Promote Stress Management Research Articles

Mothers In Motion intervention effect on psychosocial health in young, low-income women with overweight or obesity

BackgroundMothers in Motion (MIM), a community-based intervention program, was designed to help young, low-income women with overweight or obesity prevent further weight gain by promoting stress management, healthy eating, and physical activity. This paper presents the MIM’s intervention effect on self-efficacy to cope with stress, emotional coping response, social support for stress management, stress, depressive symptoms, and positive and negative affect.MethodsParticipants (N = 612) were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan. They were randomly assigned to an intervention group (410 participants) or comparison group (202 participants). During the 16-week intervention, intervention participants watched ten video lessons at home and joined ten peer support group teleconferences. Surveys with established validity and reliability were used to measure self-efficacy to cope with stress, emotional coping response, and social support for stress management. The Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and Positive and Negative Affect Scale were used to measure stress, depressive symptoms, and positive and negative affect, respectively. A general linear mixed model was applied to test the intervention effect at the end of the 16-week intervention (T2, n = 338) and at three-month follow-up (T3, n = 311).ResultsAt T2, the intervention group reported significantly higher self-efficacy to cope with stress (effect size [Cohen’s d] = 0.53), better emotional coping response (d = 0.38), less stress (d = 0.34), fewer depressive symptoms (d = − 0.27), and more positive affect (d = 0.31) than the comparison group. However, there were no significant differences in social support for stress management and negative affect between these two groups. At T3, the intervention group still reported significantly higher self-efficacy to cope with stress (d = 0.32) and better emotional coping response (d = 0.34) than the comparison group but did not report significantly higher social support for stress management, stress, depressive symptoms, and positive and negative affect.ConclusionsTo help young, low-income women with overweight or obesity manage stress, researchers and program planners may consider focusing on building self-efficacy to cope with stress.Trial registrationClinical Trials NCT01839708; registered February 28, 2013.

Effects of a Stress Management Program Based on Psychological Risk Factors of Cardiovascular Disease after Retirement in an Underpopulated Area: A Pilot Study

Background: To develop an effective health education program to prevent cardiovascular disease in middle-aged residents after retirement in underpopulated areas, we explored the effects of a stress management program based on the type A behavior pattern. Methods: This study was carried out in a rural city in Japan recognized as underpopulated and participants were civil servants aged 45 - 64 who joined a stress management program offered as part of staff training. Learning materials for the program were developed based on the type A behavior pattern. Measures for the impact evaluation were Bloom’s learning domains and stage of change for stress management practice. Measures for the outcome evaluation were KG’s Daily Life Questionnaire (KG Questionnaire), the Hospital Anxiety and Depression Scale (HADS) and the Framingham 10-year cardiovascular risk score (CVD risk score). We statistically analyzed changes in each item between time points. Results: Eighteen participants completed questionnaire surveys at pre-, post-, and 4 weeks post-program and eleven had complete blood pressure and weight measurements at pre- and post-program. In the impact evaluation, the Friedman test found significant differences between the three time points in all of Bloom’s learning domain scores and stage of change for stress management. In the post hoc analysis, a significant increase was seen between pre- and post-program and between pre- and 4 weeks post-program in cognitive domain score, psychomotor domain score and stage of change for stress management. In the outcome evaluation, a significant decrease in systolic blood pressure was seen between pre- and post-program. Conclusion: The present study suggested that a stress management program using learning materials based on type A behavior could promote stress management practices and reduce the risk of cardiovascular disease. This stress management program is expected to be useful as a health promotion activity for middle-aged residents after retirement in underpopulated areas.

Understanding and Promoting Stress Management Practices Among College Students Through an Integrated Health Behavior Model

ABSTRACTBackground: College students are susceptible to undermanaged stress and its detrimental effects, and though they could use evidence-based stress reduction techniques (SRTs) to remedy this, many do not. Unfortunately, little is known about what might encourage greater use. Purpose: This study examined to what extent a framework integrating cognitive, social, behavioral, and experiential factors related to influential health behavior models could account for increased intention to use SRTs (intention) and willingness to recommend SRTs (promoter willingness). Methods: College students (n = 233) completed a survey assessing health beliefs, past and intended future use of SRTs, willingness to recommend SRTs, and potential changes in intention or promoter willingness following brief Health Education messages. Results: Health Belief Model components, theory of planned behavior descriptive norms, and prior SRT use predicted significant variability in intention and promoter willingness (experienced effectiveness of particular SRTs also predicted intention), and Health Education messages increased both outcomes. Discussion: Informational and experiential exposure to different SRTs may promote greater SRT use and dissemination. Translation to Health Education Practice: Institutions can assess student stress management needs and increase student SRT use and dissemination through existing modalities that provide students information, peer discussion opportunities, and reinforcing effects of SRT practice.

Recruitment Challenges and Enrollment Observations from a Community Based Intervention (Mothers In Motion) for Low-Income Overweight and Obese Women.

BackgroundMothers In Motion (MIM), a randomized controlled trial, aimed to help young, low-income overweight and obese mothers prevent weight gain by promoting stress management, healthy eating, and physical activity. This paper describes MIM recruitment challenges and reports demographic characteristics affecting enrollment.MethodsParticipants who were African American or Non-Hispanic White were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Michigan. We faced numerous recruitment challenges and learned that several strategies facilitated recruitment. Logistic regression analyses were performed to examine demographic characteristics that affect enrollment.ResultsWomen who had a higher body mass index (BMI, OR 1.06, 95% CI 1.02–1.10); were at late postpartum, (OR 1.24, 95% CI 1.10–1.40), were breastfeeding (OR 5.0, 95% CI 2.34–10.65); or were at early postpartum and breastfeeding (OR 0.42, 95% CI 0.22–0.81) were more likely to enroll than their counterparts. Compared to African American women, Non-Hispanic White women were more likely to enroll (OR 1.77, 95% CI 1.29–2.42). Also, women who were non-smokers (OR 0.54, 95% CI 0.40–0.73) or had a higher education were more likely to enroll (OR 1.21, 95% CI 1.04–1.42) than those who smoked or had a lower education.ConclusionFuture lifestyle behavioral intervention studies for similar target audiences may consider tailoring their recruitment messages based on relevant participant demographic characteristics identified as potential determinants of enrollment in this study.Trial registrationClinical Trials NCT01839708.

Care for the Caregiver

Stress affects the well-being of both nursing students and the individuals with whom they work. With the theory of cognitive appraisal as a framework for this study, it is proposed that mind-body self-care strategies promote stress management by stabilization of emotions. Outcomes will be a perception of less stress and more mindful engagement with the environment. Objective of the study was to describe an evaluation of student perceived stress and mindfulness to 1-hour per week of class time dedicated to mind-body self-care (yoga, mindful breathing, Reiki, and essential oil therapy). It was a quasi-experimental study; data collection took place at 4 time points. Participants were entry-level accelerated nursing students from 3 US universities: 50 in the treatment group, 64 in the comparison group. Data included health-promoting practices using Health-Promoting Promotion Lifestyle Profile II as a control variable, stress and mindfulness (Perceived Stress Scale [PSS] and Mindful Attention Awareness Scale [MAAS]), and demographic information; analysis using mixed-design repeated-measures analysis of variances. There was a statistically significant interaction between intervention and time on PSS scores, F(3, 264) = 3.95, P = .009, partial η(2) = 0.043, with PSS scores of the intervention group decreasing from baseline to T3 when intervention ended whereas PSS scores of the comparison group increased from baseline. The average scores on the MAAS did not differ significantly. Evaluation of an embedded mind-body self-care module in the first nursing course demonstrated promising improvements in stress management. The findings support the appropriateness of integrating mind-body self-care content into nursing curricula to enhance students' ability to regulate stress.

Promoting Stress Management and Wellbeing in Educators: Feasibility and Efficacy of a School-Based Yoga and Mindfulness Intervention

We evaluated the feasibility and efficacy of the Community Approach to Learning Mindfully (CALM) program for educators. CALM is a brief daily school-based intervention to promote educator social-emotional competencies, stress management, and wellbeing. Two middle schools were randomly assigned to waitlist control condition or the CALM program. Participants included 64 educators. Intervention sessions included gentle yoga and mindfulness practices and were offered 4 days per week for 16 weeks. Pre- and posttest measurements included self-report surveys of social-emotional functioning and wellbeing, blood pressure readings, and diurnal assays of cortisol. Compared to the control condition, CALM had significant benefits for educators’ mindfulness, positive affect, classroom management, distress tolerance, physical symptoms, blood pressure, and cortisol awakening response. There were trend-level effects for two measures related to stress and burnout. No impacts were observed for relational trust, perceived stress, or sleep. Effect sizes for significant impacts ranged from 0.52 to 0.80. Educators found the intervention feasible and beneficial as a method for managing stress and promoting wellbeing. Initial evidence suggests that CALM has potential as a strategy to improve educators’ social-emotional competence and wellbeing, prevent stress-related problems, and support classroom functioning.

Perceptions of caregiver distress, health behaviors, and provider health-promoting communication and their relationship to stress management in MS caregivers

This study applied the Stress/Health Model to examine a novel approach for promoting stress management among 67 caregivers of persons with multiple sclerosis, who often face unique caregiving challenges. Hierarchical regressions indicated that caregiver distress (i.e., emotional burden) and engagement in other health-promoting activities (i.e., controlling alcohol use) were the best predictors of caregiver stress management. Communication with the MS care recipient’s health provider about caregiver engagement in health-promoting activities was associated with caregiver stress management, but not significantly more so than explained by the other factors (i.e., caregiver distress and engagement in health-promoting behaviors). A more controlled study would be indicated to further explain how to encourage, within the medical setting, caregiver engagement in self-care activities.

Chronic stress and cortical responsiveness to suprathreshold heat: fMRI-based evidence for stress management in pain rehabilitation

Background:Maximizing patient outcomes while shortening treatment duration is an ongoing challenge for physical therapists and their patients. A successful outcome following physical therapy is dictated by patient-reported outcomes and perceived pain intensity, which may be influenced by countless physiological, psychological, and environmental factors. Although physical therapists may successfully treat the anatomic origin of pain, the perception of painmay persist in the absence of injury (central sensitization). The overall literature suggests that chronic stress may initiate, exacerbate, or prolong the pain experience. Stress may decrease pain modulation or increase cortical responsiveness to aversive stimuli, resulting in central sensitization. Patients experiencing central sensitizationmay be unaware of the non-anatomic contributions to their pain, develop a fear of pain, and learn to avoid movements that reproduce pain. Therefore, to maximize patient outcomes and shorten treatment duration, it is important that patients be educated about the psychological contributions to pain. Therefore, the present analysis seeks to provide evidence for the effect of perceived stress on cortical responsiveness to repeated pulses of suprathreshold heat stimuli, a commonmeasure of central sensitization (temporal summation). Purpose: Using functional magnetic resonance imaging (fMRI), the goal of the present analysis is to examine the effect of chronic stress on central sensitization in pain-free volunteers. We hypothesize that subjects reporting higher levels of stress within the previous month will demonstrate increases in cortical responsiveness to suprathreshold heat. Our results may be utilized by physical therapists to educate patients about the role of stress in the pain experience, promote stress management as an adjunct to physical therapy, and maximize patient-reported outcomes. Methods: 11 healthy volunteers completed the Perceived Stress Scale (PSS), a validated measure of chronic stress, prior to undergoing fMRI of the brain during a validated protocol designed to measure central sensitization (temporal summation). During fMRI scanning, subjects experienced 4 bouts of 6 suprathreshold heat pulses (max temperature = 51 ◦C) separated by 90 second rest periods. Multiple regression and independent samples t-tests were used to examine the relationship between PSS scores and brain activity during heat pulses. Results:Perceived stress significantly predicted increased activation of cingulate cortex during heat pulses as compared to rest (k= 1202, x= 45, y= 12, z= 6, p 10 demonstrated a greater response in the cingulate cortex as compared to subjects with a PSS score <10 (k= 1202, x= 45, y= 12, z= 6, p< .001 FWE-corrected). Conclusion(s): These preliminary findings suggest that participants with higher levels of stress are likely to demonstrate increased responsiveness to potentially noxious stimuli in the cingulate cortex of the limbic system. Increases in pain sensitivity, prior to pain onset, may predispose individuals to a magnified pain experience and poor outcomes following physical therapy intervention. Implications: Physical therapists may utilize these findings to educate patients about the role of stress in the pain experience, promote stress management in pain rehabilitation, and maximize physical therapy outcomes. Ultimately, the integration of stress management in pain rehabilitation may prevent the transition from acute to chronic pain and improve quality of life.

A community based prevention of weight gain intervention (Mothers In Motion) among young low-income overweight and obese mothers: design and rationale

BackgroundOver 45% of American women 20–39 years old are at risk for type 2 diabetes, cardiovascular disease, and other health conditions because they are overweight or obese. The prevalence of overweight and obesity is disproportionately high among low-income women. This paper describes the study design and rationale of a community based intervention (Mothers In Motion, MIM) aimed to prevent weight gain among low-income overweight and obese mothers18-39 years old by promoting stress management, healthy eating, and physical activity.Methods/DesignPeer recruiters approach participants from 5 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Michigan. The MIM delivers theory-based, culturally-sensitive intervention messages via a combination of DVDs and peer support group teleconferences (PSGTs). The DVD features African American and white overweight and obese WIC mothers who participated in a healthy lifestyle intervention patterned after MIM. The PSGTs are led by paraprofessionals from Michigan State University Extension and WIC providers in Michigan who are trained in motivational interviewing and group facilitation skills. Participants are randomly assigned to an intervention (n = 350) or comparison group (n = 175). The intervention group receives a 16-week intervention on a weekly or bi-weekly basis. Participants are asked to watch 10 MIM DVD chapters at home and join 10 PSGT sessions by phone. The comparison group receives printed educational materials. The primary outcome is body weight. Secondary outcomes include dietary fat, fruit, and vegetable intake; physical activity; stress, and affect. Mediators are self-efficacy, emotional coping response, social support, and autonomous motivation. Telephone interviews and in-person data collection at WIC offices occur at 3 time points: baseline, immediately, and 3 months after the 16-week intervention.DiscussionIf MIM shows effectiveness, it could have a favorable impact on public health and community programs. The DVDs and PSGTs will be disseminated in WIC, Extension, clinical practice that promote healthy lifestyles for similar target audiences to make a broad contribution to the prevention of weight gain in low-income mothers. Also, our methodology can be adapted by researchers and community stakeholders to help other low-income populations prevent weight gain.Trial registrationClinical Trials Number: NCT01839708.

Student Perspectives on Burnout

Context: While burnout has received a great deal of attention within the athletic training profession, there is little data on how it affects athletic training students (ATSs). Objective: To determine what factors influence burnout among ATSs enrolled in accredited athletic training education programs. Design and Setting: Basic, interpretive qualitative study employing on-line interviews with students enrolled in Commission on Accrediting Athletic Training Education (CAATE) athletic training programs. Patients or Other Participants: Each of the 14 (7 males, 7 females) ATSs, who represented 3 NATA districts, had completed at least one full academic semester of coursework and a clinical assignment. The average age of the participants was 21.4 +/− 1.5 , eight of the ATSs were seniors, and six were junior level students. Data Collection and Analysis: All interviews were conducted electronically with three separate days of postings using an on-line platform. Interviews were cut and pasted verbatim and analyzed inductively borrowing from the grounded theory approach. Peer review, data triangulation, and multiple analyst triangulation were completed to ensure credibility and trustworthiness of the study's findings. Results: Twelve out of the fourteen ATSs stated that they have experienced burnout, and all associated a career in athletic training with the potential for burnout. Role Strain and Time emerged as the two major factors leading to burnout, and many capitalized on Social Support and Personal Time to alleviate the stressors causing their burnout. Conclusion: Athletic training students must find time to balance multiple roles and responsibilities, however, when they feel unable to adequately address those roles, they experience burnout. Program directors and educators are encouraged to promote stress management strategies with their students, and encourage them to seek involvement in outside activities to help increase their ability to regulate and control their stress levels.

The Development of a Computer-Administered Cognitive-Behavioral Intervention to Promote Stress Management Among HIV+ Women

Few interventions address the unique psychosocial needs of HIV+ women. To address this unmet need, we developed and pilot tested a brief, cognitive-behavioral computerized stress management intervention with 60 HIV+ women. This interactive intervention included modules that promoted cognitive appraisal skills, encouraged appropriate coping responses and problem solving skills, and provided relaxation training. In this report we provide an overview of the intervention and present acceptability and feasibility data from a pilot intervention trial. All participants successfully navigated the computerized program and most found the intervention to be acceptable. Overall, the results indicated that a brief, computerized stress management intervention was a feasible and acceptable approach to enhance stress management skills; use of this intervention has the potential to reduce distress and improve health outcomes among HIV+ women.

Assessment of the Pros and Cons of Stress Management among Adolescents: Development and Validation of a Decisional Balance Measure

This article reports on the development of a decisional balance measure based on the transtheoretical model (TTM) for stress management among adolescents. Measurement development was conducted with participants of a pilot survey. Surveys were completed in health and physical education classes. Ninth and tenth graders (N=317) completed an assessment of TTM constructs. The focus of this paper is the development of a decisional balance measure. A split-half cross-validation procedure was implemented. A brief reliable eight-item instrument was developed measuring the pros and cons of practicing stress management. A theoretically consistent pattern of pros and cons across the stages of change was obtained and indicated construct validity. Girls were more likely to practice and acknowledge benefits of stress management. This instrument will aid future work on promoting stress management practices among adolescents, particularly when using the TTM to develop interventions.

Stress and well­being in health­care staff: the role of negative affectivity, and perceptions of job demand and discretion

A questionnaire survey was administered to volunteer staff from the Surgical and Mental Health Directorates of an English hospital district. The aim was to investigate the relationships between job stressors, coping strategies, job satisfaction and well-being, in light of Karasek's demand–discretion model. The effects of controlling for age, gender and negative affectivity were also of interest. After controlling for these factors, there was found to be no interaction between job demand and discretion for either job satisfaction or psychological distress, so Karasek's model was not supported. Both job dissatisfaction and psychological distress were found to be influenced by lack of resources, while perception of demand was strongly influenced by workload; these were also the stressors that differentiated the two hospital directorates, with the surgical staff suffering higher levels of both. Controlling for negative affectivity had a stronger influence on the measure of distress than on job satisfaction and the two outcome measures were not interchangeable. Recommendations centred on improving structural conditions, especially for surgical staff, and on reducing levels of anxiety and hostility by promoting stress management. © 1998 John Wiley & Sons, Ltd.

Sources of Stress

This paper explores the potential for mismatch between pupils' own understanding of and responses to the experiences which they find stressful and pastoral care staffs awareness and understanding of these. Consideration is given to the role which schools can play in reducing or inducing stress for students. The paper examines how the structure of the pastoral system can serve both to promote and reinforce this role. Data is presented which was gathered during a study investigating student stress which took place in three secondary schools and involved 455 year 9 and 11 students. This data indicates instances where there is clear agreement among many of the students regardless of age, gender or school as to what causes them stress and how they responded to this. This is contrasted with the views of pastoral care staff in the three schools. These teachers seemed to be using stereotypes gained from general life experience when describing stress for the pupils rather than basing their understanding of pupil stress on the actual experiences and behaviour of pupils themselves. Among the implications for future research arising are questions about how useful it might be to incorporate stress management for children into both the curriculum and existing teacher stress management training and in what ways staff awareness of pupil stress might be enhanced. This paper sets out to consider the extent to which there is a mismatch between some students' experiences of stress and the awareness of this experience by pastoral care staff in their schools. The paper is based on a study which took place in three secondary schools in a South Yorkshire town investigating causes and effects of stress in 12-and 14-year-old pupils. The paper will go on to consider how the pastoral care system can promote stress management within the school community.