3.3 Managing stress

1. 3.3 Managing stress

2. Learning outcomes Understand the following three studies on managing stress: • Cognitive (Meichenbaum, D. (1972) ‘Cognitive modification of test anxious college students’, Journal of Consulting and Clinical Psychology 39, 370–80); • Behavioural (Budzynski et al. (1970) ‘Feedback induced muscle relaxation applied to tension headache’, Journal of Behaviour Therapy and Experimental Psychology 1, 205–11); • Social (Waxler-Morrison et al. (1993) ‘Effects of social relationship on survival or women with breast cancer’, Social Science and Medicine 33 (2), 177–83).

3. Cognitive methodKey theory: Meichenbaum (1972), Stress inoculation therapy (SIT) Meichenbaum suggests that there are three components of SIT: • The patients with the stress have to become aware of the thoughts they have in any stressful situations.

4. Key theory: Meichenbaum (1972), Stress inoculation therapy (SIT) (cont.) • The second component is the coping strategies that patients are taught to enable them to restructure their thoughts. • Finally the person puts into practice what they have learned in a real-life stressful situation.

5. Key study: Meichenbaum (1972) Aim • To compare SIT with standard behavioural systematic desensitisation and a control group on a waiting list. Method • A field experiment where students were assessed before and after treatment using self-report and grade averages.

6. Participants • 21 students aged from 17 to 25 who responded to an advert for treatment of test anxiety. Design • Matched pairs design with random allocation to either the SIT therapy group, the waiting list control group or the standard systematic desensitisation group. • Matched groups on gender and anxiety levels.

7. Procedure • Each participant was tested using a test anxiety questionnaire and allocated to their group. • In the SIT group the participants received eight therapy sessions. They were given the ‘insight’ approach to help them identify their thoughts prior to the tests. They were then given some positive statements to say and relaxation techniques to use in test situations.

8. Procedure (cont.) • In the systematic desensitisation group the participants were given eight therapy sessions with progressive relaxation training, which they were encouraged to practise at home. • The control group were told they were on a waiting list and that they would receive therapy in the future.

9. Findings • Performance on the tests improved in the SIT group compared with the other two groups. • The significant difference was between the two therapy groups and the control group. • Participants in the SIT group showed more reported improvement in their anxiety levels, although both therapy groups showed overall improvement compared to the control group.

10. Conclusions • SIT is a more effective way of reducing anxiety in students who are anxiety prone in test situations. It is more effective than behavioural techniques such as systematic desensitisation as it adds a cognitive component to the therapy.

11. Behavioural method Key study: Budzynski et al. (1970) Aim • To see whether biofeedback is an effective method of reducing tension headaches. Method • Experimental method, with patients being trained in a laboratory.

12. Participants • 18 participants who replied to an advertisement in a local paper in Colorado. Design • Independent design. The participants were randomly allocated to one of three groups.

13. Procedure • For two weeks patients kept a record of their headaches. • Groups A and B were given 16 sessions of training, with 2 sessions each week for 8 weeks. • Group A were taught relaxation and told the ‘clicks’ of the biofeedback machine would reflect their muscle tension, with slower clicks indicating less muscle tension.

14. Procedure (cont.) • Group B were told to concentrate on the varying clicks. They were given pseudo-feedback. • Group C were given no training but were told they would begin training in two months.

15. Findings • The muscle tension of Group A was significantly different from Group B by the end of the training, and after three months, Group A’s tension was significantly lower than Group B’s. • Group A’s reported headaches dropped significantly from their baseline, whereas the other didn’t, and was also significantly less than Group B’s and Group C’s reported headaches.

16. Findings (cont.) • Drug usage in Group A decreased, more than in Group B. • Group A reported less headache activity than Group B. • There was a follow up for Group A after 18 months, when four out of the six participants were contacted. Three reported very low headache activity, and the fourth reported some reduction.

17. Conclusions • Biofeedback is an effective way at training patients to relax and reduce their tension headaches, so can be seen as an effective method of stress management. • Relaxation training is also more effective than just being monitored, but is better when used together with biofeedback.

18. Social support Key study: Waxler-Morrison et al. (1993) Aim • To see how social relationships influence response to breast cancer and survival. Method • A quasi-experiment with women who were diagnosed with breast cancer.

19. Participants • 133 women under 55 years (pre-menopausal). Design • Independent design as women had existing social networks.

20. Procedure • Patients were mailed a self-administered questionnaire to gather information on: their demography and existing social networks, their educational level, who they were responsible for (e.g. children), contact with friends and family, perception of support from others. • They were given a psychometric test of social network that combined marital status, contact with friends and family and church membership.

21. Procedure (cont.) • The details of their diagnosis was abstracted from their medical records between June 1980 and May 1981, and then their survival and recurrence rates were checked in their medical records in January 1985.

22. Findings • Six aspects of social network were significantly linked with survival. These were: marital status, support from friends, contact with friends, total support, social network and employment. • The qualitative data from the interviews showed that practical help such as childcare, cooking and transport to hospital were the concrete aspects of support.

23. Findings (cont.) • Married women who survived tended to report supportive spouses. • Jobs were seen as important, even if they were not financially important, as they were a source of support and information.

24. Conclusions • The more social networks and support, the higher the survival rate of women with breast cancer, although type of cancer was still the main factor in survival.