Promoting Stress Management: The Role of Comprehensive School Health Programs. ERIC Digest. 

by Massey, Marilyn S. 

Stress has been defined as, "the inability to cope with a perceived or real (or imagined) threat to one's mental, physical, emotional, and spiritual well-being [sic] which results in a series of physiological responses and adaptations" (Seaward, 1997, p. 5). In addition to responding physiologically, people may respond cognitively and emotionally to stress. Studies indicate that 70-80% of all disease and illness is stress-related (Seaward, 1997). 

Stress affects each of the five dimensions of health: physical, mental, emotional, social, and spiritual. Examples of "distressors" (negative stressors) that children and adolescents may confront within these dimensions include: illness, injury, inadequate nutrition, and low levels of physical fitness (physical dimension); pressures to excel in academic and extracurricular activities, depression, and anxiety (mental/emotional dimension); relational issues, peer pressure, and dysfunctional family lives (social dimension); and inability to find purpose in life or to understand how individual lives contribute to a much larger and grander universe (spiritual dimension). 

Rather than how much stress individuals experience, the critical issue seems to be how they perceive stress and respond to it. Seaward (1997) points out that coping with stress is an ongoing process. Therefore, it is critical that children and adolescents are given opportunities to develop life skills that will help them effectively cope with daily stressors, major life events, and change. The purpose of this Digest is to examine how comprehensive school health programs may promote stress management. 


A recently conceptualized model (Allensworth, Lawson, Nicholson, & Wyche, 1997) describes four key elements of CSHPs: community participation and focus, school environment, education, and services. Each of these areas is linked to enhance the well-being of the entire school and community. Examples of how stress management can be promoted through these components follow. 


School health efforts must be coordinated with the community at large. There are numerous ways in which stress management strategies can involve families and communities: 

1. School health newsletters sent home and to community agencies may include health facts, tips, family activity ideas, and resources for further information on a particular health topic, such as time management. 

2. The Family Involvement Calendar (Birch, 1994) includes ideas for family participation in health activities that reinforce a specific health topic or unit that is being studied at school. 

3. Health fairs and community nights that include enjoyable educational activities can be held at the school (National PTA, 1997; Valentine, 1997); community groups can be involved in program planning and delivery. 

4. Local newspapers, radio, and television stations can promote wellness activities including poster and/or writing contests for different age groups focussing on the importance of stress management. Prizes may be donated by local businesses, and winning posters and/or writings can be displayed within the school or community (e.g., supermarkets). 

5. Guest speakers from the community can address various stress management issues at student and staff health promotion programs. 


The school environment includes the physical setting as well as the policy and administrative environment, psychosocial environment, and health promotion for staff. Physical conditions that play a role in stress and the overall learning process include school size, lighting, temperature and ventilation, noise control, crowding, sanitation and cleanliness, and accessibility. The teacher's personality and behavior, respect for diversity and individual differences, and effective classroom management play a role in helping to ensure that students feel a sense of belonging, security, and trust. A nurturing emotional environment is especially important for those children and youth whose families exhibit behaviors such as abuse and neglect, violence, and alcohol and other drug abuse. School safety is directly associated with the stress experienced by students, teachers, and parents. Important areas that should be considered regarding safety and injury prevention include playground safety, violence prevention, conflict resolution, procedures for emergencies and disasters, and promotion of smoke- and drug-free schools. 

It is critical that teachers and other school staff possess emotional wellness in order to manage their own lives as well as the lives of the children within their circle of influence. According to Pransky (1991), teachers who have participated in school health promotion programs report decreased absenteeism, enhanced morale, improvement in the quality of their teaching, enriched attitudes about their personal health, and a sense of well-being. Moreover, healthy teachers and staff serve as positive role models for children and their families. A staff wellness program might include instruction in relaxation techniques, diet planning, communication skills, smoking cessation, and incentives for lifestyle improvements, such as lower health insurance rates, bonus checks, and free or reduced-cost health club memberships. 


Various curricular areas offer practical opportunities to promote stress management (Gilbert & Orlick, 1996; DeWolfe & Saunders, 1995; Anderson & Haslam, 1994; Romano, 1992; Miller & McCormick, 1991). School-based life skills programs that focus on such strategies as relaxation, problem solving, and positive perspectives are successful in teaching children and adolescents how to control their stress (Gilbert & Orlick, 1996; De Wolfe & Saunders, 1995). Miller & McCormick (1991) offer excellent suggestions for teaching stress management and relaxation skills to preschool and elementary children. These strategies can be effectively implemented by physical educators, classroom teachers, and parents. 

Curricular areas that offer opportunities for curriculum infusion include: 

HEALTH EDUCATION. Mental and emotional health is one of the 10 major content areas of health education, and stress management techniques can be taught as a part of this unit. Also, stress management can be addressed in other health content areas such as family living; nutrition; personal health; physical fitness; and tobacco, alcohol, and other drugs. Personal and social skills--decision making, problem solving, communication, conflict resolution, peer resistance, and goal setting--are essential in helping children to cope with stress. There are numerous skill-building activities that can be used in the classroom (see Bender, Neutens, Skonie-Hardin, & Sorochan, 1997; Miller, Telljohann, & Symons, 1996; Fetro, 1992). 

PHYSICAL EDUCATION. Many of the health benefits derived from regular physical activity are directly related to stress management, including the reduction of depression and anxiety and the promotion of psychological well-being and improved vitality. Daily physical education provides students with multiple opportunities to engage in physical activity and to develop personal and social skills. Through quality physical education, students can learn various relaxation techniques (including the basics of deep breathing), acquire the knowledge and skills for participating in lifelong regular physical activity, develop self-discipline, learn how to cooperate with others, and have fun in the process. 

CURRICULUM INFUSION. There are other areas of the curriculum where stress management may be infused: language arts (children's literature, creative writing, journal writing); social studies (Eastern traditions of meditation, yoga, Tai Chi; learning to appreciate and value diversity; and learning to work cooperatively to solve problems); science (physiology of the stress response and relaxation response); and art and music (creative ways to relax and express thoughts and feelings). 


Children's health problems can cause distress and, if undetected and untreated, hinder both health and learning. School services that can help reduce children's stress include health services; counseling, psychological, and social services; nutrition and food services; and comprehensive family services. School services may provide needed medical treatments, teach effective management of health, serve as the primary source of nutrition (if necessary), and offer services that deal with a variety of mental and emotional health issues that may cause stress. 


Schools play a vital role in stress management by assuring a healthy learning environment, providing services for stress reduction, enhancing student and staff knowledge and skills for coping with stress, and coordinating activities with families and communities. The Comprehensive School Health Program is an effective model for implementing stress management in schools and communities to enhance the well-being of children. 


The American Institute of Stress, 124 Park Avenue, Yonkers, NY 10703; (914) 963-1200. 

Mental Health Net; 

North Carolina Cooperative Extension Service. Disaster Recovery: Children's Needs (includes information about recognizing stress in children and strategies for parents and teachers); 


Allensworth, D., Lawson, E., Nicholson, L., & Wyche, J. (Eds.). (1997). SCHOOLS AND HEALTH: OUR NATION'S INVESTMENT. Washington, DC: National Academy Press. 

Anderson, A., & Haslam, I. R. (1994). A three phase stress inoculation program for adolescent learners. JOURNAL OF HEALTH EDUCATION, 25(1), 4-9. EJ 478 602. 

Bender, S. J., Neutens, J. J., Skonie-Hardin, S., & Sorochan, W. D. (1997). TEACHING HEALTH SCIENCE: ELEMENTARY AND MIDDLE SCHOOL. Boston: Jones and Bartlett. 

Birch, D. A. (1994). Involving families in school health education: Implications for professional preparation. JOURNAL OF SCHOOL HEALTH, 64(7), 296-299. EJ 495 635. 

De Wolfe, A. S., & Saunders, A. M. (1995). Stress reduction in sixth-grade students. JOURNAL OF EXPERIMENTAL EDUCATION, 63(4), 315-329. EJ 517 187. 


Gilbert, J. N., & Orlick. T. (1996). Evaluation of a life skills program with grade two children. ELEMENTARY SCHOOL GUIDANCE & COUNSELING, 31, 139-151. 

Miller, D. F., Telljohann, S. K., & Symons, C. W. (1996). HEALTH EDUCATION IN THE ELEMENTARY IN THE ELEMENTARY & MIDDLE-LEVEL SCHOOL (2nd Ed). Madison, WI: Brown & Benchmark. 

Miller, S., & McCormick, J. (1991). Stress: Teaching children to cope [Special feature]. JOURNAL OF PHYSICAL EDUCATION, RECREATION, and DANCE, 62(2), 53-70. EJ 425 072. 

National PTA. (1997). BUILDING A HEALTHY CHILD. Washington, DC: Author. 

Pransky, J. (1991). PREVENTION: THE CRITICAL NEED. Springfield, MO: Burrell Foundation & Paradigm Press. 

Romano, J. L. (1992). Psychoeducational interventions for stress management and well-being. JOURNAL OF COUNSELING & DEVELOPMENT, 71(2), 199-202. EJ 455 381. 


Valentine, J. (1997). Schools and communities work together for healthy children. WELLNESS MANAGEMENT, 13(1), 11. 

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