see Table 10).

Table 8

Ranked Mean and Standard Deviation Scores for Functional Stress Management Activities

0 = not at all, 1 = one hour per week, 2 = 1-2 hours per week, 3 = 3-4 hours per week, 4 = 5-6 hours per week, 5 = 7-8 hours per week, 6 = more than 8 hours per week

Table 9

Ranked Mean and Standard Deviation Scores for Dysfunctional Stress Management Activities

0 = not at all, 1 = one hour per week, 2 = 1-2 hours per week, 3 = 3-4 hours per week, 4 = 5-6 hours per week, 5 = 7-8 hours per week, 6 = more than 8 hours per week

Table 10

Ranked Mean and Standard Deviation Scores from OTC, prescription,and recreational drug use

0 = Never, 1 = About once per month, 2 = About 2-3 times per month, 3 = Once per week, 4 = 3-5 times per week, 5 = Daily, and 6 = Several times daily.

Beyond the mean and standard deviation scores, each stress managing activity can be broken down into time frequency, as participation is reported by amount of time per week, on average. An item analysis of each stress managing activity is shown in Table 11.

For biofeedback, 94% (525) participated less than one hour per week or not at all. Similarly, the percentage of students who use body relaxation exercises less than one hour per week or not at all was 87% (483). The number of students who drink to manage stress varied widely. Twenty-nine percent (164) said they did not drink at all. A fairly even distribution across all time periods was described by respondents. Twelve percent (68) said they drank more than eight hours per week. Eighty-seven percent (400) of the students said they used eating as a means to manage stress 3-4 hours per week or less.

The distribution of people who exercise to manage stress was wide. Fourteen percent (78) said not at all, 19 percent (104) exercise less than one hour per week, 22 percent (121) exercise 1-2 hours per week, 20 percent (110) exercise 3-4 hours per week, 10 percent (56) exercise 5-6 hours per week, and 6 percent (31) said they exercise 7-8 hours per week. Ten percent of the students (58) said they exercised more than eight hours per week.

The percentage of students who participated in hobbies or leisure activities was fairly even for each of the time periods with the highest percentage, twenty-two percent (120) participating in these types of activities 3-4 hours per week. Most of the students (78%) said they never, or less than one hour per week, practiced any type of massage. A similar representation (87%) of students said they practiced any type of meditation less than one hour per week with the greatest percentage (73%) doing it not at all. For mental activities, 57 percent (319) said not at all, another 20 percent (110) indicated less than one hour per week.

The number of people who use naps for managing stress varies somewhat more evenly across the time distributions. The amount of time that showed the greatest number of responses was 1-2 hours per week (25%) and 3-4 hours per week (21%). The number of people who said they use sexual activities for managing stress was also quite varied. Thirty-four percent (191) said not at all, 17 percent (95) said less than one hour per week, and another 21 percent (119) said 1-2 hours per week.

Most of the respondents said they used shopping for managing stress very little. Forty-one percent (230) said not at all, another 28 percent (156) said less than one hour per week.

Fifty-five percent (309) of respondents do not use smoking for managing stress. Across the other time periods during the week, the percentage was even at around 8 percent. Thirteen percent (72) said they smoked more than eight hours per week.

Social activities, which had the highest mean score (see Table 9) showed 24 percent (132) participated in these activities for more than eight hours per week. Of all the stress managing categories, this one had the highest number of people who participate in this type of activity for more than eight hours per week. The second largest time period for this activity was 22 percent (123) who indicated participating in social activities for 3-4 hours per week.

The Spiritual or Religious Development category showed that most of the students (85%) participate in these types of activities 1-2 hours per week or less. Forty-one percent (228) said they participated in spiritual or religious development not at all.

Fifty percent of the respondents (279) said they spent between 1-4 hours per week talking with family, friends or other supportive people. Seventeen percent (94) said they did these activities less than one hour per week while 11 percent (63) used talking for managing stress more than eight hours per week.

The largest proportion of students who participate in time management activities say they did it either less than one hour per week (32%) or 1-2 hours per week (29%). Seventeen percent (93) said they did not participate in time management activities at all.

For students reporting the amount of time they spent watching television, 21 percent (116) said they watched more than eight hours per week. Only social activities had more people who participated in that activity for more than eight hours per week. The distribution across the time periods for amount of time they spent watching television was fairly even with the highest number of people (119) saying they watch television 3-4 hours per week.

Drug use, which was scored slightly differently as far as frequency was concerned, found that for over-the-counter or prescription drug use to manage stress, 53 percent (294) said they never used them. An additional 19 percent (106) said they used them about once per month and 16 percent (88) said they used them about 2-3 times per month.

Reported use of recreational drugs for managing stress showed that the largest majority, 77 percent (432) said they never used recreational drugs with an additional 8 percent (47) saying they used recreational drugs about once per month. Only 5 percent (28) of respondents reported using recreational drugs more than once per week to help them manage stress.

Table 11

Frequency and Percentage Distribution for Stress Managing Activities

An additional element on the Relaxation Frequency Inventory was an open-ended question asking for other activities that people may participate in to manage stress:

There may be other activities that you do to help you relax, cope, unwind, or deal with stress that do not fit into any of the categories (60-77) listed above. We are very interested in knowing anything else you regularly do and for what amount of time you do them, during a typical week. Please use the accompanying blank sheet of paper to list these activities. Also, write the approximate amount of time that you participate in each activity that you list. There are no right or wrong answers.

This question yielded the following responses including demographic specifics of each respondent. The parenthetical section of each response shows the demographic information of each respondent. Responses were presented exactly as they were written on the response sheet:

• Weightlifting 1-2 hours a day helps relief stress (m, 20-21, w, s)

• go hunting 3 hours a week (m, 18-19, w, f)

• Reading a book for enjoyment and to stop thinking about the pressures of my life (f, 18-19, w, b)

• Sitting Around/Talking w/ friends/watching TV - whatever I can do that doesn't have to do w/ home work or things I should be doing. I do this as much as I can get away with (m, 18-19, w, s)

• Cooking 2 hours. Lounge around 8 hours. Get massages 2 hours (m, 18-19, b, s)

• play piano - used to all the time, now I have no time 1-2 hours a week. Draw - 1-2 hours a week. Read - 1-2 hours a week. (f, 20-21, w, j)

• To relax, I often just sit in a comforTable position and clear my head, making an almost physical effort to relax my body & mind. This seemed similar to choices offered on the survey but not quite the same (f, 20-21 ,w, s)

• listen to country music 5-6, 7-8 hr/week. Read a book 2-3 hr/week (f, 20-21, w, s)

• To Relax: 1. Write in Journal - less than one hour a week (f, 20-21, w, f)

• Computer games & other things on the computer ~30 hrs/week. Read ~5 hrs/week. Role Playing Games (eg. Dungeons & Dragons) ~4 hrs/week. Movies ~ 2 hrs/week (m, 20-21, w, j)

• hunting spend a day relaxing with my girlfriend (m, 20-21, w, j)

• I watch a lot of John Woo films Why? Because he is a genius at violent films! Only John can make it possible for 3 guys to go into a building and kill 60 men using every gun known to man - and then smoke a cigarette when done. What a rush!!! It's either watch other people to it, of suffer Disgruntaled Postal Worker Sundrome and do it myself- (f, 22-23, w, j)

• SMOKING MARIJUANA TO RELAX 4 or 5 times a WEEK (m, 18-19, w, f)

• watching movie, take a nap, Riding a bike (m, 18-19, w, s)

• Before I had Jesus in my life I was always stressed, annoyed by people/things lonely & felt out of control. Christ has given me the love I never felt I received from others. Now its easy to love myself, others, and to be content in any & all situations. Anything needing to be done is possible w/ God. Jesus takes my burdens, loosens my yokes And I know that there is no reason to fret in any situation, God has it under control & He loves us He works for the good of those who love Him so I know that things will always work out. My life is no longer abounded by depression, fear, loneliness, etc. Jesus took those things to the cross for us when He died. And has given us life & life abundantly (f, 18-19, w, s).

• The way in which I'm able to unwind next to exercising is going to the movies/and writing letters to friends pretty much avoid being in the dorm take a walk or go to friends room (f, 22-23, h, s)

• Playing Computer Games - 5 hrs/week Surfing in the internet - 3 hrs/week (m, 20-21, h, sen)

• Take drives by myself - 1-2 hrs/week Eat lunch outside on sunny days - 1-2 hrs/week (m, 18-19, w, s)

• 1. Play pool 2. Throw football 3. Sleep (m, 18-19, w, f)

• 1. play on the computer 2. Clean 3. Organize 4. Back cookies, cake (f, 20-21, Asian, s)

• GOING TO WORK AND BEING IN THAT ENVIRONMENT (MOSTLY) MAKES ME RELAX. Whenever I SEEM TO FEEL PRESSURES, BY GOING TO WORK I AM ABLE TO FEEL BETTER TEMPORARILY ABOUT STUFF (f, 18-19, b, j)

• Working on the farm or helping out (5-6 hrs a week) Driving very fast on country roads. (There are no set hours a week. I only do it when I am very mad and need to relieve stress) (m, 18-19, w, f)

• I listen to music to cope with stress. More than 8 hrs a week (m,18-19,w,s)

• 1. Watch T.V. - 7-8 hrs. weeks 2. Sleep - 7-8 hours night, 3. Go to rec center 3-4 times a week, 4. Call friends from home - 1-2 week. 5. Listen to music - 5-6 hours week (f, 18-19, w, f)

• -WORKOUT -DRINKING -SPEND TIME W/FRIENDS DRINKING (m, 18-19, w, s)

• taking a long warm bath - approx 1 hr. Baking, cooking - approx 3 hrs (f, 20-21, w, sen)

• 1. go for a walk. 2. Write in a journal - Expressing feelings or attitudes about your day (f, 18-19, w, s)

• Listening to Music (m, 20-21, w, sen)

• taking long hot showers 1-2 hrs sitting in a dim room listening to music 1-2 hrs reading 3 writing 2 "spacing out" 3 (f, 18-19, w, f)

• go Hunting and fishing Being outdoors (m, 22-23, w, f)

• (5-10 hrs)-listening to Muzik (15-20 hrs) REAdINg (10-30 hrs) Going to the library & Researching (10-15 hrs) Spend time on the phone w/ someone (m, 20-21, w, s)

• weed

• Another way I cope with stress is to cry. Let all my emotions out at once. Or I will write down on paper how I have been feeling, make a short story out of it (f, 18-19, w, s)

• Listening To Music 5-6 Hrs/Wk - Reading The Newspaper 2-3 Hrs/Wk - Playing W/Pets (Bird) 2-3 Hrs/Wk (f, 20-21, w, j)

• talking to boyfriend on phone (f, 18-19, w, f)

• I back chocolate chip cookies usually twice a week. I do not eat much of the batter or the cookies, I simply relax by baking. (F, 20-21, w, s)

• I smoke marijuana too much, like every day ... But only after I am done with my studies. (M, 20-21, w, j)

• go to AA meetings (f, 22-23, w, sen)

• I worry for 10 minutes per day and that's it. I set a timer. If I'm really stressed I write down all the stressors and think of ways to fix them & make some goals (f, 18-19, w, b)

• long shower or bath (f, 20-21, w, s)

• I smoke pot to get rid of my stress. Nothing works better to relax me than smoking pot. As a matter of fact, I'm high right now (m, 19-20, w, f)

• Things I do on the side for my own enjoyment are running my own business - It creates stress, but it is interesting and I enjoy it. As far as my $ problems I have a loan on it, and some stores that have not paid me and are not intending to. For enjoyment I see movies, talk to friends - coffee or smoke pot and paint or walk on the treadmill (f, 26+, w, sen)

• An important aspect of my life that needs to be considered in this survey is that I am married (f, 22-23, w, j)

• Drive 3-4 hr/week Hike 1-2 hr/week Climb less than 1 hr/week (m, 22-23, w, sen)

The responses that contained a time frame for the frequency that they regularly participated in the activities, in every case, fit into one of the question items (60-79). The scores on the scantrons were modified to reflect the additional frequency of that item.

Research Question Four

Is there a relationship between the amount of stress perceived by college students and the amount of time they spend involved in stress reducing or relaxing activities?

The Pearson product-moment correlation was used to detect the relationship between the subject's score on PSS and the three frequency mean scores, functional, dysfunctional and drug use derived from the Relaxation Frequency Inventory.

Analysis showed no significant correlation between PSS and the Functional activities of stress management (r = -0.045, p > .05). The correlation analysis between PSS and the Dysfunctional activities yielded a small, yet statistically significant positive relationship (r = .170, p < .001). Correlational analysis between PSS and Drug Use activities found no statistically significant relationship (r = .083, p > .05) (Table 12).

Table 12

Relationship between Perceived Stress Scale Scores and Relaxation Activities: Functional, Dysfunctional, and Drug Use

*statistically significant relationship

Research Question Five

What differences exist by gender, by age, by race, and by year in school for perceived levels of stress, sources of stress and for methods of managing stress?

Mean and standard deviation scores were calculated for the demographic variables. ANOVA and t-test scores were used to calculate differences. PSS scores for the independent variables suggested that females were more stressed than were males at the .05 level. No particular age group is more stressed than any other and no specific race showed different stress levels than the others. Similarly, for education level, no differences were found for levels of stress (Table 13).

ICSRLE scores indicated that males and females experience similar levels of intensity and frequency of hassles. The age group 24-25 was different from the other age groups with higher mean scores on ICSRLE (See Table 14). The differences existed for the scores between the Whites and the Asians. For education level, no differences were

Table 13

Results of Differences Analyses for PSS by Gender, Age, Race, and Year in School

* denotes significant difference

found for frequency and intensity of hassles. Differences were based on a post hoc pairwise comparison procedure by Tukey. (All post hoc differences procedures for this study were determined using Tukey HSD [honestly significant difference].)

Table 14

Results of Differences Analyses for ICSRLE by Gender, Age, Race, and Year in School