Running head: STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 1

What are Positive Coping Strategies for College Students Under Stress?

Emily Shields

Marium Khan

Michelle Vidale

Valerie Jeffery

Youngstown State University

NURS 3749 Nursing Research

Mrs. Molly Roche

Summer 2016
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The purpose of this research related project is to describe what a literature review of

fourteen research articles reviewed by BSN nursing students in an undergraduate research class

revealed about the health related benefits related with positive coping strategies while under

stress. This research group consisting of four nursing students critically read fourteen articles on

the relationship of different coping strategies and how they relate to stress in college students.

This class assignment is being implemented to assist in learning the research process and its

importance to nursing practice. The concept of health promotion was chosen by the class to

increase the understanding of this topic with college students. Health promotion was chosen as

an important concept as identified in Healthy People 2020. Through poster presentation students

will share current knowledge about their findings and implications of their practice.

II. Literature Review

The following articles were researched and reviewed to align with the purpose of the

research project. First, the articles, “An Examination of Stress in College Students Over the

Course of a Semester,” by Timothy Baghurst and Betty C. Kelley, “Biofeedback Intervention for

Stress and Anxiety Among Nursing Students: A Randomized Controlled Trial,” by Paul

Ratanasiripong, Nop Ratanasiripong, and Duangrat Kathalae, and, “Effect of Integrated Yoga

Practices on Immune Responses in Examination Stress - A Preliminary Study,” by Aravind

Gopal, Sunita Mondal, Asha Gandhi, Sarika Arora, and Jayashree Bhattacharjee, studied the

relationship between the amount of physical activity and stress a person experiences. By

contrast, the relationship between the amount of sleep college students get and the amount of

stress that they then experience was investigated in “Sleep Patterns and Predictors of Disturbed

Sleep in a Large Population of College Students,” by Hannah G. Lund, Brian D. Reider, Annie

B. Whiting, and J. Roxanne Prichard, and also in the article, “Effective Lifestyle Habits and
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 3

Coping Strategies for Stress Tolerance Among College Students,” by Paul D. Welle and Helen

M. Graf.

In addition, another topic that was examined focused on the amount of stress a student

undergoes and its influence on their academic ability, especially on a student's’ grade point

average. This topic was mentioned in “Stress Management through Written Emotional

Disclosure Improves Academic Performance Among College Students with Physical

Symptoms,” by Mark A. Lumley and Kimberly M. Provenzano, “School Stress, Academic

Performance, and Coping in College Freshmen,” by Curtis Hill, and also in the article, “Stress

Among Higher Education Students: Towards a Research Agenda,” by David Robotham.

Furthermore, another topic that was researched explored the relationship between stress and

drinking alcohol. “Perfectionism, Perceived Stress, Drinking to Cope, and Alcohol-Related

Problems Among College Students,” by Kenneth G. Rice and Amy C. Van Arsdale, and also in

the article, “Reducing Stress on a College Campus” by Marilyn Klainberg, Bonnie Ewing, and

Marybeth Ryan, both examined this topic in-depth. The articles, “Interventions to Reduce Stress

in University Students: A Review and Meta-Analysis” by Cheryl Regehr, Dylan Glancy, and

Annabel Pitts, and, “Agentic Personality Characteristics and Coping: Their Relation to Trait

Anxiety in College Students,” by Ingrid K. Weigold and Christine Robitschek, research the

effect that each person’s unique personality, cognitive, and behavioral interventions have on

stress. The articles that explain how a social support system, and other factors such as religion,

affect how stress can factor into the life of a college student are, “Examining Factors that

Increase and Decrease Stress in Adolescent Community College Students,” by Nancy R. Ahern

and Anne E. Norris, and also, “Differences in Perceived Stress and Its Correlates Among
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 4

Students in Professional Courses,” by Abhay B. Mane, M. K. Krishnakumar, Paul C. Niranjan,

and Shashidhar G. Hiremath.

The primary purpose for reviewing literature on the topic of stress and its negative

physiological effects was to increase knowledge base on health promotion. The studies explained

how stress will negatively affect our health over time. On top of that, college students sometimes

use negative coping strategies to cope with stress, including alcohol, decreased sleep, and drug

abuse. These interventions will also lead to negative physiologic effects. Some researchers have

hypothesized that implementing stress prevention programs on campus will be beneficial. By

adding these stress prevention programs, researchers hope to promote mindfulness and more

awareness of specific stressors in the student’s life. Another positive effect of dealing with stress,

other than health promotion, was that students who have lower stress would directly correlate to

a higher GPA. The studies named multiple positive coping strategies for college students to

implement, however they emphasized that everyone deals with stress differently, and therefore

various coping strategies cannot be generalized to all students. The articles focus on positive

mechanisms, which will hopefully encourage students to equip themselves with knowledge of

positive interventions to cope with stress, and will in turn, increase lifelong healthy habits.

A. Physical Activity

In the study, “An Examination of Stress in College Students Over the Course of a

Semester,” the researchers, Baghurst and Kelley (2013), address the health promotion

interventions for stress reduction among college students. Simply put, there are numerous

stressful elements in a college student’s life including increased academic, personal, social, and

moral pressures in their lives. Stressful situations can lead to increased anxiety, loneliness,

depression, hopelessness, headaches, sleep disturbances, colds, and sometimes suicidal ideations
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(Kelley, 1993; O’Donovan & Hughes, 2008). Some other negative physiological effects of stress

explained in this article include hypertension, high levels of muscle tension, and lowering of the

immune system defenses. This article talks about a few coping mechanisms for stress, including

physical exercise and psychological interventions.

Physical activity is one simple, yet effective way to reduce stress. More specifically,

cardiovascular exercise can be very effective in reducing the negative effects of physiological

stress. Earlier research studies (e.g., Keller & Seraganian, 1984) found that fit individuals were

more readily able to recover from a stressor than an individual who is not as in good of health.

Baghurst and Kelley (2013) also concluded that meditation and relaxation can be as effective as

physical activity in reducing stress. This particular study consisted of 531 people, 293 male and

238 female. This study collected its data by giving students a “perceived stress scale.” Students

would use a “likert-type” scale (1=never to 5= very often) to estimate how often they felt

stressed. Students who participated in this study were put into three separate groups, cognitive

behavioral stress management, physical activity, and no intervention. The study found that those

students who were placed in both stress management and physical activity had significantly

lower levels of perceived stress. The study did have a few limitations. The researchers found that

students who exercised specifically for reducing stress were higher in test anxiety than those

students who just exercised for fitness and enjoyment.

In the research article, “Biofeedback Intervention for Stress and Anxiety Among Nursing

Students: A Randomized Controlled Trial” by Paul Ratanasiripong, Nop Ratanasiripong and

Duangrat Kathalae, 60 second-year female baccalaureate nursing students at a public college in

Thailand were randomly assigned to a either an experimental group or a control group in order to

investigate the impact of biofeedback intervention on stress and anxiety for 5 weeks. In the
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 6

experimental group, 30 students received 2 training sessions on how to use a portable

biofeedback device to help manage their stress and anxiety as they start their first clinical

experience. The devices were used in the hopes to receive feedback on heart rate, skin

temperature, brain wave activity, blood pressure, respiration, and muscle activity in order to

better measure the amount of stress the person might be under. The remaining 30 students did

not receive any training or device to use. The results from this study showed that the 5 week

biofeedback training intervention significantly decreased the nursing students’ stress and anxiety

levels. The students who received the biofeedback trained were also able to significantly reduce

their anxiety levels even though they experienced more stressors and demands from their new

clinical training (Ratanasiripong, Ratanasiripong, Kathalae, 2012). The students who did not

receive any training or device to use greatly increased their stress and anxiety levels over the

same period of time. This study concluded that if students are exposed to high stress and anxiety

levels, that it can “negatively affect learning and academic performance by impeding memory,

concentration, and problem solving skills (Ratanasiripong, Ratanasiripong, Kathalae,2012).”

Ratanasiripong, Ratanasiripong, and Kathalae (2012) also explain that by using biofeedback

methods to control stress, it enabled nursing students to gain awareness how the body and mind

work and also how they are linked together. This study concluded that if students are better able

to manage their stress and anxiety, it would allow them to be more successful in their clinical

training (Ratanasiripong, Ratanasiripong, Kathalae, 2012).

In this study, “Effect of integrated yoga practices on immune responses in examination

stress,” 60 first year, all female MBBS students’ stress levels were evaluated during their exam

week, after engaging in a 12 week yoga program with a trained instructor. The purpose of this

study was to “evaluate the impact of stress on psychological, physiological parameters and
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immune system during medical term - academic examination and the effect of yoga practices on

the same” (Arora et al., 2011, p. 1). The experimental group (30) practiced yoga for 35 minutes a

day while the control group (30) did not participate in any sort of stress management. Vital signs

(heart rate, respiratory rate and blood pressure) for the physiological parameters were taken after

their exams, and compared to their baselines taken at the beginning of the study when there was

not an exam being issued. The researchers concluded that, “the findings of the present study

clearly indicate that yoga practice attenuates the increase in cortisol levels during examination

stress” (Arora et al., 2011, p. 3).

B. Sleep

In the study, “Sleep Patterns and Predictors of Disturbed Sleep in a Large Population of

College Students,” by Hannah G. Lund, Brian D. Reider, Annie B. Whiting, and J. Roxanne

Prichard, 1,125 college students ranging from ages 17 to 24 from an urban Midwestern

university participated in an online survey concerning their sleeping habits and how it

contributed to their quality of life. An online survey was provided to measure the sleeping

patterns of the college students using five published scales related to sleep, mood, and stress. The

scales used to measure the sleeping habits included the Pittsburgh Sleep Quality Index (PSQI),

the Epworth Sleepiness Scale (ESS), the Horne-Ostberg Morningness Eveningness Scale (MES),

the Subjective Units of Distress Scale (SUDS), and the Profile of Mood States (POMS). The

Pittsburgh Sleep Quality Index (PSQI) is used to differentiate quality of sleep the students

receive by measuring seven distinct areas: subjective sleep quality, sleep latency, sleep duration,

habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction

over the past month (Lund et al., 2010). The Epworth Sleepiness Scale (ESS) is used to identify

excessive sleepiness associated with sleep debt or clinical sleep disorders in the form of a
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 8

questionnaire (Lund et al., 2010). The Horne-Ostberg Morningness Eveningness Scale (MES) is

used to distinguish between chronotropes that describe the preference for either morning or

evening patterns of activity (Lund et al., 2010). The Subjective Units of Distress Scale (SUDS)

assess a person’s baseline level of stress (Lund et al., 2010). The final scale used in this research

study, the Profile of Mood States (POMS), assessed how severely the participants experienced

depression, tension, fatigue, confusion, vigor, and anger (Lund et al., 2010). In order to further

understand the sample they were working with, the students who participated were also asked a

series of questions regarding their academic performance, physical health, and psychoactive drug

use.

This research study concluded that the factor that contributed most to the process of

sleeping was stress at 68% (Lund et al., 2010). Many of the students labeled this stress as either

academic or emotional. In college students, perceived stress, either by erratic schedules or final

exam periods, was the reason for poor sleep. Also, this research study theorizes that college

students may not have developed the proper coping strategies for handling stressful events,

causing them to experience them at an even higher level. This study also concluded that in order

to regulate their sleep/wake cycles, students who reported poor sleeping habits were more likely

to report higher alcohol consumption and OTC drug abuse (Lund et al., 2010). “Approximately

90% of adolescents entering drug rehab programs report self-medicating with psychoactive drugs

to control sleep and combat fatigue” (Lund et al., 2010). The study concluded that students who

experienced poor sleeping habits related to mood and distress were more likely to be at risk for

chronic insomnia as well as becoming highly involved in drug abuse. As increased stress

correlated to decreased sleep, researchers also found correlations to decreased sleep leading to

increased alcohol consumption.

STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 9

The authors of this study, conducted research with college students that determined how

“Effective lifestyle habits and coping strategies are on stress tolerance among college students,”

specific to race and gender. According to the current study in the article, if significant gender or

racial differences are found, programs will be developed to suit the person instead of utilizing the

broad approach. According to the article, the research study wanted to address the following

questions: 1 - What is the prevalence of stressors and stress symptoms among college students? 2

- Are any lifestyle habits or coping factors used by college students significantly associates with

either high or low stress tolerance? 3 - Do habits and factors significantly associated with high or

low stress tolerance differ by gender or race? The study was conducted through randomized

cluster sampling. Healthy Living classes were used for this study and 541 surveys were handed

out to these classes. 470 were returned. According to the article their research indicate that males

take a “fight or flight” response and females tend to “find strength in numbers” and will adopt a

response called “tend and befriend.” Based on information from the article, not all people act the

same when confronted with similar stressors. The question that was posed was: how some people

can seemingly handle large amounts of stress while others are crippled with much less (Welle &

Graf, 2011). Tables were constructed to outline the summary of information and results.

According to the article, the results of the study reflected that younger college students who

participated experienced a lot of stress over a very limited period of time. The results reflected

that students, because of their physical and psychological distress in college, need a feeling of

support, positive social interactions, regular contact with their families. Along with this they

need to obtain 8+hours of sleep per night, making sure they eat well, regular exercise and a sense

that they have control over their life (personal and academic). According to the article the
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authors also state that students should have leisure time and a calming hobby to allow the body

time to rest and get energy for any upcoming stressors.

C. Academic Performance and GPA

GPA is one of the most competitive parameters used to measure student success in

college. In “Stress Management Through Written Emotional Disclosure Improves Academic

Performance,” 74 college students taking an Intro to Psychology course at Wayne State

University were used to determine if journaling about stressful events led to an increase in

average GPAs, and if “writing-induced negative moods” (Lumley & Provenzano, 2003) could

predict potentially positive GPAs. All participants reported elevated physical symptoms (i.e.

headaches, pains, soreness, hot-cold spells etc.), and were then randomly divided into a control

and experimental group - one writing about time management, and the other about stressful

situations/experiences, respectively. After each writing day, students were given a mood

evaluation, and experimenters were provided with each student’s transcripts as a baseline.

Compared to the next semester, the experimental group’s GPAs were significantly higher. Also

among the experimental group and not the control, those student’s mood evaluations improved

over the course of the 4 day period, predicting higher GPAs in the following semester (Lumley

& Provenzano, 2003). The study concluded that writing about general life stressors will

positively affect academic performance, particularly the ones who do not mind journaling about

those stressors in the first place.

Continuing on, the research article, “School Stress, Academic Performance, and Coping

in College Freshmen,” by Curtis Hill surveyed 38 freshman students from the University of

California Los Angeles, between the ages of 18 to 20, to assess their stress levels, coping levels,

and academic performance. This was achieved by completing a stress inventory measured
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through the Student-Life Stress Inventory (SLSI), a coping inventory measured through the

Coping Inventory for Stressful Situations (CISS), and a demographic inventory which was

measured by the students answering questions related to their high school GPA, current GPA,

and other academic related questions. This survey was given only to the students in class who

volunteered to participate in the survey. It was found through his study that students were using

emotion to heavily cope with their stress, and that it “accounted for about half the variance, about

44%, in stress” (Hill, 2014). However, it was not stated whether this emotional coping was

positively or negatively observed. Hill (2014), went on to explain that if students used a negative

emotional response to cope with stress, either by feeling overwhelmed by the amount of work

that needs to be done, feeling depressed, or by getting frustrated at oneself for procrastinating, it

was highly likely to increase their stress levels rather than lower them. The study also found that

a student’s first emotional response would be negative and result in a large amount of stress. It

was concluded that incoming college students would need more support and tools in order to

cope with stress in a more beneficial way (Hill, 2014). However, due to the small sample size of

students surveyed, it was unclear whether or not the amount of stress a student undergoes in their

freshman year of college was directly correlated with their GPA. Hill (2014) went on to say that

if the study had a sufficient sample size (about 65 or more students), stress and the way that

students coped with the stress may be able to predict their GPA. The author concluded by saying

that students who are freshman in college, rely heavily on emotional coping to relieve their

stress, and that further research in this field would benefit them by conducting workshops to help

educate positive emotional coping habits instead.

Furthermore, in the study, “Stress Among Higher Education Students: Towards a

Research Agenda,” by David Robotham, students from a university in the UK were observed to
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identify different types of stressors faced while achieving a higher education. This study

identified that there is evidence from previous studies linking high levels of stress to increasing

mental health problems (Robotham, 2008). This study identifies many stressors that can affect a

college student’s academic performance in negative ways. One such stressor is studying, which

can lead to lack of sleep for students who believe they have “too little time” (Robotham, 2008).

This lack of sleep can reduce the student’s ability to cope with an increase in stress causing their

health to deteriorate. Robotham (2008) identifies students that are classified as high achievers to

experience more stress. Another stressor identified by Robotham (2008) that college students

experience is when they start examinations that can lead to numerous health problems such as

nausea, changes in eating and sleeping patterns, and can also result in stomach pains. Most

college students experience stress with exams due to being anxious about the test itself and not

about what is on the test itself. This study also goes onto identify additional stressors related to a

freshman student’s transition to university, being away from home, or being from a different

country altogether that can cause new stressors because they have to take up new responsibilities

while keeping up academic performances at the same time. The study also identifies stressors

related to financial issues that may be temporary but still cause a significant amount of stress to

students who are trying to support themselves. The study found that 59% felt more stressed while

going to college with an additional job than they had in previous educational experiences

(Robotham, 2008). It is then explained that students have numerous responses to stress that

range from emotional (fear, anxiety, worry, guilt, grief or depression), cognitive (i.e. their

appraisal of stressful situations and strategies), behavioral (crying, abuse of self or others,

smoking, and irritability), and psychological (sweating, trembling, stuttering, headaches, weight

loss or gain, body aches)” (Robotham, 2008). Due to the numerous ways that students cope with
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 13

stress in a negative way, Robotham (2008) found that students who were under a lot of stress

reported that they were unsatisfied with their health overall, weight, and level of fitness. In order

to combat the negative stressors facing a college student, this study identifies positive coping

measures such as making changes to the environment in which they are currently in, looking at

the stressor in a different way, or changing the emotional focus that the college student has for

that stressor. This study concludes that “suffering in silence” can have a negative impact on a

student’s health if they are not coping well with the numerous stressors mentioned. With the

proper coping strategies, incoming students to university can decrease the negative health side

effects one would get if the stressors were ignored.

D. Alcohol-Related Coping

Based on the correlation mentioned above, the research article, “Perfectionism, Perceived

Stress, Drinking to Cope, and Alcohol-Related Problems Among College Students,” by Kenneth

G. Rice and Amy C. Van Arsdale expands on the significance of alcohol use related with stress

in the college student. A sample size of 354 college students between the ages of 18 to 27 years

old from a large, public university in the Southeastern United States that had a reputation for

significant alcohol consumption among its enrolled students was surveyed. The survey was

conducted to understand the relationship between perfectionism, perceived stress, drinking to

cope, and alcohol-related problems. This survey was conducted through a secured website that

had the students report whether or not they have consumed alcohol within the last 30 days, for

the study would only focus on those students who had consumed some form of alcohol. The

survey then had the students complete questionnaires from different scales, including the Young

Adult Alcohol Problems Screening Test, the Drinking Motives Questionnaire, the Perceived

Stress Scale, and the Almost Perfect Scale–Revised. Through this survey it was found out that
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 14

women were at a particular risk for drinking to cope with their stress following an event of

sadness where they were motivated to drink (Rice & Van Arsdale, 2010). Rice and Van Arsdale

(2010) mention a study in their research article done by Timko, Finney, and Moos (2005) that

conducted and 8 year study which found that women experienced more stress and were also

more likely to drink to cope with stress when compared to men. Rice and Van Arsdale’s study

also revealed that the levels of stress and drinking to cope were high for maladaptive

perfectionists (Rice & Van Arsdale, 2010). The study concluded that by understanding the

relationship between perfectionism, perceived stress, drinking to cope, and alcohol-related

problems it would be beneficial to universities to create campus prevention programs and to help

its student find better coping mechanisms for stress and perfectionism than drinking alcohol. The

next study further explains the outcomes of implementing a campus prevention program.

In this study, “Reducing Stress on a College Campus,” the researchers, Marylin

Klainberg, Bonnie Ewig and Marybeth Ryan, set out to study the effects of implementing a stress

reduction room (SRR) on a college campus. Their main consideration and goal was promoting

health on college campuses by implementing strategies to cope specifically with stress. The

Spring 2006 National College Health Assessment (ACHA,2007), developed by the American

College Health Association, reported stress as the number one health impediment to the

academic performance of students. This study also explained how stress can lead to unhealthy

lifestyles habits including overeating, smoking, anxiety disorders, alcohol and depression (Ewig

et al., 2007). The director of Health Services identified an increase in the number of people

visiting the health services during midterms and finals. This study later goes on to talk about the

supported literature with data that links the role of stress and the impairment of the immune

system. Due to the overwhelming evidence of the negative effects stress can have on health,
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 15

especially pertaining to college students, the researchers set out to create a way for students to

decrease stress. The researchers created the SRR as a place for meditation and relaxation to

hopefully decrease stress. The college art students painted the stress reduction room with murals

of underwater scenes so as to implement a tranquil mood. The rooms also consisted of lounge

chairs, a TV, quiet music, soothing sounds, and headphones. The hopes of the researchers was

that by having an opportunity for students to utilize the SRR room, students might become more

mindful of specific stressors that impact their lives and use the room to decrease stress. The

initiation of the SRR room was a vital step toward alleviating some stress in college students and

thereby helped them to maintain a healthier state. The stress reduction room allowed students to

make time to be more mindful of what was stressing them out. Other studies have proven that

this intervention, being mindful of stress, will lower stress in college students. The following

study expands on this idea.

E. Cognitive Interventions

The authors of the study, “Interventions to reduce stress in university students: A review

and meta-analysis,” reviewed through evidenced based research if cognitive, behavioral and

mindfulness interventions make a difference in lowering the stress in college students. The study

was conducted through random sampling of 8155 students from 15 US colleges. Students from

Tehran, Switzerland, Jordan, Scotland, England and Tasmania were also included in the studies.

According to Garlow et al (2008) in the article their research indicates that few students under

stress seek out treatment. In one study that was cited in the article, Downs and Eisenberg (2012),

situations that hinder students from seeking treatment are (1) a preference for dealing with stress

alone (73.3%), (2) the belief that stress is normal in college (52.2%), (3) not seeing their needs as

serious (52.1%) and (4) not having time for treatment (46.7%). The participants ranged from
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undergraduate to professional students who took part in interventions directed at reducing stress

levels. A table was produced to reflect the breakdown of the population taking part in the study

to examine how effective the interventions were, by the study, design, nature of the intervention,

length of intervention and stress outcome measures. The table showed a systematic review and

meta-analysis of 24 controlled studies. The researchers found the outcome of the meta-analysis

to show that cognitive, behavioral and mindfulness-based interventions significantly reduce

symptoms of stress in college students. The study was supported by a Cochrane Review based on

an analysis of 22 studies that reported CBT approaches were effective in addressing generalized

anxiety disorders in mixed populations (Hunot et al., 2007). Other systematic reviews have

proven that cognitive- behavioral approaches inclusive of SIT and EMDR were effective in

reducing symptoms of PTSD (Bisson and Andrew, 2007, Regehr et al., 2012 and Sherman,

1998). Relaxation techniques were more effective in reducing depression than no treatment, but

less effective than other CBT techniques (Jorm et al., 2008). According to the article, they found

that despite the many variations, including the fact that they were students in different programs

and from different countries, the results were remarkably consistent. Along with being mindful

of stressors in one’s life, some researchers went one step further to find if writing down these

negative stressors would decrease stress and even increase GPA.

Although stress can affect individuals in many ways, consideration must be made for the

differences that the gender role can play a part in the manner of stressor. The authors of this

study “Agentic Personality Characteristics and Coping: Their relation to trait anxiety in college

students,” conducted research with college students that reflected that their levels of stress differ

due to personality traits and “human agency.” According to the article: Bandura (2001) defined

human agency as a person’s ability to have some measure of control over his or her life.
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 17

According to the current study in the article, it was hypothesized that personal traits associated

with, or predisposing a person to, human agency, might increase the individual’s capacity to

cope effectively with stressful situations and therefore decrease possible damaging effects of

such difficulties. The study was conducted with participants from a large Southwestern college,

who were traditional students ages 17-25 years old. The final 478 participants that were chosen

consisted of 171 men and 307 women. The participants completed the different variables,

predictor, mediator and criterion of the data in three time spans. According to the article the

authors reviewed a meta-analysis of gender differences in situational coping and it reflected that

women are more likely than men to assess stressors negatively, which may account for some of

the gender disparities in coping. According to the article, the study used this disparity to examine

several related traits as predictors. The traits used were: hardiness, personal growth initiative,

coping self-efficacy, coping strategies and stress (anxiety). A model was designed to reflect the

hypothesis with the traits connected to problem focused coping, emotion focused coping and

avoidant coping. According to the article, the results of the current study have implications for

practice and future research. The researchers found that counselors should take into

consideration the role of agentic personality characteristics when they are working with their

clients. For example, women may be considered to use more emotional forms of coping when

stressed. Also when considering men and women, hardiness might be useful in decreasing this

coping style.

F. Social/Psychological Support

In the study, “Examining Factors That Increase and Decrease Stress in Adolescent

Community College Students,” the researchers, Nancy R. Ahern and Anne E Norris, set out to

determine what factors decrease stress in college students. More specifically they hypothesized,
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 18

(1) women will report higher stress levels than men and (2) resilience, number of financial

supports, involvement in extracurricular activities, and attendance of religious services will be

associated with decreased stress. Other studies that were reviewed by these researchers found a

significant positive relationship between involvement in religion and adjustment(Eccles &

Barber, 2003; Park, 2005). Ahern and Norris also synthesized that other studies have shown

extracurricular activities participated in by university students had achieved better educational

outcomes. And lastly they came across much in current literature about the students who were

lacking financial support tended to be more stressed (Miller, Danner, & Staten, 2008; Miller et

al., 2005). This study in particular consisted of participants ranging from 18 to 20 year olds and

totaled 166 with 59.6% males and 40.4% females. After the collection of data researchers were

surprised by their findings. First, their study reported higher levels of stress in males than

females which was contrary to their hypothesis. This finding could be due to their unequal

expression of genders in the sample. Second, there was not as much of a significant correlation

with the interventions and decrease stress levels as hoped. Due to the studies limited selection of

participants, the researchers believe that more research should be done on college students

pertaining to the benefits of extracurricular activities, religious activities and financial support to

the direct correlation of decreasing stress.

In the research article, “Differences in Perceived Stress and Its Correlates Among

Students in Professional Courses,” by Abhay B. Mane, M. K. Krishnakumar, Paul C. Niranjan,

and Shashidhar G. Hiremath, 276 college students studying various professional majors such as

dental, nursing, pharmacy, engineering, physiotherapy etc. were evaluated using a “self-

administered, standardized and semi-structured questionnaire,” touching on their

“sociodemographic characteristics, the PSS scale, the sources of stress and the coping strategies
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 19

they undertook” (Mane, Krishnakumar, Niranjan, Hiremath, 2011). At the end of the study,

dental students appeared to have the highest levels of perceived stress. Overall, most answers

generated by the sample size included positive coping strategies, however there were some

negative methods in response to help alleviate stress. The most popular positive coping strategy

across all majors was talking to friends and family members, whereas drugs and alcohol were the

least popular response across the board. Researchers concluded not every stress-coping strategy

would work for every major or even every student. They believed that college campuses should

reach out to their student bodies in order to gauge which types of stress coping strategies would

be most beneficial to each academic major group, ranging from social/psychological support

from friends and family, to stress reduction and relaxation methods, to individual counseling

mechanisms.

III. Discussion

In summation of reading through the many articles on stress, much knowledge was

gained pertaining to health promotion. For starters, the literature review allowed for a greater

understanding of what can first cause stress in the college student. According to Baghurst and

Kelley in the article, “An examination of stress in college students over the course of a

semester,” they pointed out that students are potentially feeling stress from increased academic,

personal, social, and moral pressures in their lives. In addition Robotham points out in his study,

“Stress among higher education students: towards a research agenda,” that freshman are at risk

for highly stressful situations including transitioning away from home, being in a different

country, and many stressors related to finances. Not only did the literature review expand

knowledge and understanding on what causes stress, but also very shockingly explained the

negative physiological effects of stress to the body. According to Baghurst and Kelley in the
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 20

article, “An examination of stress in college students over the course of a semester,” they

mentioned that stress can lead to increased anxiety, loneliness, depression, hopelessness,

headaches, sleep disturbances, colds, suicidal ideations, hypertension, high levels of muscle

tension, and lowering of the immune system defenses. The study done by Marylin Klainberg,

Bonnie Ewig and Marybeth Ryan titled, “Reducing Stress on a College Campus,” also

corroborated that stress directly affects the immune system. This study also explained how stress

can lead to unhealthy lifestyles habits including overeating, smoking, anxiety disorders, alcohol

and depression (Ewig et al., 2007). While acknowledging the substantial harm that stress could

do to the body it proved important to further understand what positive coping mechanisms could

be implemented to decrease these effects and promote health in the community. Additionally, in

the article, “Perfectionism, Perceived Stress, Drinking to Cope, and Alcohol-Related Problems

Among College Students,” by Kenneth G. Rice and Amy C. Van Arsdale stated that students

who are perfectionist who drink to cope with the high amounts of stress they constantly have are

more likely to develop drinking problems over the course of their lifetime. The study conducted

by Hannah G. Lund, Brian D. Reider, Annie B. Whiting, and J. Roxanne Prichard in the article,

“Sleep Patterns and Predictors of Disturbed Sleep in a Large Population of College Students,”

troubled sleep due to the many stressors in the life of a college student is considered a predictive

sign and symptom for many illnesses. One of the illness mentioned by Lund et al. (2010) is

chronic insomnia that causes college students to be at even greater risk for major mood and

substance abuse disorders.

According to the article by Welle & Graf, “Effective lifestyle habits and coping strategies

for stress tolerance among college students,” having a strong social network with family and

friends is very effective as a positive coping mechanism. They went on to state some obvious
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 21

interventions, for instance getting enough sleep, eating a balanced diet and getting regular

exercise as coping strategies towards lowering stress and promoting better health. They also

added that being able to balance control over personal life and academics is a beneficial way to

work towards maintaining health, and being able to handle any adversities that they may come

up against in their day to day life. “Agentic Personality characteristics and coping: Their relation

to trait anxiety in college students studied the fact that men and women deal with stress

differently, women being emotional and men being avoidant. This being said the results implied

that the study showed a decrease in stress reduction based on gender coping characteristics.

(Regehr, Glancy and Pitts, 2012) positioned that their study, regardless of where the student was

from, dealt with stress in similar fashions and cognitive, behavioral and mindfulness play a big

part in this. Their study focused on students being more aware of themselves and their abilities

and what they were about. Other positive coping mechanisms that decreased stress were physical

activity and meditation and relaxation (Baghurst and Kelley). In the article “Reducing Stress on a

College Campus,” by Marylin Klainberg, Bonnie Ewig, and Marybeth Ryan they found that

implementing a room on campus for students to be mindful of what was stressing them out

helped to decrease stress. As well as being mindful of what was stressful in the student's life this

study also showed that meditation and relaxation in the room helped to decrease stress as well

(Klainberg, Ewig, Ryan, 2010-2011). In “Stress management through written emotional

disclosure improves academic performance among college students with physical symptoms,”

Lumley & Provenzano found that overall GPA and academic performance generally increased

after writing about life stressors. Along with writing, overall mood increased as well. The

researchers in “Differences in perceived stress and its correlates among students in professional

courses” found that different coping strategies affected different majors across the board. The
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 22

most positive intervention among all majors was talking to friends/parents/relatives, whereas

smoking/alcohol/tobacco use was the most negative intervention, and the least used. Yoga

managed to bring down stress levels during exam week for MBBS students in the study, “Effect

of integrated yoga practice on immune responses in examination stress.” Arora, Bhattacharjee,

Gopal, Mondal and Gandhi concluded that “yoga practice attenuates the increase in cortisol

levels during examination stress” (Arora et al., 2011, p. 1). Additional positive coping strategies,

such as emotion-focused coping where students gain support from friends and family for stress

are outlined by Curtis Hill (2014) in his research article, “School Stress, Academic Performance,

and Coping in College Freshmen.” Other positive coping strategies mentioned by Curtis Hill

(2014) are attacking the problem head-on, exercising to relieve stress, or even venting to a friend

about a stressor seem to be better than negatively using emotion to cope with stress. In the

research article, “Biofeedback Intervention for Stress and Anxiety Among Nursing Students: A

Randomized Controlled Trial,” Paul Ratanasiripong, Nop Ratanasiripong, and Duangrat

Kathalae mention that using a biofeedback device to control heart rate variability through slower

breathing and positive emotions is a positive way to cope with stress that is faced by college

students because it enables college students to be more aware of their body and psychological

well-being. In order to positively cope with stress in students who have been seen to drink to

cope instead, Kenneth G. Rice and Amy C. Van Arsdale suggest implementing campus

prevention programs in their research article, “Perfectionism, Perceived Stress, Drinking to

Cope, and Alcohol-Related Problems Among College Students.” This type of program is similar

to the one that Marylin Klainberg, Bonnie Ewig and Marybeth Ryan researched in their study by

implementing a stress-free room on campus for college students under stress. David Robotham

(2008) states in his research article that a positive way to cope with stress is to seek professional
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 23

support, changing the environment to a more positive one, or even emotionally focusing on how

to change the negative meaning of the stressor to a more positive one in order to see how it has

impacted their life as a college student. Robotham (2008) states that this is the best route to

positively cope with stressors as a college student because “suffering in silence” can have a long

lasting negative effect on their health and well-being.

IV. Limitations

While reviewing literature on the topic of stress, it became apparent through most of the

studies that more research needed to be conducted concerning the individuality of each person.

Moreover, people are different, therefore cope with stress differently. For example, in the

research study done by Baghurst and Kelley on the topic of physical activity, they found that in

some cases physical activity helped the student decrease stress while in other students it

increased stress. To fill this gap in the literature, and increase our understanding of stress more,

researchers could focus specifically on differences in stress coping found in genders, races,

different majors, and socioeconomic classes just to name a few. A new research questions may

be, What are the differences in stress coping mechanisms across gender, race, socioeconomic

class? Overall, it was clear throughout the literature that researchers should focus on the

individuality of the participants instead of trying to find a “one size fits all” approach to decrease

stress. Not only did the review of literature help to show what gaps in the knowledge base there

are, it also showed some limitations to the studies as well.

Limitations of the studies included sampling. For example, the study done by Nancy R.

Ahern and Anne E. Norris, included students from a community college instead of university and

also had an unequal representation of genders with 59.6% males and 40.4% females. This they

believe skewed results and limited their chances of proving their hypothesis. Other studies
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 24

included samples from other countries, which may be a limitation on who nurses can teach the

findings too. In “Biofeedback Intervention for Stress and Anxiety Among Nursing Students: A

Randomized Controlled Trial” by Paul Ratanasiripong, Nop Ratanasiripong and Duangrat

Kathalae, they did their study in Thailand. This setting may be limited to cultural differences,

and could lead to different findings. Therefore it may be one nurses cannot teach to surrounding

college campuses in America. The study, “Interventions to reduce stress in university students:

A review and meta-analysis,” used 15 US colleges for their research that also included students

from Tehran, Switzerland, Jordan, Scotland, England and Tasmania. The inclusion of these

students may be a limitation to the study and is something to be aware of when teaching these

findings to US students on US college campuses.

Another limitation that could be looked at after reviewing all of the articles is that the

sample size for each study conducted is drastically different. In the research article, “School

Stress, Academic Performance, and Coping in College Freshmen,” by Curtis Hill, the sample

size for the study conducted was only 38 college students, while in the research article,

“Interventions to Reduce Stress in University Students: A Review and Meta-Analysis” by Cheryl

Regehr, Dylan Glancy, and Annabel Pitts, the sample size for the survey conducted was 8,155

college students. This significant difference of sample size in each of these studies, can alter the

relevance of the data that was found. For example in the study conducted by Curtis Hill, the

biggest drawback was that there was not a reasonable amount of people available to state the

information found as credible. Also, in the study conducted by Cheryl Regehr, Dylan Glancy,

and Annabel Pitts, it would be very difficult to compare the information found in this research

study with other studies conducted unless the sample size was relatively close to each other. One

way to fix this from becoming a problem in the future if these studies are replicated is to increase
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 25

sample size so that the information found can be credible, and also to put a cap on the amount of

surveys received so that the information can be easily compared and contrasted with other

relatable studies. Besides the limitations and knowledge gap in the area of stress in college

students, this literature review allowed for more understanding of the topic and will apply

directly to nurses.

V. Implications/ Conclusion

After reviewing numerous literature on the topic of stress in the college students, there is

evident implications for nurses. Firstly, by educating nurses about stress they can more

efficiently and promptly recognize the signs of stress in a college student. Once those signs are

acknowledged, nurses can better interview their patient on what specifically could be stressing

them out. And most importantly, studying literature on stress in the college student can improve

the nurses knowledge base and in turn enhance their patient teaching. By enhancing patient

teaching, the goal is to decrease stress in college which will ultimately lead to a healthier

lifestyle and increased productivity in college students.

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