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Self-Care Practices and Perceived Stress Levels Among Psychology Graduate

Students

Article  in  Training and Education in Professional Psychology · February 2012

DOI: 10.1037/a0026534

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Training and Education in Professional Psychology © 2012 American Psychological Association
2012, Vol. 6, No. 1, 55– 66 1931-3918/12/$12.00 DOI: 10.1037/a0026534

Self-Care Practices and Perceived Stress Levels Among Psychology

Graduate Students

Shannon B. Myers, Alison C. Sweeney, Victoria Popick, Kimberly Wesley,

Amanda Bordfeld, and Randy Fingerhut
La Salle University

It is well known that stress among psychology graduate students can negatively impact academic
performance, clinical skills, and personal well-being. However, less is known about factors related to
stress management among psychology graduate students. The current study examined self-care practices
and perceived stress among psychology graduate students Four hundred eighty-eight psychology grad-
uate students from across the United States completed an anonymous survey of self-care practices and
stress. Multiple regression analyses indicated that sleep hygiene, social support, emotion regulation, and
acceptance within a mindfulness framework were significantly related to perceived stress. Results
suggest that educating students about self-care practices can be an integral part of helping students
manage stress associated with clinical training.

Keywords: psychology graduate students, stress, self-care, psychology training and education.

Stress has been defined as the perception that the demands of an particularly vulnerable to stress and that, while they promote
external situation are beyond one’s perceived ability to cope self-care practice and stress management with clients, psycholo-
(Lazarus, 1966). DeAngelis (2002) suggests that psychologists are gists rarely heed their own advice. Psychology graduate students
are also vulnerable to stress because of the multiple demands of
graduate school including academic coursework, research, clinical
SHANNON B. MYERS earned her PsyD in Clinical Psychology from La training, and financial constraints. Stress related to performance
Salle University. She is currently completing a postdoctoral fellowship at anxiety, competition, institutional demands, lack of experience,
UMDNJ-The Cancer Institute of New Jersey. Her research interests include and interpersonal/professional relationships has been noted in this
psycho-oncology, interventions to improve quality of life in cancer, and
population (Badali & Habra, 2003). Furthermore, psychology
issues related to graduate training.
graduate students represent a unique population who must navigate
ALISON C. SWEENEY earned her PsyD in Clinical Psychology from La
Salle University. She is currently completing a postdoctoral fellowship these stressors and their new roles, while simultaneously develop-
specializing in women’s mental health and trauma at the San Francisco VA ing the knowledge and skills necessary to provide clinical and
Medical Center/University of California, San Francisco. Dr. Sweeney’s therapeutic services to others.
research interests include postpartum depression and general women’s Professionals involved in the training of psychology graduate
health issues. students, both in educational and clinical settings (e.g., practicum
VICTORIA POPICK Brady completed her MA in Clinical Psychology at La
and internship), need to understand the role of stress among
Salle University in 2009 and anticipates her PsyD in Clinical Psychology
in 2012. Her primary areas of research interest include the correlates of
students to provide guidance on effective stress management and
stress and well-being in psychology graduate students as well as under- self-care. Professionals will be prepared for training of students
standing how mindfulness-based constructs influence change in treatment. and will also be better able to promote well-being within the field
KIMBERLY WESLEY earned HER MA in Clinical Psychology from La and facilitate ethical clinical practice. The American Psychological
Salle University. She is currently pursuing a PsyD in Clinical Psychology Association (APA) Ethics Code (2010a), in Standard 2.03. Per-
from La Salle University. Her research areas include graduate student sonal Problems and Conflict, highlights the need to be aware of
self-care and psycho-oncology.
personal issues that may influence clinical practice and the impor-
AMANDA BORDFELD is currently in her fourth year at La Salle University
in pursuit of a PsyD in Clinical Psychology and has obtained her MA in
tance of addressing these issues. A recent survey examining stress
route. Her research interests include anxiety disorders, women’s health, among Americans found that high levels of stress were related to
and psychosocial risk factors related to stress in various populations. poor physical health, emotional distress, and disruption in the
RANDY FINGERHUT is an Associate Professor of Psychology at La Salle family (APA, 2010b). Based on these negative effects, high levels
University, where he also serves as Director of Clinical Training for their of stress among psychology graduate students may impact clinical
PsyD Program. He received his PhD in Clinical Psychology from The practice and the overall graduate training experience. To best
University of Miami. Dr. Fingerhut’s areas of research include postpartum
understand the role of stress and address the needs of psychology
depression and self-care for graduate students.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to
graduate students, it is necessary to explore stress levels, identify
Shannon B. Myers, The Cancer Institute of New Jersey-UMDNJ, 195 Little variables that influence stress, and determine factors that may be
Albany Avenue, New Brunswick, NJ 08901. E-mail: shmyers1@ targeted to reduce stress. This research will help identify psychol-
hotmail.com ogy graduate students who may be vulnerable to significant stress
55
56 MYERS ET AL.

and provide information used to develop preventative programs conducted a large scale study exploring well-being as it relates to
and reduce stress. race and ethnicity in 3,080 medical students. Findings revealed
that minority students reported additional stressors that negatively
Stress and Psychology Graduate Students impacted their medical school experience, including racial dis-
crimination, racial prejudice, feelings of isolation, and different
The literature on stress among psychology graduate students is cultural expectations. Furthermore, minority students who reported
relatively sparse, but the existing studies do indicate significant the aforementioned stressors had higher rates of burnout, depres-
levels of stress among this population. A survey study of 281 sive symptoms, and reduced quality of life. A more recent web-
clinical psychology trainees revealed that three-quarters of the based national study of 1,219 African American, Latina/o, Asian
trainees reported being moderately or very stressed as a result of American, and European American psychology graduate students
training (Cushway, 1992). A recent survey conducted by the found that African-American students reported more academic
American Psychological Association of Graduate Students barriers than European-American students (Maton, Wimms, Grant,
(APAGS) and APA’s Advisory Committee on Colleague Assis- Wittig, Rogers, & Vasquez, 2011). While students in minority
tance found that 70% of graduate students reported that their groups report additional stressors, research has also shown that
functioning was impaired by at least one stressful event, such as Asian-American, African-American, and international graduate
finances, academics, relationships, and health (El-Ghoroury, students are actually less likely to use counseling services in
2011). The findings indicate the need to examine stress among response to stressors (Hyun, Quinn, Madon, & Lustig, 2006). In
psychology graduate students and to disseminate the information sum, research suggests that racial/ethnic minorities may experi-
to those who are involved in the education and training of students. ence unique stressors during graduate school. It is therefore im-
Much of what has been understood about stress and graduate portant to consider cultural differences when examining stress
school has been based on research with medical students. A among psychology graduate students.
number of studies have noted significant levels of stress and the Additional research has focused on the relationship between
need for mental health services among medical students (Ey, stress and academic performance. Nelson et al. (2001) found that
Henning, & Shaw, 2000; Midtgaard, Ekeberg, Vaglum, & Tyssen, psychology graduate students who reported higher levels of
2008). The ability to generalize this research has been suggested coursework-related stress were more likely to report higher grade
by studies noting similar levels of stress across medical students point averages (GPA). However, the relationship between aca-
and other graduate student groups. A study comparing perceived demic success and broad stress over such factors as finances, time,
stress levels among medical students, law students, and psychol- relationships, and clinical work was not significant. The relatively
ogy graduate students revealed significant stress in all groups and small sample size (n ⫽ 52) and limited geographical location of
comparable levels of stress between medical students and psychol- the study may prevent broad generalizations to psychology grad-
ogy graduate students (Heins, Fahey, & Leiden, 1984). uate students across various geographic locations. Additionally,
Furthermore, there are similarities in the factors that contribute there may be another variable, such as perceived importance of
to stress between medical students and psychology graduate stu- grades, which influences both academic-related stress and GPA.
dents. Levey (2001) noted that factors contributing to stress among Promoting stress management throughout graduate training is an
medical residents include time constraints, sleep deprivation, fi- important task for those involved in training psychology graduate
nancial limitations, limited free time, and responsibility for patient students in both educational and clinical (i.e., practicum and in-
care. Similarly, a sample of clinical psychology graduate students ternship) settings. Research is needed to inform professionals of
rated coursework, dissertation work, time constraints, limited effective ways to promote stress management among students.
availability, the internship process, and finances as the highest Variables such as gender and ethnicity are important to consider
stressors (Nelson, Dell’Oliver, Koch, & Buckler, 2001). The re- when examining stress in this population. To promote effective
search suggests similarities across the groups that may be used to stress management, it is also necessary to determine whether
understand stress among psychology graduate students. factors and behaviors that are amenable to change are related to
To further understand psychology graduate student stress, re- stress. There has been an indication that factors such as unhealthy
search has examined the impact of gender and ethnicity. There eating habits, irregular sleep patterns, less frequent engagement in
have been inconsistencies regarding gender differences with some exercise, and maladaptive coping styles are related to stress among
research suggesting that female students endorse higher levels of psychology graduate students (McKinzie, Altamura, Burgoon,
stress than male students (Cahir & Morris, 1991) and other studies Bishop, 2006; Nelson et al., 2001). Further research examining
noting no gender differences (Hudson & O’Regan, 1994). A more these variables will provide useful information for those involved
current study noted that female psychology graduate students in education and training. The research will facilitate the identifi-
reported greater stress over time management issues (Nelson et al., cation of factors that could be targeted on either an individual or
2001). graduate program level to assist in stress prevention and reduction,
There is literature to suggest that students who identify as an thereby improving academic performance and development of
ethnic minority face additional and unique stressors compared with clinical skills.
students who identify with the majority ethnic group. Research
exploring stress in Asian American, African American, and Latino Self-Care Practice and Stress
undergraduate students attending a predominately white university
found stress specifically related to one’s minority status to be Self-care practice may be defined as engagement in behaviors
distinct from global perceived stress and significantly related to that maintain and promote physical and emotional well-being and
college persistence (Wei, Ku, & Laio, 2011). Dyrbye et al. (2007) may include factors such as sleep, exercise, use of social support,
 SELF-CARE PRACTICES AND PERCEIVED STRESS 57

emotion regulation strategies, and mindfulness practice. There is exercise recommendations, while at least 80% students who re-
limited research examining self-care practice and stress among ported no stress complied with CDC exercise recommendations
psychology graduate students, but the existent literature has noted (Frank, Tong, Lovelo, Carrera, & Duperly, 2008). The study
a significant relationship. A survey of 65 psychology graduate suggests that those who were more likely to exercise regularly
students in the New York metropolitan area found that daily habits were less likely to experience stress.
related to sleep and exercise were related to stress (McKinzie et al., Further studies that have focused on undergraduate college
2006). Because of the lack of literature specific to psychology students have noted a relationship between exercise and stress.
graduate students, an examination of the broader self-care litera- Brown (1991) conducted a study examining physical activity
ture may offer an indication of practices that could be applied to among undergraduates at a private university and found that phys-
psychology graduate students’ management of stress. ical activity and perceived fitness buffered the effects of stress on
health. In a more recent study of 814 college students, researchers
Sleep and Stress found that physical activity was significantly related to daily
hassles. The relationship between physical activity and perceived
The relationship between sleep and stress has been explored in stress was not statistically significant, but it was noted that the
research with various populations. For example, a study conducted effect size, though insignificant, was similar to previous studies of
with healthy women found that individuals with lower objective physical activity and stress (Nguyen-Michel, Unger, Hamilton, &
sleep quality, measured by wake percentage during sleep, had a Spruijt-Metz, 2006). Researchers who conducted a study with
blunted response to an experimental stressor, suggesting that poor college students who were enrolled at large southeastern university
sleep quality may have adverse health effects (Wright, Valdimars- found that students who exercised at least three times per week
dottir, Erblich,& Bovbjerg, 2007). Another study of 184 adults reported lower mean stress levels than sedentary students (McIn-
found that psychosocial and physiological stress was related to tosh, Bhandari, & Holcomb, 2007). While the studies did not focus
nightly variability in individuals’ sleep duration (Mezick, Mat- on psychology graduate students, the findings lend support to the
thews, Hall, Kamarack, Buyusse, Owens, et al., 2009). need to examine exercise as a variable related to stress.
The relationship between sleep quality and stress has been noted
in research with various student groups, including college students Social Support and Stress
(Lund, Reiter, Whiting & Prichard, 2010), nursing students (Win-
wood & Lushington, 2006), and medical students (Huen, Chan, Social support and engaging in activities that promote social
Yu, & Win, 2007). In a survey study of 219 Japanese graduate support may be considered an aspect of self-care practice. The
students, 25.6% of the students were identified as poor sleepers relationship between stress and positive social relationships has
and poor sleep quality was related to poor perceived health (Pallos, been explored in graduate student populations. For instance, grad-
Gergely, Yamada, Miyazaki, & Okawa, 2007). The negative im- uate program support and family support have been found to be
pact of sleep deprivation and fatigue was noted in a study that related to graduate student stress in various types of graduate
found that first- and second-year medical residents who reported programs (Mallinckrodt & Leong, 1992). Social support has also
sleeping five hours or less per night were more likely to report been found to be inversely related to anxiety among female grad-
serious accidents or injuries, conflict with other professional staff, uate students in various programs (Munir & Jackson, 1997). Fi-
and having made significant medical errors (Baldwin, & Daugh- nally, a study of 82 students in doctor of nursing practice programs
erty, 2004). The research indicates that sleep has a significant found a significant relationship between perceived stress and sense
impact across student populations. Based on these findings, it is of belonging. While these studies do not focus specifically on
likely that sleep is related to stress among psychology graduate psychology graduate students, there is an indication that social
students and thus can have a significant impact on clinical care and support is related to well-being among graduate students.
overall training experience. Existent literature with psychology graduate students indicates a
significant relationship between social support and stress. One
Exercise and Stress study found that female students enrolled in online doctoral psy-
chology programs who reported a need for social support were
Exercise has been associated with physical benefits, such as more likely to report higher levels of perceived stress (Kaufman,
reduced risk of cardiac disease, reduced risk of Type 2 diabetes, 2006). In another study, 284 counseling psychology doctoral stu-
strengthened bones and muscles, and weight management (Center dents from 53 training programs throughout the United States
for Disease Control & Prevention, 2010). Moreover, exercise has completed anonymous online measures. Students who perceived
been related to emotional well-being with research suggesting that more support from their advisor, other students, and family and
regular moderate physical activity may reduce stress and prevent friends reported less global stress (Clark, Murdock, & Koetting,
stress-induced suppression of the immune system (Fleshner, 2009).
2005). The specific impact of exercise among psychology graduate
students is less clear, but broad research with students may serve Emotion Regulation and Stress
as an indication of the relationship between exercise and stress.
Researchers who conducted a study of 555 second-year medical Strategies used to regulate emotions may also be related to
students found that physical activity was related to academic stress stress. Gross (2007) defined emotion regulation as processes that
(Sheetsa, Gorenfloa, & Forneyb, 1993). Another survey study of influence which emotions an individual experiences and how the
medical students across the United States found that the majority emotions are experienced or expressed. He further differentiates
of students who reported a lot of stress did not achieve the CDC emotion regulation strategies based on the timing in which a
58 MYERS ET AL.

strategy is enacted. Antecedent-focused strategies are implemented Christopher, & Lichtenstein, 2009). Another study randomized 54
early in the process and change the effect of emotion-generating psychology graduate students to either an eight-week MBSR class
stimuli. An example is cognitive reappraisal, which refers to or a control class. Compared with students in the control class,
changing the meaning of an emotion-invoking situation. Response- students in the MBSR class reported decreased perceived stress
focused strategies are implemented later in the process and focus (Shapiro, Brown, & Biegel, 2007). Based on the research, psy-
on changing the emotional output or expression. An example is chology graduate students may use mindfulness practice as a stress
emotion suppression, which refers to inhibition of internal emo- management technique and experience lower levels of stress.
tional state. The present study examined self-care practices and perceived
Emotion regulation literature has examined the impact of these stress among clinical psychology graduate students across the
strategies on stress. Moore, Zoellner, and Mollenholt (2007) ex- United States to inform professionals involved in education and
amined cognitive reappraisal and expressive suppression in an training of the specific behaviors and self-care practices that can be
undergraduate sample and a trauma-exposed community sample. targeted to help students effectively manage stress. The five spe-
Cognitive appraisal was related to lower levels of stress-related cific self-care practices in the study included sleep patterns, exer-
symptoms, and expressive suppression was related to higher levels cise behaviors, perceived social support, use of emotion regulation
of stress-related symptoms in both samples. Furthermore, expres- strategies, trait mindfulness, and formal mindfulness practice. The
sive suppression was related to PTSD in the trauma-exposed self-care practices were chosen based on previous research sug-
sample. In a study of 362 predominantly female undergraduate gesting a significant relationship to stress levels. It was hypothe-
college students positive reappraisal was significantly related to sized that engagement in exercise behaviors, healthy sleep pat-
depression, anxiety, and stress (Martin & Dahlen, 2005). terns, higher levels of perceived social support, more frequent use
Less is known about the relationship between stress and emotion of the emotion regulation strategy of cognitive reappraisal, engage-
regulation among psychology graduate students. Nelson et al. ment in mindfulness practice, and trait mindfulness would be
(2001) found that psychology graduate students frequently re- related to lower levels of perceived stress. Furthermore, consistent
ported using positive reinterpretation, which may be a form of with previous literature (Gross & John, 2003), the emotion regu-
cognitive reappraisal, but there is no indication whether the strat- lation strategy of suppression, was hypothesized to be related to
egy is related to lower levels of stress. Based on the aforemen- higher levels of perceived stress. To date, the present study is one
tioned literature suggesting that cognitive reappraisal is related to of the largest to examine stress and behaviors among psychology
lower levels of stress in undergraduates and community samples, graduate students.
it may also be related to stress among psychology graduate stu-
dents. Method

Mindfulness and Stress Participants

The term mindfulness has been defined as nonjudgmental, The present study included 488 graduate students in clinical
present-moment awareness and engagement (Bishop et al., 2004), psychology graduate programs across the United States. Partici-
and it has been related to reduced stress levels (Chiesa & Serretti, pants ranged in age from 20 to 61 years (M ⫽ 27, SD ⫽ 5.44) and
2009; Shapiro et al., 2007). Mindfulness can be conceptualized as were majority female (84%), Caucasian (87%), enrolled in a Ph.D.
a multifaceted trait (Baer, Smith, Hopkins, Krietemeyer, & Toney, program (58%), and enrolled in a graduate program accredited by
2006). Mindfulness practice, defined as engagement in behaviors the American Psychological Association (94%). See Table 1 for a
aimed at increasing present-moment awareness, acceptance, and full presentation of the demographic characteristics.
engagement, is a self-care practice that has been shown to reduce
emotional distress and to increase positive well-being (Greeson,
Measures
2009). Carmody and Baer (2008) noted a relationship between
mindfulness practice and levels of mindfulness and stress among Demographics questionnaire. A demographic information
174 adults. Research has also suggested that dispositional mind- questionnaire was developed by the researchers to assess partici-
fulness may be related to reduced stress and improved quality of pants’ age, gender, race, degree program, geographic location,
life (Brown & Ryan, 2003). relationship status, and financial status. The demographic variables
The relationship between mindfulness and stress has been ex- were chosen based on previous research on variables associated
amined in both laboratory studies and outcome research. In a with stress.
laboratory study involving both clinically anxious and nonanxious Sleep Hygiene Index. The Sleep Hygiene Index (Mastin,
individuals, trait mindfulness was related to weakened responses to Bryson, Corwyn, 2006) is a 13-item self-report measure assessing
laboratory stressors (Arch & Craske, 2010). Outcome research has sleep hygiene behaviors. Participants rate frequency (always, fre-
found that individuals who participated in a mindfulness-based quently, sometimes, rarely, never) of sleep-related behaviors. Sam-
stress reduction (MBSR) program have reduced negative affect ple items include, “I take daytime naps lasting two or more hours”
and improvement in symptoms of anxiety and depression (Goldin and “I go to bed at different times from day to day” (Mastin et al.,
& Gross, 2010). 2006). Higher scores are indicative of more maladaptive sleep
Mindfulness practice among clinicians has also been studied. hygiene practices. The measure was normed on 632 undergraduate
Master’s level students in a counseling psychology program who students. It has demonstrated good test–retest reliability (r ⫽ .71)
completed a 15-week course on mindfulness reported relaxation and has been found to be positively correlated with indicators of
and increased calmness after completing the course (Chrisman, inadequate sleep hygiene as well as other measures of sleep
 SELF-CARE PRACTICES AND PERCEIVED STRESS 59

Table 1
Demographic Characteristics Within the Sample (n ⫽ 488)

APA data first year

Characteristic Frequency Percentage graduate students

Race
Caucasian 422 86.5% 72%
African American 13 2.7% 8%
Latin American/Hispanic 12 2.5% 9%
Asian American 16 3.3% 7%
Mixed race 10 2.0% 3%
Other 15 3.1%
Gender
Male 76 15.6% 25%
Female 282 84.2% 75%
Other 1 0.2%
Degree program
M.A. 70 14.3%
Ph.D. 282 57.8%
Psy.D. 120 24.6%
Other 16 3.3%
Geographic regions
Northeast 121 25%
Midwest 191 39%
West 69 14%
South 90 18.5%
Other 17 3.5%
Relationship status
Single 114 23.4%
Dating 47 9.6%
Unmarried, committed relationship 200 41.0%
Married 118 24.2%
Divorced 4 0.8%
Separated 5 1.0%

Note. Data obtained from APA Center for Workforce Studies (Hart et al., 2010).

hygiene (Mastin et al., 2006). The measure was selected because of on three separate groups consisting of 265 pregnant women, 74
its psychometric strength and applicability to student populations. adolescents, and 55 pediatric patients (Zimet, Powell, Farley,
Cronbach’s alpha for the Sleep Hygiene Index was .74. Werkman, & Berkoff, 1990). It has demonstrated internal reliabil-
Godin Leisure Time Exercise Questionnaire. The Godin ity (r ⫽ .85) (Zimet et al., 1988) and has been found to be
Leisure Time Exercise Questionnaire (GLTEQ; Godin & Shep- negatively correlated with measures of depression and anxiety and
hard, 1985) is a brief measure designed to assess individuals’ positively correlated with other measures of social support (Zimet
engagement in physical activities during free time. The GLTEQ et al., 1990). The measure has been used in previous research with
contains three open-ended questions assessing average frequency college students (Hefner & Eisenberg, 2009) and graduate students
of engagement in strenuous, moderate, and mild forms of exercise (Perepiczki, Chandler, & Becerra, 2011). Cronbach’s alpha of the
during a typical week. Higher scores are indicative of more fre- MSPSS was .91.
quent engagement in exercise. The GLTEQ was normed on a Emotion Regulation Questionnaire. The Emotion Regula-
sample of 306 healthy adults. It has demonstrated adequate test– tion Questionnaire (ERQ; Gross & John, 2003) is a 10-item self-
retest reliability across a two-week period (r ⫽ .74) and moderate report measure designed to assess the use of two emotion regula-
correlations with other measures of exercise (Godin & Shephard, tion strategies: cognitive reappraisal and expressive suppression.
1985; Miller, Freedson, & Kline, 1994). The measure was chosen Each item consists of a seven-point Likert scale ranging from
because of ease of administration and previous use with student strongly disagree (1) to strongly agree (7). Higher scores indicate
populations. Cronbach’s alpha of the GLTEQ was .20. greater use of the strategy. The measure was selected because of its
Multidimensional Scale of Perceived Social Support. The ability to independently measure the two strategies through two
Multidimensional Scale of Perceived Social Support (MPSS; (Zimet, separate subscales. The normative sample for the ERQ consisted of
Dahlem, Zimet & Farley, 1988) is a 12-item self-report measure 1,628 undergraduate students. The ERQ has demonstrated ade-
designed to assess perceived level of social support. Participants quate test–retest reliability (r ⫽ .69) and adequate internal consis-
rate each question on a seven-point Likert scale according to the tency for both reappraisal and suppression subscales, as well as
extent to which they agree or disagree with each statement. Sample adequate convergent validity with other measures of emotion
items include, “My family really tries to help me” and “I can talk regulation and coping (Gross & John, 2003). Cronbach’s alpha for
about my problems with my friends.” Higher scores indicate the cognitive reappraisal subscale and expressive suppression sub-
higher levels of perceived social support. The measure was normed scale was .87 and .82, respectively.
60 MYERS ET AL.

Mindfulness practice. Participants responded to a question cal Training, or other relevant school liaison, by email. In this
assessing frequency of engagement in mindfulness practice rang- contact, the researchers requested that an email be forwarded to the
ing from never (1) to very often (5). Mindfulness practice was program’s students describing the current study and providing a
defined as “the intentional act of bringing awareness to thoughts, link to a survey. Participants who chose to participate were di-
feelings, and bodily sensations for a period of time when this is the rected to an anonymous online survey using Psychdata, an Internet
sole activity (e.g., sitting meditation or another mindfulness activ- psychology research database. Responses were received from Feb-
ity).” Higher scores indicate more frequent mindfulness practice. ruary 2010 through March 2010. Participants provided informed
Philadelphia Mindfulness Scale. The Philadelphia Mindful- consent before completing the measures described above. The
ness Scale (PHLMS; Cardaciotto, Herbert, Forman, Moitra, & procedure and recruitment process for this study were approved by
Farrow, 2008) is a 20-item self-report questionnaire designed to the Institutional Review Board before data collection.
measure self-reported levels of mindfulness. The scale produces
two subscales: acceptance and awareness. Acceptance has been Results
defined as “experiencing events fully and without defense, as they
are” (Hayes, 1994, p. 30) and is assessed via statements such as “I
Preliminary Analyses
try to distract myself when I feel unpleasant emotions” and “I wish
I could control my emotions more easily.” Cardaciotto et al. (2008) Preliminary analyses were conducted to explore demographic
described the awareness component as “the continuous monitoring differences in perceived stress among psychology graduate stu-
of the totality of experience” (p. 205). It is assessed via statements dents. Significant differences emerged based on relationship sta-
such as “I am aware of what thoughts are passing through my tus, age, and cost of living to income sufficiency. Married students
mind” and “whenever my emotions change I am conscious of them reported significantly lower levels of perceived stress than gradu-
immediately.” The measure was chosen because of its ability to ate students that were not married, t(484) ⫽ 2.54, p ⫽ .012. Older
independently examine both components of mindfulness practice. graduate students reported significantly lower levels of perceived
Each item is assessed using a five-point Likert scale ranging from stress (r ⫽ ⫺1.07, p ⫽ .019). More sufficient cost of living to
never (1) to very often (5). The PHLMS was normed on five income ratio was found to be significantly related to lower levels
different samples: two nonclinical (n ⫽ 204 and 559) and three of perceived stress (r ⫽ ⫺1.43, p ⫽ .002). There were no signif-
clinical samples, including psychiatric outpatients (n ⫽ 52), eating icant differences based on race, geographic location, and type of
disordered inpatients (n ⫽ 30), and outpatients at a student coun- degree program. A linear regression was conducted to explore the
seling center (n ⫽ 78) (Cardaciotto et al., 2008). It has demon- degree to which demographic variables accounted for variance in
strated good internal consistency for the awareness (Cronbach’s perceived stress among graduate students. The overall model was
alpha ⫽ .86) and acceptance (Cronbach’s alpha ⫽ .91) subscales, significant, F(6, 469) ⫽ 5.10, p ⬍ .000, and accounted for 5% of
as well as adequate concurrent validity with other measures of the variance of perceived stress (Adjusted R2 ⫽ .050). Analyses of
mindfulness (Cardaciotto et al., 2008). Cronbach’s alpha for the the predictor variables revealed that cost of living to income ratio
acceptance and awareness subscales were .90 and .81, respec- independently contributed to variance in level of perceived stress
tively. (␤ ⫽ ⫺.145, p ⫽ .001), and age also independently contributed to
Perceived Stress Scale. The Perceived Stress Scale (PSS-14; variance in perceived stress (␤ ⫽ ⫺.141, p ⫽ .011).
Cohen, Kamarck, & Mermelstein, 1983) is a 14-item self report
questionnaire that measures current perception of stress levels. Primary Analyses
Each item is rated within the last month on a five-point Likert
scale, ranging from never (0) to very often (4). Example items To investigate the relationship between self-care practices and
include “In the last month, how often have you felt that you were perceived stress, a hierarchical multiple regression was conducted.
unable to control important things in your life” and “In the last The method was chosen to determine whether the self-care vari-
month, how often have you felt nervous and stressed.” Higher ables were significantly related to perceived stress after controlling
scores are indicative of higher levels of perceived stress. The for the effects of the demographic variables that were found to be
measure was normed on 446 college students and 64 members of significantly related to perceived stress. The demographic vari-
a community smoking cessation group. It has demonstrated ade- ables relationship status, age, and sufficiency of cost of living to
quate coefficient alpha reliability across studies (r ⫽ .84 and .86), income ratio were entered in the first step. The self-care variables,
adequate 2-day test–retest reliability and 6-week test–retest reli- healthy sleep practices, perceived social support, frequency of
ability (r ⫽ .85 and .55, respectively), and demonstrated adequate exercise, frequency of mindfulness practice, mindful awareness,
convergent validity with measures of health-related outcomes and mindful acceptance, cognitive reappraisal, and suppression, were
divergent validity with measures of depressive symptomatology entered in the second step of the regression. The overall model was
(Cohen et al., 1983). The measure was selected because of ease of significant, F(11, 450) ⫽ 32.86, p ⫽ .000, and accounted for
administration, the range of stressors assessed, and psychometric 43.8% of the variance in perceived stress scores (Adjusted R2 ⫽
strength. Cronbach’s alpha was .90. .438). After controlling for the effects of the demographic vari-
ables, the self-care variables accounted for a significant portion of
Procedure the variance of graduate students’ perceived stress levels, R2
change ⫽ .404, F(8, 439) ⫽ 40.45, p ⫽ .000.
A list of nationwide clinical psychology graduate programs was Analysis of the specific predictor variables revealed significant
obtained from the American Psychological Association (APA) patterns. In support of our hypothesis, healthy sleep practices (␤ ⫽
website. Researchers contacted each program’s Director of Clini- ⫺.203, p ⫽ .000) and higher levels of social support (␤ ⫽ ⫺.128,
 SELF-CARE PRACTICES AND PERCEIVED STRESS 61

p ⫽ .002) were significantly related to lower levels of perceived relational support, which has been linked to lower levels of stress
stress. Contrary to our hypothesis, engagement in exercise was not in students (Craddock, 1996). Finally, age significantly predicted
significantly related to perceived level of stress (␤ ⫽ ⫺.031, p ⫽ perceived stress levels, in that the older students reported less
.415). Contrary to our hypothesis, frequency of engagement in perceived stress. Previous research has suggested that older indi-
mindfulness practice did not have a significant effect on perceived viduals report fewer daily hassles than their younger counterparts
stress (␤ ⫽ ⫺.008, p ⫽ .843). There were differences within the possibly as a result of the development of alternative coping
construct of mindfulness in relation to perceived stress. Mindful strategies (Folkman, Lazarus, Pimley, & Novacek, 1987). Older
awareness was not significantly related to perceived stress (␤ ⫽ students may have developed more effective ways to cope with the
⫺.015, p ⫽ .701), but mindful acceptance was significantly related competing demands of graduate school and therefore perceive less
to perceived stress (␤ ⫽ ⫺.475, p ⫽ .000). Upon closer exami- stress.
nation, higher level of mindful acceptance was significantly related After controlling for the effects of the demographic variables,
to total engagement in mindfulness practice (r ⫽ .16, p ⬍ .000). cost of living to income ratio, relationship status, and age, the
As hypothesized, more frequent use of cognitive reappraisal was self-care practices were significantly related to perceived stress
significantly related to lower levels of perceived stress (␤ ⫽ among psychology graduate students. Specific self-care practices
⫺.218, p ⫽ .000). Contrary to our hypothesis, more frequent use emerged as independently contributing to variance in perceived
of suppression was also related to lower levels of perceived stress stress. Consistent with the hypothesis, better sleep hygiene practice
(␤ ⫽ ⫺.101, p ⫽ .012). Table 2 provides information on predictors was related to lower levels of perceived stress. This is also con-
of perceived stress. sistent with literature suggesting that sleep hygiene is strongly
related to daytime sleepiness and fatigue, which is subsequently
Discussion correlated with stress (Mastin et al., 2006; Tanaka, Fukuda,
Mizuno, Kuratsune, & Watanabe, 2009). In addition to sleep
The current study suggests that self-care practices are related to hygiene, students’ report of strong social support was related to
perceived stress levels among psychology graduate students across lower levels of perceived stress. This is consistent with the hy-
the United States. There were also some differences based on pothesis and research suggesting that social support can serve as a
demographic factors. Age, relationship status, and sufficiency of buffer for stress among graduate students (Calicchia & Graham,
income to cost of living were significantly related to perceived 2006).
stress levels. Psychology graduate students who indicated that their The emotion regulation strategies of cognitive reappraisal and
household income was insufficient compared with their cost of suppression were also significantly related to perceived stress.
living perceived more stress, which is consistent with previous Gross and John (2003) suggest that the process of cognitive
research suggesting a reciprocal relationship between perceived reappraisal involves reevaluating stressful situations in a way that
stress and financial satisfaction in adult students (Sandler, 2000). alters the emotional impact, while suppression involves inhibiting
Married students also reported significantly less stress than their the expression of emotion. Research has previously suggested that
nonmarried counterparts. This pattern has emerged in previous more frequent use of reappraisal, as opposed to suppression, to
research in which psychology graduate students who were not in a regulate emotions is related to greater well-being. The current
committed relationship reported the highest levels of stress (Hud- study suggests that more frequent use of either strategy is related
son & O’Regan, 1994). Marriage can provide a strong source of to less perceived stress in this population. The discrepant findings
may be attributable to the context of short- and long-term conse-
quences. For instance, a study by Goldin, McRae, Ramel, and
Table 2 Gross (2008) that examined the neural bases of these two emotion
Multiple Regression of Predictors of Perceived Stress Among regulation strategies found that expressive suppression may have
Psychology Graduate Students adaptive results in the short-term as individuals may be able to
temporarily reduce negative emotion experience and behavior.
Predictor ␤ t R2 However, over the long-term, frequent use of suppression may be
Step 1 associated with less adaptive outcomes and decreased well-being.
Age ⫺.122 ⫺2.565ⴱ It is possible that the relationship between frequent use of sup-
Cost of living ⫺.152 ⫺3.219ⴱⴱ pression and lower perceived stress in the current study may reflect
Relationship status ⫺.075 ⫺1.562 the short-term adaptive effect of suppression, as perceived stress
Model 1 .047
Step 2
was only assessed over a one-month period. Based on previous
Sleep hygiene ⫺.203 ⫺5.158ⴱⴱⴱ research, assessment of overall well-being may have revealed that
Social support ⫺.128 ⫺3.093ⴱⴱ frequent use of suppression was related to decreased well-being
Exercise frequency ⫺.031 ⫺.816 and life satisfaction, despite the relationship to lower levels of
Cognitive reappraisal ⫺.218 ⫺5.845ⴱⴱⴱ current perceived stress.
Suppression ⫺.101 ⫺2.526ⴱ
Mindful acceptance ⫺.475 ⫺11.835ⴱⴱⴱ The findings did not support the hypothesis that more frequent
Mindful awareness ⫺.015 ⫺.385 engagement in formal mindfulness practice would be related to
Frequency of mindful practice ⫺.008 ⫺.198 lower perceived stress. Interestingly, the trait measure of mindful
Model 2 .452 acceptance was significantly related to perceived stress levels.
⌬R2 .404ⴱⴱⴱ
Despite the discrepancy between these two findings, there was a
Note. n ⫽ 488. correlation found between the frequency of mindfulness practice
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱⴱⴱ
p ⬍ .001. and mindful acceptance. A closer examination of group differences
62 MYERS ET AL.

found that participants who never engaged in formal mindfulness frequency of practicing self-care behaviors may vary widely
practice had lower levels of mindful acceptance than those who throughout the academic year, and the results may have been
engaged in mindfulness practice very often. This is consistent with influenced by experiences at the time of data collection rather than
previous findings that formal mindfulness practice and trait mind- a reflection of typical stress levels or self-care behaviors. There are
fulness are significantly correlated (Carmody & Baer, 2008). Fur- limitations with regard to the reliability of the exercise measure
thermore, Carmody and Baer found that increases in trait mind- which prevent conclusions regarding the relationship between ex-
fulness completely mediated the relationship between time spent ercise and stress. Not all of the measures were normed on graduate
engaging in formal mindfulness practice and stress reduction. In student or student populations. While the most of them have been
other words, formal mindfulness practice reduces stress by increas- used in research on students, there should be some caution in
ing trait mindfulness. Therefore, it may be that only students who interpreting the findings.
engage in formal mindfulness practice very often achieve enough In terms of the sampling bias, we sampled current graduate
of an increase in trait mindfulness to reduce stress. An alternative students and did not assess students who withdraw from school,
explanation for these findings is that only subjective ratings of possibly because of difficulty managing stress. Therefore, the
time spent engaging in formal mindfulness practice were obtained. sample may be skewed toward students who have lower stress
Perception of what it means to engage in mindfulness practice very levels or use self-care behaviors to manage stress more effectively.
often may vary between students, thus skewing results. The study The sample was also self-selected, and it is possible that stress
of mindfulness has rapidly grown over the past several years; levels and self-care behaviors differ between students who opted to
however, there is not currently consensus among researchers on complete the survey and those who did not. It is also possible that
the best methods for measuring mindfulness practice. In a recent training directors who chose to disseminate the recruitment email
review of the literature on mindfulness interventions, 98 studies tend to have more emphasis on self-care within the graduate
were reviewed for home practice tracking methods. Methods used program, which may have biased results.
included daily self-report logs, weekly report forms, and retrospec- The sample was majority Caucasian and female limiting the
tive report using either single or multiitem survey. No study generalizability of the results to individuals of other gender groups
reported on the psychometrics of these tracking methods (Vettese, and ethnic identities. Because of the lack of diversity in the
Toneatto, Stea, Nguyen, & Wang, 2009). It is possible that the sample, we were unable to assess whether there were differences
inherent limitations of assessing mindfulness practice influenced based on gender and race. It is possible that individuals who
the results of this study. However, there is no clear empirical identify with the minority group may perceive stress in a different
evidence suggesting that measurement methods significantly in- manner and/or used different coping strategies. Despite the lack of
fluence the relationship found between mindfulness practice and diversity in the sample, the distribution is fairly consistent with
outcome measures. APA statistics of psychology graduate students indicating that
Findings did not support the hypothesis that exercise behavior between 65 and 70% of students are Caucasian and 75–77% of
would correlate with stress in psychology graduate students. Em- students are female (Hart, Wecherki, & Kohout, 2010). Therefore,
pirically, exercise behavior has been linked to reduced stress. this study may represent the overall majority of psychology grad-
However, research also suggests that individual differences such as uate students but may not capture the important differences that
coping styles and personality dimensions may impact one’s ability may exist in underrepresented groups. Further research with more
to psychologically benefit from exercise (Folkins & Sime, 1981). diverse samples is necessary to enhance knowledge of stress and
Moreover, the impact of exercise on stress may be dependent on self-care during psychology graduate training across all student
the type of stressor and the beliefs one holds about the efficacy of groups.
exercise as a coping strategy (Salmon, 2001). For instance, re- As the study was one of the first large-scale studies to examine
search has found that during times of academic stress students stress and self-care, we chose to recruit specifically from clinical
actually decrease their physical activity (Steptoe, Wardle, Pollard, psychology graduate programs. Similar patterns may emerge
& Canaan, 1996). Some students may believe engaging in physical among psychology graduate students in other programs (e.g.,
activity will decrease stress levels, while others find that exercise, counseling, school, experimental). However, further research is
especially in the face of academic pressure, actually increases needed to determine whether there are differences in stress and
stress. Given the reliability estimate of the measure in the present self-care between students in different types of programs. Despite
study, it is likely that the measure did not accurately assess the programmatic differences, it is possible that self-care will
exercise behavior and therefore conclusions on the impact of remain significantly related to stress among students in other
exercise on stress cannot be drawn. programs. In the present study there were no differences in stress
While the results of this study are promising, there are several among students enrolled in different degree programs (i.e., Ph.D.,
factors that limit the conclusions that can be drawn. Because of the Psy.D., Masters), suggesting that despite programmatic differences
cross-sectional design of the study, the results are correlational in psychology graduate students may experience similar levels of
nature and therefore causality cannot be assumed. The conclusions stress.
may also be limited by the lack of specificity in the measurement While no significant differences were found among the various
of certain variables. In particular, the frequency of formal mind- degree programs, there are limitations in understanding program-
fulness practice was measured using a subjective rating scale. The matic variables in general and program variables with regard to
measure of stress was intended to assess the stressfulness of self care. The general program variables that would be important
participants’ lives over the past month, but it is possible that for future research in this domain may include the following:
responses were influenced by specific situational stress when student to faculty ratio; size of the program and institution which
completing the questionnaire. Furthermore, stress levels and the may affect funding, resources, and the academic environment;
 SELF-CARE PRACTICES AND PERCEIVED STRESS 63

model of mentoring between students and faculty; model used for and students. The committee should be responsible for evaluating
training and of potential interest the theoretical orientation with the self-care needs of the student body as well as organizing the
which the program identifies. All of these factors may influence workshops and other activities. The results of the present study can
the financial, social, and professional support a student is given. serve as guidance for training programs aiming to improve stu-
Other programmatic variables to consider include formal measures dents’ self-care practices.
taken to encourage student self-care, such as workshops on self- Interested programs and students can learn more about specific
care or policies on maximum schedule hours. All of these pro- self-care practices and ways to reduce stress via the following
grammatic components could influence the level of self-care en- programs. The Sleep Treatment and Education Program for Stu-
couraged at the program level and may also influence the dents (STEPS), which involves education about sleep hygiene and
individual attitudes toward self care. Understanding these compo- stimulus control, has demonstrated efficacy in improving sleep
nents should be considered in future research within this popula- quality among students (Brown, Buboltz, Barlow, & Soper, 2006).
tion. Mindfulness Based Stress Reduction (MBSR) programs teach par-
ticipants to attend to present moment experiences in a nonjudg-
Implications for Education and Training mental way and have demonstrated effectiveness in reducing per-
ceived stress, negative affect, anxiety, and rumination among
As the field of psychology advances, the ability to engage in graduate counseling psychology students (Shapiro et al., 2007).
adequate self-care is being recognized as a core competency of Training programs may incorporate either of these full programs
clinical training (Rodolfa, Bent, Eisman, Nelson, Rehm, & Ritchie, into their self-care initiatives, or they may consider inviting guest
2005). The promotion of self-care practice in graduate school can speakers to host workshops on such topics. In addition, interested
be conceptualized from a “preventative model” that creates a students may consider beginning a student-led mindfulness med-
foundation for a career-long pursuit of professionalism (Elman, itation group. Incorporating mindfulness into program-based self-
Illfelder-Kaye, & Robiner, 2005). Students who perceive training care initiative will not only help to reduce students’ stress, but
demands to be manageable are more likely to display resiliency in extant literature also suggests that engaging in mindful meditation
learning and working environments (Kuyken, Peters, Power, & before individual therapy sessions improves patient outcomes
Lavender, 2003). Academic performance, especially in students (Grepmair, Mitterlehner, Loew Bachler, Rother, & Nickel, 2007).
with low resourcefulness in stressful situations, is negatively cor- To ensure that students can adequately engage in training and
related with both subjective and physiological stress responses provide ethical and competent clinical care, it is prudent that
(Akgun & Ciarrochi, 2003; Ng, Koh, & Chia, 2003). Furthermore, graduate training programs assist students in developing compe-
stress and burnout among psychology graduate students can have tency in self-care. The programs and suggestions mentioned here
a negative impact on their ability to provide adequate clinical care are only a few of the ways that psychology graduate training
(Figley, 2002; Wicks, 2008). The relationship between stress and programs can help students enhance their self-care behaviors and
self-care in psychology graduate students found in this study lends reduce overall stress. We believe that an important first step in
further support for the importance of self-care as a training com- improving self-care among psychology graduate students is dis-
petency to decrease the negative impact of stress on both academic cussing and understanding the experiences of stress and self-care
and clinical training. This research also provides direction for among students. The creation of a self-care committee may be a
specific self-care behaviors that are related to lower stress levels in good way to begin such a discussion. Training programs may also
psychology graduate students. As self-care continues to be pro- recommend readings on self-care such The Resilient Clinician
moted during graduate training, it is important for professionals (Wicks, 2008), which offers a mindfulness-based approach to
involved in training to promote specific behaviors that are effec- self-care for mental health professionals. Finally, training pro-
tive in reducing stress in this population, as opposed to encourag- grams may want to emphasize the importance of social support and
ing the vague concept of self-care. develop events to facilitate and promote camaraderie among stu-
One program that may be used as a model for how to incorpo- dents and support between faculty and students.
rate self-care into graduate training is the POWER (Professional
Opportunities for Wellness Education and Revitalization) pro- Conclusions and Future Directions
gram, developed by two counseling psychology students at Ari-
zona State University (Dittmann, 2005). The primary components In conclusion, self-care practices were found to be significantly
of this program include peer mentoring, workshops, and social related to perceived stress levels in a national sample of clinical
activities to promote self-care behaviors among psychology grad- psychology graduate students. More specifically, sleep hygiene,
uate students. Peer mentoring of first-year students by more ad- social support, the emotion regulation strategy of reappraisal and
vanced students is an excellent way to provide support and guid- mindful acceptance were found to be significantly related to per-
ance as students begin their graduate careers. Furthermore, ceived stress levels in the population. The results of this study are
workshops can be held periodically, led by students or invited strengthened by the large sample size in addition to the represen-
guest speakers, which address various self-care topics such as tation of students across the nation. Participants were recruited
sleep hygiene, recognizing the signs of stress, teaching mindful- from diverse institutions and varied types of degree programs.
ness, and much more. Social activities can also be hosted by either These findings provide a foundation for future research to explore
the program or the students to help build a sense of camaraderie moderating and mediating variables between self-care practices
and support among the student body. In addition to the steps taken and stress levels, such as personality factors and beliefs about the
by the POWER program, the present authors suggest that training impact of self-care behaviors. Additionally, further research with
programs develop a self-care committee consisting of both faculty more diverse populations and with students from different types of
64 MYERS ET AL.

psychology programs will broaden the knowledge and allow for practice and level mindfulness, medical and psychological symptoms
more specificity in the approach to promoting self-care. Future and well-being in a mindfulness based stress reduction program. Journal
studies should examine the nature of stress and specific stressors of Behavioral Medicine, 31, 23–33. doi:10.1007/s10865-007-9130-7
among psychology graduate students and how they may differ Center for Disease Control & Prevention. (2010). Physical Activity Re-
from students in other fields. Finally, the field will benefit from trieved from http://www.cdc.gov/physicalactivity/
Chiesa, A., & Serretti, A. (2009). Mindfulness-based stress reduction for
evaluating the efficacy of programs designed to increase self-care
stress management in healthy people: A review and meta-analysis. The
and reduce stress among psychology graduate students and how Journal of Alternative and Complementary Medicine, 15, 593– 600.
academic performance and clinical work is affected by these doi:10.1089/acm.2008.0495
efforts. Chrisman, J. A., Christopher, J. C., & Lichtenstein, S. J. (2009). Qigong as
a mindfulness practice for counseling students: A qualitative study.
References Journal of Humanistic Psychology, 49, 236 –257. doi:10.1177/
0022167808327750
Akgun, S. & Ciarrochi, J. (2003). Learned resourcefulness moderates the Clark, H. D., Murdock, N. L., & Koetting, K. (2009). Predicting burnout
relationship between academic stress and academic performance. Edu- and career choice satisfaction in counseling psychology graduate stu-
cational Psychology, 23, 287–294. doi:10.1080/0144341032000060129 dents. The Counseling Psychologist, 37, 580 – 606. doi:10.1177/
American Psychological Association. (2010a). Ethical principles of psy- 0011000008319985
chologists and code of conduct. Retrieved from http://www.apa.org/ Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of
ethics/code/index.aspx perceived stress. Journal of Health and Social Behavior, 24, 385–396.
American Psychological Association (2010b). APA survey raises concern
Retrieved from http://www.jstor.org/pss/2136404. doi:10.2307/2136404
about health impact of stress on children and families. Retrieved online
Craddock, A. (1996). Relational resources as buffers against the impact of
from http://www.apa.org/news/press/releases/2010/11/stress-in-
stress: A longitudinal study of seminary students and their partners.
america.aspx
Journal of Psychology and Theology, 24, 38 – 46.
Arch, J. J. & Craske, M. G. (2010). Laboratory stressors in clinically
Cushway, D. (1992). Stress in clinical psychology trainees. British
anxious and non-anxious individuals: The moderating role of mindful-
Journal of Clinical Psychology, 31, 169 –179. doi:10.1111/j.2044-
ness. Behaviour Research and Therapy, 48, 495–505. doi:10.1016/
8260.1992.tb00981.x
j.brat.2010.02.005
DeAngelis, T. (2002). Normalizing practitioners’ stress. APA Monitor, 33, 62.
Badali, M. A. & Habra, M. E. (2003). Self-care for psychology students:
Retrieved from http://www.apa.org/monitor/julaug02/normalizing
Strategies for staying healthy & avoiding burn out. Psynopsis: Canada’s
.aspx
Psychology Newspaper, 25, 14. Retrieved from http://www.cpa.ca/
Dittman, M. (2005). Arizona State students create self-care program.
cpasite/userfiles/Documents/students/Psynopsis25(4).pdf
Retrieved from http://www.apa.org/gradpsych/2005/03/cover-
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006).
selfcare.aspx
Using self-report measures to explore facets of mindfulness. Assessment,
Dyrbye, L. N., Thomas, M. R., Eacker, A., Harper, W.; Massie, F. S.,
13, 27– 45. doi:10.1177/1073191105283504
Power, D. V., . . . Shanafelt, T. D. (2007). Race, ethnicity, and medical
Baldwin, D. C. & Daugherty, S. R. (2004). Sleep deprivation and fatigue
in residency training: Results of a national survey of first and second- student well-being in the United States. Archives of Internal Medicine,
year residents. Sleep, 27, 217–223. 167, 2103–2109. doi:10.1001/archinte.167.19.2103
Bishop, S. R., Lau, M. Shapiro, S., Carlson, L., Anderson, N. D., Carmody, El-Ghoroury, N. H. (2011, March). Self-care is not just for emergencies.
J., . . . Devins, G. (2004). Mindfulness: A proposed operational defini- gradPSYCH Magazine, 9, 21. Retrieved from http://www.apa.org/
tion. Clinical Psychology: Science and Practice, 11, 230 –241. doi: gradpsych/index.aspx
10.1093/clipsy.bph077 Elman, N. S., Illfelder-Kaye, J., & Robiner, W. N. (2005). Professional
Brown, F., Buboltz, W., & Soper, B. (2006). Development and evaluation development: Training for professionalism as a foundation for compe-
of the Sleep Treatment and Education Program for Students (STEPS). tent practice in psychology. Professional Psychology: Research and
Journal of American College Health, 54, 231–237. doi:10.3200/ Practice, 36, 367–375. doi:10.1037/0735-7028.36.4.367
JACH.54.4.231-237 Ey, S., Henning, K., & Shaw, D. (2000). Attitudes and factors related to
Brown, J. D. (1991). Staying fit and staying well: Physical fitness as a seeking mental health treatment among medical and dental students.
moderator of life stress. Journal of Personality and Social Psychology, Journal of College Student Psychotherapy, 14, 23–39. doi:10.1300/
60, 555–561. doi:10.1037/0022-3514.60.4.555 J035v14n03_05
Brown, K. W. & Ryan, R. M. (2003). The benefits of being present: Figley, C. (2002). Compassion fatigue: Psychotherapist’s chronic lack of
Mindfulness and its role in psychological well-being. Journal of Per- self care. Journal of Clinical Psychology, 58, 1433–1441. doi:10.1002/
sonality and Social Psychology, 84, 822– 848. doi:10.1037/0022- jclp.10090
3514.84.4.822 Fleshner, M. (2005). Physical Activity and Stress Resistance: Sympa-
Cahir, N. & Morris, R. D. (1991). The psychology student stress question- thetic Nervous System Adaptations Prevent Stress-Induced Immuno-
naire. Journal of Clinical Psychology, 47, 414 – 417. doi:10.1002/1097- suppression. Exercise and Sport Sciences Review, 33, 120 –126.
4679(199105)47:3⬍414::AID-JCLP2270470314⬎3.0.CO;2-M Retrieved from http://journals.lww.com/acsm-ess/2005/07000/
Calicchia, J. A. & Graham, L. B. (2006). Assessing the relationship Physical_Activity_and_Stress_Resistance_.4.aspx doi:10.1097/
between spirituality, life stressors, and social resources: Buffers of stress 00003677-200507000-00004
in graduate students. North American Journal of Psychology, 8, 307– Folkins, C. H. & Sime, W. E. (1981). Physical fitness training and mental
320. Retrieved from http://findarticles.com/p/articles/mi_6894/is_2_8/ health. American Psychologist, 36, 373–389. doi:10.1037/0003-
ai_n28410572/ 066X.36.4.373
Cardaciotto, L., Herbert, J. D., Forman, E. M., Moitra, E., & Farrow, V. Folkman, S., Lazarus, R. S., Pimley, S., & Novacek, J. (1987). Age
(2008). The assessment of present-moment awareness and acceptance: differences in stress and coping processes. Psychology and Aging, 2,
The Philadelphia mindfulness scale. Assessment, 15, 204 –223. doi: 171–184. doi:10.1037/0882-7974.2.2.1717974.2.2.171
10.1177/1073191107311467 Frank, E., Tong, E., Lovelo, F., Carrera, J., & Duperly, J. (2008). Physical
Carmody, J. & Baer, R. A. (2008). Relationships between mindfulness activity levels and counseling practices of U.S. medical students. Med-
 SELF-CARE PRACTICES AND PERCEIVED STRESS 65

icine and Science in Sports and Exercise, 40, 413– 421. doi:10.1249/ Mallinckrodt, B. & Leong, F. T. (1992). Social support in academic
MSS.0b013e31815ff399 programs and family environment: Sex differences and role conflicts for
Godin, G. & Shephard, R. J. (1985). A simple method to assess exercise graduate students. Journal of Counseling and Development, 70, 716 –
behavior in the community. Canadian Journal of Applied Sport Sci- 723.
ences, 10, 141–146. Martin, R. C. & Dahlen, E. R. (2005). Cognitive emotion regulation in the
Goldin, P. R. & Gross, J. J. (2010). Effects of mindfulness-based stress prediction of depression, anxiety, stress, and anger. Personality and
reduction (MBSR) on emotion regulation in social anxiety disorder. Individual Differences, 39, 1249 –1260. doi:10.1016/j.paid.2005.06.004
Emotion, 10, 83–91. doi:10.1037/a0018441 Mastin, D. F., Bryson, J., & Corwyn, R. (2006). Assessment of sleep
Goldin, P. R., McRae, K., Ramel, W., Gross, J. J. (2008). The neural bases of hygiene using the Sleep Hygiene Index. Journal of Behavioral Medicine,
emotion regulation: Reappraisal and suppression of negative emotion. Bio- 29, 223–227. doi:10.1007/s10865-006-9047-6
logical Psychiatry, 63, 577–586. Retrieved from http://spl.stanford.edu/ Maton, K. I., Wimms, H. E., Grant, S. K., Wittig, M. A., Rogers, M. R., &
pdfs/Goldin_08.pdf Vasquez, M. J. T. (2011). Experiences and perspectives of African
Greeson, J. M. (2009). Mindfulness research update: 2008. Complementary American, Latina/o, Asian American, and European American psychol-
Health Practice Review, 14, 10 –18. doi:10.1177/1533210108329862 ogy graduate students: A national study. Cultural Diversity & Ethnic
Grepmair, L., Mitterlehner, F., Loew, T., Bachler, E., Rother, W., & Minority Psychology, 17, 68 –78. doi:10.1037/a0021668
Nickel, M. (2007). Promoting mindfulness in psychotherapists in train- McIntosh, A., Bhandari, M. W., & Holcomb, D. (2007). College students’
ing influences the treatment results of their patients: A randomized, declining physical activity levels and increasing self-reported stress
double-blind, controlled study. Psychotherapy and Psychosomatics, 76, levels. Paper presented at APHA Annual Meeting, Washington, DC.
332–338. doi:10.1159/000107560 McKinzie, C., Altamura, V., Burgoon, E., & Bishop, C. (2006). Exploring
Gross, J. J. & John, O. P. (2003). Individual difference in two emotion the effect of stress on mood, self-esteem, and daily habits with psychol-
regulation processes: Implications for affect, relationships, and well- ogy graduate students. Psychological Reports, 99, 439 – 448. doi:
being. Journal of Personality and Social Psychology, 85, 348 –362. 10.2466/pr0.99.2.439-448
Retrieved from http://spl.stanford.edu/pdfs/2003%20Gross-John% Mezick, E., Matthews, K., Hall, M., Kamarck, T., Buysse, D., Owens, J.,
20JPSP.pdf & Reis, S. E. (2009). Intra individual variability in sleep duration and
Gross, J. J. (2007). Handbook of emotion regulation. New York, NY: fragmentation: Associations with stress. Psychoneuroendocrinology, 34,
Guilford Press.
1346 –1354. doi:10.1016/j.psyneuen.2009.04.005
Hart, B. M., Wecherki, M., & Kohout, J. L. (2010). 2008 –2009 Master’s-
Midtgaard, M., Ekeberg, O., Vaglum, P., & Tyssen, R. (2008). Mental
and Doctoral-level students in U.S. and Canadian graduate departments
health treatment needs for medical students: A national longitudinal
of psychology 2010 graduate study in psychology. Center for Workforce
study. European Psychiatry, 23, 505–511. doi:10.1016/j.eurpsy.2008
Studies: American Psychological Association. Retrieved from http://
.04.006
www.apa.org/workforce/publications/10-grad-study/students.aspx
Miller, D. J., Freedson, P. S., & Kline, G. M. (1994). Comparison of
Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame
activity levels using Caltrac accelerometer and five questionnaires. Med-
theory, and the third wave of behavioral and cognitive therapies. Behav-
icine and Science in Sports and Exercise, 26, 376 –382.
ior Therapy, 35, 639 – 665. doi:10.1016/S0005-7894(04)80013-3
Moore, S. A., Zoellner, L. A., & Mollenholt, N. (2007). Are expressive
Hefner, J. & Eisenberg, D. (2009). Social support and mental health among
suppression and cognitive reappraisal associated with stress-related
college students. American Journal of Orthopsychiatry, 79, 491– 499.
symptoms? Behaviour Research and Therapy, 46, 993–1000. doi:
Heins, M., Fahey, S. N., & Leiden, L. I. (1984). Perceived stress in
10.1016/j.brat.2008.05.001
medical, law, and graduate students. Journal of Medical Education, 59,
Munir, S. S. & Jackson, D. W. (1997). Social support, need for support, and
169 –179.
Hudson, S. A. & O’Regan, J. (1994). Stress and the graduate psychology anxiety among women graduate students. Psychological Reports, 80,
student. Journal of Clinical Psychology, 50, 973–977. doi:10.1002/ 383–386.
1097-4679 Nelson, N. G., Dell’Oliver, C., Koch, C., & Buckler, R. (2001). Stress,
Huen, L., Chan, T., Yu, W., & Wing, Y. (2007). Do medical students in coping, and success among graduate students in clinical psychology.
Hong Kong have enough sleep? Sleep and Biological Rhythms, 5, Psychological Reports, 88, 759 –767.
226 –230. doi:10.1111/j.1479-8425.2007.00278.x Ng, V., Koh, D., & Chia, S. (2003). Examination stress, salivary cortisol,
Hyun, J. K., Quinn, B. C., Madon, T., & Lustig, S. (2006). Graduate and academic performance. Psychological Reports, 93, 1133–1134.
student mental health: Needs assessment and utilization of counseling Nguyen-Michel, S. T., Unger, J. B., Hamilton, J., & Spruijt-Metz, D.
services. Journal of College Student Development, 47, 247–266. (2006). Associations between physical activity and perceived stress/
Kaufman, J. (2006). Stress and social support among online doctoral hassles in college students. Stress and Health, 22, 179 –188. doi:
psychology students. Journal of College Student Psychotherapy, 20, 10.1002/smi.1094
79 – 88. doi:10.1300/J035v20n03_07 Pallos, H., Gergely, V., Yamada, N., Miyazaki, S., & Okawa, M. (2007).
Kuyken, W., Peters, E., Power, M., & Lavender, T. (2003). Trainee clinical The quality of sleep and factors associated with poor sleep in Japanese
psychologists’ adaptation and professional functioning: A longitudinal graduate students. Sleep and Biological Rhythms, 5, 234 –238. doi:
study. Clinical Psychology & Psychotherapy, 10, 41–54. doi:10.1002/ 10.1111/j.1479-8425.2007.00316.x
cpp.350 Perepiczka, M., Chandler, M., & Becerra, M. (2011). Relationship between
Lazarus, R. S. (1966). Psychological stress and the coping process. New graduate students’ statistics self-efficacy, statistics anxiety, attitude to-
York, NY: McGraw-Hill. ward statistics, and social support. The Professional Counselor. Re-
Levey R. I. (2001). Sources of stress for residents and recommendations for trieved from http://tpcjournal.nbcc.org/wp-content/uploads/2011/04/
programs to assist them. Academic Medicine 70, 142–150. Perepiczka-Digest.pdf
Lund, H., Reider, B., Whiting, A., & Prichard, J. (2010). Sleep patterns and Rodolfa, E., Bent, R., Eisman, E., Nelson, P., Rehm, L., & Ritchie, P.
predictors of disturbed sleep in a large population of college students. (2005). A cube model for competency development: Implications for
Journal of Adolescent Health, 46, 124 –132. Retrieved from http:// psychology educators and regulators. Professional Psychology: Re-
www.nechaonline.org/attachments/File/2010_Handouts/Keynote_ search and Practice, 36, 347–354. doi:10.1037/0735-7028.36.4.347
Carskadon.pdf Salmon, P. (2001). Effects of physical exercise on anxiety, depression, and
66 MYERS ET AL.

sensitivity to stress: A unifying theory. Clinical Psychology Review, 21, Wei, M., Ku, T., & Liao, K. Y. (2011). Minority stress and college
33– 61. doi:10.1016/S0272-7358(99)00032-X persistence attitudes among African American, Asian American, and
Sandler, M. (2000). Career decision-making self-efficacy, perceived stress, Latino students: Perception of university environment as a mediator.
and an integrated model of student persistence: A Structural model of Cultural Diversity & Ethnic Minority Psychology, 17, 195–203.
finances, attitudes, behavior, and career development. Research in Wicks, R. (2008). The resilient clinician. New York, NY: Oxford Univer-
Higher Education, 41, 537–580. doi:10.1023/A:1007032525530 sity Press.
Shapiro, S. L., Brown, K. W., & Biegel, G. M. (2007). Teaching self-care Winwood, P. & Lushington, K. (2006). Disentangling the effects of psy-
to caregivers: Effects of mindfulness-based stress reduction on the chological and physical work demands on sleep, recovery and maladap-
mental health of therapists in training. Training and Education in Pro- tive chronic stress outcomes within a large sample of Australian nurses.
fessional Psychology, 1, 105–115. doi:10.1037/1931-3918.1.2.105 Journal of Advanced Nursing, 56, 679 – 689. doi:10.1111/j.1365-
Sheetsa, K. J., Gorenfloa, D. W., & Forneyb, M. A. (1993). Personal and 2648.2006.04055.x
behavioral variables related to perceived stress of second-year medical Wright, C., Valdimarsdottir, H., Erblich, J., & Bovbjerg, D. (2007). Poor
students. Teaching and Learning in Medicine, 5, 90 –95. doi:10.1080/ sleep the night before an experimental stress task is associated with
10401339309539598 reduced cortisol reactivity in healthy women. Biological Psychology, 74,
Steptoe, A., Wardle, J., Pollard, T., & Canaan, L. (1996). Stress, social 319 –327. doi:10.1016/j.biopsycho.2006.08.003
support and health-related behavior: A study of smoking, alcohol con- Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The
sumption and physical exercise. Journal of Psychosomatic Research, 41, multidimensional scale of perceived social support. Journal of Person-
171–180. doi:10.1016/0022-3999(96)00095-5 ality Assessment, 52, 30 – 41. doi:10.1207/s15327752jpa5201_2
Tanaka, M., Fukuda, S., Mizuno, K., Kuratsune, H., & Watanabe, Y. Zimet, G. D., Powell, S. S., Farley, G. K., Werkman, S., & Berkoff, K.
(2009). Stress and coping styles are associated with severe fatigue in (1990). Psychometric characteristics of the multidimensional scale of
medical students. Behavioral Medicine, 35, 87–92. doi:10.1080/ perceived social support. Journal of Personality Assessment, 55, 610 –
08964280903231979 617. doi:10.1207/s15327752jpa5503&4_17
Vettese, L., Toneatto, T., Stea, J., Nguyen, L., & Wang, J. (2009). Do
mindfulness meditation participants do their homework? And does it
make a difference? A review of the empirical evidence. Journal of Received June 21, 2011
Cognitive Psychotherapy, 23, 198 –225. doi:10.1891/0889- Revision received October 4, 2011
8391.23.3.198 Accepted October 11, 2011 䡲

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