To design, implement, and examine the psychoneuroendocrine responses of three different types of stress management programs.
Design.
Randomly assigned. A pre/post experimental design comparing variables between three different programs and a control group. The first program included training in deep breathing, relaxation response, meditation, and guided imagery techniques (RRGI). The second program included training in cognitive behavioral techniques (CB). The third program included both RRGI and CB (RRGICB).
Setting.
The study was conducted at Buenos Aires University.
Subjects.
Participants (N = 52) were undergraduate students.
Measures.
Anxiety, anger, hopelessness, neuroticism, respiration rate, and salivary cortisol levels were assessed.
Analysis.
Wilcoxon signed rank test was used to investigate differences in pre and post variables.
Results.
Subjects in the RRGI group showed significantly lower levels of anxiety (p < .011), anger (p < .012), neuroticism (p < .01), respiratory rate (p < .002), hopelessness (p < .01), and salivary cortisol (p < .002) after the treatment. Subjects in the CB group showed significantly lower levels of anxiety (p < .018), anger (p < .037), and neuroticism (p < .03) after the treatment. Subjects in the RRGICB group showed significantly lower levels of anxiety (p < .001), anger (p < .001), neuroticism (p < .008), hopelessness (p < .01), respiratory rate (p < .001), and salivary cortisol (p < .002) after the treatment. Subjects in the control group showed only one variable modification, a significant increase in cortisol levels (p < .004).
Conclusions.
The combination of deep breathing, relaxation response, meditation, and guided imagery techniques with CB seems to be effective at helping people to deal with stress.
IglesiasSLAzzaraSSquillaceM. A study on the effectiveness of a stress management programme for college students. Pharm Educ.2005;5:27–31.
2.
ChinavehMIshakNMSallehAM. Improving mental health and academic performance through multiple stress management intervention: implication for diverse learners. Procedia Soc Behav Sci.2010;7:311–316.
3.
RiedLMotyckaCMobleyCMeldrumM. Comparing self-reported burnout of pharmacy students on the founding campus with those at distance campuses. Am J Pharm Educ.2006;70:114.
4.
SegrinC. Social skills, stressful life events, and the development of psychosocial problems. J Soc Clin Psychol.1999;18:14–34.
5.
ShapiroSLShapiroDESchwartzGE. Stress management in medical education: a review of the literature. Acad Med.2000;75:748–759.
DixonWARumfordKGHeppnerPPLipsBJ. Use of different sources of stress to predict hopelessness and suicide ideation in a college population. J Couns Psychol.1992;39:342–349.
8.
NiemiPMVainiomakiPT. Medical students′ distress—quality, continuity and gender differences during a six-year medical programme. Med Teach.2006;28:136–141.
9.
LabbéEEMurphyLO'BrienC. Psychosocial factors and prediction of headaches in college adults. Headache.1997;37:1–5.
10.
StoneAABovbergDHNealeJM. Development of common cold symptoms following experimental rhinovirus infection is related to prior stressful life events. Behav Med.1992;18:115–120.
11.
GaabJBlättlerNMenziT. Randomized controlled evaluation of the effects of cognitive-behavioral stress management on cortisol responses to acute stress in healthy subjects. Psychoneuroendocrinology.2003;28:767–779.
12.
McCrayLCronholmPFBognerHR. Resident physician burnout: is there hope?Fam Med.2008;40:626–632.
13.
DeckroGBallingerHHoytM. The evaluation of a mind/body intervention to reduce psychological distress and perceived stress in college students. J Am Coll Health.2002;50:281–287.
14.
ElkinsGFisherWJohnsonA. Mind-body therapies in integrative oncology. Curr Treat Options Oncol.2010;11:128–140.
15.
ChanASSzeSLCheungM-C. Dejian mind-body intervention improves the cognitive functions of a child with autism. Evid Based Complement Altern Med.2011;2011:E549254. doi:10.1155/2011/549254.
16.
EllisA. Reason and Emotion in Psychotherapy. New York, NY: Lyle Stuart;1962.
17.
ChildressARBurnsDD. The basic cognitive therapy. Psychosomatics.1981;22:1017–1027.
18.
MahoneyMJNezworskiMT. Cognitive-behavioral approaches to children's problems. J Abnorm Child Psychol.1985;13:467–476.
19.
RonenT. Cognitive Developmental Therapy With Children. Chichester, United Kingdom: Wiley;1997.
20.
GalvinJBensonHDeckroG. The relaxation response: reducing stress and improving cognition in healthy aging adults. Complement Ther Clin Pract.2006;12:186–191.
21.
JacobsGDBensonHFriedmanR. Topographic EEG mapping of the relaxation response. Biofeedback Self Regul.1996;21:121–129.
22.
RusyLMWeismanSJ. Complementary therapies for acute pediatric pain management. Pediatr Clin North Am.2000;47:589–599.
23.
WeydertJAShapiroDEAcraSA. Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial. BMC Pediatr.2006;6:29.
24.
KingstonJChadwickPMeronDSkinnerCT. A pilot randomized control trial investigating the effect of mindfulness practice on pain tolerance, psychological well-being, and physiological activity. J Psychosom Res.2007;62:297–300.
25.
SchwartzJMStappHPBeauregardM. Quantum physics in neuroscience and psychology: a neurophysical model of mind-brain interaction. Philos Trans R Soc Lond B Biol Sci.2005;360:1309–1327.
26.
TeasdaleJDSegalZVWilliamsJMG. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol.2000;6:615–623.
Kabat-ZinnJMassionAOKristellerJ. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry.1992;149:936–943.
29.
RichardsonKMRothsteinHR. Effects of occupational stress management intervention programs: a meta-analysis. J Occup Health Psychol.2008;13:69–93.
30.
SpielbergerCDReheiserEC. Assessment of emotions: anxiety, anger, depression, and curiosity. Appl Psychol Health Well-Being.2009;1:271–302. doi:10.1111/j.1758-0854. 2009.01017.x.
31.
Roy-ByrnePPDavidsonKWKesslerRC. Anxiety disorders and comorbid medical illness. Gen Hosp Psychiatry.2008;30:208–225. doi:10.1016/j.genhosppsych.2007.12.006.
32.
JylhäPIsometsäE. The relationship of neuroticism and extraversion to symptoms of anxiety and depression in the general population. Depress Anxiety.2006;23:281–289. doi:10.1002/da.20167.
GoldbergLR. The structure of phenotypic personality traits. Am Psychol.1993;48:26–34.
35.
LaheyBB. Public health significance of neuroticism. Am Psychol.2009;64:241–256. doi:10.1037/a0015309.
36.
De GraafRBijlRVRavelliA. Predictors of first incidence of DSM-IIIR psychiatric disorders in the general population: findings from the Netherlands mental health survey and incidence study. Acta Psychiatr Scand.2002;106:303–313.
37.
KendlerKSGatzMGardnerCOPedersenNL. Personality and major depression: a Swedish longitudinal, population-based twin study. Arch Gen Psychiatry.2006;63:1113–1120.
38.
BarnhoferTChittkaT. Cognitive reactivity mediates the relationship between neuroticism and depression. Behav Res Ther.2010;48:275–281.
39.
LiuRAlloyL. Stress generation in depression: a systematic review of the empirical literature and recommendations for future study. Clin Psychol Rev.2010;30:582–593. doi:10.1016/j.cpr.2010.04.010.
40.
HellhammerDHWüstSKudielkaBM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology.2009;34:163–171.
41.
CacioppoJT. Somatic responses to psychological stress: the reactivity hypothesis. In: AdairJGBélangerDDionKL, eds. Advances in Psychological Science.Hove, United Kingdom: Psychology Press;1998:87–109.
42.
KirschbaumCHellhammerDH. Salivary cortisol in psychobiological research: an overview. Neuropsychobiology.1989;22:150–169.
43.
AdamEKHawkleyLCKudielkaBMCacioppoJT. Day-to-day dynamics of experience-cortisol associations in a population-based sample of older adults. Proc Natl Acad Sci U S A.2006;103:17058–17063.
44.
MoonsWGEisenbergerNITaylorSE. Anger and fear responses to stress have different biological profiles. Brain Behav Immun.2010;24:215–219.
45.
VreeburgSAZitmanFGvan PeltJ. Salivary cortisol levels in persons with and without different anxiety disorders [published online ahead of print February 26, 2010]. Psychosom Med. 2010;72:340–347. doi:10.1097/PSY.0b013e3181d2f0c8.
46.
MantellaRCButtersMAAmicoJA. Salivary cortisol is associated with diagnosis and severity of late-life generalized anxiety disorder. Psychoneuroendocrinology.2008;33:773–781. doi:10.1016/j.psyneuen.2008.03.002.
47.
CzernikGEGiménezSMayraMMAlmirónLM. Variables sociodemográficas y síntomas de depresión en estudiantes universitarios de Medicina de Corrientes, Argentina. Alcmeon, Revista Argentina de Clínica Neuropsiquiátrica.2006;13:64–73.
48.
PiemontesiSHerediaD. Relaciones entre la ansiedad frente a los exámenes, estrategias de afrontamiento, autoeficacia para el aprendizaje autorregulado y rendimiento académico. Revista Tesis.2009(2):74–86.
49.
FurlanLASánchezRJHerediaD. Estrategias de aprendizaje y ansiedad ante los exámenes en estudiantes universitarios. Pensamiento Psicologico.2009;5(12): 117–124.
50.
WaldmanSVDiezJCAraziHC. Burnout, perceived stress, and depression among cardiology residents in Argentina. Acad Psychiatry.2009;33:296–301.
51.
CorrecheMSLabianoL. Aplicación de técnicas psicoterapeúticas a un grupo de estudiantes con síntomas de estres. Fundamentos en Humanidades.2003;4:129–147.
EysenckHJEysenckSBG. Manual of Eysenck Personality Questionnaire. London: Hoalder & Songhton;1975.
54.
CasulloMLeibovich de FigueroaNAszkenaziM. Teorías y Técnicas de Evaluación Psicológica. El cuestionario de personalidad de Eysenck. Formas adulta e infanto-juvenil. Buenos Aires: Psicoteca Editorial;1991.
55.
SpielbergerCD. Manual for the State Trait Anger Expresion Inventory (Staxi). Revised Research Edition. Odessa, Fla: Psychological Assesment Resources Inc;1991.
56.
LeibovichNBSchmidtVIGolS. El inventario de expresion de enojo estado-rasgo (staxi) y su uso en diferentes poblaciones. Revista oficial de la asociacion iberamericana de diagnostico y evaluacion psicologica (AIDEP).2001;11:55–73.
57.
SpielbergerCDGorsuchRLLusheneRE. Manual for the State-Trait Anxiety Inventory. Palo Alto: Consulting Psychologist Press;1970.
58.
CasulloMLeibovich de FigueroaNAszkenaziM. Teorías y Técnicas de Evaluación Psicológica. Ansiedad: Algunas concepciones teóricas y su evaluación. Buenos Aires: Psicoteca Editorial;1991.
59.
BeckASteerR. Beck Hopelessness Scale. Manual. New York, NY: The Psychological Corporation Harcourt Brace Jovanovich, Inc;1988.
60.
MikulicIM. Desesperanza: Aportes de la Escala de Desesperanza BHS de A. Beck a la Evaluación Psicológica. Buenos Aires: Departamento de Publicaciones, Facultad de Psicología, Universidad de Buenos Aires;2006.
61.
Kunz-EbrechtSRKirschbaumCMarmotMSteptoeA. Differences in cortisol awakening response on work days and weekends in women and men from the Whitehall II cohort. Psychoneuroendocrinology.2004;29:516–528.
62.
SchlotzWHellhammerJSchultzPStoneAA. Perceived work overload and chronic worrying predict weekend–weekday differences in the cortisol awakening response. Psychosom Med.2004;66:207–214.
63.
EysenckHJEysenckSBG. Manual of the Eysenck Personality Scales. Sevenoaks, United Kingdom: Hodder and Stoughton;1991.
MonnazziPLeriOGuizzardiL. Anti-stress effect of yoga-type breathing: modification of salivary cortisol, heart rate and blood pressure following a step-climbing exercise. Stress Health.2002;18:195–200. doi:10.1002/smi.938.
66.
MacLaughlinBWWangDNooneA-M. Stress biomarkers in medical students participating in a mind body medicine skills program. Evid Based Complement Altern Med.2011;2011:950461. doi:10.1093/ecam/neq039.
67.
PecoraroNDallmanMFWarneJP. From Malthus to motive: how the HPA axis engineers the phenotype, yoking needs to wants. Prog Neurobiol.2006;79:247–340.
68.
Späth-SchwalbeESchöllerTKernW. Nocturnal adrenocorticotropin and cortisol secretion depends on sleep duration and decreases in association with spontaneous awakening in the morning. J Clin Endocrinol Metab.1992;75:1431–1435.
69.
Van CauterEPlatLLeproultRCopinschiG. Alterations of circadian rhythmicity and sleep in aging: endocrine consequences. Horm Res.1998;49:147–152. doi:10.1159/000023162.
70.
EdwardsSClowAEvansPHucklebridgeF. Exploration of the awakening cortisol response in relation to diurnal cortisol secretory activity. Life Sci.2001;68:2093–2103.
71.
WilhelmIBornJKudielkaBM. Is the cortisol awakening rise a response to awakening?Psychoneuroendocrinology.2007;32:358–366.
72.
SchulzPKirschbaumCPruessnerJHellhammerDH. Increased free cortisol secretion after awakening in chronically stressed individuals due to work overload. Stress Med.1998;14:91–97.
73.
WüstSWolfJHellhammerDH. The cortisol awakening response—normal values and confounds. Noise Health.2000;7:77–85.
74.
KudielkaBWustS. Human models in acute and chronic stress: assessing determinants of individual hypothalamus– pituitary–adrenal axis activity and reactivity. Stress.2010;13:1–14.
75.
LundbergUFrankenhaeuserM. Pituitary-adrenal and sympathetic-adrenal correlates of distress and effort. J Psychosom Res.1980;24:125–130.
76.
O'ConnorTMO'HalloranDJShanahanF. The stress response and the hypothalamic-pituitary-adrenal axis: from molecule to melancholia. Q J Med.2000;93:323–333.
77.
GrossiGPerskiAEkstedtM. The morning salivary cortisol response in burnout. J Psychosom Res.2005;59:103–111.
78.
AlderlingMTheorellTde la TorreBLundbergI. The demand control model and circadian saliva cortisol variations in a Swedish population based sample (the PART study). BMC Public Health.2006;6:288.
79.
KirschbaumCHellhammerDH. Salivary cortisol. In: FinkG, ed. Encyclopedia of Stress. Vol 3. San Diego, Calif: Academic Press;2000:379–383.
80.
BroderickJEArnoldDKudielkaBMKirschbaumC. Salivary cortisol sampling compliance: comparison of patients and healthy volunteers. Psychoneuroendocrinology.2004;29: 636–650.
81.
KudielkaBMBuchtalJUhdeAWüstS. Circadian cortisol profiles and psychological self-reports in shift workers with and without recent change in the shift rotation system. Biol Psychol.2007;74:92–103.
82.
TangYYYinghuaWWangJ. Short term meditation training improves attention and self-regulation. Proc Natl Acad Sci U S A.2007;104(43): 17152–17156. doi:10.1073/pnas. 0707678104.
83.
ZeidanFGordonNSGoolkasianP. The effects of brief meditation training on experimentally induced pain perception [published online ahead of print October 23, 2009]. J Pain. 2010;11:199–209. doi:10.1016/j.jpain.2009.07.015.
