Stress Management Group Proposal

Running head: STRESS MANAGEMENT STUDENTS 1

Stress Management Group Proposal for Undergraduate & Graduate Students

Keith W. Sun

Regent University

STRESS MANAGEMENT STUDENTS 2

Stress Management Group Proposal for Undergraduate & Graduate Students

Purpose

This program is designed to function as a short-term therapeutic group environment for

students, both undergraduate- and graduate-level, to learn how to improve stress management.

During this process, students will become self-aware of personal factors that contribute to their

unhealthy levels of stress and/or inability to manage stress effectively.

Population

The group focuses on students at the undergraduate-level or graduate-level, including

both part-time and full-time students. These students may be attending community college,

vocational schools, or universities. The students will include both genders, male and female.

Students will have reached, at minimum, the age of 18 with no maximum age limit. Students

may join on a voluntary basis or be referred from counseling centers on their respective

campuses.

Rationale

Students encounter multiple stressors during their academic years that create challenges

not only to their academic success, but also to their mental health and their ability to cope well

with many dimensions of life, including relationships, spirituality, finances, family, and

vocation. A large proportion of students across the United States confess feeling overwhelmed

and having to endure stress on a regular basis (“1 in 5 undergrads is constantly stressed,” 2008).

The college years, especially, are a time of major adjustment to full adulthood with new

responsibilities and expectations. Given a stressful environment, students make themselves prone

to a variety of mental disorders including depression, anxiety, substance abuse, and eating

disorders (“Stress and the College Student,” n.d.). Common stressors include academic demands,


financial pressures, decision-making, preparation for life after graduation, distance from home,

and personal identity development (“Stress and the College Student,” n.d.).

This population requires special consideration because of their lack of awareness of

mental health services and their potential precipitation of mental disorders. University students

who struggle with stress utilize counseling services at low rates, after many surveys have

indicated (“1 in 5 undergrads is constantly stressed,” 2008). This strongly indicates many

students whose stress demands remain harmful with inadequate treatment. Also, scientific

evidence strongly links chronic stress with higher risk for mental health problems in the future

(Sanders, 2014). By helping students manage stress to minimal levels, they will maintain

stronger states of mental and emotional health over the course of their lifetime.

Group approach is a much more viable form of treatment than individual for students on

the topic of stress management because of the solidary it provides as well as the possible stress

relief that may come from being surrounded by other students who want the same goal – good

stress management skills. Talking with supportive friends or peers can be extremely beneficial

and conducive to relaxation and greater coping ability (“Managing stress,” n.d.). Also, forming

healthy relationships is key to maintaining healthy stress levels (“Stress and the College

Student,” n.d.). In a group therapy environment, students experiment in initiating and building

healthy relationships while gaining confidence and efficacy in managing stress.

Theoretical Approach

The group leader will use primarily cognitive behavior therapy (CBT) approaches with

students for therapeutic outcomes. A positive and helpful attitude towards self and circumstances

demonstrates decreased stress levels (“Managing stress,” n.d.). Often, negative self-talk distorts a

student’s perception of a life circumstance, promoting a stress reaction (Scott, 2014). By


addressing those irrational, negative beliefs about oneself and circumstances outside oneself,

students can quickly gain traction in reducing general stress. This CBT technique of positive

self-talk proves useful in many campus stress management groups (“Stress management,” 2007).

In addition, in a group setting that plans to meet for eight weeks at the most, cognitive behavior

therapy functions well as a quick, short-term approach that maximizes benefits and solves

problems (Scott, 2014). When combined with mindfulness and relaxation techniques, CBT

increases its effectiveness in helping stressed students.

Recruitment

Given the group’s target population of university-level students, the recruitment will

primarily take place in university settings. The group leader and assistant leaders will visit

multiple university housing areas to present on the benefits of the group to students, as well as

make presentations at the campus counseling center and for many student organizations who

share interest in promoting stress management for their members. Also, leaders will put up flyers

and posters on bulletin boards in academic buildings where there is high student traffic. Because

most universities have a student services department, the leaders will arrange meetings with

school counselors to discuss potential candidates who may benefit from such a group. In

addition, leaders will provide contact information and informational resources via flyers as well

at the student support services departments.

Outside of the university setting, group leaders also will post flyers at local cafes, public

libraries, and community mental health agencies. Students highly frequent these locales and are

likely to notice information promoting this stress management group.

Screening


Interested students will fill in two assessment forms to determine level of stress and need

for this group. The first assessment form will be the Holmes-Rahe Stress Inventory (see

Appendix). This form seeks to ascertain what stressors are currently present in a student’s life

(Holmes-Rahe Stress Inventory, n.d.). Examples include death of a close family member, a major

change in financial state, and a change in residence. The second assessment form will be the

College Stress Test (see Appendix). This second form similarly determines what stressors are

present in a student’s life that fit the college lifestyle (College-Stress Test, n.d.). These two

assessments hope to help the group leader(s) to understand the main sources of stress for students

admitted into the group, and to narrow the focus for managing stress to those specific areas.

In addition to the screening forms, the group leader(s) will interview each potential

candidate individually. The interview will consist of informal questions that seek to get to know

the general issue with stress the student candidate is currently undergoing. Also, the interview

will provide an opportunity for the student to ask questions regarding the group, as well as for

him/her to sign a contract of commitment to the group, understanding its duration of time, its

expectations for confidentiality and active participation.

Exclusion criteria for students is as follows: below score of 150 on Holmes-Rahe Stress

Inventory, under 1300 for College Stress Test, and/or leader judgment for incompatibility with

group (e.g. inability to commit to full 8 weeks, unwillingness to abide by group policies, and

mental instability with possible suicidal ideation).

Structure

The group will take place on Thursday evenings from 5:00 PM to 6:30 PM for eight

consecutive weeks. The format for the group will be closed. Once screened, no new members

will join the group until a new group forms after the current one is completed. The size of the


group will require a minimum of 6 members and not exceed a maximum of 10 members, not

including the group leader(s). Possibilities for the group will be a mental health agency

conference room or office, a church classroom, or a small university classroom, most central to

the current residences of students admitted into group.

Pre and Post Group Meetings

Pre-Group Meetings for group leaders will be scheduled for the preceding Wednesday

evening of each week that the group meets, at the same time of day, 5 PM, for at least an hour, at

the same location for group meetings. These Pre-Group Meetings serve the purpose of preparing

the group leader(s) with understanding of the lesson plan, as well as rehearsing the activities and

potential questions to ask students. In addition, the Pre-Group Meetings assist the group leader(s)

in determining specific leader roles during the group.

Post-Group Meetings for group leaders will be scheduled for Thursdays of each week

that the group meets, from 6:45 PM to 7:30 PM in the evenings. These Post-Group Meetings

serve to have the group leader(s) reflect on the work done during group, and on assessment of

each individual student’s status and progress. Topics for discussion include: areas for

improvement, affirmations, and possible revisions to group curriculum for future groups.

Goals

The group leader(s)’(s) goals for the group are reduction of stress symptoms, increased

self-awareness of students’ sources of stress, and development of stress management skills that

are lacking for each student in specific areas. The group leader will also require students to write

down their own goals as a personal statement to oneself with handwritten signature.

Ground Rules/Norms

1. Students will not talk when someone else is speaking.


2. All discussion during group meeting will remain confidential, as signed on initial

contract. Confidentiality means students will not divulge names of other participants nor

details of information shared. Students may talk, in a general sense, about they have

learned about themselves.

3. Students will attend meetings on time, and if an emergency occurs, will notify the group

leader(s) at least 24 hours ahead of time.

4. Students are encouraged to speak openly and participate as actively in the discussion and

activities for maximum benefit from the group.

5. Group leaders are not here to solve students’ problems, but are here to empower students

to achieve individualized stress management goals. Group leaders are not experts and

also are learning to improve stress management skills as well.

6. Enjoy the experience, and students are encouraged to keep in contact with leaders and

fellow students throughout the week, and even after the group finish its eight-week

length.

Ethical Issues

Multiple ethical issues exist when the group leaders establish a stress management

therapy group. First, because these students are at least 18 years of age, the group does not

require parental permission for any participation from the students. As legal adults, the

participants are completely within their own rights to sign any contractual policy for the group

proposed. Second, as discussed in the Screening section previously, the group leader will screen

prospective members to make sure they are compatible with the goals of the group and will not

be an impediment to the work of the group process (American Counseling Association, 2014,

A.9.a.). By providing a minimum of criteria for participation in the group, the group leader


maximizes the therapeutic benefits of the group for all students participating in its process. Third,

in a group counseling setting, confidentiality and informed consent are necessary topics of

discussion for group leaders with group participants. The group leader must explain the

boundaries of confidentiality for the group ahead of time, or by the end of the first session

(American Counseling Association, 2014, B.4.a.). As for informed consent, the group leader

expects to abide fully to federal and state laws in this area (ACA, 2014, B.5.a.). Students have

the right to access current leader notes on their individual file, as well as to expect privacy with

any discussion for group purposes only, unless an emergency situation precludes it (ACA, 2014,

B.7.a.). An emergency situation includes potential harm to oneself or others (ACA, 2014,

B.1.d.). For all other potential ethical dilemmas, the group leader shall refer to the most current

Code of Ethics by the American Counseling Association for guidance.

Multicultural Issues

In a stress management group, a main multicultural issue is the varied cultural

perspectives on expressing symptoms of stress. The issue of self-disclosure about the extent of

stress may differ from a person of one ethnic background to a person of another ethnic

background. The group leader will briefly discuss at the first meeting the need to respect

different cultures in the room and for participants to disclose in the most culturally appropriate

manner.

Recognizing that university settings are highly likely to be composed of many cultural

backgrounds amongst students, the group leader will seek to address each student’s

understanding of reacting to stress from their cultural background. The group leader may ask

each student to explain how people in his/her culture interpret the type of stress the student is

currently undergoing. In addition to ethnic differences, the group leader will also discuss


international differences, given the scenario of the participation of international students studying

in the U.S. By being upfront about the cultural diversity in the group, student participants will be

more attuned and aware to potential misunderstandings of each other and will be better equipped

to understand themselves and each other.

Other multicultural issues will arise that cannot be foreseen in this proposal but group

leaders are bound to the most contemporary Code of Ethics of the American Counseling

Association and will need to have demonstrated a minimal degree of multicultural competence

before being eligible to lead the group.

Group Leadership

Group leaders must have training in school counseling and experience working with

students at the university level. This provides a threshold level of competence to be necessarily

effective for the therapeutic goals of the group. Characteristics of a qualified group leader

include: 1) empathy, 2) evidence of continued supervision by another counselor, 3) cultural

competence, 4) emotional stamina, and 5) evidence of self-care. The theoretical model for the

stress management group is a cognitive-behavioral approach; therefore, the group leader will

take on an active, directive role with the students as well as provide some psychoeducation on

stress management techniques and skills.

Risks and Benefits

A potential risk in a group setting is that participants will not get the full attention in

individual therapy for their stress concerns, and may perceive their needs as inadequately

addressed in an eight-week long period. Another risk inherent in the group process is the lack of

trust and group chemistry between participants, which may lead to minimal self-disclosure and

minimal therapeutic effect for everyone. A third risk is the chance of inappropriate therapeutic


theory for certain participants. Not every participant in the group will be receptive and

responsive to the cognitive-behavioral approach. Some resistance can be expected.

Potential benefits include the supportive communal system of students in solidarity over

stress, breakthroughs in therapeutic hindrances through the presence and actions of others, the

equipping of students with applicable stress management skills beyond the academic world, and

the open realization and motivation of students to continue therapy if needed, after group

termination, on an individual basis. Primarily the benefits of the stress management group stem

from the communally supportive atmosphere inherent in its structure.

Evaluation

In order to determine the efficacy of the group, the group leader will disburse an

evaluation form (see Appendix) to group participants at the eighth and final meeting. The

evaluation will focus on a 1-5 scale rating of the group leaders, the effectiveness of presentation

of sessions, personal gain from the group, and comments for constructive feedback. “1” will

represent Poor and “5” will represent Excellent. The form will also include space for details

regarding personal therapeutic benefits from participants. Future group leaders may seek

permission from participants for anonymous disclosure of their success in the group for public

marketing purposes.

Group Sessions

1. Session One

a. Goal – Set group expectations. Introduce the concept and definition of stress, and the

need for stress management.

b. Potential problem – Discomfort with participant disclosure at the first meeting

c. Potential strength – Beginnings of development of trust between participants


d. Discussion Topics – Definition of stress, definition of stress management

e. Activities/Techniques – Presentation of problem by all participants, Psychoeducation

2. Session Two

a. Goal – Identify sources of stress. Explore the effects of stress.

b. Potential problems – Multicultural differences in stress symptomology

c. Potential strength – Increased self-awareness of the consequences of stress unique to

each participant

d. Activities/Techniques – Presentation of personal sources of stress by all participants,

Psychoeducation

3. Session Three

a. Goal – Introduce the concept of negative self-talk. Explain the connection between

thoughts, feelings, & behaviors according to the cognitive-behavior model.

b. Potential problem – Lack of receptivity to cognitive-behavioral model of therapy

c. Potential strength – Increased rapport between members, Increased self-awareness of

d. Activities/Techniques – Identify automatic thoughts and emotions (Beck, 2011, pgs.

137, 159), Psychoeducation

4. Session Four

a. Goal – Introduce the concept of evaluating and responding to automatic thoughts.

b. Potential problem – Resistance to changing automatic thoughts, Lack of belief in the

need to change thoughts

c. Potential strength – Self-disclosure between members, Possibility of catharsis,

Helpfulness from other students in evaluating thoughts from a third-person

perspective


d. Activities/Techniques – Asking the evidence question, Asking the “alternative

explanation” question (Beck, 2011, pp. 172-173), Role-play, Homework,

Psychoeducation

5. Session Five

a. Goal – Identify and modify core beliefs.

b. Potential problem – Lack of readiness to go deeper into identity-related beliefs

c. Potential strength – Progress in building positive self-worth

d. Activities/Techniques – Restructuring Early Memories (Beck, 2011, p. 248),

Homework, Psychoeducation

6. Session Six

a. Goal – Begin teaching stress management skills. Teach participants relaxation and

mindfulness techniques.

b. Potential problem – Lack of closure in transition from automatic beliefs to skills

learning

c. Potential strength – Enthusiasm for more behavioral techniques

d. Activities/Techniques – Mindfulness & Relaxation Techniques (Beck, 2011, pp. 263-

264), Homework, Psychoeducation

7. Session Seven

a. Goal – Teach common ways to reduce stress. Help participants to adopt at least one

strategy of reducing stress.

b. Potential problem – Lack of follow-through from participants on stress reduction

strategy

c. Potential strength – Sense of empowerment happens for participants


d. Activities/Techniques – Psychoeducation, Open Discussion

8. Session Eight

a. Goal – Create effective closure. Summarize group work over the previous sessions.

Inform group about referral resources.

b. Potential problem – Unrealistic expectations for change from one group

c. Potential strength – New lifestyle applications

d. Activities/Techniques – Evaluation form, Feedback


References

American Counseling Association. (2014) Code of Ethics. Retrieved April 2, 2015 from

http://www.counseling.org

1 in 5 undergrads is constantly stressed. (2008, March 18). Retrieved April 2, 2015, from

http://www.nbcnews.com/id/23693229/ns/health-mental_health/t/undergrads-constantly-

stressed/#.VR2i6GOa-Sq

Beck, J. (2011). Cognitive-Behavior Therapy: Basics & Beyond. New York NY: The Guilford

Press.

College-Stress Test. Retrieved April 2, 2015 from

http://highered.mheducation.com/sites/0073382736/student_view0/health_psychology/

college_stress_test__/index.html

Holmes-Rahe Stress Inventory. Retrieved April 2, 2015 from

http://www.stress.org/holmes-rahe-stress-inventory/

Managing Stress. University Health Center, University of Georgia. Retrieved April 2, 2015, from

https://www.uhs.uga.edu/stress/wellnesslifestyle.html

Sanders, R. (2014, February 11). New evidence that chronic stress predisposes brain to mental

illness. UC Berkeley News Center.

Retrieved from http://newscenter.berkeley.edu/2014/02/11/chronic-stress-predisposes-

brain-to-mental-illness/

Scott, E. (2014, December 4). Cognitive Therapy for Stress Relief. Retrieved April 2, 2015 from

http://stress.about.com/od/professionalhelp/a/cognitive.htm

Stress and the College Student. (2004). Wellness Center, University of Illinois, Chicago.


Retrieved April 2, 2015 from https://www.uic.edu/depts/wellctr/docs/Stress%20and

%20the%20College%20Student.pdf

Stress management. Cal Poly Student Academic Services. Retrieved April 2, 2015 from

http://sas.calpoly.edu/asc/ssl/stressmanagement.html

Stress management. Counseling & Mental Health Center, The University of Texas at Austin.

(2007). Retrieved April 2, 2015 from

http://cmhc.utexas.edu/clearinghouse/files/TI050.pdf

Appendix


Evaluation Form

Rate the following on a scale from 1 to 5: 1 – Poor, 2 – Neutral, 3 – Fair, 4 – Good, 5 – Excellent

1. The group leader facilitated the sessions adequately and demonstrated effective

preparation, knowledge, and counseling skill.

1 2 3 4 5

Please comment:

2. The presentation of topics during group was easy to follow and helpful.

1 2 3 4 5

Please comment:

3. I gained a lot of skills in stress management and felt I learned a lot about who I am as a

person

1 2 3 4 5

Please comment:

Share any feedback you would consider helpful for group leaders for future stress management

groups. Comment:

Also, please share your own personal testimony of how this stress management group has been

helpful for you overall. Comment:


(http://www.stress.org/holmes-rahe-stress-inventory/)


)

College Stress Test

Please indicate whether you have experienced any of the following events in in the past year by

writing “yes” or “no”

__ Being raped

__ Finding out that you are HIV-positive

__ Being accused of rape

__ Death of a close friend

__ Death of a close family member

__ Contracting a sexually transmitted disease (other than AIDS)

__ Concerns about being pregnant

__ Finals week

__ Concerns about your partner being pregnant

__ Oversleeping for an exam

__ Flunking a class

__ Having a boyfriend or girlfriend cheat on you

__ Ending a steady dating relationship

__ Serious illness in a close friend or family member

__ Financial difficulties

__ Writing a major term paper

__ Being caught cheating on a test

__ Drunk driving

__ Sense of overload in school or work


__ Two exams in one day

__ Cheating on your boyfriend or girlfriend

__ Getting married

__ Negative consequences of drinking or drug use

__ Depression or crisis in your best friend

__ Difficulties with parents

__ Talking in front of class

__ Lack of sleep

__ Change in housing situation (hassles, moves)

__ Competing or performing in public

__ Getting into a physical fight

__ Difficulties with a roommate

__ Declaring a major or concerns about future plans

__ A class you hate

__ Drinking or use of drugs

__ Confrontations with professors

__ Starting a new semester

__ Going on a first date

__ Registration

__ Maintaining a steady dating relationship

__ Commuting to campus, or work, or both

__ Peer pressures

__ Being away from home for the first time


__ Getting sick

__ Concerns about your physical appearance

__ Getting straight A’s

__ A difficult class that you love

__ Making new friends: getting along with friends

__ Fraternity or sorority rush

__ Falling asleep in class

__ Attending an athletic event (e.g., football game)

http://highered.mheducation.com/sites/0073382736/student_view0/health_psychology/

college_stress_test__/index.html

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