relationship between strength of a religious …
TRANSCRIPT
RELATIONSHIP BETWEEN STRENGTH OF A RELIGIOUS
AFFILIATION AND PERCEIVED STRESS LEVEL
A Thesis Presented to the Faculty
of
California State University, Stanislaus
In Partial Fulfillment
of the Requirements for the Degree
of Master of Social Work
By
Kimberly D. Sisney
May 2014
CERTIFICATION OF APPROVAL
RELATIONSHIP BETWEEN STRENGTH OF A RELIGIOUS
AFFILIATION AND PERCEIVED STRESS LEVEL
by
Kimberly D. Sisney
Signed Certificate of Approval Page is
on file with the University Library
Elizabeth Breshears, Ph.D.
Associate Professor of Social Work
Robin Ringstad, Ph.D.
Associate Professor of Social Work
Date
Date
© 2014
Kimberly D. Sisney
ALL RIGHTS RESERVED
iv
DEDICATION
For my parents, brother, and family, who encouraged me and supported me
through my education. I am blessed to have such amazing family who pushed me and
kept me going.
v
ACKNOWLEDGEMENTS
I would like to express my appreciation for those who helped me accomplish
my goals. First, I would like to thank my parents and brother. Without your guidance,
love, and support I would not have been able to be who I am today. Second, I would
like show my love and appreciation to my Papa. Your encouragement was the push I
needed to keep going. Juan, you were always there to support me and encourage me
when I felt like giving up. I would like to thank all of my family for showing support
and showing me how proud you were. I would like to extend a special thank you to
Dr. Breshears and Dr. Ringstad, for their guidance, support, and helpful critique to
help me get through this thesis. Last, but not least, I would like to thank my cohort for
letting me vent and providing me with a shoulder to lean on while we all
accomplished our goals. This program and thesis would not have been possible
without the love, encouragement, and support of you all. Thank you.
vi
TABLE OF CONTENTS
PAGE
Dedication ............................................................................................................... iv
Acknowledgements ................................................................................................. v
List of Tables ......................................................................................................... viii
Abstract ................................................................................................................... ix
CHAPTER
I. Introduction ........................................................................................... 1
Statement of the Problem .......................................................... 1
Statement of the Purpose .......................................................... 4
Implications of the Study .......................................................... 5
II. Literature Review.................................................................................. 6
Introduction ............................................................................... 6
Stress Defined ........................................................................... 6
Advantages and Disadvantages to Stress .................................. 7
Coping Strategies ..................................................................... 9
Religious Affiliation ................................................................ 12
Religion as a Coping Strategy .................................................. 13
Social Work and Clients .......................................................... 14
Conclusion ............................................................................... 15
III. Methodology ........................................................................................ 16
Overview ................................................................................... 16
Design ...................................................................................... 16
Sampling Plan .......................................................................... 17
Instrumentation ........................................................................ 18
Data Collection ........................................................................ 19
Plan for Data Analysis ............................................................. 20
Protection of Human Subjects ................................................. 21
IV. Results .................................................................................................. 23
Overview of Chapter ................................................................. 23
vii
Overview of Sample ................................................................. 23
Religious Affiliation and Religions Connection ...................... 24
Perceived Stress Level ............................................................. 25
Religious Affiliation and Perceived Stress Score .................... 25
Summary .................................................................................. 26
V. Discussion ............................................................................................. 28
Overview of Major Findings ..................................................... 28
Limitations ............................................................................... 28
Existing Knowledge ................................................................. 29
Practice Implications of the Major Findings ............................ 30
Implications for Future Research ............................................. 30
References ............................................................................................................... 33
Appendices
A. Informed Consent........................................................................................ 40
B. Survey Questions ........................................................................................ 41
C. Survey Instrument ....................................................................................... 42
viii
LIST OF TABLES
TABLE PAGE
1. Connection Score ............................................................................................. 24
2. PSS Score Grouped in Low, Medium, and High ............................................. 25
ix
ABSTRACT
The purpose of this study is to determine if there was a relationship between
perceived stress level and connection to a religious affiliation. The question guiding
this study was: Does being connected to a religious affiliation reduce the stress of
undergraduate CSU, Stanislaus college students? The research question is addressed
through a quantitative descriptive survey. The participants of this study had to be
attending CSU, Stanislaus full-time and be undergraduate students. The online survey
received 391 completed responses. The survey has 17 questions of which 14 of the
questions are taken from the Perceived Stress Scale or the PSS-14. The results reveal
that the majority of participants identify with being connected to a religious affiliation
and fall into the category of having medium levels of stress. The Statistical Package
for the Social Sciences (SPSS) analyses shows that there were not any significant
differences in individual’s perceived stress score based on their connection to a
religious affiliation. Further research needs to be done to examine the relationship.
1
CHAPTER I
INTRODUCTION
Statement of the Problem
Stress has become part of everyday American life. According to the
University of Maryland Medical Center (2013) 44 percent of Americans have stated
they have felt an increase in stress within the last five years. This shows that stress is
becoming more and more of a prevalent issue with Americans. Stress can come from
minor changes in an individual’s environment or it can come from extreme changes.
According to Wilks and Spivey (2010), stress is the way in which an individual’s
body reacts to specific changes within his or her environment. Factors such as family
issues, children, finances, lack of sleep, change in activities, or academics can all be
causes of increased stress levels (Womble, n.d.). Further, the University of Maryland
Medical Center (2013) identifies a person’s job, the economy, and major illnesses as
major factors related to stress.
Excessive stress can be harmful to an individual. The American Institute of
Stress (n.d.), states that people can develop a wide range of symptoms related to
stress. These symptoms include depression, anxiety, heart attacks and strokes, a
lowering of the immune system, hives and rashes, weight gain, problems within the
reproductive system, and gastrointestinal problems. Further, stress can also cause an
increase in blood pressure (Campbell, Lawrence, Svenson, & Jarvis, 1992), a
decrease in academic performance, and a decrease in overall well-being (Ross,
2
Niebling, & Heckert, 1999). Too much stress is dangerous to the lives of individuals.
On the other hand, a small amount of stress can be beneficial. According to
Popovic (2013) a small amount of stress can create a positive arousal within an
individual’s body. This positive arousal is called excitement. Such stress can be
useful in situations of danger because it allows individuals to run faster and respond
more quickly. Also, it can be beneficial when in competitive situations because it can
increase performance due to the excitement of the situation. Stress factors affect
everyone differently. Each individual lives within their own environment and their
ability to cope depends on the amount of stress enacted upon each person-in-
environment situation (Ross et al., 1992). However, when stress becomes
uncomfortable or overwhelming, coping mechanisms are needed to relieve this excess
stress.
Various methods of coping are used to relieve stress. According to Campbell
et al. (1992), coping mechanisms include avoidance, social support, positive
reappraisal, and religion. Other authors identify coping methods as engaging in
exercise, using relaxation techniques such as meditation and breathing exercises,
using Cognitive Behavioral Therapy, and using herbal and natural remedies
(University of Maryland Medical Center, 2013). Although studies have shown that all
these methods are beneficial, for the purpose of this study how religion is used as a
coping mechanism will be examined.
Religion has become a large part of life within the American culture.
According to Inzlicht, McGregor, Hirsh, and Nash (2009), within the United States 92
3
percent of the population believes in God and 82 percent of the population states that
religion is important to them. These authors discussed that religion helps people to
find their beliefs, find a way of life, find how to act within their surroundings, find
how to live within their environment, and find how to help alleviate uncertainty.
Religion can be either beneficial to relieve stress or harmful if individuals have gone
against what they believe. The benefits of affiliating with a religion can create a
communal identity within people to feel accepted. It may also lead to resilience and
personal and interpersonal healing (Miley, O’Melia, & DuBois, 2004). According to
Hackney and Sanders (2003), religion has been found to be beneficial to an
individual’s psychological well-being. Psychological well-being has been described
as having a sense of autonomy, gaining personal growth, creating stronger positive
interpersonal relationships, finding purpose in one’s life, and accepting one’s self
(Seifert, 2005). Religion can be harmful when individuals commit acts that contradict
their religious beliefs because they feel bad which may lead to an increase in anxiety
and a decrease in self-esteem. These factors may, in turn, lead to higher levels of
stress (Behere, Das, Yadav, & Behere, 2013).
Research has suggested that it may be beneficial for counselors, therapists, or
anyone working within the helping profession to use religion as a coping mechanism
when working with clients. As previously stated, Americans are reporting increasing
levels of stress, which means that helping professionals’ clients are more likely to
identify stress as a concern. It may be helpful to encourage clients who have a
religious background to participate in their religious activities to increase well-being
4
and create more social support (Hackney & Sanders, 2003). Koeing and Larson
(2001) suggest that religion plays an important part in facilitating coping within
Americans dealing with acute and severe stress. Increasing a client’s well-being and
social support and decreasing a client’s stress may help the healing process or change
process occur more quickly.
Incorporating religiosity within practice with clients has been debated and not
accepted by all those working within the helping profession. Social workers may be
hesitant to incorporate religion into their practice because it may not be seen as
evidenced-based practice. Evidence-based practice is defined as an integration of the
best current research or evidence, clinical expertise, and client values or presenting
problem (Duke University Medical Center Library and the Health Sciences Library,
2013). The social work profession has initiated evidence-based practice within its
field to boost the validity of the profession.
Some social workers may avoid incorporating religion into practice because of
personal beliefs or biases, including the social worker being non-religious or wanting
to avoid religion due to some religions oppressing and discriminating against various
populations (Zapf, 2005). Religion is very complex and there are a large variety of
religions to choose from, yet religion has a lot to offer. Religion can be encouraging
and be a source to overcome injustices (Miley et al., 2004).
Statement of the Purpose
The purpose of this study was to determine if there was a relationship between
stress and religious affiliation. Specifically, the study examined if the presence of a
5
strong religious affiliation served as coping mechanism when dealing with stressful
events. This quantitative study surveyed undergraduate students at California State
University, Stanislaus (CSU, Stanislaus) to gain an understanding of the affects that
being connected to a religion had on the perceived stress of an individual. The
question guiding this study was: Does being connected to a religious affiliation
reduce the stress of undergraduate CSU, Stanislaus college students? Previous
research has suggested that religion does affect stress levels of those who are a part of
a religion.
Implications of the Study
This study can inform social workers, psychologists, and others working
within the helping profession about the relationship between religion and client stress
factors. The findings may assist with understanding ways clients cope with various
changes in their environment that cause stress. The results of this study can be used to
help social workers working in a college setting to create workshops or programs that
may help alleviate stress of students. Further, the results of this study may lead to
information in future studies which may create an evidence-based practice approach
to using religion within the client-worker collaborative relationship.
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CHAPTER II
LITERATURE REVIEW
Introduction
The previous chapter presented information on stress and the impact it has on
individuals as well as information regarding the importance religion may play in
reducing stress. The present chapter provides more detail regarding the definition of
stress and religious affiliation, history of religion and healing, advantages and
disadvantages of stress, coping strategies of stress including religion, and how
religion can be used as a coping mechanism with clients when working in the social
work profession. These topics informed the research process of determining if being
connected to a religious affiliation reduced the stress level of undergraduate CSU,
Stanislaus students.
Stress Defined
Stress refers to external factors in an environment that impedes an individual’s
internal responses (Hayward, 2005). According to Hayward (2005) stress affects an
individual’s mental or physical state by releasing adrenaline within the body. External
anxieties or factors that cause internal responses help to create equilibrium or balance
within an individual (Dow, 2014). However, too much or too little stress can be
harmful and disrupt balance in the body. Impacts of stress levels can be shown
through a bridge analogy described by Lazarus (1993). A bridge is created to
withstand a certain amount of pressure such as wind, earthquakes, and weight. The
7
external forces on the bridge create stress that the bridge can withstand. However, if
the bridge has an element out of place or if the external elements exceed the pressure
it was built to withstand the bridge can collapse (Lazarus, 1993). Stress, therefore, is
an element that is important to an individual’s survival, yet stress in abundance can
cause an individual to break.
Advantages and Disadvantages of Stress
Stress can be both beneficial and harmful to the human body. There are
advantages and disadvantages to stress. Many researchers have studied how stress can
affect individuals including several studies that have examined stress among college
students. Guzman (2011) surveyed 350 CSU, Stanislaus graduate students and found
that within the previous month, 90 percent of graduate students reported being
stressed or feeling a sense of nervousness. Guzman (2011) concluded that more
research needed to be done to find ways in which students could cope with their
stress. Campbell et al. (1992) conducted a study of 457 undergraduate college
students, asking them how they perceived their stress level and how they felt they
could reduce it. These authors’ findings suggested that women tended to have more
stress than men. Also, they found that both men and woman were able to identify
ways to overcome stress, but were not able to use those strategies due to the amount
of stress that they were experiencing. It was explained by Campbell et al. (1992) that
these college students were so overwhelmed with stress that they felt they could not
use stress-reduction strategies even though they knew what strategies might be
effective. Ross et al. (1999) used the Student Stress Scale to conduct research on the
8
perceived stress of 100 undergraduate college students. Results suggested that
students had high stress levels affecting their personal and academic lives. These
studies collectively suggest that too much stress can affect thinking, performance,
ability to overcome stress related problems, and personal life.
Love and marriage are personal experiences that many college aged students
experience. Research has shown that an excessive amount of stress can affect whether
individuals stay in love or stay in marriage. According to Kiecolt-Glaser, Bane,
Glaser, and Malarkey (2003) stress hormones can affect a couple’s relationship.
These researchers conducted a study with 90 couples in which they did an initial
assessment and reassessed those same couples or divorced individuals ten years later.
Kiecolt-Glaser et al. (2003) found that in the initial assessment some individuals had
a higher amount of stress hormones than others. When reassessed ten years later,
these researchers found that those couples who had higher levels of stress hormones
were more likely to be divorced and those with lower amounts of stress hormones
were still together. This research suggests that the presence of stress can be harmful
to personal relationships.
Between work, school, personal life, and other life demands it is important for
individuals to stay healthy in order to accomplish all tasks of life. When immune
systems are weakened, people become tired and have a harder time functioning.
Cohen, Janicki-Deverts, Doyle, Miller, Frank, et al. (2012) assessed individuals’
stressful life events, control variables, and demographics of healthy adults. These
healthy individuals were then isolated and exposed to a rhinovirus. Following close
9
examination, the researchers found that those individuals who recently had a stressful
event happen in their life were more likely to contract the common cold (Cohen,
Janicki-Deverts, Doyle et al., 2012). The American Institute of Stress (n.d.) has found
that too much stress make individuals more susceptible to colds, hives, stomach pain,
nausea, nervous habits, nausea, and memory loss. All of these symptoms can prevent
an individual from normal daily functioning.
Although stress has many disadvantages, it also can be beneficial in small
amounts. According to Popovic (2013) small amounts of stress are good. A small
amount of stress may come in the form of excitement such as receiving a gift or an
athlete preparing and getting ready for a competition. When stress first starts to arise
in the body it makes a person alert (Sapolsky, 2000). Further, being alert helps
individuals to retain and receive information and helps them become more sensitive
to sensory functioning. According to Sapolsky (2000), energy is released when small
amounts of stress are produced in the body. Sapolsky (2000) gave an example of a
lion chasing a zebra. Both the lion and the zebra need stress to feel alert in order have
energy to run and survive. The lion needs energy to catch the prey and the zebra
needs energy to run from the attacker. This relates to people in the sense that people
need energy and alertness to survive and pursue daily activity. Healthy individuals are
able to turn off the small amounts of stress that are produced, as needed, to stop from
creating a stress related disorder (Sapolsky, 2000).
Coping Strategies
Research has demonstrated that stress can have negative effects and it is
10
important that individuals learn coping strategies to off-set excess amounts of stress.
According to the Merriam-Webster dictionary (2014), the word cope means “to deal
with and attempt to overcome problems and difficulties.” This definition suggests that
the use of coping strategies is a way for individuals to overcome the difficulties that
stress can cause in one’s life.
Humor can create a sense of relief and happiness. One study found that humor
can be used as a coping method to reduce stress (Abel, 2002). Able (2002) queried
258 undergraduate college students enrolled in psychology courses and compared the
results of a perceived stress scale to a humor scale. The results of Abel’s (2002) study
indicated that the college students who had an increased sense of humor had a lower
level of perceived stress. The humor was used as a way to release the negative effects
of stress on the individual.
Meditation is another method known to provide a sense of calmness within the
body. In a pilot study following Hurricane Katrina in New Orleans, individuals who
were directly a part of the destructive hurricane were diagnosed with post-traumatic
stress disorder, anxiety, and depression due to the extreme stress caused by the event
(Waelde et al., 2008). Waelde, et al. (2008) reported that an eight week meditation
program lowered the effects of stress related diagnoses among this population. This
study demonstrated that the use of meditation or mindfulness is effective in reducing
stress.
Holistic approaches such as exercising and yoga have been noted at ways to
calm and get in touch with the internal processes of the body. Steptoe, Kimball, and
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Basford (1998) examined the relationship between exercise, mood, and the
experience of daily life stressors. Their sample of 38 men and 35 women kept a
journal of their exercise, mood, and stressors. Results indicated that those individuals
who exercised more experienced a better mood throughout the day, meaning that the
individuals had less stress and anxiety on the day of the exercise. Another study
conducted in a women’s yoga clinic found that women who engaged in yoga were
more likely to have reduced anxiety than those who did not engage in yoga
(Javnbakht, Hejazi Kenari, & Ghasemi, 2009). The women felt a sense of calming
due to the yoga experience.
Brougham, Zail, Mendoza, and Miller (2009) conducted a study comparing
gender differences in coping strategies of college students. Results indicated that both
women and men used more emotion-focused coping strategies rather than problem-
solving coping strategies (Brougham et al., 2009). According to Taylor (1998)
emotion-focused coping strategies are strategies that attempt to regulate emotions in
the case of a stressful event. An example of this type of coping would be venting or
having friend and familial support. In contrast, problem-solving strategies are ways in
which an individual attempts to regulate stress by doing something active such as
exercising (Taylor, 1998).
There are various ways for individuals to cope with stress. Each individual
differs in their amount of perceived stress and their preference of which coping
strategies work best. Religion and connection to a religious affiliation can be a useful
area to consider when determining ways to reduce stress. This emotion-focused
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strategy of coping may be an essential strategy to society because religion and
connectedness to a particular group, in this case a religious affiliation, is important to
many cultures.
Religious Affiliation
Definition
The definition of religion according to the Oxford Dictionary (2014) is “a
particular system of faith and worship.” Religion can include beliefs about life and
death, rules for behavior, and beliefs about spirits, angels, and demons (Koenig,
2009). According to the Merriam-Webster dictionary (2014) affiliate means “to
closely connect (something or yourself) with or to something (such as a program or
organization) as a member or partner.” These definitions state that an individual is
connected to a religious affiliation when they are closely connected with others and a
place where they can practice their faith, beliefs, and values, and where they can
worship the deity in which they believe.
Prevalence of Religious Affiliation
A study conducted in 2007 by the Pew Forum (2013) surveyed 35,000
Americans age 18 and older to determine if they identified with a religious affiliation.
The study found that of the 35, 000 participants, 78.4 percent stated that they were
affiliated with a Christian religion, 4.7 percent stated that they were affiliated with a
religion other than Christian, and 16.1 percent stated that they did not affiliate with
any religion. More men than women stated that they were not connected to a religious
affiliation. A random digit-dialed telephone survey conducted using the American
13
Religious Identification Survey found that in 2001, 86 percent of Americans
identified with a religion (Kosman, Moyer, & Keysar, 2001). This study also
concluded that 54 percent of surveyed individuals stated that at least one member in
their household belonged to a place of worship. Places of worship include, but are not
limited to churches, synagogues, and mosques. On a wider scale, according to Koenig
(2009) 90 percent of the world’s population is connected to a religion or spiritual
practice. These various statistics suggest that many individuals value religion and
that more than half of U.S. Citizens belong to a place of worship.
Religion as a Coping Strategy
Many studies have shown that religion is important to coping and that prayer
and faith are important to coping with stress (Graham, Furr, Flowers, & Burke, 2001).
According to Pargament, Smith, Koenig and Perez (1998) empirical research
indicates that many people use religious coping in times of stress. Graham et al.
(2001) found that master’s level counseling students who identified that they had
religious beliefs were able to cope with stress much more easily than students who
did not have religious beliefs.
According to Park (2005), religion is connected to physical and psychological
well-being of individuals. Ano and Vasconcelles (2005) stated that regular church
attendance has been related to lower levels of depression. Flannelly and Inouye
(2001) compared the connection of having a religious affiliation to quality of life with
a sample of participants who had been diagnosed with HIV. Results indicated that
those who associated with a religious affiliation felt that they had a higher quality of
14
life (Flannelly & Inouye, 2001). A meta-analysis of 49 studies showed that religion
has a large impact on psychological adjustment to stress (Ano & Vasconcelles, 2005).
Previous research also indicates that individuals have increased positive reactions to
stressful events when using positive religious coping skills. Positive religious coping
includes methods such as using prayer, seeking out religious support, and obtaining
religious forgiveness (Pargament et al., 1998).
Although there are various studies on how beneficial religious coping can be
to increased well-being and decreased stress, some studies indicate that religious
coping may be harmful to individuals. Religion can cause anxiety which leads to
stress when an individual is confused about his or her beliefs (Behere et al., 2013).
Pargament et al. (1998) found that negative religious coping skills caused emotional
distress within individuals. According to these authors, negative religious coping
strategies include struggling with spirituality, a weak relationship with God, or unsure
feelings about the world. Religious coping has been shown to have negative impacts
on people in the case of a major death in the family or of a close friend, major illness,
or relationship problems (Ano & Vasconcelles, 2005). Religion as a coping method
has been shown to have benefits and pitfalls which indicate that more research is
needed to continue to understand its positive and negative effects.
Social Work and Clients
Based on the high number of individuals who identify with a religion, those in
the helping professions are very likely to have many clients with a belief and faith in
a religion (Graham et al., 2001). Clients may bring their religious beliefs with them
15
into the counseling session if they consider their faith important to them. Graham et
al. (2001) stated that they found counseling students are very uncomfortable working
with clients who use their faith in the counseling session. These findings suggest that
courses in counseling programs should implement discussions regarding information
and discomfort regarding working with religious clients. Lack of seeing religion as
scientific or empirical sometimes deters social workers from using religion as a form
of treatment (Zapf, 2005). These findings suggest religion as a coping method should
be talked about further within the schooling and training of helping professionals and
should be more accepted within the helping profession to better work with client
needs.
Conclusion
Stress has been shown to cause more negative than positive effects on people.
The harmful nature of excess stress on the body makes it important to find coping
methods or strategies to reduce the amount of stress. There are many coping
mechanisms to help decrease stress levels within the body. Religion is a coping factor
that has been shown to increase well-being in many individuals. The majority of
people within and outside of the United States have identified that they are associated
with a religious affiliation. Some individuals connected to a religious affiliation are
highly involved with their religion and place of worship. Studies have shown that
large numbers of individuals identify with a faith, indicating the importance for social
workers as well as others in helping professions to feel comfortable and be accepting
of individuals wanting to use their religion as a coping method in counseling.
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CHAPTER III
METHODOLOGY
Overview
This quantitative study was conducted with undergraduate college students on
the CSU, Stanislaus campus. The purpose of the study was to explore how having a
religious affiliation might or might not affect the perceived stress levels of college
students. Many college students are pressured with time constraints, due dates, and
demands of life that cause stress. Religious affiliations are important to a majority of
people. The results of this study provide evidence for future research in this area. The
major research question this study answered was: Does being connected to a religious
affiliation reduce the stress of undergraduate CSU, Stanislaus college students?
Design
The research question was addressed through a quantitative descriptive
design. A descriptive design is appropriate for describing the relationships between
variables in a particular population. In this study the variables were connection to a
religious affiliation and stress level. The population studied was undergraduate
students attending CSU, Stanislaus.
The first step to the design was to create and conduct an anonymous online
survey. This survey consisted of questions asking undergraduate CSU, Stanislaus
college students if they were a full-time student, if they had a religious affiliation, and
17
how connected they felt to their religious affiliation. The survey also included an
instrument that asked questions regarding the students’ perceived stress levels.
The survey gathered information to determine if having a connection to a
religious affiliation did or did not affect the perceived stress level of undergraduate
CSU, Stanislaus college students. Second, the results of the study showed if a strong
religious affiliation was more likely to reduce stress than a low or no religious
affiliation. Strengths of this design were the anonymity and ease of the online survey.
At times religion can be a touchy subject and can hinder individuals from answering
truthfully or at all. Allowing the participants to be anonymous gave them the feeling
of security, which in turn made it more likely for participants to answer truthfully.
Sampling Plan
The participants of this study had to be attending CSU, Stanislaus full-time
and be undergraduate students. For the purpose of this study a participant was
considered full-time if enrolled in at least twelve units during the time of the study.
The reasoning behind having full-time undergraduate students participate was to
promote a more realistic rate of stress level due to deadlines and demands of life. The
duration of college experience was not considered in order to insure a larger and more
diverse sample of participants.
A non-probability purposive sampling plan was utilized in this study. This
type of sampling was used because participating in the survey was voluntary and the
surveys were sent to a specific population (undergraduate CSU, Stanislaus students)
in order to obtain a specific sample. The survey was sent out to a population of 2,000
18
students. The online survey received 391 completed responses. The researcher
worked with the Office of Institutional Research, located on the CSU, Stanislaus
Campus, to gather a sample of students and e-mail them the surveys. The surveys
were distributed in November near the end of the Fall 2013 semester. The e-mail
contained a link to the survey, it asked students to complete the survey within a three
week time span, and included a description of the survey. To ensure an adequate
number of participants, a follow up e-mail was sent to remind students to participate
in the study. This sampling plan was utilized in order to obtain the maximum number
of participants and a diverse sample.
Instrumentation
The survey was constructed on Qualtrics. A link to the survey was
incorporated within the e-mail sent to potential participants. The survey contained
seventeen questions (see Appendices B and C). The first three questions were created
by the researcher. The first question asked whether or not the participant was a full-
time student, having at least twelve units. If the participant answered no, he or she
was not allowed to continue the survey. Question two asked the participants if they
had a religious affiliation. If the participants selected they did not have a religious
affiliation they were directed to skip question three and continue with question four.
The third question asked the participants how connected they felt to their religious
affiliation using a 5-point Likert scale, with 1 meaning weakly connected to 5
meaning strongly connected. The questions were direct and factual increasing
reliability and validity.
19
The next fourteen questions asked about the participants’ perceived stress
levels. The stress questions were taken from the Perceived Stress Scale-14 (PSS-14).
The PSS-14 has high validity and reliability as it has been used and is still used in
many research studies (Cohen & Janicki-Deverts, 2012; Cohen, Kamarck, &
Mermelstein, 1983; Cohen & Williamson, 1988). The instrument was created by Dr.
Cohen, a psychologist who has implemented this instrument within his own work.
Permission was granted to use this instrument for non-profit academic research and
non-profit education purposes (Carnegie Mellon University, 2013).The scale asks
participants about their feelings and thoughts within the last month to configure the
participants’ perceived stress. Each question’s score is based on a 5-point Likert scale
ranging from 0 never to 4 very often.
Data Collection
The data were collected through the Qualtrics online survey software. As the
participants opened the survey they read instructions and informed consent. The
survey lasted approximately five minutes. The survey was also self-explanatory, so
there was no need for the researcher to be present during the time participants
answered the questions. When the survey was completed participants submitted their
results. The survey database kept the results stored. After the Office of Institutional
Research sent out the e-mail to participants they had three weeks to complete the
survey. Four reminder e-mails were sent during the three weeks to remind students
the survey was available. Questions four through fourteen on the survey were given a
score based on the participant’s answer, which were added together to produce the
20
perceived stress level total score. The total score indicated the perceived level of
stress for each participant. The score was taken from the PSS-14. The researcher then
used the Statistical Package for the Social Sciences (SPSS) to analyze the data.
Plan for Data Analysis
To address the research questions, the researcher utilized a quantitative data
analysis process, which included univariate and bivariate analyses. The univariate
analysis explored each variable within the data set separately, finding the variables
central tendencies. Further, any patterns found between connection to a religious
affiliation and perceived stress levels were examined. The bivariate analyses explored
the relationships among the dependent and independent variables. This was done
using an Independent Samples T-Test. This statistical test was utilized because it can
compare two groups on an interval/ratio level variable when all parametric
assumptions are met. Also, a Spearman’s Rho was utilized to determine if there was a
relationship between the dependent and independent variable.
This study had two variables: the dependent variable, perceived stress level,
which was measured by the PSS-14, and the independent variable, connection to a
religious affiliation, which was determined by participants’ choices marked within the
survey. The Independent Samples T-Test permitted the researcher to compare
religious affiliation and stress level to determine if there was connection between the
two variables, which helped to answer the research question within this study. A
Spearman’s Rho test was used to determine if a strong religious affiliation was more
likely to reduce stress than a low or no religious affiliation.
21
The data collected from the survey were analyzed and examined by using
SPSS. This software allowed the researcher to draw meaning and understanding from
the survey results. Further, the analysis of the results provided implications for social
workers and future studies. The researcher created visuals using graphs and tables of
the data to better explain the results.
Protection of Human Subjects
All participants were provided with information regarding the contents of the
study. This information was written within the e-mail sent out asking undergraduate
CSU, Stanislaus students to voluntarily participate in the survey. Participants were
provided with the purpose of the study, approximately how long it would take to
complete the survey, how long the survey would be available, and it reassured
participants that they would be anonymous. The survey was anonymous because there
was no demographic information collected and the participants were not required to
enter any identifying information. The link to the survey was attached to the e-mail.
Before participants began the survey they were presented with the informed consent.
Once participants agreed to the informed consent they continued on to the survey. See
Appendix A for the informed consent. Participants had the ability to stop the survey
at anytime. Prior to this study being conducted, it was reviewed and approved by the
CSU, Stanislaus Institutional Review Board.
The participants were asked to truthfully answer the questions presented
within the survey. The researcher did not foresee any potential harm or risk that the
participants may undergo while participating in the online survey. Although religion
22
may be a touchy subject to participants, their responses were anonymous. Participants
were not asked to put in any identifying information such as their name, birthday, or
address. The researcher was not able to identify which results went with which
participant. This better ensured truthful answers and allowed participants to feel
secure while completing the survey. Only the researcher and the researcher’s thesis
chair had access to the raw data. This raw data will be deleted one year after the
publication of the thesis to further protect the participants of the study.
23
CHAPTER IV
RESULTS
Overview of Chapter
The purpose of this study was to describe how having a religious affiliation
might or might not affect the perceived stress levels of college students. The study
was guided by one research question: Does being connected to a religious affiliation
reduce the stress of undergraduate CSU, Stanislaus college students? The assumption
of the research question was that students connected to a religious affiliation would
have less stress than those who did not have a religious affiliation. This study was
administered to participants through e-mail. The survey was conducted through the
online Qualtrics survey software and analyzed through SPSS. This chapter discusses
the overview of the sample, the religious affiliation and religious connection of the
sample, perceived stress levels of the sample, and summary of results.
Overview of Sample
CSU, Stanislaus undergraduate students were sent an e-mail through CSU,
Stanislaus’ Office of Institutional Research. The e-mail asked students to participate
in an online survey about stress, therefore a non-probability purposive sample of
convenience was employed. A total of 418 students started the online survey and 391
completed the survey. All students who completed the survey were full-time CSU,
Stanislaus undergraduate students. The participants were able to stop the survey at
24
anytime and were not allowed to continue with the survey if they were not a full-time
CSU, Stanislaus undergraduate student.
Religious Affiliation and Religious Connection
The statistical analysis software SPSS was used to analyze the data resulting
from the 17 question survey. Univariate analyses were conducted through frequency
charts and crosstabulations to analyze the central tendencies and distribution of
variables (see Table 1). The majority (n=229, 58.6%), of participants in the study
were connected to a religious affiliation. There were 162 (41.4%) participants who
responded they were not connected to a religious affiliation. Of the participants
connected to a religious affiliation, 19 (4.9%) felt they were weakly connected, 62
(15.9%) felt they were somewhat connected, 94 (24%) felt they were moderately
connected, and 54 (13.8%) felt they were strongly connected.
Table 1
Connection Score
Frequency Percent Cumulative
Percent
Not Connected 162 41.4 41.4
Weakly Connected 19 4.9 46.3
Somewhat Connected 62 15.9 62.1
Moderately Connected 94 24.0 86.2
Strongly Connected 54 13.8 100.0
Total 391 100.0
25
Perceived Stress Level
Univariate analyses were used to analyze the distribution of participant’s
perceived stress levels. The CSU, Stanislaus college students fell into three categories
of stress which are displayed in Table 2. A large majority (n=298, 76.2%), of CSU,
Stanislaus undergraduate college students had moderate stress. Only 32 (8.2%) of the
students had low stress and 61 (15.6%) had high stress. The average PSS-14 score for
participants was 29.48, which was categorized in the moderate stress level. The
lowest PSS-14 score was 6 with two participants obtaining that score. The highest
PSS-14 score was 50 with only one participant with that score.
Table2
PSS Score Grouped in Low, Medium, and High Frequency Percent Cumulative Percent
Valid low 32 8.2 8.2
medium 298 76.2 84.4
high 61 15.6 100.0
Total 391 100.0
Religious Affiliation and Perceived Stress Score
An Independent Samples T-test was utilized to compare participants’ PSS-14
stress level scores based on whether they did or did not report a religious affiliation.
Participants who responded ‘no’ to having a connection to a religious affiliation had
an average PSS-14 score of 29.69. Participants who responded ‘yes’ to having a
connection to a religious affiliation had an average PSS-14 score of 29.33. With a t-
value of .441 and an associated two-tailed significance level of .660, the results of the
26
test clearly indicated that there was not a significant difference in CSU, Stanislaus
students’ perceived stress level based on whether or not they reported a religious
affiliation. Specifically, the results of this test indicated that connection to a religious
affiliation did not reduce stress level.
A Spearman’s Rho was utilized to examine the relationship between
participants’ PSS-14 stress level scores and their level of connection to their religious
affiliation if any. The PSS-14 scores were grouped into three categories to complete
this correlation test. The three categories were low stress (0-18), medium stress (19-
37), and high stress (38-56). The level of connection was grouped in to five
categories, not connected, weakly connected, somewhat connected, moderately
connected, and strongly connected (labeled 0-5 in terms of rank order). With an r =
.022 and an associated p-value of .658, the results do not indicate a significant
correlation between level of connectedness to a religious affiliation and perceived
stress level.
Summary
The participants in this study were full-time CSU, Stanislaus undergraduate
students. The majority (58.6%) of participants connected to a religious affiliation. Of
the 58.6% of participants who reported a religious affiliation, most felt they were
moderately connected to their religion. The average PSS-14 stress level score (29.48)
fell into the medium stress category. The results of the Independent Samples T-test
indicated that the two participant groups, one with and one the other without a
religious affiliation, did not differ significantly in their perceived levels of stress. The
27
results of the Spearman’s Rho correlation indicated that there was not a significant
relationship between level of connectedness to religious affiliation and perceived
stress level. Overall, the hypothesis that CSU, Stanislaus undergraduates who were
connected to a religious affiliation would have lower levels of stress was not
supported. Further research will need to be conducted to examine the relationship.
28
CHAPTER V
DISSCUSSION
Overview of Major Findings
The major findings of the representative sample of CSU, Stanislaus students
showed that the majority of students had medium stress levels. The findings also
showed that over half of the participants responded that they had a religious
affiliation. Of those students, most responded that they were moderately connected to
their religious affiliation. The statistical tests showed that the hypothesis could not be
supported. In other words, the findings did not indicate that having a religious
affiliation reduced perceived stress levels of CSU, Stanislaus undergraduate students.
Limitations
There are various limitations to this study. The study was only conducted with
one California State University (CSU). There may have been a better representation
of undergraduate college students if the study was conducted over various CSU
campuses. Surveying undergraduate students only and not incorporating graduate
students may have led to students having less stress than if graduate students were
also surveyed. A public survey outside of CSU, Stanislaus may have enhanced the
results because the students at CSU, Stanislaus may have similar beliefs or interests.
The sample would then be more diverse. The study did not examine the differences
between genders. If gender was taken into consideration there may have been
significance for males or females. The online survey could have skewed the results in
29
that participants may have rushed through the questions or simply clicked answers to
finish the survey. It might have been beneficial to do an in person interview.
Religious affiliation and religious connectedness may not have resonated with CSUS
undergraduate students as much as the word spirituality may have. There may have
been a greater difference in the results if spirituality was analyzed because it goes
beyond a title of a religious affiliation.
Existing Knowledge
Existing research conducted by Ross et al. (1999), Campbell et al. (1992), and
Guzman (2011) showed that college students tend to have high stress levels. This
thesis research study found that although some participants fell into the category of
high stress, most participants had medium levels of stress. The difference in the
results may have been due to only surveying undergraduate students on the CSUS
campus. In the survey conducted by the Pew Forum (2013), results showed that more
than half of the sample was connected to a religious affiliation, which reflects this
sample’s results. The results could be similar due to both survey’s having a
representative sample. Research carried out by Pargament et al. (1998), Ano and
Vasconcelles (2005), and Graham et al. (2001) showed that participants who used
religion as coping strategy were better able to reduce their stress levels. Behere et al.
(2013) found that stress may be harmful to individuals and cause anxiety. The results
of the current study, however, did not show that religion as coping strategy was
harmful or beneficial.
30
Practice Implications of the Major Findings
The major finding of this study can be useful to social workers and others in
the helping profession when working with clients. Although the results did not
support the hypothesis, the results did show that a majority of students believe or
connect in some way to a religious affiliation. Practitioners should still be open to the
use of a client’s religious beliefs in practice if that is what the client feels comfortable
with and uses as a support system or coping mechanism. Social workers and others in
the helping professions should continue to train and research the importance of
religion as a coping mechanism and research the effects it has on stress. Spirituality
as a coping mechanism may be a significant strength that they client brings to any
treatment or counseling session. As service providers it is important to be open and to
be respecting of clients’ needs and clients’ empowered solutions.
Implications for Future Research
Future research should examine the connection to spirituality as a coping
mechanism for stress rather than religious affiliation. Using spirituality may allow
more individuals to be comfortable when answering the questions and more
individuals may relate to being spiritual than relate to having a religious affiliation.
Future studies should also consider comparing demographics such as gender, age,
culture, race, ethnicity, and college major to see if there are any significant
differences between groups. Currently research shows that many individuals within
the United States connect in some way to a religious affiliation indicating that more
research needs to be done to fully understand its relationship to stress within various
31
populations. Research has shown that many individuals have stress. It has also shown
that too much stress can cause harm and that coping mechanisms are used as an
important aspect in reducing stress levels. A future study might look into which
coping mechanism works best for certain populations in reducing stress levels. Time
may have been a factor that influenced the study. Future research should examine
college academic calendars, keeping in mind times that include midterms and final
exams, in which religion may play a greater role in students’ lives. Studies in the
future might consider looking at the outcomes of clients who have used religion as a
coping mechanism in therapy and counseling settings.
REFERENCES
33
REFERENCES
Abel, M. H. (2002). Humor, stress, and coping strategies. Humor: International
Journal of Humor Research, 15(4), 365-381.
Affiliate. (2014). In Merriam-Webster online dictionary. (11th
ed.). Retrieved from
http://www.merriam-webster.com/dictionary/affiliate
The American Institute of Stress, (n.d). Stress effects. Retrieved from:
http://www.stress.org/stress-effects/
Ano, G. G., & Vasconcelles, E. B. (2005). Religious coping and psychological
adjustment to stress: A meta-analysis. Journal of Clinical Psychology, 61(4),
461-480. doi:10.1002/jclp.20049
Behere, P. B., Das, A., Yadav, R. & Behere, A. P. (2013). Religion and mental health.
Indian Journal Psychiatry 55(2), S187-S194. doi: 10.4103/0019-5545.105526
Brougham, R., Zail, C., Mendoza, C., & Miller, J. (2009). Stress, sex differences, and
coping strategies among college students. Current Psychology, 28(2), 85-97.
doi:10.1007/s12144-009-9047-0
Campbell, R. L., Lawrence, W., Svenson, L.W. & Jarvis, G. K. (1992). Perceived
level of stress among university undergraduate students in Edmonton, Canada.
Perceptual and Motor Skills 75(2), 552-55. doi: 10.2466/pms.1992.75.2.552
Carnegie Mellon University. (2013). Dr. Cohen’s scales. Retrieved from:
http://www.psy.cmu.edu/~scohen/scales.html
34
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived
stress. Journal of Health and Social Behavior 24(4), 385-396.
Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample of the
U.S. in S. Spacapam & S. Oskamp (Eds.), The social psychology of health:
Claremont symposium on applied social psychology. Newbury Park, CA:
Sage.
Cohen, S., & Janicki-Deverts, D. (2012). Who’s stressed? Distributions of
psychological stress in the United States in probability samples from 1983,
2006, and 2009. Journal of Applied Social Psychology 42(6), 1320-1334.
Cohen, S. Janicki-Deverts, D., Doyle, W., Miller, G., Frank, E., Rabin, B.S., Turner,
R.B. (2012). Chronic stress, glucocorticoid receptor resistance, inflammation,
and disease risk. Proceedings of the National Academy of Sciences of the
United States of America, 109(16), 5995-5999.
Cope. (2014). In Merriam-Webster’s online dictionary. (11th
ed.). Retrieved from
http://www.merriam-webster.com/dictionary/cope
Dow, J. (2014). Stress. The Journal of Experimental Biology, 217(1), 5.
Duke University Medical Center Library and the Health Sciences Library. (2013).
Introduction to evidence-based practice. Retrieved from:
http://guides.mclibrary.duke.edu/content.php?pid=431451&sid=3529499
Flannelly, L.T., & Inouye, J. (2001). Relationships of religion, health status, and
socioeconomic status to the quality of life of individuals who are HIV
positive. Issues in Mental Health Nursing, 22, 253–272.
35
Graham, S., Furr, S., Flowers, C., & Burke, M. (2001). Religion and spirituality in
coping with stress. Counseling and Values, 46(1), 2.
Guzman, M. G. R. (2011). Levels of stress among CSUS graduate students
(Unpublished master’s thesis). California State University, Stanislaus,
Turlock, CA.
Hackney, C. H., & Sanders, G. H. (2003). Religiosity and mental health: A meta-
analysis of recent studies. Journal for the Scientific Study of Religion 42(1),
43–55.
Hayward, R. (2005). Stress. Lancet, 365(9476), 2001.
Inzlicht, M., McGregor, I., Hirsh, J. B., & Nash, K. (2009). Neural markers of
religious conviction. Association for Psychological Science 20(3). 385-392.
Retrieved from: http://michaelinzlicht.com/research/publications
/Inzlicht,%20McGregor,%20Hirsh,%20&%20Nash,%202009.pdf
Javnbakht, M., Hejazi Kenari, R., & Ghasemi, M. (2009). Effects of yoga on
depression and anxiety of women. Complementary Therapies in Clinical
Practice, 15(2), 102-104.
Kiecolt-Glaser, J., Bane, C., Glaser, R., & Malarkey, W. (2003). Love, marriage, and
divorce: Newlyweds’ stress hormones foreshadow relationship changes.
Journal of Consulting and Clinical Psychology, 71(1), 176-188.
Koenig, H. G. & Larson, D. B. (2001). Religion and mental health: Evidence for an
association. International Review of Psychiatry, 13, 67–78.
36
Koenig, H. G. (2009). Research on religion, spirituality, and mental health: A
review. Canadian Journal of Psychiatry, 54(5), 283-291.
Kosman, B., Moyer, E., & Keysar, A. (2001). American religious identification
survey. Retrieved from http://www.gc.cuny.edu/CUNY_GC/media/CUNY-
Graduate-Center/PDF/ARIS/ARIS-PDF-version.pdf
Lazarus, R. (1993). From psychological stress to the emotions: A history of changing
outlooks. Annual Review of Psychology, 44(1), 1-22.
Miley, K. K., O’Melia, M. & DuBois, B. (2004). Generalist social work practice: An
empowering approach. Boston, MA: Allyn and Bacon. 235.
Pargament, K. I., Smith,B. W., Koenig, H. G., & Perez, L. (1998). Patterns of
positive and negative religious coping with major life stressors. Journal for
the Scientific Study of Religion, 37(4), 710-724.
Park, C. L. (2005). Religion as a meaning-making framework in coping with life
stress. Journal of Social Issues, 61(4), 707-729. doi:10.1111/j.1540
-4560.2005.00428.x
Pew Forum. (2013). Pew research religion and public life project: Religious
landscape survey. Retrieved from http://religions.pewforum.org/reports#
Popovic, H. (2013). Five essential steps to handling acute stress. Charter, 84(2), 34.
Religion. (2014). In Oxford Dictionaries online. Retrieved from
http://www.oxforddictionaries.com/us/definition/american_english/religion
37
Ross, S. E., Niebling, B. C. & Heckert, T. M. (1999). Sources of stress among college
students. College Student Journal 3(2), 312-317. Retrieved from:
http://www.rosehulman.edu/StudentAffairs/ra/files
/CLSK/PDF/Section%20Two%20Instructor%20Resources
/Sources%20of%20Stress%20Among%20College%20Students.pdf
Sapolsky, R. M. (2000). Stress hormones: Good and bad. Neurobiology of Disease,
7(5), 540-542.
Seifert, T. A., (2005). The Ryff scales of psychological well-being. Center of Inquiry.
Retrieved from: http://www.liberalarts.wabash.edu/ryff-scales/
Steptoe, A., Kimbell, J., & Basford, P. (1998). Exercise and the experience and
appraisal of daily stressors: A naturalistic study. Journal of Behavioral
Medicine, 21(4), 363-374.
Taylor, S. (1998). Coping Strategies. University of San Francisco. Retrieved from
http://www.macses.ucsf.edu/research/psychosocial/coping.php
University of Maryland Medical Center. (2013). Stress. Retrieved from
http://umm.edu/health/medical/reports/articles/stress
Waelde, L. C., Uddo, M., Marquett, R., Ropelato, M., Freightman, S., Pardo, A., &
Salazar, J. (2008). A pilot study of meditation for mental health workers
following Hurricane Katrina. Journal of Traumatic Stress, 21(5), 497–500.
Wilks, S. & Spivey, C. (2010). Resilience in undergraduate social work students:
Social support and adjustment to academic stress. Social Work Education,
29(3), 276-288
38
Womble, L. P., (n.d.) Impact of stress factors on college students academic
performance. University of North Carolina at Charlotte. Retrieved from:
http://www.psych.uncc.edu/Womble.pdf
Zapf, M. K. (2005). The spiritual dimension of person and environment: Perspectives
from social work and traditional knowledge. International Social Work, 48(5),
633–642. doi: 10.1177/0020872805055328
APPENDICES
40
APPENDIX A
INFORMED CONSENT
Dear Participant: You are being asked to participate in a research project that is being done to fulfill
requirements for a Master’s degree in Social Work at CSU Stanislaus. The purpose of this
study is to determine if there is a relationship between being connected to a religious
affiliation and perceived stress level. If you decide to volunteer, you will be asked to
complete one questionnaire with seventeen questions that will take about 5-10 minutes.
There are no known risks to you for your participation in this study. As a way to protect your
right to privacy, you will not be asked to provide your name or any other identifying
information. It is possible that you will not benefit directly by participating in this study. The information
collected will be protected from all inappropriate disclosure under the law. All data will be
kept in a secure location. The data will be collected through a web-based survey tool. Only
the researcher and thesis chair will have access to the results of the survey. Further, all
participants will complete the survey anonymously. There is no cost to you beyond the time and effort required to complete the procedure(s)
described above. Your participation is voluntary. Refusal to participate in this study will
involve no penalty or loss of benefits. You may withdraw at any time without penalty or loss
of benefits. If you decide to complete the survey, please critically think and respond to the
questions of the survey, truthfully. Your views and experience are a vital component of this
research. If you agree to participate, please check the box below and continue with the survey. If you
have any questions about this research project please contact me, Kimberly Sisney, at
[email protected] or my faculty sponsor, Dr. Elizabeth Breshears, at
[email protected]. If you have any questions regarding your rights and participation as
a research subject, please contact the UIRB Administrator by phone (209) 667-3784 or email
Sincerely,
Kimberly Sisney
41
APPENDIX B
SURVEY QUESTIONS
1. Are you a full time student enrolled in at least 12 units?
a. Yes
b. No
2. Are you connected to a religious affiliation?
a. Yes
b. No
3. How connected do you feel to your religious affiliation on a scale of 1 to 5?
1. Weakly Connected
2. Somewhat Connected
3. Neutrally Connected
4. Moderately Connected
5. Strongly Connected
42
APPENDIX C
SURVEY INSTRUMENT
INSTRUCTIONS:
The questions in this scale ask you about your feelings and thoughts during the last
month. In each case, you will be asked to indicate your response by placing an “X”
over the circle representing HOW OFTEN you felt or thought a certain way.
Although some of the questions are similar, there are differences between them and
you should treat each one as a separate question. The best approach is to answer fairly
quickly. That is, don’t try to count up the number of times you felt a particular way,
but rather indicate the alternative that seems like a reasonable estimate.
In the last month, how often have you been upset because of something that happened
unexpectedly?
Never Almost Never Sometimes Fairly Often Very Often
In the last month, how often have you felt that you were unable to control the
important things in your life?
Never Almost Never Sometimes Fairly Often Very Often
In the last month, how often have you felt nervous and “stressed”?
Never Almost Never Sometimes Fairly Often Very Often
In the last month, how often have you dealt successfully with day to day problems
and annoyances?
Never Almost Never Sometimes Fairly Often Very Often
In the last month, how often have you felt that you were effectively coping with
important changes that were occurring in your life?
Never Almost Never Sometimes Fairly Often Very Often
In the last month, how often have you felt confident about your ability to handle your
personal problems?
Never Almost Never Sometimes Fairly Often Very Often
43
In the last month, how often have you felt that things were going your way?
Never Almost Never Sometimes Fairly Often Very Often
In the last month, how often have you found that you could not cope with all the
things that you had to do?
Never Almost Never Sometimes Fairly Often Very Often
In the last month, how often have you been able to control irritations in your life?
Never Almost Never Sometimes Fairly Often Very Often
In the last month, how often have you felt that you were on top of things?
Never Almost Never Sometimes Fairly Often Very Often
In the last month, how often have you been angered because of things that happened
that were outside of your control?
Never Almost Never Sometimes Fairly Often Very Often
In the last month, how often have you found yourself thinking about things that you
have to accomplish?
Never Almost Never Sometimes Fairly Often Very Often
In the last month, how often have you been able to control the way you spend your
time?
Never Almost Never Sometimes Fairly Often Very Often
In the last month, how often have you felt difficulties were piling up so high that you
could not overcome them?
Never Almost Never Sometimes Fairly Often Very Often