OBSERVATION INDICES OF PROGRESSIVE RELAXATION TRAINING
DISSERTATION
North Texas State University in Partial
Fulfillment of the Requirements
For the Degree of
Denton, Texas
August, 1981
Self-Rating,and Behavioral Observation Indices of Progressive
Relaxation Training. Doctor of Philosophy (Clinical
Psychology), August, 1981, 5^ PP-> 10 appendices, references,
109 titles.
effect that caffeine may have in inducing deeper states of
relaxation. The degree of relaxation was assessed by physio-
logical measures, self-ratings, and behavioral observations
of relaxation behavior. The low-caffeine group consisted
of 10 subjects; 20 subjects were randomly assigned to
either a high-caffeine group or a caffeine withdrawal group
(10 subjects in each group).
During the pretreatment assessment of relaxation skills,
subjects were exposed to a 10-minute baseline, followed by
10 minutes of self-directed relaxation, followed by 10 minutes
during which the subject was instructed to maintain the
relaxation. They were then instructed in progressive deep-
muscle relaxation and asked to practice twice a day for 2
weeks. The high-caffeine group was asked to consume caffeine
before relaxation practice, and the caffeine withdrawal group
was asked to continue avoiding caffeine (they had withdrawn
from caffeine at least k days earlier). The low-caffeine
group was asked to maintain their present rate of caffeine
consumption. The posttreatment assessment of relaxation
skills was similar to the pretreatment assessment of
relaxation skills except that subjects employed progressive
deep muscle relaxation learned during training rather than
self-directed relaxation and they watched 10 minutes of
a stressful film following the relaxation maintenance
period.
pretreatment measure of state anxiety, trait anxiety, frontal
EMG levels, self-rating of relaxation, and "behavioral obser-
vations of relaxation. There was no differential ability in
group members' learning to relax. However, the high-caffeine
group was unable to maintain their low EMG levels, especially
when stressed. Both the low-caffeine group and the caffeine
withdrawal group showed little reactivity to the stressful
situation. Self-ratings and behavioral observations of
relaxation did not discriminate among groups during post-
treatment. The importance of caffeine withdrawal as part
of a relaxation training program was emphesized.
TABLE OF CONTENTS
Table Page
1. The Quantity of Caffeine Contained in Commonly Ingested Substances 11
2. Summary of the Steps for Each Treatment Session 13
3. Mean Values of Anxiety, Relaxation, and Caffeine Measures for the Low-Caffeine, High-Caffeine and Caffeine Withdrawal Groups 18
4. Summary of Levels of Significance for Statistical Analysis of the Data 20
IV
OBSERVATION INDICES OF PROGRESSIVE RELAXATION TRAINING
A variety of techniques have been developed to facili-
tate lowered levels of arousal including hypnosis (Barber &
Hahn, 1963; Paul, 1969), autogenic training (Schultz & Luthe,
1969)> progressive relaxation (Jacobson, 19^0), the relaxa-
tion response (Benson, 1975)> transcendental meditation
(Wallace & Benson, 1972; Weiner, 1977), yoga meditation
(Elson, Hauri, & Cunis, 1977), and biofeedback training
(Budzynski, Stoyva, & Adler, 1970; Raskin, Johnson, &
Rondestvedt, 1973)- Relaxation training has become, clinic-
ally, very prominent and has been used to treat a variety of
physical and emotional disorders such as anxiety (Canter,
Kondo, & Knott, 1975; Stoyva & Budzynski, 197^; Zeisset,
1968), migraine headaches (Lutker, 1971; Mitchell & Mitchell,
197l)» tension headaches (Budzynski, Adler, & Mullancy, 1973;
Chesney & Shelton, 1976; Cox, Freundlich, & Meyer, 1975;
Epstein, Hersen, & Hemphill, 197^5 Haynes, Griffin, Mooney,
& Parise, 1975; Wickramesekera, 1973)» asthma (Davis,
Saunders, Creer, & Chair, 1973)> peptic ulcers (Beaty, 1976),
hyptertension (Benson, 1975; Patel, 1975; Shoemaker & Fasto,
1975)> and pain (Melzack & Perry, 1975)•
Relaxation training, in various forms, has been used
frequently in conjunction with or as a prelude to other
psychological techniques. It is commonly used with
systematic desensitization (Paul & Shannon, 1966; Wolpe,
1958), fear reduction techniques (Spiegler, Liebert, McMains,
& Fernandez, 1969; Laxer & Walker, 1970; Denney, 197*0,
inhibiting responses to stressful imagery (Paul & Trimble,
1970), and dealing with anxiety-evoking stimuli (Suinn &
Richardson, 1971).
relaxation have been reported. Frequently used techniques
of quantifying states of relaxation include self-monitoring
(Blanchard & Epstein, 1978; Carnahan & Nugent, 1975; Kazdin,
197*0; behavioral observation (Blanchard & Epstein, 1978;
Epstein, Cinciripini, McCoy, & Marshall, 1977; Luiselli,
Steinman, Markolin, & Steinman, 1978); and various physio-
logical measures such as Electromyogram (EMG) (Schandler &
Grings, 1976; Hersen, 1973; Lang, 1968), Galvanic Skin
Response (GSR) (Kimmel, 1967; Patel, 1975; Paul, 1969), skin
temperature (Boudewyns, 1976; Wolff, 1963), heart rate
(Headrick, Feather, & Wells, 1971; Scott, Peters, Gillespie,
Blanchard, Edmundson, & Young, 1973), and Electroencephalo-
gram (EEG) (Hart, 1967; Kamiya, 1968; Nowlis & Kamiya, 1970).
There exist a number of uncontrolled variables in
experiments using relaxation training such as family history,
medical history, exposure to toxins, metabolism rate, body
weight, circadian rhythms, gender, intelligence, and person-
ality. One of the uncontrolled variables which may effect
outcome measures is the influence of caffeine. In a study
of EMG biofeedback assisted relaxation, Asterita (1980)
found that caffeine inhibited the reduction of muscle tension
levels.
xanthine compound along with theophylline and theobromine
(Truitt, 1971). The xanthines resemble each other in general
pharmacologic action and are found in varying combinations
and concentrations in coffee, tea, cola drinks, cocoa,
chocolate candy, and some medication (Grollman & Grollman,
1970).
where it increases cellular metabolism and also influences
physiological and psychological functions (Goldstein &
Warren, 1962). The degree to which it influences bodily
function is related to amount of caffeine consumed, indi-
vidual body weight, individual tolerance, existing autonomic
conditions, the presence of other foods or drugs, and the
amount of food in the stomach (Grollman & Grollman, 1970;
Julien, 1975. Truitt, 1971)• Caffeine is rapidly and almost
completely absorbed in the intestines, although small
amounts are absorbed in the stomach, and the maximum stimu-
lating effects are reached in approximately 15 to 30 minutes
following ingestion (Landis, 1958).
activity of most physiological systems following ingestion
of between 50 mg and 200 mg (Ritchie, 1970; Truitt, 1971)'
Caffeine increases respiratory rate (Truitt, 1971); increases
heart rate and blood pressure (Grollman & Grollman, 1970;
Julien, 1975; Truitt, 1971); stimulates skeletal muscle
activity (Truitt, 1971); increases the volume and acidity of
gastric secretions (Truitt, 1971); stimulates the cerebral
cortex, thalamus, and vasomotor centers (Reimann, 1967);
increases blood glucose levels (Grollman & Grollman, 1970);
and increases catecholamine release (Truitt, 1971). These
effects are variable and are based on characteristics of the
individual as well as the circumstances of administration
(Grollman & Grollman, 1970; Truitt, 1971).
Excessive or chronic caffeine consumption has been
associated with a variety of medical disorders such as head-
aches (Landis, 1958; Dreisbach & Pfeiffer, 19^2; Harrie,
1970), myocardial infarction (Jick, Miettinen, Neff, Shapiro,
Heinonen, & Slone, 1973? Paul, Lepper, Phelan, Dupertuis,
MacMillan, McKean, & Park, 1963), cardiac arrhythmias (Flynn,
1970; Silver, 1971)» insomnia (Punke, 197^; Truitt, 1971),
ulcers (Truitt, 1971)» respiratory arrest (Truitt, 1971), and
dehydration (Truitt, 1971)- As may be anticipated, sensi-
tivity to the effects of caffeine is individualized based on
the frequency and amount consumed as well as individual
tolerances (Colton, Gosselin, & Smith, 1967; Grollman &
Grollman, 1970; Truitt, 1971).
dependent. Moderate amounts of caffeine (150 mg or less)
5
(Goldstein, Kaizer, & Whitby, 1969; Goldstein & Kaizer,
1969)• Larger amounts (between 150 mg and 300 mg) produce
nervousness, irritability, feverishness, and disturbed sleep
(Goldstein, Kaizer, & Whitby, 1969; Goldstein & Kaizer,
1969; Nash, 1962; Greden, 197^)• Larger amounts of caffeine
have also been reported to increase depression, gastric
irritability, and intermittant heart beat (Furlong, 1975)>
as well as fever and anorexia (Reimann, 19&7)• Individuals
who ingest very little or no caffeine on a daily basis tend
to react to lower doses of caffeine than do heavy users.
Also, individuals who ingest caffeine regularly tend to
report being less alert, less relaxed, less active, more
sleepy, and more irritable in the morning prior to caffeine
consumption (Goldstein, Kaizer, & Whitby, 1969)• The degree
of tolerance seems to be an important factor when analyzing
the effects of caffeine consumption. Heavy users of caffeine
report less nervousness, less wakefulness at night, and more
desirable stimulant effects than do abstainers and light
users when the same amount of caffeine is consumed (Goldstein,
Kaizer, & Whitby, 1969) •
(1975) found that twice as many patients drank more than
five cups of coffee a day and that patients diagnosed as
having a personality disorder had a higher probability of
drinking coffee. Among psychiatric inpatients, high caffeine
consumers tended to "be older, tended to be diagnosed psy-
chotic, and tended to exhibit more state anxiety (Winstead,
1976). Psychiatric inpatients who consumed large amounts of
caffeine exhibited more state and trait anxiety, more depres-
sion, more clinical symptoms, greater use of hypnotics and
minor tranquilizers, and poorer perceived physical health
(Greden, Fontaine, Lubetsky, & Chamberlin, 1978). Among
normals there seems to be a positive correlation between
coffee intake and anxiety level (Hire, 1978).
There has been extensive research concerning the effects
of caffeine on human performance. Hollingsworth (1912)
found that mental functions such as perception, association,
discrimination, attention, and judgment were enhanced by
caffeine. Concerning motor performance, he found that speed
was increased, steadiness was decreased, and coordination
was increased by small doses of caffeine but retarded by
large doses. He suggested that effects on mental processes
has a slower onset and is more persistent than motor proc-
esses. Also, the magnitude of these effects varies inversely
with body weight, increases with the number of hours the
individual is awake, and decreases when food is present in
the stomach. For moderate doses of caffeine there is
evidence to support the improvement in physical endurance
and capacity, motor coordination, simple and complex cogni-
tive tasks, learning, judgment, and mood (Weiss & Raties,
1962) .
7
motor reaction time (Gilliland & Nelson, 1939; Smith, Tong,
& Leigh, 1977), decreases visual discrimination reaction
time (Cheney, 1936), decreases auditory reaction time
(Franks, Hagedorn, Hensley, Hensley, & Starmer, 1976), and
decreases decision time (Smith et al., 1977). In contrast,
some suggest that caffeine has no effect on reaction time
(Seashore & Ivy, 1953; Lehmann & Csank, 1957); no effect on
visual reaction time (Franks et al., 1975; Lovingood, Blyth,
Peacock, & Lindsay, 1967) and produces longer reaction time
when less than 250 mg is used, "but results in decreased
reaction time when more than 300 mg is used (Hollingsworth,
1912).
Burkhardt, Ivy, & Atkinson, 1950; Gilliland & Nelson, 1939;
Hollingsworth, 1912; Lehmann & Csank, 1957; Smith et al.,
1977)- These effects were found with dosages of from 80 mg
to 360 mg of caffeine and primarily involved the areas of
the hand, arm, and shoulder. Franks et al. (1975), found
an increase in "body sway using 300 mg of caffeine. Seashore
& Ivy (1953) and Lovingood et al. (1967) failed to find
hand steadiness impaired "by caffeine, but their subjects
were either fatigued or exposed to high temperatures.
The effect of caffeine on coordination seems to be
dosage dependent as well as task dependent. Finger-tapping
8
Lehmann & Csank, 1957)> but it also may not be effected
(Adler et al., 1950)- Tracking and monitoring coordination
tasks seem to be improved by varying caffeine dosages
(Seashore & Ivy, 1953; Payne & Hauty, 1955; Seele, 197*0.
Caffeine may have no effect on manual dexterity (Franks et
al., 1975; Lovingood et al., I967K but some report that
it stimulates motor skills (Vila Grafula, & Diego Garcia,
1971; Lehmann, Black, & Ban, 1970)- Simulated automobile
driving tasks suggest that caffeine increased alertness
(Regina, Miller, Keiper, & McKelvey, 197*0 » inhibited visual
attention lapses (Baker & Theologus, 1972), and showed no
specific effect on the "psychical" component of driving
ability (Klebelsberg & Mostbeck, 1963)•
acoustic signal of less than 16 msec duration is decreased
(Baru, 1967); and, the sensitivity to low intensity auditory
stimuli is initially decreased for males, but increased for
females followed by increased sensitivity for both sexes
(Klein & Salzman, 1975)•
been extensively investigated. Caffeine has been shown to
improve handwriting speed (Dhawan, Bapat, & Saxena, 1969);
to improve performance on a cancellation task (Ammon, 1973);
to have no effect on a cancellation task (Froberg, 1968); to
initially impair, but then to improve> verbal associative
ability (Hrbek, Komenda, Macakova, & Siroka, 1971); to have
no effect on memory tasks (Mitchell, Ross, & Hurst, 1974);
and to have no effect on reasoning, comprehension, and per-
sonality measures (Bachrach, 1966). The differential effect
of caffeine on introverts and extroverts has been investi-
gated. Extroverts seem to be less vigilant than introverts,
but following the ingestion of caffeine, the difference is
minimized (Keister & McLaughlin, 1972). Speed and accuracy
of test responses are increased in extroverts and introverts
following caffeine consumption, but the effects are reversed
for introverts if the dosage reaches 4 mg/kg of body weight
(Gilliland, 1976). Caffeine has also been shown to increase
the number of problems attempted (Barnack, 19^0), increase
the rate of adding (Gilliland & Nelson, 1939)» and improve
numerical reasoning (Franks et al., 1975)•
Physical endurance is enhanced by caffeine. Work out-
put as measured by working to exhaustion on a bicycle
ergometer is increased (Foltz et al., 19^2). Tests of
motor ability as well as subjective symptoms following
10
(Seashore & Ivy, 1953)-
caffeine on relaxation training. It is hypothesized that
the ingestion of caffeine will significantly inhibit an
individual's ability to reach and to maintain a deep
state of relaxation.
State University. The mean age of the subjects involved
in this study was 31• Subjects consisted of 18 females
and 12 males who were equally distributed among three
groups.
The subjects were recruited by a research bulletin
(see Appendix A) and were required to meet one of two
separate criteria to be eligible for the experiment.
They had to regularly consume at least a moderate amount
of caffeine (at least 300 mg per day) or a low amount of
caffeine (less than 100 mg per day). The quantity of
caffeine was estimated as shown in Table 1 (Grollman &
Grollman, 1970; Pruitt, 1971). The primary caffeine
containing substance consumed by the subjects in this
study was coffee.
The Quantity of Caffeine Contained in Commonly Ingested Substances
Quantity Quantity of Quantity of Caffeine of Caffeine For Purpose of
Substance (mg) This Study (mg) Substance
Coffee Percolated 6 oz . 100-150 120 Instant 6 oz. 86-99 90 Decaffeinated 6 oz. 2-k 3
Tea 6 oz. 17-110 60 Cola 6 oz. 25-40 30 Cocoa 6 oz. 40-70 60 Chocolate 6 oz. 100-150 120 Common Medication
100-150
Aspirin 1 6-32 20 No Doz 1 100 100
Note: The quantity of caffeine for the purpose of this study was estimated by computing the mean mg reported by Grollman & Grollman, 1970 and Pruitt, 1971.
Apparatus
muscle tension. The system consisted of the following
modules: the model S75-01 Hi Gain Bioamplified/Coupler with
a band pass width from 90 Hz to 1000Hz, the model S76-21
Cumulating/Resetting Integrator, the model S76-01 Contour
Following Integrator (average), the model S21-06 Precision
Bipolar Comparator, the model S24- 05 Voltage Controlled
Oscillator, the model S82-24 Audio Mixer/Amplifier, the
12
Supply. EMG levels were recorded every 100 seconds on the
model R21-16 Data Print. Muscle-produced electrical activity
was detected through 3 silver chloride electrodes 6.5 mm in
diameter. Two electrodes were placed 25 mm above each
eyebrow and 100 mm apart with the ground electrode placed
between them equidistant from each. The subject was seated
in a reclining chair.
(see Appendix A). A participant Release Form was signed by
all subjects giving informed consent to implement the experi-
mental procedures (see Appendix B). A Relaxation Checklist
(see Appendix C) similar to that used by Luiselli et al.
(1978), was utilized by the experimenter in the behavioral
observation of each subject's state of relaxation. A sub-
jective report of mental and physical relaxation similar to
that suggested by Rosen (1977) was introduced to each subject
utilizing Appendix D.
various steps for each of the four treatment sessions.
During the initial meeting all subjects were oriented as to
the purpose of the experiment (see Appendix E), were asked
to sign an informed consent form (see Appendix B), were given
an explanation concerning the EMG (see Appendix F), and were
13
Treatment Session Steps
withdrawn from caffeine) Assessment of expectations
Collect data on caffeine consumption Assessment of relaxation skills (EMG,
self-report, and behavioral obser- vation during reading, relaxation, and relaxation maintenance)
Taught progressive relaxation Continue recording caffeine consumption Start monitoring relaxation Assessment of expectations
Collect data Reinforce compliance Discuss any problems Continue recording caffeine consumption Continue monitoring relaxation Assessment of expectations
Collect data Assessment of relaxation skills (EMG,
self-report, and behavioral obser- vation during reading, relaxation, relaxation maintenance and film)
Debriefing
(Spielberger, Gorsuch & Lushene, 1970). All phases of this
study were conducted in the same room with the same experi-
menter. All subjects were asked to record their caffeine
consumption (see Appendix G) prior to and during experimental
treatment. The subjects were randomly assigned to one of
three treatment conditions. If their self-report of caffeine
consumption showed that the subject consumed less than 100 mg
per day of caffeine they were assigned to the low-caffeine
group. If the subject consumed more than 300 mg per day of
caffeine he was randomly assigned either to a caffeine with-
drawal group or a high-caffeine group. The caffeine with-
drawal group was asked to avoid all caffeine (coffee, tea,
cola drinks, cocoa, chocolate candy, and over the counter
medications such as No Doz) for the remainder of the study
after recording caffeine consumption for at least 3
days. These subjects avoided caffeine for at least 4
days prior to the beginning of the treatment phase. The
high-caffeine group was asked to continue consuming caffeine
at their present dosage. Each subject was given the expec-
tation that their treatment condition would facilitate
learning the relaxation technique. Expectations were
assessed at the beginning of the four meetings with each
subject (see Appendix J).
t wo) . During the second meeting (approximately 1 week
after orientation) each subject was seated in a reclining
chair and asked to read a passage from "A Biofeedback Primer"
(Blanchard & Epstein, 1978). EMG levels, the Relaxation
Checklist (see Appendix C), and the subject's subjective
report of mental and physical relaxation (see Appendix D)
were recorded every 100 seconds throughout the entire
session. During this assessment subjects were told to read
at their own pace and to keep body movements at a minimum.
Following this baseline condition» the subject was instructed
to relax by any means which he thought would be effective.
The subject was then told to cease self-directed relaxation
10 minutes later and to remain relaxed (maintenance) since
data would be recorded for the next 10 minutes.
Relaxation training. Also during the second meeting*
each subject was instructed in progressive relaxation as sug-
gested by Rosen (1977) and Jacobson (19^0). To ensure a thor-
ough understanding of the technique, each subject was given an
outline of the progressive relaxation instructions (see Appen-
dix I) and then asked to instruct the experimenter in this
technique. Any discrepancies in his instruction of the pro-
gressive relaxation technique were discussed with the subject.
Each subject was then instructed to practice progressive re-
laxation twice a day for 2 weeks. The high-caffeine group
was instructed to consume caffeine between 30 minutes to 60
16
In addition, each subject was asked to monitor frequency and
duration of relaxation practice, pre- and postratings of re-
laxation levels, and quantity of caffeine consumed (see Appen-
dix H). Each subject was asked to contact the experimenter
if any problems were encountered before the next session.
Data collection (session three). During the third
meeting (1 week after the second meeting) all data was
collected from the previous week. Any problems were dis-
cussed with the subject. The subject was reinforced for
adherence to his treatment regimen and asked to continue
this regimen for 1 more week.
Posttreatment assessment of relaxation skills (session
four].. The fourth meeting (2 weeks after the second meet-
ing) was similar to the second meeting with two exceptions.
Firstly, instead of practicing a relaxation technique of
their own preference, each subject was instructed to practice
progressive relaxation. Also, after remaining relaxed for
10 minutes (maintenance) each subject viewed 10 minutes of
a stressful film (Deems, 1969)• This film vividly and with
realistic detail showed actual victims of traffic accidents.
Debriefing. All subjects were given factual information
concerning the research hypotheses. They were allowed to
peruse their data. All questions concerning the study were
answered by the experimenter.
measures and the caffeine consumption are presented in
Table 3• Table ^ is a summary of the levels of significance
found during statistical analysis of the data. Using a
3 x 1 (groups x scores) analysis of variance (ANOYA), no
significant difference is found for pretreatment measures
of state anxiety or trait anxiety. No significant difference
is found using an ANOYA with a 3 x 1 (groups x practice
time) design for the amount of relaxation practice each day
during treatment.
A 3 x k (groups x sessions) ANOVA is performed on the
subjects' expectations of treatment at each treatment ses-
sion. Neither the main effect for sessions nor the groups x
sessions interaction is significant. However, the main
effect for groups is significant, F (27,2) = .33, p < .05.
Post hoc comparisons (Newman-Keuls' Multiple-Range Test) of
the group differences show that the low-caffeine group's
mean expectation rating is significantly higher than the
caffeine withdrawal group, p < .05. No other significant
group differences are found.
A 3 x 2 (groups x time of rating) ANOVA is performed
on the ratings of relaxation during home practice, both
before progressive relaxation and after progressive relaxa-
tion. The groups x time of rating interaction is not
significant. The main effect for groups is significant,
18
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F (27,2) = 3-86, £ < .05 and the main effect for time of
ratings is significant, F (27,1) = 126-35, p < .001. Post
hoc comparisons of the group differences show that the low-
caffeine group's mean relaxation rating is significantly
higher than the high-caffeine group, p < .05. No other
significant group differences are found. The mean rating
of tension after progressive relaxation is significantly-
higher (more relaxed) than before progressive relaxation.
During the pretreatment assessment of relaxation skills
a 3 x 2 (groups x conditions) analysis of covariance (ANCOVA)
is performed on the EMG levels while the subject was per-
forming self-directed relaxation and maintaining the relaxa-
tion. The EMG level while reading is utilized as the
covariant. Neither the main effect for groups nor the groups
x conditions interaction is significant. However, the main
effect for conditions is significant, F (27,1) = 13.92,
p < .001. The mean EMG level during self-directed relaxation
is lower than during maintenance of relaxation.
During the pretreatment assessment of relaxation skills,
a 3 x 2 (groups x conditions) ANCOVA is performed on the
self-rating of relaxation while the subject was performing
self-directed relaxation and maintaining the relaxation.
The self-rating of relaxation while reading is utilized as
the covariant. Neither the main effect for groups nor the
groups x conditions interaction is significant. However,
the main effect for conditions is significant, F(27,l) = 9,.85
23
relaxation is higher than during maintenance of relaxation.
During the pretreatment assessment of relaxation skills,
a 3 x 2 (groups x conditions) ANCOVA is performed on the
behavioral observation of relaxation while the subject was
performing self-directed relaxation and maintaining the
relaxation. Behavioral observation of relaxation while
reading is utilized as the covariant. Neither the main
effect for groups nor the groups x conditions interaction
is significant. However, the main effect for conditions
is significant, F (27,1) > 61.33, P < .001. The mean
behavioral observation of relaxation during self-directed
relaxation is lower than during maintenance of relaxation.
During the posttreatment assessment of relaxation skills,
a 3 x 3 (groups x conditions) ANCOYA is performed on the
EMG levels while the subject was performing progressive
relaxation, maintaining the relaxation, and viewing the
stressful film. The EMG level while reading is utilized
as the covariant. The main effect for groups is not
significant. However, the main effect for conditions is
significant, F (59>2) = 3*65, p < -05 and the groups x condi-
tions interaction is significant, F (5^,^) = .35, p < .005.
Post hoc comparisons of the relaxation, maintenance, and
film conditions show that the high-caffeine group's mean
EMG level is significantly lower during relaxation as
compared to the maintenance condition p < .05 and as compared
24
for the low caffeine group or the caffeine withdrawal group
are found. Post hoc comparisons during the relaxation
condition reveal no significant difference among the three
groups with respect to their mean EMG levels. However,
during the maintenance condition the low-caffeine group's
mean EMG level is significantly lower than the high-caffeine
group's, p < .05. Also, during the stressful film condition,
the high-caffeine group's mean EMG level is significantly-
higher than both the low caffeine group (p < .05) and the
caffeine withdrawal group, p < .05- No other significant
group differences were found.
During the posttreatment assessment of relaxation skills,
a 3 x 3 (groups x conditions) ANCOYA is performed on the
self-rating of relaxation while the subject was performing
progressive relaxation, maintaining the relaxation, and
viewing the stressful film. The self-rating of relaxation
while reading is utilized as the covariant. Neither the
main effect for groups nor the groups x conditions interac-
tion is significant. However, the main effect for condi-
tions is significant, F (5^»2) = 38.67, p < .001. Post
hoc comparisons show that the subject's mean self-rating
is significantly lower (more tense) during the film condi-
tion as compared to both the relaxation condition (p < .01)
and the maintenance condition, p < .01. No other differences
between treatment conditions are found.
25
During the posttreatment assessment of relaxation
skills, a 3 x 3 (groups x conditions) ANCOVA is performed on
the behavioral observation of relaxation while the subject
was performing progressive relaxation, maintaining the relaxa-
tion, and viewing the stressful film. Behavioral observation
of relaxation while reading is utilized as the covariant.
Neither the main effect for groups nor the groups x
conditions interaction is significant. However, the main
effect for conditions is significant, F (59,2) = ^.55,
p < .05. Post hoc comparisons show that the behavioral
observation of relaxation is significantly higher during
the film condition as compared to both the relaxation con-
dition (p < .05) and the maintenance condition, p < .01. No
other significant differences between treatment conditions
are found.
On the basis of the obtained results it is concluded
that the research hypothesis is supported. Specifically,
it is concluded that the ingestion of certain levels of
caffeine significantly inhibits an individual's ability to
benefit from progressive relaxation training.
This conclusion is additionally supported by measures
taken before the onset of relaxation training. There are
no pretraining differences among groups on state anxiety,
trait anxiety, EMG levels, self-rating of relaxation, or
behavioral observation of relaxation. This supports the
26
idea that the differences between groups are not due to
variables other than the daily level of caffeine ingestion.
The subjects' expectation of treatment rating adds more
support to the research hypothesis. The caffeine withdrawal
group rates themselves the lowest of the three groups in
their expectations of positive treatment outcome. Since low
expectation is frequently associated with less success, one
may predict inhibited treatment outcome. However, the caf-
feine withdrawal group exhibits equal or superior relaxation
ability as compared to the other groups.
The EMG level after relaxation training shows that the
high-caffeine group is unable to maintain a state of relaxa-
tion rather than being unable to learn how to relax. There
is no difference between groups while relaxing, before or
after relaxation training. The low-caffeine group exhibits
a lower EMG level than the high-caffeine group, while main-
taining a state of relaxation. The inability of the high-
caffeine group to maintain a state of relaxation persists
during the film stress condition. Both the low-caffeine
group and the caffeine withdrawal group exhibit lower EMG
levels than the high-caffeine group during the film stress
condition. This result is important, because relaxation
training in clinical practice is primarily used to help the
individual deal with stressful situations. In general, it
seems that the caffeine withdrawal group is essentially
equivalent to the low-caffeine group.
27
EMG levels during these conditions. One explanation is that
the progressive relaxation training has no effect. This
could be because of an ineffectual training regimen or
because of the limited amount of time between the pretreat-
ment and posttreatment assessment. An additional alternative
explanation for this phenomena is that posttreatment assess-
ment occurs the week before final examinations and thus
during a higher level of stress than is present during
pretreatment.
indicates no difference between groups either before or after
relaxation training. This may suggest that the individuals'
perception of arousal is mediated by variables other than
those tapped by EMG measurement. These differences could be
cognitive and related to the subjects' perception of affective
and behavioral responses.
tion of the subject's level of relaxation. Since this is
not a double blind study, the experimenter's bias may have
been a contributing variable. In general, behavioral obser-
vation of relaxation shows little change with the variance
being very low for all groups combined. The behavioral
28
observation of relaxation mean after training ranges from
1.2k to 1.^5 for the four treatment conditions. The range
varies from .300 to .^00 and the standard deviation varies
from .062 to .101.
be a useful component of a relaxation training program.
Withdrawal from caffeine seems to be effective in facili-
tating training effects as compared with high caffeine
consumption, especially during stressful situations.
One hypothesis which may confound the interpretation of
this study is that withdrawal from caffeine alone and not in
combination with relaxation training produced the obtained
results. The nature of this research design makes it im-
possible to separate the relative contribution of these two
factors.
This study is hampered by the law of initial values.
Because the EMG levels before training are low, one would
predict that it would be difficult to decrease these levels.
One would expect EMG levels to remain the same or increase
in this case. On the other hand, a clinical population with
initially high EMG levels would be expected to evidence
appreciable EMG reductions. Future research could evaluate
this possibility and its relation to the effect of caffeine
withdrawal. Future studies should control for the intake of
other substances such as nicotine and alcohol. Replication of
this study would also be desirable before utilizing the
results in applied relaxation training programs.
29
If you consume a large amount of caffeine (coffee, tea,
or carbonated beverage) or a small amount of caffeine you
qualify to learn a relaxation technique which may help you
reduce anxiety and tension in stressful situations. You
will also be given the opportunity to learn about biofeed-
back equipment.
tigating the effects of caffeine on relaxation training may
do so in hours (1 hour during four consecutive weeks).
If you qualify and are interested in this opportunity, call
788-2631 or 566-22 4-2 (after 5'00 p.m.). This project is
being supervised by Dr. Howard Hughes at North Texas State
University.
30
William T. Floyd III to perform or supervise the following
investigational procedure or treatment: relaxation training
utilizing electronic instruments to monitor physiological
responses (muscle tension). I understand that this investi-
gation does not involve either medical diagnosis or medical
treatment and that consulting a physician is my choice.
I have (seen, heard) a clear explanation and understand
the nature and purpose of the procedure or treatment; possi-
ble appropriate alternative procedures that would be
advantageous to me (him, her); and the attendant discomforts
or risks involved and the possibility of complications which
might arise. I have (seen, heard) a clear explanation and
understand the benefits to be expected. I understand that
the procedure or treatment to be performed is investigational
and that I may withdraw my consent for my (his, her) status.
With my understanding of this, having received this informa-
tion and satisfactory answers to the questions I have asked,
I voluntarily consent to the procedure or treatment desig-
nated in the paragraph above.
Appendix B—Continued 31
If the subject is not competent, the person responsible shall
be the legal appointed guardian or legally authorized
representative.
If the subject is a minor under 18 years of age, the person
responsible is the mother or father or legally appointed
guardian.
If the subject is unable to write his name, the following
is legally acceptable: John H. (his X mark) Doe and
two witnesses.
Appendix C
Relaxation Checklist
2. Eyes
3- Neck
Head
Close to body or 5 ^ 3 2 1 shoulders raised
6. Hands
7 • Legs
8. Feet
Together, flat on 5 4 3 2 1 floor, tapping
9 • Breathing
Rapid, uneven
Loosely closed, almost fluttering
Tilted to side or forward
On chair arms or lap or away from body, shoulders forward
Open, palms up, resting on lap or chair arms
Apart, knees out, no movement
Apart, resting on heels, toes pointing out
5 M 2 1 Slow, even
Relatively still
Physical Relaxation
Every 100 seconds you will hear a "click" sound which
is the Electromyogram printer. Each time you hear this
sound, I want you to rate your level of mental and physical
relaxation. On a scale from 1 to 10, where 1 stands for
totally tense and 10 stands for totally relaxed, rate your
level of relaxation. You will need to verbalize this rating
so that the experimenter will be able to record this
number.
3^
caffeine might have on relaxation training. Relaxation
training is a technique commonly used to treat a variety of
anxiety-related disorders. It involves focusing on different
muscle groups in the body and by tensing and relaxing
these muscles inducing deep muscle relaxation.
Electromyogram (EMG) biofeedback equipment will be used
to assess your level of muscle tension. Three electrodes
will be placed on your forehead in order to measure muscle
activity.
A maximum of four sessions which will last approxi-
mately one hour each will be involved. You will be taught
deep muscle relaxation and asked to practice twice a day for
two weeks. You will also be asked to record each day the
amount of caffeine consumed, the amount of relaxation
practice, and levels of tension. You will also be asked to
watch a stressful film.
group. The equipment is designed so that electrical activity
that your body produces can travel from the electrodes that
are placed on your forehead to the apparatus. It is designed
with safety features to prevent the possibility that you
could receive a shock. Every 100 seconds you will hear a
"click" sound which is the EMG printing a number which
represents the electrical activity of your forehead muscles.
36
Consumed* Quantity of
Caffeine Consumed
Caffeine is contained in coffee, "tea, cola drinks, cocoa, chocolate candy, and medications such as No Doz.
37
Caffeine Consumed**
Quantity of
Before Practice
After Practice
Quantity of
Caffeine Consumed
*0n a scale from 1 to 10 where 1 stands for totally tense and 10 stands for totally relaxed rate your level of relaxation.
1 2 Totally Tense
~ZT ~3~ 10 Totally Relaxed
Caffeine is contained in coffee, tea, cola drinks, cocoa, chocolate candy, and medications such as No Doz.
38
B. Find a comfortable position and avoid crossing the
arms or legs.
lenses if possible.
E. Become aware of thoughts and bodily sensations, but
don't try to control them.
F. When you feel ready, begin to focus your attention
on relaxation training.
A. For all of the following muscle groups tense the
muscle as indicated for about 3 seconds, and con-
centrate on the tension. Then relax the muscle,
noticing the feeling of relaxation and the differ-
ence between tension and relaxation. This should
be done twice for each muscle group allowing from
10 to 20 seconds for the muscle to relax before
tensing again.
1• Both hands and forearms. Make a fist and hold
it tight.
your palms up, try to lift your forearms toward
your shoulder while at the same time resisting
any movement of the forearms.
3* Forehead and scalp. Lift eyebrows as high as
possible.
your nose.
6* Lips and tongue. Press your lips together and
press your tongue against the roof of your mouth.
7- Neck and throat. Try to pull your chin down and
at the same time oppose such movement.
8- Shoulders and upper back. Pull your shoulders
up and try to touch your shoulder blades together
9• Chest. Take a deep breath, hold it for 6
seconds; exhale evenly and smoothly.
10. Stomach. Make your stomach hard.
11 • Thighs and buttocks. Press down on your heels.
12. Calves. Point your toes up.
13* Feet. Turn your feet inward while curling your
toes.
40
The following statements concern the study in which you
are presently involved. On a scale from 1 to 10 where 1
stands for strongly disagree and 10 stands for strongly
agree, indicate the extent to which you agree or disagree
with the following statements by circling the appropriate
number.
3 ^ 5 6 7 8 9
I expect the treatment to be successful.
3 ^ 5 6 7 8 9
I would recommend this treatment to a friend.
3 ^ 5 6
Strongly ± 2 Disagree
41
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