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A comparison of aerobic conditioning and stress inoculation as stress-management interventions Long, Bonita Clarice 1982

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A COMPARISON OF AEROBIC CONDITIONING AND STRESS INOCULATION AS STRESS-MANAGEMENT INTERVENTIONS fay BONITA CLARICE LONG M.A., The U n i v e r s i t y of B r i t i s h Columbia, 1978 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY i n THE FACULTY OF GRADUATE STUDIES ( I n t e r d i s c i p l i n a r y S t u d i e s ) We accept t h i s t h e s i s as conforming t o the r e q u i r e d standard THE UNIVERSITY CF BRITISH COLUMBIA^ JUNE 19R2 ( c ) Bonita C l a r i c e Long, 1982 In presenting t h i s thesis i n p a r t i a l f u l f i l m e n t of the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y available for reference and study. I further agree that permission f o r extensive copying of t h i s thesis f o r s c h o l a r l y purposes may be granted by the head of my department or by his or her representatives. I t i s understood that copying or publication of t h i s thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission. Department of J^Ktl^^r)^^/^n.cz^ly ^ ^ J C ^ C J ^ The University of B r i t i s h Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date ^ C / f / ^ ABSTRACT The e f f i c a c y of an a e r o b i c c o n d i t i o n i n g program ( j o g g i n g ) i n modifying se I f — r e p o r t ed c h r o n i c i n t e r m i t t e n t s t r e s s Is compared to s t r e s s - 1 n o c u l a t i o n t r a i n i n g ( s e l f - s t a t e m e n t mod-i f i c a t i o n ) and a w a i t i n g l i s t c o n t r o l group. G u i d i n g t h i s r e s e a r c h i s a t r a n s a c t i o n a l wodel of s t r e s s * The p a r t i c i -pants were community r e s i d e n t s ; 48 were females and 25 were males* Therapy s e s s i o n s were conducted over a 10—week p e r i -od w i t h s u b j e c t s meeting i n groups f o r 1 1/2 hours per week and a l s o completing homework assignments and a c t i v i t i e s * The S t a t e and T r a i t Anxiety I n v e n t o r i e s , the Tension Ther-mometer, a T h o u g h t - l i s t i n g Technique and a S e l f - e f f i c a c y S c a l e were a d m i n i s t e r e d a t p r e , post, and three—month f o l -low-up. Tn a d d i t i o n , a submaximal b i c y c l e ergometer t e s t was u t i l i z e d to p r e d i c t maximum oxygen uptake ( a measure of c a r d i o v a s c u l a r f i t n e s s ) * M u l t i v a r i a t e a n a l y s e s of variance i n d i c a t e that both the a e r o b i c c o n d i t i o n i n g program and the s t r e s s - I n o c u l a t ion t r a i n i n g were e f f e c t i v e i n reducing s e l f - r e p o r t e d a n x i e t y and i n c r e a s i n g s e l f - e f f i c a c y * These changes were maintained three months a f t e r c o m p l e t i n g the program* Subjects who ex-p e r i e n c e d s t r e s s more c o g n l t l v e l y than s o m a t i c a l l y reduced t h e i r l e v e l of s t r e s s from pre— to p-osttestlng s i g n i f i c a n t l y more than those who experienced s t r e s s more s o m a t i c a l l y , r e -g a r d l e s s of treatment c o n d i t i o n . However, from post to f o l l o w — u p the somatic s u b j e c t s continued to improve while the c o g n i t i v e s u b j e c t s stayed approximately the same. Com-pared to the w a i t i n g l i s t c o n t r o l group, s u b j e c t s ' p o s i t i v e s e l f - s t a t e n e n t r a t i n g s i n c r e a s e d s i g n i f i c a n t l y from pre— to p o s t t e s t i n g f o r the s t r e s s — i n o c u l a t i o n group. Subjects' s e l f — s t a t ement r a t i n g s and j u d g e s 1 s e l f —st at em en t r a t i n s s changed d i f f e r e n t i a l l y between groups and over time. Sub-j e c t s i n the a e r o b i c c o n d i t i o n i n g program improved t h e i r c a r d i o v a s c u l a r f i t n e s s compared to the s t r e s s - i n o c u l a t i o n and w a i t i n g l i s t groups. P a r t i c i p a t i o n i n an aerobic c o n d i -t i o n i n g program was found to be a v i a b l e a l t e r n a t i v e to st res s - i nocu I at ion t r a i n i n g as a stress-management t r e a t -ment. Although the p a t t e r n of changes d i f f e r e d between treatment groups and amoninr types of i n d i v i d u a l s from pre- to p o s t t e s t i n K on some measures, at three—nsonth f o l l o w —up few d i f f e r e n c e s were found between treatment groups. ACKNOWLEDGEMENTS I wish to thank the members of my t h e s i s committee, Dr. John Banmen , Dr » Doug Clement, Dr. Ken C r a i g , Dr. David Law-son, Dr. John Ledsome, and my t h e s i s chairman, Dr. Robert Conry f o r t h e i r c o ntinued support and f o r t h e i r comments and suggestions throughout the progress of the t h e s i s . S p e c i a l thanks are a l s o given t o Dr. Park Davidson f o r the support and encouragement he extended me throughout my graduate y e a r s . - W -C O N T E N T S ABSTRACT . . . . . . . . . . . . . . . . . . i i AC KNOW L E T GEM ENT S Iv OVERVIEW 1 REVIEW OF THE LITERATURE . . . . . . . . . . . . . . . . 4 S t r e s s 4 D e f i n i t i o n s . . . . . . . . . . . . 5 A Model of S t r e s s . . . . 7 Environmental Demands • • • • » • • • • • • • • 8 C o g n i t i v e A c t i v i t i e s . . . . . . . . . . . . . 9 A p p r a i s a l s • • • • • • • • • • • • « • • • • 9 Expectancy • • • • • • • . . . . . . . . . . 1 1 P h y s i o l o g i c a l Reactions . . . . . . . . . . . . 14 Overt Behavior . . . . . . . . . . . . . ' . . . 1 7 I n t e r v e n t i o n s • • • • • • • • • • • • • • • • • • 1 8 Treatments • • • • • • • • • • • • • • • • • • • • • • 2 1 Treatment packages • • • . . . . . . . . . . . 2 3 Self-Statement M o d i f i c a t i o n . . . . . . . . . . 2 6 Outcome Research . . . . . . . . . . . . . . 2 8 Summary • • • • • • • • • • « • • • • • • • 30 Aerobic Co nd i t 1 on i ra; . • « « "« 34 P h y s i o l o g i c a l B e n e f i t s « • • • » 35 P s y c h o l o g i c a l B e n e f i t s . . . . . . . . . . . 4 1 Chronic E x e r c i s e . . . . . . . . . . . . . . 43 "Acute F x e r c i s e • • • • • • • • • • • • • • • 48 Measures of Treatment Cutccrees • • • • • • • • • • 52 Measures of S t r e s s . . . . . . . . . . . . . . 52 St a t e - T r a i t 54 Tension Thermometer . . . • • • . . . . « . 56 I n d i v i d u a l D i f f e r e n c e s • • • • • • • • • • • • 56 Cognitive-Somat 1 c • • • • • . . . • . • • . 5 7 C o g n i t i v e Mediators 60 Measures of S e l i - B f i i c a c y • • • . . . . . . 6 0 Measures of SeIf-Stateraents . . . . . . . . 6 3 Measures of Aerobic C o n d i t i o n i n g . . . . . . . 6 8 STATEMENT OF THE PRCELEN 70 METHOD "73 S u b j e c t s : Recruitment and S e l e c t i o n . . . . . . 73 Subject C h a r a c t e r i s t i c s . . . . . . . . . . . . 7 4 T r a i n i n g anot S u p e r v i s i o n of Co—leader and T h e r a p i s t 77 Treatments "78 Aerobic C o n d i t i o n i n g . . . . . . . . . . . . 78 S t r e s s I n o c u l a t i o n . . . . . . . . . . . . . S O Experimental r e s i g n . . . . . . . . . . . . . . . 8 1 Dependent Measures . . • • • . . . . • . . • . 8 2 The S t a t e - T r a i t Anxiety I n v e n t o r i e s (STAI-S, STAI-T) 82 Tension Thermometer . . . . . . . . . . . . 83 S e l f - E f f i c a c y Scale 84 T h o u g h t - l i s t i n g . . . . . . . . . 8 5 Cognitive-Somatic A n x i e t y Q u e s t i o n n a i r e (CSAC) 86 Submaximal B i c y c l e Ergoneter Test . . . . . 87 A n c i l l a r y measures . . . . . . . . . . . . . 8 8 Program E v a l u a t i o n . . . . . . . . . . . . . 89 Apparatus, Equipnsert. and F a c i l i t i e s . . . . . 89 Procedures . . . . . . . . . . . . . . . . . . 90 E x e r c i s e Test Procedures . . . . . . . . . . 90 Follow-up . . . . . . . . . . . . 9 1 E x p e c t a t i o n s . . . . . . . . . . . . . . . . . 9 1 Li m i t at ions 92 , Data A n a l y s i s . . . . . . . . . . . . . . . . . . 93 RESULTS . . . . . . . . 95 Demographics . . . . . . . . . . . . . . . . . 96 P r e t e s t Measures . . . . . . . . . . . . . . . 97 E x p e c t a t i o n s of Treatment E f f e c t i v e n e s s . . . . 98 Measures of S t r e s s . . . . . . . . . . . . . . 99 The Cognitive-Somatic Mode 102 S e l f - s t a t e m e n t s and S e l f - e f f i c a c y . . . . . . 104 A n c i l l a r y Measures . . . . . . . . . . . . . 109 Program E v a l u a t i o n C u e s t l o n t i a i r e . . . . . . 114 Summary of F i n d i n g s . . . . . . . . . . . . . 115 DISCUSSION . . . 116 Therapy Cutccree . . . . . . . . . . . . . . . . 117 Expectancy . . . . . . . . . . . . . . . . . . . 118 I n d i v i d u a l D i f f e r e n c e s 119 C o g n i t i v e Mediators 123 Self- S t a t e m e n t s • • 123 S e l f - E f f i c a c y 126 C a r d i o r e s p i r a t o r y F i t n e s s . . . . . . . . . . . 129 Summary and Conclus i o n s . . . . . . . . . . . . 135 Recommendations . . . . . . . . . . . . . . . 135 v 5. REFERENCES . . . . . . . . . . . . . . . 138 A. SD ENAXIMAL TEST PROTOCOL 2 0 2 B . TELEPHONE AND PERSONAL INTERVIEW . 2 0 5 C. TENSION THERMOMETER AND THOUGHT—LISTING TECHNIQUE . 2 1 1 D. INFORMED CONSENT 2 1 7 E. TWENTY-FOUR HOUR MEDICAL AND EXERCISE HISTORY . . . 2 2 0 F. EXERCISE PRINCIPLES AND GUIDELINES . . . 2 2 3 G. CORRELATION MATRIX - PEAFSCN-FRODUCT MOMENT CORRELATIONS 2 2 7 H. DEMOGRAPHIC SUMMARY 2 3 0 I. EXAMPLES OF PERCEIVED STRESSORS 2 3 5 J . POST AND FOLLOW-UP PROGRAM EVALUATION . 2 3 7 K. INTERRAT ER RELIABILITIES 2 4 8 L. SELF-STATEMENT MODIFICATION OUTCOME RESEARCH SUMMARY . . . . . . . . . . . . . . 2 5 0 M . EXAMPLES OF PERSONAL GOALS 2 5 9 - v i i -LIST CF TABLES 1. Summary of Chi—square Tests of group demographic data 161 2. Means and standard d e v i a t i o n s of expectancy s c o r e s 162 3. Summary of a n a l y s e s of va r i a n c e on expectancy . • 1 6 3 4. Means and standard d e v i a t i o n s f o r outcome measures of s t r e s s at pre, pest and follow-up . . . . . 164 5. M u l t i v a r i a t e and u n i v a r i a t e summary for measures of s t r e s s — Pre S post or AC 1 , SI1 and WL groups . 165 6. M u l t i v a r i a t e and- u n i v a r i a t e summary for measures of s t r e s s Pre S post on AC 1 , SI I, AC 2, and SI2 groups . . . . . . . . . . . . . . . . . . . . 165 7. M u l t i v a r i a t e and u n i v a r i a t e summary l o r measures of s t r e s s Pre, post fi follow—up on ACl and SI 1. groups . . . . . . . . . . . . . . . . . . . . 166 8. Means and s t a n d a r d d e v i a t i o n s of outcome treasures of s t r e s s — — B l o c k e d on c o g n i t i v e - s o m a t i c mode . . . 167 9. M u l t i v a r i a t e and u n i v a r i a t e summary on measures of s t r e s s blocked on c c g n l t l v e - s o m a t i c mode—Pre G Post on ACC and SIC groups . . . . . . . . . . 168 1 0 . M u l t i v a r i a t e and u n i v a r i a t e summary on measures of s t r e s s blocked on c o g n i t i v e - s o m a t i c mode—Pre and Post 169 11. Means and standard ' J e v l e t i o n s f o r s e l f - e f f i c a c y at pre, post and follow—up . . . . . . . . . . . . 170 12. Means f o r s u b j e c t s ' and judges' s e l f - s t a t e m e n t r a t i n g s at p r e , post and follow—up . . . . . . 171 1 3 . Means f o r s u b j e c t s ' and judges' s e l f - s t a t ement r a t i n g s at pre, post and follow—up . . . . . . 172 - v l l i -14. Multivariate and univariate sutnwary cn s e l f - e f f icac y and self — sto. temen t measures—Pre S post — AC1 ,3 It , W L 173 15. Multivariate and univariate summary on sel f - e f f icacy and sel f-sta.teraent measures—Pre G post-AC1,S11, AC2,SI2 . . . . . . . . . 174 16. Multivariate and univariate summary on S e l f - e f l i c a c y and self—statement measures Pre B post for AC1 and SIl groups . . . . . . . . . . . . . . . . 175 17. Means and standard deviations f o r predicted MV02 by group . . . . . . . . . . . . . . . . . . . . . 176 18. Summary of analyses of variance cn predicted MV02 177 19. Mear-s and standard deviations on measures of s t r e s s — P r e t e s t only f cr combined groups blocked on MV02 S sex . . . . . . . . . . . . . . . . . 178 2 0 . Multivariate summary on measures ot stress Pretest only f o r combined groups blocked on sex and MV02 179 2 1 • Means and standard deviations on measures of stress blocked on MVG2—— Pre .8 post for combined AC groups . . . . . . . . . . . . . . . . . . . . ISO 22. Multivariate and univariate surareary of measures of stress-Pre & post blocked on MVC2 for combined AC . . 180 23. Means and standard deviations for Cornell Medical Symptoms Checkl 1st—— Pre, post, and follow-up • 181 24. Analyses of variance summary on Cornell Medical Symptoms Checklist . . . . . . . . 182 25. Summary of~slgnJ f leant multivariate and univariate tests for the dependent measures . • . . . . . 183 26. Maximal and subiraximal heart rates by age . . . . 184 27. C l a s s i f i c a t i o n of itaxl nal oxynen uptake by age and group. Recommended percent of maximum heart rate 185 - f x -LIST CF FIGURES JLLsass pjaiis 1-. Elements of the S t r e s s Syndrome . . . . . . . . . 1S6 2. Examples of I n t e r v e n t i o n s t h a t I n t e r r u p t the Str e s s Response Syndrome: Instrumental and P a l l i a t i v e 187 3 . Time—lagged c r o s s o v e r c o n t r o l design f o r t h r e e comparison groups . . . . . . . . . . . . . . . 188 4. Submaximal B i c y c l e Ergoireter Test - Heart Rate a not Work Load 139 5. Mean change f o r the treatment and w a i t i n g l i s t groups over time on the Tension Thermometer . . 190 6. Mean change f o r the treatment and wa i t i n g l i s t groups over time on the State Anxiety Inventory 191 7. Mean change f o r the treatment and w a i t i n g l i s t groups over time on the T r a i t A n x i e t y Inventory 192 8. Mean change f o r combined groups (AC 1 + SI1) blocked on the C o g n i t i v e and Somatic Mode . . . . . . . 193 9. Mean change f o r treatment and w a i t i n g l i s t groups over time on S e l f - e f f i c a c y . . . . . . . . . . 194 10. Mean change ( r a t i o s ) on Self—statements (S-S) f o r treatment and w a i t i n g l i s t groups over time . • 195 11. Mean change ( r a t i o s ) on Self - s t a t e m e n t s (S—S) f o r treatment and w a i t i n g l i s t groups over time . . 196 12. Mean change ( r a t i o s ) on Self - s t a t e m e n t s ( S-S) f o r combined treatment groups over time . . . . . 197 13. Mean change ( r a t i o s ) on Self - s t a t e m e n t s ( S-S) f o r combined treatment groups over time • • • • • 198 14. Mean change f o r treatment and w a i t i n g l i s t groups over time on MVC2 (ml/kg/min) . 199 x 1 5 . Mean change l o r treatment and waiting l i s t groups over time on the Cornell Medical Symptoms Checklist . . . . . . . . . . . . 2 0 0 16. Guide to s e t t i n g workloads for Subnra * i mal H icy c l e Test . 201 OVERVIEW In t h e p a s t d e c a d e r e s e a r c h on s t r e s s has e x panded t o encompass b o t h t h e e t i o l o g y and c o n s e q u e n c e s of p s y c h o l o g i -c a l s t r e s s and t o a s s e s s t h e e f f i c a c y of methods f o r c o p i n g w i t h s t r e s s . I t i s a p p a r e n t f r o m a r e v i e w of the l i t e r a t u r e t h a t a c o n c e p t u a l model i n t e g r a t i n g t h e d i v e r s e r e s e a r c h f i n d i n g s i n t h e f i e l d does h o t y e t e x i s t . C o n s e q u e n t l y , a model b a s e d on s o u n d t h e o r e t i c a l f o r m u l a t i o n s I s needed to i n t e g r a t e and d i r e c t r e s e a r c h on s t r e s s . The model s h o u l d have c l e a r i m p l i c a t i o n s f o r a p p r o p r i a t e management s t r a t -e g i e s and t r e a t m e n t c o m p a r i s o n s . The p u r p o s e of t h i s s t u d y i s t o compare two s t r e s s - m a n a g e m e n t i n t e r v e n t i o n s w i t h i n s u c h a model o f s t r e s s . The model p r e s e n t e d e m p h a s i z e s r e -l a t i o n s h i p s among c o g n i t i v e , b e h a v i o r a l , and p h y s i o l o g i c a l c o p i n g mechanisms o f s e l f - r e g u l a t i o n . T r a d i t i o n a l t r e a t m e n t s f o r s t r e s s i n b e h a v i o r a l p s y -c h o l o g y have been b a s e d on t h e S—R model ( H u l l , 1943; Wolpe, 1958 ). f r o m which s e v e r a l t e c h n i q u e s have d e v e l o p e d ( e . g . , s y s t e m a t i c dese ns 1 t l z a t i on , f l o o d i n g , p r o l o n g e d e x p o s u r e ) . However, t h e s e a p p r o a c h e s have r e c e n t l y been r i v a l e d by c o g -n i t i v e o r i e n t e d t e c h n i q u e s ( e . g . , r a t i o n a l e m o t i v e t h e r a p y , t h o u g h t - s t o p p i n g , s t r e s s i n o c u l a t i o n ) b a s e d on a c o g n i t i v e m e d l a t i o r a l model o f s t r e s s ( L a z a r u s , 1966; Meichenbaum, 1977 ). In a d d i t i o n , h e a l t h p r a c t i t i o n e r s have begun t o f o -c u s on p h y s i c a l a c t i v i t y as a s t r e s s - m a n a g e m e n t i n t e r v e n -t i o n . T h i s f o c u s i s p a r t i a l l y due to t h e i n c r e a s e d a c c e p -t a n c e o f t h e p h y s i o l o g i c a l b e n e f i t s of e x e r c i s e i n a l l e v i a t -i n g t h e n e g a t i v e p h y s i o l o g i c a l r e a c t i o n s t o c h r o n i c s t r e s s ( E l i o t , 1974, 1979). A n o t h e r f a c t o r has been the s h i f t t o a h o l i s t i c p e r s p e c t i v e In m e n t a l and p h y s i c a l h e a l t h ( P e l l e t i -e r , 1977; P o m e r l e a u , 1 9 7 9 ) . F u r t h e r m o r e , p h y s i c a l e d u c a t o r s ( C u r e t o n , 1973; Montoye, 1975) and t h e p o p u l a r p r e s s ( C o o p -e r , 1978 ; F i x x , 1977; Sheehan , 1978) have r e c o g n i z e d f o r some t i m e t h e a p p a r e n t r o l e t h a t e x e r c i s e ( e s p e c i a l l y e n d u r -ance t r a i n i n g ) p l a y s i n the r e d u c t i o n o f t h e s t r e s s r e -s p o n s e . T h u s , the r e l a t i o n s h i p between i m p r o v e d p h y s i c a l h e a l t h and e n h a n c e d m e n t a l w e l l — b e i n g has begun to r e c e i v e e m p i r i c a l s u p p o r t ( e . g . , Bahrke & Morgan, 1978; E v a n s , Cox, G J a m l e s o n , 1977; Morgan, 1979). The c o m p a r i s o n o f two t r e a t m e n t p a c k a g e s w h i c h can be c o n s i d e r e d v i a b l e a l t e r n a t i v e s was p r o p o s e d by K a z r l l n and W i l s o n (1978 ) f o r outcome r e s e a r c h when the p r i m a r y commit-ment i s to d i s c o v e r a t r e a t m e n t t h a t a m e l i o r a t e s a c l i n i c a l p r o b l e m . S e l f - s t a t e m e n t m o d i f i c a t i o n ( SSM ) p r o g r a m s have been shown to be e f f e c t i v e i n r e d u c i n g s t r e s s ( O o l d f r l e d , 1979 ; Melchenbaum $ J a r e m ko, i n p r e s s ) . In t h i s s t u d y , SSM i s u s e d as a s t a n d a r d w i t h which t o compare t h e l e s s w e l l r e s e a r c h e d e n d u r a n c e t r a i n i n g program a s a s t r e s s - m a n a g e m e n t i n t e r v e n t i o n . T h e r e f o r e , the e f f i c a c y o f a w e l l d e v e l o p e d 3 SSM program ( " s t r e s s I n o c u l a t i o n " ) i s compared to +hat of a p h y s i c a l c o n d i t i o n i n g program u t i l i s i n g walk/jogging* I m p l i c a t i o n s f o r the h e a l t h — c a r e f i e l d are apparent in the f o l l o w i n g areas* At a p r a c t i c a l l e v e l , data i s p r o v i d e d f o r those i n v o l v e d i n planning and implementing p r e v e n t i v e h e a l t h —care programs. The design allows f o r both the exami-nation of the a c t i v e i n g r e d i e n t s of the treatments (e.g., c o g n i t i v e mediators) and the assessment of d i f f e r e n t i a l ef-f e c t i v e n e s s ( e . g . , s u b j e c t c h a r a c t e r i s t i c s ) . In a d d i t i o n , the r e l a t i v e e f f e c t s of c o g n i t i v e and p h y s i o l o g i c a l i n t e r -v e n t i o n s are weighed w i t h i n an I n t e g r a t e d model of s t r e s s , thus c o n t r i b u t i n g to the advancement of theory In t h i s f i e l d . REVIEW OF THE LITERATURE In recent years there has been an i n c r e a s i n g awareness of the i n c i d e n c e of s t r e s s and i t s demonstrated negative e f -f e c t s on the p h y s i c a l h e a l t h and p s y c h o l o g i c a l w e l l — b e i n g of i n d i v i d u a l s (Antonovsky, 1979; Cohen, 1979; Dohrenwend 6 Dohrenwend, 1974; Weiner, 1977). E p i d e m i o l o g i c a l data on s t r e s s r e a c t i o n s and d i s o r d e r s p r o v i d e evidence that a s i z e -able p o r t i o n of the g e n e r a l p o p u l a t i o n experiences s t r e s s i n a v a r i e t y of s i t u a t i o n s f L a d e r , 1975). S t r e s s r e s e a r c h has h i s t o r i c a l l y developed i n two l a r g e l y separate s pheres, the b e h a v i o r a l s c i e n c e s and the l i f e s c i e n c e s . P s y c h o l o g i c a l s t r e s s concepts appear to have a r e l a t i v e l y long h i s t o r y and r e l a t e to p s y c h o s o c i a l demands on the i n d i v i d u a l . P h y s i o l o g i c a l s t r e s s concepts grew l a r g e l y out of the work of Hans Selye, beginning i n the 1930's. However, the q u e s t i o n of what correspondence e x i s t s between the s t r e s s concepts d e r i v e d l a r g e l y from pharmacolo-g i c a l and p h y s i o l o g i c a l r e s e a r c h , and the s t r e s s concepts developed Independently i n psychology, has yet to r e c e i v e much a t t e n t i o n . - 4 -5 The terms SJiJISLaM and a,nxie ty occur frequent l y i n the l i t e r a t u r e and although d i s t i n c t i o n s have been attempted, no u n i v e r s a l c o n v e n t i o n s c u r r e n t l y govern t h e i r use (Mason, 1975 )• Since i t seems p o s s i b l e to use these words i n t e i — changeably, a c r o s s a v a r i e t y of s i t u a t i o n s and with l i t t l e l o s s o f c l a r i t y , s t r e s s and anxiety w i l l be considered e q u i v a l e n t c o n s t r u c t s l n t h i s paper ( Bowman, 1977; S p l e l b e r -ger, 1966, 1975 ). In a h i s t o r i c a l review o f the s t r e s s f i e l d , Mason (1975) suggested t h a t : The s i n g l e most remarkable h i s t o r i c a l f a c t con-; c e r n i n g the term " s t r e s s " i s I t s p e r s i s t e n t , wide-spread usage i n b i o l o g y and medicine i n s p i t e of c h a o t i c disagreement over i t s d e f i n i t i o n , ( p.6) Some of t h i s c o n f u s i o n i s due to the various f o r m u l a t i o n s of the s t r e s s concept. Three main types i d e n t i f i e d by Holroyd (1979) are* (1) a demand or s t i m u l i , that i s , a c l a s s of en-vironmental events t h a t impose unusual demands upon the i n -d i v i d u a l (e.g., Holmes S Rahe, 1967), (2) a response to such demands (e.g., S e l y e , 1956), and (3) a type of t r a n s a c t i o n with the environment ( e . g . , Lazarus, 1966, 1980). Each of these f o r m u l a t i o n s suggests d i s t i n c t research and approaches to the study of s t r e s s . In the t r a d i t i o n a l approach adopted here, s t r e s s i s not d e f i n e d s o l e l y by the adapt i v e demands c o n f r o n t i n g an i n d i -v i d u a l , or in terms of the i n d i v i d u a l ' s response to those demands, but by both f a c t o r s i n c l u d i n g the c o g n i t i v e pro-cesses mediating them. Sfj[£ss i s d e f i n e d here as a hypo-t h e t i c a l s t a t e of I m b a l a n c e between e n v i r o n m e n t a l demands and t h e r e s p o n s e c a p a b i l i t i e s of t h e p e r s o n o r s y s t e m t o cope w i t h t h e s e demands ( M c G r a t h , 1970; M e c h a n i c , 1968 ). St r e s s rjaflfi-t-ifiaS a r e t h e a d v e r s e h e a l t h and b e h a v i o r a l c o n -s e q u e n c e s o f the f a i l u r e t o cope w i t h e n v i r o n m e n t a I demands. S t r e s s o r e a r e a v e r s i v e e v e n t s o r e l e m e n t s i n v a r i o u s e n v i -r o n m e n t a l f i e l d s t h a t d i s t u r b the e q u i l i b r i u m , i n t e r f e r e w i t h p e r f o r m a n c e , o r even t h r e a t e n s u r v i v a l . P s y c h o l o g i c a l p r o c e s s e s a r e assumed t o m e d i a t e the i m p a c t of e n v i r o n m e n t a l den-ands ( s t r e s s o r s ) and c o n s e q u e n t l y a f f e c t i n d i v i d u a l s i n a u n i q u e r a t h e r t h a n u n i f o r m manner ( Novaco, S t o k o l s , Camp-b e l l , S S t o k o l s , 1 9 7 9 ) . S t r e s s o r s may be d e s c r i b e d as a c u t e , c h r o n i c i n t e r m i t -t e n t o r c h r o n i c ( E u r c h f i e l d , , 1 9 7 9). An a c u t e s t r e s s o r i s any e v e n t which o c c u r s w i t h i n a g i v e n , u s u a l l y s h o r t , time p e r i -od and does not r e c u r f r e q u e n t l y , I f a t a l l . A c h r o n i c i n -t e r m i t t e n t s t r e s s o r i s a d i s c r e t e s t i m u l u s t o w h i c h t h e o r -g a n i s m i s r e p e a t e d l y e x p o s e d o v e r a g i v e n time p e r i o d , f o r a s p e c i f i e d amount o f t I m e — — u s u a l l y l e s s t han one h o u r . A c h r o n i c s t r e s s o r , " o n t h e o t h e r hand, I s a s t i m u l u s t o w h i c h t h e o r g a n i s m 13 c o n t i n u o u s l y e x p o s e d . C h r o n i c i n t e r m i t t e n t s t r e s s o r s a r e presumed t o be the t y p e o f s t r e s s o r s most f r e -q u e n t l y e n c o u n t e r e d and most l i k e l y t o c a u s e p h y s i o l o g i c a l c h a n g e s w h i c h p r e d i s p o s e an o r g a n i s m to t i s s u e damage ( l i u r c h f i e l d , 1979 ). These d i s t i n c t i o n s a r e i m p o r t a n t s i n c e t h e c h a r a c t e r i s t i c s of s t r e s s o r s a f f e c t s u c h p r o c e s s e s as h a b i t u a t i o n and a d a p t a t i o n ( S k l a r S Anisman, 1981; Chattopa-dhyay, Cooke, Toone, S Lader, 1980). A .Mp.«te.A sX. MlHRSS The. model that guides t h i s study i s based on t h e o r i e s of p s y c h o l o g i c a l s t r e s s (Appley B Trumball, 1967; Lazarus, 1966, 1 980; Melchentaum & Jaremko, ir: press) which are i n -t e r a c t i o n i s t i n n a t u r e . The s t r e s s response can most ade-q u a t e l y be d e s c r i b e d as p a r t of a complex and dynamic system of t r a n s a c t i o n s between the person and the environment. Tn a d d i t i o n , i t i s assumed that environmental I n f l u e n c e s are mediated by c o g n i t i v e , p e r s o n a l i t y and s o c i a l - p s y c h o l o g i c a l f a c t o r s . It f o l l o w s that the e f f e c t s of a v e r s i v e events w i l l vary as a f u n c t i o n of i d e n t i f i a b l e p s y c h o l o g i c a l f a c -t o r s a s s o c i a t e d with how s t r e s s o r s are experienced. The model, presented in F i g u r e 1, i s adapted from a scheme of L i f e S t r e s s and I l l n e s s d e s c r i b e d by Ru he and Ar-thur (1978) and from a c o n c e p t u a l model of s t r e s s by Smith (1979). A s e r i e s of o p t i c a l l e n s e s and f i l t e r s r epresent important processes i n the s t r e s s syndrome. A s u b j e c t ' s ex-posure to e_n.yjr<irnnenta 1 <JeiJ!.a_ndj= i s i n d i c a t e d by a s e r i e s of " l i g h t rays" of d i f f e r e n t i n t e n s i t i e s which d i f f e r e n t i a t e s the s i g n i f i c a n c e of v a r i o u s demands. C ogn 11 iv q SS-^J^XLXsa. are represented as a f i l t e r capable of f o c u s i n g or b l o c k i n g the impact o f the demands. The p h y s i o l o g i c a l r e a c t i o n s rep-r e s e n t e d by wavy l i n e s emerging from the phv si, pi. Q E T I cftl XS.~ £J2S>M££. generator, cease to represent demands and. bea.in to r e p r e s e n t p h y s i o l o g i c a l responses. The £y_ejr^ t i£_hav.5i,Qr- gen-e r a t o r i s represented by a lense with d o t t e d l i n e s emerging, s y m b o l i z i n g v a r i o u s i n s t r u m e n t a l or overt b e h a v i o r s . A l -though not f u l l y diagrammed, t h i s c h a i n of events i s meant to be p o r t r a y e d as a dynamic sequence of interchanges, which are t r a n s a c t i o n a l over Time, with m u l t i p l e feedback and feedforward l o o p s . The f o l l o w i n g l i t e r a t u r e review presents s e l e c t e d rep-r e s e n t a t i v e s t u d i e s r e l a t e d to the four components of the model. Although not comprehensive, t h i s review attempts to provide e m p i r i c a l support f o r the model presented in F i g u r e 1-Esy.kr.nr.afnla! Dem&n.dg The s t i m u l i which c o n s t i t u t e the "demands" may be ex-t e r n a l or i n t e r n a l i n o r i g i n . For example, thoughts, memo-r i e s and images, as w e l l as a c t u a l f e a r f u l s i t u a t i o n s , may induce a s t r e s s response ( Smith, 1979). Environmental de-mands i n everyday s i t u a t i o n s are l i k e l y to be ambiguous and complex. I t has been found that previous experience wi+h st ressors'and the nature of the s t i m u l i ( e.g., acute, chron-i c ) a f f e c t the Impact of the demands ( R u r c h f i e l d , 1979; Ep-s t e i n , 1967 ; Orne , 1965). Recent evidence a l s o suggests that " d a l l y h a s s l e s " (Kanner, Coyne, Schaefer, 5 Lazarus, 1981) as w e l l as s o c i a l support (Coppel, 1980) a f f e c t the magnitude of the stress response. Due to learning, history or genetic c o n s t i t u t i o n , i t can be assumed that individuals d i f f e r in terms of the " r e l a t i v e functional importance of external and i n t e r n a l cues and their i n t e r a c t i o n " (Rorkovec, 1976, p. 264). Consequently, ind i v i d u a l s ' stress responses to the same or sim i l a r demands may vary considerably. £.9£Ed,tJLyjB A£±Ax±l JJ£g Novaco (1979) has proposed that the two basic classes of cognitive processes important to an analysis of psycho-l o g i c a l stress are appraisals and expectations. Although expectations could be considered a subset of the appraisal process, they w i l l be discussed separately here. Ap p r al s, al s, o In i t s broadest sense, appraisal refers to the psychological processes by which an event is assimilated into a cognitive structure ( i . e . , sets of ideas, be l i e f s and expectations ) and thus given meaning ( A v e r i l l , 1979, p. 367). To become a source of stress, an event must be ap-praised as p o t e n t i a l l y harmful to the individual. Smith (1979) considers the appraisal process as being the most im-portant element in the model as " i t creates the psychologi-cal r e a l i t y to which people respond" ( p. 266). Systematic work by Lazarus and his colleagues (Lazarus, 1966; Lazarus 8 Launler, 1978) demonstrated how subjects' appraisals or Interpretations of events produced d i f f e r i n g stress reactions when d i r e c t l y altered. Lazarus has made the d i s t i n c t i o n between "primary" and "secondary" appraisal. 10 In the stress response, primary appraisal refers "to the i n -dividual's assessment of a s i t u a t i o n as being dangerous, threatening, or benign whereas secondary appraisal refers to the appraisal of the coping resources available to the i n d i -v i d u a l . Given the information obtained by both these ap-p r a i s a l s , some sense of the overall threat i s determined, followed by any adjustment cr reappraisal of the s i t u a t i o n that i s required in l i g h t of the appraisal and the changing stimulus context. These appraisal processes are not seen as being completely independent in that what i s i n i t i a l l y judged as p o t e n t i a l l y s t r e s s f u l ln part depends on the i n d i -viduals coping s k i l l s (Lazarus S Launier, 1978 ). Appraisals may r e s u l t ln coping processes that are either d i r e c t act Ion (e.g., fighting, fleeing) or further cognitive a c t i v i t y . Lazarus has labeled these two coping mechanisms as p a l l i a -tive ( I.e., changing the emotional reactions through further cognitive a c t i v i t i e s ) or instrumental ( I.e., changing the s i t u a t i o n ) . Consequently, coping i s not only a reaction to stress, but also a shaper of the stress experience. Recent investigations of threat of shock ( Ko Imes B Houston, 1974 ), exposure to gory scenes ( Neufeld, 1975 ), v i -olent scenes (Geen, Stcnner, & K e l l y , 1974), and ego threat-ening si t u a t i o n s (Dobson S Neufeld, 1979) have extended La-zarus' work. For example, Rogers and Newborn ( 1976), In conducting a study on fear pertaining to disease and injury, found that the appraised severity cf the threatened event 11 and the b e l i e f of the e f f i c a c y of coping responses were the only s i g n i f i c a n t variables in predicting intentions to adopt recommended health p r a c t i c e s . In addition, Dobson and Nf eu-f e l d ( 1 9 7 9 ) found that for both high and low t r a i t anxious subjects, the appraisal of the anticipated degree of stress best predicted the ratings of pos t— stimulus stress in an ego-threatening task. While i t appears that both primary and secondary ap-p r a i s a l s do occur, t h e i r Independence and the degree to which a l t e r i n g one mitigates the other i s not yet c l e a r . Furthermore, only recently have investigators examined the extent to which people u t i l i z e p a l l i a t i v e and/or instrumen-t a l coping (Folkman S Lazarus, 1980; Pearlln & Schooler, 1 9 7 8 ) . Preliminary evidence suggests that the two responses usually co-exist, however, the context and how the event is appraised seem to be the most Important influences (Folkman 6 Lazarus, 1 9 8 0 ) . £ xnSF..f.9i B£i; • According to Novaco ( 1 9 7 9 ) expectations have been researched under a number of rubrics and variously labeled cognitive a c t i v i t i e s (e.g., locus of control, pre-d i c t a b i l i t y , learned helplessness, perceived c o n t r o l ) . No-vaco suggests that "contro labi l l t y manipulations can be viewed as having influenced an expectancy for personal e f f i -cacy. ..the essence being some subjective p r o b a b i l i t y about events and ones responses to them" ( p. 2 4 9 ) . 12 The n o t i o n of p e r c e i v e d c o n t r o l or m a s t e r y has r e c e n t l y p r o v i d e d t h e b a s i s f o r B a n d u r a ' s (1977) s e l f - e f f i c a c y t h e o -r y . G o l d f r i e d and P o b i n s ( i n p r e s s ) s u g g e s t t h a t s e l f — e f f i -c a c y t h e o r y i s b r o a d e r i n s c c p e and a p p l i c a b i l i t y t h a n p r e -v i o u s c o n c e p t u a l i z a t i o n s . B a n d u r a * s p r i m a r y e m p h a s i s i s on e f f i c a c y e x p e c t a n c i e s , w h i c h a r e b e l i e v e d t o d e t e r m i n e the i n i t i a t i o n and d e g r e e o f p e r s i s t e n c e o f c o p i n g . I n a d d i -t i o n , Bandura d i s t i n g u i s h e s between outcome e x p e c t a n c i e s , d e f i n e d a s "a p e r s o n ' s e s t i m a t e t h a t a g i v e n b e h a v i o r w i l l l e a d t o c e r t a i n outcomes" a n d e f f i c a c y e x p e c t a n c i e s , d e f i n e d a s " t h e c o n v i c t i o n t h a t one can s u c c e s s f u l l y e x e c u t e t h e be-h a v i o r r e q u i r e d t o p r o d u c e t h e outcomes." The d i m e n s i o n s on w h i c h e f f i c a c y e x p e c t a n c i e s m a y v a r y a r e ncagni t u d e , g e n e r a l -i t y , and s t r e n g t h . The v a r i c u s s o u r c e s o f e f f i c a c y e x p e c t a -t i o n s a r e p e r f o r m a n c e a c c o m p l i s h m e n t s , v i c a r i o u s e x p e r i e n c e , v e r b a l p e r s u a s i o n and e m o t i o r a l a r o t i s a l . A c c o r d i n g t o Ban-d u r a , p e r f o r m a n c e a c c o m p l i s h m e n t s a r e the most d e p e n d a b l e a n d t h e r e f o r e the most i n f l u e n t i a l . S e l f - e f f i c a c y T h e o r y has n o t been w i t h o u t I t s c r i t i -q u e s — as e v i d e n c e d i n a s p e c i a l i s s u e of Advanc es J..n, fifiilJLv— JL°.-E E£_seajrcj2 a._n_d, JJ£i e^rajav. • ( 1 978 ) which f o c u s e d on s e l f - e f f i -c a c y t h e o r y . I t was a r g u e d t h a t s e l f - e f f i c a c y e x p e c t a n c y i n no way r e f l e c t s c a u s a l mechanisms b u t i s a s i m n l e nhenomena t h a t o n l y r e f l e c t s b e h a v i o r change ( B o r k o v e c , 1978; E y s e n c k , 1978 ). However, Bandura and Adairs ( 1977 ) f o u n d t h a t e x p o -s u r e a l o n e c a n n o t p r e d i c t p e r f o r m a n c e n e a r l y as w e l l as ex-13 p e c t a n c i e s . E m p i r i c a l support has begun to appear to v a l i -date Bandura's c o n t e n t i o n s . Although e a r l i e r r esearch t e s t -i n g the theory's p r e d i c t i o n s focused on phobics I Bandura S Adams, 1977; Bandura, Adams, 8 Beyer, 1977 ), research has s i n c e expanded to other areas such as a ss e r t i ven ess (Kazdin, 1979), smoking c e s s a t i o n ( C o n d i o t t e & L ic htens te i n, 1981; DiCleraente, 1981), p h y s i c a l stamina (Weinberg;, Gould, S Jackson, 1979 ), and d i v i n g performance ( F e l t z , i n p r e s s ) . There i s some evidence t h a t i n d i v i d u a l d i f f e r e n c e v a r i a b l e s are r e l a t e d to changes in s e l f - e f f i c a c y (Chambliss £ Murray, 1979). In a d d i t i o n , moderate p o s i t i v e c o r r e l a t i o n s have been found between s e l f — e f f i c a c y and f u t u r e performance ( B a r r i o s , 1980; Condiotte S L i c h t e n s t e i n , 1981; Kendrlck, 1979). I t appears that e f f i c a c y expectancies are thought to I n f l u e n c e how i n d i v i d u a l s w i l l behave, as w e l l as i n f l u e n c -i n g c o g n i t i v e and emotional r e a c t i o n s ( G c l d f r i e d H- Robins, i n press ). Bandura ( 1977 ) suggests that the a c t i v e compo-nent of many t r a d i t i o n a l and n o n t r a d i t i o r a I treatments for a n x i e t y i s the degree to which the treatment enhances the person's b e l i e f that he or she can perform a c t i o n s which w i l l r e s u l t i n p e r s o n a l l y b e n e f i c i a l outcomes. However, i t has yet to be determined which sources of e f f i c a c y expecta-t i o n s have the g r e a t e r impact f o r which problem and to what extent and under what c 1 rcuirs t a nces , e f f i c a c y e x p e c t a t i o n s g e n e r a l i z e to other areas of f u n c t i o n i n g . 14 E h x s , ! Q . I P ^ A E A ! £«e&£*JLsjas Mason { 1975 ) and Lacey ( 1967 ) suggest that a s t r e s s r e -sponse which Is p r i m a r i l y b i o l o g i c a l l y determined, such as the f i g h t or f l i g h t r e a c t i o n or the general a d a p t a t i o n syn-drome (Cannon, 1936; S e l y e , 1956), inadequately e x p l a i n s ' the s t r e s s response* An a l t e r n a t e hypothesis that the p a t -t e r n i n g of p h y s i o l o g i c a l s t r e s s responses i s dependent upon the environment (Mason, 1975) and c o g n i t i v e mediation ( L a z a -rus, 1980) has gained e m p i r i c a l support and v a l i d a t i o n * S t u d i e s by O b r i s t (1976) and L i g h t (1981) suggest that s p e c i f i c p a t t e r n s of coping may be a s s o c i a t e d with i d e n t i f i -able p a t t e r n s o f p h y s i o l o g i c a l responses. For example, dur-ing p a s s i v e coping, which cccurs during c l a s s i c a l a v e r s i v e c o n d i t i o n i n g , the heart appears to be under vagal c o n t r o l , while blood pressure i s dominated by v a s c u l a r processes. However, d u r i n g a c t i v e coping, such as c c c u r s d u r i n g shock avoidance, the heart appears to be under sympathetic c o n t r o l and c a r d i a c I n f l u e n c e s on fclood p r essure become dominant. Lacey ( 1967) has a l s o reviewed evidence i n d i c a t i n g that the p a t t e r n i n g of autonomic nervous system responses may r e f l e c t both c o g n i t i v e coping a c t i v i t y and a r c u s a l . Thus, as H o l -ro yd ( 1 879) suggests "aut on err i c responses to s t r e s s are, to some extent, p a t t e r n e d In accordance with the demands con-f r o n t i n g the organism and the coping responses that these demands generate" (p. 198). 15 Frarkenhaeuser" s ( 1981 ) work with i n d u s t r i a l employees has demonstrated that there are i n d i v i d u a l d i f f e r e n c e s with regard to the temporal p a t t e r n o f a d r e n a l medullary a c t i v i t y d u r i n g s t r e s s and recovery* suggesting that some i n d i v i d u a l s spend resources u n n e c e s s a r i l y . Tt was found that time f o r unwinding v a r i e d p r e d i c t a b l y with the i n d i v i d u a l ' s s t a t e of gene r a l w e l l - b e i n g . Recovery to p h y s i o l o g i c a l ( a d r e n a l i n ) b a s e l i n e was i n c r e a s e d a f t e r a v a c a t i o n p e r i o d which had im-proved the workers* p h y s i c a l and p s y c h o l o g i c a l w e l l - b e i n g . In a d d i t i o n * s t u d i e s by Frankenhaeuser (1976) and Weiss, G l a z e r , and Pohorecky ( 1976) have shown that the amount of c o n t r o l exerted over s t r e s s o r s - and the a v a i l a b i l i t y o f "cop-i n g responses" i n f l u e n c e catecholamine- responses to s t r e s s . Taken together, these s t u d i e s i n d i c a t e that the p h y s i o l o g i -c a l response to environmental demands i s i n f l u e n c e d by the coping resources a v a i l a b l e to the i n d i v i d u a l and i s mediated by the a p p r a i s a l p r o c e s s . From another p e r s p e c t i v e , s o c i a l p s y c h o l o g i c a l r e s e a r c h has shewn t h a t the s t r e n g t h and d i r e c t i o n of emotional r e -sponses depend not only on a person's a p p r a i s a l of a s i t u -a t i o n , but a l s o on t h e i r p e r c e p t i o n s of t h e i r p h y s i o l o g i c a l responding. In t h e i r well-known experiment, Schachter and Si n g e r (1962) found that s u b j e c t s who a t t r i b u t e d an a l t e r e d s t a t e of a r o u s a l to the e f f e c t o f a drug were l e s s l i k e l y to behave i n an emotional manner than s u b j e c t s who b e l i e v e d heightened a r o u s a l was the r e s u l t of a s o c i a l s i t u a t i o n . On 16 the b a s i s of such f i n d i n g s , Schachter concluded that I n d i -v i d u a l s who experience a s t a t e of p h y s i o l o g i c a l a r o u s a l for which there i s no Immediate e x p l a n a t i o n , w i l l l a b e l t h e i r s t a t e and d e s c r i b e t h e i r f e e l i n g s in terms of the c o g n i t i o n s a v a i l a b l e to them. While sonce support f o r Schachter's theo-ry has emerged (Erdmann S Jarke 1978; Gerdes, 1979; Schan-dry, 1981 ), o t h e r s have c r i t i c i z e d his f i n d i n g s ( M a r s h a l l 6 Zimardo, 1979). Present research supports a more moderate r e l a t i o n s h i p between p l i y s i o l c g i c a l a r o u s a l and emotions such as anxiety, f o r i t appears that p e r c e i v e d a r o u s a l i s more important than a c t u a l a r o u s a l (Gerdes, 1979; Schandry, 19 81 ). A v e r i l l (1979) noted that I nformation about p h y s i o l o g i -c a l r e a c t i o n s may change e x p e c t a t i o n s and, by p r o v i d i n g a normative frame o f r e f e r e n c e , may a l s o a l t e r the a p p r a i s a l of t h r e a t . Meichenbaum ( 1977) suggests that i t is not ar-ousal but what you t e l l y o u r s e l f about the a r o u s a l that Is important to the a p p r a i s a l process and subsequent coping. Recent s t u d i e s ( G l a z e s k i , Ho11 andsworth, S Jones, 1979; H o l -landsworth, G l a z e s k i , K i r k l a n d , Jones, & Van Norman, 1979) support the f i n d i n g that a r o u s a l can be f a c i l i t a t i v e at l e a s t i n t e s t - t a k i n g s i t u a t i o n s . Tt i s apparent that a complex i d i o s y n c r a t i c i n t e r a c t i o n occurs between p h y s i c a l , b e h a v i o r a l and c o g n i t i v e v a r i a b l e s . E o d i l y a r o u s a l Is oprt of the a d a p t a t i o n to a s i t u a t i o n that i s judged to r e q u i r e p r e p a r a t i o n f o r a n t i c i p a t e d b e h a v i o r a l 17 demands and p r o v i d e s feedback i n f o r m a t i o n that must be ap-p r a i s e d and r e a p p r a i s e d * Conversely, through the a p p r a i s a l process mis at t r 1 but i ons r e g a r d i n g b o d i l y a r o u s a l may occur. Thus, an i n t i m a t e r e c i p r o c a l . r e l a t i o n s h i p e x i s t s between c o g n i t i v e p r o c e s s e s and b o d i l y r e a c t i o n s (Murray 6 Jacobson, 1978 ). Lazarus (1980) c l a s s i f i e d anything one does (except c o g n i t i v e l y ) to handle s t r e s s f u l t r a n s a c t i o n s ( e . g . , a l t e r -ing the person-environment r e l a t i o n s h i p ) as i n s t r u m e n t a l or a c t i v e coping. T h i s may i n c l u d e such a c t i o n s as e x p r e s s i n g anger, f l e e i n g , committing s u i c i d e , problem—solving a c t i v i -t i e s and p h y s i c a l e x e r c i s e . S u r p r i s i n g l y l i t t l e r e s e a r c h has been done on how behavior per se a f f e c t s the s t r e s s r e -sponse. Gal and Lazarus {1975) reviewed s t u d i e s comparing s t r e s s r e a c t i o n s d u r i n g which persons c c u l d o r c o u l d not take a c t i o n . They concluded that the adaptive p o t e n t i a l of a c t i v i t y Included the sense of mastery and c o n t r o l p r o v i d e d by a c t i v i t y , a c t i v i t y as a means of a t t e n t i o n d i v e r s i o n , and a c t i v i t y as a means of d i s c h a r g i n g energy generated by mobi-l i z a t i o n . Gal and Lazarus ' review, and the r e c o u n t i n g of wartime o b s e r v a t i o n s by Pachnan (197S), support the no t i o n that a c t i v i t y , whether r e l a t e d to danger or not, reduced f e a r . Consequently, i n s t r u m e n t a l responses which include task o r i e n t e d , s o c i a l , end coping behaviors are assumed to 18 be a f f e c t e d by, and a f f e c t , c o g n i t i v e and p h y s i o l o g i c a l pro-cesses (Smith, 1979). The purpose of p r o v i d i n g a model of s t r e s s is to a i d i n c o n c e p t u a l i z i n g the s t r e s s response by i n t e g r a t i n g s e l e c t i v e l i t e r a t u r e on s t r e s s and coping. From t h i s review, i t ap-pears that the most important component of the s t r e s s r e -sponse i s the c o g n i t i v e p r o c e s s e s represented i n t h i s model as " f i l t e r s " • However, i t Is a l s o apparent the c o g n i t i v e a c t i v i t i e s are shaped and i n f l u e n c e d by the other compo-nents • The model of s t r e s s presented here i l l u m i n a t e s s e v e r a l s p e c i f i c p o i n t s of p o t e n t i a l i n t e r v e n t i o n in the s t r e s s cy-c l e . Figure 2 s c h e m a t i c a l l y p r e s e n t s i n t e r v e n t i o n s which may a f f e c t the Impact of v a r i o u s environmental demands. Any one of the four elements ( e cv i r onmen t a l demands, c o g n i t i v e a c t i v i t y , p h y s i o l o g i c a l responses, overt behaviors) may be a t a r g e t f o r i n t e r v e n t i o n . A s s e s s i n g and a l t e r i n g , s t r e s s - p r o d u c i n g aspects of the environment may Include such s t r a t e g i e s as t r a i n i n g i n d e c i -sion-making, a s s e r t i v e n e s s and problem—soIvlng. C l i e n t s may need help i n d e c i d i n g how and when to attack environmental demands. A number of s t r a t e g i e s that enable c l i e n t s to In-f l u e n c e t h e i r s o c i a l environments may minimize the s t r e s s -f u l n e s s of r e l a t i o n s h i p s . Important self-management s k i l l s (Krumbo I t * S T h o r e s e n , 1976; Mahoney f> T h o r e s e n , 1974 ) I n -v o l v e i n d i v i d u a l s l e a r n i n g t o I n f l u e n c e the e n v i r o n m e n t , and a l t e r unwanted b e h a v i o r . Foor tlme-manaeement s k i l l s and poor h e a l t h h a b i t s c a n a l s o be m o d i f i e d s y s t e m a t i c a l l y . O t h e r a c t i o n s i n c l u d e j o i n i n g s u p p o r t g r o u p s or, p e r h a p s the most e l e m e n t a l a c t i o n , a v o i d i n g o r l e a v i n g t h e s i t u a t i o n . P h y s i o l o g i c a l a r o u s a l can be m o d i f i e d i n a number of ways i n c l u d i n g v a r i o u s m e d i t a t i v e t e c h n i q u e s ( B e n s o n , 1975 ). M u s c l e r e l a x a t i o n and p h y s i c a l e x e r c i s e can a l s o r e d u c e mus-c u l a r t e n s i o n (DeV.rl.es. 1 9 6 8 ) . A d d i t i o n a l p h y s i o l o g i c a l r e -a c t i o n s t o s t r e s s t h a t a r e m o d i f i e d by e n d u r a n c e t r a i n i n g s u c h as j o g g i n g a r e r e v i e w e d by E l i o t ( 1974 ). J a c o b s o n ' s ( 1938 ) p r o g r e s s i v e m u s c l e r e l a x a t i o n a p p r o a c h p r o d u c e s r e -l a x a t i o n by e m p h a s i z i n g c o n t r a c t i o n and r e l a x a t i o n o f t h e s k e l e t a l m u s c l e s . B i o f e e d b a c k can a l s o a i d i n the l e a r n i n g i o f a r e l a x a t i o n r e s p o n s e and can p r o v i d e s u p p l e m e n t a r y c u e s e n a b l i n g the i n d i v i d u a l t o r e e s t a b l i s h c o n t a c t w i t h i n t e r n a l p r o c e s s e s ( S c h w a r t z , 1 9 7 7 ) . F u r t h e r m o r e , some methods s u c h as a u t o g e n i c t r a i n i n g ( S c h u l t z S L u t h e , 1S60) f o c u s on r e s -p i r a t i o n a n t ) s e n s a t i o n s . E x p e c t a t i o n s and a p p r a i s a l s a r e c o g n i t i v e f a c t o r s t h o u g h t t o be g i v e n r e p r e s e n t a t i o n i n l a n g u a g e form t h r o u g h t h e p e r s o n ' s p r i v a t e s p e e c h . Thus, i n t e r n a l s e n t e n c e s o r s e l f - s t a t e m e n t s a r e t h o u g h t to r e f l e c t e x p e c t a t i o n s and ap-p r a i s a l s . P r i v a t e s p e e c h a s s e l f - s t i m u l a t i o n i s presumed t o b o t h e l i c i t a n d s u s t a i n t h e s t r e s s r e s p o n s e ( Meichenbaum, 20 1977). Various c o g n i t i v e o r i e n t e d t h e r a p i e s , such as Cogni-t i v e R e s t r u c t u r i n g ( G o l d f r i e d , 1979), Self-statement M o d i f i -c a t i o n (Meichenbaum, 1977), F a t i o n a l Emotive Therapy ( E l l i s , 1973 ), and others are aimed at modifying inner d i a l o g u e and b e l i e f s . These approaches nay a l t e r c o g n i t i v e media t l o n a l responses by i d e n t i f y i n g unproductive mental p a t t e r n s and encouraging more r e a l i t y-ba s ed p e r s p e c t i v e s . I n d i v i d u a l s can d i s c o v e r , c h a l l e n g e and change unproductive s e l f — s t a t e -ments. I n t e r e s t i n g l y , a common p a t t e r n of " n e g a t i v e s e l l — r e f e r e n t I d e a t i o n " has emerged from many s t u d i e s , , across many p o p u l a t i o n s and with many assessment d e v i c e s . The pat-t e r n has the f o l l c w i n g c h a r a c t e r i s t i c s ( Meichenbaum &. But-l e r , 1979, p. 3 4 ) : 1. Worrying about one's performance i n c l u d i n g how w e l l others are doing compared to o n e s e l f . 2. Ruminating too lone and f r u i t l e s s l y over a l t e r n a t i v e responses. 3. Eeing p r e o c c u p i e d with b o d i l y r e a c t i o n s a s s o c i a t e d with a r o u s a l . 4. Ruminating about p o s s i b l e consequences of doing poor-l y i n the task or s i t u a t i o n ; overconcern with s o c i a l d i s a p p r o v a l , l o s s of s t a t u s or esteem, punishment, or damage to one's s e l f - c o n c e p t . 5. Thoughts and f e e l i n g s of inadequacy, i n c l u d i n g a c t i v e s e l f - c r i t i c i s m or self-condemnation, c o n s i d e r i n g one-s e l f as w o r t h l e s s . 21 T h i s common p a t t e r n nay provide a focus f c r treatment s t r a t -egies employed and t h e i r v a r i o u s components. In summary, s t r e s s i s a m u l t i d i n e n s l o n a l concept that i n v o l v e s complex sequences of environmental and b o d i l y events mediated by c o g n i t i v e a p p r a i s a l s of the s i t u a t i o n s , the person's a b i l i t y to cope »ith the s i t u a t 1 o n , and f e e d -back or feedforward from p h y s i o l o g i c a l a r o u s a l * D e s p i t e t h i s mutual i n t e r a c t i o n , there i s c o n s i d e r a b l e autonomy among the v a r i o u s k i n d s of coping responses, so that each can be manipulated or i n f l u e n c e d se rv 1— i ndepende n t l y of the others. Importantly, t h e r a p i s t s should not a u t o m a t i c a l l y s e l e c t c o g n i t i v e therapy as a treatment of c h o i c e . Of the i n t e r v e n t i o n s t hat emerge frcrr t h i s model, two c o n t r a s t i n g treatment packages f o r a n x i e t y r e d u c t i o n , se If ,-sta tement m o d i f i c a t i o n and endurance t r a i n i n g , are seen as v i a b l e a l -t e r n a t i v e s as they c o n t a i n many of the a c t i v e i n g r e d i e n t s i d e n t i f i e d i n the model d i s c u s s e d above. To date, compara-t i v e outcome r e s e a r c h and r e s e a r c h on t h e i r d i f f e r e n t i a l e f -f e c t i v e n e s s has not been attempted. l3Z££±S&£jaS£ I n t e r e s t i n t r a i n i n g programs designed to help i n d i v i d -u a l s acquire coping responses stem from d i v e r s e t r e n d s ln psychotherapy, i n c l u d i n g concerns f o r s e l l - c c n t r o l and cog-n i t i v e processes, d i s s a t i s f a c t i o n with t r a d i t i o n a l behavior therapy approaches and renewed i n t e r e s t in p r e v e n t i o n ( B a r -r i o s S Shigetomi, 1 P 7 9 ) . In the treatment of anxiety the c l a s s i c a l S — R mortel has been the most i n f l u e n t i a l ( L i c k F, K a t k i n , 1976). Systematic desens 1 t i z a t i on (Wolpe, 1958), Implosive therapy ( S t a m p f l & L e v i s , 1967), f l o o d i n g (Watson, Galnd, & Marks, 1972), grad-uated p r a c t i c e ( L e l t e n b e r g S C a l l a h a n , 1973), and graded ex-posure ( D ' Z u r l l l a , Wilson, 6 Nelson, 1973) are some of the t h e r a p e u t i c approaches developed from t h i s model. More re-c e n t l y , a c o g n i t i v e — m e d i a t i c n a l model has become the focus of treatment i n t e r v e n t i o n s f o r a n x i e t y (Lazarus, 1966; Mei-chenbaum, 1977). The major t h e r a p e u t i c techniques developed from t h i s model i n c l u d e thought—stopping (Rlmm, 1973; Wolpe, 1969 ), r a t i o n a l emotive therapy ( E l l i s , 1 S73; C o l d f r i e d , D e-centeceo, S Weinberg, 1974) and s t r e s s i n o c u l a t i o n (Melchen-baum, 1977 ). In a review of coping s k i l l s t r a i n i n g f o r anx-i e t y , E a r r i o s and Shigetomi (197S) suggest that the d i s s a t i s f a c t i o n with t r a d i t i o n a l approaches stemmed from the f o l l o w i n g concerns; ( a ) some c l i e n t s are unable to maintain v i v i d imagery, (b) e x c e s s i v e amounts of t h e r a p i s t time are r e q u i r e d , (c.) l i t t l e gen e r a l i z abl 1 i t y to nontargeted behav-i o r s occurs, and (d) there i s l i m i t e d a p p l i c a b i l i t y for m u l t i p l e a n x i e t y r e a c t i o n s ( p . 492). A recent review by Murray and Jacobson ( 1 978 ) on the new "c oen 11 i v e—lea rn i ng oe r spec 11 ve " i n d i c a t e s both a recog-n i t i o n and an attempt a t i n t e g r a t i n g c o g n i t i v e processes with emotion, p e r s o n a l i t y and s o c i a l i n t e r a c t i o n . The re-s u l t has been the acceptance of c o g n i t i v e processes as l e -23 gitimate investigative targets and c l i n i c a l l y relevant v a r i -ables i n outcome research ( Moloney S Kazdin, 1979). The concern for s e l f — c c n t r o I , one of the most exten-s i v e l y investigated areas i n behavioral therapy, i s based on the premise that people can direct t h e i r behavior toward valued goals by arranging the environmental conditions most l i k e l y to e l i c i t the desired behavior and by creating cogni-tive aids and s e l f — r e i n f o r e ine consequences to sustain the behavior (Bandura, 1977 ). Interest i n s e l f - c o n t r o l has been advanced by two different lir.es of research; a "conceptual" (Kanfer, 1980 ), and an "applied" l i n e (Goldfried S 3 old-f r i e d , 1980 ). The conceptual approach i s characterized by constructing a t h e o r e t i c a l model of the s e l f — c o n t r o l process followed by laboratory research to test the v a l i d i t y of the proposed model. In the applied approach to s e l f - c o n t r o l i t is assumed that c l i e n t s can be taught s p e c i f i c s k i l l s (e.g., seIf- r e l a x a t i o n , problem solving, s e l f - i n s t r u c t i o n ) that w i l l enable them to cope more e f f e c t i v e l y with future s t r e s s f u l l i f e events. Thus s e l f — c o n t r o l programs are aimed at in s t r u c t i n g the individual i n generalizable methods for reducing anxiety. Xr.«al«ieni Racjcftijen Kazdin and Wilson (1978) have suggested that a f t e r a treatment i s well developed, i t is e s p e c i a l l y meaningful to raise questions about i t s ' efficacy r e l a t i v e to a viable a l -24 t e r n a t l v e , ( I.e., comparative r e s e a r c h ) . The comparison i s only important when each technique i s known to he e f f e c t i v e in some s p e c i f i c area and pr e s e n t s an a l t e r n a t i v e to an ex-i s t i n g treatment with s i m i l a r evidence. Comparative r e -search r e q u i r e s c o n t r a s t i n g w e l l - s p e c i f i e d treatments which minimize o v e r l a p p i n g components i n order to p r o v i d e t h e best p o s s i b l e experimental t e s t . A treatment package, a c c o r d i n g to Kazdin and Wilson, denotes that s e v e r a l components of the treatment may be d i s t i n g u i s h a b l e both on conceptual and op-e r a t i o n a l grounds. In a d d i t i o n , Jacobson and Baucom ( 1975) suggest that s i n c e m e t h o d o l o g i c a l l y sound placebo c o n d i t i o n s are d i f f i -c u l t to c r e a t e , comparisons of the treatment of i n t e r e s t could fce made with whatever other procedure appears t o be most promising f o r a p a r t i c u l a r problem behavior. O'Leary and Borkovec (1978) suggest that t h i s "standard" i n t e r v e n -t i o n c o u l d be e s t a b l i s h e d that would c o n t r o l f o r f a i t h in the therapy or t h e r a p i s t , Increased a t t e n t i o n to a problem, suggestion, and other n o n s p e c i f i c therapy f a c t o r s (p. 823). As lone as the treatments are equated f o r d u r a t i o n of con-t a c t time and other n o n s p e c i f i c v a r i a b l e s , and as long as independent assessment i n d i c a t e e q u i v a l e n t g e n e r a t i o n of ex-pectancy f o r improvement throughout treatment, such a design provi les c o n t r o l f o r some of the usual f a c t o r s addressed by a t t e n t i o n placebo c o n d i t i o n s . Of the SSM programs a v a i l a b l e , s t r e s s I n o c u l a t i o n i s a we l l e s t a b l i s h e d treatment package ( Meichenbaum, 19* 7 7 ; Mei — chenbaum G Jaremko, in p r e s s ) that has progressed to compo-nent a n a l y s i s r e s e a r c h (Glogower, Fretncuw, 8 McCroskey, 1978; Jaremko, 1979; Kendal l 8 K o r g e s k i , 1979). In t h i s r e-search i t w i l l be con s i d e r e d the standard i n t e r v e n t i o n from which a comparison with endurance t r a i n i n g w i l l be made. In a d d i t i o n , a w a i t i n g l i s t c o n t r o l w i l l assess the extent of improvement from: (a) n o n s p e c i f i c t h e r a p u t i c f a c t o r s occur-r i n g from the environment, ( t ) spontaneous remissions, ( c ) assessment procedures, and (d) the premise of treatment sometime i n the f u t u r e . A group treatment approach was chosen as much of the r e s e a r c h that demonstrates t t e e f f e c t i v e n e s s of these i n t e r -v e n t i o n s has been conducted w i t h i n a framework of group treatments ( H i l y e r 8 M i t c h e l l , 1979; Holrcyd, 1976; Meichen-baum, 1977 ). In a d d i t i o n , Meichenbaum ( 1977 ) has suggested that the group approach " g r e a t l y f a c i l i t a t e d treatment" (p. 258 ). In keeping with W i l k i n s (1S79) concern f o r d e f i n i t i o n and i l l u m i n a t i o n - of the common elements u s u a l l y c o n s i d e r e d " n o n s p e c i f i c s " , the f o l l o w i n g processes, common to a v a r i e t y of group " s e l f - h e l p " programs are i d e n t i f i e d . Levy (1977) i d e n t i f i e d 11 processes Inherent i n these groups end which bear a resemblance to change mechanism I d e n t i f i e d i n i n d 1 -v i s u a l psychotherapy • They Include four b e h a v i o r a l p r o c e s s -es: ( a ) s o c i a l reinforcement of egosyntonlc behavior and 26 e l i m i n a t i o n of problems; (b) t r a i n i n g , i r d o c t r i n a t i o n , sup-port f o r s e l f - c o n t r o l behaviors; ( c ) modeling of methods of changing and coping with s t r e s s ; and (d) an agenda and r a -t i o n a l e to change the s o c i a l environment* In a d d i t i o n , Levy-l i s t s seven c o g n i t i v e p r o c e s s e s : ( e) r a t i o n a l e f o r problems and d i s t r e s s and the group's uay of d e a l i n g with i t , demyst-l l i c a t i c n , and i n c r e a s i n g expectancy f o r change; ( f ) p r o v i -s i o n of normative and i n s t r u m e n t a l i n f o r m a t i o n ; (g) expan-s i o n of range of a l t e r n a t i v e p e r c e p t i o n s of member's problems and ways to change them; (h) enhancement of d i s -c r i m i n a t i v e a b i l i t i e s toward s t i m u l u s and event contingen-c i e s ; ( i ) support f o r change i n a t t i t u d e s toward s e l f , fce-h a v l o r and s o c i e t y ; ( j ) r e d u c t i o n or e l i m i n a t i o n of a sense of i s o l a t i o n or uniqueness r e g a r d i n g problems through s o c i a l comparisons and consensual v a l i d a t i o n ; and <k) development of s u b s t i t u t e c u l t u r e and s o c i a l systems i n which members can develop new d e f i n i t i o n s of I d e n t i t y and new norms on which to base s e l f - e s t e e m . A.S Levy found these processes present in a wide range of group treatments, i t i s assumed that they are a l s o present in the two group i n t e r v e n t i o n s compared h e r e — s t r e s s i n o c u l a t i o n and endurance t r a i n i n g . 3sJ.£-£.iS*fiH_e.jrjt ModlfJLc.aJtI.oji The m o d i f i c a t i o n of what c l i e n t s say to themselves ( s e l f - s t a f e m e n t s ) and b e l i e v e Is one of the fundamental c h a r a c t e r i s t i c s of what i s now c a l l e d co gn i t iv e—be hav i or 27 t h e r a p y (Meichennaum , 1977 ) . S e l f - s t a t e m e n t m o d i f i c a t i o n (SSM) i s b a s e d on t h e a s s u m p t i o n t h a t c l i e n t s ' a n x i e t i e s de-pend on t h e i r i n t e r p r e t a t i o n s o f s i t u a t i o n s . The common t r e a t m e n t components t h a t u n d e r l i e t h e many d i f f e r e n t c o g n i -t i v e - S S M programs I n c l u d e ( Meichenbaum, 1977 , p. 147 ) : ( a ) t e a c h i n g the c l i e n t the r o l e o f c o g n i t i o n s i n p r o d u c i n g t h e p r o b l e m , e.g., d e r o g a t o r y t h o u g h t s about the way the e n c o u n -t e r i s h a n d l e d ' ( b ) t r a i n i n g i n t h e s e l f - m o n i t o r i n g o f m a l a -d a p t i v e s e l f — s t a t e m e n t s and b e h a v i o r s ? ( c ) t r a i n i n g i n t h e f u n d a m e n t a l s o f p r o b l e m - s o l v i n g , e . g . , p r o b l e m d e f i n i t i o n , a n t i c i p a t i o n o f c o n s e q u e n c e s , e v a l u a t i n g f e e d b a c k ; ( d ) mod-e l i n g and r e h e a r s a l o f e f f e c t i v e s e l f - s t a t e m e n t s , a t t e n t i o n -f o c u s i n g s k i l l s a nd p o s i t i v e s e l f - e v a l u a t i o n ! ( e ) t r a i n i n g i n s p e c i f i c c o p i n g s k i l l s s u c h a s r e l a x a t i o n and a s s e r t i v e -n e s s ; and ( f ) Jja v i y j i b e h a v i o r a l a s s i g n m e n t s t h a t become i n -c r e a s i n g l y d e m a n d i n g . V i e w i n g t h e s t r e s s r e s p o n s e i n a manner s i m i l a r t o t h a t o f L a z a r u s ( 1 9 8 0 ) , t r e a t m e n t p r o c e d u r e s a r e " d e s i g n e d t o f a -c i l i t a t e a d a p t i v e a p p r a i s a l s , t o enha n c e t h e r e p e r t o i r e o f c o p i n g r e s p o n s e s and t o n u r t u r e the c l i e n t ' s c o n f i d e n c e i n and u t i l i z a t i o n of h i s o r h e r c o p i n g c a p a b i l i t i e s " O f e l c h e n -baum S Cameron, i n p r e s s , p . 6 ) . Melchenbaum and Cameron ( 1973 ) i n i t i a l l y f o r m a l i z e d s e l f - s t a t e m e n t m o d i f i c a t i o n i n t o a c o n i n g s k i l l s p ackage c a l l e d " s t r e s s i n o c u l a t i o n " (ST ). SI was o r i g i n a l l y c o n c e i v e d as h a v i n g w e l l s p e c i f i e d t r e a t m e n t c o m p o n e n t s . i n c l u d i n g an e d u c a t i o n a l phase, a s k i l l phase and a r e h e a r s a l phase* However* mere r e c e n t l y , Mei-chenbaum and Cameron ( In press) have d e s c r i b e d SI t r a i n i n g as a " g e n e r i c term r e f e r r i n g to a general treatment p a r a -digm"* S i m i l a r SSM t h e r a p i e s , v a r i o u s l y known as " c o g n i -t i v e - b e h a v i o r m o d i f i c a t i o n " , " s e l f - s t a t e m e n t m o d i f i c a t i o n " , " r a t i o n a l r e s t r u c t u r i n g " , and " c o g n i t i v e r e s t r u c t u r i n g " ! w i l l be c o n s i d e r e d i n the f o l l o w i n g review as well as t r e a t -ments s p e c i f i c a l l y l a b e l e d s t r e s s i n o c u l a t i o n * SSM has been used s u c c e s s f u l l y f o r a widening range of problems, f o r example, the management of pain (Horan, Hack— e t t , Buchanan, Stone, S Derochik—Stone, 1S77), multiphohlas (Meichenbaum & Cameron, 1973), anger ( Novaco, 1975 ), t e s t a n x i e t y (Hussian S Lawrence, 1878), speech anxiety (Jaremko G Walker, 1978 ), and i n t e r p e r s o n a l a n x i e t y ( G l a s s , CJottman, S Shmurak, 1976), to name a few. For more d e t a i l e d d i s c u s -sions of the s t r e s s - i n o c u l a t i o n paradigm, the reader is r e -f e r r e d to Meichenbaum (1977), Meichenbaum and Jaremko ( i n p r e s s ) , and Turk, Meichenbaum, and Genest (1982). In a d d i -t i o n ,-psychotherapy treatment and t r a i n i n g t e x t s now common-l y i n c l u d e d e t a i l e d procedures f cr l i r p l e nenti ng SI t r a i n i n g and therapy ( e . g . , Cormier S Cornrier, 197S). Syijgojne ges.£.air.cji • I n i t i a l l y , most outcome resea r c h was of the "Grand P r i x " v a r i e t y ( G l a s s & Smith, 1976) i n which i n v e s t i g a t o r s p i t some form of SSM against a b e h a v i o r a l ap-proach such as r e l a x a t i o n , s y s t e m a t i c d e s e n s l t i z a t l o n or s k i l l t r a i n i n g . At present, SSM procedures have mcst exten-29 s l v e l y been a p p l i e d to the management of anxiety or f e a r that i s aroused by r e l a t i v e l y w e l l d e f i n e d t h r e a t e n i n g s i t u -a t i o n s . Current evidence suggests that SSM procedures are e f f e c t i v e i n t e a c h i n g i n d i v i d u a l s to manage a v a r i e t y of s i t u a t i o n a l s t r e s s o r s . Presented i n Appendix 1 Is a t a b u l a t e d summary of the g e n e r a l f i n d i n g s of s e l e c t e d SSM outcome s t u d i e s which f a -c i l i t a t e c r o s s — s t u d y comparisons. The review i s l i m i t e d to Test Anxiety, Speech A n x i e t y , I n t e r p e r s o n a l Anxiety, M u l t i -p l e A n x i e t i e s , and a few recent s t u d i e s t a r g e t i n g a d d i t i o n a l r e l e v a n t areas. The summary i n d i c a t e s the success of t r e a t -ment and r e v e a l s the ire t hod c I og i c a l adequacy of the study. A number of c a t e g o r i e s Included i n t h i s t a b u l a t i o n require d e f i n i t i o n . Under the heading C o n d i t i o n s Compared, mainly primary techniques are l i s t e d , minor p r o c e d u r a l v a r i a t i o n s may not be l i s t e d . Under the heading of Outcome, the e f f e c -t i v e n e s s of t h e r a p e u t i c c o n d i t i o n ( s ) was f r e q u e n t l y d i f f i -c u l t to present s i n c e m u l t i p l e dependent measures r e v e a l e d a v a r i e d p a t t e r n of outcome r e s u l t s . Therefore, when c o n f u -sion was paramount the r e s u l t s at follow-up are presented. One e x c e p t i o n to t h i s case i s when p h y s i o l o g i c a l changes d i s c r i m i n a t e d between groups at p o s t t e s t i n g s i n c e t h i s was such an unusual f i n d i n g . The major cha.nneK s) that d i f f e r -e n t i a t e d groups on outcome measures i s also i n d i c a t e d (*). A c e r t a i n degree of s u b j e c t i v e b i a s was i n c u r r e d in determi-nation of the outcomes and i s acknowledged. Under the head-30 i n ? o f G e n e r a l i z a t l o n , a n y a t t e m p t s a t g e n e r a l i z a t i o n t o n o n t a r e e t e d b e h a v i o r s a l o n g w i t h t h e d i s c r i m i n a t e d g r o u p i s n o t e d . U n d e r t h e h e a d i n g o f D e p e n d e n t M e a s u r e s , o n l y t h e c h a n n e l s a s s e s s e d a r e r e p o r t e d b e c a u s e o f t h e l a r g e n u m b e r o f d e p e n d e n t v a r i a b l e s e m p l o y e d I n some o f t h e s t u d i e s . The d a t a a r e g r o u p e d a l p h a b e t i c a l l y a c c o r d i n g t o t a r g e t a r e a . §ii£JBS3EX» Of t h e s t u d i e s i d e n t i f i e d , t h e m o s t f r e q u e n t -l y s t u d i e d a n d m o s t c a r e f u l l y c o n t r o l l e d t a r g e t w a s t e s t a n x i e t y . T a k e n t o g e t h e r , t h e r e s u l t s o f t h e s e s t u d i e s s u g -g e s t t h a t p r o v i d i n g s u b j e c t s w i t h a c o p i n g ( i • e. , l e a r n i n g a p r o c e d u r e f o r a c t i v e l y a n d i n d e p e n d e n t l y r e d u c i n g t h e i r a n x -i e t y ) , c o m p a r e d t o a p a s s i v e f r a m e w o r k , i s c r i t i c a l f o r t r e a t m e n t s u c c e s s . C o n s e q u e n t l y , a c o m b i n e d t h e r a p y ( S S M + S D ) f o r t e s t a n x i e t y h a s b e e n f o u n d t o be no m o r e e f -f e c t i v e t h a n e i t h e r o f t h e t w o c o m p o n e n t s when t h e y a r e o f -f e r e d f r o m a c o p i n a p e r s p e c t i v e ( G o l d f r i e d , 1 9 7 9 ) . W h e t h e r SSM i s m o r e e f f e c t i v e t h a n ST) f c r s p e e c h a n x i e t y r e m a i n s an o p e n q u e s t i o n . H o w e v e r , i t a p p e a r s t h a t t h e m o r e g e n e r a l i n t e r p e r s o n a l a n x i e t y c a n b e m o r e e f f e c t i v e l y r e d u c e d b y SSM t h a n b y SD. Few s t v i d i e s h a v e f o c u s e d o n l e s s s p e c i f i c a l l y t a r g e t e d o r m u l t i p l e a n x i e t i e s . T h e f e w t h a t h a v e ( B o w m a n , 1 9 7 7 ; W o o d w a r d S J o n e s , 1 9 8 C ; Y o r d e V W i t m e r , 1 9 8 0 ) r e p o r t s u b j e c t s w i t h t r a i t a n x i e t i e s t h a t a r e h i g h e r t h a n t h e u s u a l s u b j e c t s i n a n a l o g u e s t u d i e s . T h e m o s t e f f e c t i v e t r e a t m e n t f o r m u l t i p l e a n x i e t i e s a p p e a r s t o b e c o m b i n e d SSM a n d r e l a x -a t i o n f o r a m i n i m u m o f f o u r t o s e v e r , h o u r s o v e r s e v e r a l we ek s • 31 T h e r e s u l t s o f t h e m i s c e l l a n e o u s o u t c o m e s t u d i e s a r e r e p r e s e n t a t i v e o f c o n v e r g i n g d a t a a c r o s s t y p e s o f m e t h o d o l o -g i e s ( A n d e r s o n e t a l . , 1981; H u r l b u r t 6 S i p p r e l l e , 1978 ), t a r g e t e d a n x i e t i e s ( H o l r o y d S A n d r a s i k , 1978; K e n d r i c k , 1979; K l e p a c e t a l . , 1981) a n d p o p u l a t i o n s ( K i m , 1 9 8 0 ) . SSM a p p e a r s t o h a v e t h e g r e a t e r i m p a c t w h i l e t h e e f f e c t s o f v a r -i o u s f o r m s o f r e l a x a t i o n , s y s t e m a t i c d e s e n s i t l z a t i o n a n d s k i l l t r a i n i n g o n t r e a t m e n t o u t c o m e i s e q u i v o c a l . O v e r a l l , m o s t o f . t h e s t u d i e s u s e d b o t h b e h a v i o r a l a n d s e l f - r e p o r t m e a s u r e s o f a n x i e t y , w h i l e o n l y a f e w ( C o o l e y S S p i e g l e r , 1980; F r e m o u w £ Z i t t e r , 197S; H o l r o y d C A n d r a s i k , 1978; K a n t e r 6 G o l d f r i e d , 1979; K e n d r i c k , 1979; Y o r d e S W i t -me r , 1980) a t t e m p t e d t o a s s e s s t h e p h y s i o l o g i c a l c h a n n e l . I n con-pa r i s o n s b e t w e e n SSM t o n o - t r e a t m e n t , SSM was f o u n d t o be s u p e r i o r a l m o s t a l l t h e t i m e . H o w e v e r , s e v e r a l a t t e n t i o n p l a c e b o g r o u p s w e r e n o t s i g n i f i c a n t l y d i f f e r e n t t h a n t h e e x -p e r i m e n t a l t r e a t m e n t s o n o u t c o m e m e a s u r e s ( B o w m a n , 1977; H o l r o y d 6 A n d r a s i k , 1978; N y e - W a r r e n , 1979). T h e r e s u l t o f c o m p a r i s o n s b e t w e e n SSM a n d e t h e r t r e a t m e n t s s u c h as s y s t e m -a t i c d e s e n s i t l z a t i o n a n d p r o l o n g e d e x p o s u r e a r e m i x e d , a l -t h o u g h SSM i s s u p e r i o r f o r roost t r e a t m e n t s i n v o l v i n g h i g h l e v e I s o f a n x i e t y ( E l d e r e t a l . , 1 S S 1; F r emo uw £ Z i t t e r , 19 78 ). On b o t h s e l f — r e p o r t a n d b e h a v i o r a l m e a s u r e s , SSM i s s u -p e r i o r t o o t h e r t r e a t m e n t s i n a b o u t 6 1% o f c o m p a r i s o n s , a n d i n a b o u t 27% o f the? c o m p a r i s o n s t h e t r e a t m e n t s a r e n o t d i i -32 f e rent l a l l y e f f e c t i v e . Cf the s t u d i e s that examined gener-a l i z a t i o n o f e f f e c t s to ncn target a n x i e t i e s , about 18% f a i l e d to f i n d treatment e f f e c t s . In most of the f o l l o w - u p comparisons, u s u a l l y r e s t r i c t e d to s e l f - r e p o r t measures and taken anywhere from one to e i g h t months a f t e r treatment, s p e c i f i c treatments were found to be s u p e r i o r to c o n t r o l groups. The number of m e t h o d o l o g i c a l problems and i s s u e s appar-ent from t h i s review may account f o r many of the e q u i v o c a l f i n d i n g s . Perhaps, with the e x c e p t i o n of t e s t a n x i e t y In c o l l e g e students, there may be l i t t l e s i m i l a r i t y between r e -search s u b j e c t s and c l i n i c a l p a t i e n t s , l i m i t i n g the e x t e r n a l v a l i d i t y or g e n e r a l i z a b 1 I i t y of the research f i n d i n g s . The s t u d i e s c i t e d almost e x c l u s i v e l y c o n s i s t of c o l l e g e students ranging in age from 18 to 25 y e a r s . Evidence suggests that s t r e s s responses and coping a b i l i t i e s may well d i f f e r a c r o s s age and occupations ( Pearl In 8 Schooler, 1978; Folkman 8 La-zarus, 1980; Kobasa, Maddi, 8 Kahn, 19 82). More s e n s i t i v e dependent measures that adequately tap the s i t u a t i o n s and b e h a v i o r s of I n t e r e s t are necessary in order to determine treatment e f f i c a c y . Importantly, only a few s t u d i e s a sses se d c o g n i t i v e changes ( i . e . , s e l f - s t a t e -ments, b e l i e f s , s e l f - e f f i c a c y )« F r e q u e n t l y b e h a v i o r a l and p h y s i o l o g i c a l measures f a i l e d to d i f f e r e n t i a t e treatment ef-f e c t i v e n e s s . Rather than a "shotgun" approach to assessment there should be a w e l l e s t a b l i s h e d t h e o r e t i c a l r a t i o n a l e lor 33 e a c h a s s e s s m e n t d e v i c e . T h i s w o u l d r e q u i r e a b e t t e r u n d e r -s t a n d i n g o f t h e r e l a t i o n s h i p s b e t w e e n t h e p h y s l o l o g i c a l , b e -h a v i o r a l a n d c o g n i t i v e r e s p o n s e s t o s t r e s s a n d how t h e y i n -t e r a c t ( E u r c h f i e l d t 197.9; C r a b b s Q H o p p e r , 1980; M o r r o w S L a b r u m , 1978 ). M a n y s t u d i e s d i d n o t p r o v i d e a d e q u a t e a t t e n t i o n p l a c e b o g r o u p s a n d t h o s e t h a t d i d f o u n d some I m p o r t a n t c h a n g e s o c -c u r r i n g ( F r e m o u w S Z i t t e r , 1£78; G l o g o w e r e t a l . , 1978; H o l -r o y d S A n d r a s i k , 1978). F o r e x a m p l e , s p o n t a n e o u s c h a n g e s i n n e g a t i v e s e l f — s t a t e m e n t s h a v e b e e n f o u n d i n d i s c u s s i o n c o n -t r o l g r o u p s a n d i n some c a s e s t h e r e w a s no d i f f e r e n c e at f o l l o w — u p b e t w e e n t r e a t m e n t a n d a t t e n t i o n p l a c e b o g r o u p s . C o n s e q u e n t l y , t h e r e i s a n e e d t o d e v i s e a l t e r n a t i v e c o n d i -t i o n s w h i c h c o n t r o l f o r c r e d i b i l i t y a n d c l i e n t e x p e c t a t i o n s a s w e l l a s o t h e r n o n s p e c i f i c e f f e c t s ( N l s b e t t S W i l s o n , 1977 ; W i l k l n s , 1979 ). F u r t h e r m o r e , t h e I m p o r t a n t c o m p o n e n t s t h a t a r e i n h e r e n t i n g r o u p p r o c e s s n e e d t o b e a s s e s s e d . F o l l o w — u p p r o c e d u r e s v a r i e d I n t e r m s o f d e p e n d e n t m e a s -u r e s e m p l o y e d , l e n g t h o f t i m e , a n d a t t r i t i o n r a t e . C o n s e -q u e n t l y , t h e I m p o r t a n t i s s u e o f m a i n t e n a n c e o f t r e a t m e n t e f f e c t s h a s n o t b e e n a d e a u a t e l y a s s e s s e d . S i n c e f e w s t u d i e s t r e a t e d s u b j e c t s w i t h m u l t i p l e a n x i e t i e s , t h e g e n e r a l i z a t i o n o f c o p i n g s k i l l s t o n o n t a r p e t e d a n x i e t y p r o v o k i n g s i t u a t i o n s i s u n c e r t a i n . W h a t e v i d e n c e i s a v a i l a b l e s u g g e s t s t h a t SSM h a s a g r e a t e r t e n d e n c y t o g e n e r a l i z e t h a n o t h e r t r e a t m e n t s ( G o l d f r i e d e t a l . , 1978; H u s s i a n G L a w r e n c e , 1978; K a n t e r S 34 G o l d f r i e d , 1979). In a d d i t i o n . the i n t e r a c t i o n of s u b j e c t c h a r a c t e r i s t i c s and treatment components has r e c e i v e d t i t t l e a t t e n t i o n (Malkiewich S M e r l u z z i , 19fi0", Meichenbaum, G i l -more, S F e d o r v i c l u s , 1971). Research i s needed to i d e n t i f y c l i e n t — t r e a t m e n t i n t e r a c t i o n s that maximize success. Tt ap-pears that many of the c o n t r a d i c t o r y f i n d i n g s could l i k e l y be a t t r i b u t e d t o the lack of u n i f o r m i t y i n treatment proce-dures (Jaremko, 1979 ). To date, the c r i t i c a l treatment components of SI remain u n c l e a r . The r e s u l t s of component analyses have suggested that although the c o g n i t i v e component should be emphasized, the complete package i s s t i l l most e f f e c t i v e (Jaremko, 1979; Ke n d a l l 6 Korg e s k i , 1979). However, grea t e r understanding of the SI program w i l l r e s u l t from component analyses that c o n s i d e r process v a r i a b l e s rather than merely the presence or absence o f a component. Jter.p.iJJLc. fandiliJLfiiiJjifi P s y c h o t h e r a p i s t s u s u a l l y acknowledge the r o l e of b i o l o -g i c a l f a c t o r s i n the e t i o l o g y and maintenance of emotional d i s o r d e r s ( C a r k h u f f , 1972; Frank, 1973), yet few p r e s c r i b e e x e r c i s e as a primary mode of i n t e r v e n t i o n ( K. os t rubal a, 1976 ). In recent years a rumber of rese a r c h e r s have sug-gested that manipulations of p h y s i c a l f i t n e s s through a p h y s i c a l t r a i n i n g program can be used to change p s y c h o l o g i -c a l f u n c t i o n i n g In p r e d i c t a b l e d i r e c t i o n s ( e . g . , fl1 Iyer & 35 M i t c h e l l , 1979; I s m a i l 8 T r a c h t m a n , 19 73; L e d w i d g e , 1980; Y o u n g 8 I s m a i l , 1976). S e v e r a l c a s e s t u d i e s ( L i o n , 1978; M u l l e r 8 A r m s t r o n g , 1975; C r w i n , 1973,1974) a n d a n u m b e r o f e m p i r i c a l i n v e s t i g a t i o n s ( D r l s c o l l , 1 976; M o r g a n 8 H o r s t m a n , 1976; M o r g a n , R o b e r t s , 8 F e i n e r m a n , 1971 ) s u g g e s t t h a t v i g -o r o u s e x e r c i s e , g e n e r a l l y some f o r m o f r u n n i n g o r w a l k i n g , r e s u l t s i n s i g n i f i c a n t r e d u c t i o n s i n s e l f - r e p o r t e d a n x i e t y . H o w e v e r , t h e c a u s a l r e l a t i o n s h i p b e t w e e n e x e r c i s e a n d a n x i e -t y r e d u c t i o n h a s n o t y e t b e e n d e m o n s t r a t e d a n d m o s t o f t h e s t u d i e s h a v e b e e n u n c o n t r o l l e d o r c o n d u c t e d o n a n a l o g u e p o p -u l a t i o n s . M a n y t e n t a t i v e h y p o t h e s e s r e g a r d i n g e x e r c i s e a n d a n x i -e t y r e d u c t i o n h a v e b e e n s u g g e s t e d , i n c l u d i n g b o t h p h y s i o l o g -i c a l l y a n d p s y c h o l o g i c a l l y o r i e n t e d o n e s . S i n c e t h e s e h y -p o t h e s e s a r e o f t e n n o t m u t u a l l y e x c l u s i v e , r e s e a r c h m e t h o d o l o g i e s t h a t c o u l d s u p p o r t .theni d i f f e r e n t i a l l y h a v e b e e n d i f f i c u l t t o d e s i g n . P h y s l o l o G i c a l Jisjj.gf j t g • T h e p h y s i o l o g i c a l b e n e f i t s o f e x e r c i s e h a v e b e c o m e w i d e l y a c c e p t e d ( E l i o t , 1974; F o l k l n s 8 A m s t e r d a m , 1977) a n d a r e d o c u m e n t e d e l s e w h e r e ( A s t r a n d 8 R o d a h l , 1977). I n o r d e r t o r e d u c e t h e p h y s i o l o g i c a l l y h a r m -f u l e f f e c t s o f s t r e s s , f a v o u r a b l e a d j u s t m e n t s i n m a x i m a l o x -y g e n u p t a k e ; , m y o c a r d i a l and p e r i p h e r a l a d a p t a t i o n s , a n d b l o o d c h e m i s t r y a n d f i b r i n o l y t i c m e c h a n i s m s s h o u l d o c c u r ( E l i o t , F o r k e r , 8 R o b e r t s o n , 1976). T h e t y p e s o f e x e r c i s e b e s t s u i t e d f o r t h e p h y s i o l o g i c a l r e l i e f o f s t r e s s a r e t h o s e t h a t s t i m u l a t e n e a r maximal a d j u s t m e n t s i n t h e o r g a n s o f 36 c i r c u l a t i o n and r e s p i r a t i o n f o r r e l a t i v e l y e x t e n d e d p e r i o d s o f t i m e — c a r d i o r e s p i r a t o r y e n d u r a n c e e x e r c i s e s * Common forms o f e n d u r a n c e e x e r c i s e t h a t enhance c a r d i o v a s c u l a r f u n c t i o n i n g i n c l u d e j o g g i n g , swimming and c y c l i n g . When g r o s s motor movements s u c h as r u n n i n g or swimming a r e p e r -f o r m e d w i t h s u f f i c i e n t f r e q u e n c y , d u r a t i o n , and i n t e n s i t y , c h r o n i c a d a p t a t i o n s i n c a r d i o v a s c u l a r , r e s p i r a t o r y , and met-a b o l i c p r o c e s s e s o c c u r * D u r i n g a c t i v i t i e s p e r f o r m e d at s u b -maximal r a t e s , m u s c u l a r c o n s u m p t i o n o f oxygen i n c r e a s e s w i t h o u t p r o d u c i n g an i n t o l e r a b l e oxygen d e b t * T h i s t y p e of e n d u r a n c e a c t i v i t y i s commonly c a l l e d a e r o b i c , e x e r c i s e or a e r o b i c c o n d i t i o n i n g * D e c r e a s e s i n t h e s e v e r i t y and d u r a t i o n o f t h e p h y s i o -l o g i c a l r e s p o n s e t o p h y s i c a l s t r e s s due t o a e r o b i c c o n d i -t i o n i n g a r e w e l l documented ( A s t r a nd 8 R o d a h l , 1977 ), t h a t I s , f o r any g i v e n work l o a d t h e w e l l t r a i n e d a t h l e t e e n j o y s a l o w e r h e a r t r a t e , s l o w e r r e s p i r a t i o n and l e s s a c c u m u l a t i o n of the a c i d by p r o d u c t s o f e x e r c i s e ( l a c t i c a c i d ) . B i o c h e m -i c a l c h a n g e s a r e a l s o r e d u c e d as a r e s u l t o f t r a i n i n g s i n c e an a c u t e e x e r c i s e bout p r o d u c e s a s m a l l e r r i s e i n plasma g l u c o c o r t i c o i d s i n t r a i n e d s u b j e c t s t h a n i n t h e i r u n t r a i n e d c o u n t e r p a r t s ( T h a r p , 1975; White, I s m a i l , ft Bo t t o m s , 1976). • S e v e r a l h y p o t h e s e s , from a p h y s i o l o g i c a l p e r s p e c t i v e , have been p r o p o s e d t o a c c o u n t f o r t h e e f f e c t s o f e x e r c i s e on s t r e s s r e a c t i o n s * F o l k i n s , L y n c h , and G a r d n e r ( 1 9 7 2 ) hy-p o t h e s i z e d t h a t " p h y s i c a l phenomena when r e c e i v e d at t h e 37 c o g n i t i v e l e v e l " h a v e s o m e b e a r i n g on a p e r s o n ' s s e n s e n i p s y c h o l o g i c a l f i t n e s s . T h e r e f o r e . s i n c e e x e r c i s e h a s b e e n s h o w n t o be a, n a t u r a l m u s c l e r e l a x a n t ( D e V r i e s , 1 9 6 8 ) , r e -duced; e l e c t r i c a l a c t i v i t y i n t h e m u s c l e s may b e a s i g n i f i -c a n t f e e d b a c k c u e f o r a n i n d i v i d u a l t o r a t e h i m s e l f o r h e r -s e l f a s l e s s a n x i o u s . D r i s c o l l ( 1976 ) s u g g e s t s t h e f o l l o w i n g r a t i o n a l e f o r u s i n g p h y s i c a l a c t i v i t y t o l o w e r a n x i e t y : ( a ) e x e r t i o n i s a c o m p e t i n g o r i n c o m p a t i b l e r e s p o n s e o f an a c t i v e , a s s e r t i v e a n d f o r c e f u l n a t u r e ; (to) e x e r t i o n i s t h e n a t u r a l u s a g e a n d c o n s u m p t i o n o f p h y s i o l o g i c a l a r o u s a l a n d t e n s i o n ; a n d ( c ) s u f f i c i e n t e x e r t i o n c a n p a r t i a l l y e x h a u s t a n d I n h i b i t t h e c a p a c i t y f o r f u r t h e r a n x i e t y a r o u s a l . G l a s s e r ( 1 9 7 6 ) h a s s u g g e s t e d t h a t t h e r e l e a s e o f a c h e m i c a l s i m i l a r t o m o r p h i n e o c c u r s d u r i n g e n d u r a n c e t r a i n -i n g . T h i s n a t u r a l l y o c c u r r i n g c h e m i c a l s u b s t a n c e , e n k e -p h a l i n , i s p r o p o s e d t o be a s s o c i a t e d w i t h f e e l i n g s o f p l e a s -u r e . I n a d d i t i o n , h o r m o n e s r e l e a s e d f r o m o t h e r a r e a s o f t h e b o d y may h a v e a p o w e r f u l e f f e c t on t h e b r a i n ( e . g . , s e x u a l s t e r i o d s ) a s t h e y a r e r e l e a s e d e l s e w h e r e a n d c a r r i e d t o t h e b r a i n b y t h e c a r d i o v a s c u l a r s y s t e m d u r i n g e x e r c i s e ( C o l t , W a r d l a w , 8 F r a n t z , 1 9 8 1 ; I s m a i l 8 Y o u n g , 1 9 7 7 : L e h m a n n , K e u l , H u b e r , G Ca P r a d a , 1 9 8 1 ) . T h e s e b i o c h e m i c a l h y p o t h -e s e s w h i c h h a v e b e e n a d v a n c e d a s e x p l a n a t i o n s f o r t h e r e d u c -t i o n o f a n x i e t y t h r o u g h e x e r c i s e h a v e n o t b e e n f i r m l y e s t a b -l i s h e d . 38 A few s t u d i e s hove attempted to t e s t these p h y s i o l o g i -c a l e x p l a n a t i o n s . Evans, Cox, and Jarrleson ( 1977 ) and Cox, Evans, and Jamleson (1979) assessed the r e l a t i o n s h i p between aer o b i c power and recovery from p s y c h o l o g i c a l s t r e s s i n 70 hea l t h y v o l u n t e e r s u b j e c t s . A s t r a n d and Ryhming's (1954) b i c y c l e ergometer method was used to measure aerobic power. The r e l a t i o n s h i p s were i n v e s t i g a t e d using m u l t i p l e r e g r e s -s i o n a n a l y s i s . No evidence »as found t o i n d i c a t e that aero-b i c power was r e l a t e d - to the nagnitude of one's response to p s y c h o l o g i c a l s t r e s s o r s ( e. g., c r i t i c i s m of performance on comprehension, a r i t h m e t i c , and IQ s u b t e s t s ) . S u b j e c t s ' heart rate recovery change scores were s i g n i f i c a n t l y and n e g a t i v e l y r e l a t e d to aerobic power ( j r = -. G 27 ) . The authors concluded that s u b j e c t s with the highest a e r o b i c power r e -covered most q u i c k l y from the e f f e c t s of the p s y c h o l o g i c a l s t r e s s o r s (as measured by heart r a t e f i v e minutes a f t e r t e r -mination of s t r e s s ) . The authors r e l a t e d t h e i r f i n d i n g s to Schachter and S i n g e r ' s ( 1962 ) two component theory of erto-t i o n ; that Is, one must be s t r e s s e d and c o g n i t i v c l y a t t r i -bute the source of s t r e s s to some app r o p r i a t e s i t u a t i o n a l f a c t o r i n order to experience the erection. These authors propose that slow recovery In between s i t u a t i o n a l s t r e s s o r s might r e s u l t i n being c h r o n i c a l l y s t r e s s e d . In a d d i t i o n , they suggest that perhaps people with g r e a t e r a e r o b i c power and subsequent f a s t e r h e a r t - r a t e recovery, experience emo-ti o n s f o r s h o r t e r p e r i o d s of time. These f i n d i n g s are very t e n t a t i v e a s t h i s w a s a c o r r e l a t i o n a l s t u d y — a e r o b i c p o w e r was m e a s u r e d b u t n o t m a n i p u l a t e d . A l t h o u g h i t I s w e l l k n o w n ( A s t r a n d S R o d a h l , 1 9 7 7 ) t h a t h e a r t r a t e s o f f i t i n d i v i d u a l s r e c o v e r m o r e q u i c k l y t h a n t h o s e o f t h e u n f i t a f t e r p h y s i c a l e x e r t i o n , t o w h a t e x t e n t t h i s m e c h a n i s m a f f e c t s t h e s t r e s s a p p r a i s a l p r o c e s s i s y e t t o h e d e t e r m i n e d . Z i m m e r m a n a n d F u l t o n ( 1981) r e p l i c a t e d t h e C o x e t a l . (1979) s t u d y w i t h 20 f i t a n d 20 u n f i t m a l e s . I n a d d i t i o n t o a e r o b i c p o w e r , t h e y m e a s u r e d e l e c t r o d e r m a I a c t i v i t y a n d s e I f — r e p o r t e d S t a t e — T r a i t A n x i e t y . F i t n e s s l e v e l s f o r t h e t w o m a t c h e d g r o u p s w e r e d e t e r m i n e d b y t h e c a l c u l a t i o n o f C o -o p e r ' s (1978) a e r o b i c p o i n t s ( s e I f — r e p o r t e d ) f o r a t h r e e -m o n t h p e r i o d . P s y c h o l o g i c a l s t r e s s o r s I n c l u d e d R a v e n ' s A d -v a n c e d M a t r i c e s , a c o n c e p t m a s t e r y t e s t , a n d d i s t r a c t i n g n o i s e . D u r i n g r e c o v e r y t i m e ( t h r e e m i n u t e s ) , p h y s i o l o g i c a l m e a s u r e s w e r e r e c o r d e d c o n t i n u o u s l y . No d i f f e r e n c e s b e t w e e n g r o u p s w e r e f o u n d o n t h e e l e c t r o d e r m a I m e a s u r e s a n d s t a t e a n x i e t y . H o w e v e r , t r a i t a n x i e t y w a s s i g n i f i c a n t l y d i f f e r e n t s u g g e s t i n g t h e f i t a r e l e s s p r o n e t o a n x i e t y i n t h e a b s e n c e o f p s y c h o l o g i c a l s t r e s s o r s . T h e a u t h o r s c o n c l u d e d t h a t i n c o n t r a s t t o C o x e t a l • Vs ( 1979) f i n d i n g s , l o w e r r e c o v e r y r a t e w a s n o t d u e t o f a s t e r r e c o v e r y t i m e b u t l o w e r r e s t i n g b a s e l i n e s . H o w e v e r , t h i s s t u d y w a s c o n f o u n d e d b y u s i n g n o i s e ( a p h y s i c a l s t r e s s o r ) a s a s t r e s s o r a n d , i n a d d i t i o n , t h e i r b a s e l i n e p h y s i o l o g i c a l m e a s u r e s s e e m e d t o b e i n f l a t e d s u g g e s t i n g t h a t t h e y w e r e n o t s t a b l e m e a s u r e s . 40 K e l l e r a n d S e r a , g a n i a n { 1977 ) s t u d i e d t h e c o r r e l a t i o n s b e t w e n f i t n e s s l e v e l a n d r e s p o n s e t o e m o t i o n a l s t r e s s I n 45 men d i v i d e d i n t o t h r e e g r o u p s — t r a i n e d ( ri*a r a t h one r s ) , u n -t r a i n e d , a n d t r a i n e r s ( r e c e n t l y s t a r t e d a r i g o r o u s f i t n e s s p r o g r a m ) . C l e a r w i t h i n a n d b e t w e e n g r o u p d i f f e r e n c e s i n f i t n e s s l e v e l s ( p u l s e r a t e r e c o v e r y t i m e f o l l o w i n g a s t e p -p i n g t a s k ) w e r e r e p o r t e d . T h e m e a s u r e s w e r e t a k e n t h r e e t i m e s a t t h r e e w e e k i n t e r v a l s o v e r n i n e w e e k s . T h e p h y s i -c a l l y f i t s h o w e d l e s s l a b i l i t y I n m e a s u r e s o f a u t o n o m i c r e -s p o n s e (HR S G S R ) t o I n d u c e d p s y c h o l o g i c a l s t r e s s ( S t r o o p C o l o u r W o r d T e s t , s p e e d o f l e a r n i n g t a s k ) . F r o m t h e s e r e -s u l t s , t h e a u t h o r s s u g g e s t t h a t p h y s i c a l l y f i t I n d i v i d u a l s c o p e w i t h e m o t i o n a l s t r e s s t e t t e r t h a n t h e l e s s f i t . As t h e s e f i n d i n g s a r e c o r r e l a t i o n a l i n n a t u r e , a n a l t e r n a t i v e h y p o t h e s i s may b e t h a t t h o s e e n r o l l e d i n f i t n e s s c l a s s e s a r e p r e d i s p o s e d t o c e r t a i n c h a n g e s i n e m o t i o n a l r e s p o n s i v l t y . A m e re r e c e n t s t u d y ( K e l l e r 55 S e r g a n l a n , 1 9 7 9 ) a d d s f u r t h e r s u p p o r t t o t h e s e f i n d i n g s . S i x t y s u b j e c t s ( m a l e s a n d f e m a l e s ) w e r e r a n d o m l y a s s i g n e d t o e i t h e r an e x e r c i s e , m u s i c a p p r e c i a t i o n o r m e d i t a t i o n c l a s s . H a l f - h o u r c l a s s e s w e r e h e l d f o u r d a y s p e r w e e k f o r t e n w e e k s . T h e e x e r c i s e c l a s s e s c o n s i s t e d o f p r o g r e s s i v e r u n n i n g a n d c a l i s t h e n i c s . T e s t s e s s i o n s w e r e c o n d u c t e d d u r i n g t h e s e c o n d , s i x t h , a n d t e n t h w e e k s o f t h e s t u d y — a s t e p - t e s t o f p h y s i c a l f i t n e s s a n d t w o t a s k s s e l e c t e d t o i n d u c e e m o t i o n a l s t r e s s w e r e a d -m i n i s t e r e d . GSR s e r v e d a s a r i n d e x o f e m o t i o n a l a r o u s a l a n d 41 p h y s i c a l f i t n e s s was i n f e r r e d from recovery h e a r t - r a t e time f o l l o w i n g completion of a s t e p p i n g task. GSR recovery r a t -i o s r e v e a l e d s i g n i f i c a n t lower recovery r a t i o s in the exer-c i s e than m e d i t a t i o n and music groups. The K e l l e r et a l . s t u d i e s suggest t h a t improvement i n p h y s i c a l f i t n e s s i s ac-companied by more r a p i d autonomic recovery. ( heart r a t e , GSR) from s t r e s s induced emotional a r o u s a l . thus c o n f i r m i n g the Cox et a l . , (1977; 1979) s t u d i e s but i n c o n t r a s t to Zim-merman's e t a l ' s (1S81) f i n d i n g s . In summary, i t i s w e l l known that many p h y s i o l o g i c a l b e n e f i t s of a e r o b i c c o n d i t i o n i n g reduce the harmful' p h y s i o -l o g i c a l e f f e c t s of c h r o n i c s t r e s s . Tt Is not known whether feedback from these p h y s i o l o g i c a l b e n e f i t s ( e . g . , a c c e l e r a t -ed autonomic re c o v e r y ) change the phenomenology of s t r e s s or are independent. The above s t u d i e s lacked measures and re-s u l t s that would i n d i c a t e that changes i n the s u b j e c t i v e ex-p e r i e n c e c o r r e l a t e d with the p h y s i o l o g i c a l b e n e f i t s that ac-company i n c r e a s e d a e r o t i c c a p a c i t y . However, the p r e v i o u s l y d i s c u s s e d f i n d i n g s c.f Frank enhaeuser ( 1981) would suggest that r a p i d recovery- ( p h y s l o l c s i c a l ) i s an important f a c t o r in coping with s t r e s s . ESXiiJiaJkoiilcal B.ejjefi.ts. D e s p i t e s p e c u l a t i o n that the p h y s i c a l l y f i t are mere r e l a t e d , have a heightened s e l f - i m -age, and t o l e r a t e b e t t e r the s t r e s s e s of d a l l y l i f e (Cooper, 1978 ), experimental evidence r e g a r d i n g causal i n f e r e n c e s is l a c k i n g . However, there seems to be c l i n i c a l agreement that 42 s i g n i f i c a n t p s y c h o l o g i c a l a s w e l l a s p h y s i o l o g i c a l c h a n g e s o c c u r w h e n a n i n d i v i d u a l t r a i n s a e r o b i c a l l y ( M o r g a n , 1981). T n a d d i t i o n , s e l f — r e p o r t d a t a f r o m m a n y d i f f e r e n t p o p u l a -t i o n s s u g g e s t t h a t t h e r e a r e m a n y p e r c e i v e d p o s i t i v e b e n -e f i t s o f p a r t i c i p a t i n g i n e n d u r a n c e t r a i n i n g p r o g r a m s s u c h a s J o g g i n g ( H a r r i s , 1981; R e n f r o w 6 B c l t o n , 1979). G r e l s t , K l e i n , E i s c h e n s , F a r i s , G u r m a n , a n d M o r g a n ( 1979 ) p r o p o s e d a n u m b e r c f h y p o t h e s e s t o a c c o u n t f o r t h e b e n e f i c i a l e f f e c t s o f r u n n i n g . T h e s e r e l e v a n t t o s t r e s s m a n a g e m e n t a r e : ( a ) a n i n c r e a s e d s e n s e o f m a s t e r y , ( 2 ) d i s -t r a c t i o n f r o m p h y s i o l o g i c a l s y m p t o m s o f a n x i e t y , a n d (3) d e -s e n s i t i z a t l o n t o t h e s o m a t i c c o m p o n e n t s o f a n x i e t y t h r o u g h g r a d e d e x p o s u r e t o e x e r c i s e . B a s e d c n a n e x t e n s i v e l i t e r a -t u r e r e v i e w o n a c t i v i t y a s a c o p i n g t o o l i n s t r e s s f u l s i t u -a t i o n s , G a l a n d L a z a r u s (1975) a l s o s u g g e s t t h a t a c t i v i t y , w h i c h c o u l d i n c l u d e j o g g i n g a s w e l l a s e t h e r o v e r t b e h a v -i o r s , p r o m o t e s a s e n s e o f m a s t e r y a n d c o n t r o l , d i s c h a r g e s e n e r g y b y m o b i l i z a t i o n , a n d a c t s a s a m e a n s o f a t t e n t i o n d i v e r s i o n . G a l a n d L a z a r u s s u g g e s t t h a t i n t e r p r e t i n g r e -s e a r c h i n t h i s a r e a i s d i f f i c u l t a s t h e d i s t i n c t i o n s b e t w e e n t h r e a t r e l a t e d a n d t h r e a t u n r e l a t e d a c t i v i t i e s a r e o f t e n n o t m a d e c l e a r . H o w e v e r , t h e r e I s s o m e e v i d e n c e t o s u g g e s t t h a t e v e n t h r e a t u n r e l a t e d a c t i v i t i e s ( e . g . , r e s t , t i m e o u t ) a c t a s d i v e r s i o n a n d s u b s e q u e n t l y r e d u c e t h e s t r e s s r e s p o n s e ( M o r g a n , 19 8 1 ). 43 T h e f o l l n w i n s j s e c t i o n o f t h i s p a p e r ' r e v i e w s t h e r e -s e a r c h cn p h y s i c a l a c t i v i t y t h a t f o c u s e s o n t h e p s y c h o l o g i -c a l c h a n g e s t h a t o c c u r I n r e l a t i o n s h i p t o s t r e s s r e d u c t i o n * R e s e a r c h i n t h i s a r e a h a s f o c u s e d o r t w o d i s t i n c t t y p e s o f e x e r c i s e — c h r o n i c o r l o n e t e r m e n d u r a n c e t r a i n i n g a n d a c u t e o r s h o r t b o u t s o f e x e r c i s e . To d a t e , v e r y f e w c o n t r o l l e d s t u d i e s h a v e b e e n d o n e w i t h a c l i n i c a l l y s t r e s s e d p o p u l a t i o n u s i n g c h r o n i c e x e r c i s e a s a c o p i n g t c c l . C h j r c yai _c. E x e r c i s e ^ » One o f t h e f e w s t u d i e s u s i n g a c l i n -i c a l p o p u l a t i o n was r e p o r t e d b y L i o n ( 1 9 7 8 ) . I n t h i s p r e — l l m l n a r y s t u d y , s i x c h r o n i c p s y c h i a t r i c p a t i e n t s who w e r e r a n d o m l y a s s i g n e d t o a p r o g r a m o f r e g u l a r s u p e r v i s e d j o g g i n g s h e w e d l e s s p o s t t e s t a n x i e t y , as m e a s u r e d b y t h e S t a t e -T r a i t A n x i e t y I n v e n t o r y , t h a n d i d a c o n t r o l g r o u p . U n f o r t u -n a t e l y , t h e s t u d y w a s m a r r e d by m e t h o d o l o g i c a l w e a k n e s s e s i n t e r m s o f s a m p l i n g , i n s t r u m e n t a t i o n a n d d e s i g n . I s m a i l a n d T r a c h t m a n ( 1 9 7 3 ) s t u d i e d a g r o u p o f s i x t y m i d d l e - a g e d ire n who e x e r c i s e d f o r o n e a n d o n e — h a l f h o u r s t h r e e t i m e s a w e e k o v e r f o u r m o n t h s . B y i s o l a t i n g h i g h a n d l o w p h y s i c a l f i t n e s s g r o u p s , t h e l o w f i t n e s s g r o u p s h o w e d s i g n i f i c a n t i n c r e a s e s i n e m o t i o n a l s t a b i l i t y , i m a g i n a t i v e -n e s s , a n d s e l f - s u f f i c i e n c y ( C a t t e t l 1 6 — P F ) on c o m p l e t i o n o f t h e p r o g r a m a n d a p p r o a c h e d t h e p r e t e s t s c o r e s o f t h e h i g h f i t n e s s g r o u p o n t h e s e v a r i a b l e s . I n a s i m i l a r s t u d y . Y o u n g a n d I s m a i l ( 1 9 7 6 ) i n v e s t i g a t e d p e r s o n a l i t y d i f f e r e n c e s a m ong h i g h - f i t y o u n g , h i g h — f i t o l d , l o w — f i t y o u n g , a n d l o w - f i t o l d -14 s u b j e c t s before and a f t e r a f i t n e s s program. They found that r e g a r d l e s s of age, the h i g h - f i t group was more i n t e l -l e c t u a l l y i n c l i n e d , e m o t i o n a l l y s t a b l e , composed, s e l f — c o n -f i d e n t , easy going, and r e l a x e d . These s t u d i e s suggest that u n f i t "normals" show e v i -dence of more p s y c h o l o g i c a l d i s t r e s s and d y s f u n c t i o n than do c o n d i t i o n e d i n d i v i d u a l s . It appears t h a t the more uncondi-t i o n e d people are, the l e s s "normal" t h e i r p s y c h o l o g i c a l t e s t scores and the more change they demonstrate as they achieve an improved l e v e l of p h y s i c a l f i t n e s s . In a stvxdy by Heinzelman ( 1975 ), r a t h e r than r e l y i n g on s e l f - s e l e c t i o n , f i t n e s s l e v e l s were e x p e r i m e n t a l l y manipu-l a t e d . Program p a r t i c i p a n t s were randomly assigned t o an e x e r c i s e program I n v o l v i n g e x e r c i s e two or three times a week f o r 18-months, or to a c o n t r o l c o n d i t i o n . S o c i a l and p s y c h o l o g i c a l e f f e c t s of an e x e r c i s e program were s y s t e m a t i -c a l l y examined among 188 men aged 45 to £4. About 45% of the f i t n e s s and 20% of the c o n t r o l group reported f e e l i n g l e s s s t r e s s and t e n s i o n . F o l k i n s , Lynch, and Gardner ( 1972) measured aspects of p h y s i c a l and p s y c h o l o g i c a l " f i t n e s s " i n c o l l e g e students at the beginning and end of a semester— Icns jog g i n g course and compared them t o a c o n t r o l group that p a r t i c i p a t e d i n a r c h -ery or g o l f c o u r s e s . At the cut s e t of the study, women In 'the j o g g i n g course were found to he le s s p s y c h o l o g i c a l l y f i t ( A d j e c t i v e C h e c k l i s t , M u l t i p l e A f f e c t C h e c k l i s t ) than women 45 i n t h e c o n t r o l g r o u p . I n a w i t h i n g r o u p a n a l y s i s , s i g n i f i -c a n t p s y c h o l o g i c a l I m p r o v e m e n t c o r r e l a t e d w i t h i m p r o v e d p h y s i c a l f i t n e s s f o r t h o s e women o n l y . I t a p p e a r s t h a t s u b -j e c t s l n t h e p o o r e s t p h y s i c a l a n d p s y c h o l o g i c a l c o n d i t i o n s h o w e d t h e g r e a t e s t i m p r o v e m e n t . T h e c o m p a r i s o n g r o u p s u g -g e s t s t h a t t h e e f f e c t was n o t s i m p l y o p p o r t u n i t y f o r s o c i a l c o m p a n i o n s h i p o r a H a w t h o r n e e f f e c t . A s t u d y i n c l u d i n g c o u n s e l l i n g a s a n a d j u n c t was r e p o r t -e d b y H i I y e r a n d M i t c h e l l ( 1979). T h e y c o m p a r e d an e x p e r i -m e n t a l g r o u p r e c e i v i n g a f i t n e s s p r o g r a m , a s e c o n d e x p e r i -m e n t a l g r o u p r e c e i v i n g t h e same t r a i n i n g p l u s a n h o u r p e r week o f c o u n s e l l i n g ( d e s i g n e d t o r e i n f o r c e t h e f i t n e s s p r o -g r a m a n d e n h a n c e g e n e r a l i z a t i o n ) , a n d a t h i r d c o n t r o l g r o u p t h a t r e c e i v e d n o t r a i n i n g o r c o u n s e l l i n g . A f t e r a 10—week p r o g r a m , t h e g r o u p r e c e i v i n g f i t n e s s t r a i n i n g a n d c o u n s e l l -i n g m ade a s i g n i f i c a n t g a i n i n s e l f — c o n c e p t ( T e n n e s s e e S e l f — C o n c e p t S c a l e ) . T h e s e f i n d i n g s s h o u l d b e v i e w e d w i t h c a u t i o n a s t h e s t u d y l a c k e d a c o u n s e l l i n g — o n l y g r o u p . T h i s s t u d y d o e s i n d i c a t e , h o w e v e r , t h a t a f i t n e s s p r o g r a m c a n be e n h a n c e d by c o u n s e l l i n g s e s s i o n s . H l u i t e n t h a l ,' W i l l i a m s , W i l l i a m s , a n d W a l l a c e ( 1980 ) f o u n d t h a t a 10-week e x e r c i s e p r o g r a m s i g n i f i c a n t l y r e d u c e d c a r d i o v a s c u l a r , r i s k f a c t o r s ( I . e . , r e d u c t i o n s i n b l o o d p r e s -s u r e , w e i g h t , a n d an i n c r e a s e i n p l a s m i n o g e n a c t i v a t o r r e -l e a s e ) a n d t h e m a g n i t u d e c f T y p e A b e h a v i o r p a t t e r n , a s m e a s u r e d by J e n k i n s A c t i v i t y S u r v e y - F o r m B, f o r h e a l t h y m i d -46 d i e - a g e d a d u l t s c l a s s i f i e d as Type A. U n f o r t u n a t e l y t h e l a c k c f c o n t r o l g r o u p s d o e s n o t p e r m i t the c o n c l u s i o n t h a t I t was t h e e x e r c i s e t h a t c a u s e d t h e s e c h a n g e s i n Type A b e -h a v i o r • S e v e r a l s t u d i e s have a t t e m p t e d t o a s s e s s whether p h y s i -c a l f i t n e s s o r m e r e l y p a r t i c i p a t i o n In an endvirance program m e d i a t e s p s y c h o l o g i c a l c h a n g e s . I n a c o n t r o l l e d e x p e r i m e n -t a l c o m p a r i s o n , J a s n o s k i , Holmes, Solomon, and A g u i a r (198 1) compared women i n a 10—week e x e r c i s e c l a s s w i t h w a i t i n g l i s t c o n t r o l s and an i n d e p e n d e n t c o n t r o l g r o u p • They f o u n d t h a t p a r t i c i p a t i o n p e r s e i m p r o v e d s c o r e s on s e l f - p e r c e i v e d a b i l -i t i e s r e g a r d i n g j o g g i n g a s w e l l as c o n f i d e n c e ( i . e . , meas-u r e s o f c e r t a i n t y o f t h o s e a b i l i t i e s ) r e l a t i v e to the c o n -t r o l g r o u p s . They a l s o f o u n d t h a t the c h a n g e s In a e r o t i c power, a s measured by C o o p e r ' s ('1878) 12—mlnute r u n , were not r e l a t e d to s e l f - p e r c e i v e d a b i l i t i e s and c o n f i d e n c e . A f u r t h e r s t u d y by J a s n o s k i and Holmes ( 198 1) a s s e s s e d 103 u n d e r g r a d u a t e women, p r e and p o s t , i n a 15-week a e r o t i c t r a i n i n g p r o g r a m . R e g r e s s i o n and c c v a r i a n c e a n a l y s i s r e -v e a l e d t h a t b e t t e r p e r s o n a l i t y f u n c t i o n i n g was r e l i a b l y a s -s o c i a t e d w i t h h i g h e r I n i t i a l l e v e l s of a e r o b i c c c n d i t i o n l r n , p a r t i c i p a t i o n In t h e t r a i n i n g program i ndependent of c h a n g e s i n f i t n e s s , and c h a n g e s i n f i t n e s s . The measures u s e d were t h e 16PF, Zung r e p r e s s i o n S c a l e , Type A p e r s o n a l i t y s u r v e y , and C o o p e r ' s 12—minute r u n . However, each o f t h e s e f a c t o r s r e l a t e d t o d i f f e r e n t a s p e c t s o f p e r s o n a l i t y . O n l y the 47 s e l f - a s s u r a n c e d i m e n s i o n ( F a c t o r 01 was r e l a t e d t o e a c h o f t h e f l t n e s s / t r a l n l n g v a r i a b l e s . T t s h o u l d b e n o t e d t h a t t h e s u b j e c t s i n t h e s e t w o s t u d i e s w e r e n o r m a l a d u l t women* a n d i t w o u l d be e x p e c t e d t h a t f e w c h a n g e s w o u l d o c c u r o n t h e s e p e r s o n a l i t y m e a s u r e s . M o r g a n ( 1979) s u g g e s t s t h a t t h e c h r o n i c e f f e c t s o f p h y s i c a l a . c t i v l t y m i g h t n o t he d e m o n s t r a b l e b e c a u s e a n x i e t y a n d a c u t e p h y s i o l o g i c a l a c t i v i t y may c o v a r y . T e n s i o n may be r e d u c e d d u r i n g t h e p h y s i c a l a c t i v i t y o r i m m e d i a t e l y a f t e r . H o w e v e r , t h e s u b j e c t ' s s t a t e o f a n x i e t y m i g h t g r a d u a l l y i n -c r e a s e , r e a c h i n g i t s o r i g i n a l l e v e l s d u r i n g t h e n e x t 24 h o u r s b e f o r e e x e r c i s e , o n l y t o d e c r e a s e o n c e a g a i n f o l l o w i n g a c u t e e x e r c i s e . He s u g g e s t s t h a t t h e c h i e f p s y c h o l o g i c a l b e n e f i t o f p h y s i c a l a c t i v i t y w o u l d n o t b e i t s a b i l i t y t o r e -d u c e t e n s i o n b u t r a t h e r i t s a b i l i t y t o m a i n t a i n a d e s i r e d t e n s i o n s t a t e o r p r e v e n t a n e l e v a t e d s t a t e o f a n x i e t y . I n s u m m a r y , a l t h o u g h t h e a c t i v e i n g r e d i e n t s i n t h e s e p r o g r a m s h a v e n o t b e e n i d e n t i f i e d , p a r t i c i p a t i o n i n a e r o b i c c o n d i t i o n i n g p r o g r a m s i s r e l a t e d t o r e d u c t i o n s i n a n x i e t y a n d o t h e r p o s i t i v e p e r s o n a l i t y c h a r a c t e r i s t i c s . I n a d d i -t i o n , t h e r e i s s o m e e v i d e n c e t h a t c o u n s e l l i n g s e s s i o n s i n c o n j u n c t i o n w i t h e x e r c i s e a r e f a c i 1 1 t a t i v e . S t u d i e s u s i n g c h r o n i c e x e r c i s e h a v e s h o w n i m p r o v e d p s y c h o l o g i c a l f u n c t i o n -i n g i n v a r i o u s p o p u l a t i o n s , y e t t h e d i f f e r e n t i a l e f f e c t i v e -n e s s o f h i g h v e r s u s l o w a e r o b i c p o w e r on p s y c h o l o g i c a l , v a r i a b l e s h a s n o t b e e n a s s e s s e d . T h i s w o u l d r e q u i r e m a n l p u -48 l a t i c n of a e r o b i c power and I t s r e l a t i o n s h i p to measures of s t r e s s r e d u c t i o n * Acute Ejs.e.r.cJ.Se. P i t t s and McClure ( 1967 ) expressed an e x c e p t i o n to the view that e x e r c i s e reduces a n x i e t y . They proposed that l a c t a t e , an e x e r c i s e m e t a b o l i t e , can provoke a n x i e t y symptoms and a t t a c k s i i i a n x i e t y n e u r o t i c s and i n normal persons under s t r e s s . P i t t ' s t h e o r i z i n g and data have been c r i t i c i z e d by a. number of i n v e s t i g a t o r s ( Grosz S Farmer, 1969; L e v i t t , 1972; Vorgan , 1 973 ). A c o n v i n c i n g se-r i e s of experiments by Morgan and h i s c o l l e a g u e s demonstrat-ed that vigorous p h y s i c a l e x e r c i s e c o n s i s t e n t l y l e a d s to s i g n i f i c a n t decrements i n s t a t e a n x i e t y among both normal and high anxious s u b j e c t s . Morgan (1979) noted that s u b j e c t s s c o r i n g high on t e s t s of aerobic power produce s i g n i f i c a n t l y l e s s l a c t i c a c i d than l e s s f i t ones. Therefore , he suggested that even i f anxiety n e u r o t i c s produced abnormal q u a n t i t i e s of l a c t i c a c i d with e x e r c i s e , t h i s might r e f l e c t the l e v e l of f i t n e s s , not psy-ch opathology. S i x men diagnosed as a n x i e t y n e u r o t i c s and s i x normals p o s s e s s i n g comparable l e v e l s o f a e r o b i c power ran to complete exhaustion on a t r e a d m i l l . The two groups possessed comparable r e s t i n g l a c t a t e l e v e l s and t h e i r l a c -t a t e response f o l l o w i n g maximal e x e r c i s e was e s s e n t i a l l y i d e n t i c a l . In a d d i t i o n , s t a t e a n x i e t y decreased s i g n i f i -c a n t l y f o l l o w i n g maximal e x e r c i s e In both the normals and high-anxious s u b j e c t s . 49 A s t u d y b y D r i s c o l l ( 1 9 7 6 ) d e s c r i b e d a n I n i t i a l v a l i d a t i o n a n d c o m p o n e n t a n a l y s i s o f a p r o c e d u r e r e f e r r e d t o a s e x e r t i o n t h e r a p y t h a t c o m b i n e s e x e r c i s e ( s t a t i o n a r y r u n -n i n g ) a n d p o s i t i v e i m a g e s . He r e p o r t e d t h a t 16 h i g h l y t e s t - a n x i o u s s u b j e c t s s i g n i f i c a n t l y r e d u c e d t h e i r a n x i e t y w i t h b o t h t h e e x e r t i o n t h e r a p y a n d t a p e d d e s e n s i t i z a t i o n t r e a t m e n t . W h i l e e x e r c i s e o r f a n t a s y a l o n e p r o d u c e d d e c r e -m e n t s i n a n x i e t y , t h e d e c r e a s e s w e r e n o t a s g r e a t a s t h a t p r o d u c e d w i t h t h e m c o m b i n e d . I n t e r e s t i n g l y , t h e d e g r e e o f e f f e c t i v e n e s s w a s f o u n d t o be r e l a t e d t o t h e d e g r e e o f e n -j o y m e n t o f p h y s i c a l a c t i v i t y . B a h r k e a n d M o r g a n ( 1 9 7 8 ) r a n d o m l y a s s i g n e d 7 5 men t o c o n d i t i o n s c o n s i s t i n g o f 20 m i n u t e s o f e x e r c i s e a t 10% o f m a x i m a l a e r o b i c p o w e r , n o n c u l t i c m e d i t a t i o n , a n d a c o n t r o l c o n d i t i o n o f c r u i e t r e s t i n a s o u n d f i l t e r e d r o o m . T h e e x e r -c i s e a n d m e d i t a t i o n g r o u p s t o t h e x p e r i e n c e d s i g n i f i c a n t d e -c r e a s e s i n s t a t e a n x i e t y , h o w e v e r , t h e c o n t r o l g r o u p a l s o e x p e r i e n c e d a d e c r e a s e i n s t a t e ' a n x i e t y * B a h r k e a n d M o r g a n s p e c u l a t e t h a t d i v e r s i o n , n o t e x e r c i s e o r m e d i t a t i o n i s t h e c r u c i a l i n g r e d i e n t . O r w i n ( 1 9 7 4 ) r e p o r t e d t h e s u c c e s s f u l u s e o f r u n n i n g as a t r e a t m e n t f o r s i t u a t i o n a l p h o b i a a n d a g o r a p h o b i c p a t i e n t s . M u l l e r a n d A r m s t r o n g ( 1 9 7 5 ) a l s o u s e d r u n n i n g a s t h e m a j o r i n t e r v e n t i o n i n t h e t r e a t m e n t o f a p a t i e n t w i t h e l e v a t o r p h o b i a . T h e y s u g g e s t t h a t r u n n i n g d e e s n e t p r o d u c e a u t o n o m -i c b e h a v i o r a n t a g o n i s t i c t o f e a r b u t b e h a v i o r i d e n t i c a l t o 50 i t • The d i f f e r e n c e Is only i n the explanation f o r the oc-currence of the a r o u s a l . They r e l a t e t h i s to Schachter's (1 964 ) and F e s t i n g e r ' s ( 195") work by suggesting that with Jogging therapy, the elemerts "nay heart i s pounding" and "other people are calm" are suddenly made consonant by the experience of running which l e g i t i m i z e s high l e v e l s of ar-ousal without the need to e rr p I oy panic to the e x p l a n a t i o n . Consequently, the same r e a l i t y i s p e r c e i v e d and I n t e r p r e t e d d i f f e r e n t l y ( i . e . , rea t.tr i b u t i o n ) . Heaps ( 1978 ) attempted to determine whether there Is a d i r e c t , p h y s i c a l c a u s a t i o n of c e r t a i n p s y c h o l o g i c a l charac-t e r i s t i c s or whether they are determined p r i m a r i l y by c o g n i -t i v e i n t e r p r e t a t i o n s of b o d i l y r e a c t i o n s . College-aged males who were a c t i v e but nonathletes (,rj=50) comoleted a p h y s i c a l f i t n e s s t e s t (Cooper's 12-minute run) and r e c e i v e d p r e d e t e r m i n e d — p o s i t i v e or n e g a t i v e — s o c i a l and p h y s i c a l i n -formation about t h e i r p h y s i c a l c o n d i t i o n . On s e l f - a t t i t u d e q u e s t i o n n a i r e s p a r t i c i p a n t s estimated t h e i r p h y s i c a l f i t n e s s l e v e l s . Heaps found that the s u b j e c t s ' estima. tes of t h e i r p h y s i c a l f i t n e s s l e v e l s were i n f l u e n c e d by both s o c i a l and p h y s i c a l standards of s e I f - c ompa r I s c n. Subjects' percep-t i o n s of t h e i r f i t n e s s l e v e l s were p o s i t i v e l y r e l a t e d to a n x i e t y about b o d i l y f u n c t i o n i n g . The s u b j e c t s ' a c t u a l f i t -ness l e v e l s were only s l i g h t l y r e l a t e d to t h e i r f i t n e s s s e l f - e s t i m a t e s and were not r e l a t e d to the other s e l f - a t t i -tudes s t u d i e d . Heaps concluded that the p s y c h o l o g i c a l ben-e f l t s of physical, e x e r c i s e are Largely a r e s u l t of emotional or p s y c h o l o g i c a l p e r c e p t i o n s of the p h y s i c a l and personal value cf c o n t i n u e d e x e r t i o n . Although these f i n d i n g s are p r o v o c a t i v e . a e r o b i c power was not d i r e c t l y manipulated. T h i s study d i d not d i r e c t l y assess whether an i n c r e a s e in p h y s i c a l f i t n e s s i s the c a u s a l f a c t o r i n improved ps y c h o l o g -i c a l f u n c t i o n i n g . In summary, acute v i g o r o u s e x e r c i s e , In both l a b o r a t o r y and n a t u r a l s e t t i n g s , has been shown to be r e l a t e d to the r e d u c t i o n of s t a t e anxiety f o r c l i n i c a l l y anxious, normal and phobic s u b j e c t s . From the s t u d i e s reviewed, i t seems apparent that c o g n i t i v e processes such as r e l a b e l i n g of a i — o u s a l , p e r s o n a l v a l u e s and a t t e n t i o n d i v e r s i o n are important v a r i a b l e s that may account f o r the e f f e c t i v e n e s s of p h y s i c a l a c t i v i t y i n s t r e s s management. Taken tog e t h e r , these s t u d i e s support the use of a e r o -b i c c o n d i t i o n i n g as an i n t e r v e n t i o n f o r s t r e s s management. However, c o n t r o l l e d s t u d i e s ere r e q u i r e d i n order to i d e n t i -f y the a c t i v e i n g r e d i e n t s i n these orogrems and to examine the i s s u e of p h y s i c a l d e t e r m i n a t i o n versus c o g n i t i v e media-t i o n of p s y c h o l o g i c a l f u n c t i o n i n g . In other words, do the b e n e f i t s d e r i v e d from endurance e x e r c i s e r e s u l t from physio-l o g i c a l improvement, per s e , from the p s y c h o l o g i c a l percep-t i o n s that accompany such a program, cr from seme i n t e r a c -t i o n e f f e c t ? 52 H&s-^xtxsis fiX Ixsalmsnl Su.lp.assa. A l t h o u g h b e h a v i o r a l t h e r a p i s t s h a v e a d v o c a t e d a " t r i p l e r e s p o n s e - m o d e " a p p r o a c h t o m e a s u r i n g s t r e s s ( R o r k o v e c , S t o n e , O ' B r i e n , F, K a l o u p e c k , 19*74; L a n g , 1971), t h i s a p -p r o a c h i s n o t w i t h o u t i t s c r i t i c s ( C o n e , 1979). M a n y s t u d -i e s h a v e f o u n d a l a c k o f c o r r e l a t i o n b e t w e e n c o g n i t i v e , b e -h a v i o r a l , a n d p h y s i o l o g i c a l r e s p o n s e s * A l t h o u g h s ome r e s e a r c h e r s ( S c h w a r t z , D a v i d s o n , S G o l e m a n , 1978) s u g g e s t t h e s e m o d e s a r e a s y n c h r o n o u s , o t h e r s ( C o n e , 1979) s u g g e s t t h a t m e a s u r e m e n t i s c o n f o u n d e d b y b o t h c o n t e n t a n d m e t h o d v a r i a n c e a n d t h e b a s i c u n r e l i a b i l i t y o f many m e a s u r e s u s e d * In a d d i t i o n , t h e r e i s l i t t l e c o n s e n s u s a s t o w h a t s u b j e c t i v e o r o b j e c t i v e c h a r a c t e r i s t i c s c o n s t i t u t e e a c h d i s t i n c t mode ( C o n e , 1979 ) . F r o m t h e r e v i e w o f o u t c o m e r e -s e a r c h i n t h e c o p i n g s k i l l s a r e a p r e s e n t e d e a r l i e r , i t a p -p e a r s t h a t p e r f o r m a n c e m e a s u r e s d o n o t c o r r e l a t e w e l l w i t h s e l f - r e p o r t m e a s u r e s o f g e n e r a l a n x i e t y . B e h a v i o r a l m e a s -u r e s a p p e a r t o be t o o i n d i r e c t t o s e r v e as o u t c o m e m e a s u r e s i n t h i s c o n t e x t . " S i n c e t h e c l i e n t p o p u l a t i o n i n t h i s s t u d y i s h e t e r o g e n e o u s w i t h r e g a r d t o s y m p t o m a t o l o g y , a u n i f o r m b e h a v i o r a l m e a s u r e w o u l d b e i n a p p r o p r i a t e a n d p o s s i b l y m l s -1 e a d i n g . P h y s i o l o g i c a l m e a s u r e s o f t e n f a l l t c r e f l e c t t r e a t m e n t e f f e c t i v e n e s s , p a r t l y b e c a u s e t h e s t r e s s I n d u c e d a s s e s s m e n t e l e v a t e s a r o u s a l t o s u c h a n e x t e n t t h a t d i f f e r e n c e s b e t w e e n 53 experimental c o n d i t i o n s are l n d i s t l n u u l s b a h l e . Using canon-i c a l c o r r e l a + i o n a n a l y s e s . Vorrow and La brum- ( 1978) found, n o n s i g n i f i c a n t a s s o c i a t i o n s between a set of s i x phys i o l o g l — c a l parameters of s t r e s s and four p s y c h o l o g i c a l t e s t s * They concluded that a g r e a t e r degree of confidence would he ob-t a i n e d by only comparing p s y c h o l o g i c a l measures with psycho-l o g i c a l measures as there was l i t t l e agreement amonc p h y s i o -l o g i c a l measures. Crabns and Hopper (1980) reported s i m i l a r f i n d i n g s . It appears that there i s a complex, i d i o s y n c r a t i c i n t e r a c t i o n between p h y s i o l o a i c a l , p e r s o n a l i t y and c o g n i t i v e v a r i a b l e s that i s not yet well understood. C o n s i d e r i n g the lack of c o n s i s t e n c y across b e h a v i o r a l , p h y s i o l o g i c a l and s e l f - r e p o r t measures, Bronley (1981) suggests that f o r the present, s u b j e c t i v e s e l f — r e p o r t s be used in a s s e s s i n g s t r e s s responses. Consequently, i n t h i s study, the focus i s cn s e l f - r e p o r t s of c o g n i t i v e processes, behaviors and ph y s i o -l o g i c a l s t r e s s r e a c t i o n s . The most popu l a r device f o r the measurement of c o g n i -t i v e a n x i e t y i s the i n v e n t o r y , s c a l e or q u e s t i o n n a i r e . The accumulated body of research data i n d i c a t e s that these i n -struments p r o v i d e v a l i d a n x i e t y change measures i n response to experimental or r e a l l i f e s t r e s s (Davidson i> Schwartz, 1976; L e v i t t , 1967: S p l e l b e r g e r , 1 S72 ) . The S t a t e - T r a i t Anxiety Inventory and the Tension Thermometer were adminis-t e r e d as outcome measures of s t r e s s . 54 § JfeSJt£Z.Z r.a A.1 • E u r i n g t h e p a s t d e c a d e t h e r e h a s b e e n c o n s i d e r a b l e d e b a t e I n t h e f i e l d o f p e r s o n a l i t y a s s e s s m e n t on t h e r e l a t i v e i m p o r t a n c e o f t r a i t s a n d s i t u a t i o n a l s p e c i f -i c i t y (Kazdin» 1979t). S t u d i e s i n t h e a r e a o f a n x i e t y h a v e c o m p a r e d t h e p r e d i c t i v e v a l i d i t y o f " a n x i e t y t r a i t " t e s t s t h a t i n c l u d e d t h e s i t u a t i o n v a r i a b l e s I n t h e d e s i g n o f t h e t e s t w i t h t h o s e t h a t d i d n o t . I n t h e s e s t u d i e s , g e n e r a l t r a i t t e s t s w h i c h a r e i n t e n d e d t o m e a s u r e r e l a t i v e l y s t a h . l e i n d i v i d u a l d i f f e r e n c e s i n g e n e r a l a n x i e t y p r c n e n e s s a r e e v a l u a t e d a g a i n s t s p e c i f i c s t a t e m e a s u r e s , w h i c h a s s e s s a p e r s o n ' s d i s p o s i t i o n t o b e a n x i o u s i n a p a r t i c u l a r s i t u a t i o n o r c l a s s o f s i t u a t i o n s . A l t h o u g h t h e r e s u l t s h a v e i n d i c a t e d t h a t s p e c i f i c s t a t e m e a s u r e s a r e m o r e p r e d i c t i v e o f a n x i e t y I n t h e c o r r e s p o n d i n g c r i t e r i o n s i t u a t i c n , t h e r e h a v e b e e n i n s t a n c e s i n w h i c h t h e g e n e r a l t r a i t t e s t s w e r e n e a r l y o r e q u a l l y a s p r e d i c t i v e . T h i s s e e m s t o h a p p e n w h e n t h e r e i s some t h r e a t t o s e l f - e s t e e m i n t h e c r i t e r i o n s i t u a t i o n ( M e l — l e s t r o m , C i c a l a , £ Z u c k e r m a n , 1976). R e c e n t l y , H o l r n y d ( 1976 ) a n d K a n t e r a n d G o l d - f r i e d (1979) e m p h a s i z e d t h e i m p o r -t a n c e o f c o n t i n u i n g t o d i s t i n g u i s h t h e p e r v a s i v e n e s s ( t r a i t ) a n d t h e I n t e n s i t y ( s t a t e ) o f s t r e s s r e s p o s e s . A c o m m o n l y u s e d m e a s u r e i n c o r p o r a t i n g b o t h s t a t e a n d t r a i t a n x i e t y i s S p i e I h e r g e r ' s S t a t e — T r a i t A n x i e t y I n v e n t o -r y . I t w a s d e v e l o p e d t o p r o v i d e a r e l i a b l e s e l f - r e p o r t m e a s u r e o f b o t h s t a t e a n d t r a i t a r x i e t y . S t a t e a n x i e t y IT ay be c o n c e p t u a l i z e d a s a t r a n s i t o r y e i r c t i o r a l s t a t e o r c o n d i -t i o n that v a r i e s i n I n t e n s i t y and f l u c t u a t e s over time. This c o n d i t i o n i s c h a r a c t e r i z e d by s u b j e c t i v e , c o n s c i o u s l y p e r c e i v e d f e e l i n g s of t e n s i o n and apprehension, as w e l l as a c t i v a t i o n of the autonomic nervous system. The l e v e l of s t a t e a n x i e t y s h o u l d be high in circumstances t h a t are per-c e i v e d by an i n d i v i d u a l to be t h r e a t e n i n g i r r e s p e c t i v e of the o b j e c t i v e danger; s t a t e a n x i e t y I n t e n s i t y should be low in n e n s t r e s s f u l s i t u a t i o n s , or i n circumstances i n which an e x i s t i n g danger i s not p e r c e i v e d as t h r e a t e n i n g . . T r a i t a n x i e t y r e f e r s to r e l a t i v e l y s t a b l e i n d i v i d u a l d i f f e r e n c e s In a n x i e t y proneness, that i s , d i f f e r e n c e s in the d i s p o s i t i o n to p e r c e i v e a wide range of s t i m u l u s s i t u -a t i o n s as dangerous or t h r e a t e n i n g , and i n the tendency to respond to such t h r e a t s with s t a t e a n x i e t y r e a c t i o n s . T r a i t a n x i e t y may a l s o be regarded as r e f l e c t i n g i n d i v i d u a l d i f -f e rences i n the frequency and the i n t e n s i t y with which s t a t e a n x i e t y has been manifested in the past, and i n the prob-a b i l i t y that such s t a t e s w i l l be experienced in the f u t u r e . Persons who are high i n t r a i t anxiety tend to p e r c e i v e a l a r g e r number of s i t u a t i o n s as dangerous or t h r e a t e n i n g than persons who are low i n t r a i t anxiety and to respond; to t h r e a t e n i n g s i t u a t i o n s with s t a t e anxiety e l e v a t i o n s of g r e a t e r i n t e n s i t y . The S t a t e - T r a i t A n x i e t y Inventory has been vised f r e q u e n t l y i n both s t r e s s - I n o c u l a t i o n and aerobic c o n d i t i o n i n g s t u d i e s and was used In t h i s study as an out-come measure of s t r e s s . 56 XejGSJLQ.Ii XllJSXjnaae *e. r • The F e a r o r T e n s i o n The rmome "te r i s a s p e c i f i c r a t i n g f o r m used to a s s e s s t h e deg r e e of d i s -c o m f o r t e x p e r i e n c e d d u r i n g r e c e n t e x p o s u r e t o a n x i e t y — p r o -v o k i n g s i t u a t i o n s * Cn t h i s 1 0 — p o i n t r a t i n g s c a l e , d e v e l o p e d by Walk ( 1956 ), t h e s u b j e c t e s t i m a t e s t h e d e g r e e o f h i s or h e r a n x i e t y . Walk v a l i d a t e d t h i s d i r e c t method o f a n x i e t y a s s e s s m e n t and f o u n d t h a t s c o r e s d i s c r i m i n a t e d q u a l i t y of b e h a v i o r a l p e r f o r m a n c e , were s i g n i f i c a n t l y r e l a t e d t o o t h e r s e l f - r e p o r t m e a sures o f f e a r , were s p e c i f i c to t h e t e s t i n g s i t u a t i o n i t s e l f , and d i d n o t r e f l e c t a g e n e r a l t e n d e n c y among h i g h s c o r e r s t o admit f e a r , .lUdiKlrfUjal. J2lfJtej * e j a£es Tn k e e p i n g w i t h the l i t e r a t u r e on t h e i n t e r a c t i o n a l ap-p r o a c h t o s t r e s s ( E n d l e r , 1978), a n o t h e r i m p o r t a n t component of t h e a p p r a i s a l p r o c e s s i s the p e r s o n i n v o l v e d p e o p l e d i f -f e r i n t e r m s o f t h e i r p r o p e n s i t y t o r e a c t i n a t h r e a t e n e d manner and l i k e l y a p p r a i s e s i t u a t i o n s d i f f e r e n t l y . The im-p o r t a n c e of m a t c h i n g t r e a t m e n t m o d a l i t i e s t o c l i e n t s ' p e r -s o n a l i t y d i s p o s i t i o n s so as t o maximize t h e r a p e u t i c g a i n has been e m p h a s i z e d ( B e r g i n S S t r u p p , 1072; K i e s l e r , 1 9 7 1 ) . Re-s e a r c h a s s e s s i n g t h e d i f f e r e n t i a l e f f e c t i v e n e s s o f s t r e s s -management p r o g r a m s and i n d i v i d u a l d i f f e r e n c e s has been s c a r c e and t h e f i n d i n g s e q u i v o c a l ( E l d e r , E d e l s t e i n , S F r e -mouw, 198 1", Fremouw S Z i t t e r , 1 978; M a l k l e w i c h 8 M e r l u z z l , 19 80 ). 57 fijH£J3JLiAy^.n-Sj5I»!SWi is. • Schwartz, Davidson, and dole man ( 1978 ) have simgested that i n d i v i d u a l s manliest a n x i e t y i n predominantly e i t h e r a c o g n i t i v e or a somatic mode and that most an x i e t y q u e s t i o n n a i r e s r e f l e c t a r unknown mixture of ty pol og ice. I l y d i f f e r e n t forms of a n x i e t y . An Item a n a l y s i s ( B a r r e t t , 1972 ) of an x i e t y items from a l a r g e b a t t e r y of commonly used s c a l e s i n d i c a t e d two major subsets" ( 1 ) aware-ness of somatic change, e.g., I blush o f t e n or I am aware of my heart .beating, and (2) conscious awareness o:f unpleasant f e e l i n g s about s e l f or e x t e r n a l s t i m u l i , e.g., I f r e a u e n t l y f i n d myself worrying about something. On the b a s i s of both l o g i c a l and e m p i r i c a l a n a l y s i s of the anxiety c o n s t r u c t , Borkovec ( 1976 ) a r r i v e d at a s i m i l a r d i s t i n c t i o n with some minor m o d i f i c a t i o n s . He o p e r a t i o n a l l y d e f i n e d a n x i e t y by the m u l t i p l e measurement of three separate but I n t e r a c t i n g response components: c o g n i t i v e , overt b e h a v i o r a l , and phys-i o l o g i c a l . Each system i s s e p a r a t e l y i n f l u e n c e d by d i f f e r -ent environmental c o n d i t i o n s and each i n d i v i d u a l may d i f f e r " i n i n t e n s i t y and/or f u n c t i o n a l importance of the response from each component" ( 1976, p.267). Schwartz et a l . ( 1978 ) suggest that although p h y s i o l o g i c a l parameters may provide independent measures of c o g n i t i v e processes, they may not n e c e s s a r i l y always be a p a r t of the phenomenology of an x i e -t y . Consequently, Davidson and Schwartz ( 1976) have assumed that there are two r e l a t i v e l y independent types of anxiety, c o g n i t i v e and somatic, and that d i f f e r e n t i n t e r v e n t i o n s d i f -5R f e r In the degree to which they a f f e c t f he c o g n i t i v e and so— iratic system. Davidson (1978) proposed that p h y s i c a l e x e r c i s e would r e s u l t In r e d u c t i o n s p r i m a r i l y In somatic a n x i e t y with l e s s e f f e c t cn c o g n i t i v e a n x i e t y . A l t e r n a t i v e l y , a technique r e -q u i r i n g the s e l f - g e n e r a t i o n of c o g n i t i o n s would l e a d to greater r e d u c t i o n i n c o g n i t i v e versus somatic a n x i e t y . E v i -dence f o r t h i s p a t t e r n i n g i s presented by Schwartz, David-son, and Goleman ( 1 9 7 8 ) . They found that p a t t e r n i n g c o u l d be r e l i a b l y d i s t i n g u i s h e d on the b a s i s of the p a t t e r n i n g of c a r d i o v a s c u l a r , e l e c t r oder ital and electromyographic meas-ure s . In a d d i t i o n , they found that s u b j e c t s who r e g u l a r l y p r a c t i s e d e x e r c i s e ( j o g g i n g ) showed l e s s somatic than c o g n i -t i v e a n x i e t y than s u b j e c t s who r e g u l a r l y p r a c t i s e d medita-t i o n , although there was no s i g n i f i c a n t d i f f e r e n c e between groups on o v e r a l l anxiety assessed g l o b a l l y . A s s e s s i n g both phys1olegica 1 and c o g n i t i v e channels of anxiety, Crabbs and Hopper (1980) found that these channels were Independent but p a r a l l e l in n a t u r e . In support of Davidson and Schwartz's (1976) theory, they s p e c u l a t e d that the anxiety re spon se way be mode s p e c i f i c , that i s , experienced s o m a t i c a l l y and/or c o o n l t i v e l y . S u b j e c t s i n t h e i r study appeared to have an awareness of one dimension e x c l u s i v e of the other, w h ile other s u b j e c t s were moderately aware cf both dimensions. A few s t u d i e s report some support f o r the d i f f e r e n t i a l e f f e c -t i v e n e s s of treatments on the s u b s y s t e m s — c o g n i t i v e versus somatic* For example* L e h r c r , Scholcket f C a r r i h g t o n , and Woolfolk (1980) found that p h y s i o l c p l c a l and s e l f - r e p o r t measures d i f f e r e n t i a t e d Meditation and P r o g r e s s i v e Relaxa-t i o n on the c o g n i t i v e and s c i r a t i c mcdes. T e r e i l l a (1981) a l s o showed that c o g n i t i v e and somatic subcomponents were d i f f e r e n t i a l l y a f f e c t e d by Benson's Relaxation Response and P r o g r e s s i v e R e l a x a t i o n . A study by Jones (1981) u t i l i z e d 8r> s e l f - s e l e c t e d s u b j e c t s f o r a 1 0—week course In r a c k e t b a l l , running or m e d i t a t i o n . ... Comparing only the runners and the r a c k e t b a l l p l a y e r s , he found s u b j e c t s i r the e x e r c i s e pro-gram ( j o g g i n g ) r e p o r t e d decreases i n both somatic and c o g n i -t i v e a n x i e t y , while s u b j e c t s i n r a c k e t b a l l reported decreas-es s o l e l y i n somatic a n x i e t y . Cn g e n e r a l s e l f — r e p o r t measures of a n x i e t y , s u b j e c t s in the jogging, group decreased t r a i t a n x i e t y while s u b j e c t s p l a y i n g r a c k e t p a l l i n c r e a s e d s t a t e a n x i e t y . However, these f i n d i n g s should be c o n s i d e r e d c a u t i o u s l y , as the study s u f f e r e d from methodological Inade-quac i es• The Cognltive-Somat1c Anxiety Q u e s t i o n n a i r e developed by Schwartz et a l . (1978) i s a dual component s c a l e which s e p a r a t e l y a s s e s s e s c o g n i t i v e and somatic t r a i t anxiety and was used in t h i s study to assess the d i f f e r e n t i a l e f f e c t s of a c o g n i t i v e versus somatic treatments. 60 M££US»£&S .of 5.e.JLfr:JEJE/.i.5?.i»CJJ- A l t h o u g h s e l f - e f f i c a c y p e r se has n e t been s t u d i e d I n r e l a t i o n t o d i s t i n c t p s y c h o p a t h o -l o g i c a I c o n d i t i o n s , e f f i c a c y e x p e c t a t i o n s have been f o u n d to be a p o w e r f u l p r e d i c t o r o f n c n a v o i d a n t p e r f o r m a n c e i n a f e a r p r o d u c i n g s i t u a t i o n ( B a n d u r a , 1977), The a s s e s s m e n t of s e l f - e f f i c a c y may be v a l u a b l e In t h e i n v e s t i e a t i o n o f the r o l e o f c o g n i t i v e p r o c e s s e s l n b e h a v i o r change. K e n d a l l and K o r g e s k i ( 1 9 7 9 ) , i n t h e i r r e v i e w o f a s s e s s m e n t i n c o g n i t i v e -b e h a v i o r a l i n t e r v e n t i o n s , recommended t h a t e f f i c a c y e x p e c -t i o n s s h o u l d be u s e d as a d e p e n d e n t measure i n t h e r a p y o u t -come. S e l f - e f f i c a c y e x p e c t a t i o n s have been measured by b r i e f q u e s t i o n n a i r e s which have s u b j e c t s s t a t e whether o r n o t t h e y had e x p e c t e d t o be a b l e t o p e r f o r m each c f a l i s t of b e h a v -i o r s i n v o l v i n g t h e f e a r e d o t j e c t o r s i t u a t i o n . T h e y th e n r a t e , on a 10- t o 1 0 0 - p o l n t s c a l e , how c o n f i d e n t t h e y are. t h a t t h e y c o u l d c o m p l e t e the t a s k l i s t e d . The r e s p o n s e can be s c o r e d f o r l e v e l (how many t a s k s s u b j e c t s f e l t t h e y c o u l d p e r f o r m ) and s t r engt h ( b a s e d on the a v e r a g e c o n f i d e nc e sc c re p e r t a s k ) o f e f f i c a c y e x p e c t a t i o n s . A l t h o u g h t h e m e t h o d o l o -gy i s a p p l i c a b l e to any number o f b e h a v i o r s , a s p e c i f i c s e l f - e f f i c a c y i n s t r u m e n t would need to be d e v i s e d f o r each b e h a v i o r u n d e r I n v e s t i g a t i o n . f t seems s e n s i b l e t o assume t h a t a c h r o n i c a l l y a n x i o u s p e r s o n i s someone who m a i n t a i n s a g e n e r a l b e l i e f t h a t t h e 61 environment i s h o s t i l e , and that he or she i s Incahable of mastery ( I n e f f 1 c a c y ) • Such b e l i e f systems can t h e o r e t i c a l l y vary from the most general ( e v e r y t h i n g i s a t h r e a t ) , to mere s p e c i f i c s i t u a t i o n s or c l a s s e s of s i t u a t i o n s . Folkman, Schaefer, and Lazarus (1979) contend that "when we speak of b e l i e f s of s e l f — e f f i c a c y , we should recognize that t h i s v a r -i e s on a dimension from the most g e n e r a l to the s p e c i f i c " (p.287). While Bandura dees not view s e l f - e f f i c a c y as a g l o b a l p e r s o n a l i t y t r a i t , c o n t i n u i n g c o n t r o v e r s y e x i s t s r e -garding the u t i l i t y of s t a t e - t r a i t dimensions ( A l l e n S Pot-kay, 1981). Furthermore, Kazdln (1S78) suggests that a d d i -t i o n a l work i s needed to support the c o n s t r u c t of s e l f - e f f i c a c y and t h a t j " c o n s t r u c t , t r a i t , convergent, and d i s c r i m i n a n t v a l i d a t i o n would seem a p p r o p r i a t e " (p.182) in order to determine whether s e l f - e f f i c a c y i s , Indeed, the c r u c i a l c o n s t r u c t that i s being assessed. Coppel (1980) has developed a s e l f — r e p o r t i n v e n t o r y of s e l f - e f f i c a c y that appears to measure a broader t r a i t aspect of the c o n s t r u c t . He found that c o r r e l a t i o n s with other measures were i n the p r e d i c t e d d i r e c t i o n , that i s , higher s e l f — ef f icacy i n d i v i d u a l s were in b e t t e r health, had b e t t e r psycho1cgica 1 adjustments, had s i g n i f i c a n t l y greater s o c i a l c o n t a c t s , and were more i n t e r n a l i n t h e i r l o c u s of c o n t r o l . S e l f - e f f i c a c y has not yet heen assessed in aerobic con-d i t i o n i n g programs, however the s u b j e c t i v e reports of change in s e I f — c o n f i d e n e e and sense cf competence would warrant i t s 62 use as an outcome measure. A c c o r d i n g t o B andura ( 1.978). p e r f o r m a n c e a c c o m p l i s h m e n t s b a s e d on m a s t e r y e x p e r i e n c e s a r e e s p e c i a l l y i n f l u e n t i a l i n i n c r e a s i n g the l e v e l o f s e l f - e f f i -c a c y . Once e s t a b l i s h e d , enhanced s e l f - e f f i c a c y t e n d s to g e n e r a l i z e t o o t h e r s i t u a t i o n s i n w h i c h p e r f o r m a n c e was s e l f - d e b i l i t a t e d by p r e o c c u p a t i o n w i t h p e r s o n a l i n a d e q u a -c i e s . As a r e s u l t , B a n d u r a s u g g e s t s t h a t improvements i n b e h a v i o r a l f u n c t i o n i n g t r a n s f e r n o t o n l y t o s i m i l a r s i t u -a t i o n s but t o a c t i v i t i e s t h a t a r e s u b s t a n t i a l l y d i f f e r e n t from t h o s e on w h i c h th e t r e a t m e n t was f o c u s e d . B a n d u r a , Ad-ams, Hardy, and H o w e l l ' s ( 1 9 8 0 ) have p r o v i d e d some e v i d e n c e f o r t h e g e n e r a l i t y o f e f f i c a c y t h e o r y a c r o s s b e h a v i o r a l do-mains and t r e a t m e n t m o d a l i t i e s . C o n s e q u e n t l y , m a s t e r i n g the p e r c e i v e d d i f f i c u l t t a s k o f e n d u r a n c e t r a i n i n g f o r s e d e n -t a r y , m i d d l e - a g e d a d u l t s s h o u l d e n h a n c e s e l f - e f f i c a c y and g e n e r a l i z e t o o t h e r a r e a s o f d i f f i c u l t y . In a d d i t i o n , Ban-d u r a s u g g e s t s t h a t h a v i n g a s e r v l c a b l e c o p i n g s k i l l a t o n e ' s d i s p o s a l u n d o u b t e d l y c o n t r i b u t e s to one's sense of p e r s o n a l e f f i c a c y . More r e c e n t l y , SI outcome s t u d i e s have a s s e s s e d change i n s e l f - e f f I c a c y e x p e c t a t i o n s u s i n g s e l f — r e p o r t i n v e n t o r i e s . J aremko and W a l k e r ' s ( 1 9 7 8 ) s t u d y wHh s p e e c h a n x i o u s s u b -j e c t s f o u n d t h a t a t f o l l o w — u p , s u b j e c t s who r e c e i v e d SI t r a i n i n g showed a s i g n i f i c a n t i n c r e a s e i n s e l f - e f f i c a c y ex-p e c t a t i o n s from p r e t r e a t m e n t l e v e l s . However, t h e group t h a t r e h e a r s e d g e n e r a l r a t h e r t h a n s p e c i f i c 63 d i d not demonstrate s e l f - e f f i c acy change. S e v e r a l other s t u d i e s by Jaremko (Jaremko, 19SG; Jaremko et a l . . 19R0) a l s o demonstrated i n c r e a s e s in s e l f - e f f i c a c y f o r speech anx-ious s u b j e c t s a f t e r SI t r a i n l n t r . A study by Kendrick ( 1979) of musical performance a n x i e t y r e v e a l e d that on expectancy of e f f i c a c y , the s e I f - i n s t r u e t i c n and a t t e n t i o n f o c u s i n g group was s u p e r i o r to the b e h a v i o r a l r e h e a r s a l group a l -though both changed s i g n i f i c a n t l y frcm p r e t e s t i n g . While there i s some evidence that £1 t r a i n i n g f c r s p e c i f i c t a r g e t -ed areas enhances s e l f —e If icacy , the extent to which a SI program f o r m u l t i p l e a n x i e t i e s w i l l enhance s e l f - e l f i c a c y is yet to be determined. Measures of. SgIf~Stat.?5!ents• C o g n i t i v e f a c t o r s such as e x p e c t a t i o n s and a p p r a i s a l s which are considered d e t e r m i -nants of s t r e s s are thought to be given r e p r e s e n t a t i o n in language form through the person's p r i v a t e speech. Thus i n -t e r n a l sentences or s e I f — s t a t e m e n t s r e f l e c t e x p e c t a t i o n s and a p p r a i s a l s . P r i v a t e speech as s e l f - s t i m u l a t i o n i s thought to both s u s t a i n and e l i c i t s t r e s s r e a c t i o n s . However, the r e l a t i o n s h i p between p r i v a t e speech and s t r e s s i s s t i l l hy-p o t h e t i c a l . E a r l y l e a r n i n g theory f o r m u l a t i o n s of psychoth-erapy ( t o l l a r d 6 M i l l e r , 195:0) emphasized the r o l e of thought and language as cue-producinu responses that a f f e c t emotional a r o u s a l . However, the e f f e c t s of s e l f - s t a t e m e n t s on emotional s t a t e have j u s t begun to be explored, l a r g e l y due to the i n f l u e n c e of F i l l s (1973), neck (1976), and Mei-64 c h e n b a u i r (1977). A n e x t e n s i v e a c c o u n t o f t h e m e c h a n i s m s of p r i v a t e s p e e c h a n d i t s r o l e a s s e l f - 1 n s t r u c t i o n c a n b e f o u n d i n M e i c h e n b a u m (1977). W i t h t h e i n c r e a s i n g i n t e r e s t i n t h e t h i n g s p e o p l e say-t o t h e m s e l v e s , s e l f - s t a t e m e n t s a r e b e c o m i n g a n i m p o r t a n t f o -c u s f o r a s s e s s m e n t . K e n d a l l a n d K o r g e s k i ( 1979) a n d m o r e r e c e n t l y M e r l u z z i , G l a s s , a n d G e n e s t ( 1H81 ) h a v e r e v i e w e d s e v e r a l d e v i c e s f c r c o g n i t i v e s e l f - s t a t e m e n t a s s e s s m e n t . S e l f — s t a t e r n e n t i n v e n t o r i e s a n d r e c o n s t r u c t i o n t e c h n i -q u e s p r o v i d e p s y c h c m e t r i c a l l y s o u n d w a y s t o m e a s u r e t h e r e l -a t i v e i m p o r t a n c e o f c e r t a i n k i n d s o f t h i n k i n g f o r a d a p a t i v e a n d m a l a d a p t i v e b e h a v i o r . I n a d d i t i o n , t h e y c a n be u s e f u l i n t h e c o n f i r n a t l o n o f t r e a t m e n t m e c h a n i s m s ( K e n d a l l S K o r g e s k i , 1979). C a c i o p p o , G l a s s , a n d M e r l u z z i (1979) d e -v e l o p e d a n a s s e s s m e n t d e v i c e c a l l e d " t h o u g h t — 1 i s t i n a " , a r e -c o n s t r u c t i o n t e c h n i q u e n o t l i m i t e d t o a p r e d e t e r m i n e d numfcer o f s e l f — s t a t e m e n t s. T h e s e a u t h o r s a s s e s s e d - s e l f - s t a t e m e n t s b y h a v i n g s u b j e c t s w r i t e t h e i r t h o u g h t s a n d t h e n l a b e l t h e m a s p o s i t i v e , n e g a t i v e o r n e u t r a l . C o m p a r i s o n s o f t h e v a l i d i -t y o f t h i s o p e n - e n d e d a p p r o a c h w i t h t h e more s t r u c t u r e d s e l f - s t a t e m e n t i n v e n t o r y a p p r o a c h a r e n e e d e d , h o w e v e r , a ma-j o r d i f f i c u l t y i n t h e a r e a i s t h e l a c k o f a p p r o p r i a t e v a -l i d i t y c r i t e r i o n . A l t h o u g h K e n d a l l a n d K o r g e s k i (1979) c o n c l u d e d t h a t n e g a t i v e o r m a l a d a p t i v e c o g n i t i o n s m o r e t h a n a p a u c i t y o f p o s i t i v e o n e s a r e i m p o r t a n t c o n t r i b u t o r s t o b e h a v i o r a l p r o p -65 lems , more recent s t u d i e s suggest that t h i s r e l a t i o n s h i p is not so c l e a r . Tn Kendrick's ( 1979) musical performance anx-i e t y study, she found both c o g n i t i v e therapy and b e h a v i o r a l r e h e a r s a l s i g n i f i c a n t l y d i f f e r e n t from a p r e t e s t assessment at 5-week fo l l o w — u p on a se1f-staternent inventory, however, the treatments were not d i f f e r e n t from each other. In a d d i -t i o n , p o s i t i v e s e l f - s t a t e m e n t s a t p o s t t e s t i n g were a s s o c i a t -ed with r e d u c t i o n s i n v i s u a l signs of a n x i e t y at follow-up, but not to improved performance. Tn c o n t r a s t to t h i s study, K e n d a l l , W i l l i a m s , Fachacek, S h i s s l a k , and Herzoff (1979) found that c a r d i a c c a t h e t e r i z a t i o n s u b j e c t s ' n e g a t i v e s e l f -statements c o r r e l a t e d n e g a t i v e l y with p h y s i c i a n s ' r a t i n g s (r=-.34) and t e c h n i c i a n s ' r a t i n g s of adjustments ( jr=-,32). P o s i t i v e s e l f - s t a t e m e n t s were not s i g n i f i c a n t l y r e l a t e d , nor the degree t h a t the s u b j e c t s endorsed s e l f - s t a t e m e n t s r e l a t -ed to adjustment. The seIf-statement i n v e n t o r y d i d not d i s -t i n g u i s h between treatments, although the s u b j e c t s i n the s e l f - s t a t e m e n t m o d i f i c a t i o n i n t e r v e n t i o n e x h i b i t e d a h i g h e r number of p o s i t i v e s e l f - s t a t e m e n t s . U s i n g a t b o u g h t - l i s t I n g technique, A r n k o f f (1980) found that at post therapy, t e s t anxious s u b j e c t s who l e a r n e d to c h a l l e n g e t h e i r maladaptive b e l i e f s regarding achievementi showed s i g n i f i c a n t l y fewer negative s el f - st a t e me nt s p r i o r to an actvial exam than the w a i t i n g l i s t c o n t r o l s . Subjects who l e a r n e d to use s e l f - s t a t e m e n t s regarding worry, a t t e n t i o n and r e l a x a t i o n d u r i n g a t e s t , showed not only fewer neg— 66 a t I v e , b u t a l s o p i g r l f i c a n t l y m e re p o s i t i v e s e l f - s t a t e m e n t s t h a n w a i t i n g l i s t c o n t r o l s * M a l k i e w i c h a n d V e r l u z z i (1980) s t u d i e d s o c i a l l y a n x i o u s r r a l e s a n d f o u n d t h a t b o t h R a t i o n a l E m o t i v e T h e r a p y a n d S y s -t e m a t i c D e s e n s i t i z a t 1 on r e d u c e d n e g a t i v e s e l f — s t a t e m e n t s c o m p a r e d t o a c o n t r o l b u t w e r e n o t d i f f e r e n t f r o m e a c h o t h -e r * No d i f f e r e n c e s w e r e f o u n d f o r p o s i t i v e s e l f - s t a t e m e n t s a n d n e u t r a l s e I f — s t a t e m e n t s a s r a t e d b y t h e a u t h o r s * T h e t h o u g h t — I I s t i ng t e c h n i q u e , ( i . e . , s u b j e c t s w e r e a s k e d t o r e -c o n s t r u c t t h e i r t h o u g h t s ) was a d m i n i s t e r e d a f t e r a v i d e o t a o e d c o n v e r s a t i o n w i t h o t h e r g r o u p m e m b e r s * C a c l o p p o , G l a s s , a n d V e r l u z z i ( 1979 ) s h o w e d t h a t o n a t h o u g h t - l i s t i n g t e c h n i q u e , h i g h a n d l o w s o c i a l l y a n x i o u s s u b j e c t s r a t e d t h e i r s e l f - s t a t e m e n t s a s e q u a l l y f a v o r a b l e , b u t i n d e p e n d e n t j u d g e s r a t e d t h e t h o u g h t s b y h i g h s o c i a l l y a n x i o u s i n d i v i d u a l s a s b e i n g d i s t i n c t l y d i f f e r e n t . C r a i g -h e a d , K i m b a l l , a n d K e h a k ( 1979) d e m o n s t r a t e d t h a t s o c i a l l y a n x i o u s s u b j e c t s e m i t t e d m o r e n e g a t i v e s e l f - s t a t e m e n t s t h a n n o n - s o c i a l l y a n x i o u s s u b j e c t s . H o w e v e r , p o s i t i v e s e l f -s t a t e m e n t s d i d n o t d i f f e r e n t i a t e b e t w e e n g r o u p s . M e r l u z z l , C a c i o p p o , a n d G l a s s (1979) f o u n d t h a t h i ^ h s o c i a l l y a n x i o u s men's t h o u g h t s w e r e f o c u s e d mere on t h e m s e l v e s w h e r e a s , l ow a n x i o u s men's t h o u g h t s w e r e f o c u s e d on t h e i m p e n d i n g i n t e r -a c t i o n c r on t h e e t h e r p e r s o n . A. c a s e s t u d y b y H u r l b u r t a n d S i p p r e l l e (1978) u s e d a t h c u g h t — s a mpl i n a t e c h n i q u e ( r a n d o m i n t e r v a l g e n e r a t o r ) w i t h a. h i g h l y a n x i o u s m i d d l e - a g e d man. 67 Although s i g n i f i c a n t l y improved, they did not fin d a reduc-tion in the subjects' negative self-statements and they sub-sequently postulated that changing the bond between target cognitions and resultant problem behaviors or a f f e c t «as more important than changing self-statements. In addition, spontaneous i n i t i a t i o n of coping s e l f -statements (weisman S SobeI , 1979) have been observed in procedures such as systematic de sens 1 t i za 11 on (Lang, 1969), modeling (Geer S Turtletaub, 1967) and flooding (Marks, Boulougouri s, 8 Marset, 1971 )• Glogower, Fremouw, and McCroskey ( 1978 ) also described the spontaneous use of cop-ing statements in an experimental group that was not d i r e c t -l y taught to a l t e r t h e i r coping statements. From these studies, a clear pattern does not emerge re-garding the impact of self-statement programs on the genera-tion or perception of self—statement valences ( p o s i t i v e or negative). This may be due to the type of assessment device (inventory, reconstruction), the temporal aspects of the de-mand s i t u a t i o n ( a n t i c i p a t i o n , retrospect) end the o r i g i n of the ratings (subject, judges). Cacioppc et a l . 1 s thought-l i s t i n g technique used in this study is a direct test of the effectiveness of the self-statement m od 11' lea t i on program and an assessment of spontaneous self-statement change in the a e r o b i c conriit i n n i n g program. 68 A e r c b i c p o w e r , a n i n d i v i d u a l d i f f e r e n c e v a r i a b l e u s e d e x t e n s i v e l y b y e x e r c i s e p h y s i o l o g i s t s ( i s t r a n d S R o d a h l , 1.977 ), r e l a t e s t o t h e c a p a c i t y o f o n e ' s h e a r t a n d l u n g s t o e x t r a c t a n d u t i l i z e o x y g e n f r o m t h e a i r . . A e r o b i c p o w e r i s a l s o d e s c r i b e d a s c a r d i o r e s p i r a t o r y f i t n e s s a n d i s c o n s i d -e r e d b y many ( C a r d u s » 1978; M a t t h e w s S F o x , 1976) a s t h e b e s t s i n g l e m e a s u r e o f p h y s i c a l ( c a r d i o r e s p i r a t o r y ) f i t n e s s . I n a d d i t i o n , t h e p h y s i o l o g i c a l b e n e f i t s o f a e r o b i c e x e r c i s e i n t h e r e l i e f o f s t r e s s d e p e n d s u p o n f a v o r a b l e a d j u s t m e n t s i n m a x i m a l o x y g e n u p t a k e , m y o c a r d i a l a n d p e r i p h e r a l a d a p t a -t i o n s , a n d b l o o d c h e m i s t r y a n d f i b r i n o l y t i c m e c h a n i s m s ( E l i -o t , F o r k e r , G R o b e r t s o n , 1976). C o n s e q u e n t l y , a e r o b i c p o w e r i s a r e l e v a n t d e p e n d e n t m e a s u r e l n a n j i n v e s t i g a t i o n o f p h y s i c a l f i t n e s s , i s h i g h l y r e l a t e d t o maximum c a r d i a c o u t -p u t , a n d i s a n e x c e l l e n t d i s c r i m i n a t o r y m e a s u r e o f a n i n d i -v i d u a l ' s p r i o r e x e r c i s e h l s t c r y . A e r o b i c p o w e r c a n b e m e a s u r e d b y h a v i n g a p e r s o n w o r k p h y s i c a l l y t o h i s o r h e r maximum h e a r t r a t e a n d t h e n by d e -t e r m i n i n g how m u c h o x y g e n t h e p e r s o n I s e x t r a c t i n g f r o m t h e a i r . H o w e v e r , a f t e r a n e x t e n s i v e r e v i e w o f t e s t s o f a e r o -b i c p o w e r , i t was c o n c l u d e d t h a t t h e m o s t a p p r o p r i a t e t e s t f o r a h e t e r o g e n e o u s s a m p l e o f s t r e s s e d a d u l t s w o u l d b e a s u b m a x i m a l t e s t w h e r e m a x i m a l o x y g e n c o n s u m p t i o n (MV02) i s m e r e l y e s t i m a t e d . The i n d i r e c t e s t i m a t e o f MV02 p r o v i d e s a m e a s u r e o f c a r d i o r e s p i r a t o r y f u n c t i o n a l c a p a c i t y . By t a k i n g b o d y w e i g h t i n t o c o n s i d e r a t i o n , a r e l a t i v e m e a s u r e o f a e r o -69 b i c f i t n e s s can be u s e d t o c o m p a r e I n d i v i d u a l s o f d i f f e r c n t b o d y s i z e a s w e l l a s t o i n d i c a t e e n d u r a n c e c a p a c i t y f o r e x -e r c i s e t h a t r e q u i r e s r a i si n g t h e b o d y ' s c e n t r e o f g r a v i t y , a s i n w a l k i n g o r r u n n i n g . V a l u e s f o r t h e w e i g h t a d j u s t e d MV02 i n a s y m p t o m a t i c , s e d e n t a r y a d u l t s r a n g e f r o m b e l o w 20 t o o v e r 45 m i l l i l i t e r s p e r k i l o g r a m b o d y w e i g h t p e r m i n u t e . An i n d i v i d u a l i s c o n s i d e r e d t o he s e d e n t a r y i f he o r she d o e s n o t r e g u l a r l y p a r t i c i p a t e i n p h y s i c a l a c t i v i t y w h i c h m i g h t c o n f e r a c a r d i o v a s c u l a r t r a i n i n g e f f e c t . A m u l t i -s t a g e b i c y c l e e r g o i r e t e r t e s t was c h o s e n f o r t h i s s t u d y . T h e s p e c i f i c p r o t o c o l i s d i s c u s s e d i n t h e m e t h o d s s e c t i o n o f t h i s p a p e r ( s e e a l s o A p p e n d i x A ). I n c o n c l u s i o n , t h e f o l l o w i n g t r e a t m e n t o u t c o m e m e a s u r e s w e r e u s e d i n t h i s s t u d y ; S t a t e - T r a i t A n x i e t y I n v e n t o r y , T e n -s i o n T h e r m o m e t e r , C o g n i t 1 v e - S o m a t 1 c C u e s t i o n n a i r e , S e l f - e f -f i c a c y S c a l e , T h o u g h t - l i s t i n g , a n d a M u l t i - s t a g e S u b m a x i i t a l E i c y c l e T e s t . STATEMENT CF THE PROBLEM The present research has two major alms: (1) to d e t e r -mine the r e l a t i v e e f f e c t i v e n e s s of two stress—man agement treatments, a e r o b i c c o n d i t i o n i n g (AC) and s t r e s s - i n o c u l a t i o n ( S I ) , and (2) to assess the a c t i v e components of these pro-grams. It i s expected that bc-th programs w i l l s i g n i f i c a n t l y reduce s e l f - reported s t r e s s and maintain these reductions three months a f t e r completing the program. As the a e r o t i c c o n d i t i o n i n g program i s c o s t - e f f e c t i v e and has a d d i t i o n a l p h y s i c a l h e a l t h b e n e f i t s , i t s r e l a t i v e e f f e c t i v e n e s s t o a proven treatment package i s important i n f o r m a t i o n f o r h e a l t h p r o f e s s i o n a l s i n program p l a n n i n g . I t would a l s o be expected that s u b j e c t s who experience s t r e s s i n predominantly one mode ( c o g n i t i v e or somatic) would be more s u c c e s s f u l i n the treatment that f ocuses on that mode. This would be u s e f u l i n f o r m a t i o n In c o u n s e l l i n g i n d i v i d u a l s r e g a r d i n g an appro-p r i a t e i n t e r v e n t i o n f o r s t r e s s r e d u c t i o n . The r e l a t i o n s h i p of s f l f - e f f i c a c y and se If - 3 ta te me n t v a r i a b l e s to treatment e f f i c a c y would c o n t r i b u t e to a grow-i n g body of knowledge r e g a r d i n g behavior change that occurs from d i v e r s e t h e r a p i e s . In a d d i t i o n , these v a r i a b l e s are of p r a c t i c a l importance in the e v a l u a t i o n of treatment programs 71 t h a t f o c u s o n v a r i o u s c o m p o n e n t s o f t h e s t r e s s r e s p o n s e s y n -d r o m e . F u r t h e r m o r e , i f s t r e s s r e d u c t i o n I s d u e t o p a r t i c i -p a t i o n p e r s e i n a n a e r o b i c t r a i n i n g p r o g r a m , r a t h e r t h a n o r d e s p i t e t h e d e v e l o p m e n t o f an e f f i c i e n t c a r d i o v a s c u l a r s y s -t e m , t h i s k n o w l e d g e w o u l d c o n t r i b u t e t o t h e o r i e s o f s t r e s s a n d b e h a v i o r c h a n g e a s w e l l a s b e i n g r e l e v a n t f o r i n t e r v e n -t i o n p l a n n i n g o T h e f o l l o w i n g h y p o t h e s e s a r e a d v a n c e d i n t h e p r e s e n t s t u d y ; 1. F o t h a e r o b i c c o n d i t i o n i r g a n d s t r e s s i n o c u l a t i o n a r e m o r e e f f e c t i v e t h a n a n o - t r e a t m e n t w a i t i n g l i s t ( WL) c o n t r o l i n r e d u c i n g s t r e s s a s m e a s u r e d by s e l f — r e p o r t i n d i c e s • 2. A e r o b i c c o n d i t i o n i n g i s m o r e e f f e c t i v e t h a n s t r e s s i n o c u l a t i o n i n r e d u c i n g s t r e s s f o r s u b j e c t s who s e l f — r e p o r t s o m a t i c a n x i e t y a s b e i n g g r e a t e r t h a n c o g n i t i v e a n x i e t y , r e l a t i v e t o t h e s o m a t 1 c - t o — c o g n 1 -t l v e r e l a t i o n s h i p w l t h i r t h e g r o u p . 3. S t r e s s i n o c u l a t i o n i s m o r e e f f e c t i v e , t h a n a e r o b i c c o n d i t i o n i n g i n r e d u c i n g s t r e s s f o r s u b j e c t s who s e l f - r e p o r t c o g n i t i v e a n x i e t y a s b e i n g g r e a t e r t h a n s o m a t i c a n x i e t y , r e l a t i v e t o t h e c o g n i t i v e - 1 o - s o m a t I c r e l a t i o n s h i p w i t h i i i t h e g r o u p . 4. S t r e s s i n o c u l a t i o n i s m o r e e f f e c t i v e t h a n a e r o b i c c o n d i t i o n i n g i n r e d u c i n g n e g a t i v e s e l f - s t a t e m e n t s a n d i n c r e a s i n g p o s i t i v e s e l f - s t a t e m e n t s a s m e a s u r e d by a s e l f - r e p o r t index. 5. Aerobic c o n d i t i o n i n g i s more e f f e c t i v e than s t r e s s i n o c u l a t i o n i n i n c r e a s i n g s e l f - e f f i c a c y as measured by a s e l f - r e port i n d e x . In a d d i t i o n t o these hypotheses, a number of quest i o n s are suggested: 1. Co those p a r t i c i p a n t s with more e f f i c i e n t c a r d i o v a s -c u l a r systems as measured by p r e d i c t e d MV02 e x p e r i -ence l e s s s t r e s s ? 2« Do those p a r t i c i p a n t s i n the aerobic c o n d i t i o n i n g program who run f o r longer p e r i o d s of time e x p e r i -ence l e s s s t r e s s than those who run f o r s h o r t e r p e r i -ods o f t im e? 3. Do those p a r t i c i p a n t s with the g r e a t e s t i n c r e a s e in p r e d i c t e d NVC2 change the most on dependent measures of s t r e s s ? 4. Do p a r t i c i p a n t s i n the aer o b i c c o n d i t i o n i n g and/or s t r e s s I n o c u l a t i o n programs improve on a general measure of p h y s i c a l w e l l - b e i n g ? METHOD Subject recruitment took place In March, 1981, a t which time 126 community r e s i d e n t s from the g r e a t e r Vancouver area responded to newspaper advertisements, posted n o t i c e s , and a radio i n t e r v i e w , C.t those respondents, 72 were p e r s o n a l l y interviewed f o l l o w i n g telephone screening ( s e e Appendix B ); 57 s a t i s f i e d the i n t e r v i e w screening c r i t e r i a and were ac-cepted f o r the program. Subjects who were not .interviewed, due to time l i m i t a t i o n s , were t o l d that they would be con-t a c t e d i n June i f there was space f o r them in the summer groups. Subjects were randomly assigned to groups with males and females e q u a l l y d i v i d e d among the three groups ( a e r o t i c c o n d i t i o n i n g (AC1)=19, s t r e s s i n o c u l a t i o n ( SI 1 )= 19 , w a i t i n g l i s t c o n t r o l (WL) = 19). A t o t a l of 57 a d u l t s ranging i n age from 24 to 65 years with a median of 36,5 (M = 39.9, Sl>=10.6) p a r t i c i p a t e d . There were 36 females and 21 males. P r i o r to the summer r e p l i c a t i o n ( J u n e ) , 20 additlona.l respondents from March were i n t e r v i e w e d , 16 met the scre e n i n g c r i t e r i a and were randomly assigned to new AC and SI groups along with the other Wl sub j e c t s , who were a v a i l a b l e to p a r t i c i p a t e in the summer r e p l i c a t i o n study ( a e r o h i c c o n d i t i o n i n g r e p l i -c a t i o n (AC2) = 15, s t r e s s i n o c u l a t i o n r e p l i c a t i o n (SI2) = 15), - 73 -74 I n t h e * L g r o u p , 6 d i d n o t c o m p l e t e t h e p r o g r a m : 3 h a d c o n -f l i c t i n g h o l i d a y c o m m i t m e n t s ? , 2 f e l t t h e y no l o n g e r w a n t e d t o be i n v o l v e d , a n d o n e w a s i l l . M a l e s a n d f e m a l e s w e r e e q u a l l y d i v i d e d b e t w e e n t h e t w o g r o u p s . F o r t h e c o m b i n e d s o r i n g ( t r e a t m e n t ) a n d summer ( r e p l i c a t i o n ) g r o u p s , a t o t a l o f 73 a d u l t s r a n g i n g i n a g e i r o n 24 t o 65 y e a r s w i t h a m e d i -a n o f 36.8 (1=39.9, ^£=10.5) s a t i s f i e d s c r e e n i n g c r i t e r i a a n d w e r e a c c e p t e d i n t o t h e s t u d y . T h e r e w e r e 48 f e m a l e s a n d 25 m a l e s i n t h e t o t a l s a m p l e . T h e s e x d i s p r o p o r t i o n o c c u r -r e d b e c a u s e t h e i n i t i a l v o l u n t e e r s u b j e c t p o o l c o n t a i n e d f a r m o r e women t h a n men, n o t b e c a u s e t h e r e j e c t i o n r a t e was h i g h e r f o r men. T h e s u b j e c t s w e r e s e l e c t e d on t h e b a s i s o f t h e f o l l o w -i n g c r i t e r i a ? ( a ) t h e y w e r e e x p e r i e n c i n g a t l e a s t 2 o n g o i n g c h r o n i c i n t e r m i t t e n t s t r e s s o r s ; ( b ) t h e y r a t e d t h e m s e l v e s as f i v e o r a b o v e o n t h e T e n s i o n T h e r m o m e t e r ( W a l k , 1956); ( c ) t h e r e w a s n o p h y s i o l o g i c a l r e a s o n why t h e y c o u l d n o t p a r t i c -i p a t e i n a j o g g i n g p r o g r a m ; a n d ( d ) t h e y w e r e n o t c u r r e n t l y j o g g i n g t h r e e o r m o r e t i m e s p e r w e e k f o r a d u r a t i o n o f 30 o r r r o r e m i n u t e s p e r s e s s i o n . A s u m m a r y o f c l i e n t c h a r a c t e r i s t i c s , p r o f e s s i o n s a n d / o r o c c u p a t i o n s i s p r e s e n t e d i n A p p e n d i x H. The m a j o r i t y (59^) o f t h e s u b j e c t s w e r e m a r r i e d , 26% w e r e s i n g l e a n d t h e r e -m a i n i n g 15% w e r e w i d o w e d , s e p a r a t e d o r d i v o r c e d . E i g h t y -n i n e p e r c e n t w e r e e m p l o y e d * F i f t y - s e v e n p e r c e n t h a t a u n i -v e r s i t y e d u c a t i o n a n d 42% h a d a c o l l e g e o r h i g h s c h o o l e d u -c a t i o n * T h e m e d i a n t i m e p e r i o d t h e s u b j e c t s h a d b e e n c o n -c e r n e d a b o u t s t r e s s w a s t w o t o f i v e y e a r s t w i t h t h e mode b e -i n g g r e a t e r t h a n f i v e y e a r s * C v e r 80% h a d p r e v i o u s l y s o u g h t h e l p f o r s t r e s s . w i t h 39% h a v i n g s o u g h t h e l p f r o m t h e m e d i -c a l p r o f e s s i o n a t o n e t i m e . C f t h e s t r e s s f u l s i t u a t i o n s w h i c h b r o u g h t c l i e n t s t o t r e a t m e n t , t h e w e s t f r e q u e n t l y c i t -e d w e r e f a m i l y r e l a t i o n s h i p s a n d j o b d i s s a t i s f a c t i o n ( 32% e a c h ) . A p p e n d i x T c o n t a i n s e x a m p l e s o f p e r c e i v e d s t r e s s o r s . O n l y 13% o f t h e s u b j e c t s r e p o r t e d w e e k l y j o g g i n g o f two t o f i v e m i l e s , a n d 66% e n g a g e d i n p h y s i c a l a c t i v i t y l e s s t h a n t h r e e t i m e s p e r w e e k . N o n e o f t h e p a r t i c i p a n t s r e g u l a r l y j o g g e d t h r e e o r m o r e t i m e s p e r week f o r d u r a t i o n s l o n g e r t h a n 30 m i n u t e s p e r s e s s i o n * T h e r a n g e o f p r e d i c t e d M VO 2 i n m i l l i l i t e r s p e r k i l o g r a m b o d y w e i g h t p e r m i n u t e ( m l / k g / m i n ) f o r f e i r a l e s was 20 t c 55 (_M=30.9, j=D=7.4) a n d f o r m a l e s i t was 24 t c 52 ( M = 3 £ , 0 , SD=8.2). D u r i n g t e l e p h o n e s c r e e n i n g , r e s p o n d e n t s w e r e a s k e d q u e s t i e n s a b o u t t h e n a t u r e o f s t r e s s - p r o d u c i n g s i t u a t i o n s , t h e d u r a t i o n o f t h e p r o b l e m , c u r r e n t t r e a t m e n t r e g i m e n s , i n -t e r e s t i n t h e t r e a t m e n t b e i n g o f f e r e d , a c t i v i t y r i s k f a c -t o r s , a n d t h e i r w i l l i n g n e s s t o be r a n d o m l y a s s i g n e d t o t r e a tm en t • R e s p o n d e n t s c o n s i d e r e d a p p r o p r i a t e f o r t r e a t m e n t p a r -t i c i p a t e d i n a more e x t e n s i v e a s s e s s m e n t I n t e r v i e w i n w h i c h 76 i n f o r m a t i o n concerning "the f o l l o w i n g t o p i c s was s y s t e m a t i -c a l l y c o l l e c t e d . The i n t e r v i e w format i s appended (see Ap-pend i x B ) • 1. The s e v e r i t y of the problem: a) number o l s t r e s s f u l s i t u a t i o n s , b) amount of time dur i n g which the c l i e n t experienced an uncomfortable l e v e l of a n x i e t y , c) extent to which a n x i e t y i n t e r f e r e d with d a i l y ' l i v -i n g . 2. r e s c r i p t ion of s t r e s s f u l s i t u a t i o n s : a) s p e c i f i c i t y of an J<1 e ty—produc 1 n g s t i m u l i , b) a b i l i t y of c l i e n t to r e c o g n i z e commonalities a c r o s s s t r e s s f u l s i t u a t i o n s - . 3. The nature and outcome of past attempts to reduce s t r e s s . 4. M o t i v a t i o n f o r treatment. 5. Par Q - - A c t i v l t y r i s k f a c t o r s . The r i s k f a c t o r s were taken from a p h y s i c a l a c t i v i t y ques-t i o n n a i r e (Par Q) that has been v a l i d a t e d (Chisholm, ' C o l -l i n s , Kulak, Davenport, 8 Gruber, 1975). Those who respond-ed a f f i r m a t i v e l y to the Par 0 q u e s t i o n s were r e q u i r e d to o b t a i n a medical c l e a r a n c e lrom t h e i r f a m i l y p h y s i c i a n in order to p a r t i c i p a t e i n the program. 77 JjcaiflAr)^ a n i l S u£e,r_ v j . ^ j i £ j j s>£. £s~..\.ss.ii&£. &.P& I h e r a a J s t T e l e p h o n e a n d p e r s o n a l I n t e r v i e w s w e r e c o n d u c t e d b y t h e e x p e r i m e n t e r a n d t h e g r o u p c o - l e a d e r . T h r o u g h o u t t h e c o u r s e oJ! I n t e r v i e w i n g , a n y d i f f i c u l t i e s w h i c h a r o s e w e r e d i s c u s s e d w i t h t h e e x p e r i m e n t e r . T h e fcicycle e r g c m e t e r t e s t was a d -m i n i s t e r e d b y t h r e e i n d i v i d u a l s t r a i n e d i n e x e r c i s e s t r e s s t e s t i n g . A l l . w e r e • q u a l i f i e d i n g e n e r a l f i r s t a i d a n d a t l e a s t o n e t e s t e r w a s c e r t i f i e d i n C . P . E . ( c a r d i o - p u l m o n a r y r e s u s c i t a t i o n )• T h e e x p e r i m e n t e r a n d a c o m m u n i t y h e a l t h n u r s e w i t h s p e -c i a l t r a i n i n g i n e x e r c i s e p h y s i o l o g y a n d e x e r c i s e m a n a g e -m e n t , c o — l e d t h e g r o u p t r e a t m e n t s . B o t h h a d h a d e x t e n s i v e e x p e r i e n c e l e a d i n g a d u l t g r o u p s , a n d o n e was a r e g i s t e r e d p s y c h o l o g i s t i n B r i t i s h C o l u m b i a . B e f o r e t r e a t m e n t b e g a n , a s e r i e s o f m e e t i n g s was h e l d t o d i s c u s s t h e p u r p o s e s o f t h e p r o j e c t , t h e r a t i o n a l e s u n d e r l y i n g t h e c h c s e n t h e r a p i e s , a n d t h e s o e c i f i c p r o c e d u r e s i n v o l v e d . T h e c o - l e a d e r was u n a w a r e o f t h e s p e c i f i c h y p o t h e s e s b e i n g t e s t e d . A t r e a t m e n t m a n u a l b a s e d o n M e i c h e n b a u m a n d C a m e r o n ' s ( 1 9 7 3 ) ma n u a 1, C o r m i e r a. n d Co r m i e r ' s ( 1 9 7 9 ) c h a n t e r on s t r e s s i n o c u l a t i o n , a n d J a r e m k o ' s ( 1 9 7 9 ) s p e c i f i c a t i o n s r e -g a r d i n g t r e a t m e n t c o m p o n e n t s was d e v e l o p e d as a g u i d e f o r t h e s t r e s s - i n o c u l a t i o n p r o g r a m . T h e A m e r i c a n C o l l e g e o f S p o r t s M e d i c i n e ' s ( 1 9 8 0 ) ex e r c l s e g u i d e l i n e s we r e f o i l o wed I n d e v e l o p i n g i n d i v i d u a l j o g g i n g p r e s c r i p t i o n s . I n a d d i -t i o n , a c o u n s e l l i n g c o m p o n e n t d e s c r i b e d t y H i I y e r a n d M i t c -h e l l ( 1 9 7 9 ) , a u g m e n t e d b y a r e v i e w ci t h e l i t e r a t u r e on e x -78 e r c i s e adherence, c o n s t i t u t e d a manual developed f o r the a e r o b i c conditioning; treatment. Weekly meetings were h e l d to d i s c u s s problems and p r o g r e s s . The d e t a i l e d manuals of procedures prepared f o r both treatment c o n d i t i o n s formed the b a s i s f o r t h e r a p i s t t r a i n i n g . S u b j e c t s i n the treatment c o n d i t i o n s met i n groups of 19 (AC1, SI1 ) and 15 ( AC2 , SI2) members for a s e r i e s of ten one and one-half hour weekly group s e s s i o n s . The main treatment component's designed to be present in both the a e r o b i c c o n d i t i o n i n g and the s t r e s s - i n o c u l a t I o n treatments were; ( a ) an e d u c a t i o n a l phase p r e s e n t i n g a treatment r a t i o n a l e f o r s t r e s s management; (b) the use of s e 1 f - m c n 1 t o r i n g , that i s , keeping records of changes in symptoms and b e h a v i o r s ; ( c ) a graduated problem-solving ap-proach to managing s t r e s s ( e i t h e r p h y s i c a l or mental ); and (d ) an i n f o r m a l s u p p o r t i v e atmosphere with the c o — l e a d e r s a c t i n g as c o p i n g models and c o l l a b o r a t o r s . The s p e c i f i c ..treatment components that d i f f e r e n t i a t e d the two groups were d i r e c t i n s t r u c t i o n ln i d e n t i f y i n g and modifying s e l f - s t a t e m e n t s ( s t r e s s i n o c u l a t i o n ) and i n c r e a s -ing a e r o b i c power through a walk—jogging program. A&XL&hJLs. CpjjdJ.JJ»SIiiJ3fi • Subjects were . p l a c e d on a pro-g r e s s i v e walk/jogaing program and were encouraged to i n -crease t h e i r d i s t a n c e and decrease t h e i r time in a systemat— 70 i c w a y ( s e e A p p e n d i x F l o r d e t a i l s o f t h e e x e r c i s e p r e s c r i p t i o n a n d g u i d e l i n e s ) . S u b j e c t s w e r e t a u g h t b a s i c s t a t i c f l e x i b i l i t y m o v e m e n t s t o u s e a s a p r e s c r i b e d warm-up b e f o r e e a c h r u n . F o r e a c h t r a i n i n g s e s s i o n , t i m e s , d i s t a n c -e s a n d h e a r t — r a t e s w e r e r e c o r d e d ( p r e r u n a n d r e c o v e r y ) , as w e l l a s t h e e m o t i o n a l a n t e c e d e n t s a n d c o n s e q u e n c e s o f t h e r u n . T h e A m e r i c a n C o l l e g e o f S p o r t s M e d i c i n e ' s r e c o m m e n d a -t i o n s w e r e c a r e f u l l y f o l l o w e d r e g a r d i n g q u a l i t y a n d q u a n t i t y o f e x e r c i s e . C a r e w a s t a k e r t o e s t a b l i s h a n a t m o s p h e r e o f c o n c e r n a n d o f h e l p f u l n e s s t o a l l s u b j e c t s , a n d p e r s o n a l a t -t e n t i o n was g i v e n t o i n j u r i e s a n d c o m p l a i n t s . D u r i n g g r o u p s e s s i o n s s u b j e c t s w a l k / j o g g e d o n s i d e s t r e e t s f o r a h a l f m i l e u n t i l t h e y w e r e i n a p a r k a r e a w h e r e p a t h s w e r e a v a l l a — b l e • E a c h g r o u p s e s s i o n c o n s i s t e d o f 5 t o 10 m i n u t e s o f s t r e t c h i n g f o l l o w e d b y a g r o u p w a l k / j o g . A f t e r t h e j o g , c o o l i n g down a c t i v i e s w e r e f o l l o w e d b y d i s c u s s i o n s o f t h e s u c c e s s e s a n d f a i l u r e s o f t h e p a r t i c i p a n t s d u r i n g t h e p a s t w e e k . P r o b l e m s a n d c o n c e r n s a s w e l l a s s u c c e s s e s w e r e e x a m -i n e d f r o m a s u p p o r t i v e b u t a p r o b l e m — s o l v i n g p e r s p e c t I v e i E a c h s u b j e c t s e t t h e i r cwn p e r s o n a l i z e d e x e r c i s e g o a l b a s e d on h e a r t r a t e a n d p e r c e i v e d e x e r t i o n . The l a t t e r p a r t o f e a c h s e s s i o n c o n s i s t e d o f l e c t u r e s , d i s c u s s i o n s a n d d e m o n -s t r a t i o n s o f t o p i c s r e l a t e d t o j o g g i n g a n d i n c l u d e d : ( a ) p r o p e r e q u i p m e n t , ( b ) n u t r i t i o n , ( c ) i n j u r y p r e v e n t i o n a n d t r e a t m e n t , ( d ) c o n d i t i o n i n g e f f e c t s , ( e ) e x e r c i s e m a i n t e -n a n c e , a n d ( f ) e x e r c i s e p r i n c i p l e s . so S..t.XE.SS. XnoxyiajU.i?n. As o r i g i n a l l y conceived (Welchen-baum 5 Cameron, 1973 ), s t r e s s i n o c u l a t i o n c o n s i s t s of three phases: education, r e h e a r s a l and a p p l i c a t i o n . Meichenbaum and Cameron d e s c r i b e t h i s s e l f - s t a t e m e n t m o d i f i c a t i o n t r e a t -ment as i n v o l v i n g : (1) p r e s e n t i n g the r a t i o n a l e that s e l f -statements or v e r b a l i z a t i o n s mediate anxiety, ( 2 ) having c l i e n t s become aware of t h e i r s e l f - s t a teruents i n a n x i e t y a r o u s i n g s i t u a t i o n s , and ( 3 ) teaching c l i e n t s to r e p l a c e these statements and behaviors with incompatible s e l f -statements through r e h e a r s a l with a n x i e t y - a r o u s i n g s t i m u l i ( imagery ). Each s e s s i o n c o n s i s t e d of bcth l a r g e and small group d i s c u s s i o n s . In order to i n c r e a s e awareness, s u b j e c t s moni-tored ( d u r i n g the week) s i t u a t i o n s t h a t were a n x i e t y provok-i n g . S u b j e c t s i d e n t i f i e d t h e i r negative inner d i a l o g u e ln s t r e s s f u l s i t u a t i o n s and were taught to c h a l l e n g e or r e p l a c e i t with more p o s i t i v e s e l f - s t a t e m e n t s . The s t r e s s response was d e s c r i b e d as having f o u r phases and s u b j e c t s rehearsed coping s k i l l s and s e l f-s t at emen t s r e l e v a n t to each phase. Coping imagery'and a modified systematic d e s e n s i t l z a t ion procedure was a l s o i n c l u d e d . Tn order to reduce s u b j e c t a t t r i t i o n , p a r t i c i p a n t s were encouraged to n o t i f y the c o - l e a d e r s i n advance i f they were going to be absent. Those who d i d not comply were immedi-a t e l y telephoned upon missing a s e s s i o n . The reason f o r t h e i r absence was d i s c u s s e d and arrangements were made to 81 r e v i e w a n y m i s s e d m a t e r i a l . An e m p h a s i s was p u t on t h e p a r -t i c i p a n t ' s r e s p o n s i b i l i t y f o r k e e p i n g u p w i t h t h e m a t e r i a l . D e t a i l e d t r e a t m e n t m a n u a l s w e r e u s e d a s t h e b a s i s l o r e a c h s e s s i o n i n o r d e r t o s t a n d a r d i z e t r e a t m e n t p r o c e d u r e s a c r o s s g r o u p s . J S P . e r J j n e ^ t a l De.sJ.jgri A t i m e - l a g g e d c r o s s o v e r c o n t r o l d e s i g n o f t h r e e c o m p a -r a b l e g r o u p s w i t h r a n d o m a s s i g n m e n t t o g r o u p s was i m p l e m e n t -e d a n d i s p r e s e n t e d i n F i g u r e 3. A l l g r o u p s a r e m e a s u r e d on t h e o u t c o m e v a r i a b l e s p r i o r t o i n t e r v e n t i o n a t t i m e 1. One week l a t e r , a t t i m e 2, g r o u p A r e c e i v e s t h e a e r o b i c c o n d i -t i o n i n g p r o g r a m (AC1), g r o u p B r e c e i v e s s t r e s s i n o c u l a t i o n ( S I l ), w h i l e g r o u p C ( W L ) r e c e i v e s r.c p r o g r a m . A t t h i s p o i n t I n t i m e , g r o u p s A a n d B a r e s e r v i n g a s t h e e x p e r i m e n -t a l g r o u p s w h i l e C s e r v e s a s a c o n t r o l . A t t i m e 3 I t e r m i n a -t i o n o f 10-week t r e a t m e n t ) , o u t c o m e m e a s u r e s a r e t a k e n a g a i n on a l l g r o u p s . One week l a t e r , a t t i m e 4, t h e i n t e r v e n t i o n " c r o s s o v e r " t a k e s , p l a c e , w h e r e b y g r o u p C i s r a n d o m l y a s -s i g n e d t o t r e a t m e n t s ( AC2 , S 12 ) a n d r e c e i v e s t h e e x p e r i m e n -t a l i n t e r v e n t i o n s a n d g r o u p s A a n d B b e c o m e t h e c o n t r o l g r r r n p , r e c e i v i n g no I n t e r v e n t i o n . F i n a l l y , a t t i m e 5 ( a f t e r 10—week t r e a t m e n t ) o u t c o m e m e a s u r e s f c r a l l g r o u p s a r e t a k e n f o r a t h i r d t i m e . C o m p a r i s o n s o f t h e g r o u f s c o r e s on t h e o u t c cme m e a s u r e s a r e made a t t i m e s 1, 3, a n d £. C o m p a r i s o n s a t t i m e 1 i n d i -82 cate the c o m p a r a b i l i t y of the three groups on the outcome measures p r i o r to i n t e r v e n t l c n . Before and a f t e r compari-sons a t time 3, w i t h i n and between groups A, B, and C, give the f i r s t i n d i c a t i o n of program e f f e c t i v e n e s s and are iden-t i c a l to the comparisons that would be made in a c l a s s i c a l experimental study. Comparisons with group C between times 3 and 5 would r e p l i c a t e the experiment with group C. Within the l a t t e r two time p e r i o d s , the d i f f e r e n c e s observed be-tween group A and. B would i n d i c a t e whether the the p o s i t i v e e f f e c t s of the i n t e r v e n t i o n s diminished a f t e r t e r m i n a t i o n . A major advantage of the time—lagged c r o s s o v e r c o n t r o l design ( E p s t e i n S T r i p o d l , 1877) i s t h a t i n t e r n a l v a l i d i t y f a c t o r s are c o n t r o l l e d . Randomization of group assignment c o n t r o l s for d i f f e r e n t i a l s e l e c t i o n of s u b j e c t s and s t a t i s -t i c a l r e g r e s s i o n e f f e c t s . The r e p l i c a t i o n a l s o makes i t p o s s i b l e to i n f e r that f i n d l r a s that are c o n s i s t e n t through-out the experiment may he g e n e r a l i z e d to comparable programs wi t h i n s i m i l a r s e t t i n g . £ej5£Sden.J Mea^vjre«; T.h£ Sta.te-JTxftJ.t Ai3ALet.v lnS£XXlQZX&§ < ST.AI,-£, SJAI^T >-These i n v e n t o r i e s ( S p i e l b e r g e r , Gorsuch, K Lushene, 1970) were chosen as measures of both s i t u a t i o n a l and t r a i t anxie-t y . S t a t e a n x i e t y (STAl-S) r e f l e c t s a n x i e t y at a p a r t i c u l a r time ( s i t u a t i o n a l s t r e s s ) . The t r a i t Inventory (STAI-T) measures the c o n t i n u i n g s t r e s s r e a c t i o n s that appear to c h a r a c t e r i z e -the s u b j e c t over a range cf s i t u a t i o n a l c o n d i -t i o n s . It r e f l e c t s a tendency to manifest a s t r e s s r e a c t i o n to a v a r i e t y of c i r c u m s t a n c e s , thus e v i d e n c i n g c h r o n i c t e n -s i o n . These i n v e n t o r i e s have been used as outcome measures in both c o g n i t i v e and a e r o b i c treatment programs and are used here to f a c i l i t a t e comparison with ether s t u d i e s . The two i n v e n t o r i e s are b r i e f (15 minutes) s e l f - r e p o r t measures c o n s i s t i n g of twenty statements, each of which d e f i n e s a continuum of i n c r e a s i n g l e v e l s of i n t e n s i t y . High scores r e f l e c t t e n s i o n , nervousness, apprehension and t e a r f u l n e s s . E x t e n s i v e evidence has been presented to support the v a l i d -i t y of the STA I ( S p i e l b e r g e r et a l . , 1970). R e l i a b i l i t y and v a l i d i t y c o - e f f i c i e n t s are well w i t h i n a c c e p t a b l e t o l e r a n c e I e v e l s ( .73 t o .92 ) . Xfi.rig.i_on, Jhermomjeter» The Tension Thermometer, a d e r i v -a t i v e of Walk's ( 1 9 5 6 ) Fear Thermometer, was used to o b t a i n an o v e r a l l t e n s i o n r a t i n g . D a l l y responses are averaged over a seven—day p e r i o d . l i e Thermometer, which u t i l i z e s a 10—point s c a l e , i s quick to administer and i s a p p l i c a b l e to any f e a r s i t u a t i o n . A number of b e h a v i o r a l l y o r i e n t e d t h e r -apy outcome s t u d i e s have employed some form of the Thermome-t e r ( e . g . , Bowman, 1977). Immediate t e s t — r e t e s t c o r r e l a - -t i o n s (.94 to .98, Borkovec S Craighead, 1971) and r e l i a b i l i t y over s e v e r a l weeks ( r=.94, T r e x l e r C Karst, 1972) have been g e n e r a l l y q u i t e high in s t u d i e s of both snake phebia and speech a n x i e t y . Phobic p a t i e n t s ' r a t i n g s 84 o f f e a r l e v e l h a v e g e n e r a l l y c o r r e l a t e d h i g h l y w i t h t h e i r t h e r a p i s t ' s a n d m e d i c a l a s s e s s o r ' s r a t i n e s ( e . g . , .75 t o .87, W a t s o n S M a r k s , 1971 ). ( See A p p e n d i x C f o r a c o p y o f t h i s i n s t r u m e n t ) . S e l f - E f f l e e c y S c a l e . C o p p e l ' s (1980) S e l f - e f f i c a c y S c a l e i s b a s e d o n t h e c o n c e p t u a l i z a t i o n o f s e l f - e f f I c a c y p u t f o r t h b y B a n d u r a (1977) a n d i s a s s e s s e d a s a " t r a i t " . S e l l - e f f i c a c y i s t h e o r i z e d a s b e i n g t h e e x p e c t a t i o n - t h a t o n e c a n e x e c u t e t h e b e h a v i o r r e q u i r e d t o p r o d u c e a p o s i t i v e o u t -c o m e . An o r i g i n a l p o o l o f 25 s t a t e m e n t s w e r e b a s e d o n f a c e v a l i d i t y ( e . g . , " I n a new s i t u a t i o n I e x p e c t I c a n h a n d l e t h i n g s . " ) . T h e r e s p o n d e n t i s a s k e d t o r a t e e a c h o f 22 s e l f - d e s c r i p t i v e s t a t e m e n t s on a 5 — p o i n t s c a l e r a n s i n a f r o m " n o t a t a l l " t o " v e r y much l i k e me". I n a s t u d y by C o p p e l ( 1 980) u t i l i z i n g U n i v e r s i t y o f Washington u n d e r g r a d u a t e s t u d e n t s (a=166 ), t h e p e r c e i v e d s e l f - e f f i c a c y s c a l e d e m o n -s t r a t e d h i g h i n t e r n a l c o n s i s t e n c y ( c o e f f i c i e n t a l p h a = « 9 1 )• Tn a d d i t i o n , a t e s t — r e t e s t r e l i a b i l i t y c o e f f i c i e n t o f £=.86 w a s o b t a i n e d o v e r a t w o - w e e k i n t e r v a l (j\=90). C o p p e l p r e -d i c t e d t h a t s e l f - e f f I c a c y a n d s e l f — e s t e e m a s m e a s u r e d by t h e C o o p e r s m i t h S e l f - e s t e e m I n v e n t o r y wovil d b e s t r o n g l y r e -l a t e d . D a t a c o l l e c t e d b y C o p p e l r e v e a l e d t h e s e t w o s c a l e s t o h a v e c o r r e l a t i o n c o e f f i c i e n t s r a n g i n g i r o n x = • ° 8 to r=.73. I n a d d i t i o n , C o p p e l r e p o r t e d a p r i n c i p a l c o m p o n e n t s f a c t o r a n a l y s i s o f t h i s s c a l e a c c o u n t i n g f o r 56% o f t h e v a r i a n c e . T h e f o l l o w i n g f a c t o r s w e r e e s s e n t i a l l y s t a b l e o v e r a t w o -week i n t e r v a l . F a c t o r I c o n s i s t e d of statements d e a l i n g with p o s i t i v e c o p i n g , p r i d e , and p o s i t i v e l e a r n i n g expecta-t i o n s . Factor I I was made up of l o u r statements r e f l e c t i n g one's exp e c t a t i o n s i n i n t e r p e r s o n a l s i t u a t i o n s . F a c t o r I I I was made up of f i v e statements which deal with one's f e e l i n g of i n f l u e n c e , or c o n t r i b u t i o n to one's l i f e . F a c t o r I V had four statements which r e f l e c t negative s e l f - t h o u g h t s and lac k o f s e l f — a s s u r e d n e s s . XJhS3JfitlirJyLsi£iJ3iS • Change i n n e g a t i v e s e l f - s t a t e m e n t s was assessed by a t h o u g h t - l i s t i n g technique d e s c r i b e d by Ca-cioppo and Pe t t y (1SS1). Tn a d d i t i o n to s u b j e c t s ' r a t i n e s , the thoughts l i s t e d were submitted to two judges f o r s c o r i n g as e i t h e r p o s i t i v e , negative, n e u t r a l cr i r r e l e v a n t s e l f -statements. Judges were unaware of the c o n d i t i o n s to which s u b j e c t s were a s s i g n e d . Scores f o r both judges' and sub-j e c t s ' r a t i n g s of thoughts were computed by summing the num-ber o f statements l n each category f o r each s u b j e c t and c a l -c u l a t i o n s made of the p r o p o r t i o n of p o s i t i v e , negative and n e u t r a l thoughts to t o t a l thoughts. Thus each su b j e c t has p o s i t i v e , n e g a t i v e , and n e u t r a l r a t i o scores based on h i s or her own r a t i n g s and a judges* r a t i n g . Appropriate r e l i a b i l -i t y checks were made of the judaes* s c o r i n g , with c o r r e l a -t i o n s of .76 to .78 beine fcund cn r e s c o r i n g . I n t e r r a t e r r e l i a b i l i t i e s at pre, post and f O I I O W - U F are presented in Appendix K. The r e l i a b i l t i e s reported ( Independent and c o l -l a b o r a t i v e ) represent the s m a l l e r t o t a l d i v i d e d hy the l a r g -86 e r o n e m u l t i p l i e d b y 1 0 0 . When j u d p e g ' s c o r i n g d i d n o t a g r e e , the. s e l 1 - s t a t em e n t was d i s c u s s e d a n d r e s c o r e d . I f a g r e e m e n t was S t i l l n o t r e a c h e d , t h e s u b j e c t s ' r a t i n g was u s e d . E a s e d o n K a z d i n a n d S t r a w ' s ( 1 9 7 6 ) c o n v e n t i o n t h a t a g r e e m e n t s h o u l d f a l l b e t w e e n 8 0 ^ a n d 10 0%, a g r e e m e n t was c o n s i d e r e d a c c e p t a b l e . T h e r e l i a b i l i t i e s w e r e s u f f i c i e n t l y h i g h t o i n d i c a t e t h a t v a l e n c e s c a n be r e l i a b l y r a t e d o n s u b -j e c t s ' v e r b a l s e l f — r e p o r t e d t h o u g h t s . I n a d d i t i o n , C u l l e n ( 1 9 6 8 ) f o u n d t h a t b o t h s p l i t - h a l f a n d t e s t - r e t e s t r e l i a b i l i -t i e s w e r e a c c e p t a b l y h i g h . The a v e r a g e s p l i t — h a l f r e l i a b i l -i t y w a s . 6 4 . T h e m e a s u r e h a s b e e n f o u n d t o b e b o t h s e n s i -t i v e t o e n v i r o n m e n t a l I n t e r v e n t i o n s ( C a c l o p p o S P e t t y , 1 9 7 9 ) a n d a s s o c i a t e d w i t h r e l a t e d i n d i v i d x i a l d i f f e r e n c e s ( C a c l o p -p o , G l a s s , Q M e r l u z z i , 1 9 7 9 ) . I n t h e p r e s e n t s t u d y , s u b -j e c t s w e r e i n s t r u c t e d t o l i s t a l l t h o u g h t s t h a t o c c u r r e d t o t h e m d u r i n g a n i m a g i n e d s t r e s s f u l s i t u a t i o n . \ d e s c r i p t i o n o f t h i s p r o c e s s a p p e a r s i n - A p p e n d i x C. £PMBdAkX£=.S&m3i&l£ Ar>MX&lS QS2&S±lan&&JLre. < P. JA,Q ). T h i s t r a i t I n v e n t o r y ( S c h w a r t z , D a v i d s o n , S G o l e m a n , 1 9 7 3 ) was c o n s t r u c t e d b y s e l e c t i n g i t e m s f r o m w e l l — k n o w n q u e s t i o n -n a i r e s t h a t t h r e e i n d e p e n d e n t j u d g e s u n a n i m o u s l y a g r e e d r e -f l e c t e d c o g n i t i v e a n d s o m a t i c a n x i e t y . H a l f t h e 1 4 - i t e m s c o m p r i s i n g t h e I n v e n t o r y a r e c o g n i t i v e a n d h a l f a r e s o m a t i c . S u b j e c t s a r e a s k e d t o " r a t e t h e d e g r e e t o w h i c h y o u g e n e r a l -l y o r t y p i c a l l y e x p e r i e n c e t h i s s y m p t o m when y o u a r e f e e l i n g a n x i o u s " by c i r c l i n g a n u m h e r f r o m o n e t h r o u g h f i v e , w i t h 37 o n e r e p r e s e n t i n g " n o t a t a l l " a n d f i v e r e p r e s e n t i n g " v e r y much s o " . T h e s u m s o f t h e c i r c l e d r a t i n e s a r e s e p a r a t e l y c o m o u t e d l o r t h e c o g n i t i v e a n d s o m a t i c i t e m s * T h e c o g n i t i v e a n d s o m a t i c i t e m s a p p e a r i n r a n d c i r o r d e r . T o a s c e r t a i n v a -l i d i t y o f t h e CSAQ, S c h w a r t z e t a l . ( 1S7S ) c o m p u t e d c o r r e l a -t i o n s b e t w e e n t h e l a t t e r t e s t a n d a s t a n d a r d m e a s u r e o l t r a i t a n x i e t y . T h e S p i e l b e r g e r S t a t e — T r a i t A n x i e t y I n v e n t o -r y was a d m i n i s t e r e d i n t h e t r a i t f o r m t o a s a m p l e o f 78 n o n — e x e r c I s e r s , and. i t was o b s e r v e d t h a t c o r r e l a t i o n s b e -t w e e n t h e c o g n i t i v e a n d s o m a t i c s c a l e s o f t h e CSAQ a n d t h e S T A I —T w e r e b o t h h i g h l y s i g n i f i c a n t (£=.67 a n d . 40,. r e s p e c -t i v e l y ) . T h e c o r r e l a t i o n b e t w e e n c o g n i t i v e a n d s o m a t i c s c a l e s o f t h e CSAQ f o r t h e e n t i r e s a m p l e was r=0.42. T h e s e d a t a i n d i c a t e t h a t t h e c o g n i t i v e a n d s o m a t i c s c a l e s a r e mod-e s t l y c o r r e l a t e d , a n d t h a t t h e i r s h a r e d v a r i a n c e i s s u f f i -c i e n t l y l o w t o a l l o w f o r p a t t e r n i n g c f r e s u l t s a s a f u n c t i o n o f d i f f e r e n t t r a i n i n g e f f e c t s . S u b j e c t s whose r a t i o o f c o g -n i t i v e t o s o m a t i c s c o r e s w e r e g r e a t e r t h a n o n e w e r e c l a s s i -f i e d a s b e i n g i n t h e c o g n i t i v e mode a n d t h o s e w i t h a r a t i o o f o n e o r l e s s w e r e c l a s s i f i e d a s b e i n g i n t h e s o m a t i c m o d e . SilbflAXifflAl. ILicjKcle Ergjoaste r J e s j t . A c o n t i n u o u s , m u l -t i s t a g e , s u b m a x i m a l b i c y c l e e r g o m e t e r t e s t was u s e d t o p r e -d i c t m a x i m a l o x y g e n u p t a k e . T h e t e s t u s e s t h e h e a r t r a t e r e s p o n s e a t d i f f e r e n t w o r k l e a d s t o make t h i s p r e d i c t i o n . T h e a s s u m p t i o n o f t h i s t e s t i s t h a t h e a r t r a t e a n d o x y g e n u p t a k e a r e l i n e a r f u n c t i o n s c f w o r k r a t e , a n d t h u t a c c u r a t e e x t r a p o l a t i o n s c a n b e made. T h e t e s t c o n s i s t s o f a s e r i e s o f f o u r - m i n u t e work b o u t s t h a t p r o g r e s s h i g h e r i n l o a d and at a l e v e l d e p e n d e n t on the p a r t i c i p a n t ' s a b i l i t y . The t e s t p r o t o c o l u s e d i n t h i s s t u d y i s based on the PVVC170 t e s t . S i n c e b e i n g i n t r o d u c e d by S j o s t r a n d ( 1947) and Wahlund (1948 ), t h i s t e s t has been w i d e l y u s e d . A t e s t r e - t e s t r e -l i a b i l i t y c o e f f i c i e n t of .93 was r e p o r t e d f o r t h i s p h y s i c a l work c a p a c i t y ( PWC ) t e s t ( B o u c h a r d , B o u l a y , T h l b a u l t , C a r r i -e r , S D u l u c , 1980). A s t r a n d and fiodahl (1977) r e p o r t e d t h e s t a n d a r d e r r o r o f t h e method as about 10% In w e l l - t r a i n e d i n d i v i d u a l s o f t h e same age, and up t o 15% i n m o d e r a t e l y t r a i n e d i n d i v i d u a l s o f d i f f e r e n t a g e s when c o r r e c t e d f o r age. The subma*imaI t e s t p r o t o c o l a p p e a r s In A p p e n d i x A. An a p p r o p r i a t e r e g r e s s i o n e q u a t i o n c o n v e r t i n g work l e a d to MV02 was d e v e l o p e d by f i r s t c a l c u l a t i n g a s i m p l e l i n e a r e q u a t i o n f o r e a c h s u b j e c t ' s t h r e e h e a r t r a t e s and w o r k l o a d s . W o r k l o a d (WL) at maximum h e a r t r a t e (determine'd f r o m t a b l e d v a l u e s i n P o l l o c k , W l l m o r e , S Fox, 1S78) was p r e d i c t e d and s u b s e q u e n t l y c o n v e r t e d t o p r e d i c t e d MV02 by a r e g r e s s i o n e q u a t i o n b a s e d on t h e t a b l e d v a l u e s i n P o l l o c k e t a l . The f o l l o w i n g r e g r e s s i o n e q u a t i o n was u s e d : MV02=. 22476( MAXWL ) + .10857. MVC2 i n l i t e r s p e r m i nute was t r a n s f o r m e d to m i l -l i l i t e r s per k i l o g r a m body weight p e r m i n u t e . A n cj. lA.a ry_ nejjs,ur£.eg •> Tn order to a s s e s s g e n e r a l h e a l t h s t a t u s , the C o r n e l l M e d i c a l Symptoms C h e c k l i s t was a d m i n i s -t e r e d . T h i s measure l i s t s 62 symptoms o r p r o b l e m s t h a t peo-p l e sometimes h a v e . S u b j e c t s a r e a s k e d t o i n d i c a t e how much t h e c o m p l a i n t b o t h e r e d o r d i s t r e s s e d t h e m d u r i n g t h e p a s t w e e k o n a o n e t o l o u r s c a l e r a n g i n g f r o m " n o t a t a l l " t o " e x t r e m e l y " . P o s s i b l e s c o r e s r a n g e d . f r o m 62 t o 248 . T h e s y m p t o m s i n c l u d e d b o t h p h y s i c a l n n d p s y c h o l o g i c a l c o m -p l a i n t s . G e n e r a l h e a l t h m a y b e e x p e c t e d t o c h a n g e a s a r e -s u l t o l s t r e s s - m a n a g e m e n t p r o g r a m s o r , I n t u r n . p o o r h e a l t h m a y a l l ' e c t t r e a t m e n t o u t c o m e s ( L u b o r s k y 8 M c L e l l a n , 1-981 ). E21fi£JE!aH E v a l « a , t i p n . A q u e s t i o n n a i r e w a s a d m i n i s t e r e d t o a l l s u b j e c t s a t t h e e n d o f t r e a t m e n t a n d a t t h r e e - m o n t h f o l l o w — u p . S u b j e c t s w e r e a s k e d t o e s t i m a t e , o n a 5 — p o i n t s c a l e , how w e l l t h e y w e r e c o p i n g w i t h s t r e s s . T h e y a l s o u s e d 5 — p o i n t s c a l e s t o e s t i m a t e t h e v a r i o u s c o n t r i b u t i o n s o f t h e p r o g r a m s ' c o m p o n e n t s . I n a d d i t i o n , t h e y i n d i c a t e d o n o p e n - e n d e d q u e s t i o n s w h a t t h e y t h o u g h t w a s m o s t u s e f u l , w h a t t h e y w e r e d o i n g d i f f e r e n t l y , how t h e y f e l t d i f f e r e n t l y , a n d t o w h a t e x t e n t t h e y a c h i e v e d t h e i r g o a l s f o r t h e p r o g r a m . S u b j e c t s i n t h e j o g g i n g p r o g r a m w e r e a l s o a s k e d t o r e p o r t o n w h e t h e r t h e y i n c r e a s e d , d e c r e a s e d o r m a i n t a i n e d t h e i r j o g -g i n g p r o g r a m . ( S e e A p p e n d i x J ) i t e E a X f t j t u s , E a p . i _ B m e j i t , ijnd. EaslXXlAsS T h e b i c y c l e t e s t i n g w a s c o m p l e t e d a t t h e P h y s i o l c a y L a b o r a t o r y i n t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a ' s W a r M e m o -r i a l G y m . T w o a d j a c e n t r o o m s w e r e a v a i l a b l e l o r t h e c o m p l e -t i o n o f q u e s t i o n n a i r e s a n d d i s c u s s i o n s . T h e e q u i p m e n t a v a i l a b l e f o r u s e i n t h i s s t u d y i n c l u d e d t h r e e m e c h a n i c a l l y 90 b r a k e d Monark b i c y c l e e r e o m e t e r s and t h r e e 3 — l e a d e l e c t r o -c a r d i o g r a p h s . The t r e a t m e n t g r o u p s met once a week f o r one and a h a l f h o u r s i n a C o n t i n u i n g E d u c a t i o n C o n f e r e n c e room i n downtown V a n c o u v e r . The rooir was e q u i p p e d w i t h a b l a c k -b o a r d and had a c a r p e t e d f l o o r . P.Efl£e<|ijrjgs. D u r i n g the p e r s o n a l i n t e r v i e w , a l l r e s p o n d e n t s a s s e s s e d as a p p r o p r i a t e were a s k e d to s i g n a c o n s e n t form ( s e e Appen-d i x D)« The f o l l o w i n g a s s e s s m e n t b a t t e r y : S t a t e — T r a i t I n -v e n t o r y , S e l f - e f f i c a c y S c a l e , C o r n e l l M e d i c a l Symptoms C h e c k l i s t , T e n s i o n Thermometer, C o g n i t i ve—Som at Ic A n x i e t y Quest 1 o n n a r i e , and T h o u g h t - i i s t i n g T e c h n i q u e was a d m i n i s -t e r e d i n a b a l a n c e d o r d e r so t h a t c a r r y o v e r was c o n t r o l l e d f o r . A p p o i n t m e n t s f o r f i t n e s s t e s t i n g were s c h e d u l e d f o r weekend m o r n i n g s . A d e s c r i p t i o n o f t h e t e s t i n g r e q u i r e -ments, r a t i o n a l e f o r t h e t e s t , and any c o n c e r n s or a n x i e t i e s about t h e t e s t i n g p r o c e d u r e s were d i s c u s s e d . J5Xfi££.is>£ J L S S * J^ jr oc_edujr e_s- . The s u b j e c t s a r r i v e d at t h e p h y s i o l o g y l a b o r a t o r y two o r t h r e e a t a. t i m e and were g r e e t -ed by t h e e x p e r i m e n t e r . Most came a p p r o p r i a t e l y d r e s s e d f o r t h e t e s t , a l t h o u g h change and shower f a c i l i t i e s were a v a i l a -b l e . W e i g h t , b l o o d p r e s s u r e , e x e r c i s e h i s t o r y , and 24-hour m e d i c a l s t a t u s was a s s e s s e d ( s e e A o p e n d l x F ) . E a c h s u b j e c t r e c e i v e d t h e p e r s o n a l a t t e n t i o n of the e x p e r i m e n t e r . De-t a i l e d v e r b a l e x p l a n a t i o n s of t h e t e s t p r o c e d u r e s were g i v e n p r i o r t o e x e r c i s e t e s t i n g . P a r t i c u l a r a t t e n t i o n was g l v o n t o d e s c r i b i n g t e s t p r o c e d u r e s s o t h a t t h e s u b j e c t f u l l y u n -d e r s t o o d t h e t e s t i n g r o u t i n e a n d d e v e l o p e d a p o s i t i v e a t t i -t u d e , t h e r e b y e n h a n c i n g t h e v a l i d i t y o f t h e t e s t r e s u l t s . E a c h b i c y c l e e r g o m e t e r s t a t i o n w a s p a r t i t i o n e d b y s c r e e n s t o e n s u r e p r i v a c y d u r i n g t e s t - t a k i n g . O n c e t h e f i t n e s s t e s t w a s c o m p l e t e d , d a t e , t i m e a n d p l a c e o f t h e f i r s t g r o u p m e e t i n g f o r t h e t r e a t m e n t g r o u p s was g i v e n v e r b a l l y a n d i n w r i t i n g . T h e s u b j e c t s a s s i g n e d t o t h e w a i t i n g l i s t w e r e t o l d t h a t a l t h o u g h t h e p r e s e n t p r o g r a m was f u l l , i t was g o i n g t o be r e p e a t e d i n t h r e e m o n t h s a n d t h a t t h e y w e r e g u a r a n t e e d a p o s i t i o n i n t h e g r o u p . A l l s u b -j e c t s w e r e r e a s s e s s e d w i t h t h e a b o v e m e n t i o n e d a s s e s s m e n t b a t t e r y a n d f i t n e s s t e s t a t t h e e n d o f t h e 10-week t r e a t m e n t p e r i o d . A 11—week n o - c o n t a c t p e r i o d t h e n e l a p s e d d u r i n g w h i c h t i m e t h e w a i t i n g l i s t g r o u p r e c e i v e d t r e a t m e n t ; t h e s t u d y w a s , t h e n , e s s e n t i a l l y r e p l i c a t e d . J5aJJLQ.£.~SAIl» E l e v e n w e e k s a f t e r c o m p l e t i n g t h e p r o g r a m t h e f i r s t t w o e x p e r i m e n t a l g r o u p s w e r e c o n t a c t e d b o t h by t e l e p h o n e a n d m a i l a n d w e r e r e a s s e s s e d i n t h e s a m e m a n n e r as p r e v i o u s l y d e s c r i b e d . A s a c h e c k on t h e p o s s i b i l i t y t h a t t h e e x p e r i m e n t a l c o n d i t i o n s g e n e r a t e d d i f f e r e n t d e m a n d c h a r a c t e r i s t i c s , t h r e e r a t i n g s o f " c o n f i d e n c e l n t r e a t m e n t " w e r e o b t a i n e d . The 92 f i r s t r a t i n g s c a l e was a d m i n i s t e r e d a n o n y m o u s l y a f t e r t h e s u b j e c t s w e r e p r e s e n t e d w i t h t h e r a t i o n a l e f o r t h e i r p a r t i c -u l a r t r e a t m e n t c o n d i t i o n a t the' e n d o f t h e f i r s t s e s s i o n . T h e s e c o n d r a t i n g was a d m i n i s t e r e d i m m e d i a t e l y a f t e r t h e l a s t t r e a t m e n t s e s s i o n b u t b e f o r e p o s t t e s t i n g . T h e t h i r d r a t i n g was a d m i n i s t e r e d a t f o l l o w - u p p r i o r t o t e s t i n g . S u b -j e c t s w e r e a s k e d how l o g i c a l t h i s t y p e o f p r o g r a m s e e m s , how c o n f i d e n t t h e y w e r e t h a t t h e p r o g r a m w i l l b e / o r was s u c c e s s -f u l i n r e d u c i n g t h e i r s t r e s s r e a c t i o n s , a n d how c o n f i d e n t t h e y w e r e i n r e c o m m e n d i n g t h e p r o g r a m t o a f r i e n d who was e x t r e m e l y a n x i o u s . T h e r a t i n g f o r m c o n s i s t s o f a s e v e n -p o i n t s c a l e a n c h o r e d w i t h " n e t a t a l l " s c o r e d " 0 " a n d " v e r y much s o " s c o r e d " 7 " . Due t o l i m i t e d r e s o u r c e s a v a i l a b l e , p a r t i c i p a n t s i n n e e d o f m e d i c a l s u p e r v i s i o n c o u l d n o t be a c c e p t e d i n t o t h e p r o g r a m . F i v e r e s p o n d e n t s w e r e i n a p p r o p r i a t e f o r m e d i c a l r e a s o n s . R e c r u i t m e n t was d o n e o n a l i m i t e d s c a l e , r e l y i n g m a i n l y o n p e r s o n a l p r e s e n t a t i o n s i n t h e c o m m u n i t y a n d s m a l l n e w s p a p e r a d v e r t i s e m e n t s . A b o u t 7 0 % o f t h e r e s p o n s e s w e r e t h e r e s u I t o f a r a d i o t a l k — s h o w p r e s e n t a t i o n a n d may h a v e i n t r o d u c e d a b i a s i n t h e s a m p l e . I n a d d i t i o n , m e a s u r i n g p h y s i o l o g i c a l i n d i c e s o f c h a n g e r e l a t e d t o t h e s t r e s s r e -s p o n s e ( i . e . , n o r a d r e n a 11n, a d r e n a l i n , C o r t i s o l ) w a s a l s o b e y o n d t h e s c o p e o f t h i s s t u d y , t h u s a g r e a t e r r e l i a n c e was 93 made on s e l l " - r e p o r t m e a s u r e s . A l t h o u g h e v a l u a t i n g m a i n t e -nance o l e f f e c t s a c r o s s t i m e i s i m p o r t a n t , due t o p r a c t i c a l r e a s o n s , e v a l u a t i o n was not c a r r i e d c u t be y o n d t h r e e months. 2§Jl& A n a l y s i s The d a t a was a n a l y z e d u s i n g a r e p e a t e d measures m u l t i -v a r i a t e a n a l y s i s of v a r i a n c e { MA NOVA ) . The M" ULTI VAPT ANCE ( F i n n , 1977) computer program was employed t o p e r f o r m t h e MANOVA. The use of m u l t i v a r i a t e p r o c e d u r e s p e r m i t s t h e a n a l y s e s o f m u l t i p l e outcome s c o r e s w i t h c o n s i d e r a t i o n o l t h e i r I n t e r c o r r e l a t i o n s i n c o n t r o l l i n g Type I e r r o r r a t e . I f , as a r e s u l t o f t h e otrnifcus m u l t i v a r i a t e t e s t , the n u l l h y p o t h e s i s o f no d i f f e r e n c e i s r e j e c t e d , c o r r e s p o n d i n g u n i -v a r i a t e JF s t a t i s t i c s a r c t e s t e d i n d i v i d u a l l y to d e t e r m i n e which v a r i a b l e ( s ) a c c o u n t f o r the s i g n i f i c a n t group-mean d l f f e r e n c e ( s ). S i n c e ' the d a t a were a n a l y z e d by m u l t i v a r i a t e a n a l y s e s o f v a r i a n c e , t h e r e p e a t e d measures were t r e a t e d as m u l t i p l e d e p e n d e n t measures i n a c c o r d a n c e w i t h t h e recommendations of F i n n ( 1975 ). F o r e x a m p l e , the t h r e e r e p e a t e d measures ( I . e . , p r e , p o s t , and f o l l o w - u p ) a r e t r a n s f o r m e d to two i n -dep e n d e n t measures t h r o u g h the u s e o f o r t h o g o n a l t r a n s f o r m a -t i o n s . T i l l s r e s u l t s i n t h e two de p e n d e n t v a r i a b l e s ( p r e v e r s u s t h e a v e r a g e of p o s t and f o l l o w — u p , and p o s t v e r s u s f o l l o w - u p ) and r e q u i r e s a d i f f e r e n t i n t e r p r e t a t i o n o f t h e •MANOVA r e s u l t s : t h e g r o u p s main e f f e c t i s an i n d i c a t i o n o f ,94 v a r i a b i l i t y anion? groups on these d i f f e r e n c e s c o r e s . Thus i t i s e q u i v a l e n t t o the more t r a d i t i o n a l repeated measures group by time i n t e r a c t i o n and should he i n t e r p r e t e d s i m i l a r -l y . Planned orthogonal c o n t r a s t s necessary to t e s t p r e c i s e -l y Hypotheses 1« 4 and 5 were the average of the two t r e a t -ments versus a w a i t i n g l i s t c o n t r o l and a between treatment comparison. Hypotheses 2 and 3 included a between treatment comparison b l o c k e d on the c o g n i t i v e and somatic mode. RESULTS T h e r e s u l t s o f t h i s s t u d y a r e p r e s e n t e d i n t h e f o l l o w -i n g s e q u e n c e : 1. C h i - s c j u a r e a n a l y s e s t o e v a l u a t e t h e c o m p a r a b i l i t y o f g r o u p s o n a n u m b e r o f d e m o g r a p h i c v a r i a b l e s a f t e r r a n d o m a s -s i g n m e n t o f s u b j e c t s t o g r o u p s * 2. T h e r e s u l t s o f a n a l y s e s o f v a r i a n c e t o a s s e s s s u b -j e c t s ' e x p e c t a t i o n s o f t r e a t m e n t e f f e c t i v e n e s s . 3 . T h e r e s u l t s o f t h r e e s e r i e s o f m u l t i v a r i a t e a n d u n i -v a r i a t e a n a l y s e s o f v a r i a n c e t o t e s t f o r d i f f e r e n t i a l e f f e c -t i v e n e s s o f t r e a t m e n t a n d c o n t r o l c o n d i t i o n s ( H y p o t h e s e s 1, 2.S 3 . 4 S 5 ) . P l a n n e d o r t h o g o n a l c o n t r a s t s w e r e n e c e s s a r y t o t e s t t h e h y p o t h e s e s p r e c i s e l y . ) 4. W i t h r e s p e c t t o t h e r e p l i c a t i o n o f t h e s t u d y * t h e r e p l i c a t i o n g r o u p s ( A C 2 , S I 2 ) w e r e c o m p a r e d t o t h e t r e a t m e n t g r o u p s ( A C 1 , S T l ) t o d e t e r m i n e I f t h e y e x h i b i t e d t h e s a m e n a t u r e a n d d e g r e e o f c h a n g e o v e r t i m e . W h e r e t h i s h e l d , t h e d a t a w e r e c o l l a p s e d a c r o s s r e p l i c a t e s ( AC 1 + A.C2=ACC; S I 1 + S I 2 = S T C ) f o r a n a l y s e s o f t h e h y p o t h e s e s . 5. A n a l y s e s t o e v a l u a t e t h e m a i n t e n a n c e o f t r e a t m e n t e f f e c t s b o t h i f c m p r e t o t h e a v e r a g e o f p o s t a n d f o l l o w — u p , a n d f r o m p o s t t o f o l l o w - u p . 6 . F i n a l l y , t h e r e s u l t s o f a n a l y s e s f o r s o m e a d d i t i o n a l q u e s t i o n s t h a t w e r e r a i s e d b y t h i s s t u d y a r e d i s c u s s e d r e l a -t i v e t o p r e d i c t e d VVC2 a n d t h e C o r n e l l M e d i c a l S y m p t o m s C h e c k I 1 s t . B e f o r e t h e a n a l y s e s , s i x s u b j e c t s ' d a t a w e r e d i s c a r d e d * One s u b j e c t m o v e d a f t e r a t t e n d i n g o n l y t w o s e s s i o n s ( S I I ) ; o n e s u b j e c t r e f u s e d t o p a r t i c i p a t e i n t h e j o g g i n g p r o g r a m ( A C ! ) a n d w a s s u b s e o u e n t l y a s s i g n e d t o t h e w a i t i n g l i s t ( WL ) g r o u p . T h r e e s u b j e c t s a t t e n d e d l e s s t h a n t w o s e s s i o n s ( AC2 ) f o r h e a l t h a n d f a m i l y . r e a s o n s a n d w e r e c o n s i d e r e d d r o p -o u t s . Two s u b j e c t s , a l s o c o n s i d e r e d d r o p - o u t s , d i d n o t a t -t e n d a n y s e s s i o n s ( S 12 ) a s one m o v e d a n d t h e o t h e r h a d w o r k c o n f l i c t s . S u b s e q u e n t l y , f o r t h e p u r p o s e s o f a n a l y s e s , t h e g r o u p s c o n s i s t e d o f : A e r o b i c C o n d i t i o n i n g ( A C 1=18); S t r e s s I n o c u l a t i o n ( S I l = 1 8 ) ; W a i t i n g L i s t (WL=20); A e r o b i c C o n d i -t i o n i n g r e p l i c a t i o n (AC2=12); S t r e s s I n o c u l a t i o n r e p l i c a t i o n (SI2=13); A e r o b i c C o n d i t i o n i n g C o m b i n e d (ACC=30); S t r e s s I n -o c u l a t i o n C o m b i n e d (STC=31). T h e r e l a t i o n s h i p s a m o n g t h e g r o u p s a n d t h e d e m o g r a p h i c v a r i a b l e s o f a g e , m a r i t a l , s t a t u s , a n d e d u c a t i o n w e r e e x a m -i n e d Dy s e p a r a t e c h i — s q u a r e t e s t s o f i n d e p e n d e n c e f o r b o t h t h e i n i t i a l t r e a t m e n t a nd c o n t r o l g r o u p s ( A C l , S I l , W L ) a n d t h e c o m b i n e d t r e a t m e n t a n d r e p l i c a t i o n g r o u p s ( ACC , S I C ) . T h r e e d e m o g r a p h i c v a r i a b l e s w e r e c o m p a r e d : m a r r i e d v e r s u s 97 n o n m a r r i e d , h i g h s c h o o l o r c o l l e g e v e r s u s u n i v e r s i t y d e g r e e , and ages 35 y e a r s and o l d e r v e r s u s under 35 y e a r s . T h e r e were no s i g n i f i c a n t d i f f e r e n c e s among g r o u p s on any o f "the t h r e e v a r i a b l e s . The r e s u l t s o f t h e c h i - a q u a r e t e s t s a r e p r e s e n t e d i n T a b l e 1. The d i s p r o p o r t i o n a l i t y o f gend e r i s s i m i l a r to o t h e r s t u d i e s u t i l i z i n g v o l u n t e e r community r e s -i d e n t s ( G o l d f r i e d , L i n e h a n , 8 S m i t h , 1.878; K a n t e r 8 G o l d -f r i e d , 1979; Y o r d e 8 Witmer, 1980). C o r r e l a t i o n s among a l l d e p e n d e n t measures were c a l c u -l a t e d ; the c o r r e l a t i o n m a t r i x i s p r e s e n t e d In A p p e n d i x G and I n c l u d e s p r e and p o s t d a t a f o r t h e combined t r e a t m e n t g r o u p s (ACC 8 S I C ) . The g r o u p a s a whole had a mean s c o r e o f 6.7 (SJJ=1.3) on the T e n s i o n Thermometer. The r a t i n g i n d i c a t e s a moderate l e v e l of o v e r a l l t e n s i o n ( W a l k , 1956). Mean s c o r e s f o r T r a i t a n d S t a t e A n x i e t y were 47.7 and 43.0, r e s p e c t i v e l y (SJJ=9.8 and 1 2 . 8 ) . The T r a i t s c o r e Is s i m i l a r to t h e a v e r -age s c o r e r e p o r t e d f o r a g r o u p o f p s y c h i a t r i c p a t i e n t s (47.7 ) w i t h a d i a g n o s i s of a n x i e t y r e a c t i o n ( S p i e l b e r g e r et a l . , 1970 ) and the S t a t e s c o r e o f t h e p r e s e n t sample i s com-p a r a b l e to g e n e r a l m e d i c a l and s u r g i c a l p a t i e n t s ( 42.4) a l s o r e p o r t e d by S p i e l b e r g e r e t a l • ( 1 9 7 0 ) . On the S e l f — e f f i c a c y S c a l e , the mean s c o r e o f 74.8 (SJJ-13.4) p r i o r t o t r e a t m e n t i s l o w e r than t h e mean ( 7 6 . 5 ) r e p o r t e d by C o n p e l ( 19^0) f o r a g r o u p o f c o u n s e l l i n g c e n t r e 98 c l i e n t s , Indicating lower s c U - e i l l c a c y than this-: c l i n i c a l group. On this scale possible scores raneed from zero to 110, with higher scores i n d i c a t i n g a greater sense, of compe-tence. For males and females t i e mean scores on predicted MV02 in ml/kg/min were 35.0 (J§I>=.S.2) and 30.9 ( SD=7.4), respec-t i v e l y . These means are similar to those reported by Massi-cotte, Avon, and Corriveau ( 1979) for r e l a t i v e l y sedentary adults (36.5 and 29.S, r e s p e c t i v e l y ) . Average weights for the AC1 and SI1 groups at pre, post. and follow-up were 68.9, 69.3, 68.4 and 64.5, 64.9, 65.2, respectively. In order to insure anonymity, subjects were assessed without i d e n t i f i c a t i o n , therefore the expectancy measure could not be analyzed as repeated measures. Two-way (groups by time) ran do;n lz ed—group » analyses of variance were comput-ed on expectations of treatment effectiveness. This v a r i -able is measured on a seven-point scale, resulting from three questions administered after the f i r s t session, the la s t session and at three-month follow-up. Scores were sum-med across questions for the analyses. The means and stan-dard deviations are presented in Table 2. A nonsignificant group by time Interaction indicated that the AC 1 and ST1 groups did not change d i f f e r e n t i a l l y from pre— to posttest-ing (F<1 ). Further analyses revealed a nonsignificant ( rep — 99 l i c a t i c r t b y g r o u p b y t i m e ) i n t e r a c t i o n l o r t h e t r e a t m e n t ( A O , S T 1 ) a n d r e p l i c a t i o n g r o u p s (AC2, ST2), I n d i c a t i n g t h a t a l l f o u r g r o u p s s h o w e d c o m p a r a b l e r a t e s o f c h a n g e o v e r time« A n a l y s e s o f v a r i a n c e a r e p r e s e n t e d i n T a l i l e 3. How-e v e r , a s m a l l b u t s i g n i f i c a n t g r o u p m a i n e f f e c t ( F( 1, 1 14 )=4. 75, n<.0314) w a s f o u n d , i n d i c a t i n g a h i g h e r e x -p e c t a n c y f o r t h e ACC g r o u p a v e r a g e d o v e r p r e — a n d p o s t t e s t — i n g . An a d d i t i o n a l a n a l y s i s o f t h e p o s t t o f o l l o w - u p d a t a y i e l d e d n o n s i g n i f i c a n t e f f e c t s f o r g r o u p s ( j 3<.1131), t i m e (F<1 ), a n d i n t e r a c t i o n (F<1 ) , i n d i c a t i n g t h a t e x p e c t a n c y was m a i n t a i n e d t h r e e m o n t h s f o l l o w i n g c o m p l e t i o n o f t h e p r o g r a m . S i n c e e x p e c t a n c y d i d n o t d i f f e r a m ong t h e t r e a t m e n t ( \C1, S I 1 ) a n d r e p l i c a t i o n g r o u p s (AC2 , S I 2 ) , d i f f e r e n t i a l t r e a t -m e n t e f f e c t s c a n n o t be a t t r i b u t e d t o t h e s u b j e c t s ' i n i t i a l e x p e c t a t i o n s o f ' I m p r o v e m e n t , Ms.Asur.eg a l S-tuuess. I n o r d e r t o d e t e r m i n e w h e t h e r t h e t r e a t m e n t g r o u p s w e r e m o r e e f f e c t i v e t h a n t h e w a i t i n g l i s t c o n t r o l g r o u p , a n d w h e t h e r t r e a t m e n t g r o u p s w e r e d i f f e r e n t i a l l y e f f e c t i v e i n r e d u c i n g s t r e s s ( H y p o t h e s i s 1 ) , a t w o - w a y ( g r o u p s b y t i m e ) r e p e a t e d m e a s u r e s , m u l t i v a r i a t e a n a l y s i s o f v a r i a n c e was p e r f o r m e d o n t h e p r e a n d p o s t s c o r e s o f t h e d e p e n d e n t m e a s -u r e s : T e n s i o n T h e r m o m e t e r , S t a t e A n x i e t y , a n d T r a i t A n x i e t y . T h e o r t h o g o n a l c o n t r a s t s t h a t w e r e n e c e s s a r y t o t e s t Hy-p o t h e s i s 1 w e r e : t h e a v e r a g e o f t h e t w o t r e a t m e n t s v e r s u s a 100 w a i t i n g l i s t c o n t r o l f W L ) , a n d a b e t w e e n t r e a t m e n t c o m p a r i -s o n (AC v e r s u s S I ) . M e a n s a n d s t a n d a r d d e v i a t i o n s f o r t h e t r e a t m e n t a n d c o n t r o l g r o u p s (AC1.ST1 . W L ) a n d t h e r e n l l c a -t i o n g r o u p s (AC2.SI2) a r e s u m m a r i z e d i n T a b l e 4. T h e r e -s u l t s o f t h e m u l t i v a r i a t e a n a l y s i s a n d u n i v a r i a t e t e s t s a r e p r e s e n t e d i n T a b l e 5. A s t h e e f f e c t s o f h y p o t h e t i c a l i n -t e r e s t w e r e t i m e a n d t h e d e g r e e t o w h i c h t h e g r o u p s s h o w e d d i f f e r e n t i a l c h a n g e s o v e r t i m e , a l l m u l t i v a r i a t e a n a l y s i s o f v a r i a n c e t a b l e s I n c l u d e o n l y t h e t i m e m a i n e f f e c t , a n d t h e i n t e r a c t i o n o f t i m e w i t h o t h e r f a c t o r s . A s i g n i f i c a n t m a i n e f f e c t w a s f o u n d f o r t i m e ( £ ( 3, 5 1 )= 10 . 06 , _o<.000 1). I n o r -d e r t o i d e n t i f y t h e v a r i a b l e s c o n t r i b u t i n g t o t h i s s i g n i f i -c a n t m u l t i v a r i a t e JF , u n i v a r i a t e , a n a l y s e s o f v a r i a n c e w e r e c o m p u t e d a n d a l l t h r e e d e p e n d e n t m e a s u r e s w e r e f o u n d t o b e s i g n i f i c a n t . I n a d d i t i o n , t h e o r t h o g o n a l c o m p a r i s o n c o n -t r a s t i n g t h e t r e a t m e n t s a n d t h e w a i t i n g l i s t c o n t r o l g r o u p w a s s i g n i f i c a n t (_F( 3 , 51 )= 5 . 01 , r><.0041 ). U n i v a r i a t e F„g w e r e c o m p u t e d a n d r e v e a l e d t h a t a l l t h r e e m e a s u r e s w e r e s i g n i f i -c a n t (>2<.0042, <.004£, <.00O7). H o w e v e r , t h e AC 1 v e r s u s SI1 b y t i m e c o n t r a s t w a s n o t s i g n i f i c a n t ( F< 1 ) • T h u s t h e t r e a t -m e n t g r o u p s d i d n o t c h a n g e d i f f e r e n t i a l l y o v e r t h e t r e a t m e n t p e r i o d . F r o m t h e a n a l y s e s a n d F i e u r e s S , 6 a n d 7, I t a p p e a r s t h a t t h e t r e a t m e n t £r o u p s . ..im p r o v e d s i g n i f i c a n t l y f r o m p r e -t o p o s t t e s t i n g o n m e a s u r e s o f s t r e s s , w h i l e t h e WL g r o u p d i d n o t . to i I n o r d e r t o d e t e r m i n e i t t h e r e p l i c a t i o n g r o u p s c h a n g e d i n t h e same m a n n e r a s t h e t r e a t m e n t g r o u p s , a t h r e e - w a y ( g r o u p s b y r e p l i c a t i o n by t i r r e ) r e p e a t e d T r e a s u r e s , m u l t i v a r -i a t e a n a l y s i s o f v a r i a n c e w a s p e r f o r m e d c n t h e t h r e e d e p e n -d e n t m e a s u r e s o f s t r e s s ( s e e T a b l e 6 . ) The c o n t r a s t o f i n -t e r e s t — t h e i n t e r a c t i o n o f g r o u p s ( A C 1 + A C 2 , S I 1 + S I 2 ) b y r e p l i c a t i o n ( A C l + S I l , A C 2 + S I 2 ) b y - t i m e was n o t s i g n i f i c a n t ( F ( 3 , 5 5 ) = 2 . 1 7 , J J < . 1 0 2 6 ) . T h e r e f o r e c o l l a p s i n g a c r o s s r e p l i -c a t e s a n d t r e a t m e n t g r o u p s a p p e a r e d t o b e v a l i d f o r f u r t h e r c o m p a r i s o n s ( i . e . , t h e t w o a e r o b i c g r o u p s , AC I a n d A C 2 , w e r e c o m b i n e d ( A C C ) a n d t h e t w o s t r e s s i n o c u l a t i o n g r o u p s , S I 1 a n d S 1 2 , w e r e c o m b i n e d ( S I C ) f o r a n a l y s e s ) . A s i g n i f i c a n t m a i n e f f e c t w as f o u n d f o r t i m e ( F ( 3 , 5 5 ) = 2 2 . 0 4 , E < . 0 0 0 1 ) f o r t h e c o m b i n e d g r o u p s . F o l l o w - u p u n i v a r i a t e t e s i s r e v e a l e d t h a t a l l t h r e e m e a s u r e s w e r e s i g -n i f i c a n t ( o < » 0 0 0 l , < . 0 0 0 6 , < . 0 0 0 1 ) . T h e m u l t i v a r i a t e ACC v e r s u s S I C c o n t r a s t ( t r e a t m e n t b y t i m e ) was n o t s i g n i f i c a n t ( F < 1 ) . A l t h o u g h b o t h g r o u p s c h a n g e d s i g n i f i c a n t l y f r o m p r e -t o p o s t t e s t i h g ) t h e y d i d n o t c h a n g e d i f f e r e n t i a l l y . o v e r t i ree • To t e s t f o r m a i n t e n a n c e o f c h a n g e o v e r t h e t h r e e m o n t h f o l l c w — u p p e r i o d , a t w o — w a y ( g r o n n s b y t i m e ) r e p e a t e d m e a s -u r e s , m u l t i v a r i a t e a n a l y s i s o f v a r i a n c e wes p e r f o r m e d o n t h e t h r e e m e a s u r e s o f s t r e s s f o r t h e AC1 a n d S I l g r o u p s . > f u l t l -v a r l a t e a n d u n i v a r i a t e t e s t s a r e s u m m a r i z e d I n T a b l e 7. A n a l y s e s i n c l u d e c o n t r a s t s c o m p a r i n g p o s t t o f o l . l o w - u p , a n d p r e to- t h e a v e r a g e o f p o s t a n d f c l l c w - u p . T h e m a i n e f f e c t 102 f o r t i m e w a s s i g n i f i c a n t ( F( 6 , 2S )= 1 0. 62, I><. 0001 ). U n i v a r i a t e a n a l y s e s o f v a r i a n c e w e r e t h e n c o m p u t e d o n t h e t h r e e d e p e n d e n t m e a s u r e s f o r p o s t t o f o l l o w —up a n d p r e t o t h e a v e r a g e o f p o s t a n d f o l l c w — u p c o n t r a s t s . O n l y t h e T r a i t A n x i e t y m e a s u r e w a s s i g n i f i c a n t (rj<.0281 )» s h n w i n r a c o n -t i n u e d r e d u c t i o n l n t r a i t a n x i e t y f r o m p o s t t o f o l l o w — u p . T h e m u l t i v a r i a t e AC1 v e r s u s S I l b y t i m e c o n t r a s t was n o t s i g n i f i c a n t , F <1. It a p p e a r s t h a t h o t h g r o u p s m a i n t a i n e d t h e t r e a t m e n t e f f e c t s t h r e e m o n t h s a f t e r c o m p l e t i n g t h e o r o g r a m o n t h e t h r e e d e p e n d e n t m e a s u r e s o f s t r e s s . I n a d d i t i o n , a f u r t h e r r e d u c t i o n o f t r a i t a n x i e t y o c c u r r e d f r o m p o s t t o f o l l o w - u p f o r b o t h g r o u p s . F i g u r e s 5, 6 a n d 7 i l l u s t r a t e s t h e n a t u r e o f t h e s e f i n d i n g s . JiXS Cft£nA±i.Xe-So.mat.IJS JVjocte T o e v a l u a t e d i f f e r e n t i a l t r e a t m e n t e f f e c t i v e n e s s f o r s u b j e c t s w h o e x p e r i e n c e s t r e s s p r e d o m i n a n t l y i n e i t h e r a c o g n i t i v e o r s o m a t i c m o d e ( H y p o t h e s e s 2, 3), a t h r e e - w a y ( g r o u p s b y c o g n i t i v e / s o m a t i c b y t i m e ) r e p e a t e d m e a s u r e s , m u l t i v a r i a t e a n a l y s i s o f v a r i a n c e w a s c o m p u t e d a n d t h e d e -p e n d e n t m e a s u r e s o f s t r e s s ( T e n s i o n T h e r m o m e t e r , S t a t e A n x i -e t y , a n d T r a i t A n x i e t y ) w e r e u s e d f o r p r e t o p o s t o u t c o m e s c o r e s . M e a n s a n d s t a n d a r d d e v i a t i o n s a r e p r e s e n t e d I n T a -b l e 8 . A s i t h a d a l r e a d y b e e n d e t e r m i n e d t h a t t h e AC I , A C 2 , S I l a n d S T 2 g r o u p s c h a n g e d s i m i l a r l y o n t h e s e d e p e n d e n t 103 m e a s u r e s ( s e e T a b l e 6), t h e c r o u p s w e r e c o m b i n e d l o r f u r t h e r a n a l y s e s ( A C C , S I C ) . M u l t i v a r i a t e a n d u n i v a r i a t e t e s t s a r e s u m m a r i z e d i n T a b l e P. The c o g n i t i v e v e r s u s s o m a t i c b y t i m e I n t e r a c t i o n w a s s i g n i f i c a n t ( F( 3 , 5 5 ) = 2 . 7 c, p.<.051). To d e -t e r m i n e t h e e x a c t n a t u r e o f t h e s e d i f f e r e n c e s . u n i v a r i a t e a n a l y s e s o f v a r i a n c e w e r e c o m p u t e d a n d i t was f o u n d t h a t t h e c o g n i t i v e / s o m a t i c c o n t r a s t was s i g n i f i c a n t f o r b o t h S t a t e a n d T r a i t A n x i e t y ( j3<.027S a n d £<.G083, r e s p e c t i v e l y ) . A t p o s t t r e a t m e n t , s u b j e c t s who i n i t i a l l y r e p o r t e d e x p e r i e n c i n g s t r e s s i n t h e c o g n i t i v e mode h a d I m p r o v e d m o r e o n t h e S t a t e a n d T r a i t m e a s u r e s t h a n s u b j e c t s who i n i t i a l l y e x p e r l — r e n c e d s t r e s s m o r e i n t h e s o m a t i c m o d e . To d e t e r m i n e I f t h e s e d i f f e r e n c e s w e r e m a i n t a i n e d , t h e AC1 a n d S I 1 g r o u p s d a t a w e r e a n a l y z e d b y c o m p u t i n g t w o — w a y ( g r o u p s b y t i m e ) r e p e a t e d m e a s u r e s , m u l t i v a r i a t e a n a l y s i s o f v a r i a n c e . A n a l y s e s w e r e c o m p u t e d f o r p o s t t o f o l l o w - u p a n d p r e t o t h e a v e r a g e o f p o s t a n d f o l l o w — u p c o n t r a s t s . T h e m u l t i v a r i a t e F f o r t i m e was s i g n i f i c a n t ( F_( 6,27)=10»47, _Q<.000 1 ), a s w o u l d be e x p e c t e d f r o m t h e p r e v i o u s a n a l y s e s ( s e e T a b l e 7 ) . T h e m u l t i v a r i a t e F o f I n t e r e s t — t h e c o g n i -t i v e v e r s u s s o m a t i c c o n t r a s t — was n o t s i g n i f i c a n t ( F ( 6 , 27 = 1 . 6 5,r»< . 1 728 ) . A l t h o u g h t h e u s u a l p r o c e d u r e i s t o e x a m i n e u n i v a r i a t e F_g o n l y i f t h e m u l t i v a r i a t e F i s s i g n i f i -c a n t , i n t h i s c a s e i t w a s f e l t t h a t a n e x a m i n a t i o n o f t h e u n i v a r i a t e Fs. w o u l d be t h e o r e t i c a l l y r e l e v a n t a s r e s e a r c h i n t h i s a r e a i s new a n d e x p l o r a t o r y ! t h e r i s k o f m a k i n g a T y p e 104 I e r r o r o u t w e i g h s t h e r i s k o f m a k i n g a T y p e TT e r r o r . T h e r e f o r e , u n i v a r i a t e a n a l y s e s o f v a r i a n c . e w e r e c o m p u t e d a n d a r e p r e s e n t e d i n T a b l e 10. Cn t h e p o s t t o f o l l o w - u p c o n -t r a s t , S t a t e a n x i e t y was s i g n i f i c a n t (p,<.0064), a n d T r a i t A n x i e t y a p p r o a c h e d s i g n i f i c a n c e (nK.0905). F u r t h e r m o r e , t h e p r e v e r s u s t h e a v e r a g e o f p o s t a n d f o l l o w - u p c o n t r a s t s w e r e n o t s i g n i f i c a n t o n a n y o f t h e t h r e e d e p e n d e n t m e a s u r e s o f s t r e s s . F i g u r e 8 i l l u s t r a t e s t h e n a t u r e o f t h e s e c h a n g e s . I t a p p e a r s t h a t t h e s o m a t i c g r o u p , o n t h e a v e r a g e , c o n t i n u e d t o c h a n g e f r o m p o s t t o f o l l c w — u p o n t h e S t a t e a n d T r a i t A n x -i e t y m e a s u r e s , w h i l e t h e c o g n i t i v e g r o u p , o n t h e a v e r a g e , e i t h e r d i d n o t c h a n g e a n y f u r t h e r ( T r a i t a n x i e t y ) o r i n -c r e a s e d t h e i r s t a t e a n x i e t y l e v e l . S s l i ~ S t.ajterne jQt s. ajad, ££.\J.-£JS±£&£X. I n o r d e r t o d e t e r m i n e t h e r e l a t i v e e f f e c t i v e n e s s o f t h e t r e a t m e n t s , t w o — w a y ( g r o u p s b y t i m e ) r e p e a t e d m e a s u r e s , m u l -t i v a r i a t e a n a l y s e s o f v a r i a n c e w i t h t h r e e d e p e n d e n t m e a s -u r e s ( S e l f - e f f i c a c y , P o s i t i v e S e l f - s t a t e m e n t s , N e g a t i v e S e l f - s t a t e m e n t s ) w e r e c o m p u t e d f o r H y p o t h e s e s 4 a n d 5. M e a n s a n d s t a n d a r d d e v i a t i o n s f o r S e l i - e t f i c a c y s c o r e s a r e p r e s e n t e d i n T a b l e 11. A n a l y s e s w e r e p e r f o r m e d I n d e p e n d e n t -l y f o r t h e s u b j e c t s ' a n d j u d g e s ' s e l f - s t e t e m e n t v a l e n c e r a t -i n g s . R a t i o s o f p o s i t i v e , n e g a t i v e a n d n e u t r a l s e l f — s t a t e -m e n t s t o t h e t o t a l n u m b e r o f s t a t e m e n t s w e r e c o m p u t e d f r o m f r e q u e n c y d a t e . F r e q u e n c y a n d r a t i o mean s c o r e s f o r s e l f -statements are summarized .in Tables 12 and 13, M u l t i v a r i a t e and u n i v a r i a t e t e s t s are presented In Table 14. The r e s u l t s of the m u l t i v a r i a t e a n a l y s i s c o n t r a s t s f c r both judges* and s u b j e c t s * r a t i n g s I n d i c a t e d a s t a t i s t i c a l l y s i g n i f i c a n t e f -f e c t f o r time ( JH 3 , 51 )= 11 . 19 , o<.0001 and P ( 3 , 5 1 ) = 9 . 49, rX.009 1, r e s p e c t i v e l y ) . U n i v a r i a t e analyses of v a r i a n c e were computed and revealed that a l l three ttep&n'J.&nt measures were s i g n i f i c a n t . In a d d i t i o n , the m u l t i v a r i a t e comparisons of treatments versus w a i t i n g l i s t c o n t r o l by time were s i g -n i f i c a n t f o r both judges' r a t i n g s ( £( 3 , 51 ) = 3. 45, Q<,0234) and s u b j e c t s * r a t i n g s ( £( 3 , 51 ) = 4 . 6 5 , £ <»C06). The f o l l o w -up u n i v a r i a t e t e s t s I n d i c a t e d that the s e l f — e f f i c a c y measure was s i g n i f i c a n t (j=<»0021 ). However, of the se I f —s t at em ent r a t i n g s only the s u b j e c t s ' r a t i n g s of p o s i t i v e s e l f - s t a t e -ments were s i g n i f i c a n t , (o<,0105). F i g u r e s 9, 10 and 11 i l -l u s t r a t e the nature cf these changes, Tt appears that the treatment groups changed d i f f e r e n t i a l l y from pre- to p o s t -t e s t i n g compared to the w a i t i n g l i s t group on measures of s e l f-e f f 1 ca cy and s u b j e c t s ' r a t i n g s cf p o s i t i v e s e l f - s t a t e — tre nts • The m u l t i v a r i a t e F f o r the orthogonal c o n t r a s t l o r the AC 1 v e r s u s S l l group was not s i g n i f i c a n t ( F< I) on the judg-es' seIf—statement r a t i n g s and s u b j e c t s ' s e l t - s t a t e m e n t s (F(3,51 ) = 1,D9, jrj<«127)« A d d i t i o n a l c o n t r a s t s comparing the S l l and ACl groups independently with the *L group y i e l d e d s i g n i f i c a n t and n e a r l y s i g n i f i c a n t m u l t i v a r i a t e s 106 ( F<3 ,31 }=5.48, ja<.0C25 a n d F( 3 , 5 t )= 2 . 57 , o.<.0b47, r e s p e c -t i v e l y ). R e c a v . s e a l t h e p o s t - h o c n a t u r e o f t h e s e t e s t s ? u n i v a r i a t e f o l l o w - u p s w e r e d o n e u s i n g S c h e f f e ' s ( H a r r i s , 1975 ) t e s t r a t t i e r t h a n t h e l e s s c o n s e r v a t i v e u n i v a r i a t e a n a l y s i s o f v a r i a n c e * W i t h r e g a r d t o s e l f - s t a t e m e n t s , t h e s u b j e c t s ' r a t i n e s o f p o s i t i v e s e l f - s t a t e m e n t s y i e l d e d a s i g -n i f i c a n t ()2=<.05) d i f f e r e n c e b e t w e e n t h e S l l g r o u p a n d t h e WL c o n t r o l g r o u p f r o m p r e - t o p o s t t e s t i n g . I t s h o u l d b e n o t -e d t h a t t h e s u b j e c t s * r a t i n g s o f n e g a t i v e s e l f - s t a t e m e n t s w o u l d h a v e b e e n s i g n i f i c a n t a t t h e l e s s c o n s e r v a t i v e a =* • 10. In a d d i t i o n , t h e r e w a s no s i g n i f i c a n t d i f f e r e n c e on s e I f - s t a f e m e n t s b e t w e e n t h e A C l g r o u p a n d t h e WL g r o u p o v e r t 1 me • T h e s e a n a l y s e s r e v e a l e d t h a t o n t h e d e p e n d e n t m e a s u r e o f s e I f — e f f i c a c y , b o t h t h e A C l a n d S l l g r o u p s c h a n g e d s i g -n i f i c a n t l y f r o m p r e — t o p o s t l e s t l n g , t h a t t h e y w e r e s u p e r i o r t o t h e WL c o n t r o l g r o u p a t p o s t t e s t i n g a n d t h a t t h e y d i d n o t c h a n g e d i f f e r e n t i a l l y f r o m e a c h o t h e r . M t h r e g a r d t o t h e s e l f - s t a t e m e n t d e p e n d e n t m e a s u r e s , o n l y t h e s u b j e c t s ' r a t -i n g s o f p o s i t i v e s e l f — s t a t e men t s s h o w e d s i g . n l f 1 c a n t d i f f e r -e n c e s a mong g r o u p s . T h e S l l g r o u p s i g n i f i c a n t l y i n c r e a s e d i n n u m b e r o f p o s i t i v e s e I f — s t a t e m e n t s c o m p n r e d t o t h e WL g r o u p f r o m p r e - t o p o s t t e s t i n g . T o d e t e r m i n e i f t h e r e p l i c a t i o n g r o u p s c h a n g e d i n t h e same m a n n e r a s t h e t r e a t m e n t g r o u p s , t w o t h r e e - w a y ( g r o u p s b y r e p l i c a t i o n b y t i m e ) r e p e a t e d m e a s u r e s , m u l t i v a r i a t e 107 a n a l y s e s o f v a r i a n c e were p e r f o r m e d w i t h "the A C l , S i 1 i AC2, and SI2 g r o u p s on -the dependent measures o f s e l f - e f f i c a c y , and s u b j e c t s * and j u d g e s ' r a t i n g s o f p o s i t i v e and n e g a t i v e s e l f - s t a t e m e n t s . M u l t i v a r i a t e and u n i v a r i a t e t e s t s a r e p r e -s e n t e d i n T a b l e 15. The c o n t r a s t o f I n t e r e s t , t h e i n t e r a c -t i o n o f g r o u p s by r e p l i c a t i o n by t i m e , was n o t s i g n i f i c a n t f o r e i t h e r a n a l y s i s ( j u d g e s * or s u b j e c t s ' r a t i n g s ) , b o t h F, v a l u e s b e i n g l e s s t h a n one. T h e r e f o r e , c o m b i n i n g r e p l i c a -t i o n s and t r e a t m e n t s a p p e a r e d t o be v a l i d f o r f u r t h e r com-p a r i s o n s ( AC1+AC2=ACC; S 11+ S 12= S I C ) . The main e f f e c t f o r t i m e , a v e r a g e d o v e r r e p l i c a t e s and g r o u p s , was s i g n i f i c a n t (j_><.0001 ). F o l l o w - u p u n i v a r i a t e a n a l y s e s of v a r i a n c e i n d i -c a t e d t h a t a l l t h r e e measures were s t a t i s t i c a l l y s i g n i f i -c a n t . T h i s h e l d f o r b o t h j u d g e s ' and s u b j e c t s ' r a t i n g s of p o s i t i v e and n e g a t i v e s e l f — s t a t e men t s (p,<.0001). The com-p a r i s o n of ACC v e r s u s SIC g r o u p s o v e r t i m e ( t r e a t m e n t s by t i m e ) s u g g e s t e d s i g n i f i c a n t d i f f e r e n c e s f o r t h e s u b j e c t s ' r a t i n g s ( F( 3 , 55 ) = 2 . 53 , E<.G668 ) and t h e j u d g e s ' r a t i n g s ( F ( 3, 5 5 ) = 2. 27 , j 3 < » 0 9 ) . U n i v a r i a t e t e s t s were computed which f o u n d s e l f - e f f i c a c y t o be n o n s i g n i f i c a n t w h i l e s u b j e c t s * r a t i n g s of p o s i t i v e and n e g a t i v e s e l f - s t a t m e n t s were s i g -n i f i c a n t (p_<.0124 a n d r><.9153, r e s o e c t i v e l y ) . However, u n i -v a r i a t e a n a l y s e s of v a r i a n c e o f .judges' r a t i n g s i n d i c a t e d t h a t o n l y n e g a t i v e s e l f - s t a t e m e n t s were s i g n i f i c a n t (o<.0107 )• Con seaue n t l y , the SIC gro u p showed G r e a t e r change than the ACC g r o u p on s u b j e c t s ' r a t i n g s of p o s i t i v e 108 a n d n e g a t i v e s e I f — s t a t e me n t s a n d j u d g e s 1 r a t i n g s o f n e g a t i v e s e l f - s t a t e m e n t s . T h e s e c h a n g e s a r e i l l u s t r a t e d i n F i g u r e s 12 a n d 13. I t a p p e a r s t h a t s u b j e c t s ' r a t i n g s o f t h e i r s e l f - s t a t e m e n t s , ( i . e . , t h e i n c r e a s e c f p o s i t i v e s e l f - s t a t e -m e n t s a n d r e d u c t i o n o f n e g a t i v e s e l f - ^ s t a t e m e n t s ) a r e m o r e l i k e l y t o d i s t i n g u i s h b e t w e e n g r o u p s ( A C C v s S I C ) t h a n t h e j u d g e s * r a t i n g s o f p o s i t i v e a n d n e g a t i v e s e l f - s t a t e m e n t s . To d e t e r m i n e w h e t h e r t h e t r e a t m e n t e f f e c t s w e r e m a i n -t a i n e d , a n a l y s i s o f t h e t h r e e m o n t h f o i l o w — u p d a t a w as com-p u t e d w i t h t w o - w a y ( g r o u p s b y t i m e ) r e p e a t e d m e a s u r e s , m u l -t i v a r i a t e a n a l y s e s o f v a r i a n c e f o r t h e A C l a n d S l l g r o u p s . A n a l y s e s i n c l u d e d o r t h o g o n a l c o n t r a s t s c f p o s t t o f o l l o w - u p a n d p r e t o t h e a v e r a g e o f p o s t a n d f o l l o w — u p . M u l t i v a r i a t e a n d u n i v a r i a t e t e s t s a r e s u m m a r i z e d i n T a b l e 16. T h e r e -s u l t s y i e l d e d a s i g n i f i c a n t m u l t i v a r i a t e F. m a i n e f f e c t f o r t i m e o n b o t h j u d g e s ' ( j;( 6 ,29 )=S . 82 , o<.CC01 ) a n d s u b j e c t s ' ( F ( 6 , 29 )=5.8 1, £ < . 0 0 0 5 ) r a t i n g s . U n i v a r i a t e t e s t s w e r e t h e n c o m p u t e d o n s e l f - e f f i c a c y a n d b o t h s u b j e c t s * a n d j u d g e s ' r a t i n g s o f p o s i t i v e a n d n e g a t i v e s e l f — s t a t e m e n t s . T h e p o s t t o f o l l o w - u p a n a l y s e s w e r e s i g n i f i c a n t o n l y f o r s e l f - e f f i c a -c y ( n < « 0 4 4 6 ) , a n d j u d g e s ' p o s i t i v e ( r X . 0433) a n d n e g a t i v e s e l f - s t a t e m e n t s ( . rX.0203) . F i g u r e s 10 a n d 11 i l l u s t r a t e t h e n a t u r e o f t h e s e c h a n g e s . I t a p p e a r s t h a t t h e j u d g e s ' r a t -i n g s o f p o s i t i v e a n d n e g a t i v e s e l f - s t a t e m e n t s w e r e s i g n i f i -c a n t l y d i f f e r e n t f r o m p o s t t o f o l l o w - u p w h i l e t h e s u b j e c t s ' r a t i n g s d i d n o t c h a n g e s i g n i f i c a n t l y * The j u d g e s ' r a t i n g s i n d i c a t e d a s i g n i f i c a n t i n c r e a s e I n p o s i t i v e s e l f — s t a t e m e n t s 109 a n d d e c r e a s e i n n e g a t i v e s e l f - s t a t e m e n t s f r o m p o s t t o f o l l o w - u p f o r b o t h g r o u p s ( A C l , S i t ) . F u r t h e r m o r e , t h e m u l -t i v a r i a t e a n a l y s e s f o r t h e A C l v e r s u s S l l c o n t r a s t s o v e r t i m e w e r e n o t f o u n d t o b e s i g n i f i c a n t f o r e i t h e r j u d g e s ' o r s u b j e c t s ' r a t i n g s (£<1. ), i n d i c a t i n g t h a t c h a n g e s f r o m p r e -t o p o s t t e s t i n g t o f o l l o w — u p f o r b o t h s u b j e c t s ' a n d j u d g e s * r a t i n g s w e r e t h e s a m e f o r b o t h t r e a t m e n t g r o u p s . I n a d d i -t i o n , t h e f o l l o w - u p a n a l y s e s r e v e a l e d t h a t f r o m p o s t t e s t i n g t o f o l l o w - u p , b o t h g r o u p s ( A C l , S l l ) c o n t i n u e d t o i n c r e a s e t h e i r l e v e l o f s e I f — e f f l c a c y . I n o r d e r t o t e s t f o r t h e e f f e c t i v e n e s s o f t h e AC g r o u p s i n b r i n g i n g a b o u t i m p r o v e m e n t o f s u b j e c t s ' g e n e r a l l e v e l o f f i t n e s s ( a s m e a s u r e d b y p r e d i c t e d M V C 2 ) , a r e p e a t e d m e a s u r e s a n a l y s e s o f v a r i a n c e ( g r o u p s b y t i m e ) w a s c o m p u t e d o n t h e A C l , S l l a n d W l g r o u p s . S e a n s a n d s t a n d a r d d e v i a t i o n s a r e p r e s e n t e d I n T a b l e 1 7 , a n d t h e a n a l y s e s a r e s u m m a r i z e d I n T a b l e 1 8 . R e s u l t s r e v e a l e d a s i g n i f i c a n t m a i n e f f e c t f o r t i m e (jt!<.0001 ) a n d a s i g n i f i c a n t g r o u p s b y t i m e i n t e r a c t i o n (x><.0305 ). I n o r d e r t o d e t e r m i n e t h e n a t u r e o f t h e d i f f e r -e n c e s a m o n g t h e t h r e e g r o u p s o v e r t i m e , S c h e f f e ' s t e s t s f o r i n d i v i d u a l c o m p a r i s o n s w e r e c o m p u t e d . T h e s e c o m p a r i s o n s i n -d i c a t e d t h a t o n p r e d i c t e d MVC2, t h e A C l g r o u p s h o w e d s r r e a t e r i m p r o v e m e n t f r o m p r e — t o p o s t t e s t i n g t h a n t h e WL g r o u p (r><.05 ). I n a d d i t i o n , t h e AC I g r o u p d i d n o t d i f f e r s l g n l f l -110 c a n t l y from the S I l group. It should be noted however, that the AC1 group would have been s i g n i f i c a n t l y d i f f e r e n t from the S I l group at the l e s s c o n s e r v a t i v e a =" .10 l e v e l of s i g -n i f i c a n c e f o r the Scheffe t e s t . To determine whether the r e p l i c a t i o n groups ctianged In a s i m i l a r manner tc the treatment groups, a two—way (group by time) repeated measures a n a l y s i s of v a r i a n c e was comput-ed and i s presented i n Table 18. The s i g n i f i c a n t i n t e r a c -t i o n (joCO'l') was followed up with S c h e f f e ' s t e s t s for m u l t i -ple comparisons. The n o n s i g n i f i c a n t r e s u l t s i n d i c a t e d that the r e p l i c a t i o n groups d i d not change d i f f e r e n t i a l l y than the treatment groups. T h e r e f o r e the data were combined and a s i m i l a r a n a l y s i s f o r the combined groups was computed. The r e s u l t s are summarized in Table 18. The r e s u l t i n g s i g -n i f i c a n t i n t e r a c t i o n showed that the s u b j e c t s in t h e com-bined aerobic c o n d i t i o n i n g (ACC) group i n c r e a s e d t h e i r l e v -e l of f i t n e s s ( MVC2 ) from pre- to p o s t t e s t i n g s i g n i f i c a n t l y more than the s u b j e c t s i n the combined s t r e s s - i n o c u l a t I o n (SIC) group ( F( 1 ,58 )= 10.22 , £<.G023 ). An a d d i t i o n a l r e -peated measures a n a l y s i s of variance (groups by time) on the pre, post and f o l l o w — u p d a t a , y i e l d e d a s i g n i f i c a n t main ef-f e c t f o r time ( _Q< • 00G 1 ) • and a s i g n i f i c a n t groups by time i n -t e r a c t i o n (£<.0006). S c h e f f e ' s t e s t s f o r m u l t i p l e compari-sons Indicated that the groups by time (post t o follow-up) was s i g n i f i c a n t a t j><.05. As can be seen in F i g u r e 1.4 i t is apparent that the ACl group continued to improve t h e i r l e v e l 111 of f i t n e s s from post to follow-up while the S I l group did no t * These analyses r e v e a l e d t h a t the AC groups were suc-c e s s f u l i n s i g n i f i c a n t l y improving l e v e l o f f i t n e s s from pre- to p o s t t e s t i n g compared to the ViL and SI groups, and s u b j e c t s not onl y maintained hut f u r t h e r improved t h e i r f i t -ness l e v e l from post to f o l l c w — u p . Due to the AC groups im-provement i n l e v e l of f i t n e s s , two important q u e s t i o n s were addressed. In order to t e s t the f i r s t q u e s t i o n — w h e t h e r s u b j e c t s with i n i t i a l l y h i g h e r p r e d i c t e d MVQ21s were l e s s s t r e s s e d on the dependent measures of s t r e s s ( Tension Ther-mometer, S t a t e and T r a i t Anxiety) when compared to those with r e l a t i v e l y lower p r e d i c t e d MVC2*s, s u b j e c t s were d i v i d -ed i n t o high and low MVC2 c a t e g o r i e s independently f o r males and females f o r the combined (ACC,SIC) groups. Males with a p r e d i c t e d MV02 of 34 ml/kg/min or g r e a t e r were c l a s s i f i e d as hi g h f i t males while females of 30 ml/kg/min or grea t e r were c l a s s l f l e d as high f i t females. Means, standard d e v i a t i o n s and ranges are presented i n Table IS. A two-way ( sex by MV02 ) m u l t i v a r i a t e a n a l y s i s of v a r i a n c e was computed on the p r e t e s t dependent measures of s t r e s s . The m u l t i v a r i a t e Fs were not s i g n i f i c a n t (see Table 20). There were no d i f f e r -ences between the high and lew p r e d i c t e d MV02 groups at pre-t e s t i n g on these measures of s t r e s s . A second q u e s t i o n suggested by these data was whether s u b j e c t s who showed most improvement i n t h e i r l e v e l of f i t -112 n e s s ( p r e d i c t e d MVC2 ) a l s o d e i r o n s t r a t c d g r e a t e r rertuc t i o n In t h e i r se I f - r e po r t e d l e v e l s of s t r e s s . S u b j e c t s whose p r e -d i c t e d MV02 s c o r e s i m p r o v e d l i v e o r more ml/kg/min were c o n -t r a s t e d w i t h t h o s e s u b j e c t s w i t h l e s s t h an a f i v e p o i n t im-provement on t h i s measure. Means and s t a n d a r d d e v i a t i o n s a r e p r e s e n t e d i n T a b l e 2 1 . A two-way ( MV02 by t i m e ) r e p e a t -ed m e a s u r e s , m u l t i v a r i a t e a n a l y s i s o f v a r i a n c e was computed on t h e combined a e r o t i c g r o u p s ( ACC ). The S t a t e , T r a i t Anx-i e t y I n v e n t o r i e s and t h e T e n s i o n Thermometer were the d e p e n -d e n t m e a s u r e s . The r e s u l t I r a F v a l u e f o r t h e MVO2 main e f -f e c t was n o n s i g n i f i c a n t ( F < 1 ) . R e s u l t s a r e p r e s e n t e d i n T a b l e 22. T h e s e a n a l y s e s s u g g e s t t h a t e g r e a t e r improvement i n f i t n e s s a s measured by p r e d i c t e d M"VC2 i s n o t an i n d i c a t o r o f g r e a t e r improvement on measures o f s t r e s s . Tn o r d e r t o d e t e r m i n e whether the t r e a t m e n t s were e f -f e c t i v e i n i m p r o v i n g g e n e r a l h e a l t h s t a t u s , a two-way ( g r o u o by t i m e ) r e p e a t e d measures a n a l y s i s o f v a r i a n c e was computed on t h e C o r n e l l M e d i c a l Symptoms C h e c k l i s t . The means and s t a n d a r d d e v i a t i o n s a r e p r e s e n t e d i n T a b l e 23. The r e s u l t s of an a n a l y s i s on t h e A C l , S l l and WL g r o u p s a t p r e - and p o s t t e s t i n g y i e l d e d a main e f f e c t f o r t i m e , F( 1,53)=1S.46, J3<.0001, and a s i g n i f i c a n t I n t e r a c t i o n , F ( 2,53 )=4•60, JQ<.0 14. R e s u l t s a r e p r e s e n t e d i n T a b l e 24. In o r d e r t o de-t e r m i n e the n a t u r e of the d i f f e r e n c e s among the t h r e e g r o u p s , S c h e f f e ' s t e s t s f o r m u l t i p l e c o m p a r i s o n s were com-p u t e d . T h e s e c o m p a r i s o n s r e v e a l e d t h a t on t tie C h e c k l i s t 113 b o t h t h e A C l a net S I l g r o u p s s i g n i f i c a n t l y i m p r o v e d t h e i r l e v e l o f g e n e r a l h e a l t h f r o m p r e - t o p o s t t e s t i n g c o m p a r e d t o t h e WL g r o u p ( a< «05 a n d • 1 0 , r e s p e c t i v e l y ) , H o w e v e r , t h e AC 1 a n d S I l g r o u p s d i d n o t c h a n g e d i f f e r e n t i a l l y f r o m p r e -t o p o s t t e s t l n g o n t h e C h e c k l i s t . A f u r t h e r a n a l y s i s w a s p e r f o r m e d t o d e t e r m i n e w h e t h e r t h e r e p l i c a t i o n g r o u p s c h a n g e d s i m i l a r l y . A n a l y s i s o f t h e c o m b i n e d g r o u p s r e v e a l e d a s i g n i f i c a n t m a i n e f f e c t f o r t i m e ( £ C 1 , 5 7 ) = 3 5 • 3 6 , £ < . 0 0 0 1 ) a n d a p p r o a c h i n g s i g n i f i c a n c e f o r t h e g r o u p m a i n e f f e c t ( j 3 < . 0 5 3 ) . T h i s i n d i c a t e s a s i g n i f i -c a n t c h a n c e f r c m p r e - t o p o s t t e s t l n g f o r b o t h t r e a t m e n t g r o u p s a n d , a s c a n b e s e e n i n F i g u r e 15, t h e S I C g r o u p s c o r e d h i g h e r t h a n t h e ACC g r o u p . T a b l e 24 r e v e a l s a n o n -s i g n i f i c a n t i n t e r a c t i o n ( F< 1 ) i n d i c a t i n g t h a t t h e S I C g r o u p s c o r e s r e m a i n e d s i g n i f i c a n t l y h i g h e r t h a n t h e ACC g r o u p f r o m p r e — t o p o s t t e s t l n g . A s a n i n d i c a t o r o f m a i n t e n a n c e o f c h a n g e f o r t h e A C l a n d S I l g r o u p s , a t w o — w a y ( g r o u p s b y t i m e ) r e p e a t e d m e a s u r e s a n a l y s i s o f v a r i a n c e w a s p e r f o r m e d o n t h e p r e , p o s t a n d t h r e e - m o n t h f o l l o w — u p d a t a . T h e m a i n e f f e c t f o r t i m e was s i g n i f i c a n t ( F( 2, 68 )-21 . 3 , rj< . 0 0 0 1 ) . To d e t e r m i n e t h e n a -t u r e o f t h e d i f f e r e n c e s o v e r t i m e , S c h e f f e ' s t e s t s f o r i n d i -v i d u a l c o m p a r i s o n s w e r e c o m p u t e d . T h e p o s t t o f o l l o w — u p c o n -t r a s t was n o t s i g n i f i c a n t , I n d i c a t i n g t h a t n o f u r t h e r i m p r o v e m e n t o c c u r r e d b e y o n d p o s t t e s t l n g . F i g u r e 15 i l l u s -t r a t e s t h e n a t u r e o f t h e s e c h a n g e s . 114 E.CP.SE.a.rn Jfcgfe.lafe.tJ.fl.B £Ls>g.£±ls>nnpl.x.g. A summary of the program e v a l u a t i o n q u e s t i o n n a i r e r e -s u l t s a t p o s t a rdt f o l l o w - u p can be seen i n A p p e n d i x J . At t h e o u t s e t o f t h e t r e a t m e n t p r o g r a m s . p a r t i c i p a n t s were a s k e d t o l i s t f r o m t h r e e t o l i v e p e r s o n a l outcome g o a l s . A sample o f t h e s e g o a l s i s p r e s e n t e d i n A p p e n d i x M. The t r e a t m e n t g r o u p s as a w h o l e i d e n t i f i e d a n a v e r a g e of 3.6 p e r s o n a l g o a l s . i n r e s p o n s e t o t h e pos t t r e a t me nt q u e s t i o n "To what e x t e n t d i d you a c h i e v e y o u r g o a l s ? " , b o t h t h e ACC and S I C g r o u p s had an a v e r a g e o v e r a l l r a t i n g o f t h r e e on a s c a l e o f one t o f i v e . T h i s r e p r e s e n t s a c a t e g o r y o f "some-what", r e l a t i v e to t h e s c a l e e x t r e m e s o f " n o t at a l l " and " c o m p l e t e l y " . Or. the t h r e e - m o n t h f o l l o w — u p q u e s t i o n "How s u c c e s s f u l do you c u r r e n t l y f e e l i n c o p i n g w i t h s t r e s s ? " , t h e t r e a t m e n t g r o u p s a s a whole had an a v e r a g e r a t i n g o f 3.0, ( o n a s c a l e of one t c f i v e ) which f e l l c l o s e s t t o t h e " q u i t e w e l l " c a t -e g o r y . O n l y one p a r t i c i p a n t ( S I C ) i n d i c a t e d " n o t at a l l " . W i t h r e g a r d t o m a i n t e n a n c e o f j o g g i n g a c t i v i t y , at t h r e e - m o n t h f o l l o w - u p , e i g h t ( 4 4 % ) A C l p a r t i c i p a n t s had i n -c r e a s e d t h e i r j o g g i n g from p o s t t e s t i n g , s i x ( 3 3 % ) d e c r e a s e d t h e i r j e g g i n g , two ( 1 1 % ) s t a >ed the same, and t h e two ( 1 1 % ) who were n o t j o g g i n g a t p o s t t r e a t m e n t were s t i l l not j o g -g i n g . T a b l e 2 5 p r e s e n t s a summary- o f a l l o f .the s t a t i s t i c a l l y s i g n i f i c a n t m u l t i v a r i a t e a n d f o l l o w — u p u n i v a r i a t e t e s t s f o r t h e m a i n e f f e c t s o f t i m e e n d f o r t h e g r o u p s b y t ime i n t e r a c -t i o n s . T h e o r d e r o f p r e s e n t a t i o n f o l l o w s t h e d o c u m e n t e d r e -s u l t s o f t h e c h a p t e r . Tn a d d i t i o n , t h e s t a t i s t i c a l l y s i g — n i f l c a n t u n i v a r i a t e a n a l y s e s o f v a r i a n c e f o r t h e a n c i l l a r y m e a s u r e s i n c l u d e d : ( I ) S i g n i f i c a n t g r o u p m a i n e f f e c t o n t h e m e a s u r e o f e x p e c t a n c y i n d i c a t i n g a s m a l l b u t s i g n i f i c a n t d i f f e r e n c e b e t w e e n ACC a n d S I C g r o u p s f r o m p r e - t o p o s t t e s t -i n g o n l y . ( 2 ) Cn l e v e l o f f i t n e s s ( p r e d i c t e d M V 0 2 ) , t h e a e -ro to i c c o n d i t i o n i n g g r o u p s c h a n g e d d i f f e r e n t i a l l y f r o m t h e S I a n d WL g r o u p s f r o m p r e — t o p o s t t e s t i n g a n d p o s t t o f o l l o w -u p . ( 3 ) A n a l y s e s o f d a t a f r o m t h e C o r n e l l M e d i c a l S y m p t o m s C h e c k l i s t r e v e a l e d a s i g n ! l e a n t m a i n e f f e c t f o r t i m e a n d a s i g n i f i c a n t g r o u p by t i m e i n t e r a c t i o n . F o l l o w - u p S c h e f f e ' s t e s t s i n d i c a t e d t h a t t h e t r e a t m e n t a n d t h e WL g r o u p s c h a n g e d d i f f e r e n t i a l l y f r o m p r e — t o p o s t t e s t i n g . DISCUSSION The r e s u l t s of t h i s study have shown that f o r c h r o n i c , I n t e r m i t t e n t l y s t r e s s e d a d u l t s : { 1) P a r t i c i p a t i o n in both an ae r o b i c c o n d i t i o n i n g program ( j o g g i n g ) and s t r e s s - i n o c u l a -t i o n t r a i n i n g are more e f f e c t i v e than a w a i t i n g l i s t c o n t r o l in r e d u c i n g s e l f - r e p o r t e d s t a t e and t r a i t a n x i e t y . ( 2 ) Par-t i c i p a t i o n i n an a e r o b i c c o n d i t i o n i n g program i s not more e f f e c t i v e than s t r e s s - i n o c u l a t i o n t r a i n i n g i n reducing s t r e s s f o r s u b j e c t s who s e l f — r e p o r t somatic a n x i e t y as being g r e a t e r than c o g n i t i v e a n x i e t y . ( 3) Stress — i n o c u l a t i o n t r a i n i n g i s not more e f f e c t i v e than an a e r o b i c c o n d i t i o n i n g program i n r e d u c i n g s t r e s s f o r s u b j e c t s who s e l f - r e p o r t cog-n i t i v e a n x i e t y as b e i n g g r e a t e r than somatic a n x i e t y . ( 4 ) P a r t i c i p a t i o n i n s t r e s s - i n o c u l a t i o n t r a i n i n g i s more e f f e c -t i v e than an a e r o b i c c o n d i t i o n i n g program in r e d u c i n g neg-a t i v e s e l f — s t a t e m e n t s and Increasing p o s i t i v e s e l f - s t a t e -ments. ( 5 ) P a r t i c i p a t i o n i n an aer o b i c c o n d i t i o n i n g orogram i s not more e f f e c t i v e than s t r e s s — i n o c u l a t 1 on t r a i n i n g in i n c r e a s i n g s e l f — e f f I c a c y • - ! .1 6 -117 T h i s study i n d i c a t e s that p a r t i c i p a t i o n i n an aerobic c o n d i t i o n i n g program ( j o g g i n g ) r e s u l t e d in s i g n i f i c a n t de-crements In s t a t e and t r a i t a n x i e t y which were e i t h e r main-t a i n e d or improved t h r e e months a f t e r t e r m i n a t i o n of treatment. The r e s u l t s a l s o support previous f i n d i n g s ( G c l d f r l e d , Linehan, 8 Smith, 1978; Husslan Q Lawrence, 1978; Kanter © G o l d f r i e d , 1979; Woodward 8 Jones, 1980) that s t r e s s - i n o c u l e t i o n t r a i n i n g Is an e f f e c t i v e treatment l e a d -ing t o s i g n i f i c a n t decreases i n s e l f - r e p o r t e d a n x i e t y . Since both treatment groups changed s i g n i f i c a n t l y compared to the w a i t i n g l i s t group, and the w a i t i n g l i s t groun showed no change, e x p e c t a t i o n s of upcoming treatment and assessment procedures d i d r o t have a s i g n i f i c a n t impact on s u b j e c t i v e r e p o r t s of s t r e s s . Although s t r e s s — i n ccula t i on t r a i n i n g , compared to a j o g g i n g program, p l a c e s much g r e a t e r emphasis cn changing c l i e n t s * c o g n i t i o n s , i t d i d net appear to have a g r e a t e r impact on s u b j e c t i v e f e e l i n g s of a n x i e t y . S i n c e a l l three r e l a t i v e l y independent measures of a n x i e t y ( c o r r e l a -t i o n s ranging from —• 65 to .36) showed s i g n i f i c a n t changes, c o n s i d e r a b l e c o n f i d e n c e can te placed i n these treatments. It has been suggested ( f l u r c h f l e l d , 1979: L l a h t , 198 1; S k l a r S Anisinan, 1981) that maladaptive responses to c h r o n i c i n t e r m i t t e n t s t r e s s o r s are h i g h l y r e l a t e d to p h y s i o l o g i c a l damage or i l l n es s onset. Consequently, red vie t ion on t ra i t a n x i e t y measures, assuming that these measures r e f l e c t a 118 p r o p e n s i t y f o r m a l a d a p t i v e r e s p o n d i n g , i s a n I m p o r t a n t h e a l t h - r e l a t e d o u t c o m e . I n a d d i t i o n , I t may he u s e f u l t o c o n s t r u e " t r a i t s " a s a c h a r a c t e r i s t i c w a y o f p r o c e s s i n g i n -f o r m a t i o n r a t h e r t h a n a n i n v a r i a n t p e r s o n a l i t y s t r u c t u r e . C o n s e q u e n t l y , c h a n g e s on t r a i t m e a s u r e s o f s t r e s s may r e -f l e c t a c h a n g e i n t h e s u b j e c t ' s c h a r a c t e r i s t i c way o f p r o -c e s s i n g r e l e v a n t i n f o r m a t i o n . . T h i s i n f o r m a t i o n p r o c e s s i n g m o d e l o f s t r e s s i s d i s c u s s e d m o r e f u l l y i n H a m i l t o n a n d W a r -b u r t o n (1979). H a m i l t o n (1979) d e f i n e s t r a i t a n x i e t y a s " a d y n a m i c s y s t e m o f b e h a v i o r a l r e a d i n e s s w h i c h i s c a p a b l e o f a c c o m m o d a t i n g new e x p e r i e n c e s w h i c h e i t h e r c o n f i r m o r f a l s i -f y t h e p a t t e r n o f e x p e c t a n c i e s " , w h i l e s t a t e a n x i e t y i s " h u t a r e f l e c t i o n o f t h e p r e d i s p o s i n g t r a i t , i t i s s i t u a t i o n s p e -c i f i c a n d i s f u e l l e d b y t r a n s i t o r y a r o u s a l a n d a c t i v a t i o n p r o c e s s e s " ( p . 92). I n a d d i t i o n , H a m i l t o n c o n c l u d e s t h a t t r a i t a n x i e t y i s t h e v a r i a b l e o f m o s t i m p o r t a n c e . I t i s u n l i k e l y t h a t t h e i m p r o v e m e n t s i n t h e j o g g i n g p r o g r a m w e r e a t t r i b u t a b l e t o d i f f e r e n t i a l e x p e c t a t i o n s , o r d e m a n d c h a r a c t e r i s t i c s a s s o c i a t e d w i t h t h e d i f f e r e n t t r e a t -m e nt c o n d i t i o n s . P a r t i c i p a n t s i n e a c h o f t h e c o n d i t i o n s w e r e I n i t i a l l y c o m p a r a b l e i n t h e i r e x p e c t a t i o n f o r I m p r o v e -m e n t . In a d d i t i o n , t h e r a t i o n a l e p r e s e n t e d , p r o g r a m p a r t i c -i p a t i o n , a n d t h r e e m o n t h f e l l o w — u p d i d n o t d i f f e r e n t i a l l y a l t e r t h e s e e x p e c t a t i o n s . 1 19 U n e x p e c t e d l y , t h e c o g n i t i v e a n d s o m a t i c mode d i d n o t d i s c r i m i n a t e b e t w e e n t r e a t m e n t s o n m e a s u r e s o l s t r e s s — i n d i v i d u a l s c l a s s i f i e d a s e i t h e r c o g n i t i v e c r s o m a t i c o n t h e CSAO, d i d n o t r e s p o n d d i f f e r e n t i a l l y t o t r e a t m e n t s c o n s i d -e r e d m o s t e f f e c t i v e f o r t h a t mode ( i . e . , j o g g i n g - s o m a t i c , s t r e s s i n o c u l a t i o n — c o g n i t i v e ) . H o w e v e r , an i m p o r t a n t p a t -t e r n w as r e v e a l e d . T h e c o g n i t i v e s u b j e c t s , r e g a r d l e s s o f t r e a t m e n t , c h a n g e d s i g n i f i c a n t l y f r o m p r e - t o p o s t t e s t l n g c o m p a r e d t o t h e s o m a t i c s u b j e c t s . F u r t h e r m o r e , t h e s o m a t i c s u b j e c t s c o n t i n u e d t o r e d u c e t h e i r l e v e l o f s t r e s s f r o m p o s t t o f o l l o w - u p w h i l e t h e c o g n i t i v e s u b j e c t s e i t h e r m a i n t a i n e d o r i n c r e a s e d t h e i r s e l f — r e p o r t e d s t r e s s . O ne a p p a r e n t r e a s o n f o r t h i s f i n d i n g may h a v e b e e n t h e c l a s s i f i c a t i o n p r o c e d u r e . A b o u t o n e t h i r d o f t h e s u b j e c t s e x p e r i e n c e d s t r e s s a l m o s t e q u a l l y i n b o t h m o d e s . C o n s e -q u e n t l y , b l o c k i n g t h e s e s u b j e c t s i n t o c o g n i t i v e o r s o m a t i c m odes may h a v e o b s c u r e d a n y d i f f e r e n t i a l t r e a t m e n t e f f e c t s f o r s u b j e c t s who w e r e m o r e p r e d o m i n a n t l y l n o n e o r t h e o t h e r m ode. H o w e v e r , t o a v o i d t h i s w o u l d h a v e p r e c l u d e d r a n d o m a s s i g n m e n t t o t r e a t m e n t s o r a l a r g e r s a m p l e s i z e i n o r d e r t o a p p l y a p p r o p r i a t e s t a t i s t i c a l a n a l y s e s . F u r t h e r m o r e , i t c o u l d be a r g u e d t h a t m o r e c h a n g e s w e r e s e e n i n i t i a l l y f o r t h e c o g n i t i v e s u b j e c t s b e c a u s e t h e s t a t e a n d t r a i t a n x i e t y m e a s u r e s a r e p r e d o m i n a n t l y c o g n i t i v e i n n a t u r e . H o w e v e r , t h e r e s u l t s f o r t h e T e n s i o n T h n r m o m e t e r 120 d i s p l a y e d t h e same t r e n d , a l t h o u g h the change was not s t a -t i s t i c a l l y s i g n i f i c a n t . In a d d i t i o n , t h i s e x p l a n a t i o n does n o t a c c o tin t f o r t h e l a c k o f change c r i n c r e a s i n g s e l f — r e -p o r t e d s t r e s s on t h e s t a t e and t r a i t a n x i e t y measures f o r the c o g n i t i v e s u b j e c t s f r o m p o s t t o f o l l o w — u p , e s p e c i a l l y i n l i g h t of the s i g n i f i c a n t r e d u c t i o n o f t r a i t a n x i e t y a c r o s s t r e a t m e n t g r o u p s d u r i n g t h a t t i m e . These f i n d i n g s a r e some-what i n c o n s i s t e n t w i t h t h o s e of D a v i d s o n (1978) and S c h w a r t z e t a l • (1978). They c o n c l u d e d t h a t a n x i e t y modes can be matched w i t h t e c h n i q u e s which s h o u l d be most e f f e c t i v e . However, t h e i r r e s e a r c h c o n s i s t e d c f r e t r o s p e c t i v e r e p o r t s and i d e n t i f i c a t i o n of c a r d i o v a s c u l a r , e l e c t r o d e r m a l and e l e c t r o m y o g r a p h i c p a t t e r n i n g i n t h e s e modes r a t h e r than c o n t r o l l e d e x p e r i m e n t a l s t u d i e s . R e s e a r c h on " w o r r y and e m o t i o n a l i t y " , which d e v e l o p e d i n d e p e n d e n t l y o f the c o g n i t 1 v e - s o m a t i c l i t e r a t u r e , has been s t u d i e d f r e q u e n t l y i n r e l a t i o n t o t e s t a n x i e t y . A r e v i e w by M o r r i s , D a v i s , and H u t c r i n g s ( 1981) on the "worry—emo-t i o n a l i t y " d i m e n s i o n s i s h i g h l y r e l e v a n t t o t h e p r e s e n t s t u d y . M o r r i s e t ~ a l . summarized t r e a t m e n t s t u d i e s and c o n -c l u d e d t h a t most c o g n i t i v e t r e a t m e n t s f o r t e s t a n x i e t y s u c -c e s s f u l l y r e d u c e d t h e w o r r y component and sometimes the emo-t i o n a l i t y c o m p o n e n t i However, " t h e r e i s no a p p a r e n t c o n n e c t i o n between t h e t y p e s of t r e a t m e n t u s e d i n t h e s t u d -i e s and t h e i r e f f e c t i v e n e s s i n r e d u c i n g e m o t i o n a l i t y " ( p . 546). T h e s e a u t h o r s p r o p o s e t h a t w o r r y a nd e m o t i o n a l i t y r e -121 s p c n s e s a r o q u a l i t a t i v e l y d i f f e r e n t , d e v e l o p e d t h r o u g h d i f -f e r e n t l e a r n i n g e x p e r i e n c e s , a n d a r e u n d e r c o n t r o l o f d i f -f e r e n t s i t u a t i o n a l s t i m u l i , Tn k e e n i n g w i t h t h e M o r r i s e t a l . ' s (1981) d i s t i n c -t i o n s , s o m a t i c a n x i e t y o r e m o t i o n a l i t y may b e c o n s t r u e d as r e i t h e r ; (1) a s e t o f c o n d i t i c n e d fcodi l y r e a c t i o n s t o s t i m u l i w h i c h v e r y a m o n g i n d i v i d u a l s a c c o r d i n g t o t h e i r c o n d i t i o n i n g h i s t o r i e s , a n d / o r (2) u n c o n d i t i o n e d r e s p o n s e s t o s t i m u l i t h a t n a t u r a l l y e l i c i t b o d i l y a r o u s a l . S i m i l a r l y , t h e c o g n i -t i v e r e s p o n s e s a r e c o n c e i v e d a s v a r y i n g a c c o r d i n g t o t h e s o -c i a l l e a r n i n g h i s t o r y , p a s t e x p e r i e n c e s a n d e n v i r o n m e n t a l c i r c u m s t a n c e s . C o n s e q u e n t l y , a s e t h e r s h a v e n o t e d ( F i n g e r S G a l a s s i , 1977) t h e c o g n i t i v e c o m p o n e n t i s m o r e r e a d i l y m o d i -f i e d , w h i l e t h e s o m a t i c m o d e , a s c o n d i t i o n e d r e s p o n s e s , w i l l c h a n g e m o r e s l o w l y . T h e s e f i n d i n g s a r e i n k e e p i n g w i t h t h e s t u d i e s t h a t s u g g e s t t h a t f o r s o c i a l l y o r g e n e r a l l y a n x i o u s s u b j e c t s , i t i s n o t b o d i l y a r o u s a l p e r s e w h i c h i s c r i t i c a l , b u t how i t i s p e r c e i v e d a n d i n t e r p r e t e d ( R o l l a n d s w o r t h e t a l . , 1979; K i r k l a n d e t a l . , 1980; M e i c h e n b a u m , 1977 ). A* r e c e n t s t u d y b y S h a h a r a n d M e r b a u m ( 1981 ) f o u n d t h a t s u b j e c t s who w e r e s t r o n g c n a u t o n o m i c p e r c e i v i n g a n d p h y s i o l o g i c a l r e a c t i v i t y c o m p a r e d t o s u b j e c t s w e a k on t h e s e d i m e n s i o n s d i d a s w e l l i n a c o g n i t i v e t r e a t m e n t ( r a t i o n a l - r e s t r u c t u r i n g ) as I n a s o -m a t i c t r e a t m e n t ( s y s t e ma t i c de s e n s I t i z a t l o n ) . T h e y a l s o c o n c l u d e d t h a t s e l f — c o n t r o l t e c h n i q u e s d o n o t i n i t i a l l y h a v e 122 a s a l i e n t e f f e c t on the overt and/or autonomic i n d i c e s of a n x i e t y . It appears that while i n d i v i d u a l s can be i d e n t i f i e d as e x p e r i e n c i n g s t r e s s In e i t h e r a c o g n i t i v e or somatic mode, or a balance of the two, i n d i v i d u a l s who are i n i t i a l l y mere c o g n i t i v e may be more h i g h l y dependent on c o g n i t i v e evalua-t i o n s and e x p e c t a t i o n s , w h ile somatic i n d i v i d u a l s may r e -spond to more n on ev a lua t i ve s i t u a t i o n a l cues. However, de-pending on the degree to which these elements are present in a s i t u a t i o n and are s a l i e n t , c o g n i t i v e and somatic s t r e s s r e a c t i o n s may c o v a r y . Future r e s e a r c h would be a s s i s t e d by breaking down p h y s i o l o g i c a l responding i n t o a c t u a l or p er-c e i v e d a r o u s a l (Deffenfcacher , 1980) and determining the re-l a t i o n s h i p s between emotional a r o u s a l and c o g n i t i o n (Geen, 1980 ). Despite the p h y s i o l o g i c a l consequences of aerobic con-d i t i o n i n g ( i . e . , r e d u c t i o n i n r e s t i n g heart r a t e and i n -creases ln autonomic recovery to p h y s i c a l work), s u b j e c t s who s c o r e d high on p e r c e i v e d h o d l l y r e a c t i o n s to s t r e s s o r s d i d no b e t t e r In the a e r o b i c c o n d i t i o n i n g program than ln the s t r e s s i n o c u l a t i o n t r a i n i n g . However, these f i n d i n g s must be c o n s i d e r e d c a u t i o u s l y and should be s u b j e c t e d to f u r t h e r r e p l i c a t i o n . It should a l s o be noted that the sub-j e c t s were c l a s s i f i e d a c c ording to p e r c e i v e d a r o u s a l r a t h e r than a c t u a l l y measured a r o u s a l . 123 Se.If.nS taterag n * s As expected, the s t r e s s - i n o c u l a t i o n group s i g n i f i c a n t l y changed t h e i r s e l f - s t a tecnen ts from pre- to p o s t t e s t i n g com-pared to the a e r o b i c c o n d i t i o n i n g group. T h i s study extends the f i n d i n g s of previous r e s e a r c h demonstrating the Impact of s t r e s s - I n o c u l a t i o n t r a i n i n g upon g e n e r a l l y anxious sub-j e c t s ' s e l f - r e p o r t e d i n n e r d i a l o g u e . Although other s t u d i e s have deucnst r a t e d d i f f e r e n c e s between high or low anxious s u b j e c t s on the frequency cf p o s i t i v e or negative s e l f -statements, t h i s study has i l l u s t r a t e d changes over time on r a t i o s of p o s i t i v e and negative s e l f — s t a t e r n e n t s . I t was found that the s u b j e c t s i n the combined s t r e s s -i n o c u l a t i o n programs r a t e d t h e i r s e l f — s t a t e m e n t s as more po-s i t i v e and l e s s n e g a t i v e f r c n pre— to p o s t t e s t i n g , than the combined a e r o b i c c o n d i t i o n i n g groups, with r e l a t i v e l y l i t t l e change three months a f t e r treatment t e r m i n a t i o n . The a e r o -b i c c o n d i t i o n i n g group showed s l i g h t changes i n the same d i -r e c t i o n from pre— to p o s t t e s t i n g e s p e c i a l l y on the s u b j e c t s ' r a t i n g s of p o s i t i v e s e l f — s ta temen t s . The changes i n s e l f -statements f o r the s t r e s s - I n o c u l a t i o n group are c o n s i s t e n t with other s t u d i e s . Arnkoff ( 1980) found that at post treatment s u b j e c t s i n a coping s e l f — s t a t e m e n t therapy exhib-i t e d fewer n e g a t i v e and more p o s i t i v e s e l f - s t a t e m e n t s com-pared to a w a i t i n g l i s t c c r . t r o l group. One would expect t h i s i n c r e a s e In p o s i t i v e s e I f — s ta t e me n t s from grouos that had been e x p l i c i t l y taught to generate p o s i t i v e statements 124 and c h a l l e n g e n e g a t i v e s t a t e m e n t s . These c h a n g e s a t t e s t to t h e e f f i c a c y o f t r e a t m e n t s . However, t h e s e 1 f - s t a t e r n e n t c hanges i n t h e a e r o b i c c o n d i t i o n i n g . g r o u p s u g g e s t t h a t an u n d e r l y i n g change p r o c e s s had o c c u r r e d f o r those s u b j e c t s as w e l l . To t h e e x t e n t t h a t t h i s i n n e r d i a l o g u e r e f l e c t s t h e a p p r a i s a l a n d r e a p p r a i s a l p r o c e s s e s , changes In t h e s e l f -s t a t e m e n t s o f a e r o b i c c o n d i t i o n i n g p a r t i c i p a n t s s h o u l d o c -c u r , e s p e c i a l l y i n l i g h t o f t h e c h a n g e s t h a t o c c u r r e d on measures o f s t r e s s and s e l f - e f f i c a c y . The f i n d i n g t h a t the j u d g e s * r a t i n g s , compared t o t h e s u b j e c t s ' , d i d not as c l e a r l y d i s c r i m i n a t e between t r e a t m e n t groups i s somewhat i n c o n s i s t e n t w i t h C a c i o p p o , G l a s s , and M e r l u z z l ' s ( 1 0 7 9 ) r e s u l t s . They f o u n d t h a t j u d g e s ' r a t h e r t h a n s u b j e c t s ' r a t i n g s d i s c r i m i n a t e d between h i g h and low s o c i a l l y a n x i o u s men who were a n t i c i p a t i n g a s t r e s s f u l e v e n t . However, t h e s e a u t h o r s u s e d f r e q u e n c i e s r a t h e r t h a n r a t i o s i n t h e i r a n a l y s e s . A d d i t i o n a l l y , i n t h e i r s t u d y as w e l l as i n A r n k o f f ' s s t u d y , s e l f - s t a t e m e n t s were r e c o r d e d f o r an a n t i c i p a t e d s t r e s s o r , whereas i n t h e p r e s e n t s t u d y , s u b j e c t s were r e c a l l i n g a s t r e s s f u l s i t u a t i o n f r o m t h e i r Im-m e d i a t e p a s t . Cne c o u l d assume t h a t t h e a p p r a i s a l and r e a p -p r a i s a l p r o c e s s e s may be more s a l i e n t i n t h i s r e c o n s t r u c t i v e method a s l o n g t e r m memory would p l a y an i m p o r t a n t r o l e In r e c a l l . More c o n s i s t e n t w i t h the f i n d i n g s o f t h e p r e s e n t s t u d y a r e t h e r e s u l t s t h a t s u g g e s t some i n d i v i d u a l s e v a l u a t e t h e m s e l v e s more n e g a t i v e l y than t h e y do o t h e r s — a n e v a l u a — 125 t l o n which inc luries n e g a t i v e l y biased s e l e c t i v e a t t e n t i o n and memory ( C l a r k C Arkowitz, 1S75; Curran, Wallander, tt F i s c h e t t i , 1980 ). F u r t h e r research would b e n e f i t from r e l i a b l e assessment of s e l f - v e r b a l i z a t i o n s d u r i n g the s t r e s s f u l s i t u a t i o n , in a n t i c i p a t i o n of a s t r e s s f u l event, as well as r e t r o s p e c t i v e r e p o r t s u s i n g both r e c a l l and r e c o g n i t i o n methods. As seen by t h i s study, s u b j e c t s ' s e l f - r e p o r t e d r a t i n g s are e s s e n t i a l to c l a r i f y the c l i e n t s ' i d i o s y n c r a t i c percep-t i o n s as they p r o v i d e d d i f f e r e n t i n f o r m a t i o n than the o b j e c -t i v e judges' r a t i n g s . As Hurlburt end S i p p r e l l e (1978) found, the s u b j e c t i v e meaning cr s a l i e n c e of the s e l f - s t a t e -ments appears to be most r e l e v a n t . I t i s noteworthy that from post to f o l l o w — u p judges' r a t e d a s i g n i f i c a n t change i n s e l f - s t a t e m e n t s ( i . e . , i n c r e a s e d p o s i t i v e , decreased neg-a t i v e ) whereas the s u b j e c t s ' r a t i n g s d i d not change s i g n i f i -c a n t l y . Perhaps c l i e n t s ' p e r c e p t i o n s preceeded a c t u a l change i n s e l f - s t a t e m e n t c o n t e n t . While a n a l y s i s of r a t i o s cores reveals that a l l t h r e e groups* s e l f - s t a t e m e n t r a t i n g s changed s i g n i f i c a n t l y over time, examination of the components of these r a t i o s y i e l d s f u r t h e r i n f o r m a t i o n . The a e r o b i c c o n d i t i o n i n g group mani-f e s t e d changes from negative to p o s i t i v e on s u b j e c t s ' r a t e d s e l f - s t a t e m e n t s while the w a i t i n g l i s t c c n t r o l changed from negative to n e u t r a l . Consequently, at post and follow-up the treatment groups had a more even d i s t r i b u t i o n of p o s i t i v e . 126 n e g a t i v e , a n d n e u t r a l s t a t e m e n t s t h a n t h e w a i t i n g l i s t c r o u p . W h i l e p o s i t i v e , n e g a t i v e o r n e u t r a l v a l e n c e r a t i n g s a r e m o s t c o m m o n , a l t e r n a t i v e m e t h o d s o l e x a m i n i n g s e l f -s t a t e m e n t s h a v e b e e n s u g g e s t e d ( C a c l o p p o y P e t t y , 1981; M e i -c h e n b a u m G C a m e r o n , 1981). A s s e s s m e n t h y s e q u e n c e a n a l y s i s , p a t t e r n s a n d t h e m e s , a n d a s t r u c t u r a l b a s i s may p r o v i d e f u -t u r e r e s e a r c h e r s w i t h a r i c h e r v i e w o l t h e u n d e r l y i n g p r o -c e s s e s o r " d e e p s t r u c t u r a l r u l e s " ( A r n k o f l , 1980) t h a t c o n -s t i t u t e t h e c o p i n g p r o c e s s e s , S j & l . £ - £ f . f J L S J a c y . C o n t r a r y t o e x p e c t a t i o n s , t h e m o r e p e r f o r m a n c e b a s e d j o g g i n g p r o g r a m d i d n o t r e s u l t i n g r e a t e r p e r c e p t i o n s o f s e l l - e l f i c a c y t h a n t h e s t r e s s - i n o c u l a t i o n t r a i n i n g . B o t h s t r e s s — i n o c u I a t 1 o n a n d j o g g i n g p r o g r a m s s i g n i f i c a n t l y i n -c r e a s e d p e r c e i v e d s e l f - e f f i c a c y f r o m p r e — t o p o s t t e s t i n g a n d p o s t t o f o l l o w - u p . T h e n a t u r e o f the* j o u g i n g p r o g r a m p r o -v i d e d p a r t i c i p a n t s w i t h r e a l i s t i c g o a l s , i m m e d i a t e a n d u n a m -b i g u o u s p e r f o r m a n c e f e e d b a c k a n d m a s t e r y e x p e r i e n c e s . A c -c o r d i n g t o B a n d u r a (1977) " c o g n i t i v e e v e n t s a r e i n d u c e d a n d a l t e r e d m o s t r e a d i l y b y e x p e r i e n c e s c f m a s t e r y a r i s i n g f r o m e f f e c t i v e p e r f o r m a n c e " ( o . 191 ). I t f o l l o w s t h a t b y l e a r n -i n g t o d e a l e f f e c t i v e l y w i t h a d i f f i c u l t p r o b l e m ( I . e . , j o g -g i n g ) , t h e c l i e n t g a i n s c o n f i d e n c e i n h i s o r h e r a b i l i t i e s t o h a n d l e l i f e ' s p r o b l e m s . 127 Bandura t h e o r i z e d t h a t a n e c e s s a r y e l e m e n t i n t h e de-v e l o p m e n t o £ s t r o n g s e l l - e f f i c a c y Is se I f - a t t r i b u t i o n o f t h e m a s t e r y p e r f o r m a n c e . In a d d i t i o n , g e n e r a l i z a t i o n s w i l l o n l y r e s u l t as a c o n s e q u e n c e o f a l t e r i n g t h e f u n d a m e n t a l c o g n i -t i v e m e d i a t i n g p r o c e s s . The r e s u l t s o f t h i s s t u d y a r e s u g -g e s t i v e t h a t g e n e r a l i z a t i o n d i d o c c u r . The d e g r e e t o w h i c h j o g g i n g p e r f o r m a n c e was a s o u r c e o f i n f o r m a t i o n f o r I n -c r e a s e d s e l f - e f f i c a c y has been h y p o t h e s i z e d as b e i n g d e p e n -dent upon b o t h t h e - i n f o r m a t i o n c o n v e y e d by t h e j o g g i n g e x p e -r i e n c e and t h e i n f o r m a t i o n p r o c e s s e d and t r a n s f o r m e d hy the c l i e n t about t h e meaning o f t h e e v e n t ( e . g . , s e l f - a t t r i b u -t l o n ) . F u t u r e r e s e a r c h e f f o r t s s h o u l d aim a t a s s e s s i n g t h e meaning c f m a s t e r y p e r f o r m a n c e s f o r t h e c l i e n t i n o r d e r t o f u r t h e r v a l i d a t e t h e c o n c e p t o f s e l f - e f f i c a c y . S i n c e no d i f f e r e n c e was f o u n d between s t r e s s i n o c u l a -t i o n a n d a e r o b i c c o n d i t i o n i n g , i t may be t h a t e f f i c a c y was e n h a n c e d by components o f t h e p rograms common to b o t h g r o u p s . F o r i n s t a n c e b o t h t r e a t m e n t s p r o v i d e d a p r o b l e m -s o l v i n g s t a n c e , d i r e c t v e r b a l p e r s u a s i o n and m a s t e r y m o d e l -i n g by t h e c o - l e a d e r s . The group p r o c e s s e s i d e n t i f i e d by L e v y ( 1977) may a l s o have c o n t r i b u t e d t o i n c r e a s e d e f f i c a c y . T h i s e x p l a n a t i o n i s c o n s i s t e n t w i t h a r e c e n t s t u d y by D ' A l e -l i o and Murray (1981 ) who f o u n d t h a t s u b j e c t s i n i t i a l l y c o n -s i d e r e d group i d e n t i f i c a t i o n as c o n t r i b u t i n g most t o change w h i l e group m o d e l i n g , f e e d b a c k and s u p p o r t became most s a -l i e n t l a t e r i n the p r o g r a m . Tn the p r e s e n t s t u d y , a number of s u b j e c t s In both groups, cn an open ended quest ion, r a t e d group p a r t i c i p a t i o n us being most h e l p f u l . "Having a s e r v i -cable coping s k i l l a t one's d i s p o s a l " has been suggested by Bandura as c o n t r i b u t i n g t o one's sense of s e l f - e f f i c a c y and a l s o c o u l d be c o n s i d e r e d common to both groups. In a d d i -t i o n , both groups were encouraged to use t h e i r new s k i l l s in t h e i r d a i l y l i v e s , and an emphasis was placed on t h e i r cwn e f f o r t s and s k i l l s a. s being r e s p o n s i b l e f o r p o s i t i v e chang-es . The j o g g i n g group p r a c t i c e d .jn, v_j vo at l e a s t two times per week a p a r t from the group meeting and i s evidenced in t h e i r i n c r e a s e d average a c t i v i t y per week from pre to post and follow-up (_M= 1 • 2 , 3 . 1 , 2.9, r e s p e c t i v e l y ) . The extent to which new c o p i n g s k i l l s were p r a c t i c e d i j x xJLyji. by the s t r ess—inoc u la 1 1 o n group was not as r e a d i l y apparent, a l -though d u r i n g most s e s s i o n s , time was spent f o c u s i n g on group members who had t r i e d new s k i l l s and d i s c u s s i n g the consequences of t h e i r e f f o r t s . However, i t i s noteworthy that on an open—ended q u e s t i o n cn the p o s t - e v a l u a t i o n ques-t i o n n a i r e , the s t r e s s — i n o c u l a t i o n groups were more l i k e l y than the a e r o b i c c o n d i t i o n i n g groups to report f e e l i n g more i n c o n t r o l or more competent as a r e s u l t of the program. Tt i s apparent that the s p e c i f i c a c t i v e i n B r e d i e n t ( s ) that account f o r enhanced s e l f - e f f i c a c y remain u n i d e n t i f i e d and await f u r t h e r s t u d i e s of component a n a l y s i s and con-s t r u c t v a l i d a t i o n . Although the a d d i t i o n a l coping s k i l l s taught p a r t i c i p a n t s i n the s t r e s s - i n o c u l a t i o n group may have 129 enhanced t h e i r p e r c e p t i o n of s e l f - e f f i c a c y i i t appears that they f a r e d no b e t t e r than the more 'generalized coping s k i l l of j o g g i n g . These r e s u l t s are c o n s i s t e n t with Z e i s s , I.ewin-sohn, and Munoz's (1979) f i n d i n g s . Comparing a number of s p e c i f i c treatments f o r the r e d u c t i o n of d e p r e s s i o n , they found that t r a i n i n g i n s p e c i f i c s k i l l s was not the a c t i v e i n g r e d i e n t but a " r e s t o r a l cf morale" (Frank, 1973) which they regarded as s i m i l a r to s e l f - e f f i c a c y . O v e r a l l , i t appears t h a t f o r c l i e n t s with g e n e r a l i z e d a n x i e t i e s , r a t h e r than s p e c i f i c f e a r s , sovirces of e f f i c a c y Information from a v a r i e t y of areas may be r e l e v a n t i n changing e f f i c a c y e x p e c t a t i o n s . Subjects in t h i s study most f r e q u e n t l y f a c e ambiguous and complex s t r e s s o r s where per-formance i s d i f f i c u l t to assess and l i t t l e feedback i s ob-t a i n e d . Bandura's conten t i o n that performance i s the best p r o v i d e r of e f f i c a c y expectancy awaits f u r t h e r t e s t i n g . £ A rjd l ^ r jg spj, r a t fjjy, O-in^JaJ? The r e s u l t s of t h i s study IndicBte that the a e r o b i c c o n d i t i o n i n g program was e f f e c t i v e in i n c r e a s i n g l e v e l of f i t n e s s over the ten —week program, with f u r t h e r i n c r e a s e s at the three—month f o l l c w - u p . In g e n e r a l , these chenaes were of the magnitude that lias been reported for s i m i l a r groups who t r a i n e d from three to s i x months ( P o l l c c k , F o s t e r , S a l -i s b u r y , 6 Smith, 19S2). It appears t h a t e program o f f e r e d to the publ i c as stress-management t r a i n ing ( meet ing once a 1 30 w e e k ) a n d c o n d u c t e d a c c o r d i n g t c a c c e p t e d p r i n c i p l e s o f e x -e r c i s e p r e s c r i p t i o n s may y i e l d r e s u l t s s i m i l a r t o t h o s e d o c -u m e n t e d I n m o r e r i g i d l y m a n a g e d c o n d i t i o n i n g p r o g r a m s * T h e s l i g h t r i s e i n p r e d i c t e d MVC2 I n t h e s t r e s s i n o c u -l a t i o n g r o u p s s u g g e s t s t h a t t h e f i t n e s s t e s t may h a v e b e e n s l i g h t l y r e a c t i v e . Some p a r t i c i p a n t s v e r b a l l y r e p o r t e d b e -c o m i n g m o r e a c t i v e a s a r e s u l t o f t h e b i c y c l e t e s t p r o c e -d u r e s . A l t h o u g h f o r m o s t , i t w a s n o t c f t h e f r e q u e n c y , d u -r a t i o n , o r i n t e n s i t y t o m a i n t a i n t h e s e i n i t i a l c h a n g e s a t p o s t o r f o l l o w - u p . A n o t h e r e x p l a n a t i o n f o r t h e s e i n c r e a s e s i s t h e c h a n g i n g s e a s o n s — s p r i n g t o s u m m e r . T h i s may w e l l h a v e a f f e c t e d t h e r e s u l t s a s E r i k s s e n a n d K o d a h l ( 1 9 7 9 ) f o u n d c o n s i d e r a b l e c h a n g e I n p h y s i c a l f i t n e s s r e l a t e d t o t h e s e a s o n s . T h e y s p e c u l a t e d t h a t t h e s e c h a n g e s w e r e d u e t o i n -c r e a s e d l e i s u r e a c t i v i t y d u r i n g b e t t e r w e a t h e r a n d t h e h o l i -d a y s e a s o n . S v i r p r i s i n g l y , t h e i n i t i a l l e v e l o f f i t n e s s ( h i g h v e r -s u s l o w MV0 2 ) was n o t s i g n i f i c a n t l y r e l a t e d t o p r e t e s t s e l f - r e p o r t e d l e v e l s o f s t r e s s o n t h e S t a t e , T r a i t , o r T e n -s i o n T h e r m o m e t e r . A l t h o u g h Z i m m e r m a n a n d F u l t o n ( 1931 ) f o u n d p a r t i c i p a n t s i n a j o g g i n g g r o u p ( h i g h f i t ) r e p o r t e d l o w e r t r a i t a n x i e t y t h a n m a t c h e d n o n — j o g g e r s , t h i s f I n d l n s ; may h a v e b e e n a f u n c t i o n o f p a r t l c i u a t i o n o r s e l f - s e l e c t I o n r a t h e r t h a n I n c r e a s e d M V C 2 . I n c o n t r a s t , J a s n o s k i a n d H o l m e s ( 1 9 8 1 ) f o u n d t h a t i n i t i a l l e v e l o f f i t n e s s was r e l a t -e d t o g r e a t e r s e l f - a s s u r a n c e , g r e a t e r e m o t i o n a l s t a b i l i t y , 131 l e s s d e p r e s s i o n and l e s s p r e t e n t i o u s n e s s ( 16PF; / u n a : Denres— s l o n S c a l e ) . F-owever, the s i g n i f i c a n t r e l a t i o n s h i p found between these p e r s o n a l i t y c h a r a c t e r i s t i c s accounted f o r very l i t t l e v a r i a n c e (jr=.44), l e s s than 20% f o r the best pre-d i c t o r s . As t h i s data i s c o r r e l a t i o n a l i t i s not c l e a r whether p e r s o n a l i t y i n f l u e n c e d f i t n e s s or f i t n e s s i n f l u e n c e d p e r s o n a l i t y . J a s n o s k i ' s study a l s o c o n s i s t e d of a popula-t i o n of normal a d u l t women, i n which one would not expect many changes o r v a r i a t i o n s on p e r s o n a l i t y v a r i a b l e s . Another reason why i n i t i a l l e v e l o f f i t n e s s may not have d i s c r i m i n a t e d among l e v e l s of coping a b i l i t y in t h i s study i s r e l a t e d to the measure i t s e l f . Although p r e d i c t e d MV02 i s an adequate measure of change for an i n d i v i d u a l , i t ' s v a l i d i t y as a. comparative estimate across peoole has been qu e s t i o n e d ( A s t r a n d 8 Rodahl, 1.977 ). In a d d i t i o n , the g e n e r a l l y low f i t n e s s l e v e l o l the t o t a l group r e s u l t e d i n a "high" f i t group which was, in f a c t , r a t h e r average in f l t -ne ss • The f i n d i n g that a e r o b i c c o n d i t i o n i n g p a r t i c i p a n t s who improved the most ( 1 . e . , i n c r e a s e d more than f i v e ml/kg/min) from pre- to p o s t t e s t l n g were not s i g n i f i c a n t l y d i f f e r e n t on measures of s t r e s s from those who showed l e s s change i s par-t i a l l y supported by J a s n o s k i , Holnes, Sclcmon, and Vtiuiar's ( 1 9 8 1 ) s tudy . This was a ten —week a e r o b i c c o n d i t i o n i n g pro-gram with 20 women l n f a i r c o n d i t i o n . They found that scores r e f l e c t i n g changes in s e l f - p e r c e i v e d a b i l i t i e s and 132 c o n f i d e n c e w e r e n o t r e l i a t l y c o r r e l a t e d w i t h c h a n g e s i n a e -r o b l c p o w e r . An e a r l i e r s t u d y b y F o l k i n s . L y n c h , a n d G a r d n e r ( 19*72) t h a t s h o w e d s i g n i f i c a n t c o r r e l a t i o n s b e t w e e n f e m a l e p e r f o r m -a n c e c h a n g e s c o r e s on a 1•15 m i l e r u n a n d c h a n g e s c o r e s on a n x i e t y , d e o r e s s i o n , s e l f - c o n f i d e n c e a n d w o r k e f f i c i e n c y may h a v e b e e n s u p e r f l u o u s f o r a n u m b e r o f r e a s o n s . F i r s t , t h e same r e s u l t s w e r e n o t o b t a i n e d f o r men. S e c o n d , t h e 1.75 m i l e r u n r e s u l t s " may h a v e r e f l e c t e d l e a r n i n g a n d d e m a n d c h a r a c t e r i s t i c s o f t h e s i t u a t i o n r a t h e r t h a n t r u e i m p r o v e d MVG2• Tn a d d i t i o n , t h e c o n t r o l g r o u p d i d n o t r e c e i v e t h e p h y s i c a l f i t n e s s t e s t a n d c o u l d n o t b e c o m p a r e d . As t h e wo-men w e r e a l s o i n i t i a l l y h i g r e r on t h e s e m e a s u r e s t h a n t h e men o r t h e c o n t r o l s , t h e p h e n o m e n a o f r e g r e s s i o n t o w a r d s t h e mean tray h a v e o c c u r r e d . C o n s e q u e n t l y , c h a n g e s on m e a s u r e s o f s t r e s s d o n o t a p -p e a r t o be d u e t o i n c r e a s e d MVC2, n c r a r e h i g h e r I n i t i a l l e v e l s o f f i t n e s s r e l a t e d t o l e s s s e l f — r e p o r t e d s t r e s s . F i n d i n g s by H e a p s ( 1 S 7 S ) a l s o s u g g e s t t h a t t h e c h a n g e s I n s t r e s s a s s o c i a t e d w i t h t r a i n i n g p r o g r a m s may b e d u e t o o t h e r a s p e c t s o f t h e p r o g r a m . The e a r l i e r f i n d i n g s o n s e l f - e f f i -c a c y h a v e a l s o s u g g e s t e d t h a t t h e c o m p o n e n t s o f g r o u p s o f t e n c o n s i d e r e d a s " n o n - s p e c i f i c s " may tie c o n t r i b u t i n g c o n s i d e r a -b l y t o p o s i t i v e c h a n g e s . A n u m b e r o f s t u d i e s ( G l o g o w e r , F r e m o u w , P M c C r o s k e y , 1 9 7 8 : H o l r o y d 5 A n d r a s i k , 1 9 7 8 ; Z e i s s e t a l . , 1 9 7 9 ) h a v e f o u n d p a r t i c i p a t i o n i n d i s c u s s i o n g r o u p s 133 or o ther n o n — a c t i v e sroups to have an e f f e c t on outcome measures. It Is suggested that f u r t h e r r e s e a r c h assess the impact, over time, of the c r i t i c a l I n g r e d i e n t s of treatment, and that the b e h a v i o r a l and c o g n i t i v e processes i d e n t i f i e d by Levy ( 1977 ) be used as a guide. I t was honed that p a r t i c i p a n t s , through n a t u r a l s e l e c -t i o n , would f a l l i n t o c a t e g o r i e s of long or short d i s t a n c e runners. • However, most s u b j e c t s in the a e r o b i c c o n d i t i o n i n g group tended tc run between 30 to 35 minutes at post and follow—up, without s u f f i c i e n t v a r i a b i l i t y to permit c l a s s i -f i c a t i o n on t h i s v a r i a b l e f o r f u r t h e r a n a l y s e s . At f o l l o w -up, 13 of the 30 s u b j e c t s p a r t i c i p a t e d In a 10 k i l o m e t e r run which took them from 55 minutes to 1 1/2 hours to complete. None of the runners were c o n s i s t e n t l y running l o n g e r than one hour. It Is suggested that the v a r i a b l e of time spent running needs to be e x p l o r e d , as c o n s i d e r a b l e "popular" e v i -dence suggests that the "runners high" experienced with long runs may c o n t r i b u t e to acute and/or c h r o n i c p s y c h o l o g i c a l changes. I n t e r e s t i n g l y , on the pest program—evaluation q u e s t i o n -n a i r e , s u b j e c t s in the j o g g i n g groups r a t e d " p h y s i c a l sense of w e l l - b e i n g " as c o n t r i b u t i n g most to t h e i r coping: a b i l l ty. T h i s may be r e l a t e d to C s l k s z e n t m i h a l y i ' s (1975) "flow s t a t e " of a c t i v i t y and a t t e n t i o n which i s based on a theo-r e t i c a l model f o r enjoyment. Although not evidenced in re-search f i n d i n g s as y e t , Lazarus ( 1SS0) has suggested that 134 " u p l i f t s " contribute to overall coping a b i l i t y . Perhaps jogging could be considered an added " u p l i f t " or "flow state" in one's daily l i f e . Once again, the meaning of the experience is an important consideration for the psycholosi-cal consequences of these a c t i v i t i e s . The f a c t that 89% of the ACl group continued jogging beyond the treatment program can be accounted for by studies that show that b e l i e f s and attitudes of sedentary—made—ac-tive groups s h i f t during exercise programs and approach those held by v o l i t i o n a l groups ( Harris, 1970). Consequent-l y , people who may be motivated to participate in ohysical a c t i v i t y for instrumental reasons, such as the population in t h i s study, may eventually p a r t i c i p a t e for more i n t r i n s i c re asons. Although these results suggest that i t is the p a r t i c i -pation per se and not the Increased f i t n e s s level that af-fected the measures of s t r e s s , this i s not to suggest that improved fitness and recovery time could not mediate psycho-l o g i c a l change. However, this has not yet been demonstrated experimentally. Whether exercise and emotional behavior ac-t u a l l y u t i l i z e d i s t i n c t neural pathways and produce q u a l i t a -t i v e l y d ifferent cardiovascular adjustments ( Schwartz, W e i n -berger, S Singer, 1981) remains unclear. Schwa rtz e t aI. suggest that emotions have basic l i n k s to the cardiovascular system—they can interact us well as augment the massive ad-justment associated with exercise (p. 3 62 ). 135 •SAusmflry. and SaaslMSicBa In summary, "the r e s u l t s of the present study provide s t r o n g support f o r the e f f i c a c y of p a r t i c i p a t i o n i n an aero-b i c c o n d i t i o n i n g ( j o g g i n g ) program i n reducing s e l f - r e p o r t e d s t r e s s and improving other p s y c h o l o g i c a l c h a r a c t e r i s t i c s of s t r e s s e d community members, The reason why t h i s method works i s not d i r e c t l y d i s c e r n i b l e from the r e s u l t s of t h i s study, although the data suggest that group processes common to v a r i o u s coping programs ( e . g . , s o c i a l supno r t , mastery experiences, coping s k i l l s , e t c . ) are important v a r i a b l e s . It i s apparent that the ae r o b i c c o n d i t i o n i n g program can he widely disseminated as p a r t i c i p a n t s found the manner in which treatment e f f e c t s were achieved as being both a c c e p t a -b l e and p l a u s i b l e , Tn a d d i t i o n , the program can be c o n s i d -ered c o s t e f f e c t i v e as a d d i t i o n a l h e a l t h b e n e f i t s were ac-crued ( i . e . , . improved l e v e l of c a r d i o v a s c u l a r f i t n e s s ) and t h e r a p i s t contact time was augmented by heme assignments and a c t i v i t i e s . However, what the r e s u l t s would be If c l i e n t s were a s s i g n e d t o treatment m o d a l i t i e s on the b a s i s of pre— assessment data or c l i e n t p r e f e r e n c e s rather than randomly, are'unknown. On the b a s i s of the c u r r e n t r e s u l t s and t lie model of s t r e s s presented, the f o l l o w i n g c l i n i c a l recommendations are made r e g a r d i n g the implementation of aerobic c o n d i t i o n i n g 136 p r o g r a m s a s s t r e s s - m a n a g e m e t i l I n t e r v e n t i o n s : ( a ) T h e r a p y s h o u l d b e g i n w i t h a n e d u c a t i o n a l p h a s e t h a t i n c l u d e s a c l e a r r a t i o n a l e * T h e r a t i o n a l e s h o u l d l e a d t h e c l i e n t t o b e l i e v e t h a t he o r s h e h a s some c o n t r o l o v e r t h e i r b e h a v i o r a n d c o n -s e q u e n t l y , t h e i r s t r e s s r e s p o n s e . ( b ) T h e r a p y s h o u l d p r e s -e n t e n d u r a n c e t r a i n i n g f r o m a p r o b l e m — s c l v i n e p e r s p e c t i v e . T h e p r i n c i p l e s s h o u I d b e a p p l i e d t o o t h e r a r e a s o f t h e c l i e n t s d a i l y l i f e . ( c ) F r e - a n d p o s t - a s s e s s m e n t o f c a r -d i o r e s p i r a t o r y f i t n e s s s h o u l d be c o n d u c t e d s o t h a t u n a m b i g u -o u s f e e d b a c k c a n be g i v e n t o t h e c l i e n t s . ( d ) C l i e n t s s h o u l d b e r e q u i r e d t o p r a c t i c e on t h e i r cwn i n o r d e r t o d e -v e l o p i n d e p e n d e n c e f r o m t h e g r o u p a n d t h e t h e r a p i s t . ( e ) C h a n g e s i n m o o d s h o u l d b e m o n i t o r e d hy t h e c l i e n t ( p r e a n d p o s t r u n s ) w i t h s e l f — a t t r i b u t i o n s e n c o u r a g e d . ( f ) A n o p -p o r t u n i t y t o d i s c u s s c o n c e r n s ( s u c c e s s e s . a n d f a i l u r e s ) i n an a t m o s p h e r e o f s u p p o r t a n d e n c o u r a g e m e n t s h o u l d be p r o v i d e d . T h e g r o u p l e a d e r s s h o u l d a c t a s c o p i n g m o d e l s w i t h a p p r o p r i -a t e s e l f - d i s c l o s u r e s a n d t h e y s h o u l d d e v e l o p a r e l a t i o n s h i p o f c o l l a b o r a t i o n w i t h t h e p a r t i c i p a n t s . ( g ) C l i e n t s s h o u l d be e n c o u r a g e d t c be r e s p o n s i b l e t o t h e g r o u p f o r t h e i r a t -t e n d a n c e a n d when a b s e n c e s c c c u r , i m m e d i a t e c o n t a c t s h o u l d be m a d e by t h e l e a d e r s . T h e m a j o r r e c c m m e n d a t i o n s f o r f u r t h e r r e s e a r c h t h a t e m e r g e d f r o m t h i s s t u d y i n c l u d e : ( a ) C r o u p p r o c e s s e s a n d c o p i n g s k i l l s s h o u l d b e e x a m i n e d m o r e c l o s e l y a n d t h e i r i n -t e r r e l a t i o n s h i p b e c o n s i d e r e d p o s s i b l e e x p l a n a t i o n s f o r t h e 137 e f f e c t i v e n e s s of the a e r o b i c co nd 11 1 c n i n p a not s t r e s s i n o c u -l a t i o n programs. (b) The r e l a t i v e impact, over time, of coping s k i l l s t r a i n i n g on the c o g n i t i v e and somatic compo-nents of the s t r e s s response should be examined. However, I t i s important that p e r c e i v e d and a c t u a l a r o u s a l be d i s c r i m i -nated, (c ) C l i e n t s * s u b j e c t i v e meaning of events ( 1. e.» performance, s t r e s s o r s , e t c . ) should be assessed and r e l a t e d to hypothesized c o g n i t i v e mediators. ( d ) The r e l a t i o n s h i p of autonomic recovery time and c a r d i o v a s c u l a r f i t n e s s should be examined f u r t h e r with adequate p h y s i o l o g i c a l measures as w e l l as s u b j e c t i v e measures i n c l u d e d i n the t e s t b a t t e r y , ( e ) Stress—management programs should i n c l u d e v a r i o u s combi-n a t i o n s cf both s t r e s s - i n o c u l a t i o n t r a i n i n g and a e r o b i c con-d i t i o n i n g and e v a l u a t e d f o r t h e i r e f f e c t i v e n e s s f o r v a r i o u s p o p u l a t i o n s and c l i e n t c h a r a c t e r i s t i c s . I f ) Stress-manage-ment programs s h o u l d be developed with other forms of aero-b i c c o n d i t i o n i n g programs ( e.g., c y c l i n g , swimming) to de-termine t h e i r e f f e c t i v e n e s s as s t r es s — man ageme nt treatments, ( g ) A major l i m i t a t i o n of t h i s study i s i t s e x c l u s i v e use of s e l f - r e p o r t data, t h e r e f o r e , o b t a i n i n g " s i g n i f i c a n t other" c o l l a b o r a t i v e evidence might strengthen the f i n d i n g s and a l s o f a c i l i t a t e t h e r a p e u t i c change. R E F E R E N C E S A l l e n , FJ. P., S P o t k a y , C. Cn t h e a r b i t r a r y d i s t i n c t i o n b e t w e e n s t a t e s a n d t r a i t s . iLga .SB.&l o j ; P e x ^ n ^ l . l l y . aacj S S f i l a i ZgX£±&±BSUL f 1 9 8 1 , J I , 9 1 6 - 9 2 8 . A m e r i c a n C o l l e g e o f S p o r t s M e d i c i n e . 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L^X£lW.lj^l£JlA J i s a s r t s . , 198 1, J8, £11-918. 161 T a b l e 1 Summary of C h i - s q u a r e T e s t s of Group Demographic Data Demographic Data Groups Compared a AC 1 SI1 df = 2 WL ACC SIC df =1 C h i - s q u a r e 2 C h i - s q u a r e 2 M a r i t a l S t a t u s .432 .81 .191 .66 E d u c a t i o n .027 .98 . 1 77 .67 Age 3.990 . 1 4 1.313 .25 AC1=Aerobic C o n d i t i o n i n g Treatment Group S I 1 = S t r e s s I n o c u l a t i o n Treatment Group' WL=Waiting L i s t C o n t r o l Group ACC=Combined A e r o b i c C o n d i t i o n i n g Groups (AC1+AC2) SIC=Combined S t r e s s I n o c u l a t i o n Groups (SI1+SI2) 162 T a b l e 2 Means and St a n d a r d D e v i a t i o n s of Expectancy Scores Group a AC 1 SI 1 AC2 , SI2 (n=l8) (n=!8) (n=l2) (n=13) Ex p e c t a n c y M SD M SD M SD M SD Pre 16.6 3.2 15.6 2.2 17.3 3.7 16.7 2.4 P o s t 18.2 2.8 16.7 4.5 18.6 2.1 16.6 3.5 F o l l o w - u p 17.9 2.8 16.9 3.1 AC1=Aerobic C o n d i t i o n i n g Treatment Group S I 1 = S t r e s s I n o c u l a t i o n Treatment Group AC2=Aerobic C o n d i t i o n i n g R e p l i c a t i o n Group S I 2 = S t r e s s I n o c u l a t i o n R e p l i c a t i o n Group T a b l e 3 Summary of A n a l y s e s of V a r i a n c e on Expectancy Source df MS F e a Groups: AC 1 & S I l ; Time: Pre t o Post Group (G) 1 29.39 2.74 . 1 025 Time (T) 1 34.72 3.24 .0764 GxT 1 .89 <1 E r r o r : wi t h i n eel 1 68 10.73 R e p l i c a t i o n s (AC2,SI2); Groups (AC 1 & SI 1 ) ; Time: Pre t o Post R e p l i c a t i o n (R) , 7.59 <1 Group (G) 1 47.57 4.75 .0314 Time (T) 1 29.99 2.99 .0864 RxT . 1 .00 <1 RxG 1 4.26 <1 GxT 1 6.34 <1 RxTxG 1 1 .72 <1 E r r o r : wi t h i n eel 1 1 1 4 10.02 a G r o u p s : AC1 & SI 1 ; Time: Po s t t o F o l l o w - u p Group (G) 1 29. 39 2.58 .1131 Time (T) 1 . 06 <1 GxT 1 .89 <1 E r r o r : wi t h i n eel 1 68 1 1 . 40 a s e e T a b l e s 1 & 2 T a b l e 4 Means and S t a n d a r d D e v i a t i o n s f o r Outcome Measures of S t r e s s a t P r e , Post and F o l l o w - u p Measure S t a t e T r a i t T e n s i o n Group a M SD M SD -M SD AC 1 (n=l8) Pre 40.4 12.2 46.2 7.3 6.9 1.0 Post 33.4 9.5 38.9 9.4 4.9 1.6 F o l l o w - u p 34.2 9.4 36.9 8.7 5.2 2.1 511 (n=l8) Pre 44.6 15.8 51.9 11.1 6.6 1.3 Post 35.7 13.4 44.1 10.9 5.3 2.1 F o l l o w - u p 34.8 11.2 39.8 10.8 5.3 1.9 WL (n=20) Pre 41.0 10.2 44.8 10.0 6.5 1.5 Post 43.9 10.9 45.1 9.9 6.2 1.3 AC2 (n=12) Pre 37.3 7.4 41.8 8.9 6.1 1.2 Post 31.5 7.9 34.3 5.9 5.1 1.6 512 (n=13) Pre 48.9 11.4 48.6 8.9 7.4 1.2 Post 35.8 8.8 40.5 9.1 5.1 1.7 Note: H i g h e r v a l u e s i n d i c a t e more a n x i e t y , see T a b l e s 1 & 2 165 T a b l e 5 M u l t i v a r i a t e and U n i v a r i a t e Summary f o r Measures of S t r e s s Pre & Post on AC1 r SI 1 and WL Groups E f f e c t M u l t i v a r i a t e (F , p'< ) U n i v a r i a t e s (p< ) df=3,5l T e n s i o n S t a t e T r a i t Time 10.06 .0001 .0001 .0254 .0001 Treatments by WL by Time 5.01 .0041 .0041 .0049 .0007 AC vs SI by Time <1 T a b l e 6 M u l t i v a r i a t e and U n i v a r i a t e Summary f o r Measures of S t r e s s -Pre & P o s t on Treatments: ACl & S l l ; R e p l i c a t i o n : AC2 & SI2 Ef f e c t M u l t i v a r i a t e (F,p<) U n i v a r i a t e s (p<) df=3,55 T e n s i o n S t a t e T r a i t Time 22.04 .0001 .0001 .0006 .0001 R e p l i c by Time <1 T r e a t by Time <1 R e p l i c a t i o n by Treatment by Time 2.17 .1026 .0367 .4052 .9815 166 Table 7 M u l t i v a r i a t e and U n i v a r i a t e Summary f o r Measures of S t r e s s P r e , P ost & F o l l o w - u p on AC 1 and S11 Groups Ef f e c t M u l t i v a r i a t e (F,p<) U n i v a r i a t e s (p<) df=6,29 T e n s i o n S t a t e T r a i t Time 10.62 .0001 pr e / a v e r a g e of p o s t & f o l l o w - u p .0001 .0006 .0001 post t o f o l l o w - u p .5500 .9559 .0291 AC vs SI by Time <1 167 T a b l e 8 Means and S t a n d a r d D e v i a t i o n s of Outcome Measures of S t r e s s - B l o c k e d on C o g n i t i v e - Somatic Mode _________ Measure AC 1 S I l ACC SIC M SD M SD M SD M SD C o g n i t i v e n= 8 n =  9 n= 1 5 n = 20 S t a t e Pre 43. ,6 1 1 . ,4 47. 6 18. ,5 41 . , 1 9. ,2 47. ,9 14. 9 Post 32. ,6 1 1 . ,9 31 . 3 9. ,5 32. ,3 9. ,7 33. ,7 9. , 4 Follow--up 38. ,0 12. ,0 37. 2 15. , 1 — — T r a i t Pre 50. , 1 7. , 5 55. 0 12. ,7 47. ,9 6. ,9 52. ,2 10. ,6 Post 40. ,0 10. .5 45. 1 1 2. ,6 37. ,3 8. .4 42. ,5 10. ,7 Fo l l o w ' -up 41 . , 1 7, .9 43. 0 13. .7 Te n s i o n Pre 7. . 1 .9 6. 3 1 . ,3 6. .9 1 , .0 . 6. 7 1 . , 4 Pos t 5. .0 1 , .9 4. 4 2. ,5 5. , 1 1 , .6 4, .8 2. . 1 F o l l o w -up 5. .3 1 , .8 5. 3 2. ,5 Somat i c n = 10 n= =.9 n = 1 5 rf= 1 1 S t a t e Pre 38, .0 12, .8 42. 0 8, .9 37, .3 1 1 , .6 43, .6 12, . 5 Post 34, . 1 7, .6 40. 1 15, .7 33, .0 8, . 1 39, .5 14, .3 F o l l o w -up 31 , .5 6, . 1 32. 3 5, . 1 — T r a i t Pre 43, .0 5, .7 49. 0 12, .8 40, .9 7, .9 47, .5 9, . 1 Post 38, .2 9, .0 43. 0 9, .6 36, .8 8, .7 42, .8 9, .7 F o l l o w -up 33, .6 8, .2 37. 0 6, .3 Te n s i o n Pre 6, .7 .9 6. 9 1 , .4 6, .2 1 . 1 6 .9 1 , .3 Post 4, .8 1 , .3 6. 1 1 , .2 4, .8 1 .6 5 .9 1 , . 1 F o l l o w -up 5, .2 2, .3 5. 3 1 , . 1 —" —" Note: H i g h e r v a l u e s i n d i c a t e more a n x i e t y . see T a b l e 1 168 T a b l e 9 M u l t i v a r i a t e and U n i v a r i a t e Summary on Measures of S t r e s s B l o c k e d on C o g n i t i v e Somatic Modes - Pre & Post on ACC and SIC Groups E f f e c t M u l t i v a r i a t e (F,p<) df=3,55 U n i v a r i a t e s (p<) Te n s i o n S t a t e T r a i t Time 24.01 .0001 0001 0001 0001 AC vs SI by Time <1 C o g n i t i v e vs Somatic by Time 2.76 .051 0 1 082 .0278 .0083 Group by Mode by Time - <1 Table 10 M u l t i v a r i a t e and U n i v a r i a t e Summary on Measures of S t r e s s B l o c k e d on C o g n i t i v e Somatic Mode - P r e , P o s t , F o l l o w - u p on AC 1 and S11 Groups 163 E f f e c t M u l t i v a r i a t e (F,p<) DF=6,27 Time 10.47 .0001 pre/ a v e r a g e p o s t f o l l o w - u p p o s t t o f o l l o w - u p AC vs SI by Time <1 C o g n i t i v e vs Somatic by Time 1.65 .1728 pre/ a v e r a g e p o s t f o l l o w - u p p o s t t o f o l l o w - u p Group by Mode by Time <1 U n i v a r i a t e s (p<) Te n s i o n S t a t e T r a i t 0001 541 5 6127 2357 0006 951 4 1 783 0064 0001 0269 3666 0905 T a b l e 1 1 Means and S t a n d a r d D e v i a t i o n s f o r S e l f - e f f i c a c y a t P r e , Post and F o l l o w - u p Time Pre Post F o l l o w - u p Group a M SD M SD M • SD AC 1 76.2 12.7 84.7 11.1 86.9 10.3 S11 71.8 11.5 81.0 12.6 84.3 12.0 WL 78. 1 16.7 77.4 14.6 - -AC2 75.1 14.1 82.2 13.4 • - -SI2 75.5 13.3 81.7 10.2 — — Note; H i g h e r v a l u e s i n d i c a t e g r e a t e r s e l f - e f f i c a c y . see T a b l e 1 _ 2 T a b l e 12 Means f o r S u b j e c t s ' and Judges' S e l f - s t a t e m e n t R a t i n g s a t P r e , P o s t and F o l l o w - u p Group R a t i o s AC 1 M S11 M WL M AC2 M SI2 M S u b j e c t s ' R a t i n g s P o s i t i v e SS Pre Post F o l l o w - u p 19.2 15.1 20.3 19.0 16.0 32.0 53.8 22.3 36.2 56.0 38.0 45.0 -N e g a t i v e SS Pre Post F o l l o w - u p N e u t r a l SS Pre Post F o l l o w - u p .58.0 44.0 35.0 23.0 24.4 27.4 65, 29. 31 . 19. 17 24 61 .2 49.5 18.5 28.2 40.0 25.0 42.0 39.0 66.0 26.3 18 18 Judges' R a t i n g s P o s i t i v e SS Pre 14.8 16.6 6.7 10.1 10.4 Post 22.5 34.1 14.4 26.3 40.2 F o l l o w - u p 37.0 42.0 N e g a t i v e SS Pre 70.1 67.2 72.0 59.0 58.3 Post 53.2 30.5 52.0 52.0 21.2 F o l l o w - u p 35.0 24.0 -N e u t r a l SS Pre 15.1 16.2 21.4 31.1 31.3 Post 24.3 35.4 34.0 22.0 39.0 F o l l o w - u p 29.0 35.0 -a see Table 1 & 2 T a b l e 13 Means f o r S u b j e c t s ' and Judges' S e l f - s t a t e m e n t R a t i n g s a t P r e , Post and F o l l o w - u p Group a Frequency AC 1 SI 1 WL AC2 SI 2 S u b j e c t s ' R a t i n g s Pre 6.4 7.2 5.5 6.0 7.0 Post 6.4 6.7 5.8 5.8 6.3 F o l l o w - u p 6.8 7.9 Judges' R a t i n g s Pre 7.7 6.7 6.1 6.8" 6.8 P o s t 6.6 7.9 6.5 5.5 8.7 F o l l o w - u p 7.5 9.6 a see T a b l e 1 & 2 T a b l e 14 M u l t i v a r i a t e and U n i v a r i a t e Summary on S e l f - e f f i c a c y and S e l f - s t a t e m e n t Measures - Pre & P o s t on AC1, S11 and WL Groups E f f e c t s M u l t i v a r i a t e (F,p<) U n i v a r i a t e s (p<) df = 3,51 S- E f f J - P S S 3 J-NSS a Time 11.19 .0001 . 0004 .0077 .0001 Treatment vs WL by Time .3.45 .0234 .0021 .5525 .5440 AC vs SI by Time <1 S - E f f S-PSS b S-NSS Time 9.49 .0001 .0004 .0002 .0003 Treatment vs WL by Time 4.65 .0060 .0021 .0105 .2135 AC vs SI by Time 1 .99 . 1 270 .8519 .0187 .0950 SI vs WL 5.48 .0025 .05° .05° . 1 0 C AC vs WL 2.57 .0647 .05° ns ns aJ-PSS=Judges' P o s t i v e S e l f - s t a t e m e n t s ,J-NSS=Judges' N e g a t i v e S e l f - s t a t e m e n t s S-PSS=Subjects' P o s i t i v e S e l f - s t a t e m e n t s cS-NSS=Subjects' N e g a t i v e S e l f - S t a t e m e n t s S c h e f f e c o n t r a s t T a b l e 15 M u l t i v a r i a t e and U n i v a r i a t e Summary on S e l f - e f f i c a c y and S e l f - s t a t e m e n t Measures - Pre _ Post f o r Treatments: AC 1 & SI 1; R e p l i c a t i o n s : AC2 & SI2 M u l t i v a r i a t e (F,p<) U n i v a r i a t e s (p<) E f f e c t df=3,55 Time 17.84 .0001 R e p l i c by Time 1.37 .2603 Treatment by Time 2.27 .0900 R e p l i c a t i o n by Treatment by Time ' <1 S- E f f J-PSS J-NSS a .0001 .0001 .0001 .9965 .0850 .0107 S - E f f S-PSS S-NSS a Time 18.63 .0001 .0001 .0001 .0001 R e p l i c by Time <1 Treatment by Time 2.53 .0668 .9965 .0124 .0153 R e p l i c a t i o n by Treatment by Time <1 a see T a b l e 14 175 Table 16 M u l t i v a r i a t e and U n i v a r i a t e Summary on S e l f - e f f i c a c y and S e l f - s t a t e m e n t Measures - P r e , Po s t and F o l l o w - u p f o r ACl and S11 Groups E f f e c t M u l t i v a r i a t e (F,p<) df=6,29 Time 8.82 .0001 pr e / a v e r a g e post f o l l o w - u p p o s t t o f o l l o w - u p AC vs SI by Time <1 Time 5.81 .0005 pr e / a v e r a g e post f o l l o w - u p p o s t t o f o l l o w - u p AC vs SI by Time U n i v a r i a t e s (p<) S-Eff J-PSS J-NSS' .0001 .0008 .0001 .0446 .0433 .0203 S-Eff' S-PSS S-NSS' .0001 .0001 .0001 .0446 .7926 .4878 <1 see T a b l e 14 T a b l e 17 Means and S t a n d a r d D e v i a t i o n s f o r P r e d i c t e d MV02 by Group Pre Post F o l l o w - u p Group M SD M SD M SD AC 1 30. 1 5.6 34.5 5 . 1 36.7 6.4 S11 35.9 9.6 38. 1 9.9 36.7 10.6 WL 31. 1 7.0 31.9 6.5 - -AC2 32.9 5.5 39. 1 7. 1 - -SI2 36.7 8.7 37.2 8.7 - -Note: MV02 r e p o r t e d i n ml/kg/min a s e e T a b l e 1 & 2 T a b l e 18 Summary of A n a l y s i s of V a r i a n c e on P r e d i c t e d MV02 Source df MS F _ a G r o u p s : A C l , SI 1, WL ; Time: Pre t o Post Group (G) 2 313.46 2.94 .061 9 E r r o r : S(G) 50 106.53 Time (T) 1 194.04 36.53 .0001 T x G 2 19.89 3.74 .0305 E r r o r : S(G)xT 50 5.31 a Groups: AC 1, SI 1 , AC2, S I 2 ; Time: Pre t o Post Group (G) 3 169.01 1 .53 .2160 E r r o r : S(G) 56 • 110.23 Time (T) 1 320.62 33.20 .0001 T x G 3 40.09 4.15 .0100 E r r o r : S(G)xT 56 9.66 a Groups: ACC, SIC; Time: Pre t o Post Group (G) 1 310.41 2.83 .0981 E r r o r : S(G) 58 109.82 Time (T) 1 323.41 33.37 .0001 T x G 1 99.01 10.22 .0023 E r r o r : S(G)xT 58 9.69 a Groups: AC1, S11; Time: P r e , P o s t , & F o l l o w -up Group (G) 1 229.50 1.24 .2743 E r r o r : S(G) 32 185.48 Time (T) 2 125.92 16.35 .0001 T x G 2 63.65 8.26 .0006 E r r o r : S(G)xT 64 7.70 Note: Pre t o P o s t : AC1 = 18, AC2=12, SI 1 = 17, SI 2=13 , ACC=30, SIC=30, WL=18; P r e , P o s t , F o l l o w - u p : AC 1 , SI 1 = 17 see Tables 1 E 2 178 T a b l e 19 Means and S t a n d a r d D e v i a t i o n s on Measures of S t r e s s -P r e t e s t Only f o r Combined Groups B l o c k e d on MV02 & Sex Measure Hig h a T b Low M SD M SD Female (n=22) (n=20) Te n s i o n 6.8 1 .3 6.8 1.1 S t a t e 41 .4 12.1 41.3 12.0 T r a i t 46.9 8.2 45. 1 10.7 Male (n = 9) (n = 9) Te n s i o n 6.7 1 .5 6.9 1.2 S t a t e 43.9 14.0 49.8 15.-6 T r a i t 50. 1 9.3 51.. 8 11.0 Range f o r f e m a l e s : h i g h , 32 - 55 ml/kg/min Range f o r males: h i g h , 35 - 52 ml/kg/min Range f o r f e m a l e s : low , 2 1 - 3 1 ml/kg/min Range f o r males: low, 24 - 34 ml/kg/min 179 T a b l e 20 M u l t i v a r i a t e Summary on Measures of S t r e s s - P r e t e s t Only f o r Combined Groups B l o c k e d on Sex and MV02 E f f e c t M u l t i v a r i a t e (F,p<) df=3,5 4 Sex 1 . 4 5 .2381 MV02 <1 Sex x MV02 <1 180 T a b l e 21 Means and S t a n d a r d D e v i a t i o n s on Measures of S t r e s s B l o c k e d on MV02 - P r e , P o s t f o r Combined AC Groups T e n s i o n S t a t e T r a i t MV02 . M SD M SD M SD~ > 5 (n =15) Pre 6.5 1.4 40.8 12.5 46.1 7.8 Post 4.9 1.7 33.4 11.0 38.9 9.0 < 5 (n =15) Pre 6.6 0.8 37.5 8.1 42.7 8.4 Post 5.0 1.5 31.9 6.1 35.3 7.6 Note; MV02 r e p o r t e d i n m i l l i l i t e r s per k i l o g r a m body weight per minute. T a b l e 22 M u l t i v a r i a t e and U n i v a r i a t e Summary on Measures of S t r e s s Pre & Post B l o c k e d on MV02 Change f o r Combined AC Group E f f e c t M u l t i v a r i a t e (F,p<) U n i v a r i a t e s (p<) df=3,26 T e n s i o n S t a t e T r a i t Time 9.81 .0002 .0001 .0029 .,0002 MV02 <1 181 T a b l e 23 Means and S t a n d a r d D e v i a t i o n s f o r C o r n e l l M e d i c a l Symptoms C h e c k l i s t - P r e , P o s t , F o l l o w - u p Time Pre P o s t F o l l o w - u p Group a M SD M SD M SD~~ AC 1 113. . 1 26. , 6 89. ,9 20. , 0 89, .2 18 .0 SI 1 1 23. ,0 35. ,9 105. ,2 30. .2 96, .6 33 .5 WL 100. .6 23. .7 100. , 1 22, .9 -AC2 97. .8 17. .7 85, .5 12, . 1 -SI2 114, .9 20. ,8 91 , .8 17, .9 -a see T a b l e 1 & 2 T a b l e 24 A n a l y s i s of V a r i a n c e Summary on C o r n e l l M e d i c a l Symptoms C h e c k l i s t Source df MS F p a Groups: AC 1 , S11 WL; Time: Pre to P o s t Groups (G) 2 2149.68 1.85 .1671 E r r o r : S(G) 53 1161.44 Time (T) 1 5356.37 18.46 .0001 Time x Group 2 1334.68 4.60 .0144 E r r o r : S(G)xT 53 290.21 a G r o u p s : A C l , SI 1 , AC2 , SI 2; Time: Pre t o Post Group (G) 3 2527.73 2.72 .0530 E r r o r : S(G) 57 . 930.20 Time (T) 1 1 0740. 16 35.36 .0001 Time x Group 3 183.22 <1 E r r o r : S(G)xT 57 303.70 a G r o u p s : AC 1 & S11 ; Time : P r e , Post & F o l l o w - u p Group (G) 1 3212.23 1.81 .1874 E r r o r : S(G) 34 1774.43 Time (T) 2 6437. 1 2 21.30 .0001 Time x Group 2 146.29 <1 E r r o r : S(G)xT 68 302.23 see Tables 1 & 2 TABLE 25 Summary of S i g n i f i c a n t M u l t i v a r i a t e and Un i v a r i a t e Tests f o r the Dependent Measures V a r i a b l e MEASURES OF STRESS SELF-EFFICACY AND SELF-STATEMENTS M u l t i v a r i a t e (p <•) Time Pre to Post Pre to Average Post to Follow-up .0001 .0001 Group by Time Interactions .0041 Treatments vs WL Cognitive vs Somatic Pre to Post Post to Follow-up .0510 .1728 Time Pre to Post Pre to Average Post to Fol1ow-up Group by Time Interactions .0001 .0001 .0005 .0001 Treatments vs WL SI vs WL ACC vs SIC .0234 .0060 .0025 .0900 .0668 Tens i on Un i v a r i a t e s (p<) State T r a i t .0001 .0254 .0001 .0001 .0006 .0001 ns ns ..0291 .0041 .0049 .0007 ns .0278 .0083 ns .0064 .0905 S-EFF JPSS JNSS SPSS SNSS b .0004 .0077 .0001 .0002 .0003 .0001 .0008 .0001 .0001 .0001 .0446 .0433 .0203 ns ns .0021 ns ns .0021 .0105 ns • 0 5 8 ns ns .05 a .10 a ns ns .0107 ns .0124 .0153 Scheffe contrast 3see Table 14 CO Table 26 MAXIMAL AND SUBMAXIMAL HEART RATES BY AGE AGE 100% a 90% b 20 201 187 21 200 186 22 199 185 23 198 184 24 198 184 25 197 183 26 196 182 27 195 181 28 194 180 29 193 180 30 193 180 31 193 180 32 192 179 33 191 178 34 191 178 35 190 177 36 189 176 37 189 176 38 188 175 39 187 174 40 186 173 41 186 173 42 185 172 43 184 717 44 184 171 45 183 171 46 182 170 47 181 169 48 181 169 49 180 168 50 179 167 51 179 167 52 178 166 53 177 165 54 176 164 55 176 164 56 175 163 , 57 ^-^ a > maximum heart rate 58 174 162 5g U2 152 C u t he~rt rate 60 172 161 ( 9 0 % ) 61 172 161 62 171 160 63 170 159 64 169 158 65 169 158 Hote: Adapted frcm P o l l o c k , M. L . , Wi lmore, J . , & Fox, S . M. Heal th and f i t n e s s through p h y s i c a l a c t i v i t y . ACSM S e r i e s . New York• John W i l e y , l97o"! 185 Table 27 CLASSIFICATION OF MAXIMAL OXYGEN UPTAKE BY AGE AND RECOMMENDED PERCENT OF MAXIMUM HEART RATE FOR EXERCISE TRAINING TARGET HEART RATE AGE 70% 75% 80% 85% VERY WOMEN LOW SOMEWHAT.LOW AVERAGE HIGH HIGH 20-29 -28 29-34 35-43 44-48 49+ 30-39 -27 28-33 34-41 42-47 48+ 40-49 -25 26-31 32-40 41-45 46+ 50-65 -21 22-28 29-36 37-41 42+ AGE VERY MEN LOW SOMEWHAT LOW AVERAGE HIGH HIGH 20-29 -38 39-43 44-51 52-56 - 57+ 30-39 -34 35-39 40-47 48-51 52+ 40-49 -30 31-35 36-43 44-47 48+ 50-59 -25 26-31 32-39 40-43 44+ 60-69 -21 22-26 27-35 36-39 40+ Note: Adapted from: Astrand, P. 0. and Rodahl, K. Textbook of Work Physiology. New York: McGraw-Hill, 1977. F igure 1 . Elements of the S t ress Syndrome: Environmental P h y s i o l o g i c a l R e a c t i o n s , and Overt B e h a v i o r s . Demands, C o g n i t i v e A c t i v i t i e s , P h y s i o l o g i c a l Response Generator PALLIATIVE COPING In te rna l Environmental Demands - P e r s o n a l i t y FActors E x t e r n a l Environmental Demands - S o c i a l Condi t ions e . g , a t t e n t i o n focus imagery Reapprai sa l e . g . , s e l f - s t a t e m e n t s b e l i e f s INSTRUMENTAL COPING e . g . , r e l a x a t i o n med i t a t i o n apprai s a l expectancy e . g . . j o g g i n g a s s e r t i o n Overt Behavior Generator F igure 2. Examples of In tervent ions that i n t e r r u p t the S t r e s s Response Syndrome: P a l l i a t i v e and Instrumental Coping. Group T i me 1 T i me 2 T i me 3 T i me k T i me 5 RANDOM ASSIGNMENT 1 week Measure Var i ab]es Measu re V a r i a b l e s Measure V a r i a b l e s 10 weeks Ae rob i c Inter vent ion St ress Inoculat i on W a i t i n g L i s t Control 1 week Measu re Var i ab les Measure V a r i a b l e s Measure Var i ab les 10 weeks No I n t e r v e n t i o n No I n tervent ion Ae rob i c I n t e r v e n t i o n S t r e s s I n o c u l a t i o n 1 week Measure Var i ab les Measure V a r i a b l e s Measure V a r i a b l e s FIGURE 3. Time- lagged crossover cont ro l design f o r three comparison groups . 189 NAME NO: _ Date : Age: WEIGHT: Max.HR: Cut o f f heart r a t e : PHASE PHASE 2 Work Loads: PHASE 3 FIGURE k. Submaximal B i c y c l e Ergometer Test - Heart Rate and Work Load 190 O O COMBINED (SM + SI 2 ) A COMBINED (AC 1+ AC 2) _ j : L _ PRE POST F igure 5. Mean change fo r the treatment and w a i t i n g l i s t groups over time on the Tension Thermometer. 191 o— • WAITING L IST <D S T R E S S INOCULATION (SI 1) A AEROBIC CONDITIONING (AC 1) P R E POST F O L L O W - U P F i gure 6 . Mean change f o r the treatment and w a i t i n g l i s t groups over time on the S ta te Anx ie ty Inventory . 192 • • W A I T I N G L I S T O S T R E S S I N O C U L A T I O N ( S M ) •A A E R O B I C C O N D I T I O N I N G ( A C 1 ) t _ _ J I L PRE POST FOLLOW-UP Figure 7. Mean change for the treatments and waiting l i s t groups over time on the Trait Anxiety Inventory. Figure 8. Mean change for combined groups (ACl + SIl) blocked on the Cognitive and Somatic Mode. 194 9 0 | 2 8 5 LL. UJ I U-_J Ul CO 8 0 75 7 0 P R E POST r_h- • WAITING L IST O O S T R E S S INOCULAT ION ( S M ) A- - A AEROBIC CONDITIONING ( AC 1 ) F O L L O W - U P >• 9 0 < o 85 u. LL LU i 8 0 LF -75 UJ cn P R E P O S T -O COMBINED (SI 1+ SI 2 ) - A C O M B I N E D (AC 1 + AC 2 ) F i g u re 9. Mean change for treatment and waiting l i s t groups over time on Sel f -ef f i cacy . 195 CO 1 5 0 1 CO 4 0 — to o o_ 3 0 CO 1- 2 0 — CJ LU ~3 10 CD — _3 CO 0 • - O W L • - - • WAITING LIST O O S T R E S S INOCULATION ( S I1 ) A AEROBIC CONDITIONING (AC 1) P R E POST F O L L O W - U P CO 1 CO CO O Q. CO LU O Q Z> —> 5 0 4 0 3 0 2 0 10 0 _ - d WL A— PRE POST F O L L O W - U P Figure 10. Mean change (ratios) on Self-statements (S-S) for treatment and waiting l i s t groups over time. 196 F i gure 11. Mean change (ratios) on self-statements (S-S) for treatment and waiting l i s t groups over time. Figure 12. Mean change (ratios) on Self-statements (S-S) for combined treatment groups over time. Figure 13. Mean change (ratios) on Se1f-statements (S-S) for combined treatment groups over time. 199 — 3 8 c I 3 6 | ^ 3 4 [ O > 3 2 3 0 El • WAITING LIST O - ^ O S T R E S S INOCULATION (SI I) A - - A AEROBIC CONDITIONING ( AC 1 ) P R E P O S T F O L L O W - U P F igure 14. Mean change f o r treatment and w a i t i n g l i s t groups over time on MV02 (ml/kg/min) . 200 Fi gure•15 . Mean change for treatment and waiting l i s t groups over time on the Cornell Medical Symptom Checklist . MALES FEMALES 1 .0 F i r s t Workload (Kp) 2.5 2.0 Second Workload 130-145 3-5 3.0 c 130-145 3.0 2.5 Thi rd Workload F i g u r e 16. Guide t o s e t t i n g work l o a d s f o r submaximal b i c y c l e t e s t , 2.0 Appendix A SUUMAXIMAL TEST FKCTOCCL - 202 -203 Submaximal B i c y c l e Test A continuous, multistage, submaximal b i c y c l e test was used to p r e d i c t maximal oxygen uptake. The t e s t uses the heart rate response at three d i f f e r e n t work loads to make th i s p r e d i c t i o n . The assumption of this test i s that heart rate and oxygen uptake are l i n e a r functions of work ra t e ; consequently an adequate estimation can be made. The test consists of a serie s of four minute work bouts that progress higher i n load and at a l e v e l dependent on the p a r t i c i p a n t ' s a b i l i t y (heart rate response). Heart rate i s determined from an ECG s t r i p during the l a s t 15 seconds of each minute. Normal pretest s y s t o l i c and d i a s t o l i c pressure was assessed by ausculation using the cuff method. Equipment needed 1. B i c y c l e ergometers (Monark Type) 2. Metronome and l i g h t 3. 3-lead electrocardiographs 4. Stethoscope 5. Blood pressure cuff 6. Scales (kilograms) Procedures 1. Measure weight, s y s t o l i c and d i a s t o l i c blood p r e s s u r e — check for normal reading 150/100. Have subject record exercise and 24-hour medical h i s t o r i e s . 2. Set up the subject f o r a b i c y c l e ergometer t e s t — a d j u s t seat. Attach 3-lead ECG and check for pulse under 100 beats per minute. 3. Set metronome and l i g h t at 100 beats per minute and have subject pedal with a l i g h t load u n t i l he or she can maintain cadence p r e c i s e l y (one minute to warm up). 4. Set work load at appropriate kilopond meters per minute of work. 5. Take heart rate i n the l a s t 15 seconds of each minute. At the end of each heart rate count, the scores are recorded on a form such as the one shown i n Figure 4. 204 6. The heart rate i n the t h i r d and fourth minutes should not d i f f e r by more than 5 beats per minute. I f they do, extend the test period for an a d d i t i o n a l minute or u n t i l a stable value i s maintained. 7. To determine next work load, check the heart rate value f o r the t h i r d minute of the i n i t i a l work load. The same procedure i s used for counting and recording heart rate as described i n 5. 8. The guide f o r s e t t i n g the work loads i s shown i n Figure 16. 90% of maximum heart rate was the maximum cut o f f point for the test (see Table 26 ) . 9 . During the recovery period the subject continues to pedal at a very low work-load (100-150) for several minutes. An appropriate regression equation was used to estimate maximal oxygen uptake. As maximum heart rate was not known, i t was obtained from the tabled values i n Pollock, Wilmore and Fox (1978) and i s presented i n Table 26. Maximum oxygen uptake was expressed i n m i l l i l i t e r s per kilogram of body weight per minute (ml/kg/min). To determine the subject's r e l a t i v e f i t n e s s l e v e l , a comparison was made using norms from Astrand and Rod ah 1 (1977) and are presented in Table 27-Appendix B TELEPHONE AND PERSONAL INTERVIEW - 205 -206 Telephone Interview Name: Home Phone: Business Phone: Procedures: The purpose of the study i s two-fold: (1) to o f f e r a pu b l i c service stress management program; and (2) to assess the effectiveness of treatments that have been shown to work for some people. There i s no charge to p a r t i c i p a n t s i n the program but volunteers who consent to p a r t i c i p a t e w i l l be expected to attend a l l the sessions to which they are assigned. Your involvement w i l l be for 10-weeks, once a week for one and one h a l f hours, i n a group meeting. You w i l l be given some p e n c i l and paper psychological assessments and a submaximal b i c y c l e test. There are two programs being offered. One focuses treatment on the way we think, what we say to ourselves and the other one focuses on how your body reacts, and how ph y s i c a l a c t i v i t y can help you cope. You w i l l be randomly assigned to one of these treatments. I f we have a large response we w i l l run this program again i n three months, time. Do you have any questions? Do you think you might l i k e to p a r t i c i p a t e ? ( i f no, f i n d out why not) Before I schedule you for a personal interview I would l i k e to ask you a few questions: Can you describe the si t u a t i o n s i n which you f e e l anxious? How long has t h i s been a problem for you? What do you do now when you f e e l stressed? Is there any reason you are aware of that would i n h i b i t you from p a r t i c i p a t i n g i n a b i c y c l e test or the jogging program? Do you have any questions? (Set a time for a personal interview i f appropriate, i f not r e f e r them to community resources). 207 Personal Interview Interview Assessment Form No. 1. Demographics: Name: Age: Address: Telephone No. 2 . Description of Stress: 1. When did you f i r s t notice that you had a problem? 2. What kinds of si t u a t i o n s pose a problem for you? When Where 3. What have you done about i t ? (medications, doctor, etc.) 4. Are you currently taking medication for your nerves? _ a) When did you obtain the most current p r e s c r i p t i o n s ? b) What i s the brand name of the medication? (explain that they are expected to continue taking i t at t h e i r present l e v e l during treatment. Check for c o n t r a i n d i c a t i o n of Exercise Testing). What's upsetting_ When Where What's upsetting 5. What aspects of your l i f e do you handle well? 208 6. Do you often have periods of hours or days during which you experience l i t t l e or no tension? ' 7. I f l a s t week'was a t y p i c a l week, (see attached thermometer) on a scale of one to ten, how stressed do you f e e l on the average? 8. Is the p a r t i c i p a n t concerned about excess drinking or depres-sion? 3) I f su i t a b l e a) explain the two conditions and describe i n d e t a i l the exercise t e s t i n g they w i l l p a r t i c i p a t e i n ; b) sign consent form, explain u n i v e r s i t y requirements. I f not su i t a b l e a) explain:they would not be happy with t h i s program; b) make a r e f e r r a l through l i f e s t y l e d i r e c t o r y or to family physician. 4) Administer Evaluation Battery i n the order found i n t h e i r f o l d e r . 1. S e l f - e f f i c a c y 2. S t a t e - T r a i t Anxiety Inventory 3. C o r n e l l Medical Index 4. Cognitive-Somatic Anxiety Inventory 5. Personal Data Personally administer the t h o u g h t - l i s t i n g technique. Have them imagine a s t r e s s f u l s i t u a t i o n s i m i l a r to one described to you e a r l i e r . Have them close t h e i r eyes and imagine they are about to encounter such a s i t u a t i o n . Time the th o u g h t - l i s t i n g technique (2% min. to l i s t ideas). 5) Describe and give hand out regarding the requirement for exercise te s t i n g e < 9 •-clothes , eating, etc., and give them d e t a i l e d i n s t r u c t i o n s as to how to get to U.B.C., parking, etc. I f they are unable to make the appointment, be sure to ask them to n o t i f y us so i t can be rescheduled. 6) Any questions or concerns? C h e c k l i s t : Demographics Fear Thermometer Evaluation Battery Handout of exercise requirements Appointment at Gym made Map of UBC Consent Form ___£: t h i s form was completed while the c l i e n t s were f i l l i n g i n the evaluation Battery. Personal Data: Occupation: Number of years i n t h i s f i e l d of work Type of work: sedentary medium-light l i g h t heavy Indicate the highest l e v e l of education achieved? High School College Un i v e r s i t y Other (please explain) : _____ Health r e l a t e d : Do you smoke? Yes_ No Number of cigarettes a day Do you consume alcohol? Yes No Number of beer (bottles) per week Wine (oz.) per week ^ S p i r i t s (oz.) per week Do you drink coffee or tea? Yes No Number of cups per day: coffee tea Marital Status 210 To e n s u r e t h e a c c u r a c y o f t h e i n i t i a l a s s e s s m e n t , i t i s e s s e n t i a l t h a t a l l p a r t i c i p a n t s o b s e r v e t h e f o l l o w i n g r e s t r i c t i o n s p r i o r t o coming t o t h e l a b : 1. D r i n k no a l c o h o l i c b e v e r a g e s 12 h o u r s b e f o r e y o u r s c h e d u l e d appo i n t m e n t . 2. Do n o t smoke or d r i n k t e a , c o f f e e , o r s o f t d r i n k s f o r a t l e a s t 3 h o u r s b e f o r e h a n d . 3. Do n o t o v e r e x e r t y o u r s e l f p h y s i c a l l y w i t h i n 24 h o u r s o f t h e a s s e s s m e n t . 4. A l i g h t meal 3 h o u r s b e f o r e y o u r s c h e d u l e d a s s e s s m e n t would be a d v i s e a b l e . 5. Guys, where r u n n i n g s h o e s , s h o r t s and s h i r t ; Women, wear r u n n i n g s h o e s , s h o r t s ( o r l i g h t sweat p a n t s ) , and h a l t e r t o p o r b i k i n i t o p under a s h i r t . 6. Park i n SUB p a r k i n g l o t / A c q u a t i c c e n t e r p a r k i n g . 7. T e s t s a r e d o w n s t a i r s a t t h e WAR MEMORIAL GYM. See map below. TIME : Appendix C TENSION TiiERMCWETEF AND THOUGHT — i I ST ING TECHNIQUE - 211 -212 Thought-Listing Instructions Take a few moments now and try to imagine a s t r e s s f u l s i t u a t i o n that has occurred f a i r l y recently for you. Perhaps one of the situations you just described for me. Close your eyes i f you l i k e and try to make the image as r e a l as possible. See yourself i n the si t u a t i o n once again. Make the scene as v i v i d as possible. I ' l l give you a few moments to imagine the scene. (Hand the c l i e n t the form and have them read the instructions on the front page. Be sure they understand what's expected of them before they begin. Time them for 2 1/2 minutes, allow them to f i n i s h the thought they were w r i t i n g when time i s up. Proceed with the inst r u c -tions on the f i n a l page. Reinforce that the valence judgement of the self-statements should r e f l e c t how they f e e l about the statements. I f necessary give a simple example e.g., I think I'm awful—a negative statement. I r e a l l y l i k e what I d i d — a positive statement.) No DATE 213 THOUGHT-LISTING We a r e now i n t e r e s t e d i n e v e r y t h i n g t h a t went t h r o u g h y o u r mind a b o u t t h e i m a g i n e d s i t u a t i o n . P l e a s e l i s t t h e s e t h o u g h t s , w h e t h e r t h e y were a b o u t y o u r s e l f , t h e s i t u a t i o n , a n d / o r o t h e r s ; w h e t h e r t h e y were p o s i t i v e , n e u t r a l and / o r n e g a t i v e . Any c a s e i s f i n e . IGNORE S P E L L I N G , GRAMMAR, AND PUNCTUATION. You w i l l h a ve 2 1/2 m i n u t e s t o w r i t e . We have d e l i b e r a t e l y p r o v i d e d more s p a c e t h a n we t h i n k p e o p l e w i l l n e e d , t o i n s u r e t h a t e v e r y o n e .would h a v e ' p l e n t y o f room. P l e a s e Be c o m p l e t e l y h o n e s t . Y o u r r e s p o n s e s w i l l be anonymous. The n e x t page c o n t a i n s t h e f o r m we h a v e p r e p a r e d f o r y ou t o use t o r e c o r d y o u r t h o u g h t s and i d e a s . S i m p l y w r i t e down t h e f i r s t t h o u g h t y o u had i n t h e f i r s t b o x , t h e s e c o n d i n t h e s e c o n d b o x , e t c . P l e a s e w r i t e o n l y one i d e a o r t h o u g h t i n a b o x . 2)k 215 We w o u l d now l i k e • y o u t o t u r n b a c k t o t h e page on w h i c h y o u w r o t e down y o u r t h o u g h t s . We w o u l d l i k e you t o go b a c k a nd r a t e e a c h o f t h e i d e a s t h a t y o u w r o t e down. I n t h e l e f t m a r g i n b e s i d e e a c h i d e a t h a t y o u w r o t e down, we w o u l d l i k e t o know i f t h a t i d e a was (+) f a v o r a b l e t o w a r d y o u r s e l f , (-) u n f a v o r a b l e t o w a r d y o u r s e l f , o r ( 0 ) n e i t h e r f a v o r a b l e n o r u n f a v o r a b l e t o w a r d y o u r s e l f . I f t h e i d e a t h a t you w r o t e down seemed t o be f a v o r a b l e t o w a r d y o u r s e l f , y o u s h o u l d p l a c e + ( p l u s ) i n t h e l e f t m a r g i n b e s i d e t h e i d e a ; i f t h e i d e a y o u w r o t e down seems u n f a v o r a b l e t o w a r d y o u r s e l f , y o u s h o u l d p l a c e a -( m i n u s ) i n t h e l e f t m a r g i n b e s i d e t h a t i d e a ; and i f t h e i d e a was n e i t h e r f a v o r a b l e n o r u n f a v o r a b l e , o r had n o t h i n g t o do w i t h y o u r s e l f y o u s h o u l d p u t a 0 ( z e r o ) i n t h e l e f t m a r g i n . P l e a s e go b a c k now and r a t e e a c h i d e a l i s t e d by p u t t i n g , a +, -, o r 0 i n t h e l e f t m a r g i n . Be s u r e t o r a t e e a c h t h o u g h t t h a t y o u w r o t e down. P l e a s e a l s o be h o n e s t w i t h y o u r r a t i n g . 216 No . PAST WEEK TENSION THERMOMETER Date:_ T h i n k back o v e r t h e p a s t week. Take e a c h day s e p a r a t e l y and remember a s much as you can o f what, you d i d , how t h e day went, and p a r t i c u l a r l y t h e l e v e l o f t e n s i o n y o u e x p e r i e n c e d . Now, use t h e t h e r m o m e t e r b e l o w t o r a r e y o u r a v e r a g e l e v e l o f t e n s i o n f o r t h e p a s t week. - 10 c o m p l e t e l y t e n s e (.not r e l a x e d a t a l l ) - 9 8 v e r y t e n s e (.only s l i g h t l y Relaxed) - 7 6 t e n s e - 5 1 r e l a x e d - 3 2 v e r y r e l a x e d - 1 0 c o m p l e t e l y - r e l a x e d ( n o t t e n s e a t a l l ) Appendix 0 INFO5MED CONSENT - 217 -218 Informed Consent I am conducting a research study i n v o l v i n g the e f f e c t s of aerobic conditioning (exercise) and self-statement modification (what we say to ourselves) on stress reactions. As you may know, stress i s f a i r l y common and plays an important part i n many diseases. There i s l i m i t e d evidence i n d i c a t i n g that both exercise and self-statement modification help some people cope with stress b e t t e r . The purpose of my study w i l l be to compare the effectiveness of exercise ( i .e ., walk/jogging) and a self-statement (stress-inoculation) program i n t h e i r a b i l i t y to influence stress reactions. I would l i k e you to volunteer to p a r t i c i p a t e i n my study, and I w i l l now o u t l i n e the actual requirements of the study. I f you volunteer to p a r t i c i p a t e i n the study i t w i l l be necessary for you to attend 3 t e s t i n g sessions at the War Memorial Gym which i s located at U.B.C. These sessions w i l l l a s t approximately one hour. You w i l l perform a graded exercise test on a b i c y c l e ergometer. The purpose of this test i s to examine the response of your heart and lungs to exercise. The test consists of r i d i n g the ergometer at one or more le v e l s of d i f f i c u l t y . Your electrocardiogram w i l l be monitored throughout the exercise and recovery periods. I t i s expected that you w i l l complete the exercise test with no complications. Because of the very uncommon, unpredictable response of some i n d i v i d u a l s to exercise, unforeseen d i f f i c u l t i e s may a r i s e which would necessitate treatment. You are asked to report any unusual symptoms during the test. We may stop the t e s t at any time because of signs of fatigue or discomfort. Every e f f o r t w i l l be made to conduct the test i n such a way as to minimize discomfort and r i s k . However, there e x i s t s the p o s s i b i l i t y of p o t e n t i a l r i s k , such as, abnormal blood pressure, f a i n t i n g , disorders of heart beat, and very rare instances of heart attack. Your agreement to p a r t i c i p a t e w i l l include random assignment to e i t h e r an exercise program or self-statement modification. These programs w i l l meet once a week for one and one h a l f hours. Your agreement to p a r t i c i p a t e w i l l also include the completion of psychological inventories, before the program s t a r t s , at completion and three months l a t e r . These tests are the paper and p e n c i l type. A l l r e s u l t s w i l l be treated anonymously and i n a c o n f i d e n t i a l manner. In reporting the r e s u l t s of t h i s experiment names of the subjects involved w i l l not be used. I f you have any questions about any aspects of this study please f e e l free to discuss them with i n d i v i d u a l s associated with this study. In signing t h i s consent form you state that you have read and understood the d e s c r i p t i o n of the tests and t h e i r complications. You enter the te s t i n g w i l l i n g l y and may withdraw at any time. Consent I have read the above comments and understand the explanation, and I wish to proceed with the tests . In agreeing to such an examination, I waive any l e g a l recourse against the members of the s t a f f at the War Memorial Gym from any and a l l claims r e s u l t i n g from personal i n j u r i e s sustained during this test. Date: Signature: Witness: A p p e n d i x £ TWENTY—FCUK HOUK M E D I C A L AND E X E K C I S E H I S T O R Y - 2 2 0 -221 Date: 24-Hour History Number Resting Pulse rate: Blood Pressure: Weight: Age: D i r e c t i o n s : Please respond to the following questions as accurately as you can. Also, i f you do not understand any of the questions please ask for c l a r i f i c a t i o n . 1. In general terms please i n d i c a t e how you f e e l today by p l a c i n g a c i r c l e around the word or words which best describes your state of well-being. Very bad Bad Good Very Good 2. Have you been i l l during the past ten days? Yes No I f yes, please elaborate: 3. Have you taken any p r e s c r i p t i o n or nonprescription drugs within the l a s t 48 hours? Yes No . I f yes please elaborate: 4. How many hours sleep did you get l a s t night? 5. How many hours of sleep do you normally get? 6. How many hours has i t been since your l a s t meal or snack? » hours. 7. Have you had a cup of coffee or tea within the past four hours? Yes No 8. Have you smoked a c i g a r e t t e , pipe or cigar within the past four hours? Yes No 9. Have you consumed any a l o c o h o l i c beverages within the past 24 hours? Yes No Please specify quantity: 10. Have you p a r t i c i p a t e d i n any form of vigorous exercise today? Yes No - If yes please describe: 222 Number: Date: Exercise History-Are You: Sedentary (untrained)? Sporadic a c t i v i t y (few times a month)? Regular but l i g h t exercise (few times a week)? Rather intense t r a i n i n g (1-4 times a week)? Hard t r a i n i n g for competition (3-7 times a week)? Types of t r a i n i n g : Walking only. Jogging up to a mile, but less than 2 miles. Jogging more than 2 miles, and less than 5 miles. Jogging long.distance—6 to 12 miles or greater. Sprint running—20 minute session. I n t e r v a l t r a i n i n g — 2 0 minute sessions. Other (please describe) How long have you trained for? ( i . e . , a week, two weeks, a month, years)? B r i e f d e s c r i p t i o n of t r a i n i n g program: Times per week: -Minutes per session:  A p p e n d i x i v E X E K C I S E P3INCIPLES AND G U I D E L I N E S - 2 2 J -224 Exercise P r i n c i p l e s and Guidelines Psychological adjustment consistent with improving p h y s i c a l f i t n e s s occurs i n response to programs of regular p h y s i c a l a c t i v i t y and vary with the frequency, i n t e n s i t y and duration of the a c t i v i t y which follows c e r t a i n known p r i n c i p l e s . Overload. Unless t r a i n i n g programs include a c t i v i t i e s that produce a stimulus above a c e r t a i n i n t e n s i t y threshold, improvement i n ph y s i c a l f i t n e s s w i l l not occur. S p e c i f i c i t y . Adaptations to t r a i n i n g are s p e c i f i c , determined by the type of t r a i n i n g undertaken. I n i t i a l Level of Fi t n e s s . I t appears reasonable to recommend that i n d i v i d u a l s with lower i n i t i a l l e v e l s of f i t n e s s s t a r t at a lower i n t e n s i t y . Less f i t and overweight p a r t i c i p a n t s are also more suscept-i b l e to i n j u r y . I f a person's l e v e l of p h y s i c a l f i t n e s s i s already high the minimal threshold for improvement may be as high as 85% of. maximum capacity max). Warm-up. An i n i t i a l f i v e to ten minutes of each exercise session should be devoted to warm-up a c t i v i t i e s with less f i t and middle-aged and older p a r t i c i p a n t s taking more time to warm-up. Proper warm-up and s t r e t c h i n g may help prevent muscle and j o i n t i n j u r y , give the re s p i r a t o r y and c i r c u l a t o r y systems a chance to adapt and provide a gradual progression i n t o a more vigorous phase. I t i s also good prac-t i c e to cool down for f i v e to ten minutes a f t e r the exercise session. Progression. U n f i t and/or overweight i n d i v i d u a l s should begin an exercise program at a low l e v e l . The lower l e v e l usually means a program of reduced i n t e n s i t y , but i f there i s a need for increased energy expenditure, i t can also mean a greater frequency and duration of t r a i n i n g . There i s a general consensus that the maximum increase i n t o t a l work should be no more than 10% per week. P a r t i c i p a n t s should be encouraged to monitor t h e i r own bodies and feeli n g s during exercise and use th i s information to provide input on the rate of progression. Individual Difference. Exercise p r e s c r i p t i o n for p h y s i c a l f i t n e s s must be i n d i v i d u a l i z e d with p a r t i c i p a n t s active i n planning and implementing t h e i r own programs. Exercise p r e s c r i p t i o n i s based on frequency, i n t e n s i t y , duration of tr a i n i n g and mode (type) of a c t i v i t y as well as i n i t i a l l e v e l of f i t n e s s . The American College of Sports Medicine has recommended the following guidelines, which have been approved by the Research Consortium of AAHPERD for the average healthy adult: 225 1. Frequency of t r a i n i n g : 3 to 5 days per week. 2. Intensity of t r a i n i n g : 60% to 90% of maximum heart reserve or, 50% to 85% of V02 max. 3. Duration of t r a i n i n g : 15 to.60 minutes of continuous aerobic a c t i v i t y . Duration i s dependent on the i n t e n s i t y of the a c t i v i t y ; thus lower i n t e n s i t y a c t i v i t y should be conducted over a longer period of time. Lower to moderate i n t e n s i t y a c t i v i t y of longer duration i s recommended for the nonathlete adult (higher inten-s i t y a c t i v i t i e s require 20 to 30 minutes of continuous e f f o r t ; moderate a c t i v i t i e s such as f a s t walking—40 to 50 minutes). 4. Mode of a c t i v i t y : Any a c t i v i t y that uses large muscle groups, that can be maintained continuously and i s rhythmical and aerobic i n nature, e.g., running-jogging, walking-hiking. For the purpose of this study, the walk/jog mode w i l l be the recommended a c t i v i t y . The key to improving function i s the t o t a l work or energy cost of the exercise program: energy cost = frequency x i n t e n s i t y x duration. Maintenance. Fitness i s maintained by continuing t r a i n i n g at an optimal l e v e l and not progressing to higher e f f o r t loads. If a p a r t i c i -pant stops completely, a l l improvements are l o s t , generally within 3 to 8 months. A s i g n i f i c a n t loss i n f i t n e s s occurs i n j u s t one to two weeks. Reducing the t r a i n i n g frequency by as much as 50% for from 5 to 15 weeks has not shown much decrement i n f i t n e s s . Training frequency can be reduced to j u s t two days per week, without loss of t r a i n i n g e f f e c t . Adherence. The exercise leader should be a good l i s t e n e r , nonjudge-mental, n o n c r i t i c a l and frequently ask open-ended questions regarding exercise adherence. The p a r t i c i p a n t s should be led to accept responsi-b i l i t y for t h e i r own actions and to set r e a l i s t i c goals. Records of t h e i r a c t i v i t y may improve adherence. The leader should help p a r t i c i p a n t s a n t i c i p a t e , examine, and plan for obstacles that may i n t e r f e r e with t h e i r exercise program. P a r t i c i p a n t s should receive p o s i t i v e reinforcement and the exercise leader should be a good model. A comprehensive review of research on exercise adherence has been completed and the conclusions w i l l guide the administration of the aerobic conditioning program. Exercise Training. Exercise t r a i n i n g was prescribed on the basis of the submaximal exercise test r e s u l t s , with the main objective of improving maximal oxygen uptake—endurance capacity. A person with a normal exer-cise test was given a standard aerobic exercise program. The warm-up period consisted of ten to f i f t e e n minutes of s t a t i c stretching and abdominal, hip and leg strengthening exercises. The cardiorespiratory exercise which followed the warm-up met three c r i t e r i a : (a) a minimum 226 frequency of three sessions per week, (2) a duration of f i f t e e n to t h i r t y minutes of continuous exercise, and (3) an i n t e n s i t y e l i c i t i n g 65 to 90 percent of age predicted maximal heart rates as monitored by ten second pulse counts during and a f t e r exercise. The beginner was advised to jog for no longer than three minutes to avoid muscle or j o i n t soreness. This minimal duration was increased gradually. I f muscle or j o i n t tenderness occurred, the duration of exercise was held constant u n t i l the symptoms disappeared. A t y p i c a l middle-aged beginner took four to eight weeks to reach f i f t e e n to t h i r t y minutes of continuous jogging. A post exercise warm-down of fi v e to s i x minutes u t i l i z e d more s t a t i c s t r e t c h i n g i n the supine p o s i t i o n to promote e f f e c t i v e c i r c u l a t o r y recovery.. The advantages of cautious exercise p r e s c r i p t i o n may be: (1) greater safety; (2) better adherence rates due to less overexertion; (3) a longer duration of p o s i t i v e reinforcement from the slow t r a i n i n g gains made over a long period of time; and (4) a form of t r a i n i n g which i s ea s i e r to tolerate over many years. The disadvantage of cautious exercise p r e s c r i p t i o n i s that the high l e v e l s of MV02 attained through intense t r a i n i n g were not achieved. Appendix G COtfSELATICN MATRIX - PEAKSON-PSODUCT MC ME NT CORRELATIONS - 227 -l/l l/l 2 "3 O n - c o o n i o i o ^ O ^ O o i i N n O n i M o n o u u i M n n n o n i i i § 0 i c - c i O L i r > O r " - c N T U > — in — n c N — •— CM — O — — O -• —• — o - o o o o o o o o o o o o o o C T n T T O r- — r~ O C " n 01 m O Ol ID — -- o o o o 228 a "3 O c o c o c p r - a ) O i c N ( n c N i r ) c N O c T i r o i f ) O co oi — c N n n o i D O i n o o o m c n T O i n a i u i O T K i < t - O n o t N i ( N i n - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1/1 a 1/1 a O in CN a> cn in o CN ID OJ — CO O d aj O — co O cn r- c> o O - o o o o o i/i 2 in O c o o / m c o c N C N i a r ^ n — > r ~ r - o j o o c N - — O — n m — i D i n i p i N r , — — n — — c n o O O O c n c n i c c o r - c o c M i n o o i i D O i c N — O O i n t O O w « - 0 - n « n O " 0 - o o o o o o b o o o o o o o o o O n rt n c — o O in CN T — r~ c i O oi co in r- in n O O O - - T O - o o o o o d O — O i c IN IN n ^ IN o oi — r- T — n - oi O r ^ n c M O — o- o- O — r- O ixi io o ui m •-0 0 L P T - 0 O O 0 O O - - O . C O O O - o o o o o o o o o o o o o o o o o O C 5 c C T r - r - O C i O in n ul r- 01 ii) r-O n O M J • n O O I C N O O — ci — - O O O O O O O O CN T — O moo in oi — t o i p c n r ~ t i i r i n c i O n m r - * * - c o T c n i n O c o O ( N C N c y a ) r i ' T C i O o i i n r ~ o O i N x O c o O o } r ~ o i c D O r - - i n i : i O O n T i t - o - n - O i n O O O O f i O - o o o o o o o o o o o o o o o o o o o o u a O T oi Ci IN c ID m r-O cn C T ci T — o O C O c. cc - i o ID n C T ci D oi in -- o • o o o o o o o 1/1 O O C N O I O — o i i D r ^ o i — — O I D O I — c o n i n — O to CN - ID — IT ID m — f - c N i n i D T n c o f - . O i n O CN n ID r- co — i D c o c - r ~ T o i T o i O i n o i T C -O ci CN IN — — <i o - O CN —• in CN — O — O — O - O O O O O O O O O O O O O O O O O O O O i n O i n - O c c m - t t o O 01 s- co - cn a} — n r. O r~ T O in r- u~ — CN O u n in O • x> O - o o o o o o o o o 13 o u O c i O c D O c o i n T r - c o o - i n c i i D o i — r -cn — IDOI O M C M v O c f t i O f f i - M V M O m K i i - r i Qt - - — o - r- o n in o. i s - n i D - o o o O - - n G i n T o i o i — INID — — O i n i n — o — o O O o -- O O O O O O O O O O O O O O O O O O O O O O O c i e ' J .1 n n 7 O IN T in o ID -r r- cn n n O O ID m ui m o n O O r C Ul n n ci O " O - 13 O - o o o o o o o o o p a oc O c o c o o i c o r i T i n o i T i n i n i n r - O T i D oi — i n a i T 0 « ) n t " J O n o c i O O i n 0 5 i O O i i ) i n - o ) 0 O o ) c M r - T T < N o o r > i D O c n o i i n c N O r ~ a i — O in — O i D n c D — T I N C I C ^ O O — I D T O T — — O O T O - o o o o o o o o o o o o o o o o o o o o o 2 _ r-a O O c r i n i n m - T — i n n c N i n 6 - n O - t i i n a « i m n O — ID O ui T CN r~ ci co o- n O 10 n n - — — w o ci in O — o o o o o o o o o o o o u o ID O Oi c -c o - o < 1/1 O « t ' T T in o- — — ic — o i c o c i c o o i c - c N t T o - O n O ci — O o i c i i n i n i n o v c N c N i r i — c o C i s n o o i i P T r i O i n i D — — i n T C i o — 0101 — T o i c c r ~ c O T L n i D i D — O l O T C N O — T C N C > r ~ 0 < N T T C ) 0 - C S O — — T O - o o o o o o o o o o o o o o o o o o o o o o CN o > O n u i n o n u i n - j i n o o O T O O O - C O O oi T i n — x io i O ci r~ in in CN O ID IN co — in — O O O O • O C N - O O O O - O O O O O C O O O O O O l/l O O 15 O T Oi O r- in o - o - c c O i o i D O i D t t c D — T O i a j i o i n i D i n r - c N T T i n T O i O T G c D r ^ c j o o — T T — c o c o o i c o c i c i c o — T — I D T — o - c o O i n r i T C i i N O — — — C N O C C O O I T C N T T C T I C I I T O I — O T T P I O J I N — C I O - T O O I C I O I - O O C N O — O C N O - o o o o o o o o o o o o o o o o o o o o o o o 0£ O O 0 M c 0 i n m u n 0 5 i 3 ' T C N O o T n IT co ^  I— o co o i o- ID o~" O c 15 - n in c R o N O in O O O O c. in n - CN CI — o O in O - o o o o o o o o o o o o o i/i a. -> a - o CN O o CO O Cl C : O m - O O O — c N C J T m i o r - o o o i O Cl C T T i n i D P - C O C l O — C N C l T — — — — — — — — CNINCNCNCN — C N C l T i n i D I ^ C D O l O — C N C I T — — — — — — — — — CNCNOICNCN — CM C) T Oi CN Cl IN 1/1 i/i i/i i/i IN 2 < < a U- 10 i/i i/i in o Cl < < c 2 ii_ l/l l/l i/i a o i/-1/1 in l/i n a o UJ cc o o G. 2 c. • > a: o UJ o o C L 2 a. a > CL u_ a 2 a o > t— 1/1 1 - u l/l UJ l/l i/i ~- o o > 1— Irt o UJ l/l i/i ^i o ~z L U i/i i/l r> u 2 a a a a C L a a a a a a. a o IE 0. a. 0. a a c 0. a c C L C L a CL 223 C o r r e l a t i o n Matrix Combined Groups ACC & SIC Note: Pre Dependent Measures Post TEN Tension Thermometer PTEN STAT State Anxiety PSTA TRAI Tract Anxiety PSTRA COG Cognitive Mode PCOG SOM Somatic Mode PSOM EFF S e l f - E f f i c a c y PEFF SPSS P o s i t i v e Self-Statement-Subjects PSPS SNSS Negative Self-Statement-Subjects PSNS JPSS P o s i t i v e Self-Statement-Judges PJPS JNSS Negative Self-Statement-Judges PJNS CORN Cornell Medical Symptom Che c k l i s t POOR MVO2 Maximum Oxygen Uptake PMVO S i g n i f i c a n c e P <.01 .33 P <-05 .25 Appendix H DEMOGRAPHIC SUMMARY - 2 JO -231 Demographics Frequencies and Percentages AC C = 30 SIC = 31 Age less than 35 more than 35 Married yes no Employed yes no Sex male female Timed Stressed Less than 1 year 1 to 2 years 2 to 5 years more than 5 15 15 30 20 IP. 30 27 _3 30 8 11 30 6 9 4 JJ. 30 50% 50 67% 33 90% 10 27% 73 20% 30 13 37 11 20 31 19 12 31 27 _4 31 11 20 31 2 7 6 i i 31 36% 64 61% 39 87% 13 36% 64 7% 23 19 52 Help Sought None Medical P s y c h i a t r i s t Exercise Physiotherapy S e l f Help Psychologist 9 5 1 5 3 7 _0 30 30% 17 3 17 10 23 0 3 7 9 6 1 4 _1 31 10% 23 29 19 3 13 3 Situations Family Relations Work Relations Job D i s s a t i s f a c t i o n Other Occupations Mean number of years i n f i e l d Type of work Sedentary Light Medium Lig h t Heavy 11 4 9 _6 30 11 15 8 7 _0 30 37% 13 20 20 50% 27 23 0 11 3 9 _8 31 11 17 8 5 _1 31 36% 10 29 26 55% 26 16 3 232 ACC = 30 SIC = 31 Education High School 4 13% 6 19% College 7 23 7 23 University 19 63 18 58 30 31 Weight Pre (kilograms) - mean 66.8 64. 1 Post (kilograms) - mean 66.9 64.6 A c t i v i t y Level Sedentary 8 27% 7 23% Sporadic 13 43 15 48 Regular Light 7 23 7 23 Intense 2 7 2 7 30 31 T r a i n i n g — E x e r c i s e Pre None 2 '7% 1 3% W a Iking Only 17 57 14 45 Jogging 2 miles 5 17 4 13 Jogging 2 to 5 1 3 7 23 Other a c t i v i t i e s 5 17 5 16 30 31 Post None 0 0% 1 3% Walking Only 3 10 11 36 Jogging 2 miles 2 7 6 19 Jogging 2 to 5 25 84 6 9 30 24 Other 8 27% 7 23% Length of T r a i n i n g — P r e No response 13 43% 2 7% 1-3 months 5 17 2 7 3-6 months 3 10 3 10 6 months - 1 year 1 3 2 7 1-2 years 1 3 12 39 more than 2 years 7 23 10 32 30 31 A c t i v i t y — T i m e s per week—Pre None 14 47% 2 / 1 4 13 11 2 8 27 6 19 3 3 10 *) J 10 4 0 0 3 10 7 1 3 2 6 30 31 Act iv i ty--T imes per week--Post None •u i o 3 k 5 7 Minutes Per Session--Pre 0 0-15 15-30 30-60 Minutes Per Session--Post 0 0-15 15-30 30-60 ACC = 30 SIC = 31 0 0* 2 7^  1 3 15 2 7 6 20 67 i» 13 r; 17 0 0 1 3 1 3 1 3 1 3 30 31 U 4 7* 2 7: 13 10 3 29 6 20 15 8^ 7 23 5 16 30 31 0 0% . 2 T 0 0 .7 23 13 63 17 55 l l 37 5 16 30 31 OCCUPATIONS or PROFESSIONS CIVIL-ENGINEER ACCOUNTANT HOUSEWIFE-PTEXERCISE-LEADER-DANCE MARKETING-REPRESENTATIVE EDITOR COMMUNITY-HEALTH-NURSE IMPORT-BUSINESS PSYCHOLOGIST MANAGER-INSURANCE SECRETARY PERSONNEL-COORDINATOR TEACHER OFFICE-MANAGER OFFICE-ADMINISTRATOR MEDICAL-TECHNOLOGIST CHEMIST COMPUTER-TECHNICIAN PHYSICIAN SECRETARY ACCOUNTANT PROJECT-MANAGER NURSING-ADMINISTRATOR EDUCATION-STUDENT FASHION-DESIGNER COMMERCIAL-INVESTIGATOR RETIRED CORRECTIONAL-OFFICER REGISTERED-NURSE COMPUTER-OPERATOR MOTHER MANAGER TEACHER LAWYER MILLWORKER HOUSEWIFE HOUSEWIFE OCCUPATIONAL-THERAPIST RENTALSMAN-OFFICER FIREFIGHTER ACCTS-PAYABLE-CLERK SECRETARY-HOUSEWIFE DRAFTSMAN-DESIGNER SOCIAL-WORKER HOUSEWIFE TRAVEL-AGENT CLAIMS-OFFICER WEAVER SYSTEMS-ANALYST CLERK TEACHER PROBATION-OFFICER BOOKKEEPER SALES-MANAGER LIBRARY-ASSISTANT PROFESSIONAL-ENGINEER WRITER-TEACHER SECRETARY HOMEMAKER-MOTHER S UB S TITUTE-TEACHER MEDIA-TECHNOLOGIST SECRETARY SALES-MGR-INSURANCE V-P-SALES OCCUPATIONAL THERAPIST RECEPTIONIST-SECRETARY SECRETARY OFFICE-MANAGER P-T-ACCOUNTNAT INSTRUCTOR-HOSPITAL SELF-EMPLOYED HOMEMAKER Appendix I EXAMPLES Ob' PERCEIVED STKESSCRS - 235 -236 Perceived Stressors The following situations were identified by the participants as representat of their chronic intermittent stressors: Decision-making in own business Daughter an alcoholic Pressure at work Father a lingering terminal i l lness Nonsupportive work situation Trying to meet other people Wi fe an alcoholic Remodeling House - ongoing problems Public speaking related to job Children's Health (cancer); death of son Husband ret i ri ng 16-month old son - d i f f i c u l t y parenting substitute teaching Career advancement - frustrations Loss of status due to no job in area Family break up Social anxiety Teenage daughter Son in trouble with police Wife agoraphobic .Can't leave work behind Two young children (3 'years, 6 months) Own health Job uncertainty Shifting roles at work Financial concerns Driving a ca r Organizing dinner party Movi ng Everything Weight and smoking out of control People arguing What to do i n 1i fe Change of roles (wife to professor) Interruptions (e .g . , Phone rings) Late Bus Relationships with people Taking on too much (courses, work) Fr i end i11 Managing money, home, school Husband overly possessive, jealous A p p e n d i x J POST AND E C L L C W - U F PROGRAM E V A L U A T I O N - 2J7 -Post Program Evaluation ACC Gi=30) SIC (N=31) Goal Attainment Mean number of goals: Extent achieved goals: not at a l l minimally somewhat a great deal completely Mean number of new goals (n=ll , 1 2 ) Extent achieved new goal: not at a l l minimally somewhat a great deal completely ACC SIC 3.2 3.9 5 % 4 % 16 19 35 41 32 32 11 3 100 7- 100 % •2.if 1.3 13 % o % 4 0 26 47 43 27 13 27 100 % 100 % What do you do d i f f e r e n t l y as a consequence of this program? Don't worry Time for s e l f Exercise to cope Don't overreact Challenge Task Oriented Identity Self-statements P o s i t i v e Inner Dialogue Nothing—No response Other ACC SIC 4 14% 1 3% 3 10 0 0 13 45 0 0 0 0 8 26 0 0 10 32 0 0 2 7 0 0 2 7 0 0 3 10 2 6 3 10 8 27 2 6 30 100% 31 100% 239 3) In what way do you f e e l d i f f e r e n t l y as a consequence of th i s program? ACC SIC Relaxed 7 24% 4 13% Confident 5 17 12 39 Body image/self image 3 10 0 0 Healthier 8 28 0 0 In c o n t r o l 0 0 5 16 Change emotions 0 0 2 7 Other 5 17 5 16 No response 2 7 3 10 30 100% 31 100% 4) What was most h e l p f u l i n th i s program ACC SIC Sharing situation-groups 8 28% 3 10% Conditioning (physical) 10 35 0 0 Finding a coping s k i l l 5 17 0 0 Rationale 2 7 0 0 Rehearsing 0 0 3 10 P o s i t i v e Self-Statement 0 0 10 32 Lectures and homework 0 0 3 10 Other 3 10 10 32 No response 2 7 2 7 30 100% 31 100% 5) Number of treatment sessions attended out of 10 ACC SIC mean 7.3 7.7 median 7.7 7.8 6) Reasons f o r not attending sessions ACC SIC Work 14 30% 10 21% Family 10 21 4 9 Program d i s s a t i s f a c t i o n 0 0 2 4 Holidays 11 23 8 17 Health 8 17 11 23 Energy 0 0 2 4 Expectation 0 0 3 6 Other 3 6 7 17 No Response 1 2 0 0 240 Stress Inoculation Post and Follow-up Program Evaluation Post SIC = 31 Follow-up S I l = 18 To what extent are you currently able to put to use the following concepts and s k i l l s i n order to cope b e t t e r with s t r e s s f u l s i t u a t i o n s . 1) Challenge negative self-statements Post Follow-up Not at a l l 1 3% 1 6% Minimally 2 7 1 6 Somewhat 11 35 2 11 A great deal 15 48 14 78 Almost always 2 7 0 0 31 100% . 18 100% M = 3.5 M = 3.6 Md = 3.6 Md = 3.9 2) Replacing negative self-statements with p o s i t i v e self-statements and i n s t r u c t i o n s . Post Follow-up Not at a l l 0 0% 1 6% Minimally 2 7 1 6 Somewhat 12 38 4 22 A great deal 15 48 11 61 Almost always 2 7 1 6 31 100% 18 100% M = = 3.6 M = = 3.6 Md = =. 3.6 Md = = 3.8 3) Mentally rehearse coping behaviours Post Follow-up• Not at a l l 2 7% 0 0% Minimally 3 10 3 17 Somewhat 13 42 7 39 A great deal 11 36 6 33 Almost always 2 7 2 11 31 100% 18 100% M = 3.3 M = 3.4 Md = 3.3 Md = 3.4 Induce Muscle Relaxation Post Follow-up Not at a l l 2 7% 0 0% Minimally 4 13 3 17 Somewhat 15 48 6 33 A great deal 9 29 8 44 Almost always 1 3 1 6 31 100% 18 100% M = 3.1 M = 3.4 Md = 3.1 Md = 3.5 Slow down breathing Post Follow-up Not at a l l 1 3% 1 6% Minimally 3 10 1 6 Somewhat 14 45 7 39 A great deal 10 32 8 44 Almost always 3 10 1 6 31 100% 18 100% M = 3.4 M = 3.4 Md = 3.3 Md = 3.5 Becoming task oriented (planning) Post Follow-up Not at a l l 1 3% 1 6% Minimally 0 0 0 0 Somewhat 9 29 2 11 A great deal 19 61 14 78 Almost always 2 7 1 6 31 100% 18 100% M = 3.7 M = 3.8 Md = 3.8 Md = 3.9 Other techniques: Post F o i l .ow-up No response 11 36% 9 50% Minimal 1 3 2 11 Somewhat 8 26 1 6 A great deal 9 29 6 33 Almost always 2 7 0 0 31 100% 18 100% Aerobic Conditioning Post and Follow-up Program Evaluation Post ACC (n.=30) Follow-up ACl (n = 18) To what extent are you currently using the following aspects of a jogging program to help you cope with s t r e s s f u l s i t u a t i o n s . 1) Changes i n mood from negative to p o s i t i v e . Post Follow-up Not at a l l 2 7% 2 11% Minimally 2 7 5 28 Somewhat 10 33 3 17 A great deal 9 30 7 6 . Almost always 7 23 1 6 36 100% 18 100% M = 3.6 M = 3. 1 Md = 3. 7 Md = 3.3 2) Jogging acts as a d i s t r a c t o r Not at a l l Minimally Somewhat A great deal Almost always 3) Physical sense of well-being Not at a l l Minimally Somewhat A great deal Almost always Post Follow-up 3 10% 2 11% 3 10 4 22 7 23 5 28 10 23 6 33 7 23 1 6 30 100% 18 100% M = 3.6 M = 3. 1 Md = 3.8 Md = 3.2 Post Follow-up 1 3% i Gl 0 c 2 1 1 5 17 1 6 11 37 13 56 13 4 30 100% 18 100% M = 4 . 3 Md = 4 . 4 M. = 3 . 9 Md = 4.1 243 4) Greater sense of competence (can tackle other tasks with confidence) Not at a l l Minimally Somewhat A great deal Almost Always 5) Improved body image Not at a l l Minimally Somewhat A great deal Almost Always 6) Sense of control over one's l i f e s t y l e Not at a l l Minimally Somewhat A great deal Almost Always 7) Problem sol v i n g during runs Not at a l l Minimally Somewhat A great deal Almost Always Post Follow-up 2 7% 2 11% 4 13 1 5 10 33 5 28 8 27 10 ' 56 6 20 0 0 30 100% 18 100% M = 3.5 M = 3.4 Md = 3.5 Md = 3.7 Post Follow-up 3 10% 3 17% 2 7 2 11 11 37 2 11 7 23 7 39 7 23 4 22 100% 18 100% M = 3.5 M = 3.5 Md = 3.5 Md = 3.9 Post FOIIOW-UD 2 7% 2 11% 2 7 2 11 10 33 6 33 10 33 6 33 6 20 2 11 30 100% 18 100% M = 3.6 M = 3.3 Md = 3.7 Md = 3.4 Post Follow-up 7 23% 5 28% 11 37 7 39 7 23 5 28 3 10 0 0 2 7 1 6 30 100% 18 100% M = 2.4 M = 2.2 Md = 2 ?. Md = 2.1. 8) Improved sleeping habits Not at a l l Minimally Somewhat A great deal Almost Always 9) Free Association—Thoughts wander Not at a l l Minimally Somewhat A great deal Almost Always 10) Other Techniques No response Minimally Somewhat A great deal Almost Always Post Follow-up 5 17% 6 34% 7 23 5 28 8 27 4 22 8 27 2 11 2 . 7 1 6 30 100% 18 100% M = 2.9 M = 2.4 Md = 2.9 Md = 2.2 Post Follow-up 3 7% 3 17% 5 17 2 11 10 33 4 22 8 27 7 39 4 13 2 11 30 100% 18 100% M = 3.2 M = 3.3 Md = 3.3 Md = 3.5 Post Follow-up 12 40% 8 44% 0 0 1 6 1 3 2 11 12 40 6 33 5 17 1 6 30 100% 18 100% M = 2.0 M = 3.4 Md = '.5 Md = 3.8 2h5 3-Month Followup Program Evaluation  ACl = 18 S I l = 18  Frequencies and Percentages 1) Major l i f e events occurring during the past 3 months that had a major impact on how they coped with s t r e s s : Negative Influence P o s i t i v e Influence ACl 1 6% 3 17% S1I 4 22 4 22 2) A d d i t i o n a l help sought Pr o f e s s i o n a l (Medical) Counselling (Therapy) Exercise* Self-help material Biofeedback Wo rkshop s-S eminar s Relaxation Training Other None the past three months: ACl S I l 1 6% 0 0% 1 6 1 6 7 39 5 28 1 6 3 17 0 0 0 0 0 0 0 0 0 0 1 6 1 6 1 6 7 39 7 39 18 100% 18 100% Health : habit changes during the past 3 months: ACl SI l Smoking Increased 0 0% 0 0% Decreased 1 6 1 6 No Change 17 94 17 94 Alcohol Increased 2 11 2 11 Decreased 5 28 2 11 No Change 11 61 14 78 Coffee/ Increased 2 11 2 11 Tea/Cola Decreased 6 33 5 28 No Change 10 56 11 61 18 100% 18 100% * For ACl group—other than jogging. Current success in coping with stress: ACl S l l Not at a l l Somewhat Quite Well Completely 0 0% 1 6% 2 11 1 6 15 83 16 89 1 6 0 0 18 100% 18 100% M = 3.94 M = 3. Md = 4. 1 Md = 3.94 247 A C l 3 Month Follow-up (N=18) What has happened to your jogging since we stopped meeting as a group. 1) Increased = 8 pa r t i c i p a n t s (44%) Number of times per week 3 17% Length of run i n time 8 44 Distance covered 7 39 To what do you a t t r i b u t e your maintenance and continued progress? Partner 2 11% Program (stress) 1 6 Goals ' 2 11 Benefits 2 11 Feels Good 1 6 2) Stayed the same. Jogging i n June and unchanged 2 11% Not jogging i n June and unchanged 2 11% 3) Decreased = 6 pa r t i c i p a n t s Number of times run per week 8 44% Length of run i n times 6 33 Distance covered 5 28 3) What has gotten i n the way of maintaining or increasing your program? Health 1 6% Injury 1 6 Lack of support 3 17 Holidays 3 17 Work schedule 3 17 Weather 1 1 Personal motivation 4 22 k) Of the reasons mentioned above, which one would you consider the most important reason you did not continue. Health 1 6% Injury 1 6 No support 1 6 Personal Motivation 5 28 Appendix K 1NTERRATER RELIABILITIES - 248 -Interrater R e l i a b i l i t i e s Percent Agreement Before and A f t e r Discussion Judges' Ratings of Self-Statements (+,-,C) TIME GROUP a p r e Post Follow-up ACl 97 80 93 98 100 99 AC2 95 95 97 98 511 93 92 85 98 99 100 512 85 93 93 96 WL 99 88 100 98 see Tables 1 s 2 SELF—STATEMENT Appendix L UGD I F ICAT ION—CUTCC ME RESEARCH SUMMARY - 250 -Test Anxiety Author (s) Target Anxiety Subjects Conditions Compared Length of Treatment Assessment Channel F-Up Outcome Generali-zation Arnkoff (1980) Test Students N=55 SSM - B e l i e f s SSM - Coping NT 4 weeks S e l f - r e p o r t * Behaviour 10 wks SSM - B e l i e f s = SSM - Coping > NT B i s t l i n e , Jaremko & Sobelman (1980) Test S tudents N=39 Covert Modeling SSM Combined NT 5 sessions S e l f - r e p o r t * 2 mo. Covert Modellng> SSM = Combined > NT D'a l e l i o & Murray (1981) Test Students N=55 SSM NT Ik hr x 4 wks or 8 wks Se l f - r e p o r t * Behaviour — SSM (8 wks)> NT Cooley & Spiegler (1980) Test S tudents N=78 D i f f e r e n t i a l Relaxation SSM Combined AT 5 hrs. x 2 wks Se l f - r e p o r t * Behaviour P h y s i o l o g i c a l 5 wks SSM = Combined> DR > AT Deffenbacher & Hahnloser (1981) Test S tudents N=31 females N= 16 males SSM Relaxation (coping) Combined NT .50 min. x 2 wks Se l f - r e p o r t * Behaviour 5 wks Combined = Cognitive SSM= Relaxation> NT Tes t A n x i e t y A u t h o r ( s ) T a r g e t A n x i e t y S u b j e c t s C o n d i t i o n s Compared Length of Treatment Assessment Cha n n e l F-Up Outcome G e n e r a l i -z a t i o n G o l d f r i e d , L i n e h a n , & Smith (1978) T e s t Community Res. N=21 females N=15 males SSM P r o l o n g e d Exposure(PE) NT 1 6 hr x s e s s i o n s S e l f - r e p o r t * 6 wks SSM > PE > NT > SSM H o l r o y d (1976) T e s t S t u d e n t s N=29females N=24males SSM SD SSM + AT NT SD 1 7 h r x weeks S e l f - r e p o r t * B e h a v i o u r a l * 1 mo SSM > SSM + SD> AT > NT H u s s i a n & Lawrence (1978) T e s t S t u d e n t s N=39females N=9 males SSM -SSM -1) 1 B C I I f NT S p e c i f i c G e n e r a l i z e d i s l o n (AT) 3 3 hr x wks S e l f - r e p o r t * BehavLour 3 8 wk + mo. SSM - S p e c i f i c = SSM - General = D i s c u s s i o n > NT SSM Spec. I f i c. K a p l a n , McCordick, & T w i t c h e l l T e 3 t Students N=17females SI) SSM Combined NT 2 5 h r x wks S e l f - r e p o r t * B e h a v i o u r * SSM > SSM + SD = • SD > NT M c C o r d i c k , K a p l a n , Smith, & F i n n (1981) T e s t Students N=34females N= 1 lmales SSM+SD+Study S k i l l s (SK) SSM+SD+Pressures+SK SSM+Practice+SK Study S k i l l s ( S K ) NT 14 h r s b i w e e k l y S e l f - r e p o r t B e h a v i o u r SSM+Practice+SK > SSM+SD+Pressures+SK> SSM+SD+SK> SK > NT M U l M Test A n x i e t y A u t h o r ( s ) T a r g e t A n x i e t y S u b j e c t s C o n d i t i o n s Compared Length o f Treatment Assessment Channel F-Up Outcome G e n e r a l i -z a t i o n M c C o r d i c k , K a p l a n , F i n n , & Smith (1979) Test S tudents N=37 SSM + SK SSM + R e h e a r s a l Model SSM + V i d e o Model S k i l l T r a i n i n g (SK) NT 10 h r s . B i w e e k l y S e l f - r e p o r t * B e h a v i o u r SSM + R e h e a r s a l > SSM + V i d e o Tape = SSM + SK = SK > NT Meichenbaum (1972) T e s t S t u d e n t s N=15 males N=6 females SD SSM + SD NT 8 s e s s i o n s S e l f - r e p o r t * B e h a v i o u r 1 mo. SSM + SD > SD > NT Nye-Warren (1979) Test S t u d e n t s N=84 SSM + IA + M o d e l i n g SSM + M o d e l i n g I n f o r m a t i o n NT 6 h r s . S e l f - r e p o r t B e h a v i o u r * SSM + IA + M = SSM + M = I n f o r m a t i o n > NT Osarchuk (1976) T e s t S tudents SD ( c o n i n g ) SSM SSM + SD (c o p i n g ) P r o l o n g e d Exposure(PE) 6 h r s . S e l f - r e p o r t * B e h a v i o u r 2 mo. SD ( c o p i n g ) = SSM = SSM + SD ( c o p i n g ) > PE Speech A n x i e t y A u t h o r ( s ) T a r g e t A n x i e t y S u b j e c t s C o n d i t i o n s Compared Len g t h o f Treatment Assessment Channel F--Up Outcome G e n e r a l i -z a t i o n Fremouw & Z i t t e r (1978) Speech St u d e n t s N=19 males N=27 females Response A c q u i s ! t i o n ( R A ) SSM + R e l a x D i s c u s s i o n P l a c e b o (AT) NT lll.gli vs T.ow Anx i o u s 1 h r x 5 wks S e l f - r e p o r t * B e h a v i o u r * Phys 1 0 l o g i c a l 2 mo. High & Low RA = SSM + R e l a x > AT = NT Hi oh : SSH+[>-:Uix No Jaremko (1980) Speech Students N=62 SSM + Reh. (c o p i n g ) P u b l i c S p e a k i n g C l a s s ( N C ) 2 h r s S e l f - r e p o r t * B e h a v i o u r SSM + r e l a x > NC Jaremko, H a d f i e l d , & Walker (1980) Speech Students N=31 Coping S k i l l s + EP Coping S k i l l s E d u c a t i o n Phase (EP) N a t u r a l C o n t r o l 2 h r s . S e l f - r e p o r t * B e h a v i o u r -EP = C o p i n g S k i l l s + EP > Coping S k i l l s > Combined = NC Jaremko & Walker (1978) Speech St u d e n t s N=24 SSM-Reversal SSM-General NT S e l f - r e p o r t * B e h a v i o u r SSM R e v e r s a l > SSM G e n e r a l * NT Meichenbaum, Gi l m o r e , & F e d o r a v i c i u s (1971) Speech Students N=35 males N=18 females SSM SD SSM + SD AT NT 8 s e s s i o n s S e l f - r e p o r t * B e h a v i o u r 3 mo. SSM > SD> SSM + SD> NT= AT SSM N3 U l -C-Speech Anxiety Author(s) Target Anxiety Subjects Conditions Compared Length of Treatment Assessment Channel F-Up 1 Outcome Generali-zation Thorpe, Amatu Blakey, & Burns (1976) Speech Students High School N=22 males N= 11 females SSM - General SSM - S p e c i f i c I n s t r u c t i o n a l Rehearsal (IR) SSM + Rehearsal (SSM+IR) 30 min. x A wk S e l f - r e p o r t * Behaviour 3 mo. SSM=general = SSM s p e c i f i c > I R = SSM + IR Weissberg (1977) Speech Students N=56 females N = 17 males SSM + SD SD SD (coping) NT 2 hrs x 3 wks S e l f - r e p o r t * Behaviour 11 wks SSM + SD (Coping)= SD (Coping) = SD > NT Soc i a l Anxiety Elder, E d e l s t e l n , & Fremouw (1981) S o c i a l Students N=21 females N=17 males SSM Response Acquis!tion(RA) AT High/Low Anxious 2 hrs x 3 wks Self-report-' Behaviour * RA > SSM > AT High: SSM > RA Gardner (1981) S o c i a l Community Residents N=54 SSM + SD SSM Behaviour Assertiveness(BA) NT Se l f - r e port* Beliavl on r P h y s i o l o g i c a l SSM = SSM + SD = BA > NT Glass, Gottman, Shmurak (1976) Inter -pe rsona 1 Students N=61 SSM Sk i l l s ( R A ) Combined NT 4 - hr sessions S e l f - r e p o r t * Behaviour* 6 mo. SSM = RA = Combined > NT N> SSM Ul S o c i a l Anxiety Author (s) Glogower, Fremouw, & McCroskey (1978) Kanter & Go l d f r i e d (1979) Malkiewich & Merluzzi (1980 Bowman (1977) Target Anxiety Communi-cation Appre-hension S o c i a l S o c i a l General Anxiety Subjects Students N=29 males N=31 females Community Residents N=50 females N=18 males Students N=59 males Community Res idents N=66 Conditions Compared SSM (Neg SS) Knowledge & Rehearsal (SSMJ) Combined E x t i n c t i o n NT SSM SD (coping) SSM + SD (coping) NT High/Moderate Anx. SSM SD (coping) NT Conceptual Level High vs. Low Length of Treatment 1 hr x 5 wk 2 hrs x 5 wks 1 hr. x 5 wks Assessment Channel M u l t i p l e Anxieties SSM Awareness S k i l l s (coping) Minimal Treatment Ik hr. x 6 wks Se l f - r e p o r t * Behaviour * Se l f - r e p o r t * Behaviour P h y s i o l o g i c a l S e l f - r e p o r t * Behaviour S e l f - r e p o r t * S i g n i f i c a n t Other F-Up 6 wks 9 wks • 4 wks 6 wks Outcome Comb> Coping SS> NSS> Ext> NT SSM> SSM + SD> SD> NT High. Mod: SSM = SD SSM> SD (coping)> NT Conceptual l e v e l : SSM = SD SSM = Awareness = S k i l l s = M i n i . Treatment Generali-zation Yes SSM SSM + SD CTN M u l t i p l e Anxieties Author(s) Target Anxiety Subjects Conditions Compared Length of Trea tmen t Assessment Channel F -Up Outcome Generali-zation Woodward & Jones (1980) General Anxiety Community Residents (outpatients) N=16 females N= 11 males SSM SD (coping) Combined NT Ik hrs x 8 wks S e l f - r e p o r t s * 1 mo. Combined > SSM > SD (coping) > NT Yorde & Witmer (1980) General Anxiety Community Residents N = 17 males N=21 females SSM + Relax SSM + Biofeed. Contingent SSM + Biofeed. Noncon-tingent Biofeedback only Noncontingent Biofeed. lh. hr. x 4 wks S e l f - r e p o r t * P h y s i o l o g i c a l 3 mo. SSM + relax > Biofeedback Miscellaneous Anderson, Lawrence & Olson (1981) Tension Headache Students N=12females N=2 males Single case SSM Autogenics Combined 4 wks S e l f - r e p o r t * 7 mo. SSM = Autogenics = Combined Holroyd & Andrasik (1978) Tension Headache Community Residents N=35 females N=4 males SSM + Relax SSM Discussion (AT) Symptom Monitoring 1 3/4 hr x 5 wks S e l f - r e p o r t * P h y s i o l o g i c a l 6 wks SSM + Relax = SSM = Discussion > Monitoring ho vn Hurlburt & S i p p r e l l e Anxiety Attacks Single Case 48 year old male SSM + Relax 28 hrs 20 days S e l f - r e p o r t * 2 mo. SSM + Relax. A u t h o r (s) T a r g e t A n x i e t y S u b j e c t s C o n d i t i o n s Compared Length o f Treatment Assessment Channel F -Up Outcome G e n e r a l i -z a t i o n K e n d a l l , W i l l i a m s , Pechacek, S h i s s l a k , & H e r z o f f (1979) C a r d i a c Cathe-t e r i z a -t i o n H o s p i t a l i z e d P a t i e n t s N=44 males SSM E d u c a t i o n I n s t r u c t i o n AT N a t u r a l C o n t r o l (NC) 45 mi nutes S e l f - r e p o r t * B e h a v i o u r a l * 2 days SSM > E d u c a t i o n > AT = NC K e n d r i c k (1979) P e r f o r -mance ( P i a n o ) P i a n o S t u d e n t s N=48 females N=5 males SSM + A t t e n t i o n B e h a v i o u r a l R e h e a r s a l ( B R ) NT IU h r . 3 wks S e l f - r e p o r t * B e h a v i o u r * P h y s i o l o g i c a l 5 wks SSM + A t t e n = BR > NT Yes Kim (1980) E d u c a t i o n ( C a r e e r ) A n x i e t y S tudents (Korean) N=21 males N=9females SSM + SD SSM NT AO min. x 3 days S e l f - r e p o r t * B e h a v i o u r * 6 wks SSM + SD > SSM > NT K l e p a c , Hauge, & McDonald (1981) Fear of D e n t i s t r y Students N=72 Exposure R e l a x a t i o n SSM + R e l a x a t i o n Exposure + SSM Exposure + R e l . + SSM Exposure + R e l a x a t i o n 30 min. 2 x wk (1.5-3.5 h r s ) S e l f - r e p o r t B e h a v i o u r * —— SSM = R e l a x + Exposure No SSM S e l f - s t a t e m e n t M o d i f i c a t i o n ; NT No Treatment C o n t r o l ; AT A t t e n t i o n P l a c e b o ; SD S y s t e m a t i c D e s e n s i t i z a t i o n ; SK S k i l l T r a i n i n g ; IA Induced A f f e c t ; NC N a t u r a l C o n t r o l ; IR I n s t r u c t i o n a l R e h e a r s a l ; RA Response A c q u i s i t i o n ; PE P r o l o n g e d Exposure Assessment Channel d i f f e r e n t i a t i n g treatment e f f e c t i v e n e s s oo Appendix M EXAMPLES CF PERSONAL GOALS - 26i) -Examples of P a r t i c i p a n t s ' Goals: Pre Testing More e f f e c t i v e personal management Learning to accept s e l f Learning to relax away from job Eliminate p r o c r a s t i n a t i o n Back to sports Control responses under s t r e s s f u l s i t u a t i o n s Reduce general l e v e l of stress Understand long term e f f e c t s of stress Regulate Stress Not get angry so quickly Exercise R e l a x — d i s c o n t i n u e medicine Honest and open Express emotions Less work/more play Leave marriage B u i l d a new l i f e Make things happen Take action Forget problems of others Inner Voice-Stop Relax body 

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