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= Stress among undergraduate students =

Introduction
University students, especially undergraduates, are more vulnerable to stress and depression  .Stress is an everyday health problem for most undergraduate students that can affect all areas of functioning, motivation, and concentration, alongside feelings of self-worth and mood, disrupting the most critical time of the students’ lives in terms of learning and social and professional development.

Definition
Stress is: “a pattern of cognitive appraisal, physiological response, and behavioral tendencies that occurs in response to a perceived imbalance between situational demands and resources available to cope with them" . Stress is sometimes recognized by low motivation and activity that affects thoughts, behaviour, feelings and sense of well-being. On the most elementary level, stress occurs when environmental demands exceed individuals’ resources to deal with them. Stress thus depends on a convergence of environmental, individual and transactional (individual-environmental) factors.

Causes
University is regarded as a time of heightened psychological distress. Students experience more stress during their university studies than preregistration levels, and the stress levels of undergraduate students are generally higher than those of non-students, including professionals. Many factors are regarded as key sources of students’ stress, such as meeting academic requirements, financial problems, social relationships and culture shock.

Academic requirements
Academic requirements are generally regarded as the main source of stress for undergraduate students at university. Academic requirements include completing important papers, high workload of assignments, unfamiliar professional requirements, adjusting to unfamiliar modes of learning, getting ready for major exams, and possibly getting ready for important interviews. However, students who were satisfied with the education they received and their own academic progress had lower levels of depression, anxiety and stress.

Financial
Financial issues play a fundamental role in student well-being and academic performance itself. According to Nursaw Associates (2015), around a quarter of students who participated in their survey have high levels of financial stress, which of course affects their learning outcomes. Half of the students are necessarily working and study at the same time, or they depend on their families and friends to borrow money. Also, around 10% of students aged 20 asked for hardship loans from their families, relatives or formal bursars. Due to experiencing financial hardship, many students cannot concentrate on their studies. In the United kingdom (UK), 91% of British students reported experiencing financial stress, especially since the 2010 legislation to increase university tuition fees substantially.

Social relationships
Additionally, changing and interrupting social relationships has negative affects on students. For most first-year undergraduates it is their first time living away from their families and childhood peers. This separation from family and friends and moving to a new area or country make students have stress and sadness, particularly females, due to the obvious severance of family contact.

Furthermore, sometimes first-year students have a lack of social relations, which puts them into social isolation and alienation even from their teachers and peers. This because of introverted behaviours that result in poorer relationships with peers and faculty members, characterized by a lack of participation in campus clubs and activities. Additionally, another reason is a culture of constant comparison and a sense of inadequacy due to cultural changes which makes students to face stress, which is exacerbated in the case of international students, who also face additional language barriers.

Effects
College students experience many effects of stress in most most perspectives of their lives such as interpersonal, intrapersonal, academic and environmental.

Stress affects students’ social activities and can exacerbate or cause conflicts in scenarios with latent potential for conflict, for instance with roommates, romantic partners and parents. Intrapersonal affects mean students are physically affected by stress, such as impacts on sleeping and eating habits, which can be associated with increased blood pressure, heart rate and headaches as a result of stress, generally compounded by use of alcohol and sometimes drugs. Stress is a catalyst in the context of a number of underlying variables that can have considerable negative impacts on academic performance. Sometimes due to stress students get lower grades than anticipated, often due to absenteeism, serious arguments with instructors, causing failure or transferring to other departments or universities.

Interventions to reduce stress
There are various ways to reduce the affect of stress, as explained below.

Some students who have this problem do not have skills in handling a stressful situation. Knowing what the physical and emotional limits are is the basic step of beginning to cope and manage stress. Elimination of negative stress requires first identifying stressors, which is itself often a cathartic process known to effectively help offset the dysfunctional effects of stress, comprising a strong psychological adjustment on the part of an individual. Furthermore, maintaining good health is an important way to generally reduce stress. For example, the physiological impacts of stress in the body (e.g. tense posture and muscles) can be released by exercising. Furthermore, physical activity releases endorphins and promotes contentment and happiness to alleviate stress hormonally, while it is often associated with improved social interactions such as by accessing campus facilities and participating in intramural sports.

Peer support programmes are sometimes proposed to help students who have stress. Student-led programmes provide support to other students facing similar conditions, problems and experiences. People who have encountered and overcome adversity can help, support and encourage others facing similar situations. This kind of intervention increases ratings of confidence and self-esteem, and avoids social isolation by allowing them to meet and engage with others, increasing confidence and empowerment, supporting people to widen their social circles. Despite their great potential, such services are generally underutilised. The importance of social support is because of providing the individual with feedback, validation, and a sense that one can master adverse environments

Interventions by universities and concerned organizations are designed to decrease stress in terms of changing behaviour, cognition, feelings and emotions. One widely used technique for this is cognitive behavioural therapy (CBT), by which behaviour and emotions are changed by influencing cognition. CBT is an active structured program to treat a variety of psychiatric disorders, helping patients to correct their false self-beliefs that lead to negative thoughts and behaviours. Cognitive therapy for depression. Due to emotions and behaviours being products of perceptions, training and coping skills will help to recognize, evaluate and restructure thinking to obtain a more positive and realistic interpretation and explaining current events, and to make choices, become more assertive and increase self-esteem. For instance, the therapist plays a great role to help individuals to identify and change unhelpful thoughts, emotions and behaviours.

Cognitive restructuring approach as a one method of CBT is a good strategy to eliminate negative thoughts that induce stress. For example, through tools such as Socratic questioning, thought recording and guided imagery, cognitive restructuring of the client’s validity thoughts can be implemented, which can be tested by asking for evidence that thoughts are true or false, what should be done about it, having an alternative explanation, and considering the best- and worst-case scenarios. Also, in terms of relaxation training such as meditation and hypnosis based mindfulness stress reduction it could help reduce stress by using techniques of abdominal breathing and using the imagery in relaxation.

Additionally, scheduling activities is another major CBT strategy used to increase activity levels and maximize mastery and pleasure. The schedule is having a plan each day in advance on an hour-by-hour basis to help reduce an overwhelming mass of tasks, encouraging an increase in satisfying activities, giving patients more control over their lives. For example, visiting a friend, taking a walk with a spouse, and going to the cinema could be scheduled and gradually help someone to enjoy daily activities.

Barriers to reduce stress
There are many barriers to anti-stress interventions for the patient group of students, who generally have a propensity toward self-reliance, discomfort talking about personal problems, and general burnout from academic and other activities. Furthermore, the perception that stress is an inevitable and normal part of college experience makes some students think it is inappropriate to seek help, and they presume that the problem will get better by itself. They may consequently also be afraid of being judged as weak or mentally unstable by their peers and the university authorities, and they may question whether medication or therapy is really helpful (possibly to rationalize their inaction in terms of seeking professional help). Furthermore, students sometimes lack trust in the relevant services, being worried that their treatments and sessions could be documented in medical or academic records and that someone else would notify their parents.

Service providers can themselves provide barriers, such as being insensitive while providing help, long waiting times for appointments, and limited (and therefore undervalued) numbers of sessions. The perceived lack of efficacy of services combine with latent barriers such as academic and other responsibilities, financial reasons and lack of time to make it very difficult for students to take serious action to address stress and other mental problems.