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What are Positive Coping Strategies for College Students Under Stress?
Emily Shields
Marium Khan
Michelle Vidale
Valerie Jeffery
Summer 2016
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 2
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.
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
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
Performance, and Coping in College Freshmen,” by Curtis Hill, and also in the article, “Stress
Furthermore, another topic that was researched explored the relationship between stress and
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
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
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
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 5
(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 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
In the research article, “Biofeedback Intervention for Stress and Anxiety Among Nursing
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
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,
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
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
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 7
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
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
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
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 10
authors also state that students should have leisure time and a calming hobby to allow the body
GPA is one of the most competitive parameters used to measure student success in
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
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
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 11
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
Research Agenda,” by David Robotham, students from a university in the UK were observed to
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 12
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
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
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
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.
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
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
STRESS COPING STRATEGIES FOR COLLEGE STUDENTS 16
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
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
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
associated with decreased stress. Other studies that were reviewed by these researchers found a
Barber, 2003; Park, 2005). Ahern and Norris also synthesized that other studies have shown
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
In the research article, “Differences in Perceived Stress and Its Correlates Among
and Shashidhar G. Hiremath, 276 college students studying various professional majors such as
dental, nursing, pharmacy, engineering, physiotherapy etc. were evaluated using a “self-
“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
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
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
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
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
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
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
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
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
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,
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
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