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ScienceDirect Procedia - Social and Behavioral Sciences 205 (2015) 228 – 235

6th World conference on Psychology Counseling and Guidance, 14 - 16 May 2015

Effectiveness of progressive muscle relaxation and biofeedback relaxation in lowering physiological arousal among students with regard to personality features Ieva Peciulienea*, Aidas Perminasa, Loreta Gustainienea, Gabija Jarasiunaitea ࢟Vytautas Magnus University, Jonavos str. 66-326 Kaunas, LT-44191, Lithuania

Abstract Background. Students make a rather specific population, which has to overcome many obstacles in order to pursue their academic goals (Pierceall, Keim 2007). Special programmes for stress prevention, based on relaxation training are being established in universities. The effectiveness of these programmes is constantly assessed and ways of their improvement are being studied (Jones, Johnston 2000, Beddoe, Murphy, 2004). One of the directions for such studies is the studying the effectiveness of relaxation training in relation to personality characteristics. However, there is lack of studies analysing the impact of personality features on individual’s ability to relax and ability to learn to relax. Both biofeedback-assisted and progressive muscle relaxation are regarded as interventions aimed at lowering stress response. These methods help to train relaxation skills as well. The aim of the study was to assess the effectiveness of biofeedback-assisted relaxation as well as progressive muscle relaxation in lowering psychophysiological parameters with regard to personality features. Method. The subjects of the study were 122 university students. 105 (85 female and 20 male) of them, aged 18 to 36 (mean age 21.13 (SD 2.58), participated in all relaxation training sessions. Participants were randomly assigned into three different groups: a) four progressive muscle relaxation sessions (n = 34) or b) four biofeedback-assisted relaxation sessions (n = 35). Subjects in the c) control group participated only in the 1st and the 6th session without relaxation training (n = 36). Biofeedback-assisted relaxation was conducted using device NeXus – 10 (The Netherlands). Results and conclusions. Both relaxation methods proved to be effective in lowering psychophysiological variables. Methods of lowering psychophysiological variables should be applied with regard to personality traits of individuals: the course (of four sessions) of both types of relaxation helps to lower skin conductance in persons with higher scores of openness, agreeableness and conscientiousness and helps to lower heart rate in persons with higher scores of neuroticism and extraversion. © 2015 2015The TheAuthors. Authors.Published Published Elsevier © byby Elsevier Ltd.Ltd. This is an open access article under the CC BY-NC-ND license Peer-review under responsibility of Academic World Research and Education Center. (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer-review under responsibility of Academic World Research and Education Center.

* Ieva Peciuliene. Tel.: +370 37 327 824,; fax: 370 37 327 824. E-mail address: [email protected]

1877-0428 © 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer-review under responsibility of Academic World Research and Education Center. doi:10.1016/j.sbspro.2015.09.064

Ieva Peciuliene et al. / Procedia - Social and Behavioral Sciences 205 (2015) 228 – 235 Keywords: : personality, biofeedback-assisted relaxation, progressive muscle relaxation, students;

1. Introduction Experiencing average levels of stress is rather common among students (Busari, 2014). Nevertheless, too much stress might be related to an increased anxiety level and depression symptoms (Dyson, 2006), worse sleep quality, fatigue (Kelly, 2001), muscle tension (Davey, Cheung, 2010), unhealthy eating habits, low physical activity, lower self-esteem, suicidal tendencies (Hudd et al., 2000; Busari, 2014) and decreased academic performance (Womble, 2003; Busari, 2014). Strong and long-lasting stress may reduce academic achievements, have a negative influence on students’ life and increase substance abuse (Richlin-Klonsky, Hoe, 2003). Universities employ a large variety of skills training programmes for academic stress reduction. These programmes include various stress management tachniques, such as cognitive restructuring, problem solving or time management skills training (Jones, Johnston 2000; Beddoe, Murphy, 2004), improvement of relaxation skills using progressive muscle relaxation (PMR) or biofeedback-assisted relaxation (BAR) (Rasid, Parish, 1998; Ratanasiripong, Sverduk, Prince, Hayashino, 2012), etc. PMR as well as BAR are used to improve relaxation skills enabling a student to lower stress response. Researchers analyse the effectiveness of these methods (Kerr, 2000; Yucha, Gilbert, 2004) including students’ population as well (Ratanasiripong, Sverduk, Prince, Hayashino, 2012; Khanna et al., 2007; Rasid, Parish, 1998; Matsumoto, Smith, 2001). Many studies have confirmed the effectiveness of these relaxation techniques (Khanna et al., 2007; Ratanasiripong et al., 2012; Matsumoto, Smith, 2001). It is assumed that personality features might be related to the occurrence of chronic or frequent stress, which has a negative impact on a person’s health. Therefore, recent studies include analyses of personality characteristics in relation to stress (Sharma, 2011; Vearing, Mak, 2007; Connelly, Denney, 2007; Gorynska, Winiewski, Zajenkovski, 2015). Personality plays a significant role not only in stress evaluation (reaction to different stimuli) and in coping mechanisms of an individual, it has an impact upon selection and modelling of stress-inducing situations as well (Vollrath, 2001; Karimzade, Besharat, 2011). Acording to Sharma (2011) relaxation plays a significant role in facing stress. 100 college students participated in the study with the the aim to analyse the influence of personality patterns on individual’s ability to relax. The study demonstrated that extraverts relaxed more easily than introverts and relaxation was related to facilitating coping reactions. This suggests that in designing stress management techniques personality must be taken into consideration to make these techniques effective. Another study (Zin et al., 2008) reported that extraverts, rather than introverts, seemed to benefit more from both music and progressive muscular relaxation. Thompson, Steffert, Gruzelier (2009) point out the importance to consider personality when planning stress intervention measures. The aim of their study was to determine whether the effectiveness of guided imagery training on immune-based measures was dependent upon openness to experience. The results indicated that training effectiveness was moderated by openness. When openness was high, cortisol increased and tiredness decreased as compared to the cntrol group. No differences across groups were observed when openness was low. The authors agreed that openness to experience should be considered as a potentially important moderator in future studies examining intervention efficacy in healthy populations. Nevertheless, in their study the autors did not analyse other Big Five personality traits like neuroticism, extraversion, agreeableness and conscientiousness. Thompson, Steffert, Gruzelier, (2009) found that in some studies not all individuals have demonstrated benefits from guided imagery, and they agreed that one possible explanation for this finding was that intervention efficacy is dependent upon personality. The influence of personality dimensions on relaxation response is still poorly understood (Schneider, 2011). Earlier research studies examining the role of personality in coping strategy use have been focused on the role of single traits. It is assumed that complex examination of personality features may add to our understanding of the stress and coping process (Vearing, Mak, 2007; Sharma, 2011; Karimzade, Besharat, 2011; Lee-Baggley, Preece, & DeLongis, 2005). Finally, very limited research has analysed interactions between the Big Five dimensions of personality and relaxation training efficacy (Thompson, Steffert, Gruzelier, 2009; Ziv, Rotem, Arnon, Haimov, 2008).

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In the current study, we decided to include a wider range of personality traits. Specifically, we studied all traits from the five-factor (Big Five) model: neuroticism (tendency to experience negative emotions, e.g., anxiety, depression or anger), extraversion (high activity, positive emotions, assertiveness and a tendency towards social behavior), openness to experience (tendency to engage in intellectual activities and experience new sensations and ideas), agreeableness (tendency to be compassionate and cooperative), and conscientiousness (tendency to be organized, self-disciplined, and dutiful, show aim for achievement (Costa, McCrae, 1992). Austin et al. (2010) indicate one more limitation of similar studies, i. e. self-report measures. It is suggested to use more objective physiological measures of stress such as hormone levels and cardiovascular responses (Loft et al., 2007) and examination of the associations of such measures with personality. Consequently, in the current study, we studied changes in physiological parameters with regard to personality characteristics. 2. Methods 2.1 Participants The subjects of the study were undergraduate students from various faculties of Vytautas Magnus University (Kaunas, Lithuania). Initial survey was performed in 2013 and in 2014 in order to assess the students’ academic stress level. 1421 students were surveyed, and 359 of them, having the highest levels of stress, were invited to take part in a stress reduction programme. 122 of the invited agreed to participate in the programme, and 105 of them completed the course of individual stress management sessions, which included two types of relaxation: biofeedback-assisted relaxation and progressive muscle relaxation. Data analysis included the data of 105 students (85 females and 20 males), aged 18-36 (mean age 21). Subjects were asked to refrain from nicotine, strenuous physical exercise and caffeine for at least 2 hours and from alcohol for at least 12 hours prior to testing. All participants participated in the experiment voluntarily having signed the informed consent, and the study was carried out adhering to ethical standards. 2.2 Physiological measures Skin conductance level (SC), skin temperature (TMP), heart rate (HR) were used as physiological indicators of relaxation. SC, TMP and HR were recorded continously using Mind Media device NeXus – 10, serial No 0928050233 (The Netherlands). SC was recorded using a pair of silver–silver chloride electrodes. The electrodes were then affixed to the palmar surface of the medial phalanges of the second and fourth digits of the nondominant hand. Changes in HR were recorded via a light plethysmograph attached to the third digit of the nondominant hand. Heart rate was recorded continuously and displayed on a computer monitor. TMP was monitored using an electrode fixed on the forearm of the non-dominant hand. A decrease in SC and HR, and an increase in TMP can be expected as relaxation response indices. Personality characteristics were assessed by the Lithuanian version (Bagdonas, Barkauskiene, Kairys et al., 2012) of NEO Five-Factor Inventory (NEO-FFI; Costa & McCrae, 1992). This 60-item self-report measure assesses five personality dimensions such as extraversion, neuroticism, openness, agreeableness, and conscientiousness. Participants were required to indicate on a 5-point scale (strongly disagree, disagree, neutral, agree, strongly agree), whether the statement was true of them. The NEO-FFI has shown adequate levels of validity and reliability across a range of diverse populations (see McCrae & Costa, 2004). 2.3 Procedure In order to study the efficacy of different relaxation techniques, a between subjects design was used with three experimental conditions and repeated measurements (pre and post training). All surveyed students having high scores of perceived stress were invited to participate in stress management programme and were randomly assigned into three groups: two groups of relaxation (biofeedback-assisted or progressive muscle relaxation) and a control group. Invitation to individual relaxation sessions was sent three times with several days’ interval. Further screening


occurred to exclude individuals taking certain medications that would affect physiological responses (i.e., benzodiazepines, tricyclic antidepressants, and methylphenidate). Those who agreed to volunteer and were not excluded were allotted individual schedule to participate in the experiment. The programme was performed in the Psychology Laboratory, Vytautas Magnus University. Students for stress management programme were selected using convenience sampling procedure. Stress management programme for each participant (excluding control group) consisted of 6 individual sessions: at the 1st (measurement I) and the 6th sessions (measurement II), prior to the psychophysiological test, participants filled in the NEO Five-Factor Inventory and answered sociodemographic and health-related questions, no relaxation training was performed. Participants underwent a psychophysiological testing before and after relaxation training session with the following sequence: participants were instructed to lie down with their eyes closed and relax; physiological ctivity was continually assessed for 10 min: a) baseline resting period for 2 min with physiological recording and b) 8 min continuation of physiological recording. During the last 8 min participants were instructed to relax and remain still; this period served as the pure baseline physiological index (the data of 2 min were excluded from statistical analysis). For the purpose of data analysis, the baseline period data were not included, as the intent of this period was to allow an individual’s responses to adjust and stabilize. The sessions between the 1st and the 6th session were four one-hour individual relaxation sessions, conducted one or two times a week with 2-3-day intervals. Participants of a control group were invited only to two sessions, the 1st and the 6th, during which they were asked to fill in the questionnaire prior to the psychophysiological test, in the same way as in experimental groups. 2.4 Relaxation training programme Progressive muscle relaxation (PMR) sessions were performed for each participant individually. Session 1 started with a breaf explanation of the basic principles of PMR. The subjects were comfortably seated in an armchair with backrest, without any accessories, which could hamper relaxation process. Sessions were the same for all individuals. Progressive muscle relaxation was conducted by psychologists, specially trained for the relaxation procedure in the Department of Theoretical Psychology, Vytautas Magnus University. Biofeedback-assisted relaxation (BAR) sessions began with a short introduction of the relaxation technique and the device NeXus-10. Afterwards participants had electrodes placed on their non-dominant hand fingers. As in the case of PMR, participants were asked to sit comfortably in an armchair having removed any possible obstacles for easy and calm breathing. On the computer monitor participants could watch relaxing views of nature which were organized as a kind of puzzle, which formed a one-piece view of a picture when a person managed to reach high levels of relaxation, and the pieces of the puzzle remained scattered in the case of high levels of experienced stress. In this way, participants could detect what feelings and/or thoughts have relaxing or stressful impact and act accordingly to reach as much relaxed state as possible. Sessions were the same for all individuals. Biofeedbackassisted relaxation was conducted by psychologists, specially trained for the procedure in the Department of Theoretical Psychology, Vytautas Magnus University. Detailed description of BAR and PMR sessions is presented in methodological publication (Perminas et al., 2014). Control group members had two face-to-face meetings (the 1st and the 6th) without any type of relaxation. During these meetings, participants were asked to fill in the NEO Five-Factor Inventory and answer sociodemographic questions. 2.5 Statistical analysis Data analysis was performed using SPSS 17.0 for Windows. Kolmogorov – Smirnov and Shapiro - Wilk criteria were used to assess normality of the data. Hypotheses were tested using statistical significance level of 0.05. For all subsequent analyses, preliminary assumption testing was conducted to check for normality, linearity, univariate and multivariate outliers, homogeneity of variance – covariance matrices, and multicollinearity. Differences in physiological variables before and after relaxation sessions among experimental and control groups were analysed using repeated measures analysis of variance (3 (group) × 2 (time periods: before and after training cycle) ANOVA). Included were within subjects effects of physiological parameters (the means of 8 minutes of measurements in 1st

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and last (6th) sessions and between-subjects effects of the three training conditions. Separate analyses of variance were calculated for dependent variables SC, TMP and HR. The training conditions (type of group) were as independent variables. Therefore, a priori contrasts for repeated-measures ANOVA were used. This study employed two contrasts: contrast 1 for assessing differences between two intervention and one comparison groups, and contrast 2 for detecting differences between the intervention groups. We conducted five separate analyses, one for each NEO-FFI personality factor (dichotomized at the median score to facilitate interpretation of interactions). The aim of the study was to answer the main question: how different types of relaxation are related to changes in physiological parameters among students with regard to their personality features.

3. Results Analysis of HR scores among respondents with higher levels of neuroticism revealed a significant withinsubjects main effect for Time (pre vs. post), F (1, 2380) = 4.405, p = .041, partial eta squared = .080. There was a significant time × group interaction effect on HR variable F (2, 2380) = 7.420, p = .001, partial eta squared = .225. Statistically significant differences were observed analysing mean differences among control groups and the comparison group F (1, 4760) = 11.782, p = .001, partial eta squared = .188 (contrast 1). This means that HR scores decreased differently with regard to relaxation type as compared to no-relaxation. Contrast 2 did not reveal statistically significant differences between progressive muscle relaxation and biofeedback-assisted relaxation F (1, 4760) = 1.999, p = .163, partial eta squared = .038 (contrast 2). These findings demonstrate that both progressive muscle relaxation and biofeedback-assisted relaxation help to decrease HR scores in a group of subjects with higher scores of neuroticism. Changes in SC and TMP were not significant among respondents with lower levels of neuroticism. Analysis of SC, TMP and HR scores among respondents with lower levels of neuroticism did not reveal significant alterations. Analysis of HR scores among respondents with higher levels of extraversion revealed a significant withinsubjects main effect for Time (pre vs. post), F (1, 2306) = 2.615, p = .010, partial eta squared = .131. There was a significant time × group interaction effect on HR variable F (2, 2306) = 7.504, p = .001, partial eta squared = .231. Statistically significant differences were observed analysing mean differences among control groups and the comparison group F (1, 4612) = 14.567, p = .0001, partial eta squared = .226 (contrast 1). This means that HR scores decreased differently with regard to relaxation type as compared to no-relaxation technique. Contrast 2 did not reveal statistically significant differences between progressive muscle relaxation and biofeedback-assisted relaxation F (1, 4612) = 1.914, p = .173, partial eta squared = .037 (contrast 2). These findings demonstrate that both progressive muscle relaxation and biofeedback-assisted relaxation help to decrease HR scores in a group of subjects with higher scores of extraversion. The interaction for SC and TMP was not significant among respondents with lower levels of extraversion. Analysis of SC, TMP and HR scores among respondents with lower levels of extraversion do not revealed significant changes. Our study showed within-subjects main effects for reapeted HR measurements. This means that HR decreased in both high and low scorers on openness, agreeableness and conscientiousness. These findings demonstrate that both progressive muscle relaxation and biofeedback-assisted relaxation help to decrease HR in a group of subjects with high and low scores of openness, agreeableness and conscientiousness. Contrast 2 did not reveal statistically significant differences between progressive muscle relaxation and biofeedback-assisted relaxation among respondents with higher and lower levels of openness, agreeableness and conscientiousness. Focusing on within-subjects main effects, the results showed effects for reapeted SC measurements. The main within-subjects effects for SC scores among respondents with higher levels of openness, agreeableness and conscientiousness. With regard to main effects, there were significant changes for SC for Time (pre vs. post), among respondents with higher levels of agreeableness F (1, 32) = 3.851, p = .048, partial eta squared = .092, also a significant time × group interaction F (2, 32) = 3.797, p = .028, partial eta squared = .116, and 1 st contrast F (1, 64) = 6.700, p = .012, partial eta squared = .104. There were significant changes for SC for time × group interaction effect on SC variable among respondents with higher levels of openness F (2, 18) = 2.510, p = .042, partial eta squared = .093, and 1 st contrast F (1, 36) = 4.553, p = .038, partial eta squared = .085. There were significant changes for SC for time × group interaction effect on SC variable among respondents with higher levels of conscientiousness F (2, 33) =


2.655, p = .040, partial eta squared = .094, and 1 st contrast F (1, 67) = 5.038, p = .029, partial eta squared = .090. Contrast 2 did not reveal statistically significant differences between progressive muscle relaxation and biofeedback-assisted relaxation among respondents with higher levels of openness, agreeableness and conscientiousness. These findings demonstrate that both progressive muscle relaxation and biofeedback-assisted relaxation help to decrease SC scores in a group of subjects with higher scores of openness, agreeableness and conscientiousness. The interaction for SC was not significant among respondents with lower levels of of openness, agreeableness and conscientiousness. In our study, we examined whether the Five Factor model personality factors moderated the effect of the stress management intervention. Consistent with prior research (Gale et al., 2001; Stemmler, Wacker, 2010; Robinson, 2001; Vassend, Knardahl, 2005; Delgado et al., 2010) we found that physiological arousal was associated with higher levels of neuroticism and extraversion (HR), and higher levels of agreeableness, openness to experience and conscientiousness (SC). 4. Discussion and conclusion The results of the current research demonstrated that during PMR and BAR sessions heart rate decreased for persons with high scores on neuroticism and extraversion. No such decrease was observed among students with low scores on neuroticism and extraversion. Our findings about the decrease of heart rate among high scorers on neuroticism could be explained by the results of other research studies. Individuals who score high on neuroticism frequently experience negative emotions. In contrast, persons with low scores on neuroticism are calm and balanced even in stressful situations (Costa, McCrae, 1992). In general, people scoring high in neuroticism may have difficulty managing their stress or controlling anger. Similarly, these people are more sensitive and are often tense, worried, or angry (Costa, McCrae, 1992). According to Zverev and Mipando (1999), those scoring high on neuroticism have higher sympathetic activities than those scoring low (Zverev and Mipando, 1999). It is suggested, that in the case with high levels of neuroticism, relaxation training, which include modules on affective regulation, may lead to self-efficacy improvements by helping them cope with difficult emotions (Franks, 2009). Sharma’s (2011) study results show that extraverts were able to decrease their arousal very quickly. These results can be explained very well with reference to personality theory of Eysenck (Sharma, 2011). With regard to different neural processes author concludes that techniques of relaxation cannot relax extraverts and introverts equally (Sharma, 2011). Nevertheless, there are studies where there were no moderator effects of neuroticism or extraversion on blood flow or other cardiovascular responses (Vassend, Knardahl, 2005). Our findings revealed that skin conductance during PMR and BAR decreased in individuals with higher scores on openness, agreeableness and conscientiousness. Literature reported higher scores on conscientiousness, agreeableness and openness being related to lower levels of everyday stressors (Vollrath, 2001; Besser, Shackelford, 2007) as well as to lower level of subjectively perceived stress (Ebstrup, Eplov, Pisinger, Jørgensen, 2011). One can assume that relaxation training is more effective for such individuals due to lower levels of stress experienced, which can further be reduced utilising skills, acquired in short-term relaxation trainings. One more explanation suggests that individuals with higher scores on conscientiousness, agreeableness and openness to experience tend to use problem solving stress management strategy (Vollrath, Torgersen, 2000, Karimzade, Besharat, 2011). Using efficient coping strategies, compatible with personality traits, can make stressful situations more manageable and less damaging (Karimzade, Besharat, 2011). Relaxation training enhanced stress management possibilities of individuals with such character traits, which have been suscessfully applied in their everyday lives. In our study, after PMR and BAR cycle heart rate parameters decreased among students with different levels of openness, conscientiousness and agreeableness. Neuroticism and extraversion are the most often analysed traits, and agreeblenesss, openness to experience and conscientiousness were less studied, therefore, relatively less is known about the impact of such traits upon relaxation training (Leandro, Castilo, 2010; Giluk, 2009). One potential explanation for the lack of group differences in physiological response in the present study is that students with highest stress levels only have been selected for the study, which may have induced greater relaxation effect. If so, physiological response would be expected to remain relatively constant across two measurements for both groups. Senf and Liau (2012) analysed the role of personality characteristics in two positive interventions (gratitude-based and strength-based) and found that higher extraversion was related to the decrease in depressive symptoms in both intervention groups.

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To summarize, both relaxation methods proved to be effective in lowering psychophysiological variables. Methods of lowering psychophysiological variables should be applied with regard to personality traits of individuals: the course (of four sessions) of both types of relaxation helps to lower skin conductance in persons with higher scores of openness, agreeableness and conscientiousness and helps to lower heart rate in persons with higher scores of neuroticism and extraversion. Some limitations of this study could be mentioned. As the population of the study consisted mainly of young (aged 18-36), and predominantly female subjects, these findings cannot extend to more diverse or clinical samples. The data have not been analysed taking into account the levels of stress within a semester, and this could have affected the results. No analysis of the data was performed for drop-outs or non-participants of the study, thus depriving the study of valuable information. This type of studies is very rare in Lithuania, so extending the variety of psychological and physiological indices, e.g., including a subjective measure of perceived stress and additional physiological measures (e.g., respiratory rate, cortisol levels, or electromyography) in future studies may provide a more comprehensive picture in this area and in this population. Also including situational factors (e. g. momentary moods) could be beneficial (Gorynska, Winiewski, Zajenkowski, 2015). Acknowledgements This research was funded by a grant (No. MIP-111/2012) from the Research Council of Lithuania. References Austin, E. J., Saklofske, D. H., & Mastoras, S. M. (2010). Emotional intelligence, coping and exam-related stress in Canadian undergraduate students. Australian Journal of Psychology, 62(1), 42-50. Bagdonas, A., Barkauskiene, R., Kairys, A., Liniauskaite, A., Valickas, G., & Žukauskiene, R. (2012). Taisyto NEO asmenybes (NEO PI-R) ir NEO penkiǐ faktoriǐ (NEO-FFI) klausimynǐ vadovas. Beddoe, A. E., & Murphy, S. O. (2004). Does mindfulness decrease stress and foster empathy among nursing students?. The Journal of nursing education, 43(7), 305-312. Besser, A., & Shackelford, T. K. (2007). Mediation of the effects of the big five personality dimensions on negative mood and confirmed affective expectations by perceived situational stress: A quasi-field study of vacationers. Personality and Individual Differences, 42(7), 13331346. Busari, A. O. (2014). Academic Stress among Undergraduate Students: Measuring the Effects of Stress Inoculation Techniques. Mediterranean Journal of Social Sciences, 5(27P2), 599. Connelly, M., & Denney, D. R. (2007). Regulation of emotions during experimental stress in alexithymia. Journal of psychosomatic research, 62(6), 649-656. Costa, P. T., & McCrae, R. R. (1992). Revised Neo Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI). Psychological Assesment Resources. Davey, K. R., Cheung, J. C. K., Visvanathan, R., & Willison, J. W. (2010). A unique assessment of stress and stress factors on engineering academics in the research and teaching environment. Dyson, R., & Renk, K. (2006). Freshmen adaptation to university life: Depressive symptoms, stress, and coping. Journal of clinical psychology, 62(10), 1231-1244. Ebstrup, J. F., Eplov, L. F., Pisinger, C., & Jørgensen, T. (2011). Association between the Five Factor personality traits and perceived stress: is the effect mediated by general self-efficacy?. Anxiety, Stress & Coping, 24(4), 407-419. Franks, P., Chapman, B., Duberstein, P., & Jerant, A. (2009). Five factor model personality factors moderated the effects of an intervention to enhance chronic disease management selfǦefficacy. British journal of health psychology, 14(3), 473-487. Giluk, T. L. (2009). Mindfulness, Big Five personality, and affect: A meta-analysis. Personality and Individual Differences, 47(8), 805-811. GoryĔska, E., Winiewski, M., & Zajenkowski, M. (2015). Situational factors and personality traits as determinants of college students’ mood. Personality and Individual Differences, 77, 1-6. Hudd, S. S., Dumlao, J., Erdmann-Sager, D., Murray, D., Phan, E., Soukas, N. & Yokozuka, N. (2000) Stress at college: effects on health habits, health status and self-esteem, College Student Journal, 34(2), 217–227. Yucha, C., & Gilbert, C. (2004). Evidence based practice in biofeedback & neurofeedback. Wheat Ridge, CO: AAPB. Jones, M. C., & Johnston, D. W. (2000). Reducing distress in first level and student nurses: a review of the applied stress management literature. Journal of Advanced Nursing, 32(1), 66-74. Karimzade, A., & Besharat, M. A. (2011). An investigation of the Relationship Between Personality Dimensions and Stress Coping Styles. Procedia-Social and Behavioral Sciences, 30, 797-802. Kelly, W. E., Kelly, K. E., & Clanton, R. C. (2001). The relationship between sleep length and grade–point average among collage students–

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