Stress Management
Experiment: Stress Intervention
Evaluate: Stress Intervention
In the past I have implemented exercise as my stress-management technique. Exercise promotes better resilience to stress. When a person who exercises often is experiencing stress their body recovers faster than those who do not. (Childs, E., & de Wit, H. 2014) My technique for exercises looked different most days because I do have such a hard time finding time. Depending on the day we were swimming, running, or doing exercises with patients. I kept this technique nonspecific, so all types of these exercises fit the mold. I did this because my days are hectic and I have to make things work into my schedule since I don’t have a lot of time. This was perfect because I work in a gym, a hospital gym, and my daycare has a gym as well. This fit into my schedule because I am already dropping my children off at daycare, treating patients in the gym, I am around all the equipment at lunch, or I can walk around the lake at lunch too. This is
something that fits into my personality and preference well as someone from Colorado and an
I grew up in gyms and outside often for exercise and it is something I have always enjoyed. I began testing this technique on Monday the 15th of September.
Evaluation of 5-Day Practice
My first practice, even though it was only 5 days, I found myself with a lot of challenges, I even missed one day and had to make up for it later on in the week. I had to quickly learn to adapt my schedule, figure out how my kids fit into my work out, and adjust what works for me. It was a little bit of a rough start but I did benefit from it quite a bit, overall it went really well. I did multiple different exercises inside and out working out arms, doing work outs with my patients and going for walks with my children or friends. I found that I enjoyed being outside and got the most benefit from exercising outside! I also greatly benefited from the social aspect of walking with friends. This practice was really effective in helping me find what worked best for me and what made the best change. This round I will change all of my workouts to outside, I think that would have been a good change for me. I also will make sure my husband is with me when I have the kids so I can take them with me or leave them with him so I don’t have the stress or anxiety of if it will go well. I plan on working out earlier in the morning on weekends or at night after the kids are asleep when my husband is home to make things flow easier. Playing and working with the kids is always an option!
Hypotheses
This time I will be doing an extended intervention, 4 weeks long! I am aiming to do the majority of my exercises outside! I hope to sleep better, fall asleep in less than 30 minutes and have less internal conflict, reducing usage of PRN anxiety medication to less than 2 times a week. I also want to be more patient and tolerant with my children, reducing conflict and raising my voice with them less than 3 times a week. I do not want to feel frustrated or annoyed with my children for being children. My ultimate goal is to obtain a larger internal peace and anger slower while returning to calm faster.
This intervention will result with less conflicts with my husband, less than 5 conflicts noted in the 4 week period and 3 or less yelling events at my children a week. It will also result in a calmer home, less irritability, and more patience. This will look like fewer than 3 redirections from me to my kids for activities that there is nothing wrong with, but I just find loud and overwhelming.
Method
Measures
To evaluate how well my 4-week outdoor exercise intervention works, I will use two different measures, one for each of my hypotheses. The first one is assessing internal stress and emotional regulation, this will be for my first hypothesis. The other measurement will be for tracking conflict within myself and parenting behavior. This is for my second hypothesis. Both measures are evidence based and supported and backed up with up to date information as well. Both measures are able to track changes over the 4 weeks specific to their hypothesis they will be used for.
For my first hypothesis, improving my emotional regulation and reducing internal conflict I will be using the Depression Anxiety Stress Scale. I chose this scale because it is an evidence based, easy, and short, measure that is done by self evaluation questionnaire. It will best capture how I am feeling like I am doing regarding the stress in my life and more tailored to me because I am diagnosed with anxiety and depression. It will help assess the severity of my mental health as well. This stress directly relates to my emotional instability. Due to this, I have chosen it to help track my goal of improving my mental and emotional well being.
Recent evidence continues to validate the reliability of the Depression Anxiety Stress Scale, Ali, A. M. et al. (2021) analyzed this measure as well as the short term version and they found that the 8 question version was also reliable and that it could differentiate a psychiatric patient from the general population. Lee et. al, (2019) did a systematic review analysing 48 studies, they used the COSMIN Risk of Bias checklist and Grade approach for quality of research and quality of study, they found that this measure has a high “bifactor structural validity, internal consistency, criterion validity (Depression subscale), and hypothesis testing for construct validity”. More importantly since I have given birth recently this scale is more important to use. “Regarding the criterion validation, only the DASS-depression subscale and EPDS demonstrated satisfactory ability to discriminate cases from non-cases with no significant difference between their ability to detect either minor or moderate depression among women who have recently given birth.” (Moya et al, 2022) My baseline for the DASS will be at the beginning of the 4 week trial. I will then take the same DASS measure at the end of this trial.
For my second hypothesis, reducing outburst with parenting and increasing patience, I will be using the PSI (Parent Stress Index). I have chosen this assessment to measure outcomes by doing a pre experiment assessment and post experiment assessment. This measurement is important because it focuses on stress directly related to parenting and differentiates and excludes outside stressors such as financial strain (Rios, M. et,al. 2022). This is an extremely important study to me because the results have been linked to child abuse, lack of love given to the child, and other forms of neglect. Rios et al. (2022) also reports high stress can lead to depression and marital conflict, because of this it will also benefit my assessment of conflicts with my husband.
The PSI is most common because it is easy to complete and good for short term progress tracking. There are many other options, “instruments exist to measure parental stress with different levels of evidence (e.g., Caregiver Strain Questionnaire (CGSQ); Family Impact Questionnaire (FIQ); Parenting Daily Hassles Scale (PDH); Parental Stressor Scale; Stress
Index for Parents of Adolescents (SIPA;); Questionnaire on Resources and Stress (QRSF) and Parental Stress Scale (PSS; or related to specific times such as labor or postpartum or preterm birth)” ( Rios, M et al, 2022 p. 1 ). Despite the volume of options PSI remains the most common, leaving it the clear choice. Aracena et al, (2016) focused on the validity of the measure and found it to be very beneficial for a wide range of things including home environment, and understanding and improving the environment. González-López et al, (2024) also reported high reliability of this method when studying it including the short form. I will be able to see my score on this at the beginning of the study, the lower the score the better so I will be able to see progress I have made over the 4 week trial.
Procedure
My intervention will consist of outdoor exercise 4-5 times a week with the goal of decreasing stress and improving emotional regulation with the ultimate goal of greater patience with parenting. My protocol is intentionally flexible to allow grace for unpredictable schedule changes, and the uncertainty life brings. However it will still have a solid structure.
The exercise will be outdoor physical activity. This will look like brisk walking, jogging, body weight exercises, and active play with my children outdoors. Each session will last at least 30 minutes. I will use the Nike Training Club app for guided bodyweight workouts and the Apple watch workout walk feature to track my walks. I may listen to music or a mindful music playlist on Spotify while doing these things. Each workout will begin with 5 minutes of light stretching and deep breaths. This will then be followed by 20-25 minutes of light intensity movement such as walking, jogging, bodyweight exercise or child play. It will then end with a 5 minute cool down of deep breathing and reflection outdoors. This method is used as a baseline for my 4-5 activities a week, but I will also use it when I am noticing higher stress and irritability.
Implementing this at least 4-5 times a week during lunch breaks, immediately after work before daycare pick up, or at home early morning or after children are asleep is ideal. If I need to use this method because of an increase of stress symptoms I will apply a modified version of this intervention to best fit my environment to allow myself a moment to calm down. This will be noted in a notebook or note app to track how many unplanned interventions are done. This will help remind me of increasing stress that I was having and be able to accurately fill out the measures and serve as its own measure to monitor, hopefully, a decrease in events each week.
I will implement these exercises in areas that are easily accessible to me such as the trail around the retention pond at my workplace or in my neighborhood. Outdoor gyms at the parks my children are playing at, or the neighborhood park. As we enter fall I am looking for temperate conditions during the daylight hours. I also am looking for quiet environments with low distractions. If the weather does not allow for outside activities, I will substitute for indoor areas near open windows or covered areas that are protected from the weather. All of this is with the goal to be sustainable, adaptable and flexible to be able to better fit in my daily life. It reflects my preference of being outside, the environmental access I have and my parenting barriers. This is all to help set me up for success in hopes to be more efficient and successful when responding to stress in real time.
Results
Although I tried very hard to adhere very closely to the details of my procedure there were little things that I did not do well. Tracking workouts was difficult since I did not always have my watch with me. I did well working out at least 4 times a week, but sometimes even if the weather was perfect I used my modified method and worked out inside by the windows. There was no reason for me not to, besides it felt more possible for my brain. Until the last week of my intervention the weather was beautiful. Numerically my outcomes improved. My measures improved, but it is important to note that my baseline measurements were taken during a really hard period of time filled with hospital visits and stress. Due to that I feel my results were skewed. Physically and mentally I do feel better, but again, I am finally getting out of a really difficult period of time. It is hard to correlate my wellbeing with this intervention due to that. I believe for the most part I did meet my goals. I spent a lot more time outside, I felt better overall. I did notice less conflict with my husband and more tolerance with my kids. I did not reduce my conflict with my husband to less than 1 time a week consistently. I stepped back from correcting my kids from behaviors that are harmless but I found annoying. I noticed the less I got after them the less they participated in these activities. My parent stress measurement scored a 110, this represents “high stress range” and a 54 on the DASS, meaning “moderate stress, anxiety, and depression” at the beginning of this intervention. At the end of week 4 my parent stress measurement was down to 96 and my DASS was down to 41. These aren't huge jumps but it was good progress!. My intervention did help me meet my goals for the most part. I feel my stress did decrease and my emotional regulation is much better. My 4 week intervention went as follows: Week 1 I did 4 work outs (3 mile walk, bike ride, park play, morning yoga) and had 6 conflicts with my children, and 4 conflicts with my husband. Week 2 I did 7 work outs ( 3 mile walks x 3, 1 yoga, 2 bike rides, 1 bodyweight work out), 7 conflicts with my children, and 0 conflicts with my husband. I was off all week. Week 3 I did 4 work outs ( 1 mile walk, 1park play, 1 bike ride, and indoor workout with weight), 4 conflicts with my children, and 2 conflicts with my husband, and returned back to work this week for half a week. Week 4- 3 work outs ( 1 outdoor walk, 1 bike ride, 1 park play), 2 conflicts with my children, and 2 conflicts with my husband. This was Thanksgiving week.
Discussion
Based on my experience and results I have a hard time saying this intervention was effective. The outcome measure showed improvement, however, my graphs when looking at the number of work out in comparison to conflicts, there is no clear correlation. Overall, I feel like my interventions had a lot of unplanned events causing outliers. I planned my intervention around a normal work schedule and my average week. However my intervention started the day my daughter fell and broke her teeth, causing a skew in my measurements. Following that I was off of work a week and a half due to my daughter having surgery, so my schedule changed vastly. Banyard et al. (2025) conducted a meta-analysis on the effects of aerobic exercises on anxiety and depression. The meta-analysis showed that aerobic exercises are a very effective option! The article analyzed 30 different studies, it found that of the 26 only 2 studies found no notable difference. 13 studies reported significant improvement and the remainder still reported improvement. The analysis they did on anxiety was on 12 different trials. Anxiety still showed an improvement with exercise but the results were much more inconsistent than depression. Sample sizes were small and only 3 studies met the WHO requirements for exercise. (Branyard et. al 2025 p.7- 13) My results do not reflect this claim. My results have no clear correlation and have a lot of variance. I believe my intervention was different because I had so many events that added new and intense stress. My intervention was too short to track the change and if I improved because of the large change I encountered mid intervention. Furthermore, Barnyard 2025 excluded yoga from their analysis. Studies that allowed yoga were thrown out, yoga was one of my exercises. The study also evaluated depression and anxiety separately, which I did not. Banyard felt that exercise is a great treatment option and would be a viable option even on its own. Due to my outcomes I do not agree with this. I concluded exercises are a good option, but in conjunction with other interventions. It is important to note that I also participated in my interventions while on depression and anxiety medication.
Based on my experience and the meta-analytic evidence, I would suggest this intervention to others. This intervention would be a great option for people who are consistent and disciplined. A key factor in this intervention is consistency. People who have less busy schedules or can set aside a designated time to participate in exercise are also likely to be more successful. The ideal participant would be someone who is disciplined, consistent, and has available time. Additionally they would benefit from slightly more intense exercises. Some contraindications from this intervention would be patients with comorbidities such heart problems, uncontrolled blood pressure, uncontrolled diabetes, sedentary lifestyle, and limited availability to participate. Indications would include anxiety, stress, depression, and the want to get better. An active person, who is motivated and has a history of athletics or active lifestyle is also a great option for a participant.
My intervention has multiple limitations. My intervention needed longer to get a better idea of the correlation versus causation. Even though my outcome measures improved I do not think they are supported by the data collected of exercises and conflicts. Better outcome measurements that are more closely related to the correlation of workouts on anxiety depression would be a better choice. Another limitation my intervention had was outside events that probably would have excluded me from a randomized control trial. While life happens and this trial was specific to stress, the event I faced during this trial vastly skewed my results. If I was to redo the intervention I would change the outcome measurements, specify the activity to very specific workouts, and focus less on tackling conflicts. In general I would make the intervention more successful for others by focusing less on conflicts. I believe doing this focuses on the negative and gives you a sense of failure when tracking. I would instead add in a gratitude practice and at the end of the day write down what went well today with the intervention.
My next steps in managing the stress in my own life is giving myself more grace and letting go of the control I feel I need. I plan on focusing on finding acceptance in small things that aren't exactly the way I want but are still acceptable. I plan to do this through a different intervention. I plan to change interventions into meditations or mindful practice working on acceptance. I enjoy doing affirmations with my children, I believe this is a more practical option and easier for me to apply. Due to the difficulty I had trying to complete this intervention, I will not be continuing with this intervention. I feel it was not a good fit. It felt like a chore and not something that was relaxing or beneficial for me.
References
Ali, A. M., Alkhamees, A. A., Hori, H., Kim, Y., & Kunugi, H. (2021). The Depression Anxiety Stress Scale 21: Development and Validation of the Depression Anxiety Stress Scale 8-Item in Psychiatric Patients and the General Public for Easier Mental Health Measurement in a Post COVID-19 World. International journal of environmental research and public health, 18(19), 10142. https://doi.org/10.3390/ijerph181910142
Aracena, M., Gómez, E., Undurraga, C., Leiva, L., Marinkovic, K., & Molina, Y. (2016). Validity and reliability of the parenting stress index short form (PSI-SF) applied to a Chilean sample. Journal of Child and Family Studies, 25(12), 3554–3564. https://doi.org/10.1007/s10826-016-0520-8
Banyard, H., Edward, K. L., Garvey, L., Stephenson, J., Azevedo, L., & Benson, A. C. (2025). The Effects of Aerobic and Resistance Exercise on Depression and Anxiety: Systematic Review With Meta-Analysis. International journal of mental health nursing, 34(3), e70054. https://doi.org/10.1111/inm.70054
Childs, E., & de Wit, H. (2014). Regular exercise is associated with emotional resilience to acute stress in healthy adults. Frontiers in Physiology, 5, 161. https://doi.org/10.3389/fphys.2014.00161
González-López, K.T., Vásquez-Chingay, S.N., Rodrigo-Tintaya, R.A., Leiva-Coloset F. V., Morales-García W. C., Adriano-Rengifo C. E.(2024) Psychometric properties of the Parenting Stress Index-Short Form in a Peruvian sample. Psicol. Refl. Crít. 37, 42 . https://doi.org/10.1186/s41155-024-00327-w
Lee, J., Lee, E. H., & Moon, S. H. (2019). Systematic review of the measurement properties of the Depression Anxiety Stress Scales-21 by applying updated COSMIN methodology. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 28(9), 2325–2339. https://doi.org/10.1007/s11136-019-02177-x
Moya, E., Larson, L. M., Stewart, R. C., Fisher, J., Mwangi, M. N., & Phiri, K. S. (2022). Reliability and validity of Depression Anxiety Stress Scale (DASS-21) in screening for common mental disorders among postpartum women in Malawi. BMC Psychiatry, 22, Article 352. https://doi.org/10.1186/s12888-022-03994-0
Ríos, M., Zekri, S., Alonso-Esteban, Y., & Navarro-Pardo, E. (2022). Parental Stress Assessment with the Parenting Stress Index (PSI): A Systematic Review of Its Psychometric Properties. Children, 9(11), 1649. https://doi.org/10.3390/children9111649
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