CHAPTER II

REVIEW OF RELATED LITERATURES

(RRL) This chapter important for overview of the current knowledge on the topic. It provides

the investigator with a framework on which to build an appropriate hypothesis.

Foreign Literature

The benefits of Stress Management

There is considerable evidence that the stress inherent in health care negatively impacts

health care professionals. Stress can lead to increased depression (Tyssen, Vaglum, Gronvold, &

Ekeberg, 2001), decreased job satisfaction (Blegen, 1993; Flanagan & Flanagan, 2002),

disrupted personal relationships (Gallegos, Bettinardi-Angres, & Talbott, 1990), psychological

distress

(V. Jain, Lall, McLaughlin, & Johnson, 1996); and even suicide (Richings, Khara, & McDowell,

1986). Stress also may harm professional effectiveness: It decreases attention (Smith, 1990),

reduces concentration (Askenasy & Lewin, 1996), impinges on decision-making skills (Klein,

1996; Lehner, Seyed-Solorforough, O’Connor, Sak, & Mullin, 1997), and reduces providers’

abilities to establish strong relationships with patients (Pastore, Gambert, Plutchik, & Plutchik,

1995). Stress also may lead to increased burnout (Spickard, Gabbe, & Christensen, 2002),

defined as a syndrome of de-personalization, emotional exhaustion, and a sense of low personal

accomplishment. A recent study found that burnout was significantly associated with suboptimal

self-reported patient care (Shanafelt, Bradley, Wipf, & Back, 2002). Over a decade ago, the field

identified these problems and called for change, advocating better care for health professionals

(Butterfield, 1988). Despite this call for change, dissatisfaction and distress have continued to
increase. For example, a study of U.S. physicians showed a decline in satisfaction with every

aspect of their professional life from 1986 to 1997 (Murray et al., 2001). It is clear that health

care professionals need support in addressing the numerous stressors inherent in their work. The

current study attempted to address this need, by offering an intervention to health care

professionals to help cope with their considerable stress. The intervention was modeled after a

well-established, cost-effective stress reduction program, mindfulness-based stress reduction

(MBSR), developed by Kabat-Zinn and colleagues at the University of Massachusetts Medical

Center (Kabat-Zinn, 1982). MBSR is an educationally based program focusing on training in the

Eastern contemplative practice of mindfulness. Mindfulness is a form of meditation originally

derived from the Theravada tradition of Buddhism (Hanh, 1976). The 2,500-year-old practice

known as Vipassana was developed as a means to cultivate greater awareness and insight

(Goldstein, 1976). Mindfulness is often translated as “to see with discernment. The MBSR

intervention is designed to teach participants to become more aware of, and relate differently to

thoughts, feelings, and body sensations. MBSR helps participants cultivate a non-judging yet

discerning observation of all the stimuli that enter their field of awareness moment by moment.

Mindfulness practice allows for greater awareness of the “here and now,” as the practitioner

learns to let go of ruminations about the past and fears regarding the future. In this way,

practitioners learn to see their habitual reactions to stress and to cultivate healthier, more

adaptive ways of responding. The essence of mindfulness involves awareness and acceptance of

whatever is occurring in the present moment. Research demonstrates that mindfulness

interventions can effectively reduce stress, anxiety, and depression in both clinical and

nonclinical populations (Miller, Fletcher, & Kabat-Zinn, 1995; Shapiro, Schwartz, & Bonner,

1998). Further, research suggests that MBSR is an effective intervention for prevention of
relapse of major depression (Teasdale et al., 2000; Teasdale, Segal, & Williams, 1995). Evidence

also suggests that MBSR may be an effective intervention for psoriasis (Kabat-Zinn, Wheeler,

Light, & Cropley, 1998), chronic pain (Kabat-Zinn, 1982; Kabat-Zinn, Lipworth, & Burney,

1985), and fibromyalgia (Kaplan, Goldberg, & Galvin-Nadeau, 1993) and has been associated

with significant decreases in general medical symptomatology (Kabat-Zinn et al., 1992).

Specifically related to health care professionals, two previous studies have demonstrated the

beneficial effects of MBSR for medical students and prehealth students. In a randomized control

trial of MBSR for medical and premedical students, findings indicated significant decreases in

depression and anxiety and significant increases in empathy in the MBSR intervention group as

compared with controls (Shapiro, Schwartz, & Bonner, 1998). These findings were replicated in

a recent randomized controlled trial of prehealth students (S. Jain, Shapiro, Swanick, Bell, &

Schwartz, 2004). Although these studies contribute significantly to the literature on preparing

health care students in training, they do not directly test the effects of MBSR for health care

professionals actively engaged in clinical practice. The current study aimed to do this by

examining the effects of MBSR on job burnout and psychological distress in health care

professionals currently involved in clinical work.

Local Literature

Stress Management techniques that students can use

Stress, mental health problems and promotion, intervention, treatment, academic performance

and stress management techniques, methods and well-being. This paper deals with stress and its

biology, which is a major problem for students throughout the modern world. It outlines and

suggests stress management techniques, which are easy to practice for students and teachers even

during lessons, Japanese finger stress relief techniques and yoga panorama. Stress is a significant
problem of our times and affects both the physical and mental health of people. The main

objectives are to ascertain the extent to which stress affects students’ academic success and

health and to suggest some techniques and practice to cope with stress for students. Stress coping

methods are the physiological, cognitive, behavioral and psychological methods to deal with

stress. The main method used has been to gather and analyses the relevant data. For this purposes

questionnaire about stress were randomly distributed to different student groups mostly at three

Kazakhstani universities. The results obtained show that students need to be given effective

techniques to cope with stress while they are studying. After a thorough literature review in

major databases stress management techniques were identified and are presented and briefly

discussed here. Stress can be managed through the introduction of a stress management course

and engaging in extracurricular physical and mental activities. These techniques are easy to learn

and practice, with excellent results in individuals with sound health or even those with health

issues. They are beneficial and very helpful for both students and teachers. Stress is a reality of

everyday life. The term “stress” used first in physics in order to analyze the problem of how

man-made structures must be designed to carry heavy loads and resist deformation. With the

transition from physics to the behavioral sciences, the usage of the term “stress” changed.

According to Wheeler C. M. stress is a word of physics, which refers to the amount of force used

on an object and it relates in real life to how certain issues that carry force are applied to humans.

Examples like financial difficulties, health issues, personal conflicts and work issues all carry

force or pressure on a person's body, mind and spirit. Some of the pressures originate from the

environment but most often it emanates from within a person's head in the form of worry,

anxiousness, regret, discouragement and low confidence and self-esteem. This article uses the

term “stress” in the context of mental health. For roughly the last 50 years the term stress has
increasingly been used in the behavioral and health sciences. The accompanying social “theory”

explains observations about stress as an aspect of student life. Our findings about stress

confirmed, that Kazakhstani students at universities always experience a significant amount of

stress during their academic life and they need ways to help to cope with it. Undoubtedly, stress

has become the number one reported impediment to academic performance. A Publication of

New York University stated that 55% of students claimed their biggest stressor to be academic in

nature. 6 in 10 college students report having felt so stressed they could not do their studies on

one or more occasion. Stress is the process by which a person reacts when faced with external or

internal problems and challenges. “The organism processes numerous systems to coordinate such

adaptive responses both at systematic and cellular levels,” that means, stress has direct effects on

the brain and the whole anatomy of the body: failure to adapt to a stressful condition can result in

brain malfunctions, physiological problems and also areas of psychological challenges in the

form of depression, anxiety, pain and burnout. Additionally, many of the emotional and physical

symptoms that occur commonly in the student population, such as headaches, fatigue,

depression, anxiety, and the inability to cope, can be attributed to or exacerbated by stress.

Surveys conducted by Kansas State University reveal a 58% increase in stress-related mental

health issues reported to campus counselor between 1988 and 2001. These increased stress loads

come with some dire consequences. Suicide rates among college-aged students are three times

higher than they were in 1950, as described by American College Health Association statistics

published in Psychology Today (Retrieved on March 10, 2016). (Kassymova, 2018).

 CHAPTER III

METHODOLOGY

This chapter describes the research method and procedure, techniques and sources of data

that helped the researcher for further data gatherings. It includes the research design, respondents

of the study, research instrument and data gathering process, data analysis procedure, and ethical

considerations.

Research Design