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Coping strategies for working women : aerobic exercise and relaxation interventions Haney, Colleen Judith 1986

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COPING STRATEGIES FOR WORKING WOMEN: AEROBIC EXERCISE AND RELAXATION INTERVENTIONS COLLEEN JUDITH HANEY A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PHYSICAL EDUCATION i n FACULTY OF GRADUATE STUDIES P h y s i c a l E d u c a t i o n and R e c r e a t i o n We accept t h i s t h e s i s as conforming to the r e q u i r e d standard THE School of THE UNIVERSITY OF BRITISH COLUMBIA December 1986 © COLLEEN JUDITH HANEY, 1986 In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of the requirements f o r an advanced degree at the The U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and study. I f u r t h e r agree that p e r m i s s i o n f o r e x t e n s i v e copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the Head of my Department or by h i s or her r e p r e s e n t a t i v e s . I t i s understood that copying or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l gain..shall not be allowed without my w r i t t e n p e r m i s s i o n . School of P h y s i c a l Education and R e c r e a t i o n The U n i v e r s i t y of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 Date: December 1986 i i ABSTRACT T h i s s t u d y e x a m i n e d t h e e f f e c t s o f two 8-week 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 ( a e r o b i c e x e r c i s e a n d p r o g r e s s i v e r e l a x a t i o n ) on r e d u c t i o n s i n t r a i t a n x i e t y , i n c r e a s e s i n s e l f - e f f i c a c y , a n d enhancement o f c o p i n g s t r a t e g i e s f o r s e d e n t a r y w o r k i n g women. I t was e x p e c t e d t h a t a e r o b i c e x e r c i s e , a r e l a t i v e l y new t r e a t m e n t , w o u l d be a s e f f e c t i v e o r more e f f e c t i v e t h a n p r o g r e s s i v e r e l a x a t i o n , a w e l l r e s e a r c h e d t r e a t m e n t , 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 . The s u b j e c t s were .72 f e m a l e s a g e d 2 4 - 5 9 , (M = 39.8) s o l i c i t e d f r o m t h e V a n c o u v e r c o m m u n i t y v i a n e w s p a p e r a d v e r t i s e m e n t a s k i n g f o r s t r e s s e d v o l u n t e e r s t o p a r t i c i p a t e i n t w o * s t r e s s - m a n a g e m e n t p r o g r a m s . They were i n t e r v i e w e d a n d r a n d o m l y a s s i g n e d t o an a e r o b i c e x e r c i s e o r p r o g r e s s i v e r e l a x a t i o n t r e a t m e n t . The t r e a t m e n t s e s s i o n s were c o n d u c t e d o v e r an 8-week p e r i o d w i t h s u b j e c t s m e e t i n g i n g r o u p s f o r 1 1/2 h o u r s p e r week. P r i o r t o t h e f i r s t s e s s i o n s u b j e c t s were a d m i n i s t e r e d : STAI-T ( S p i e l b e r g e r , G o r s u c h , & L u s h e n e , 1 9 7 0 ) , t h e G e n e r a l S e i f - E f f i c a c y S c a l e ( S h e r e r e t a l . , 1 9 8 2 ) , Ways o f C o p i n g C h e c k l i s t ( L a z a r u s 6 F o l k m a n , 1 9 8 4 ) , a n d a 7-Day E x e r c i s e R e c a l l I n v e n t o r y ( B l a i r , 1 9 8 4 ) . S u b j e c t s were a s s e s s e d a g a i n a t p o s t t r e a t m e n t a n d a t 8-week f o l l o w - u p . i i i 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 i t h p r e p l a n n e d c o n t r a s t s , i n d i c a t e d t h a t b o t h t r e a t m e n t g r o u p s were e f f e c t i v e i n d e c r e a s i n g t r a i t a n x i e t y a n d i n c r e a s i n g 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 r e a t m e n t . T h e s e c h a n g e s were m a i n t a i n e d a t 8-week f o l l o w - u p . I n a d d i t i o n , a one-way 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 i t h r e p e a t e d m e a s u r e s i n d i c a t e d t h a t t h e t o t a l number o f c o p i n g s t r a t e g i e s , a s w e l l a s t h e d i f f e r e n c e b e t w e e n t h e number o f p r o b l e m - f o c u s e d a n d e m o t i o n - f o c u s e d c o p i n g s t r a t e g i e 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 f r o m p r e - t o p o s t t r e a t m e n t . A d d i t i o n a l l y , t h e r e was a n e g a t i v e r e l a t i o n s h i p b e t w e e n l o w s c o r e s i n s e l f - e f f i c a c y a n d h i g h s c o r e s i n e m o t i o n - f o c u s e d c o p i n g . I n r e s p o n s e t o a n c i l l a r y p o s t t r e a t m e n t a n d f o l l o w - u p q u e s t i o n n a i r e s , a e r o b i c e x e r c i s e was p e r c e i v e d by t h e p a r t i c i p a n t s a s a more s a t i s f a c t o r y s t r e s s - m a n a g e m e n t t r e a t m e n t . I m p l i c a t i o n s o f t h e s e r e s u l t s a n d s u g g e s t i o n s f o r f u t u r e s t u d i e s a r e d i s c u s s e d . Table of Contents ABSTRACT i i LIST OF TABLES v i i LIST OF FIGURES v i i i ACKNOWLEDGEMENTS i x INTRODUCTION 1 REVIEW OF LITERATURE 9 Theories/Models of Coping.. 9 Fu n c t i o n s of Coping 10 Measurement of Coping 20 Gender D i f f e r e n c e s i n Coping ; 23 Stress-Management Treatment Packages 25 E x e r c i s e 26 P r o g r e s s i v e R e l a x a t i o n 31 S e l f - E f f i c a c y Theory 34 Adherence 39 Summary 39 METHOD 41 S u b j e c t s 41 Design and Procedures 42 Measures 44 T r a i t A nxiety 44 General S e l f - E f f i c a c y S c a l e 45 Ways of Coping C h e c k l i s t 45 7-Day R e c a l l . • 46 M a n i p u l a t i o n Check 48 A n c i l l a r y Measures 48 V Treatments 49 Leaders . 50 Exercise Walk/Jog Program 50 Progressive Relaxation Program 51 RESULTS 53 Group Comparabi l i ty -Descr ip t ive S t a t i s t i c s 53 Chi-Square Analys i s 53 Subject A t t r i t i o n 54 MANOVA for Pretreatment 54 S e l f - e f f icacy-STAI 54 Coping-Exercise 56 Manipulat ion Check 56 Treatment Ef fec t s 57 MANOVA for S e l f - e f f i c a c y - T r a i t Anxiety 57 MANOVA for Coping 59 S e l f - e f f i c a c y as a Predictor V a r i a b l e 61 A n c i l l a r y Measures 61 MANOVA for Exerc ise 61 Post and Follow-up Questionnaires 62 C o r r e l a t i o n Matrix 64 DISCUSSION. 66 REFERENCES. 74 APPENDIX A 89 Telephone Screening 90 Interview 91 Informed Consent 93 APPENDIX B 9 4 vi Tension Thermometer 95 Par Q 96 APPENDIX C 97 Examples of P e r c e i v e d S t r e s s o r s 98 APPENDIX D 99 General S e l f - E f f i c a c y S c a l e 100 APPENDIX E 101 F a c t o r A n a l y s i s and R e l i a b i l i t y 102 Revised Form of Coping C h e c k l i s t 104 APPENDIX F 105 7-Day R e c a l l 106 Occupations and P r o f e s s i o n s . . . . . . 107 A n c i l l a r y Measures ^.108 Expectancy Q u e s t i o n n a i r e . . . . . 115 v i i L i s t o f T a b l e s I . Summary o f S u b j e c t C h a r a c t e r i s t i c s 43 I I . Means a n d S t a n d a r d D e v i a t i o n s o f Outcome M e a s u r e s . 55 I I I . Means a n d S t a n d a r d D e v i a t i o n s o f E x p e c t a n c y S c o r e s 58 I V . Summary 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 R e s u l t s f o r Outcome M e a s u r e s 60 V. C o r r e l a t i o n M a t r i x o f D e p e n d e n t V a r i a b l e s a n d O t h e r S e l e c t e d F a c t o r s 65 L i s t o f F i g u r e s P r e , P o s t a n d F o l l o w - u p G r o u p Means f o r E x e r c i s e C o m p o s i t e S c o r e ( m i n u t e s X i n t e n s i t y ) . ix A c k n o w l e d g e m e n t s I f e e l g r e a t l y i n d e b t e d t o my f r i e n d s , my f a m i l y a n d my t h e s i s c o m m i t t e e f o r t h e i r s u p p o r t , e n c o u r a g e m e n t a n d u n d e r s t a n d i n g t h r o u g h o u t my t h e s i s p r o j e c t . I w o u l d l i k e t o e x p r e s s a p p r e c i a t i o n t o my s u p e r v i s o r , D r . B o n i t a L o n g who n o t o n l y p r o v i d e d me w i t h t h e i n s p i r a t i o n a n d m o t i v a t i o n t o c o m p l e t e my t h e s i s b u t h e l p e d me d e v e l o p an e a g e r n e s s "fco p u r s u e r e s e a r c h . As my m e n t o r , D r . L o n g p r o v i d e d a d v i c e , a n d u n d e r s t a n d i n g t h r o u g h o u t my t h e s i s a n d was a l w a y s t h e r e when I n e e d e d h e r . From D r . L o n g I h a v e l e a r n e d many t h i n g s . I w o u l d l i k e t o t h a n k D r . R. S c h u t z f o r h i s v a l u a b l e f e e d b a c k on s t a t i s t i c a l m a t t e r s a n d f o r b e i n g a v a i l a b l e when I n e e d e d a s s i s t a n c e . F i n a l l y , I w o u l d l i k e t o t h a n k D r . F. S m o l l f o r h i s s u p p o r t a n d comments on my t h e s i s a n d f o r t a k i n g t i m e f r o m h i s b u s y s c h e d u l e a t t h e U n i v e r s i t y o f W a s h i n g t o n t o a t t e n d my t h e s i s p r o p o s a l a n d d e f e n c e . 1 Introduct ion Women's p a r t i c i p a t i o n i n the workforce has more than doubled i n the past 30 years, yet few s t u d i e s have co n c e n t r a t e d on how women cope with work-related s t r e s s . There has a l s o been l i m i t e d focus on how women cope with s t r e s s as a r e s u l t of stress-management i n t e r v e n t i o n s d e s p i t e the p r o l i f e r a t i o n of such i n t e r v e n t i o n s (Woolfolk & Lehrer, 1984). U n f o r t u n a t e l y , coping s t r a t e g i e s ( i . e . , techniques i n d i v i d u a l s use to sol v e problems or reduce emotional responses, Lazarus & Folkman, 1984) have seldom been s t u d i e d as an i n t e r v e n t i o n "outcome" (Meichenbaum & Jaremko, 1983). T h e r e f o r e , the primary purpose of t h i s study was to compare the e f f e c t i v e n e s s of stress-management i n t e r v e n t i o n s f o r working women, and to examine changes i n coping s t r a t e g i e s as an outcome. T r a d i t i o n a l l y , i n v e s t i g a t o r s c o n c e p t u a l i z e d coping as a t r a i t r a t h e r than as a process ( i . e . , s t u d i e s focused upon the i n d i v i d u a l ' s general d i s p o s i t i o n , r a t h e r than the s t r a t e g y employed). Examples of s t u d i e s which i n c l u d e coping t r a i t s are Friedman and Rosenman's (1974) Type A behavior and Bryne's (1964) r e p r e s s i o n - s e n s i t i z a t i o n . T r a i t measures are seldom found to c o r r e l a t e with coping s t r a t e g i e s (Fleming, Baum, & Singer, 1984). In most cases, t r a i t measures are evaluated along a s i n g l e dimension, but many s i t u a t i o n s c a l l f o r a wide range of coping s t r a t e g i e s 2 (Moos & B i l l i n g s , 1982). For example, an i l l person must deal with s e v e r a l sources of s t r e s s - - p a i n , the h o s p i t a l s i t u a t i o n , and v i s i t o r s . Because of the m u l t i p l e s i t u a t i o n s i n v o l v e d , i t i s d o u b t f u l whether a l l of the ways an i n d i v i d u a l copes can be accounted for by a s i n g l e dimensional measure. Thus, r e s e a r c h e r s are beginning to examine the d i v e r s e range of coping s t r a t e g i e s (Astor-Dubin & Hammen, 1984; Folkman & Lazarus, 1985; Parkes, 1984). Folkman and Lazarus (1980) have developed a model which c o n s i d e r s two b a s i c dimensions of c o p i n g : problem-focused coping and emotion-focused c o p i n g . These two s t r a t e g i e s can f u n c t i o n s e p a r a t e l y or i n c o n j u n c t i o n with one another (Lazarus & Folkman, 1984). Emotion-focused coping i s l i k e l y to occur when the s i t u a t i o n has been a p p r a i s e d such that nothing can be done to change i t , whereas problem-focused coping i s more l i k e l y to be used when s i t u a t i o n s are a p p r a i s e d as p o s s i b l e to change. Evidence i s a c c r u i n g that the use of problem-focused s t r a t e g i e s are r e l a t e d to more e f f e c t i v e coping ( B i l l i n g s & Moos, 1981; F i n n , 1985; P e a r l i n & Schooler, 1978). Although some r e s e a r c h e r s i d e n t i f y other coping dimensions (e.g., a p p r a i s a l - f o c u s e d c o p i n g ) , most forms of coping s c a l e s i n c o r p o r a t e problem-focused and emotion-focused coping as b a s i c components. In a study of 100 middle-aged s u b j e c t s , Folkman and Lazarus (1980) found that both 3 problem-focused and emotion-focused coping were used by a l l s u b j e c t s . R e s u l t s from these s t u d i e s suggest that both emotion-focused and problem-focused coping should be e v a l u a t e d when measuring an i n d i v i d u a l ' s coping s t r a t e g i e s . While some r e s e a r c h e r s have found evidence f o r gender d i f f e r e n c e s i n coping (Astor-Dubin & Hammen, 1984; B i l l i n g s & Moos, 1981; Folkman & Lazarus, 1980; P e a r l i n & Schooler, 1978), few s t u d i e s have s p e c i f i c a l l y examined coping responses i n women. Folkman and Lazarus (1980) found that men used more problem-focused coping than women i n s i t u a t i o n s that were unchangeable but that women used both types of coping s t r a t e g i e s more o f t e n . V i t a l i a n o , Russo, Carr, Maiuro, and Becker (1985) examined three d i v e r s e samples ( p s y c h i a t r i c p a t i e n t s , spouses of p a t i e n t s with A l i z h e i m e r ' s d i s e a s e , and medical students) and a l s o found that females had s i g n i f i c a n t l y higher scores than males f o r t o t a l number of coping s t r a t e g i e s . P e a r l i n and Schooler (1978) found that men and more educated i n d i v i d u a l s used a more e f f e c t i v e mode of coping. E f f e c t i v e coping was d e f i n e d as a v a r i e d r e p e r t o i r e of coping s t r a t e g i e s . T h i s study focused on enduring r a t h e r than recent s p e c i f i c s t r e s s f u l encounters. In a r e l a t e d study on d e p r e s s i o n , Astor-Dubin and Hammen (1984) found that women make more coping responses, engage i n more a c t i v e and b e h a v i o r a l coping, and seek 4 others out, while men use more c o g n i t i v e c o p i n g . However, in t h e i r study the nature of the s t r e s s o r was not c o n t r o l l e d . Since the above s t u d i e s have examined coping behaviors in s p e c i f i c c o n t e x t s , i t cannot be assumed that coping behaviors w i l l g e n e r a l i z e to other s i t u a t i o n s . In summary, resea r c h on coping has been hampered by t r e a t i n g v a r i a b l e s as i f they were u n i d i r e c t i o n a l , d e f i n i n g coping as a t r a i t , f o c u s i n g on s i n g l e s t r e s s f u l events, using inadequate measurements and methodology, and f a i l i n g to c o n s i d e r gender d i f f e r e n c e s . However, c u r r e n t s t u d i e s are beginning to focus on s t r a t e g i e s of coping u t i l i z e d over time and there i s c o n t i n u i n g development of t e s t instruments (e.g., Ways of Coping C h e c k l i s t , Folkman & Lazarus, 1980) as w e l l as r e v i s i o n s of the coping dimensions ( B i l l i n g s & Moos, 1981; V i t a l i a n o et a l . , 1985). T r a d i t i o n a l treatments f o r coping with s t r e s s have i n v o l v e d b e h a v i o r a l techniques, such as systematic d e s e n s i t i z a t i o n and r e l a x a t i o n , and more r e c e n t l y , c o g n i t i v e techniques, such as s t r e s s i n o c u l a t i o n and thought stopping (Woolfolk & Lehrer, 1984). A promising i n t e r v e n t i o n , p h y s i c a l a c t i v i t y , has a l s o been used as a stress-management treatment (e.g., Long, 1984). Evidence i s accumulating that p h y s i c a l a c t i v i t y , p a r t i c u l a r l y a e r o b i c e x e r c i s e may p l a y an important r o l e i n s t r e s s r e d u c t i o n ( f o r reviews see 5 E i d e , 1982; F o l k i n s & Sime, 1981; Ledwidge, 1980; Mihevic, 1982). The terms e x e r c i s e , a e r o b i c e x e r c i s e , and p h y s i c a l a c t i v i t y are used in t e r c h a n g e a b l y i n t h i s paper and r e f e r to gross muscle a c t i v i t i e s . For a e r o b i c b e n e f i t s to occur i n d i v i d u a l s should e x e r c i s e at a minimum i n t e n s i t y of 60% of maximum heart r a t e , for a d u r a t i o n of 15 to 60 minutes at a frequency of 3 to 5 days per week (American C o l l e g e of Sports Medicine, 1980). P a r t i c i p a t i o n i n an a e r o b i c e x e r c i s e program has been shown to be r e l a t e d to r e d u c t i o n s i n a n x i e t y i n both c l i n i c a l and n o n - c l i n i c a l p o p u l a t i o n s . However, most s t u d i e s l i m i t e d t h e i r samples to sedentary i n d i v i d u a l s (Doyne, Chambless, & B e u t l e r , 1983; F o l k i n s , Lynch, & Gardner, 1972; H i l y e r & M i t c h e l l , 1979; Young & I s m a i l , 1976). From s t u d i e s reviewed, i t appears that processes such as b e t t e r p s y c h o l o g i c a l f u n c t i o n i n g , improved s e l f - e f f i c a c y ( i . e . , the b e l i e f that one can s u c c e s s f u l l y perform a coping b e h a v i o r ) , and reduced a n x i e t y are important outcomes that may account f o r e x e r c i s e as an e f f e c t i v e stress-management i n t e r v e n t i o n (Jasnoski & Holmes, 1981; Long, 1984). For example, in a c o n t r o l l e d study Long (1984) found that s u b j e c t s reduced a n x i e t y and i n c r e a s e d s e l f - e f f i c a c y as the r e s u l t of a 10-week a e r o b i c e x e r c i s e i n t e r v e n t i o n . These changes were maintained at a 15-month follow-up. 6 A study by Jas n o s k i and Holmes (1981) assessed 103 women a f t e r they p a r t i c i p a t e d i n a 15-week a e r o b i c t r a i n i n g program. I t was found that 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 (more emotional s t a b i l i t y , more s e l f - a s s u r a n c e and l e s s r e p o r t e d tenseness) was r e l i a b l y a s s o c i a t e d with higher l e v e l s of ae r o b i c f i t n e s s , and with p a r t i c i p a t i o n i n the program independent of changes i n / f i t n e s s . Furthermore, J a s n o s k i , Holmes, Solomon, and Aguiar (1981) assessed whether p h y s i c a l f i t n e s s or merely p a r t i c i p a t i o n i n an endurance program mediates p s y c h o l o g i c a l change. These re s e a r c h e r s compared women i n a 10-week e x e r c i s e c l a s s with w a i t l i s t c o n t r o l s and an independent c o n t r o l group. They found that p a r t i c i p a t i o n per se (a) improved scores on s e l f - p e r c e i v e d a b i l i t i e s i n r e l a t i o n to jogging, and (b) improved ge n e r a l s e l f - c o n f i d e n c e , compared to c o n t r o l groups. Thus, there appears to be some support f o r e x e r c i s e p a r t i c i p a t i o n per se as a v i a b l e stress-management i n t e r v e n t i o n f o r sedentary i n d i v i d u a l s . While evidence accumulates to support the b e n e f i t s of e x e r c i s e f o r mental h e a l t h , maintenance of e x e r c i s e behavior has been problematic (Martin & Dubbert, 1985). A growing body of res e a r c h suggests that the m a j o r i t y of people who begin an e x e r c i s e program w i l l stop, o f t e n w i t h i n the f i r s t few months (Dishman, 1982; Mar t i n & Dubbert, 1982; Ward & Morgan, 1984). One of 7 the 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 found to c o r r e l a t e p o s i t i v e l y with the p r o b a b i l i t y of adherence to an e n a c t i v e program ( i . e . , walking, smoking treatment) i s s e l f - e f f i c a c y (Condiotte & L i c h t e n s t e i n , 1981; Kaplan, A t k i n s , & Reinsch, 1984). According to s e l f - e f f i c a c y theory, e x p e c t a t i o n s of s e l f - e f f i c a c y determine what a c t i v i t i e s people engage i n , how much e f f o r t they w i l l expend and how long they w i l l p e r s i s t i n the face of a d v e r s i t y (Bandura, 1977). Evidence supporting s e l f - e f f i c a c y as a p r e d i c t o r of behavior change comes from areas such as h e a l t h behavior, f o r example smoking c e s s a t i o n (Condiotte & L i c h t e n s t e i n , 1981), and o b e s i t y treatments ( M i t c h e l l & S t u a r t , 1984). Kazdin and Wilson (1978) propose that the comparison of two treatment packages i s c o n s i d e r e d v i a b l e f o r outcome r e s e a r c h when the primary commitment i s to d i s c o v e r a treatment to accommodate a c l i n i c a l problem, when the treatments are s i m i l a r , and when one treatment i s known to be e f f e c t i v e . Since P r o g r e s s i v e R e l a x a t i o n programs (Woolfolk & Lehrer, 1984) have been shown to be e f f e c t i v e i n reducing t r a i t and s t a t e a n x i e t y , changing mood, and i n c r e a s i n g the a b i l i t y to r e l a x f o r a wide v a r i e t y of p o p u l a t i o n s ( C a n g e l o s i , 1980; H e i d i & Borkovec, 1983; Wood, 1978; Woolfolk, Lehrer, McCann, & Rooney, 1982), i n t h i s study p r o g r e s s i v e r e l a x a t i o n was used as a standard with which to compare an a e r o b i c e x e r c i s e program as a 8 stress-management i n t e r v e n t i o n . An a e r o b i c walk/jog program was used because i t was time and cost e f f i c i e n t , easy to a d m i n i s t e r , and other s t u d i e s have used s i m i l a r programs (Jasnoski et a l . , 1981; Long, 1984). The main o b j e c t i v e of t h i s study was to examine the e f f e c t s of two 8-week stress-management i n t e r v e n t i o n s ( p r o g r e s s i v e r e l a x a t i o n and a e r o b i c e x e r c i s e ) f o r sedentary working women. I t was hypothesized that an 8-week e x e r c i s e i n t e r v e n t i o n would be e q u a l l y or more e f f e c t i v e than p r o g r e s s i v e r e l a x a t i o n i n s i g n i f i c a n t l y reducing t r a i t 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 . In a d d i t i o n , i t was hypothesized that both treatment groups would i n c r e a s e t h e i r coping s t r a t e g i e s and, more s p e c i f i c a l l y , problem-focused s t r a t e g i e s would i n c r e a s e and emotion-focused s t r a t e g i e s would remain the same a f t e r the i n t e r v e n t i o n s . Furthermore, i t was hypothesized that p a r t i c i p a n t s with g r e a t e r l e v e l s of s e l f - e f f i c a c y a f t e r the e x e r c i s e i n t e r v e n t i o n s , would show a g r e a t e r frequency of jogging at follow-up than p a r t i c i p a n t s lower i n s e l f - e f f i c a c y . 9 Review of L i t e r a t u r e Coping with c h r o n i c s t r e s s f u l events i s f o r the most p a r t p o o r l y understood and may be due to t r a d i t i o n a l t r a i t - o r i e n t e d f o r m u l a t i o n s of coping (Folkman & Lazarus, 1980). T h e r e f o r e , Folkman and Lazarus' (1980) p r o c e s s - o r i e n t e d t r a n s a c t i o n a l model of coping i s used to examine coping p r o c e s s e s . Through a review of re s e a r c h i n the area of coping, the i s s u e s of measurement and gender d i f f e r e n c e s are d i s c u s s e d . In a d d i t i o n , support f o r stress-management i n t e r v e n t i o n s such as a e r o b i c e x e r c i s e and p r o g r e s s i v e r e l a x a t i o n i s prov i d e d . Furthermore, s e l f - e f f i c a c y e x p e c t a t i o n s which are c o n s i d e r e d to a f f e c t both the i n i t i a t i o n and p e r s i s t e n c e of coping behavior (Bandura, 1977) are reviewed i n r e l a t i o n to stress-management programs. Theories/Models of Coping Although coping p l a y s a c e n t r a l r o l e i n c u r r e n t t h e o r i e s of s t r e s s , r e s e a r c h i s j u s t beginning to explore the s p e c i f i c coping processes people use i n adapting to s t r e s s f u l l i f e c ircumstances. A t r a d i t i o n a l t h e o r e t i c a l p e r s p e c t i v e , p s y c h o a n a l y t i c ego theory ( V a l l i a n t , 1977), has c o n t r i b u t e d to c u r r e n t c o n c e p t u a l i z a t i o n s and measures of coping. In p s y c h o a n a l y t i c theory coping i s d e f i n e d as r e a l i s t i c and f l e x i b l e thoughts and a c t s intended to solve problems and t h e r e f o r e reduce s t r e s s . T h i s theory d i f f e r e n t i a t e s among a number of processes that people 10 use to handle person-environment r e l a t i o n s h i p s . These ego processes are c o g n i t i v e mechanisms whose f u n c t i o n s are d e f e n s i v e ( r e a l i t y d i s t o r t i n g ) and emotion focused ( o r i e n t e d toward t e n s i o n r e d u c t i o n ) . Lazarus and Folkman (1984) developed a t r a n s a c t i o n a l model of coping as an a l t e r n a t i v e to p s y c h o a n a l y t i c f o r m u l a t i o n s of coping. The t r a n s a c t i o n a l model i s p r o c e s s - o r i e n t e d i n that the person and the environment are viewed as being i n a dynamic, mutually r e c i p r o c a l , b i d i r e c t i o n a l r e l a t i o n s h i p . Coping i s d e f i n e d as changing c o g n i t i v e and b e h a v i o r a l e f f o r t s to manage s p e c i f i c e x t e r n a l and/or i n t e r n a l demands that are a p p r a i s e d as exceeding the resources of the i n d i v i d u a l . The person-environment r e l a t i o n s h i p , i n the context of coping, i s p r o c e s s - o r i e n t e d and t h e r e f o r e concerned with what the person a c t u a l l y t h i n k s and does in a s p e c i f i c context, and with changes in thoughts and a c t i o n s as an encounter u n f o l d s . F u n c t i o n s of Coping According to Lazarus and Folkman (1984) coping serves two o v e r r i d i n g f u n c t i o n s : (a) managing or a l t e r i n g the problem causing stress--problem-focused coping (P-focused), and (b) r e g u l a t i n g the emotional response to the problem-- emotion-focused coping ( E - f o c u s e d ) . These two major f u n c t i o n s of coping have a l s o been i d e n t i f i e d by Moos and B i l l i n g s (1982), 11 F e l t o n and Revenson (1984), and P e a r l i n and Schooler (1978) i n t h e i r r e s e a r c h . E-focused coping i n c l u d e s s t r a t e g i e s such as avoidance, s e l e c t i v e a t t e n t i o n , and w i s h f u l t h i n k i n g . It i s used when the s i t u a t i o n has been a p p r a i s e d such that nothing can be done to change i t (Lazarus & Folkman, 1984). In a d d i t i o n , E-focused coping helps an i n d i v i d u a l maintain hope and optimism and to r e f u s e to acknowledge the worst. As a r e s u l t , E-focused processes may lend themselves to an i n t e r p r e t a t i o n of s e l f - d e c e p t i o n (Lazarus, 1985). S e l f - d e c e p t i o n i s best d e s c r i b e d as being on a continuum r a t h e r than dichotomized as pathogenic or h e a l t h y . For example, s e l f - d e c e p t i o n can lead to s e r i o u s consequences i f a person ignores an i l l n e s s such as d i a b e t e s which r e q u i r e s a t t e n t i o n to d i e t and e x e r c i s e . A l t e r n a t e l y , s e l f - d e c e p t i o n can have a p o s i t i v e value at an e a r l y stage of coping when a person's resources are i n s u f f i c i e n t to cope in a more P-focused way ( i . e . , a s p i n a l c o r d p a t i e n t i s helped f o r a while by b e l i e v i n g the i n c a p a c i t a t i o n i s not as severe as i t seems). Lazarus (1985) suggests that only l a t e r w i l l the person come to terms with the r e a l i t y of the s i t u a t i o n and s t r u g g l e to cope in a more P-focused manner. P-focused s t r a t e g i e s i n c l u d e generating s o l u t i o n s to the problem, weighing the a l t e r n a t i v e s , and a c t i n g on the problem. P-focused coping i s t y p i c a l l y used 1 2 when s i t u a t i o n s are a p p r a i s e d as p o s s i b l e to change, and e m p i r i c a l r e s e a r c h suggests that P-focused s t r a t e g i e s are r e l a t e d to more e f f e c t i v e coping ( B i l l i n g s & Moos, 1981; F e l t o n & Revenson, 1984; F i n n , 1985; P e a r l i n & Schooler, 1978). The f o l l o w i n g s t u d i e s , although not without methodological problems pr o v i d e some support f o r the e f f e c t i v e n e s s of P-focused coping. For example, i n d i v i d u a l s s e l f - r e p o r t that they are l e s s s t r e s s e d when they r e l y more on P-focused than E-focused coping (Finn, 1985; Holahan & Moos, 1985). S t r e s s i n these s t u d i e s has been measured by a r e v i s e d form of S t r e s s f u l L i f e Events Scale (Dohrenwend & Dohrenwend, 1974), and psychosomatic symptoms and d e p r e s s i o n q u e s t i o n s adapted from work by Langner (1962). However, i t should not be assumed that P-focused coping i s always more e f f e c t i v e than E-focused c o p i n g . As mentioned e a r l i e r , both forms of coping are used i n most s t r e s s f u l s i t u a t i o n s and they tend to f a c i l i t a t e each other i n almost every coping episode (Folkman, Lazarus, Gruen, & DeLongis, 1986). B i l l i n g s and Moos (1981) found i n a survey study of 194 f a m i l i e s that fewer avoidance behaviors (E-focused) and more r e l i a n c e on a c t i v e attempts (P-focused) to deal with a s t r e s s f u l event were a s s o c i a t e d with l e s s s t r e s s . Respondents i n d i c a t e d a recent s t r e s s f u l event, then responded to 19 items a s k i n g how they d e a l t with the event. I n t e r e s t i n g l y , \ 1 3 i l l n e s s events e l i c i t e d more P-focused coping than d i d most other c a t e g o r i e s ( i . e . , work, home, and c h i l d r e n ) . T h i s i s c o n t r a r y to f i n d i n g s by Folkman and Lazarus (1980) i n an e m p i r i c a l study of 100 community r e s i d e n t s aged 45 to 65. These r e s e a r c h e r s found that h e a l t h c o n t e x t s favored E-focused coping while work contexts favored P-focused c o p i n g . P a r t i c i p a n t s i n t h i s study were in t e r v i e w e d seven times at 4-week i n t e r v a l s about s t r e s s f u l events that had occured d u r i n g the p r e v i o u s month. A 68-item Ways of Coping C h e c k l i s t (WCC) was used to i n d i c a t e which types of coping they used i n the s t r e s s f u l s i t u a t i o n . As mentioned above, work was a s s o c i a t e d with higher l e v e l s of P-focused coping. In a d d i t i o n , f a m i l y - r e l a t e d s t r e s s e s e l i c i t e d a mix of P-focused and E-focused coping and while E-focused coping was most frequent in h e a l t h - r e l a t e d episodes, P-focused coping was a l s o used i n these episodes. One weakness in both of the s t u d i e s appears to be the use of a b i n a r y response format which f a i l s to show the i n t e n s i t y of a s t r a t e g y and f o r c e s the i n d i v i d u a l to answer yes/no. A l s o , B i l l i n g s and Moos' study was s e l f - r e p o r t , c o r r e l a t i o n a l data c o l l e c t e d at a s i n g l e p o i n t i n time while Folkman and Lazarus' study focused on s p e c i f i c s t r e s s f u l episodes (1,332) on seven d i f f e r e n t o c c a s i o n s . T h e r e f o r e , while both s t u d i e s i d e n t i f i e d the types of responses made to v a r i o u s s t r e s s f u l events only Folkman and Lazarus' study 1 4 measured the frequency of responses over time. P e a r l i n and Schooler (1978) inter v i e w e d 2,300 people between the ages of 18 and 65. Data f o r t h e i r study were c o l l e c t e d through an i n t e r v i e w which asked p a r t i c i p a n t s t o : (a) i d e n t i f y p o t e n t i a l l i f e s t r a i n s ( c o n f l i c t s , t h r e a t s ) , (b) i d e n t i f y how they d e a l t with the s t r a i n s , and (c) express the extent to which they experienced a n x i e t y . P a r t i c i p a n t s i d e n t i f i e d s t r a i n s from the areas of marriage, p a r e n t i n g , home and o c c u p a t i o n . A t y p i c a l r o l e - r e l a t e d q u e s t i o n was, "With regard to your job how (bothered, worried, tense) do you f e e l ? " The r e s e a r c h e r s found that manipulation of goals was more e f f e c t i v e f o r work-related s t r e s s e s while having a v a r i e d r e p e r t o i r e was f a v o r a b l e f o r coping with m a r i t a l and p a r e n t a l s t r e s s o r s . More, s p e c i f i c a l l y , they found s e l f - r e l i a n c e and c o n t r o l l e d r e f l e c t i v e n e s s more e f f e c t i v e i n coping with m a r i t a l s t r a i n s while making p o s i t i v e comparisons was most h e l p f u l i n coping with p a r e n t a l s t r a i n s . In a d d i t i o n , i n the work area manipulation of goals ( i d e n t i f i e d as P-focused coping by B i l l i n g s & Moos, 1981) seemed to be the most e f f e c t i v e way of coping. One p o s s i b l e problem with the above study was the general nature of the q u e s t i o n s which tended to focus on the day-to-day f e e l i n g s of the i n d i v i d u a l s r e g a r d i n g t h e i r r o l e r a t h e r than a s p e c i f i c s t r e s s f u l event. A l s o , s u b j e c t s were asked how they u s u a l l y coped with 1 5 gener a l sources of s t r e s s not how they a c t u a l l y coped i n s p e c i f i c s i t u a t i o n s . In a d d i t i o n , women and men were compared on o c c u p a t i o n a l coping, yet, a l l of the women i n the study were from a lower socio-economic s t a t u s than the men. Ther e f o r e , i t i s d i f f i c u l t to g e n e r a l i z e from t h i s study to other p o p u l a t i o n s because s t u d i e s are f i n d i n g that i n d i v i d u a l s not only cope d i f f e r e n t l y a cross s i t u a t i o n s (Folkman & Lazarus, 1980) but a l s o that i n d i v i d u a l s from lower socio-economic s t a t u s may have l i m i t e d coping r e p e r t o i r e s due to t h e i r s i t u a t i o n ( B i l l i n g s & Moos, 1981). F i n d i n g s by F e l t o n and Revenson (1984) provide a d d i t i o n a l support f o r the e f f e c t i v e n e s s of P-focused s t r a t e g i e s . In a study of 151 middle-aged and ol d e r a d u l t s s u f f e r i n g from c h r o n i c i l l n e s s , i n f o r m a t i o n seeking was found to have s a l u b r i o u s e f f e c t s on adjustment while w i s h - f u l f i l l i n g f a n t a s i e s were l i n k e d to poorer adjustment. Using the WCC (Folkman & Lazarus, 1980) s u b j e c t s were asked how f r e q u e n t l y they had used each of the behaviors l i s t e d in r e l a t i o n to t h e i r c h r o n i c i l l n e s s . However, r a t h e r than f o c u s i n g on how the i n d i v i d u a l coped with a s p e c i f i c s t r e s s f u l encounter, s u b j e c t s were asked how they " g e n e r a l l y " coped. Asking t h i s q u e s t i o n may tend to s o l i c i t i n f o r m a t i o n about an i n d i v i d u a l ' s p e r s o n a l i t y d i s p o s i t i o n r a ther than f i n d i n g out what a c t u a l l y happened s i n c e there i s a poor c o r r e l a t i o n with what 1 6 people say they do and what they a c t u a l l y do (Folkman & Lazarus, 1980). In an e x p l o r a t o r y study of b a t t e r e d women (n = 56), Finn (1985) found that abused s u b j e c t s , compared to the general female p o p u l a t i o n , used p a s s i v e coping as opposed to problem-solving coping s t r a t e g i e s when d e a l i n g with s t r e s s f u l s i t u a t i o n s . Thus, the coping s t r a t e g i e s used by b a t t e r e d women were l e a s t l i k e l y to a l t e r t h e i r circumstances or r e s o l v e t h e i r s t r e s s e s . Subjects completed a 29-item F-Copes s c a l e developed by McCubbin, Larsen, and Olson (1982) to r e c o r d how they d e a l t with 10 commonly c i t e d spouse-abuse s t r e s s o r s . G e n e r a l i z i b i l i t y of t h i s study i s l i m i t e d to l o w e r - c l a s s b a t t e r e d women who u t i l i z e d a spouse-abuse s h e l t e r . In a d d i t i o n , the study focused on a l i m i t e d range of events to assess coping s t r a t e g i e s . Perhaps b a t t e r e d women only use E-focused coping in home s i t u a t i o n s . P a t t e r s o n and McCubbin (1984) reported that wives (n = 82) faced with the s t r e s s o r of long term ( m i l i t a r y ) s e p a r a t i o n from t h e i r husbands coped b e t t e r when they used a balanced coping s t r a t e g y which r e f l e c t e d a high usage of both P- and E-focused coping. In a d d i t i o n , the non-st r e s s e d women scored s i g n i f i c a n t l y higher than the s t r e s s e d women on acceptance of l i f e s t y l e and optimism. T h i s study suggests that e f f e c t i v e copers use a wide range of 1 7 P-focused and E-focused coping s t r a t e g i e s . The former broadly focused s t u d i e s have exp l o r e d how an i n d i v i d u a l copes i n major l i f e r o l e s ( i . e . , work, marriage, p a r e n t i n g and f i n a n c e ) . The f o l l o w i n g study focuses on a s p e c i f i c s t r e s s f u l encounter (midterm exam) and d e s c r i b e s how an i n d i v i d u a l copes throughout the encounter. Folkman and Lazarus (1985) s t u d i e d 108 students d u r i n g three stages of a midterm exam: (a) the a n t i c i p a t i o n stage before the exam, (b) the w a i t i n g stage a f t e r the exam before the grades were posted, and (c) a f t e r grades were posted. A 57-item form of WCC (Folkman & Lazarus, 1980) was used to r e c o r d how s u b j e c t s r e a c t e d i n each of the above s t r e s s f u l stages. The r e s e a r c h e r s found that 97% of the s u b j e c t s used both P-focused and E-focused forms of coping at each stage. However, P-focused coping was used most o f t e n at the a n t i c i p a t o r y stage, while E-focused coping ( d i s t a n c i n g ) was used most o f t e n at the w a i t i n g stage and a combination of P- and E-focused coping was used a f t e r the grades were posted. T h i s study r a i s e s i s s u e s concerning how E-focused coping may f a c i l i t a t e or impede P-focused c o p i n g . For example, emphazing the p o s i t i v e aspects of a s t r e s s f u l encounter may f a c i l i t a t e P-focused coping while se l f - b l a m e may impede P-focused coping (Lazarus & Folkman, 1984). Although Folkman and Lazarus' (1985) 18 study examines a s t r e s s f u l event as i t u n f o l d s , i t i s d i f f i c u l t to g e n e r a l i z e t h e i r f i n d i n g s to other s t r e s s f u l contexts because of the s p e c i f i c nature of the s i t u a t i o n . Folkman, Lazarus, Dunkel-Schetter, DeLongis, and Gruen's (1986) recent a r t i c l e adds f u r t h e r i n f o r m a t i o n on P-focused and E-focused coping. They i n t e r v i e w e d 75 married couples once a month over a 6-month p e r i o d . Subjects were asked to i d e n t i f y the most s t r e s s f u l encounter d u r i n g the past week and then to respond on a r e v i s e d 51-item WCC (Folkman & Lazarus, 1985). Part of the assessment was done i n t r a i n d i v i d u a l l y (comparing the same person with himself or h e r s e l f over 5 s t r e s s f u l e n c o u n t e r s ) . F i n d i n g s i n d i c a t e d that coping was d i f f e r e n t i a l l y r e l a t e d to s a t i s f a c t o r y and u n s a t i s f a c t o r y outcomes ( i . e . , f o r work s i t u a t i o n s s a t i s f a c t o r y outcome was c h a r a c t e r i z e d by higher l e v e l s of P-focused coping) and that coping s t r a t e g i e s vary depending on what i s at stake and on what op t i o n s the i n d i v i d u a l had for coping. I n t e r e s t i n g l y , s p e c i f i c combinations of P-focused coping and E-focused coping were i d e n t i f i e d . For example, i n d i v i d u a l s used a p l a n f u l p roblem-solving (P-focused) coping s t r a t e g y i n c o n j u n c t i o n with a s e l f - c o n t r o l (E-focused) coping s t r a t e g y f o r encounters i n v o l v i n g a goal at work more of t e n than other forms of coping. Furthermore, Folkman et a l . (1986b) sp e c u l a t e that emotional s e l f - c o n t r o l 19 may f a c i l i t a t e p r oblem-solving e s p e c i a l l y in the work s i t u a t i o n and that seemingly c o n t r a d i c t o r y coping s t r a t e g i e s can f a c i l i t a t e each other i n many coping s i t u a t i o n s . In summary, although P-focused and E-focused coping were used by a l l s u b j e c t s i n almost every s t r e s s f u l i n c i d e n t , i n d i v i d u a l s who used more P-focused coping appeared to be l e s s s t r e s s e d than those who r e l i e d on E-focused coping ( B i l l i n g s & Moos, 1981; F i n n , 1985; Lazarus & Folkman, 1984). P-focused coping appears to be used more f r e q u e n t l y i n work-related s i t u a t i o n s while E-focused coping seems more r e l e v a n t f o r h e a l t h - r e l a t e d s t r e s s o r s (Folkman & Lazarus, 1980; P e a r l i n & Schooler, 1978). I n t e r e s t i n g l y , P-focused coping may be f a c i l i t a t e d by E-focused coping (Folkman et a l . , 1986b) i n s t r e s s f u l s i t u a t i o n s . However, g e n e r a l i z a t i o n s are confounded as some s t u d i e s i d e n t i f y a s t r e s s f u l event or r o l e while others i d e n t i f y a s p e c i f i c s t r e s s f u l i n c i d e n t . Measurement of Coping The assessment of how an i n d i v i d u a l copes with s t r e s s poses one of the major problems in c u r r e n t r e s e a r c h . According to Folkman and Lazarus (1985), three c r i t e r i a must be s a t i s f i e d to study coping as a pr o c e s s : (a) a s p e c i f i c s t r e s s f u l encounter must be examined, (b) what the person a c t u a l l y d i d or thought i n the encounter must be d e s c r i b e d , and (c) continuous 20 assessments must be made durin g the encounter to examine changes over time. One of the most widely used i n v e n t o r i e s , WCC (Folkman & Lazarus, 1980) r e q u i r e s an i n d i v i d u a l to summarize a recent s t r e s s f u l event and respond to 68 statements that d e s c r i b e ways of d e a l i n g with the event. Researchers have used v a r i a t i o n s of t h i s i n v e n t o r y c r e a t i n g s u b c a t e g o r i e s w i t h i n the broader s t r a t e g i e s of P-focused and E-focused coping. Consequently, f i n d i n g s are sometimes d i f f i c u l t to i n t e r p r e t . For example, Folkman and Lazarus (1980) c l a s s i f y " t a l k e d to someone who c o u l d do something about the problem" as P-focused on a subscale while V i t a l i a n o et a l . (1985) c a t e g o r i z e s i t as s o c i a l support on a subsc a l e . Some r e s e a r c h e r s have f a c t o r analyzed the WCC and have found d i f f e r e n t s u b c a t e g o r i e s which may be due to using d i f f e r e n t p o p u l a t i o n s and s t r e s s o r s (Folkman & Lazarus, 1985; V i t a l i a n o et a l . , 1985). Another measurement issue concerns c o n s i s t e n c y of coping behavior. Some i n v e s t i g a t o r s have questioned the assumption that coping i s c o n s i s t e n t a c r o s s s i t u a t i o n s (Folkman & Lazarus, 1980). To date only a few s t u d i e s have examined c r o s s - s i t u a t i o n a l c o n s i s t e n c y . Stone and Neale (1984) report that people are r e l a t i v e l y c o n s i s t e n t i n the coping s t r a t e g i e s they use with the same problem on d i f f e r e n t o c c a s i o n s . In 21 the ir study 60 married couples completed a coping quest ionnaire over 21 days. The subjects described the most s t r e s s f u l event of the day and then rated on a scale of 1 to 100 how s t r e s s f u l the event was. In contrast , a study by Folkman and Lazarus (1985) supports the i r o r i g i n a l hypothesis that coping was more var iab le than stable when looking at how an i n d i v i d u a l copes with a spec i f i c event ( i . e . , a test) over three d i f f erent stages. It appears that by examining how people cope with an event as i t unfolds rather than as an i so la ted event, valuable information would be provided about consistency. Studying coping over a var ie ty of s i tuat ions would also help c l a r i f y whether those people who sh i f t from one strategy to another cope more e f f e c t i v e l y than those people who re ly on spec i f i c s trateg ies for most problems. In summary, a standard way to assess coping has not yet been found. Some studies ident i fy a s t r e s s f u l event ( i . e . , i l l n e s s ) and measure coping general ly , while others ident i fy a spec i f i c s t r e s s f u l event but do not measure the i n d i v i d u a l ' s coping s trateg ies over time. It seems that to measure coping e f f e c t i v e l y one would have to focus on a p a r t i c u l a r area (work, home, or i l l n e s s ) , then i so la te spec i f i c incidents and assess which s trategies are used to deal with the s t r e s s f u l events. Perhaps, then a pattern w i l l emerge, i f indeed ind iv idua l s do have coping patterns . Coping research 22 to date seems to be t r y i n g to encompass too many v a r i a b l e s i n too many d i f f e r e n t s i t u a t i o n s r a t h e r than f o c u s i n g on a s p e c i f i c area ( i . e . , work) and measuring the s t r a t e g i e s an i n d i v i d u a l uses a c r o s s w o r k - s i t u a t i o n s . Gender D i f f e r e n c e s i n Coping. In a d d i t i o n to measurement problems, r e s e a r c h e r s are f i n d i n g gender d i f f e r e n c e s i n copi n g . Folkman and Lazarus (1980), in a study of 100 middle-aged community r e s i d e n t s , found that men used more P-focused coping than women, but only at work and i n s i t u a t i o n s r e q u i r i n g acceptance. Women and men d i d not d i f f e r i n t h e i r use of E-focused coping. I n t e r e s t i n g l y , women had s i g n i f i c a n t l y higher scores than men on both P- and E-focused coping s c a l e s . P e a r l i n and Schooler's (1978) study support these f i n d i n g s and a l s o suggest that because the men in t h e i r study used more P-focused coping, they were more e f f e c t i v e copers than women. However, commonly c i t e d s t r e s s o r s f o r men were o c c u p a t i o n - r e l a t e d while p a r e n t i n g and m a r i t a l s t r e s s o r s were c i t e d by women. Furthermore, the respondents i n the study were asked how they u s u a l l y coped with general sources of s t r e s s not how they a c t u a l l y coped i n s p e c i f i c s i t u a t i o n s . To p r o p e r l y examine gender d i f f e r e n c e s i n work-related coping would r e q u i r e a sample of men and women from s i m i l a r jobs. Menaghan and Merves (1984) 2 3 suggest that female gender i s not a s s o c i a t e d with l e s s a daptive coping e f f o r t s . Data f o r t h e i r study was drawn from 1106 c i t y r e s i d e n t s (517 employed). P a r t i c i p a n t s were inter v i e w e d r e g a r d i n g source of o c c u p a t i o n a l s t r e s s ( i . e . , workload, d e p e r s o n a l i z a t i o n , inadequate b e n e f i t s , and noxious environment). The major coping f a c t o r s i d e n t i f i e d were: (a) d i r e c t a c t i o n , (b) o p t i m i s t i c comparison (comparing one's s i t u a t i o n to the past or to p e e r s ) , (c) s e l e c t i v e i n a t t e n t i o n ( f o c u s i n g only on p o s i t i v e work s i t u a t i o n s ) , and (d) conscious r e s t r i c t i o n of ex p e c t a t i o n s ( i . e . , focus on monetary awards). F i n d i n g s i n d i c a t e d that o p t i m i s t i c comparison was a s s o c i a t e d with r e d u c t i o n i n s t r e s s over time f o r both males and females. However, men were more l i k e l y to use r e s t r i c t i o n of e x p e c t a t i o n s r a t h e r than s e l e c t i v e i g n o r i n g . A d d i t i o n a l l y , men r e p o r t e d more work-related ( i . e . , overload) problems than women but d i d not d i f f e r i n experienced d e p e r s o n a l i z a t i o n at work. Women were more l i k e l y than men to use n e g o t i a t i o n , a s t r a t e g y a s s o c i a t e d with reduced s t r e s s . There was no evidence that coping e f f o r t s had d i f f e r e n t e f f e c t s f o r men and women. R e s u l t s c o u l d be m i s l e a d i n g as p a r t i c i p a n t s were asked how they handled sources of s t r e s s i n general r a t h e r than how they d e a l t with s p e c i f i c s i t u a t i o n s . 24 Stone and Neale (1984) s t u d i e d the coping responses of 60 married couples over a p e r i o d of 21 days. The s u b j e c t s were asked to d e s c r i b e the most s t r e s s f u l event of the day or an a n t i c i p a t e d f u t u r e s t r e s s f u l event and to i n d i c a t e which coping s t y l e they used or would use f o r each event. R e s u l t s i n d i c a t e d that men p r e f e r i n s t r u m e n t a l (P-focused) coping while women p r e f e r E-focused c o p i n g . However, i t should be noted that the magnitude of the coping d i f f e r e n c e s was small and s t a t i s t i c a l s i g n i f i c a n c e i n t h i s study may have been due to the l a r g e number of problems analyzed (over 2,000 f o r each coping s t r a t e g y ) . Another weakness i n the study concerns a s k i n g the i n d i v i d u a l to a n t i c i p a t e how they w i l l cope, which c o u l d be co n s i d e r e d a t r a i t measure and as such g i v e s l i t t l e i n f o r m a t i o n on how the i n d i v i d u a l d i d cope. Astor-Dubin and Hammen (1984) found that women u t i l i z e d both b e h a v i o r a l and c o g n i t i v e s t r a t e g i e s while men used mostly c o g n i t i v e s t r a t e g i e s f o r d e a l i n g with s t r e s s f u l l i f e encounters. S u b j e c t s were s t r e s s e d c o l l e g e students (n = 170) who completed a q u e s t i o n n a i r e l i s t i n g at l e a s t one s t r e s s f u l event. Perhaps, d i f f e r e n t coping p a t t e r n s would have emerged i f the s u b j e c t s were s t u d i e d over time. In summary, from the s t u d i e s reviewed (Folkman & Lazarus, 1980; Menaghan & Merves, 1984; P e a r l i n & Schooler, 1978; Stone & Neale, 1984), there i s some 25 support f o r gender d i f f e r e n c e s i n coping. However, the only c o n s i s t e n t f i n d i n g i s that women use more P-focused and E-focused coping than men i n most s i t u a t i o n s . A d d i t i o n a l l y , study designs have f a i l e d to match men and women on m a r i t a l s t a t u s , o c c u p a t i o n a l s t a t u s , and socio-economic s t a t u s yet they are oft e n compared to each other based on these c a t e g o r i e s . Stress-Management Treatment Packages—Outcome Research T r a d i t i o n a l treatments f o r coping with s t r e s s have i n v o l v e d b e h a v i o r a l techniques such as r e l a x a t i o n and med i t a t i o n , and more r e c e n t l y , c o g n i t i v e techniques such as s t r e s s i n o c u l a t i o n and thought stopping (Woolfolk & Lehrer, 1984). A promising i n t e r v e n t i o n , p h y s i c a l a c t i v i t y , has a l s o been used as a treatment fo r stress-management (Long, 1984). Kazdin and Wilson (1978) propose that the comparison of two treatment packages i s c o n s i d e r e d v i a b l e f o r outcome re s e a r c h when the primary commitment i s to d i s c o v e r a treatment to accommodate a c l i n i c a l problem. In a d d i t i o n , the use of d i f f e r e n t a c t i v e treatments i n c r e a s e s the l i k e l i h o o d that c r e d i b i l i t y and expectancy w i l l be s i m i l a r across groups, yet may allow c o n c l u s i o n s about d i f f e r e n t a c t i v e i n g r e d i e n t s (Kazdin, 1980). Since P r o g r e s s i v e R e l a x a t i o n (PR) programs have been shown to be e f f e c t i v e i n reducing t r a i t and s t a t e a n x i e t y , changing mood, and i n c r e a s i n g the a b i l i t y to r e l a x f o r a wide v a r i e t y of problems and 26 people ( C a n g e l o s i , 1980; H e i d i & Borkovec, 1983; Wood, 1978; Woolfolk et a l . , 1982), in t h i s study i t w i l l be used as a standard with which to compare a l e s s w e l l e s t a b l i s h e d treatment (aerobic e x e r c i s e ) as a stress-management i n t e r v e n t i o n . E x e r c i s e I n t e r v e n t i o n s The p s y c h o l o g i c a l and p h y s i c a l b e n e f i t s of a e r o b i c e x e r c i s e have been widely accepted ( f o r reviews see Astrand & Rodahl, 1977; E i d e , 1982; F o l k i n s & Sime, 1981; Ledwidge, 1980; Mihevic, 1982). An e a r l y study by d e V r i e s (1968) l i n k e d both the p h y s i c a l and p s y c h 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 . d e V r i e s found e x e r c i s e to be a n a t u r a l muscle r e l a x a n t because i t reduces the e l e c t r i c a l a c t i v i t y i n the muscle and t h i s feedback may allow the i n d i v i d u a l to r a t e h i m s e l f or h e r s e l f as l e s s anxious. Evidence to support t h i s n o t i o n was found in a comparison of meprobamate, a t r a n q u i l i z e r , and e x e r c i s e i n a c o n t r o l l e d r e s e a r c h study. No s i g n i f i c a n t d i f f e r e n c e s were found among groups using meprobamate, a placebo group ( p i l l ) , or a c o n t r o l group ( s i t t i n g r e a d i n g ) . However, the e x e r c i s e group showed lower b o d i l y t e n s i o n as measured by EMG. In recent years r e s e a r c h e r s have suggested that a e r o b i c t r a i n i n g programs 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 i n p r e d i c t e d d i r e c t i o n s (e.g., Morgan, 1981; Young & I s m a i l , 1976). S e v e r a l i n v e s t i g a t o r s suggest that v i g o r o u s e x e r c i s e , u s u a l l y 27 jogging or walking, 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 in s e l f - r e p o r t e d a n x i e t y ( H i l y e r & M i t c h e l l , 1979; Long, 1984). In a d d i t i o n , evidence i s accumulating that e x e r c i s e may play an important r o l e i n s t r e s s r e d u c t i o n i n both c l i n i c a l and n o n - c l i n i c a l p o p u l a t i o n s . However, s u b j e c t s from both p o p u l a t i o n s tend to be sedentary i n d i v i d u a l s (Doyne et a l . , 1983; F o l k i n s et a l . , 1972; H i l y e r & M i t c h e l l , 1979; Young & I s m a i l , 1976). The f o l l o w i n g s t u d i e s are reviewed as support f o r the p o t e n t i a l t h e r a p e u t i c e f f e c t s of a e r o b i c e x e r c i s e as a stress-management i n t e r v e n t i o n . Reduced a n x i e t y , enhanced s e l f - e f f i c a c y and l e a r n i n g new coping s t r a t e g i e s are important outcomes that may account f o r e x e r c i s e as an e f f e c t i v e stress-management i n t e r v e n t i o n (Jasnoski & Holmes, 1981; Long, 1984). According to Lazarus and Folkman (1984) e x e r c i s e i s an E-focused coping s t r a t e g y because i t reduces p h y s i o l o g i c a l a r o u s a l . Thus an i n d i v i d u a l p e r c e i v e s h i m s e l f / h e r s e l f as l e s s anxious. E x e r c i s e was used as a stress-management i n t e r v e n t i o n i n a c o n t r o l l e d experiment by J a s n o s k i and Holmes (1981) who assessed 103 undergraduate women aged 17 to 31 before and a f t e r they p a r t i c i p a t e d i n a 15-week a e r o b i c t r a i n i n g program. The measures used were p e r s o n a l i t y t e s t s and Cooper's 12-minute run (Cooper, 1968). F i n d i n g s i n d i c a t e d that i n i t i a l l e v e l s of a e r o b i c f i t n e s s (as measured by 12-minute walk/run), 28 p a r t i c i p a t i o n in an a e r o b i c program per se, and changes i n a e r o b i c f i t n e s s were r e l a t e d to more p o s i t i v e p e r s o n a l i t y f u n c t i o n i n g . S p e c i f i c a l l y , (a) i n i t i a l l e v e l s of f i t n e s s were r e l a t e d to s e l f - a s s u r a n c e and g r e a t e r emotional s t a b i l i t y , (b) p a r t i c i p a t i o n per se was r e l a t e d to s e l f - a s s u r a n c e and i n c r e a s e d easy-goingness, and (c) improvements in f i t n e s s were r e l a t e d to i n c r e a s e d s e l f - a s s u r a n c e and decreased t e n s i o n . Since the s u b j e c t s were normal c o l l e g e students few changes on these p e r s o n a l i t y measures c o u l d be expected (e.g., c l i n i c a l d e p r e s s i o n ) . Another problem with t h i s study was lack of a comparison group and f a i l u r e to a s c e r t a i n i f the s u b j e c t s were anxious p r i o r to the program. A l s o , an improvement of 10% in the 12-minute walk/run c o u l d be c o n s i d e r e d a p r a c t i c e e f f e c t r a t h e r than a t r a i n i n g e f f e c t . I t would have been i n t e r e s t i n g to compare the r e s u l t s at posttreatment to a follow-up s e s s i o n to see i f the changes in p s y c h o l o g i c a l v a r i a b l e s were maintained over time, an important c o n s i d e r a t i o n f o r any i n t e r v e n t i o n . A c o n t r o l l e d study by Long (1984) found that s u b j e c t s reduced a n x i e t y and i n c r e a s e d s e l f - e f f i c a c y as the r e s u l t of an e x e r c i s e i n t e r v e n t i o n . Seventy-two c h r o n i c a l l y s t r e s s e d female (n = 48) and male (n = 25) community r e s i d e n t s aged 24 to 65 were randomly as s i g n e d to a 10-week e x e r c i s e i n t e r v e n t i o n or a c o g n i t i v e therapy ( s t r e s s i n o c u l a t i o n ) . R e s u l t s 29 i n d i c a t e d that treatment groups 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 and reduced s t a t e and t r a i t a n x i e t y compared to a w a i t l i s t group. In a d d i t i o n , continued r e p o r t s of l e s s a n x i e t y and i n c r e a s e d s e l f - e f f i c a c y were maintained at 15-month follow-up (Long, 1985). Furthermore, i t was concluded that p a r t i c i p a t i o n i n an a e r o b i c e x e r c i s e (walk/jog) program was a v i a b l e a l t e r n a t i v e to s t r e s s i n o c u l a t i o n as a stress-management treatment. T h i s r e s e a r c h i s one of the few m e t h o d o l o g i c a l l y sound e m p i r i c a l s t u d i e s on e x e r c i s e as a treatment. I n t e r e s t i n g l y , J a s n o s k i et a l . (1981) assessed whether p h y s i c a l f i t n e s s or merely p a r t i c i p a t i o n i n an endurance program mediates p s y c h o l o g i c a l change. These r e s e a r c h e r s compared women (n = 20) i n a 10-week ae r o b i c e x e r c i s e c l a s s with a w a i t l i s t c o n t r o l (n = 8) and an independent c o n t r o l c o n d i t i o n (n = 11). F i n d i n g s i n d i c a t e that p a r t i c i p a t i o n per se improved scores in s e l f - p e r c e i v e d a b i l i t i e s ( s e i f - e f f i c a c y ) i n r e l a t i o n to jogging as w e l l as s e l f - c o n f i d e n c e compared to the c o n t r o l groups. However, one t h r e a t to the i n t e r n a l v a l i d i t y of t h i s study was the lack of random assignment to the three groups. S i g n i f i c a n t d i f f e r e n c e s between i n d i v i d u a l s who choose to e x e r c i s e , as compared to those who are a s s i g n e d to e x e r c i s e , may e x i s t that could account f o r the b e n e f i t s e x e r c i s e r s r e c e i v e from such a c t i v i t y . Thus, although t h i s study 30 has methodological problems there appears to be support f o r e x e r c i s e p a r t i c i p a t i o n per se as a v i a b l e stress-management i n t e r v e n t i o n f o r sedentary women. In a d d i t i o n to the n o n - c l i n i c a l s t u d i e s reviewed above a growing body of l i t e r a t u r e i s accumulating to a t t e s t to the e f f i c a c y of e x e r c i s e treatment f o r depr e s s i o n ( f o r a review see Simons, E p s t e i n , McGowan, Kupfer, & Robertson, 1985). Although depression i s not a t o p i c f o r t h i s paper, one c o n t r o l l e d study s u p p o r t i n g p a r t i c i p a t i o n per se i n an e x e r c i s e program w i l l be examined. McCann and Holmes (1984) t e s t e d the e f f e c t s of a e r o b i c e x e r c i s e , a placebo group ( r e l a x a t i o n i n s t r u c t i o n s ) , and a no-treatment c o n t r o l group on a sample of 43 c o l l e g e women. Subjects were s e l e c t e d on the b a s i s of extreme scores compared to other c o l l e g e students on the Beck Depression inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). In a d d i t i o n , a l l s u b j e c t s completed Cooper's 12-minute walk/run f i t n e s s t e s t before the 10-week treatment. R e s u l t s i n d i c a t e d that the e x e r c i s e group showed a s i g n i f i c a n t improvement i n dep r e s s i o n compared to the placebo and no-treatment group. Since expectancy was s i m i l a r f o r a l l groups and s i n c e the su b j e c t s showed improvements in dep r e s s i o n a f t e r 5-weeks i n t o the program, i t was suggested that change was due to p a r t i c i p a t i o n per se rather than the c o n d i t i o n i n g e f f e c t . One problem with t h i s study 31 concerns g e n e r a l i z a t i o n of r e s u l t s from perhaps l e s s depressed c o l l e g e students to a depressed p o p u l a t i o n i n a c l i n i c a l s e t t i n g . In summary, p a r t i c i p a t i o n i n an e x e r c i s e program i s r e l a t e d to r e d u c t i o n s i n a n x i e t y and i n c r e a s e s i n s e l f - e f f i c a c y . However, most s t u d i e s s u f f e r from design problems. For example, t h r e a t s to i n t e r n a l v a l i d i t y i n c l u d e : (a) f a i l u r e to randomly a s s i g n s u b j e c t s to groups, (b) f a i l u r e to use a comparison group or a c o n t r o l group, and (c) f a i l u r e to use a p p r o p r i a t e measuring instruments ( i . e . , using c l i n i c a l instruments to measure a n o n - c l i n i c a l p o p u l a t i o n ) . Threats to e x t e r n a l v a l i d i t y i n c l u d e : (a) g e n e r a l i z a t i o n of treatment ( i . e . , t r e a t i n g non-anxious s u b j e c t s and g e n e r a l i z i n g to an anxious p o p u l a t i o n ) , and (b) using u n i v e r s i t y s u b j e c t s (e.g., g e n e r a l i z i n g to c l i n i c a l p a t i e n t s ) . In a d d i t i o n , although the use of follow-up assessments to determine maintenance of behaviors i s recognized as e s s e n t i a l f o r an e f f e c t i v e treatment few s t u d i e s use follow-up procedures. P r o g r e s s i v e R e l a x a t i o n P r o g r e s s i v e R e l a x a t i o n (PR) was developed by Edmond Jacobson, a p h y s i o l o g i s t , i n 1938. The purpose of PR i s to r i d the body of r e s i d u a l t e n s i o n , which i s l e f t over t e n s i o n a f t e r an u n t r a i n e d person t r i e s to r e l a x . According to Lazarus and Folkman (1984), PR would be c o n s i d e r e d an E-focused coping s t r a t e g y as i t 32 reduces p h y s i o l o g i c a l response (muscle t e n s i o n ) and an i n d i v i d u a l p e r c e i v e s h i m s e l f / h e r s e l f as l e s s anxious. PR t r a i n i n g c o n s i s t s of l e a r n i n g to tense and r e l a x v a r i o u s muscle groups throughout the body while at the same time paying c l o s e a t t e n t i o n to the f e e l i n g s a s s o c i a t e d with both t e n s i o n and r e l a x a t i o n . T h i s technique f o r r e l a x i n g i s c a l l e d PR because each of the major muscle groups i s r e l a x e d one a f t e r the other and as a new group i s added a person s i m u l t a n e o u s l y r e l a x e s the other p a r t s u n t i l t o t a l body r e l a x a t i o n i s achieved. Numerous s t u d i e s have examined the e f f e c t s of PR on the r e d u c t i o n of a n x i e t y ( f o r reviews see B a r r i o s & Shigetomi, 1979; Borkovec & Sid e s , 1979; Lehrer & Woolfolk, 1984). Evidence s u p p o r t i n g the use of PR as a t h e r a p e u t i c technique f o r t e n s i o n r e d u c t i o n comes from areas such as h e a l t h behavior, f o r example t e n s i o n headaches (Blanchard, Andrasik, & S i l v e r , 1980), hyp e r t e n s i o n (Redmond, Gay l o r , McDonald, St Shapiro, 1974), and insomnia (Borkovec & Fowles, 1973; Turner & Ascher, 1979). A d d i t i o n a l l y , r e s e a r c h f i n d i n g s i n d i c a t e that PR i s an e f f e c t i v e treatment f o r phobias ( f o r reviews see Borkovec & O ' B r i e n , 1976; Mathews, 1978), and t e s t a n x i e t y (Reed & Saslow, 1980). Furthermore, i n r e l a t i o n to ge n e r a l a n x i e t y , f i n d i n g s i n d i c a t e that PR i s s u p e r i o r or equal to other t h e r a p e u t i c techniques when the r e s e a r c h design 33 i n c l u d e s s t r e s s e d s u b j e c t s and random assignment (Gross & Fremouw, 1982; Woolfolk et a l . , 1982). Since the a b i l i t y to use r e l a x a t i o n i n a s t r e s s f u l s i t u a t i o n o u t s i d e of the t r a i n i n g s e s s i o n i s the most v i t a l t e s t for any therapy, two s t u d i e s that have measured the g e n e r a l i z e d e f f e c t s of t r a i n i n g w i l l be reviewed. Woolfolk et a l . (1982) found PR and m e d i t a t i o n e q u a l l y e f f e c t i v e in a m e l i o r a t i n g symptoms of d a i l y s t r e s s f o r 34 s t r e s s e d community r e s i d e n t s . S u b j e c t s were randomly assigned to PR, m e d i t a t i o n , and a s e l f - m o n i t o r i n g c o n t r o l . Both treatment groups showed s i g n i f i c a n t improvements on a n x i e t y , somatic a r o u s a l , and were calmer than c o n t r o l s u b j e c t s . These gains were e i t h e r maintained or enhanced at 6-month follow-up. S i m i l a r i l y , PR and C o g n i t i v e R e s t r u c t u r i n g treatments both showed decreased a n x i e t y compared to a w a i t l i s t c o n t r o l group (Gross & Fremouw, 1982) f o r 63 speech-anxious undergraduates who were randomly assigned to each group. Treatment groups met f o r 5 hours and outcome measures were overt behavior (video-tape of speech), s t a t e a n x i e t y , f e a r , s o c i a l a n x i e t y , and heart r a t e . I n t e r e s t i n g l y , both treatment groups improved on the s e l f - r e p o r t measures compared to a w a i t l i s t group but 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 d i d not d i s c r i m i n a t e between the t r e a t e d and untreated groups. 34 Consequently, because PR i s a w e l l - r e s e a r c h e d treatment f o r reducing a n x i e t y i n t h i s study i t i s c o n s i d e r e d a standard stress-management technique with which to compare an a e r o b i c e x e r c i s e program. In a d d i t i o n to reducing a n x i e t y , i n d i v i d u a l s a l s o appear to improve t h e i r s e l f - e f f i c a c y as a r e s u l t of stress-management programs. The concept of s e l f - e f f i c a c y w i l l be d i s c u s s e d in the next s e c t i o n . S e l f - e f f i c a c y Theory Bandura's S o c i a l Learning Theory (Bandura, 1977) attempts to p r e d i c t and e x p l a i n behavior change using the concepts of s e l f - e f f i c a c y and outcome e x p e c t a t i o n s . S e l f - e f f i c a c y e x p e c t a t i o n s are d e f i n e d as c o n v i c t i o n s that one can s u c c e s s f u l l y execute behaviors that w i l l l e a d to s u c c e s s f u l coping while outcome e x p e c t a t i o n s are d e f i n e d as an i n d i v i d u a l ' s estimate that a given behavior w i l l l e a d to a c e r t a i n outcome (Bandura, 1977). Both e f f i c a c y and outcome e x p e c t a t i o n s r e f l e c t a person's b e l i e f about c a p a b i l i t i e s and b e h a v i o r s . S e l f - e f f i c a c y e x p e c t a t i o n s are c o n s i d e r e d to a f f e c t both the i n i t i a t i o n and p e r s i s t e n c e of coping behavior as w e l l as people's emotional r e a c t i o n s such as a n x i e t y or d i s t r e s s and thought p a t t e r n s ( S t r e c h e r , D e V e l l i s , Becker, & Rosenstock, 1986). Thus, i n d i v i d u a l s with high l e v e l s of s e l f - e f f i c a c y about a p a r t i c u l a r task w i l l be l e s s anxious and more c o n f i d e n t i n performing the task than those low i n s e l f - e f f i c a c y . 35 S e l f - e f f i c a c y theory p r e d i c t s that performance based treatments w i l l not only l e a d to higher l e v e l s of p e r c e i v e d s e i f - e f f i c a c y , but may a l s o l e a d to more g e n e r a l i z e d e x p e c t a t i o n s of s e l f - e f f i c a c y . Stress-management i n t e r v e n t i o n s have been shown to i n c r e a s e an i n d i v i d u a l ' s s e l f - e f f i c a c y . For example, Long (1984) found that c h r o n i c a l l y s t r e s s e d community r e s i d e n t s (N = 73) s i g n i f i c a n t l y i n c r e a s e d t h e i r g e n e r a l s e l f - e f f i c a c y a f t e r a 10-week a e r o b i c e x e r c i s e i n t e r v e n t i o n or a c o g n i t i v e therapy. S i m i l a r i l y , Ewart, T a y l o r , Reese, and Debusk (1983) s t u d i e d 40 men aged 52 to 59 a f t e r a myocardial i n f a c t i o n and found that s u b j e c t s improved t h e i r s e l f - e f f i c a c y a f t e r a t r e a d m i l l t e s t and a c o u n s e l l i n g s e s s i o n . The s u b j e c t s who performed b e t t e r on the t r e a d m i l l t e s t showed gr e a t e r i n c r e a s e s i n s e l f - e f f i c a c y than s u b j e c t s who performed p o o r l y . The c o u n s e l l i n g s e s s i o n not only i n c r e a s e d s p e c i f i c e x e r c i s e s e l f - e f f i c a c y but i n c r e a s e d more general s e l f - e f f i c a c y (e.g., e f f i c a c y r e g a r d i n g sexual a c t i v i t y ) . From these examples i t appears that changes in behavior ( i . e . , a e r o b i c e x e r c i s e and p r o g r e s s i v e r e l a x a t i o n ) may be mediated by changes in p e r c e i v e d s e l f - e f f i c a c y . S e l f - e f f i c a c y e x p e c t a t i o n s not only i n c r e a s e as the r e s u l t of an i n t e r v e n t i o n (as shown above) but have been found to be more ac c u r a t e p r e d i c t o r s of performance than outcome e x p e c t a t i o n s (Bandura, 1977; 36 Lee, 1982, 1984). Since there are few, i f any, w e l l - r e s e a r c h e d s t u d i e s on p r o g r e s s i v e r e l a x a t i o n and a e r o b i c e x e r c i s e i n v e s t i g a t i n g s e l f - e f f i c a c y as a p r e d i c t o r v a r i a b l e of behavior, evidence s u p p o r t i n g t h i s theory w i l l be explored i n research on smoking c e s s a t i o n (Condiotte & L i c h t e n s t e i n , 1981), o b e s i t y treatments ( M i t c h e l l & S t u a r t , 1984), and an e x e r c i s e treatment (Kaplan et a l . , 1984). Cond i o t t e and L i c h t e n s t e i n (1981) assessed 78 c i g a r e t t e smokers aged 16 to 70 who p a r t i c i p a t e d i n smoking c e s s a t i o n programs. Measures used were: (a) a s e l f - m o n i t o r i n g d i a r y , (b) a s p e c i f i c s e l f - e f f i c a c y smoking q u e s t i o n n a i r e , (c) an informant's r e p o r t , and (d) a mood s t a t e s assessment. Both groups ( i n d i v i d u a l / g r o u p treatments) s i g n i f i c a n t l y enhanced p e r c e i v e d s e l f - e f f i c a c y . Furthermore, higher l e v e l s of pe r c e i v e d s e l f - e f f i c a c y at posttreatment were s t r o n g l y r e l a t e d to longer p e r i o d s of abstinence a f t e r the treatment and at 6-month follow-up. However, s u b j e c t s were not randomly a s s i g n e d and one treatment used i n d i v i d u a l programs while group programs were used f o r the o t h e r . Although e x p e c t a n c i e s f o r the groups were s i m i l a r even though the i n t e r v e n t i o n s t r a t e g i e s v a r i e d , i t i s d i f f i c u l t to g e n e r a l i z e from i n d i v i d u a l to group treatment. A l s o , the s t a t i s t i c a l a n a l y s i s f o r t h i s study used many i n d i v i d u a l t - t e s t s . 37 M i t c h e l l and S t u a r t (1984) found (414 female Weight Watcher members aged 20 to 65) that dropouts (n = 101) were more l i k e l y than s t a y e r s to r e p o r t low s e l f - e f f i c a c y at p r e t e s t . I n t e r e s t i n g l y , p e r c e i v e d success r a t h e r than a c t u a l success seemed to be r e l a t e d to p r e d i c t i n g who would drop out (both groups l o s t the same amount of weight). T h i s i s congruent with Bandura's (1977) theory that success i n a treatment does not always produce strong e x p e c t a t i o n s of s e l f - e f f i c a c y because sometimes i n d i v i d u a l s f a i l to p e r c e i v e themselves as s u c c e s s f u l , perhaps due to repeated p r e v i o u s f a i l u r e . In a d d i t i o n , s i n c e Weight Watchers' treatments are very b e h a v i o r a l l y o r i e n t e d , perhaps too l i t t l e a t t e n t i o n i s being p a i d to i n c r e a s i n g the p a r t i c i p a n t s s e l f - p e r c e p t i o n of success. Kaplan et a l . (1984) found that a s p e c i f i c s e l f - e x p e c t a n c y f o r walking was p o s i t i v e l y c o r r e l a t e d with adhering to a r e g u l a r walking program f o r 60 o l d e r a d u l t s with Chronic O b s t r u c t i v e Pulmonary D i s e a s e . In t h i s study s u b j e c t s were randomly a s s i g n e d to treatments of behavior m o d i f i c a t i o n , c o g n i t i v e m o d i f i c a t i o n , c o g n i t i v e - b e h a v i o r a l m o d i f i c a t i o n or an a t t e n t i o n - c o n t r o l group. A l l were given i n d i v i d u a l e x e r c i s e p r e s c r i p t i o n s p r i o r to the group meetings. At 3-month follow-up the treatment groups i n c r e a s e d t h e i r a c t i v i t y l e v e l and t h e i r s p e c i f i c walking s e l f - e f f i c a c y . The r e s e a r c h e r s a l s o suggested that 38 s p e c i f i c r a t h e r that g e n e r a l i z e d expectancies mediate behavior changes. However, t h i s i s c o n t r a r y to Bandura's (1977) t h e o r e t i c a l n o t i o n that expectancies of p e r s o n a l mastery are l i k e l y to g e n e r a l i z e once they are i n i t i a t e d . Furthermore, s i n c e e n a c t i v e treatments present the most i n f l u e n t i a l source of i n f o r m a t i o n (Bandura, 1977), they not only l e a d to higher l e v e l s of p e r c e i v e d s e l f - e f f i c a c y but perhaps to more g e n e r a l i z e d e x p e c t a t i o n s of p e r s o n a l s e l f - e f f i c a c y . T h e r e f o r e , high l e v e l s of s e l f - e f f i c a c y , once e s t a b l i s h e d , are thought to g e n e r a l i z e to other s t r e s s f u l s i t u a t i o n s (Ewart et a l . , 1984). In summary, from the s t u d i e s reviewed i t appears that changes in s e l f - e f f i c a c y are a s s o c i a t e d with b e h a v i o r a l change (Condiotte & L i c h t e n s t e i n , 1982; Ewart et a l . , 1983). A d d i t i o n a l l y , r e s e a r c h e r s have shown that s e l f - e f f i c a c y can be enhanced as the r e s u l t of an i n t e r v e n t i o n and may be an e f f e c t i v e p r e d i c t o r v a r i a b l e f o r adherence to an i n t e r v e n t i o n . More s p e c i f i c a l l y , Bandura's (1978) c o n c e p t u a l i z a t i o n of s e l f - e f f i c a c y would suggest that the l e v e l of s e l f - e f f i c a c y i s r e l a t e d to p e r s i s t e n c e i n b e h a v i o r a l f u n c t i o n i n g and that as a r e s u l t of a change in p e r c e i v e d s e l f - e f f i c a c y i t may be p o s s i b l e that behavior (e.g., p a r t i c i p a t i o n i n e x e r c i s e ) w i l l p e r s i s t . 39 Adherence to E x e r c i s e Programs Current r e s e a r c h suggests that the m a j o r i t y of people who s t a r t an e x e r c i s e program w i l l stop w i t h i n the f i r s t few months (Dishman, 1982; Martin & Dubbert, 1985). According to Dishman (1982), v a r i a b l e s that have been found to e f f e c t e x e r c i s e p a t i c i p a t i o n and e x e r c i s e adherence i n c l u d e p s y c h o l o g i c a l f a c t o r s such as s e i f - e f f i c a c y . However, for the p h y s i c a l b e n e f i t s of e x e r c i s e to accrue, from even low l e v e l s of a c t i v i t y , e x e r c i s e must be performed on a r e g u l a r b a s i s at l e a s t three times a week (American C o l l e g e of Sports Medicine, 1980). According to the r e s e a r c h reviewed i t appears that i n d i v i d u a l s who score higher i n s e l f - e f f i c a c y w i l l p e r s i s t longer at a task. Perhaps, improvement i n s e l f - e f f i c a c y d u r i n g a stress-management i n t e r v e n t i o n w i l l not only l e a d to a new coping s t r a t e g y but to g r e a t e r adherence to an e x e r c i s e program. Summary In summary, evidence has been presented to support: (a) Folkman and Lazarus' (1980) theory that there are two b a s i c f u n c t i o n s of coping--P-focused and E-focused (Lazarus & Folkman, 1984; Moos & B i l l i n g s , 1982), (b) that P-focused coping i s a s s o c i a t e d with lower l e v e l s of s t r e s s ( B i l l i n g s & Moos, 1981; F i n n , 1985), (c) that women compared to men use more P-focused and E-focused coping i n most s t r e s s f u l 40 s i t u a t i o n s (Astor-Dubin & Hammen, 1984; Folkman & Lazarus, 1980), and (d) that measurement of coping has not yet been s t a n d a r d i z e d (Lazarus & Folkman, 1984; V i t a l i a n o et a l . , 1985). With regard to stress-management i n t e r v e n t i o n s , a e r o b i c e x e r c i s e has been shown to decrease a n x i e t y and i n c r e a s e s e l f - e f f i c a c y (Ewart et a l . , 1983; Long, 1984). A d d i t i o n a l l y , s e l f - e f f i c a c y has been found to c o r r e l a t e with adherence to an e n a c t i v e treatment (Condiotte & L i c h t e n s t e i n , 1981; Kaplan et a l . , 1984). 41 Method Subjects The s u b j e c t s were s o l i c i t e d v i a p o s t e r s and a r t i c l e s i n l o c a l newspapers o f f e r i n g working women r e l a x a t i o n or e x e r c i s e stress-management programs. Of the 150 respondents 83 were p e r s o n a l l y i n t e r v i e w e d f o l l o w i n g telephone s c r e e n i n g (see Appendix A f o r telephone s c r e e n i n g and i n t e r v i e w forms) and 72 were accepted f o r the program a f t e r meeting the f o l l o w i n g c r i t e r i a : (a) the women were ab l e to i d e n t i f y at l e a s t two work-related s t r e s s o r s , (b) they scored 5 or above on Walk's (1956) Tension Thermometer, (c) they were e x e r c i s i n g l e s s than 3 times per week f o r l e s s than 30 minutes d u r i n g the past 3 months, (d) they were m e d i c a l l y f i t to p a r t i c i p a t e in the walk/jog program as screened by Par Q (Chisholm, C o l l i n s , Kulak, Davenport, & Gruber, 1975), and (e) they were w i l l i n g to be randomly assi g n e d to e i t h e r program. In a d d i t i o n , a l l p a r t i c i p a n t s were asked to pay a nominal fee ($15.00). Fees were waived f o r s u b j e c t s who cou l d not a f f o r d the fee (n = 3). See Appendix B f o r the Par Q and Tension Thermometer. The p a r t i c i p a n t s were working women, aged 24 to 59 (M = 39.8, SD = 9.6). T h i r t y - t h r e e percent were married, 33% were s i n g l e and the remaining 34% were widowed, separated, or d i v o r c e d . S i x t y - f o u r percent of the p a r t i c i p a n t s had a u n i v e r s i t y education and 36% had 42 a c o l l e g e or high school e d u c a t i o n . A summary of subject c h a r a c t e r i s t i c s i s presented i n Table 1 . At p r e t e s t the most frequent work-related s t r e s s o r s were a demanding workload (54.6%), and i n t e r p e r s o n a l c o n f l i c t (41.0%). Appendix C c o n t a i n s examples of p e r c e i v e d s t r e s s o r s . Although 72 respondents met the requirements f o r the study and completed the q u e s t i o n n a i r e s at the i n i t i a l i n t e r v i e w , 11 s u b j e c t s d i d not a t t e n d the f i r s t treatment s e s s i o n . Reasons f o r not a t t e n d i n g i n c l u d e d not having time (n=7) or they had a l r e a d y i n i t i a t e d an e x e r c i s e program (n=4), thereby reducing the number of s u b j e c t s to 61 ( E x e r c i s e n=31, R e l a x a t i o n n =30). Design and Procedures. A l l s u b j e c t s were screened through a p e r s o n a l i n t e r v i e w h e l d at the U n i v e r s i t y of B r i t i s h Columbia. A f t e r s i g n i n g an informed consent the f o l l o w i n g q u e s t i o n n a i r e s were admin i s t e r e d : Tension Thermometer, WCC, Par Q, 7-Day R e c a l l . The r e s e a r c h e r d i d not know u n t i l the l a s t 5 minutes of the i n t e r v i e w to which treatment the subject was assigned, at that time a randomly chosen envelope was opened c o n t a i n i n g a form i n d i c a t i n g group assignment. The s u b j e c t s were then t o l d the date, time and p l a c e of the f i r s t group meeting. P r i o r to the beginning of the f i r s t s e s s i o n , the STAI-T and General S e l f - e f f i c a c y Scale were adm i n i s t e r e d . At the end of the f i r s t treatment Table 1 Subject C h a r a c t e r i s t i c s ,43 Demographics (N = 72) Age (mean, range) 39 24-59 M a r i t a l Status. M a r r i e d 33% S i n g l e 34% Div/Sep/Wid 33% C h i l d r e n 1 or more c h i l d r e n 54% No c h i l d r e n 46% Education High School 28% 1-3 Years C o l l e g e 12% U n i v e r s i t y / C o l l e g e Degree 51% P r o f e s s i o n a l Degree (MA,PhD) 9% Years i n Workforce 0-3 17% 4-6 18% 7-9 21% 10-over 44% Years i n Present P o s i t i o n (mean, range)5.5 1-10 44 s e s s i o n the expectancy q u e s t i o n n a i r e was completed. A l l of the s u b j e c t s were rea s s e s s e d with the above mentioned q u e s t i o n n a i r e s at the end of the 8-week treatment p e r i o d . E i g h t weeks a f t e r completing the program a l l of the s u b j e c t s met in a group at the U n i v e r s i t y of B r i t i s h Columbia and were reassessed in the same manner as at 8-week post-treatment. Dependent Measures T r a i t A n x i e t y . Anxiety was measured with the T r a i t A n x i e t y Inventory (STAI-T) developed by S p i e l b e r g e r , Gorsuch, and Lushene (1970). The STAI-T measures 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 appear to c h a r a c t e r i z e the s u b j e c t over a wide range of s i t u a t i o n a l v a r i a b l e 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 circumstances, 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 . The STAI-T has been used as an outcome measure i n both r e l a x a t i o n and e x e r c i s e treatment programs. This inventory i s a b r i e f s e l f - r e p o r t measure c o n s i s t i n g of 20 statements responded to on a 4-point s c a l e (ranging from 1 "almost never" to 4 "almost always") with high scores r e f l e c t i n g t e n s i o n , apprehension, and t e a r f u l n e s s . 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 w e l l w i t h i n t o l e r a n c e l e v e l s (.73 to .92) and 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 STAI ( S p i e l b e r g e r et a l . , 1970). 45 General S e l f - e f f i c a c y S c a l e . Sherer et a l . (1982) developed a measure to assess general s e l f - e f f i c a c y which was based on Bandura's (1977) s e l f - e f f i c a c y theory. T h i s s c a l e c o n s i s t s of 17 items responded to on a 14-point L i k e r t s c a l e ( y i e l d i n g a sum ranging from 17 to 238) where high scores i n d i c a t e high s e l f - e f f i c a c y (see Appendix D). In the study by Sherer et a l . which u t i l i z e d i n t r o d u c t o r y psychology students, the General S e l f - e f f i c a c y Scale demonstrated high i n t e r n a l c o n s i s t e n c y (Cronbach's alpha = .86), and c r i t e r i o n v a l i d i t y was supported by p r e d i c t e d past success i n v o c a t i o n a l , e d u c a t i o n a l and m i l i t a r y a reas. Construct v a l i d i t y was demonstrated by c o n f i r m i n g s e v e r a l p r e d i c t e d r e l a t i o n s h i p s between scores on the s e l f - e f f i c a c y s c a l e and on other p e r s o n a l i t y measures (Sherer & Adams, 1983). T e s t - r e t e s t r e l i a b i l i t y has not been e s t a b l i s h e d f o r t h i s measure. Ways of Coping C h e c k l i s t (WCC). Folkman and Lazarus (1980) developed a q u e s t i o n n a i r e to measure how a person copes with a s p e c i f i c s t r e s s f u l event. T h e i r o r i g i n a l WCC was scored on a b i n a r y yes/no response s c a l e while the more recent v e r s i o n (Lazarus & Folkman, 1984) i s scored on a 4-point s c a l e . A recent s t r e s s f u l event i s i d e n t i f i e d and then a c h e c k l i s t c o n s i s t i n g of 67 items responded to on a 4-point s c a l e (from "not used" to "used a great deal") i s answered with the d e s c r i b e d s t r e s s f u l event i n mind. 46 The c h e c k l i s t i n c o r p o r a t e s two c a t e g o r i e s of c o p i n g : (a) problem-focused coping items (P-focused) that d e s c r i b e c o g n i t i v e p r o b l e m - s o l v i n g e f f o r t s and b e h a v i o r a l s t r a t e g i e s f o r managing the source of the problem (e.g., I made a plan of a c t i o n ) ; and (b) emotion-focused coping items (E-focused) that d e s c r i b e the c o g n i t i v e and b e h a v i o r a l e f f o r t s d i r e c t e d at managing emotional d i s t r e s s (e.g., I t r i e d to f o r g e t the whole t h i n g ) . I n t e r n a l c o n s i s t e n c i e s f o r the P-focused and E-focused s c a l e s were examined i n a study of 100 community r e s i d e n t s and the mean ( f o r 2 a d m i n i s t r a t i o n s of each s c a l e ) alpha c o e f f i c i e n t was .80 f o r the P-focused and .81 f o r the E-focused (Folkman & Lazarus, 1980). A m o d i f i c a t i o n of t h i s measure (2 subscales) was used i n t h i s study and i s d e s c r i b e d i n d e t a i l i n Appendix E. 7-Day R e c a l l (see Appendix F ) . S e l f - r e p o r t measures of p h y s i c a l a c t i v i t y that have good psychometric p r o p e r t i e s are d i f f i c u l t to o b t a i n due to problems in a c c u r a t e l y measuring e x e r c i s e . B l a i r (1984) developed a s e l f - r e p o r t i n v e n t o r y which r e q u i r e s s u b j e c t s to r e c o r d t h e i r p a t t e r n of p h y s i c a l a c t i v i t y over the past week. In a d d i t i o n to type of a c t i v i t y , s u b j e c t s recorded frequency ( i n days), d u r a t i o n ( i n minutes), and i n t e n s i t y . I n t e n s i t y was recorded as the s u b j e c t ' s s u b j e c t i v e f e e l i n g s of f a t i g u e with each a c t i v i t y r a t e d on a s c a l e of 6 to 20 (Borg, 1973). 47 A c t i v i t i e s not of an a e r o b i c nature (e.g., s t r e t c h i n g ) or of a work-nature (e.g., scrubbing f l o o r s ) were not i n c l u d e d . Since e x e r c i s e p a r t i c i p a t i o n , r a t h e r than l e v e l of f i t n e s s was the focus i n t h i s study, the 7-Day R e c a l l was used to d e s c r i b e change over time at pre, post and follow-up f o r a l l groups. S a l l i s et a l . (1985), i n a survey of community r e s i d e n t s (N = 2,126), found that a v e r s i o n of the 7-Day R e c a l l was an a p p r o p r i a t e measure to i n d i c a t e the p a t t e r n of a c t i v i t y , t o t a l c a l o r i c expenditure, and the types of a c t i v i t i e s f o r a l a r g e p o p u l a t i o n . In a d d i t i o n , t e s t - r e t e s t r e l i a b i l i t y was e s t a b l i s h e d (n 53) over a two week p e r i o d . The Pearson product-moment c o r r e l a t i o n between the number of vigorous a c t i v i t i e s r e p o r t e d at each i n t e r v i e w s e s s i o n was £ = .83 while f o r moderate a c t i v i t y i t was .75. T a y l o r et a l . (1984) compared data from the 7-Day R e c a l l i n v e n t o r y to a d i r e c t measure of p h y s i c a l a c t i v i t y and s e l f - r e p o r t e d p h y s i c a l a c t i v i t y f o r 30 males with a mean age of 52 years. The 7-Day R e c a l l was i n t e r v i e w e r - a d m i n i s t e r e d and asked; (a) how many hours of s l e e p the s u b j e c t s had, and (b) how many hours of a c t i v i t y they engaged in ( i . e . , they were given examples of moderate, hard and very hard a c t i v i t i e s ) . The r e s e a r c h e r s found that the 7-Day R e c a l l s i g n i f i c a n t l y agreed with s e l f - r e p o r t p h y s i c a l a c t i v i t y and d i r e c t measures of p h y s i c a l a c t i v i t y . One problem with t h i s study may be that the 48 s e l f - r e p o r t ( l o g book of a c t i v i t i e s ) enhanced the accuracy of the 7-Day R e c a l l . V e r s i o n s of the 7-Day R e c a l l have been u t i l i z e d i n other s t u d i e s (Long & Haney, 1986; S a l l i s et a l . , 1985; Wallace, McKenzie, & Nader, 1985). P h y s i c a l a c t i v i t y was measured using the t o t a l number of days (Exday) and the product of d u r a t i o n i n minutes times i n t e n s i t y ( E x e f o r t ) . M a n i p u l a t i o n Check An expectancy q u e s t i o n n a i r e was used to check the p o s s i b i l i t y that the experimental c o n d i t i o n s generated d i f f e r e n t demand c h a r a c t e r i s t i c s . Q u e s t i o n n a i r e s were given a f t e r the f i r s t , l a s t and 8-week follow-up s e s s i o n s to see how c o n f i d e n t the s u b j e c t s were that the program would e l i m i n a t e t h e i r a n x i e t y (Kazdin, 1980). The three items were summed for a n a l y s i s . In a d d i t i o n , to o b t a i n a more o b j e c t i v e measure of p r a c t i c e between s e s s i o n s , an e x e r c i s e or r e l a x a t i o n calendar was used to monitor e x e r c i s e and r e l a x a t i o n p r a c t i s e from pre- to post-treatment. See Appendix F f o r a d e s c r i p t i o n of the expectancy items. A n c i l l a r y Measures A q u e s t i o n n a i r e was a d m i n i s t e r e d to a l l s u b j e c t s at the end of the treatment and at 8-week follow-up to gain d e s c r i p t i v e i n f o r m a t i o n about the treatments. Subjects were asked to estimate, on a 5-point s c a l e , how well they were coping with s t r e s s and to what extent jogging or r e l a x a t i o n was h e l p i n g them r e l i e v e 49 s t r e s s . In a d d i t i o n , they i n d i c a t e d how they f e l t and thought d i f f e r e n t l y , and what they were doing d i f f e r e n t l y as a consequence of the i n t e r v e n t i o n s and to what degree they achieved t h e i r g o a ls f o r the program. (In the i n i t i a l s e s s i o n a l l p a r t i c i p a n t s were asked to l i s t three p e r s o n a l outcome g o a l s ) . They were a l s o asked what aspects of the program were h e l p f u l to them in l e a r n i n g to cope with s t r e s s . (See Appendix F for the post and follow-up q u e s t i o n n a i r e ) . Treatments The treatment groups (2 r e l a x a t i o n and 2 e x e r c i s e ) ranged i n s i z e from 14 to 16 p a r t i c i p a n t s . T h i s i s s i m i l a r to the group s i z e i n other s t u d i e s (Long, 1984). The groups met f o r e i g h t 1 1/2-hour weekly s e s s i o n s . The main treatment components designed to be present i n both the e x e r c i s e (walk/jog) treatment and the r e l a x a t i o n treatment were: (a) an i n i t i a l s e s s i o n d i s c u s s i n g d e f i n i t i o n s , causes and e f f e c t s of s t r e s s and p r e s e n t a t i o n of a treatment r a t i o n a l e f o r stress-management, (b) the use of a s e l f - m o n i t o r i n g form to r e c o r d f e e l i n g s , i n t e n s i t y and l e n g t h of p r a c t i c e s e s s i o n s , (c) a s k i l l development approach to l e a r n i n g each technique, and (d) an i n f o r m a l s u p p o r t i v e atmosphere with c o - l e a d e r s a c t i n g as models and fac i l i t a t o r s . 50 The treatment components that d i f f e r e n t i a t e d the two groups were r e l a x a t i o n through a p r o g r e s s i v e r e l a x a t i o n treatment and a e r o b i c e x e r c i s e through a walk/jog program. Leaders. I n i t i a l s c r e e n i n g i n t e r v i e w s were conducted by the experimenter. The treatment groups were c o - l e d by female graduate students i n the masters of P h y s i c a l Education program, and from S o c i a l Work and C o u n s e l l i n g Psychology programs. A l l had experience l e a d i n g a d u l t groups and at l e a s t one leader per e x e r c i s e group was q u a l i f i e d i n f i r s t a i d and cardio-pulmonary r e s u s c i t a t i o n . Before the treatments began and d u r i n g the treatment s e s s i o n s , a s e r i e s of meetings were held to d i s c u s s the purposes of the p r o j e c t , the r a t i o n a l e s behind the treatments, and the s p e c i f i c procedures i n v o l v e d i n order to ensure s i m i l a r i t y of approach a c r o s s groups. A treatment program s i m i l a r to that d e s c r i b e d i n Long's (1984) Stress-Management Aerobic C o n d i t i o n i n g Manual was used f o r the e x e r c i s e group while the r e l a x a t i o n treatments were based on B e r s t e i n and Borkovec's (1973) P r o g r e s s i v e R e l a x a t i o n T r a i n i n g Manual. Hence, the d e t a i l e d manuals 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 co-leader t r a i n i n g . E x e r c i s e Walk/Jog Program. A r a t i o n a l e f o r e x e r c i s e as a stress-management treatment was presented 51 at the f i r s t s e s s i o n ( i . e . , e x e r c i s e as a n a t u r a l muscle r e l a x a n t and as a d i s t r a c t o r ) . Then s u b j e c t s were p l a c e d on a walk/jog program and were encouraged to i n c r e a s e t h e i r d i s t a n c e in a gradual manner. In the e x e r c i s e group s e s s i o n s , s l o w - s t r e t c h f l e x i b i l i t y e x e r c i s e s were p r a c t i s e d before and a f t e r each walk/jog. In a d d i t i o n , s u b j e c t s were encouraged to p r a c t i c e 3 times per week on t h e i r own, r e c o r d i n g the days they p r a c t i c e d , the amount of time they e x e r c i s e d and t h e i r f e e l i n g s before and a f t e r e x e r c i s e . P r i o r to e x e r c i s i n g as a group, successes and f a i l u r e s and any problems r e l a t e d to jogging were d i s c u s s e d i n a s u p p o r t i v e atmosphere. Then the group p a r t i c i p a t e d i n 8-10 minutes of s t r e t c h i n g e x e r c i s e s f o l l o w e d by a walk/jog of i n c r e a s i n g l e n g t h s . While on the walk/jog, p e r s o n a l a t t e n t i o n and encouragement was given to each p a r t i c i p a n t . Subjects were encouraged to set t h e i r own pace on the b a s i s of heart r a t e and p e r c e i v e d e x e r t i o n . The f i n a l p a r t of each s e s s i o n c o n s i s t e d of d i s c u s s i o n s and l e c t u r e s on t o p i c s r e l a t e d to jogging such as: (a) proper running shoes, (b) i n j u r y p r e v e n t i o n and treatment, (c) components of f i t n e s s , and (d) e x e r c i s e p r i n c i p l e s and e x e r c i s e maintenance. P r o g r e s s i v e R e l a x a t i o n . The p r o g r e s s i v e muscle r e l a x a t i o n program c o n s i s t e d of two b a s i c phases: (a) four s e s s i o n s f o r the 16 muscle groups, and (b) three 52 se s s i o n s f o r the 7 muscle groups. The s u b j e c t s were encouraged to p r a c t i c e as o f t e n as p o s s i b l e but at l e a s t 3 times per week on t h e i r own. A r a t i o n a l e f o r P r o g r e s s i v e R e l a x a t i o n as a stress-management technique ( t i g h t e n i n g and r e l a x i n g muscles to a t t a i n complete r e l a x a t i o n , a t t a i n i n g homeostasis) was presented at the f i r s t s e s s i o n . Each group s e s s i o n / c o n s i s t e d of an i n i t i a l 10-15 minute review of the pre v i o u s s e s s i o n and a d i s c u s s i o n on how the s u b j e c t s ' p r a c t i s e s e s s i o n s were going. The su b j e c t s then p a r t i c i p a t e d i n the a c t u a l r e l a x a t i o n e x e r c i s e . In a d d i t i o n , the l a t e r part of each s e s s i o n c o n s i s t e d of both small and l a r g e group d i s c u s s i o n s on: (a) what the experience was l i k e f o r the p a r t i c i p a n t s , (b) the importance of p r a c t i c e , (c) common problems (cramps, f o c u s i n g a t t e n t i o n ) , (d) p h y s i o l o g i c a l and p s y c h o l o g i c a l changes as a r e s u l t of r e l a x a t i o n , and (e) r e c o g n i t i o n and use of r e l a x a t i o n when tense. To reduce a t t r i t i o n , p a r t i c i p a n t s i n both groups were encouraged to phone the group l e a d e r s to review m a t e r i a l that was missed. I f the leader was not con t a c t e d she telephoned the p a r t i c i p a n t . The average number of s e s s i o n s attended was 5.9 of 8 s e s s i o n s f o r a l l groups (Median = 6). 53 R e s u l t s Group Co m p a r a b i l i t y on Demographics and Dependent  Measures P r i o r to the i n t e r v e n t i o n s , a l l s u b j e c t s (N = 72) d i s p l a y e d evidence of a n x i e t y as evidenced by STAI-T. The o v e r a l l group mean of 46.1 was w e l l above the mean score of 35.8 re p o r t e d by S p i e l b e r g e r et a l . (1970) fo r a group of normal male and female undergraduates. I n i t i a l l y Chi-square t e s t s were computed f o r the two r e l a x a t i o n (n*s=l7, 17) and the two e x e r c i s e groups (n's=l8, 20). Since no d i f f e r e n c e s were found on the demographic v a r i a b l e s of age, m a r i t a l s t a t u s , years i n c u r r e n t job, and educati o n , these four groups were c o l l a p s e d i n t o two treatment groups (n's=25, 26) and one no show/dropout group (n=21) f o r a n a l y s i s . No shows were the s u b j e c t s who d i d not atte n d the f i r s t treatment s e s s i o n (n=11) while dropouts were s u b j e c t s who attended 3 or fewer s e s s i o n s or were u n a v a i l a b l e f o r posttreatment or follow-up assessment (n=l0). There 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 these groups f o r m a r i t a l s t a t u s , years i n c u r r e n t job, or educati o n , but there was a s i g n i f i c a n t d i f f e r e n c e f o r age (Chi-Square (2, N = 72)= 7.35,2<•03.). In the r e l a x a t i o n group the s u b j e c t s were younger (66% were under 39 compared to only 40% f o r the e x e r c i s e groups). However, as the c o r r e l a t i o n s of age with a l l the dependent measures were very small (none above .13), i t 54 i s u n l i k e l y that t h i s between-group age d i f f e r e n c e would i n f l u e n c e treatment e f f e c t s . Subject A t t r i t i o n Of the i n i t i a l 72 s u b j e c t s , 11 (no shows) d i d not show up f o r the f i r s t s e s s i o n , and 8 (dropouts) d i d not at t e n d more than 3 s e s s i o n s , thus reducing the treatment group sample s i z e to 53. A d d i t i o n a l l y , one su b j e c t c o u l d not be l o c a t e d f o r the p o s t t e s t , although she attended 7 c l a s s e s , one other s u b j e c t was i n the h o s p i t a l at the time of p o s t t e s t and one s u b j e c t d i d not complete follow-up q u e s t i o n n a i r e s although she attended 6 c l a s s e s (her data were used f o r p r e t e s t and p o s t t e s t a n a l y s i s ) . Consequently, the f i n a l sample s i z e was 50 (n = 25 f o r r e l a x a t i o n , n = 25 f o r exerc i s e ) . Compared to treatment groups the dropout group's mean score f o r s e l f - e f f i c a c y (183.1) was c o n s i d e r a b l y higher and f o r t r a i t a n x i e t y (39.0) was lower than the treatment groups score (see Table 2 f o r means and standard d e v i a t i o n s ) . T h i s i s an i n d i c a t i o n that the dropout group was more s e l f - e f f i c a c i o u s and l e s s anxious than the treatment groups. Pretreatment D i f f e r e n c e s / S e l f - e f f i c a c y and STAI. A one-way 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 (MANOVA) was used to t e s t for pre-treatment d i f f e r e n c e s between treatment groups ( r e l a x a t i o n and e x e r c i s e ) on the dependent measures of t r a i t a n x i e t y and s e l f - e f f i c a c y Table 2 Means and Standard D e v i a t i o n s of Outcome Measures STAI S e l f - E f f i c a c y E-focused P-focused E x e f o r t Exday Group M SD M SD M SD M SD M SD M SD E x e r c i s e (n = 25) Pre 46.6 9.2 168.3 32.2 11.3 7.5 16.7 7.0 483.6 953.5 1 . 1 1.5 Post 41.0 9.0 176.2 31 .4 11.4 5.5 19.8 7.3 1358 629.5 3.7 1.3 Follow-up 37.9 7.7 180.9 24.2 9.7 6.2 18.1 7.1 1558 1635 2.9 1.9 Rela x a t i o n (n=25) Pre 48.6 10.0 146.6 36. 1 13.6 10.2 14.5 8.5 487.2 662.6 1 .0 1 .4 Post 43.4 9.4 166.6 32.8 11.8 7.8 15.6 6.5 977.8 711.7 2.5 1.8 Follow-up 41.7 9.3 163.0 37.4 11.0 6.6 14.0 7.2 853.4 990.0 2.0 1.7 Note. STAI=Trait Anxiety, E-focused=Emotion-focused coping, P-focused=Problem-focused coping, Exefort=minutes X i n t e n s i t y of e x e r c i s e , Exday=frequency i n days. 56 (see Table 2 f o r means and standard d e v i a t i o n s ) . The o v e r a l l MANOVA was n o n s i g n i f i c a n t , F(2,48)=2.90, p_<.064. The o v e r a l l mean score of 157.8 f o r s e l f - e f f i c a c y i s lower than those reported by Sherer et a l . (1982) f o r 376 c o l l e g e students (M = 172.6). Coping and E x e r c i s e . A MANOVA was performed to determine i f the groups d i f f e r e d i n i t i a l l y i n e i t h e r of the coping subdomains (P-focused and E-focused). The MANOVA was n o n s i g n i f i c a n t i n d i c a t i n g no i n i t i a l d i f f e r e n c e s between groups f o r coping, F<1. There f o r e the groups d i d not d i f f e r i n the number of P-focused and E-focused s t r a t e g i e s they used p r i o r to the treatment. Furthermore, a MANOVA on p r e t e s t e x e r c i s e (Exdays, E x e f o r t ) was a l s o n o n s i g n i f i c a n t , F<1, i n d i c a t i n g that treatment groups had s i m i l a r e x e r c i s e h a b i t s before the treatments. M a n i p u l a t i o n Check To e v a l u a t e the s u b j e c t s ' e x p e c t a t i o n s of the i n t e r v e n t i o n s e f f e c t i v e n e s s , r a t i n g s were pr o v i d e d at p r e t e s t and p o s t t e s t . A ( 2 X 2 ) groups by time ANOVA with repeated measures on time (pre to post) on expectancy r e v e a l e d a s i g n i f i c a n t group main e f f e c t , F(1,49)=7.20, £<.009, and a s i g n i f i c a n t time main e f f e c t , F ( 1 , 49) =4 . 87 , p_<.03. There was no s i g n i f i c a n t group by time i n t e r a c t i o n (F<1.) Although the o v e r a l l r e l a x a t i o n group mean was lower than the e x e r c i s e mean, both groups i n c r e a s e d t h e i r expectancy s i m i l a r i l y over 57 time. See Table 3 f o r means and standard d e v i a t i o n s of expectancy s c o r e s . Treatment E f f e c t s Two two-way (group by time) MANOVA's with two preplanned nonorthogonal c o n t r a s t s using Dunn's t e s t f o r s i g n i f i c a n c e at .025 (pre to post; post to fo l l o w - u p ) , were performed s e p a r a t e l y on: (a) t r a i t a n x i e t y and s e l f - e f f i c a c y , and (b) P-focused and E-focused c o p i n g . Only the preplanned c o n t r a s t s (pre to post) and (post to follow-up) are presented below when d i s c u s s i n g the time e f f e c t . T r a i t Anxiety and S e l f - E f f i c a c y . A repeated measures, 2 X 3 (group by time) MANOVA with preplanned c o n t r a s t s was performed to evaluate 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 between the treatment groups on the dependent measures of t r a i t a n x i e t y and s e l f - e f f i c a c y . A n a l y s i s r e v e a l e d a n o n s i g n i f i c a n t group main e f f e c t , F ( 2 , 47 ) =2 . 04 , p_<.14, and a s i g n i f i c a n t time (pre to post) e f f e c t , F(2,47)=11.39, p_<.00l. The u n i v a r i a t e t e s t s f o r time were s i g n i f i c a n t ( t r a i t a n x i e t y , F( 1 , 48 > = 1 5. 33 , p_<.00l and s e l f - e f f i c a c y , F ( 1 , 48 ) = 1 4 . 34 , P_<.001). There was no s i g n i f i c a n t group by time i n t e r a c t i o n f o r the pre- to posttreatment c o n t r a s t , F(2,47)=1.76, p_<.l83. Examining the means i t appears that the two treatment groups reduced t h e i r t r a i t a n x i e t y and i n c r e a s e d t h e i r s e l f - e f f i c a c y from pre- to posttreatment i n s i m i l a r magnitudes. T a b l e 3 Means and Standard D e v i a t i o n s of E x p e c t a n c i e s Scores 58 GROUP PRE POST E x e r c i s e (n=26) M 14.0 15.7 SD 2.5 3.6 R e l a x a t i o n (n=25) M 12.6 13.5 SD 2.6 3.7 59 To assess maintenance of change over the 8-week follow-up p e r i o d a post to follow-up c o n t r a s t was used. A time (post to follow-up) e f f e c t approached s i g n i f i c a n c e , F(2,47)=3.49, 2 <«°4. The group by time i n t e r a c t i o n was not s i g n i f i c a n t F (2 , 47) = 1 . 26, p_<.292. An examination of the means i n d i c a t e d that from post to follow-up t r a i t a n x i e t y continued to reduce, while s e l f - e f f i c a c y d i d not change. There i s no evidence to suggest that the groups changed d i f f e r e n t l y from pre- to posttreatment or at 8-week follow-up. For a summary of the MANOVA and u n i v a r i a t e ANOVA's see Table 4. Coping. A one-way MANOVA with repeated measures on time with preplanned c o n t r a s t s was performed to determine i f the combined groups changed over time on t o t a l number of coping s t r a t e g i e s and i f there was a d i f f e r e n t i a l change f o r P-focused and E-focused coping as hypothesized. Dependent v a r i a b l e s were SUM ( t o t a l number of coping s t r a t e g i e s used) and DIFF (the d i f f e r e n c e score between the P-focused and E-focused coping s t r a t e g i e s ) . For the pre- to posttreatment c o n t r a s t on time, f i n d i n g s i n d i c a t e d a n o n s i g n i f i c a n t e f f e c t , F(2,45)=2.34, p_<. 1 1 . T h i s i n d i c a t e s that the t o t a l number of coping s t r a t e g i e s used and the d i f f e r e n c e between the number of P- and E-focused coping s t r a t e g i e s d i d not change s i g n i f i c a n t l y from p r e t e s t to posttreatment. 60 Table 4 Summary of M u l t i v a r i a t e and U n i v a r i a t e R e s u l t s f o r Outcome Measures E f f e c t s M u l t i v a r i a t e (F,g<) d_f U n i v a r i a t e (p_<) 2,47 S e l f - E f f i c a c y T r a i t A nxiety Group 2.04 .142 .055 .112 Time(pre to post) 11.39 .001 .001 .001 Group by Time 1.76 .183 .094 .213 Time(post to follow-up)3.49 .038 .844 .011 Group by Time 1.26 .292 .133 .438 Coping P/E a 2,45 SUM DIFF Time(pre to post) 2.34 .108 .448 .034 Time(post to follow-up)1.74 .187 .066 .691 E x e r c i s e 2,47 E x e f o r t Exday Group 3.08 .055 .098 .016 Time(pre to post) 20.48 .001 .001 .001 Group by Time 1.69 .196 .185 .069 Time(post to follow-up) 4.32 .019 .831 .045 Group by Time 1.30 .282 .363 .701 a See t a b l e 3. 61 To assess maintenance of coping behavior over the 8-week follow-up p e r i o d a post to follow-up c o n t r a s t was used. T h i s e f f e c t was not s i g n i f i c a n t , F(2,45)=1.74, p<.l9. From post to follow-up there was no i n c r e a s e i n the t o t a l number of coping s t r a t e g i e s nor was there a s i g n i f i c a n t d i f f e r e n c e f o r P- and E-focused coping. S e l f - E f f i c a c y as a P r e d i c t o r . Pearson-product moment c o r r e l a t i o n s between s e l f - e f f i c a c y at posttreatment and e x e r c i s e ( E x e f o r t and Exday) at follow-up showed no r e l a t i o n s h i p , r = -.017 and .039, r e s p e c t i v e l y . T h e r e f o r e , there was no r e l i a b l e a s s o c i a t i o n between scores on s e l f - e f f i c a c y at posttreatment and ae r o b i c e x e r c i s e at 8-week follow-up. A n c i l l a r y Measures Exerc i se. To t e s t f o r change i n e x e r c i s e p a t t e r n f o r both treatment groups a repeated measures, 2 X 3 (group by time) MANOVA was computed. E x e r c i s e was measured using Exday (number of days) and E x e f o r t (minutes X i n t e n s i t y ) . The group main e f f e c t approached s i g n i f i c a n c e at F ( 2 , 47 ) =3 . 08 , p_<.06. The pre- to posttreatment c o n t r a s t r e v e a l e d a s i g n i f i c a n t time e f f e c t , F(2,47)=20.48, £<.001. The u n i v a r i a t e t e s t s f o r time (pre to post) were s i g n i f i c a n t f o r both dependent measures (Exday, F(1,48) =41.82, p_<.00l and E x e f o r t , F(1,48)=22.87, 2 <' 0 0 1^- T h i s i n d i c a t e s that both groups improved t h e i r e x e r c i s e from pre- to 62 posttreatment. There was no s i g n i f i c a n t group by time i n t e r a c t i o n f o r the pre- to posttreatment c o n t r a s t , F(2,47)=1.69, p_<.20. Therefore the groups d i d not change d i f f e r e n t l y over time (see F i g u r e 1 ) . However, the l a r g e e r r o r v a r i a n c e may have obscured any group d i f f e r e n c e s . For the post to follow-up c o n t r a s t there was a s i g n i f i c a n t time e f f e c t , F(2 , 47) = 4.32, p_<.02. U n i v a r i a t e a n a l y s i s r e v e a l e d that Exday was s i g n i f i c a n t , p<.05. However, E x e f o r t was not s i g n i f i c a n t , Furthermore, the group by time i n t e r a c t i o n was not s i g n i f i c a n t , F(2,47)=1.30, £<.28. T h e r e f o r e , from an examination of the means, from p o s t t e s t to follow-up both groups decreased the number of days they e x e r c i s e d . Post and Follow-up Q u e s t i o n n a i r e s . In response to the posttreatment q u e s t i o n "To what extent d i d you achieve your p e r s o n a l g o a l s ? " , the o v e r a l l mean f o r the e x e r c i s e group was 3.2 while the mean f o r the r e l a x a t i o n group was 2.6 on a 5-point s c a l e ("somewhat" to " c o m p l e t e l y " ) . On the 8-week follow-up q u e s t i o n "To what extent have you maintained your e x e r c i s e / r e l a x a t i o n program?", 66% of the e x e r c i s e group rep o r t e d "somewhat" or "very much so" while only 32% made a s i m i l a r response f o r the r e l a x a t i o n group. For the qu e s t i o n "To what extent has j o g g i n g / r e l a x a t i o n helped you deal with s t r e s s ? " , 46% of the e x e r c i s e 63 Figure 1: Pre, Post and Follow-up group means for Exercise Composite Score (minutes X intensity). 64 group and 28% of the r e l a x a t i o n group responded "moderately" or "very much so". S i x t y percent of the r e l a x a t i o n group s a i d they maintained r e l a x a t i o n due to s e t t i n g an e s t a b l i s h e d p a t t e r n of p r a c t i s e compared to 58% of the e x e r c i s e group ( f o r e x e r c i s e ) . The e x e r c i s e group a l s o r a t e d " f e e l i n g good" (56%) and " h e a l t h " (48%) as c o n t r i b u t i n g to h e l p i n g them maintain an e x e r c i s e program. C o r r e l a t i o n M a t r i x . A c o r r e l a t i o n matrix f o r pre-to posttreatment measures w i l l be used to q u a n t i f y r e l a t i o n s h i p s which w i l l be examined in the d i s c u s s i o n s e c t i o n . See Table 5. Table Correlations of Dependent Variables and Other Selected Factors Correlations, _. a c e | | j n W S T, PROP I PR082 S E L F E F F I T R A I T I EXDAY1 PROBI 119 EMOTt 120 PR082 121 EMOT2 122 ACE 31 MST1 32 WSTt 33 SELFEFFI 34 TRAIT 1 35 EXDAY1 36 EXEFORT1 131 EXPECTt 39 HST2 70 WSTI 71 S1LFEFF2 ' 72 TRAIT2 73 EXOAV2 74 EXEF0RT2 132 EXPECT2 77 TOTGOAL 134 1.0000 •O.OS42 0.3336 0.04 ta -0.1450 O.OB99 0 . 3 3 1 6 O . J 5 ' 0 -0.0756 0. 1375 0.0784 0.2860 -0.0248 0. 1504 0.2832 -0.1399 0. 12 16 0.147 I 0.0301 0.1511 1.0000 -O.1834 0.7192 - 0 . 1308 -0.3040 -0.5431 -0.3346 0.5508 -0.1244 -0.0733 -0.0658 -0.0037 -0.2652 -0.2557 0.2793 -0.2570 -0.1462 0.0671 0.0066 1. oooo -0 . ,0351 1.0000 -0 .2528 -0.0495 1 .0000 0 .2424 -0.3108 0, .0003 0 . 1532 •0.4286 0 . 1899 0 .2556 -0-3B9S -0 . . 1358 -0 .2315 0.4499 0 . 1250 -0 .0223 -0-2092 0 . 1913 0 .0524 -0.0598 -0 .0573 0 .0861 - 0 0 1 5 9 0 .0157 0 .0CI4 -0.2310 -0 .2845 -0 .1654 -0.3B92 0 .0023 0. . 1790 -0.4846 -o. ,2483 -0 .2039 0.3200 0 .2276 0. , 1498 -0.3055 0, .0628 0. . 1677 -0.2337 -0 , .0226 0 .2516 -0.0019 -0 , .3488 0, .3328 - 0 . I 3 ° 3 -0 . .3960 1 .oooo 0.4270 0.3868 -0.4576 0.0561 0. '489 0.1637 0.3S10 0.3399 0.4550 -0.4812 0.0858 O. 1245 O. 12B8 0.0463 1.0000 0.5649 -0.4124 -0.1451 -O.1534 0.1805 0.2488 0.5432 0.4778 -0.337 1 0.2532 -O.1548 • 0 . M S 2 0.0364 1. .0000 -0 . .5966 • 1 oooo -0 , . 1707 0, .2343 - 0 . 1477 0. . 1217 0. ,2532 -0 . . 1329 0. .3555 -0, .33B7 0. .3460 -0 , .2787 0. .7863 -0 4933 -0 . ,547 1 0 .707 8 0. .3105 -0 . .3630 0. 0339 -0 . , 1470 0. 0521 -0 . .C825 0. 1 127 -0 , ,0278 1.0000 0.64 13 0.0542 -0.0339 -0.1716 -0.2032 O. 1829 -0.0662 0.5138 -0.0006 -0.0589 EXEFORTI EXPECT I HST2 WST 2 SELFEFF2 TRAIT2 EXDAV2 EXEF0RT2 EXPECTS EXEFORT1 131 EXPECTt 39 HST2 WST2 SELFEFF2 72 TRAIT2 73 EXDAY2 74 EXEF0RT2 132 EXPECT2 77 TOTGOAL 134 70 71 1.0000 -0.0749 -0.0882 -0.0985 -O.1467 -0.0199 - 0 . 1451 0.6232 0.0575 0.0423 1.0000 0.0897 0.0350 0.2882 •0.0460 -0.1197 -0.0047 0.2640 0.2702 1.0000 0.3277 .5701 .5718 .0710 .0094 .2 114 . 1849 1 .0000 0 . 4 6 G B •0.4621 0.1859 -O.O077 0.0004 0.0660 1.0000 -0.5761 0.1332 -0.0539 O. 1422 0.2466 1.0000 -O.1782 -0.0727 -O.1194 -0.1801 1.0000 0.0335 -0.2017 -0.0S60 1.0000 0.1036 •0.0169 1.0000 0.6078 1.0000 66 Di s c u s s i o n The r e s u l t s of t h i s study i n d i c a t e that 8-week ae r o b i c e x e r c i s e and p r o g r e s s i v e r e l a x a t i o n i n t e r v e n t i o n s are e f f e c t i v e i n s i g n i f i c a n t l y reducing t r a i t 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 at posttreatment and 8 weeks l a t e r f o r sedentary working women. Unexpectedly, n e i t h e r treatment s i g n i f i c a n t l y i n c r e a s e d the t o t a l number of coping s t r a t e g i e s . I t was expected that s e l f - e f f i c a c y at posttreatment would be p o s i t i v e l y r e l a t e d to jogging behavior at follow-up f o r the e x e r c i s e group but t h i s was not e v i d e n t . Both treatments generated s i m i l a r responses; decreased a n x i e t y and in c r e a s e d s e l f - e f f i c a c y and these changes were maintained or improved at 8-week follow-up. These f i n d i n g s are s i m i l a r to s t u d i e s by Ja s n o s k i and Holmes (1981) and Long (1984) who found that p a r t i c i p a t i o n i n an e x e r c i s e program i n c r e a s e d s e l f - e f f i c a c y and decreased a n x i e t y . Since there were no d i f f e r e n c e s between groups, s e l f - e f f i c a c y may have been i n c r e a s e d by common components in each group such as: (a) p a r t i c i p a n t s g a i n i n g a sense of mastery ( i . e . , l e a r n i n g the technique of jogging or p r o g r e s s i v e r e l a x a t i o n ) , (b) l e a r n i n g a new coping s k i l l , and (c) group support. In a d d i t i o n , while both treatment groups were taught a form of muscle t e n s i o n r e d u c t i o n ( d e V r i e s , 1968; Jacobson, 1938), s u b j e c t s s e l f - r e p o r t e d that they used j o g g i n g / r e l a x a t i o n ( E x e r c i s e 68%, 67 R e l a x a t i o n 72%) as a d i s t r a c t i o n and to gain a sense of c o n t r o l ( E x e r c i s e 72%, R e l a x a t i o n 48%) which i s s i m i l a r to f i n d i n g s by Long (1984). Arnkoff (1986) suggests that change processes r e s u l t i n g from a treatment cannot be p r e d i c t e d only from the content of treatment procedures. T h e r e f o r e , f u t u r e s t u d i e s may want to focus on s p e c i f i c treatment components in r e l a t i o n to s e l f - e f f i c a c y . The t o t a l number of coping s t r a t e g i e s d i d not s i g n i f i c a n t l y i n c r e a s e . T h i s may be due to the assessment of coping as s u b j e c t s were asked to d e s c r i b e a recent s t r e s s f u l event and then respond with how they coped with the event. I t was expected that l e a r n i n g a new coping s t r a t e g y ( e x e r c i s e / r e l a x a t i o n ) would g e n e r a l i z e to items on the WCC measure (e.g., t r i e d to f o r g e t the whole t h i n g ; or changed something about myself) however, t h i s was not evident from the r e s u l t s . One e x p l a n a t i o n f o r these f i n d i n g s may be that coping s t r a t e g i e s i n c r e a s e d only w i t h i n s p e c i f i c types of s t r e s s f u l work encounters. Rather than s p e c i f y i n g the type of s t r e s s o r , s u b j e c t s were f r e e to i d e n t i f y any work s t r e s s o r . T h i r t y - e i g h t percent of the s u b j e c t s i d e n t i f i e d workload as a s t r e s s o r while 43% i d e n t i f i e d i n t e r p e r s o n a l r e l a t i o n s h i p s at work as s t r e s s f u l and 19% i d e n t i f i e d other work s t r e s s e s . Folkman et a l . (1986b) found that coping s t r a t e g i e s v a r i e d depending on what was at stake and what o p t i o n s 68 the i n d i v i d u a l had f o r coping. Future s t u d i e s should c o n s i d e r l o o k i n g at the d i f f e r e n t types of work s t r e s s o r s because i t i s p o s s i b l e that coping s t r a t e g i e s tapped in t h i s study were confounded by the type of s t r e s s o r i d e n t i f i e d (Latack, 1986). The no t i o n of E-focused coping f a c i l i t a t i n g P-focused coping has been r e p o r t e d by Folkman et a l . (1986b). P-focused and E-focused coping s t r a t e g i e s d i d not change s i g n i f i c a n t l y over time but P-focused coping means d i f f e r e d i n the d i r e c t i o n hypothesized from pre-to posttreatment. I n t e r e s t i n g l y , the change in P-focused coping seems reasonable s i n c e the s u b j e c t s were taught a new E-focused coping s t r a t e g y ( e x e r c i s e , r e l a x a t i o n ) which may have f a c i l i t a t e d more P-focused coping, p a r t i c u l a r l y in the work s i t u a t i o n . There appears to be a r e l a t i o n s h i p between coping and the concept of s e l f - e f f i c a c y . I n i t i a l l y , women who scored high on s e l f - e f f i c a c y at pretreatment appeared to use more P-focused coping at pretreatment (r=.45, p_<. 01 ) . There was a negative r e l a t i o n s h i p between s e l f - e f f i c a c y at pretreatment and E-focused coping at pre- and at posttreatment (r = -.34, -.39, p_<. 01 ) ; lower s e l f - e f f i c a c y at posttreatment was r e l a t e d to a higher use of E-focused coping at posttreatment (r_ = -.49, P_<.01). The n o t i o n that enhanced s e l f - e f f i c a c y i s r e l a t e d to lower t r a i t a n x i e t y (r_ = -.58, p_<.0l), and a l l o w s i n d i v i d u a l s to be l e s s concerned over emotions 69 and more P-focused may be worthy of f u r t h e r study. S e l f - e f f i c a c y 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 posttreatment and was maintained at follow-up. However, s e l f - e f f i c a c y assessed at posttreatment d i d not p r e d i c t e x e r c i s e behavior at follow-up f o r the a e r o b i c e x e r c i s e group. T h i s i s c o n t r a r y to f i n d i n g s i n other s t u d i e s (Condiotte & L i c h t e n s t e i n , 1981; Kaplan et a l . , 1984) where s e l f - e f f i c a c y was found to be a good p r e d i c t o r of smoking abstinence and walking duri n g and a f t e r an i n t e r v e n t i o n . These s t u d i e s however, used a s p e c i f i c s e l f - e f f i c a c y measure at pretreatment to p r e d i c t a s p e c i f i c behavior d u r i n g or a f t e r a program. In t h i s study, pretreatment s e l f - e f f i c a c y / p o s t t r e a t m e n t e x e r c i s e ( E x e f o r t ) showed no l i n e a r r e l a t i o n s h i p (r_ = .03). However, a g e n e r a l s e l f - e f f i c a c y measure was used but was not r e l a t e d to a s p e c i f i c performance ( j o g g i n g ) . The lack of a s i g n i f i c a n t r e l a t i o n s h i p may be due t o : (a) problems with the measurement of e x e r c i s e , or (b) a need f o r a longer follow-up p e r i o d . In a d d i t i o n , c o n t r a r y to Bandura's (1977) theory, perhaps a change in p e r c e i v e d general s e l f - e f f i c a c y does not always l e a d to p e r s i s t e n c e i n a s p e c i f i c behavior. Despite the f a c t that the r e l a x a t i o n p a r t i c i p a n t s were i n s t r u c t e d not to change t h e i r e x e r c i s e p a t t e r n s both the r e l a x a t i o n and the e x e r c i s e p a r t i c i p a n t s i n c r e a s e d t h e i r e x e r c i s e over time. The reason both 70 groups i n c r e a s e d t h e i r e x e r c i s e may be due t o : (a) the programs s t a r t i n g i n snowy weather and c o n t i n u i n g i n t o the s p r i n g which c o u l d have i n f l u e n c e d a l l s u b j e c t s to walk/jog due to seasonal changes, and (b) the i n i t i a l i n t e r v i e w i n t r o d u c i n g the n o t i o n of e x e r c i s e as a stress-management technique may have encouraged some of the r e l a x a t i o n group to e x e r c i s e . In Long's (1984) study both groups improved t h e i r MV02 and i t was suggested that the bike t e s t was r e a c t i v e . Other s t u d i e s (Jasnoski et a l . , 1981; McCann & Holmes, 1984) found that p a r t i c i p a t i o n per se was r e l a t e d to l e s s t e n s i o n and i n c r e a s e d s e l f - e f f i c a c y . I t may a l s o be p o s s i b l e that " n o n - s p e c i f i c f a c t o r s " i n f l u e n c e d b e h a v i o r a l change. Furthermore, the 7-Day R e c a l l measure may not be s e n s i t i v e enough to measure improvement i n e x e r c i s e a c c u r a t e l y . For example, as i n d i v i d u a l s i n c r e a s e t h e i r a e r o b i c e x e r c i s e they may assess the time and e f f o r t more r e a l i s t i c a l l y than nonexerc i s e r s . While both groups improved i n e x e r c i s e the means i n d i c a t e that the e x e r c i s e group continued to e x e r c i s e at follow-up while the r e l a x a t i o n group had a downward trend (see F i g u r e 1). A s i m i l a r p a t t e r n was found f o r Exday. At follow-up, 36% of the e x e r c i s e s u b j e c t s i n c r e a s e d t h e i r e x e r c i s e , 48% maintained t h e i r e x e r c i s e and 16% decreased t h e i r e x e r c i s e while f o r the r e l a x a t i o n group 24% of the s u b j e c t s improved, 24% 71 maintained t h e i r e x e r c i s e and 36% of the s u b j e c t s decreased t h e i r e x e r c i s e (16% d i d no e x e r c i s e ) . Although there i s no s t a t i s t i c a l evidence to suggest that a jogging treatment i s s u p e r i o r to a p r o g r e s s i v e r e l a x a t i o n treatment, open-ended s e l f - r e p o r t data from the s u b j e c t s seem to i n d i c a t e that the jogging treatment was p e r c e i v e d as more s a t i s f a c t o r y or j u s t as s a t i s f a c t o r y as a p r o g r e s s i v e r e l a x a t i o n stress-management i n t e r v e n t i o n . For example, 8 1 % of the e x e r c i s e s u b j e c t s responded that the jogging program helped them (somewhat to o f t e n ) cope b e t t e r with s t r e s s compared to 76% of the r e l a x a t i o n group at posttreatment. However, 56% of the joggers s a i d t h e i r mood changed from negative to p o s i t i v e as a r e s u l t of jogging compared to 25% of the r e l a x a t i o n group ( f o r r e l a x a t i o n ) . A d d i t i o n a l l y , joggers tended to c o n t r i b u t e maintenance of t h e i r program t o : (a) f e e l i n g good (54%), (b) e s t a b l i s h i n g an e x e r c i s e p a t t e r n (50%), and, (c) b e t t e r h e a l t h (46%). For s u b j e c t s i n the r e l a x a t i o n group, e s t a b l i s h i n g a p a t t e r n of p r a c t i s e (60%) helped them maintain r e l a x a t i o n . Future s t u d i e s may want to explore these f i n d i n g s . It should be noted that g e n e r a l i z a b i l i t y of r e s u l t s from t h i s study are l i m i t e d to sedentary working women who v o l u n t e e r e d f o r a stress-management treatment to h e l p them cope with work s t r e s s . 7 2 In summary, the r e s u l t s demonstrated that a e r o b i c e x e r c i s e was as e f f e c t i v e as p r o g r e s s i v e r e l a x a t i o n i n reducing a n x i e t y and i n c r e a s i n g general s e l f - e f f i c a c y f o r sedentary working women. However, only s e l f - r e p o r t data were used to measure treatment outcome whereas a multimodal approach may have pr o v i d e d more s p e c i f i c i n f o r m a t i o n on outcome data (Kazdin, 1980). For example, f u t u r e s t u d i e s may i n c o r p o r a t e both b e h a v i o r a l and p h y s i o l o g i c a l dependent v a r i a b l e s to determine i f the treatments produced the d e s i r e d e f f e c t s . More s p e c i f i c a l l y , b e h a v i o r a l measures (e.g., o b s e r v a t i o n i n c o n t r i v e d s i t u a t i o n s ) may be used to observe a s u b j e c t ' s coping behavior while p h y s i o l o g i c a l measures such as an electromyogram (EMG) may be used as an o b j e c t i v e i n d i c a t o r of r e l a x a t i o n . The n o t i o n of coping as an outcome measure f o r stress-management treatments needs f u r t h e r r e s e a r c h . In t h i s study s u b j e c t s were asked to i d e n t i f y how they coped with a work-related s t r e s s o r during the past two weeks. I t i s p o s s i b l e that coping s t r a t e g i e s changed only w i t h i n s p e c i f i c types of work s t r e s s o r s (e.g., i n t e r p e r s o n a l , workload). Furthermore, although i t was not tapped in t h i s study, i d e n t i f y i n g the i n d i v i d u a l s who f e e l that they s u c c e s s f u l l y d e a l t with the s t r e s s o r may add to the t h e o r e t i c a l knowledge base of coping (Menaghan & Merves, 1984). 73 In a d d i t i o n , researchers may want to explore the re la t i onsh ip between s e l f - e f f i c a c y (as a general t r a i t ) and E-focused coping (in spec i f i c s i t u a t i o n s ) . There i s some ind ica t ion that for working women s e l f - e f f i c a c y is negatively re lated to E-focused coping. Further study of th i s r e l a t i o n s h i p may provide information on the issue of consistency in coping ( i . e . , do women who score low on s e l f - e f f i c a c y cons i s t ent ly use E-focused coping in the work s i t u a t i o n ) . 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E f f e c t s of p r o g r e s s i v e r e l a x a t i o n and m e d i t a t i o n on c o g n i t i v e and somatic m a n i f e s t a t i o n s of d a i l y s t r e s s . Behavior Research  and Therapy, 20, 461-468. 88, Young, R.J., & I s m a i l , A.H. (1976). P e r s o n a l i t y d i f f e r e n c e s of a d u l t men before and a f t e r a p h y s i c a l f i t n e s s program. Research Q u a r t e r l y , 47, 513-519. APPENDIX A lephone Screening Interview Informed Consent 90 TELEPHONE PROTOCOL P a r t i c i p a n t s l e f t t h e i r telephone number and name on a telephone answering s e r v i c e i n the r e c r e a t i o n department. A l l c a l l s were ret u r n e d w i t h i n one week. TELEPHONE INTERVIEW RECORD SUBJECT'S Name Work Phone PROCEDURES: ( i n t r o d u c e s e l f , and study) The purpose of t h i s study i s to o f f e r a stress-management program and to examine how you d e a l with s t r e s s . There w i l l be a $15.00 r e g i s t r a t i o n charge and p a r t i c i p a n t s w i l l be expected to a t t e n d a l l s e s s i o n s and a f i n a l one hour i n t e r v i e w 8-weeks a f t e r the l a s t s e s s i o n . Your involvement w i l l be f o r 8 weeks, once a week f o r one and one-half hours i n a group program. You w i l l be given some paper and p e n c i l p s y c h o l o g i c a l assessments at the f i r s t i n t e r v i e w , d u r i n g your l a s t group meeting and d u r i n g the f i n a l i n t e r v i e w . There w i l l be two programs o f f e r e d , one w i l l i n v o l v e r e l a x a t i o n and the other w i l l i n v o l v e e x e r c i s e as a means to d e a l with your s t r e s s . ( P a r t i c i p a n t s must be w i l l i n g to be a s s i g n e d e i t h e r to a r e l a x a t i o n or e x e r c i s e program). Do you have any q u e s t i o n s ? Would you l i k e to p a r t i c i p a t e ? Before we set a date f o r the i n i t i a l i n t e r v i e w I would l i k e l i k e to ask you a few q u e s t i o n s . Is t h e r e any reason why you may not be a b l e to p a r t i c i p a t e i n an e x e r c i s e program? (high blood p r e s s u r e , l e g problems). How o f t e n do you e x e r c i s e ? (what t y p e — m u s t be l e s s than 3 times per week—30 minutes or l e s s ) . When was the l a s t time you e x e r c i s e d on a r e g u l a r b a s i s ? Have you ever been i n v o l v e d i n a r e l a x a t i o n or stress-management program? Would you p r e f e r to p a r t i c i p a t e i n a program on Sat. or Sun. or would you p r e f e r a Tuesday or Wednesday evening? In the p e r s o n a l i n t e r v i e w I w i l l be a s k i n g you q u e s t i o n s such a s : "Can you d e s c r i b e s i t u a t i o n s at work which make you f e e l a n x i o u s , and What do you do when you f e e l s t r e s s e d ? " Set the date and time f o r i n t e r v i e w — l e a v e phone number to c o n t a c t i f they can't make i t . 91 I n t e r v i e w P r o t o c o l Check the i n d i v i d u a l telephone sheet to make sure t h a t both the work and home phone numbers are c o r r e c t . Ask the s u b j e c t s where they heard about the program. Ask they i f they have any q u e s t i o n s about the telephone c a l l . Ask them to read the informed consent and v e r b a l l y e x p l a i n i t to them before they s i g n i t . Questions? ( B a s i c a l l y i t reviews what was s a i d i n the telephone c a l l ) . Do a review of time commitments e i g h t one and one-half hour s e s s i o n s - - f o l l o w - u p i n t e r v i e w i n May. A l s o mention that i n the 8th s e s s i o n they w i l l be asked to f i l l out q u e s t i o n n a i r e s . The follow-up s e s s i o n w i l l be s i m i l a r to t h i s i n t e r v i e w only i t w i l l be done i n small groups. Go over the Par Q with a l l s u b j e c t s . Ask them i f th e r e i s any reason why they may not be ab l e to p a r t i c i p a t e i n the e x e r c i s e program. Check that they are e x e r c i s i n g l e s s than 3 times per week ( f o r l e s s than 30 minutes per s e s s i o n ) . Ask the s u b j e c t s to d e s c r i b e two c h r o n i c work s t r e s s o r s . T h i s i s to prepare them f o r the f i r s t q u e s t i o n n a i r e . A f t e r they have d e s c r i b e d the s t r e s s o r s ask them to f i l l i n the Tension Thermometer. They must score 5 or over t o be p a r t of t h i s program. Then ask them to f i l l out the f i r s t q u e s t i o n n a i r e make sure they understand the i n i t i a l i n s t r u c t i o n s and c l a r i f y t h a t a f t e r they have w r i t t e n out the s t r e s s o r they w i l l be answering the r e s t of the q u e s t i o n s with r e f e r e n c e to i t ( t h i s w i l l take from 15 92 to 20 m i n u t e s — l e a v e the room). Before f i l l i n g out the next set of q u e s t i o n n a i r e s g i v e the s u b j e c t s the f o l l o w i n g i n f o r m a t i o n on the programs. (1) Both groups w i l l c o n s i s t of aproximately 15 women with 2 c o - l e a d e r s . (2) The purpose of the f i r s t s e s s i o n w i l l be to meet the other members of the group and to l e a r n about s t r e s s . We w i l l a l s o d i s c u s s how the program you are i n has been s u c c e s s f u l as a stress-management program. (3) E x p l a i n the e x e r c i s e program—a walk/jog i n d i v i d u a l program which w i l l s t a r t at the l e v e l you are at and progress slowly with the i n t e n s i o n of t e a c h i n g you b a s i c jogging s k i l l s . (4) E x p l a i n P r o g r e s s i v e R e l a x a t i o n — y o u w i l l l e a r n to t i g h t e n and r e l a x v a r i o u s muscle groups i n your body so t h a t you w i l l be a b l e to a t t a i n complete r e l a x a t i o n (you w i l l be s i t t i n g c omfortably i n c h a i r s while the l e a d e r s guide you through the r e l a x a t i o n p r o c e s s ) . Have the s u b j e c t s randomly s e l e c t an envelope which i n d i c a t e s the group they w i l l be i n and g i v e them a form with the time, date, l o c a t i o n , p a r k i n g area, and phone number of the group l e a d e r on i t . ( t h i s form w i l l a l s o g i v e i n s t r u c t i o n s on what to wear f o r the f i r s t s e s s i o n ) . A l l p a r t i c i p a n t s w i l l be telephoned a few days be f o r e the f i r s t s e s s i o n s t a r t s . Thank them f o r coming. INFORMED CONSENT DOCUMENT 93 Date: November, 1985 Purpose of the Study: T h i s i n v e s t i g a t i o n i s being conducted to a s s i s t working women i n managing t h e i r s t r e s s and a n x i e t y . Procedure: As a p a r t i c i p a n t you w i l l be asked to do s e v e r a l t h i n g s : 1. Take paper and p e n c i l t e s t s (20-30 minutes) at the beginning and end of the i n v e s t i g a t i o n . 2. P a r t i c i p a t e i n 8 group t r a i n i n g s e s s i o n s which w i l l not exceed 1V2 hours i n l e n g t h per s e s s i o n . 3. Return 8 weeks a f t e r the completion of the. se s s i o n s f o r a one hour p e r s o n a l i n t e r v i e w d u r i n g which you w i l l again complete paper and p e n c i l t e s t s . 4. Pay $15.00 T h i s i s to c e r t i f y that I, , hereby agree to v o l u n t a r i l y p a r t i c i p a t e i n t h i s i n v e s t i g a t i o n on s t r e s s . I have been t o l d that I do not have to p a r t i c i p a t e i n t h i s i n v e s t i g a t i o n , that I am f r e e to withdraw my consent and may terminate my p a r t i c i p a t i o n at any time, and t h i s w i l l not j e o p a r d i z e my op p o r t u n i t y to p a r t i c i p a t e i n other programs sponsored by U.B.C.'s School of P h y s i c a l Education and R e c r e a t i o n . Anything I say or data that i s c o l l e c t e d w i l l remain c o n f i d e n t i a l with regard to my i d e n t i t y . I understand that I am f r e e to deny any answer t o s p e c i f i c items or q u e s t i o n s i n i n t e r v i e w s or q u e s t i o n a i r e s or d u r i n g the t r a i n i n g s e s s i o n s . I have had a chance to ask any q u e s t i o n s I want about t h i s i n v e s t i g a t i o n , and they have been answered to my s a t i s f a c t i o n . I have a l s o been t o l d that I may ask any q u e s t i o n s I have at any time d u r i n g the i n v e s t i g a t i o n , and that they w i l l be answered to my s a t i s f a c t i o n . date p a r t i c i p a n t ' s s i g n a t u r e F a c u l t y S u p e r v i s o r B o n i t a Long I n v e s t i g a t o r ' s S i g n a t u r e ;94 APPENDIX B Tension Thermometer Par Q No. 9 5 PAST WEEK TENSION THERMOMETER T h i n k back o v e r t h e p a s t week. Take each day s e p a r a t e l y and remember as 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 ou e x p e r i e n c e d . Now, u s e t h e t h e r m o m e t e r below t o r a t 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 ( o n l y s l i g h t l y r e l a x e d - 7 6 t e n s e - 5 4 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 ) P H Y S I C A L A C T I V I T Y R E A D I N E S S Q U E S T I O N N A I R E ( P A R - Q ) * A Self-administered Questionnaire for Adults .96 mm I K wmlm ISIS! P A R - Q is designod to holp you holp yourself. Many health benefits are associated with regular exerc iso , and tho completion o( P A R - Q is a sensible t i rsl step to take il you are planning to increase the amount of physical act iv i ty in your l i fe. For most people physical act iv i ty should not pose any problem or hazard. P A R - Q has been designed to identify the small number of adults for whom physical act iv i ty might be inappropriate or thjpse who should have medical advice concerning tho type of act iv i ty most suitable for them. Common sense is your best guide in answering these few quest ions. P lease read them care-fully and check the 0 Y E S or NO opposite tho question if it applies to you . Y E S NO • • 2 . • • 3 -• • 5 . • • a -Mas your doctor ov<;r said you havo hoar! trotiblo? Do you frequently havo pains In your hoart and chest? Do you olten leel faint or havo spe l ls of severo d izz iness? Has a doctor over said your blood pressure was too high? Has your doctor ever told you that you have a bone or join! problem such as arthrit is that has been aggravated by exerc ise , or might bo made worse with exerc ise? Is there a good physical reason no! monlioned here why you should not lo l low an act iv i ty program even if you wanted to7 Are you over age 65 and not accustomed to vigorous exerc ise? If you have not recently done so, consult with your personal physic ian by telephone or in person B E F O R E increasing your physical act iv i ty and/or taking a fitness test. Te l l him what questions you answered Y E S on P A R - Q , or show him your copy. mmmmmm After modical ovalunt ion, seok advico from your physic ian as to youi sui tabi l i ty lor; O unrestricted physical act iv i ty , probably on a gradually increasing bas is . © restricted or supervised act iv i ty to meet your spoc i l i c needs, at least on an ini t ial bas is . Check in your community for special programs or serv ices . If you answered PAR--Q accurately, you have reasonable assurance of your present suitabi l i ty for: © A G R A D U A T E D E X E R C I S E P R O G R A M -A gradual increase in proper exercise p i o -motes good fitness development while mini-mizing or eliminating discomfort. © A N E X E R C I S E T E S T - Simple tests of fit-ness (such as the Canadian Home F i tness Test) or more complex types may be under-taken i l you so des i re . mmmm If you have a temporary minor i l lness, Such as a common co ld . i 97 APPENDIX C Examples of P e r c e i v e d S t r e s s o r s 9# EXAMPLES OF PERCEIVED STRESSORS T r y i n g to keep up with the workload. Tension due to a b o r i n g job. Constant pressure--phones r i n g i n g . Homework Marking p i l i n g u p — c o n s t a n t . Heavy w o r k l o a d - - t i g h t d e a d l i n e . V i s i t o r s c o n t i n u i n g t o a r r i v e on the job. Constant i n t e r r u p t i o n s . S t r e s s f u l union meetings. Anxious about how a major p r o j e c t w i l l t u r n out. Unable to c o n c e n t r a t e at work. How I w i l l express myself at bus i n e s s meetings. Being blamed f o r problems which are not under my c o n t r o l . Students not l i s t e n i n g to i n s t r u c t i o n s . P r e ssures of emergency h o s p i t a l work. R e o r g a n i z a t i o n of work s e t t i n g ( l a y o f f s e t c . ) . D i f f i c u l t c l i e n t s . D i s r u p t i v e passengers. Lack of morale on the job. Boss d i f f i c u l t to get along with. 99 APPENDIX D Dependent Measures General S e l f - E f f i c a c y S c a l e ion S e l f - E f f i c a c y I n s t r u c t i o n s : F o r e a c h s t a t e m e n t l i s t e d b e l o w , i n d i c a t e t o what d e g r e e , on the f o u r t e e n p o i n t s c a l e , you agre e o r d i s a g r e e w i t h the s t a t e m e n t as a r e f l e c t i o n o f how you f e e l about y o u r s e l f . S t r o n g l y Agree S t r o n g l y D i s a g r e e 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1. When I make p l a n s , 1 am c e r t a i n I can make them work. 2. One of my pro b l e m s i s t h a t 1 c a n n o t g e t down t o work when I s h o u l d . 3. I f I c a n ' t do a j o b the f i r s t t i m e . I keep t r y i n g u n t i l I c a n . 4. When I s e t i m p o r t a n t g o a l s f o r m y s e l f , I r a r e l y a c h i e v e them. 5. I g i v e up on t h i n g s b e f o r e c o m p l e t i n g them. 6. I a v o i d f a c i n g d i f f i c u l t i e s . 7. I f something l o o k s t o o c o m p l i c a t e d , I w i l l n ot even b o t h e r t o t r y i t . 8. When I have something u n p l e a s a n t t o do, I s t i c k t o i t u n t i l I f i n i s h i t . 9. When I d e c i d e t o do s o m e t h i n g , I go r i g h t t o work on i t . 10. When t r y i n g to l e a r n s o m e t h i n g new, I soon g i v e up i f I am not i n i t i a l l y s u c c e s s f u l . 11. When u n e x p e c t e d problems o c c u r , I don't h a n d l e them w e l l . 12. I a v o i d t r y i n g t o l e a r n new t h i n g s when they l o o k too d i f f i c u l t f o r me. 13. F a i l u r e j u s t makes me t r y h a r d e r . 14. I f e e l i n s e c u r e about my a b i l i t y t o do t h i n g s . 15. I am a s e l f - r e l i a n t p e r s o n . 16. I g i v e up e a s i l y . 17. I do n o t seem c a p a b l e of d e a l i n g w i t h most problems t h a t come up i n l i f e . APPENDIX E Revised form of C h e c k l i s t F a c t o r A n a l y s i s and R e l i a b i l i t y 102 Revised Coping C h e c k l i s t Coping was asses s e d with a r e v i s e d v e r s i o n of the Ways of coping C h e c k l i s t (Folkman & Lazarus, 1980). The r e v i s e d instrument (Lazarus & Folkman, 1984) co n t a i n s 67 items on a 4-point s c a l e . S u b j e c t s were asked to w r i t e out the most s t r e s s f u l work event o c c u r i n g w i t h i n the past two weeks and to read each item on the c h e c k l i s t and then i n d i c a t e to what extent they used i t i n the s i t u a t i o n j u s t d e s c r i b e d . F a c t o r S t r u c t u r e The 67-item c h e c k l i s t was ad m i n i s t e r e d to 192 working women aged 18 to 61 (M=35.4, SD=9.7). F o r t y percent of the sample were married, 34% were s i n g l e and 18% were d i v o r c e d or separated. Twenty-two percent of the women had a hig h s c h o o l e d u c a t i o n , 22% from 1 to 3 years of c o l l e g e , 45% a u n i v e r s i t y degree and 11% p r o f e s s i o n a l degrees (MA, PhD). See Appendix F f o r a d e s c r i p t i o n of occupations and p r o f e s s i o n s . The items were analyzed u s i n g a p r i n c i p a l components f a c t o r a n a l y s i s c a l l i n g f o r two f a c t o r s ( t h e o r i z e d as P-focused and E-focused) u s i n g varimax r o t a t i o n . F i f t e e n items loaded h i g h l y on each of the two f a c t o r s . The other 28 items were e l i m i n a t e d because they (a) lac k e d c o n c e p t u a l coherence, (b) loaded below .40, or (c) loaded on both f a c t o r s . 103" The t h i r t y items which made up the f i n a l c h e c k l i s t was s u b j e c t e d to another f a c t o r a n a l y s i s and accounted f o r 29% of the t o t a l v a r i a n c e . I tern-analysis supported the above f a c t o r s t r u c t u r e and i n d i c a t e d s t r o n g i n t e r n a l c o n s i s t e n c y w i t h i n each s c a l e (Cronbach's alphas equal r= .81 f o r b o t h ) . Coping S c a l e s (Revised 30 Items) P-Focused F a c t o r Loading 10 T r i e d not t o burn my .46 b r i d g e s , but leave t h i n g s somewhat open. 20 I was i n s p i r e d to do .51 something c r e a t i v e . 23 Changed or grew as a .56 person i n a good way. 26 I made a p l a n of a c t i o n and f o l l o w e d i t . .51 30 I came out of the .60 experience b e t t e r than I went i n . 31 Talked t o someone who .53 c o u l d do something concrete about the problem. 34 Took a b i g chance or .41 d i d something very r i s k y . 35 I t r i e d not t o a c t too .46 h a s t i l y or f o l l o w my f i r s t hunch. 39 Changed something so .65 t h i n g s would t u r n out a l l r i g h t . 46 Stood my ground and .61 fought f o r what I wanted. 49 1 knew what had t o be .45 done, so I doubled my e f f o r t s t o make t h i n g s work out. 52 Came up w i t h a couple .70 of d i f f e r e n t s o l u t i o n s to the problem. 56 I changed something .48 63 I thought about how a .40 person i admire would handle t h i s s i t u a t i o n and used t h a t as a model. 64 I t r i e d t o see t h i n g s .50 from the other person's p o i n t of view. E-Focused F a c t o r Loading 9 C r i t i s i z e d or l e c t u r e d .48 myself. 11 Hoped a m i r a c l e would .47 happen. 12 Went along w i t h f a t e , .48 sometimes I j u s t have bad l u c k . 21 T r i e d to f o r g e t the .42 whole t h i n g . 24 I w a i t e d to see what .47 would happen before doing a n y t h i n g . 29 R e a l i z e d I brought on .48 the problem m y s e l f . 33 T r i e d t o make myself .56 f e e l b e t t e r by e a t i n g , smoking, u s i n g drugs or m e d i c a t i o n e t c . 40 Avoided being w i t h .53 people i n g e n e r a l . 43 Kept o t h e r s from .43 knowing how bad t h i n g s were. 47 Took i t out on other .50 people. 51 I made a promise to .54 myself tha t t h i n g s would be d i f f e r e n t next time. 55 Wished that I c o u l d .55 change what had happened or how I 57 I daydreamed or .62 I was i n . 58 Wished that the .60 s i t u a t i o n would go away. 59 Had f a n t a s i e s or wishes .72 about how t h i n g s might t u r n out. 105 APPENDIX F A n c i l l a r y Measures ( p r e / p o s t / f o l l o w - u p ) 7-Day R e c a l l Occupat ions Homework Sheets Expectancy Q u e s t i o n n a i r e No. 106 EXERCISE HISTORY 7-DAY RECALL Please r e c o r d your p a t t e r n of p h y s i c a l a c t i v i t y over the past week. I t i s e a s i e r i f you work backwards from todays date. I f you don't know e x a c t l y how long you e x e r c i s e d , estimate as w e l l as you can. Refer to the c h a r t below to estimate i n t e n s i t y (Borg S c a l e ) . Day A c t i v i t y (describe) Duration i n Minutes I n t e n s i t y * * Monday Tuesday Wednesday Thursday F r i d a y Saturday Sunday **Borg Scale To r a t e the i n t e n s i t y of a c t i v i t y , you are to r a t e your f e e l i n g s which are caused by the work and not the work i t s e l f . These f e e l i n g s should be g e n e r a l , that i s about the body as a whole. We are not askin g you to s p e c i f y the f e e l i n g , but to s e l e c t a number which most a c c u r a t e l y corresponds to your per c e p t i o n of your t o t a l body f e e l i n g . Keep i n mind th a t t h ere are no r i g h t or wrong numbers. Use any number you t h i n k i s a p p r o p r i a t e : 6 7 Very, very l i g h t 8 9 Very l i g h t 10 11 F a i r l y l i g h t 12 13 Somewhat hard 14 15 Hard 16 1.7 Vory Iwird 18 1<) Vi'iy, vory Imnl OCCUPATIONS PROFESSIONS S e c r e t a r y Book Keeper Nurse Teacher C o u n s e l l o r Student L i b r a r i a n Computer C o n s u l t a n t Computer Programmer S a l e s Manager Admi n i s t r a t e r D i r e c t o r Telecommunications W a i t r e s s F l i g h t Attendent S e l f Employed Baby S i t t e r I n s t r u c t o r s T r a v e l Agent P r o f e s s o r 108 WITH REGARD TO COPING WITH STRESS: (POST ONLY) 5. In what ways, i f any do you f e e l d i f f e r e n t l y See next ( i . e . , e m o t i o n a l l y ) than you d i d before t h i s page f o r workshop s t a r t e d ? q u e s t i o n 5, 6 and 6. In what ways do you behave d i f f e r e n t l y ( i . e . , 7. what you do) than you d i d before t h i s workshop s t a r t e d ? 7. In what ways do you t h i n k d i f f e r e n t l y ( i . e . , u n derstandings) than you d i d before t h i s workshop s t a r t e d ? 8. To what degree have you been s u c c e s s f u l w i t h your r e l a x a t i o n / j o g g i n g g o a l s . 1 2 3 4 5 u n s u c c e s s f u l moderately very GOAL 1 GOAL 2 GOAL 3 EX REL EX REL EX REL 4 16 12 16 4 32 23 20 19 24 27 20 19 36 31 32 15 16 39 12 34 12 42 16 15 16 4 16 12 4 (1 s u b j e c t d i d not l i s t 3 go a l s ) To what degree, i f at a l l , were the f o l l o w i n g a s p e c t s of t h i s program h e l p f u l to you i n l e a r n i n g t o cope w i t h s t r e s s ? ( c i r c l e the answer) (a) support and encouragement of the group EX. M = 3.7 1 2 3 4 5 REL. M = 3.0 not a t a l l somewhat very (b) the a c t u a l ( j o g / r e l a x ) a c t i v i t y EX. M = 4.0 1 2 3 4 5 REL. M = 3.9 not at a l l somewhat very (c) d i s c u s s i o n s a f t e r the a c t i v i t y EX. M = 3.5 1 2 3 4 5 REL. M = 2.9 not at a l l somewhat very (d) i n c r e a s e d knowledge of s t r e s s EX. M = 3.6 1 2 3 4 5 REL. M = 3.7 not at a l l somewhat very (e) encouragement from the l e a d e r s EX. M = 4.1 1 2 3 4 5 REL. M = 3.8 not at a l l somewhat very 109 (POST ONLY) L i s t e d b e l o w a r e r e s p o n s e s l i s t e d most o f t e n , 5. I n what w a y s , i f any do y o u f e e l d i f f e r e n t l y ( i . e . , e m o t i o n a l l y ) t h a n y o u d i d b e f o r e t h i s w o r k s h o p s t a r t e d ? E x e r c i s e R e l a x a t i o n I f e e l I c a n c o n t r o l s t r e s s . I f e e l h a p p i e r . I f e e l more r e l a x e d . I f e e l more m o t i v a t e d . I f e e l l e s s s e r i o u s . I f e e l more r e l a x e d . I a p p e a r l e s s t e n s e . I f e e l more i n c o n t r o l , I f e e l more c o n f i d e n t . I am somewhat h a p p i e r . 6. I n what ways do y o u b e h a v e d i f f e r e n t l y ( i . e . , what y o u do) t h a n y o u d i d b e f o r e t h i s w o r k s h o p s t a r t e d ? E x e r c i s e R e l a x a t i o n I r e c o g n i z e s t r e s s f u l s i t u a t i o n s s o o n e r . I e x e r c i s e r e g u l a r l y . U n d e r s t r e s s I am c a l m e r . I t h i n k b e f o r e r e a c t i n g . I s e e more a l t e r n a t i v e s t o p r o b l e m s . I am more m o t i v a t e d . I s m i l e a n d l a u g h more. I am more a s s e r t i v e i n p e r s o n a l s i t u a t i o n s . I t a k e t i m e f o r m y s e l f , I d o n ' t r e a c t a s n e g a t i v e l y . I'm o n l y d o i n g work t h a t i n t e r e s t s me. I u s e m u s c l e t e n s i o n r e l a x a t i o n t e c h n i q u e s . 7. I n what ways do y o u t h i n k d i f f e r e n t l y ( i . e . , u n d e r s t a n d i n g ) t h a n y o u d i d b e f o r e t h i s w o r k s h o p s t a r t e d ? E x e r c i s e R e l a x a t i o n I u n d e r s t a n d my own s t r e s s " t r i g g e r s " . I am n o t s o q u i c k t o r e a c t . I am more c o n s c i o u s a b o u t r e l a x i n g , I h a v e more c o n t r o l . I r e a l i z e t h e i m p o r t a n c e o f e x e r c i s e . I r e c o g n i z e e m o t i o n a l w e l l - b e i n g i s i m p o r t a n t . I d o n ' t c a r e a b o u t my e m p l o y e r s h a r r a s s m e n t t e c h n i q u e s . I am more a w a r e o f t e n s i o n . I h a v e e s t a b l i s h e d p r i o r i t i e s - w h a t must be done--what I am U n d e r s t a n d more a b o u t my own s t r e s s . 110 POST AND FOLLOW-UP QUESTIONNAIRE INSTRUCTIONS: Read the q u e s t i o n s c a r e f u l l y and c i r c l e the a p p r o p r i a t e answer. Post % Follow-up % EX. REL. EX. REL. In g e n e r a l , t o what degree do you 0 0 0 4 s u c c e s s f u l l y cope w i t h s t r e s s i n 4 4 4 8 NONWORK s i t u a t i o n s ? 39 56 52 52 42 32 26 28 15 8 18 8 1 2 3 4 5 not at a l l somewhat very w e l l In g e n e r a l , t o what degree do you s u c c e s s f u l l y cope w i t h s t r e s s i n WORK s i t u a t i o n s ? 0 0 0 4 23 12 1 2 4 23 44 38 48 42 32 50 32 12 12 0 1 2 1 2 3 4 5 not at a l l somewhat very w e l l 1 2 3 4 5 not at a l l somewhat very w e l l (POST ONLY) To what e x t e n t i s j o g g i n g / r e l a x a t i o n h e l p i n g you d e a l w i t h s t r e s s ? 4 8 15 16 35 48 42 20 4 8 4. To what e x t e n t do you use the f o l l o w i n g elements of r e l a x a t i o n / j o g g i n g to r e l i e v e s t r e s s ? RELAXATION/JOGGING AS: Post % F o l l o w -up (a) a d i s t r a c t o r 1 5 1 6 20 17 19 12 1 3 20 1 2 3 4 5 27 36 20 38 never somewhat o f t e n 27 24 25 17 12 12 17 17 (b) a sense of c o n t r o l 12 8 17 8 1 2 3 4 5 19 44 21 29 never somewhat o f t e n 12 28 21 33 42 16 29 29 1 5 4 1 3 0 (c) mood change from n e g a t i v e to p o s i t i v e 4 8 8 13 8 28 4 17 1 2 3 4 5 23 28 33 46 never somewhat o f t e n 39 24 29 25 27 12 25 0 (d) a t e n s i o n r e l e a s e 4 8 0 8 1 2 3 , 4 5 0 20 8 4 never somewhat o f t e n 27 32 25 17 39 40 38 54 31 0 29 17 (e) a f e e l i n g of w e l l - b e i n g 0 4 0 4 1 2 3 4 5 8 1 2 0 35 never somewhat o f t e n 1 5 28 19 26 42 36 42 34 35 20 27 0 I l l (FOLLOW-UP ONLY) 5. D i d any major s t r e s s e s occur d u r i n g the past EX.% REL.% two months? YES 46 32 NO 50 68 6. D i d you seek any a d d i t i o n a l h e l p f o r s t r e s s EX. REL. d u r i n g the past two months? (check ) ( S u b j e c t s i n d i c a t e d more than 1 response) M e d i c a l ( f a m i l y p h y s i c i a n ) 27 24 C o u n s e l l i n g 4 8 E x e r c i s e T r a i n i n g 23 8 S e l f - h e l p ( i . e . , books) 0 4 S t r e s s workshops 0 4 R e l a x a t i o n t r a i n i n g 0 20 Other 16 12 None 56 44 7. What has gotten i n the way of m a i n t a i n i n g your EX. REL. j o g g i n g / r e l a x a t i o n program? (S u b j e c t s i n d i c a t e d more than 1 response) work schedule p r o c r a s t I n a t i o n p e r s o n a l motivation_ i l l n e s s weather i n j u r y h o i iday l a z i n e s s other 54 40 28 40 20 56 28 16 50 0 28 0 12 0 36 0 0 40 EX. REL. YES 12 8 NO 88 92 . Have you changed jobs d u r i n g the past two months? 10. To what extent have you maintained your j o g g i n g / r e l a x a t i o n program? EX. M = 3.04 1 2 3 4 5 REL. M = 2.20 not a t a l l somewhat very much so • E x e r c i s e Question Only: 8. To what do you c o n t r i b u t e maintence of e x e r c i s e ? EX. ( S u b j e c t s i n d i c a t e d more than 1 response) spouse/partner support 28 s o c i a l experience 20 e s t a b l i s h e d p a t t e r n of e x e r c i s e ~ 50 f e e l i n g good 54 h e a l t h 46 other 24 112 HOMEWORK CHARTS The a v e r a g e number o f p r a c t i s e s e s s i o n s p e r EX. REL. week. 3 3 The l e n g t h o f p r a c t i s e s e s s i o n s . EX. REL. Mean ( m i n u t e s ) 25 15 Range 15-60 10-40 F e e l i n g s b e f o r e e x e r c i s e / r e l a x a t i o n . t e n s e g e a r e d up t i r e d a n n o y e d c a l m up t i g h t l a z y e n e r g e t i c h y p e r r u s h e d ok g o o d F e e l i n g s a f t e r . r e l a x e d e n e r g e t i c t i r e d g o o d g r e a t e x h a u s t e d e x h i l e r a t e d b e t t e r r e f r e s h e d warm c a l m l e s s t e n s e R a t i n g s o f p e r c e i v e d e x e r t i o n f o r E X E R C I S E . B o r g s c a l e R a n g e — ( 6 - 2 0 ) Mean (13) R a t i n g s o f p e r c e i v e d a n x i e t y f o r RELAXATION. A n x i e t y s c a l e R a n g e — ( 1 - 1 0 0 ) Mean (25) See n e x t page f o r d e s c r i p t i o n s o f t h e B o r g s c a l e a nd t h e A n x i e t y s c a l e . WEEKLY RELAXATION CHAPT DAY FEELING BEFORE LENGTH (min.) RATING OF ANXIETY FEELING AFTER 1 A b s o l u t e l y Calm ANXIETY RATING SCALE Think of the worst a n x i e t y you have ever e x p e r i e n c e d or can imagine e x p e r i e n c i n g , and a s s i g n to t h i s the number 100. Now t h i n k of the s t a t e of being a b s o l u t e l y calm and c a l l t h i s z e r o . Mow you have a s c a l e of a n x i e t y . On t h i s s c a l e , how do you r a t e y o u r s e l f a t t h i s moment? 10 0 H i g h e s t A n x i e t y 113 DAY FEELING BEFORE WEEKLY EXERCISE CHART LENGTH OF .TOG/^aT,? f n i n ) * RPF FT-?T,T''r. RTTTR 6 7 very, very l i g h t 8 9 very l i g h t 10 II f a i r l y l i g h t 12 13 somewhat hard 14 15 hard 16 17 very hard 18 19 very very hard 20 BORG SCALE To r a t e the i n t e n s i t y of a c t i v i t y , you are to r a t e your f e e l i n g s which are caused by the work and n o t the work i t s e l f . These f e e l i n g s should be g e n e r a l , that i s about the body as a whole. We are not a s k i n g you to s p e c i f y the f e e l i n g , but to s e l e c t a number which most a c c u r a t e l y corresponds to vcur t o t a l body f e e l i n g . Keep ir. mine t h a t there are no r i g h t or wronc answers. Use any number you t h i n k i s a p p r o p r i a t e . i i t n e s s *P.PE Rate o f P e r c e i v e d E x e r t i o n (Borg S c a l e ) 114 Mo. Da t.e: 115 EXPECTANCY QUESTIONNAIRE 1. "How c o n f i d e n t a r e you t h a t t h i s program w i l l be s u c c e s s f u l i n r e d u c i n g y o u r s t r e s s r e a c t i o n s ? " Not a t a l l V e r y much so 2 . "How l o g i c a l docs t h i s t y p e o f program seem t o you as a s t r e s s management t e c h n i q u e ? " 0 1 2 3 A 5_ 6 _ Not a t a l l V e r y much so 3 . "How c o n f i d e n t a r e you i n recommending the program t o n f r i e n d who i s e x t r e m e l y a n x i o u s ? " Not at a l l V e r y much so Number 116 1. How c o n f i d e n t are you t h a t t h a t t h i s program has been s u c c e s s f u l i n r e d u c i n g your s t r e s s r e a c t i o n s ? not a t a l l very much so 2. How l o g i c a l does t h i s type of program seem to you as a stress-management technique? not a t a l l very much so 3. How c o n f i d e n t are you i n recommending-the program to a f r i e n d who i s extremely anxious? not a t a l l very much so 

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