CALIFORNIA STATE UNIVERSITY, NORTHRIDGE

Stress and Coping Mechanisms Among College Students

A graduate project submitted in partial fulfillment of the requirements

For the degree of Master of Social Work

By

Joaquin Cornejo

May 2020

ii

The graduate project of Joaquin Cornejo is approved:

_______________________________________ ___________________

Dr. Alejandra Acuna Date

_______________________________________ ___________________

Dr. Jodi Brown Date

_______________________________________ ___________________

Dr. Hyun-Sun Park, Chair Date

California State University, Northridge

iii

Dedication

I would like to dedicate this paper to my fellow college students that are seeking higher

education while juggling different responsibilities in addition to life’s challenges. Like many

others I have experienced the stress that comes from working full time, attend school full time,

completing an internship, and managing different challenges life has in store for us. We must

remember the importance of self-care and self-love during our journey. These lessons will help

us help others.

iv

Table of Contents

Signature Page ii

Dedication iii

Abstract v

Introduction 1

Literature Review 3

Discussion 11

Limitations 13

References 14

v

Abstract

Stress and Coping Mechanisms Among College Students

By

Joaquin Cornejo

Master of Social Work

This research pursued the following question: Is there a relationship between self-

compassion and coping mechanisms for stress among college students? Stress is something that

college students face throughout their academic journey; however, this stress can be mitigated by

coping skills implemented by students. In this contribution, I present the results of a systematic

literature review on stress and coping mechanisms among college students to establish what

research has been conducted and to what extent there is evidence of the relationship of self-

compassion as a coping mechanism for stress among college students. The major topics

associated to stress and how college students cope with stress are stressors, maladaptive

behaviors, and coping mechanisms. Students experience numerous stressors that negatively

impact their learning capabilities and practice effectiveness (Adonizio, 2012). Countless

students have numerous role expectations and demands such as academics, internships, family,

friends, intimate relationships, work, and conflicting demands on time, all which increase stress

levels. In an effort to manage this stress, students either engage in maladaptive behaviors or

implement coping mechanisms. Self-compassion can be a valuable strategy for students to

practice to manage their stress. The purpose of this study is to assess if there is a relationship

between higher levels of self-compassion and college students’ coping skills when dealing with

stress.

viii

Keywords: Stress, college students, self-compassion, coping mechanism, well-being, and self-

acceptance.

1

Introduction

Stress is a common feeling experienced by individuals throughout life and it is imperative

to comprehend the manner in which they cope with their stressors. This is especially true for

college students. Due to the extensive academic demands college programs require from

students, learners experience high levels of stress while completing their degrees. These

increased levels can have a negative impact on students’ mental and physical wellbeing. Piko

(2000) identified that female college students reported greater psychosomatic symptomology,

increased psychological distress, and reduced perceived health status compared with their male

counterparts. How students are influenced by the stressors is dependent upon the student’s

healthy coping skills or maladaptive stress managing behaviors (Adonizio, 2012). Attending

college is a commitment that demands considerable time and energy from the student in order to

successfully complete a demanding workload (Lawson & Fuehrer, 2001). Coping strategies are

vital for students during their academic journey. Students must balance scholastic

responsibilities and their personal lives in addition to unanticipated stressors that life brings.

Chen, Wong, Ran, and Gipson (2009) found that the health of college students improved for

those who developed healthy coping skills. Furthermore, a first year student’s psychological

well-being can be improved by self-compassion (Gunnell, Mosewich, McEwen, Elkins, &

Crocker, 2017).

Purpose of the Study

The purpose of this study was to assess if there is a relationship between higher levels of

self-compassion and college students’ coping skills when dealing with stress. Countless students

have numerous role expectations and demands such as academic, internships, family, friends,

intimate relationships, work, and conflicting demands on time, which can increase stress levels.

2

Students experience numerous stressors that negatively impact their learning capabilities and

practice effectiveness (Adonizio, 2012). Self-compassion can be a valuable strategy for students

to practice. This research pursued the following question: Is there a relationship between self-

compassion and coping mechanisms for stress among college students.

Significance of project for social work

The results of this study can provide information for social work on a micro and macro

level. Starting with the micro level, a self-compassion approach can be introduced to college

students through seminars and trainings to discuss the importance of this practice. Numerous

studies have indicated that unmanaged stress can lead to physical, emotional, mental, and

behavioral problems. Therefore, self-compassion can provide learners with an additional healthy

coping strategy to manage stress. On a macro level, findings from this research could be used in

the adjustment of academic curriculum in colleges. Universities could incorporate a course or

mandatory training that addresses the importance of healthy coping skills and ways in which

individuals can self-manage stress, including, for instance, the need for self-compassion.

Intervention-style investigations of self-compassion and mindfulness have stressed that these

characteristics are teachable across a variety of contexts (Neely et al, 2009).

3

Literature Review

Student stressors

Stress is something that is a natural part of our lives, experienced in different ways and at

different points of our lives. This is particularly true for individuals attending college and,

unfortunately, not everybody copes with stress in healthy ways. College students experience

high levels of stress due to the demands placed upon them by their academics and other

responsibilities. According to Bouteyre, Maurel, and Bernaud, (2007) the typical stressful daily

challenges reported by college students were school-related, such as writing term papers, taking

tests, and the constant pressure of studying. For numerous students, the end results of these

stressors are elevated levels of anxiety and depression (Bouteyre, Maurel, & Bernaud, 2007).

Another component found to have a negative impact on college students was the increased risk

of social isolation for those who belong to one of the following groups: racial international

students, minority, and low socioeconomic status (Hefner & Eisenberg, 2009). There was a

correlation between social isolation and students with mental health problems, resulting in an

increase in stress levels (Hefner & Eisenberg, 2009).

Graduate students experience high levels of stress during their coursework and field

placement in graduate programs, which impact students in various aspects of their lives

(Adonizio, 2012). Graduate students described curriculum structure, financial responsibilities,

and professor teaching styles as rigorous demands in their program (Collins et al., 2010). Any

additional dissatisfaction is compounded with the need to meet with peers for a project, and/or to

meet with professors to address concerns.

The number of working students with additional responsibilities, such as significant

others and children, experience increased stress outside of their academic responsibilities. The

4

added stress from balancing work while tending to familial responsibilities increases the stress

faced by college students. Additional stress and demands to the student can negatively impact

relationships and can compromise the wellbeing of the students.

Single mother students

Many single parents, specifically mothers, enroll in higher education but often do not

graduate with a degree due to experiencing numerous difficulties (Goldrick & Sorensen, 2010).

Poverty, child care, and support systems are three significant areas affecting single moms, in

turn, creating stress for the student. Mothers in higher education are more susceptible to

experience hardships than male counterparts (Lynch, 2008) because of the difficulty in accessing

childcare while they attended school. Research shows that this factor alone plays a significant

difference in the mother’s level of persistence in completing their education. Single mothers are

often isolated and the lack of social support leads to mental and physical stress (Broussard,

Joseph, & Thompson, 2012). Poverty, childcare, and support systems all play a significant role

when a single mother decides to better her life by attending college.

Research suggests that having a strong family support system is one of the most

important factors to a single mother (Son & Bauer, 2010). Research has presented several

adaptive coping mechanisms used by single mothers, such as pets, exercise, internal strength,

resilience, humor, counseling, arts, and volunteering (Broussard, Joseph, & Thompson, 2012).

Furthermore, even though it is more difficult for single mothers than single fathers to further

their education, those with adequate support from friends and family are better able to cope with

their stress.

5

Mental health

Stress related disorders are prevalent among college students. According to Kessler et al.

(2005), the onset of most lifetime mental disorders occur during (or right before) the archetypal

collage age. These illnesses may be aggravated or triggered by the numerous stressors students

experience in their college life, which include, but are not limited to, changes in personal

relationships, irregular sleep patterns, and academic pressures (kadison, 2004).

According to Beiter et al. (2015), a recent study conducted by the Anxiety Association of

America stated that seven out of 10 adults in the United States claim to experience anxiety or

stress between a minimum and a moderate level on a daily basis. These mental illnesses are

more evident with college students. Additionally, students can also suffer from depression

which can negatively impact college students. According to Wolfram (2010), in the past 12

months in the United States, 10% of college students have been diagnosed or treated for

depression.

Though a better way of life and financial independence is something that our society

values, it also creates additional stress. Over the years, obtaining a college degree has gained

more notoriety as the way to improve one’s life and accomplish success, and as a result, many

students leave their home to obtain a secondary education. The transition itself can cause

depression, anxiety, and stress. Some of the symptoms students have experienced while

transitioning to a new school include appetite disturbance, depression, and concentration

problems (Price et al., 2007). Further, homesickness is a direct byproduct of moving to a

university far away from home. It is imperative that colleges and universities have the right staff

to provide support to students in need of assistance; however, education to manage mental health

6

should also be provided to students. According to Zhang et al (2016), self-compassion has been

increasing in recognition as a positive quality to facilitate mental wellbeing.

Maladaptive behavior

The negative symptoms accompanying anxiety, stress, and depression can be incredibly

debilitating, and it is vital to properly treat them in order to prevent negative behaviors. Doom

and Haeffel (2013) indicate the harmful behaviors students with depression can engage in, such

as smoking, lack of exercise, poor diet, and noncompliance with recommendations made by a

medical team as they develop and engage in maladaptive behaviors.

Many college students do not have the necessary tools to manage the stress in their lives,

and because of their inability to cope, students may turn to maladaptive behaviors such as

alcohol and drugs to alleviate the pressures they are experiencing. In addition to the different

stress students experience in college which can lead to substance abuse in an effort to cope with

the stress, peer pressure and the desire to belong are added components that may lead to

additional stress. As a result, students may engage in substance abuse and become dependent as

they develop maladaptive behaviors. Furthermore, during early college years, students tend to

experiment with substance abuse, which increases their susceptibility to engage in maladaptive

behaviors.

Cigarettes, alcohol, and illegal substances are not the only elements students abuse in an

effort to manage their stress. According to Hanson et al. (2013), students who try to manage

more than just their education, or face pressure to perform well in their academics, can at times

become susceptible to abusing other types of drugs, such as Adderall, in an effort to improve

concentration and mental alertness (DeSantis AD, Webb EM, and Noar SM, 2008). Some

students will abuse the ADHD drug for nonmedical use, as well (Hanson et al, 2008). According

7

to Teter CJ et al. (2005), the ADHD drug is used as an appetite suppressant or to counteract the

effects of other drugs.

What is self-compassion?

Neff (2003b) defined self-compassion as a healthy form of self-acceptance that includes

three components. The first is a tendency to treat oneself kindly in the face of perceived

insufficiency by engaging in self-soothing and positive self-talk. The second component involves

recognizing that one’s discomfort is an unavoidable part of the human experience. This

recognition of ‘‘common humanity’’ stimulates a sense of connection to others even in the face

of feelings of isolation and disappointment. Lastly, self-compassionate individuals are able to

face their own agonizing thoughts without evading or exaggerating them, and manage their

disillusionment and frustration by quelling self-pity and melodrama.

Self-compassion as a coping mechanisms

Coping skills can help individuals navigate through challenges brought on when

experiencing stress, and would help students to be self-reliant, solve problems, and make

informed choices which in turn promote their physical and psychological well-being. Students

should establish the efficacy of a stress coping program as a means for decreasing perceived

stress and increasing the proactive attitude towards stress. Furthermore, self-compassion was

also found to increase first year students’ psychological well-being (Gunnell, Mosewich,

McEwen, Eklund, & Crocker, 2017).

Trompetter, De Kleine, and Bohlmeijer (2016) found that self-compassion mediated the

negative relationship between positive mental health and psychopathology in college students.

Self-compassion can be a mechanism that enhances stress resiliency by promoting emotion

regulation in individuals (Trompetter et al., 2016), and can serve to decrease certain

8

psychopathology disorders, including depression, that affect individuals (Neff & Germer, 2013).

Beck, Verticchio, Seeman, Milliken, and Schaab (2017) found the overall stress level of college

students enrolled in various graduate programs decreased after completing various mindfulness

sessions. Mindfulness is an important component of self-compassion.

According to Neff & Germer (2013) self-compassion can aid to decrease certain

psychopathology disorders including depression among other mental health disorders that affect

many individuals in our society. Therefore, graduate students can struggle with various mental

health illnesses impacting their coping strategies for stress, consequently, self-compassion can

counter those challenges by becoming a protective factor (Neff & Germer, 2013).

Interventions of self-compassion and mindfulness have emphasized that these

characteristics are teachable across a variety of situations. For instance, Shapiro et al. (2005)

established that a two month course implementing mindfulness to reduce stress increased health

care workers’ self-compassion and decreased their reported stress. In the context of therapeutic

exercises, Neff et al. (2007a,b) found significant changes in undergraduates’ self-compassion

levels after they participated in a ‘‘Gestalt two-chair’’ exercise (Greenberg1983; Wagner-

Moore2004), which consisted of students voicing self-criticisms and receiving a counselor’s

guidance to answer self-disparaging statements. Results indicated that the intervention increased

students’ self-compassion scores even when initial anxiety was controlled. Moreover, the

improvement in individuals’ self-compassion was consistent for over a three week period of

time. In a controlled investigation containing counseling psychology graduate students, Shapiro

et al. (2007) sustained the notion that direct instruction in Mindfulness-Based Stress Reduction

(MBSR) techniques and practices significantly lowers individuals’ reports of stress, worry, and

anxiety. In contrast to students who did not participate in the 10 week course on MBSR,

9

participates yielded greater improvements across measures of affect, anxiety, stress, worry, and

mindfulness.

Model leading conceptualization

Bronfenbrenner’s (1979) ecological model explains the systems that impact students at a

micro, mezzo, and macro level. The micro system is the individual’s overall functioning; the

mezzo system consist of the groups influencing the individual; and the macro system is the

economic, social, and political conditions affecting the individual (Bronfenbrenner, 1994). Two

essential elements of this theory include: the interface where the exchange take place between

the individual and the social environment and the adaptation representing an individual’s ability

to acclimate to the bordering environments and coping in the manner individuals manage

stressful conditions (Bronfenbrenner, 1994).

Different systems interconnect with each other, consequently affecting the student in

multiple stages starting with the micro system when the individual interacts with the groups

surrounding them which includes of friends, family, and classmates (Bronfenbrenner, 1994).

Furthermore, the different clusters impact the student’s individual functioning if stressors are

present and the school demands impact the student’s academic responsibilities. Under the

ecological model, college students who possess higher levels of self-compassion would have a

superior ability to cope with stress due to the students possessing a healthy psychological well-

being.

Lastly, the ecological model considers all three different systems and how they influence

each other. Subsequently, when college students experience stressors from the micro, mezzo,

and macro systems their well-being and overall performance can be impacted (Bryce et al.,

2014). Therefore, the ecological model illustrates how college students are influenced by

10

different environmental factors impacting their coping skills with stress and their level of self-

compassion (Bronfenbrenner, 1994).

Limitations on current studies

Many studies have been conducted about the effects of self-compassion on a number of

individuals ranging from people with chronic illnesses, to persons with mental disorders to college

students. However, the majority of studies of self-compassion as a coping mechanism among

college students is limited to undergraduate students. A significant amount of the research is

preform with participants in their late teens and twenties which neglects an older population which

typically is also experiencing more stress due to added life responsibilities people acquire as they

get older. There is limited if any research available of studies with participants from online

programs. With the numerous online programs available to students who typically have a busy

schedules and as result attend online classes due to its flexibility in schedule to accommodate those

with demanding schedules. Additional, limitations result from selection of studies, choice of

relevant outcome, interpretation of heterogeneity, methods of analysis, and generalization and

application of results. Additionally, some of the studies also measured for other coping

mechanisms such as spirituality or religiosity in addition to self-compassion which may have

affected the results yielded. Lastly when the studies measured for stress levels they did not

measure how easily participants became stressed.

11

Discussion

This study sought to explore the relationship between higher levels of self-compassion

and college students’ coping skills when dealing with stress. It is vital to understand the

different ways students cope with the numerous stressors scholars face during their academic

career and the role self-compassion has in aiding them manage their responses due to the

potential effect this stressors can have on them. Students experience stress from their academic

responsibilities, work, family, friends, significant others, and internships. This stress can have a

negative impact on students’ mental and physical wellbeing. However, research indicates that

self-compassion can reduce the negative effects academic stress has on college student’s

performance and well-being. If students were to practice self-compassion to combat the negative

effects of stress an increase in the student’s wellbeing can be expected as well as a decrease of

maladaptive behaviors.

Students who practice self-compassion or any of its three main components experienced

increased levels of well-being. Furthermore, the implementation of self-kindness has

demonstrated to foster self-forgiveness and the ability to better manage the effects of stress. As a

result students can better cope with their deficiencies which as a result can decrease self-blame

and critical judgment. This research pursued the following question: Is there a relationship

between self-compassion and coping mechanisms for stress among college students.

The results of this study can provide information for social work on a micro and macro

level. Starting with the micro level, a self-compassion approach can be introduced to college

students through seminars and trainings to inform college students about this method. Numerous

studies have indicated that unmanaged stress can lead to physical, emotional, mental, and

behavioral problems to develop. Therefore, self-compassion can provide learners with an

12

additional healthy coping strategy. Additionally, for social work students that utilize self-

compassion as a coping mechanism they can continue to practice self-care by utilizing self-

compassion which would enable social workers once they are in the field to care for themselves

which would enable them to provide better care for others and teach them how to care for

themselves. On a macro level, findings from this research can result in the adjustment of

academic curriculum in colleges to incorporate a course or mandatory training addressing

healthy coping skills for stress which can include self-compassion. This study can inspire

departments at colleges to make the appropriate changes in their curriculum to incorporate self-

compassion courses for students. Intervention-style investigations of self-compassion and

mindfulness have stressed that these characteristics are teachable across a variety of contexts

(Neely et al, 2009).

13

Limitations

As with the majority of studies, the design of the current study is subject to limitations.

The quality of the review outcomes are dependent on the quality of the literature being reviewed.

The comprehensiveness of the literature search is also critical in the quality of the systematic

review. The heterogeneous nature of the study may have affected the review, perhaps if it would

have been a group more homogeneous the quality of the research would have improved. In

conclusion future research should implement a cross-sectional study seeking to explore the

relationship between stress and self-compassion as a coping mechanism among online MSW

students. This will provide a more distinct group of students from what previous research has

provided. Furthermore, it will be important to add a comparison group with the online students

to identify any differences between graduate programs. Future research can recruit a sample size

more than 100 participants in an effort to generalize the results to a larger population and

complete randomization for the participant selection.

The purpose of this study was to assess if there is a relationship between higher levels of

self-compassion and college students’ coping skills when dealing with stress. Countless students

have numerous role expectations and demands such as academic, internships, family, friends,

intimate relationships, work and conflicting demands on time, which can increase stress.

Students experience numerous stressors that negatively impact their learning capabilities and

practice effectiveness (Adonizio, 2012). The literature demonstrated that self-compassion can be

a valuable strategy for students to practice to manage their high levels of stress. This research

pursued the following question: Is there a relationship between self-compassion and coping

mechanisms for stress among college students

14

References

Akhtar, P., Yardi, S., & Akhtar, M. (2013). Effects of yoga on functional capacity and well-

being. International Journal of Yoga, 6(1), 76-79. 10.4103/0973-6131.105952

Annapoorna, K., & Latha, K. (2011). 252 effect of yoga therapy on psychological well-being

(subjective well being) and quality of life in common medical conditions. Asian Journal

of Psychiatry, 4, S59.

Atkinson, N., & Permuth-Levine, R. (2009). Benefits, barriers, and cues to action of yoga

practice: a focus group approach. American Journal of Health Behavior, 33(1), 3- 14.

Beiter, R., Nash, R., McCrady, M., Rhoades, D., Linscomb, M., Clarahan, M., & Sammut, S.

(2015). The prevalence and correlates of depression, anxiety, and stress in a sample of

college students. Journal of affective disorders, 173, 90-96.

Bronfenbrenner, U. (1979).The ecology of human development: Experiments by nature and

design. Cambridge, Massachusetts: Harvard University Press.

Bronfenbrenner, U. (1994). Ecological models of human development. Readings on the

development of children, 2(1), 37-43.

de Manincor, M., Bensoussan, A., Smith, V., Fahey, P., & Bourchier, S. (2015). Establishing

key components of yoga interventions for reducing depression and anxiety, and

improving well-being: A delphi method study. BMC Complementary and Alternative

Medicine, 15(1), 85-94.

DeSantis AD, Webb EM, Noar SM. Illicit use of prescription ADHD medications on a college

campus: a multi methodological approach. J Am Coll Health 2008; 57(3):315-324.

Doom, J.R., Haeffel, G.J., 2013. Teasing apart the effects of cognition, stress, and

depression on health. Am. J. Health Behav. 37, 610–619.

15

Dunn, K.D. (2009). The effectiveness of hatha yoga on symptoms of anxiety and related

vulnerabilities, mindfulness, and psychological wellbeing in female health care

employees (Order No. 3367062).

Greenberg, L. S. (1983). Toward a task analysis of conflict resolution in Gestalt therapy.

Psychotherapy: Theory, Research, and Practice, 20, 190–201.

Hanson, C. L., Burton, S. H., Giraud-Carrier, C., West, J. H., Barnes, M. D., & Hansen, B.

(2013). Tweaking and tweeting: exploring Twitter for nonmedical use of a

psychostimulant drug (Adderall) among college students. Journal of medical Internet

research, 15(4), e62.

Hartfiel, N., Havenhand, J., Clarke, G., & Krayer, A. (2011). The effectiveness of yoga for the

improvement of well-being and resilience to stress in the workplace. Scandinavian

Journal of Work, Environment & Health, 37(1), 70-76.

Holton, M., & Barry, A. (2014). Do side-effects/injuries from yoga practice result in

discontinued use? results of a national survey. International Journal of Yoga, 7(2), 152-

154.

Kadison, R. (2004, December 10). The mental-health crisis: What colleges must do. The

Chronicle of Higher Education, p. B20.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., &Walters, E. E. (2005).

Lifetime prevalence and age-of-onset distributions of DSM–IV disorders in the National

Comorbidity Survey Replication. Archives of General Psychiatry, 62,593–602.

Jadhave, S.G., & Havalappanavar, N.B. (2009). Effect of yoga intervention on anxiety and

subjective well-being. Journal of the Indian Academy of Applied Psychology, 35(1), 27-

31.

16

Moliver, N., Mika, E., Chartrand, M., Haussmann, R., & Khalsa, S. (2013). Yoga experience as

a predictor of psychological wellness in women over 45 years. International Journal of

Yoga, 6(1), 11-19.

Neely, M. E., Schallert, D. L., Mohammed, S. S., Roberts, R. M., & Chen, Y. J. (2009). Self-

kindness when facing stress: The role of self-compassion, goal regulation, and support in

college students’ well-being. Motivation and Emotion, 33(1), 88-97.

Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the

mindful self‐compassion program. Journal of Clinical Psychology, 69(1), 28-44.

Neff, K. D. (2003b). The development and validation of a scale to measure self-compassion. Self

and Identity, 2, 223–250.

Price, E.L., McLeod, P.J., Gleich, S.S., Hand, D., 2007. One-Year Prevalence Rates of Major

Depressive Disorder in First-Year University Students. 2007 40.

Rocha, K.K.F., Riberiro, A., Rocha, K.C.F., Sousa, M., Albuquerque, F. Ribeiro, S., & Silva, R.

(2011). Improvement in physiological and psychological parameters after 6 months of

yoga practice. Consciousness and Cognition, 21(1), 843-850.

Rubin, A., & Babbie, E. (2011). Research Methods for Social Work, 8th edition, Belmont,

CA: Thomson Brook/Cole.

Ryff, C.D. (1989). Happiness is everything, or is it? Explorations on the meaning of

psychological well-being. Journal Of Personality And Social Psychology, 57(6), 1069-

1081.

Ryff, C.D., & Keyes, C.M. (1995). The structure of psychological well-being revisited.

Journal of Personality And Social Psychology, 69(4), 719-727.

17

Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005).Mindfulness-based stress

reduction for health care professionals: Results from a randomized trial. International

Journal of Stress Management, 12, 164–176.

Smith, C., Hancock, H., Blake-Mortimer, J., & Eckert, K. (2007). A randomized comparative

trial of yoga and relaxation to reduce stress and anxiety. Complementary Therapies in

Medicine, 15(1), 77-83.

Teter CJ, McCabe SE, Cranford JA, Boyd CJ, Guthrie SK. Prevalence and motives for illicit use

of prescription stimulants in an undergraduate student sample. J Am Coll Health

2005; 53(6):253-262.

Wagner-Moore, L. E. (2004). Gestalt therapy: Past, present, theory, and research. Psychotherapy:

Theory, Research, Practice. Training (New York, NY), 41, 180–189.

Wolfram, R., 2010. Depression Care: Using the Chronic Care Model in a University Health

Center ([PowerPoint]). American College Health Association, Philadelphia, PA

⟨http://www.acha.org/AnnualMeeting/handouts10.cfm⟩.

Yadav, R., Magan, D., Mehta, M. & Mahapatra, S. (2012). A short-term, comprehensive, yoga-

based lifestyle intervention is efficacious in reducing anxiety, improving subjective well-

being and personality. International Journal of Yoga, 5(2), 134-139.

Zhang, Y., Luo, X., Che, X., & Duan, W. (2016). Protective effect of self-compassion to

emotional response among students with chronic academic stress. Frontiers in

psychology, 7, 1802.