The Effectiveness of Stress Management Training Given to First-class Health Students in Perceiving and Coping With Stress and Developing Resilience: A Randomized Controlled Trial
Phase: NA
Conditions: Stress Management, Perceived Stress, Coping Strategy, Psychological Resilience
Sponsor: Kutahya Health Sciences University

 
 
 
 
 
 
 
 
 
 
 
The effectiveness of stress management training given to first-class health students in 
perceiving and coping with stress and developing resilience: A randomized controlled 
trial 
08.05.2024 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

METHODS ABOUT STUDY 
Type and purpose of the research 
This study, which examined the effect of stress management training given to health students 
on students' perceived stress, coping methods with stress and psychological resilience. 
Setting and time 
This study was conducted between March and May 2024 with first-year students studying in 
the associate degree health departments of the central vocational school of a health-themed 
university in Türkiye. 
Population and sample 
The population of the study consisted of 126 first-year health students studying in the associate 
degree departments of the central vocational school of a health-themed university in Turkey. 
The sample consisted of students who met the inclusion criteria and voluntarily accepted to 
participate in the study. The sample size was calculated as at least 51 students in each group 
(intervention-control) with 5% error, 80% power, and 0.5 effect size with the G*Power 3.1.7 
programme (Cohen, 1988; Cohen, 1990; Lai, 2021; Varol et al., 2015). The study was 
completed with 102 students, 51 intervention-51 control.  
Participants 
First-year associate degree health students who voluntarily accepted to participate in the study, 
who were 18 years of age or older, and who were continuing their active education were 
included in the study. Students who did not meet the specified inclusion criteria were excluded 
from the study. Figure 1 shows the design of the study (CONSORT scheme). The students 
participating in the study were not informed which group they were in. Single blinding method 
was used in the study because the researcher was involved in group allocation, intervention and 
data collection tasks.  
Randomisation  
A total of 126 first-year students studying at a vocational school were evaluated by the 
researcher according to the inclusion or exclusion criteria. As a result, 102 participants were 
randomised and assigned to the intervention and control groups. In order to reduce selection 
bias in determining the intervention and control groups, the individuals to be included in the 
sample were determined using the www.random.org website. 
Variables of the study 
The dependent variables of the study are perceived stress scale, coping methods with stress 
scale and short psychological resilience scale. Stress management training is the independent 
variable. Sociodomographic data of the students were the control variable of the study.  
Data collection tools 
The research data were collected with a form including sociodemographic characteristics of the 
students, Perceived Stress Scale, Stress Coping Methods Scale and Brief Resilience Scale. 

Sociodemographic Data Form: It is a form consisting of 18 questions questioning the 
characteristics of the students such as age, gender, the department they study, smoking status, 
income status, and the people they live with (Gülnar et al., 2024; Taş & Yıldız, 2023). 
Perceived Stress Scale (PSS-14): Developed by Cohen et al. (1983) and adapted into Turkish 
by Eskin et al. (2013), the scale consists of a total of 14 items and evaluates the stress 
perceptions of individuals in the face of certain situations encountered in their lives. The scale 
has a five-point Likert scale. The scale has two sub-dimensions. The lowest score that can be 
obtained from PSS-14 is 0 and the highest score is 56. The higher the score obtained by the 
individuals from the scale, the higher the stress perception. Cronbach's alpha coefficient of PSS-
14 was found to be 0.84 (Eskin et al., 2013). In this study, the total score of the scale was used 
and Cronbach's alpha coefficient was calculated as 0.88 in the pretest and 0.85 in the posttest 
for the intervention group and 0.82 in the pretest and 0.77 in the posttest for the control group. 
Stress Coping Methods Scale (SCMS): The coping methods scale developed by Moos (1993) 
and adapted into Turkish by Ballı and Kılıç (2016) was used to measure coping methods with 
stress. The scale consists of a five-factor structure. Consisting of 24 statements, the scale is 
graded in 5-point Likert type and the answer options are; 1-Never, 2-Rarely, 3-Sometimes, 4-
Mostly, 5-Always. The Cronbach Alpha coefficient of the scale was calculated as 0.93 (Ballı & 
Kılıç, 2016). In this study, the total score of the scale was used and Cronbach's alpha coefficient 
was calculated as 0.81 in the pretest and 0.83 in the posttest for the intervention group and 0.83 
in the pretest and 0.75 in the posttest for the control group. 
Brief Resilience Scale (BRS): The scale is a 5-point Likert-type, 6-item, self-report 
measurement tool developed by Smith et al. (2008) and adapted into Turkish by Doğan (2015) 
in order to measure the psychological resilience of individuals. After the reverse coded items in 
the scale are translated, high scores indicate high psychological resilience. It was reported that 
the Cronbach's alpha coefficient of the scale was calculated as 0.83 (Doğan, 2015). In this study, 
Cronbach's alpha coefficient was calculated as 0.84 in the pre-test and 0.89 in the post-test for 
the intervention group and 0.87 in the pre-test and 0.87 in the post-test for the control group. 
Research procedure 
In this face-to-face study, students who met the inclusion criteria were randomised and assigned 
to the groups. In the first interview with the students assigned to the intervention and control 
groups, students were informed about the purpose of the study and the process, and pre-tests 
were applied to the students after their consent was obtained. After 1 week, students randomly 
assigned to the intervention group were given psychoeducation on stress management (Weiss 
et al., 2024; Throner et al., 2023; Şenocak & Demirkıran, 2023) consisting of 7 modules (Weiss 
et al., 2024; Throner et al., 2023; Throner et al., 2023; Şenocak & Demirkıran, 2023), each 
lasting 120 minutes (with a break), on a day determined during the week for 7 weeks. Stress 
management training was given by the researcher, who has a master's degree in Community 
Mental Health Nursing and a PhD in Mental Health and Psychiatric Nursing and has received 
training on stress and coping with stress. Two weeks after the training was completed, post-
tests were applied to the intervention and control group students (Table 1). During this process, 
no intervention was applied to the control group. After the study was completed, the same stress 
management training was given to the control group.  
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                                                                                      
 
 
 
 
Fig. 1. CONSORT flow diagram. 
 
 
 
 
 
 
 
 
 
Assessed for eligibility (N= 126) 
Randomized (n=102) 
Intervention Group  
Applying pretest (n=51) 
Control Group  
Applying pretest (n=51) 
Applying Stress Management 
Psychoeducation Program 
Applying posttests (n=51)  
Analyzed (n=51)  
Excluded from analysis (n=0) 
Applying posttests (n=51)  
Analyzed (n=51)  
Excluded from analysis (n=0) 
No intervention 
Not included (n=24) 
-Refusal to participate in the study 
(n=11). 
-Under 18 (n=3) 
-Not continuing education despite 
being registered (n=10) 
Allocation 
Analysis 
Power analysis=51 

Table 1. Stress Management Training Content 
Modules 
Contents 
First meeting: Explanation of the purpose of the research and the process, application of pre-tests 
1. Module: Stress and its components 
Definition and types of stress, theoretical approaches to 
stress, symptoms and consequences of stress, mechanism 
of stress formation 
2. Module: Stress Management 
The concept of stress management, stress management 
with constructive, evaluation-oriented, problem-oriented 
and emotion-oriented approaches. 
3. Module: Crisis and its components 
Definition and types of crisis, factors that cause the 
crisis, consequences of the crisis and crisis process 
4. Module: Crisis Management 
Purposes of crisis management, importance of planning 
against crisis, crisis management approaches and models 
5. Module: Anger and its components 
Definition of anger and its examination in the 
dimensions of emotion-thought-behavior-
communication, theoretical approaches to anger, causes, 
functions, symptoms, types, forms of expression and 
consequences of anger. 
6. Module: Anger Management 
Anger management and control, anger management 
strategies, techniques that can be used in anger 
management. 
7. Module: Psychological resilience 
Definition of psychological resilience, challenging 
situations, developmental processes and capacity, 
positive psychological outcomes, risk factors, 
components of psychological resilience in the individual 
(personal, environmental, relational), equipment that 
increases psychological resilience. 
Final meeting: Evaluation of the sessions and administration of post-tests 
 
 
Ethics  
For the scales used in the study, permission was obtained from the authors who developed the 
scales and conducted the adaptation studies into Turkish. Written permission was obtained from 
the ethics committee of the university where the study was conducted (number 2024/03-04 on 
05.03.2024) for ethical compliance and implementation. Informed consent was obtained after 
explaining the purpose of the study to the students participating in the study. In addition, the 
ethical principles of the current Helsinki Declaration were adhered to during the study. 
Analysing the data 
In this study, firstly, power analysis was performed to determine the sample size. Mean and 
standard deviation were used as descriptive statistics for quantitative variables determined by 
measurement, and number and percentage were used as descriptive statistics for qualitative 
variables determined by counting. Chi-square test and Fisher's exact test were used to analyse 
the similarity of the groups. After the normality analyses showed that the data had a normal 
distribution, independent sample t test and dependent sample t test were used for comparisons 
of pre-test and post-test scores within and between groups. Analysis of covariance (ANCOVA) 
was used to determine the effectiveness level of psychoeducation. In order to determine the 
effect size, Eta Squared (µ²) values were taken into consideration and these values were 

interpreted by taking the values determined by Cohen (1992) as criteria (small if .01, medium 
if .06 and above, and large if .14 and above) (Pallant, 2017). Cronbach's Alpha was calculated 
for reliability analysis. Analyses were performed with SPSS V25 and p<0.05 was considered 
statistically significant in comparisons.