Stress Management 101 Book

University/ College: ________________________
Name: ________________________
ID#: ________________________
Stress Management 101 For College Students

Stress Management 101 For College Students
________________________________________________________________________
A Guide For Improving Health and Performance

_____________________________________________________________
Ivor Lensworth Livingston, Ph.D., M.P.H., C.H.E.S.
StressHealth Institute International

é Olney, Maryland, U.S.A. (Head Office) é Alpharetta, Georgia, U.S.A.
é St. Andrew, Jamaica, West Indies é Missassauga, Canada
é Ogun State, Nigeria
Acknowledgment
Most authors who write books have been influenced by various events and people over a period of time.
The writing of this book was no different! I especially want to thank my wife, Shaffiran (“Toy”) who contributed
both ideas and collegial support for the writing and completion of the book. As always, her help and support were
invaluable in moving the book from an idea to the published product. I also want to say thanks to my children,
Litonya Selima and Stefan Lensworth, both of whom rendered invaluable assistance, especially in the area of
contemporary life experiences that only college students can realistically articulate. Apart from the various
colleagues that offered insights and suggestions through various revisions of the book, I especially want to thank the
many college students who I have had the privilege of teaching over the last decade and a half. It is through these
interactive, student-teacher relationships that the idea to write this book was nourished, as well as the views and
directions that are reflected in the book. I am truly grateful to these past and present students, and it is my hope that
future generations of college students will benefit from the information provided in the book, which will preclude
them from experiencing, at the extreme, the potential ravages of uncontrolled stressful experiences.
In terms of the various graphic exhibits that are included throughout the book, I want to especially thank
Jeff Fox, a graphic artist, who provided many of the earlier illustrations that appeared in my two previous books on
stress. Many of the original illustrations that are in this book were taken from these earlier publications. However,
this updated, 6th printing of this book utilizes a variety of illustrations taken from Photos.com under contract. Most,
if not all of the illustrations that appear in the book are listed, along with the photography source, on the list of separate
illustration pages that follow. Additionally, the sources for photographs that appear on the cover of the book are
listed on the illustration pages.
_________________
Copyright © 2017 by Ivor Lensworth Livingston
All rights reserved. No portion of this book may be reproduced by any process or technique, without the express
written consent of the publisher.
Printed in the United States of America (6th Printing)
Library of Congress Control Number: 2004115166
IBSN 0-9631535-9-5
Disclaimer
The information contained in this book is true and complete to the best of the author’s knowledge. However, the
information cannot and should not be considered as absolute and universal suggestions/recommendations. This
information is provided without any guarantees on the part of the author and Publisher. Further, the author and the
Publisher disclaim all liability in connection with the use of this information. Although the information presented
will, at times, seem very much related to your personal needs and experiences, this book is not intended as a
substitute for consulting with your physician, especially around matters dealing with exercise, mental conditions,
nutrition and physical ailments and/or disease. As always, all matters regarding your health require qualified medical
advice and supervision.
StressHealth Solutions International

3570 Olney Laytonsville Road #381
Olney, Maryland 20830
__________ òòò_________
Phone: 301-570-6650
Toll Free: 1-800-WIL-COPE
Fax: 301-570-6672
stresszero@comcast.net
www.stresshealthsolutions.com; www.collegestudentstress.com
Dedication
This book is dedicated to all college st dents ho are currently pursuing their university education
with its associated rigors, challenges and, yes, stress, too. It is my hope that they will profoundly
benefit from the information presented in this book and they will become “active fighters” against
(negative) stress and not “sitting ducks” for a stress attack.
Table of Contents
Illustrations xvii
Preface xxix
Introduction xxxiii
PART I: Selected Background Information on College Students 1
1. Evolving Trends Associated With The College Population 3

College Enrollment Estimates 3
Enrollment By Sex of Student 4
The Relationship Between Education, Employment and Earnings 6
Postsecondary Persistence Three Years After Enrolling in College: Reported
Findings 7
Overall Conclusions of Longitudinal Study Presented 8
Reported Trends Involving Nontraditional Undergraduates 8
Graduate Student Enrollment 9
Minority Student Enrollment 10
Students With Disabilities 10
Degree Completion 11
Income of Graduates 11
Summary Outline of Key Headings in the Chapter 12
2. Health-Related Outcomes: What Students Should Know 13

First National Survey Measuring Health Risk Among College Students 13
Selected Health Concerns For College Students 14
Meningococcal Infection 14
Physical Inactivity, Overweight and Obesity 15
Implications For Overweight and Physical Inactivity 15
Physical Activity, Exercise and Physical Fitness 16
Health Benefits of Physical Activity and Physical Illness 16
Sexual Activity, STDs and HIV/AIDS 17
Risk Factors For HIV 17
Risky Behaviors Among College Students 18
Unplanned Pregnancies 18
Alcohol Use and Abuse 18
Illicit Drug Use/Abuse 19
General Population 19
College Age Population and Other Relevant Populations 20
Depression and Suicide 20
Anxiety Disorders 21
Generalized Anxiety Disorders 21
Obsessive-Compulsive Disorder (OCD) 21
Post-Traumatic Stress Disorder (PTSD) 22
Social Phobia (or Social Anxiety Disorder) 22
Panic Disorder 22
Panic Attacks 22
viii Table of Contents
Anxiety 22
Poor Eating and Dietary Habits 23
PART II: I = Identifying the Background, Nature and Causes of Stress 27
3. What Do We Know About Stress? 29

The Position Taken Concerning Stress 29
What is Understood About Stress 30
The Role of Perception 30
Stress as a Transaction 31
The E-P-R Process: The Importance of Perception 31
Factors Influencing Perception 32
Definition of Stress 33
Exercise 3.1 35
4. Stress and College Students: A Look At Selected Areas 37

The Yerkes-Dodson Law 37
A Harvard Experience 38
Overview of the Area Concerning Stress and College Students 38
Mental Health Issues 39
Domestic and International Students 40.
College Athletes 41
African American Students 42
Racism and Discrimination As Potential Stressors 42
Nontraditional Students 44
Graduate Students 45
What is the Profile of the Typical Student? 45
Results From a National Survey on Graduate Students 45
Other Work On Graduate Students 46
College Students’ Sexual Orientations 46
Sexual Orientation or Identity 47
The Importance and Process of “Coming Out” 48
The Benefits of “Coming Out” 48
Some Issues and Concerns Surrounding “Coming Out” 49
5. What Causes Stress? 51
Who and What Stress Affects? 51
The Causes of Stress 51
Stressors: Features and Classification 52
Features of Stressors 52
Classification of Stressors 53
The Role of Perception and Subjectivity in Determining Stressors 53
The Overlapping and Arbitrary Classification of Stressors 54
Table of Contents ix
6. Personality Stressors 59
The Central and Dominant Roles of Personality Stressors 59
Main Areas of Potential Personality Stressors 60
Personality Traits and Related Behaviors 60
Perceiving Others and Ourselves . 60
Stress-Related Behaviors 61
The “Stomping Bull” Behavior 61
The “Only I Can Do It All” Behavior 62
The “Always in a Hurry” Behavior 62
The Compulsive or “Forever Time Racing” Behavior 62
The “Aggressive Competitor” Behavior 62
Mind Traps 63
Personal Beliefs 63
Being a Perfectionist 63
Having Unrealistic Expectations 64
Not Being in Control 64
Keeping Things in Perspective 64
Having Negative Self-Talk 65
7. Private Life Stressors 67

Private Life Stressors Involve Both Internal and External Conditions 67
Main Areas of Potential Private Life Stressors 68
Home Events 68
Family Concerns 69
Financial Concerns 69
Adjusting to Life Change Events . 70
Pain, Injury and Illness 70
Measuring Life Changes 71
Hardy Personalities 71
Daily Hassles 72
Everyday Nuisances 72
At-Risk Lifestyle Activities 73
Stimulants 74
Drug Misuse 74
Marijuana 74
Club Drugs 75
Alcohol 75
Caffeine 76
Cigarette or Tobacco Smoking 76
Nutrition 76
Sleep 77
The Sleep-Nutrition Relationship 77
The Sleep-Stress Relationship 78
Exercise 78
x Table of Contents
8. Psychosocial Stressors 81
The Linking Nature of Psychosocial Stressors 81
The Master Status of College Students 82
Frustrations 83
Relationship Problems 83
Friends 83
Roommates 84
Loneliness and Adjustment 84
Acculturation 85
Immigrants and Acculturative Stress 87
9. Academic Stressors 89
Academic Stressors Falling Between Internal and External Conditions 89
Four Main Areas of Potential Academic Stressors 90
Personal Skills 91
Time Management 91
Procrastination 92
Distracting Feelings 92
Panic Attacks 92
Test Anxiety 93
Study Skills 94
Scheduled Classes 95
Remedial Courses 95
Services For Disabled Students 96
Some Disability Statistics 96
Scheduled Workload 96
Career Plans and Goals 97
Academic Majors 97
Career Majors 97
Where To Begin 98
10. Organizational Stressors 101

Organizational Stressors as External Conditions 101
Main Areas of Potential Organizational Stressors 101
Non-Academic Resources 102
Parking Facilities 103
Student Services Programs 103
Academic Resources 104
Academic Reinforcement 104
Health-Related Areas 104
Office of the College/School or Department 105
Central Administration Building 105
Table of Contents xi
11. Environmental Stressors 107
Environmental Stressors As External Conditions 107
Main Areas of Potential Environmental Stressors 108
Health Concerns 109
Meningitis 109
Hepatitis B 109
Living, Eating and Studying Space Concerns 110
Dormitories 110
The Cafeteria and Other Eating Spaces 110
Community Concerns 111
Violence, Alcohol Intoxication and Rape 112
National Statistics on Violence and College Students 112
Weather Concerns 113
Classroom Concerns 114
12. Correlates of College Students’ Stressors 115

Background Information On Preliminary Data 115
Relationships To Be Explored Now and in the Future 116
Descriptive Information on Demographic Variables 117
Descriptive Information on Academics 118
Descriptive Information on Social Psychological Variables 118
Descriptive Information on Health Variables 119
Descriptive Information on Stressors 119
Research Questions 120
Demographic Variables 120
What is the Relationship Between Demographic and Social
Psychological Variables? 120
What is the Relationship Between Demographic and Health Variables? 121
What is the Relationship Between the Demographic Variables and
the Six Stressors? 121
Academic Variables 121
What is the Relationship Between the Academic and Stressor
Variables? 121
Social Psychological Variables 122
What is the Relationship Between the Social Psychological and
Stressor Variables? 122
Health Variables 123
Depression and Health Protective Behaviors 123
Students’ Ratings of Current Stress Levels and Health 124
Summary Statement Concerning the Relationship Involving Stressors 125
PART III: R = Recognizing the Signs and Reactions to Stress 127
13. The First Stage of the Stress Process - Onset 129

Beginning the Stress Process 129
xii Table of Contents
Three Main Types of Stress 130

Good Stress 130
Normal Stress 131
Bad Stress 131
Various Types of Bad Stress 132
Acute Stress 133
Episodic Stress 133
Cataclysmic Stress 133
Chronic Stress 134
Post-Traumatic Stress 134
Critical Incident Stress 134
Interrelatedness of Bad Stresses 135
14. The Second Stage of the Stress Process - Reaction 137

The Non-Specific Response of Stress 137
The Fight-or-Flight Response 137
The Physiology of the Fight-or-Flight Response 138
The Endocrine System 139
The Autonomic Nervous System 140
Fight-or-Flight: The Case of Ancient and Modern Man 141
The General Adaptation Syndrome or GAS 143
Alarm Reaction 144
The Resistance Stage 144
The Exhaustion Stage 145
A Final Note on the Three Phases of the GAS 145
15. The Third Stage of the Stress Process - Outcome 147

Categorizing Stress Effects or Outcomes 147
Behavior Effects 148
Drinking of Alcohol 148
Excessive Coffee Drinking 148
Frequent Use of Cigarettes 148
Absenteeism 149
Insomnia 149
Eating Problems 149
Accident Proneness 150
Sexual Problems 150
Suicide 150
Cognitive Effects 151
Poor self-Concept 151
Perfectionism 151
Worrying 151
Emotional Effects 152
Burnout 152
Anxiety and Fear 152
Depression 153
Table of Contents xiii
Physical Effects 153
Backaches 153
Headaches 154
Allergies and Asthma 154
Arthritis 155
Diabetes 155
Ulcers 155
Hypertension, heart Disease and Stroke 156
Cancer 157
Other Physical-Related Outcomes 157
Exercise 15.1a 160
Exercise 15.1b 162
Exercise 15.1c 164
Exercise 15.1d 166
PART IV: M = Managing Stress Using a Combination of Strategies 169
16. The Dynamics of Stress Management 171

Stress Management is Really About Having Balance 171
The Importance of Change For Stress Management 171
Required Skills For Stress Management 173
Awareness Skills 173
Acceptance Skills 174
Coping Skills 174
Action Skills 174
The Importance of the I-R-M Approach to Stress Management 175
Step #1: I - Identifying Your Stressors 175
Exercise 16.1 175
Step #2: R - Recognizing Your Stress Signals 176
Exercise 16.2 176
Step #3: M - Managing Your Stress Using Selected Strategies 176
Strategies For managing Stress: Your Personal Plan of
Action (PPOA) 177
The Relationship Between Stress Management Strategies and
Stressors 178
The Inter-Relationship of the Stress Management Strategies 179
17. Cognitive Restructuring 183

What is Cognitive Restructuring 183
Reframing 184
The E-P-R Model of Stress 185
Restructuring Your Perceptions 184
The Knowledge-Perception Relationship and Stressors 185
Exercise 17.1: Evaluation Report 187
Exercise 17.2: Identifying Your Uncontrollable and Controllable Stressors 192
xiv Table of Contents
Assess Your Self-Perception 194

Clarify Your Goals and Related Activities 194
Set Realistic Goals 194
Sort Out Your Priorities 196
Accept What You Cannot Change and/or Control 196
Think “Could” Not “Should” 197
Refrain From Having Distorted and Negative Thinking 197
Engage in Positive Thinking and Expressions - Affirmations 198
18. Psychosocial Adjustments 201

Remember To Laugh a Bit 201
Talk Things Out and Share Your Stress 202
Lean on a Friendly Shoulder 202
You Don’t Have to be Right All the Time 202
Spend Needed Time With Family and Have Fun 203
Be a Participant in On-Going Activities 203
Learn to Say “NO” 204
Avoid Loneliness 204
Try To Improve Your Communication 205
Consider Getting a Pet 205
19. Lifestyle Adjustments 207

Know Your Body Clock and Biological Prime Time 207
Discover Your Tolerance Level For Stress 208
Strive To Have a Healthy Body 208
Have Sufficient Sleep 208
Have An Adequate Diet 209
The Food Pyramid With Its Five Designated Food Groups 210
Bread, Cereal, Rice and Pasta Group 210
Vegetable Food Group 210
Fruits and Fruit Juices Group 211.
Dairy Products Group 211
Meat and Meat Products Group 212
Tips For When You Are Eating 212
Tips on Nutrition To Lessen Stress 212
Becoming An Educated Shopper 213
Disagreements With the Food Pyramid 213
Pseudostressors 215
Get Appropriate Exercise 216
Main Types of Exercises 216
Aerobic Exercises 217
Aerobic Dancing 217
Specific Benefits of Aerobic Exercise 217
Swimming 218
Bicycling 218
Walking 218
Table of Contents xv
Jogging 218
Hiking 219
Jumping Rope 219
Anaerobic Exercises 219
Medical Caution 219
Avoid the Use of Alcohol and Drugs 220
20. Situational Adjustments 223

React Only When It Is Important - The Case of Road Rage 223
Suggested Tips To Avoid Road Rage 224
Change Your Pace When Events Overwhelm You 224
Try To Have Patience 224
Learn To Control Your Anger 225
Keep a Journal 225
Study Habits 226
Studying Time 226
Attitudes, Values, Behavior (Action) and Time Management 226
Attitudes 227
Values 227
Time Management 228
Problems 228
Setting Goals and Priorities 229
Test Taking 230
Test Anxiety 231
Panic Attacks 232
Dealing With Stress At Your Computer 231
Why Should You Seek Professional Help? 232
21. Relaxation Experiences 235

Misconceptions About Relaxation Involving Selected Activities 235
Leisure Time Is Not Always Relaxing 235
Sleeping is Not Always Relaxing 236
Television and Movie Shows are Not Always Relaxing 236
Watching a Sporting Show is Not Always Relaxing 236
Vacations are Not Always Relaxing 237
Heavy Drinking of Alcohol Does Not Help You to Relax 237
Cigarette Smoking Does Not Help You To Relax 238
Tranquilizing Drugs are Not Relaxing in the Long Run 238
Competitive Activities are Not Necessarily Relaxing 238
General Methods of Relaxation 239
Engaging in Non-Stressful Outdoor Activities 239
Getting Away From It All (GAFIA) 239
Be Creative in Boring Activities 239
Engaging in Non-Stressful Indoor Activities 240
The Power of Warm Water 240
Physical Activity: Stretching and Swimming 240
xvi Table of Contents
Reading in a Quiet Location 241

Systematic Methods of Relaxation 241
Deep Breathing 242
Meditation 242
Positive Imagery 243
Massage Therapy 243
Progressive Relaxation 245
Biofeedback 245
The Technique of ReZeroing 246
22. Where To Go From Here 249

Stress and College Students 249
Approaches To Stress Taken in the Book 250
The Stressor-Tiger Analogy 250
The Transactional Nature of Stress and the E + P = R Formulation 250
Specific Approaches To Control Stress in the College Student Population 252
Personal Plan of Action (PPOA) 252
Institutional Support and Related Recommendations 253
N Note Sheets 254

Appendix 257
9 Exercises 257
O 16.1 - Stress Diary 258
O 16.2 - Listing, Concerns and Responses to Systems of Stress 261
O Life Planning Guide 262
O Word Find For College Students 267
9 Livingston’s Stress Pledge For a Better Health 268
9 The Impact of Colors on the Mind 269
9 101 Stress Management Tips For College Students 270
9 Potential Stress Periods and Stressors For College Students During a
Typical Academic Year 271
9 College Student Stress Index (CSSI) 273
9 Some Additional Resources For College Students 275
9 N Additional Note Sheets 278
9 References 281
9 Index 300
Preface
ë
“Worry is a thin stream of fear trickling through the mind. If encouraged, it cuts a
channel into which all other thoughts are drained.”
- Arthur Somers Roche
___
As indicated by the title of the book, the emphasis is on the stress college students experience and
the impact this stress has on their health and performance. The main reason for writing this book is
twofold: (1) to report on the stress-health-performance relationship, especially among college students
and (2) to present in an easy-to-understand manner information about stress and ways to successfully
manage it in college, as well as beyond the college years. With this view in mind, the book is organized
into four main sequential Parts:
I. Selected Background Information on College Students;

II I = Identifying the Background, Nature and Causes of Stress;
III. R = Recognizing the Signs and Reactions To Stress; and
IV. M = Managing Stress Using a Combination of Strategies.
The book is unique in several ways. Apart from its segmentation into the four parts mentioned
above, another strong and unique feature is the systematic inclusion of specially drawn illustrations to
complement adjacent information presented in the text. Readers are also provided with Exercises at key
sections of the text. After reading this book, college students, as well as other related individuals, should
have a firm grasp of the following:
K A realization of why stress is a part of contemporary life in general and college life in
particular;
K Why stress is more appropriately viewed conceptually in transactional terms;
K The importance of seeing stress as a subjective and personal phenomenon;
K The practical significance of better understanding stress and stress management in terms
of the 3-Step I-R-M Approach;
K The need to have a Personal Plan of Action (or PPOA), which encompasses the 3-Step
Approach;
K Based on the I-R-M Approach, and more specifically within college students’
experiences, be able to:
9 Identify the background, nature and causes of stress;

9 Recognize personal signs and reactions to stressful experiences; and
9 Manage stress using one or a combination of proven strategies.
Thus, students do not have to be “sitting” ducks for a stress attack; instead, they can become “active”
fighters if the tenets discussed in the I-R-M Approach are firmly understood and applied on a consistent
daily basis.
Our present-day society has been labeled as pressurized, hectic, anxiety-arousing, and unrelenting
in its demands on us. Such realizations have led to the suggestion that we are living in a "stress age,"
which can be destructive to our health. Given this reality, it is incumbent on us to know more about stress
xxix
xxx Preface
so that we can manage it effectively.

As we look around us daily, we see and hear evidence of this age of nervous tension or stress.
Observing the behaviors of fellow citizens on buses (Exhibit P1), at work and on the streets, in addition to
hearing reports on crime, economic hardships and health-related problems, help to emphasize the stress-
oriented nature of our present-day society.
A very important point must be made, however, that for
every person who is managing life's stressful experiences
effectively, there are millions who, for whatever the reasons, seem
unable to cope satisfactorily with their day-to-day stressful life
experiences. To a large extent, this latter group constitutes the "pill
poppers;" chronic alcohol and substance abusers; individuals with
touchy tempers; chronic insomniacs and individuals with a variety
of psychosomatic ailments. It is primarily for these college students
(and related others) that this book is written.
To live is to experience stress. Life without stress means
death. Therefore, it is more practical if we direct our efforts not at
trying to eliminate stress, but, instead, at learning how to live with
it, i.e., keeping stress manageable or under control. Managing stress
Exhibit P.1: Overcrowding on the train as a
potential source of stress
more effectively can mean using it as an ally or a friend (i.e.,
positive stress or "eustress") in your day-to-day activities. It also
means that you can control the potentially destructive side of stress or the "enemy" (i.e., negative stress or
distress).
For practical reasons, it is almost impossible for us to control our "outer" environment, the latter
of which contains potential sources of stress (or stressors) for us. Therefore, stress management should, of
necessity, involve learning to take control of our lives by regulating our perceptions and subsequent
reactions to potentially stressful events or conditions in the environment. It must be emphasized that
although this book is about the stress college students experience and the ways they can successfully
manage stress in order to improve their health and productivity, their experiences cannot, and should not,
be separated from the wider society in which they live. Many of the stressors college students are likely
to experience are a result of how they were socialized to believe and perceive their environments.
Additionally, although college life has its own unique set of potential stressors, many of the stressors
college students experience are similar to those of the rest of society, simply because they, too, are part of
our modern-day, fast-paced, society.
The potentially stressful nature of our society can
largely be explained by the rapid evolution of technological
advances that are associated with modern-day living. It is
reasoned that these advances, among other things, are
potentially stressful based on the impact they have on our
bodies, in general, and on our mental, nervous and
cardiovascular systems, in particular.
Outgrowths of our modern-day society, which may
be either potentially stress-producing , involve our health-
destructive lifestyles. It has been suggested that as modern-
day people, we live, eat, sleep and relax (i.e., when we do)
Exhibit P2: Our fast-paced, modern-day society
at a "fast" pace, and such behaviors (Exhibit P2), which are
a direct result of our twentieth-century "machine-oriented" society, are potentially destructive for our
health and well-being. Yet, not everyone who experiences these and other potentially stress-producing
phenomena will, necessarily, experience (negative) stress and, subsequently, its related dysfunctions.
Preface xxxi
It is important to note that stress does not just happen anymore than a candle simply ignites itself.
A series of events occur on an individual level, beginning with a trigger or a stressor, which in turn may
or may not lead, over time, to a standard bodily reaction of stress. With these points in mind, it should be
emphasized that the environment around us does not cause stress; instead, stress, for the most part, results
from 1) how we perceive (internal) conditions associated with our personal needs and 2) how we
perceive conditions and events in our external environments.
It is reasoned that with an improved understanding of the stress process, college students will
become more conscious of the importance of their perceptions and reactions to potential day-to-day
stress-related conditions, or stressors. This knowledge of the stress process will, in turn, allow for better
and more effective management of stress. Why is this so? The simple answer is that students, then, can
take greater control of their lives and do things that are necessary for them either to avoid (negative)
stress or use (positive) stress to their advantage. It also can be said that when students take control of their
lives, they are motivated not only to have a better understanding of stress and its management, but to be
continuously motivated to practice what they have learned.
In summary, this book, which is appropriately labeled “Stress Management 101 For College
Students: A Guide For Improving Health and Performance,” will provide the needed information and
knowledge that will keep college students’ stress within defined, tolerable and manageable levels. When
stress is controlled, students will experience far more positive experiences regarding the quality and
quantity of their lives, which in turn will improve their overall health and performance, both within the
college environment and beyond.
Introduction
ë
“It is unwise to be too sure of one’s own wisdom. It is healthy to
be reminded that the strongest might weaken and the wisest might err.”
- Mahatma Gandhi
A
decade or so ago, stress was just another word in the dictionary and, at best, it was negatively
used only in the context of a few people (e.g., corporate executives) and conditions (e.g.,
ulcers, strokes, heart attacks). Today, however, stress is mentioned in the context of all types
of conditions and people. In recent years stress is increasingly being mentioned in the context of
college students. Basically, stress can be viewed “As the psychological (mind) and physiological
(body) wear and tear, or reaction, to perceived conditions (or stressors) in and around us
(Livingston, 2010). Perceived obstacles to goal achievement, environmental change, life challenges
and periods of significant transition are common stress triggers for college students (Hall, 2003). All
of us experience stress on a regular basis. Most of this stress is actually positive (good stress or
eustress) serving to motivate us. However, like most things in excess, too much stress can be negative
(i.e., distress).
Are We Experiencing a Stress Epidemic?
Our modern-day society has been labeled as part of the "stress age." Past topics on stress have
been seen on the front pages of several leading magazine publications. For example, Time
Magazine’s June 6, 1983 cover story (Exhibit I.1) asked the question “Stress:
Can We Cope?” Newsweek Magazine’s issue of June 14, 1999 (Exhibit I.2)
focused on “How Stress Attacks Your Body,” and “Fighting Back: What You
can Do.” In the April 2000 issue of the magazine Health, the question was asked
“Is Stress Making You Depressed?”
These and other reports underscore the fact that we are indeed
experiencing a stress epidemic of huge proportions. According to the American
Academy of Family physicians, two-thirds of office visits to
family doctors result from stress-related conditions. Stress is Exhibit I.1: Time
known to be either directly or indirectly implicated in the magazine article on
incidence of heart disease, cancer, lung ailments, cirrhosis of stress
the liver, suicide and accidental injuries, which are six of the leading causes of
death in the United States (Grunwald, 1983; Adler, 1999; Livingston, 2004).
Although some of the drug names may have changed, a statement made two
decades ago related to why certain drugs were taken still applies today: “It is a
Exhibit I.2: News- sorry sign of the times that the three best selling drugs in the country are an ulcer
week article on stress medication (Tagamet), a hypertension drug (Inderal) and a tranquilizer
(Valium)” (Grunwald, 1983, p. 48).
The Importance of Stress Management For College Students
Although more will be said about stress and college students later in the book, a brief
mention is made here concerning the implications of the stress epidemic for college students in
xxxiii
xxxiv Introduction
particular. Although there are no major magazines that have run front page articles on stress and
college students, a variety of books and articles have either directly or indirectly addressed the
subject. Examples of books include the following: “Keys to Success in College, Career and Life” by
Carol Carter, Joyce Bishop and Sarah Kravits (2003). In the case of journal articles, some examples
include the following: “College Student’s Academic Stress and its Relation to Their Anxiety, Time
Management and Leisure Satisfaction” (Misra & McKean, 2000); “Stress at College: Effects on
Health Habits, Health Status and Self-Esteem “ (Hudd, 2000); “Heavy Drinking From the Freshman
Year into Early Young Adulthood: The Roles of Stress, Tension-Reduction Drinking, Motives, Gender
and Personality” (Rutledge & Sher, 2001).
The sad truth is that people in general, and college students in particular, are not fully aware
of this stress epidemic and, are therefore, not doing anything to protect themselves. In short, many
people are either heading for the “stress trap,” not aware that they are already in the stress trap, and
others, for a variety of reasons, are in denial that they are in the stress trap. It is equally saddening
that a great variety of individuals, including college students who are experiencing stress, do not have
the potential to control their stress. Additionally, an even frightening number of individuals do not
even know that they have or can learn of this potential with the appropriate health
education knowledge and related information (Livingston, 2006).
It is hoped that after reading this book, college
students will be more informed about stress and its possible
consequences and, therefore, apply one or a combination of
the techniques discussed to manage their stress more
effectively. It is reasoned in this book that to more effectively
manage stress it is beneficial to symbolize stressors. This
being the case, a brief overview is presented on the tiger,
which is used throughout this book as a symbol of a stressor
that should, especially in times of “negative” stress (or Exhibit I.3: Tiger
distress), be avoided. The aim is to ultimately “tame” (see successfully tamed
Exhibit I.4: Fierce Exhibit I.3) this fierce animal (see Exhibit I.4), or stressor,
tiger as stressor
when students have the needed resources (i.e., stress management skills).
symbol
The Symbolic Importance of the Tiger as a Potential Stressor
The tiger is known as one of the most fearsome animals in the wild, and if we are caught in
its large “claws” and/or “teeth” we would certainly die. Although we will experience many more
stressors that are far less potentially threatening than what the tiger symbolically represents, it is used
to represent “like stressors,” perhaps at the extreme, that we should be aware of and attempt to
control before they control and/or harm us.
In ancient times, the “saber-tooted” tiger was actually a very real threat to our cave-dwelling
forefathers who basically had two choices - fighting or fleeing. However, in today’s fast-paced, and
substantially-changed societies, it has been replaced with a variety of potentially stressful conditions.
These potential stressors that have replaced the ‘real” tiger in earlier times range from the mild (e.g.,
disagreements with classmates, roommates) through the moderate (e.g., traffic congestion, traffic
tickets; failing grades in classes), to the very severe (e.g., violence at the workplace, classroom,
and/or in the neighborhood).
Contrary to this portrayal, the tiger when viewed in a less aggressive manner, is also used in
the book as a symbol of calmness and relaxation. In Part IV of the book that deals with stress
Introduction xxxv
management, the picture of the tiger that appears depicts it as potentially non-threatening, i.e., it is
lying down and, therefore, is amenable to be approached (see Exhibit I.3). Portrayed in this light, it
no longer poses a threat. At this point, the symbolism is that just as how the once fierce tiger was a
potential stressor, it is no longer a threat, simply because the “stressor” has been managed or
controlled. This is the point that everyone, including college students, must strive to attain, simply
because when there is no appreciable stress being experienced, health and performance improve.
A Brief History About the Tiger and Its Symbolic Relevance in the Book
Historically, and as mentioned before, the tiger, especially the saber-tooth tiger, has played a
very important role in explaining how our cave-dwelling ancestors, the cave men, either fought or
fled (i.e., the “fight-or-flight” reaction, which is discussed in a later chapter) from existing threats.
Briefly, tigers, whose Latin name is Panthera tigris, are the biggest cats in the world, and they live in
steamy hot jungles and icy cold forests of selected countries of the world (e.g., China, India,
Cambodia). Although today’s tigers are an endangered species, with only approximately 5,000-7,000
tigers left in the wild, they are known for their speed, hunting skills and ferociousness. The two main
types are the popular Siberian and Bengal tigers which are found in Siberia and India, respectively.
Tigers are referred to as the largest cats because fully grown adults have weights that are in excess of
500 pounds.
Again, based on its unique characteristics the tiger is used in this book, both as a symbol of a
stressor (i.e., when it is ferocious - see Exhibit I.4), and as a symbol that it (i.e., stressors) can be
controlled (see Exhibit I.3). In many ways, the ferocious nature of the tiger, especially when hunting
and/or stalking other animals (see Exhibit I.5), is very synonymous with
the extreme stressors modern-man faces. In another respect, the lurking
behavior of the tiger, again seen in its hunting behavior, and the
persistence it demonstrates in getting its prey, is very synonymous with the
variety of chronic stressors and stresses modern-man (including college
students) faces. Additionally, and in a related manner, the speed of the
tiger is very synonymous with the acute (i.e., the swift-like nature) variety
of stressors and stresses modern-man experiences.
Exhibit I.5: The persistent
Our Modern-Day Society and Its Stressors stalking nature of tigers
Stress has the potential to manifest itself in various forms and life experiences for college
students, including the following experiences taking an examination; problems with professors, and
financial concerns. Many people feel that stress is caused only by anxiety, frustration and conflict. In
fact, any change that is either anticipated or experienced can cause stress, as is evidenced in body
changes. Some of these changes include: elevated blood pressure, tense muscles, accelerated
breathing and sweating.
Although the position taken by many stress researchers is that not all stress is bad (i.e.,
eustress), of primary interest to the position taken in this book is the negative or deadly type of stress
commonly called distress. Distress can sap your energy, contribute to wasted time and, at more
serious and chronic levels, can cause headaches, backaches, cold and clammy hands, muscle tension,
knotty stomachs, and loss of memory. At a more heightened extreme, human life can be threatened
and if the stress is not abated, stress can even be responsible for permanent physical injury. Death
can occur through several illness/disease-related conditions, for example, heart attacks, strokes, and
cancer. While no one enjoys living with this form of negative stress, many people do not know how
to manage stress effectively by taking control of their lives.
xxxvi Introduction
As mentioned before, stress is not caused by the environment outside ourselves; instead,
stress is a direct result of our reactions to the environment. Therefore, it is reasoned in this book, that
once you get a basic understanding of the stress process, you can, in turn, come to tolerate and
manage stress more effectively. In short, this means taking greater control of your life by better
managing the stressors or tigers that contribute to the stress traps you have experienced, are
experiencing, and are likely to experience in the future.
Stress is inherent in our lives from the day we are born to the day we die. As stress is an
integral part of our lives, from which there is no total escape, complete freedom from stress means
death. The potential to experience stress surrounds us each day no matter who we are and under
which conditions we might find ourselves.
For EXAMPLE: Whether you have just passed an examination or lost a friend due to an
accident; whether you have just heard news relating to entry into graduate school or news
of some past tragedy; whether you have been promoted recently or fired from your job,
because of the subjective nature of stress these conditions are potentially stressful for you.
Although potential sources of stress are many and vary a great deal, the physical evidence or
body reactions to these stressors are the same for everyone. With this latter point in mind, according
to Hans Selye, who is the refuted “father of stress,” stress has been viewed in the past as "... the non-
specific response of our bodies to any demands placed on them" [Selye, 1956].
Not All Stress Is Bad

Based on how stress is normally viewed, the conventional wisdom, shared by medical and
laymen alike, is to avoid stress. That is, take it easy, don't work too hard and, as a result, you are apt
to live longer and enjoy a better life. Recent evidence, however, contradicts this "gloomy" picture of
stress as the "all-present and powerful evil."
Selye (1956) suggests that: "Freedom from stress is death!" He says, "Don't try to avoid stress
- it is the very salt and spice of life ... but do learn to master and use it!" Stress can be either good
(eustress) or bad (distress) for you. Good stress can literally get you going and, in cases such as
athletic and dance performances, it can enhance your performance. Bad stress, moreso distress of a
chronic nature, can be destructive and potentially deadly for you. Distress can result in somewhat
minor irritations, for example, recurring headaches, muscle tension, upset stomachs, and
forgetfulness.
Chronic unrelentless stress takes the fun out of life and it is unbearable to live with. When
this point is reached, many people will need help in managing stress more effectively, by being in
better control of their lives. Students need to have a fundamental understanding about stress and the
process that is involved, both of which are necessary prerequisites for them to learn how to manage
their stress effectively. This being the case, this book is written with the express purpose of
introducing college students to a step-by-step understanding of stress, thereby allowing them to better
manage potential stress traps, or tigers, in their lives. Contrary to several other books already written
on the subject, this book is based on the premise that a basic understanding of stress is necessary
before any attempt is made to manage it more effectively. Besides this very important difference,
other features include: a) the feature of using carefully positioned illustrations to enhance
understanding of the material discussed; b) analogies are used to simplify understanding of particular
points; c) empirical information from past studies involving stress and college students is presented
and discussed; and d) various Exercises are included immediately after chapters, as well as in the
Introduction xxxvii
Appendix, providing opportunities for students to be engaged in the subject matter being discussed.
Understanding As a Prerequisite To Controlling Stress
Stress affects everyone, yet many people lack a basic understanding of it

and, therefore, are unable to control and/or manage it effectively. Stress comes at
us from all sides and affects us in different ways. In order to survive, however,
we have to learn to deal with stress, eliminating it where possible and desirable;
in other cases, coping with it (e.g., by taking vacations, employing visualization
or imagining strategies - see Exhibit 1.6) as best we can and even, on occasion,
using it in a positive way. Virtually everything in life is potentially stressful to
someone. However, whether you allow a situation to affect you adversely
depends largely on your personal appraisal of it.
Controlling or managing stress for many people, however, is easier said
than done. The overwhelming nature of our daily activities, and the fast pace at Exhibit 1.6: Unique
which these activities are carried out, make people unaware as to which of their relaxing experiences
daily activities (i.e., real or anticipated) are potentially stressful for them. Further, many people are
unaware of when and how their bodies react to stress; hence they are not proactive, but more reactive,
in attempting to control stress. That is, in the former, they are not working to prevent or reduce the
occurrence of stress; instead, as in the case of the latter, they simply respond to stress as best they can
whenever it occurs.
The nature of our present-day society plays an important role in the kinds of stresses we
experience and how successful we are in managing stress. Many believe
that the fast pace at which our modern-day society runs inhibits many
people from "slowing" down, i.e., doing their daily activities at a slower
pace. Some have even gone so far as labeling our modern-day society as
a society of "rushers" (see Exhibit 1.7), for example, we rush to eat,
work, play and, yes, even to sleep. Therefore, because of our fast-paced
lifestyle, very few people take the necessary time to appreciate the
natural beauty of things around them. Likewise, few people take well-
earned vacations that, in many cases, would allow them to relax and,
therefore, help them to manage their stress.
As our modern-day society places undue pressures or stressors
Exhibit 1.7: The rushing nature
of modern-day society
on us daily, many of us are unaware of:
K This potential reality;

K What are these stressors;
K The effect these stressors can have on us;
K How to recognize the stress of our internal bodily reactions to these stressors; and
K How to cope with or manage this stress.
In short, we lack important knowledge about stress, which, in turn, would allow us to manage stress
more effectively. This point is very true for college students who are the target group of the book.
Stress management is basically a learning process about stress, as well as about ourselves.
This being the case, you have to learn how to discover if you actually are stressed and, if so, what
effect, if any, stress is having on you. This latter issue is very important given our individual
tolerance levels for stress, as well as the various types of stresses (e.g., good versus bad, chronic
xxxviii Stress Management 101 For College Students
versus acute/episodic) that we are likely to experience. Managing stress is more than just coping; it is
learning to cope adaptively and effectively. It is very important to know what not to do as what to try.
For example, for many people their first response to stress is to light a cigarette or reach for a drink.
However, these actions are ineffective ways of coping, which, in the long run, do nothing to solve the
root cause(s) of stress. As a matter of fact, in many cases these ineffective coping behaviors or
strategies only add to further problems. Therefore, because of the importance of these ineffective
coping behaviors or strategies, any comprehensive stress management approach should include
information on important misconceptions associated with stress. Examples of such misconceptions
are presented in the course.
Preventive Maintenance: Similarities Between a Car and The Human Body
In emphasizing the "preventive" value of stress management, which is implied throughout the
book, an important analogy must be made at this point. It is recognized that there is an important
relationship between a car and our bodies. Specifically, there is
agreement concerning the similarity in how they are
constructed, how they function and, very importantly, how they
should be managed to get effective performance and longevity.
A Car
For a car (see Exhibit 1.8), it is not necessary to wait
until it breaks down on the road before you have it serviced or
repaired. In fact, if we understand the "basics" about cars, we
can see certain signs of a problem approaching and, therefore,
take the car in to be serviced before the problem either
develops, or gets worse and gets more expensive to be repaired.
Also, having a basic understanding about cars allows for Exhibit I.8: Do preventive maintenance on
anticipating future car-related problems. In a related manner, your car
this knowledge allows us to see the cost effectiveness of using "preventive
maintenance" strategies to offset these car-related problems.
The Human Body

For stress and the human body, the same policy of acting on "signs"
and using "preventive maintenance" strategies (see Exhibit 1.9), as is true
of a car, should be adopted to manage stress more effectively. As with cars,
understanding what is involved, i.e., in the stress process, plays a very
important role in changing from, avoiding or dealing with stress more
effectively. Therefore, in discussing the ABCs of stress management, this
book provides answers to the following very important questions:
Exhibit I.9: Do preventive
main-tenance on your body K What do we mean by stress?
K Why do we need ("good") stress sometimes?
K What damage can ("bad") stress do to us?
K What are some typical signs and symptoms that are likely to be seen when someone
is experiencing stress?
K What do we know about the "bodily" mechanisms involved in the stress process?
Introduction xxxix
K How can we avoid the dangers of potentially stressful daily situations or tigers? Or,
more importantly, how can we manage stress more effectively?
If you are unable to prevent stress-related experiences from occurring, this does not
necessarily mean that you are automatically doomed for despair, because all is not lost. By having a
basic understanding of what is involved in the stress process and, therefore, knowing how you, as an
individual, react to stress, i.e., knowing its tell-tale signs and symptoms, you can then select one of
several stress management strategies that are always available to you, wherever you are. Several of
these strategies are discussed in the book and, once you have selected the method most appropriate to
your needs, you will be in a better position to reduce or tolerate the stress you are experiencing.
Therefore, after reading this book, you will be armed with a variety of valuable information that will
allow you to accomplish the following:
K Understand stress and its related processes;

K Identify if, and when, you are experiencing intolerable amounts of stress;
K Select and use an appropriate stress management strategy that suits your particular
needs, resources and environment; and
K You will no longer be a helpless "victim" of stress; instead, you will be an active
"fighter" of stress.
Major Points of The Book
Following this brief introductory overview, the major points to be emphasized in this book
include the following:
K Stress is a process that has a series of events involving three interrelated stages:
onset, reaction and effect.
K As stress is mainly subjective, it primarily exists in the eyes of the beholder;
therefore, it varies from one individual to the other.
K Stress is defined as your perceived inability to cope with demands (i.e., stressors)
placed on you from your environment when these demands exceed your perceived
response capabilities.
K Stressors trigger the stress process and stress is your internal reaction to stressors.
K Stress is both controllable and tolerable and, in some forms, it can be constructively
used as an ally or friend in your daily activities.
K Understanding the stress process is vitally necessary for you ultimately to achieve
effective stress management.
K You have to become motivated and remain motivated in order to "reap" the benefits
(i.e.,improved quality and quantity of life) that are associated with effective stress
management.
K Lastly, you have to work out your personal plan of action (or PPOA) in order for you
to be successful in adjusting to or managing potential sources of stress in your life.
Following what has been said, and as a point of reiteration, the main purpose of this book is
to allow college students to take control of their lives and manage stress more effectively. This can
only be gotten through first understanding the entire stress process. This knowledge will allow
xl Stress Management 101 For College Students
college students to develop important individual stress management techniques within a defined "plan
of action." To help this very important purpose, then, the major points mentioned before must be very
clearly understood by them. Therefore, to enhance clarity and understanding about stress and how to
manage it more effectively, this book is divided into the following sequential Parts:
Part I: Selected Background Information On College

Students
Part II: Identifying the Background, Nature and Causes of

Stress
Part III: Recognizing the Signs and Reactions to Stress
Part IV: Managing Stress Using a Combination of

Strategies
Part I
Selected Background Information on College Students
This part of the book deals with selected

background information on college students. In 1. Evolving Trends Associated With
Chapter 1, information is presented on various the College Population
trends associated with post-secondary Health-Related Outcomes: What
education (e.g., enrollment numbers, degree 2.
completion). In Chapter 2, various health and Students Should Know
related conditions (e.g., physical inactivity,
depression) are discussed that students need to
be aware of and address if they are to be healthy
and successful in college.
1
1.
Evolving Trends Associated With the College Population
<
“Knowing is not enough, we must apply. Willing is not enough, we must do.”
- Johann von Goethe
T
he college experience is very important in a number of ways. However, the overriding importance
that is usually attributable to going to college is to acquire an education that will prepare students
for the job market. It is also expected that being successful at the job and career of one’s choice
will, in turn, provide a standard of living that is both expected and desirous. The unfortunate truth
is that college life, while potentially positive, can be potentially negative as well. Although this latter
point is related to several factors, it can be argued that the experiences in college are significant contributors.
As the title of the book indicates, stress is
emphasized as a major experiential condition during the
college years, which, in turn, has the potential to have a
negative impact on college students’ health and
performance. However, before a discussion is presented
on the role of stress in college students’ lives, as well as
the potential contributing role it plays in their overall
health and performance, some selective background
information needs to be presented about demographic
factors associated with college students. It is reasoned that
this information will allow the reader to better understand
the context and the importance of the college experience.
In order to place college students’ stressful
experiences into context, a brief overview is presented on
the following selected areas: a) College Enrollment Exhibit 1.1: The college experience
Estimates; b) Post-secondary Enrollment By Selected
Characteristics of Students; c) The Relationship Between
Education, Employment and Earnings; d) Post-secondary Persistence Three Years After Enrolling in
College: Reported Findings; e) Reported Trends Involving Nontraditional Undergraduates; f) Graduate
Student Enrollment; g) Minority Student Enrollment; h) Students with Disabilities; i) Degree
Completion; and i) Income of Graduates.
College Enrollment Estimates
Based on information from the National Center for Education Statistics ( CE , 2016),
it was reported that the overall enrollment in degree-granting institutions is expected to rise between
2000 and 2026. Changes in age-specific enrollment rates and college-age populations will affect
enrollment levels over the next 12 years. Most importantly, is the projected rise of college enrollment is the
projected increase of 15 percent in the traditional college-age population of 18- to 24-year-olds from 2000
to 2012 (NCES, 2007). The 25- to 29-year-old population is projected to decrease by 2 percent between 2000
and 2002, and then increase by 15 percent between 2002 and 2012, for a net increase of 13 percent. The 30
to 34-year-old population is expected to decrease by 7 percent between 2000 and 2007 and then increase
10 percent by 2012. The 35- to 44-year-old population is expected to decrease by 13 percent between 2000
and 2012. The increases in the younger population are expected to more than offset the loss of students from
the older populations, thereby contributing to the increases in college enrollment over the projection period.
3
4 PART I % Selected Background Information on College Students
.
It was reported (Gerald & Hussar, 2002) that, for the nation, college enrollment increased from
13.8 million in 1990 to 14.5 million in 1992. Then it decreased to 14.3 million in 1995. Thereafter, it
increased to 15.3 million in 2000. Under the middle alternative, college enrollment is projected to rise to
17.7 million by 2012, an increase of 15 percent from 2000. Under the low alternative, college enrollment
is projected to increase from 15.3 million in 2000 to 17.1 million by 2012, an increase of 12 percent over
the projection period. Under the high alternative, college enrollment is expected to increase from 15.3
million in 2000 to 18.2 million by 2012, an increase of 19 percent over the projection period.
Post-secondary Enrollment By Selected Characteristics of Students
Enrollment in degree-granting post-secondary institutions increased by 9 percent between 1989

and 1999. Between 1999 and 2009, enrollment increased 38 percent, from 14.8 million to 20.4 million.
Much of the growth between 1999 and 2009 was in full-time enrollment; the number of full-time students
rose 45 percent, while the number of part-time students rose 28 percent. During the same time period, the
number of enrolled females rose 40 percent, while the number of enrolled males rose 35 percent.
Enrollment increases can be affected by both population growth and rising rates of enrollment. Between
1999 and 2009, the number of 18- to 24-year-olds increased from 26.7 million to 30.4 million, an increase
of 14 percent, and the percentage of 18- to 24-year-olds enrolled in college rose from 36 percent in 1999 to
41 percent in 2009. In addition to enrollment in accredited 2-year colleges, 4-year colleges, and
universities, about 472,000 students attended non-degree-granting, Title IV1 eligible post-secondary
institutions in fall 2008.
In recent years, the percentage increase in the number of students age 25 and over has been larger
than the percentage increase in the number of younger students, and this pattern is expected to continue.
Between 2000 and 2009, the enrollment of students under age 25 increased by 27 percent. Enrollment of
students 25 and over rose 43 percent during the same period. From 2010 to 2019, NCES projects a 9
percent rise in enrollments of students under 25, and a 23 percent rise in enrollments of students 25 and
over.
Enrollment trends have differed at the undergraduate and post-baccalaureate levels (which include
graduate and first-professional programs). Undergraduate enrollment generally increased during the 1970s,
but dipped from 10.8 million to 10.6 million between 1983 and 1985. From 1985 to 1992, undergraduate
enrollment increased each year, rising 18 percent before stabilizing between 1992 and 1998.
Undergraduate enrollment rose 39 percent between 1999 and 2009. Post-baccalaureate enrollment had
been steady at about 1.6 million in the late 1970s and early 1980s, but rose about 73 percent between 1985
and 2009.
Since 1988, the number of females in post-baccalaureate programs has exceeded the number of
males. Between 1999 and 2009, the number of male full-time post-baccalaureate students increased by 36
percent, compared with a 63 percent increase in the number of females. Among part-time post-
baccalaureate students, the number of males increased by 14 percent and the number of females increased
by 26 percent. See increases in female versus male students from 1970 to 2009 (Table 1).
__________________
1
Title IV programs, which are administered by the U.S. Department of Education, provide financial aid to
post-secondary students.
Chapter 1 . Evolving Trends Associated With the College Population 5
The percentage of college students who are Hispanic, Asian/Pacific Islander, and Black has been
increasing. From 1976 to 2009, the percentage of Hispanic students rose from 3 percent to 12 percent, the
percentage of Asian/Pacific Islander students rose from 2 percent to 7 percent, and the percentage of Black
students rose from 9 percent to 14 percent. During the same period, the percentage of White students fell
from 83 percent to 62 percent. Nonresident aliens, for whom race/ethnicity is not reported, made up 3
percent of the total enrollment in 2009. (See Tables 1.1and 1.2 below).
Tables 1.1: Total Fall Enrollment in Degree-Granting Institutions, By Sex and Attendance Status: Selected years, 1970
through 2009 [In thousands]
Institutions of higher Degree-granting institutions

education
Sex and attendance
status 1970 1980 1990 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Total 8,581 12,097 13,819 15,312 15,928 16,612 16,911 17,272 17,487 17,759 18,248 19,103 20,428
Sex
Male 5,044 5,874 6,284 6,722 6,961 7,202 7,260 7,387 7,456 7,575 7,816 8,189 8,770
Female 3,537 6,223 7,535 8,591 8,967 9,410 9,651 9,885 10,032 10,184 10,432 10,914 11,658
Attendance status
Full-time 5,816 7,098 7,8291,010 9,448 9,946 10,326 10,610 10,797 10,957 11,270 11,748 12,723
Part-time 2,765 4,999 5,998 6,303 6,480 6,665 6,585 6,662 6,690 6,802 6,978 7,355 7,705
SOURCE: U.S. Department of Education, National Center for Education Statistics. (2011). Digest of Education Statistics, 2010
(NCES 2011-015
Table 1.2: Percentage Distribution of Students in Degree-Granting Institutions, By Race/Ethnicity: Selected Years, Fall 1976 Through
Fall 2009.
Institutions of higher Degree-granting institutions
education
Race/ethnicity 1976 1980 1990 2000 2003 2004 2005 2006 2007 2008 2009
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
White 82.6 81.4 77.6 68.3 66.7 66.1 65.7 65.2 64.4 63.3 62.3
Total, selected races/ethnicities 15.4 16.1 19.6 28.2 29.8 30.4 30.9 31.5 32.2 33.3 34.3
Black 9.4 9.2 9.0 11.3 12.2 12.5 12.7 12.8 13.1 13.5 14.3
Hispanic 3.5 3.9 5.7 9.5 10.1 10.5 10.8 11.1 11.4 11.9 12.5
Asian/Pacific Islander 1.8 2.4 4.1 6.4 6.4 6.4 6.5 6.6 6.7 6.8 6.5
American Indian/Alaska Native 0.7 0.7 0.7 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0
Nonresident alien 2.0 2.5 2.8 3.5 3.5 3.4 3.3 3.4 3.4 3.5 3.4
SOURCE: U.S. Department of Education, National Center for Education Statistics. (2011). Digest of Education Statistics, 2010 (NCES 2011-015),
.
The Relationship Between Education, Employment and Earnings
The education obtained in college prepares college students for the wider world in general and
the employment world in particular after college is completed. By infusing students with a range of
knowledge that covers latent belief and value systems, as well as the more manifest outcomes involving
needed knowledge, they are in a better position to seek and successfully obtain the necessary
employment opportunities (see Figure 1.1). Based on the past experiences of students, these job
opportunities, in time, will lead to successful careers, all of which can be directly attributed to their
college and other educational achievements. Some of these educational relationships are seen in
Figures 1.1 and 1.2. As educational attainment increases, i.e., from lower than a high school education
(14.1%) up to a doctoral degree (2.5%), the unemployment rate gets lower in 2011. In the case of
earnings, it also shows in Figure 1.1 that there is a positive relationship between education and median
income. As seen, those with less than a high school education earned a low median weekly income of
$426 versus a higher median weekly income of $1,555 for those with a doctoral degree.
Figure 1.1: The Relationship Between Education, Employment and Earnings For Persons 25
and Over (2011).
Source: Extracted from the U.S. Bureau of Labor Statistics, Current population Survey (March 2012).
In the case of Figure 1.2, there is a positive correlation between educational attainment and
median income earned for persons 25 years and older in 2005. For all educational levels, starting with the
lowest level of some high school (less than the 9 grade) (men = $24,192 versus women = $15,073)
and ending with a professional degree (men = $67,123 versus women = $45,730), there was a vast
and consistent gender gap, with men earning more than their female counterparts.
..
Figure 1.2: Median Annual Income of Persons 25 Years and Over, By Highest Level of
Education and Sex: 2005
Source: National center for Education Statistics - http:/nces.edu.gov, U.S. Department of Education
Post-secondary Persistence Three Years After Enrolling in College: Reported Findings
To be successful in college students have to be persistent and adhere to their goals of successfully
matriculating from college. A recently reported longitudinal follow-up study on post-secondary
persistence, three years after enrolling in college, provided some important information on the subject
(U.S. Department of Education, NCES, 1998). Selected aspects of this report are presented below. It was
reported that as of 1998 (U.S. Department of Education, NCES, 1998), roughly two-thirds of students
who had first enrolled in a 4-year college in 1995-96 were still enrolled in the same college (including 6
percent who had left and returned). The attrition rate of students who begin their higher education at
community colleges far exceeds that at 4-year public and private institutions (Marti, 2008).
It was important that the level of college students' high school curricula was strongly related to
their persistence in post-secondary education. This was true both for maintaining enrollment at their
.
initial institution (institutional retention) and, if they transferred, staying on track to a bachelor's degree.
For example, 79 percent of students who had participated in rigorous high school academic curricula
were continuously enrolled in their initial institution (including 1 percent who had attained a bachelor's
degree). In contrast, 62 percent and 55 percent, respectively, of those in mid-level curricula or core
curricula or lower were continuously enrolled in their initial institution. Students in rigorous curricula
also were less likely to transfer from their first institution (13 percent) than those who participated in
less than rigorous curricula, whether in mid-level or core or lower curricula (23 percent of both groups
transferred).
It was further reported (U.S. Department of Education, NCES, 1998), that the difference between
levels of academic curricula was especially notable with respect to staying on track to a bachelor's degree
(i.e., continuous enrollment in any 4-year institution). As the level of academic curricula increased, so did
the proportion of undergraduates who stayed on track. As of 1998, the vast majority (87 percent) of those
who had participated in rigorous high school academic curricula were still on track to a bachelor's degree,
compared with 71 percent of those in mid-level curricula and 62 percent of those who completed core
curricula or lower. Correspondingly, the proportion of those who had left post-secondary education and did
not return declined with each successive level of academic curriculum (from 17 percent to 10 percent to 4
percent).
Overall Conclusions of Longitudinal Study Presented
The findings of the longitudinal study demonstrated a consistent advantage experienced by students
who completed rigorous high school curricula, and to a lesser extent by those completing mid-level curricula,
over their peers completing core curricula or lower. However, the level of high school curricula students
reported completing also was related to their family background characteristics and indicators of
socioeconomic status, including family income, parents' education, race/ethnicity, and the economic status
of their high school's student body. All of these factors relate to whether or not students have the
opportunities to participate in and complete rigorous curricula. Moreover, students' success in staying in
college was also related to where they first enrolled and how well they performed in their first year. Yet, even
when all these factors were taken into consideration, the advantage of completing a rigorous high school
academic curriculum remained.
The same was not observed for levels of SAT scores. Similar to the findings for curriculum levels,
SAT scores were related to persistence when first-year college GPA was not included in the regression.
However, after GPA was added, high school curriculum remained a significant factor, but SAT scores did not.
These findings are consistent with recent research based on high school transcripts for a cohort of 1980 high
school sophomores (Alderman 1999); this study demonstrated that high school curriculum was a stronger
predictor of bachelor's degree attainment than standardized test scores or other measures of high school
academic performance.
Perhaps most notable in the current study is the apparent benefit of a strong high school academic
curriculum for transfer students. Students who transfer from their initial 4-year college may do so because
they are struggling either academically or socially, and attempting to find a better fit in another institution.
One-fifth of 1995-96 beginning undergraduates enrolled in 4-year colleges had transferred from their first
institution by 1998.
Reported Trends Involving Nontraditional Undergraduates
Today’s undergraduate population is different from it was a generation ago. In addition to being 72
percent larger in 1999 than in 1970 (with fall enrollment growing from 7.4 to 12.7 million), proportionately
more students are enrolled part time (39 versus 28 percent) and at 2-year colleges (44 versus 31 percent), and
women have replaced men as the majority (representing 56 percent of the total instead of 42 percent) (indicator
5). There are proportionately more older students on campus as well: 39 percent of all postsecondary students
were 25 years or older in 1999, compared with 28 percent in 1970 (U.S. Department of Education 2002).
The "traditional" undergraduate, characterized here as one who earns a high school diploma,
enrolls full time immediately after finishing high school, depends on parents for financial support, and
either does not work during the school year or works part time, is the exception rather than the rule. In
1999 - 2000, just 27 percent of undergraduates met all of these criteria. Thus, 73 percent of all
undergraduates were in some way "nontraditional." Comparable data for a generation ago are
not available, but the fact that much of the change in demographic characteristics and enrollment patterns
described above occurred in the 1970s (U.S. Department of Education 2002) suggests that this is not a
recent phenomenon.
While traditional undergraduates are generally able to direct most of their energy toward their
studies, older students, parents (especially single parents), and students who work full time have family
and work responsibilities competing with school for their time, energy, and financial resources.
Difficulties in obtaining child care and class schedules that do not mesh with work schedules are just two
of the barriers that nontraditional students may encounter. In addition, some of the older students who did
not pursue a post-secondary education when they were younger may have made this decision because
they were not prepared academically. Consequently, they may struggle when they enroll later.
Nontraditional students who enter post-secondary education seeking a degree are, in fact, less likely than
traditional students to attain a degree or remain enrolled after 5 years (Horn 1996). To design effective
programs and services to help nontraditional students reach their degree goals, policymakers and
post-secondary administrators need information on how many students are affected, the details of their
enrollment patterns, and the nature of their persistence problems.
The first part of this discussion of nontraditional students uses the National Post-secondary
Student Aid Study (U.S. Department of Education, NPSAS, 2000) to describe their demographic
characteristics, enrollment patterns, how they combine school and work, and their participation in
distance education. The second part examines the relationship between nontraditional status and
persistence using the Beginning Post-secondary Students Longitudinal Studies (BPS), which followed
cohorts of students enrolling in post-secondary education for the first time in 1989 - 90 and in 1995 - 96.
Unless a specific type of institution is specified, the data refers to students at all types of post-secondary
institutions (less than 2- years, 2-years, and 4 years).
Graduate Student Enrollment
It has been reported (U.S. Department of Education, National Center for Education Statistics (2003)
that graduate enrollment had been steady at about 1.3 million in the late 1970s and early 1980s, but rose
about 34 percent between 1985 and 2000. After rising very rapidly during the 1970s, enrollment in
first-professional programs stabilized in the 1980s. First-professional enrollment began rising again in
the1990s and showed an increase of 12 percent between 1990 and 2000.
Since 1984, the number of women in graduate schools has exceeded the number of men.
Between 1990 and 2000, the number of male full-time graduate students increased by 17 percent,
compared to 57 percent for full-time women. Among part-time graduate students, the number of men
decreased by 3 percent compared to an 11 percent increase for women.
1 This includes undergraduates of all types of post-secondary institutions (less than a 2-years, 2-years and 4
years)
2 U.S. Department of Education, NCES. National Post-secondary Student AID Study (NPSAS, 2000)
.
Minority Student Enrollment
The proportion of American college students who are minorities has been increasing. In 1976, 15
percent were minorities, compared with 28 percent in 2000. Much of the change can be attributed to rising
numbers of Hispanic and Asian or Pacific Islander students. The proportion of Asian or Pacific Islander
students rose from 2 percent to 6 percent, and the Hispanic proportion rose from 4 percent to 10 percent
during that time period. The proportion of Black students fluctuated during most of the early part of the
period, before rising slightly to 11 percent in 2000 from 9 percent in 1976. Nonresident aliens for whom
race/ethnicity is not reported comprise 4 percent of the total enrollment (U.S. Department of Education,
National Center for Education Statistics, 2003; Digest of Education Statistics, 2003).
Students With Disabilities
According to a U.S. Department of Education recent report (U.S. Department of Education,

National Center for Education Statistics,1999), there is an estimated 428,280 students with disabilities
enrolled at 2-year and 4-year post-secondary education institutions in 1996-97 or 1997-98. Most of the
students were enrolled at public 2-year and public 4-year institutions, and at medium and large
institutions. Learning disabilities was the most frequent disability, with almost half of the students with
disabilities (195,870 out of 428,280 students) in this category. Institutions reported 59,650 students with
mobility or orthopedic impairments, 49,570 students with health impairments or problems, and 33,260
students with mental illness or emotional disturbance. Institutions also reported 23,860 students with a
hearing impairment, 18,650 students that were blind or visually impaired, and 4,020 students that had a
speech or language impairment. The remaining 38,410 students were reported by the institutions in the
"other, specify" category.
Degree Completion
A recent report by the U.S. Department of Education indicated the approximate time it took
students to complete their studies in college (U.S. Department of Education, NCES, 2003). In the case of
first-time recipients of bachelor's degrees in 1999 - 2000, who had not stopped out of college, it took
them about 55 months from first enrollment to degree completion. On average, first-time recipients of
bachelor's degrees in 1999 - 2000 who had not stopped out of college for 6 months or more took about 55
months from first enrollment to degree completion. Graduates who had attended multiple institutions
took longer to complete a degree. For example, those who attended only one institution averaged 51
months between post-secondary entry and completion of a bachelor's degree, compared with 59 months
for those who attended two institutions and 67 months for those who attended three or more institutions.
This pattern was found among graduates of both public and private not-for-profit institutions.
Students who began at public 2-year institutions and transferred to another institution in order
to complete a 4-year degree, took about a year and one-half longer to complete a bachelor's degree than
students who began at public 4-year institutions (71 vs. 55 months). It took almost 2 years longer for
students who began at private not-for-profit 4-year institutions (50 months). The type of institution
from which graduates received a degree was also related to time to degree: graduates of public
institutions averaged about 6 months longer to complete a degree than graduates of private
not-for-profit institutions (57 vs. 51 months).
Other factors are also related to time to degree completion. As parents' education increases, the
average time to degree completion decreases. In addition, as age and length of time between high school
graduation and post-secondary entry increases, time to degree completion also increases. Higher grade-
point averages were associated with a shorter time to degree completion among graduates of
public institutions but not among graduates of private not-for-profit institutions.
Income of Graduates
A recent comparison report was given of the average income for students graduating from
post-secondary institutions compared with those graduating from high school (Table 1.3). Between
1994 and 2000, the median annual income of male full-time year-round workers, when adjusted for
inflation, increased by 6 percent and the income for females rose by 7 percent. Women's incomes
remained lower than men's incomes, even after adjusting for level of education. The average 2000
incomes for full-time year-round workers with a bachelor's degree were $56,334 for men and $40,415
for women.
Table 1.3: Median annual income of year-round, full-time workers 25 years old and over, by level of education completed
and sex: 1990 to 2000 [In current dollars]
All Education
Year Levels High School Graduate Bachelor's Degree
Men
1990 $30,733 $26,653 $39,238
1991 31,613 26,779 40,906
1992 32,057 27,280 41,355
1993 32,359 27,370 42,757
1994 33,440 28,037 43,663
1995 34,551 29,510 45,266
1996 35,622 30,709 45,846
1997 36,678 31,215 48,616
1998 37,906 31,477 51,405
1999 40,333 33,184 52,985
2000 41,059 34,303 56,334
Wom en
1990 $21,372 $18,319 $28,017
1991 22,043 18,836 29,079
1992 23,139 19,427 30,326
1993 23,629 19,963 31,197
1994 24,399 20,373 31,741
1995 24,875 20,463 32,051
1996 25,808 21,175 33,525
1997 26,974 22,067 35,379
1998 27,956 22,780 36,559
1999 28,844 23,061 37,993
2000 30,327 24,970 40,415
Source: U.S. Department of Education, National Center for Education Statistics, Digest of Education Statistics, 2003, Table 381
.
Summary Outline of Key Headings in the Chapter

Evolving Trends Associated With the College Population
O College Enrollment Estimates (p.3)

O Post-secondary Enrollment By Selected Characteristics of Students (p.4)
O The Relationship Between Education, Employment and Earnings (p.6)
O Post-Secondary Persistence Three Years After Enrolling in

College: Reported Findings (p.7)
9Overall Conclusions of Longitudinal Study Presented (p.8)
O Reported Trends Involving Nontraditional Undergraduates (p.8)
O Graduate School Enrollment (p.9)
O Minority Student Enrollment (p.10)

O Students With Disabilities (p.10)
O Degree Completion (p.10)
O Income of Graduates (p.11)
____________________________________________________________________________________
2.
Health-Related Outcomes: What Students Should Know
ë
“Worry affects the circulation, the heart, the glands, the whole nervous system, and
profoundly affects the health. You have never known a man who died from
overwork, but many who died from doubt.”
- Charles W. Maya, M.D.
I
t is an unfortunate reality that while students are pursuing higher forms of knowledge in college (see
Exhibit 2.1), they are very likely to become sick.
Depending on their health, lifestyle and social activities, for
some students their sicknesses may be mild; however, for
others, their sicknesses can be very serious and, in some cases,
life-threatening. Having good health in college is very
important for students because it has a direct impact on their
academic and other activities.
Colleges and universities are important settings for
reducing important health-risk behaviors (e.g., drinking and
driving) among many young adults. However, before a national
college-based survey was conducted in 1995, the prevalences of
health-risk behaviors among college students nationwide had
not been well characterized. The potential complexity of the Exhibit 2.1: The college experience can
problem is underscored by the amount of students in U.S. predispose students to health problems
colleges and universities. Estimates of enrollment figures are provided below by the National Center for
Education Statistics (NCES).
“Overall enrollment in degree-granting institutions is expected to rise between 2000 and 2012. Changes
in age-specific enrollment rates and college-age populations will affect enrollment levels over the next 12
years (figures 13 and 14). The most important factor in the projected rise of college enrollment is the
projected increase of 15 percent in the traditional college-age population of 18- to 24-year-olds from
2000 to 2012 (appendix table B4). The 25- to 29-year-old population is projected to decrease by 2
percent between 2000 and 2002, and then increase by 15 percent between 2002 and 2012, for a net
increase of 13 percent. The 30- to 34-year-old population is expected to decrease by 7 percent between
2000 and 2007 and then increase 10 percent by 2012. The 35- to 44-year-old population is expected to
decrease by 13 percent between 2000 and 2012. The increases in the younger population are expected to
more than offset the loss of students from the older populations, thereby contributing to the increases in
college enrollment over the projection period” (Gerald & Hussar, 2002).
First National Survey Measuring Health Risk Among College Students
To monitor the priority health-risk behaviors among young persons, in 1990, CDC developed the
Youth Risk Behavior Surveillance System (YRBSS) (Kolbe et al., 1993). The YRBSS includes: a)
national, state, and local school-based surveys of high school students conducted biennially since 1991,
b) a household-based survey conducted in 1992 among a national sample of youth aged 12-21 years,
whether enrolled in school, and c) the 1995 National College Health Risk Behavior Survey (NCHRBS)
conducted in 1995.
13
The purpose of the NCHRBS is to monitor a broad range of priority health-risk behaviors among
college students: behaviors that contribute to unintentional and intentional injury; tobacco use; alcohol
and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted
diseases (STD), including human immunodeficiency virus (HIV) infection; unhealthy dietary behaviors;
and physical inactivity. The NCHRBS is the first national survey to measure health-risk behaviors among
college students across these six important areas of behaviors. The NCHRBS also helps measure progress
toward achieving 28 national health objectives (Public Health Service, 2000) related to health behaviors
of college students and two national health objectives related to the availability and characteristics of
health promotion programs on college campuses. This report summarizes results from the NCHRBS and
describes priority health-risk behaviors among college students nationwide and the health promotion
programs on college campuses.
Based on the findings of the 1995 National College Health Risk Behavior Survey (MMWR,
1997), which was conducted by the Centers for Disease Control and Prevention, it was reported that
many college students in the United States engage in a variety of behaviors that place them at risk for
serious health problems. The following risky behaviors were reported:
K 29 percent were current smokers.

K 35 percent reported episodic heavy drinking during the 30 days preceding the survey.
K 27 percent drank alcohol and drove during the prior 30 days.
K 20 percent of female college students had been forced to have sexual intercourse during
their lifetime.
K Only 30 percent of the students who had sexual intercourse during the 3 months
preceding the survey used a condom.
K 37 percent had engaged in vigorous physical activity, and 19 percent had engaged in
moderate physical exercise, while 74 percent had failed to eat recommended servings of
fruits and vegetables.
Selected Health Concerns For College Students

College students’ perceptions about their health risk behaviors have an influence on the manner
in which they eventually behave. Therefore, by understanding students’ perceptions of their behaviors,
given their relationship to actual behaviors, health educators and college personnel can provide
appropriate intervention-related health programs for their respective college populations (Luquis et al.,
2003).
While space does not allow for a discussion of the variety of conditions that are associated with
students’ health, in this chapter mention is made of selected conditions that are more typically seen on
college campuses. In some cases, these health conditions may be potentially life-threatening, while in
other cases, these are more of a time-consuming hindrances for the students affected by them.
Meningococcal Infection
As a result of the control, of Haemophilus influenzae type b infections, N meningitidis has
become the leading cause of bacterial meningitis in children and young adults in the United States
(Schuchat et al., 1995). Outbreaks of meningococcal disease were rare in the United States in the 1980s;
however, since 1991, the frequency of localized outbreaks has increased (Jackson et al., 1995). It has
been reported that from July 1994 through July 1997, 42 meningococcal outbreaks were reported, four of
which occurred at colleges (Woods, Rosenstein & Perkins, 1998). The Centers for Disease Control and
Prevention report that college freshmen living in dormitories have a higher risk of contracting meningitis
than other college students. There is supporting evidence that vaccinating incoming freshman each year
could substantially decrease their risk of contracting meningococcal meningitis, which is a bacterial
Chapter 2 . Health-Related Outcomes: What Students Need to Know 15
infection of the membranes around the brain and spinal cord. It is important to know that the infection
can be spread by kissing or sharing utensils. Meningococcal meningitis is fatal in about 10 percent of
cases and causes significant harm in another 10 percent. Another form, viral meningitis, generally is less
serious. Also, other studies have indicated that students who live on campus have a higher risk of
developing the disease than students who live in off-campus housing (USFDA, 2001).
Dormitories can be the center of a student's social life. But sharing living, eating and studying
space with so many students may make students more susceptible to meningococcal meningitis. That's an
infection and inflammation of the membranes (meninges) and fluid (cerebrospinal fluid) surrounding
your brain and spinal cord. Meningococcal meningitis commonly occurs when bacteria from an upper
respiratory infection enter your bloodstream. It's highly contagious and may cause localized epidemics in
boarding schools and on military bases, mainly because infectious diseases tend to spread quickly
wherever large groups of people congregate.
One recent study, which was published in the August issue
of the Journal of the American Medical Association, analyzed the
records of 96 American college students ages 18 to 23 who were
found to have had meningococcal infection between Sept. 1, 1998,
and Aug. 31, 1999. It reported that 68 percent of the 79 students for
whom information was available had infections that may have been
prevented through vaccination (see Exhibit 2.2). The study also
found that the overall incidence of meningococcal meningitis was
0.7 per 100,000 students, compared with 5.1 per 100,000 for
freshmen living in dormitories. According to the study, crowded
Exhibit 2.2: Engage in preventive practices
conditions and the possibility that upperclassmen may have and have needed examinations by designated
developed protective immunity to the disease may explain the medical personnel
differences. Increasingly, colleges and universities are warning
incoming students of the bacterial disease and are sponsoring vaccination clinics. The vaccine is effective
for three to five years (USFDA, 2001).
Physical Inactivity, Overweight and Obesity

It is increasingly being recognized that obesity is a complex, multifaceted chronic disease
involving a variety of factors (e.g., social, cultural, genetic, physiologic, behavioral and psychological).
Obesity is the second leading cause of preventable deaths in the United States. Further it has been said
that the 21st Century’s youth is considered the most inactive in generations, and this can be directly traced
to a reduction in school physical education programs (Hossain, 2003). In 1999-2000, 15 percent of
children and adolescents (ages 6 -19) were overweight triple what the proportion was in 1980 (Ogden
et al., 2002).
Obese children and adolescents are more likely to become obese adults (Casey et al.,1992) Body
mass index from childhood to middle age: a 50-year follow-up. American Journal of Clinical Nutrition
56:14-8, 1992. overweight adults are at increased risk for heart disease, high blood pressure, stroke,
diabetes, some types of cancer, and gallbladder disease (Public Health Service, 1988). It is estimated that
many young adults on college campuses are not meeting the suggested physical activity recommenda-
tions (Centers for Disease Control and Prevention, 1997; Dinger, 1999) and a large portion of these
individuals are leading a sedentary lifestyle (Pinto & Marcus, 1995; Behrens & Dinger, 2003).
Implications for Overweight and Physical Inactivity

The National Heart, Lung and Blood Institute (NHLBI) Clinical Guidelines on the Identification,
Evaluation, and Treatment of Overweight and Obesity in Adults (1998) state that the United States has
approximately 97 million overweight and/or obese adults. Data from the Third National Health and
Nutrition Examination Survey (NHANES III) show that the prevalence of obesity in the United States
continues to increase (Kuczmarski, Flegal, Campbell & Johnson, 1994). The NHLBI and others (e.g.,
Pate et al., 1995) have linked obesity and overweight to various health conditions, e.g., hypertension,
adult onset diabetes, heart disease, colon cancer, osteoporosis, anxiety and depression. The increasing
prevalence of obesity also affects mortality rates and health care costs. For example, in 1995
approximately $99.2 billion of health care expenditures were attributed to obesity-related diseases and
conditions (NHLBI, 1998). Aditionally, dietary factors and sedentary lifestyle contributed to 300,000
potentially avoidable deaths (McGinnis & Foege, 1993).
Nutrition and physical inactivity are the two most important lifestyle factors that contribute to
excess weight gain. While Americans have reduced their intake of fat, they have not decreased their
consumption of total amount of food energy (Rippe, Crossley & Ringer, 1998). In the case of physical
activity, only 22 percent of American adults regularly exercise at 30 minutes per day while 24 percent are
sedentary (Rippe et al., 1998).
Physical Activity, Exercise and Physical Fitness

Distinctions between physical activity, exercise, and physical fitness are useful in understanding
health research. Physical activity is "any bodily movement produced by skeletal muscles that results in
energy expenditure. Exercise is a subset of physical activity that is planned, structured, and repetitive"
and is done to improve or maintain physical fitness. Physical fitness is "a set of attributes that are either
health- or skill-related." Health-related fitness includes cardiorespiratory endurance, muscular strength
and endurance, flexibility, and body composition; skill-related fitness includes balance, agility, power,
reaction time, speed, and coordination (Caspersen, et al.,1985).
Health Benefits of Physical Activity and Physical Illness

There are several benefits to be accrued from regular physical activity. For example, it improves
cardiorespiratory endurance, flexibility, and muscular strength and endurance (USHEW, 1996) (see
Exhibit 2.3). Physical activity may also reduce obesity (Ching et al., 1996), alleviate depression and
anxiety (Weyerer, 1992), and build bone mass density (Greendale, et al,
1995). Physically active and physically fit adults are less likely than
sedentary adults to develop the chronic diseases that cause most of the
morbidity and mortality in the United States: cardiovascular disease (e.g.,
Lee, 1995), hypertension (Folsom et al., 1990), non-insulin-dependent
diabetes mellitus (Burchfiel et al., 1995), and cancer of the colon
(Longnecker et al., 1995). All-cause mortality rates are lower among
physically active than sedentary people (Haapanen et al.,1996).
Among healthy young people, physical activity and physical fitness
Exhibit 2.3: Engage in physical
may favorably affect risk factors for cardiovascular disease (e.g., body mass
activity whenever you can
index, blood lipid profiles, and resting blood pressure) (Blessing et al.,
1995). Physical activity among adolescents is consistently related to higher levels of self-esteem and self-
concept and lower levels of anxiety and stress (Calfas & Taylor, 1994). Although the relationship
between physical activity during youth and the development of osteoporosis later in life is unclear
(Bailey & Martin , 1994), evidence exists that weight-bearing exercise increases bone mass density
among young people (Rubin et al., 1993).
Some universities are taking the matter of obesity very seriously. For example, at Georgia State,
help and direction are as near as the recreation center and as easy to access as the campus website. One
of the major causes of American’s obesity is the lack of exercise. At Georgia State, “Any student who
has paid his/her student activities fee is automatically a member of the recreation center,” says Debbie
Rupp, the Associate Director of Programs at Recreational Services. “The recreation center offers an array
of activities from day hikes, kayaking lessons and water fitness classes to martial arts and yoga. The nice
thing about the recreational center is the diversity of programming that is available” (Levine 2003).
According to Pinto et al. (1998), college students who regularly engage in exercise experience
both physiological and psychological benefits. For example, some benefits include reductions in total
cholesterol and low-density lipoprotein cholesterol (LDL) among students who previously had high
cholesterol. Additionally, regular exercise has been shown to be associated with increase in lumbar bone
mass, reduction in test anxiety, improvements in self-esteem and deceases in anxiety and depression.
Sexual Activity, STDs, and HIV/AIDS

Approximately 22,000 AIDS cases have been reported in individuals between the ages of 20 and
24 (CDC, October 5, 1999). This represents approximately 4 percent of
reported AIDS cases. While this number may appear to be insignificant,
over 240,000 AIDS cases have been reported in individuals between the
ages of 25-35 (CDC, June 30, 1999). Many of these individuals with AIDS
in the 25 to 35 year-old age group actually acquired the HIV infection in
their late teens and early twenties and are just now showing symptoms
because of HIV's long latency period. HIV takes an average of 10-12 years,
and sometimes longer because of new drugs, to progress to AIDS
(HIV/AIDS Awareness, 2003). Knowledge concerning sexual activity,
HIV/AIDS and other STDs, that is imparted by designated individuals to the
Exhibit 2.4: Be aware of population at risk is one very important way to control the rising tide of
HIV/AIDS and other STDs sexually transmitted diseases in the adolescent, college and other vulnerable
through unprotected sexual
populations (see Exhibit 2.4).
activity.
Risk Factors For HIV/AIDS

The main factors that increase the risk for transmitting HIV (see Exhibit 2.5) are as follows:
K Having oral, anal, or vaginal sex;

K Multiple sex partners- Of students in the 18 to 24 year old age
group, 25.7 percent have had six or more sex partners in their
lifetime (Douglas, et al, 1997);
K Alcohol misuse/abuse- 35 percent of students have engaged in
some form of sexual activity that was influenced by alcohol
consumption and 15percent have abandoned safe-sex techniques
due to alcohol consumption (Meilman, 1993);
K Date rape-55 percent of the perpetrators and 53 percent of the

Exhibit 2.5:Preventing
victims of acquaintance and date rape were under the influence of unwanted pregnancies
alcohol; and and the associated
complications of
K Sharing needles with an infected person. HIV/AIDS and STDs
Risky Behaviors Among College Students

Two recent studies have highlighted the scope of risky behaviors
among college students (see Exhibit 2.6). In 1995, the CDC in
cooperation with universities and other relevant national organization,
developed and administered the National College Health Risk Behavior
Study to measure behaviors related to six key areas of health: injuries,
tobacco use, alcohol and other drug use, sexuality, diet, and physical
activity. Over 4,600 students at 136 institutions completed the survey. Of
those students
Exhibit 2.6: Say “NO” to drugs
K 20.4 percent of the women and 3.9 percent of the men reported that they had been forced
to have sexual intercourse
K 27 percent of the women and 43.8 percent of men reported episodic heavy drinking
K 31.8 percent of the women and 37.8 percent of the men reported having six or more sex
partners during their lifetimes
K 25.8 percent of women and 32.4 percent of men reported that they used a condom during
their last sexual encounter.
K 25.1 percent of women and 32.4 percent of men reported consistent condom use.
Unplanned Pregnancies
Previous reports at the national and state (e.g., Louisiana) levels on teenage pregnancy and STD
rates, indicate that pre-college and college age individuals are engaging in sexual behaviors. In many
cases, no protection is used when having sex (see Exhibit 2.7). More specifically, based on data reported
from the 1999 Youth Risk behavioral Survey (CDC 2000) and the 1995 College Risk Behavioral Survey
(CDC, 1997), the percentage of students who reported engaging in sexual intercourse by age 13 was 8.3
percent; by senior year of high school, 49.9 percent; and by college 79.5
percent.
There is an estimated 15.3 million college students in the United
States with females comprising 56.1 percent of this population (US
Department of Education, 2002). “Approximately 1.3 percent of college
women report the occurrence of an unintended pregnancy as a cause of an
academic problem such as receiving a lower grade on an exam, project or
Exhibit 2.7:If you are engaging course, or causing them to receive an ‘incomplete’ or drop a course.” Fennell
in sexual activity, be aware of (p.1. 2003)(American College Health Association, 2003).
your “protective” options.
Alcohol Use and Abuse
There were approximately 16,000 motor vehicle fatalities and
310,000 injuries in the United States involving alcohol during the
year 2001 (NHTSA, 2000) and a high percentage of these events
involved adolescents and young adults (Wechsler et al. 2003). Binge
drinking is a major contributor to these injuries and fatalities, and
there are higher rates of drinking in the college population versus the
peers of the same age who do not attend college (O’Malley &
Exhibit 2.8: Alcohol as a stress-related
Johnson, 2002) (see Exhibit 2.8). As a matter of fact, heavy episodic
outcome
alcohol use, or binge drinking, among college students is a nationally recognized problem (Wechsler, et
al., (2002a).
National studies have reported that approximately 2 out of every 5 college students are binge
drinkers (CDC, 1997). Binge drinking has some very serious implications. For example, it harms the
drinker as well as others on the campus. Such harm can be in the form of physical assaults, unwanted
sexual advances, disruptions of sleep and physical assaults (Wechsler et al., 2002b; Perkins, 2002).
There is reported socio-demographic variation in the students who binge drink. For example, binge
drinkers tend to be more white, male and younger students versus minority (i.e., African American,
Asian, female and older).
Illicit Drug Use/Abuse
General Population
According to data from the 2002 National Household Survey on Drug Use and Health
(NSDUH), formerly called the National Household Survey on Drug Abuse (NHSDA) --
· 108 million Americans age 12 or older (46% of the population) reported illicit drug use at least
once in their lifetime
· 15% reported use of a drug within the past year
· 8% reported use of a drug within the past month.
Data from the 2002 survey showed that marijuana and cocaine use is most prevalent among persons age
18 to 25 (see Table 2.1).
Table 2.1: Marijuana and cocaine use, 2002
Age of Respondents
Drug Use 12-17 18-25 26+
Marijuana
Last month 8.2% 17.3% 4.0%
Last year 15.8% 29.8% 7.0%
Cocaine
Last month 0.6% 2.0% 0.7%
Last year 2.1% 6.7% 1.8%
Source: SAMHSA, Office of Applied Studies, 2002 National Survey on Drug Use and Health: National
Findings, September 2003.
In 2002, the SAMHSA Drug Abuse Warning Network (DAWN) reported 670,307 drug-related
visits in hospital emergency departments nationwide, an increase from the 518,880 reported in 1994.
DAWN provides information about some of the health-related consequences of drug abuse in the United
States, including representative estimates of drug abuse-related emergency department visits and drug
mentions for the coterminous United States and for 21 metropolitan areas.
College Age Population and Other Relevant Populations

According to a recent Monitoring the Future Survey (Johnston et al. 2004), which presented
drug use data for high school and college students, “party drugs” as well as certain pharmaceuticals have
become popular among these two groups of students. For example, 53.9 percent of high school seniors
and 53.6 percent of college students had used an illicit drug during their lifetime; while 25.7 percent of
high school seniors and 21.9 percent of college students had used an illicit drug in the previous 30 days.
With reference to party drugs, approximately 11.7 percent of high school seniors and 14.7 percent of
college students had used ecstasy at least once in their lifetime. The report concluded that with these
statistics in mind, it is imperative that prevention, intervention and treatment specialists along with law
enforcement agencies strategically address drug use within these populations.
Depression and Suicide

While the college years can be the best years for many students, for others it can be fraught with
mental health issues and self-destructive activities, for example, drug abuse and suicides. Researchers
are discovering that mental illnesses may be traced to earlier trauma which surfaces in times of stress and
change, such as the college years. It is for these and other reasons that college students, especially
incoming freshmen who are undergoing rapid and unaccustomed “changes” (e.g., leaving home, greater
independence, poor time management skills, interpersonal problems, financial issues) must be carefully
monitored by counselors and other health personnel for mental health and related self-destructive
tendencies and/or behaviors.
"Depression is a huge problem in the college student population," says John Greden, M.D.,
executive director of the U-M Depression Center (see Exhibit 2.9). "The age of onset for depressive
illnesses tends to peak during the ages of 15 to 19. That's when it starts to appear, and the estimates are
that probably 15 percent of the college student population may be struggling
with depressive illnesses" (Gavin, 2003). According to Peterson (2002),
“College students are the focus of negative headlines about everything from
binge drinking to campus crime. Now a new concern may dwarf the earlier
crises: an alarming increase in cases of mental illness on college campuses.”
Some variations have been reported regarding stress and depression,
which has been reported to be increasing among college students (Astin,
1993). When college freshmen were surveyed, it was found that 9.7 percent
experienced frequent depression; and only 48 percent of the women,
Exhibit 2.9: Feelings of compared with 59.3 percent of the men, were confident in their emotional
depression health (Sax, 1997). Reed et. al., (1996) reported that 58 percent of African
American college women sampled had a high rate of depressive symptoms, with 12 percent to 18 percent
experiencing severe symptoms. Additionally, Beeber (1998) and Peden et al. (2000a; 2000b), reported
mild-to-severe depressive symptoms in more than one third of the college women sampled. In the 1995
National College Health Risk Behavior Survey (Douglass et al., 1997), 10.3 percent of the students
reported serious thoughts of suicide, 6.7 percent had made plans for suicide, and 1.5 percent said they
had attempted suicide. The findings in these studies suggest the need for prevention interventions to
reduce risks for depression among college students.
According to Gavin (2003), information on depression and college students include the
following: Depression is a real disease based in brain chemistry, genes and emotions. Hormone and
brain changes in teens and young adults can increase the risk of developing it. Symptoms of depression
include sadness; anxiety; decreased energy or fatigue; loss of interest or pleasure in usual activities; sleep
disturbances; appetite and weight changes; feelings of hopelessness, guilt, and worthlessness; thoughts of
death or suicide, or suicide attempts; difficulty concentrating, making decisions, or remembering;
irritability or excessive crying; and chronic aches and pains not explained by another physical condition.
Stressful events and experiences, or lifestyle changes, can trigger episodes of depression. As
many as 15 percent of college students may have symptoms of depression, and about 10 percent of
college students arrive on campus with a history of depression. More than 18 million American adults
have depression, and many of them first experienced symptoms in their teen or young-adult years.
Untreated depression is one of the most disabling conditions, according to the World Health
Organization, interfering with a person's ability to learn, work, socialize and enjoy life. Depression
treatments include psychotherapy with a trained professional (also known as "talk therapy" and
"counseling"), and medications to balance brain chemistry. Early detection and treatment can prevent
depression from worsening over a person's lifetime (USDHHS, 2001).
Anxiety Disorders
According to a report by the National Institute of Mental Health (NIMH, 2004), “Anxiety is a
normal reaction to stress. It helps one deal with a tense situation in the office, study harder for an exam,
keep focused on an important speech. In general, it helps one cope. But when anxiety becomes an
excessive, irrational dread of everyday situations, it has become a disabling disorder.” The report further
stated that there were five major types of anxiety disorders. Because of space and other limitations, what
follows is a brief overview for each disorder, as presented exactly by the National Institute of Mental
Health. Effective treatments for obsessive-compulsive disorder are available, and research is yielding
new, improved therapies that can help most people with OCD and other anxiety disorders lead
productive, fulfilling lives. More information about any of these disorders can be found at the following
location: http://www.nimh.nih.gov/healthinformation/anxietymenu.cfm)
1) Generalized Anxiety Disorder (CAD):

Generalized Anxiety Disorder, or GAD, is an anxiety disorder characterized by chronic anxiety,
exaggerated worry and tension, even when there is little or nothing to provoke it. People with
generalized anxiety disorder can't seem to shake their concerns. Their worries are accompanied by
physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, difficulty swallowing,
trembling, twitching, irritability, sweating, and hot flashes. Effective treatments for anxiety disorders are
available, and research is yielding new, improved therapies that can help most people with anxiety
disorders lead productive, fulfilling lives.
2) Obsessive-Compulsive Disorder (OCD):

Obsessive-Compulsive Disorder, OCD, is an anxiety disorder characterized by recurrent, unwanted
thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as
handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive
thoughts or making them go away. Performing these so-called "rituals," however, provides only
temporary relief, and not performing them markedly increases anxiety. People with OCD may be plagued
by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals. They
may be obsessed with germs or dirt, and wash their hands over and over. They may be filled with doubt
and feel the need to check things repeatedly.
3) Post-Traumatic Stress Disorder (PTSD):

Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop after exposure to a
terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that
may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or
military combat. People with PTSD have persistent frightening thoughts and memories of their ordeal
and feel emotionally numb, especially with people they were once close to. They may experience sleep
problems, feel detached or numb, or be easily startled.
4) Social Phobia (or Social Anxiety Disorder):

Social Phobia, or Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety
and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one
type of situation, such as a fear of speaking in formal or informal situations, or eating or drinking in front
of others. In its most severe form, it may be so broad that persons experience symptoms almost anytime
they are around other people. People with social phobia have a persistent, intense, and chronic fear
of being watched and judged by others and being embarrassed or humiliated by their own actions. Their
fear may be so severe that it interferes with work or school, and other ordinary activities. Physical
symptoms often accompany the intense anxiety of social phobia and include blushing, profuse sweating,
trembling, nausea, and difficulty talking.
5a) Panic Disorder:

Panic disorder is an anxiety disorder and is characterized by unexpected and repeated episodes of intense
fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of
breath, dizziness, or abdominal distress. People with panic disorder have feelings of terror that strike
suddenly and repeatedly with no warning. During a panic attack, most likely your heart will pound and
you may feel sweaty, weak, faint, or dizzy. Your hands may tingle or feel numb, and you might feel
flushed or chilled. You may have nausea, chest pain or smothering sensations, a sense of unreality, or
fear of impending doom or loss of control.
National Institute of Mental Health. Anxiety Disorders. Retrieved 7/8/04
(http://www.nimh.nih.gov/healthinformation/anxietymenu.cfm)
5b) Panic Attacks

Panic attacks are very much related to panic disorder. In many cases, while they are viewed as the same,
panic attacks are seen as more immediate (or acute), and panic disorder is seen as more encompassing a
“problem”(or chronic). Again, the symptoms are very much the same. It is interesting to note, however,
that in many cases a forerunner or precursor to a feeling of panic is a feeling of being anxious. So what
basically is anxiety?
Anxiety is described by the dictionary as painful uneasiness of mind, dread, foreboding, worry, or
apprehension. There is much daily anxiety which is part of our routine. Anxiety in response to immediate
danger is part of our defense mechanism. But there are times when anxiety is irrational, exaggerated, and
unhealthy, which in turn can lead to panic attacks. Panic attacks can immobilize and distress a person to
the point of nervous illness.
Similar to the symptoms described for panic disorder, panic attacks are characterized by rapidly
racing heart, "missed" heartbeats, palpitations, pain around the heart, churning stomach, sweating hands,
trembling, breathlessness, nausea, weakness, difficulty in swallowing, and powerlessness to take action.
These crises of anxiety--especially when accompanied by fatigue--not only increase in intensity, but they
need less and less to set them off. Dread of having a panic attack may bring on a whole sequence. The
very effort to relax or to will oneself to function normally may cause the frequent and intense spasms of
fear which paralyze the person even further. The average sufferer is alarmed by these symptoms, focuses
on them, and begins to watch for them. Individual responds may include trying to run from reality or
staying and fighting the experience. The individual becomes impatient because he/she cannot find a cure
overnight and begins to wonder whether there is something seriously wrong.
Panic attacks may be seen as a kind of "systems overload" in which there is a choking-off of the
ability to function because we have allowed the anxiety to create a log-jam of distress. When feelings and
fears are not dealt with healthily, the anxiety level reaches an unmanageable peak and sends the nervous
system into a tail spin. Often these feelings and fears are not at the conscious level. Thus the anxiety may
appear to be irrational. But when the basic feeling or thought is exposed and recognized, it becomes
rational and we understand what is happening. At that point we are able to take control, and the attack
usually will begin to subside (NAMB, 2004).
For more information on panic attacks, go to: http://www.namb.net/helplink/pa-cpe.asp.
Poor Eating and Dietary Habits

Good nutrition and dietary habits contribute a great deal to the overall health of the adult
population. College students, by virtue of the stresses and changes they experience in college are prone
to not follow the recommended guidelines for healthy eating, hence their increase likelihood of having a
variety of health impairments, both during their college years and long thereafter. Experimental and
epidemiological research has produced ample evidence linking diets high in total and saturated fat,
cholesterol, and energy and low in fiber to cardiovascular diseases (Kritchevsky, 1998), certain types of
cancers (Lichtenstein, Kennedy, Barrier, & Danford, 1998), and diabetes (Pick, Hawrysh, Gee, & Toth,
1996).
It has been reported that college students comprise a
group whose dietary practices and nutritional status are of
concern to nutrition professionals (Marietta, Welshimer, &
Anderson, 1999; Binger, 1999). These Concerns are based on
research that characterizes the diets of college students as low
in energy, fiber, calcium, iron, vitamin A and carotinoids, and
high in fat (Huang, Song, Schemmell, & Hoerr, 1994; Hertzler,
Webb, & Frary, 1995; Schuette, Song, & Hoerr, 1996). These
findings reflect poor food choices and suggest that college
students could benefit from an enhanced awareness of and
greater compliance with the recommendations presented in the
Dietary Guidelines for Americans and the Food Guide Pyramid
by the Food and Drug Administration (see Exhibit 2.10).
Research on the dietary practices of college students Exhibit 2.10: USDA 5-food group pyramid
has identified several behaviors that are associated with the
consumption of poor quality diets. Horwath (1991), Hendricks and Herbold (1998), and Marietta and
coworkers (1999) have reported that college students frequently skip meals, consume large amounts of
fast foods and alcohol, snack on high-calorie foods, avoid certain nutritious foods (see Exhibit 2.11) , and
adopt unsound weight loss techniques. Marietta and co-workers (1999) and Huang, Hoerr, and Song
(1997) have observed that college students make more food selection and food preparation decisions
after moving away from home while simultaneously adapting to an unfamiliar environment and lifestyle.
During this transition phase several influential factors can contribute to
the adoption of poor dietary practices. These factors include the
availability of foods of low nutrient density, preoccupation with weight,
financial restrictions, limited food preparation skills, restricted food
storage and cooking facilities, difficulty with time management, and
nutritional misconceptions (Horacek & Betts, 1998a; Horacek & Betts,
1998b).
The inappropriate dietary practices, as well as the poor quality
diets of college students, are of concern to health educators because of
Exhibit 2.11: Nutritious food to eat -
their possible adverse impact on the long-term health status of these
fruits young adults. Several authors (Betts et al., 1997; Horacek & Betts,
1998b) have noted that consumption of inadequate diets during young
adulthood can trigger unfavorable physiological events conducive to the occurrence of diet-related
degenerative diseases later in life. Despite the concerns about the dietary practices and food choices of
college students, little research has been conducted to assess their awareness of key nutrition issues, such
as food composition, healthful eating, and the relationship between diet and health which are related to
the Dietary Guidelines for Americans and Food Guide Pyramid (Marietta, Welshimer, & Anderson,
1999). Considering that there are currently an estimated 14 million individuals between the ages of 18
and 24 enrolled in U.S. colleges and universities, and that this figure is expected to reach 16 million by
2007 (Knutson, 2000), it is critically important to assess the need for nutrition education interventions
about these three nutrition topics with the aim of preventing many new cases of diet-related chronic
disease.
Health-Related Outcomes: What Students Need To Know
O First National Survey Measuring Health Risk Among College Students (p.13)
O Selected Health Concerns For College Students (p.14)

9 Meningococcal Infection (p.14)
9 Physical Inactivity, Overweight and Obesity (p.15)
: Implications For Overweight and Physical Inactivity (p.15)
: Physical Activity, Exercise and Physical Fitness (p.16)
: Health Benefits of Physical Activity and Physical Illness (p.16)
9 Sexual Activity, STDs, and HIV/AIDS (p.17)
: Risk Factors For HIV/AIDS (p.17)
: Risky behaviors Among College Students (p.17)
: Unplanned Pregnancies (p.18)
9 Alcohol Use and Abuse (p.18)
9 Illicit Drug Use/Abuse (p.19)
: General Population (p.19)
: College Age Population and Other relevant Populations (p.20)
9 Depression and Suicide (p.20)
9 Anxiety Disorders (p.21)
: Generalized Anxiety Disorder (p.21)
: Obsessive-Compulsive Disorder (OCD) (p.21)
: Post-Traumatic Stress Disorder (PTSD) (p.22)
: Social Phobia (or Social Anxiety Disorder) (p.22)
: Panic Disorder (p.22)
: Panic Attacks (p.22)
3 Anxiety (p.22)
9 Poor Eating and Dietary Habits (p.23)
Part II
I = Identifying the Background, Nature and Causes of
3. What Do We Know About Stress?

This part of the book deals with the first section 4. Stress and College Students
of the I-R-M Approach to Stress Management. 5. What Causes Stress?
Essentially, it allows college students to identify 6. Personality Stressors
and understand the background, nature and 7. Private Life Stressors
causes of stress. As the chapter outline to the 8. Interpersonal Stressors
right indicates, after reviewing information 9. Organizational Stressors
pertaining to stress and college students, a 10. Academic Stressors
schematic presentation is made of six categories 11. Environmental Stressors
of stressors and the relevance of these potential 12. Correlates of College Students’
stressors on college students’ lives. Stressors
27
___________________________________________________________________________________
3.
What Do We Know About Stress?
ë
“Nothing is good or bad but thinking makes it so.”
- William Shakespeare.”
D
o you know your stress tigers? Life in general (Exhibit 3.1) and college life in particular can be
potentially stressful for millions of students. The position taken in this book is that a prerequisite
for successfully managing stress is for individuals to first know
about the “stress tigers” in their lives. However, to know of these stress
tigers, or stressors (which is covered in this section of the book) as they
are called, requires a basic understanding about the background of stress
and stressors: how they occur in the first place, who is susceptible, how to
recognize when they are occurring (which is the topic of Part III of the
book), and, lastly, employ one or a combination of strategies to manage
stress (which is the topic of Part IV of the book). After reading the
chapters covered under Part II, as well as Part III of this book, students
will be better equipped to provide an answer to the question asked
regarding knowing their stress tigers.
The Position Taken Concerning Stress Exhibit 3.1: Understanding

stress
Although the target group of the book is college students, a
majority of the information concerning the background of stress and stressors is general and generic in
nature. Where applicable and necessary, examples involving college students will be included. Given
that the stress process is basically the same for everyone, a generic presentation on the background of
stress is very appropriate. given that stress and the process that is involved when it is occurring is
basically the same for everyone. However, in the case of college students, differences may arise in some
of the conditions, or stressors, that give rise to stress in college versus those that occur in society as a
whole.
While there are some uniquely different stressors for college students, there are many similar
stressors that they share with the general population, hence another reason for the chapter to be more
generic in nature. What is emphasized throughout the book, beginning in the chapters covered under this
first part, is that whether the reacting person is a student or a non-student, “personal appraisal” of the
stressor is very important to initiate the stress process. Given this view of stress, the position taken in
this book is that stress is personal and subjective. This being the case, what is stressful for one person
(student) may not be seen as stressful for another person, assuming that both persons have similar
background characteristics.
In keeping with the analogy of the tiger representing the stress in your life, PART I of the book
examines the various sources of stress, or stressors, that you need to be aware of in order to ultimately
control and manage stress to the best of your ability. Based on the simplified I-R-M Approach used
29
30 PART II: % Identifying the Background, Nature and Causes of Stress
throughout this book to manage stress, where I represents identifying your stressors, this first section of
the book, then, is very important to the overall plan you develop in managing your stress. Simply put,
you cannot begin to manage the stress tiger unless you know how the tiger appears in one of several
forms. In attempting to categorize the many forms in which the stress tiger can appear, six areas are
discussed in the chapters under this section of the book.
K Personality Stressors
K Private Life Stressors
K Psychosocial Stressors
K Organizational Stressors
K Academic Stressors
K Environmental Stressors
What Is Understood About Stress
If asked, many people would claim that they know what stress is all about. In reality, however,
the truth of the matter is that somewhat few people really do understand stress to the extent that they can
do the following:
[a] recognize when they are under stress or are in a stress-related situation;
[b] recognize what stress does within their bodies, i.e., the stress reaction; and
[c] how best to control and manage stress, by making it, if need be, an ally or friend in daily
activities.
Stress is a common part of everyday life. Initially, stress was a concept borrowed from the study
of physics, where it referred to the action of a system of forces on a body resulting in pressure or strain.
For the purposes of this book, stress is viewed as a process involving three essential stages (i.e., onset,
reaction and outcome) and perception plays a very crucial role, especially at the onset of the stress
process.
The Role of Perception
As seen in Exhibit 3.2, stress involves a process of events that essentially has three basic,
interrelated and sequential stages: onset, reaction and outcome. As also seen in Exhibit 3.2, which
illustrates the important E-P-R conditions, perception plays a very important role in the stress process,
hence the point made that stress is a subjective experience.
Chapter 3 . What Do We Know About Stress? 31
Stress As a Transaction
In the late 1960s Richard Lazarus
proposed that stress is apart of an ongoing
interaction between the person and the
environment. On one hand are all the
demands, pressures, and expectations (i.e.,
stressors) we face, both from the outside
world and from inside ourselves (More is
said about these stressors in a moment). On
the other hand are the resources we have to
meet these demands.
When we perceive (and believe) that
there is a disparity between demands and our
available resources, and we anticipate harm
and/or threat from the situation, we feel
stressed (Exhibit 3.2). At this point, the stress
process is initiated. These series of events
depict basically the transactional view of
stress that guides how stress and stress
management are viewed in this book. This
view is in contrast to other views that see
stress either as: a) a stimulus or b) as a
reaction.
The E-P-R Process: The Importance of

Perception
At the core of the transactional view Exhibit 3.2: A functional model of the stress process
of stress is the crucial mediating role that
perception plays in the stress reaction (Exhibit 3.3). Again, the simplified explanation of the E-P-R
process is as follows:
E = events (or stressors, which can be either external or

internal);
P = perception (your views, beliefs, interpretations, etc.);
and
R = response or actions (which in turn contributes to the
quality and quantity of related reactions and outcomes).
These reactions and outcomes occur in four basic areas:

Exhibit 3.3: The important “link” of perception
behavioral, mental, physical and social. Based on the
above explanation, the ensuing formulation follows:
E+P=R
This formulation is very important for stress management because it underscores two important factors:
a) Stress is truly subjective given the central role perception plays between the E, which is
essentially the stimulus, and R, which is essentially the response; and
b) As E is a constant, usually beyond our control (i.e., with the possible exception of internal
factors that are likely stressors), and P is the variable [E + ? = R], usually within our control, R and the
subsequent stress-related reactions and outcomes are definitely controllable using a combination of
strategies (which is the subject matter of Part IV of the book).
As a result of the above mentioned transaction view of stress, it is our thoughts and
expectations, i.e., how we interpret and label our experiences, that can serve either to relax or cause us
stress. These series of events suggest, then, that stress is really in the “eyes of the beholder,” or simply
that it is a subjective and personal phenomenon. For example, interpreting a “sour look” from someone to
mean that they are unhappy with something you did is likely to be very anxiety provoking. However,
interpreting the same look as tiredness or preoccupation with a personal problem should not be as
frightening or stressful to us.
Dwelling on worries produces tension in your body, which in turn creates the subjective
feeling of uneasiness and leads to more anxious thoughts. Therefore, you have the power to prevent most,
if not all of these stress and stress-related outcomes from occurring. Because most people do not know
about these abilities, it is very important for them to acquire the necessary knowledge (what to…), skills
(how to…) and desire (want to…) as they formulate the strategies to control stress. In his book, Seven
Habits For Effective People, Covey (1989) defines habits as the intersection between knowledge, skill
and desire. Therefore, in terms of stress management, in some cases, you may have to relinquish old and
potentially destructive “habits” (which may be behavioral, mental, interpersonal and/or physical) and
replace them with newer and more health-conscious habits (e.g., positive thoughts, exercising, meditating
– which is the subject matter in Part III of the book).
Factors Influencing Perception

Several important factors influence our
perceptions and, in turn, determine how much stress we
experience (Exhibit 3.4). Our childhood learning creates
patterns and expectations that we carry into adult life.
Feelings about ourselves, our abilities, our expectations
of ourselves and other people can stem from childhood
conditioning. Each of us learns a style of responding to
challenges and thinking about the world that greatly
affects how safe or threatening the world appears to us. A
person who feels safe and confident will experience less
stress than one who is fearful and full of self-doubt. In Exhibit 3.4: Factors influencing perception
all, two of the most important factors influencing our
perceptions are our personalities and the resources that are available to us.
Based on the above-mentioned information, we manufacture stress for ourselves when we worry,
anticipate the worst, or create unrealistic demands on ourselves. When we imagine a stressful situation,
our bodies act as if the event is really happening and the stress response is triggered. Thus we can reduce
stress simply by reducing our negative thoughts and expectations, and, therefore, being more in control.
Events are essentially "neutral" - maybe to some extent even nonexistent - without the presence
of our minds to perceive them and give them meaning. As illustrated in Exhibits 3.2 and 3.3, perception
is the very important link between the event and our ultimate response. With this point in mind, stress
exists, for the most part, primarily because we make it happen. Once we perceive demands related to
either a single or several sources as stressors (e.g., conflicts with others; unrealistic expectations we have
for ourselves; heavy workloads; finance obligations we cannot keep), and we repeatedly fail to "cope"
(i.e., the demands of the source(s) exceed our available resource capabilities) with the perceived threat,
the second stage of the process becomes activated - reaction (see Exhibit 3.2).
EXAMPLE: Missing a plane at the airport, failing a course in school, having a bothersome
boss at work, and experiencing your car breaking down on the road do not automatically cause
stress. Instead, it is your perceptions, i.e., the meaning you give to these events, that cause them
to become stressors and, in turn, these stressors can lead you to experiencing stress.
Depending on our available resources, we may choose to engage in one of several possible
actions: ignoring, fighting, fleeing or solving the problem (Exhibit 3.2). Depending on the outcome of
these actions, our bodies may, then, become physiologically aroused. Therefore, as the name suggests, in
the reaction stage of the stress process, our bodies react by showing certain telltale signs and symptoms
of being activated, and it is at this stage that stress actually occurs.
As time goes on and, for whatever reason, we continue to fail to cope with the threatening source
or stressor(s) in our environment, it is likely that we will experience delayed, unbroken, or chronic stress.
Following such an experience, the last stage of the process is, then, very likely to become activated -
outcome. At this stage, we are likely to begin experiencing several possible dysfunctional outcomes or
consequences. Depending on our unique (physical and mental) composition and circumstances, these
consequences could manifest themselves as mental (i.e., thinking), emotional (i.e., feeling), behavioral
and/or physical reactions. Again, depending on the circumstances involved, these reactions may appear
mild at first, but over time increase in their frequency and severity as the stressors persist. Although
some of these reactions were mentioned before, greater attention will be paid to them and the stress
reaction stage of the stress process in Part II of the book.
Definition of Stress
Stress has been defined as the "rate of wear and tear caused by life.” For purposes of this book,
however, stress is viewed in a very particular manner.
Stress, which is an internal psychological and physiological reaction, occurs when

there is a perceived discrepancy between demands or stressors (both internal and
external) placed on us and our perceived or real resource capabilities to meet these
demands, which results in some threatening experiences [see Exhibit 3.5]. Simply
put, then, stress, which is an internal reaction, occurs when there is an imbalance
between demands and resources associated with the individual.
As is illustrated in Exhibit 3.4, depending on the relationship between the demands placed on you
and all the resources available to you (i.e., internal and external) at anytime determine if, and to what
degree, you will experience stress. Specifically, as seen in Exhibit 3.5(3A), when your life demands (i.e.,
both internal and external) are in relative balance with your resources (i.e., evenload), you have "ideal"
living experiences with, at best, negligible or "tolerable" amounts of stress. This situation rarely occurs,
for the average person usually experiences one or the other of the two remaining possibilities of
imbalance seen in Exhibits 3.5(3B) and 3.5(3C).
For Exhibit 3.5(3B), you are likely to experience stress because your life demands "outstrip" or
"outweigh" your available resources. This example is a case of the stressor being an "overload." The size
of the overload (i.e., your perception of, for example, the short time available to study for an exam) is in
turn related to the degree of stress (e.g., unusually painful stomachaches) you are likely to experience.
The situation is the reverse of that seen in Exhibit 3.5(3C), where your available resources
"outweigh" your varied life demands.
EXAMPLE: You feel that your current activities (e.g., at school) do not in any way allow you to
be challenged; instead, you feel a sense of boredom and frustration from this lack of intellectual
stimulation.
This example is a case of the stressor being an "underload." The size of the underload (i.e., your sense of
boredom) is related to the degree of stress you are likely to experience.
EXAMPLE: You have to complete an assignment and you don’t have either the time or the
effort to do the job satisfactorily. You become upset, especially if you are a person who
normally turns in your assigned work on time.
Exercise 3.1: Load Experienced
Based on your school and life activities, are you experiencing any, or a combination, of the following
types of loads? For each category that you check, provide examples of some of these experiences.
Evenload
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Overload
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Underload
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______________________________________ Exhibit 3.5: Stress - The relationship between demands and resources
____________________________________________________________________________________
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____________________________________________________________________________________
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What Do We Know About Stress?
O The Position Taken Concerning Stress (p.29)
O What Is Understood About Stress (p.30)
O The Role of Perception (p.30)

9 Stress As a Transaction (p.31)
9 The E-P-R Process: The Importance of Perception (p.31)
9 Factors Influencing Perception (p.32)
O Definition of Stress (p.33)

N Exercise 3.1: Loads Experienced (p.35)
__________________________________________________________________________________
4.
Stress and College Students: A Look At Selected Areas
ë
“Everything’s in the mind. That’s where it all starts. Knowing what
you want is the first step toward getting it.”
- Mae West
C
ollege is potentially stressful for many students, especially as they undergo the process of
adaptation to new social, educational and other experiences (Misra & Castillo, 2004). College
students in general, and freshmen in particular, are as a group particularly prone to stress
(Towbes & Cohen, 1996) due to the transitional
nature of college life (D’Zurilla & Sheedy, 1991). Among
the various factors they have to deal with include: adjusting
to being away from home for the first time (Exhibit 4.1),
maintaining a high level of academic achievement, the
pressures of finding a job, and coping with interpersonal
relationships (Ross et al. (1999).
While many studies are increasingly being done on
stress and college students (e.g., Edwards et al. 2001;
Misra, et al. 2000; Zaleski et al., 1999), there is a paucity of
books that address the subject in an informed and systematic
manner with the ultimate aim of having students becoming Exhibit 4.1: College life experiences
more aware and successfully managing their stress in
college. This chapter, along with the entire book, is a deliberate effort to reduce this unfortunate void
in the literature.
The dynamic relationship between the person and environment in stress perception and
reaction is especially magnified in college students. The problems and situations encountered by
college students may differ from those faced by their non-student peers (Hirsch & Ellis, 1996). The
environment in which college students live is quite different. While jobs outside of the university
setting involve their own sources of stress, such as evaluation by superiors and striving for goals, the
continuous evaluation that college students are subjected to, such as weekly tests and papers, is one
which is not often seen by non-students (Wright, 1964). The pressure to earn good grades and to earn a
degree is very high (Hirsch & Ellis, 1996). Earning high grades is not the only source of stress for
college students. Other potential sources of stress include excessive homework, unclear assignments,
and uncomfortable classrooms (Kohn & Frazer, 1986).
As a result of the increasingly pervasive nature of stress on college campuses, identifying and
treating college stress, along with its associated negative health outcomes and behaviors (e.g., alcohol
drinking), have become a growing challenge for college administrators (Kanters et al., 2003). Most
major universities in the United States have responded to this challenge by incorporating student
development programs and services in an attempt to assist students coping more effectively with the
stresses of college life (Hensley, 1997).
The Yerkes-Dodson Law
A critical issue concerning stress among students is its effect on learning. The Yerkes-Dodson
law (1908) postulates that individuals under low and high stress learn the least and that those under
37
38 PART II % Identifying the Background, Nature and Causes of Stress
moderate stress learn the most. A related point is that evidence supports the notion that excessive stress
is harmful to students' performance. Mechanisms that explain why students perform badly under stress
include "hypervigilance" (excessive alertness to a stressful situation resulting in panic--for example,
overstudying for an exam) and "premature closure" (quickly choosing a solution to end a stressful
situation--for example, rushing through an exam).
It is a known fact that students react to college in a variety of ways. It is also known that in the
case of some students, college is stressful because it is an abrupt change from high school. However,
for others, separation from home is a source of stress. Although some stress is necessary for personal
growth to occur, the amount of stress can overwhelm a student and affect the ability to cope (Whitman,
2004).
A Harvard University Experience
Being aware of the enormous toll that stress takes on a society, including the college
community, Harvard University has established a project that is intended to counter the deleterious
effects of stress on its students. Speaking at a meeting of new students, Potier (2003) states “For the
next several weeks, the entire Harvard community will be getting de-stressed, balanced, massaged,
yoga’d, and, one hopes, a good night’s sleep.” As reported in the Harvard University Gazette, this
event is the “Third Caring For the Harvard Community,” which is a series of events that lasts for about
a week, which aims to unwind the University’s collective psyche. There are discussions and workshops
in undergraduate dorms and houses, graduate schools and administrative offices. While the main goal
is not to solve all mental health issues on campus, it attempts to introduce the Harvard community to the
University’s rich resources of help and support whenever they are needed. The following quotation was
taken from the Harvard University Gazette, and it sums up the intent and goals of the university-wide
attempt.
“Harvard is an extremely stimulating community, and sometimes the pace of everyday

life can be quite stressful for those who study and work here,” says Assistant Provost
Marsha Semuels, who founded the event and oversees it for the Office of the Provost.
“Caring for the Harvard Community offers a community-wide time for a deep breath and
a chance to think about how we balance our lives and build positive relationships.”
This project is worth duplicating at all colleges and universities.
Overview of the Area Concerning Stress and College Students
Stress is a subjective experience (Livingston, 1994), because what may be distressing for one
person may be stimulating to another. Also, one’s reaction to the event that causes stress (i.e., the
stressor) makes the difference between those (e.g., college students) who succeed and those who fail. It
is important to note that the American psychiatric Association’s Diagnostic and Statistical Manual of
Mental Disorders (1994) considers stress an essential ingredient of every psychiatric diagnosis. You
may recall that as discussed earlier stress results from the interaction between events (or stressors) and
the individual’s perception and reaction to these events (Romano, 1992; Livingston, 1992; Livingston &
Livingston, 1994). In essence, the reaction (or response) to an event is influenced by the person’s
Chapter 4 . Stress and College Students: A Look At Selected Areas 39
perception of that event (see Exhibits 3.1, 3.2 & 3.3 in Chapter 3), which is a function of his/her culture
(e.g., college culture).
A recent study by Sax (1997) indicates a nationwide increase in college students’ stress.
Although various sources of stress were implicated, academic-related sources were the most prevalent.
Such stressors include, for example, students’ perception of the extensive knowledge base required for
college and the added perception of inadequate time to acquire it (Carveth, Geese & Moss, 1996).
Students reported experiencing academic stress, with the greatest sources of academic stress being
found in taking and studying for exams. Additionally, students were anxious about grade competition,
as well as the large amount of content they had to master in a small amount of time (Abouserie, 1994).
College students, especially freshmen, are a group particularly prone to stress (D'Zurilla &
Sheedy, 1991), due to the transitional nature of college life (Towbes & Cohen, 1996). They must adjust
to being away from home for the first time, maintain a high level of academic achievement, and adjust
to a new social environment. College students, regardless of year in school, often deal with pressures
related to finding a job or a potential life partner. These stressors do not cause anxiety or tension by
themselves. Instead, stress results from the interaction between stressors and the individual's perception
and reaction to those stressors (Romano, 1992). The amount of stress experienced may be influenced by
the individual's ability to effectively cope with stressful events and situations (D'Zurilla & Sheedy,
1991). If stress is not dealt with effectively, feelings of loneliness and nervousness, as well as
sleeplessness and excessive worrying may result. It is important that stress intervention programs be
designed to address college students’ stress and related problems.
Mental Health Issues and Related Conditions
According to Peterson (2002), the National Institute of Mental Health (NIMH) pays special
attention to college students and mental illness on their Web site (www.nih.gov). A major reason for
this emphasis could be that mental illness is on the rise on college campuses (Exhibit 4.2). North
America’s college counseling centers report an increase in troubled
students. Based on a survey conducted at counseling centers, 85
percent of colleges report an increase during the past five years in
students with severe psychological problems (Peterson, 2002).
Apart from direct mental health issues, colleges are breeding
grounds for an array of mental health and other stress-related
ailments as colds, flu, mononucleosis and strep infections, again,
especially for freshmen. In the case of freshmen, many are on their
own for the first time and have no structure in their lives.
Exhibit 4.2: Seeking mental health Additionally, they may be homesick, they may not be eating right
services because they skip meals, and they are living “close” to other
students. In a recent study involving “negative life events and
psychological distress, Williams (2002) reported the following:
“Freshmen, indeed have the highest stress reaction to negative life events.
Freshmen who reported negative events happening to them were more emotionally
distressed than seniors who reported the same types of events... Sophomores and
juniors were also more upset by these problems than seniors, but freshmen were the
most vulnerable.”
Even though campus health centers expect to see students with health problems from the
beginning of the semester, the biggest workload of the academic year usually comes during final exam
week of the fall semester. At this time students lack sleep, are eating poorly and, in many cases, the flu
is prevalent (USA Today, 1966). Another frequently seen phenomenon at this stressful period for
students is the response of the skin to stress, which is manifested in the form of severe outbreaks of
acne (Chiu, Chon, & Kimball, 2003).
An increasingly prevalent mental health outcome on college campuses is depression and
depressive symptoms (Affsprung, 1998; Okazaki, 1997). It has been estimated that college students are
twice as likely to have clinical depression and dysthymia (which is a less intense type of depression
involving long-term, chronic symptoms that are less severe, but which impact the ability to be happy) as
are people of similar ages and backgrounds in the workforce (Bonner & Rich, 1988). Depression and
dysthymia have special importance for college students in that they can interfere with the educational
process and are often associated with a lack of college success and attrition (Dixon & Reid, 2000).
According to the NIMA (2004), researchers are finding that many mental illnesses may be
traced to trauma whose damage surfaces in times of stress and change, such as the college years. Based
on this NIMA (2004) report, some of the threats to college students' mental well-being are highlighted
below.
K Depression affects over 19 million American adults annually, including college
students. At colleges nationwide, large percentages of college students are feeling
overwhelmed, sad, hopeless and so depressed that they are unable to function.
According to a recent national college health survey, 10 percent of college students
have been diagnosed with depression, including 13 percent of college women.
K Anxiety disorders affect over 19 million American adults every year, and anxiety levels
among college students have been rising since the 1950s. In 2000, almost seven percent
of college students reported experiencing anxiety disorders within the previous year.
Women are five times as likely to have anxiety disorders.
K Eating disorders affect 5-10 million women and 1 million men, with the highest rates
occurring in college-aged women.
K Suicide was the eighth leading cause of death for all Americans, the third leading cause
of death for those aged 15-24, and the second leading killer in the college population in
1998.
K According to the Federal Centers for Disease Control and Prevention (CDC), 7.8
percent of men and 12.3 percent of women ages 18-24 report frequent mental distress
–– a key indicator for depression and other mental disorders.
K College students are feeling more overwhelmed and stressed than fifteen years ago,
according to a recent UCLA survey of college freshman. More than 30 percent of
college freshman report feeling overwhelmed a great deal of the time. About 38 percent
of college women report feeling frequently overwhelmed.
Domestic and International Students
The numbers of international students have been increasing steadily in the United States since
the 1950s and, as such, they constitute a sizable proportion of higher education students (Misra &
Castillo, 2004). According to the Institute of International Education Report (2002), a total of 582, 996
students representing more than 186 nations attended 2,500 institutions of higher education in the
United States in 2001. In many ways college life has the potential to be more stressful for international
students who have the added responsibility of learning different cultural values and language, as well as
the needed academic preparations for college (Mori, 2000).
According to Misra & Castillo (2004), while there are various studies on stress and college
students in general, there is a dearth of such studies on international students. While both domestic and
international students share certain common academic stressors, such as family-related pressures,
financial burdens, competition in classes, and course-related stress (Cheng, Leong & Geist, 1993), there
are differences that set them apart. For example, international students may perceive their academic
environment differently; in addition they may have different coping strategies that result from their
cultural backgrounds (Sanuhu & Asrabadi, 1994).
Reactions to stressors may take on many forms, including physical and psychological arousal.
Because it is not unusual for excessive stress to induce physical impairments, it is not uncommon for
students to be afflicted with persistent lack of energy, loss of appetite, headaches, and/or
gastrointestinal problems (Winkelman, 1994). For some international students, may somaticize their
feelings of stress to avoid the stigma of seeking psychological assistance (Mori, 2000). This being the
case, for example, international students’ experiences of headaches, loss of appetite, or sleep may be
attributed to a physical illness even though the complaints have no clear organic basis (Mori, 2000).
Furthermore, although American students experience stress reactions , such as anxiety, depression, or
both, many international students do not distinguish emotional distress from somatic complaints (Mori,
2000). Thus they use the college health service more frequently than American students for stress-
related problems (Essandoh, 1995).
College Athletes
On any university or college campus student athletes, both males and females, are an important
part of the student body. While in many cases the concerns of athletes are similar to those of non-
athlete students, in many respects there are important differences
(Exhibit 4.3).. Current National Collegiate Athletic Association (NCAA)
statistics approximate that over 361,000 student athletes are participating
in collegiate sports.
Reports suggest that approximately 10-15 percent of American
college student athletes are coping with issues significant enough to
warrant the need for professional counseling services (Ferrante, et al.,
1996). Student athletes attend college with the same academic,
emotional, and personal goals and concerns as other college students
(Ferrante, et al., 1996). However, one noticeable difference is that
college athletes also cope with additional influences that impact their
cognitive, social, moral, educational, and psychosocial development. It Exhibit 4.3: Athletic activities
is important to note that although college counseling centers are available, student athletes have
traditionally chosen to seek help from other sources such as coaches, teammates, family, and friends
(Watson, 2004).
The positive side concerning athletes are the benefits associated with exercise, which many
athletes as a matter of training have to adopt in a relatively regimental manner. In many cases, physical
fitness is positively correlated with cognitive functioning and self-discipline, or that it is negatively
correlated with stress. However, especially with team sports, athletes who exercise vigorously
everyday, the "dumb jock" stereotype still exists. Just being a team sports athlete increases stress for
some students. Some athletes handle the stress of being an athlete better than others depending on their
level of self-discipline, personality and supportive structure around them.
The importance of exercise as having many physical and psychological benefits was
underscored by research reports in the past. For example, in a study on the relationship between
physical activity and the cognitive ability of older adults (Clarkson-Smith & Hartley, 1989), some
adults did 1 1/4 hours of strenuous exercise a week; others exercised less than ten minutes per week.
The results showed that the adults who exercised more performed better on tests of reasoning, memory,
and reaction time than the adults who exercised very little.
Misconceptions and stereotypical viewpoints have hindered the development of effective
counseling interventions with this population. Ferrante, Etzel, and Lantz (1996) noted that the general
view of college athletes is that they are over privileged, pampered, lazy, out-of-control, and primarily
motivated to attend school for the sole purpose of participating in intercollegiate athletics. These
misconceptions cloud the fact that student athletes are individuals with problems like everyone else, yet
they are not receiving the potential benefits of counseling services. Recent findings have shown that this
is more of an issue than originally estimated (Maniar, Curry, Sommers-Flanagan, & Walsh, 2001). In
fact, researchers have shown that student athletes are not only hesitant to seek help from a counselor,
but they are also reluctant to take advantage of sport psychology services (Brewer, Van Raalte, Petipas,
Bachman, & Weinhold, 1998).
Traditionally, student athletes have been raised in an environment that stresses the importance
of resiliency and self-reliance (Etzel, Ferrante & Pinkney, 1991). The good of the team or the overall
athletic performance takes precedence over personal problems (Etzel, 1989). This mentality may lead to
the onset of barriers to help-seeking behavior. These barriers include a win-at-all-costs philosophy and
the social stigma associated with seeking help.
In dealing with college student athletes, it is often necessary for the counseling professional to
be proactive. A working knowledge of barriers that might factor into a student athletes' decision to seek
counseling can help counselors better respond to the unique challenges and concerns of this population.
Counselors can help student athletes overcome internal barriers to seeking help by promoting the
connection between mental and physical health. Individuals who enjoy optimal mental health will
perform better by being able to manage stress and concentrate more on their performance (Vandervoot
& Skorikov, 2002). Counselors can also conduct sessions in or near athletic facilities where student
athletes can access services privately. They may also work directly with teams by attending practices or
designated team meetings (Watson, 2004).
African American Students
Many researchers have voiced the view of race as a sociological designation that indicates the
likelihood of exposure to common life experiences (Williams,
1992). According to Anderson et al. (1991), the history of Blacks
(Exhibit 4.4) and the larger American society is one characterized
by oppression, alienation and exclusion from full participation.
This being the case, it is logical to expect that there may be
experiential differences between African American and
Caucasians that go beyond their relatively similar developmental
experiences. These latter differences tend to be more obvious
when African American students are at predominantly White
institutions (PWIs) (Neville & Heppner, 1997; Bylsma et al.,
2003).
Exhibit 4.4: Civil rights achieve-ments
Racism and Discrimination as Potential Stressors
African American college students, especially those attending PWIs, may experience additional
stressors that are beyond the customary academic-related experiences. For example, empirical reports
suggest that a large number of African American college students attending PWIs are still exposed to
racially insensitive comments on campus (D’Augelli & Hershberger, 1993), where it is not surprising
that in some cases these comments were identified as stressful (Neville & Thompson, 1991). These
revelations are extremely important given that African Americans experience racism and related
discrimination on a daily basis and that these events, in turn, are related to psychological adjustment
(Jenkins, 1995).
One way to cope effectively with racism and discrimination is to undergo various types of
psychological adjustments. One such form of adjustment that has been suggested in the past is by
Baldwin (1985). Baldwin argued that for healthy psychological functioning to occur, African
Americans must develop a positive African self-consciousness (ASC). Essentially, African self-
consciousness is a component of Black personality and identity that emphasizes a relational, collective
and communal self-consciousness. All of these factors are organized as a congruent pattern of basic
African traits, which include beliefs, attitudes and behaviors. The elements of the African self-
consciousness construct include the following factors:
K Collective African identity and self-fortification;

K Resistance against anti-African forces;
K Value for African-centered institutions and cultural expressions; and
K Value for African Culture (For more information on these elements, see Kambon, 1996.).
In a test of the validity of having a positive African self-consciousness, Thompson (1996)

reported a positive correlation between the African Self-Consciousness (ASC) Scale and Health-
Promoting Lifestyle Profile II (HPLP) in a sample of African college students. According to Chambers
et al., 1998), an African American self-consciousness orientation that is both positive and culturally
affirmative should, therefore, have the potential to moderate some of the negative effects of chronic
stress and racial oppression. Additionally, African Americans who are trapped ambivalently between
self-affirmation and self-denial may experience intrapsychic conflict and dissonance, all of which may
lead to distress and other injurious health outcomes.
Heppner et al. (2004) also investigated the effect of race-related stress on African American
college students' adjustment to attending a predominantly White university. The participants (N = 260)
completed the Black Student Stress Inventory (BSSI) and a measure of psychological adjustment. Based
on statistical analyses, the BSSI yielded a three stress-related outcome: race-related stress,
psychological/interpersonal stress, and academic stress. As hypothesized, general and race-related
perceived stressors were related to psychological distress, whereas academic stress was specifically
related to overall grade point average.
Apart from the research involving African American students at PWIs, there have been other
reports involving African American students at Historically Black Colleges and Universities, or
HBCUs. Many of these areas of research activity have been in non-traditional areas. For example,
within the last decade, researchers have begun to investigate a host of positive psychological factors
(e.g., optimism, spirituality, social support) that have been shown to influence general well-being. In
the case of optimism, Scheier, Carver and Bridges (2000), referred to dispositional optimism as the
degree to which an individual holds positive expectancies for their future. More specifically, individuals
who believe that the desired goal is attainable will overcome adversity to reach that goal. These
individuals, in turn, expect a positive outcome from their effort and are properly called optimists. In
particular, optimism is linked to desirable outcomes such as good morale, achievement, improved
health, and coping with adversity (e.g., Chang, 1996). Baldwin et al. (2003) reported on a negative
correlation between optimism and reported life-stress events for a sample of African American students.
That is, students who scored high on measures of optimism reported significantly less perceived stress
than their pessimistic counterparts. Additionally, underclassmen reported more academic stress than
upperclassmen.
Research concerning African American female college students have also been reported, for
example in the stress-related area of suicide ideation. Generally speaking, because African American
women have lower suicide rates than other women and men in the United States, it is thought that they
may possess suicide buffers. Such buffers include social support, religiosity, negative attitudes
regarding suicide acceptability, and African American culture. Marion and Range (2003) examined the
relationship that buffers may have with suicide ideation, using African American female college
students (N=300). They identified three variables which accounted for a significant and unique portion
of the variance in suicide ideation: family support, unacceptability of suicide, and a collaborative
religious problem-solving style. They identification of these factors may help in the assessment,
prevention, and intervention of suicide for African American women, as well as for other women and
men.
Nontraditional Students
Traditionally, college populations were viewed as relatively homogenous, composed primarily of
White males between 18-24 years old. However, today’s college population is more diverse and more
students are enrolled part-time, they are older (25 years and older), and have multiple roles (Smith,
1993)(Exhibit 4.5). Sometimes these older students are referred to as non-traditional students (i.e.,
versus traditional or more typical students with regard to age, marital status, etc.), and they may either
be undergraduate or graduate students. According to Kanters et al. (1998), the changing environment of
college has heightened stress levels for these as well as for all other students attending colleges and
universities.
Nontraditional can be defined as having multiple roles (e.g., parent,
employee, student) and at least one year between high school and college.
Traditional students usually do not have most of those roles; they enroll in
college directly from high school (Dill & Henley, 2003). Elson (1992) suggests
that in excess of one-third of the students currently enrolled in U.S. colleges are
nontraditional and more than 35 years old. The U.S. Department of Education
predicted that 46 percent of all college students will be older than 24 years
(Manning, 1992). Projection such as these underscore the need to address the
potential problems (e.g., stressful experiences) nontraditional students face as
they reenter institutions of higher learning. What follows is a selection of reports
from some such studies.
Dill & Henley (1998) compared stressors experienced between Exhibit 4.5:
Nontraditional student
traditional and nontraditional college students. Their findings suggest that
nontraditional college students possess a greater desire to learn as evidenced by more often completing
homework and viewing it more desirably. On the other hand, traditional college students reported more
often that they worry about their performance in school; and they view homework as less desirable than
the nontraditional college student (Dill & Henley, 1998).
Another study investigated achievement motivation goals in college students in relation to academic
performance and found that nontraditional college students endorsed a learning goal orientation
significantly more than did traditional college students (Eppler & Harju, 1997). They also discovered
that the older the nontraditional students were, the more frequently they adopted learning goals and
were more committed to them than their younger traditional peers.
A recent increase in the number of nontraditional college students has raised the possibility
that traditional and nontraditional college students utilize different coping styles when confronted with
stressful situations. Endler and Parker (1990) argue that people develop distinct styles of coping when
responding to stressful situations. Based on the results of their study, Morris, Brooks & May (2003)
suggest that a relationship exists between student status, academic goal orientation, and type of coping
style utilized. Specifically, it was reported that nontraditional college students more often endorsed
learning goals and utilized task-oriented coping, in addition to exhibiting a wider repertoire of coping
behaviors than did the younger traditional college students. The results of this and other studies have
important implications for attempting to outline the role that achievement goals and coping styles play
in reducing college-related stress both within and between traditional and nontraditional college
students.
Graduate Students
There are approximately 1.5 million young adults enrolled in graduate programs throughout the United
States (Barma, 2004). Although the stereotypical notion is that graduate students are fresh out of
college, the truth of the matter is that the real profile suggest that they are older, established in their
careers, are paying mortgages and having kids (Abell, 2002).
What is the Profile of The Typical Student?

According to a recent report from the National Center for Education Statistics, the average
graduate student is approximately 33 years old. Also, one-half are married,
, and about a third have children (Exhibit 4.6). Because of their positions
in life, for many of these students a full-time graduate program does not
make any sense. Additionally, only 36 percent of all masters’ students and
61 percent of doctoral students attend school full time (Abell, 2002).
Because of the nature of their advanced professional work in college, as
well as the expectations of others (including themselves), graduate students
have the potential to experience a great deal of stress (Barma, 2004; Reed
& Giacobbi, Jr, 2004).
Exhibit 4.6: The varied
Results From a National Survey on Graduate Students responsibilities of a typical
In an effort to find out who graduate students really are, moreso graduate student
because most of them will be the leaders of tomorrow, a survey was
conducted in order to address the paucity of information about this vital segment of the college
population. The Barna Research Group worked in cooperation with Grad Resources to conduct a
national survey of graduate students. Using telephone surveys with a representative sample of 404
students, stratified by degree program and type of school, students’ responses were evaluated based on
their interests, lifestyles, and expressed needs. Important areas of feedback, such as i) Anxiety-arousing
concerns; ii) stress and burnout; iii) coping with pressure and stress; and iv) having a balance in life, are
all presented below with exact narratives drawn from the report.
“The most crippling anxiety affecting grad students was the struggle to achieve balance in life.
While there is gratification earned from academic achievement, grad students fear being
transformed into academic machines, devoid of any real life outside the classroom or library. In
conjunction with this fear was concern for their personal health. Many grad students indicated
that stresses and pressures of grad school were taking an emotional toll on them.”
“Nine out of ten grad students concurred that stress and burnout were already major concerns in
their life. Although the majority of grad students are in their twenties and early thirties, they are
already wrestling with major issues ascribed to people in the later stages of life: those caught in
the throes of a fast-lane career.”
“How do grad students handle the weight of pressure they encounter? They turn inward.
Independent and self-reliant, they turn to the one person in whom they have ample trust and
confidence: themselves. Nine out of ten grad students claimed that they "frequently" rely upon
themselves for growth and stability. Other common sources of encouragement and stability cited
were friends and family, but these were called on for help with limited frequency.”
“The importance of the issue of balance in lifestyle cannot be over emphasized. Balance is not one
of the post graduate realities for which students are being prepared. Discussions about balancing
career achievement and personal wholeness are absent from classroom lectures, and missing from
pages of the text books that are underlined and memorized. Yet the conclusion grad students arrive
at regarding balance may be among the most important products of their studies. Their definition
of balance, their means of achieving it, and the importance of balancing competing interests will
set the pace for their post collegiate lifestyles. And that, as much as anything else they derive from
their studies, will direct the quality of their lives.”
Other Work On Graduate Students

In an effort to document evidence of stress on a more physiological level, i.e., cortisol (stress
hormone) (which in many ways is more a definitive test of the stress response), the results of an
empirical study was reported by Ng,Koh,and Chia (2003). These authors reported that immediately
before and after participation in a written final examination, 11 graduate students rated their self-
perceived stress and provided saliva samples for cortisol assay. Students rated stress higher before the
examination, and these ratings were associated with increased salivary cortisol. Students who reported
higher stress and had higher cortisol levels before the examination tended to have significantly lower
examination scores.
In an attempt to take a more comprehensive view of reducing the stress experienced by graduate
students, a series of measures were recommended. It was said (ASHE-ERIC, 2001) that the “perilous
passage” toward a graduate degree must ideally begin with important systemic changes. However,
modifying academic programs is a good first step in the right direction. As faculty are asked to
contribute more to making graduate education less stressful, the following conditions were suggested
for faculty to accomplish:
K Find ways of increasing diversity (i.e., of the student population, thereby, for example,
increasing students’ feelings of security);
K Offer both financial and moral support (both are needed when students are under stress
pursuing the graduate curriculum); and
K Modify their own behavior (i.e., make their behaviors open, welcoming and supportive) to
complement the emotional and other academic-related needs (i.e., stresses) of graduate
students.
College Students’ Sexual Orientations

College life, while being the best years for some students, can become the worst years for
others. While many factors contribute to these two possibilities occurring, based on the theme of this
book it is argued that how students manage their stress will contribute to where they fall on the
continuum ranging from being stressed and not being well to being relatively un-stressed and being
well. Depending on how students’ sexual orientations are addressed, they can be a source of stress for
students who may be bombarded by a litany of other demands.
Sexual Orientation or Identity

Before any discussion is made about sexual orientation it is appropriate to present some
definitions for concepts and answers for some questions associated with sexual orientation or identity.
What follows is such information compiled in a fact sheet format by Nicholas & Murphy (2004).
Sexual orientation refers to one’’s attractions/feelings toward women and/or men.

Is Sexual Orientation a Choice?
There is increasing evidence that sexual orientation has at least some biological basis, and most people report
that their sexual orientation is not something they have chosen. Instead, most people, regardless of their sexual
orientation, feel that their sexual orientation is something that has always been there as it is.
It is normal to question your sexual orientation. Many people do this during their college years, when they are
exposed to new people and new experiences. Of course, some people explore their sexual orientation at a younger
or older age.
Who is Lesbian, ……or Gay, Bisexual, Transgender (LGBT)?
Lesbian, gay, and bisexual people are any age, gender or racial/ethnic group. Of course, cultural and social
differences may alter the way a lesbian, gay, or bisexual person manages her/his feelings and identity because
these dictate the way others will perceive and react to them.
LGBT: Lesbian, Gay, Bisexual, Transgender, and Questioning - What do these terms mean?
Lesbians: Women who are attracted (sexually and/or romantically) to other women.
Gay men: Men who are attracted (sexually and/or romantically) to other men.
Bisexual: People who are attracted (sexually and/or romantically) to both women and men
Transgender: People whose gender identity or gender expression contrast with traditional social norms and
expectations for their physical sex. “Transgender” is an umbrella term that includes various identities (too
numerous to list here) such as pre-operative; post-operative; non-operative transsexuals, who report feeling
that they have been born into the wrong physical sex; cross-dressers (traditionally known as transvestites), who
wear opposite-sex clothing as a means of expressing their inner cross-gender identity and/or as a method to
become sexually aroused; and intersexed individuals (previously known as hermaphrodites), who have both
female and male reproductive organs.
People who identify as transgender, may or may not be lesbian, gay, or bisexual. Transgenderism has to
do with one’s gender identity, as opposed to one’s sexual orientation. LGBT and Q people are often
grouped together because these groups are all considered sexual minorities. They each face issues of
identity that make them susceptible to homophobia, physical violence, personal rejection, and more, largely
because of misinformation, prejudice, and discrimination.
For more information on transgender issues, visit the web site:
http://www.youth-guard.org/pflag-t-net/.
While adjusting to college can be a difficult process for students, when these adjustments also
include struggles with accepting and disclosing their own homosexuality or bisexuality, their college
experience can become more complicated and challenging (Bellman 2004). College students typically
further develop their sense of identify as they gain greater independence from parents and family. The
stressful nature of this process may be increased due to the integration of a gay, lesbian, or bisexual
sexual orientation, especially in situations where family and friends do not know of the person's sexual
orientation (Hetrick & Martin, 1987).
The Importance and Process of “Coming Out”

A very important milestone for students to express their sexual orientation is the “coming out”
process. According to Rhoads (1994), coming out is the process of disclosing one's sexual orientation,
and it is described as a lifelong process. "No matter how many people know about one's sexual
orientation, there will be others to whom that individual will have to come out" (Rhoads, 1994, p. 77).
Although there are many models of the coming-out process that have been described, generally the
process begins with self-acknowledgment and ends with the acknowledgment to others of one's sexual
orientation. According to Bellman (2004), the sequential stages usually follow a customary pattern of
self-revelation and acknowledge self-disclosure decisions and disclosure to parents. Disclosure
decisions are extremely difficult, painful and stressful for some individuals; yet, for others, it is the best
and satisfying release they ever experienced.
At the onset, telling family and friends can be very risky, especially when they fear that others
will reject them (Gluth & Kiselica, 1994). Many, if not most, lesbian, gay, and bisexual people self-
disclose by age 21 (D'Augelli, 1991). Many homosexual and bisexual individuals have reported that
they first disclosed their sexual orientation to someone, usually a friend, by age 16 or 17, followed by
disclosure to a parent approximately one year later (Maugen, Floyd, Bakeman, & Armistead, 2002).
Many individuals have reported coming out to homosexual peers first because they anticipate a lesser
threat of rejection (Gluth & Kiselica, 1994). It is important to note, however, that as individuals
develop stronger social networks, they generally become more self-confident and self-accepting. As a
result, they learn to feel more comfortable disclosing their sexual orientation with those whom the
threat of rejection is greater (e.g., family and friends) (Bellman, 2004).
The Benefits of “Coming Out”

Regarding the benefits of disclosing individual’s disclosing their sexual orientation, many individuals
have described coming out as one of the most significant experiences of their lives (Rhoads, 1994). In
the case of students, many have used words such as, "a great relief," or an experience that is, "freeing,"
"empowering," "frightening," and "challenging," to illustrate their coming-out process. None of the
students interviewed in Rhoads' project reported any regrets about coming out. In general, homosexuals
who have been able to come out tend to report more positive self-esteem, fewer anxiety symptoms, and
less depression (Coleman, 1982).
Research has shown that youths who have disclosed their sexual orientation to a wider range of
family and friends experience greater self-esteem as adults (Jordan & Deluty, 1998). LaSala (2000)
found that although almost all of the gay men in his study reported initial and ongoing parental
disapproval for their lifestyles and relationships, most men believed that it benefited their same-sex
unions to be "out". Advantages of coming out to their parents and their partners' parents included not
having to hide the relationship as well as inclusion of one's partner in family events. Similarly, another
study found that lesbians who more widely disclosed their sexual orientation expressed a great degree
of satisfaction with their relationships, greater than those who have not done so (Jordan & Deluty,
2000).
Some Issues and Concerns Surrounding “Coming Out”
Though sexual orientation issues have largely been ignored in studies of adolescents and young
adults, current research finds the gay, lesbian and bisexual (GLB) adults are at high risk for many
stress-related problems, for example: suicide, depression and fear of harassment or violence (Cochran &
Mays, 2000; Bernat et al., 2001). Additionally, GLB young adults are more likely to have been
threatened with a weapon, to have a fight-related injury requiring medical attention, to feel unsafe at
school (i.e., both in high school and college), and to have been the target of anti-gay violence (Bernat et
al., 2001).
What follows are some interpretations made and responses given by GLB college students when
they were interviewed.
ê Most students reported that they “came out” once they saw that it was fairly acceptable to
do so – more so than in their home environments. Students coming from small towns, or
conservative families who felt that they could not be open with their sexuality at home, said
they felt paranoid, because they were actually leading double lives at school and at home.
ê One female student said she came out when she arrive at college, and she began her first lesbian
relationship. Her lover was also new to the lifestyle, and she was unwilling to commit to a GLB
community. Consequently, conflicts in the relationship became so stressful for both women that they
ended it because it started to affect their grades.
Whether a student is homosexual, bisexual or transexual, there are many factors that can cause
stress and lead to further problems (e.g., HIV/AIDS, pressured sexual activity, alcohol/drug use/abuse).
Some GLBT students will choose a variety of stress relievers; however, for others the only relief can
and must be found through consultations with a trained professional at college (e.g., clinical
psychologist, counselor, psychiatrist).
Stress and College Students: A Look At Selected Areas
O The Yerkes-Dodson Law (p.37)
O A Desirable Harvard University Experience (p.38)
O Overview of the Area Concerning Stress and College Students (p.38)
O Mental Health Issues and Related Conditions (p.39)
O Domestic and International Students (p.40)
O College Students (p.41)
O African American Students (p.42)

9 Racism and Discrimination As Potential Stressors (p.42)
O Nontraditional Students (p.44)
O Graduate Students (p.45)

9 What is the Profile of The Typical Student? (p.45)
9 Results From a National Survey on Graduate Students (p.45)
9 Other Work On Graduate Students (p.46)
O College Students’ Sexual Orientations (p.46)

9 Sexual Orientation or Identity (p.46)
9 The Importance and Process of “Coming Out” (p.48)
9 The Benefits of “Coming Out” (p.48)
: Some Issues and Concerns Surrounding “Coming Out” (p.49)
___________________________________________________________________________________
5.
What Causes Stress?

ë
“ Don’t cross your bridges until you get to them. We spend our lives
defeating ourselves crossing bridges we never get to.”
- Bob Bales
O
ur modern-day society is increasingly recognized as an "age of stress," i.e., a time in which
stressful factors press on us from literally every side. Stress is so widespread in our modern-day
society that it affects us wherever we are, i.e., whether we are at home, school, work, and even
on the streets when we are commuting (e.g., by car or train) to some destination. In a related manner,
just as there are many ways stress can affect us, there are as many sources of stress (or stressors) that
can affect each of us in a different way.
Who and What Stress Affects
Stress affects everyone despite age, gender, race, ethnic group, job affiliation, and geographic
location. The economic and human toll from stress and its related problems are estimated to be in the
billion of dollars annually. Some areas affected by stress and its related problems include, but are not
limited to, the following:
K Absenteeism at work;
K Accidents on- and off-the-job;
K Sickness;
K Alcoholism, insomnia, depression, heart disease;
K Poor grades in school;
K Roommate problems
K Financial problems
K Career choices
K “Burnout” on-the-job; and
K Death (e.g., fatal heart attacks)
In today's society, attempts to escape the grip of stress are evidenced in many forms. These
include, for example, the heavy uses of alcohol, tranquilizers, and sedatives; the upsurge in suicides;
the popularity of esoteric stress reducing techniques like biofeedback, Zen, Transcendental Meditation,
Progressive Mind Control and Yoga; and the increase frequency to and use of spas, exercise programs
and built-in gyms at large corporations for their employees.
The Causes of Stress

Given the definition of stress, another way to ask this question is as follows: What is
responsible for triggering our bodies to react and become physiologically excited? In short, what begins
the first stage of the stress process or stress onset? (See Exhibit 3.2).
Based on the illustration of the stress process presented (see Exhibit 3.2), the answer to the
51
52 PART II % Identifying the Nature,Background and Causes of Stress
above question, then, is stressors. At the onset stage, you perceive one or a combination of events or
stressors that are occurring (or are likely to occur) in your life as threatening, primarily because of your
perceived inability to cope or manage the demands associated with these events. By saying that "I am
under much stress," most people think of stress as coming from the outside, i.e., external to them. This
is a very frequent and common misconception (see insert).
COMMON MISCONCEPTION: It is generally thought that stress is an external condition, experience

or event (i.e., stressor) that is responsible for us feeling “uptight.” The truth of the matter is that stress
is the host of internal body reactions we experience as a result of stressors.
EXAMPLE: The mere presence of a crowded subway train; an unexpected downpour of heavy rain;
or a stop light that does not seem to be changing as fast as you would want, are all events external to
you. These events are usually thought of as automatically responsible for the stress we experience.
Such thinking, however, is incorrect, misleading and in need of factual explanation.
FACTS: Stress refers to our reaction to that “external event,” not to the cause itself. As mentioned
before, stress is the term used to refer to our response to events in our environments that we perceive
as posing a threat to us or creating a demand for us to cope with them. Lacking the necessary resources
to cope determine, to a great degree, the quality, quantity, frequency, intensity and duration of stress
we ultimately experience.
Hans Selye (1980), who is generally viewed as the "father" of stress research, called stress the
"nonspecific response of the body (which may be triggered by various causes, depending on our
individual makeup) to any demand made upon it." These demands may be mental, physical or both, but
they always involve the same physiologic changes within our bodies. In keeping with how stress has
been defined before in this book, it is important to note that how successfully we respond to stressors
will, in turn, determine how much stress we experience.
Stressors: Features and Classification

Features of Stressors
As mentioned before, stress does not just happen any more than a candle simply ignites itself.
Just as you have to light a match and hold it to the candle wick to get it to burn, in a similar manner
stress is initiated or triggered by stressors. Again, as previously mentioned, external events or
situations that trigger stress onset and, therefore, cause stress, are called stressors. These events that are
potential stressors are varied as they are many.
These events that are likely stressors may be threatening (e.g., fear of having a fatal disease)
also non-threatening (e.g., marriage), and they may be real and immediate (e.g., a robbery, accident) or
imagined/futuristic (e.g., planning to fly on an airplane). In short, just about any event, good or bad, we
experience, or are likely to experience, can be potential stressors. As is illustrated in Exhibit 5.1 by the
number or reminder sticky notes,, potential stressors come in a variety of shapes and forms. They can
be physical (e.g., climatic conditions, pain, noise), social (e.g., meeting new friends, crowded
commuter buses and trains), or psychological (e.g., up-coming events that cause you to be anxious,
such as flying on an airplane and marriage). Stressors also may be hidden, i.e., we are "unaware" of
their influence (e.g., when you feel some unexplained anger, envy, or resentment toward someone else)
versus stressors being obvious, i.e., when you are somewhat aware of their presence. These latter and
53 Chapter 5 . What Causes Stress?
more obvious stressors are emphasized in this book, simply because a) these stressors are more easily
addressed (i.e., managed) and b) for the most part, they occur more frequently.
Classification of Stressors
Generally speaking, several factors influence the
types of effect stressors have on us. There are six very
important such factors that stand out above the rest and,
as such, should be noted and taught in every stress
management course, seminar and/or workshop (see
Exhibit 5.2).
It is important to note that while each factor can be
an independent contributor to stress on its own, they are
best understood as a constellation of conditions, all of
these are very much interrelated. For example, the
various types of stressors (e.g., low course grades,
Exhibit 5.1: Daily potential sources of stress or
parking tickets, roommate problems) students experience stressors
at any one point in time have more of an impact on them
depending on how long (i.e., duration) they have experienced these conditions; how many other
stressors (i.e., numbers) are involved at the time;
how often they occurred (i.e., frequency); how
strong they were (i.e., intensity); and past
experiences, if any, students have had in dealing
with identical and/or similar stressors in the past
(i.e., experiences).
The Role of Perception and Subjectivity in

Determining Stressors
A fact previously stated is worth mentioning
again, particularly because of its relevance and
importance in the area of stress management.
Conditions that represent a stressor for you may not
be perceived as a stressor for another person. There
are literally thousands of events in our daily life that
Exhibit 5.2: Factors influencing the effect of stressors can be more appropriately called potential stressors.
The major point here is that an event only becomes
an actual stressor when you perceive it as such (see Exhibits 3.2 & 3.3); this makes the stress process
very subjective and personal in its own right.
Perhaps the most frequently perceived stressors, still, are events or conditions that have to do
with threats or fears. Threats and fears can be either related to known or experienced events (e.g.,
inadequate feelings about yourself, physical danger, such as an on-coming truck, train); not known or
yet-to-be experienced events (e.g., getting an up-coming job, passing an examination).
Threats or fears also can take the form of worrying about the unknown. For example, what will
happen to you in the future? or will you be afflicted with a disease? However, given that there are
various stressors, and they differ from individual-to-individual, they need not, and should not, always
be thought of as associated with events that are only threatening in nature.
The Overlapping and Arbitrary Classification of Stressors

Aspects of our life activities are very much interrelated. Therefore, when we speak about
potential stressor areas, in an attempt to classify them, we find that there is considerable overlap
between the areas under which the various stressors fall, as well as the stressor categories themselves.
In the case of attempting to group stressors under various headings, it must be pointed out that any such
attempt, including the one made in this book, is arbitrary.
These difficulties notwithstanding, six such areas are usually spoken about which, collectively,
cover approximately all areas of
college students’ lives (i.e., both O Personality Stressors (Chapter 6)
college-related and non-college- O Private Life Stressors (Chapter 7)
related) from which they are O Psychosocial Stressors (Chapter 8)
likely to perceive or experience O Academic Stressors (Chapter 9)
stress. See a listing of these O Organizational Stressors (Chapter 10)
stressors in the insert below O Environmental Stressors (Chapter 11)
along with the chapters that
discuss each in more detail.
Also, see a brief description of these six stressor categories and how interrelated they are in Exhibits
5.3, 5.4 and 5.5. Although subsequent sections in chapter 6 will discuss each of these six stressor
categories, it is important to establish the interrelationship between them.
The point must be made again that although the focus is on college-related conditions that are
likely to be perceived as stressors, or stress-producing for students, the fact of the matter is that college
students also live in and are affected by non-college experiences like the rest on the non-college
population. This being the case, and as seen in Exhibits 5.3 thru 5.6, academic-related stressors are
only one of a variety of other conditions that are likely to negatively impact students.
As seen in Exhibit 5.3, an attempt is made to categorize the life experiences of college
students. Such experiences can be placed in the internal (i.e., physical, behavioral, cognitive and
behavioral areas) and external (i.e., physical, organizational and social-cultural environments)
“demanding” worlds. The linking stressors to both the internal and external demanding conditions
associated with college students are the psychosocial conditions (which also includes interpersonal
conditions). It is the dynamic interplay of all these conditions that have the potential to give rise to the
stress college students
ultimately experience.
In the case of Exhibit
5.4, an attempt is made to
categorize six stressor
conditions, each of which could
be labeled (i.e., based on
Exhibit 5.3) as internal, external
and intermediate demanding
conditions or stressors. These
six, separate yet interrelated
stressor conditions, have some
suggested specific experiences
Exhibit 5.3: Sources of potential pressure for college students
that may be associated with
each of the six conditions.
Again, at the center of all activities, are the personality conditions that are stress-producing or stressors.
As indicated, personality conditions, as seen by the bold circle line, is at the center of all other
conditions and they impact each of these conditions. Equally important, as indicated by the double-
Chapter 5 . What Causes Stress? 55
Exhibit 5.4: The interrelationship of the six potential stressor conditions (with some examples). The core role of
personality conditions is illustrated, as well as the “connecting” role of interpersonal conditions.
-headed arrows, there are reciprocal relationships between all of the six stressor categories as well.
Following the point made in Exhibit 5.3, and as illustrated by the directional arrows in Exhibit 5.4,
psychosocial conditions are the interactive or intermediate link between the more external (e.g., private
life, organizational, environmental) and internal conditions (e.g., personality, private life and
academics).
It is also important to note from Exhibit 5.4, that personality stressors form the “dominant core,”
from which all of the other five stressors evolve. Exhibit 5.5, further illustrates and underscores the
central role personality stressors play. That is, by being the dominant and primary group of stressors,
they subsume the other stressors and, by so doing, regulate their existence from the beginning.
In Exhibit 5.5, the dynamics of the stress process is further demonstrated by the more closer
interlocking of the stressor categories. Again, it is noted that because of the overall importance of
personality stressors, they constitute the “umbrella” stressor under which the other five stressors are
located. Further, it is very important to note that where all stressor categories meet and overlap in the
middle, if any individual finds himself/herself at this central location, he/she is at greatest risk to
Exhibit 5.5: Six main stressor areas and their relationship to each other. Again, personality conditions represent
the “core” stressor category. Also, the individual is at maximum risk to experience stress and its concomitant effects
if he/she is undergoing all of the effects of the six stress conditions simultaneously. This possibility is illustrated by
the individual being at the “center” where all conditions overlap.
experience stress-related problems. In short, any student who happens to be experiencing some stress
relating to all of six categories at the same time is a likely candidate for a series of negative outcome
experiences, including performance decline in school work and sickness. Depending on the quality and
quantity (see stressor categories in Exhibit 5.1) of the prevailing stressor conditions, and, in more
extreme cases, heart attacks, stroke, and, ultimately, death can be experienced. Therefore, because
being in such a position is very dangerous to your health, all efforts must be made to manage the tigers
around you that contribute to your being in this very vulnerable and health-threatening position, or
stress trap.
Chapter 5 . What Causes Stress? 57
What Causes Stress?
O Who and What Stress Affects? (p.51)
O The Causes of Stress (p.51)
O Stressors: Features and Classification (p.52)

9 Features of Stressors (p.52)
9 Classification of Stressors (.53)
: The Role of Perception and Subjectivity in Determining
Stressors (p.53)
: The Overlapping and Arbitrary Classification of
Stressors (p.54)
___________________________________________________________________________________________
6.
Personality Stressors
ë
“An optimist may see a light where there is none, but why must a pessimist always run to
blow it out?”
- Michel DeSaint-Pierre
A
s mentioned before and illustrated in Exhibits 5.4 and
5.5, personality conditions, or stressors, constitute the
“core” conditions of all our stressors, based on the
central impact they have on the other five stressor conditions.
In other words, these stressors are at the “epicenter”of the
subsequent stressful experiences we are likely to have on a daily
basis. Essentially, these qualities, or stressors, arise out of our
special attributes, behaviors and experiences that no one else is
directly responsible for, except ourselves (see Exhibit 6.1). In
other words, we are literally responsible for the existence and Exhibit 6.1: Our personality-related
continued existence of these destructive, tiger-like conditions or attributes and dispositions directly
stressors. influence the stressors we are likely to
experience.
The Central and Dominant Roles of Personality Stressors

As seen in Exhibit 6.2, personality stressors are both central and dominant in the position they
hold relative to the other five interrelated stressors. So central and dominant are these stressors, that
the perceptions students have of the other stressors are very much influenced by students negative (and
positive) personality dispositions (or stressors). With this position in mind, the argument suggests that
to understand the primary influence on students’
interpretation and subsequent experiences with their
daily stressors their personality dispositions first have
to be taken into consideration.
Various types of dispositions will be later
discussed as potential stressors, as well as facilitators
of students’ perceiving sources of stress as stressors. It
is important at the onset to break down the categories
under which personality stressors may be categorized.
Again, all this underscores the central importance of
the personality stressors.
The personality-related stressors associated
with all of us, can be arbitrarily grouped in the
following areas:
Exhibit 6.2: As part of the central conditions, personality
stressors have a central and dominant role over the other K Personality Traits and Related Behaviors and
five interrelated stressors. K Mind Traps
59
Main Areas of Potential Personality Stressors
Given the pivotal importance of personality stressors, as well as how they are defined in this
book (see Exhibits 5.4 and 5.5), Exhibit 6.3 provides a clear picture of the main areas and subareas
involved. As a summary statement, it can be said that if students cannot control the designated
personality traits and related behaviors, as well as “mind trap” ways of thinking, they have the potential
to experience personality stressors. These personality stressors also have the potential of leading to the
other five stressor areas.
Exhibit 6.3: The main areas of potential personality stressors
Personality Traits and Related Behaviors
Our perception of life, the personality traits we have and the way we behave can have the
potential to cause us to experience stress. A reasonable point to make is that the stress we experience is
directly related to the way we conduct or carry-out our lives on a daily basis. These daily activities
involve the following:
K Perceiving others and ourselves (i.e., our self-concept) and
K Stress-related behaviors.
Perceiving Others and Ourselves

While interacting with relatives, friends, and people daily, you may, for whatever reasons, have
feelings of anger, resentment, envy, hatred, etc. directed toward them. Whatever the reasons for your
harboring such internal feelings, they are potentially damaging to both mind and body and can result in
feelings of stress. Whether it is called self-esteem, or the more popular term self-image, how you feel
about yourself is an important contributing factor to stress. The following formula depicts this
relationship:
Chapter 6 . Personality Stressors 61
[ Goals - Success ] = [ ï Self-Image] = [ ñ Stress]
When your goals meet with success, your positive self-image is likely to increase and your
stress is likely to decrease. On the other hand, however, when you fail
to achieve your goals (e.g., obtaining a certain job; graduating from
high school or college; having a stable and lasting marriage), your self-
image is likely to be affected in a negative way. This being the case,
your stress is likely to increase.
As you go through life, whether you succeed or fail, you are
likely to have some stress-related experiences. Also, success and failure
have the tendency to influence your self-perception (see Exhibit 6.4).
Therefore, it is not surprising that individuals with a positive self-image
are, as a rule, generally more successful in every aspect of their lives
than those with a negative self-image. Additionally, individuals with a
positive self-image can overcome obstacles that would be more difficult
for others who have a less positive view of themselves. Feeling that you Exhibit 6.4: Having confidence in
can do just about anything you put your mind to do, i.e., being self- yourself
confident, is, then, related to having a positive view of yourself. This
feeling of self-confidence will definitely lead to various successes in your life.
Stress-Related Behaviors
The types of behaviors we exhibit in carrying out our daily activities can also be a source of
stress for us. In short, the question can be asked: Is it your behavior that is bothering you? In the past
two types of behavior patterns have been identified in the past that relate to our having a stress-prone
personality. They are the Type-A Pattern and the Type-B Pattern (Friedman & Rosenman, 1974;
Shirma, 1996). Individuals with the Type-A pattern are more prone to experience stress compared with
individuals with the Type-B pattern.
Type-A persons tend to be more aggressive, and impatient; competitive and achievement-
oriented; hard-working and very time conscious and time-urgency-
oriented, always in a hurry; impatient with waiting; irritable and
intolerant of interruptions; find it very difficult to delegate authority to
others; and workaholics. What follows are highlights and illustrations of
the four main forms Type-A behaviors take.
The "Stomping Bull" Behavior

By exhibiting the stomping bull behavior (see Exhibit 6.5), Type-
As literally stomp and rage when speaking to others. They suffer from
pent-up aggression that manifests itself in such features as clenched fists,
grinding teeth and nervous tics, etc. When speaking with others, they
rush along the conversation, interrupt more frequently than they should,
Exhibit 6.5: The “stomping bull” emphasize their "points" very dramatically, and often jump from one
behavior subject to the next.
The "Only I Can Do It All" Behavior

By believing that success is due to getting things done faster and better than others, Type-As are
afraid to slow down and let others do some work for them (see Exhibit 6.6). A resident fear is that
others, namely their competitors, will get ahead of them. For example, at work they end up scheduling
more activities than they have the time to do. Therefore, it becomes stress-producing when they have to
depart from their arranged schedule because of unforseen
occurrences not allowed for by their "rigid" schedules. As a
result of the need to "get the edge on their competitors,"
Type-As find it very difficult to delegate work to others (e.g.,
subordinates, co-workers). They think they have to do all the
work by themselves to ensure its correct and timely
completion.
The "Always in a Hurry" Behavior

Impatience is a very important trait for Type-As.
They are unhappy with the Exhibit 6.6: The “only I can do it all”
rate or pace at which most behavior
things go on around them.
(see Exhibit 6.7). They get frantic over waiting in lines at the
supermarket, department stores and even in traffic lines on the road.
When in these situations, they get annoyed because the line is not
moving fast enough and often try to get ahead of others. Also, when
they cannot tolerate these slow moving lines anymore, they may opt to
leave the line. Such behaviors have the potential to be stress-producing,
both during and after such experiences.
The “Compulsive Time-Racing"

Exhibit 6.7: The “always in a hurry”
behavior Behavior
Time urgency is
fundamental to the Type-A person (see Exhibit 6.8). We have
already said that they try to do too much with too little time
available; so they have a compulsion to race to get extra time in
the day. Therefore, they always need more time in a 24-hour day.
As time is valued, then, they feel a sense of guilt when they are not
doing anything, even for a short while, particularly when they are
relaxing. In the last Part of the book, when we speak about
relaxation as a very important means to reduce stress, it becomes
obvious why this trait of the Type-A person is perhaps the most Exhibit 6.8: The “compulsive time
destructive of their typical behavior patterns. racing” behavior
The "Aggressive Competitor" Behavior

Because Type-As are success and achievement-oriented, it is not
surprising that they also are very competitive in most, if not all, of their
activities (see Exhibit.6.9). These activities may be at work, at home or
even on the play field, for example, the friendly card game or the week-
end tennis game. This is not to say that competition is bad, but the Type-A
takes it to its extreme. The Type-A person engages in relationships only
with one main intention or goal in mind - to win. This constant
preoccupation with winning is, therefore, potentially stress-producing for
the Type-A person.
Exhibit 6.9: The “aggressive
competitor” behavior
Type-Bs, who have the opposite traits of Type-A individuals, find it more easy to relax, or
engage in behaviors more typical of a lifestyle that has very positive implications for their future health.
In summary, the Type-A versus the Type-B behavior pattern is one that is more “stress-prone” because
of its inherent and predisposing stress-related qualities.
Mind Traps
As another form of personality stressors, mind traps are
very real and potentially stress-producing; however, if we are aware
of them their effects can be controlled (see Exhibit 6.10). Think of
mind traps as the “enemy within us” (i.e., our minds) that makes us
vulnerable to experience stress by literally “trapping” us to think,
feel and, subsequently behave, in ways that predispose us to have
stress. A brief discussion follows about some selected mind traps.
Personal Beliefs
All of us have beliefs that we carry around about ourselves, Exhibit 6.10: Mind trap examples
other people and things. Some of these beliefs are referred to as
“negative self-talk” (see adjacent text box). While a great many of these beliefs may or may not be true,
we operate as though they are and, as such, follow them like they are “gospel truth.”
The truth of the matter is that we make up many of these beliefs, and, in some cases, they are
incorrect. This being the case, we can change or modify them at times to suit the situation. Because
beliefs in many ways influence
our behaviors they can, in many
EXAMPLES of typical beliefs include: cases, be stress-producing for
L I can’t do it because I am not good enough; us. Why is this so? Simply
L Nobody likes me so why should I try; because believing and following
L I do things so poorly that nobody likes me;
certain beliefs, when we don’t
L I know my teacher does not like me because I am a C student;
L I can’t cry because I am a man;
have to, can cause us stress. See
L I will not pass my calculus exam because I am not good enough; some examples in the text box
and below.
L College is harder for me because I was not born smart.
Being a Perfectionist
While believing that
you are a perfectionist, i.e., everything you do has to be just right and exact, is not stressful in all cases,
but it certainly has the potential to make you feel stressed under certain circumstances. How is this
possible? When you constantly strive to be perfect in everything you do it places undue burdens on you.
Simply put, in many cases you will never achieve the perfect outcome you desire, because it is “ideal”
and never attainable. Therefore, you are likely to get frustrated or stressed over your continuous
inability to get that perfect outcome. Also, in pursuing this elusive perfect outcome, you are wasting
valuable time, perfect outcome, you are wasting valuable time, energy and other important outcomes
that are likely stress-producing themselves. See some examples in the text box.
EXAMPLES of a perfectionist’s actions:
L Are you especially hard on yourself when you don’t get

things done perfectly?
L Do you feel a constant pressure to get the best possible
outcome, no matter what the consequences?
L Do you feel at times that you have not done enough, no
matter what you do?
Having Unrealistic Expectations

If you hold unrealistic expectations you are likely to experience stress, simply because they are
not practical to have in the first
place. That is, don’t look for EXAMPLES of unrealistic expectations:
these thoughts or expectations
to be met. In most cases, L I don’t have to work because I will win the lottery one day;.
depending on what is involved, L Everything I do must be perfect the first time;
the expectations that you have L I want all the people I know to love and admire me;
will never be realized; hence it L I will be successful at everything I do; and
is stressful for you to continue L I expect people to be honest all the time.
having them (see some
examples in the text box).
Not Being in Control

Perhaps one of the most important factors that allow us to cope with stress is the feeling we have
control over our life’s conditions. It has been said that situations in which we perceive ourselves as
being helpless or trapped or feeling out of control will be far more stressful than situations over which
we believe we have some control (Hafen et al., 1996).
While in some situations it is necessary for us to seek and be in control (e.g., the pace at which
we study for an examination or do our jobs; how our children progress at certain tasks; how our cars
function by keeping them
EXAMPLES of uncontrollable conditions include: adequately maintained, etc.), in
other cases it is impractical and
L Some unexpected rain showers; foolhardy for us to seek and be
L The rate at which children learn certain concepts; in control. As these latter
L If and when the economy slows down; conditions by virtue of their
L How other people like or dislike us; and nature are beyond our ability to
L Certain environmental outcomes, such as global warming. influence (e.g., date financial
aid decisions are made, time
class meets), it is futile and potentially stressful to even attempt to control them.
Keeping Things in Perspective

Things have a way of getting worse before getting better. Therefore, if things appear different
from what they usually are, or they are getting worse than they usually are, you are likely to experience
stress if you don’t put things in perspective. That is, see things for what they really are; recognize what
you can change and/or control; recognize that you are doing the best you are capable of doing in the
situation; and learn to accept whatever is inevitable. Some examples are seen in the text box of putting
things in perspective, thereby reducing your stress.
EXAMPLES of ways of putting things in perspective:
L Although I did not expect it, I will accept it;

L Somethings are better left alone;
L Sometimes a problem is just an opportunity that proves
challenging for me;
L I can really learn from this problem; and
L Other people would deal with this problem no better than I would.
Having Negative Self-Talk

Negative self-talk is like an inner voice that creates stress for you by contributing to the
following: pessimistic thinking, self-criticism, over-analyzing of situations and self-doubt. In short,
think of negative self-talk as the opposite of optimism, where it causes stress by destroying your
confidence, slows down your mental and related skills, and it interferes with your daily performance
and accomplishments. Some examples of negative self-talk appear in the text box below.
EXAMPLES of negative self-talk include:
L If I try it I will fail in my classes, so I won’t try very hard to pass;

L I am very bad at meeting people, so I won’t try;
L I don’t deserve the job I have and I wonder when they will find out;
L Everyone around is so successful, except me;
L I will never amount to anything, even if I try; and
L I will never be a success because people don’t like me.
Personality Stressors
O The Central and Dominant Roles of Personality Stressors (p.59)
O Main Areas of Potential Personality Stressors (p. 60)
O Personality Traits and Related Behaviors (p.60)

9 Perceiving Others and Ourselves (p.60)
9 Stress-Related Behaviors (p.61)
: The “Stomping Bull” Behavior (p.61)
: The “Only I can Do It All” Behavior (p.61)
: The “Always in a Hurry” Behavior (p.62)
: The “Compulsive Time-Racing” Behavior (p.62)
: The “Aggressive Competitor” Behavior (p.62)
O Mind Traps (p.63)

9 Personal Beliefs (p.63)
9 Being a Perfectionist (p.63)
9 Having Unrealistic Expectations (p.64)
9 Not Being in Control (p.64)
9 Keeping Things in Perspective (p.64)
9 Having Negative Self-Talk (p.65)
___________________________________________________________________________________________
7.
Private Life Stressors
ë
“Worry is a thin stream of fear trickling through the mind. If encouraged, it cuts a
channel into which all other thoughts are drained.”
- Arthur Somers Roche
P
rivate life stressors are the unique experiences individuals have that characterize their home life and
other personal life and lifestyle activities. In other
words, these experiences are not necessarily
publicly known experiences, and they primarily reside
with individuals themselves unless they choose to reveal
them to others. These experiences, or stressors, may
manifest themselves as positive, yet potentially
threatening, family vacations (see Exhibit 7.1);
adjustments involving health conditions/issues,
adjustments to daily hassles, as well as at-risk lifestyle
activities, to only mention a few. Again, given the
symbolism used throughout the book, each of these
sources of stress has the potential, at its extreme, to be as Exhibit 7.1: The family experience can be either
ferocious as the tiger given the unchecked damage it can negative or positive depending on the personalities and
cause. the circumstances involved.
Private Life Stressors Involve Both Internal and External Conditions

As seen in
Exhibit 7.2, although private life stressors are personal
in nature, they are derived from both internal and
external conditions. This fact makes them more
controllable in some cases (i.e., when they are derived
from internal conditions) and less controllable (i.e.,
when they are derived from external conditions) in
others. Whatever their source, however, they remain
important potential stressors for everyone concerned,
especially college students.
A great number of these stressors are our own
private experiences. We are in a good position to be
proactive in knowing about them, anticipating them
and, therefore, ultimately controlling them before we
fall into the stress trap. What it means is that in the case
Exhibit 7.2: Private life stressors are both part of of these stressors we have some control over their
internal and external conditions. “tiger-related destructive potential,” and we can,
therefore, attempt to control them before they cause us real stress.
A very obvious and limiting quality of these private life stressors is that because they are by
their very nature private, people around us may not necessarily know that we are having any stress-
related problems unless we inform them. Therefore, the very people who may help us will not do so
67
PART II % Identifying the Nature, Background and Causes of Stress 68
unless they know what is happening in our personal lives.

The private stressors that occur can be arbitrarily grouped in the following areas:
K Home Events;
K Adjusting to Life Change Events;
K Daily Hassles; and
K At-Risk Lifestyle Activities
Main Areas of Potential Private Life Stressors

While private life stressors are not as pivotal as personality stressors, as seen from Exhibit 5.4,
they consist of a number of events, circumstances and conditions that can affect students in their
personal lives. If students cannot adequately control these private life potential stressors, as seen in
Exhibit 5.4, they can have an impact on all of the other stressors. Furthermore, if students are
experiencing these stressors, as well as the other five stressors at the same time (see Exhibit 5.5), they
are at maximum risk to experience negative health-related and productivity outcomes. The main areas
associated with the potential private life stressors are see in Exhibit 7.3).
Exhibit 7.3: The main areas of potential private life stressors
Home Events
These stressors are known to you and they occur primarily in the home and related
environments. Because of the mainly home-like nature of these conditions they are sometimes referred
to as “private” stressors. A variety of such private conditions can, under certain circumstances, be a
source of stress for each of us. These factors include, but are not limited to, the following:
69 Chapter 7 . Private Life Stressors
K Not having sufficient time for pursuing particular interests;

K Pressures exerted on us from family members to accomplish certain things;
K Overall concerns with your present and future health;
K Dealing with family problems/issues;
K Problems relating to the upkeep of the car,
K Immediate pain and injury concerns;
K Financial concerns related to school and other issues; and
K Problems with living accommodations.
Space does not allow for an expansion on all of these factors; thus a selected discussion is presented on
two of the more salient ones - family concerns and financial concerns.
Family Concerns
The family, with its varying structure and organization encompassespasses various kinds and
degrees of relationships and issues. This being the case, the family has
the potential to cause us a variety of concerns which can involve on-
going or unexpected problems with parents (e.g., ageing parents, step-
parents, foster parents, grand parents) or a spouse. Although a seemingly
happy event, the unexpected addition to the family of a child, can
unfortunately be another potential source of stress within the family (see
Exhibit 7.4).
Extended family relationships (i.e., with in-laws, aunts, step-
relatives, etc.) can be a cause of concern because of several reasons.
These reasons include having a shortage of available space, unwarranted
interferences by household members, financial factors, substance abuse
(e.g., drugs, alcohol) issues, and lack of communication. If you are a
college student, whether living at home, or away with relatives, you will
Exhibit 7.4: A potential family
most likely experience these related challenges.
life-related stressor
Financial Concerns
Although financial concerns can occur within the context of the family, given that there are so
many, it is necessary to address them separately as potential sources of private life stressors (see
Exhibit 7.5). It is generally agreed that financial difficulties are the root causes of most of the
difficulties we experience as individuals. These difficulties result from, or are related to, the following
possible stressful outcomes:
K Losing jobs;
K Being underpaid in current jobs;
K Finding it very difficult to meet daily financial
obligations regarding rent and food;
K Being unable to afford college tuition;
K Being unable to afford medical bills; and
K Being unable to afford books for college.
Exhibit 7.5: Financial concerns

Perhaps the most stressful financial situation occurs when
you end up spending more than you earn, sometimes referred to as a “champagne taste on a beer
budget.” Whatever the source and/or outcome, these and other related concerns are increasingly
70 PART II % Identifying the Nature, Background and Causes of Stress
becoming real-life problems, or stressors, for many people, especially for “tightly budgeted” college
students.
Adjusting to Life Change Events
It has been said that the one sure thing about life is change. Failure in successfully adapting to
changes, in general, and life events changes, in particular, can be stressful. Good health in the human
body is maintained through a health balance involving mental and physical processes. This state of
“balance” is referred to as homeostasis (i.e., defined as “Equilibrium in the internal functions of the
body”).
Research suggests that because change (e.g., through life change events) disturbs the body’s
functional need for homeostasis, balance can only be restored through adaptation. Adaptation can be
defined as “The tendency of the body to fight to restore homeostasis in the face of forces that upset this
natural bodily balance.” For the purposes of this book, we are also speaking about adaptation in the
context of individuals adjusting to the life changes they have experienced, which in turn contributes,
i.e., on a bodily/cellular level, to homeostasis. If this occurs, the individual is likely to experience less
stress overall, simply by achieving “balance” in his/her life. What follows is a discussion about a
combination of life change events that most people
unfortunately have to adjust to at one time or
another - pain, injury and illness.
Pain, Injury and Illness

It is a fact that pain, injury and illness (see
Exhibit 7.6) are indisputable conditions of all
societies. Although these experiences can be viewed
as private stressors, how you react to them or
tolerate them is greatly influenced by the
environmental influences you have been exposed to
over time. More specifically, these influences
relate to the knowledge you have acquired from Exhibit 7.6: A pending surgical procedure as a stressor
people and other sources in your environment and,
basically, how you have been socialized to think and behave. These environmental interactions, which
may have been direct and/or indirect, determine to a large extent how you get injured (e.g., playing
sports, involvement with illegal activities, etc.) in the first place; how you react to pain (e.g., cry,
withstand it, etc.); and how ill you become and your reaction to such illness (e.g., denial, acceptance,
opportunity to change things in your life), are all potential sources of stress, or stressors, for you.
In the case of injury or illness, it has been said that the more fully prepared you are for the
experiences that accompany the injury and illness, the fewer the potential stressful sensations you are
likely to have associated with these experiences. In a related manner, when you lack information (i.e.,
from environmental sources), or information is vague about these events, your anxiety often increases
in direct proportion to your need to get this information. An example of this is having "minor" surgery
and not knowing what to expect. Another example is when you experience constant and severe pain in
your stomach and do not know that the pains are related only to “gas” (i.e., something minor), as
compared with the possibility of having "ulcers" (i.e., something much more serious); therefore, you
become anxious and worried.
Chapter 7 . Private Life Stressors 71
Measuring Life Changes

Years ago two psychiatrists (Thomas Holmes and Richard Rahe) developed a 43-item index to
measure life change or stress. Life change was measured by the accumulative changes or “disruptions”
associated with major life events in a person’s life. This index, which was published in 1967 and is
today still valued as a benchmark, is called the Social Readjustment Rating Scale or SRRS (Holmes &
Rahe, 1967).
When Holmes and Rahe tested their index, they reported that the greater the life change, the
greater the chance of illness. These findings support the view that stress affects human health, moreso
in a negative manner. Life events were evaluated in terms of life change units (LCUs) with 100 being
the most severe, i.e., most perceived stress resulting from changes in corresponding life changes. The
death of a spouse was rated as the highest (100 LCUs) and marriage was rated in the middle (50
LCUs). The authors reported that individuals who scored 150-199 LCUs showed a 37 percent chance
of illness the following year, those who scored 200-299 LCUs showed a 51 percent chance, and those
who scored over 300 LCUs showed a 79 percent chance.
Since initial publication of the SRRS, there have been alternative views concerning the
fundamental premise that “change” itself (i.e., whether it be the death of a spouse or the winning of a
lottery) is not inherently stressful. Furthermore, it has been said that, from a person’s point of view, a)
distinctions have to be made between seemingly negative(-)[e.g., death of a spouse] and negative
(-)[e.g., getting a job promotion] stress associated with an event; b) the extent of change involved; c)
the consequences of the change); and d) the duration of the change associated with the life event(s).
Hardy Personalities
Apart from the alternative views regarding the interpretation
of change and change scores (e.g., LCUs) on the SRRS mentioned
above, there have been other factors mentioned as possible
(intervening or coming in-between) factors that affect the change-
stress-health relationship. Because space does not allow for an
elaboration of these various factors, three of the more prominent
factors are subsumed under the umbrella term “hardiness” coined by
a psychologist called Kobasa (1979a and 1979b) (see Exhibit 7.7).
These factors are sometimes referred to as the three Cs and they
include: a) control, b) challenge, and c) commitment. Exhibit 7.7: The need for students to
Individuals with hardy personalities can withstand a great deal develop “hardy” personalities
of life stressors, whether they appear in the form of life change events
or any other form (e.g., daily hassles). This point is consistent with
the fundamental point made in Chapter 5, and underscored by Exhibits 5.4 and 5.5, of the dominant
role personality conditions or stressors have over all the other five stressor categories.
Individuals (as college students) who have hardy personalities do not feel helpless regarding
these private (or life events) stressors (see Exhibit 7.7). On the contrary, they feel they can reduce,
terminate or prevent unwanted stressors from occurring. Therefore, hardy individuals are those who see
themselves as having the ability to regulate or control (versus feeling trapped or out of control)
definable life circumstances, e.g., conditions at work, interpersonal relationships, etc. In short, because
these individuals have some say in the presence/absence and/or outcome of events, they are less likely
to experience stress.
Besides having the feeling of being in control, as mentioned before, individuals with hardy
personalities are also occupied with reconciling challenges and they usually have high levels of
commitments to defined tasks and ensuing responsibilities. In the case of challenges, rather than giving
up, they turn the negative situation into something they can attend to with all their energies to solve or
address. In the case of commitment, these individuals after identifying their objectives, challenges, etc.,
stay with them toward the end in order to achieve some resolution. Again, these qualities make the
hardy individuals who they are and how they are more likely to resist the stress-tiger when it comes
prowling.
Daily Hassles
Think of daily hassles as more minor occurring daily events or stressors. They are relatively
minor in comparison to major life events. However, while they may not be major events, they can be
temporary, frequently occurring and, in most cases, unpleasant, unwanted and irritating.
It is increasingly believed that while life change events can be perceived as stressful, more
minor and frequently occurring events can be equally stressful, if not more stressful for some people.
Some evidence exists that for some individuals, and under certain circumstances, daily hassles may be
even more detrimental to your health than major life events. This fact is aptly illustrated by the poem
that follows by Charles Bukowski.
“It’s not the large things that send a man to the madhouse... no, it’s the continuing
series of small tragedies that send a man to the madhouse... not the death of his love
but a shoelace that snaps with no time left...”
Like major life events, many daily hassles are unavoidable and,
as such, are beyond your control or capacity to change. Examples
include:
K Appliance malfunctioning;
K Living in a high crime neighborhood, encountering traffic
jam to and from work;
K Unpleasant dormitory personnel;
K Getting a campus parking ticket (see Exhibit 7.8)
K Temperature changes (hot versus cold); Exhibit 7.8: Life’s daily hassles
K Losing contact lens;
K Mechanical problems with the car or running out of gas on the way to school;
K Waiting in long lines at the bookstore; and
K Misplacing keys for desk which has typed and ready-to-go term paper.
A brief discussion is presented on a very likely and typical daily hassle - home overload. In a
related manner, it must be noted that the opposite of home overload is home underload, which is
basically feeling bored or underutilized at home. Depending on the person involved, just like overload,
this can be a source of stress as well.
Everyday Nuisances
The home environment has always had the potential to harbor various forms of stress-related
problems that can be termed, overload. Although both children and parents are constantly in a dynamic
interaction in the family-home environment, and both can experience overload, it is usually the parents
who are at the center of attention.
Unfortunately, children only become the center of attention regarding stress/overload when
they begin to exhibit antisocial (e.g., withdrawal behaviors) and/or destructive (e.g., shooting of fellow
students at school, as was the case recently) and self-destructive behaviors (e.g., alcohol, drug abuse).
In many cases when these behaviors are realized, it may prove too late for the children themselves, as
well as for others who were at the receiving end of the behavior. Clearly the goal, as always, must be to
prevent these behaviors from occurring in the first place. Although a comprehensive view of the
problem is beyond the scope of this book, it can be said that contributing factors to overload in the
home environment (i.e., at home with parents or in the dormitory at college) include, but are not limited
to the following factors:
K Excessive responsibilities;
K Poor time management skills;
K Difficulties juggling school and work activities;
K Demands of interpersonal relationships; and
K Over-involvement with the emotional, health and financial occurrences within the
household.
Stress from overload is always possible given the responsibilities associated with preparing;
maintaining, and working on various aspects of school life. Such activities include: studying; doing
class papers, working with other students in a tutoring program. The
stresses from overload must be prevented, if at all possible, before the
possible adverse consequences (e.g., destructive and self-destructive
behaviors, such as alcohol abuse, drug abuse and violence) become a
reality. Again, if these things are occurring in dormitories at colleges
and universities, they may affect students’ abilities to do needed
homework assignments in a timely manner (see Exhibit 7.9).
Exhibit 7.9: House chores

interfering with ability to complete
homework for college classes
At-Risk Lifestyle Activities
The various choices we make in our daily lives have the potential of being possible sources of
stress for us. Thus for us to manage stress effectively, we have to change and/or modify our behaviors.
Therefore, like the other private stressors discussed so far, these lifestyle stressors are within our
control, hence the possibility for us to prevent or modify their occurrence before they do us possible
harm. For purposes of this book, the focus is on a selective overview of lifestyle activities, all of which
have the potential to be changed or modified by the persons involved. These select activities include:
K Stimulants;
K Nutrition;
K Sleep;
K Sleep-Nutrition Relationship;
K Sleep-Stress Relationship; and
K Exercise.
Stimulants
Any substance that we put inside our bodies that cause our nervous (or sympathetic) system to
be falsely stimulated can be referred to as stimulants or pseudostressors. Generally speaking, certain
drugs, including caffeine in coffee and nicotine in cigarettes, fall into this category, where initial use is
usually related to the desire to reduce stress by feeling relaxed. In the long run, however, these
stimulants cause more anxiety, stress and health problems. It has been said that “It can be hard for
drug using students to connect their experiences to the horror of addiction” (ONDCP, 2004, p.15).
This being the case, drug use should be stopped or severely curtailed in general and, more specifically
(given the target group of this book), in the college population.
Drug Misuse
Drug misuse occurs when drugs (legal or illegal) are taken for medical or recreational reasons
when other alternatives or options are advisable. There are other drug-related problems associated with
drug misuse.
EXAMPLE of drug misuse is as follows:

“A college student who is feeling somewhat nervous before a big examination takes some
valium and/or alcohol to relax himself. This results in him oversleeping, missing his
examination and getting a low grade in the course.”
For example, there is compulsive abuse and addiction. Compulsive abuse occurs when a person uses a
drug despite experiencing adverse medical (e.g., seizures) and/or social (e.g., loss of job) outcomes and
develops an intense reliance on self-medication with the drug(s).
Addiction is viewed as the most severe outcome of drug misuse. This behavior is characterized
by overwhelming involvement in securing and using drugs (e.g., valium, librium, marijuana) on a
fairly habitual basis. In short, drugs literally control the person’s life. Extreme forms of drug addiction
result in various health, social and behavioral problems, all of which have the potential to be additional
sources of stress. For college students, drug misuse, or illicit drugs, continue to be a rising problem,
hence being seen as a potential stressor. What follows is a brief discussion on selected drug use by
college students, with accompanying beliefs and behaviors, all of which can make for a very potential
explosive and stressful situation.
Marijuana: Of all the illicit drugs found on college campuses today, marijuana is by far the most
ubiquitous. Many students and adults take the attitude that marijuana use by young people is
normal—that there is nothing to fear because “pot” is benign, its effects temporary and harmless.
“This is simply wrong. Many marijuana users have trouble stopping on their own. Of all teenagers in drug
treatment in 2001, for example, about 62 percent had a primary marijuana diagnosis. Today, more young
people are in treatment for marijuana dependency than for alcohol or for all other illegal drugs combined.
Contrary to prevailing myths, marijuana does cause harm. Long-term use of the drug is associated with
stealing, aggression, cutting classes, and destruction of property. Marijuana use often occurs in
combination with alcohol, and the drug may actually be responsible for more campus and community
vandalism and disturbances of the peace than has previously been recognized. Marijuana also poses
significant health risks. One joint contains as much cancer- causing tar as four tobacco cigarettes, and
research provides strong evidence that smoking marijuana increases the likelihood of developing certain
types of cancer.” (ONDCP, 2004, p. 21)
A published study in 2002 by the Journal of the American Medical Association (ONDCP,
2004), suggests that long term use of marijuana causes memory loss and attention problems, effects that
can have an adverse impact on academic achievement, interpersonal relationships, and daily
functioning. It does not take much imagination to visualize the threat posed by a mind-dulling
substance on an environment created for learning.
And the threat is growing. Scientists have determined that today’s marijuana contains more of
the active chemical THC and is thus more potent than the “weed” of the Woodstock era. In the 1960s
and 1970s, the amount of THC in most marijuana averaged 1 or 2 percent. Today the average is about 7
percent, with the potency of some hydroponically grown varieties climbing to 30 percent or higher.
Meanwhile, the proportion of higher potency marijuana in the U.S. market has been rising rapidly
(ONDCP, 2004).
Club Drugs: Young adults are also at risk from those drugs known collectively as club drugs, so named
because their use was once confined almost exclusively to clubs and late night parties called raves.
Now, however, these drugs are often used on college campuses and at private parties. Probably the
most well known among the club drugs is MDMA, more commonly referred to as Ecstasy, which in
recent years has gained an almost cult-like following. According to the 2002 National Survey on Drug
Use and Health, 4.3 percent of people age 12 and older reported using Ecstasy in their lifetime. Users
between the ages of 18 and 25 reported the highest lifetime Ecstasy use, at 15.1 percent. In 1997,
Monitoring the Future showed that only 2.4 percent of college students admitted using Ecstasy within
the past year. By 2002, that figure had jumped to 6.8 percent (ONDCP, 2004).
Alcohol
Alcohol is perhaps one of the most widely use and abused drug (see Exhibit 7.10). As a
nonprescription drug, which is a powerful central nervous system depressant, it is only second to
caffeine as the most widely used psychoactive drug-related substance in the world. It has been said that
“Alcohol has gained the reputation as the ultimate stress-relieving drug, and relaxation and recreation
are the most often cited reason for consuming it.”
In times of stress, the alcoholic learns about the
rewarding effects of alcohol. As a depressant drug, while it does
not stop the actual stress, it performs other actions that allows for
the mimicking of feelings of relaxation. Essentially, alcohol
blocks the hypothalamus to a sugar defiance and from stimulating
the release of adrenalin (i.e., a stress hormone) through its action
on the pituitary gland (another gland involved in the stress
reaction). Because some of the intermediate products of alcohol
metabolism stimulate the parasympathetic system, this triggers
Exhibit 7.10: Alcohol and/or drugs as
blood flow to the skin to promote a feeling of warmth and well- stressors
being.
As mentioned before, like any other drug, alcohol does not truly reduce stress; instead,
depending on its rate and level of consumption, it causes a whole lot of stress-producing health and
related problems for the individual. For example, in addition to contributing to stress-related problems
associated with economics, family, marriage and psychological feelings (e.g., defiance, insecurity,
depression, etc.), behavioral problems (e.g., abuse, driving-related accidents, fatalities, etc.), it can
contribute to serious physical problems involving the vitamin deficiencies, neurological disorders and
the liver dysfunctions (e.g., cirrhosis). This information is very important given the increasing
incidence of alcohol use and abuse in the college population, which was discussed in Chapter 2 (e.g.,
see Wechsler et al., 2002).
Research indicates that the two most common “oral habits,” caffeine consumption and cigarette
smoking, are highly deleterious to human health. Their effects, whether individually or combined, are
attributable to stress.
Caffeine
Caffeine is referred to as a “pseudostressor” or a sympathomimetric agent because as a
chemical agent it falsely mimic’s the sympathetic stress response. Caffeine is found in coffee, tea,
chocolate and many carbonated beverages and it can exacerbate a stress
response that is already occurring. Frequently seen symptoms of excessive
use, i.e., more than 250 milligrams per day, include irritability, anxiety,
inability to concentrate and diarrhea. The average 6-ounce cup of brewed
coffee contains approximately 100 milligrams (see Exhibit 7.11).
Caffeine is a chemical that belongs to the xanthine group of drugs.
These drugs are amphetamine like stimulants that do the following: increase
metabolism resulting in a highly active and awake state, which explains why
Exhibit 7.11: Caffeine in people drink coffee to stay awake. These drugs are also capable of releasing
coffee as a stressor the stress hormones, which are in turn capable of increasing the heart rate,
blood pressure, arrhythmia (i.e., irregular heart beats), as well as the oxygen
demands on the heart.
Cigarette or Tobacco Smoking

Cigarette, or tobacco, has come under severe attack, more so
within the last year, because of its stimulating qualities, as well as
cancer-producing capabilities. Nicotine is to be found in tobacco and,
like caffeine, it is a pseudostressor or a sympathomimetric chemical
(see Exhibit 7.12). Therefore, like caffeine, nicotine is capable of
initiating the arousal effect associated with the stress response. It can
cause the stress response each time it is taken in the body, i.e.,
whether by directly smoking a cigarette (or cigar for that matter),
inhaling the smoke of others (i.e., “passive” smoking), or chewing
tobacco.
When the smoker lacks the stimulating effects of nicotine, the Exhibit 7.12: Cigarette smoking as a
stressor
loss can create a mild state of depression and a generally uneasy
feeling, which in turn leads to the desire for an infusion of nicotine (i.e., smoking a cigarette). This
scenario may be referred to as needing a “nicotine fix.” For the college population this has important
implications. A national study concluded that “Cigarette use is increasing on campuses nationwide in
all subgroups and types of colleges. Substantial numbers of college students are both starting to smoke
regularly and trying to stop. National efforts to reduce smoking should be extended to college
students” (Wechsler et al., 1998).
Nutrition
The foods that we eat can be stressors themselves, or they can increase the effects of other
stressors. Sufficient evidence exists that prolonged exposure to daily stressors can have a negative
impact on our health (e.g., through a weakened immune system there is an increased likelihood of some
minor illnesses such as the flu, colds and persistent coughs). Additionally, while research linking
nutrition and stress is not clear and definitive, there have been various suggestive findings. For
example, research indicates that physical stress (e.g., of injury and illness) can lead to a greater need
for extra vitamins (e.g., B for a healthy central nervous system , C for resistance to infection), proteins
and minerals.
Low blood sugar, or hypoglycemia, may contribute to stress. If you suffer from hypoglycemia
you are more vulnerable to stress. Why? Because you are feeling tired most of the time and partly
because hypoglycemia generally slows down concentration and thinking. Other symptoms include
anxiety, dizziness, headache, trembling and increased cardiac activity. These symptoms can cause
normal stimuli into acute stressors by making the individual more irritable and impatient. They in effect
help to lower the individual’s tolerance for stress. Although there are
various causes for hypoglycemia, two of these have links to an
individual’s dietary behavior. 1) Reactive hypoglycemia is caused by
a high consumption of sugars within a limited amount of time (e.g.,
eating a meal/snack high in sugar). 2) Functional hypoglycemia
occurs, in part, when meals are missed. One of the best ways to avoid
the stresses of hypoglycemia (and other related problems, e.g.,
glucocorticoid stress response) is to eat well-balanced meals that
include a minimum of sugar and processed foods (see Exhibit 7.13).
There is some evidence that while emotional stress may not
necessarily lead directly to increases in nutritional requirements, this
Exhibit 7.13: The importance of eating type of stress can affect a person’s eating behavior. For example,
from the five main food groups
some people may respond to eating less or eating more. Therefore,
depending on the degree of stress, the results can range from nutritional deficiency to obesity.
Depending on the severity of the problem, the person’s health (e.g., obesity-related conditions of
hypertension, diabetes, heart disease and eating-related disorders of anorexia and bulimia) may be
affected. In short, a person’s nutrition can be a source of stress, whether it be in a direct or indirect
manner. The Albany Times Union (2002) reports that inappropriate nutrition has important
implications for college students.
Sleep
The relationship between stress and sleep is very dynamic. It can be said that there is a two-
way street, i.e., stress affects sleep and sleep affects stress. For the purposes at hand, however, it is
important to note that the stress we feel and how well we sleep are very much interrelated. It has been
said that stress is a major contributing factor to sleep problems and, in turn, ineffective sleep is a major
cause of stress. Because we can at this point address one aspect of this stress-sleep relationship, the
question then becomes, “What can we do to achieve effective or optimum sleep?”
Optimum sleep can be achieved in two ways: a) the quality of sleep received and b) the number
of hours spent sleeping. On a more specific level, effective sleep means optimizing complex events in
two sleep states, REM or rapid eye movement and NREM or non-rapid eye movement. Research
suggests that it is during dream, or REM sleep, that the brain sorts through the activities of the day,
putting things in order, keeping only what is needed, and discarding information that is not needed.
Therefore, it is during sleep that the brain puts things into perspective on things that are creating stress
for us. Deep sleep, or NREM, plays a very important role in maintaining our general health, while
REM sleep affects our performance/behavior and moods. This is achieved by the brain processing
learning and memory and resolving various forms of emotional distress.
The Sleep-Nutrition Relationship

Poor or inadequate sleeping and eating habits tend to go hand-in-hand. And, although we are
responsible for what we do, the truth of the matter is that we engage in these undesirable behaviors
based on what we learn from people (e.g., family, friends, co-workers, etc.) and other sources (e.g.,
television, movies, etc.) in our environment.
Increasing our sleep and improving (i.e., having at least a representative daily sampling from
the five suggested food groups - see Exhibit 7.13) the kinds of
food we eat are within the control of many people. It has been
shown that strenuous work schedules (see Exhibit 7.14) combined
with little (i.e., approximately 3 to 6 hours) or no sleep and
reduced caloric intake result in negative changes in our minds and
bodies.
Studies of sleep deprivation (i.e., lack of sleep) have
shown outcome effects in terms of being more moody, reduced
alertness to signals, and increased confusion, aggression and
despondency. On a more physical level, there can be outcomes,
such as dizziness, loss of appetite, tremors, shivering, back and
limb pains. The conclusion, therefore, has been that the combined Exhibit 7.14: Stressors include
stressors of lack of sleep and inadequate caloric intake contribute inadequate sleep and poor dietary intake
to distress.
The Sleep-Stress Relationship

The stress you feel and how well you feel are interrelated. Research suggests that stress is the
number one contributing condition to sleep problems, and ineffective sleep is, in turn, a major cause of
increased stress. Therefore, while there is a circular relationship between stress and less than optimum
sleep, the process starts somewhere. This starting point is the initial relationship between stress and the
difficulty you have falling asleep.
Your inability to fall asleep, or sleep the desirable number of hours can, in many cases, be
attributed to your stress response being activated by feelings of fear or anxiousness (e.g., associated
with financial problems, health issues, interpersonal problems, etc.). Because you have these
“feelings” before going to bed, your brain senses them and it activates the stress response, which
involves the secretion of the stress hormone adrenaline to be released into your blood stream. This
stress hormone, along with other stress-related secretions, interfere with the natural functioning of the
sleep cycle. In essence, the stress response and the sleep response are polar opposite reactions in the
body. That is, the presence of one automatically means the absence of the other.
The implications of sleep deprivation for college students are best underscored by a student in
a replay to his instructor (Smith, 2002) below:
“ Sleep Deprivation is like a disease. It happens in college students because they fail to get any
sleep. College students who experience sleep deprivation only get about two to three hours of sleep
and end up not doing the homework that was assigned to them or they'll end up failing an exam.
Most teenagers need eight to ten hours of sleep. College students can also cause car accidents
involving sleep deprivation. Students stress themselves out too much worrying about a final exam.
Get more sleep than you intend to and the results might surprise you.”
Exercise
Inappropriate or excessive exercise is another potential form of personal internal stressors that
can be controlled. Generally speaking, strenuous exercise makes enormous demands on our bodies.
It is not unusual for our bodies to experience "failure" (e.g., muscle problems, heart attacks) in
attempting to meet these demands (see Exhibit 7.15). Not having the necessary resources to deal with
the physical demands we place on ourselves could be due to several factors, for example: our age, time
of the day we exercise and/or our total physical condition. If allowed to continue, the stress reaction
can, in more extreme cases, lead to dizziness, blackouts, and various forms of cardiac dysfunctions
(e.g., heart attacks, erratic heart palpitations).
Appropriately done exercise is usually beneficial (e.g., improvements in the functioning of the
immune system, cardiovascular system, and mental functioning, etc.) for our overall health. While the
how, where, when, why, type and duration, etc. of exercising are usually controlled by us, the final
choices we make are influenced to a great degree by environmental
conditions (e.g., the weather), people (family, friends, co-workers,
finances, etc.), and other exposures (e.g., the media portrayal of having
a “beautiful” body, the need to have a healthy body, etc.).
The health-related and other implications for having poor
exercising habits in the general adolescent population, as well as more
specifically in the college age population, were discussed in Chapter 2
(e.g., see Pinto et al., 1998; Levine 2003). Therefore, because of the
health implications associated with inadequate exercising, there is an
urgent need to improve prevention and intervention efforts to increase
exercising among the U.S. college-age population.
Exhibit 7.15: Inappropriate

exercise as a stressor
Private Life Stressors
O Private life Stressors Involve Both Internal and External Conditions (p.67)
O Major Areas of Potential Private Life Stressors (p. 68)
O Home Events (p.69)

9 Family Concerns (p.68)
9 Financial Concerns (p.69)
O Adjusting To Life Change Events (p.70)

9 Pain, Injury and Illness (p.70)
9 Measuring Life Changes (p.71)
9 Hardy Personalities (p.71)
O Daily Hassles (p.72)

9 Everyday Nuisances (p.72)
O At-Risk Lifestyle Activities (p.73)

9 Stimulants (p.74)
: Drug Misuse (p.74)
, Marijuana (p.74)
, Club Drugs (p.75)
: Alcohol (p.75)
: Caffeine (p.76)
: Cigarette or Tobacco Smoking (p.76)
9 Nutrition (p.76)
9 Sleep (p.77)
: The Sleep-Nutrition Relationship (p.77)
: The Sleep-Stress Relationship (p.78)
9 Exercise (p.78)
___________________________________________________________________________________
8.
Psychosocial Stressors
ë
“Those who cannot give friendship will rarely receive it, and never hold it.”
- Dagobert D. Runes
P
sychosocial stressors are potentially stressful conditions that occur when you have some “need
directed” involvement (i.e., actual, imagined
and/or anticipated) with other individuals (and/or
events) in your surrounding environments (e.g., home,
work, community, school - see Exhibit 8.1). Because
psycho = individual and social = society (or others),
these stressors are derived from the interactions we
have with others.
The Linking Nature of Psychosocial Stressors

Recall from the discussion in Chapter 5 (see
Exhibit 5.3), that psychosocial stressors are the Exhibit 8.1: Students interacting with professor
“linking” stressors between the core internal stressors in class
(i.e., personality), those that straddle both internal and
external conditions (i.e., private life and

academic), and the pure external stressors
(i.e., organizational and environmental) (see
also Exhibit 8.2). It is also important to recall
that because personality stressors are the
dominant and primary stressors (see Exhibit
5.4; 5.5), it is these personality conditions (or
dispositions) that have a direct influence on
the “needs” we have, the latter of which, in
turn, influence the quality and quantity of the
interactions and relationships we have with
others, i.e., psychosocial stressors. In other
words, most of these stressors occur either
when a) your presence triggers/influences
their reality, or b) their realities are created by
the interaction between you, other people
Exhibit 8.2: The interrelationship of all six stressors, emphasizing: and/or ongoing events.
a) the interlinking nature of psychosocial stressors to the internal As a great portion of these
and external conditions and b) private life and academic stressors psychosocial stressors originate, in part, in the
straddling both of these internal and external conditions internal environment, we have some control
over them, as is the case with the personal and
81
82 PART I 2 Identifying the Background, Nature and Causes of Stress
private life stressors discussed in Chapter 3 and Chapter 4, respectively. In order for us to manage these
psychosocial stressors, we have to adopt a different philosophy regarding “control,” and we invariably
have to work with other people, some of whom are associated with the advent of the stressors in the
first place. More will be said about the
management of these stressors under stress
management in PART IV of the book.
The Master Status of College Students

Because psychosocial stressors involve
the interaction of the individual with people and
events around him/her, interpersonal relationships
constitute a key ingredient of the interaction
process. In the case of students, as seen in
Exhibit 8.3, it is their master (or central) status, as
students, which determines the relative positions
(i.e., statuses) of others around them and the
expected behaviors (i.e., roles) between students
and those around them. As will be pointed out Exhibit 8.3: The relationship of students’ master status to other
shortly, these ensuing interactions and complementary statuses and roles, any of which can contribute
relationships, which are largely determined by stress for students
students’ master status, have the potential to be stressful (i.e., psychosocial stressors) if students’ needs
are not satisfactorily addressed and/or satisfied. What follows are definitions for status, role, master
status, role set and related concepts.
Status: “Socially defined position in a social structure.”

Status set: “All of the statuses a person has at a given time”
Status inconsistency: “A person occupies two or more statuses that society deems contradictory”
Master status: “A status that dominates all other statuses”
Role: “A set of expectations, rights and duties that are attached to a particular status.”
Role distance: “People play a role but remain detached from it to avoid any negative aspects of the
role.”
Role embracement: “When a person’s sense of identity is partially influenced by a role”
Role sets: “Multiple roles are attached to almost every status”
Role strain: “Contradictory expectations and demands attached to a single role” (e.g., student)
Role conflict: “When a person cannot fulfill the roles of one status without violating those of another”
Social network: “Includes the total web of an individual’s relationships and group memberships”
Source: Thompson, W.E., & Hickey, J.V. 1999). Society in focus: An introduction to sociology. New York:
Longman.
Apart from the university environment, students are likely to experience stress (i.e., conflict,
frustration) in other related environments including home, work and the community. The psychosocial
stressors that are likely to occur are discussed below:
Chapter 8 . Psychosocial Stressors 83
K Frustrations;
K Relationships Problems; and
K Acculturation
Frustrations
Frustration is an experience that most people undergo in many of their daily activities. It is
simply defined as the “...thwarting or inhibiting of natural or desired behaviors and/or goals.”
Typically, frustration occurs when you are blocked or prevented from doing something you want to do.
What you want to do may be a behavior you wish to perform or a goal you want to attain.
Frustration = Blocked Aspirations + Needs + Desires
Some common examples of frustration include:
K Instructor not giving the desired grade in class;

K Traffic moving too slow;
K Roommates late again with their portion of the rent;
K Waiting in a slow-moving grocery line;
K You want to attend college but don’t have the necessary funds; and
K Difficulties completing an homework assignment on the computer (see Exhibit 8.4).
Although the response to frustration

can vary, it generally includes some emotional
expression, such as anger and aggression.
These responses are also accompanied by a
corresponding set of nervous and internal
hormonal responses, the latter of which
translates into the stress reaction. In short,
then, frustration can very much lead to stress
if circumstances that contributed to it in the
first place are not addressed.
Exhibit 8.4: Student’s frustration with homework assignment
Relationship Problems
As seen in Exhibit 8.3, given the master status of college students, they have the potential to be
in conflict with a variety of individuals who complement their status on a daily basis. Again, based on
how psychosocial stressors are defined, the problem that arises is derived primarily from the students’
personalities (personality conditions). A brief mention is made of some typical relationship problems
(stressors) in the areas of friends, family, roommates and faculty.
Friends
According to Winters (2003), "There's a great hunger for understanding relationships, not just
body parts," says Sarah Brown, president of the National Campaign to Prevent Teen Pregnancy. "Young
people tell us they're almost drowning in information about AIDS, condoms, pregnancy. But they want
to know, 'How do I break up with my boyfriend without hurting his feelings?'" One recent study of
college students' use of counseling services at Kansas State University showed that the percentage of
students seeking help for relationship problems rose from 34% in 1989 to 60% in 2001.
Zusman and Knox (1998) reported on a study that assessed whether college students, as
"casual" and "involved" daters, experience different problems in their respective relationships. While
earlier studies identified the general nature of relationship problems college students experience (Knox
and Wilson, 1997), more recent studies have focused on sexual decision making (Finkelstein and
Brannick, 1997), the stress associated with problem resolution (Simpson et al., 1996), and jealousy
(Peretti and Pudowski, 1997). However, there seems to be a void in the literature concerning casual and
involved daters and their reported experiences and problems (stressors).
The following results were reported by Zusman and Knox (1998) between the both groups.
Both "casual" and "involved" daters reported communication and jealousy issues among the top three
problems. A higher percentage of casual daters reported problems related to different values, honesty,
shyness, unwanted pressure to engage in sexual behavior, and acceptance than involved daters.
Similarly, a higher percentage of involved daters reported problems related to time for each other, lack
of money, and places to go. Based on how psychosocial stressors are defined, the latter of which are
initially influenced by students’ personality conditions (see Exhibit 8.2), will determine which
individuals in these two groups of students perceived their problems as stressors.
Roommates
At most colleges, especially during the freshman year, it is mandatory for students to have on-
campus housing. For students, especially those going from high school to college, they can experience
many transitional changes. One of the biggest is living with a roommate. According to Shaffer (2002),
“Orientation sessions will explain the nifty features and services on campus that should enhance the
pursuit of higher education. But there's one crucial element of university life that is often glossed over
or never even mentioned in the handbooks and welcome packets. It is a human element that is difficult
to predict or plan for. It's called "the roommate” (p.11).
Although the problems of living with a roommate seem endless, they usually include some
fairly typical and constant issues: division of room space and possessions; noise factor associated with
musical instruments, radios, televisions, etc., unannounced and/or noisy, unmannered guests, tidiness of
the room, living, and/or eating/cooking areas. Naturally, these possible problems, or stressors, can be a
major distraction to school work, as well as to any meaningful and cordial relationship between those
concerned.
If a problem does arise that cannot be fixed roommates have two basic options: a dorm room
swap and a room reassignment. According to the Executive Director at the Association of College and
University Housing Officers-International (ACUHO-I), which is a research and professional
organization that focuses on college housing issues, the number of students who seek a room change is
usually a smaller percentage of the total housing population. Some of the major disagreements
surround the areas of: cleanliness, smoking, sleep time, and the study environment (Runmore, 2004).
However, not all cases have to be a problem, and in some cases a roommate can be a huge asset.
Most people enjoy the company of others and desire the opportunity to share opinions, interests, and
good times. Sharing a room with another individual can sometimes result in a few problems, but they
need not become so irritating as to upset the enjoyment found in residence hall living (College Prep
101, 2001; Jenista, 2001).
Loneliness and Adjustment

It is incorrect to think that loneliness is just being alone. In fact, many if not most people enjoy
solitude. Loneliness is missing and longing for some kind of human interaction, i.e., even if you are in a
crowd. However, the kind of contact missed varies greatly, e.g. one could miss one particular person or
one kind of social interaction (e.g. at work or old friends or emotional intimacy in a love relationship)
or social activity in general. Again, the subjectivity of one’s loneliness is underscored by the way in
which stress is defined and the fundamental impact personal conditions have on psychosocial stressors
(see Exhibit 8.2).

In adjusting to university, some students find the transition to university an exciting challenge
to personal growth. Others find these changes overwhelming and experience emotional maladjustment
and depression. Leaving home to attend a university involves a number of changes, e.g., in lifestyle and
social activities, work patterns, and degree of independence and self-sufficiency. This being the case,
these cumulative acquired effects can make people feel uncertain of what to do or how to be. When this
happens, social insecurities can then creep in, even in people who normally feel quite socially adept.
Therefore, for some individuals, loneliness is a new and disconcerting experience, while for others it is
more familiar, but may now be accompanied by reassessing the University as disappointing in that it did
not usher in the desired changes and fulfillment (again, see Exhibit 8.2).
Research confirms the assumption that college environments perceived as supportive are linked
with increased adjustment and higher achievement (Pascarella, & Terenzini,1991).Grieving the loss of
pre-college friends is thought to be manifested by preoccupation and concerns associated with losing an
established network of friends. Distress might last for several months, and during this time students try
to maintain their precollege friendships as they were before. Paul and Brier (2001) suggest that students
who are highly preoccupied with and concerned about their pre-college friendships exhibit poorer
adjustment to college along a number of dimensions.
Acculturation
Acculturation is basically the degree to which individuals adjust to and/or being absorbed into a
new surrounding or group. Considerable evidence exists that when individuals are adjusting to a new
environment it is likely that they will experience some (psychosocial) stress simply because their needs
are not met. A variety of circumstances exist whereby individuals fail to be acculturated, hence the
feeling of stress. Students beginning college for the first time, especially international students coming
to a new and unfamiliar country are typical examples of groups of people who are likely to experience
stress resulting from their perceived needs (e.g., desire to fit in with the others) not being met (see
Exhibit 8.2).
“Acculturation is a process whereby individuals learn about the rules for behavior characteristic of
a certain group of people. The term culture refers to the way of life of a people and includes the tools
or methods with which they extract a livelihood from their environment. It includes the web of social
relations, understandings, customs, and rules or attitudes...” (Corsini, R.J. Concise encyclopedia of
psychology. New York: Wiley, 1987, pp.7-8).
Immigrants and Acculturative Stress

In the case of immigrants in general, who come from all over the world (see Exhibit 8.5), on a
world-wide basis they have higher rates of mental problems than non-immigrants. Adjustment to life
(e.g., conflicts involving emotions, cultural differences, interpersonal relationships; and roles; low self-
esteem; and loss of control) in a new country can be very stressful for some immigrants.
With the advent of a “global” world, i.e., where nations are very much interconnected via
transportation systems (e.g., involving air, sea and land), traveling and permanent migration have been
increasing (Exhibit 8.5). Adjustment to the destination country can be stressful for immigrants
irrespective of where they are from. This adjustment is usually referred to as acculturation and the
resultant difficulties in adjustment are referred to collectively as “acculturative stress. Acculturative

Stress as defined by Dressler and Bernal (1983): “when an individual’s adaptive resources are
insufficient to support adjustment to a new cultural environment”( Roysircai-Sodowsky & Maestas,
2000, p. 138).
Synonyms for acculturative stress that have been used
in the literature include “culture stress, “culture shock,”
“culture fatigue,” “role shock,” and “language shock.” The
uniqueness of this special type of psychosocial stressor, which
involves great loss and challenge, is difficult to understand for
people who have never had the need to immigrate.
The stress associated with acculturation involves a
complex series of events and, can in some cases, vary by the
particular back-ground of immigrants. The process usually
involves four stages: Exhibit 8.5: Immigrants come from a variety of
countries all over the world.
K The initial feeling of joy and relief for
arriving in the country of destination;
K Having some initial and immediate regrets for leaving the home country;
K Experiencing stress; and
K Accepting, adjusting and reorganizing to suit the conditions of the immigrant’s “new”
country.
It must be noted that the last step only occurs if the accumulative stress is reasonably
surmounted. Failure of the immigrant to reach this last step can result in the accumulative stress leading
to a variety of health-related outcomes, e.g., suicide, alcoholism, family violence, depression, to only
mention a few.
Several factors can lead to immigrants failing to cope with or reduce acculturative stress. What
is perhaps one of the most important contributing factors is the loss of social support in the form of
family ties. For immigrants, such as Hispanics from Central and South America coming to the United
States, the loss of social support in the form of family ties and close interpersonal relationships can be
especially devastating or stressful.
Another factor associated with acculturative stress is the loss of the immigrant’s identity. As
acculturative stress increases, immigrants are less likely to invest in the development of needed skills
and/or the acquisition of resources (e.g., learning the language of the host country) that may be an asset
in emerging difficult situations (e.g., arguing for rights). If the situation is perceived as getting worse,
immigrants may begin re-evaluating their roles within their new country and their feeling of not
belonging, or being an “outsider.” In some extreme cases of acculturative stress, some immigrants pack
their belongings and return to their home countries. The immigrants who return are usually those who
did not flee their home countries because of political repression; instead, they migrated primarily to
improve their standard of living.
In the case of immigrant students, it was reported that Asian American immigrant college
students were more likely to report family conflicts than second-generation students because the
acculturation gap between parents and children is largest soon after immigration. Additionally, it was
seen that Asian American college students, regardless of generation status, were more likely than White
and Hispanic students to report these types of conflicts and such conflicts were associated with
psychological distress. Furthermore, Asian American students who used avoidant coping strategies to
manage these conflicts experienced greater psychological distress (Lee & Liu, 2001).

Psychosocial Stressors
O The Linking Nature of Psychosocial Stressors (p.81)
O The Master Status of College Students (p.82)
O Frustrations (p.83)
O Relationship Problems (p.83)

9 Friends (p.83)
9 Roommates (p.84)
9 Loneliness and Adjustment (p.84)
O Acculturation (p.85)
9 Immigrants and Acculturative Stress (p.85)
___________________________________________________________________________________
9.
Academic Stressors
ë
“Whenever you face obstacles in college, become challenged by the challenge to be
challenged. This way of viewing life will contribute to many future successes for you.”
- Dr. Ivor Lensworth Livingston
A
cademic stressors constitute a very important
source of stress for college students. Although
they can be experienced anywhere, they are
usually related to and/or experienced in some classroom
environment (Exhibit 9.1).
Academic stressors include the student's perception of
the extensive knowledge base required and the
perception of an inadequate time to develop it (Carveth,
Gesse, & Moss, 1996).
Students report experiencing academic stress at
predictable times each semester with the greatest sources
of academic stress resulting from taking and studying for
exams, grade competition, and the large amount of
content to master in a small amount of time (Abouserie, Exhibit 9.1: The classroom experiences that are
1994; Britton & Tesser, 1991). Therefore, when very important contributors to academic stressors.
academic stressors are mentioned they are usually
referred to in the context of classes, grades, examinations, and associated skills (e.g., comprehension,
studying time, test anxiety, preparation time).When stress is perceived negatively or becomes
excessive, students experience physical and psychological impairment (Murphy & Archer, 1996).
Academic Stressors Falling Between Internal and External Conditions
Before a discussion is presented on

academic stressors, it is important to again note their
position relative to the other four stressors, as well as
to their straddling position between the internal and
external conditions (see Exhibit 9.2).
As with the other stressors discussed before,
these relative positions are important to better
understand how they are likely to be a) perceived as
stressors in the first place and b) how they can be
controlled or managed (which is the discussion in
Part IV of the book). Again, personality stressors,
which are part of our internal conditions (and
therefore more controllable) have a likely influence
on academic conditions or stressors. This
Exhibit 9.2: The interrelationship of all six stressors, relationship may be through connecting psychosocial
emphasizing: a) the interlinking nature of psychosocial stressors, or directly to the academic stressors
stressors to the internal and external conditions and b) themselves. Another point illustrated in Exhibit 8.2,
private life and academic stressors straddling both of these
internal and external conditions
89
is that some academic stressors (e.g., poor studying habits) are under students’ control (i.e., partly
under internal conditions), while other academic stressors (e.g., class size) are under the control of the
University (i.e.., external conditions).
Four Main Areas of Potential Academic Stressors
The literature is consistent that there is no totally agreed upon subareas that constitute
academic stressors. However, based on a review of the existing literature, for purposes of this book,
the four areas that contribute to students experiencing academic stressors are as follows: a) personal
skills; b) scheduled courses; c) scheduled workload; and d) career plans and goals (see Exhibit 9.3).
Exhibit 9.3: The four main areas of potential academic stressors and their related factors
It should be pointed out again that depending on how stress is defined in this book, i.e., as a
perceived discrepancy between demands and available resources, all the possible conditions listed
under the four subareas are only potential academic stressors. They only become real stressors to the
extent to which students perceive them as such, hence the need to further underscore the subjective
nature of stress (see Exhibits 3.2 and 3.3). As a summary statement, it can be said that based on
personality conditions (or dispositions) from which all stressors are initially derived, if students have a)
personal skills, b) scheduled their classes appropriately, c) scheduled their workload appropriately, and
d) they have career goals, the stress that they experience should be less compared with other students.
.
Chapter 9 . Academic Stressors 91
Personal Skills
Not only are students’ personal skills a major determiner of the stresses (i.e., academic
stressors) they are likely to experience, but they are a direct result of students’ personal dispositions.
As seen in Exhibit 9.3. a variety of such skills that students should have and, therefore, failing to have
these skills increase the likelihood of experiencing stress. These stress-producing lacking skills
include: poor study habits, procrastinating, inability to control panic attacks, poor time management,
planning and test-taking skills. Invariably, what guides your personal skills, are your values, which are
the beliefs that you believe to be correct that influence your choices. In this case, these choices are to
acquire and maintain a value system that contains these personal skills, all of which will allow you to
experience less stress, be healthier, and be more successful at college. A brief discussion is presented
on a select few.
Time Management
If you ever stayed up late cramming for an examination in
the morning or meeting the deadline for a term paper due the next
day, you are likely to experience stress due to poor time
management (see Exhibit 9.4). Thus, you may say to yourself “If
only I had started earlier.”
“It is very important to cultivate the habit of setting priorities

and deciding how much time to devote to each task you must Exhibit 9.4: The need for having personal
accomplish. Some things will naturally take more time than skills, e.g., planning, good study habits, time
others, and it’s up to you to manage your time wisely”(Rowh, management
1989, p.76).
According to Lay and Schouwenburg (1993), time management is defined in terms of clusters
of behavior that are deemed to facilitate productivity and alleviate stress. Although programs
emphasize beginning large tasks well in advance of due dates, breaking down large tasks into smaller
ones, and doing small tasks on a regular schedule, students regularly ignore these suggestions and,
therefore, find themselves in great distress , for example, before exams (Brown, 1991).
“Mark leaves everything to the last minute. For Mark this is an attempt to deal with anxiety about his
school work since it gives him no time to agonise about whether it is good enough. However putting
things off is actually very stressful and Mark encounters difficulties over more complex, long term
projects or if a last minute crisis occurs. Using a more systematic approach helps Mark feel more in
control and as a result more able to deal constructively with his anxieties about his school work.”
If you did not plan to study for an upcoming examination, or you did not plan to allocate the
appropriate portion of time between study periods and sleeping periods, and if you did not take the time
to plan how you will approach your “end-of-term” final examination, which is worth 60 percent of your
final grade, can all amount to stressful experiences for you. These examples underscore the important
interrelatedness of the various areas under personal skills.
Procrastination
Basically, procrastination is the avoidance of doing a task which needs to be accomplished, or
simply "letting the low-priority tasks get in the way of high priority ones." This dynamic and complex
phenomenon is manifested in both the general public and the academic environment (Ferrari, Johnson
and McCown, 1995). Normally, the procrastinator will work on less important obligation, rather than
fulfilling the more important obligation, or she/he may use her/his time wastefully in some minor
activity or pleasure. In most cases, procrastinators keep themselves ready to work, but end up avoiding
the activity (Yaakub, 2000).
Procrastination, as a sporadic or chronic response to task engagement, is a pervasive problem
for a large number of individuals in many societies. For example, researchers have estimated that in
academic settings in North America, over 70 percent of students exhibit this behavior. Many of these
individuals are highly vulnerable to negative consequences such as poor performance, decreased
subjective well-being, negative affect, and reduced life achievements (Schouwenburg et al., 2004). A
procrastinator is someone who knows what (s)he wants to do, is equipped to perform the task, is trying
and planning to perform the task, but does not complete the task, or excessively delays performing the
task.
Most research on procrastination that had been carried out has focused primarily on college
students (McCown and Roberts, 1994). While many college students procrastinate, some procrastinate
to avoid a difficult assignment, and others do it because they found a rare payoff in being able to wait
until the last minute and still be able to accomplish arduous tasks. For others, it may just be a simple
habit. Students have been found to have high procrastination and this tendency seems to increase in
higher education. College students who procrastinate in their academic work are also likely to have
unhealthy sleep, diet, and exercise patterns, according to one of several studies presented by scholars at
a recent annual meeting of the American Psychological Association (Glen, 2002).
Distracting Feelings
Students have to be concerned about acquiring the needed
skills to control a variety of distracting feelings, all of which can be
stressors in themselves, or contribute to other conditions (e.g., low
examination grades) becoming stressful (see Exhibit 9.5). A
distracting feeling is viewed as any condition, physical, emotional or
otherwise, that students experience which serve to interfere with their
academic pursuits in some way or another. Usually these skills will
come with students becoming more informed about the nature and
outcomes of these distracting feelings. While several conditions can
qualify as distracting feelings, e.g., inability to concentrate, phobias, Exhibit 9.5: Stressful distracting feelings
anxiety disorders, panic attacks, because of space limitations only
panic attacks and test anxiety are discussed.
Panic Attacks
There are approximately 3-6 million teenagers and young adults struggling with panic disorders
(as well as other related maladies, e.g., generalized anxiety disorders, stress, and social phobias)(Trego,
2004). Hinton et al. (2003) claims that a panic attack is the body's natural "fight or flight" reaction to a
sudden threat. If there is no real external threat, the adrenaline pumping around the body is experienced
as a panic attack: the heart beats fast and hard, we may sweat, feel faint or nauseous. All these
symptoms can be very frightening. If you experience a panic attack, it is important to remind yourself
that none of these feelings can harm you - you are not going to have a heart attack, faint, or be sick. If
you can accomplish this feeling, you are on your way in acquiring a personal skill to help combat this
academic-related stressor.
Evidence seems to support the view that anxiety symptoms can foster panic, depending on how
we think about them. People who have a "fear of fear" tend to be more likely to panic. These people
interpret anxiety symptoms as a threat of a traumatic disease. Other people consider these symptoms as
passing irritations. The people with this "fear of fear" are more likely to panic (Azar, 1996).
According to Trego (2004), there are three types of panic attacks. These different types of
panic attacks are important to know in that they will help to reduce the stress when you experience
them, as well as this information helps in allowing for greater acquisition of person skills to manage
panic attacks (or disorders).
The first is the unexpected panic attack. If you suffer this type of panic attack, it isn’t associated with
what you’’re doing as the time. For example, you could be hanging out with your friends when all of
a sudden you feel dizzy and as if you’re going to go crazy.
The second type of panic attack is one that is situationally bound. This means that you are in the midst
of doing something when the panic attack happens. For example, you always suffer a panic attack
when you think about a test or are about to actually get out your pencil or pen and take it.
The third type of panic attack is a situationally predisposed panic attack. This type of panic attack is
associated with a cue, but does not necessarily occur immediately after the exposure. For example,
you might have two tests to take and get through the first one without suffering a panic attack.
Important Note! Please acknowledge that if these attacks persist, the services of a trained, licensed
practitioner must be sought.
Test Anxiety
For thousands of college students test anxiety is a major source of academic stressor
(see Exhibit 9.6). It must be said at the onset that no one is born with a fear of examinations, which is
directly related to test anxiety. Essentially, because students acquire this disposition (see Exhibits 9.2
and the importance of internal personality conditions or stressors) over their formative socialization
experiences (i.e., the process through which learning occurs),
they can with qualified and professional assistance “unlearn”
this counter-productive and stressful experience.
Many students experience some nervousness or
apprehension before, during, or after an exam, which is both
understandable and expected. This kind of anxiety can be a
powerful motivator (later to be referred to as eustress or
positive stress). However, some students experience test-
related anxiety to such a degree that it can lead to negative
health outcomes, poor performance and interference with
Exhibit 9.6: Test anxiety as a distracting feeling their learning experiences. It has been said that
approximately 20 percent of U.S. college students experience
symptoms of test anxiety (CampusBlues, 2004).
Test anxiety is basically an exaggerated emotional reaction students have to examinations. It
should be characterized as an anxiety attack (As a recap, see the discussion on Anxiety Disorders in
Chapter 2). Test anxiety is extremely specific. Individuals may suffer an anxiety attack during or even
prior to an exam (e.g., the night before, which would make it an anticipatory anxiety attack). Because
of the usual fear students have with mathematics, studies have been reported that link test anxiety with
mathematics anxiety (Zettler & Raines, 2000). However, test anxiety applies to all tests and test-taking
experiences. In the case of college students, the fear students have of exams is not an irrational fear.
The fact is that how students perform on college exams can shape the course of their academic careers.
However, the excessive fear of exams interferes with their ability to be successful in college.
Although many factors can influence the onset of test anxiety, the following conditions are
usually reported as very important (see Exhibit 9.6):
K When students perceive they are in the presence of a difficult, threatening or
challenging situation (e.g., an advance calculus examination);
K When students believe they are inadequately prepared to meet either existing or
anticipated challenges; and
K When students fear the consequences of possible failure and are aware of the
consequences that failure will bring (e.g., academic probation, loss of a scholarship,
repeating a course).
“Students who experience long term test anxiety speak of feeling "stressed out" at the mere thought
of an upcoming exam. Some become physically ill, while others "space out." Still others find that
no matter how many hours spent studying, once the exam begins nothing they read stayed in their
minds. It felt like every fact and idea drained out of their minds, down their spines, and seeped out
the bottom of their shoes onto the floor. Students express thoughts of "I am going to fail this exam."
"I can't remember the answers." "I'm going to do badly, and prove how much of a failure I am, once
again."
Students who have experienced test anxiety know that worry, stress, and tension add to the
difficulties of taking a test. The physical and emotional reactions associated with test anxiety can be
very harsh and they usually interfere with thinking and concentration. More will be said later on, in
Part III of the book that deals with stress reaction about some of the symptoms of test anxiety, which
are very similar to the basic stress reactions all individuals exhibit when they are under stress.
Study Skills
As seen from Exhibit 9.3, the lack of students’ skills (e.g., appropriate studying hours test-
taking skills, note-taking skills, time planning and communicating effectively) which are a major spin-
off from their personal skills, are a major asset in eventually reducing their academic stressors. There
are too many college students who have very poor study habits. Unfortunately, many students entering
college are poorly prepared for college work. Most have poor or no study habits, i.e., routines that are
necessary for academic success. For example, an increasing number of students are entering college
without the ability or know-how for taking notes and for critical/logical reasoning, both of which are
key for success in college, which in turn can reduce the stresses they are also likely to experience when
at college. Additionally, many students do not plan their study time and do not know how to organize
subject material in order to learn and succeed. Unfortunately, if effective study routines are not learned
or taught before entering college, as they should, the student must learn them during their Freshman
year and this must then be regarded as remedial work. Without good study habits, a student will not be
likely to succeed (Solomon, 2002).
A national survey of 63,000 college students found less than 15 percent came close to studying
the traditional two hours outside class for every hour in class. The National Survey of Student
Engagement (NSSE) conducted by Indiana University researchers found that 55 percent of students
spend only an hour or less for every class hour. However, it was also said that many factors besides
academic aptitude can affect college students' grades and learning: How they manage time, how much
they value good grades, when they study during the academic term (The Cincinnati Enquirer, 2000).
Success in college is dependent on students’ ability to study effectively and efficiently. For
Weiss (2004), the results of poor study skills are wasted time, frustration, and low or failing grades.
Students should recognize one key difference between college and high school: freedom. They are free
to pass or fail, complete assignments or not. Instructors won't hold them accountable; only they will. In
terms of studying skills, your study approach should be designed to meet the requirements of the class.
It should also meet the testing needs of the course. These facts make solid study skills imperative.
Scheduled Classes
As seen from Exhibit 9.3, scheduled courses, as well as the main characteristics of these
courses, are important contributors to students’ academic stressors. Because students have some choice
in selecting “appropriate” classes, times, etc., they should do
with care and early enough so that their classes run smoothly
(e.g., they do not have to rush and be stressed between classes
- see Exhibit 9.7). It has also been said (Rowh, 1989), “A sure
path to stress is taking too many classes in any given term.
Usually for colleges operating on a semester basis, an hour of
credit is roughly equivalent to an hour spent in the classroom
every week for 14 to 16 weeks”(p.78). At most colleges, you
must take a minimum of 12 semester hours to be considered a
full-time student.
According to NCES (2004), large majorities of
students enrolling in post-secondary education for the first Exhibit 9.7: Select appropriate classes and
times to minimize rushing
time in 1995-1996 reported being satisfied with course
availability, class size (and their instructor’s ability to teach). All of the other characteristics (e.g.,
type, mixture, meeting time level of difficulty, required or elective), if not meeting the needs of college
students, may also be potential sources of academic stress. Because of the unique issues surrounding
remedial courses and services for students with disabilities, a slight elaboration is made about these
characteristics.
Remedial Courses
A potential source of stress is the issue (e.g., embarrassment) of doing remedial work in
college. Many students enter post-secondary institutions lacking the reading, writing, and/or
mathemathic skills necessary to perform college-level work. This being the case, most institutions
enrolling freshmen offer remedial courses to bring these students’ skills up to the college level.
Remedial education provides opportunities for students who lack the academic skills to
succeed in post-secondary education. It was reported that 28 percent of entering freshmen enrolled in
any remedial coursework (reading, writing, or mathematics) in fall 2000. Twenty-two percent
undertook remediation in mathematics, 14 percent in writing, and 11 percent in reading. Freshmen at
public 2-year colleges were the most likely group to enroll in a remedial course (42 vs. 12 to 24 percent
of freshmen at other types of institutions). At the 4-year level, freshmen at public institutions were
more likely than those at private institutions to do so (NCES, 2004).
Services For Disabled Students
Another potential source of stress is seeking and being identified as a student with special
needs or disabilities. Usually, when students access the courses the services are attached as well.
According to the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973 -
all Americans with disabilities are guaranteed access to public buildings and services. Under these
laws, educational institutions must provide access and reasonable accommodations to qualified
students with disabilities (NCES, 2004). Therefore, if students qualify for these services they should
not be under any stress for not availing themselves of the needed services and accommodations.
Some Disability Statistics

According to the 1995–96 National Post-secondary Student Aid Study (NPSAS:96), roughly 6
percent of all undergraduates reported having a disability. Among 1995–96 undergraduates with a
disability, approximately 29 percent reported having a learning disability, and 23 percent reported an
orthopedic impairment. About 16 percent of students with disabilities reported having a hearing
impairment, 16 percent a vision impairment, and 3 percent a speech impairment. In addition, one in five
undergraduates with disabilities (21 percent) reported having another “health-related” disability or
limitation. Students with and without disabilities differed somewhat with respect to age and the type of
institution they attended in 1995–96. The average age of students with disabilities was 30, compared to
an average age of 26 among students without disabilities, and nearly one-quarter of students with
disabilities were 40 or over, compared to 12 percent of students without disabilities (NCES, 2004).
Scheduled Workload
While being a college student is potentially stressful, this stress is likely to increase a great deal
when students are working as well as going to school. The hours spent working after (or during )
school may be proportionate to the stress-related experience reported
by students. The troubling fact is that more and more college students
are holding jobs now in order to pay for college or to survive
financially while in school (see Exhibit 9.8).
Approximately one-third of undergraduates are older students
who are combining school and work: 43 percent of 1999–2000
undergraduates were age 24 and above, and, of those students, 82
percent worked while enrolled. Furthermore, about two-thirds of
these older working students characterized themselves as primarily
“employees who studied,” as opposed to “students who worked to
meet their educational expenses” (NCES, 2004).
Academic studies have also become much more strenuous
Exhibit 9.8: Your workload between over the last 30 years (Reisberg, 2000). It is reasonble to hypothesize
classes and part-time or full-time work that there is a much higher chance that a student with a job will be
can be a source of stress
more stressed than a student without a job because of these
circumstances. Reisberg (2000) found that 25 percent of freshman college students reported a
probability of getting a full-time job during school, and 77 percent of students said they would need to
work to pay for college. In terms of the implications of working while attending college, 65 out of 100
students reported that holding a job was a source of stress according to Ross, Niebling & Heckert
(1999). In addition, Dunkel-Schetter & Lobel (1990) found that financial worries were a common
source of stress. The reason for these answers is that students often feel overwhelmed because of a
limited amount of time to do all that is required of them as students, and this is particularly true for
those that hold part-time or full-time jobs (Macan, Shahani, Dipboye, & Phillips, 1990).
From a physical point of view, pushing your body too hard is another cause of stress. When we
take on the responsibility of becoming a student, we take on a lot more than we really realize.
Sometimes we "Spread ourselves too thin." We commit ourselves to do more than our bodies will
allow; keeping up with our social lives, as well as our work at school, can lead to damage of our bodies
and emotional well being. Studies have shown that students with a job while in college generally do
better than those students who do not have a job. However, students who spend too much time at their
jobs are creating problems for their college careers. Another point to be made has to do with the length
of time students are working, how well they like what they are doing, and what is the relationship of
these working hours to the hours they have to put in for their college work. It stands to reason that
students who like what they are doing at work, are working fewer hours compared with the time they
spend studying, are less likely (i.e., versus students who have an opposite scenario) to be negatively
impacted by their working hours.
Career Plans and Goals
Not knowing what major you will be concentrating

on in college and later on what career you will pursue can be
potentially stressful (see Exhibit 9.9). However, this
tendency of not knowing which majors and careers to pursue
is not unusual for thousands of students who enter college
each year. According to Carter et al. (2001), career
exploration, a job-hunting strategy and money management
can work to help you find and maximize a career. Because
knowledge is very important in this enterprise, it is equally
important to make a distinction between two types of majors Exhibit 9.9: Failure to decide on a major and
- academic and career. career options can be stressful
Academic Majors
These are formal programs of study designed to impart knowledge and skills that represent the
accumulated knowledge base in a subject area. The instruction is typically designed to be
comprehensive, theoretical, and decontextualized (from a labor market perspective). For example, a
mathematics major typically provides instruction across a broad range of mathematical content areas,
including in-depth study of historical and theoretical perspectives, with minimal regard to specific
occupational applications.
Career Majors
These are formal programs of study designed to impart knowledge and skills that represent the
relevant accumulated knowledge within the context of occupation-specific job requirements. The
knowledge and skills imparted typically involve less theory, more application, and a narrower
focus than what is taught in an academic major; they are also often explicitly linked to occupational
skill demands. For example, an engineering major (or engineering technology major) focuses on the
mathematical principles and applications that are required for practice as an engineer (or engineering
technologist), with more limited attention to areas of mathematics that do not have engineering
applications.
Where To Begin?
The situation tends to be more severe or potentially stressful as you leave your freshman years
and advance through the college ranks. The matter gets further complicated when other related things
(e.g., debt) are occurring in your life, as indicated by the testimony of a college student in the text box
below.
“This is a personal experience for me. I was recently told I have an ulcer - and was
ordered to reduce my stress wherever I could. How is that possible for any college senior,
I'd like to know? Here's my life in a nutshell: I have some of my hardest (and most in-
depth) classes this semester, as well as mounds of debt piled up, and I have no idea where
I will be after graduation, which is only a few short weeks away. Plus, how will I meet
people after college? I'm not the type to want to meet someone at a bar, and yet I'm not a
regular church-goer either.”
Sloboch, K. (2000). Stress and the college student: A debate. Nevada Outpost. Accessed
7/20/2002.
http://www.jour.unr.edu/outpost/voices/voi.slaboch.stress.html
Although students are at different stages along this continuum regarding defining majors and
careers, the logical starting point is the acquisition of relevant knowledge to make informed decisions.
Ask instructors, relatives, mentors and fellow students about careers they are familiar with. Also, check
with the reference librarian at your library and ask for recommended books to read on designated
fields. Try to remain current with major and career-related information. For example, try staying on
top of what careers are growing the most rapidly. The U.S. Bureau of Labor keeps updated statistics on
the status of various career areas. You can keep tabs on this timely information by checking the
Occupational Outlook Handbook. This source is published by the Bureau of Labor Statistics every two
years. It can be found in the local library, or you can look up highlights on the internet at:
http://stats.bls.gov/ocohome.htm.
Summary Outline of the Key Headings in the Chapter
Academic Stressors
O Academic Stressors Falling Between Internal and External Conditions (p.89)
O Four Main Areas of Potential Academic Stressors (p.90)
O Personal Skills (p.91)

9 Time Management (p.91)
9 Procrastination (p.92)
9 Distracting Feelings (p.92)
: Panic Attacks (p.92)
: Test Anxiety (p.93)
O Study Skills (p.94)
O Scheduled Classes (p.95)

9 Remedial Courses (p.95)
9 Services for Disabled Students (p.96)
: Some Disability Statistics (p.96)
O Scheduled Workload (p.96)
O Career Plans and Goals (p.97)

9 Academic Major (p.97)
9 Career Major (p.97)
9 Where To Begin (p.98)
___________________________________________________________________________________
10.
Organizational Stressors
ë
“Whatever the situation, and however disheartening it may be, it is a great hour when a
man ceases adopting difficulties as an excuse for despondency and tackles himself as the
real problem.”
- Harry Emerson Fosdick
O
rganizational stressors constitute a very important potential source of stress for college students.
As the focus of the book is on college students, these stressors are essentially university (or
college)-related resources that are either lacking and/or not functioning effectively, e.g., like a
functioning library facility for students (see Exhibit 10.1).
When students attend universities it is expected
that there will be certain resources in place for them in
order to ensure their academic and related successes. If
these resources are lacking, or they are not functioning
properly, students are likely to perceive this reality (see the
dominance of personality conditions relative to
organizational stressors in Exhibit 10.2) as organizationally
stressful.
Exhibit 10.1: Having access to an organizational

Organizational Stressors As External Conditions
resource, such as the library
Before a discussion is presented on organizational
stressors, it is important to note their relative position
relative to the other five stressors (see Exhibit 10.2). This
discussion is key to better understanding how students are
likely to experience organizational stressors in the first
place.
As with the other stressors discussed before, the
relative positions of these stressors are important to better
understand, not only how they originate, but eventually
how they can be controlled or managed. Again (as seen in
Exhibit 10.2), personality stressors, which are part of our
internal conditions, have a likely influence on
organizational conditions or stressors. This relationship
may be through connecting psychosocial stressors, or
Exhibit 10.2: The interrelationship of all six stressors
going directly to the organizational stressors themselves.
emphasizing: a) the interlinking nature of psychosocial Another point, which is illustrated in Exhibit 10.2,
stressors to the internal and external conditions and is that, for the most part, the non-existence of conditions
b) organizational stressors are located primarily (e.g., lack of appropriate course offerings) that lead to
under external conditions
potential organizational stressors are outside the realm of
students. However, given how stress is defined in this book (see Exhibits 3.2 and 3.3), the ultimate
perception of the lack of the needed resources by students is what makes these potential stressors real
and, therefore, experiential.
101
Main Areas of Potential Organizational Stressors

Although reports exist concerning organizational stress in the work environment (e.g., Styhre &
Ingelgard, 2003), there is a void in the literature as to how to view organizational stressors relative to
the university context. For this reason, organizational stressors are viewed in five main areas (see
Exhibit 10.3) in this chapter. As a summary statement, it can be said that based on personal
Exhibit 10.3: The five main areas of potential organizational stressors and their related factors
conditions (or predispositions), from which all stressors are initially derived, if students do not have
access to: a) non-academic resources, b) academic resources, c) health-related areas, d) resources in
the office of the college/school and department, and e) resources in the central administration building,
they have the potential to experience academic-related stress.
Non-Academic Resources
As seen in Exhibit 10.3, a variety of potential non-academic resources, if lacking, can be
sources of potential stressors. These non-academic stressors include: parking problems (e.g., ability
and convenience of driving own car and not paying a price, such as being unnecessarily ticketed), lack
of access to (campus) Post Office (e.g.., not having the ability to send and receive important mail),
inadequate housing (e.g., congested dormitories), problems with bank nearest campus (e.g., not having
the convenience of doing typical monetary transactions); and lack of access to the Office of Special
Needs for students (e.g., not having the ability to seek out needed help from counselors and advisors as
a result of any special need, such as attention deficit disorder, or ADD, remedial course work). Only
two of these potential organizational stressors - lack of parking facilities and lack of an Office of
Chapter 10 . Organizational Stressors 103
Special Needs are presented below.
Parking Facilities
Most universities and colleges, especially those that are located in urban and relatively heavily
used (i.e., by motor vehicles) areas, lack adequate facilities for parking. This problem is especially
more serious for larger campuses (e.g., in excess of 15,000 students). According to Fahy (2003), with
more and more students bringing their cars to school, it is not surprising that a major problem among
students these days is trying to find a parking spot on or near campus (and their classes). While driving
to school can allow students the flexibility of coming and going, there are obvious potential drawbacks
to driving. This being the case, students have to make the judgement call if these problems are worth
bringing their cars on campus. Even students who commute to campus, while having a more legitimate
reason for driving, are not immune to these parking-related problems.
The potential problems that inadequate parking can bring for students seem endless. Some of
these potential organizational stressors that students may experience include the following factors:
K Paying hefty sums each year in terms of parking violations;

K Dealing with traffic congestions;
K Loss of parking privileges due to outstanding or unpaid fines;
K The nuisance of having your car booted and/or towed with possible ensuing damage;
K Being late for classes trying to locate suitable spaces;
K The frustration of using a campus lottery to gain the few parking spaces available;
K The frustration of how faculty and staff get to park near designated buildings; and
K The possibility of cars getting damaged and/or stolen.
Student Services Programs

When students make the transition to college, especially those coming directly from high
school, there are many challenges to be experienced, hence the important need for colleges (and
universities) to have a variety of student services programs (e.g., student life/orientation; housing;
orientation to university’s resources including the library, social life on campus, financial aid;
supportive services, remedial and psychological needs). To the extent that these programs are lacking,
students do not transition well to college life, because of the ensuing stressful experiences and related
poorer health and substandard academic performances. While sometimes it is difficult to differentiate
between service programs that are non-academic versus those that are more academically oriented,
either way there are various programs that colleges (and universities) (i.e., organizations) should make
available for students.
Basically, students services programs enhance student life by offering a variety of programs and
services that supplement classroom experiences and encourage both personal and professional growth
and development. To the extent that such programs are lacking, students are likely to experience stress
by experiencing one or a combination of the following:
K No orientation to college policies, programs and activities;

K No job placement services and resources;
K No encouragement to be involved and participate in campus life;
K No fair and sound disciplinary grievance procedures;
K No fair and sound testing program for entrance purposes; and
K No support and assistance in making realistic decisions concerning academic and non-
academic concerns.
Academic Resources
As seen in Exhibit 10.3, there is a variety of potential academic resources which, if they are
lacking, can be sources of potential stressors. These academic stressors include: academic advisory
center (i.e., where students go in the schools or colleges for advisement on their course selection, issues
related to selected academic concentrations, or majors); library (i.e., where students have access to
journals, books, online resources); academic reinforcement (i.e., where students get needed help
regarding deficiencies in English, Mathematics, studying habits, etc.); computer laboratories (e.g.,
where students have access to computers and related technologies to assist them in being successful at
school); and various support laboratories (e.g., in foreign languages). Again, only a brief discussion is
presented on a lack of academic reinforcement resources.
Academic Reinforcement
While there are various names given to academic
reinforcement, the services provided are essentially remedial
in nature. Apart from there being an absence, or a question
concerning the quality and availability of the services
provided, because the services are remedial in nature many
students do not want classmates to know that they are
utilizing these services for fear of appearing “different,” or
less than adequate compared with other “normal” students.
Either way, both the lack and diminished quality of the
services provided, in addition to the “perceived” stigma
associated with the services, are potential stressors in Exhibit 10.4: The need to have special, academic
support services
themselves for many college students.
As mentioned before, not only do many students come to college ill-prepared for college life in
general, but on a more particular basis they require trained and qualified assistance (see Exhibit 10.4) in
reading, Mathematics and English, to only mention the areas more frequently utilized. Students’
success in college is clearly dependent on having a reasonable degree of mastery in these fundamental
subject areas. Assistance should also be available in the areas of studying habits, time management,
procrastination, goal setting, career paths, etc. Again, to the extent that students have dire needs for
these services and they are either lacking and/or substantially diminished both in quality and quantity,
the students are likely to experience stress.
Health-Related Areas
When it comes to their health (i.e., both physical and psychological), many students become
extremely concerned when either the quality and/or quantity of health services that should be provided
to them, when needed, are lacking or are in question. This latter fact is of even more concern when
students are out-of-state and, therefore, many miles from home and supportive family members,
especially parents.
In chapter 2, several potential health conditions that are typically found among the college
population were discussed. Such conditions included, but are not limited to the following conditions:
meningococcal infection; obesity-related issues; sexual activity; STDs and HIV/AIDS; unwanted
pregnancies; alcohol use and abuse; illicit drugs; depression; suicide, anxiety disorders; and poor eating
and dietary habits. Although any of these health-related conditions can be elaborated on to underscore
the point that students may perceive any inadequacies associated with health facilities on campus as a
source of stress, depression is selected as a more pivotal condition.
Chapter 10 . Organizational Stressors 105
In a recent article entitled, “Depression Among College Students Rising,“ Peterson (2002) it
was reported that “Mental illness is absolutely going off the charts on college campuses.” It was also
reported that “College counseling centers used to be the backwaters of the mental health care system.
Now they are the front line.” A study from the American College Health Association in 2000 reported
that 10 percent of college students have been diagnosed with depression. And the National Mental
Health Association refers to a study that mentioned 30 percent of college freshmen report feeling
overwhelmed a great deal of the time. Among the various factors responsible for college students
remaining in college, even with a diagnosis of mental illness (e.g., depression), is the increasing
availability of psychiatric services at college. Usually these services are free and it is a good place to
get diagnosed and treated. Again, these facts suggest that if these needed services are not made
available by universities (or organizations), students are likely to experience stress.
Office of The College/School or Department

As seen from Exhibit 10.3, depending on students’ typical issues/problems (e.g., incomplete
grades, graduation dates, grievance with instructors), these issues/problems are usually addressed in one
or a combination of places. These concerns are addressed in either the office of the College, School
and/or Department where students’ majors are located. Again, if these offices are not functioning
efficiently, because of the pressing needs students have that may relate to academic (e.g., rectifying
incomplete grades from a previous semester) and other non-academic concerns (e.g., career goals that
are not very clear), they are prone to experiences stress.
Central Administration Building

As seen from Exhibit 10.3, based on the varied and crucial functions that the Central
Administration Building plays, it usually is the “hub” or the center of many administrative activities
associated with the daily functioning of any university. For example, personnel in the Central
Administration Building are responsible for coordinating certain designated student-related activities.
Such activities include, but are not limited to the following: accommodations for special needs students;
financial aid/scholarship; course and class scheduling; and the dropping and addition of classes. All of
these activities are very important for students; therefore if they are absent or compromised, students
are prone to experience stress. While in some cases the direct activities associated with some of these
activities may take place at other locations (e.g., Office of the Dean in a College or School, or a
Chairperson in a Department), for the most part personnel in the Central Administration Building are
usually responsible or accountable for students’ activities or concerns (e.g., failure to get a class
dropped even after the required procedures were followed) associated with these activities.
Summary Outline of the Key Headings in the Chapter
Organizational Stressors
O Organizational Stressors As External Conditions (p.101)
O Main Areas of Potential Organizational Stressors (p.102)
O Non-Academic Stressors (p.102)

9 Parking Facilities (p.103)
9 Student Services Programs (p.103)
O Academic Resources (p.104)

9 Academic Reinforcement (p.104)
9 Health-Related Areas (p.104)
O Office of the College/School or Department (p.105)
O Central Administration Building (p.105)

___________________________________________________________________________________
11.
Environmental Stressors
ë
“To get up each morning with the resolve to be happy... is to set our own conditions to
events of the day. To do this is to condition circumstances instead of being
conditioned by them.”
- Ralph Waldo Trine
E
nvironmental stressors, like the preceding five stressors mentioned before, constitute a very
important potential source of stress for college
students. As the focus of the book is on college
students, the emphasis is on conditions associated with the
campus, such as having a fear of walking across relatively
lonely sections of campus (see Exhibit 11.1) and related
environments (e.g., cafeterias, dormitories, libraries,
classrooms and health-related facilities). It also includes
the general environment and its associated conditions (i.e.,
the weather, temperature). It is argued that in these
environments, depending on students’ experiences, as well
as their perceptions of these experiences, they are likely to
experience stress.
Exhibit 11.1: The fear of walking across campus
Environmental Stressors As External Conditions
Before a discussion is presented on environmental

stressors, it is again important to note their position
relative to the other five stressors (see Exhibit 11.2). This
discussion is key to better understanding how students are
likely to experience environmental stressors in the first
place.
As with the other stressors discussed before, the
relative positions of these stressors are important to better
understand, not only how they originate, but eventually how
they can be controlled or managed. Again (as seen in
Exhibit 11.2), personality stressors, which are part of our
internal conditions, have a likely influence on
environmental conditions or stressors. This relationship
may be going through connecting psychosocial stressors, or
Exhibit 11.2: The interrelationship of all six
stressors emphasizing: a) the interlinking nature going directly to the environmental stressors themselves.
of psychosocial stressors to the internal and Another point, which is illustrated in Exhibit 11.2,
external conditions and b) environmental is that, for the most part, the existence of conditions (e.g.,
stressors are located primarily under external loud noise, binge drinking by other students in the
conditions
dormitories, violence directed at students) that lead to
potential environmental stressors is usually outside the realm of students’ abilities to control. However,
107
given the definition of stress in this book (see Exhibits 3.2 and 3.3), it is students’ ultimate perception
of these environmental realities that makes these potential stressors real and, therefore, experiential.
Main Areas of Potential Environmental Stressors

There is a void in the literature as to how to view environmental stressors relative to the
university context. Whereas previous reports have addressed potentially stress-producing activities
surrounding college students (e.g., drinking, Wechsler et al., 2004; Perkins, 2002; vandalism, violence,
Hart, 2003) as more a result of students’ behaviors, these activities were not themselves viewed as
potential environmental stressors or experiences. Given that stress is defined in this book as a personal
and subjective experience (see Exhibits 3.2 & 3.3), distracting, individual actions (e.g., abusive
drinking) are viewed in Chapter 7 as private life stressors. However, in this chapter which focuses on
environmental stressors, when these same distracting behaviors occur, they are viewed as potentially
distracting (or stressful) by other students who, in these cases are the recipients (not perpetrators) of
these experiences in various college-related environments (again, for example, on campus and in
dormitories).
For purposes of this chapter, environmental stressors are viewed in the context of five main
areas (see Exhibit 11.3). As a summary statement, it can be said that based on personality conditions
Exhibit 11.3: The five main areas of potential environmental stressors and their related factors
(or dispositions), from which all stressors are initially derived, if students have: a) health and related
concerns; b) living, eating and studying space concerns; c) community concerns; d) weather concerns;
and e) classroom concerns, they are prone to experience environmental-related stressors.
Chapter 11 . Environmental Stressors 109
Health Concerns
The environment surrounding college students can be a main source of concern, especially
when students perceive that this environment is making them sick. Although there are various kinds of
health concerns related to the environment, this chapter focus on more physical health, which is likely
to be impacted by a set of standard, contagious health hazards (see Exhibit 11.3) associated with college
life. Again, although there are various environments through which contagious (disease) outcomes
(e.g., influenza, tuberculosis, meningitis, hepatitis B) may be manifested for college students, the one
that is usually given the most attention is the college dormitory.
What follows is a brief discussion on two of the most mentioned contagious and, in some cases,
deadly disease outcomes for college students - meningitis and hepatitis B. Based on their contagious
and potentially deadly outcomes, students who know about them may have the fear of contracting them,
especially if they live in crowded dormitories on campus.
Meningitis
Meningitis is an infection of spinal cord fluid and the fluid surrounding the brain that can be
caused by bacteria or by a virus. Meningitis can be quite contagious, depending on the organism
causing the infection. Recent reports show that college students, especially freshmen living in
dormitories, are at increased risk for meningococcal meningitis. Doctors say college students are at
special risk for contagious diseases because they live in close quarters. The Centers for Disease Control
and Prevention (CDC)(1997) and the American Academy of Pediatrics (AAP)(1997) now recommend
that college students and parents be educated about meningococcal disease and for them to consider
vaccination.
College students get meningitis 2.6 times more often than peers the same age (Jackson et al.,
1995). Beginning in 1997, the American College Health Association (ACHA) recommended
considering meningococcal vaccination for all college students. Unfortunately, many students are not
aware of the risks of meningococcal disease and the availability of a vaccine against it. While the
American Academy of Pediatrics does not yet recommend routine vaccination except during a local
outbreak, the number of outbreaks has climbed steadily over the last decade.
Hepatitis B
Hepatitis B is a potentially life––threatening viral liver disease. It has been reported that the
hepatitis B virus can be 100 times more infectious than HIV in some settings. Over one million people
in the United States are chronically infected with hepatitis B. The disease is spread by contact with
body fluids of an infected person, such as blood, semen, vaginal secretions, and saliva. It can cause
lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.
Hepatitis B is extremely contagious for the college population. It can be spread not only
through sexual activity, but also through body piercings, tattooing, sharing a razor or toothbrush, and
contact sports. According to survey findings1, these are all common practices among college students. If
a contaminated needle is unknowingly used to apply a tattoo or piercing, adolescents and young adults
could put themselves at risk for contracting hepatitis B. Similarly, if an individual uses a razor or
_____________________________
This survey, conducted by Harris Interactive between April 24, 2003 and May 8, 2003, was completed using an online survey
among full––time college students at four––year institutions, living away from home, aged 18 to 22 years. Those surveyed
included 516 students nationally. The margin of error was plus or minus 4.3 percentage points at the 95% confidence level.
The survey was funded by a grant from GlaxoSmithKline.
toothbrush borrowed from a contaminated individual, he or she could become infected with hepatitis B.
Forty percent of college students either have a tattoo or body piercing or are likely to get one before
they graduate. In addition, one––third of college students admitted to sharing either a razor or
toothbrush with a roommate, partner or friend, also putting them at risk for contracting the disease (The
Society for Adolescent Medicine, 2003).
Living, Eating and Studying Space Concerns
Students are very much concerned with the places where they live, e.g., dormitories; eat, e.g.,
cafeteria; and study, e.g., library. Although there are other spaces of importance to students (e.g.,
recreational and social spaces), these three environments tend to be the most important in contributing
to students’ success in college.
Whereas in Chapter 10 questions concerning the quality and quantity of these three facilities
were viewed as organizational stressors, in this chapter concerns regarding these facilities are viewed as
environmental stressors. Conditions existing in these facilities, e.g., dormitory rooms, are viewed as
potential environmental stressors by students because the concerns (see Exhibit 11.3: noise,
temperature, cleanliness, size) students have are unique to these environmental spaces.
Dormitories
Most colleges mandate that freshmen live on campus, at least for the first year. The rationale
being that dorm life helps students transition from high school to
college. However, the environment of the dorms, while suitable
in some cases can be very stressful for many other students
because of conditions related to: a) the level of noise (both by
other students and from the outside environment); b) the
inability to achieve a desirable room temperature because of
possible structural issues; c) the cleanliness of the rooms,
hallways and bathrooms; d) and the size, configuration and
theme (e.g., singles, doubles, suites, single-sex or co-ed,
chemical or substance free, special interest or “theme”
Exhibit 11.4: Students try to make the best of
orientation) of the assigned rooms. Any one or a combination of their dorm room assignment
these concerns can be stressful for students where, in some
cases, to escape these realities they move out from their designated dorms (see Exhibit 11.4).
The Cafeteria and Other Eating Spaces
While students eat just about anywhere (e.g., in hallways, their rooms, classrooms, outside on
campus), the officially designed space is the cafeteria. If cafeteria environments do not possess the
basic factors of: cleanliness; appropriate configuration and arrangement of food and eating spaces;
appealing aroma; acceptable secular/popular background music; and wide selection of food students can
perceive these shortcomings as environmentally stressful.
Although some may think of food served in cafeterias as only a service provided by
organizations and, therefore, any negative issues surrounding it would be viewed as an organizational-
related stressor, this is a limiting view to have on the subject. In this chapter, both real and anticipatory
food and related services are viewed in an environmental context. Students come to expect certain
kinds of food “selection” in their cafeterias and, as such, they associate their eating environments as
either attractive or unattractive regarding culinary selection and availability. Again, students’ may
experience stress to the extent to which their culinary expectations either are not met or, for that matter,
will never be met to their satisfaction.
Cafeteria managers and college personnel are keenly aware of the need to make students
associate their cafeteria environments with having the appropriate culinary choices and selections. This
point was underscored in a recent article entitled, “Colleges Adjust Menus to Suit Students’ Changing
Tastes (Williams, 2003). What follows are some of the reports mentioned in the article that reflect a
broad spectrum of college cafeteria practices.
L “At the University of Pittsburg... employees of Sodexho Management Services, one of the country's
leading food-service providers to business and industry, schools and health-care institutions -- have
attended classes at the Culinary Institute of New York to learn about the flavor dynamics of Asian cuisine
and the Mediterranean region and how to prepare foods to appeal to international students.”
L “Carnegie Mellon University students from afar also can get a "taste of home" on campus -- from
Chicken Curry and Gulab Jamun (dry milk dumplings dipped in honey sauce) at the Taste of India
restaurant in Resnick Hall, to Seven-Pepper Tuna and Black Bean Hummus at Si Senor in the University
Center... The Student Body Dining Committee is an active group at Carnegie Mellon, he says. Members
meet regularly to handle issues at different locations around campus and work with administrators
toward the best on-campus dining program possible.”
L “At Penn State, students can opt for the traditional cafeteria-style experience in one of five dining
halls near their dormitories. However, ‘traditional’ has taken on a whole new meaning .... As a service
to students who ‘asked us why we never serve them steak,’ Wandel says, special menus are offered once
or twice a month. For an additional charge, clients can order savories such as prime rib, grilled
barbecued shrimp kebabs, snow crab clusters, mahi-mahi or a 12-ounce rack of ribs.... Daily, students
can fill their plates with entrees, sides, salads and desserts at an "All-You-Can-Eat" station, or they can
visit The Bagel Basket, The Waffle Iron, Ice Cream Alley, The Veg Stop, Big Daddy's Deli or rigaTony's
at Pollock Dining Commons, one of the traditional dining halls... ‘Our customers like for us to make
things for them’... adding that the majority of students would rather wait in line for a customized
sandwich than purchase one already prepared at the Deli Bar.”
Community Concerns
Most colleges and universities, especially those located in urban versus rural locations, are
situated in local communities. Depending on the relationship between the colleges and universities and
the surrounding communities, the relationship may be positive, supportive, and conciliatory or negative,
unsupportive and confrontational.
Universities that have strong community outreach programs and/or active student involvement
in local communities usually have a positive relationship with the surrounding community. However, if
universities have a contrary relationship with the surrounding community, for example, where there is
not supportive behavior coming from the university, and the community sees a gradual “expansion” of
university buildings deeper in the communities, there is usually ensuing animosity between both parties.
Whatever the nature of the relationship, students who attend the colleges and universities are usually
affected (i.e., positively or negatively) by the ensuing community-academic institution relationships.
Apart from the negative attitudes of community residents and inadequate parking space
concerns, another very important concern is neighborhood crime or violence (see Exhibit 11.3). It must
be pointed out, however, that violence affecting college students does not only occur off campus in
local surrounding communities, but it also occurs on campus (e.g., in classrooms, in libraries and in
dormitories) as well. For this reason, a discussion follows concerning violence and college students
across a wide spectrum of environments, especially the local communities and on-campus as well.
Wherever violence occurs, it can and usually is a source of perceived stress for college students.
Violence, Alcohol Intoxication and Rape

Female college students are likely to experience stress based on the alarming statistics
associated with one of the most frequently occurring violent actions - rape. When alcohol is included in
the mixture, unfortunately rape becomes more likely to occur. Overall, one in 20 (4.7 percent) women
reported being raped in college since the beginning of the school year –– a period of approximately 7
months –– and nearly three-quarters of those rapes (72 percent) happened when the victims were so
intoxicated they were unable to consent or refuse. These were among the findings of a study of 119
schools nationwide, by researchers at the Harvard School of Public Health College Alcohol Study, Saint
Joseph's University and the University of Arizona (Henegar, 2004).
"This study reveals that a woman's chance of being raped is far more pronounced on campuses where the
student body as a whole engages in a high rate of binge drinking and when individuals consume a large
amount of alcohol," said Meichun Mohler-Kuo, Sc.D., lead author of the study and research scientist at the
College Alcohol Studies at Harvard School of Public Health.
"Binge drinking isn't a harmless rite of passage but a risk factor in violence against women," said George
W. Dowdall, Ph.D., a co-author of the study and professor of sociology at Saint Joseph's University.
"Institutions of higher education need to change the culture of college drinking in order to make colleges
safer and healthier environments."
National Statistics on Violence and College Students

Recent data from the Department of Justice (DOJ) show the most recent trends associated with
violence and college students. A report from DOJ concerning its first study of violent crime on college
campuses indicates college students were victimized by violent crime at a lower rate (68 violent
victimizations per 1,000 students 18 to 24 years old) than were non-students of the same age (82 violent
victimizations per 1,000 non-students aged 18 to 24 years old). However, the report also shows that
violence against college students decreased by 40 percent while violence against non-students of the
same age fell 44 percent during the survey period (Hart, 2003).
As part of the DOJ report, the Bureau of Justice Statistics (BJS) (Hart, 2003) provided the
following estimates:
L Of the approximately 7.7 million U.S. college students aged 18-24, an average of 526,000
experienced violent crimes (rape, robbery, aggravated assault, and simple assault) each year, most
(492,000) occurring off campus. Among students living in student housing, about 85 percent of violent
victimizations occurred off-campus, compared to 95 percent for students living off-campus.
L Female college students were about half as likely as were male college students to be victims of violent
crime — an annual average of 47 violent crimes per 1,000 female students vs. 91 violent crimes per 1,000
male students. Female college students were substantially less likely to be victimized by a violent crime than
were similarly aged women in the general population (47 per 1,000 vs. 78 per 1,000).
L Black and white college students also experienced lower rates of violent victimization than similarly aged
non-students. Only Hispanic students experienced rates of violent victimization equivalent to those of the
same age in the general population.
L Violence against college students was less likely to be reported to police (34 percent of all victimizations)
than violence against non-students (47 percent). Student victims who did not report the crime they
experienced to the police said it was because they considered the violence a private or personal matter.
L Firearms were present in 9 percent of all violent victimizations against college students, including 7
percent of all assaults and 30 percent of all robberies.
Weather Concerns
Relative to the other concerns seen in Exhibit 11.3, weather concerns by students represent true
environmental conditions. This being the case, these concerns are, therefore, usually outside the ability
of students to control. As seen in Exhibit 11.2, the two main concerns that can be potentially stressful
for college students include the climate and the temperature. In the case of the climate changes, which
can involve rain, snow, high winds and at more extremes pending hurricanes, storms, flooding and
tornados, all of these can be stressful for students depending on the level of severity. More particularly,
if these weather-related occurrences impede handing in crucial class projects and/or the taking of
important exams (especially ones that students were fully prepared for), can lead to their experiencing
stress. The same line of reasoning applies to the temperature, especially in cases where there are
extremely cold temperature (e.g., 50 below) and/or extremely hot temperatures. In either case students,
like anyone else, are likely to feel upset and angry, especially when these temperatures impede school
work and other activities (e.g., the postponing of a long-awaited elimination basketball tournament
between rival colleges).
Classroom Concerns
The classroom environment has to be conducive for students to not experience a great deal of
negative stress, the latter of which can impede how successful they are at their classwork. As seen from
Exhibit 11.3, the more typical sources of environmental classroom impediment, which can be stressful
for students, include: a) dirty classrooms; b) noisy and distracting classrooms; c) small classrooms; d)
poor temperature control and lighting; e) substandard hearing or acoustics; f) poor odor control; and f)
overcrowded classrooms. Each one of these classroom-related conditions can have a negative impact
on how students perform in class. This being the case, and especially for students who want to move
ahead, these presence of these conditions can be both frustrating and stressful over time.
Environmental Stressors
O Environmental Stressors As External Conditions (p.107)
O Main Areas of Potential Environmental Stressors (p.118)
O Health Concerns (p.109)

9 Meningitis (p.109)
9 Hepatitis B (p.109)
O Living, Eating and studying Space Concerns (p.110)

9 Dormitories (p.110)
9 The Cafeteria and Other Eating Spaces (p.110)
O Community Concerns (p.111)

9 Violence, Alcohol Intoxication and Rape (p.112)
9 National Statistics on Violence and College Students (p.112)
O Weather Concerns (p.113)
O Classroom Concerns (p.113)

___________________________________________________________________________________
12.
Correlates of College Students’ Stressors
ë
“If you are distressed by anything external, the pain is not due to the thing itself, but to
your estimate of it; and this you have the power to revoke at any moment.”
- Marcus Aurelius
S
tress is a major issue for college students (see Exhibit 12.1) and by all accounts the problem is
increasing, because of intervention studies (Deckro et
al., 2002) and stress-related outcomes (e.g., increase
suicide rates, Patterson, 2003; alcohol use and abuse,
Spear, 2001). As this point has been underscored in the
previous chapters, especially Chapter 4, no effort is made
in this chapter to emphasize this fact again. Instead, the
main thrust of this chapter is to present some preliminary
data showing the relationships between the six stressor
areas discussed in Chapters 6 through 11 (see Exhibit 12.2)
and selected demographic (i.e., gender, college
classification, age); psychological (i.e., self-esteem and
self-control) and health (i.e., health-protective behavior).
This Exhibit 12.1: The classroom as a potential source of
chapter presents stress for students
exploratory data that were specifically collected for inclusion
in this book. As the data are preliminary in nature, only
descriptive (versus more analytical) information is presented.
Another reason for the kind of data analysis and subsequent
mode of presentation has to do with the goal of the book. Part
II of the book presents six chapters, each of which discussed
one of the six stressors that have the potential to influence
college students’ daily experiences.
The preliminary descriptive analysis of the data
presented in this Chapter is an attempt to provide first-hand
empirical information on the College Student Stress Index (or
CSSI - see copy in Appendix), which is derived from content
Exhibit 12.2: The interrelationship of all six specific to each of the six stressors. The relationship between
stressors each of these six stressors is assessed relative to designated
demographic, psychological and health-oriented correlates.
Background Information on Preliminary Data

The preliminary data collected specifically for inclusion in this chapter were collected from a
large eastern United States university in the spring semester of 2004. The sample size, which was N =
104, will be described in greater detail later in the chapter. The primary purpose for collecting the data
was to explore and assess the independent relationship between essentially four sets of correlates, i.e.,
demographic, academic, social psychological and health, and the six stressors (see Exhibit 12.2)
discussed in this book. As mentioned before, because of the preliminary nature of the data, the main
desire is to present descriptive analyses of the data highlighting what relationships, if any, exist between
115
subcategories within these four correlates and the six stressors categories. As all six stressors were
discussed in Chapters 6 through 11, the specific rationale of this chapter is to present empirical
evidence of the importance of these stressors as they may or may not relate to other defined areas
associated with college students’ experiences. This attempt has never been done before to the best of
this author’s knowledge, hence the preliminary and exploratory nature of the analyses. In the future, it
is anticipated that more complex analyses and interpretations of the data will be conducted elsewhere,
again for publication in designated health and college-oriented academic journals.
Relationships To Be Explored Now and In the Future

Future and more complex analyses of the data will reorder the positions of the variables used in
the analyses to be consistent with prior results presented in the literature. For example, the following
will be done:
K The demographic and academic conditions will remain as independent variables;
K The six stressor conditions will be viewed as independent variables;
K The social psychological conditions will be viewed as mediating variables (i.e., variables
occurring between the independent and dependent variables and affecting the independent-
dependent relationship outcome); and
K The health conditions will be viewed as the major dependent variables.
For purposes of this chapter, the main relationships to be explored between the four correlates
(and their subareas) and the six stressors are depicted below in Figure 12.1. The main relationships to
be explored between the four correlates (and their subareas) and the six stressors are depicted below in
Figure 12.1. Because of the direction and intent of the chapter, the six stressors are viewed as separate
dependent variables (i.e., outcomes that are determined or influenced by other variables). The
demographic, social psychological and health factors are viewed as independent variables (i.e.,
conditions antecede, influence or determine the outcomes of other variables) in these descriptive and
preliminary analyses.
As seen in Figure 1, for conceptual clarity, the major independent variables are placed at
different antecedent positions. Although these different positions will not be further elaborated on in
the chapter (but will be addressed in future analyses), it can be seen that demographic variables are at
the first level. The selected conditions examined here are students’ reported: a) age and b) gender. This
is followed by academic variables. The selected conditions examined here are students’ reported: a)
classification status and b) how they rate their academic performance to date. This is followed by
social psychological variables. The selected conditions examined here are students’ reported levels of:
a) self-control, b) self-esteem, and c) social support.
The last group of independent variables deal with health-related issues. The selected conditions
examined here are students’ reported levels of: a) depression, b) how they rate their health c) how well
they engage in designated health protective behaviors, and d) how well they rate their health. The
major outcome variables are students’ reported levels concerning: a) personality stressors, b) private life
stressors, c) psychosocial stressors, d) academic stressors, e) organizational stressors, and f)
environmental stressors.
Chapter 12 . Correlates of College Students’ Stressors 117
Based on the direction and intent of the chapter, the six stressors are viewed as separate
outcome or dependent variables (i.e., outcomes that are determined or influenced by other variables).
The demographic, social psychological and health factors are viewed as antecedent or independent
variables (i.e., conditions antecede, influence or determine the outcomes of other variables) in these
descriptive and preliminary analyses. Before any preliminary analyses are presented, a basic
descriptive overview is given for each of the major variables.
Descriptive Information on Demographic Variables
As seen in Table 12.1, the majority of the sample was between 17-19 years old (51.5%), with
the average age being 20.69 years and females being in the majority (82.5%).
Table 12.1: Distribution of Main Demographic Variables

Variables Number (%) Mean
Age: 20.69 years
1= 17-19 yrs. 52 (51.5%)
2 = 19.1 - 30 yrs. 48 (47.5%)
Gender:
1=male 17 (16.8%)
2=female 83 (82.5%)
Descriptive Information on Academic Variables
As seen in Table 12.2, freshmen were in the majority (67.3%) and the majority (40.6%)
reported that their academic performance was about the same as most other students.
Table 12.2: Distribution of Main Academic Variables

Variables Number (%)
Classification:
1= freshmen 68 (67.3%)
2= sophomores, juniors & seniors 31 (30.7%)
Rate of Academic Performance:

1= much poorer than most 3 ( 3.0%)
2= a little poorer than most 10 ( 9.9%)
3= about the same as most 41 (40.6%)
4= a little better than most 36 (35.6%)
5= much better than most 11 (10.9%)
Descriptive Information on Social Psychological Variables
As seen in Table 12.3, the overall mean response for students’ reported levels of self-control
was 22.16. When the distribution of responses were broken into two halves, a slight majority reported
Table 12.3: Distribution of Social Psychological

Variables
Self-Control: 22.16
1= low 54 (53.5%)
2= high 44 (43.6%)
Self-Esteem: 27.26
1= low 50 (49.5%)
2= high 48 (47.5%)
Social Support: 9.12
1= living alone 48 (47.5%)
2= not living 53 (52.5%)
alone
that they had low levels of self-control (53.5%). In the case of self-esteem, the overall average response
was 27.26, with a majority of students again reporting low levels of self-esteem (49.5%). Lastly, in the
case of having social support, the overall mean response was 9.12, and the majority of students (52.5%)
reported having a high level of social support as defined in the study.
Descriptive Information on Health Variables
As seen in Table 12.4, the overall mean score on the depression index was 40.92 and the
majority of students (50.5%) had low depression scores. In the case of health protective behaviors, the
overall mean score was 57.55 and the majority of students (48.5%) were engaging in low amounts of
health protective behavior. The majority of students (62.4%) reported that their health was in good
condition and their stress level was moderate (45.5%).
Table 12.4: Distribution of Health Variables

Depression: 40.92
1= low 51 (50.5%)
2= high 46 (45.5%)
Health Protective Behavior: 57.55

1= low 49 (48.5%)
2= high 46 (45.5%)
Self-rating of Health: ---
1= poor-fair 20 (19.8%)
2= good 63 (62.4%)
Accessing Current Stress ---
Level
1= relatively low 9 (89.0%)
2= mild 31 (30.7%)
3= moderate 46 (45.5%)
4= severe 12 (11.9%)
Descriptive Information on Stressors
As seen from Table 12.5, psychosocial stressors have the lowest mean score (13.4) and
personality stressors have the highest mean score (26.5). However, because these sub indices of
stressors have a different number of response items, the indices cannot be compared with each other.
Therefore, in essence, each of the stressor indices is an independent stressor measurement. Because the
CSSI and its validation represent the core of this Chapter, the entire CSSI (including the number of
items on each sub index, response categories, etc.) is presented in the Appendix (see page 273) for
readers to peruse.
Table 12.5: Distribution of Stressor Variables

Personality Stressors 98 26.45
Private Life Stressors 97 17.39
Psychosocial Stressors 99 13.37
Academic Stressors 100 18.91
Organizational Stressors 100 15.47
Environmental Stressors 100 13.64
Research Questions
Most research is driven by research questions that require answers. These preliminary analyses
are no different and the directional arrows seen in Figure 12.1 indicate the basic research questions
asked in this preliminary data analyses. The selected preliminary questions addressed are as follows:
K What is the relationship of demographic variables (i.e., age and gender) to:
9 Social psychological variables (i.e., self-control, self-esteem and support)?
9 Health variables (i.e., controlling health, current stress levels, depression, health
protective behaviors and rating health)?
9 Six stressor variables?
K What is the relationship of the academic variables to the stressor variables?
K What is the relationship of the social psychological variables to the stressor variables?
K What is the relationship of the health variables to the stressor variables?
Demographic Variables
What is the Relationship Between Demographic and Social Psychological Variables?

As a form of secondary analysis, the relationship between students’ age and gender is assessed
in the context of the three sub-variables that comprise the social psychological conditions. The only
relationships found to be of importance (i.e., achieving a level of significance at the .05 level) were: a)
between students’age and self-esteem and b) gender and social support. In terms of age, younger
students (i.e., between 17-19 years) reported lower self-esteem (mean of = 26.49) versus older students
(i.e., 19+ years; mean = 28.17). In terms of gender, female students reported having more support from
friends and relatives (mean = 9.27) versus male students (mean = 8.29).
What is the Relationship Between Demographic and Health Variables?
The data showed no clear relationship (i.e., the mean differences did not achieve statistical
importance, using the criterion of the .05 level of significance) between the demographic variables and
the selected health variables. Although the differences were not clear cut, the following relationships
were seen from the data analyses regarding age and gender of students:
Age of students:
K Older students (mean = 2.75) reported more current levels of stress than younger
students (mean = 2.65);
K Younger students reported higher levels of depression (mean = 42.20) than older
students (mean = 39.40);
K Younger students reported engaging in more health protective behaviors (mean =
58.26) than older students (mean = 56.82); and
K Older students rated their health more positively (mean = 2.00) than younger students
(mean = 1.94).
Gender of students:
K Female students (mean = 2.71) reported a slightly higher level of current stress than
male students (mean = 2.65);
K Female students (mean = 41.03) reported higher levels of depression than male students
(mean = 40.19);
K Male students (mean = 60.38) reported more health protective behaviors than female
students (mean = 57.01); and
K Female students (mean = 2.00) rated their health more positively than male students
(mean = 1.82).
What is the Relationship Between the Demographic Variables and the Six Stressors?
With the exception of the relationship between age and personality stressors, there were no
other relationships between students; age and their gender that amounted to a strong (i.e., the mean
difference achieved statistical significance at the .05 level of significance). In the case of age and
personality stressors, it was seen that younger students reported higher levels of personality
stressors(mean = 27.66) than their older counterparts (mean = 25.04). Space limitations preclude
reporting the other mean differences (i.e., that were not statistically significant) between age, gender
and the six stressor categories.
Academic Variables
What is the Relationship Between the Academic and Stressor Variables?

While students’ college classification did not appear to have any meaningful relationship with
any of the six stressors, how students rated their academic performances was related to personality
stressors and academic stressors.
K In the case of personality stressors, students who rated their performances a little better than
most (mean = 24.56, significant at the .05 level) reported lower personality stressors than students at the
extreme who rated their performances a little poorer than most (mean = 28.67) and much poorer than
most (mean = 33.33).
K In the case of academic stressors, students who rated their performances much better than
most (mean = 15.55, significant at the .001 level) reported lower academic stressors than other students
at the other extreme who rated their performances a little poorer than most (mean = 23.30) and much
poorer than most (most = 26.00).
Social Psychological Variables
What is the Relationship Between the Social Psychological and Stressor Variables?
As seen in Table 12.6, students who reported lower levels of self-control, self-esteem and social
support universally reported having higher levels of stress. This fact is evident by the higher
(statistical) mean scores on all of the six stressor sub scales. The only mean differences, although in the
Table 12.6: Relationship Between Self-Control, Self-Esteem, Social Support and

Stressors (N = 104)
Self-Control Self-Esteem Social Support

Stressor Variables Levels N Mean N Mean N Mean
Personality low 52 28.40*** 49 29.27*** 45 27.02

high 43 24.16 47 23.49 53 25.94
Private Life low 51 18.73*** 49 18.71** 44 18.68**
high 43 15.74 46 15.65 53 16.32
Psychosocial low 52 14.29** 49 14.33** 46
high 44 12.02 48 12.21 53 15.22***
11.77
Academic low 53 20.23*** 50 20.22** 47 20.47**
high 44 17.18 48 17.31 53 17.53
Organizational low 54 16.44* 50 16.44 48 16.63*
high 43 14.12 47 14.38 52 14.40
Environmental low 54 14.61** 50 14.26** 47 14.77**
high 44 12.34 48 12.94 53 12.64
Note: Total N may not add up to 104 because of missing data.
* = p<.05; ** = p<.01; *** = p<.001
appropriate direction that were not meaningfully different (i.e., the means were not statistically
significant), were self-esteem and organizational stressors and social support and personality stressors.
Health Variables
Depression and Health Protective Behaviors

As seen in Table 12.7, students who reported having higher levels of depression reported
significantly higher mean scores on all six stressor variables. However, in three cases: psychosocial ,
organizational and environmental stressors, while students who reported lower depression scores also
reported having lower scores on these three stressors, i.e., versus those who had higher depression
scores, these mean differences were not (statistically) meaningful. In the case of engaging in desirable
Table 12.7: Relationship Between Depression and Health Protective

Behaviors and Stressors (N = 104)
Depression Health Protective

Behaviors
Stressor Levels N Mean N Mean
Variables
Personality low 51 25.49* 48 27.73**

high 44 27.86 45 24.82
Private Life low 50 16.56** 47 18.38**
high 44 18.50 45 16.13
Psychosocial low 51 12.35** 48 13.85
high 45 14.51 46 12.89
Academic low 51 17.37** 49 19.82*
high 46 20.54 46 17.67
Organizational low 50 14.80 49 16.18
high 46 16.22 45 14.80
Environmental low 51 12.51* 49 13.55
high 45 14.91 45 13.84
* = p<.05; ** = p<.01; *** = p<.001
health protective behaviors, students who reported having lower levels of health protective behaviors
generally had higher mean levels, i.e., versus those who had higher mean levels, on all six stressor
variables. However, with exception of the following variables: psychosocial, organizational and
environmental, these mean differences were not (statistically) meaningful.
Students’ Ratings of Current Stress Levels and Health

As seen in Table 12.8, there was a consistent relationship between students rating of their
overall health and their responses on each of the six stressors. As was expected, students who rated
their health poor/fair tended to have higher scores on all the six stressors, with some slight exceptions,
such as private life, psychosocial and academic. For these stressors, while the poor/fair responses were
still associated with the highest scores on all of the stressors, in some cases students who reported their
Table 12.8: Relationship Between Students’ Report of Current Stress Level,

Ratings of Health and Stressors (N = 104)
Stress Level Rating Health

Stressor Levels N Mean N Mean
Variables
Personality mild 40 24.38* poor/fair 19 28.74*
moderate 44 27.14 good 61 26.20
severe 11 29.18 excellent 17 25.00
Private Life mild 38 15.09*** poor/fair 17 20.35***

moderate 46 17.96 good 62 16.74
Psychosocial mild 40 12.08** poor/fair 18 15.50**

moderate 46 13.39 good 63 12.65
Academic mild 40 16.27*** poor/fair 19 22.32**

moderate 46 19.59 good 63 18.03
Organizational mild 40 13.27** poor/fair 20 17.70**

moderate 45 15.91 good 62 15.50
Environmental mild 39 11.92* poor/fair 20 13.35

moderate 46 14.13 good 63 14.03

* = p<.05; ** = p<.01; *** = p<.001
health as excellent had slightly higher mean scores that those who reported their health as only good
(e.g., see private life, psychosocial and academic stressors). The only mean differences that did not
appear (statistically) meaningful was the relationship between health and environmental stressors.
Summary Statement Concerning the Relationships Involving Stressors
The preliminary analyses of data derived from the College Student Health Survey provided
some important empirical information for the study of stress among college students. The main
intention of Chapter 12 was to provide original data that tested the validity of the College Student Stress
Index (or CSSI). The CSSI comprised six sub indices (i.e., personality, private life, psychosocial,
academic, organizational and environmental). It is very important to note that the topic matter
addressed in each of the six stressors in the CSSI is equated with the six stressor categories used in the
book (see Exhibit 12.1) and discussed in the earlier chapters 6 through 11.
Although the intention in Chapter 12 was simply to describe a set of relationships determined
by a series of research questions, more in-depth analyses and interpretation of the data, especially with
respect to other reports concerning stress and college students, will be completed in future undertakings.
For purposes of this chapter, especially in the primary (or main) analyses (see Figure 12.1), certain
basic relationships between the main independent variables: a) demographic, b) academic, c) social
psychological, and d) health and the main dependent variables - the six stressors, were firmly
established, albeit on a preliminary basis. The strongest relationships were between the social
psychological (see Table 12.6) and health (see Tables 12.7 and 12.8) variables and the stressors. While
these relationships need to be replicated and expanded on in future empirical research, they have
important implications both for prevention and intervention-oriented activities that attempt to improve
college students’ health in general and how college students’ improve their stress in particular.
Correlates of College Students’ Stressors
O Background Information on Preliminary Data (p.115)

9 Relationships to be Explored Now and in the Future (p.116)
O Descriptive Information on Demographic Variables (p.117)
O Descriptive Information on Academic Variables (p.118)
O Descriptive Information on Social Psychological Variables (p.118)
O Descriptive Information on Health Variables (p.119)

O Descriptive Information on Stressors (p.119)
O Research Questions (p.120)
O Demographic Variables (p.120)

9 What is the Relationship Between Demographic and Social Psychological
Variables? (p.120)
9 What is the Relationship Between Demographic and Health Variables?
(p.121)
9 What is the Relationship Between Demographic Variables and Six
Stressors? (p.121)
O Academic Variables (p.121)

9 What is the Relationship Between the Academic and Stressor Variables
(p.121)
O Social Psychological Variables (p.122)

9 What is the Relationship Between the Social Psychological and Stressor
Variables? (p.122)
O Health Variables (p.123)

9 Depression and Health Protective Behaviors (p.123)
9 Students’ Ratings of Current Stress Levels and Health (p.124)
O Summary Statement Concerning Relationships Involving Stressors (p.125)

Part III
R = Recognizing the Signs and Reactions to Stress
This part of the book deals with the second

section of the I-R-M Approach to Stress
Management. Given that stress is basically an 13. The First Stage of the Stress Process -
internal body process, the three chapters that
comprise this part of the book, inform college Onset
students about the basics of this dynamic and 14. The Second Stage of the Stress Process -
internal processes. The rational is that if
Reaction
students recognise when they are experiencing
stress they are in a better position to manage it 15. The Third Stage of the Stress Process -
more effectively. As the chapter outline to the Outcome
right indicates, the three basic components of
the reaction stage - onset, reaction and outcome,
will constitute chapters 1, 2 and 3, respectively.
127
___________________________________________________________________________________
13.
The First Stage of the Stress Process - Onset
ë
“Worry affects the circulation, the heart, the glands, the whole nervous
system, and profoundly affects the health. You have never known a
man who died from overwork, but many who died from doubt”
- Charles W. Mayo, M.D.
W
hile stress has been mislabeled as “tension,” “anxiety” and/or “depression,” the true
meaning and our reaction to stress goes far beyond the limited scopes of these and other
related concepts. That is not to say, however, that these concepts are not in some way related
to stress, because they are! This part of the book deals with how we react to stress. During times of
stress, both the body and mind are affected; therefore, we have to learn more about stress in order for
the mind and body to regain an homostatic balance. This is the somewhat ideal position where stress is
at a minimum and, therefore, performance and good health are the customary experiences of the day.
The better we understand
how our bodies operate, the “Stress is like an allergy, once we’re sensitized, just a touch
greater will be our capacities to triggers a blitz from within.” (Carpi, 1996)
gain control over our stresses and,
subsequently, our health. However,
based on how stress was defined in PART I as a subjective phenomenon, the various reactions we have
to stress are influenced, in part, by who we are, what our resources are and the quality and quantity of
our experiences.
Beginning the Stress Process

As a recap from Chapter 3, it should be recalled that a transactional view of stress is used as the
dominant view of stress in this book. Potential stressors are what begin the onset stage of the stress
process. As mentioned before (see Exhibit 3.3 and 3.4 in Chapter 3), stress - the body’s reaction, is not
automatic, simply because you have to first perceive demands (i.e., stressors) in your environment as
being out of alignment with your available resources (i.e., capabilities and coping skills). Your
uniqueness and individual differences influence how your body deals with the entire stress process.
These individual differences are reflected in the following factors:
K Your personality;
K Your available knowledge;
K Your past experience(s) with stressor(s);
K The kind and amount of "support" available to you in time of need;
K Your ability to identify stressors; and
K Your ability to recognize stress signals.
129
130 PART III . Recognizing the Signs and Reactions to Stress
Therefore, based on your perceptions and individual resources, your body is likely to react to your
experiencing different amounts and degrees of essentially three main types of stress.
Three Main Types of Stress

Generally speaking, all of us experience three different, yet interrelated, kinds of stress. Adding
to the two kinds already mentioned in section one, i.e., good stress
or eustress and bad stress or distress, the third type is called
normal stress. On any given day, it is conceivable that we may
experience different aspects of all three stresses simultaneously
(see Exhibit 13.1).
As mentioned before, stress itself is necessary for life
itself (i.e., optimal well-being) and, therefore, a total lack of it can
be harmful. This necessary stress is called "normal" stress. In a
manner of speaking, it can be said that the absence of good and
normal stress can contribute to "bad" stress or distress, simply
because both are needed for daily functioning in their respective
ways. Taken collectively, however, each of these three kinds of
stress represents a three-stage series of reactions within our bodies
that enable them to adapt to change. You may recall in a previous Exhibit 13.1: Three types of stress
discussion that change is the universal or forever present stressor in
our lives. Therefore, since life represents constant change, adaptive reactions to change are, then,
important for our basic survival. All three types of stress relate to and interface with each other in very
important ways.
Good Stress
As mentioned earlier, some stress, or eustress, is good for us and in certain instances we use it
to accomplish selected activities. Basically, it is the stress that we initiate in order to accomplish
certain set and/or immediate goals. For example,
good stress or positive stress is the "edge" we
feel when we are about to perform in some
activity or event. It perks us up and provides us
with that extra attentiveness and/ zip needed to
do our best.
An athlete "psyching" himself or herself
up for competition creates tension and anxiety or
the "stress alarm" to achieve his/her optimum
stress point (see Exhibit 13.2). In so doing, he/she
is very likely to outperform his/her competitors
who remained “emotionally flat” (i.e., they did
Exhibit 13.2: Athletic readiness as a form of good or positive
stress not psyche themselves up).
Other instances of where good stress, if
properly regulated, can work for you, include: taking an examination, speaking in front of a large
audience and performing on the stage. In other words, a certain amount of positive stress (which
includes the secretion in the body of a very stimulating body hormone called adrenaline, to be
Chapter 13 . The First Stage of the Stress Process - Onset 131
mentioned in a later section) helps to ensure top quality performance, whether it is in athletics or in the
performing arts (e.g., dancing, music and singing). In other more diverse areas, such as disasters and
wars, which in themselves can be (perceived) stressors, people have been found to ban together literally
to survive and, in the process, build a spiritual will to live. Especially in these latter examples, positive
stress can be the very "salt" of life that contributes to the prolongation of life itself.
Normal Stress
As the name suggests, normal stress is what we are likely to experience during our daily living,
such as an unexpected downpour of rain (see Exhibit 13.3). The basic difference between bad stress
and normal stress is that whereas in the former we expend a more conscious effort to initiate it, in the
case of the latter it is activated more automatically based on customary experiences. Alike any other
type of stresses our bodies react in the customary excitable manner to this type of stress. Whereas
normal stress is usually not negative for us based
partly on its expected occurrence and short-lived
duration, if it occurs on an extended basis,
thereby making it chronic, it then becomes bad
stress. Normal stress, then, because of its
protective function, is necessary for our daily
adaptation, functioning and survival. Normal
stress produces negligible damage to our body
systems because of its short duration and
intensity.
The more frequently occurring
threatening situations we face daily serve as
other excellent cases that generates normal Exhibit 13.3: Daily experiences as arousing normal stress
stress. For example, a car swerving towards you at a fast rate of speed; seeing a child about to place her
hand on a hot stove; hearing the sounds of footsteps following you when you are alone on a dark and
lonely street and having a large dog in an adjacent yard snarl and bark as you are walking by on your
way home from the groceries. Alike other form of stress, we get physiologically excited about these
events; however, because they come and go so fast, our systems (e.g., blood pressure, blood sugar, etc.)
become deactivated and usually return close to their initial pre-arousal levels.
Bad Stress
Basically normal stress is necessary to keep us functioning and positive stress is necessary to
allow us to attain certain desirable daily accomplishments. However, because of the unrelenting nature
of bad stress, it can be hazardous to our well-being. Given that we all need some degree of stress to
keep us alive and going, it is important for each person to find that crucial “balance” between sufficient
(i.e., normal and good stress) and too much stress (i.e., chronic stress or bad stress) to suit his/her daily
functioning.
Stress can be productive once it does not pass your physiological tolerance limit. A seen in
Exhibit 13.4, most persons tolerance levels are not above the “normal line.” The normal line represents
the point of homeostasis or equilibrium where all of our body functioning is at its best or optimum
level. In other words, stress (e.g., normal or positive) is tolerable for our bodies and, because of this
state of balance, we are functioning quite well. Again, because of how stress has been viewed and
discussed in the book, it is very important to note, however, that stress tolerance limits vary from
132 PART III % The First Stage of te Stress Process - Onset
individual to individual.
One way to look at the picture is to say that bad stress is normal or acute stress that has become
chronic or long-lasting. In other words, there is a greater frequency and duration of stressful
experiences (i.e., stress alarm)
than is tolerable with fewer
intermittent periods of rest or
recuperation by the body.
Basically, one stressful
experience follows another
without any appreciable "break"
in between for you to literally
Exhibit 13.4:Chronic or unrelenting conditions that give rise to “bad” stress "catch your breath" (i.e., as
expressed by "whews"),
readjust, or simply, to return to (or as close to) the ideal point of homoeostatic normalcy.
The unrelenting or demanding conditions that give rise to bad stress spell trouble for us and, if
something is not done to break its cycle of occurrence, the last stage of the stress process effect, begins.
A good example of how chronic stress is likely to come about involves a typical day in the life of a
student called Jane who is attending a local university (see Exhibit 13.5).
A series of events occur continuously that do not allow Jane to have a break or to catch her
breath and say "whew." Having had a
difficult day in classes, where she received a
low grade on her examination, she leaves for
the school library to prepare for as class
paper. This call paper is worth 50 percent of
her final grade. Jane realizes for the first time
that she is over her head in doing the work to
be successful in college. While she has
gathered most of the books needed to write
her class paper, she lacks the requisite skills
to integrate the material in the books. She
also realized that she waited too long to begin
this class assignment and now it was too late
to ask for assistance, given that the paper is
due morning. Apart from this immediate
Exhibit 13.5: Continuous negative daily life adjustments can equal
problem, because of low grades the previous bad stress
semester, Jane has been placed on academic
probation. At this point, Jane is likely to be experiencing bad stress and, therefore, exhibits a very
customary stress reaction - e.g., frustration. If this pattern of activity continues for Jane, day-after-day, it
becomes chronic stress. The longer these series of negative experiences, or stressors continue, the more
likely it will deplete Jane of her available resources to deal successfully with these stressors.
Various Types of Bad Stress

Because bad stress or distress is the type of stress you should be concerned with when we speak
about stress management, what follows is a brief description of the various subtypes of stress that can
be argued to fall under bad stress (see Exhibit 13.6). After this discussion is presented concerning the
various subgroups of bad stress, the term stress will be used to refer to bad stress. However, when it is
necessary, either the terms normal or good stress
will be used. The same thing applies for the
specific usage of any one or a combination of the
subtypes of bad stress when it is deemed
necessary.
Acute Stress: When there is an immediate threat

to your life or physical well-being you are
experiencing acute stress, which is perhaps the
most common form of stress. In small doses
(e.g., skiing down a challenging ski slope), acute
stress can be thrilling and exciting, but too much Exhibit 13.6: Three types of stress, including
(e.g., repeatedly going down the slope on the subgroup types of stress under bad stress
same day) can be detrimental to your health (e.g.,
you may experience tension headaches, stomach problems, diarrhea, irritable bowel syndrome, jaw pain
and other related symptoms). In some cases, however, one single experience of acute stress (e.g., being
held up at gun point) can be very stressful in itself.
Episodic Stress: When you suffer frequent experiences of acute stress you are really experiencing
episodic stress. Basically, it is a lot of stressors that occur within certain defined periods (or episodes)
of time.
EXAMPLE: Jane went to the library to drop off some overdue books in the book bin. She came out of the
car, left it running and shut her car door not realizing that her door locks were pressed down. In essence,
she locked herself out of the car. Other problems she had included the gas being low and she needed to get
back home to attend to study for examination the next day and she was very hungry. She could not contact
her boyfriend who was on the road, but his cellular phone was not turned on.
The typical symptoms of episodic acute stress are the conditions usually associated with
extended arousal. These conditions may include: migraines, hypertension, chest pain, persistent tension
headaches, etc. Sufferers may resist any changes that are needed to help them, and they tend to blame
their woes on other people and external events.
Cataclysmic Stress: Major societal and naturalistic events all qualify as conditions that give rise to
cataclysmic stress. Examples of these events include natural disasters (hurricanes, tornadoes, tidal
waves, volcanic eruptions, earthquakes), as well as man-made disasters (nuclear leaks or fallouts, germ
warfare, terrorist actions). In the case of the naturally occurring events, with the exception of certain
countries, which have frequent experiences (e.g., volcanic eruptions in the Philippines, hurricanes in the
Eastern Caribbean and tornadoes in the Midwest of the United States, these events are relatively rare
and are experienced very infrequently.
In geographic areas that these events are repeatedly experienced, residents can have a variety of
symptoms including, but not limited to hypertension, tension headaches, stomach problems, heart
disease, etc. In the case of man-made events, while somewhat infrequent, there are still some people
who anticipate and fear their likely occurrence and, therefore, experience a variety of stress-related
symptoms, such as those mentioned above.
Chronic Stress: The conditions that typify acute stress and the initial accompanying thrills and
excitement are in direct contrast to the conditions are accompanying feelings associated with chronic
stress. Chronic stress is by nature long-lasting, seemingly endless and, therefore, wears the body down.
At its extreme, it destroys minds, bodies and even lives.
The examples of conditions that give rise to chronic stress are well known. They include, but
are not limited to the following conditions: extreme poverty, dysfunctional families, institutional
racism, being trapped in an unhappy family relationship, ethnic rivalry, and working for several years in
a despised job.
Although the outcomes
of chronic stress varies, they “Chronic stress comes when a person never sees a way out of a
most definitely include the miserable situation. It’s the stress of unrelenting demands and
following conditions: tension pressures for seemingly interminable periods of time. With no
headaches, depression, hope, the individual gives up searching for solutions.”
alcoholism, suicide, heart
disease, cancer violence, stroke
and heart attacks. This type of stress can be very deadly because the individual’s mental and physical
resources are severely depleted through the long-term attrition. The symptoms of chronic stress can be
very difficult to treat. In many cases, patients require extended medical care, as well as behavioral
treatment and stress management.
Post-Traumatic Stress: As the name indicates, this kind of stress occurs after some event has occurred.
In essence, there is some delayed time period before this stress is manifested. In post-traumatic stress,
the individual experiences some trauma (i.e., stressor) at an earlier period, for example, sexual abuse,
extreme violence brush with death, being shot at or killed someone in the line of duty (e.g., soldiers,
policemen). If the psychological issues surrounding any one of these earlier experiences or stressors are
not resolved, later on in life the initial trauma associated with them can reoccur. This special kind of
stress is known as posttraumatic stress disorder or PTSD.
PTSD can bring with it a variety of conditions or symptoms. These include, for example,
intrusive, flashback memories, numbness or loss of feeling, extreme outbursts to minor events,
problems with concentration, controlling impulses, and memory becoming distorted..
Various factors can increase the stress associated with an acute traumatic event that can lead to
PTSD. Basically, stress increases when the event was deliberate (e.g., someone broke your arm versus
it being broken by accident in a football game), ongoing and/or repeated (e.g., spousal abuse), and/or
inflicted by a “protective” person or a loved one (e.g., parent, close family member).
Depending on the severity of the stress, the person may need to seek the help of a therapeutic
counselor. Why? Simply because overcoming stress and getting more control of your life can be a
difficult and, at times, complicated proposition. As seen from above, not only are there different types
of bad or negative stress (see Exhibit 12.6), but each has its own patterns of cause, duration, symptoms
and treatment. The dynamics associated with managing stress is, in part, underscored by the fact that,
for example, chronic stress can be aggravated by acute and episodic stress. Also, you may have to
struggle will a possible combination of these bad stresses at the same time, therefore making how you
manage stress that much more difficult. Anyhow, when you can recognize that you are experiencing
stress by your tell-tale symptoms, you will certainly be in a much better position to manage it more
effectively.
Critical Incident Stress: Tragedies, serious injuries, deaths, hostage situations, threatening situations
are all referred to as “critical incidents.” Basically, then, a critical incident is any event that is outside
the usual realm of the human experience that is clearly distressing or troubling for the individual who
experienced it, which in turn allows him/her to experience critical incident stress or CIS. Some
examples of CIS include the following: l
K Sudden or unexpected death of relative, friend or colleague

K Any life threatening experience (e.g., wars, fires, floods)
K Suicide, attempted suicide and/or homicide(s)
K Sexual assault
K Robbery and violent crimes
K Child abuse and/or injury or death of a child
K Terrorism
K Multiple injury/fatality accidents
Based on their job activities, medical workers (including college students who may hold such
jobs in order to finance their college expenses) and others who respond to emergencies (e.g., rescue
personnel as firefighters, police, medical personnel on ambulances, etc.) encounter highly stressful
events almost everyday. This being the case, these workers may experience an event that is so
traumatic or overwhelming that they, in turn, may experience significant stress reactions. If these
experiences occur, a process called Critical Incident Stress Management (CISM) is highly
recommended. The procedures associated with CISM are specifically designed to prevent or mitigate
the development of post-traumatic stress, especially among emergency service workers.
The Interrelatedness of the Bad Stresses: As seen in Exhibit 13.6, people in general and students in
particular are at risk when they are in the middle of the bad stress circle. Also, because of the
overlapping manner in which the various bad stresses are illustrated, it indicates that they are very much
interrelated. Depending on the severity of the stress, individuals may need to seek the help of a
therapeutic counselor. Why? Simple because overcoming stress and getting more control of their lives
can be difficult and, at times, a complicated proposition. As seen from the above discussions, not only
are there different types of bad or negative stresses (see Exhibit 13.6), but each has its own patterns of
causes, durations, symptoms and treatments. The dynamics associated with managing stress is, in part,
underscored by the fact that, for example, chronic stress can be aggravated by acute and episodic stress.
Furthermore, a vivid experience with an acute stressor (e.g., a gun shot fired at a loved one) can be the
main source for later PTSD. Also, students may have to struggle with several possible combinations of
these bad stresses at the same time, therefore, making how students manage their stresses more difficult.
It is reasoned, however, that when students recognize that they are experiencing stress by the personal
accompanying tell-tale symptoms, they will certainly be in a much better position to manage their
stresses more effectively.
Summary Outline of the Key Headings in Chapter
The First Stage of the Stress Process - Onset
O Beginning the Stress Process (p.129)
O Three Main Types of Stress (p.130)
9 Good Stress (p.130)

9 Normal Stress (p.131)
9 Bad Stress (p.131)
: Various Types of Bad Stress (p.132)
3 Acute Stress (p.133)

3 Episodic Stress (p.133)
3 Cataclysmic Stress (p.133)
3 Chronic Stress (p.134)
3 Post-Traumatic Stress (p.134)
3 Critical Incident Stress (p.134)
3 The Interrelatedness of the Bad Stresses (p. 135)
___________________________________________________________________________________________
14.
The Second Stage of the Stress Process - Reaction
ë
“Our energy is in proportion to the resistance it meets. We attempt nothing
great but from a sense of the difficulties we have to encounter; we persevere
in nothing great but from a pride in overcoming them.”
- William Hazlitt
A
t the center of the very dynamic stress process is the stress reaction, which occurs mainly within
our bodies. These internal body events are true and effective means to document if a person is
experiencing stress. The complex array of information associated with this area is by far too
voluminous and, as such, is outside the introductory scope of this book. What follows is a selected
presentation of key topics, concepts and persons associated with this area. Two important names and
concepts that need mentioning include: Dr. Hans Selye, with his notion of the General Adaptation
Syndrome (GAS) and Dr. Walter Cannon, with his notion of the fight-or-flight response.
The Non-Specific Response of Stress

As mentioned before, Selye defined stress as the nonspecific response of our bodies to any
demand placed upon them. All stressors are alike in that they produce similar bodily changes, e.g.,
altered heart rate, hormonal changes and a consequent need for adjustment or adaptation to the problem
at hand. For Selye, this adaptation is stereotyped or is a constant response to any stressor, whether it is an
infection, joy or sorrow, cold or heat, a loud noise, or an irritating supervisor/co-worker on-the-job, and
so on. The response our body makes, according to Selye, is hormonal and totally nonspecific, since it is
the same whatever the stressor. Perhaps Selye best underscored this point about the nonspecificity of our
bodily reaction to stressors when he drew an analogy between stress and electricity, the former of which
he said is like the latter.
We use electricity for good or bad, to light a lamp or ring a bell, to heat or to cool, but the most
important point is that it is all electricity. Therefore, whether it is a bad stressor (e.g., when a parent is
old that her child is in a serious accident) or a good stressor (e.g., a neighbor learning that he just won
first place in a million dollar lottery), both individuals experience a stress response (or "stress alarm").
Therefore, the body responds in a similar manner to the degree and the intensity of the stressor despite its
type or kind (i.e., hurtful or bad versus pleasurable or good). Selye discussed how our bodies respond to
stress in a three-stage model that he called the General Adaptation Syndrome or GAS. More will be said
about Selye and the GAS following a discussion of Cannon’s fight-or-flight response and how our bodies
react when we experience stress.
The Fight-or-Flight Response

As a past professor of physiology at Harvard University over a half century ago, Dr. Cannon
provided answers relating to: a) the change that accompanies stressors, for example, pain, hunger, and the
major emotions and b) how potentially life threatening situations produce vast bodily changes (or
adaptive responses) to provide the best possible chance for survival. These internal physiological
changes that give us a survival advantage in the face of physical and/or other perceived threats are
referred to collectively as the fight-or-flight (or stress) response (see Exhibit 14.1).
137
138 PART III % Recognizing the Signs and Reactions to Stress
According to Cannon, animals, including human beings, either fought when the circumstances
(i.e., stressors) were "ripe" for success (e.g., having the necessary resources to surprise and confront a
threatening would-be prowler in your house) or fled in the wake of overwhelming stressor demands
(e.g., when the circumstances were
"ripe" for failure by your not having
the needed resources). An example
of fleeing is the case where an
individual runs away after being
chased by a group of people, where
he was clearly outnumbered. Other
examples include being chased by a
large animal in the woods, for Exhibit 14.1: Fighting or fleeing: The relationship between demands and resources
example, a grizzle bear, and rather
than stay and fight it out with the
bear, you literally flee for your life. More will be said about fighting and fleeing in a later section.
The Physiology of the Fight-or-Flight Response
Various complex processes are involved when our bodies are under the fight-or-flight or stress
response, which involves a series of more than 1,400 known physiochemical reactions. This area
involves a great deal of technical information; however, in keeping with the ABC format of the book,
only an overview is presented of key areas of information. An understanding of the basic workings of the
stress response, as well as knowing some of the likely stress-related outcomes, are very important in
successfully managing your stress. The information presented here will prove to be very useful to you,
especially in PART IV of the book, where a discussion is presented about ways of improving your
management of stress by selecting one or a combination of strategies when you are under stress.
The activation of the fight-or-flight response begins with the perception of a stressor. In PART
II of this book mention is made of six different types of stressors. With the possible exception of
organizational and environmental stressors, which can involve physical, internal (e.g., viruses, trauma)
and/or external (noise, temperature, odors) stimuli, the other four stressors are directly or indirectly more
psychogenic (psyche: mind; genesis: origin; of mental origin) in nature. Basically, then, the ensuing
psychogenic stress is an adaptive, physical response of the body that is initiated by cognitive arousal,
such as the perception of threat in the five stressor areas involving differences between demands and
existing resource capabilities (see Exhibit 3.2).
As seen in Exhibit14.2, the stress response begins in the brain and involves several major organs
and related network systems in the body. Stressors are perceived by the mind and translated by the brain.
Through a complex series of networking pathways the brain, in turn, instructs the remainder of the body
how to adjust to the stressor(s). The two main network systems activated by the brain (i.e., the
subcortex) via the hypothalamus are the autonomic or involuntary nervous system and the endocrine
system.
The activities of both the endocrine and autonomic nervous systems complement each other. The
hypothalamus, which controls the activation of the endocrine and nervous systems, is the gland in the
center of the brain believed to be the center governing human emotions. Not only does the hypothalamus
controls these two systems, but it also responds to cortical messages (i.e., cognitively perceived stressors)
and, therefore, provides a very important link in the process by which psychogenic stress produces a host
of physiological reactions.
Chapter 14 . Second Stage of the Stress Process - Reaction 139
The Endocrine System

The endocrine system includes all the glands that secrete hormones. These hormones, in turn,
modify the function of other bodily tissues and they are transported through the circulatory system to
various target structures including: the pituitary, thyroid, parathyroid, adrenal glands, pancreas, ovaries,
testes, pineal gland and thymus gland.
Exhibit 14.2: Stress pathways and affected organs - Selected focus on endocrine and
autonomic nervous systems
As illustrated in Exhibit 14.2, when the anterior hypothalamus releases corticotropin releasing
factor or CRF (E1 in Exhibit 14.2), this, in turn, instructs the pituitary gland (sometimes referred to as
the “leader of the endocrine orchestra”) at the base of the brain to secrete adrenocorticotropic hormone
or ACTH (E2). ACTH then activates the adrenal cortex in the adrenal glands located on top of the
kidneys to secrete two important corticoid hormones: glucocorticoids, with the primary hormone being
cortisol and mineralocorticoids, with the primary hormone being aldosterone (E3).
The action of ACTH on the adrenal glands is considered a very important reaction in relation to
the stress response. It must be pointed out that while ACTH is influencing the adrenal glands, the
pituitary simultaneously is releasing thyrotrophic hormone or TTH, causing the thyroid gland to secrete
thyroxine. Thyroxine is a hormone that influences the rate of metabolism and governs mental, physical
and sexual growth and development.
With respect to the corticoid hormones, cortisol provides the “fuel” for battle (i.e., fight-or-
flight). Its primary function is to increase blood sugar that is needed for energy in ongoing stress-related
action. Cortisol also mobilizes free fatty acids from fat (i.e., adipose tissue), breaks down protein and
increases arterial blood pressure.
Among the other important physiological changes brought about by cortisol is the decrease of
lymphocytes released from the thymus gland. This is a very critical outcome for our health, because
lymphocytes as “soldiers that guard our immune system,” destroy invading substances (e.g., viruses).
High cortisol levels can cause shrinkage of the spleen and thymus, which play a vital role in the
producing of white blood cells. Specifically, cortisol reduces the level of T helper cells and increases T
suppressors, and inhibits the production of natural killer cells. Recent evidence also points to the view
that cortisol reduces virus-fighting interferon. This latter point (along with the others) has important
implications for the HIV/AIDS epidemic. With these facts in mind, therefore, any increase in cortisol
means a decrease in the effectiveness of the immune response, hence the increase likelihood of becoming
ill.
The other corticoid hormone - aldosterone, also prepares the body for action. The primary
purpose of aldosterone, however, is to increase blood pressure in order that food and oxygen can be
transported to parts of the body involved in action, such as limbs and designated organs. Blood pressure
is increased by increasing blood volume. The two ways this is done include having: 1) a decrease in
urine production and 2) an increase in sodium retention. It is important to note that both of these
mechanisms result in less elimination of body fluids, greater blood volume, and a resultant rise in blood
pressure.
The Autonomic Nervous System

As a basic background overview, the nervous system is divided into two main branches: 1) the
central nervous system, or CNS, and the peripheral nervous system, or PNS. The CNS is composed of
the brain and spinal cord, and the PNS is composed of the remainder of the nerves throughout the body.
Basically, these include 1) the somatic nervous system, which carries sensory and motor signals to and
from the CNS and 2) the autonomic nervous system (ANS), which carries the various impulses that
regulate the internal functioning of the body, for example, heart rate and respiration. Therefore, the
ANS, whose functions are emphasized here, controls the involuntary functions of the body.
Although the traditional view of our inability to control “involuntary” systems is somewhat
challenged by mind-body activities (e.g., biofeedback), examples of involuntary functions include heart
rate, blood pressure, body fluid regulation and respiration. Control is maintained by two components of
the ANS. 1) The sympathetic nervous system, or SNS, is responsible for increasing energy (e.g.,
respiratory rate), thereby stimulating the body and preparing it for action. 2) The parasympathetic
nervous system, or PSNS, is responsible for conserving energy (e.g., decreasing respiratory rate), thereby
calming the body down.
When a stressor is perceived by the mind and translated by the brain the posterior portion of the
hypothalamus, in turn, activates the adrenal medulla (the inner portion of the adrenal gland). This
activation is carried out via a direct sympathetic nerve connection from the posterior section of the
hypothalamus to the adrenal medulla. The adrenal medulla in turn releases the catecholamine "stress"
hormones adrenalin, or epinephrine, and/or noradrenaline or norepinephrine (see A2 in Exhibit 14.2).

Research suggests that the hormones produced by the adrenals are a sure sign of stress. Also, the
concentration of these hormones can imply the intensity of the stress within each one of us.
Many people have experienced “adrenalin rush,” which is a surge of power that enables people to
perform apparently miraculous feats of strength, e.g., lifting up of a car to save the life of a family
member after an accident occurred on a deserted country highway. This is an example of the power of
the fight-or-flight response. These feats are accomplished when the medulla releases great amounts of
adrenalin into the system. In essence, the adrenalin released acts via the liver, mobilizing glucose in the
bloodstream, thereby providing a quick energy source for the cells to use in response to the needs of the
stressor. Additional outcomes as a result of an increase of adrenalin include: increases in metabolism of
carbohydrates; dilation of arteries in the skeletal muscles and the heart; stimulation of heart leading to
increase blood circulating in the body; elevations in body temperature; increases in oxygen consumption;
and increases in carbon monoxide production. The parasympathetic nervous system is generally
responsible for returning the body to a relaxed state when the stressor is no longer perceived as a threat.
Noradrenaline has a opposite effect, where it leads to the constriction of arteries and raises blood
pressure. However, under certain stress conditions adrenalin is released, while under other noradrenaline
is released. Whereas adrenalin is generally associated with fear responses, noradrenaline is usually
associated with anger.
The release of hormones, such as adrenalin, cortisol and aldosterone into the blood stream, has
the desired effect of starting and mobilizing our bodies for fight-or-flight action. Several such actions
occur that enable us to deal more effectively with the perceived stressor or threat. As a reiteration, when
the body is prepared, the following changes occur:
K Expectation of vigorous action and defense against injury;

K Hearing and other senses become more acute;
K The pupils become more dilated to admit a greater quantity of external light for
increased sensitivity in seeing;
K Faster breathing occurs to bring in more oxygen;
K The mucous membrane of the nose and throat shrinks to widen these passages for
enhanced "air flow;"
K The heart rate increases, thereby allowing more blood with its "richer" content of
oxygen to be brought to the brain, lungs, and muscles where it is greatly needed;
K The skin perspires to cool the body by evaporation; and
K All digestive activity becomes halted.
If for whatever reason (e.g., when you receive financial and/or emotional "support" from family,
friends, co-workers) the perceived threats or stressors are eliminated or reduced, the activity of the
pituitary-adrenal system is also reduced, and we return to our "normal" or more customary level of body
functioning. In this latter regard, it is generally felt that the anterior (or front portion) of the
hypothalamus plays a very important role in how we feel relaxed.
Fight-or-Flight - The Case of Ancient and Modern Man

Our ancestors, prehistoric men, literally survived based on the readiness the fight-or-flight
response gave them. Depending on the circumstances, they had to fight off threatening animals (like wild
bears and/or saber-tooth tigers that walked into their cave) or other attacking tribes. In other instances,
they had to flee from these and other stressors when it was necessary (i.e., when it was foolhardy to
fight)(see Exhibit 14.3). Therefore, whatever the time period, be it prehistoric time, 20th or 21st
centuries, the fight-or-flight response has been and continues to be relatively life-sustaining for man. A
word of caution, however, has to be mentioned in this latter regard.
As our societies modernize and change markedly from the
"open" atmosphere of our ancestors, where they could do just about
anything (i.e., fighting or fleeing) they desired, we are very much
constrained in our actions. Therefore, based on our abilities or
inabilities to either fight or flee when we want (i.e., the sufficiency or
insufficiency of our "resources"), the fight-or-flight response can turn
out, in certain cases, to be one of our worst enemies. How often have
you wanted to either fight or flee in a certain situation, but you did not
simply because it was not the appropriate thing to do (see Exhibit
14.4)?
In terms of fleeing, for example, some people may at times
feel like running away from the overwhelming demands of various
private, personal and interpersonal stressors, such as financial
pressures, a difficult and challenging course load in a semester, and a
crime/drug infested neighborhood. The reality is that they do not flee,
if nothing more, because of obligations to remain right where they
are. In terms of fighting, several examples exist. A practical example Exhibit 14.3: Ancient man that could
has to do with perceived interpersonal stressors on the job. There may customarily flee from a stressor, e.g.,
tigers, bears.
be a boss or supervisor who has
been forever harassing (stressor) you on the job. Your gut feeling is to
literally lash-out at the person, but you have to hold yourself back for
fear of losing your job and, of course, the income and security (i.e.,
providing for a family) that goes with maintaining your job.
These and similar experiences can be disastrous, simply
because the stress is no longer normal or acute (i.e., sudden), but
chronic (i.e., long-lasting). From a physiologic or hormonal level,
your body literally stays in a state of "hype" or preparedness. Some
bodily occurrences mentioned before include the following: your heart
beats faster, your blood pressure is increased so that fuel and oxygen
are always available, muscles are prepared for greater efforts, and
extra specific activating hormones (adrenaline) are secreted in your
blood stream to bring your body up to peak performance.
In short, your body is brought to peak capacity for action,
whether it is to fight or flee; but given the realistic nature of various
modern-day situations, referred to before, neither option or action is
Exhibit 14.4: Modern-day man
fighting and fleeing
carried out. Why is this the case? The answer is simple, because these
options (e.g., hitting your professor because he has a pattern of
"getting under your skin") are simply not conducive or appropriate to carry out. What, then, happens to
this unreleased or pent-up stress-related, adaptational energy?
The stress created by living in a state of "high rev" activity (as is true of a car where the engine is
all "charged" up, but the brakes are not released to let it go), or fight or flight readiness, if not released,
has the potential to wear down the body. Whereas the stress hormones (e.g., adrenalin) in the stress
response are, at first, beneficial in preparing and stimulating us to action, when they are prolonged or
excessive they cause severe health problems. If the stress response continues without a “discharge,”
either by a fighting, fleeing and/or other related activities, the biochemical changes in the body that are a
result of the stress response can seriously wear and tear our bodies and, therefore, can endanger our
health. This wear and tear can continue until the weakest body system and/or organ breaks down and
illness occurs (or in the case of a car, the engine wears out). The
various illnesses that can result from such a scenario are endless;
however, any such list includes the following conditions:
headaches; heart disease; high blood pressure; ulcers; colitis;
kidney ailments; backaches; and sexual impotence.
If this stress-illness possibility continues unabated,
where individuals are in a high state of "rev" or activity (e.g., by
having a Type A personality, dealing with a forever nagging
supervisor at work), their bodies will begin to show evidence of
wear and tear. If this occurs, the "breaking down" process
begins until the body finally breaks down (see Exhibit 14.5). At
this final stage, the individual is likely to experience one or a
combination of health-related outcomes, some of which are
mentioned before. Unfortunately, the ultimate outcome of
unabated stress can be death. More will be said about these and
other possible outcomes of stress in a later section of the book
that deals with the last stage of the stress process - outcome or
effect. Exhibit 14.5: The body’s reaction to
unrelenting stress
General Adaptation Syndrome or GAS
Selye made some very important statements that are elucidating insofar as the stress process
goes. Put simply, Selye said that each of us inherits a "fixed store of vitality" with which to meet the
various and potential stressors of daily living. The use of this "vitality" he called "adaptational energy."
Given the importance, then, of vitality, Selye (1980) said that:
“Vital energy is like a special kind of bank account that you can use up by withdrawal but cannot increase
by deposits. Your only control over this precious fortune is the rate at which you make your withdrawals.
The solution is evidently not to stop withdrawing, for this would be death. Nor is it to withdraw just for
survival, for this would permit only a vegetable life, worse than death. The intelligent thing to do is to
withdraw generously, but never expend wastefully."
The characteristic (i.e., nonspecific) response made by all of us to whatever stressor we

experience, Selye called the General Adaptation Syndrome or GAS. Essentially, the GAS is characterized
by a three-phased response to any given stressor over time: alarm, resistance and exhaustion (see Exhibit
14.6). It is important for students to be familiar with the GAS syndrome, so that they can better control
the stresses that they may likely experience, by being more fully aware of the stage they are experiencing
in the stress process.
The Alarm Reaction

You may recall it being mentioned before that Cannon referred to the fight-or-flight response
also as the "alarm reaction." In fact, most if not all of the bodily activities mentioned under the section of
the fight-or-flight response are also applicable under this Selye's first phase of the GAS. Therefore,
under this phase, the brain (i.e.,
including the hypothalamus)
perceives the stressor(s) that, as
explained before, leads to the
stimulation and activation of the
nervous and endocrine systems.
The former gives rise to
"electrical" messages and the
latter causes "chemical"
messages in the form of
Exhibit 14.6: Three phases of the general adaptation syndrome or GAS hormones. These two systems
are responsible for activating
other systems and major organs of the body (see Exhibit 14.7).
Because of the activation of these body systems (e.g., nervous), people respond with varying
mixtures of alertness, anticipation, curiosity and fear, often setting off a search for new information and
solutions. It is important to note, however, that during this "alarm" phase the "resistance" of the body to
the stress being experienced is diminished. Also, a prolonged alarm response or, for that matter,
many"small" ones, could very much lead to the second phase of the GAS - the resistance phase.
The Resistance Phase

This phase is an attempt
made by the body to recuperate, i.e.,
repairing the damage initiated in the
alarm phase and returning to a state
of normalcy. If this phase is
successful, i.e., the stressors are not
overwhelming, various "signs" of
the alarm phase fade away.
However, if the stressor(s)
continues without a break in
duration and intensity, which would
allow for the experiencing of
chronic stressor, for that matter, the Exhibit 14.7: The stress response via the alarm phase (or Fight-or-Flight
experiencing of several close bouts Response)
of acute stress, various feelings are likely to be felt at different levels of intensity. For example, we may
start to feel fatigued, restless, unable to sleep, lose interest in living, and body pains may begin.
When this phase is ongoing, there is a search for other ways to resolve the problems that initiated
the stressors. Also, during this phase we often make important discoveries or are inspired to great
performances or other productive consequences, all of which result from the "challenging goal" of stress.
If this occurs, it would be a form of positive stress-related activities mentioned earlier in the book.
The Exhaustion Phase

If our body is unsuccessful in adapting to the stressors in the resistance
phase, i.e., this last phase of the GAS - exhaustion - begins. If we continue to
experience this phase our adaptive energy will eventually be exhausted (see
Exhibit 14.8). Also, the same signs that were evident under the alarm phase
will begin to reappear.
Recall what Selye said in the quotation mentioned before. That is,
adaptation energy, which is really what he called "vitality," is not limitless.
Therefore, we should use this precious cargo of ours most wisely, because it
cannot be replaced when it is finally depleted. If unsuccessful adaptation is
made to the stressors and no solutions are found, it is very likely that, over
time, our vitality will diminish. If this phase continues without any relief,
various consequences of being under (chronic) stress will begin to be Exhibit 14.9:The tiger as
experienced. Once this stage is reached we have entered the last stage of the the stressor that needs to
be controlled
stress process - outcome. It

should be noted that when
all our vitality is
completely exhausted,
accordingly to Selye, we
are likely to experience the
ultimate dysfunction of all -
death.
Exhibit 14.8: Graphic representation of the three phases of the General Adaptation
Syndrome or GAS
A Final Note on the Three Phases of the G.A.S

Following their descriptions, the three phases of the GAS can be thought of in sequence as:
"build-up," "blow-up," and "breakdown" (see Exhibit 14.8). When the stress process is viewed in this
graphic manner, it is evident that, like the engine of a car running at a "constantly high rev," we cannot
tolerate or forever sustain the buildup of tension over long periods of time without reaching a "breaking"
point. In the case of a car, the engine will eventually burn up. In our case, we can literally breakdown and
possibly die, depending on the extreme and unrelenting stressor conditions being experienced (see
Exhibit 14.9). In terms of college students, if stress has a negative impact on them, they need to find ways
of successfully controlling the “stress tiger,” or it will literally eat them alive.
To prevent the tiger from winning, the key is to manage stress more effectively. Students taking
greater control of their lives through learning effective stress management techniques (which will be
discussed in PART IV of the book). They have to learn to "accelerate" up the hill (i.e., positive stress)
when their particular life circumstances require it. Similarly, they also have to learn when to decelerate or
literally take their feet off the gas pedal, again when the situation warrants it. This latter action will allow
students’ body systems to return, as close as possible, to its "normal rev" or baseline stage (i.e.,
experiencing normal or everyday stress - see Exhibit 14.6).
The analogy of the human body with a car (mentioned in Chapter 1) is very relevant to
underscore the importance of certain appropriate and inappropriate lifestyle actions. It is important to
acknowledge that these three phases of the stress syndrome involving the GAS can, and do, occur for
many students several times during the day and, in a more general manner, throughout their lives. For
Selye, these three stages are similar to the three stages of a person's life: childhood - with its
characteristic low resistance and excessive responses to any kind of stimulus; adulthood - where ability to
resist and cope increases; and finally, senility, which is characterized by eventual exhaustion that can
culminate in death.
The Second Stage of the Stress Process - Reaction
O The Non-Specific Response of Stress (p.137)
O The Fight-or-Flight Response (p.137)
O The Physiology of Fight-or-Flight Response (p.138)

9 The Endocrine System (p.139)
9 The Autonomic Nervous System (p.140)
O Fight or Flight - The Case of Ancient and Modern Man (p.141)
O The General Adaptation Syndrome (or G.A.S.) (p.143)

9 The Alarm Reaction (p.144)
9 The Resistance Stage (p.144)
9 The Exhaustion Phase (p.145)
9 A Final Note on the Three Phases of the G.A.S. (p.145)
___________________________________________________________________________________________
15.
The Third Stage of the Stress Process - Outcome
ë
“A thought which does not result in an action is nothing much,
and an action which does not proceed from a thought is nothing at all.”
- Georges Bernanos
T
he last stage of the stress process occurs only after repeated failures of our bodies to adapt to or
alleviate the demands of the stressors initially perceived during the first phase of the stress process
- onset. For us to reach this last phase our "resource" capabilities (i.e., mental, behavioral and
physical) were simply not adequate in dealing with various stressor demands (see Exhibit 3.2 in Chapter
3).
Concerning the occurrence of this last stage of the GAS, a very important point must be
emphasized. It should not be thought that once we reach this last stage of the stress process that we are
"doomed" to forever experience the
ravages associated with the chronic stress
tiger, quite the contrary! In fact, given the
potentially "circular" or "rebounding"
nature of the stress process, as illustrated
earlier, a resurgence in our resources
(e.g., getting "support" of either an
emotional and/or financial nature from a
relative, fellow student) can in turn
"dilute" the stressor demands perceived
or experienced, whatever they might be.
If these events occur, the chronic nature
of the stress can be broken, and it is very
likely that our body functioning will
return somewhat close to the pre-alarm or
normal stage of reaction or homeostasis
(see Exhibit 14.6).
For practical purposes, however,
let us assume that the stress outcome
stage is reached. That is, our resource
capabilities proved to be insufficient in
meeting the demands of the stressors we Exhibit 15.1: Some possible stress effects or outcomes
have perceived, are perceiving, or are
anticipating. If such possibilities occur, it increases the chances for certain health-related outcomes to be
experienced, especially over time (see Exhibit 15.1).
Categorizing Stress Effects or Outcomes
As illustrated in Exhibit 15.1, there are four distinct, yet very much interrelated, categories under
which most, if not all, of the stress effects or outcomes can be placed:
147
K Behavior Effects;
K Cognitive (thinking) Effects;
K Emotional (feeling) Effects; and
K Physical Effects.
The placement of one or several outcomes under each of these four categories is often a result of
interpretation. Due to the interrelated nature of the categories, it is possible that an outcome can be
placed under more than one category at a time. What follows is a brief mention of some selected
outcomes from each of the four areas.
Behavior Effects
The problems listed here, although they may have their origins elsewhere, require some form of
behavior for them to become a reality. Because of this latter point, these problems are more open to
conscious change or modification on our part. This point will be made again when a more detailed
discussion is presented regarding the specifics of managing stress in the last section of the book. What
follows, then, is a brief overview of selected problems under this category.
Drinking of Alcohol
Great care has to be taken with drinking alcoholic
beverages. Alcohol is thought to be a stress reliever, because it
works well in allowing you to temporarily forget the real
sources of your distress and to focus on the good stress of
feeling elated, or, at least, tranquil. Therefore, because it does
bring your system back to normal and allows you to relax, if
you are not careful, you may end up with a severe drinking
problem (see Exhibit 15.2), where you look to the bottle for the Exhibit 15.2: Excessive alcohol consumption
solution to the problem and not address the problem itself (i.e.,
the stressor(s). See Chapter for information that was presented before on alcohol consumption and
college students.
Excessive Coffee Drinking

It is commonplace to see coffee drinkers increase their consumption
of coffee when they are under stress. In fact, the chronicity of stress can, in
part, be gauged by the amount, frequency, and strength of the coffee taken.
The typical or average cup of coffee contains 100-150 mg. of caffeine (see
Exhibit 15.3).
It is a fact that headaches, nervousness, insomnia, and even more
serious conditions, as ulcers, have all been related to as little as 250 mg. of
caffeine. It follows, therefore, that people who drink three (i.e., 300-450 mg.)
or more cups of coffee daily are at risk to develop any of the above-mentioned
(and, possibly, other) health problems. Excessive amounts of coffee also can
cause you to experience feelings of being "edgy" or being unusually anxious.
Such feelings can be stressors in themselves, especially if they are of concern.
Exhibit 15.3: Excessive drink-
ing of coffee
Chapter 15 . The Third Stage of the Stress Process - Outcome 149
Frequent Use of Cigarettes

Cigarettes come in so many kinds and forms that there is an abundant amount to choose from if
students are smokers. While smoking can itself be an indication that students are under stress, any
notable increase in smoking rate can suggest that they are failing to adjust
to certain stressors or "demands" in their environment. Cigarettes have a
very important addictive drug called nicotine. Nicotine acts first as a
stimulant, that is why you feel a sense of relief, after taking the first couple
or so puffs (see Exhibit 15.4).
More importantly, however, the nicotine in cigarettes also serves as
a depressant. Physically speaking, nicotine increases the stress in the body
because it acts temporarily to cause body responses (e.g., increased blood
pressure; increased heart rate; and increased levels of cholesterol and
noradrenaline. Noradrenaline is a close relative of adrenaline, which is a
major body activating hormone mentioned before.
Exhibit 15.4: Excessive cigarette
smoking
Absenteeism
Chronic stress can definitely result in the desire to avoid school. Interestingly enough, several
factors can account for the stressors here. For example, some psychosocial stressors, mentioned before,
such as being overloaded or, for that matter, being underloaded at college are prime candidates.
Whatever the nature of the stressor, some students will find an excuse not to go to school, although they
are quite able to do so. Increase absenteeism can have an adverse impact on students’ health (e.g., when
they push themselves too hard to catch-up for lost time and classes they missed during the semester).
Insomnia
Whether it is waking up in the middle of the night or simply not being able to fall asleep can be a
very frustrating experience (see Exhibit 15.5). The harder you try, the more difficult it is to fall asleep.
The reason you may be suffering from insomnia can be due to the possibility that you are excited (i.e.,
good stress or eustress) or that you are upset and/or anxious, (i.e., bad stress or distress) about an up-
coming (perhaps the following day) event. A related physiological explanation is that stress makes
sleeping more difficult by doing the following: raising
body temperature, raising skin resistance, narrowing
blood vessels, and increasing body movements.
Chronic insomnia suggests that you are under
too much stress. It is not uncommon for the average
person to have insomnia for a day or so. However, if it
persists, both in frequency and intensity, this can be a
direct consequence of your experiencing chronic stress.
Taking sleeping pills to fall asleep is not a cure for
insomnia. It only provides a temporary, yet short-lived,
relief to the problem. Therefore, to address meaningfully
Exhibit 15.5: Insomnia and its associated difficulties the issue of insomnia requires focusing on one of its
main causes - stress.
Eating Problems
Because of our "stress gauge" being too high, some of us will respond by eating too much while
others may respond by eating too little. For the former, obesity could result and for the latter various
nutritional problems could result, for example, anorexia nervosa. Each of these possibilities has further
negative implications for us (for example, obesity contributes to heart and circulatory diseases). Stress
causes an upset in our nutritional balance, which in turn disturbs the needed level of homeostasis that our
bodies need to function effectively. Stress can cause increases in the metabolic rate, hyperglycemia from
the liver’s overproduction of glucose and a breakdown proteins and various other nutrients in our bodies.
In a related manner, when we are under stress it is very important to maintain an intake of certain
nutrients. During stress, the body requires increased levels of thiamine, riboflavin, vitamins A and C and
protein (to repair tissue damage).
For some people, overeating may be an attempt to divert attention from the stressors and toward
food. Physiologically, a full stomach draws more blood in the stomach, by bringing on a tranquilizing
effect because of a decrease in blood circulating in the brain. This feeling may, in part, encourage eating,
further. On the other hand, when some people experience too much stress they are likely to experience
related stomach disorders. If this latter case occurs, there is usually a decline in appetite and, eventually,
loss of weight follows. Therefore, if you are gaining or losing weight (i.e., more than is customary) it
could be an indication that you are under too much stress. As always, the advice of a clinical specialist
must be sought in these and related matters.
Accident Proneness
When you experience frequent and, worse yet, unexplained accidents in close proximity to each
other (see Exhibit 15.6), this may be an indication that you are under too much
stress. These accidents need not necessarily be major, but sometimes involve
several minor occurrences, for example, a "fender-bender" with your car;
dropping the drinking glass in the kitchen; forgetting to put the top back on
your red ink pen, thus getting your shirt pocket all messed up; and mistakenly
closing the car door on your finger. If these accidents occurred within the
space of two days, something unusually is happening. One possibility is that
you may be under too much stress. If this is the case, it may be that you are
preoccupied with certain thoughts that, in turn, suggest why you are not
adequately dealing with present events, the latter of which has turned into a
series of multiple accidents. The solution is to address the stress-related
thoughts that are preoccupying your attention.
Exhibit 15.6: Accident
Sexual Problems proness as a result of stress
Although all sexual problems are not caused by stress, excessive or
chronic stress is responsible for some sex-related problems. For example, impotence and premature
ejaculation in men and frigidity in women are frequent and likely occurrences. Chronic stress is also said
to be responsible for decreasing sexual desire in men and inhibiting the formation of sperm cells, the
latter of which is vitally necessary for fertilizing eggs in the woman's ovary. The successful fertilization
of eggs by sperm is essential for the initiation of the reproduction process. Other stress-related
consequences include, but are not limited to, the following conditions: the reduction of the male hormone
(testosterone), and insufficient milk in women during lactation (i.e., the period when milk is produced).
Suicide
Given that there is a possible range of behaviors that are consequences of chronic stress, the
taking of one's life is the ultimate self-destructive behavior. Whatever the reason or reasons, suicide
represents an unfortunate "grand finale" of the stress process. It is realistic to assume in some cases that
this final behavior is a result of the overpowering demands of one or several simultaneous stressors out-
reaching individuals’ resource capabilities. In this stage of exhaustion (i.e., the third stage of the GAS -
see Exhibit 14.6), "vital energy" is finally depleted and, in extreme cases, death is very likely to occur. In
the case of suicide, however, death was not brought on by a failure of the body systems, but directly
through human behavior or action.
Cognitive Effects
The problems that fall under this category have one thing in common, the mind plays a very
important role in either their initiation, maintenance, and/or continuation. In essence, these effects are a
result of how you think. This being the case, you have to learn to control how you think, because the
kinds of thoughts you have can have a direct influence on the stressors you experience. What follows is a
brief discussion of some selected examples.
Poor Self-Concept
Depending on the individual's exposure to the stressor (or stressors) and, of course, his/her
resource capabilities, there can be feelings of inadequacy about self-worth, and the inability to
accomplish basic desired goals and objectives. The results can be self-doubt, hesitancy in carrying out
daily functions, and, therefore, greater dependency on others to provide direction and help. Such persons
may likely end up having serious dependency complexes, which can, in turn, contribute to stressful
experiences.
Perfectionism
The need to always be first or best, to always achieve and never make mistakes is the sign of
perfectionism. This way of thinking is common to contemporary cultures and college life, where most
things desired are very competitive. Some characteristics of perfectionism include: unrealistic
expectations of self and others; no room allowed for mistakes in self and others; and indispensable need
for achievement; extreme competitiveness, etc. These kinds of thinking, as well as related behaviors, can
contribute to stressful experiences, as well as maladaptive ways of
coping.
Worrying
For many people, worrying is a constant fact of life. It goes
with their personality and, in turn, with the daily circumstances they
experience (see Exhibit 15.7). According to Simmons (2000), worry is
physically harmful. This fact was underscored by Dr. Charles Mayo,
who helped found the Mayo Clinic, in the following statement: "Worry
affects the circulation, heart, glands, the whole nervous system, and
profoundly affects health. I've never known anyone who died of
overwork, but I know many who died of worry. You can worry yourself
to death, but you'll never worry yourself into a long life." The report by Exhibit 15.7: Worrying as an
Simmons went on to say the following about worrying: everyday experience for some
people
“It takes precious energy to maintain a high anxiety level. This effort makes a chronic worrier
significantly more vulnerable to physical and emotional consequences. Human beings were
designed to have a "fight or flight" reaction to potentially harmful situations. Our ancestors often
found themselves in highly stressful predicaments, such as the prospect of wild animals attacking
them. In their case, worry often saved lives. The difference is their stress forced them to make
quick decisions. Our reaction to stress was never meant to be a continuous state of mind.”
Emotional Effects
The problems that fall under this category are influenced by your emotions or feelings. As was
the case with cognitive effects, you have to be aware of how emotionally involved you become when you
interact with various events, conditions and people (i.e., potential stressors), because such involvement
can lead to stressful experiences. What follows is a brief discussion of some selected examples.
Burnout
This problem is usually mentioned in the context of the work environment. It is an excessive
stress reaction to one's environment, manifested by feelings of emotional
and physical exhaustion, coupled with a sense of frustration and failure.
Although several stressors work individually and in combination to
produce burnout over time, one stressor that is often responsible is
overload (i.e., too many demands being placed on you at any one point in
time) (see Exhibit 15.8). In the context of the college environment,
burnout can contribute to high rates of absenteeism from classes,
substance abuse, low levels of productivity and poorer health of students.
Anxiety and Fear

Anxiety should not be confused with fear. Both anxiety and fear
are likely consequences of stress. Anxiety is usually pervasive feelings of
uptightness, dread, and apprehension. It can
Exhibit 15.8: Burnout as a possible be related to general conditions, identifiable
outcome of stress
conditions, or anticipated conditions, the
particular form of which is unknown. Fear,
on the other hand, is a reaction to specific or immediate danger. As a
startling response, both are possible outcomes of stress also contributing
factors to stress itself. In both instances, the body deals with and responds
to the arousal of these mental states similarly with respect to hormonal and
internal body reactions (see Exhibit 15.9).
Depression
As a common consequence of stress, depression refers to a chronic,
low-keyed sense of dejection about one's total life situation (see Exhibit
15.10 and the discussion on depression and college students presented in
Chapter 4). For some cases of depression, the causal stressors are known, Exhibit 15.9: Feelings of
anxiety and fear arousal
for example, the death of a loved one. Yet, in other cases depression may be
a more generalized response, sometimes without any apparent cause or stressor.
Depending on the circumstances and who is involved, the
generalized kind of depression can be more difficult to address successfully
by only using stress management techniques. Sometimes drug therapy may
be advisable, depending on the circumstances. If depression is not
controlled it can lead to suicidal behavior. Depression is usually
characterized by sadness, lack of energy, inactivity and difficulty in
maintaining mental concentration. Such characteristic features severely
retard the successful completion of complex and also simple everyday tasks.
In the case of college students, depression can be a major impediment to
their health, well being and success in college.
Exhibit 15.10: Feelings of

depression
Physical Effects
This is by far the largest category of problems and, as the name suggests, the problems under this
category all have a direct relationship to our physical bodies. These problems also are more frightening to
us, cause us more pain and, therefore, are responsible for us seeing the physician or medical personnel
more frequently. Like the previous categories, a selected overview of physical problems are presented
below.
Backaches
Backaches along with headaches continue to be two of the most common outcomes of excessive
stress. When combined, both account for a little over half of all
visits to the physician or related medical personnel. Generally
speaking, most cases of backaches are caused by muscular tension
or weakness. It is our sedentary lifestyle habits (i.e., being
somewhat fixated or constantly seated in the pursuit of daily
activities) that contribute to weak and inflexible back muscles.
Many times the chairs that we sit in are not ergonomically correct
(i.e., they do not facilitate good “body posture”), hence they can
exaggerate underlying muscular problems (see Exhibit 15.11).
Additionally, the hectic pace and pressures (i.e., stressors)
of our modern-day living, cause tension, which in turn is Exhibit 15.11: Backaches resulting from
frequently concentrated in the region of the lower back. Therefore, stress and related conditions
it is the constant and prolonged tightening or contracting of these
muscles that cause back pains or backaches. Stress management, especially using various forms of
exercise, which will be discussed in the last section of the book, has been a proven and effective means to
control and relieve acute also chronic backaches. If problems continue to persist, however, it is advisable
to seek medical advice and help.
Headaches
The migraine headache is viewed as the most frequently experienced headache. Although the
picture is not totally clear how a migraine works, it is believed that it is a result of constriction and spasm
of blood vessels supplying the brain. The pounding pain associated with
migraines is particularly painful. This pounding pain is felt because every
time the heart beats, it sends a surge of blood through distended and swollen
blood vessels, and this creates the pounding pain (see Exhibit 15.12).
Apart from stress, other factors that trigger migraines include:
caffeine, hypoglycemia (i.e., low blood sugar), and fatigue. In terms of
stress, however, it is interesting to note that for many people they tend to get
migraine headaches not when stress is at its peak, but shortly after the stress
has lifted. For example, Sunday is a customary day for people to have
migraine headaches, because it is the day of rest after completing a usually
hectic week on-the-job. The extent of pain experienced in either the
Exhibit 15.12: Headache as an
backache or headache is, like the other problems mentioned before, directly
outcome of stress
related, in part, to your particular mental and physiologic composition and,
of course, the characteristics of the stressor(s) involved.
Allergies and Asthma

Stress plays a very important role in hyperimmune responses of the body. Basically,
hyperimmune responses are outcomes, like allergies, that are characterized by an overactive response by
the body’s immune system. Overt reaction includes constriction of vessels, swelling and itching. Hay
fever is a good example of a hyperimmune response in which the immune system overacts in the
presence of antigens like pollen. In many cases, allergies appear only when a person is experiencing
stress.
For an allergic reaction to occur, the white blood cells (that are important in the body’s
immunological defense) mistake a harmless substance (e.g., wheat or
pollen) for the enemy. As a result, white blood cells produce
antibodies that latch onto cells in, for example, the nose, intestines,
stomach, or skin in readiness for battle. This constitutes an allergy
attack (see Exhibit 15.13). The most common antibody that is
produced in an allergic reaction is Immunoglobulin E (IgE). Evidence
exists that people who are under stress have higher levels of IgE than
persons under less stress. Emotional problems (i.e., stressors) can
either precipitate allergic attacks or exacerbate existing allergic
conditions.
Asthma is perhaps the most common allergic outcome and it is
not uncommon for stress to trigger an asthma attack. Basically, an Exhibit 15.13:The problems of
asthma attack is characterized by shortness of breath, and occasionally allergies.
coughing or sneezing. Interestingly enough, for some persons
(approximately 1 in 25) who are experiencing stress under the fight-or-flight reaction (see Exhibit 14.1 in
Chapter 14), their bodies react in an opposite manner. That is, rather than being stimulated under the
sympathetic nervous system and experiencing dilation of the airways (bronchiole) and, therefore,
increased flow of needed oxygen; these persons are stimulated by the parasympathetic nervous system.
These latter outcomes result in constriction of the vessels leading to the lungs and, hence, the wheezing
or grasping for needed air by asthmatics. It is not unusual for an emotional stimulus, such as the death of
a loved one (distress) or the surprise visit of a long-lost-friend (eustress) to trigger an asthmatic attack.
Given that both negative and positive stressors have the potential to trigger an asthma attack, the answer
becomes very simple - learn to control your stress response by using improved stress management
techniques.
Arthritis
There is no clear answer about what causes arthritis. However, rheumatologists agree that there
is a genetic disposition to rheumatoid arthritis, because there is a blood factor present in arthritic patients
as well in approximately 20 percent of their healthy relatives. It is also increasingly agreed that stress
plays a very important role in the onset or exacerbation of arthritis. An increasingly accepted view is
that if you have the rheumatoid factor in your blood and remain in psychologically good health (i.e.,
relatively free from distress), you will either not get arthritis, or you will experience a milder form of the
disease. From a physiologic point of view, arthritis results when there is a breakdown in the
immunological system, and stress contributes to this breakdown. It is one of the chief causes of physical
disability for adults and children (e.g., juvenile arthritis) the world over and, if severe enough, arthritis
requires ongoing medical attention. It usually manifests itself as painful inflammation of the joints. In
somewhat mild cases it can be an irritating experience; however, in more severe cases it can be extremely
painful and confining.
Diabetes
Diabetes is a problem where there is usually too much "sugar" (or glucose as it is normally
called) circulating in the blood. There is a genetic disposition to diabetes, that is, if your parents had
diabetes you are more prone to develop it later in life. An additional contributing factor to diabetes is
your lifestyle, especially psychological impairments. The amount of stress you experience can influence
the onset and severity of diabetes. The stress-diabetes association is underscored by research done on
animals. For example, it is shown that diabetes can be produced in health animals by making a lesion in
the area of the hypothalamus. A previous discussion (see Exhibits 14.2 and 14.7 in Chapter 14)
addressed the role of the brain and the hypothalamus in activating the stress response via the nervous
and endocrine systems of the body.
Basically, when we are under stress, our blood-sugar levels become elevated. Medically
speaking, under prolonged (i.e., chronic) stress, the body is inhibited further (i.e., the pancreas) in its
efforts to manufacture a substance called insulin. This insulin enables the sugar to be used up, i.e., by
penetrating individual body cells and to create actual energy. The body's storehouse of sugar, besides that
being acquired daily, is literally backed-up. There are different types of diabetes (e.g., insulin- dependent
and non-insulin-dependent). Whatever the type of diabetes, however, it needs to be controlled. Severe
forms of diabetes require clear, swift and consistent medical treatment, besides stress management
intervention.
Ulcers
Among all the physical problems discussed so far, the relationship between ulcers and stress is
perhaps the most widely accepted, at least up until the last ten years. Although the stress-ulcer
relationship is emphasized here, another view is that ulcers are caused by a bacterium called Helicobacter
Pylori. It is believed by some people that this bacterium is acquired at an early age and it lives in the
stomach lining and causes inflammation. Because of the emphasis on stress here, ulcers are physical
problems resulting from a mind-body interaction. These mind-body interaction health outcomes are
called psychosomatic problems.
Many people suffer from some form of ulcers during their lives. One way to picture ulcers is to
visualize them as sores on the inside of our bodies, especially in our gastrointestinal tract. An ulcer
becomes bad when it bleeds, and even worse, when it erodes the mucus membrane of the gastrointestinal
tract causing further damage (e.g., a hole in the gastrointestinal tract). These latter possibilities can lead
to more bleeding, and if the bleeding is not stopped soon after it begins, extreme sickness or death can
result. Intense or chronic stress not only produces ulcers, but it also contributes to their bleeding as well.
Conditions that are conducive to ulcers include the following activities in the gastrointestinal tract
(moreso stomach): excess acidity, excess digestive enzymes and a relative thin mucus lining. When the
stress response is activated (see Exhibit 14.2 in Chapter 14) through endocrine (e.g., cortisol) and
nervous (catecholamines) system activities secretions, all of these gastrointestinal activities are
increased, hence the increased risk to experience ulcers. Serious forms of ulcers (i.e., involving bleeding)
need prompt medical attention and, if not corrected in time, can be fatal.
Hypertension, Heart Disease, and Stroke

Stress is increasingly being accepted as a major contributing factor in the deadly conditions of
hypertension and heart disease. Hypertension or high blood pressure is too high a pressure for the blood
pumping through the circulatory system (i.e., veins and arteries). Some pressure is necessary to transport
oxygen-carrying blood to all parts of our bodies (e.g., brain, heart, muscles and tissues). Without this
oxygen these parts would literally starve and ultimately die. However, this pressure must always be
carefully controlled by a series of complex mechanisms, also within our bodies.
Depending on the level of blood pressure, our blood-carrying vessels (e.g., arteries, veins and
arterioles), like any other conveying structure (e.g., a pipe) cannot tolerate higher than normal pressures
for prolonged periods, before something negative occurs. Such prolonged high pressures are damaging to
several organs, notably among them are the kidneys, brain and heart. This being the case, and because
these organs are vital to our survival, annual and other examinations must be conducted by qualified
medical personnel to ascertain the proper functioning of these and related
organs (see Exhibit 15.14).
Sometimes because of various reasons (e.g., a congenital
problem) a "blowout" (or an aneurysm) of a blood vessel occurs. If the
blowout happens in the brain - we have a stroke (or a cerebrovascular
accident). When the oxygen-carrying blood supply (i.e., via the arteries)
to the heart muscles is interrupted a heart attack occurs. If the blood is
interrupted, either through arterial occlusion (i.e., blockage) and/or
breakage, the muscle fibers fed by that damaged artery die. The death (or
necrosis) of heart muscle fibre is called myocardial infarction, and is
accompanied by severe pain in the sternum region of the chest called
angina. Depending on the nature of the problem and the speed at which
medical help is received can make the difference between life and death
when a heart attack occurs.
Stress can contribute to strokes and heart attacks in various ways. EXHIBIT 15.14: Medical check-
ups for heart and related stress
For example, if the vascular or circulatory system is weakened (e.g., problems
through previous aneurysms, arteriosclerosis), a sudden rise in blood
pressure can quickly terminate blood flow in a given area, therefore giving rise to a vascular accident
(e.g., aneurysm). Based on the various nervous and endocrine activities that are initiated in the stress (or
fight-or-flight) reaction that were discussed earlier (see Exhibit 14.1 in Chapter 14), stress plays a very
important role in vascular accidents. For example, epinephrine acts on the heart to increase cardiac
output quickly. In a related manner, norepinephrine acts on the vascular system to increase
vasoconstrictive (or reducing). Overall, these two effects act together to raise blood pressure quickly.
During normal daily activities, it is natural for our blood pressure to fluctuate, e.g., during
periods of understandable excitement it goes up. It is important to know that after the stimulating
experience ceases, blood pressure attempts to return close to its normal resting level. For people
experiencing unrelenting or chronic stress, their blood pressure increases above normal levels so
frequently that when it attempts to return to normal levels, it never quite succeeds (see Exhibit 14.6 in
Chapter 14). Therefore, over a period of years if this scenario of events continues, these persons show a
steady elevation in blood pressure, which can lead, over time, to hypertension or high blood pressure.
Lifestyle alteration, which most definitely should include the acquisition of stress management
techniques, must be part of the arsenal of treatment for everyone. Yet, if people have seriously elevated
blood pressure, and even more seriously if they have already experienced some related consequence (e.g.,
stroke, heart attack and/or kidney dysfunction), medical advice and care should be the first priorities of
action.
Cancer
The relationship between stress and cancer is increasingly being recognized by medical and other
experts. As is true of arthritis, it is normally viewed that stress operates via suppressing the body's
immune or protective system. Our repeated inability to control stress, then, contributes to the failure of
our body's immune system to reduce or stop the growth of cancer cells. These cancer cells also are
destructive to adjoining body tissues. However, if the cancerous growth is successfully located and
contained human life can be prolonged.
Although various factors contribute to the stress-cancer relationship, one important factor is the
hormone cortisol. In an earlier discussion in this section, cortisol was discussed as the primary
glucocorticoid hormone released by the adrenal cortex during the stress response (see Exhibit 14.2 in
Chapter 14). Among the various activities associated with cortisol release, two stand out as being
relevant to the stress-cancer relationship. In helping to provide “fuel” for battle (i.e., the fight-or-flight
response), cortisol breaks down protein. Therefore, because cortisol is converting protein in the body
into energy, there is a reduction in the amount of needed protein to manufacture new (white blood)cells.
This activity, in turn, leads to a second set of activities that are equally important for the stress-cancer
relationship.
One of the more important physiological changes associated with cortisol release is the decrease
of lymphocytes (released from the thymus gland and lymph nodes) found in white blood cells.
Lymphocytes play a very important role in destroying invading substances (e.g., bacteria) and, therefore,
are important for the effective functioning of the immune system. In short, cortisol release is associated
with immunosuppression. In the case of cancer, because of insufficient white blood cells, the body
cannot effectively guard against abnormalities, hence the increased opportunity for malignant cells to slip
through the body’s defenses establishing tumors. This latter points argues, then, that stress does not
necessarily cause cancer; however, the psychogenic stress response weakens the body’s defense system,
thereby increasing the chances for cancer to develop.
Conversely, if successful cancer intervention strategies are not achieved, even with the marvel of
modern-day technology (e.g., radiation treatment and chemotherapy), the reality of death becomes more
eminent. Given the poor prognosis and potentially fatal nature of cancer, especially certain types, it
makes more practical sense to prevent its occurrence at all costs. Although several other factors (e.g.,
diet, heredity and exposure to toxic environmental pollutants) also play a role in the onset, exacerbation
and maintenance of cancer, the contributing role stress plays is recognized as being very important. To
this end, the effective control and management of stress should become an even more important goal in
our lives.
Other Physical-Related Outcomes

There are a variety of other stress-related health problems that have been implicated; however,
because of space limitations only a brief mention is made of these conditions. As in these cases of the
conditions mentioned before, stress does not necessarily cause the onset of these conditions, but it may
serve to exacerbate their occurrences. Additionally, in some of these conditions, more (empirical)
research is needed to make a stronger case for either the direct or indirect contribution stress makes to
their occurrences.
Some research is showing that hair (e.g., whitening of the hair, hair loss) and scalp problems
(e.g., dandruff) may be related to emotional problems (stressors) experienced by individuals. Emotions
are also being reported to be associated with dental cavities. High bacteria levels in saliva, which is a
result of stress, have been reported as a possible contributing factor to dental cavities. In a related
manner, stress may also be related to gum disease (e.g., trench mouth). Emotions have been linked to
irritable bowel syndrome. It has long been recognized that the gastrointestinal tract is particularly
susceptible to emotional stress. People who overreact to everyday worries, and are more anxious and
depressed tend to have irritable bowel syndrome, which can include a painful combination of cramping,
diarrhea and occasional vomiting. Although there is no direct evidence linking stress to the etiology of
emphysema, there is evidence that stress exacerbates this incurable disease. Emphysema is a common
disease in cigarette smokers. Basically, it is characterized by the destruction of tissue within the lungs,
which, in turn, impairs airflow in the lungs and breathing. Stress exacerbates the problem, because
during stress the body needs more oxygen; therefore, the breathing difficulty of the person with
emphysema is amplified.
For practice, please complete EXERCISES #15.1a thru #15.1d that follow. These Exercises
allow you to think about and evaluate your stress-related experiences in the past six (6) months. You
should report these stress-related experiences under the following four areas discussed before and
mentioned below:
N Behavior Effects (15.1a)

N Cognitive Effects (15.b)
N Emotional Effects (15.1c)
N Physical Effects (15.1d)
The Third Stage of the Stress Process - Outcome
O Categorizing Stress Effects or Outcomes (p.147)
O Behavior Effects (p.148)

9 Drinking Alcohol (p.148)
9 Excessive Coffee Drinking (p.148)
9 Frequent Use of Cigarettes (p.149)
9 Absenteeism (p.149)
9 Insomnia (p.149)
9 Eating Problems (p.150)
9 Accident Proness (p.150)
9 Sexual Problems (p.150)
9 Suicide (p.151)
O Cognitive Effects (p.151)

9 Poor self-Concept (p.151)
9 Perfectionism (p.151)
9 Worrying (p.151)
O Emotional Effects (p.152)

9 Burnout (p.152)
9 Anxiety and Fear (p.152)
9 Depression (p.153)
O Physical Effects (p.153)

9 Backaches (p.153)
9 Headaches (p.154)
9 Allergies and Asthma (p.154)
9 Arthritis (p.155)
9 Diabetes (p.155)
9 Ulcers (p.155)
9 Hypertension, Heart Disease and Stroke (p.156)
9 Cancer (p.157)
9 Other Physical-Related Outcomes (p.157)
EXERCISE #15.1a
Instructions: In the table below, please reflect on your health-related experiences within the last six(6)
months. Within this time period, categorize and list these experiences under the appropriate heading
to the left, and to the right include a short statement about your experiences and the outcome(s)
associated with the effect.
Behavior-Related Effects Notable Experiences Actual and Expected Outcomes

EXERCISE #15.1a - Continued

Behavior-Related Effects Notable Experiences Actual and Expected Outcomes

EXERCISE #15.1b
Cognitive-Related Effects Notable Experiences Actual and Expected Outcomes

EXERCISE #15.1b - Continued

Cognitive-Related Effects Notable Experiences Actual and Expected Outcomes

EXERCISE #15.1c
Emotional-Related Effects Notable Experiences Actual and Expected Outcomes

EXERCISE #15.1c - Continued

Emotional-Related Effects Notable Experiences Actual and Expected Outcomes

EXERCISE #15.1d
Physical-Related Effects Notable Experiences Actual and Expected Outcomes

EXERCISE #15.1d - Continued

Physical-Related Effects Notable Experiences Actual and Expected Outcomes

Part IV
M = Managing Stress Using a Combination of Strategies
This part of the book deals with the last

section of the I-R-M Approach to Stress
Management. Given that students are now
informed about the first two segments of the
I-R-M Approach to Stress Management, they
are now in a better position to more fully
understand the dynamic steps and processes
involved in managing stress both efficiently 16. The Dynamics of Stress Management
and effectively. In Chapter 16, the dynamics
17. Cognitive Restructuring
of stress management are discussed, followed
in Chapter 17 with important steps to manage 18. Psychosocial Adjustments
stress effectively. Chapters 18 thru 21 deal
19. Lifestyle Adjustments
with five distinct strategies that students can
use successfully in managing their stress, 20. Situational Adjustments
which can lead to improvements in their
21. Relaxation Experiences
health and academic performances. Chapter
22 presents wrap-up information. 22. Where To Go From Here
169
___________________________________________________________________________________
16.
The Dynamics of Stress Management
ë
“Grant me the courage to change the things I can change, the serenity to accept the
things I can’t change, and the wisdom to know the difference.”
- Reinhold Niebuhr
S
tress management is an increasingly used concept in today’s high pressured, fast-paced society.
However, because of the inherent complexities surrounding stressors, i.e., how we subjectively
perceive, interact and react to them, and how our bodies, once activated, respond to stress in a
similar manner, the process that is involved has the potential to be both dynamic and complex at the
same time.
Stress Management is Really About Having Balance
As discussed in previous chapters, stress can be both challenging (i.e., positive stress or
eustress) or debilitating (i.e., negative stress or distress), depending on how we perceive and react to
stressors. If (negative) stress is viewed as a “problem,” then, we are motivated to cope with and/or
avoid this problem by learning certain skills. In essence,
stress management provides us with these necessary skills in
order that we can achieve and maintain balance in our lives
(see Exhibit 16.1).
It has also been said that stress management is not one
specific technique or program of activities or a “one size fits
all” approach. Rather, stress management is a generic term
that is used to define any coherent attempt at achieving better
control over stress.
Exhibit 16.1: Stress management means

The Importance of Change For Stress Management having balance between all of your activities
Just as how the stressors in your life involve changes (e.g., death of family member, failing a
course, getting a parking ticket), in a similar manner the stress management strategies you are
introduced to in this section of the book will involve some changes, or restructuring on your part. Why
is this so? Most of the stress many people have is self-generated (internal) versus other-generated
(external). For example, given that we create most of our anxieties, frustrations, upsets, etc., we can
attempt to do something about them. In short, given this realization that most of our stress is internally
generated, we have some degree of choice and control associated with changes (or potential stressors)
171
172 PART IV % Managing Stress Using a Combination of Strategies
in our lives. Personal choice and self-control are very important to the success we have in successfully
managing stress.
The stress management-change relationship has to be fully appreciated if stress management
efforts are to achieve the success they are capable of
achieving. In essence, you have to figure out what you
are doing that is contributing to your stress problem and,
then, attempt to change or restructure it. This would be
done after you understand the background of stress,
stressors and how you respond to stress. This
information was covered in PART I and PART II of the
book.
While in some cases, depending on the
circumstances involved, the changes required are not
that easy to make, they generally fall under six
fundamental areas. As illustrated in Exhibit 16.2, and
later in Exhibit 16.3, these areas include the two related
areas of thinking and feeling (hence the overlapping
circles), self-care behaviors, interactions with others, Exhibit 16.2: Areas in your life that may need
changing or restructuring
personal management activities, and your situational
views of wherever you may be primarily located (e.g., at college).
It is important to
note that all the six areas
listed are under your
control, therefore they
are potentially easy to
change. For some areas,
however, it may prove to
be challenging to change
at the onset. Also,
because all areas to be
changed are associated
with you, the individual,
each area is linked to or
affected by another, as
illustrated by the
connecting circle seen in
Exhibit 16.2. This being
the case, any change in
one of these six areas has
the potential to have
subsequent impact on any
or a combination of the
other five factors. The
bottom line, however, is
that you have a great
Exhibit 16.3: Practical areas in life that may need changing
Chapter 16 . The Dynamics of Stress Management 173
degree control over critical changes in areas associated with your life, all of which have the potential to
allow you to better manage your stress. The discussion of the various stress management strategies
presented in subsequent chapters, implicitly utilize and incorporate these six areas of change,
restructuring, or adjustment.
In an attempt to make these six areas of change more realistic and functional, a more expanded
illustration is shown of identifiable and practical areas of change (see Exhibit 16.3), all of which relate
to the six areas illustrated in Exhibit 16.2. As seen in Exhibit 16.3, and consistent with the point made in
Chapter 6 that personality stressors are the main and overriding stressors for most individuals, the
main areas we have to change are related to how we think/perceive and our emotional reactions to
events and people around us. The next important area of change is our behavioral response to events
around us. Therefore, three of the six areas that need change, i.e., thinking and feeling, as well as
behaviors, are represented by changes in our mental (thinking), emotional (feeling) and behaviors,
respectively.
Regarding the other areas, lifestyle choices, and relaxation activities, seeking professional
services, monitoring and evaluating your behavior are related to changes in self-care activities. How
you interact with others are also again related to changes in your behavior. Situational changes are also
related to your activities in whatever environment you find yourself. Therefore, with this comparison in
mind, it becomes evident how the six fundamental areas of change are represented in the practical areas
of change that we have to address in selecting and utilizing appropriate stress management strategies.
Required Skills For Stress Management

Along with the desire and willingness to change old lifestyle and other habits, thinking, feelings,
behavior and circumstances, seen in Exhibit 16.2, there are certain skills that must also be learned in
order to be more successful in enacting these changes (see Exhibit 16.4). Essentially, whatever
strategies are adopted to manage stress, it is highly advisable that individuals (e.g., students) posses
these skills, as they serve as complements to these strategies.
As seen in Exhibit 16.4, although awareness skills are usually the first to be acquired, which in
turn leads to acceptance and coping skills, at any time any of these initial skills can lead to the overall
and desirable - actions skills. However, the ideal scenario is to acquire these skills in a left-to-right
direction and coping skills, in turn, lead to action skills. Although more is said about the I-R-M
Approach to stress management in subsequent chapters, based on what has been discussed previously it
shows that both awareness and acceptance skills, especially the former, are encompassed under the “I
portion of the I-R-M Approach. Managing stress is a complex, yet sequential process. Nowhere is this
fact more aptly demonstrated than with the I-R-M. Approach To Stress Management discussed
throughout this book and along
with the four basic
complementary skills seen in
Exhibit 16.4.
Awareness Skills
Awareness skills
essentially assist you in
identifying what causes you
stress or your stressors. You
Exhibit 16.4: Four needed skills to enhance stress management
may recall that in PART II, the variety of common stressors were categorized under five headings (see
Exhibits 5.4 and 5.5):
Œ Personality Stressors
œ Private Life Stressors
– Psychosocial Stressors
— Academic Stressors
“ Organizational Stressors
” Environmental Stressors
Awareness skills also relate to how you recognize that you are experiencing stress simply by
acknowledging certain stress-related symptoms. The simple truth is that you cannot begin to manage
your stress until you are aware of what factors/conditions are causing you to experience stress, and
when you are experiencing stress, as indicated by certain tell-tale symptoms that you recognize that may
be specific to you.
Acceptance Skills
Acceptance skills are basically the skills you use to “take as a given” some conditions you are
experiencing. Sometimes when things are beyond our control to influence (e.g., the date for a final
examination), you are best advised to simply accept them for what they are and do not loose any
valuable energy over trying to change them. On the other hand, you should spend your energies wisely
by mainly addressing those conditions that you have some control over, hence the possibility of
rectifying (e.g., studying differently to improve a math grade). In some instances, you may need to seek
professional help to allow you to accept the condition in question that is beyond your control.
Coping Skills
Coping skills are basically the things you do that allow
you to better able to deal with the stressors and stress that you
are experiencing. You may recall from Chapter 3 (see Exhibit
3.2) that when we are under stress, apart from the two historic
and customary options of fighting or fleeing, we have at least
four other options in how we respond to the stressor(s). These
include: flowing with the stressor, learning from the stressor,
ignoring the stressor, and, last but certainly not least, solving
or having coping skills for the stressor (see Exhibit 16.5).
These two latter options are the most ideal and, therefore, the
most sought after to engage in, depending on the existing
circumstances. In subsequent chapters, information is
presented as to how coping may be actualized, for example
through frequent exercise; balanced meals; having the support
of important people in your life; engaging in positive mental
Exhibit 16.5: Options associated with the
feelings, expressions and /or thinking; and engaging in a stressors experienced
meaningful and consistent form of relaxation.
is managed, you have to carry out your share of “stress-busting” actions.
The Importance of the I-R-M Approach to Stress Management

Chapters 3 thru 15 of the book presented a variety of information on how stress can be
successfully managed using the I-R-M Approach to stress management. As noted before, M, which
stands for managing your stress using selected strategies is, therefore, the main focus of the remaining
chapters of the book. In keeping with the analogy of the tiger representing the stress in your life, the
information presented in PART IV is directed to teaching you how to literally “tame the potentially
ferocious tiger,” which could very well be the main contributor to your everyday stress.
The dynamics of stress management dictates that any meaningful attempt at managing stress
must, of necessity, be multifaceted, holistic and, of course, logical and sequential. The I-R-M Approach
used in this book covers all of these topics, especially the last. Once you identify your sources of stress
or stressors [I], you attempt to recognize when you are experiencing symptoms or reactions related to
stress [R], and only after these steps have occurred are you in a better position to select one or a
combination of strategies or techniques that work best in allowing you to manage your stress
successfully [M].
Step #1: I - Identifying Your Stressors
Identifying your stressors is the first and very important step

you have to take in managing your stress more successfully.
Just knowing what your stressors are, and being able to
anticipate and prepare for them, will help in your overall stress
management plan and response.
Exercise 16.1 -Stress Diary (See Appendix at back of the

book)
Given the discussions presented in Chapters 6 thru 11

regarding the six stressors likely to be associated with college
students, at this point you are ready to complete Exercise 16.1.
Essentially, you are going to use a diary format and identify
and enter, in the appropriate column, which stressor(s)
bothered you within the last six(6) months. As the Exercise Exhibit 16.6: Livingston’s 3-Step Approach to
indicates, you are requested to do the following: Stress Management
a) Identify which stressor you are addressing;

b) Provide an example of the stressor experience;
c) Identify the time the stressor occurred (time of day);
d) Identify the date the stressor occurred (month/day/year);
e) Identify the signals that accompanied the stressors;
f) Identify the method(s) used in resolving the ensuing stress that came from the stressor(s); and
g) Indicate how successfully were your actions.
Step #2: R - Recognizing Your Stress Signals
After identifying the stressors that have been bothersome to you and examining the true nature
of these stressors in the context of your perception and circumstances, the next step is to recognize your
tolerance limits for stress associated with these stressors. This is
especially true for those stressors that you cannot change and/or
control and, therefore, are real, even if you wanted the situation to be
otherwise. As your body reacts to chronic or even occasional (or
episodic) stress by sending out stress signals, you have to learn to
recognize and become familiar with these specific signals, thereby
gauging how you respond to stress.
As discussed before in PART III of the book, stress reactions
vary for each individual; therefore, you have to learn how to recognize
your personal stress signals. In attempting to be more aware of your
stress signals, you have to watch very closely for your own personal
stressors. You have to become personally aware of your internal stress
"gauge" (i.e., your personal knowledge of how good you are feeling -
see Exhibit16.7) which, if known, can serve as a barometer for you to
Exhibit 16.7: Your internal stress
gauge recognize important information. For example, when you are under
stress you should be able to answer the following questions:
K How much stress are you experiencing?

K What kind of stress (e.g., underload, overload) are you experiencing?
K Are you using negative strategies in coping with stress?
K How effectively are you are using positive coping skills and strategies?
Exercise 16.2 - Identifying Stress Signals (See Appendix at back of the book)
Although stress signals vary in kind and intensity from person to person, these signals usually
fall under four categories (i.e., behavioral, cognitive, emotional and physical) discussed before. These
categories are shown in Exercise 16.2 in the Appendix. Go through the list and check off [T]those
stress symptoms that you experience in the last six (6) months. SE = symptoms you experienced; SC =
symptoms that are of concern to you; SA = symptoms that you are currently addressing; and SS =
symptoms that you have stopped through your actions and/or with the help of others.
Step #3: M - Managing Your Stress Using Selected Strategies
There are several ways you can choose to deal with your stress. The method you choose,
however, should be effective in preventing and/or containing bad stress or distress. To this end, the
information presented in this section is very important for the specific stress management strategy (or
strategies) you choose to adopt. These strategies are discussed in Chapters 17 through 21.
When choosing specific strategies to manage stress, it is first of all very important to know that
these strategies are as varied as the stressors themselves that were responsible for our experiencing
stress in the first place. But apart from this fact, there are four other equally important factors that you
must realize when managing your stress:
K In stress management, there is “no one size shoe that fits all.” This means that there is no one
method that enjoys universal success. Instead, success normally comes with the person using a
combination of approaches.
K Because of the variability associated with both the stressor and the person involved, what
works for one person may not necessarily work for another.
K Relating to the variability involved, because stress can be either good (positive) or bad
(negative), the conditions that give rise to stress differ from person to person, which in turn lead
to different needs in addressing each emergent stressful experience.
K Because stress can lead to illness, as well as a variety of potential health conditions, it is
always advisable that persons check with their physicians before, during, and after their
involvement with selected stress management strategies, especially those (e.g., exercising) that
affect their cardiovascular systems.
In order to present a straight forward and practical discussion of the facts, this section is broken down
into two main subsections:
K Strategies For Managing Stress: Your Personal Plan of Action (PPOA

K The Inter-Relationship of the Stress
Management Strategies
Strategies For Managing Stress: Your

Personal Plan of Action (PPOA)
At the beginning of the book it was
said that stress is not caused by the
environment outside ourselves; instead, stress
is a result of the reaction or meaning we assign
to what happens to us because of this outer
environment. These occurrences make stress a
very individual matter and, as such, it varies
from person to person. Therefore, what is
stressful for one person may be excitement for
another. Given these and other facts, it was
suggested that for stress management to be
effective, we have to have a thorough
understanding of the entire stress process from
onset, reaction, up through the last stage - Exhibit 16.8: Five strategies for effective stress
effect (see Exhibit 3.2). management
Having discussed important stages and
factors associated with the stress process up to this point, this section of the book emphasizes the need
for you to adopt a Personal Plan of Action or PPOA, which includes various stress management
techniques (see Exhibit 16.8 for how these techniques are categorized under five strategies).
In essence, your PPOA reflects your particular needs, resources and systematic use of these
stress management techniques, all of which are important in your efforts to manage stress effectively.
Not all stress management strategies will work equally well for all persons. Therefore, as you read and
understand the specific techniques discussed under the five strategy areas, you should select those that
you think will work best for you. Your decision should be made with a keen awareness of the resources
(e.g., physical and mental) available at your disposal. The techniques you select will constitute an
important part of your overall PPOA.
Although subsequent chapters will discuss each of these stress management strategies, before
this is done it is important to have a brief discussion concerning the relationship between the potential
stressors discussed before, and these five stress management strategies.
The Relationship Between Stress Management Strategies and Stressors

In order to maintain continuity between Part II of the book that discusses stressors and Part IV of the
book that discusses stress
management strategies, it is
important to attempt to establish
the relationship between both
sections (see Exhibit 16.9). Once
this is accomplished, the ensuing
discussion becomes clearer
because a connection is made
between sources of stress, or
stressors, and the means used to
manage stress (or the strategies),
if and when the individual
experiences stress.
The relationships that are
pointed out between the stress
management strategies and
stressors are not the only
relationships that can, and do,
Exhibit 16.9: The relationship of stress management strategies to stressors exist. Depending on the person
involved, as well as the existing
circumstances, there may be other directional paths between stress management strategies and stressors
not illustrated in Exhibit 16.9. In short, the relationships illustrated are suggestive, and they are
reasoned to be the most likely and logical to occur. However, under different circumstances, other
relationships may occur as well. Another point to be made is that, again depending on the
circumstances, that many of these simple or complex relationships sometimes occur simultaneously.
The relationships seen in Exhibit 16.9 are important to note. First of all, although the directional
arrows from the five stress management strategies to the five stressors are one-way, directional arrows, a
case could easily be made to explore reciprocal, or two-way relationships, as well. Another noted
feature is that all stress management strategies impact, with few exceptions, all of the stressor categories
(see large single arrow between stress management strategies and stressors in Exhibit 16.9). However,
in the case of personality stressors, which were discussed as the main stressors under which all other
stressors are subsumed (see Chapter 6, Exhibit 6.2), there is an effort made in Exhibit 16.9 to direct
separate arrows from all five stress management strategies to this pivotal stressor. The reason being that
if you are able to manage your personality stressors, based on discussion presented in this book, you will
then be in a better position to manage the other remaining five stressors, all of which are subsumed
under personality stressors. An additional point illustrated in Exhibit 16.9, is the bold arrow running
from cognitive restructuring strategies to personality stressors. As will later be discussed, alike
personality stressors, cognitive restructuring strategies are the more pivotal, or “umbrella-like”
strategies, under which the other four strategies fall, hence its connecting importance in Exhibit 16.9.
The Inter-Relationship of the Stress Management Strategies

Apart from simply listing the five stress management strategies that one can use to control
his/her stress, it is important to show the relationship of each strategy to the other. As seen in Exhibit
16.10, the dominant strategy (i.e.,
the one that encompasses all the
other strategies, is cognitive
restructuring, where we have to
change how we think and
perceive (and subsequently, react
to things) on a daily basis. If you
recall form Chapter 5 (see
Exhibits 5.4 and 5.5), where the
discussion surrounded the six
stressors, that personality
stressors are the dominant
stressors. Additionally, like
cognitive restructuring strategies,
they subsumed all the other five
stressors.
At the inner portion of
the circle is the connecting
psychosocial restructuring
strategy. There is a similarity
with the connecting psychosocial
stressor discussed in Chapter 5
(see Exhibit 5.4) and in Chapter 8
(see Exhibit 8.2). Psychosocial Exhibit 16.10: The primary and relative importance of the five stress
restructuring strategies, which are management strategies
basically techniques we use to
facilitate how we interact with people around us, are the linking interactive techniques between how we
think and perceive (i.e., cognitive restructuring strategies) that influence the other three strategies (i.e.,
lifestyle adjustments, situational adjustments and relaxation experiences). In summary, think of the
variety of psychosocial restructuring activities as the links between how we think and perceive (i.e., our
cognitive experiences) and what we do in the external world. It is also important to note in Exhibit
16.10 that, although strategies can be independent, it is more practical and constructive to see them on a
continuum from a more loose form of connected strategies to a much closer inter-connected form (see
Exhibit 16.11).
From a theoretical point of view, again as illustrated in Exhibit 16.11, when all of the five
strategies are completely inter-locked the stress tiger, which represents the variety of stressors we are
likely to experience, is fully controlled and contained. It is important to note that at this point the tiger
is not ferocious and snarling (as
was the case in illustrations seen in
earlier chapters). Instead, because
the tiger is contained, it is resting in
a peaceful manner. This fact
concerning the tiger is underscored
by placing, the now placid and non-
threatening tiger, at the core or
center where all stress management
strategies (or circles) intersect
(again, see Exhibit 16.11).
What is evident from
Exhibit 16.11 are two factors: i) all
four strategies, including,
psychosocial restructuring
strategies, are fully under the lead
cognitive restructuring strategy and
ii) all three strategies (i.e., lifestyle
adjustments, situational adjustments
and relaxation experiences are fully
interlocked through the linked
efforts of the psychosocial
restructuring strategies. As
Exhibit 16.11: The ultimate and desirable interlocking relationship of the five mentioned before, this is the best
stress management strategies possible experience to have where,
at least from a theoretical point of
view, the complementary strengths of all the five stress management strategies are at their maximum
effectiveness. When these maximum complementary strengths are experienced, we are in the best
possible position to control stress and, therefore, the stress tiger is fully contained. In short, the tiger is
no longer the fearful and ferocious beast he once was for us. In subsequent chapters, a more detailed
discussion is presented for each of the five stress management strategies.
Summary Outline of Key Headings in The Chapter
The Dynamics of Stress Management
O Stress Management is Really About Having a Balance (p.173)
O The Importance of Change For Stress Management (p.173)
O Required Skills For Stress Management (p.175)

9 Awareness Skills (p.175)
9 Acceptance Skills (p.176)
9 Coping Skills (p.176)
9 Action Skills (p.177)
O The Importance of the I-R-M Approach to Stress Management (p.177)
O Step #1: I - Identifying Your Stressors (p.177)
N Exercise 16.1 - Stress Diary (See Appendix at back of the book)
O Step #2: R - recognizing Your Stress Signals (p.178)
N Exercise 16.2 - Identifying Stress Signals (See Appendix at back of the

book)
O Step #3: M - Managing Your Stress Using Selected Strategies (p.179)

9 Strategies For Managing Stress: Your Personal Plan of Action (PPOA)
(p.179)
9 The Relationship Between Stress Management Strategies and
Stressors (p.180)
9 The Inter-Relationship of the Stress Management Strategies (p.181)
__________________________________________________________________________________
17.
Cognitive Restructuring
ë
“He who cannot change the very fabric of his thought will never be able
to change reality.”
- Anwar Sadat
C
ognitive restructuring is perhaps the most pivotal and important stress management strategy that
can be used. It is the most dominant and influential strategy that subsumes all of the other
strategies. Why is this so? The reason is simple! When we reconstruct or reconfigure how we
think, we are, in essence, changing our perception. It is our perception that determines how we see,
interact with, and react to events in our world, or basically,
all of our experiences (see Exhibit 17.1).
What is Cognitive Restructuring?

The skills that are very important to have in
cognitive restructuring are outlook skills. “With these skills
you place an emphasis on a positive view of life rather than
a negative view of life.” If you recall the discussion from
Chapter 3, you will remember that it is our perception (or
our beliefs) that determines if we experience stress or not.
Literally, a person has to perceive a situation or event as
stressful or threatening in order to experience stress.
Therefore, in changing how we think, we in turn change our
perception, which in turn influences how we view and,
ultimately, respond to potential stressors or events around
Exhibit 17.1: Your perceptions determine your life
us. experiences.
To a large extent, the amount of stress experienced
by individuals depends on what information they absorb and block; how the information is perceived,
and evaluated, and given meaning; and what effect this whole process has on their mental and physical
activities. While our attitudes are very much related to the meaning and value we attribute to our life
experiences, it is our personalities that determine what attitudes we have and how they are manifested.
This point is very important because in Chapter 6 a discussion was presented on the primary importance
of personality stressors and how they are derived from individuals’ personality dispositions. Therefore,
individuals may alter stress-causing attitudes by learning how these attitudes are formed and then
working to change that process through cognitive restructuring.
Apart from what is said above, from a more theoretical sense, cognitive restructuring is
basically a technique used initially by (clinical) psychologists and counselors. Cognitive restructuring
suggests that stressful situations do not cause our feelings and physiological responses as much as the
way we choose to think about these situations (Hafen et al., 1996). Furthermore, it involves learning to
identify your negative thoughts and other inappropriate cognitions or ways of thinking, for example,
overgeneralizing, “thinking all-or-none,”seeing the smaller picture versus the bigger picture, getting
caught up only with the “here-and-now” in addition to the “then-and-there,” etc.
183
To correct, or restructure your “faulty”cognitions, then, you have to learn to identify them at
first and, where, necessary, substitute them with more appropriate, positive and/or realistic thoughts.
After several practices, you will eventually learn to catch yourself before the negative thought
actualizes itself, thereby, over time, leading to your having more positive and rewarding life
experiences.
Reframing
Another way in which cognitive restructuring has been addressed, albeit in a more limited
manner, involves the concept called “reframing.” Basically, reframing is a technique used to change
how we look at things in order that we may feel better about them. The key to reframing is to
recognize that there are various ways to perceive and interpret the same situation. In other words, the
same situation can have two different perspectives and, hence, two different reactions. How would you
respond to the following question: Is the glass half empty or is the glass half full? Again, both answers
are correct, but how you responded suggests how you perceived the water in the glass in the first place.
Another more elaborate example of reframing or cognitive restructuring follows.
The message is clear that to manage our perceptions we have to change our attitudes, which in
turn influence how we perceive and respond to events and other life experiences. In short, the stressors
we experience are a result of how we “horriblize” and “awfulize” the perceived events around us.
Therefore, to prevent us from experiencing stress over time, we then have to consciously engage in
ways to alter or reconstruct our cognitions or attitudes. The remaining portion of this chapter is spent
discussing several ways in which this can be accomplished.
The E-P-R Model of Stress
You may recall in Chapter 3, (see Exhibits 3.3 and 3.4), that mention was made of three factors
involved in the stress process: event, perception and response. This is very similar to the ABC Model,
where
E = Events or stressors, E+P=R

P = Perception or appraisals, and
R = Response or outcomes
In terms of stress management, especially cognitive restructuring, because P plays the pivotal role in
the stress process, the need exists to know as much about B, e.g., beliefs, attitudes, so that they can be
“restructured,” or changed, therefore reducing the likelihood of stress being experienced.
Restructuring Your Perceptions

To change your perceptions and, therefore, reduce your stress, you have to realize how
perception works. You perceive situations as stressful based on your (see Exhibit 3.4):
K Values (e.g., things that you see as important);

K Resources (e.g., things that help you cope more positively with difficulties, such as
finances, availability and reliability of family, education, jobs);
K Track record or past experiences (e.g., how you handled a crisis or stressful situations
in the past);
Chapter 17 . Cognitive Restructuring 185
K Feelings of control (e.g., the knowledge that you can control the outcome of the
situation in any way); and
K Personality types (e.g., you do not have confidence in yourself, you have difficulty
delegating responsibilities to others, and you are always in a hurry to get things
accomplished - see Chapters 5 and 6).
Therefore, in order to mange your stress, you have to change or restructure how you perceive events or
stressors. For this process to be effective, you have to first assess your values, available resources,
past experiences with similar stressors, your personality disposition(s), etc. All these prerequisite
conditions further underscore the subjective nature of stress and, therefore, your ability to manage it
using selected strategies..
The Knowledge-Perception Relationship and Stressors

After you have identified a stressor, you should try to understand all you can about it. One way
to achieve this end is for you to determine the answer to five very important questions. A short
discussion follows concerning issues relating to each of these five questions. After the discussion, you
are given the opportunity respond to all five questions as they appear on an Evaluation Report (i.e.,
Exercise 17.1).
ÿ What is it About the "Event" That Really Upsets You?

This is the first and very basic question to ask yourself (see Exhibit 17.2). Only until you know
what it is about a stressor that is upsetting for you can you begin to do something about it. EXAMPLE:
While a stalled traffic light that caused you to be late for school may appear to be the stressor, what
really bothers you is the actual embarrassment you experience from
going to school (classes) late. Other possible stressors may be your
fear of discontent from your teacher, or even the possibility of being
marked absent for the day.
In another EXAMPLE, you are sitting by your desk in the
dorm and really feeling angry, but you don't know why. Suddenly, and
after some careful thinking, you realize that it is your roommate,
through his constant arguments with you in the immediate past who is
mainly responsible for your being angry. Therefore, he is the source
of your stress or stressor. With these possibilities in mind, you should,
in any given situation, then, attempt to analyze your own thoughts.
You should try to answer the question of: What is really responsible
for bothering you? Until you have satisfactorily answered this ques- Exhibit 17.2: Understanding your
tion you will not be in any position to take steps to address the stressors
unexplained feelings you are having.
Ÿ Is the Stressor Really Worth Getting All "Stirred" Up About?

In attempting to answer this question, you should determine what difference, if any, will the
stressor make, now or in the future, regarding your goals or objectives. Obviously, if the stressor will
have a "sizeable" impact on your ability to accomplish your goals, all of your energies should be
directed to coping more successfully with the stressor(s).
EXAMPLE: You are a sophomore at college and you have been commuting to school for the last two
years. However, the demands of commuting to school have become over burdensome for you (stressor
= overload). You are always late for classes, thereby missing quizzes and exams, and your grades are
declining. As a result of your main goals (i.e., getting good grades) being threatened, you decide to
move closer to school by getting dormitory housing close to campus.
As seen in Exhibit 17.3, moving closer to the

university involved your ability to now bicycle to
school and not having to drive or take shuttle buses,
etc. This compromise to reduce your stress involved
restructuring how you thought, as well as initiating
needed action. Both of these factors were within
your control and you exercised the appropriate
options, thereby reducing your stress.
⁄ Can the Stressor Be Avoided?

Sometimes your answer will be yes because
you can discover stressors that can be avoided.
Better still, sometimes you are carrying around a Exhibit 17.3: Knowing about your stressors and reducing
bunch of useless stressors, some or all of which can them by taking appropriate actions
be avoided without any major sacrifice to yourself.
EXAMPLE: You have an old car that breaks down constantly even after it has just been repaired. The
car would appear to be an unnecessary stressor given that you don’t really need a car to go to school.
You live on campus and you also work close by in walking distance from the campus. Selling the old
car with the problems would seem to be the most practical way of getting rid of an unnecessary
stressor.
Depending on the circumstances, you may not be able to avoid a stressor, hence your answer
will be no. If your answer is no, explain the reason(s) why a particular stressor that you have identified
cannot be avoided. Again, space is provided for your response on Exercise 17.1.
€ If The Stressor Cannot Be Changed, Are There Any Alternatives To It?

Before you answer this question, ponder on the following points. In many cases there are
different methods to use in acquiring what we want. In giving your answer: (a) think creatively and list
as many behavioral alternatives as you can imagine, and (b) evaluate the best possible alternative(s)
from your list. Whatever your choice of an alternative, it is only effective if it allows you to have the
following accomplishments:
K Meeting your goals;

K Minimizing the sacrifices to be made on your part;
K Not increasing the number of stressors you encounter (i.e., you are simply not trading one
set of stressors for another); and
K Ultimately reducing your stress.
In summary, you should evaluate your alternatives to existing stressors in terms of their stress-
reducing and goal attainment capabilities (see Exhibit 17.4).
EXAMPLE: Referring to the example mentioned

earlier, if moving to the dormitory housing closer
to the university is creating more stress for you
(e.g., noise of other students, less privacy, sharing
of bathrooms), the alternative of move has to be
questioned. However, if on an overall basis you
are still better off being in the dorm, versus where
you were before, then the dorm is a better
alternative. Simply put, this alternative helps to
reduce your stress!
Exhibit 17.4: Choosing the best alternative to a stressor
What follows is Exercise 17.1. It requires that you complete an Evaluation Report on the stressors
that you feel have affected you in the past six months.
Exercise 17.1: Evaluation Report
Œ Describe the stressor(s) you identified before.

Exercise 17.1: Evaluation Report (Continued...)
œ What upsets you about the stressor(s)?
– Can you avoid this stressor? 9 YES 9 NO
If you answered YES, stop right here and begin to avoid the stressor as soon as possible.
If you answered NO, go to the next question (#iv).
— Why can’t the stressor be avoided? Simply list the reasons, including the goals that the
stressor helps you achieve.
“ Describe some possible alternative behaviors to the stressor.
” Evaluate each alternative described. See which one best allows you to accomplish the
following:
(a) Meet your goals:
(b) Helps you to reduce your stress:
‘ Given your responses in Question ”, what is the best possible alternative to the stressor?
’ Attempt to implement the best possible alternative to the stressor that you selected. Keep
in mind that you may still be able to improve upon this alternative as more information
becomes available to you.
‹ Is the Stressor Controllable?

Depending on the degree of control you have over stressors, they can be subdivided into two
categories: controllable and uncontrollable stressors.
Controllable Stressors are the stressors over which you have some,
if not all, control. Often it is your perception of these stressors that
allows you to have some regulation or control over them. In short, by
being able to do something about these kinds of stressors (e.g.,
watching what you eat in college to offset putting on weight - see
Exhibit 17.5), you can protect yourself from their potential negative
effects.
Uncontrollable Stressors are the stressors that you have virtually no

ability to control. The nature of these stressors, i.e., their
uncontrollability, makes them potentially dangerous to your health,
especially if you perceive them as a problem. Therefore, because in
many cases you cannot stop these stressors from occurring (e.g., you
Exhibit 17.5: Controllable stressors and
experience unexpected traffic problems on the road - see Exhibit non-controllable stressors
17.6) circumstances, you are forced to take appropriate actions so
that they do not pose a problem for you (e.g., taking an alternate route to avoid the traffic problems on
the road).
In order to be clear about which of your stressors are controllable or uncontrollable, Exercise
17.2 is provided. In completing Exercise 17.2, you must go back to the stressors you previously
identified that were bothering you (see Exercise 16.1 seen in the Appendix). If you think about any
additional stressors (i.e., that you did not write down initially), include them in the appropriate columns
along with the ones you identified previously. As Exercise 17.2 indicates, the two columns of choice
deal with uncontrollable or controllable stressors. Use your answers given to the following questions
as a guide in placing the stressor in the appropriate column.
K Is this problem my responsibility?
K How much control do I have over this
stressor?
Exhibit 17.6: Inappropriate action based on faulty perception

of external event or stressor
Please Note!
If during the exercise you find it difficult in providing answers to these questions regarding
your stressors, you may consider these particular stressors as being uncontrollable in nature. Some
examples are given at the beginning of the exercise to help stimulate your responses.
Exercise 17.2: Identifying Your Uncontrollable and Controllable Stressors
Uncontrollable Stressors Controllable Stressors

- Being late for classes because the shuttle bus was not on time. - Poor grades at college due to lack of studying.
- Your examination was cancelled because of a snow storm. - Choice of classes by registering early in the designated period.
Exercise 17.2: Identifying Your Uncontrollable and Controllable Stressors (Continued...)

Assess Your Self-Perceptions
Since it is your perceptions (see Exhibit 17.7) that allow you

to be open to a variety of stressors, which can be hazardous to your
health, a first and logical step in managing stress is to make a careful
review of how you view yourself. You should ask yourself the
following questions:
KAre your views mainly positive or negative?

KDo you have an inflated view of yourself, which may be a
cover-up for underlying deep-seated negative feelings?
KDo you tend to be "over critical" of yourself?
If you answer yes to any or all of these questions, you may be prone
to experience your life experiences as stressors. If you are overly
critical of yourself, it is very likely that no matter what you do, at Exhibit 17.7: Have self-perception
checks and balances
home, work or on the playing field, you will think that it was not
good enough. Such firmly held feelings of, for example, self-inadequacy, can be stress-producing in the
future.
Clarify Your Goals and Related Activities
Spend some time asking yourself what goals you would like to achieve and what periods of
time you are setting for yourself to attain and make decisions regarding these goals (see Exhibit 17.8).
Think about the things that are pleasurable and painful,
and the things that allow you to laugh and cry. Think
about the things that you would go just about all out for,
and others that are not worth the effort. If need be, write
these goals and associated feelings down so you can be
sure of them. Clarifying your goals and identifying which
ones are the most important for you will influence your
perception of other potential stressors (i.e., competing
goals).
Set Realistic Goals
Setting realistic goals is a very important

strategy. Failing to use this strategy successfully can
result in your experiencing unwanted amounts of stress.
Related to the previous strategy is the idea that you
Exhibit 17.8: Clarifying priority goals to accomplish
should try to accomplish your stated goals within the time
available and the resources you have at your disposal. In short, know the extent of your capabilities and
recognize and accept them for what they mean. Don't feel pressured by others to engage in activities
beyond your defined capability levels (see Exhibit 17.9).
EXAMPLE: Don't aspire to run five miles a day when you know, because of medical and other reasons,
that goal is virtually impossible to achieve. Don’t take twenty-one credits a semester when you are
working full-time and your grade point average is relatively low.
Realistic goals, then, are more manageable, because they are more under your control. When
goals are set that are not under your control, for example, waiting for your boss
to treat you differently, your frustration is likely to increase. In addition, when
you have identified realistic goals, it is important to differentiate them from
results. Success or happiness is a result not a goal. Your goal, then, should be
the specific steps you must take to be happy and successful.
As you attempt to achieve your goals, you may undoubtedly
experience various barriers or obstacles in your path, some of which may not
have been anticipated. These barriers may be in the form of the need for more
resources (e.g., money, information and skills). Whatever the barrier may be,
seek out and obtain as much support as you can get from important people in
your life, such as family, friends and co-workers. The value of such support is
very important in reducing or preventing the host of potential stressors that can
Exhibit 17.9: Setting
arise as you pursue your defined goals.
“realistic” goals
Another approach you can use after setting realistic goals and also
having an overall life goal plan (see Exhibit 17.10) is to further increase the manageability of your
goals. Begin with small goals
and gradually more up to larger
goals. Your first step should
involve small and easily
attainable goals. As always,
remember that the smaller
goals, as well as the more
larger ones, should all be
consistent with your overall
major life goal.
The success you achieve
with these smaller goals will
increase your confidence and,
therefore, you can build the
momentum towards achieving
Exhibit 17.10: Making goals more manageable by dividing them in priority groups larger desired goals. One way
from small to large. to accomplish this task is to
classify and divide each of your goals into step-like categories, each leading to the next, where each
should be estimated to be reached within a projected amount of time. In planning and carrying out
these activities, you should be forever reminded that, like everyone else, there are limits to your
capacity and, therefore, you should work within these limits.
Sort Out Your Priorities
As an individual, you may want personally to accomplish several long-term and short-term
goals. Not only must you be aware of these goals and establish their
order of priority, but you must also appreciate the necessary tasks or
steps you will need to satisfactorily to accomplish these goals. Given
that it is usually difficult to accomplish all these activities all at once,
you may lack the necessary "resources" (e.g., money, time, energy,
support). Therefore, given these possibilities, the importance of
prioritizing your needs become even more important (see Exhibit
17.11).
Your needs can be broken down essentially into a “To Do
List” consisting of three priority areas:
“A” activities that are essential and need immediate action;
“B” activities that are essential but can be postponed for a
later time; and Exhibit 17.11: Making needed
“C” activities that are not essential but would be nice to priority decisions on a “to-do-
list”
accomplish some time in the future.
In a related manner, you also need to provide answers to the following questions: 1) Who will
be involved in these activities (e.g., tasks)? 2) Where must these activities be conducted? 3) How
much time will the activities require? 4) What prerequisites are necessary for the successful
completion of your designated activities?
Accept What You Cannot Change and/or Control
Sometimes events in your life are beyond your control to change, e.g., missing a flight (see
Exhibit 17.12). One important reason why some events cannot be changed is because they are
uncontrollable by nature. Concern yourself with the things
you can control, not the issues or events that are out of your
hands.
EXAMPLE: You just missed your connecting flight because of
an elderly passenger who was in the line before you. This means
that you will be late in getting back to college and, therefore,
miss your midterm examination the following day. As there is
nothing you can do about the flight being missed, think about
what you can do which is within your control. For example, send
your professor an e-mail explaining the situation and requesting
a make-up examination.
Exhibit 17.12: Accepting events beyond your

control
Think “Could” Not “Should”
Try to avoid feelings that suggest that you "should do this" and "should do that" associated
with goals and daily activities (see Exhibit 17.13). EXAMPLE: "I should exercise more regularly" or
"I should stop eating so much fattening foods." Thinking this
way takes much of the pleasure from an activity and turns it
into a chore or something unpleasant. Therefore, think in
terms of what you could do and, for that matter, want to do.
EXAMPLE: "I could exercise more regularly" or "I could
stop eating so much fattening foods." Sometimes the only
difference between a pleasant task and an unpleasant one is
the manner in which you approach it.
You should invest more energy in goals which are
"wants" (EXAMPLE: "I want to get a new car.") than in Exhibit 17.13: How you think about your goals
goals which are "shoulds" (EXAMPLE: "I should get a new makes a difference in how and when they are
car") or goals which are "ought tos" (EXAMPLE: "I ought to accomplished.
get a new car."). When goals are expressed in terms of wants,
working toward them can be a challenge. However, when goals are "shoulds" or "ought tos," we are
more likely to experience pressure to achieve them. Challenge is positive stress (or eustress) and
pressure, in this case, is negative stress (or distress).
Refrain From Having Distorted and Negative Thinking
Distorted and negative thoughts can be stress-producing (see Exhibit 17.14). Therefore, you
should try staying away from them as best you can. Remember the following two important rules: 1)
Don’t be your worse enemy and 2) You don’t have to be your worst enemy. One way of not becoming
your worst enemy is to become aware of the negative self-thoughts you either have had and/or are
currently having. This being the case, in an attempt to manage your stress by overcoming negative
self-thinking, you should do the following:
K Don’t put yourself down;

K Try not to be too much of a self-critic, even if you
make a mistake, take it in stride and realize that
most people do make mistakes ever so often; and
K Don’t doubt your abilities and expect to succeed,
not fail, in your daily and future activities and goals.
In essence, believe in yourself and your abilities.
Exhibit 17.14: Reduce negative self-talkNegative thinking is the opposite of optimism. Basically, it
has the potential to destroy confidence, interfere with your
performance, and slow down your mental skills. In Chapter 6 negative thinking was referred to as a
personality stressor.
Engage in Positive Thinking and Expressions - Affirmations

One of the best ways to create change is by using affirmations. An affirmation is just another
form of self-talk. Based on what Susan Jeffers had to say in her book Feel the Fear and Do It Anyway,
“an affirmation is a positive statement that something is already happening.” Affirmations are simple
statements that you say to yourself over and over again. Basically, through constant repetition, your
subconscious mind picks up the message and you start taking action to create change. It's a way of
changing behavior to achieve your goal. Therefore, affirmations create positive thinking versus
negative thinking, which in turn leads to greater change.
In their book entitled “Career Success/Personal Stress - How To Stay Healthy in a High-Stress
Environment,” Christine Leatz and Mark Stolar said: “The idea behind affirmations is to develop ones
for yourself that talk about the changes you want to make in your life, and to talk about them as
happening right now.”(p. 197) They went on to say that affirmations should always be stated in the
present and they provided the following examples:
: Incorrect: I will start to exercise regularly to make my body strong.
T Correct: I am exercising regularly to make my body strong.
Also, affirmations should be stated in the positive, such as:
: Incorrect: I look better than I have in the past.
T Correct: I look great!
Some examples of affirmations were also provided.
L I am achieving a balanced life.

L I am finding the perfect job for me.
L I am achieving what I want in life, easily and effortlessly.
L I am filling my life with peace and joy.
L I am creating a healthy body through diet and exercise.
L I am creating a more relaxing atmosphere at home and school.
L My word is filled with love and abundance.
For affirmations to be successful they must be relatively short, not awkward and not difficult to
remember. If your affirmations do not meet these criteria they will not be beneficial for you. You may
wonder what happened and say the affirmations didn't work, or, basically, they do not have any power.
Well, they didn't -- simply because they were the wrong affirmations based on how they were worded
and/or expressed. However, if you have “right” affirmation, you should repeat them at least once or
twice a day and also reflect on the meanings for you as a person.
Positive thinking versus negative thinking is not just a philosophy, but a practice, i.e.,
something you have to do everyday, over and over again. Therefore, affirmations are a great way to
start developing positive thinking. However, the use of affirmations should be viewed as only one
technique that you employ to complement your other skills and activities in your quest for more
positive ways of thinking. Apart from the more general affirmations mentioned before that deal more
with self-enhancement, other types involve topics that deal with scripture or religion. Religious themes
are some of the more popular affirmations that are used and like other affirmations you must choose
expressions that have particular meaning for you and recite them once or twice a day (or as often as
you feel) for them to bring about changes in how you think and, later, how you behave. It must also be
said that these and other affirmations can be used as screen savers on your personal computer, with
accompanying complementary background scenes and/or music.
Cognitive Restructuring
O What is Cognitive Restructuring? (p.183)

9 Reframing (p.184)
O The E-P-R Model of Stress (p.184)
9 Restructuring Your Perceptions (p.184)
O The Knowledge-Perception Relationship and Stressors (p.185)

N Exercise 17.1: Evaluation Report (p.187)
N Exercise 17.2: Identify Your Uncontrollable and Controllable
Stressors (p.192)
O Assess Your Self-Perceptions (p.194)
O Clarify Your Goals and Related Activities (p.194)
O Set Realistic Goals (p.194)
O Sort Out Your Priorities (p.196)
O Accept What You Cannot Change and/or Control (p.196)
O Think “Could” Not “Should” (p.197)
O Refrain From Having Distorted and Negative Thinking (p.197)
O Engage in Positive Thinking and Expressions - Affirmations (p.198)

___________________________________________________________________________________________
18.
Psychosocial Adjustments
ë
“No medicine is more valuable, none more efficacious, none better suited to the cure
of all our temporal ills than a friend to whom we may turn for consolation in time of
trouble, and with whom we may share our happiness in time of joy.”
- Saint Ailred of Rievaulx
P
sychosocial restructuring involves changes. However, just like in cognitive restructuring, the
change on your part is how you interact with others, as well as how you react to conditions in your
environment. Whereas psychosocial stressors, which were discussed in Chapter 8, deal with
potential stressful experiences derived from your interacting experiences, psychosocial adjustments
involve changing or modifying your interactions and reactions that led you to these negative outcome
experiences in the first place.
Strategies under this section have to do with
your actions, both toward yourself and others. The
emphasis here, however, is the "quality" and
"quantity" of the interactions you have with others,
especially those people who have the real or imagined
potential to contribute a "buffer" or protection for the
various daily life stressors you are likely to
experience. The interaction you have with these
people may be on a one-to-one basis or through some
kind of organizational structure (e.g., in the
classroom, in the counseling office - see Exhibit Exhibit 18.1: Establish a good working relationship
18.1). with those around you, e.g., your academic advisor
Remember to Laugh a Bit

Throughout your life laughter or humor can be beneficial for you (see Exhibit 18.2). Try not to
use laughter only as a last resort when everything else fails. In a more preventive sense, try to
incorporate laughter in the interactions you have with others on a daily
basis. Specifically, laughter can be beneficial to you given its potential
to reduce anxiety, frustration, tension and/or anger you may have as a
result of interacting with other people.
Evidence suggests that laughter may protect you from the potential
ravages of negative stress simply by activating the release of certain
"natural" painkillers (e.g., endorphins) in the body. Also, laughter can
be potentially relaxing if it helps in reducing "pent up" anxiety and
energy within your body. Therefore, when meeting people or interacting
with them, you should laugh whenever the situation warrants it.
Laughter oxygenates the blood, increases energy level, relaxes muscles

and exercises all major cardiovascular and respiratory systems ( Boucher,
2002).
Exhibit 18.2: Laughing is healthy
201
Talk Things Out and Share Your Stress
When something is bothering you, talk it out with a supportive and trustworthy person (see
Exhibit 18.3). Research suggests that it is better to share your
troubles with others. In short, having social support from
others is a very important buffer or protector against stress.
By simply explaining and discussing the problem with
someone, you actually define it for yourself and, at the same
time, you are very likely to rid yourself of "pent-up" feelings
associated with the problem. This interaction might even
allow you to see a solution to the problem itself. If you feel
your problem requires professional help, seek out the
services of a psychiatrist, psychologist or counselor at the
university. Knowing when to ask for help can help prevent
more serious problems later down the road. Exhibit18.3: Having someone trustworthy to
talk to is very important
Lean On a Friendly Shoulder
This strategy is very much related to the previously mentioned strategy of "talking it out" with
someone. When you have the feeling that you are loved and cared for by your family, relatives, friends,
and co-workers, this certainly helps in protecting you from the potential negative effects of stress.
As buffering or protecting agents, these people literally can absorb, protect and reduce the
stressful outcomes of your daily life experiences. Although
varied, their support can be in the form of financial and/or
emotional contributions to you. Your interaction with these
people can be on a one-to-one basis (see Exhibit18.4)as well
as through your association with groups in an organizational
setting (e.g., Campus Pals, Liberal Arts Students Council). A
very important way, however, is simply to have a very good
friend with whom you can speak with concerning issues that
are troubling you. In summary, then, you should surround
yourself with people whom you think will be available when
you need them, especially "when the going gets tough."
Exhibit 18.4: Having a friendly shoulder to lean

on is very important
You Don’t Have to be Right All the Time

As you interact with people everyday there are times when there will be disagreements. These
disagreements can be stressful, especially when other people don’t want to see or do things your way.
In order to reduce your stress you may consider trying cooperation instead of confrontation.
Cooperation is less psychologically “taxing” for you and it can, in some cases, be better than being
“right” all the time. Basically, a little give and take by both parties involved can reduce the stress and
make you feel more comfortable in the long run.
Chapter 18 . Psychosocial Adjustments 203
Spend Needed Time With Family and Have Fun
If you have a family, especially one that you think can give you the love, affection, and support
referred to above, then you should try to spend some
"quality" time or a defined period of “productive” time with
them. You cannot and should not expect that if you work
twenty hours a day you can still maintain the desired
relationship with your family. Not being able to devote
sufficient time to families, especially when pursuing an
education, is often a very important stressor experienced by
students. Therefore, designate times and places (e.g.,
picnics during summer breaks, Thanksgiving dinners) that
will involve the entire family (see Exhibit 18.5).
Try to find “balance” between the demands of
your education and the demands of your family. Keep
reminding yourself of the possible consequences of Exhibit18.5: The importance of spending time
inattention to your family. Even if you have a successful with family members
college experience with all the associated benefits, no
family member may be around to share your "success." Such a lost, could be a stressor in itself and
serve to escalate an already emotional, burden-some, and stressful situation.
As you schedule time with family (or friends) your must concentrate on having some fun at the
same time. Having some fun can be just as important to your well-being. Occasionally, you need to
take a break from your school work and other routines to just relax and have some well-deserved fun,
e.g., going to the movies and/or bowling with friends.
Be a Participant in On-Going Activities and Help Others in Need
In Chapter 5 it was mentioned that stress can result from overload as well as underload. You
may recall that in the case of underload, stress occurs when resources exceed demands, in short, when
you are bored. The opposite occurs in the case of overload. If you are feeling bored or “underutilized,”
simply get involved in various social activities and become a participant, e.g., a
volunteer for selected campus and/or
community organizations, or a tutor for some
college project/activity - see Exhibits 18.6 and
18.7.
Help yourself by helping others. Not
only will you feel more wanted and productive
by becoming a participant, but you will feel
good about yourself for helping others.
Additional benefits include making new friends
and enjoying new activities as the same time.
Exhibit18.6: Get Volunteering any spare time you may have is a
involved in activities great way to help others and at the same time let
you feel good about yourself. Also, just being active in the presence
of others has the potential to reduce your stress because, if nothing
more, it allows you to take your mind off what is bothering you, at Exhibit 18.7:Get involved by
least for a period of time. volunteering your services to the
needy
Learn to Say “NO”
There are various reasons why people over commit themselves. In some cases, people think
that they can handle many activities only to later find out that they have
over extended themselves. In other cases, people would really like to
refrain from extra commit-ments, but they found it difficult to say no
when asked by others to take on some tasks (see Exhibit 18.8).
Generally speaking, don't try to be everything to everyone. If
you allow that to happen, other people will overwhelm you with their
demands. A common cause of stress is the feeling of over commitment.
You can avoid this feeling by simply saying - NO. Much stress is the
product of faulty expectations of us by others (and in some cases, by
ourselves).
EXAMPLE: You take on all the assignment requests When we
made for the group project by your group members. cannot live up
When this happens it takes you away from completing to these Exhibit 18.8: Saying “NO” to
your own work on time, and this can be stress-producing expectations of excessive demands
for you. others, stress
occurs. One solution to the problem is to
define yourself clearly to others. Try
communicating to others (e.g., at school) what you can and can’t do, essentially setting your limits.
Purposely avoiding a person because you find it difficult to say no can be even more stressful,
especially if you end up running into the person at a time when he or she is not expected. This can be
very embarrassing and stressful. Therefore, learn to say NO up front when it becomes necessary and it
will free your time for doing and accomplishing other important tasks. Things that will allow you to
feel more comfortable in saying NO include:
K a) Learning to estimate your own capabilities;
K b) Practicing saying NO in a polite yet firm manner; and
K c) Postponing making a decision agreeing to a request by others until you know the full
picture of what you are getting into (i.e., kind and duration of the task).
If the answer is to be NO, you then have some time to plan and practice how to refuse. You do
not have to explain your answer to people in all cases; however, those times that you feel compelled to
give an explanation, do so in as truthful and polite manner as you can. If you know of someone else
who can do the task, offer this information as well. All these activities make you feel less guilty for
saying NO.
Avoid Loneliness
Although feeling lonely at times is understandable, if these feelings are not checked they can
add to your stress (see Exhibit18.9). Sometimes you feel lonely because you have lost hope that things
will work out for you. If this is the case, you have to entertain the belief that things will eventually get
better. Without this “positive” thought, you will not have the necessary will and strength to cope with
your daily stressors. On the other hand, your loneliness may be a result of your view (i.e.,personality
stressor) that society promotes a dependence on external things (e.g., money, cars, drugs) and people.
In the case of people, therefore, some have come to accept the view that if they are not constantly
Chapter 18 . Psychosocial Adjustments 205
surrounded by others they are less than adequate. By becoming more of a “participant” in social
activities, we can overcome the feeling of loneliness (again, see Exhibit 18.6 and 18.7).
Perhaps a more lasting solution, however, is to become more
closer with yourself (i.e., come to know yourself better), thereby
realizing that you will never be truly lonely again. The truth of the
matter is that most people need and feel more comfortable around
other people. Studies also suggest
that people tend to have less stress
and better health when they interact
with and are part of a supportive
network of people they like.
Exhibit 18.9: Loneliness does not
have to be a way of life
Try To Improve Your Communication
Human beings are socially-oriented by nature and, as such,

the need to communicate is very strong. In fact, most of our wakeful
hours are spent in some interpersonal relationship where we are Exhibit 18.10: Improve your
communicating with others (see Exhibit 18.10). This being the case, communication with others
we should try to improve our communications with others, thereby
reducing any possible “problems” that might arise as a result of
“faulty” communications.
EXAMPLE: If your communication with others is too aggressive or hostile, you run the risk of
antagonizing or alienating them. On the other had, however, if your communication style is too passive,
others may take advantage of you. Either condition can be stressful for you. Therefore, a balance is needed
between these two extremes. If you have difficulty speaking up for yourself, you may need to have
assertiveness training where you are taught to express your needs without offending others.
Consider Getting a Pet

One of the most frequently heard expressions is that “A dog is a man’s best friend.” While this
statement is true, there are many other pets that can be of benefit to individuals, especially college
students, who traditionally do not have sufficient living space (e.g., in dormitories) to accommodate
large pets, such as dogs. This being the case, more practical pets for college students would be small
caged mammals (e.g., mice, gerbils) and fish (see Exhibit 18.11).
Research has demonstrated that pets have reduced the
amount of stress found in their owners. Pets are more common than
children in American households. Estimates suggest that there are
more than 51 million dogs, 56 million cats, 45 million birds, 75
million small mammals and reptiles and various amounts of
aquarium fish. Pets play a very important role in reducing the stress
people experience. Even though the underlying reasons are not
fully understood, research shows that pet owners visit the doctor
less often than individuals who do not own pets. Pets help to
stimulate socialization by providing a topic of conversation with
Exhibit 18.11: Choosing fish as pets others. In many cases during these conversations, happy moments
with pets are shared. It is very interesting to note that research also
indicates that people (women) show less physiologic reactions (e.g., blood pressure and pulse
increases) when in the presence of pets versus the presence of friends. One possible explanation for
this outcome may be that pets are comforting and, very importantly, non-evaluative.
A summary of the research benefits of pet ownership are as follows:
K Pets can reduce stress by improving the pet owners psychological well-being and they
report fewer health problems.
K As you pet and talk to your pet blood pressure levels decrease, reducing the risk for
heart disease. This also enables you to have a companion which can help you forget
the problems you are experiencing.
K Because regular walks and exercise are required for dogs, dog owners become more
active. Pets are also socially stimulating because pet owners meet other pet owners
when they walk their pets.
K Pet owners who live alone experience less loneliness because they have their pets to
converse with if they choose to do so.
Psychosocial Adjustments
O Remember to Laugh a Bit (p.201)
O Talk Things Out and Share Your Stress (p.202)
O Lean on a Friendly Shoulder (p.202)
O You Don’t Have To Be Right All the Time (p.202)
O Spend Needed Time With Family and Have Fun (p.203)
O Be a Participant in On-Going Activities and Help Others in Need (p.203)
O Learn To Say NO (p.204)
O Avoid Loneliness (p.204)
O Try To Improve Your Communication (p.205)
O Consider Getting a Pet (p.205)

___________________________________________________________________________________________
19.
Lifestyle Adjustments
ë
“Whatever the situation, and however disheartening it may be, it is a great hour
when a man ceases adopting difficulties as an excuse for despondency and tackles
himself as the real problem.”
- Harry Emerson Fosdick
L
ifestyle behavior changes involve the activities you have to engage in throughout your life that
will serve to ensure that you will be better able to deal with stress and, therefore, improve your
health and well-being in the long run. For the
most part, the strategies under this section deal mainly
with your daily activities that relate to the manner in
which you treat your mind and body, e.g., amount of
sleep you get, the foods you eat (see Exhibit 19.1) and
the exercise you take. Also, how your body, in turn,
reacts to your daily lifestyle activities.
It should be emphasized that since no two
people are alike mentally, the same point can be made
that no two people are the same physically. With this
fact in mind, the strategies you carry out involving
your body will not necessarily result in the exact same
outcome for another person. These and other points Exhibit19.1: Shopping for the right kinds of food
exhibit the tremendous variation that exists between
each one of us. Therefore, it is important for you to become familiar, as best you can, with how your
individual body functions and what are its special needs.
Know Your Body Clock and Biological Prime Time

Depending on our body clock, we are at our best at different
times of the day (see Exhibit 19.2). As mentioned before, we all
differ in our needs and reactions to life situations. With this point in
mind, don't impose undue or unnecessary pressures on yourself,
especially if they are to suit the wishes of others. Accept your
personal idiosyncrasies or limitations and act as you see fit to
accomplish your personal goals. Based on your body functioning
and related activities, would you say that you are: a morning person?
a night owl? or a late afternoon whiz?
EXAMPLE: Some people can function quite well early in the morn-
ing. Don't feel frustrated if you cannot accomplish as much as other
people (e.g., friends) early in the morning.
Exhibit 19.2: Knowing when you
function the best
207
Perhaps your body clock (i.e., the messages you get from your body regarding its performance)
suggests that your most productive period is late morning, as opposed to early morning. With this self
knowledge, you can reduce your frustration and stress level by modifying your lifestyle to suit the
specifics of your body functioning.
Discover Your Tolerance Level For Stress

When you are attempting to know your body clock, you should be also attempting to read the
signals coming from your "stress gauge" (i.e., your body's reaction to stress). These signals will allow
you to know how much stress you can tolerate without beginning to suffer the negative consequences
of negative stress or distress. In essence, then, you must know your personal stress barometer or level.
EXAMPLE: If you are studying too hard for an upcoming exam at school (Stressor = overload), by
knowing your stress level or tolerance, you know when to back off. By the same token, if you are not
being pushed to an acceptable limit (stressor = underload), you know when to push on. In both cases
these are personal decisions based on your knowledge of the unique workings of your body. The
result is your experiencing less (negative) stress and its accompanying consequences.
Strive to Acquire a Healthy Body
In order to cope more effectively with stress, it is important that your body (and mind) be in the
best possible condition. Apart from the numerous advantages for having a healthy body, it is better
prepared to handle the physical changes that accompany stress. There are several lifestyle choices we
make that are known to improve our overall sense of well-being, including control of our daily stressful
life experiences. Three such important lifestyle activities include: a) have sufficient sleep, b) eat an
adequate diet, c) get appropriate exercise and d) avoid the use of alcohol and drugs. Each of these
activities is discussed on the following pages. Because these three lifestyle choices are known to
increase our stress-resistance, it is in your best interest to implement them early in your life, preferably
in small and manageable steps. As always, any major adjustments involving your physical activities
should first be accompanied by an appropriate medical examination.
Have Sufficient Sleep

Sleep is nature’s medicine for many human ills, mainly in part
because of its ability to revive and rejuvenate our minds and bodies.
Because our hectic daily activities tend to tire us out, we need to take
time out to stop, rest and, eventually, sleep. Although we all need
different amounts of sleep, the average person needs six to eight hours
of sleep each night. Lack of adequate sleep can act as a stressor for our
bodies (see Exhibit 19.3).
When your body lacks sufficient sleep it reduces your ability to
deal with other stressors. Pace yourself when studying and set aside
hours for sleep, especially before an examination. Reflecting on what Exhibit 19.3 Be alert and
was said before about “knowing your body clock” and “your stress healthy by getting sufficient
tolerance level,” you should try knowing what is the minimum hours of sleep
sleep you need to achieve your optimum level of performance at
Chapter 19 . Lifestyle Adjustments 209
college, as well as involving other activities (e.g., outside work).

When students are under stress and have too much to do, they often try to get by with less sleep
Sleep is important for us because it heals the minor wear and tear on our bodies each day. Lack of
sleep also affects our interpersonal and professional relationships, as well as our performances. Sleep
also helps us to consolidate our daily events and preserve them in our memory. Therefore, because the
restorative, integrating and other functions of sleep are important “tools” in managing stress, we must
at all costs try to make time to get sufficient sleep. Some tips to help you sleep include the following:
K Stop and smell certain fragrances (e.g., lavender), where certain smells have been
proven to induce a degree of deep relaxation;
K Get a heating blanket (that is if you live in cold climates), where heating blankets help
you to sleep by relaxing the muscles - one of the main factors that induce
sleep; and
K Get a “white noise” machine, which emits a sound that blocks out many noises in the
environment, thereby allowing many people to sleep.
Eat an Adequate Diet

The stress-nutrition relationship is extremely important for your health, in general, and your
specific stress-related outcomes in particular. Therefore, you
should shop carefully for the kinds of foods you eat (see Exhibit
19.4), thereby providing your body with the right nutrients needed
for health and daily sustenance. Preferably, your selection of a
variety of foods should come from the five food groups (see
revised USDA Food Pyramid Guide in Exhibit 19.5 ). This color
coded guide has recommendations that include: variety,
proportionality, moderation and activity in the pursuit of
individuals’ dietary needs and physical activity levels. As the wider
base of the pyramid indicates, more food is consumed from the five
Exhibit 19.4: Try at all times to eat from food groups as physical activity increases.
the right food groups
There is a two-way relationship between stress and
nutrition. What you eat affects the functioning of your body (i.e., stress-related outcomes), and stress
affects the nutritional status of your
body. In the case of the former, you
would not expect your car to run
smoothly if you filled it with nothing
but low grade, inferior gasoline, so why
would you expect your body to deal
with stress more effectively if you do
not eat properly? In the case of the
latter, physical stress associated with
injury and illness, and perhaps to a
lesser degree, emotional stress, can lead
to a greater need for proteins, vitamins,
minerals and carbohydrates.
Why does the body need certain
nutrients when it is experiencing stress?
One possible explanation has to do with Exhibit 19.5: The USDA revised food pyramid with partially imposed labels.
the fact that when under stress, your Only oils and physical activity are not labeled
need for certain nutrients increases
because your body burns up stored nutrients at a fast rate. Therefore, to replace these nutrients you
should eat a well-balanced diet of carbohydrates, vitamins, minerals and proteins. No one food group
supplies all the nutrients needed; therefore, you have to eat a variety of foods in the recommended
servings from the recognized five food groups.
Apart from the possible (emotional) stress-nutritional relationship, there is also a stress-
behavior relationship. Basically, when some people are under stress, they tend to eat more or eat less.
Depending on the changes that take place, the results can range from nutritional deficiency to obesity.
In terms of stress, a diet of high nutrient foods is very important. Poor nutrition all by itself can deplete
needed energy. For example, it has been said that the “Shortages of iron, vitamins B 12 or folic acid,
magnesium, protein and just about every other essential nutrient can lead to fatigue.”
It is important to note that food provides the body with energy, and it is calories - units of
energy from food - that are “burned,” just as gasoline is combusted in an engine to make a car move.
How are calories “burned” in the body (a process that is called energy metabolism)? Nutrients are
needed to burn calories. Some nutrients, for example, the B-complex, magnesium and zinc, act as
catalysts for calorie burning. Experts suggest that many people are overfed and undernourished. This
basically means that they get too much calories, but unfortunately, not enough of the nutrients that are
needed to metabolize those calories.
As mentioned before, stress increases cellular activity which, in turn, leads to nutrient usage.
Nutrients that are commonly deflected by stress include the antioxidant Vitamin A, C and E, the B
Vitamins and Minerals (e.g., zinc, iron, potassium and calcium). In a related manner, less food may be
eaten during times of stress. The main reason being that the digestive tract may be somewhat upset,
and the higher nutrients may compensate for lower consumption. A corollary factor related to the issue
of nutrients is the need to drink lots of water, simply because water keeps the body well hydrated.
Water also helps counteract stress by circulating needed nutrients around the body. It is recommended
that 5-8 glasses of water be taken each day.
The Food Pyramid With Its Five Designated Food Groups

The Food Guide Pyramid, seen in Exhibit 19.5, emphasizes foods from the five major food
groups. Each of these food groups provides some, but not all, of the nutrients you need. For example,
oranges (fruit group) provide vitamin C but no vitamin B12; cheese (milk group) provides vitamin B12
but no vitamin C. It is important to note that foods in one group cannot replace those in another. Also,
no food group is more important than another, you need them all. Additionally, one size doesn’t fit all.
For a quick estimate of what and how much you need to eat, enter your age, sex and activity level in the
My Pyramid Plan Box at: www.mypyramid.gov/mypyramid/index.aspx
Grain Group: Included under this group are rice, wheat, corn, oats, rye,
barley, breads, corn meal, pasta and cereals (both hot and cold)- all foods
from grain (see Exhibit 19.6). These foods provide complex
carbohydrates (starches), which are an important source of calories (or
energy), especially in low fat diets. They also provide vitamins, minerals
and fiber. Small amounts of incomplete proteins, vitamins and minerals
are often lost in milling and processing. Therefore, in order to increase
Exhibit 19.6: Grain group
the nutritive value, most flours and cereals are now enriched, or
“fortified,” by the addition of these nutrients. Look for “whole” on the grain name on the list of
ingredients. The Food Guide Pyramid suggests 3 ounces of whole grain bread, cereal, crackers, rice, or
pasta every day.
Vegetable Group: Vegetables provide vitamins, such as vitamin A and C and folate, and minerals,
such as iron and magnesium (see Exhibit 19.7). They are naturally low in fat and
also provide fiber. Any vegetable or 100% vegetable juice counts as a
member of the vegetable group. Vegetables may be raw or cooked; fresh,
frozen, canned, or dried/dehydrated; and may be whole, cut-up, or mashed.
They are classified as dark, orange, starch and other. The Food Pyramid
suggests that you should eat more of dark and orange veggies. Also, you
should eat more of dry beans and peas.
TIPS:
Exhibit 19.7: Vegetable kEat a variety of vegetables for your required nutrients, for example: dark-green
group leafy vegetables (spinach, romaine lettuce and broccoli - are especially good
sources of vitamins and minerals);
k deep-yellow vegetables (carrots, sweet potatoes);
k starchy vegetables (potatoes, corn, peas);
k legumes (navy, pinto and kidney beans, chickpeas); and
k other vegetables (lettuce, tomatoes, onions and green beans).
Fruit Group: This group provides important amounts of vitamins A and

C and potassium (see Exhibit 19.8). They are low in fat and sodium..
Any fruit or 100% fruit juice counts as part of the fruit group. Fruits may
be fresh, canned, frozen, or dried, and may be whole, cut-up, or pureed.
Eat a variety of fruits..
TIPS:
k When possible, choose fresh fruits, fruit juices and frozen, or dried
fruit. (Dried prunes and figs are valued as natural laxatives.) Exhibit 19.8: Fruit food group
k Try to avoid fruit canned or frozen in heavy syrups and sweetened fruit
juices.
k Eat whole fruits often - they are higher in fiber than fruit juices.
kHave citrus fruits, melons and berries regularly. They are rich in vitamin C.
k Count only 100 percent fruit juice as fruit. Punches and most fruit drinks contain only a little juice
and lots of added sugars. Also, grape and orange sodas do not count as fruit juice.
Milk Group: Milk products provide protein, vitamins and minerals (see Exhibit 19.9). All fluid milk
products and many foods made from milk are considered part of this food group. Foods made
from milk that retain their calcium content are part of the group (e.g., yogurt), while foods
made from milk that have little to no calcium, such as cream cheese, cream, and butter, are
not.
· TIPS:
k Choose skim milk, and nonfat yogurt often. They are the lowest in fat.
k Use 1-1/2 to 2 ounces of cheese and 8 ounces of yogurt count as a serving from this
group because they supply the same amount of calcium as 1 cup of milk.
k Cottage cheese is lower in calcium than most cheeses. One cup of cottage cheese
counts as only Ω serving of milk.
k Go easy on high fat cheese and ice cream. They can add a lot of fat (especially
Exhibit 19.9: Milk
group saturated fat) to your diet.
k Choose “part skim” or low-fat cheeses when available and lower fat milk desserts, for example, ice
milk or frozen yogurt.
Meat and Bean Group: All foods made from meat, poultry, fish, dry beans or peas, eggs, nuts,
and seeds are considered part of this group (see Exhibit 19.10). Dry beans and peas are part of
this group as well as the vegetable group. Additional sources that are beneficial include: peanut
butter, lentils and tofu. Meat, poultry and fish supply protein, B
vitamins, iron and zinc. The other foods in this group - dry beans, eggs
and nuts - are similar to meats in providing protein and most vitamins
and minerals.
TIPS:
k Choose lean meat, poultry without skin, fish, and dry beans and peas
often. They are the choices lowest in fat.
k Prepare meats in low fat ways, for example: a)trim away all the fat
Exhibit 19.10: Meat and bean
you can see and b) boil, bake or boil (i.e., the three Bs) these foods, group
instead of frying them.
k Go easy on egg yolks; they are high in cholesterol. Use only one yolk in egg dishes.
k Nuts and seeds are high in fat, so eat them in moderation.
k Cook fish simply, avoiding heavy sauces. It is better if you can grill or bake the fish.
What are Oils? Oils are fats that are liquid at room temperature, like the vegetable oils used in
cooking. Oils come from many different plants and from fish. Some common oils are: canola
oil, corn oil, cottonseed oil, olive oil, safflower oil, soybean oil, and sunflower oil.
TIPS:
k Make most of your fat sources from fish, nuts and vegetable oil.
k Limit solid fats like butter, stick margarine, shortening, and lard.
WORD OF CAUTION! These daily, dietary recommendations may vary from person to person
depending on age, health and other issues. As always, consult with your physician before changing
or modifying your nutritional intake.
Tips For When You Are Eating

Your attitude before and during eating influences how effective the food eaten is for your body.
k Try to set time aside to enjoy your food and be sure to eat slowly, savoring every mouthful.
Although the temptation is there, you should not eat while talking on the telephone, reading, or
working.
kThe quality and quantity of the foods you eat may be related to certain disorders, notably depression.
Depression was mentioned earlier as one possible stress-related outcome. Therefore, if you see that
you are eating when depressed, try to do something different, such as going for a walk, calling a friend,
or exercising. In essence, do something to take your mind away from the food and, hopefully, from
what is disturbing you. When you do eat, however, you should enjoy your food.
Tips on Nutrition To Lessen Stress

What you drink (e.g., alcohol, coffee) as well as what you eat (e.g., vitamins, minerals,
carbohydrates, fats and protein) affects your mood. Therefore, you can improve your health by having
a better understanding of which foods affect you and what kinds of foods to eat in managing your
stress.
k Vitamins and Minerals in your diet play a very important role in affecting your moods. Some
examples follow:
hA deficiency in B vitamins, which are found in peanuts, tuna and kidney beans, can make you
nervous, grouchy and depressed.
hVitamin B12, which is found in soybean products, gives you energy; however, if there are insufficient
amounts of B12, you may have trouble sleeping, feeling depressed and/or grouchy.
hThiamin, which is found in soybean products, helps you feel calm, fight depression and sleep well.
hA deficiency in iron, which is found in spinach and molasses, can make you feel nervous, forgetful
and/or grouchy.
k Fats, Carbohydrates and Protein: Generally speaking, fats slow you down and make you sluggish.
hCarbohydrates, which include pasta, bread and wheat, tend to calm you down.
hLow-fat proteins, which includes, meat, low-fat dairy products and fish, give you energy.
k Summary Tips: It is important to eat a healthy and balanced diet, especially when you are
experiencing stress. Such a diet should include: complex carbohydrates (e.g., vegetables, whole grains
and fruit); low-fat proteins (e.g., selected meat, fish and beans); and small amounts of fats (e.g., olive,
sunflower or other vegetable oils). Try avoiding “excessive” amounts of sugar, alcohol and coffee
(caffeine), all of which contribute to your (negative) stress burden.
Becoming An Educated Shopper

You should become an educated consumer or shopper when
you purchase food and related groceries (see Exhibits 19.1 and 19.11).
At supermarkets, for example, you must read labels carefully to
determine the contents and nutritional values of the food products you
buy. The simple message provided so far in this book is that “you are
what you eat.” Knowing about and shopping for the right foods to eat
ensure quality caloric intake and balance. This defined caloric intake
and balance (see Food Pyramid in Exhibit 19.5) are crucial factors that Exhibit 19.11: Shop carefully
keep your body fine-tuned, so that it is a resource for coping with stress. for the right foods from the main
groups
Food Intake Patterns Based on the Food Pyramid
The suggested amounts of food to consume from the basic food groups, subgroups, and oils to
meet recommended nutrient intakes at 12 different calorie levels. Nutrient and energy contributions
from each group are calculated according to the nutrient-dense forms of foods in each group (e.g., lean
meats and fat-free milk). The table also shows the discretionary calorie allowance that can be
accommodated within each calorie level, in addition to the suggested amounts of nutrient-dense forms
of foods in each group. Please note that the information presented in this section was taken from the
U.S. Department of Agriculture (USDA) for Nutrition Policy and Promotion (April 2005) [ Accessed
July 9, 2006:
www.mypyramid.gov/downloads/MyPyramid_Calorie_Levels.pdf].
Table 19.1: Daily Amount of Food From Each Group

Calorie Level1 1,000 1,200 1,400 1,600 1,800 2,000 2,200 2,400 2,600 2,800 3,000 3,200
Fruits2 1 cup 1 cup 1.5 1.5 1.5 cups 2 cups 2 cups 2 cups 2 cups 2.5 2.5 2.5
cups cups cups cups cups
Vegetables3 1 cup 1.5 1.5 2 cups 2.5 cups 2.5 3 cups 3 cups 3.5 3.5 4 cups 4 cups
cups cups cups cups cups
Grains4 3 oz-eq 4 oz- 5 oz- 5 oz- 6 oz-eq 6 oz- 7 oz- 8 oz-eq 9 oz- 10 oz- 10 oz- 10 oz-
eq eq eq eq eq eq eq eq eq
Meat & 2 oz-eq 3 oz- 4 oz- 5 oz- 5 oz-eq 5.5 oz- 6 oz- 6.5 oz- 6.5 oz- 7 oz- 7 oz- 7 oz-eq
eq eq eq eq eq eq eq eq eq
Beans5
Milk6 2 cups 2 cups 2 cups 3 cups 3 cups 3 cups 3 cups 3 cups 3 cups 3 cups 3 cups 3 cups
Oils7 3 tsp 4 tsp 4 tsp 5 tsp 5 tsp 6 tsp 6 tsp 7 tsp 8 tsp 8 tsp 10 tsp 11 tsp
Discretionary
calorie 165 171 171 132 195 267 290 362 410 426 512 648
allowance8
1
Calorie Levels are set across a wide range to accommodate the needs of different individuals.
2
Fruit Group includes all fresh, frozen, canned and dried fruits and fruit juices. In general, 1 cup of fruit or 100%
fruit juice, or Ω cup of dried fruit can be considered as 1 cup from the fruit group.
3
Vegetable Group includes all fresh, frozen, canned, and dried vegetables and vegetable juices. In general, 1 cup of
raw or cooked vegetables or vegetable juice, or 2 cups of raw leafy greens can be considered as 1 cup from the
vegetable group.
4
Grains Group includes all foods made from wheat, rice, oats, cornmeal, barley, such as bread, pasta, oatmeal,
breakfast cereals, tortillas and grits. In general, 1 slice of bread, 1 cup of ready-to-eat cereal, or Ω cup of cooked rice,
pasta, or cooked cereal can be considered as 1 ounce equivalent from the grains group. At least half of all grains
consumed should be whole grains.
5
Meat & Beans Group In general, 1 ounce of lean meat, poultry, or fish, 1 egg, 1 Tbsp. peanut butter, 1/4 cup cooked
dry beans, or Ω ounce of nuts or seeds can be considered as 1 ounce equivalent from the meat and beans group.
6
Milk Group includes all fluid milk products and foods made from milk that retain their calcium content, such as
yogurt and cheese. Foods made from milk that have little to no calcium, such as cream cheese, cream, and butter, are
not part of the group. Most milk group choices should be fat-free or low-fat. In general, 1 cup of milk or yogurt, 1 Ω
ounces of natural cheese, or 2 ounces of processed cheese can be considered as 1 cup from the milk group.
7
Oils includes fats from many different plants and from fish that are liquid at room temperature, such as canola, corn,
olive, soybean, and sunflower oil. Some foods are naturally high in oils, like nuts, olives, some fish, and avocados.
Foods that are mainly oil include mayonnaise, certain salad dressings, and soft margarine.
8
Discretionary Calorie Allowance is the remaining amount of calories in a food intake pattern after accounting for
the calories needed for all food groups. – using forms of foods that are fat-free or low-fat and with no added sugars.
Pseudostressors
Certain substances found in foods can create a stress-like outcome and may themselves be
considered stressors. These substances are called pseudostressors and they can actually mimic
sympathetic nervous system stimulation, which constitutes a very important part of the stress response
discussed earlier in the book (see Exhibit 14.2). These stimulants are capable also of intensifying your
existing feelings of stress. As chemical stimulants, pseudostressors are found primarily in what we
drink (e.g., coke, chocolate, caffeine in coffee and in many carbonated beverages, and theobromine in
tea) and in what we smoke (e.g., nicotine in cigarettes).
Caffeine is perhaps one of the most serious of the pseudostressors and it is recommended that
the drinking of coffee be stopped, if possible, or severely curtailed (see Exhibit 19.12). Not only can
large amounts of caffeine produce symptoms similar to the stress response, but it can also exacerbate a
stress response that is already occurring. Coffee is the most common source of caffeine, and the
average 6-ounce cup of brewed coffee contains approximately 100 milligrams. On the average,
Americans over the age of 14 consume 3 cups of coffee per day. Besides the stress reaction, excessive
caffeine use (i.e., more than 250 milligrams per day) contributes to other symptoms, such as diarrhea,
irritability, anxiety and an inability to concentrate.
CAUTION! If you have been a heavy coffee drinker you must wean yourself gradually from it or
you are likely to experience migraine-type headaches from caffeine withdrawal. One method to use
is decreasing your intake of coffee by one drink per day until you reach zero, then begin to abstain.
The nicotine found in cigarettes is another major pseudostressor that also mimics the stress
response, among other things. The negative effects of smoking on the body are numerous. For
example, smoking:
K Decreases stress resistance;
K Destroys body cells;
K Increases chance of getting lung cancer;
K Increases blood pressure and heart rate;
K Increases metabolism making your body always in a state of
overdrive;
K Lowers high density lipoproteins (i.e., the “good” proteins for
reducing cholesterol versus low density lipoproteins - the “bad”
proteins), and
K Increases carbon monoxide in the blood.
Depending on your level of addiction to anyone or a

combination of these pseudostressors, your level of intake should be
modified in a positive way providing that you are willing to change
Exhibit 19.12: Getting rid of the coffee your lifestyle. With this in mind, avail yourself of the support
jug and caffeine services of existing groups, e.g., Ex-smokers Against Smoking.
Get Appropriate Exercise

In an earlier section when a discussion was made concerning stressors, exercise was referred to
as a possible stressor. This point relates to a previous strategy discussed regarding "knowing your
tolerance level for stress" (see Exhibit 16.7). As is to be expected, there are different kinds of exercise
activities. Exercise varies in terms of how vigorously it is carried out as well as its effects and benefits
on the body. For example, too much exercise, particularly for a low tolerance body, can be stressful.
However, what is referred to in this section is regular, consistent exercise.
Given our increasing fast-paced, modern-day society, most people live a very sedentary
existence. This kind of existence is contrary to our history, because as members of the animal
kingdom, like other animals, we need to exercise. For many people, their greatest form of exercise is
getting up and sitting back down again, e.g., around a dining table to eat or around a desk at school.
This sedentary lifestyle is at odds with medical research that finds that persons who exercise regularly
have lower risks of heart disease and cancer (the number one and number two killers, respectively of
modern-day man), and have an increased sense of well-being. Regular exercise can be a stress reducer.
For example, in addition to neutralizing the bad effects of stress, regular exercise produces other
benefits. These include the following:
K Improved appearance through weight loss and better muscle tone;

K Pumping stress-busting endorphins into the bloodstream;
K Improved sleeping patterns;
K Feeling more alert and energetic;
K Improved self-concept;
K Improved self-confidence;
K Feelings of being more relaxed by increasing the brain’s alpha waves, which are patterns
of electrical activity associated with relaxation.
K Making the skeletal muscular system stronger; and
K Making the cardiovascular and respiratory systems more efficient.
Main Types of Exercises

There are many types of exercises from which you can
choose. As a medical caution, check with your doctor (see Exhibit
19.13) before beginning any form of (rigorous) exercise program.
Each kind of exercise, in fact, has its special appeal to those who
participate. Investigate a variety of exercises and try several. The
choice is yours to make, and it may depend on where you live, the
equipment or facility needed, what you enjoy doing, and the time
you can spare.
The specific kind of exercise is not as important as its
type. For you to benefit from exercise, it must require some
exertion (of your cardiovascular and respiratory systems) and
involve, preferably, your entire body. It is also advisable to select Exhibit 19.13: Check with your doctor
an exercise you know that you will keep on enjoying in the future. before beginning any rigorous exercise
Your choice of an exercise, however, must depend on its program
suitability to your needs, resources, physical makeup and, very
importantly, its appeal to you.
Whatever your choice, you should select one that is an "active" exercise and one that can
benefit your body the most. As you select an exercise, remember that not all exercises are good or
appropriate for everyone. Although the type of exercise you choose, in addition to your body's
composition, etc., determine the frequency and duration of the exercise work out, the following is
usually recommended.
Irrespective of your choice of exercise, you should be consistent with your selected exercising
activities. Also, it is usually advised that this regular exercise be conducted for at least thirty minutes a
"workout" every other day. Limitations on a person's part, such as age and physical ailments, may
preclude him/her from engaging in this suggested exercise regimen. Although the immediate effect of
any type of exercise is strain on those body parts most actively involved (e.g., muscles), as the body
adapts, the strain and pain subsides. In sum, your body becomes stronger, functions more efficiently,
and has more endurance as an outcome of regular exercise. As a physically fit person, you feel able to
withstand greater amounts of both physical and emotional stress than you would before this newly
acquired state of feeling and well-being.
Aerobic Exercises: The most popular forms of exercises to reduce stress and, at the same time,
increase cardiovascular (heart and circulatory system) and pulmonary (lung) health, are aerobic
exercises (versus anaerobic exercise). Aerobic means “with oxygen.” Aerobic exercises are the best
stress-busters and they use the same large muscle group, rhythmically, for a period of 15 to 20 minutes
or longer while maintaining 60-80 percent of your maximum heart rate. In general, you should try to
perform activities that you enjoy and, therefore, are more likely to stick with. Typical aerobic exercise
programs should include about 20 minutes of vigorous, continuous exercise, 3 to 5 times per week.
How often and how long a person does an aerobic exercise are more important than speed or distance.
Think of aerobic activity as being long in duration yet low in intensity.
Aerobic Dancing: This form of exercise has become a major craze symbol of the fitness craze (see
Exhibit 19.14). It is currently one of the most popular ways to get fit, and
also remain fit, all over the world. Although aerobic dancing varies,
usually most programs have an hour’s workout to music. Most typical
aerobic programs begin with 5-10 minutes of warm-ups and stretching,
periods with 20-30 minutes of specially designed heart range dance,
continue with 20 minutes of muscle stretching, and end with 5-10 minutes
cooling down and more stretching. The immediate benefits of aerobics,
especially dancing, are: increased cardiopulmonary efficiency,
strengthened heart and lungs, lowered cholesterol, and stress and anxiety
reduction. Because aerobics is usually done in the company of others and
with music, it has a very high social appeal. Aerobic exercise classes can
be found at local gyms, spas and community centers.
Specific Benefits of Aerobic Exercise: The specific benefits of

Exhibit 19.14: Aerobic dancing
aerobic exercises that are either directly or indirectly related to the control
of stress are as follows:
K Reduce the risk of heart attack and stroke;
K Help weight loss;
K Increase body flexibility, muscle tone and strength;
K Alleviate depression;
K Improve sleep; and
K Increase self-esteem.
There are five very common and relatively inexpensive aerobic exercises that most people do (see
Exhibits 19.15 thru 19.18):
K Swimming,
K Bicycling,
K Walking,
K Jogging and
K Dancing.
Swimming: A good, all-around exercise with little personal injury. Swim for at least 40 minutes.
Obey all safety rules and precautions (see Exhibit 19.15).
Bicycling: A fun exercise that can be worked into your daily

schedule, e.g., commuting to work, commuting to school,
and/or doing errands by bike. If you
are at home or at the gym, stationary
bicycling time can be used to read, Exhibit 19.15: Swimming
watch television, etc. If bicycling on
the road, use the proper headgear and reflectors to prevent an injury (see
Exhibit 19.16).
Walking: Many experts say that a brisk 2 to 5 mile walk each day is the
safest, most effective exercise. When you begin to
Exhibit 19.16: Bicycling combine a steady walk with a brisk walk you are
getting into the practice of what it is called “power walking.” For fun, listen
to music through earphones and/or walk with a friend (see Exhibit 19.17).
Jogging: This is an effective, efficient and enjoyable

sport for all ages. It is one of the most popular
forms of aerobic exercises. Generally, a jogger
burns up more calories per minute than in most other
sports. Also, jogging is an ongoing, noncompetitive Exhibit 19.17: Walking
activity that does not require any unusual skills or coordination. Gradual
conditioning, warm-up exercises and proper shoes are necessary to prevent
injury. As with all the other exercises, know your limits and check with your
Exhibit 19.18: Jogging
physician before embarking on a program or aerobic exercises (see Exhibit
19.18). Depending on your resources (i.e., place of residence, available time,
and money), there are other forms of exercise that you can choose from.
Hiking: This activity is increasingly becoming a popular form of alternative exercise; however,
because of its requirements, e.g., elevated terrain, aerobic endurance and muscular strength of
participants, it is a very limited choice of exercise for many groups of people. Additionally, there is a
relative amount of difficulty associated with hiking. For aerobic fitness to be improved by hiking, it is
suggested that persons travel, sometimes with the burden of a backpack, at the rate of approximately
one mile every 15 minutes (i.e., 4 MPH).
Jumping Rope: This form of exercise is very appealing to the young, and it is also appealing to people
who have no good place to walk or jog. If done frequently, consistently and for a defined duration
(e.g., 20 minutes), it is an excellent and relatively inexpensive form of exercise to give you the desired
cardiovascular, pulmonary and other workouts. However, a person should have a good amount of
fitness prior to using jumping rope as a means of developing cardiopulmonary endurance and fitness.
As with jogging, you set your pace. On a comparative basis, approximately ten minutes of skipping
rope may be equivalent to half an hour of jogging. An additional positive factor associated with
jumping is that the jump rope can be folded up and carried just about anywhere (e.g., on vacation);
therefore, your exercising routine or schedule does not have to be broken.
Anaerobic Exercises
Anaerobic, which means “without oxygen,” is in contrast to aerobic exercise. It involves
short bursts of exertion followed by periods of rest. The body develops stronger muscles as the result
of anaerobic exercise. Although anaerobic exercise does not burn fat, its muscle-building results
complement aerobic exercise (and bigger muscles burn bigger calories). Some anaerobic exercises
(such as sprinting or weight training) require more effort and a great deal of fuel (95%) used will be
carbohydrates. Examples of anaerobic exercise include push ups, stomach crunches, pull ups, and
lifting weights.
MEDICAL CAUTION!
Again, if you find that it is desirable to increase your current level of physical activity, you
should be aware of the fact that there are some very important medical
contraindications to physical exertion. If you are not sure what these
conditions are, you are strongly advised to check with your physician.
Whatever your knowledge base, however, it is very important that you
obtain a complete physical examination from a physician before
beginning any physically exerting exercise program of activities (see
Exhibit 19.19), such as those mentioned before.
Once you have received a consultation with a physician, and

you are ready to begin exercising, there are a few additional cautions
that you should follow to protect your health and, of course, receive the
maximum stress-reducing benefits from the exercise you are about to
begin.
K Exercise Safely: Exercise in moderation and do so to

Exhibit 19.19: Obtaining a
help prevent injury, e.g., to your muscles. physical examination before
starting an exercise program
K Wait: Wait for approximately two to three hours after
eating before beginning to exercise.
K Warm Up: Before you begin fully exercising, warm up, e.g., stretching, for approximately
five minutes. When you do start, start off very slowly then, if you desire, increase the pace in
the activity you are doing. When you are through exercising, you should cool down in the
same gradual manner.
K Do Not Overdo Your Activity: Gradually lead into your exercise program of activities and,
with the advice of your physician, recognize and accept what kind of exercise is appropriate
for you and your body composition (see Exhibit 19.20) . Know
when to stop or take a break away from exercising. In this latter
regard, pay close attention to the muscles of your arms and legs,
the difficulty with which you are breathing, and how your heart
feels as you exercise. Any strange or uncomfortable feeling
should be reported to your physician at the earliest possible
time.
Exercise 19.20: Engaging in appropriate

exercise
Avoid the Use of Alcohol and Drugs.

In Chapter 2 a discussion was presented concerning the increase use of alcohol and illicit drugs
on college campuses. Alcohol and drugs can help to mask stress and the underlying stress-related
problems students are experiencing. As stress is associated with the use of drugs, it is logical to reason
that if students manage their stress they, will in turn, also
control their intake of illicit drugs (see Exhibit 19.21).
Some tips to control drug abuse include:
K Know about the addictive and

destructive nature of drugs;
K Be aware of peer pressure which may
lead to drug use;
K If you are bored, or overworked, explore
various activities, rather than drugs;
K Be aware that while some drugs may
provide a quick feeling of “upliftment,”
in the long run this feeling only masks
the basic problem, rather than provide a Exhibit 19.21: Manage stress thereby managing drug
solution to the problem. In some cases, use/abuse
drug use may even make the underlying problem(s) worse; and
K If things feel as if they are beyond your ability to cope, seek professional help from
counselors and other medical personnel that are on campus.
Summary Outline of Headings in the Chapter
Lifestyle Adjustments
O Know Your Body Clock and Prime Time (p.207)
O Discover Your Tolerance Level For Stress (p.208)
O Strive To Have a Healthy Body (p.208)

9 Have Sufficient Sleep (p.208)
9 Eat an Adequate Diet (p.209)
: The Food Pyramid With Its Five Designated Food Groups (p.210)
3 Grain Group (p.210)
3 Vegetable Group (p.210)
3 Fruit Group (p.211)
3 Milk Group (p.211)
3 Meat and Bean Group (p.212)
: Tips For When You Are Eating (p.212)

: Tips on Nutrition To Lessen Stress (p.212)
: Becoming an Educated Shopper (p.213)
: Food Intake Patterns Based on the Food Pyramid (p.213)
: Pseudostressors (p.215)
9 Get Appropriate Exercises (p.216)

: Main Types of Exercises (p.216)
3 Aerobic Exercises (p.219)
ó Aerobic Dancing (p.217)
ó Specific Benefits of Aerobic Dancing (p.217)
ó Swimming (p.218)
ó Bicycling (p.218)
ó Walking (p.218)
ó Jogging (p.218)
ó Hiking (p.218)
ó Jumping Rope (p.218)
3 Anaerobic Exercises (p.219)
9 Medical Caution (p.219)
9 Avoid the Use of Alcohol and Drugs (p.220)

`__________________________________________________________________________________________
20.
Situational Adjustments
ë
“Success is to be measured not so much by the position that one has
reached in life as by the obstacles he has overcome trying to succeed”
- Booker T. Washington
S
ituational changes encompass various actions and activities that are basically determined by
existing and emergent events and conditions
around you. However, how you respond
“situationally” is a direct result of your personality and
how you think and feel, hence the primary importance
of the relationship between cognitive restructuring
(discussed in Chapter 17) and personality stressors
(discussed in Chapter 6) (see Exhibit 16.9).
When a discussion was made concerning the
dynamics of stress management in Chapter 16, mention
was made of the importance of various skills, e.g.,
action, awareness, acceptance and coping skills (see
Exhibit 16.4), in successfully managing stress. Exhibit 20.1: Adjusting to people and circumstances in
Although all of these skills are important in addressing the environment
situational adjustments, perhaps the most important and direct skill has to do with how aware you are
of people and circumstances in your surrounding environment (see Exhibit 20.1).
In this chapter, a brief discussion is presented on conditions and circumstances that are likely to
require adjustments in order to control stressful experiences. Some of the adjustments mentioned in the
chapter are more a result of how and what people have to do to deal with ongoing and emergent
situational circumstances, than they have to do with how they are formulated in the first place. In other
words, while the situational response is more immediate, the skills that led to the appropriate response
were acquired on an priori basis. Points like these underscore the interrelatedness of the five stress
management strategies seen in Exhibit 16.9.
React Only When It is Important - The Case of Road Rage
Given that many events can cause stress in your life, you have to choose which ones will get
your attention and which won't. Don't let little irritations
bother you.
EXAMPLE: In this day and age where the threat of “road rage”
(see Exhibit 20.2) is very real, if another motorist “closely”
overtakes you on the road, simply ignore the action and let him go
on in front of your car. If you were to react negatively, such as
swerving your car or speeding up to him, you could cause a very
serious accident; therefore it is simply not worth any “follow-up”
action on your part.
Exhibit 20.2: Take steps to avoid road rage
223
Although students are mainly on campus, when they get off campus, whether going to a social
event or driving home (e.g., out of state), they, too, are likely to experience the stress of road rage. As
a matter of fact, whatever stress they may be experiencing can itself contribute to how they respond to
drivers on the road.
Suggested Tips To Avoid Road Rage:
K Practice detachment and don’t get caught up

in the emotion of the moment;
K Monitor yourself, especially when you are about to become aroused, and try defusing
your emotions by seeing the situation differently;
K Avoid eye contact. Simply looking someone in the eye can be viewed as challenging;
K Don’t retaliate;
K If an aggressor continues to hassle you, drive to the nearest police station or busy
intersection;
K Retreat from a situation calmly;
K Don’t do anything that might be construed by your aggressor as threatening;
K When you come to a halt in traffic, leave ample space so that you can pull out from the
car in front of you. In other words, expect the unexpected and plan for it.
Change Your Pace When Events Overwhelm You
At times you may be exposed to several demanding situations. If this happens, your resources
could be overwhelmed and, as a result, you are likely to experience negative stress or distress. In
Chapter 3 this kind of stress was referred to as overload. However, if
your resources were greater than the perceived demands placed on you,
this type of stress was referred to as underload. An example of an
overloading situation follows.
EXAMPLE: You are experiencing some stress associated with three

exams pending for next week. You are very anxious about your inability
to fully concentrate and study for these exams. Try taking a break away
from your studies by taking an extended walk, listening to some of your
favorite music, or going dancing for a short while (see Exhibit 20.3).
When you return to your studies you are likely to feel refreshed
and be more focused on studying for your exams.
Exhibit 20.3: Dancing as a way
to deal with overwhelming
activities
Try To Have Patience
Try to exercise patience in most, if not all, of your activities, especially when these activities
get unbearable. Sometimes you may be involved in an activity that is not working out the way you
want it to work; hence you get overly impatient because the outcome is not what you expect.
Chapter 20 . Situational Adjustments 225
EXAMPLE: How many times have you had to wait longer than expected
for an established appointment? (see Exhibit 20.4). However, what ends
up happening is that because of the importance of the interview you had
patience, remained relatively calm and, at the end, things worked out
Simply put, impatience can cloud your judgement, thereby having a

negative influence on our perception of events (i.e., potential stressors)
Exhibit 20.4: If you have around you. Cultivate patience!
patience “good” things will
come your way
Learn To Control Your Anger
Uncontrollable anger (see Exhibit 20.5) not only increases your stress but it places you at risk
for sickness and, in some extreme cases, death. In the long run, anger does not help in the solution of
the problem, simply because when you are angry your are so “emotionally charged” that you are not in
a position to think clearly and rationally. These two latter conditions are usually two important
preconditions needed to meaningfully solve most problems. Therefore, try to
look at the facts relating to the problem and attempt to solve the problem in
a logical and/or rational manner.
It is felt that anger is often stress in denial and, as such, is best
approached via one-to-one counseling. Whereas training courses can convey
anger management and stress reduction theory and ideas, one-to-one
counseling is necessary to turn theory into practice. Management of anger
and the stress that causes it, can only be improved if the person wants to
change - so awareness is the first requirement. Some angry people take pride
in their anger and don't want to change; others fail to appreciate the effect on
self and others. Without a commitment to change there's not a lot that a
counselor can do to help. Therefore, anger management is only possible
when the angry person (e.g., student) accepts and commits to the need to Exhibit 20.5:Controlling
change and/or adjustments. your anger
Like stress, anger management includes angry persons to understand
the cause of their angry tendency, which will be a combination of stressors and stress susceptibility
factors. Angry people need help in gaining this understanding - the counselor often won't know the
reason either until rapport is established. If the problem is a temporary tendency, then short-term acute
stress may be the direct cause. One-to-one counseling is best used to discover the causes and then
agree on the necessary action to deal with them. Where the anger is persistent, frequent and ongoing,
long-term chronic stress is more likely to be the underlying cause.
Keep a Journal
When things are written down they have a way of putting things in perspective. As you place
your worries into words this act may help you see that you don’t really have that much to worry about,
or it may help you better understand your situation and, therefore, manage your stress. Regardless,
keeping a journal should help you identify your concerns and establish a plan for moving forward. In
an earlier chapter this effort was referred to as having a Personal Plan of Action, or PPOA. What
follows are some tips to keep an on-going journal of your activities and response to these activities.
K List the situations that produce stress in your life;

K Describe what coping strategy you used to cope with each type of stressful experience;
K Evaluate your responses. Are they healthy or unhealthy, appropriate or unproductive?
K Consider which of these styles or combination of them is more comfortable for you and
will allow for better results;
K Become task-oriented, thereby analyzing the situation and taking action to handle it;
K Become emotionally-oriented, thereby dealing with your feelings and finding needed
social supports.
K Become distraction-oriented: you use designated activities to take your mind off the
situation.
Study Habits
Many students fail at college not because they are not “smart enough,” but because they did not
do what was expected of them. In short, they literally “worked against themselves” (this issue was
addressed under personality stressors in Chapter 6, see Exhibit 6.2) with practically little or no
assistance from others, at least not directly. While students’ success in college is dependent on many
factors (e.g., no cramming; taking notes in class and of readings; preparing for next day assignments;
studying at set times; having a plan of action for achieving your educational goals), a major factor has
to do with how students apply themselves to their college (and related) work, or simply put, their study
habits.
However, for students to develop effective study habits they must engage in the following
activities:
K Establish their values, priorities and goals to be accomplished;

K Establish a practical schedule of daily, weekly, monthly, semester and yearly schedules;
K Be aware of how they will manage their time (i.e., time management skills); and
K Engage in the needed behavior to accomplish their goals.
Studying Time
Most universities recommend that students study at least two hours outside of class for every
hour spent in class, although some recommend even more. Many students are taking 15 hours per
semester, which probably means spending about 15 hours a week in class. Therefore, studying at least
30 hours a week outside of classes would be recommended. Combining the 15 hours a week in class
and the 30 study hours outside of class, many students will need to plan to spend about 45 hours a week
on school. This being the case, it is very important that you organize your time by having a schedule of
planned and prioritized activities.
Attitudes, Values, Behavior (Action) and Time Management

Our social experiences contribute to the formation of our personalities, which are fairly
consistent patterns of acting, thinking and feeling that distinguish us from each other. Two very
important and interrelated aspects of our personalities that affect our time management skills are our
attitudes and values.
Most people do not realize the important relationship between values, behaviors and time, all
of which are interrelated. Have you heard the expression that “people should identify their values and
then support them behaviorally?” (see Exhibit 20.6). Many important, or core, values need to be
identified, and then accomplished in a timely manner. Therefore, if these values are not achieved
within the designated time framework, it can be potentially stressful for those concerned.
Accomplish Your Value-

Define and Prioritize Your Related Time Management
Values Goals and Objectives
Engage in Supportive Behaviors
Exhibit 20.6: The relationship

between values, behaviors, goals and
time management
To begin with, many people do not identify the values that are important to them and which ones
need accomplishing in a defined period of time. Also, while some people may identify their important (or
core) values, they do not engage in appropriate behaviors that will allow the values to be accomplished in
a timely manner. In essence, they should define their values in terms of actions. Additionally, they should
make a schedule for their values. “If you don’t get it on the schedule, it isn’t going to happen.”
Attitudes
One of the reasons many people find it very difficult to apply the skills of good time management is
that these skills run counter to their personal habit patterns (or personalities), which are difficult to break.
How you think, or the attitudes you have, are a major influence on the habits you maintain. Therefore, to
be more successful at managing your time, you have to first of all, change how you think – or simply your
attitudes. Any change in your attitudes will very likely affect your values and value system. This issue was
discussed, in part, under Chapter 17 dealing with cognitive restructuring.
Values
Values are your personal thoughts and feelings that you use to access what is good and desirable,
and that serves as broad guidelines for your later or subsequent actions. As a group, these factors
collectively represent your value system. You demonstrate your particular value system in the priorities you
set; how we communicate with each other; our family and work lives; and career choices.
Here are some reasons why examining your values is a useful first step in goal-setting.
K Self-understanding: You cannot achieve a clear picture of what you want out of life until
you understand what is truly important to you.
K Relating to the world around you: Understanding what you value helps you choose
your relationships with people (e.g., family, friends, co-workers, supervisors) according
to how their values compare to yours.
K Building a personal foundation: Having a strong set of values give you a foundation to
return to when difficulty in achieving a goal forces you to reevaluate what you want and
what is possible. Your responsibility is to make value choices based on what is right for
you and those involved with you. Think through the following when considering your
values:
9 Be wary of setting goals according to other people’s values.

9 Evaluate your values clearly to determine if they are right for you.
9 Reevaluate your values periodically as you experience change.
The goals that you set for yourself express your values and translate them into action. You experience a
strong drive to achieve if you build goals around what is most important to you.
Time Management
The term time management is a misnomer, or it is misnamed, simply because we cannot manage
what we cannot control. However, time management is really self-management, because we can control
ourselves and our activities in relation to the “fleeting continuum” referred to as time. Time
management can be improved by doing the following:
ê Identify your top five time wasters (examples usually include: telephone interruptions, inadequate planning,
attempting too much, drop-in visitors, personal disorganization, inability to say no, procrastination, poor
communication, socializing);
ê Identify strengths and weaknesses in your time management practices;
ê Learn strategies for making a daily, weekly and semester schedule. (It is important to note the.following about
schedules: keep to the facts; be realistic; allow for plenty of free time, recreation, etc.; choose class times with
appropriate study breaks; eat lunch and go to other classes in other buildings. Scheduling fails for many students
because they set up a schedule that is too rigid and unrealistic. Also, you must be able to keep your goals and
priorities in mind in order to motivate yourself to follow this schedule. See typical class schedule in Exhibit 20.7);
ê Construct and learn how to evaluate your time schedule;
ê Assess where your time goes (do a time log of your daily and weekly activities to begin with); and
ê Learn some strategies for improving your time management (e.g., prioritizing your goals and activities using the
ABC method, i.e., A = what must be done now, more urgent than important; B = what should be done as soon as
possible, more important than urgent; and C = what is nice to be done, i.e., not really important and non-urgent).
Problems
As time management is a serious problem for many college students, the following problems
associated with procrastination, distractions and other conditions were mentioned for students to note:
ê Time management seems like a very sensible approach, yet many people never really learn to manage their time.
If you are having a problem with time management, consider the following suggestions:
ê Review your long-term and intermediate goals often. Keep a list where you will see it often.
ê Continually try to eliminate unnecessary tasks that are not related to your goals or to maintaining a balanced
lifestyle.
ê Take advantage of your natural cycles, schedule the most difficult activities when you are sharpest.
ê Learn to say "No" to people, including friends, roommates and relatives.
ê Reward yourself for effective time management.
ê Solicit cooperation from those around you. Let your family members, roommates, and others know about your efforts
to manage time.
ê Attend to your needs for spontaneity.
ê Do not set yourself up to fail. Be realistic and work toward an individualized approach that makes sense for you.
ê Record schedules, priorities, and plans on paper.
___________________________________________________________
Source: Archer, J. (2003). The University of Florida Counseling Center, Gainesville, Florida. Accessed 8/20/04:
http://www.counsel.ufl.edu/selfHelp/timeManagement.asp
Setting Goals and Priorities

One of the first steps in effectively managing time is to develop a clear statement of your
long-range goals. When this is done you will then be able to set short range goals and to prioritize
specific activities according to how much they contribute to your goals. You will also establish clear
objectives, or the means to achieve these defined goals. However, setting these first long-range goals
may appear more difficult at the onset. This goal-setting process can force you to confront decisions
that you have been postponing, or value issues that you did not want to address at this time.
Monday Tuesday Wednesday Thursday Friday
8:00-9:00 HPPL159-02 HPPL159-02 HPPL159-02

LUR2013 LUR2013 LUR2013
8:10-9:00 8:10-9:00 8:10-9:00
9:00-10:00 MATH006-30 MATH006-30
DGH0133 DGH0133
9:40-11:00 9:40-11:00
10:00-11:00 Read over class Read over class Read over class
notes notes notes
11:00-12:00 ANTH110-02 ANTH110-02 ANTH110-02

CHM0205 CHM0205 CHM0205
11:10-12:00 11:10-12:00 11:10-12:00
12:00-1:00 Lunch Lunch Lunch Lunch Lunch
1:00-2:00 AFST101-03 AFST101-03
LKH0105 LKH0105
1:10-2:00 1:10-2:00
2:00-3:00 LPPL175-01 LPPL175-01 LPPL175-01
POR2011 POR2011 POR2011
2:10-3:00 2:10-3:00 2:10-3:00
3:00-4:00 Library 3:00-9:00 Work 3:00-9:00 Library 3:00-9:00 Work 3:00-9:00 Library 3:00-9:00
4:00-5:00
Exhibit 20.7: Typical class schedule. Note the even spacing of classes that allow for needed and important lunch
breaks and study periods.
Test Taking
A fundamental part of college life is associated with taking tests. For some students, test taking
is the main stress-related tiger that they have to learn to control. Based on how stress has been defined
in this book as a subjective
phenomenon (see Exhibit 3.2 and 3.3), Be Prepared: No matter what other tips you may read and use, nothing can take the
tests are not inherently stressful. It is place of studying on a regular basis.
students who perceive them as stressful Do your Homework: Homework and assignments are meant to give you the practice
based on the demand-resource and knowledge you will need for an exam. Often exam questions are based on what you
discrepancy associated with tests. For have already read and completed.
students to have lower stress, Review Regularly: Avoid cramming by studying and reviewing each day. Review
improvements in their health and, notes, homework, and reading for a few moments every day. Quiz yourself and start the
therefore, improvements in their studying process early. Study key terms, definitions, examples, lists, diagrams, and
charts. Pay particular attention to items your professor emphasizes in class.
academic performances at college, they
have to control the “stress tiger” Ask for Help: There are many resources available to help you succeed. Ask your
associated with taking tests. What instructor if you don't understand something. Form a study group. Check out the
services available in the Academic Support Center including peer tutoring, study skills
follows are some suggested tips to assistance, and advising.
improve test taking skills:
Understand vs Memorize: Memorization techniques can be helpful if there are many
facts to remember. However, it is best to truly learn and understand the material.
Multiple Choice Tests
Attend all Classes: It is easy to get behind and miss vital information by skipping
Try to answer the question before looking at classes. If you must miss a class, arrange to copy someone's notes or even tape the
the answers. lecture (with instructor's permission.)
Read through the entire test and answer Control Anxiety During the Test: Arrive early. Get settled, relax, and give yourself
those questions you know first. time to organize your thoughts. Listen carefully to all instructions before beginning.
Quickly review the test. Answer the easiest questions first. If you get stuck on a
Rephrase the question in your own words. question, leave it and go back to it later. If you have no idea of an answer, remain calm,
try to recall what you do know and use other test questions to give you clues. If you do
Eliminate the choices you know are become anxious take a moment to relax. Close your eyes, take deep breaths and
incorrect and choose your answer from the concentrate on relaxing your body.
remaining selection.
Get Plenty of Sleep and Eat Well Before A Test: Feeling rested and eating a
Sometimes the answer to one question is balanced diet will go a long way in relieving stress symptoms.
revealed in other test questions. Skip any
questions you don't know and maybe the -------------
answer will become clear later.
Source: Test Taking Tips, Western Student Services Center. Accessed: 8-20-2004
Essay Tests http://www.western.edu/ssc/study_skills/test_taking.html
Read directions carefully. Notice whether

you must answer all the questions and
True and False Tests
whether your test time is limited. Generally, there are more true than false statements.
Read all questions before beginning. If you If part of a statement is true and part of it is false, then the answer is false.
can select questions to answer, choose those Statements with qualifiers (sometimes, seldom, rarely, most) tend to be true.
for which you are best prepared.
Matching Tests
Answer the easiest questions first. This will Because the lists don't always match evenly, review the entire section before
beginning.
help you feel confident and reduce anxiety. Start with the easiest matches first. To eliminate confusion, cross out matches as
you use them.
Test Anxiety
In Chapter 2 some information was presented on college students and anxiety. It was
mentioned that anxiety (i.e., nervousness or apprehension) is usually a part of college life, especially
around threatening events, e.g., an examination, where the anxiety can occur either before and/during
the examination. In some cases, however, this kind of anxiety can be a powerful motivator. In other
cases, some students experience test-related anxiety to such a degree that it can lead to poor
performance and interfere with their learning. When anxiety reaches this level, students have to address
the issue. What follows are some suggested tips; however, students must be ready to seek professional
help if these tips are not sufficient to slow the tide of the anxiety they are experiencing.
ê Preparation - develop good study habits, spreading studying over several days; ask for additional help when
needed; eat good foods, get adequate rest, and exercise to build energy; attend class regularly and complete all
assignments in a timely manner; make and take practice tests;
ê Keep a positive attitude - develop reasonable expectations; do not allow your grades to become dependent
on the outcome of one exam; avoid negative and irrational thoughts about catastrophic results; set up a system
of rewards for dedicated studying and good test performance; encourage yourself;
ê Relaxation techniques - deep breathing exercises, imagery and visualization, and muscle relaxation
techniques can help to increase focus an concentration; don't arrive too early or get distracted by others
preparing for the test; check to make sure you have everything you will need;
ê Learn good test-taking skills - do not panic if you can't remember something right away; answer questions
you know well first, and then go back to other ones; read questions and directions carefully before you begin;
outline essays before you begin to write; keep short-answers short; don't spend a lot of time reviewing answers
Source: Campusblues.com. Test and Performance Anxieties. Accessed 8-20-2004. http://www.campusblues.com/test.asp
Panic Attacks
Panic Disorder is caused not by high amounts of anxiety or stress per se, but instead by the
person's beliefs (cognition) about the personal consequences of anxiety and stress. If the person strongly
believes that anxiety/stress (racing heart, shortness of breath) has harmful consequences (heart attacks,
illness), the person is at risk for panic disorder regardless of how often anxiety and stress are
experienced.
Suggestion: If the person believes that anxiety and stress are unpleasant but harmless emotions, the
person is unlikely to develop panic attacks, no matter how much anxiety and stress are experienced. If
attacks continue, students are strongly advised to seek assistance from a qualified medical professional
who has an expertise in this area.
Dealing With Stress At Your Computer
Students spend a great deal of time at computers doing class-related assignments. Working at the
computer can be a major source of stress for students. In order to reduce the likelihood of experiencing
these computer-related stresses (see Exhibit 20.8), part of your Personal Plan of Action, or PPOA (see a
discussion of the PPOA in Chapter116), should include the following tips:
K Computer and peripherals must have and undergo a

maintenance schedule (e.g., disk fragmentation, clean-
up);
K Have extra supplies of print cartridges, computer disks
and paper;
K Have an updated virus program; and
K As a back-up plan, make sure to have an alternative
source (e.g., at school’s Computer Center) to type and/or
print your class project/assignment.
Exhibit 20.8:Reduce stress at your
computer
When Should You Seek Professional Help?

When students are in the midst of a stressful situation, it is very difficult for some to determine
whether they are simply feeling stress or something more serious. The longer stress remains in your
body (see the discussion on the G.A.S. in Chapter 14), the more likely it is to produce physical and
psychological illness. It is usually time to seek professional help (see Exhibit 20.9) if you are
experiencing any one or a combination of the following:
K Feel like things are closing in on you;

K Feel that “troubles” will never end;
K Feel so desperate that you do not think about school;
K Feel like taking drugs to let you forget;
K Feel like injuring yourself;
K Feel depressed, sad, tearful, or that life is not worth living;
K Lost your appetite and find it difficult to sleep;
K Find that you are eating, drinking alcoholic beverages,
smoking, or using recreational drugs in unusually large
amounts;
K Have worries, feeling and thoughts that are hard to talk
about; Exhibit 20.9: When to seek
professional help
K Hear voices telling you what to do; and
K Feel that stress is affecting your health and school performance.
Situational Adjustments
O React Only When It is Important - The case of Road Rage (p.223)

9 Suggested Tips To Avoid Road Rage (p.224)
O Change Your Pace When Events Overwhelm You (p.224)
O Try To Have Patience (p.224)
O Learn To Control Your Anger (p.225)
O Keep a Journal (p.225)
O Study Habits (p.226)

9 Studying Time (p.226)
9 Attitudes, Values, Behaviors (Action) and Time Management (p.226)
: Attitudes (p.227)
: Values (p.227)
9 Time Management (p.228)
9 Problems (p.228)
9 Setting Goals and Priorities (p.229)
O Test Taking (p.230)

9 Test Anxiety (p231)
9 Panic Attacks (p.231)
O Dealing With Stress at Your Computer (p.231)
O When Should You Seek Professional Help? (p.232)

___________________________________________________________________________________________
21.
Relaxation Experiences
ë
“Part of the happiness of life consists not in fighting battles, but in avoiding them.
A masterly retreat is in itself a victory.”
- Norman Vincent Peale
R
elaxation strategies to lower stress are as old as
human civilization. There are old and more
familiar techniques and newer and more
unfamiliar techniques. In this chapter, the older and
more familiar techniques will be referred to as
"general methods" and the newer and more
unfamiliar techniques will be referred to as
"systematic methods" of relaxation. Relaxation
strategies, particularly those associated with the
systematic methods, have demonstrated to be most
effective approaches for reducing the physiologic
arousal of stress. The discussion that follows will
include both types of relaxation methods. Exhibit 21.1: Relaxing by reading on a palm tree on the
Generally speaking, relaxation is thought to beach
be involved with activities that are "mentally
passive." That is, we think we are relaxed if we don't have to think, at least for a while, about "thought-
provoking"activities and/or carry-out major responsibilities. On reading this section of the book, you
may say to yourself that you are already doing several things to help you relax, such as reading on a
palm tree on a beautiful beach (see Exhibit 21.1). However, after a careful look you may also agree that
you are not feeling any less tense or uptight. Could it be that you are like many other people who are
not really sure what relaxation means? Or, could it be that you have been misled by certain
misconceptions about what relaxation is not?
Misconceptions About Relaxation Involving Selected Activities

Given the possibility that individuals are likely to engage in activities that they may deem
universally relaxing, it is important to present a brief discussion concerning a select number of these
activities. Therefore, as you select strategies to manage your stress, these strategies will be selected in
the context of the various misconceptions concerning relaxation that exist.
Leisure Time Is Always Relaxing
This is perhaps one of the most important misconceptions that exist. As a matter of fact, many,
if not all, of the activities (e.g., sleeping under a shaded tree -
see Exhibit 21.2) we normally associate with leisure time are
themselves potential stressors. The logical question becomes
Why are leisure-related activities not relaxing all of the time?
The simple answer is that when we engage in or pursue
leisure-time activities, they are capable of triggering emotional
responses (e.g., thinking of a loved one who you recently
broke off a relationship with). It is these emotional responses
that can, themselves, be potential sources of stress.
Exhibit 21.2: Leisure can be different from

relaxation
235
Sleeping Is Always Relaxing

Sleeping can be stressful, especially if it involves heightened periods of dreaming (see Exhibit
21.3) that are emotionally arousing. EXAMPLE: when we are dreaming of fleeing from an attacking
dog. Normally when we are awake the tendency is to feel
more tired than when we went to bed. As a matter of fact,
depending on the "intensity" of the dream-related arousal,
when we awaken we may still feel the effects of our bodies
being aroused physiologically to meet the demands of our
emotionally arousing dream. Such physiologic arousal is no
way different from our bodies becoming just as aroused in
response to day-to-day wakeful and conscious stressful
physiologic activities.
Although there is no definitive way to prevent these
emotionally-related dreams from occurring, it has been said Exhibit 21.3: Sleeping can be stressful based on
that one way to reduce the likelihood of their occurrence is dreams
to try not having any stimulating thoughts immediately
before going to bed. The rationale for this suggestion is that these thoughts, accompanied by related
activities, become lodged in your subconscious mind and they are expressed when you are asleep. It is
during sleep that the unconscious mind is successful in expressing itself over the conscious mind,
hence your dreaming about the emotional experiences you had just before going to bed.
Television and Movie Shows Are Always Relaxing

Popular shows, whether they be seen on the television or in the theater, usually attract our full
attention the more emotionally involved we perceive them as being (see Exhibit 21.4)
EXAMPLE: How many times have you literally

stopped from breathing in anticipation of some action
you are about to witness on the television or at the
movies? How many times have you been so frightened
or astonished by what you see on the television that
the "shock" literally raises you off your chair in
reaction?
Exhibit 21.4: Emotionally-oriented shows can be For some people, these emotional arousals,
stressful which are very much physiological in nature, are
certainly not relaxing. Having realized the impact that
these programs are having on you, the prudent thing to do is either to stop watching these kinds of
programs, or try to understand them for what they are - only "make-believe experiences.
Watching a Sporting Show is Usually Relaxing
Depending on the type of sporting activity and how involved you are with the activity, watching
it can be stressful for you. Similar to having an emotionally involved dream during sleep, when we
watch an involved sporting activity our bodies become physiologically aroused. Sometimes this
arousal state is maintained during the entire period of the activity.
Chapter 21 . Relaxation Experiences 237
EXAMPLE: You are watching either a football, soccer,

or basketball game where the team you are cheering for
is losing. Because you cannot tolerate the way the game
is going, i.e., your favorite team losing, you get
somewhat "irate" and smash the television set (see
Exhibit 21.5). Not only are you now without a television
set after this emotionally charged outburst, but your
overall activity is responsible for allowing you to feel
even more tired and exhausted than you were before the
game started.
Exhibit 21.5: Excessive

involvement in a sporting
activity can be stressful
Vacations Are Usually Relaxing
While vacations are usually pleasurable, depending on the circumstances associated with them,
they can be stressors. Vacations by their nature subject us to different conditions (e.g., climate, culture,
physical surroundings, people, food) for which we have to adjust. This adjustment can be stressful,
particularly when it brings with it frustration, anger, and resentment toward
conditions associated with the vacation.
EXAMPLE: How many times have you taken a

vacation and you experienced several factors (e.g.,
quality of your accommodations, loud noises,
pungent smells, distasteful food, intolerable
temperatures, closed accommodations) that
brought out the stress tiger in you?" (see Exhibit
21.6).
Exhibit 21.6: Vacationing

experiences can be stressful
Heavy Drinking of Alcohol Usually Helps You To Relax

As was mentioned before, alcohol is a drug that
should only be used in moderation (see Exhibit 21.7). It has
been found that heavy drinking can cause sexual problems
among other physical and mental ailments. Although
alcohol may, at first, let you have experiences of "feeling
good," its potentially devastating consequences (e.g.,
diminishing ability to control emotions and behavior that
can lead to altercations with others, as well as accidents on
the road and in the home) are likely to follow, especially if Exhibit 21.7: Drinking alcohol does not help you
you continue to drink more alcohol. to relax
If nothing more, these resulting conditions can be
sources of concern, which in turn makes them likely candidates for stressors. With these facts in mind,
alcohol consumption does not help us to relax, especially in the long run, and it is potentially
devastating to our bodies in large and frequent quantities.
Cigarette Smoking Usually Helps You To Relax

Although the process of "lighting up" and taking the initial puffs on a cigarette may seem
relaxing, over a period of time, it is not reducing your stress (see Exhibit 21.8). As previously
mentioned, the nicotine in the cigarette acts as a pseudostressor that
artificially stimulates the body, thereby "mimicking" the stress reaction
described earlier. As is the case with drinking coffee and alcohol,
moderation in your actions is very important.
Given the stress-related and other health consequences that are
associated with cigarette smoking, especially chronic and incessant
smoking, the most prudent action to take is to cease smoking. If you
cannot stop smoking on your own you should seek help from competent
medical and other personnel (e.g., support groups) who have the
expertise to assist you in this regard.
Tranquilizing Drugs Are Relaxing In the Long Run

Tranquilizing drugs (see Exhibit 21.9) help you relax at first, but at a
Exhibit 21.8: Cigarette smoking is
price! They depress or "turn off"
not relaxing in the long run activity within your nervous system.
The outcome of this pseudo-relaxation is the following: dulled senses,
impaired performance, lethargy, difficulty thinking, and a reduced
activity potential. Additionally, if these drugs or substances are taken
constantly, over an extended period of time, they may produce "side
effects" and addiction, thereby making them dangerous to your health.
As a passing note, never take tranquilizers (or other forms of
medication) with alcohol. In combination, tranquilizers and alcohol
present a "lethal" force that can threaten your life. With these facts in
mind, the best thing to do is take tranquilizers only if they are Exhibit 21.9: Tranquilizing and other
drugs can be addictive and they can
prescribed by a physician. Tranquilizers can be addictive. And like also become sources of stress
other addictive substances, if you are addicted, you may require the
help of competent medical and other personnel to assist you with your addiction and, subsequent,
rehabilitation.
Competitive Activities Are Usually Relaxing

Activities that involve competition, whether it be for money, pleasure, prestige, or just for fun,
are emotionally arousing and, therefore, can trigger the stress reaction in our bodies. The basic
mechanism of this stress reaction was discussed earlier in Chapter 14. Several competitive activities
exist, for example, playing a "fierce" tennis game (see Exhibit 21.10) ; playing in a high stake poker or
card game; betting at the race track; competing in activities, such as the sledge hammer-bell ringing
contest at local fairs. These represent only a few examples that may appear to be fun at first, but for
some people they are not relaxing.
More specifically, these and similar activities are usually stressful because we "perceive"
something important (e.g., money, pride, love, image) being dependent on their outcomes. It is the
anticipation of losing such outcomes, whatever they may be, that are emotionally arousing and, thereby,
potentially stressful.
General Methods of Relaxation
Most people use a variety of ways to help them to relax. Although these methods may work for
some and not for others, they are general methods of
relaxation, or GMOR. These methods do not allow us to
achieve a relatively high degree of mental passivity or inner
peace or calm. That is, we are still attending to potentially
emotional events in the environment around us. It is mainly
for this reason that it was previously suggested that some of
the activities, for example, taking a vacation, watching a
television show, which are associated with this general
method of relaxation can, depending on the circumstances,
be stress-producing themselves. What follows are various
types of relaxation methods used that could fall under this Exhibit 21.10: Excessive competition can be a
category of general relaxation. source of stress
Engaging in Non-Stressful Outdoor Activities

Getting Away From It All
Many people feel that when they are faced with certain pressing or demanding life conditions
(i.e., stressors), the best way to relax is simply to get away from it all (or GAFIA). These activities can
involve inside as well as outside recreational, stress-free
activities. Some outside-related activities include: taking a
slow drive in the scenic country-side (see Exhibit 21.11);
and playing non-competitive games. All of these and
similar activities take one both physically and mentally
away from stress-provoking situations (e.g., the attending
school work). One of the major factors accounting for the
non-stressful nature of the above mentioned activities has to
do with the fact that their outcomes don't usually depend on
any other factor being fulfilled, e.g., competition and the
need to win.
Exhibit 21.11: Relaxing by taking a leisurely drive
along scenic roads EXAMPLE: If you go for a leisurely ride, because you are
not rushed to reach to any particular destination, you can
fully appreciate and enjoy the scenic view and the ride with no
competing worries.
Be Creative in Doing Boring Activities

There are many activities at college that you have to
accomplish that may be viewed as boring “chores,”and
therefore, potentially stressful for you (e.g., filing class papers
in designated folders, library research, cleaning up our living
and working areas). As a result of the nature of these
activities, you simply don’t like doing them. What you have to
learn to do is try turning these customary chores into fun-
related activities, for example, be creative in how you think
and what you do when out with your friends (see Exhibit Exhibit 21.12: Turning a boring activity into
21.12). a relaxing experience
One way to be relaxed and to accomplish a task, such as doing library research for a class
paper, is to reframe the task. That is, how you perceive the task (see Chapter 17 on Cognitive
Restructure where reframing was discussed). By reframing it, you come to see it in a different light,
possibly as a more enjoyable (because you are now including your friends) task than previously
thought, hence the motivation to accomplish it. It certainly helps to make the task less stressful and
acceptable to you if you simultaneously engage in other stimulating activities (like socializing with
friends) when you are doing the task (collecting library information) itself. If this is accomplished,
these chores, whether they include cutting your grass and/or filing papers, will then be easier to do and,
at the same time, they can become both satisfying and relaxing for you.
Engaging in Non-Stressful Indoor Activities

The Power of Warm Water
There are various indoor, non-stressful activities that can be done. The important factor
associated with these activities is that you find them
relaxing and they work for you. An EXAMPLE of this
activity is taking a warm bath, which is in itself relaxing and
soothing for your muscles.(see Exhibit 21.13). If you do not
have access to a bath, you can take a warm shower. Try
adjusting the shower head so
that it gives off a slow
pulsating stream of water.
This pulsating stream of
water should be directed to
Exhibit 21.13: Relaxing by taking a warm bath. areas of your body that tend
to hold tension, e.g., the
shoulders, upper and lower back, and the back of the neck (see Exhibit
21.14). Whatever the activity, keep on doing it if, by your standards, it
makes you feel relaxed and refreshed.
The major characteristic of all these categories of events is that,
while they all require some "mental activity" (i.e., attention and
concentration), they are for the most part: a) non-competitive; b)
different from routine daily activities; and, perhaps, most importantly of Exhibit 21.14: Relaxing with warm,
all, c) they are both pleasurable and relaxing for you. In short, they are pulsating shower water
totally enjoyable! Therefore, if you select a method of relaxation from this general category, you
should make certain that it fulfills, in your estimation, these important stress reducing conditions.
Physical Activity: Stretching and Swimming
Physical activity can reduce stress and the stress response. Aerobic exercise the kind that
increases your heart rate, such as walking, running, bicycling, or
swimming, which was discussed in Chapter 19, is especially useful for
counteracting the harmful effects of stress for college students.
Stretching is also a good way to relieve muscle tension (see Exhibit
21.15). When you stretch your muscles you feel relaxed and less tense.
Regular, moderate physical activity may be the single best approach to
managing stress. As a general rule, it is important to exercise three times
a week for a minimum of 30 minutes each time. Choose a variety of
activities that you enjoy to prevent exercise from being a burden.
Exhibit 21.15: Stretch to relax
Swimming is an all round

physical activity that is highly recommended for college students. Whether it is early or late evening
swims (see Exhibit 21.16) at the indoor college pool, or the enclosed pool at the local YMCA, students
can achieve a genuine feeling of relaxation after completing their
leisurely swims.
Reading in a Quiet Location
Reading can be very relaxing if it is done in a quiet and
undisturbing location. While you may not necessarily want to
read your text book at this time, you may select an entertaining
book that you deem acceptable. Exhibit 21.16: Swimming for relaxation
Usually these books that are
selected are non-threatening, enjoyable and pleasing to read. However,
the environment in which you read the book makes a difference to
whether the experience is relaxing or not. While a secluded place on
campus is one such ideal location to read a book and feel relaxed,
another can be quite spot on the lawn of the campus where you can read
a book and relax (see Exhibit 21.17).
Exhibit 21.17: Relaxing by reading
in a quiet location
Systematic Methods of Relaxation
As previously mentioned, compared to the general methods, systematic methods of relaxation

or SMOR, as they are introduced in this book, are more recent and specific techniques of relaxation.
However, although they are becoming increasingly popular, they are not as widely used as the general
methods of relaxation, or GMOR, mentioned before. One reason is that SMOR are not readily
accessible to the average person because they usually require more specific knowledge and training for
their implementation. Nevertheless, SMOR have proven to be more reliable and effective than
techniques associated with GMOR. This has been particularly true when assessing a) how people have
reached their desired level of relaxation or "mind functioning" (e.g., in biofeedback) and b) the
scientific validity of these methods for verification and other reasons.
Although there are several explanations for the relative effectiveness of the SMOR in
achieving relaxation, a major one is that the training techniques under these methods are both
consciously learned and systematically applied to daily situations. Also, when these techniques are
applied, a deliberate cognitive (or mental) action is taken along with a carefully focused attention to
achieve one and only one objective, i.e., to have a relaxed and functioning body with a clear mind, as
well as a focused and "tuned perception" of daily life events. In short, the mental passivity referred to
before, which is so important for effective relaxation to occur, is more widely achieved using these
SMOR techniques.
Another reason why these SMOR techniques are relatively effective has to with the fact that,
when they are carried out correctly, they stimulate "key" nervous (e.g., parasympathetic) systems,
which in turn act to reduce the arousal of our internal organs (which is part of the internal stress
reaction). An additional benefit derived from systematic relaxation training is referred to as the "carry-
over effect." That is, through the regular practicing of systematic relaxation techniques, your mind and
body become conditioned to respond even to relatively low levels of internal physiologic arousal (i.e.,
from perceived stressors), even when you are not consciously trying to relax.
EXAMPLE: If you regularly practice any one of the relaxation techniques before your day begins, say
in the mornings before going off to school, you will become less mentally and physically "drained" in
response to perceived stressors throughout your day.
There is an increasing variety of SMOR training techniques currently used to achieve
relaxation. As is expected, these techniques have their advocates and detractors. There is no one
universally acceptable technique that will work equally well for all people. You simply have to see
which one, if any, works the best for you and stick with it. What follows is a brief overview of selected
techniques that qualify as SMOR. Where applicable, follow the instructions and practice each
technique and see which one or a combination of techniques work the best for your needs. Because of
limitations of space, a more thorough coverage of these methods of relaxation is not possible;
however, use the reference list at the back of this book as a guide to locate specific books and
additional information regarding these techniques.
Deep Breathing
When you feel tension beginning to build up during your day, it is advisable to take a few
minutes to relax. One way to do this is by controlling your breathing (see Exhibit 21.18). This has the
effect of relaxing selected muscles in your body, as well as increasing the supply of oxygen to your
body system (e.g., your brain and related organs). However, for the breathing to be effective, it must be
carried out correctly.
PROCEDURE:
The position of your body is "key" to achieving success. Make yourself
as comfortable as possible. If it is convenient, lie on your back with your
feet slightly apart and knees bent. Breathe slowly through your nose,
inhale deeply and slowly, let your stomach expand. Next, exhale slowly
and completely through your mouth at the same time letting your jaw
and neck muscles relax. Practice this procedure for several minutes
until it becomes natural and rhythmic. Rather than doing this breathing
exercise only when you feel the need to, adopt a more "prevention
approach" and do the breathing exercise at least twice each day, Exhibit 21.18: Practicing deep
preferable in the mornings and in the afternoons using approximately breathing to relax
15-20 minutes duration for each session.
Meditation
Meditation is increasingly becoming a widely used technique for relaxation (see Exhibit 21.19).
There are several forms of meditation, ranging from the more "popularized" Transcendental Meditation
or (T.M.) to the old Eastern meditative disciplines such as Yoga and
Zen. In its basic form, meditation is the art of deliberately emptying
the mind of its customary demanding bodies of thought, and allowing
an inner "voice" to speak to your innermost "soul." In essence, the
technique allows the mind and body an opportunity to rest, relax and,
if need be, recover from prior stressful experiences.
PROCEDURE:
The success of this technique is very much dependent on your body's
position. More specifically, the muscles in your body should be
consciously relaxed. Choose a "comfortable" position, preferable on
Exhibit 21.19: Using meditation to an upright chair, in which you feel you can sit for approximately 20
relax
minutes without feeling any strain on your back or legs. Now close your eyes and inhale and exhale
deeply and slowly a few times, allowing your body to go limp. At this point, clear your mind of any
conscious thoughts and concerns, and just attempt to listen mentally.
This process will not occur easily at first. As a matter of fact, ordinary thoughts will come
flowing back into your mind, but you must try to resist them. As time goes on, you will acquire the
ability to resist the intrusion of these "undesirable" thoughts for shorter, then, eventually, longer
periods of time until you achieve the point of doing it without interruption for the desired 20 minutes,
twice daily periods. As you are able to perfect this technique, you will find that this "quiet time" is a
cherished period of "peace" in the midst of a forever "fast-moving" world around you. The good thing
about this technique is that you can practice it just about any place, e.g., in the car pool or train going
to or coming from work; in the park; at home; and at work during breaks. The major criterion is that
there be relative quietness around you and that you will be uninterrupted for at least 20 minutes.
Positive Imagery
This is a relatively new technique used for relaxing. Using imagery means creating mental
pictures that activate the "natural" relaxation response in your body. These mental pictures can be
provided by an outside source, e.g., an instructor, or they can be created by you. Our bodies seem to
respond more readily to pictures created in our minds than to verbal commands (see Exhibit 21.20).
PROCEDURE:
Position yourself in a situation that is comfortable and, if
possible, quiet as well. Allow your mind to enjoy for at least 5
minutes some quiet scene that has been a favorite of yours in the
past. EXAMPLES include: a scenic country side; the sun setting
behind the backdrop of mountains in the evening; a slowly
running stream where fish and other animals exist; a gracefully
falling waterfall; the beautiful sounds coming from birds and
other small animals in the woods at early morning. These and a
variety of other "scenes" you can think about can be very
refreshing and, thereby, relaxing for you. Again, the beauty about Exhibit 21.20: Using positive imagery to
this technique is that you don't have to be physically at the relax
"scene" of any of these experiences; you have only to allow your
mind to construct them realistically to experience their primary "rewarding benefits" of relaxation.
Massage Therapy
Therapeutic massage, or simply massage therapy, is increasing in
popularity simply because it fills the gap created by our modern-day
stressful living. Massage is one of the oldest forms of health treatment (see
Exhibit 21.21). Its use has been documented from records taken from the
Japanese, Chinese, Egyptian and Arabic cultures. Hippocrates, the reputed
father of modern medicine, prescribed massage for patients and athletes.
Since approximately 75-80 percent of all the illnesses we suffer today are
related to tension and emotion, massage therapy, by its very nature,
represents a tremendous benefit to countless number of people who suffer
from nervous tension and emotional stress. While there are a many types of
massages, Swedish Massage remains one of the most widely practiced
Exhibit 21.21: Using forms used for many reasons, including relaxation and improvements in
therapeutic massage for health.
relaxation
Massage acts on the nervous system to compensate for the body’s response to stress.
Essentially, it helps in relaxing muscle tension and allowing the heart rate, circulation and blood
pressure to return to normal. Many people report having a rejuvenating experience following a
therapeutic massage. The following are a few of the known effects of massage therapy: a) increase in
circulation of blood and lymph; b) relief of muscle tension, including the “re-education” of muscles
after trauma; c) initiating the relaxation response and generalized feeling of well-being; d) pain
reduction; and e) generalized stress reduction.
In terms of stress reduction, therapeutic massage allows us to relax. Sometimes we forget how
to relax and, perhaps more importantly of all, that we are allowed to relax. Massage provides an
opportunity to release tension and do “repair” on both psychological and physiological levels. It has
been reported that the therapeutic touching involved in massage encourages the release of hormones
that produce the tense “fight-or-flight” internal stress reaction, which was mentioned in Section two of
the book.
PROCEDURES:
Unlike the other forms of systematic relaxation, therapeutic massage puts you more in a
receivership role where the certified massage therapist or MT does all of the work on you for you.
Generally speaking your MT begins the session by asking you some basic health questions simply
because there are some conditions for which massage is not appropriate. As there are various types of
therapeutic massages, the exact procedure will vary as a function of the type being used. However, as
mentioned before, the Swedish is one of the more popular methods used.
Therapy is given by a certified MT who has had training in basic anatomy and physiology, as
well as massage. The therapist may also have other skills in related areas (e.g., Aromatherapy,
Reflexology, Deep Tissue Massage, Trigger-point, acupressure, Rolfing, Myofascial release and Reiki).
Whatever the form of massage used, such as a full-body massage (see Exhibit 21.21), it can be done in
a shortened 10-15 minute format or a longer 45-90 minute format. The shorter session, which is
sometimes called a “stressbuster” massage, is done in the seated position (hence its label “seated
massage”), in a specially designed chair (see Exhibit 21.22), using no oils and without disturbing
everyday “work attire.” Basically, it concentrates attention to the neck, shoulders, back, lower back,
arms and hands. Through pressure on specific stress release points, as well as gentle manipulation, the
body is able to throw off its built-up tension.
As mentioned before, an increase in circulation is a byproduct of
massage.. Because this type of massage is usually done in an office, its main
advantage (i.e., over the longer version) is that it leaves you feeling awake,
alert, and ready to continue your daily work and related activities. The
important bottom line, however, is that you feel totally relaxed and
rejuvenated.
In the case of the longer and more intensive form of massage (see
Exhibit 21.21), after taking your medical history your MT leaves the room
while you undress to the level that you feel most comfortable (i.e., fully or
partially) and you cover yourself in a fresh sheet and relax on a table in the Exhibit 21.22: Specially
room. Your MT enters and makes sure that you are properly covered, designed chair for seated
comfortable and relaxed. Some sort of oils or lotion may be used. massages
In the case of Swedish Massage, it usually begins with a light steady touch. This in turn is
usually followed by broad, flowing strokes, kneading and friction. These activities start calming your
nervous system, and tension locked up in your muscles begin to be released in your superficial muscles.
As your body becomes more relaxed, your MT works more deeply to relax specific areas (especially
these areas you discussed with the MT that needed the greatest work, e.g., neck muscles). Deep tissue
massage is work affecting deeper layers of muscle and connective tissue to break up accumulated
congestion and speed removal of the body’s metabolic waste.
Progressive Relaxation
This is a relatively new technique used for relaxation. Progressive relaxation is a technique that
focuses on muscle group awareness, where you actively tense and then deliberately relax one group of
muscles after another. Again, this technique will be more successful if you are in a relatively quiet
surrounding and in a comfortable position either lying on your back or
sitting in an upright chair (see Exhibit 21.23).
PROCEDURE:
This technique can be facilitated by an external source, e.g., an
instructor, or you can give yourself instructions verbally or mentally.
Whatever the case, instructions are given that will systematically
progress from one muscle group to the next indicating when you should
tense and when you should relax. Until you get accustomed to the
technique, it would be advisable to let someone knowledgeable with the
procedure carry you through the exercise. If done correctly, you should
Exhibit 21.23: Using progressive
feel more relaxed after you have applied the technique. And like the
relaxation to feel relaxed other techniques, it is advisable that you practice it at least twice a day
for 20 minutes duration. The ideal times are during the morning before
you begin your day and in the afternoon after you have just about completed your day. It should be
noted that this technique is especially helpful during certain experiences, for example, when you are
agitated, angry, and/or frustrated. The physical activity in these conditions helps in releasing the
tension you are trying to release.
Biofeedback
This is not only another relatively new technique to achieve relaxation, but it is perhaps the
only one that requires, particularly at the onset, the use of "space age" electronics. It is due perhaps to
this latter factor, why this technique is relatively more expensive and somewhat more inaccessible to
many people than the other techniques. It is perhaps because of this latter factor why biofeedback has
not yet enjoyed a more popular appeal among the "general" public.
Biofeedback uses various types of instruments to measure the
manner in which your body operates. Therefore, by carefully monitoring the
operation of your body, these instruments can detect the onset and level of
the stress response. More specifically, information concerning your heart
rate, hand temperature, muscle tension, perspiration levels, and brain wave
activity is transformed by modern-day electronic equipment into various
signals that you can either: see (visual), hear (audio), and/or feel (tactile). By
trial and error you learn how to control your bodily functions that you
thought were under the control of the body's involuntary system (see Exhibit
21.24 ). Therefore, it is reasoned that with such "voluntary" control on your
part, you can learn to control many of your everyday stressors that are likely Exhibit 21.24:Using biofeed-
to activate the stress response in your body. back to relax
PROCEDURE:
This technique can be practiced on your own if you have the necessary biofeedback equipment or you
are in some defined laboratory setting under the supervision of an instructor. Whatever the source and
depending on the type of equipment available, when you are in the sitting position "electrodes" are
placed either on your fingers, skin, forehead, and chest. Whatever the particular site of attachment
used for the electrodes, the idea is to ascertain and monitor underlying electrical activity and
information in your body. This information pertains to, for example, your pulse rate, brain wave, heart
rate, and muscle activity/reactivity. This information, which indicates your present level of "tension,"
as exemplified through your underlying bodily activity, is fed or shown to you through one of several
sensory sources, i.e., visual and audio, on the biofeedback equipment. With this information in hand,
you are supposed to modify the "readings" (as they are warranted) by a conscious manipulation of
your body system, using selected, conscious mental activities.
FOR EXAMPLE: If your pulse rate was shown to be too high, and you were in a confined clinical
setting, you would be instructed to use, for example, mental imagery to lower your pulse reading and,
very importantly, witness how successful you are in achieving this or similar objectives. It is reasoned,
that once you learn to modify your body mechanism via mental thought, you will no longer need to be
"hooked up" to the biofeedback machine anymore to attain acceptable body functions, which
undoubtedly include relaxation. When you have, through regular practice sessions, learned to control
your "body activity" whenever the situation warrants it, you can now begin to initiate the process in the
future without being attached anymore to the biofeedback instrumentation.
The Technique of Rezeroing

The complexities of our modern-day living suggest that we should, especially because of health
implications, relax and "regroup" our resources as often as our schedules will allow. "Rezeroing" is a
simple “cognitive” technique (see Exhibit 21.25) that will allow you to: a) relax, b) "recharge your
mental and physical energies, and c) as a result be in a more ”resourceful” position to deal with
potential life stressors on a daily basis.
Learning to relax on a regular basis is an important part of coping with stress. Whatever
method you use to relax, use it often. But you should still aspire to achieve a much more "overriding"
effect from relaxation, which would go a very long way in allowing you to achieve more lasting and
effective stress management skills.
The sum total that you should try to achieve, using any one or a combination of the afore-
mentioned relaxation techniques, be it from the GMOR or the SMOR, is trying to regain your
maximum "equilibrium" point of origin. Theoretically, this is where you were before you got tense,
anxious, or under stress. It is the "ideal" point where all your body systems were functioning as they
were fully capable of functioning. In other words, you should try, preferable at the "beginning" of your
day, to literally "reset" your sensory and bodily apparatus back to the position of optimum efficiency.
This is what is referred to as “ReZeroing.” Given the all-encompassing nature of ReZeroing as a form
of relaxation, it is presented last as an important form of SMOR.
PROCEDURE:
This is a very simple technique and “cognitive”or mental exercise, which is recommended to
be done at the start of each day, just as soon as you get up in the mornings. In essence, it combines
some of the techniques already referred to before, e.g., progressive relaxation and deep breathing. At
first you locate a spot that is "quiet" so that you will not be disturbed for at least 15 minutes. Focus on
the inner workings of your body and try to compare your body with that of a thermometer, especially
the "mercury" in the center of the thermometer, which is at its highest point. As you imagine the
mercury being systematically lowered to the initial point of "Zero" (0),
think of your entire body system (e.g., heart, blood pressure and
kidneys) similarly. Another way to ReZero is to focus on a "slot
machine" that has three columns of nines (9s), and now these nines (9s)
are returning to zeros (0s), i.e., their baseline positions or points of
origin. Think that your body system is "elevated" (as in the case of the
mercury or the higher numbers in the slot machine) because of the
previous day's working, but now you have to return it to its initial point
of maximum effectiveness, ZERO or BASELINE. Having understood the
analogy of your body system with that of the "falling mercury" in the
thermometer, or with 9s changing to 0s, focus now entirely on the
falling or "ReZeroing" of your combined body system. If this is done Exhibit 21.25: ReZeroing as a
cognitive method to relax
repeatedly and successfully, you will literally feel "charged-up" to deal
with all the potential stressors that you are likely to perceive and experience as you begin your daily
activities.

Relaxation Experiences
O Misconceptions About relaxation Involving Selected Activities (p.235)

9 Leisure Time is Not Always Relaxing (p.235)
9 Sleeping is Not Always Relaxing (p.236)
9 Television and Movie Shows Are Not Always Relaxing (p.236)
9 Watching a Sporting Show is Not Always Relaxing (p.236)
9 Vacations Are Not Always Relaxing (p.237)
9 Heavy Drinking of Alcohol Does Not Help You To Relax (p.237)
9 Cigarette Smoking Does Not Help You To Relax (p.238)
9 Tranquilizing Drugs Are Not Relaxing In the Long Run (p.238)
9 Competitive Activities Are Not Necessarily Relaxing (p.238)
O General Methods of Relaxation (p.239)

9 Engaging in Non-Stressful Outdoor Activities (p.239)
: Getting Away From It All (GAFIA) (p.239)
: Be Creative in Doing Boring Activities (p.239)
9 Engaging In Non-Stressful Indoor Activities (p.240)

: The Power of Warm Water (p.240)
: Physical Activity: Stretching and Swimming (p.240)
: Reading In a Quite Location (p.241)
O Systematic Methods of Relaxation (p.241)

9 Deep Breathing (p.242)
9 Meditation (p.242)
9 Positive Imagery (p.243)
9 Massage Therapy (p.243)
9 Progressive Relaxation (p.245)
9 Biofeedback (p.245)
9 The Technique of ReZeroing (p.246)
___________________________________________________________________________________________
22.
Where To Go From Here
ë
“To be what we are, and to become what we are capable of
becoming, is the only end of life.”
- Baruch Spinoza
W
hile the health and success students have in college are dependent on various interacting
factors, the main position taken in this book is that stress is one of these salient contributing
factors to students’ health and success in college, as
well as beyond. This point is underscored by the title of the
book, “Stress Management 101 For College Students: A
Guide For Improving Health and Performance.”
As was discussed in previous chapters, stress has
reached epidemic proportions on college campuses. Given
the documented evidence of the stress-health and stress-
performance relationships, the implications for such an
epidemic are enormous. As was argued in the book,
ultimate control and management of stress involves efforts at
the societal, or macro level, as well as efforts at the
individual, or micro level. While both levels of intervention
are important, given how stress was defined in the book as
being a “personal” issue, greater emphasis was placed on Exhibit 22.1: Controlling college students’ stress
individual efforts at controlling college students’ stress. In in the future
this last chapter of the book, some reiterations are made concerning some of the major points made in
some of the previous chapters. In addition to this information, the main thrust of the chapter, while
building on this information, outlines some steps that must be taken to minimize college students stress
in the future (see Exhibit 22.1).
As we plan for the future, we must build on the information and the achievements acquired in
the past. This information concerns the following: a) stress and college students, b) approaches to
stress taken in the book; and c) specific approaches to control stress in the college student population.
Stress and College Students
In Chapter 4 a discussion was presented concerning the need to urgently address the “epidemic
nature” of stress among college students (see Exhibit 22.2), especially
incoming freshmen. The conditions that cause stress, or stressors,
include their personality dispositions (i.e., personality stressors); events
in their personal lives (i.e., private life stressors); their interpersonal
relationships (i.e., psychosocial stressors); conditions that they
experience related to their academics (i.e., academic stressors); and
experiences they have related to how college life is organized (i.e.,
organizational stressors); and experiences they have related to the
environment around them at college (i.e., environmental stressors).
Exhibit 22.2: A variety of

stressors students are likely to
experience. 249
250 PART IV % Where To Go From Here
Approaches to Stress Taken in the Book

There are certain distinct approaches taken in this book regarding stress and stress
management for college students. These approaches reflect the author’s decade and a half long work in
the areas of stress and stress management. However, while some of the diagrams and positions offerred
are original and specifically designed for this book, most, if not all, of the information suggested is a
reflection of past ideas and research in the area of stress and stress management over the last thirty-five
years or more. Essentially, what was done included simplifying and streamlining the information to suit
the needs of vulnerable populations, such as college students. The overall information presented is
consistent with Dr. Livingston’s Three-Step Approach to Stress Management, or the I-R-M Approach.
While the I-R-M Approach is discussed through out the book, the last three parts of the book deal
exclusively with each sequential section.
The Stress-Tiger Analogy

While other analogies could be made with ongoing stressors, the tiger
was chosen, because of its known “ferociousness” (see Exhibit 22.3) to depict
stressors that can, if allowed to go unchecked, harm us in many ways. While
not all tigers will hurt us, the idea of the analogy is to remind college students
that the various stressors they experience on a daily
basis have this potential to physically and mentally hurt
them if they allow them to do so. This being the case,
they have to know about the stress process ti be in a
better position of controlling the stress tiger and not let
it control them. If they are successful at knowing about
this process they will, in time, enjoy improvements in Exhibit 22.3: Tiger
their health and, subsequently, their performance in being ferocious
college, as well as in their overall lives. When this
occurs, as seen in Part IV of the book (Chapters 17 through 21), the symbolic
representation of the tiger changes from having a ferocious snarl to one that is
Exhibit 22.4: Tiger more subdued and under control (see Exhibit 22.4). The message for college
being being calm students then is clear, appreciate the potential destructiveness of the stress
tigers in their lives and, with this knowledge, learn how to control these stress
tigers (i.e., using stress management strategies), thereby making them calm and controllable.
The Transactional Nature of Stress and the E + P = R Formulation

In Chapter 3 the importance of viewing stress in transactional terms was discussed along with
the related formulation of E + P = R. Both of these complementary discussions are at the core of how
stress is presented in this book (see Exhibit 22.5). These discussions also relate to how college students
are advised to better understand and ultimately learn to manage their stresses using one or a
combination selected strategies.
Students need to be educated about the simple, yet effective notion, behind the E + P = R
formulation. As seen in Exhibit 22.5, and as discussed in Chapter 3 and elsewhere in the book, stress is
defined in terms of a perceived discrepancy between the demands and resources available to students.
Exhibit 22.5 shows the various contributing factors to students’ resources as well as the five categories
of stressors (also seen in Exhibit 22.6) discussed in the book under separate chapters.
Chapter 22 . Where To Go From Here 251
Exhibit 22.5: The transactional view of stress and the E+P=R formulation
Both Exhibits 22.5 and 22.6

illustrate the crucial contributing
factors to E and R, as well as to the
core, or “unknown” in the equation
- P (or perception). Students need
to understand the importance of
these contributing factors to both E
and P. What is equally important
for students to know is the
fundamental important role their
personalities play as salient
contributors to the overall demands,
as well as directly to their
perceptions of these demands.
Therefore, given that students’
personalities play such a crucial
role in how they perceive stressors
and stress, as well as the subsequent
stress responses that ensue, the
personal nature of stress and the
effective role students can play in
managing their stress are further
underscored.
Exhibit 22.6: The interlocking importance of the five integrated stressors
Specific Approaches To Control Stress in the College Student Population
As mentioned before, and as is evident in the chapters of the book, the simplified 3-Step
Approach to Stress Management that I have developed over the last decade served as the guide for the
information on stress and college students presented in the book.
Part II of the book (i.e., chapters 3 through 12) deals with the
“I,” Part III (i.e., Chapters 15 through 15) deals with “R,” and
Part IV (i.e., Chapters 16 through 21) deals with “M.” It is my
hope that college students who are prone to experiences stress
(see Exhibit 22.7) will be exposed to this I-R-M Approach to
Stress Management as early as their freshman year in college, so
that they can learn about the steps that they should take in
managing their stress over the next four years and beyond.
Personal Plan of Action (PPOA)

As discussed in the book, for college students to be Exhibit 22.7: Students being familiar with Dr.
successful at managing their stress, and thereby improving their Livingston’s 3-Step I-R-M Approach to Stress
management
overall health and performance, they must have an action-
oriented Personal Plan of Action, or PPOA. When students have defined their PPOAs, whether it is
with the help of counselors or others, they literally have a “scheme” to follow throughout their college
years and beyond.
Essentially, the PPOA for students must adhere to the 3-Step Approach to Stress Management,
where there is an important interrelationship between the six(6) categories of stressors they are likely to
experience and the five(5) stress
management strategies they can
choose from in controlling their
stress (see Exhibit 22.8).
Regarding the I-R-M Approach,
students must first understand and
identify the background, nature
and causes of their stress, or
stressors [I]; next they must
recognize the signs and reactions
they have and make to stress [R];
and lastly, they must manage stress
using a combination of strategies
[M]. Again, students must pay
close attention to the designated
chapters in the book that discussed
individual aspects of the I-R-M
Approach and take from this
Exhibit 22.8: A PPOA must include the basics of the 3-Step I-R-M Approach to
Stress Management, which in turn allows for a greater understanding of the
knowledge specific information
interrelationship between stressors and stress management strategies. that is peculiar and/or unique to
their individual circumstances. It
is this special kind of information
that will be instrumental in allowing them to be successful in managing their stress.
Chapter 22 . Where To Go From Here 253
Institutional Support and Related Recommendations
Administrators, mental health workers, and other support-related personnel at colleges and
universities have a very important role to play in how successful students are in managing their stress.
The following resources and activities must and should be a part of the college student experience:
K There should be an active counseling center that has outreach programs advising
students on the pros and cons of stress and stress management following the I-R-M
Approach discussed in the book;
K The counseling center must have a very informative, up-to-date, interactive web site on
stress and other related health topics that students can readily access;
K Colleges should have a mental health week set aside every semester where discussions
and information on stress and related subjects can be readily discussed and
disseminated to students, staff and faculty;
K Special attention at University-sponsored health fairs, web sites and campus
discussions must be given to “vulnerable” or “at risk” populations, such as incoming
freshmen, international students and non-traditional students; and
K Program activities and research on stress and college students must be ongoing and
updated information must be included in students’ curricula, as well as welcoming
brochures and books distributed at the time students are entering college. This
important information must also be distributed during special programs, such as
Freshmen Seminars and Colloquia.
It is very important that the above-mentioned information on stress be readily available to
students. Notice concerning these resources, as well as general information on stress and stress
management, must be posted at pivotal locations on campus for students to see and access (e.g.,
classrooms, dormitories, residence halls, study rooms, cafeterias, sorority and fraternity houses).
Where To Go From here
O Stress and College Students (p.249)

9 Approaches to Stress Taken in the Book (p.250)
: The Stress-Tiger Analogy (p.250)
: The Transactional Nature of Stress to the E+P=R Formulation
(p.250)
O Specific Approaches to Control Stress in the College Student Population (p.252)

9 Personal Plan of Action (or PPOA) (p.252)
9 Institutional Support and Related Recommendations (p.253)
N Exercises
ê Exercise 16.1 - Stress Diary (Page 258)
ê Exercise 16.2 - Listing, Concerns...(Page 261)
ê Life Planning Guide (Page 262)
ê Word Find For College Students (Page 267)
Other Stress-Related Information
ê Livingston’s Stress Pledge... (Page 268)

ê The Impact of Colors on ... (Page 269)
ê 101 Stress Management Tips... (Page 270)
ê Potential Stress Periods... (Page 271)
ê College Student Stress Index ... (Page 273)
ê Some Important Resources (Page 275)
ê Additional Note Sheets (Page 278)
ê References (Page 281)
ê Index (Page 300)
257
Exercise 16.1 - Stress Diary
Using a Stress Diary As a Learning Tool To Document How You Identify Stressors and Manage Your Stress
Classification of Provide Example of What Time did What Date Did What Signals What Means Used to How Successful Were
Stressors: Stressor the Stressor the Stressor Accompanied the Resolve the Stressor? Your Efforts?
9 Personality (Type of stressor experienced Occur? Occur? Stressor?
9 Private Life should determine the example (Include AM or (State full date Example: Example:
9 Psychosocial cited). PM with time). of mth /day/ Example: è Cognitive restructuring è 1. Not very good
9 Academic year). è Behavioral è Psychosocial adjustments è 2. Somewhat good
9 Organizational è Cognitive è Lifestyle adjustments è 3. Good
9 Environmental è Emotional è Situational adjustments è 4. Very good
è Physical è 5. Extremely good
è Relaxation experiences
9 None occurred (Skip
all other columns)
258
Exercise 16.1 - Stress Diary (Continued...)
Classification of Provide Example of What Time What Date What Signals What Means Used to How Successful Were
Stressors: Stressor did the Did the Accompanied the Resolve the Stressor? Your Efforts?
Stressor Stressor Stressor?
Occur? Occur?
259
Exercise 16.1 - Stress Diary (Continued...)
Classification of Provide Example of What Time What Date What Signals What Means Used to How Successful Were
Stressors: Stressor did the Did the Accompanied the Resolve the Stressor? Your Efforts?
Stressor Stressor Stressor?
Occur? Occur?
260
Exercise 16.2 - Listing, Concerns and Responses to Symptoms of Stress
Instructions: Based on your experiences within the last six(6) months, please go through the list below of possible
stress symptoms that you may have experienced under the four categories of: behavioral, cognitive, emotional and
physical. For each box that is adjacent to a symptom, please place a check [ T]in the box indicating the following:
SE = symptoms you experienced; SC = symptoms that are of concern to you; SA = symptoms that you are
addressing; and SS = symptoms that you have stopped through your actions and/or with the help of others.
Behavioral Symptoms Emotional (Feelings) Symptoms - Continued
SE SC SA SS None SE SC SA SS None
Accident prone Boredom
Foot tapping Agitation
Nervous laugh Frustration
Insomnia Other (specify):
Excessive drinking Other (specify):
Finger tapping Cognitive (Thinking) Symptoms

Absenteeism Compulsions
Lowered productivity Excessive fears
Boisterous Perfectionism
Impulsive/reckless Forgetful
Nagging Repetitive thinking
Lashing out Poor self-concept
Withdrawn Lethargy
Intolerance Excess worrying
Few contacts Putting self down
Loneliness Other (Specify):
Clamming up Physical Symptoms

Alcohol use Dizziness
Other (Specify): Nausea, light headiness
Emotional (Feeling) Symptoms Rapid heart rate
Nervousness Chest pains
Fear Grinding teeth
Anxiety Indigestion
Burnout Fatigue
Depression Headaches
Hopelessness Other (Specify):
261
Exercise: Life Planning Guide
Planning To Improve Selected Life Conditions As a Means of Reducing Stress
Important Conditions to Do You Need Priority Speed of Action: Expected Time Outcome
Status to For Improvements:
Recognize as Plans are Made to to Improve Improve 9 Slow action
Assess and Reduce Future Stresses This Condition: 9 Medium action 9 0-6 months
Condition? 9 Fast action 9 6 months - 1 year
9 Low 9 Very fast action 9 1 - 3 years
9 Yes 9 Medium 9 Extremely fast action 9 3 - 5 years
9 No 9 High 9 5 years and more
If no, skip other
columns
Improving your
personal attitudes
Improving your
time management
skills
Improving your
organizational skills
Having a religious
consciousness
and/or believing
in the need to have a
spiritual awakening
Having regularly
scheduled medical
examinations
Learning to say NO
262
Exercise: Life Planning Guide (Continued...)
If no, skip other
columns
Issues relating to
accidents, illness and
death
Reducing substance
use and/or abuse
Getting adequate
sleep
Engaging in regular
and appropriate
exercise
Having regular
vacations and
recreational
activities
Engaging in family
and related private
life matters
263
If no, skip other
columns
Improving dietary
and nutritional
habits
Having a regular
time to practice
relaxation
Addressing
educational and
career-related
issues
Modifying
personality and
lifestyle activities,
thereby “slowing
down”
Addressing financial
and related issues
Appreciating
humor and
the Ability
to laugh
when needed
264
If no, skip other
columns
Becoming more
aware of security
and crime-related
issues in the
environment
Selecting
manageable work
given your
resources
Having confidence
in yourself and
abilities to achieve
your desired goals
Becoming more
concerned about
emergent
environmental
threats to security
Seeking out and

having supportive
family and friends
to “lean on” in
times of need
Knowing more
about stress by
following Dr.
Livingston’s 3-Step
I-R-M Approach to
Stress Management
265
If no, skip other
columns
Knowing your
stress gauge and
related signals
Balancing your
activities, whether
they be at college or
elsewhere
Having a Personal
Plan of Action
(PPOA) to reduce
your stress now and
in the future
Is there another
condition not
mentioned that you
want to improve?
Specify:
Is there another
condition not
mentioned that you
want to improve?
Specify:
Is there another
condition not
mentioned that you
want to improve?
Specify:
266
Exercise: Word Find For College Students
Instructions: Please find the following words in the puzzle below.
Alcohol Exercise Library Students
Anger Family Management Studying
Anxiety Financial Meditation Support
Bus Food Panic Tickets
Cars Friends Parking Time
Coaches GPA Procrastination Validation
Computer Grades Professors Violence
Counseling Graduation Relationships Weather
Crime Headache Rooommates
Diet Health Sleep
Doctor Honors Stress
Drugs Hospital Stressors
L M S F A M I L Y R C O A C H E S M F R I E N D S S T O S P
H E E H A B E M A N A G E M E N T S U P P O R T E E E R S E
T D A C N R O C P R O C R A S T I N A T I O N N C T N G P R
L I I T R E L A T I O N S H I P S V I O L E N C E A T N E K
A T S P P A S C R I M E R I G H T M P P I D C N A M O I S A
E A A T R A E L R N U I E S N S E X E R C I S E N M N L L P
H T E R R O S A E S T U D Y I N G R M F D T E O H O W E O H
F I S A E E F R E E F L S O K S H O N O R S I O I O E S H L
S O A E A T S E O A P O R N R U A R C O T T S T T R A N O G
T N N N D B U S S S D I O A A N N T P N A P A N I C T U C N
E O A E G A T P S S S I C D P R O A E D I U A N R L H O L E
K E S O P E R F M A O E E P O R N D I T D S S P G R E C A L
C E R G G N R G T O F R R T O I U L A A F L S O N S R N N H
I S L I B R A R Y I C O S T C T A L R S F I N A N C I A L I
T A N X I E T Y D R U G S S S V R G A D S H E A D A C H E O
H F R O I R O S A C I S D N A N E S Y A R R A S I S L H I S
267
Other Stress-Related Information
Source: Taken from Livingston, I.L., & Livingston, S. (1994). Understanding Stress Using Pointed Illustrations.
Olney, Maryland: StressHealth Institute International.
268
The Impact of Colors on the Mind
Cools, calms, secures, reduces tension and Associated with inner peace, calm, balance and
stimulates the mind. It also allows for feelings of spirituality.
spaciousness.
Represents calm, balance and Associated with coolness and

sympathy. It can reduce eye gives a feeling of freshness and
strain. spaciousness.
Associated with mental action Can induce feelings of

and creative thought. It can also impatience and restlessness. It
be expansive, cheerful and is also a strong appetite
uplifting. stimulant.
Associated with passionate Associated with tranquility,

feelings. It stimulates, warms composure, spirituality and
and is very eye-catching. serenity.
Associated with spirituality, purity, wholeness These shades can be intimate and protective.
and unity. Its effects range from coldness to They are the preferred colors for highly
calmness. responsible people.
Color is essentially reflected light. The color waves of the spectrum blend into each other, running from violet (the
shortest visible wave) through blue, green, yellow and orange to red (the longest visible wave). We see it through
our eyes, our sensory makeup and our minds. The vibrational energy of color, whether it is associated with your
environment and/or the clothes you wear, serves to stimulate your moods, hence your ability to perceive stressors.
Strong energy is present in all bright, warm colors, because they are the longest rays of the visible spectrum of light.
However, this is not the case with pastel colors or the cooler blues and violets, whose intensities are lesser in length
and strength. Given that most people are color bias, you should carefully select colors that help you to relax and
also enhance your moods.
269
270
Potential Stress Periods and Stressors For College Students During A Typical Academic Year
August-September October November December January February
(Adjustment and assimilation) (Possible misjudgements (Academic pressures and (Worry over exams and (Feeling refreshed optimistic (Academic, career, relation-
over college) bad lifestyle habits collide) holiday concerns) or pessimistic) ship s and related issues)
ê Continuation issues (on-going ê Did college live up to ê Midterm grades need ê Panic, fear, depression, anxiety ê Too early to tell! ê Are the feelings of pessimism
students expectations, especially for improving may set in because of final ê Preparing to come back strong coming becoming a reality?
ê Adjustment issues, especially for freshmen ê Pressure to perform on final examinations and the need to if Fall Semester grades were ê Are the feelings of optimism
beginning Freshmen students: ê Did I make the right examination perform well weak becoming a reality?
ê Beginning conflict over values and choice in going to college? ê Mental and physical health ê Will I be coming back in the ê Feelings of pessimism ê The reality of the second
peer pressures related to drugs, ê Did I make the right issues related to maladjustment to Spring worries and concerns? ê Feelings of optimism semester begins to sink in, good
alcohol, sex, parties, religion, race, choice in selecting this college life ê Same fears and concerns ê Possibly second thoughts about or bad
etc. college? ê Decision to call it quits associated with the Thanksgiving selection of major ê If grades continue to suffer,
ê Feelings of “small fish in big pond” ê Midterm concerns ê Loneliness sets in, especially recess are associated with the ê Hoping financial needs met for decisions about major begin to
ê Transitional differences between ê Relationships finding for those who did not make the Christmas holidays going home the semester become more of a reality.
high school and college. “Am I up to friends, being invited out, needed friends ê Financial issues associated ê Other: ê Relationship issues need
the task?” saying some “ Nos” to ê Thanksgiving a period of joy with traveling home addressing. If any changes
ê Independence from home invitations and anticipation for some, while ê Financial issues associated occurred over the Christmas
ê Unrestrained involvement in social ê Pregnancies begin to show for others it is a period that they with buying gifts and for whom break, whether they are good or
activities, resulting in guilt, concern, from sexual activities in the want to pass ê Leaving friends made at bad they will begin to become
time management issues, Summer ê For those who see the college, especially if family more evident and obvious
poor lifestyle activities (sleep, ê Job opportunities not Thanksgiving break as negative, members at home are not viewed ê Failed social relationships may
nutrition, exercise) working out, either on it may involve not wanting to see as a worthy substitute result in first time or intensified
ê Parents becoming annoying because campus or off campus relatives, leave friends at college, ê Pressure to have sexual antisocial behavior and/or
they are constantly “calling in” and ê Other: explain to family that grades were relations because of impending destructive lifestyle activities
asking probing questions not good, especially for the last separation and the pressure to (drugs, drinking, etc.)
ê Pregnancies begin to show based on ê Other: midterm cycle. This latter point “cement” relationship ê Summer employment thoughts
sexual activities over summer is more problematic, especially if ê Other: ê Other:
ê Other: ê Other: grades were sent home
ê Other:
271
March April May
(Midterms, doing better, doing (Graduation and end-of- (Apprehensions, goodbyes,
worse, or doing the same as year Jitters regrets and sorrows)
before)
ê Academic concerns established, ê Graduation jitters, both ê Graduation jitters, both
especially after midterm examination positive and negative positive and negative increase
grades ê Undeclared Freshmen may ê Graduating anxieties, remorse,
ê For upperclassmen, graduation be anxious about choosing a and depression wanting to leave,
preparation intensifies, and so does a suitable major but not wanting to leave friends
variety of feelings (e.g., apprehension, ê Exams and papers and college
fear of leaving friends behind, fear of ê Pressure to do good and ê Continuing students - will I be
the job market, fear of not making the bring up GPA for the year returning in the Fall?
necessary grades to graduate ê Job recruitment anxiety ê Job market, graduate and
ê X-mas pregnancies showing ê Pre-registration issues professional schools anxieties
ê Other: ê Other: ê Other:
Some of the above information was taken from the following source: http://www.hsc.edu/counseling/selfhelp/stress_periods.html. Accessed 8/20/2004.
272
College Student Stress Index (CSSI)©
Instructions: Based on your life experiences, please respond to the lead statements that appear below by CIRCLING the appropriate
number to the right of the statement.
Never Seldom Occas- Often Most of

ionally the Time
[1] [2] [3] [4] [5]
How often do the following apply?
1* Being confident that you can achieve what you want in life. 5 4 3 2 1
2 Postponing doing things until the last moment 1 2 3 4 5
3 Worrying about the goals you set for yourself 1 2 3 4 5
4* Actively trying solutions to the problems that you are having 5 4 3 2 1
5* Having a positive outlook on life 5 4 3 2 1
6* Setting aside and prioritizing the goals you set for yourself 5 4 3 2 1
7* Identifying important values in life and engaging in the 5 4 3 2 1

needed behavior to achieve these values
8* Beginning with the end in mind at the onset of most, if not all, 5 4 3 2 1
of your activities
9 Getting upset and remaining upset when things do not go as 1 2 3 4 5

planned
10 Finding it difficult to allow others to help you when needed 1 2 3 4 5
11 Having difficulties with your finances 1 2 3 4 5
12 Being concerned about your health 1 2 3 4 5
13 Feeling that you need to have more hours in the day 1 2 3 4 5
14 Being concerned about the relationship you have with family, 1 2 3 4 5

friends and others
15 Not being contented with who you are as a person 1 2 3 4 5
16 Difficulty dealing with minor everyday problems 1 2 3 4 5
17 Having conflicts with friends, roommates and/or others 1 2 3 4 5
18 Experiencing problems with one or more of your professors 1 2 3 4 5
19 Not getting the needed support from others 1 2 3 4 5
20 Needing to avoid meeting with certain people around you 1 2 3 4 5
21 Having difficulties with your boyfriend and/or girlfriend 1 2 3 4 5
22 Not having the ability to cope very well with situations and 1 2 3 4 5
people around you
273
23 Having poor studying habits 1 2 3 4 5
24 Being very worried about your grades and how you are doing 1 2 3 4 5
in college
25 Difficulty choosing a major area of concentration 1 2 3 4 5
26 Not preparing enough for your classes and/or taking needed 1 2 3 4 5

notes
27 Being concerned about your future plans and career after 1 2 3 4 5

college
28 Having concerns about the course load and sequence you are 1 2 3 4 5
taking
29 Being concerned about the University’s policies as they affect 1 2 3 4 5

you
30 Having serious concerns about the registration process 1 2 3 4 5
31 Being bothered by conditions in the dormitory or place that 1 2 3 4 5

you live
32 Being bothered by the kind of interaction between staff and 1 2 3 4 5

students
33 Having concerns with the facilities (e.g., library, cafeteria, 1 2 3 4 5

computer labs, classroom) you use on campus
34 Being concerned with the size of classes connected to the 1 2 3 4 5

selected course you take
35 Having concerns about threats (e.g., crime) in the 1 2 3 4 5

neighborhood
36 Being concerned with one or a combination of problems 1 2 3 4 5

associated with commuting, parking, getting parking tickets
and/or taking the school bus
37 Being concerned about the weather (heat, cold, snow, etc.) 1 2 3 4 5
38 Being concerned with the area surrounding the building where 1 2 3 4 5

you live
39 Being bothered with the possibility of a terrorist attack 1 2 3 4 5
40 Being bothered by too many rapid unpleasant changes 1 2 3 4 5

occurring around you
Note: © College Student Stress Index (CSSI) is copyrighted and any reproduction in whole or in part is prohibited unless permission is
granted by the author.
*Items #1 and #4 thru #8 are reversed scored in order to make increasing scores mean greater levels of stress on each of the six
indices.
Personality stressors = items 1-10; Private life stressors = items 11-16; Psychosocial stressors = items 17-22; Academic stressors =
items 23 -28; Organizational stressors = items 29 -34; and Environmental stressors = items 35 - 40.
274
Some Important Resources For College Students
www.collegestudentstress.com
Books
Barkin, C. (1999). When Your Kid Goes to College: A Parent's Survival Guide (ISBN: 0380798409).
Carter, C., Bishop, J., and Kravits, S.L. (2003). Keys to success in college, career and life. Upper
Saddle River: New Jersey, Prentice Hall.
Fraser, Lisa. Making Your Mark (5th Edition)
Gottesman, G., Baer, D., & Friends (1999). College survival. MacMillian.
Johnson, H.E., & Schelhas-Miller, C. (2000). Don't Tell Me What to Do, Just Send Money.
The essential parenting guide to the college years. New York: St Martin's Griffin.
Lauer, R.H., & Lauer, J.C. (1999). How to Survive and Thrive in an Empty Nest: Reclaiming Your Life
When Your Children Have Grown.
Pasick, P. (1998). Almost Grown: Launching Your Child from High School to College.
Rowh, M.. (1989). Coping with stress in college. New York: College Entrance Examination Board.
Steenhouse, A.V., & Parker, J. (1998). Empty Nest, Full Heart: The Journey from Home to College.
Articles
Carr, S. (2000, November 3). Parents learn about their children's challenges at college by taking a class
themselves. The Chronicle of Higher Education, p. 45.
Coburn, K. L., & Treeger, M. L. (1992). Letting go: A parents' guide to today's college experience (2nd
275
ed.). Bethesda, MD: Adler\ & Adler Publishers.
Coburn, K. L., & Woodward, B. (2001). More than punch and cookies: A new look at parent orientation
programs. In B. V. Daniel & B. R. Scott (Eds.), Consumers, adversaries and partners: Working
with the families of undergraduates. New Directions for Student Services, no. 94, (pp. 27-38).
San Francisco: Jossey Bass.
College Board News (2001, August 28). 2001 College bound seniors are the largest, most diverse group
in history: More than a third are minority, but gap remains. The College Board News 2000-2001.
Retrieved October 8, 2001, from http://www.collegeboard.org/press/senior01/html/082801.html
Levine, A., & Cureton, J. S. (1998). What we know about today's college students. About Campus, 3(1),
4-9.
Lillard, D., & Gerner, J. (1999). Getting to the ivy league: How family composition affects college
choice. Journal of Higher Education, 70, 706-703.
Nuss, E. M. (1998). Redefining college and university relationships with students. NASPA Journal, 35,
183-192.
Oluwasanmi, N. A. (2000, September). Tuition: Impossible. Smart Money, 146-154.
Scott, B. R., & Daniel, B. V. (2001). Why parents of undergraduates matter to higher education. In B. V.
Daniel & B. R. Scott (Eds.), Consumers, adversaries and partners: Working with the families of
undergraduates. New Directions for Student Services, no. 94, (pp. 83-89). San Francisco: Jossey-
Bass.
Strage, A. A. (1998). Family context variables and the development of self-regulation in college students.
Adolescence, 33, 17-31.
Wintre, M. G., & Yaffe, M. (2000). First-year students' adjustment to university life as a function
of relationships with parents. Journal of Adolescent Research, 15(1), 9-37.
Mental Health and Related Outcomes

The National Mental Health Association has several resources, including fact sheets on post-traumatic
stress disorder, depression, coping with loss and other topics. To obtain this information, visit
www.nmha.org or call our toll-free line at 800-969-NMHA (6642).
National Mental Health Association

2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22311
Phone 703/684-7722
Fax 703/684-5968
Mental Health Information Center 800/969-NMHA
TTY Line 800/433-5959
276
For additional information, visit the following Web sites:
American College Counseling Association www.collegecounseling.org
American College Health Association www.acha.org
American College Personnel Association: www.acpa.nche.edu
American Foundation for Suicide Prevention www.afsp.org
Anxiety Disorders Association of America www.adaa.org
Depression: National Institutes of Mental Health, college depression:
www.nimh.nih.gov/publicat/students.cfm
National Clearinghouse for Alcohol and Drug Information www.health.org
National Institute of Mental Health www.nimh.nih.gov
Additional Web Addresses and Resources

CampusTalkblog.com
http://campustalkblog.com
College Student Stress

http://www.stressaffect.com/college-student-stress.html
College Survival Tips: Making the Transition

http://www.collegeboard.com/article/0,3868,2-10-0-963,00.html
Coping With Disaster: Tips For College Students

http://www.nmha.org/reassurance/collegetips.cfm
Free College Resources: Getting Help Meeting College Demands

http://www.collegeboard.com/article/0,3868,2-10-0-956,00.html
Graduate Student Resources on the Web

http://www-personal.umich.edu/~danhorn/graduate.html
Growing Income and Gender Gaps in College Graduation, Institute for Social Research, University of
Michigan.
http://www. Sampler.isr.umich.edu/2011/research/growing-income-and-gend... (4/0/2012)
Panic/Anxiety Disorders
http://panicdisorder.miningco.com/
Pressures of High School and Economy Weigh on College Freshmen (Jacques Steinberg)
http://www.thechoice.blogs.nytimes.com/2011/01/27/emotional-health/?pagemode=print
Real World Freshman Guide to College

http://www.studentnow.com/collegelist/freshmanguide.html
Stress in College: Common Causes of Stress in College.

http://stress.about.com/od/studentstress/a/stress_college.htm
277
N Note Sheets
278
N Note Sheets
279
N Note Sheets
280
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Chapter 12
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299
300
Index
-A-
Absenteeism, 51, 149, 152, 159
Academic conditions, 56, 89. 116
Academic reinforcement 104. 106
Academic resources, 102, 104, 106
Academic stressors, 27, 30, 41, 54, 81, 89, 99, 102, 104, 106, 116, 120-122, 125, 173, 249
Acceptance skills, 174
Accident proneness, 150, 159
Acculturation, 83, 85-87
Action skills, 174-175
Adaptation, 37, 69, 131, 137, 143-146
Affirmation, 43, 198-199
African American: students, 42-45, 50; racism and discrimination, 42-45
African Self-Consciousness (ASC) Scale, 43
Aerobic exercise, 217-219, 221, 240
Alcohol: risk factor, 17-20; use and abuse, 18, 25, 75, 104, 115
Allergies, 154, 159
American College Health Association, 18, 105, 109
American Journal of Clinical Nutrition, 15
American Psychiatric Association, 38
Anaerobic exercise, 217, 219, 221
Anger, 22, 52-53, 56, 60, 83, 132, 141, 143152, 190, 201, 223, 233, 237-238
Anxiety, 22-23
Anxiety: dancing, 17; disorders, 21-23,40: generalized anxiety disorders, 21; obsessive-compulsive
disorder (OCD), 21-22; Post-traumatic stress disorder (PTSD), 22; panic attacks, 22; panic
disorder. 22, 233; social phobia, 22; test taking, 230-231
Arthritis, 155, 157, 159 Athletes, 41-42, 243 Asthma, 154-155,159
Association of College and University Housing Officers International, 84
Awareness skills, 174
-B-
Backaches, 143, 153, 159
Balance, 16, 21, 33, 38, 45-46, 69, 76, 129, 131, 150, 171, 174, 181, 194198, 203, 205209, 213, 228, 230
300
Barma, G. 45
Beliefs, 31,43, 62-63, 65, 73, 91183-184, 231
Bicycling, 218-219
Biofeedback, 51, 140, 241, 245-246, 248
Bisexual, 47-49
Body clock, 207-208, 221
Body responses, (reactions), 149
Burnout, 45, 51, 152, 159
-C-
Cancer, 15-16, 74-75, 109, 134, 157, 215-216

Cannon, 137-138, 144
Cardiovascular disease, 16, 23
Centers for Disease Control and Prevention (CDC), 13, 14-15, 17-19,40, 104
Change, 3, 9, 10, 13, 20, 23, 172-173, 225, 227, 233, 250
Cigarettes, 73-74, 149, 159, 215
Coffee: excessive drinking, 14, 159; stimulants, 73, 75; tips regarding use, 213
Cognitive effects: perfectionism, 151; poor self-concept, 113; worrying, 151 (see emotional
effects, 152)
Cognitive restructuring: affirmations, 198-199; assess perceptions, 194; attitudes, 227; change
and control, 198-199; clarify goals, 196; definition, 183-184; E-P-R model, 184-185;
knowledge-perception relationship and stressors, 185-187; negative thinking, 199; other
strategies, 179, 201; reframing, 184; set realistic goals, 194; sort out priorities, 196
College estimates: by gender, 4-5; education and employment, 6-7; longitudinal study, 8;
overall enrollment, 3-4; postsecondary persistence, 7-8
College students: African Americans, 42-44; athletes, 41-42. degree completion, 11; domestic,
40-41; education and employment, 6-7; graduate enrollment. 9; international, 40-41;
mental well-being. 40; minority enrollment, 10, 15; nontraditional undergraduates, 8-9;
postgraduate income, 11-12; sexual orientations, 46-47; students with disabilities, 10;
suicide 43
College Student Stress Index (CSSI), 43, 115, 125
College students' stressor correlates, 117-127
Coming out: benefits, 48; importance, 48; issues, 49
Correlation, 6, 43
Cortisol, 46, 140-141, 156-157
-D-
Daily hassles, 73-74
Deep breathing, 244
301
Demands: academic stressors 90, 97, 186; as a transaction 31-35; burnout 152; causes of stress 52, 142;
cigarettes, 149; exercise 78; family 203; health 75; home overload 72; inadequate sleep
236-master status 82-83; overwhelming events 224; saying NO 204; sexual orientations
47; stress 129. 134. 138; stress process 147, 250-251; suicide 151
Depression. 22-23, 40. 155
Diabetes 15-16, 23, 76, 155, 159
Dietary (diet), 14. 16, 18, 23-25, 76-77, 92, 104, 157, 198, 208-214,221, 230
Digest of Education Statistics, 10
Diarrhea, 73, 133, 158,215
Discrimination, 42, 47
Distress {see bad stress): xxxiii-xxxiv,22-23, 38-41, 43, 77, 85-86, 91, 115, 130, 132, 134, 148-149,
154-155, 171, 176, 197,208,224
DodsonJ.D. 37.50
Drinking: binge, 18-19
Drug abuse warning network (DAWN). 20
D'Zurilla, T.J.. 37, 39
-E-
Eating: poor habits, 77; problems 97, 150, 159
Emotional effects: anxiety and fear, 154; burnout, 154; depression,
155 Emphysema, 158
Epidemic: Aids 140; stress, 249 Epinephrine, 140, 156
Environmental conditions, 56
Environmental stressors, 27, 30, 54 56-57; 107-114, 116, 120, 123, 125. 138, 173, 249
Equilibrium, 69, 131,246 E-P-R: model, 184-185, 199; process, 31, 36 Eustress, 93, 130, 149,
154, 171,197
Evcnload, 35 Exercise: backaches, 153; importance 41, 197-198, 207-208, 215-217, 231;
lifestyle activities, 73; physical 14, 17, 78-79, 197, 240; procrastination 92; research 206; s
tress 51; types 216-220
-F-
Facts, 52, 105, 140, 177, 212, 225, 228, 230, 237-238
Fear, 22-23, 45,48-49, 52, 61, 67, 74, 77, 92-94, 104, 107, 109, 133, 141-142, 144, 152, 159, 185,
198
Feelings, 20-23, 32, 39,41,46-47, 53, 60, 75, 77, 83, 92, 99, 134, 144, 148, 151-153, 174, 183-185,
194, 197, 202, 204, 215-216, 226-227
Fight-or flight reaction (response), 137-138, 146, 154,
156,244
Food pyramid, 209-214, 221
Friedman, M. 60
302
Frustration, 82-83, 95, 103, 152, 195, 201, 208, 237
-G-
Gay, 47-49 (see Lesbian)
General Adaptation Syndrome (GAS), 137, 143-146
General methods of relaxation: indoor activities, 242-243; outdoor activities, 241-242
Geraldm D.E. 3,
Goals, 7, 9, 37-37.41,44, 60, 82, 90, 99, 105, 130, 151, 185-186, 189, 194-197, 199, 207, 226-229, 233
Graduate students: enrollment, 9; income, 11; national survey, 45-46; other work, 46; typical, 45
-H-
Haemophilus influenza, 14
Hardiness, 70
Hardy personalities, 70-71
Harvard University experience, 38
Health-Promoting Lifestyle Profile II (HPLP), 43
Health risk behaviors, 13-14, 18, 20
Headaches, 21, 41, 133-134, 143, 148, 153-154, 159, 215
Heart disease, 1516, 51, 76, 133-134, 143, 156, 159. 206, 216
Hepatitis, 109-110, 114
Hiking, 218-219.221
HIV/AIDS: cases, distribution, risk factors, 17; STDs, 17
Holmes, T.H. 70
Home events, 70-71
Hormones. 21.46, 75,77, 131, 139. 140, 149-150, 157
Human body, xxxvi-xxxvii
Hussar, W.J. 3
Hypertension, 16, 76, 133, 156-157, 159
Hypothalamus, 75, 138-141, 144, 155
-I-
Illicit drug use and abuse, 21
Insulin, 16, 155
Irritable bowel syndrome, 133, 158
Immigrants, 85-87
Inderal, xxxi
Insomnia, 51, 148-149, 159
Interpersonal, 20, 27, 32, 37,43, 54-55, 71-72, 74, 77, 82, 86, 142205, 209, 249
Insulin, 16, 155
303
l-R-M approach to stress management, xxvii, 27, 29, 127, 169, 173, 175,181, 250, 252, 253
-J-
Jumping rope, 4, 219, 221
Jogging, 218-219
Journal of the American Medical Association, 15
-K-
Kobasa, S.C. 70
-L-
Laughter, 201
Lesbian, 47-49 (see Gay)
Lesbian, gay, bisexual and transgender (LGBT), 49-50
Lifestyle adjustments, 207-220
Lifestyle, 13, 15-16, 21, 24, 43, 45-46, 48-49, 62, 67-68, 72-73, 79, 84, 145, 153, 155, 157, 169,
173, 180, 207-208, 215-216, 221, 228 Life change events: hardy personalities, 71-72; measuring
life changes, 72; pain, injury and illness, 71-72
Life experiences, 37,42, 54, 183-184, 194, 202, 208
Livingston, xxxi, 38, 89, 175, 250, 252 Lymphocytes, 140, 157
-M-
Massage therapy, 243-244
Meditation: forms of relaxation 242, 248; transcendental 51
Meningitis, 14-15, 109, 144
Meningococcal infection, 14-15
Mental health, 21-22, 38-40,42, 50, 105, 253
Mental Illness, 10, 20, 39-40, 105
Mind traps, 62-63
Mononucleosis, 39
Monthly Morbidity Weekly Report (MMWR), 14
Morbidity, 16
Mortality, 16
- N-
National Center for Educational Statistics, 3
National College Health Risk Behavior Survey (NCHRBS),
3-14, 20
National Health and Nutrition Examination Survey (NHANES),
16
304
National Heart Lung and Blood Institute (NHLBI), 15-16
National Institute of Mental Health (NIMH), 23; 39
National Survey on Graduate Students, 45
Newsweek magazine, xxxi
Nontraditional: undergraduate students, 8-9, 44-45
Norepinephrine, 144, 156 (see epinephrine)
Nutrition, 16, 76 (sec poor eating and dietary habits, 23-24)
-O-
Obesity, 15-16,25, 76, 104, 150 (see
overweight)
Obsessive-compulsive
disorder (OCD), 23 Organizational
conditions, 56
Organizational stressors, 56-57; 103-107
Overweight, 15-16, 25
Overload: systems, 23, 35
-P-
Panic attacks, 24-25
Panic disorder, 24
Perception: and subjectivity, 55; influencing factors, 32-33; transaction process, 31
Personality conditions, 56
Personality stressors. 59-64
Personality trails and related behaviors, 60-62
Physical effects: allergies and asthma, 156-157; arthritis, 157; backaches, 155-156; cancer, 159,
diabetes, 157; headaches, 156; hypertension, heart disease and stroke, 158-159; other
conditions, 159-160; ulcers, 157-158 Physical inactivity: distinctions, 16; health benefits,
18; overweight and obesity, 17; physical illness, 18
Positive imagery, 243
Post-traumatic stress disorder (PTSD), 22, 25
Pregnancies: unplanned, 18
Preventive maintenance, xxxvi-xxxvii
Priorities, 91, 157, 19199,226-229,233
Private life stressors, 27, 30, 54, 67-68, 78, 81, 108, 116, 20173,
249
Private life conditions, 56
Procrastination, 92, 104, 174,228
Progressive relaxation, 245
305
Pseudoslressors, 215, 238
Psychosocial adjustments, 204-208
Psychosocial conditions, 55
Psychosocial stressors, 30, 54, 80-84, 87, 89, 101, 107, 116, 119-120, 149, 173, 201, 249
Public Health Service, 14-15, 112-113
-R-
Racism. 42, 50. 134
Rahe, R. 70
Refraining. 184
Relaxation: experiences, 239-241; general methods 239-241; systematic forms 241-247
Relaxation misconceptions, 235-239
Resources, 56
ReZeroing, 246-247
Risk factors: HIV/AIDS, 17
Road rage, 223-224, 233, 224, 233
Romano, J.L. 38-39
Rosenman, R. 60
-S-
S A M HSA, 19-20 Sax, LJ. 20

Self-concept, 16, 60, 151, 159, 216
Selye, H., xxiv, 52, 137, 143-145
Sexual activity: alcohol use and abuse, 20; identity and orientation, 47-48; illicit drug use and abuse, 21;
problems, 152; risk factors for HIV/AIDS, 19; risky behaviors among college students, 19-20;
STDs and HIV/AIDS, 19; Unplanned pregnancies, 20 Sexual orientation or identity, 49
Sexual problems, 150, 159, 237
Sexual transmitted diseases (STDs), 17, 25, 104
Sleep: depression 21, 213; deprivation 77; desirable 39, 41, 207-209, 218, 230; drugs 73; insomnia 149;
misconceptions 235-236; nutrition 73, 77; overview 76-77; patterns 216; post traumatic stress
disorder (PTSD) 22; professional help 232; research 92, 144; roommates 85; stress 73, 77; states
73, 77; study outcomes, 19; studying and examinations 91
306
Situational adjustments, 225-234
Stampfer, M. 213-214
Stress: acculturative 86-87; affects, 51; as a transaction, 31; causes, 51-52; definition, 33-34; E-P-R
process, 31-32; position taken in book, 29-30, 38-39; role of perception, 30-31;
understanding, 30 Stress reactions: behavior effects, 148-151; cognitive effects, 151-152;
emotional effects, 152-153; physical effects, 153-160 Stress process: first stage - onset,
129-135; second stage - reaction, 137-145; third stage - outcome, 147-
158 Stress: acute 133; bad, xxiv, 131-135; cataclysmic 133-134; causes, 51-52; chronic 134;
critical incident 134-135; definition, 36; episodic 133; good, 130; facts, 54; management, ;
misconception, 54; normal 131; post-traumatic 134; role of perception, 33-35; tranactional
view, 31,250-251,253
Stress management: cognitive restructuring, 185-201; dynamics, 173-182; lifestyle adjustments,
209-222; psychosocial adjustments, 203-208; relaxation experiences, 237-249; situational
adjustments. 225-234 Stressors: features and classification, 52-56; demands 30-33; modern
day, xxxiii-xxiv Stretching, 240
Stroke, 15, 56, 134, 156-157, 159, 217, 244
Students: African Americans, 42-43; athletes, 41-42;
domestic and international, 40-41; graduate, 45-46; nontraditional, 44-45
Systematic methods of relaxation: biofeedback, 247-248; deep breathing, 244; massage therapy,
245-246; meditation, 244-245; positive imagery, 245; ReZeroing, 248-249
Suicide: African American college females 43; "coming out" 49; family support 44; Depression
20-21; health 104, 151; rates 115; stress 51, 86, 134-135
Support: addiction 215, 238; African American students, 43-44; attitudes and values, 227;
conceptual importance, 116; coping skills. 174,financial 8; goal-seeking, 195; graduate
students, 46; institutional, 38, 253, 104; panic attacks, 92; priorities 196; research 70, 86,
118-120; stress reduction, 129, 141, 147, 202-203; test-taking, 230
Survey: National College Health Risk Behavior Survey (NCHRBS), 13-14; Youth Risk
Behavior Surveillance System (YRBSS), 13 Swimming: good all-around exercise,
218, reducing stress, 240-241
-T-
Tagamet, xxxi
The Barna Research Group, 45
Tiger: symbolic importance and history, xxxii-xxxiii; 252
Time magazine, xxxi
Time management, 20, 24,91, 99, 104, 226-228, 233
Tranquilizer, xxxi
Transactional, 31, 129, 250-251, 253
Transgender, 47
307
-U-
Ulcers, 70, 143, 148, 155-156, 159
Underload, 34-35,72,149,176,203,208,224
U.S. Department of Education, 7-11,18
-V-
Valium, xxxi,73
-W-
Wechsler, H.,18-19,75-76,108
Willett, W., 213-214
Worrying, 39, 53, 77, 151, 159
-Y-
Yerkes-Dodson Law, 37-38
Yerkes, R.M. 37,50
Yoga, 17,51,242
Youth Risk Behavior Surveillance System (YRBSS), 15-16,18
308

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Stress Management 101 For College Students

A Guide For Improving Health and Performance

Ivor Lensworth Livingston, Ph.D., M.P.H., C.H.E.S.

StressHealth Institute International

Copyright © 2017 by Ivor Lensworth Livingston

Printed in the United States of America (6th Printing)

Library of Congress Control Number: 2004115166

StressHealth Solutions International

PART I: Selected Background Information on College Students 1

1. Evolving Trends Associated With The College Population 3

2. Health-Related Outcomes: What Students Should Know 13

PART II: I = Identifying the Background, Nature and Causes of Stress 27

3. What Do We Know About Stress? 29

4. Stress and College Students: A Look At Selected Areas 37

7. Private Life Stressors 67

10. Organizational Stressors 101

12. Correlates of College Students’ Stressors 115

PART III: R = Recognizing the Signs and Reactions to Stress 127

13. The First Stage of the Stress Process - Onset 129

Three Main Types of Stress 130

14. The Second Stage of the Stress Process - Reaction 137

15. The Third Stage of the Stress Process - Outcome 147

PART IV: M = Managing Stress Using a Combination of Strategies 169

16. The Dynamics of Stress Management 171

17. Cognitive Restructuring 183

Assess Your Self-Perception 194

18. Psychosocial Adjustments 201

19. Lifestyle Adjustments 207

20. Situational Adjustments 223

21. Relaxation Experiences 235

Reading in a Quiet Location 241

22. Where To Go From Here 249

N Note Sheets 254

I. Selected Background Information on College Students;

9 Identify the background, nature and causes of stress;

so that we can manage it effectively.

Are We Experiencing a Stress Epidemic?

The Importance of Stress Management For College Students

The Symbolic Importance of the Tiger as a Potential Stressor

Not All Stress Is Bad

Understanding As a Prerequisite To Controlling Stress

Stress affects everyone, yet many people lack a basic understanding of it

K This potential reality;

Preventive Maintenance: Similarities Between a Car and The Human Body

The Human Body

K Understand stress and its related processes;

Major Points of The Book

Part I: Selected Background Information On College

Part II: Identifying the Background, Nature and Causes of

Part III: Recognizing the Signs and Reactions to Stress

Part IV: Managing Stress Using a Combination of

This part of the book deals with selected

College Enrollment Estimates

Post-secondary Enrollment By Selected Characteristics of Students

Enrollment in degree-granting post-secondary institutions increased by 9 percent between 1989

Institutions of higher Degree-granting institutions

The Relationship Between Education, Employment and Earnings