MEDIA ASSISTANCE:

EXPLORING THE EFFECTS OF THREE METHODS OF GUIDED RELAXATION ON

STRESS WITH ADOLESCENTS

by

Daniel L. Gaylinn

A dissertation submitted

in partial fulfillment of the requirements

for the degree of Doctor of Philosophy

in Clinical Psychology

Institute of Transpersonal Psychology

Palo Alto, California

May 22, 2009

I certify that I have read and approved the content and presentation of this dissertation: ________________________________________________ __________________ Patricia Campbell, Psy.D., Committee Chairperson Date ________________________________________________ __________________ Janice Holden, Ed.D., Committee Member Date ________________________________________________ __________________ Anees Sheikh, Ph.D., Committee Member Date

UMI Number: 3358661

Copyright 2009 by Gaylinn, Daniel L.

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ii

Abstract

Media Assistance:

Exploring the Effects of Three Methods of Guided Relaxation on Stress With Adolescents

by

Daniel L. Gaylinn

I explored the effects of 3 methods of delivering a brief 10-minute guided relaxation with an

ethnically diverse population of 77 adolescents with an average age of 15.2 years within a

Northern California high school classroom. Of the 77 participants recruited for the study, a total

of 21 appeared to disengage from the study as evidenced by the minimal variability of their

responses to the scale used for the study and were thus removed from the primary analyses.

Using a pre-post experimental research design, multiple repeated measures analyses of variance

revealed that, of the 3 delivery methods explored (audio-guided, video-guided, and live-guided),

all 3 produced statistically significant decreases in all 5 subscales of nonclinical psychological

stress as measured by the Smith Stress Symptoms Inventory—State scale (Autonomic

Arousal/Anxiety, Attention Deficit, Worry/Negative Emotion, Striated Muscle Tension, and

Interpersonal Conflict/Anger). No 1 method of delivery was significantly more effective in its

reduction of self-reported levels of psychological stress than any other. Preliminary correlations

showed that males with low grade point averages were more likely to disengage. Significant

decreases in the levels of Attention Deficit, Autonomic Arousal/Anxiety and Striated Muscle

Tension were reported by participants who also reported closing their eyes to some extent during

the audio or video conditions. Participants in the afternoon classes reported significantly higher

Interpersonal Conflict/Anger and Worry/Negative Emotion scores than participants in the

morning classes. Subjectively, many participants responded favorably to their exposure to the 3

iii

treatment conditions, and most participants reported an overall preference for the video condition

over the other 2. The results of this study has implications for the possible adjunctive therapeutic

role electronic media-assisted psychological treatments may play in the modern lives of

adolescents as well as to the relative convenience of providing media-assisted programs to

adolescents by teachers in a high school setting.

iv

Dedication

I dedicate this work to children feeling lost in the darkness.

Your light resides within; your spirit is larger than belief itself.

v

Acknowledgements

I would like to express my deepest gratitude to everyone whose support, encouragement,

and guidance helped make this work a reality. My thanks go to my committee chairperson, Dr.

Patricia Campbell, whose steadfast support served as a lifeline to me during periods that felt like

insurmountable setbacks. Without her guidance and assistance, this dissertation would not have

been possible.

I would like to thank my committee members, Dr. Janice Holden and Dr. Anees Sheikh,

whose patience, rigor, and positivity served and continues to serve as an inspiration to me in my

academic endeavors. Great thanks go to them for demonstrating by example the essence of

scientific scholarship.

In addition, a thank you goes to everyone whose advice and guidance helped to clarify for

me the many questions and concerns that arose over the course of this project. They tolerated my

pedantic nature with patience and positivity. In this group, I include the faculty and staff at the

Institute for Transpersonal Psychology, my statistics assistant, Dr. Jean Oggins, and all those I

count among my friends and esteemed colleagues in the field.

I wish to thank all of the teachers and students involved with the Focus on Success

program at Henry M. Gunn high school, especially Tarn Wilson, whose willingness to grant me

access to the students could not have come at a better time. Of course, special thanks go to all of

the students who participated in this study. May you continue to find benefit from your practice

of relaxation.

Last but not least, I wish to thank my family whose love, humor, and temerity is proof of

nothing short of a miracle. Thank you for believing in me. We have more than any other family I

have ever known.

vi

Table of Contents

Abstract .......................................................................................................................................... iii

Dedication ........................................................................................................................................v

Acknowledgements........................................................................................................................ vi

List of Tables ...................................................................................................................................x

Chapter 1: Introduction ....................................................................................................................1

Adolescents, Media, and Stress ...........................................................................................1

Psychotherapy and Visual Media.........................................................................................2

Visual Media Research ........................................................................................... 3

Visual Media Therapy............................................................................................. 4

The Present Study ................................................................................................................5

Chapter 2: Literature Review...........................................................................................................9

Psychological Stress.............................................................................................................9

Stress in Adolescence ........................................................................................... 11

Stress in Adolescent Development ....................................................................... 12

Stress Management ............................................................................................................15

Relaxation Response............................................................................................. 16

Guided Relaxation .............................................................................................................18

Audio-Guided Relaxation ..................................................................................... 19

Video-Guided Relaxation ..................................................................................... 21

Audio- and video-Guided Relaxation ................................................................... 24

Chapter 3: Method .........................................................................................................................26

Research Design.................................................................................................................26

Participants.........................................................................................................................28

vii

Instruments.........................................................................................................................31

Demographic Questionnaire ................................................................................. 34

Reactions to an Experiential Exercise Scale (REES) ........................................... 35

Smith Stress Symptoms Inventory-State (SSSI-S) ............................................... 37

Procedure ...........................................................................................................................42

Treatment Conditions............................................................................................ 46

Chapter 4: Results ..........................................................................................................................49

Treatment of Data ..............................................................................................................49

Data Analysis ........................................................................................................ 50

Analysis of Subjective Reports............................................................................. 52

Results of the Analyses......................................................................................................53

Additional Findings .............................................................................................. 65

Qualitative Findings.............................................................................................. 65

Chapter 5: Discussion ....................................................................................................................69

Summary and Interpretation of Findings ...........................................................................69

Limitations and Delimitations............................................................................................79

Directions for Future Research ..........................................................................................91

References......................................................................................................................................95

Appendix A: Informed Consent...................................................................................................107

Appendix B: Demographic Questionnaire...................................................................................109

Appendix C: Smith Stress Symptoms Inventory-State (SSSI-S).................................................110

Appendix D: Reactions to an Experiential Exercise Scale (REES).............................................111

Appendix E: Guided Relaxation Transcript.................................................................................112

Appendix F: Instructions for the Interventions............................................................................114

Appendix G: Permission to Screen Digital Video Disc...............................................................115

viii

Appendix H: Pretreatment Talk Transcript..................................................................................116

Appendix I: Reader / Transcriber Confidentiality Agreement ....................................................117

Appendix J: Relaxation Techniques Handout..............................................................................118

ix

List of Tables Tables 1 Demographic Variables .............................................................................32

2 Guided Relaxation Treatment Schedule for All Seven Classes.................45

3 Reported Media Preferences and Prior Experience With Relaxation Techniques .................................................................................................55 4 Descriptive Statistics for Baseline Subscales of the Smith Stress Symptoms Inventory-State.........................................................................56 5 Descriptive Statistics for the Conflict/Anger and Worry/Negative Emotion Subscales of the Smith Stress Symptoms Inventory-State for All Treatment Conditions and Baseline Scores With Time of Day as a Covariate ....................................................................................................58 6 Descriptive Statistics for the Muscle Tension, Attention Deficit, and Autonomic Arousal of the Smith Stress Symptoms Inventory-State for All Treatment Conditions and Baseline Scores With Eye

Closure as a Covariate ...............................................................................60

7 Summary of Significant Stress Reductions for All Three Treatment Methods......................................................................................................64 8 Summary of Common Themes and Method Preferences From Subjective Reports .....................................................................................67

x

1

Chapter 1: Introduction

Adolescents, Media, and Stress

Adolescents growing up in the 21st century live in a world saturated with all forms of

visual media, including television, videos, and videogames. Their pervasive exposure to such

media has steadily increased over the last decade (Comstock & Scharrer, 2006). Studies have

shown that adolescents tend to spend more time watching some form of visual media than they

do engaging in any other waking activity, including being in school (Roberts, Henriksen, &

Foehr, 2004). Such immersion in visual media makes modern adolescents unlike any preceding

generation of adolescents, leading one researcher to name this particular segment of the

population the “new media generation” which she described as

the first cohort to have grown up learning their ABCs on a keyboard in front of a computer screen, playing games in virtual environments rather than their backyards or neighborhood streets, making friends with people they have never and may never meet through Internet chat rooms, and creating custom CDs for themselves and their friends. (Brown, 2005, p. 279)

Some researchers have correlated adolescent exposure to visual media with the prevalence of

stress in this demographic, leading some researchers to suggest that adolescents may be using

media partly as a means of coping or at least as a means of temporarily escaping the

uncomfortable feelings associated with stress (Bickham et al., 2003; Lohaus et al., 2005).

In direct contrast with this postulation, some researchers suggested that visual media may

in fact be evoking the stress response. Laboratory studies exploring the attentional and

physiological effects of visual media have revealed that the simple formal features of visual

media, such as cuts, edits, zooms, pans, or sudden noises routinely activate the orienting reflex,

an instinctual and spontaneous reaction to any sudden or novel stimulus (Kubey &

Csikszentmihályi, 1990; La Ferle, Edwards, & Lee, 2000; Lang, Zhou, Schwartz, Bolls, &

2

Potter, 2000; Reeves & Thorson, 1986). As Halgren (1992, p. 205) originally discovered, this

orienting reflex is an autonomic reaction originating in the limbic region of the brain that gives

rise to the fight or flight—that is, stress—response.

These contrasting positions raise important questions as to the role of visual media in the

process of mediating a psychological condition such as stress. Whereas adolescents may be using

visual media partly as a means of coping with stress (Lohaus et al., 2005), the impact of this

media may be implicitly evoking the stress response (La Ferle et al., 2000). This contradiction

may be resolved by a theory put forth by a small number of media researchers that postulates that

the effect of visual media may be a dialectical one in that the viewer’s own unique experiences,

motivations, and expectations interact with the media to a greater degree than has been

previously assumed (Brown, 2006; Brown & Walsh-Childers, 2002; Levy & Windahl, 1985;

Rubin, 2002; Steele & Brown, 1995; Ward, Gorvine, & Cytron-Walker, 2002).

Theorists who adhere to this Media Practice Model hold that the influence of a particular

medium is a function of the user’s sense of identity, the user’s reason for selecting the media, the

context or situation in which one uses the medium, and the user’s interpretation of that medium

(Steele & Brown, 1995). This model supports the notion that a medium used for a therapeutic

purpose may influence measures associated with that purpose. Although the purpose of the

present study is not to examine this theory directly, the theory does describe how viewers’

expectations influence the medium’s effects inasmuch as these effects correspond with the

medium’s therapeutic purpose.

Psychotherapy and Visual Media

The association between psychotherapy and visual media began when they both emerged

at the same moment in history. In 1895, when Sigmund Freud, the pioneer of what has become

3

modern psychotherapy, published his seminal work, Studies in Hysteria (Freud, 1895/2004), he

initiated the commencement of the scientific analysis of purely mental conditions. Mere months

later, Auguste and Louis Lumière (as cited in Tarnas, 1995, p. 88) unveiled their cinematograph

invention, marking an event that most film historians consider to be the birth of cinema as a

commercially viable medium (Salazard, Casanova, Zuleta, Desouches, & Magalon, 2003). Since

that time, both psychotherapy and visual media have made great strides towards the realization

of what may be considered a shared impulse: to project the image of mind in a linguistically or

visually tangible form so as to illuminate and influence its inner workings. Although these

disciplines have dramatically different intentions, insofar as psychotherapy is to treat mental

illness and electronic media are to inform and entertain, they do seem to share this unique

purview on the mind.

Since their beginnings, both psychotherapy and visual media have made great strides in

their respective domains. On the one hand, visual media have integrated story, performance,

stylistic techniques, and compelling images to influence audiences’ moods and emotions,

evoking sadness, anger, curiosity, joy, and even fear. On the other hand, psychotherapy employs

scientific research and clinical practices that yield a vast range of instruments and methodologies

that influence the critical functioning of the human mind. Yet, it has been within only the past 2

decades that researchers and clinicians have begun to examine and explore the role that visual

media may play in the influence and treatment of the mind.

Visual media research. Although a study on the mental effects of a photo-play, which

was described as a series of projected images on a screen, can be found in the psychology

literature as early as 1916 (Münsterberg, 1916), serious and scientific inquiry into the effects of

visual media did not emerge until “the advent and market penetration of television in the 1950s

4

[was] coupled with concerns about unconscious influences of advertising, in all its forms and

venues” (Fischoff, 2005). As a result of the concern over potentially “subliminal effects” in

media, specifically in advertisements, Media Psychology emerged as a subdiscipline in

psychology, evidenced by the inauguration of the Journal of Media Psychology in 1996 and the

inception of Division 46 for media psychology in the American Psychological Association.

Similarly, the emergence of communication science and media research resulted in psychologists

publishing in nonpsychology journals such as the Journal of Communication, founded in 1951,

and the Journal of Broadcasting and Electronic Media, founded in 1956. Together, these journals

have offered a wide range of content pertaining to the changing faces and interactions between

media and psychology.

In these and other peer-reviewed journals, concern has been raised regarding the

influence of visual media on children and adolescents, particularly for three reasons: (a) Youth

spend more time with media than they do in school or with their parents, (b) The media

frequently depicts glamorous portrayals of risky adult behavior, and (c) Parents and other

socialization agents have been unable to direct youth towards less risky behaviors (Steele &

Brown, 1995). In one early example of such research, the investigation of the influence of media

on children issued a severe indictment of all motion pictures as being an inspiration for all bad

behavior among children (Thurstone, 1931).

Visual media therapy. In contrast to these concerns, some clinicians have begun to

employ various therapeutic uses of media in their practices, including (a) Cinematherapy,

combining bibliotherapy with film-viewing as a means of inducing a therapeutic effect or

catalyzing a therapeutic discussion (Berg-Cross, Jennings, & Baruch, 1990); (b) Instructional

Media, transmitting information regarding a treatment, procedure, or therapeutic process to

5

inform clients of their roles and any preparations or decisions they must make during the course

of treatment (Wilkins et al., 2006); (c) Media Recall, recording and later reviewing recordings of

clinical sessions (Trierweiler, Nagata, & Banks, 2000); (d) Creative Media, using the tools of

media production, such as audiorecording and videorecording equipment, as a form of art

therapy enabling clients to reflect on their experiences, express themselves, and increase their

self-awareness (Orr, 2006); (e) Biofeedback, using auditory or visual feedback to depict

physiological processes in real-time (e.g., heart rate or brainwave activity) and to facilitate a

greater awareness of them (Masterpasqua, 2005); (f) Virtual Reality, recreating an artificial

environment in which a client can experience known fears in relative safety (Riva, 2003); (g)

Media Assistance, a term herein coined by the author, defined as the use of sounds and images

from audio or video content, such as music, nature imagery, and verbal inductions, for the

purpose of guiding individuals through an internal psychological process. This method draws

upon research dating from 1970 to the present that has investigated the use of media programs as

a means of eliciting psychological processes, most notably for relaxation (Boersma & Gagnon,

1992; Byrnes, 1996; DeSchriver & Riddick, 1990; Putman, 2000; Robar, 1978; Smyth, Soefer,

Hurewitz, & Stone, 1999; Tsai, 2004; Ulett, Akpinar, & Itil, 1972; Wells, 2005; Wood, 1986).

The term Media Assistance is intended to unify these disparate studies into a single therapeutic

method and to initiate inquiry into the use of media as a guide for psychological processes.

The Present Study

Of the seven clinical methods of employing some form of visual media in the service of

psychotherapeutic treatment, Media Assistance serves as the intervention to be investigated in

the present study. The purpose of selecting Media Assistance is threefold.

6

First, many adolescents already use visual media as a way of managing or at least

temporarily escaping the stress they experience in their day-to-day lives (Bickham et al., 2003;

Lohaus et al., 2005).

Second, despite the many therapeutic claims made by the producers of commercially

available audio and video tapes, CDs, and DVDs that principally utilize Media Assistance as a

means of delivering relaxation, such as Direct Source Special Products (2006), surprisingly no

studies in the literature were found to support the efficacy of these claims. This finding alone

may serve to justify the rationale behind the present study, in which I aim to explore the validity

of these claims as to the efficacy of nature videos in the management of stress.

Third, numerous studies demonstrate the clinical efficacy of elements that may be

considered a form of Media Assistance, including listening to audiotapes of guided relaxation or

watching nature imagery on video, as a way of managing stress (Boersma & Gagnon, 1992;

Byrnes, 1996; DeSchriver & Riddick, 1990; Putman, 2000; Smyth et al., 1999; Tsai, 2004; Ulett

et al., 1972; Wells, 2005; Wood, 1986). These elements of Media Assistance have been shown to

trigger the relaxation response (RR; Jacobs, Benson, & Friedman, 1996), effectively reducing

symptoms of psychological stress (Tsai, 2004; Wells, 2005). Surprisingly, only one study within

the past 20 years was found to have been published comparing audio and video methods of

facilitating relaxation (Byrnes, 1996).

The present study was aimed in part to replicate and update these findings specifically

with regard to how in-person guided relaxation (Cropley, Ussher, & Charitou, 2007), audiotaped

relaxation (Smyth et al., 1999), video guided relaxation (DeSchriver & Riddick, 1990; Wells,

2005), or both audio and video guided relaxation (Byrnes, 1996) have each been shown to

facilitate the management of some indicators of psychological stress. Because the use of audio or

7

video tape is significantly cheaper and more readily available to the average person than is

working with a professional clinician, research on the use of media as a therapeutic adjunct, or

Media Assistance, may help to serve individuals in an efficacious manner.

To explore the clinical viability of Media Assistance, I employed a prepost experimental

research design to investigate the potential differences between three different methods of

delivering a guided relaxation to a population of adolescents. The purpose of this study was to

investigate the differences in effectiveness between a Video-Guided Relaxation Program, VGRP;

an Audio-Guided Relaxation Program, AGRP; and a Live, in vivo, Guided Relaxation Program,

LGRP, on the self-reported levels of stress among a sample of high school students. All three

treatment conditions lasted 10 minutes in duration and employed the same guided relaxation

transcript (Appendix E) that I prerecorded or read live.

Upon meeting the criteria for participation in the study, participants completed a

preassessment research packet made up of a demographic questionnaire (Appendix B) and a

brief assessment of frequently reported symptoms of stress (SSSI-S; Appendix C; Piiparinen &

Smith, 2003, 2004), which established a baseline stress state upon which to compare the effects

of the treatments. Next, I utilized the seven separate classes to serve as separate treatment groups

to receive the first of the three treatment conditions. Each group received the remaining two

treatment conditions over the course of the next 3 days. All participants received all three

treatment conditions by the end of the 4 days. After each exposure to treatment, participants

again completed the stress symptoms scale as well as a scale designed specifically for the present

study to measure the participants’ reactions to the experiential exercise (REES; see Appendix D).

This study was designed mainly to answer one specific research question: “Is there a

relationship between the means of delivering guided relaxation to adolescents and the amount of

8

stress that they report?” If a relationship was found, then a follow-up question explored in this

study was “What is the magnitude of the relationship between the method of delivering guided

relaxation to the amount of stress adolescents report?” Secondary research questions examined

the extent to which reactions to the treatments influenced their effects and what demographic

variables, if any, correlated with the influence of the treatment conditions on the reported levels

of stress.

9

Chapter 2: Literature Review

Psychological Stress

Psychological stress is defined as “a particular relationship between the person and the

environment that is appraised by the person as relevant to the individual’s well-being and in

which the person’s resources are taxed or exceeded” in a foundational study (Lazarus &

Folkman, 1984, p. 152). The term stress, first used in the psychological sense by Harvard

physiologist Walter B. Cannon, identifies the physiological fight or flight (i.e., stress) response

as evidenced by the biochemical changes that take place within the body during times of

difficulty by generating the quick bursts of energy needed to fight or flee the threat of danger

(1914).

The term stress was brought into prominent use in psychology by Hans Selye who found

that any threat of danger, be it real or imagined, can elicit a cascading physiological effect

throughout the individual’s entire body (Selye, 1950). His early research revealed a universal

reaction to stress, broken into three stages, termed the General Adaptation Syndrome (GAS;

Selye, 1956). Recent studies have supported and elaborated upon this paradigm (Lazarus, 2007;

Uchino, Smith, Holt-Lunstad, Campo, & Reblin, 2007). The GAS defines the first stage, termed

Alarm, as the body’s stress (i.e., fight or flight) response to the perceived presence of danger,

triggers the production of adrenaline and cortisol along the hypothalamic-pituitary-adrenal axis

of the autonomic nervous system (Tsigos & Chrousos, 2002). If the stressor persists, stage two,

termed Resistance, occurs when the body attempts to regain homeostasis in spite of the stressor.

Because the body cannot resist the stressor indefinitely, stage three, termed Exhaustion, occurs as

the body’s resources are gradually depleted and autonomic nervous system symptoms appear,

such as increased sweating, heart rate, respiration, muscle tension, metabolism, and blood

10

pressure (Segerstrom & Miller, 2004; Selye, 1950). Additional physiological symptoms

associated with stress include a contracted anus, dilated pupils, sharpened vision and hearing, a

feeling of butterflies in the stomach, or cold hands and feet resulting from the redirection of

blood flowing away from the digestive system and extremities and into the larger muscles of

body facilitating motility (Selye, 1950; Taché & Selye, 1985).

Whereas the biochemical changes associated with stress at one time provided ancestral

humans with the quick bursts of energy that they needed to fight or flee a threat of danger

(Cannon, 1914), modern humans must learn how to manage stress in a manner that is more

appropriate to societal customs. Failure to appropriately manage the symptoms of psychological

stress and its consequent biochemical and physiological changes has been shown to lead to a

wide array of social and health problems. Some short-term effects of unmanaged stress include

the exhibition of aggression (Hampel & Petermann, 2005), anxiety, depression (Segrin, 1999),

suicidal ideation, and hopelessness (Dixon, Rumford, Heppner, & Lips, 1992). Some long-term

effects include substance abuse (Macleod et al., 2004; Sadava & Pak, 1993) and various

behavioral problems (Compas, Connor-Smith, Saltzman, Thomsen, & Wadsworth., 2001;

Compas, Orosan, & Grant, 1993; McNamara, 2000).

Although the direct association between unmanaged stress and physical illness has

remained somewhat modest in strength (Barr, Boyce, & Zeltzer, 1996), the excessive presence of

stress hormones has been shown to be coincident with various maladies of the vital systems of

the body. The autonomic nervous system may be affected causing headaches (Wittrock &

Forkaer, 2001), sleep disturbances (Farnill & Robertson, 1990), irritable bowel syndrome

(Blanchard & Turner, 2000), and high blood pressure (Schwartz, Pickering, & Landsbergis,

1996). The endocrine and immune systems can be affected causing chronic fatigue (Chalder,

11

Cleare, & Wessely, 2000), rheumatoid arthritis (Zautra & Smith, 2001), lupus (Peralta-Ramírez,

Jiménez-Alonso, Godoy-García, & Perez-García, & the Group Lupus Virgen de las Nieves,

2004), and asthma (Rietveld, Beest, & Everaerd, 1999), as well as a susceptibility to infection (S.

Cohen, 2002), illness (J. Cohen, Tyrrell, & Smith, 1991), and the common cold (Stone,

Bovbjerg, Neale, & Napoli, 1992).

Stress in adolescence. Although stress is a condition that one must learn to manage

throughout one’s lifespan, it may not emerge as a critical condition until one reaches adolescence

(Wagner, Abela, & Brozina, 2006). This is partly due to the physical and hormonal changes that

occur in a maturing body between ages of 10 and 20, but it may also pertain to the many

cognitive, social, and emotional changes that emerge during this period as well. In this unique

phase of life, as the individual is transformed from a child into an adult, a great many

possibilities for learning and maturation emerge, but it can also be a period in which personal

resources and social limits are routinely tested and frequently exceeded.

Consequently, psychological stress is considered to be a natural part of adolescent

development by many researchers (Hutchinson, Baldwin, & Oh, 2006; Kraag, Zeegers, Kok,

Hosman, & Abu-Saad, 2006; Washburn-Ormachea, Hillman, & Sawilowsky, 2004). Whereas

studies demonstrate that adolescents are most particularly affected by those stressors that arise

out of ongoing and daily routines over which they perceive they have little or no control, such as

school assignments, quarrels within peer relationships, family responsibilities, and other stressors

(Frydenberg & Lewis, 2004; Hurrelmann & Raithel, 2005; Hutchinson et al., 2006), such

challenges may be exacerbated by the incidence of traumatic life events, such as accidents,

illnesses, parental divorce, child abuse, or the loss of a loved one (Nastasi et al., 2007).

Teenagers whose present living environment is chaotic, whose upbringing taxes their resources,

12

or who presently suffer from a serious emotional or behavioral problem, are more likely to have

difficulty coping with stress during adolescence and later in life (J. Compas, 1987; Hampel &

Petermann, 2006; Windle, 1992).

It is important to note that stress has emerged as a significant issue within the adolescent

population in recent years. The literature reveals that the rate of adolescent suicides (Gibbons,

Hur, Bhaumik, & Mann, 2006) as well as adolescents’ need for antipsychotic and antidepressant

medications (dosReis et al., 2005) have both increased markedly in the last decade. Although it

would be erroneous to posit a correlation between these findings and the increased rate of

adolescent use of visual media as noted in Chapter 1 (Comstock & Scharrer, 2006), such findings

suggest the need for a close investigation into how stress is impacting this particular segment of

the population.

Stress in adolescent development. As adolescents develop and explore new roles and

behaviors, they must learn new ways of managing the stress they face lest they fall prone to

dangerous or risky behaviors as an escape from the discomfort engendered by stressful

encounters (i.e., use of drugs or promiscuous sex; Compas et al., 2001; Macleod et al., 2004).

Stress in adolescence may be considered closely tied with adolescent development. Two

developmental changes are undergone in adolescence according to prominent psychological

theory: (a) the cognitive developmental stage of formal operations is achieved (Piaget, 1972),

and (b) the psychosocial developmental stage of self-identity is forged (Erikson, 1950, 1968).

Both of these theories of adolescent development are discussed below regarding their relevance

to the present study, followed by some discussion of identity development particularly and how

media may influence it.

13

According to cognitive developmental theorist, Jean Piaget, adolescence is the phase of

life when abstract reasoning, or what he called formal operational thinking, begins to appear

(Piaget, 1972). The stage of formal operations enables individuals to extend their thoughts

beyond the here-and-now and to begin to make predictions and create plausible ideals based on

hypotheses using logic and reason. While this stage enables individuals to engage thoughtfully

and meaningfully in the larger social issues of society (e.g., pollution or racism), this capacity

also makes the individual susceptible to the anxiety, worries, and stressors that such awareness

may bring and the existential threats they potentially impose (Piaget, 1972). Thus, the ability to

recognize and manage the uncomfortable feelings and emotions that such cognitions may bring

helps to lay the cognitive foundation that the adolescent will need to establish the appropriate

thinking and stress management habits the individual will need to draw upon later as an adult.

With regard to the present study, formal operations may predispose teens to the stress that

accompanies exposure to certain forms of media, but it may also help teens to learn how to

recognize and manage stress before it becomes detrimental (Harrison, 2006).

According to psychosocial developmental theorist, Erik Erikson, adolescence can be

conceptualized as the period of life in which the emerging self, or ego, must establish an identity

as separate from but interconnected with the wider social context or consequently suffer from

role confusion (Erikson, 1950, 1968). In Erikson’s view, psychosocial development may be seen

from the point of view of the conflicts, inner and outer, which the vital personality weathers, re-emerging from each crisis with an increased sense of inner unity, with an increase in the capacity “to do well” according to his [sic] own standards and the standards of those who are significant to him. (Erikson, 1968, pp. 91-92)

Thus, the adolescent self is psychologically characterized as a tester of social limits, an explorer

of roles and behaviors, and a pursuant of existential quandaries such as “Who am I?” and “Why

am I here?” Adolescence can be viewed as a period of moratorium, as a temporary postponement

14

of societal commitments, such that a differentiated self-identity can be established (Erikson,

1968).

In the past 20 years, researchers have expanded on Erikson’s fifth (i.e., adolescent) stage

of development. Among them, James Marcia has examined the role of identity formation from

the two aspects of crisis and commitment (Marcia, 1966, 1980). According to Marcia’s

perspective, adolescent identity can be conceptualized as being one of four identity statuses that

he describes according to the presence or absence of crisis (i.e., defined as making one’s own

decisions) and commitment (i.e., defined as investing personally in an ideology). These four

identity statuses are (a) identity diffusion (i.e., the absence of both crisis and commitment), (b)

identity foreclosure (i.e., the presence of commitment in the absence of crisis), (c) moratorium

(i.e., the presence of crisis in the absence of commitment), and (d) identity achieved (i.e., the

presence of both crisis and commitment; Marcia, 1980). According to this theory, these identity

statuses can be ordered into two subcategories such that identity diffused and identity foreclosed

can be considered to be lower and less sophisticated, whereas moratorium and identity achieved

can be considered to be higher and more sophisticated (Marcia, 1980).

This theory supports the assertion that stress can be considered an integral part of

adolescent development insofar as adolescents must forge a new identity by differentiating

themselves from the beliefs, values, and goals that are passed on to them by their parents and

society and committing to an identity based upon their own existential exploration. This

exploration can become a stressful period of confusion and doubt, but the avoidance of this vital

piece of development may result in psychological stagnation and a proneness to pathology

(Marcia, 1980). The establishment of a stable adult identity, then, may be considered a

15

consequence of the adolescent’s capacity to recognize and manage the stress generated in the

course of existential exploration (Johnson, Buboltz, & Seeman, 2003; Makros & McCabe, 2001).

It is worth noting that adolescent exploration may occasionally be sought through the use

of visual media (Bickham et al., 2003; Lohaus et al., 2005). However, studies have suggested

that the content of the media to which many adolescents gravitate tends to portray messages and

behaviors that promote unattainable standards and expectations (Csikszentmihályi & Schneider,

2000; Signorielli & Kahlenberg, 2001). Such portrayals may contribute to the stress they feel,

rather than offering some relief from it. Some research of commercial television suggests that

market researchers aim to influence and monetize the moods and behaviors of the adolescent

demographic specifically (Comstock & Scharrer, 2006; Desmond & Carveth, 2007; Nelson &

McLeod, 2005). This type of directive influence may not be conducive to their general health

and well-being, but may instead encourage maladaptive behaviors such as aggressiveness

(Anderson et al., 2003; Darwish, 2002), disordered eating (e.g., Alperin, 2005; Tiggemann,

2005), sexual promiscuity (L’Engle, Brown, & Kenneavy, 2006; Tolman, Kim, Schooler, &

Sarsoli, 2007), substance abuse (e.g., Primack, Gold, Land & Fine, 2006; Stacy, Zogg, Unger, &

Dent, 2004), and other risky behaviors (e.g., Buwalda, 2004). It is for this reason that alternative

forms of media content, such as those associated with Media Assistance, are explored in the

present study, and serve as the basis for investigation.

Stress Management

Traditionally, at least four different kinds of approaches have been clinically employed as

a form of stress management: (a) guided relaxation training, (b) social problem solving, (c) social

adjustment and emotional self-control, and (d) a combination of each of these approaches (Kraag

et al., 2006). Given the one-way (i.e., prerecorded) communication that is implicit in the Media

16

Assistance method of treatment, guided relaxation served as the best approach to stress

management for exploration in the present study. Before discussing guided relaxation as an

approach to stress management, the way in which relaxation itself influences the mind and body

and impacts stress warrants further discussion.

Relaxation response. As noted above, cardiologist Herbert Benson (1977) demonstrated

that an individual can use one’s mind to change physiology for the better, thus improving one’s

health and emotional outlook on life. In a seminal paper published by Benson and his colleagues

(Benson, Beary, & Carol, 1974), the relaxation response (RR) was demonstrated to initiate an

integrated set of physiological changes that directly counteract the fight or flight (i.e., stress)

response thereby triggering the body’s natural restorative process. According to Benson, a person

can shut off or tune out the physiological danger signals associated with stress by initiating the

RR (e.g., by taking deep diaphragmatic breaths, actively relaxing their muscles, slowly repeating

calming words or phrases, or passively ignoring distracting thoughts or feelings). After 3

minutes, the stress response burns out as the cerebral cortex stops sending emergency signals to

the hypothalamus, which in turn ceases to send panic messages to the nervous system such that

heart and breathing rate, muscle tension, metabolism, and blood pressure all return to their

normal levels (Benson, Beary & Carol, 1974). Whereas the stress response is characterized by

sympathetic activation stimulating the body to react to potential threats, the RR is characterized

by parasympathetic activation that enables the body to maintain a generalized state of

homeostasis (Jacobs et al., 1996).

Additional studies from the 1970s showed that triggering the RR decreases oxygen

consumption, and lowers heart rate, arterial blood pressure, and the rate of respiration (Wallace

& Benson, 1972). In the 1980s, the regular and extensive elicitation of the RR for 4-6 weeks of

17

daily practice was associated with more enduring physiological changes such as a generally

reduced responsiveness to the stress hormone, norepinephrine, an increased resiliency to stress,

and the reduced need for medication (Benson, Arns, & Hoffman, 1981; Lehmann, Goodale, &

Benson, 1986).

In more recent studies, the regular triggering of the relaxation response has been shown

to help individuals manage many of the symptoms associated with anxiety, addiction, and stress,

and generally improve their mental and physical functioning (Deckro et al., 2002; Scheufele,

2000). Among middle school populations, students whose classes were taught by teachers trained

in the relaxation response curriculum exhibited higher academic performance, as measured by

GPA (p = .0001), better work habits (p = .0001), and a greater degree of cooperativeness (p =

.0001) than those students whose teachers were not trained in the RR curriculum (Benson,

Wilcher et al., 2000). Another recent study showed that daily practice of the RR has been linked

with significant improvements in symptoms associated with irritable bowel syndrome (Keefer &

Blanchard, 2001).

Popular techniques for triggering the relaxation response (RR) include massage,

progressive muscle relaxation (PMR), yoga stretching, diaphragmatic breathing, imagery,

meditation, or some combination of these (Smith, Amutio, Anderson, & Aria, 1996). Benson

(1977) proposed four underlying elements that should be present during the relaxation,

regardless of the technique being used, in order to effectively elicit the RR: (a) the presence of an

object on which to focus, such as a candle, a mantra, one’s breath, a television; (b) a quiet

environment; (c) a comfortable position; and (d) a positive attitude. These elements, coupled

with three cognitive skills proposed by Smith (1990), will ensure the influence of the technique

on cognitive and somatic arousal. These cognitive skills are (a) focusing, described as the ability

18

to identify, differentiate, maintain attention on, and return attention to simple stimuli for an

extended period; (b) passivity, described as the ability to stop unnecessary goal-directed and

analytic activity; and (c) receptivity, described as the ability to tolerate and accept experiences

that may be uncertain, unfamiliar, or paradoxical. These underlying elements and cognitive skills

are implicitly beneficial, but aid the efficacy of the particular relaxation technique when

practiced over time (Smith, 1990, p. 65).

Guided Relaxation

While the skills associated with triggering the relaxation response (RR) are accessible to

almost everyone, guided and deliberate practice relaxing is usually needed for the individual to

learn to recognize and manage the indicators of psychological stress (Jacobson, 1925, 1934,

1970). Even a single exposure to the guided practice of relaxation has been demonstrated in early

studies to have ameliorative effects on mental and physical conditions (Benson, Beary et al.,

1974; Benson, 1977; Benson, Arns, & Hoffman, 1981; Benson, 1983).

In a systematic review of the literature exploring various relaxation techniques in the

treatment of pain from 1996 to 2005 (Kwekkeboom & Gretarsdottir, 2006), the randomized trials

of relaxation interventions were analyzed in an effort to draw conclusions as to the efficacy of

various relaxation interventions (e.g., progressive muscle relaxation, jaw relaxation, rhythmic

breathing, and other relaxation exercises). The authors concluded that most of the 15 studies that

were reviewed demonstrated weaknesses in methodology, limiting the ability to draw

conclusions as to the efficacy of the interventions. Among these weaknesses, the authors noted

that many of the studies failed to address individual differences among participants as to their

responsiveness to particular relaxation techniques. The present investigation addresses one such

19

weakness by examining how the method by which guided relaxation is delivered influences its

potential efficacy with stress.

Audio-guided relaxation. The research cited above demonstrates the relative efficacy of

live or in-person guided relaxation programs. Yet, it is not always feasible, practically or

financially, for individuals to employ the services of trained professionals in order to make use of

a relaxation program, particularly if one intends to gain the more enduring and lasting benefits

that come from a daily practice routine. As such, audio tapes may be used to guide individuals

into the RR in lieu of in-person instruction. When practicing with a tape rather than with a live

trainer, some disadvantages arise, such as the inability to tailor the program to the individual’s

own unique style or challenges. The benefit of having ready access to a tape that can be used at

any time may outweigh some of these potential drawbacks.

Most of the early research into the use of audio tapes for guided relaxation met with an

underwhelming response in the literature. In a systematic meta-analysis of the early research

exploring audiotaped relaxation, Paul and Trimble (1970) stated, “None of the available

literature provides evidence that recorded relaxation instructions . . . produce effects comparable

with those obtained by ‘live’ treatment procedures,” (pp. 299-300). When these early studies of

audiotaped relaxation programs were shown to be at all beneficial, it tended to be when the audio

programs were used in combination with live training (Zeisset, 1968). As such, Paul and Trimble

(1970) concluded that the lack of efficiency of audiotaped procedures was due to the “lack of

response contingent feedback in the recorded mode,” (p. 300). In other words, the responsiveness

of a live trainer to the individual differences of individual participants was lost in the

employment of recorded training.

20

Given the datedness of Paul and Trimble’s (1970) meta-analysis of the literature, it is the

position of the researcher that responsiveness to audiotaped instructions has possibly increased

since that time, as demonstrated by Smyth et al. (1999). In this research, the effects of the use of

an audiotaped guided relaxation on the symptoms associated with asthma (i.e., self-report and

expiratory flow), stress, and general well-being were examined with a group of middle-aged

asthmatics (n = 20). Their results showed that listening to the relaxation tape generated responses

in the direction of the hypothesis and achieved statistical significance in the measures of reported

asthma symptoms (p < 0.1) and expiratory flow (p < 0.05). [This p-value is reported in the

primary source article by Smyth et al. (1999). Because the social sciences report statistical

significance at p < 0.05 or lower, it is presumed that the authors’ reporting of significance with a

p < 0.1 does not broaden the definition of what constitutes a significant finding, but is more

likely the result of a misprint of “p < 0.01” in the original article. At the time of this writing, the

authors of the study did not respond to e-mailed requests for confirmation of this assumption.]

Listening to the relaxation tape did appear to decrease negative mood (p < 0.05) and stressor

reports (p < 0.01) in the treatment group, but the effects were unrelated to positive mood (p =

0.001). Although the researchers maintained some reservations regarding the small sample size

and the potential threats to internal validity posed by the Hawthorne, or placebo, effect or the

tendency for scores to regress towards the mean, these findings remain suggestive that guided

relaxation audio tapes can serve as a brief, low-risk, and relatively inexpensive form of

supplemental treatment for stress.

In another recent study published in 2007, Cropley et al. examined the effects of a 10-

minute guided relaxation tape on the desire to smoke and several symptoms associated with

tobacco withdrawal, such as tension, irritability, and restlessness, with a group of smokers of at

21

least 10 daily cigarettes for at least 3 years (n = 30). Participants were asked to rate the strength

of their desire to smoke and to rate the intensity of their withdrawal symptoms before a guided

relaxation, immediately following the relaxation tape, and at three 5-minute intervals following

the intervention. The research tentatively demonstrated that the desire to smoke decreased

immediately following the relaxation and for at least 5 minutes following the relaxation as

compared to the control group that did not receive guided relaxation (p = 0.05). Although the

authors recognized that the effects of the intervention were “modest and requires [sic]

replication” (p. 992), the effects that were measured were in the predicted direction of the present

hypothesis, namely that even a brief 10-minute guided relaxation audiotape can impact

participants’ scores on self-reported measures.

Video-guided relaxation. As mentioned in the previous chapter, psychological research

into the effects of visual media has been in the literature for as long as the medium has been in

existence. Since its inception, many studies have been published suggesting that visual media

(specifically, video) can influence behavior, either as the result of social modeling (Bandura,

Ross, & Ross, 1963) or as a result of how it influences the various neurological processes in the

brain (Kelly, Grinband, & Hirsch, 2007) or both.

The majority of studies that examine the effects of visual media, such as television,

movies, and videogames, on adolescents tend to focus primarily on how violent content tends to

lead to the exhibition of violent or aggressive behaviors (Anderson & Dill, 2000; Ferguson,

2007; Palys, 1986). While it is difficult to refute the direct effects of media on adolescents

revealed in these laboratory studies, the view that violent media invariably leads to violent

behaviors has been challenged by a small group of researchers who have posited a theory that the

effect of visual media is not necessarily as direct as is presumed by these studies. These

22

researchers posit the Media Practice Model that holds that the effect of visual media is more

dialectical and interactive with the viewer’s own unique experiences, motivations, and

expectations and may relate to the user’s sense of identity, the user’s reason for selecting the

media, the context or situation in which that media is viewed, and the viewer’s interpretation of

that media (Brown, 2006; Brown & Walsh-Childers, 2002; Levy & Windahl, 1985; Rubin, 2002;

Steele & Brown, 1995).

Given this theoretical basis, the effect that a particular piece of visual media has with an

adolescent may have more to do with the purpose or intention behind watching the video than is

usually presumed by the direct effects model. This interactive quality of the Media Practice

Model serves as a theoretical support for the therapeutic use of video herein proposed. Previous

exploration into the use of video with a therapeutic intention has demonstrated some promising

results. In one study in particular, a process of using video imagery called photic stimulation—

flashes of light from a video screen—was shown to induce relaxation in individuals who watched

it as the frequency of the flashes was progressively slowed over time (Landeck, 2004). Landeck

suggested that photic stimulation could be used as an alternative approach to inducing relaxation

in a clinical setting with reluctant or anxious clients.

Only a few studies were found in the literature to explore the potential therapeutic value

of video. Among them, the earliest known study was published nearly 20 years ago and

examined how videos of quiescent animals could be used to moderate the stress response in an

elderly population (DeSchriver & Riddick, 1990). DeSchriver and Riddick investigated whether

the stress-ameliorating effects of animal companionship (Allen, Blascovich, & Mendes, 2002;

Friedmann, Thomas, & Eddy, 2000) are comparable to watching videos of animals, which could

avert the potential allergies or phobias that could be triggered by the use of live animals in a

23

clinical setting. To this end, the researchers evaluated the muscle tension and cardiovascular

responses using pulse rate and skin temperature in a relatively small sample (n = 27) of elders

(with a mean age of 75 years) who were randomly assigned to two experimental conditions (e.g.,

viewing an aquarium or a video tape of an aquarium with the sound of water trickling over

rocks) and a control condition (a placebo video tape of television color bars and static). Members

of all three groups perceived their treatments as relaxing, and results appeared to move in the

expected direction, but the results did not achieve statistical significance overall. However,

qualitative evaluations elicited the overall sentiment from the participants that gazing at the fish

was an enjoyable and beneficial activity. Almost universally, participants stated that the videos

allowed them to feel “totally relaxed” and helped them to temporarily “forget about [their]

problems while watching” the videos (DeSchriver & Riddick, 1990, p. 47). Subjective reports

such as these, which are suggestive of results in the direction of the present study’s hypothesis,

raise the possibility that the lack of empirical support offered by this study is not a matter of the

videos being ineffectual, but rather the failure of the instrumentation utilized to measure the

effect.

In another more recent and compelling study of the therapeutic use of video, Wells

(2005) extended the findings of DeSchriver’s and Riddick’s work (1990) beyond videos of fish

to also include videos of other animals as well. In this study, Wells evaluated the heart rate and

blood pressure of a larger sample (n = 100) of younger university students (with a mean age of

19.71), who were randomly assigned to three experimental conditions (i.e., videos of fish, birds,

or primates) and two controls (videos of humans or a blank screen). She found that the videos

universally encouraged relaxation, with participants in all three experimental conditions

exhibiting significantly (p < 0.001) lower levels of heart rate and blood pressure than those

24

individuals exposed to the control videos. She concluded that “videotapes of certain animals can

reduce cardiovascular responses to psychological stress and may help to buffer viewers from

anxiety, at least in the short term” (in abstract). Overall, the results from Wells’ (2005) study

suggest that the presence of animals in video form can have a stress-ameliorating effect on

cardiovascular dynamics similar to that of live animals. However, this study investigated the

effects of the video only in the short-term, and thus, long-term implications cannot be drawn. It

is possible that participants may become habituated by repeated viewings of the video such that

its stress-reducing impact may be weakened.

It may be noted that Wells’ (2005) study is the first study of its kind to present

videotapes of animals without any type of auditory stimulation (p. 213). While certain types of

auditory cues (e.g., classical or new age music) have been demonstrated to reduce stress (Chafin,

Roy, Gerin, & Christenfeld, 2004; Krout, 2007; Pelletier, 2004; Smith & Joyce, 2004), the

results from Wells’ study show that visual stimulation by itself can buffer people against some of

the symptoms of stress. This finding gives support to the lack of auditory stimulation, in the

treatment conditions explored by the present study.

Audio- and video-guided relaxation. As noted in the previous chapter, only one study was

found to have been published in the last 2 decades exploring the comparative efficacy of audio

and video methods of facilitating relaxation (Byrnes, 1996). In this study, Byrnes measured the

ongoing levels of stress experienced by 33 adult subjects and 21 college students (n = 54) as they

were subjected to one of three experimental conditions. Subjects were randomly assigned to

either listen to a piece of classical music, view an underwater film of tropical sea life, or listen to

the same piece of classical music while viewing the same underwater film of tropical sea life.

Participants were also asked to complete a brief questionnaire pertaining to profession and

25

relaxation preferences, and they were asked to rate their current level of stress on a 7-point Likert

scale both before and after the intervention. Then, during the intervention itself, participants

utilized a device designed to assess their overall tension on a continuum in real time (known as

the Continuous Response Digital Interface or CRDI) by which participants turned a dial to

denote their current level of tension during the exposure to the intervention. The data gathered by

the CRDI was subjected to a post hoc t test analysis against the perceived stress levels as

reported by the pretreatment and posttreatment questionnaires.

Byrnes’ (1996) results demonstrated that there was a significant difference between the

pretreatment and posttreatment stress responses for the combined audio-video condition (p =

0.002), but not for the audio or video conditions separately (p = 0.154). Although the results for

all three conditions did not achieve statistical significance, Byrnes stated that participants in all

three conditions reported an overall decrease of tension and stress over the course of the

intervention and, upon completion, reported that they enjoyed their participation. Such positive

results offer promise to the employment of VGRP in the reduction of stress and facilitation of

relaxation, albeit they are inconclusive at this time. Byrnes’ treatment lasted approximately 2

minutes and 50 seconds, which is a relatively brief intervention that would not be expected to

generate as robust an effect as it seemed to based on the participants’ subjective experience of

stress. Moreover, one cannot discount the possible placebo effect of the use of the CRDI

instrumentation as well as of the video tape itself. However, Byrnes’ study suggests the

possibility of eliciting a similarly effective result from Media Assistance programs as was found

by the present study.

26

Chapter 3: Method

Research Design

At the end of Chapter 1, the basic research design of this study was briefly discussed. In

this chapter, I explore this subject more deeply. Given that live (in vivo) guided relaxation has

already been shown to help individuals manage stress (Cropley et al., 2007), as discussed

previously in Chapter 2, the primary aim of this study was to explore whether Media Assistance

might be a comparable adjunct to the clinical treatment of stress. The investigation of Media-

Assisted forms of treatment provided useful findings in terms of determining their potential role

in the range of clinical treatments.

In this research, I explored how three different methods of delivering guided relaxation—

video, audio, and live—influence various symptoms associated with stress. As is described in

more detail below, the video-guided relaxation program, or VGRP, is composed of nature

imagery that was used with permission from a commercially available DVD (see Appendix G).

The visual imagery is accompanied by a prerecorded audio track of the guided relaxation

transcript recited in a calm and soothing intonation (see Appendix E). The audio-guided

relaxation program, or AGRP, was composed of the same audio track used in the VGRP in the

absence of the visual nature imagery. The live, or in vivo, guided relaxation program, or LGRP,

was composed of the researcher reciting the guided relaxation transcript (see Appendix E) in a

calm and soothing intonation, in person with the participants. No music was employed with any

of these methods as this could potentially confound the primary focus of whether visual imagery

helps or hinders the stress-ameliorating efficacy of guided relaxation.

27

The purpose of this research was to answer the following questions:

1. “Is there a relationship between the method used to deliver guided relaxation to

adolescents and the amount of stress they report after receiving the treatment?” and

2. “What is the magnitude of the relationship between the method of delivering guided

relaxation and the amount and subtypes of stress levels that are reported?” Secondary research

questions were:

1. “Which demographic variables, if any, correlate with the influence of the guided

relaxation programs on reported levels of stress?” and

2. “To what extents do the participants’ reactions to the treatment conditions correlate

with reported levels of stress after exposure to treatment?”

In an effort to answer these questions, I utilized quantitative methods that had been

employed to view data objectively and to understand the relationship between variables in a

uniform fashion (Braud & Anderson, 1998). To establish and maintain a high quality of

standards, quantitative measures, such as questionnaires and surveys that have a high degree of

reliability and validity, were used. Quantitative methods are one of the most accepted forms of

data collection in the field of psychology today and are presumed to be the most congruent with

the scientific method (Creswell, 1994).

In this study, I employed a prepost experimental research design to serve an exploratory

function as to how three methods of delivering guided relaxation influence reports on a

psychological measure of stress. Specifically, I compared the effects that a Video-Guided

Relaxation Program (VGRP), an Audio-Guided Relaxation Program (AGRP), and a Live (in

vivo) Guided Relaxation Program (LGRP) had on the self-reported levels of stress among a

group of 77 Northern California high school students.

28

Upon acceptance into the study, all participants completed a pretreatment research packet

composed of a Demographic Questionnaire (Appendix B) and an assessment of frequently

reported stress symptoms, as measured by the Smith Stress Symptoms Inventory-State version

(SSSI-S, see Appendix C; Piiparinen & Smith, 2003, 2004) to establish demographics and the

baseline measures of participants’ present state of stress prior to the treatment. The third

instrument utilized in the present study, the Reactions to an Experiential Exercise Scale (REES,

see Appendix D), was employed after each treatment condition. A more detailed discussion of

these instruments is provided later in this chapter.

Upon completion of the pretreatment research packet, participants received the first of the

three treatment conditions (e.g., VGRP, AGRP, or LGRP), depending on the class to which they

were assigned. Each class received a different treatment condition for each of the 4 days of data

gathering. In other words, all seven classes received all three treatment conditions during the 4-

day period, albeit in a different order. This counterbalancing design was used to maintain the

distinction between the effects of order with that of the treatment itself. Participants completed

the two psychological assessments, the REES and the SSSI-S, after each exposure to a treatment

condition.

Participants

A convenience sample of 91 adolescents was recruited from a local high school in

Northern California to participate in the study in order to obtain sufficient statistical data that

could be made generalizable to the population at large and to account for the possibility of

attrition. Participation was solicited through contact with the school’s teachers with the

understanding that students’ participation throughout the study was entirely voluntary, although

teachers were encouraged to offer class participation credit for involvement in the study. All

29

participants and at least one of each participant’s parents were required to sign an informed

consent form (Appendix A) and were told about the nature of the study prior to filling out the

pretreatment questionnaires. Participants and at least one parent were informed that participation

in the study was entirely voluntary and that participants might choose at any time to discontinue

participation for any reason.

The required criteria for inclusion in the study were as follows: (a) willingness to

participate, (b) ability to speak and read English fluently as attested by their teacher, (c) signed

and parentally cosigned informed consent forms, and (d) full-time enrollment in mainstream,

rather than special-education, classes at a local high school. Students from special education

classes were excluded so as to ensure that all participants in this study had the appropriate level

of intelligence and the minimal fluency in English that was required to maintain the scientific

validity of the assessments.

Participants were selected from a diverse sampling across all grade levels from within a

“Focus on Success” class, the purpose of which was to offer students skills and techniques that

fostered good study habits. Although a diverse sample was difficult to achieve within a single

high school, diversity of participants was sought within the confines of the above-stated criteria.

Out of the 91 participants recruited, 77 returned the parentally cosigned informed consent forms

and were thus given the Demographic Questionnaire (Appendix B) and the Smith Stress

Symptoms Inventory-States version (Appendix C; Piiparinen & Smith, 2003, 2004) to establish

the baseline measures of stress.

After all of the data were collected, 21 of the 77 participants needed to be eliminated for

the reason that invalid data was suspected. These 21 participants’ responses to both the baseline

measures and to the three repeated measures of SSSI-S reflected the overall impression that none

30

of the items on the stress scale applied to them at all. (A thorough discussion of the rigorous

manner by which the participants’ “disengagement” from the study was conceptualized will be

provided later in this chapter.)

A preliminary correlational analysis between this disengaged segment of the sample and

the rest of the participants showed that this group of disengaged participants was more likely to

be male (r = .32, p < .004) and to report lower grades (e.g., Ds and Fs; r = -.23, p < .05) than the

group whose scores were included in the primary analysis. Although suggesting that males with

low grades would typically disengage from studies such as this one, this study did not have

enough individuals in the sample to allow this finding to serve a predictive function. The other

participants’ inclusion in the study was not related to any of the other demographic variables

including ethnicity, socioeconomic status, grade, primary language, or media preferences.

Although a moderate amount of selection bias—or a distortion of data arising from the

way in which the data is collected—is to be expected in any self-reported measure, this amount

of disengagement within the study was higher than expected. It is possible that doing research in

a classroom setting created a conflation between participation in the study with other in-class

assignments. Those students who disengaged from the study might have been disposed to tuning

out in-class assignments, in an effort to be “cool,” hostile, or otherwise resistant to in-class

authority. If so, their responses would not have accurately reflected the effects of the

interventions on how people perceived their emotional responses—which was the primary focus

of the study—and so therefore a decision was made to remove these participants’ scores from the

primary sample in order to maintain the validity of the study.

This scenario raises some interesting questions pertaining to the way in which

interventions such as the ones explored in this research might be brought into the classroom

31

setting and used with individuals who fit this particular demographic profile. The interventions

themselves might have, in fact, been quite effective with such participants, but their general

disengagement from participation in the study might have evoked what could be considered to be

due to the study’s methodology or due to a problem of instrumentation for this particular

subgroup of the population. A more thorough exploration of these methodological findings and

the limitations they imposed on the present research are discussed in more detail in Chapter 5.

The demographics for the remaining 56 participants are shown in Table 1. This sample of

participants was evenly split between the two genders, with an average age of 15 years (M =

15.2, SD = 1.1), primarily English-speaking, in 9th and 10th grade, and who reported getting

mostly Bs or Cs academically. They reported being mainly Caucasian or Latino/Hispanic,

followed by Bimultiracial, Asian, African American or another unlisted ethnicity. A majority of

the students reported that they did not know their socioeconomic status, but those that did know

predominantly reported a high SES (e.g., more than $100 thousand per year), with some lower-

income exceptions.

Instruments

In this study, participants completed three questionnaires. The first questionnaire was

designed to gather general demographic information from the participants and to gather specific

information pertinent to the present topic of inquiry (Appendix B). The second questionnaire, the

Smith Stress Symptoms Inventory-States version (SSSI-S, see Appendix C; Piiparinen & Smith,

2003, 2004) was designed to measure frequently reported stress symptoms, such as

Worry/Negative Emotions, Striated Muscle Tension, Attention Deficit, Autonomic

Arousal/Anxiety, Depression, and Interpersonal Conflict/Anger. The third questionnaire, the

Reactions to an Experiential Exercises Scale (REES, see Appendix D), was an instrument

32

Table 1

Demographic Variables N %

Gender

Male 28 50%

Female 28 50%

Age 14 20 36%

15 12 21%

16 16 29%

17 7 13%

18 1 2%

Grade

9 26 46%

10 21 38%

11 2 4%

12 7 13%

Language

English 41 73%

Other 13 23%

No Response 2 4%

33

Table 1 (continued) N %

Ethnicity

Caucasian 23 41%

Latin / Hispanic 13 23%

Bimultiracial 7 13%

Asian 6 11%

African American 4 7%

Other 3 5%

No Response 1 2%

Grade Point Average

As 4 7%

Bs 34 61%

Cs 16 29%

Ds 1 2%

Fs 0 0%

No Response 1 2%

34

Table 1 (continued) N %

Socioeconomic Status

More Than $100 Thousand 10 18%

Between $75 & $100 Thousand 3 5%

Between $50 & $75 Thousand 7 13%

Between $25 & $50 Thousand 3 5%

Less Than $25 Thousand 2 4%

Don’t Know 30 54%

No Response 1 2%

designed especially for the purposes of this study and measured participants’ reactions (in terms

of their Enjoyment, Engagement, and Interest in Repeating the exercise) to each of the three

treatment conditions. All of these instruments will be discussed in greater detail below.

Demographic questionnaire. All participants completed a demographic questionnaire.

This questionnaire (see Appendix B) consisted of 10 multiple choice items that elicited

participants’ demographic information, such as their age, grade, sex, ethnicity, academic

performance, and socioeconomic status. Additional questionnaire items were included in an

attempt to explore participants’ media preferences in general, while relaxing, average time spent

daily using said media, and the extent of any prior experience with relaxation techniques that the

participants may have had. It was hoped that the data generated by these items would enable me

to explore whether a participant’s predilections toward and uses of media would influence the

participant’s compliance to the Media Assistance methods being studied as well as the

participant’s response to them. Although follow-up research would be needed to focus on this

35

relationship more directly, such exploratory data could help to provide the basis for such studies

examining how elements of the Media Practice Model (discussed in Chapter 1) might relate to

the potential efficacy of Media Assistance as an adjunctive form of clinical treatment. Items

about media preference were coded as binary variables for each type of media listed with type of

media reported = 1 and not reported = 0.

Reactions to an Experiential Exercise Scale (REES). The Reactions to an Experiential

Exercise Scale (REES; Appendix D) is an 18-item, 6-point Likert-type scale designed expressly

for the purposes of the present study. I developed it to measure the extent to which individuals

felt Engagement during, Enjoyment of, and an Interest in Repeating the given experiential

exercise. Respondents to this questionnaire were asked to indicate the extent to which a

statement fit with how the respondent felt “in reaction to the exercise” along a 6-point Likert

scale (with 1 indicating “Strongly Disagree” and 6 indicating “Strongly Agree”). The statements

used in the REES were used to assess three subscale reaction categories: engagement,

enjoyment, and interest in repeating the exercise. The REES is written at a junior high school

reading level, is easy to administer with groups or individuals, and takes about 5 to 7 minutes to

complete.

For the purposes of the present study, a 19th item was added to the REES to elicit the

extent to which participants elected to close their eyes during the exercise, as measured across a

6-point Likert-type scale, with 1 indicating “Strongly Disagree” and 6 indicating “Strongly

Agree.” The purpose of including this additional item was to evaluate the potential confound

imposed by the possibility of participants closing their eyes during the exercise. As some

research has shown (Craig et al., 2000; Putman, 2000), closed eyes increases alpha brainwaves,

which are 8-12 cycles per second, and which in turn increase relaxation, reduce stress, and

36

reduce the beta brainwaves, which are 13-25 cycles per second, and thus reducing wakefulness.

Moreover, this item may have helped to elicit data concerning the relative efficacy of the

imagery used in the VGRP on the reported levels of stress among participants in this condition

who reported that they kept their eyes open during the treatment. For this study, the measure of

whether participants closed their eyes during the treatment conditions was reverse-coded and

then recoded as a dichotomous variable with closed eyes reported as 1 and eyes opened to any

extent reported as 2.

For the final implementation of the REES after the third treatment condition was

completed, an open-ended question was added to elicit participants’ preference and experience

with each of the three conditions. Participants were asked to describe the treatment that they

liked the best and why, in as much detail as they wanted. This item was intended to elicit

subjective information about which aspects of the three conditions aided or hindered the

participants’ relaxation and overall reaction. It was hoped that this qualitative information would

help to deepen the interpretation offered by the quantitative data of the questionnaires and

possibly guide the direction of future studies.

To determine the reliability of the REES, the instrument was piloted in a total of seven

separate graduate-level psychology classes in Northern California in which students underwent

brief experiential exercises lasting approximately 10 minutes in duration (n = 75, M age = 29.3

years old, SD = 6.4 years) with 48 females, 15 males, and 13 participants with undisclosed age

and gender. The specific classes to pilot the REES participated in various creative expression

exercises that related to their personal goals for the academic semester. The Cronbach’s alpha

coefficient for internal reliability was calculated for the entirety of the REES at .92 (for

subscales, Enjoyment = .83, Engagement = .85, and Interest in Repeating = .86). For females,

37

alpha was .92 for the REES overall, with Enjoyment = .84, Engagement = .85, and Interest in

Repeating = .86. For males, alpha was .85 for the REES overall, with Enjoyment = .72,

Engagement = .83, and Interest in Repeating = .88.

For the present study, the Cronbach’s alpha coefficient for internal reliability for the

REES was calculated for each of the three treatment conditions. The participants of the present

study (n = 56) were all treated to the three treatment conditions in seven separate classes in

varying orders over the course of 4 consecutive days. Cronbach’s alpha for each of the three

subscales for each of the three treatment conditions ranged from .71 to .93, meeting the minimal

criterion of alpha = .50 (J. Cohen, 1987).

The overall reactions to each of the interventions tended to be correlated with one another

so that participants who enjoyed the live condition also tended to enjoy the audio and video

conditions, with similar findings revealed for their feeling of engagement with the interventions

and their interest in repeating the interventions. Cronbach’s alpha for Enjoyment for the

combined live, audio, and video conditions was .81, for Engagement was .71, and for Interest in

Repeating was .84. As a result, a decision was made to average ratings of Enjoyment,

Engagement, and Interest in Repeating across conditions, to give one score each for each

respondent in each of the three subscales.

Smith Stress Symptoms Inventory-State (SSSI-S). The Smith Stress Symptoms Inventory-

State version (SSSI-S) is a 34-item 4-point Likert-type scale measuring the degree to which

individuals currently feel a range of frequently reported stress symptoms (see Appendix C;

Piiparinen & Smith, 2003, 2004). Respondents to this questionnaire were asked to indicate the

extent to which a statement described how they felt “right now” along a 4-point Likert scale,

with a 1 indicating “Doesn’t fit me at all” and a 4 indicating “Fits me very well.” The SSSI-S

38

was based on the Smith Stress Symptoms Scale (1990) and the Stress Costs Inventory (Smith,

1993) and was designed to reflect content areas typically measured by cognitive anxiety

inventories. It measures five symptom categories identified through a thorough factor analysis of

stress (Smith, Rausch, & Kettmann, 2004): (a) Worry/Negative Emotion, (b) Attention Deficit,

(c) Striated Muscle Tension, (d) Autonomic Arousal/Anxiety, and (e) Interpersonal

Conflict/Anger. Each of these symptom categories is well established in the stress literature as

reflecting part of naturally-occurring stress responses. The SSSI-S is not a measure of

psychopathology inasmuch as its items and categories were obtained from and tested on

nondiagnosed college students and no clinical samples were used in its development. As a result,

the symptoms assessed by the SSSI-S are to be considered normal mood states, or naturally-

occurring stress symptoms, and not comprehensive enough to suggest a psychopathological

diagnosis. The SSSI-S is written at a junior high school reading level and is easy to administer

with individuals or groups in about 5 to 7 minutes.

Each subscale of the SSSI-S is made up of a sample of questionnaire items, the scores of

which are averaged together to calculate the reported level for that particular symptom’s

subscale. For example, the Striated Muscle Tension subscale is made up of item number 17 (“My

shoulders, neck, or back are tense.”), item number 20 (“My muscles feel tight, tense, or clenched

up.”), item number 23 (“I have backaches”), and item number 32 (“I have headaches.”). Taken

together, these items can offer a good picture of the participant’s current level of muscle tension;

however, this score may be distorted by the incidence of a passing headache or temporary injury.

Similarly, the other symptom subscales are based on items that may be prone to transient

changes. So, overall, the SSSI-S should not be used to serve a diagnostic function. Rather, the

39

scale offers an assessment of the participant’s moment-to-moment incidence of naturally-

occurring stress symptoms to serve as an area requiring further evaluation.

Although Smith created the SSSI-S with a subscale for Depression, I decided to remove

this subscale from the analyses for this study because the two items associated with this subscale

(item number 11, “I feel distressed,” and item number 13, “I am depressed”) were both included

among the items comprising the Worry/Negative Emotion subscale making it somewhat

redundant. Additionally, the Depression items subscale might have been somewhat

underreported by adolescents who might report depressive mood states in a more active language

such as those associated with the Interpersonal Conflict/Anger subscale (e.g., item number 16, “I

feel cynical or hostile,” and item number 35, “I feel irritated or angry,”), as opposed to the

passive language associated with the Depression subscale.

In terms of psychometrics, the SSSI-S has a Cronbach’s alpha coefficient ranging from

0.86 to 0.79 (Smith, 1990, p. 199), suggesting that it has high internal reliability. However, no

studies have yet been performed to evaluate its concurrent validity—that is, its validity as

compared with other similar scales of stress or anxiety. Nevertheless, the results of many studies

have demonstrated that the SSSI-S has substantial construct validity. An instrument’s construct

validity refers to the extent to which it measures all of the unobservable facets of the social

construct that it purports to measure. In the case of the SSSI-S, the scale’s construct validity is

evaluated by its measurement of the six stress symptom categories noted above as a function of

recognized patterns of response to a stressful situation.

An example of the SSSI-S’s construct validity is evident in two complementary studies

performed by Piiparinen and Smith (2003, 2004) who investigated the influence of the terrorist

attacks in New York City on September 11, 2001 (9/11). Archival data of the SSSI-S

40

administered to a sample of Chicago-area college students 5 months prior to 9/11 (n = 320, M

age = 25.7, SD = 8.6) was compared with data gathered 1 to 5 weeks after 9/11 with a similar,

albeit a separate, group of Chicago-area college students (n = 149, M age = 22.0, SD = 6.1). The

two groups did not differ by gender distribution, but the pre-9/11 group was slightly older.

Analyses of variance showed that men and women displayed the same pattern of stress

symptoms.

Multiple analyses of variance, with age included as a covariate, indicated that the post-

9/11 respondents scored higher than pre-9/11 respondents on the attention deficit scale (F[1, 467]

= 7.6, p = 0.006), indicating that college students displayed higher scores on stress-related

attention deficit after the attacks of 9/11 than a comparable group of college students did before

the attacks. The attention deficit scale, as implemented by the SSSI-S, measures cognitive

responses to stress, including memory loss, loss of concentration, feeling disorganized, feeling

confused, and becoming easily distracted. Interestingly, no other significant differences were

found between the two groups in any of the other six categories of stress symptoms. Moderately

strong correlations between attention deficit, autonomic arousal/anxiety (r = .66, p < .0005),

worry (r = .69, p < .0005), and anger (r = .60, p < .0005) and moderate correlations with muscle

tension (r = .45, p < .0005) and depression (r = .57, p < .0005) were found, supporting the

suggestion that the attention deficit measured was related to stress.

In other words, the pattern of these college students’ stress-related attention deficit

resembled the kind of dissociative symptoms and denial that are associated with the initial phases

of posttraumatic stress disorder (Piiparinen & Smith, 2003). As Lazarus and Folkman (1984)

suggested, dissociation and denial serve as ways of distancing oneself from the disruptive and

negative feelings following a traumatic event in response to which nothing concrete can be

41

accomplished. As Piiparinen and Smith (2003) pointed out, this pattern of distancing oneself

from negative affect is consistent with the findings shown in studies of posttraumatic stress

reactions of persons living in terrorized communities. The comparability of these findings

demonstrates the SSSI-S’s adequate construct validity as a stress scale and presents the SSSI-S

as an effective measure of the social construct of stress, including its cognitive, physical, and

emotional ancillaries as delineated by the instrument’s six categorical subscales.

This scale was selected because it is the only available nonpathological self-report

measure that elicits the participant’s moment-to-moment transient state symptoms of stress

across a variant of cognitive, physical, and emotional subscales. Short of using

psychophysiological measures, such as electroencephalograms, electrocardiograms, or galvanic

skin response measures (which can be difficult to employ for the purposes of a brief intervention

in a classroom setting), a state-based self-report questionnaire served as the best and most

feasible method for eliciting individuals’ moment-to-moment awareness of their present states of

mind. Further, all of the other self-report measures of stress I found were either assessments for

clinical pathology, such as the State-Trait Anxiety Inventory, or served as measures of the static

disposition or trait of stress rather than the momentary state of stress, such as the Perceived

Stress Scale. These measures were deemed inappropriate because the intention of the study was

to examine the immediate impact of a brief intervention on participants’ transient stress states in

a nonclinical setting. Although the SSSI-S assesses state of mind, which is, by definition,

transient and subject to low test-retest reliabilities, the SSSI-S serves as a one-of-a-kind self-

report measure inasmuch as it enables the individual to evaluate the individual’s own present

experience of stress in the present moment. This moment-to-moment awareness is critical for the

development of meditative attention (Smith, 2005). As such, a measure like the SSSI-S requires

42

respondents to attend to their current state of mind, thereby enhancing the meditative attention

that is indicative of the present study’s approach to relaxation (Smith, 2001).

For the present study, the Cronbach’s alpha coefficient for internal reliability for the

SSSI-S was calculated for each of the three treatment conditions. The participants of the present

study were all treated to the three treatment conditions in seven separate classes in varying orders

over the course of 4 consecutive days. Cronbach’s alpha for each of the six subscales for the

baseline scores and each of the three treatment conditions range from .56 to .92, meeting the

minimum criterion of .50.

Procedure

Teachers in a Northern California high school were contacted through a mutual associate,

and permission to conduct research in their seven “Focus on Success” study-habits classes was

requested. A written description of the study was provided to introduce the study in greater

depth. Upon receipt of permission to conduct research at the high school, I visited each of the

classes designated for prospective participation in order to introduce myself and the study to the

students and the teachers, to answer any questions that the students or teachers might have had,

as well as to provide information pertinent to the topic of the study and informed consent forms

to all interested persons. The study was introduced by informing potential participants that

research had determined that most people find relaxation exercises to be beneficial and

enjoyable. Although it is understood that such information may have biased participants’

responses and generated placebo effects, such information was given to all participants so that

any placebo effects were distributed uniformly across all treatment conditions and made

irrelevant to the focus of the present study, specifically, the comparative efficacy of the three

treatments, not whether the treatments themselves were effective at reducing reported levels of

43

stress (see Appendix H for a transcript of what was disclosed to participants just prior to each

treatment). Providing such information is considered to be part of the participants’ informed

consent and part of what is likely to occur when introducing similar relaxation exercises in actual

clinical practice. A brief explanation of stress, its causes, and its effects was offered, followed by

a brief description of relaxation, its causes, its effects, and the benefits of reducing stress. Lastly,

a general description of what was entailed in participation in the study was given.

All interested participants were asked to take an informed consent form, sign it, have it

signed by at least one parent, and then return it to a designated collection folder at the school

maintained by a teacher. Prior to distributing the informed consent forms, the forms were

verbally explained to the students in the classes with regard to the nature of the study and what

was required of them if they chose to participate. Additional copies of the informed consent

forms were provided to the teachers to distribute to prospective participants upon request. The

students had 4 weeks to contact the researcher with any questions and to return the signed and

cosigned informed consent forms. The teachers’ assistance was enlisted to remind the students of

the deadline and to distribute additional copies of the informed consent forms should they be

needed.

Once enough qualified participants submitted their informed consent forms, each

student’s name was written on a master list with a three-digit numeric code corresponding to the

random number assigned to each of the pretreatment research packets that were distributed to the

participants at the commencement of the study. This numeric code became the participant’s

identification number throughout the course of the study.

The instructions for both of the pretreatment questionnaires were explained to the

participants by the researcher with the reminder that all of the information provided by them

44

would be kept strictly confidential. The students were asked to answer all of the questions as

honestly and accurately as they could. The students had a total of 10 minutes to complete the

pretreatment research packet. The first questionnaire is the demographic questionnaire that

assesses basic information about the participant such as age, gender, academic performance,

socioeconomic status, preferred methods of relaxation, and electronic media preferences (see

Appendix B). The second questionnaire is the Smith Stress Symptoms Inventory-State version

(SSSI-S; Piiparinen & Smith, 2003, 2004), a 34-item 4-point Likert-type questionnaire designed

to measure the degree to which individuals feel that statements pertaining to stress symptoms fit

how they are feeling right now. The students were instructed to return the completed research

packets to the researcher upon completion. These were then placed in a locked file box and

stored in a secure location to which the researcher had sole access in order to maintain

participants’ confidentiality.

Each of the seven classes received each of the three treatment conditions—LGRP,

AGRP, or VGRP—once per day over the course of four days. The order in which the classes

received the treatments followed a counterbalancing method, also known as the Latin Squares

method, which helped to minimize the threats posed by the order of the treatment methods or

other outside influences that might have impacted the results of the study (e.g., natural disasters

or the death of a classmate), while increasing the statistical significance achieved by a within

groups analysis of the data. (For an illustration of the order in which the seven classes received

the three treatment methods over the course of the 4 days of the study, see Table 2.)

It would have been more convenient for the statistical rigor of the study if all seven

classes had rotated through the schedule uniformly, so that their respective treatment conditions

would not be influenced by the relative time of day over the course of the study; however, not all

45

Table 2

Guided Relaxation Treatment Schedule for All Seven Classes Period Day 1 Day 2 Day 3 Day 4

1 Class 5: Audio Class 4: Video Class 3: Live Class 2: Audio

2 Class 1: Video Class 5: Live Class 4: Audio Class 3: Video

3 Class 2: Live Class 1: Audio Class 5: Video Class 4: Audio

4 Class 3: Audio Class 2: Video Class 1: Live No Treatment

5 Class 6: Audio Class 7: Live Class 7: Audio Class 7: Audio

6 No Treatment Class 6: Video No Treatment Class 6: Audio of the classes rotated through the schedule. As Table 2 shows, periods 5 and 6 (i.e., the afternoon

periods) were split between Class 6 and Class 7. Such realities of the school’s class schedule

made the implementation of a uniform treatment schedule challenging within the school setting.

Preliminary statistical analyses comparing the morning classes and the afternoon classes

showed some significant differences between the two groups, which will be discussed in greater

detail in the following chapter. These differences may be accounted for by the fact that by the

afternoon students may have experienced increased stress as a function of classroom activities or

peer interactions throughout the day. However, these differences might also be accounted for by

reasons other than the time-of-day, including the relatively smaller sizes of the afternoon classes

(n = 11) as compared to the morning classes (n = 45), or bias as a function of class assignment.

A thorough discussion of the details for each of the three treatment conditions is

described in detail below. Upon completion of each treatment, participants were asked to

complete a posttreatment questionnaire, consisting of the SSSI-S and a version of the REES

which includes an open-ended question (see item 20 in Appendix D) to elicit the participants’

46

overall experience of the three treatment conditions. Participants’ written responses to this open-

ended question were treated with the same level of confidentiality as all of the data gathered over

the course of the study. This qualitative data did not receive the in-depth thematic analysis that

might have been warranted for the reason that such an in-depth analysis fell outside the scope of

the present study. Rather, these data were compared with the participants’ demographic

information to see if any demographic correlates emerged in comparison to the participants’

reception of the three methods of treatment. These data were also used to evaluate the possible

direction of future studies based on the participants’ open-ended feedback about their own

unique experiences of the three methods of guided relaxation. Although the need for a reader or a

transcriber for these open-ended answers was not planned, in the event that the need for a reader

or a transcriber arose as a necessity, the confidentiality of participant information was ensured by

the use of a Reader/Transcriber Confidentiality Agreement (see Appendix I).

Upon receipt of the participants’ completed final questionnaires, all participants received

a complimentary copy of a Relaxation Techniques Handout (see Appendix J) detailing various

ways of maintaining a relaxation practice throughout the day. All of the completed

questionnaires were hand-scored by the researcher according to the directions designated by the

assessment manual.

Treatment conditions. The treatment condition of most critical importance to the present

study was the VGRP. The other treatment conditions, AGRP and LGRP, served as comparisons

to evaluate the extent to which the video-delivered guided relaxation influenced the measures

being evaluated, as opposed to the audio or the live guided relaxation. To reiterate for the sake of

clarity, following their completion of the pretreatment assessment, each of the seven classes

received each of the three treatment conditions, once per day over the course of four days.

47

All three treatment conditions began with a memorized pretreatment talk (see Appendix

H), which was recited with a natural intonation to all seven classes. The purpose of this

pretreatment talk was threefold. First, it was intended to account for the placebo effect across all

three conditions, because expectancy effects are intended for most clinical uses of relaxation

programs. Second, it informed participants of their option to close their eyes during the treatment

or to keep them open in a soft, eyes-opened, unfocused gaze, so as to reduce the threat posed by

the likelihood of participants closing their eyes in the AGRP and LGRP, but not the VGRP,

respectively. Lastly, it was to remind participants that they ought to keep their personal thoughts

and feelings about the treatment they receive to themselves until after the study had been

completed on the 4th day. The purpose of this last procedure was to minimize the threats to the

study’s validity posed by participants comparing their reactions with others, thereby biasing or

influencing either their own or other participants’ reactions to the respective treatments.

For the VGRP, the video imagery was made up of a compilation of various scenes from

nature (i.e., ocean waves, trees, breaches, clouds, and a sunset) with each shot lasting roughly 10

seconds; there were brief dissolve edits between the scenes. This imagery is part of a DVD

entitled Mind Body Spirit: Simply Relax (2006) and was used for the purpose of this study with

the express permission from the producer (see Appendix G). The audio component of the DVD

was muted and replaced by a recording of the researcher’s voice, guiding participants through

the relaxation program. This procedure was to minimize the number of variables that might

influence the relative efficacy of each of the three conditions. The researcher recorded a guided

relaxation instruction in a calm intonation (see Appendix E). The guided relaxation lasted the

entire 10-minute duration of the treatment.

48

Detailed instructions for presenting the three treatments are available in Appendix F. All

three presentations followed a similar format. In the case of the VGRP, the video was played on

an available DVD player that was connected to an overhead projector onto a 36-inch screen at

the front of the classroom. The video was played inside the classroom provided by the school.

Participants were asked to clear their desks and to find a comfortable position in their seats such

that they had an unobstructed view of the screen. They were instructed to follow along with the

instructions offered by the guided relaxation program and to pay very close attention to how the

program made them feel. They had the option of closing their eyes if they so chose.

For the AGRP, the audio CD was identical to the audio content used for the VGRP. This

CD was played on an available stereo sound system at a reasonable volume so all participants

could comfortably hear the program clearly and easily. Participants were asked to find a place, to

clear their desks, and to find a comfortable position in their seats such that they were able to

follow along with the instructions provided by the guided relaxation program and to pay very

close attention to how the program made them feel. They had the option of closing their eyes if

they so chose.

For the LGRP, the intervention consisted of the researcher reading aloud the guided

relaxation instructions that had been used in both the VGRP and the AGRP in a calm and

soothing intonation similar to the way it was recorded for the VGRP and the LGRP (see

Appendix E for the transcript). Again, participants in this group were asked to clear their desks

and to find a comfortable position in their seats such that they were able to follow along with the

instructions given in the guided relaxation program and to pay very close attention to how it

made them feel. They had the option of closing their eyes if they so chose.

49

Chapter 4: Results

Treatment of Data

The Informed Consent Forms and the master lists containing the participants’ names and

their respective numeric codes were kept together in a locked file box that was placed in a locked

office to which the researcher had sole access. The completed pretreatment and posttreatment

research packets were also kept in a locked file box that was kept in a secure office space to

which, in maintenance of the participants’ confidentiality, the researcher had sole access. These

steps were taken in order to secure and maintain the participants’ anonymity and confidentiality

to the greatest extent possible and to ensure that the participants’ personal information was used

strictly for the purposes of the present research.

As stated above, in the course of reviewing the gathered data, evidence for invalid data

was suggested in that some of the participants did not seem to respond thoughtfully to the

questionnaires. This was achieved by tabulating all of the participants’ reports on the SSSI-S

over the course of the entire study, including baseline measures and all three conditions. These

scores were summed, showing that some participants had scores that were consistently low,

indicating that the given measures did not, in the verbiage of the scale, “fit [them] at all.”

Because any scientific instrument requires participants’ engagement with it in order for its

measurements to have value, it was necessary to exclude individuals who reported that none of

the items of the scale fit their present experience at baseline or after any of the three treatment

conditions. As such, a minimum cutoff score was used to remove those individuals with very

little or no variability in their scores. Subscale scores were averaged and then summed, with a

score of 7 or below used to remove students from the sample.

50

Data analysis. The data for the remaining 56 participants were scored through the

Statistical Package for the Social Sciences (SPSS) program, and a professional statistician was

consulted to assist the researcher in the scoring and analysis. All statistical analyses for this study

were performed using the SPSS default confidence level of 95%. Initially, descriptive statistics

were run in order to establish the means and standard deviations for the SSSI-S and the REES.

Preliminary analysis of the data using repeated measures analyses of variance for the stress

subscales (not including the baseline scores), and a p value set at .05 revealed no significant

differences between any of the five stress subscales or any of the three reactions subscales.

Further preliminary analyses of this type showed no significant decreases in the scores from the

first administration of the guided relaxation to the second or third. This finding showed that there

were no significant order effects that needed to be taken into account when analyzing the effects

of the three treatment conditions. Final preliminary repeated measures ANOVAs revealed that

there were no significant effects of any of the demographic variables or reports of prior

experience with relaxation techniques on reported levels of stress as they changed over the

course of the three treatments. This finding showed that neither the participants’ prior experience

with relaxation techniques, nor their unique demographic status significantly influenced the

efficacy of any of the three treatment conditions’ amelioration of stress.

Frequencies were run for participants’ reports of their preferred media for relaxation and

preferred media in general, daily exposure to media, and their prior experience with relaxation

techniques. Baseline measures of stress were also entered into a multivariate analysis of variance

(MANOVA) to obtain the means and standard deviations for these variables and were correlated

with each other using Pearson’s two-tailed correlations. Frequencies were also run for

51

participants’ reported levels of Engagement in, Enjoyment of, and Interest in Repeating the

intervention; correlations of these variables with each other were run as well.

Next, analyses were run to examine whether there was a relationship between the method

used to deliver the guided relaxation to adolescents and the amount of stress that they reported

after receiving the treatment. Repeated measures analyses of variance (ANOVAs) or covariance

(ANCOVAs) were run to examine changes that occurred in each dependent variable measuring

stress after the guided relaxation was delivered in the three treatment conditions. With p value set

at .05 and 95% confidence, if a relationship was found between the treatment condition and

reduced stress, then a post hoc test was employed to answer the follow-up question: For each

treatment condition, what is the magnitude of the effect size for the impact of the treatments? For

the present study, a small effect size was considered to fall between 0.1 and 0.3, a medium effect

size between 0.4 and 0.7, and a large effect size between 0.8 and 1.0 (J. Cohen, 1987).

Possible covariates (such as demographic variables, the time of day the treatment was

administered, whether participants had their eyes open or closed, and the level of Engagement,

Enjoyment, and Interest in Repeating the exercise that the participants reported) were also tested

in repeated measures ANCOVAs with p values of .05 to answer the secondary research

questions: “Which additional variables, if any, correlate with the influence of the guided

relaxation programs on reported levels of stress?” and “To what extents do participants’

reactions to the treatment conditions correlate with the reported levels of stress after exposure to

the treatment?” If no additional variables were significantly associated with treatment effects,

only repeated measures ANOVAs were run and the data for those insignificant variables were

not reported.

52

For the qualitative responses, an informal procedure was followed by which participants’

responses were coded into themes, and these results were tallied in an effort to offer a

preliminary report of the overall reactions expressed by the participants in their own words. This

treatment of the qualitative responses is not to be confused with rigorous qualitative analysis,

which subjects the data to a protocol of thematic analysis, a procedure that fell outside the scope

of the present research. Rather, these qualitative findings, as stated in the previous chapter,

served more as guides for the directions of future research than as primary results of the present

study.

Analysis of subjective reports. For the participants’ subjective responses to the open-

ended question at the end of the final implementation of the REES, an informal procedure was

followed to code the participants’ subjective responses to the open-ended question at the end of

the third use of the REES into a series of common themes. These results are intended to serve as

a cumulative summary of the participants’ overall reactions to the exercises as expressed in their

own words. This summary does not constitute the rigors and scope of a formalized qualitative

thematic analysis, however, and should be considered to be preliminary findings in need of

further study. These subjective reports may serve as guides for future research aimed at building

upon or deepening the findings reported by the present study.

Participants’ subjective responses to the open-ended question at the end of the last use of

the REES were transcribed and then coded into common themes to provide a sense of the most

common reactions or responses that participants offered in their own words. These themes were

then tallied in order to determine a range of responses from the least common to the most

common. Because all of the feedback and responses offered by the participants was potentially

useful for the ongoing development and improvement of these exercises, those provided by the

53

participants who had disengaged from the quantitative portion of the assessment and were

thereby dropped from the statistical analyses were included for this qualitative portion of the

study.

Results of the Analyses

In this section, I will report the results of the analyses described in the previous section.

However, before reporting these results, I would like to briefly discuss the statistical notations

that are associated with the ANOVA and are used in this section. The notation M refers to the

mean, or average, scores that were reported by participants of the given sample. For example, the

average stress scores for the Attention Deficit subscale that were calculated for all of the study’s

participants at baseline came out to be 2.24, or M = 2.24. This is to say that, on average, the

participants reported that the items associated with the Attention Deficit subscale “Fits me a

little” on the SSSI-S. These scores have a standard deviation, or SD, of .71, which is to say that

most of the participants’ scores (68% for a normal distribution) were spread within a range of .71

(or from 1.53 to 2.95) from the mean Attention Deficit score at baseline.

In order to approximate the size of the sample or group involved in a particular

experiment, one is subtracted from the number of participants in order to determine the degrees

of freedom, or df, for the particular experimental analysis. In the example above, the total

degrees of freedom for the analyses are 54 (or the number of participants involved in the

analysis, 55, minus 1). This statistic is presented as two separate values which indicate both the

between-groups estimate (which, in this case is 6, or 7 groups minus 1), and the within-groups

estimate (which in this case is 48, or the total number of participants, 55, minus the total number

of groups, 7).

54

Because the scores of this particular test are prone to variance, or distribution around the

mean, a statistical ratio has been devised to determine the overall variability of the scores divided

by the variability that may be due to random error of the scores. This is done by dividing the

mean sums of squares due to between-group differences by the mean sums of squares due to

within-group differences. The resulting value is known as the F statistic, or F ratio, which in the

example provided above can be presented as follows: F(6, 48) = 8.65, p < .0001. This final

notation, p < .0001, indicates that the probability is less than .01% on any one test of the null

hypothesis that the average scores of each group’s Attention Deficit scores was due to random

chance rather than as a result of the intervention. Because the p-value for this experiment was set

at .05, the conclusion is that the research hypothesis (that guided relaxation facilitates the

amelioration of stress) is more likely than the null hypothesis that guided relaxation does not

facilitate the amelioration of stress.

Reports of the participants’ media preferences in general and for relaxation, along with

duration of daily exposure to electronic media, are presented in Table 3. A majority of the

participants selected music as their primary medium for relaxing, followed by videogames and

the internet, then movies, television, and other media. A relatively large portion of respondents

reported using the internet daily, but not as a means of relaxing. Participants reported that music

was the second most preferred medium in general. Many of the participants reported spending

between 3 and 5 hours daily with some form of electronic media, followed by many that reported

using media less than 3 hours a day, and a few that reported using it more than 5 hours per day.

All participants reported spending some time with electronic media on a daily basis. Also

included in this table are the participants’ reports of any previous experience they may have had

with various types of relaxation techniques, such as progressive muscle relaxation, breathing

55

Table 3

Reported Media Preferences and Prior Experience With Relaxation Techniques

For relaxation1 In general1

N % N %

Media preference

Music 33 59% 23 41%

Videogames 12 21% 9 16%

Internet 11 20% 24 43%

Movies 10 18% 6 11%

Television 9 16% 11 20%

Other 9 16% 2 4%

Daily exposure to electronic media

None at all 0 0%

Less than 3 hours 19 34%

Between 3 and 5 hours 24 43%

More than 5 hours 13 23%

Prior experience with relaxation techniques

None at all 31 55%

Less Than 3 months 12 21%

Between 3 and 5 months 7 13% More than 5 months 6 11%

1Respondents could select more than one choice, so percentages exceed 100%.

56

techniques, or meditation. Most of the respondents reported having no prior experience with

relaxation techniques, although some reported having a moderate-to-extensive amount of prior

experience. As reported at the end of the previous chapter, covariate analysis of the participants’

prior experience revealed no significant difference as it pertains to the efficacy of the three

interventions at decreasing the levels of reported stress.

The means and standard deviations from a multivariate analysis of variance (MANOVA),

in which the baseline measures of stress of each of the five subscales (Worry/Negative Emotion,

Attention Deficit, Striated Muscle Tension, Autonomic Arousal/Anxiety, and Interpersonal

Conflict/Anger) were entered as a dependent variable, is presented in Table 4. The table shows

that the means for these items differed significantly from each other, with students reporting that

their present experience was more likely to involve Attention Deficit and Muscle Tension and

less likely to involve Negative Emotions, such as Worry, Anxiety, Depression, and Anger. All

subscale variables correlated with one another from .29 to .77 at p < .05, except for the Attention

Deficit subscale, which did not correlate significantly with the other subscales at all. Additional

correlations showed that media preferences did not correlate significantly with baseline stress

scores with one exception: Participants who reported using movies as their preferred relaxation

medium tended to have high Attention Deficit scores at baseline (r = .36, p < .01).

With respect to the participants’ reactions to the interventions, students tended to report

that they slightly enjoyed the intervention (M = 4.16, SD = .94) and were slightly interested in

repeating it (M = 3.88, SD = .97). They tended to give neutral reports of feeling engaged with the

intervention (M = 3.39, SD = .79). Reports of Engagement, Enjoyment, and Interest in Repeating

the exercise correlated with each other between .78 to .84, p < .0001.

57

Table 4

Descriptive Statistics for Baseline Subscales of Smith Stress Symptoms Inventory-State Subscale M SD df F Attention Deficit 2.24 .71 6, 48 8.65*

Striated Muscle Tension 2.03 .73

Worry/Negative Emotion 1.84 .63

Autonomic Arousal/Anxiety 1.78 .51

Interpersonal Conflict/Anger 1.62 .56 Note. N = 55. *p < .0001. Items coded from 1, “Does not fit me at all,” to 4, “Fits me very well.”

Although participants seemed to show somewhat neutral responses to the treatment,

findings showed that all of the participants did seem to experience some reduced stress as a result

of the treatments. None of the stress scores increased as a result of the treatments. Table 5 shows

the means and standard deviations for the Interpersonal Conflict/Anger and Worry/Negative

Emotion subscales from baseline and across the three treatment conditions. For both subscales,

there was a significant decrease in negative affect after all of the treatment conditions as

compared to the baseline condition. Because the class schedule did not allow for the different

classes to rotate between the morning and the afternoon periods (see Table 2), I measured the

impact that the time of day had on the decreased stress levels reported by the participants. Out of

all five stress symptoms assessed by the SSSI-S, only the Worry/Negative Emotion subscale was

found to be significantly impacted by the time of day, so this covariate was included in the

presentation in Table 5. There was also a significant interaction of condition x time of day.

Participants who underwent the interventions in the afternoon were found to have a higher

Worry/Negative Emotion score at baseline as compared to those who received the interventions

58

in the morning; however, this difference between morning and afternoon baseline scores was

found to be too small to be considered statistically significant (p < .07). For the afternoon group,

the magnitude of the effect for the treatment was greater [η2 = .48] than for the morning group

[η2 = .22]. This finding showed that students tended to be slightly more keyed up in the

afternoon classes; however, because the classes did not rotate between morning and afternoon

periods, the extent to which this difference was a function of the students who made up these

classes as opposed to the time in which they undertook the exercise is unclear.

To reiterate for the sake of clarity, as stated in the instruments section in the previous

chapter, the stress symptoms assessed by the SSSI-S are based on nonclinical, nonpathological

questionnaire items. Therefore, the appearance of certain stress symptoms for a participant’s

score does not fulfill a diagnostic criterion but, rather, a signpost that indicates areas of the

participant’s naturally-occurring stress-states that were affected by the given treatment

conditions. In this case, a significant score suggests that these mood states were significantly

influenced by the treatment conditions rather than being the result of random chance.

Table 6 shows the means and standard deviations for the Autonomic Arousal/Anxiety,

Striated Muscle Tension, and Attention Deficit subscales from baseline and across the three

treatment conditions. For all three measures, there was a significant decrease in negative affect

after all of the treatment conditions as compared to the baseline condition. For these three

subscales, whether or not participants reported having their eyes open or closed was related to

the magnitude of the change in reported stress. Because most participants reported closing their

eyes to some extent at some point during at least one of the relaxation conditions, I measured the

impact that eye closure had on the decreased stress levels reported by the participants. Out of all

59

Table 5

Descriptive Statistics for the Conflict/Anger and Worry/Negative Emotion Subscales of the Smith Stress Symptoms Inventory-State for All Treatment Conditions and Baseline Scores With Time of Day as a Covariate

M (SD)

Subscale Baseline Live Audio Video Source df F η2

Conflict/Anger 1.62a (.56) 1.22b (.29) 1.26b (.31) 1.36b (.56) Condition 3 17.68* .24

Worry/Neg. Emotion 1.84a (.63) 1.36b (.42) 1.41b (.45) 1.42b (.58) Condition 3 22.27* .29

Morning 1.77a (.61) 1.36b (.42) 1.42b (.47) 1.45b (.61) Time of Day (TOD) 1 .06 .00

Afternoon 2.13a (.64) 1.33b (.42) 1.37b (.32) 1.30b (.45) Condition x TOD 3 3.31* .06

___________________________________________________________________________________________________________

Note. N (for analyses) = 56. Means marked a are significantly higher (p < .05) than means marked b. *p < .05.

60

Table 6

Descriptive Statistics for the Muscle Tension, Attention Deficit, and Autonomic Arousal Subscales of the Smith Stress Symptoms Inventory-State for All Treatment Conditions and Baseline Scores With Eye Closure as a Covariate

M (SD)

Live (L) Audio (A) Video (V)

Eyes Open Closed Open Closed Open Closed Source df F η2

Muscle Tension Condition (C) 3 4.04** .08

Baseline 1.97 (.72) 2.45 (.69) 1.98 (.69) 2.31 (.95) 1.92 (.70)bd 2.69ac (.59) C x Eyes (A) 3 .11 .00

Posttest 1.43 (.45) 1.68 (.64) 1.48 (.53) 1.69 (.50) 1.47 (.60)d 1.42c (.73) C x Eyes (V) 3 3.38* .07

C x Eyes (L) 3 .52 .01

Note. N (for all analyses) = 50. Means marked a are significantly higher (p < .05) than means marked b. Change in means marked c are

greater than changes in means marked d. **p < .01 and *p < .05.

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Table 6 (continued)

M (SD)

Live (L) Audio (A) Video (V)

Eyes Open Closed Open Closed Open Closed Source df F η2

Attention Deficit Condition (C) 3 18.18** .28

Baseline 2.21 (.72) 2.43 (.68) 2.20 (.71) d 2.47 c (.76) 2.18 (.75) 2.53 (.52) C x Eyes (A) 3 2.79* .06

Posttest 1.51 (.51) 1.53 (.41) 1.65 (.53)ad 1.31bc (.30) 1.50 (.57) 1.67 (.64) C x Eyes (V) 3 .74 .02

C x Eyes (L) 3 .39 .01

Autonomic Arousal Condition (C) 3 18.61** .29

Baseline 1.73 (.46) 2.00 (.59) 1.74 (.47)d 2.03c (.67) 1.71bd(.48) 2.22ac (.49) C x Eyes (A) 3 3.86* .08

Posttest 1.39 (.32) 1.45 (.51) 1.41 (.34)d 1.42c (.32) 1.41d (.47) 1.57 c (.58) C x Eyes (V) 3 2.80* .06

C x Eyes (L) 3 .24 .01

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five stress symptoms assessed by the SSSI-S, only the Autonomic Arousal/Anxiety and Muscle

Tension subscales were found to be significantly impacted by eye closure, so this covariate was

included in the presentation in Table 6. As this table shows, participants who reported having

their eyes closed during the video condition reported higher levels of Autonomic

Arousal/Anxiety and Muscle Tension at baseline than their counterparts who kept their eyes

open during this condition. As a result, eyes-closed participants showed steeper decreases in

arousal and tension as a result of the intervention.

Participants who closed their eyes during the Audio condition also showed steeper

decreases in Autonomic Arousal than their counterparts who kept their eyes open during this

condition. These participants also had especially low scores for Attention Deficit at posttest, and

their change in scores for Attention Deficit from baseline to posttest was steeper than for their

counterparts who kept their eyes open. Correlations also showed that people who kept their eyes

closed in the Video condition had higher scores of Engagement with the task (r = .25, p < .04),

with the same being true for people who kept their eyes closed during the Live condition (r = .27,

p < .03), but not for the audio condition. Stated more simply, participants who reported closing

their eyes during the relaxation tended to report having less Autonomic Arousal after the Audio

condition than those who preferred to keep their eyes open during the Audio condition. In

addition, participants who closed their eyes during the Video and Live condition tended to report

being more engaged by these conditions than those who kept their eyes open. Because no

significant between-subjects effects for whether or not participants had their eyes open or closed

during any of the three treatment conditions were found for these three stress symptoms, the F

statistic for these particular effects were not presented in Table 6.

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Across all six variables, medium effect sizes for the intervention were found for

Autonomic Arousal/Anxiety (η2 = .44), Attention Deficit (η2 = .37), and Worry/Negative

Emotion (η2 = .35). Small effect sizes were found for Interpersonal Conflict/Anger (η2 = .24)

and for Muscle Tension (η2 = .16). Considering the brevity of the interventions used in this

research, a medium effect size can be considered to suggest a robust effect, worthy of closer

examination. In these findings, the relationship between the interventions and certain symptoms

of stress, such as Autonomic Arousal/Anxiety and Attention Deficit, were stronger than the

relationship between the interventions and the symptoms of Interpersonal Conflict/Anger and

Striated Muscle Tension.

Broken down even further, there was a small effect size found for the effects of the

treatment conditions on the Worry/Negative Emotion subscale for the afternoon classes,

suggesting that the intervention influenced this subscale more strongly in the afternoon than in

the morning. Similarly, small effect sizes were found on the basis of whether participants closed

their eyes during a particular treatment condition on various symptoms of stress. For example, a

small η2 of .08 was found on the Autonomic Arousal/Anxiety subscale for those participants

who closed their eyes during the Audio condition, as compared to an even smaller η2 of .06 for

those who closed their eyes during the Video condition or η2 of .01 for the Live condition. This

finding suggests that the Audio condition was more effective at reducing reports of Autonomic

Arousal/Anxiety than the Video or Live conditions for those participants who reported closing

their eyes to some extent during the treatment. The same was true for the Attention Deficit

subscale, but, in contrast, the Video condition seemed to have more of an impact on the Muscle

Tension subscale than either of the other two conditions combined. A more thorough and

detailed interpretation of these findings will be provided in the following chapter.

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In an effort to present these tabulated findings in a simpler and clearer manner, all of the

results that were found to be statistically significant for the present study have been compiled in

Table 7. This Table shows that all of the stress subscale scores showed significant decreases after

all of the three methods of delivering guided relaxation. In addition, some of the stress subscale

Table 7

Summary of Significant Stress Reductions for All Three Treatment Methods

• Autonomic Arousal/Anxiety x All Treatments**

Eyes closed x Audio Treatment*

Eyes closed x Video Treatment*

• Attention Deficit x All Treatments**

Eyes closed x Audio Treatment*

• Worry/Negative Emotion x All Treatments*

Afternoon x All Treatments*

• Interpersonal Conflict/Anger x All Treatments*

• Striated Muscle Tension x All Treatments**

Eyes closed x Video Treatment*

N = 55, * p < .05, **p < .01

scores dropped significantly on the basis of whether or not participants closed their eyes during a

particular treatment condition (i.e., Autonomic Arousal/Anxiety was reduced for those who

closed their eyes during the Audio or Video conditions, Attention Deficit was reduced for those

who closed their eyes during the Audio condition, and Striated Muscle Tension was reduced for

those who closed their eyes during the Video condition). The Worry/Negative Emotion subscale

was found to show greater decreases for those who participated in the intervention in the

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afternoon rather than in the morning, partly due to the fact that the afternoon classes started

higher on this subscale. Overall, none of the three treatment conditions stood out as being more

or less effective at ameliorating participants’ reports of stress symptoms.

Additional findings. Some additional results were found that bordered on significance that

may require further inquiry to discover the robustness of these findings. Among these findings

were significant correlations between certain baseline levels of stress and certain items reported

on the demographic questionnaires. These findings include a strong positive correlation for

participants who reported using movies as a preferred method for relaxing and the level of

Attention Deficit they reported at baseline (r = .36, p < .01). For participants who reported using

media between 3 and 5 hours per day, baseline levels of Autonomic Arousal/Anxiety were also

significantly higher (r = .35, p < .01). Slightly weaker, but still significant correlations were

found for participants reporting use of electronic media between 3 and 5 hours per day with the

baseline levels of Worry/Negative Emotion (r = .28, p < .05) and Interpersonal Conflict/Anger (r

= .33, p < .05) that they reported. High baseline levels of Interpersonal Conflict/Anger were also

positively correlated with a general preference for music (r = .30, p < .05) but were negatively

correlated with the use of media for more than 5 hours per day (r = -.27, p < .05).

Qualitative findings. A total of 75 of 77 students responded to the subjective open-ended

question at the end of the final implementation of the REES that asked participants to “take as

much space as you need to describe your experience with each of the three exercises and be sure

to state which exercise(s) you enjoy the most and least, and why?” Of these, only 42 participants

reported which of the three delivery methods they liked the most, least, or both. As stated above,

subjective reports for all of the participants who provided answers were included in this

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preliminary qualitative inquiry, including those who had been selected out of the quantitative

analysis for the reason of their apparent disengagement.

Overall, the students offered a positive response to the three exercises as a whole,

although some reported negative or neutral reactions to their involvement in the program. These

qualitative findings have been tallied and presented in Table 8. This table shows that most of the

students reported that the exercises helped them to feel relaxed overall. Some participants

reported feeling distracted during the program, although some stated that the feelings of

distraction may have aided their relaxation. Some participants reported feeling sleepy or sedated

during the program, with one participant reporting that the exercises “helped me understand how

sleep deprived I am.” Just as many participants reported feeling bored or restless during the

exercises. A few more than 10% of the participants reported their enjoyment of the exercise and

a few less than 10% reported feeling calmed or soothed by the exercise. A few participants

reported experiencing “no change” as a result of the exercise, revealing that they were already

calm or without stress prior to their involvement in the study. A few participants reported feeling

more stressed or tensed by the exercises with one participant stating “sitting still” created stress.

A few participants expressed difficulty relaxing, stating that the “voices were too sharp” or

“annoying,” that the “room was too cold,” or that the exercises themselves were “repetitive,”

“tedious,” “irritating,” and “not fun.” Finally, a couple of participants reported feeling focused

and engaged by the exercises, with one noting that discipline helped to “clear her mind.”

Exactly half of the participants who reported having a preference of one delivery method

over another reported enjoying the video method the most, with many making specific comments

about their enjoyment of the nature imagery itself, or just having something to look at during the

program. Fewer than half as many participants reported enjoying the live method the most, with

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Table 8

Summary of Common Themes and Method Preferences From Subjective Reports

Preferred method (N = 42) Theme (N = 75)

Most Least

N % N % N %

Method

Video 21 50% 5 12%

Live 8 19% 6 14%

Audio 7 17% 5 12%

Theme

Relaxation 21 28%

Distraction 12 16%

Sleepiness/Sedation 11 15%

Boredom/Restlessness 11 15%

Enjoyment 8 11%

Calmness 7 9%

No change 6 8%

Stress/Tension 5 7%

Difficulty/Irritation 5 7%

Focus/Engagement 2 3% about as many reporting the audio method as most preferred. In terms of the least

preferred method, almost equal numbers of participants reported enjoying each method

the least, with the live method being the least preferred method overall.

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Anecdotally, a teaching assistant, who was the only other individual besides the

researcher who was in the classroom for all 21 performances of the treatment exercises

(and who had participated actively in many of them), expressed his preference at the

completion of the 4 days of treatment. After sitting through all three methods multiple

times, he stated that the video method seemed to shed too much light into the room and

was too distracting for relaxation. Between the audio method and the live method, he

reported feeling “safer” and more able to “trust” the audio method more than the live

method, due to its predictability and what he described as a sort of acoustic depth that

was lacking in the live version. He had not met me prior to the study and did not know

how well he could trust me during the live method, but felt that he could relax in the trust

he felt with the audio method, despite his knowledge that the voice in the audio method

was mine as well. This subjective report seemed genuine enough to include in this

section, if only to provide information for similar research intended for older participants.

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Chapter 5: Discussion

Summary and Interpretation of Findings

Overall, the research appeared to be successful inasmuch as the results showed that a

brief 10-minute guided relaxation produced statistically significant reductions in self-reported

stress levels for all participants in the study. These findings make a strong argument for the

inclusion of similar exercises in school curricula to aid students’ general composure and well-

being. Some of the findings uncovered by this study are consistent with the existing research that

was outlined in Chapter 2. However, some findings are anomalous. In this section I will present

the major findings of the present study and provide some interpretation for the results in light of

the research already cited or with the help of studies that have not yet been cited. In all cases, I

will offer some interpretations of these results and suggestions for the direction that might be

taken for follow-up research.

The present study found that all three methods of delivering guided relaxation were

equally and significantly effective in the amelioration of all five subscales of stress. These

findings were consistent with the kinds of research cited in Chapter 2, which suggested that

various types of guided relaxation will reduce most kinds of psychological stress (Smith et al.,

1996). However, the fact that there was no increase in any of the stress reports, or any

differences between the three methods in terms of their efficacy in the amelioration of stress

reports, was somewhat surprising and inconsistent with earlier research. For example, previous

studies comparing recorded and live methods of guided relaxation suggested that the recorded

methods were less effective in their reduction of stress than the live methods due to their lack of

contingent feedback with the participants (Paul & Trimble, 1970). Given the datedness of that

research, the present study may have served to update these findings, suggesting that either an

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older mean age of the participants, or a more contemporary population may be more predisposed

to the use of recorded media than those studied in earlier research. The absence of significant

differences between the three methods explored by the present study provides useful information

as to the utility of Media Assistance as an adjunct to more traditional forms of intervention.

The absence of statistically significant differences between the efficacies of the three

methods also suggests that some forms of visual media may not increase stress as has been

previously posited in the literature (Kubey & Csikszentmihályi, 1990; La Ferle et al., 2000; Lang

et al., 2000; Reeves & Thorson, 1986). Although these studies suggest that some of the stress

induced by visual media is due to its graphic or provocative content, many of the studies point to

the basic features of visual media (such as cuts, zooms, pans, and edits) that were present in the

video used for the present study. According to these studies, these basic features of visual media

may be responsible, at least in part, for the stress-inducing functions of the format. To be sure,

the kinds of dissolve transition edits used in the visual media that was explored by the present

study is of a very different type than the kinds of abrupt and rapid-style edits used in the kinds of

media that examined by these studies. However, the findings of this study call for a closer

examination of the potentially positive role visual media may play in the lives of adolescents,

and stand in contrast to an indictment of the medium as a whole.

The results of the present study suggest that the basic features of visual media, alone, are

insufficient to significantly influence participants’ self-reports of stress. Although the lack of

stress-inducing impact of the video condition may have been due to the limited amount of time in

which the participants were exposed to it, follow-up research would be needed to conclusively

confirm this speculation. Indeed, no one method of delivering guided relaxation was found to be

more efficacious in its reduction of stress than any other method explored in the present study.

71

Some significant differences were found between the different subscales of stress that

were measured, however. Participants who underwent the three conditions in the afternoon

periods as compared those who participated in the morning periods had marginally higher (p <

.07) baseline scores for the Worry/Negative Emotion subscale than their counterparts in the

morning periods. However, these scores dropped to equally low levels for both the morning and

afternoon participants at the time of the posttest. Such a finding suggests that students in the

afternoon periods may have been more “keyed up” than their morning counterparts. It remains

unclear whether this difference was a result of the time of day (as, for example, the accumulated

stress associated with mounting academic and social pressures that built up over the course of the

school day), or if it was merely the result of a biased sample in which a predominance of

distressed or worried students were assigned to the afternoon sections of this course as compared

to the morning sections. This finding seems relevant for education, particularly as it pertains to

classroom assignment or the scheduling of certain curriculum during the school schedule. Yet, in

order to determine whether the time of day was in fact responsible for the higher levels of worry

and negative emotion after midday or if it was a function of classroom assignment, a similar

study would need to be run with classes whose schedule changed between morning and

afternoon periods. In the absence of the definitive data that such a study would yield, the impact

that the time of day had on the students’ reports of worry and negative emotion remains partially

in an area of speculation.

Differences between the various subscales were also found to be associated with

participants’ reports of closing their eyes to some extent during one or more of the conditions. In

fact, participants’ level of relaxation appeared to be a function of closing one’s eyes, especially

during the video condition. For those participants who reported closing their eyes to some extent

72

during the video condition, significantly greater decreases on both the Striated Muscle Tension

subscale and on the Autonomic Arousal/Anxiety subscale were found when compared to those

participants who elected to keep their eyes open. Similarly, participants who reported closing

their eyes to some extent during the audio condition reported significantly lower Autonomic

Arousal/Anxiety and Attention Deficit levels after the relaxation than those participants who kept

their eyes open. Such differences could be expected given the research associating closing one’s

eyes with the process of relaxing, as cited in Chapter 2 (Benson, 1977; Craig et al., 2000;

Putman, 2000), but the absence of significant differences on the other three stress symptoms

between those participants who closed their eyes and those participants who did not is not well

understood.

This finding might have been due to the predisposition of participants who reported

closing their eyes. The results of the present study showed that the baseline scores for Muscle

Tension and Autonomic Arousal were significantly higher for those participants who reported

closing their eyes during the Video condition than for those who reported keeping their eyes

open. This finding suggests that individuals with high levels of tension or arousal may be more

predisposed to closing their eyes during all or part of the video condition than those with lower

tension or arousal. Students with high anxiety, arousal, or tension may be seeking a refuge from

the discomfort of muscle tension and anxiety by closing their eyes during the Video condition as

indicated by the fact that closed-eyed stress levels drop to equally low levels as open-eyed stress

levels. It is conceivable that, by closing their eyes, students with high tension or arousal

successfully established the kind of “quiet environment” that Benson (1977) posited as one of the

four underlying elements that should be present to effectively elicit the Relaxation Response

(RR). This interpretation also helps to explain why Attention Deficit levels would dropped

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significantly lower for those students who closed their eyes during the audio condition than those

students who kept their eyes open. These results indicate that, in presenting these types of

exercises, some individuals may feel more comfortable closing their eyes than others, due to the

individual’s own history, comfort, or present level of trust in the presenter. Given that, it may be

noted that individuals who wish to close their eyes during the program may even be encouraged

to follow their inclination to do so, providing that they remain awake, given that the research

suggests that those who close their eyes seem to benefit from doing so across certain subscales of

stress.

Other baseline measures of stress were found to be significantly correlated with

participants’ use of various media. Such correlations are indicative of certain associations

between adolescents’ use of media and stress levels but require further inquiry to suggest a

definitive link. The presence of Attention Deficits at baseline for those individuals who reported

using movies as a preferred method of relaxation (r = .36, p < .01) is one such finding that

warrants follow-up research. This finding may be interpreted along the lines of compensatory

behavior inasmuch as movies elicit the greatest demand on sustained exterior attention than any

of the media choices presented on the demographic questionnaire. In comparison with music,

television, or the internet, movies tend to elicit prolonged attention to external stimuli, which

may help those with attention deficits to establish a relaxed (or homeostatic) state of mind.

Whether one causes or facilitates the other would require follow-up research.

Another correlation warranting follow-up research pertains to the presence of high levels

of Anxiety, Worry, and Anger at baseline for those participants who reported a daily exposure to

electronic media for 3 to 5 hours. Reports of this level of daily media exposure were claimed by

nearly half of the entire population that was studied, suggesting the prevalence of electronic

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media in these adolescents’ lives. Whether the significant correlation of Anxiety (r = .35, p <

.01), Worry (r = .28, p < .05), and Anger (r = .33, p < .05) with 3 to 5 hours of daily media is

indicative of teens seeking escape from stress through various forms of media—as some

researchers (Bickham et al., 2003; Lohaus et al., 2005) have suggested—or the result of

electronic media inducing stress—as other researchers (La Ferle et al., 2000) have suggested—

the association between extended use of media with certain emotional states in teens has been

confirmed by this study and warrants further research. Interestingly, reports of Anger were

significantly lower for those participants reporting daily exposure to electronic media of 5 hours

or more (r = -.27, p < .05), suggesting that extended periods with electronic media is associated

with decreased levels of anger.

Aside from these correlations, no additional demographic variables were associated with

the stress-ameliorating efficacy of any of the guided relaxation methods. In other words, gender,

age, ethnicity, grade point average, socioeconomic status, and media preferences were in no way

significantly related to the efficacy of one guided relaxation condition over any other. This result

is in slight contrast with the Media Practice Model theory (Steele & Brown, 1995), which

suggests that an individual’s sense of identity (that is, the individual’s unique experiences,

motivations, and expectations) may influence the impact that certain media has on that

individual. Whereas this may be the case for certain narrative forms of media as some

researchers have suggested (Brown, 2006; Brown & Walsh-Childers, 2002; Levy & Windahl,

1985; Rubin, 2002; Ward et al., 2002), this theory was not borne out by the data gathered in the

present study, which may have been limited in terms of the content employed in the media used,

limited demographic diversity represented by the sample studied, or the unique sensitivity of the

instrumentation that was employed. The different forms of imagery used in the video, for

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example, or the greater cultural diversity participating in the study, or the more qualitative

measures used for assessment may have each yielded differences within the efficacy of the three

methods explored in this study. Further exploration would be needed along these lines in order to

determine the role a dialectic interaction between various forms of media and its users could

have, especially with regard to Media Assistance methods of treatment as outlined in Chapter 2

(Byrnes, 1996; DeSchriver & Riddick, 1990; Smyth et al., 1999; Wells, 2005).

In terms of the participants’ subjective reactions to the three exercises, it was remarkable

to find such a robust preference for the video method over the other two methods of delivery.

Exactly half of the participants who reported a preference at all reported the video method as

their most preferred method of the three conditions. The audio and live methods split the

remainder almost equally, suggesting that the video method was the most subjectively enjoyable.

Although this finding was not expected, the ubiquity of visual media in the lives of modern

adolescents as discussed in Chapter 1 may help explain a preference for visual media over the

other two methods of delivery. This interpretation is underscored by the fact that the live method

was reported as the least favorite method among those who reported a least preferred method,

albeit by a small amount more than the other two. Whether the participants’ reported preferences

of one method over another was associated with their reports of their daily exposure to media or

preferred form of media is an inquiry warranting further attention. Given the fact that one

participant’s preferred method of delivery may be another participant’s least preferred method, in

addition to the fact that no one method was found to be significantly more effective in its

reduction of stress than any other, presenters of these exercises may be well-served to offer their

participants the choice of which method—if any—the adolescent would like to use once they

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have had the opportunity to experience both the Audio and the Video formats, which tend to be

the more convenient and less expensive formats in comparison to the Live format.

In terms of the participants’ more descriptive reactions, there seemed to be a majority of

students reporting feeling relaxed by the exercises overall. This may have been due to the

demand characteristics of participants reporting what they believe the researcher wants or

expects to receive. The same may be said for those participants who reported enjoying the

exercises, or feeling “calm[ed]” or “soothe[d]” by them. To the as-yet-unknown extent that these

reports were authentic, participants were positively impacted by their involvement in this study,

supporting its continued use with students in the classroom setting.

Yet, the participants’ reports of less positive reactions warrant discussion, as such

reactions may be associated with individuals’ stress levels or other forms of well-being. For

example, participants’ reports of feeling sleepy or sedated may be attributable to the relative

novelty of these types of exercises with regard to the participants’ overall lack of prior

experience (as indicated in the demographic questionnaires). An exercise whose purpose is

relaxation that is not sleep, may evoke a certain amount of dissonance for those participants with

little or no prior experience relaxing. The familiar subjective interpretation of such dissonance

may be in terms of sleepiness, which is an appropriate reaction to relaxation if someone is

unfamiliar with its practice. Similarly, participants who reported feeling bored or restless during

the conditions may have also been unaccustomed to involvement with exercises whose chief aim

is not to impart information or some overt behavior, but rather whose purpose is aimed at

becoming more reposed and restful. The process of relaxation, for students whose entire day may

be filled with demands on their external attention, may seem rather “boring” or “tedious.”

Follow-up research would be valuable along the lines of the extent to which previous exposure to

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relaxation techniques correlates with subjective reports of sleepiness, boredom, or restlessness as

a result of the exercise. Similarly, students may be filling their days with activities to distract

themselves, in part, from the discomfort associated with the stress they are carrying. Practicing

relaxation could, in effect, allow the stress to become apparent, which the student experiences as

“boredom,” “irritation,” “annoyance,” and other negative feelings.

For those participants who subjectively reported “no change” in their stress levels after

the exercises, distinctions at baseline were not apparent between them and the rest of the sample.

Similarly, those participants who reported feeling “annoy[ed]” or “irritate[d]” by the exercises

were not significantly higher on the Anger subscale than the rest of the sample at baseline.

Unfortunately, such comparisons were not entirely reliable due to the small sample sizes among

the groups that constituted the themes elicited by the qualitative analysis. Yet, in the absence of

statistical comparison, such negative reactions might be interpreted in a number of ways. One

interpretation may be that participants’ negative reactions to the exercise might have been due to

a feeling of dislike or distrust of the researcher. If, for example, the exercise was taught and

employed by a student peer, a familiar teacher, or a professional trainer, the students’ reactions

may have been more positive. Another interpretation may be that these participants were deterred

by the specific content of the exercise and that different content, such as one that employed

music or directions for yogic stretching, might have been more conducive to these participants’

overall enjoyment. Yet another interpretation may be that the participants were positively

impacted by their involvement in the exercise, that they felt genuinely relaxed by it, and that

these participants felt disarmed or disoriented by such an impact and therefore reacted with

feelings of negativity. Further exploration along these lines, with larger sample sizes, would be

warranted and valuable for the exploration of such connections.

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With regard to the portion of the population who had apparently disengaged from

participation in the study as evidenced by their minimal reports of stress on the SSSI-S, it would

be worth exploring the extent to which these students differed from their more engaged

counterparts, aside from the demographic distinctions noted in Chapter 4. It may be interesting to

examine, for example, how participants who failed to engage with in-class activities such as the

one employed in the present study compare with those that did engage in terms of the

psychosocial development. That is, do the disengage participants predominate within any one of

Marcia’s four identity statuses, as outlined in Chapter 2? Do they tend to present a more diffused

or foreclosed identity than those who are more engaged? Do the engaged participants tend to

present a more achieved identity than those who have disengaged? If such a distinction could be

established, students’ participation (or lack thereof) in relaxation exercises such as the ones

presented by this study might not only serve as a useful means of teaching and practicing a

stress-reduction technique, but might also help the assessment of the students’ level of

development, which, in turn might facilitate a more individualized and tailored approach.

Moreover, the fact that there was a subgroup of students who had seemed to disengage

from the exercises raises the issue of some students’ capacity to self-determine their needs and to

self-regulate their personal level of involvement in such programs. According to the self-report

measures of stress, some students did not appear to find any personal relevance of the exercise

for them in their relaxation, indicating a sort of self-regulated disengagement from the program.

From this, I interpret that making an exercise such as this one a requirement for all students

would be contraindicated, given that it would, at best, produce little or no benefit or, at worst, an

increase rather than a reduction in stress levels due to the student’s resistance. These findings

suggest that students may have the ability to determine for themselves what they need. As such,

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they may be given the option as to whether or not they wish to participate. Overall, students

seem to know whether or not they needed or would benefit from engaging in a relaxation

exercise, whether or not they would benefit from keeping their eyes opened or closed, and which

medium they subjectively enjoyed the most. As a result, future indications of relaxation exercises

such as these would be well-served to offer participants options across each of these dimensions.

Limitations and Delimitations

The shape and scope of the present research posed many limitations and delimitations on

the utility of its results. This section will discuss this study’s many limitations and delimitations,

some of the ways I attempted to curb their influence on the results, and suggestions as to how

such limitations might be addressed in future research. The first limitation in this study is that it

is primarily an exploratory study that aimed to explore the role of electronic media in the

treatment of stress with adolescents as well as the role of relaxation in the classroom

environment. Given the current dearth of research on these topics, particularly as they pertain to

adolescents, this study aimed to explore this population in terms of its relationship with

electronic media and relaxation techniques in the service of stress reduction. As mentioned in

Chapter 2, Media Assistance is a generally emergent area of research and has yet to be

thoroughly defined or researched.

One significant limitation is that the population sampled by this study is representative

only of self-selected Northern California high school students in the “Focus on Success”

program and thus posed a threat to the study’s external validity. The study’s results are not

generalizable to the wider population of adolescents because the sample was localized and

participants’ involvement was voluntary. It is hoped that the findings, however ungeneralizable,

might still provide a preliminary indication as to whether segments of the adolescent population

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are influenced by different ways of delivering guided relaxation. Larger, school-wide

participation in future studies would yield far more generalizeable results in terms of the

usefulness of Media Assisted guided relaxation programs in the classroom.

Another limitation of the present study has to do with the fact that the first day of the

data-collection portion of this study took place on a historical day. The classes’ routine was

modified slightly so that students were allowed to view the inauguration of a new President of

the United States of America. The extent to which any excitement about such an event could

have influenced the stress-ameliorating impact of a guided relaxation program is unclear, but the

fact of this event coinciding with the implementation of a relaxation program should not be

overlooked as a potential limitation of the study’s results, keeping in mind that all of the students

viewed this historic event at the same time, thereby presumably influencing all of the participants

uniformly.

In terms of the interventions themselves, the quality of the equipment being used did not

generate the most immersive experience to participants and might therefore have limited the

robustness of its effects. For the AGRP, a medium-sized stereo system was used to play the

recorded program on CD at a medium volume. This same stereo was used to provide the audio

component for the VGRP while the video of nature imagery was played on DVD and projected

onto a 36-inch screen at the front of the classroom. It should be noted that the projected image

occasionally flickered during the treatment condition, which may or may not have influenced the

amount of relaxation (or concomitant stress) that was achieved. A careful record of which trials

of the video-guided program might have been impacted by the flickering image was not

recorded. Such occurrences have implications for future research studies that explore this method

of delivering guided relaxation. A research assistant might be employed to monitor and record

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such instances to explore whether or not they influence the efficacy of the program or

intervention. However, it may be noted that, although the equipment used for this condition was

prone to some dysfunction, this limitation did not seem to interfere with the significant benefits

that many students managed to glean from its employment. In fact, most students still expressed

an overall preference for this condition over the other two.

Whereas a high quality video image might have positively influenced the impact of the

visual imagery being depicted, such equipment was outside the financial and logistical scope of

the present study and would not be entirely representative of the ways in which VGRP would be

most readily implemented as an adjunct to clinical treatment (Persky & Blascovich, 2007).

Similarly, whereas multiple speakers surrounding the listener would be more likely to generate a

more immersive and therefore robust and significant effect, such equipment is not yet a feasible

expectation for how Media Assistance may be implemented, although it is hoped that, with

further research, such equipment might be explored for its potential viability for Media

Assistance. Again, as the benefits reported by the participants in spite of the slight technical

difficulties with the equipment seemed to indicate, such perfectly functional equipment does not

seem to be necessary to evoke a positive effect.

Another threat to this study’s internal validity was due to the potential for contamination

that might have occurred between the seven treatment groups. It is possible that the participants

in the seven groups could have discussed their experiences with one another during the interim

periods between the treatment conditions, thereby influencing the responsiveness or expectations

of the participants during subsequent meetings. Moreover, nonclinical group exposures to the

three treatment conditions created the likelihood of individuals’ responsiveness to the treatments

regressing towards the overall mean for the seven groups. Given the traditional high school

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setting, with students intermingling throughout the day, the potential for contamination as a

threat to the study’s internal validity cannot be entirely controlled. However, I aimed to minimize

this threat of contamination by encouraging the participants to keep their thoughts and feelings

about the treatments to themselves until after their participation had been completed (see

Appendix H). Moreover, it is believed that, for the influence of the treatment conditions to be

viable, their effects would need to maintain a magnitude that outweighed any possible influence

that such contamination between the groups might have had.

Another limitation that posed a threat to the present study’s external validity was that the

use of questionnaires to quantify the symptoms of stress could be somewhat superficial in terms

of eliciting more meaningful or in-depth information about the experience or the phenomenon of

stress. Although questionnaires can be helpful in the collection of large amounts of information

on specific conditions, some of the more meaningful or compelling nuances and intricacies of

those conditions are not adequately captured by the statistical analysis of pencil-and-paper

surveys. However, objective assessment aside, the subjective self-report measures serve as

perhaps the greatest determinants of whether or not participants are likely to continue with a

given exercise (as the strong correlations of the three subscales of the REES between Enjoyment,

Engagement, and Interest in Repeating seemed to indicate). Thus, if a person is to benefit from

an activity, the person will need to practice in an ongoing manner. Ongoing practice, according

to this correlational finding, is best sustained if the activity is subjectively experienced as

positive and beneficial, as seemed the case for many of the participants in the present study.

In addition, the self-report measures of stress might have been prone to a certain amount

of floor effects whereby the participants’ reports hovered proximal to the lowest possible value,

failing to adequately depict the variable extent of stress states the participants were experiencing

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at the moment of reporting. Even after selecting out a sizeable portion of the population whose

reporting variability ranged minimally if at all, the majority of the remaining participants’ mean

scores ranged between 1 (“doesn’t fit me at all”) and 2 (“fits me a little”), with only a few

exceptions. Expanding the levels of possible responses from 4 to 6 might help to limit the impact

such floor effects might have had on the reliability of the data analyzed by the present study.

Furthermore, reverse-coding some of the items (that is, phrasing an item in terms of its opposite)

might also help to limit the students’ tendencies to respond to the questionnaire by rote, as

opposed to a more thoughtful report of their self-assessment.

In addition, all of the participants’ measures were self-reported. Although self-assessment

can be a way to solicit information about certain psychological experiences or conditions, they

may be subject to some degree of participant biases. Participant bias occurs when research

participants make an intentional effort to influence the outcome of their responses. Such bias

may be magnified among an adolescent population whose tendency may be to respond in ways

that suggest “normalcy” as opposed to accuracy or honesty. Because many of the questions on

the SSSI-S (see Appendix C) and the REES (see Appendix D) can be seen by the participants as

having a “correct”—that is, more socially desirable—answer, it is difficult to discern the degree

to which participants selected answers that best represented their feelings as opposed to those

that portrayed them in a more positive (or negative) way. Therefore, another threat to the present

study’s external validity and a limitation in its design is that the measures did not necessarily

evaluate the presence or absence of stress directly but, rather, the participants’ tendencies to

respond to the questionnaires as such; thus, their responses may have been biased.

Because a certain amount of inaccuracy is expected in the use of self-report measures that

are not automatically responsive, self-report measures such as the specific instruments used in

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this study were designed to overcome the potential for bias by including multiple statements

referencing a single category or state (Piiparinen & Smith, 2003, 2004). It may be added that the

SSSI-S is a measure of a state of mind that is, by definition, transient and subject to change

(Smith, 2005). As a result, the timing in which the measure is administered might have

influenced the data that were produced. It is important, for example, that these measures evaluate

the participants’ stress as a function of the particular treatment condition and not as a function of

the instrument itself. In an attempt to minimize this threat, the SSSI-S was administered

immediately upon completion of the treatment, and was then followed by the REES. Also, the

same instruments were used in all of the treatment conditions so that any effects measured by the

instruments themselves remained uniform.

However, modifications to the self-report instruments could not control for those students

who appeared to resist participation in the study altogether. As reported above, a total of 21 of

the 77 participants appeared to disengage from the study and were thus eliminated from the

sample pool prior to the primary analysis of the data. Preliminary results confirmed that this

disengaged segment of the sample were more likely to be males who reported a low grade point

average. Although the specific reasons for this segment’s disengagement remain unclear, it may

be speculated that their disengagement might have been related to their perception of the study as

being a formal “class assignment” and therefore subject to the poor academic performance that

they reported to exhibit throughout their academic career. It is possible that the students,

primarily males, who tended to disengage from the study may be opposed to participation in

sedentary activities in general—hence the poor grades on assignments which tend to reward

mental over physical performance—and relaxation exercises specifically. Academic incentives

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such as extra credit may have paradoxically deterred some participants who are generally

opposed to academic rewards for curricular performance.

Their disengagement might also have been related to their perception of the researcher as

a teacher, rather than as a peer, who would be grading their performance as a teacher would

examine a classroom assignment. In this manner, the level of disengagement might have been

due to the study’s methodology rather than the result of the students’ lack of stress at the outset

of the study and throughout the duration of the interventions. This segment’s lack of candor on

the given assessments might have been related to an overall resistance to perceived authorities—

as the researcher may have appeared to them—although this speculation could not be confirmed

without additional research or examination. Whatever the reasons for this segment’s minimal

participation in the study, the efficacy of the given treatments with this group remains unknown,

as the lack of valid data neither confirms nor rejects the given treatments’ effectiveness Had I

more time, charisma, or resources available to connect with all of the students more closely or

had the classes been more accustomed to my presence in the classroom with them over time, the

number of resistant or disengaged participants might have been reduced or eliminated. In

addition, had the treatments themselves been presented by someone other than myself, either a

teacher with whom the students had come to form a relationship or perhaps even another peer,

the number of resistant or disengaged students might have been reduced or eliminated. These

issues raised by the unexpectedly high number of disengaged students might offer some

suggested guidelines for future studies along these lines, which might help to implement

alternate settings to control for such a problem or alternate measures to aid in capturing its

effects.

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Participants whose responses to both the baseline measures and to the three repeated

measures of SSSI-S reflected the overall sense that the scale did not apply to them at all were

removed from the data sample prior to analysis. Although it is possible that these students were

extremely relaxed from the outset, it is unlikely that no statement on the SSSI-S seemed to fit

their present experience at any time throughout the three employments of the instrument. As

such, these participants’ scores were removed because it is believed that this data would have

skewed the data in such a way that suggested that the treatment conditions were having little or

no effect when, in fact, they were having an effect which was going under-reported. With this in

mind, it was determined that, due to the appearance that the instrumentation was inadequate to

capture the students’ experience of stress, whatever effects that the treatments might have been

having among these 21 participants, the self-report instruments that were being used to assess

such effects were inadequate tools of measurement for this portion of the sample. Follow-up

studies with more adequate measures of stress would be needed to further confirm the efficacy of

these types of interventions for this portion of the population. However, at the same time these

self-report measures proved invaluable for picking up this subset of the population that

disengaged from the study in a similar manner as the false-positive or false negative scales

embedded within the Minnesota Multiphasic Personality Inventory (MMPI) would do.

One variable has been identified as having a likelihood of confounding the results of the

present study and limiting the conclusions that may be drawn from it. The variable of individuals

tending to close their eyes during the AGRP and the LGRP, but not during the VGRP, might

have potentially influenced the extent of relaxation and, by extension, stress reduction that was

achieved and reported. Such a discrepancy between eyes-open and eyes-closed relaxation

techniques has been borne out by several recent studies that have shown how closing one’s eyes

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can increase the appearance of the alpha brainwaves (8-12 cycles per second) associated with

relaxation in the place of beta brainwaves (13-25 cycles per second) associated with the state of

being awake and alert (Craig et al., 2000; Putman, 2000).

Another limitation has to do with the limited time constraints of the participants’

availability at the high school. Whereas some research has shown that multiple 30-minute

sessions practicing relaxation techniques are sometimes necessary in order for the participant to

become proficient enough to demonstrate the technique’s specific effects (Smith et al., 1996),

participants in this study practiced the technique for a total of only three 10-minute sessions. This

restriction limits the potential efficacy of the treatment and of the effects reported in this study to

differences that could become more robust given a more prolonged exposure to and practice with

the various treatment conditions being explored. If the students had more time with me and with

the techniques, they might have felt more comfortable and been better able to follow along with

the guided relaxation instructions. Having a mere 10 to 15 minutes per class to complete the

exercise and to fill out the questionnaires may have created a feeling of being rushed that

counteracts the establishment of deep levels of relaxation. An attempt to overcome this limitation

was made in the increased sensitivity of the statistical methods used to analyze the data gathered

during the course of the interventions. Moreover, given that the results of the present study

indicated the general utility of the three relaxation methods, a more extended exposure to the

treatment conditions should be considered for follow-up studies.

Similarly, the fact that the conditions themselves were only practiced for a total of three

times for each class served as a limitation on the potential impact that these exercises could have

had on the students’ levels of stress. Although it is possible that some of the effects of the

exercise were due to its relative novelty for the participants—a novelty that would quickly

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diminish over prolonged use of the exercise—it is also possible that the exercise could have had

more robust and long-lasting effects, serving not only to reduce the participants’ moment-to-

moment stress states, but also to enhance some of the additional benefits associated with guided

relaxation that were discussed in Chapter 2 (Deckro et al., 2002; Scheufele, 2000). It is

encouraging to note that teachers with limited time and resources can still feel justified in

presenting a brief relaxation exercise a few times with imperfect equipment, as even the brief

exercises with imperfect equipment did seem to evoke beneficial effect.

Along these lines, another limitation had to do with the limited knowledge that I had of

the living, social, and school environments to which the students were accustomed. As noted in

Chapter 2, stress tends to be a combination of normal adolescent development (Hutchinson et al.,

2006; Kraag et al., 2006; Washburn-Ormachea et al., 2004), the presence of certain situations

over which individuals perceive themselves to have little or no control (Frydenberg & Lewis,

2004; Hurrelmann & Raithel, 2005; Hutchinson et al., 2006), and the challenges posed by

traumatic life events, such as accidents, illnesses, or divorces (Nastasi et al., 2007). The limited

familiarity that I had with the relative presence or absence of these contributing factors in the

lives of my participants might have limited my ability to connect with the students during the

exercises and to understand them during my analysis and interpretation of the results. This is

particularly the case for the portion of the students who had disengaged from the study, as well

as for those students who presented greater anxiety during the afternoon classes. The ability to

spend more time in getting to know the students and their unique living, social, and school

environments might increase the depth that might be gleaned from this research.

In addition, because almost every element of this study was considered to be innocuous if

not intentionally beneficial, it is impossible to anticipate or know how all of the participants

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might have interpreted, responded, or reacted to every aspect of their involvement in this study.

Although relaxation techniques tend to be beneficial for most people, a paradoxical relaxation-

induced anxiety reaction remains a distinct possibility (Smith et al., 1996) as evidenced by some

of the students more negative subjective responses (e.g., irritation or tension). As a result, I took

all of the known precautions, including providing my contact information to the all of the

participants, should concerns arise or a list of clinical referrals for counseling services be

requested. Although no such contact or requests were made during the course of the study, it

remains unclear whether the informed consent forms, which delineated to all the participants

their right to deny their consent or to discontinue their participation in the study at any time

during the research process and for any reason without discrimination, served as an adequate

informant to the participants’ liberties throughout the study. Although such relaxation-induced

anxiety was not evidenced by the quantitative measures of stress provided by the SSSI-S, this

response did seem to appear in the participants’ more negative subjective responses, such as

feeling irritated or tensed by the exercises.

Several possible demand characteristics in this study may have influenced its results and

thus represented another limitation. One demand characteristic was that the participants received

the intervention and were given the surveys in a classroom setting. As a result, the participants’

experiences of the interventions and their responses on the questionnaires might have both been

influenced by their presence in this particular environment, treating the interventions as an

academic, rather than therapeutic, activity and treating the questionnaires as an academic, rather

than psychological, assessment. This might have limited the therapeutic potential of the

treatments and the reflective candor elicited by the questionnaires. As such, the extent to which

the context and setting of the treatments influenced their respective impact as compared to, for

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example, if the study had been performed during a study hall, or after school, or outside of the

school setting altogether remains unclear. Furthermore, some students may have completed the

questionnaires according to their willingness to go along with what they perceived to be the

researcher’s expectations of them, as opposed to being an authentic response to the given

exercise. Such a demand characteristic might have been further exacerbated by the teachers’

routine provision of in-class participation credit after each employment of a daily exercise, of

which this study was a part. Another demand characteristic pertains to the sort of motivations

with which the participants entered the study. These may have ranged from being influenced by

the presence of their peers, their desire to receive approval from their teacher, escape class work

or to get class credit, or their curiosity about being involved in a psychological study.

In terms of experimenter bias, my involvement in the study has undoubtedly impacted the

effects found in the research, although the exact impact of my involvement remains unclear. For

example, the fact that I recorded and performed the guided relaxation programs for all three

treatment conditions might have influenced some participants to respond to me as a certain type

of person, rather than to the treatment condition itself. Suffice it to say that the extent to which

the participants’ reactions to the treatments would have been different had I been older or

younger than I am, an employee of the school or a classmate, a woman of a different ethnicity or

background, and so on remains unknown. The fact that it was clear to the participants that I was

both serving in the role of the researcher of the study as well as being the provider of the various

treatment conditions could have influenced the demand characteristics of the study in one

direction or the other. Again, this bias was held by the researcher throughout the study for all of

the participants and so whatever influence this bias may have had would have been uniform

across all participants.

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In addition, as the researcher I firmly believe that stress in adolescence is an important

area of research and that guided relaxation tends to be a viable means of managing it. Although I

remained mindful of this bias during the distribution of the consent forms and research packets

during the interventions themselves and during the analysis and interpretation of the data, it is

certainly difficult to omit this bias completely given my own positive experiences with the

processes that were presented. Although the lack of available resources made it impossible to

double-blind this study, I did enlist unbiased assistance during the scoring of the instruments and

the analysis of the data, even though objective and statistical measures were selected specifically

in order to curb the potential for interpretative bias and increase the validity of the results

produced.

Directions for Future Research

The present study offers many fruitful directions for follow-up studies and future

research. It is quite heartening to find that such a brief intervention, lasting only 10-minutes in

duration, which is economical in terms of its required time, equipment needs, and overall effort,

produces significant drops in self-reported levels of psychological stress. As such, follow-up

studies along these lines would be warranted and encouraged. Among these include research that

explores some of the educational and clinical implications posed by the present results. The fact

that none of the methods, be it audio, video, or live, was found to be more effective in its

amelioration of stress reports than any other provides encouraging support to the use of audio- or

video-recorded relaxation exercises in the absence of a live trainer. In fact, the live method

appeared to be the least preferred method among the participants studied here, suggesting that

the cheaper, more convenient methods of audio- or video-guided relaxation programs are just as

effective and also more preferable. As such, audio CDs or video DVDs might be made available

92

to adolescent clients or to students as a means of learning, practicing, or supplementing a stress-

reduction protocol. Such easily accessible exercises might help to facilitate classroom

management or other clinical interventions that are otherwise difficult to achieve when needed.

The exploration of these exercises in the classroom or clinical setting could yield invaluable data

with regard to its usefulness for students’ academic performance or in terms of its utility for

clients’ psychological or emotional wellbeing. Such follow-up inquiries seem warranted by the

results gleaned by the present study.

As noted in the previous section, a closer examination of the role that time of day had on

participants’ baseline measures of stress would provide useful information in terms of how to

schedule these types of exercises during the school day. In addition, a more controlled

examination of the role that eye closure had on the impact of the exercises may be useful in

terms of understanding how it may directly impact one subscale over another. The fact that such

findings emerged during the analysis of the data suggests that research on this factor, as a central

focus of future studies, is warranted by the results found here.

Another avenue for future research could entail its implementation by a teacher or

someone with whom the students have established an existing relationship. This may help to

reduce some of the bias that could have been generated by the demand characteristics of the

study inasmuch as the students are able to honestly present their current level of stress, rather

than compose their responses to a particular expectation.

Additional replication of the present study would be needed to address some of the

subtler findings noted above. For example, the use of more rigorous psychophysiological

measures (such as EEG, EKG, GSR, and others) could serve to illustrate, in a more finely-tuned

manner, the neurological, psychological, and physiological impact that guided relaxation can

93

have on adolescents. Short of the enormous resources needed to implement instrumentation of

that type with a large population, the present study might be replicated with the use of a stress

scale that limited the potential for floor effects and that reverse coded some of the items to

discourage disengagement. In this way, a more finely-tuned picture of the stress levels reported

by the participant could emerge.

Furthermore, it would be worth offering a program like this one over the course of

several weeks, perhaps providing students with the freedom to choose among the three

conditions, to explore the extent to which the stress-ameliorating effects of the exercises persist

over time and to examine if significant distinctions between the effects of the three conditions

emerge over the course of time. It is possible that one condition is more conducive to repeated

practice than another, but further research would be needed to elaborate upon this speculation.

Such follow-up research or longitudinal replication would also help to elucidate the extent to

which the effects of these types of interventions tend to last and how quickly such effects tend to

diminish.

Another way to follow-up on the present study would be to replicate it with the use of

different measures, aimed to explore the psychosocial impact that such exercises might have with

this population. As noted above, a better sense of the psychological distinctions that existed

between those participants who seemingly disengaged from the study and those who did not

would be most useful in terms of guiding the focus of future interventions of this kind. For

example, such follow-up research may help in the determination of the extent to which those

who seemed to disengage from the program are action-oriented or generally opposed to

sedentary activities. Equipped with such information, it might be possible to tailor these

94

exercises in such a way that no participants disengage. However, without such research, a certain

amount of disengagement from the study might need to be expected.

Future studies may recruit larger samples so as to increase the likelihood of a wider

demographic diversity and add statistical significance to those correlative findings linking certain

baseline stress scores, for example, with media preferences or demographic differences. Such

information might help to guide educational or clinical interventions aimed at addressing the

impact of a given type of media or at targeting particular portions of the adolescent population.

This type of information might also guide further iterations of Media Assisted forms of

clinical treatment that might be used to address specific psychological or emotional conditions or

certain deficits associated with a particular group. In this manner, Media Assisted forms of

treatment might be designed to exploit the Media Practice Model directly, by uncovering what

unique experiences, motivations, or expectations played into the clinical efficacy of a particular

form of media (Steele & Brown, 1995).

Lastly, the present study serves as a touchstone for studies aimed at introducing

transpersonal techniques, such as yoga, mindfulness, and group meditation, into the school

curriculum. With the prevalence of stress in the lives of contemporary adolescents, the need to

implement exercises like those explored in the present research continues to increase. Future

research exploring the benefits of relaxation in the school setting may serve as precursors for

transpersonally oriented practices. While the initial steps may be small and tentative at first, the

hope is that, with the accumulation of studies examining the benefits of relaxation among

teenagers, there will be a wider acceptance of such practices and a deeper appreciation for the

benefits of living with moderated levels of stress.

95

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Appendix A: Informed Consent

To the Research Participant and the Parents or Guardians of Research Participants: You have been invited to participate in a study to explore the effects of guided relaxation. For this study, you will meet for a total of three separate 15-minute sessions at the high school. During each of these meetings, you will be asked to fill out a brief questionnaire about who you are and how much stress you are under. You will then receive a brief 10-minute guided relaxation exercise. The school administration and your teachers have all been notified of this study and are in support of your participation given your and your parent’s consent. The school has made accommodations with regard to scheduling and class assignments.

For the preservation of privacy, all information provided by you will be kept completely confidential as to its source and identity. To this end, you will be given a confidential numeric code so as to protect your identity. The master list of names and corresponding numeric codes will be kept in a locked file box. The completed questionnaires will be kept in a separate locked file box. These locked file boxes will only be accessed by the researcher and will be kept in the researcher’s secure office. In the event that any information is used in published material, please know that information that may identify you will be altered so as to ensure all parties’ complete anonymity. Guided relaxation has been repeatedly shown to be generally pleasant and beneficial for most people who make use of it. The program used in this study has served as an effective way of regulating and managing most minor forms of stress, such as the kind that arises from academic or performance-related issues or from minor conflicts with family or friends. It has also been demonstrated to be an effective way of managing the discomfort associated with tension and pain. Although few studies of this program have been performed with teenagers to date, existing research suggests that those children who choose to participate in this study and who continue its practice upon its completion will receive many of the same benefits with which it has been associated. Overall, the program is generally pleasant and provides a valuable skill that, with repeated use, can offer you many lasting and positive benefits. While I have expressly designed this study to minimize any potential risks that may arise from this program, all of the many possible reactions can not be fully addressed. For example, some individuals may be sensitive to test-taking, so the completion of any pencil-and-paper questionnaire in a classroom-type setting may potentially evoke some feelings of uneasiness. Be advised that the completion of this questionnaire will not influence your academic grades. Secondly, in some rare instances, participants in a guided relaxation program may experience feelings of stress or discomfort rather than the expected feelings of well-being. Please be assured that, as the researcher of this study with specialized clinical training with teens, I will be in the room with you at all times during the program and if, at any point, I observe any distress or discomfort, I pledge to call a halt to the session immediately and take all of the appropriate steps to ensure all participant’s well-being. If, in the rare instance, any aspect of this program is deemed to be too upsetting to you during or following your involvement, referrals for counseling are available for ongoing support.

If, at any time, you have any questions or concerns, I will make every effort to discuss them with you and inform you of the options available to you for resolving your concerns. You are encouraged call me collect at (xxx) xxx-xxxx, or my Dissertation Chairperson, Patricia Campbell, PsyD., at (xxx) xxx-xxxx, or the head of the Ethics Committee at the Institute for

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Transpersonal Psychology, Frederic Luskin, Ph.D., at (xxx) xxx-xxxx, ext. xxx. If you decide to participate in this research, you may withdraw your consent and discontinue participation at any time during the conduct of this study and for any reason without penalty or prejudice. A brief statement of the conclusions of the study will be made available for all interested parties. The statement will include the conclusions found from the information collected during the course of the study. You may request a summary of the findings of this research by providing your mailing address in the designated area below your signature.

By signing below, you are acknowledging that you have read and understood this consent form and have had the study explained to you and have had any questions about this research answered to your satisfaction. You are also acknowledging that your participation in this research is entirely voluntary and that no coercion has been applied to encourage such participation. Your signature below indicates your willingness to participate in this research. Thank you kindly for your attention. _____________________________________________ __________________ Participant’s Name (please print clearly) Date _____________________________________________ __________________ Participant’s Signature Date _____________________________________________ __________________ Parent’s Signature Date _____________________________________________ __________________ Researcher’s Signature Date Mailing Address (if you wish a summary of the research findings mailed to you): ______________________________________________________________________________________ Name of Participant and/or Participant’s Parent or Guardian ______________________________________________________________________________________ Street Address City ______________________________________________________________________________________ State Zip Code Country

_____________________________________________ __________________ Researcher’s Signature Date Daniel L. Gaylinn, MA Mailing Address: Mailing address E-mail: E-mail address

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Appendix B: Demographic Questionnaire

INSTRUCTIONS: Your honest answer to EACH item is very important. Please CIRCLE the response which is most true for you. 1. Age: (a) 14 (b) 15 2. Grade: (a) 9th (b) 10th

(c) 16 (d) 17 (c) 11th (d) 12th

(e) 18 3. Gender: (a) Male 4. Primary Language: (a) English (b) Female (b) Other: ______________

(please indicate) 5. Ethnicity: (a) Caucasian (b) Latin/Hispanic (c) African American (d) Asian (e) Bimultiracial (f) Other: ____________________

(please indicate) 6. What is your level of academic performance (on average)?:

(a) A’s: Better than 90% (b) B’s: 80-90% (c) C’s: 70-80% (d) D’s: 60-70% (e) F’s: Worse than 60%

7. What is your best estimate of your family’s annual income (on average)?:

(a) More than $100 Thousand (b) Between $75 and $100 Thousand (c) Between $50 and $75 Thousand (d) Between $25 and $50 Thousand (e) Less than $25 Thousand (f) Don’t Know

8. How much experience would you say you have with relaxation techniques (e.g., progressive muscle relaxation, breathing techniques, meditation, etc.)?: (a) More Than 5 Months (b) Between 3 and 5 Months (c) Less Than 3 Months (d) None At All 9. When you want to relax, what do you frequently tend to do?

(a) Music (b) Videos/Movies (c) Books (d) Friends (e) Videogames (f) Other: ______________

(please describe on reverse side of page)

10. How much time do you generally spend with various forms of electronic media (e.g., television, movies, videogames, radio, music) each day? (a) More Than 5 Hours (b) Between 3 and 5 Hours (c) Less Than 3 Hours (d) None At All 11. When you do use electronic media, what do you use most often? (a) Music (b) Television (c) Movies (d) Internet (e) Videogames (f) Other: ____________________

(please describe on reverse side of page)

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Appendix C: Smith Stress Symptoms Inventory-State (SSSI-S)

The statements in this scale are about how you feel right now at the present moment. Although some of the statements are similar to one another, there are differences between them and you should treat each one separately. For each statement, please indicate the extent to which it fits how you are feeling right now at the present moment by circling one of the numbers corresponding with one of the following options: 1 = Doesn’t fit me at all; 2 = Fits me a little; 3 = Fits me moderately well; 4 = Fits me very well 1. I have a nervous stomach. 1 2 3 4 2. I am easily distracted. 1 2 3 4 3. I feel like I am losing my memory and forgetting things. 1 2 3 4 4. I feel like I am losing sleep. 1 2 3 4 5. I worry too much about things that do not really matter. 1 2 3 4 6. My breathing is hurried, shallow, or uneven. 1 2 3 4 7. I have conflicts with others. 1 2 3 4 8. I find myself thinking in narrow, rigid ways. 1 2 3 4 9. My heart is beating fast, hard, or irregularly. 1 2 3 4 10. I have difficulty controlling negative thoughts. 1 2 3 4 11. I feel distressed (discouraged or sad). 1 2 3 4 12. I have lost my appetite. 1 2 3 4 13. I am depressed. 1 2 3 4 14. I am anxious. 1 2 3 4 15. I feel distaste or disgust. 1 2 3 4 16. I feel cynical or hostile. 1 2 3 4 17. My shoulders, neck, or back are tense. 1 2 3 4 18. I have difficulty keeping troublesome thoughts out of mind. 1 2 3 4 19. I feel confused. 1 2 3 4 20. My muscles feel tight, tense, or clenched up (furrowed brow, tightened fist, clenched jaw). 1 2 3 4 21. I feel less sensitive or caring to others. 1 2 3 4 22. I feel fatigued. 1 2 3 4 23. I have a backache. 1 2 3 4 24. I feel like I am losing my concentration. 1 2 3 4 25. I am afraid. 1 2 3 4 26. My mouth feels dry. 1 2 3 4 27. I feel like I might make mistakes. 1 2 3 4 28. I perspire or feel too warm. 1 2 3 4 29. I feel disorganized. 1 2 3 4 30. I feel the need to go to the rest room unnecessarily. 1 2 3 4 31. I find myself thinking unimportant, bothersome thoughts. 1 2 3 4 32. I have a headache. 1 2 3 4 33. I feel less cooperative with others. 1 2 3 4 34. I feel restless and fidgety. 1 2 3 4 35. I feel irritated or angry. 1 2 3 4

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Appendix D: Reactions to an Experiential Exercise Scale (REES)

Your feedback on this exercise is kindly requested. Your responses will remain anonymous and are kept completely confidential and will only be used in the service of improving this program. Your honesty is greatly appreciated. The items in this scale measure a variety of states of mind associated with your reactions to the guided relaxation program you just experienced. For each statement, please circle the number that indicates the extent to which you agree with the statement describing your experience of the program. 1 = Strongly Disagree 2 = Disagree 3 = Slightly Disagree 4 = Slightly Agree 5 = Agree 6 = Strongly Agree 1. For me the exercise was not enjoyable. 1 2 3 4 5 6 2. I have no real desire to repeat this program. 1 2 3 4 5 6 3. The idea of doing this exercise regularly does not appeal to me. 1 2 3 4 5 6 4. During the exercise, I felt bored or restless. 1 2 3 4 5 6 5. I would rather not do this exercise again. 1 2 3 4 5 6 6. I enjoyed the exercise overall. 1 2 3 4 5 6 7. During the exercise, I felt focused or engaged. 1 2 3 4 5 6 8. I found the exercise enjoyable. 1 2 3 4 5 6 9. I would do this exercise again. 1 2 3 4 5 6 10. I felt the exercise was pleasant. 1 2 3 4 5 6 11. During the exercise, I had trouble staying focused. 1 2 3 4 5 6 12. I disliked the exercise overall. 1 2 3 4 5 6 13. I feel I would benefit from repeated use of the exercise. 1 2 3 4 5 6 14. During the exercise I felt absorbed or engrossed. 1 2 3 4 5 6 15. I found the program unpleasant. 1 2 3 4 5 6 16. During the exercise, I felt involved and interested. 1 2 3 4 5 6 17. During the exercise, I felt my mind wandering. 1 2 3 4 5 6 18. If I could do this exercise on a regular basis, I would. 1 2 3 4 5 6 19. During the exercise, my eyes were closed. 1 2 3 4 5 6 *20. You have now completed all three exercises. Please take as much space as you need to describe your experience with each of the three exercises and be sure to state which exercise(s) you enjoyed the most and least, and why?

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Appendix E: Guided Relaxation Transcript

As you settle into a comfortable and relaxing position, allow the weight of your body to

relax into the support of the chair. Notice how your body makes contact with the chair. Relax the

back of your legs in your seat. . . . Relax the back of your hips. . . . Relax the back of your arms. .

. . Relax the back of your neck. . . . Relax the back of your head. Make any adjustments that you

may need to make, in order to relax your body into your chair more fully. Relax yourself into the

support of the chair, completely.

Relax the muscles of your face. Relax your eyes and your forehead. Relax your temples

and cheeks. Relax your mouth and your jaw. Relax your entire face. Place your hands on your

belly. Feel the rise and fall of your belly as you breathe. Notice each inhalation as it enters your

body, and each exhalation as it exits your body. Allow your breathing to become soft, full, and

easy. Without effort or strain. Simply allow the body to be breathed as you relax. As you inhale,

listen to the word “Let,” and as you exhale, listen to the word “Go.” Inhale, Let. Exhale, Go.

Continue to observe the natural rhythm of your breath, allowing your body to sink deeper

and deeper into relaxation. Allow your arms to rest comfortably by your side or in your lap. As

you exhale, feel any tension and strain leaving through your hands. As you inhale, feel any

tension, and as you exhale, let it go, soft and relaxed. Allow your body to sink deeper and deeper

into the support of the chair.

Now, bring your awareness to your feet. Feel the soles of your feet, and all ten of your

toes. Imagine that you could inhale and exhale through the soles of your feet. Imagine the breath

entering your body through the soles of your feet, and exiting your body through the soles of

your feet. Inhale, Let. Exhale, Go.

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Now, bring your awareness back to your hands. Feel the back of your hands and the

palms of your hands and all ten fingers. Imagine you could inhale and exhale through the palms

of your hands. Imagine the breath entering the body through the palms of your hands, and exiting

the body through the palms of your hands. Inhale, Let. Exhale, Go.

Now, bring your awareness to your belly. Feel your belly rise and fall as you breathe.

Imagine that you could inhale and exhale through your navel, through your belly button. Imagine

your breath entering your body through your navel, and filling your belly with calm and relaxing

air. Imagine the breath exiting your body through your navel, taking with it any stress or strain

you may be holding. Inhale, Let. Exhale, Go.

Now, allow your mind to relax deeper, below the awareness of your breath. Allow your

mind to relax below the level of concentration on anything at all, including your breath. Allow

your body and mind to let go. Let go completely. [pause for several minutes to allow

participants to relax.]

Now bring your attention back to your breathing. Notice each inhalation as it enters your

body, and each exhalation as it exits your body. Bring your attention back to your belly and feel

the belly rise and fall with each and every breath. Allow your breathing to be soft, full, and easy.

Notice your entire body. Notice your entire body supported by the chair. Notice how easy it is to

be in your body, in this moment. Feeling calm, relaxed, and supported. When you are ready to

begin moving out of this relaxation process, you can begin by gently moving your fingers and

your toes. Allow some sensation to spread into your hands and feet. Stretch or move in any way

that feels good. Take your time, remain relaxed. Breathe easily. Take the best feeling of

relaxation with you.

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Appendix F: Instructions for the Interventions

For the Video-Guided Relaxation Program (VGRP), the video of nature imagery will be

played on a DVD player connected to a television with a 36-inch screen or larger. Participants

will be asked to seat themselves in their assigned seats or in a place where they feel most

comfortable and have an unobstructed view of the screen. They will be instructed to follow along

with the guided relaxation program and to pay close attention to how the program makes them

feel. They will have the option of closing their eyes if they so choose, or leave them open in a

soft, unfocused gaze a few feet in front of them.

For the Audio-Guided Relaxation Program (AGRP), the audio tape will be identical to

the audio used for the VGRP. This tape will be played on an available stereo sound system so all

participants will comfortably hear the program clearly and easily. Participants will be asked to

seat themselves in their assigned seats or in a place where they feel most comfortable. They will

be instructed to follow along with the guided relaxation program and to pay close attention to

how the program makes them feel. They will have the option of closing their eyes if they so

choose, or leave them open in a soft, unfocused gaze a few feet in front of them.

For the Live-Guided Relaxation Program, the intervention will consist of the researcher

reading the same guided relaxation instructions used in both the VGRP and the AGRP in person

with a calm and soothing intonation. Participants will be asked to seat themselves in their

assigned seats or in a place where they feel most comfortable. They will be instructed to follow

along with the guided relaxation program and to pay close attention to how it makes them feel.

They will be given the option of closing their eyes or leaving them open in a soft, unfocused

gaze a few feet in front of them.

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Appendix G: Permission to Screen Digital Video Disc

Dear Daniel L. Gaylinn, MA It gives us pleasures (sic) to allow you the use of the Mind Body and Spirit DVD titled Simply Relax for your research study. Sincerely, Tony Lacroix Manager, Home Video Product Development Direct Source Special Products Inc. Street Address City, Province Country, Zip Code tel xxx-xxx-xxxx ext. xxx fax xxx-xxx-xxxx e-mail address

Please consider the environment before printing this e-mailVeuillez considérer l’environnement avant d’imprimer ce courriel.

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Appendix H: Pretreatment Talk Transcript

Thank you for your participation in today’s program. Please be sure that you are seated

comfortably, with your arms and legs uncrossed, and completely unobstructed by anything in

your immediate area. In a moment, I will ask you to follow along with a brief guided relaxation

exercise. Although you have the option of keeping your eyes open or closed throughout the

session, I invite you to keep your eyes open using a soft, unfocused gaze without attending to

anything in particular. This is to ensure that, while your body is relaxing, you will remain awake

throughout the session. As you allow your body to become relaxed, I invite you to follow along

with the instructions provided by the program, paying very close attention to how you feel in

your own body. Most people find relaxation exercises to be very beneficial and enjoyable,

especially when practiced over the course of several days. However, your experience is unique

and you are permitted to respond in any way that feels right and natural for you. If, during the

session, you experience any noises or distractions, I would like you to see if you can allow

anything short of a real emergency to simply help you to relax more deeply. During your

involvement with this program, you may feel the desire to share your experiences with others. I

would like to request that you please keep all of your thoughts and feelings of what you

experience here to yourself, making note of them in the questionnaires that you complete after

each session. On the final day of the study, you will be given the opportunity to share all of your

thoughts and feelings about your involvement in the study with me. You will then be free to

share your experiences here with others. Thank you again for your cooperation and for your

participation in today’s program. I would like to now invite you to follow along with this guided

relaxation exercise.

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Appendix I: Reader / Transcriber Confidentiality Agreement

I, __________________________________________________, the Reader / Transcriber agree to:

• Keep all of the research information shared with me confidential by not discussing or sharing the research information in any form or format (e.g., disks, tapes, transcripts) with anyone other than the Researcher.

• Keep all research information in any form or format (e.g., disks, tapes, transcripts) secure

while it is in my possession.

• Return all research information in any form or format (e.g., disks, tapes, transcripts) to the Researcher when I have completed the research tasks.

• After consulting with the Researcher, erase or destroy all research information in any

form or format regarding this research project that is not returnable to the Researcher (e.g., disks, tapes, transcripts, information stored on a computer hard drive).

• Refrain from duplicating in part or in full any of the digital or written materials regarding

this research project (e.g., disks, tapes, transcripts). Reader / Transcriber __________________________ __________________________ _________ (print name) (signature) (date) Researcher __________________________ __________________________ _________ (print name) (signature) (date)

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Appendix J: Relaxation Techniques Handout

1. Everyday Quick Techniques. a. Walk in nature; watch clouds in the sky, observe the wind. b. Put head down and close eyes for a few minutes. c. Rub hands together until warm; cup them over closed eyes. d. Vigorously shake your hands and arms for 10 seconds.

2. Six-Second Minirelaxation: The Quieting Reflex relieves muscle tightening, jaw

clenching, breath holding, and activation of sympathetic nervous system. For best results, practice Quieting Reflex frequently throughout the day, at the moment a stressful situation arises. With several months’ practice, this Quieting Reflex can become an automatic skill. It can be done with eyes opened or closed.

a. Become aware of what is annoying you (a sound, a comment, an urge, a thought, etc.). This becomes the cue to start the Quieting Reflex.

b. Repeat the phrase “Alert mind, calm body,” to yourself. c. Smile inwardly with eyes and mouth to prevent facial muscles from

displaying angry or fearful expressions. This is more a feeling than any observable expression.

d. Inhale slowly to the count of three, imagining that the breath comes in through the bottom of your feet. Then exhale slowly, feeling your breath move back down your legs and out through your feet. Allow your jaw, tongue, neck, and shoulder muscles to loosen.

3. Breathing: Changing your breathing can shift attention and mood. Breathing

patterns can reflect and redirect emotions a. Relax with belly breathing. All babies, some children, and some pets use

abdominal (belly or diaphragmatic) breathing. This is when your belly distends as you inhale and contracts as you exhale. As we grow up, many replace belly breathing with chest breathing—shallow, rapid breathing associated with tension and anxiety. Many take on the puffed chest, flat belly posture to impress, but this is not healthy.

i. Lay down on back on a comfortable surface. Knees may be bent, feet slightly apart. Loosen belt or constrictive clothing. Place hands just below navel. Close eyes, imagine a balloon inside your abdomen.

ii. As you inhale, imagine balloon is filling up with air, feel hands gently rise. As you exhale, imagine balloon deflating and feel hands gently fall.

iii. Focus on the sound and sensation of breathing as you relax. b. Quick tension relief

i. Reach for the sky or the ceiling as you inhale deeply and fully. Then exhale forcefully as you bend forward at the waist. Inhale deeply as you straighten up and reach. Repeat several times.

ii. Stand with arms straight in front of you. As you inhale, make several large backward circles with arms like a windmill. Then exhale, reverse

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the direction of the circles. You can also alternately swing your arms, as if you were doing the backstroke.

c. Breathing with imagery: You can use mental images like warmth, coolness, vitality, peacefulness as you breathe. Imagine that your breath is charged with that particular quality. As you exhale, allow breath to carry that quality throughout your body as though you were exhaling through the entire surface of your skin. Below are some suggestions, but you can experiment with your own images.

i. Imagine inhaling warm, soothing air as you inhale, sending this soothing sensation throughout your body as you exhale.

ii. Imagine taking cool blue breaths if you feel warm. iii. See how it feels to inhale sparkling and energizing breaths. iv. Inhale heaviness to help settle and relax you. v. Direct the energy of your breath to certain areas of your body that feel

tense or pain to relax or heal that area.

4. Muscle Relaxation: People carry unnecessary tension in their muscles even though it may feel “normal” or “relaxed” to them. Learning to relax each muscle individually helps you to learn the difference between how it feels when your muscles are tense and when they are relaxed. It is based on the idea that whatever relaxes your body will also relax your mind. You can guide your friend through this process, you can have your friend guide you, or you can read the instructions into a tape recorder and play it for yourself. Daily practice will help to learn how to scan your body and pinpoint areas of tension that you can tense and then relax.

a. Find comfortable chair, supportive of head and neck or, lay down on a soft surface. Tense and relax muscle groups one at a time.

b. Tense each muscle group for about 5 seconds, concentrate on what tension feels like. The individual groups can be as follows:

i. Hands and Arms ii. Legs and Feet

iii. Abdomen and Buttocks iv. Chest, Back, and Shoulders v. Neck and Throat

vi. Head and Face vii. Your Entire Body

c. Breathe deeply. As you exhale, let go of all the tension as though an electrical current was suddenly turned off, so that all of your muscles go completely limp.

d. For 10 to 20 seconds, observe how it feels to have muscles that are tense as compared to ones that are relaxed.

e. Go through your body tensing and relaxing each muscle group twice. f. Leave time to notice the difference during the relaxation phase.

5. Mindfulness: Most people live on “automatic pilot,” either thinking about the past or

anticipating the future, while the present moment slips by barely noticed. Mindfulness involves keeping attention in the present moment, without judging it as

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happy or sad, good or bad. It encourages living each moment—even painful ones—as fully and mindfully as possible. Mindfulness is an attitude toward living by calmly, consciously observing and accepting whatever happens, moment to moment. This may sound simple, but restless, judging minds make it surprisingly difficult. As a monkey jumps from branch to branch, our mind jumps from thought to thought. In mindfulness, you focus your mind on the present moment. The only moment we have is the present one and living it as fully aware as possible is what mindfulness is about, nurturing an inner balance of mind that enables you to respond to life situations with composure, clarity, and compassion. It reduces our tendency to react automatically. For example, the sound of someone’s voice (e.g., your mother’s, your teacher’s, your classmate’s) might trigger tension, anger, or fear. You can learn to mindfully observe this reaction to the voice without reacting or judging it. The “goal” is simply to observe—with no intention of changing or improving anything. People are positively changed by the practice of observing and accepting life as it is, with all its pleasures, pains, frustrations, disappointments, and insecurities. As you develop your capacity of mindfulness, you will become calmer, more confident, and better able to cope with whatever comes along:

a. Single-focused mindfulness: Sit comfortably on floor or in a chair, with back, neck, and head straight, but not stiff.

i. Concentrate on a single object, such as breathing. Focus attention on the feeling of the air as it passes in and out of nostrils with each breath. Do not attempt to control your breath, speeding it or slowing it. Simply observe it as it is.

ii. Even with attention focused solely on breath, your mind may wander to thoughts of other topics. As this occurs, observe that your mind has strayed, gently return attention to breathing.

iii. Each time a thought or feeling arises, acknowledge that breath has wandered, without analysis or judgment. Again, gently observe it, return attention to breath.

iv. Abandon thoughts of achieving some goal or having any special occurrence. Simply string moments of mindfulness together, breath by breath.

v. Practice this for 5 minutes at a time; gradually extend this period to 10, 20, or 30 minutes

Your thoughts are like waves on the surface of an ocean. Do not attempt to stop them to make the water flat, peaceful, or still. As you observe these waves, you begin to find relief from the turbulence and no longer get swept away easily.

Copeland, M.E. (2001). Wellness recovery action plan. New York: Haworth Press.