Abstract
School stress is something that affects all students, those who have mental illnesses and those who do not. This study was conducted to see how college students with no mental illness cope with school stress verses college students with Borderline Personality Disorder (BPD) cope with school stress, and if coping mechanisms make it easier to deal with stress or not. This study analyzed the use of coping mechanisms throughout first year college students by using self-report studies as well as emotion-focused and solution-focused therapies to see if the use would help them manage stress better. Results showed that those with BPD were able to cope with stress better, having already used these types of strategies, but there was an overall drop in school stress for most of the participants involved.
Introduction
While numerous studies have been done comparing stress and its effect it can have on people, there have not been studies showing how school stress can affect college students as well as people who have Borderline Personality Disorder. According to the National Institute of Mental Health, Borderline Personality Disorder is defined by an ongoing pattern of varying moods, self-image as well as varying behavior. Due to these symptoms, people who have BPD have problems with relationships and have impulsive actions. People with BPD may also experience intense episodes of depression, anger and anxiety that can last from a couple of hours to days (2017). School stress is something experienced by all college students, and this study was done to see if coping-skills would be beneficial to help combat school stress, and if students with BPD would have a higher correlation in effectively handling said stress.
Literature Review
Borderline Personality Disorder
According to the American Psychiatric Association, Borderline Personality Disorder (BPD) is a pattern of instability in personal relationships, intense emotions, poor self-image and impulsivity (2017). Someone with this disorder goes to extreme lengths to avoid feeling abandoned, have suicide ideations, have ongoing feelings of emptiness, and display inappropriate intense anger (Robitz, 2018). While no statistics show the exact amount of students in the United States with BPD – which could be due to data not being collected—a diagnostic interview data done by the National Comorbidity Study Republication (NCS-R) showed the past year prevalence of adults with BPD aged eighteen years and older was 1.4%.
Students in the United States in College
According to the National Center for Education, the number of students that were registered to attend colleges and universities in the United States for the fall of 2018 was 19.9 million (National Center for Education Statistics, 2018). According to research done by the American Psychological Association, one-third of first-year college students have symptoms that are consistent with a diagnosable mental health disorder, and while major depressive disorder was the most common, the second prevailing symptoms were in line with symptoms of generalized anxiety (Schulman, 2018). The impact and prevalence of adverse life events, specifically for college students was investigated to find correlation to reported stress levels (Smyth, 2008). Undergraduate college students with different events, specifically Post Traumatic Stress Disorder (PTSD) were monitored, as this happens to be a more serious symptom of a life event. Researchers wanted to know if findings would suggest more care needed for certain life stressors and also improve supportive services on college campuses (Smyth, 2008). The findings reported in this study showed that while students might not always report negative life events or self-identify, the potential benefits of this study can help college students with life stressors (Smyth, 2008).
Coping Skills
Coping skills that can be used to help manage feelings of stress can be generalized into two general categories, problem-focused coping and emotion-focused coping. A study was done that allowed university students to take a survey surrounding social and academic stressors, and see how peers dealt with said stressors (Earnest & Dwyer, 2010). The purpose of this study was to hopefully decrease stress and anticipatory stress future college students would have by teaching them about problem and emotion-focused coping. Furthermore, the study also hoped that by eliminating said stress, university retention rates would be higher. It was stated in this study that most college student retention issues arise from escape-avoidance strategy, which is a form of emotion-focused coping. An example of escape-avoidance would be if a student has a paper due, and instead of tackling this stressful task, students would participate in something less stressful, such as watching TV. This study showed future students how their peers handle such stressful situations, and techniques they used that helped them overcome stress. The results of this study showed that future students were likely to use the techniques their peers were practicing if a stressful situation was to emerge (Earnest & Dwyer, 2010).
Dialectical Behavior Therapy
While there are many coping skills for people with Borderline Personality Disorder (BPD) to use, a helpful type of therapy some therapists may try is Dialectical behavior therapy (DBT). DBT is therapy specifically used to help people with BPD address their behaviors and cope with emotion deregulation by using healthy and helpful skills to solve life problems. In addition to talking through problems, in DBT individuals are encouraged to actively change behavior associated with dysfunctional behaviors and self-monitor to intervene unhealthy thoughts and actions (Rizvi & Thomas, 2015). A study examined the effect DBT would have on college students who reported at least 1 non suicidal but harmful act or had a suicide attempt. College students also had to have met three or more of the BPD diagnostic criteria as defined in the DSM-5. Over 7-12 months this study was conducted, DBT was found as an effective treatment, and was useful for college students experiencing either BPD symptoms, or suicidal ideations (Pistorello, 2012).
Cognitive Behavioral Therapy
A meta-analytic evaluation examined which interventions were most helpful in decreasing stress in undergraduate and graduate students. While this specific study took place in the United States, other countries have done meta-analysis studies focusing on decreasing stress as well (Yusufov, 2018). This study focused on anxiety, but also perceived stress students may experience. The results from this study showed most of the interventions used in this experiment were effective in reducing perceived stress as well as depression. This analysis used several techniques, which included psychoeducation, relaxation training, cognitive behavioral therapy (CBT), social support, coping skills training, or mindfulness training. While the results showed that most of the interventions were effective, it should be noted interventions more effective in reducing perceived stress were CBT, social support and coping skills whereas mindfulness, relaxation training and psychoeducation were more effective in relieving anxiety (Yusufov, 2018).
Mindfulness Based Therapy
Another study looked at the correlation between Mindfulness Based therapy and depressed college students. While depression and stress are not always associated, diverse treatment options may be affective in helping alleviate many of the same symptoms associated with both Major Depressive Disorder (MDD) and stress, especially school related stress. In this study, Mindfulness Based Therapy (MBT) was the intervention used on depression symptoms and students were asked to refrain from other mindfulness practices, so researchers could freely gauge how well MBT was as a treatment without other strategies being used as well. After this study concluded the mass of the participants who originally met criteria for MDD no longer met the MDD diagnostic criteria. Knowing MBT can effectively reduce stress and depression is necessary in further studies on how college students, specifically those dealing with depression and stress can better cope (Clark, 2016).
Research Question
Are those with BPD symptoms more or less likely than college students who don’t have BPD symptoms to use coping skills in helpful ways when dealing with school stress?
Method
Study Design
This study took place over the place of participant’s freshman year of college, and was done in a pre and posttest format. Students were given self-questionnaires and surveys in the beginning of the school year and biweekly had to practice different coping mechanisms to see what was most effective in helping them deal with school related stress. Furthermore, participants were required to have written documentation monthly if they felt the coping mechanisms they were using was effective in relation to their school stress.
Study Participants
This study compared coping mechanisms of college freshman over their first year of school (fall to spring semester). Participants included one group of 352 students, diagnosed with Borderline Personality Disorder (BPD), for at least four years. The comparison group consisted of 364 students who have not been previously diagnosed with any mental illness, but who are also college freshman. The ages of both groups range from 18 to 21 and include both men and women. In the BPD group 150 of the participants were men while 202 were women. The reasoning for the disparity between the men and women population is due to there being more women diagnosed with BPD then men in this population. The comparison group however consisted of 222 women and 142 men. Fifty-three percent of both groups were Caucasian, while the remainders of the groups were minorities. Everyone who participated in this study had been given a discloser presentation on what this study entailed, could choose not to participate at any time, and were each given a written consent form to fill out.
Sampling Methods
To make sure there was not a biased sample of participants, some participants volunteered, and some participants had to participate due to requirements of their classes. To avoid the issue of confirmation bias, the participants completed the survey independently with no researchers in the room. Overall, 500 participants for each group were initially selected, but simple random sampling was used, and used computerized randomizers to choose 400 students from each group to participate. Computer randomized sampling was used so there was no researcher bias as to the population selected, and so there would not be a skew in results due to the participants selected. Due to participants who ended up dropping out before or during the study, there were a total of 352 participants in the BPD group and 364 in the comparison group. Furthermore, because this study was conducted to see how effective different coping skills are in relation to school stress, and the ultimate goal was to test specifically how those with BPD cope as well, there had to be use of purposive sampling (Morling, 2018) to make sure one of the groups only included students with BPD.
Study Procedures
This study involved emotion and solution focused coping, as well as other styles of coping, to see what would be most beneficial to helping students deal with school stress. Problem focused coping involves using constructive efforts about stressful conditions that can be challenging, harmful or threatening to an individual. Emotion focused coping involves working to regulate emotions experienced due to a stressful event. Emotional approach coping, which relates to emotion focused coping, involves focusing and working through emotions in response to dealing with stressors (Taylor, 2018). Procedures also include mindfulness therapy, which overall can improve quality of life, reduce anxiety and help improve coping. Mindfulness is also a type of coping skill used in DBT to help people with BPD. Mindfulness Based Stress Reduction (MBSR) is used to help people manage their reactions to stress, and hopefully approach stressful situations more attentively than automatically (Taylor, 2018). Questionnaires and self-surveys were given over the course of the year, to help monitor the participant’s self-perception of school stress, and how well they believed they were coping with the stress.
Study Materials
The goal of this study was to compare the coping skills of those with BPD to those with no mental illness in terms of dealing with school stress. To do so, participants were first given a Perceived Stress Scale (PSS). The PSS is an easy questionnaire for participants to fill out, asking ten questions about their thoughts and feelings over the past month (0 being never to 4 being very often), on how different things made them feel. Scores ranging from 0-13 were considered low stress, scores ranging from 14-26 were considered moderate stress, and scores of 27-40 were considered high-perceived stress (“Perceived Stress Scale”). At the end of each month, participants had to retake this study, to see if their perceived stress changed after each month.
Discussion
Expected Findings
College students with BPD symptoms differ from college students who don’t have BPD symptoms in the way in which they apply coping skills in stressful situations. These applied coping skills, learned in therapy, could provide an advantage or a disadvantage over those who have not been provided with this set of skills.
A positive correlation was found in the application of coping mechanisms related to school stress levels and college students affected by Borderline Personality Disorder (BPD) more so than when compared to students who are not affected by this illness. However, those not affected by BPD will still benefit from knowing these skills. While other research has not directly looked at the use of lowering stress of school by using coping skills this research has showed using certain techniques such as mindfulness, and problem-focused coping does have a positive affect on students ability to better cope with school stress. Mindfulness as well as physical practices such as yoga also have a positive impact on reducing stress, as they have been shown to reduce heart rate, muscle tension, anxiety as well as other physical and psychological benefits (Taylor, 2018). Solution-focused strategies such as also had a huge influence on lowering school related stress, as participants reported they were better able to handle certain stressors, by building on their strengths. Overall, using coping mechanisms will help relieve school based stress on those with BPD more, due to these participants practicing them in day to day living to help with other aspects of this illness. Additionally, participants not affected by BPD will have a positive result from use of these skills as well. However, since they will not practice them every day, and only use them when experiencing school stress, it will not be as effective.
Strengths and Limitations
Strengths of this study include the measurements used to gauge how participants felt in relation to stress of school. Other strengths include participant group size, and how participants were selected through the use of computerized random sampling. Strengths also included demographics of participants selected due to the fact they were all close in age, were all from the United States and were of varying races. Additionally, a strength to this study is that it possesses the characteristic of reliability, or consistency of measure. This is due to the fact that each participant was given the same survey questions and were provided with the same background knowledge as each other. Limitations of this study included only looking at stress participants experienced due to school. Only choosing to look at participants with BPD and participants that did not have any sort of illness also is a limitation experienced. Another limitation was the length of time it took for the study to be completed, including using a PSS as this is type of questionnaire will differ from person to person. Another reason the PSS would be considered a limitation is due to the fact that different school stressors could arise depending on what was going on during college at that time. At certain points, students would be taking finals and midterms, and this study also included the months students may have breaks such as winter break, or snow days. Other limitations include not taking into account other symptoms of BPD and how it could possibly affect the findings of this study, or skew the results of how BPD participants may have felt. Limitations include self-survey and questionnaires because participants have a biased self-concept, which could have skewed the validity of the study, because the study was solely based off of self-survey.
Implications of Results
This study was impactful to the psychology community because it looks at how beneficial coping skills can be overall, not just to those who experience illnesses. It was also important to show that much of the research done does not actually focus on people with BPD, and how while they experience the same stressors others do, research does not always show how to help cope with certain things they experience. Also, much of the research was in relation to that of traumatic stress and Posttraumatic Stress Disorder, not necessarily school stress, or generalized anxiety.
Future Direction
More studies should be done involving the community affected by BPD, and not only looking at how they are affected by school stress, but how other day to day activities affect them. Also, coping mechanisms have a healthy impact on everyone and research showing that everyone can benefit from it is also helpful, as it has been shown some stress may result in less retention in returning to college (Earnest & Dwyer, 2010). Future research would also be beneficial if questionnaires were more geared to school stress, and not just surrounding overall stress students may experience.
References
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Earnest, D. R., & Dwyer, W. O. (2010). In their own words: an online strategy for increasing stress-coping skills among college freshmen. College Student Journal, 44(4), 888+. Retrieved from http://link.galegroup.com.libproxy.temple.edu/apps/doc/A248733622/AONE?u=temple_main&sid=AONE&xid=ea50c80a
Morling, Beth. (2018). Research Methods in Psychology (3rd ed.). New York, NY
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National Institute of Mental Health. Borderline Personality Disorder. (2017, December). Retrieved from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml
Pistorello, J., Fruzzetti, A. E., MacLane, C., Gallop, R., & Iverson, K. M. (2012). Dialectical behavior therapy (DBT) applied to college students: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 80(6), 982–994. Retrieved From https://doi-org.libproxy.temple.edu/10.1037/a0029096
Rizvi, S.L., Thomas, M.C. (2015, September 2). Dialectical Behavior Therapy Retrieved From https://www-sciencedirect-com.libproxy.temple.edu/science/article/pii/B9780123970459000215
Robitz, Rachel, M.D. (November, 2018) What are Personality Disorders? American Psychiatric Association. Retrieved from https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders
State Of New Hampshire Employee Assistance Program. Perceived Stress Scale. Retrieved from https://das.nh.gov/wellness/docs/percieved%20stress%20scale.pdf
Shulman, Michael. (2018, September 13). One in Three College Freshmen Worldwide Reports Mental Health Disorder. Retrieved from https://www.apa.org/news/press/releases/2018/09/freshmen-mental-health.aspx
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