Biofeedback as a technique of stress management has been criticised by Gatchel  who claimed that the suggested therapeutic efficiency of it had been severely exaggerated or even wrong as the benefits through the reduction of stress may be because a sense of control has been re-established and not due to any purely physical means. Also, it has been suggested by other psychologists that it is hard to distinguish whether it is biofeedback or the relaxation training involved in it that has led to its beneficial effects. Attanasio highlighted that individual differences are not accounted for in the method of biofeedback. Attanasio et al  studied a biofeedback programme that reduced muscle contraction headaches and found that children experienced greater benefits than adults. This was possibly due to the observation that children were more enthusiastic and less sceptical than adults and so was arguably more willing to try hard to succeed.
A second physiological method of stress management is the employment of anti anxiety drugs. These work because the body produces hormones that create anxiety, however, these can be countered by using other chemical substances to intercept and reduce this activity. Barbiturates were developed to act as depressants on the central nervous system and long acting barbiturates reduce anxiety effectively. However, as they act on the entire central nervous system they have the effect of also making the participant feel slow or depressed. Barbiturates also have a number of other side effects and tend to be addictive. Patients who stopped taking the drugs often reported symptoms of delirium, irritability and increased sweating. This therefore highlights the limitations of drug therapies as a method of stress management, although a second form of drug was produced in order to act more effectively as knowledge of stress and the nervous system grew. Benzodiazepines, including Librium and Valium were brought in to replace barbiturates and work at the synapses between neurones where neurotransmitters would normally be released but they reduce this activity, particularly of the brain neurotransmitter serotonin. Benzodiazepines have shown to be successful, however inappropriate prescriptions can lead to physiological and psychological dependency as they should only be offered for short periods of time. They also have a great number of side effects; Ashton  showed how they can react unpredictably with alcohol. The most recently developed anti anxiety drugs are buspirones which facilitate the effects of serotonin, and have some advantages over benzodiazepines, for example it does not lead to a sedative effect and there are no marked withdrawal symptoms. However, Goa and Ward’s research shows that they can produce other side effects such as headaches and depression. Drug therapies may therefore reduce the effects of stress and anxiety, however their usefulness as a stress management technique is limited by the number of undesirable side effects and their tendency to lead to physiological and psychological dependency.
A common criticism of both the physiological method of stress management is that although they may be highly effective in treating the symptoms of anxiety this is greatly undermined by the fact that they do not recognise the significance of removing the cause of the anxiety. This is where the cognitive therapies can be said to be of greater usefulness than the physiological methods. The cognitive therapies aim to replace negative and irrational self-doubting thoughts with positive rational ones. This approach, therefore assumes that it is not the problem but the way in which the person thinks about it that is maladaptive. If one can be trained to restructure one’s thoughts then the problem will simply disappear and this concept was put into practice by Meichenbaum  through his “Stress Inoculation Training” programme. There are three stages to this programme. Firstly, the nature of the problem is assessed and discussed as well as the individual’s perception of how best to eliminate it. Secondly, stress reduction techniques are employed, for example the individual would learn techniques of relaxation and self-instruction in order to reduce stress. Finally, these strategies are applied to everyday situations via role play or discussion with the therapist so that the individual can eventually follow-through wherein these techniques are transferred to real life.
Meichenbaum later compared his Stress Inoculation Training to the principles of desensitisation as the individual is subjected to their object of fear whilst simultaneously being taught to relax. He used participants suffering from both rat-phobia and snake-phobia using one of the two methods. He found that both methods were effective, however the Stress Inoculation Training had the hidden benefit of greatly reducing the non-treated phobia, whereas desensitisation did not. This is because methods associated with the Stress Inoculation Training for example self instruction can easily be generalised to other stressful situations with the same effect, whereas desensitisation is used specifically to treat a particular problem. Therefore, this is a successful method of stress management.
However, other research has highlighted some limitations in Meichenbaum’s programme. Some research suggests that it has less value when treating individuals who suffer chronically from stress or those who are regularly exposed to highly stressful situations. Also, others have pointed out that it does not take account of individual differences and responses to the programme, for example some may not benefit as much as others from using self instruction as a coping mechanism.
Kobasa  came up with the concept of hardiness and the idea that this characteristic provides a natural resistance to stress. She also believed that this characteristic could be learned by other individuals in order to reduce their anxiety, in a similar structure to that of Meichenbaum.. She called this Hardiness Training. There are three stages to this programme. Firstly, the individual learns to focus on their physical signs of stress so that they can be aware when further attention is required. Secondly, they make two lists with the therapist about stressful circumstances; one being those situations that have turned out well and the other being those that had gone badly. This forces the individual to become aware that situations could be worse and so allowing them to take on a more positive outlook. Finally, the individual learns to compensate through self improvement they learn to take on a challenge that they are able to master when they face stressors that cannot be changed as this reassures them that they can cope. The Hardiness Training programme was supported by the research of Sarafino  which reports that those who have followed such a programme do score higher on tests for hardiness, as well as reporting feeling less stressed and have lower blood pressure than before.
Social support has also been found to reduce overall levels of stress. Kiecolt and Glaser et al  found that students who had more social support suffered less immunosuppression prior to university examinations. However, definitions of “social support” may vary and so limiting the accuracy in this statement. Schaefer put forward the definition that social support could be categorised in two ways; social network [the number of people who are able to provide support] and perceived support [the strength of social support that can be provided by these individual]. Schaefer suggested that these types of social support had very different effects on health. Perceived support is positively related to health, whereas social support is unrelated to well being or can even be negatively related as maintaining this social network can be time consuming and stressful in itself. However, the extent of a person’s social network and perceived support tend to be correlated positively.
This concept that one’s social network and perceived support are often positively correlated with a reduction in stress levels has been supported by the work of Brown and Harris . They discovered that 61% of severely depressed women in their sample had experienced a stressful life event in the previous nine months and of these 37% did not have an intimate friend compared with 10% who did. This therefore suggests that that intimate friend meant that the stress caused by the life event had a reduced effect on the individual. However, many women managed to cope with life events without becoming severely depressed and so this limits the usefulness of social support as a method to reduce stress as it may be more to do with the role of individual differences. Similar research was undertaken by Numholls, Cassell and Kaplan  who took a sample of pregnant women. They found that those who had experienced many stressful life events recently were more likely to suffer from medical complications in their pregnancy if they lacked psychological assets including perceived support and a social network. Tache, Selye and Day  found that cancer was more common among adults who were divorced, widowed or separated than in those who were married. An explanation for this is that those who were not married lacked social support and so were more stressed leading to immunosuppression and illness and so this would support the view that social support is a successful way of counteracting the effects of stress. However, it is hard to establish causal relationships from this evidence as we can merely say that the two aspects are related and not that one caused the other. It may be that those who were divorced or separated were more vulnerable to stress than those who were married and that such a vulnerability played a role in the collapse of their marriages. If this is the case then individual differences override the importance of social support in terms of stress management.
In conclusion, psychological research highlights the variety of stress management techniques and programmes as well as their respective strengths and weaknesses. However, the most appropriate method of stress management appears to depend on individual differences so a clear determination of the most useful method can not be reached.