CHAPTER I: INTRODUCTION BACKGROUND OF THE STUDY Stress is in the mind of the beholder.

Anonymous Stress is defined as broad class of experiences in which tension occurs when demanding situations tax the resources, coping and the level of adaptation of the individual. (Beare and Meyers, 1994) A certain amount of stress is necessary for meeting the challenges of our lives and providing the energy required to maintain life, resist aggression and adapt to constantly changing external influences. We are always under some stress, as long as we are alive. Sometimes the stress is low, when we are asleep, for instance; and sometimes the stress is high for instance, when we are being attacked by muggers. But as long as we are alive, we are experiencing stress. Stress cannot be avoided, and our stress level is never at zero. If we experience too high a stress level for too long, physiological problems such as headaches, ulcers, and muscle pains can develop. (Johnson, 1997) College life can be very stressful in one way or the other. Generally, we idealize the college experience and remember it as that idyllic time when we had few worries or responsibilities. To students currently attending college, however, the process is often stressful and frustrating. The competition for grades, the need to perform, peer relationships, fear of failure, career choice, and many other aspects of the college environments are real life challenges that manifest as mental stress. (Folkman, S., & Lazarus, R. S. (1980). Coping is a response aimed at diminishing the psychological burden that is linked to stressful life events and daily hassles. Therefore, by this definition, coping strategies are those responses that are effective in reducing an undesirable load. The effectiveness of the coping strategy rests on its ability to reduce immediate distress, as well as to contribute to more long term outcomes such as psychological well being or disease status. ( Snyder, 1999)

In one early attempt to define coping, Folkman and Lazarus (1980) suggested that coping is all the cognitive and behavioral efforts to master, reduce, or tolerate demands. It makes no difference whether the demands are imposed from the outside (e.g. by family, friend, job, school) or from the inside (e.g. while wrestling with an emotional conflict or setting impossibly high standards). Coping seeks in some way to soften the impact of demands.(Folkman, S., & Lazarus, R. S. (1980). As a college student, there are increased levels of stress due to the demands of the academic subjects. College students may complain about lack of sleep, excessive workloads and stress, but in general, life as a co-ed is pretty good. This leads to a number of coping behaviors that may affect the individuals personality, lifestyle, and insights about the subjects and teachers, and also the course they chose. At first, some students may be very eager and excited for college because of the perks and freedom that it may give. But then, they discover that the actual experience falls short of their expectations when they reach their junior year, especially for medical courses like Physical Therapy. During the junior year of a PT student, it is claimed as an important transitional period to be prepared for the demands of the professional subjects. Transitional period in the sense that from all the art subjects since 1st year and 2nd year to major subjects in the 3rd year of the course. Some think that they can make it through the junior year without putting much effort. Little do they know that what they think is incorrect. They dont realize what the course demands from the student, demands like time and effort, that is why some students have a hard time coping up with the new environment that have to face. Entering junior year requires youths to face multiple transitions, including changes in their living arrangements, academic environments, and friendship networks, while adapting to greater independence and responsibility in their personal and academic lives. Although many successfully make this transition to higher levels in college, others experience long-term emotional maladjustment and depression.

Adjustment of PT students to the demands of the course is necessary. If you apply a coping attitude in your life, you will enhance your own potential for personal growth. You can make your life more interesting by mastering new skills and taking on meaningful challenges. (Kleinke, 1998). This study will be conducted to investigate the common stressors encountered, the coping resources and adjustment levels of junior and senior physical therapy students of Silliman University in the school year 2012-2013.

STATEMENT OF THE PROBLEM This study investigates stressors, coping resources and adjustment level of Junior and Senior Physical Therapy students of Silliman University in the school year 2012 2013. Research Questions: Specifically, the study seeks to answer the following questions:
1. What are the five common stressors encountered by junior and senior PT students of

Silliman University in SY 2012-13.

2. What are the levels of adjustment of junior and senior physical therapy students in the

areas of: a. Anxiety b. Depression c. Suicidal ideation d. Substance abuse e. Self esteem f. Interpersonal problems g. Family problems h. Academic Problems i. Career Problems
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3. Is there a significant difference in the levels of adjustment between junior and senior PT

students?
4. Is there a significant difference in the levels of adjustment between regular and irregular

junior and senior PT students?

5. Is there a significant difference in the levels of adjustment between the males and females

junior and senior PT students?

6. What are the five common problem solving or stress management resources are being

utilized by junior and senior PT students in coping with their adjustment difficulties? HYPOTHESES Problems 1, 2 and 6 are hypotheses free. For problems 3, 4 and 5, the following are the null hypotheses with the corresponding alternative hypotheses which are tested in this study.
1. H0: There is no significant difference in the levels of adjustment between junior and

senior PT students. H1:There is a significant difference in the levels of adjustment between junior and senior PT students.
2. H0: There is no significant difference in the levels of adjustment between regular and

irregular junior and senior PT students. H1: There is a significant difference in the levels of adjustment between regular and irregular junior and senior PT students.
3. H0: There is no significant difference in the levels of adjustment between the males and

females of the junior and senior PT students. H1:There is a significant difference in the levels of adjustment between the males and females of the junior and senior PT students. PURPOSE OF THE STUDY The researches aim to achieve the following:
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1. To identify the common stressors encountered by junior and senior PT students of

Silliman University in SY 2012-2013.

2. To determine the levels of adjustment of junior and senior PT students of Silliman

University in SY 2012-2013 in the areas of: A. Anxiety B. Depression C. Suicidal ideation D. Substance abuse E. Self esteem F. Interpersonal problems G. Family problems H. Academic Problems I. Career Problems
3. To determine if there is a significant difference in the levels of adjustment between

junior and senior PT students.

4. To determine if there is a significant difference in the levels of adjustment between

regular and irregular PT students.

5. To determine if there is a significant difference levels of adjustment between the

adjustment between the males and females PT students.

6. To identify the problem solving or stress management resources being utilized by

junior and senior PT students in coping with their adjustment difficulties. SIGNIFICANCE OF THE STUDY To the Students
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The findings of this study will be a valuable guide for PT students to identify the common stressors and how to adjust or cope up with the stresses and pressures of Physical Therapy course. To the Teachers The findings of this study will hopefully make the PT teachers realize the struggles of their students and thus, will understand the situations and take time in knowing the learning styles and studying capacity of their students. To the IRS Department The findings of this study will help the Institute of Rehabilitative Sciences to come up with appropriate stress managements for students. Also to provide interventions to lessen the stress and pressures felt by the students.. The Guidance Counselors The findings of the study provide guidance counselors opportunity to broaden their awareness of some influences that can affect students college adjustment and facilitate them to implement the proposed guidance program. With this study, they can continue to modify and improve their personality enhancement programs and stress management programs. The Researchers The findings of this study serve as valuable references for further studies. This may as well as encourage other researchers to conduct similar areas of endeavor for further studies. SCOPE AND LIMITATIONS OF THE STUDY Although all physical therapy students are supposed to experience adjustment problems in college, this study is limited to junior and senior physical therapy students of Silliman University who are enrolled in the 2nd semester of school year 2012 2013.

DEFINITION OF TERMS Adjustment adaptation to a particular condition, position, or purpose. Adjustment difficulty inability to adjust demands of interpersonal relationships and stresses of daily living. Coping - represents efforts to prevent or reduce the negative effects of stress on well-being. -is defined as efforts to influence stress and well-being, not as the successful implementation of these efforts. Coping mechanism any conscious or nonconscious mechanism of adjusting to environmental stress without altering personal goals or purposes. Level of adjustment stage of adjustment: 1) accepting responsibility, 2) reorganization, 3) coping Normal adjustment ability to adjust demands of interpersonal relationship and stresses of daily living. Physical therapy - this is a branch of rehabilitative health that uses specially designed exercises and equipment to help patients regain or improve their physical abilities - treatment of disease, injury, or deformity by physical methods such as massage, heat treatment and exercise rather than by medicinal drugs or surgical procedures. Stress is a situational condition or event or a psychological or physiological response of the person - from a homeostatic point of view, a stress is some stimulus condition that results in disequilibrium in the system and produces a dynamic kind of strain, that is, changes in the system against which mechanisms of equilibrium are activated. - any condition that disturbs normal functioning Stressor - a specific condition or event in the environment that challenges or threatens a person. CHAPTER II: Review of Related Literature A. STRESS

Richard Lazarus defined stress as a state of anxiety produced when events and responsibilities exceed ones coping abilities. It is also the experience of perceived (real or imagined) threat to mental, physical, emotional and spiritual well-being, resulting in a series of physiological responses and adaptations. (Seaward, 2004) Stress -- the nonspecific response of the body to any demand placed upon it to adapt, whether that demand produces pleasure or pain (Hans Selye, 1960). It is also defined by Kozier as a condition in which the person responds to changes in the normal balance state. Etiology The stress reactions appear to be the result of conditions that disrupt or endanger well established personal and social values of the people exposed to them, or, in the animal work, physiological survival or well-being. The stimulus conditions are therefore identified as situations of stress. And the severity of reaction makes us dramatically aware of the range and depth of the disturbance in biological and psychological and social functioning that can be brought about by stress situations. They become the prototypes of stress phenomena when we seek to define what is meant by the term. Problems arise when we try to set the lower limits of stress, on either the stimulus or response side. In a recent study, for example, merely attaching subjects to psychogalvanic electrodes in a tiny, dimly lit room produced evidence of stress reactions. It soon becomes clear that stress cannot be defined exclusively by situations because the capacity of any situation to produce stress reactions depends on characteristics of the individual. The important role of personality factors in producing stress reactions requires that we define stress in terms of transactions between individuals and situations, rather than of either one in isolation. (Lazarus, 1966) Epidemiology

Stress contributes to 50% of all illness in the US. Approximately 70-80% of all visits to the doctors are for stress-related and stress-induced illness and the cost of job stress in the US amounted to $200 billion.While in the Philippines 80% of all illnesses are related to stress (Caf, 2008) Types of Stress According to Selye (1960), there are three types of stress: eustress, distress and neustress.

Eustress is a good stress and arise in any situation that a person finds motivating or inspiring. Neustress is a sensory stimuli that have no consequential effect: neither good nor bad. Distress is a stress considered bad. Distress can be further classified as acute and chronic.Acute distress is quite intense and disappears quickly while chronic distress is less intense but seems to linger for prolonged periods of time.

Levels of Stress Level 1 : The first level is characterized by mild anxiety. Among the four levels of stress, it is the first level that is considered as healthy stress. On this level, a person is highly motivated and his energy levels are sufficient to cope up with the stressor. It is also in this level that a person feels very productive. Level 2 : The second level of stress is experienced by an individual when a stressor continues to make a considerable effect on an individuals daily life. At this stage, the individual may already have some complaints of overloading and a feeling of overwhelm and distress. Level 3 : The third level is already characterized as chronic stress. If the stressor is still not addressed during this level of stress, there would already be explicit negative manifestations of stress such as feelings of irritability and even somatic manifestations such as tension-related headaches. Level 4 :

At this stage, the individual chronically feels exhausted, both physically & emotionally. The individual may even feel a reduced sense of self-fulfillment. Some serious somatic manifestations without supporting medical diagnosis may also be experienced. This final level among the four levels of stress requires consideration of anti-stress remediations. Characteristics of stress stimuli and reactions: On the stimulus side: Conditions that produce stress reactions According to different studies, the more important values and goals of the people observed were endangered or disrupted. There was great uncertainty about physical survival, the maintenance of ones identity, the ability to control ones environment even a little, and the opportunity to avoid pain and privation. In another study, they found disruption of community life and loss of loved ones in addition to the danger that these things might happen. Again, the most important human values and goals are endangered or actually disrupted. On the response side: The nature of stress reactions. There are four main classes of reaction that have been typically used to index stress:
1. Reports of disturbed affects such as fear or anxiety, anger, depression and guilt. 2. Motor behaviors may also signify stress reactions for example, tremor, increased

muscle tension, speech disturbances, particular facial expressions and at the animal level, the characteristic posturing in fear and anger. The behavioral reactions of flight and attack or aggression could also be included here. He directionality of the behavior as well as its intensity contributes to the interference that is a form of stress response.
3. Changes in the adequacy of cognitive functioning represent a third category of stress

response.
4. Physiological change is one of the most widely used classes of indicators of stress

reaction. This includes reactions of both the autonomic nervous system and the adrenal glands which secrete various hormones under stress.

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Signs and symptoms of stress

General irritability, hyperexcitation, or depression Dryness of throat and mouth Urge to cry, scream, or run and hide Easily fatigued, constantly tired Floating anxiety Easily startled Stuttering Pacing, moving about, cannot sit still Gastrointestinal signs and symptoms: butterflies in the stomach, diarrhea, vomiting Changes in menstrual cycle Loss of or excessive appetite Increased use of legally prescribed drugs Injury prone Disturbed behavior Pounding of the heart Emotional instability, impulsive behavior Inability to concentrate Feelings of unreality, weakness, or dizziness Tension Trembling, nervous tics Nervous laughter Grinding of teeth Insomnia, nightmares, or other sleep difficulties Excessive perspiration Frequent urination Muscle tension and headaches Pain in the neck or lower back Increased smoking Alcohol and drug addiction

Source: Based on Selye, H. (1976). Stress in health and disease. Stoneham, MA: Butterworth-Heinemann

Stressor and Classification of Stressor This can be a situation, circumstance, or any stimulus perceived to be a threat or that which causes or promotes stress. Stressor is any factor that produces stress and disturbs the bodys equilibrium thereby requiring change or adaptation. The 2 classification of stressors are Internal Stressor and External Stressor (Osborn, Wraa & Watson, 2009). A. Internal stressor Internal stressor originate inside the person or also called psychointrapersonal influences. These are perceptions of stimuli that we create thru our own mental processes. These involves those thoughts, values, beliefs, attitudes, and perceptions that we use to defend our identity or ego. Table 1.1 Examples of Internal Stressors
Lifestyle choices Negative behaviour in response to stress/Negative self talk Pessimistic thinking Self criticism Over analyzing Mind traps Personality traits

Caffeine Lack of sleep Overloaded schedule

Unrealistic expectations Taking things personally All or nothing thinking Exaggeration Rigid thinking

Perfectionist Workaholics Type A Personality

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B. External Stressor This can originate outside the person. Example could include adverse physical conditions (such as pain or hot or cold temperatures) or stressful psychological environments (such as poor working conditions or abusive relationships). Table 1.2 Examples of External Stressors
Physical environment Noise Bright lights Heat Confined spaces Social interaction Rudeness Bossiness Aggressiveness by others Bullying Organizational Rules and regulations Deadlines Major life events Birth Death Lost job Promotion Marriage Dailey hassles Commuting Traffic Lost things Flat tire

Physiological Responses to Stress Physiological responses to stress should be considered within the context of the body as an open living system with an internal and external environment, with information and matter being exchanged continuously between these two environments. Within the internal environment each organ, tissue, and cell is a system unto itself and a subsystem of the whole, with each system exchanging information and matter. Each subsystem also exchanges information and matter in an attempt to maintain a dynamic balance, or a steady state, even in the presence change, so as to maintain harmony with each other; in other words, homeostasis. When stress occurs that causes a body function to deviate from its stable range, processes are initiated to restore and maintain the dynamic balance. When these compensatory processes are not adequate, the steady state is threatened, function becomes disordered, and pathophysiological mechanisms occur. The pathophysiological mechanisms can lead to disease, thus, becoming a threat to the steady state. Disease is an abnormal variation in the structure or function of any part of the body that occurs within a living system when the sum of stressors acting on that living system exceeds the systems ability to adapt. It disrupts function and

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therefore limits the persons freedom of action. Because disease may be localized or generalized, it can affect part of the living system or the entire living system (Wilkin, 2005). Studies suggest that the inability to adapt to stress is associated with the onset of depression or anxiety (Manktelow, 2003). Some evidence suggests that repeated release of stress hormones produces hyperactivity in the HPA axis and disrupts normal levels of serotonin, the nerve chemical that is critical for feelings of well-being. On a more obvious level, stress diminishes the quality of life by reducing feelings of pleasure and accomplishment, and relationships often are threatened. Stress and Illness Stress may increase vulnerability to almost any illness. It has long been suspected to play a role in the etiology of many diseases. How a stress-provoking event is perceived and how one reacts to it determines its impact on health. When something happens to an individual, she automatically evaluates the situation mentally and decides if it is threatening. She then decides how to deal with the situation and what skills she can use. If she decides that the demands of the situation outweigh the skills she has, the situation is labelled stressful and the classic stress response begins. If the individual decides that her coping skills outweigh the demands of the situation, then it is not viewed as stressful (Osborn , Wraa, Watson 2009). B. COPING Coping refers to the processes or skills that individuals use to deal with events, circumstances or situations that are out of ordinary. It is the cognitive and behavioural effort to manage specific external or internal demands that are appraised as taxing the resources of the person. Two alternative perspectives can be adopted as we consider how personality traits influence the process of coping with threat. First, they may work by affecting how the situation will be appraised. Thus, a social norm will not serve as a situational constraint if it does not communicate with an important motive. In this case, the constraint will be appraised as unimportant. It is rather obvious that if social approval is unimportant to the individual, situational constraints which threaten loss of approval will have little actual power constrain,
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since disapproval will pose no threat. Or if the individual believes that he will not punished by his parents for certain classes of behavior, their threats will have little constraining influence on his actions. A slightly more complicated example is the case where the disapproval comes from a source, say a teacher, which the individual does not respect and whose attitudes he cares little about and when he knows that others whose good opinion he values, say his peers or family, will not share the disapproving attitude. In this case, the teacher in authority will have little constraining influence, since his attitudes will not be backed up by those who really count in the eyes of the pupil. Secondly, coping processes may depend on capacities of the individual which directly affect the behavior without the mediating process of appraisal. Certain forms of coping or defense may or may not be within the response repertoire of the individual, or they may be preferred. When personality psychologists treat coping or defensive processes as dispositional variables or traits, they are taking a neutral theoretical position about how these actually affect behavior. Intervening steps such as appraisal are not conceptualized as necessarily accounting for the outcome. On the basis of the assessment of the disposition, certain actions are predicted in certain situations. We shall consider four classes of factors within the psychological structure that influence coping: 1) Pattern of motivation The pattern of motivation of an individual determines which stimuli pose important threats and which are inconsequential or nonthreatening. Not only does this apply to the original appraisal of threat but it also applies to secondary appraisal and the coping process. This is because, certain action tendencies activated to cope with the threat may be further threatening either because of situational constraints or because of internalize social values. 2) Ego resources Certain personality traits are traditionally assumed to reduce vulnerability to threat and facilitate healthy or adaptive forms of coping. An example is the concept of ego strength. It is usually poorly and inconsistently defined and seldom if at all measured with any care. The extensive use of this type of concept in clinical work and in personality theory warrants our
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examination of some of the clinical observations and analyses relevant to the concept and psychological stress. 3) Defensive/coping dispositions Most of the research and theory in this area have been with a sub-category of coping, defensive. Defensive dispositions are personality traits comprising the tendency to use one or another type of defense when the individual is threatened. The choice of defense is assumed to reside partly or entirely within the individual rather than in the stimulus conditions. 4) General beliefs about the environment and ones resources. If the individual believes that the environment is dangerous and overpowering, or that he is inadequate to cope with it, not only will he be likely to appraise threat chronically, but he will also be apt to use flight and avoidance as coping processes rather than attack. Moreover, if he is subject to high degrees of threat, more primitive forms of defensive coping will be rule. Coping is a response aimed at diminishing the psychological burden that is linked to stressful life events and daily hassles. Therefore, by this definition, coping strategies are those responses that are effective in reducing an undesirable load. The effectiveness of the coping strategy rests on its ability to reduce immediate distress, as well as to contribute to more long term outcomes such as psychological well being or disease status. (Lazarus, 1966) C. COPING MECHANISMS Managing bodily reaction Much of the body immediate discomfort of stress in caused by the bodys fight-or-flight emotional response. The body is ready to act, with tight muscles and a pounding heart. When action is prevented, we merely remain uptight. A sensible remedy is to learn a reliable, drugfree way of relaxing. Exercise Because stress prepares the body for action, its effects can be dissipated by using the body. Any full-body exercise can be effective. Swimming, dancing, jumping rope, yoga, most sports, and especially walking are valuable outlets. Be sure to choose activities that are vigorous enough to be done repeatedly. Exercising for stress management is most effective when it is
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done daily. Remember, though, that this refers to light exercises, such as walking. If you do move vigorous exercise to maintain aerobic fitness, 3 to 4 times a week is about right. Meditation Many stress counselors recommend mediation for quieting the body and promoting relaxation. Meditation is one of the most effective ways to relax. But be aware that listening to or playing music, taking nature walks, enjoying hobbies and the like can be meditations of sorts. Anything that reliably interrupts upsetting thoughts and promotes relaxation can be helpful. Progressive Relaxation Progressive relaxation refers to a method in which people can learn to relax systemically, completely and by choice. The basic idea is to tighten all the muscles in a given area of the body (the arms for instance) and then voluntarily relax them. By first tensing and relaxing each area of the body, you can learn to be highly aware of how muscle tension feels. Then when each area is relaxed, the change is more noticeable and more controllable. In this way it is possible, with practice, to greatly reduce tension. People who have difficulty learning progressive relation may find biofeedback helpful. Guided imagery Relaxation can also be promoted by visualizing peaceful scenes. Pick several places where you feel safe, calm and at ease. Typical locations might be a beach or lake, the woods, floating on an air mattress in a warm pool, or lying in the sun at a quite park. To relax, vividly imagine yourself in one of these locations. In the visualized scene, you should be alone and in a comfortable position. It is important to visualize the scene as realistically as possible. Try to feel, taste, smell, hear and see what you would actually experience in the calming scene. Practice forming such images several times a day for about 5 minutes each time. When your scenes became familiar and detailed they can be used to reduce anxiety and encourage relaxation. Modifying Ineffective Behavior Stress is often made worse by our response to it. The following suggestions may help you deal with stress more effectively: a. Slow Down Remember that stress can be self- generated. Try to deliberately do things at a slower pace- especially if your pace has speeded up over the years. b. Organize
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Disorganization creates stress. Try to take a fresh look at your situation and get organized. Setting priorities can be real a stress fighter. Ask yourself whats really important and concentrate on the things that count. Learn to let go of trivial but upsetting irritations. c. Strike a balance Damaging stress often comes from letting one element (especially work or school) get blown out of proportion. Your goal should be quality in life not quantity. Try to strike a balance between challenging good stress and relaxation. Set aside time for me acts such as loafing, browsing, puttering, playing, and napping. d. Recognized and accept your limit Set gradual, achievable goals for yourself. Also set realistic limits on what you try to do on any given day. Learn to say no to added demands or responsibilities. e. Seek social report Family and friends serves as a buffer to cushion the impact of stressful events. Talking out problems and expressing tensions can be incredibly helpful if things really get bad, seek help from a therapist, counselor. If you dont have someone you can talk to about stressful events, you might try expressing your thoughts and feelings in writing. f. Avoiding upsetting thoughts Stress is greatly affected by views we take of events. Physical symptoms and tendencies to make poor decisions are increase by negative thought or self talk. What you say to your self can be the difference between coping and collapsing. g. Coping statements Clients learn to identify and monitor negative self statements. Negative, self critical thoughts are a problem because they tend to directly elevate physical arousal. To counter this effect, clients learn to replace negative statements with coping statement from a list before giving a short speech, for instance, you would replace Im scared, I cant do this, My mind will go blank and Ill panic or Ill sound stupid and boring, Ill breathe deeply before I start my speech or my pounding heart just means Im psyched up to do my best. This statement should be replaced by positive coping statement in order to pursue ones own goal. h. Coping with frustration and conflict Try to identify the source of your frustration if it is external or personal or is the source of frustration is something that can be changed or how hard would you have to work to change it
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and lastly, if the source of your frustration can be changed or removed, are the necessary effort worth it. This answers the questions help determine if person will be futile. (Coon & Mitterer, 2010) D. THE NINE COLLEGE ASSESSMENT SCALES 1. Anxiety (AN) - Anxiety is a feeling of nervousness, apprehension, fear, or worry. Some fears and worries are justified, such as worry about a loved one or in anticipation of taking a quiz, test, or other examination. Problem anxiety interferes with the sufferer's ability to sleep or otherwise function. It is noteworthy that teenagers are particularly susceptible to having irritability as a symptom of a number of emotional problems, including anxiety. Anxiety may occur without a cause, or it may occur based on a real situation but may be out of proportion to what would normally be expected. Severe anxiety can have a serious impact on daily life.(Anxiety, 2012) 2. Depression (DP) - is a state of low mood and aversion to activity that can have a negative effect on a person's thoughts, behaviour, feelings, world view and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, worried, helpless, worthless, guilty, irritable, hurt or restless. They may lose interest in activities that once were pleasurable, experience loss of appetite or overeating, have problems concentrating, remembering details, or making decisions and may contemplate or attempt suicide. Insomnia, excessive sleeping, fatigue, loss of energy, or aches, pains or digestive problems that are resistant to treatment may also be present. 3. Suicidal Ideation (SI) - is a common medical term for thoughts about suicide, which may be as detailed as a formulated plan, without the suicidal act itself. Although most people who undergo suicidal ideation do not commit suicide, a significant proportion go on to make suicide attempts. The range of suicidal ideation varies greatly from fleeting to detailed planning, role playing, selfharm and unsuccessful attempts, which may be deliberately constructed to fail or be discovered, or may be fully intended to succeed. (Suicidal Ideation, 2012)

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4. Substance Abuse (SA) - also known as drug abuse, is a patterned use of a substance (drug) in which the user consumes the substance in amounts or with methods neither approved nor supervised by medical professionals. Substance abuse/drug abuse is not limited to mood-altering or psycho-active drugs. (Substance Abuse, 2012) 5. Self-esteem Problems (SE) - is a term in psychology to reflect a person's overall evaluation or appraisal of his or her own worth. It is conceptualized as an attitude toward the self and is similar to a judgment of oneself. Self-esteem encompasses beliefs (for example, "I am competent", "I am worthy") and emotions such as triumph, despair, pride and shame. The self-concept is what we think about the self the positive or negative evaluations of the self, is how we feel about it. (Self Esteem, 2012) 6. Interpersonal Problems (IP) - records of everyday interpersonal expectations showed that people were more likely to expect positive (supportive and inviting) than negative (critical or dismissive) reactions from others, were more likely to expect positive (listening and opening up) than negative (arguing or ignoring) counterreactions from the self, and were more likely to experience positive (confident and connected) than negative (angry and ashamed) feelings. Not surprisingly, anticipating positive reactions evoked positive feelings and counterreactions, whereas anticipating negative reactions evoked negative feelings and counterreactions. (Locke, 2005) 7. Family Problems (FP) family problems includes separation, an alcoholic or drug addicted parent, an abused parent, an abusive parent, parents who nag or criticize, parents who are overprotective, parents who fight and parent's remarriage (Edwards,2012) 8. Academic problems (AP) - Students, previously a good or at least passing student suddenly showing tendencies towards failing grades, missing classes and disinterest in school can be signs of academic problems. Internalized learning disorder that includes signs such as academic problems boredom or carelessness with school property, homework, disinterest in school or reluctance to go to school completely, withdrawal or disinterest in class, even in subject previously preferred by the student, disorganized, inattentive, lack of focus or motivation, work
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that looks sloppy and poorly done, despite claims of putting his or her best effort into it and lastly physical symptoms of stress such as headaches and stomach pains, frequent trips to the school nurse or infirmary. (Academic Problems, 2008) 9. Career problem (CP) - Career dissatisfaction at career change level is based on loss of motivation, Lack of interest, disinterest in career options, lack of application to career issues, and in some cases there is a total rejection of the career goals. ( Career Change, 2011) E. PHYSICAL THERAPY COURSE AND DESCRIPTION Physical Therapy is an allied medical profession which develops, coordinates, and utilizes selected knowledge and skills in planning, organizing, directing, and evaluating programs for the care of individuals whose ability to function is impaired or threatened by disease or injury. It requires an in-depth knowledge of human growth and development, human anatomy and physiology, neuroanatomy and neurophysiology, biomechanics and abnormal psychological responses to injury, sickness and disability, and the cultural and socio-economic influences of the individual. The goal of Physical Therapy is to help the patient reach maximum potential and to assume her/his due place in society while learning to live within the limits of such capabilities. The Physical Therapist works under the supervision of the Physiatrist, the Rehabilitation Medicine specialist (su.edu.ph). Physical Therapy Program Level Objectives Level I General: At the end of the first year, the student now recognizes that the human being is a unified yet unique whole with biological, psychological, socio-cultural and spiritual needs and that, as an individual, he has a responsibility towards himself, his family, community and the world. The student is now able to Level II General: At the end of the second year, the student is expected to being and his environment; in addition to his acquisition beginning skills in research together with the positive attitude to the self for his role as a future health personnel.
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Level III General: At the end of the third year, the student is expected to enough knowledge to understand man as a biological being in the light of health concepts, as well as develop the beginning skills and positive attitudes pertinent to Physical Therapy practice. Level IV General: At the end of the fourth year, the student is expected to have learned professional skills in Physical Therapy; acquire the knowledge on the rehabilitative significance of specific diseases, and recognize his moral and ethical responsibilities in the practice of his profession. Level V General: At the end of the fifth year (clinical internship), the student will have acquired knowledge, skills and desired attitudes for professional practice so as to work in collaboration with others in the promotion of health, prevention, control, and the rehabilitation of diseases in an everchanging society. Table 1.3 Curriculum of the third year and fourth year BSPT III
First Semester PT 11A Anatomy 1 (Histology, Embryology, Anatomy of the Limbs and Back) PT 11B Anatomy 2 (Internal Organs, Face Neuroanatomy) PT 12A Physiology 1 (General Physiology, Neurophysiology) PT 13 Human Growth and Development PT 14A Physical Therapy 1 (Intro to Patient Care, Hydrotherapy, Massage and Superficial Heat) Second Semester PT 11C Anatomy 3 (Kinesiology) PT 12B Physiology 2 (Organ System Physiology) PT 15 Pathology/Microbiology (Gen. Pathology and General Microbiology) PT 16A Therapeutic Exercise 1 (Physiology of Exercise, Types and Posture) PT 18A Med Surg 1 (Gen. Med. Condition)

BSPT IV
Physical Therapy 2 (Electrotherapy) PT 14C Physical Therapy 3 (Principles of Eval Techniques, ROM, MMT, History Taking and Charting) PT 16B Therap Ex 2 (Specific Exercise, PREs) PT 17 Organization and Administration PT 18B Med Surg Cond 2 (Neurology) PT 19 Ethics in Physical Therapy PT 20A Seminar 1 (Clinical Correlation & Team Approach

Second Semester PT 16C Therap Ex 3 (Adva.Therap Exercise, PNF) PT 18C Med Surg Cond 3 (Gen Surg Cond, Radiology, Ortho & Traumatology, ObsGyne, Misc.) PT 20B Seminar 2 (Clinical Correlation & Team Approach) PT 21 Ortho & Prosthetics (Splinting, Casting, Bandaging, Bracing, Artificial Limbs) PT 22 Psychiatry

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PT 23 Clinical Education (Intro to Clinics)

F. REVIEW OF RELATED STUDIES Berganza and Aguilar (1997) in their further study on depression females and males were compared. It was emphasized that female had higher rates of depression than males. They also explain that males and females differ in rates on depression: A. Cognitive style- females tend to attribute their failures to internal factors while male stand to attribute them external ones; B. Types of adaptation and adjustment processes- for example, males show depression because they are more likely to utilized denial as defense mechanism, or to self medicate their depression through the use of alcohol or other drugs. C. Assignment of social roles were one of the psycho social risk factor that could be related to the higher rate of depression in females is a limited number of option available to them. They have fewer socially accepted means for channelling aggressive and sexual impulses. Meanwhile, Forman and Linneys (1998) study showed that there are three types of primary prevention programs: drug education, social resistance and coping skills training. Coping skill training is the most effective. This kind of training recognized the multiple reason for substance use, low self esteem, anxiety and impulsiveness. In the study of Baker and Siryk (1984), academic adjustment involves more than simply as students scholarly potential and identifies that motivation to learn, taking action to meet academic demands, a clear sense of purpose, and general satisfaction with the academic environment. One of the most important adjustment problems in encountered by college students and late adolescents is career related. Anton and Reed (1991), noted that career adjustment includes setting career goals and making decisions instrumental to career goal attainment. The student who has career problems is experiencing anxiety or worry in selecting academic major or future career. This study claimed that difficulty selecting is the result of lack of, lack of information on course absence of clear career goals.
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G. THEORETICAL FRAMEWORK

Figure 1

The model presented was developed, tested and modifies based on a study, by the first author, of international graduate students who had recently sojourned to a large Midwestern US university to carry out their graduate studies (Shupe, 1997). The model conceptualizes sojourner stress as phenomenon important at both the level of a single stress cycle and the level of overall stress on the system.

Figure 2

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One part of the model, cast at the level of the individual stress cycle, is a stressorappraisal-coping model. That model links sets of features of the person and of single conflict event to the stressfulness of that conflict event; and it then links that experienced stressfulness of the conflict event to coping responses. The main constructs of the part of the model are: uncertainty (including indices of predictability, controllability, social support, and cultural distance), importance (including indices reflecting what is at stake, status of the other party, and duration), incident stressfulness, and coping behaviors (Cooper, 1998). Theories of Stress Stress theory emerged in 1865 when the French physiologist Claude Bernard developed the concept of constancy in the internal milieu. He defined the internal milieu as the fluid that bathed the cells, and constancy was the balanced internal state maintained by physiological and biochemical processes. Bernards principle implied a static or fixed process.Bernards concept was expanded on by Walter Cannon (1932) when he developed the concept of homestasy, physiological equilibrium or homeostasis. Cannon established the existence of the well-known fight-or-flight response. He also is credited with determining that the stability of the bodys internal environment is coordinated by compensatory processes that respond to changes in the internal environment, thereby causing a compensatory response to minimize the change. These compensatory responses are biologic and seek physiological and chemical balance within the internal milieu. They include blood oxygen and carbon dioxide levels, blood pressure, body temperature, blood glucose, and fluid and electrolyte balance. Dr. Hans Selye (1936), known as the father of stress theory (Gabriel, 1997), took a different approach from Cannon. Starting with the observation that many different diseases and injuries to the body seemed to cause the same symptoms in patients, he identified a general response with which the body reacts to a major stimulus, the general adaptation syndrome (GAS). While the fight-or-flight response, as identified by Cannon, works in the very short term, the GAS operates in response to longer term exposure to causes of stress. Selye also recognized the paradox that the physiological systems activated by stress not only can protect and restore, but can damage the body. He applied his theory of stress to the everyday stress of life and
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defined a code of behavior to help avoid negative stress and keep an acceptable and necessary level of positive stress. Although Cannon had earlier introduced the term stress to medicine, it was Selye who popularized it. In 1965, Rene Dubos provided further insight into the dynamic nature of the bodys internal environment with his theory that two complementary concepts, homeostasis and adaptation, were necessary for homeostatic balance. Dubos noted that homeostatic processes occurred quickly in response to stress, making the necessary adjustments rapidly in order to maintain the internal environment. Dubos, consistent with the concepts set forth by Selye, concluded that acceptable ranges of response to stimuli existed, and these levels of acceptability varied from individual to individual. He concluded that homeostasis and adaptation are both necessary for survival in a changing (Cooper, 1998).

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STUDENT LIFE SITUATION >UNIT EXAMS >QUIZZES >PROJECTS >MIDTERM AND FINAL EXAMS Etc.

INTERVENTIONS

ST OP
PRIMARY PREVENTION >Relaxation >effective communication >regular exercise >balanced diet >efficient time management

PERCEPTION

EMOTIONAL RESPONSE

ST OP
SECONDARY PREVENTION >Managing anger >Coping with anxiety

PHYSIOLOGICAL RESPONSE

ST OP
TERTIARY PREVENTION

NEGATIVE CONSEQUENCES Acute chronic >Palpitation >hypertension >Dry mouth >CAD >diarrhea >stroke >anxiety >peptc ulcer

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Figure 3.

. STRESS DEVELOPMENT AND INTERVENTION

For students, their sources of stress can be their school works such as quizzes, projects and examinations. Emotional response depends on the students perception. Some take stress as positive, thus viewing it as challenges and opportunities to learn, while others take the contrary, viewing stress as a threat. Emotions are affected as well as the body system. Stress may disturb the homeostasis of the human body system and could lead to negative physiological responses like palpitation, dry mouth, diarrhea, anxiety, hypertension and other heart diseases. Once stress is developed, one can stop or prevent it. There are three levels of interventions: Primary, Secondary, and Tertiary. Primary Intervention includes relaxation, effective communication, regular exercise, balanced diet. Secondary Intervention includes anger management and anxiety coping mechanism. Tertiary intervention deals with chronic stresses, thus medications are recommended. (ROMAS & SHARMA 1995)

H. CONCEPTUAL FRAMEWORK
Stressors

Coping Resources

Adjustment Level

Junior and Senior PT Students

Figure4

Regular and Irregular PT Students

Male and Female Students

The conceptual model shows that when stressors are present in an individual there should be an adjustment and coping resources. The model will identify the stressors and the coping
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resources of which is either categorized as internal or external resources. To determine the adjustment level of junior and senior physical therapy students, College Assessment Scale (CAS) instrument with the scale of (a) above average, (b) average, (c) low and (d) significant low will be used. The researchers will then tabulate data gathered and compare results of CAS of junior vs. senior students, regular vs. irregular PT students and male vs female students. CHAPTER III: METHODOLOGY A. Research Design This study will be using a descriptive-comparative type of research. This is descriptive in a sense that the researchers will be identifying the stressors and coping resources that the junior and senior PT students have encountered; comparative in the sense that this will determine significant difference of College Adjustment Scale (CAS) between junior and senior PT students, regular and irregular PT students and the male and female PT students. B. Research Setting The study will be conducted in the Institute of Rehabilitative Sciences of Silliman University, Dumaguete City. It is located at the Angelo King building with a population of 217 as of 1st semester of SY 2012 2013.The Institute of Rehabilitative Sciences offers one undergraduate course in Physical Therapy. C. Research Respondents Variables Year Level: a. Junior b. Senior Academic Status a. Regular b. Irregular # of PT students 40 45 30 (Junior); (Senior) 2 (Junior); (Senior) *subject to change, enrollment on going Percentage

Gender a. Male b. Female Distribution of Respondents Classified as to Selected Variables

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The respondents of this study are composed of Junior and Senior Physical Therapy students with both academic and clinical subjects. The sampling procedure in this study will use total enumeration. There are forty (40) junior and forty-five (45) senior PT students with both regular and irregular academic status. D. Research Instruments The research instruments used in this study are the College Adjustment Scale (CAS) and a researcher-developed questionnaire. The norm used in this study will be College Adjustment Scales formulated by Anton and Reed (1991). The norm provided by the College Adjustment Scales is appropriate to reveal college adjustment experiences and coping levels of Silliman University physical therapy students. The College Adjustment Scales (CAS) is an inventory for use by professionals who provide counseling services to college students. The CAS was developed to provide a rapid method of screening college counseling clients for common developmental psychological problems. Based on analyses of presenting problems in college counseling centers, the CAS scales provide measures of psychological distress, relationship conflict, low self-esteem, and academic and career choice difficulties. The nine CAS scales are: Anxiety (AN): A measure of clinical anxiety, focusing on common affective, cognitive, and physiological symptoms Depression (DP): A measure of clinical depression, focusing on common affective, cognitive, and physiological symptoms. Suicidal Ideation (SI): A measure of the extent of recent ideation reflecting suicide, including thoughts of suicide, hopelessness, and resignation. Substance Abuse (SA): A measure of the extent of disruption in the interpersonal, social, academic, and vocational functioning as a result of substance use and abuse. Self-esteem Problems (SE): A measure of global self-esteem which taps negative self-evaluations and dissatisfaction with personal achievement.
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Interpersonal Problems (IP): A measure of the extent of problems in relating to others in the campus environment. Family Problems (FP): A measure of difficulties experienced in relationships with family members. Academic Problems (AP): A measure of the extent of problems related to academic performance. Career Problems (CP): A measure of the extent of problems related to career choice.

The CAS is a 4-page item booklet with 108 items. A profile form is provided which allows raw score conversion to T & percentile scores which are used to interpret the students performance on the CAS. Another instrument that we will be using will be a researcher-developed questionnaire. This was constructed to gather needed data of respondents, to investigate the common stressors and their problem-solving resources utilized in coping with difficulties and troubles, and to get supplementary information about their college adjustment. E. Data Procedure 1. Permission to conduct the study will be obtained from the director of the Institute of Rehabilitative Sciences. 2. The questionnaire will be pre-tested to at least 10 junior and senior Medical Technology students of Silliman University to ensure that the questionnaire will solicit the necessary information. Permission to conduct the pilot study will be obtained from its director. The students will be informed of the purpose of the study and obtain their verbal consent before administering the questionnaire. 3. The names of the PT students will be obtained from the IRS office. The researchers will then obtain verbal consent from each respondent and will be informed of the purpose of the study before administering the questionnaire. 4. The respondents will be subject to answer the sets of questionnaire. The researcher-developed questionnaire will be used to identify the students stressors and coping resource; and the College Adjustment Scale (CAS) questionnaire to measure their level of adjustment. (CAS) questionnaire
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will be conducted by the help of the Physical Therapy Department Guidance Counselor and guidance team in the second semester, school year 2012 2013. 5. For the administration and computation of the CAS, Silliman University Testing Center will do the computation since they own the CAS material. 6. Once data are computed, the researchers will gather and tabulate the results according to the desire objectives. Then segregate data and results of Junior and Senior BSPT students; male and female BSPT students and regular and irregular BSPT students. 7. Treatment of the data will be done by using the mean, the standardized deviation and percentage, to see the extent of college adjustments of the junior and senior PT students. (for comparative statistical tool) F. Sampling A complete enumeration will be used. This is a type of enumeration technique where all members of the whole population are measured; 40 junior and 45 senior students will be selected. They will be the ones who will provide response to two sets of structured questionnaires design to solicit their view about coping mechanism, to identify coping resources and to quantify their adjustment levels above average, average, low, significant low. G. Statistical Treatment The analysis will be carried out in accordance with the research questions. In each case, the responses to questionnaire questions will be scored and the mean and standard deviation will be determine. Treatment of data was done in the following manner: first, the mean, the standardized deviation and percentage were used to see the level of adjustment of Junior and Senior PT students such as above average adjustment, average adjustment, low adjustment and significant low adjustment. The mean score and standard deviation for each group of related items were then pooled together and used to analyze the hypothesis formulated using t-test. The second step to test the difference of means between the extent of college adjustment of two sample groups divided by each selected variable. Critical region is Z>+1.645.
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The third and last step dealt on frequency, percentage and rank which are used for presentation of data obtained by the questionnaire. The significance of the difference between the perceptions of two groups Junior Vs Senior; Male Vs Female and Regular Vs Irregular BSPT students about the level of their college adjustment is to be studied; the computation of the difference between means is to be made. The statistical measure computed is called t. T test is used to confirm the existing relationship between the two variables.

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REFERENCES Books : Asterita, M.F. (1985). The Physiology of Stress. Human Press, New York. Coon, D. (1995). Introduction to Psychology, Exploration and Application. 7th Ed. West Publishing Company, New York. Epstein, R. (1999). Stress Management and Relaxation Activities for Trainers. Mc Graw Hill Companies, USA. Haberlandt, K. (1997). Cognitive Psychology. 6th Ed. Viacom Company, Needham Height Massachusetts. Johnson, David W., 1997) Reaching Out: Interpersonal Effectiveness & Self Actualization 6th ed, A Viacom company, 160 Gould street , Needham Heights, MA Kleinke, C. (1998). Coping With the Life Challenges. Brookes/Cole Publishing Company, New York. Lazarus, R. (1966). Psychological Stress and the Coping Process. Mc Graw Hill Book Company, New York. Osborn, K., Wraa, C. & Watson, A. (2009). Medical Surgical Nursing. Pearson Upper Saddle River, New Jersey. Romas, J. & Sharma, M. (1995). Practical Stress Management. Simon & Schuste Company, Needham Heights Massachusetts. Selye, H. (1976). Stress in health and disease. Stoneham, Massachusets. Shaver, K. (1993). Psychology. MacMillan Publishing Company, New York. Snyder, C. (1999). Coping: The Psychology of What Works. Oxford University Press Inc., New York. Journal: Folkman, S. & Lazarus, R.S. (1980). An Analysis of Coping in a Middle-aged Community Sample. Journal of Health and Social Behavior.

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Unpublished Material: Aquino, D. (1991). Determinants of Occupational Stress; Personality and Coping Behaviours As Moderators . Moon, S. (1999). College Adjustment Experiences and Coping Levels of Student Assistants: An assistant. Silliman University, Dumaguete City. Internet sources : Suicidal Ideation. Retrieved from http://en.wikipedia.org/wiki/Suicidal_ideation. 2012 Locke, K. (2005) Interpersonal Problems and Interpersonal Expectations in Everyday Life. Retrieved from http://www.class.uidaho.edu/klocke/publications/jscp05.pdf. Academic Problem. Retrieved from http://www.centerfordiscovery.com/mentalhealthprogram/academicproblems/ 2008 Call Adjustment Scales retrieved from http://psycentre.apps01.yorku.ca/drpl/?q=node/15718. 2011 Career change or job dissatisfaction: How to tell the difference. Retrieved from http://www.cvtips.com/career-choice/career-change-or-job-dissatisfaction-how-to-tell-thedifference.html. 2011 Depression. Retrieved from http://en.wikipedia.org/wiki/Depression_(mood). 2012 Edwards, R. (2012). Anxiety. Retrieved from http://www.emedicinehealth.com/anxiety/article_em.htm. Family Problem. Retrieved from http://www.covenanthouse.ca/Youth/Different-kinds-offamily-problems Introduction to stress management. Retrieved from http://www.mindtools.com/stress/UnderstandStress/StressIntro.htm Self esteem. Retrieved from http://en.wikipedia.org/wiki/Self-esteem. 2012 Simon, H. (2009). Stress - Introduction. Retrieved from http://www.umm.edu/patiented/articles/what_stress_000031_1.htm. Silliman University retrieved from http://en.wikipedia.org/wiki/Silliman_University#Institutes Substance. Retrieved from http://en.wikipedia.org/wiki/Substance_abuse. 2012
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The Four Levels of Stress: Which level are you? (2011) retrieved from http://jenaisle.com/2011/03/16/the-four-levels-of-stress-which-level-are-you-in/ Wilkin, T. (2005). A definition of disease. Future positive. Retrieved from http://futurepositive.synearth.net/eoo5/12/05?print-friendly=true

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November 9, 2012 Dear Respondent, We are Physical Therapy students of the Institute of Rehabilitative Sciences at Silliman University, and we are conducting a study entitled The Stressors, Coping Resources and Adjustment level of Junior and Senior Physical Therapy Students of Silliman University in the School Year 2012 2013. The results of this study will hopefully help the students cope and adjust with stressors surrounding them. This study may as well give understanding to the teachers, guidance counselors and the Physical Therapy Department on the students situation. It is our understanding that you are currently a BSPT III IV student. I am interested in your experiences and responses as a BSPT third year and fourth year student, so I have enclosed a questionnaire which asks you to respond to a series of statements and questions. Your participation and time will be greatly appreciated Diannah Anne Zendon Kathleen Alabastro Adeliz Aromin Chester John Yucor Angelica Japos Jarome Simon Tiffany Villalon
BSPT IV Student of Silliman University Batch 2014

James Angelo Fabe Kenny Jude Fernandez Frankie Bacang Eli Voskamp

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Name: Gender:

Year Level: Academic Status: regular

irregular

Please check or fill up the information asked for:Please answer the following questions by putting a check ( / ) mark on the blank before the item or items applicable to you. 1. Why did you decide to become a physical therapy student? ___To be a Physical Therapist ___For pre - med ___For experience ___To be with my close friends who are also physical therapy students ___Because it was chosen by my parents ___Others, please specify: ______________________________

2. How frequent are unit examinations held in your college?

___ 1-2 times in a week ___ 3-4 times in a week ___ > 5 times in a week

3. Do you maintain a regular calendar in studying?

___Yes ___No

4. If you find these as stressors that affects your student life, rate the following as: 4- strongly
agree, 3 agree, 2- disagree, 1- strongly disagree ___ Coursework ___ Schedule of exams ___ Schedule of class ___ Terror teachers ___ Types of exams ___ Bully classmates ___ Family problems ___ Break ups ___ Financial matters ___ Co-curricular activities ___Pessimistic thinking ___Self-criticism ___Over-analyzing ___Environmental disturbances ___Rules & regulations ___Exaggeration ___Rigid thinking ___Personality Traits ___Others, please specify: ______________________________ 4.1 How often are you stressed? ___Always ___Sometimes ___Rarely ___Never 37

4.2 I am stressed because of:

___Being at the bottom of the class ___Not being able to finish my course on time ___Not being good at practical exams ___Not being able to contribute to class projects ___Not being loved/like by teachers ___Not being loved/like by classmates ___Not being confident of myself ___Others, please specify: ______________________________ 5. In times of stressful situation, what problem-solving resource(s) do you usually utilize in coping with them? ___ Ministry ___ Family ___ Guidance counselor ___ Friends ___ Alcohol & Drugs ___ Eating ___ Movies ___ Sports and Recreation ___ Self help (Positivism) ___ Others (please specify) ___________________________________

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