Running head: STRESS INOCULATION FOR
LAW STUDENTS
Richard Sheehy
Drake University
And
John J. Horan
Arizona State University
Subsequently
published as:
We examined the effects of stress inoculation training (SIT) on the anxiety, stress, irrationality, and academic performance of first year law students. A 2 x 3 (treatment-sequence by repeated-measures) crossover design was employed in which the middle assessment occasion marked when control participants began receiving SIT. Compared to those in the control phase, participants initially receiving SIT showed decrements on personal, emotional, and general stress. Additional analyses indicated that all participants who received SIT displayed lower levels of anxiety, stress, and irrationality over time. Finally, the academic ranks of participants predicted to finish in the bottom 20% of their class on the basis of LSAT scores, reflected conspicuous and significant improvement. We conclude that SIT has promising applicability to the stress experienced by first-year law students.
Effects of Stress Inoculation Training for First
Year Law Students
The legal profession is currently plagued by increasing numbers of lawyers who are dissatisfied with their careers and abandon the practice of law for seemingly less stressful career alternatives (Daicoff, 1997, 1998; Rhode, 2002). Contributing factors include anxiety, depression, relationship issues, and existential questions involving personal values and the meaning of life (Beck, Sales & Benjamin, 1995; Schiltz, 1999). These sources of psychological and physical distress may compound throughout one’s career; however, research indicates they often begin in law school (Benjamin, Kaszniak, Sales, & Shanfield, 1986; Krieger, 1998; Lake, 2000). Indeed, law students consistently show higher levels of stress, depression, and anxiety as well as lower self-esteem and life satisfaction than medical students, graduate students, and non-students (Alfini & Van Vooren, 1995; Heins, Fahey & Henderson, 1983). The literature attributes responsibility to several specific stressors in the law school experience: (a) the perceived competitive nature of law school, particularly in the first year, (b) the lack of adequate performance feedback, (c) the kind of instructional methods employed, (d) value conflicts or cognitive dissonance stemming from required new ways of thinking, and (e) succumbing to “myths” surrounding the first year.
The competitive nature of law school is very different from what most students have previously experienced. Law-student groups are much more task-oriented and less personally supportive than student groups found in undergraduate colleges. Many law students believe that career options are determined by first year grades, thus exacerbating their stress (Boyer & Cramton, 1974; Dubin, 1982; Kaufman, 1994; Lake, 2000). Although there is an element of truth in this belief, the perceived career-defining pressure of achieving superior grades from the very beginning of law school produces stress and anxiety, as well as intense feelings of inadequacy and doubt about the choice of law as a career (Iijima, 1998; Maloney, 2001).
Lack of adequate feedback compounds the problem. Standard law school practice involves a single end-of-term examination as the primary grade determinant; students receive no feedback about their progress throughout the semester. Segerstom (1996) found the lack of feedback, especially positive feedback, as particularly stressful to students. Archer and Peters (1986) report this deficit to be the primary reason why law school is viewed as less nurturing and supportive than the undergraduate experience. Lack of feedback also contributes to the reluctance of law students to approach professors with questions or to ask advice (Maloney, 2001; Shanfield & Benjamin, 1985).
Instructional methods vary among law professors; however, the majority continues to use some form of Socratic dialog (Friedland, 1996). This process involves questioning students extensively until they contradict themselves or can no longer advance their position (Maloney, 2001). It has also been described as the professor driving “students into a corner by refuting any position they take” (Gutierrez, 1985, p. 131). The constant correcting, uncertainty, and embarrassment may produce frustration rather than enlightenment, as well as heightened vulnerability, fragility, anxiety, and depression (Garner, 2000; Kutalakis, 1992; Watson, 1968). Of course, not all law professors abuse the Socratic dialog which can be effective in stimulating abstract and creative thinking (Areeda, 1996; Davis & Steinglass, 1997; Kerr, 1999).
Value conflicts and cognitive dissonance may arise when the first year student is faced with the need to “think like a lawyer.” Such narrowness of focus can isolate one from the rest of the world (Lake, 2000; Thaler, 2000). Students learn pragmatic strategies designed to ensure victory, rather than morally “correct” argumentation (Granfield, 1986). Materialism and new-knowledge of how the law works often conflict with altruistic motives for attending law school (Benjamin, et al., 1986; Carney, 1991). By the end of the first year, many students report a heightened sense of cynicism, which masks feelings of disappointment and anxiety; publicly they project strength and enthusiasm, but privately they feel awkward, defensive, and nervous (Krieger, 1998; Reich, 1976).
Female students face additional pressure to succeed in a male-dominated field, thus often exhibit higher levels of stress than males (Goring, 1996; McCleary & Zucker, 1991; McIntosh, Keywell, Reifman, & Ellsworth, 1994). They experience law school differently than males (Granfield, 1994; Homer & Schwartz, 1990). For example, Guinier, Fine and Balin (1994, p. 42) noted: “The women students we interviewed almost universally expressed stronger and more passionate feelings of alienation and outrage than the male students … almost all described their first-year as a radical, painful, or repressive experience.”
Finally, many students succumb to first year myths, an enduring set of irrational beliefs that corrode one’s quality of life (Lake, 2000). These include (a) I am only as good as my grades and class rank, (b) I must study all the time, (c) I must be at the top of my class to be successful, (d) I can’t have a social life in law school, and (e) I have no time for leisure or for fun. Many law students feel they have no control, and thus “… after awhile, just do their time” (Granfield, 1986, p.16). Such irrational beliefs are correlated with anxiety (Day & Maltby, 2003; Rohsenow & Smith, 1982); their internalization by law students is a likely contributor to stress.
Many stress-inducing practices in law school are steeped in tradition; they have remained unchanged for generations and will probably remain constant in the near future. Nevertheless, stress does interfere with academic performance (Glesner, 1991; Hess, 1997; Iijima, 1998), suggesting the need to provide law students with preparatory information and coping skills (Hazard, 1995; Maloney, 2001; Thaler, 2000). Attention to increasing the availability of counseling services for law students dates back to the 1980s (Dickerson, 1987; St. Lawrence, McGrath, Oakley, & Sult, 1983), but outcome studies are rare. Fortunately, theoretical, clinical, and empirical advances have occurred both in the field of stress management (Leahy & Dowd, 2002) as well as in our understanding of the sources of stress experienced by law students.
Stress Inoculation Training (SIT) has been successfully evaluated in a wide variety of psycho-education, prevention, and remediation programs (Meichenbaum & Deffenbacher, 1988). These include anger control (Timmons, Oehlert, Sumerall & Timmons, 1997), pain management (Hackett & Horan, 1980; Ross & Berger, 1996), test and other performance anxieties (Saunders, Driskell, Johnston & Salas, 1996; Schneider & Nevid, 1993), and student coping (Israelashvili, 1998). The pronounced effectiveness of SIT on occupational stress (West, Horan, & Games, 1984) is highly relevant to this study, given that the daily pressures on law students resemble what they will face in their careers.
SIT typically involves three phases (Meichenbaum, 1993). First, participants are educated about the sources of their stress including, for example, its relationship to irrational thinking and possible ways to reduce it at both the physiological and psychological levels. Next, coping skills directed toward specific stressors are fostered. These include, for example, relaxation techniques and cognitive restructuring. (Here, we tailored the coping skills to the individual stressors identified in the law school experience, i.e., competition, lack of feedback, instructional methods, value conflicts, and myths). The final application phase involves exposure to real or simulated situations for practice in using the coping skills.
We expected that our SIT program would result in improvements on a battery of outcome measures reflecting anxiety, stress, irrational thinking, and the academic performance of law students. To evaluate its effects, we used a crossover design in which students were randomly assigned to either of two treatment sequences. Half received SIT after pretesting; the other half were placed on a waiting list and began treatment after those in the former sequence were posttested. We hypothesized that (a) students exposed to SIT-first would exhibit less anxiety, stress, and irrational thinking at posttest than would waiting list controls on all measures, (b) improvements evidenced by students in the SIT-first sequence would endure throughout a follow-up phase, and (c) students in the waiting-list control sequence would evidence similar repeated-measures changes on anxiety, stress, and irrational thinking after eventually receiving treatment.
Since all participants eventually received SIT, an experimental-control comparison could not be conducted on grade point average. However, we were especially interested in monitoring potential improvements in the academic performance of those students whose LSAT scores predicted them to finish in the bottom 20% of their class. Finally, although not raised to the level of research hypotheses, we explored the implications of the literature suggesting that women experience law school differently than men.
METHOD
A recruiting letter explaining the study’s purpose, voluntary nature, and time commitment was sent to all 158 first-year law students during the summer preceding their matriculation at state university. Twenty-nine (17 women, 12 men) returned informed consent documents; 22 (16 women and 6 male) began and completed treatment. Their median age was 30; 16 described themselves as Caucasian, 2 as Hispanic, and 1 each as Asian, African American, Native American, and Appalachian American.
Three
advanced doctoral students in counseling psychology (two men, one woman) each
treated one third of the participants via small groups in both treatment
sequences. Two of the counselors were attorneys as well as psychologists in
training. The counselors received a detailed treatment manual, approximately
three hours of instruction, and weekly monitoring to ensure ongoing fidelity to
the treatment manual.
A 2 x 3 (treatment-sequence by repeated-measures) design was employed. Half the participants received the experimental treatment in a pre/post/follow-up sequence. The other half experienced a waiting-list phase prior to being treated. All were tested prior to and at the end of the study; the assessment occasion in the middle marked the changing of phases, i.e., a posttest for SIT in the first sequence, and a pretest for SIT in the second sequence. The participants were initially blocked on gender and randomly assigned to each of the two treatment sequences. Students receiving SIT were further randomly assigned to counselors.
The State-Trait Anxiety Inventory (STAI, Spielberger, Gorsuch, & Lushene, 1970) yielded two outcome measures in this study, namely, STAI-state and STAI-trait; the former taps state anxiety (how one feels currently), and the latter trait anxiety (how one generally feels). Presumably only a very powerful treatment would be able to significantly impact trait anxiety, so the STAI-trait was analyzed separately in an exploratory fashion.
Form X-1 of the STAI-state contains 20 items in 4-point Likert format anchored by “almost never” and “almost always;” high scores reflect greater levels of state anxiety. An internal-consistency reliability coefficient of .96 was obtained from the pretests of participants in this study. Form X-2 of the STAI-trait contains 20 items scored similarly; pretest internal consistency was .89.
The Derogatis Stress Profile (DSP, Derogatis, 1984) is derived from
interactional stress theory; its 77 self-report items are rated on a 5-point
scale anchored by “not at all true of me” and “extremely true of me.” Only two domains of the DSP are relevant to the law school experience, namely, DSP-emotional and DSP-personal. The DSP-emotional
consists of 11 items with higher scores reflecting hostility, anxiety and
depression. The DSP-personal
similarly consists of 11 items with higher scores indicating the presence of
multiple personality mediators associated with medical or psychological
stress-related disorders (such as propensity for driven behavior, ability to
deal with time pressure, relaxation potential, attitude posture, and role
definition). Pretest internal consistency coefficients in the present study
were .85 for DSP-emotional and .77
for DSP-personal.
The Symptoms of Stress Inventory (General Stress, Leckie & Thompson, 1979; Thompson & Leckie, 1979) is a general and specific measure of stress consisting of 118 items rated on a five-point scale anchored by “never” and “very frequently” in response to how often various physical and emotional stress-related symptoms have occurred in the previous two weeks. The measure yields 10 subscale scores as well as a total score, with high scores indicating more pronounced symptoms. Only the total score measure of General Stress was used in this study; a pretest internal consistency coefficient of .97 was found.
The Irrational Beliefs Test (Irrationality, Jones, 1969) measures 10 irrational beliefs on separate 5-point Likert-type subscales corresponding to the common irrational ideas described by Ellis (1962). The five subscales most closely associated with the law school experience are: Demand for Approval, High Self-Expectancies, Anxious Overconcern, Helplessness, and Perfectionism. Only the total score reflecting the sum of these scales was used in the analyses; internal consistency was .85.
Class rank, both actual and that predicted on the basis of the Law School Admission Test (LSAT, LSAC, Inc., 2001), are routinely calculated and monitored by school administrators for all students. We were interested in noting possible improvements of those students predicted to finish in the bottom 20% of their class on first-semester grades.
A Knowledge test was administered to
determine if the participants learned the concepts presented in the SIT
sessions. Comparing SIT participants with those in the waiting-list control
condition would yield an independent variable manipulation check; however, differences
between these conditions failed to emerge due to a ceiling problem.
Participants met with their counselors in four weekly sessions, each lasting
90 minutes. The assessment occasions were scheduled for participants in each
treatment sequence within a day of each other.
The SIT treatment was derived from Meichenbaum and Deffenbacher (1988) and Kiselica, Baker, Thomas, and Reedy (1994), but modified and manualized as a result of a pilot study undertaken in the previous academic year involving undergraduate and graduate students in two separate stress management groups at a university counseling center. A qualitative questionnaire assessing the perceived effectiveness of SIT’s three treatment phases and the utility of the specific coping skills was administered. The data suggested eliminating several relaxation techniques, streamlining the education phase, and shortening the application component. These revisions were incorporated in the present study.
The education phase (one session) focused on stress, stressors, anxiety, and anxiety-related symptoms. Potential sources of and reactions to stress, particularly those related to the law school experience, were fully discussed. Moreover, participants learned diaphragmatic breathing and the ABCs of Ellis’s (1962) rational emotive therapy. A handout on personal experience with stress and anxiety was provided as was an overview of the remaining sessions.
The coping skills phase occupied most of the next two sessions. Various relaxation techniques were taught and practiced in session; these techniques were specifically linked to the stress and anxiety associated with the lack of adequate feedback, the professor-student interaction, and the myths described previously. Cognitive restructuring focused on negative self-statements related to performance, competition, value conflicts, and other aspects of the law school experience not open to change. Participants received homework assignments involving practice in identifying and disputing their irrational beliefs. Time management and study skills were also taught and rehearsed in session.
The coping skills and application phases overlapped as cognitive restructuring began; that is, as each new skill was presented and mastered in session, role plays facilitated their application to real-life experiences in law school. The final session involved review of what transpired during previous sessions, processing of participant experiences, and additional role-played applications of skills. Posttesting followed.
Waiting-list control participants were informed that due to the large number of students requesting help, half would receive treatment after a delay of several weeks. All assessment devices were administered to control participants within one day of those receiving SIT.
RESULTS
Pretest equivalency for both treatment-sequence conditions was evident from insignificant univariate ANOVAs conducted on all measures. Pretest inter-correlations were calculated showing reasonable concurrent validity. Among the three stress measures, DSP-personal and DSP-emotional correlated .76; the General Stress r with the former was .67 and .74 with the latter. All stress rs were significant (p < .05). Finally, the two anxiety measures STAI-trait and STAI-state correlated .66 with each other.
Reports
in the literature that women experience higher stress in their first year of
law school than their male classmates were explored via univariate ANOVAs on
all measures and testing occasions with gender as the fixed factor. No
significant main effects were found on any measure at either the pretest or
final assessment occasions. On the second of the three assessment points women
showed higher General Stress than
males F (1,20) = 4.33, p = .05; however, this lone difference
is likely an artifact of family-wise error. In sum, the anxiety, stress, and
irrationality experienced by the women in our study were comparable to that of
the men.
Table 1 depicts the means and standard deviations for experimental and control participants on all measures and testing occasions.
We expected that students who received SIT first would exhibit greater declines in anxiety, stress, and irrationality than would students in the waiting-list control phase. Analyses focused on the first two assessment occasions revealed significant treatment-by-repeated measures interactions on all three stress measures [DSP-personal F (1,18) = 4.52, p = .048,
ES = .20; DSP-emotional F (1,18) = 5.38, p = .032, ES = .23; General Stress F (1,20) = 6.06,
p = .023, ES = .23], indicating that experimental students exhibited lower stress than their control counterparts on the second assessment occasion. No treatment-by-repeated-measures interactions appeared on any other measure.
In addition to the foregoing interactions, significant repeated-measures effects were found on the DSP-emotional, General Stress, and Irrationality measures indicating a decline in stress and irrational beliefs for all participants over the course of these two assessment periods [DSP-emotional F (1,18) = 10.06, p = .005; General Stress F (1,20) = 10.66, p = .004; Irrationality F (1,20) = 8.83, p = .008]. Thus, although all participants declined in stress, those in the SIT-first condition showed significantly greater improvement. The decrement in irrationality, however, cannot be ascribed to the SIT-first treatment sequence, however, as routine sources of internal invalidity (history, maturation, etc.) may have contributed.
We expected that benefits produced by SIT would endure throughout the follow-up period. Thus, pre-to-final changes were specifically examined via correlated t-tests. A significant decline on General Stress occurred: t (10) = 2.96, p = .01, and decreases on both anxiety measures were manifested as well: STAI-state t (10) = 2.63, p = .03; STAI-trait, t (10) = 4.40, p = .001. Although the previously exhibited decreases on the DSP domains washed out, it is interesting to note that additional "delayed" effects emerged on state and trait anxiety.
We also expected that the waiting list control subjects would eventually show improvements when they received the SIT treatment. Unfortunately the number of participants available for assessment in this phase of their treatment sequence was small (8 or 9), thus reducing statistical power. Only declines in Irrationality registered as significant, t (8) = 2.44,
p = .04.
Additional repeated measures ANOVAs were conducted on a reconfigured design that collapsed the SIT-first and SIT-delayed participants into a single group of participants with pre and posttest scores. All analyses yielded significant effects, indicating that SIT participants improved on all measures: STAI-state, F (1,19) = 9.33, p = .007, ES = .33; STAI-trait, F (1,19) = 11.75, p = .003, ES = .38; DSP-personal, F (1,17) = 7.88, p = .01, ES = .32; DSP-emotional,
F (1,17) = 6.79, p = .02, ES = .29; General Stress, F (1,19) = 7.75, p = .01, ES = .29; and Irrationality, F (1,19) = 7.58, p = .013, ES = .29.
Finally, seven participants who received the SIT treatment in either sequence were predicted to finish in the bottom 20% of their class on the basis of their LSAT scores. At the
semester’s end, however, only three did so. Of the other four, one finished above that level, another in the upper half, a third in the upper quarter, and the fourth in the upper 20%. This
amount of improvement could not have occurred by chance (Fisher exact probability = 0.035).
DISCUSSION
We examined the effects of stress inoculation training (SIT) on the anxiety, stress, irrationality, and academic performance of first-year law students and noted an outcome pattern that permits promising conclusions. Our primary analyses focused on the first two assessment periods where SIT was set against the control condition. A significant impact on all three measures of stress was demonstrated.
Additional ANOVA and correlated t analyses simply took advantage of data available in the crossover portion of the design; they are interesting, albeit less convincing indicators of causality. Namely, those receiving SIT after a wait-list phase eventually declined in irrationality and manifested levels of stress comparable to those initially receiving SIT; and decrements in general stress for SIT-first participants endured throughout a follow-up period. Finally, when SIT participants from both treatment sequences are collapsed, analyses of their combined pre and post scores reflect improvement on all measures of anxiety, stress, and irrationality.
Since we intended to provide SIT to all participants, we could not use grade-point-averages in a controlled experimental comparison. Nevertheless, the fact that more than half of those receiving SIT significantly improved their predicted class rank is a conspicuously promising piece of evidence.
We also found no gender differences; the male and female participants experienced equivalent amounts of anxiety, stress, and irrationality throughout the course of the study. The literature, of course, would suggest otherwise (Goring, 1996; McCleary & Zucker, 1991; McIntosh, Keywell, Reifman, & Ellsworth, 1994); however, the literature describes a phenomenon enduring over decades. Perhaps the stress reported by women participants in our study was atypically low, or maybe the greater number of women admitted to law schools in recent years has produced changes in climate and/or perception. Future studies focused specifically on gender differences could shed light on this issue.
It should be noted that our promising univariate
outcome pattern does not adequately handle Type I error concerns;
unfortunately, a completely satisfactory way to do so does not exist.
Multivariate analyses are increasingly being viewed as inappropriate for
controlling experiment-wise error (e.g., Huberty & Morris, 1989); on the
other hand, the alternative strategy of partitioning the alpha according to the
number of measures employed is an overly stringent criterion that seriously
exacerbates the risk of a Type II error with small sample sizes and
conceptually divergent outcome criteria such as we employed. In the absence of
clear precedent in the methodological literature, we elected to present the
obtained univariate outcome pattern and let readers make whatever alpha
corrections they deem appropriate.
A final unanswered question concerns the optimal time in the semester for delivering the SIT treatment. In our study, 29 of 158 admitted first year students originally volunteered for the SIT program. Of these, seven withdrew once school began, citing that the time commitment was “too much” for an already-heavy workload. The workload of a first-year law student is significant and many students find themselves ignoring all other aspects of their lives just so they can be law students (Halpern; 1982; Maloney, 2001). Arguably, for some individuals, being treated for stress might add to their stress. One remedy would be to offer the program prior to the beginning of the semester; unfortunately, doing so might preclude participation by out-of-state students who face moving constraints, and it might weaken the application phase of SIT which focuses on the transition from coping skills to real-life situations. Similarly, research has not definitively answered how the experience of stress covaries with week of the semester. Thus, SIT might be differentially effective if offered at different time periods.
In sum, law students experience significantly higher anxiety and stress than students in other graduate programs (e.g., Alfini & Van Voooren, 1995; Heins, Fahey, & Leiden, 1984). Moreover, law schools do not teach students how to handle the everyday anxiety and stress that accompany the practice of law (Krieger, 1998; Maloney, 2001). Our study had the support of the local law school administration, was easily implemented, and produced beneficial effects. If other schools incorporated the principles of SIT into their curricula and other programs, perhaps both students and graduates would experience less occupational stress as well as improved academic and professional success.
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Table 1
Means and Standard Deviations for Outcome Measure as a
Function
of Treatment Condition and Time of Testing
Treatment STAI-State STAI-Trait General Stress
condition M SD M SD M SD
SIT-first
Pretest 45.00 13.70 44.36 12.41 112.67 57.98
Middle 37.82 12.29 38.55 10.05 81.18 44.39
Follow-up 42.09 12.92 40.27 12.92 82.64 57.14
Control
Pretest 42.56 17.78 42.67 7.19 92.62 35.47
Middle 46.22 13.14 40.11 7.37 86.11 34.27
Follow-up 39.67 8.92 37.22 3.60 81.78 34.41
Table 1 (continued).
Function of Treatment Condition and Time of Testing
Treatment DSP-personal DSP-emotional
Irrationality
Condition M SD M SD M SD
SIT-first
Pretest 66.10 15.16 39.00 10.51 142.64 16.52
Middle 56.91 15.21 30.27 13.22 136.73 4.46
Follow-up 63.00 18.46 32.20 14.78 138.45 18.48
Control
Pretest 62.27 13.14 36.64 14.11 147.44 9.15
Middle 63.80 17.86 35.30 15.92 143.33 9.51
Follow-up 57.50 12.25 29.25 10.05 138.00 9.15
Note. Higher scores reflect greater levels of stress, anxiety, and irrational beliefs. The Middle assessment occasion served as a posttest for the SIT-first condition and as a pretest for the SIT phase of the waiting-list control condition.