1. Holly Abel1, 2. Annette Abel1, 3. Robert L. Smith2
Article first published online: 27 MAR 2012 DOI: 10.1002/j.1556-6978.2012.00005.
x Keywords: • stress management;
• stress management coping techniques;
• counselors;
• counselor education;
• graduate school
Abstract
The effects of a stress management course on the stress knowledge and coping techniques of 101 graduate students in counseling were examined. Participants, drawn from various racial groups, were typically female (79%) and 21 to 55 years of age. Seven of the 8 null hypotheses were rejected. There were significant differences on 6 of the 7 dependent variables (overall knowledge of stress, perceived state and trait anxiety, stress response to positive and negative self-statements, and general and current stress level).
The treatment group learned and implemented stress management strategies to better cope with stress. Recommendations and further directions for research are offered. Stress and stress-related symptoms are a part of the lives of graduate students, including those in counselor preparation programs. Stress is a major concern for graduate students as they struggle with a variety of academic, personal, financial, and social issues (Cooke, Sims, & Peyrefitte, 1995; Di Pierro, 2010; Hyun, Quinn, Madon, & Lustig, 2007; Oswalt & Riddock, 2007; Ross, Niebling, Bradley, & Heckert, 1999). Graduate students face more pressures than undergraduate students because they typically balance more responsibilities while in school, including full-time employment, marriage, children, aging parents, more challenging academic and degree requirements, extremely limited spare time, higher tuition, and loan repayments from previous degrees (Calicchia & Graham, 2006; Cooke et al., 1995; Di Pierro, 2010; Hudson & O'regan, 1994; Oswalt & Riddock, 2007; Saunders & Balinsky, 1993). These are all factors over which the graduate student has little control. Because removing these stressors is usually not an option, the graduate student needs to learn ways to cope with them while maintaining satisfactory progress in the graduate program (Di Pierro, 2010; Saunders & Balinsky, 1993). Even in a well-managed life, one will experience daily stressors. Girdano, Everly, and Dusek (2001) stated that stress can “be implicated in at least 80 percent of the illnesses that plague modern society” (p. 1). Selye (1991) defined stress as the result of any demand that is placed on the body, whether psychological or physiological. Selye (1936) first described the physiological changes occurring during the stress response in the body, including increases in heart rate and blood pressure, rapid breathing, muscle tension, and changes in metabolism. According to Girdano et al. (2001), “Even stress that is not particularly severe can, if prolonged, fatigue and damage the body to the point of malfunction and disease” (p. 2). In contrast, the American Institute of Stress declared that there is not a common definition of stress that researchers agree on, because stress affects everyone differently and to varying degrees (see Rosch, 2007). The sources of stressful demands are environmental, physiological, sociological, and psychological (Davis, Eshelman, & McKay, 2000). “A more immediate consequence is that excess stress robs us of joy in our lives” (Girdano et al., 2001, p. 2). Two terms used to describe the positive and negative aspects of stress are, respectively, eustress (e.g., improved performance, motivation, productivity, healthy moods, passing an examination, graduation) and distress (e.g., frustration, unhealthy moods, irritation, fatigue, illness, poor problem solving, lowered cognitive functioning; H. Smith, 2002). Optimal stress is the point between where one's peak performance occurs with a balance of eustress and distress (Girdano et al., 2001). Graduate students in counselor preparation programs are inundated daily with an infinite number of internal and external stressful experiences, such as grades, comprehensive exams, professor demands, competition, intense worry, self doubt, and even isolation (F. R. Hughes & Kleist, 2005; H. Smith, 2002; R. Smith, Maroney, Abel, Abel, & Nelson, 2006). As noted in the 2009 Standards of the Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2009), counselor preparation programs are encouraged to implement wellness strategies that support student success; stress management training is a recognized component of wellness programs (Seaward, 2004; Young, 2005). A major goal of graduate schools is to produce successful graduates (Lovitts, 2001). Comprehensive student mentoring and wellness programs have been advocated in counselor education (Black, Suarez, & Medina, 2004; Myers & Sweeney, 2008). If programs such as these are not available, then the graduate student may be unable to cope and negative consequences may occur (physically, psychologically, socially, and academically) resulting in failing grades and/or attrition (Cooke et al., 1995; Girdano et al., 2001; Greenberg, 2002; Kjerulff & Wiggins, 1976; Mallinckrodt, Leong, & Fretz, 1983, 1985; Seaward, 2004). It is our opinion that graduate programs have a responsibility to support students by offering preventive services and programs, such as those that mediate stress. We chose a stress management course as the vehicle for treatment in this study because researchers have indicated that counseling students and counseling professionals experience a high risk of stress and burnout because of the psychological and emotional nature of their work (Culbreth, Scarborough, Banks-Johnson, & Solomon, 2005; Niles, Akos, & Cutler, 2001; Polson & Nida, 1998; Stanley, Feldman, & Kaplan, 1999). We sought to examine the effects of a stress management course on graduate students’ knowledge of stress and coping techniques. The stress management course was an elective offered in the program. A main objective of the stress management course and treatment was to reverse the stress response and therefore reduce chronic stress. The relaxation response is a common stress management technique intended to replace the stress response (Seaward, 2004). The relaxation response involves a series of physiological responses directly opposite to the stress response, such as decreases in heart rate, blood pressure, breathing, muscle tension, insomnia, pain, diseases with psychosomatic components, and anxiety (Benson, 1975). The practice of relaxation techniques like the relaxation response can reverse the stress response within 3 minutes, therefore returning all bodily functions to normalcy or achieving homeostasis (Davis et al., 2000). Regular elicitation of the relaxation response has increased individual resiliency against the effects of stress (Benson, 1975). There is a need for experimental research that examines the efficacy of wellness components, such as stress management training for students enrolled in counselor preparation programs (Roach & Young, 2007; Sweeney & Myers, 2005). Practicing preventive measures such as stress management may aid students in reducing stress-related symptoms, which in turn might negate stressors that students face while in their program (Myers & Sweeney, 2008; Roach & Young, 2007; H. L. Smith, Robinson, & Young, 2007). The purpose of the present study was to determine whether participation in a stress management course might reverse the stress response and therefore reduce symptoms related to chronic stress among graduate students who are enrolled in a counselor preparation program. The course addressed three domains in which stress is found in a typical graduate student's life: psychological, physiological, and socioenvironmental. In addition to teaching an underlying theory of stress, the course emphasized a variety of stress management techniques and skills for coping with stress. We measured participants’ state and trait anxiety because of their related characteristics to stress. Both describe an overall experience of a physiological and psychological state of heightened arousal (Greenberg, 2002; Levitt, 1980; Spielberger, 1979). This construct view of the interrelatedness of stress and anxiety is also supported by Endler and Edwards (1982), Lazarus (1966), and Spielberger (1979). We used the Perceived Stress Scale (PSS; Cohen, 1994) to measure participants’ perception (appraisal) of stress as related to specific situations in life through self-statements. The Random House Webster's College Dictionary's (1998) definition of appraise is “to estimate the nature, quality, importance of” something. The “PSS can be used as an outcome variable, measuring people's experienced levels of stress as a function of objective stressful events, coping resources, personality factors” (Cohen, Kamarck, & Mermelstein, 1983, p. 386). The research questions were designed to measure whether a difference existed between the treatment group and control group in the following areas: the combined seven dependent variables for the overall effect of the stress management class, overall knowledge of stress, perceived state and trait anxiety, perceived stress response in terms of negative and positive self-statements, and perceived general and current stress level. Method Participants Criteria for inclusion in the study for the treatment and control groups included having no prior stress management courses and/or participation in stress management presentations at conferences within the past 5 years. The convenience sample consisted of 101 participants from a population of 180 graduate students enrolled in master's-level courses in a CACREP counselor education program in the southwestern United States. Treatment and control group participants were seeking a master's degree in counseling (mental health counseling, school counseling, and marriage and family counseling). The treatment group consisted of 55 students enrolled in an elective stress management course, and the control group consisted of 46 students enrolled in general counselor preparation courses (i.e., Introduction to Marriage and Family Counseling or Introduction to Counseling). All students in each class were given the option to not participate in the study and were informed that their choice had no bearing on their course grade. Class memberships were independent of each other (i.e., each participant in the study was enrolled in only one of the three courses used in the sample). In the three specific courses used for the sample, the response rate was 100%; none of the students enrolled in these three courses refused to engage in the study as either a treatment group or control group participant. Both groups consisted of graduate-level students in a counselor preparation program; the treatment group participants were enrolled in an elective stress management course, and the control group was not. The treatment and control group participants met the required criteria to be included in the study. Descriptive data were obtained through the researcher-created questionnaire. The participants in the treatment group had a mean age of 32 years, were unmarried (55%) women (76%) with children (49%), and were employed full time (85%). They self-identified as Hispanic/Latino (44%), Caucasian (38%), African American (9%), other (6%), and multiracial (3%). Their self-identified program identity consisted of school counseling (22%), mental health counseling (40%), marriage and family counseling (11%), and undecided (27%). Treatment group participants were enrolled in an average of 9 credit hours and had completed 12 total credit hours in the program. The control group participants had a mean age of 32 years, were unmarried (46%) women (83%) with children (57%), and were employed full time (76%). They self-identified as Hispanic/Latino (48%), Caucasian (46%), African American (4%), and Asian Pacific Islander (2%). Their self-identified program identity consisted of school counseling (13%), mental health counseling (48%), marriage and family counseling (26%), and undecided (13%). They were enrolled in an average of 6 credit hours and had completed 15 total credit hours in the program. Procedure The research team consisted of a two doctoral students (first and second authors) in a counselor education and supervision program and a full-time counselor education faculty member (third author). The first author did not serve as an instructor for any of the three courses used in this study but did collect the research data from all group participants. The role of the additional doctoral student (second author) and full-time faculty member (third author) was to assist in analyzing the collected research data. This study was approved by the university's institutional review board committee, and the participants received and signed an informed consent concerning the study. The participants’ grade for their respective course was not connected to their experiences in the study or their choice to participate. The research questions for this study were designed to measure whether a difference existed between the treatment and control group means on the (a) combined seven dependent variables for the overall effect of the stress management class; (b) participants’ overall knowledge of stress (theory, consequences, and stress management techniques); (c) participants’ perceived state anxiety response; (d) participants’ perceived trait anxiety response; (e) participants’ perceived stress response in terms of negative self-statements; (f) participants’ perceived stress response in terms of positive self-statements; (g) participants’ general perceived stress level; and (h) participants’ current perceived stress level. A pre–post control group design was used, and the total treatment time was 14 weeks. The stress management course for the treatment group was 2 hours per week. The other two general counselor preparation courses were an average of 2 to 3 hours per week. During the 1st week, participants in both groups (treatment and control) completed a packet of three self-report questionnaires at the beginning (pretest) and end (posttest) of treatment. Participant demographic data were gleaned through one of these questionnaires. During the 1st and 2nd week, treatment group participants were instructed to individually identify and select a personal stress-related symptom they wished to change (via a personal self-management project log). To provide a baseline of their chosen symptom, treatment group participants tracked their symptom for the first 2 weeks of the study. Instruction in the first 2 weeks of class consisted of basic stress theory. In the remaining 12 weeks, stress management relaxation content and techniques were introduced and practiced. At the end of the 12 weeks, treatment group participants submitted a written personal self-management project log that discussed any change they experienced in their personal stress-related symptom. Also during the 1st and 2nd week, the control group participants identified a personal stress-related symptom they wished to change, tracked their symptom for the remaining 12 weeks but with no treatment, and did not produce a personal self-management project log. Instead, they reported whether they experienced any change in their symptom on the researcher-created questionnaire posttest. If change in the symptom occurred, both groups were asked to describe clearly how and why they believed the symptom changed. The treatment group reported this in the personal self-management project log and the control group on the researcher-created questionnaire posttest. The specific stress management treatment components were chosen for this study based on a review of current literature recommendations for the design of a comprehensive stress management program (Girdano et al., 2001; Greenberg, 2002; Seaward, 2004). Treatment components included (a) a content dissemination of stress theory and stress management relaxation techniques; (b) in-class practice of specific techniques that could be used outside of class to elicit a relaxation response; (c) in-class practice of specific techniques used to elicit the relaxation response; (d) tracking personal stress-related symptom progress through a self-management project log; and (d) cognitive processing after each content and in-class practice session, including discussion and question/answer interactions. The treatment program content was consistent with recommendations of literature to address three domains in which stress may be found in a person's life: psychological, physiological, and socioenvironmental (Girdano et al., 2001; Greenberg, 2002; Seaward, 2004). Each class began with an open discussion time to allow participants to share any concerns related to the stress management course. Next, direct instruction, role-play demonstration and discussion of new stress management material, and a relaxation technique provided an opportunity to increase the treatment group members’ content knowledge. Then, a time for group practice of a specific technique occurred, with all participants practicing the same technique together. The synergistic nature of stress management technique instruction allowed participants to learn a new technique each week while incorporating previous ones. Each class concluded with an open discussion to process experiences related to that class session. Treatment Curriculum The first two classes introduced an underlying theory of stress, including basic information about stress and its consequences (physical and psychological), the stress reaction response, and two stress models (medical–biological model and person–environmental model). In each subsequent class, the instructor introduced and provided time for the in-class practice of a new stress management relaxation technique and the review of previously practiced techniques. The order of the specific stress management treatment content introduced throughout the 14-week class included the following: stress theory and response, nutrition and exercise, breathing and body awareness, relaxation response and progressive muscle relaxation, autogenics, visualization/imagery, meditation, worry control, thought stopping, refuting irrational thoughts, goal setting and time management, and assertiveness training. All content disseminated in the stress management class came from the three required course textbooks: The Relaxation Response (Benson, 1975), Beyond the Relaxation Response (Benson, 1984), and The Relaxation and Stress Reduction Workbook (5th ed.; Davis et al., 2000). Measures Assessment instruments included two standard and two researcher-developed self-report questionnaires. Standard instruments included the State–Trait Anxiety Inventory, Form Y 1 and 2 (STAI-Y 1–2) and the Perceived Stress Scale (PSS). Data were also gathered from a researcher-developed questionnaire and a personal stress-related symptom self-management project log (treatment group only). STAI-Y 1–2 (Spielberger, 1983). The STAI-Y 1–2 is a 40-item instrument designed to assess how adults currently (state) and generally (trait) feel about a variety of life experiences. The purpose of the measure is to quantify two distinct types of perceived anxiety: state (transient) and trait (stable; Takashi, Tsukamoto, & Abe, 2000). The STAI-Y-1 contains 20 items and is purported to measure state anxiety. “I feel strained” is a sample item from the STAI-Y-1. The STAI-Y-2 contains 20 items and is purported to measure trait anxiety. “I feel satisfied with myself” is a sample item from the STAI-Y-2. This instrument used a Likert scale ranging from 1 (very much so) to 4 (not at all); the examinee chose one response for each question (Spielberger, 1983). Both anxiety and stress describe an overall experience of a physiological and psychological state of heightened arousal (Greenberg, 2002; Levitt, 1980; Spielberger, 1979). This construct's view of the interrelatedness of stress and anxiety has also been supported by Endler and Edwards (1982), Lazarus (1966), and Spielberger (1979). Test–retest reliability coefficients of .54 for the state scale and .86 for the trait scale have been reported for a 20-day period (Spielberger, 1983; Spielberger, Gorsuch, & Lushene, 1970). The STAI-Y has been used in more than 2,000 studies requiring anxiety assessment since its creation in 1970 by Charles Spielberger (see Spielberger, 1983). PSS (Cohen, 1994). The PSS is a 10-item instrument designed to assess one's perception of stress (Cohen, 1994). The purpose of the PSS is to measure the degree to which people perceive (appraise) specific situations in life as stressful (Cohen, 1994). This instrument uses a Likert scale ranging from 0 (never) to 4 (very often); the examinee selects one response for each question. “PSS items were designed to tap the degree to which respondents found their lives unpredictable, uncontrollable, and overloading” (Cohen et al., 1983, p. 387). Authors report coefficient alphas for scores on the PSS between .84 and .86 (Cohen et al., 1983). Reliability for this instrument is reported as .85 by Cohen et al. (1983). For scoring purposes only, the 10 items of the PSS were separated into two categories: (a) negative statements concerning one's self and one's abilities in dealing with life stressors or (b) positive statements concerning one's self and one's abilities in dealing with life stressors. PSS Items 1, 2, 3, 6, 9, and 10 are negative statements. For example, Item 1 asks, “In the last month, how often have you been upset because of something that happened unexpectedly?” PSS Items 4, 5, 7, and 8 are positive statements. For example, Item 4 asks, “In the last month, how often have you felt confident about your ability to handle your personal problems?” Researcher-created questionnaire. We created a self-report demographics questionnaire for this study to survey participants’ specific life characteristics. These life characteristics were viewed as possible contributors to stressors (Cooke et al., 1995; Di Pierro, 2010; Hudson & O'regan, 1994; Matheny, Ashby, & Cupp, 2005; Oswalt & Riddock, 2007; Ross et al., 1999). Information from the questionnaire was used to describe the sample. The demographic data included gender, age, marital status, parental status (how many, ages, residency), ethnicity, master's program orientation (mental health counseling, school counseling, or marriage and family counseling), semester hours currently enrolled, credit hours completed, employment status (part time, full time, or not employed), a description of the personal stress-related symptom participants chose and wanted to change (control group only), and if participants experienced any change in their symptom (control group only; posttest questionnaire). Three items using a Likert scale were utilized from this questionnaire in relation to the research questions to explore if a difference existed between the treatment and control group mean for overall knowledge of stress (theory, consequences, and stress management techniques), ranging from 0 (no knowledge or ability) to 4 (extremely knowledgeable and able to use), and general perceived stress level and current perceived stress level, both ranging from 1 (little to none) to 5 (extremely). Personal self-management project log. The personal self-management project log was a typewritten report that treatment group participants completed during the 14-week study. This log was kept hourly, daily, and/or weekly according to the symptoms, to account for the progress of participants’ personal stress-related symptom. Because the types of symptoms that participants chose varied greatly, the tracking schedule depended on the symptom characteristics (i.e., increased exercise habits might be tracked weekly, whereas decreased smoking habit might be tracked hourly or daily). The report included a description (frequency, duration, and intensity) of participants’ personal stress-related symptom before treatment (2-week baseline), during treatment (12 weeks of instruction), and at the end of treatment. The treatment group participants submitted personal self-management project logs ranging from two to five pages at the end of the treatment period. They used this detailed log to create a graphical representation to display what happened with regard to their personal stress-related symptom. Control group participants did not produce a personal self-management project log but did report any change in the symptom on a posttest researcher-created questionnaire. We analyzed the data provided by the participants by determining if a positive change occurred in the stress symptom they chose to track. We defined positive change as a satisfactory adjustment as reported by the participant in moving toward lessening the negative effects of the stress symptom tracked in treatment. For example, a participant might choose excessive nail biting as the stress-related symptom; a positive change in this symptom would be a reduction in the frequency, duration, and intensity of nail biting. Data Analysis There were seven dependent variables in the study: (a) overall knowledge of stress; (b) perceived state anxiety response; (c) perceived trait anxiety response; (d) perceived stress response in terms of negative self-statements; (e) perceived stress response in terms of positive self-statements; (f) perceived general stress level; and (g) perceived current stress level. Another variable was the treatment and control groups’ self-reported change with regard to the personal stress-related symptom each participant chose to track. Participants reported either a positive change (as yes) or no change (as no) on their chosen symptom. We calculated the percentages for positive change for each group (dividing the total number of participants who reported a positive change by the total enrollment for that group). To test pre–post comparisons, we used a multivariate analysis of covariance (MANCOVA) to determine whether there were significant differences between the groups on the combined seven dependent variables and whether the covariate significantly influenced the combined dependent variables, and we used follow-up analysis of covariance (ANCOVA) on each dependent variable to determine which dependent variable was affected by the independent variable (group membership) after adjusting for the covariate (pretest scores). The MANCOVA is a multivariate extension of the ANCOVA procedures in which there are multiple dependent variables being tested, one or more covariates, and one or more fixed factors (independent variables; Newton & Rudestam, 1999). The design of this study used one fixed factor or independent variable (group membership), seven dependent variables, and seven covariates. The advantage of using MANCOVA was that the researcher can incorporate one or more covariates into the analysis. The effects of these covariates are then removed from the analysis, leaving the researcher with a clearer picture of the true effects of the independent variables on the multiple dependent variables. (Mertler & Vannatta, 2005, p. 137) A preliminary MANCOVA was conducted to test the following assumptions: (a) homogeneity of variance–covariance matrices (equality of the dependent variables across the groups) and (b) homogeneity of regression slopes (Mertler & Vannatta, 2005). The homogeneity of variance–covariance assumption is determined through the Box's test (Mertler & Vannatta, 2005), which was significant (p= .001). Therefore, the appropriate test statistic to use to examine the homogeneity of regression slopes and the full factorial MANCOVA was Pillai's trace (Mertler & Vannatta, 2005). We determined the homogeneity of regression slopes by examining the results of the fixed Factor × Covariate interaction; if the interaction is not significant, then one may “proceed with conducting the full MANCOVA analysis” (Mertler & Vannatta, 2005, p. 144). In this study, the Factor × Covariate interaction (group membership by all seven pretests) was not significant, Pillai's trace = .089, F(14, 170) = 0.562, p= .891. Therefore, a full MANCOVA was conducted and was reported significant at the p < .05 level. The follow-up ANCOVA tests were reported significant at the p < .007 level, using a Bonferroni adjustment to accommodate for seven dependent variables (.05/7 = .007; see Table 1). Table 1. Summary of the Follow-Up ANCOVA for Each of the Seven Dependent Variables Covariate (Pretest Adjustment) SS MS F(1, 92) p Partial η2 1. Note. ANCOVA = analysis of covariance; SS = Type III sum of squares; MS = mean square. 2. *p≤ .007. Overall knowledge of stress Perceived state anxiety response Perceived trait anxiety response Perceived stress response in terms of negative self-statements Perceived stress response in terms of positive self-statements General perceived stress level Current perceived stress level 2,847.10 598.68 357.02 121.30 96.40 12.53 4.46 2,847.10 598.68 357.02 121.30 96.40 12.53 4.46 69.63 14.40 8.50 15.98 28.02 29.88 7.22 .000* .000* .004* .000* .000* .000* .009 .43 .14 .09 .15 .23 .25 .07 Results Hypotheses 1–8 For Hypothesis 1, the MANCOVA tested for differences among the treatment group and control group with all seven dependent variables combined; results revealed that the group factor significantly influenced the combined dependent variables, Pillai's trace = .85, F(7, 86) = 68.04, p= .001, multivariate η2= .85 of the variance. These results indicated that change did occur in the participants’ population mean scores on the combined dependent variables. Significance required follow-up univariate ANCOVA tests to further determine which dependent variables were significantly different (see Table 1). For Hypotheses 2–8, we conducted follow-up univariate ANCOVAs to the MANCOVA for the each of the seven dependent variables. For Hypothesis 2, we assessed the participants’ overall knowledge of stress to determine if it was affected by its covariate (pretest) adjustment and group factor. The ANCOVA revealed a significant difference on the covariate adjustment for the dependent variable, F(1, 92) = 69.63, p= .001, partial η2= .43. For Hypothesis 3, we examined the participants’ perceived state anxiety response to determine if it was affected by its covariate adjustment and group factor. The ANCOVA revealed a significant difference on the covariate adjustment for the dependent variable, F(1, 92) = 14.40, p= .001, partial η2= .14. For Hypothesis 4, we examined the participants’ perceived trait anxiety response to determine if it was affected by its covariate adjustment and group factor. The ANCOVA revealed a significant difference on the covariate adjustment for the dependent variable, F(1, 92) = 8.50, p= .004, partial η2= .09. For Hypothesis 5, we assessed the participants’ perceived stress response in terms of negative self-statements to determine if it was affected by its covariate adjustment and group factor. The ANCOVA revealed a significant difference on the covariate adjustment for the dependent variable, F(1, 92) = 15.98, p= .001, partial η2= .15. For Hypothesis 6, we assessed the participants’ perceived stress response in terms of positive self-statements to determine if it was affected by its covariate adjustment and group factor. The ANCOVA revealed a significant difference on the covariate adjustment for the dependent variable, F(1, 92) = 28.02, p= .001, partial η2= .23. For Hypothesis 7, we examined the participants’ general perceived stress level (participants ranked how stressed they felt most of the time on a Likert scale from 1 to 5) to determine if it was affected by its covariate adjustment and group factor. The ANCOVA revealed a significant difference on the covariate adjustment for the dependent variable, F(1, 92) = 29.88, p= .001, partial η2= .25. For Hypothesis 8, we examined the participants’ current perceived stress level (participants ranked how stressed they felt at the present time on a Likert scale from 1 to 5). The ANCOVA did not reveal a significant difference on the covariate adjustment for the dependent variable, F(1, 92) = 7.22, p= .009, partial η2= .07. Personal Self-Management Project Log In the personal self-management log, participants recorded a personal stress-related symptom they were experiencing and desired to change. The results revealed significant changes for the treatment group compared with the control group. One hundred percent of the participants in the treatment group (n= 55) experienced a positive change in their personal stress-related symptom compared with only 30% (n= 14) of the participants in the control group. The following is an author-categorized list of the self-diagnosed personal stress-related symptoms that participants desired to change: (a) physical issues (temporal mandibular joint disorder, fibromyalgia, migraine and sinus headache, high blood pressure, chronic body pain); (b) environmental issues (driving stress, sensitivity to surrounding noises and temperature); (c) wellness issues (insomnia, excessive soda and alcoholic beverage consumption, eating habits and weight loss, lack of exercise, smoking cessation); and (d) psychological issues (panic attacks, excessive anxiety, worry, nightmares). Discussion Seven of the eight null hypotheses were rejected. We speculate that the lack of statistical significance between the treatment and control groups’ current perceived stress level means may be due to the stressful social and environmental conditions occurring at the time of posttest, during the seasonal demands of end-of-semester activities (i.e., academic finals and course assignments; B. M. Hughes, 2005). The overall MANCOVA revealed that the groups’ mean scores differed significantly on the combined seven dependent variables. The follow-up ANCOVA tests produced significant differences among the groups’ mean scores on six of the seven dependent variables. The personal self-management project log revealed that significantly more participants in the treatment group experienced a positive change in their stress-related symptom compared with participants in the control group. The list of stress-related symptoms that participants chose to change revealed the variety of stressors that graduate students experience, indicating the need for diverse stress management coping skills (Girdano et al., 2001; Greenberg, 2002; Seaward, 2004). The curriculum for the stress management course was supported by the participant-generated list of personal stress-related symptoms. These were the symptoms that the participants wanted to change, and they are congruent with known sources of stress as highlighted in the literature (psychological, physiological, and socioenvironmental; Girdano et al., 2001; Greenberg, 2002; Seaward, 2004). From these results, we concluded that a stress management course was effective in changing participants’ knowledge of stress, levels of anxiety, and personal stressors over a 14-week period. Results show that participants in the treatment group were able to learn and implement stress management strategies that may help reduce stressors often faced during their graduate studies. These findings indicate that a stress management course in graduate school, specifically a counselor education program, may be beneficial in helping the students cope more effectively with daily stressors; this in turn could contribute to decreasing the degree of attrition (Lovitts, 2001; Roach & Young, 2007; R. Smith et al., 2006). Stress management training can be infused into a series of courses that are already a part of the students’ degree program, but a stand-alone course may provide a more intense learning experience that will aid in the students’ overall understanding, application, and life integration. Findings support the inclusion of a wellness component, specifically a stress management course to be offered in counselor preparation programs. A stress management course, as a wellness component within a graduate program, may help students cope more effectively with daily stressors (Schure, Christopher, & Christopher, 2008; R. Smith et al., 2006). Additionally, stress management courses in counselor preparation programs may enable students as future clinicians to assist clients also experiencing daily stress-related symptoms (Myers & Sweeney, 2008; Witmer & Granello, 2005). Finally, by understanding and implementing the principles of stress management, graduate students may prevent burnout and impairment as future professional counselors (Roach & Young, 2007). Limitations and Recommendations for Future Research Several limitations of this study are recognized. The participants’ treatment and the resulting data collected were limited to a one-semester course on stress management and thus did not provide a longitudinal view of the potential impact of treatment. We suggest there is a need for future research from a longitudinal study showing long-term effects of a stress management course. Second, instruments and self-report questionnaires were assumed to accurately measure concepts studied in this investigation, and the responses of the participants were assumed to be honest and true; however, it is possible that social desirability may have influenced some participants’ responses. Third, although both groups were similar on a number of variables, a complete matching of groups is not possible because of the nature of the two intact groups (e.g., students who enrolled in two different classes). Fourth, several extraneous variables could have affected the results, including support from family, friends, church, and other outside groups or experiences, and although noted as a potential limitation, we recognize that both groups equally had opportunities to be influenced by outside events. Lastly, the researcher-created questionnaire was not piloted before the study. The questionnaire was created to glean demographic data on study participants and included three items (pre and post) related to the research questions. The limitations listed here did not adversely affect the outcome of the study. Recommendations for future research include investigation with other populations experiencing high levels of chronic stress due to the nature of their occupational tasks and environments. A second area of future research might be with other diverse cultural factors such as race, gender, and socioeconomic status. A third area of future research might include addition of internal and external dependent variables to allow researchers to measure and record any change beyond those in this study. A fourth area might be an alternative design, utilizing a mixed paradigm with both quantitative and qualitative elements to determine which segments of this stress management class or other program were most significant in predicting participant change. Phenomenological qualitative studies are recommended that explore the attributions provided by participants who have successfully benefited from wellness program components such as stress management training. Although many stress management research studies have been conducted and reported with various populations, there is a dearth of information on the graduate student population and, more specifically, those within the counseling field. The significance of this study was to generate necessary information concerning the effects of a stress management course on the graduate student population. 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