STRESS

Original Articles

Double Mediation Effect of Social Interaction Anxiety and Experiential Avoidance between Internalized Shame and Social Media Addiction Tendency: Kiyeon Nam, Myoung-Ho Hyun, Young-Sil Kwon; STRESS. 2025;33(1):45-52. Published online March 28, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.1.45

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Abstract PDF: Background
This study examined the pathway by which internalized shame influences the tendency toward social media addiction through the mediating roles of social interaction anxiety and experiential avoidance.
Methods
Data were collected from 174 Korean adults who completed surveys measuring internalized shame, social interaction anxiety, experiential avoidance, and social media addiction. Linear regression and Process Macro were used for data analysis.
Results
Internalized shame affected social media addiction by mediating experiential avoidance, and the mediation effect of social interaction anxiety was not significant. However, the double mediating effect of social interaction anxiety and experiential avoidance on the relationship between internalized shame and social media addiction was significant.
Conclusions
People who chronically experience negative perceptions and shame about themselves seek stability through others; however, they experience anxiety in face-to-face interactions and use social media to control and avoid these anxieties. To effectively reduce the tendency toward social media addiction, intervention is required to avoid social interaction anxiety, rather than attempting to change maladaptive identity.

Validation of the Sexual Self-Determination Competency Assessment Scale: Yu-jeong Son, Hyeon-gi Hong, Ki-pyoung Kim, Hyung-ki Ji, Hye-hyun Cho, Chae-bin Lee, Myoung-Ho Hyun; STRESS. 2025;33(1):33-44. Published online March 28, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.1.33

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Abstract PDF: Background
This study aims to refine and validate the Sexual Self-Determination Competency Assessment Scale (2020) to enhance its effectiveness.
Methods
The scale comprises self-reported and scenario-based sections. We revised item phrasing; expanded content to better address sexual crimes involving children, adolescents, and individuals with intellectual disabilities; and adjusted the scoring method for better comprehension by individuals with intellectual disabilities. The revised scale was administered to 500 middle and high school students aged 14∼18 to assess reliability and validity. Additionally, we replaced Likert-scale items with open-ended questions to minimize response bias in the scenario-based section. Interviews were conducted with 17 adolescents and individuals with intellectual limitations.
Results
The self-report section demonstrated content validity through an expert review of item appropriateness. Construct and criterion validities were confirmed through statistical analyses. The internal consistency was also high. In the scenario-based section, four open-ended questions were finalized based on interview data, and five scoring criteria were developed to evaluate responses.
Conclusions
This study improved the format and content of the existing scale, thereby enhancing its applicability in investigative and practical contexts. Notably, modifying scenario-based items to an open-ended format enables a qualitative assessment of perception, judgment, and coping abilities in sexual offense scenarios, representing a significant contribution to the field.

Effect of Distress Tolerance Improvement Intervention for Problematic Drinkers: Gwang-Pyo Jang, Hyae Young Yoon; STRESS. 2025;33(1):22-32. Published online March 28, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.1.22

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Abstract PDF: Background
This study examined the effects of an intervention to improving distress tolerance, drinking refusal self-efficacy, and alcohol consumption in problematic drinkers.
Methods
Adults who reported problematic drinking were randomly assigned to either the intervention group (n=11) or comparison group (n=11). The groups were either administered treatment to improve distress tolerance or watch a video in which abstinent women talked about their drinking and abstinence experiences.
Results
The repeated-measures ANOVA showed no significant change in alcohol consumption in the intervention group. However, appraisal, a distress tolerance subscale, and opportunity for drink refusal self-efficacy, a drink refusal self-efficacy subscale, increased.
Conclusions
Short-term interventions to improve distress tolerance may help change distress tolerance and drinking refusal self-efficacy.

The Influence of Attention-Deficit/Hyperactivity on School Adjustment among Adolescents: Focusing on the Moderated Mediation Effect of Depression by Household Economic Status: RaeHyuck Lee; STRESS. 2025;33(1):13-21. Published online March 28, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.1.13

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Abstract PDF: Background
This study examines the influence of attention-deficit/hyperactivity on school adjustment among adolescents and investigates the moderated mediation effect of depression on household economic status.
Methods
The research hypotheses were tested using data from the Korean Teenagers’ Mental Health Study and analyzed utilizing the PROCESS Macro method.
Results
Attention-deficit/hyperactivity had a significant negative impact on students’ school adjustment. Additionally, depression partially mediated the relationship between attention-deficit/hyperactivity and school adjustment. While household economic status did not moderate the influence of attention-deficit/hyperactivity on school adjustment, it did moderate the mediating effect of depression. Specifically, the mediating effect of depression on the relationship between attention-deficit/hyperactivity and school adjustment was more pronounced for adolescents from low-income households than for those from medium- or high- income households.
Conclusions
This study discusses the research implications and considerations.

Review Article

An Integrative Review on Risk and Relapse Factors for Narcotics Addiction: Based on an Ecological Model: Youjin Shin, Hwal Lan Bang, Soo-Hyun Nam; STRESS. 2025;33(1):1-12. Published online March 28, 2025; DOI: https://doi.org/10.17547/kjsr.2025.33.1.1

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Abstract PDF: Background
The study aim was to explore and integrate the experiences of individuals with substance addiction in South Korea using a ecological model to identify risk factors and relapse triggers across multiple dimensions.
Methods
This integrative review was conducted using Whittemore and Knafl’s five-step integrative review method. A comprehensive literature search was conducted using five Korean electronic databases from June 13 to July 25, 2023. Keywords included “narcotic,” “drug,” “addict,” and “recovery.”
Results
A total of 22 studies met the inclusion criteria. Risk and relapse factors in narcotics addiction were categorized into intrapersonal (emotional, cognitive, behavioral, physical, physiological), interpersonal (family, relationships, occupation), community (social, structural), and public policy (legal, institutional) aspects. These factors interacted to form a complex structure that heightened addiction risk and overlapped as both risk and relapse factors.
Conclusions
Narcotics addiction remains a serious public health issue that is exacerbated by various intrapersonal, interpersonal, community, and public policy-related factors. The study findings underscore the multifaceted nature of addiction and relapse and provide a broad perspective on the complexities of prevention and recovery strategies.

Original Articles

A Reliability and Validity of the Korean Version of Behavioral Activation for Depression Scale-Short Form: A Community Sample of Adults: Yeongeun Kim, Jini Tae, Yoonhyoung Lee, Kiho Park, Wonhye Lee; STRESS. 2024;32(4):214-220. Published online December 27, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.4.214

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Abstract PDF: Background
The behavioral activation method is a short-term, evidence-based approach that promotes functional activation by reinforcing adaptive behaviors and eliminating avoidance behaviors. This study aims to validate the Korean version of the Behavior Activation for Depression Scale-Short Form (K-BADS-SF) among Korean community adults, providing an objective measure of behavioral activation.
Methods
A total of 471 participants, ranging in age from 18 to 69 years, completed an online survey. They filled out the K-BADS-SF and its long-form version, the K-BADS, as well as the Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scales, the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7). The K-BADS-SF was subject to a thorough psychometric evaluation, which included analyzing internal consistency, test-retest reliability, exploratory and confirmatory factor analyses, and both convergent and discriminant validity analyses.
Results
Exploratory and confirmatory factor analyses show that the model fit of the K-BADS-SF improves when certain items from the original scale are moved from the activation factor to the avoidance factor.
Conclusions
The K-BADS-SF exhibits sufficient reliability and validity in the Korean community sample, confirming its effectiveness as a valuable tool for assessing behavioral activation.

The Effectiveness of an Imagery-Based Behavioral Activation Intervention for Depressive Symptoms: Sujeong Yun, Eun-Jung Shim; STRESS. 2024;32(4):204-213. Published online December 27, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.4.204

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Abstract PDF: Background
Behavioral activation treatment (BAT) is an evidence-based treatment for depression. However, depressive symptoms can make it difficult to engage in activities crucial for the success of behavioral activation. Mental imagery may assist with activity engagement. This study examined the effectiveness of imagery-based BAT (BAT-I) compared to standard BAT in reducing depressive symptoms and improving behavioral activation, activity anticipation, activity motivation, and activity completion rates.
Methods
Thirty adults with moderate to severe depressive symptoms were randomly assigned to either the BAT-I or BAT groups. The participants received eight sessions of twice-weekly BAT intervention, with an additional four-eight mental imagery sessions provided for the BAT-I group.
Results
Repeated measures analysis of variance indicated that participants in both groups showed reductions in depressive symptoms and improvements in behavioral activation, activity anticipation, and activity motivation. However, the BAT-I group demonstrated significantly higher activity motivation (6.1＞ 5.1) and activity completion rates (93.17%＞66.18%) than the BAT group.
Conclusions
While use of imagery appears to support activity engagement, further research is needed to explore how imagery can be utilized to enhance the BAT effectiveness.

Internalized Shame Mediates the Relationship between Borderline Personality Traits and Suicidal Ideation: Nanyoung Bae, Hyejeen Lee; STRESS. 2024;32(4):196-203. Published online December 27, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.4.196

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Abstract PDF: Background
Internalized shame, defined as the enduring incorporation of shame as a trait due to repeated experiences of shame, is considered a core emotion in individuals with borderline personality traits. It is closely related to self-destructive behaviors, such as self-harm and suicidal ideation. This study aimed to investigate whether internalized shame mediates the relationship between borderline personality traits and suicidal ideation.
Methods
Self-report questionnaires were administered to 303 undergraduate and graduate students to assess borderline personality traits, suicidal ideation, internalized shame, depression, impulsivity, and history of suicide attempts.
Results
Internalized shame mediated the relationship between borderline personality traits and suicidal ideation, even after controlling for known predictors of suicidal ideation, including depression, impulsivity, history of suicide attempts, sex, and age. Specifically, higher borderline personality traits were associated with stronger feelings of shame, which in turn increased suicidal ideation.
Conclusions
These findings suggest that addressing internalized shame could be a key target for interventions aimed at reducing suicide risk in individuals with borderline personality traits.

Moderated Mediating Effect of Anxiety by Household Type on the Relationship between Daily Life Stress and Non-Suicidal Self-Injury among Adolescents: RaeHyuck Lee; STRESS. 2024;32(4):188-195. Published online December 27, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.4.188

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Abstract PDF

Background
This study examined the impact of adolescents’ daily life stress on non-suicidal self-injury among adolescents, focusing on the mediating role of anxiety and the moderated mediating effect of anxiety by household type (two-parent vs. single-parent households).
Methods
This study utilized data from the Korean Teenagers’ Mental Health Study, conducted by the National Youth Policy Institute and applied the PROCESS macro method for analysis.
Results
First, daily life stress significantly increased the likelihood of non-suicidal self-injury among adolescents. Second, anxiety played a full mediating role. Third, no significant difference was observed in the direct impact of daily life stress on non-suicidal self-injury between adolescents from two-parent and single-parent households. Fourth, the mediating effect of anxiety on the relationship between daily life stress and non-suicidal self-injury was more pronounced among adolescents in single-parent households than those in two-parent households.
Conclusions
The findings highlight the need for tailored interventions to deal with non-suicidal self-injuries among adolescents, particularly in the context of household type.

Citations

Citations to this article as recorded by

The Influence of Attention-Deficit/Hyperactivity on School Adjustment among Adolescents: Focusing on the Moderated Mediation Effect of Depression by Household Economic Status
RaeHyuck Lee
STRESS.2025; 33(1): 13. CrossRef

Social Representation Study on Disabled Persons: A Longitudinal Study of Mentally Ill Patients and Verification of Differences by Type: Yeun-Joo Hur, KyuMan Han, MinKyu Rhee; STRESS. 2024;32(4):178-187. Published online December 27, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.4.178

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Abstract PDF: Background
This study aimed to examine changes in the social representation of mental illness over the past 50 years and to compare these changes with the social representation of physical disability.
Methods
To measure the causes, symptoms, treatment, and attitudes toward patients and hospitals for the general public, opinion surveys on mental illness were based on questionnaires, and in the case of physically disabled people, the scale of mental illness was revised and supplemented.
Results
As a result of this study, it was confirmed that the social representation of the general public about mental illness has changed significantly over the past 50 years, but certain parts have deteriorated in some negative directions. Furthermore, when comparing the physically disabled and the mentally ill, it was confirmed that the social representation of the mentally ill was more negatively formed than that of the physically disabled.
Conclusions
Based on these research results, the implications and limitations of this study were discussed.

The Effects of Internalized Shame and Social Exclusion on Approach-Avoidance Behavior: Jae-Yun Sim, Myoung-Ho Hyun; STRESS. 2024;32(4):171-177. Published online December 27, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.4.171

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Abstract PDF

Background
This study examined the effects of internalized shame and social exclusion on approach-avoidance behavior.
Methods
A survey was conducted offline and online with 618 adult participants to assess their level of internalized shame. Among them, 59 were selected and assigned to either the high- or low-internalized shame group. These participants were then randomly assigned to either the social exclusion or inclusion condition. After experimental manipulation, explicit and implicit approach-avoidance behaviors were measured.
Results
In terms of explicit behavioral choices, the high-internalized shame group exhibited approach behavior in the social inclusion condition and avoidance behavior in the exclusion condition. In terms of explicit behavioral preferences, the high-internalized shame group and social exclusion condition exhibited avoidance responses. In terms of implicit behavior, the low-internalized shame group exhibited approach responses in the social exclusion condition, whereas the high-internalized shame group exhibited avoidance responses.
Conclusions
This study investigated the impact of internalized shame and social exclusion on social functioning and confirmed that individuals with high levels of internalized shame are more vulnerable to social exclusion. Finally, the implications, significance, and limitations of this study are discussed.

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The Impact of Social Exclusion Experience on Impulsive Buying: The Mediating Effect of Materialism and the Moderating Effect of Mindful Consumption
Namuundari Battulga, Jin-Hwa Lee
Journal of the Korean Society of Costume.2025; 75(2): 29. CrossRef

Efficacy of Ecological Momentary Intervention Tailored to Drinking Motives for Reducing Problematic Drinking in Young Adults: Hee-Eun Kim, Eun-Jung Shim; STRESS. 2024;32(3):161-169. Published online September 30, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.3.161

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Abstract PDF: Background
Brief interventions can inform young problematic drinkers about the risks associated with alcohol use. Ecological Momentary Interventions (EMIs), which provide feedback closer to the point of drinking, may help to translate the internal changes made from these brief interventions into actual behavior.
Methods
Thirty-six problematic drinkers aged 19∼34 years were randomly assigned to one of three groups: Ecological Momentary Assessment (EMA), Standard EMI, or Tailored EMI. Participants in all groups completed two daily EMAs for four weeks following a single-session intervention. They reported their drinking intentions and motives for the current day, and their alcohol consumption and drinking motives from the previous day. The Standard EMI group received feedback on the general negative consequences of drinking, while the Tailored EMI group received feedback specifically tailored to their drinking motives based on their EMA responses.
Results
Problematic drinking, along with related variables (e.g., drinking behavior, alcohol consumption, negative consequences, alcohol expectancies, and drinking motives) was reduced across all groups.
Conclusions
Further research is needed on the potential of monitoring drinking behavior to reduce problematic drinking and how to improve tailored EMI.

Emotional Dissonance and Coping Strategies According to the Emotional Processing Type of Call Center Counselors: SoonJin Choi, HaeYoun Choi; STRESS. 2024;32(3):153-160. Published online September 30, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.3.153

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Abstract PDF: Background
This study explored the emotional processing types of call center counselors and examined the differences in emotional dissonance and related adaptation indicates of coping strategies, emotional exhaustion and work performance orientation according to the types.
Methods
A total of 271 call center agents (204 females, 67 males; mean age 36.5) participated in the study. Latent class analysis of emotional awareness, emotional expression, ambivalence over emotional expression were conducted. Analysis of variance(ANOVA) was used to examine differences in adaptation indicators according to emotion processing type.
Results
Emotional processing types were categorized into Clear(CG), Passive(PG) Repressive(RG) groups. The CG showed low emotional dissonance, good adaptation indicates and functional coping strategies whereas results for the RG type revealed the opposite.
Conclusions
By distinguishing between emotional processing types, this study found that emotional processing type is more closely correlated with burnout and work performance orientation than emotional dissonance itself.

Does Stress Affect Adolescent Anxiety by Mediating Sleep Time?: Si On Jang; STRESS. 2024;32(3):142-152. Published online September 30, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.3.142

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Abstract PDF

Background
Health is essential for the sustainable well-being, yet high stress, anxiety, and lack of sleep among Korean adolescents have become significant social concerns.
Methods
This study examined the impact of stress on anxiety and investigated whether sleep time mediates this relationship in 46,870 male and female adolescents, ranging from first-year of middle school students to third-year high school students. Data were obtained from the "18th Korea Youth Risk Behavior Survey" conducted by the Korea Disease Control and Prevention Agency.
Results
The analysis showed that increased stress was associated with reduced sleep time and higher anxiety levels, stress was found to heighten anxiety, partly by reducing sleep time.
Conclusions
Based on these findings, the study recommends: ① developing mental health indicators to quickly identify adolescents at risk for mental health issues, ② encouraging cooperation between schools, government agencies, healthcare providers to enhance access to mental health programs for adolescents, and ③ implementing policies that promote healthy behaviors, ensure adequate sleep, and improve overall well-being.

Citations

Citations to this article as recorded by

Comparative effects of music therapy and aromatherapy on stress, quality of life, and happiness among shift nurses in Korea: a randomized controlled trial
So-heun Lee, Won-jong Kim, Eun-Hi Choi, Myung-Haeng Hur
Journal of Korean Biological Nursing Science.2024; 26(4): 337. CrossRef

Review Article

An Integrative Review of Interventions for Preventing Internet and Smartphone Addiction in Elementary School Students: Based on the IMB Model: Hyemin Park, Bohye Kim, Jaehee Jeong, Hwa Jeong Kim, Yebin Kim; STRESS. 2024;32(3):133-141. Published online September 30, 2024; DOI: https://doi.org/10.17547/kjsr.2024.32.3.133

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Abstract PDF: Background
This study analyzes and evaluates the effectiveness of various interventions designed to prevent internet and smartphone addiction among elementary school students based on the Information-Motivation-Behavioral Skills (IMB) model.
Methods
An integrative literature review examined studies published in the last ten years that focus on preventive interventions for internet and smartphone addiction among elementary school students. The selected studies were analyzed using the IMB model, which includes information, motivation, and behavioral skills as key components.
Results
The analysis identified several critical components of effective prevention programs: providing relevant information, enhancing interpersonal relationships, emotional management, self-control, and impulse control skills. Effective programs often included group interventions, visual aids, play activities, and parental involvement.
Conclusions
The findings suggest that balanced integration of information, motivation, and behavioral skills is essential for developing effective prevention programs for internet and smartphone addiction among elementary school students. The study provides a foundation for future research and the development of comprehensive prevention programs tailored to the unique characteristics of this age group.

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