MINDSET OVER MATTER: THE EFFICACY OF A THREE-WEEK STRESS MINDSET INTERVENTION WITH

FIRST-YEAR COLLEGE STUDENTS

By

Caitlyn A. Loucas

Submitted to the

Faculty of the College of Arts and Sciences

of American University

in Partial Fulfillment of

the Requirements for the Degree of

Doctor of Philosophy

In

Clinical Psychology

Chair:

Dean of the College of Arts and Sciences

Date

2021

American University

Washington, D.C. 20016

_________________________________ Kathleen C. Gunthert, Ph.D.

_________________________________ Nicole E. Caporino, Ph.D.

_________________________________ Laura L. Duval, Ph.D.

_________________________________ Evelyn Behar, Ph.D.

October 11, 2021

© COPYRIGHT

by

Caitlyn A. Loucas

2021

ALL RIGHTS RESERVED

I am deeply grateful for the mentorship and support of Dr. Kathleen Gunthert, who not

only provided me with the initial opportunity to pursue my Ph.D., but whose brilliant clinical and

research mentorship has made the past five years incredibly fulfilling. This project would also

not have been possible without the hard work and collaboration of my fellow lab members in the

Stress and Emotion Lab.

This dissertation and my degree would also not have been possible without the support

and patience of my loved ones - To my husband, Patrick, whose love and puns have sustained

me during the most challenging moments of this journey. To my sister, Hanna, whose humor,

compassion, and joy are as prominent as her ability to quickly respond to text messages is absent.

And finally, this project is dedicated to Kathy and Wayne Loucas for their boundless

love, creativity, strength, and support. Of all the blessings in my life, I rank among the highest

that I can call you both my parents.

iii

MINDSET OVER MATTER: THE EFFICACY OF A THREE-WEEK

STRESS MINDSET INTERVENTION WITH

FIRST-YEAR COLLEGE STUDENTS

BY

Caitlyn A. Loucas

ABSTRACT

Although stress is commonly characterized as negative and harmful, recent research has

demonstrated that interventions encouraging a more positive mindset about stress (i.e., that stress

can have both enhancing and harmful effects) can lead to improved physiological, psychological,

and behavioral outcomes. However, these experimentally-induced improvements to health and

functioning have rarely been tested over longer intervals of time and appear prone to rapid decay.

Our study tested the efficacy of a novel stress mindset intervention including daily 21-day

rehearsal on psychosocial health outcomes and daily stress-related processes. Eighty-eight first-

year college students were randomized to either a non-intervention control (NIC) or a stress-is-

enhancing (SEC) condition. The SEC participated in an interactive seminar providing

psychoeducation about the acute stress response and training about how to adopt a more positive

stress mindset. All participants completed online surveys for 21-days to record daily processes

(perceived stress, stress mindset, affect, and appraisals of daily stressors), and the SEC was

encouraged to rehearse stress mindset strategies. Results demonstrated that our intervention

produced more adaptive stress mindsets, improved mood symptoms, as well as improved

challenge appraisals and perceptions of abilities to cope with daily stressors. This research

further supports the efficacy of stress mindset interventions in promoting psychosocial health and

more adaptive cognitive responses to daily stress, and also suggests that rehearsal of stress-

mindset strategies may help minimize decay over time.

iv

TABLE OF CONTENTS

ABSTRACT .........................................................................................................................iii

LIST OF TABLES .................................................................................................................v

LIST OF ILLUSTRATIONS ................................................................................................vi

CHAPTER 1 INTRODUCTION ...............................................................................1

CHAPTER 2 METHOD ...........................................................................................19

CHAPTER 3 RESULTS ...........................................................................................29

CHAPTER 4 DISCUSSION .....................................................................................38

REFERENCES ......................................................................................................................46

v

LIST OF TABLES

Table

Table 1. Means and Standard Deviations of Time 1 and Time 2 Variables (N=88)……......30

Table 2. Means and Standard Deviations of Daily Variables……………………….……...30

Table 3. Baseline Correlations Among Time 1 Variables………………………..…..…….32

vi

LIST OF ILLUSTRATIONS

Illustration

Figure 1. Interaction between Stress Mindset Condition and Baseline Stress Mindset…......36

Figure 2. Relationship between Daily Stress and Emotional Coping Resources……….…...37

1

CHAPTER 1

INTRODUCTION

There has been a great deal of attention given to the negative effects of stress on physical

health, mental health, relationships, performance, and on interventions designed to reduce the

frequency, duration, and intensity of stressors (Cohen et al., 2007; Davis et al., 2008). However,

researchers have more recently begun to argue that we need to shift the narrative toward a more

balanced conceptualization of stress in order to harness its positive effects (McGonigal, 2016). In

the present study, we test whether a novel “stress-is-enhancing” mindset intervention including

nightly rehearsal for first-year college students leads to improved psychosocial and emotional

outcomes after 21-days.

Background

Stress is a common and inevitable experience in life, but it represents a complex psycho-

physiological phenomenon. Stress is often defined as a dynamic interaction between the external

challenges faced by an organism, as well as the organism’s appraisals of the stressor and of their

own coping resources (Folkman & Lazarus, 1984). In this way, stress is said to occur when

appraisals of a stimuli that threaten an individual’s goals or wellbeing are believed to exceed

their perceived ability to cope with the stressor. The resultant stress response in the body initiates

a cascade of physiological arousal, including activation of the sympathetic-adrenal-medullary

(SAM) system, parasympathetic withdrawal, and the hypothalamic-pituitary-adrenal (HPA) axis

(Dhabhar, 2018; Mendes & Park, 2014). Some of the early theorists studying the human

experience of stress characterized the stress response as a nonspecific physiological reaction

produced in response to a wide degree of emotionally-valanced situations that can persist for

varying durations of time (Selye, 1936). While no standardized definition exists to differentiate

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acute from chronic stress, extended exposure to a stressor and the ongoing physiological stress

response is often referred to as “allostatic load” in which allostasis, or the body’s internal process

of regaining its baseline state of homeostasis, is repeatedly activated to address a perceived

stressor. This pattern of overactivation produces progressive wear-and-tear on the body’s natural

allostatic systems and can lead to physiological dysregulation over time (Juster et al., 2010;

McEwen & Stellar, 1993). In line with this theory, chronic stress has been linked to a host of

negative physical and mental health outcomes, including heart disease and autoimmune diseases

(Cohen et al., 2007; Sapolsky, 1996), as well as anxiety and depression (Hammen, 2005; Phillips

et al., 2005).

It is no wonder, then, that the common narrative about stress often describes it as a

negative and dangerous experience that should be avoided in order to lead a healthy life. Given

that the most frequent bodily changes associated with the body’s stress response are typically

regarded as unpleasant (i.e., muscle tension, increased heart rate, etc.), it is understandable that

the most common goal would be to manage or reduce these sensations. In accordance with this

belief system, traditional interventions to address stress most commonly implement stress-

reduction strategies aiming to minimize the individual’s stress response (Varvogli & Darviri,

2011). Framing stress as an enemy to public health and well-being has spawned a rapidly

growing self-help industry promoting strategies about how to live a “stress-free” life (Olpin &

Bracken, 2014). Certainly, cognitive, behavioral, and interpersonal strategies can be effective

(Hofmann et al., 2012), and it is important to help people manage high levels of stress. However,

in the typical human experience, there will be no way to construct a “stress free” existence or

even to maintain low levels of stress, as there will be challenges at times that tax the body’s

physical, cognitive, and emotional resources. Importantly, the very stress response that is often

3

targeted for remediation also serves important and adaptive physiological, cognitive, and social

functions.

The Adaptive Nature of Stress

Despite these well-accepted tenets about the consequences of stress, when we focus on

reducing stress, we sometimes fail to consider that the evolutionary function of the stress

response is to mobilize physical and cognitive resources to adaptively meet acute challenges and

promote survival (McGonigal, 2016; Sapolsky, 2007). Although chronic stress can be a barrier to

healthy functioning, the acute stress response can support physical recovery, enhance the

immune system, and promote improved musculoskeletal and cardiovascular functioning

(Dhabhar, 2014; Rosenberger et al., 2009). For example, rats exposed to short-term stress during

viral inoculation showed significantly enhanced immune responses to the same antigen nine

months later compared to those inoculated under non-stressed circumstances, suggesting that the

enhancing effects of the acute stress response may also persist beyond the duration of the stressor

(Dhabhar & Viswanathan, 2005).

The adaptive nature of stress is certainly not a recent concept. Early theoretical models

had posited differences in neurocortical activation under conditions of “positive” stress (Levi,

1971), leading to a foundational publication by Hans Selye (1974) that introduced the term

“eustress” to refer to a physiological response to a stressor that is initiated by pleasant emotional

states. Compared to its counterpart “distress,” which occurs in negatively-valanced emotional

situations and can lead to poor health outcomes, eustress can improve function and wellbeing.

Recent work by Kelly McGonigal (2016) has reviewed a number of domains in which stress can

have positive effects, including performance, social relationships, and connection to sources of

meaning and purpose in life.

4

Positive Effects of Stress on Performance

Although stress is commonly viewed as detrimental to performance and productivity,

research suggests that some forms of stress may actually be beneficial and, in fact, necessary to

achieve performance goals. Studies have demonstrated that the acute stress response can

facilitate improved cognitive performance through the release of neurohormones, such as

adrenaline, and cortisol. These hormones increase oxygenation and bloodflow to the brain, which

can result in maximizing efficient use of energy resources, enhancing physical capabilities, and

heightening attention and focus under conditions of stress (Cahill et al., 2003; Chajut & Algom,

2003). Similar to the Yerkes-Dodson Law, more recent theories have conceptualized the

curvilinear relationship between stress and performance as an individual zone of optimal

functioning in which the zone of moderate physiological arousal that is capable of improving

performance differs from person to person (Hanin, 2007; Teigen, 1994). This makes intuitive

sense, as many high-stress professions that require remarkable acts of precision and focus, such

as performing emergency surgery or engaging in military action, are successfully undertaken

under highly stressful circumstances. Research in the field of sports psychology has also

debunked the notion that optimal levels of performance must occur in the absence of stress. One

study by Hanin (1986) asked a sample of 46 elite athletes to rate their levels of pre-competition

stress and anxiety; they found that their responses fell at the approximate midpoint of the stress

measure, rather than at values closer to zero. This has been further supported by interviews with

athletes designated as “high-performers,” who reported the belief that their best performances

occur under conditions of stress (Jones et al., 1993). Additionally, senior surgeons have reported

higher awareness of stress during procedures than their junior colleagues, but rated lower

perceptions that these stressors would impair their performance (Wetzel et al., 2006). In lab

5

paradigms, inducing moderate levels of stress have been shown to enhance learning-based

performance, especially with regard to emotional material (Payne et al., 2006; Smeets et al.,

2007). Taken together, the physical and cognitive effects of the acute stress response can actually

prepare, rather than impair, the body to perform at its highest level.

Positive Effects Stress on Social Functioning

Stress can also play a facilitative role in promoting and strengthening social relationships.

In contrast to the more familiar stress hormones, such as cortisol, associated with sympathetic

activation, oxytocin is also released from the pituitary gland as part of the body’s natural stress

response and increases sensations of calm, trust, and social connection (Uvnäs-Moberg &

Petersson, 2010). In contrast to the “fight-or-flight” reaction of the sympathetic nervous system,

oxytocin is frequently acknowledged as the main mechanism of the “tend-and-befriend”

physiological response due to its role in promoting positive risk-taking and motivation to engage

in social behaviors, particularly in females (McGonigal, 2016). In animal models, oxytocin-

knockout rats have impairments in social responses and social memory without demonstrating

difficulties with other cognitive and olfactory tasks, suggesting a unique relationship between

oxytocin and social behaviors (Ferguson et al., 2000). Among its many functions in human

subjects, oxytocin has been shown to increase social attachment and prosocial approach

behaviors, such as trust (Baumgartner et al., 2008; Kosfeld et al., 2005). For individuals with

autism spectrum disorder, a neurodevelopmental disorder characterized by difficulties with

social awareness, social cues, and communication, administration of oxytocin temporarily

improved emotion recognition and retention of social information (Guastella et al., 2010;

Hollander et al., 2007). Experimental administrations of oxytocin have demonstrated that the

complex neurohormone may not only play a role in increasing approach behaviors through more

6

frequent and accurate interpretation of subtle social cues, but in moderating responses to social

information (i.e. faces displaying anger) that could initiate withdrawal (Evans et al., 2010; Kemp

& Guastella, 2010). For example, oxytocin produced increases in social-cognitive behaviors

through increased eye contact with human faces (Guastella et al., 2008) and improves the

accuracy of facial emotion recognition, even after controlling for arousal and mood (Domes et

al., 2007). In a study of women exposed to a stressor, oxytocin levels were related to increased

social bonding behaviors, including proximity and connection seeking (Light et al., 2005). Taken

together, the body’s acute stress response appears to create conditions under which individuals

may be more physiologically prepared and motivated to seek out social support and strengthen

social connection during stressful situations.

Positive Effects of Stress on Meaning and Purpose

While the commonplace dialogue about stress posits it as a detractor from experiencing a

good life, more recent research suggests that it can be the opposite – namely, that stress is the

natural byproduct of pursuing a meaningful life. In one study, a large sample of American adults

rated the degree to which they perceived their lives as meaningful, in addition to estimating the

number of stress events experienced in their lives. The results demonstrated that those who

experienced the most stressful events were more likely to also report that their life was highly

meaningful. In addition to recalling prior stressful events, this finding held true for those who

reported experiencing the highest degrees of stress in the present moment (Baumeister et al.,

2013). A subset of analyses from the Gallup World Poll provided a more global approach to

correlations between stress and indexes of well-being and life satisfaction from approximately

125,000 respondents representing 121 countries. The findings demonstrated that nations with

higher stress indexes also had higher ratings on multiple indexes of national wellbeing, including

7

life expectancy, life satisfaction, health, GDP, and happiness (Diener & Tay, 2015). Although

the nature of stress may be an uncomfortable physiological experience, it can often be

conceptualized as a reaction in a situation where a source of meaning is perceived as threatened.

For example, the stress a student feels about an upcoming exam may be inextricably linked to the

meaning derived from their identity as a successful student, whereas the stress stemming from an

unsuccessful job interview may relate to the goal of pursuing a particular valued career.

Although more physiologically comfortable, a lack of stress in response to challenging

experiences would likely indicate that successful resolution of the stressor holds little value and

could lead to reduced motivation toward goal-directed behaviors. In this way, the stress response

can also represent engagement and connection with valued activities, roles, and goals that are

indicative of personal meaning and sources of positive growth.

The Role of Mindsets

These contrasting findings regarding how stress can have enhancing effects in some

contexts (i.e., improved performance) and deleterious effects in others (i.e., poor health

outcomes) have formed what is known as the stress paradox (Crum et al., 2013), and led to a

growing field of research exploring potential moderators of stress-related outcomes. Stress

researchers have begun to ask whether an individual’s mindset about the experience of stress

itself can affect health outcomes. In general, mindsets are defined as a mental frameworks

through which information is organized and encoded in order to guide how an individual

understands and responds to stimuli in their environment (Crum et al., 2013; Dweck, 2000).

Similar to a cognitive schema, a mindset allows individual to selectively filter incoming

information in accordance with existing belief systems at an automatic or nearly-automatic level

that initiates a concordant battery of thoughts, emotions, and actions.

8

Early research into mindsets built off of literature exploring implicit theories about the

perceived malleability of personal attributes, such as personality or intelligence (Dweck, 1996;

Dweck & Leggett, 1988; Yeager & Dweck, 2012). Growth mindsets have been associated with a

host of adaptive psychosocial and achievement outcomes, including academic performance

(Yeager & Dweck, 2012), athletic ability (Kasimatis et al., 1996), weight management (Burnette,

2010), and social judgments about others (Chiu et al., 1997). Growth mindsets about aging have

been associated with a wide range of physical health outcomes, including increased engagement

in proactive health behaviors and overall longevity (Levy et al., 2002; Levy & Myers, 2004).

Interestingly, mindsets and implicit beliefs have also been shown to affect physiological

processes inside the body as well. For example, a study by Alia Crum and colleagues (2011)

found that levels of ghrelin, a hormone that induces the sensation of hunger, declined steeply for

individuals who held the mindset that they were consuming a more calorie-rich milkshake,

compared to stable ghrelin levels when the same milkshake was consumed under the mindset

that it had fewer calories – suggesting a form of psychological mediation of the body’s

physiological processes. There is a literature, then, that suggests that the mindsets through which

experiences are filtered can influence physical and health outcomes.

Stress Mindsets

A stress mindset refers to the extent to which an individual believes that stress will have

enhancing or debilitating effects (Crum et al., 2017). In this literature, researchers draw a

distinction between an individual’s perceived stress levels and their belief about how the stress

they experience will affect their health and functioning. Although related, there are subtle but

important distinctions between a stress appraisal and stress mindset. Whereas stress appraisal is

defined as the degree to which an individual perceives a stressor as a threat (as opposed to a

9

challenge) and taxing to their coping resources, a stress mindset reflects the individual’s beliefs

about stress in general (Jamieson et al., 2018). While specific stress appraisal is context-

dependent and inextricably linked to each unique transaction between the environment and the

individual, a stress mindset can apply across a spectrum of stressful circumstances (Crum et al.,

2013; Kilby & Sherman, 2016). Individuals with a stress-is-debilitating mindset would be more

likely to believe that optimal outcomes occur in the absence of stress, whereas individuals with a

stress-is-enhancing mindset would be more likely to perceive stress as a helpful context for

growth and enhanced performance.

Having an adaptive stress mindset has been associated with benefits to subjective and

objective markers of health and wellbeing (Crum et al., 2013; Nabi et al., 2013). Interestingly,

these results hold true above and beyond measured levels of stress itself. In one large-scale

study, individuals who reported high levels of stress had an elevated risk of premature mortality

than those with lower levels of stress; however, researchers found that these results only held

true for individuals who also had a negative stress mindset and believed that stress was harmful

to their health. Conversely, individuals who reported high stress but held a more positive stress

mindset were no more likely to prematurely die than those reporting lower levels of stress

(Keller et al., 2012). Similarly, the British Whitehall II longitudinal cohort study of 10,308

British civil servants found that individuals who believed stress was debilitating to their health

were significantly more likely to have cardiac complications, including increased likelihood of a

non-fatal heart attack or cardiac-related death at an 18-month follow-up (Nabi et al., 2013).

Among students, viewing stress as debilitating was associated with higher burnout in both

personal and academic environments (Klussman et al., 2020).

10

Additional research has supported the associations between stress mindsets and stress-

related outcomes in response to laboratory-induced stressors as well. In a study by Crum and

colleagues (2013), undergraduate students underwent a modified Trier Social Stress Task in

which participants prepared a brief speech that they were told would be viewed and evaluated by

a team of experts. In response to this stress-induction procedure, participants who held a stress-

is-enhancing mindset showed more adaptive cortisol profiles during the task, regardless of their

individual level of baseline cortisol reactivity, and were more likely to request feedback about

their performance. Research by Keech and colleagues (2018) using a similar student population

found that participants who held more adaptive stress mindsets were also more likely to engage

in proactive and problem-focused coping behaviors that were associated with increased

psychological wellbeing. Taken together, these results suggest that there are physiological and

behavioral differences in how mindsets can affect the likeliness of pursuing growth opportunities

in the face of stressful experiences. Importantly, holding an adaptive stress mindset has been

shown to improve these outcomes without attenuation of the SNS activity, supporting stress

mindset theories that reduction or elimination of the body’s stress response is not necessary to

enhance performance (Beltzer et al., 2014; Jamieson et al., 2010). From this perspective, the goal

isn’t to reduce stress, but to recognize how the body’s stress response can facilitate positive

outcomes and growth.

Stress mindsets may also moderate the relationship between the experience of stressful

life events and psychological outcomes. For example, a cross-sectional study by Jiang and

colleagues (2019) examined stress mindsets in a sample of Chinese adolescents belonging to

rural-to-urban migrant families who were at an increased risk of experiencing adverse challenges

related to transitioning during urban relocation. In this sample, adaptive stress mindsets buffered

11

the impact of stressful life events on depressive symptoms. Additionally, Park and colleagues

(2018) studied a large, diverse cohort of adolescent students over the course of an academic year

and found that increases in stressful adverse events resulted in higher perceived distress at an

end-of-year follow-up; however, this association was weaker for those who had endorsed a

stress-is-enhancing mindset. In addition to research examining outcomes at one or two distinct

timepoints, a recent study by Laferton and colleagues (2020) used naturalistic methodology in a

sample of university students, in which participants completed daily diaries for 10 consecutive

days about their daily experiences of stress and affect. Individuals with negative beliefs about

stress showed strong negative affect and decreased positive affect in response to their experience

of daily stressors, whereas those who endorsed more adaptive beliefs about stress showed no

change in positive affect and demonstrated a weaker association with negative affect in response

to stressful events. These results support how an individual’s mindset about stress can be directly

associated with stress-related outcomes and, ultimately, might result in a self-fulfilling prophecy

for individuals with a more positive outlook about the impact of stress on health and daily

functioning.

Experimental Manipulations for Stress Mindsets

In addition to studies examining existing associations between stress mindsets and stress-

related outcomes, a recent and growing field of experimental research has demonstrated that

stress mindsets are often malleable to intervention. Experimental interventions frequently use a

psychoeducational format that increases awareness of the individual’s implicit judgments about

stress and offers new information to shift their expectations (Jamieson et al., 2018). In a

community sample, participants who were randomized to receive information encouraging a

positive stress mindset demonstrated improved cardiovascular stress responses and decreased

12

attentional bias for negatively-valenced emotional content following a lab-induced stressor

(Jamieson et al., 2012). In addition to improved physiological responses following a laboratory

stress task, participants who had viewed a 3-minute video with information about the enhancing

effects of stress on cognitive performance demonstrated more adaptive neuroendocrine profiles,

heightened attentional bias toward positive stimuli, and increased cognitive flexibility, compared

to participants who received a parallel intervention about the debilitating effects of stress (Crum

et al., 2017). Research has also examined the effect of stress mindsets interventions on affective

measures, and has found evidence that a positive stress mindset intervention predicted both a

reduction in negative affective displays of anxiety and shame (Beltzer et al., 2014) and increases

in positive affect (Crum et al., 2017) in response to lab-based stressors.

Compared to experimental videos highlighting either the purely positive or purely

negative effects of stress, Liu and colleagues (2017) found that individuals in a condition that

included a balanced perspective demonstrated the most adaptive physiological profiles following

a lab-induced stress task. Although this study found that their positive stress mindset condition

demonstrated improved outcomes over the negative stress mindset condition, the authors

highlighted the importance of acknowledging and recognizing the debilitating effects of chronic

stress in order to prevent biased and unrealistic expectations about stressful experiences and,

consequentially, reduced internalization and rejection of the intervention information.

While lab-induced paradigms are able to more carefully control the source and context of

the experienced stressors, interventions have demonstrated efficacy as well in response to

naturally occurring experiences of stress. One study by Crum and colleagues (2011) used a

sample of 229 employees who participated in a stress management training program through

their workplace that provided information about the enhancing effects of stress. Compared to

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those randomly assigned to a control condition that received no information, intervention

attendants reported more adaptive stress mindsets, as well as improvements in mood and anxiety.

These findings were additionally supported in a study using employees at a large financial

institution who, in addition to those in a control condition, viewed three brief videos over the

course of one week presenting information about either the enhancing or debilitating effects of

stress in the domains of health, performance, and learning and growth. Results showed that

individuals in the stress-is-enhancing condition demonstrated improvements in self-reported

ratings of psychological distress and work productivity at a two-week follow-up (Crum et al.,

2013). Finally, a study by Jamieson and colleagues (2010) used a sample of participants

preparing to take the Graduate Record Examination (GRE), a high-stakes standardized test used

for applications for academic programs. In this study, participants randomized to a stress-

reappraisal condition read a brief statement providing information about the positive effects of

the stress response on performance prior to taking a practice GRE test. On both the laboratory-

based practice test and their subsequent performance on the actual GRE, participants who had

viewed information highlighting the adaptive effects of stress outperformed their counterparts in

a control condition, suggesting that the lab-based stress-mindsets manipulation had generalized

to a real-world testing environment. Despite these promising results, the existing literature on

stress mindsets interventions remains limited. Many of these prior studies examine momentary

changes in psychological and health variables within short time periods after receiving

intervention content; however, the larger goal would be to examine longer-term changes

indicative of sustained improvement. Further research is needed to more fully explore the

efficacy and feasibility of experimental stress mindset manipulations over longer intervals of

time.

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Stress in College Students

While the experience of stress is certainly not localized to one particular demographic,

college is often a time of anticipated stress and anxiety for incoming students. For many of these

late adolescents, college represents a transitional period in which they must face and adapt to a

host of new situations, including academic structures and workloads, social/romantic

relationships, explorations of identity, and managing an increasing number of responsibilities

(i.e., financial, medical, etc.). In addition to these sources of stress, students are also often

warned about the negative consequences of experiencing stress. Informational campaigns on

American University’s own campus display warnings that the effects of stress include, among

other things, low energy, lower immunity against illness, and low concentration. Current

approaches to addressing stress often exclusively promote strategies to avoid stress (i.e., time-

management skills) or reduce stress reactions (i.e., meditation or relaxation). As many sources of

stress are unavoidable, an exclusive focus on a “stress-avoidant” approach could lead to students

to believe that times of stress are an indication that they are losing a battle against stress and are

failing to have a healthy experience in college. Over time, consistent experiences of “failing” to

avoid stress may also lead students to feel a sense of helplessness in the face of stressors, which

may dissuade them from taking steps to pursue improvement or growth.

A recent survey of college students found that a combined 57.6% of undergraduate

students surveyed reported experiencing an overall stress level that was “more than average” or

“tremendous” over the prior 12 months and that stress was endorsed as the leading factor

negatively impacting their individual academic performance (American College Health

Association, 2018). With regard to first-year students in particular, the frequency of individuals

who endorse frequently feeling overwhelmed has been steadily increasing from 14% of

15

respondents in 1985 to 39% in 2018 (Astin, 1987; Stolzenberg et al., 2019). Across all other

generations, college-aged Americans have recently reported not only the highest average stress

levels and the most frequent experience of physical and emotional symptoms attributed to stress,

but also the highest levels of belief that they are not managing their stress effectively (American

Psychological Association, 2018). In fact, this same cohort of college-aged students rated their

own stress level as higher than the average perceived “healthy” amount of stress, suggesting that

this demographic views their experience of stress as not healthy – in line with a “stress-is-

debilitating” mindset. With an increasing number of students reporting stress as a major concern

during their college experience and societal messaging that reinforces the detrimental impact of

stress, establishing effective and empirically supported interventions with the potential to support

large groups of students with diverse sources of stressors is critical to meet these rising demands.

In the present study, we will use a sample of first-year undergraduate students to examine

whether a stress mindset seminar and rehearsal of stress mindset strategies can improve

psychological wellbeing and help maintain improved functioning over a 21-day period,

compared to a control group. Additionally, we aim to explore whether participants in the

intervention group experience more adaptive daily cognitive-emotional processes.

Overview of Current Study and Hypotheses

While a growing body of research has demonstrated the malleability of stress mindsets

and the efficacy of interventions on improving stress-related outcomes over a short period of

time, it has not yet been established whether these changes are maintained for longer periods in

the context of everyday stressors. Currently, the longest follow-up period for a peer-reviewed

stress mindset intervention is two-weeks using a guided imagery manipulation, and the

researchers did not find that improvements in health and performance outcomes were maintained

16

at the two-week time point (Keech et al., 2019). It may be that stress mindsets and their impact

on stress-related outcomes are highly suggestible following short-term exposure to targeted

information, but tend to decay toward an individual’s baseline state within a relatively short

period of time. Changing one’s implicit mindset about stress is likely an effortful process that

requires repeated conscious implementation of positive stress mindset strategies when facing

stressful experiences.

In light of current findings, it would be beneficial to explore whether naturalistic

methodology is able to measure the daily variation in emotional or cognitive processes affected

by an individual’s stress mindset that cannot be captured by traditional pre- and post-intervention

repeated measures. While prior research using daily diaries has tested whether negative stress

mindsets moderate the relationship between perceived daily stress and affective variables

(Laferton et al., 2020), research has yet to examine whether this relationship, as well as

improvements across other psychological variables, is consistent with stress mindsets induced

during an experimental intervention.

Prior research from the Stress and Emotion Lab (Chue, 2019) has examined experimental

manipulations for stress mindsets using brief (3.5-minutes) intervention videos administered to a

community sample of participants that described either enhancing or debilitating effects of stress.

Results showed that, while the intervention was successful in shifting participants’ mindsets

about stress in the expected direction at two weeks post-manipulation, there was no significant

impact to daily cognitive processes. It was therefore suggested to expand upon this prior work by

creating a more robust intervention that uses in-person attendance, interactive discussion, and

daily opportunities for rehearsal of intervention material in order to maximize participants’

17

abilities to internalize the stress-is-enhancing messaging and apply it to naturalistic experiences

of stress in their daily lives.

As such, the present study aimed to test a novel intervention consisting of a 90-minute

stress mindset seminar in addition to nightly 21-day rehearsal in a group of first-year

undergraduate students. In addition to information compared between baseline (Time 1) and at

21-days (Time 2), we will use daily diaries to capture self-report experiences of perceived stress,

daily stress mindset, affect, and cognitive appraisals during the 21-day study period. For

individuals in the experimental intervention condition, daily diaries will also serve to encourage

rehearsal of strategies presented during the intervention seminar to encourage a stress-is-

enhancing mindset in response to naturalistic stressors. A naturalistic approach was selected to

capitalize on its advantages over other forms of experimental methodology, such as increased

ecological validity in the context of perceptions of daily stress and affect, as well as the ability to

examine both within-person and between-person changes over time (Gunthert & Wenze, 2012).

Naturalistic designs are especially well-suited for these variables, compared to pre-/post-

intervention data capture, given that the proximity of assessment to the occurrence of daily

events can minimize the impact of recall bias (Shiffman et al., 2008).

In this study, we specifically opted to use a non-intervention control, as opposed to a

“stress-is-debilitating” condition for multiple reasons grounded in ethical, statistical, and theory-

driven considerations. Firstly, our presumption is that participants in our sample will have a

default stress mindset that is already indicative of beliefs that stress has largely negative

consequences. This has been supported by prior research showing that baseline measurements of

stress mindsets prior to intervention content have overwhelmingly produced scores indicative of

a “stress-is-debilitating” mindset (Crum et al., 2013; Liu et al., 2017; Park et al., 2018). Hence,

18

absent any intervention content, many people will already hold the belief that stress has

debilitating consequences. Additionally, it has been suggested that intervention conditions

reinforcing the detrimental effects of stress might result in a floor effect; stress mindsets in

general tend to be fairly negative, limiting their ability to be further lowered (Crum et al., 2013).

In light of the prevailing perspective that stress has debilitating consequences to health, it did not

seem necessary or ethical to experimentally worsen stress mindsets in a population that has

consistently reported elevated experiences of stress, especially in a longitudinal study.

Compared to individuals in a non-intervention control (NIC), we predict that individuals

in the stress-is-enhancing condition (SEC) will report improved psychosocial outcomes after 21

days, as well as more adaptive daily stress mindset, cognitive appraisal, and affective variables.

More specifically, we hypothesize that individuals in the SEC will report:

1. More adaptive (“stress is enhancing”) stress mindsets at Time 2

2. Lower symptoms of mixed mood, including depression, anxiety, and general distress,

at Time 2.

3. Lower symptoms of perceived stress at Time 2

4. More adaptive daily stress mindsets.

5. Higher positive affect (PA) and lower negative affect (NA).

6. More adaptive daily appraisals of stress-related outcomes. We predict that the SEC

will rate their worst daily stressor as less threatening, more controllable, more of a

surmountable challenge, and will report having adequate emotional resources to cope.

We also conducted exploratory analyses to examine whether the within-person relationships

between daily stress and stress mindset, affective, and cognitive variables differ as a function

of intervention condition.

19

CHAPTER 2

METHOD

Participants

Participants were deemed eligible to participate if they were if they were 18+ years of

age, first-year undergraduate students at American University, and fluent in the English

language. With institution approval, participants were recruited using flyers and institution-

associated social media platforms. An a-priori power analysis based on the average effect size

found in prior experimental stress appraisal literature (e.g., (Crum et al., 2017; Jamieson et al.,

2010) led to a goal sample size of 51 participants per condition (Faul et al., 2014); however,

recruitment was prematurely halted due to the onset of the COVID-19 pandemic, resulting in a

total sample of 89 students..

Initially, 123 individuals provided informed consent and completed the baseline survey.

Participants who completed the baseline survey were randomly assigned to experimental

condition, which was generated using assigned probability in order to yield approximately equal

numbers of participants across both conditions throughout the duration of the study. Of these

students, 30 did not continue participation after the baseline survey and 5 participants did not

meet minimum participation requirements (i.e. completion of 11 of 21 daily surveys) for the

Time 2 survey. These participants were removed from any subsequent analyses, leaving the final

sample size of 88 individuals. Of this final sample, 47 participants had been randomly assigned

to the experimental “stress-is-enhancing” (SEC) condition and 41 participants had been assigned

to the “non-intervention control” (NIC) condition. There were no significant differences on

demographic or baseline study variables between those who were and were not eligible to

complete Time 2 measures. The final full sample included 71 (80.7%) females and 17 (19.3%)

20

males who ranged in age from 18 to 21 (M = 18.51, SD = 0.62). Racial/ethnic identity was self-

reported as 60.2% White/Caucasian, 4.5% Hispanic/Latinx, 12.5% Asian, 9.1% Black/African

American, 1.1% Middle Eastern/North African, and 12.5% Multi-Racial.

Measures

Time 1 and Time 2 Measures

Stress Mindsets

The Stress Mindset Measure - General (SMM-G; Crum et al., 2013) is an 8-item self-

report questionnaire that measures an individual’s mindset about stress, specifically the degree to

which participants view stress as either enhancing or debilitating. Responses are rated on a 5-

point Likert scale (0 = “Strongly disagree” - 4 = “Strongly agree”). A total score is created by

reverse scoring the negative-valenced items (i.e., “The effects of stress are negative and should

be avoided”) and averaging the scores together with the scores of the positively-valenced items

(“Experiencing stress enhances my performance and productivity.”), with higher scores

indicative of a more positive stress mindset. This measure has been shown to have good internal

consistency (α = 0.86), as well as good discriminant validity and predictive validity for health

and life-satisfaction outcomes (Crum et al., 2013). Internal consistency scores in the current

study were good (α = 0.80).

Depressed Mood

The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977) is a 20-

item self-report measure that assesses symptoms of depressed mood, including feelings of guilt

and worthlessness, hopelessness, lack of energy, as well as disruptions in sleep and appetite by

rating frequency of occurrence during the previous week. Responses are rated on a 4-point scale

(0 = “Rarely or none of the time - Less than 1 day”; 1 = “Some or a little of the time – 1-2 days”;

21

2 = “Occasionally or a moderate amount of time – 3-4 days”; 3 = “Most or all of the time - 5-7

days”). Positively-valenced items are reverse-coded and summed with the remaining items to

create a total score, with higher scores reflecting more distressed mood. Prior research suggests

good internal consistency (α = 0.85-0.92), good test-retest reliability (r=0.4-0.7), as well as

excellent concurrent and construct validity across groups varying by age, sex, and ethnicity

(Radloff, 1977; Roberts, 1980). In the current study, internal consistency scores were excellent

(α = 0.90).

Mixed Depression and Anxiety Symptoms

The Mood and Anxiety Symptoms Questionnaire – 30 (MASQ-30; Wardenaar et al.,

2010) is an abbreviated version of the original MASQ that evaluates dimensions of the tripartite

model (Clark & Watson, 1991) that distinguishes the distinct symptoms of anxiety (somatic

arousal) and depression (anhedonia and low NA). For each of the 30 items, respondents are

asked to indicate the extent to which they have experienced each symptom over the past two

weeks. Responses are rated on a 5-point Likert scale (1 = “Not at all” - 4 = “Extremely”) and

produces three 10-item subscales for General Distress, Anhedonic Depression, and Anxious

Arousal. Reverse-coded items are summed with the remaining items to create total subscale

scores, with higher scores reflecting increasing self-reported distress. Prior research suggests

good internal consistency (α = 0.82-0.93; Topper et al., 2017), as well as good discriminant and

convergent validity (Lin et al., 2014; Wardenaar et al., 2010). Comparable to prior studies,

internal consistency scores for all subscales ranged from good to excellent (α = 0.83-0.90).

Perceived Stress

Perceived Stress Scale (PSS-14; Cohen et al., 1983) is 14-item self-report measure

assessing frequency of respondents’ levels of perceived stress in the past month, including

22

perceived ability to cope with stressful situations. Responses are rated on a 5-point Likert scale

(0 = “Never” – 4 = “Very often”). Reverse-coded items are summed with the remaining items to

create a total score, with higher scores reflecting increasing perceived stress. Prior research has

demonstrated good internal consistency in diverse samples ( α = 0.75-0.86; Cohen et al., 1983;

Mimura & Griffiths, 2004). Reliability has been demonstrated to be variable based on duration of

time between administrations; however, the PSS has shown good test-retest reliability for

reassessment intervals less than 6 weeks (Lee, 2012). In the current study, internal consistency

scores were good (α = 0.84).

Daily Measures

Daily Affect

Daily affect was assessed using a combination of 13 items from the PANAS-X (Watson

& Clark, 1999) and the Circumplex Model of Affect (Posner et al., 2005). The circumplex model

describes unique affective states through its placement on a continuum of two-dimensional axes:

valence (ranging from pleasant to unpleasant) and arousal (ranging from deactivation to

activation), and was used in order to ensure inclusion of items representing both low and high

arousal for positive affect (PA) and negative affect (NA). Evening surveys asked participants to

rate the extent to which they felt specific affective states during the current day using a 7–point

scale (1 = “Not at all” – 7 “Extremely”). A score of overall PA was created from the mean

ratings of six items (happy, excited, alert, relaxed, content, and calm). Internal consistency scores

were good for PA ratings (α=.83). A score of overall NA was also created from the mean ratings

of seven items (nervous, tense, angry, bored, sad, depressed, and hostile). Internal consistency

scores were also good for NA ratings (α=.80).

23

Daily Stress Mindset

Daily stress mindset was assessed using six items rated on a 7-point scale (1=”Not at all”

– 7 “A lot”) to measure the extent to which participants believed their stress during that day

either helped or hindered across the three domains discussed during the intervention. 1)

Motivation, performance, or learning, 2) Interpersonal relationships, and 3) Connection to

sources of personal meaning and purpose. Three items reflected positive effects of stress (i.e.

“Help to motivate you,” “Help you feel closer to another person,” and “Make you think about

what’s important in life) while three items were worded to reflect negative impacts on these

domains (i.e. “Interfere with your motivation,” “Interfere with your relationships,” and “Distract

you from what’s important in life”). Negatively-valenced items were reverse-coded and averaged

together with the scores of the positively-valenced items.

Appraisal of Daily Stress

During completion of the evening surveys, participants were asked to evaluate the

perceived stressfulness of their day through the question “Overall, how stressful was your day?”

using a 7-point response scale (1 = “Not at all” – 7 “Extremely”). This question format has

previously been used to measure daily stress and has been shown to have good predictive

validity (Armeli et al., 2016).

Specific Stressor Appraisals

During completion of the daily surveys, participants identified a category pertaining to

the worst stressor they faced during the current day (e.g., interpersonal, academic, etc.).

Participants then rated how much they agreed with statements that the stressor was controllable

(“I had control over the resolution of the problem/stressor”), a threat (“The problem/stressor was

threatening”), a surmountable challenge (“The problem/stressor was a challenge that I could

24

overcome”), and that they had sufficient emotional resources (“I had the emotional resources to

successfully cope with the problem/stressor”) using a 7-point response scale (1 = “Not at all” – 7

“Extremely”).

Procedure

Following initial contact with the study team, all participants completed electronic

informed consent and a baseline survey that collected demographic information, stress mindsets,

and depression and anxiety symptoms. Participants also completed questions and measures

relevant to a larger study, including perceived stress, distress tolerance, and perceived social

support. All participants were then randomized to either the SEC or NIC.

Prior to beginning daily surveys, participants randomized to the SEC attended an in-

person interactive seminar led by the lead study investigator. The content of this seminar was a

multimedia presentation adapted with permission from Dr. Alia Crum’s “Rethink Stress

Intervention” (Stanford Mind and Body Lab, n.d.) and contained the following content: 1) The

role stress plays in our lives, which provided balanced information about both the debilitating

and enhancing elements of stress, 2) The power of mindset, which provided a definition as well

as empirical research examples that characterize how mindsets can alter our cognitive,

emotional, and physiological responses, and 3) Strategies for how to acknowledge, welcome, and

use experiences of daily stress by adopting a stress-is-enhancing mindset. Semi-structured

discussion content further focused on how stress can have enhancing effects in three distinct

areas: 1) Motivation, performance, or learning, 2) Interpersonal relationships, and 3) Connection

to sources of personal meaning and purpose. Similar to other in-person experimental stress

mindset interventions (see Crum, 2011), the presentation and discussion lasted approximately 90

minutes. Participants were told that their daily surveys would guide them in practicing the

25

reframing techniques modeled in the seminar in response to their experiences of daily stress for

the duration of the three-week intervention. Participants in the NIC did not receive any seminar

content, but completed parallel daily surveys.

Over the course of three weeks, participants were sent automated emails at 9:00pm every

evening containing links to the appropriate daily surveys hosted through Qualtrics software. For

all participants, regardless of condition, these evening surveys included questions about self-

reported affect, perceived level of stress, the category of their worst daily stressor, and cognitive

appraisals regarding this event. In order to help facilitate rehearsal of seminar strategies to

reframe stress, participants in the SEC were given three brief writing prompts regarding whether

their worst source of daily stress facilitated positive outcomes in each of the three domains

outlined during the seminar: 1) “Can you identify any way that the stress you selected helped

to improve your motivation, performance or learning, and/or prepared you to do your best?” 2)

“Can you identify any way in which the stress you selected helped you to connect with others or

facilitated bonding?” 3) “Can you identify any way in which the stress you selected is present in

your life because it is connected to meaning and purpose in your life (e.g., roles, relationships,

activities, goals)?” Qualitative examples of responses received from participants in the SEC

include “My work stress reminds me that academic work is important to me” and “Because of

my stress, I bonded with other contestants who happened to be strangers about how difficult the

tasks were. Now, I'll see friendly faces around campus.”

In the event that participants indicated that they could not identify ways to reframe their

experience of daily stress in accordance with any of the three experimental domains, a question

automatically populated to prompt the participant to continue rehearsing these reframing skills

using a hypothetical situation. For example, in the event that a participant could not identify how

26

their stress that day could improve social connection, a new question would read: “It's important

to practice these skills! Even if it didn't happen today, please write about any ways this kind of

stress could help you connect with others or facilitate bonding.” In the event that participants

missed two consecutive days of survey completion, email reminders were provided by study

staff. At the end of the three-week study period, participants who completed at least half of their

assigned daily surveys were invited to complete a follow-up survey including re-assessment of

all baseline variables. All participants were compensated for their time using a university-

sponsored cash alternative (ClinCard) with amounts commensurate with survey completion.

Participants received $5 for completing the Time 1 survey, $0.50 for each of the first seven daily

surveys, $1 for each of second seven daily surveys, $1.50 for each of the third seven daily

surveys, and $15 for those who completed the Time 2 survey. To incentivize higher daily survey

completion, participants could earn an additional $5 for completing at least 17 of the total 21

daily surveys. In total, participants were able to earn a maximum of $46 for complete study

participation.

Data Analysis

For our primary analyses, we created main effect models to test the effect of experimental

condition on both our Time 1-Time2 variables and daily outcomes. SPSS Statistics Version 26.0

was used to test hypotheses examining change between scores at baseline (Time 1) and follow-

up (Time 2). Time 2 scores were regressed on their corresponding Time 1 scores to create

unstandardized residualized change variables to adjust for the variance in post-intervention

scores predicted by each individual’s pre-intervention scores. This method has been previously

used in the literature and is often referenced as a more statistically appropriate measure of

variation over time than a subtraction method of computing pre-post change scores (Prochaska et

27

al., 2008; Rowan et al., 2017). Independent samples t-tests were then used to calculate

differences in mean residualized change scores between the SEC (coded as 1) and NIC (coded as

2).

Due to the hierarchical structure of our data (i.e. daily surveys nested within participants),

analyses examining daily affect and cognitive appraisal variables across the 21-day study period

used Hierarchical Linear Modeling (HLM; Bryk & Raudenbush, 1992) to account for non-

independence of observations. The data were represented by a two-level model in which Level-1

variables represented daily within-subject outcome variables (i.e. daily affect) and Level-2

variables represented between-subject characteristics (i.e. intervention condition). Our

exploratory analyses also examined whether participation in the stress mindset seminar

moderated the within-subject relationship between perceived daily stress and daily affect and

cognitive appraisals. Level 1 predictors were person-centered, while Level 2 predictors were

grand mean-centered. An example of the model constructed to examine these relationships is

below.

PAij = b0j + b1j*(Stressij) + eij

b0j = γ00 + γ01(Stress Mindset Condition) + u0j

b1j = γ10 + γ11(Stress Mindset Condition) + u1j

In this instance, the model examines the association of perceived stress (Stress) and

positive affect (PA), where for participant i, PAij is the level of PA on day j; the intercept b0i is

the average level of PA at average levels of perceived stress; b1j is the slope of the relationship

between perceived stress and PA on day j; and eij is the error. In this way, each participant has a

unique regression parameter that represents their own relationship between perceived stress and

PA. By examining how within-person relationships vary depending on between-subjects

28

characteristics at Level 2, we can examine whether these statistical relationships varied as a

function of stress mindset condition (SEC vs. NIC).

For our secondary analyses, we examined whether these effects were moderated by each

individual’s baseline stress mindset or levels of depression symptoms.

29

CHAPTER 3

RESULTS

Descriptive Statistics

Overall, there was an 86% compliance rate with the daily surveys, with 1584 completed

out of a possible 1848. On average, participants completed 18.03 daily surveys (SD=2.88,

range=11-21) and compliance rates were not shown to significantly differ between experimental

conditions. The number of surveys completed over the 21-day study period was not significantly

related to baseline variables, including levels of stress mindsets (r=.13, p=.20), CES-D

depression (r=.03, p=.77), general distress (r=.05, p=.58), anhedonic depression (r=.16, p=.13),

anxious arousal (r=.02, p=.81), or perceived stress levels (r=-.08, p=.47). Descriptive statistics

for variables measured during Time 1 and Time 2 surveys are reported in Table 1. The mean

scores for depression, distress, anxiety, and perceived stress are relatively high compared to

established cut-offs and reference values in non-clinical adult samples (Cohen et al., 1983;

Radloff, 1977; Schulte-van Maaren et al., 2012); however, they are comparable to other recent

studies examining college student samples (Huebschmann & Sheets, 2020; Le et al., 2021;

Pittard et al., 2017; Seppälä et al., 2020; Zhao & Zhang, 2018). HLM was used to generate

descriptive information for daily variables (see Table 2).

30

Table 1. Means and Standard Deviations of Time 1 and Time 2 Variables (N=88)

Note. SMM-G = Stress Mindset Measure – General; CES-D = The Center for Epidemiologic

Studies Depression Scale; MASQ-GD = The Mood and Anxiety Symptoms Questionnaire –

General Distress; MASQ-AD = The Mood and Anxiety Symptoms Questionnaire – Anhedonic

Depression; MASQ-AA = The Mood and Anxiety Symptoms Questionnaire – Anxious Arousal;

PSS-14 = Perceived Stress Scale

Table 2. Means and Standard Deviations of Daily Variables

Note. NA=Negative Affect; PA=Positive Affect

Preliminary Analyses: Associations between Demographic, Baseline, and Daily Variables

At baseline, there were no significant differences found between conditions with regard

to demographic characteristics, including age (t(86)=-.012, p=.99), gender (X2 (1, N=88)=1.26,

p=.26), or race (X2 (5, N=88)=1.75, p=.88). Age, gender, and race were also not found to be

associated with baseline variables (all p’s>.05). We also examined whether our daily variables

varied significantly as a function of between-person demographic characteristics at Level 2.

Racial/ethnic group categories were dummy-coded with Caucasian/White students serving as the

reference group. Compared to their peers who identified as Caucasian/White, participants who

Time 1 Time 2

M SD M SD

Stress Mindset (SMM-G) 1.72 0.59 2.10 0.65

Depression (CES-D) 22.42 10.76 22.57 11.18

General Distress (MASQ-GD) 25.94 7.45 26.78 7.20

Anhedonic Depression (MASQ-AD) 31.60 7.37 30.69 7.61

Anxious Arousal (MASQ-AA) 19.23 6.91 20.60 7.31

Perceived Stress (PSS-14) 29.46 7.91 29.79 8.29

M Within-SD Between-SD

Perceived Stress 3.76 1.47 0.62

Stress Mindset 4.23 1.00 0.64

Threat Appraisal 2.60 1.81 1.18

Challenge Appraisal 4.31 1.87 1.02

Control Appraisal 4.11 2.03 1.01

Emotional Resource Appraisal 4.37 1.92 1.34

NA 2.67 1.07 0.74

PA 3.57 1.14 0.77

31

identified as Hispanic reported overall lower challenge appraisals of daily stressors (b = -.750,

t(86) = -2.953, p=.004), lower average NA (b = -.752, t(86) = -3.296, p=.001), and lower average

PA (b = -.652, t(86) = -2.566, p=.012). No other differences emerged for race/ethnicity variables

across daily outcome variables. However, women reported lower amounts of stress (b = -.505,

t(86) = -3.506, p=.003), lower appraisal of their worst daily stressor as threatening (b = -.938,

t(86) = -3.048, p=.003), and lower average NA (b = -.755, t(86) = -3.492, p<.001) compared with

men, but no other gender-related differences emerged. As such, gender and ethnicity variables

were controlled in all analyses that included these variables.

Preliminary correlations between repeated measure variables at baseline are shown in

Table 3. Stress mindset was correlated with perceived stress, such that higher beliefs in the

adaptive nature of stress was significantly associated with lower levels of perceived stress;

however, it is interesting to note that this significant correlation only results in 9% shared

variance, suggesting that these are indeed tapping into different constructs. Baseline stress

mindsets were not associated with repeated measure reports of mood symptoms on either the

CES-D or MASQ subscales. As would be expected, all measures of mood were significantly

associated with each other in expected directions and strongly associated with perceived stress

symptoms.

32

Table 3. Baseline Correlations Among Time 1 Variables

*p<0.05. **p<0.01. ***p<0.001.

Primary Analyses: Main Effects of Intervention on Time 2 Variables

First, we checked whether intervention was associated with any differences at baseline.

Baseline psychosocial health variables (stress mindset, depression, mixed anxiety/depression

symptoms, and perceived stress) were not found to vary as a function of experimental condition

(all ps>.05).

Effect of Intervention on Stress Mindsets

We tested whether the intervention was successful in shifting participants to a more

adaptive (“stress is enhancing”) stress mindset at Time 2. In support of our hypothesis, there

were significant differences found between the SEC and NIC (t(86)=5.929, p<.001), indicating

that participants in the SEC (M residualized change = .311, SD = .597) reported significantly

higher stress-is-enhancing beliefs relative to individuals in the NIC (M residualized change = -

3.61, SD = .441).

Effect of Intervention on Negative Emotion Symptoms

Next, we investigated whether participants in the SEC reported lower negative emotion at

Time 2, including symptoms of depression, anxiety, and distress. Again, consistent with our

hypothesis, participants in the SEC reported statistically significantly lower (M residualized

1 2 3 4 5 6

1. Stress Mindset Measure (SMM-G) -

2. Depression (CES-D) -.20 -

3. General Distress (MASQ-GD)

-.12 .81*** -

4. Anhedonic Depression (MASQ-AD)

-.18 .61*** .48** -

5. Anxious Arousal (MASQ-AA)

.10 .54*** .63*** .25* -

6. Perceived Stress Scale (PSS-14) -.30** .74*** .71*** .64*** .40*** -

33

change = -2.15, SD = 8.89) symptoms of depression on the CES-D than participants in the NIC

(M residualized change = 2.56, SD = 9.64; t(86)=-2.384, p=.019). When examining the MASQ-

30 subscale for Anhedonic Depression, participants in the SEC reported lower (M residualized

change = -1.18, SD = 6.80) levels of symptoms than participants in the NIC (M residualized

change = 1.48, SD = 6.03); however, these differences were only trending in significance (t(86) -

1.941, p=.056). In further support of our hypotheses, significant differences were found between

the SEC and NIC for symptoms of both General Distress and Anxious Arousal. Participants in

the SEC reported significantly lower symptoms of distress (M residualized change = -1.33, SD =

5.52) than participants in the NIC (M residualized change = 1.63, SD = 5.38; t(86)=-2.548,

p=.013), and additionally reported significantly lower symptoms of anxious arousal (M

residualized change = -1.35, SD = 5.41) than participants in the NIC (M residualized change =

1.62, SD = 5.92; t(86)=-2.458, p=.016)

Effect of Intervention on Perceived Stress

Next, we investigated whether participants in the SEC reported lower perceived stress at

Time 2. Consistent with our hypothesis, there were significant differences found between the

SEC and NIC (t(84)=-4.120, p<.001), indicating that participants in the SEC (M residualized

change =-2.49, SD=6.88) reported significantly lower levels of perceived stress compared to

individuals in the NIC (M=3.05, SD=5. 63).

Effect of Intervention on Daily Stress Mindset, Affect, and Cognitive Appraisals

Individuals did not significantly differ in their reports of perceived daily stress (b = -.03,

t(85)= -.27, p=.78), suggesting that participants in both conditions appraised their days as

similarly stressful. We hypothesized that individuals in the SEC would show more adaptive daily

stress mindsets in response to their identified worst daily stressor. Indeed, there was a significant

34

difference between the two conditions (b = -.64, t(86)= -5.58, p<.001), indicating that individuals

in the SEC endorsed having more adaptive beliefs about whether everyday stress helped or

hindered their functioning with regard to performance, social relationships, and connection to

meaning. We predicted that individuals in the intervention condition would report higher daily

PA and lower NA than those in the control condition. However, contrary to our hypotheses,

participants in the two conditions did not significantly differ on either PA (b = -.11, t(86)= -.73,

p=.46) or NA (b = .11, t(85)= .797, p=.42).

Finally, we investigated whether individuals in the SEC would appraise their identified

worst daily stressor more adaptively than those in the NIC (i.e. decreased threat appraisal,

increased challenge appraisal, increased control, and having increased emotional resources).

Participants in conditions did not vary in their threat appraisals (b = .07, t(85)= -.29, p=.76) or

appraisal of control over their worst daily stressor (b = -.26, t(86)= -1.22, p=.22) However,

statistically significant differences were found for challenge (b = -.72, t(85)= -2.58, p=.01) and

emotional resource (b = -.63, t(86)= -2.30, p=.02) appraisals. These results suggest that

individuals who participated in the intervention were more likely to appraise their worst daily

stressor as a challenge they could overcome and, additionally, that they had sufficient emotional

resources to successfully cope with the situation.

Moderation Effects of Baseline Stress Mindset and Depression: Time 2 Variables

Next, we tested whether the efficacy of the intervention varied as a function of an

individual’s baseline mindset about stress. For our Time 1-Time 2 variables, we created multiple

regression models predicting our residualized change variables (CES-D, MASQ-GD, MASQ-

AD, MASQ-AA, and PSS-14) and including centered predictor variables for baseline stress

mindset, condition, and an interaction term between condition and baseline stress mindset. All

35

interactions between condition and baseline stress mindset were found to be non-significant (all

p’s>.05). To examine whether the intervention was more effective for individuals with higher or

lower baseline depression symptoms, we repeated these analyses using an interaction term

between condition and baseline depression symptoms; however, no significant differences

emerged (all p’s>.05). Taken together, these results suggest that baseline stress mindset and

levels of depression symptoms did not impact the efficacy of the stress mindset intervention.

Moderation Effects of Baseline Stress Mindset and Depression: Daily Variables

In these analyses, we ran our hierarchical models with condition predicting our daily

outcome variables (daily stress mindset, affect, and cognitive appraisals) and additionally entered

baseline stress mindset and an interaction term between condition and baseline stress mindset at

Level 2. All interactions between condition and baseline stress mindset were found to be non-

significant (all p’s>.05) in predicting daily outcomes, with the exception of perceived stress (b =

-.40, t(83)= -2.18, p=.03). In the NIC, individuals with a more negative baseline stress mindset

reported higher perceived daily stress than their peers with more stress-is-enhancing mindset.

However, for individuals in the SEC, this effect appeared to be buffered with no apparent change

in perceived stress based on baseline stress mindset, suggesting that the intervention might have

been particularly helpful for individuals who entered the study with more stress-is-debilitating

beliefs about stress (see Figure 1). To examine the moderating effect of baseline depression

symptoms, we repeated these analyses using an interaction term between condition and baseline

depression symptoms; however, no significant differences emerged (all p’s>.05), suggesting

baseline depression did not affect the efficacy of the stress mindset intervention.

36

Figure 1. Interaction between Stress Mindset Condition and Baseline Stress Mindset.

Exploratory Analyses: Reactivity to Daily Stress

We also conducted exploratory analyses to investigate whether the within-person relationship

between daily stress and our daily outcome variables (stress mindset, affect, cognitive appraisal)

varied based on intervention condition. We first examined whether, as daily stress increases,

adaptive daily stress mindsets decreased less for individuals in the intervention condition;

however, we found so such effect (b = -.06, t(85)= -1.61, p=.11). Additionally, we found no

differential effect between conditions on the relationship between daily stress and PA (b = -.01,

t(84)= -.01, p=.99), nor for the relationship between daily stress and NA (b = .02, t(84)= . 70,

p=.48). Similarly, we did not find differences in the associations between daily stress with most

cognitive appraisal variables, including perceptions of their worst daily stressor as threatening (b

= .05, t(85)= .76, p=.44), controllable (b = -.02, t(85)= -.24, p=.80), or a surmountable challenge

(b = -.06, t(84)= -.76, p=.44). However, there were significant differences in the within-person

relationship between daily stress and appraisals of having sufficient emotional resources to cope

(b = -.14, t(85)= -2.18, p=.03). Individuals in the SEC reported generally higher emotional

2

2.5

3

3.5

4

4.5

More Negative More Positive

Dai

ly P

erce

ived

Str

ess

Baseline Stress Mindset

SEC NIC

37

resources to cope with their worst daily stressor. However, on days with higher perceived stress,

these emotional coping resources were not observed to decrease as steeply for those in the SEC

as for their peers in the NIC (see Figure 2).

Figure 2. Relationship between Daily Stress and Emotional Coping Resources.

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Lower Stress Higher StressPer

ceiv

ed E

moti

onal

Copin

g

Res

ourc

es

Daily Stress

SEC NIC

38

CHAPTER 4

DISCUSSION

The present study combined experimental and naturalistic methodologies to examine the

efficacy of a 21-day stress mindset intervention on psychosocial and emotional outcomes in a

sample of first-year college students. Our specific intervention used an in-person seminar format

that was informed from existing literature about the adaptive benefits of stress to enhance

performance, interpersonal relationships, and connection to personal meaning (Crum et al., 2013;

McGonigal, 2016). Prior research has demonstrated that stress mindsets are malleable and,

additionally, that stress mindset interventions can shift individuals to adopt more positive beliefs

about stress and improve stress-related outcomes (Beltzer et al., 2014; Jamieson et al., 2012;

Crum et al. 2011; Crum et al., 2017). While these results are certainly encouraging, few studies

have evaluated whether experimentally-induced change in stress mindsets and associated

psychosocial outcomes can be maintained over longer intervals of time. At present, two-weeks

represents the longest peer-reviewed interval for a stress mindset manipulation and, in this study,

experimental gains for health and performance outcomes were not found to persist at follow-up

(Keech et al., 2019). Prior research from the Stress and Emotion Lab had demonstrated that brief

(3.5 minutes) stress mindset intervention videos were successful in changing and maintaining

stress mindsets in the expected directions after a 2-week interval, but did not yield differences in

daily cognitive and emotional functioning (Chue, 2019). Building off this finding, our

manipulation was created to offer a more robust and interactive intervention session about the

adaptive effects of stress and, additionally, included a novel 21-day rehearsal component for

those in the intervention condition in order to encourage a stress-is-enhancing mindset in relation

to daily stressors. After 21 days (Time 2), we hypothesized that, compared to the control (NIC)

39

condition, individuals in our stress-is-enhancing (SEC) intervention condition would show more

adaptive mindsets about stress and psychosocial health, including symptoms of anxiety,

depression, and perceived stress. Using a daily diary design, we further hypothesized that

individuals in our intervention would report improved daily stress mindsets, affect, and cognitive

appraisals of daily stressors.

Overall, participants at baseline reported a relatively negative stress mindset, indicating

that individuals in our study initially viewed stress as having predominantly negative and

debilitating effects. These results are unsurprising and consistent with prior published research

(Crum et al., 2013; Liu et al., 2017; Park et al., 2018), but are certainly reflective of the

prevailing perception about how stress affects health and wellbeing. After adjusting for baseline

variance, those who participated in the stress mindset intervention reported significantly higher

beliefs at Time 2 that stress can have enhancing qualities compared to those in a control group.

Importantly, they also reported lower symptoms of depression, distress, and physiological

symptoms of anxiety. One subscale of negative emotion (Anhedonic Depression), although

trending in significance, was not found to be significantly different between experimental

conditions at Time 2. Individuals in the intervention condition also reported significantly lower

symptoms on a measure of perceived stress (PSS-14) at Time 2. Although titled as a measure of

perceived stress, it is interesting to note that this specific measure includes items assessing

general, negative feelings (i.e. “How often have you felt that things were going your way?”) and

perceptions of emotional control (i.e. “How often have you been angered because of things that

happened that were outside of your control?”). This has led to criticisms of circularity in which

stress and emotion outcomes are essentially confounded within the same measure (Lazarus et al.,

1985). In concordance with stress mindset theory, our intervention did not attempt to make

40

participants experience less stress; perhaps this finding, then, is similar to our other findings of

lowered distress (rather than fewer experiences of stressful events). Taken together, these

findings add support to a growing literature demonstrating that stress mindset interventions can

be an effective tool in changing perceptions about the enhancing effects of stress, and perhaps

more importantly, can also improve reports of psychological wellbeing, including symptoms of

depression, anxiety, and distress.

We had also hypothesized that our intervention and control groups would differ on

ratings of daily variables, such as stress mindset, affect, and cognitive appraisals of participants’

daily stressors. Although there has been limited research on how stress mindset affects daily

psychosocial processes (Laferton et al., 2020), there have not been published studies examining

whether daily cognitive-emotional processes differ for experimentally-induced stress mindsets.

First, we did not find differences between conditions on perceived daily stress, suggesting that

both groups reported having similarly stressful days. This null finding is perhaps unsurprising

given the nature of our stress mindset manipulation – more specifically, that our intervention did

not posit that participants should aim or expect to experience less daily stress, but should in fact

be mindfully aware of the stress they were already experiencing as a way to facilitate their

performance, social functioning, and goals. This finding highlights an important element of

stress mindset theory, as it suggests that attenuation of the stress response is not necessarily the

goal of adopting a stress-is-enhancing mindset (Beltzer et al., 2014; Jamieson et al., 2012). This

has also been demonstrated using objective measures of stress reactivity, as prior research by

Crum and colleagues (2017) found that participants with enhancing stress mindsets had similar

cortisol profiles following a lab-based stressor, but demonstrated more adaptive cognitive and

physiological (DHEA) responses indicative of “psychological thriving.”

41

We found that participants who attended the intervention reported more adaptive daily

stress mindsets in response to their identified worst daily stressor. To our knowledge, this is the

first study that examines stress mindsets as a daily variable recorded in response to naturalistic

daily stressors and suggests that the effects of stress mindset interventions can extend beyond

construct-level evaluations of stress (i.e. Is my general experience of stress adaptive?) and can

impact perceptions of specific stressors at a daily level (i.e. Was my experience of this specific

stressor adaptive?).

We also found that individuals in our intervention condition reported more adaptive

cognitive appraisals related to beliefs that their identified worst daily stressor was a challenge

they could overcome and that they had sufficient emotional resources to successfully cope with

the situation. However, there were no differences between conditions in appraisals of their worst

daily stressor as threatening or controllable. Although contrary to our hypotheses, these null

findings may also be reflective of the content provided during the intervention seminar, which

did not specifically encourage attempts to exert control over stressors and, instead, was explicit

in its provision of strategies about how each individual’s daily stress could instead be viewed and

used as adaptive. Additionally, while threat and challenge appraisals have been occasionally

viewed as dual ends of the same continuum (Kilby et al., 2018), this finding is consistent with

experimental research positing that they are at least partially-independent constructs (Uphill et

al., 2019) and, additionally, that stress mindsets in particular may be more strongly associated

with challenge appraisals (Kilby & Sherman, 2016).

Previous research has shown that experimental manipulations for stress mindsets or

positive stress reappraisal have produced higher ratings of positive affect and lower negative

emotion in response to lab-based stressors (Beltzer et al., 2014; Crum et al., 2017). Additionally,

42

although research is limited, there has been research using naturalistic measurement

demonstrating that viewing stress as more controllable (rather than enhancing or debilitating) has

been associated with higher positive daily affect (Laferton et al., 2020). However, our results

indicate that participants in our two conditions did not differ in their reports of daily affect,

including both positive and negative affective variables.

We conducted additional exploratory analyses to determine whether our intervention

would impact the association between daily stress and our cognitive-emotional outcome

variables. Previous studies have found that people with more adaptive stress mindsets have

weaker associations between stressful life events or daily stressors and stress-related outcomes

(Laferton et al., 2020; Park et al., 2018). Therefore, we reasoned that those in the intervention

condition might appear less reactive in terms of their affective responses and cognitive appraisals

on higher stress days than those in the control group. However, the two conditions did not differ

on the relationships between stress and our daily outcome measures, with the exception of

perceived emotional resources to cope with the identified worst daily stressor. While this isolated

finding is encouraging and consistent with prior research, we cannot rule out that this result

could reflect Type 1 error considering our large number of exploratory analyses. We conclude,

then, that there did not appear to be consistent differences between conditions in cognitive-

emotional reactions on low vs. high stress days.

To our knowledge, this is the first study examining how experimentally-induced stress

mindsets function at the daily level in response to naturalistic stressors. As prior peer-reviewed

research has only examined test-retest intervals up to two weeks, these findings also expand

notably upon the existing literature base by demonstrating evidence that psychosocial benefits of

stress mindsets interventions can be maintained for up to three weeks. Our study findings

43

coupled with rising reports of mental health and stress-related concerns in undergraduate

populations suggest that stress mindset interventions and opportunities to incorporate practicing

mindset strategies might be considered as a viable way to promote improvements to

performance, social connection, and overall wellbeing in college-aged young adults.

However, while our study demonstrated several ecological and methodological strengths,

there were also some important limitations. First, due to the global emergence of COVID-19,

recruitment efforts were prematurely terminated. As such, our sample size was smaller than

anticipated and might limit our ability to detect real differences. Additionally, although we

hypothesized that daily rehearsal of stress mindset strategies would help maintain gains and

prevent post-intervention decay, we are unable to extricate the effects of our intervention from

the supplemental effects of daily rehearsal. In order to evaluate the efficacy of rehearsal

strategies, future research might add an “intervention-only” condition for comparison. A “non-

intervention” control was selected for this study specifically because, ethically-speaking, it did

not seem necessary to experimentally induce a debilitating stress mindset in a population already

characterized by high reported stress. However, future research might also include a comparison

condition that involves a different positive intervention that has been shown to enhance

psychosocial wellbeing (i.e. positive affect induction, self-compassion, etc.) in order to better

isolate and characterize the unique role of stress-is-enhancing mindsets on stress-related

outcomes. We also recorded compliance data based on survey completion, but did not control for

degree of engagement with intervention strategies within the daily surveys of our intervention

group. Although outside of the scope of the current study, qualitative coding could be used to

determine whether engagement with the intervention strategies moderates the effect of the

44

intervention on both repeated measures and daily outcomes, which would lend further support

for the role of rehearsal in maximizing efficacy and maintaining gains.

Our recruitment sample is disproportionately Caucasian and female, therefore, is not

representative of a general college-aged sample. Finally, our manipulation was designed to

specifically address individual experiences of day-to-day stress and our results might not be

applicable to other forms of stress, including chronic, systems-level stressors – such as identity-

related discrimination, threats to safety, significant financial or health related concerns that may

disproportionally target marginalized communities (Murphy, 2021). Additionally, we did not ask

questions regarding each participant’s history of depression, anxiety, and/or psychological

therapy, which may impact mental health outcomes or differences in emotion regulation

strategies. Future research may consider adding supplemental questions to the baseline survey

assessing these individual factors. Finally, it is possible that the change demonstrated by the

intervention group could be due to demand characteristics on study outcomes (Nichols & Maner,

2008). Although participants were not informed about the specific study aims, it would not be

challenging to intuit that the seminar material and daily rehearsal strategies were designed to

help encourage adoption of a more adaptive stress mindset. Although steps were taken to reduce

demand characteristics (i.e., discussing confidentiality of responses, gathering self-report data in

non-laboratory settings), it is possible participants may have felt pressure to adjust their answers

to reflect the supposed goals of the experimenters. Finally, although the present study

demonstrates that the benefits of stress mindset interventions can be maintained for up to three

weeks, future longitudinal research is needed with longer follow-up intervals to evaluate the

long-term effectiveness of mindset manipulations.

45

In conclusion, the present study measured the efficacy of an enhanced stress mindset

intervention including daily 21-day rehearsal on psychosocial health and daily stress-related

outcomes. We found evidence that our intervention was effective, with individuals who attended

the intervention reporting more adaptive stress mindsets, improved mood symptoms, as well as

improved challenge appraisals and perceptions of their abilities to cope with daily stressors. To

our knowledge, this study represents the longest documented maintenance of psychosocial gains

for experimentally-induced stress mindsets and, additionally, suggests that encouraging daily

rehearsal of stress mindset strategies may play a role in helping minimize or prevent post-

intervention decay. Given the inevitability of stress in our daily lives, these findings add support

to a growing body of literature implicating the role of stress mindsets in promoting psychosocial

health and more adaptive cognitive responses to stress in vulnerable emerging adult populations.

46

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