Study investigates effects of stress management tool that can also appeal to younger generation

Can modern technology be the solution to the ever-increasing problem of overworked and overstressed college students? Johns Hopkins University School of Nursing (JHUSON) doctor of nursing practice (DNP) student Billinda Tebbenhoff sought to find out.

Her study, "The Use of Virtual Reality for Stress Reduction for College Students," investigates the effects of a stress management tool that can also appeal to the younger generation.

In this case, it is through use of a smartphone app called Breathe2Relax, created by the National Center for Telehealth & Technology (T2) and available for iPhone, iPad and Android devices. It provides users with healthy breathing techniques and ways to chart their stress levels.

Tebbenhoff, also the Assistant Professor of Nursing at Shenandoah University, conducted the study of 23 nursing students (21 women and two men) toward the end of the spring 2011 semester at her campus.

"Ideally, the ratio would have been 50/50," she said. "However, the gender distribution in this project was representative of the gender distribution of second-degree nursing students in the United States. Nineteen of the 23 subjects (83%) were second-degree nursing students."

The biological basis of her study centered on the salivary cortisol levels of the participants. Salivary cortisol is the steroid hormone in saliva released in response to the body's stress fluctuations. Tebbenhoff collected cortisol samples from the students who took part in daily virtual reality stress ratings and stress reduction sessions using the Breathe2Relax app. Following their two weeks of participation, their saliva samples were collected again and the cortisol levels were tested. The results showed that the virtual reality subjective stress ratings were cut by more than half from an average score of 2.52 to 1.22. The scale is measured from 0-5, with zero being not stressed and five being highly stressed. Fourteen of the 23 students showed reduced cortisol levels. The average cortisol levels dropped 0.013μg/dL (micrograms per deciliter) per student.

Tebbenhoff believes that the length and timing of the testing-two weeks at the end of a semester-played a factor in the small cortisol decrease. She proposes that extending and changing the testing periods as well as adding more participants will benefit a similar study in the future.

"Testing students at different times throughout the semester might have rendered very different results. It would be fascinating to lengthen the intervention to capture an entire semester," she added.

"The goal during the experience was to bring awareness to the need for stress management as part of maintaining good overall health during the college experience," Tebbenhoff said. However, she found that the most rewarding aspect of the study came from results that she didn't measure.

"After all of the data was collected, several participants shared that they noticed that they slept better and felt more focused while using the app," Tebbenhoff said. "I think that many people believe that chronic stress is an unavoidable fact of life. This doesn't have to be the case."