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.

Please note that this is not a required part of the IB curriculum.  However, when discussing problems, it is not a bad idea to think about potential solutions...

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 aging 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.

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 suggest 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.

 Teacher only box

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?

When discussing what this would look like, ethics should be a key part of the discussion.  How would this work in your community? How could the anonymity of the people seeking out support be managed? And would it be ethical for IB psychology students to do the support?  What would be the limitations that the students would have to acknowledge in the support group - e.g. when x happens, then I will have to recommend that you seek out assistance from a professional.

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?

What type of guidance would you give to people in the support group?  What have you learned about stress in this unit that you would pass on to the members of the group? The discussion would also focus on whether they think that such advice online is helpful, or is it important to meet as a group in person to discuss stress management?

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

This question is a bit different from the first as this is about the day-to-day management of the group. This might include not pressuring people to answer questions that they feel are uncomfortable - e.g. do you think that your life at home is part of your stress? Are you struggling with your sexuality? In addition, those running the sessions need to recognize when someone needs professional help and they should encourage them to do so.  They should not believe that they can solve everyone's personal problems with stress.

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.

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?

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 percent, and a reduction of 35 percent 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 effects were 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.

 Teacher only box

Presentations will vary - but the important part of any presentation is that it addresses the limitations of mindfulness programs in addressing stress. Here is a study that addresses the question. Students should acknowledge that a good mindfulness program would allow students to opt out as there is clear evidence that not everyone has a positive experience from mindfulness programs.