Analysis of Perfectionism on Perceived Stress and Sleep Hygiene in Physical Therapy Students

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Lindsay Cowman, SPT, Trey Furgeson, SPT, JP Noonan, SPT

37 Comments on “Analysis of Perfectionism on Perceived Stress and Sleep Hygiene in Physical Therapy Students

  1. Hey guys! Nice job on your poster, it was easy to read and was very interesting! What did your study describe “poor sleep quality” as? Was it amount of time in REM and/or overall hours of sleep, amount of time waking up, trouble falling asleep, etc? Also, I saw there were a few countries included within this study, did there seem to be a difference between the U.S. and other countries with students perceived stress? One reason why I ask that is that American’s seem to be portrayed as having “busier” schedules and other stereotypes. Thanks guys!

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    • Hi Sydney! The article used the Pittsburg Quality Sleep Index which is a measure of self report for the quality of sleep that the person feels they get each night. So it is a self reported measure with similar questions to what you stated and not looking at REM sleep! In response to your second question, we did not come across any studies comparing the US to other countries specifically. In the US, the degree obtained is a doctorate of physical therapy, while in other countries it is a masters or even a bachelors degree. Because of the amount of time students are in school and the level of the degree obtained, one could think that US PT students would be more stressed, but my group did not come across anything stating so. That would be an interesting study though! Thanks for your questions!

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  2. Great job on your poster guys! I am not surprised by the results as I found that I had increased stress and lesser quality of sleep throughout PT school, especially during finals week. In the studies utilized, did the authors mention how to work through perfectionism? If not, what would your groups’ recommendations when battling with perfectionism during PT school? Thanks!

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    • Hi Michaela,
      We didn’t find any articles within our inclusion criteria that talked about perfectionism. So that is an area that should be researched within our profession! Some suggestions that I have found helpful is accepting that as a treating therapist, you will not know everything or find out everything day 1 with a patient. I had a CI tell me that he always treats the impairments that are limiting the patient the most, rather than diagnosis hunt, and he has had a lot of success that way. He said he could develop a good relationship with the patient and be upfront that he doesn’t know everything, but he would continue to work on getting them better and that decreased a lot of stress he had upon graduating.

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    • Hey, Michaela! That is a very good question. In addition to what Lindsay said, we do know that PT school can be quite challenging, and that perfectionism is not necessarily a practical expectation for academic performance. With this in mind, one may predict that having a perfectionism-based mindset could potentially lead to stress, as actual classroom results may not equal expectations. If this is the case, the strategies in the discussion section above may be beneficial to help one work though the stressors of perfectionism. Moreover, another consideration would be to have PT institutions educate students on the realistic expectations of the program and to acknowledge that overall academic success is possible, despite the possible reduction in performance at times. All of these are just considerations at this point, however, as more research needs to be done regarding perfectionism. Hope this helps answer your question!

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  3. Great poster Lindsay, Trey, and JP! This research is very relevant to us as students and it is reassuring to know that other students are also feeling increased stress and reduced quality of sleep. I saw that you had mentioned in the ‘Clinical Relevance’ section that PT programs should implement meditation and mindfulness strategies and education on sleep habits which would be beneficial. What other things do you think that PT programs could implement in order to promote decreased stress, perfectionism, and to improve sleep strategies?

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    • Hi Jenny! I think that PT programs should offer a variety of opportunities for students when it comes to stress management. In my own personal experience and throughout our research, I found that what works for one person to reduce stress does not always work for another. So having a variety of opportunities and resources available for students depending on their preferences would be helpful. I also think that programs should try to incorporate some stress reducing techniques within classes instead of having all the opportunities outside of class time. As students, we can already feel stretched for time, and so having these available within the class session could decrease the stress of even just having to attend the class/event itself. I also think that throughout the semester, the professors could do a “check in” to ask how students are doing within each class. This would allow there to be an open communication between the professor and the class and help identify stressors that may be contributing to performance in class.

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    • Hi Jenny!

      I agree with Lindsays comment in stating that it would be great if mindfulness strategies could be implemented during classroom time. If we could implement even 15 minutes of intential mindfulness techniques during class time It may show benefits in the students stress levels. On top of these techniques it would be beneficial to break off into groups and have candid conversations on how we are individually doing with stress and what we are doing to combat it. Discussing and implementing mindfulness techniques as a group may be a benefit to the student. Thanks for the question!

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  4. Very nice presentation! Your group mentioned that physical therapy programs should be aware of the stress students experience as well as provide programs for mindfulness and meditation. What does you group propose for how a physical therapy program should address stress management with their PT students? For example, would it be more beneficial for students to take a class regarding stress management, or should the professors provide opportunities for students to participate in throughout the semester such as meditation? I hope this makes sense. I enjoyed reviewing you group’s poster.

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    • Hi Maia!! I think that professors should include some part of mindfulness/meditation within their classes throughout the semester. I don’t think that a separate class should be required for students, as we are already have many classes on our plates. Plus, not everyone might enjoy that class because those forms of stress relief don’t resonate with them, so it could actually add to the stress for some students. Thank you for your question!!

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    • Hi Maia!

      Great question. I am on the same page with Lindsay where I don’t think a specific class should be required, but professors could provide mindfulness techniques into their classes to help reduce stress. Also, I believe there are more resources that the university provides that could be presented throughout our DPT tenure. I know the faculty does a good job of having counseling come in, but maybe having them come in during both years and at strategic times in the semester when stress is higher. Thanks for the question!

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  5. Great job on the poster! This topic definitely hits close to home. I’ve always been pretty good about managing stress, but PT school has challenged me in this aspect. Through a lot of trial and error with different techniques and strategies throughout my first year, I feel like I have a good grasp on what works for me to decrease stress and improve my sleep. While I have tried some of the things you have listed, what would all be included in a 4 week health enhancement program? For instance, would it more so focus on the mental health side of things, or is it something that would also include physical health (such as exercise promotion) as well? Also, did you come across anything that related stress and sleep quality to performance in school? I know for me while I’d prefer to be stress free all the time, there is a certain amount of stress that I need to do well in school.

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    • Thanks, Jason. You bring up some good questions. First, the health enhancement program is based on research by Lo, Francis-Cracknell, and Hassed.1 The program was four weeks and consisted of four one-hour lectures and two one-and-a-half-hour tutorial classes.1 The first week covered healthy education and lifestyle change.1 The second week looked at stress management, the connection between mind and body, and mindfulness.1 Week three considered nutrition and physical activity.1 The fourth week consisted of spirituality and environmental variables that affect well-being.1 As you can see, this particular health enhancement program covered multiple different areas. In terms of your second question, most of our articles that we used for our systematic review specifically examined the prevalence of stress, causes of stress, strategies to combat stress, and sleep quality/perceived sleep quality in PT students, not necessarily the influence on academic performance. However, interestingly, Jacob and Einstein found that perceived stress was not related to academic achievement.2 One may predict that stress and poor sleep would negatively influence academic outcomes, but more research needs to be done in this area. If you are interested in seeing either of these two articles, let us know and we can send them to you.

      1. Lo K, Francis-Cracknell A, Hassed C. A health enhancement programme for physiotherapy students: a mixed methods pilot study. New Zealand Journal of Physiotherapy. 2017;45(3):143-153. https://doi.org/10.15619/NZJP/45.3.06
      2. Jacob T, Einstein O. Stress among bachelor physical therapy students in Israel during clinical practice and its association with academic achievements. Internet Journal of Allied Health Science and Practice. 2016;14(1). ISSN 1540-580X

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  6. Great poster guys! This is an extremely relevant topic and definitely seems to be something a lot of us PT students can relate to.

    I see that you listed a few ways that PT students can try to reduce their stress. Was there any one intervention that seemed to work best/better than the others listed?

    Additionally, was there a certain method that had better compliance, in terms of students using them on a regular basis?

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    • Hey, Kiana! Thanks for the questions! In terms of deciding which stress reducing method was most beneficial, it is challenging to say as these methods we not compared to one another. We did see that these methods individually were useful for PT students, according to the literature. Moreover, everyone has a unique way of relieving stress, so we cannot necessarily say one strategy is better than the other, as that may not be true with different people. Regardless, individuals should consider these options if they are experiencing increased stress as they have been helpful for some. Considering your second question, that is also hard to say. I didn’t see any of the articles mention students keeping up with the stress reducing strategies outside of the respected studies and the results from such. It would be very interesting to know if these strategies were beneficial if consistently used in the long run, however.

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  7. Great job on the study guys! It is interesting to me that you did not find any literature relating perfectionism to stress, as I have often heard that perfectionism is associated with higher levels of stress. I assume that most students in post-graduates program have perfectionism characteristics, as we tend to hold ourselves to high standards. Do you guys believe there is a direct relationship between perfectionism and perceived stress for physical therapy students even though your research did not yield a connection?

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    • Hey, McKenze! We also thought that was interesting. Yes, it could be predicted that a perfectionism based mindset could potentially lead to increased stress. Similar to my response to Michaela, we all know that PT school has many challenges and it is unrealistic to believe that academic performance will always be where one would like it to be. In other words, actual performance in the classroom may not always equal expectations. With this is mind, one may find ourself in a state of increased stress as they are “under performing” based on their standards, which again, are not very practical. Hopefully more research with be done in this area. Thanks for the question!

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  8. Hey McKenze!

    Great question. It was surprising that we did not find much research on perfectionism in physical therapy students. I think since perfectionism is so hard to measure in individuals it’s making it difficult for research to get published on it. Since some may think some traits are perfectionistic and others think they are normal.

    I personally think perfectionism can play a significant role in stress in students due to the fact that most grad students aim very high within their academics. I don’t think it’s the sole proprietor of stress though. Academic load, exams, personal life, etc contribute to that stress level too. Thanks for the question!

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  9. Great job on the poster! The topic is very relevant to all of us.
    How could or how did PT programs implement the strategies to combat stress? How do you think it could be monitored for students stress and how could PT programs track if the strategies are decreasing students’ stress?

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    • Hey Ashley!

      One of the studies was a RCT that implemented mindfulness techniques at the beginning of each class. They had a group that received the intervention and a group that did not. The group receiving mindfulness training at the beginning of class saw positive effects on their perceived stress levels.

      I would suggest that it would be best if we could implement the mindfulness training during class time. This could be a 10 minute session at the beginning of class. As graduate students we already have a strict time schedule between class and studying , so implementing mindfulness during class sessions would be ideal and then you would be able to experience the training with your classmates. This may not always work, so other resources should be readily available for students to access. Thanks for the question!

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      • Tracking the progress would need to be through self assessment and could be accomplished through student surveys. The perceived stress scale would be ideal to use within the survey. Also, advisors are a great resource for students to voice concerns of stress during annual advising meetings. If advisors received access to the survey scores than the topic could be discussed during a 1 on 1 meeting.

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    • Hi Ashley! I agree with JP that meeting up with your academic advisor would be a good way of tracking stress. However, I do think that it is important that keep track of stress management techniques should not be viewed as an additional assignment because that could in its own way increase stress in the student. The academic advisor and student could just talk about what strategies they have tried and how they have felt after them. That way there is time for reflection without it being a burden on the student to keep strict notes and times that they have participated in stress management techniques.

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  10. Great job on your poster it was interesting information and very applicable to us. Obviously from your research there is a need for more to be done especially regarding sleep hygiene. How do you see this research being done? Through randomized control trails, observational studies, or case studies?

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    • Good question, Brooke. Ideally, we would hope that more research regarding sleep hygiene would consist of randomized control trials, as we know that randomized control trials are some of the higher quality pieces of literature. However, we did find one article that considered sleep hygiene in the physical therapy student population by utilizing a cross-section research design, which is more observational. I could see more sleep hygiene research being observational or survey based because of practicality and efficiency of these methods. Nonetheless, any kind of research design in this area would be beneficial due to the scarcity of such. More specifically, it would be great to see how if sleep hygiene has any connection to perfectionism and stress.

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    • Hey Brooke!

      That is a great question and I agree with Trey that it would be ideal to conduct research through a randomized control trial, but it may be difficult. I think it would be productive if surveys regarding sleep quality were taken in conjunction with the perceived stress scale. These surveys could be sent to multiple PT programs and to all the students within the programs. This would give data to compare between multiple PT programs. Observational studies may be too difficult to perform, especially if we’re wanting to conduct research on PT students specifically who already have very busy schedules. Thanks for the question!

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  11. Great job with the presentation. Was there anything found in research that suggested that positive stress or perfectionism would improve scores or academics in Physical Therapy school or if all stress and perfectionism is bad? Did the group finding anything on if there are benefits in being religious or spiritual? Thank you in advance for your reply!

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    • Hey Justin!

      You present 2 great questions. We found limited research on the topic of perfectionism and its relation to stress within the student physical therapy population, so it is hard to give you a definitive answer. In my opinion, not all stress and perfectionism is bad. We found that perfectionists often hold themselves to very high standards, which would ideally translate over to improved academic performance within PT school. The bad stress presents itself when perfectionists hold themselves and their peers to unrealistically high standards. So, as long as the student has perfectionistic traits, but does become unrealistic in their performance/goals it would be considered good stress. The topic of spirituality in the research we found was limited, but if it is definitely an avenue that a PT student could take to combat stress levels if it is a priority in their life. Thanks for the questions!

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  12. Great poster! Definitely an important topic for PT students to consider. Did you come across any literature that compared the effectiveness of stress-related coping mechanisms? Was there one that was deemed superior? Were there any comparisons between positive coping mechanisms, such as meditation, and negative coping mechanisms, such as drinking or drug use?

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  13. Hi Cody,
    Our research did not show that one stress-related coping mechanism was deemed superior to the others. We did find that students found partaking in stress-related coping mechanisms stated they were less stressed than those that did not. I personally don’t think that a certain coping mechanism is superior than the others. I think it ultimately think that whatever works best for the student is what is good for them. Our research did not come across anything about negative coping mechanisms such as drinking and drug use, but that would be interesting to compare! There is a lot of research still to be done on this topic.
    Thanks for the question!

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  14. Great job on your poster! This is a very interesting and relevant topic. I wish there was more research that tied in the perfectionism aspect of your research question. I find myself caught up in perfectionism at times and would be curious how that relates to stress and sleep. Sleep hygiene is something that really grabs my attention because I have tried many things to improve my sleep quality and nothing seems to work. What were some of the suggestions given in the studies you found on how to improve sleep? What are some things that have worked for any of you to improve your sleep?

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    • Hey Madason!

      The quality of ones sleep may depend on multiple variables, but it seems stress is a big component contributing to poor sleep qaulity. Through our research we found that mindfulness and health enhancement programs among others help reduce stress, which would ideally improve the quality of sleep in the the student experiencing increased stress levels. We found limited research on ways to improve the quality of sleep in the physical therapy student population, but did find quality information on combating stress, which may play a crucial role in disrupting sleep.

      From my personal experience, ways that I have improved my sleep during the past 3 years is to put away all study materials at least 1 hour before bed so my mind is not racing through information while trying to fall to sleep. Also, I attempt to maintain a steady workout schedule no matter how busy I am within the program. Exercise helps fuel the brain by releasing endorphins and increasing energy levels, which ultimately helps increase the quality of our studying and sleep hygiene. I believe that stress will always be present during the PT curriculum, so finding your own personal ways to combat it is crucial! Thanks for the question!

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  15. Great presentation! It is definitely a topic that hits close to home. Did you guys come across any research that categorized the students perceived stress at different points through their PT school experience, such as just starting their first year or getting closer to graduation and preparing for boards? Would you expect to see any improvement throughout the time or would you expect to see some of the same negative effects? Great job again!

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    • Hi Tyler! We did have a few studies that took a look at physical therapy students in their first year, second year, and third year of school, but they were all different cohorts instead of following one class for their entire curriculum. The researches asked the students about what their stressors were and the first year students reported more stress with the increased workload, exams, and group projects. The third year students reported more stress with board prep, interviewing for jobs, and upcoming graduation. It would be interesting to follow one cohort and see how their response to stress changes over the cirriculum. I think that your stressors change as you get more into the program speaking from experience. While I am no longer stressed about group projects and exams, I am becoming more stressed about board prep, a potential move following graduation, and the costs that come from all of that. All forms of stress are valid, I just think that they change as you mentioned above. Thanks for your question!

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  16. Nice work with the poster! It looks like there has not been much discussion of the strategies of animal therapy or laying supine. It seems like there would be many potential variables with these strategies. Do the types of animals matter for animal therapy (examples: cuddly kitten vs hyper dog vs fish)? Was laying supine the only requirement or were the participants encouraged to take a nap or do something specific during the 90 minutes? I can definitely see how there could be benefits with these strategies, but for me, I feel that I could end up more stressed if I am around overly energetic animals or if I just lay in one place and think about my stressors.

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    • Hi Kyle, great question. The study on animal therapy used a specific trained therapy dog. So the dog was trained to be calm with the students! We did not come across another study that had used animals, but I agree that being around a hyperactive animal prior to a stressful exam or practical could add more stress. As for the other study for laying supine, the participants were not allowed to sleep. They were to lay there quietly in a dark room and just relax. Thanks for the questions!

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  17. Well done on your poster! I appreciated the layout; it was very organized and easy to read. Stress is such an important topic and ideally some of these relaxation techniques will be implemented into PT programs in the future. I was wondering if you found any programs that already implement any stress-management techniques? If so, what are the participation rates? Do students find these techniques valuable, or view them as “one more assignment to do”?

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    • Hey, Jessica! Thank you for the question. We did not see any particularly programs that were consistently implementing stress management interventions. However, I believe it would be beneficial if they did, especially if they implemented such during class time. This way, students wouldn’t feel like they have extra “busy work” to do on top of academic assignments. For example, Dr. Zimney would sometimes start his classes with a quick 1-2 min quiet meditation so students clear their heads to better focus on classroom material. I believe many programs would see good results with something similar to this approach. Thanks again!

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