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Relaxation training with children

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Title:
Relaxation training with children
Creator:
Proeger, Charlene, 1947-
Publication Date:
Copyright Date:
1978
Language:
English
Physical Description:
vi, 109 leaves ; 28 cm.

Subjects

Subjects / Keywords:
Anxiety ( jstor )
Child psychology ( jstor )
Control groups ( jstor )
Counselor training ( jstor )
Intelligence quotient ( jstor )
Inurement ( jstor )
Learning ( jstor )
Muscle relaxation ( jstor )
Placebos ( jstor )
Test anxiety ( jstor )
Anxiety in children ( lcsh )
Counselor Education thesis Ph. D
Dissertations, Academic -- Counselor Education -- UF
Relaxation ( lcsh )
Genre:
bibliography ( marcgt )
non-fiction ( marcgt )

Notes

Thesis:
Thesis--University of Florida.
Bibliography:
Bibliography: leaves 100-108.
General Note:
Typescript.
General Note:
Vita.
Statement of Responsibility:
by Charlene Proeger.

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University of Florida
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University of Florida
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Copyright [name of dissertation author]. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
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022801493 ( ALEPH )
05086286 ( OCLC )
AAJ6458 ( NOTIS )

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RELAXATION TRAINING WITH CHILDREN


By

CHARLENE PROEGER














A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF
THE UNIVERSITY OF FLORIDA
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
DEGREE OF DOCTOR OF PHILOSOPHY




UNIVERSITY OF FLORIDA

1978















ACKNOWLEDGEMENTS


I would like to thank Robert Myrick for his tremendous enthusiasm,

interest, and support. I would also like to thank Betsy Altmaier and

Ellen Amatea for their contributions. I would like to express

appreciation to the following counselors from Alachua County who

contributed their time and energy to this research: Chari Campbell,

Barbara Cleveland, Beth Dovell, Finnette Fabrick, Carolyn Fouts,

Nancy Mitchum, Liz Parker, Sylvia Stuart, and Mary Anne Wagner. I

would like to recognize Beth Dovell, my Gainesville coordinator, for

her special contributions. I would also like to thank Terry Proeger

for his contributions and encouragement.
















TABLE OF CONTENTS


ACKNOWLEDGEMENTS .............................................. ii

ABSTRACT ...................................................... v

CHAPTER

I INTRODUCTION.......................................... 1

Purpose of the Study .............................. 2
Need for the Study................................ 2
Definition of Terms ............................... 3
Organization of the Study ......................... 4

II REVIEW OF THE LITERATURE.............................. 5

Definition of Anxiety ............................. 5
Anxiety in Children ............................... 7
Anxiety and Learning........................... 8
Personal and Social Variables................. 14
Physiological Variables....................... 19
Systematic Desensitization in the Treatment of
Anxiety ....................................... 19
Reciprocal Inhibition (Wolpe)................. 20
Clinical Treatment of Children's Anxieties.... 23
School Settings ............................... 26
-Relaxation Training................................ 29
Advantages..................................... 29
Relaxation Training with Children............. 36
Summary ................................ ......... 39

III METHODS AND PROCEDURES............................ ..... 41

Population and Sample ............................... 41
Population.................................... 41
Sample ........................................ 41
Hypotheses ............................ ............ 42
Experimental Procedures ........ ............... 43
First Week...................... .. .......... 43
Second Week........... ........................ 43
Third and Fourth Weeks ....................... .. 44
Fifth Week.................................... 44
Sixth Through Tenth Weeks ...................... 44
Eleventh Week................................. 46








Instruments ........................................ 46
Anxiety Identification (AID) Scale............. 46
Children's Manifest Anxiety Scale (CMAS)....... 48
Reading Subtest of the Metropolitan
Achievement Test (MAT) ................ ... 50
Feelings Checklist............................. 51
Walker Problem Behavior Identification
Checklist (WPBIC) .......................... 52
Experimental Design and Analysis of the Data....... 54

IV ANALYSIS OF RESULTS.................................... 55

V SUMMARY, DISCUSSION, LIMITATIONS, RECOMMENDATIONS, AND
CONCLUSIONS........................................ 68

Summary ............................................ 68
Discussion......................................... 69
Limitations ........................................ 73
Recommendations .................................... 74
Conclusions........................................ 75

APPENDICES

A DIRECTIONS FOR COUNSELORS.............................. 77

B THE DMR TRAINING SESSIONS .............................. 79

C THE FANTASY SESSIONS .................................... 92

D ANXIETY IDENTIFICATION (AID) SCALE..................... 99

REFERENCES ..................................................... 100

BIOGRAPHICAL SKETCH ............................................ 109















Abstract of Dissertation Presented to the Graduate Council
of the University of Florida in Partial Fulfillment
of the Requirements for the Degree
of Doctor of Philosophy



RELAXATION TRAINING WITH CHILDREN

By

Charlene Proeger

December, 1978

Chairperson: Robert D. Myrick
Major Department: Counselor Education

This study investigated the effects of training in relaxation on

anxious fourth-grade children. Children were selected from fourth-

grade classes in nine elementary schools. Counselors administered a

screening instrument developed for this study, the Anxiety Identifica-

tion (AID) Scale, in the classrooms. From the AID Scale, counselors

determined which children were eligible to participate in the study.

At each of the nine schools, the eligible children were randomly

divided into three groups of five children each: the Deep Muscle

Relaxation (DMR) group, a placebo group, and a control group. Thus,

a total of 135 children participated in the study: 45 in the DMR

group, 45 in the placebo group, and 45 in the control group.

The children in all three groups were administered the criterion

variables, which included the Children's Manifest Anxiety Scale (CMAS),

a Feelings Checklist, and the Reading subtest of the Metropolitan

Achievement Test (MAT). Teachers completed the Walker Problem Behavior









Identification Checklist (WPBIC). These instruments were administered

before and after the treatment.

The treatment lasted 5 weeks. During this time, children in the

DMR and placebo groups met with their counselors. Both groups met

twice a week for a total of 10 sessions. The relaxation exercises for

the DMR group were presented on a pre-recorded tape, with the counselors

facilitating the discussion. During the first five meetings, children

were taught to tense and relax their muscles. During the last five

sessions, children practiced DMR without first tensing their muscles

and instead used the cue word "relax." Attention to the physical

awareness of anxiety and relaxation, as well as daily practice of DMR,

was encouraged throughout the program. As the sessions progressed,

children were increasingly encouraged to use DMR when they became

anxious. Children in the placebo group listened to a pre-recorded

fantasy and then discussed how they felt about the experience.

Analyses of covariance, with pretest scores as covariates, were

used to determine if there were significant differences between the

three groups. The analyses comparing the means of the CMAS, Feelings

Checklist, MAT, and WPBIC indicated no significant differences.

Even though the DMR group tended to have more positive outcomes on

the criterion measures, none of the null hypotheses could be rejected.

However, the responses of teachers, counselors, children, and

parents were positive and indicated that the children were learning to

relax. Since little research has been attempted in this area with

children, procedures and instruments need to be refined. Considering

the negative effects of high levels of anxiety, further research is

necessary to determine effective methods of helping children relax.















CHAPTER I
INTRODUCTION


Excessive anxiety has been found to have adverse and debilitating

effects on persons of all ages. Indeed, studies with children have

shown that excessive anxiety has many negative effects, including

difficulties in interpersonal relationships, impaired performance on

tests (Sarason, Davidson, Lighthall, Waite, & Ruebush, 1960), and

reduced capacity for learning (Phillips, Martin, & Meyers, 1972).

Indicative of the severity of the problem is the number of methods used

to relieve anxiety. Among these approaches are muscle relaxation

(Bernstein & Borkevec, 1973), systematic desensitization (Wolpe, 1958),

meditation (Benson, 1975), hypnosis (Kroger, 1963), biofeedback

(Fuller, 1978), yoga (Stern, 1969), and psychotherapy (e.g., Rogers,

1961).

Of these methods, training in relaxation appears to be one of the

most practical methods for reducing anxiety in a school setting.

Extensive specialized training is not necessarily required to teach

relaxation (Russell & Wise, 1976), and children learn the skills easily.

In addition, training in relaxation lends itself to working with children

in groups. It also appears to be a readily accepted approach in most

school systems. Moreover, it seems to have immediate, as well as

long-term, benefits (Cautela, 1969). However, there has been little

research on relaxation training with children.









Counselors in the elementary schools often work with children who

experience excessive anxiety. What benefits would result if counselors

taught anxious children to relax?


Purpose of the Study

The purpose of the study was to determine the effects of training

in relaxation on fourth-grade children. Specifically, the following

research questions were investigated:

1. What effect does training in relaxation have on children's

self-reported general anxiety?

2. What effect does training in relaxation have on situational

anxiety related to school?

3. What effect does training in relaxation have on classroom

behavior?

4. What effect does training in relaxation have on children's

test performance?


Need for the Study

Excessive anxiety appears to have a detrimental effect on a number

of behaviors necessary for success in school. High levels of anxiety

have been found not only to interfere with short-term learning (e.g.,

memorization), but to result in long-term deterioration of more complex

intellectual skills, such as problem-solving ability (Phillips et al.,

1972). Often the main variable that prevents otherwise capable students

from performing up to their ability level on both IQ and achievement

tests is excessive anxiety (Sarason et al., 1960). In addition to these

negative effects, anxiety in elementary school children has been related

to poor relationships with peers and teachers and to hostility and







3

aggression (Phillips et al., 1972; Sarason et al., 1960). Indeed, there

are many children who experience anxiety to the extent that they are

dysfunctional in school. Thus, there exists a definite need to develop

methods of helping these highly anxious children reduce their anxiety

so that they can experience success in school.

Although there has been increasing evidence of the effectiveness

of relaxation training in reducing anxiety in adults (Deffenbacher &

Snyder, 1976), very few studies have focused on children. In most of the

studies with children, relaxation training has been used in combination

with systematic desensitization and has occurred in clinical settings

with severely impaired children. The few studies of relaxation training

with systematic desensitization which take place in schools have focused

primarily on the desensitization of test anxiety.

Recent research with adults, however, has suggested that training

in relaxation alone has more generalized and long-term effects than

desensitization (Denny, 1974; Snyder, 1975). Although several recent

publications (e.g., Hendricks & Roberts, 1977; Koeppen, 1974) have

proposed that training in relaxation can benefit children, there have

been few research articles to support this. Little attention has been

given to the effects of training children in relaxation on test

performance or anxiety. There have been virtually no systematic studies

of the effects of relaxation training on classroom behavior.


Definition of Terms

General anxiety--refers to a relatively stable tendency to be tense

or to feel worried.

Situational anxiety--refers to transitory feelings of tension

related to a specific situation in which there is no physical danger.







4

Anxious children--refers to children who feel they are more anxious

than other children.

Deep muscle relaxation (DMR)--refers to the procedure used in this

study. It involves learning to relax muscles, first by tensing them;

awareness of muscular tension; and practice and application of relaxation.


Organization of the Study

The remainder of this study is organized into four chapters. A

review of the relevant literature on anxiety and relaxation training

is presented in Chapter II. The rationale for this study is also

discussed. The population and sample, hypotheses, instrumentation,

treatment, design, and statistical analysis are presented in Chapter III.

The results are presented in Chapter IV. Chapter V includes a summary

of the study and implications for elementary school counselors and

teachers.















CHAPTER II
REVIEW OF THE LITERATURE


The relevant literature on anxiety and methods of reducing anxiety

are reviewed in this chapter. Specifically, the following areas receive

attention: (a) anxiety and its manifestations, (b) muscle relaxation

with systematic desensitization, and (c) relaxation training.


Definition of Anxiety

It appears that there are as many definitions of anxiety as there

are theories of personality. Indeed, anxiety is a major construct in

most personality theories (Patterson, 1966; Ruebush, 1963). However,

anxiety has typically been defined as fear when there is no physical

danger (Beck, 1972; Cattell, 1963; Kolb, 1973; Nichols, 1974; Ruebush,

1963; Wolpe, 1958).

In defining anxiety, several authors have focused on the distinction

between anxiety and fear. Fear has been defined as involving an

objective physical danger (Kolb, 1973; Ruebush, 1963). Anxiety, on the

other hand, can be a response to internal conflict (Lester, 1973; Phillips

et al., 1972; Wolff, 1973) or social situations (Carkhuff, 1969; Kolb,

1973). However, the physiological experience of fear and anxiety are

the same (Beck, 1972; Ruebush, 1963; Wolpe, 1958). The physiological

manifestations of anxiety will be discussed later in this chapter.

After reviewing the literature on anxiety, Phillips et al. (1972)

concluded that anxiety is (a) manifested physiologically, phenomeno-

logically, and behaviorally; (b) general or situational; and (c) elicited

5









by stress, or by threatened deprivation of an anticipated satisfaction.

They also noted that defensiveness occurs with excessive anxiety and

that the consequences of anxiety are usually negative, interfering, and

debilitating in nature.

The distinction between general and situational anxiety is an

important one. General anxiety, also called trait, chronic, or neurotic

anxiety, is a dispositional characteristic, a general tendency to be

anxious. General anxiety has an internal locus and is a function of

past experience. Situational or state anxiety, however, is a direct

function of contemporary events. These two types of anxiety interact,

so that general anxiety influences susceptibility to situational anxiety

(Phillips et al., 1972), and frequent elicitations of situational

anxiety produce a tendency toward general anxiety (Benson, 1975).

General and situational anxiety can be measured by different scales.

Frequently, general anxiety in children is measured by the Children's

Manifest Anxiety Scale (Castenada, McCandless, & Palermo, 1956). The

Manifest Anxiety Scale (Taylor, 1953) is often used with adults. The

most widely used measures of situational anxiety are the test anxiety

scales, such as the Test Anxiety Scale for Children (O'Reilly & Wightman,

1971) and the Test Anxiety Inventory (Spielberger, Gonzalez, Taylor,

Algaze, & Anton, 1978).

Alpert and Haber (1960) studied several measures of general and

situational anxiety. They concluded that these scales do indeed measure

different constructs. For example, they found that measures of situational

anxiety, such as the test anxiety scales, were better predictors of

performance than general anxiety scales.









Anxiety in Children

There is increasing concern with the subject of anxiety. Indicative

of the extent of interest in anxiety are the number of professional

publications written each year which deal with the subject. During

1977, over 300 articles and books on anxiety were written. Approximately

15% of these focused on anxiety in children.

A further indication of the prevalence of anxiety was provided by

Benson (1975). He noted that hypertension, a physiological manifestation

of anxiety, was present in 15 to 323 of the population. He also provided

evidence that the effects of hypertension have become a concern in

increasingly younger age groups.

Anxiety is a very common and serious problem for children. Anna

Freud (1970), for example, stated that anxieties and fears are one of

the most common and potent causes of suffering in childhood. She

listed many sources of anxiety in infants, including fears of darkness,

solitude, noise, strangers, and helplessness. For older children, the

list included anxiety about rejection, punishment, and social disgrace,

especially in school.

Sermet (1974) studied 100 highly anxious and 100 non-anxious

5- to 12-year-old children. He found that anxiety-disorder was the

largest group of neurotic conditions in children. One-third of the

children with anxiety-disorder were also found to have specific fears

or phobias. In addition, highly anxious children were found to dislike

doctors, receive outpatient treatment, be admitted to hospitals, and

receive pills more frequently than non-anxious children.

A further indication of the prevalence of anxiety in children was

reported by Hundleby and Cattell (1968). Studying 273 12-year-old










children, they found eight major personality factors. One of these

factors was anxiety. In addition, Cattell and Scheier (1961) found that

anxiety was a major factor in neurosis.

Other indications of the extent of anxiety in children are the

responses on the Children's Manifest Anxiety Scale (CMAS). Palermo

(1959) reported that the mean score for normal black boys and girls on the

anxiety scale of the CMAS was 23. This means that, on the average, these

children responded "yes" to 23 of the 42 anxiety items on the scale.

The CMAS, which will be discussed more thoroughly in Chapter III,

contains such items as "It is hard for me to go to sleep at night ..

I worry most of the time. . I am nervous" (Castenada et al., 1956).

Kitano (1960) reported that the mean score on the CMAS for 153 normal

children was 20. These studies indicate the extent of feelings of

anxiety in normal children.

After reviewing the literature on anxiety in normal children,

Ruebush (1963) concluded that "the research findings . constitute

evidence of the viability and prominence of anxiety as a variable of

basic and enduring concern in child psychology" (p. 504). Indeed,

anxiety is a prevalent and significant problem for children.

Anxiety and Learning

When anxiety becomes excessive, it can interfere with many variables

necessary for success in school. After reviewing the literature,

O'Reilly and Wightman (1971) concluded that anxiety interferes with

school performance. Low-anxious children perform better than high-

anxious children on a variety of tasks. In general, excessive anxiety

has been found to be negatively related to measures of IQ and achievement,

as well as learning capacity and problem-solving ability.









Intelligence. The literature indicates that there is a negative

correlation between general anxiety and scores on IQ tests. For

instance, Lighthall, Ruebush, Sarason, and Zweibelson (1959) found that

low-anxious children made greater gains over time on the Otis-Lennon

Mental Ability Test than high-anxious children. Phillips (1962) studied

the relationship between scores on the Children's Manifest Anxiety Scale

(CMAS) and IQ tests for 1,200 fifth- and sixth-grade students. He found

a significant negative correlation between high levels of anxiety on

the CMAS and IQ scores. A similar conclusion was reached after two

extensive reviews of the literature on anxiety in children (Phillips et al.,

1972; Ruebush, 1963).

There is an even greater negative correlation between test anxiety

and scores on IQ tests. For example, Dodds (1976) explored the

relationships between IQ, test anxiety, and general anxiety for 150

seventh-grade children. He found a negative relationship between IQ and

test anxiety, but no relationship between IQ and general anxiety. This

finding was supported by the literature review by Sarason (1960).

Sarason concluded that the majority of studies showed that general

anxiety was not related to IQ, whereas high test anxiety was consistently

related to poorer performance on IQ tests.

Does anxiety cause lower IQ scores, or does low intelligence cause

anxiety? Several studies have supported the hypothesis that it is

anxiety which causes the lower IQ score and not the reverse (Phillips

et al., 1972). For example, when IQ is held constant, low-anxious

children perform better than high-anxious children on a variety of

tasks (Sarason et al., 1960). Thus, these authors concluded that

anxiety is not a result of low intelligence.









Several studies have shown that changes in anxiety level are

related to changes in IQ scores. Sarason and associates studied the

relationship between anxiety and IQ in a group of 670 elementary school

children for a period of 5 years. They found that increases in anxiety

were related to decreases in IQ test performance, while decreases in

anxiety were related to increases in IQ test performance (Hill & Sarason,

1966; Sarason, 1966; Sarason, Hill, & Zimbardo, 1964).

In addition, Sarason et al. (1964) found no trend toward interaction

between test anxiety and IQ. Using high and average IQ groups, they

found no evidence that anxiety had a differential effect between IQ

levels. This finding suggests that test anxiety affects the more

intelligent, as well as average, students.

It is apparent that anxiety, especially test anxiety, is related

to poor performance on IQ tests. There is some evidence that a high

level of anxiety is the cause of poorer performance on IQ tests.

Achievement. Most of the literature on anxiety in children shows

a negative relationship between anxiety and achievement. For example,

Gifford and Marston (1966) studied the relationship between anxiety and

reading on 31 fourth-grade boys. They found that high levels of anxiety

were significantly related to slow reading rates and reduced comprehen-

sion. Similar results were found by Standford, Dember, and Standford

(1963) with third-grade children. They found that high levels of anxiety

were related to low reading grades and that anxiety level was as effective

as IQ in predicting reading grades.

In a study with 1,038 eighth-grade students, Khan (1969) found that

anxiety was a useful predictor of scores on subtests of the Metropolitan

Achievement Test. He found that anxiety levels yielded higher correla-

tions with subsequent achievement test results than other predictors,









including attitudes and study habits. The negative relationship

between anxiety and achievement has also been documented in studies by

Phillips (1962) with seventh-grade students and by Hawkes and Furst (1971)

with fifth- and sixth-grade children.

Longitudinal studies have provided further evidence of the negative

effect of anxiety on school performance. For instance, Hill and

Sarason (1966) concluded that anxiety was negatively related to school

progress, as measured by grades. Although most high-anxious children

were found to progress normally through school (i.e., did not repeat

grades), their rate of gain was found to be less than that of low-

anxious children (Sarason et al., 1964). They suggested that the

highly anxious child lacks qualities "that make for the productive

acquisition and utilization of knowledge" (p. 37).

Interestingly, anxiety may be more strongly related to reading

achievement test scores than to math scores in fourth-grade children.

In a study by Sarason et al. (1964), the correlation of test anxiety

scores in the first grade were significantly related to fourth-grade

reading test scores on the Metropolitan Achievement Test. In addition,

changes in test anxiety scores correlated significantly with changes in

reading scores over time.

After reviewing the literature, both Phillips and his associates

(1972) and Ruebush (1963) concluded that there is a negative relationship

between anxiety and achievement. Ruebush reviewed 16 studies showing a

negative relationship between anxiety and achievement test scores, one

study suggesting a positive relationship, and three studies reporting

no relationship. In addition, he noted several studies indicating that

anxiety is an important part of the personality of underachieving children.







12

Why do highly anxious children perform poorly on achievement tests?

In reviewing the literature on test anxiety, Sarason (1972) found several

studies showing that test-anxious persons focus on themselves when

confronted with evaluative situations. They focus on the possibility

of failure, with such thoughts as "I won't pass." Their attention to

self, rather than to the task, interferes considerably with test perfor-

mance. This finding was supported by the literature review on test

anxiety by Wine (1971).

Learning. Although studies of the effects of anxiety on easy tasks

have shown inconsistent results, it has generally been agreed that

excessive anxiety has a detrimental effect on complex learning (Phillips

et al., 1972; Ruebush, 1963; Sarason, 1972). Ruebush (1963) reviewed

several studies which showed that anxiety in normal children has

negative effects on difficult tasks such as digit symbol and IQ tests.

After reviewing the literature on test anxiety, Sarason (1972) concluded

that test anxiety was negatively related to verbal and motor learning,

stimulus generalization, and size estimation. When the task is complex,

task-irrelevant responses interfere to a greater degree than when the

task is simple (Phillips et al., 1972; Sarason, 1972).

The performance of highly anxious persons can be enhanced by

positive reinforcement and low stress conditions (Horowitz & Armentrout,

1965; Marlett & Watson, 1968; Phillips et al., 1972; Sarason, 1972;

Sarason et al., 1960). Phillips and his associates (1972), for example,

reported that high-anxious persons responded more to reinforcement than

low-anxious persons. They suggested that reinforcement reduces the

ambiguity of the situation and thus serves to counteract anxiety.







13

In addition to these findings, Phillips and associates (1972) noted

several other trends in the literature. For instance, they found that

anxiety reduces incidental learning by limiting the perceptual field of

the learner. They also reported indications that anxiety negatively

affects short-term memory.

These reviews of the literature provide consistent evidence of the

negative effect of anxiety on a variety of learning tasks and especially

on complex learning. In summarizing their findings, Phillips et al.

(1972) concluded that anxiety is generally debilitating in regard to

academic behavior.

Problem-solving. Anxiety generally impairs children's performance

on verbal and non-verbal problem-solving tasks. For example, Ruebush

(1963) found that most studies supported the contention that anxiety

interferes with tasks such as mazes and embedded figures and the use of

abstract concepts. He also reviewed several studies which provided

evidence that anxiety in children is negatively related to scores on

tests of creativity and curiosity.

Sarason and associates (1960) systematically studied the effects

of anxiety on problem-solving ability in elementary school children.

They matched high- and low-anxious children for 1Q, sex, and grades. In

several problem-solving situations, high-anxious children performed more

poorly than low-anxious children. In addition, highly anxious children

tended to be more cautious. Finally, high-anxious children gave fewer

responses than low-anxious children on the Rorschach.

There are several behaviors related to anxiety which interfere with

problem-solving ability. Several studies have provided evidence that

anxiety reduces responsiveness to the environment and interferes with








14

the accurate perception of reality (Ruebush, 1963). Similarly, Sarason

(1972) reported that highly anxious persons neglect or misinterpret

important cues that may be readily available, due to their focus on

self, rather than the task. In addition, the highly anxious person

often experiences attentional blocks (Ruebush, 1963).

In this section, it has been shown that anxiety in children

interferes with performance in school. Several reviews of the literature

which supported this hypothesis were discussed. Generally, anxiety has

been found to negatively affect such cognitive tasks as performance on

IQ and achievement tests, and learning and problem-solving ability in

elementary school children.

,Personal and Social Variables

Anxiety has been related to many personality characteristics and

social variables. Dependence, low self-concept, aggression, defensive-

ness, and disturbed relationships with peers and teachers may be related

to high levels of anxiety. Other variables that have been related to

anxiety include indecisiveness, rigidity, cautiousness, and guilt.

Dependence. After reviewing the literature, Ruebush (1963)

reported evidence that excessive anxiety was related to dependence in

children. This finding was supported by Phillips and associates (1972)

in their review of the literature. Similarly, they reported that

direction-seeking and conforming tendencies were related to anxiety.

Anxious children appear to have an external locus of control, that

is, to be dependent on external authority for reinforcement. For

instance, Finch and Nelson (1974) reported a high correlation between

general anxiety and an external locus of control in a group of 50

emotionally disturbed children.









Rosenthal (1967) studied the effects of high- and low-anxious

conditions on the dependency behavior of 3- to 5-year-old girls. The

children were placed in a strange room with an adult under low- or high-

anxiety conditions. The frequency of attention-seeking behavior

decreased significantly faster under low-anxiety conditions. Attention-

seeking behaviors included attempts to get the adult's attention,

praise, or aid.

Dependence in children may contribute to poor relationships with

teachers. For example, dependent children may occupy the teacher's time

by asking many questions. Finally, dependence on external authority

for approval may be a factor contributing to a lack of creativity in

anxious children (Sarason et al., 1960).

Hostility and aggression. Excessive anxiety has generally been

related to aggressive and hostile feelings in children. However, anxious

children may vary in the manner in which they cope with these feelings.

Sarason and associates (1960) found that anxious children often turn

their aggression inward, whereas Phillips and associates (1972) reported

evidence that anxious children express their aggression outwardly by

misbehaving. Indeed, Ruebush (1963) hypothesized that whether aggression

in anxious children is expressed outwardly or inwardly depends in part

on teacher and parent variables.

Extensive study of the backgrounds of highly anxious children led

Sarason et al. (1960) to conclude that children who experience anxiety

in evaluative situations are reacting with strong unconscious hostility

toward authority figures. These feelings of hostility may result from

negative, punitive child-rearing practices (Ruebush, 1963; Sarason et al.,

1960). Since this hostility conflicts with their dependency needs, the









children frequently turn their aggressive feelings inward, in the form

of self-derogatory attitudes (Sarason et al., 1960).

Somewhat different findings were reported by Phillips and associates

(1972). After studying anxious children for 2 years, they reported a

significant relationship between school anxiety and hostile, aggressive

behavior in school, as reported by teachers.

Thus, it appears that excessive anxiety in children is related to

aggressive feelings. Depending on the situation, these aggressive

feelings may be expressed outwardly or turned inward.

Self-concept. A consistent relationship has been found between

excessive anxiety and low self-concept (Phillips, Hindsman, & Jennings,

1960; Phillips et al., 1972; Ruebush, 1963; Sarason, 1972; Ziv & Luz,

1973). For example, Phillips et al. (1972) found consistent evidence

in the literature of the relationship between anxiety and two aspects

of self-concept: self-disparagement and feelings of inferiority. They

also reported that excessive anxiety has been associated with feelings

of guilt, school inadequacy, and lack of self-assuredness. These

findings were supported by Cattell and Scheier (1961), who found that

anxiety was related to lack of self-confidence, inferiority, and guilt.

Sarason (1972) reported an interesting study involving 15- to 19-

year-old juvenile delinquents. The boys were given an opportunity to

observe models role play successful coping in interpersonal situations.

The delinquent boys then had a chance to role play the situations, one

group with the aid of video-taped feedback and one without. Surprisingly,

the addition of the video tape had a negative effect on the highly

anxious boys. Follow-up interviews revealed the reason: Highly anxious

boys attended to the discrepancy between themselves and the socially







17

successful models on the video tape. The visual feedback confirmed their

feelings of their own inadequacy.

Other personality variables. High levels of anxiety in children

have been related to a variety of other personality characteristics.

Ruebush (1963), for example, provided evidence that a positive relation-

ship exists between anxiety and various measures of clinical maladjust-

ment. Indeed, Kitano's (1960) study supported this contention. Behavior

problem children in adjustment classes were found to be significantly

more anxious than normal children in regular classes.

Anxiety has also been related to defensiveness (Phillips et al.,

1972; Wolff, 1973). Indeed, Sarason et al. (1964) found that changes

in anxiety over time were significantly related to changes in defensive-

ness.

Sarason and associates (1960) also reported that high-anxious

children differed from low-anxious children in their responses to the

Rorschach. The responses of high-anxious children reflected more

mutilation and more rigidity. The responses of low-anxious children

contained more smiles and more playfulness.

Other personality characteristics have been related to excessive

anxiety. Ruebush (1963) found considerable research supporting the

relationship between anxiety and general behavioral constriction,

including indecisiveness, guardedness, caution, and rigidity. In

addition, relationships have been found between anxiety and exhititionism,

authoritarian attitudes, jealousy, and guilt (Ruebush, 1963). Finally,

anxiety may also be related to speech problems, hypochondria, and

excessive day-dreaming (Aspects of Anxiety, 1968).







18

Peer relationships. Several studies have indicated that excessive

anxiety is related to low peer status. Hill (1963), for example,

studied the effects of anxiety on sociometric status in four third-grade

classrooms. He found that high levels of anxiety were related to

negative sociometric status. Interestingly, Ruebush (1963) reported a

negative relationship between anxiety and accuracy of perception of

one's own sociometric status.

Phillips et al. (1972) presented the following cycle of anxiety

and rejection. Isolated and rejected children experience anxiety in

social situations. This leads to either a diminution of activity or

heightened activity. These activities (or lack of them) are seen as

"problem behavior" by teachers and peers. Although there is a desire

to affiliate when one experiences anxiety, the rejected or isolated

child is denied this opportunity and consequently experiences more

anxiety.

Relationships with teachers. Excessive anxiety appears to be

related to poor relationships with teachers (Hawkes & Furst, 1971;

Ruebush, 1963; Sarason et al., 1960). For example, Sarason and

associates (1960) reported that highly anxious children tended to seek

excessive attention or to avoid the teacher. Attention-seeking behaviors

included misbehavior and asking many questions. They also observed

informally that high-anxious boys seemed more insecure around the

teacher than low-anxious boys.

Phillips et al. (1972) referred to adults as "the ubiquitous

authority figures" in the child's environment (p. 423). Adults in

general sometimes arouse anxiety in children, according to these authors.









They also suggested that teachers are often seen by children as

evaluators, the dispensers of reward and punishment. Teachers may,

indeed, contribute to anxiety in children.

Physiological Variables

In 1963, Ruebush reported that relatively little was known about the

physiological antecedents and correlates of anxiety in children. More

recently, Phillips et al. (1972) reported that anxiety in children is

related to blood pressure rate, heart rate, and skin conductance. They

also noted that certain behavioral factors are associated with anxiety.

These include tremor, facial expressions, and speech disturbance. In

addition, Sarason et al. (1960) reported that high-anxious children

tended to be ill more often than low-anxious children.

There is more information on the physical manifestations of anxiety

in adults. For example, Wilson (1976) noted that muscle spasms and

headaches often result from tension. Anxiety may also result in an

increased breathing rate (Benson, 1975). Forrandino and Marlowe (1977)

reported that anxiety produces depression, insomnia, and nervousness.

Indeed, Fuller (1978) used the term psychophysiological to convey the

concept of the mind-body unity. Every emotion has its physiological

counterpart.


Systematic Desensitization in the Treatment of Anxiety

Many methods have been suggested for reducing anxiety, including

muscle relaxation, systematic desensitization, meditation, hypnosis,

biofeedback, yoga, and psychotherapy. Of these methods, relaxation

training in combination with systematic desensitization has received

the most attention in the literature.









Reciprocal Inhibition (Wolpe)

The method of systematic desensitization involving muscle relaxation

was developed by Wolpe (1958). The process was based on learning theory.

"Since neurotic behavior demonstrably originates in learning, it is only

to be expected that its elimination will be a matter of 'unlearning' "

(p. ix).

Wolpe (1958) developed his theory of reciprocal inhibition based

on his experiments with cats. Cats were subjected to shocks in an

experimental cage. They developed resistance to the cage and physiolog-

ical symptoms, such as muscular tension, within the cage. For some cats

these anxiety reactions generalized to being in rooms similar to the

experimental room and to the experimenter. Thus, learning had occurred.

The neurotic behavior was learned in only one to two sessions of a few

minutes each. After the neurosis was well-established, desensitization

was begun.

Since eating and anxiety had been discovered to be incompatible

responses, feeding was used to eliminate anxiety. The cats were fed

in rooms increasingly similar to the experimental room and eventually

in the experimental cage. As the cats were able to eat in the experi-

mental cage, all symptoms of anxiety dissipated. Thus, neurotic anxiety

was eliminated by getting the cats to eat in the presence of small, then

increasingly greater, doses of the anxiety-evoking stimuli. The treat-

ment produced quite rapid results. Neurotic anxiety was eliminated in

an average of four sessions per cat. Follow-up for several weeks

revealed no indication of anxiety responses in any cat.

Thus, "if a response antagonistic to anxiety can be made to occur

in the presence of anxiety-evoking stimuli so that it is accompanied







21

by a complete or partial suppression of the anxiety responses, the bond

between these stimuli and the anxiety responses will be weakened"

(Wolpe, 1958, p. 71). Wolpe discovered that there were responses more

convenient than eating to counteract anxiety in people. The most useful

of these were relaxation, assertion, and sexual responses. Of these,

relaxation has been the most widely used.

Wolpe's method of relaxation was based on the procedure of

progressive relaxation developed by E. Jacobson (1938, 1964). Jacobson

gave patients prolonged and intensive training in relaxation. In fact,

100 to 200 sessions were often required to train a patient to relax.

The first step of progressive relaxation was recognition of muscle

tension. This involved contracting the muscles and then relaxing them.

The patient was next taught to relax each major muscle group. In

addition, the patient was instructed to practice relaxation for several

hours daily. Jacobson (1938) found that this method decreased blood

pressure and resulted in improvement in most cases, including anxiety

neurosis, tic, stammering, and tremor.

Woipe (1958) expressed several criticisms of Jacobson's technique.

First, Wolpe discovered that relaxation training could be accomplished

in far fewer than 100 to 200 sessions. Secondly, in progressive

relaxation, there was no control over the anxiety-evoking stimuli.

Without warning, the person might be subjected to anxiety and not able

to relax enough to inhibit it. The anxiety-connected stimulus also might

not arise often enough at times convenient for inhibition through

relaxation.

Wolpe's procedure involved several steps. First, the therapist

explained that relaxation has emotional effects directly opposing









anxiety, which could be applied in the therapy room and in real-life

situations. Secondly, the patient was taught to relax. The patient

learned to differentiate between tension and relaxation by contracting

and relaxing muscles. After tensing, the patient was instructed to

relax far past the point where no tension was felt. Relaxation training

took five to seven sessions, focusing on different muscle groups each

time.

Practice of relaxation was encouraged. Patients were instructed

to relax for 30 minutes each day. They were also encouraged to keep

all muscles not in use relaxed all the time. Finally, patients were

encouraged to use relaxation in anxiety-producing situations.

The third step was the construction of an anxiety hierarchy. The

patient was instructed to make a list of everything that was frighten-

ing, disturbing, or embarrassing (except situations that would frighten

anyone). Material for the hierarchy was also drawn from the Willoughby

questionnaire and elicited during interviews. The patient then looked

for themes in the list. Finally, the patient ranked the items on the

subdivided list from least to most anxiety-producing. This process

resulted in the hierarchies. Wolpe stated that even the character

neuroses consisted of intricate systems of phobias that could be

organized and treated in the same way as a simple phobia.

The fourth part of the procedure involved presentation of the

hierarchies to the patient. During the first session of systematic

desensitization, the patient, already trained in relaxation, was

hypnotized and made to relax as deeply as possible. The patient was

told that s/he would be asked to vividly imagine a number of scenes.

If any scene caused anxiety, the patient was to raise his/her hand.







23

The weakest scenes were then presented. If the patient raised his/her

hand or any bodily tension was observed, the scene was terminated.

If relaxation was not affected by an image, a slightly stronger

"dose" was presented at the next session. The dosage was gradually

increased from session to session until the most phobic dose could

be presented without affecting relaxation. The patient then ceased

to react anxiously in real life.

With this method and the benefits of the "nonspecific events of

the interview situation" (p. ix), Wolpe reported that 90% of his

patients were apparently cured or very much improved in an average

number of 31 sessions. Wolpe did report, however, that some patients,

after being desensitized to a hierarchy, discovered several other

themes requiring desensitization.

Clinical Treatment of Children's Anxiety

Until recently, systematic desensitization has been used mainly

in clinical settings with children with serious problems. For example,

Lazarus (1959) described the successful use of systematic desensitiza-

tion with relaxation to reduce separation anxiety in a 9-year-old girl.

The girl had become fearful of losing her mother due to exposure to

three deaths. She refused to be separated from her mother and

developed nightmares and "illness" at school. A hierarchy was con-

structed. The girl was asked to imagine that she would not see her

mother for increasingly longer periods of time (5 minutes, 15 minutes,

1 week) while relaxed. Five sessions in 10 days alleviated all

symptoms. At follow-up, 15 months later, the cure was still in

effect.







24

Desensitization with relaxation training has been used to reduce

fear of reading in an ll-year-old girl (Word & Rozynko, 1974). She

had begun to fail in reading, apparently because her teacher was

negative and punishing toward her in her reading group. The child was

treated in 10 sessions, each lasting 30 to 90 minutes, twice a week.

During the first two sessions, she was taught to relax. She helped to

write a story about reading during the third session. The remainder

of the sessions involved presentation of a reading hierarchy and

praise for reading.

Very positive results were reported. After two sessions, the

girl became less distractible. By the last session she would volun-

tarily pick up a book and read aloud. She started checking books out

of the library, and her reading grades improved.

Sometimes relaxation training must precede in very small steps. .

Miklich (1973) described teaching relaxation to a 6-year-old hyper-

kinetic asthmatic boy. The boy was rewarded with points for sitting

quietly relaxed with his eyes closed and no evidence of tension. The

sessions took place daily, for about 30 minutes a day. By the 14th

session, the boy could relax for 5 minutes. Next, the child was

rewarded with points for each second he could remain relaxed while the

therapist attempted to "frighten" him with descriptions of progressive-

ly worsening asthma attacks. As a result, the boy's asthma panic and

hyperactivity decreased.

Systematic desensitization sometimes involves the use of several

hierarchies. For example, Miller (1972) discussed the case of a

10-year-old boy with school phobia, separation anxiety, and insomnia.










After relaxation instruction, each phobia was treated with a separate

hierarchy. The treatment successfully eliminated the problems.

Ince (1976) also described the use of relaxation training coupled

with several hierarchies. The subject in this study was a 12-year-old

epileptic boy. He had become fearful of school and peers because of

his seizures. During the first two sessions the child was taught

relaxation. Several hierarchies were then constructed, related to

each of his problem areas: seizures, school, and ridicule by peers.

This procedure resulted in the elimination of all seizures, both

grand mal and petit mal, without medication.

Emotive imagery. A variation of systematic desensitization is

emotive imagery (Lazarus & Abramovitz, 1962). This procedure was

developed for use when relaxation training was not possible. Emotive

imagery involves the use of those types of images which arouse feelings

of pride, self-assertion, affection, humor, and similar anxiety-

reducing responses.

Lazarus and Abramovitz (1962) described the steps involved in

emotive imagery. First, one assesses the nature of the feared situation

and constructs a hierarchy from most to least feared. Then the nature

of the child's hero images are established. The child is next asked

to close his/her eyes and imagine a sequence of events, close to real

life, concerning his/her favorite hero. The child relaxes as the

fantasy is presented. When the therapist observes that the child is

very relaxed (facial expression, breathing, muscle tension), the

therapist introduces the lowest item of the hierarchy into the story.

The child is instructed to raise his/her finger if discomfort or fear

is felt.










Lazarus (1971) described the use of emotive imagery with an

8-year-old boy who was afraid to go to the dentist. He had the child

imagine himself accompanying Batman and Robin on adventures and then

imagine the heroes being treated by the dentist. The boy was asked to

picture this scene five times a day for a week. During the second

session, the child was asked to imagine himself in the dentist's chair,

while Batman and Robin watched. He was told to practice this scene

several times a day for a week. The boy was afterward able to visit

the dentist and sit through four fillings without flinching.

School Settings

Most of the studies of systematic desensitization based on

relaxation training have been in clincial settings, generally with

children who have severe and fairly well-established problems.

Recently, however, there has been increasing interest in using

desensitization within the school setting. Almost all of the experi-

mental studies of systematic desensitization with normal school

children have involved the desensitization of test anxiety.

A few researchers have studied the effects of systematic desen-

sitization of anxiety within the elementary school. For example,

Freedenberg (1975) compared the effects of desensitization and

attentional training, desensitization alone, and a control group with

9- and 10-year-old children high in test anxiety. Desensitization

was described as a variation of Wolpe's method. Attentional training

was described as a discussion of task-irrelevant self-talk (i.e.,

self-derogatory statements) and its relationship to taking tests. The

groups met once a week for 4 to 6 weeks. Although the systematic

desensitization group experienced some reduction in test anxiety,









only the desensitization plus attentional training group resulted in

significantly lower test anxiety. There was no difference between the

treatments on a performance test.

Positive results have been reported in studies which have used

performance measures as criteria. For instance, Barabasz (1973) studied

the effects of systematic desensitization on high- and low-anxious

children. He divided one class each of fifth- and sixth-grade children

into high- and low-anxious groups, based on galvanic skin response. A

control group was also formed from one fifth-grade and one sixth-grade

class.

Relaxation training was presented to the experimental group in

their regular homeroom classes. The first two sessions consisted of

relaxation training, followed by presentation of a test hierarchy

during the next three sessions. If two hands were raised, the step

would be repeated. The highly anxious children who received the

intervention scored significantly higher on an IQ test and were more

relaxed, as measured by their galvanic skin responses, when compared

to the control group. No change was found for the low-anxious group.

However, the results of this study must be viewed with caution. Since

intact classrooms, rather than randomized groups, were used, one

cannot assume that desensitization, rather than other events within

the classrooms, contributed to the outcome.

Deffenbacher and Kemper (1974a) studied the effects of relaxation

training on 21 sixth-grade volunteers. They randomly assigned the

students to an experimental or control group. During the first two

sessions, they taught the children in the experimental group to relax.

During the next five sessions, they presented a test hierarchy.









Counseled children had significant increases in GPA, compared to the

control group. Also, failing students who received counseling improved

significantly more than those who did not. However, these findings

need to be viewed with caution, since there was no attempt to control

for the teachers' positive expectations for children in the experimental

group.

Similarly, positive outcomes were attained by Showalter (1974).

The children involved in this study were 161 highly anxious elementary

and junior high school students. Approximately six sessions of

relaxation training followed by systematic desensitization resulted in

positive outcomes on a math test and an anxiety scale.

Several studies have reported positive results in reducing test

anxiety with middle school children. For example, Deffenbacher and

Kemper (1974b) worked with groups of middle school children who were

high in test anxiety. They followed the standard procedure of presen-

tation of a test hierarchy, preceded by two sessions of relaxation

training. The treatment lasted 6 to 8 weeks. Counseled students,

including those who had been failing, improved significantly in GPA.

As noted by the authors, however, the results of this study must be

regarded with caution, since a control group was not used.

Vicarious desensitization of test anxiety in middle school

students has also been explored. For instance, Mann (1972) randomly

selected 80 seventh- and eighth-grade students from a group of 100

referred by counselors for test anxiety. The children observed the

video-taped desensitization of a genuinely anxious peer model for six

45-minute sessions twice a week. The treatment significantly reduced









test anxiety and increased performance on reading tests of speed and

comprehension.

Positive results with seventh-grade students were also reported

by Mann and Rosenthal (1969). They randomly assigned 70 students to

desensitization and control groups and found that desensitization

reduced test anxiety and improved performance on a reading test. The

students also reported that they felt generally less tense in class and

in social situations.

The results of these studies suggest that relaxation training

combined with systematic desensitization can benefit normal children.

However, several of the studies (e.g., Barabasz, 1973; Deffenbacher &

Kemper, 1974a, 1974b) had methodological weaknesses and must be

viewed with caution. The studies which were well-controlled (e.g.,

Mann, 1972; Mann & Rosenthal, 1969) indicated that systematic desensi-

tization reduces anxiety and facilitates performance on tests.


Relaxation Training

Advantages

While a variety of approaches have been used to relieve anxiety,

the most thoroughly documented has been systematic desensitization

based on muscle relaxation. Indeed, this procedure appears to have

many positive benefits, as noted in the previous section. Recently,

however, there has been increasing interest in the value of relaxation

training without the addition of systematic desensitization.

Behaviorists have traditionally maintained that relaxation train-

ing alone was not effective in reducing anxiety (Rachman, 1968; Wolpo,

1958). The process of desensitization through the use of a hierarchy










or similar procedure was considered to be an essential part of the

process. Indeed, several studies appeared to support the hypothesis

that relaxation training alone was ineffective.

For example, Johnson and Sechrest (1968) compared the effects of

two treatments, relaxation with desensitization and relaxation without

desensitization, with an untreated control group. The subjects, 41

highly anxious undergraduates, were randomly assigned to the groups.

After five individually administered sessions, the groups were compared.

The desensitization group was significantly less anxious and had higher

grades than the relaxation or the control group, which did not differ

from each other. However, the students in the relaxation group were

not instructed to practice or apply their skills outside the group.

Similar results were reported by Hyman and Gale (1973) with

female undergraduates with snake phobia. The 24 subjects were assigned

to three groups: relaxation with neutral scenes, desensitization with

relaxation, and desensitization without relaxation. The treatment was

presented individually once a week for 6 weeks. On the criteria,

galvanic skin response and self-reported fear, the desensitization with

relaxation group had more positive results. The authors concluded that

both systematic desensitization and relaxation were necessary compon-

ents. However, since the students in the relaxation group were not

taught to apply their skills, these results must be regarded with

caution.

Systematic desensitization has also been reported to have more

positive effects than relaxation in reducing drug usage (Yorkston,

McHugh, Brady, Serber, & Sergeant, 1974). They randomly assigned 14

asthmatic adults to a desensitization or a relaxation group. Ratings










by psychiatrists showed a greater decrease in drug usage by the

desensitization group. These benefits were maintained 2 years later

at follow-up. The subjects in the relaxation group, however, were not

instructed to practice relaxation or to use relaxation when they

became tense.

These early studies concluded that systematic desensitization was

essential. Relaxation training alone was not reported to be beneficial.

Recently, however, several studies have indicated that the value of

relaxation training alone may equal or even surpass the benefits of

systematic desensitization. Indeed, Goldfried (1971) contended that

studies reporting no benefit from relaxation training had the following

limitation: Subjects were simply trained in relaxation and never

instructed how or when to use it.

The essential elements of effective relaxation training appear to

be (a) training in deep muscle relaxation, (b) developing awareness of

and sensitivity to muscular tension, and (c) practice and application.

The use of a cue word, such as "relax" is also helpful. This procedure

has been referred to as applied relaxation, relaxation as self-control,

conditioned relaxation, progressive relaxation, and cue-controlled

relaxation. The procedure used in the present study will be referred

to as Deep Muscle Relaxation (DMR).

Several studies have reported that relaxation training may equal

the benefits of desensitization in reducing situational anxiety. For

example, Russell and Wise (1976) compared the effects of cue-controlled

relaxation, systematic desensitization, and control conditions on

undergraduates high in speech anxiety. The students in the relaxation

group were taught to become relaxed in response to a cue word. This







32

association was developed by having the students repeat the word "calm"

while relaxed. The treatment was conducted in groups of two to four

persons for five sessions over a period of 6 weeks. Both treatments

were more effective than no treatment in reducing self-reported speech

anxiety, with no difference between the treated groups. In this study,

neither treatment reduced general anxiety.

Similar results were reported by Zeisset (1968). He assigned 48

neurotic and functional psychotic patients to four groups: systematic

desensitization, progressive relaxation plus application, attention

control, and no-treatment control. The treatments lasted for four

sessions. Both the relaxation and desensitization groups improved on

behavioral ratings and self-reported measures of interview anxiety

with no differences between the two treatments.

Training in relaxation may be as effective as systematic desensi-

tization in reducing test anxiety. Russell, Wise, and Stratoudakis

(1976) reported that, after five sessions, both cue-controlled relax-

ation and desensitization reduced test anxiety in a group of under-

graduates. Similar results were noted by Suinn and Richardson (1971),

who found that both relaxation training and desensitization successfully

reduced anxiety related to math.

Training in relaxation has been reported to be as effective as

systematic desensitization in reducing general anxiety. For instance,

Zenmore (1975) investigated the effects of desensitization and

relaxation as self-control with a group of undergraduates who were

anxious in relation to both public speaking and taking tests. Both

treatments resulted in the reduction of both treated and untreated

fears after eight sessions. Similarly, Deffenbacher and Payne (1977)










reported that both systematic desensitization and muscle relaxation

reduced targeted anxiety and generalized to non-targeted areas.

There is some evidence that relaxation training may have more

generalized effects than desensitization. For example, Chang-Liang and

Denny (1976) investigated the effects of applied relaxation, desensiti-

zation, relaxation without application, and a control condition. The

applied relaxation involved discussion and practice. They reported that

applied relaxation was more effective than the other groups on measures

of general and test anxiety and test performance. The treatment lasted

only 3 weeks.

In an earlier study, Denny (1974) investigated the effects of

relaxation training, several variations of systematic desensitization,

and a control condition. After six to eight individual sessions,

persons involved in applied relaxation received a significantly higher

GPA than persons in the other groups. The greatest decline in prequiz

anxiety was for the relaxation group. In addition, the relaxation

group was the only group to improve significantly on an IQ test,

compared to the control group. However, the desensitization groups

all decreased significantly more in test anxiety than the control

group, whereas the relaxation group did not.

In a study with test-anxious undergraduates, Snyder (1975)

reported similar results. Although both relaxation and desensitization

reduced test anxiety, only the students trained in relaxation experi-

enced a reduction in general anxiety. In addition, students trained in

relaxation changed their perceptions of their ability, themselves, and

their feelings about the unpleasantness of the test-taking situation,

whereas the students in the desensitization group did not.








34

Thus, it appears that relaxation training may have more generalized

benefits than desensitization. Indeed, several authors have suggested

this. For instance, Paul (1969) noted that brief training in relaxation

may provide sufficient skills to reduce physical tension and psycholog-

ical distress. Similarly, Cautela (1969) emphasized several advantages

of relaxation training over desensitization. First of all, with

relaxation training, practice is encouraged more, possibly resulting

in more rapid elimination of the undesired behavior and saving time

and money. Secondly, patients develop self-confidence when they

discover that they have a skill readily available which can effectively

reduce anxiety. A third advantage is that large numbers of people can

be taught at once. Indeed, there has been increasing interest in using

behavioral principles to prevent mental health problems (Poser, 1976),

and relaxation training has this potential.

Other advantages of relaxation training over desensitization have

been suggested. For example, since relaxation training does not

require the construction of hierarchies, it is more easily administered

than desensitization (Russell & Matthews, 1975). One of the difficul-

ties with systematic desensitization is presentation in a group, since

persons often have different hierarchies (Russell & Wise, 1976). In

addition, some persons are anxious in a large number of situations.

Using desensitization in these cases would involve working through a

large number of hierarchies (Russell & Sipich, 1973).

Several authors have emphasized that relaxation training is more

generalizable than systematic desensitization. Deffenbacher (1976),

for example, suggested that relaxation training gives clients skills

to manage and reduce future stress, as well as resolve the immediate










problem. Relaxation can also be taught to high-risk individuals to

prevent future problems (Deffenbacher & Payne, 1977). In addition,

Russell, Lent, and Sipich (1977) suggested that relaxation skills can

easily be used in real-life situations.

Various other advantages have been cited. For instance, it has

been suggested that systematic desensitization results in dependency on

the therapist (Suinn & Richardson, 1971). Relaxation training, on the

other hand, results in greater capacity for self-management (Deffenbacher

& Snyder, 1976). Russell and Wise (1976) suggested that relaxation

training could be successfully administered by carefully trained

paraprofessionals. In addition, relaxation training is preferable to

desensitization for those who cannot achieve vivid hierarchal images

(Zeisset, 1968). Finally, Russell and Sipich (1974) reported that,

since relaxation training is less time-consuming than systematic

desensitization, especially with those who would require a large number

of hierarchies, it may be easily combined with other counseling

procedures. Once trained, a person can experience relaxation of the

16 major muscle groups in about 25 minutes.

Thus, it appears that the benefits of relaxation training may

surpass the results obtained with systematic desensitization. Indeed,

it appears that relaxation training can provide persons with a skill

which can have more long-term and generalized benefits than systematic

desensitization. In addition, relaxation training can be used in a

wide variety of situations and is a method of enhancing general well-

being and preventing future problems.










Relaxation Training with Children

There has been increasing interest in relaxation training with

children. Relaxation scripts, modified for use with elementary school

children, have been published recently (Hendricks & Roberts, 1977;

Hendricks & Wills, 1975; Koeppen, 1974). Although few researchers have

investigated the effects of relaxation training with children, the

studies which do exist tend to show positive results.

Clinical settings. A few studies have explored the effects of

relaxation training with children in clinical settings. For instance,

Davis, Saunders, Creer, and Chai (1973) investigated the effects of

relaxation training on asthmatic children. The 24 children in this

study, whose ages ranged from 6 to 15, were divided into three groups.

One group received relaxation training assisted by biofeedback. A

second group was trained in progressive relaxation. The children in

the control group were simply told to relax.

After five sessions over a period of 3 weeks, the groups were

compared on a physiological measure of airway resistance, which is one

of the symptoms of asthma. Non-severe asthmatics in both relaxation

groups improved, although the greatest change was noted for the group

assisted by biofeedback. However, children classified as severe

asthmatics did not improve. Children also completed the Mood Affect

Checklist. There were no significant differences on this measure.

In a study by Well and Goldfried (1973), the effect of muscle

relaxation on insomnia in an 11-year-old girl was explored. The girl

was trained to relax and provided with tape-recorded relaxation

instructions to help her relax at night. The taped instructions

included directions to tense her muscles first and then relax. Over










a period of several weeks, the taped instructions were faded, as she

learned to attain a deep state of relaxation on her own. Self-

relaxation eliminated her insomnia. Although she had about 40 sessions

of relaxation, only seven of them directly involved the therapist.

Meisels (1976) reported the results of teaching relaxation to a

7-year-old boy who was referred because of nervous habits, including

repetitive finger movements, tics, and walking on tip-toe. He was

taught a modified version of Jacobson's method. After learning

relaxation, he was encouraged to relax in class. The intervention

reduced the nervous finger movements, although it did not eliminate the

other habits.

These studies appear to indicate that relaxation training may be

an effective procedure for children with serious problems. However,

control subjects were not used in two of the studies (Meisels, 1976;

Well & Goldfried, 1973), thus making it difficult to attribute the

results to relaxation training, rather than other variables. The study

by Davis et al. (1973), however, was well-controlled, and its results

indicate that relaxation can be beneficial.

School settings. There are a few studies which have investigated

the effects of relaxation training on children in school. For instance,

Carter and Synolds (1974) used tape-recorded relaxation instructions to

teach a class of 8- to 11-year-old minimally brain-injured children to

relax. Seven minutes of relaxation training were presented three times

a week for 4 weeks. Handwriting, as rated by two judges, improved

significantly for this group, compared to a control group of normal

fourth- and fifth-grade children. The improvement was maintained out








38

of the special class after 4 months. However, because a non-equivalent

control group was used, these results must be viewed with caution.

McBrien (1978) reported the effects of relaxation training with a

hyperactive first-grade boy. In addition to excess activity, the boy

did not do his school work and fought with other children. The

treatment consisted of two 60-minute sessions per week for 12 weeks

with a tutor. Each session included relaxation training, discussion,

tasks to build attention span, and a fun activity. In addition, the

boy earned points when his teacher reported positive behavior to his

mother.

The boy was first taught to relax by tensing and relaxing his

muscles. Tensing was eliminated after four sessions. He was taught

to relax himself in those real-life situations where he would normally

get into trouble. After 2 months, he reported using relaxation to

calm himself to keep out of a fight. After 3 months of intervention,

his mother reported that he was behaving appropriately. According to

his teacher, he was calmer, completing his school work, and not

fighting. However, it is difficult to attribute these positive results

specifically to relaxation training, since a multiple-intervention

approach was used.

In a study by Rossman and Kahnweiler (1977), the effect of

relaxation training on eight fourth- and fifth-grade volunteers was

explored. The children were taught to relax and encouraged to use

relaxation outside the group. The treatment was evaluated by an

"unrefined" scale and a control group was not used. It was noted,

however, that the children began using relaxation in anxiety-producing

situations outside the group.










The relationship between relaxation and learning for black second-

grade children was investigated by Harlem (1976). He assigned 59

children to a relaxation or a placebo control group. Relaxation

training took place for 10 minutes each day for 10 school days. The

procedure was described as a "modified version of autogenic training

developed by the experimenter." In autogenic training, persons are

taught to relax their muscles by statements such as "my right arm is

heavy . my left arm is warm and very heavy." On all dependent

measures, the children in the experimental group improved more than

children in the control group. The dependent measures included digit

span, approach to problems, a paired-associate task, matching familiar

figures, a general ability test, and a measure of relaxation. Gains

were maintained at a 2-week follow-up.


Summary

Excessive anxiety is a serious problem for many children, affecting

many aspects of their lives. Anxiety appears to interfere with learning

and with performance on many types of tasks. In addition, many

undesirable personality characteristics have been associated with high

levels of anxiety, including excessive aggression, dependence, and low

self-concept. Children high in anxiety also appear to have difficulties

in their relationships with teachers and peers.

Many methods have been suggested for reducing anxiety. Of these

methods, relaxation training with systematic desensitization has

received the greatest amount of attention in the literature. Although

this procedure is apparently effective, it is often limited to

reduction of anxiety related to a specific situation. For this reason,

desensitization is generally administered individually.







40

Relaxation training may have more generalized benefits than

desensitization. Training adults in relaxation has been reported to

effectively reduce both general and situational anxiety. Relaxation

training also appears to positively affect performance, as measured by

increases in test scores and grades in several studies.

However, very few articles have explored relaxation training with

children. Most of the articles on relaxation training with children

are descriptive, and there has been little research in this area.

Although the effects of autogenic training on children's anxiety and

test performance have been explored, there has been no systematic

research on the effects of deep muscle relaxation on children's

anxiety, test performance, and behavior.















CHAPTER III
METHODS AND PROCEDURES


Chapter III includes the hypotheses, population, sampling proce-

dures, and procedures for data collection. The method of training in

Deep Muscle Relaxation (DMR) and the procedures for the placebo group

are also discussed. This chapter concludes with a description of the

experimental design and the statistical analysis of the data.


Population and Sample

Population

The population for this study was approximately 324 children who

were identified as anxious. This number represents about 30% of the

fourth-grade students in nine elementary schools (K 5) in the

Alachua County School System of Gainesville, Florida. There were

approximately 120 fourth-grade students in each school. The schools

were racially integrated, with about 60% white and 40C black students,

and there was approximately an equal number of boys and girls in each

school.

Sample

A school counselor in each of the nine schools administered the

Anxiety Identification Scale (AID, Appendix D) in the fourth-grade

classes. Using the AID Scale, which is described more thoroughly in

the "Instruments" section of this chapter, counselors identified







42

anxious children. The number of eligible children was about 30%, or

36 students in each school. The total number of eligible children in

all nine schools was about 324.

There were 135 children involved in the study: 45 receiving

training in DMR, 45 in the placebo control group, and 45 in an untreated

control group. They were selected according to the following criteria.

Children in programs for the mentally retarded, learning disabled, and

emotionally handicapped were eliminated because they were already

receiving specialized attention. Using a table of random numbers, 15

children in each school were selected to participate in the study. Five

children received training in DMR, five children were assigned to a

placebo control group, and five children were placed in an untreated

control group. Children in the untreated control group did not receive

counselor attention until the study was completed. In addition,

counseling for children in the DMR and placebo groups was limited to

the prescribed treatment. All participating children were volunteers.

The ratio of girls to boys was about 2:1 in all three groups.

The nine counselors were certified in elementary school counseling

by the State of Florida Department of Education and were employed full-

time in Alachua County. All of the counselors were female and had

from 2 to 5 years of counseling experience. Counselors were aware that

the placebo group was not considered to be a treated group. Each

counselor facilitated both the experimental and placebo groups.


Hypotheses

This study attempted to investigate the effect of DMR on anxious

children. Since few researchers have investigated relaxation training









with children, this research was exploratory in nature. Therefore, a

rejection-support design was used. The following four hypotheses were

investigated:

1. There is no significant difference in general anxiety, as

measured by the Children's Manifest Anxiety Scale, between children who

experience DMR, a placebo group, and a control group.

2. There is no significant difference in situational anxiety, as

measured by a Feelings Checklist, between children who experience DMR,

a placebo group, and a control group.

3. There is no significant difference in classroom behavior, as

measured by the Walker Problem Behavior Identification Checklist,

between children who experience DMR, a placebo group, and a control

group.


Experimental Procedures

This study took place during the spring of 1978. The chronology

of events, including training of counselors, selection of the sample,

data collection, and training in DMR follows. Additional instructions

for counselors are presented in Appendix A.

First Week

The counselors were trained to teach DMR to children. They had

personally experienced two exercises: "Rag Doll" and "Instant

Relaxation." Then, common difficulties in teaching DMR to children

were discussed. Sampling and data collection procedures were explained.

Second Week

The counselors met with the teachers and administrators in their

respective schools to elicit support for the program and study. The









counselor and teachers in each school established the times for

selecting the population and sample, for the groups to meet, and for

the administration of the instruments to the 15 children involved in

the study.

Third and Fourth Weeks

During this time, as a part of the county testing program,

participating children took the Metropolitan Achievement Test (MAT)

with their classes. The MAT includes the Reading subtest. The sample

was also selected during this time.

Fifth Week

Teachers completed the Walker Problem Behavior Identification

Checklist for all children in the study. Counselors administered the

Children's Manifest Anxiety Scale and the Feelings Checklist.

Sixth Through Tenth Weeks

Experimental group. Children in the experimental group were

trained in DMR. They met with their counselor for 10 30-minute sessions

over a period of 5 weeks (twice a week). The relaxation exercises

were presented on a pre-recorded tape, with the counselors facilitating

the discussion. During the first five meetings, children were taught

to relax their muscles by tensing them first. During the last five

sessions, children practiced DMR without first tensing their muscles

and instead used the cue word "relax." Attention to the physical

awareness of anxiety and relaxation, as well as the daily practice of

DMR, were encouraged throughout the program. As the sessions progressed,

children were increasingly encouraged to use DMR when they became

anxious. An outline of the training sessions in DMR is presented in

Table 1. Appendix B describes the complete DMR program.










TABLE 1

DEEP MUSCLE RELAXATION (DMR) TRAINING SESSIONS




Session Activities and Focus


One Introductions.
Relaxing the arms and legs. Tensing and relaxing
the muscles.
Awareness of muscular tension and relaxation.

Two Relaxing the stomach and back. Tensing and
relaxing the muscles.
Awareness of muscular tension and relaxation.

Three Relaxing the face. Tensing and relaxing the
muscles.
Awareness of tension and relaxation.

Four Relaxing the neck, shoulders, and chest. Tensing
and relaxing the muscles.
Instant relaxation. Tensing and relaxing all
muscles.

Five Deep relaxation. Tensing and relaxing each
muscle, using the cue word "relax."

Six Talking to the body. Relaxing all muscles without
prior tensing, using the cue word "relax."

Seven Relaxing cloud. Experiencing the spread of
relaxation throughout the body, using the cue
word "relax."

Eight Stretching. Relaxing the shoulders.
Rag doll. A quick relaxation exercise.

Nine Earth relaxation. Experiencing the spread of
relaxation through the body, using the cue
word "relax."

Ten Breath awareness relaxation. Awareness of the
role of breathing in relaxation.
Closure.










Placebo group. The purpose of this group was to control for the

effect of counselor attention. Children who were in the placebo group

also met 10 times, twice a week, for 5 weeks. They listened to a pre-

recorded fantasy tape and then discussed how they felt. Although this

group might appear to some readers to be another treatment group, the

children were not instructed in deep muscle relaxation or advised to

practice and apply relaxation. The exercises for this group focused

mainly on affective and cognitive activities. In fact, the fantasy

sessions were edited to minimize relaxation instructions, especially

muscle relaxation. An outline of the fantasy sessions for the placebo

group is presented in Table 2. Appendix C contains the complete content

of the fantasy tapes.

Control group. Children in the control group did not receive

counseling until the study was completed.

Eleventh Week

All instruments, including the Reading subtest of the MAT, were

re-administered during the week following the completion of training

in DMR.


Instruments

Anxiety Identification (AID) Scale

The researcher developed the AID Scale as a screening instrument

to identify anxious children. Six items which appeared to be typical

of the types of items on anxiety scales were selected. A copy of the

instrument is included in Appendix D.

The AID Scale is scored as follows: 2 points are assigned to

each item marked "more than other children," 1 point to each item










TABLE 2

FANTASY SESSIONS




Session Summary


One Creative cave includes a journey into a cave and
and an encounter with a statue which talks.

Two Next to nature takes the children on a canoe trip
on a beautiful sunny day.

Three The head trip involves an imaginative encounter
and conversation with one's "other self."

Four The new you allows the children to fantasize
discarding one personality trait they do not
like.

Five Stump, cabin, stream asks the children to imagine
in detail life as a stump in the forest, a
cabin, and a stream.

Six Motorcycle explores what life would be like as a
motorcycle.

Seven Swapshop takes the children to a shop which has
everything.

Eight Undersea cave takes the children on an undersea
adventure.

Nine Seashore is a journey to the beach.

Ten Still waters of the mind suggests that their
thoughts become like ripples on a lake.










marked "about the same as other children," and 0 points to each item

marked "less than other children." Thus, the possible range of scores

is from 0 to 12. Those children scoring 7 or more points, and who

were also interested in learning to relax more, were considered eligible

to participate.

To determine the validity of the AID Scale, the Children's

Manifest Anxiety Scale and the AID Scale were administered to a

classroom of fourth- and fifth-grade students. The correlation between

these two instruments was .88. Thus, the AID Scale appeared to be a

valid measure of anxiety in children.

To determine the reliability of the AID Scale, it was re-

administered after a 2-month lapse. The correlation after 2 months

was .91. This correlation provided some evidence of the stability of

the AID Scale. Since the scale contains only six items, the researcher

decided not to compute split-half reliability.

Children's Manifest Anxiety Scale (CMAS)

The Children's Manifest Anxiety Scale was developed by Castenada

et al. (1956). It is an adaptation of the Taylor Manifest Anxiety

Scale for use with fourth-, fifth-, and sixth-grade children. The

most widely used anxiety scale with this age group, it contains 42

items related to chronic and general anxiety and 11 items designed to

measure the child's tendency to falsify his/her response (L scale).

For example, some of the items on the anxiety scale are: "I get

nervous when someone watches me work. . I worry most of the time.

I am afraid of the dark." Items on the L scale include: "I

am always good. . I never lie." Children answer "yes" or "no" to

each of the items on both scales. A level of anxiety is computed by









summing the "yes" responses to the anxiety scale items. An L scale

score is the sum of the "yes" responses to the L scale items.

Several studies have measured the reliability of the anxiety scale

of the CMAS. Kitano (1960) reported that the split-half reliability of

the anxiety scale was .86. This study suggested that the CMAS possesses

internal consistency. Castenada et al. (1956) found that the test-

retest reliability after 1 week on a population of 361 students

(fourth-, fifth-, and sixth-grade children) was .90 for the anxiety

scale. With emotionally disturbed children after a 1-month lapse,

Finch, Montgomery, and Deardorff (1974) reported that the test-retest

reliability was .77. Palermo (1959) reported that the test-retest

reliability after 1 month for fourth-grade children was .60 for white

females (N = 66), .63 for black males (N = 18), .89 for white males

(N = 76), and .91 for black females (N = 17). These studies provide

some evidence for the stability of the CMAS.

Reliability for the L scale is somewhat less than that for the

anxiety scale. Castenada et al. (1956) reported that the test-retest

reliability for the L scale after 1 week was .70.

Bledsoe (1973) studied the validity of the CMAS. He administered

the CMAS to 611 students in grades four through seven and factor-

analyzed the data. He reported two factors. One factor contained the

42 items of the anxiety scale; the other factor was composed of the 11

items of the L scale. This provides some evidence for the construct

validity of the CHAS.

The CMAS takes about 15 minutes to administer. Counselors

emphasized that there are no right or wrong answers. Although the










CMAS is a paper-and-pencil test, counselors read the questions to the

children to ensure that they understood the items.

Reading Subtest of the Metropolitan Achievement Test (MAT)

This test contains 45 items designed to measure the student's

ability to comprehend written material. Pupils read a paragraph and

then answer questions about it. Items include comprehending the

literal meaning of paragraphs, drawing inferences from the material,

and identifying main ideas. Some items require determining word

meaning from context. For each question, there are four possible

answers, in a multiple choice format. Examples of the items include:

Mother made a cake. She put candles on it.
The candles told how old I was. Mother got
ice cream and candy. She got paper hats.
She asked children to come to our house.
A Mother was getting ready for--
(A) Halloween (C) Christmas
(B) a birthday (D) a picnic
B In this story the word told means--
(E) said (G) explained
(F) counted (H) asked

Split-half reliability for this subtest has been reported to be

as high as .92 (Durost, Bixler, Wrightstone, Prescott, & Balow, 1971).

Content validity is reported in the Teacher's Handbook (Durost et al.,

1971): the MAT was derived from the types of topics taught in schools.

It has been used in Alachua County for several years to assess programs

and measure student achievement. For the purposes of this study,

however, this test was viewed as a measure of test performance more

than achievement.

Achievement tests are often used to assess the effects of

relaxation training. Finger and Galassi (1977) reported that about







51

60% of the research on the treatment of anxiety has involved the use of

performance criteria to evaluate outcomes. These measures of perfor-

mance include achievement and IQ tests, as well as other types of tasks.

Alternate forms of the elementary battery were used, Form F was

administered as part of the county testing program and used as pretest

data. Form G was administered as the posttest. The Manual for

Interpreting (Prescott, 1973) states that the forms are statistically

equivalent, but does not provide the reliability coefficients.

The test takes 25 minutes to administer. The administrator reads

the directions to the students and shows them two examples. The child-

ren then work on their own.

Feelings Checklist

This instrument is an adaptation of the Affect Adjective Checklist,

developed by Zuckerman (1960) to measure situational anxiety. The

original instrument contained 21 adjectives related to anxiety. The

11 anxiety-plus words (afraid, desperate, fearful, frightened, nervous,

panicky, shaky, tense, terrified, upset, worrying) were scored 1 if

checked. The 10 anxiety-minus words (calm, cheerful, contented, happy,

joyful, loving, pleasant, secure, steady, thoughtful) were scored 1 if

not checked. Adding these two scores yielded the total score, with a

possible range from 0 to 21.

In designing the instrument, Zuckerman (1960) reviewed two studies

where anxious respondents checked certain words on a checklist. Those

words which were common to both studies became the words on the

Affect Adjective Checklist. To determine the validity of the instrument,

it was administered for several days to a group of 35 college students.

The average increase in anxiety scores on exam days was significantly








52

higher (.05 level) than on non-exam days (Zuckerman, 1960). Zuckerman

calculated the internal reliability of the checklist with the Kuder-

Richardson Formula 20. The coefficient was .85.

For the present study, 12 words from the original checklist were

selected: 6 anxiety-plus words (afraid, frightened, upset, nervous,

shaky, worrying) and 6 anxiety-minus words (cheerful, calm, happy,

joyful, pleasant, loving). Pilot studies have indicated that most

children this age understand these 12 words but have difficulty with

the other 9 words. The children were asked to check those adjectives

that described how they felt about being in school that day. Zuckerman's

scoring system was used, with a possible range from 0 to 12.

To determine the reliability of this revised instrument, the

researcher administered it to a classroom of 30 fourth- and fifth-

grade children. They were asked to check each adjective that described

how they felt about being in school that day. A week later, they

again completed the checklist. The checklists of those children who

said they felt the same about school both times (N = 18) were used to

compute a reliability of .88.

This scale takes about 5 minutes to administer. Counselors

emphasized that there are no right or wrong answers. Although the

Feelings Checklist is a paper-and-pencil test, counselors read the

words to the children to ensure that they understood the words.

Walker Problem Behavior Identification Checklist (WPBIC)

This instrument was designed to measure the problem behavior of

fourth-, fifth-, and sixth-grade children. Teachers choose which of 50

behaviors apply to the children. The WPBIC can be completed in 2 to 10

minutes.










The WPBIC yields a total score, as well as scores on five scales

measuring different areas of problem behavior. Scale 1 measures acting

out, including disruptive, aggressive, and defiant behaviors, such as

having temper tantrums. Scale 2 measures withdrawal. This scale

contains items which focus on restricted functioning and avoidance

behavior, such as not having friends and not engaging in group activ-

ities. Scale 3, distractability, measures such behaviors as short

attention span and inadequate study skills, including such items as

underachieves and does not complete tasks. Scale 4, disturbed peer

relations, includes items to measure inadequate social skills and

negative self-image, such as referring to oneself as dumb, stupid, or

incapable. Scale 5, immaturity, includes such items as cries without

provocation and complains of nightmares (Walker, 1970).

With a group of 534 fourth-, fifth-, and sixth-grade children,

Walker (1967) found the split-half reliability of the scale to equal

.98. Walker (1967) also provided evidence for the validity of the

WPBIC. He found that the scores of 38 children identified as disturbed

differed from the scores of non-disturbed children at the .001 level of

significance. Children were identified as disturbed according to one

or more of the following criteria: (a) examined by a psychologist and

referred to a psychiatric or clinical facility, (b) received specific

educational provisions at school due to behavior problems, or (c)

received instruction at home due to inability to profit from school

instruction because of behavior problems. The instrument was reported

to be a valid and reliable predictor of behavior disturbance in

elementary school children.







54

To minimize the halo effect, teachers were not told which children

were in the DMR group and which children were in the placebo group

until after posttesting.


Experimental Design and Analysis of the Data

The design of the study was an elaboration of Campbell and

Stanley's design four, the pretest-posttest control group design

(Campbell & Stanley, 1966). A placebo control group was added,

resulting in a factorial design with three groups: the experimental

group, a placebo group, and a control group.

Pretest and posttest scores were obtained for the experimental,

placebo, and control groups on the CMAS, Feelings Checklist, Reading

subtest of the MAT, and WPBIC. An analysis of covariance, with pretest

scores as covariates, was used to determine whether there were

significant differences between the three groups on each of the

instruments. This statistical method was selected in order to control

for potential variability in the pretest scores. Roscoe (1975)

recommended this analysis for this particular design.
















CHAPTER IV
ANALYSIS OF RESULTS


This study investigated the effects of deep muscle relaxation

(DMR) training, a placebo group, and an untreated control group on

elementary school children who were identified as highly anxious. Data

were obtained on four dependent variables. These were the Children's

Manifest Anxiety Scale, a Feelings Checklist, the Walker Problem

Behavior Identification Checklist, and the Reading subtest of the

Metropolitan Achievement Test. In order to control for initial

differences between the groups, an analysis of covariance was selected

as the statistical test. The .05 level of confidence was used for the

analysis. This chapter reports a systematic analysis of the data

obtained in this study.

Hypothesis 1. There will be no significant difference in general
anxiety, as measured by the Children's Manifest Anxiety Scale,
between children who experience DMR, a placebo group, and a
control group.

The researcher had reasoned that children scoring high on the "L"

scale of the CMAS would not admit anxiety on the AID Scale and would

not become eligible for the study. Children in the reliability and

validity studies for this research who had high "L" scores on the CMAS

did not admit anxiety on the AID Scale. A high "L" score indicates

defensiveness and a reluctance to admit anxiety. Interestingly,

however, several children who had high "L" scores on the CMAS became

eligible for the study. The researcher decided that children who









extensively falsified their responses on the CMAS would not have valid

anxiety scores. In a study by Kitano (1960) the mean score on the L

scale was 4.5 with a standard deviation of 2.3 for normal children

(N = 153) and children with behavior problems (N = 124). Thus, scores

between 2.2 and 6.8 fell within one standard deviation. Considering

these data, the researcher chose to eliminate the scores of all children

scoring 7 or more points on the L scale on either the pretest or the

posttest from the analysis of the CMAS. Thus, for the testing of this

particular hypothesis, 7 children were eliminated from the DMR group,

10 from the placebo group, and 6 from the control group.

The pretest, posttest, and adjusted posttest means for the CMAS

are reported in Table 3. The adjusted posttest mean for each group is

obtained by the formula Y' = Y. bw(Xj M ), where Y. is the obtained

posttest mean of the group, b is the common slope, X. is the obtained
w J
mean of the protest scores of the group, and M is the general mean of

the pretest scores for all groups. Readers are referred to Roscoe

(1975) for a more detailed explanation. An inspection of Table 3

indicates that all groups had a decrease in general anxiety scores

(M M ), with a slightly greater decrease for the DMR group (2.59),
x y
followed by the control group (2.19) and the placebo group (1.71).

The results of the analysis of covariance of the means are

reported in Table 4. The obtained F value of .21 was not significant

at the .05 level of confidence. Therefore, the null hypothesis was

retained.









TABLE 3

MEANS AND STANDARD DEVIATIONS FOR THE
CHILDREN'S MANIFEST ANXIETY SCALE


Pretest Posttest Adjusted
Posttest
Group N M SD M SD M
x x y y

DMR 37 27.75 6.63 25.16 7.74 24.34

Placebo 35 26.91 6.61 25.20 8.23 25.00

Control 37 25.24 5.56 23.05 7.70 24.07






TABLE 4

SUMMARY TABLE FOR THE ANALYSIS OF COVARIANCE FOR THE
CHILDREN'S MANIFEST ANXIETY SCALE



Source
of
Variance df SS SP SS df' SS' MS'
x y y y

Between 2 120.98 108.78 110.54 2 17.15 8.58

Within 106 4180.34 3062.57 6598.52 105 4354.03 41.47

Among 108 L301.32 3171.35 6709.06 107 4371-18


F = .21, n,s.









Hypothesis 2. There will be no significant difference in situational
anxiety, as measured by a Feelings Checklist, between children who
experience DMR, a placebo group, and a control group.

The pretest, posttest, and adjusted posttest means are reported in

Table 5. An inspection of the table indicates that all groups decreased

from pretest to posttest on this measure, with a slightly greater

decrease for the DMR group (1.54), followed by the placebo group (1.27)

and the control group (1.02).

The results of the analysis of covariance of the means are

reported in Table 6. The obtained F value of .03 was not significant

at the .05 level of confidence. Thus, the null hypothesis was retained.

Hypothesis 3. There will be no significant difference in classroom
behavior, as measured by the Walker Problem Behavior Identification
Checklist, between children who experience DMR, a placebo group,
and a control group.

The Walker Problem Behavior Identification Checklist (WPBIC)

yields a total score, as well as scores on five scales measuring

different areas of problem behavior. Means and standard deviations

are reported in Tables 7, 9, 11, 13, 15, and 17. An inspection of the

tables indicates that all groups showed a decrease in problem behavior

from pretest to posttest. On scales 1 (acting out), 2 (withdrawal),

and 3 (distractability), as well as on the total WPBIC, the DMR group

improved more than the other groups. The adjusted posttest mean on

the WPBIC for the DMR group (8.02) was lower than the adjusted means of

either the placebo group (9.60) or the control group (10.60). However,

on scales 4 (disturbed peer relations) and 5 (immaturity), the placebo

group showed the greatest improvement from pretest to posttest,

followed by the DMR group and the control group.









TABLE 5

MEANS AND STANDARD DEVIATIONS FOR THE
FEELINGS CHECKLIST


Pretest Posttest Adjusted
Posttest
Group N M SD M SD M
x x y y

DMR 44 6.02 3.71 4.48 3.39 4.32

Placebo 44 5.36 3.16 4.09 3.03 4.14

Control 42 5.21 2.82 4.19 3.27 4.30


TABLE 6

SUMMARY TABLE FOR THE ANALYSIS OF COVARIANCE FOR THE
FEELINGS CHECKLIST


Source
of
Variance df SS SP SS df' SS' MS'
x y y y

Between 2 16.08 6.87 3.52 2 .61 .31

Within 127 1346.23 457.36 1327.10 126 1171.94 9.30

Among 129 1362.31 464.23 1330.62 128 1172.55


F = .03, n.s.








60

The results of the analysis of covariance of the means are reported

in Tables 8, 10, 12, 14, 16, and 18. The obtained F value of 1.77 for

the total WPBIC was not significant at the .05 level of confidence. The

F values for scales 1 through 5 were .63, .65, 1.84, .74, and .02,

respectively. The F values for the 5 scales also failed to reach

significance. Therefore, the null hypothesis was retained.

Hypothesis 4. There will be no significant difference in test perfor-
mance, as measured by the Reading subtest of the Metropolitan
Achievement Test, between children who experience DMR, a placebo
group, and a control group.

The pretest, posttest, and adjusted posttest means are reported in

Table 19. All groups showed a decrease in mean scores in reading from

pretest to posttest, with the smallest decrease for the control group

(2.0), followed by the DMR group (2.2) and the placebo group (2.41).

An inspection of the adjusted posttest scores indicates a slightly

higher score (27.54) for the DMR group than for the placebo group

(26.74) or the control group (27.02).

The results of the analysis of covariance of the means are reported

in Table 20. The obtained F value of .20 was not significant at the

.05 level of confidence. Therefore, the null hypothesis was retained.

None of the null hypotheses were rejected. Therefore, it was not

necessary to perform further analyses of the data. A discussion of the

findings, implications, and conclusions follows in the next chapter.









TABLE 7

MEANS AND STANDARD DEVIATIONS FOR THE
WALKER PROBLEM BEHAVIOR IDENTIFICATION CHECKLIST


Pretest Posttest Adjusted
Posttest
Group N M SD M SD M
x x y y

DMR 44 14.98 12.21 9.25 9.24 8.02

Placebo 45 14.00 12.40 10.13 10.88 9.60

Control 42 10.69 9.95 8.74 11.22 10.60


TABLE 8

SUMMARY TABLE FOR THE ANALYSIS OF COVARIANCE FOR THE
WALKER PROBLEM BEHAVIOR IDENTIFICATION CHECKLIST


Source
of
Variance df SS SP SS df' SS' MS'
x y y y

Between 2 431.69 84.52 43.85 2 143.33 71.17

Within 128 17243.96 12425.85 14043.57 127 5089.41 40.07

Among 130 17675.65 12510.37 14087.15 129 5231.74


F = 1.77, p = .18










TABLE 9

MEANS AND STANDARD DEVIATIONS FOR THE
WPBIC, SCALE 1 (ACTING OUT)


Pretest

N M SD
x X


5.75

3.98

3.40


6.43

5.68

4.97


Posttest

M SD
y y


2.52

2.64

2.69


Adjusted
Posttest
M


4.62 1.62

4.94 2.91

4.92 3.34


TABLE 10

SUMMARY TABLE FOR THE ANALYSIS OF COVARIANCE FOR THE
WPBIC, SCALE 1 (ACTING OUT)


Source
of
Variance df' SS SP SS df' SS' MS'
x y y Y

Between 2 129.80 50.69 21.46 2 11.93 5.65

Within 128 4207.35 2784.65 2984,27 127 1140.62 8.91

Among 130 4337.15 2835.34 3005.73 129 1152.55


F .63, n.s.


Group


DMR

Placebo

Control










TABLE 11

MEANS AND STANDARD DEVIATIONS FOR THE
WPBIC, SCALE 2 (WITHDRAWAL)


Pretest Posttest Adjusted
Posttest
Group N M SD M SD M
x x y y

DMR 44 1.95 2.85 1.07 2.43 .87

Placebo 45 1.80 2.90 1.44 3.53 1-35

Control 42 1.24 2.47 .86 2.10 1.17


TABLE 12

SUMMARY TABLE FOR THE ANALYSIS OF COVARIANCE FOR THE
WPBIC, SCALE 2 (WITHDRAWAL)


Source
of
Variance df SS SP SS if' SS' MS'
x y y y

Between 2 12.16 6.01 7.63 2 4.99 2.50

Within 128 968.73 695.57 983.16 127 483.66 3.84

Among 130 980.89 701.58 990.79 129 502.35


F = .65, n.s.









TABLE 13

MEANS AND STANDARD DEVIATIONS FOR THE
WPBIC, SCALE 3 (DISTRACTABILITY)


Pretest Posttest Adjusted
Posttest
Group N Mx SD M SD M
x x y y

DMR 44 3.98 3.34 2.77 3.34 2.70

Placebo 45 3.78 3.22 3.13 3.22 2.98

Control 42 3.21 2.97 2.86 2.97 3.38











TABLE 14

SUMMARY TABLE FOR THE ANALYSIS OF COVARIANCE FOR THE
WFBIC, SCALE 3 (DISTRACTABILITY)



Source
of
Variance df SS SP SS df' SS' MS'
x y y y

Between 2 13.39 .25 3.17 2 11.08 5.54

Within 128 1295.83 1009.39 1170.07 127 384.41 3.00

Among 130 1309.22 1009.64 1173.24 129 395.49


F = 1.84, p .17










TABLE 15

MEANS AND STANDARD DEVIATIONS FOR THE
WPBIC, SCALE 4 (DISTURBED PEER RELATIONS)


Pretest Posttest Adjusted
Posttest
Group N M SD M SD M
x x y y

DMR 44 1.34 2.24 .73 1.40 .82

Placebo 45 1.98 3.07 1.02 2.82 .76

Control 42 1.19 2.48 .95 1.45 1.13


TABLE 16

SUMMARY TABLE FOR THE ANALYSIS OF COVARIANCE FOR THE
WPBIC, SCALE 4 (DISTURBED PEER RELATIONS)


Source
of
Variance df SS SP SS df' SS' MS'
x y y y

Between 2 15.38 3.16 2.10 2 3.00 1.50

Within 128 881.35 481.49 519.61 127 256.57 2.02

Among 130 896.73 484.65 521.71 129 259.77


F = .74, n.s.










TABLE 17

MEANS AND STANDARD DEVIATIONS FOR THE
WFBIC, SCALE 5 (IMMATURITY)


Pretest Posttest Adjusted
Posttest
Group N M SD M SD M
x x y y

DMR 44 1.95 2.75 1.43 2.53 1.51

Placebo 45 2.47 2.85 1.67 2.48 1.46

Control 42 1.64 2.46 1.36 2.63 1.54


TABLE 18

SUMMARY TABLE FOR THE ANALYSIS OF COVARIANCE FOR THE
WPEIC, SCALE 5 (IMMATURITY)


Source
of
Variance df SS SP SS df' SS' MS'
x y y y

Between 2 15.13 5.82 2.29 2 .17 .09

Within 128 930.75 441.23 828.44 127 619.27 4.88

Among 130 945.88 447.05 830.73 129 619.44


F = .02, n.s.










TABLE 19

MEANS AND STANDARD DEVIATIONS FOR THE
READING SUBTEST OF THE MAT


Pretest Posttest Adjusted
Posttest
Group N M SD M SD M
x x y y

DMR 44 31.20 9.25 29.00 9.08 27.54

Placebo 43 28.60 9.14 26.19 8.79 26.74

Control 44 28.06 8.65 26.06 8.63 27.02












TABLE 20

SUMMARY TABLE FOR THE ANALYSIS OF COVARIANCE FOR THE
READING SUBTEST OF THE MAT



Source
of
Variance df SS SP SS df' SS' MS'
x y y y

Between 2 244.71 242.66 243.66 2 13.95 6.98

Within 128 9995.08 7739.98 10398.42 127 4404.66 34.68

Among 130 10239.79 7982.64 10642.08 129 4418.61


F = .20, n.s.
















CHAPTER V
SUMMARY, DISCUSSION, LIMITATIONS, RECOMMENDATIONS, AND CONCLUSIONS


Summary

The purpose of this study was to investigate the effects of

training in relaxation on anxious fourth-grade children. Specifically,

the study investigated four hypotheses related to the children's

general anxiety, anxiety about school, test performance, and classroom

behavior.

Children were selected from fourth-grade classes in nine schools

in Alachua County, Florida. Counselors administered a screening

instrument, the Anxiety Identification (AID) Scale in the classrooms.

From the AID Scale, counselors determined which children were eligible

to participate in the study.

At each of the nine schools, the eligible children were randomly

divided into three groups of five children each: the Deep Muscle

Relaxation (DMR) group, a placebo group, and a control group. Thus,

a total of 135 children participated in the study: 45 in the DMR

group, 45 in the placebo group, and 45 in the control group.

The children in all three groups were administered three criterion

instruments, which included the Children's Manifest Anxiety Scale

(CMAS), a Feelings Checklist, and the Reading subtest of the

Metropolitan Achievement Test (MAT). Teachers completed the Walker

Problem Behavior Identification Checklist (WPBIC). These four

instruments were administered before and after the treatment.

68








69

The study lasted 11 weeks. During the first week, counselors were

trained to teach DMR to the children. In the second week, counselors

met with the teachers in their schools to establish times for groups and

data collection. During the third and fourth weeks, the sample was

selected and all fourth-grade children were administered the MAT in

their classes. In the fifth week, counselors administered the CMAS and

Feelings Checklist, while teachers completed the WFBIC. During the

sixth through tenth weeks, children in the DMR and placebo groups met

with their counselors. Each group met twice a week for a total of 10

sessions. The children in the control group did not receive counseling

during this time. During the eleventh week, the criterion measures were

re-administered.

Analyses of covariance, with pretest scores as covariates, were

used to determine whether there were significant differences between the

means of the three groups. Although the mean differences were in favor

of the DMR group, the analysis of covariance on each of the criterion

measures--the CMAS, Feelings Checklist, Reading subtest of the MAT,

and WPBIC--indicated no significant differences. All four null

hypotheses were retained.


Discussion

Although the results of the statistical analysis of the WPBIC

indicated no statistically significant differences, the DMR group had

the lowest adjusted posttest mean. Thus, children in the DMR group

displayed less problem behavior than children in the other groups when

pretest differences were considered. One possible explanation for the

lack of significant difference is that the instrument may not have been










sensitive enough to show subtle changes which occurred. Indeed,

anecdotal evidence indicated that counselors and teachers noticed

changes in the children. Some commented that the WPBIC was not

calibrated enough to measure these changes.

The DMR group decreased more on the CMAS than the other two groups

from pretest to posttest, although no significant differences were

found between the three groups. When completing the posttests, several

children told the counselors that they were more relaxed and wanted to

answer "sometimes" rather than a simple "yes" or "no" to the questions.

The format of the CMAS did not allow for this, and this may have

prevented the children from reporting any significant changes.

On the Feelings Checklist, although the statistical analysis

revealed no significant differences, the DMR group again decreased more

from pretest to posttest than the other two groups. Once again,

several children told counselors that the changes they experienced

could not be reported accurately on the checklist. For example, one

child said, "I'm still nervous sometimes, but not as much."

Interestingly, although no stastically significant differences

were found using the Reading subtest of the MAT, the adjusted posttest

mean of the DMR group was higher than the adjusted posttest means of

the placebo and control groups, suggesting that DMR had a more positive

effect on test performance than the other two groups. A possible

explanation for the lack of stastically significant results is that

the children may have needed assistance in applying relaxation skills

to the testing situation. Role playing within the DMR group or

teacher support in the classroom might have facilitated the generaliza-

tion of relaxation skills.










Although no statistically significant results were found on any

instrument, it is interesting that all groups decreased from pretest

to posttest on all the criterion measures. Due to high pretest

scores, it is possible that the posttest scores might reflect

regression toward the mean. For example, the pretest means on the

WPBIC for the DMR (14.98) and placebo (14.00) groups were above the

mean of 11 for normal children in the standardization studies for this

instrument. In addition, the pretest scores on the CGAS and Feelings

Checklist were well above average compared to the scores of children

in the reliability studies for these instruments. Finally, the

percentile rank of the mean of the pretest scores on the Reading

subtest was .88 for the DMR group and .84 for the placebo and control

groups. However, there is a second possible explanation for the

decrease in anxiety and problem behavior for all three groups.

Regular guidance sessions were conducted by the counselors in some

of the classrooms, and these sessions may have affected the children's

feelings and behavior.

The lack of statistically significant results was surprising to

the investigator and the counselors in view of the positive comments

by children. Counselors, teachers, children, and parents indicated

that DMR was of benefit to the children. Some examples of anecdotal

comments follow.

Some children told the counselors that they were
not as anxious as before.

Several children who suffered from insomnia reported
that they could get to sleep faster if they used DMR.

One child used relaxation on the way to the hospital
after he was stabbed to control his pain and fear.










Another child said of the group, "Something is
happening to me. This isn't me. I never used
to be funny." The counselor believed that
learning relaxation had facilitated this change.

Similarly, the mother of another child made the
unsolicited comment that the DMR group had
"changed my child's life." She felt that her
daughter had become more outgoing as a result
of the DMR group. Three months after the group
ended, she reported that her child continued to
practice DMR regularly and had taught it to her
younger brother.

Other parents also told the counselors how
appreciative they were that their children
were learning to relax.

One counselor said, "You can tell that the
children are really relaxed in the group. They
go back to class real quietly, even though it's
the end of the day."

Some teachers also claimed that the children
had changed, but reported that the WPBIC was not
sensitive to the changes they observed.

One counselor reported that the children enjoyed
the group so thoroughly that they wanted to meet
every day.

Within the schools, there was tremendous enthusiasm and support

for the DMR group. In one school, after the DMR group had met only

two times, the fourth-grade teachers whose classes were not already

involved in the study asked for DMR groups for their children. A

teacher at another school requested that DMR be taught to the whole

class so that she could learn to relax, too.

As an indication of their enthusiasm for DMR, some of the

counselors taught DMR to the control group and classrooms which

contained control group children the last week of school, as soon

as posttests were collected. Most plan to use DMR in the future.










Several said it was one of the most enjoyable, meaningful, and

effective procedures they had used with this age child.


Limitations

The instruments used in this study may not have been sensitive

enough to ascertain important positive changes that were apparent as

a result of relaxation training with the children. Teachers and

children indicated that the yes/no format of the CMAS, Feelings

Checklist, and WPBIC made it impossible to communicate the changes

they noticed. Perhaps a Likert-type scale would have been more

sensitive to the degree of change.

Some children may not have received enough practice in DMR.

Although frequent practice of relaxation is an essential element of

DMR, some children admitted not using relaxation very often outside

the group. Perhaps more frequent meetings would have helped establish

the habit of using relaxation regularly. In addition, parents and

teachers might have been directly involved in encouraging practice

and use of relaxation skills.

A third limitation is that some of the children in the study had

serious emotional problems and were extremely anxious. Of the 131

children who completed the study, 32 scored more than 21 points on

the WPBIC, which is an indication of serious emotional problems. It

was intended that these children would have been screened out by

eliminating children in classes for the emotionally handicapped.

Counselors indicated that many of these children needed a more

long-term, intensive intervention, rather than a short-term group.








74

For many of the counselors, this was their first exposure to any

systematic form of relaxation training, and this may have been a

limitation. They reported that this procedure was very different

from other methods they had used with children. Perhaps more

experience and training in DMR would have helped them better facilitate

the groups.


Recommendations

The positive reactions of children, counselors, teachers, and

parents and the consistent trend in the results in favor of the DMR

group were encouraging. Since this was the first systematic study of

the effects of DMR with this age child, further research is recommended.

A study examining a wider variety of variables might yield

important information. For instance, what are the effects of other

forms of relaxation, such as yoga, meditation, fantasy, and biofeed-

back? Are there any personality variables which determine who

benefits most from each of the various methods of relaxation?

The group composition might also be modified. It is possible

that groups composed of just one sex would be less distracted.

Initial anxiety level might also be a factor in selecting groups.

Extremely anxious children with serious emotional problems may need

to proceed in much smaller steps, and for many more sessions, than

the anxious child who is otherwise normal.

More sensitive criterion measures may be needed. For example,

objective measures of specific behaviors may be more likely to be

effected in a short period of time. Counting the number of headaches,

stomachaches, fights, or times the child feels anxious could provide










important information. In addition, items on the WPBIC and anxiety

scale of the CMAS describe only negatively worded behaviors.

Instruments measuring increases in positive behavior might reflect

more change. Also, biological measures, such as GSR, cardiac rate,

or blood pressure, might be useful indicators of change. Finally, a

concentration task, rather than an achievement test, might be more

reflective of change.

Another recommendation is that teachers and parents become more

involved in the DMR program. As mentioned in Chapter II, anxiety

results from negative relationships with parents. Sometimes teachers

contribute to anxiety in children. Thus, involving these significant

others in the treatment may have an even greater impact on the

children. Parents and teachers could also help children remember to

practice relaxation and thus assist the children in generalizing their

relaxation skills from the counselor's office to home and school.

An important outcome of this study is the development of the

Anxiety Identification (AID) Scale. It appears to be a valid and

reliable measure of anxiety. Its test-retest reliability of .91,

after 2 months, compares favorably with CMAS reliabilities of .90,

after 1 week, and .?7, after 1 month. Six items, contrasted with the

42 anxiety items on the CMAS, make it an instrument that is easier to

administer and score.


Conclusions

As a result of this study, it appears that DMR was not signifi-

cantly more effective in reducing anxiety than a placebo or a control

group. However, the DMR group tended to have more positive outcomes








76

on the criterion measures. In addition, the positive responses of

children, teachers, parents, and counselors suggested that the

children were learning to relax. Since few systematic studies of

relaxation training with children have been attempted, procedures and

instruments need to be refined. Considering the negative effects of

high levels of anxiety, further research is recommended.

















APPENDIX A
DIRECTIONS FOR COUNSELORS


Environment

Meet with the groups in your office. Choose quiet times to meet,
when you will not be interrupted, and place a "Do Not Disturb" sign on
the door. The children can lie on a carpeted floor or sit in
comfortable chairs, depending on the facilities available and your
preference.


DMR Group

Facilitation of Relaxation

These are the steps to facilitate relaxation. First of all,
children on the floor should lie on their backs. Second, relaxation
is easier if shoes are removed. Third, hands should be kept to
oneself. Fourth, turning off the light can be used as a cue for
quiet and to facilitate relaxation. Fifth, eyes should be kept
closed while the tape plays. Finally, if you do the exercises and
follow-up yourself, you will be better able to facilitate the
children's experience.

Discussion

Although the relaxation exercises are tape-recorded, counselors
are responsible for the discussion before and after the exercises.
The discussion topics (listed in Appendix B) are merely a guide to
discussion. Be yourselves, use your facilitative skills, and be
aware of the needs of your group, rather than mechanistically
following the guide.


Placebo Group

Play the fantasy tape for the children in the placebo group and
then ask the children how they felt about the experience. Do not
teach the children DMR or instruct them to practice or apply
relaxation.








78

Communication with Counselors

Contact with the counselors was considered crucial to the success
of the study. This was especially important since the researcher lived
200 miles away from Gainesville. Constant communication was maintained
through letters, telephone calls, and traveling to Gainesville. The
researcher met with the counselors as a group two times before the
study began to review procedures and provide experiential activities.
As the study proceeded, the researcher continued communication through
weekly telephone calls and letters to each counselor. In addition,
one of the counselors served as the local coordinator. The coordinator
met with the counselors at their regular meetings to ascertain whether
the study was proceeding as planned.
















APPENDIX B
THE DMR TRAINING SESSIONS


The materials for these DMR training sessions were drawn
primarily from the following sources: Bernstein and Borkovec (1973),
Carkhuff (1969), Hendricks and Roberts (1977), Hendricks and Wills
(1975), Kelly (1972), Koeppen (1974), Lazarus (1972), Russell and
Sipich (1973), and Wittmer and Myrick (1974).


Session One--Relaxing Arms and Legs

Goals

Each child will learn the name of everyone else. Children will
learn to relax their arms and legs by tensing and relaxing their
muscles. The counselor will focus the children's awareness on the
contrasting feelings of tension and relaxation.

Exercises

Introductions. If the children are from different classes, go
around the group and have everyone say their name. Then allow the
children to take turns naming everyone in the group, until they know
each other's names.

Discussion. Explain the purpose of the group: In this group we
are going to learn to relax better. We cannot be tense and relaxed
at the same time. The exercises we wil be learning will help us
when we feel worried, nervous, or tense. These exercises are nothing
mysterious. You won't be hypnotized or asleep, but you will be
relaxed. You will need to try hard to do exactly what I say. Pay
attention to how your muscles feel when they are tight and when they
are relaxed. Are there any questions before we start?

Relaxation training. "We will begin to learn to relax by
tightening and then relaxing our muscles. You will need to close
your eyes and be very still and quiet. You will need to listen to
my voice and try hard to do exactly what I say. Settle back. Let
your arms and legs and head rest comfortably. Become still now.
"Close your eyes and let yourself sink down, resting there,
very still and very comfortable. Listen to my voice and let all
other noises just fade away."

"Pretend you have a whole lemon in your right hand. Now
squeeze it hard. Try to squeeze all the juice out. Feel the










tightness in your hand and arm as you squeeze. Now drop the lemon.
Notice how your muscles feel when they are relaxed. Take another
lemon and squeeze it. Try to squeeze this one harder than you did
the first one. That's right. Real hard. Now drop the lemon and
relax. See how much better your hand and arm feel when they are
relaxed" (Koeppen, 1974, p. 17). Repeat for the left hand and amn.

"Now pretend that you are standing barefoot in a big, fat mud
puddle. Squish your toes down deep into the mud. Try to get your
feet down to the bottom of the mud puddle. You'll probably need your
legs to help you push. Push down, spread your toes apart, and feel
the mud squish up between your toes. Now step out of the mud puddle.
Relax your feet. Let your toes go loose and feel how nice that is.
It feels good to be relaxed. Back into the mud puddle. Squish your
toes down. Let your leg muscles help push your feet down. Push your
feet. Hard. Try to squeeze that mud puddle dry. Okay. Come back
out now. Relax your feet, relax your legs, relax your toes. It
feels good to be relaxed. No tenseness anywhere. You feel kind of
warn and tingly" (Koeppen, 1974, p. 20).

"Be aware of your body. How are you feeling? Where are you
relaxed? Is there any part that is tense? Take a deep breath, let
it out slowly, and relax all over, giving in to the pleasant feeling
of relaxation. In order to become really good at relaxing, you need
to practice every day. At night, before you go to sleep, is a good
time. Just tighten then relax your muscles. Or remember the lemon
and the mudpuddle. Relaxing at night can help you go to sleep.
"Now, when I count to three, you can open your eyes. One, you
are becoming more alert; two, you are even more alert; and three, you
can open your eyes. Wiggle your toes, legs, hands, and shoulders a
little as you sit up to help you become more alert."

Discussion. How did you like that? How did you feel? Was it
difficult or easy to relax? Did you feel the difference between
being relaxed and tense? Was there anything else you noticed?

Follow-up activity. Between now and the next session, try to
notice a time when you feel relaxed and a time you feel tense. We'll
talk more about this next time. Try to practice these exercises
every day. Before you go to sleep is a good time.


Session Two--Relaxing the Stomach and-Baek

Goals

By tensing and relaxing their muscles, the children will learn
to relax their stomach and lower back. The children will become more
aware of the contrasting feelings of tension and relaxation.










Exercises

Discussion. Think for a moment of the time since our last
meeting. Try to remember a time you felt calm and relaxed and a time
you felt nervous or upset. Does anyone remember a time when you were
relaxed and calm? (Help them elaborate, focusing on physical and
emotional feelings.) Did anyone have something happen that made them
feel nervous or upset? (Help them expand.)
Did anyone remember to practice the exercises? (If yes, let them
tell which ones they practiced and when they practiced. If not, that's
OK. It will take a while to learn a new behavior.) We can use these
relaxation exercises to help us when we get tense or nervous. Today
we are going to practice some more relaxation exercises. Does anyone
have any questions before we start?

Relaxation training. "Get comfortable. Let your feet and arms
rest comfortably. Don't hold back. Just sink down and let yourself
go. Remember to pay attention to my voice and try hard to do as I
say. Close your eyes and don't open them until I tell you to.
Remember to pay attention to your muscles and how they feel when they
are tight . how they feel relaxed. Pay attention to my voice,
letting all outside noises fade away."

"Hey! Here comes a cute baby elephant. But he's not watching
where he's going. He doesn't see you lying there in the grass, and
he's going to step on your stomach. Don't move. You don't have time
to get out of the way. Just get ready for him. Make your stomach
very hard. Tighten up your stomach muscles real tight. Hold it. It
looks like he is going the other way. You can relax now. Let your
stomach go soft. Let it be as relaxed as you can. That feels so
good. Oops, he's coming this way again. Get ready. Tighten up your
stomach. Real hard. If he steps on you when your stomach is hard,
it won't hurt. Make your stomach into a rock. Okay, he's moving
away again. You can relax now. Kind of settle down, get comfortable,
and relax. Notice the difference between a tight stomach and a
relaxed one. That's how we want it to feel--nice and loose and
relaxed" (Koeppen, 1974, p. 19).

"This time imagine that you want to squeeze through a narrow
fence and the boards have splinters on them. You'll have to make
yourself very skinny if you're going to make it through. Try to be as
skinny as you can. You've got to get through. Now relax, You don't
have to be skinny now. Just relax and feel your stomach being warm
and loose. Okay, let's try to get through that fence now. Squeeze
up your stomach. Make it touch your backbone. Get it real small and
tight. Get as skinny as you can. Hold tight, now. You've got to
squeeze through. You got through that skinny fence and no splinters.
You can relax now. Settle back and let your stomach come back out
where it belongs. You can feel really good now. You've done fine"
(Koeppen, 1974, p. 19).

"Now take a deep breath, let it out, and relax all over. Breathe
in and out slowly. Don't hold your breath. Just let it flow in and










out. Feel how good it is to be relaxed. When I count to three, you
can open your eyes. One, two, three, you can open your eyes. Stretch
and wiggle around a little as you get up to help you become more
alert."

Discussion. How was that? Was there anything that made it
hard for you to relax? Did anyone find it easy to relax? How about
the difference between being tight and relaxed? Did you notice the
difference in the feelings in your muscles? Can you describe the
difference?

Follow-up activity. Again, between now and the next meeting, pay
attention to times when you feel relaxed and times when you feel
nervous, worried, or tense. Remember to practice these exercises.
Before bed is a good time to practice. You can use these exercises
to help you relax when you feel worried or nervous.


Session Three--Relaxing the Face

Goals

The children will develop skill in relaxing the facial muscles
by tensing and relaxing various muscles. The children will become
more aware of the contrasting feelings of tension and relaxation.

Exercises

Discussion. Take a moment and think back since our last meeting.
Was there a time you felt relaxed? (Help them talk about it, focusing
on physical and emotional feelings.) Do you remember a time you felt
nervous or tense? Have you remembered to practice these exercises
outside the group? (Let then give an example if they have.) Have
you used any of these exercises when you felt tense or nervous? (It
is possible, but not expected. If they have, let them describe the
experience.)

Relaxation training. "Let your body find a position where you
can be completely comfortable. Just sink down. Let go completely,
sinking down. Close your eyes. Let all other sounds just fade away.
Listen only to my voice."

"Here comes a pesky old fly. He has landed on your nose. Try
to get him off without using your hands. That's right, wrinkle up
your nose. Make as many wrinkles in your nose as you can. Scrunch
your nose up real hard. Good. You've chased him away. Now you can
relax your nose. Oops, here he comes back again. Right back in the
middle of your nose. Wrinkle up your nose again. Shoo him off.
Wrinkle it up hard. Hold it just as tight as you can. Okay, he
flew away. You can relax your face. Notice that when you scrunch up
your nose that your cheeks and your mouth and your forehead and your
eyes all help you, and they get tight, too. So when you relax your








83
nose, your whole face relaxes, too, and that feels good. Oh-oh. This
time that old fly has come back, but this time he's on your forehead.
Make lots of wrinkles, trying to catch him between all those wrinkles.
Hold it tight now. Okay, you can let go. He's gone for good. Now
you can just relax. Let your face go smooth, no wrinkles anywhere.
Your face feels nice and smooth and relaxed" (Koeppen, 1974, p. 18).

"Allow your whole body to relax. If there is any place that is
tense, tell that place to relax, and let the tensions drain out into
the floor. Feel how good it is to be so relaxed, so calm, so
peaceful. Pay attention to your breathing. Watch your breath flow
in and out. Now take a deep breath, let it out slowly, and relax all
over. Feel how good it is to be so relaxed. You can use these
exercises to help you relax when you feel tense or nervous. Just
remember to tighten and then relax your muscles; or you can remember
the mud puddle, the fly, the fence, the lemon, or the elephant.
Remember to practice these exercises every night before you go to
sleep, so you can become very good at relaxing. Now, on the count of
three, you can open your eyes. One, you are starting to become more
alert; two, you are even more alert; and three, you can open your
eyes. Stretch a little to help yourself become even more alert."

Discussion. How did you like that? What was the hardest thing
that we did today? What did you find the easiest to do? When did you
feel the most relaxed? What else were you aware of?
Today we learned to relax our face. What are some of the other
relaxation exercises we have learned? (If time allows and the children
seem receptive, you can do some "special requests" of exercises from
the previous sessions.)

Follow-up activity. Practice outside the group, every night
before you go to sleep. Try to be aware of a time you feel nervous
or worried and a time you feel relaxed and calm.


Session Four--Relaxing the Neck, Shoulders, and Chest; Instant Relaxation

Goals

The children will learn to relax their upper trunk and neck and
then their entire body. The cue word "relax" will be introduced.

Exercises

Discussion. Did you notice a time when you were relaxed and
calm? A time when you were tense? Did you practice or use the
exercises outside the group? (If yes, let them discuss their
experiences. If not, help them discuss what is preventing them from
practicing. Encourage daily practice so they will become really
good at relaxing.)










Relaxation training. "Let your arms find a comfortable position.
Let your legs lie loose and relaxed. Let your head find a comfortable
place. Close your eyes and sink down, being as relaxed as you can.
Let all outside noises fade away. Listen only to my voice."

"Now pretend you are a turtle. You're sitting out on a rock by
a nice, peaceful pond, just relaxing in the warm sun. It feels nice
and warn and safe here. Oh-oh! You sense danger. Pull your head
into your house. Try to pull your shoulders up to your ears and push
your head down into your shoulders. Hold in tight. It isn't easy to
be a turtle in a shell. The danger is past now. You can come out
into the warn sunshine, and once again, you can relax and feel the
warm sunshine. Watch out now! More danger. Hurry, pull your head
back into your house and hold it tight. You have to be closed in
tight to protect yourself. Okay, you can relax now. Bring your head
out and let your shoulders relax. Notice how much better it feels to
be relaxed than to be all tight. One more time, now. Danger! Pull
your head in. Push your shoulders way up to your ears and hold tight.
Don't let even a tiny piece of your head show outside your shell.
Hold it. Feel the tenseness in your neck and shoulders. Okay, you
can come out now. It's safe again. Relax and feel comfortable in
your safety. There's no more danger. Nothing to worry about.
Nothing to be afraid of. You feel good" (Koeppen, 1974, p. 18).

"Now tense every muscle in your body at the same time. Legs,
arms, fists, face, shoulders, stomach. Hold them . tightly. Now
say the word 'relax' to yourself and relax all over. Take a breath
and, as you breathe out, say the word 'relax' to yourself, relaxing
completely. Let your whole body go limp. Feel the tension pour out
of your body and mind . replacing the tension with calm, peaceful
energy . letting each breath you take bring calmness and relax-
ation into your body. Just think the word 'relax' as you breathe
out and feel yourself relax all over. Feel how good it feels to be
so relaxed.
"Now, tense every muscle in your body and at the same time take
a deep breath. Hold your body tense and hold your breath for a few
seconds. Then say 'relax' to yourself and, when you do, let your
breath go and relax. Take a deep breath and hold it about 10 seconds.
Then say 'relax' to yourself and let yourself go. When you feel like
relaxing, just take a deep breath, say 'relax,' and let it all go.
Practice this again by yourself two or three times. Now, on the
count of three, slowly open your eyes. One, two, three, you can open
your eyes" (Adapted from Hendricks & Wills, 1975).

"Wiggle around a little and stretch to help you become even more
alert."

Discussion. How was that? When did you feel the most relaxed?
Was there anything hard about it? What are some situations when
you feel nervous, tense, or worried? What exercises could you use
at these times to relax?










Follow-up activity. Practice relaxation outside the group, at
least once a day. Before you go to sleep at night is a good time to
practice. Try to be aware of when you feel worried or nervous and
when you feel calm and relaxed. Try using these exercises when you
feel nervous or tense.


Session Five--Deep Relaxation

Goals

The children will practice tensing and relaxing all body parts,
using the cue word "relax."

Exercises

Discussion. Did you notice a time when you were relaxed and
calm? Did you notice a time when you were nervous and tense? Did
you try to relax? Were there any times when you were nervous and
could have used a relaxation exercise, but didn't?

Relaxation training. "This is an activity that can help us learn
to relax our bodies and minds by tensing and relaxing our muscles. We
cannot be tense and relaxed at the same time, so if we learn to relax,
we can avoid wasting energy through muscle tension. If you ever feel
tense, while asking a question, or taking a test, or anytime, you can
use the feeling of relaxation to feel better.
"Close your eyes and think of your hands. Feel the bones inside
them; feel the muscles that move the bones; feel the weight of them
on the floor. Now make a fist with your hands and clench them
tightly. Hold your hands tightly. Now relax and feel the soothing,
tingly feeling of relaxation come into your hands. (Pause 10 seconds
or so between instructions.) Now draw up your arms and tighten your
biceps as tight as you can. Hold them tightly. Now say 'relax' and
feel the tension drain out of your arms. Shrug your shoulders now,
pushing them as if to push them up through your ears. Hold them
tightly there. Now tell them to relax and feel all the tension drain
out of your body.
"Continuing to keep your eyes closed, open your mouth as far as
it will go, stretching the muscles at the corners of your mouth. Hold
it tightly. Tell your mouth to relax and enjoy the tingling feeling
as the tension dissolves in your mouth. Now press your tongue against
the roof of your mouth and tighten your jaw muscles. Press tightly
and hold it. Tell your mouth to relax; let go and relax. Let the
peaceful feeling of relaxation flow through your body. Now wrinkle
your nose and make a face. Scrunch up your face tightly and hold it.
Say 'relax' as you let your face go, feeling the tension flow out of
your face. Now tighten the muscles of your chest, stomach, and
abdomen. Draw all of the muscles in tightly and hold them tense.
Now let them go, saying 'relax' as you do, feeling the soothing
feeling of relaxation pour in. Feel how good it feels to be relaxed.










"Now tense the muscles of your thighs by straightening your legs.
Hold them tightly. Tell your thighs to relax. Let all of the tension
drain out of them. Now tense the backs of your legs by straightening
your feet. Hold your legs tensely. Now say 'relax' and relax your
legs. Let all the tension go. Now tense your feet by curling the
toes. Keep them curled tightly. Tell your toes to relax and feel the
delicious feeling of relaxation come into your feet. Your whole
body is feeling loose and relaxed now.
"Breathe deeply, letting each breath fill your body with deeper
and deeper feelings of relaxation. As you breathe out, say the word
'relax' to yourself, letting your body become more relaxed with each
and every breath. If you feel tense in any area, take a deep breath,
and, as you let it out, tell that part to relax. Let the feeling of
tension leave your body. Now, on the count of three, you can open
your eyes. One, two, three, open your eyes" (Adapted from Hendricks
& Wills, 1975).

Discussion. How did you feel? What did you notice? When were
you the most relaxed? When could you use this exercise?

Follow-up activity. Practice relaxing outside the group. Try
to notice when you feel nervous or relaxed at home and at school.
Try using relaxation when you get uptight and see what happens.


Session Six--Talking to the Body

Goals

The children will relax each body part without first tensing the
muscles, using the cue word "relax."

Exercises

Discussion. Did you notice a time when you were relaxed? Tense?
Did you practice the exercises? Was it easy? What did you notice?
Did you use relaxation when you felt tense? What happened? Which
exercise did you use? How did you feel?

Relaxation training. "Let your body settle down. Now we are
going to go through various parts of the body, telling each part to
relax, and as you tell each part to relax, you will be able to feel a
soothing feeling of relaxation enter that part of your body. Now let
your attention go to your feet. Tell your feet to relax. (Pause
about 10 seconds between instructions.) Tell your hands to relax.
Tell your legs to relax. Tell your arms to relax. Tell your stomach
to relax. Tell your shoulders to relax. Tell your chest to relax.
Tell your neck to relax. Tell your face to relax. Tell your mind
to relax.
"Let your body sink into total relaxation. Let your mind and
body be perfectly still. Breath in deeply. Let it out slowly,
telling your body to relax as your breath flows out. Let every










breath bring calm into your body. When you exhale, let all the
tension leave your body with your breath. Let your breath flow in and
out, bringing you calmness and taking away the tension. You can use
this feeling of relaxation whenever you want to feel more comfortable
and relaxed. Just tell your whole body to relax, and it will listen
to you. Now I will count from 10 down to one, and as I do you will
feel yourself becoming more alert. Ten, nine, eight, seven, feel your
body beginning to stir . six, five, four, let your mind wake up
* . three, two, one, feeling rested and alert. Wiggle around a
little and stretch to become completely alert as you sit up" (Adapted
from Hendricks & Wills, 1975).

Discussion. How did you feel? How did you like it? What was
the hardest part to relax? The easiest? Was there any part you could
not relax? What did you do?

Relaxation training. If time allows, and you and the children
want to, practice previous exercises by request.

Follow-up activity. Pay attention to times when you are calm and
times when you are relaxed. Practice relaxing. Try relaxing when you
are tense, with or without tightening your muscles first.


Session Seven--The Relaxing Cloud

Goals

The children will progressively relax their muscles, starting
with the most relaxed part of their bodies, using the cue word
"relax."

Exercises

Discussion. Did anyone practice any of the exercises? Do you
remember a time since the last meeting when you were relaxed? Do you
remember a time when you were tense? Did you use relaxation when you
were tense?

Relaxation training. "Sink down and become relaxed. (Pause 5
to 10 seconds.) Now choose a spot on the ceiling to look at. Just
let your eyes softly focus on that spot as the rest of the room just
fades away. Continue letting your eyes get softer and softer until
they close, feeling warm and relaxed. As your mind relaxes and
floats along, imagine that you are lying outside, watching clouds
float by above in the sky. Watch them peacefully and lazily float
along, easy and graceful. Now find a place in your body which is
very relaxed. Imagine that area surrounded by a warm, fuzzy cloud of
relaxation. Let that area be supported inside the cloud, very
relaxed, very warm. Now let the cloud expand through other parts of
you. Say 'relax' as the cloud moves, until all of you is floating










along inside this beautiful, warm cloud. Feel how good it feels to
be relaxed.
"Is there any part of you that is not relaxed? Just take a breath
and, as you breathe out, tell that part to relax. Feel the pleasant
feeling of relaxation. As you breathe out, tell your whole body to
relax even more. With each and every breath you become more relaxed.
Just sink down. Just floating along on this peaceful cloud of
relaxation. (Pause for 1 to 2 minutes.) And now it's time to come
back to the people around you. I will count backwards from 10 down
to one, and when I come to one, sit up, feeling peaceful and alert.
Ten, nine, .. one" (Adapted from Hendricks & Roberts, 1977).

Discussion. What were you aware of? How did you feel? Who can
name some of the exercises we have learned? When can you use them?

Relaxation training. If you wish, repeat previous exercises by
request.

Follow-up activity. Encourage the children to practice relaxation
daily outside the group. If they are not practicing, you may want to
discuss such things as when is a good time to practice. Also,
encourage them to use relaxation when they get tense or nervous and
ask them to bring an example to share next time. As always, encourage
them to notice times when they are relaxed and times when they are
tense.


Session Eight--Stretching and Rag Doll

Goals

The children will learn two quick methods of relaxing their
muscles.

Exercises

Discussion. How was relaxation practice? When do you practice?
Which exercises do you use? Are there any difficulties with relaxation
practice? Did you notice a time when you were relaxed? Did you notice
a time when you were tense? Did you use relaxation when you were
tense or worried? (If yes, discuss which ones they used, when they
used them, and how they felt.)

Relaxation training. "We need to do these two exercises sitting
up on the floor or in a chair. Find a place where you can sit
comfortably. Close your eyes."

"Now pretend you are a furry, lazy cat. You want to stretch.
Stretch your arms out in front of you. Raise them up high over your
head. Way back. Feel the pull in your shoulders. Stretch higher.
Now just let your arms drop back to your side. Okay, kittens, let's










stretch again. Stretch your arms out in front of you. Raise them
over your head. Pull them back, way back. Pull hard. Now let them
drop quickly. Good. Notice how your shoulders feel more relaxed.
This time let's have a great big stretch. Try to touch the ceiling.
Stretch your arms way out in front of you. Raise them way up high
over your head. Push them way, way back. Notice the tension and
pull in your arms and shoulders. Hold tight, now. Great. Let them
drop very quickly and feel how good it is to be relaxed. It feels
good and warm and lazy" (Koeppen, 1974, p. 17).

"Sit with your back straight and your legs apart a little. Now
let yourself collapse like a rag doll, letting your head and arms fall
into your lap. Close your eyes and listen to your breathing. Let
each breath relax you more, relaxing into your lap. Imagine that
your eyes are soft and relaxed, so loose that you aren't putting any
effort into then. Tell your mouth and jaw to relax, so relaxed that
your whole face becomes warm and heavy. Remember what being relaxed
feels like, so that the next time you feel tense or scattered, you
can relax like a rag doll. Now we'll count backwards to one, and when
we hit one, you will feel rested and alert. Ten, nine, . one.
Sit up, feeling rested and alert" (Adapted from Hendricks & Roberts,
1977).

Discussion. How did you feel? Were the exercises difficult?
Easy? When did you feel the most relaxed? What did you like best
about what we did today?

Relaxation training. Previous exercises may be repeated by
request if you and the children wish.

Follow-up activity. Pay attention to times when you are nervous
and times you could use relaxation. Practice relaxation daily. Use
relaxation when you get nervous or tense.


Session Nine--Earth Relaxation

Goals

Children will experience the spread of relaxation throughout
their bodies, using the cue word "relax."

Exercises

Discussion. How did relaxation practice go? Did you notice a
time you were relaxed? Did you notice a time you were nervous? Did
you use relaxation when you were nervous? Which exercise did you
use? How did it go?

Relaxation training. "This exercise can be done sitting or
lying down. Close your eyes and find a way of sitting or lying down
that feels comfortable. Give your eyes and ears a rest, and let your










attention go inside you. Take a moment to be aware of your body. Let
yourself go. Just sink down.
"Now imagine that the earth is a big ball of relaxation that you
can draw upon to make yourself feel relaxed and good. You can imagine
that relaxation is warm and peaceful or glowing. Tell your feet to
relax now, and imagine that relaxation beginning to come into your
feet. Now tell your ankles to relax and lot the relaxation come up
through your ankles toward your legs. Tell your legs to relax, and
feel the relaxation pouring up through them. Now tell your hips to
relax and let the relaxation flow on up through your hips, letting
everything below your waist feel very relaxed. Now tell your stomach
to relax. Feel the relaxation spreading through your body. Tell your
chest to relax . your throat to relax. And now let the feeling of
relaxation come up through your eyes as you tell them to relax; on up
through the top of your head, as you tell your head to relax. Feel
the flow of relaxation on up through the top of your head. Feel how
good it feels to be relaxed.
"Take a deep breath, and, as you let it out slowly, say 'relax,'
and relax all over. Whenever you need to completely relax, just feel
that flow of relaxation come up through your feet into your body.
It's there whenever you need it. Now, when I count to three, you can
let your attention come back to the roon, feeling rested and refreshed.
One, two, three" (Adapted from Hendricks & Roberts, 1977).

Discussion. What was that like? How did you feel? Was it
difficult or easy? What exercises have we learned? When could we
use these exercises?

Relaxation training. If you and the children are in the mood,
repeat previous exercises by request.

Follow-up activity. Be aware of times you are relaxed and times
you are tense. Use relaxation when you get tense or nervous.
Practice relaxation daily.


Session Ten--Breath Awareness Relaxation

Goal

The children will become more aware of the role of breathing in
relaxation.

Exercises

Discussion. When have you been relaxed? When were you tense or
nervous? What was relaxation practice iike? Which exercises did you
use or practice? When did you use or practice them?

Relaxation training. "Settle down and get comfortable. Let your
eyes gently close, feeling them relax in the darkness. Let your body
begin to settle down, one part at a time. Let your head and neck










relax . then your chest . your stomach . your hips . .
your legs. Now gently let your right hand come up to rest on your
stomach. Feel the rise and fall of your stomach as your breath flows
in and out of your body. Now place your left hand on your chest,
feeling the rise and fall as your breath flows in and out of your
chest. Compare your hands to see which moves first and which moves
more. Listen to your breath flowing in and out of your body.
(Pause 15 seconds.)
"Now take a deep breath. As you let it out slowly, say 'relax,'
and relax all over. Take another deep breath, and, as you let it
out, say 'relax,' and relax even more. Do this a few times on your
own, each time saying 'relax' as you exhale and sink down even
deeper into relaxation. (Pause 1 to 2 minutes.) And now let your
breathing go back to normal again, enjoying the feeling of relaxed
alertness you feel inside. When I count backwards to one, sit up,
feeling refreshed and calm. Ten, nine, one" (Adapted from
Hendricks & Roberts, 1977).

Discussion. How did you like it? How did you feel? What happens
to our breathing when we get angry? Scared? Excited? Why does our
breathing change when we have feelings? How can being tense affect
our breathing?

Relaxation training. If time allows, and you and the children
wish, repeat previous exercises by request.

Follow-up activity. Encourage the children to use and practice
relaxation.

Closure. Ask the children these unfinished sentences: "In this
group I learned . Something I discovered was . What I liked
best was . What I liked least was . I use relaxation
when . "
















APPENDIX C
THE FANTASY SESSIONS


Session One--The Creative Cave

"Close your eyes and get in the most comfortable position you
can find. Put your hands and your feet where they are the most
comfortable and relax. Imagine you see a very beautiful field and
you are walking barefoot across it toward a small woods off in the
distance (pause). As you approach the woods, you can see the leaves
on the trees and you can feel the green velvety grass between your
toes. There is a slight breeze. It brushes gently against your
face. It's very pleasant. It feels so good to be so close to nature.
Walking on, you come to the top of a small hill on the edge of the
woods. You are standing in this grass. The grass is very green,
soft and velvety to your feet, delicate, very soft and very delicate.
You can feel it as it touches your feet (pause). You see beautiful
flowers in bloom and smell them.
"Right in front of you there is a small mountain. As you gaze
at the mountain you notice an opening . an opening leading into
a cave (pause). As you enter the cave, you can see the rock forma-
tions, feel the moistness, and in the background you can hear the
drip, drip of water. The cave gradually leads down deeper into the
ground. Very quiet and peaceful here in the cave. Make your way
down deeper into the cave. It is so pleasant here. As you look
there toward the back of the cave you notice a bright light coming
from an area on the other side of this opening at the back of the
cave. You make your way through this opening now, going into another
section of the cave. It is light in this very beautiful area of the
cave (pause). There in front of you is a statue. A statue (pause).
This statue can talk. Talk to the statue now. (Pause for at least
2 minutes.)
"I am going to ask you to make a decision concerning the statue.
Will you bring the statue out with you, or will you leave it behind in
the cave? You must decide now. You have just a moment. (Pause for
about 60 seconds.) Okay, make your way back out of the cave, out
into the sunlight. Now, at the count of three you will be alert,
completely awake. One, coming up. Two, becoming more and more alert.
And three, your eyes are open" (Adapted from Wittmer & Myrick, 1974).










Session Two--Next to Nature

"Close your eyes now. Try to relax. Just let yourself go.
Relax more with each breath. Let any noises you hear just fade away.
Imagine that you are walking in a forest on a beautiful, sunny day.
See the trees. Look at them (pause). There are light, fleecy clouds
overhead (pause). You feel wonderfully free. As you walk along, you
notice flowers (pause) . shrubs . trees . and you see the
patterns of light as the sun shines down through the branches. You
feel a slight breeze. It brushes lightly against your face. You hear
the sound of water bubbling over the rocks in a. nearby small stream.
"Now, see yourself walking down this small path in the forest.
As you follow a turn in the path, you come to a clearing, and there to
the front of you is a small stream. There is a small canoe pulled up
on the shore. You are walking toward the canoe. You step in, push
off easily and effortlessly (pause). There is a nice soft pillow at
one end of the canoe, and you lean back as the boat lazily drifts
along. You notice the trees on the shore as they fade into the
distance. You're drifting down the small stream. Lean back onto the
soft cushion, just drifting now. Look up at the soft white clouds
overhead. There in the distance you can see and hear a tiny airplane,
and as you watch the airplane releases white smoke and slowly spells
out your name in giant letters across the sky (pause).
"As you lie there in the canoe, you are there. You are seeing,
doing, and feeling as if you were in a normal activity. Do not see
yourself, just simply be there and let all of your senses come into
being.
"Now, reach over the right side of the canoe. The water on that
side is chilly. It's somewhat numbing (pause). Put your other hand
in the water over the other side of the canoe. On this side the
water is warm (pause). Now, it's almost time to wake up. On the
count of three, I will ask you to open your eyes. One, coming up,
two, almost awake, and three, completely awake" (Adapted from
Wittmer & Myrick, 1974).


Session Three--The Head Trip

"Now close your eyes and let your body relax. Just sort of
sink down. Let your head go where it wants to go. Let everything go
from your mind; just let your mind go blank.
"Imagine that your arms are like wet cloths . very heavy and
limp. Imagine that your legs are like pieces of wood. You feel heavy
all over . as if you have a coat of armor on you. You are now
sort of drifting, very vague, very loose, and very pleasant.
"As you remain now in this relaxed state, use your imagination.
Don't strain to hear my words . just follow them. First, imagine
that you can see yourself as you are right now. Let yourself see
you. Whether you are sitting or lying down, you are looking at you
as you are right now . there with your eyes closed. See yourself
as you are right now.







94
"Now, see yourself very tiny. So small that you are less than an
inch in height. You are very small . a very tiny you (pause).
See yourself now. The image becomes clear as you see yourself .
less than an inch in height very much alive, yet so small, so
tiny. Now, that tiny you is walking into your mouth . walking
into your mouth (pause). As you stand there inside . it's kind of
dark .. a little wet. Looking around now, you look upward. There
in the roof of your mouth a trap door is extending downward. You can
see that it is well lighted in that part of your head. There is a
small ladder leading upward. Just remain relaxed.
"Climb the ladder now. Climb the ladder and enter that part of
your head. Let your imagination go now as to what you see. (Pause
for about 30 seconds.) As you look toward the back of your head you
see a small door that leads to another part of your head (pause).
Open the door. Enter, and close the door behind you. You can make
out an image there in the semi-darkness. That image is another you,
but a different you . another self. How is the other self
dressed? How does it look? Now, without saying anything out loud,
talk to your other self. Carry on a conversation. (Pause about 30
seconds.)
"Now, you must make a decision. Will you bring your other self
out with you, out into reality, or will you leave it where it is?
You must decide now. (Pause about 30 seconds.) Now, open your eyes"
(Adapted from Wittmer & Myrick, 1974).


Session Four--The New You

"Now that your eyes are closed, let your body sink down.
Imagine yourself sinking down . just let yourself go. Take a deep
breath (pause) and listen to what I say. I am going to count from
five down to zero and you will be able to see the numbers. Now,
picture the number five, think about it, imagine that you are tracing
it with your finger. Now, you see the number four, it becomes more
and more clear . trace it. Picture the three . two .. one.
Just let yourself go. Now, picture the zero and take a deep breath
(pause) letting it out slowly. Imagine the zero is a magic carpet .
get on.
"You are gliding peacefully and slowly . you feel the air
brushing lightly against your face .. you come to a forest where
it is beautiful, and you land there. Picture yourself going for a
walk down a trail in the woods.
"You see the trees . almost smell them. Each tree becomes
more and more clear as you become more relaxed. As you walk along the
path, think about how beautiful and peaceful it is . how good it
is to be this close to nature. As you walk on, you can see the
shadows cast on the ground below you. You can see the sun twinkling
between the trees. Feeling so close to nature makes you feel so
peaceful.
"As you walk on, you come to a clearing at the end of the trail.
There before you is a beautiful, quiet pond. It's like a mirror and
you can see the reflections of the trees in it. As you stop beside




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RELAXATION TRAINING WITH CHILDREN By GHARLENE PROEGER A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FUI,FILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 1978

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ACKNOWLEDGEMENTS I would like to thank Robert Myrick for his tremendous enthusiasm, interest, and support. I would also like to thank Betsy Altmaier and Ellen Amatea for their contributions. I would like to express appreciation to the following counselors from Alachua County who contributed their time and energy to this research: Chari Campbell, Barbara Cleveland, Beth Dovell, Finnette Fabrick, Carolyn Fouts, Nancy Mitchum, Liz Parker, Sylvia Stuart, and Mary Anne Wagner. I would like to recognize Beth Dovell, my Gainesville coordinator, for her special contributions. I would also like to thank Terry Proeger for his contributions and encouragement.

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TABLE OF CONTENTS ACKNOWLEDGEMENTS ii ABSTRACT v CHAPTER I INTRODUCTION 1 Purpose of the Study 2 Need for the Study 2 Definition of Terms 3 Organization of the Study II REVIEW OF THE LITERATURE k Definition of Anxiety 5 Anxiety in Children 7 Anxiety and Learning 8 Personal and Social Variables 1^ Physiological Variables 19 Systematic Desensitization in the Treatment of Anxiety 19 Reciprocal Inhibition (Wolpe) 20 Clinical Treatment of Children's Anxieties.... 23 School Settings 26 -—Relaxation Training 29 Advantages 29 Relaxation Training with Children 3^ Summary 39 III METHODS AND PROCEDURES '^l Population and Sample ^+1 Population ^1 Sample ^1 Hypotheses ^'-2 Experimental Procedures ^3 First Week » '^3 Second Week ^3 Third and Fourth Weeks ^^ Fifth Week ^^ Sixth Through Tenth Weeks ^^ Eleventh Week ^6

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Instruments ^1-6 Anxiety Identification (AID) Scale ^6 Children's Manifest Anxiety Scale (CMAS) ^8 Reading Subtest of the Metropolitan Achievement Test (MAT) 50 Feelings Checklist 51 Walker Problem Behavior Identification Checklist (WPBIC) 52 Experimental Design and Analysis of the Data 5^ IV ANALYSIS OF RESULTS 55 V SUMMARY, DISCUSSION, LIMITATIONS, RECOMMENDATIONS, AND CONCLUSIONS 68 Summary 68 Discussion 69 Limitations 73 Recommendations 7^ Conclusions 75 APPENDICES A DIRECTIONS FOR COUNSELORS 77 B THE DMR TRAINING SESSIONS 79 C THE FANTASY SESSIONS 92 D ANXIETY IDENTIFICATION (AID) SCALE 99 REFERENCES 100 BIOGRAPHICAL SKETCH 109

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Abstract of Dissertation Presented to the Graduate Council of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy RELAXATION TRAINING WITH CHILDREN By Gharlene Proeger December, 1978 Chairperson: Robert D. Myrick Major Department! Counselor Education This study investigated the effects of training in relaxation on anxious fourth-grade children. Children were selected from fourthgrade classes in nine elementary schools. Counselors administered a screening instrument developed for this study, the Anxiety Identification (aid) Scale, in the classrooms. From the AID Scale, counselors determined which children were eligible to participate in the study. At each of the nine schools, the eligible children were randomly divided into three groups of five children each: the Deep Muscle Relaxation (DMR) group, a placebo group, and a control group. Thus, a total of 135 children participated in the study: ^5 in the DMR group, 45 in the placebo group, and 45 in the control group. The children in all three groups were administered the criterion variables, which included the Children's Manifest Anxiety Scale (CMAS), a Feelings Checklist, and the Reading subtest of the Metropolitan Achievement Test (MAT). Teachers completed the Walker Problem Behavior

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Identification Checklist (WPBIC). These instruments were administered before and after the treatment. The treatment lasted 5 weeks. During this time, children in the DMR and placebo groups met with their counselors. Both groups met twice a week for a total of 10 sessions. The relaxation exercises for the DMR group were presented on a pre-recorded tape, with the counselors facilitating the discussion. During the first five meetings, children were taught to tense and relax their muscles. During the last five sessions, children practiced DMR without first tensing their muscles and instead used the cue word "relax." Attention to the physical awareness of anxiety and relaxation, as well as daily practice of DMR, was encouraged throughout the program. As the sessions progressed, children were Increasingly encouraged to use DMR when they became anxious. Children in the placebo group listened to a pre-recorded fantasy and then discussed how they felt about the experience. Analyses of covariance, with pretest scores as covariates, were used to determine if there were significant differences between the three groups. The analyses comparing the means of the CMAS, Feelings Checklist, MAT, and WPBIC indicated no significant differences. Even though the DMR group tended to have more positive outcomes on the criterion measures, none of the null hypotheses could be rejected. However, the responses of teachers, counselors, children, and parents were positive and indicated that the children were learning to relax. Since little research has been attempted in this area with children, procedures and instruments need to be refined. Considering the negative effects of high levels of anxiety, further research is necessary to determine effective methods of helping children relax.

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CHAPTER I INTRODUCTION Excessive amciety has teen found to have adverse and de"bilitating effects on persons of all ages. Indeed, studies with children have shown that excessive anxiety has many negative effects, including difficulties in interpersonal relationships, impaired performance on tests (Sarason, Davidson, Lighthall, Waite, & Ruebush, I96O), and reduced capacity for learning (Phillips, Martin, & Meyers, I972). Indicative of the severity of the problem is the number of methods used to relieve anxiety. Among these approaches are muscle relaxation (Bernstein & Borkevec, 1973) 1 systematic desensitization (Wolpe, 1958), meditation (Benson, 1975) i hypnosis (Kroger, I963) , biofeedback (Puller, 1978), yoga (Stern, I969), and psychotherapy (e.g., Rogers, 1961). Of these methods, training in relaxation appears to be one of the most practical methods for reducing anxiety in a school setting. Extensive specialized training is not necessarily required to teach relaxation (Russell & Wise, 19?6), and children learn the skills easily. In addition, training in relaxation lends Itself to working with children in groups. It also appears to be a readily accepted approach in most school systems. Moreover, it seems to have immediate, as well as long-term, benefits (Cautela, 1969)However, there has been little research on relaxation training with children.

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2 Counselors in the elementary schools often work with children who experience excessive anxiety. What henefits would result if counselors taught anxious children to relax? Purpose of the Study The purpose of the study was to determine the effects of training in relaxation on fourth-grade children. Specifically, the following research questions were investigated: 1. What effect does training in relaxation have on children's self-reported general anxiety? 2. What effect does training in relaxation have on situational anxiety related to school? 3. What effect does training in relaxation have on classroom tehavior? 4. What effect does training in relaxation have on children's test performance? Need for the Study Excessive anxiety appears to have a detrimental effect on a numter of "behaviors necessary for success in school. High levels of anxiety have been found not only to interfere with short-term learning (e.g., memorization) , but to result in long-term deterioration of more complex intellectual skills, such as problem-solving ability (Phillips et al., 1972) , Often the main variable that prevents otherwise capable students from performing up to their ability level on both IQ and achievement tests is excessive anxiety (Sarason et al . , I960). In addition to these negative effects, an;
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aggression (Phillips et al . , 1972; Sarason et al., I960) . Indeed, there are many children who experience anxiety to the extent that they are disfunctional in school. Thus, there exists a definite need to develop methods of helping these highly anxious children reduce their anxiety so that they can experience success in school. Although there has been increasing evidence of the effectiveness of relaxation training in reducing anxiety in adults (Deffenbacher & Snyder, 1976), very few studies have focused on children. In most of the studies with children, relaxation training has been used in combination with systematic desensitization and has occurred in clinical settings with severely impaired children. The few studies of relaxation training with systematic desensitization which take place in schools have focused primarily on the desensitization of test anxiety. Recent research with adults, however, has suggested that training in relaxation alone has more generalized and long-term effects than desensitization (Denny, 197^; Snyder, 1975) • Although several recent publications (e.g., Hendricks & Rober-ts, 1977; Koeppen, 197^) have proposed that training in relaxation can benefit children, there have been few research articles to support this. Little attention has been given to the effects of training children in relaxation on test performance or anxiety. There have been virtually no systematic studies of the effects of relaxation training on classroom behavior. Definition of Terms General anxiety — refers to a relatively stable tendency to be tense or to feel worried. Situational anxiety — refers to transitory feelings of tension related to a specific situation in which there is no physical danger.

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Anxious children — refers to children who feel they are more anxious than other children. Deep muscle relaxation (DMR) — refers to the procedure used in this study. It involves learning to relax muscles, first by tensing them; awareness of muscular tension; and practice and application of relaxation. Organization of the Study The remainder of this study is organized into four chapters. A review of the relevant literature on anxiety and relaxation training is presented in Chapter II. The rationale for this study is also discussed. The population and sample, hypotheses, instrumentation, treatment, design, and statistical analysis are presented in Chapter III. The results are presented in Chapter IV. Chapter V includes a summary of the study and implications for elementary school counselors and teachers .

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CHAPTER II REVIEW OF THE LITERATURE The relevant literature on anxiety and methods of reducing anxiety are reviewed in this chapter. Specifically, the following areas receive attention: (a) anxiety and its manifestations, (b) muscle relaxation with systematic desensitization, and (c) relaxation training. Definition of Anxiety It appears that there are as many definitions of anxiety as there are theories of personality. Indeed, anxiety is a major construct in most personality theories (Patterson, I966; Ruebush, I963) . However, anxiety has typically been defined as fear when there is no physical danger (Beck, 1972; Cattell, I963; Kolb, 1973; Nichols, 197^; Ruebush, 1963; Wolpe, 1958). In defining anxiety, several authors have focused on the distinction between anxiety and fear. Fear has been defined as involving an objective physical danger (Kolb, 1973; Ruebush, I963) . Anxiety, on the other hand, can be a response to internal conflict (Lester, 1973; Phillips et al., 1972; Wolff, 1973) or social situations (Carkhuff, I969 ; Kolb, 1973)However, the physiological experience of fear and anxiety are the same (Beck, 1972; Ruebush, I963; Wolpe, 1958). The physiological manifestations of anxiety will be discussed later in this chapter. After reviewing the literature on anjciety, Phillips et al. (I972) concluded that anxiety is (a) manifested physiologically, phenomenologically, and behaviorally ; (b) general or situational; and (c) elicited 5

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6 by stress, or ty threatened deprivation of an anticipated satisfaction. They also noted that defensiveness occurs with excessive anxiety and that the consequences of anxiety are usually negative, interfering, and debilitating in nature. The distinction between general and situational anxiety is an important one. General anxiety, also called trait, chronic, or neurotic anxiety, is a dispositional characteristic, a general tendency to be anxious. General anxiety has an internal locus and is a function of past experience. Situational or state anxiety, however, is a direct function of contemporary events. These two types of anxiety interact, so that general anxiety influences susceptibility to situational anxiety (Phillips et al., 1972), and frequent elicitations of situational anxiety produce a tendency toward general anxiety (Benson, 1975). General and situational anxiety can be measured by different scales. Frequently, general anxiety in children is measured by the Children's Manifest Anxiety Scale (Casteziada, McGandless, & Palermo, 1956). The Manifest Anxiety Scale (Taylor, 1953) is often used with adults. The most widely used measures of situational anxiety are the test anxiety scales, such as the Test Anxiety Scale for Children (O'Reilly & Wightman, 1971) and the Test Anxiety Inventory (Spielberger, Gonzalez, Taylor, Algaze, & Anton, 1978). Alport and Haber (I960) studied several measures of general and situational anxiety. They concluded that these scales do indeed measure different constructs. For example, they found that measures of situational anxiety, such as the test anxiety scales, were better predictors of performance than general anxiety scales.

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7 Anxiely in Children There is increasing concern with the su"bject of anxiety. Indicative of the extent of interest in anxiety are the numter of professional publications written each year which deal with the subject. During 1977, over 300 articles and books on anxiety were written. Approximately \.% of these focused on anxiety in children. A further indication of the prevalence of anxiety was provided by Benson (l973)He noted that hypertension, a physiological manifestation of anxiety, was present in I5 to -}% of the population. He also provided evidence that the effects of hypertension have become a concern in increasingly younger age groups. Anxiety is a very common and serious problem for children. Anna Freud (l970), for example, stated that anxieties and fears are one of the most common and potent causes of suffering in childhood. She listed many sources of anxiety in infants, including fears of darkness, solitude, noise, strangers, and helplessness. For older children, the list included anxiety about rejection, punishment, and social disgrace, especially in school. Sermet (l97^) studied 100 highly anxious and 100 non-anxious 5to 12-year-old children. He found that anxiety-disorder was the largest group of neurotic conditions in children. One-third of the children with anxiety-disorder were also found to have specific fears or phobias. In addition, highly anxious children were found to dislike doctors, receive outpatient treatment, be admitted to hospitals, and receive pills more frequently than non-anxious children. A further indication of the prevalence of anxiety in children was reported by Hundleby and Cattell (1968). Studying 273 12-year-old

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children, they found eight major personality factors. One of these factors was anxiety. In addition, Gattell and Scheier (196I) found that anxiety was a major factor in neurosis. Other indications of the extent of anxiety in children are the responses on the Children's Manifest Anxiety Scale (CMAS). Palermo (1959) reported that the mean score for normal hlack boys and girls on the anxiety scale of the CMAS was 23. This means that, on the average, these children responded "yes" to 23 of the 4-2 anxiety items on the scale. The CMAS, which will be discussed more thoroughly in Chapter III, contains such items as "It is hard for me to go to sleep at night. . . . I worry most of the time. ... I am nervous" (Castenada et al . , 1956). Kitano (196O) reported that the mean score on the CMAS for 153 normal children was 20. These studies indicate the extent of feelings of anxiety in normal children. After reviewing the literature on anxiety in normal children, Ruebush (1963) concluded that "the research findings . . . constitute evidence of the viability and prominence of anxiety as a variable of basic and enduring concern in child psychology" (p. 50'+)Indeed, anxiety is a prevalent and significant problem for children. Anxiety and Learning When anxiety becomes excessive, it can interfere with many variables necessary for success in school. After reviewing the literature, O'Reilly and Wightman (1971) concluded that anxiety interferes with school performance. Low-anxious children perform better than highanxious children on a variety of tasks. In general, excessive anxiety has been found to be negatively related to measures of IQ and achievement, as well as learning capacity and problem-solving ability.

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9 Intelligence . The literature indicates thrat there is a negative correlation between general anxiety and scores on IQ tests. For instance, Lighthall, Ruebush, Sarason, and Zweibelson (1959) found that low-anxious children made greater gains over time on the Otis-Lennon Mental Ability Test than high-anxious children. Phillips (1962) studied the relationship between scores on the Children's Manifest Anxiety Scale (CMAS) and IQ tests for 1,200 fifthand sixth-grade students. He found a significant negative correlation between high levels of anxiety on the CMAS and IQ, scores. A similar conclusion was reached after two extensive reviews of the literature on anxiety in children (Phillips et al . , 1972; Ruebush, I963) . There is an even greater negative correlation between test anxiety and scores on IQ tests. For example, Dodds (1976) explored the relationships between IQ, test anxiety, and general anxiety for I50 seventhgrade children. He found a negative relationship between IQ and test anxiety, but no relationship between IQ and general anxiety. This finding was supported by the literature review by Sarason (196O). Sarason concluded that the majority of studies showed tha,t general anxiety was not related to IQ, whereas high test anxiety was consistently related to poorer performance on IQ tests. Does anxiety cause lower IQ scores, or does low intelligence cause anxiety? Several studies have supported the hypothesis that it is anxiety which causes the lower IQ score and not the reverse (Phillips et al., 1972). For example, when IQ is held constant, low-anxious children perform better than high-anxious children on a variety of tasks (Sarason et al . , I960) . Thus, these authors concluded that anxiety is not a result of low intelligence.

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10 Several studies have shown that changes in anxiety level are related to changes in IQ scores. Sarason and associates studied the relationship between anxiety and IQ in a group of 67O elementary school children for a period of 5 years. They found that increases in anxiety were related to decreases in IQ test perf oiinance , while decreases in anxiety were related to increases in IQ test performance (Hill & Sarason, 1966; Sarason, I966; Sarason, Hill, & Zimhardo, 196'^). In addition, Sarason et al. (1964) found no trend toward interaction between test anxiety and IQ. Using high and average IQ groups, they found no evidence that anxiety had a differential effect between IQ levels. This finding suggests that test anxiety affects the more intelligent, as well as average, students. It is apparent that anxiety, especially test anxiety, is related to poor performance on IQ tests. There is some evidence that a high level of anxiety is the cause of poorer performance on IQ tests. Achievement . Most of the literature on anxiety in children shows a negative relationship between anxiety and achievement. For example, Gifford and Marston (1966) studied the relationship between anxiety and reading on 3I fourth-grade boys. They found that high levels of anxiety were significantly related to slow reading rates and reduced comprehension. Similar results were found by Standford, Dember, and Standford (1963) with thirdgrade children. They found that high levels of anxiety were related to low reading grades and that anxiety level was as effective as IQ in predicting reading grades. In a study with 1,038 eighth-grade students. Khan (1969) found that anxiety was a useful predictor of scores on subtests of the Metropolitan Achievement Test. He found that anxiety levels yielded higher correlations with subsequent achievement test results than other predictors,

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11 including attitudes and study habits. The negative relationship between anxiety and achievement has also been documented in studies by Phillips (1962) with seventhgrade students and by Hawkes and Furst (l97l) with fifthand sixth-grade children. Longitudinal studies have provided further evidence of the negative effect of anxiety on school performance. For instance, Hill and Sarason (1966) concluded that anxiety was negatively related to school progress, as measured by grades. Although most high-anxious children were found to progress normally through school (i.e., did not repeat grades) , their rate of gain was found to be less than that of lowanxious children ( Sarason et al., 196'^). They suggested that the highly anxious child lacks qualities "that make for the productive acquisition and utilization of knowledge" (p. 3?). Interestingly, anxiety may be more strongly related to reading achievement test scores than to math scores in fourth-grade children. In a study by Sarason et al . (196^), the correlation of test anxiety scores in the first grade were significantly related to fourth-grade reading test scores on the Metropolitan Achievement Test. In addition, changes in test anxiety scores correlated significantly with changes in reading scores over time. After reviewing the literature, both Phillips and his associates (1972) and Ruebush (I963) concluded that there is a negative relationship between anxiety and achievement. Ruebush reviewed I6 studies showing a negative relationship between anxiety and achievement test scores, one study suggesting a positive relationship, and three studies reporting no relationship. In addition, he noted several studies indicating that anxiety is an important part of the personality of underachieving children.

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12 Why do highly anxious children perform poorly on achievement tests? In reviewing the literature on test anxiety, Sarason (1972) found several studies showing that test-anxious persons focus on themselves when confronted with evaluative situations. They focus on the possiljility of failure, with such thoughts as "I won't pass." Their attention to self, rather than to the task, interferes consideral)ly with test performance. This finding was supported ty the literature review on test anxiety by Wine (l97l). Learning . Although studies of the effects of anxiety on easy tasks have shown inconsistent results, it has generally been agreed that excessive anxiety has a detrimental effect on complex learning (Phillips et al., 1972; Ruebush, I963; Sarason, 1972). Ruebush (1963) reviewed several studies which showed that anxiety in normal children has negative effects 021 difficult tasks such as digit symbol and IQ tests. After reviewing the literature on test anxiety, Sarason (l972) concluded that test anxiety was negatively related to verbal and motor learning, stimulus generalization, and size estimation. When the task is complex, task-irrelevant responses interfere to a greater degree than when the task is simple (Phillips et al., 1972; Sarason, 1972). The performance of highly anxious persons can be enhanced by positive reinforcement and low stress conditions (Horowitz & Armentrout, 1965; Marlett & Watson, I968; Phillips et al., 1972; Sarason, 1972; Sarason et al., I960). Phillips and his associates (l972), for exajnple, reported that high-anxious persons responded more to reinforcement than low-anxious persons. They suggested that reinforcement reduces the ambiguity of the situation and thus serves to counteract anxiety.

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13 In addition to these findings, Phillips and associates (1972) noted several other trends in the literature. For instance, they found that anxiety reduces incidental learning by limiting the perceptual field of the learner. They also reported indications that anxiety negatively affects short-term memory. These reviews of the literature provide consistent evidence of the negative effect of anxiety on a variety of learning tasks and especially on complex learning. In summarizing their findings, Phillips et al. (1972) concluded that anxiety is generally debilitating in regard to academic behavior. Problem-solving . Anxiety generally impairs children's performance on verbal and non-verbal problem-solving tasks. For example, Ruebush (1963) found that most studies supported the contention that anxiety interferes with tasks such as mazes and embedded figures and the use of abstract concepts. He also reviewed several studies which provided evidence that anxiety in children is negatively related to scores on tests of creativity and curiosity. Sarason and associates (196O) systematically studied the effects of anxiety on problem-solving ability in elementary school children. They matched highand lowanxious children for IQ, sex, and grades. In several problem-solving situations, high-anxious children performed more poorly than low-anxious children. In addition, highly anxious children tended to be more cautious. Finally, high-anxious children gave fewer responses than low-anxious children on the Rorschach. There are several behaviors related to anxiety which interfere with problem-solving ability. Several studies have provided evidence that anxiety reduces responsiveness to the environment and interferes with

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1^ the accurate perception of reality (Ruebush, I963) . Similarly, Sarason (1972) reported that highly anxious persons neglect or misinterpret important cues that may be readily available, due to their focus on self, rather than the task. In addition, the highly anxious person often experiences attentional blocks (Ruebush, I963) . In this section, it has been shown that anxiety in children interferes with performance in school. Several reviews of the literature which supported this hypothesis were discussed. Generally, anxiety has been found to negatively affect such cognitive tasks as performance on IQ and achievement tests, and learning and problem-solving ability in elementary school children. Personal and Social Variables Anxiety has been related to many personality characteristics and social variables. Dependence, low self-concept, aggression, defensiveness, and disturbed relationships with peers and teachers may be related to high levels of anxiety. Other variables that have been related to anxiety include indecisiveness , rigidity, cautiousness, and guilt. Dependence . After reviewing the literature, Ruebush (1963) reported evidence that excessive anxiety was related to dependence in children. This finding was supported by Phillips and associates (l972) in their review of the literature. Similarly, they reported that direction-seeking and conforming tendencies were related to anxiety. Anxious children appear to have an external locus of control, that is, to be dependent on external authority for reinforcement. For instance, Finch and Nelson (197^) reported a high correlation between general anxiety and an external locus of control in a group of 50 emotionally disturbed children.

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15 Rosenthal (1967) studied the effects of highand low-anxious conditions on the dependency "behavior of 3~ "to 5-year-old girls. The children were placed in a strange room with an adult under lowor highanxiety conditions. The frequency of attention-seeking behavior decreased significantly faster under low-anxiety conditions. Attentionseeking behaviors included attempts to get the adult's attention, praise, or aid. Dependence in children may contribute to poor relationships with teachers. For example, dependent children may occupy the teacher's time "by asking many questions. Finally, dependence on external authority for approval may be a factor contributing to a lack of creativity in anxious children (Sarason et al . , I960) . Hostility and aggression . Excessive anxiety has generally been related to aggressive and hostile feelings in children. However, anxious children may vai-y in the manner in which they cope with these feelings. Sarason and associates (1960) found that anxious children often turn their aggression inward, whereas Phillips and associates (1972) reported evidence that anxious children express their aggression outwardly by misbehaving. Indeed, Ruebush (1963) hypothesized that whether aggression in anxious children is expressed outwardly or inwardly depends in part on teacher and parent variables. Extensive study of the backgrounds of highly anxious children led Sarason et al . (1960) to conclude that children who experience anxiety in evaluative situations are reacting with strong unconscious hostility toward authority figures. These feelings of hostility may result from negative, punitive childrearing practices (Ruebush, I963; Sarason et al., i960). Since this hostility conflicts with their dependency needs, the

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16 children frequently turn their aggressive feelings inward, in the form of self-derogatory attitudes (Sarason et al . , I96O) . Somewhat different findings were reported by Phillips and associates (1972). After studying anxious children for 2 years, they reported a significant relationship "between school anxiety and hostile, aggressive "behavior in school, as reported "by teachers. Thus, it appears that excessive anxiety in children is related to aggressive feelings. Depending on the situation, these aggressive feelings may "be expressed outwardly or turned inward. Self-concept A consistent relationship has heen found "between excessive anxiety and low self-concept (Phillips, Hindsman, & Jennings, I96O; Phillips et al., 1972; Rue"bush, I963; Sarason, 1972; Ziv & Luz , 1973) • For example, Phillips et al . (l972) found consistent evidence in the literature of the relationship "between anxiety and two aspects of self-concept: self-disparagement and feelings of inferiority. They also reported that excessive anxiety has been associated with feelings of guilt, school inadequacy, and lack of self-assuredness. These findings were supported by Gattell and Scheier (196I), who found that anxiety was related to lack of self-confidence, inferiority, and guilt. Sarason (l972) reported an interesting study involving 15to 19year-old juvenile delinquents. The boys were given an opportunity to observe models role play successful coping in interpersonal situations. The delinquent boys then had a chance to role play the situations, one group with the aid of video-taped feedback and one without. Surprisingly, the addition of the video tape had a negative effect on the highly anxious boys. Follow-up interviews revealed the reason: Highly anxious boys attended to the discrepancy between themselves and the socially

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17 successful models on the video tape. The visual feedback confirmed their feelings of their own inadequacy. Other personality variaTples . High levels of anxiety in children have been related to a variety of other personality characteristics. Ruebush (1963), for example, provided evidence that a positive relationship exists between anxiety and various measures of clinical maladjustment. Indeed, Kitano's (I960) study supported this contention. Behavior problem children in adjustment classes were found to be significantly more anxious than normal children in regular classes. Anxiety has also been related to def ensiveness (Phillips et al., 1972; Wolff, 1973)Indeed, Sarason et al. (196^^) found that changes in anxiety over time were significantly related to changes in def ensiveness. Sarason and associates (I96O) also reported that high-anxious children differed from low-anxious children in their responses to the Rorschach. The responses of high-anxious children reflected more mutilation and more rigidity. The responses of low-anxious children contained more smiles and more playfulness. Other personality characteristics have been related to excessive anxiety. Ruebush (1963) found considerable research supporting the relationship between anxiety and general behavioral constriction, including indecisiveness , guardedness, caution, and rigidity. In addition, relationships have been found between anxiety and exhititionism, authoritarian attitudes, jealousy, and guilt (Ruebush, I963). Finally, anxiety may also be related to speech problems, hypochondria, and excessive day-dreaming ( Aspects of Anxiety , I968) .

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18 Peer relationships . Several studies have indicated that excessive anxiety is related to low peer status. Hill (1963), for example, studied the effects of anxiety on sociometric status in four third-grade classrooms. He found that high levels of anxiety were related to negative sociometric status. Interestingly, Ruetush (I963) reported a negative relationship between anxiety and accuracy of perception of one's own sociometric status. Phillips et al. (l972) presented the following cycle of anxiety and rejection. Isolated and rejected children experience anxiety in social situations. This leads to either a diminution of activity or heightened activity. These activities (or lack of them) are seen as "problem behavior" by teachers and peers. Although there is a desire to affiliate when one experiences anxiety, the rejected or isolated child is denied this opportunity and consequently experiences more anxiety . Relationships with teachers . Excessive anxiety appears to be related to poor relationships with teachers (Hawkes & Furst, 1971; Ruebush, I963; Sarason et al . , I96O). For example, Sarason and associates (196O) reported that highly anxious children tended to seek excessive attention or to avoid the teacher. Attention-seeking behaviors included misbehavior and asking many questions. They also observed informally that high-anxious boys seemed more insecure around the teacher than lowanxious boys. Phillips et al. (1972) referred to adults as "the ubiquitous authority figures" in the child's environment (p. -^23). Adults in general sometimes arouse anxiety in children, according to these authors.

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19 They also suggested that teachers are often seen by children as evaluators , the dispensers of reward and punishment. Teachers may, indeed, contribute to anxiety in children. Physiological Variables In 1963, Ruebush reported that relatively little was known about the physiological antecedents and correlates of anxiety in children.-' More recently, Phillips et al. (l972) reported that anxiety in children is related to blood pressure rate, heart rate, and skin conductance. They also noted that certain behavioral factors are associated with anxiety. These include tremor, facial expressions, and speech disturbance. In addition, Sarason et al. (I96O) reported that highanxious children tended to be ill more often than low-anxious children. There is more information on the physical manifestations of anxiety in adults. For example, Wilson (1976) noted that muscle spasms and headaches often result from tension. Anxiety may also result in an increased breathing rate (Benson, 1975) • Ferrandino and Marlowe (l977) reported that anxiety produces depression, insomnia, and nervousness. Indeed, Fuller (I978) used the term psychophysiological to convey the concept of the mind-body unity. Every emotion has its physiological counterpart. Systematic Desensitization in the Treatment of Anxiety Many methods have been suggested for reducing anxiety, including muscle relaxation, systematic desensitization, meditation, hypnosis, biofeedback, yoga, and psychotherapy. Of these methods, relaxation training in combination with systematic desensitization has received the most attention in the literature.

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20 Reciprocal Inhibition (Wolpe) The method of systematic desensitization involving muscle relaxation was developed "by Wolpe (1958). The process was based on learning theory. "Since neurotic behavior demonstrably originates in learning, it is only to be expected that its elimination will be a matter of 'unlearning' " (p. ix). Wolpe (1958) developed his theory of reciprocal inhibition based on his experiments with cats. Cats were subjected to shocks in an experimental cage. They developed resistance to the cage and physiological symptoms, such as muscular tension, within the cage. For some cats these anxiety reactions generalized to being in rooms similar to the experimental room and to the experimenter. Thus, learning had occurred. The neurotic behavior was learned in only one to two sessions of a few minutes each. After the neurosis was well-established, desensitization was begun. Since eating and anxiety had been discovered to be incompatible responses, feeding was used to eliminate anxiety. The cats were fed in rooms increasingly similar to the experimental room and eventually in the experimental cage. As the cats were able to eat in the experimental cage, all symptoms of anxiety dissipated. Thus, neurotic anxiety was eliminated by getting the cats to eat in the presence of small, then increasingly greater, doses of the anxietyevoking stimuli. The treatment produced quite rapid results. Neurotic anxiety was eliminated in an average of four sessions per cat. Follow-up for several weeks revealed no indication of anxiety responses in any cat. Thus, "if a response antagonistic to anxiety can be made to occur in the presence of anxietyevoking stimuli so that it is accompanied

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21 by a complete or partial suppression of the anxiety responses, the bond between these stimuli and the anxiety responses will be weakened" (Wolpe, 1958, p. 71). Wolpe discovered that there were responses more convenient than eating to counteract anxiety in people. The most useful of these were relaxation, assertion, and sexual responses. Of these, relaxation has been the most widely used. Wolpe 's method of relaxation was based on the procedure of progressive relaxation developed by E. Jacobson (1938, 1964) • Jacobson gave patients prolonged and intensive training in relaxation. In fact, 100 to 200 sessions were often required to train a patient to relax. The first step of progressive relaxation was recognition of muscle tension. This involved contracting the muscles and then relaxing them. The patient was next taught to relax each major muscle group. In addition, the patient was instructed to practice relaxation for several hours daily. Jacobson (1938) found that this method decreased blood pressure and resulted in improvement in most cases, including anxiety neurosis, tic, stammering, and tremor. Wolpe (1958) expressed several criticisms of Jacobson 's technique. First, Wolpe discovered that relaxation training could be accomplished in far fewer than 100 to 200 sessions. Secondly, in progressive relaxation, there was no control over the anxietyevoking stimuli. Without warning, the person might be subjected to anxiety and not able to relax enough to inhibit it. The anxietyconnected stimulus also might not arise often enough at times convenient for inhibition tlxrough relaxation. Wolpe 's procedure involved several steps. First, the therapist explained that relaxation has emotional effects directly opposing

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22 an:
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23 The weakest scenes were then presented. If the patient raised his/her hand or any bodily tension was observed, the scene was terminated. If relaxation was not affected by an image, a slightly stronger "dose" was presented at the next session. The dosage was gradually increased from session to session until the most phobic dose could be presented without affecting relcLxation. The patient then ceased to react anxiously in real life. With this method and the benefits of the "nonspecific events of the interview situation" (p. ix) , Wolpe reported that ^Qf% of his patients were apparently cured or very much improved in an average number of '}! sessions. Wolpe did report, however, that some patients, after being desensitized to a hierarchy, discovered several other themes requiring desensitization. Clinical Treatment of Children's Anxiety Until recently, systematic desensitization has been used mainly in clinical settings with children with serious problems. For example, Lazarus (1959) described the successful use of systematic desensitization with relajcation to reduce separation anxiety in a 9-year-old girl. The girl had become fearful of losing her mother due to exposure to three deaths. She refused to be separated from her mother and developed nightmares and "illness" at school. A hierarchy was constructed. The girl was asked to imagine that she would not see her mother for increasingly longer periods of time (5 minutes, 15 minutes, 1 week) while relaxed. Five sessions in 10 days alleviated all symptoms. At follow-up, 15 months later, the cure was still in effect.

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2^ Desensitization with relaocation training has been used to reduce fear of reading in an 11-year-old girl (Word & Rozynko, 197^). She had begun to fail in reading, apparently because her teacher was negative and punishing toward her in her reading group. The child was treated in 10 sessions, each lasting 30 to 90 minutes, twice a week. During the first two sessions, she was taught to relax. She helped to write a story about reading during the third session. The remainder of the sessions involved presentation of a reading hierarchy and praise for reading. Very positive results were reported. After two sessions, the girl became less distractible. By the last session she would voluntarily pick up a book and read aloud. She started checking books out of the library, and her reading grades improved. Sometimes relaxation training must precede in very small steps. ^ Mikllch (1973) described teaching relaxation to a 6-year-old hyperkinetic asthmatic boy. The boy was rewarded with points for sitting quietly relaxed with his eyes closed and no evidence of tension. The sessions took place daily, for about 30 minutes a day. By the l^th session, the boy could relax for 5 minutes. Next, the child was rewarded with points for each second he could remain relaJ
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25 After relaxation instruction, each pho"bia was treated with a separate hierarchy. The treatment successfully eliminated the problems, Ince (1976) also described the use of relaxation training coupled with several hierarchies. The subject in this study was a 12-year-old epileptic boy. He had become fearful of school and peers because of his seizures. During the first two sessions the child was taught relaxation. Several hierarchies were then constructed, related to each of his problem areas: seizures, school, and ridicule by peers. This procedure resulted in the elimination of all seizures, both grand mal and petit mal, without medication. Bnotive imagery . A variation of systematic desensitization is emotive imagery (Lazarus & Abramovitz, I962). This procedure was developed for use when relaxation training was not possible. Einotive imagery involves the use of those types of images which arouse feelings of pride, self-assertion, affection, humor, and similar anxietyreducing responses. Lazarus and Abramovitz (1962) described the steps involved in emotive imagery. First, one assesses the nature of the feared situation and constructs a hierarchy from most to least feared. Then the nature of the child's hero images are established. The child is next asked to close his/her eyes and imagine a sequence of events, close to real life, concerning his/her favorite hero. The child relaxes as the fantasy is presented. When the therapist obse2rves that the child is very relaxed (facial expression, breathing, muscle tension), the therapist introduces the lowest item of the hierarchy into the story. The child is instructed to raise his/her finger if discomfort or fear is felt.

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26 Lazarus (l9?l) described the use of emotive imagery with an 8-year-old boy who was afraid to go to the dentist. He had the child imagine himself accompanying Batman and Robin on adventures and then imagine the heroes being treated by the dentist. The boy was asked to picture this scene five times a day for a week. During the second session, the child was asked to imagine himself in the dentist's chair, while Batman and Robin watched. He was told to practice this scene several times a da.y for a week. The boy was afterward able to visit the dentist and sit through four fillings without flinching. School Settings Most of the studies of systematic desensitization based on relaxation training have been in clincial settings, generally with children who have severe and fairly well-established problems. Recently, however, there has been increasing interest in using desensitization within the school setting. Almost all of the experimental studies of systematic desensitization with normal school children have involved the desensitization of test anxiety. A few researchers have studied the effects of systematic desensitization of anxiety within the elementary school. For exajnple, Freedenberg (l975) compared the effects of desensitization and attentional training, desensitization alone, and a control group with 9and 10-year-old children high in test anxiety. Desensitization was described as a variation of Wolpe's method. Attentional training was described as a discussion of task-irrelevant selftalk (i.e., self-derogatory statements) and its relationship to taking tests. The groups met once a week for ^ to 6 weeks. Although the systematic desensitization group experienced some reduction in test anxiety.

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2? only the desensitization plus attentional training group resulted in significantly lower test anxiety. There was no difference hetween the treatments on a performance test. Positive results have teen reported in studies which have used performance measures as criteria. For instance, Baratasz (1973) studied the effects of systematic desensitization on highand low-amcious children. He divided one class each of fifthand sixthgrade children into highand low-anxious groups, based on galvanic skin response. A control group was also formed from one fifth-grade and one sixth-grade class. Relaxation training was presented to the experimental group in their regular homeroom classes. The first two sessions consisted of relaxation training, followed "by presentation of a test hierarchy during the next three sessions. If two hands were raised, the step would be repeated. The highly anxious children who received the intervention scored significantly higher on an IQ test and were more relaxed, as measured by their galvanic skin responses, when compa.red to the control group. No change was found for the lowanxious group. However, the results of this study must be viewed with caution. Since intact classrooms, rather than randomized groups, were used, one cannot assume that desensitization, ra,ther than other events within the classrooms, contributed to the outcome. Deffenbacher and Kemper (l97'+a) studied the effects of relaxation training on 21 sixth-grade volunteers. They randomly assigned the students to an experimental or control group. During the first two sessions, they taught the children in the experimental group to relax. During the next five sessions, they presented a test hierarchy.

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28 Counseled children had significant increases in GPA, compared to the control group. Also, failing students who received counseling improved significantly more than those who did not. However, these findings need to "be viewed with caution, since there was no attempt to control for the teachers' positive expectations for childr-en in the experimental group. Similarly, positive outcomes were attained by Sho waiter (19?'^), The children involved in this study were l6l highly anxious elementary and junior high school students. Approximately six sessions of relaxation training followed by systematic desensitization resulted in positive outcomes on a math test and an anxiety scale. Several studies have reported positive results in reducing test anxiety with middle school children. For example, Deffenbacher and Kemper (l97^b) worked with groups of middle school children who were high in test anxiety. They followed the standard procedure of presentation of a test hierarchy, preceded by two sessions of relaxation training. The treatment lasted 6 to 8 weeks. Counseled students, including those who had been failing, improved significantly in GPA. As noted by the authors, however, the results of this study must be regarded with caution, since a control group was not used. Vicarious desensitization of test anxiety in middle school students has also been explored. For instance, Mann (1972) randomly selected 80 seventhand eighth-grade students from a group of 100 referred by counselors for test anxiety. The children observed the video-taped desensitization of a genuinely anxious peer model for six ^5-'ninute sessions twice a week. The treatment significantly reduced

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29 test anxiety and Increased performance on reading tests of speed and comprehension. Positive results with seventh-grade students were also reported by Mann and Rosenthal (1969). They randomly assigned 70 students to desensitization and control groups and found that desensitization reduced test anxiety and improved performance on a reading test. The students also reported that they felt generally less tense in class and in social situations. The results of these studies suggest that relaxation training combined with systematic desensitization can benefit normal children. However, several of the studies (e.g., Barabasz, 1973; Deff enbacher & Kemper, 197^a, 197^b) had methodological weaknesses and must be viewed with caution. The studies which were well-controlled (e.g., Mann, 1972; Mann & Rosentl-ial, I969) indicated that systematic desensitization reduces anxiety and facilitates performance on tests. Relaxation Training Advantages While a variety of apparoaches have been used to relieve anxiety, the most thoroughly documented has been systematic desensitization based on muscle relaxation. Indeed, this procedure appears to have many positive benefits, as noted in the previous section. Recently, however, there has been increasing interest in the value of relaxation training without the addition of systematic desensitization. Behaviorists ha.ve traditionally maintained that relaxation training alone was not effective in reducing anxiety (Rachman, I968; Wolpe, 1958) . The process of desensitization through the use of a hierarchy

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30 or similar procedure was considered to "be an essential part of the process. Indeed, several studies appeared to support the hypothesis that relaxation training alone was ineffective. For example, Johnson and Sechrest (1968) compared the effects of two treatments, relaxation with desensitization and relaxation without desensitization, with an untreated control group. The subjects, ^1 highly anxious undergraduates, were randomly assigned to the groups. After five individually administered sessions, the groups were compared. The desensitization group was significantly less anxious and had higher grades than the relaxation or the control group, which did not differ from each other. However, the students in the relaxation group were not instructed to practice or apply their skills outside the group. Similar results were reported "by Hyman and Gale (1973) with female undergraduates with snake phobia. The 24 su"bjects were assigned to three groups: relaxation with neutral scenes, desensitization with relcLxation, and desensitization without relaxation. The treatment was presented individually once a week for 6 weeks. On the criteria, galvanic skin response and self-reported fear, the desensitization with relaxation group had more positive results. The authors concluded that "both systematic desensitization and relaxation were necessary components. However, since the students in the relaxation group were not taught to apply their skills, these results must be regarded with caution. Systematic desensitization has also been reported to have more positive effects than relaxation in reducing drug usage (Yorkston, McHugh, Brady, Serber, & Sergeant, 197'^)They randomly assigned Ik asthmatic adults to a desensitization or a relaxation group. Ratings

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31 by psychiatrists showed a greater decrease in drug usage "by the desensitization group. These "benefits were maintained 2 years later at follow-up. The subjects in the relaxation group, however, were not instructed to practice relaxation or to use relaxation when they became tense. These early studies concluded that systematic desensitization was essential. Relaxation training alone was not reported to be beneficial. Recently, however, several studies have indicated that the value of relaxation training alone may equal or even surpass the benefits of systematic desensitization. Indeed, Goldfried (I97I) contended that studies reporting no benefit from relaxation training had the following limitation; Subjects were simply trained in relaxation and never instructed how or when to use it. The essential elements of effective relaxation training appear to be (a) training in deep muscle relaxation, (b) developing awareness of and sensitivity to muscular tension, and (c) practice and application. The use of a cue word, such a,s "relax" is also helpful. This procedure has been referred to as applied relaxation, relaxation as self-control, conditioned relaxation, progressive relaxation, and cue-con tiDlled relaxation. The procedure used in the present study will be referred to as Deep Muscle Relaxation (DMR). Several studies have reported that relaxation training may equal the benefits of desensitization in reducing situational anxiety. For example, Russell and Wise (1976) compared the effects of cue-controlled relaxation, systematic desensitization, and control conditions on undergraduates high in speech anxiety. The students in the relaxation group were taught to become relaxed in response to a cue word. This

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32 association wa.s developed by having the students repeat the word "calm" while relaxed. The treatment was conducted in groups of two to four persons for five sessions over a period of 6 weeks. Both treatments were more effective than no treatment in reducing selfreported speech anxiety, with no difference "between the treated groups. In this study, neither treatment reduced general anxiety. Similar results were reported "by Zeisset (1968). He assigned 48 neurotic and functional psychotic patients to four groups: systematic desensitization, progressive relaxation plus application, attention control, and notreatment control. The treatments lasted for four sessions. Both the relaxation and desensitization groups improved on "behavioral ratings and self-reported measures of interview anxiety with no differences between the two treatments. Training in relaxation may "be as effective as systematic desensitization in reducing test anxiety. Russell, Wise, and Stratoudakis (1976) reported that, after five sessions, "both cue-controlled relaxation and desensitization reduced test anxiety in a group of undergraduates. Similar results were noted by Suinn and Richardson (I97I), who found that both relaLxation training and desensitization successfully reduced anxiety related to math. Training in relaxation has been reported to be as effective as systematic desensitization in reducing general anxiety. For instance, Zenmore (1975) investigated the effects of desensitization and relaxation as self-control with a group of undergraduates who were anxious in relation to both public speaking and taking tests. Both treatments resulted in the reduction of both treated and untreated fears after eight sessions. Similarly, Deffenbacher and Payne (1977)

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33 reported that "both systematic desensitization and muscle relaxation reduced targeted anxiety and generalized to nontargeted areas. There is some evidence that relaxation training may have more generalized effects than desensitization. For example, Chang-Liang and Denny (I976) investigated the effects of applied relaxation, desensitization, relaxation without application, and a conti'ol condition. The applied relaxation involved discussion and practice. They reported that applied relaxation was more effective than the other groups on measures of general and test anxiety and test performance. The treatment lasted only 3 weeks. In an earlier study, Denny (197^) investigated the effects of relaxation training, several variations of systematic desensitization, and a control condition. After six to eight individual sessions, persons involved in applied relaxation received a significantly higher GPA than persons in the other groups. The greatest decline in prequiz anxiety was for the relaxation group. In addition, the relaxation group was the only group to improve significantly on an IQ test, compared to the control group. However, the desensitization groups all decreased significantly more in test anxiety than the control group, whereas the relaxation group did not. In a study with test-anxious undergraduates, Snyder (1975) reported similar results. Although both relaxation and desensitization reduced test anxiety, only the students trained in relaxation experienced a reduction in general anxiety. In addition, students trained in relaxation changed their perceptions of their ability, themselves, and their feelings about the unpleasantness of the testtaking situation, whereas the students in the desensitization group did not.

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3^ Thus, it appears that relaxation training may have more generalized benefits than desensitlzation. Indeed, several authors have suggested this. For instance, Paul (1969) noted that "brief training in relaxation may provide sufficient skills to reduce physical tension and psychological distress. Similarly, Gautela (I969) emphasized several advantages of relaxa,tion training over desensitlzation. First of all, with relaxation training, practice is encouraged more, possibly resulting in more rapid elimination of the undesired behavior and saving time and money. Secondly, patients develop self-confidence when they discover that they have a skill readily available which can effectively reduce anxiety. A third advantage is that large numbers of people can be taught at once. Indeed, there has been increasing interest in using behavioral principles to prevent mental health problems (Poser, 1976), and relaxation training has this potential. Other advantages of relaxation training over desensitlzation ha,ve been suggested. For example, since relaxation training does not require the construction of hierarchies, it is more easily administered than desensitlzation (Russell & Matthews, 1975) • One of the difficulties with systematic desensitlzation is presentation in a group, since persons often have different hierarchies (Russell & Wise, 19?6). In addition, some persons are anxious in a large number of situations. Using desensitlzation in these cases would involve working through a large number of hierarchies (Russell & Slpich, 1973)Several authors ha,ve emphasized that relaxation training is more generalizable than systematic desensitlzation. Deffenbacher (1976), for example, suggested that relaxation training gives clients skills to manage and reduce future stress, as well as resolve the immediate

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35 problem . Relaxation can also be taught to high-risk individuals to prevent future problems (Deffenbacher & Payne, 197?). In addition, Russell, Lent, and Sipich (197?) suggested that relaxation skills can easily be used in real-life situations. Various other advantages have been cited. For instance, it has been suggested that systematic desensitization results in dependency on the therapist (Suinn & Richardson, 1971). Relaxation training, on the other hand, results in greater capacity for self -management (Deffenbacher & Snyder, 1976). Russell and Wise (1976) suggested that relaxation training could be successfully administered by carefully trained paraprofessionals. In addition, relaxation training is preferable to desensitization for those who cannot achieve vivid hierarchal images (Zeisset, I968). Finally, Russell and Sipich (1974) reported that, since relaxation training is less time-consuming than systematic desensitization, especially with those who would require a large number of hierarchies, it may be easily combined with other counseling procedures. Once trained, a person can experience relaxation of the 16 major muscle groups in about 25 minutes. Thus, it appears that the benefits of relaxation training may surpass the results obtained with systematic desensitization. Indeed, it appears that relaxation training can provide persons with a skill which can have more long-term and generalized benefits than systematic desensitization. In addition, relaxation training can be used in a wide variety of situations and is a method of enhancing general wellbeing and preventing future problems.

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36 Relaxation Training with Children There has been increasing interest in relaxation training with children. Relaxation scripts, modified for use with elementary school children, have "been published recently (Hendricks & Roberts, 1977 i Hendricks & Wills, 1975; Koeppen, 197^). Although few researchers have investigated the effects of relaxation training with children, the studies which do exist tend to show positive results. Clinical settings . A few studies have explored the effects of relaxation training with children in clinical settings. For instance, Davis, Saunders, Greer, and Chai (l973) investigated the effects of relaxation training on asthmatic children. The 2^ children in this study, whose ages ranged from 6 to 15, were divided into three groups. One group received relaxation training assisted by biofeedback. A second group was trained in progressive relaxation. The children in the control group were simply told to relax. After five sessions over a period of 3 weeks, the groups were compared on a physiological measure of airway resistance, which is one of the symptoms of asthma. Non-severe asthmatics in both relaxation groups improved, although the greatest change was noted for the group assisted by biofeedback. However, children classified as severe asthmatics did not improve. Children also completed the Mood Affect Checklist. There were no significant differences on this measure. In a study by Weil and Goldfried (1973) > the effect of muscle relaxation on insomnia in an 11-year-old girl was explored. The girl was trained to relax and provided with tape-recorded relaxation instructions to help her relax at night. The taped instructions included directions to tense her muscles first and then x'elax. Over

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37 a period of several weeks, the taped instructions were faded, as she learned to attain a deep state of relaxation on her own. Selfrelaxation eliminated her insomnia. Although she had about 40 sessions of relaxation, only seven of them directly involved the therapist. Meisels (1976) reported the results of teaching relaxation to a 7-year-old boy who was referred because of nervous habits, including repetitive finger movements, tics, and walking on tiptoe. He was taught a modified version of Jacobson's method. After learning relaxation, he was encouraged to relax in class. The intervention reduced the nervous finger movements, although it did not eliminate the other habits. These studies appear to indicate that relaxation training may be an effective procedure for children with serious problems. However, control subjects were not used in two of the studies (Meisels, I976 ; Weil & Goldfried, 1973), thus making it difficult to attribute the ' results to relaxation training, rather than other variables. The study by Davis et al . (l973)i however, was well-controlled, and its results indicate that relaxation can be beneficial. School settings . There are a few studies which have investigated the effects of relaxation training on children in school. For instance, Carter and Synolds (197^) used tape-recorded relaxation instructions to teach a class of 8to 11-year-old minimally brain-injured children to relax. Seven minutes of relaxation training were presented three times a week for 4 weeks. Handwriting, as rated by two judges, improved significantly for this group, compared to a control group of normal fourthand fifth-grade children. The improvement was maintained out

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38 of the special class after k months. However, because a non-equivalent control group was used, these results must be viewed with caution, McBrien (1978) reported the effects of relaxation training with a hyperactive first-grade boy. In addition to excess activity, the boy did not do his school work and fought with other children. The treatment consisted of two 60-minute sessions per week for 12 weeks with a tutor. Each session included relaxation training, discussion, tasks to build attention span, and a fun activity. In addition, the boy earned points when his teacher reported positive behavior to his mother. The boy v/as first taught to relax by tensing and relaxing his muscles. Tensing was eliminated after four sessions. He was taught to relax himself in those reallife situa,tions where he would normally get into trouble. After 2 months, he reported using relaxation to calm himself to keep out of a fight. After 3 months of intervention, his mother reported that he was behaving appropriately. According to his teacher, he was calmer, completing his school work, and not fighting. However, it is difficult to attribute these positive results specifically to relaxation training, since a multiple-intervention approach was used. In a study by Rossman and Kahnweiler (197?), the effect of relaxation training on eight fourthand fifthgrade volunteers was explored. The children were taught to relax and encouraged to use relaxation outside the group. The treatment was evaluated by an "unrefined" scale and a control group was not used. It was noted, however, that the children began using relaxation in anxiety-producing situations outside the group.

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39 The relationship "between relaxation and learning for Islack secondgrade children was investigated "by Harlem (l976). He assigned 59 children to a relaxation or a placelio control grt)up. Relaxation training took place for 10 minutes each day for 10 school days. The procedure was descrited as a "modified version of autogenic training developed "by the experimenter." In autogenic training, persons are taught to relax their muscles by statements such as "my right arm is heavy ... my left arm is warm and very heavy." On all dependent measures, the children in the experimental group improved more than children in the control group. The dependent measures included digit span, approach to problems, a pairedassociate task, matching familiar figures, a general ability test, and a measure of relaxation. Gains were maintained at a 2-week follow-up. Summary Excessive anxiety is a serious problem for many children, affecting many aspects of their lives. Anxiety appears to interfere with learning and with performance on many types of tasks. In addition, many undesirable personality characteristics have been associated with high levels of anxiety, including excessive aggression, dependence, and low self-concept. Children high in anxiety also appear to have difficulties in their relationships with teachers and peers. Many methods have been suggested for reducing anxiety. Of these methods, relaxation training with systematic desensitization has received the greatest amount of attention in the literature. Although this procedure is apparently effective, it is often limited to reduction of anxiety related to a specific situation. For this reason, desensitization is generally administered individually.

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^0 Relaxation training may have more generalized benefits than desensitization. Training adults in relaxation has "been reported to effectively reduce both general and situational anxiety. Relaxation training also appears to positively affect performance, as measured by increases in test scores and grades in several studies. However, very few articles have explored relaxation training with children. Most of the articles on relaxation training with children are descriptive, and there has been little research in this area. Although the effects of autogenic training on children's anxiety and test performance have been explored, there has been no systematic research on the effects of d.eep muscle relaxation on children's anxiety, test performance, and behavior.

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CHAPTER III METHODS AND PROCEDURES Chapter III includes the hypotheses, population, sampling procedures, and procedures for data collection. The method of training in Deep Muscle Relaxation (DMR) and the procedures for the placeto group are also discussed. This chapter concludes with a description of the experimental design and the statistical analysis of the da,t8. . Population and Sample Population The population for this study was approximately 32^ children who were identified as anxious. This numher represents ahout yjfo of the fourth-grade students in nine elementary schools (K 5) in the Alachua County School System of Gainesville, Florida. There were approximately 120 fourthgrade students in each school. The schools were racially integrated, with about 60^ white and ^0% "black students, and there was approximately an equal number of boys and girls in each school . Sample A school counselor In each of the nine schools administered the Anxiety Identification Scale (AID, Appendix D) in the fourth-grade classes. Using the AID Scale, which is described more thoroughly in the "Instruments" section of this chapter, counselors identified ^1

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42 anxious children. The number of eligible children was about 30?g, or 36 students In each school. The total number of eligible children in all nine schools was about ^2^-. There were I35 children involved in the study: l-i-^ receiving training in DMR, 45 in the placebo control group, and 45 in an untreated control group. They were selected according to the following criteria. Children in programs for the mentally retarded, learning disabled, and emotionally handicapped were eliminated because they were already receiving specialized attention. Using a table of random numbers, I5 children in each school were selected to participate in the study. Five children received training in DMR, five children were assigned to a placebo control group, and five children were placed in an untreated control group. Children in the untreated control group did not receive counselor attention until the study was completed. In addition, counseling for children in the DMR and placebo groups was limited to the prescribed treatment. All participating children were volunteers. The ratio of girls to boys was about 2:1 in all three groups. The nine counselors were certified in elementary school counseling by the State of Florida Department of Education and were employed fulltime in Alachua County. All of the counselors were female and had from 2 to 5 years of counseling experience. Counselors were aware that the placebo group was not considered to be a treated group. Each counselor facilitated both the experimental and placebo groups. Hypotheses This study attempted to investigate the effect of DMR on anxious children. Since few researchers have investigated relaxation training

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^3 with children, this research was exploratory in nature. Therefore, a rejection-support design was used. The following four hypotheses were investigated: 1. There is no significant difference in general anxiety, as measured by the Children's Manifest Anxiety Scale, between children who experience DMR, a placebo group, and a control group. 2. There is no significant difference in situational anxiety, as measured by a Feelings Checklist, between children who experience DMR, a placebo group, and a control group. 3. There is no significant difference in classroom behavior, as measured by the Walker Problem Behavior Identification Checklist, between children who experience DMR, a placebo group, and a control group. Experimental Procedures This study took place during the spring of 1978. The chronology of events, including training of counselors, selection of the sample, data collection, and training in DMR follows. Additional instructions for counselors are presented in Appendix A, First Week The counselors were trained to teach DMR to children. They had personally experienced two exercises: "Rag Doll" and "Instant Relaxation." Then, common difficulties in teaching DMR to children were discussed. Sampling and data collection procedures were explained. Second Week The counselors met with the teachers and administra,tors in their respective schools to elicit support for the program and study. The

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44 counselor and teachers In each school established the times for selecting the population a,nd sample, for the groups to meet, and for the administration of the instruments to the 15 children involved in the study . Third and Fourth Weeks During this time, as a part of the county testing program, participating children took the Metropolitan Achievement Test (MAT) with their classes. The MAT includes the Reading subtest. The sample was also selected during this time. Fifth Week Teachers completed the Walker Problem Behavior Identification Checklist for all children in the study. Counselors administered the Children's Manifest Anxiety Scale and the Feelings Checklist. Sixth Through Tenth Weeks Experimental group . Children in the experimental group were trained in DMR. They met with their counselor for 10 30-miiiute sessions over a period of 5 weeks (twice a week). The relaxation exercises were presented on a pre-recorded tape, with the counselors facilitating the discussion. During the first five meetings, children were taught to relax their muscles by tensing them first. During the last five sessions, children practiced DMR without first tensing their muscles and instead used the cue word "relax." Attention to the physical awareness of anxiety and relaxation, as well as the daily practice of DMR, were encouraged ihix>ughout the program. As the sessions progressed, children were increasingly encouraged to use DMR when they became anxious. An outline of the training sessions in DMR is presented in Table 1. Appendix B describes the complete DMR program.

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^5 TABLE 1 DEEP MUSCLE RELAXATION (DMR) TRAINING SESSIONS Session Activities and Focus One Introductions, Relaxing the arms and legs . Tensing and relaxing the muscles. Awareness of muscular tension and relaxation. Two Relaxing the stomach and Lack . Tensing and relating the muscles. Awareness of muscular tension and relaxation. Three Relaxing the face . Tensing and relaxing the muscles. Awareness of tension and relaxation. Four Relaxing the neck, shoulders, and chest . Tensing and relajcing the muscles. Instant relaxation . Tensing and relaxing all muscles . Five Deep relaxation . Tensing and relaxing each muscle, using the cue word "relax." Six Talking to the Lody . Relaxing all muscles without prior tensing, using the cue word "relax." Seven Relaxing cloud . Experiencing the spread of relaxation throughout the Lody, using the cue word "relax." Eight Stretching . Relaxing the shoulders. Rag doll . A quick relaxation exercise. Nine Earth relaxation . Experiencing the spread of relaxation through the Lody, using the cue word "relax." Ten Breath awareness relaxation . Awareness of the role of Lreathing in relaxation. Closure.

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46 Placebo group . The purpose of this group was to control for the effect of counselor attention. Children who were in the placeho group also met 10 times, twice a week, for 5 weeks. They listened to a prerecorded fantasy tape and then discussed how they felt. Although this group might appear to some readers to "be another treatment group, the children were not instructed in deep muscle relaxation or advised to practice and apply relaxation. The exercises for this group focused mainly on affective and cognitive activities. In fact, the fantasy sessions were edited to minimize relaxation instructions, especially muscle relaxation. An outline of the fantasy sessions for the placeho group is presented in Table 2. Appendix G contains the complete content of the fantasy tapes. Control group . Children in the control group did not receive counseling until the study was completed. Eleventh Week All instruments, including the Reading subtest of the MAT, were re-administered during the week following the completion of training in DMR. Instruments Anxiety Identification (AID) Scale The researcher developed the AID Scale as a screening instrument to identify anxious children. Six items which appeared to be typical of the types of items on tinxiety scales were selected. A copy of the instrument is included in Appendix D. The AID Scale is scored as follows: 2 points are assigned to each item marked "more than other children," 1 point to each item

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47 TABLE 2 FANTASY SESSIONS Session Summary One Creative cave includes a journey into a cave and and an encounter with a statue which talks. Two Next to nature takes the children on a canoe trip on a beautiful sunny day. Three The head trip involves an imaginative encounter and conversation with one's "other self." Four The new you allows the children to fantasize discarding one personality trait they do not like. Five Stump, cabin, stream asks the children to imagine in detail life as a stump in the forest, a cabin, and a stream. Six Motorcycle explores what life would be like as a motorcycle. Seven Swapshop takes the children to a shop which has everything. Eight Undersea cave takes the children on an undersea adventure . Nine Seashore is a journey to the beach. Ten Still waters of the mind suggests that their thoughts become like ripples on a lake.

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^8 marked "about the same as other children," and points to each Item marked "less than other children." Thus, the possible range of scores is from to 12. Those children scoring ? or more points, and who were also interested in learning to relax more, were considered eligible to participate. To determine the validity of the AID Scale, the Children's Manifest Anxiety Scale and the AID Scale were administered to a classroom of fourthand fifth-grade students. The correlation between these two instruments was .88. Thus, the AID Scale appeared to be a valid measure of anxiety in children. To determine the reliability of the AID Scale, it was readministered after a 2-month lapse. The correlation after 2 months was ,91. This correlation provided some evidence of the stability of the AID Scale. Since the scale contains only six items, the researcher decided not to compute split-half reliability. Children's Manifest Anxiety Scale (CMAS) The Children's Manifest Anxiety Scale was developed by Gastenada et al. (1956). It is an adaptation of the Taylor Manifest Anxiety Scale for use with fourth-, fifth-, and sixthgrade children. The most widely used anxiety scale with this age group, it contains 42 items related to chronic and general anxiety and 11 items designed to measure the child's tendency to falsify his/her response (L scale). For example, some of the items on the anxiety scale are: "I get nervous when someone watches me work. ... I worry most of the time. ... I am afraid of the dark." Items on the L scale include: "I am always good. ... I never lie." Children answer "yes" or "no" to each of the items on both scales. A level of anxiety is computed by

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ij.9 summing the "yes" responses to the anxiety scale Items. An L scale score is the sum of the "yes" responses to the L scale items. Several studies have measured the reliability of the anxiety scale of the CMAS. Kitano (I960) reported that the split-half reliability of the anxiety scale was .86. This study suggested that the CMAS possesses internal consistency. Gastenada et al. (I956) found that the testretest reliability after 1 week on a population of 36I students (fourth-, fifth-, and sixth-grade children) was .90 for the anxiety scale. With emotionally disturbed children after a 1-month lapse. Finch, Montgomery, and Deardorff (197^) reported that the test-retest reliability was .??. Palermo (l959) reported that the test-retest reliability after 1 month for fourthgrade children was .60 for white females (N = 66), .63 for black males (N = 18), .89 for white males (N = 76), and .9I for black females (n = I7). These studies provide some evidence for the stability of the CMAS. Reliability for the L scale is somewhat less than that for the anxiety scale. Gastenada et al. (1956) reported that the test-retest reliability for the L scale after 1 week was .70. Bledsoe (l973) studied the validity of the CMAS. He administered the CMAS to 6II students in grades four through seven and factoranalyzed the data. He reported two factors. One factor contained the kZ items of the anxiety scale; the other factor was composed of the 11 items of the L scale. This provides some evidence for the construct validity of the CMAS. The CMAS takes about 15 minutes to administer. Counselors emphasized that there are no right or wrong answers. Although the

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50 CMAS is a paper-and-pencil test, counselors read the questions to the children to ensure that they understood the items. Reading Subtest of the Metropolitan Achievement Test (MAT) This test contains 45 items designed to measure the student's ability to comprehend written material. Pupils read a paragraph and then answer questions about it. Items include comprehending the literal meaning of paragraphs, drawing inferences from the material, and identifying main ideas. Some items require determining word meaning from context. For each question, there are four possible answers, in a multiple choice format. Examples of the items include: Mother made a cake. She put candles on it. The candles told how old I was. Mother got ice cream and candy. She got paper hats. She asked children to come to our house. A Mother was getting ready for-(a) Halloween (c) Christmas (b) a birthday (d) a picnic B In this story the word told means(e) said (g) explained (f) counted (h) asked Split-half reliability for this subtest has been reported to be as high as .92 (Durost, Bixler, Wrightstone, Prescott, & Balow, I97I) . Content validity is reported in the Teacher's Handbook (Durost et al., 1971): the MAT was derived from the types of topics taught in schools. It has been used in Alachua County for several years to assess programs and measure student achievement. For the purposes of this study, however, this test was viewed as a measure of test performance more than achievement. Achievement tests are often used to assess the effects of relaxation training. Finger and Galassi (197?) reported that about

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51 60^ of the research on the treatment of anxiety has involved the use of performance criteria to evaluate outcomes. These measures of performance include achievement and IQ tests, as well as other types of tasks. Alternate forms of the elementary "battery were used. Form F was administered as part of the county testing program and used as pretest data. Form G was administered as the posttest. The Manual for Interpreting (Prescott, 1973) states that the forms are statistically equivalent, hut does not provide the reliability coefficients. The test ta,kes 25 minutes to administer. The adjninistrator reads the directions to the students and shows them two examples. The children then work on their own. Feelings Checklist This instrument is an adaptation of the Affect Adjective Checklist, developed by Zuckerman (1960) to measure situational anxiety. The original instrument contained 21 adjectives related to anxiety. The 11 anxiety-plus words (afraid, desperate, fearful, frightened, nervous, panicky, shaky, tense, terrified, upset, worrying) were scored 1 if checked. The 10 anxiety-minus words (calm, cheerful, contented, happy, joyful, loving, pleasant, secure, steady, thoughtful) were scored 1 if not checked. Adding these two scores yielded the total score, with a possible range from to 21. In designing the instrument, Zuckerman (I960) reviewed two studies where anxious respondents checked certain words on a checklist. Those words which were common to both studies became the wo iris on the Affect Adjective Checklist. To determine the validity of the instrument, it was administered for several days to a group of 35 college students. The average increase in anxiety scores on exam days was significantly

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52 higher (.05 level) than on non-exam days (Zuckerman, I960). Zuckerman calculated the internal reliability of the checklist with the KuderRichardson Formula 20. The coefficient was .85. For the present study, 12 words from the original checklist were selected: 6 anxiety-plus words (afraid, frightened, upset, nervous, shaky, worrying) and 6 anxiety-minus words (cheerful, calm, happy, joyful, pleasant, loving). Pilot studies have indicated that most children this age understand these 12 words but have difficulty with the other 9 words. The children were asked to check those adjectives that described how they felt about being in school that day. Zuckerman 's scoring system was used, with a possible range from to 12 . To determine the reliability of this revised instrument, the researcher administered it to a classroom of 30 fourthand fifthgrade children. They were asked to check each adjective that described how they felt about being in school that day. A week later, they again completed the checklist. The checklists of those childxen who said they felt the same about school both times (N = 18) were used to compute a reliability of .88. This scale takes about 5 minutes to administer. Counselors emphasized that there are no right or wrong answers. Although the Feelings Checklist is a paper-and-pencil test, counselors read the words to the children to ensure that they understood the words. Walker Problem Behavior Identification Checklist (VJPBIC) This instrument was designed to measure the problem behavior of fourth-, fifth-, and sixth-grade children. Teachers choose which of 50 beha.viors apply to the children. The WPBIG can be completed in 2 to 10 minutes.

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53 The WPBIC yields a total score, as well as scores on five scales measuring different areas of problem behavior. Scale 1 measures acting out, including disruptive, aggressive, and defiant behaviors, such as having temper tantrums. Scale 2 measures withdrawal. This scale contains items which focus on restricted functioning and avoidance behavior, such as not having friends and not engaging in group activities. Scale 3> distractability , measures such behaviors as short attention span and inadequate study skills, including such items as underachieves and does not complete tasks. Scale ^, disturbed peer relations, includes items to measure inadequate social skills and negative self-image, such as referring to oneself as dumb, stupid, or incapable. Scale 5> immaturity, includes such items as cries without provocation and complains of nightmares (Walker, 1970). With a group of 53^ fourth-, fifth-, a.nd sixth-grade children. Walker (196?) found the split-half reliability of the scale to equal .98. Walker (1967) also provided evidence for the validity of the WPBIC. He found that the scores of 38 children identified as disturbed differed from the scores of non-disturbed children at the .001 level of significance. Children were identified as disturbed according to one or more of the following criteria: (a) examined by a psychologist and referred to a psychiatric or clinical facility, (b) received specific educational provisions at school due to behavior problems, or (c) received instruction at home due to inability to profit from school instruction because of behavior problems. The instrument was reported to be a valid and reliable predictor of behavior disturbance in elementary school children.

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5h To minimize the halo effect, teachers were not told which children were in the DMR group and which children were in the placebo group until after posttesting. Experimental Design and Analysis of the Data The design of the study was an elaboration of Campbell and Stanley's design four, the pretest-posttest control group design (Campbell & Stanley, I966). A placebo control group was added, resulting in a factorial design with three groups; the experimental group, a placebo group, and a control group. Pretest and posttest scores were obtained for the experimental, placebo, and control groups on the GMAS, Feelings Checklist, Reading subtest of the MAT, and WPBIC . An analysis of covariance, with pretest scores as covariates, was used to determine whether there were significant differences between the three groups on each of the instruments. This statistical method was selected in order to control for potential variability in the pretest scores. Roscoe (l975) recommended this analysis for this particular design.

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CHAPTER IV ANALYSIS OF RESULTS This study investigated the effects of deep muscle relaxation (DMR) training, a placebo group, and an untreated control group on elementary school children who were identified as highly anxious. Data were obtained on four dependent variables. These were the Children's Manifest Anxiety Scale, a Feelings Checklist, the Walker Problem Behavior Identification Checklist, and the Reading subtest of the Metropolitan Achievement Test. In order to control for initial differences between the groups, an analysis of covariance was selected as the statistical test. The .05 level of confidence was used for the analysis. This chapter reports a systematic analysis of the data obtained in this study. Hypothesis 1. There will be no significant difference in genera l anxiety, as measured by the Children's Manifest Anxiety Scale , between children who experience DMR, a placebo group, and a control group . The researcher had reasoned that children scoring high on the "L" scale of the CMAS would not adjnit anxiety on the AID Scale and would not become eligible for the study. Children in the reliability and validity studies for this research who had high "L" scores on the CMAS did not admit anxiety on the AID Scale. A high "L" score indicates defensiveness and a reluctance to admit anxiety. Interestingly, however, several children who had high "L" scores on the CMAS became eligible for the study. The researcher decided that children who 55

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56 extensively falsified their responses on the CMAS would not have valid anxiety scores. In a study by Kitano (196O) the mean score on the L scale was 4.5 with a standard deviation of 2,3 for normal children (N = 153) a-fid. children with behavior problems (N = 124). Thus, scores between 2.2 and 6.8 fell within one standard deviation. Considering these data, the researcher chose to eliminate the scores of all children scoring 7 or more points on the L scale on either the pretest or the posttest from the analysis of the CMS. Thus, for the testing of this particular hypothesis, 7 children were eliminated from the DMR group, 10 from the placebo group, and 6 from the control group. The pretest, posttest, and adjusted posttest means for the CMAS are reported in Table 3The adjusted posttest mean for each group is obtained by the formula Y'=Y.-b(X.-M), where Y. is the obtained J w^ J x" J posttest mean of the group, b is the common slope, X. is the obtained mean of the pretest scores of the group, and M is the general mean of the pretest scores for all groups. Readers are referred to Roscoe (1975) for a more detailed explanation. An inspection of Table 3 indicates that all groups had a decrease in general anxiety scores (M M ), with a slightly greater decrease for the DMR group (2.59) 1 ^ y followed by the control group (2.I9) and the placebo group (I.71). The results of the analysis of covariance of the means are reported in Table 4. The obtained F value of .21 was not significant at the .05 level of confidence. Therefore, the null hypothesis was retained.

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51 TABLE 3 MEANS AND STANDARD DEVIATIONS FOR THE CHILDREN'S MANIFEST ANXIETY SCALE

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58 Hypothesis 2. There will "be no significant difference in situational anxiety, as measured by a Feelings Checklist, between children who experience DMK, a placebo group, and a control group . The pretest, posttest, and adjusted posttest means are reported in Table 5. An inspection of the table indicates that all groups decreased from pretest to posttest on this measure, with a slightly greater decrease for the DMR group (1.5^). followed by the placebo group (1.2?) and the control group (l.02). The results of the analysis of covariance of the means are reported in Table 6. The obtained F value of .O3 was not significant at the .05 level of confidence. Thus, the null hypothesis was retained. Hypothesis 3. There will be no significant difference in classroom behavior, as measured by the Walker Problem Behavior Identification Checklist, between children who experience DMR, a placebo group , and a control group . The Walker Problem Behavior Identification Checklist (WPBIC) yields a total score, as well as scores on five scales measuring different areas of problem behavior. Means and standard deviations are reported in Tables ?, 9, 11, I3, I5, and 1?. An inspection of the tables indicates that all groups showed a decrease in problem behavior from pretest to posttest. On scales 1 (acting out), 2 (withdrawal), and 3 (distractability) , as well as on the total WPBIC, the DMR group improved more than the other groups. The adjusted posttest mean on the WPBIC for the DMR group (8.02) was lower than the adjusted means of either the placebo group (9-60) or the control group (IO.60). However, on scales ^ (disturbed peer relations) and 5 (immaturity), the placebo group showed the greatest improvement from pretest to posttest, followed by the DMR group and the control group.

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TABLE 5 MEANS AND STANDARD DEVIATIONS FOR THE FEELINGS CHECKLIST 59 Group

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60 The results of the analysis of covaria.nce of the means are reported in Tables 8, 10, 12, 14, l6, and 18. The obtained F value of 1.?? for the total WPBIG was not significant at the .05 level of confidence. The F values for scales 1 tlirough 5 were .63, .65, 1.8'4., .74, and .02, respectively. The F values for the 5 scales also failed to reach significance. Therefore, the null hypothesis was retained. Hypothesis k. There will be no significant difference in test perfor mance, as measured by the Reading subtest of the Metropolitan Achievement Test, between children who experience DMR, a placebo group, and a control group . The pretest, posttest, and adjusted posttest means are reported in Table 19. All groups showed a decrease in mean scores in reading from pretest to posttest, with the smallest decrease for the control group (2.0), followed by the DMR group (2.2) and the placebo group (2.4l). An inspection of the adjusted posttest scores indicates a slightly higher score (27.54) for the DMR group than for the placebo group (26.74) or the control group (27-02). The results of the analysis of covariance of the means are reported in Table 20. The obtained F value of .20 was not significant at the .05 level of confidence. Therefore, the null hypothesis was retained. None of the null hypotheses were rejected. Therefore, it was not necessary to perform further analyses of the data. A discussion of the findings, implications, and conclusions follows in the next chapter.

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61 TABLE 7 MEANS AND STANDARD DEVIATIONS FOR THE WALKER PROBLEI^ BEHAVIOR IDENTIFICATION CHECKLIST

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62 TABLE 9 MEANS AND STANDARD DEVIATIONS I^OR THE WPBIG, SCALE 1 (ACTING OUT)

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63 TABLE 11 MEANS AND STANDARD DEVIATIONS FOR THE WPBIG, SCALE 2 (WITHDRAWAL)

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64 TABLE 13 MEANS AND STANDARD DEVIATIONS FOR THE WPBIC, SCALE 3 (DISTRAGTABILITY)

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65 TABLE 15 MEANS AND STANDARD DEVIATIONS FOR THE WPBIC, SCALE k (DISTURBED PEER RELATIONS)

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TABLE 1? MEANS AND STANDARD DEVIATIONS TOR THE WPBIG, SCALE 5 (immaturity)

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67 TABLE 19 MEANS AND STANDARD DEVIATIONS FOR THE READING SUBTEST OF THE MAT

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CHAPTEE V SUMMARY, DISCUSSION, LIMITATIONS, REGOMMENDATSIONS, AND CONCLUSIONS Summa.ry The purpose of this study was to investigate the effects of training in relaxation on anxious fourth-grade children. Specifically, the study investigated four hypotheses related to the children's general anxiety, anxiety about school, test performance, and classroom beha.vior. Children were selected from fourth-grade classes in nine schools in Alachua County, Florida. Counselors a,djJiinistered a screening instrument, the Anxiety Identification (AID) Scale in the classrooms. From the AID Scale, counselors determined which children were eligible to participate in the study. At each of the nine schools, the eligible children were ra.ndomly divided into three groups of five children each; the Deep Muscle Relaxation (DMR) group, a placebo group, and a control group. Thus, a total of 135 children participated in the study: ^5 in the DMR group, 45 in the placebo group, and ^5 ii^ the control group. The children in all three groups were administered three criterion instruments, which included the Children's Manifest Anxiety Scale (CMAS), a Feelings Checklist, and the Reading subtest of the Metropolitan Achievement Test (MAT) . Teachers completed the Walker Problem Behavior Identification Checklist (WPBIC). These four instruments were administered before and after the treatment. 68

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The study lasted 11 weeks. During the first week, counselors were trained to teach DMR to the children. In the second week, counselors met with the teachers in their schools to estahlish times for groups and data collection. During the third and fourth weeks, the sample was selected and all fourth-grade children were administered the MAT in their classes. In the fifth week, counselors administered the CMAS and Feelings Checklist, while teachers completed the WEBIG. During the sixth through tenth weeks, children in the DHR and placetio groups met with their counselors. Each group met twice a week for a total of 10 sessions. The children in the control group did not receive counseling during this time. During the eleventh week, the criterion measures were re-administered. Analyses of covariance, with pretest scores as covariates, were used to determine whether there were significant differences between the means of the three groups. Although the mean differences were in favor of the DMR group, the analysis of covariance on each of the criterion measures — the CMAS, Feelings Checklist, Reading subtest of the MAT, and WPBIG--indiGated no significant differences. All four null hypotheses were retained. Discussion Although the results of the statistical analysis of the WEBIG indicated no statistically significant differences, the DMR group had the lowest adjusted posttest mean. Thus, children in the DMR group displayed less problem behavior than children in the other groups when pretest differences were considered. One possible explanation for the lack of significant difference is that the instrument may not have been

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70 sensitive enough to show subtle changes which occurred. Indeed, anecdotal evidence indicated that counselors and teachers noticed changes in the children. Some commented that the WPBIC was not calibrated enough to measure these changes. The DME group decreased more on the CMAS than the other two groups from pretest to posttest, although no significant differences were found between the three ginups. When completing the posttests, several children told the counselors that they were more relaxed and wanted to answer "sometimes" rather than a. simple "yes" or "no" to the questions. The format of the CHAS did not allow for this, and this may have prevented the children from reporting any significant changes. On the Feelings Checklist, although the statistical analysis revealed no significant differences, the DMR group again decreased more from pretest to posttest than the other two groups. Once ?.gain, several children told counselors that the changes they experienced could not be reported accurately on the checklist. For example, one child said, "I'm still nervous sometimes, but not as much." Interestingly, although no stastically significant differences were found using the Reading subtest of the MAT, the adjusted posttest mean of the DMR group was higher than the adjusted posttest means of the placebo and control groups, suggesting that DMR had a more positive effect on test performance tha,n the other two groups. A possible explanation for the lack of stastica.lly significant results is that the children may have needed a,ssistance in applying relaxation skills to the testing situation. Role playing within the DMR group or teacher support in the classroom might ha.ve fa.cilitated the generalization of relaxation skills.

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71 Although no statistically significant results were found on any instrument, it is interesting that all groups decreased from pretest to posttest on all the criterion measures. Due to high pretest scores, it is possible that the posttest scores might reflect regression toward the mean. For example, the pretest means on the WPBIC for the DMR (14-. 98) and placebo (l^.OO) groups were above the mean of 11 for normal children in the standardization studies for this instrument. In addition, the pretest scores on the CMAS and Feelings Checklist were well above average compared to the scores of children in the reliability studies for these instruments. Finally, the percentile rank of the mean of the pretest scores on the Reading subtest was .88 for the DMR group and .8^for the placebo and control groups. However, there is a second possible explanation for the decrease in anxiety and problem behavior for all three groups. Regular guidance sessions were conducted by the counselors in some of the classrooms, and these sessions may have affected the children's feelings and behavior. The lack of statistically significant results was surprising to the investigator and the counselors in view of the positive comments by children. Counselors, teachers, children, and parents indicated that DMR was of benefit to the children. Some examples of anecdotal comments follow. Some children told the counselors that they were not as anxious as before. Several children who suffered from insomnia reported that they could get to sleep faster if they used DMR. One child used relaxation on the way to the hospital after he was stabbed to control his pain and fear.

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n Another child said of the group, "Something is happening to me. This isn't me. I never used to "be funny." The counselor believed that learning relaxation had facilitated this change. Similarly, the mother of another child made the unsolicited comment that the DMR group had "changed my child's life." She felt that her daughter had become more outgoing as a result of the DMR group. Three months after the group ended, she reported that her child continued to practice DMR regularly and had taught it to her younger brother. Other parents also told the counselors how appreciative they were that their children were learning to relax. One counselor said, "You can tell that the children are really relaxed in the group. They go back to class real quietly, even though it's the end of the day." Some teachers also claimed that the children had changed, but reported that the WPBIC was not sensitive to the changes they observed. One counselor reported that the children enjoyed the group so thoroughly that they wanted to meet every day. Within the schools, there was tremendous enthusiasm and support for the DMR group. In one school, after the DMR group had met only two times, the fourth-grade teachers whose classes were not already involved in the study asked for DMR groups for their children. A teacher at another school requested that DMR be taught to the whole class so that she could learn to relax, too. As an indication of their enthusiasm for DMR, some of the counselors taught DMR to the control group and classrooms which contained control group children the last week of school, as soon as posttests were collected. Most plan to use DMR in the future.

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73 Several said it was one of the most enjoyable, meaningful, and effective procedures they had used with this age child. Limitations The instruments used in this study may not have been sensitive enough to ascertain important positive changes that were apparent as a result of relaxation training with the children. Teachers and children indicated that the yes/no format of the CMAS, Feelings Checklist, and WPBIG made it impossible to communicate the changes they noticed. Perhaps a Likert-type scale would have been more sensitive to the degree of change. Some children may not have received enough practice in DMR . Although frequent practice of relaxation is an essential element of DMR, some children admitted not using relaxation very often outside the group. Perhaps more frequent meetings would have helped establish the habit of using relaxation regularly. In addition, parents and teachers might have been directly involved in encouraging practice and use of relaxation skills. A third limitation is that some of the children in the study had serious emotional problems and were extremely anxious. Of the I3I children who completed the study, 32 scored more than 21 points on the WPBIG, which is an indication of serious emotional problems. It was intended that these children would have been screened out by eliminating children in classes for the emotionally handicapped. Counselors indicated that many of these children needed a more long-term, intensive intervention, rather than a short-term group.

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74 For many of the counselors, this was their first exposure to anysystematic form of relaxation training, and this may have "been a limitation. They reported that this procedure was very different from other methods they had used with children. Perhaps more experience and training in DMR would have helped them better facilitate the groups. Recommendations The positive reactions of children, counselors, teachers, and parents and the consistent trend in the results in favor of the DMR group were encouraging. Since this was the first systematic study of the effects of DMR with this age child, further research is recommended. A study examining a wider variety of variables might yield important information. For instance, what are the effects of other forms of relaxation, such as yoga, meditation, fantasy, and biofeedback? Are there any personality variables which determine who benefits most from each of the various methods of relaxation? The group composition might also be modified. It is possible that groups composed of just one sex would be less distracted. Initial anxiety level might also be a factor in selecting groups. Extremely anxious children with serious emotional problems may need to proceed in much smaller steps, and for many more sessions, than the anxious child who is otherwise normal. More sensitive criterion measures may be needed. For example, objective measures of specific behaviors may be more likely to be effected in a short period of time. Counting the number of headaches, stomachaches, fights, or times the child feels anxious could provide

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75 LTiportant information. In addition, items on the WPBIC and anxiety scale of the CMS describe only negatively worded behaviors. Instruments measuring increases in positive behavior might reflect more change. Also, biological measures, such as GSR, cardiac rate, or blood pressure, might be useful indicators of change. Finally, a concentration task, ra.ther than an achievement test, might be more reflective of change. Another recommendation is that teachers and parents become more involved in the DMR program. As mentioned in Chapter II, anxiety results from negative relationships with parents. Sometimes teachers contribute to anxiety in children. Thus, involving these significant others in the treatment may have an even greater impact on the children. Parents and teachers could also help children remember to practice relaxation and thus assist the cliildren in generalizing their relaxation skills from the counselor's office to home and school. An important outcome of this study is the development of the Anxiety Identification (AID) Scale. It appears to be a valid and reliable measure of anxiety. Its test-retest reliability of .91» after 2 months, compares favorably with GMAS reliabilities of .90i after 1 week, and .??, after 1 month. Six items, contrasted with the k2 anxiety items on the GMAS, make it an instrument that is easier to administer and score. Conclusions As a result of this study, it appears that DMR was not significantly more effective in reducing anxiety than a placebo or a control group. However, the DMR group tended to have more positive outcomes

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76 on the criterion measures. In addition, the positive responses of children, teachers, parents, and counselors suggested that the children were learning to relax. Since few systematic studies of relaxation training with children have teen attempted, procedures and instruments need to be refined. Considering the negative effects of high levels of anxiety, further research is recommended.

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APPENDIX A DIRECTIONS FOR GOUNSELORc Environment Meet with the groups in your office. Choose quiet times to meet, when you will not be Interrupted, and place a "Do Not Disturb" sign on the door. The children can lie on a carpeted floor or sit in comfortable chairs, depending on the facilities available and your preference . DMR Group Fa.cilitation of Relaxation These are the steps to facilitate relaxation. First of all, children on the floor should lie on their backs. Second, relaxation is easier if shoes are removed. Third, hands should be kept to oneself. Fourth, turning off the light can be used as a cue for quiet and to facilitate relaxation. Fifth, eyes should be kept closed while the tape plays. Finally, if you do the exercises and follow-up yourself, you will be better able to facilitate the children's experience. Discussion Although the relaxation exercises are tape-recorded, counselors are responsible for the discussion before and after the exercises. The discussion topics (listed in Appendix b) are merely a guide to discussion. Be yourselves, use your facilitative skills, and be aware of the needs of your group, rather than mechanistically following the guide. Placebo Group Play the fantasy tape for the children in the placebo group and then ask the children how they felt about the experience. Do not teach the children DMR or instruct them to practice or apply relaxation. 77

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78 Communication with Counselors Contact with the counselors was considered crucial to the success of the study. This was especially important since the researcher lived 200 miles away from Gainesville. Constant communication was maintained through letters, telephone calls, and traveling to Gainesville. The researcher met with the counselors as a group two times Taefore the study began to review procedures and provide experiential activities. As the study proceeded, the researcher continued communication through weekly telephone calls and letters to each counselor. In addition, one of the counselors served as the local coordinator. The coordinator met with the counselors at their regular meetings to ascertain whether the study was proceeding as planned.

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APPENDIX B THE DMR TRAINING SESSIONS The materials for these DMR training sessions were drawn primarily from the following sources; Bernstein and Borkovec (l973), Garkhuff (1969), Hendricks and Roberts (l977), Hendricks and Wills (1975). Kelly (1972), Koeppen (l97^), Lazarus (l972), Russell and Sipich (1973), and Wittmer and Myrick (l97^). Session One — Relaxing Arms and Legs Goals Each child will learn the name of everyone else. Children will learn to relax their arms and legs by tensing and relaxing their muscles. The counselor will focus the children's awareness on the contrasting feelings of tension and relaxation. Exercises Introductions . If the children are from different classes, go around the group and have everyone say their name. Then allow the children to take turns naming everyone in the group, until they know each other's names. Discussion . Explain the purpose of the group: In this group we are going to learn to relax better. We cannot be tense and relaxed at the same time. The exercises we, wil^ be learning will help us when we feel worried, nervous, or tense. These exercises are nothing mysterious. You won't be hypnotized or asleep, but you will be relaxed. You will need to try hard to do exactly what I say. Pay attention to how your muscles feel when they are tight and when they are relaxed. Are there any questions before we start? Relaxation training . "We will begin to learn to relax by tightening and then relaxing our muscles. You will need to close your eyes and be very still and quiet. You will need to listen to my voice and try hard to do exactly what I say. Settle back. Let your arms and legs and head rest comfortably. Become still now. "Close your eyes and let yourself sink down, resting there, very still and very comfortable. Listen to my voice and let all other noises just fade away." "Pretend you have a whole lemon in your right hand. Now squeeze it hard. Try to squeeze all the juice out. Feel the 79

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80 tightness in your hand and arm as you squeeze. Now drop the lemon. Notice how your muscles feel when they are relaxed. Take another lemon and squeeze it. Try to squeeze this one harder than you did the first one. That's right. Real hard. Now drop the lemon and relax. See how much "better your hand and arm feel when they are relaxed" (Koeppen, 19?^, p. 1?). Repeat for the left hand and arm. "Now pretend that you are standing barefoot in a "big, fat mud puddle. Squish your toes down deep into the mud. Try to get your feet down to the bottom of the mud puddle. You'll probably need your legs to help you push. Push down, spread your toes apart, and feel the mud squish up between your toes. Now step out of the mud puddle. Relax your feet. Let your toes go loose and feel how nice that is. It feels good to be relaxed. Back into the mud puddle. Squish your toes down. Let your leg muscles help push your feet down. Push your feet. Hard. Try to squeeze that mud puddle dry. Okay. Come back out now. Relax your feet, relax your legs, relax your toes. It feels good to be relaxed. No tenseness anywhere. You feel kind of warm and tingly" (Koeppen, 19?^, p. 20) . "Be aware of your body. How are you feeling? Where are you relaxed? Is there any part that is tense? Take a deep breath, let it out slowly, and relax all over, giving in to the pleasant feeling of relaxation. In order to become really good at relaxing, you need to practice every day. At night, before you go to sleep, is a good time. Just tighten then relax your muscles. Or remember the lemon and the mudpuddle. Relaxing at night can help you go to sleep. "Now, when I count to three, you can open your eyes. One, you are becoming more alert; two, you are even more alert; and three, you can open your eyes. Wiggle your toes, legs, hands, and shoulders a little as you sit up to help you become more alert." Discussion . How did you like that? How did you feel? Was it difficult or easy to relax? Did you feel the difference between being relaxed and tense? Was there anything else you noticed? Follow-up activity . Between now and the next session, try to notice a time when you feel relaxed and a time you feel tense. We'll talk more about this next time. Try to practice these exercises every day. Before you go to sleep is a good time. Session Two--Relaxing the Stomach aad~B^.-€k Goals By tensing and relaxing their muscles, the children will learn to relax their stomach and lower back. The children will become more aware of the contiusting feelings of tension and relaxation.

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81 Exercises Discussion . Think for a moment of the time since our last meeting. Try to remember a time you felt calm and relaixed and a time you felt nervous or upset. Does anyone remember a time when you were relaxed and calm? (Help them elaborate » focusing on physical and emotional feelings.) Did anyone have something happen that made them feel nervous or upset? (Help them expand.) Did anyone remember to practice the exercises? (if yes, let them tell which ones they practiced and when they practiced. If not, that's OK. It will take a while to learn a new behavior.) We can use these relaxation exercises to help us when we get tense or nervous. Today we are going to practice some more relaxation exercises. Does anyone have any questions before we start? Relaxation training . "Get comfortable. Let your feet and arms rest comfortably. Don't hold back. Just sink down and let yourself go. Remember to pay attention to my voice and try hard to do as I say. Close your eyes and don't open them until I tell you to. Remember to pay attention to your muscles and how they feel when they are tight . . . how they feel relaxed. Pay attention to my voice, letting all outside noises fade away." "Hey I Here comes a cute baby elephant. But he's not watching where he's going. He doesn't see you lying there in the grass, and he's going to step on your stomach. Don't move. You don't have time to get out of the way. Just get ready for him. Make your stomach very hard. Tighten up your stomach muscles real tight. Hold it. It looks like he is going the other way. You can relax now. Let your stomach go soft. Let it be as relaxed as you can. That feels so good. Oops, he's coming this way again. Get ready. Tighten up your stomach. Real hard. If he steps on you when your stomach is hard, it won't hurt. Make your stomach into a rock. Okay, he's moving away again. You can relax now. Kind of settle down, get comfortable, and relax. Notice the difference between a tight stomach and a relaxed one. That's how we want it to feel--nice and loose and relaxed" (Xoeppen, 197^, p, I9) , "This time imagine that you want to squeeze through a narrow fence and the boards have splinters on them. You'll have to make yourself very skinny if you're going to make it through. Try to be as skinny as you can.You've got to get through. Now relax. You don't have to be skinny now. Just relax and feel your stomach being warm and loose. Okay, let's try to get through that fence now. Squeeze up your stomach. Make it touch your backbone. Get it real small and tight. Get as skinny as you can. Hold tight, now. You've got to squeeze through. You got through that skinny fence and no splinters. You can relax now. Settle back and let your stomach come back out where it belongs. You can feel really good now. You've done fine" (Koeppen, 19?^, p. I9) . "Now take a deep breath, let it out, and relax all over. Breathe in and out slowly. Don't hold your breath. Just let it flow in and

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82 out. Feel how good it is to "be rela;
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83 nose, your whole face relaxes, too, and that feels good. Oh-oh. This time that old fly has come back, but this time he's on your forehead. Make lots of wrinkles, trying to catch him between all those wrinkles. Hold it tight now. Okay, you can let go. He's gone for good. Now you can just relax. Let your face go smooth, no wrinkles anywhere. Your face feels nice and smooth and relaxed" (Koeppen, 19?^, p. 18). "Allow your whole body to relax. If there is any place that is tense, tell that place to relax, and let the tensions drain out into the floor. Feel how good it is to be so relaxed, so calm, so peaceful. Pay attention to your breathing. Watch your breath flow in and out. Now take a deep breath, let it out slowly, and relax all over. Feel how good it is to be so relaxed. You can use these exercises to help you relax when you feel tense or nervous. Just remember to tighten and then relax your muscles; or you can remember the mud puddle, the fly, the fence, the lemon, or the elephant. Remember to practice these exercises every night before you go to sleep, so you can become very good at relaxing. Now, on the count of three, you can open your eyes. One, you are starting to become more alert; two, you are even more alert; and three, you can open your eyes. Stretch a little to help yourself become even more alert." Discussion . How did you like that? What was the hardest thing that we did today? What did you find the easiest to do? When did you feel the most relaxed? What else were you aware of? Today we learned to relax our face. What are some of the other relaxation exercises we have learned? (if time allows and the children seem receptive, you can do some "special requests" of exercises from the previous sessions.) Follow-up activity . Practice outside the group, every night before you go to sleep. Try to be aware of a time you feel nervous or worried and a time you feel relaxed and cairn. Session Four— Relaxing the Neck, Shoulders, and Chest; Instant Relaxation Goals The children will learn to relax their upper trunk and neck and then their entire body. The cue word "relax" will be introduced. Exercises Discussion . Did you notice a time when you were relajced and calm? A time when you were tense? Did you practice or use the exercises outside the group? (if yes, let them discuss their experiences. If not, help them discuss what is preventing them from practicing. Encourage daily practice so they will become really good at relaxing.)

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84 Relaxation training; . "Let your arms find a comfortatile position. Let your legs lie loose and relaxed. Let your head find a comfortable place. Close your eyes and sink down, "being as relaxed as you can. Let all outside noises fade away. Listen only to my voice." "Now pretend you are a turtle. You're sitting out on a rock by a nice, peaceful pond, just relaxing in the warm sun. It feels nice and warm and safe here. Oh-oh! You sense danger. Pull your head into your house. Try to pull your shoulders up to your ears and push your head down into your shoulders. Hold in tight. It isn't easy to be a turtle in a shell. The danger is past now. You can come out into the warm sunshine, and once again, you can relax and feel the warm sunshine. Watch out now! More danger. Hurry, pull your head back into your house and hold it tight. You have to be closed in tight to protect yourself. Okay, you can relax now. Bring your head out and let your shoulders relax. Notice how much better it feels to be relaxed than to be all tight. One more time, now. Danger! Pull your head in. Push your shoulders way up to your ears and hold tight. Don't let even a tiny piece of your head show outside your shell. Hold it. Feel the tenseness in your neck and shoulders. Okay, you can come out now. It's safe again. Relax and feel comfortable in your safety. There's no more danger. Nothing to worry about. Nothing to be afraid of. You feel good" (Koeppen, 1974( p18). "Now tense every muscle in your body at the same time. Legs, arms, fists, face, shoulders, stomach. Hold them . . . tightly. Now say the word 'relax' to yourself and relax all over. Take a breath and, as you breathe out, say the word 'relax' to yourself, relaxing completely. Let your whole body go limp. Feel the tension pour out of your body and mind . . . replacing the tension with calm, peaceful energy . . . letting each breath you take bring calmness and relaxation into your body. Just think the woM 'relax' as you breathe out and feel yourself relax all over. Feel how good it feels to be so relaxed. "Now, tense every muscle in your body and at the same time take a deep breath. Hold your body tense and hold your breath for a few seconds. Then say 'relax' to yourself and, when you do, let your breath go and relax. Take a deep breath and hold it about 10 seconds. Then say 'relax' to yourself and let yourself go. When you feel like relaxing, just take a deep breath, say 'relax,' and let it all go. Practice this again by yourself two or three times. Now, on the count of three, slowly open your eyes. One, two, three, you can open your eyes" (Adapted from Hendricks & Wills, 1975) • "Wiggle around a little and stretch to help you become even more alert. " Discussion . How was that? When did you feel the most relaxed? Was there anything hard about it? What Eire some situations when you feel nervous, tense, or worried? What exercises could you use at these times to relax?

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85 Follow-up activity . Practice relaxation outside the group, at least once a day. Before you go to sleep at night is a good time to practice. Try to be aware of when you feel worried or nervous and when you feel calm and relaxed. Try using these exercises when you feel nervous or tense. Session Five--Deep Relaxation Goals The children will practice tensing and relaxing all body parts, using the cue word "relax," Exercises Discussion . Did you notice a time when you were relaxed and calm? Did you notice a time when you were nervous and tense? Did you try to relax? Were there any times when you were nervous and could have used a relaxation exercise, but didn't? Relaxation training . "This is an activity that can help us learn to relax our bodies and minds by tensing and relaxing our muscles. We cannot be tense and relaxed at the same time, so if we learn to relax, we can avoid wasting energy through muscle tension. If you ever feel tense, while asking a question, or taking a test, or anytime, you can use the feeling of relaxation to feel better. "Close your eyes and think of your hands. Feel the bones inside them; feel the muscles that move the bones; feel the weight of them on the floor. Now make a fist with your hands and clench them tightly. Hold your hands tightly. Now relax and feel the soothing, tingly feeling of relaxation come into your hands. (Pause 10 seconds or so between instructions.) Now draw up your arms and tighten your biceps as tight as you can. Hold them tightly. Now say 'relax' and feel the tension drain out of your arms. Shrug your shoulders now, pushing them as if to push them up through your ears. Hold them tightly there. Now tell them to relax and feel all the tension drain out of your body. "Continuing to keep your eyes closed, open your mouth as far as it will go, stretching the muscles at the corners of your mouth. Hold it tightly. Tell your mouth to relax and enjoy the tingling feeling as the tension dissolves in your mouth. Now press your tongue against the roof of your mouth and tighten your jaw muscles. Press tightly and hold it. Tell your mouth to relax; let go and relax. Let the peaceful feeling of relaxation flow through your body. Now wrinkle your nose and make a face. Scmanch up your face tightly and hold it. Say 'relax' as you let your face go, feeling the tension flow out of your face. Now tighten the muscles of your chest, stomach, and abdomen. Draw all of the muscles in tightly and hold them tense. Now let them go, saying 'relax' as you do, feeling the soothing feeling of relaxation pour in. Feel how good it feels to be relaxed.

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"Now tense the muscles of your thighs "by straightening your legs. Hold them tightly. Tell your thighs to relax. Let all of the tension drain out of them. Now tense the hacks of your legs hy straightening your feet. Hold your legs tensely. Now say 'relax' and relax your legs. Let all the tension go. Now tense your feet by curling the toes. Keep them curled tightly. Tell your toes to relax and feel the delicious feeling of relaxation come into your feet. Your whole hody is feeling loose and relaxed now, "Breathe deeply, letting each hreath fill your body with deeper and deeper feelings of relaxation. As you breathe out, say the word 'relax' to yourself, letting your body become more relaxed with each and every breath. If you feel tense in any area, take a deep breath, and, as you let it out, tell that part to relax. Let the feeling of tension leave your body. Now, on the count of three, you can open your eyes. One, two, three, open your eyes" (Adapted from Hendricks & Wills, 1975), Discussion . How did you feel? What did you notice? When were you the most relaxed? When could you use this exercise? Follow-up activity . Practice relaxing outside the group. Try to notice when you feel nervous or relaxed at home and at school. Try using rela;>cation when you get uptight and see what happens. Session Six — Talking to the Body Goals The children will relax each body part without first tensing the muscles, using the cue word "relax." Exercises Discussion . Did you notice a time when you were relaxed? Tense? Did you practice the exercises? Was it easy? What did you notice? Did you use relaxation when you felt tense? What happened? Which exercise did you use? How did you feel? Relaxation training . "Let your body settle down. Now we are going to go through various parts of the body, telling each part to relax, and as you tell each part to relax, you will be able to feel a soothing feeling of relaxation enter that part of your body. Now let your attention go to your feet. Tell your feet to relax. (Pause about 10 seconds between instructions.) Tell your hands to relax. Tell your legs to relax. Tell your arms to relax. Tell your stomach to relax. Tell your shoulders to relax. Tell your chest to relax. Tell your neck to relax. Tell your face to relax. Tell your mind to relax. "Let your body sink into total relaxation. Let your mind and body be perfectly still. Breath in deeply. Let it out slowly, telling your body to relax as your breath flows out. Let every

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87 breath bring calm into your body. When you exhale, let all the tension leave your body with your breath. Let your breath flow in and out, bringing you calmness and taking away the tension. You can use this feeling of relaxation whenever you want to feel more comfortable and relaxed. Just tell your whole body to relax, and it will listen to you. Now I will count from 10 down to one, and as I do you will feel yourself becoming more alert. Ten, nine, eight, seven, feel your body beginning to stir . . .six, five, four, let your mind wake up . . . tliree, two, one, feeling rested and alert. Wiggle around a little and stretch to become completely alert as you sit up" (Adapted from Hendricks & Wills, 1975). Discussion . How did you feel? How did you like it? What was the hardest part to relax? The easiest? Was there any part you could not relax? What did you do? Relaxation training . If time allows, and you and the children want to, practice previous exercises by req^uest. Follow-up activity . Pay attention to times when you are calm and times when you are relaxed. Practice relaxing. Try relaxing when you are tense, with or without tightening your muscles first. Session Seven — The Relaxing Cloud Goals The children will progressively relax their muscles, starting with the most relaxed part of their bodies, using the cue word "relax." Exercises Discussion . Did anyone practice any of the exercises? Do you remember a time since the last meeting when you were relaxed? Do you remember a time when you were tense? Did you use relaxation when you were tense? Relaxation training . "Sink down and become relaxed. (Pause 5 to 10 seconds.) Now choose a spot on the ceiling to look at. Just let your eyes softly focus on that spot as the rest of the room just fades away. Continue letting your eyes get softer and softer until they close, feeling warm and relaxed. As your mind relaxes and floats along, imagine that you are lying outside, watching clouds float by above in the sky. Watch them peacefully and lazily float along, easy and graceful. Now find a place in your body which is very relaxed. Imagine that area surrounded by a warm, fuzzy cloud of relaxation. Let that area be supported inside the cloud, very relaxed, very warm. Now let the cloud expand through other parts of you. Say 'relax' as the cloud moves, until all of you is floating

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along inside this beautiful, warm cloud. Feel how good it feels to be relaxed. "Is there any part of you that is not relaxed? Just take a breath and, as you breathe out, tell that part to relax. Feel the pleasant feeling of relaxation. As you breathe out, tell your whole body to relax even more. With each and every breath you become more relaxed. Just sink down. Just floating along on this peaceful cloud of relaxation. (Pause for 1 to 2 minutes.) And now it's time to come back to the people around you. I will count backwards from 10 down to one, and when I come to one, sit up, feeling peaceful and alert. Ten, nine, . . . one" (Adapted from Hendricks & Roberts, 19??). Discussion . What were you aware of? How did you feel? Who can neune some of the exercises we ha,ve learned? When can you use them? Relaxation training . If you wish, repeat previous exercises by request. P"ollow-up activity . Encourage the children to practice relaxation daily outside the group. If they are not practicing, you may want to discuss such things as when is a good time to practice. Also, encourage them to use relaxation when they get tense or nervous and ask them to bring an example to share next time. As always, encourage them to notice times when they are relaxed and times when they are tense. Session Eight--Stretching and Rag Doll Goals The children will learn two quick methods of relaxing their muscles . Exercises Discussion . How was relaxation practice? When do you practice? Which exercises do you use? Are there any difficulties with relaxation practice? Did you notice a time when you were relaxed? Did you notice a time when you were tense? Did you use relaxation when you were tense or worried? (if yes, discuss which ones they used, when they used them, and how they felt.) Relaxation training . "We need to do these two exercises sitting up on the floor or in a chair. Find a place where you can sit comfortably. Close your eyes." "Now pretend you are a furry, lazy cat. You want to stretch. Stretch your arms out in front of you. Raise them up high over your head. Way back. Feel the pull in your shoulders. Stretch higher. Now just let your arms drop back to your side. Okay, kittens, let's

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stretch again. Stretch your arms out in front of you. Raise them over your head. Pull them back, way hack. Pull hard. Now let them drop quickly. Good. Notice how your shoulders feel more relaxed. This time let's have a great big stretch. Try to touch the ceiling. Stretch your arms way out in front of you. Raise them way up high over your head. Push them way, way back. Notice the tension and pull in your arms and shoulders. Hold tight, now. Great. Let them drop very quickly and feel how good it is to be relaxed. It feels good and warm and lazy" (Koeppen, 197'^ > P1?) "Sit with your back straight and your legs apart a little. Now let yourself collapse like a rag doll, letting your head and arms fall into your lap. Close your eyes and listen to your breathing. Let each breath relax you more, relaxing into your lap. Imagine that your eyes are soft and relaxed, so loose that you aren't putting any effort into them. Tell your mouth and jaw to relax, so relaxed that your whole face becomes warm and heavy. Remember what being relaxed feels like, so that the next time you feel tense or scattered, you can relax like a rag doll. Now we'll count backwarxis to one, and when we hit one, you will feel rested and alert. Ten, nine, . . . one. Sit up, feeling rested and alert" (Adapted from Hendricks & Roberts, 1977). Discussion . How did you feel? Were the exercises difficult? Easy? When did you feel the most relaxed? What did you like best about what we did today? Relaxation training . Previous exercises may be repeated by request if you and the children wish. Follow-up activity . Pay attention to times when you are nervous and times you could use relaxation. Practice relaxation daily. Use relaxation when you get nervous or tense. Session Nine — Earth Relaxation Goals Children will experience the spread of relaxation throughout their bodies, using the cue word "relax." Exercises Discussion . How did relaxation practice go? Did you notice a time you were relaxed? Did you notice a time you were nervous? Did you use relaxation when you were nervous? Which exercise did you use? How did it go? Relaxation training . "This exercise can be done sitting or lying down. Close your eyes and find a way of sitting or lying down that feels comfortable. Give your eyes and ears a rest, and let your

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90 attention go Inside you. Take a moment to be aware of your body. Let yourself go. Just sink down. "Now imagine that the earth is a "big hall of relaxation that you can draw upon to make yourself feel relaxed and good. You can imagine that relaxation is warm and peaceful or glowing. Tell your feet to relax now, and imagine that relaxation beginning to come into your feet. Now tell your ankles to relax and let the relaxation come up through your ankles toward your legs. Tell your legs to relax, and feel the relaxation pouring up through them. Now tell your hips to relax and let the relaxation flow on up through your hips, letting everything below your waist feel very relaxed. Now tell your stomach to relax. Feel the relaxation spreading through your body. Tell your chest to relax , . . your throat to relax. And now let the feeling of relaxation come up through your eyes as you tell them to relax; on up through the top of your head, as you tell your head to relax. Feel the flow of relaxation on up through the top of your head. Feel how good it feels to be relaxed. "Take a deep breath, and, as you let it out slowly, say 'relax,' and relax all over. Whenever you need to completely relax, just feel that flow of relaxation come up through your feet Into your body. It's there whenever you need it. Now, when I count to three, you can let your attention come back to the room, feeling rested and refreshed. One, two, three" (Adapted from Hendricks & Roberts, 197?) • Discussion . What was that like? How did you feel? Was it difficult or easy? What exercises have we learned? When could we use these exercises? Relaxation training . If you and the childi-en are in the mood, repeat previous exercises by request. Follow-up activity . Be aware of times you are relaxed and times you are tense. Use relaxation when you get tense or nervous. Practice relaxation daily. Session Ten--Breath Awareness Relaxation Goal The children will become more aware of the role of breathing in relaxation. Exercises Discussion . When have you been relaxed? When were you tense or nervous? What was relaxation practice i^ike? Which exercises did you use or practice? When did you use or practice them? Relaxation training . "Settle down and get comfortable. Let your eyes gently close, feeling them relax in the darkness. Let your body begin to settle down, one part at a time. Let your head and neck

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91 relax . . . then your chest . . . your stomach . . , your hips . . . your legs. Now gently let your right hand come up to rest on your stomach. Feel the rise and fall of your stomach as your breath flows in and out of your body. Now place your left hand on your chest, feeling the rise and fall as your breath flows in and out of your chest. Compare your hands to see which moves first and which moves more. Listen to your breath flowing in and out of your body. (Pause 15 seconds.) "Now ta.ke a deep breath. As you let it out slowly, say 'relax,' and relax all over. Ta.ke another deep breath, and, as you let it out, say 'relax,' and relax even more. Do this a few times on your own, each time saying 'relax' as you exhale and sink down even deeper into relaxation, (Pause 1 to 2 minutes.) And now let your breathing go back to normal again, enjoying the feeling of relaxed alertness you feel inside. When I count backwards to one, sit up, feeling refreshed and calm. Ten, nine, . . . one" (Adapted from Hendricks & Roberts, 1977). Discussion . How did you like it? How did you feel? What happens to our breathing when we get angry? Scared? Excited? Why does our breathing change when we have feelings? How can being tense affect our breathing? Relaxation training . If time allows, and you and the children wish, repeat previous exercises by request. Follow-up activity . Encourage the children to use and practice relaxation. Closure . Ask the children these unfinished sentences: "In this group I learned . . . Something I discovered was . . . What I liked best was . . . What I liked least v/as ... I use relaxation when ..."

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APPENDIX G THE FANTASY SESSIONS Session One--The Creative Cave "Close your eyes and get in the most comfortable position you can find. Put your hands and your feet where they are the most comfortable and relax. Imagine you see a very beautiful field and you are walking barefoot across it toward a small woods off in the distance (pause). As you approach the woods, you can see the leaves on the trees and you can feel the green velvety grass between your toes. There is a slight breeze. It brushes gently against your face. It's very pleasant. It feels so good to be so close to nature. Walking on, you come to the top of a small hill on the edge of the woods. You are standing in this grass. The grass is very green, soft and velvety to your feet, delicate, very soft and very delicate. You can feel it as it touches your feet (pause). You see beautiful flowers in bloom and smell them. "Right in front of you there is a small mountain. As you gaze at the mountain you notice an opening ... an opening leading into a cave (pause). As you enter the cave, you can see the rock formations, feel the moistness, and in the background you can hear the drip, drip of water. The cave gradually leads down deeper into the ground. Very quiet and peaceful here in the cave. Make your way down deeper into the cave. It is so pleasant here. As you look there toward the back of the cave you notice a bright light coming from an area on the other side of this opening at the back of the cave. You make your way through this opening now, going into another section of the cave. It is light In this very beautiful area of the cave (pause). There in front of you is a statue. A statue (pause). This statue can talk. Talk to the statue now. (Pause for at least 2 minutes . ) "I am going to ask you to make a decision concerning the statue. Will you bring the statue out with you, or will you lea.ve it behind in the cave? You must decide now. You have just a moment. (Pause for about 60 seconds.) Okay, make your way back out of the cave, out into the sunlight. Now, at the count of three you will be alert, completely awake. One, coming up. Two, becoming more and more alert. And three, your eyes are open" (Adapted from Wittmer & Myrick, 197^). 92

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93 Session Two--Next to Nature "Close your eyes now. Try to relax. Just let yourself go. Relax more with each breath. Let any noises you hear just fade away. Imagine that you are walking in a forest on a "beautiful, sunny day. See the trees. Look at them (pause). There are light, fleecy clouds overhead (pause). You feel wonderfully free. As you walk along, you notice flowers (pause) . . . shruhs . . . trees . . . and you see the patterns of light as the sun shines down through the tranches. You feel a slight Lreeze. It brushes lightly against your face. You hear the sound of water bubbling over the rocks in a nearby small stream. "Now, see yourself walking down this small path in the forest. As you follow a turn in the path, you come to a clearing, and there to the front of you is a small stream. There is a small canoe pulled up on the shore. You are walking toward the canoe. You step in, push off easily and effortlessly (pause). There is a nice soft pillow at one end of the canoe, and you lean back as the boat lazily drifts along. You notice the trees on the shore as they fade into the distance. You're drifting down the small stream. Lean back onto the soft cushion, just drifting now. Look up at the soft white clouds overhead. There in the distance you can see and hear a tiny airplane, and as you watch the airplane releases white smoke and slowly spells out your name in giant letters acixiss the sky (pause). "As you lie there in the canoe, you are there. You are seeing, doing, and feeling as if you were in a normal activity. Do not see yourself, just simply be there and let all of your senses come into being. "Now, reach over the right side of the canoe. The water on that side is chilly. It's somewhat numbing (pause). Put your other hand in the water over the other side of the canoe. On this side the water is warm (pause). Now, it's almost time to wake up. On the count of three, I will ask you to open your eyes. One, coming up, two, almost awake, and three, completely awake" (Adapted from Wittmer & Myrick, 197^-) Session Three--The Head Trip ^ "Now close your eyes and let your body relax. Just sort of sink down. Let your head go where it wants to go. Let everything go from your mind; just let your mind go blank. "Imagine that your arms are like wet cloths , . . very heavy and limp. Imagine that your legs are like pieces of wood. You feel heavy all over . . . as if you have a coat of aimor on you. You are now sort of drifting, very vague, very loose, and very pleasant. "As you remain now in this relaxed state, use your imagination. Don't strain to hear my words . . . just follow them. First, imagine that you can see yourself as you are right now. Let yourself see you. Whether you are sitting or lying down, you are looking at you as you are right now . . . there with your eyes closed. See yourself as you are right now.

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9^ "Now, see yourself very tiny. So small tliat you are less tlTan an inch in height. You are very small ... a very tiny you (pause). See yourself now. The image hecomes clear as you see yourself . . . less than an inch in height . . . very much alive, yet so small, so tiny. Now, that tiny you is walking into your mouth . . . walking into your mouth (pause). As you stand there inside . . .it's kind of dark ... a little wet. Looking around now, you look upward. There in the roof of your mouth a trap door is extending downward. You can see that it is well lighted in that part of your head. There is a small ladder leading upward. Just remain relaxed. "Climb the ladder now. Climb the ladder and enter that part of your head. Let your imagination go now as to what you see. ( Pause for about 30 seconds.) As you look toward the back of your head you see a small door that leads to another part of your head (pause). Open the door. Enter, and close the door behind you. You can make out an image there in the semi-darkness. That image is another you, but a different you . . . another self. How is the other self dressed? How does it look? Now, without saying anything out loud, talk to your other self. Carry on a conversation. (Pause about 3O seconds. ) "Now, you must make a decision. Will you bring your other self out with you, out into reality, or will you leave it where it is? You must decide now. (Pause about 30 seconds.) Now, open your eyes" (Adapted from Wittmer & Myrick, 197^)Session Four — The New You "Now that your eyes are closed, let your body sink down. Imagine yourself sinking down . . . just let yourself go. Take a deep breath (pause) and listen to what I say. I am going to count from five down to zero and you will be able to see the numbers. Now, picture the number five, think about it, imagine that you are tra.cing it with your finger. Now, you see the number four, it becomes more and more clear . . . trace it. Picture the three . . . two . . . one. Just let yourself go. Now, picture the zero and take a deep breath (pause) letting it out slowly. Imagine the zero is a magic carpet . . get on. "You are gliding peacefully and slowly . . . you feel the air brushing lightly against your face . . . you come to a forest where it is beautiful, and you land there. Picture yourself going for a walk down a trail in the woods. "You see the trees . . . almost smell them. Each tree becomes more and more clear as you become more relaxed. As you walk along the path, think about how beautiful and peaceful it is , . . how good it is to be this close to nature. As you walk on, you can see the shadows cast on the ground below you. You can see the sun twinkling between the trees. Feeling so close to nature makes you feel so peaceful. "As you walk on, you come to a clearing at the end of the trail. There before you is a beautiful, quiet pond. It's like a mirror and you can see the reflections of the trees in it. As you stop beside

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95 the pond and gaze into the water, you see your own reflection (pause). The image iDecomes very clear. You see what you are wearing. You see you, "Imagine that this pond is magic ... a place where you can get rid of any habit or personality trait you have that you want to get rid of . . . something that you dislike ahout yourself . . . something that you would like to change. Take a moment to decide what you wish to throw away (pause). As you continue to gaze at your reflection in the pond, you see yourself as you are with this part of you that you wish to rid yourself of (pause). The image is hecoming clear. Then, someone drops a rock into the water and the ripples made by the rock wash away the old image. The unwanted part is being washed away in the water (pause) . "As the water stills again, you see your new image. You see yourself rela^ced, smiling, cheerful, and excited about the image of you that you now see in the reflection (pause). Now, slowly open your eyes" (Adapted from Wittmer & Myrick, 197^). Session Five--Stump, Cabin, Stream "I'd like you to imagine that you are a tree stump in the mountains. Become this tree stump. See yourself and your surroundings, Take some time to feel what it's like to be a tree stump. Wha^t kind of stump are you? What's your shape? What kind of bark and roots do you have? Try to get into the experience of being this tree stump. What is your life like as a tree stump? What kinds of things happen to you as this stump? "Fairly nea.r this stump, there is a cabin, I'd like you now to become this cabin. And, again, I'd like you to imagine being this cabin. What are you like? Explore your life as a cabin. What do you have inside you, and what happens to you? Take some time to be aware of being this cabin. "Near this cabin, there is a stream. I'd like you now to become this stream. As a stream, what kind of life do you have? What kind of a stream are you? How do you feel as a stream? What kinds of things happen to you as a stream? What are your surroundings like? "As this stream, I would like you to talk to the cabin. What do you say to the cabin? Talk to the cabin and imagine that the cabin answers back, so that you have a conversation. As this stream, what do you say to this cabin and what does the cabin answer back? Now, become the cabin again and continue the conversation. What do you have to say to the stream? Continue this conversation for a while. "Now say goodbye to the mountains. Say goodbye to the cabin, the stream, the stump, and come back here to this room. Open your eyes when you feel like it" (Adapted from Stevens, 1971).

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Session Six--Hotorcycle "Imagine that you are a motorcycle. What kind of motorcycle are you? What is your life like as a motorcycle? Where do you spend most of your time and what is it like there? Where is your home and where do you go? How do you feel as this motorcycle? Feel what it's like to be this motorcycle for a while. "Now, start up and go somewhere. How do you get started, and what kind of sounds do you make when you're running? What are your surroundings like, and what is the ground heneath your wheels like? Be aware of how you work and how your tires feel as they touch the ground. Where are you going? Look back now, and see who is riding you. What is your rider like? How do you feel towards your rider? What is it like to be a motorcycle? Take a couple of minutes to imagine your life as a motorcycle. "Now, when I count to three, you can open your eyes. One, two, ' three, open your eyes" (Adapted from Stevens, 19?!). Session Seven-Swapsho p "Settle down, get very relaxed, and close your eyes. I want you to imagine that you are walking in a city at night in the rain. You are warmly dressed, and you can see the lights of the city reflected in the wet streets. Just walk along for awhile and explore your city. What do you see? What is your city like? What happens in your city? How do you feel as you walk through this city? "Just ahead there is a little neglected side street. Walk down this side street, and soon you will see an old abandoned store. The front display window is dirty, misty, and spattered with rain, but if you look closely, you can see some dim shapes behind it. What has been left abandoned in this store window? Move closer and try to see what is there. Wipe away some of the mist and moisture so that you can see more clearly. Examine this abandoned thing closely. What is it like? Notice all the details of it. Slowly say goodbye to this store window and what is in it, and walk on through the city streets. Continue to explore your city for a while. "Just ahead there is another strange little side street. As you walk down this street, you will see one store window that has an incredible va.riety of things in it — some old, some new, some very ancient. Some of it is junk and some is treasure, and you'd never expect to see all these things in the same window. As you stand there looking at this window full of things, a friendly little old man walks out of the door and invites you into his shop. He explains that this is no ordinary shop. Within this apparently small shop there is everything in the world. Anyone who finds his way to this shop can choose one thing from the shop and take it with him. You cannot take money, and you cannot sell what you take for money. Aside from this, you can have any one thing from the shop. Take some time now to look around the shop and see what is there. There are all sorts of little nooks and side rooms, with things that you might

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97 like to ha,ve. Eventually you will have to decide which of these things you want to take with you. When you have decided what you want to take with you, take some time getting to know it better. Look at it carefully, and notice all the details about it. Touch it with your hands, handle it, and smell it. How do you feel about this thing? "As you start to walk out the door with it, the storekeeper speaks to you once again and says, 'You may have this, as I said before. There is only one condition. You must give me something in return. It can be absolutely anything you have, and you need not have it with you now, but you must give me something in return for what you take.' What will you give to the old man? Take a little time to decide. Now tell the old man what you will give him. Now, walk out the door, and take a last look at your city. Slowly say goodbye to this city. Now, return to this room and bring with you whatever you decided to take from the shop. When I count to three, you can open your eyes. One, two, three" (Adapted from Stevens, 197l) . Session Eight — Undersea Gave "Imagine that you are skin-diving In a tropical sea near the shore. Listen to all the sounds that you hear, and look around to see what is making each sound in your undersea world. Swim around in this undersea world and explore it. Wha.t is it like, and how do you feel about being there? What do you see, and what can you feel with your hands and skin? Explore some more, and discover more about this experience of being a skin-diver. "Just ahead, you can see the opening of an undersea cave. As you swim toward it, you can see it's quite large and deep. There is something hidden in the back of this cave, where the light is very dim and it's difficult for you to see. Slowly explore this cave and see what you discover when you come to the back of it. When you find something, look at it carefully and see what it is like. How do you feel toward it? Now talk to it, and imagine that it can reply. What do you say to it? And what does it answer? Tell it how you feel toward it. Now, switch places. Become the thing in the cave and continue the conversation. How do you feel as this thing? Look at the skin-diver in the cave with you. How do you feel toward the skin-diver and what do you say to him? What else is going on between you as you talk? Switch places whenever you wish, and continue the conversation with each other for a while. "Now become yourself as the skin-diver and get ready to say goodbye to your undersea world. Take a last look around, and then return to this room" (Adapted from Stevens, 1971). Session Nine--Seashore "I want you to imagine that you are at the seashore somewhere. What is your seashore like? Walk around a, bit. What is the beach under your feet like? Reach down, touch the beach, and get to know

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98 it better. Go down to the water's edge and feel the salt water. Walk along the shore and see what has drifted in on the tide. What can you smell? What is the weather like? How do you feel being there? Explore your seashore on your own for a while, and see what else you can discover. "Now I want you to look out at the ocean. What is the ocean like? Look up and down the coast. Now look straight out to sea. Quite far out there is something gradually moving toward you, coming in with the waves. At first you will he uncertain ahout what it is and how large it is, "but as it slowly comes closer you will "be ahle to see what it is. Watch it closely as it comes closer and eventually comes up to the "beach. When it does come in, go over to it, examine it carefully, and discover all you can about it. Walk around it and look at it from the other side. What is it like? Touch it and see how it feels. Can you guess anything about its past and what events brought it to this beach? How do you feel toward it? "Now I want you to become this object ths.t came in to your beach. As this thing, what are you like? How do you feel being this thing? What has happened to you that brought you to this beach? Take a little time to feel what it's like to be this thing. "Now become yourself again, and look again at this object on your beach. Do you see anything that you didn't notice before? How do you feel towards this thing now? Take a last look around at your seashore, and notice if anything else has changed. Now, slowly say goodbye to your seashore, and to whatever came in on your beach, and return to this 2X)om . When I count to three, you can open your eyes. One, two, three, open your eyes" (Adapted from Stevens, 1971). Session Ten--Still Waters of the Mind "Find a space where you can feel comfortable. Let your body relax so that it feels supported, and let all the tension drain out of you so you can be peaceful yet very alert. (Pause 5 seconds.) "And now let your mind relax and picture yourself floating along on a raft on a lake . . . feel the gentle ripples of the water flowing under you . . . feel the water supporting you. Whenever thoughts go through your mind, just pretend they are ripples on the lake, then go back to just floating on the lake again. Let your thoughts be ripples. (Pause 1 minute . ) "Now let your lake be perfectly still . , . let all the ripples become still and peaceful. (Pause 10 seconds.) "Then let your mind become active again, and sit up, feeling rested and alert" (Adapted from Hendricks and Roberts, 1977).

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APPENDIX D ANXIETY IDENTIFICATION (AID) SCALE Check how you feel compared to other children. More than other children 1. It is hard for me to go to sleep at night. 2. I worry a lot. 3. I get headaches. ^. I am secretly afraid of a lot of things. 5. My feelings get hurt easily. 6. I am nervous. About the same as other children Less than other children Would you like to learn to relax more? yes not sure 99

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REFERENCES Alpert, R., & Hater, R. N. Anxiety in academic achievement situations, Journal of Abnormal and Social Psychology , I96O , 6I, 207-215. Aspects of anxiety . Philadelphia: Lippincott, I968 . Barabasz, F. Group desensitization of test anxiety in the elementary school. Journal of Psychology , 1973, QJ, 2953OI. Beck, A. T. Cognition, anxiety, and psychophysiological disorders. In C. D. Spielherger (Ed.), Anxiety; Current trends in theory and research (Vol. 2). New York: Academic Press, 1972. Benson, H. The relaxation response . New York: William Morrow, 1975. Bernstein, D. A,, & Borkovec, T. D. Progressive relaxation training ; A manual for the helping professionals . Champaign, 111.; Research Press, 1973. Bledsoe, J. G. Factor invariance in the measurement of children's manifest anxiety. Psychological Reports , 1973, j6, 12. Campbell, D. T. , & Stanley, J. C. Experimental and quasi-experimental designs for research . Chicago: Rand McNally, I966. Carkhuff, R. R. Helping and human relations (Vol. l) . New York: Holt, Rinehart, & Winston, Garter, J. L., & Synolds, D. Effects of relaxation training upon handwriting quality. Journal of Learning Disabilities , 197^, 7(^), 236-238. Castenada, A., McGandless, B. R., & Palermo, D. S. The children's form of the Manifest Anxiety Scale. Child Development , 1956, 27, 317-326. Cattell, R. B. The nature and measurement of anxiety. Scientific American, I963 , 208, 96-IO6. Cattell, R. B., & Scheier, I. H. The meaning and measurement of neuroticism and anxiety . New York: Ronald Press, I96I. Cautela, J. R. Behavior therapy and self-control: Techniques and implications. In C. M. Franks (Ed.), Behavior therapy; Appraisal and status . New York: McGraw-Hill, I969. 100

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101 Chang-Liang, R., & Denny, D. R. Applied relaxation as training in self-control. Journal of Counseling Psychology, I976, 23, 183-189. ~ Davis, M. H., Saunders, D. R., Creer, T. L. , & Chai , H. Relaxation training facilitated by hiofeedtack apparatus as a supplemental treatment in tronchial asthma. Journal of Psychosomatic Research. 1973. 17, 121-128. Deffenbacher, J. L. Relaxation in vivo in the treatment of test anxiety. Journal of Behavior Therapy and Experimental Psychi atry, 1976, 7, 289-292. Deffenbacher, J, L., & Kemper, C. C. Counseling test-anxious sixth graders. Elementary School Guidance and Counseling , 1974, 9, 22-29. (a) Deffenbacher, J. L., & Kemper, C. C. Systematic desensitization of test anxiety in junior high students. School Counselor , 1974, 21, 216-222. (b) Deffenbacher, J. L., & Payne, D. M. Two procedures for relaxation as self-control in the treatment of communication apprehension. Journal of Counseling Psychology , 1977, 24, 255-258. Deffenbacher, J. L,, & Snyder, A. L. Relaxation as self-control in the treatment of test and other anxieties. Psychologic al Reports, 1976, 22' 379-385. Denny, D. Active, passive, and vicarious desensitization. Journal of Counseling Psychology , 1974, 21, 369-375. Dodds, J. H. An attribution theoiy approach to the correlation of children's anxiety with IQ, sex, SES, and school achievement. (Doctoral dissertation, Syracuse University, 1975). Dissertation Abstracts International , 1976, JlW , 1957A-1958A. (University Microfilms No. 76-18,507) Durost, W. N,, Bixler, H. H. , Wrightstone, J. W., Prescott, G. A,, & BaloH, I. H. Metropolitan achievement tests . New York: Harcourt Brace Javonovich, 1971. Ferrandino, J. J,, & Marlow, H. A., Jr. Relaxation . Tampa, Florida: Florida Mental Health Institute, 1977. Finch, A. J., Jr., Montgomery, L. E., & Deardorff, P. A. Children's Manifest Anxiety Scale: Reliability with emotionally disturbed children. Psychological Reports , 1974, J4, 658. Finch, A. J., Jr., & Nelson, W. M., III. Locus of control and anxiety in emotionally disturbed children. Psychological Reports , 1974, ^(1, pt.2), 469-470.

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102 Finger, R. , & Galassi, J. P. Effects of modifying cognitive versus emotionality responses in the treatment of test anxiety. Journal of Consulting and Clinical Psychology , 1977, ^, 280-287. Freedenberg , R. A. Effects of systematic desensitization and attentional training on anxiety and performance of 9and 10-yearold children. (Doctoral dissertation. University of Texas at Austin, 197^). Dissertation Al)stracts International , 1975, 15(9), ^649B. (University Microfilm No. 75-4370) Freud, A. The symptomatology of childhood. Psychoanalytic Study o f the Child , I97O, 25, 19-L\-1. Fuller, G. D. Current status of biofeedback in clinical practice. American Psychologist , 1978, J}> 39-^^8. Gifford, E. M., & Marston, A. R. Test anxiety, reading rate, and task experience. Journal of Educational Research , I966, ^, 303-306. Goldfried, M. R. Systematic desensitization as training in selfcontrol. Journal of Consulting and Clinic al Psychology. 1971, 37, 228-234. Harlem, S. H. The effects of psychophysiological relaxation upon selected learning tasks in urban elementary school children. (Doctoral dissertation. University of Pennsylvania, 1975). Dissertation Abstracts International , I976, j6(8), 5149A. (University Microfilms No. 76-3I69) Hawkes, T. H. , & Furst, N. F. Research notes: Race, socio-economic situation, achievement, IQ, and teacher ratings of students' behavior as factors relating to anxiety in upper elementary children. Sociology of Education , I97I, 44, 333-350. Hendricks, G., & Roberts, T. B. The second centering book . Englewood Cliffs, Nevf Jersey: Prentice-Hall, I977 . Hendricks, G., & Wills, R. The centering book . Englewood Cliffs, New Jersey: Prentice-Hall, 1975. Hill, K. T. The relationship of test anxiety, defensiveness, and intelligence to sociometric status. Child Development, I963, 34. 767-776. ^ Hill, K. T., & Sarason, S. B. The relationship of test anxiety and defensiveness to test and school performance over the elementary school years: A further longitudinal study. Monograph of the Society for Research in Child Development , I966, 31(2, Serial No, 104^ Horowitz, F. , & Arrnentrout, J. Discrimination-learning, manifest anxiety, and effects of reinforcement. Child Developme nt, I965, 16, 731-748.

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103 Hundlety, J. D., & Cattell, R, B. Personality structure in middle childhood and prediction of school achievement and adjustment. Monographs of the Society for Research in Child Development , I968 , J}{5, Serial No. 121). Hyman, E. T., & Gale, E. N. Galvanic skin response and reported anxiety during systematic desensitization. Journal of Consulting and Clinical Psychology , 1973, ^, 108-114. Ince, L. P. The use of relaxation training and a conditioned stimulus in the elimination of epileptic seizures in a child: A case study. Journal of Behavior Therapy and Experimental Psychiatry , I976, 7, 39-^2 . Jacobson, E. Progressive relaxation . Chicago:' University of Chicago Press, 1938. Jacohson, E. Anxiety and tension control . Philadelphia: J. B. Lippincott, 1964. Johnson, S. M., & Sechrest, L. Comparisons of desensitization and progressive relaxation in treating test anxiety. Journal of Consulting and Clinical Psychology , I968, J2, 280-286. Kelly, G. Guided fantasy as a counseling technique with youth. Journal of Counseling Psychology , 1972, I9, 355-361. Khan, S. B. Affective correlates of academic achievement. Journal of Educational Psychology/ , I969, 60, 216-221. Kitano , H. L. Validity of the Children's Manifest Anxiety Scale and the modified revised California Inventory. Child Development , i960, ^, 67-72. Koeppen, A. S. Relaxation training for children. Elementary School Guidance and Counseling , 1974, 2> 14-21. Kolh, L. C. Modern clinical psychiatry . Philadelphia: W. B, Saunders, 1973. Kroger, W. S. Clinical and experimental hypnosis . Philadelphia: Lippincott, 1963Lazarus, A. A. The elimination of children's phoLias hy deconditioning. In H. J. Eysenck (Ed.), Behavior therapy and the neurosis . Oxford: Pei-gamon Press, 1959Lazarus, A. A. Behavior therapy and beyond . New York: McGraw-Hill, 1971. Lazarus, A. A. , & Abramovitz, A. The use of emotive JJnagery in the treatment of children's phobias. Journal of Mental Science , I962, 108, 191.

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104 Lester, E. Symbol and symptom in childhood. Canadian Psychiatric Association Journal , 1973, 18, 421-426. Lighthall, F. F. , Ruebush, B. K. , Sarason, S. B., & Zweihelson, I, Change in mental ability as a function of test anxiety and type of mental test. Journal of Consulting Psychology , 1959, 2/}, 34-38. Mann, J. Vicarious desensitization of test anxiety through observation of video-taped treatment. Journal of Counseling Psychology , 1972, 19, 1-7. Mann, J., & Rosenthal, T. L. Vicarious and direct counterconditioning of test anxiety through individual and group desensitization. Behavior Research and Therapy , I969, 7, 359-367. Marlett, N. J., & Watson, D. Test anxiety and immediate or delayed feedback in a test-like avoidance task. Journal of Personality and Social Psychology , I968, 8, 200-203. McBrien, R. J. Using relaxation methods with first-grade boys. Elementary School Guidance and Counseling , 1978, _12, 146-152. Meisels, L. Muscle relaxation as a competing self-control response for tense behavior in a young child. (Doctoral dissertation, Boston College, 1976). Dissertation Abstracts International , I976 J7(2), 978B. (University Microfilm No. 76-18,860) Miklich, D. Operant conditioning procedures with systematic desensitization in a hyperkinetic asthmatic boy. Journal of Behavior Therapy and Experimental Psychiatry , 1973, 4, 177-182, Miller, M. The use of visual imagery and muscle relaxation in the counterconditioning of a phobic child. Journal of Nervous and Mental Disease , 1972, 154, 457-460. Nichols, K. Severe social anxiety. British Journal of Medical Psychology , 1974, 47, 3OI-306. O'Reilly, P., & Wightman, L. E. Improving the identification of anxious elementary school children through the use of an adjusted anxiety scale. Journal of Educational Measurement , 1971, 8, 107-112. PaleiTDo, D. Racial comparisons and additional normative data on the Children's Manifest Anxiety Scale. Child Development , 1959, 30 , 53-57. Patterson, C. H. Theories of counseling and psychotherapy . New York: Harper & Row, I966. Paul, G. L. Physiological effects of relaxation training and hypnotic suggestion. Journal of Abnormal Psychology , I969, 74, 425-437.

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105 Phillips, B. N. Sex, social class, and anxiety as sources of variation in school achievement. Journal of Educational Psychology , 1962, ^, 316-322. Phillips, B. N. , Hindsman, E., & Jennings, E. Influence of intelligence on anxiety and perception of self and others. Child Development , I96O , ^, 41-^^6. Phillips, B. N., Martin, R. P., & Meyers, J. Interventions in relation to anxiety in school. In G. D. Spielberger (Ed.), Anxiety: Current trends in theory and research (Vol. 2). New York; Academic Press, 1972. Poser, E. G. Strategies for behavioral prevention. In P. 0. Davidson (Ed.), The behavioral mana,f3:ement of anxiety, depression , and pain . New York: Brunner/Mazel , 1976. Prescott, G. A. Manual for interpreting the Metropolitan Achievement Tests . New York: Harcourt Brace Jovanovich, 1973Rachman, S. The role of muscular relaxation in desensitization therapy. Behavior Research and Therapy , I968, 6, 159-166. Rogers, C. On becoming a person . Boston: Houghton Mifflin, I96I. Roscoe, J. T. Fundamental resea.rch statistics for the behavioral sciences . New York: Holt, Rinehart, & Winston, 1975Rosenthal, M. K. The effect of a novel situation and anxiety on two groups of dependency behaviors. British Journal of Psychology , 1967, i8, 357-364. Rossman, H. M., & Kahnweiler, J. B. Relaxation training with intermediate grade students. Elementary School Guidance and Counseling , 1977, 11, 259-266. Ruebush, B. Anxiety. In H. Stevenson, J. Kagan, & C. Spiker (Eds.), Child psychology; The 62nd yearbook of the National Society for the Study of Education (Part l). Chicago : The University of Chicago Press, 1963. Russell, R. K., Lent, R. W., & Sipich, J. F. Incorporating cuecontrolled relaxation and systematic desensitization in reduction of anxiety. Psychological Reports , 1977, 40, 635-538. Russell, R. K., & Matthews, C. 0. Cue-controlled relaxation in in vivo desensitization of a snake phobia. Journal of Behavior Therapy and Experimental Psychiatry , 1975, 6, 49-51. Russell, R. K., & Sipich, J. F. Cue-controlled relaxation in the treatment of test anxiety. Journal of Behavior Therapy and Experimental Psychiatry , 1973, 4, 47-49.

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108 Zeisset, R. M. Desensltization and relaxation in the modification of psychiatric patients' interview "behavior. Journal of Abnormal Psychology , I968, 72^Q-^^Zenmore, R. Systematic desensltization as a method of teaching a general anxiety-reducing skill. Journal of Consulting and Clinical Psychology , 1975, 'ji}, 157-161. Ziv, A., & Luz, M. Manifest anxiety in children of different socio-economic levels. Human Development , 1973, I6, 22^-232. Zuckerman, M. The development of an affect adjective check list for measurement of anxiety. Journal of Consulting Psychology , I96O, 24., -^57-/^62.

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BIOGRAPHICAL SKETCH Gharlene Proeger was born June 3» 19'+?, in Norfolk, Virginia. She attended schools in West Hollywood, Florida, and graduated in June, 1965. from McArthur High School. After attending Florida Presbyterian College for 2 years, she graduated from the University of Florida with the degree of Bachelor of Arts in August, 1969She began her graduate work in counselor education in January, 19?0, and received her MEd and EdS from the University of Florida in June, 1972. During the next 5 years, she worked as a counselor in the elementary schools of Alachua county and at P. K. Yonge, the laboratory school of the University of Florida. 109

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I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. Hooert D. 'Ayrlck, Chairperson Professor of Counselor Education I certify that I have read xhis study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. ^^s— .%. / / /V^ Ellen Araatea -"' Assistant Professor oJ Counselor Education I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. Elizabeth Aitmaier Assistant Professor Psychology This dissertation was submitred to the Graduate Faculty of the Department of Counselor Education in the College of Education and to the Graduate Council, and was accepted as -partial fulfillmen-: of the requirements for the des^rse of Doctor of PhilosoDhy. December, 1973 Dean, Graduate Scnooi

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UNIVERSITY OF FLORIDA 3 1262 08552 9344