Strategies for coping with stress

Knowing that stress has so many negative effects on our health, it is important that we find ways to manage our stress. In theory, we can just leave stress situations and escape the stressor.  If I am stressed by having too many after-school commitments, I can drop out of a club or decide to only attend once a month.  But often this is not an option - or it is a difficult option.  Simply "getting out of" a stressful relationship or a job is not always easy.  In cases of chronic stress caused by poverty or systemic discrimination in a society, it may be impossible.

Self-help books are full of advice on how to cope with stress.  What do psychologists think are the best strategies for addressing this health problem?

Cognitive-appraisal model of coping

Folkman and Lazarus (1988) suggested two main coping strategies. The first one is problem-focused coping, which is dealing with the stressor itself. The purpose is to change the problematic situation - for example, quitting an impossible job or leaving an abusive partner. The second strategy is called emotion-focused coping. The purpose is to handle the emotional aspects of stress rather than changing the problematic situation. There are several ways that people do this, such as going to the movies, relaxation exercises, seeking social support, or taking medication to alleviate tension.

However, it is difficult to make a clear distinction between the two ways of coping. Problem-focused coping is probably more likely to happen if the person feels they can control the stressor. Emotion-focused coping is more likely in cases where people feel they have little control over the stressor. Generally, a situation perceived as one that has to be endured - for example, in the case of the death of a loved one - is more likely to result in emotion-focused coping. However, it should be noted that the two strategies influence each other. Problem-focused coping may result in the reduction of unpleasant emotions. Likewise, emotion-focused coping (e.g. talking with close friends) may reduce tension and eventually result in more effective problem-focused coping.

Generally, if people believe they can manage stress, the stress is less intense and of shorter duration. This has implications for reducing risk factors in health - for example, in terms of the relationship between stress and heart disease. 

Strategy 1: Social support

Psychologists have long known that having friends is important to mental well-being. A longitudinal study of ageing found that regular personal and telephone contact with friends and family increases life expectancy (Gilles et al. 2005). Social support also seems to be an important factor in the way people cope with stress.

Social support can be defined as the experience of being part of a social network, with mutual assistance and obligations, and that one is cared for by others. Social support can come from a partner, relatives, friends, or various social support groups. Numerous studies have demonstrated that having a network of supportive relationships contributes to psychological well-being. When you have a social support network, you benefit in the following ways:

  • Sense of belonging. Spending time with people helps ward off loneliness. Just knowing you're not alone can go a long way toward coping with stress.
  • Increased sense of self-worth. Having people who call you a friend reinforces the idea that you're a good person to be around.
  • Feeling of security. Your social network gives you access to information, advice, guidance and other types of assistance should you need them. Since you feel you have support, you may appraise potentially threatening situations as less stressful.

Research in psychology: Coan, Schaefer & Davidson's (2006)

Coan, Schaefer & Davidson's (2006) research shows how social support may play a key role in stress reduction. In their study 16 married women were threatened with an electric shock while holding their husband's hand, the hand of an anonymous male experimenter or no hand at all while they were in a fMRI brain imaging scanner. While in the fMRI the women were shown 12 non-threat indicating images (safety cues) and 12 threatening images (threat cues) - that is, images that when shown, indicated that an electrical shock was possible. The cues activated brain regions associated with fear and anxiety.

Results showed that the brain's "threat response" was lowest when holding their husband's hand and strongest when no hand was held. Not only this, but there was a negative correlation between the reported marital quality and the threat response - that is, the higher the reported marital quality, the lower the brain's threat response. It appears that social support is key to resilience.

Heinrichs et al (2003) argue that in addition to the fact that social support gives us informational, emotional and practical support, it also increases our level of oxytocin, which is a protective factor against stress. In their double-blind study, 37 healthy men were randomly assigned to receive intranasal oxytocin or a placebo 50 min before carrying out a stressful interview process. The participants were given five minutes to prepare a five-minute presentation. In one condition, the participant received social support from their best friend during this preparation time. In the other condition, the participants worked alone, without any social support. The researchers found that the combination of oxytocin and social support exhibited the lowest cortisol concentrations as well as decreased anxiety during stress. This study indicates that there may be biological underpinnings of the role of social support on stress reduction.

The following video demonstrates the study by Coan, Schaefer & Davidison (2006)

Taylor (2002) has argued that there are gender differences when it comes to actively seeking out social support during times of stress. Taylor's argument is that this is due to evolutionary-based differences between men and women - where men activate the "flight or fight" response, whereas women activate the "tend and befriend" response - that is, women tend to use social support more as a coping mechanism than men do. Studies conducted by Repetti (1989) show that women respond to highly stressful workdays by providing more nurturing behaviours towards their children. In contrast, fathers who experienced stressful workdays were more likely to withdraw from their families or display more interpersonal conflict.

Psychologists suggests that culture is a variable that may moderate how social support is perceived. One dimension of culture is independence (western cultures) versus interdependence (non-western cultures). In individualistic cultures, there is a strong emphasis on the self as independent, whereas collectivist cultures perceive the individual as part of a social group—the self is interdependent. This has implications for seeking social support. Taylor et al. (2004) explored cultural differences in the use of social support as a form of coping. European, US, and Korean students were asked about their ways of coping with stress, including individual and social coping strategies. They found that a significantly lower number of Korean students used social support as a way of coping. They hypothesized that the Asian concern about disruption of harmony in the group, social criticism, or losing face could be an explanation.

CAS: Social support in a digital world

The importance of Internet-based social support groups is rising. These groups can help people who do not have a social network or may offer an additional source of support.  Participating in such groups provides people with a sense of belonging. Since they are so popular, it would seem that such groups are quite efficient at helping people. But what does the research say?

Wenzelberg et al. (2003) carried out a randomized controlled experiment, which was aimed at evaluating the beneficial effects of online support groups. The participants were 72 women diagnosed with breast cancer. They were randomly assigned to a 12-week Web-based social support group.  The researchers found that the web-based program was effective in reducing participants' scores on depression, perceived stress, and cancer-related trauma measures.

The researchers argue that Web-based support groups offer advantages, but that there are ethical issues that need to be addressed. One is the privacy of the participants. According to the researchers, securing participant confidentiality is important in groups like these.  It is also important that such support groups do not take the place of treatment.

Questions

1. If you were to undertake a CAS project on how to establish an online support group for IB students suffering from exam stress, how would you go about it?

2. Use your knowledge of stress and suggest how you could provide informational and emotional support. Would it be possible to provide practical support online?

3. What ethical guidelines would you have to put in place for your support group?

Evaluation of the strategy

  • There are several studies that show that social support groups reduce stress
  • Much of the research done is based on self-reports about how much support has been received. It is difficult, therefore, to actually measure the level of actual support.
  • It is difficult to isolate social support as a variable. Social support may also result in more activity, a rise in self-esteem or practical information that helps the individual to solve a problem. It may not actually be the presence of others alone, as suggested by Heinrichs et al (2003), that alleviates the stress.
  • It is not really clear how social support is related to coping. The relationship between support and appraisal strategies has not been reliably demonstrated.
  • There may be gender and culturally based differences in the likelihood to actively pursue social support.

    Strategy 2: Exercise

    Another way to reduce stress is to increase one's level of physical activity. As we know, when the body is under threat, there is a biochemical response that takes place: an increased secretion of glucocorticoids and noradrenaline, and the activation of the sympathetic nervous system. Evidence supports the beneficial effects of regular exercise in preventing or lessening the physiological effects of chronic stress.

    Exercise increases your overall health and your sense of well-being. Physical activity also helps increase the production of your brain's feel-good neurotransmitters, called endorphins. But the effects are not all physical.

    Exercise changes our focus and often allows us to stop thinking about the stressors that are bothering us. Whether playing tennis or swimming laps in a pool, when exercising people concentrate on their body's movements - a process that is very similar to mindfulness programs - as we will see below.

    Exercise also improves your mood. Regular exercise can increase self-confidence, it can relax you, and it can lower the symptoms associated with mild depression and anxiety. Exercise can also improve sleep, which is often disrupted by stress.  All of these benefits can help to counteract the negative effects of stress.

    Brown & Siegel (1988) carried out a prospective longitudinal study of 384 female middle school students. The researchers gave the students a "life events survey" to determine which stressors they had experienced, as well as an activity questionnaire. The tests were given at the beginning and at the end of the academic year. In addition, they carried out a medical health check-up. They found that the negative impact of stressful life events on health declined as exercise levels increased.

    King et al (1993) carried out a 12-month study of adults aged 50 - 65. They were randomly assigned a low or high-intensity exercise training program. The researchers found that regardless of the exercise regime, an increase in exercise was related to lower levels of stress and depression.

    Research in psychology: Hamer, Stamatakis and Steptoe

    Hamer et al (2008) carried out a survey of 20,000 men and women in Scotland to determine the effect of exercise and/or physical activity on their health.

    The survey was carried out over two household visits. During the first visit, the participants discussed their levels of physical activity, and their weight and height were measured. During the second visit, they were asked about their general health and physical activity. They participants took the General Health Questionnaire (GHQ-12), which measures psychological distress which consists of 12 questions about participants’ general level of happiness, experience of depressive and anxiety symptoms, and sleep disturbance over the last four weeks.

    The researchers found that any form of daily physical activity was linked to a lower risk of psychological distress. The more physical activity people engaged in, the less likely they were to indicate psychological distress on their questionnaires. The research also showed that the different activities, including domestic tasks (such as gardening), walking and sports, all showed a reduced chance of psychological distress. The strongest effects were observed for those who played sports.

    The researchers concluded that stress reduction benefits were observed at a minimal level of at least 20 minutes a week of any physical activity. In addition, there was a greater risk reduction for activity that was undertaken for longer or at a higher intensity.

    The study does suffer from bidirectional ambiguity - that is, there is the possibility that results are actually showing that those who suffer from stress or anxiety are less likely to take part in physical activity, instead of the other way around.

    Here is a quick video on the positive effects of exercise on the brain. What can you learn from this video that could help explain the benefits of exercise in coping with stress?

    Evaluation of the strategy

    • There is clear biological evidence of the positive effects of exercise.
    • Exercise may promote self-esteem, social activity and provide time away from stressors such as work or family. Thus, it is difficult to determine the extent to which exercise alone is effective against stress.
    • Several studies on the effect of exercise use a very loose definition of stress. Often "mood", "stress" and "health" are mixed - making it difficult to know to what extent stress is actually being regulated.

    Strategy 3: Mindfulness

    One reason for stress is people worrying about the past or the future, doing too many things at the same time, and not enjoying the moment because they are thinking about what they have to do next. Since the mind is related to the body in a complex way, learning to relax and concentrate on one thing at a time could be a way to reduce stress. A large body of research has documented the beneficial effects of relaxation techniques in stress reduction. One such technique is mindfulness-based stress reduction (MBSR).

    Mindfulness aims to teach people how to respond to stressful situations "mindfully" - that is, being able to appraise stressors realistically and step back from related thoughts and emotions. It is believed that the positive or neutral appraisal of environmental stressors is what decreases the stress response.

    Shapiro et al. (1998) carried out a controlled study with a group of premedical students who were offered the MBSR course at the University of Arizona. People who signed up for the course were randomly assigned to the course (n = 37) or to a waiting list (n = 36). Participants in the MBSR group and the waiting-list group filled out a self-report questionnaire assessing stress before the course and during exams after the course. The study was designed to coincide with exams, since this is known to be a high-stress period. The participants also completed a questionnaire on empathy.

    The researchers found no difference between the two groups at the beginning of the term, but they did identify differences around the time of the exams. People on the waiting list expressed more anxiety compared to those who had participated in the MBSR class, who were, in fact, less anxious than at the start. This suggests that the course had taught them to cope effectively with the stress of exams.

    Can these results be generalized to other people? The participants were medical students; they were a self-selected sample; and they were offered course credits to participate, which probably ensured the low drop-out numbers in this study. These are just some of the considerations that may be included in any evaluation of this research.

    Speca et al. (2000) performed a controlled test with a sample of cancer patients. They recruited the participants by publishing the MBSR course in a cancer clinic in Calgary. Those who were interested were randomly allocated to the experimental group or to a waiting list (the control). The effectiveness of MBSR was assessed using a stress symptoms questionnaire. The experimental group showed a reduction in total mood disturbance (anxiety, anger, depression) of an impressive 65 per cent, and a reduction of 35 per cent in stress symptoms. The time spent practicing meditation correlated positively with improvements in mood. There were no changes in the average scores for the control group over the same period. The results provide evidence that MBSR had a therapeutic effect. However, it may be that some of the effect was due to social desirability effects, which could play a role in the patients’ self-reports on mood and stress changes. Maybe they wanted to show that they had complied with the treatment and that it had had an effect? This cannot be ruled out.

    ATL:  Thinking critically

    Watch the following video on mindfulness.

    Many schools have started to incorporate mindfulness into the daily routine for their students.  The argument is that mindfulness will not only help improve their stress during exam periods, but it will help with overall help and well-being.

    Imagine that a group of students at your school wanted to begin a mindfulness program at your school and that the school board intervenes and says that this is not an acceptable idea - seeing it at least as unnecessary - at most, as religious propaganda. Design a presentation for the school board in which you explain the benefits of a mindfulness program in your school.  In addition, be able to discuss the limitations of the program, but explain why these may not be a reason not to have the program.

    Evaluation of the strategy

    • There is research that demonstrates that MSBR is a successful treatment method for many people.
    • It is not clear how meditation affects physiological processes with regard to stress.
    • Mindfulness as a construct is not well defined. It is difficult to measure one's "level of mindfulness" in order to determine its effect on stress.
    • There is not enough research to account for placebo effects of the treatment. More research is needed.

    Evaluation of coping strategies - overview

    When looking at these three strategies, you will see that there are some general issues that should be discussed in a general discussion of how we can cope with stress.

    • How do we measure stress? Many studies are reliant on self-reported data, rather than biological markers of stress.
    • It is difficult to control extraneous variables in longitudinal studies.
    • Often the link between the strategy and the reduction in stress is not clear - that is, we cannot really explain why it reduces stress.
    • Personality, gender and culture may play a significant role in stress management.
    • It is difficult to measure the effectiveness of strategies as people usually engage in more than one. For example, a person practicing MSBR may join a group for meditation. It is the social support then that alleviates the stress, or is it MSBR? Or it is a combination of the two?
    • Much of the research on stress is done on students. This leads to problems of generalization of the findings

      Checking for understanding

      1. What is meant by the statement that "social support gives us informational, emotional and practical support?"

      Informational support is advice that helps us to cope better with a stressor. Emotional support includes listening, empathizing and comforting. Practical support is actual assistance - for example, someone helping out her recently divorced sister by taking care of the children so that the sister has some time to do things with less stress.

      2. Explain why Heinrichs et al used a "double-blind study."

      In a double-blind study the researcher is trying to reduce researcher bias by not knowing which data came from which condition - and by the researchers carrying out the actual study, not knowing exactly what the goals of the study are. In this case, the researcher will "blindly" determine from the data whether social support reduced stress by reading cortisol levels. After all data is analysed, then the conditions would be revealed to see if the hypothesis is supported.

      3. According to Taylor (2002), what is the reason for gender differences in seeking social support for stress reduction?

      Taylor argues that there is an evolutionary advantage to this strategy. When women are pregnant, nursing, or providing childcare, fleeing a stressor may compromise the health and safety of offspring. In the presence of threats, protecting and calming offspring while blending into the environment may have increased chances of survival for mother and child.

      4. What are some of the limitations of Brown & Siegel's study on exercise and stress?

      There are several limitations. First, it is only correlational, with very little control over variables. Second, measurements were only taken at the very beginning and the end of the academic year. The study used a sample of middle school students. This makes it difficult to generalize the findings to a broader population. Finally, the data about exercise is self-reported. It is therefore questionable how the level of activity was really measured. In addition, it is questionable whether all types of exercise lead to the same reduction in stress.

      5. Many of the studies on stress reduction have a problem with construct validity. What is the problem?

      If no biological markers are used, then the question is "how is stress being defined in this study?" When comparing studies, it is important to know how stress was defined because the definitions may have an effect on the findings.

      6. What is one strength and one limitation of the Shapiro et al (1998) study?

      One strength of the study is that participants were randomly allocated to conditions. All participants were interested in MSBR as a way to reduce stress, which reduces participant variability in the sample to some extent. Limitations include that the sample is limited to students, which are younger and should be more resilient to stress. In addition, there is no way to actually measure the extent to which mindfulness practices were actually carried out. Finally, stress levels were assessed through self-reported data.

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      Comments 2

      Ed Cascarino 5 September 2018 - 05:03

      Hi John,

      Will there be a coping strategies question in the new curriculum? I don't see anything specific about coping strategies in the Health guidance.

      John Crane 6 September 2018 - 05:53

      Dear Ed

      Technically, no. But the question could simply be to "Discuss on health problem." This means that they could write about prevention/treatment. And for me, it is also important for them to know how to deal with health problems, so it is a major gap for me in the curriculum. This is a way to fill in that gap, without it having to be assessed by the IB