Can Positive Emotion Reduce the Impact of Stress in Teens?

High school students today face increasing pressure to perform, succeed and excel. UCSF Osher Center researcher, Judy Moskowitz, PhD, is teaching high school students how to cope with stress in an unexpected and innovative way–by increasing their positive emotions. The program, called Coping and Emotional Development for Adolescents to Reduce Stress (CEDARS), is being piloted with students at a local high school in San Francisco. In a recent interview, Dr. Moskowitz provided insight into this unique, school-based intervention that is helping teens better cope with increasing levels of stress.

Dr. Moskowitz, would you describe the project?
The basic idea of CEDARS is to test a positive emotion skills intervention that we’ve developed in adults coping with serious illness to see if it helps high school students, and eventually middle school students, cope better with stress. We think that these positive affect, or positive emotion, skills aren’t specific to people with illness or major life stress. We think these skills can work for anyone experiencing any type of stress.

We are teaching eight positive emotion skills to approximately one hundred students in activity-based sessions that happen once a week for five weeks. We engage the teens through activities, games and discussion, and extend our impact beyond the classroom with “homework” that challenges the students to use the skills outside of class too. For example, in our gratitude exercises, students share an example of people, accomplishments or simple moments in the day for which they are grateful. They continue this practice throughout the week and create a supportive and accepting environment for skills development. At the close of the five weeks we’ll survey the kids regarding their stress, emotion and well being and ask them for feedback on the sessions. We hope to use these pilot data in grant proposals to do a larger, more scientifically rigorous study. Ultimately we would love to translate this program into a national model that can apply to all age levels and be infused throughout grade school, middle school and high school curricula.

What are some positive emotion skills?
There are eight basic skills currently being taught through the CEDARS project: noticing positive events, amplifying them, being grateful, practicing mindfulness and positive reappraisal, noting personal strengths, setting attainable goals, and performing acts of kindness.

Are there particular stresses that kids face nowadays?
We’re working with a public school in San Francisco, so it is in an urban setting with some of the same stressors that any urban public school faces. It is also different because it is a very high achieving school, where students compete based on academic performance in order to get in, and then there is pressure to continue to excel. By eleventh and twelfth grade, students are taking six advanced placement classes. It is basically like going to college your senior year and this can be overwhelming. In addition to school, there are societal stressors and expectations to be smart, good looking and athletic, as well as stress associated with home and family. It’s a lot for teens to handle. Although the positive emotion skills we are teaching aren’t a cure-all, we believe they can help kids cope with that stress.

What do you see as the potential benefit?
I’m a stress and coping researcher who is interested in understanding the stress in people’s lives and how they cope with it. Through CEDARS, we are letting these teens know that it is ‘okay’ to have positive emotions; we are helping them make space for the positive in their lives, even if they are currently experiencing a lot of stress. It is normal to experience both the positive and the negative, and the positive emotions could actually be helpful to cope with the stress at hand. Through this greater emotional capacity and by experiencing the full range of emotions, we think teens will cope better with whatever stressors they are facing now and in the future as well.

Why is it important to focus on positive emotion?
Stress is part of life. Yet our modern culture has high levels of stress that can negatively impact our health. We want to develop better coping strategies to reduce this impact of stress.

During my career, there has been a shift in coping research. Traditionally, the focus has been on negative events and how to reduce the depression and anxiety that come from these events. There was little focus on the positive nor an understanding of how the negative and positive interrelate. What we saw in our research is that if you can really increase positive emotion, it will help people better cope with stress, whatever the stress is. For example, among people with serious illness like HIV or diabetes, positive emotion is associated with longer life. We also learned that there’s not a one-to-one correspondence between positive and negative. This means that reducing the negative doesn’t necessarily increase the positive, and it underscores the importance of developing unique strategies for increasing positive emotions. We are investigating these types of strategies in a number of groups experiencing different types of stress, and we will be able to determine whether a focus on positive emotion can pay off in coping with stress.

In the long term, do you see clinical applications, say in a pediatrician’s office someday?
I believe that there is absolutely a place for positive emotion in the pediatric or other types of clinics. At the Osher Center, we are starting to think about ways to integrate positive emotion into clinical practice. The advantage is that the skill set is easy. You don’t need to be a professional to do it. I was presenting the positive affect research to the pediatric grand rounds at San Francisco General Hospital, and I had a resident come up to me afterwards who was really interested in how she could teach these skills to her patients. She has what is called a ‘continuity clinic’ where she sees kids frequently over a period of time. Even though appointments are short, she has the advantage of seeing the kids repeatedly–a rare opportunity to perhaps teach some of these skills to her patients. She is not a researcher, but she has already started to track her attempts to integrate positive emotion into her clinic. For example, one simple way would be to incorporate some questions about positive emotion along with other related questions that pediatricians already ask. They ask, “What did you have for breakfast today,” to get at nutrition. Similarly, a pediatrician could ask, “What are three things that make you happy?”

Do you use any of these skills yourself?
I do. I’m a natural at positive reappraisal (seeing the good that might come out of a stressful event or seeing how it could have been worse), and I have tried to teach that one to my kids. If there is something stressful going on for one of my kids, I try to help them think about the good things that are happening in their lives, too. So you didn’t get much playing time in the basketball game; you got an A on your last math test. Isn’t that great how you studied so hard, and it really paid off in that math test? I engage with them to do positive reappraisal, noting positive events and then savoring them.

Any final thoughts?
Positive emotion is important for all of us to think about, yet for many people it is not customary. I think all of us could benefit from making space for positive emotions, even if we are experiencing stress. If we are able to re-frame the way we think about and the way we cope with stress, we can help to reduce the burden of that stress on our health and in our lives.

Judith Moskowitz, PhD, MPH

Associate Professor in Residence in the Department of Medicine at UCSF, received her PhD in Social Psychology from Dartmouth and her MPH in epidemiology from UC Berkeley. Her research is focused on coping and emotion in the context of health-related chronic stress.

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