ArticlePDF Available

Abstract and Figures

stress yoga humor
Content may be subject to copyright.
Journal of College Teaching & Learning December 2009 Volume 6, Number 8
79
Stress Management Strategies For Students:
The Immediate Effects Of Yoga, Humor,
And Reading On Stress
Denise Rizzolo, Seton Hall University, USA
Genevieve Pinto Zipp, Seton Hall University, USA
Doreen Stiskal, Seton Hall University, USA
Susan Simpkins, UT Southwestern Medical Center, USA
ABSTRACT
Background: Health science programs can be demanding and difficult for many students, leading
to high levels of stress. High levels of stress can have a negative effect on students and
subsequently the practicing clinician. Research suggests that yoga, humor, and reading are
simple, effective methods to help reduce stress. To date no research compares the acute effects of
yoga, humor, and reading in doctor of physical therapy and master’s of occupational therapy
students. Additionally, it is undetermined if one technique is more effective than the other in
reducing stress. Purpose: The purpose of this study was to compare the immediate effects of yoga,
humor, and reading on acute stress in students enrolled in doctor of physical therapy and master’s
of occupational therapy programs. It was hypothesized that following a 30-minute yoga, humor,
and reading intervention session, students would demonstrate a reduction of stress on the Daily
Stress Inventory (DSI) and a decrease in blood pressure and heart rate. Subjects: Twenty-two
students from the School of Graduate Medical Education Doctor of Physical Therapy (DPT)
program (n=14) and Master’s of Science in Occupational Therapy (OT) program (n=8)
volunteered to participate in the study. Methods: At baseline subjects completed a demographic
survey. All subjects participated in a yoga, humor, and reading intervention session, once a week
on the same day and at the same time for a total of three weeks. Intervention sessions were
randomized and counterbalanced across subjects. Before and after each intervention session,
stress was measured using the Daily Stress Inventory, systolic blood pressure (SBP), diastolic
blood pressure (DSP), and heart rate (HR). Results: A repeated one-way ANOVA indicated that
all three interventions significantly decreased SBP, DBP, and HR and no one intervention was
more effective than the other in reducing these dependent variables (p = . 058, p = .315 and p=
.180 respectively). There was no significant main effect or interaction of the yoga, humor, or
reading intervention session on the DSI scores (p = .362). Conclusions: The results of this study
indicate that one 30-minute session of yoga, humor, and reading had similar effects in decreasing
acute stress in health science students. This finding is important since these interventions resulted
in a significant reduction in stress in a relatively short amount of time, allowing educators to
begin to consider different stress management strategies to offer to students.
Keywords: stress, humor, yoga, reading
INTRODUCTION
tress is a growing public health concern, affecting many individuals both physically and psychologically
(Sobel, 1995). Many individuals are able to cope with small exposures to stress, and some people even
become more productive when under pressure (Folkman, 1984; Rowe, 2006). However, it is problematic
when stress becomes overwhelming and a person begins to suffer from its adverse consequences including increased
anxiety and depression, multiple somatic complaints without an organic cause, or engaging in unhealthy behaviors
including smoking, poor dietary habits, and poor sleep habits( Friedman, Sobel, Myers, Caudill, & Benson, 1995;
S
Journal of College Teaching & Learning December 2009 Volume 6, Number 8
80
Seyle, 1956; Sobel, 1995). Stress can equally affect all college students; however, the effects of stress are of
particular interest in students enrolled in health science programs. Students in health science programs have an
intensive academic curriculum and also participate in patient care which can cause an increase in their stress levels
(Malathi, & Damodaran, 1999; Mosley, Perrin, Neral, Dubbert, Grothues, & Pinto, 1994; O’Meara, Kostas,
Markland, & Previty 1994). While all programs in health science have their own unique stressors, it has been
suggested that increased levels of stress are commonly seen in physical therapy students (Frazer & Echternach,
1995; O’Meara, et al. 1994). For example, Frank and Cassady (2005) found mean stress levels to be higher on the
Perceived Stress Scale in 163 doctor of physical therapy (DPT) students compared to a general population of
working peers. Not only are levels of stress higher in DPT students, occupational therapy (OT) students experience
high levels of stress as well. Tyrell and Smith (1996) found that compared to a group of age matched working
adults, occupational therapy students had higher levels of psychological stress on the General Health Questionairre-
28 (43% compared to 5% respectively). PT and OT students consistently report the following factors increase their
stress levels: clinical rotations, long hours of studying, lack of free time, and the amount of class work they had to.
Furthermore, research suggests that as stress increases so do the number of reported incidences of illnesses,
infections, gastrointestinal complaints, neurological, and emotional disorders along with other health problems
complete (O’Meara, et al., 1994).
The inability of students to successfully cope with stress may lead to a cascade of negative consequences
on both a personal and professional level. Stress can lead to academic decline, poor relationships with peers and
family members, and overall dissatisfaction with life (Linn & Zeppa, 1984). It is postulated that stress begins during
the educational process and continues throughout one’s professional career (Rowe, 2006). It would therefore be
beneficial to encourage the use of stress management techniques at the start of a student’s education, thereby
assisting them in developing a foundation from which healthy behaviors can be created (Wolf & Kissling, 1984).
While a variety of techniques have been investigated to help reduce stress, three particular adjunctive stress
management techniques of interest are yoga, humor, and reading because they are relatively simple and easily
accessible. Given that individuals may prefer different stress management techniques or may have different ones
available to them assessing if a difference exists in the effectiveness of yoga, humor, and reading is imperative.
Furthermore, it would be counter-productive to recommend a technique for stress reduction if the student has no
interest in that activity.
Yoga is one of the most recognized forms of exercise, stretching, and mediation. Yoga has been found to
modify stress responses and a person’s attitude towards stress, while improving self-confidence, increasing one’s
sense of well-being, and creating a feeling of relaxation and calmness (Malathi, & Damodaran, 1999; Taylor, 2003).
For example, Schell, Allolio and Schonecke (1993) found that after 25 healthy adult females participated in a one-
hour session of hatha yoga (n=12) stress scores significantly decreased on the Stress Coping Questionnaire and their
heart also decreased compared to a control group (n=13). Malathi and Damadoran (1999) determined that a one-
hour yoga program, twice a week, for three months significantly decreased medical students’ (n= 25) anxiety levels
on the Spielberger’s Anxiety Scale compared to a control group (n=25). Students who participated in the yoga
group also reported improved concentration and an optimistic outlook on life.
While yoga can decrease stress, humor can be a stress modifier as well. The use of humor to help reduce
stress has received increased attention by both health care providers and the general public because of its
psychological and physiological benefits (Martin, 2001). Humor is defined as the capacity to perceive, appreciate, or
express what is funny, amusing, or ludicrous (Humormatters.com Accessed September 5, 2009). To determine the
effects of humor on stress, White and Camarena (1989) recruited 93 college students and compared the effects of
three different interventions on stress: laughter (n=26), relaxation training (n=36), and a control (n=33), all
performed for a period 90 minutes. After the students participated in the interventions for 6 weeks the researchers
found that the laughter group demonstrated a decrease in anxiety on the Spielberger State-Trait Anxiety scale, a
decrease in systolic blood pressure, and a decrease in heart rate compared to a comparable control group. Similar to
these findings, White and Winzelberg (1992) found that after 74 college students participated in 20-minutes of
laughter, relaxation training, or a control session, the laughter intervention was as effective as the relaxation session
in significantly reducing psychological stress on the Spielberger State Trait Anxiety Inventory and also clinically
decreased heart rate.
Journal of College Teaching & Learning December 2009 Volume 6, Number 8
81
While there have been many studies examining the effects of yoga and humor on stress very few have
looked at the effects reading has on stress. In one of the few studies on this topic, Jin (1992) found that after a
group of 24 healthy adults participated in a stressful task then read for 60-minutes, they experienced a significant
reduction in anxiety, heart rate, and blood pressure. Given the limited data on the affects of reading on stress
reduction future work investigating its effects are warranted.
Since researchers have determined that some students in health science graduate programs experience high
levels of stress which may affect their academic performance it is important for educators to identify a variety of
stress management techniques that students can use to manage the stress during graduate school and in the future.
Literature on yoga and humor suggests that individually these two methods decrease stress and strengthen coping
mechanisms; however, the findings are still limited and many have been equivocal. There has been even less
research on the effects of reading on stress. To date no research has compared the acute effects of yoga, humor, and
reading on stress in students enrolled in health science programs and more specifically on students enrolled in doctor
of physical therapy and master’s in occupational therapy programs. Additionally, no research has compared the
effects of yoga, humor, and reading on stress to determine if one method is more effective compared to another.
Therefore, the purpose of this study was two-fold: (1) to determine the acute effects of yoga, humor, and reading on
physical and psychological stress in students enrolled in doctor of physical therapy and master’s of occupational
therapy programs and (2) to determine if one intervention was more effective then the other in reducing stress. The
hypothesis was that immediately following one 30-minute session of yoga, humor, and reading, students would
demonstrate a reduction in systolic blood pressure, diastolic blood pressure, heart rate, and psychological stress.
METHODS
Design
The study was a quasi-experimental within subject repeated measure design.
Participants
All students from the Seton Hall University Doctor of Physical Therapy (DPT) and Masters of Science in
Occupational Therapy (OT) were asked to participate in this study. The Seton Hall University Institutional Review
Board (IRB) approved the research proposal.
Inclusion criteria consisted of any student enrolled in the SHU DPT or OT program. Exclusion criteria
included the following: (1) pregnancy, (2) baseline systolic blood pressure less than 90 mmHg and/or diastolic blood
pressure less than 60 mmHg, (3) a yes response to any question on the Physical Activity Readiness Questionnaire
(PAR-Q), (4) students who actively practiced in restorative hatha yoga exercises, similar to the yoga exercises
performed in the video instruction, or (5) any subjects with musculoskeletal conditions that would prevent them
from practicing light stretching techniques. Based on the above criteria a homogeneous sample of convenience of
22 subjects was recruited.
The dependent variables were psychological stress scores as measured by the Daily Stress Inventory and
SBP, DBP, and HR which were measured simultaneously using a Critikon Dinamap XL 9340 Vital Signs Monitor.
The independent variables were the 3 interventions: (1) yoga intervention, (2) humor intervention, and (3) reading
intervention.
Measurements
Demographic Data
The demographic survey collected general information from the students and obtained additional
sociodemographic data which could account for any confounding effects that were observed on the dependent
variables. Questions regarding prescription medication, over the counter medication, herbal supplements, along
with whether the student uses a rescue medication during and/or after exercise were included in the survey.
Journal of College Teaching & Learning December 2009 Volume 6, Number 8
82
Hypertensive agents, psychotropic agents and inhaled short-acting bronchodialators may or may not affect
psychological stress levels, blood pressure, and heart rate so it was important to determine if the students were using
any of these medications (American College of Sports Medicine, 2006).
Stress Survey
The Daily Stress Inventory (DSI) is a 58 item self-report measure that allows a person to indicate how often
a specific stressful event has affected him or her over the past 24 hours (Brantley, Waggoner, Jones, & Rappaport,
1987). After identifying which events occurred, the individual rates the stressfulness of those events on a Likert
scale from 1 (“occurred but was not stressful”) to 7 (“caused me to panic”). For the present study only the SUM
score was analyzed with the lowest and highest score possible being 0 to 406 respectively. The authors chose only to
analyze the SUM score since it demonstrates the total impact the stressors had on the individual in the past 24 hours
and subsequently the SUM score can be compared between subjects. The SUM measurement of the DSI is
significantly correlated to the Daily Hassles and Uplift Scale (0.57 for hassle frequency and 0.56 for hassles
intensity) demonstrating concurrent validity. The SUM measurement is correlated to the State-Trait Inventory
(0.42) supporting the construct validity of the SUM measurement. The reliability across items for the SUM is 0.87.
Higher scores on the scale indicate a greater psychological stress (Brantley, et al., 1987).
Coping Surveys
The coping surveys were distributed during the screening session and the results were used as part of
another study. The Coping Humor Scale (CHS) is seven item self-reported scale that assesses the degree to which
subjects report using humor to cope with stress (Martin, 1996). The Coping Style Scale (CSS) is a 20- item self-
reported scale which is part of the Stress Profile published by Western Psychological Services (WPS) (Nowack,
1990; Nowack, 1999). The CSS lists common ways of coping with daily stressors, irritants, annoyances, and
challenges.
Physiologic Measurements
Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR), were taken before and after
the interventions simultaneously using an automatic Critikon Dinamap XL 9340 Vital Signs Monitor. SBP, DBP, and
HR were measured with the patient in a seated position both feet flat on the floor. Since laughter can initially stimulate
the sympathetic nervous system causing an immediate elevation in heart rate and blood pressure, a ten minute delay after
each intervention occurred before re-recording SBP, DBP, and HR (Forghieri-Santaella, et al; Fry, 1994).
Interventions
All subjects participated once in each of the following three interventions over the course of three weeks
with each intervention session lasting 30-minutes.
Yoga
Three sections from the Yoga for Meditation DVD, with Rodney Yee, developed by GAIAM, were used. The
entire 30-minutes of the DVD is narrated by Rodney Yee and includes soft music in the background. Only clips that
practiced restorative yoga, which included light stretching, deep breathing, and meditation were taken. The sections
of the DVD that included active aerobic types of yoga techniques were excluded.
Humor
The subjects selected one of the following videos to watch: The Best of Saturday Night Live with Will
Farrell, Chris Farley, or Jimmy Fallon.
Journal of College Teaching & Learning December 2009 Volume 6, Number 8
83
Reading
During the reading intervention session the subjects read articles about historical events and innovative
technology. Articles were taken from Newsweek and various internet sites. The material was non-provocative and it
did not relate to any health maintenance topics.
Procedure
During a screening visit students completed the PAR-Q followed by blood pressure measurements to
determine inclusion status. If the student met the inclusion and exclusion criteria, they then completed the baseline
scales including the demographic survey, the Coping Style Scale, and Coping Humor Scale. Following the scales the
students were assigned to a different intervention session sequence to control for order effects.
During the three intervention sessions stress was initially assessed using the Daily Stress Inventory, SBP,
DSP, and HR. Immediately following the intervention the DSI was completed and 10 minutes later SBP, DSP, and
HR were recorded. Each subject was exposed to each of the independent variables and performance was compared
across treatment conditions within each subject to help control for intersubject differences. Over a three week
period each student participated each of three interventions. All data and intervention sessions were recorded and
performed on the same day of the week and at the same time of day in order to control for possible weekly and daily
fluctuations in SBP, DSP, HR and stress levels. Data collection occurred during the first four weeks of the semester
in attempt to avoid the confounding effects of midterms
Data Analysis
Frequency counts and descriptive statistics were used to analyze the demographic data. After mean
psychological stress scores were calculated from the DSI they were found to have a high standard deviation
suggestion there scores were extremely variable. Therefore the scores from the DSI were entered into a logarithmic
regression model in order to normalize the data prior to the ANOVA analysis. To determine the effect of yoga,
humor, and reading on stress a One-Way Within Subjects Repeated Measures ANOVA was computed using a p
value of less then 0.05 to determine significance (Munro, 2005; Portney & Watkins, 1993). The Statistical Package
for the Social Sciences (SPSS) software, version 15.0 for Windows (2007), was utilized for all computations.
RESULTS
Demographic Profile
Twenty-four full-time students with a mean age of 23 years (range 20 to 37 years) volunteered for the
study. After the initial screening visit, one student withdrew at the beginning of the first session for an unspecified
reason. One student did not complete the yoga intervention nor yoga post-tests due to cervical pain unrelated to the
present study. Eight students (36%) used prescription medications including birth control, cetirizine HCl (Zyrtec),
and one student took sertraline hydrochloride (Zoloft). Two students (9%) used over the counter medication, none
of the students used medication before or after exercise, and 2 (9%) students stated they used some form of herbal
supplements. Seventeen (77%) students exercised at least three days a week, for an average of 50 minutes per
session. Types of exercise included predominately running, walking, elliptical machine, and strength training. Only
3 students (14%) participated in an aerobic form of yoga once per week. The 12 students (54%) who reported
drinking alcohol on average consumed only one drink per week. The results indicated that the sample consisted of
healthy college students that exercise regularly, do not abuse alcohol nor smoke tobacco, and do not use medications
to control blood pressure. A summary of the remaining demographic and personal habits is presented in Table 1.
Journal of College Teaching & Learning December 2009 Volume 6, Number 8
84
Table 1: Demographic Data
Characteristics
N
%
Gender
Male
Female
3
19
14
86
Program
Physical Therapy
Occupational Therapy
14
8
64
36
Marital Status
Single
Married
20
2
91
9
Children
Yes
No
1
21
Alcohol intake
Yes
No
10
12
46
54
Tobacco
Yes
No
0
22
0
100
Read to Reduce Stress
Yes
No
12
10
54
46
Psychological and Physiological Measures
Calculated means and standard deviations for the DSI scores SBP, DBP, and HR appear in Table 2. The
mean blood pressure and heart rate levels indicate that these variables were normal to low at baseline, suggesting
that this sample consisted of healthy young students (Chobanian, et al. 2003).
Table 2: Summary of Pre and Post Mean DSI Scores, Blood Pressure and Heart Rate by Intervention
Intervention
Yoga
Mean (SD)
Humor
Mean (SD)
Reading
Mean (SD)
Pre DSI Score
58.64 (60.63)
65.41 (74.00)
61.00 (71.21)
Post DSI Score
39.36 (52.33)
74.00 (58.18)
49.27 (63.72)
Pre Systolic BP
117.00 (10.88)
113.95 (10.03)
110.68 (11.21)
Post Systolic BP
108.14 (11.42)
110.45 (12.08)
105.82 (12.88)
Pre Diastolic BP
68.09 (8.06)
70.05 (7.72)
65.18 (7.76)
Post Diastolic BP
64.77 (8.74)
65.09 (8.83)
62.05 (6.58)
Pre HR
73.73 (11.33)
77.41 (9.64)
70.09 (12.25)
Post HR
70.09 (10.64)
73.41 (8.75)
68.73 (9.94)
Note. BP=Blood pressure in mm/Hg
HR=Heart rate in beats/min
A repeated measures analysis of variances (ANOVA) indicated there was no significant main effect of
intervention on the DSI scores. A significant main effect of time on DSI scores was found (F (1) = 18.56, p = .000).
However, there was no significant interaction between intervention x time, indicating that no one intervention
reduced DSI scores more than another.
Journal of College Teaching & Learning December 2009 Volume 6, Number 8
85
There was a significant main effect of the intervention (F (2) = 5.27, p = .009) and time (F (1) = 32.12, p <
.05) on SBP. The interaction between intervention x time approached but did not reach significance (F (1.511) =
3.403, p = .056), indicating that no one intervention reduced SBP more than another.
There was a significant main effect of the intervention (F (2) = 3.48, p = .04) and time (F (1) = 41.90, p =
.000) on DBP. Yet, there was no significant interaction between intervention x time, indicating that no one
intervention reduced DBP more than another.
A significant main effect of the intervention (F (2) = 5.56, p = .008) and time (F (1) = 12.33, p = .002) on
HR was also found. Yet, there was no significant interaction between intervention x time, indicating that no one
intervention reduced HR more than another.
DISCUSSION
The results suggest that one 30-minute session of yoga, humor, and reading acutely reduced physiological
and psychological stress in students enrolled in graduate DPT and OT programs. Specifically, participation in a
single session of yoga significantly reduced students’ SBP, DSP, and HR. The observed change in the DSI scores
and the significant decrease in the physiologic variables noted after the yoga session could be attributed to the
decrease in sympathetic arousal that occurs when subjects participate in this type of activity (Schell & Allolio &
Schonecke, 1993). In the present study the light stretching and quiet mediation during the yoga intervention session
could have caused a decrease in physiologic parameters, which in turn may have contributed to a decrease in the
psychological perception of stress.
Similar to the decrease in stress seen after the yoga intervention session, the humor intervention
session clinically decreased psychological and physiologic stress. The results are consistent with some of the
findings White and Winzelberg (1992) who found that after a group of college students watched a humorous video
for 20 minutes a significant decrease on the State-Trait Anxiety Inventory (STAI) occurred along with an observed
but not significant reduction in blood pressure. The authors (1992) believed blood pressure did not significantly
decrease because during the laughter session, the subjects laughed for less then four minutes, which may have been
an insufficient amount of time to cause a decrease in sympathetic arousal. In comparison, in the present study, the
primary researcher observed that almost all the students laughed throughout the entire length of the 30-minute video
which could explain the significant decrease in SBP, DBP, and HR observed.
After the reading intervention session the students also had a decrease in the stress variables. These results
were not unexpected since over half the students admitted using reading to help reduce stress. However, even
though 12 of the 22 students read to reduce stress, this did not significantly influence the effect of any intervention
on the dependent variables (p = 0.66). The students may have found the neutral reading material to be relaxing,
thereby decreasing the sympathetic nervous system arousal and resulting in a reduction of stress. Since there are
limited studies on the effects of reading on stress, more research is needed to clearly determine why reading reduces
stress levels.
Findings from the present study on graduate health science students demonstrate that individually one 30-
minute yoga, humor, and reading session are equally effective in acutely reducing stress. Thus, supporting the notion
that there are multiple methods one can utilize to help reduce the negative effects of a stressful situation. Since time
constraints are one of the most frequently cited reasons for high stress levels reported by health science students, 30-
minutes of one of these techniques can be easily incorporated into their schedule without diverting a large amount of
time from their studies. Finally, the combination of a significant reduction in acute stress in a short amount of time is
of importance because yoga, humor, and reading can be suggested to students for immediate stress reduction before
examinations, practicals, presentations and even during a highly stressful day.
Limitations and Future Research
The author recognizes there are limitations to the present study. First, a sample of convenience was
recruited that included DPT and OT students from one university, thus limiting the generalizability of the results.
Journal of College Teaching & Learning December 2009 Volume 6, Number 8
86
The sample size was smaller than initially projected do to the limited recruitment period which was designed to
attempt to avoid the confounding effects of midterms. Although the study was done during the first four weeks of
class to account for increased stress levels as the semester progresses, it was impossible to control for outside
influences that may have increased or decreased the students’ stress levels. Additionally, an unequal number of
students from these two programs volunteered for the study, however, their stress levels were found to be similar at
baseline. In the future, physiological measurements should be taken throughout the intervention and after the
completion of the intervention to determine short and long-term effects of yoga, humor, and reading on stress.
CONCLUSION
Programs in health science place students in demanding, fast-paced, and stressful academic environments.
It is well known that students in health science programs perceive their academic environment to be stressful (Frazer
& Echternach, 1995; O’Meara et al., 1994). While professors teach students pathology, diagnosis, and treatment
they do not generally teach them how to cope with the stress frequently encountered in many health science
professions. The stress they face during their education may continue throughout their careers, ultimately leading to
burnout (Balogun et al., 2002). Given the high prevalence of burnout among physical therapists and occupational
therapists as a whole, it is important for programs to begin to focus their attention on the students stress so they can
learn how to cope and manage stress before they enter their professional fields (Rowe, 2006). In addition to
preparing students for their work as clinicians, educators should help student identify stressors. Early self
identification of stress is important in order to develop coping methods essential for managing the high stress
position of a professional practitioner. Hopefully by dealing with stress effectively as a student and then as a
practicing clinician, some of the adverse physiological and psychological effects of stress will be mitigated.
AUTHOR INFORMATION
Dr. Rizzolo is an Assistant Professor at the Seton Hall Physician Assistant program. She received her PhD from the
Graduate Programs in Health Sciences at Seton Hall University in 2008. She currently works as a Physician
Assistant at the Care Station in Springfield, New Jersey. Her research interests focus on stress management and
adjunctive techniques to management specifically, yoga and humor.
Dr. Pinto Zipp is Associate Professor and Chair of the Department of Graduate Programs in Health Sciences at
Seton Hall University. She received her EdD from Teachers College Columbia University in 1996. She currently
teaches management of neuromuscular problems in the Doctor of Physical Therapy program. Her research interests
focus on, a) effects of performing dual tasks on walking performance and postural sway in children and adults, and
b) curriculum design issues including the use of mind mapping and video based cases in professional education for
the promotion of clinical decision making skills.
Dr. Simpkins is Associate Professor in the Department of Physical Therapy,UT Southwestern Medical Center. She
received her EdD from Teachers College Columbia University in 2000. She currently teaches management of
pediatrics neuromuscular problems in the Physical Therapy program. Her research interests focus on, a) effects of
obstacles on walking performance in children, and b) curriculum design issues.
Dr. Stiskal-Galisewski is an Associate Professor and Chair of the Seton Hall University Physical Therapy Program.
She received her PhD from the Graduate Programs in Health Sciences at Seton Hall University in 2003. Her
research interests are in osteoarthritis, rheumatoid arthritis, and the effects on Tai Chi on these conditions.
REFERENCES
1. American College of Sports Medicine. (2006). Resource Manual for Guidelines for Exercise Testing and
Prescription (5th ed). Baltimore, MD: Lippincott Williams & Wilkins.
2. Brantley, P. J., Waggoner, C. D., Jones, G. N., & Rappaport, N. B. (1987). A daily stress inventory:
development, reliability, and validity. Journal of Behavioral Medicine, 10(1), 61-74.
3. Balogun, J.A., Titiloye, V., Balogun, A., Oyeyemi, A., & Katz, J. (2002). Prevalence and determinants of
burnout among physical and occupational therapists. Journal of Allied Health, 31(3), 131-139.
Journal of College Teaching & Learning December 2009 Volume 6, Number 8
87
4. Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L. et al., (2003)
Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high
blood pressure. Hypertension, 42, 1206-1252.
5. Folkman, S. (1984). Personal control and stress and coping processes: a theoretical analysis. Journal of
Personality and Social Psychology, 46, 839-852.
6. Forghieri-Santaella, D., Aparecida-Araujo, E., Coelho-Ortega, K., Tinucci, T., Mion, D., Negrao, C.E., &
Lucia de Moraes-Forjaz, C. (2006). After effects of exercise and relaxation on blood pressure. Clinical
Journal of Sports Medicine, 19(4), 341-347.
7. Frank, L.M. & Cassady, S.L. (2005). Health and wellness in entry-level physical therapy students: are
measures of stress , anxiety, and academic perfromance related? Cardiopulmonary Physical Therapy
Journal, 16, 5-16.
8. Frazer, G. H, & Echternach, J. L. (1991). Response of physical therapy students to stress indicators.
Journal of Physical Therapy Education, 5, 72-77.
9. Friedman, R., Sobel, D., Myers, P., Caudill, M., & Benson, H. (1995). Behavioral medicine, clinical health
psychology, and cost offset. Health Psychology, 14(6), 509-518.
10. Fry, W. F. (1994). The biology of humor. Humor, 7(2), 111-126. Humormatters.com (2009). Definitions of
humor. Retrieved September 7, 2009 from http://humormatters.com.
11. Jin, P. Efficacy of tai chi, brisk walking, meditation, and reading in reducing mental and emotional stress.
Journal of Psychosomatic Research, 36(4), 361-370.
12. Linn, B. S., & Zeppa, R. (1984). Stress in junior medical students: Relationship to personality and
performance. Journal of Medical Education, 59(1), 7-12.
13. Malathi, A., & Damodaran, A. (1999). Stress due to exams in medical students-role of yoga. Indian Journal
of Physiology and Pharmacology, 43(2), 218-24.
14. Martin, R. A. (1996). The situational humor response questionnaire and coping humor scale: a decade of
research findings. Humor, 9, 251-272.
15. Martin, R. A. (2001). Humor, laughter and physical health: methodological issues and research findings.
Psychological Bulletin, 127(4), 504-519.
16. Mosley, T. H., Perrin, S. G., Neral, S. M., Dubbert, P. M., Grothues, C. A., & Pinto, B. M. (1994). Stress,
coping, and well-being among third year medical students. Academic Medicine, 69(9), 765-767.
17. Munro, B. H. (2005). Statistical Methods for health care research. 5th ed. Philadelphia, PA, Lippincott
Williams & Williams.
18. Newman, M. G., & Stone, A. A. (1996). Does humor moderate the effects of experimentally-induced
stress? The Society of Behavioral Medicine. 18(2), 101-109.
19. Nowack, K. M. (1990). Initial development of an inventory to assess stress and health risk. American
Journal of Health Promotion, 4, 173-180.
20. Nowack, K. M. (1999) Stress Profile Manual. Western Psychological Services, Los Angeles, CA.
21. O’Meara, S., Kostas, T., Markland, F., and Previty, J. C. (1994). Perceived academic stress in physical
therapy students. Journal of Physical Therapy Education, 8, 71-74.
22. Portney, L.G., & Watkins, M.P. (1993). Foundations of clinical research. 1st ed. Stanford, CT: Appleton &
Lange.
23. Rowe, M. M. (2006). Four-year longitudinal study of behavioral changes in coping with stress. American
Journal of Health Behavior, 30(6), 602-612.
24. Schell, E. J., Allolio, B., & Schonecke, W. (1993) Physiological and psychological effects of hatha-yoga
exercise in healthy women.International Journal of Psychosomatics, 41, 46-52.
25. Selye, H. (1956). Stress of Life. New York, NY: McGraw-Hill Bock Company.
26. Sobel, D. S. (1995). Rethinking medicine: improving health outcomes with cost-effective psychosocial
interventions. Psychosomatic Medicine, 57, 234-244.
27. Statistical Package for the Social Sciences, 15.0 for Windows (2007). Chicago Illinois: SPSS, Inc.
28. Taylor, M. J. (2003). Yoga Therapeutics: an ancient, dynamic systems theory. Techniques in Orthopedics,
18(1), 115-125.
29. Tyrrell, J. & Smith, H. (1996). Levels of psychological distress among occupational therapy students.
British Journal of Occupational Therapy, 59(8), 365-371.
30. White, S. & Camarena P. (1989). Laughter as a stress reducer in small groups. Humor, 2(1), 73-79.
31. White, S. & Winzelberg, A. (1992). Laughter and stress. Humor,5(4), 343-355.
Journal of College Teaching & Learning December 2009 Volume 6, Number 8
88
32. Wolf, T. M., & Kissling, G. E. (1984). Changes in life style characteristics, health, and mood of freshman
medical students. The Journal of Medical Education, 58, 806-814.
NOTES
... Even mild stress or pressure can have a significant negative effect on one's well-being. Among young adults, stress is usually the reason for the decline in academic attainment, low self-efficacy, and poor social relationships (Rizzolo et al., 2009). Furthermore, Rizzolo et al. (2009) claimed that the inability to cope with stress can lead to a variety of potential consequences at both personal and professional levels among working adults. ...
... Among young adults, stress is usually the reason for the decline in academic attainment, low self-efficacy, and poor social relationships (Rizzolo et al., 2009). Furthermore, Rizzolo et al. (2009) claimed that the inability to cope with stress can lead to a variety of potential consequences at both personal and professional levels among working adults. ...
Article
Full-text available
There are various benefits of having books at home as it supports cogni tive growth to later succeed academically by enhancing literacy, numeracy and technological skills. However, there are not many studies examining the relationship between the number of books available at home and how it is affecting an individual’s psychological well-being. The aim of this study is to examine this relationship among Malaysians. A total of 1306 survey was distributed to residents living in the western part of Malaysia in an attempt to measure the psychological well-being and the number of books at the respondents’ home. After analyzing the responses, it was found that respondents with very few to no books were related to experiencing anger more frequently than the other two groups with 11-100 and 100 and more books. We also found similar linkages for depression, stress, and worry. Interestingly, we found that the positive psychological well-being items revealed that the group with more than 51 books or more were related to experiencing more enjoyment rather than those with a lesser number of books. The finding of the present study reinforces the importance of books in one’s life, particularly the psychological state and experiences. Keywords: anger, books, depression, happiness, psychological well- being, stress, worry
... Research about the acute physiological responses of college students to a single yoga session is as scarce as the information previously referenced related to acute psychological outcomes. We found only one study in the literature showing that 30-minutes of restorative yoga significantly decreased blood pressure and heart rate for graduate students [27]. ...
Article
Full-text available
College students experience increased stress levels that could predispose them to develop mental and physical health conditions throughout adulthood. Yoga is an ancient mind-body practice including breath techniques, body exercises, and meditation that may be a useful strategy for enhancing college student health. Likewise, exposure to nature has been shown to have beneficial impacts on human health. This study investigates physiological and psychological responses of college students to yoga practiced in outdoor versus indoor environments. Fifty-eight college females between the ages of 18-28 were randomly assigned to complete a 40-minute Hatha yoga session either indoors (empty classroom) or outdoors (green park) at a mid-sized public university. Heart rate, respiration rate, perfusion index, and positive and negative affect states were recorded pre/post yoga. Heart rate, respiration rate, and negative affect significantly improved after the yoga sessions in both indoor and outdoor environments. Baseline self-reported negative affect was significantly lower in the outdoor group compared to the indoor group. There were no significant interaction effects of yoga and environment. This study suggests that one 40-minute-session of Hatha yoga may be a useful method to alleviate acute signs of physiological stress and decrease negative affect for college females in both indoor and outdoor environments. Further research about potential synergistic effects of yoga and exposure to nature is warranted to better understand whether the environment in which yoga is practiced could enhance the benefits of this mind-body modality on health.
... This new finding indicates that the positive association between these two types of symptoms is weaker for children with greater engagement in literacy activities in their spare time. In the literature, literacy activity engagement has been shown to improve emotion regulation, facilitate positive emotions, bolster self-efficacy, and mitigate psychological distress [68][69][70]. All of these desirable changes brought by literacy activity engagement may serve as a protective factor from developing internalizing or externalizing problems [44,46], including GD that is the target problem examined in the present study. ...
Article
Full-text available
Nowadays, playing both online and offline video games is a popular leisure activity among youngsters, but excessive gaming activity engagement may lead to gaming disorder that disrupts daily functioning. Identifying risk and protective factors of this emerging problem is thus essential for devising prevention and intervention strategies. This mixed-method, cross-sectional study aimed to examine the roles of parental depressive symptoms and children’s leisure activity engagement on children’s gaming disorder symptoms. Furthermore, the moderating roles of risky and protective leisure activity engagement were investigated. The sample comprised 104 parent-child dyads recruited from a population-based survey (parents: Mage = 45.59 years, SD = 6.70; children: Mage = 11.26 years; SD = 4.12). As predicted, parental depressive symptoms and children’s gaming activity engagement were positively associated with children’s gaming disorder symptoms, whereas children’s literacy activity engagement was negatively associated with these symptoms. Moreover, engagement in these two types of leisure activity moderated the association between parental depressive symptoms and children’s gaming disorder symptoms in distinct manners, further indicating literacy activities as beneficial and gaming activities as risk-enhancing. These new findings imply that parental depressive symptoms and children’s leisure activity engagement should be considered when designing parent-based programs for gaming disorder prevention and intervention.
... Research indicates that book readers have a lower risk of mortality than non-book readers (Bavishi, Slade, & Levy, 2016) and readers of fiction are more comfortable with ambiguity than nonfiction readers (Djikic, Oatley, & Moldoveanu, 2013). Fiction also improves empathy (Mar, Oatley, & Peterson, 2009), reduces stress (Rizzolo, et al., 2009), improves brain connectivity (Berns, et al., 2013), and has been shown to enhance theory of mind (Kidd & Castano, 2013). Given that participants chose fiction books over many other forms of reading in the current study, integrating more fiction in university classrooms may provide another avenue for improving reading skills and self-efficacy. ...
Article
Reading is a basic skill that is needed for academic success and employment opportunity. Aliteracy, or the lack of a reading habit, and lower motivation to read, are problems at the university level, especially among ethnically diverse adults. Reading self-efficacy is associated with reading comprehension, word reading, foreign language learning and the use of reading strategies. Given that ethnic identity has been linked to well-being and an improved sense of competence among minoritized adults, the present study sought to investigate the connection between reading self-efficacy and ethnic identity as well as the reading practices of African American and Hispanic American adults. Results revealed that ethnic identity, ethnicity, and home language explained a statistically significant amount of variance in reading self-efficacy. Similarities and differences in reading choices based on gender were also investigated.
... 17 It is particularly important to target specific stress management strategies in light of relatively recent evidence of the effectiveness of such strategies among students in a PT doctoral program and among students in general. 16,17 Evaluating Perceived Stress among Students Previous studies have described different approaches to evaluate perceived stress, measured globally, or as event-specific perceived stress. Examples of tools that measure global stress are the Perceived Stress Scale (PSS) and the Beck Depression Inventory, which measure the degree to which participants appraise their individual situation as stressful. ...
Article
Full-text available
Purposes: This study aimed 1) to evaluate perceived stress of a cohort of bachelor physical therapy (PT) students from Ariel University in Israel across three clinical practice periods; 2) to evaluate the relationship between perceived stress and academic achievements; 3) to evaluate the relationship between students' perceived stress and clinical practice periods' order and content; and 4) to identify clinical and socio-demographic variables related to perceived stress. Methods: A longitudinal study was conducted among a cohort of undergraduate PT students during their first, second, and third clinical practice assignments. Data were collected using an online questionnaire. The Perceived Stress Scale 10 (PSS) and the Scale for Assessing Academic Stress (SAAS) were used to evaluate perceived stress. A ten-degree Visual Analogue Scale (VAS) was used to evaluate perceived difficulty. Students' grade point averages from the first three years of study were considered academic achievements. An ANOVA was used to evaluate the relationship between perceived stress and academic achievements, and between clinical practice order and area and the socio-demographic characteristics. Results: A total of 39 undergraduate physical therapy students participated in the study. The degrees of PSS and SAAS were higher than those reported previously in undergraduate PT students. Perceived stress was not related to academic achievement, clinical practice order or area, or to socio-demographic characteristics. Conclusions: Participation in clinical practice in general might be a stressful situation, but no specific clinical or socio-demographic factors that might be a source of higher levels of perceived stress were identified. As undergraduate students are away from the campus during clinical practice periods, it is suggested that clinical instructors, who are in daily contact with the students, should receive guidance regarding the ways to identify individuals who present signs of increased stress and the types of strategies that can help students cope with stress in real time.
Article
In this systematic review, we sought to understand the effects of laughter-inducing interventions on blood pressure and heart rate variability. For this purpose, we identified 32 relevant records through database searching. The results suggest that laughter is associated with a decrease in blood pressure in pre-post measurements. However, this association varies according to the type of intervention delivered and the characteristics of participants. In controlled between-groups comparisons, the effect of laughter-inducing interventions on blood pressure was found to be non-significant, which can be due to the small number of studies available and its high level of heterogeneity. In studies involving heart rate variability, the most consistent findings point to an association between laughter and decreases in both frequency (LF/HF) and time-domain (SDNN) indicators. Longitudinal studies suggest that laughter frequency is associated with improved cardiovascular health. Several studies presented sub-optimal levels of quality, and more research is necessary to examine the impact of individual and intervention-related factors in the effectiveness of laughter-inducing interventions in cardiovascular health.
Article
The present study aimed to find out differences in health risk factors of COVID-19 among doctors, nurses and psychologists by determining the relationship of cognitive appraisal, coping styles, stress and fear among health professionals. Cross-sectional research design was used. Sample comprised of 3 groups; doctors, nurses and psychologists (n = 145 in each group) working in tertiary care hospitals. Stress appraisal measure, Brief COPE inventory, Perceived stress scale and Fear contracting COVID-19 questionnaire were used to assess cognitive appraisal, coping, stress and fear respectively. Results showed that nurses had high uncontrollable, stressfulness and primary appraisal, used more avoidant emotional and problem focused coping, were more stressed and fearful as compared to doctors and psychologists. Psychologists had a high appraisal of control-self and control-others as compared to doctors and nurses and were more fearful than doctors. Doctors and psychologists used more coping of humor as compared to nurses. Moreover, primary appraisal and avoidant emotional coping positively predicted stress whereas control-self appraisal negatively predicted stress among health professionals. Uncontrollable and stressfulness appraisal positively correlated with fear. This study will direct the administrative authorities to take effective measures to improve psychological wellbeing and to deal with fear and stress of health professionals.
Article
Full-text available
Stress continues to be one of the challenging of responding in different situations. It evokes negative thoughts and feelings in a person. It is known that there are many ways to reduce stress, like counseling, training, exercise, e.t.c. Although, nowadays, through technology have developed different ways to face with it. There are many applications in smartphones and tablets, which are designed for stress management. These applications contain many and different techniques to reduce stress, such as meditation, mindfulness breathing, cognitive behavior therapy and relaxation techniques.
Thesis
Full-text available
Objective of the research – the connection between 1st year students of psychology, social pedagogy, primary education pedagogy, preschool pedagogy strategies for coping with stress and attitudes towards suicide The aim of the research: to investigate 1st year students of psychology, social pedagogy, primary education pedagogy, preschool education pedagogy strategies for coping with stress, attitudes towards suicide and the connection between them. Tasks of the study are: 1. To investigate and compare the strategies for coping with stress by study programs: of primary education pedagogy and preschool education pedagogy students of the university, as well as strategies for coping with stress of psychology and social pedagogy students. 2. To investigate and compare the attitudes towards suicide by study program: of primary education pedagogy and prechool education pedagogy, as well as students of psychology and social pedagogy. 3. To establish links between the university's first-year students strategies for coping with stress and attitudes towards suicide in psychology, social pedagogy, primary education pedagogy, preschool education pedagogy. Methods used in the research: Attitudes towards suicide questionnaire (ATTS), created by E. Salander Renberg and L. Jacobsson in swedish and Four-factor stress overcoming questionnaire (lt. Keturių faktorių streso įveikos klausimynas - Lithuanian stress coping assessment methodology) created by Ž. Grakauskas and G. Valickas (2006). Research participants - In the study participated 135 students. The study involved 123 women, the majority of respondents to the study, and 12 men. The age of the participants is 18-22 years. Results of the research: The University's first-year: primary education pedagogy, pre-school pedagogy, psychology and social pedagogy programs students` stress coping strategies did not show a statistically significant difference (p> 0,05). It was found that there was a statistically significant differences between primary education pedagogy and pre-school pedagogical study program students` attitudes towards suicide: judgement attitude (p=0,031) and normal/common attitude (p=0,024). 6 Data from the Psychology study program shows a statistically significant weak negative link between avoidance coping with stress strategies and readiness to help attitude towards suicide (r=-0,302, p=0,041). The results of the answers of the students of the primary education pedagogy study program shows a statistically significant weak negative correlation between the avoidance coping with stress strategy and interpersonal relations attitude towards suicide (r=-0,476, p=0,039). Pre-school pedagogical study program students` results shows statistically significant average negative correlation between problem solving coping with stress strategy and the helplessness of the surrounding attitude towards suicide (r=-0,600, p=0,014), also there was a statistically significant negative average correlation between social support coping with stress strategies and the normal/common attitude towards suicide (r=-0,504, p=0,046). Results of the study program in psychology shows very statistically significant weak negative link between problem solving coping with stress strategies and the helplessness of the surrounding attitude towards suicide (r =-0,410, p=0,005). The results of the study programs of social pedagogy shows a weak negative, very statistically significant relationship between the problem solving coping with stress strategy and the acceptability attitude towards suicide (r=-0,403, p=0,003).
Article
Anxiety, depression, and burnout are being discussed across health professions. Despite rising concern, studies investigating stress in students enrolled in Doctor of Physical Therapy (DPT) programs remain limited. Only recently have studies exploring stress in DPT students surfaced with any consistency. In this study, our aim was to elucidate the self-identified challenges first-year DPT students faced, how they reacted, and what they did to manage them. Evidence suggests that DPT students, like other health professional students, report high levels of anxiety. Despite rising concern, studies investigating the impact of stress on DPT students remain limited. This concern also raises the question of the role of health professions educators in helping students develop the coping strategies needed to manage stress. Programs across the health professions have been proffered to address student stress; however, limited data exist to effectively guide educators. From the insights gained, we offer recommendations linked to the emic or student perspective that may help educators facilitate adaptive coping skills in their learners. Participants included first-year DPT students from 3 private universities. A critical incident questionnaire was used to capture the student experience. Narratives were submitted electronically. Responses were deidentified, and researchers were blinded to participation. An inductive interpretivist approach was used to analyze the data. Strategies to ensure trustworthiness included prolonged engagement, triangulation of investigators, and peer review. Eighty-two first-year DPT students responded; 70 complete responses were analyzed. Three major themes were identified: 1) first-year DPT students faced academic, personal, and mixed challenges; 2) challenges evoked a range of negatively charged emotions; and 3) students relied on adaptive and some potentially maladaptive personal characteristics, behaviors, and strategies to manage their challenges. First-year DPT students face many of the same challenges as other health professional students. Most successfully navigated their challenges, however, not without some degree of emotion. As educators, we must prepare students to develop the coping strategies needed to manage not only current academic stressors but ultimately the stressors inherent in clinical practice. Toward that end, we offer recommendations, linked to the emic perspective obtained, that may help educators facilitate adaptive coping skills in their learners.
Article
Full-text available
The Situational Humor Response Questionnaire (SHRQ) and the Coping Humor Scale (CHS) are self-report measures of different aspects of the sense of humor that were developed in the context of an investigation of the stress-moderating effects of humor. The SHRQ assesses the degree to which subjects laugh and smile in a wide variety of situations, and the CHS measures the degree to which respondents make use of humor in coping with stress in their lives. Both scales have been translated into more than 10 languages, and a fairly large body of research findings has accumulated, providing evidence for the reliability and construct validity of these measures. This article reviews research on these scales with regard to (1) the stress-moderator hypothesis, (2) correlations with coping-related variables, and (3) the factor space occupied by the measures. The paper addresses the range of usefulness of both measures, as well as their limitations as measures of sense of humor.
Article
All published research examining effects of humor and laughter on physical health is reviewed. Potential causal mechanisms and methodological issues are discussed. Laboratory experiments have shown some effects of exposure to comedy on several components of immunity, although the findings are inconsistent and most of the studies have methodological problems. There is also some evidence of analgesic effects of exposure to comedy, although similar findings are obtained with negative emotions. Few significant correlations have been found between trait measures of humor and immunity, pain tolerance, or self-reported illness symptoms. There is also little evidence of stress-moderating effects of humor on physical health variables and no evidence of increased longevity with greater humor. More rigorous and theoretically informed research is needed before firm conclusions can be drawn about possible health benefits of humor and laughter.
Article
This study measured levels of psychological distress among a sample of Irish occupational therapy students. Students from all four undergraduate classes (n=102) were surveyed, using the General Health Questionnaire (GHQ-28). Over 40% of the students scored as having a ‘just significant clinical disturbance’ on the GHQ-28. Mean GHQ scores (or symptom levels) varied throughout the 4-year course and were highest just before examinations and during fieldwork placements. Students who had unhealthy diets or who smoked had significantly higher levels of psychiatric symptomatology. The prevalence of psychological distress among occupational therapy students was similar to that found in students from four other disciplines; however, the university students had much higher levels of symptomatology than the non-university peer group. The article concludes with some suggestions for dealing with stressful aspects of professional education and some recommendations for further research.
Article
An overview is presented of important issues having to do with relationships between humor and biology, including those having to do with the genetic origin of the sense of humor, physiology of mirthful response to humor, impacts on health of humor physiology. Discussion is provided on theoretical implications derived from the complex relationship between humor and biology.
Article
To investigate the effectiveness of laughter as a stress reducer, 93 students were randomly assigned to one of three groups: laughter, control, and relaxation training. Each group met for 1.5 hours each week for six weeks. Measures of heart rate, blood pressure, mood, and anxiety were taken as indices of changes in stress level. While the laughter group did not experience significantly reduced stress, it did show consistent decreases in stress levels for the two psychological measurements as compared to the control group.