Self-Care Practices and Perceived Stress Levels Among Psychology Graduate Students

Abstract

It is well known that stress among psychology graduate students can negatively impact academic performance, clinical skills, and personal well-being. However, less is known about factors related to stress management among psychology graduate students. The current study examined self-care practices and perceived stress among psychology graduate students Four hundred eighty-eight psychology graduate students from across the United States completed an anonymous survey of self-care practices and stress. Multiple regression analyses indicated that sleep hygiene, social support, emotion regulation, and acceptance within a mindfulness framework were significantly related to perceived stress. Results suggest that educating students about self-care practices can be an integral part of helping students manage stress associated with clinical training.

Full text

Self-Care Practices and Perceived Stress Levels Among Psychology
Graduate Students
Shannon B. Myers, Alison C. Sweeney, Victoria Popick, Kimberly Wesley,
Amanda Bordfeld, and Randy Fingerhut
La Salle University
It is well known that stress among psychology graduate students can negatively impact academic
performance, clinical skills, and personal well-being. However, less is known about factors related to
stress management among psychology graduate students. The current study examined self-care practices
and perceived stress among psychology graduate students Four hundred eighty-eight psychology grad-
uate students from across the United States completed an anonymous survey of self-care practices and
stress. Multiple regression analyses indicated that sleep hygiene, social support, emotion regulation, and
acceptance within a mindfulness framework were significantly related to perceived stress. Results
suggest that educating students about self-care practices can be an integral part of helping students
manage stress associated with clinical training.
Keywords: psychology graduate students, stress, self-care, psychology training and education.
Stress has been defined as the perception that the demands of an
external situation are beyond one’s perceived ability to cope
(Lazarus, 1966). DeAngelis (2002) suggests that psychologists are
particularly vulnerable to stress and that, while they promote
self-care practice and stress management with clients, psycholo-
gists rarely heed their own advice. Psychology graduate students
are also vulnerable to stress because of the multiple demands of
graduate school including academic coursework, research, clinical
training, and financial constraints. Stress related to performance
anxiety, competition, institutional demands, lack of experience,
and interpersonal/professional relationships has been noted in this
population (Badali & Habra, 2003). Furthermore, psychology
graduate students represent a unique population who must navigate
these stressors and their new roles, while simultaneously develop-
ing the knowledge and skills necessary to provide clinical and
therapeutic services to others.
Professionals involved in the training of psychology graduate
students, both in educational and clinical settings (e.g., practicum
and internship), need to understand the role of stress among
students to provide guidance on effective stress management and
self-care. Professionals will be prepared for training of students
and will also be better able to promote well-being within the field
and facilitate ethical clinical practice. The American Psychological
Association (APA) Ethics Code (2010a), in Standard 2.03. Per-
sonal Problems and Conflict, highlights the need to be aware of
personal issues that may influence clinical practice and the impor-
tance of addressing these issues. A recent survey examining stress
among Americans found that high levels of stress were related to
poor physical health, emotional distress, and disruption in the
family (APA, 2010b). Based on these negative effects, high levels
of stress among psychology graduate students may impact clinical
practice and the overall graduate training experience. To best
understand the role of stress and address the needs of psychology
graduate students, it is necessary to explore stress levels, identify
variables that influence stress, and determine factors that may be
targeted to reduce stress. This research will help identify psychol-
ogy graduate students who may be vulnerable to significant stress
SHANNON B. MYERS earned her PsyD in Clinical Psychology from La
Salle University. She is currently completing a postdoctoral fellowship at
UMDNJ-The Cancer Institute of New Jersey. Her research interests include
psycho-oncology, interventions to improve quality of life in cancer, and
issues related to graduate training.
A
LISON C. SWEENEY earned her PsyD in Clinical Psychology from La
Salle University. She is currently completing a postdoctoral fellowship
specializing in women’s mental health and trauma at the San Francisco VA
Medical Center/University of California, San Francisco. Dr. Sweeney’s
research interests include postpartum depression and general women’s
health issues.
V
ICTORIA POPICK Brady completed her MA in Clinical Psychology at La
Salle University in 2009 and anticipates her PsyD in Clinical Psychology
in 2012. Her primary areas of research interest include the correlates of
stress and well-being in psychology graduate students as well as under-
standing how mindfulness-based constructs influence change in treatment.
K
IMBERLY WESLEY earned HER MA in Clinical Psychology from La
Salle University. She is currently pursuing a PsyD in Clinical Psychology
from La Salle University. Her research areas include graduate student
self-care and psycho-oncology.
A
MANDA BORDFELD is currently in her fourth year at La Salle University
in pursuit of a PsyD in Clinical Psychology and has obtained her MA in
route. Her research interests include anxiety disorders, women’s health,
and psychosocial risk factors related to stress in various populations.
R
ANDY FINGERHUT is an Associate Professor of Psychology at La Salle
University, where he also serves as Director of Clinical Training for their
PsyD Program. He received his PhD in Clinical Psychology from The
University of Miami. Dr. Fingerhut’s areas of research include postpartum
depression and self-care for graduate students.
C
ORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to
Shannon B. Myers, The Cancer Institute of New Jersey-UMDNJ, 195 Little
Albany Avenue, New Brunswick, NJ 08901. E-mail: shmyers1@
hotmail.com
Training and Education in Professional Psychology © 2012 American Psychological Association
2012, Vol. 6, No. 1, 55– 66 1931-3918/12/$12.00 DOI: 10.1037/a0026534
55

and provide information used to develop preventative programs
and reduce stress.
Stress and Psychology Graduate Students
The literature on stress among psychology graduate students is
relatively sparse, but the existing studies do indicate significant
levels of stress among this population. A survey study of 281
clinical psychology trainees revealed that three-quarters of the
trainees reported being moderately or very stressed as a result of
training (Cushway, 1992). A recent survey conducted by the
American Psychological Association of Graduate Students
(APAGS) and APA’s Advisory Committee on Colleague Assis-
tance found that 70% of graduate students reported that their
functioning was impaired by at least one stressful event, such as
finances, academics, relationships, and health (El-Ghoroury,
2011). The findings indicate the need to examine stress among
psychology graduate students and to disseminate the information
to those who are involved in the education and training of students.
Much of what has been understood about stress and graduate
school has been based on research with medical students. A
number of studies have noted significant levels of stress and the
need for mental health services among medical students (Ey,
Henning, & Shaw, 2000; Midtgaard, Ekeberg, Vaglum, & Tyssen,
2008). The ability to generalize this research has been suggested
by studies noting similar levels of stress across medical students
and other graduate student groups. A study comparing perceived
stress levels among medical students, law students, and psychol-
ogy graduate students revealed significant stress in all groups and
comparable levels of stress between medical students and psychol-
ogy graduate students (Heins, Fahey, & Leiden, 1984).
Furthermore, there are similarities in the factors that contribute
to stress between medical students and psychology graduate stu-
dents. Levey (2001) noted that factors contributing to stress among
medical residents include time constraints, sleep deprivation, fi-
nancial limitations, limited free time, and responsibility for patient
care. Similarly, a sample of clinical psychology graduate students
rated coursework, dissertation work, time constraints, limited
availability, the internship process, and finances as the highest
stressors (Nelson, Dell’Oliver, Koch, & Buckler, 2001). The re-
search suggests similarities across the groups that may be used to
understand stress among psychology graduate students.
To further understand psychology graduate student stress, re-
search has examined the impact of gender and ethnicity. There
have been inconsistencies regarding gender differences with some
research suggesting that female students endorse higher levels of
stress than male students (Cahir & Morris, 1991) and other studies
noting no gender differences (Hudson & O’Regan, 1994). A more
current study noted that female psychology graduate students
reported greater stress over time management issues (Nelson et al.,
2001).
There is literature to suggest that students who identify as an
ethnic minority face additional and unique stressors compared with
students who identify with the majority ethnic group. Research
exploring stress in Asian American, African American, and Latino
undergraduate students attending a predominately white university
found stress specifically related to one’s minority status to be
distinct from global perceived stress and significantly related to
college persistence (Wei, Ku, & Laio, 2011). Dyrbye et al. (2007)
conducted a large scale study exploring well-being as it relates to
race and ethnicity in 3,080 medical students. Findings revealed
that minority students reported additional stressors that negatively
impacted their medical school experience, including racial dis-
crimination, racial prejudice, feelings of isolation, and different
cultural expectations. Furthermore, minority students who reported
the aforementioned stressors had higher rates of burnout, depres-
sive symptoms, and reduced quality of life. A more recent web-
based national study of 1,219 African American, Latina/o, Asian
American, and European American psychology graduate students
found that African-American students reported more academic
barriers than European-American students (Maton, Wimms, Grant,
Wittig, Rogers, & Vasquez, 2011). While students in minority
groups report additional stressors, research has also shown that
Asian-American, African-American, and international graduate
students are actually less likely to use counseling services in
response to stressors (Hyun, Quinn, Madon, & Lustig, 2006). In
sum, research suggests that racial/ethnic minorities may experi-
ence unique stressors during graduate school. It is therefore im-
portant to consider cultural differences when examining stress
among psychology graduate students.
Additional research has focused on the relationship between
stress and academic performance. Nelson et al. (2001) found that
psychology graduate students who reported higher levels of
coursework-related stress were more likely to report higher grade
point averages (GPA). However, the relationship between aca-
demic success and broad stress over such factors as finances, time,
relationships, and clinical work was not significant. The relatively
small sample size (n ⫽ 52) and limited geographical location of
the study may prevent broad generalizations to psychology grad-
uate students across various geographic locations. Additionally,
there may be another variable, such as perceived importance of
grades, which influences both academic-related stress and GPA.
Promoting stress management throughout graduate training is an
important task for those involved in training psychology graduate
students in both educational and clinical (i.e., practicum and in-
ternship) settings. Research is needed to inform professionals of
effective ways to promote stress management among students.
Variables such as gender and ethnicity are important to consider
when examining stress in this population. To promote effective
stress management, it is also necessary to determine whether
factors and behaviors that are amenable to change are related to
stress. There has been an indication that factors such as unhealthy
eating habits, irregular sleep patterns, less frequent engagement in
exercise, and maladaptive coping styles are related to stress among
psychology graduate students (McKinzie, Altamura, Burgoon,
Bishop, 2006; Nelson et al., 2001). Further research examining
these variables will provide useful information for those involved
in education and training. The research will facilitate the identifi-
cation of factors that could be targeted on either an individual or
graduate program level to assist in stress prevention and reduction,
thereby improving academic performance and development of
clinical skills.
Self-Care Practice and Stress
Self-care practice may be defined as engagement in behaviors
that maintain and promote physical and emotional well-being and
may include factors such as sleep, exercise, use of social support,
56
MYERS ET AL.

emotion regulation strategies, and mindfulness practice. There is
limited research examining self-care practice and stress among
psychology graduate students, but the existent literature has noted
a significant relationship. A survey of 65 psychology graduate
students in the New York metropolitan area found that daily habits
related to sleep and exercise were related to stress (McKinzie et al.,
2006). Because of the lack of literature specific to psychology
graduate students, an examination of the broader self-care litera-
ture may offer an indication of practices that could be applied to
psychology graduate students’ management of stress.
Sleep and Stress
The relationship between sleep and stress has been explored in
research with various populations. For example, a study conducted
with healthy women found that individuals with lower objective
sleep quality, measured by wake percentage during sleep, had a
blunted response to an experimental stressor, suggesting that poor
sleep quality may have adverse health effects (Wright, Valdimars-
dottir, Erblich,& Bovbjerg, 2007). Another study of 184 adults
found that psychosocial and physiological stress was related to
nightly variability in individuals’ sleep duration (Mezick, Mat-
thews, Hall, Kamarack, Buyusse, Owens, et al., 2009).
The relationship between sleep quality and stress has been noted
in research with various student groups, including college students
(Lund, Reiter, Whiting & Prichard, 2010), nursing students (Win-
wood & Lushington, 2006), and medical students (Huen, Chan,
Yu, & Win, 2007). In a survey study of 219 Japanese graduate
students, 25.6% of the students were identified as poor sleepers
and poor sleep quality was related to poor perceived health (Pallos,
Gergely, Yamada, Miyazaki, & Okawa, 2007). The negative im-
pact of sleep deprivation and fatigue was noted in a study that
found that first- and second-year medical residents who reported
sleeping five hours or less per night were more likely to report
serious accidents or injuries, conflict with other professional staff,
and having made significant medical errors (Baldwin, & Daugh-
erty, 2004). The research indicates that sleep has a significant
impact across student populations. Based on these findings, it is
likely that sleep is related to stress among psychology graduate
students and thus can have a significant impact on clinical care and
overall training experience.
Exercise and Stress
Exercise has been associated with physical benefits, such as
reduced risk of cardiac disease, reduced risk of Type 2 diabetes,
strengthened bones and muscles, and weight management (Center
for Disease Control & Prevention, 2010). Moreover, exercise has
been related to emotional well-being with research suggesting that
regular moderate physical activity may reduce stress and prevent
stress-induced suppression of the immune system (Fleshner,
2005). The specific impact of exercise among psychology graduate
students is less clear, but broad research with students may serve
as an indication of the relationship between exercise and stress.
Researchers who conducted a study of 555 second-year medical
students found that physical activity was related to academic stress
(Sheetsa, Gorenfloa, & Forneyb, 1993). Another survey study of
medical students across the United States found that the majority
of students who reported a lot of stress did not achieve the CDC
exercise recommendations, while at least 80% students who re-
ported no stress complied with CDC exercise recommendations
(Frank, Tong, Lovelo, Carrera, & Duperly, 2008). The study
suggests that those who were more likely to exercise regularly
were less likely to experience stress.
Further studies that have focused on undergraduate college
students have noted a relationship between exercise and stress.
Brown (1991) conducted a study examining physical activity
among undergraduates at a private university and found that phys-
ical activity and perceived fitness buffered the effects of stress on
health. In a more recent study of 814 college students, researchers
found that physical activity was significantly related to daily
hassles. The relationship between physical activity and perceived
stress was not statistically significant, but it was noted that the
effect size, though insignificant, was similar to previous studies of
physical activity and stress (Nguyen-Michel, Unger, Hamilton, &
Spruijt-Metz, 2006). Researchers who conducted a study with
college students who were enrolled at large southeastern university
found that students who exercised at least three times per week
reported lower mean stress levels than sedentary students (McIn-
tosh, Bhandari, & Holcomb, 2007). While the studies did not focus
on psychology graduate students, the findings lend support to the
need to examine exercise as a variable related to stress.
Social Support and Stress
Social support and engaging in activities that promote social
support may be considered an aspect of self-care practice. The
relationship between stress and positive social relationships has
been explored in graduate student populations. For instance, grad-
uate program support and family support have been found to be
related to graduate student stress in various types of graduate
programs (Mallinckrodt & Leong, 1992). Social support has also
been found to be inversely related to anxiety among female grad-
uate students in various programs (Munir & Jackson, 1997). Fi-
nally, a study of 82 students in doctor of nursing practice programs
found a significant relationship between perceived stress and sense
of belonging. While these studies do not focus specifically on
psychology graduate students, there is an indication that social
support is related to well-being among graduate students.
Existent literature with psychology graduate students indicates a
significant relationship between social support and stress. One
study found that female students enrolled in online doctoral psy-
chology programs who reported a need for social support were
more likely to report higher levels of perceived stress (Kaufman,
2006). In another study, 284 counseling psychology doctoral stu-
dents from 53 training programs throughout the United States
completed anonymous online measures. Students who perceived
more support from their advisor, other students, and family and
friends reported less global stress (Clark, Murdock, & Koetting,
2009).
Emotion Regulation and Stress
Strategies used to regulate emotions may also be related to
stress. Gross (2007) defined emotion regulation as processes that
influence which emotions an individual experiences and how the
emotions are experienced or expressed. He further differentiates
emotion regulation strategies based on the timing in which a
57
SELF-CARE PRACTICES AND PERCEIVED STRESS

strategy is enacted. Antecedent-focused strategies are implemented
early in the process and change the effect of emotion-generating
stimuli. An example is cognitive reappraisal, which refers to
changing the meaning of an emotion-invoking situation. Response-
focused strategies are implemented later in the process and focus
on changing the emotional output or expression. An example is
emotion suppression, which refers to inhibition of internal emo-
tional state.
Emotion regulation literature has examined the impact of these
strategies on stress. Moore, Zoellner, and Mollenholt (2007) ex-
amined cognitive reappraisal and expressive suppression in an
undergraduate sample and a trauma-exposed community sample.
Cognitive appraisal was related to lower levels of stress-related
symptoms, and expressive suppression was related to higher levels
of stress-related symptoms in both samples. Furthermore, expres-
sive suppression was related to PTSD in the trauma-exposed
sample. In a study of 362 predominantly female undergraduate
college students positive reappraisal was significantly related to
depression, anxiety, and stress (Martin & Dahlen, 2005).
Less is known about the relationship between stress and emotion
regulation among psychology graduate students. Nelson et al.
(2001) found that psychology graduate students frequently re-
ported using positive reinterpretation, which may be a form of
cognitive reappraisal, but there is no indication whether the strat-
egy is related to lower levels of stress. Based on the aforemen-
tioned literature suggesting that cognitive reappraisal is related to
lower levels of stress in undergraduates and community samples,
it may also be related to stress among psychology graduate stu-
dents.
Mindfulness and Stress
The term mindfulness has been defined as nonjudgmental,
present-moment awareness and engagement (Bishop et al., 2004),
and it has been related to reduced stress levels (Chiesa & Serretti,
2009; Shapiro et al., 2007). Mindfulness can be conceptualized as
a multifaceted trait (Baer, Smith, Hopkins, Krietemeyer, & Toney,
2006). Mindfulness practice, defined as engagement in behaviors
aimed at increasing present-moment awareness, acceptance, and
engagement, is a self-care practice that has been shown to reduce
emotional distress and to increase positive well-being (Greeson,
2009). Carmody and Baer (2008) noted a relationship between
mindfulness practice and levels of mindfulness and stress among
174 adults. Research has also suggested that dispositional mind-
fulness may be related to reduced stress and improved quality of
life (Brown & Ryan, 2003).
The relationship between mindfulness and stress has been ex-
amined in both laboratory studies and outcome research. In a
laboratory study involving both clinically anxious and nonanxious
individuals, trait mindfulness was related to weakened responses to
laboratory stressors (Arch & Craske, 2010). Outcome research has
found that individuals who participated in a mindfulness-based
stress reduction (MBSR) program have reduced negative affect
and improvement in symptoms of anxiety and depression (Goldin
& Gross, 2010).
Mindfulness practice among clinicians has also been studied.
Master’s level students in a counseling psychology program who
completed a 15-week course on mindfulness reported relaxation
and increased calmness after completing the course (Chrisman,
Christopher, & Lichtenstein, 2009). Another study randomized 54
psychology graduate students to either an eight-week MBSR class
or a control class. Compared with students in the control class,
students in the MBSR class reported decreased perceived stress
(Shapiro, Brown, & Biegel, 2007). Based on the research, psy-
chology graduate students may use mindfulness practice as a stress
management technique and experience lower levels of stress.
The present study examined self-care practices and perceived
stress among clinical psychology graduate students across the
United States to inform professionals involved in education and
training of the specific behaviors and self-care practices that can be
targeted to help students effectively manage stress. The five spe-
cific self-care practices in the study included sleep patterns, exer-
cise behaviors, perceived social support, use of emotion regulation
strategies, trait mindfulness, and formal mindfulness practice. The
self-care practices were chosen based on previous research sug-
gesting a significant relationship to stress levels. It was hypothe-
sized that engagement in exercise behaviors, healthy sleep pat-
terns, higher levels of perceived social support, more frequent use
of the emotion regulation strategy of cognitive reappraisal, engage-
ment in mindfulness practice, and trait mindfulness would be
related to lower levels of perceived stress. Furthermore, consistent
with previous literature (Gross & John, 2003), the emotion regu-
lation strategy of suppression, was hypothesized to be related to
higher levels of perceived stress. To date, the present study is one
of the largest to examine stress and behaviors among psychology
graduate students.
Method
Participants
The present study included 488 graduate students in clinical
psychology graduate programs across the United States. Partici-
pants ranged in age from 20 to 61 years (M ⫽ 27, SD ⫽ 5.44) and
were majority female (84%), Caucasian (87%), enrolled in a Ph.D.
program (58%), and enrolled in a graduate program accredited by
the American Psychological Association (94%). See Table 1 for a
full presentation of the demographic characteristics.
Measures
Demographics questionnaire. A demographic information
questionnaire was developed by the researchers to assess partici-
pants’ age, gender, race, degree program, geographic location,
relationship status, and financial status. The demographic variables
were chosen based on previous research on variables associated
with stress.
Sleep Hygiene Index. The Sleep Hygiene Index (Mastin,
Bryson, Corwyn, 2006) is a 13-item self-report measure assessing
sleep hygiene behaviors. Participants rate frequency (always, fre-
quently, sometimes, rarely, never) of sleep-related behaviors. Sam-
ple items include, “I take daytime naps lasting two or more hours”
and “I go to bed at different times from day to day” (Mastin et al.,
2006). Higher scores are indicative of more maladaptive sleep
hygiene practices. The measure was normed on 632 undergraduate
students. It has demonstrated good test–retest reliability (r ⫽ .71)
and has been found to be positively correlated with indicators of
inadequate sleep hygiene as well as other measures of sleep
58
MYERS ET AL.

hygiene (Mastin et al., 2006). The measure was selected because of
its psychometric strength and applicability to student populations.
Cronbach’s alpha for the Sleep Hygiene Index was .74.
Godin Leisure Time Exercise Questionnaire. The Godin
Leisure Time Exercise Questionnaire (GLTEQ; Godin & Shep-
hard, 1985) is a brief measure designed to assess individuals’
engagement in physical activities during free time. The GLTEQ
contains three open-ended questions assessing average frequency
of engagement in strenuous, moderate, and mild forms of exercise
during a typical week. Higher scores are indicative of more fre-
quent engagement in exercise. The GLTEQ was normed on a
sample of 306 healthy adults. It has demonstrated adequate test–
retest reliability across a two-week period (r ⫽ .74) and moderate
correlations with other measures of exercise (Godin & Shephard,
1985; Miller, Freedson, & Kline, 1994). The measure was chosen
because of ease of administration and previous use with student
populations. Cronbach’s alpha of the GLTEQ was .20.
Multidimensional Scale of Perceived Social Support. The
Multidimensional Scale of Perceived Social Support (MPSS; (Zimet,
Dahlem, Zimet & Farley, 1988) is a 12-item self-report measure
designed to assess perceived level of social support. Participants
rate each question on a seven-point Likert scale according to the
extent to which they agree or disagree with each statement. Sample
items include, “My family really tries to help me” and “I can talk
about my problems with my friends.” Higher scores indicate
higher levels of perceived social support. The measure was normed
on three separate groups consisting of 265 pregnant women, 74
adolescents, and 55 pediatric patients (Zimet, Powell, Farley,
Werkman, & Berkoff, 1990). It has demonstrated internal reliabil-
ity (r ⫽ .85) (Zimet et al., 1988) and has been found to be
negatively correlated with measures of depression and anxiety and
positively correlated with other measures of social support (Zimet
et al., 1990). The measure has been used in previous research with
college students (Hefner & Eisenberg, 2009) and graduate students
(Perepiczki, Chandler, & Becerra, 2011). Cronbach’s alpha of the
MSPSS was .91.
Emotion Regulation Questionnaire. The Emotion Regula-
tion Questionnaire (ERQ; Gross & John, 2003) is a 10-item self-
report measure designed to assess the use of two emotion regula-
tion strategies: cognitive reappraisal and expressive suppression.
Each item consists of a seven-point Likert scale ranging from
strongly disagree (1) to strongly agree (7). Higher scores indicate
greater use of the strategy. The measure was selected because of its
ability to independently measure the two strategies through two
separate subscales. The normative sample for the ERQ consisted of
1,628 undergraduate students. The ERQ has demonstrated ade-
quate test–retest reliability (r ⫽ .69) and adequate internal consis-
tency for both reappraisal and suppression subscales, as well as
adequate convergent validity with other measures of emotion
regulation and coping (Gross & John, 2003). Cronbach’s alpha for
the cognitive reappraisal subscale and expressive suppression sub-
scale was .87 and .82, respectively.
Table 1
Demographic Characteristics Within the Sample (n ⫽ 488)
Characteristic Frequency Percentage
APA data first year
graduate students
Race
Caucasian 422 86.5% 72%
African American 13 2.7% 8%
Latin American/Hispanic 12 2.5% 9%
Asian American 16 3.3% 7%
Mixed race 10 2.0% 3%
Other 15 3.1%
Gender
Male 76 15.6% 25%
Female 282 84.2% 75%
Other 1 0.2%
Degree program
M.A. 70 14.3%
Ph.D. 282 57.8%
Psy.D. 120 24.6%
Other 16 3.3%
Geographic regions
Northeast 121 25%
Midwest 191 39%
West 69 14%
South 90 18.5%
Other 17 3.5%
Relationship status
Single 114 23.4%
Dating 47 9.6%
Unmarried, committed relationship 200 41.0%
Married 118 24.2%
Divorced 4 0.8%
Separated 5 1.0%
Note. Data obtained from APA Center for Workforce Studies (Hart et al., 2010).
59
SELF-CARE PRACTICES AND PERCEIVED STRESS

Mindfulness practice. Participants responded to a question
assessing frequency of engagement in mindfulness practice rang-
ing from never (1) to very often (5). Mindfulness practice was
defined as “the intentional act of bringing awareness to thoughts,
feelings, and bodily sensations for a period of time when this is the
sole activity (e.g., sitting meditation or another mindfulness activ-
ity).” Higher scores indicate more frequent mindfulness practice.
Philadelphia Mindfulness Scale. The Philadelphia Mindful-
ness Scale (PHLMS; Cardaciotto, Herbert, Forman, Moitra, &
Farrow, 2008) is a 20-item self-report questionnaire designed to
measure self-reported levels of mindfulness. The scale produces
two subscales: acceptance and awareness. Acceptance has been
defined as “experiencing events fully and without defense, as they
are” (Hayes, 1994, p. 30) and is assessed via statements such as “I
try to distract myself when I feel unpleasant emotions” and “I wish
I could control my emotions more easily.” Cardaciotto et al. (2008)
described the awareness component as “the continuous monitoring
of the totality of experience” (p. 205). It is assessed via statements
such as “I am aware of what thoughts are passing through my
mind” and “whenever my emotions change I am conscious of them
immediately.” The measure was chosen because of its ability to
independently examine both components of mindfulness practice.
Each item is assessed using a five-point Likert scale ranging from
never (1) to very often (5). The PHLMS was normed on five
different samples: two nonclinical (n ⫽ 204 and 559) and three
clinical samples, including psychiatric outpatients (n ⫽ 52), eating
disordered inpatients (n ⫽ 30), and outpatients at a student coun-
seling center (n ⫽ 78) (Cardaciotto et al., 2008). It has demon-
strated good internal consistency for the awareness (Cronbach’s
alpha ⫽ .86) and acceptance (Cronbach’s alpha ⫽ .91) subscales,
as well as adequate concurrent validity with other measures of
mindfulness (Cardaciotto et al., 2008). Cronbach’s alpha for the
acceptance and awareness subscales were .90 and .81, respec-
tively.
Perceived Stress Scale. The Perceived Stress Scale (PSS-14;
Cohen, Kamarck, & Mermelstein, 1983) is a 14-item self report
questionnaire that measures current perception of stress levels.
Each item is rated within the last month on a five-point Likert
scale, ranging from never (0) to very often (4). Example items
include “In the last month, how often have you felt that you were
unable to control important things in your life” and “In the last
month, how often have you felt nervous and stressed.” Higher
scores are indicative of higher levels of perceived stress. The
measure was normed on 446 college students and 64 members of
a community smoking cessation group. It has demonstrated ade-
quate coefficient alpha reliability across studies (r ⫽ .84 and .86),
adequate 2-day test–retest reliability and 6-week test–retest reli-
ability (r ⫽ .85 and .55, respectively), and demonstrated adequate
convergent validity with measures of health-related outcomes and
divergent validity with measures of depressive symptomatology
(Cohen et al., 1983). The measure was selected because of ease of
administration, the range of stressors assessed, and psychometric
strength. Cronbach’s alpha was .90.
Procedure
A list of nationwide clinical psychology graduate programs was
obtained from the American Psychological Association (APA)
website. Researchers contacted each program’s Director of Clini-
cal Training, or other relevant school liaison, by email. In this
contact, the researchers requested that an email be forwarded to the
program’s students describing the current study and providing a
link to a survey. Participants who chose to participate were di-
rected to an anonymous online survey using Psychdata, an Internet
psychology research database. Responses were received from Feb-
ruary 2010 through March 2010. Participants provided informed
consent before completing the measures described above. The
procedure and recruitment process for this study were approved by
the Institutional Review Board before data collection.
Results
Preliminary Analyses
Preliminary analyses were conducted to explore demographic
differences in perceived stress among psychology graduate stu-
dents. Significant differences emerged based on relationship sta-
tus, age, and cost of living to income sufficiency. Married students
reported significantly lower levels of perceived stress than gradu-
ate students that were not married, t(484) ⫽ 2.54, p ⫽ .012. Older
graduate students reported significantly lower levels of perceived
stress (r ⫽⫺1.07, p ⫽ .019). More sufficient cost of living to
income ratio was found to be significantly related to lower levels
of perceived stress (r ⫽⫺1.43, p ⫽ .002). There were no signif-
icant differences based on race, geographic location, and type of
degree program. A linear regression was conducted to explore the
degree to which demographic variables accounted for variance in
perceived stress among graduate students. The overall model was
significant, F(6, 469) ⫽ 5.10, p ⬍ .000, and accounted for 5% of
the variance of perceived stress (Adjusted R
2
⫽ .050). Analyses of
the predictor variables revealed that cost of living to income ratio
independently contributed to variance in level of perceived stress
(␤⫽⫺.145, p ⫽ .001), and age also independently contributed to
variance in perceived stress (␤⫽⫺.141, p ⫽ .011).
Primary Analyses
To investigate the relationship between self-care practices and
perceived stress, a hierarchical multiple regression was conducted.
The method was chosen to determine whether the self-care vari-
ables were significantly related to perceived stress after controlling
for the effects of the demographic variables that were found to be
significantly related to perceived stress. The demographic vari-
ables relationship status, age, and sufficiency of cost of living to
income ratio were entered in the first step. The self-care variables,
healthy sleep practices, perceived social support, frequency of
exercise, frequency of mindfulness practice, mindful awareness,
mindful acceptance, cognitive reappraisal, and suppression, were
entered in the second step of the regression. The overall model was
significant, F(11, 450) ⫽ 32.86, p ⫽ .000, and accounted for
43.8% of the variance in perceived stress scores (Adjusted R
2
⫽
.438). After controlling for the effects of the demographic vari-
ables, the self-care variables accounted for a significant portion of
the variance of graduate students’ perceived stress levels, R
2
change ⫽ .404, F(8, 439) ⫽ 40.45, p ⫽ .000.
Analysis of the specific predictor variables revealed significant
patterns. In support of our hypothesis, healthy sleep practices (␤⫽
⫺.203, p ⫽ .000) and higher levels of social support (␤⫽⫺.128,
60
MYERS ET AL.

p ⫽ .002) were significantly related to lower levels of perceived
stress. Contrary to our hypothesis, engagement in exercise was not
significantly related to perceived level of stress (␤⫽⫺.031, p ⫽
.415). Contrary to our hypothesis, frequency of engagement in
mindfulness practice did not have a significant effect on perceived
stress (␤⫽⫺.008, p ⫽ .843). There were differences within the
construct of mindfulness in relation to perceived stress. Mindful
awareness was not significantly related to perceived stress (␤⫽
⫺.015, p ⫽ .701), but mindful acceptance was significantly related
to perceived stress (␤⫽⫺.475, p ⫽ .000). Upon closer exami-
nation, higher level of mindful acceptance was significantly related
to total engagement in mindfulness practice (r ⫽ .16, p ⬍ .000).
As hypothesized, more frequent use of cognitive reappraisal was
significantly related to lower levels of perceived stress (␤⫽
⫺.218, p ⫽ .000). Contrary to our hypothesis, more frequent use
of suppression was also related to lower levels of perceived stress
(␤⫽⫺.101, p ⫽ .012). Table 2 provides information on predictors
of perceived stress.
Discussion
The current study suggests that self-care practices are related to
perceived stress levels among psychology graduate students across
the United States. There were also some differences based on
demographic factors. Age, relationship status, and sufficiency of
income to cost of living were significantly related to perceived
stress levels. Psychology graduate students who indicated that their
household income was insufficient compared with their cost of
living perceived more stress, which is consistent with previous
research suggesting a reciprocal relationship between perceived
stress and financial satisfaction in adult students (Sandler, 2000).
Married students also reported significantly less stress than their
nonmarried counterparts. This pattern has emerged in previous
research in which psychology graduate students who were not in a
committed relationship reported the highest levels of stress (Hud-
son & O’Regan, 1994). Marriage can provide a strong source of
relational support, which has been linked to lower levels of stress
in students (Craddock, 1996). Finally, age significantly predicted
perceived stress levels, in that the older students reported less
perceived stress. Previous research has suggested that older indi-
viduals report fewer daily hassles than their younger counterparts
possibly as a result of the development of alternative coping
strategies (Folkman, Lazarus, Pimley, & Novacek, 1987). Older
students may have developed more effective ways to cope with the
competing demands of graduate school and therefore perceive less
stress.
After controlling for the effects of the demographic variables,
cost of living to income ratio, relationship status, and age, the
self-care practices were significantly related to perceived stress
among psychology graduate students. Specific self-care practices
emerged as independently contributing to variance in perceived
stress. Consistent with the hypothesis, better sleep hygiene practice
was related to lower levels of perceived stress. This is also con-
sistent with literature suggesting that sleep hygiene is strongly
related to daytime sleepiness and fatigue, which is subsequently
correlated with stress (Mastin et al., 2006; Tanaka, Fukuda,
Mizuno, Kuratsune, & Watanabe, 2009). In addition to sleep
hygiene, students’ report of strong social support was related to
lower levels of perceived stress. This is consistent with the hy-
pothesis and research suggesting that social support can serve as a
buffer for stress among graduate students (Calicchia & Graham,
2006).
The emotion regulation strategies of cognitive reappraisal and
suppression were also significantly related to perceived stress.
Gross and John (2003) suggest that the process of cognitive
reappraisal involves reevaluating stressful situations in a way that
alters the emotional impact, while suppression involves inhibiting
the expression of emotion. Research has previously suggested that
more frequent use of reappraisal, as opposed to suppression, to
regulate emotions is related to greater well-being. The current
study suggests that more frequent use of either strategy is related
to less perceived stress in this population. The discrepant findings
may be attributable to the context of short- and long-term conse-
quences. For instance, a study by Goldin, McRae, Ramel, and
Gross (2008) that examined the neural bases of these two emotion
regulation strategies found that expressive suppression may have
adaptive results in the short-term as individuals may be able to
temporarily reduce negative emotion experience and behavior.
However, over the long-term, frequent use of suppression may be
associated with less adaptive outcomes and decreased well-being.
It is possible that the relationship between frequent use of sup-
pression and lower perceived stress in the current study may reflect
the short-term adaptive effect of suppression, as perceived stress
was only assessed over a one-month period. Based on previous
research, assessment of overall well-being may have revealed that
frequent use of suppression was related to decreased well-being
and life satisfaction, despite the relationship to lower levels of
current perceived stress.
The findings did not support the hypothesis that more frequent
engagement in formal mindfulness practice would be related to
lower perceived stress. Interestingly, the trait measure of mindful
acceptance was significantly related to perceived stress levels.
Despite the discrepancy between these two findings, there was a
correlation found between the frequency of mindfulness practice
and mindful acceptance. A closer examination of group differences
Table 2
Multiple Regression of Predictors of Perceived Stress Among
Psychology Graduate Students
Predictor ␤ tR
2
Step 1
Age ⫺.122 ⫺2.565
ⴱ
Cost of living ⫺.152 ⫺3.219
ⴱⴱ
Relationship status ⫺.075 ⫺1.562
Model 1 .047
Step 2
Sleep hygiene ⫺.203 ⫺5.158
ⴱⴱⴱ
Social support ⫺.128 ⫺3.093
ⴱⴱ
Exercise frequency ⫺.031 ⫺.816
Cognitive reappraisal ⫺.218 ⫺5.845
ⴱⴱⴱ
Suppression ⫺.101 ⫺2.526
ⴱ
Mindful acceptance ⫺.475 ⫺11.835
ⴱⴱⴱ
Mindful awareness ⫺.015 ⫺.385
Frequency of mindful practice ⫺.008 ⫺.198
Model 2 .452
⌬R
2
.404
ⴱⴱⴱ
Note. n ⫽ 488.
ⴱ
p ⬍ .05.
ⴱⴱ
p ⬍ .01.
ⴱⴱⴱ
p ⬍ .001.
61
SELF-CARE PRACTICES AND PERCEIVED STRESS

found that participants who never engaged in formal mindfulness
practice had lower levels of mindful acceptance than those who
engaged in mindfulness practice very often. This is consistent with
previous findings that formal mindfulness practice and trait mind-
fulness are significantly correlated (Carmody & Baer, 2008). Fur-
thermore, Carmody and Baer found that increases in trait mind-
fulness completely mediated the relationship between time spent
engaging in formal mindfulness practice and stress reduction. In
other words, formal mindfulness practice reduces stress by increas-
ing trait mindfulness. Therefore, it may be that only students who
engage in formal mindfulness practice very often achieve enough
of an increase in trait mindfulness to reduce stress. An alternative
explanation for these findings is that only subjective ratings of
time spent engaging in formal mindfulness practice were obtained.
Perception of what it means to engage in mindfulness practice very
often may vary between students, thus skewing results. The study
of mindfulness has rapidly grown over the past several years;
however, there is not currently consensus among researchers on
the best methods for measuring mindfulness practice. In a recent
review of the literature on mindfulness interventions, 98 studies
were reviewed for home practice tracking methods. Methods used
included daily self-report logs, weekly report forms, and retrospec-
tive report using either single or multiitem survey. No study
reported on the psychometrics of these tracking methods (Vettese,
Toneatto, Stea, Nguyen, & Wang, 2009). It is possible that the
inherent limitations of assessing mindfulness practice influenced
the results of this study. However, there is no clear empirical
evidence suggesting that measurement methods significantly in-
fluence the relationship found between mindfulness practice and
outcome measures.
Findings did not support the hypothesis that exercise behavior
would correlate with stress in psychology graduate students. Em-
pirically, exercise behavior has been linked to reduced stress.
However, research also suggests that individual differences such as
coping styles and personality dimensions may impact one’s ability
to psychologically benefit from exercise (Folkins & Sime, 1981).
Moreover, the impact of exercise on stress may be dependent on
the type of stressor and the beliefs one holds about the efficacy of
exercise as a coping strategy (Salmon, 2001). For instance, re-
search has found that during times of academic stress students
actually decrease their physical activity (Steptoe, Wardle, Pollard,
& Canaan, 1996). Some students may believe engaging in physical
activity will decrease stress levels, while others find that exercise,
especially in the face of academic pressure, actually increases
stress. Given the reliability estimate of the measure in the present
study, it is likely that the measure did not accurately assess
exercise behavior and therefore conclusions on the impact of
exercise on stress cannot be drawn.
While the results of this study are promising, there are several
factors that limit the conclusions that can be drawn. Because of the
cross-sectional design of the study, the results are correlational in
nature and therefore causality cannot be assumed. The conclusions
may also be limited by the lack of specificity in the measurement
of certain variables. In particular, the frequency of formal mind-
fulness practice was measured using a subjective rating scale. The
measure of stress was intended to assess the stressfulness of
participants’ lives over the past month, but it is possible that
responses were influenced by specific situational stress when
completing the questionnaire. Furthermore, stress levels and the
frequency of practicing self-care behaviors may vary widely
throughout the academic year, and the results may have been
influenced by experiences at the time of data collection rather than
a reflection of typical stress levels or self-care behaviors. There are
limitations with regard to the reliability of the exercise measure
which prevent conclusions regarding the relationship between ex-
ercise and stress. Not all of the measures were normed on graduate
student or student populations. While the most of them have been
used in research on students, there should be some caution in
interpreting the findings.
In terms of the sampling bias, we sampled current graduate
students and did not assess students who withdraw from school,
possibly because of difficulty managing stress. Therefore, the
sample may be skewed toward students who have lower stress
levels or use self-care behaviors to manage stress more effectively.
The sample was also self-selected, and it is possible that stress
levels and self-care behaviors differ between students who opted to
complete the survey and those who did not. It is also possible that
training directors who chose to disseminate the recruitment email
tend to have more emphasis on self-care within the graduate
program, which may have biased results.
The sample was majority Caucasian and female limiting the
generalizability of the results to individuals of other gender groups
and ethnic identities. Because of the lack of diversity in the
sample, we were unable to assess whether there were differences
based on gender and race. It is possible that individuals who
identify with the minority group may perceive stress in a different
manner and/or used different coping strategies. Despite the lack of
diversity in the sample, the distribution is fairly consistent with
APA statistics of psychology graduate students indicating that
between 65 and 70% of students are Caucasian and 75–77% of
students are female (Hart, Wecherki, & Kohout, 2010). Therefore,
this study may represent the overall majority of psychology grad-
uate students but may not capture the important differences that
may exist in underrepresented groups. Further research with more
diverse samples is necessary to enhance knowledge of stress and
self-care during psychology graduate training across all student
groups.
As the study was one of the first large-scale studies to examine
stress and self-care, we chose to recruit specifically from clinical
psychology graduate programs. Similar patterns may emerge
among psychology graduate students in other programs (e.g.,
counseling, school, experimental). However, further research is
needed to determine whether there are differences in stress and
self-care between students in different types of programs. Despite
the programmatic differences, it is possible that self-care will
remain significantly related to stress among students in other
programs. In the present study there were no differences in stress
among students enrolled in different degree programs (i.e., Ph.D.,
Psy.D., Masters), suggesting that despite programmatic differences
psychology graduate students may experience similar levels of
stress.
While no significant differences were found among the various
degree programs, there are limitations in understanding program-
matic variables in general and program variables with regard to
self care. The general program variables that would be important
for future research in this domain may include the following:
student to faculty ratio; size of the program and institution which
may affect funding, resources, and the academic environment;
62
MYERS ET AL.

model of mentoring between students and faculty; model used for
training and of potential interest the theoretical orientation with
which the program identifies. All of these factors may influence
the financial, social, and professional support a student is given.
Other programmatic variables to consider include formal measures
taken to encourage student self-care, such as workshops on self-
care or policies on maximum schedule hours. All of these pro-
grammatic components could influence the level of self-care en-
couraged at the program level and may also influence the
individual attitudes toward self care. Understanding these compo-
nents should be considered in future research within this popula-
tion.
Implications for Education and Training
As the field of psychology advances, the ability to engage in
adequate self-care is being recognized as a core competency of
clinical training (Rodolfa, Bent, Eisman, Nelson, Rehm, & Ritchie,
2005). The promotion of self-care practice in graduate school can
be conceptualized from a “preventative model” that creates a
foundation for a career-long pursuit of professionalism (Elman,
Illfelder-Kaye, & Robiner, 2005). Students who perceive training
demands to be manageable are more likely to display resiliency in
learning and working environments (Kuyken, Peters, Power, &
Lavender, 2003). Academic performance, especially in students
with low resourcefulness in stressful situations, is negatively cor-
related with both subjective and physiological stress responses
(Akgun & Ciarrochi, 2003; Ng, Koh, & Chia, 2003). Furthermore,
stress and burnout among psychology graduate students can have
a negative impact on their ability to provide adequate clinical care
(Figley, 2002; Wicks, 2008). The relationship between stress and
self-care in psychology graduate students found in this study lends
further support for the importance of self-care as a training com-
petency to decrease the negative impact of stress on both academic
and clinical training. This research also provides direction for
specific self-care behaviors that are related to lower stress levels in
psychology graduate students. As self-care continues to be pro-
moted during graduate training, it is important for professionals
involved in training to promote specific behaviors that are effec-
tive in reducing stress in this population, as opposed to encourag-
ing the vague concept of self-care.
One program that may be used as a model for how to incorpo-
rate self-care into graduate training is the POWER (Professional
Opportunities for Wellness Education and Revitalization) pro-
gram, developed by two counseling psychology students at Ari-
zona State University (Dittmann, 2005). The primary components
of this program include peer mentoring, workshops, and social
activities to promote self-care behaviors among psychology grad-
uate students. Peer mentoring of first-year students by more ad-
vanced students is an excellent way to provide support and guid-
ance as students begin their graduate careers. Furthermore,
workshops can be held periodically, led by students or invited
guest speakers, which address various self-care topics such as
sleep hygiene, recognizing the signs of stress, teaching mindful-
ness, and much more. Social activities can also be hosted by either
the program or the students to help build a sense of camaraderie
and support among the student body. In addition to the steps taken
by the POWER program, the present authors suggest that training
programs develop a self-care committee consisting of both faculty
and students. The committee should be responsible for evaluating
the self-care needs of the student body as well as organizing the
workshops and other activities. The results of the present study can
serve as guidance for training programs aiming to improve stu-
dents’ self-care practices.
Interested programs and students can learn more about specific
self-care practices and ways to reduce stress via the following
programs. The Sleep Treatment and Education Program for Stu-
dents (STEPS), which involves education about sleep hygiene and
stimulus control, has demonstrated efficacy in improving sleep
quality among students (Brown, Buboltz, Barlow, & Soper, 2006).
Mindfulness Based Stress Reduction (MBSR) programs teach par-
ticipants to attend to present moment experiences in a nonjudg-
mental way and have demonstrated effectiveness in reducing per-
ceived stress, negative affect, anxiety, and rumination among
graduate counseling psychology students (Shapiro et al., 2007).
Training programs may incorporate either of these full programs
into their self-care initiatives, or they may consider inviting guest
speakers to host workshops on such topics. In addition, interested
students may consider beginning a student-led mindfulness med-
itation group. Incorporating mindfulness into program-based self-
care initiative will not only help to reduce students’ stress, but
extant literature also suggests that engaging in mindful meditation
before individual therapy sessions improves patient outcomes
(Grepmair, Mitterlehner, Loew Bachler, Rother, & Nickel, 2007).
To ensure that students can adequately engage in training and
provide ethical and competent clinical care, it is prudent that
graduate training programs assist students in developing compe-
tency in self-care. The programs and suggestions mentioned here
are only a few of the ways that psychology graduate training
programs can help students enhance their self-care behaviors and
reduce overall stress. We believe that an important first step in
improving self-care among psychology graduate students is dis-
cussing and understanding the experiences of stress and self-care
among students. The creation of a self-care committee may be a
good way to begin such a discussion. Training programs may also
recommend readings on self-care such The Resilient Clinician
(Wicks, 2008), which offers a mindfulness-based approach to
self-care for mental health professionals. Finally, training pro-
grams may want to emphasize the importance of social support and
develop events to facilitate and promote camaraderie among stu-
dents and support between faculty and students.
Conclusions and Future Directions
In conclusion, self-care practices were found to be significantly
related to perceived stress levels in a national sample of clinical
psychology graduate students. More specifically, sleep hygiene,
social support, the emotion regulation strategy of reappraisal and
mindful acceptance were found to be significantly related to per-
ceived stress levels in the population. The results of this study are
strengthened by the large sample size in addition to the represen-
tation of students across the nation. Participants were recruited
from diverse institutions and varied types of degree programs.
These findings provide a foundation for future research to explore
moderating and mediating variables between self-care practices
and stress levels, such as personality factors and beliefs about the
impact of self-care behaviors. Additionally, further research with
more diverse populations and with students from different types of
63
SELF-CARE PRACTICES AND PERCEIVED STRESS

psychology programs will broaden the knowledge and allow for
more specificity in the approach to promoting self-care. Future
studies should examine the nature of stress and specific stressors
among psychology graduate students and how they may differ
from students in other fields. Finally, the field will benefit from
evaluating the efficacy of programs designed to increase self-care
and reduce stress among psychology graduate students and how
academic performance and clinical work is affected by these
efforts.
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Received June 21, 2011
Revision received October 4, 2011
Accepted October 11, 2011 䡲
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