apa format research paper on stress

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APA Style Template for Google Docs

Here is a Google Docs template that you can use for APA formatted student papers. The template is View Only, so you will need to make a copy to use it. Click the  Use Template  button in the upper right corner to make a copy. 

These template has headers, page numbers, margins, fonts and line spacing already set up for you. Just make a copy and type over the filler text. 

APA Template Google Doc

Finding quick Citation Info

Apa style resources.

Here are some general APA Style resources. Scroll down further to see more details about citations and paper formatting. 

• APA Style Website The APA Style Website is the official website for APA 7th edition, and includes formatting guidelines for formatting your overall paper including title page setup, tables and figures, as well as guidelines for formatting reference citations. Sample papers are included.
• Excelsior Online Writing Lab: APA Style The Excelsior OWL is an excellent resource for how to write and cite your academic work in APA Style. This is a recommended starting point if you're not sure how to use APA style in your work, and includes helpful multimedia elements.

Several print copies of the APA 7th edition Publication Manual are available for checkout at the Mardigian Library.

(Sorry, APA does not provide an eBook version of this for libraries at the present time.)

APA Style 7th edition Citations (References and In-Text Citations)

If you're new to citation, this brief video will cover an introduction to in-text citations and reference lists in APA 7th edition. Scroll down for more recommended resources about citations. 

More information including examples and sample papers can be found at the recommended websites below: 

• APA Style Website: Reference Examples Guidelines about references from the official APA Style website.
• APA Style Website: In-text Citations Guidelines for in-text citations from the official APA Style website.
• APA 7th edition quick reference handout This quick reference guide to APA 7th edition citations is handy and includes many commonly cited source types and corresponding in-text citations.
• APA In-text Citation Checklist APA's official In-text citation checklist for the 7th edition.

APA Style 7th edition Formatting for Student Papers

APA Style is more than just citations--it includes guidelines on how you entire paper should be formatted! Here are some quick tutorials and resources for formatting a student paper in APA 7th edition style. (Note that for more formal assignments, like a thesis or dissertation, you should instead follow the formatting guidelines for Professional papers.)

The video below will show you how to format an APA 7th edition student paper using Microsoft Word. Scroll down for more recommended resources about formatting. 

• APA Style Website: Paper Format The APA Style website's paper format page includes all of the elements of paper format that you need to follow, including information about the title page, margins and spacing, fonts and headings. Sample papers are included.
• APA Style Website: Academic Writer Tutorial This tutorial is designed for writers new to APA Style. Learn the basics of seventh edition APA Style, including paper elements, format, and organization; academic writing style; grammar and usage; bias-free language; mechanics of style; tables and figures; in-text citations, paraphrasing, and quotations; and reference list format and order.
• Excelsior OWL: APA Formatting Guide The Excelsior OWL includes this great APA 7th edition formatting guide featuring a handy checklist.
• Student Paper Formatting Checklist APA's official student paper formatting checklist.
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Health & Stress Management: APA Format, 7th Edition

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• APA Format, 7th Edition

Introduction

When you reference another’s work in your own papers or essays, you need to cite that author’s work.  APA Citation Style is typically used to cite work in social sciences and education fields.  When creating a citation, you will need two things:

• In-text or parenthetical citations – located within the body of your paper
• Works Cited or Bibliography – reference list that appears at the end of your paper.

Below is a guide to creating a 7th edition APA reference page. There are also links to external websites for more specific rules. 

APA Citation Reference List

Articles 

Article found in a database or in print, with one author:

Lastname, F. M . (Year) . Title of article . Title of Journal , volume (issue), pages .

Pajares, F . (2001) . Toward a positive psychology of academic motivation . Journal of Educational Research , 95 (1), 27-35 .

In-Text Citation

( Last name , Year ) OR ( Last name , Year , p. # )

( Pajares , 2001 ) OR ( Pajares , 2001 , p. 28 )

Article found on the open web, with one author:

Lastname, F. M . (Year) . Title of article . Title of Journal , volume if available (issue if available), pages if available. doi: OR

Retrieved from URL

Cohen, P. (2009, October 9 ). Author's personal forecast: Not always sunny, but pleasantly skeptical . The New York Times .

Retrieved from http://www.nytimes.com/2009/10/10/books/10ehrenreich.html?_r=1

( Last name , Year ) OR ( Last name , Year , paragraph/page # )

( Cohen , 2009 ) OR ( Cohen , 2009 , para. 7 )

Article (from the open web) with two authors:

Lastname, F. M., & Surname, F. M. (Year) . Title of article . Title of Journal , volume (issue), pages . doi: OR Retrieved from

Norem, J. K., & Chang, E. C. (2002) . The positive psychology of negative thinking . Journal of Clinical Psychology , 58 (9),

993-1001 . https://doi.org/10.1002/jclp.10094

 ( Last names , Year ) OR ( Last names , Year , paragraph/page # )

 ( Norem & Chang , 2002 ) OR ( Norem & Chang , 2002 , p. 997 )

Article with three to six authors:

Lastname, F. M., Surname, F. M., & Lastname, F. M. (Year) . Title of article . Title of Journal , volume (issue), pages.    

Jutras, S., Vinay, M. C., & Castonguay, G. (2002). Inner-city children's perceptions about well-being . Canadian Journal of

Community Mental Health , 21 (1), 47-65 .

( First last name et al. , Year ) OR ( Last name , Year , p. # )

( Jutras et al. , 2002 ) AND ( Jutras et al., 2002 , p. 48 )

More than 20 authors? List the first 19 authors and the last author.

Authorone, F. M., Authortwo, F. M., Authorthree, F. M., Authorfour, F. M., Authorfive, F. M., Authorsix, F.M.  . . . 

Finalauthor, F. M. (Year) . Title of article . Title of Journal , volume (issue), pages .  

Book with one author:

Lastname, F. M . (Year). Title of book: Subtitle of book . Publisher . 

Bok, S . (2010) . Exploring happiness: From Aristotle to brain science . Yale . 

( Last name , Year ) OR ( Last name , Year , p. #)

( Bok , 2010 ) OR ( Bok , 2010 , p. 10)

Books with multiple authors:

The format follows the author format as listed under articles.

An edited book:

Editor, F. M . (Ed.) . (Year) . Title of book: Subtitle of book . Publisher .

Snyder, C.R. & Lopez, S. J. (Eds.) . (2009) . The Oxford handbook of positive psychology . Oxford

University Press .

( Editor , Year ) OR ( Editor , Year , p. #)

( Snyder & Lopez , 2009 ) OR ( Snyder & Lopez , 2009 , p. 78)

Web site with one author:

Lastname, F. M. (Date published) . Title of page . URL

Lopez, S. J. (2000) . The emergence of Positive Psychology: The building of a field of dreams.

http://www.apa.org/apags/profdev/pospsyc.html

( Last name , Date )  OR ( Last name , Date , para. #) 

( Lopez , 2000 )  OR ( Lopez , 2000 , para. 5) 

Web site with a corporate or organizational author:

Organization name . (Date published) . Title of page . URL

Positive Psychology Center. (2007) . A ttributional style research (Adults) . http://www.ppc.sas.upenn.edu

( Organization name , Date )  OR ( Organization name , Date , para. #) 

( Positive Psychology Center , 2007 )  OR ( Positive Psychology Center , 2007 , para. 3) 

Image from an online source with a creator listed:

Creator, F. M. (Date created) . Title of image [Description of image] . Retrieved [date] from URL

Swanbrow, D. (2008, July 23) . A happiness ranking of 97 nations [table] . Retrieved January 21, 2010 from

http://www.ur.umich.edu/0708/Jul14_08/23.php

In-Text Citation  

( Last name , Year )

( Swanbrow , 2008 )

Image from an online source with no creator listed:

Title of image [Description of image]. (Date created) . Retrieved [date] from URL

( Title of image , Year )

Image from a print source with a creator listed:

Creator, F. M. (Date created) . Title of image. [Continue with title of book or article as appropriate.]

( Last Name , Year )

Updates in APA

Here are some of the changes in the latest version of APA Style:

• APA now has different title page requirements for student papers. This title page does not require a running head and has a different set of information to include. See  APA Style: Student Title Page Guide .
• Titles of papers are now bolded, with a blank line before the author's name.
• There is no font requirement as long as the font is legible and consistent.
• The heading for the References list is now bolded.
• APA has simplified in-text citations in regards to multiple authors.  For three or more authors, list only the first author's name and then  et al.
• In the opposite direction, APA now requires listing up to  20 authors  for a source in the references list. This is a change from 8 in the 6th edition. For works with more than 20 authors, list the first 19, insert an ellipsis point, and then list the last author's name.
• For books, no longer list the publication location.
• eBooks should be cited exactly as print books. Do not include a database.
• If an article has an article number, use that in place of the page numbers.
• Include a URL if it will take the reader to the full text without logging in. The article title is formatted regularly and the newspaper or magazine title is italicized.
• Omit the words 'Retrieved from' before the URL. Include the name of the website unless it is the same as the author. Italicize the name of the webpage.

APA Style Resources

• Purdue OWL - APA
• APA Style Central
• Empire State University - Writing Resources
• APA Citation Game
• EasyBib - APA Guide
• Video: APA Style Citation (Word)
• Video: APA Format Reference

Still have questions? Click here .

The information on this page was borrowed from URI LibGuides.

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HED 474/574: Stress Management

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Citing Your Sources

Why are citations important? Why is it necessary to cite?

To avoid plagiarism, you must give proper credit to all sources you use! Whenever you paraphrase or directly quote information, you must cite the sources of the information using a specific citation style. One of the most commonly used citation styles is APA -- the Publication Manual of the American Psychological Association (APA) . The current version of the APA Manual is the 7th edition, 2020 . When using APA to cite your sources, you must have a list of References at the end of your paper and corresponding in-text citations in the body of your paper.

Cleveland State University takes plagiarism very seriously. Please see The Code of Student Conduct , which defines plagiarism as "stealing and/or using the ideas or writings of another in a paper or report and claiming them as your own. This includes but is not limited to the use, by paraphrase or direct quotation, of the work of another person without full and clear acknowledgment" (p. 53). Many CSU professors require their students to use a program named Turnitin.com , which checks papers for plagiarism.

Please take the time to become familiar with APA style since you will use it a lot in your courses! There are many RULES to follow when citing sources in APA style, such as order of the elements, capitalization, and punctuation.

• If you do not have access to the paper APA Manual, then refer to the Citation Guides page on the Library's Virtual Reference Desk . It contains links to websites to help you format your citations. A good starting point is the Purdue OWL site. 
• The Purdue OWL is an excellent website for learning about APA Citation Style. Once you access the website, explore the links to the left, including In-Text Citations: The Basics and Reference List: Basic Rules . Review the many examples for citing different formats in APA style and the rules pertaining to Authors as well.
• The APA citing help inside a research database is a good starting point, but ALWAYS check the references because the formatting is NOT 100% correct.
• You can use free citation generators like Citation Machine or EasyBib to format citations, but they are not perfect, either! Double check your work! 
• Use the References tab in Microsoft Word to insert citations and manage your sources. You can generate a reference list and insert in-text citations in your paper from this References tab. Make sure to check your citations for accuracy!
• Use Mendeley or Zotero , which are free, web-based tools "to help you collect, organize, cite, and share your research sources." See the Mendeley Research Guide and/or the Zotero Research Guide for more information. Mendeley and Zotero are powerful reference management tools, but errors still can occur. Remember that you are responsible for the accuracy of your citations. Make sure to proofread before submitting your work.

Writing Help

If you need help with the writing process (including properly citing sources), then make an appointment with CSU's Writing Center , which is located on the 1st floor of the Michael Schwartz Library.

APA Manual (Paper Version)

The Michael Schwartz Library has copies of the APA Manual available for review.

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Generate accurate APA citations for free

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APA Formatting and Citation (7th Ed.) | Generator, Template, Examples

Published on November 6, 2020 by Raimo Streefkerk . Revised on January 17, 2024.

The 7th edition of the APA Publication Manual provides guidelines for clear communication , citing sources , and formatting documents. This article focuses on paper formatting.

Generate accurate APA citations with Scribbr

Throughout your paper, you need to apply the following APA format guidelines:

• Set page margins to 1 inch on all sides.
• Double-space all text, including headings.
• Indent the first line of every paragraph 0.5 inches.
• Use an accessible font (e.g., Times New Roman 12pt., Arial 11pt., or Georgia 11pt.).
• Include a page number on every page.

Let an expert format your paper

Our APA formatting experts can help you to format your paper according to APA guidelines. They can help you with:

• Margins, line spacing, and indentation
• Font and headings
• Running head and page numbering

Table of contents

How to set up apa format (with template), apa alphabetization guidelines, apa format template [free download], page header, headings and subheadings, reference page, tables and figures, frequently asked questions about apa format.

Scribbr Citation Checker New

The AI-powered Citation Checker helps you avoid common mistakes such as:

• Missing commas and periods
• Incorrect usage of “et al.”
• Ampersands (&) in narrative citations
• Missing reference entries

References are ordered alphabetically by the first author’s last name. If the author is unknown, order the reference entry by the first meaningful word of the title (ignoring articles: “the”, “a”, or “an”).

Why set up APA format from scratch if you can download Scribbr’s template for free?

Student papers and professional papers have slightly different guidelines regarding the title page, abstract, and running head. Our template is available in Word and Google Docs format for both versions.

• Student paper: Word | Google Docs
• Professional paper: Word | Google Docs

In an APA Style paper, every page has a page header. For student papers, the page header usually consists of just a page number in the page’s top-right corner. For professional papers intended for publication, it also includes a running head .

A running head is simply the paper’s title in all capital letters. It is left-aligned and can be up to 50 characters in length. Longer titles are abbreviated .

APA headings have five possible levels. Heading level 1 is used for main sections such as “ Methods ” or “ Results ”. Heading levels 2 to 5 are used for subheadings. Each heading level is formatted differently.

Want to know how many heading levels you should use, when to use which heading level, and how to set up heading styles in Word or Google Docs? Then check out our in-depth article on APA headings .

The title page is the first page of an APA Style paper. There are different guidelines for student and professional papers.

Both versions include the paper title and author’s name and affiliation. The student version includes the course number and name, instructor name, and due date of the assignment. The professional version includes an author note and running head .

For more information on writing a striking title, crediting multiple authors (with different affiliations), and writing the author note, check out our in-depth article on the APA title page .

The abstract is a 150–250 word summary of your paper. An abstract is usually required in professional papers, but it’s rare to include one in student papers (except for longer texts like theses and dissertations).

The abstract is placed on a separate page after the title page . At the top of the page, write the section label “Abstract” (bold and centered). The contents of the abstract appear directly under the label. Unlike regular paragraphs, the first line is not indented. Abstracts are usually written as a single paragraph without headings or blank lines.

Directly below the abstract, you may list three to five relevant keywords . On a new line, write the label “Keywords:” (italicized and indented), followed by the keywords in lowercase letters, separated by commas.

APA Style does not provide guidelines for formatting the table of contents . It’s also not a required paper element in either professional or student papers. If your instructor wants you to include a table of contents, it’s best to follow the general guidelines.

Place the table of contents on a separate page between the abstract and introduction. Write the section label “Contents” at the top (bold and centered), press “Enter” once, and list the important headings with corresponding page numbers.

The APA reference page is placed after the main body of your paper but before any appendices . Here you list all sources that you’ve cited in your paper (through APA in-text citations ). APA provides guidelines for formatting the references as well as the page itself.

Creating APA Style references

Play around with the Scribbr Citation Example Generator below to learn about the APA reference format of the most common source types or generate APA citations for free with Scribbr’s APA Citation Generator .

Formatting the reference page

Write the section label “References” at the top of a new page (bold and centered). Place the reference entries directly under the label in alphabetical order.

Finally, apply a hanging indent , meaning the first line of each reference is left-aligned, and all subsequent lines are indented 0.5 inches.

Tables and figures are presented in a similar format. They’re preceded by a number and title and followed by explanatory notes (if necessary).

Use bold styling for the word “Table” or “Figure” and the number, and place the title on a separate line directly below it (in italics and title case). Try to keep tables clean; don’t use any vertical lines, use as few horizontal lines as possible, and keep row and column labels concise.

Keep the design of figures as simple as possible. Include labels and a legend if needed, and only use color when necessary (not to make it look more appealing).

Check out our in-depth article about table and figure notes to learn when to use notes and how to format them.

The easiest way to set up APA format in Word is to download Scribbr’s free APA format template for student papers or professional papers.

Alternatively, you can watch Scribbr’s 5-minute step-by-step tutorial or check out our APA format guide with examples.

APA Style papers should be written in a font that is legible and widely accessible. For example:

• Times New Roman (12pt.)
• Arial (11pt.)
• Calibri (11pt.)
• Georgia (11pt.)

The same font and font size is used throughout the document, including the running head , page numbers, headings , and the reference page . Text in footnotes and figure images may be smaller and use single line spacing.

You need an APA in-text citation and reference entry . Each source type has its own format; for example, a webpage citation is different from a book citation .

Use Scribbr’s free APA Citation Generator to generate flawless citations in seconds or take a look at our APA citation examples .

Yes, page numbers are included on all pages, including the title page , table of contents , and reference page . Page numbers should be right-aligned in the page header.

To insert page numbers in Microsoft Word or Google Docs, click ‘Insert’ and then ‘Page number’.

APA format is widely used by professionals, researchers, and students in the social and behavioral sciences, including fields like education, psychology, and business.

Be sure to check the guidelines of your university or the journal you want to be published in to double-check which style you should be using.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

Streefkerk, R. (2024, January 17). APA Formatting and Citation (7th Ed.) | Generator, Template, Examples. Scribbr. Retrieved August 18, 2024, from https://www.scribbr.com/apa-style/format/

Is this article helpful?

Raimo Streefkerk

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APA Sample Paper

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This page is brought to you by the OWL at Purdue University. When printing this page, you must include the entire legal notice.

Copyright ©1995-2018 by The Writing Lab & The OWL at Purdue and Purdue University. All rights reserved. This material may not be published, reproduced, broadcast, rewritten, or redistributed without permission. Use of this site constitutes acceptance of our terms and conditions of fair use.

Note:  This page reflects the latest version of the APA Publication Manual (i.e., APA 7), which released in October 2019. The equivalent resource for the older APA 6 style  can be found here .

Media Files: APA Sample Student Paper  ,  APA Sample Professional Paper

This resource is enhanced by Acrobat PDF files. Download the free Acrobat Reader

Note: The APA Publication Manual, 7 th Edition specifies different formatting conventions for student  and  professional  papers (i.e., papers written for credit in a course and papers intended for scholarly publication). These differences mostly extend to the title page and running head. Crucially, citation practices do not differ between the two styles of paper.

However, for your convenience, we have provided two versions of our APA 7 sample paper below: one in  student style and one in  professional  style.

Note: For accessibility purposes, we have used "Track Changes" to make comments along the margins of these samples. Those authored by [AF] denote explanations of formatting and [AWC] denote directions for writing and citing in APA 7. 

APA 7 Student Paper:

Apa 7 professional paper:.

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STRESS AND HEALTH: Psychological, Behavioral, and Biological Determinants

Stressors have a major influence upon mood, our sense of well-being, behavior, and health. Acute stress responses in young, healthy individuals may be adaptive and typically do not impose a health burden. However, if the threat is unremitting, particularly in older or unhealthy individuals, the long-term effects of stressors can damage health. The relationship between psychosocial stressors and disease is affected by the nature, number, and persistence of the stressors as well as by the individual’s biological vulnerability (i.e., genetics, constitutional factors), psychosocial resources, and learned patterns of coping. Psychosocial interventions have proven useful for treating stress-related disorders and may influence the course of chronic diseases.

INTRODUCTION

Claude Bernard (1865/1961) noted that the maintenance of life is critically dependent on keeping our internal milieu constant in the face of a changing environment. Cannon (1929) called this “homeostasis.” Selye (1956) used the term “stress” to represent the effects of anything that seriously threatens homeostasis. The actual or perceived threat to an organism is referred to as the “stressor” and the response to the stressor is called the “stress response.” Although stress responses evolved as adaptive processes, Selye observed that severe, prolonged stress responses might lead to tissue damage and disease.

Based on the appraisal of perceived threat, humans and other animals invoke coping responses ( Lazarus & Folkman 1984 ). Our central nervous system (CNS) tends to produce integrated coping responses rather than single, isolated response changes ( Hilton 1975 ). Thus, when immediate fight-or-flight appears feasible, mammals tend to show increased autonomic and hormonal activities that maximize the possibilities for muscular exertion ( Cannon 1929 , Hess 1957 ). In contrast, during aversive situations in which an active coping response is not available, mammals may engage in a vigilance response that involves sympathetic nervous system (SNS) arousal accompanied by an active inhibition of movement and shunting of blood away from the periphery ( Adams et al. 1968 ). The extent to which various situations elicit different patterns of biologic response is called “situational stereotypy” ( Lacey 1967 ).

Although various situations tend to elicit different patterns of stress responses, there are also individual differences in stress responses to the same situation. This tendency to exhibit a particular pattern of stress responses across a variety of stressors is referred to as “response stereotypy” ( Lacey & Lacey 1958 ). Across a variety of situations, some individuals tend to show stress responses associated with active coping, whereas others tend to show stress responses more associated with aversive vigilance ( Kasprowicz et al. 1990 , Llabre et al. 1998 ).

Although genetic inheritance undoubtedly plays a role in determining individual differences in response stereotypy, neonatal experiences in rats have been shown to produce long-term effects in cognitive-emotional responses ( Levine 1957 ). For example, Meaney et al. (1993) showed that rats raised by nurturing mothers have increased levels of central serotonin activity compared with rats raised by less nurturing mothers. The increased serotonin activity leads to increased expression of a central glucocorticoid receptor gene. This, in turn, leads to higher numbers of glucocorticoid receptors in the limbic system and improved glucocorticoid feedback into the CNS throughout the rat’s life. Interestingly, female rats who receive a high level of nurturing in turn become highly nurturing mothers whose offspring also have high levels of glucocorticoid receptors. This example of behaviorally induced gene expression shows how highly nurtured rats develop into low-anxiety adults, who in turn become nurturing mothers with reduced stress responses.

In contrast to highly nurtured rats, pups separated from their mothers for several hours per day during early life have a highly active hypothalamic-pituitary adrenocortical axis and elevated SNS arousal ( Ladd et al. 2000 ). These deprived rats tend to show larger and more frequent stress responses to the environment than do less deprived animals.

Because evolution has provided mammals with reasonably effective homeostatic mechanisms (e.g., baroreceptor reflex) for dealing with short-term stressors, acute stress responses in young, healthy individuals typically do not impose a health burden. However, if the threat is persistent, particularly in older or unhealthy individuals, the long-term effects of the response to stress may damage health ( Schneiderman 1983 ). Adverse effects of chronic stressors are particularly common in humans, possibly because their high capacity for symbolic thought may elicit persistent stress responses to a broad range of adverse living and working conditions. The relationship between psychosocial stressors and chronic disease is complex. It is affected, for example, by the nature, number, and persistence of the stressors as well as by the individual’s biological vulnerability (i.e., genetics, constitutional factors) and learned patterns of coping. In this review, we focus on some of the psychological, behavioral, and biological effects of specific stressors, the mediating psychophysiological pathways, and the variables known to mediate these relationships. We conclude with a consideration of treatment implications.

PSYCHOLOGICAL ASPECTS OF STRESS

Stressors during childhood and adolescence and their psychological sequelae.

The most widely studied stressors in children and adolescents are exposure to violence, abuse (sexual, physical, emotional, or neglect), and divorce/marital conflict (see Cicchetti 2005 ). McMahon et al. (2003) also provide an excellent review of the psychological consequences of such stressors. Psychological effects of maltreatment/abuse include the dysregulation of affect, provocative behaviors, the avoidance of intimacy, and disturbances in attachment ( Haviland et al. 1995 , Lowenthal 1998 ). Survivors of childhood sexual abuse have higher levels of both general distress and major psychological disturbances including personality disorders ( Polusny & Follett 1995 ). Childhood abuse is also associated with negative views toward learning and poor school performance ( Lowenthal 1998 ). Children of divorced parents have more reported antisocial behavior, anxiety, and depression than their peers ( Short 2002 ). Adult offspring of divorced parents report more current life stress, family conflict, and lack of friend support compared with those whose parents did not divorce ( Short 2002 ). Exposure to nonresponsive environments has also been described as a stressor leading to learned helplessness ( Peterson & Seligman 1984 ).

Studies have also addressed the psychological consequences of exposure to war and terrorism during childhood ( Shaw 2003 ). A majority of children exposed to war experience significant psychological morbidity, including both post-traumatic stress disorder (PTSD) and depressive symptoms. For example, Nader et al. (1993) found that 70% of Kuwaiti children reported mild to severe PTSD symptoms after the Gulf War. Some effects are long lasting: Macksound & Aber (1996) found that 43% of Lebanese children continued to manifest post-traumatic stress symptoms 10 years after exposure to war-related trauma.

Exposure to intense and chronic stressors during the developmental years has long-lasting neurobiological effects and puts one at increased risk for anxiety and mood disorders, aggressive dyscontrol problems, hypo-immune dysfunction, medical morbidity, structural changes in the CNS, and early death ( Shaw 2003 ).

Stressors During Adulthood and Their Psychological Sequelae

Life stress, anxiety, and depression.

It is well known that first depressive episodes often develop following the occurrence of a major negative life event ( Paykel 2001 ). Furthermore, there is evidence that stressful life events are causal for the onset of depression (see Hammen 2005 , Kendler et al. 1999 ). A study of 13,006 patients in Denmark, with first psychiatric admissions diagnosed with depression, found more recent divorces, unemployment, and suicides by relatives compared with age- and gender-matched controls ( Kessing et al. 2003 ). The diagnosis of a major medical illness often has been considered a severe life stressor and often is accompanied by high rates of depression ( Cassem 1995 ). For example, a meta-analysis found that 24% of cancer patients are diagnosed with major depression ( McDaniel et al. 1995 ).

Stressful life events often precede anxiety disorders as well ( Faravelli & Pallanti 1989 , Finlay-Jones & Brown 1981 ). Interestingly, long-term follow-up studies have shown that anxiety occurs more commonly before depression ( Angst &Vollrath 1991 , Breslau et al. 1995 ). In fact, in prospective studies, patients with anxiety are most likely to develop major depression after stressful life events occur ( Brown et al. 1986 ).

DISORDERS RELATED TO TRAUMA

Lifetime exposure to traumatic events in the general population is high, with estimates ranging from 40% to 70% ( Norris 1992 ). Of note, an estimated 13% of adult women in the United States have been exposed to sexual assault ( Kilpatrick et al. 1992 ). The Diagnostic and Statistical Manual (DSM-IV-TR; American Psychiatric Association 2000 ) includes two primary diagnoses related to trauma: Acute Stress Disorder (ASD) and PTSD. Both these disorders have as prominent features a traumatic event involving actual or threatened death or serious injury and symptom clusters including re-experiencing of the traumatic event (e.g., intrusive thoughts), avoidance of reminders/numbing, and hyperarousal (e.g., difficulty falling or staying asleep). The time frame for ASD is shorter (lasting two days to four weeks), with diagnosis limited to within one month of the incident. ASD was introduced in 1994 to describe initial trauma reactions, but it has come under criticism ( Harvey & Bryant 2002 ) for weak empirical and theoretical support. Most people who have symptoms of PTSD shortly after a traumatic event recover and do not develop PTSD. In a comprehensive review, Green (1994) estimates that approximately 25% of those exposed to traumatic events develop PTSD. Surveys of the general population indicate that PTSD affects 1 in 12 adults at some time in their life ( Kessler et al. 1995 ). Trauma and disasters are related not only to PTSD, but also to concurrent depression, other anxiety disorders, cognitive impairment, and substance abuse ( David et al. 1996 , Schnurr et al. 2002 , Shalev 2001 ).

Other consequences of stress that could provide linkages to health have been identified, such as increases in smoking, substance use, accidents, sleep problems, and eating disorders. Populations that live in more stressful environments (communities with higher divorce rates, business failures, natural disasters, etc.) smoke more heavily and experience higher mortality from lung cancer and chronic obstructive pulmonary disorder ( Colby et al. 1994 ). A longitudinal study following seamen in a naval training center found that more cigarette smoking occurred on high-stress days ( Conway et al. 1981 ). Life events stress and chronically stressful conditions have also been linked to higher consumption of alcohol ( Linsky et al. 1985 ). In addition, the possibility that alcohol may be used as self-medication for stress-related disorders such as anxiety has been proposed. For example, a prospective community study of 3021 adolescents and young adults ( Zimmerman et al. 2003 ) found that those with certain anxiety disorders (social phobia and panic attacks) were more likely to develop substance abuse or dependence prospectively over four years of follow-up. Life in stressful environments has also been linked to fatal accidents ( Linsky & Strauss 1986 ) and to the onset of bulimia ( Welch et al. 1997 ). Another variable related to stress that could provide a link to health is the increased sleep problems that have been reported after sychological trauma ( Harvey et al. 2003 ). New onset of sleep problems mediated the relationship between post-traumatic stress symptoms and decreased natural killer (NK) cell cytotoxicity in Hurricane Andrew victims ( Ironson et al. 1997 ).

Variations in Stress Responses

Certain characteristics of a situation are associated with greater stress responses. These include the intensity or severity of the stressor and controllability of the stressor, as well as features that determine the nature of the cognitive responses or appraisals. Life event dimensions of loss, humiliation, and danger are related to the development of major depression and generalized anxiety ( Kendler et al. 2003 ). Factors associated with the development of symptoms of PTSD and mental health disorders include injury, damage to property, loss of resources, bereavement, and perceived life threat ( Freedy et al. 1992 , Ironson et al. 1997 , McNally 2003 ). Recovery from a stressor can also be affected by secondary traumatization ( Pfefferbaum et al. 2003 ). Other studies have found that multiple facets of stress that may work synergistically are more potent than a single facet; for example, in the area of work stress, time pressure in combination with threat ( Stanton et al. 2001 ), or high demand in combination with low control ( Karasek & Theorell 1990 ).

Stress-related outcomes also vary according to personal and environmental factors. Personal risk factors for the development of depression, anxiety, or PTSD after a serious life event, disaster, or trauma include prior psychiatric history, neuroticism, female gender, and other sociodemographic variables ( Green 1996 , McNally 2003 , Patton et al. 2003 ). There is also some evidence that the relationship between personality and environmental adversity may be bidirectional ( Kendler et al. 2003 ). Levels of neuroticism, emotionality, and reactivity correlate with poor interpersonal relationships as well as “event proneness.” Protective factors that have been identified include, but are not limited to, coping, resources (e.g., social support, self-esteem, optimism), and finding meaning. For example, those with social support fare better after a natural disaster ( Madakaisira & O’Brien 1987 ) or after myocardial infarction ( Frasure-Smith et al. 2000 ). Pruessner et al. (1999) found that people with higher self-esteem performed better and had lower cortisol responses to acute stressors (difficult math problems). Attaching meaning to the event is another protective factor against the development of PTSD, even when horrific torture has occurred. Left-wing political activists who were tortured by Turkey’s military regime had lower rates of PTSD than did nonactivists who were arrested and tortured by the police ( Basoğlu et al. 1994 ).

Finally, human beings are resilient and in general are able to cope with adverse situations. A recent illustration is provided by a study of a nationally representative sample of Israelis after 19 months of ongoing exposure to the Palestinian intifada. Despite considerable distress, most Israelis reported adapting to the situation without substantial mental health symptoms or impairment ( Bleich et al. 2003 ).

BIOLOGICAL RESPONSES TO STRESSORS

Acute stress responses.

Following the perception of an acute stressful event, there is a cascade of changes in the nervous, cardiovascular, endocrine, and immune systems. These changes constitute the stress response and are generally adaptive, at least in the short term ( Selye 1956 ). Two features in particular make the stress response adaptive. First, stress hormones are released to make energy stores available for the body’s immediate use. Second, a new pattern of energy distribution emerges. Energy is diverted to the tissues that become more active during stress, primarily the skeletal muscles and the brain. Cells of the immune system are also activated and migrate to “battle stations” ( Dhabar & McEwen 1997 ). Less critical activities are suspended, such as digestion and the production of growth and gonadal hormones. Simply put, during times of acute crisis, eating, growth, and sexual activity may be a detriment to physical integrity and even survival.

Stress hormones are produced by the SNS and hypothalamic-pituitary adrenocortical axis. The SNS stimulates the adrenal medulla to produce catecholamines (e.g., epinephrine). In parallel, the paraventricular nucleus of the hypothalamus produces corticotropin releasing factor, which in turn stimulates the pituitary to produce adrenocorticotropin. Adrenocorticotropin then stimulates the adrenal cortex to secrete cortisol. Together, catecholamines and cortisol increase available sources of energy by promoting lipolysis and the conversion of glycogen into glucose (i.e., blood sugar). Lipolysis is the process of breaking down fats into usable sources of energy (i.e., fatty acids and glycerol; Brindley & Rollan 1989 ).

Energy is then distributed to the organs that need it most by increasing blood pressure levels and contracting certain blood vessels while dilating others. Blood pressure is increased with one of two hemodynamic mechanisms ( Llabre et al.1998 , Schneiderman & McCabe 1989 ). The myocardial mechanism increases blood pressure through enhanced cardiac output; that is, increases in heart rate and stroke volume (i.e., the amount of blood pumped with each heart beat). The vascular mechanism constricts the vasculature, thereby increasing blood pressure much like constricting a hose increases water pressure. Specific stressors tend to elicit either myocardial or vascular responses, providing evidence of situational stereotypy ( Saab et al. 1992 , 1993 ). Laboratory stressors that call for active coping strategies, such as giving a speech or performing mental arithmetic, require the participant to do something and are associated with myocardial responses. In contrast, laboratory stressors that call for more vigilant coping strategies in the absence of movement, such as viewing a distressing video or keeping one’s foot in a bucket of ice water, are associated with vascular responses. From an evolutionary perspective, cardiac responses are believed to facilitate active coping by shunting blood to skeletal muscles, consistent with the fight-or-flight response. In situations where decisive action would not be appropriate, but instead skeletal muscle inhibition and vigilance are called for, a vascular hemodynamic response is adaptive. The vascular response shunts blood away from the periphery to the internal organs, thereby minimizing potential bleeding in the case of physical assault.

Finally, in addition to the increased availability and redistribution of energy, the acute stress response includes activation of the immune system. Cells of the innate immune system (e.g., macrophages and natural killer cells), the first line of defense, depart from lymphatic tissue and spleen and enter the bloodstream, temporarily raising the number of immune cells in circulation (i.e., leukocytosis). From there, the immune cells migrate into tissues that are most likely to suffer damage during physical confrontation (e.g., the skin). Once at “battle stations,” these cells are in position to contain microbes that may enter the body through wounds and thereby facilitate healing ( Dhabar & McEwen 1997 ).

Chronic Stress Responses

The acute stress response can become maladaptive if it is repeatedly or continuously activated ( Selye 1956 ). For example, chronic SNS stimulation of the cardiovascular system due to stress leads to sustained increases in blood pressure and vascular hypertrophy ( Henry et al. 1975 ). That is, the muscles that constrict the vasculature thicken, producing elevated resting blood pressure and response stereotypy, or a tendency to respond to all types of stressors with a vascular response. Chronically elevated blood pressure forces the heart to work harder, which leads to hypertrophy of the left ventricle ( Brownley et al. 2000 ). Over time, the chronically elevated and rapidly shifting levels of blood pressure can lead to damaged arteries and plaque formation.

The elevated basal levels of stress hormones associated with chronic stress also suppress immunity by directly affecting cytokine profiles. Cytokines are communicatory molecules produced primarily by immune cells (see Roitt et al. 1998 ). There are three classes of cytokines. Proinflammatory cytokines mediate acute inflammatory reactions. Th1 cytokines mediate cellular immunity by stimulating natural killer cells and cytotoxic T cells, immune cells that target intracellular pathogens (e.g., viruses). Finally, Th2 cytokines mediate humoral immunity by stimulating B cells to produce antibody, which “tags” extracellular pathogens (e.g., bacteria) for removal. In a meta-analysis of over 30 years of research, Segerstrom & Miller (2004) found that intermediate stressors, such as academic examinations, could promote a Th2 shift (i.e., an increase in Th2 cytokines relative to Th1 cytokines). A Th2 shift has the effect of suppressing cellular immunity in favor of humoral immunity. In response to more chronic stressors (e.g., long-term caregiving for a dementia patient), Segerstrom & Miller found that proinflammatory, Th1, and Th2 cytokines become dysregulated and lead both to suppressed humoral and cellular immunity. Intermediate and chronic stressors are associated with slower wound healing and recovery from surgery, poorer antibody responses to vaccination, and antiviral deficits that are believed to contribute to increased vulnerability to viral infections (e.g., reductions in natural killer cell cytotoxicity; see Kiecolt-Glaser et al. 2002 ).

Chronic stress is particularly problematic for elderly people in light of immunosenescence, the gradual loss of immune function associated with aging. Older adults are less able to produce antibody responses to vaccinations or combat viral infections ( Ferguson et al. 1995 ), and there is also evidence of a Th2 shift ( Glaser et al. 2001 ). Although research has yet to link poor vaccination responses to early mortality, influenza and other infectious illnesses are a major cause of mortality in the elderly, even among those who have received vaccinations (e.g., Voordouw et al. 2003 ).

PSYCHOSOCIAL STRESSORS AND HEALTH

Cardiovascular disease.

Both epidemiological and controlled studies have demonstrated relationships between psychosocial stressors and disease. The underlying mediators, however, are unclear in most cases, although possible mechanisms have been explored in some experimental studies. An occupational gradient in coronary heart disease (CHD) risk has been documented in which men with relatively low socioeconomic status have the poorest health outcomes ( Marmot 2003 ). Much of the risk gradient in CHD can be eliminated, however, by taking into account lack of perceived job control, which is a potent stressor ( Marmot et al. 1997 ). Other factors include risky behaviors such as smoking, alcohol use, and sedentary lifestyle ( Lantz et al. 1998 ), which may be facilitated by stress. Among men ( Schnall et al. 1994 ) and women ( Eaker 1998 ), work stress has been reported to be a predictor of incident CHD and hypertension ( Ironson 1992 ). However, in women with existing CHD, marital stress is a better predictor of poor prognosis than is work stress ( Orth-Gomer et al. 2000 ).

Although the observational studies cited thus far reveal provocative associations between psychosocial stressors and disease, they are limited in what they can tell us about the exact contribution of these stressors or about how stress mediates disease processes. Animal models provide an important tool for helping to understand the specific influences of stressors on disease processes. This is especially true of atherosclerotic CHD, which takes multiple decades to develop in humans and is influenced by a great many constitutional, demographic, and environmental factors. It would also be unethical to induce disease in humans by experimental means.

Perhaps the best-known animal model relating stress to atherosclerosis was developed by Kaplan et al. (1982) . Their study was carried out on male cynomolgus monkeys, who normally live in social groups. The investigators stressed half the animals by reorganizing five-member social groups at one- to three-month intervals on a schedule that ensured that each monkey would be housed with several new animals during each reorganization. The other half of the animals lived in stable social groups. All animals were maintained on a moderately atherogenic diet for 22 months. Animals were also assessed for their social status (i.e., relative dominance) within each group. The major findings were that ( a ) socially dominant animals living in unstable groups had significantly more atherosclerosis than did less dominant animals living in unstable groups; and ( b ) socially dominant male animals living in unstable groups had significantly more atherosclerosis than did socially dominant animals living in stable groups. Other important findings based upon this model have been that heart-rate reactivity to the threat of capture predicts severity of atherosclerosis ( Manuck et al. 1983 ) and that administration of the SNS-blocking agent propranolol decreases the progression of atherosclerosis ( Kaplan et al. 1987 ). In contrast to the findings in males, subordinate premenstrual females develop greater atherosclerosis than do dominant females ( Kaplan et al. 1984 ) because they are relatively estrogen deficient, tending to miss ovulatory cycles ( Adams et al. 1985 ).

Whereas the studies in cynomolgus monkeys indicate that emotionally stressful behavior can accelerate the progression of atherosclerosis, McCabe et al. (2002) have provided evidence that affiliative social behavior can slow the progression of atherosclerosis in the Watanabe heritable hyperlipidemic rabbit. This rabbit model has a genetic defect in lipoprotein clearance such that it exhibits hypercholesterolemia and severe atherosclerosis. The rabbits were assigned to one of three social or behavioral groups: ( a ) an unstable group in which unfamiliar rabbits were paired daily, with the pairing switched each week; ( b ) a stable group, in which littermates were paired daily for the entire study; and ( c ) an individually caged group. The stable group exhibited more affiliative behavior and less agonistic behavior than the unstable group and significantly less atherosclerosis than each of the other two groups. The study emphasizes the importance of behavioral factors in atherogenesis, even in a model of disease with extremely strong genetic determinants.

Upper Respiratory Diseases

The hypothesis that stress predicts susceptibility to the common cold received support from observational studies ( Graham et al. 1986 , Meyer & Haggerty 1962 ). One problem with such studies is that they do not control for exposure. Stressed people, for instance, might seek more outside contact and thus be exposed to more viruses. Therefore, in a more controlled study, people were exposed to a rhinovirus and then quarantined to control for exposure to other viruses ( Cohen et al. 1991 ). Those individuals with the most stressful life events and highest levels of perceived stress and negative affect had the greatest probability of developing cold symptoms. In a subsequent study of volunteers inoculated with a cold virus, it was found that people enduring chronic, stressful life events (i.e., events lasting a month or longer including unemployment, chronic underemployment, or continued interpersonal difficulties) had a high likelihood of catching cold, whereas people subjected to stressful events lasting less than a month did not ( Cohen et al. 1998 ).

Human Immunodeficiency Virus

The impact of life stressors has also been studied within the context of human immunodeficiency virus (HIV) spectrum disease. Leserman et al. (2000) followed men with HIV for up to 7.5 years and found that faster progression to AIDS was associated with higher cumulative stressful life events, use of denial as a coping mechanism, lower satisfaction with social support, and elevated serum cortisol.

Inflammation, the Immune System, and Physical Health

Despite the stress-mediated immunosuppressive effects reviewed above, stress has also been associated with exacerbations of autoimmune disease ( Harbuz et al. 2003 ) and other conditions in which excessive inflammation is a central feature, such as CHD ( Appels et al. 2000 ). Evidence suggests that a chronically activated, dysregulated acute stress response is responsible for these associations. Recall that the acute stress response includes the activation and migration of cells of the innate immune system. This effect is mediated by proinflammatory cytokines. During periods of chronic stress, in the otherwise healthy individual, cortisol eventually suppresses proinflammatory cytokine production. But in individuals with autoimmune disease or CHD, prolonged stress can cause proinflammatory cytokine production to remain chronically activated, leading to an exacerbation of pathophysiology and symptomatology.

Miller et al. (2002) proposed the glucocorticoid-resistance model to account for this deficit in proinflammatory cytokine regulation. They argue that immune cells become “resistant” to the effects of cortisol (i.e., a type of glucocorticoid), primarily through a reduction, or downregulation, in the number of expressed cortisol receptors. With cortisol unable to suppress inflammation, stress continues to promote proinflammatory cytokine production indefinitely. Although there is only preliminary empirical support for this model, it could have implications for diseases of inflammation. For example, in rheumatoid arthritis, excessive inflammation is responsible for joint damage, swelling, pain, and reduced mobility. Stress is associated with more swelling and reduced mobility in rheumatoid arthritis patients ( Affleck et al. 1997 ). Similarly, in multiple sclerosis (MS), an overactive immune system targets and destroys the myelin surrounding nerves, contributing to a host of symptoms that include paralysis and blindness. Again, stress is associated with an exacerbation of disease ( Mohr et al. 2004 ). Even in CHD, inflammation plays a role. The immune system responds to vascular injury just as it would any other wound: Immune cells migrate to and infiltrate the arterial wall, setting off a cascade of biochemical processes that can ultimately lead to a thrombosis (i.e., clot; Ross 1999 ). Elevated levels of inflammatory markers, such as C-reactive protein (CRP), are predictive of heart attacks, even when controlling for other traditional risk factors (e.g., cholesterol, blood pressure, and smoking; Morrow & Ridker 2000 ). Interestingly, a history of major depressive episodes has been associated with elevated levels of CRP in men ( Danner et al. 2003 ).

Inflammation, Cytokine Production, and Mental Health

In addition to its effects on physical health, prolonged proinflammatory cytokine production may also adversely affect mental health in vulnerable individuals. During times of illness (e.g., the flu), proinflammatory cytokines feed back to the CNS and produce symptoms of fatigue, malaise, diminished appetite, and listlessness, which are symptoms usually associated with depression. It was once thought that these symptoms were directly caused by infectious pathogens, but more recently, it has become clear that proinflammatory cytokines are both sufficient and necessary (i.e., even absent infection or fever) to generate sickness behavior ( Dantzer 2001 , Larson & Dunn 2001 ).

Sickness behavior has been suggested to be a highly organized strategy that mammals use to combat infection ( Dantzer 2001 ). Symptoms of illness, as previously thought, are not inconsequential or even maladaptive. On the contrary, sickness behavior is thought to promote resistance and facilitate recovery. For example, an overall decrease in activity allows the sick individual to preserve energy resources that can be redirected toward enhancing immune activity. Similarly, limiting exploration, mating, and foraging further preserves energy resources and reduces the likelihood of risky encounters (e.g., fighting over a mate). Furthermore, decreasing food intake also decreases the level of iron in the blood, thereby decreasing bacterial replication. Thus, for a limited period, sickness behavior may be looked upon as an adaptive response to the stress of illness.

Much like other aspects of the acute stress response, however, sickness behavior can become maladaptive when repeatedly or continuously activated. Many features of the sickness behavior response overlap with major depression. Indeed, compared with healthy controls, elevated rates of depression are reported in patients with inflammatory diseases such as MS ( Mohr et al. 2004 ) or CHD ( Carney et al. 1987 ). Granted, MS patients face a number of stressors and reports of depression are not surprising. However, when compared with individuals facing similar disability who do not have MS (e.g., car accident victims), MS patients still report higher levels of depression ( Ron & Logsdail 1989 ). In both MS ( Fassbender et al. 1998 ) and CHD ( Danner et al. 2003 ), indicators of inflammation have been found to be correlated with depressive symptomatology. Thus, there is evidence to suggest that stress contributes to both physical and mental disease through the mediating effects of proinflammatory cytokines.

HOST VULNERABILITY-STRESSOR INTERACTIONS AND DISEASE

The changes in biological set points that occur across the life span as a function of chronic stressors are referred to as allostasis, and the biological cost of these adjustments is known as allostatic load ( McEwen 1998 ). McEwen has also suggested that cumulative increases in allostatic load are related to chronic illness. These are intriguing hypotheses that emphasize the role that stressors may play in disease. The challenge, however, is to show the exact interactions that occur among stressors, pathogens, host vulnerability (both constitutional and genetic), and such poor health behaviors as smoking, alcohol abuse, and excessive caloric consumption. Evidence of a lifetime trajectory of comorbidities does not necessarily imply that allostatic load is involved since immunosenescence, genetic predisposition, pathogen exposure, and poor health behaviors may act as culprits.

It is not clear, for example, that changes in set point for variables such as blood pressure are related to cumulative stressors per se, at least in healthy young individuals. Thus, for example, British soldiers subjected to battlefield conditions for more than a year in World War II showed chronic elevations in blood pressure, which returned to normal after a couple of months away from the front ( Graham 1945 ). In contrast, individuals with chronic illnesses such as chronic fatigue syndrome may show a high rate of relapse after a relatively acute stressor such as a hurricane ( Lutgendorf et al. 1995 ). Nevertheless, by emphasizing the role that chronic stressors may play in multiple disease outcomes, McEwen has helped to emphasize an important area of study.

TREATMENT FOR STRESS-RELATED DISORDERS

For PTSD, useful treatments include cognitive-behavioral therapy (CBT), along with exposure and the more controversial Eye Movement Desensitization and Reprocessing ( Foa & Meadows 1997 , Ironson et al. 2002 , Shapiro 1995 ). Psychopharmacological approaches have also been suggested ( Berlant 2001 ). In addition, writing about trauma has been helpful both for affective recovery and for potential health benefit ( Pennebaker 1997 ). For outpatients with major depression, Beck’s CBT ( Beck 1976 ) and interpersonal therapy ( Klerman et al. 1984 ) are as effective as psychopharmacotherapy ( Clinical Practice Guidelines 1993 ). However, the presence of sleep problems or hypercortisolemia is associated with poorer response to psychotherapy ( Thase 2000 ). The combination of psychotherapy and pharmacotherapy seems to offer a substantial advantage over psychotherapy alone for the subset of patients who are more severely depressed or have recurrent depression ( Thase et al. 1997 ). For the treatment of anxiety, it depends partly on the specific disorder [e.g., generalized anxiety disorder (GAD), panic disorder, social phobia], although CBT including relaxation training has demonstrated efficacy in several subtypes of anxiety ( Borkovec & Ruscio 2001 ). Antidepressants such as selective serotonin reuptake inhibitors also show efficacy in anxiety ( Ballenger et al. 2001 ), especially when GAD is comorbid with major depression, which is the case in 39% of subjects with current GAD ( Judd et al. 1998 ).

BEHAVIORAL INTERVENTIONS IN CHRONIC DISEASE

Patients dealing with chronic, life-threatening diseases must often confront daily stressors that can threaten to undermine even the most resilient coping strategies and overwhelm the most abundant interpersonal resources. Psychosocial interventions, such as cognitive-behavioral stress management (CBSM), have a positive effect on the quality of life of patients with chronic disease ( Schneiderman et al. 2001 ). Such interventions decrease perceived stress and negative mood (e.g., depression), improve perceived social support, facilitate problem-focused coping, and change cognitive appraisals, as well as decrease SNS arousal and the release of cortisol from the adrenal cortex. Psychosocial interventions also appear to help chronic pain patients reduce their distress and perceived pain as well as increase their physical activity and ability to return to work ( Morley et al. 1999 ). These psychosocial interventions can also decrease patients’ overuse of medications and utilization of the health care system. There is also some evidence that psychosocial interventions may have a favorable influence on disease progression ( Schneiderman et al. 2001 ).

Morbidity, Mortality, and Markers of Disease Progression

Psychosocial intervention trials conducted upon patients following acute myocardial infarction (MI) have reported both positive and null results. Two meta-analyses have reported a reduction in both mortality and morbidity of approximately 20% to 40% ( Dusseldorp et al. 1999 , Linden et al. 1996 ). Most of these studies were carried out in men. The major study reporting positive results was the Recurrent Coronary Prevention Project (RCPP), which employed group-based CBT, and decreased hostility and depressed affect ( Mendes de Leon et al. 1991 ), as well as the composite medical end point of cardiac death and nonfatal MI ( Friedman et al. 1986 ).

In contrast, the major study reporting null results for medical end points was the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial ( Writing Committee for ENRICHD Investigators 2003 ), which found that the intervention modestly decreased depression and increased perceived social support, but did not affect the composite medical end point of death and nonfatal MI. However, a secondary analysis, which examined the effects of the psychosocial intervention within gender by ethnicity subgroups, found significant decreases approaching 40% in both cardiac death and nonfatal MI for white men but not for other subgroups such as minority women ( Schneiderman et al. 2004 ). Although there were important differences between the RCPP and ENRICHD in terms of the objectives of psychosocial intervention and the duration and timing of treatment, it should also be noted that more than 90% of the patients in the RCPP were white men. Thus, because primarily white men, but not other subgroups, may have benefited from the ENRICHD intervention, future studies need to attend to variables that may have prevented morbidity and mortality benefits among gender and ethnic subgroups other than white men.

Psychosocial intervention trials conducted upon patients with cancer have reported both positive and null results with regard to survival ( Classen 1998 ). A number of factors that generally characterized intervention trials that observed significant positive effects on survival were relatively absent in trials that failed to show improved survival. These included: ( a ) having only patients with the same type and severity of cancer within each group, ( b ) creation of a supportive environment, ( c ) having an educational component, and ( d ) provision of stress-management and coping-skills training. In one study that reported positive results, Fawzy et al. (1993) found that patients with early stage melanoma assigned to a six-week cognitive-behavioral stress management (CBSM) group showed significantly longer survival and longer time to recurrence over a six-year follow-up period compared with those receiving surgery and standard care alone. The intervention also significantly reduced distress, enhanced active coping, and increased NK cell cytotoxicity compared with controls.

Although published studies have not yet shown that psychosocial interventions can decrease disease progression in HIV/AIDS, several studies have significantly influenced factors that have been associated with HIV/AIDS disease progression ( Schneiderman & Antoni 2003 ). These variables associated with disease progression include distress, depressed affect, denial coping, low perceived social support, and elevated serum cortisol ( Ickovics et al. 2001 , Leserman et al. 2000 ). Antoni et al. have used group-based CBSM (i.e., CBT plus relaxation training) to decrease the stress-related effects of HIV+ serostatus notification. Those in the intervention condition showed lower distress, anxiety, and depressed mood than did those in the control condition as well as lower antibody titers of herpesviruses and higher levels of T-helper (CD4) cells, NK cells, and lymphocyte proliferation ( Antoni et al. 1991 , Esterling et al. 1992 ). In subsequent studies conducted upon symptomatic HIV+ men who were not attempting to determine their HIV serostatus, CBSM decreased distress, dysphoria, anxiety, herpesvirus antibody titers, cortisol, and epinephrine ( Antoni et al. 2000a , b ; Lutgendorf et al. 1997 ). Improvement in perceived social support and adaptive coping skills mediated the decreases in distress ( Lutgendorf et al. 1998 ). In summary, it appears that CBSM can positively influence stress-related variables that have been associated with HIV/AIDS progression. Only a randomized clinical trial, however, could document that CBSM can specifically decrease HIV/AIDS disease progression.

Stress is a central concept for understanding both life and evolution. All creatures face threats to homeostasis, which must be met with adaptive responses. Our future as individuals and as a species depends on our ability to adapt to potent stressors. At a societal level, we face a lack of institutional resources (e.g., inadequate health insurance), pestilence (e.g., HIV/AIDS), war, and international terrorism that has reached our shores. At an individual level, we live with the insecurities of our daily existence including job stress, marital stress, and unsafe schools and neighborhoods. These are not an entirely new condition as, in the last century alone, the world suffered from instances of mass starvation, genocide, revolutions, civil wars, major infectious disease epidemics, two world wars, and a pernicious cold war that threatened the world order. Although we have chosen not to focus on these global threats in this paper, they do provide the backdrop for our consideration of the relationship between stress and health.

A widely used definition of stressful situations is one in which the demands of the situation threaten to exceed the resources of the individual ( Lazarus & Folkman 1984 ). It is clear that all of us are exposed to stressful situations at the societal, community, and interpersonal level. How we meet these challenges will tell us about the health of our society and ourselves. Acute stress responses in young, healthy individuals may be adaptive and typically do not impose a health burden. Indeed, individuals who are optimistic and have good coping responses may benefit from such experiences and do well dealing with chronic stressors ( Garmezy 1991 , Glanz & Johnson 1999 ). In contrast, if stressors are too strong and too persistent in individuals who are biologically vulnerable because of age, genetic, or constitutional factors, stressors may lead to disease. This is particularly the case if the person has few psychosocial resources and poor coping skills. In this chapter, we have documented associations between stressors and disease and have described how endocrine-immune interactions appear to mediate the relationship. We have also described how psychosocial stressors influence mental health and how psychosocial treatments may ameliorate both mental and physical disorders. There is much we do not yet know about the relationship between stress and health, but scientific findings being made in the areas of cognitive-emotional psychology, molecular biology, neuroscience, clinical psychology, and medicine will undoubtedly lead to improved health outcomes.

ACKNOWLEDGMENTS

Preparation of this manuscript was supported by NIH grants P01-MH49548, P01- HL04726, T32-HL36588, R01-MH66697, and R01-AT02035. We thank Elizabeth Balbin, Adam Carrico, and Orit Weitzman for library research.

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Stress Research Paper

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Coping with Stress

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Get 10% off with 24start discount code, i. concept of coping, a. why is coping important for mental health, b. historical overview, ii. determinants of coping responses, a. personality characteristics as determinants of coping, b. situational specificity in coping, iii. ways of coping with stress, a. problem-focused coping, b. emotion-focused coping, 1. emotional expression, 2. seeking social support, 3. escape-avoidance, 4. positive illusion, 5. social comparison, c. relationship-focused coping, 1. empathic responding, 2. active engagement and protective buffering, iv. conclusion.

In common parlance, ‘‘coping’’ is often used to suggest that individuals are handling stress well or that they have the situation under control. However, most health psychologists who study stress and coping would define coping broadly to include all thoughts and behaviors that occur in response to a stressful experience, whether the person is handling the situation well or poorly. Coping includes what we do and think in response to a stressor, even if we are unaware of why or what we are doing. This broad definition is important for two reasons. First, if we limit the definition of coping to thoughts and behaviors that the individual purposefully and intentionally engages in as a way of handling the stressful situation, we may exclude a wide array of responses that typically remain outside of awareness. These can include, for example, believing in unrealistically positive illusions, escaping through the use of alcohol and other drugs, or fleeing from stress in one area of life (e.g., family) by immersing oneself in some unrelated activity (e.g., work). Second, this definition of coping does not assume a priori that some forms of coping are bad and others are good. All of the person’s responses to the stressor are considered coping, whether or not they help to resolve the situation. This is important, as in recent years researchers have found that many forms of coping that have traditionally been considered bad coping, such as escape-avoidance, may actually have beneficial effects when coping with certain types of stressors under specific circumstances.

Many disorders of mental health are either directly caused by stress or their expression is triggered by stress. In cases where a person is already experiencing poor health, stress can exacerbate and maintain the problems. However, there are wide individual differences in the effects of stress, and these are thought to be largely due to individual differences in coping with stress. Therefore, many health psychologists have turned their attention in recent years to trying to understand the antecedents and consequences of various ways of coping with stress.

In early models, certain forms of coping (and people who used them) were viewed as immature, dysfunctional, or maladaptive. Many emotion-focused strategies were not even considered forms of coping, but merely defenses. These models lost favor as evidence accumulated that many forms of coping previously assumed to be maladaptive could sometimes have positive effects, at least in certain circumstances. Researchers such as Lazarus conceptualized coping as a process in constant flux, responsive to changes in situational demands. The focus on situational factors as primary determinants of coping responses was welcomed as a correction of previous tendencies to treat coping in trait terms. Claims made by Mischel in 1968 that personality traits are poor predictors of behavior were also influential. Furthermore, the findings of a number of studies suggest that in general, situational factors play a larger role in determining responses to stress than do personality traits. Thus, earlier notions of rigid ‘‘styles’’ of coping have been replaced by an understanding that coping is best conceived in process terms. Given this new understanding of coping that emerged during the 1970s and 1980s, the role of personality in coping was given scant attention during those years. Recently, it has been acknowledged that although personality may not be the single most important determinant of coping responses to stress, its role is nonetheless quite important. In the past few years, health psychologists have again turned their attention to examining personality factors that might determine how people cope with stress. Currently, most researchers in the field would agree that how a person copes with stress will shift over time depending on an array of factors that can be broken down into two broad categories: person and situation.

Clinicians and researchers alike have examined the role of personality in coping in an attempt to predict and explain which individuals are at risk for experiencing psychological maladjustment. The underlying assumption is that personality can influence how one copes with stress, and coping determines whether stress will have deleterious effects on health and well-being. A consistent set of personality traits have emerged as significant predictors of the ways in which people cope and the impact coping has on their health. The following is a brief summary of the various personality traits that have been empirically related to coping.

The last 50 years have seen a growing interest in the role of personality as measured by the big five personality traits of neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. These five factors are believed by many personality researchers to be the five basic underlying dimensions of personality. Researchers have tended to find that neuroticism (the tendency to experience negative affect) is related to maladaptive coping efforts and poor psychological well-being. In comparison, researchers have tended to find that extraversion (the tendency to be gregarious and to experience positive affect) is related to adaptive coping and better psychological well-being. Individuals high on openness (the tendency to be creative and open to feelings and experiences) remain strong in the face of adversity and are more able to engage in coping that is sensitive to the needs of others. Given that two defining features of openness to experience are originality and creativity, future research may show individuals high on openness to be particularly effective and flexible copers. Those individuals high on agreeableness (the tendency to be good-natured) also appear to cope in an adaptive manner that is sensitive to the needs of others. Individuals high on agreeableness tend to engage in less negative interpersonal coping strategies (e.g., confronting others), more positive interpersonal coping (e.g., seeking social support), and lower levels of maladaptive emotion-focused coping (e.g., escape avoidance). Individuals high on agreeableness may seek to avoid additional conflict and distress when coping. Finally, those individuals high on conscientiousness (the tendency to be careful and reliable) have been found to engage in lower levels of maladaptive emotion-focused coping (e.g., escape avoidance) and higher use of problem-focused coping. Individuals high in conscientiousness may seek to engage in the most responsible and constructive forms of coping.

The way in which one anticipates future events has also been established to have an impact on well-being. The tendency to anticipate positive outcomes for the future is referred to as optimism. Carver, Scheier, and others have reported this trait to be associated with both adaptive coping and good mental health. High levels of optimism may lead to higher levels of constructive coping, which in turn reduce distress, making positive expectations highly adaptive. In contrast, pessimistic individuals (those who do not generally anticipate positive future outcomes) tend to use more maladaptive coping strategies, which in turn are related to higher levels of both anxiety and depression.

An internal locus of control (i.e., feeling a sense of personal control) over the events and experiences in one’s life is often positively related to psychological well-being, whereas an external sense of control (i.e., lacking a sense of personal control and feeling that control over events is external to oneself) is often negatively related to mental health criteria. Research examining locus of control as a stable personality trait has identified several ways in which this trait influences both coping and psychological adjustment. For example, studies have found that an internal locus of control is related to greater use of problem-focused coping. It appears that a belief in one’s ability to impact or change events is related to constructive attempts to alter or change aspects of the environment or oneself under times of duress. Given that such problem-focused coping efforts are generally associated with better psychological outcomes, at least when used with stressors that are controllable, an internal locus of control can have beneficial effects upon mental health.

Currently, there is much interest among researchers in studying the factors within a given situation that determine how an individual will cope, how the chosen coping strategies influence mental health, and how this process varies from situation to situation. In 1984, Lazarus and Folkman identified a number of dimensions of stressful situations that are important determinants of the stress and coping process. Novelty (has the individual coped with this type of stressor in the past?), predictability (are there signs that will alert an individual to the onset of the stressful event /situation?), event uncertainty (how likely is it that the situation will occur?), imminence (is the event likely to occur in the near future?), duration (how long will the experience last?), and temporal uncertainty (is it possible to identify whether the event will occur?) all impact affective, cognitive, and behavioral reactions to stress. That is, these situational factors play a role in determining the extent to which a person experiences a situation as stressful, and in turn, how he or she copes with the stressful situation.

Several researchers have conducted studies that explore a variety of situational determinants of coping. Consistent with the hypothesis that situational factors do influence the coping process, researchers have tended to find that different situations elicit different forms of coping, and similar situations elicit similar modes of coping. In addition, similar coping strategies have been found to have different effects across different situations, in that the effectiveness of any one coping strategy and its impact on well-being varies from situation to situation. This points to the importance of a match between a chosen coping strategy and the situationally specific demands of a stressor to maximize emotional adjustment and minimize ongoing struggles. Thus, the particular characteristics of a stressful situation determine both coping choice and coping effectiveness. For example, positive reappraisal is generally an effective coping strategy related to psychological well-being. However, in 1991, Wethington and Kessler noted that when the stressful situation calls for some form of action to be taken, the use of positive reappraisal alone is related to psychological maladjustment. Likewise, in 1994, Aldwin pointed out that emotion- focused coping is more effective when coping with a situation that is perceived as involving loss, whereas problem-focused coping is more effective when coping with a situation that is appraised as a threat or challenge. Therefore, one must be cautious in making generalizations about the relation of specific coping strategies to mental health, as this relation will vary according to the situational demands.

Empirical evidence supports the hypothesis that individuals will vary their coping efforts and choices systematically to fit a given stressor. General coping styles aggregated over time tend to be poorly correlated with the ways in which one copes in a specific situation. That is, researchers or clinicians cannot accurately predict how an individual will cope with any one specific stressor by relying on the average way in which the same individual copes across a variety of situations over time. To illustrate, an individual may engage in moderately high levels of a particular coping strategy over time but not use this particular strategy at all when coping with a certain type of stressor. Averaging coping responses across multiple situations, therefore, obscures important information about how coping is related to well-being under specific and well-defined circumstances.

Researchers such as Wethington and Kessler have identified several ways in which coping varies from situation to situation. First, the ways in which individuals cope with an acute but short-term stressor often differs from the ways in which they cope with an ongoing chronic stressor. Second, the ways in which individuals cope can also be influenced by the coping responses of others around them. Third, individuals tend to use different strategies depending on the role domain in which stress occurs. Fourth, situations are defined by a multitude of demands and therefore any one stressor may demand multiple coping strategies in order to be resolved effectively. Those with the highest psychological well-being may well be those individuals who can successfully engage in a variety of coping strategies. Rigid adherence to a small set of coping strategies geared toward direct resolution of the stressor, at the expense of those that might help to reduce stress-related negative emotions, could be maladaptive in many circumstances.

Researchers have begun to examine the ways in which situational factors interact with person factors in determining how people cope with stress. Existing evidence suggests that coping varies as a function of both the situation and the person. For example, in 1986, Parkes found that individuals low in neuroticism varied their use of direct action according to the level of work demands. In comparison, those individuals high in neuroticism did not vary their use of direct action in response to changing levels of work demands. Furthermore, although situational factors play a larger role overall in determining coping responses, the more ambiguous a stressful situation is, the greater the influence of person factors on the coping process.

Historically, coping has been seen as serving two basic functions: problem-focused (active attempts to alter and resolve the stressful situation) and emotion-focused (efforts to regulate one’s emotions). Recently, a third function that concerns relationship-focused coping (efforts to manage and maintain social relationships during stressful periods) has been studied as well.

Problem-focused coping includes those forms of coping that are geared directly toward solving the problem or changing the stressful situation. Most of the research examining problem-focused coping has been on planful problem-solving. Coping strategies based on planful problem-solving involve conscious attempts to determine and execute the most appropriate course of action needed to directly prevent, eliminate, or significantly improve a stressful situation. Making a plan of action and following it is an example of the sort of cool deliberate strategy that typifies this form of coping. Although the primary effect of problem-focused modes of coping is to change or eliminate the stressful environment, it is not unusual for such coping to result inadvertently in a reduction in negative affect and/or an increase in positive affect (e.g., devising and carrying out a plan to finish a task that one has felt pressured to complete). The increase in positive affect following the use of planful problem-solving may be the result of an improvement both in the way one perceives the stressful situation and in the direct changes in the stressful situation itself. In general, planful problem-solving tends to be associated with less negative emotion, more positive emotion, positive reappraisals of the stressful situation, and satisfactory outcomes.

Important moderators of this strategy and its influence on psychological well-being have been documented. First, it appears that individuals engage in a higher use of planful problem-solving when they perceive a situation or encounter as one in which something can be changed for the better. Furthermore, the use of this strategy in uncontrollable or unchangeable situations seems to have a negative impact on psychological health. It appears that pursuing a futile course of action can interfere with the adaptive function of accepting those things that cannot be changed or altered. Second, when a loved one has something to lose in a stressful situation, individuals tend to use lower amounts of planful problem-solving than when a loved one does not have something to lose. Individuals seem to experience difficulty formulating a plan of action when coping with the added emotional distress invoked by concern for a loved one’s well-being. Third, when the stress occurs at work, individuals tend to use higher levels of planful problem-solving. In this context, many forms of emotion-focused coping strategies may be viewed as ineffective and socially inappropriate.

In summary, in situations that require a course of action to minimize or reduce stress, the individual may be better off engaging in planful problem-solving efforts rather than in emotion-focused strategies such as denial. Such efforts will more likely improve the interactions between an individual and their environment, and have a positive impact on well-being.

Emotion-focused modes of coping include those forms of coping that are geared toward managing one’s emotions during stressful periods. A larger number of studies have examined emotion-focused modes of coping than either problem- or relationship-focused modes of coping. All of the many forms of emotion-focused coping that have been described in the literature cannot possibly be discussed here. Instead, we focus on those forms that have received the most attention in the scholarly literature.

Emotional expression is the active expression of one’s thoughts and feelings about an experience or event, and is a common way to cope with stress. The expression can take place through a variety of interpersonal, verbal, and artistic means, including talking or corresponding with someone, keeping a diary, and drawing or painting.

Pennebaker reviews the historical relation of emotional expression to mental health, as reflected in Maslow’s notion of self-expression and Freud’s concept of emotional catharsis. However, modern researchers studying this phenomenon have construed emotional expression as more than simply the venting of emotions. Pennebaker and his colleagues suggest that it is the active expression of both thoughts and feelings surrounding experiences that makes emotional expression a beneficial form of coping with stress. Pennebaker suggests that this expression can aid in deriving a sense of meaning, insight, and resolution by initiating a process in which facts, feelings, thoughts, and options can be organized effectively.

Pennebaker and colleagues have found across several studies that emotional expression is positively related to both psychological and physical well-being. These studies used a variety of modes of emotional expression, such as writing essays about one’s experiences, talking out loud into a tape recorder, or talking to another individual. In comparison, active inhibition (i.e., the deliberate and conscious nonexpression of one’s thoughts and feelings) has been found to be negatively related to psychological well-being. In addition, emotional expression that is inappropriately disclosing (e.g., telling a nonreceptive stranger), overly self-absorbed (i.e., disengaging and isolating the listener), overly intellectualized (i.e., lacking acknowledgment and expression of one’s feelings), or done in the presence of an unsupportive and critical person, is less likely to have beneficial effects.

There are individual differences in people’s ability and desire to engage in emotional expression. For example, some people tend to engage in high levels of emotional expression, whereas others do not. This area of research suggests that the degree of emotional expression may reflect a general personality trait. Gender differences in emotional expression have also been found as women tend to report higher levels of emotional expression than men.

There are a variety of contexts in which individuals coping with stress may engage in emotional expression. As Pennebaker points out, support groups, self-help programs (e.g., Alcoholics Anonymous), telephone crisis lines, psychotherapy, pastoral counseling, and even internet discussions all provide a context in which emotional expression is supported, if not actively encouraged. Evidence suggests that emotional expression has a disease-preventative effect.

Another common way of coping with stress is to seek some form of social support. The social support sought may be informational support (e.g., an individual recently diagnosed with HIV contacting a support group to find out more about the virus), tangible support (e.g., a grieving widow asking a friend to help baby-sit her children for an afternoon), or emotional support (e.g., a recently laid-off worker accepting sympathy and understanding from a friend). In general, higher levels of social support are associated with better psychological and physical well-being. However, the quality of available social support is more important to well-being than the absolute amount of available social support. To illustrate, an individual who has a few constructively supportive friends and family members may receive better social support and experience greater health benefits than an individual who has many friends and family members but who do not provide constructive social support. In this context, constructive social support consists of support provision that meets the needs of the individual seeking such support.

In 1988, Fisher and colleagues differentiated between solicited versus unsolicited social support. There are times when members of one’s social support network provide unsolicited social support. Unsolicited support tends to occur when the stressor is highly visible and there exist social norms as to how members of the social network should behave (e.g., a death in the family, loss of a child, dissolution of a marriage). However, individuals often have to cope with stressors that are not readily apparent to those around them. During such times, an individual must actively seek social support in order to receive it. Furthermore, a variety of factors seem to play a role in the extent to which individuals will seek social support as part of their coping with such stressors. For example, if individuals blame themselves for the occurrence of a stigmatizing stressor (e.g., contracting HIV after having unprotected sex), they may be less likely to seek social support because of the potential for embarrassment, stigmatization, judgment, and further blame. Given that nondisclosure of stressful experiences has been associated with threats to psychological well-being, not seeking social support may result in an increase risk for disorders of health and well-being.

Individuals may also resist seeking social support when the support available has the potential to add stress to an already stressful situation. Social support would be feared when the support provider delivers social support in an excessive or inappropriate manner. To illustrate, an individual suffering from a chronic, debilitating illness such as rheumatoid arthritis (RA) may avoid seeking social support if doing so threatens their independence (e.g., a support provider insists on doing everything for the individual with RA rather than simply facilitating the sufferer’s own coping efforts).

In addition, individual differences have been found in both the extent to which individuals will seek social support and the degree to which they perceive seeking social support to be an effective coping strategy. For example, Thoits, in 1991, found that women engage in higher levels of support seeking than men and perceive seeking social support as a more effective coping strategy than do men. Personality differences also influence the extent to which seeking social support is an effective coping strategy. Recent research has indicated that certain personality traits may explain some of the individual differences in the seeking and receiving of social support. To illustrate, individuals high in neuroticism may tend to elicit negative reactions from others when they seek social support, whereas individuals low in neuroticism may tend to elicit positive reactions. Therefore, different individuals may seek social support to varying degrees and invoke different reactions from others depending on their particular personality and interpersonal style. This suggests that the very individuals most likely to experience threats to their psychological well-being (e.g., those high in neuroticism) and therefore most in need of social support may be those individuals least likely to seek and receive social support in a way that is beneficial to their mental health.

There are times when individuals fail to cope actively with a stressful situation and instead engage in efforts to avoid confronting the stressor. Attempts at escape and avoidance can take a variety of cognitive or behavioral forms, such as wishful thinking, distancing, denial, or engaging in distracting activities. For example, an individual may attempt to repress thoughts of a recently deceased spouse as a cognitive means of escape-avoidance. Likewise, one could immerse oneself in cleaning the house as a way of avoiding a stressful task such as paying bills. As Aldwin noted, certain ways of coping can serve as avoidant coping strategies on one occasion despite serving as approach coping strategies on another. As an example, Aldwin suggests that cognitive reappraisal may function as a constructive approach strategy when used to view a stressful situation more positively and when acting as a catalyst for further action. Conversely, cognitive reappraisal may serve as an avoidant coping strategy when used to rationalize a lack of action or justify engaging in actions that lead to further avoidance (e.g., drinking to make oneself feel better).

Avoidant coping strategies are often a response to the negative affect that results from a stressful situation. For example, some individuals may initially deny that a stressful situation has occurred in an effort to minimize their distress (e.g., not accepting the possibility that a lump in one’s breast may be cancer). Researchers such as Lazarus have suggested that in the early stages of a stressor, such avoidant type strategies may be adaptive in that minimizing distress levels allows one time to adapt and to gather one’s resources. By decreasing levels of distress, short-term escape avoidance may increase one’s ability to engage in active problem-focused coping. Similarly, the use of escape- avoidance may minimize negative affect while one is waiting for a potentially short-term stressor to pass (e.g., reading a magazine to relieve anxiety while waiting to hear the results of an important medical test).

Despite the positive short-term effectiveness of escape- avoidance in reducing psychological distress, the long-term use of escape-avoidance is generally associated with lowered psychological well-being. For example, although distraction is useful when coping with short-term stressors (e.g., medical and dental procedures), long-term use of distraction with an ongoing stressor (e.g., coping with unemployment) is associated with maladjustment. The negative association between the use of escape-avoidance strategies and well-being may result from the lack of constructive action that the continued use of escape-avoidance can entail. That is, when avoiding thoughts or behaviors that are directed at a stressor, one also tends to avoid engaging in constructive efforts that could potentially reduce both the source and degree of one’s distress. In extreme situations, the use of prolonged escape-avoidance can backfire by amplifying a stressful situation and creating added emotional distress (e.g., avoiding obtaining medical attention until it is too late to receive basic treatment).

Historically, it has been assumed that reality-based perceptions are essential to the maintenance of mental health and psychological well-being. However, in 1988, Taylor and Brown suggested that ‘‘positive illusions’’ (i.e., unrealistically positive perceptions) are related to several common criteria of mental health, such as feelings of contentment and the ability to care for others. They argue that a positive misconstrual of experiences over time is beneficial to the psychological adjustment of the individual engaging in such perceptions. Research suggests that more positive views of the self are associated with lower levels of distress, and Taylor and Brown have argued that a relatively unbiased and balanced perception of the self tends to be related to higher levels of distress. Given that distress tends to be related to less constructive forms of coping, a positive view of the self may have beneficial effects through an increase in constructive coping efforts, even if the positive self-view is illusory. For example, individuals fighting life-threatening illnesses such as diabetes may perceive themselves to be higher in personal strength than others, which in turn may lead to more persistent and effective attempts to cope with their disease.

In a similar vein, Taylor reviews research that establishes a positive relation between illusory perceptions of control and mental health. For example, depressed individuals have been found to have perceptions of control closer to reality than nondepressed individuals. Research assessing control has also demonstrated that when coping with a stressful experience, those individuals who feel a greater sense of control will tend to experience better psychological well-being, even when the sense of control is overestimated. For example, a patient dying of AIDS may experience better psychological well-being by choosing to use alternative medicine, thus obtaining some sense of personal control over the treatment of a disease that remains incurable.

Various mechanisms may explain the relation between positive illusions and mental health when individuals are faced with coping with stress in their lives. For example, Taylor hypothesizes that positive illusions are related to positive mood, which in turn is related to social bonding, which in turn is related to higher levels of well-being. Given the adaptive role that constructive social support plays in the coping process, the potential ability of positive illusions to increase social bonding could be highly beneficial. Taylor also suggests that illusions may enhance creative functioning, motivation, persistence, and performance. Higher levels of all of these factors may lead to more effective coping and better well-being (e.g., higher levels of motivation and creativity could increase one’s ability to develop an unusual but highly effective coping strategy).

Recently it has been suggested that conclusions regarding the relation between positive illusions and mental health are an artifact of methodological problems inherent to this area of study. Specifically, Colvin, Block, and Funder, in 1991, argued that previous research has not used valid criteria for establishing objective reality. Without such criteria, it is difficult to verify which individuals are truly engaging in positive illusions. Therefore, conclusions regarding the relation between positive illusions and psychological adjustment may have been premature. These researchers found empirical evidence suggesting that positive illusions can have negative influences on both short-term and long-term mental health.

In 1954, Festinger suggested that individuals are driven to compare themselves to others as a means of obtaining information about oneself and the world during times of threat or ambiguity (i.e., stress). Although the patterns of findings are diverse and sometimes complex, most research in this field suggests that social comparison processes have important implications for psychological well-being. In fact, several researchers have proposed that social comparisons play a central role in the way in which people cope with stressful experiences. For example, social comparisons can help individuals evaluate their resources and provide information relevant to managing emotional reactions to stress. However, the underlying motivation and purpose that each individual has for engaging in this type of coping and the resultant psychological outcomes can be diverse.

In 1989, Wood described three classes of motivational factors that drive a person to engage in social comparisons: self-evaluation, self-improvement, and self-enhancement. All three purposes can be relevant to coping with stress and may aid the individual in striving toward an adaptive outcome. Self-evaluation motivations to engage in social comparison stem from an individual’s desire to obtain information regarding his or her standing on a particular skill or attribute. Self-improvement motivations to engage in social comparison suggest that individuals are interested in deriving information regarding another’s standing on a particular skill or attribute in order to improve their own standing on the same dimension. Self-enhancement motivations to engage in social comparison stem from a need to see oneself in a more positive manner; that is, the results of the social comparison are used to make one feel better about one’s own standing on a particular skill or attribute relative to others.

When an individual seeks a social comparison target as a means of coping with an ambiguous or threatening situation, several options are available. One can select an individual who has a higher or more positive standing than oneself on the dimension in question (i.e., an ‘‘upward social comparison’’). Alternatively, one can select an individual who has a lower or more negative standing than oneself on the relevant dimension (i.e., a ‘‘downward social comparison’’). Presumably, comparisons against others who differ from oneself produce distinctive and discriminating information that has immediate and practical implications for the individual when engaging in coping efforts.

In general, research suggests that when people engage in downward comparisons, they feel more positive and less negative about themselves than when they engage in upward comparisons. Individuals engaging in downward social comparisons because of self-enhancement motivations tend to experience reduced levels of negative affect and feel better about themselves in both field and experimental studies. For example, in their 1985 study of women coping with breast cancer, Wood and her colleagues found that downward comparisons appeared to help women feel better about how they were dealing with their illness by yielding positive evaluations relative to women who were not coping as effectively. However, research has also demonstrated that when individuals are motivated by self-improvement or self-evaluation needs, there is a clear preference for upward comparison information. Under these circumstances, comparisons may help determine what kinds of interventions or efforts are both possible and necessary to cope more effectively with a particular stressor.

Collins proposed in 1996 that the outcomes of social comparisons are not predetermined by the direction in which one makes a comparison. Instead, evidence supports the notion that both upward and downward comparisons can have both positive and negative impacts on psychological well-being. First, upward comparisons can generate negative psychological outcomes through a contrast effect (i.e., one feels inferior to the comparison target). Second, upward comparisons may also yield positive effects through the inspiration and hope they generate. These types of comparisons may be especially helpful for problem-solving activities, as they can provide constructive information that suggests specific coping strategies. Third, downward comparisons can lead to positive outcomes presumably because they allow one to focus on ways in which one is doing well relative to others. Such comparisons may be especially helpful in regulating negative emotions. Finally, downward comparisons can lead to negative outcomes from the fear that one will ‘‘sink’’ to the lower level of the comparison target at some future point in time. Such comparisons may have special significance for individuals coping with illness, where it is feasible that their disease will progress negatively. Given that both downward and upward comparisons contain both positive and negative information relevant to the self, the particular aspect the individual focuses on while coping will determine the valence of the outcome.

A growing number of moderating variables are being identified as important factors in determining the impact social comparison will have as a coping strategy during times of stress, threat, or ambiguity. For example, it appears that individuals with high self-esteem have a greater tendency to derive positive outcomes from either upward or downward social comparisons than individuals with low self-esteem. Other researchers have also noted the important role played by perceived control. Individuals with high degrees of perceived control over the dimension in question may be less likely to experience negative reactions to social comparisons in contrast to those with low levels of control. Individual differences in familiarity with a stressor may also moderate the process of social comparison. For example, an individual who has just discovered they have HIV (unfamiliar dimension)may select different comparison targets for coping than an individual who has been living with the illness for some time (familiar dimension). Presumably, the type of information one needs in order to adapt to threats will vary according to how long one has been dealing with the threat. In addition to individual differences, it appears that the situational context in which the social comparison process takes place is an important determinant of the impact of the comparison itself. For example, different contexts vary in terms of the potential social comparison targets they provide.

At times, individuals will actively self-select when to engage in social comparison and with whom they wish to compare themselves. However, as Collins noted, social comparisons can sometimes be forced on the individual. For example, researchers have found that someone who needs health care services for a serious condition may have no choice but to sit in a waiting room with other individuals who also have the same condition, making social comparisons unavoidable. Such comparisons most likely make it difficult for an individual to avoid the possibility that his or her own illness and condition could get worse. In addition, researchers have suggested that the impact of forced comparisons can be particularly aversive when the comparison target is someone with whom the individual is interdependent (e.g., close friend, co-worker). This suggests that individuals may sometimes have to cope with the stressful nature of the social comparison itself.

Regardless of whether or not one chooses to engage in social comparison, once the social comparison process is underway (i.e., target is compared against), there are some active strategies that individuals can use to maximize the probability of obtaining a positive outcome. First, peripheral dimensions can be used to moderate comparison outcomes. If a comparison produces an unfavorable outcome (e.g., an upward comparison that leaves one feeling inferior), one can always attribute the lower standing to differences between oneself and the target on other related variables (e.g., sex, ethnicity, duration of stressor). Alternatively, as previously discussed, individuals can actively distort information to maintain a more positive perception of reality.

In summary, social comparison processes provide valuable information that individuals can use for a variety of purposes when coping with stress, threat, or ambiguity. The target selected, the situation or context in which the comparison is made, and the unique traits of both the individual and the comparison target have an impact on the outcome of the comparison process. As a result, social comparison may have a positive impact on well-being for particular individuals in certain situations, and a negative impact on well-being for other individuals in different situations. Research has demonstrated the relevance of social comparison to coping with a variety of stressors such as illness and marital problems.

Relationship-focused coping refers to the various attempts made by the individual to manage, regulate, or preserve relationships when coping with stress. Recently, there has been growing interest in the interpersonal dimensions of coping as distinct from the intrapersonal dimensions of emotion- and problem-focused coping.

Empathic coping is one such form of relationship-focused coping. The use of empathy has been related to positive social behaviors such as providing social support and caring for others. Recently, O’Brien and DeLongis have suggested that empathic coping includes the following elements: (a) attempts to see the situation from another’s point of view, (b) efforts to experience personally the emotions felt by the other person, (c) attempts to read between the lines in order to decipher the meaning underlying the other person’s verbal and nonverbal behavior to reach a better understanding of the other person’s experience, (d) attempts to respond in a way that conveys sensitivity and understanding, and (e) efforts to validate and accept the person and their experience while avoiding passing judgment. One may engage in empathic coping either verbally (e.g., telling a spouse that you understand what they are feeling) or nonverbally (e.g., tenderly holding someone’s hand as they talk).

Empathic coping can play a significant role in coping with stress, particularly stress caused by interpersonal problems. Research suggests that empathic coping is related to a decrease in distress caused by interpersonal tension and an increase in relationship satisfaction. The increased understanding gained from empathic coping may result in more appropriate and well-considered coping choices that will maximize the benefits for all involved. Empathic coping may also lead to further benefits for psychological adjustment because of its impact on concurrent or subsequent use of problem- and emotion-focused coping. For example, in 1993, Kramer found that caregivers who engaged in empathic coping strategies were more likely to engage in planful problem-solving than caregivers who did not engage in empathic coping. The greater use of these strategies was related to greater caregiver satisfaction with the care-giving role. In the same study, lower use of empathic coping was related to more maladaptive emotion-focused coping efforts, which were in turn related to depression.

Individuals vary in how often and how effectively they use empathic coping. For example, O’Brien and DeLongis have found that when a close other is involved in a stressful situation, those high in neuroticism are less able to use empathic coping than are those low in neuroticism.

In addition to empathic coping, other forms of relationship- focused coping are also receiving attention. In 1991, Coyne and Smith identified active engagement (e.g., discussing the situation with involved others) and protective buffering (e.g., attempting to hide worries and concerns from involved others) as two forms of relationship-focused coping. They found that higher degrees of protective, relationship-focused coping (e.g., not conveying fears to one’s spouse) among wives of myocardial infarction patients was related to higher degrees of distress among the wives. Note that this is consistent with research suggesting that suppression of emotional expression is related to lowered psychological well-being. However, wives’ use of protective buffering was positively related to self-efficacy among their husbands. It appears that the wives were coping with the stress of their spouse’s illness in a way that maximized the benefits for their sick husbands (i.e., interpersonally adaptive) yet threatened their own well-being (i.e., intrapersonally maladaptive). Such results point to the need to include interpersonal dimensions of coping in addition to the traditional intrapsychic dimensions of coping in order to understand the relation of coping and health outcomes.

In conclusion, there is no one ‘‘good’’ way to cope with stress. Stress takes on many forms, and likewise, so must coping. The most adaptive way to cope with any given stressor depends on both the personality of the stressed individual and the characteristics of the stressful situation. Dimensions of the stressful situation that must be considered in determining the best way to cope with a given stressor include (a) whether others are involved in the situation, how they are coping, and the relationship of these people to the stressed individual; (b) the timing of the stressor and the degree to which it is anticipated or controllable; (c) the types of specific demands inherent to the stressful situation, the duration of such demands, and one’s prior experience with similar stressors; and (d) what is at stake in the stressful situation. Perhaps the key to good coping is flexibility. That is, the ability to vary one’s coping depending on the demands of the situation. What is clear is that no one form of coping will be effective in dealing with all stressors. There are times when attempts at problem-focused coping will be a waste of time and energy that could be better spent engaged in emotion- and relationship-focused coping. At other times, when something can be done directly to prevent or alter the stressful demands, energy may be better spent doing something concrete to solve the problem rather than concentrating on emotion management. Perhaps it is the wisdom to know the difference, and then to act on that knowledge, that is essential to successful coping.

Bibliography:

• Aldwin, C. (1994). Stress, coping, and development: An integrative perspective. New York: Guilford Press.
• Collins, R. (1996). For better or for worse: The impact of upward social comparison on self-evaluations. Psychological Bulletin, 119, 51–69.
• Eckenrode, J. (Ed.). (1991). The social context of coping. New York: Plenum Press.
• Gottlieb, B. (Ed.). (1997). Coping with chronic stress. New York: Plenum Press.
• Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.
• Goldberger, L., & Breznitz, S. (Eds.). (1993). Handbook of stress: Theoretical and clinical aspects. New York: Free Press.
• O’Brien, T. B., & DeLongis, A. (1996). The interactional context of problem-, emotion-, and relationship-focused coping: The role of the Big Five personality factors. Journal of Personality, 64, 775–813.
• Pennebaker, J. W. (1990). Opening up: The healing power of confiding in others. New York: William Morrow.
• Taylor, S. E. (1989). Positive illusions: Creative self-deception and the healthy mind. New York: Basic Books.
• Zeidner, M., & Endler, N. S. (Eds.). (1996). Handbook of coping: Theory, research, applications. New York: John Wiley & Sons.

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How to Write a Research Proposal: (with Examples & Templates)

Table of Contents

Before conducting a study, a research proposal should be created that outlines researchers’ plans and methodology and is submitted to the concerned evaluating organization or person. Creating a research proposal is an important step to ensure that researchers are on track and are moving forward as intended. A research proposal can be defined as a detailed plan or blueprint for the proposed research that you intend to undertake. It provides readers with a snapshot of your project by describing what you will investigate, why it is needed, and how you will conduct the research.  

Your research proposal should aim to explain to the readers why your research is relevant and original, that you understand the context and current scenario in the field, have the appropriate resources to conduct the research, and that the research is feasible given the usual constraints.  

This article will describe in detail the purpose and typical structure of a research proposal , along with examples and templates to help you ace this step in your research journey.  

What is a Research Proposal ?  

A research proposal¹ ,²  can be defined as a formal report that describes your proposed research, its objectives, methodology, implications, and other important details. Research proposals are the framework of your research and are used to obtain approvals or grants to conduct the study from various committees or organizations. Consequently, research proposals should convince readers of your study’s credibility, accuracy, achievability, practicality, and reproducibility.   

With research proposals , researchers usually aim to persuade the readers, funding agencies, educational institutions, and supervisors to approve the proposal. To achieve this, the report should be well structured with the objectives written in clear, understandable language devoid of jargon. A well-organized research proposal conveys to the readers or evaluators that the writer has thought out the research plan meticulously and has the resources to ensure timely completion.  

Purpose of Research Proposals  

A research proposal is a sales pitch and therefore should be detailed enough to convince your readers, who could be supervisors, ethics committees, universities, etc., that what you’re proposing has merit and is feasible . Research proposals can help students discuss their dissertation with their faculty or fulfill course requirements and also help researchers obtain funding. A well-structured proposal instills confidence among readers about your ability to conduct and complete the study as proposed.  

Research proposals can be written for several reasons:³  

• To describe the importance of research in the specific topic  
• Address any potential challenges you may encounter  
• Showcase knowledge in the field and your ability to conduct a study  
• Apply for a role at a research institute  
• Convince a research supervisor or university that your research can satisfy the requirements of a degree program  
• Highlight the importance of your research to organizations that may sponsor your project  
• Identify implications of your project and how it can benefit the audience  

What Goes in a Research Proposal?    

Research proposals should aim to answer the three basic questions—what, why, and how.  

The What question should be answered by describing the specific subject being researched. It should typically include the objectives, the cohort details, and the location or setting.  

The Why question should be answered by describing the existing scenario of the subject, listing unanswered questions, identifying gaps in the existing research, and describing how your study can address these gaps, along with the implications and significance.  

The How question should be answered by describing the proposed research methodology, data analysis tools expected to be used, and other details to describe your proposed methodology.   

Research Proposal Example  

Here is a research proposal sample template (with examples) from the University of Rochester Medical Center. 4 The sections in all research proposals are essentially the same although different terminology and other specific sections may be used depending on the subject.  

Structure of a Research Proposal  

If you want to know how to make a research proposal impactful, include the following components:¹  

1. Introduction  

This section provides a background of the study, including the research topic, what is already known about it and the gaps, and the significance of the proposed research.  

2. Literature review  

This section contains descriptions of all the previous relevant studies pertaining to the research topic. Every study cited should be described in a few sentences, starting with the general studies to the more specific ones. This section builds on the understanding gained by readers in the Introduction section and supports it by citing relevant prior literature, indicating to readers that you have thoroughly researched your subject.  

3. Objectives  

Once the background and gaps in the research topic have been established, authors must now state the aims of the research clearly. Hypotheses should be mentioned here. This section further helps readers understand what your study’s specific goals are.  

4. Research design and methodology  

Here, authors should clearly describe the methods they intend to use to achieve their proposed objectives. Important components of this section include the population and sample size, data collection and analysis methods and duration, statistical analysis software, measures to avoid bias (randomization, blinding), etc.  

5. Ethical considerations  

This refers to the protection of participants’ rights, such as the right to privacy, right to confidentiality, etc. Researchers need to obtain informed consent and institutional review approval by the required authorities and mention this clearly for transparency.  

6. Budget/funding  

Researchers should prepare their budget and include all expected expenditures. An additional allowance for contingencies such as delays should also be factored in.  

7. Appendices  

This section typically includes information that supports the research proposal and may include informed consent forms, questionnaires, participant information, measurement tools, etc.  

8. Citations  

Important Tips for Writing a Research Proposal  

Writing a research proposal begins much before the actual task of writing. Planning the research proposal structure and content is an important stage, which if done efficiently, can help you seamlessly transition into the writing stage. 3,5  

The Planning Stage  

• Manage your time efficiently. Plan to have the draft version ready at least two weeks before your deadline and the final version at least two to three days before the deadline.
• What is the primary objective of your research?  
• Will your research address any existing gap?  
• What is the impact of your proposed research?  
• Do people outside your field find your research applicable in other areas?  
• If your research is unsuccessful, would there still be other useful research outcomes?  

  The Writing Stage  

• Create an outline with main section headings that are typically used.  
• Focus only on writing and getting your points across without worrying about the format of the research proposal , grammar, punctuation, etc. These can be fixed during the subsequent passes. Add details to each section heading you created in the beginning.   
• Ensure your sentences are concise and use plain language. A research proposal usually contains about 2,000 to 4,000 words or four to seven pages.  
• Don’t use too many technical terms and abbreviations assuming that the readers would know them. Define the abbreviations and technical terms.  
• Ensure that the entire content is readable. Avoid using long paragraphs because they affect the continuity in reading. Break them into shorter paragraphs and introduce some white space for readability.  
• Focus on only the major research issues and cite sources accordingly. Don’t include generic information or their sources in the literature review.  
• Proofread your final document to ensure there are no grammatical errors so readers can enjoy a seamless, uninterrupted read.  
• Use academic, scholarly language because it brings formality into a document.  
• Ensure that your title is created using the keywords in the document and is neither too long and specific nor too short and general.  
• Cite all sources appropriately to avoid plagiarism.  
• Make sure that you follow guidelines, if provided. This includes rules as simple as using a specific font or a hyphen or en dash between numerical ranges.  
• Ensure that you’ve answered all questions requested by the evaluating authority.  

Key Takeaways   

Here’s a summary of the main points about research proposals discussed in the previous sections:  

• A research proposal is a document that outlines the details of a proposed study and is created by researchers to submit to evaluators who could be research institutions, universities, faculty, etc.  
• Research proposals are usually about 2,000-4,000 words long, but this depends on the evaluating authority’s guidelines.  
• A good research proposal ensures that you’ve done your background research and assessed the feasibility of the research.  
• Research proposals have the following main sections—introduction, literature review, objectives, methodology, ethical considerations, and budget.  

Frequently Asked Questions  

Q1. How is a research proposal evaluated?  

A1. In general, most evaluators, including universities, broadly use the following criteria to evaluate research proposals . 6  

• Significance —Does the research address any important subject or issue, which may or may not be specific to the evaluator or university?  
• Content and design —Is the proposed methodology appropriate to answer the research question? Are the objectives clear and well aligned with the proposed methodology?  
• Sample size and selection —Is the target population or cohort size clearly mentioned? Is the sampling process used to select participants randomized, appropriate, and free of bias?  
• Timing —Are the proposed data collection dates mentioned clearly? Is the project feasible given the specified resources and timeline?  
• Data management and dissemination —Who will have access to the data? What is the plan for data analysis?  

Q2. What is the difference between the Introduction and Literature Review sections in a research proposal ?  

A2. The Introduction or Background section in a research proposal sets the context of the study by describing the current scenario of the subject and identifying the gaps and need for the research. A Literature Review, on the other hand, provides references to all prior relevant literature to help corroborate the gaps identified and the research need.  

Q3. How long should a research proposal be?  

A3. Research proposal lengths vary with the evaluating authority like universities or committees and also the subject. Here’s a table that lists the typical research proposal lengths for a few universities.  

Q4. What are the common mistakes to avoid in a research proposal ?  

A4. Here are a few common mistakes that you must avoid while writing a research proposal . 7  

• No clear objectives: Objectives should be clear, specific, and measurable for the easy understanding among readers.  
• Incomplete or unconvincing background research: Background research usually includes a review of the current scenario of the particular industry and also a review of the previous literature on the subject. This helps readers understand your reasons for undertaking this research because you identified gaps in the existing research.  
• Overlooking project feasibility: The project scope and estimates should be realistic considering the resources and time available.   
• Neglecting the impact and significance of the study: In a research proposal , readers and evaluators look for the implications or significance of your research and how it contributes to the existing research. This information should always be included.  
• Unstructured format of a research proposal : A well-structured document gives confidence to evaluators that you have read the guidelines carefully and are well organized in your approach, consequently affirming that you will be able to undertake the research as mentioned in your proposal.  
• Ineffective writing style: The language used should be formal and grammatically correct. If required, editors could be consulted, including AI-based tools such as Paperpal , to refine the research proposal structure and language.  

Thus, a research proposal is an essential document that can help you promote your research and secure funds and grants for conducting your research. Consequently, it should be well written in clear language and include all essential details to convince the evaluators of your ability to conduct the research as proposed.  

This article has described all the important components of a research proposal and has also provided tips to improve your writing style. We hope all these tips will help you write a well-structured research proposal to ensure receipt of grants or any other purpose.  

References  

• Sudheesh K, Duggappa DR, Nethra SS. How to write a research proposal? Indian J Anaesth. 2016;60(9):631-634. Accessed July 15, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037942/  
• Writing research proposals. Harvard College Office of Undergraduate Research and Fellowships. Harvard University. Accessed July 14, 2024. https://uraf.harvard.edu/apply-opportunities/app-components/essays/research-proposals  
• What is a research proposal? Plus how to write one. Indeed website. Accessed July 17, 2024. https://www.indeed.com/career-advice/career-development/research-proposal  
• Research proposal template. University of Rochester Medical Center. Accessed July 16, 2024. https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/pediatrics/research/documents/Research-proposal-Template.pdf  
• Tips for successful proposal writing. Johns Hopkins University. Accessed July 17, 2024. https://research.jhu.edu/wp-content/uploads/2018/09/Tips-for-Successful-Proposal-Writing.pdf  
• Formal review of research proposals. Cornell University. Accessed July 18, 2024. https://irp.dpb.cornell.edu/surveys/survey-assessment-review-group/research-proposals  
• 7 Mistakes you must avoid in your research proposal. Aveksana (via LinkedIn). Accessed July 17, 2024. https://www.linkedin.com/pulse/7-mistakes-you-must-avoid-your-research-proposal-aveksana-cmtwf/  

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Even a joyous holiday season can cause stress for most Americans

• Marriage and Relationships

Nearly nine in 10 U.S. adults say something causes them stress during the holiday season

Washington — U.S. adults are feeling joyous but overwhelmed this holiday season, as nearly nine in 10 (89%) say that concerns such as not having enough money, missing loved ones and anticipating family conflict cause them stress at this time of year, according to the results of a new poll by the American Psychological Association.

While nearly half of U.S. adults (49%) would describe their stress levels during the traditional U.S. holiday season between November and January as “moderate,” around two in five (41%) said their stress increases during this time compared with other points in the year. While stress appears to be common at this time of year, 43% said that the stress of the holidays interferes with their ability to enjoy them and 36% said the holidays feel like a competition.

“The holiday season can be both a happy and stressful time of year in part due to expectations to spend time with family and friends, navigate family conflicts and uphold important traditions,” said Arthur C. Evans Jr., PhD, APA’s chief executive officer. “At this hectic time of year, it is important that people take care of their mental health, especially in communities whose members feel disproportionately burdened or excluded from what is traditionally considered the holiday season.”

The survey was conducted among 2,061 adults by The Harris Poll between Nov. 14 and 16, 2023.

Financial concerns were most often cited as a cause of stress during the holidays, with 58% of U.S. adults saying that spending too much or not having enough money to spend causes them stress. This was followed by finding the right gifts (40%) and the stress of missing family or loved ones during the holidays (38%). Households earning under $50K annually especially feel under pressure at this time of year and were more likely to rate their stress levels as high compared with households earning more than $100K annually (24% vs. 18%, respectively).

Those who celebrate traditionally Jewish or other non-Christian religious holidays reported additional sources of stress during these months. Roughly one in five adults who celebrate traditionally Jewish holidays (23%) and those who celebrate other non-Christian holidays (20%) said they experience stress because the holiday season doesn’t reflect their culture, religion or traditions, compared with 7% of adults who celebrate traditionally Christian holidays. They also said they do not feel a part of what is considered “the holiday season” in the U.S. (45% of those celebrating Jewish holidays and 57% other non-Christian holidays vs. 29% Christian holidays) and that they worry they may be discriminated against for their religion, traditions or culture at this time of year (42% and 55% vs. 13%, respectively).

The holiday season sparks conflicting feelings as over two in five U.S. adults (43%) would use both positive and negative words to describe the holidays, and 72% agree that the holiday season can feel bittersweet. Four in five adults (80%) would describe the holidays in positive terms such as fun (50%), joyous (49%), or exciting (45%), while 63% would use negative words such as stressful (40%), overwhelming or exhausting (34% each).

To manage the stress of the holiday season, nearly nine in 10 adults who reported experiencing stress at this time (88%) said they have coping mechanisms that help them handle it. A majority of adults who experience stress (70%) said they are comfortable talking with others about their stress during this time—although only 41% said they actually do so—while others focus on strategies such as managing their expectations (38%), reminding themselves that the season will pass (35%) or volunteering to help others (16%).

Fewer adults said they turn to negative or potentially harmful coping mechanisms during the holiday season. Close to two in five adults who experience stress during the holiday season (38%) said they use negative coping mechanisms such as isolating themselves (21%), changing their eating habits by overeating or restricting their diets (16%), or relying on substances such as alcohol or nicotine to feel better (13%).

Overall, though, a majority of U.S. adults agreed that the holiday season can be a positive experience. Nearly seven in 10 (69%) agreed that the stress surrounding the holidays is worth it, and 84% said the holiday season creates a sense of togetherness.

“Though the holidays may increase stress levels, they can also be an opportunity. Psychological science tells us that setting aside time to strengthen our relationships and engage in traditions can benefit our physical, mental and emotional well-being, which can prepare us to better manage stress year-round,” said Evans.

Methodology

This survey was conducted online within the United States by The Harris Poll on behalf of APA from Nov. 14–16, 2023, among 2,061 adults ages 18 and older. The sampling precision of Harris online polls is measured by using a Bayesian credible interval. For this study, the sample data is accurate to within + 2.7 percentage points using a 95% confidence level.

A full methodology and topline data are available (PDF, 93KB).

Sophie Bethune

(202) 336-6134

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