progressive muscle relaxation: effects of expectancy · bernstein and borkovec (1973). these...
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PROGRESSIVE MUSCLE RELAXATION: EFFECTS OF EXPECTANCY
AND TYPE OF TRAINING ON MEASURES OF ANXIETY
by
Michael E. Stefanek
Thesis submitted to the Faculty of the
Virginia Polyteclmic Institute and State University
in partial fulfillment of the requirements for the degree of
MASTER OF SCIENCE
APPROVED:
R. Hodes
in
Psychology
Richard Eisler, Chairman
May, 1982
Blacksburg, Virginia
A. Schulman
ACKNOWLEDGEMENTS
I would like to thank my committee for its support and suggestions
throughout this project. In particular, I would like to express my ap-
preciation to Robert Hodes, without whose expertise in psychophysiology
this project would not have been undertaken. A hearty thank you is also
extended to Mike Patsfall for his assistance with the data analyses,
~nd to Jean Sales and Dan Fones, research assistants, whose dependabili-
ty through a sometimes tedious task is much appreciated.
ii
TABLE. OF CONTENTS
ACKNOWLEDGEMENTS • • • • • • • • • • • • • • • • . • . • • • • • • • • . ii
LIST OF TABLES. • • • • • • • • • • • • • • •
LIST OF FIGURES
INTRODUCTION .•
Background and Description of Progressive Muscle Relaxation Efficacy of Progressive Muscle Relaxation. • • • • • ••• Psychophysiological and Self Report Assessment of
Relaxation Training • • • • • • • . • • • • • • • Procedural Variables of Progressive Muscle Relaxation •••• Live Versus Taped Relaxation Investigations •••••• Methodological Smnmary: Live versus Taped Instructions Treatment Expectancy and other Control Procedures. Present Investigation ••••••••••
METHOD ••.
Subjects •• Design ••• Apparatus. Dependent Variables Procedure •.••••
Live Relaxation Groups •• Taped Relaxation Groups ••••• Self Relaxation Groups. • • • • • • High Expectancy Conditions. Low Expectancy Conditions •••••
RESULTS
Pretreatment Measures •••• Analysis of Treatment Effects
·. . .
DISCUSSION . . . . . . . . . . ' . . The Role of Expectancy and Other Active Multidimensional Nature of Anxiety •.• Caveats and Future Directions ••••• Concluding Remarks •••••••••
Therapeutic Elements •••
REFERENCES. • • • • • • • • • • • • • . . . . . . . . . . . . . . .
V
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1
1 3
6 ll 14 18 24 29
32
32 34 34 36 37 39 41 42 43 43
44
44 49
61
62 68 71 74
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APPENDICES. •
Anxiety Differential. • • •• A. B. c. D. E. F. G.
Inventory of General Trait Anxiousness •••••••••••• Consent Form and Self Monitoring Contract.
82
83 86 90 92 94 96
Expectancy Questionnaire. • • • • •••••• Post-Session 1 Questionnaire. • • • • • .• Procedural Outline: Session 1. Procedural Outline: Session 2.
H. L
• •• 98 • •• 100
• • 102 J.
Self Monitoring Sheets ••• ~ •• Pre-Relaxation Instructions--Taped. Live and Taped Relaxation Instructions. Self Relaxation Self-Monitoring Form ••
• ••• 104 K. L. Tables. . . . . . . . . . . . . . . . . . . . .
1. Analysis of Variance for SR-GTA. • ••• 2. Analysis of Variance for Baseline Period Measure. 3. Session 1 Baseline Heart Rate ••• 4. 5. 6. 7. 8. 9.
10.
Session 2 Baseline Heart Rate • • • • • • • • • t-test for Heart Rate Median Split •••••••• Analysis of Variance for Experimenter Differences. Analysis of Variance for Self-Monitoring Sheets •• Analysis of Variance for Relaxation Ratings •••• Multivariate Analysis of Variance for the Overall Effects of Treatment, Expectation, and Sessions. . • . • • . • • • • •.• Univariate Analyses of Variance for Dependent. Variables . . . . . . . . • • • •
VITA • ••
ABSTRACT
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• 108 • 110 • 111 • 112
• •• 114 • 115
• • 116 • 117 • 118
119
• •• 120
• 121
•• 123
LIST OF TABLES
Table
1. Live versus Taped Relaxation Training.
2. Mean Scores for SR-GTA.
3. Relaxation Rating Means ••
4. Mean Change Scores for Dependent Variables.
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45
51
56
5. Correlation Matrix for Self Report Dependent Variables. 58
6. Correlation Matrix for Self Report/Physiological Dependent Variables .. 59
V
Figure
1.
2.
3.
LIST OF FIGURES
Baseline Heart Rate~Session 1.
Baseline Heart Rate~Session 2.
Heart Rate Change Scores ••••
4. Skin Fluctuation Change Scores ••
5. Anxiety Differential Change Scores .•
6. Finger Pulse Change Scores.
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Page
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Introduction
The therapeutic technique known as progressive muscle relaxation
has been used as a treatment technique for a variety of psychological
disorders (e.g., tension headaches, test anxiety) and as a component
in other behavioral strategies (e.g., systematic desensitization,
participant modeling). Despite rather widespread use, a variety of
issues pertaining to progressive muscle relaxation remain clouded.
More specifically, psychophysiological effects in stress and nonstress
situations, and critical procedural variables involved in its effec-
tive implementation, have not been definitely delineated. Th~ present
investigation examines the latter area of confusion, specifically, the
modality used in training progressive muscle relaxation (i.e., live or
taped training) and the role of expectancy factors in examining the
efficacy of progressive muscle relaxation.
Background and Description of
Progressive Muscle Relaxation
At this point in time, progressive muscle relaxation is considered
the most prevalent technique of inducing relaxation (King, 1980). The
procedure itself involves systematically tensing and relaxing various
gross muscle groups throughout the body. The individual attends to the
feelings of tension and relaxation concomitant with the tensing and
relaxing of the muscle groups. The goal of the procedure is to in-
crease the individual's ability to discern and eliminate tension.
Despite the early work of Jacobsen (1929) with progressive relaxa-
tion, it was several decades before the technique was used extensively
1
2
in applied settings. As King (1980) noted, the major reason may well
have been due to the central role psychoanalysis played as a model of
psychopathology. Psychoanalytic treatment is based on the unconscious
role played by the id, ego, and superego and the dynamics created by
the interplay of these inner forces. In addition., great emphasis is
given the role of childhood development as the individual progresses
through a series of psychosexual stages. Psychopathology results when
progression through these stages is prevented. Relaxation training
does not purport to deal with unconscious forces or psychosexual con-
flict. Hence, based on this view, progressive relaxation W'Ould be seen
as a very superficial treatment strategy. In addition, the substantial
time investment needed for the full training as proposed by Jacobsen
served as a further deterrent. As developed by Jacobsen, progressive
relaxation required a total of 50 hourly sessions of systematic
training.
As alternatives to psychoanalysis have developed, particularly
behavior therapy, the use of progressive muscle relaxation has in-
creased extensively. Wolpe (1958) served to promote the procedure
when he selected muscle relaxation as the main anxiety inhibitor in
his procedure of systematic desensitization. In addition, he estab-
lished an abbreviated form of progressive muscle relaxation, incorpo-
rating six 20 minute sessions with two 15 minute practice sessions
daily between training sessions. This shortened version of progres-
sive relaxation has increased the popularity of the technique. un-
doubtedly, the most thorough and frequently cited description of
3
abbreviated progressive muscle relaxation (Israel & Beinan, 1977;
Russell,Sipich, & Knipe, 1976, among many others) is the manual by
Bernstein and Borkovec (1973). These authors recommend the following
sequence of events with each of the major muscle groups: (1) the
attention of the subject is focused on a particular muscle group; (2)
the muscle group is tensed upon a signal from the therapist; (3) ten-
sion is maintained for 5-7 seconds; (4) the muscle group is then re-
laxed, upon signal from the therapist; and (5) the subject's attention
is focused upon the muscle group as it relaxes. Sixteen muscle groups
are tensed and relaxed in the following order: dominant hand and
forearm; dominant biceps; nondominant hand and forearm; nondominant bi-
ceps; forehead, upper cheeks, and nose; lower cheeks and jaw; neck and
throat; chest, shoulders, and upper back; abdominal or stomach region;
dominant thigh; dominant calf; dominant foot; nondominant thigh; non-
dominant calf; nondominant foot.
Efficacy of Progressive Muscle Relaxation
Since Wolpe's initial work, progressive relaxation has been ex-
tensively used as a treatment technique in its owri right in addition
to its use as a component of the desensitization paradigm. Russell and
Sipich (1974) found significant decreases in the Test Anxiety Scale
(Sarason, 1957), the State-Trait Anxiety Inventory {Spielberger &
Gorsuch, 1966) and the Anxiety Differential {Husek & Alexander, 1962)
following progressive muscle relaxation with a test anxious population.
Russell, Miller, and June (1976) also found changes due to progressive
muscle relaxation with this same population on the Test Anxiety Scale
4
and State Trait Anxiety Inventory. Borkovec and Fowles (1973) found
decreases in the number of minutes required to fall asleep, the number
of minutes awake during the night, and the degree of restfulness upon
awakening with insomniacs with training in progressive muscle relaxa-
tion. Matthews and Gelder (1969) investigated progressive muscle re-
laxation with individuals reporting phobic reactions or generalized
anxiety and found decreases with relaxation on EMG, skin conductance
activity, and skin conductance level measures. Borkovec, Grayson, and
Cooper (1978),working with a generalized anxiety population, found
significant effects attributable to progressive muscle relaxation in
daily tension percentage and a respiration measure, inspiration/
expiration amplitude ratio. Tasto and Chesney (1974) have also used
progressive muscle relaxation for treatment of dysmenorrhea finding
decreases in the Symptom Rating Scale (Muller, 1971) and the Menstrual
Activities Scale. Finally, Shoemaker and Tasto (1975) found that
progressive muscle relaxation training had a significant effect upon
lowering systolic and diastolic blood pressure in hypertensives. In
general, then, researchers using abbreviated progressive relaxation
as a single model therapy have reported positive results across re-
sponse systems (somatic, cognitive, and behavioral), particularly in
the areas of insomnia and anxiety.
Progressive relaxation also compares favorably with other modes
of relaxation training. In the area of insomnia, Nicasso and Bootzin
(1975) found progressive relaxation superior to control groups and
equivalent to autogenic relaxation. This latter type of relaxation
5
training (Schultz & Luthe, 1959) involves no direct tensing of muscle
groups. Rather, phrases are introduced to the trainee (e.g., "My arm
is heavy and warm."), and the trainee is instructed to passively con-
centrate on these phrases. These instructions are shifted to different
limbs, and also to cardiac activity ("heartbeat calm and regular"),
respiration, the abdominal region, and the forehead. Similar results
supporting progressive relaxation exist with other problem areas in-
cluding dental fears (Miller, Murphy, & Miiler, 1978) and headaches
(Blanchard, Theobald, Williamson, Silver, & Brown, 1978; Cox, Freund-
lich, & Meyer, 1975). King (1980) noted that despite investigations
supporting the efficacy of progressive muscle relaxation as a single-
model therapy (Deffenbacher, 1976; Russell et al., 1976), a number of
methodological problems prevent a definitive statement of the effec-
tiveness of the single model therapy approach with progressive muscle
relaxation. Among these problems are inadequate controls for demand
characteristics or expectation and lack of reliability and validity of
the dependent measures. More specifically, studies attesting to the
efficacy of progressive relaxation have implemented control strategies
involving subjects discussing a variety of topics with the therapist in
lieu of progressive relaxation training (Goldfried & Trier, 1974;
Haynes, Woodward, Moran, & Alexander, 1974), a rather weak control for
demand characteristics. In addition, dependent measures frequently
involve only self report, a measure fraught with inherent reliability
and validity problems. As an example of the prevalence of this
measurement problem, Luiselli, Steinman and Steinman (1979) reviewed
6
70 articles from four major psychological journals regularly publish-
ing research concerned with relaxation training and noted that 70% of
the articles gave no indication of how the effects of relaxation were
assessed. Moreover, only five studies involving physiological
measures reported the use of more than one physiological measure, and
only five studies reported data involving more than one category of
measurement. Finally, a large number of studies have used college
students with problems of less than clinical intensity implementing
very lenient selection criteria. This choice of subjects severely
limits the ability to generalize to clinical populations. Thus, al-
though results are very promising, a conservative view of the efficacy
of progressive relaxation 'WOUld fall short of enthusiastic endorsement.
In sum, widespread use of progressive relaxation should not be
seen as proof of the efficacy of progressive muscle relaxation in the
problem areas discussed in this section. Despite great promise and a
preponderance of favorable research results, the efficacy of this ap-
proach as a single model therapy and facilitator of other interven-
tions can still be questioned. In addition to the methodological
problems noted, the infrequent measurement of or inconsistent results
garnered from self report measures or psychophysiological assessment
contributes to this question of efficacy.
Psychophysiological and Self Report
Assessment of Relaxation Training
As might be gleaned from the above discussion of physiological
measures, results of the numerous investigations of relaxation on
7
physiological responding are somewhat inconsistent. In his early
research, Jacobsen (1929, 1934, 1940) found that training in progres-
sive relaxation produced dramatic decreases in muscle activity,
blood pressure, and heart rate. However, as noted previously, Jacob-
sen relied upon a large number of lengthy training sessions and ne-
glected to utilize statistical procedures and appropriate control pre-
cautions (Mathews, 1971). Abbreviated progressive relaxation has been
shown to effect changes in electrodermal measures (Beiman, Israel, &
Johnson, 1978; Brandt, 1973), muscle tension (Mathews & Gelder, 1969;
Paul, 1969), respiration (Delman & Johnson, 1976; Paul, 1969), heart
rate (Ollendick & Murphy, 1977; Paul & Trimble, 1970), and blood
pressure (Deabler, Fidel, Dilenkoffer, & Elder, 1973; Shoemaker &
Tasto, 1975). However, Brokovec and Sides (1979), investigating 25
studies directly related to this issue, found 15 reporting progressive
relaxation superiority, while 10 indicated equivalence. In addition,
King (1980) suummarized studies of the psychophysiological effects of
relaxation training noting: "A clear picture fails to emerge with
respect to the psychophysiological effects of progressive muscle re-
laxation in stress and nonstress situations" (p. 155). In an attempt
to provide some explanation of these results, Borkovec and Sides
(1979) posit that the number of sessions, population differences
(anxious v. normal subjects), and live vs. taped presentation of pro-
gressive relaxation instructions act as differences between those
studies showing and not showing physiological effects.
8
Historically, heart rate is by far the most frequently assessed
cardiovascular output parameter, and, as noted by Borkovec, Weerts,
and Bernstein (1977), has received the greatest empirical investiga-
tion with respect to anxiety assessment. A host of investigators
have utilized this measure in assessing anxiety (Edelman, 1970; Mat-
thews & Gelder, 1969; Paul, 1969; Schandler & Grings, 1970, among
others). The majority of investigators have noted decreases in heart
rate with progressive muscle relaxation over control conditions
(Brandt, 1973; Edelman, 1970; Ollendick & Murphy, 1977; Paul, 1969)
although these results are not unanimous (Beiman et al., 1978; Borko-
vec et al., 1978). In sum, heart rate has consistently been the car-
diovascular measurement of choice in the physiological assessment of
anxiety.
Finger pulse volume amplitude (FPV) has also been used as a
measure of cardiovascular functioning. As Borkovec et al. (1977) note,
different measures of cardiovascular functioning are all interrelated,
but not in a simple, positive, linear fashion, and thus, cannot be
assumed interchangeable. Blood volume represents the absolute level
of blood in the tissue with blood volume pulse representing the blood
flow through the tissue with each cardiac contraction. Bloom, Houston,
and Burish (1976) explored the utility of FPV as a measure of anxiety.
In this investigation, subjects were exposed to either a threatening
(threat of electrical shock) or nonthreatening situation, while in-
dices of physiological arousal (pulse rate and finger pulse volume)
and self reports of anxiety (Affect Adjective Checklist) were
9
collected. Results indicated significant correlations of FPV with
pulse rate and AACL measures and that FPV was differentially respon-
sive to two levels of experimentally manipulated anxiety. It should
be noted, however, that the strengths of the relationships between FPV
and pulse rate and AACL were not substantial (r .41 and .24, respec-
tively), although typical of correlations between physiological
measures and other physiological and self report measures of anxiety
(Martin, 1961). A further investigation (Bloom & Trautt, 1977) served
to substantiate the above findings.
Measures of electrodermal activity (EDA) have also been investi-
gated with relation to changes in skin conductance with progressive
relaxation training. Beiman et al. (1978), Brandt (1973, Lehrer
(1977, and Schandler and Grings (1976) have all found significant
changes on GSR frequency with progressive muscle relaxation over a
variety of control conditions, while Davidson and Hiebert (1971) and
Mathews and Gelder (1969) found no differences in skin conductance
measures between treatment and control conditions. Other than the
Beirnan et al. (1978) investigation, those studies examining live versus
taped relaxation have not selected a physiological measure from the
electrodermal response system.
vec et al. (1977), note: "
This is despite the fact that, as Borke-
• of all the bodily systems available :·for
measurement, the skin's electrical properties have most often been
elected as a convenient measure of the physiology of the anxiety state"
(p. 411).
10
In the present investigation, spontaneous fluctuations in skin
resistance, heart rate, and finger pulse volume amplitude were all
used as a physiological assessment of anxiety.
As opposed to the literature's inconsistent physiological results,
self report measures consistently support the use of progressive re-
laxation training as a means of reducing subjective tension and anxiety.
The Affect Adjective Checklist (Zuckerman, 1960), State-Trait Anxiety
Inventory (Spielberger, Gorsuch, & Lushene, 1968), and Anxiety Differ-
ential (Husek & Alexander, 1962) have been used extensively in re-
search with progressive relaxation (Beiman & Johnson, 1978; Edelman,
1970; Paul, 1969, 1970; Schandler & Grings, 1976) with positive re-
sults. The latter measure was used in the present investigation. This
instrument is a self report semantic differential state anxiety measure
(Appendix A). The AD was developed as a verbal response measure of
situational anxiety, with ratings of concepts simply involving checking
bipolar scales of adjectives (e.g., loose-tight, deep-shallow}. Anx-
ious subjects instructed to "fake good" have been found to display
higher anxiety scores than a nonanxious control group. In a subsequent
investigation, knowing the purpose of the AD was unrelated to anxiety
scores. Internal consistency was adequate in several studies (Alex-
ander & Husek, 1962; Husek & Alexander, 1963}. In addition, Paul
(1966) reported a moderate 7 week test-retest correlation (r = .54)
for a speech anxious sample, while a 3 week test-retest relationship
among 47 nontreated socially anxious subjects has been found to be
fairly high (r = .78) in a study by Borkovec, Stone, O'Brien,
11
and Kaloupek (1978). Finally, all investigations dealing with the
issue of live versus taped relaxation have used this measure (Beiman
et al., 1978; Israel & Beiman, 1977; Paul & Trimble, 1970; Russell,
Sipich, & Knipe, 1976), thus facilitating comparison of results.
Typically, correlations between subjective ratings of anxiety
and physiological variables have been low and nonsignificant. A num-
ber of factors may account for ,:the inconsistent findings including
population differences, techniques of assessing anxiety level, inten-
sity of training, the complexity of the "anxiety" construct itself,
and/or emotional desynchrony (Hodgson & Rachman, 1974; Lang, 1978;
Lehrer, 1978). The latter possibility refers to different rates of
change for different emotional behaviors observed in the same subject.
Procedural Variables of
Progressive Muscle Relaxation
A host of issues related to progressive relaxation training re-
main unsolved. Borkovec and Sides (1979), in a recent review of pro-
cedural variables related to the physiological effects of progressive
relaxation referred to earlier in this paper, found a series of dif-
ferences between studies dem::>nstrating progressive relaxation superiority
and those not demonstrating superiority. Among the former, the mean
number of sessions was 4. 5.7, 73% employed live administration of the
procedures, and 47% involved patient samples. A:nK>ng studies finding
equivalence between progressive relaxation and control conditions,
the average number of sessions was 2.30, 80% involved normal subjects,
and.70% employed standardized taped instructions. It is this latter
12
issue, i.e., the issue of live versus taped training, which will be of
concern in the present study •. In addition to the authors' disclaimer
stating that considerable overlap existed between groups of the studies
providing different results on the procedural aspects noted above,
methodological problems in ·the studies discussed serve to question
their conclusions. More specifically, the seven studies employing
taped relaxation instruction which produced findings indicating pro-
gressive muscle relaxation to be equivalent to or inferior to appro-
priate control conditions include a high frequency of methodological
weaknesses. The large number of methodological problems serves to
dissolve the significant difference found between live and taped
instructions with regard to physiological effects. A series of these
experiments (Edelman, 1970; Haynes, Moseley, & McGowan, 1975; Lader &
Mathews, 1970) included only one relaxation session. Also, Davidson
and Hiebert (1971) employed, in addition to one experimental session,
two relaxation training sessions, one the day prior to the experimental
session and one immediately prior to the experimental session. Hence,
the degree of training of relaxation skills may have been inadequate
in these studies reporting negative results for taped relaxation.
Further, Davidson and Hiebert used only skin conduction as their
measure of assessing physiological effects, while Haynes et al. (1975)
restricted their physiological measures to frontalis EMG recordings.
This poses a problem since different individuals may respond to pro-
gressive relaxation by a large decrease in heart rate and a small or
insignificant decrease in skin conductance, while another individual
13
may respond with the opposite pattern (Lacey, Bateman, & Van Lehn,
1953; Martin, 1961). Thus, the use of a single measure of physio-
logical response is severely limiting the prospects for finding
changes with relaxation training. Tasto and Huebner (1976), another
study cited by Borkovec and Sides (1979), found no differences in
measures of systolic and diastolic blood pressure with normotensives,
using taped instructions. However, Shoemaker and Tasto (1975) found
that muscle relaxation has a significant effect upon lowering systolic
and diastolic blood pressure using taped progressive muscle relaxation
instructions with a hypertensive population. It is conceivable, as
Tasto and Huebner point out, that there may be a lower limit below
which blood pressure will not go regardless of how relaxed a person
becomes. If this is true, Tasto and Huebner's work can hardly be said
to be an indictment of the efficacy of progressive muscle relaxation.
Finally, these investigations, including Paul and Trimble (1970), suf-
fer from weaknesses in the area of subject selection (i.e., use of
normal population) and lack of controls for treatment expectancies.
Based on all seven studies reviewed, the issue regarding the ef-
fectiveness of taped instructions has not been isolated from the
effects of normal versus clinical populations, number of sessions
(amount of practice), or other factors as a determinant in not achiev-
ing physiological effects with progressive muscle relaxation. For-
tunately, a series of studies have specifically investigated the ef-
fects of live versus taped relaxation instructions (Bieman et al.,
1978; Israel & Beiman, 1977; Paul & Trimble, 1970; Russell et al., 1976).
14
Live Versus Taped Relaxation Investigations
The first investigation directly comparing the effects of recorded
versus live relaxation training was that of Paul and Trimble (1970).
In this study, three groups (N = 10) of undergraduate females par-
ticipated individually for two sessions, 1 week apart, receiving
either: (1) abbreviated progressive muscle relaxation via recorded
tape; (2) hypnotic induction emphasizing direct suggestions of heavi-
ness, warmth, etc. via recorded tape; (3) self relaxation control
procedure. The experimenter was not present during the sessions in
all three conditions. Among other results, the authors found recorded
relaxation to be inferior to live, with live data based on results ob-
tained previously. That is, recorded relaxation training was com-
pared to live relaxation training, while taped self relaxation and
hypnotic induction groups were compared to live self relaxation and
live hypnotic induction groups, respectively. With regard to the pro-
gressive relaxation condition, significant differences were found on
measures of heart rate and tonic muscle tension (forearm), favoring
the live condition. No differences were found among groups on the
Anxiety Differential (Husek & Alexander, 1962), a self report measure
of state anxiety.
Obviously, the retrospective data comparison must be considered
a weakness in the investigation under discussion. The fact that the
data from the live groups across conditions was drawn from a prior
investigation (Paul, 1969) poses problems of internal validity.
Other weaknesses include: (1) the use of different tapes for each of
15
the two sessions; (2) the lack of close monitoring of between session
practice ("requested" of the subjects by the authors); (3) the use of
a population consisting of female undergraduates participating as part
of a research requirement, unselected except for absence of drug use
and presence of good physical health; (4) use of one experimenter
across groups; and (5) lack of controls for expectancy factors.
Russell et al. (1976) also contrasted live versus taped instruc-
tion,in a four-group design involving two sessions 1 week apart; the
groups included: (1) live presentation, 16 muscle groups; (2) taped
presentation (experimenter absent), 16 muscle group; (3) live presen-
tation, four muscle groups; and (4) self relaxation control group.
Dependent measures included EMG recordings (location not noted), and
the Anxiety Differential. The population for the study consisted of
34 undergraduate females. Significant reductions in both EMG and
Anxiety Differential measures occurred only in the 16 live condition,
while the 16 taped condition showed significant reductions on the
Anxiety Differential, but not with EMG measure. The four live condi-
tion showed no changes in either dependent measure, while the control
condition demonstrated significant pre~post EMG changes. This inves-
tigation suffers from a host of weaknesses including: (1) small and
unequal number of subjects across conditions (16 live= 11, 16 taped=
6, 4 live = 8, self relaxation= 9), and no explanation given regarding
these unequal cell assignments; (2) lack of practice between sessions;
(3) use of nonanxious female undergraduates as subjects with no infor-
mation provided regarding screening decisions; (4) no information
16
provided regarding assignment of subjects to groups or assignment of
the three therapists to groups; (5) no control for client expectan-
cies; (6) no specification of electrode placement for the EMG measure;
and (7) the use of only one physiological measure (EMG) and no mention
of between group comparisons with only pre-post within-group changes
provided.
Israel and Beiman (1977) compared the effects of live and taped
progressive relaxation training and self relaxation using frontalis
EMG and the Anxiety Differential as dependent measures. Subjects were
individuals who responded to advertisements for tension relief (14
males, 11 females). Treatment involved three sessions, and results
indicated no difference between live, taped, and self relaxation con-
ditions on heart rate, respiration, or EMG (frontalis) measures, with
the live relaxation group superior to both taped and self relaxation
groups on the Anxiety Differential. All subjects showed significant
reductions on all measures during the sessions with no difference be-
tween treatment conditions or across sessions. No mention is made of
experimenter presence/absence during taped relaxation, and practice
between sessions was not monitored. Weaknesses in this particular
study include possible subject selection problems since no mention is
made of exclusion due to previous relaxation training or medication.
Also, considerable ambiguity exists regarding the criterion of anxiety
measures used, i.e., "above average" scores on the STAI (Spielberger
et al., 1968) and the MCAL (Zuckerman, 1960). In addition to the above
weaknesses, this investigation unfortunately involved no controls for
17
treatment expectancy variables, while use of the same therapist across
all three groups is also questionable.
Finally, Beiroan et al. (1978} compared live and taped relaxation
training, self relaxation, and electromyogram biofeedback on measures
of autonomic and somatic arousal and subjective tension. Male and fe-
male respondents (N = 40} to an advertisement soliciting tense indi-
viduals to participate in a psychology study were assigned to one of
the groups above and evaluated in five sessions of decreasing duration
(35, 35, 15, 15, and 5 minutes). This decreasing duration coincided
with training involving 16 muscle groups, then four, then training in
relaxation by recall, spread over a total of 24 days. Due to this de-
crease in session length for live and taped groups, statistical com-
parisons were limited to live versus taped and self versus biofeedback
group comparisons. Dependent measures included the Trait Scale of the
STAI, the MACL, the skin resistance response (SRR), heart rate, respira-
tion rate, and muscle tension measures. The experimenter was not pres-
ent during taped instruction. Among other findings, live progressive
relaxation was significantly superior to taped training on three of the
four physiological measures (no significant difference on respiration
rate), while no significant difference was found between the live and
taped groups with regard to the Anxiety Differential or other self
report measures implemented. A posttreatment 10-minute assessment
(i.e., a sixth session) also favored the live relaxation condition.
During this session, subjects were told to relax as much as possible
using the relaxation skills developed in the previous five training
18
sessions. Specifically, the live relaxation condition was superior
on the SRR measure. The self and live relaxation condition were
equivalent and superior to biofeedback and taped groups with regard
to the respiration rate measure, while EMG and subjective tension
measures were equivalent across groups. The lack of objective measures
of anxiety as a screening device, lack of control for experimenter in-
fluence,and expectancy effects, and lack of monitoring of requested
practice between sessions limit internal validity and generalizability
of this investigation.
Methodological Swnn1ary:
Live Versus Taped Investigations
Briefly reviewing the four studies dealing directly with the issue
of live versus taped relaxation (Israel & Beiman, 1977; Israel, et al.,
1978; Paul & Trimble, 1970; Russell et al., 1976), a series of common
methodological weaknesses are found.
1. Subject selection. While Israel and Beiman and Beiman et al.
purport to use "anxious" populations, the criteria for selection are
either inadequate (i.e., no objective measure of anxiety implemented,
no assessment of prior use of relaxation) or ambiguous (use of objec-
tive measures with little delineation of participant's scoring rela-
tive to normative data). In addition, Paul and Trimble (1970) and
Russell et al. (1976) used unselected female undergraduates, with no
measures of anxiety, either subjective or objective, used for screen-
ing purposes. Despite these weaknesses, all investigators attempt to
19
generalize findings to clinical settings with only Paul and Trimble
adding a cautionary note.
2. Group assignment: Therapists and subjects. While Russell
et al. (1976) make no mention of how subjects were assigned to differ-
ent groups, random assignment was used by the other three investiga-
tors under discussion. Based on the relatively small number of sub-
jects used in each investigation (Beiman et al.~10/group; Israel &
Beiman~8/group; Paul & Trimble~lO/group), a better option might
have involved random assignment based on anxiety level~ With the small
number of subjects in each group, placement of two to three of the
most anxious individuals in a particular group may bias findings in
that anxious individuals have shown more physiological response to
progressive relaxation training (Borkovec & Sides, 1979; Lehrer, 1978).
In addition, Russell et al. (1976) provide no information regarding
assignment of therapists to groups, while Beiman et al. (1978), Israel
and Beiman (1977) and Paul and Trimble (1970) all used the same thera-
pist across groups with the resulting possible confounds of therapist
expectancy factors.
3. Expectancy factors. None of the four investigations atte~ted
to control for subject expectancy variables. Hence, it may well be
that expectancies for improvement are higher for live versus taped or
self relaxation. This point is especially critical in Paul and Trim-
ble's (1970) study in which different instructions are given among
groups which clearly favors the live relaxation condition in terms of
purported efficacy.
20
4. Practice effects. Israel and Beiman (1977) and Russell et
al. (1976) do not mention between session practice, while Paul and
Trimble (1970) requested subjects to practice, twice daily, but pro-
vided no check on whether the practice was in fact completed. Finally,
Beiman et al. (1978) improve in this area somewhat.by making the re-
quest and discussing the practice at the second session. Unfortunately,
no monitoring of actual task completion was attempted. This failure
to either request or monitor relaxation practice seems critical in
terms of generalizing to clinical settings and possible between-group
differences (considering the small number of subjects per group across
studies) in practice leading to differential changes across groups in
the dependent measures.
In sum, based on the above considerations, the rather accepted
notion that live relaxation is superior to taped relaxation training
appears somewhat premature. To add to the confusion, consider that
self reported anxiety has been found not to differ between taped and
live instruction (Paul & Trimble, 1970; Russell et al., 1976), to be
significantly lowered with live instruction (Israel & Beiman, 1977),
and to be equivalent across types of instructions but showing defini-
tive downward trends favoring live relaxation (Beiman et ai., 1978).
With regard to physiological measures, Russell et al. (1976) found
significant EMG decrease with live and self relaxation (16 muscle
group condition), while Israel and Beiman (1977) found lower EMG re-
cordings for all groups (taped, live, and self). Further, Paul and
Trimble (1970) found taped relaxation inferior to live on EMG and
21
heart rate measures, and no significant difference with respiration
measures. Finally, Beiman et al. (1978) found decreases in SRR,
heart rate, and muscle tension with live instruction, superior to
changes with taped relaxation instruction within training sessions
(see Table 1) •
Those studies finding a superiority of live versus taped instruc-
tions have postulated either experimenter presence/absence or the is-
sue of response versus program contingent progression as a causal
factor in this superiority. The latter refers to the fact that with
live relaxation training the experimenter does not proceed to tension
release of -successive muscle groups until the current group is com-
pletely relaxed, a procedure at best impractical with taped relaxation.
Beiman et al. (1978) and Paul and Trimble (1970) note the need for
further research to delineate the basis for the superiority of live
versus taped relaxation training. Three of the four studies noted
that have dealt directly with the issue of taped versus live instruc-
tion (Bieman et al., 1978; Paul & Trimble, 1970; Russell et al., 1976)
have had the experimenter absent during taped instructions, while the
fourth (Israel & Beiman, 1977) does not specifically detail this pro-
cedural aspect.
A recent study by Borkovec et al. (1978) with anxious undergradu-
ates (based on questionnaire data relating to percent of time "anxious"
daily, an anxiety level moderately severe or greater, and a desire to
receive treatment for tension problems) assigned subjects randomly
within blocks of percent tense to three treatment conditions. These
Authors
B0iman, Israel, & Johnson (1978)
Israel &
Beiman (1977)
Paul & Trimble (1970)
Russell, Sipich, & Knipe (1976)
Table 1
Live versus Taped Relaxation Training
Type of Group, N
Live, 10 Tape, 10 Self, 10 EMG biofeedback, 10
Live Taped Self *Total N = 25
Taped, 10 Hypnotic Induction, 10 Self, 10
Live, 16 muscle group, 11 Tape, 16 muscle group, 6 Live, 4 muscle group, 8 Self, 9
Number of Sessions
5
1 (post)
3
2
2
Dependent Variables
EMG
Skin Conductance
Heart rate
Respiration
MIIACL
STAI-Trait
Anxiety Differential
EMG
Respiration
Heart Rate
Anxiety Differential
EMG (forearm)
Heart rate
Respiration
Anxiety D.lfferential
EMG
Anxiety Differential
Results
Live> Taped Self= Biofeedback (Bf)
Posttraining Session: Live=Taped=Self=Bf
Live> Taped Self= Biofeedback
Posttraining Session: Live > Self=Taped=Bf
Live> Taped Self > Biofeedback
Posttraining Session: No pre-post ma.in effects
Live=Taped Self and Biofeedback=<no pre-post reductions
Posttraining Session: Live=Self) Bf, Taped
Live=Taped=Self=Bf (Significant pre-post main effects)
Live=Taped=Self=Bf (Significant pre-post main effects)
Live=Taped=Self=Bf {Significant pre-post main effects)
Live=Taped=Self
Live=Taped=Self
Live=Taped=Self
Live> Taped, Self
Live>Taped
Live >Taped
Live=Taped
Live=Taped
Pre-post analyses: significant reductions with Live, 16 muscle group and self
Pre-post analyses: significant reductions with Taped and Live, 16 muscle group
*No information provided regarding distribution of subjects across groups.
N N
23
groups included: (1) progressive relaxation training with tension
release; (2) relaxation without tension release; and (3) no treatment.
The instructions were taped, but, by means of two cassettes and sub-
ject control over alternation between tapes, subjects controlled
their progress in treatment establishing a response-contingent progres-
sion procedure. The measure of percent tense indicated superiority
for treatment conditions, while subjects in the tension release group
required significantly fewer training cycles to produce subjective
reports of complete relaxation. It is interesting to note that the
literature would suggest that the study under discussion would maxi-
mize the probability of obtaining significant physiological reduction
effects: several sessions, subject controlled treatment progression,
and a P!~senting:problem of anxiety or the use of an anxious popula-
tion. The absence of treatment effects on physiological measures
(heart rate, respiration, frontalis EMG), then, is somewhat surpris-
ing. The main difference between the authors' procedure and previous
studies finding significant relaxation effects with live instruction
was therapist presence. The authors conclude that the therapist factor
may be the critical factor in promoting physiological reduction during
relaxation training. The components of the therapist present factor
have yet to be addressed. It seems feasible that the support of the
therapist, i.e., verbal encouragement, may increase motivation on the
part of the subject. Other therapist-subject factors may prove of
critical importance such as therapist-subject relationship, the sub-
ject's perception of the therapist's involvement as a result of
24
therapist presence/absence, or increased client expectancy with thera-
pist present. This latter postulation, i.e., expectancy explanations
for the superiority of live versus taped relaxation training, has not
been addressed in the studies noted in this paper investigating live
versus·taped relaxation training.
Treatment Expectancy and
Other Control Prodcedures
In addition to the taped versus live issue, several studies have
noted relaxation effects (both in terms of subjective reports and
physiological measures) with a control or self-relaxation condition.
Israel and Beirnan (1977) found no difference in EMG measures among
live, taped, and self relaxation controls, while Miller and Bornstein
(1977) reported that the self relaxation group used in their investi-
gation relaxed as effectively as any of the formal training groups
based on EMG (forearm) measures and self report. Other investigators
(Borkovec & Fowles, 1973; Lader & Mathews, 1970) have noted similar re-
sults but attributed these results to experimental confounding. Fin-
ally, several investigators (e.g., Paul & Trimble, 1970; Schandler &
Grings, 1970) have not found self relaxation to be efficacious with
respect to physiological or self report measures. In addition, these
differences cannot be related to different population samples (i.e.,
"normal" versus "anxious"). That is, across population samples, self
relaxation has been, on oocasion, as efficacious as live or taped
strategies. In all of the above investigations, self relaxation has
25
involved instructing the subject to relax in any manner that they
choose,without falling asleep.
Israel and Beiman (1977), interpreting their positive results
with a self relaxation condition, note that this condition was pre-
sented as a potentially effective treatment for tension in their in-
vestigation, a presentation not given in previous research. This is
especially evident in the research conducted by Paul and Trimble (1970)
in which different instructions across groups clearly favored the ac-
tive treatment condition. Reinking and Kohl (1975), reporting their
finding of no differences in subjective tension scores between a self
. relaxation control group and treatment groups (EMG plus progressive
relaxation, EMG only, progressive relaxation only, EMG plus money),
note that if the goal is subjective calm, any procedure should work
equally well if presented as a relaxation procedure.
Within a more general framework, this issue of expectancy or
treatment credibility has become a major issue in treatment outcome
studies (Borkovec & Nau, 19721 Kazdin, 19791 McGlynn & McDonnell,
1974). The question has been raised as to whether typically used
placebo conditions in outcome research do, in fact, control for client
expectations or experimental demand. A number of authors (Baker &
Kohn, 19721 Rosenthal & Frank, 1956) have noted that a placebo condi-
tion should be theoretically inert and capable of generating a positive
expectancy equivalent to its comparison treatment condition. Kazdin
(1980) and Kazdin and Wilcoxon (1976) note several strategies for
developing adequate control groups in which the investigator wishes to
26
rule out differential expectancies for changes across groups as a ri-
val explanation of results. The attention placebo control strategy
consists of any procedure the experimenter designates as a control for
nonspecific treatment effects. This strategy may or may not fulfill
its intended purposes, however, since client expectancies for change
may or may not be equal across control and treatment conditions. The
treatment element control strategy involves a control group resembling
the actual treatment as closely as possible, with as few procedural
changes as possible. Again, this strategy is limited since the credi-
bility of treatment and client's expectancy are not necessarily con-
trolled. That is, the inclusion of treatment elements in a control
group does not necessarily equalize credibility across groups. For
example, as Borkovec and Nau (1972) noted, groups receiving a single
component of desensitization do not generate expectancies for success
equivalent to groups receiving the complete desensitization procedure.
Finally, the empirically derived control strategy involves an empirical
demonstration that the expectancy for change is equivalent across
treatment and control groups. One method is to devise any procedure,
followed by assessment of this procedure's credibility relative to the
treatment groups. A potential weakness in this procedure is that any
procedure equivalent in credibility can be used as a control group.
Kazdin (1976) noted that the greater the procedural difference, the
more likely that some difference in group procedures contributes to
outcome differences, thus reflecting other nonspecific treatment ef-
fects or other specific therapeutic ingredients (e.g., different
27
behavior change mechanisms). In order to explain the mechanism of the
treatment being evaluated, this possibility must be ruled out •. Based
on the above, Kazdin recommends a synthesis of nonspecific treatment
control strategies. A combination of the empirically derived control
strategy and the treatment element control strategy control effectively
for equal credibility across treatment and control groups and the simi-
larity between treatment,and control conditions. This combination of
strategies, incorporated into the present investigation, most effec-
tively rules out differential,nonspecific treatment effects across
treatment and control conditions.
Historically, despite the recommendations of Kazdin (1980) and
Kazdin and Wilcoxon (1976) noted above, the assumption that the place-
bo condition is credible has rarely been empirically tested, while
placebo and therapy credibility comparisons are rare. With regard to
the latter, a series of investigations (Borkovec & Nau, 1972; Boudewyn
& Borkovec, 1974; McGlynn & McDonnell, 1974) indicate that treatment
conditions often may not be equivalent in credibility. Borkovec and
Nau, using a subject population of 450 introductory psychology .stu-
dents, found the rationale and procedural description of systematic
desensitization more er.edible than Davidson's (1968) relaxation-recall
control, Borkovec and Nau's (1972) avoidance response placebo, Paul's
(1966) attention-placebo, and ,Marcia, Rubin, and Effran' s. (1969)
tachistoscope placebo, while implosive therapy was also superior to
the control groups. Boudewyn and Borkovec (1974) conducted a study
with 120 psychiatric inpatients as subjects and found drug treatment
28
and psychoanalytic rationales significantly more credible than an
attention-placebo rationale. Finally, McGlynn and McDonnell (1974)
demonstrated that snake phobic college students exposed to samples
from a desensitization treatment and a frequently employed pseudo-
therapy control procedure, rated the desensitization treatment as
significantly more credible than the latter.
All of the investigators above used the Borkovec and Nau (1972)
scale, a five question; ~0-point rating scale for credibility/expec-
tancy for any improvement. The scale inquires as to the logic of the
type of treatment, confidence in recommending the treatment to a
friend, willingness to undergo such a treatment, and generality of
effects predicted from the treatment. Hence, these results indicate
that certain treatment conditions are more credible than others, at
least as measured on the aforementioned rating scale. These results
are strengthened in a study by Nau, Caputo, and Borkovec (1974) using
Ornes' (1965) simulation procedure. In this investigation, snake
phobic subjects, following pretesting on a behavioral avoidance task,
were exposed to a ratiom~le and procedural descriptions of: (1) sys-
tematic desensitization (2). attention placebo, (3) implosive therapy,
(4) tachistoscope placebo, (5) relaxation plus recall strategies.
Subsequent to the rationale and description, subjects were asked to
simulate on the posttest the effects they would expect to occur had
they undergone five sessions of the described technique. Based on
three investigations, the hypothesis that variability in self reported
confidence in different treatment conditions is related to different
29
demand characteristics for improvement in the treatment procedures
themselves was supported. That is, in all three studies credibility
ratings of the rationales correlated significantly with simulated
treatment outcome. It seems apparent that efforts to guarantee equi-
valence of credibility among therapy and control conditions are criti-
cal. It should be noted that these findings do not show that treatment
effects are due to credibility of treatment procedures. The different
treatments might be equally effective for different reasons. However,
they do indicate that claims attributing therapeutic effects to spe-
cific treatment ingredients may not be valid. Within the context of
the present discussion, this may mean that live relaxation may indeed
be more credible than taped or self relaxation, particularly consid-
ering the traditional procedure of experimenter presence for live re-
laxation and experimenter absence for taped relaxation training.
Hence, physiological and subjective changes in measures of anxiety
favoring live relaxation may be due to expectancy factors.
Present Investigation
The purpose of the present investigation is to compare, on self
report and physiological indices, live, taped, and self relaxation.
Changes from the previous studies investigating live versus taped
relaxation include: (1) the use of an "anxious" population assessed
objectively, based on the recommendations of Borkovec and Sides (1979)
and Shapiro and Lehrer (1980); (2) the use of multiple physiological
measures as dependent variables, as a means of assessing changes in
more than one physiological response system (i.e., cardiac and somatic);
30
(3) assessing the role of expectancy across treatment modalities
(live, taped, and self); (4) the use of between session self monitor-
ing across groups to ensure equivalent practice effects; (5) control~
ling for the experimenter absent/present by having the experimenter
present across groups for training; and (6) soliciting ratings of
relaxation across taped and live groups to assess differences in sub-
jective relaxation as movement is made through the 16 muscle groups.
The latter two inclusions are based on hypotheses related to the
superiority of live relaxation training. More specifically, Paul and
Trimble (1970) support the notion that the lack of response contingent
progress in the recorded mode may be critical. That is, while subjects
in live relaxation training move to the next muscle group contingent
upon reported relaxation of the current muscle group, subjects in taped
conditions progress with the recorded instructions. Borkovec et al.
(1978), however, postulated, based on their results, that the presence
of the experimenter may be the critical component. A review of the
four studies investigating taped versus live progressive relaxation
training reveals that the experimenter is absent for all taped condi-
tions,and present for all live instructions. Thus, the present inves-
tigation will elicit subjective ratings of each muscle group prior to
movement into the next group with the aim of comparing these ratings
across groups. This will provide a test of the response-progression
hypothesis.
Contrasting these inclusions with prior investigations, two of the
studies have used an "anxious" population (Bieman et al., 1978; Israel
31
& Beiman, 1977). However, the weaknesses of screening procedures in
these studies have been discussed previously. The use of multiple
physiological measures has been employed on only two of the four
studies (Beiman et al., 1978; Paul & Trimble, 1970), while the assess-
ment or control of experimenter present/absent effects, between ses-
sion self-monitoring, expectancy factors, and subjective ratings of
successive muscle group relaxation have been completely neglected in
prior research.
In sum, the chief issues this proposal will explore are: (1) Can
taped progressive muscle relaxation and/or self relaxation be as ef-
fective as measured by physiological and self-report measures of re-
laxation as live progressive muscle relaxation? (2) Is the degree of
subjective and/or physiological relaxation contingent upon client
expectancy factors regardless of relaxation instruction provided?
In addition, the effects of experimenter absence/presence and
the differences in subjective relaxation ratings across treatment
conditions will be investigated. This latter factor will help to de-
termine the influence of response progression or therapist presence/
absence influences on progressive muscle relaxation training.
Method
Subjects
The 54 participants in this study were selected from the under-
graduate psychology mass testing session at Virginia Polytechnic Ins-
titutute and State University. All students involved in this testing
(N = 262) were administered the S-R Inventory of General Trait Anxious-
ness (Endler & Okada, 1975), a multidimensional test of trait anxiety.
This instrument employs a sample of four general situations (interac-
tions with others, physical danger, novel situations, daily routine);
and nine modes of response to each of the four situations. These re-
sponse modes include: Seeks experiences like this, perspire, have an
"uneasy" feeling, feel exhilarated and thrilled, get fluttering feel-
ing in stomach, feel tense, enjoy these situations, heart beats faster,
and feel anxious. Subjects are asked to respond to this 36 item
instrument on a 5-point scale ranging from "not at all" to "very much"
in terms of the intensity of the particular response (see Appendix B}.
Over a series of investigations (Endler & Hunt, 1966; Endler & Okada,
1975), reliability for the situations have been consistently high,
while strong evidence for the validity of the inventory as a multidi-
mensional measure of trait anxiety exists.
Those students scoring highest on the SR-GTA, representing a high-
er anxiety level, were offered a position in the investigation in re-
turn for receiving three introductory psychology credits. Other in-
clusion criteria included: (1) no prior participation in previous
experiments dealing with relaxation or experience with relaxation
32
33
procedures; (2) no prior or current history of heart disease; (3) no
current ingestion of tranquilizers or prescribed medication which
might interfere with relaxation procedures. The 54 subjects included
in the present study were among the top 66 scorers on the SR-GTA, with
10 participants in the mass testing sessions solicited unable to par-
ticipate in the study for a variety of reasons, while two prospective
subjects were excluded for prior experience with relaxation procedures.
The 54 subjects participating in the present investigation repre-
sented the top 25.2% of scores among the total subject pool of 262
students. The overall mean of students participating in the mass test-
ing session was 98.90 with a standard deviation of 14.48. This close-
ly parallels Endler and Okada's (1975) mean across sexes of 98.75. In
contrast, the range of scores among subject participating in the
present study was 106-141, with a mean of 116.38.
The students selected as subjects were stratified according to
their scores on the S-R GTA (top, middle, bottom) and randomly assigned
to one of the three groups constituting the live, taped, self component
of the design. For assignment to high or low expectancy groups, a high
or low slip was randomly selected followed by selection of one slip
from each of the top, middle, and lower SR-GTA scores within the live
group. This procedure was followed for the taped and self conditions
until three of the six slots within each category (live-top 1/3, live-
mid 1/3, live-low 1/3, etc.) were filled with either high or low expec-
tancy conditions. At this point, selection of high or low expectancy
34
conditions were based on equalizing expectancy conditions within each
of these categories.
Design
This investigation involved a (3 X 2 X 2) mixed design, with the
factors represented by treatment modality (Le., live, taped, self
relaxation training), expectancy conditions (high, low),and number of
sessions. Thus, across both sessions, all 54 subjects were assigned to
the following conditions: (1) live training/high expectancy; (2) live
training/low expectancy; (3) taped training/high expectancy; (4) taped
training/low expectancy; (5) self training/ high expectancy; and (6)
self training/ low expectancy. Each group was balanced according to
initial level of anxiety,based on SR-GTA scores.
Apparatus
The heart rate and finger pulse volume in this investigation were
recorded from the subject's right thumb on a Lafayette model 76604 re-
flectance photoelectric plethysmograph coupled with a Lafayette model
76406 amplifier and model 76102-10 Data Graph Systems polygraph. The
skin resistance response was measured on the right palmar site, spe-
cifically, one 76602 model silver-silver chloride electrode on the
thenar eminence area and one on the hypothemar eminence. Subjects
were seated in a comfortable reclining chair throughout each session.
Therapists included a second year Clinical Psychology graduate
student, who was familiar with the rationale and implementation of pro-
gressive muscle relaxation training, and two upper level undergraduate
students (1 male, 1 female), who volunteered for the study as part of
35
an independent study project. The students were trained in relaxation
training via written material delineating the muscle groups to be re-
laxed and relaxation instructions to be used during the study. The
total time invested in training the two therapists consisted of ap-
proximately 4 hours and, in addition to the material noted above, in-
volved familiarization with the physiological recording equipment and
procedural aspects of both scheduled sessions. A step-by-step pro-
cedural manual was provided for each session and kept in the equipment
room for review as needed. The senior investigator was available dur-
ing the first session for each of the junior investigators to provide
assistance as needed. In addition, 12 procedural folders, represent-
ing all groups across both sessions, were available with questionnaires
and instructions (e.g., expectancy conditions, pre-relaxation instruc-
tions) in sequential order to provide procedural structure for the re-
searchers involved. In terms of group assignment, therapists were
assigned randomly and counterbalanced across all groups. Each thera-
pist was randomly assigned to three subjects within each treatment
condition (live/high, live/low, taped/high, taped/low, self/high,
self/low) and initial scoring level on the SR-GTA. The latter was done
as a means of balancing the degree of subject's anxiety across thera-
pists. Finally, experimenters were assigned to subjects across both
treatment sessions. That is, an experimenter who ran a particular
subject in Session 1 remained with that particular subject for Session
2.
36
Dependent Variables
Dependent variables in this investigation directly assessing anxi-
ety reduction consisted of both physiological and self report measures.
The self report measures included: (l) subjective relaxation ratings on
a 1 (very relaxed) to 10 (very tense) scale during the relaxation training
itself~ and (2) the Anxiety Differential (Husek &Alexander, 1962). Physi-
ological measures included heart rate, finger pulse volume, and spon-
taneous fluctuations in skin resistance (SF). In addition to the meas-
ures noted above ( self report ratings, Anxiety Differential, heart rate, SF,
fingerpulsevolume) directly assessing the anxiety construct, subjects
were also administered the Borkovec and Nau (1972) Expectancy Scale which
served as a manipulation check to ensure that subjects assigned to high
and low expectancy conditions did, in fact, differ on this dimension.
All physiological data were scored during a 1 minute baseline peri-
od at the termination of the relaxation training. Heart rate was mea-
sured by beats/minute, and finger pulse volume amplitude measures were
. derived by measuring (in mm) every fourth heartbeat and dividing by the
number of heartbeats per period, thus deriving a mean amplitude over the
two sampling periods. Skin fluctuations involved a frequency count for
each period requiring at least a 1 mm deflection to be scored as a
fluctuation. Change scores were used to analyze the physiological mea-
sures (presession-postsession values) with the exception of finger pulse
volume amplitude. To correct for the wide range of amplifer sensitivi-
ties employed in recording finger pulse volume, the following formula
was used: post-presession/pre-session values.
37
Procedure
Following assignment of subjects to groups (N = 9), each subject
was scheduled for two relaxation sessions of approximately 1 hour at a
1 week interval. During the first session, the designated therapist
greeted the subject. The subject was then taken to the relaxation
chamber. A consent form and self monitoring contract were signed by
the subject (see Appendix C), and the subject received a brief descrip-
tion of the relaxation procedure appropriate for his/her group assign-
ment and expectancy condition rationale. The physiological measures
and equipment were then explained by walking the subjects to the equip-
ment room and describing the measures to be taken and the form of the
data to be gathered from the physiological monitoring equipment (i.e.,·
SF electrodes and finger-wrap for finger pulse volume and heart rate).
Following attachment of the physiological monitoring equipment, an ex-
pectancy questionnaire was administered consisting of five items rated
on a 10-point credibility scale. The Borkovec and Nau (1972) expect-
tancy assessment instrument, which emphasizes the elimination of
speech anxiety, was altered to emphasize learning the ability to relax
away general tension and anxiety (see Appendix D). At the same time,
the self report measure of anxiety chosen for the present investigation,
the Anxiety Differential, was administered. Following the completion
of these instruments, a 5 minute adaptation period was begun with the
last minute used as the pretreatment baseline for physiological meas-
ures (Period 1). During this time, the subject was asked to sit
quietly with eyes closed for instrument calibration. Following this
38
post-adaptation period, the pre-relaxation instructions were given for
each group followed by the beginning of relaxation proper. During the
relaxation training, subjects were intermittently requested to rate
the level of relaxation in the particular muscle group being tensed
and relaxed at the time of request. In the live and taped condition,
this occurred following the second tense-release cycle of the muscle
group, while in the self relaxation group this occurred every other
minute (i.e., 1, 3, 5, ..• 29). Following relaxation proper, the
posttreatment Anxiety Differentialwasadministered, electrodes detached,
and a discussion of the training (maximum duration= 5 minutes) ini-
tiated. For the latter procedural aspect, three identical open-ended
questions were given across groups (see Appendix E). At this point,
one self monitoring form was distributed and discussed. An example was
provided on the sheet demonstrating appropriate completion of the
form. Requirements included practicing once daily for 20 minutes and
a signature (pledge) for each daily entry confirming the fact that re-
laxation practice had occurred. These sheets were deposited daily
(not including weekends) in a box in the lobby of the fifth floor of
Derring Hall,where the subjects also picked up a new sheet assigned
for that day's practice. For a summary outline of the experimental
procedures for Session 1, see Appendix F.
Session 2 was identical to Session l1but without the introduction/
rationale, administration of the expectancy questionnaire, introduc-
tion to the physiological monitoring equipment, and disbursement and
explanation of the self monitoring forms. A 5 minute pre-session
39
discussion occurred to review self monitoring forms. Again, three
open-ended questions were used with the therapist inquiring: "How did
you find the relaxation during the week compared to the first session
of training?", "How did the relaxation sessions go during the week?",
"What questions do you have either about the forms you have been using
or the relaxation you have been practicing?". An addition to Session 1
included a debriefing for low expectancy subjects in the live and
taped conditions. Subjects in these groups were informed that progres-
sive relaxation training has been shown to be a rather effective pro-
cedure in learning to reduce anxiety and that the information provided
to them regarding its ineffectiveness was to evaluate the influence of
expectancy factors. For a summary outline of the experimental pro-
cedures for Session 2 across groups, see Appendix G.
Live relaxation groups. Each subject in the live relaxation con-
ditions, either high (N = 9) or low (N = 9) expectancy, was given the
following general relaxation instructions/rationale.
For this study, we are interested in examining the process of progressive muscle relaxation. Basically, progressive muscle relaxation training consists of learning to sequentially tense and then relax various groups of muscles all through the body while at the same time paying very close and careful attention to the feelings associated with both tension and relaxation. The tensing of the muscle prior to letting them relax is like giving ourselves a "running start" toward deep relaxation through the momentum created by the tension re-lease. Another important advantage to creating and releasing tension is that it will give you a good chance to focus your attention upon and become clearly aware of what tension really feels like in each of the various groups of muscles we will be dealing with. In addition, the tensing procedure will make a vivid contrast between tension and relaxation and will give you an excellent opportunity to directly compare the two and appreciate the difference in feeling associated with each of these states. While you are relaxing, I will be
40
monitoring your heart rate, skin conductance, and finger pulse volume. Finally, after the relaxation session, in about 45 minutes, we will get a chance to talk about how you felt during the relaxation exercise. Do you have any questions?
In addition to the above general rationale provided to the sub-
jects in the live condition, pre-relaxation instructions (i.e., follow-
ing completion of the physiological adaptation period and self-report
measures and irmnediately prior to relaxation proper) were:
As I described before, the procedure we will be using is called progressive relaxation training which consists of learning to tense and release various muscle groups through-out the body. I will be asking you to tense a particular muscle group for about 5 seconds and then to relax that muscle group for 30-45 seconds. We will go through e.ach muscle group twice. It is important to remember to release the muscle tension immediately rather than gradually, when I say the word, "relax." Also, once a group of muscles is relaxed, do not move it unnecessarily (except to make your-self more comfortable). Finally, after each muscle group, I will ask you to rate on a scale of 1-10 how relaxed that muscle group is. A rating of 1 will indicate that the mus-cle group is completely relaxed, while a rating of 10 will indicate a great deal of tension in that muscle group. Re-member, a 1 means that you are thoroughly and completely relaxed, while a 10 means that you are very tense. Do you have any questions?
The relaxation training in the live groups was response contingent.
That is, prior to progression to the next muscle group, the subject was
required to verbally report his level of relaxation on a l(very re-
laxed) to lO(very tense) scale. A rating of at least 3 was required to
progress. Ratings of 4 or above after the second tension release cycle
prompted a third presentation of the tension-release cycle for the
particular muscle group involved. If, following a third presentation,
self report indicated a tension level of 4 or above, training
progressed to the next muscle group. The relaxation procdur~ itself
41
involved 5-10 seconds of tensing for each muscle group followed by .30-
45 seconds of relaxation within.that muscle group. Subjects received
a list of muscle groups to relax included on their self monitoring
sheets (see Appendix H).
Taped relaxation groups. As in the live condition, subjects in the
taped relaxation conditions (both high expectancy [N = 9] and low ex-
pectancy [N=9] conditions) were presented with a general instructions/
rationale regarding progressive muscle relaxation and group specific
pre-relaxation instructions. These were identical to the live condition
in every respect other than the mode of presentation involved. That is,
subjects were told that they would be listening to a tape directing them
to tense and relax the particular muscle groups, and, wit:h regard to. the
pre-relaxation instructions, informed that the tape would request the
subjective relaxation ratings (see Appendix I). The other procedural
difference between this group and the live relaxation group was the
lack of response contingent progression. Progression to muscle groups
was program contingent in that the tape dictated when new muscle groups
were introduced for relaxation. Subjects in this group progressed to
the next muscle group regardless of these ratings. The tapes them-
selves consisted of 5-10 seconds of tensing instructions for each
muscle group followed by 30-45 seconds of relaxation and a prompt to
rate the relaxation level of the particular muscle group. The relaxa-
tion "patter" was identical across live and taped training conditions.
That is, the content of the relaxation instructions on the tape matched
matched those on the instructional sheet used during live relaxation.
42
A series of six different phrases were used systematically across
muscle groups in both groups to control for differential relaxation in-
structions across groups and amount of relaxation instructions (see Ap-
pendix J). As in the live relaxation group, subjects received a list of
muscle groups to relax included on their self rronitoring sheets.
Self relaxation groups. In this group, subjects were told to relax
in any way they chose but not to fall asleep. Verbal self reports of
relaxation level were requested every 2 minutes beginning with the
first minute (i.e., 1, 3, 5, ••• 29) to control for attending to and
rating relaxation levels as done in the live and taped groups. Self
monitoring forms in this group did not list muscle groups to attend to
in relaxing their bodies. The forms were more global in nature rather
than referring to particular muscle groups (see Appendix K). For the
self/high and self/low groups, the following general rationale was
provided:
For this study, we are interested in examining the process of relaxation. Since different people relax in different ways, you will be asked to relax in any way that you would like without falling asleep. In other words, any thoughts or images which help you to relax can be used during the relaxation exercises. While you are relaxing, I will be monitoring your heart rate, skin conductance, and finger pulse volume. Finally, after the relaxation session, in about 45 minutes, we will get a chance to talk about how you felt during the relaxation exercise. Do you have any questions?
In addition to the foregoing, the self relaxation groups also re-
ceived pre-relaxation instructions immediately prior to relaxation
proper:
As mentioned before, we are interested in the process of relaxation. When I ask you to begin, just relax yourself
43
in any way you feel will be effective. Please do not move around unnecessarily (except to make yourself comfortable), or fall asleep during relaxation. Finally, at varying in-tervals I will ask you to rate how relaxed you feel, on a scale of 1 to 10. A rating of 1 will indicate that you are completely relaxed, while a rating of 10 will indi-cate that you are very tense. Remember, a 1 means that you are thoroughly, completely relaxed, while a 10 means that you are very tense. Do you have any questions?
High expectancy conditions. Across live, taped, and self relaxa-
tion instructions, 27 subjects received the following high expectancy
instructions immediately following the general relaxation instructions/
rationale.
The relaxation training you will undergo has been proven to be a very effective procedure in a lot of problem areas. People using relaxation have been able to sleep better, elimi-nate headaches and, more generally, report feeling much more relaxed on a day to day basis. Since the evidence for the beneficial effects of relaxation is abundant, there is little doubt that you will get some benefit out of this relaxation practice. You will also very likely notice some beneficial effects very quickly and will feel very relaxed and calm dur-ing your relaxation exercises.
Low expectancy conditions. Across all training conditions, 27 sub-
jects assigned to this ·condition received the following low expetancy
instructions immediately following the general relaxation instructions/
rationale:
It will very likely be the case that this relaxation pro-cedure will be of little benefit to you. The evidence demonstrating a positive effect for the relaxation train-ing you will be undergoing is very weak. You have been assigned to what is called a "control" group for this study. Basically, this means that the relaxation training you will be given is not of proven effectiveness but does control for the time you will spend in the relaxation room, practice in relaxation during the week, etc. In sum, the relaxation procedure you will be undergoing simply has not been shown to be an effective means of learning relaxation, but we are interested in studying this particular method of relaxation.
Results
Pretreatment Measures
The S-R Inventory of General Trait Anxiousness was used in this
investigation as a screening instrument to select high anxious subjects.
To assess whether subjects, across conditions, were equivalent on the
measure of anxiety, a 3 X 2 (treatment X expectancy) ANOVA was per-
formed. No significant differences were observed (see Appendix L, Table
1), indicating that subjects were indeed equivalent on this measure
across treatment and expectancy conditions. Mean scores for each ex-
perimental condition are presented in Table 2.
To determine if subjects in the two expectancy conditions, high
and low, did differ on the Expectancy Questionnaire, at-test was per-
formed on subjects' scores between the two conditions. Those subjects
in the High Expectancy condition did score higher on the Expectancy
Questionnaire (X = 37.37) than those subjects in the Low Expectancy
condition (X = 29.18). Thus, the high and low expectancy instructions
did establish different expectancies regarding the effectiveness of re-
laxation between the two conditions (t = 3.82, R < .003).
Differences in baseline measures for heart rate (Session 1 = HRll,
Session 2 = HR21), finger pulse volume (FPll, FP21), spontaneous fluc-
tuations in skin resistance (SFll, SF21), and the Anxiety Differential
(ADl, AD3) were tested across Treatment and Expectancy conditions.
Figure 1 summarizes the results of the 3 X 2 (treatment X expectancy)
ANOVA, indicating a significant difference among groups for the Session
1 baseline heart rate data (HRll), with the Live High and Taped High
44
45
Table 2
Mean Scores' for SR-GTA
Treatment Expectancy Group Condition Score
Live High 119.11
Tape High 113.66
Self High 117.77
Live Low 116.22
Tape Low 115.22
Self Low 116. 33
46
84
83
82
81
80
79
78
77 Tape High
76 r Q) 76.33 -g 75 -~ 74 ~
[/J 73 .µ m Q) 72 ~
(!) 71 .µ
~ 70 X
.µ 69 70.22 lo-I Live Low m Q) 68 ::i::
67
66
65
64
63 63.55 62 Tape Low
61-
60-
Live Tape Self Treatment Levels
Figure 1. Baseline heart rate~Session 1.
47
conditions exhibiting a significantly higher baseline rate. The analy-
sis demonstrated a significant effect on HRll for Expectancy, F (1, 48)
= 7.34, E. ).009, and a Treatment X Expectancy interaction,! (2, 48) = 3.44 £_).04 {see Appendix L, Tables 2 and 3). In addition, differences
existed for the heart rate baseline data in Session 2 {HR21). Spe-
cifically, the Taped High condition had a significantly higher baseline
heart rate than the Taped Low condition. Figure 2 illustrates this
Treatment X Expectancy interaction for the HR21 data,! (2, 48) = 5.39,
p).007 {see Appendix L, Table 4). Finally, there were a greater number
of skin fluctuation responses in the High Expectancy condition (X = 4.59) than in the Low Expectancy condition {X = 1. 79) for Session 2
baseline data (SF21), indicating a main effect for Expectancy,! (1, 48)
= 7.08, p) .01 (See Appendix L, Table 2). No other significant differ-
ences were found among baseline measures. Borkovec and Sides (1979), as
previously noted, postulated that progressive muscle relaxation is
superior to control conditions when high anxious subjects are used.
Also noting the potential importance of baseline differences on subse-
quent physiological changes, Wilder's_(l953) Law of Initial Values
would predict greater changes on physiological measures when baseline
values are elevated. Therefore, to assess the influence of these base-
line differences on subsequent physiological and self report changes,
subjects were split on baseline heart rate (HRll), and change scores
across dependent measures were analyzed via at-test procedure. Sub-
jects were divided into a high heart rate category (HR11)71) and low
heart rate category (HRll 4 71) based on the median heart rate values
48
84
83
82 X
81 82.00 Self Low
80
79
78 77
...... 76 76.44 Q) .µ
75 Live High ::I -~ 74 ~ ....... rn 73 .µ
Self High Ill Q) IXl 72 ...... Q) 71 .µ ;2 70 X
70.88 .µ Live Low M 69
Ill Q)
68 :::i:::
67
66 65 64
63 62 62. 77 61 Tape Low
60
Live Tape Self Treatment Levels
Figure 2. Baseline heart rate~Session 2.
49
of the Session 1 baseline period. No significant differences were found
on any measure due to initial heart rate (see Appendix L, Table 5). To
further control for the baseline differences noted above, change scores
were used to analyze changes in the main dependent variables in this
investigation (heart rate, skin fluctuation responses, finger pulse vol-
ume a.zt\Plitude, Anxiety Differential). It should be noted that finger
pulse change scores were derived by the following formula rather than
post-pretreatment values (post-pretreatment/pretreatment values). This
was done to correct for the wide range of amplifier sensitivities em-
ployed in recording finger pulse volume.
Analysis of Treatment Effects
Prior to investigating differences across dependent measures due
to training and expectancy variables, differences in change scores due
to the experimenter variable were tested. A one-way ANOVA was completed
.for both Sessions 1 and 2. As summarized in Appendix L, Table 6, finger
pulse change scores in Session 1 were significant,! (2, 51) = 7.56, £
<. 001. Nb .other change scores attained significance due to the experi-
menter variable. Due to the large number of comparisons made in this
investigation, this difference is seen as a chance finding and will not
be considered in further analyses.
To determine if differences among groups on the dependent measures
could be attributed to differential practice effects, differences among
groups on the return of the daily self monitoring sheets were investi~
gated. Testing for these differences·via a 3 X 2 (treatment X expec-
tancy) ANOVA found no differences among groups (see Appendix L, Table 7),
50
The number of sheets returned per subject ranged from 5.44 (Taped Low)
to 6.22 (Self Low) out of a possible 7 sheets.
One of the aims of the present investigation was to assess dif-
ferences across types of relaxation training in within session relaxa-
tion ratings. A 3 X 2 X 2 (treatment X expectancy X session) ANOVA was
performed on· the in-session relaxation ratings, with the dependent
variable consisting of the number of ratings above 3 on a 1 (relaxed) to
10 (tense) rating scale. Results indicated that subjects gave fewer re-
ports of residual tension during Session 2 than during Session 1, !. ( 1, 48) = 8. 90, £ ( . 004 ( see Appendix L, Table 8) • Further, within
session relaxation ratings were equivalent across treatment groups.. In
particular, relaxation ratings did not differ between the live and taped
groups. Table 3 presents the means for each of the Treatment X Expec-
tancy cells for these ratings.
The main empirical question in the present investigation was
whether live relaxation was superior to taped and self relaxation and to
assess the role of expectancy across the relaxation training conditions.
For a graphic. summary of change scores for each dependent variable
across sessions, see Figures 3, 4, 5, and 6. Mean values for each de-
pendent measure are included in Table 4.
Due to the number of dependent variables selected, a multivariate
analysis of variance (~OVA) including treatment, expectancy, and ses-
sion variables was completed on change scores for the physiological mea-
sures and the main self report measure in the investigation, the Anxiety
Differential. Three scores for the SF measure were missing, resulting
51
Table 3
Relaxation Rating Means
Treatment Expectancy Session N *Relaxation
Group Condition Ratings
Live High 1 9 2.55
Live High 2 9 1.44
Live Low 1 9 4.77
Live Low 2 9 2.88
Tape High 1 9 6.22
Tape High 2 9 4.44
Tape Low 1 9 6.00
Tape Low 2 9 3.66
Self High 1 9 4.33
Self High 2 9 3.33
Self Low 1 9 6.44
Self Low 2 9 5.88
*Number of relaxation ratings greater .than 3 on 1 (very relaxed) to 10 (very tense) scale.
Session 1 X = 5.05 Session 2 X = 3.60
9-
8-
. 7-i:: ·.-1 0 ~ 6.66 ' 6-Ill 6.22 .l,J m ;< Q) 5-l:!l ,5. 77 ......
/ Q) 4- / t,'I i:: / ~ 3- / CJ / Q) / .jJ 2 / &! X .jJ 1 1.55 J..l m Q) ::i:: 0
-1
-2
L Live Live
Session 1 Session 2
5.~
X
2.44'
'
·Tape Session 1
' ' '
4.55
' ' ' 'x -1.44
'!'ape· Session 2
Figure 3. Heart Rate Change Scores
6.88
/ x"'
3.00
; /
.,,,/'
,,x ;5. 77
o = High Expectancy----
x = Low Expectancy - -
Self Session 1
Self Session 2
U1 r,.,
4.2 4.0 3.8 3.6 3.4
II) 3.2 (I) I,.! 3.0 0 0 2.8 Cl) ....... 2.6 (I) . g' -~ 2.4 Ill ::E: 2.2 tj ~ 2.0 ~ § 1.8 0 ·rl
.... +l 1.6 +l Ill ~ .B
1.4~ 1.50 ... ........
+l 0 1.2 ~
8 .:1 1.0 1.22 r-1 r.. r.. ..... .8 -~ .6 ~ .4 Cl)
.2
.0 -.2 -.4 -.6
I I Live Live
Session 1 Session 2
2.55
o = High Expectancy----x = Low Expectancy - - -
~ 2.33, 2.22 ', ....
',, ' 'x
1.37
2.22 X ' 2.00
\
Self
\ \
'
Tape Session 1
Tape Session 2 Session 1
Figure 4. Skin fluctuation change scores.
' U1 \ w ' \ ' \ \
\ \
\ \
\ 'x
-.so Self
Session 2
10
(I) 9 °' X 8.55 (I)
H 9.33 ,9.11 0 '\x,/ ~55 u 8 U) x---------iC (I) 8.00 8.00 tn 7 7.66 §
,, ,, , ..c: , CJ 6
, ,, .--l ,, Cll X
·.-l 5 5.88 5.88 .µ ~ 5.33 (I) H 4 (I)
'1-1 X '1-1 ,, ·.-l
3 ., ., 3. 88
Q ., U1 ,, ~ >, ., o = High Expectancy~ .j.) .,
(I) 2 ,, ,, ·.-l ,, x = Low Expectancy - ~ >< x" ~ 1
1.11
Live Live Tape Tape Self Self Session 1 Session 2 Session 1 Session 2 Session 1 Session 2
Figure 5. Anxiety Differential Change Scores
Cll Q) 1-1 ...... 8 ~ tJl
i:: Q) ·ri t:11 i:: "d rt! Q) .c: :::s u .µ
·ri Q) ..... ~, p..
1-1 § ~~ i:: ....... .... r:r.i
.25
• 20.
.15
.10
.OS
.oo
-.OS~ -.10
-.15
-.20
-.25
-.30
I
u' -.OS I
X -.09
Live Session 1
I I
I I
X 119 r
I I
I I
Live Session 2
X .. .10,
' ' ' ' ' ' ' ' ' ' ' ' X -.11
o,:. _______ .,..,
-.22 -?24
Tape Session 1
Tape Session 2
o = High Expectancy--
x = Low Expectancy - - -
0... ... ..x -.oa ... ~, ,, ' -.oa
X' -.17
-.21
Self Session 1
Self Session 2
Figure 6. Finger pulse chanqe scores. (Positive scores represent vasodilation.)
U1 U1
Table 4
Mean Change Scores for Dependent Variables
Treatment Expectancy Session N HR SF FP AD Group Condition
Live High 1 9 6.66 1.50 -o.os 9.33
Live High 2 9 6.22 3.44 0.05 5.88
Tape High 1 9 5.66 2.55 -0.22 7.66
Tape High 2 9 4.55 2.22 -0.24 8.55
Self High 1 9 6.88 2.22 -0.08 7.11
Self High 2 9 8.11 3.88 -0.21 5.33 U1 O'I
Live Low 1 9 1.55 1. 77 -0.09 5.88
Live Low 2 9 5.77 1.22 0.19 9.11
Tape Low 1 9 2.44 2.33 0.10 1.11
Tape Low 2 9 -1.44 1.37 -0.11 3.'88
Self Low 1 9 3.00 2.00 -0.17 8.00
Self Low 2 9 5.77 -a.so -0.08 8.00
57
in unequal cell size. Since each missing value came from different
groups (i.e., Live-High, Taped-Low, Self-Low), values derived from the
mean for each group were substituted for the missing values. The MANOVA
results indicated an expectancy main effect (See Appendix L, Tjible 9).
That is, regardless of the type of training (live, taped, self), those
subjects in the high expectancy condition demonstrated greater change
toward a relaxed state than those subjects in the low expectancy condi-
tion. This main effect is further examined by looking at the univari-
ate analyses of variance for each dependent measure. As shown in
Appendix L, Table 10, there was a significant Expectancy effect for
heart rate with significantly higher heart rate change scores for the
High Expectancy condition, !_ (1, 48) = 10.94, g,( .001. In addition,
the SF change scores were significantly higher for the High Expectancy
condition, demonstrating a significant expectancy effect for this de-
pendent variable, !_ (1, 48) = 5.43, g_ ( .024. Although it should be
viewed very conservatively based on the fact that the MANOVA was sig-
nificant only for the Expectancy manipulation, the heart rate univari-
ate analysis of variance showed a trend toward a significant treatment
effect, F (2, 48) = 3.12, £( .053, with the Duncans Multiple Range Test
indicating a superiority of Live and Self conditions over the Taped
relaxation condition.
Finally, Tables 5 and 6 demonstrate a series of correlations among
self. report measures and between self-report and physioloqical measures,
respectively. More specifically,. correlations were m:,derately high and
very significant between the relaxation ratings (RRl = Session 1, RR2 =
58
Table 5
Correlation Matrix for Self Report Dependent Variables
Dependent Variables ADl AD2 AD3 AD4 ADCHl ADCH2 RRl RR2
ADI .68+ .61+ .40** -. 57+ · -.29* -.36** -.34**
AD2 .59+ .64+ .19 .09 -.56+ -.46+
AD3 • 76+ -.16 -.31* -.28* -.28* ' AD4 .17 .36** -.40** -.32**
ADCHl .50+ -.14 -.05
ADCH2 -.18 -.07
RRl .73+
*£ ( .05 **.2. < .01 +£<. .001
Dependent Variables
ADl
AD2
AD3
AD4
ADCHl
ADCH2
RRl
RR2
HRll
HR15
HR21
HR25
HRCHl
*£ <.. 05 **12. <.. 01
59
Table' 6
Correlation Matrix for Self ·Report/
Physiological Dependent Variables
HRll HR15 HR21 HR25 .HRCHl
-.29* -.25 "".'.00 .08 -.13
- .. 02 -.05 -.09 -.04 .06
-.13 -.02 .12 .26* -.29*
.07 .10 .23 .29* -.04
.36** .29* -.10 -.15 .24
.30* .18 .15 .05 • 34**
-.02 .07 .03 .03 -.22
.07 .13 .11 .10 -.12
.91** .41** .33* • 38**
.47** .43** -.OB
.85** .04
-.15
HRCH2
.19
-.10
-.23
-.08
.OB
.21
.oo
.03
.19
.12
.38**
-.15
.20
60
Session 2) and the Anxiety Differential within sessions. That i.s, the
fewer relaxation ratings above 3 on the within session ratings given
after each tense/relax cycle for each muscle group, the higher the Anx-
iety Differential scores (high scores indicating lower anxiety). Thus,
a relationship existed between self reports of muscle tension and anx-
iety. In addition, the pre-relaxation AD measures in seach session (ADl
= Session 1, AD3 =Session 2) were significantly and negatively correlated
with the Anxiety Differential change scores within that same session.
Thus, a relationship existed between scores indicating high anxiety
prior to relaxation (i.e., low scores) and change on this measure in
the relaxed direction. The more anxiety reported prior to relaxation,
the greater decrease across the session. Finally, with regard to cor-
relations between physiological and self report measures, only heart
rate correlated with the latter. More specifically, Table 6 shows a
moderately high and significant negative correlation between Session 1
baseline heart rate (HRll) and the pretreatment Session 1 Anxiety Differ-
ential (ADl). Thus, higher baseline heart rate in Session 1 was related
to lower Anxiety Differential scores (denoting hiaher anxiety). Also a
positive correlation between HR-11 and Session l Anxiety Differential
change scores (ADCH 1) was found. There were no significant correlations
between the in-sesison relaxation ratings and heart rate measures.
Finallv, none of the other physiological measures (SF, FPV) correlated
significantly with any self report measure or with heart rate measures.
However, SF change scores in Session 1 did correlate with finger pulse
change scores in Session 1 (r = • 36; J2. (. 007) •
Discussion
The chief concerns of the present investigation were with the
relative efficacy of live versus taped and self relaxation training pro-
cedures as measured by physiological and self report measures of relaxa-
tion and the assessment of the role of expectancy on these measures.
The present study found no differences among live, taped, and self re-
laxation procedures on any of the physiological measures used (heart
rate, finger pulse volume amplitude, skin fluctuation responses) or the
self report measure of anxiety, the Anxiety Differential. These results
are in marked contrast to those of Beiroan et al. (1978), Paul and Trim-
ble (1970), and Russell et al. (1976), who found live relaxation to be
superior to taped on both physiological and self report measures. How-
ever, the results concord ·with the Israel and Beiman (1977) finding that
live, taped, and self relaxation conditions all resulted in significant
heart rate decreases with no differences across groups. Although these
same authors found a significant difference favoring the live relaxa-
tion condition on the same self report measure of anxiety used in the
present investigation, the Anxiety Differential, this finding was not
replicated by these authors in a later investigation (Beiman et al.,
1978). Interestingly, it was Israel and Beiman (1977) who initially
presented their control or self relaxation condition as a potentially
effective treatment for tension and posited expectancy as a possible
explanation for the equivalent effects across groups. Miller and Born-
stein (1977) also found a self relaxation treatment group to be
61
62
equivalent to several other relaxation conditions on EMG and self re-
port measures, including a taped progressive muscle relaxation group.
Borkovec and Sides (1979) had posited, in their meta-analytic
review of progressive muscle relaxation training, that certain critical
procedural variables were related to effecting physiological changes
with progressive muscle relaxation. More specifically, studies demon-
strating progressive muscle relaxation training superiority over control
conditions had involved live relaxation procedures, with high anxious
populations, over several sessions, although the latter condition showed
a great deal of variability (X = 4.57, SD= 3.02). The present investi-
gation quite clearly challenges these findings. In the present investi-
gation, a high anxious population was used along with live relaxation
training. In addition, although only two supervised training sessions
occurred, subjects attested to the fact that practice occurred between
sessions, the frequency of which was equivalent across all treatment
conditions. Despite the presence of these conditions, the presumed
superiority of progressive muscle relaxation training over the self
relaxation condition was not demonstrated in this investigation.
Rather, the subjects' expectancy for change based on information pro-
vided by the therapists regarding the efficacy of the given relaxation
procedure was the critical factor in decreasing anxiety.
The Role of Expectancy and Other
Active Therapeutic Elements
In essence, the chief finding in this investigation involved the
critical role of expectancy in achieving decreases in physiological and
63
self report indices of anxiety. That is, regardless of the type of
training or whether explicit training existed at all, those subjects
who were informed, and based on the expectancy measure employed, be-
lieved that the particular relaxation procedure was an effective means
of achieving relaxation, did indeed show significantly larger decreases
on heart rate and spontaneous skin fluctuation measures than did low
expectancy groups.
The four investigations comparing live versus taped and self re-
laxation (Beirnan, Israel & Johnson, 1978; Israel & Beiman, 1977; Paul &
Trimble, 1970; Russell et al., 1976) did not investigate the role of
differing expectancies across treatment conditions. It seems very
plausible that a live relaxation condition could be viewed as a more
powerful intervention than either taped or self relaxation training.
As noted previously, Paul and Trimble 1 s (1970) instructions to subjects
certainly favored the live relaxation condition in terms of expectancy
for change. Perhaps the critical procedural variable of progressive
muscle relaxation is an expectancy for change rather than those varia-
bles postulated by King (1981) and Borkovec and Sides (1979). Investi-
gations by Borkovec and Nau (1978), McGlynn and McDonnell (1974) and
others in which active treatment conditions were indeed seen as more
credible and as fostering a higher expectation for improvement than
control conditions certainly support this position. Moreover, these in-
vestigations included as active treatment components the therapeutic
procedures of desensitization, of which progressive muscle relaxation is
an integral part. Thus, the increased credibility of these procedures
64
may have been due, in part, to the increased credibility of the progres-
sive muscle relaxation procedure.
In addition to the reasons noted above, perhaps all of the train-
ing conditions shared elements producing a relaxed state. Benson,
Beary and Carol (1974) delineated four basic elements of the relaxation
response which are necessary and sufficient to induce a relaxed state.
Specifically, these elements include a shift away from logical extern-
ally oriented thought, a passive attitude with attention directed toward
the relaxation technique, a comfortable position, and a quiet environ-
ment. These elements were included in all of the relaxation groups used
in this investigation. Finally, perhaps the choice of relaxation pro-
cedure is not critical with high anxious populations. That is, high
anxious subjects may relax so infrequently, either subjectively or
physiologically, that any technique producing a state of rest may induce
physiological and self report changes in anxiety level. This postula-
tion contradicts the evidence reviewed by Borkovec and Sides (1979),
but has some support in the work of Miller and Bornstein (1977) and
Israel and Beiman (1977), who found self relaxation with anxious indi-
viduals to be as effective as progressive muscle relaxation. In addi-
tion, Smith (1976), using subjects responding to advertisements for an
anxiety reduction program, found a transcendental meditation treatment
condition to be no more effective in reducing trait anxiety than a con-
trol treatment consisting of sitting without meditation. Unfortunately,
no physiological measures were implemented. Finally, in one of a series
of investigations, Cuthbert, Kristeller, Simons, Hodes, and Lang (1981)
65
found that subjects given only instructions to try to relax were as suc-
cessful at achieving heart rate reductions as either of two training
groups (heart rate feedback and meditation).
An interesting finding involves the Expectancy and Treatment X
Expectancy effects for heart rate baseline data, and a main effect for
expectancy for skin fluctuation response on Session 2 baseline data.
These baseline data were taken following the instructions,,and it seems
plausible that the expectancy manipulation influenced basal physio-
logical measures. Although this possibility should certainly be viewed
with caution, perhaps high expectancy instructions are detrimental ini-
tially by instilling a strong demand among subjects to change. In addi-
tion, high expectancy instructions given during a pretreatment phase may
prompt decreased effort. That is, if a treatment is proposed as an ex-
tremely efficacious one, the perception by the subject may be that ex-
tensive effort is not needed for change. In this investigation, high
heart rate and a greater number of skin fluctuation responses, indi-
cants of anxiety, were higher for those individuasl given high expec-
tancy instructions. Obviously, an alternative explanation to those
noted above is that the differences were in fact real basal level dif-
ferences, uninfluenced by expectancy manipulations. This question cer-
tainly deserves further investigation.
It is noteworthy that self report measures of anxiety .and muscle
tension did not differ among groups regardless of training or expectancy
manipulations. Reinking and Kohl (1975) had noted that if the desired
effect is subjective calm, then" ••• any procedure should work
66
equally well if 'sold' as a relaxation procedure" (p. 599). The present
investigation found changes in the relaxed direction across all condi-
.tions on the Anxiety Differential (see Figure 5 and Table 4). Thus,
perhaps no "selling" is necessary to facilitate subjective calm. It
may be that merely providing instructions to try to relax may be the
critical variable in producing decreases in subjective anxiety.
As noted, the within session relaxation ratings, while indicating
increased relaxation among muscle groups across sessions, did not differ
across live, taped, or self relaxation training conditions. These rat-
ings were included to test the response contingent hypothesis (Paul &
Trimble, 1970) as an explanation for previous findings of live training
superiority over taped training. In addition to this hypothesis, Borko-
vec et al. (1978) had postulated that experimenter presence in live
relaxation training and absence in taped training was the critical
variable leading to live relaxation training superiority. In the pres-
ent investigation, experimenter presence was equivalent across groups
with the experimenter present for all treatment conditions. As noted
in the present study, relaxation ratings did not differ between live
and taped conditions. The lack of superiority for live versus taped
relaxation, combined with the equivalence of the relaxation ratings
across live and taped conditions thus favors the Borkovec et al. (1978)
conceptualization stressing experimenter presence. That is, some aspect
of therapist presence may be critical in relaxation training. Albeit
this study does not allow for the specification of this aspect, it
should be noted that the therapists in the present investigation were
67
active in terms of explaining the relaxation process, physiological
monitoring equipment, self-monitoring homework, etc. and served a func-
tion during relaxation proper by recording the relaxation ratings given
after the second tension-release cycle of each muscle group. Cuthbert
et al. (1981) addressed this issue by actively manipulating the subject-
experimenter relationship across two training conditions designed to
decrease heart rate. The high-involvement procedure included considera-
ble general conversation between subject and experimenter, positive
support and information about performance, instr.uctions to practice at
home, and literature about the relationship between the experimental
task and relaxation. The low-involvement condition was defined as the
experimenter interacting no more than necessary to answer procedural
questions. Although the relationship was a complex one, results strong-
ly indicated that relationship factors and knowledge of results inter-
acted significantly, lending some support in favor of the experimenter
presence argument. Obviously, more definitive answers to this issue of
therapist presence would have been possible within the present investiga-
tion if live relaxation training had indeed proved superior to taped
relaxation. With the equivalence of these training modalities, the
above discussion should be considered cautiously.
This finding may, however, have implications for self-help thera-
pies, if indeed therapist presence proves to be a critical variable in
effecting changes in anxiety level. Without therapist involvement,
self-help strategies,particularly those dealing with tension and anxiety
may be lacking a critical component necessary for symptom reduction.
68
Unfortunately, as Foreyt and Goodrick (1979) note, there is a glaring
absence of data based evaluations of self-help treatment strategies,
thus precluding conclusions regarding this postulation.
Multidimensional Nature of Anxiety
As noted previously, the different response systems that define
anxiety have been found to be frequently discordant (Lang, 1978; Martin,
1961). The present investigation provides little challenge to these
consistent findings. More specifically, in the present investigation,
while heart rate and skin fluctuation measures showed significant dif-
ferences due to the expectancy manipulation, self reports of anxiety
did not. There were, however, some rather interesting relationships
among the dependent measures. Correlations between the anxiety self
report measure in this investigation (Anxiety Differential) and the re-
laxation ratings were significant and negative. More specifically,
posttreatment anxiety reports in Sessions 1 and 2 (AD2, AD4) were very
significantly correlated with RR! and RR2 respectively (r = -. 56, E_(.001;
r = -.32, 12.(.0l). That is, high scores on the AD indicating low
anxiety, were correlated with fewer relaxation ratings greater than 3
on the 1 (relaxed) to 10 (tense) scale used to rate muscle relaxation.
This has clinical relevance, in that, with replication, within session
relaxation ratings may be an accurate indicant of subjective anxiety
level. This is particularly encouraging when considering the covert
nature of the Anxiety Differential, as substantiated by the finding
previously noted that anxious subjects instructed to "fake good" have
69
been found to display higher anxiety scores than a non-anxious control
group.
In addition, baseline heart rate was significantly and positively
correlated with the Session 1 Anxiety Differential Change Score (ADCH 1).
The fact that heart rate did indeed.correlate with. self report, along
with significant decreases in this dependent variable due to the expec-
tancy manipulation and a trend toward training modality differences
(i.e., live and self> tape) indicates the sensitivity of this measure
in the present investigation. The sensitivity of the heart rate measure
in studies of anxiety has been noted previously (Agras, 19811 Bo~kovec
et al., 1977). Indeed, Agras (1981) in ranking a variety of measures
in order of increasing sensitivity to change in anxiety-arousing situa-
tions, found heart rate to be the most sensitive physiological measure.
Other correlations between heart rate measures and self report measures
were consistently higher than other physiological-self report pairings,
although,when significant, were low (.20's). This finding, added to the
lack of correlation among physiological measures and the significant
expectancy effects with heart rate and skin fluctuation response but
not finger pulse volume amplitude, is typical of research findings both
across (i.e., self report, physiological,behavioral) and within (e.g.,
different physiological measures) response systems. Martin (1961)
notes that one reason for the lack of intercorrelations among physio-
logical measures stems from Lacey, Bateman and Van Lehn's (1953) finding
of individual patterns of autonomic responses. Certain individuals may,
for example, respond to stress by increased heart rate and a small
70
change in skin conductance while another may respond with the opposite
pattern. Lang (1978) concurs noting:
Despite the ubiquity of relevant physiological measures, empirical investigations have also shown that the group intercorrelations among these measures are remarkably low, and that the shared variance within the physiological system seldom exceeds 10 or 15%. (p. 383)
The lack of change in the finger pulse volume amplitude measure
warrants some discussion, particularly considering the significant
change scores on the heart rate and skin fluctuation response measures
related to the expectancy factor. In addition to the response stereo-
typy noted above, several other factors may be related to this lack of
effect. First, room temperature and humidity must be closely regulated
in the measurement of peripheral blood flow, regulation not possible
in the laboratory in which this study was conducted. Second, position
of the transducer is critical when sites such as the finger are em-
ployed (Jennings, Tahmoush, & Redmond, 1980). Thus rather minute varia-
tions in position placement among subjects may have contributed to non-
significant effects. Third, none of the four relaxation investigations
contrasting live versus taped relaxation training used this cardiovascu-
lar measurement. Moreover, only three studies investigating progressive
muscle relaxation have used peripheral blood flow, with two investiga-
tions using forearm blood flow as the physiological measure of choice
(Lader & Mathews, 1970; Mathews & Gelder, 1969), with neither study
finding differences between progressive muscle relaxation and control
groups. In the third investigation, Van Egeren, Feather, and Hein
(1971) found that relaxed subjects showed less decrease in skin
71
resistance to phobic stimuli than those who were not relaxed but no
differences in finger pulse amplitude between relaxed and unrelaxed sub-
jects. Finally, Kallman and Feuerstein (1977) note that autonomic in-
nervation of the blood vessles is poorly understood. To illustrate this
confusion, Lader and Mathews (1970) reported a subject who showed in-
consistency within the cardiovascular system, with a rise in forearm
blood flow and a drop in heart rate.
The failure of the self report measures (~nxiety Differential,
relaxation ratings) to correlate with the physiological measures in the
present study is also no surprise. Indeed, Parloff, Waskau and Wolfe
(1978) note that a repeated finding in psychotherapy is that different
measures of even the same criterion fail to show high correlations.
This oft-repeated finding may reflect the role of individual differ-
ences in patterns of anxiety responses and also the complexity of the
construct of anxiety. The latter is illustrated by the fact that
anxiety has been u.ewed as a behavior ("doesn't he look anxious"), a
trait ("he's an anxious individual"), an explanation of the behavior ("he
smokes because he is anxious"), and a state ("I feel anxious doing
this"), the latter influenced by a host of situational variables. It is
obvious that anxiety is a multidimensional construct, and the definition
or conception of anxiety as unitary (e.g., an emotional state) is not
sufficient.
Caveats and Future Directions
Finally, there are several procedural variables to be considered
prior to generalizing the present results beyond this investigation.
72
First, volunteers were solicited for this investigation with subjects
receiving extra points in an introductory psychology course for parti-
cipation. However, these participants did score substantially above
the norm for normal male and female samples on the anxiety measure used
for screening purposes, the S-R Inventory of General Trait Anxiousness
(Endler & Okada, 1975), indicating that the subjects used in this in-
vestigation were indeed high anxious subjects.
A number of investigations have examined the effects of progres-
sive muscle relaxation on psychophysiological responding to stress in-
ducing stimuli with inconsistent results (King, 1981). This question
was not a focus of the current investigation. Therefore, results should
not be generalized to situations involving the express presentation of
anxiety-eliciting stimuli during the relaxation procedure.
Therapists actively interacted with the subjects before and after
each session and were active during relaxation proper, eliciting relaxa-
tion ratings. Since therapist presence may indeed be a critical varia-
ble in the efficacy of the relaxation training procedure, any or all of
these components may be critical. Relaxation practice between sessions
was stressed, with participants filling out daily relaxation rating
sheets requesting them to rate their ability to relax. This practice
and the emphasis given it by the therapists involved may also be an
important factor in acquiring relaxation skills.
The expectancy conditions instructions (i.e., high and low) in
the present investigation were extremely disparate limiting generaliza-
tion to investigations implementing expectancy instructions of equal
73
disparity. That is, low expectancy subjects were told that they were in
a control group and that the evidence did not support the use of the
particular procedure, etc., while high expectancy subjects were told
that the relaxation procedure was of proven effectiveness and that they
would undoubtedly receive benefit from the relaxation training.· The
question remains as to whether the same effects would be found if sub-
jects were given moderately vs. extremely high expectation or counter
demand instructions (i.e., informed that progress would not occur for
several weeks). As Kazdin (1979) suggests, assessing expectancy at
different times within treatment (e.g., post-instructions, post-session
1) may also provide valuable information regarding the role of this
construct in the relaxation process by noting changes in expectancy ~nd
concurrent changes in self report and physiological indices. There is
no question that more data are needed to confirm the role of expectancy
in relaxation training. However, the present investigation does cer-
tainly corroborate the findings of others who have suqgested that the
role of expectancy in a host of psychotherapeutic procedures may be a
critical one (Borkovec & Nau, 1972; Israel & Beirnan, 1977).
It is possible that extending the number of sessions beyond the
two used in this study would result in differential results among
training conditions. This possibility is supported by the findings of
Borkovec and Sides (1979), although the present investigation found no
changes due to the sessions variable on physiological or self report
measures of anxiety. Finally,_ the present investigation did not in-
volve a follow~up session. Such a session may well produce different
74
results across treatment conditions. Indeed, Beiman et al. (1978) did
find some differences across physiological measures during a oost-
treatment session. Replications of the present research should certain-
ly investigate this issue.
Concluding Remarks
In sum, this investigation, using high anxious subjects under-
going two relaxation sessions under either live, taped, or self relaxa-
tion training found that information provided to the subject regarding
the efficacy of the procedure was the critical independent variable in
two physiological change scores, heart rate and skin fluctuation re-
sponses. There were no differences between groups in within session
relaxation ratings or with1he self report of anxiety as measured by the
Anxiety Differential. However, relaxation ratings did decrease across
sessions, and the Anxiety Differential change scores did indicate a
decrease in anxiety in all treatment groups.
As noted above, self report measures (relaxation ratings, Anxiety
Differential) were equivalent across groups while physiological mea-
sures (heart rate, skin fluctuation response) showed a significantly
greater decrease under high expectancy conditions. Thus, the possi-
bility exists that the active elements needed to reduce subjective com-
ponents of anxiety may be different than that for physiological compon-
ents. This response fractionation certainly supports the multidimension-
al view of anxiety.
Further investigations are needed to delineate the necessary com-
ponents for the influential role of therapist presence in relaxation
75
training and to further substantiate the chief finding of this investi-
gation, i.e., the critical influence of expectancy in the relaxation
process. Investigations should also include incorporation of a measure
of tonic muscle tension (EMG). This measure may prove to differentiate
live versus taped and self relaxation since progressive muscle relaxa-
tion direcly deals with the tensing and relaxing of different muscle
groups, albeit some evidence exists (Israel & Beirnan, 1977; Beiman et
al., 1976) incidating that self relaxation training can be as effective
on this measure of anxiety.
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APPENDICES
82
APPENDIX A
ANXIETY DIFFERENTIAL
83
84
INSTRUCTIONS
The purpose of this form is to measure the meanings of certain things to various people by having them judge them against a series of de-scriptive scales. In completing this form, please make your judgments on the basis of what these things mean to you. Below are different concepts to be judged and beneath each a set of scales. You are to rate the concept on each of these scales in order. Here is how to use these scales:
If you feel that the concept at the top of each scale is very closely related to one end of the scale, you should place your check-mark as follows:
Fair X Unfair ---or
Fair X Unfair ---If you feel that the concept is quite closely related to one or the other end of the scale (but not extremely), you should place your check mark as .follows:
Strong _____ x ________________ Weak
or Strong ___ ------ ______ __ x _ ___ Weak
If the concept seems only slightly related to one side as opposed to the other side, then you should check as follows:
Active X Passive ---or
Active X Passive --- ---If you consider the concept to be neutral on the scale, both sides of the scale being equally associated with the concept, or if the scale is completely irrelevant, unrelated to the concept, then you should place your check mark in the middle space:
Safe -~---- _____ x __________ Dangerous
IMPORTANT: (1) Place your check marks in the middle of spaces, not on the boundaries.
(2) Be sure you check every scale for every concept~ do not omit any.
(3) Never put more than one check mark on a single scale.
85
ME
Frightened Fearless
DREAMS Loose Tight ---
MY MIND Loose Tight
LITTLE BOYS Safe Dangerous
ME Jittery Calm
BREATHING Careful Carefree
FINGERS Loose Tight
SCREW Strong Weak
GERMS Deep Shallow
ME Helpless Secure
SCREW Nice Awful
FINGERS Stiff Relaxed
MOVIES Loose Tight
SCREW Loose Tight
HANDS Good Bad
DREAMS Near Far
HANDS Wet Dry
APPENDIX B
S-R INVENTORY OF GENERAL TRAIT ANXIOUSNESS
86
87
INVENTORY OF ATTITUDES TOWARD GENERAL SITUATIONS
NAME:
AGE: SS#:
SEX: PHONE:
This inventory represents a means of studying people's reactions to and attitudes towards various types of General situations. On the fol-lowing pages are represented four general kinds of situations which most people have encountered. For each of these general kinds of situa-tions certain conunon types of personal reactions and feelings are listed.
You Are in Situations Involving Interaction with Other People
(We are primarily interested in your reactions in General to those situations that involved interacting with other people. This includes situations that involve frineds, family, acquaintances, strangers, etc.
l 2 3 4 5 1. Seek experiences Very much Not at all
like this 1 2 3 4 5
2. Perspire Not at all Perspire much
1 2 3 4 5 3. Have an "uneasy Not at all Very much
feeling: 1 2 3 4 5
4. Feel exhilarated Very much Not at all and thrilled
1 2 3 4 5 5. Get fluttering Not at all Very much
feeling in stomach 1 2 3 4 5
6. Feel tense Not at all Very tense
l 2 3 4 5 7. Enjoy these situations Very much Not at all
1 2 3 4 5 8. Heart beats faster Not at all Much faster
1 2 3 4 5 9. Feel anxious Not at all Very anxious
88
You Are in Situations Where You Are About to Or May Encounter Physical Danger
(We are primarily interested in your reactions in General to those situations involving Physical Danger.
10. Seek experiences like this
11. Perspire
12. Have an "uneasy feeling"
13. Feel exhilarated and thrilled
14. Get fluttering feel-ing in stomach
15. Feel tense
16. Enjoy these situations
17. Heart beats faster
18. Feel anxious
1 Very much
1 Not at all
1 Not at all
1 Very much
1 Not at all
1 Not at all
1 Very much
1 Not at all
1 Not at all
2 3 4
2 3 4
2 3 4
2 3 4
2 3 4
2 3 4
2 3 4
2 3 4
2 3 4
You Are in a New Or Strange Situation
5 Not at all
5 Perspire much
5 Very much
5 Not at all
5 Very much
5 Very tense
5 Not at all
5 Much faster
5 Very anxious
(We are primarily interested in your reactions in General to~~ strange situations.)
19. Seek experiences like this
20. Perspire
21. Have an "uneasy feeling"
22. Feel exhilarated and thrilled
1 Very much
1 Not at all
1 Not at all
1 Very much
2
2
2
2
3 4 5 Not at all
3 4 5 Perspire much
3 4 5 Very much
3 4 5 Not at all
89
1 2 3 4 5 23. Get fluttering Not at all Very much
feeling in stomach 1 2 3 4 5
24. Feel tense Not at all Very tense
1 2 3 4 5 25. Enjoy these Very much Not at all
situations 1 2 3 4 5
26. Heart beats faster Not at all Much faster
1 2 3 4 5 27. Feel anxious Not at all Very anxious
You Are Involved in Your Daily Routines
(We are primarily interested in yoru reactions in General to Routine Situations.)
1 2 3 4 5 28. Seek experiences Very much Not at all
like this 1 2 3 4 5
29. Perspire Not at all Perspire much
1 2 3 4 5 30. Have an "uneasy Not at all Very much
feeling" 1 2 3 4 5
31. Feel exhilarated Very much Not at all and thrilled
1 2 3 4 5 32. Get fluttering Not at all Very much
feeling in stomach 1 2 3 4 5
33. Feel tense Not at all Very tense
1 2 3 4 5 34. Enjoy these situations Very much Not at all
1 2 3 4 5 35. Heart beats faster Not at all Much faster
1 2 3 4 5 36. Feel anxious Not at all Very anxious
APPENDIX C
CONSENT FORM
SELF MONITORING CONTRACT
90
91
CONSENT FORM
I, , have been informed of my responsibility as a volunteer in this research project and of the time commitment in-volved. More specifically, I am aware that the study will involve two sessions of approximately 60 minutes duration, with sessions scheduled one week apart. I am also aware that: (1) the study of the relaxation process is the focus of the project; (2) the relaxation training is not meant to serve as a substitute for psychological counseling; and (3) that physiological measures of relaxation will be taken during the two sessions, the results.of which will be unavailable to me until the com-pletion of the study. These measures will involve the attachment of monitoring equipment to the forehead and one finger and will cause no discomfort or pain. In addition, I realize that my commitment also in-volves practicing relaxation for 20 minutes daily during the interval between session 1 and session 2. Finally, I understand that I will re-ceive 3 academic credits for my participation in this research project and that my participation in this study will remain completely confi-dential other than the identification necessary for academic credit assignment.
Signature
Date
SELF MONITORING CONTRACT
I, , agree to:
1. Practice relaxation once daily for a minimum of 20 minutes;
2. Pick up a relaxation practice sheet daily from the 5th floor lobby at which time the completed sheet for the previous day will be returned;
3. Sign each relaxation practice sheet as a pledge that relaxa-tion practice did indeed occur.
Signature
Date
Witness
APPENDIX D
EXPECTANCY QUESTIONNAIRE
92
93
QUESTIONNAIRE
Please read the following questions and circle the number which matches how you feel about the type of .relaxation that you will be learning. Please do not hesitate to make use of the entire scale.
1. How logical does this type of treatment seem to you?
2 1 totally
illogical; makes no sense
3 4 5 6 7 8 9 10 extremely
logical and sensible
2. How confident are you that this treatment will be successful in making you less tense and anxious?
_J, __ ~~--...._ __ _,_ __ _,_ __ _._ __ _._ __ -"' ___ ~----
1 2 not confident
at all
3 4 5 6 7 8 9 10 extremely
confident; certain
3. How confident would you be in recommending this treatment to a friend who was tense and anxious?
1 2 not confident
at all
3 4 5 6 7 8 9 10 extremely confident
4. How successful do you feel this treatment would be in decreasing fears; for example, being very nervous before taking tests?
1 2 certain it would be unsuccessful
3 4 5 6 7 8 9 10 certain it would work
5. If you were extremely nervous in certain situations, for example, taking tests, would you be willing to undergo the relaxation training you will be practicing?
_l __ _.._ __ --J __ ___. __ __,_ __ __._ _______ ___._ __ __,_ ______ .__
1 definitely
not
2 3 4 5 6 7 8 9 10 yes,
definitely
APPENDIX E
POST-SESSION 1 QUESTIONNAIRE
94
95
POST-SESSION l QUESTIONNAIRE
1. Tell me a little bit about how you felt during the relaxation practice.
2. What difficulties, if any, did you have in getting relaxed?
3. What questions do you have about the relaxation that you have just practiced?
APPENDIX F
PROCEDURAL OUTLINE: SESSION 1
96
97
PROCEDURAL OUTLINE: SESSION 1
1. Greeting of subject a. Consent form signed b. Self monitoring contract signed
2. Statement of relaxation instruction and rationale and expectancy condition.
3. Physiological monitoring explained and instruments attached.
4. Expectancy measure and Anxiety Differential administered.
5. Subject asked to remove glasses, contacts, and rings.
6. 5 minute adaptation period with final 1 minute serving as pretreat-ment baseline period for physiological measures (begun following completion of Anxiety Differential and expectancy measure)
7. Pre-relaxation instructions (includes modeling tensing the face, relaxing "all at once" and instructions to recline and close eyes).
8. Begin relaxation proper. a. Record self ratings following relaxation of each muscle group. b. Press event marker in live and taped conditions (once for
tensing, twice for relaxation). c. Press event marker signalling final 30 seconds of relaxation
session.
9. Anxiety Differential administered.
10. Subject detached from physiological equipment.
11. Discussion of post-session 1 questions.
12. Self monitoring forms explained and distributed with statement that a discussion of practice will occur next session.
APPENDIX G
PROCEDURAL OUTLINE: SESSION 2
98
99
PROCEDURAL OUTLINE: SESSION 2
1. Greeting of subject. a. Collection of self monitoring sheet from previous day's
practice. 2. Pre-session 2 questions discussed.
3. Apparatus attached.
4. Anxiety Differential administered.
5. 5 minute adaptation period with final 1 minute serving as pretreat-ment baseline period for physiological measures.
6. Begin relaxation proper. a. Record self ratings following relaxation of each muscle group. b. Press event marker in live and taped conditions (once for
tensing, twice for relaxation). c. Press event marker signalling final 30 seconds of relaxation
session.
7. Anxiety Differential administered.
8. Subject detached from physiological monitoring equipment.
9. Debrief subject in live/low, taped/low conditions.
APPENDIX H
SELF MONITORING SHEETS
100
101
NAME:
1. Fist on nondominant hand; relax 2. Elbow pressed down agains arm of chair, nondominant arm; relax 3. Fist on dominant hand; relax 4. Elbow pressed down against arm of chair, dominant arm; relax 5. Lift eyebrows; relax 6. Squint and wrinkle nose; relax 7. Bite teeth together, corners of mouth back; relax 8. Chin down; relax 9. Deep breathmd hold, shoulder blades back; relax
10. Stomach hard; relax 11. Tense right upper leg; relax 12. Right foot, toes up; relax 13. Right foot, point toe, foot inward, curl toes; relax 14. Tense left upper leg; relax 15. Left foot, toes up; relax 16. Left foot, point toe, foot inward, curl toes; relax
Relaxation Level Relaxation Level Date Time Before Practice After Practice
(1 = Extremely Relaxed) (1 = Extremely Relaxed) (10 = Extremely Tense) (10 = Extremely Tense)
PLEDGE:
APPENDIX I
PRE-RELAXATION INSTRUCTIONS~TAPED
102
103
PRE-RELAXATION INSTRUCTIONS~TAPED
As I described before, the procedure we will be using is called pro-gressive relaxation training, which consists of learning to tense and release various muscle groups throughout the body. You will be listen-ing to a tape, directing you to tense a particular muscle group for about 5 seconds and then to relax for 30-45 seconds. The tape will go through each muscle group twice. It is important to remember to re-lease the muscle tension immediately rather than gradually when the tape directs you to relax. Also, once a group of muscles is relaxed, do not move it unnecessarily (except to make yourself comfortable). Finally, after each muscle group, the tape will ask you to rate on a 1 to 10 scale how relaxed that muscle group is. A rating of 1 will in-dicate that the muscle group is completely relaxed, while a rating of 10 will indicate a great deal of tension in that muscle group. Remeber, a 1 means that you are thoroughly, completely relaxed, while a 10 means that you are very tense. Do you have any questions?
~Begin Relaxation Exercise~
APPENDIX J
LIVE AND TAPED RELAXATION INSTRUCTIONS
104
105
LIVE RELAXATION INSTRUCTIONS
Muscle Groups
1. Dominant hand and forearm
*la. Repeat *lb. Please rate level of
relaxation in your hand and forearm.
Exercise
Cup hand and spread fingers
(Repeat if rating is greater than 2)
2. Dominant biceps
3. Nondominant hand and forearm
4. Nondominant biceps
5. Forehead
6. Central face
7. Lower face and jaw
8. Neck
9. Chest, shoulders, upper back
10. Abdomen
11. Dominant upper leg
12. Dominant calf
Elbow down against chair
Cup hands; spread fingers
Elbow down against chair
Lift eyebrows
Squint and wrinkle nose
Bite hard; pull back corners of mouth
Chin to chest and keep it from touching
Deep breath and hold; pull blades back
Stomach hard (punch)
Lift leg slightly
Point toes toward head (brief)
Area of Tension Patter**
Hand, knuckles, lower arm
Biceps
Hand, knuckles, lower arm
Biceps
Forehead and scalp
Central part of face; upper cheeks and through eyes
Lower face and jaw
Neck
Chest, shoulders, upper back
Stomach
Upper leg
Calf
A
B
C D
E F
A B
C D
E F
A B
c· D
E F
A B
C,D
E F
13.
14.
15.
106
LIVE RELAXATION INSTRUCTIONS (Cont'd.)
Muscle Groups
Dominant Foot
Nondominant upper leg
Nondominant calf
Exercise
Curl toes; foot inward
(see 11)
(see 12)
Area of Tension Pattern**
Arch ball of A of foot B
C D
E F
16. Nondominant foot (see 13) A B
*Same for each muscle group.
**A= and relax, letting all the tension go, focusing on these muscles as they just relax completely, noticing what it feels like as the muscle becomes more and more relaxed, focusing all your attention on the feelings associated with relaxation flowing into these muscles.
B = just enjoying the pleasant feelings of relaxation, as the muscles go on relaxing more and more deeply, more and more completely. There is nothing for you to do but focus your attention on the very pleasant feelings of relaxation flowing into this area. Just noticing what it is like as the muscles become more and more deeply relaxed.
C = just enjoying the feelings in the muscles as they loosen up, smooth out, unwind,and relax more and more deeply. Just experiencing the sensations of deep, complete relaxation flowing into these muscles more and more deeply and completely relaxed. Just letting the muscles go, thinking about nothing but the very pleasant feelings of relaxation.
D = just let those muscles go and notice how they feel now as compared to before. Notice how those muscles feel when so completely re-laxed. Pay attention only to the sensations of relaxation as the relaxation process takes place. Calm, peaceful and relaxed. Now that you have relaxed as much as you have.
E = attending to the difference in how your feels now as com-pared to just a moment ago. Let your become very relaxed all over. Let the tension flow away as your muscles relax more and more completely as the tension and tightness dissolve.
107
LIVE RELAXATION INSTRUCTIONS (Cont 1 d.)
F = letting all the tension go, enjoying the feeling of relaxation as the muscles loosen up and unwind completely. Pay attention only to your muscles, noting the difference in feeling as you relax it. There is nothing for you to do but pay attention to these relaxed sensations.
APPENDIX K
SELF RELAXATION SELF-MONITORING FORM
108
109
NAME:
Relaxation Level Relaxation Level
Time Before Practice After Practice Date (1 ~ Extremely Relaxed) (1 = Extremely Relaxed) (10 = Extremely Tense) (10 = Extremely Tense)
PLEDGE:
APPENDIX L
110
111
Table l
Analysis of Variance for SR-GTA
Source
Treatment
Expectancy
Treatment X Expectancy
df
2
1
2
ss
105.44
11.57
46.25
F
0.99
0.22
0.44
112
Table 2
Analysis of Variance for Baseline Period Measure
Source df ss F
Heart Rate (HRll) Treatment 2 276.70 1.22 Expectancy 1 832.29 7.34** Treatment X Expectancy 2 780.03 3.44* Error 48 5442.88
Finger Pulse (FPll) Treatment 2 2.60 3.00 Expectancy 1 0.35 0.82 Treatment X Expectancy 2 o.oo 0.00 Error 48 20.83
Anxiety Differential (AD1) Treatment 2 107.11 0.52 Expectancy 1 21.40 0.21 Treatment X Expectancy 2 651.25 3.16 Error 48 4949.55
Skin Fluctuation Res:12onses (SFll) Treatment 2 9.30 0.44 Expectancy 1 8.28 0.78 Treatment X Expectancy 2 3.32 0.16 Error 48 498.22
Heart Rate (HR21) Treatment 2 483.44 2~02 Expectancy 1 280.16 2.34 Treatment X Expectancy 2 1290.77 5.39** Error 48 5749.11
Finger Pulse (FP21) Treatment 2 0.51 0.98 Expectancy 1 0.00 0.00 Treatment X Expectancy 2 0.07 0.15 Error 48 12.53
113
Table 2 (Cont'd.)
Source df ss F
Anxiety Differential (AD3) Treatment 2 24.48 0.13 Expectancy 1 109.79 1.14 Treatment X Expectancy 2 77.37 0.40 Error 48 4614.66
Skin Fluctuation Res~nses (SF21) Treatment 2 2.40 0.08 Expectancy 1 101.22 7.08** Treatment X Expectancy 2 24.03 0.84 Error 49 658.08
**E. <. 01 *p <. .OS
114
Table 3
Session 1 Baseline Heart Rate
Simple Main Effects for Treatment X Expectancy Interaction
Source df ss MS F
Expectancy at 1 624.22 624.22 5~'50* Live Condition
Expectancy at 1 953.39 953.39 8.40** Tape Condition
Expectancy at 1 34. 72 34.72 0.30 Self Condition
Error 50 113. 39
*E. ~. 025 **£. ~.01
115
Table 4
Session 2 Baseline Heart Rate
Simple Main Effects for Treatment X Expectancy Interaction
Source df ss MS F
Expectancy at 1 138.88 138.88 1.07 Live Condition
Expectancy at 1 1152.00 1152.00 9.62* Tape Condition
Expectancy at 1 280.06 280.06 2.33 Self Condition
Error 50 119. 77
*12.<-0l
116
Table 5
t-Test for Heart Rate Median Split
Group N df t
Heart Rate Change Session 1 (HRCHl)
HR high 26
HR low 28 52 1. 751
Finger Pulse Change Session l (FPCHl)
HR high 26
HR low 28 52 0.131
Anxietl Differential Change Session 1 (ADCHl)
HR high 26
HR low 28 52 1.935
Skin Fluctuation Change Session 1 (SFCHl)
HR high 26
HR low 28 52 0.020
117
Table 6
Analysis of Variance for Experimenter Differences
Source df ss F
Heart Rate Change Session 1 (HRCHl)
Experimenter 2 26.70 0.61 Error 51 1121.88
Finger Pulse Change Session 1 (FPCHl)
Experimenter 2 6.55 5.93 Error 51 22.08
Anxiety Differential Change Session 1 (ADCHl)
Experimenter 2 314.48 2.82 Error 51 2847.00
Skin Fluctuation Change Session 1 (SFCHl)
Experimenter 2 32.25 Error 50 285.44
Heart Rate Change Session 2 (HRCH2)
Experimenter 2 24.77 0.29 Error 51 2166. 72
Finger Pulse Change Session 2 (FPCH2)
Experimenter 2 1.37 2.92 Error 51 16.79
Anxiety Differential Change Session 2 (ADCH2}
Experimenter 2 78.37 0.90 Error 51 2208.38
Skin Fluctuation Change Session 2 (SFCH2)
Experimenter 2 26.11 1.31 Error 49 585.88
E.<: .005
118
Table 7
Analysis of Variance for Self-Monitoring Sheets
Source
Treatment
Expectancy
Treatment X Expectancy
Error
df
2
1
2
48
ss
1.03
0.46
1.92
35.33
F
0.70
0.63
1.31
119
Table 8
Analysis of Variance for Relaxation Ratings
Source df ss F
Treatment 2 108.50 1.49
Expectancy 1 40.33 1.11
Treatment X Expectancy 2 41.16 0.56
Error 48 1750.00
Session 1 46.33 8.90*
Treatment X Session 2 7.38 0.58
Expectancy X Session 1 o.59 0.09
Treatment X Expectancy
X Session 2 1.90 0.15
Error 48 303.77
*E_<.005
120
Table 9
Multivariate Analysis of Variance for the Overall
Effects of Treatment, Expectation, and Sessions
Pillai's Trace
Effect F value p<
Treatment 1.09 0.374
Expectancy 5.05 0.001*
Treatment X Expectancy 0.66 o. 718
Sessions 0.11 o. 977
Treatment X Sessions 1.10 0.371
Expectancy X Session 1.85 0.135
Treatment X Expectancy X Sessions 0.91 0.515
*Significant main effect.
121
Table 10
Univariate Analyses of Variance for Dependent Variables
Source df ss F
Heart Rate Treatment 2 188.46 3.12 Expectancy 1 330.75 10.94* Treatment X Expectancy 2 17.16 0.28 Error 48 1451.00
Sessions 1 5.78 0.24 Treatment X Session 2 118.57 2.45 Expectancy X Session 1 8.98 0.37 Treatment X Expectancy X Sessions 2 62. 90 1.30 Error 48 1162.33
Skin Fluctuation Responses Treatment 2 0.88 0.06 Expectancy 1 43.37 5.43** Treatment X Expectancy 2 15.33 0.96 Error 48 385.23
Sessions 1 0.40 0.05 Treatment X Sessions 2 9.23 0.52 Expectancy X Sessions 1 39.84 4.47** Treatment X Expectancy X Sessions 2 14.15 0.79 Error 48 428.19
Finger Pulse Volume Treatment 2 0.49 0.88 Expectancy 1 0.34 1.24 Treatment X Expectancy 2 0.18 0.33 Error 48 13.50
Sessions 1 0.03 0.18 Treatment X Sessions 2 0.46 1.41 Expectancy X Sessions 1 0.06 0.34 Treatment X Expectancy X Sessions 2 0.30 0.93 Error 48 1228.88
122
Table 10 (Cont'd.)
Univariate Analyses of Variance for Dependent Variables
Source df ss F
Anxiety Differential Treatment 2 102.24 0.67 Expectancy 1 46.67 0.61 Treatment X Expectancy 2 265.24 1. 74 Error 48 3654.66
Sessions 1 2.08 0.08 Treatment X Sessions 2 35.38 0.69 Expectancy X Sessions 1 80.08 3.,13 Treatment X Expectancy X Sessions 2 35.05 0.68 Error 48 1228.88
*R. c:: • 05 **R.< .005
The vita has been removed from the scanned document
PROGRESSIVE MUSCLE RELAXATION: EFFECTS OF EXPECTANCY
AND TYPE OF TRAINING ON MEASURES OF ANXIETY
by
Michael E. Stefanek
(ABSTRACT)
The present study compared live versus taped and self relaxation
training conditions under high and low expectancy conditions. Anxious
college students (N = 54) were stratified according to scores on the
screening instrument employed (S-R Inventory of General Trait Anxious-
ness) and randomly assigned to one of six training/expectancy conditions
for two relaxation sessions: live-high, taped-high, self-high, live-
low, taped-low, or self-low. Physiological measures of anxiety in-
cluded heart rate, spontaneous skin fluctuation responses, and finger
pulse volume amplitude. The Anxiety Differential was used to assess
self report of anxiety. Finally, within-session relaxation ratings were
elicited to evaluate differences between live and taped training condi-
tions. Results indicated that subjects in the high expectancy condition
showedasignificantly greater decrease in heart rate and spontaneous
skin fluctuation responses than low expectancy subjects, but no differ-
ences were found with the self report measure of anxiety. There were no
differences due to type of training (live, taped, self). Within-session
relaxation ratings indicated increased relaxation across sessions, but
no differences across type of training. Results were discussed in terms
of the multidimensionality of the anxiety construct and. the role of ex-
pectancy factors in progressive muscle relaxation procedures.