The Evalu ationofan EclecticStress Management Program for Adults Who Suffer From Str essAnd RelatedDisordersina
Group Psycho edu cation alSetting
By
ClAhmedAI·Faraidy,B. Ed.
AnIntern s hip Report submitted to theSchoolof Gradu ateStudi es Inpartial fulfillmentof the requirementsfor thedegree of Mast er ofEduca tion
Faculty of Education Memorial Universityof Newfoundland
July,2000
St.John's Newfoundland
ABSTRACf
This is a report of an EducationalPsychologyinternship whichwasco nd ucted at multipleclinicalsitesinSt.John's, Newfoundland,Canada. Thesesitesincluded the Psychiatric Re habilitatio nInterdisciplinary Team,the Recovery Center (Addiction Services),andtheH.Khalili&Associatesindepende ntpractice/communityagency . Allof thesesites are community focused publicandprivateagencies .
Theinte rnship wasconductedbetweenSeptembe r7andDecember 15,1999.The report consistsofan overview,a researchcomponent,anda reflectivejournal.
ChapterOnegives an overview andareport of the internship goalsand objectivesandthe activitiesundertaken by the intern to meet thesegoals and objectives.
ChapterTwo,theresearc h component,providesa current literaturereview anda research study on the intern'sevaluationof an eclectic stress managementprogram.
ChapterThreepresents thefindings and a discussio nofthe results isgive n.
The resultsofthisstudy showthatan eclecticstress managementprogram ina grouppsychoeducationalsetting increasedtheparticipants'knowledgeand decreasedthe levelof anxietyamongtheparticipants. Therefore ,the use of anecle ctic stress management program is highly signi ficant in a group psychoeducarionalsetting.
Implicationsand recommendationsare highlightedfor thereader.
ChapterFour, the reflectivejournal,provides a brief account oftheweekly internshipactivities,experiences,and contributionsto the intern' sprofessionalgrowth and developmentas a counsellor.
DEDICATION
Tomydaughter,Halo, whowas born duringthewriting
of thisfinalreport.
Youare abeaconofHght to me.
Through youreyes shineslife'smeaning . Lovealways.
Dad
iii ACKNOWLEDG MENTS
Iwouldlike to express deepestthankstomy Governmen tof SaudiAmbiaandthe Head oftheKingdom ofSaudiArabia,The Custodianof the TwoHoLy Mosques,King FahdIbnAbdul AzizAlSaud,forthe tremendousopportunityaffordedto meto complete myMastersprogram at Memorial Univers ityofNewfoundland,Canada.
Also, sincerethanks to theGovernme ntof Canadafor allowingmeto pursuemy MastersProgram of Studiesinthiswond erfuLcountry.
Special thanks toDr. CharlesMcCaffray for allhis assistanceintheinternat ional student application process.
Specialthanks toDr.JaapTuinman,Vice-Preside nt, Memori al Universityand to Dr.TerryPiper,Deanof the Faculty of Education, MemorialUniversityforall their professionaladviceand assistanceduring my graduatestudies.
My sincerest thanks toDr.William Kennedy,my graduateschooladviserandto Dr.HassanKbalili,FieldSupervis or, for theirinvaluableguidance,support,andgraduate supervision.Yourteaching andsnaringof professionalexpe rtisehas greatl yenhanced my developmentas aprofessionalpsychologist.
Thank-youto Mr.Hans Asche, my on-site superv isor,forhissupportofmy researchstudy andoverall contributiontomyfield supe rvisio n,Thank-youtoMs. Kim Baldwin,Division Managerof AddictionsSen-ices forher support and acceptanceasa clinicalinterninpractice at thisfacility.
IamgratefuLto aILmy professo rsfortheir teaching andacadem icsupport;my graduatecolleague,Bill Kelly,adoctoralstudent atthe UniversityofTorontofor his very helpful revisionsuggestions, andadvice.Iam also gratefulto allstaffat the Facultyof Education,Memorial Universityfortheirassistanceduringmy studies.
To aILof you for yourcontributio ntowardsmy successfulcompletionofmyMasters degree-Iexpress myheartfeltthanks.
Iv TABLE OF CO:NTENTS
PAG E
ABSTRACT._
AC KNO WLEDG MENTS. LIST OF TABLES_
.. . . .. ..i ..__Hi
vi CHAP TER1:OVERVIEWOF INTERNSHIPREPORT •.. . .. _1
RATIONALEFOR THE INTERNSHIPOPTION. .1
RATIONALE FORTHE CHOICE OF THE INTERNSHIP SETIING. .2
DESCRIPTIONOF THE INTERNSHIPSErrmG. ....3
MentalHealth Program:PsychiatriicRehabilitati onInter-Discipli nary
Team. .3
MentalHealth Program,Waterford Hospital. .. _4 Ad dict io ns Services!RecoveryCeerer. •.. . . _4
Independ entPractice/Community..Agency. . .5
GOALS AND OBJECTIVES FOR THE LNTERNSHIP 6
Statemen tofIntemshipGoalsandObjec tive s 6
DURATION. . (0
SUP ERVISION_ .. ... ._... .to
Identification of the Univers ityandFieldSupervis ors _.. . _ LO
LIMITATIO NOFTHE STUDY. . __. 10
ACT lVITIESTO MEET INTERNSHIPGrOALS_ .._.. _ t1
Coun selling . . .. . ... . .. . .. .II
Co nsultanc n.. . 12
Asses sm ent. . 13
TestAn alysis . . 14
Drugand AlcoholRecovery and Paevenuon . . 14 DiagnosisandTreatment of ChronzicMentalIllnes s. . .. I5
HealthCareSysteminNewf bundffan d. .15
EthicalandLegalIssues ... ... . .. .. .. . 16
AdditionalActivities 16
ResearchComponent Completion 17
CLIENTSANDCO NCERNS. .18
AREVIEW OF THE OBJECTIVES. . 19
CHAPTER 2:RESEARCH COMPONENT. . 20
RATIONALE AND PURPOSE. . 20
Rationale for Research Project (Significance of Study) 20
Hypothesis . . 21
Objectives .22
LITERATURE REVIEW 23
Introduction .. . 23
STATEMENT OF THE PROBLEM... . . ... . . ... . . ... .. 24
Section1:Stress 24
Definitionof Stress . . 24
Kinds ofStressors. . 25
Section11:Group Psychoeducati ona l. . 21
Definition of Group. . 28
DESCRIPTION OF THESTRE SS MANAGEMENT PROGRAM .. 29
Introduction . 29
METHODOLOGY . .... . .. . . ... . 30
Research Instruments. . ... . . ... ... ... ... . 30
Sample 32
Analysis . 33
Quantitative Data Analysis 33
Reliability of instruments . . 33
QualitativeData Analysis 40
Summaryof theQualitativeData. . 50
The Stress Management Program 5 I
TheProgram Setting . . .5I
The FacilitatorsConduct of the Sessions . . 51
Future Program Improvements 52
CHAPTER 3:DISCUSSION .
IMPUCAnONS.
RECOMMENDAnONS.
... .. .. . . ...53
. 55
. 56
CHAPTER 4: THE INTERNSHIP EXPERIENCE : AREFLECTIVE JOURNAL....58
REFERENCES ... . 73
vi APPENDICES
A. Additional Readings Completed During Internship. . 76
B. Beck AnxietyInventory(SAl) 80
C. Knowledge-Based Questions 8 l
D. Open-EndedQuestionnaire. . 82
E. Letterto DivisionManager. . __.._.. 83
F. LettertoParticipantsFor Consent 84
G. PsychoeducationalGroupProcedures. . _..85
H. SessionAgenda/Outlin e .._. . . ... . ... . 86 I. Descrip tionof the EclecticStress ManagementProgram. .87
vii LIST OF TABLE S
TABLEI: Cron Bach'sAlpha ReliabilityForTheBAI,BAI Sub-ScalesAnd
Knowledge Based Questions. . _._ 34
TABLE 2: Means And StandardDeviations On Pre-testAnd Post-testScores For The Becks AnxietyInventory . .... 35 TABLE 3: Two factor ANOVA forRepeated Measures Source Data on
Beck 's AnxietyInventorypre-test and post-test by gender. ...35 TABLE 4: Meansand stan darddeviationsonpre-testand post-t est scores for
the Knowledge based questionnairescale .36 TABLE 5: Twofactor ANQVA for Repeated MeasuresSourceData on
Knowl edge based questionnairepre-test andpost-test by gender.. .. 36 TABLE6: Means And StandardDeviations OnPre-test AndPe st-test Scores
ForTheBec ks AnxietyInventorySub-scale For
Neurophysiological ..37
TABLE 7: Two Factor ANOVA forRepeated Measures Source Dataon Beck'sAnxiety Inventory Sub-scale Neurophysio logica l Pre-test
andPost-test By Gender . 37
TABLE8: MeansAndStandardDeviations On Pre-test AndPost-test Scores For theBecks Anxiety Inventory sub-scalefor Subjective 38 TABLE 9: Two FactorANOVA For Repeated MeasuresSourceData On
Beck'sAnxietyInventory Sub-ScaleFor Subjective Pre-test and Post-testBy Gende r.. . _.._ _ 38 TABLE10: Means AndStandard Deviations On Pre-restAnd Post-testScores
For The Becks Anxiety Inventory Sub-scaleFor Panic. . . 39 TABLE11: Two Factor ANOVA ForRepeatedMeasures Source Data On
Beck' s Anxiety InventorySub-scale ForPanicPre-test andPost-
test By Gender . . 39
TABLE 12: Means And StandardDeviationsOnPre-testandPost-test Scores For The Becks Anxiety InventorySub-scaleForAutonomic 40
viii TABLE13: Two FactorANOVA ForRepeated Measures SourceDataOn
Beck'sAnxietyInventory Sub-Scale AutonomicPre-testAnd Post-
testBy Gender. . 40
CHAPTER 1
OVERVIEW OF INTERNSHIP REPORT
RATIONALEFORTHE lNTERNSHlPOPTIO N
Inorder to completethe Master's Degreein Educationa lPsychology at Memorial Univ ersi ty,studentsha ve the choice of doing eithe r a thesis,paperfo lio,projector an internshipreportwhic hincludes a research co mpo nent. The internshipwas completedin a clinicalsettingatfo ur communityheal th services centersthat included:a psychiatri c re habili tatio n services facility,aho spi tal , an addict ionsservices!recoverycenter,and a privateclinic.Adescriptionofeach centerwillbegivenin a subsequent sectionof this report.
There were manypersonaland profes sionalreasons forthechoice afthe interns hip option to completethe requirementsof myMaste r'sDegree.The reasonsare as follows:
Professiona linteraction andexchangeduring theinternsh ipexperience allowed the intern the opportunityto compare the Addiction services and MentalHealth programming inCanada withsimilarprogramsin his home country, SaudiArabia.
2. It allowedthe interntoapplythe knowledgegainedfrom his presentacademic studiesand previousworkexpe rience.
3. It gave the intern thechancetogaininsight and broadenhisknowledge about group and individual counseling throughpractical experiencewith variousprofessionals inthisfield.
4. Because groupcounselling is notcomm onlyused in SaudiArabia. this internship experiencein Canada provided the intern the opportunity to develophis competenciesin these areas.The internship madeit possible todeveloptheknowledgeto establish similar programsin theintern' shomecountryifrequiredto do so.
5. The interngainedsomefirst hand experie ncewithandinformationabout the Health care servicesin thiscountry.Thishas inturnenhanced the intern'sabilityto providemoreinformed andknowledgeab lecounsellingto clients.
6. Theinternacquiredexperiencewiththe interview and evaluationprocessin the medical field.
7. Thissetting generously providedthe opportunityto conduct the researchproject compone ntof the internshiprequirements.
RATIONAL EFOR THECH OI CE OFTHE INTERNSffiP SETTING The reasonsfor thischoice ofsettingwere:
To gain the opportunityto work with professionalindividuals, mostof whom have distinguish edreputationsinthe clinicalcounselingfield.
2. To obtaintheopportunityto applythe academic knowledgewhichtheintern gainedduring graduate studies. Theinternwasable to sharpen the skinsand abilities developedduring theinternship experience throughthe properprofessionalguidanceand expertise.
3. The clinicalsettingprovidedtheinternwith an excellentopportunitytocondu ct research projects.
4. To workclosely with the intern'ssupervisortoobtain fairly immediate feedback onthe negativeand positive aspectsofthe intern'sabilities and skills.
DESCRIPTIONOF THE INTERNSHIPSETTING
MentalHealth Program:PsvchiatricReh abililationInler -Disciplinary Team The Psychiatric RehabilitationInter-DisciplinaryTeam whichis set up by the HealthCare Corporatio nof St,John's, conducts a MentalHealth Program at 203 Pleasant Street inSt. John's, NF.Hans P.Asche, M.Ed. is a psychologist with this program, who assisted Dr. Khaliliwith on-sitesupervision of the intern. The facility and services are described as an interdisciplinary team whose representatives are from the discip linesof Social Work; PastoralCare;Nursing; Recreational Therapy; Occupational Therapy;
Psychology, with consultation providedby Pharmacyand Psychiatry.
Clients suffering fromlong term chronic mentalillness are referred tothe Psychiatric Rehabilitation Inter-DisciplinaryTeam from inpatient psychiatric services, the medicalcommunity,or othercommunity healthservices. This program provides rehabilitation,psychiatricand psychological assessmentand diagnosis,treatment and support to inpatients and outpatients.
The program alsooffers a range ofmuch neededservices notnecessarilyavailable inthe traditionalinstirutionalsetting such the provision oftransitionalsupportto return to the community.These transitionalservices includeassistancewith basic copingskills, maintena nceof socialnetworks, and"the provision of a framework for the skills, training, and support necessary toboth addressthe clientsdisabilitiesand to maximize their
potential to adequatelyperformsocial, vocational,anddaily living role functions" (Health Care Corporation,p.l).
Mental Health Pl'"ognm Watenol'"d Hospital
The Mental Health program is one of 17clinical programsofferedbytheHealth Care Corporationof St.John 's. The Waterford Hospital,one of the settingsthat offers the Mental HealthProgram,has a total of204 beds thatservice the following areas; Acute care,DevelopmentallyDelayed, Forensic,Geriatrics, and Psychiatric Rehabilita tion.
Psychiatric Rehabi litationis a 23 bed inpatientunit for individualsdiagnosed with a severemental illness .ThePsychiatric RehabilitationTeammonitors and managesa significantnumberof theseinpatientsin additionto theover
roo
community based clients who have been reintroducedto communitylivingon an outreachcase management approach.Addictions Sel'"VicesfReuveryCenter-
TheRecovery Center,locatedin St.John 's, Newfoundland,offersnon-medical detoxification servicesto adults sufferingfrom intoxication and alcohol andlor drug related dependency.The center providesa free service to a client maximum of twentybeds andthe staff includes anexperienced supe rvisorin this field, a physicianwho is availablefor medicaVpsych iatric assessments wheneverneeded,a counsellor,a social worker,and treatment attendants.
Thecenter's atmosphereis non-threateni ng and non-jud gmental asitsuppo rtsthe clientthrougha programthat triesto meet allclient needs thatcan range from physical psychological, andsocialneeds. Theprogram encompasses individualandgroup counselling, education,andself-help meetings.
The program offered bytheRecovery centerconsistsof the followingservices:
(I) non-medicaldetoxwith medica lconsultation as required (2) assessment and treatmentplanning
(3) videoanddiscussion (4) education sessions (5) groupcounselling (6) nutritionalassessments (7) A.A.meetings (8) women's meeting (9) referraland follow-upservices
(10) Optiona lopportunity toparticipate in exercise, relaxation.and leisureprograms. Clientsare usuallyself-referred,or referred from communityagenciessuchas the RoyalNewfoundlandConstabu lary.SocialServices,hospital emergency units.and physicians.
Independent Practitt/CommunltyAgency
TheIndependent Practice/CommunityAgency,byH. Khalili, PhD and Associates.39 1Empire Avenue, St.Jo hn 's,Newfoundland,offers afee forservice
psychologicalservicecomprisedofseven psychologists andIsexologist. Abroad range of therapeutic servicesare offered at the clinicforallages.The sessionsareled by qualifiedmasters levelandPh O.level professionalswhohaveatremendousrange of experience inpsychotherapy.
The types of assessment and treatment servicesavailableat theclinic include:
depressionand anxiety,anger,phobia,alcohol anddrug problems,sexualeducationand sexualproblems, self-confidenceandpersonal growth, education,careerandemployment issues;and many otherareas ofassessmentand treatment.
GOALSAND OBJECTIVES FORTHEINTERNSH IP Statementof Inter nship Goalsand Obj ecti ves
The intern'sworkexperiencewith theClinical Psychological Unit in hishome country, in addition tohisstudies atMemorial Universityof Newfoundland,have providedhim with the many skillsnecessaryfor both anacademicand a clinical experienceatthegraduate level.During theinternshipwithAddictionServices(recovery center),Dr.Khalitiand hisassociates(private/independentclinic),and thePsychiatric RehabilitationInter-DisciplinaryTeam, the internlookedforwardto applying aILthathe baslearnedthrough theseexperiencesto realsituationsunderprofessionalsupervision.
Inaddition,itis his intention togain more insight intocertain issues such as:
To develop skillsin individualandgroupcounseling.
Goal I: Objectives:
Refinecommunica tionskillsthroughcounseling in clients individuall y and ingroupsett ings.
Observe professio nal (psychologist) in counselingsessions.
Continue tostudyandresearc h on theoryand practice in this area.
Goal2: Todevelop skills in consultation.
Objectives:
To observe howprofessional counse lorsutilize consultation practices.
To exploreandfocus ontheprocedure requirement for consultation.
Goal3: To gain knowledgein areaofassessment Objectives:
Become familiar with a variety ofassessmentsused in different situations andcontexts(Lepersonality tests, intelligencetests).
Practice andconduct assessment tests.
Follow guide linesoft est manuals.
Goal 4: Develop skill s test ana lysisand recommendationsbases on results.
Objectives:
By consultingprofessional counselors togain knowledgeoftheir interp retationandanalysis.
To focusonproperguidelinesused in writing theanalysisand diagno stics.
GoalS: Todevelo pknowledgeand skills on recovery and prevention from drug andalco hol abuse.
Objecti ves:
Observeprofessionalpractitione rsprocedur esoninterve ntion and preventionof clients withaddictionsproblems.
To gain knowledgeand practicethemost commonlyusedtheori es in addictionstherapy.
Goal 6: Togainski llsand knowledgeof diagnos es and treatmentof clients with long term, chronic menialand emotionalproble ms . Objectiv es:
Gaininsightand knowledgethrough consultatio n and guidancewith professiona lpractitionerinthis area.
Consultat ion and participating on theplans and treatmentsof clients who requirerehabilitation.
Goal7: Tobecome familiar with theexisti ng systemand services providedby the PsychiatricRehabilitation Inter-Disciplinary Team .
Objective s:
By focusingon the representat ivesandtheir roles.
To becomeaware ofspecificentry criteria.
Goal8: To becomefamiliar with the ethical and legalissuesof the counseling profession.
Objectives :
To become familiarwith the medial board policiesregarding counseling legal responsibilities.
To consultwith the CanadianPsychologicalAssociancn (C.P.A), the Association ofNewfoundland Psychologists (A. N.P) and the Canadian CounsellingAssociation(CCA) Code of Ethics, 1999.
Continuefurtherreading and study onthis area.
Goal 9: To participateIn additionalactivities asthesituationrequires.
Goal 10: To rulliU theresearchcomponent of theGra d ua te Internship Pro gram.
10
~
Thefifteen-w eekinternshipplacem entbeganTuesda y,September7,1999 andended Decem ber 15.1999.
SUPERVISION
Identificatio nof theUniversity andFieldSupenlsors
The supervisionandevaluationof theinternwas provided by both Dr.Bill Kennedy,as academic supervisor andDr.Hassan Khalili,a localPsychologist.,as field supe rvi so r.Both
or
these indivi d uals holdPh.D.degreesand eachhas manyyearsof experienc eintheirfield ofprac tice .LIM ITAnON OF TilE:STUDY
The research studyconductedwasanevaluatio nofan eclecticstress man ageme nt program .Eclectic programs arebytheirnatureacombinat ion ofvarious techniques and theories.Thereforethe resultsor this researchwillbe applica ble onlyto theprogram understudy.Any othereclecticprogram mayconsistofdifferenttechniq ues and theories.
Forthis reason,eachprogramwillneedtobe eva luatedindi viduallytodeterminethe ir efficiency andvalidity.
II ACTIVITIESTO MEET INTERNSHIPGO AL S
A description of the ten goals and theactiv itiesundertakenby theintern to meet thesegoals isprovided below.The internship activities enabled theinternto attain allten goals. Overall,the internshipexperie nce was highlysuccess fuland the intern's professiona lcounsellingexpertise and research abilityhave been greatlyincreased and enhancedin many areas of psychology.
Goa l1: Todevelop skill sinindhid ua landgro up counselin g.
The internsh ip settings gave the internopportunities to counsel cliente le presentingwithproblems from a range ofpsychologicalproblemsituations: addictions, neurosis, and psychosis. The intern engagedinnumerousactivitiesthat provided opportunities[0shadow, assess, consult, discuss,and participat eina plan forclient treatment.Inaddictionto providingcounselling,theintern observed the professionals in theirrole within their clinical settings andinthe daily performance of theirclinical activities.
While engaged inindi vidual counsellingactivitiestheintern broadenedhis research knowledge inmanydifferentareas such as:
Schizophrenia;
Anxiety and Depression ; Eating Disorders;
Addictions;
12 High and Low self-esteem;
Divorce;
Conflict Resolution;
Suicide;
AssertiveBehavior.
The intern was involvedin group counsellingand group activitiesranging from ward rounds and interdisciplinary meetingswithprofessionals,to group work on addictions and participating in a psychoeducationalgroup.Weekly participationingroup counselling sharpened the intern'sskills and increased his knowledge overall.
Consu lta ti on
Goal2: Todevelopskillsin consulta tio n.
Inchoosingtheinternship routeand by workingwithexperienced psychologists, theintern engaged in severalconsultation sessions and meetings which provided immediate feedback.Thisfeedback guided hisperceptionand thinking towards decision - making,clinicalplanning,and furtherresearch.Through observationand involvementin various consultation activitiesnew techniquesinconsultation werelearned and refined.
The knowledgeandexperienceshared bythe professiona lshas developedimmenselythe intern 'sskills in consultation practices.
13 A§sessmen t
Goal 3: Toga in knowled ge in the ar ea of assessme nt
The internhadbecomefamiliarwitha variety of assessm entswhileinthe internshipsetti ngs.Someof the tools,while familiar tohim,still providednew expe rie nces in theclinicaladministration and interpretationof data.Itwasvery beneficial to observ eand parti cipat einthe useofnewtoolsunderthe guidanc eof professiona lsin thefield.
Assessmenttoolsexploredand employedinclude:
ClinicalIntervi ew Assessment Beck AnxietyInventory
MinnesotaMultiphasicPersonalityInventory- 2(MMPI-2) Stress Self-AssessmentChecklist
WechslerAdultIntelligence Scale(WAIS Ill,ThirdEdition) Wechs lerMemoryScale(WMS,ThirdEdition) EatingDisorderInventory (EOl) Myers-Briggs Type Indicator(MBTI)
Theexplorationofvariousassessmen ttoolsincreasedthe intern 's knowledge base andthe objectiveuseofthese instrumentsin differentproblem situations.Furtherreading anddiscussion on assessment related to the analyzingand interpretingof thedata was conducted .Overall,theadministrationofnew instrument sin a new cultural setting enlargedthe interns hip experience and increasedtheintern 'ssensibility10the import ance of theirreliabilityandvalidityin different culturalsettings.
14 Test Analysis
Goal4: Developskillstest analysisandrecom menda tions based on results.
Through the internship setti ng.theinterndemonstratedsometestsandreflected on themthrough oralandwritten reports. Thefield supervisorprovidedvaluablefeedbac k whichgenerated further discus sion and explanation forusing and analyzingcertain tests.
The discussion andfeedbacksharpened the intern'sabilityinthe analysis and interpretationofthe data.
Drug and Alco h o l Recoveryand Preven tion
GoalS: Todevelop knowled ge an d skillson recove ry an dprevention from drug andalcohol abuse.
By weeklyparticipa tionand observationof professionalpractice. theintern acquired a more in-depth knowledgebase and a more developedskills re pertoirefor applicationin drug and alcoho laddictions.From withinthe range of expertisein assessmentandtreatment offered at an advanced institutionsuch as theRecovery Center, he gained the skillsandroo ts that proved highlyvaluable in alcohol and drug addic tion therapyfor prevention and intervention.
IS
DiagnosisandTr ea t me n tof Chron icMentalllln ~'!l
Goa l 6: Togain ski llsand knowledgeof dia gn oses an d treatmentofclie n ts with longterm, chro nic mental and physicalillnesses.
Inpractice withthe Psychiatric RehabilitationTeam, the intern participatedinthe counselling of clientsandconductedregular ward rounds. Thisparticipation helped him to increase his knowledgeandexperience while at the same timeallowedtheintern to sharpenand empower hisskills in diagnosis and planning for treatment.
Moreover,the discussionswiththeteamtowards theclient'sprogress had great valuetothe intern in recognizing and acquiringtheprofess ion al skillsindiscussingand part icipa ting during the interdisciplinaryteammeetings .
Hea lt hCa n System in Newfoundland
Goal 7: To become familiar withtbeexisti n g syst emand servicespr ov idedby the Psyc hiatric Reh a bili ta tio n Inter-DisciplinaryTea m.
Theinternship orientationsession,further reading, and professional feedbac k enabled the intern to meetthis goal. By experiencingthe operation of the system,he was ableto achievean overallunderstanding of theinner workingsof the Community Health and Health Care Corporation organizationalstructure and the interconnectedness of each branch of the system.
Anadvanced system of computertechnology allows the healthsystemin Newfoundlandto facilitatethe practitioner'swork intermsof client infonn ati on sharing, fileaccess, and on-line int erd is ciplinary consultationsand meetings.These advanced
16 systems broadenedtheintern' s aware nessofthepracticalapplicationfortechnology in themedicaland clinical areastoincreaseahealthcare system 's overallefficiency and effecti venessinmeetingclient needs.
Ethicalan d Leg alIssues
Goal S: Tobecome fam ilia r with theethical and legal issuesof thecounselin g pro fess io n.
Allfourprinciples: respectfor thedignityofpersons,res ponsible caring, inte grity of relations hips,and responsib ility tosocietyaretakeninto accoun t whenthe intern started hisinternship.Further reading tookplaceduringthe internshiponthismatter. See Append ixA.Consultingwithsupervisorsandcolleaguesinthisfield enhanced and broadened the intern'srespon sibi lity to prot ecttheweU-being of theind ivid ual , family, group,orcommunity involved.The internreflectedonthe emphasisthatisnow placedon themoraland legalissuesin dealing withhumansubjects.These principlesguided the intern'sprofessionalpracticeand will contin ueto guideall future practice.
Ad d iti on a lActivi ti es
Goal 9: To parti cipat e Inadd itio n alactivitiesasthesituationrequires.
Additional opportunit ies aroseduringtheinternship thatwere bothpersonally and professionall y rewarding forthe intern. Theseactivitiesare brieflydescribed below:
Visitation toHerMaj esty'sPenitenarywiththefieldsuperv isorand colleaguesfor assessmen t andinterv iewofsexual offender
.7 Attendan ceat the AnnualMentalHea lthConference heldat WaterfordHospital entitled, Psychosis:acros sthevarious ages and stages
Attendanc eat the one dayworkshopentitledWorkingWithClie nts Who Have Sex ual Difficultiesat theWaterford Hospital
Attendanc eateducationalsessions at the Recovery Centersuchasnutrition session
A gambling awareness workshopone daytraining held at Cordage Place A workshopentitled FundamentalConcepts inAddictionsheld at the Schoolof SocialWork,St.John'sCollege.MemorialUniversityof Newfoundland.
A Visitationto theMentalHealthCrisisCenter and CrisisLine atHeaLthand Community ServicesinSt.John 's , Newfound la nd.
Rese arch Co m po ne n t Completion
GaallO: To fulfill the resear c hcom po ne n t of the GraduateIntern shippro gram. The finalgoalwas achieved through:
focu sed re adingin theresearch area
the commencementof the stress management programbyusing psychceducational settings
theadministra tionof the pre and postteststhroughthe firstandlast group session the interpr etat ion,analysis,presentationand discu ssionof the dataresults thecompletionof a finalresearc h report.
18 CLIENTS AND CONCERNS
Duringthc interns hi p atotalof 16clients were seenbytheinternfora total of35 indivi dua lsessions.Of the16clients, threewerefemal esand thirteen weremale.The clientsession freque nc y is asfollows:
twelveclientswere seen for one session each, oneclientwas seen fo rtwosessions, oneclient was seen for three sessions, oneclie ntwas seen for four sessions, one clientwasseen fo r fourteensessions.
Terminationofclientsessions wasasfollo ws:
sixclients term inated theirses s ionsbymutual consen t two clients actu alized sessionterminatio n ontheir own five clients'sessionswereterminated bythe intern.
Inorder tomaintain clientconfidentiality,clients'perso nal concernswillnotbe discussed in detail. However,theoverallclient issuesand con cerns can summarized under thefollowi ng:
Stress management Depression Generalanxietyand phobia Relationshipconcerns
19 Assertiveness
Alcoho land Drugabuse and dependen cy Sexual disorders
Bi-polarmanic depressivedisorder Obsessi veCompulsiveDisorder(OeD) Atte ntio n DeficitDisorder(ADD)
A REVIEWOFTHEOBJECTIVES
Insummary,the objectiveswererealizedthrough thebroad rangeof professiona l activities,learningexperiences.and research endeavor that the intern wasengaged in throug ho ut thefifteenweek internship. Professionalpractice,mentorand resea rch consultation with renownand highly capablepsycholog istshas given the interna wider knowledgebaseand continuum of skillswithwhichto use inhisprofessional counselling
'0
CHAPTER2 RESEARCH COMP ONEN T
RATIONALE AND PURPOSE
RationalefOTRes e uchProject (Significan ceof Study)
Aftergrad ua ting from the King Saud UniversityinSaudi Arabiawith a Bachelor 's DegreeinPsychol o gyfrom theFacul ty of Educati on ,theresearc her spen tsixyears working in theMil itary HospitalatRiyadh.Indiv idual counse lling and psych otherapy wereamaj or part cf the researcher 'sdutiesandthisexperienc eprovided asolid foundationof knowled geinthesefields.Aftercoming to Canadatocompletea Master's Degree.the researc herpart icipated inacoursewhich affo rded theopportunity to co-lead a psychoeducationalgroup.Itwas during thistime that theimport anc e ofgroup cou nse ling becameclear tothe resear che r andspar ked hisinter est in learning moreabout thistypeof counsellin g.There areveryfewprofessiona ls inSaudiArabiawhoare expe riencedenoughto cond uct group counselli ng.Thereforetherearefew opportun ities forclients to accessthis typeof treatment,The knowledg egained duringthisinternsh ip placeme ntgavetheresearchertheco mpetenceto support a greateruseofgroup coun selingandemphasiz ethe ben e fitsof thistypeoftreatmenI.
Stress and stressrelat ed disorders are rapidlyincreasingwo rldw ide.The changin g structure of societywith its growing population,shiftingjob marke t,changi ngeconomics, globa l politicalinfluencesand advancingtechno logyand medic ine maybeha ving an impact onthisincreas e(pritchett&Pound 1995). The research topic studied during the inte rnsh ip allowedtheresearc he r the opportunity to evaluatethe effectiven essof an
21 eclecti c stressmanagementprogram through a psych oeduc ariongroupsetti ng.The researchstudyexp lored thepossibilityof whether ornot this type of programprovides anybenefitsto its participants.Thesigni fic antreasonsfor theresearch study wereto determine whether itmay:
1. Increase theprogram'scredibility.
2. Improvebow effective ly theprogramis administeredbyemphas izing it' s stre ngth s andilluminatingany areas wherethere couldbe roomforchangeor imp rov ement.
3. Allow the internto expandhisknowledgeaboutthebenefi tstobe gainedfrom group psychoeducati onaltherapy.
4. Makeitpossibl e fortheintern to estab lishingsimilarprogram sin his ow ncountry by app lyi ng this knowled ge.
5. Allow the participantsto havesomeinputinto how theprogramcanbealtere dor im prov e d.
6. Changeknowledgelevels of participantswithrespect[0 stressand/or its manage ment.
Hypoth es is
Therearefourhypothesesthat were the focusof theresearch study:
1. ThePsych oedu canonal group proc esswillaffec t knowledgeofstres s management of the grou p participant .
2. The applicationof an eclecticstress management programwillaffectstresslevels amonggroup participants.
3. There willbe nosignificant differencesintheBeck Sub- Testsbygender.
4. There will be no significantgender differencesontheKnowledgebased questionnai re.
Objectives
The objectivesofthis researchare:
I.To reviewcurrentliterature onstress management programsconducted withingroup psych oeducarional therapy,with special focus on the methodologiesused,program evaluationand benefitsforthe participants.
2. To use this literatu retochose ordevelopa pre-post test tobe administeredtothe research group.
3,To deve lop recommendations for program modificat ionsbasedon theresearch findings,
4.To gainextensiveknowledgeonhow to develop and implementan eclecticstress managementprogram in a psychoeducanonalgroup setting.
5.To gainpracticalexperienceworkingwith knowledgeableand experienced professionals in the field of group counseling.
6.Ifthe research results support thehypothesis andshowthat theprogram successfully achievesits goals,the internwould haveextensiveskillsandknowledgewithwhich to
establish and administer grouppsycboed ucationaltherap y onstressmanagementand relateddisordersinavariety of settingsinhisowncountry.
7.Condu ctingthis researchmayfaci litatemoreextensiveresearchinthis area ofstudy.
LIT E RATURE REVIEW Introdutti on
During thelasttwodecades,many stress managementtechn iqueshavebeen developed. These techn iqueshavebeenusedto reduce,copeand oftenpreventstress . Relaxationtraining,timemanagement,socialskillstraining,problem solvingtrainingand life-styleimprovement are some of themost frequ entlyusedtechniqueswhichare emp loyed tocorrectstressproducingbehaviors(Irma,Timm erman ,Emmelkamp ,and Sandenn an,1998).
Whetherornot anindividualdevelops stress -relatedhealthprobLemsdepends on severalfactors.People experiencestress everydayin one formor anotherandinvarious degreesofintensity.ItisDOtthe"stresso r" whichdeterminesthe levelcfstress experienced. buthow the indivi dual views thesituationorevent(Lazarus&Folkman.
1984 ).Howtheycopewiththis problem isaffectedbymanyfactors suchas their previou s experiencewithlhistypeof problem. thesocialsuppo rtthey receiveand their personalcharacteristics,10name afew.
This literaturereview is dividedinto two sections.Thefirstsectionfocuseson stress and stressrelateddisorders.Inthesecondsection, thefocu s ison the group, particularlythe psychoeduca tionat group.
24
STATE MENT OFTHEPROBLEM
Section 1: St ress
Stress andstre ss related disordersaffectevery individualto some degree. "Stre ss"
has become a phrasewhichis used to explain manyhuman conditions,ranging from physicalhealthproblemsto psychophysiologyproblemssuch as unhappiness (Woolfolk
&Lehrer.1993). Itis believed that psychological factorsplay an important role in mental health and physicaldisease :researchers placestress andtens ion abovetraditional risk factors suc has cholesterollevels.blood pressure andsmo king as causes ofhean attack s.
There are manythousands ofleamedarticles onstress andillness. Recentyears have seen an explosionof medical research whichtakesaccountof thepsychologica ldimension.
The literatu reon work stressis growing rapidly.although ithasonly beenin recentyears that researchers haveregarded the importance of the physical disease consequences as significant on psychological well-being(Fletch er, 1991).Since the mid 1970's, stress and the psychophysiologyof the stress responseitse lfhas gainedan important placeinthe study ofhumanhea lth and disease.Between 75 and 90percent of all diseasewhichiswidespread in today' sAmericansociety isrelatedto stressand its affects on thehumanbody (Hafen, Karren,Frandsen, andSmith1996; Asterita 1985).
Definition ofStre ss
Althoughthe term stress has become very common in societytoday,the meaning of stressis stillelusive(Liberman&Yager,1994). Thisispartlybecause eachof us experie ncesitinadifferent way. Whatone person finds stressful may notbe so for
25 another.Hans Selye,often called the"Fatherof Stress",defines stress as"a nonspecific respo nse of thebodyto anydemand" ( Hafen, Karren, Frandsen.and Smith,1996,pAZ).
Also, he definedstress as"th e rate of allthe wear and tear causedbylife", (Miller,1996, p.139).
Theliterature suggeststhat the concept ofstress is mo stuseful when referringto response"sta tes" . Mikhail(198l )spec ifically defines stressasa"3statewhich arises from an actual or perceivedemand-capabilityimbalanceintheorganism'svital adj ustmentactions"(p.14).
Kinds of Stressors
Itdoesn'tmatterifthestress-producing factor-or"stressor"-ispleasantor unpleasant.Theyall producetb.esame systematicreactionalthoughtheresu ltsmay be quitedifferent.The intensityof the respon sewilldependon ly on thedemandfor adjustment(Hafen,Karren, Frandsen.and Smith,1996; Cooper, 1983). Thereare three kindsorstressors:Physical. socialand psycholo gica l.Howan individualrespondsto these"stresso rs' is determinedbyhereditaryandenviro nm entalfactors.
Physicalstressorsare any externalfactorsincl ud ing food, drugs,po llutan ts,noise , temperatur e,exe rci se,and trauma. Ifthese cond itions are excessi veandlast lon genough thendistres swillresu lt inanyperson. Some cfthe mostcommonphysicalsymp toms includemuscle tensionand spasms,twitchingeyelids. frequentsneez ing,diffic ult breathing,drymout h,painin back,chestor shoulders,headaches,ulcers andheartdisease (Miller, 1996 ).
26 Socialsrressors includeloss of a job, retirement,. divorce, death of aloved one and financial problems. These conditionsrequire some form of interaction between the individualand his environment.Manyof thesestressors are inevitableand disturbing.
Five ofthe most cornmon social symptoms are feelingsof powerlessness, self- estrangement, isolation,meaninglessnessand normlessness(Halen, Karren,Frandsen,and Smith, 1996; Seeman, 1959).
Psychological stressors are often the most damaging kind because they tendto reoccur.They may be caused by physicalor socialstressors,or they may be self-induced . Thesepsychological stressors can beinternalfeelings such as frusrrarion, guilt, love, hate, anxiety andotherequallyintense emotions. Symptomsincludeincrease in smoking and drinking,overeating, walkingand talkingfaster,excessiveworry, depressedor hyperactive mood,lack of energy and apathy(Hans Asche,&Hassan Khalili,personal communications, October 4, 1999).
Inmedicine, "stress" is any physical,chemicalor emotional change thatca uses strains which can leadto physical illness. There are threestages in the stress response. The first stageis "alarm" where the bodyrecognizes stress and preparesfo r either"fight or flight".The heartbeat and respirationincrease,pupils dilate,digestion slowsand perspirationincreases. The second stage,"resistance",occurs whenthebody repairsany damage done by the alarm response.Ifthe stress continues,the bodyremainsalertand cannot repairitself. This eventually leads to the third stage,"exhaustion".Continued exposure to stress depletesthe body's energy and can lead to stress relateddisorders (Goldstein,1995; Selye 1978).
27 Expertshave understood for many years that peopleare more susceptibleto all kindsof diseaseswhenthey areexperienci nghigh. levelsof stress. Althoughnegative eventscreate enough stresstolowerthebody'sresistanceto disease, positive circumstances, such as a new car ornew babyalso upseta person'sno rmal abilitytofight off disease.Dr.Thomas Holmesand Dr. RichardRahehavecreated a rating scale which takes boththegood and badchanges in to acco unt. Theirscale,the "Holme s-Rahe Scale",lists41 events which involvesome oflife' smost common changes.Thescore on this surveydemonstratesthepotentiaLlevel of resi stan ce andhowlikely oneis to becom e illfromthechanges experienced during theprevious 2years.For example,deathof a spouserates100 which isthe highestvalueonthe surv ey.while minorlaw violations rates the lowes tat11(Hafen,Karren, Fran ds en,and Smith, 19 96;Shaffe r1982).
Through.theread ings, ithasbee n found that theres earchon stresshasbeen very extensiveduringthe pasttwodecades. Theincidents ofstress andstr ess related disord e rs have grown rapid lyandcont inue togrow.Because ofthis,research must further examine why so manypeople developthese disorders and whatpeopLecan do tocope with them.
Section II: Group Psychoeducational
Groups hav ebeen aroundsincethebeginningsofhumanhistory.No oneknows whenthegroup was first used buteverycivilizationhas usedthem toaid in their growth and development.Peoplehave alwaysgatheredtogetherto ach ievecommongoa ls and solve problemswhichcannotbe res o lved individu ally(Glad ding199 9).
, .
Inthe1800's groups were usuallyformed to instruct people andtaelpthem correct behavior through a psycboeducarionalmeans.InEngland,immigrants,the mentally ill and the poor were some of the groups which received this special focus. Group structure was used to help peopleunderstand themselvesand others.Thistype of group fonnat was a15:)usedin hospitals andsocial agencies tohelpclients discussand share problems.
Since that time,group therapyhas undergoneman y changes and refinem-ent.New techniquesand more specialized theories havegivenrise to familycouns.eling, psychodrama, smallgroup counseling and marathongroups. Peoplewhoworkwith groupshave become more specialized and competent. Group counseling: as a wholehas gained acceptanceand continuestobecome more professionaland consuimer orientated (Gladding1999).Regardless afthe type of group,there are many sources of literature which document theirusefulness. Group members can assist each otherby sharing informationand experiences, raising questions or making commentsabean"taboo"
subj ects , challengingor debatingwitheach otherand providing support amdacceptance.
The sharingof a common problemgives the members a feeling that theyarenot alone and can work togetherto solvetheirproblems(Shulman1984).
DefinitionofGro u p
The concept of"group work" includesalltypes of activities perfo-rmedby organized groups.The Association forSpecialists in Group Work (ASGW) defines group workas"a broad professionalpracticethat refers to the giving oflaelp or the accomplishmentof tasksina group setting.Itinvolvesthe applicationoE group theory
2.
and processbya capable professionalpractit ioner to assist an interdependentcollectionof peopleto reach their mutual goals.whichmaybepersonal, interpersonal,ortask-related in nature" (Associatio nfor-Speciali sts in GroupWork, 1991,p.14).
Psychoed ucationa Lgroups areusedtohelp reachmanypeopl e with mentalhealth problems .Inthese groups,psychologicalskillsaretaughtrather than usedto treat or help patients.This type ofgroupfocusesoninformation-givingand skillteaching and can be used forthe purpose of prevent ion, toprom otegrowthandrestorativein their pwpose andfocus .Psyc hoed ucational groups stresschange through understandin gand knowled ge(Gl addi ng1999 ).There is evidencewhich supports theideathat social supportfunctionsas a bufferbetwee nstressandheal th(C oh cn&Wills1985;Kulik&
Mahler1993;Theirs1995).Thisdemonstra testhat indivi d ualsexperiencingstress,if givenamplesupport.willnotdeve lopasmany symptoms.A hazard for developingstress related symptomsisthislack ofsocialsupport.
DESCRIPTION OF THE STRESS MANAGEMENTPROGRAM
Int r od uction
The StressMana gementProgramwas edited byHansP.Asche.a psychologist and a membe rof thePsych iatri cRehabilitation Disciplinary-Tea m.Thisprogra m was administrated toso me groupsbeforethe researcher begantoconduct the researchstudy.
Even thoughtheprogramhad beenin use.no evaluationhad been conductedon this progra m to date.Therefore.theresearch er saw theneed to studyand evaluateobjectively this kind of program.
30 After a discussi onwiththe on-si te:supervisor,the researcher devised a ten week session format for theparticipan tsofthe stress managementprogram.InWeek I the agenda/outlineof the program was discussedwithme participants.Boththe: participants andthe:researc heragreed on the ten weekage ndaoutline: forthe program.The ruderis referred to Append ix.Hfor the agenda/outl ine.
The stressman agement programingen eral focuses ontheidentificationand originofstress and thedifferent stressors onecanencounte rindailyliving. Themain purposes is to help theclient:(l)understand stressand anxiety related disorders; (2) recogn iz e stre sso rs and the symptoms of stress; and (3) effectively copeandmanage stres sbyusin g prevention and interventio n strategies .Thereforethisprogram is psychoed uca tiona!inthattheprogram providesanexplanation of psychological terminolo gyrelated to stress and anxie tyrelateddisorders byusingillustrationtools such aspresentatio ns, sclf-evalua tionactivi ties,videotapes,self-reflectio n and person al shari ngofstress experiences.Overa ll.panicipan ts,upon completionof the stress management progra m.are equipped withtheapplicabletools to enable themto effec tivelyrecognize.interpret. cope.and manage stress intheirdaily living.. Thereade ris referredto AppendixIforamoredetail eddescrip tion of the program.
METHODOLOGY ResearchInstrum ents
Forthe purposeof thisstudy.an eclecticstress managementprogram fora psycho ed ucat ional group wasevaluated usinga pre/posttest.Thistest was administer ed
31 to the groupmem bers beforethetherap y start ed andagain at the endofthetogroup sessio ns.The test wasbasedon Beck ' stestfor anxiety.TheBeck AnxietyInven tory (BAI)conta ins21itemsofdescriptive statements of symptoms whichare associ atedwith anxiety.Theseitemsaredividedinto 4sub-sca les which arc:Neurophysiologica l, Subjective,Pani cand Autonomic .These items are rated on a 4-point scalerangingfrom 0, whichis "not atall",to 4 which is"se vere ly: [couldbarelystand it"(seeappendix B).
Thistest was chosenbecause ithasproven to have ahigh internalconsistencyreliabili ty (Fydrick,Dowdall,Chambless,1990).It is widelyusedinCan ada andinternationally.
Thistest measured the beforeand afterlevelsof stress which thegroupmembers were ex perienci ng. There was also another factortoconside r when comparing theseresu lts.
Although thein formation providedduringthese sessionsmayhelp the members manage or decreasetheir stress levels,the socialenvironmentof the group sessionsmay contributetothisimprovement.Thesharing of feelin gs,thoughtsandexperien ceswith people whohavesimilar problems mayprovideso me psychologicalbenefi ts.
Inadditionto the pre/post tests,therewere alsotwo questionnairesdevised by the researcher.The first questionnaireconsistedof21 dosedended question swhichwere administered as a pre andpost testto determine the members'knowledgeof stress and stress relateddisorders(See Appendix C). The results of thistest focused onthe first hypo thesis.Theseco nd questionna irecontained 6 open-endedquestion swhichwere adminis teredat the end of the program to determinethemembers opinions and suggestions about the program. Thereader is referred to Appendix D. The data obtained
32 from thisquestionnaireenabled the intern tomakesevera lsuggestio nsabout how the program might be alteredor im proved.
~ Group Participants
The groupmem bersmetthefollow ing require me nts:
I.Thesamplingreflected acomposite ofeigh t: fourmaleand fourfemale ; 2.Theparticipants vo luntarilyagreed to participateinthe study;
3.Theparticipantage rangedfrom thirty to fiftyyears of age;
4.AUthe partic ipan tswere diagnosedassuffering anxietyor stress rel ated disorders;
5.All theparticipan tswereout-patients;somewere seen bythePsych iatric Rehabili tationTeam whilethe othe rs were referred byotheragen cies .
Individua lswerereferred fromalarge populati onbymembersof the Psychiatri c Rehabilitation team. The larger populatio nconsistsofappro xi mately130 individuals currentlyrecei ving treatme nt from mem bers of theteam forvari o us diagno sti c reasons.
Individualswhoexpressedan interes tin receivinghelp with their anxiety andstress were referredandscreened bytheinternandgrouplead er,HansP.Asche ,M.Ed.,R.Psych.
Twelve individ ualswerereferred. Allind ividuals metthe criteriaestablis hed,how ever threeindividualsdeclinedparticip ationbecause of socia l anxiety.One participant did not participateafter the firstsession dueto lack ofinterest.This le ft 8 individual s whic h were previou slyidentifi edasthemaximu mnumberforthegrou p.
33 Thegrou p participan ts cons iste d offour malesand fourfemalesov erthe ageof eighteen. All personshadspec ific anxietyand orstressrelated problems andvaried symptoms.The diagnos is of theseindiv idual s werereprese ntativeot'rhe larger Psychiatri cRehabil itationTeam.The lar gerpopulationhaddiagnosticcatego ries suchas schizo phren ia , bipolarillness,obsess ivecom p ulsive disorder,depress io n and other anxietyrelateddisord ers.
Ana lysis
AI!the datawas compiled andanalyzedusingthestatistica lcom puter software progra m called the StatisticalPacka geforthe SocialSciences (S PSS ). The analysis consistedof descriptive suchas meansandsta ndard deviationsas well as advanced analysis suchasreliabilityanalysis , corre latio ns andrepeated measure sANOVA's.
QuantitativeDat aAnalysis Reliabilityofinstr u me nts
The reliabilityof theBeckAnxietyInventory(BAl),itssub-sc ales and knowledge basedquestionswithpreand post-testhasbeendemonstrated10be accepta ble,since most preandpos t reliabilitie s wereover.700. The scales (ALPHA) reliabilityanalysis revealedaveryhighinte r-item reliabilityfor both tests (see Table1).
34 TABLE 1: Crun Bach'sAlpha Reliab ilityFor The HAl HAlSu b-
Scale s And Knowledg eBased Questions
Pre Post
BAI 0.918 0.893
Neurophysiological 0.551 0.77
Subjective 0.806 0.566
Panic 0.865 0.655
Autonomic 0.895 0.75
KNOWLEDGE 0.737 0.732
Repeated measuresanalysiswerecom pleted to determineif change hadtak e place overtimefrom thepre-test and post-test on the instruments andsub scales aftheBeck as wellason the knowledgescale (seeTables 2to (3).Analysi swere alsodoneby gender to determineif gender interactedwiththepsychoeducationalgroup.
As ca nbeseen in Table2 test scoresonthe BeckAnxietyInvent orydecreased overtimefor both males (15.50 to12.50) and fema les(32.50to26.25 ). Table 3shows therewasno sign ificant interaction between genderand Beckscores o.nthe Invent ory sca le(p>.05),norwas thereasign ifican tinteraction betwee npre-testand post -testBeck scoresover time(P>.05).
JS TABLE 2: Mean sAnd Standa rdDeviationsOnPre-t ellt And Post-
test Scores For TheBecks Anxiety Invento ry N
Males 4
Female 4
Pre test 15.5 32.5
so
lL.09 8.35
Post-lest SD
12.5 3.79
26.25 10.69
Note:Scalescores couldrange from0meaning noanxietytoa high score of63 meaning extremeanxiety.Thereforelowerscoresindicatedless anxietyon thisscale.
TABLE3: TwofactorANOV A forRepe atedMeasuresSouTce DataonBeck'sAnxietyInven to ry pre-tes t and post-t est bygen der
Source Sumo! DfMean F
$quQres square
Bec k Anxiety 68.062 68.062 1.169 0.32 1
Inventory preand post-lestscores
BeckAnxiety 18.062 18.062 0.31 0.598
Invent orypre and post-testscores by gende r
Erro r 349.315 58.229
As can be seen in Table4 test scoresontheKnowled gebas edquestionna ire increasedovertimefor both males(14.25to 18.75)andfemales(14.00to 20.38). Table 5 shows there wasno significantinteraction between genderandKnowledge scores (p> .05).There was however,a significantinteractionbetween pre-testandpost-test Knowledge basedquestionnairescores overtime(p>.05).
36 TABLE4: Means and standarddeviations on pretest and post-test
scores for theKnowledgebasedquesti on n a irescale
Male Female
N Pre-test 14.25 14
so
3.304 4.2426
Post-test SO
18.75 2.63
20 2
Note;Scale scores could rangefrom 0 meaningno knowledgetoa high score of21 meaninghighknowledge. Thereforelower scores indicated(owlevel afknowledgeon this scale.
TABLE 5: Twofacto r ANOVA for RepeatedMea su re sSource Data on Knowledgebased questionnai repre-test an d post-testby gender
Source Sumo!
DJ
Mean Fsquares square
Knowledge based tto.25 110.25 28.149 0.00 2
questionnaire pre and post-testscores
Knowledge based 2.25 2.25 0.574 0.477
questionnairepre and post-test scores by gender
E=,
23.5 3.917As canbeseenin Table6 test scores on theBeck AnxietyInve ntory sub-scale for neu ro physiolo gical decreased overtime forboth males (6.75to 5.00)and females(10.25 to 9.00). Table 7 shows there was no significant interactionbetweengenderand Beck scores on theneurop hys io lo gical (p>.05). Norwas there a significantinteraction between pre-testandpost-test beck scoresover time (p>.05 ).
37 TABLE 6: Mea nsAnd Standa rdDeviations On Pre-testAndPast-
test Scores ForTheBecks Anxiety Inventory Sub-scal e For Neurophysio logica l
Male Female
N 4 4
Pret est 6.75 lO.25
SD 4.5 2.06
Post-test SD
5 2.16
9 2.94
Note:Scalescorescouldrange from 0 meaning no neurophysio logicalsymptomsof anxietyto ahigh score of21 meaningextreme neuro physiologicalsymptomsof anxiety.
Therefore lower scores indicated less neurophysio logicalsymptomsof anxiety on this scale.
TABLE 7: Two Factor ANOVA for Repeated Measures Source Data on Beck'sAndetyInvento ry Sub-scale NeurophysiologicalPre-testand Post-tes tByGender
Source Sum of DfMean F
squares square
Beck ' s sub-sca lefor 0.904 0.378
neuro p bysiologicaLpre and pos t-lest scores
Beck sub-scalefor 0.25 0.25 0.025 0.879
neurophysiologicalpre and post-test scoresby gende r
E=,
59.75 9.958As canbe seen inTable8 testscores on theBeck Anxiety Inven to rysub-scale for subjective increase dover time for males(3.75to 4.25)and decrease d for females(11.75 to7.75). Table 9 shows there was nosignificant interact ionbetweengenderand Beck scores(p>.05). Norwas therea signi ficantinteractio n betweenpre-test andpost-test beck scoresovertime(p>.05).
38 TABLE8: MeansAnd Standard DeviationsOnPre-tedAnd Post-
testScores Fo r theBecks AnxietyInve nto ry sub-scale for Subjectiv e
Male Female
N Pretest
3.75 1U5
SD 1.71 2.63
Post-test SO
4.25 2.63
7.75 2.87
Note:Scalescores couldrange from0 meaningnosubj ectivesymptoms of anxie tytoa highscoreof18meaningextremesubjectivesymptoms of anxie ty.Therefo relower scoresindicatedless subjectivesymptomsofanxiety on this scale.
TABLE9: Two Fact orANOVA For RepeatedMeasuresSoun::e Da taOn Beck'sAnxiety Invento rySub-ScaleFo r SubjectivePre-t est and Post-tes tByGe nd er
Source Sumo! Df Mean F
squares square
Beck's sub-scaleof 12.25 12.25 2.579 0.159
subjective for pre and pest-test scores
Beck preandpost-tes t 20.25 20.25 4.2 63 0.085
scoresbygender
Error 28.5 4.75
Ascan be seen in Table10testscoreson theBeck AnxietyInventorysub-seale for panicincreased over time for males(1.00to1.25) anddecreasedforfemales (3.75to 3.50).TableIIshowstherewasnosigni ficant interact ion betweengenderand Beck scores(p>.05).Nor wasthere a significant interactionbetweenpre-test and post-rest beckscoresover time (p>.05).
3.
TABLE 10: Mean s And StandardDeviations On Pre-testAnd Post·
testScor esFor TheBecks Anxiety InventorySub-scal e ForPan ic
Male Female
N Pretest
1 3.75
SD 2 3.59
Post-test SO
L2 5 1.5
35 3.42
Note:Scalescores couldrangefrom 0 meaningnopan icattacksympto mstoa high score of12meaning ex tre mesym ptomsof panic attack. Therefore lo werscoresindicated less panic symp to ms on thisscale.
TABLE ll: TwoFactorANQVA ForRepeatedMeasuresSourc e DataOn Beck' sAnxietyInventorySub-scal e ForPanic Pre-testandPost-testByGender
Source Sum of Df Mean F
squares square
Beck 's sub-scaleof panic for pre and post -test sco res
Beck'ssub-scaleof 0.25 0.25 0.261 0.628
panic for preand post -testscoresby gender
Error 5.75 0.958
Ascanbeseenin Table 12test scores ontheBeck AnxietyInventoryforthe autonomicsub-scale decreasedovertime for both males(3.00to2.00) and femal es(7.75 to6.00).Table 13 shows there was no significant interactionbetweenge nder and Beck scores (p>.05). Nor was thereasign ificant interactio nbetween pre-testand post-test beckscoresovertime(p>.05).
40 TABL E12: MeansAnd StandardDeviati onsOn Pre-te stand Post -
testScore sForThe B«ksAnxietyInventorySub-scale ForAuto nomic
Male Fem ale
N Pretest
3 7.75
so
3.31 2.22
Post-lest SO
2 0.82
6 2.93
Note:Scalescores couldrange from0 meaning no autonom icaspects ofanxietytoa nigh score of12 meaning extremesymptomsof autonom icaspectsofanxiety.Therefo re low er scores indicatedless autonomicsymptoms onthis scale.
TABL E13: TwoFactor ANOVAForRep ea tedMeasuresSource Data On Beck'sAnxi ety Invento ry Sub- Scal e Autono micPre-t estAndPost-tes tByGender
Source Sumo! DfMean F
squares squa re
Beck's sub-scaleof 7.563 7.563 2.951 0.137
autonomic pre and post-testscores
Seek 's sub-scaleof 0.563 0.563 0.22 0.656
autonomic fo rpre and post -test scoresby gende r
E=,
15 .37 5 2.563Qualitative DataAnalysis
This data was obta inedfrom the answersof the eight participants to the sixopen- endedquest ions(see append ixD).Theindividua ls are identi fiedbynumber ratherthan Dam e forconfidentialitypurposes. The analys isand summaryof the collectedresponseof each.participant follows.
41 GroupParticipant #1:Male.
Whatwasthemost valuablepieceof informationyou gained from this experi ence ?
Ans wer: I learned bow to han dlestress andhow breathingcan helpyourelax.
2. Whatwouldyou liketosee addedor remov edfrom thisprogram?
Answe r:Ithinkthe course was fineandwell donemaybe alittlemorevideopresentation . 3. What did you likemostaboutthe setting (wherethe sess io n took place)?
Answe r. The roomwasco mfortable and the number of peoplewas just right for the program. Instruction waswell done.
4. Whatdidyou like least about the setting(where thesessiontook place)?
Answe r:The chairsco uldhave beenabit mor eco mfortab le and the roomwithair cond ition ing.
5. Whatdid youlikemostaboutthewaythe stress session wasconducted?
Answer:Ilikedthe wayitwaspresen tedand explainedwell byAhmedand Hans. Also it wasacomfortab le waytorelax and learn about stress.
6. Pleaseinclude any other comments orsuggestions you wouldliketo addabout yourexperiencein thecounsellingsessions.
Answ er:I'mglad Iattended.I learned thingsIdidn' t know andthings Iwillbeableto help my stress levelwith.Good informationwas provided. The programwas welldon e and all thepeople enjoye d anendingtheweeksession s.
42 Summary:
GroupParticipanrslfound the sessio nsvaluable,informa tive,and educational. He feels betterequippedtohandle stress. Hefelt more videopresentation wo uld enhance the sessio ns. The small group numberswere beneficia l for him.Intermsof thephys ical settinghefelt airconditioningwas needed. His overall opinionswerethatthe session presentatio ns werewelldoneandthe program itselfwas verybeneficia! to him.
GroupParticipant #2:Male.
What was the most valuab lepiece of information yougainedfrom this experience?
Answer:Ifoundthat the experie nceIhad from the informationwas aboutmy stre ss disorders and breathingtechniques.
2. WhatwouLdyoulike to see addedor removed from this program?
Answer:Itis a good program.
3. What did youlike most about the setting (wherethe session tookplace)?
Answer:Iknow someofthe peoplein thegroupandIenjoyedit.
4. What did you likeleast aboutthe setting (where the session took place)?
Answer:Nothing.
5. What didyoulikemost aboutthe way the stress sessionwas conducted?
Answer: Enjoyable .
43 6. Pleaseinclude any other commentsorsuggestionsyou wouldliketo add about your experience:in the counseUingsessions .
Answer:[cannotthink of anythingat thistime.
Summary:
GroupParticipant #2. Found overall the sessions and the programprovideda useful experienceindealingwithhisstress disorder s.Hecited thebreathingtechniques asvery he lp ful.Overall hefo und theprogra menjoya ble and state dthat the grou psessi ons introducedhim to new people.
GroupParti cipan t#3;Male.
l . What was the mostvaluablepiece ofinformatio n you gained from this experience ?
Answer:I found what stresswas and howtocopewithitby readingthematerial athand.
2. Whatwould youlike to seeaddedor removedfromthis program ? Answer:
3. What did youlikemostaboutthesetting(wherethe ses sion tookplace)?
Answer:Itwascomfortingand friendly .
4. What did you likeleast about the setting (wherethe sess io n took place)?
Answer :Itwas a bit overcrowded.
5. Wbat didyou like mostaboutthe way thestress sessionwas conducted?
Answer:Itwas to the point andinfc rmarive.
44 6. Please incl ud eanyother comme ntsor suggest ionsyouwo uld like toaddabout your experienceinthecounse lling sessions.
Answer:Irealtythinkitwas beneficial.
Summary:
GroupParticipant#3statedthat overall theprogram wasvery beneficialinteaching him how tocopewithstress. Hewould liketo seea much sma lle rnumberofparticipantsin the program.Inparticularhefoundthesessionstobeconci seand informative.
GroupParticipant#4:Male.
l. What was themost valuab le piece of informationyou gained fro mthis experience?
Answe r:Learning about stress copingskillsandthe skillsofasserti vene ss.The Stop sign assertion.
2. What wouldyou liketoseeadde d orremovedfromthis progra m?
Answer:IwouLd(ike to seemoreskills likethe sto psign asse rtionskillanduse.
3. Whatdid you likemo stabout the setting(wherethe sessiontookplace)?
Answer:Icould hear watertricklingdown outside the window,itwas relaxing,asnac k of sandwic hes plusthepeoplepresent.
4. What didyoulikeleast aboutthe setting(wherethesess io n tookplace)?
Answer:Ithoughteverythingwasfine,nonegativecomm ents.
45 5. Whatdid youlikemostaboutthe way the stresssession was conducted?
Answe r;The overheadprojector madethe writin geasie rto read and understand.
6. Pleaseincludeanyothercomments orsuggestionsyou wouldliketo add about yourexperiencein the counsellingsessions.
Answer:Hans andAhmed and everyone presentconversing andusing learnedwords in moreconve rsationfor retainingmoreso theknowledge.
Summary:
GroupParticipant#4mentio ned thatoverallthe program wasben efi cialin teachi ng him cop ingskillsand assertiv enes stechniques .Hedidn't haveany negativecomments.He foundthat thesessions taught him new ideas relatingto stressand copingwithstress.
GroupParticipan t#5:Female.
1. What wasthemostvaluable pieceof information yougainedfrom this experi ence?
Answer :Thatit' s okay10 be stressed ina good waybuttake away and learn newwaysto handlestressor'S.Its for yourown good health.
2. What wouldyou like to seeaddedor removedfromthisprogram ? Answer:WhatI would like to seeisalonger group. Moretimetospeak and learnmore aboutyourown life simauons.Otherwise good group and anexcellentfacilitator.
46 3. Whatdidyou likemost aboutthesetting(whe-re the session took place)?
Answer: The settingwasfinebutIpersonally foundi tclosedin and attimesverywarrn.
Notenough room tomove around.Ifound theroomv-erywarmwithpeople whoare dealin g witheveryday living asIam.
4. Wha tdidyoulikeleastaboutthesetting (wheeethe session took place )?
Answ er: Theleas twas the not beingable to movemu-ch.Notwantingtodisturb othersif youwant ed to go tothebathroom.rwouldstay and wcait until finish ed.
5. What did you like most about thewaythestress sessi onwas condu cted?
Answer:Ireallyenjoy ed Hans wayoftalkingabou tthte stressand makingthingsgoso mucheasier.Theway tohandlethingseasier.
6. Please includeanyothercommentsorsuggesrjionsyou would like to add about your experienceinthe counse llingsessions.
Answer:Ireallyenjoyed my time hereandwould lo ve to seean extendedgroup.I especia llyenjoyed talkingtoHansandwould loveto beable toseemoreof him.He makessomuch senseto problemsorstressors.Heis a.. wellvoicedandarticulateperson.I gota totout of this group.Andthereespeciall yneeds -tobemore.Thank-yo u verymuch toHansand Ahmed.
Summary:
Group participant#5enjoye dtheprogram and indicat ed thatshe wouldlike to seea longerprogram offered.She gained alot of knowl edgeabout coping skills anduseful techniques thatshe can apply inherdaily life. She praisedthe highdegree offac ilitation
47 in thegroupsessions. She indicated that sheparticularlybenefitted from facilitato r personal experience snaring.
Group Participant#6:Female.
1. Whatwasthe mostvaluable pieceofinfonnationyou gained from thisexperience?
Answ er:Themost valuablepiece of informationI havegainedfrom thisten week session ishaving learn ed to speak up and use theword"I"and notletmyself take things too sensitively.
2. What wouldyou liketo seeadded orremovedfrom Ibis program?
Answe r:Thething I would liketo seeadded tothis program are:(1) get everyone to speak up about some of their anxiety and stress in their Life;(2 )keep this progra mopened up forpeoplethatneed thisprogram.
3. What did you likemostaboutthesett ing (wherethesess io n tookplace)?
Answer.The most thingI likeaboutthe setting was thatit was enough peoplehere.Ten peopleisenough.
4. What didyo ulike leastaboutthesen ing (wherethe sessio ntoo k place) ? Answer:The least thingIlikeaboutthe setting where it too kplace was thatthe roomwas 100 smallandalot of heat.
5. What didyou likemostabout the way thestresssessi o n wasconducted?
Answer:Theway I likemost aboutthestress sessionwas conductedisthat wehada len weeksessio n put in order.Alsothe way the instructorswastalki ng about and their actions .
.s
6. Pleaseincludeany othercommentsor suggestions youwouldlike toaddabout yourexperience in thecounselling sessions.
Answer.My commentsorsuggestionsIexperience inme counsellingsessionsis,[learn howto cope withthe mostofthestressfromdaytoday.Also, learnbow tobe more assertiveabo ut things.
Summary:
Grouppart ici pan t#6 stated thatshedevelopedher self-esteem and learn edto be more assertive. Shealsosuggested that thesessionsfocusmore onpersonalexperie nce sha ring ratherthat just psych oeducat iona l training. Shefound thenumberof participan ts suitab le totheseni ng.Overallshelearned copi ng skins.
GroupParticipan t#7:Femal e.
Whatwasthemostvaluablepieceofinforma tionyougainedfrom Ibis experience?
Answer:Talking aboutstresshe lps.
2. Whatwouldyou liketosec:addedor removed from thisprogram?
Answer:nothi ng.
3. Whatdidyoulike mostabout thesetting(wherethe session look place)?
Answer :very comfortable .
4. What did youlikeleastabout the setting(wherethe session tookplace)?
Answer: too wann.
49 5. What did youlike most about the way the stress session was conducted?
Answer: very clear and express
6. Please include any other comments or suggestions you would liketo addabout yourexperiencein the counsellingsessions.
Answer.[wish it wasn'toverbecauseIthinkIstill can learn more.
Summary:
Grouppart ici pan t#7 indicatedthat overall the program washe lpful to her. She gained knowledge about coping skills. Sheenjo yed the group dialogue.Overall,she indicated that the sessions wereconductedwell and wouldlike to see this program continue.
Group Participant #8: Female.
L What was the most valuablepieceof information you gained from this experience'?
Answer:Themost valuab lething I gained from thisexperie nce is now to apply the information (how to use itforme).
2. What wouldyou Like to see added or removed from lhisprogram?
Answer: Totally enjoyed itand feel muchbetterabout myself-I have alot of work to do making itall work formy well being.
3. What did you likemost aboutthe setting (wherethe sessiontook place)?
Answer: Great-the food alsowas good! Thanks so much foreverything.
so
4. Whatdidyoulike leas taboutthesetting (w here the sessiontook place )?
Answer.
S. Whatdidyou like most about theway the stress session was conducted?
Answer: gxceuem-The way Hans uses personal experiences10explain. 6. Pleaseincl ude any other commentsor suggestions youwouldlike toaddabout yourexperienceinthe counsellingsessions.
Answ er:Wo uldliketo do itagain-jus ttore-enforce mythink ing.
Summary:
Group part icip ant#8 stated thatove rallshe enjoyedtheprogram . She gainedusefu l informationon how toapplystressmanagem enttechni questo herownlife. Shelikedthe waythatthe facili tat orco nd uctedthe sessions. Shewould10 participate inano therstress management program tofollow -up berprogress.
Summary of . he Qualit ati veData
There are fourmain areas thaIthe sixopen-endedquestionaddressed:
(I)the stressmanageme nt programitself,(2)thesetting where theprogram was conducted,(3) thefacilit ators conduct of tbe sessions, and (4)suggestionsandcomments for future im p rove me ntstotheprogram.
