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Is breathing control an effective coping strategy for public speaking anxiety? Hait, Aaron Vincent 1991

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S BREATHING CONTROL AN EFFECTIVE COPING STRATEGY FOR PUBLIC SPEAKING ANXIETY? By AARON VINCENT HAIT B.A., The University of B r i t i s h Columbia, 1983 M.A., The University of B r i t i s h Columbia, 1987 .A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE STUDIES Department of Psychology We accept t h i s thesis as conforming with the required standard THE UNIVERSITY OF BRITISH COLUMBIA A p r i l 1991 @ Aaron Vincent Hait, 1991 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of Ps 1* c HQ UP U Y The University of British Columbia Vancouver, Canada DE-6 (2/88) i i Abstract Two studies were conducted to determine whether controlled, abdominally-predominant breathing could be accurately implemented during periods of acute anxiety by speech anxious/phobic in d i v i d u a l s , and what e f f e c t breathing control has on autonomic and subjective indices of anxiety. Twenty-two moderately speech anxious young adults took part in Study 1. The r e s u l t s of t h i s study indicated that after two weeks of t r a i n i n g , only 50% of trainees were able to implement the controlled breathing technique with any degree of accuracy while waiting to d e l i v e r an impromptu speech before a small audience. No one were successful at r e l i a b l y implementing the technique during the speech i t s e l f . As i n previous research, t r a i n i n g had l i t t l e impact on autonomic arousal but was associated with improvements i n self-reported anxiety. Similar findings emerged for Study 2, which d i f f e r e d from Study 1 in that i t involved a larger (N = 48) and more highly speech anxious sample who participated in a longer (4-week), more intensive t r a i n i n g program. Although t r a i n i n g had l i t t l e e f f e c t on subjective or autonomic arousal during speech a n t i c i p a t i o n and speech delivery, i t did r e s u l t i n s i g n i f i c a n t l y higher predictions of speech aptitude and emotional control r e l a t i v e to no treatment. Such findings suggest that breathing control i s not a useful emotion-focused coping strategy on i t s own, but may add to the effectiveness of exposure-based therapies by enhancing patients' s e l f - e f f i c a c y and willingness to expose themselves to feared situations. i i i T a b l e o f Co n t e n t s TITLE PAGE i ABSTRACT i i TABLE OF CONTENTS i i i LIST OF TABLES i v LIST OF FIGURES v i i i ACKNOWLEDGEMENTS ix INTRODUCTION 1 PURPOSES OF STUDY 1 9 METHOD 11 Subjects 11 Research Design 12 Recording Equipment and Materials 13 Procedure 18 DATA REDUCTION AND ANALYSES 2 6 Treatment Implementation 26 Treatment Outcome 2 9 RESULTS 31 Treatment Implementation 31 Treatment Outcome 3 3 DISCUSSION ,. . . 36 PURPOSES OF STUDY 2 48 Breathing Control Implementation ., 49 Breathing Control Effectiveness 49 iv METHOD 50 Subjects 50 Research Design 53 Recording Equipment and Materials 53 Procedure 60 DATA REDUCTION AND ANALYSES 73 Treatment Implementation 73 Treatment Outcome 75 RESULTS 76 Treatment Implementation 76 Treatment Outcome 78 Corre l a t i o n a l Analyses 81 DISCUSSION . 82 Breathing Control Accuracy 82 Treatment Outcome 86 Overall Conclusions 91 REFERENCES 9 5 TABLES 106 FIGURES 12 6 APPENDICES 13 0 A. Advertisement for Subjects 130 Public Speaking Anxiety Survey 131 Instructions: PSA Survey 132 V B. Subjective Units of Discomfort Scale: Pre-Speech.... 133 Speech Expectancy Scale '. . 134 Bodily Sensations Checklist 135 Credibility/Expectancy for Improvement Scale 136 Social Phobia Interview ' 137 Personal Report of Communication Apprehension 141 Subjective Units of Discomfort Scale 142 Symptom Rating Scale.. 143 C. Script - Telephone interview 144 D. Participant consent form: Study 1 146 Participant consent form: Study 2 147 Consent to Videotaping Form 148 E. Home practice handout - Week 1 149 Home practice handout - Week 2 151 Home practice handout - Week 3 152 Home practice diary 153 Notes on e f f e c t i v e speaking 154 v i L i s t of Tables 1. Summary of Pretreatment Assessment Procedures: Studies 1 and 2 106 2. Summary of Individual Treatment Procedure: Study 1 .... 107 3. Respiratory Responses (Means +/- SD) of Trained and Untrained Subjects in Sessions 1 (PRE) and 2 (POST): Study 1 108 4. Cardiovascular Responses- (Means +/- SD) of Trained and Untrained Subjects in Sessions 1 (PRE) and 2 (POST): Study 1 109 5. Predictions (Means +/- SD) of Speech-related Anxiety, Emotional Control, and Aptitude by Trained and Untrained Subjects: Study 1 110 6. Pretreatment Characteristics (Means +/- SD) of Treatment and W a i t l i s t Subjects: Study 2 I l l 7. Summary of Group Treatment Procedure: Study 2 112 8. Percentage of Trained and Untrained Subjects Meeting the Breathing Control C r i t e r i o n in Each Period of Session 2: Study 2 113 9. Autonomic and Respiratory Responses (Means +/- SD) of Trained and Untrained Subjects in Sessions 1 (PRE) and 2 (POST) : Study 2 114 10. SUDS Ratings (Means +/- SD) of Trained and Untrained Subjects in Sessions 1 (PRE) and 2 (POST): Study 2 115 11. Number and Intensity of Anxiety Responses (Means +/- SD) Reported by Trained and Untrained Subjects: Study 2 .... 117 12. Predictions (Means +/- SD) of Speech-related Anxiety, Emotional Control, and Aptitude by Trained and Untrained Subjects: Study 2 118 13. E f f e c t Sizes for Within- and Between-Group Comparisons of Physiological Responses in Each Period of Sessions 1 (PRE) and 2 (POST) : Study 1 119 14. E f f e c t Sizes for Within- and Between-Group Comparisons of Self-report Responses in Sessions 1 (PRE) and 2 (POST) : Study 1 120 v i i 15. E f f e c t Sizes for Within- and Between-Group Comparisons of Physiological Responses in Each Period of Sessions 1 (PRE) and 2 (POST): Study 2 121 16. E f f e c t Sizes for Within- and Between-Group Comparisons of Self-report Responses in Sessions 1 (PRE) and 2 (POST) : Study 2 122 17. Selected Correlations from Session 1 of Study 2 124 v i i i L i s t of Figures 1. Mean r e s p i r a t i o n rates of trained and untrained subjects i n each period of Sessions 1 and 2: Study 1 126 2. Mean heart rates of trained and untrained subjects i n each period of Sessions 1 and 2: Study 1 127 3. Mean exhalation lengths of trained and untrained subjects i n each period of Sessions 1 and 2: Study 2 128 4. Mean heart rates of trained and untrained subjects i n each period of Sessions 1 and 2: Study 2 129 Acknowledgements This d i s s e r t a t i o n was completed with the help of a number of key i n d i v i d u a l s . Foremost among them i s my advisor, Dr. Wolfgang Linden. Thanks Wolfgang for the many times you helped to sharpen my research focus, for providing incredible technical support, and for being so approachable. Most of a l l , thanks for helping me to believe in myself. Additional thanks go to the many research assistants who worked long and hard on t h i s project. They include: Sharon Avery, Michelle Bowers, Andrea Con, Noushie Dadgar, Jola Drabik, Sid Fensome, Welman Lee, Allen Lehman, Ron Nadin, Sonia Pietsch, V a l e r i e Stowell, Ted Watson, and J u l i e Wells. It was a pleasure working with you a l l . I would also l i k e to thank Drs. Anita DeLongis and Boris Gorzalka for t h e i r important contributions as members of my d i s s e r t a t i o n committee. Thanks also go to Dr. Jim Enns for his help with s t a t i s t i c s and to Dr. Elizabeth Dean for providing constructive comments during the early stages of t h i s project. Most of a l l , I would l i k e to thank my wife Carla-Marie for p e r s i s t i n g with me through t h i s long ordeal and for doing such a marvellous job as my editor. Your patience and encouragement have been appreciated more than I can say. 1 Introduction The emergence of panic disorder as a unique diagnostic category i n DSM-III-R has sparked new and innovative ways of looking at the phenomenon of anxiety and how best to t r e a t i t . One of the new approaches to t r e a t i n g t h i s age-old problem i s breathing control t r a i n i n g . To date, at least nine treatment outcome studies have been conducted with panic disorder/ agoraphobic patients i n which some form of breathing control t r a i n i n g was included, either as the p r i n c i p a l intervention or as an adjunct to well established interventions such as graduated exposure and cognitive restructuring (e.g. de Ruiter, Rijken, Garssen, & Kraaitmaat, 1989; Hegel, Abel, Etscheidt, Cohen-Cole, & Wilmer, 1990; Michelson, Marchione, Greenwald, Glanz, Testa, & Marchione, 1990; Michelson, Marchione, & Mavissakalian, 1985; Salkovskis, Jones, & Clark, 1986). Interest i n controlled breathing has an even broader basis however. For years now, psychologists have been teaching c l i e n t s to adopt a slower, deeper, more rhythmic breathing pattern as part of stress management strategies l i k e Benson's (1975) "relaxation response", Bernstein and Borkovec's (1979) "progressive relaxation t r a i n i n g " , and Luthe's (1963) "autogenic t r a i n i n g " . Health care professionals have also advocated breathing control procedures for a variety of patients, including those preparing for p a i n f u l / s t r e s s f u l medical examinations or recovering from s u r g i c a l procedures (Bar t l e t t , Gazzaniga, & Geraghty, 1973; Flaherty & F i t z p a t r i c k , 1978; Healey, 1968; 2 Lindeman & Van Aernam, 1971; Mogan, Wells, Robertson, 1985), as well as patients with chronic disorders such as hypertension ( B a l i , 1979; English & Baker, 1983; Jacob, Kraemer, & Agras, 1977; Patel, 1977), chronic pain ( P h i l i p s , 1987), chronic obstructive pulmonary disease (Tiep, Burns, Kao, Madison, & Herrara, 1986), and idiopathic seizures (Fried, Rubin, Carlton, & Fox, 1984). P r a c t i t i o n e r s of various meditation and yoga procedures have likewise ascribed considerable importance to controlled breathing (Benson, Beary, & Carol, 1974; Fenwick, Donaldson, & Bushman, 1977; Goleman & Schwartz, 1976; Lehrer & Woolfolk, 1984; Singh, 1984; Wallace & Benson, 1972; Woolfolk, 1975). However, i t i s not at a l l c l e a r from the research l i t e r a t u r e why breathing control, and in p a r t i c u l a r slow, abdominally-predominant breathing, should have a p o s i t i v e impact on autonomic arousal or subjective d i s t r e s s . The r e s u l t s of several controlled laboratory investigations with healthy i n d i v i d u a l s suggest that a single session of t r a i n i n g to breathe more slowly with the aid of some external pacing mechanism (e.g. timing l i g h t s , tones, r e s p i r a t i o n tracings) has l i t t l e , i f any, e f f e c t on reducing p h y s i o l o g i c a l arousal to various acute stressors (Cappo & Holmes, 1984; Clark & Hirschman, 1980; Epstein & Webster, 1975; Harris, Katkin, Lick, & Habberfield, 1976; Holmes, McCaul, & Solomon, 1978; McCaul, Solomon, & Holmes, 1979). In contrast, the r e s u l t s of several treatment outcome and case studies involving p s y c h i a t r i c patients (e.g. Clark, Salkovskis, & 3 Chalkley, 1985; Compernolle, Hoogduin, & Joele, 1979; Grossman, de Swart, & Defares, 1985; Kraft & Hoogduin, 1984) and patients with various medical disorders (e.g. B a l i , 1979; English & Baker, 1983; Jacob et a l . , 1977; Patel, 1977; Tiep et a l . , 1986) have generally been quite p o s i t i v e , suggesting that breathing control t r a i n i n g may have a ro l e in reducing arousal and/or anxiety. The discrepancy between the apparent e f f e c t of breathing control on healthy and c l i n i c a l subjects draws attention to a fundamental problem in the l i t e r a t u r e on breathing control e f f e c t s . The problem i s that researchers and c l i n i c i a n s a l i k e make a number of assumptions about controlled breathing which have yet to be adequately tested. For instance, i t i s often assumed that slow, rhythmic, abdominally-predominant breathing can d i r e c t l y attenuate autonomic and somatic arousal. Some c l i n i c i a n s have even suggested that i t can induce a pleasurable "hypometabolic state" when combined with mental focusing techniques (Beary & Benson, 1974; Benson, 1975). In turn, the attenuation of phys i o l o g i c a l arousal i s commonly believed to r e s u l t i n reduced lev e l s of subjective d i s t r e s s , the primary goal of many relaxation/coping strategies (Borkovec & Sides, 1979a). In the l i t e r a t u r e on stress reduction strategies, one of the most commonly prescribed procedures for reducing subjective d i s t r e s s involves teaching c l i e n t s to reduce t h e i r l e v e l s of muscle tension by systematically tensing and relaxing d i f f e r e n t muscle groups. Other c l i e n t s are taught to reduce autonomic 4 arousal d i r e c t l y v i a techniques such as skin temperature and blood pressure biofeedback. The proponents of these methods reason that the response being learned i s opposite to the one manifested when the c l i e n t i s anxious or stressed (Jacob & Chesney, 198 6). To some extent, t h i s assumption has been borne out i n the enormous research l i t e r a t u r e that has accumulated over the past two decades (see Lehrer & Woolfolk (1984) for a comprehensive review of the l i t e r a t u r e ) . Although a number of cardiorespiratory reflexes have been i d e n t i f i e d whereby adjustments in the rate, depth, or rhythmicity of breathing can af f e c t heart rate and blood flow (Grossman, 1983; Schaefer, 1979; Shepherd, 1981; Stern & Anschel, 1968), i t has yet to be shown that the sustained practice of some breathing technique y i e l d s a corresponding decrease i n cardiovascular arousal ( i . e . reduced sympathetic tone). Even i f strategies such as slow, deep breathing are c l e a r l y found to attenuate autonomic arousal, i t i s possible that cognitive processes are responsible for t h i s e f f e c t rather than d i r e c t p h y s i o l o g i c a l ones. For instance, by p r a c t i c i n g controlled breathing, an i n d i v i d u a l ' s sense of s e l f - c o n t r o l and self-confidence may increase to the point where he or she no longer perceives the stressor as threatening. The decreased arousal observed i n t h i s s i t u a t i o n cannot simply be attributed to some s p e c i f i c p h y s i o l o g i c a l e f f e c t of the breathing strategy. Rather, i t may as a r e s u l t of reappraising a s i t u a t i o n as nonthreatening that arousal i s attenuated. The extent to which t h i s interpretation i s true can 5 be determined i n part from the person's self-reported confidence i n the breathing strategy, by the amount of t r a i n i n g he/she has had i n using the technique, and/or by his or her self-reported locus of perceived control. A l t e r n a t i v e l y , the practice of breathing control may have i t s arousal-attenuating e f f e c t s by d i s t r a c t i n g the i n d i v i d u a l from focusing on the stressor. The importance of attention d i s t r a c t i o n has long been recognized by psychologists who use exposure-based techniques l i k e systematic d e s e n s i t i z a t i o n to t r e a t phobic c l i e n t s (Craske, Street, & Barlow, 1989). However, the s p e c i f i c r o l e of d i s t r a c t i o n v i a diaphragmatic and paced breathing has yet to be evaluated. The continued monitoring of some pacing machine or one's proprioceptive breathing cues (e.g. ribcage and abdominal movement) may draw attention away from other s t i m u l i i n the person's immediate environment, including his or her catastrophic, worrying thoughts. A second commonly-made assumption underlying breathing control t r a i n i n g i s that c e r t a i n breathing patterns are dysfunctional and therefore need correcting. In general, these patterns are the ones seen most often in c l i n i c a l l y - a n x i o u s i n d i v i d u a l s (Bass & Gardner, 1985a; 1985b; Damas-Mora, Grant, Kenyon, Patel, & Jenner, 197 6; Gibson, 197 8; Lum, 1981; Skarbek, 1970; Tobin, Chadha, Jenouri, & Sackner, 1983). They are also reported to occur in normal individuals encountering r e a l - l i f e or laboratory stressors (Dudley, Holmes, Martin, & Ripley, 1964; 6 Hait & Linden, 1987; Ley, 1985b; Salkovskis, Warwick, Clark, & Wessels, 1986; Suess, Alexander, Smith, Sweeney, & Marion, 1980; Svebak, Dalen, & S t o r f j e l l , 1981). Faulty breathing habits are assumed to d i r e c t l y or i n d i r e c t l y influence emotional and cognitive functioning (e.g. Bass & Gardner, 1985b; Cowley & Roy-Byrne, 1987; Garssen, van Veenendaal, & Bloemink, 1983; Hibbert, 1984a; Huey & West, 1983; Ley, 1985a; 1988; Magarian, 1982; Salkovskis, Clark & Jones, 1986) . More s p e c i f i c a l l y , panic attacks are considered by some investigators to be the end r e s u l t of a v i c i o u s cycle i n i t i a t e d by acute overbreathing ( i . e . breathing i n excess of metabolic requirements). Whatever the cause of such overbreathing, the c r i t i c a l outcome i s a biochemically-mediated experience of cognitive and somatic symptoms that are thought to p r e c i p i t a t e a panic attack i n i n d i v i d u a l s who c a t a s t r o p h i c a l l y misinterpret t h e i r meaning (e.g. heart p a l p i t a t i o n s are interpreted as a sign of an impending f a t a l heart attack). Considerable overlap has been demonstrated between the symptoms of panic and hyperventilation. Furthermore, these symptoms have been reported to be successfully reduced or eliminated i n the majority of chronic hyperventilators who underwent breathing control t r a i n i n g (Grossman et a l . , 1985; Lum, 1976; Magarian, 1982). The r e s u l t s of two uncontrolled c l i n i c a l t r i a l s conducted with panic disorder/agoraphobic patients have also shown c l i n i c a l l y meaningful improvement with t h i s form of treatment given either alone (Clark et a l . , 1985; Salkovskis et 7 a l . , 1986) or i n combination with other strategies (e.g. Bonn, Readhead, & Timmons, 1984; Michelson, Mavissakalian, & Marchione, 1988) . A t h i r d , r elated assumption i s that slow, deep, even breathing achieved primarily by abdominal movement (versus shallow or ribcage-predominant breathing) i s the i d e a l breathing pattern to teach i n d i v i d u a l s experiencing acute or chronic emotional d i s t r e s s . This pattern i s often r e f e r r e d to as "diaphragmatic breathing", although t h i s i s a misnomer since a l l breathing involves movement of the diaphragm to some extent. Slow, abdominally-predominant breathing i s apparently taught because i t i s the pattern opposite to the one observed when people are anxious or stressed. But as several investigators have reported, when healthy subjects are trained to reduce t h e i r breathing rate by half i n a single session, they often experience increased rather than decreased somatic and subjective arousal (e.g. Harris et a l . , 1976). Other researchers have also noted that deep i n s p i r a t i o n s r e f l e x i v e l y increase heart rate (Deane, 1965; Sroufe, 1971), as well as increase the work of breathing. To date, most of the research on breathing control has involved rate manipulations. However, because t h i s strategy requires subjects to attend to some external pacing machine (or at the very least to s i l e n t l y count out the length of each breathing c y c l e ) , subjects l i k e l y had limited capacity to attend to other aspects of t h e i r immediate environments. Such 8 a t t e n t i o n a l demands may make paced breathing a useful strategy where ind i v i d u a l s are prone to dwell excessively on some upcoming aversive experience (e.g. awaiting an in j e c t i o n ) , but there are many other s i t u a t i o n s in which continuous d i s t r a c t i o n might be counterproductive (e.g. preparing to give a t a l k ; d r i v i n g a car). Paced breathing may also be too d i f f i c u l t to maintain i n some highly demanding, anxiety-laden sit u a t i o n s . Based on the research to date, i t i s not clear what the ide a l rate and depth of breathing i s , i f such an ideal even e x i s t s . Equally uncertain i s whether either of these two breathing parameters should be the focus of se l f - r e g u l a t i o n t r a i n i n g . F i n a l l y , i t i s generally assumed that breathing control strategies can be learned quickly and then accurately reproduced in situations where they are thought to be of greatest benefit, namely, where the trainee i s a n t i c i p a t i n g or a c t i v e l y coping with some anxiety provoking object or event. Furthermore, the benefits of such tr a i n i n g are frequently expected to be evident soon after i t s onset. However, conclusive evidence to support t h i s assumption i s lacking (Faling, 1986) . Because these assumptions about breathing control have been large l y ignored i n the l i t e r a t u r e there remains considerable uncertainty about whether breathing control t r a i n i n g i s of value, eith e r alone or as an adjunct to other interventions. Equally uncertain i s why breathing control t r a i n i n g should be of benefit. In other words, by what mechanism might i t influence subjective 9 and p h y s i o l o g i c a l indices of anxiety or arousal? Answers to these questions w i l l help to elucidate there i s a p h y s i o l o g i c a l basis for breathing control t r a i n i n g and whether one form should be advocated over another. Study l Purposes of Study 1 The purpose of the present research project was to address these untested assumptions with regard to usefulness of breathing control i n mitigating anxiety, p a r t i c u l a r l y p u b lic speaking anxiety. The f i r s t objective was to determine whether i n d i v i d u a l s who are taught a simple abdominally-predominant breathing strategy for attenuating anxiety/stress are able to reproduce t h i s pattern accurately when confronted with a personally-relevant stressor. Given that psychological stress can occur both i n a n t i c i p a t i o n of, and during, encounters with threatening events, a stress management strategy should be reproducible in both s i t u a t i o n s . If a breathing strategy i s to be considered useful, people must be able to implement i t during the stressor a n t i c i p a t i o n period, a period when attentional demands are r e l a t i v e l y low. If i t i s reproducible during the actual encounter with the stressor then the strategy may have additional value. In the past, people have been found to have d i f f i c u l t y implementing other forms of relaxation when a c t i v e l y encountering stressors (Cauthen & Prymak, 1977; Cuthbert, K r i s t e l l e r , Simons, Hodes, & Lang, 1981). The success of abdominal/diaphragmatic breathing where other strategies have f a i l e d would suggest i t receive greater attention as a stress management technique. The second objective of the present research project was to determine whether controlled abdominal breathing i s e f f e c t i v e i n reducing subjective and physiological arousal to highly feared events. As discussed e a r l i e r , the evidence for a physiologically-mediated e f f e c t of breathing control strategies i s weak; however, they do appear to e l i c i t lower l e v e l s of s e l f -reported anxiety. The two studies conducted as part of t h i s project were designed to t e s t the effects of controlled breathing on anxiety in the following ways. F i r s t , the breathing control t r a i n i n g taught i n each study involved (a) a plausible r a t i o n a l e , (b) graduated practice towards an i n d i v i d u a l i z e d goal for rate and depth of breathing, and (c) focusing each subject's attention on proprioceptive feedback rather than on some external feedback mechanism. Second, breathing control was taught to a population known to experience a high l e v e l of arousal to a stressor that can be simulated well in the laboratory, namely, in d i v i d u a l s with public speaking phobia giving a brief speech to a small audience (Beidel, Turner, & Dancu, 1985; Kirsch & Henry, 1979). And t h i r d , the length of t r a i n i n g was markedly increased from the sing l e 5-20 minute session common in previous studies to 2-3 60-minute sessions conducted over a 2-3 week period. Subjects also practiced d a i l y at home. Method Subjects Twenty-two young adults from the University of B r i t i s h Columbia took part i n t h i s treatment outcome study. They were re c r u i t e d v i a newspaper and classroom advertisements (Appendix A) for a free three-week t r a i n i n g program on strategies for managing public speaking anxiety. The s p e c i f i c i n c l u s i o n and exclusion c r i t e r i a are l i s t e d below. Inclusion c r i t e r i a . 1) Self-reported ratings of at least 60 on a scale ranging from 0 (complete calm) to 100 (absolute panic) describing the l e v e l of anxiety t y p i c a l l y experienced just minutes before giving a t a l k to an audience of 10 or more people. This cut-off score was thought to represent a moderately high l e v e l of public speaking anxiety. 2) A score of 700 or higher on the 14-item Subjective Units of Discomfort Scale: Pre-speech (Appendix B). Exclusion c r i t e r i a . 1) Self-report of health problems that might be exacerbated by exposure to acute stress (e.g. asthma, coronary heart disease) or might i n t e r f e r e with breathing control t r a i n i n g (respiratory i n f e c t i o n s , emphysema). 12 2) Concurrent p a r t i c i p a t i o n i n any other form of treatment for public speaking anxiety or DSM-III-R anxiety disorder. Sample c h a r a c t e r i s t i c s . The 22 subjects in t h i s study were randomly assigned to the treatment and w a i t l i s t control conditions. The sample included an equal number of men and women with a mean age of 21.6 + 2.9 years. The average pre-speech anxiety r a t i n g reported by subjects was 7 6.2 + 9.9. Although seemingly high, t h i s score was l a t e r found to be i n the normal range, based on the responses of 215 undergraduates at the University of B r i t i s h Columbia to a public speaking anxiety survey (Appendix A). A s i m i l a r finding emerged for scores on the Subjective Units of Discomfort Scale: Pre-speech questionnaire (mean = 786 + 124). These findings suggest that subjects were mildly to moderately speech anxious at the outset of t h i s study. Research Design This study can be summarized as a simple between-groups comparison (treatment versus no-treatment) involving both a pretest and a posttest. During each assessment session, repeated observations were obtained on a variety of dependent measures. Observations were recorded during a quiet r e s t period, while a n t i c i p a t i n g a stressor, and while a c t i v e l y engaged with the stressor. A two-week delay separated the pre- and posttreatment assessment sessions. In summary, the research design was of the following form: 2 (Group) X 2 (Session) X 3 (Recording Period). 13 Recording Equipment and Materials Three types of data were recorded in t h i s study: 1) autonomic; 2) s e l f - r e p o r t ; and 3) respiratory. T h e ' f i r s t two were included to assess treatment outcome; the t h i r d served both as a manipulation check and as a biofeedback source i n treatment. Autonomic measures. Autonomic a c t i v i t y was assessed on the basis of three cardiovascular measures: (1) heart rate (HR), (2) s y s t o l i c blood pressure (SBP), and (3) d i a s t o l i c blood pressure (DBP). These measures were chosen because of t h e i r frequent use i n e a r l i e r research on the effectiveness of breathing control strategies (e.g. Harris et a l . , 1976) and in studies of public speaking anxiety (e.g. Matias & Turner, 1986; McKinney & Gatchel, 1982). They have also been used frequently i n studies of anxiety responses to acute laboratory stressors (e.g. Hait & Linden, 1987; Linden, 1986; Linden, McEachern, & Frankish, 1985). Furthermore, heart rate, and to some extent s y s t o l i c blood pressure, represent objective, indices of the most commonly reported symptom of public speaking anxiety, namely, a pounding, racing heart. F i n a l l y , these measures can be obtained noninvasively, thereby l i m i t i n g the extent to which speech stressor responses are contaminated by equipment-induced arousal. A l l three cardiovascular measures were obtained v i a an automated blood pressure monitor (Dinamap 845 V i t a l Signs Monitor, C r i t i c o n Corporation) with the pressure cuff positioned 14 around the subject's upper arm (nondominant arm). Blood pressure measurements with the Dinamap monitor have been found to cor r e l a t e highly with i n t r a - a r t e r i a l measurements (Borow & Newburger, 1982). Respiratory measures. Four types of respiratory a c t i v i t y indices were recorded i n t h i s study. These include r e s p i r a t i o n rate, ribcage amplitude, abdominal amplitude, and v a r i a b i l i t y i n abdominal amplitude. Ribcage amplitude i s a measure of thoracic wall displacement. With each inhalation, the thoracic wall extends outwards. The degree of outward extension varies as a function of inhalation depth. S i m i l a r l y , abdominal amplitude represents displacement of the abdominal wall during each breathing cycle. The v a r i a t i o n i n outward movement of the abdominal wall from one breathing cycle to the next defines abdominal amplitude v a r i a b i l i t y . A l l four measures were obtained v i a bellows s t r a i n gauges, one attached around the subject's abdomen 5 cm below the sternum and the other fastened around his/her chest at the l e v e l of the armpits. The abdominal s t r a i n gauge was positioned d i r e c t l y against the subject's skin and secured i n place with s u r g i c a l tape. The thoracic s t r a i n gauge was secured over the subject's clothes with safety pins. In t h i s way, movement a r t i f a c t s were minimized i n the respiratory recordings. Output from the abdominal gauge was fed into a Beckman coupler (Model 9872) integrated with a Sensormedics Dynagraph (Model R611). This 15 si g n a l was f i l t e r e d (frequencies higher than 3 0 Hz were eliminated) and amplified (.1 mV/mm) to y i e l d the cleanest, most interpretable tracings possible, as determined by previous t e s t i n g . In addition, the coupler's s e n s i t i v i t y s e t t i n g was adjusted to produce signal amplitudes equivalent to those generated by the thoracic gauge coupler (Sensormedics Model 9853A) over a wide range of resistance changes. The thoracic gauge si g n a l was also f i l t e r e d (frequencies higher than 30 Hz and lower than .53 Hz were eliminated), with s i g n a l a m p l i f i c a t i o n set at .01 mV/mm. With the recording equipment arranged i n t h i s way, i t was possible to simultaneously record the amplitude of respi r a t o r y movements i n both respiratory compartments. Furthermore, because the two couplers had been c a l i b r a t e d to be equivalent i n s e n s i t i v i t y , i t was possible to d i r e c t l y compare ribcage amplitude with abdominal amplitude. Self-report measures. Four s e l f - r e p o r t measures were used to assess treatment outcome. These included the Speech Expectancy Scale (SES), the Symptom Rating Scale (SRS), the Subjective Units of Discomfort Scale (SUDS), and the Treatment Credibility/Expectancy for Improvement Scale. The SES i s a 3-item scale developed e s p e c i a l l y for t h i s study to assess public speaking s e l f - e f f i c a c y (Appendix B). The scale was administered following announcement of each impromptu speech. Subjects rated, on a 0-100 scale, how anxious they expected to f e e l during the upcoming speech, how much control they anticipated having over anxiety, and how well they thought they would do at t h e i r speeches. High ratings on the f i r s t item and low ratings on the second two indicate low s e l f - e f f i c a c y . The SRS (Appendix B) was also developed s p e c i f i c a l l y for t h i s study and consists of the 12 DSM-III-R symptoms of panic disorder, plus two symptoms commonly reported by speech anxious ind i v i d u a l s (dry mouth and memory lapse) and two infrequently reported symptoms (chest pain and choking). Together, these 16 symptoms represent a subset of those included on many previous inventories used to assess hyperventilation and panic (e.g. Barlow, 1988; Chambless, Caputo, Bright, & Gallagher, 1984; Clark & Helms-ley, 1982; Grossman & deSwart, 198,4; Huey & West, 1983; Ley, 1985a; Margraf, Taylor, Ehlers, Roth, & Agras, 1987; Rachman, L e v i t t , & Lopatka, 1987). Immediately a f t e r each impromptu speech, subjects rated the i n t e n s i t y of a l l 16 symptoms on a 0 (not even noticeable) to 100 (very intense) v i s u a l analog scale. Two summary scores were obtained from these ratings (1) the number of symptoms rated at or above 25, and (2) the average i n t e n s i t y of a l l 16 symptoms. A cut-off r a t i n g of 25 was chosen because i t provides a reasonably clear i n d i c a t i o n that a p a r t i c u l a r symptom had act u a l l y been experienced. I t was also thought to approximate the "1 = mild" cut-off point reported for the more commonly used 0-4 anxiety rating scale (e.g. Michelson et a l . , 1985). 17 Post-speech verbal ratings of speech-related anxiety were obtained on the 0 (no anxiety) to 100 (complete panic) SUDS scale. This scale has a long history of use i n the assessment and treatment of anxiety disorders (e.g. Clark et a l . , 1985; Craske & Craig, 1984). It i s easy to administer and i n t e r p r e t . Furthermore, c l i n i c a l use suggests that i t i s s e n s i t i v e to changes i n perceived anxiety l e v e l . However, published data on i t s psychometric properties are unavailable. Subjects i n the treatment group also completed an a d d i t i o n a l questionnaire known as the Treatment Credibility/Expectancy for Improvement Scale (Appendix B). This questionnaire consists of f i v e standard questions regarding the perceived relevance and effectiveness of treatment (Borkovec & Nau, 1972). Subjects rated how r a t i o n a l they perceived the treatment to be and how confident they were in i t s effectiveness by c i r c l i n g a number from 0 (not at a l l logical/confident) to 10 (very l o g i c a l / c o n f i d e n t ) . A maximum score of 50 on t h i s scale r e f l e c t s extreme confidence i n treatment. P r i o r research has shown that scores on t h i s scale correlate highly with treatment outcome, i r r e s p e c t i v e of they type of treatment (Agras, Horne, & Taylor, 1982). Expectation for anxiety r e l i e f has been demonstrated to be an important factor in p o s i t i v e response to progressive relaxation t r a i n i n g and systematic d e s e n s i t i z a t i o n (Borkovec, 1972; 1973; Gatchel & Procter, 1976), and to meditation (Bradley & McCanne, 1981). 18 Two other s e l f - r e p o r t measures were administered pretreatment to confirm that subjects were at l e a s t moderately speech anxious. The f i r s t was a 14-item r a t i n g scale known as the Subjective Units of Discomfort Scale: Pre-Speech (SUDS:PS). The 14 scale items represent a hierarchy of public speaking s i t u a t i o n s . Using a 0-100 scale, subjects rated how anxiety-provoking each s i t u a t i o n would be for them. Although t h i s scale has been used i n e a r l i e r speech anxiety research, d e t a i l s on i t s psychometric properties are unknown. The second measure was a SUDS r a t i n g of how anxious subjects t y p i c a l l y f e e l moments before giving a speech. It was obtained during a 15-minute assessment interview on the nature and severity of subjects' public speaking d i f f i c u l t i e s . Procedure A summary of the procedure can be found i n Table 1. Upon a r r i v a l at the recording room, subjects were introduced to the research assistant and then seated i n a straight-backed armchair located i n an adjoining, sound-attenuated room. Parti c i p a n t consent was obtained in writing following a s c r i p t e d overview of the experimental protocol (Appendix D). The p h y s i o l o g i c a l recording equipment was then attached to subjects by the assistant. Female assistants performed t h i s task with female subjects for e t h i c a l reasons. The function and safety of the equipment was described i n order to a l l a y any concerns about i t . Once the equipment had been checked and adjusted, subjects 19 remained seated qu i e t l y alone for 10-12 minutes. During t h i s waiting period, they completed the SUDS:PS questionnaire. Baseline period (BL). The 10-minute baseline period began once the a s s i s t a n t had l e f t the room. Physiological recordings were obtained during the l a s t minute of t h i s period. These served as baseline measures. Once these recordings had been obtained, the experimenter conducted a 20-minute assessment interview with each subject. Speech a n t i c i p a t i o n period (ANT). At the end of the interview, subjects were informed that i n f i v e minutes they would be expected to give a 4-minute impromptu speech to a small audience on a s p e c i f i e d t o p i c . They were also t o l d that t h e i r t a l k s would be videotaped for l a t e r review. After giving written consent to the videotaping (Appendix D), subjects completed the Speech Expectancy Scale. The speech topic was then presented. In Session 1, subjects were asked to speak about why they sought treatment for public speaking anxiety and the importance of public speaking to t h e i r present or future careers. (The topic for the posttreatment session was "Which personal q u a l i t i e s of yours are you most proud of and why?"). Subjects were reminded that they had four minutes to prepare for the speech. It was also suggested that they t r y to relax during t h i s period. 20 .Subjects were then l e f t alone for two minutes while the f i r s t p hysiological recordings were obtained (Minutes 1-2). At the beginning of Minute 3, the assistant set up the video camera and arranged chairs for the audience. The assistant was instructed not to speak with subjects during t h i s period. Further recordings were obtained between Minutes 3-4. Speech delivery period (SPE). Immediately aft e r the second of two a n t i c i p a t i o n period recordings had been obtained, the assistant instructed each subject to begin his/her speech. Subjects were reminded to remain seated throughout the speech. As in the a n t i c i p a t i o n period, physiological recordings were obtained between Minutes 1-2 and 3-4. The f i r s t time a subject stopped speaking for longer than 15 seconds, he/she was reminded to continue t a l k i n g for the f u l l four minutes. Subsequent pauses were l e f t unchallenged. In the event that subjects became noticeably distressed or c l e a r l y indicated that t h e i r speech was over before four minutes had elapsed, the assistant announced that the speech t e s t was over and thanked them for p a r t i c i p a t i n g . This occurred for three of the 22 subjects. Following the speech, a l l subjects completed the Symptom Rating Scale. Those in the treatment group were then given a 15-minute rationale for breathing control t r a i n i n g followed by 15 minutes of t r a i n i n g in abdominal/pursed l i p s breathing. Subjects 21 a s s i g n e d t o the w a i t l i s t c o n d i t i o n were i n v i t e d asked t o r e t u r n i n two weeks t o begin treatment. Breathing; c o n t r o l t r a i n i n g : S e s s i o n 1. A summary of the t r a i n i n g program can be found i n Table 2. As p a r t of the r a t i o n a l e f o r treatment, s u b j e c t s were shown r e c o r d i n g s of t h e i r b r e a t h i n g p a t t e r n s and c a r d i o v a s c u l a r responses. They a l s o monitored t h e i r own p u l s e r a t e s ( r a d i a l a r t e r y ) d u r i n g s e v e r a l deep i n s p i r a t i o n s and prolonged e x h a l a t i o n s i n order to v e r i f y e x h a l a t i o n i s a s s o c i a t e d with a r e f l e x i v e slowing of heart r a t e . During the t r a i n i n g p e r i o d , s u b j e c t s were i n s t r u c t e d to a t t e n d t o the r a t e , depth, and predominant mode of t h e i r b r e a t h i n g by p l a c i n g one hand f l a t a g a i n s t t h e i r c h e s t s and the other over t h e i r abdomens j u s t below the sternum. Next, they were coached t o i n c r e a s e the outward movement of t h e i r abdomens du r i n g i n s p i r a t i o n without i n c r e a s i n g , and p r e f e r a b l y d e c r e a s i n g , the amount of r i b c a g e movement. To a s s i s t s u b j e c t s i n l e a r n i n g t h i s technique, t h r e e mental images were d e s c r i b e d t o them. F i r s t , they were t o imagine a s o f t sponge b a l l (e.g. Nerf b a l l ) i n s i d e t h e i r abdomens which, d u r i n g e x h a l a t i o n , i s squeezed very s m a l l , but then q u i c k l y rebounds t o i t s o r i g i n a l s i z e a t the s t a r t of the next breath. The second image suggested was t h a t of a t a l l c o n t a i n e r separated i n t o two compartments by a t r a p door. Subje c t s were encouraged to imagine the top compartment f i l l e d w ith a heavy column of a i r which, when the t r a p door suddenly drops open, rushes down i n t o the lower compartment causing i t s f l e x i b l e walls to expand outwards. In the same way, subjects were to think of i n s p i r a t i o n as a rapid, r e l a t i v e l y e f f o r t l e s s expansion of t h e i r abdomens. F i n a l l y , i t was suggested that subjects think of t h e i r torsos as being l i k e a car t i r e with a puncture hole at the top. At the end of each i n s p i r a t i o n , the t i r e would be f u l l of a i r . Then, just as a i r would slowly leak out the punctured t i r e causing i t to s e t t l e downwards and outwards onto the road, so too they were to l e t a i r escape slowly from a small opening between t h e i r l i p s and notice t h e i r abdomens relaxing outwards. To ensure that subjects were accurately reproducing the prescribed breathing pattern ( i . e . a breathing rate between 7-11 breaths per minute with an abdominal amplitude at least' 50% greater than observed at rest but l i t t l e breath-by-breath f l u c t u a t i o n in amplitude), the t r a i n e r monitored each subject's thoracic and abdominal respiratory tracings by means of a video display connected to a video camera mounted above the polygraph in the adjacent room. This display was hidden from the subject's view. Verbal feedback was p e r i o d i c a l l y provided to them to reinforce successive approximations to the prescribed pattern. That pattern involved breathing at a rate of 7-11 respiratory cycles per minute (cpm) with an abdominal amplitude at least 50% greater than resting amplitude and l i t t l e v a r i a t i o n i n amplitude from breath to breath. After successfully reproducing the target pattern for at least one minute, subjects were shown t h e i r 23 tracings on the video screen and encouraged to manipulate these tracings by adjusting ribcage and abdominal movements. The f i r s t t r a i n i n g session concluded with an explanation of the homework assignment for the coming week. This assignment involved p r a c t i c i n g abdominal/pursed l i p s breathing for 10 minutes twice d a i l y . Subjects were encouraged to use t h e i r hands as they had i n the t r a i n i n g session to provide additional feedback on the extent of t h e i r ribcage and abdominal movements. The use of the mental imagery was also emphasized. A d a i l y recording sheet to enhance compliance and monitor practice time (Appendix E). Instructions were summarized i n a handout d i s t r i b u t e d at the end of the session (Appendix E). F i n a l l y , subjects completed the Treatment Credibility/Expectancy for Improvement Scale. Training session 2. Subjects i n the treatment condition returned for a second treatment session one week afte r Session 1. The 30-minute session began with a review of the previous week's homework. Subjects were asked to demonstrate the breathing technique they had been p r a c t i c i n g that week. A l l approximations to the target pattern were reinforced with praise, whereas deviations from t h i s pattern were pointed out and corrected. The t r a i n e r then modeled the breathing strategy and provided feedback to subjects as they practiced the strategy for f i v e more minutes. 24 In the remaining time, subjects were taught an exercise designed to enhance t h e i r awareness of, and control over, breathing during speech. The exercise required subjects to increase the length of time that they could sustain, at a constant p i t c h and volume, three d i f f e r e n t phonal sounds f i r s t modelled by the therapist. Subjects began by sounding the phoneme 'm' on three consecutive t r i a l s . Because t h i s sound i s formed by exhaling a i r exclusively through one's n o s t r i l s , the rate of exhalation i s slow and controllable. Subjects were coached to inhale s o l e l y v i a outward abdominal extension and to exhale s l i g h t l y more a i r than they normally would before taking t h e i r next breath. In t h i s way, subjects could learn to avoid gasping for a i r while speaking, a response that may lead to hyperventilation and increased subjective anxiety (Ley, 1985b). The same procedure was repeated in subsequent t r i a l s to produce the sounds 'oo' (moderate exhalation rate) and 'ah' (rapid exhalation r a t e ) . Subjects were encouraged to gradually lengthen these v o c a l i z a t i o n t r i a l s while maintaining good tonal qu a l i t y and volume. Incentive was provided by timing each t r i a l with a stopwatch. The f i n a l exercise involved reading a half-page paragraph u t i l i z i n g the s k i l l s learned in the previous exercises ( i . e . abdominal i n s p i r a t i o n ; sustained volume and p i t c h ; extended exhalation). Subjects were encouraged to stop speaking as soon as t h e i r voice quality began to deteriorate rather than r i s k running short of a i r and r e f l e x i v e l y gasping on the next breath. 25 Once, again, subjects were t o l d to monitor t h e i r respiratory movements with t h e i r hands and to correct performance errors i d e n t i f i e d by the t r a i n e r . The home assignment for that week was to practice both the phoneme exercise and the reading exercise once d a i l y each over the next week, and to log practice times on the recording sheet. It was also suggested that they continue p r a c t i c i n g the pursed l i p s breathing technique twice d a i l y . Assessment session 2 (posttreatment). The procedure followed in the posttreatment evaluation session (Session 2) was nearly i d e n t i c a l to the one followed i n Session 1. Both involved a baseline period followed by speech a n t i c i p a t i o n and delivery periods. Session 2 d i f f e r e d from Session 1 i n that (1) there was no assessment interview, (2) trainees were instructed to employ the breathing control strategy during the speech a n t i c i p a t i o n and delivery periods whereas t h e i r untreated peers were simply instructed to relax, and (3) trainees were t o l d that the purpose of the session was to assess t h e i r progress at the technique whereas w a i t l i s t subjects were t o l d that t r a i n i n g would begin once new baseline recordings had been obtained. Following the speech delivery period, subjects were debriefed regarding the purposes of the study. Those i n the w a i t l i s t group were offered the same t r a i n i n g program undertaken by the treatment group. In a l l cases, t h i s o f f e r was accepted. Treatment group members, on the other hand, were given additional feedback about changes observed in physiological and/or reported arousal over the course of t h e i r treatment. Videotaped recordings of t h e i r speeches were also made available to subjects. F i n a l l y , subjects were given copies of a 10-page handout on e f f e c t i v e public speaking (Appendix E). Data reduction and analyses Two types of data were generated in t h i s study. The f i r s t involved indices of treatment implementation ( i . e . r e s p i r a t i o n measures) whereas the second included indices of treatment e f f e c t ( i . e . cardiovascular and s e l f - r e p o r t measures). Treatment Implementation Respiratory a c t i v i t y was sampled during three periods of the pre- and posttreatment sessions. These periods were (1) baseline (BL), (2) speech a n t i c i p a t i o n (ANT), and (3) speech delivery (SPE). For each of the four respiratory measures (respiration rate, ribcage amplitude, abdominal amplitude, and abdominal amplitude v a r i a b i l i t y ) the two 30-second recordings (Minutes 1-2 and 3-4) obtained during the speech a n t i c i p a t i o n period were averaged to y i e l d single scores for that period. For the speech delivery period, only data recorded during the f i r s t minute were retained for analysis because of the low number of subjects who spoke long enough to obtain data during Minute 2-3. Respiratory recordings (60-second duration) were also obtained during the 27 f i r s t t r a i n i n g session to serve as reference values for evaluating subsequent technique accuracy. The. prescribed or reference pattern involved (1) breathing at a rate of 7-11 respiratory cycles per minute (cpm), (2) with an abdominal amplitude that was at least 50% greater than re s t i n g amplitude, and (3) l i t t l e breath-to-breath v a r i a b i l i t y i n abdominal amplitude ( i . e . v a r i a b i l i t y not s i g n i f i c a n t l y d i f f e r e n t from that observed during the "target" period of the f i r s t t r a i n i n g session). Trainees were expected to maintain t h i s pattern throughout the speech a n t i c i p a t i o n period. Two types of analyses were u t i l i z e d to evaluate breathing technique implementation. The f i r s t was a 2 (Group) X 2 (Session) X 3 (Recording Period) multivariate analysis of variance (MANOVA) involving the raw scores for a l l four of the respiratory parameters recorded in t h i s study. With respect to t h i s analysis, only the 2- and 3-way interactions involving the group and session factors were of inte r e s t . Subsequent simple e f f e c t s t e s t i n g involving Group X Session comparisons was planned in the event that either the 2- or 3-way interactions were s t a t i s t i c a l l y s i g n i f i c a n t . With t h i s analysis approach, i t was possible not only to determine whether trainees breathed d i f f e r e n t l y from t h e i r untrained peers following treatment, but also at what point in the assessment session ( i . e . r e s t i n g baseline, speech ant i c i p a t i o n , speech delivery) such differences occurred. 28 The decision to include Session 1 ( i . e . pretreatment) data in the analyses rather than covary them out was based on a l o g i s t i c a l problem associated with the MANOVA design. Neither of the two main s t a t i s t i c a l analysis programs currently available (SPSS:X and BMDP) permit one to include a unique covariate for each of several variates ( i . e . dependent measures) i n a multivariate repeated measures design such as the one employed in t h i s study. In other words, the researcher cannot l i m i t the ef f e c t of one covariate (e.g. pretreatment baseline heart rate) to a single variate (e.g. posttreatment baseline heart r a t e ) . Instead, that covariate w i l l apply to a l l lev e l s (e.g. baseline, speech a n t i c i p a t i o n , speech delivery) of the variate (e.g. posttreatment heart rate). Such an approach was deemed s t a t i s t i c a l l y inappropriate for the present study. The alte r n a t i v e strategy of deriving change scores (e.g. post-treatment basal heart rate minus pretreatment basal heart rate) suffers from other s t a t i s t i c a l weaknesses which make i t an undesirable option. The inclusion of each l e v e l (e.g. baseline, speech a n t i c i p a t i o n , speech delivery) of each factor (e.g. recording period) i n the MANOVA provides the most s t a t i s t i c a l l y sound, a l b e i t most conservative and complicated, approach to analyzing the data. The second type of analysis u t i l i z e d to evaluate breathing technique implementation were two separate one-way analyses of variance (ANOVA) in which the "target" breathing rates of trainees during the f i r s t t r a i n i n g session were compared with rates recorded during the speech a n t i c i p a t i o n and delivery periods of Session 2 (posttreatment). Treatment Outcome Cardiovascular arousal. Heart rate and blood pressure were sampled and analyzed in the same way as the re s p i r a t i o n data. Unlike the respiratory analyses, however, cardiovascular responses obtained during the "target" period of t r a i n i n g were not compared with posttreatment responses. Subjective anxiety. SUDS ratings obtained from treatment and w a i t l i s t subjects following the posttreatment speech were included i n a one-way ANOVA. The symptom number and symptom in t e n s i t y scores derived from the Symptom Rating Scale were included as variates i n a 2 (Group) X 2 (Session) MANOVA. S e l f - e f f i c a c y estimates. The three s e l f - e f f i c a c y predictions included on the Speech Expectancy Scale were incorporated as variates in a 2 (Group) X 2 (Session) MANOVA. Analyses of treatment outcome were considered a separate family from those used to assess treatment implementation. With use of the adjustment procedure recommended by Huberty & Morris (1989), the r i s k of a Type I error for each analysis was 5%. A 30 Type I error r i s k of .10 was accepted for the treatment manipulation analysis. For analyses involving more than two le v e l s of a repeated measure, the Greenhouse-Geisser adjustment procedure was applied. Post hoc testing involved Group X Session comparisons performed separately for each recording period. In order to f a c i l i t a t e interpretation of the r e s u l t s obtained i n t h i s study, and also to permit easy comparison with r e s u l t s obtained in other studies, e f f e c t sizes were calculated for a l l within- and between-group comparisons. This was done for each dependent measure and represented the degree of change from pretreatment to posttreatment. S p e c i f i c a l l y , the c a l c u l a t i o n procedure for within-group comparisons involved (1) subtracting the pretreatment mean scores for each recording period from the respective post-treatment mean scores, (2) d i v i d i n g these values by the respective mean standard deviations for the pre- and posttreatment sessions, and f i n a l l y (3) d i v i d i n g i n half the quotient obtained in Step 2. This procedure y i e l d s normalized mean score differences that are equatable with eta-squared estimates obtained from analyses of variance. Calculation of between-group e f f e c t sizes simply involved subtracting the within-group e f f e c t sizes for the w a i t l i s t group from those of the treatment group. In t h i s way, one can judge at a glance the r e l a t i v e degree of change from pre- to posttreatment shown by each group at each recording period and on each dependent measure. As recommended by Cohen (1977), e f f e c t sizes at or below .20 can be considered small, those between .20 and .40 are moderate, and those greater than .40 may be viewed as large. The only e f f e c t sizes of interest i n t h i s study are those involving between-group comparisons. Results Treatment Implementation Were trainees able to r e l i a b l y reproduce the prescribed breathing pattern i n an t i c i p a t i o n of and/or while a c t u a l l y engaged i n the anxiety-provoking speech test? In general, the answer i s 'Yes'. Relative to t h e i r untreated peers and t h e i r own pretreatment responses, trainees breathed more slowly and abdominally during the posttreatment assessment session. This was determined by comparing the breathing patterns (rate, depth, mode, and v a r i a b i l i t y ) of treatment and w a i t l i s t subjects at each period (BL, ANT, SPE) of Sessions 1 and 2. The r e s u l t i n g 2-way inter a c t i o n involving the Group and Session factors were s i g n i f i c a n t (F(4,16) = 12.2, p <.001). Follow-up simple effects testing, i n which Group X Session comparisons were conducted separately for each recording period, indicated that trainees breathed s i g n i f i c a n t l y d i f f e r e n t l y from t h e i r untrained peers during the speech a n t i c i p a t i o n period only. Compared to t h e i r respective pretreatment patterns, trainees breathed more slowly and abdominally while awaiting the second speech than did w a i t l i s t subjects. On average, trainees reduced t h e i r breathing rates from 15.9 cpm at Session 1 to 13.1 cpm at Session 2. W a i t l i s t subjects, on the other hand, showed no s i g n i f i c a n t change across sessions (17.1 versus 16.8 cpm, r e s p e c t i v e l y ) . These r e s u l t s can be seen in Figure 1. A s i m i l a r pattern emerged for abdominal amplitude. Prio r to treatment, the average abdominal amplitude for trainees during the a n t i c i p a t i o n period was 9.7 mV/mm; posttreatment the average amplitude increased to 19.9 mV/mm. For w a i t l i s t subjects, abdominal amplitudes remained stable across sessions (11.4 versus 11.0 mV/mm, res p e c t i v e l y ) . No group differences emerged for the baseline and speech delivery periods. Si m i l a r l y , there were no si g n i f i c a n t differences in ribcage amplitude across sessions or periods. The mean scores and standard deviations for each group are'summarized in Table 3. Ef f e c t sizes for each group comparison can be found in Table 13. In terms of the accuracy with which trainees reproduced the prescribed breathing pattern, a repeated measures ANOVA based s o l e l y on breathing rate responses revealed that i n general trainees breathed more rapidly during the speech a n t i c i p a t i o n period than they did during the i n i t i a l t r a i n i n g session (F(l,12) = 4.84,. p. < .05). In the f i r s t t r a i n i n g session, trainees averaged 8.4 breaths per minute (range = 6 - 11). This average increased to 13.1 cpm during the speech a n t i c i p a t i o n period, a period they had been instructed to implement the technique i n . This problem carried over into the speech delivery period as well. It i s u n l i k e l y that such inaccuracy i s simply due to a lack of practice since trainees reported p r a c t i c i n g the technique 33 an average of 63 minutes during the f i r s t week of t r a i n i n g and 57 minutes during the second. Overall, these r e s u l t s indicate that breathing control trainees were able to reduce t h e i r breathing rates and adopt a deeper, more abdominally-predominant breathing pattern i n a n t i c i p a t i o n of an anxiety-arousing task. However, they were generally unable to do so during the task i t s e l f . Given such findings, further analysis of the breathing strategy with respect to i t s effectiveness might best have been limited to the speech a n t i c i p a t i o n period, since i t was during t h i s period alone that the strategy was implemented with any degree of accuracy. Nevertheless, subsequent analyses included speech delivery responses in order to assess for possible carry-over e f f e c t s . Treatment Outcome The question addressed in t h i s section i s whether breathing control t r a i n i n g had a b e n e f i c i a l e f f e c t on autonomic and subjective indices of speech-elicited anxiety, and on public speaking s e l f - e f f i c a c y . With respect to autonomic arousal, multivariate comparison of the heart rate and blood pressure of the two groups across sessions and periods did not confirm the hypothesis that trainees would be less autonomically aroused posttreatment than w a i t l i s t subjects. In fact, the opposite was found to be true. Unlike w a i t l i s t subjects, trainees showed an increase i n d i a s t o l i c blood pressure from pre- to posttreatment (F(2,15) = 4.95, p_ < .01). This increase appears to account for the weak 3-way interaction between the group, session, and period factors (F(6,ll) = 1.92, p_ < .10). Follow-up simple effects t e s t i n g indicated that between-groups differences were limited to the speech delivery period (F(3,15) = 2.64, p < .10). As expected, t h i s e f f e c t was associated primarily with d i a s t o l i c blood pressure. These data are summarized in Table 4 and Figure 2. The hypothesis that trainees would experience lower levels of subjective anxiety posttreatment than untrained individuals was p a r t i a l l y confirmed by the data. Confirmatory evidence came from the symptom ratings offered by both groups following the pre- and posttreatment speeches. In general, trainees reported having experienced fewer and less intense symptoms of anxiety during the second speech than they had during the f i r s t . This was not true for w a i t l i s t subjects (F(2,14) = 8.19, p. < .01). The number of symptoms endorsed by trainees as having c l e a r l y been present decreased from an average of 7.1 i n Session 1 to 3.9 in Session 2. L i t t l e or no change occurred i n the responses of w a i t l i s t subjects (6.0 versus 6.4, re s p e c t i v e l y ) . E f f e c t sizes for these comparisons are l i s t e d in Table 14. A s i m i l a r pattern emerged for symptom i n t e n s i t y . Following treatment, trainees offered an average symptom in t e n s i t y rating of 12.9 + 14.8 compared to 2 7.7 + 18.2 pretreatment. In contrast, w a i t l i s t subjects rated t h e i r symptoms as equally intense across sessions (22.8 + 14.7 for both). The most intense and commonly reported symptoms among trainees were, i n rank order: memory impairment, d i f f i c u l t y breathing, tachycardia, blushing, trembling, and dry mouth. Among w a i t l i s t subjects these symptoms primarily included: tachycardia, dry mouth, perspiring, memory impairment, blushing, and trembling. In contrast to the above res u l t s , the anxiety ratings reported by both groups following the second speech were not s i g n i f i c a n t l y d i f f e r e n t (t(17) = -1.09, ns). The apparent difference in mean scores for the two groups (41.8 versus 6 0 . 0 for treated versus untreated groups, respectively) was washed out by high within-group v a r i a b i l i t y , e s p e c i a l l y among treatment parti c i p a n t s (SD = 2 5.8). The hypothesis that t r a i n i n g would lead to a s i g n i f i c a n t improvement i n public speaking s e l f - e f f i c a c y was not confirmed by the data. Although as a group trainees predicted they would speak better and experience less anxiety and better anxiety control during the second speech compared to the f i r s t , t h e i r responses did not d i f f e r s i g n i f i c a n t l y from those of w a i t l i s t subjects (F(3,16) = 2.02). Large variations in the responses of the trainees may have obscured a treatment e f f e c t , e s p e c i a l l y with respect to speech aptitude predictions. As Table 5 i l l u s t r a t e s , trainees became more confident i n t h e i r public speaking a b i l i t i e s from Session 1 to Session 2, whereas w a i t l i s t subjects did not. Discussion Two questions were addressed in the present study: (1) can the slower, rhythmic, more abdominally-predominant breathing pattern commonly prescribed to reduce anxiety be implemented with a reasonable degree of accuracy in a s i t u a t i o n where i t i s most l i k e l y to be of benefit, namely, while awaiting and then d e l i v e r i n g an anxiety-arousing speech? and (2) w i l l individuals trained to adopt t h i s breathing pattern to cope with anxiety ac t u a l l y experience less anxiety, either anticipatory or s t r e s s o r - s p e c i f i c , than t h e i r untrained peers? The r e s u l t s of t h i s study provide p a r t i a l l y affirmative answers to both questions. With respect to the f i r s t question, i t was found that trainees were able to breathe more slowly and abdominally while waiting to give an impromptu speech than t h e i r untrained peers. This finding supports the assumption that anxious individuals can breathe i n a controlled manner in anxiety-provoking, attention-demanding si t u a t i o n s . However, the above conclusion i s limited by three observations. 'First, only about 50% of the trained subjects ac t u a l l y produced breathing pattern changes that approximated the pattern taught. The remaining trainees either showed l i t t l e change or inconsistent change in how they breathed during the speech a n t i c i p a t i o n period. Second, even among those trainees who approximated the prescribed breathing pattern, none were accurate i n reproducing the target pattern. In general, breathing adjustments were too deep, too rapid, or inconsistently maintained. In p a r t i c u l a r , r e s p i r a t i o n rates during the speech a n t i c i p a t i o n period of Session 2, a time when subjects remained ph y s i c a l l y inactive, were on average four breaths per minute faster than the 6-10 breaths per minute rates recorded at the end of the f i r s t t r a i n i n g session. A breathing rate of 6-8 breaths per minute i s the one commonly advocated i n the c l i n i c a l and research l i t e r a t u r e for promoting relaxation (e.g. Grossman et a l . / l 9 8 5 ; Harris et a l . , 1976). F i n a l l y , trainees were generally unable to maintain the rhythmic, abdominal breathing pattern when a c t i v e l y encountering the feared event, namely, giving a speech. Although the f a i l u r e of trained subjects to maintain the prescribed breathing pattern during the speech stressor might not be s u r p r i s i n g given the inherent i n t e r a c t i o n between the technique and the task of public speaking, i t must be remembered that subjects received t r a i n i n g and practice at breathing rhythmically and abdominally while t a l k i n g . Additional t r a i n i n g may have enabled subjects to be more successful at t h i s task just as, with practice, actors, singers, and wind musicians develop proficiency at breathing "diaphragmatically" while speaking, singing, or playing. However, the emphasis i n the present study 38 was on determining whether breathing control t r a i n i n g represents a brief, e f f e c t i v e and therefore cost e f f i c i e n t a l t e r n a t i v e to other anxiety management strategies. Because i t i s possible that modifications to the t r a i n i n g process may y i e l d considerably improved performance, treatment modification should be considered for future studies. Having established that controlled abdominal breathing can be adopted to some extent during a period when i t s p r a c t i t i o n e r s are a n t i c i p a t i n g the onset of a feared event, the next question to be answered i s "Does i t have any b e n e f i c i a l impact on either subjective or physiological arousal?". The data suggest that i t does not. For instance, when the treated and untreated groups were compared with respect to cardiovascular arousal during the period when the technique was being implemented most successfully, no s i g n i f i c a n t differences emerged. This finding also held true for the speech delivery period when subjects were more p h y s i o l o g i c a l l y aroused. Sim i l a r l y , trainees showed no s i g n i f i c a n t advantage over untrained subjects with respect to how anxious they thought they would become during the second speech, how much control they thought they could exert over t h e i r anxiety l e v e l s , or how confident they were in t h e i r a b i l i t y to speak well. In contrast, trainees reported s i g n i f i c a n t l y fewer and less intense symptoms of anxiety than untrained subjects. A trend was also evident for trainees to predict experiencing less speech-e l i c i t e d anxiety, and greater emotional control and public speaking a b i l i t y following treatment than w a i t l i s t subjects. A number of hypotheses can be put forward to explain these inconsistent but generally negative findings. One hypothesis i s that trainees found the second impromptu speech more anxiety-provoking than t h e i r untreated peers due to the additional demand placed on them to accurately reproduce the prescribed breathing pattern. It could be argued that trainees were performing three tasks: 1) breathing abdominally; 2) c o n t r o l l i n g t h e i r anxiety; and 3) d e l i v e r i n g a good speech. In contrast, w a i t l i s t subjects were only responsible for d e l i v e r i n g a speech and c o n t r o l l i n g t h e i r anxiety. Thus, although the breathing strategy may be e f f e c t i v e i n c o n t r o l l i n g both subjective and autonomic signs of anxiety i n nonexperimental settings, such an e f f e c t could have been masked by c o n t e x t - e l i c i t e d performance anxiety. This problem has plagued previous laboratory studies. The present study was designed to redress t h i s problem. At least two solutions to t h i s problem can be proposed. F i r s t , rather than cue trainees to implement the breathing technique, they could be l e f t to employ the technique of t h e i r own accord. In t h i s way, breathing control implementation becomes a dependent measure, r e f l e c t i n g both how confident trainees are of the technique's effectiveness and how able they are to reproduce i t under s t r e s s f u l conditions. The second solution i s to provide trainees with opportunities to practice 40 the .technique under d i s t r a c t i n g and p h y s i o l o g i c a l l y arousing conditions such as giving a speech. However, to avoid confounding the e f f e c t s of breathing control with the e f f e c t s of stimulus exposure, the practice conditions must d i f f e r from the te s t conditions in s i g n i f i c a n t ways. Possible analogue stressors for t h i s purpose include conversing with a stranger and engaging in submaximal exercise. A second possible explanation for these inconsistent findings i s that controlled, abdominal breathing — at least as taught i n the present study — simply does not have a b e n e f i c i a l e f f e c t on cardiovascular arousal. Based on the r e s u l t s of Sroufe (1971), one could argue that the breathing patterns trainees adopted during the speech a n t i c i p a t i o n and delivery periods were more l i k e l y to e l i c i t increased, rather than decreased, heart rates. Although these patterns were also generally deeper, more e r r a t i c and more rapid than the prescribed pattern, the fact that trainees adopted them afte r two weeks of t r a i n i n g — more time than that a l l o t t e d in most research and c l i n i c a l applications to date — suggests that a modified technique may be more useful as an anxiety management strategy. As mentioned i n the introduction, i n order for breathing control strategies to be c l i n i c a l l y useful, they must be quickly and e a s i l y learned, and e a s i l y applied in anxiety-provoking situations (see Benson, 1975). This does not appear to be the case for the strategy taught in t h i s study — the second most commonly prescribed strategy in the l i t e r a t u r e next to rate-reduction techniques. Nevertheless, i t i s s t i l l possible that, with more practice, trainees could develop s u f f i c i e n t s k i l l i n performing the technique. Considering the recent findings that applied relaxation t r a i n i n g y i e l d s s i g n i f i c a n t l y better treatment outcomes with anxiety disorders than relaxation t r a i n i n g alone and/or exposure alone (e.g. Butler, Cullington, Munby, Amies, & Gelder, 1987; Goldfried & T r i e r , 1974; Osberg, 1981), subsequent studies of breathing control effectiveness would probably do well to include in vivo practice as part of t r a i n i n g . Furthermore, an emphasis on acute coping e f f o r t s , rather than prolonged practice, i s also worth considering given the d i f f i c u l t y trainees had at consistently reproducing the technique over time. To t h i s end, trainees might be taught to breathe more slowly and abdominally for a sequence of, for example, 4-6 breaths to allow s u f f i c i e n t time to regain a sense of control. Based on findings from the present study, slower, more abdominally-predominant breathing can be stimulated by having trainees prolong the length of t h e i r exhalations, the pause between exhalation and inhalation, or both. Such a strategy may one's immediate sense of control over anxiety. Hirsch and Bishop's (1981) reported that t h i s technique can t r i g g e r periodic heart rate reductions which may further convince trainees that they are achieving control over t h e i r anxiety. 42 Although the above arguments have merit one must s t i l l explain why the treatment group, which as a whole breathed more slowly and abdominally during the speech a n t i c i p a t i o n period than the w a i t l i s t group, showed no evidence of reduced cardiovascular arousal, yet reported some improvement in indices of subjective anxiety. Such a finding i s consistent with e a r l i e r research. In every breathing control study that was reviewed, only s e l f - r e p o r t measures consistently showed treatment-related improvements; few studies reported physiological improvements (e.g. Cappo & Holmes, 1984; Clark & Hirschman, 1980; Harris et a l . , 1976; McCaul et a l . , 1979; Quintanar, Cacioppo, & Monyak, 1980; Benson, Dryer, & Hartley, 1978). One conclusion that follows from such observations i s that the primary e f f e c t of breathing control t r a i n i n g i s to change trainees' perceptions of how threatening or aversive a stressor i s and/or how well they can cope with that stressor. In the present study, however, trainees showed only moderate improvement in t h e i r perceptions of how threatening (anxiety-provoking) the second impromptu speech would be. The same i s true for t h e i r estimates of how much control they could exert over anxiety. Such findings may r e f l e c t a lack of experience at successfully applying the breathing control strategy in public speaking s i t u a t i o n s . The conclusion that perceived control i s a function of s e l f -mastery, experience i s hinted in a study by Booth (1990). Booth compared three b r i e f treatments for claustrophobia, only one of which involved exposure to the fear stimulus, namely, remaining in a confined space for several minutes. Subjects i n the nonexposure-based treatments showed l i t t l e improvement i n fear predictions when tested posttreatment. The behavioral avoidance tes t used i n the posttreatment assessment represented the f i r s t opportunity these subjects had to try out the techniques they had learned. Only aft e r t h i s exposure t r i a l did subjects show any s i g n i f i c a n t reduction in predicted fear. A s i m i l a r finding was reported by Borkovec, Wall, & Stone (1974) who observed that when speech anxious subjects were led to believe that t h e i r speech-related heart rates were lower than they were, they f a i l e d to show any immediate benefit in terms of self-reported anxiety, but reported s i g n i f i c a n t l y less fear during a subsequent speech t e s t . Such findings are consistent with Bandura's (1977) predic t i o n that s e l f - e f f i c a c y i s most l i k e l y to increase when people r e a l i z e they had coped better in a feared s i t u a t i o n than they thought they would. The implication of t h i s observation for the present study i s that trainees might have predicted less fear and greater anxiety control i f such reports had been obtained post-speech. Such a finding would support the notion that cognitive reappraisal had occurred. In fact, many trainees reported f e e l i n g less anxious during the speech than they 44 predicted they would. Overall, however, the r e s u l t s indicate that treatment-specific change was rather limited. Other methodological issues a r i s i n g from t h i s study are worth noting. F i r s t , based on the magnitude of heart rate increases, i t appears that the speech stressor e l i c i t e d only moderate anxiety compared to the levels reported i n other studies (e.g. Knight & Borden, 1979). According to Barlow (1988, pp. 179-90) individuals who are experiencing profound anxiety, as i s the case with panic-prone patients exposed to various chemical infusions, t y p i c a l l y experience heart rate increases of 20 bpm or more. Such was not the case in the present study. Not only does t h i s l i m i t the study's relevance to r e a l - l i f e speaking situations, i t also leaves unanswered the question of whether breathing control e f f i c a c y i s r e s t r i c t e d to situations that induce high physiological arousal. The so-called " f l o o r e f f e c t " c e r t a i n l y has been a problem in other stress reduction studies according to Lehrer & Woolfolk (1984) and i s a factor the present study was designed to avoid. Possible ways of correcting the problem, based on the findings of e a r l i e r speech anxiety studies, include increasing the size of the audience, prolonging the speech a n t i c i p a t i o n period, assigning speech topics that require more intimate s e l f - d i s c l o s u r e , having subjects stand before a podium to d e l i v e r t h e i r t a l k s , and increasing the ambience of a r e a l - l i f e speech v i a the use of spotlights. A second, related methodological concern i s the fact that, on average, subjects showed r e l a t i v e l y l i t t l e evidence of rapid, shallow breathing during the speech stressor. While t h i s finding i s consistent with r e s u l t s of an e a r l i e r study involving 100 healthy men responding to a mental arithmetic stressor (Hait & Linden, 1987), i t i s inconsistent with the assumption underlying most c l i n i c a l applications of breathing control t r a i n i n g to date (e.g. Grossman et a l . , 1985; Lum, 1976). One i s l e f t wondering why breathing control t r a i n i n g should be undertaken with speech anxious individuals i f t h e i r breathing i s e s s e n t i a l l y normal. The old adage " i f i t ain't broke, don't f i x i t " would seem to apply here. However, before dismissing the relevance of breathing control t r a i n i n g , three observations should be considered. F i r s t , subjects in the present study were s t i l l breathing considerably faster than the rate commonly considered to be therapeutic, namely, 6-8 breaths per minute. In fact, the mechanism by which controlled breathing influences anxiety levels may have l i t t l e to do with respiratory physiology. Andrasik and Holroyd (1980), for instance, reported that headache patients who received EMG biofeedback reported s i g n i f i c a n t improvement i n headache frequency and intensity regardless of whether they increased or decreased muscle tension. So whether or not breathing patterns covary with stressor onset may be i r r e l e v a n t to the value of breathing control t r a i n i n g . 46 The second observation i s that the subjects i n t h i s study appeared to be only moderately speech anxious; whether more highly speech anxious people might have reacted to the speech tes t with increased rate and decreased depth of abdominal breathing i s unknown. In previous studies, those individuals with the highest breathing rates or other signs of "maladaptive" breathing at rest are the ones commonly diagnosed as suffering from some form of anxiety disorder (Bass & Gardner, 1985b). In panic induction situations, they are also the most l i k e l y to report symptoms associated with panic attacks (e.g. Gorman & Uy, 1987; Gorman, Fyer, Goetz, Askanazi, Liebowitz, Fyer, Kinney, & Klein, 1988; Griez & van den Hout, 1982). Such findings may hold true for speech anxious individuals as well. I t i s therefore recommended that a more highly speech anxious sample be recruited for future studies. F i n a l l y , the implications of the present study are limited by the small si z e of the subject sample. Besides the obvious l i m i t a t i o n to the s t a t i s t i c a l power of the main analyses, the small sample siz e precludes useful post-hoc analyses of those factors that discriminate "successful" trainees from "unsuccessful" ones. Such information could be of value i n matching treatment to patient, as well as providing insights into the process of change in speech anxiety treatment. In summary, the present study provides p a r t i a l support for the assumption that, with t r a i n i n g , slower, abdominally-predominant breathing can be adopted in anxiety-arousing s i t u a t i o n s . Limiting t h i s finding i s the observation that approximately 50% of the trainees had d i f f i c u l t y accurately implementing the technique. Even among those subjects who successfully reproduced the prescribed pattern while a n t i c i p a t i n g stressor onset, few could maintain i t during the stressor i t s e l f . Unfortunately, these findings did not elucidate whether reproduction inaccuracy i s s p e c i f i c to the p a r t i c u l a r breathing strategy taught in t h i s study ( i . e . continuous, abdominally-predominant breathing) or i s an inherent l i m i t a t i o n of a l l breathing control strategies attempted in response to fear-provoking events. In addition, whether the observed inaccuracies are due to i n s u f f i c i e n t length or comprehensiveness of t r a i n i n g could not be determined. A second study i s needed to answer these questions. Study 1 confirmed that breathing control t r a i n i n g had a ne g l i g i b l e impact on s t r e s s o r - e l i c i t e d cardiovascular arousal yet i s associated with some reduction in reported anxiety and anxiety symptomatology. In addition, the res u l t s suggested that when phobic i n d i v i d u a l s are taught anxiety management techniques without opportunity to practice them in vivo, they experience r e l a t i v e l y l i t t l e change in t h e i r expectations of fear or t h e i r a b i l i t y to control fear. In other words, simply learning a breathing strategy touted as having a n x i o l y t i c properties i s not s u f f i c i e n t to change one's view of how threatening a feared s i t u a t i o n i s or how well one believes he/she can cope i n that 48 s i t u a t i o n . A second study would help c l a r i f y whether breathing control t r a i n i n g e l i c i t s s e l f - e f f i c a c y changes on i t s own or requires in vivo exposure to the feared s i t u a t i o n to e l i c i t such change. A second study could also c l a r i f y other treatment-related concerns a r i s i n g from the present study. For instance, i t i s not clear whether the f a i l u r e of t r a i n i n g to attenuate cardiovascular arousal i s the r e s u l t of (a) inaccurate technique implementation, which in turn may be a function of i n s u f f i c i e n t t r a i n i n g , (b) the ineffectiveness of the breathing technique being taught, or (c) other factors that are unrelated to t r a i n i n g such as the l e v e l of anxiety experienced by subjects. Equally uncertain i s how c r i t i c a l breathing-specific changes are to any observed reductions in anxiety l e v e l . I t may be that psychological factors play the greatest, perhaps even the only, r o l e i n determining treatment outcome. Such questions could be addressed in a study that includes a larger number of subjects, a broader scope of dependent measures, and a longer, more comprehensive t r a i n i n g program. Study 2 Purposes and Hypotheses of Study 2 In l i g h t of the preceding discussion, a second study was conducted. This study had two main objectives. The f i r s t was to determine i f a longer, more comprehensive t r a i n i n g program involving a modified breathing technique could be accurately implemented under more anxiety-arousing conditions than those of Study 1. The second objective was to determine whether the revised treatment program has a c l i n i c a l l y s i g n i f i c a n t e f f e c t on expectations of fear and experiences of fear i n a highly threatening s i t u a t i o n . The s p e c i f i c hypotheses are l i s t e d below. Breathing Control Implementation 1. Trainees w i l l exhibit breathing patterns during a posttreatment coping s k i l l s demonstration that are consistent with the pattern prescribed and practiced i n treatment. 2. Trainees w i l l have posttreatment breathing patterns during the speech a n t i c i p a t i o n period, and possibly also during the speech delivery period, that are s i g n i f i c a n t l y d i f f e r e n t from those of untrained individuals, and i s consistent with the pattern prescribed in treatment. Breathing Control Effectiveness  Autonomic arousal. 1. Trainees w i l l show lower heart rates and skin conductance le v e l s during a posttreatment speech a n t i c i p a t i o n period than untreated subjects. These e f f e c t s may also extend to the speech delivery period. Subjective anxiety. 1. Trainees w i l l report experiencing reduced emotional tension/distress during the posttreatment speech .. a n t i c i p a t i o n period than untrained subjects. This group difference may also generalize to the speech delivery period, depending on how well trainees are able to implement the breathing technique during t h i s period. 2 . Trainees w i l l report having fewer and less intense symptoms of anxiety during a posttreatment impromptu speech than untrained subjects. Self-efficacy/expectations of fear. 1. Following treatment, trainees w i l l predict that they w i l l experience less anxiety, more control over anxiety, and greater confidence in t h e i r speaking a b i l i t i e s p r i o r to an impromptu speech than w i l l t h e i r untrained peers. 2 . This group difference in s e l f - e f f i c a c y predictions w i l l be even greater for ratings given with respect to a t h i r d , ostensibly more d i f f i c u l t speech. 3. The proportion of trainees who agree to give a t h i r d speech w i l l be s i g n i f i c a n t l y greater than w i l l be found among untreated subjects. Method Subjects Forty-eight speech anxious adults from the general public and u n i v e r s i t y populations participated in t h i s study. They were 51 recruited v i a newspaper, radio, and classroom advertisements for a free 4-week t r a i n i n g program on strategies for c o n t r o l l i n g public speaking anxiety. P a r t i c i p a t i o n was r e s t r i c t e d to a more highly anxious sample than that in Study 1. This was done to boost the study's power to detect possible treatment e f f e c t s and also to increase the g e n e r a l i z a b i l i t y of the findings to c l i n i c a l l y - a n x i o u s populations. The s p e c i f i c i n c l u s i o n and exclusion c r i t e r i a for t h i s study are l i s t e d below. Inclusion c r i t e r i a . 1) Self-report ratings of at least 80 on a scale ranging from 0 (complete calm) to 100 (absolute panic) describing the l e v e l of anxiety experienced minutes before giving a t a l k to an audience of 10 or more people. This cut-off score corresponded to approximately the 7 5th percentile for speech anxiety ratings given by 215 U.B.C. undergraduates. This rating also exceeded the average pre-speech anxiety rating reported by the participants in Study 1. 2) A score of at least 70 on the Personal Report of Communication Apprehension (PRCA) questionnaire (Appendix B ) . This cut-off score has been commonly used i n studies of public speaking anxiety to distinguish between highly and normally speech anxious individuals (e.g. Klopf & Cambra, 1980). Those who score 70 or above on t h i s questionnaire are i n the top 20th percentile for public speaking anxiety. Use of t h i s measure permitted comparison of the present study's findings with those of previous studies. 52 3) Reports of having avoided at least 50% of a l l public speaking opportunities over the past two years. As with previous c r i t e r i a , t h i s one was based on the re s u l t s of the U.B.C. student survey, in which the average public speaking avoidance rate was 3 0%. Exclusion c r i t e r i a . As per Study 1 (see page 11) . Sample c h a r a c t e r i s t i c s . Of the i n i t i a l 52 volunteers for t h i s study, 26 were randomly assigned to the treatment group a f t e r having been matched to 2 6 w a i t l i s t control subjects on several demographic and treatment outcome measures. These matching variables included gender, age, speech anxiety rating, and re s t i n g heart rate. For matching purposes, the l a t t e r three variables were subdivided as follows: age (in years; 20-29, 30-39, 40-49, 50-59, 60-69); anxiety rating (in SUDS; 80-89, 90-100); heart rate (in bpm; 50-59, 60-69, 70-79, 80-89, 90-99). The mean age of t h i s sample was 35.3 + 13.3 years and 54% were women. However, as a r e s u l t of two withdrawals from treatment, three cases of procedural error ( a l l treatment group members), four cases where subjects declined to give the posttreatment speech (three being treatment group members), and four cases ( a l l w a i t l i s t subjects) who scored below the cut-off score of 7 0 on the PRCA, the f i n a l sample siz e for most analyses was reduced to 39. This f i n a l sample consisted of 21 men and 18 women, with each gender equally represented across conditions. The treatment and w a i t l i s t groups also did not d i f f e r s i g n i f i c a n t l y with respect to age, resting heart rate, blood pressure, speech anxiety rating, and PRCA scores (Table 6 ) . Research Design The research design followed in t h i s study was i d e n t i c a l to that of Study 1 except that the number of observation periods ( i . e . repeated measures) increased from three to four to r e f l e c t the increased length of the speech a n t i c i p a t i o n period (from four to eight minutes). Recording Equipment and Materials As i n Study 1, two categories of physiological a c t i v i t y were recorded, autonomic and respiratory. Autonomic a c t i v i t y , represented by both heart rate and skin conductance l e v e l , served as an index of s t r e s s o r - e l i c i t e d anxiety. Autonomic measures. The rationale for recording heart rate (HR) was presented i n Study 1. The method for recording i t , however, d i f f e r e d from Study 1. In the present study, bipolar electrodes were attached to the l a t e r a l aspects of each subject's lower ribcage, with a ground electrode a f f i x e d to the back of his/her neck. This configuration was recommended by Constant (1981) and has been reported i n previous studies (e.g. Hait & Linden, 1987) to y i e l d a clean ECG signal from which heart rate can be calculated. The 54 ECG signal was f i l t e r e d (30 Hz) and amplified (.05 mV/mm) by a Sensormedics cardiotachometer coupler (Model 9857) integrated with a Sensormedics Dynagraph (Model R611). Heart rate (beats per minute) was calculated from the number of R-waves in each 30-second recording period. Skin conductance l e v e l (SCL) was included as a measure of autonomic arousal for several reasons. F i r s t , skin conductance l e v e l represents an objective estimate of a commonly reported anxiety symptom, namely, sweaty hands. Second, along with heart rate, i t has been included in previous studies of breathing control effectiveness (Wallace, Benson, & Wilson, 1971; Harris et a l . , 1976), and in studies of anxiety responses to acute stressors (Craske & Craig, 1984; Holmes et a l . , 1979; Knight & Borden, 1979), and treatments for public speaking anxiety (Borkovec & Sides, 1979b; McKinney & Gatchel, 1982). These studies have shown skin conductance l e v e l to be s e n s i t i v e to s t r e s s o r - e l i c i t e d anxiety and to the e f f e c t s ( a l b e i t temporary) of arousal-attenuating procedures l i k e meditation and paced breathing. It was with such studies that the present study's findings were compared. F i n a l l y , skin conductance l e v e l can be recorded noninvasively. As a r e s u l t , the r i s k of test-induced anxiety was minimized. It was for t h i s reason that blood pressure was not recorded. Regular i n f l a t i o n of a blood pressure cuff such as the one used in Study 1 can be disruptive. With such safeguards in place, i t was expected that Study 2 would 55 y i e l d r e s u l t s with greater internal and external v a l i d i t y than those obtained i previous studies. The procedure followed for recording skin conductance l e v e l conforms with widely-accepted standards s p e c i f i e d by Fowles, C h r i s t i e , Edelberg, Grings, Lykken, & Venables (1981). Two s i l v e r / s i l v e r chloride 1 cm^ electrodes were f i l l e d with a conductance gel comprised of one part 0.9% phy s i o l o g i c a l saline i n two parts Unibase and attached to the d i s t a l phalanges of the index and middle fingers of each subject's nondominant hand. Dual electrode c o l l a r s were used to ensure equivalence of surface contact areas across subjects. Output from these electrodes was fed into a Beckman coupler (Model 9 8 4 4 ) and recorded on chart paper. P i l o t testing revealed that a high frequency f i l t e r s e t t i n g of 30 Hz with .05 mV/mm amplification provided s u f f i c i e n t s e n s i t i v i t y to detect the range of skin conductance leve l s exhibited by 25 speech anxious individuals. For the purposes of t h i s study, skin conductance l e v e l (in micromhos units) was defined as the average of three levels recorded at equidistant time points within each 30-second recording period. Respiratory measures. The rationale for recording respiratory a c t i v i t y was the same as i n Study 1. However, unlike Study 1, only abdominal movement was monitored. The four respiratory parameters derived from t h i s signal included r e s p i r a t i o n rate (RR), abdominal amplitude (AA), f r a c t i o n a l inspiratory time (FIT), and exhalation time (Te). A l l were calculated by hand from the polygraph tracings. Calculations were based on six successive breathing cycles. The variables f r a c t i o n a l inspiratory time and exhalation time were added because they represent key elements of the revised breathing control strategy. Fractional inspiratory time, for instance, represents the r e l a t i v e amount of time spent inhaling during each respiratory cycle. The lower t h i s value, the greater the exhalation time and/or the longer the pause before inhaling again. The goal of t r a i n i n g was to reduce f r a c t i o n a l inspiratory time. Exhalation time represents an even more d i r e c t measure of the prescribed breathing pattern. I t also provides some indicati o n of breathing rate; the greater Te, the fewer in s p i r a t i o n s in a given i n t e r v a l . Self-report measures. The same four s e l f - r e p o r t measures used in Study 1 to assess treatment outcome were used in t h i s study. They included the Treatment Credibility/Expectancy for Improvement Scale, the Speech Expectancy Scale (SES), the Subjective Units of Discomfort Scale (SUDS), and the Symptom Rating Scale (SRS). The l a t t e r two underwent minor revisions. S p e c i f i c a l l y , the SUDS was converted from a verbal rating scale to a v i s u a l analog scale to reduce the impact of experimental demand on subjects' responses (Appendix B). I t was administered three times per session (post-adaptation, pre-speech, post-speech) instead of just once (post-speech) . With respect to the SRS, modifications were made to f a c i l i t a t e scoring and to permit comparison of symptom ratings i n t h i s study with those reported in other studies (Appendix B). To do t h i s , the 0-100 v i s u a l analog scale used i n Study 1 was converted to a 0-4 scale with 5 anchor points ("not even noticeable", "mild", "moderate", "severe", and "very severe"). These anchor points and corresponding numeric scale are most often reported i n the treatment outcome studies with panic disorder (e.g. Michelson et a l . , 1985) and other anxiety disorders. As i n Study 1, two summary s t a t i s t i c s were generated from these data: 1) the number of symptoms rated as being at least "mild" in inte n s i t y ; and 2) the mean in t e n s i t y of 16 symptoms associated with anxiety. The r e s u l t s of Study 1 indicated that the second s t a t i s t i c had excellent t e s t - r e t e s t r e l i a b i l i t y over two weeks (r = .95, N = 10), while the f i r s t s t a t i s t i c was less r e l i a b l e (r = .52). Behavioral measures. Two behavioral measures of treatment outcome were included in t h i s study. The f i r s t measure was of each subject's willingness to give a t h i r d talk a f t e r completing the posttreatment speech test. Subjects were led to believe that t h i s t h i r d t a l k would take place in one week and would involve speaking to an audience of 20 speech-anxious peers for 5-10 minutes on a topic of t h e i r choice. This t h i r d speech was a ruse and therefore never scheduled. It was designed to assess the g e n e r a l i z a b i l i t y of any treatment e f f e c t s . To minimize the impact of experimental demand on subjects' responses, the 58 experimenter described the t h i r d speech as a purely voluntary venture. The second behavioral measure was of each subject's a b i l i t y to accurately implement the breathing control strategy during the speech a n t i c i p a t i o n and delivery periods. This measure was included primarily as an index of how confident subjects were i n the breathing technique. Failure to implement the technique suggested that subjects either did not perceive the technique as useful or had not practiced i t enough to f e e l confident i n using i t . However, breathing control accuracy can also be seen as a measure of how well the breathing control procedure can be implemented i n the face of mounting anxiety and external d i s t r a c t i o n s . Intake assessment measures. As i n Study 1, s e l f - r e p o r t measures were used to confirm that subjects were highly speech anxious p r i o r to treatment. In Study 2, however, the structured interview (Appendix B) was a revised version of the Anxiety Disorder Interview Schedule (ADIS-R) for s o c i a l phobia (Barlow, 1988, 545-47; DiNardo, O'Brien, Barlow, Waddell, & Blanchard, 1983). The greater length and scope of t h i s structured interview was considered more representative of true c l i n i c a l assessment/treatment procedures than the one used in Study 1. In turn, the structured interview was expected to enhance perceptions of the treatment program as highly credible. The interview consisted of 10 questions addressing the extent of public speaking fear/phobia i n pa r t i c u l a r , and s o c i a l anxiety/phobia in general. I t also included two questions regarding the perceived etiology of subjects' public speaking fear plus questions about previously t r i e d treatments and current expectations regarding treatment. A f i n a l section was included to determine i f other forms of psychopathology were present which might have required immediate treatment or would have interfered with the t r a i n i n g program. The two interview responses of most interest were: 1) ratings of pre-speech anxiety levels on a 0 (complete calm) to 100 ( t o t a l panic) scale; and 2) estimates of public speaking avoidance (0-100%). A single questionnaire was administered to corroborate evidence from the interview that subjects were highly speech anxious. Unlike Study 1, the questionnaire used was The Personal Report of Communication Apprehension (PRCA) developed by McCroskey (1970). (Appendix B). The PRCA replaced the Subjective Units of Discomfort Scale: Pre-speech because of i t s frequent use i n public speaking anxiety research and i t s well documented psychometric properties. The PRCA contains 20 statements about public speaking anxiety which subjects rate, on a 1-5 i n t e r v a l scale, as being "very true" to "not at a l l true". It was normed on 2479 university students, has a mean of 60.4, a standard deviation of 11.5, and a range of 15 to 100 (McCroskey, 1970). Porter (1981) reported that the PRCA has a high l e v e l of in t e r n a l consistency (average inter-item c o r r e l a t i o n = .35, average c o r r e l a t i o n of each item with the t o t a l score = .61, ov e r a l l estimate of inter n a l r e l i a b i l i t y = .91). High t e s t -r e t e s t r e l i a b i l i t y (r = .83 over 10 days, N = 769) has been reported as well (McCroskey, 1970). Hansford & Hattie (1982) have confirmed that PRCA scores are independent of age, gender, or n a t i o n a l i t y based on a cr o s s - c u l t u r a l study of 1784. The PRCA has also been found to correlate highly with 0-100 v i s u a l analog scale ratings of anxiety (post-speech), evidence of i t s v a l i d i t y as a measure of public speaking anxiety (Taylor, 1981). In a si m i l a r study, Behnke & Beatty (1981) established that, together with heart rate, PRCA scores explained approximately 80% of the variance i n post-speech anxiety ratings (STAI-State). F i n a l l y , McCroskey (1978) summarized the findings of over a dozen studies i n which high PRCA scores were found to be good predictors of anxious behavior in a variety of s o c i a l settings (e.g. r e s t r i c t e d length of speeches). Procedure The i n i t i a l procedure followed i n the present study i s comparable to that in Study 1. Unlike Study 1, however, once the recording equipment was attached, subjects began a 15-minute assessment interview rather than a 10-minute adaptation period. A summary of the entire assessment procedure for Session 1 appears i n Table 1. 61 Baseline period (BL). Following the interview, subjects sat quietly for f i v e minutes while completing the PRCA questionnaire. During the l a s t two minutes of t h i s adaptation period, baseline recordings of respiratory and autonomic a c t i v i t y were obtained. At the end of t h i s period, subjects rated t h e i r current l e v e l of tension/anxiety using the SUDS. Speech a n t i c i p a t i o n period (ANT). Once the adaptation/baseline period was completed, the experimenter announced that in 10 minutes subjects would be required to give a 4-minute impromptu talk before a l i v e audience. Subjects were also t o l d that t h e i r t a l k s would be videotaped for l a t e r review. To reduce the r i s k of refusals, the experimenter emphasized that the talk was an es s e n t i a l part of the assessment/treatment process. Subjects were assured that the video recording was con f i d e n t i a l and that they would have a l a t e r opportunity to evaluate t h e i r recorded speech performance (Appendix D). After t h i s , guidelines were presented for the preparation and delivery of the upcoming speech. Subjects were encouraged to prepare notes over the next 8-10 minutes, but to use these sparingly when de l i v e r i n g t h e i r t a l k s . They were also informed that they were to stand before a podium to de l i v e r t h e i r t a l k s . Once a l l preparatory instructions had been given, subjects were t o l d the topic for t h e i r speeches. Half of the subjects spoke on the topic of "What do you see as being the primary issues i n the debate over abortion and what i s your personal standpoint on the issue?". The remaining subjects spoke on the topic "What do you see as being the primary issues i n the debate over c a p i t a l punishment and what i s your personal standpoint on the issue?". Assignment of topics was random and counterbalanced across sessions. At t h i s point, each subject completed the Speech Expectancy Scale, along with a consent form for the videotaping of his/her upcoming speech (Appendix D). In order to encourage unbiased responding to the Speech Expectancy Scale and a l l other s e l f -report measures, subjects were asked to seal t h e i r completed inventories i n coded envelopes. They were then reminded of t h e i r speech topics and of the order of events to follow. During the subsequent 8-minute speech a n t i c i p a t i o n period, autonomic a c t i v i t y was recorded at Minutes 0-1, 2-3, 5-6, and 7-8. These recording inte r v a l s were expected to sample the increased arousal that other researchers (e.g. Knight & Borden, 1979) have reported during speech a n t i c i p a t i o n . At the beginning of Minute 4, the research assistant arranged chairs, l i g h t i n g , and video equipment. He/she was instructed to avoid i n i t i a t i n g any verbal communication with subjects during t h i s time. At Minute 6, two confederates were escorted into the room to serve as an audience. Prior research has indicated that an audience of three i s as anxiety-provoking for most speech anxious individuals as an audience of 20 or more (Baldwin & Clevenger, 1980). I t also represents the average audience size employed i n e a r l i e r studies (Matias & Turner, 1986; McKinney & Gatchel, 1982; Schuler, Giner, Austrin, & Davenport, 1982). As before, verbal contact between confederates and subjects was discouraged. F i n a l l y , at the end of Minute 8 subjects were prompted to record t h e i r anxiety/arousal l e v e l using the SUDS. Speech delivery period (SPE). The speech delivery period began as soon as subjects completed the SUDS rating and had been reminded to speak for 4 - 5 minutes. No other directions were given unless they paused mid-speech for longer than 10 seconds. If t h i s occurred, they received a single prompt to continue speaking for the f u l l 4 - 5 minutes. Subsequent pauses were l e f t unchallenged. In the event that subjects became noticeably distressed or c l e a r l y indicated that t h e i r speech was over before four minutes had elapsed, the assistant immediately confirmed that the speech te s t was over and thanked them for p a r t i c i p a t i n g . As the assistant and audience l e f t , the experimenter informed the subject that he/she had courageously completed a d i f f i c u l t task. Autonomic recordings were obtained at Minutes 0-1 and 2 -3 . At the conclusion of the speech, subjects f i r s t rated on the SUDS scale how anxious they f e l t during the speech and then completed the Symptom Rating Scale. The session ended with arrangements being made for the f i r s t treatment session. Subjects were asked for a l i s t of available treatment times i n order to form t r a i n i n g groups. After they had been matched to a s p e c i f i c t r a i n i n g group, they were contacted by phone, usually within one week of the i n i t i a l assessment. Those in the w a i t l i s t group were t o l d that due to scheduling d i f f i c u l t i e s , treatment would be delayed by four weeks. For subjects in the treatment group, on the other hand, treatment began within the week. Breathing; control t r a i n i n g : Session 1. The treatment schedule followed in t h i s study i s summarized in Table 7. Unlike Study 1, treatment was conducted i n group format over a four-week period. Each group consisted of 6-7 trainees led by the experimenter. The f i r s t three sessions lasted one hour and were held in a Psychology C l i n i c o f f i c e . The l a s t session took place in the recording laboratory as part of the posttreatment evaluation. The decision to treat subjects in groups rather than i n d i v i d u a l l y was based on three observations. F i r s t , group therapy i s more time e f f i c i e n t than individual therapy. Second, because the popularity of group treatment i s increasing, the r e s u l t s of t h i s study were expected to have greater g e n e r a l i z a b i l i t y to c l i n i c a l settings i f group therapy was used. F i n a l l y , the r i s k of a treatment d i f f u s i o n e f f e c t due to nonspecific group process factors was expected to be low given the brevity and s k i l l s - o r i e n t e d focus of treatment. If the treatment were longer and/or involved more interpersonal interactions, factors such as a l t r u i s t i c behavior and group cohesion would begin to influence treatment outcome, masking any e f f e c t s s p e c i f i c to breathing control t r a i n i n g . Treatment proceeded in a comparable manner to that i n Study 1. It began with a 30-minute rationale for breathing control t r a i n i n g delivered by the experimenter from a memorized s c r i p t . The content of t h i s rationale was s i m i l a r to that of Study 1, as was the t r a i n i n g period that followed. The experimenter f i r s t modelling the desired breathing pattern, af t e r which trainees were encouraged to practice i t themselves. Unlike Study 1, the prescribed breathing pattern was a sequence of six deep, but progressively diminishing, inspirations followed by gradually lengthening exhalations. In Study 1, subjects were trained to adopt a continuous pattern of slower, abdominally-predominant breathing. The decision to adopt t h i s new breathing pattern followed d i r e c t l y from the r e s u l t s of Study 1 which suggested that i t i s d i f f i c u l t , i f not impossible, to maintain an abdominally-predominant breathing pattern while awaiting or d e l i v e r i n g an impromptu speech. The f i r s t goal of the new approach to t r a i n i n g was to s e n s i t i z e trainees to any increased ribcage and/or abdominal tension associated with public speaking. Possible sources of t h i s tension include involuntary breathholding, abdominal tensing, and rapid, thoracic breathing. The f i r s t step i n the s e n s i t i z a t i o n process involved taking a deep breath and holding i t for 2-3 seconds. This maneuver signaled to the trainee and experimenter that breathing control was being i n i t i a t e d . The next step involved exhaling slowly and evenly through pursed l i p s . This procedure produces a state of physical quiescence which contrasts sharply with the tension of breathholding. Such a contrast was expected to strengthen the l i n k between controlled exhalation and feelings of calm and control. The second goal of treatment was to engender a greater sense of anxiety control. The strategy for doing so involved progressively lengthening each exhalation over six breaths. The time between breaths was to be increased gradually, but not to the point of discomfort. A short period of normal breathing followed each six-breath sequence in order to avoid fatigue. Besides promoting an increased sense of s e l f - c o n t r o l , t h i s strategy prompts deeper, more abdominally-predominant inhalations, which interferes with rapid, shallow breathing associated with anxiety. It also f a c i l i t a t e s better voice q u a l i t y and control. This l a t t e r benefit may be one of the most important for individuals whose public speaking anxiety increases whenever they notice t h e i r voices trembling or lacking volume. Controlled exhalation may prevent hyperventilation-induced hypocapnea, a problem that can ari s e when individuals f i r s t begin breathing control t r a i n i n g . As some investigators have suggested 67 (e.g. Ley, 1985a), the unpleasant symptoms of hypocapnia may t r i g g e r increased, rather than decreased, anxiety. Trainees practiced the prescribed strategy for 10 minutes i n the upright seated position. Throughout t h i s period, they were encouraged to use t h e i r hands to monitor ribcage and abdominal movement. To f a c i l i t a t e greater abdominal excursion, trainees were instructed to press down firmly with t h e i r abdominal hand. Respiratory physiology research (Hirsch & Bishop, 1981; Sharp, Goldberg, Druz, & Danon, 197 5) and some p i l o t t e s t i n g have shown that t h i s simple procedure dramatically increases the depth of abdominal breathing. An additional two minutes of t r a i n i n g was conducted with trainees leaning forward 45°. This posture enabled trainees who were having d i f f i c u l t y with the technique to experience some success: in t h i s p o sition the diaphragm and abdomen can move more e a s i l y and e f f i c i e n t l y (Faling, 1986). Learning of the technique was f a c i l i t a t e d by use of the three mental images described in Study 1. In t o t a l , two sources of learning assistance were available to trainees: (1) verbal reinforcement from the experimenter for successive approximations to the prescribed breathing pattern, and (2) proprioceptive feedback. Unlike Study 1, respiratory tr a c i n g feedback was not used because such feedback was not f e a s i b l e i n group t r a i n i n g . Furthermore, i t s use might have been a threat to the external v a l i d i t y of the study. 68 Training Session 1 concluded with an overview of the f i r s t home assignment. This assignment involved p r a c t i c i n g slow, abdominally-predominant breathing at least once d a i l y for 10 minutes. Trainees who were having d i f f i c u l t y with the technique were encouraged to practice i t in the supine p o s i t i o n . Of a l l postures, the supine offers the least resistance to abdominal/diaphragmatic movement and therefore has the greatest l i k e l i h o o d of success (McLaughlin, 1977). Daily practice (5-10 minutes/day) of the six-breath sequence was also prescribed. Directions for home practice were provided i n a written handout (Appendix E). Included with the handout was a d a i l y record sheet (Appendix E) and the Treatment Credibility/Expectancy for Improvement Scale. In order to foster compliance with the home assignment, obstacles to home practice were discussed and solutions suggested. As well, subjects were encouraged to view home practice as something they did for themselves rather than for the experimenter. Training Session 2. Session 2 began with a review of the previous week's home assignment. Any problems or questions concerning the technique were dealt with and praise given for achieving practice goals. A 10-minute practice followed in which trainees demonstrated t h e i r p roficiency at the six-breath sequence. Deviations from the prescribed pattern were i d e n t i f i e d so that subjects could correct them. 69 Trainees were then taught to pair feelings and images of tension release with prolonged exhalation. After f i v e minutes of practice, t r a i n i n g s h i f t e d to a discussion of how and when to implement the technique in public speaking s i t u a t i o n s . Rhythmic, abdominally-predominant breathing was presented as a useful way to counteract the problem of one's voice becoming weak and shaky while speaking. This problem appears to exacerbate the anxiety associated with public speaking. One cause for a weak, shaky voice i s shallow, irr e g u l a r breathing accompanied by abdominal tensing. Trainees practiced controlled breathing while counting aloud from 1-30 and la t e r while reading aloud. The goal of these exercises was to maintain voice quality and volume without resorting to breathholding and the r e f l e x i v e gasping for a i r . The session ended with an overview of the home assignment. For the upcoming week, trainees continued p r a c t i c i n g the s i x -breath procedure at least 10 minutes per day, focusing on the strategy of releasing tension through prolonged exhalations. They also practiced controlled breathing while reading aloud. As added incentive, they were to bring an audio recording of one of t h e i r practice sessions to the next meeting. However, they were cautioned not to attempt public speaking u n t i l l a t e r i n therapy. Training Session 3. In Session 3, trainees demonstrated t h e i r a b i l i t y to breathe abdominally and to maintain voice tone while speaking. This was done i n dyads, with the therapist providing p o s i t i v e feedback for 70 successive approximations to the desired pattern. Time was also spent discussing and pr a c t i c i n g the revised six-breath sequence. The remainder of the session involved p r a c t i c i n g controlled abdominal breathing under r e l a t i v e l y d i s t r a c t i n g or phy s i c a l l y arousing conditions. These approximated the kind of conditions l i k e l y to be encountered in r e a l - l i f e public speaking situations. The f i r s t involved carrying on a conversation with another group member. Trainees alternated between p r a c t i c i n g the tension release procedure while l i s t e n i n g and controlled abdominal breathing while speaking. This was done for 15 minutes. After t h i s , subjects practiced reducing t h e i r heart rates using the six-breath sequence. Heart rates were f i r s t elevated to approximately 50% of age-dependent maximum leve l s by means of s t a i r climbing. This exercise was done twice. In t h i s way, trainees gained experience at employing breathing control to reduce heart rate. The homework pres c r i p t i o n for that week was to continue using the six-breath sequence to release physical and emotional tension. Trainees were encouraged to do so during or aft e r physical exercise, during conversations, while doing paperwork, and while d r i v i n g . Once again, public speaking was discouraged u n t i l a l a t e r date. F i n a l l y , arrangements were made for trainees to be seen i n d i v i d u a l l y for the f i n a l session. They were t o l d that i n d i v i d u a l - s p e c i f i c feedback would be offered i n that session. They were not informed about the scheduled speech tes t , p a r t l y to reduce the r i s k of nonattendance, and p a r t l y because w a i t l i s t subjects had also not been informed of i t . 71 Posttreatment assessment. The second assessment session took place in the same recording room and involved nearly the same procedures as used i n Session 1. During the session overview, trainees were t o l d that physiological recordings would be obtained to document t h e i r s k i l l at the breathing technique. Subjects i n the w a i t l i s t condition, on the other hand, were t o l d that new physiological baselines were needed before t r a i n i n g could begin. The goal of these rationales was to contain anticipatory anxiety about the upcoming speech t e s t to the period following adaptation/baseline. Once the recording equipment had been attached, trainees began a 10-minute discussion about the past week's home assignment, followed by a 5-minute technigue demonstration period. This procedure was similar to the one employed i n the group sessions. In addition, the two assessment sessions were comparable in duration. W a i t l i s t subjects, spent 10 minutes discussing how they t y p i c a l l y cope in anxiety-provoking situations l i k e public speaking. They then demonstrated t h e i r coping strategies over a 5-minute period. For both groups, the baseline, speech a n t i c i p a t i o n , and speech delivery periods followed as per Session 1. Both groups received i d e n t i c a l instructions for the speech a n t i c i p a t i o n period. The fact that trainees were not s p e c i f i c a l l y cued to implement the breathing control strategy permitted a behavioral t e s t of trainees' confidence in and a b i l i t y at the breathing strategy. This procedure was also expected to reduce the l i k e l i h o o d of additional performance anxiety. Once the speech test had been completed, a l l subjects were asked to give another speech, t h i s time to a larger audience and on a topic of t h e i r choice. They were t o l d that t h e i r 5-10 minute long speech would be scheduled in one week and that the audience would consist of 2 0 speech anxious peers. The voluntary nature of t h i s speech was emphasized to l i m i t response bias. Before in d i c a t i n g t h e i r decision, subjects completed the Speech Expectancy Scale with respect to t h i s upcoming speech. They then indicated whether they wished to give the t h i r d speech and at what time. Four alternate times were offered to avoid refusals based s o l e l y on scheduling problems. At t h i s point, subjects were debriefed regarding the nature and purposes of the study, including the use of deception with respect to the t h i r d speech. Both groups were shown copies of t h e i r physiological recordings from each assessment session, along with an explanation of t h e i r meaning. They also reviewed video recordings of both speeches. Subjects were encouraged to ask questions at any time. Trainees, were further encouraged to continue p r a c t i c i n g the breathing techniques, and provided with suggestions for additional treatment i f such was requested. W a i t l i s t subjects were offered the same treatment program provided to treatment group members. In most cases, t h i s o f f e r was accepted. F i n a l l y , a l l subjects received a complementary handout on e f f e c t i v e public speaking (Appendix E). Data reduction and analyses As i n Study 1, two types of data were generated i n t h i s study: (1) indices of treatment implementation; and ( 2 ) indices of treatment e f f e c t . The former involved r e s p i r a t i o n measures and the l a t t e r included a variety of autonomic, s e l f - r e p o r t , and behavioral measures. Treatment Implementation Respiratory a c t i v i t y was sampled during four periods of the pre- and posttreatment sessions. These periods were: 1 ) baseline (BL); 2 ) a n t i c i p a t i o n , Minutes 0-4 (ANT4); 3) a n t i c i p a t i o n , Minutes 5-8 (ANT8); and 4) speech delivery (SPE). Except for the speech period, the two 3 0-second recordings obtained i n each were averaged to y i e l d one score per period. For the speech period, only data recorded during the f i r s t minute were retained for analysis; too few subjects spoke long enough to obtain Minute 2 - 3 scores. Additional recordings 60 seconds in length were obtained posttreatment during the technique demonstration period. These recordings served as reference values for evaluation of technique accuracy. The c r i t e r i o n for technique accuracy was defined as an average expiratory time of 3.5 seconds or greater. This c r i t e r i o n not only exceeds the average expiratory time of over 95% of subjects at pretreatment, but also i s consistent with r e s p i r a t i o n rates (8-12 breaths/minute) adopted in e a r l i e r breathing control studies. This c r i t e r i o n i s within the range of expiratory times which trainees adopted in the practice sessions. Expiratory time was selected rather than the other four . respiratory parameters (respiration rate, f r a c t i o n a l inspiratory time, abdominal amplitude, amplitude v a r i a b i l i t y ) because i t correlated highly with each at every period of the pretreatment session (Table 17). By reducing redundancy among dependent measures, s t a t i s t i c a l power in subsequent analyses was preserved. Analyses of breathing technique accuracy were of two types: (1) tabulation of the proportion of trainees and w a i t l i s t subjects meeting c r i t e r i o n during each of the f i v e 30-second posttreatment recording periods; and (2) a 2 (Group) X 2 (Session) X 4 (Period) repeated measures ANOVA. With respect to the l a t t e r , only the 2- and 3-way interactions involving the group and session factors are of inte r e s t . The decision to define breathing technique accuracy as the proportion of participants who met c r i t e r i o n rather than as the proportion of time participants met c r i t e r i o n was based primarily on a pragmatic concern for the amount of time and e f f o r t required to derive the time-based accuracy estimate. Derivation of the l a t t e r estimate would have required hand coding of a l l nine minutes of respiratory tracings obtained for each participant i n the speech a n t i c i p a t i o n and delivery periods of both assessment sessions. The benefit of such enormous e f f o r t , i n terms of increased information about techique implementation, was not considered worth the cost. In fact, the time sampling procedure that was employed for estimating technique accuracy accounted for 25% of the t o t a l time available for implementing the breathing technique, and provided estimates from f i v e d i s t i n c t time periods in the speech an t i c i p a t i o n and delivery periods. Treatment Outcome Autonomic arousal. Heart rate and skin conductance levels were sampled and analyzed i n the same way as the res p i r a t i o n data. Subjective anxiety. SUDS ratings were obtained three times per session (post-adaptation, post-anticipation, post-speech) for inclu s i o n i n a 2 (Group) X 2 (Session) X 3 (Period) repeated measures ANOVA. The only e f f e c t s of interest are the 2- and 3-way interactions involving the group and session factors. The symptom number and symptom in t e n s i t y scores derived from the Symptom Rating Scale were included as variates in a 2 (Group) X 2 (Session) MANOVA. S e l f - e f f i c a c y estimates. The three s e l f - e f f i c a c y predictions included on the Speech Expectancy Scale were incorporated as variates i n a 2 (Group) X 3 (Speech) MANOVA. Analyses of treatment outcome were considered a separate family from those used to assess treatment implementation. With use of the adjustment procedure recommended by Huberty & Morris (1989), the r i s k of a Type I error for each analysis was 5%. A Type I error r i s k of .10 was accepted for the treatment manipulation analysis. For analyses involving more than two le v e l s of a repeated measure, the Greenhouse-Geisser adjustment procedure was applied. Post hoc te s t i n g involved Group X Session comparisons performed separately for each recording period. Results Treatment Implementation Two questions are addressed in t h i s section: (1) did trainees adequately learn the prescribed breathing pattern?; and (2) were they able to implement i t accurately during periods of increasing d i s t r a c t i o n and anxiety ( i . e . while awaiting and then giving an impromptu speech)? In general, the answer to the f i r s t question i s 'Yes' and to the second, 'No'. With respect to the f i r s t question, 83% of trainees met the c r i t e r i o n for breathing technique accuracy during the posttreatment demonstration period. The c r i t e r i o n for accuracy was defined as an average expiratory time of at least 3.5 seconds. P r i o r to treatment, only one person from the entire sample exhibited a resting expiratory time equal to or greater than t h i s value. During the demonstration period, however, 77 trainees averaged 7.4 + 1.9 seconds per exhalation, le v e l s well above c r i t e r i o n . With respect to the second question, however, success at implementing the breathing strategy declined over subsequent recording periods. As Table 8 shows, 60% of trainees met c r i t e r i o n at baseline. During the a n t i c i p a t i o n period, 20% of trainees were accurately employing the technique. Although low, these success rates s t i l l greatly exceeded those of untrained in d i v i d u a l s . They also exceeded the pretreatment success rate of the t r a i n i n g group. Nevertheless, the decline over time suggested that breathing control accuracy i s linked to s i t u a t i o n a l demands; as demands on one's time and attention increase, accuracy diminishes. Similar r e s u l t s were obtained when the expiratory times of trainees were compared with those of w a i t l i s t subjects across sessions and recording periods. Unlike untreated subjects, trainees prolonged t h e i r exhalations far longer during posttreatment baseline and a n t i c i p a t i o n periods than during the pretreatment period (Figure 3). This conclusion stems from the s i g n i f i c a n t 3-way (Group X Session X Period) in t e r a c t i o n obtained in a repeated measures ANOVA (F(3,31) = 2.79, p < .10, Greenhouse-Geisser adjusted) and the simple e f f e c t s t e s t i n g that followed. The l a t t e r involved 2 (Group) X 2 (Session) ANOVAs done separately for each recording period (BL, ANT4, ANT8, and SPE1). Only for the f i r s t three recording periods did s i g n i f i c a n t findings emerge ( F ( l , 3 6 ) = 10.53,. 4.92, 7.13, respectively, p_ < .05). No between-groups differences emerged for the speech delivery period. The e f f e c t sizes for these comparisons are l i s t e d in Table 15. Taken together, these r e s u l t s indicate that the prescribed breathing pattern was being implemented by trainees during the baseline and speech a n t i c i p a t i o n periods. However, the accuracy with which the breathing strategy was implemented was modest. Treatment Outcome The primary question addressed in t h i s section i s whether breathing control t r a i n i n g i s associated with lower l e v e l s of autonomic arousal and self-reported anxiety, and higher levels of s e l f - e f f i c a c y , r e l a t i v e to no treatment. Overall, the results suggest that t r a i n i n g had l i t t l e impact on autonomic and subjective indices of. anxiety, but had a s i g n i f i c a n t e f f e c t on public speaking s e l f - e f f i c a c y . With respect to autonomic arousal, no group differences emerged across sessions or periods; neither the Group X Session X Period in t e r a c t i o n nor the Group X Session in t e r a c t i o n involving heart rate and skin conductance l e v e l were s i g n i f i c a n t (F(6,23) = 0.41 and F(2,27) = 0.41, respectively). Both groups showed equivalent and f a i r l y large increases in arousal l e v e l from baseline to speech delivery in Sessions 1 and 2 (Table 9). In fact, the increase in speech-related arousal reported by investigators such as Knight and Borden (1979) was evident i n the heart rate data of both groups. These data are presented i n Figure 4. However, contrary to expectation, heart rate and skin conductance l e v e l were not well correlated across recording periods. The average c o r r e l a t i o n between these two indices of autonomic arousal during the pretreatment session was only r = -.17, with the range being r = -.13 to r = -.20. These correlations are presented in Table 17. The hypothesis that trainees would report s i g n i f i c a n t l y lower leve l s of speech-elicited anxiety than untrained indivi d u a l s was also not supported. Analysis of the SUDS ratings of both groups following the baseline, speech a n t i c i p a t i o n , and speech delivery periods of Sessions 1 and 2 yielded nonsignificant findings. For the 3-way interaction, F(2,36) = 0.59 (Greenhouse-Geisser adjusted). S i m i l a r l y , for the Group X Session in t e r a c t i o n the F value was 1.35 (df = 1,37). On average, trainees and w a i t l i s t subjects reported f e e l i n g moderately anxious during the baseline period of both sessions (SUDS = 34 to 46) and very anxious just p r i o r to speaking (SUDS = 71 to 78). Lower ratings were reported following each speech (SUDS = 52 to 67). The mean scores for both groups are summarized i n Table 10 while the e f f e c t sizes for each comparison are l i s t e d i n Table 16. Multivariate analysis of the number and i n t e n s i t y of symptoms endorsed on the Symptom Rating Scale also yielded a 80 nonsignificant r e s u l t (F(2,35) = 0.87). As with the SUDS ratings, both groups showed pre- to posttreatment reductions i n symptom number and intensity. However, trainees did not show consistently greater changes than t h e i r untrained peers (Table 11) . S i g n i f i c a n t between-group differences were evident for three related indices of public speaking s e l f - e f f i c a c y . Unlike w a i t l i s t subjects, trainees predicted that they would f e e l less anxious, exercise more control over anxiety, and perform better when faced with a posttreatment speaking opportunity than they had in the pretreatment session. These re s u l t s are based on a s i g n i f i c a n t 2 (Group) X 3 (Speech) multivariate interaction involving speech-related anxiety, control, and,performance predictions (F(6,33) = 2.00, p < .10) and the simple e f f e c t s tests that followed. The l a t t e r involved between-group comparisons for Speeches 1 to 3. S i g n i f i c a n t group differences were found only for Speech 3 (F(3,37) = 5.75, p_ < .01). Trainees d i f f e r e d from t h e i r untreated peers on a l l three s e l f - e f f i c a c y measures. A s i m i l a r trend was evident for Speech 2 ratings (F(3,37) = 1.75). These re s u l t s are summarized i n Table 12. A behavioral index of speech-related s e l f - e f f i c a c y f a i l e d to d i s t i n g u i s h between treated and untreated i n d i v i d u a l s . The vast majority of individuals in each group (81% and 76%, respectively) agreed to give a t h i r d , ostensibly more d i f f i c u l t t a l k . 81 Examination of the Treatment Credibility/Expectancy for Improvement Scale ratings confirmed that trainees found the treatment to be credible. The average rating was 34.9 + 7.7 on t h i s 0 (not credible) to 5 0 (very credible) scale. Correlations Among Outcome Measures To a s s i s t i n the interpretation of treatment outcome findings, correlations between selected outcome measures were computed. These correlations were based on the responses of a l l subjects combined (N = 4 2 ) in Session 1. The correlations between the two autonomic indices (heart rate, skin conductance level) and f i v e respiratory measures (breathing rate, expiratory time, f r a c t i o n a l inspiratory time, abdominal amplitude, amplitude v a r i a b i l i t y ) were consistently low across the four recording periods (BL, ANT4, ANT8, SPE). These correlations are presented in Table 17. The largest c o r r e l a t i o n was r = .29 and involved heart and breathing rate responses at Minute 1 of the speech. However, 19 of the 2 0 cardiorespiratory correlations were below an absolute magnitude of .20. The largest r e s p i r a t i o n - s k i n conductance c o r r e l a t i o n was low as well (r = .34). Only 6 of the 2 0 correlations exceeded an absolute magnitude of .20. The data did suggest a trend for autonomic and breathing rate responses to covary as task demands increased ( i . e . speech responses were more highly correlated than either a n t i c i p a t i o n or resting baseline responses). 82 Similar findings emerged for correlations between the two autonomic measures. The largest c o r r e l a t i o n across the four recording periods was only r = -.20. Likewise, the correlations between s e l f - r e p o r t measures and heart rate were consistently low, the highest being only .19. Somewhat larger correlations were found between se l f - r e p o r t responses and skin conductance l e v e l . The largest c o r r e l a t i o n involving these responses was .38, with 6 of the 7 correlations exceeding an absolute magnitude of .20. A trend was evident for s e l f - r e p o r t and skin conductance responses to covary with increasing task demands, as was the case for breathing rate and skin conductance l e v e l . Discussion Two questions were addressed in Study 2. The f i r s t was whether phobic individuals who had been taught to breathe more slowly and abdominally in order to control acute anxiety could do so while awaiting and/or a c t i v e l y encountering a highly feared event. The second question was whether such t r a i n i n g had a b e n e f i c i a l e f f e c t on fear responses in these two conditions. Breathing Control Accuracy The r e s u l t s of t h i s study indicated that trainees had learned the prescribed breathing pattern a f t e r three weeks of practice. The majority ( i . e . 83%) of them met c r i t e r i o n for breathing control accuracy during a cued demonstration period. However, t h e i r a b i l i t y to implement t h i s pattern uncued during periods of increasing anxiety and d i s t r a c t i o n was not as good as 83 expected. Technique accuracy rates dropped to between 15% and 20% while trainees prepared for an upcoming impromptu speech. Nevertheless, t h e i r breathing patterns during t h i s period more clo s e l y approximated the prescribed one than those of untrained in d i v i d u a l s . This advantage was l o s t once trainees began t h e i r speeches. One can conclude from these findings that short-term, uncued breathing control i s d i f f i c u l t to employ as a coping strategy in fear-provoking situations — at least i n situations where there are many immediate demands on one's attention. The fact that the r e s u l t s of Study 2 re p l i c a t e d those of Study 1 lends support for t h i s conclusion. Such r e s u l t s make i t d i f f i c u l t to draw meaningful conclusions about the effectiveness of prolonged exhalations for attenuating anxiety responses. However, given the r e l a t i v e l y high rates of technique accuracy during the technique demonstration and baseline periods, breathing control might be a useful coping strategy i n situations where individuals do not have to perform some task or where attention d i s t r a c t i n g events are minimal. One such s i t u a t i o n i s awaiting or enduring a painful medical procedure, a s i t u a t i o n i n which passive coping may be the only option available to the patient. One might argue that p o s i t i v e findings for breathing control effectiveness may have emerged i f t r a i n i n g had been longer or more comprehensive. However, the three-week program employed i n t h i s study i s much longer than other t r a i n i n g protocols reported in the l i t e r a t u r e , including the protocol evaluated i n Study 1. Furthermore, i n Study 2 the t r a i n i n g program included hands-on practice at implementing the technique in situations approximating r e a l - l i f e scenarios. F i n a l l y , the l e v e l of s t a t i s t i c a l power to determine i f breathing control could be implemented during times of mounting anxiety was high i n both Study 1 and Study 2 (.70 to .98, r e s p e c t i v e l y ) . Taken together, these observations suggest that the question of how well breathing control can be implemented has already been answered about as well as i t can be. From a p r a c t i c a l standpoint, additional e f f o r t s to enhance breathing control accuracy by increasing the length or comprehensiveness of t r a i n i n g would contradict the primary objective of breathing control t r a i n i n g , namely, to provide patients with an easy-to-learn, easy-to-employ acute coping strategy. An alternative to increasing the length of t r a i n i n g would be to have trainees practice the strategy on t h e i r own for a time (e.g. 1-2 months) before retesting them. Presumably, i f the technique i s perceived as easy and h e l p f u l , trainees would continue to practice i t . This objective could also be achieved by including the technique as a component of a comprehensive treatment program. However, both options open the door to treatment d i f f u s i o n e f f e c t s , poor cqmpliance, and other confounding variables which jeopardize make meaningful interpretation of the data. 85 The findings of the present study have implications for the interpretation of the results of previous studies. They c a l l into question the common conclusion that controlled breathing i s a causal factor i n po s i t i v e treatment outcomes (e.g. Fried et a l . , 1984; Grossman et a l . , 1985). It seems u n l i k e l y that trainees in these studies were implementing the strategy as well as was thought (but not actually tested). The fact that trainees could reproduce the prescribed rate or depth of breathing while res t i n g q u i e t l y i s no guarantee that they could reproduce t h i s during acute stressors — even after extensive practice. Clark and Hirschman (1990) recently reported that trainees quickly revert to t h e i r usual breathing patterns without the aid of external pacing cues For s i m i l a r reasons to those outlined above, the res u l t s of previous studies by other investigators (Harris et a l . , 1976; Holmes et a l . , 1978; McCaul et a l . , 1979) are l i k e l y of limited value. The assumption made in most of these studies was that once trainees had practiced the prescribed pattern for several minutes, they would maintain the pattern on t h e i r own during subsequent stressor periods. This did not occur i n the present study. If such a carry-over e f f e c t could be demonstrated, the chance of i t occurring a f t e r only a few minutes of t r a i n i n g , e s p e c i a l l y t r a i n i n g that focuses one's attention away from kinesthetic cues to v i s u a l or auditory pacing signals, seems remote. 86 Treatment Outcome With respect to the second question addressed i n t h i s study, the r e s u l t s suggest that breathing control t r a i n i n g has r e l a t i v e l y l i t t l e impact on how autonomically aroused or subjectively anxious individuals with public speaking phobia become while waiting to give an impromptu speech. However, t r a i n i n g does enhance t h e i r sense of control or competence i n t h i s s i t u a t i o n . The fact that autonomic arousal was largely unaffected by t r a i n i n g r e p l i c a t e s the findings of many e a r l i e r studies (e.g. Clark & Hirschman, 1980; Helbick, 1981; McCaul et a l . , 1979). This i s p a r t i c u l a r l y true for heart rate. Not a single study to date has demonstrated that heart rate can be consistently attenuated with breathing control t r a i n i n g . Yet i t has been demonstrated that breathing manipulations such as prolonged exhalations and deep inhalations can e l i c i t transient heart rate slowing (e.g. Furedy & Shulhun, 1985; Hurwitz, 1981; Porges, McCabe, & Yongue, 1982; Sroufe, 1971). The gap between these two l i n e s of research i s puzzling. Why should breathing control continue to be taught as an arousal reduction technique i f i t does not achieve t h i s goal? The answer appears to haVe more to do with the perception of control than with true control. It i s also possible that for a subset of people, meaningful heart rate attenuation or reduction can be achieved with breathing control t r a i n i n g . A v i s u a l scan of the polygraph 87 records was consistent with t h i s hypothesis. Thus, with pre-screening, the success rate for breathing control may increase markedly. With the size of the sample in Study 2, i t was not feas i b l e to tes t for subgroups of individuals capable of implementing the breathing strategy under stress. The finding that skin conductance leve l s were not s i g n i f i c a n t l y attenuated as a re s u l t of treatment i s consistent with r e s u l t s reported by others (e.g. Cappo & Holmes, 1984; Harris et a l . , 1 9 7 6 ) . When faced with threats of e l e c t r i c shock or some other aversive and d i s t r a c t i n g experience, breathing control trainees i n these studies experienced nearly as great an increase in skin conductance as control subjects. When trainees showed lower conductance levels than untrained individuals, t h i s occurred during periods of quiescence. Before concluding that breathing control has l i t t l e impact on autonomic arousal, one must keep in mind that only a small proportion of trainees implemented the technique with any degree of accuracy during the stressor periods. The t r a i n i n g group might have shown lower levels of autonomic arousal than the w a i t l i s t group i f more of them had implemented the breathing strategy. However, in situations where technique accuracy rates were high (e.g. the demonstration and baseline periods), the two groups s t i l l did not d i f f e r s i g n i f i c a n t l y . Thus i t i s unl i k e l y that controlled exhalation and abdominally-predominant inhalations a l t e r autonomic arousal to a s i g n i f i c a n t extent. 88 The finding that breathing control did not have a s i g n i f i c a n t impact on self-reported anxiety was surprising. I t ce r t a i n l y i s inconsistent with the res u l t s of previous research. What could account for t h i s discrepancy? One explanation for why trainees in t h i s study did not report s i g n i f i c a n t l y reduced anxiety i s that they simply were not implementing the breathing strategy when faced with mounting anxiety. In other words, there was no reason to expect treatment to be e f f e c t i v e since the technique was not even being implemented. However, the same argument could be made for e a r l i e r breathing control studies, including those i n which subjective anxiety was reportedly reduced. I t i s possible that technique implementation was better in t h i s study than i n e a r l i e r ones, given the length of tra i n i n g , reliance on inter n a l feedback cues, and focus on b r i e f deployment. Thus, poor technique implementation i s an unlikely explanation for the unexpectedly low l e v e l of self-reported improvement. A second possible explanation i s that the measures used to assess subjective state were either i n s e n s i t i v e or unreliable. Post hoc analyses suggested that the SUDS scale was unreliable across assessment sessions (rs = .12 to .53). However, t h i s measure has been adopted in many previous breathing control studies. The SRS, on the other hand, was found to be a r e l i a b l e (rs = .76 to .80) and v a l i d (rs = .41 to .65 with SUDS ratings) 89 index of speech-related anxiety. In a l l l i k e l i h o o d , responses to these two s e l f - r e p o r t measures were more r e l i a b l e than any obtained i n previous studies. This may r e f l e c t the fact that i n the present study, steps were taken to reduce response bias (e.g. 'good subject' roleplaying). Thus, measurement error f a i l s to explain the negative findings of t h i s study. The most plausible explanation for the fact that trainees in Study 2 did not report s i g n i f i c a n t l y reduced subjective anxiety, unlike e a r l i e r studies, i s that Study 2 participants experienced the stressor task as more anxiety-provoking. This i s evident when on comparing t h e i r autonomic and self-reported anxiety responses with those of Study 1 subjects. From these data, one can see that the subjects in Study 2 experienced intense anxiety in response to the speech tests. Individuals whose fear approaches such levels often require a more comprehensive and i n d i v i d u a l l y - t a i l o r e d treatment program than was offered i n the present study i n order to achieve c l i n i c a l l y s i g n i f i c a n t fear reduction. With no p r i o r experience to guide them, trainees may have found themselves overwhelmed when faced with the task of t r y i n g to breathe in a new way while also preparing speech notes. Additional experience at the task may have made i t easier, allowing a possible treatment e f f e c t to emerge (Ost, 1988). However, to provide trainees with such additional experience would have introduced a treatment confound, namely, the e f f e c t of exposure. For some trainees, such practice was not necessary; t h e i r posttreatment anxiety ratings were considerably lower than those reported in the pretreatment session. Thus even though breathing control t r a i n i n g produced a weak treatment e f f e c t , i t was he l p f u l for some people. The most important finding in t h i s study was that breathing control t r a i n i n g i s associated with s i g n i f i c a n t l y more po s i t i v e expectations regarding how anxious one would f e e l when faced with giving another speech, and how well one would ac t u a l l y do at that speech. This e f f e c t was strongest after trainees had had an opportunity to t r y implementing the technique during the posttreatment speech test. That experience, which can be seen as an in vivo practice session, s o l i d i f i e d improvements already made in s e l f - e f f i c a c y b e l i e f s . Such changes in b e l i e f may be very important to the o v e r a l l process of fear reduction. Individuals who believe they can cope adequately in fear-provoking situations are more l i k e l y to (a) experience less return of fear (Craske & Rachman, 1987) and (b) put themselves in such situations i n the future (Bandura, 1984). In turn, repeated exposure has been shown to be one of the most important elements i n fear reduction (Barlow, 1988, 407-409; Butler, 1985; Linden, 1981). What would be i n t e r e s t i n g to determine i s whether success at adopting the prescribed breathing pattern during the posttreatment stressor task i s associated with the greatest improvement i n s e l f - e f f i c a c y predictions with respect to the t h i r d speech. 91 Overall Conclusions Both Study 1 and Study 2 provided evidence consistent with the commonly-made assumption that controlled, abdominally-predominant breathing can be reproduced in anxiety-provoking si t u a t i o n s . However, the accuracy with which t h i s strategy can be implemented by most individuals was below c l i n i c a l l y useful l e v e l s . This was found to be true for subjects in both Study 1 and Study 2, studies which d i f f e r e d on a variety of important dimensions such as the age and pretreatment anxiety l e v e l of subjects, the s e n s i t i v i t y of the treatment outcome measures employed, and c h a r a c t e r i s t i c s of the treatment i t s e l f , such as the length of t r a i n i n g , whether the breathing technique was to be implemented continuously or sporadically, and whether implementation was cued or uncued. What t h i s finding suggests i s that breathing control implementation in e a r l i e r breathing control studies was also inconsistent and/or inaccurate (e.g. Cappo & Holmes, 1984; Clark & Hirschman, 1980; Clark et a l . , 1985; Grossman et a l . , 1985; Harris et a l . , 1976; Holmes et a l . , 1978; McCaul et a l . , 1979). Given the brevity of the t r a i n i n g procedures employed in these e a r l i e r studies, such a conclusion seems a l l the more l i k e l y . Adding further suspicion, breathing implementation accuracy during stressor exposure t r i a l s was not monitored or reported by these investigators. Evidence of accurate technique implementation i s a must i f one i s to draw meaningful conclusions about the s p e c i f i c e f f e c t s of that technique. The f a i l u r e of trainees in Studies 1 and 2 to accurately and consistently implement a controlled, abdominally-predominant breathing pattern in the face of mounting anxiety c a l l s into question conclusions arrived at in e a r l i e r breathing control studies about the s p e c i f i c e f f e cts of breathing techniques. In these e a r l i e r studies, i t was commonly reported that slower and/or abdominally-predominant breathing i s associated with decreased skin conductance response and self-reported anxiety. This was not found to be true in Studies 1 and 2. Given the methodological superiority of Studies 1 and 2 over e a r l i e r studies, and given the low le v e l of technique accuracy found for Studies 1 and 2, i t seems unlikel y that the benefits ascribed to brea'thing control in these e a r l i e r studies were due the breathing control per se. Instead, whatever benefits were reported are better attributed to nonspecific factors such as p o s i t i v e expectations for change, s o c i a l l y desirable responding, and/or chance. Consistent with the conclusion that whatever ef f e c t s breathing control has are not mediated by s p e c i f i c physiological changes i s the observation in Study 2 that the correlations between autonomic and respiratory responses were invariably low. Thus, i f one i s looking for an emotion-focused coping strategy to manage acute anxiety, other strategies such as cognitive restructuring should be considered before advocating breathing control. Nevertheless, breathing control enhances estimates of s e l f -control i n situations usually associated with low s e l f - e f f i c a c y and high avoidance rates. Given i t s r e l a t i v e s i m p l i c i t y to teach and i t s acceptance by most people as a plausible coping strategy, breathing control may serve as a useful adjunct to exposure therapies for various phobias. Whatever i t s s p e c i f i c application, breathing control may be p a r t i c u l a r l y b e n e f i c i a l i n c o n t r o l l i n g anticipatory anxiety rather than as a means of attenuating acute anxiety associated with the performance of some d i f f i c u l t or threatening task. Where performance demands are high, such as i n public speaking, the increase i n confidence that trainees might derive from implementing the technique could be of f s e t by increased performance anxiety. Situations for which i t may be i d e a l l y suited include awaiting s t r e s s f u l dental or medical procedures, and exposure to feared animals, heights, and enclosed spaces. From a t h e o r e t i c a l perspective, the present findings provide further evidence that treatments with a somatic focus, such as slow, abdominally-predominant breathing, have nonspecific rather than s p e c i f i c e f f e c t s with respect to reducing or attenuating anxiety responses. This i s p a r t i c u l a r l y evident from the observation made in both Study 1 and Study 2 that trainees reported improvements in public speaking s e l f - e f f i c a c y despite having demonstrated only minor success at implementing the breathing control strategy. The challenge for future research w i l l continue to be the delineation of how cognitive and s i t u a t i o n a l factors interact with somatically-based treatments i n achieving p o s i t i v e treatment outcomes. 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Home exercises prescribed: a) attend to breathing patterns during d a i l y a c t i v i t i e s . b) twice d a i l y practice of PLB with "hands-on" feedback. Training Session 2 1. Review home assignment, including demonstration of PLB. 2. Practice abdominally-predominant breathing while; a) s i t t i n g q u ietly. b) producing simple vowel sounds. c) reading aloud. 3. Home exercises prescribed: a) d a i l y practice at PLB to release emotional tension. b) practice abdominal breathing while t a l k i n g and reading aloud c) make 2-minute audiotape of speech or r e c i t a t i o n , changing posture etc. Posttreatment Assessment 1. Practice breathing strategies while a n t i c i p a t i n g and then giving impromptu speech. 2. Post-speech review of impromptu speech video recordings with feedback on areas of strength and evident improvement. 3. Provide Notes on e f f e c t i v e speaking and l i s t of additional public speaking resources. 108 Table 3 R e s p i r a t o r y Responses (Means +/- SD) of T r a i n e d and Untra i n e d  S u b j e c t s i n Sessions 1 (PRE) and 2 (POST): Study 1 P e r i o d Group Se s s i o n BL ANT SPE R e s p i r a t i o n r a t e (cpm) Treatment 1 16.6 (2.2) 15.9 (2.9) 12. 3 (1 .6) 2 16.0 (2.4) 13.1 (.2.6) 12. 3 (2 .8) W a i t l i s t 1 15.4 (3.7) 17.1 (3.4) 15. 1 (2 •9) 2 16.9 (3.2) 16.8 (2.5) 14. 6 (3 .5) Ribcage Amplitude (mV/mm) Treatment 1 4.5 (1.0) 5.6 (2.2) 6. 8 (2 •1) 2 4.4 (1.4) 5.1 (1.8) 5. 7 (2 .2) W a i t l i s t 1 3.8 (1.0) 3.9 (1.0) 5. 5 (2 •7) 2 5.2 (1.0) 5.2 (1.1) 6. 9 (3 •0) Abdominal amplitude (mV/mm) Treatment 1 9.6 (4.3) 9.7 (5.2) 9 . 1 (4 •9) 2 11.4 (6.4) 19.9 (9.9) 16. 0 (8 .6) W a i t l i s t 1 11.4 (5.5) 10.1 (4.1) 9. 6 (4 .2) 2 11.0 (3.4) 12.4 (4.6) 10. 9 (4 .8) Amplitude v a r i a b i l i t y (mV/mm) Treatment 1 2.7 (1.8) 3.9 (2.4) 4 . 7 (2 .8) 2 2.9 (3.0) 6.3 (4.4) 7. 4 (4 .6) W a i t l i s t 1 3.4 (2.5) 3.2 (1.2) 4 . 1 (2 •1) 2 3.5 (3.0) 3.3 (1.7) 4- 6 (2 .3) Note: BL = B a s e l i n e ANT = Speech A n t i c i p a t i o n , Minutes 0-4 SPE = Speech D e l i v e r y , Minute 0-1 109 Table 4 Cardiovascular Responses (Means +/- SD) of Trained and Untrained  Subjects i n Sessions 1 (PRE) and 2 (POST): Study 1 Period Group Session BL ANT SPE Heart rate (bpm) Treatment 1 65.8 (10.5) 71.0 (10 .1) 75 .8 (11.2) 2 67.9 ( 9.0) 78.5 ( 9 .5) 83 .7 ( 9.8) W a i t l i s t 1 71.9 ( 7.8) 76.8 (11 •4) 81. 3 (14.7) 2 74.3 (11-8) 78.4 (12 .2) 83 . 7 (12.5) Sy s t o l i c blood pressure (mmHg) Treatment 1 118.9 ( 7.5) 128.5 (14 •1) 136. 7 (15.6) 2 118.5 ( 6.8) 12 3.5 (11 •1) 142 . 5 ( 8.4) W a i t l i s t 1 118.5 (14.0) 128.3 (13 •1) 134. 2 (14.2) 2 114.1 (12.7) 124.0 ( 9 •5) 133 . 9 (12.0) D i a s t o l i c blood pressure (mmHg) Treatment 1 70.6 ( 9.2) 80.3 ( 7 .5) 87. 4 ( 8.5) 2 68.1 (11.1) 77.9 ( 8 .9) 92 . 7 ( 9.2) W a i t l i s t 1 63.6 ( 4.7) 73.5 ( 4 •9) 80. 6 ( 7.0) 2 63.4 (10.1) 69.0 ( 8 .0) 78. 1 ( 8.9) Note: BL = Baseline ANT = Speech Anticipation, Minutes 0-4 SPE = Speech Delivery, Minutes 0-1 110 Table 5 Predictions (Means + /- SD) of Speech-related Anxiety, Emotional  Control, and Aptitude by Trained and Untrained Subjects: Study 1 Speech Predictions Group 1 2 Anxiety (0-100) Treatment 72 . 6 (11. 6) 60. 0 (12. 8) W a i t l i s t 70. 0 (12 . 0) 62 . 1 (15. 4) Control (0-100) Treatment 41. 8 (13 . 5) 48. 7 (18. 7) W a i t l i s t 48 . 1 (11. 1) 44. 9 (13. 4) Aptitude (0-100) Treatment 26 . 8 (18 . 5) 41. 9 (17. 2) W a i t l i s t 45. 4 (16. 1) 43 . 1 (16. 2) Note: High scores on predictions of control and aptitude indicate greater s e l f - e f f i c a c y . Table 6 Pretreatment Characteristics (Means +/- SD) of Treatment and  Wa i t l i s t Subjects: Study 2 Group Ch a r a c t e r i s t i c Treatment W a i t l i s t Gender (male/female) 10 / 8 11 / i o Age (years) 33 . 7 (13.5) 36.7 (13.4) PRCA (15-100) 78. 9 ( 6.6) 81.0 ( 6.2) SUDS ( 0-100) 86 . 7 ( 5.1) 87. 1 ( 7.2) Resting HR (bpm) 7 6 . 2 (12.7) 74.8 (11.9) Resting SBP (mmHg) 129 . 3 (14.3) 127.6 (12.6) Resting DBP (mmHg) 79. 1 (12.4) 75.9 ( 8.2) Note: PRCA = Personal Report of Communication Apprehension SUDS = Subjective Units of Discomfort Scale 112 Table 7 Summary of Group Treatment Procedure: Study 2 Training; Session 1 1. Treatment rationale 2. Demonstration and practice of pursed l i p s breathing (PLB) i n ; a) forward-leaning b) seated upright postures. 3. Home exercises prescribed: a) attend to breathing patterns during d a i l y a c t i v i t i e s . b) twice d a i l y practice of PLB with "hands-on" feedback. Training Session 2 1. Review home assignment, including demonstration of PLB. 2. Demonstration and practice of abdominal breathing; a) pai r i n g exhalation with tension release b) while standing up and walking to podium c) while reading aloud d) while t a l k i n g . 3. Home exercises prescribed: a) d a i l y practice of breathing sequence to release tension. b) practice abdominal breathing while reading aloud, changing posture etc. Training Session 3 1. Review home assignment, including demonstration of breathing while speaking. 2. Demonstration and practice breathing sequence while; a) having a conversation b) recovering from b r i e f exercise. 3. Home exercises prescribed: a) d a i l y practice of breathing sequence to release tension. b) practice controlled breathing during/after exercise, conversations, doing paperwork, dri v i n g car etc. Posttreatment Assessment 1. Review home assignment, including demonstration of breathing control pattern. 2. Post-speech review of impromptu speech video recordings with feedback on areas of strength and evident improvement. 3. Review s e l f - r e p o r t data for treatment-related changes. 4. Provide Notes on e f f e c t i v e speaking and l i s t of additional public speaking resources. Table 8 Percentage of Trained and Untrained Subjects Meeting the  Breathing Control C r i t e r i o n in Each Period of Session 2:  Study 2 Group Period Treatment (N=20) (%) W a i t l i s t (N=21) (%) Demonstration 83 5 Baseline 60 5 Anticipation, Min. 0-4 20 5 Anticipation, Min. 5-8 15 0 Speech Delivery 50 52 Note: C r i t e r i o n = mean exhalation length > 3.5 seconds 114 Table 9 Autonomic and Respiratory Responses (Means +/— SD) of Trained and  Untrained Subjects in Sessions 1 (PRE) and 2 (POST): Study 2 Period (Means) Group Session BL ANT4 ANT8 SPE Heart rate (bpm) Treatment 1 76.2 88.2 93.4 108.4 2 78.4 88.6 96.1 112.3 W a i t l i s t 1 74.9 84.5 90.7 105.8 2 75.4 86.0 94.9 104.6 Skin conductance l e v e l ( mhos) Treatment 1 9.1 11.0 11.5 12.6 2 8.2 8.5 8.5 8.9 W a i t l i s t 1 6.8 8.9 9.3 10.1 2 7.4 7.7 7.8 8.5 Respiration rate (cpm) Treatment 1 17.3 16.8 18.6 11.3 2 11.4 15.3 15.8 9.9 W a i t l i s t 1 18.1 18.8 19.4 12.2 2 17.5 19.9 20.2 11.2 Fractional inspiratory time Treatment 1 .37 .37 .37 .38 2 .33 .35 .37 .37 W a i t l i s t 1 .36 .38 .37 .38 2 .36 .38 .39 .37 115 Table 9 (cont'd) Period (Standard Deviations) Group Session BL ANT 4 ANT 8 SPE Heart rate (bpm) Treatment 1 12.7 15.3 15. 3 20.8 2 11.9 12 . 6 15.2 18.4 W a i t l i s t 1 12. 2 15. 3 19.9 23 .1 2 13 . 0 21 . 0 23 . 7 29.1 Skin conductance l e v e l ( mhos) Treatment 1 6.1 6 . 5 6.7 7.7 > 2 3.9 3.8 3.9 4.2 W a i t l i s t 1 3 . 9 4.7 4.9 4.8 2 4 . 8 4.4 4 . 6 4.5 Respiration rate (cpm) Treatment 1 4 . 5 4.7 4.6 3.7 2 4 . 2 4.2 4 . 4 1.6 W a i t l i s t 1 3 . 7 3 . 7 4 . 0 2.7 2 3 . 6 3.4 4 . 0 2.9 Fractional inspiratory time Treatment 1 . 0 5 . 06 . 05 . 08 2 . 0 8 . 07 . 06 . 14 W a i t l i s t 1 . 05 . 05 .05 .09 2 . 05 . 04 . 04 . 10 Note: BL = Baseline ANT4 = Speech Anticipation, Minutes 0-4 ANT8 = Speech Anticipation, Minutes 5-8 SPE = Speech Delivery, Minutes 0-1 116 Table 10 SUDS Ratings (Means +/- SD) of T r a i n e d and Un t r a i n e d Subjects i n  Sessions 1 (PRE) and 2 (POST): Study 2 P e r i o d Group S e s s i o n BL ANT SPE Treatment 1 45. . 0 (22 . •4) 78. , 1 (18. 3) 67. ,2 (25. •1) 2 33 . 6 (15. ,0) 70. ,8 (18. •7) 52. .2 (18, •7) W a i t l i s t 1 45 . 9 (20. •4) 76 . , 4 (13. •9) 64 . 8 (20. .2) 2 41. . 2 (21. .0) 70. . 5 (17. .0) 60. .2 (18. •9) Note 1: BL = B a s e l i n e ANT = Speech A n t i c i p a t i o n SPE = Speech D e l i v e r y Note 2: SUDS = 0 (completely calm) t o 100 (extremely a n x i o u s ) . 117 Table 11 Number and Intensity of Anxiety Symptoms (Means + /- SD) Reported  by Trained and Untrained Subjects: Study 2 Speech Symptom Rating S c a l e . S t a t i s t i c Group 1 2 Symptom number3 Treatment 10. 6 (3. 8) 7. 9 (2. 1) W a i t l i s t 12. 8 (3. 3) 10. 6 (3. 2) Symptom i n t e n s i t y 1 3 Treatment 1. 5 (0. 8) 0. 8 (0. 3) W a i t l i s t 1. 7 (0. 6) 1. 4 (0. 5) aSymptoms rated as at least 1 (mild) i n i n t e n s i t y on a 0-4 scale. bMean rat i n g across a l l 16 symptoms of the Symptom Rating Scale. 118 Table 12 Predictions (Means +/- SD) of Speech-related Anxiety. Emotional  Control, and Aptitude by Trained and Untrained Subjects: Study 2 Speech Prediction Group 1 2 3 Anxiety 1 Treatment 80. 3 (16. 6) 68 . 5 (19. 9) 71. 0 (17. 1) W a i t l i s t 81. 0 (11. V) 75. 5 (12 . 4) 83 . 3 (10. 3) C o n t r o l 2 Treatment 37 . 3 (23 . 6) 53 . 8 (21. 3) 56. 5 (20. 8) W a i t l i s t 37 . 7 (24 . 5) 43 . 0 (21. 8) 40. 5 (24. 5) Aptitude 2 Treatment 36 . 5 (17. 6) 48. 8 (21. 5) 56. 0 (16. 7) W a i t l i s t 33 . 0 (17. 8) 34 . 5 (18. 7) 35. 0 (17. 6) 1High scores (0-100) indicate low s e l f - e f f i c a c y . 2High scores (0-100) indicate h i g h s e l f - e f f i c a c y . Table 13 Within- and Between-Group Effect Size Comparisons for the  Physiological Responses Observed in each Period of  Sessions 1 (PRE) and 2 (POST): Study 1 Analysis Period Group BL ANT S P E Within-group Between-group Respiration Rate Trained Untrained . 09 -.21 .30 51 05 46 00 08 -.08 Within-group Between-group Heart Rate Trained -.11 Untrained -.10 -.01 40 04 -.36 46 09 - . 3 7 Within-group Between-group S y s t o l i c Blood Pressure Trained Untrained . 00 . 15 . 19 . 18 -.15 .01 10 10 -.20 Within-group Between-group D i a s t o l i c Blood Pressure Trained Untrained . 17 - . 0 5 14 31 22 -.17 32 22 -.54 Note: BL = Baseline ANT = Speech Anticipation SPE = Speech Delivery Table 14 Within- and Between-Group Eff e c t Size Comparisons for Self-report  Responses in Sessions 1 (PRE) and 2 (POST): Study 1 Eff e c t Size Group Symptom Reporting Within-group Trained Untrained Between-group Number . 32 -.04 .36 Intensity .45 .00 45 Eff e c t Size Group Within-group Trained Untrained S e l f - e f f i c a c y Predictions Anxiety . 52 . 29 Control .20 -.13 Aptitude .42 -.07 Between-group .23 .33 .49 121 Table 15 Within- and Between-Group Effect Size Comparisons for the  Physiological Responses Observed in each Period of  Sessions 1 (PRE) and 2 (POST): Study 2 Period E f f e c t Size Group BL ANT4 ANT8 SPE1 Exhalation Length Within-group Trained .48 .15 .20 .16 Untrained .05 -.09 -.13 .17 Between-group .43 .24 .33 -.01 Respiration Rate Within-group Trained .64 .18 .31 .25 Untrained .08 -.14 -.13 .19 Between-group .56 .32 .44 .06 Heart Rate Within-group Trained - . 0 9 -.02 -.09 -.10 Untrained -.01 -.04 -.10 .03 Between-group -.08 .02 .01 -.13 Skin Conductance Level Within-group Trained .09 .24 .29 .32 Untrained -.07 .13 .16 .18 Between-group .16 .11 .13 .14 122 Table 16 Within- and Between-Group Eff e c t Size Comparisons for Self-report  Responses in Sessions 1 (PRE) and 2 (POST): Study 2 Ef f e c t Size Group Dependent Measure Within-group Between-group Symptom Reporting Number Trained .47 Untrained .34 Intensity . 62 . 39 13 .23 Within-group Trained Untrained Between-group S e l f - e f f i c a c y Predictions Speech 2 - Speech 1 Anxiety Control Aptitude .33 .37 .32 .23 .11 .04 10 26 28 S e l f - e f f i c a c y Predictions Speech 3 - Speech 1 Within-group Trained Untrained Anxiety Control Aptitude .28 .44 .57 -.11 .05 .05 Between-group .39 .52 Table 16 (cont'd) E f f e c t Size Group Dependent Measure SUDS Ratings Period BL ANT SPE Within-group Trained .31 .20 .34 Untrained .17 .19 .11 Between-group . 01 .23 124 Table 17 Selected Correlations from Session 1 of Study 2. Correlations Between Respiratory Measures Recorded During A l l Periods of Session 1 ( A l l Subjects Combined) Period Measure 1 Measure 2 BL ANT4 ANT 8 SPE1 Te RR -.84 -.84 -.84 -.40 FIT -.61 -.79 -.64 -.36 AA .41 . 60 . 68 .03 AAV .31 -.04 . 19 -.23 RR FIT . 47 . 62 .46 .16 AA -.33 -.49 -.54 -.23 AAV -.16 -.11 -.30 . 11 FIT AA . 03 -.31 -.15 -.18 AAV .31 . 16 -.01 .54 AA AAV . 38 -.26 . 00 -.13 Correlations Between Respiratory and Autonomic Measures Recorded During A l l Periods of Session 1 ( A l l Subjects Combined) Period Autonomic Respiratory Measure Measure BL ANT4 ANT 8 SPE1 HR Te -.03 -.14 -.14 -.14 RR . 08 . 05 . 18 . 29 FIT -.18. . 07 . 12 . 14 AA . 03 . 03 -.03 -.03 AAV . 01 . 14 -.05 -.07 SCL Te -.09 -.14 -.19 -.09 RR . 13 . 16 . 16 .33 FIT . 16 . 22 .31 -.27 AA .34 . 09 .07 .19 AAV . 13 . 06 . 07 -.34 125 Table 17 (cont'd) Correlations Between Heart Rate and Skin Conductance Level During the Four Recording Periods ( A l l Subjects Combined) Period Measure 1 Measure 2 BL ANT4 ANT8 SPE1 HR SCL -.20 -.16. -.20 -.13 Correlations Between Autonomic and Se l f -report Measures During the Four Recording Periods ( A l l Subjects Combined) Period Autonomic Self-report Measure Measure BL ANT SPE HR SUDS -.04 . 19 .08 Symptom Number . 06 .06 Symptom Rating . 14 . 16 SCL SUDS -.02 .20 .34 Symptom Number .27 . 38 Symptom Rating .21 .29 Concurrent V a l i d i t y of Anxiety Self-report Measures Recorded During Session 1 ( A l l Subjects Combined) SUDS Measure 1 Predicted SUDS Symptom Rating Symptom Number ANT . 39 . 51 .35 SPE .32 . 65 .41 Symptoms Number .31 .89 Rating .33 Note: BL ANT4 ANT 4 SPE Baseline Speech Anticipation, Minutes 0-4 Speech Anticipation, Minutes 5-8 Speech Delivery, Minutes 0-1 126 1. Mean r e s p i r a t i o n r a t e s of t r a i n e d and u n t r a i n e d ts at each p e r i o d of S e s s i o n s 1 and 2« Study 1. I PRETREATMENT A Treatment i i i BL ANT SPE Recording Period POSTTREATMENT BL = Baseline _ ANT = Speech A n t i c i p a t i o n A Treatment BL ANT SPE Recording Period 127 F igu re 2. Mean hea r t r a tes at t r a i n e d and un t ra ined subje~cts at each p e r i o d of S e s s i ons 1 and 2- Study 1. 1 1 0 1 0 0 9 0 r 8 0 7 0 6 0 PRETREATMENT • Wait-list A Treatment BL = Baseline ANT = Speech A n t i c i p a t i o n SPE = Speech Delivery BL ANT Recording Period SPE 1 1 0 1 0 0 9 0 n 8 0 7 0 • Wait-list A Treatment POSTTREATMENT BL = Baseline ANT = Speech A n t i c i p a t i o n SPE = Speech Delivery 6 0 BL ANT SPE Recording Period 128 F igu re 3. Mean e x h a l a t i o n lengths of t r a i n e d and u n t r a i n e d sub j ec t s at each p e r i o d of S e s s i o n s 1 and 2 •• Study 2. co "O c o o CD CO CD C <r> _l c o -*—' CO x UJ PRETREATMENT • Wait-list * Treatment BL BL = B a s e l i n e ANT4 = A n t i c i p a t i o n , M i n . 4 ANT8 = A n t i c i p a t i o n , M i n . 8 SPE = Speech D e l i v e r y ANT 4 ANT 8 Recording Period SPE1 <z> "O c o o CD CO CD C CD c o CO X UJ 3 -2 -POSTTREATMENT • Wait-list A Treatment / BL = B a s e l i n e * ANT4 = A n t i c i p a t i o n , M i n . 4 ANT8 = A n t i c i p a t i o n , M i n . 8 SPE1 = Speech D e l i v e r y BL ANT4 ANT8 Recording Period SPE1 129 F i g u r e 4. Mean h e a r t r a t e s o f t r a i n e d a n d u n t r a i n e d s u b j e c t s a t e a c h p e r i o d o f S e s s i o n s 1 a n d Z'- S t u d y 2 1 2 0 1 1 0 E 8 1 0 0 © a CO CD X 90 80 70 PRETREATMENT • Wait-list A Treatment BL = B a s e l i n e ANT4 = A n t i c i p a t i o n , M i n . 4 ANT8 = A n t i c i p a t i o n , M i n . 8 SPE1 = Speech D e l i v e r y BL ANT4 ANT8 Recording Period S P E 1 1 2 0 1 1 0 E 3 1 0 0 © cd GC CO © I 90 h 80 70 POSTTREATMENT • Wait-list A Treatment BL = B a s e l i n e ANT4 = A n t i c i p a t i o n , M i n . 4 ANT8 = A n t i c i p a t i o n , M i n . 8 SPE1 = Speech D e l i v e r y BL ANT4 ANT8 Recording Period S P E 1 130 Appendix A Advertisement for Subjects Anxious about speaking to audiences, giving class presentations, sharing your opinions in groups? Avoiding such opportunities? If your answer i s 'Yes' to either questions, you have the chance r i g h t now to e n r o l l in a f r e e , 4-week t r a i n i n g program in a n x i e t y  management techniques being offered through the Department of Psychology, U.B.C. For further information, c o n t a c t Aaron H a i t , M.A. @ Appendix A Public Speaking Anxiety Survey Many—people report f e e l i n g quite anxious about speaking i n public, whether i t be contributing t h e i r opinion i n a group discussion or d e l i v e r i n g an address to a large audience. In the questions below, you w i l l be asked to indicate what your own personal experience of public speaking anxiety i s l i k e . Please note that t h i s i s a survey, not a test: there i s no "best way" to answer these questions. 1. In the past two years, approximately how often have you; a) given a formal t a l k or presentation? times b) avoided a public speaking opportunity? times 2. On a scale from 0 to 100, where 0 indicates a f e e l i n g of complete calm and 100 represents feelings of panic, how anxious would you say you t y p i c a l l y f e e l i n the following s i t u a t i o n s ; waiting those l a s t few minutes before giving your t a l k : standing up in front of your audience, looking out at them just before you begin to speak: half way through your t a l k : 3. L i s t e d below are some sensations that are often associated with anxiety. Please indicate which ones you t y p i c a l l y experience when your public speaking anxiety i s at i t s peak (as rated above). Do t h i s by marking a slash ("/") on the corresponding 0-4 in t e n s i t y scale. Not even Very noticeable Mild Moderate Intense Intense Feeling light-headed/dizzy 0 1 2 3 4 ,Feeling short of breath 0 1 2 3 4 Racing/pounding heart 0 1 2 3 4 Trembling/unsteady f e e l i n g 0 1 2 3 4 Perspiring/sweaty palms 0 1 2 3 4 Nauseous/feeling sick 0 1 2 3 4 Confused/dream-like f e e l i n g 0 1 2 3 4 Restless/nervous f e e l i n g 0 1 2 3 4 Worrying that you might die 0 1 2 3 4 Fear you might lose control 0 1 2 3 4 Numbness or t i n g l i n g f e e l i n g 0 1 2 3 4 Blushing or f e e l i n g c h i l l e d 0 1 2 3 4 Chest pain or discomfort 0 1 2 3 4 Choking 0 1 2 3 — 4 Dry mouth 0 1 2 3 4 Mind goes blank/memory lapse 0 1 2 3 4 Name & phone number (optional) 132 Appendix A Instructions: Public Speaking Anxiety Survey Hi. As Dr. has already mentioned, my name i s Aaron Hait and I'm a Ph.D student i n C l i n i c a l Psychology here at U.B.C. The reason I've come to your class today i s to ask you to complete a 1-page survey and a b r i e f questionnaire about your experiences with public speaking anxiety. Your responses to these two s e l f - r e p o r t forms w i l l help to provide normative data on the extent and severity of public speaking anxiety in the un i v e r s i t y population, including the type and i n t e n s i t y of symptoms that accompany public speaking anxiety. Of course, you are under no obligation whatsoever to complete these s e l f - r e p o r t forms: p a r t i c i p a t i o n i s e n t i r e l y voluntary. I also want to describe for you a b r i e f anxiety management t r a i n i n g program I'm currently o f f e r i n g for people bothered by public speaking anxiety. You may be surprised to learn that at least one out of every f i v e people experiences such intense anxiety about giving t a l k s and presentations, or speaking up i n group meetings that t h e i r l i v e s are s i g n i f i c a n t l y i n t e r f e r e d with. Perhaps you've had t h i s experience yourself. In the survey, y o u ' l l be asked to rate how anxious public speaking makes you f e e l , and what some of the sensations are that go along with i t . Once you've completed the survey, i f you're interested i n p a r t i c i p a t i n g in 4 f r e e t r a i n i n g s e s s i o n s in anxiety management offered here on campus then at the very bottom of the questionnaire, p r i n t your name and phone number. Each session i s approximately 3 0-60 minutes i n l e n g t h and w i l l involve individual i n s t r u c t i o n i n s e l f - r e l a x a t i o n and coping s k i l l s . Some videotape feedback of your public speaking performance and physiological responses w i l l also be included. If you're not interested in the t r a i n i n g program, please f i l l out the survey anyhow and simply f o l d i t in half without writing down your name. Your survey responses are important for helping us better understand public speaking anxiety. Okay, just to summarize the procedure, everyone f i l l s out the survey. Then, i f you want to p a r t i c i p a t e i n the t r a i n i n g program or would l i k e more information about i t , write down your name, phone number, and contact times at the bottom of the survey, f o l d i t i n half, and put i t in the manila envelope being passed down your row. If you're not interested i n the t r a i n i n g program, don't bother putting down your name and number - just f o l d the survey i n half and put i t in the envelope. I ' l l c o l l e c t these envelopes i n y-minute's time. Any questions. Good. Thanks for your help. Appendix B Subjective Units of Discomfort Scale (SUDS): Pre-Speech Beside each statement, indicate the amount of anxiety you would expect to f e e l i n that p a r t i c u l a r s i t u a t i o n . The scale ranges from 0 to 100. A score of 0 describes the most relaxed and calm state you have ever experienced, while 100 ref e r s to the most anxious or d i s t r e s s i n g experience you have ever had. Please enter a response for each statement. SUDS 1. One week before you are scheduled to give a speech, you are l y i n g in your bed about to f a l l asleep. 2. You are reading about speeches alone in your room. 3. One week before your speech, you are discussing i t with a friend. 4. One week before giving a speech, you are l i s t e n i n g while another person gives a speech. 5. You are working on your speech in the l i b r a r y . 6. You are p r a c t i c i n g your speech alone i n your room. 7. I t i s the morning you give a speech and you are getting dressed. 8. You are walking over to the place where you are to give your speech. 9. On the day of your presentation, you are i n the room waiting while another speaks. 10. You are walking up to the front of the room to give your speech. 11. You are d e l i v e r i n g a speech to a group of your peers. 12. You are d e l i v e r i n g a speech to a group of strangers. 13. You are d e l i v e r i n g a speech i n a gym to around 1000 students. 14. You are d e l i v e r i n g a speech i n a h a l l to around 1000 professionals in your area of work or study. 134 Appendix B Speech Expectancy S c a l e Please complete each of the questions below by c i r c l i n g the number that best describes your c u r r e n t expectations. 1. How anxious do you think you w i l l f e e l just before and/or during your upcoming speech? Completely Extremely calm anxious 0 10 2 0 3 0 4 0 50 60 7 0 8 0 90 100 How much control do you think you w i l l have over your anxiety l e v e l before and/or during your speech? Absolutely Complete no control control 0 10 2 0 3 0 4 0 50 60 70 80 90 100 3. How well do you think you w i l l do at your speech? Very poorly Very well 135 Appendix B Bodily Sensations Checklist I.D.# List e d below are some sensations that are often associated with anxiety. Please indicate which ones you t y p i c a l l y experience when your public speaking anxiety i s at i t s peak. Do t h i s by marking a slash ("/") on the corresponding 0-100 in t e n s i t y scale. If a sensation doesn't apply to you, simply c i r c l e "0" on the scale. Not even Very noticeable Intense Feeling f a i n t or dizzy 0 100 Feeling short of breath 0 100 Racing/pounding heart 0 100 Trembling/shakiness 0 100 Perspiring/sweaty palms 0 100 Nausea 0 100 Confused/dream-like f e e l i n g 0 100 Awful, apprehensive f e e l i n g 0 100 Worrying that you might die 0 100 Mind goes blank/memory lapse 0 100 Fear you might lose control 0 100 Numbness or t i n g l i n g f e e l i n g 0 100 Chest pain or discomfort 0 100 Choking 0 100 Dry mouth 0 100 Blushing or f e e l i n g c h i l l e d 0 100 136 Appendix B C r e d i b i l i t y / Expectancy f o r Improvement S c a l e Please complete the questions below by c i r c l i n g one number for each of the questions. 1. How l o g i c a l does t h i s type of treatment seem to you? Not at a l l Very l o g i c a l l o g i c a l Tj 1 2 3 4 5 6 7 8 9 10 2. How confident would you be that t h i s treatment would be successful in s i g n i f i c a n t l y reducing your fear of speaking before a group? Not at a l l Very confident confident fj "T 2 3 4 5 6 7 8 9 10 3. How confident would you be in recommending t h i s treatment to a fr i e n d who was extremely anxious about making speeches? Not at a l l Very confident confident fj I 2 3 4 5 6 7 8 9 10 4. If you were extremely anxious i n speech sit u a t i o n s , would you be w i l l i n g to undergo such treatment? Not at a l l Very w i l l i n g w i l l i n g fj I 2 3 4 5 6 7 8 9 10 5. How successful do you f e e l t h i s treatment would be i n decreasing a d i f f e r e n t fear: for example, strong anxiety regarding s o c i a l situations such as dating, arguments etc.? Not at a l l Very successful successful 0 1 2 3 4 5 6 7 8 9 1 0 Appendix B ADIS-R Social Phobia Interview Establishing the Diagnosis: 1. a. (In s o c i a l situations where you might be observed or evaluated by others, do you f e e l fearful/anxious/nervous?) YES/NO b. (Are you overly concerned that you may do and/or say something that might embarrass or humiliate yourself i n front of others, or that others may think badly of you?) YES/NO c. (Do you t r y to avoid these situations?) YES/NO 2. (I'm going to describe some situations of t h i s type and ask you how you f e e l in each situation.) Find out how much fear, discomfort, and avoidance exists f o r each situation and rate on the 0-4 scale for fear and avoidance. No fear/ Mild fear/ Moderate fear/ Severe. Very severe/ never rarely sometimes fear/often always avoids avoids avoids avoids avoids Fear Avoid Comments a. Parties b. Meetings c. Eating i n public d. Using public restrooms e. Talking i n front of a group f. Writing i n public (forms,checks) g. Dating situations h. Talking to persons in authority i . Being assertive e.g.: 1) Refusing unreasonable requests 2) Asking others to behave d i f f e r , j . I n i t i a t i n g a conversation k. Maintaining a conversation 3. (What do you anticipate before going into What do you think w i l l happen before/during?) 4 . (Do you experience the fear nearly every time you encounter ?) YES/NO 138 5. (Does the fear come on as soon as you encounter ?) YES/NO 6. (Have you ever had what you might describe as a p a n i c a t t a c k ? If so, d e s c r i b e what i t was l i k e . ) (Look over t h i s l i s t of symptoms on t h i s sheet I've just handed you. Rate how intense each sensation t y p i c a l l y i s using the 0-4 scale provided.) 0=not present l=mild 2=moderate 3=intense 4=very intense Probe: How can you predict when one i s about to happen? : can't predict ( i . e . spontaneous) : s p e c i f i c s i t u a t i o n : physical sensations : thoughts How o f t e n have you had t h i s in the p a s t year? N = How many have you had in the p a s t 4 weeks? N = (Have you ever experienced a panic attack before or during a speech?) YES/NO (After one of these attacks, have you been so a f r a i d of having another one that you've avoided giving talks?) YES/NO (When i s the l a s t time you panicked while awaiting or giving a talk?) YEAR MONTH I f no evidence i s found f o r f e a r / a v o i d a n c e , or i f f e a r / a v o i d a n c e i s c l e a r l y r e l a t e d to f e a r of p a n i c , s k i p to obsessive-compulsive d i s o r d e r . 8. (In these situations, does i t make a difference i f the people are:) Note which i s e a s i e r ; Male Female No difference Older Younger No difference A t t r a c t i v e Less a t t r a c t i v e No difference Married Unmarried No difference Friends Strangers No difference Large group Small group No difference Informal Formal No difference 139 9. (What^public speaking s i t u a t i o n s c a r e s you the most? I t doesn't have to be one you've actually been i n or even expect to be in soon. Probe: Number of people present? N = Audience c h a r a c t e r i s t i c s : M / F Peers / Authorities Know well / Strangers Location Length of t a l k mins. Time u n t i l talk hrs. Anxiety cues 10a. (When did you f i r s t experience t h i s fear?) Year Month b. (What was the situation?) c. (Has there been a time since then when you were not bothered by these fears?) YES/NO If YES, When? From to d. (When did you l a s t give a t a l k or speech to an audience?) Year Month 11. (Has the fear interfered with your l i f e , work, s o c i a l a c t i v i t i e s , family etc.? Has your current job/educational attainment been influenced by the fears?) YES/NO If YES, How? Rate l e v e l of impairment on 0-4 scale. Etiology: 1. (Why do you think you have t h i s problem in the f i r s t place? How do you explain i t ? What caused i t ? ) Options: a) Observing or imagining someone else experience fear or trauma while public speaking? YES/NO 140 b) Being warned or t o l d unpleasant things about public speaking? YES/NO c) Being frightened by something in the s i t u a t i o n or being embarrassed or humiliated in t h i s situation? YES/NO d) Suddenly experiencing a rush of intense fear, anxiety, and/or a f e e l i n g of impending doom for no apparent reason i n t h i s situation? YES/NO (Were you able to enter t h i s s i t u a t i o n , without fear, before t h i s p a r t i c u l a r experience?) YES/NO 2. (What distresses you most about t h i s phobia?) Check one: The sensation of fear Aspects of the object or si t u a t i o n Treatment: 1. (What sort of help have you sought for t h i s p a r t i c u l a r problem?) Probe: Toastmasters? Debating club? Dale Carnegie? Assertiveness t r a i n i n g group? Night school? Self-help books (e.g. Burns) Psychologist? Psychi a t r i s t ? Medications? Relaxation training? Hypnosis? 2. (What do you expect treatment t o do for you?) Probe: What kind of treatment would help you most? Other problems: 1. (Many people have other d i f f i c u l t i e s that they wish they could have help with? Are there some other concerns that you have at t h i s time?) Probe: Depressed? Fears / Worries? Obsessions / Compulsions? Marital/family problems? Drug/alcohol abuse? 141 Appendix B Pe r s o n a l Report of Communication Apprehension This questionnaire includes 2 0 statements concerning feelings about communicating with other people. Indicate the degree to which the statements apply to you by marking whether you; 1 2 3 4 5 strongly agree undecided disagree strongly agree disagree 1. While p a r t i c i p a t i n g i n a conversation with a new acquaintance I f e e l very nervous. 2. I have no fear of facing an audience. 3. I look forward to an opportunity to speak i n public. 4.1 look forward to expressing my opinion at meetings. 5.1 f i n d the prospect of speaking mildly pleasant. 6 . When speaking, my posture feels strained and unnatural. 7. I am tense and nervous while p a r t i c i p a t i n g i n group discussions. 8. Although I ta l k f l u e n t l y with friends, I am at a loss for words on the platform. 9. My hands tremble when I handle objects on the platform. 10. I have always avoided speaking i n public i f possible. 11. I f e e l that I am more fluent when t a l k i n g to people than most others are. 12. I am f e a r f u l and tense a l l the while I am speaking before a group. 13. My thoughts become confused and jumbled when I speak before an audience. 14. Although I am nervous just before getting up, I soon forget my fears and enjoy the experience. 15. Conversing with people who hold positions of authority causes me to be f e a r f u l and tense. 16. I d i s l i k e to use my body and voice expressively. 17. I f e e l relaxed and comfortable while speaking. 18. I f e e l self-conscious when I am c a l l e d upon to answer a question or give an opinion i n class or group. 19. I face the prospect of making a speech with complete confidence. 20. I would enjoy presenting a speech on a l o c a l TV show. 142 Appendix B ~ SUDS Please rate how anxious or tense you've been f e e l i n g over the past 3-4 minutes, including your present f e e l i n g . Put a slash ("/") through the number that best represents that f e e l i n g . A quick response i s l i k e l y to be the most accurate. Completely calm Extremely anxious 1 4 3 Appendix B ~ Symptom R a t i n g S c a l e L i s t e d below are some sensations that are often associated with anxiety. Please indicate which ones you experienced while awaiting and/or d e l i v e r i n g your speech. Do t h i s by marking a slash ("/") on the corresponding 0 - 4 i n t e n s i t y scale. If a sensation doesn't apply to you, simply c i r c l e " 0 " on the scale. Not even Very n o t i c e a b l e M i l d Moderate Intense Intense Feeling light-headed/dizzy 0 — 1 — 2  3  4 Feeling short of breath 0 - 1 - — " 2 — " — " 3 — - 4 Racing/pounding heart 0 - — 1 - — — - 2 — -— " 3 — - 4 Trembling/unsteady f e e l i n g 0 — 1 — - — " 2 — - — 3 — " 4 Perspiring/sweaty palms 0 - 1 - - — - 2 - — — - 3 — - 4 Nauseous/feeling sick 0 — 1 — . 2 — - 3 — - 4 Confused/dream-like fe e l i n g 0 — - 1 — - — " 2 — -- — 3 — - 4 Restless/nervous f e e l i n g 0 — " 2 — -— " 3 — " 4 Worrying that you might die 0 - 1 - — " 2 — -— " 3 — - - — - 4 Fear you might lose control 0 — " 1 — — 2 — " " 3 — - 4 Numbness or t i n g l i n g f e e l i n g 0 — - — 2 — -— " 3 — " 4 Blushing or f e e l i n g c h i l l e d 0 — - 1 — - — " 2 — • — " 3 — " 4 Chest pain or discomfort 0 — - 1 - — " 2 — -" 3 — • 4 Choking 0 - 1 - — " 2 — • — 3 — " 4 Dry mouth 0 1 — " " 2 - — " 3 - — 4 Mind goes blank/memory lapse 0 2 — - 3  4 144 Appendix C Script 1: I n i t i a l Phone Conversation with Subjects Hi. This i s Aaron Hait from the Department of Psychology at U.B.C. I'm c a l l i n g because you indicated an inte r e s t i n the anxiety management project I'm conducting with speech anxious ind i v i d u a l s . Would you l i k e to know more about the program? Okay, as I mentioned in class, t h i s i s a 4-week long t r a i n i n g program being held on campus in the Psychology Department. You would be seen i n d i v i d u a l l y once a week by myself and an assistant. We'd s t a r t by conducting a b r i e f i n i t i a l assessment of your public speaking d i f f i c u l t i e s . After that, I would, describe the coping technique to you and have you practice a series of simple exercises designed to help you learn to relax yourself i n s t r e s s f u l situations. You would then be asked to practice some of these exercises at home on a d a i l y basis. On some occasions, recordings w i l l be made of your body's a c t i v i t y l e v e l s to help you understand the role that physiological arousal plays i n your subjective experience of anxiety. In case you were wondering, the t r a i n i n g program does not involve the use of any medications or drugs, nor would you be hypnotized. Instead, you would be taught a method for exercising physical control over public speaking anxiety. At the moment, I can't t e l l you more about the method than that except for the fact that i t i s being evaluated experimentally. As a r e s u l t , your responses would be recorded p e r i o d i c a l l y for s c i e n t i f i c study. Of course, your privacy and c o n f i d e n t i a l i t y would be s t r i c t l y guarded, and you would ret a i n the right to drop out of the program at any time you wish. Any questions? Good! I have three questions for you. F i r s t of a l l , t e l l me, how severe do you estimate your public speaking anxiety to be. I'm going to give you a scale you can use to rate i t s severity or in t e n s i t y . On t h i s scale, a " 0 " indicates being t o t a l l y relaxed while a rating of " 1 0 0 " indicates anxiety that i s so intense you're i n a state of panic. What would you rate your t y p i c a l l e v e l of anxiety to be in public speaking situations? SUDS = . Okay, thanks. Secondly, are you currently bothered by some type of respiratory disorder, such as emphysema, hay fever, or cold? How about cardiovascular disease? Any history of high blood pressure or coronary heart disease? And f i n a l l y , are you currently receiving any form of treatment for public speaking anxiety or some other anxiety problem? Thank you for answering these questions. Having heard a l i t t l e about the t r a i n i n g program, would you be w i l l i n g to p a r t i c i p a t e in i t ? Great! Why don't we schedule your 145 f i r s t appointment? Could you be available for a 1-hour session at AM/PM t h i s (date) . Okay. Come to the Psychology C l i n i c waiting area on the f i r s t f l o o r of the Kenny Building on West Mall - the one with the Totem Pole out front. I ' l l meet you in the waiting area at o'clock. Look for the Public Speaking Anxiety signs to help guide you to the waiting room. If for some reason you can't make that appointment, please leave a message for me at least 24 hours in advance at the following number: Got that? Any questions for me or concerns you'd l i k e to discuss with me now? No, then I guess I ' l l see you on (date) at (time) (subject's name). 146 Appendix D Participant Consent Form I, , agree to p a r t i c i p a t e as a volunteer i n the research project e n t i t l e d "A p i l o t study of the e f f e c t s of breathing control t r a i n i n g " conducted i n the Cardiovascular Psychophysiology Lab, U.B.C. under the d i r e c t i o n of Dr. W. Linden. The procedures of t h i s 45 to 60-minute long study have been adequately explained to me. As I understand i t , my l e v e l s of skin conductance, heart rate, peripheral blood flow, and respiratory a c t i v i t y w i l l be monitored noninvasively while I; (1) rest q u i e t l y for 10-minutes; (2) answer questions about my d i f f i c u l t i e s with public speaking anxiety; (3) learn and practice a breathing control technique; and (4) respond to a 5-minute challenge task, the d e t a i l s of which w i l l be explained to me following the t r a i n i n g period. I understand that I have the right to withhold my p a r t i c i p a t i o n in any or a l l parts of the experimental procedure at any time I wish. I also r e a l i z e that the data obtained from my p a r t i c i p a t i o n in t h i s study are s t r i c t l y c o n f i d e n t i a l . Although t h i s data may be used in future research, there w i l l be no i d e n t i f i c a t i o n of me personally on any permanent records. Furthermore, I have been given the opportunity to ask questions pertaining to the procedures of t h i s study and my r i g h t s as a participant, and I am s a t i s f i e d with the answers received. Witness Research Participant Date 147 Appendix D Participant Consent Form I, , agree to pa r t i c i p a t e as a volunteer in the research project e n t i t l e d "The effectiveness of breathing control t r a i n i n g in the management of public speaking anxiety" conducted in the Cardiovascular Psychophysiology Lab and Psychology C l i n i c , U.B.C. under the d i r e c t i o n of Dr. W. Linden. The procedures of t h i s 4-week long study have been adequately explained to me. As I understand i t , I w i l l f i r s t be interviewed and asked to complete several questionnaires regarding my experience of public speaking anxiety. Next, my heart rate, respiratory and electrodermal a c t i v i t y w i l l be monitored noninvasively while I ; (1) rest q u i e t l y for 10-minutes; (2) learn and practice an anxiety management technique; and (3) attempt to implement the technique in response to a challenge task, the d e t a i l s of which w i l l be explained to me following the t r a i n i n g period. Subsequent sessions (30-60 minutes/week) w i l l involve additional therapist-guided hands-on practice of the anxiety management technique. Some public speaking w i l l be required on occasion. I understand that I have the ri g h t to withhold my p a r t i c i p a t i o n in any or a l l parts of the study at any time I wish. I also r e a l i z e that the data obtained from my p a r t i c i p a t i o n in t h i s study are s t r i c t l y c o n f i d e n t i a l . Although t h i s data may be used in future research, there w i l l be no i d e n t i f i c a t i o n of me personally on any permanent records. Furthermore, I have been given the opportunity to ask questions pertaining to the procedures of t h i s study and my righ t s as a participant, and I am s a t i s f i e d with the answers received. F i n a l l y , I have read and understood the content of t h i s form, and have received a copy of i t . Witness Research Participant Date Contact numbers: Aaron Hait Dr. W. Linden 148 Appendix D Consent to V i d e o t a p i n g I, , agree to the videotape recording of myself de l i v e r i n g a speech on the condition that the videotape recording: 1) i s an important component of treatment; 2) w i l l be available to me to review at the end of the study; 3) w i l l not be shown to anyone without my written consent; 4) w i l l not be copied or transcribed without my written consent; 5) w i l l be erased within one month of treatment termination. Witness Research Participant Date Contact numbers: Aaron Hait Dr. W. Linden 149 Appendix E Home Practice Handout: Week 1 The technique you are to practice t h i s week i s c a l l e d pursed  l i p s breathing. Pursed l i p s breathing (PLB) involves having your l i p s i n a whistling position as you breathe out. You breathe i n through your nose, allowing your abdomen to extend outwards i n the process. Your chest and shoulders, on the other hand, should move r e l a t i v e l y l i t t l e . There are several reasons for p r a c t i c i n g t h i s breathing technique. F i r s t , i t encourages greater use of your diaphragm, the primary and most e f f i c i e n t muscle of r e s p i r a t i o n . With practice, you w i l l f i n d that diaphragmatic breathing i s easier and more relaxing than ribcage-predominant breathing. Secondly, i t prevents you from breathing too rapidly and i r r e g u l a r l y , something most people are prone to do when anxious or stressed. As mentioned in Session 1, such a breathing pattern can r e s u l t in too much CO2 being exhaled which, in turn, can t r i g g e r many of the unpleasant sensations that accompany public speaking anxiety. It can also contribute to poor voice quality when t a l k i n g - a further source of anxiety for people who f i n d public speaking d i f f i c u l t . F i n a l l y , pursed l i p s breathing can become a powerful cue for both your mind and your body to relax. I t engenders the slow, deep, rhythmic breathing pattern people experience when they are most relaxed. In essence, PLB can counteract the e f f e c t s of anxiety. However, to get the greatest benefit from t h i s technique, you need to practice i t regularly. Listed below are suggestions for the d a i l y practice of pursed l i p s breathing. TIME: - practice twice d a i l y , each session being 7-10 minutes long. - decide on these practice times i n advance and record these times on your Daily Diary once you've completed a session. LOCATION: - practice someplace quiet where you won't be interrupted (e.g. your bedroom). - s i t i n a supportive, straight-backed chair CLOTHING: - loosen a l l c o n s t r i c t i n g clothing (e.g. belts, pants/skirt buttons, ties) - remove heavy jewelry / empty your pockets - i f self-conscious about l e t t i n g your abdomen protrude outwards, wear a comfortable sweater BODY: - avoid p r a c t i c i n g when hungry or aft e r a big meal - s i t upright, with your lower back against the back of your chair and your feet f l a t on the f l o o r . Don't slouch! 150 PROCEDURE: 1. Start by paying attention to how you are breathing at t h i s moment without placing your hands on your ribcage and abdomen. Notice (a) the f e e l i n g of tension and stretch i n your ribcage and abdomen as you breathe i n ; (b) the f e e l i n g of warmth and relaxation as you breathe out; (c) whether your chest and shoulders move up and down as you breathe i n and out; and (4) how far your abdomen extends outwards as you breathe i n . Do t h i s for about 1 minute. 2. Now check how accurate your i n i t i a l assessment was. Do t h i s by placing your hands on your ribcage and abdomen while you continue to monitor your breathing for the next 4-6 breaths. 3. Begin breathing in through your nose and out through pursed l i p s at about the same depth as i s normal for you. Focus on keeping your upper hand from moving - just your lower hand should move. 4. Gradually increase the depth of each breath u n t i l your breathing i s slower but s t i l l comfortable ( i . e . you don't f e e l the need to sigh or yawn). The best way to do t h i s i s to concentrate on exhaling a b i t more f u l l y . Avoid t r y i n g to  breathe in too deeply. This only encourages greater ribcage a c t i v i t y . 5. If you f e e l l i k e yawning or taking an occasional deep breath, do so. However, rather than exhaling r i g h t away t r y holding that breath for 1-2 seconds before slowly exhaling i t through pursed l i p s . This w i l l reduce the r i s k of breathing out too much CO2. 6. Continue the pursed l i p s breathing pattern for at least 5 minutes. You may want to close your eyes as you practice. 7. REPEAT STEPS 1-6 AT LEAST 2 TIMES/DAY. Comments: a) i t i s quite common to experience disturbing or unwanted thoughts/images/feelings while p r a c t i c i n g PLB. Don't t r y to r e s i s t them. Instead, simply turn your attention back to the sensations of breathing in and out. If the problem p e r s i s t s , t r y s i l e n t l y counting out the length of each i n s p i r a t i o n and exhalation (e.g. IN - 2 - 3 - OUT -2 - 3 - 4 - I N . . . ) . b) as you get better at PLB, try imagining that with each breath out, you're exhaling stress and tension. c) be sure to record when you began each practice session, i t s length and any comments about i t on your Daily Diary form. 151 Appendix E — Home Practice Handout: Week 2 This week, you are once again to practice pursed l i p s breathing but t h i s time without using your hands to provide feedback regarding ribcage and abdominal movement. Instead, focus on the sensation of warmth in your chest and relaxation i n your lower abdomen as you breathe i n . As you breathe out, imagine that you are breathing out tension and stress. Also, t r y to breathe out for a longer period of time, with an increasingly longer pause between each exhalation and inhalation. At f i r s t you may f e e l starved for a i r , but with practice l e t t i n g your abdomen extend outwards to draw a i r into your lungs t h i s pattern should become easier. REPEAT THIS PATTERN FOR 5 MINUTES ONCE DAILY. Continue t h i s pattern for another 5 minutes, t h i s time breathing i n and out through your nose only ( i . e . omit the pursed l i p s exhalation). During your second d a i l y practice session, practice breathing i n deeply yet gently using your abdomen while either t a l k i n g , l i s t e n i n g to someone else talk, or working on some kind of problem. Concentrate on maintaining a rhythmic breathing pattern, exhaling f u l l y before taking another breath. Watch that your chest and shoulders don't r i s e when you breathe i n (watching yourself i n a mirror i s very helpful in t h i s regard). If you notice your abdomen tightening up, squeeze i t i n a l i t t l e more on your next exhalation, hold i t ti g h t for 1-2 seconds, and then l e t i t rebound outwards to i n i t i a t e your next inhalation. This should release some of the tension. F i n a l l y , tape record at least one 2-minute speech: either read something aloud or make up a speech of your own. Bring i t with you to Session 3, along with your completed Daily Diary. 152 Appendix E ~ Home Practice Handout: Week 3 Now that you've developed some proficiency at pursed l i p s breathing, i t ' s time to practice using i t to control your physical and emotional responses to stress. This can be done in a va r i e t y of si t u a t i o n s ; for instance, a f t e r climbing a set of s t a i r s , or while dr i v i n g your car, watching a suspenseful movie, t a l k i n g with a stranger, working at your desk/computer, or waiting for a performance review (e.g. getting an exam back). Use your imagination in deciding when to use the technique! Whenever you implement i t , remember to begin with a slow, deep  breath to stretch your chest and abdominal muscles, and then release that breath slowly and evenly, ending with a s l i g h t pause. Your next breath should be somewhat smaller, easier, and more abdominal in o r i g i n , with a s l i g h t l y longer pause at the end. Continue for another 3-4 breaths or however many you think you need to do to release tension and become more relaxed. Try extending the length of the pause between subsequent breaths, but don't s t r a i n , otherwise y o u ' l l be gasping for a i r . In t o t a l , each breathing sequence should include 4-5 breaths. Remember to take a break between sequences. Also, remember to record on your Daily Record form when and where you practiced the technique, and what the outcome was. WAIT UNTIL AFTER THE FINAL SESSION BEFORE ATTEMPTING ANY PUBLIC SPEAKING. The best way to ensure success with the breathing control strategy i s to practice i t i n mildly to moderately s t r e s s f u l situations f i r s t . That i s the purpose of t h i s week's exercise. Once competence i s assured, you can go on to e f f e c t i v e l y using the technique in public speaking situations. As with any s k i l l , p r a c t i c i n g the basics i s important to success. Therefore, i t i s a good idea to practice abdominally-predominant breathing a few minutes each day, focusing on the feelings that accompany prolonged exhalations and pauses. Remember to loosen your pants or s k i r t to allow greater abdominal movement. And don't forget to sit/stand upright with your hands and arms s e t t l e d comfortably on your lap or by your sides ( i f standing). If you f i n d your mind wandering to d i s t r a c t i n g or disturbing thoughts, write those thoughts down on paper. We can discuss them next session i f you l i k e . Begin a new sequence of breathing, focusing your attention on any feelings of calm and relaxation that s t a r t to develop. Appendix E Week # I.D.# Home Practice Diary For each day of the week, st a r t i n g tomorrow, please record whether or not you practiced the breathing assignment, when you practiced i t , for how long, and any comments you might have about i t (e.g. how easy i t was; questions about the procedure e t c . . . ) . Practice Length of Date started at practice Comments = 1 . 2 . 3 . 4 . 5. 6 . 7 . 8 . 154 Appendix E Notes on E f f e c t i v e Speaking Words and preparation aside, speaking i n public very often requires learning to l i v e with fear. For many of us, bodily clues to our anxiety (e.g. perspiration, rapid heart rate e t c . . ) w i l l always remain a part of public presentations. This i s not to say, however, that the audience has to be made aware of our fear. The presence of good delivery techniques creates an audience impression of poise and confidence which i s regarded as incompatible with fear. In other words, i f we must l i v e with fear, we need not share i t with our audience. The delivery techniques outlined below (adopted form Fawcett, 1974; Cribbes, 1978) are designed to promote public speaking without fear and trembling. These techniques w i l l be considered under four main headings: public speaking behaviors, odds and ends, answering questions, and s p e c i f i c speaking a c t i v i t i e s . Public Speaking Behaviors Experimental evidence has suggested the importance of several categories of public-speaking behavior (Fawcett & M i l l e r , 1975). These categories were selected for t r a i n i n g based upon a search of the l i t e r a t u r e (Cooper, 1978; Ott, 1970; Stedman, 1971). In the following section, several categories of speaking behaviors w i l l be examined: appearance, personal preparation, eye contract, posture, gestures, use of props, voice (volume, pitch, rate, pauses), i n i t i a l speaking behaviors, and closing speaking behaviors. Appearance. A speaker should dress so as not to offend the audience. The appropriate s t y l e of dress varies, of course, with the p a r t i c u l a r type of audience. It i s recommended that your appearance be well within the l i m i t s of what your audience i s accustomed to seeing in speakers. It i s important that your appearance does not detract form your message. Of course, your dress should s u i t the occasion. There i s a story of a world-renowned speaker in v i t e d to speak to the International Association of Sunbathers. Upon a r r i v a l , the speaker was met at the front gate by a nude couple who took him to h is room. There the dilemma began. Should he dress as he f e l t he should - dinner jacket and rather formally - or should he dress as was expected of him (that i s , should he not dress)? Much went through his mind and f i n a l l y he showered, dried thoroughly, combed his hair, marched out of his room and down the s t a i r s , to be greeted by a room f u l l of nudists, formally dressed i n h i s honor. 155 Personal Preparation. Make_certain that a l l l a s t minute things are done before you appear before your audience. For example, button your jacket, tuck i n your s h i r t t a i l , straighten your t i e , clear your throat — do whatever you f e e l you must do — before you come to your audience. Eye Contact. One of the most important aspects of public speaking s t y l e involves making "contact" with the audience. The employment of eye contact ( i . e . looking at people) i s probably the best technique for l e t t i n g the audience know that you r e a l i z e they are there and for convincing members of the audience of the s i n c e r i t y of your message. Eye contact consists of d i r e c t i n g your head and face toward the audience. Some say pick a spot above the heads of the audience at the back of the room and talk to that. Never! Think a moment. What would your reaction be to an i n d i v i d u a l who would not look at you when he or she talked to you? Whether you are speaking to one person, 10 people, or more than 100 people, look them in the eye. Esta b l i s h eye contact with every single person, i f time allows. Do not act l i k e your head i s on a swivel though, waving back and fort h panning the audience. Rather, est a b l i s h eye contact in a random manner, but do contact every person. A note on memorization versus reading: for most formal speaking engagements, extensive reading practice (not memorization) i s recommended. You may wish to u t i l i z e b r i e f notes i n outline form (the b r i e f e r , the better) and rehearse u n t i l the main ideas of your presentation ( i f not the precise lines) can be emitted in the presence of these b r i e f notes. For s p e c i a l speaking occasions (e.g. job interview c o l l o q u i a ) , memorization of the presentation s c r i p t i s recommended. For example, memorization might involve p r a c t i c i n g looking at a s l i d e and reading the s c r i p t l i n e s u n t i l the s l i d e alone serves to cue the words of the sentence c l u s t e r . Posture. Posture — how you stand — i s important. Good posture makes for a posed and pleasant appearance. The exact body position to be assumed, ranging from m i l i t a r y attention to a more casual stance, depends upon the speaking occasion. However, the following general rules hold true for most occasions: 1. Always stand when speaking in public. This p o s i t i o n makes i t easier for the audience to see you. 2. Do not lean on the speaker's podium or any nearby table or other object. Rest the weight of your body evenly on both feet. 3. Do not cross your legs. Stand with your feet squarely on the f l o o r and with your weight evenly d i s t r i b u t e d on the 156 b a l l s of both feet. Assume t h i s p osition by keeping your legs straight, knees relaxed, and shoulders straight. Not crossing your legs helps prevent slouching and encourages an upright and pleasant appearance. 4. Assume a comfortable position with your hands. If there i s a speaker's podium, you may rest your hands l i g h t l y (do not lean) on the top or sides of the podium. You must never, of course, r e s t r a i n your hands (e.g. put them i n your pockets); they are needed for gesturing. 5. Do not f o l d your arms across your chest, This tends to set you apart from the audience. The goal i s to look warm and f r i e n d l y , not cold and threatening. Use of Props. Props can enhance your presentation by increasing i t s c l a r i t y and holding the attention of the audience. At the same time, props often make the speaker f e e l more comfortable and at ease. E f f e c t i v e use of a prop demands adherence to the following rules: 1. Do not pick up your prop u n t i l you are ready to use i t . If you wave i t around, i t d i s t r a c t s your audience and defeats the purpose of the prop. 2. Hold your prop so a l l can see i t . 3. Do not hide behind your prop. The audience wants to see you. 4. Speak to your audience, not your prop. 5. When you are through with the prop, get r i d of i t . If you hang on to i t , you may be tempted to fidget, and fidgeting d i s t r a c t s your audience. Voice. (a) Loudness Talk loudly enough so that you may be heard i n the farthest parts of the room. If possible, station a f r i e n d or colleague in a distant part of the room or setting where your formal speech i s to take place. Ask t h i s i n d i v i d u a l to indicate to you by a hand signal whether you need to speak up. Make sure you can see his signal from the speaking platform. If you must s t r a i n you voice to be heard, request a microphone. The neck harness type, once attached, requires the least amount of further consideration. Regardless of the type employed, be cert a i n that the microphone i s close enough to your mouth (usually about four inches) to allow your voice to be heard. (b) Stress, pitch, rate and pauses Carnegie (1956) describes four important features of a good delivery: stress, pitch, rate and pausing. 157 Stress the most important words in a paragraph and subordinate the least important ones. For example, i n the following" paragraph, the underlined words might well be stressed: The f i r s t experiment addressed the question: was the take-home manual e f f e c t i v e in teaching s p e c i f i e d program behaviors to individual participants? Vary the p i t c h of your voice from high to low and low to high. A monotonous or f l a t tone has an a r t i f i c i a l , non-conversational qu a l i t y . Vary the rate of speaking, taking more time i n sections meriting emphasis and less time i n sections which are of lesser importance. The employment of variations i n speaking rate w i l l help maintain the attention of the audience. Pause before and a f t e r important points. Pauses may be used either to c a l l attention to a point about to be made or to give the audience a moment to savor a c r i t i c a l piece of information. Symbols for the above-noted features (stress, p i t c h , rate and pausing) may be incorporated in the presentation s c r i p t to cue the presenter to employ each of these techniques. The orchestration of the presentation s c r i p t for these features may prompt appropriate delivery techniques i n even the most panic-stri c k e n speakers (Fawcett, 1974). Gestures. Gestures — movement of your hands -- can have an important influence on the audience. A s u f f i c i e n t number make for a dynamic and enthusiastic presentation. The exact type and number of gestures recommended varies with the p a r t i c u l a r speaking occasion. Gestures, whether used to demonstrate an a c t i v i t y (e.g. to show the i n d i v i d u a l components of a golf swing — the grip, foot stance, head, arms, shoulders e t c . . ) or to emphasize a point, should be d e f i n i t e and even exaggerated movements, leaving no doubt as to what i s intended. Certainly, for a gesture to be v i s i b l e to the audience, i t must be a f a i r l y gross movement of one or both hands (probably for a distance of at least three inches). Examples of gestures include pointing toward a s l i d e on the screen, or any sweeping, chopping, r a i s i n g , lowering, or extending of the hand. For added emphasis, you may time the gesture to occur at the same time you pronounce an important word with added stress. To i l l u s t r a t e the effectiveness of gestures, l i s t e n to yourself say with f e e l i n g , "No,, no, no!". Now t r y the same words, but t h i s time h i t your l e f t palm with your r i g h t f i s t . Your should hear a difference; s p e c i f i c a l l y , more emphasis i n the l a t t e r . Try saying, "smooth"; then say the same word while 158 moving your r i g h t hand from l e f t to right , as i f you were running i t over a_ very smooth surface. Gestures have the advantage of, through action and movement, l e t t i n g the audience see what you are saying, while encouraging you to adjust your voice to f i t the thought. Moreover, an audience may well judge the enthusiasm of a speaker by the number and q u a l i t y of gestures he or she employs. It i s not excessive to program gestures to occur every ten seconds ( i . e . nearly every sentence c l u s t e r ) . The frequency of gestures may not be c r i t i c a l . The objective i s to demonstrate enthusiasm through animation. I n i t i a l Speaking Behaviors. I n i t i a l speaking behaviors are important i n establishing the i n i t i a l impression you wish to convey to the audience ( i . e . one of self-confidence and f r i e n d l i n e s s ) . The f i r s t step i s to take your position on stage. Walk slowly up to the speaker's position. Approach i t with confidence — as i f you belong. You do. A speaker who timi d l y approaches i s so judged and so treated. You are the expert. These people are here to l i s t e n to you. Do not destroy t h e i r confidence by appearing timid. If there i s a speaker's stand, table or microphone then take your place behind i t so that you are facing the largest part of the audience. If there i s no sp e c i f i e d speaker po s i t i o n (e.g. stand, table or microphone) then you should stand within ten feet of the f i r s t row of chairs so that you are facing the largest part of the audience. After you have taken your position on the speaking platform, and before you say anything, make an i n i t i a l eye sweep while smiling at the audience for a few seconds. At t h i s point you have said nothing, and yet there are many who have already formed opinions about you. With very l i t t l e e f f o r t , you have maximized the pro b a b i l i t y that these images are po s i t i v e ones. If you were introduced as speaker, the next step i s to acknowledge the introduction. This involves d i r e c t i n g a statement of appreciation to the host person, using his/her t i t l e and l a s t name. For example, "Thank you, Dr. Lawson"; or "I appreciate your kind introduction, Dr. Wenger". This i s a courtesy to the host. The fourth step i s to make a greeting statement to the audience. This involves facing them, smiling and making a greeting statement to show your f r i e n d l i n e s s . For example, you could say "Good morning". The l a s t step i s to introduce your topic. 159 Closing Speaking Behaviors. F i n a l remarks offe r the speaker an opportunity to leave the audience with a favorable impression. When you have finished the text of the presentation, make a f i n a l eye sweep. Then make a statement of appreciation to the audience. Simply face the audience, smile and say "Thank you" or a s i m i l a r statement which w i l l end your t a l k on a f r i e n d l y note. If time remains, you should request questions from the audience. Move out from behind the platform to be more informal for the question period. Examples of how to request questions include: "Do you have any questions?"; "I would be happy to answer any questions that you have"; or "Any questions?". S p e c i f i c considerations regarding how to handle audience questions w i l l be described in a l a t e r section. Odds and Ends Several types of speaking a c t i v i t i e s , though important, do not e a s i l y f a l l into neat categories. Three such a c t i v i t i e s ( i . e . handling presentation errors; d i r e c t i n g the viewer to v i s u a l aids; and smiling) w i l l be described i n the sections that follow. Handling Presentation Errors. Mistakes w i l l be made when de l i v e r i n g even the best prepared presentation. For example, you might forget a s c r i p t l i n e , lose your place and repeat some information delivered e a r l i e r , or say something that i s incorrect. We have a l l seen speakers recognize a mistake and then say something l i k e , "Oh, I'm sorry.". Apologies, however, draw undue attention to mistakes. When you recognize that a mistake has occurred, simply correct the error and move along. For example, i f when t a l k i n g about the mean number of behaviors for a p a r t i c u l a r measure you give an incorrect figure, you might say, "The mean number of behaviors i s a c t u a l l y Or humor can be u t i l i z e d i n correcting an error. For the above example, you might say " I t appears that I misled you. The mean number of behaviors i s i n fact ...". In short, do not apologize for mistakes made during a speech. Direct the Viewer to Slides/Overheads. For p a r t i c u l a r l y complex s l i d e s or overhead transparencies, i t i s important to d i r e c t the viewer to the c r i t i c a l portion(s) of the image. For instance, when presenting graphs or tables, always i d e n t i f y what the axes or rows and columns represent — including the units of measurement the data are expressed i n (e.g. smiles per minute). It helps to point to the sections of the image to which you are r e f e r r i n g . The employment of phrases such as "You w i l l notice..." while gesturing to the 160 slide/overhead w i l l keep the audience with you and interested i n your talk_. Smiling;. Smile at the audience. Let them know that you are a warm, f r i e n d l y person. A chuckle at one of your humorous s l i d e s or a laugh at a clever audience question provides evidence of your humanity. Answering Questions A question-and-answer period offers the speaker an opportunity to make personal contact with the. audience, c l a r i f y parts of the presentation, provide supplementary information, and otherwise delineate the nuances of his/her topic. Several question-answering considerations w i l l be discussed under the following headings: assuming an appropriate question-answering position, repeating audience questions, displaying l i s t e n i n g s k i l l s , providing d i r e c t answers, and handling c r i t i c a l questions. Assume an Appropriate Question-Answering Position. If you wish to create an a i r of informality during t h i s period, move out form behind the speaker's podium. In smaller settings i n which your voice can be heard without the microphone (or the microphone can be carried with you), you may wish to walk along the front of the stage in the d i r e c t i o n of the person providing the question. By shortening the distance and removing the b a r r i e r s (e.g. the speaker's podium) between you and your audience, you increase personal contact. Repeat Audience Questions. In large speaking settings in which acoustics are poor, i t i s often d i f f i c u l t for the audience to hear questions. Repeat audience member questions (e.g. "The question i s : ...") pr i o r to beginning your response. This increases the p r o b a b i l i t y that your answer w i l l be comprehensible to the audience. Display Listening S k i l l s . L istening involves reducing the noise i n your system so that you can attend to and understand the question being asked of you. Internal noise often takes the form of self-questioning, such as "Is t h i s questioner h o s t i l e towards me?" or "W i l l I be able to answer t h i s question?". Before accepting a question, take one or two slow, abdominal breaths to l e t out any tension you might be fe e l i n g . Provide Direct Answers. The most e f f e c t i v e answer i s a d i r e c t one. Provide a d i r e c t answer before supplying supplementary information. For example, assume that the following question asked: "What do you. see as the key components of a program for managing public speaking anxiety?". An appropriate response would begin with a d i r e c t answer to the question, such as "I believe that repeated practice 161 at public speaking, coupled with t r a i n i n g in anxiety reduction techniques, i s c r i t i c a l " . You could then go on to describe why you think t h i s i s so. The employment of d i r e c t answers demonstrates your s k i l l s as a clear-thinking speaker. Handling C r i t i c a l Questions with Respect. A s a r c a s t i c comment in response to an "offensive" question i s l i k e l y to make your audience f e e l embarrassed and uncomfortable. Do not argue with a questioner. Instead, where possible, agree with the importance of the issue being raised. If you can't think of a good answer to someone's question, admit t h i s and o f f e r to look into the matter for them i f they wish. The objective i s to show respect for both the question and the questioner, while at the same time preserving your own s e l f -respect. S p e c i f i c Speaking A c t i v i t i e s This section w i l l o f f e r guidance in f i v e areas of public speaking: introduction of a speaker, impromptu speaking, speaking to get action, t a l k i n g to inform, and proposing toasts. Introduction of a Speaker. The sequence to follow in introducing a speaker i s : (1) Topic; (2) Importance; and (3) Speaker. Never depart from t h i s order. Very few people deserve more than 60 seconds worth of introduction, so l i m i t yourself to answering the following questions: (1) Why t h i s topic? (2) Why t h i s topic for t h i s audience? (3) Why t h i s topic for t h i s audience at t h i s time? (4) Why t h i s speaker? (5) Who t h i s speaker is? An example follows: (1) The Wilson budget, as presented t h i s f a l l , has wide-ranging ramifications for a l l Canadians. (2) As Income Tax accountants we, perhaps more than others, must become f u l l y aware of a l l the new l e g i s l a t i o n in d e t a i l . (3) Since i t i s now December, we have only one month l e f t to get with i t before the tax returns s t a r t h i t t i n g our desks. (4) Few men have the experience with the changes that our speaker has. As a top l e v e l c i v i l servant, he was one of the chief a r chitects of the budget. (5) Prior to joining the finance department, our speaker led a varied l i f e . During his college days, he paid his way by playing piano in a bar and organ at church. He served as a f i g h t e r p i l o t in World War II and opened his own accounting firm a f t e r being discharged. Eighteen years, one wife and three children l a t e r he l e f t his very successful business to work as the Assistant to the Deputy Minister. You are aware of his r i s e 162 to his present position. Ladies and gentlemen, our guest speaker t h i s evening ... Remember, you are not the speaker. You are the introducer. Impromptu Speaking. Make an opening statement that w i l l make people want to hear what you have to say. Relate your opinions to the audience. Involve them. You could, for example, make a statement that i s opposite the accepted norm. Or you could s t a r t with a humorous observation about something you and the audience have i n common -- maybe something that happened on the way to or during the meeting. After r e l a t i n g the d e t a i l s of your story, conclude with an appropriate moral or statement. Speaking to Get Action. Whether you want people to vote for you, buy your product, give to your charity or whatever, use the following formula: (1) Example; (2) Point; and (3) Reason. Whether or not your talk i s successful w i l l depend upon how well you de l i v e r i t and whether you pick the r i g h t example. The example should be a personal experience i f possible. If not, be cert a i n that the t a l e you t e l l i s one with which you are very f a m i l i a r . I t could be a f a i r y t a l e you made up s p e c i f i c a l l y for the occasion. The point w i l l the answer the question "What do you want your audience to do?". The reason w i l l answer the question "Why should your audience do i t ? " . If you want examples of the above formula, l i s t e n to or watch commercials for charitable organizations. Talking to Inform. (1) Use simple language. If you must use technical terms, define and explain them. Repetition w i l l be needed i n complex areas, but rephrase rather than d i r e c t l y repeat your d e f i n i t i o n s . (2) Organize material c a r e f u l l y . Start at the beginning and proceed l o g i c a l l y through to the end. Avoid jumping forward and backward. I t confuses. (3) Use examples and i l l u s t r a t i o n s . (4) Narrow your subject down to include only what i s most important. (5) Summarize. Proposing a Toast. (1) During your opening, make reference to the reason for the gathering (e.g. a wedding). (2) Refer to the noteworthy achievements of the subject(s) of the toast. (3) Express, on behalf of the entire assembly, good wishes toward the subject(s) of the toast. 163 How,to Prepare a Talk The f i r s t task in preparing a ta l k i s to determine what you wish to say. For example, are you for or against a certa i n proposition or practice? Or what would you l i k e your audience to know or to do that they don't presently know or do? Point yourself in a d i r e c t i o n . Then spend a few days or weeks gathering quotes, anecdotes, facts, references and ideas. Keep notes, preferably in point form on 3" X 5" cards. When you have s u f f i c i e n t material, decide how you wish to present i t ( i . e . in what order). In most cases, your t a l k should s t a r t with an introduction to the thesis or main point of your t a l k . Next, indicate what your main supporting subpoints are and the order i n which you w i l l be discussing them. F i n a l l y , l i s t the supporting d e t a i l s for each main subpoint. You now have the structure and materials for the main paragraphs of your t a l k . Keep i n mind that sentences develop paragraphs and paragraphs develop a thesis statement. To help you stay on track r i g h t from the very s t a r t , write out a summary of the main ideas you want to leave with your audience. This w i l l form your concluding paragraph. Once you have l i s t e d the paragraph main points and the supporting subpoints, expand these subpoints into sentences and phrases. Then t r y reading your written t a l k to yourself out loud. Many phrases "sound" fine when read s i l e n t l y , but s t i l t e d and unappealing when read aloud. By t h i s time you should know your t a l k . Take each paragraph or idea grouping and select one word which w i l l t r i g g e r the whole thought for you. In a way, these key words are l i k e tree branches, supporting a cluster of ideas or phrases l i k e leaves. Practice r e c a l l i n g the network of branches that emanate from the s t a r t i n g point of your speech ( i . e . the tree trunk). You should be able to trace your way through the main branches of your t a l k several times without error. Highlight these key words in your speech notes or write them out on a small note card. 

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