Gaylinn Daniel Media Assistance

MEDIA ASSISTANCE:
EXPLORING THE EFFECTS OF THREE METHODS OF GUIDED RELAXATION ON
STRESS WITH ADOLESCENTS
by
Daniel L. Gaylinn
A dissertation submitted
in partial fulfillment of the requirements
for the degree of Doctor of Philosophy
in Clinical Psychology
Institute of Transpersonal Psychology
Palo Alto, California
May 22, 2009
I certify that I have read and approved the content and presentation of this dissertation:
________________________________________________ __________________
Patricia Campbell, Psy.D., Committee Chairperson Date
________________________________________________ __________________
Janice Holden, Ed.D., Committee Member Date
________________________________________________ __________________
Anees Sheikh, Ph.D., Committee Member Date

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2009
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ii

Abstract
Media Assistance:
Exploring the Effects of Three Methods of Guided Relaxation on Stress With Adolescents
by
Daniel L. Gaylinn
I explored the effects of 3 methods of delivering a brief 10-minute guided relaxation with an
ethnically diverse population of 77 adolescents with an average age of 15.2 years within a
Northern California high school classroom. Of the 77 participants recruited for the study, a total
of 21 appeared to disengage from the study as evidenced by the minimal variability of their
responses to the scale used for the study and were thus removed from the primary analyses.
Using a pre-post experimental research design, multiple repeated measures analyses of variance
revealed that, of the 3 delivery methods explored (audio-guided, video-guided, and live-guided),
all 3 produced statistically significant decreases in all 5 subscales of nonclinical psychological
stress as measured by the Smith Stress Symptoms Inventory—State scale (Autonomic
Arousal/Anxiety, Attention Deficit, Worry/Negative Emotion, Striated Muscle Tension, and
Interpersonal Conflict/Anger). No 1 method of delivery was significantly more effective in its
reduction of self-reported levels of psychological stress than any other. Preliminary correlations
showed that males with low grade point averages were more likely to disengage. Significant
decreases in the levels of Attention Deficit, Autonomic Arousal/Anxiety and Striated Muscle
Tension were reported by participants who also reported closing their eyes to some extent during
the audio or video conditions. Participants in the afternoon classes reported significantly higher
Interpersonal Conflict/Anger and Worry/Negative Emotion scores than participants in the
morning classes. Subjectively, many participants responded favorably to their exposure to the 3
iii

treatment conditions, and most participants reported an overall preference for the video condition
over the other 2. The results of this study has implications for the possible adjunctive therapeutic
role electronic media-assisted psychological treatments may play in the modern lives of
adolescents as well as to the relative convenience of providing media-assisted programs to
adolescents by teachers in a high school setting.
iv

Dedication
I dedicate this work to children feeling lost in the darkness.
Your light resides within; your spirit is larger than belief itself.
v

Acknowledgements
I would like to express my deepest gratitude to everyone whose support, encouragement,
and guidance helped make this work a reality. My thanks go to my committee chairperson, Dr.
Patricia Campbell, whose steadfast support served as a lifeline to me during periods that felt like
insurmountable setbacks. Without her guidance and assistance, this dissertation would not have
been possible.
I would like to thank my committee members, Dr. Janice Holden and Dr. Anees Sheikh,
whose patience, rigor, and positivity served and continues to serve as an inspiration to me in my
academic endeavors. Great thanks go to them for demonstrating by example the essence of
scientific scholarship.
In addition, a thank you goes to everyone whose advice and guidance helped to clarify for
me the many questions and concerns that arose over the course of this project. They tolerated my
pedantic nature with patience and positivity. In this group, I include the faculty and staff at the
Institute for Transpersonal Psychology, my statistics assistant, Dr. Jean Oggins, and all those I
count among my friends and esteemed colleagues in the field.
I wish to thank all of the teachers and students involved with the Focus on Success
program at Henry M. Gunn high school, especially Tarn Wilson, whose willingness to grant me
access to the students could not have come at a better time. Of course, special thanks go to all of
the students who participated in this study. May you continue to find benefit from your practice
of relaxation.
Last but not least, I wish to thank my family whose love, humor, and temerity is proof of
nothing short of a miracle. Thank you for believing in me. We have more than any other family I
have ever known.
vi

Table of Contents
Abstract.......................................................................................................................................... iii
Dedication........................................................................................................................................v
Acknowledgements........................................................................................................................ vi
List of Tables ...................................................................................................................................x
Chapter 1: Introduction....................................................................................................................1
Adolescents, Media, and Stress ...........................................................................................1
Psychotherapy and Visual Media.........................................................................................2
Visual Media Research ........................................................................................... 3
Visual Media Therapy............................................................................................. 4
The Present Study ................................................................................................................5
Chapter 2: Literature Review...........................................................................................................9
Psychological Stress.............................................................................................................9
Stress in Adolescence ........................................................................................... 11
Stress in Adolescent Development ....................................................................... 12
Stress Management............................................................................................................15
Relaxation Response............................................................................................. 16
Guided Relaxation .............................................................................................................18
Audio-Guided Relaxation..................................................................................... 19
Video-Guided Relaxation ..................................................................................... 21
Audio- and video-Guided Relaxation................................................................... 24
Chapter 3: Method .........................................................................................................................26
Research Design.................................................................................................................26
Participants.........................................................................................................................28
vii

Instruments.........................................................................................................................31
Demographic Questionnaire ................................................................................. 34
Reactions to an Experiential Exercise Scale (REES) ........................................... 35
Smith Stress Symptoms Inventory-State (SSSI-S) ............................................... 37
Procedure ...........................................................................................................................42
Treatment Conditions............................................................................................ 46
Chapter 4: Results..........................................................................................................................49
Treatment of Data ..............................................................................................................49
Data Analysis........................................................................................................ 50
Analysis of Subjective Reports............................................................................. 52
Results of the Analyses......................................................................................................53
Additional Findings .............................................................................................. 65
Qualitative Findings.............................................................................................. 65
Chapter 5: Discussion ....................................................................................................................69
Summary and Interpretation of Findings...........................................................................69
Limitations and Delimitations............................................................................................79
Directions for Future Research..........................................................................................91
References......................................................................................................................................95
Appendix A: Informed Consent...................................................................................................107
Appendix B: Demographic Questionnaire...................................................................................109
Appendix C: Smith Stress Symptoms Inventory-State (SSSI-S).................................................110
Appendix D: Reactions to an Experiential Exercise Scale (REES).............................................111
Appendix E: Guided Relaxation Transcript.................................................................................112
Appendix F: Instructions for the Interventions............................................................................114
Appendix G: Permission to Screen Digital Video Disc...............................................................115
viii

Appendix H: Pretreatment Talk Transcript..................................................................................116
Appendix I: Reader / Transcriber Confidentiality Agreement ....................................................117
Appendix J: Relaxation Techniques Handout..............................................................................118
ix

List of Tables
Tables
1 Demographic Variables .............................................................................32
2 Guided Relaxation Treatment Schedule for All Seven Classes.................45
3 Reported Media Preferences and Prior Experience With Relaxation
Techniques.................................................................................................55
4 Descriptive Statistics for Baseline Subscales of the Smith Stress
Symptoms Inventory-State.........................................................................56
5 Descriptive Statistics for the Conflict/Anger and Worry/Negative
Emotion Subscales of the Smith Stress Symptoms Inventory-State for
All Treatment Conditions and Baseline Scores With Time of Day as a
Covariate....................................................................................................58
6 Descriptive Statistics for the Muscle Tension, Attention Deficit, and
Autonomic Arousal of the Smith Stress Symptoms Inventory-State
for All Treatment Conditions and Baseline Scores With Eye
Closure as a Covariate ...............................................................................60
7 Summary of Significant Stress Reductions for All Three Treatment
Methods......................................................................................................64
8 Summary of Common Themes and Method Preferences From
Subjective Reports .....................................................................................67
x

1
Chapter 1: Introduction
Adolescents, Media, and Stress
Adolescents growing up in the 21st century live in a world saturated with all forms of
visual media, including television, videos, and videogames. Their pervasive exposure to such
media has steadily increased over the last decade (Comstock & Scharrer, 2006). Studies have
shown that adolescents tend to spend more time watching some form of visual media than they
do engaging in any other waking activity, including being in school (Roberts, Henriksen, &
Foehr, 2004). Such immersion in visual media makes modern adolescents unlike any preceding
generation of adolescents, leading one researcher to name this particular segment of the
population the “new media generation” which she described as
the first cohort to have grown up learning their ABCs on a keyboard in front of a
computer screen, playing games in virtual environments rather than their backyards or
neighborhood streets, making friends with people they have never and may never meet
through Internet chat rooms, and creating custom CDs for themselves and their friends.
(Brown, 2005, p. 279)
Some researchers have correlated adolescent exposure to visual media with the prevalence of
stress in this demographic, leading some researchers to suggest that adolescents may be using
media partly as a means of coping or at least as a means of temporarily escaping the
uncomfortable feelings associated with stress (Bickham et al., 2003; Lohaus et al., 2005).
In direct contrast with this postulation, some researchers suggested that visual media may
in fact be evoking the stress response. Laboratory studies exploring the attentional and
physiological effects of visual media have revealed that the simple formal features of visual
media, such as cuts, edits, zooms, pans, or sudden noises routinely activate the orienting reflex,
an instinctual and spontaneous reaction to any sudden or novel stimulus (Kubey &
Csikszentmihályi, 1990; La Ferle, Edwards, & Lee, 2000; Lang, Zhou, Schwartz, Bolls, &

2
Potter, 2000; Reeves & Thorson, 1986). As Halgren (1992, p. 205) originally discovered, this
orienting reflex is an autonomic reaction originating in the limbic region of the brain that gives
rise to the fight or flight—that is, stress—response.
These contrasting positions raise important questions as to the role of visual media in the
process of mediating a psychological condition such as stress. Whereas adolescents may be using
visual media partly as a means of coping with stress (Lohaus et al., 2005), the impact of this
media may be implicitly evoking the stress response (La Ferle et al., 2000). This contradiction
may be resolved by a theory put forth by a small number of media researchers that postulates that
the effect of visual media may be a dialectical one in that the viewer’s own unique experiences,
motivations, and expectations interact with the media to a greater degree than has been
previously assumed (Brown, 2006; Brown & Walsh-Childers, 2002; Levy & Windahl, 1985;
Rubin, 2002; Steele & Brown, 1995; Ward, Gorvine, & Cytron-Walker, 2002).
Theorists who adhere to this Media Practice Model hold that the influence of a particular
medium is a function of the user’s sense of identity, the user’s reason for selecting the media, the
context or situation in which one uses the medium, and the user’s interpretation of that medium
(Steele & Brown, 1995). This model supports the notion that a medium used for a therapeutic
purpose may influence measures associated with that purpose. Although the purpose of the
present study is not to examine this theory directly, the theory does describe how viewers’
expectations influence the medium’s effects inasmuch as these effects correspond with the
medium’s therapeutic purpose.
Psychotherapy and Visual Media
The association between psychotherapy and visual media began when they both emerged
at the same moment in history. In 1895, when Sigmund Freud, the pioneer of what has become

3
modern psychotherapy, published his seminal work, Studies in Hysteria (Freud, 1895/2004), he
initiated the commencement of the scientific analysis of purely mental conditions. Mere months
later, Auguste and Louis Lumière (as cited in Tarnas, 1995, p. 88) unveiled their cinematograph
invention, marking an event that most film historians consider to be the birth of cinema as a
commercially viable medium (Salazard, Casanova, Zuleta, Desouches, & Magalon, 2003). Since
that time, both psychotherapy and visual media have made great strides towards the realization
of what may be considered a shared impulse: to project the image of mind in a linguistically or
visually tangible form so as to illuminate and influence its inner workings. Although these
disciplines have dramatically different intentions, insofar as psychotherapy is to treat mental
illness and electronic media are to inform and entertain, they do seem to share this unique
purview on the mind.
Since their beginnings, both psychotherapy and visual media have made great strides in
their respective domains. On the one hand, visual media have integrated story, performance,
stylistic techniques, and compelling images to influence audiences’ moods and emotions,
evoking sadness, anger, curiosity, joy, and even fear. On the other hand, psychotherapy employs
scientific research and clinical practices that yield a vast range of instruments and methodologies
that influence the critical functioning of the human mind. Yet, it has been within only the past 2
decades that researchers and clinicians have begun to examine and explore the role that visual
media may play in the influence and treatment of the mind.
Visual media research. Although a study on the mental effects of a photo-play, which
was described as a series of projected images on a screen, can be found in the psychology
literature as early as 1916 (Münsterberg, 1916), serious and scientific inquiry into the effects of
visual media did not emerge until “the advent and market penetration of television in the 1950s

4
[was] coupled with concerns about unconscious influences of advertising, in all its forms and
venues” (Fischoff, 2005). As a result of the concern over potentially “subliminal effects” in
media, specifically in advertisements, Media Psychology emerged as a subdiscipline in
psychology, evidenced by the inauguration of the Journal of Media Psychology in 1996 and the
inception of Division 46 for media psychology in the American Psychological Association.
Similarly, the emergence of communication science and media research resulted in psychologists
publishing in nonpsychology journals such as the Journal of Communication, founded in 1951,
and the Journal of Broadcasting and Electronic Media, founded in 1956. Together, these journals
have offered a wide range of content pertaining to the changing faces and interactions between
media and psychology.
In these and other peer-reviewed journals, concern has been raised regarding the
influence of visual media on children and adolescents, particularly for three reasons: (a) Youth
spend more time with media than they do in school or with their parents, (b) The media
frequently depicts glamorous portrayals of risky adult behavior, and (c) Parents and other
socialization agents have been unable to direct youth towards less risky behaviors (Steele &
Brown, 1995). In one early example of such research, the investigation of the influence of media
on children issued a severe indictment of all motion pictures as being an inspiration for all bad
behavior among children (Thurstone, 1931).
Visual media therapy. In contrast to these concerns, some clinicians have begun to
employ various therapeutic uses of media in their practices, including (a) Cinematherapy,
combining bibliotherapy with film-viewing as a means of inducing a therapeutic effect or
catalyzing a therapeutic discussion (Berg-Cross, Jennings, & Baruch, 1990); (b) Instructional
Media, transmitting information regarding a treatment, procedure, or therapeutic process to

5
inform clients of their roles and any preparations or decisions they must make during the course
of treatment (Wilkins et al., 2006); (c) Media Recall, recording and later reviewing recordings of
clinical sessions (Trierweiler, Nagata, & Banks, 2000); (d) Creative Media, using the tools of
media production, such as audiorecording and videorecording equipment, as a form of art
therapy enabling clients to reflect on their experiences, express themselves, and increase their
self-awareness (Orr, 2006); (e) Biofeedback, using auditory or visual feedback to depict
physiological processes in real-time (e.g., heart rate or brainwave activity) and to facilitate a
greater awareness of them (Masterpasqua, 2005); (f) Virtual Reality, recreating an artificial
environment in which a client can experience known fears in relative safety (Riva, 2003); (g)
Media Assistance, a term herein coined by the author, defined as the use of sounds and images
from audio or video content, such as music, nature imagery, and verbal inductions, for the
purpose of guiding individuals through an internal psychological process. This method draws
upon research dating from 1970 to the present that has investigated the use of media programs as
a means of eliciting psychological processes, most notably for relaxation (Boersma & Gagnon,
1992; Byrnes, 1996; DeSchriver & Riddick, 1990; Putman, 2000; Robar, 1978; Smyth, Soefer,
Hurewitz, & Stone, 1999; Tsai, 2004; Ulett, Akpinar, & Itil, 1972; Wells, 2005; Wood, 1986).
The term Media Assistance is intended to unify these disparate studies into a single therapeutic
method and to initiate inquiry into the use of media as a guide for psychological processes.
The Present Study
Of the seven clinical methods of employing some form of visual media in the service of
psychotherapeutic treatment, Media Assistance serves as the intervention to be investigated in
the present study. The purpose of selecting Media Assistance is threefold.

6
First, many adolescents already use visual media as a way of managing or at least
temporarily escaping the stress they experience in their day-to-day lives (Bickham et al., 2003;
Lohaus et al., 2005).
Second, despite the many therapeutic claims made by the producers of commercially
available audio and video tapes, CDs, and DVDs that principally utilize Media Assistance as a
means of delivering relaxation, such as Direct Source Special Products (2006), surprisingly no
studies in the literature were found to support the efficacy of these claims. This finding alone
may serve to justify the rationale behind the present study, in which I aim to explore the validity
of these claims as to the efficacy of nature videos in the management of stress.
Third, numerous studies demonstrate the clinical efficacy of elements that may be
considered a form of Media Assistance, including listening to audiotapes of guided relaxation or
watching nature imagery on video, as a way of managing stress (Boersma & Gagnon, 1992;
Byrnes, 1996; DeSchriver & Riddick, 1990; Putman, 2000; Smyth et al., 1999; Tsai, 2004; Ulett
et al., 1972; Wells, 2005; Wood, 1986). These elements of Media Assistance have been shown to
trigger the relaxation response (RR; Jacobs, Benson, & Friedman, 1996), effectively reducing
symptoms of psychological stress (Tsai, 2004; Wells, 2005). Surprisingly, only one study within
the past 20 years was found to have been published comparing audio and video methods of
facilitating relaxation (Byrnes, 1996).
The present study was aimed in part to replicate and update these findings specifically
with regard to how in-person guided relaxation (Cropley, Ussher, & Charitou, 2007), audiotaped
relaxation (Smyth et al., 1999), video guided relaxation (DeSchriver & Riddick, 1990; Wells,
2005), or both audio and video guided relaxation (Byrnes, 1996) have each been shown to
facilitate the management of some indicators of psychological stress. Because the use of audio or

7
video tape is significantly cheaper and more readily available to the average person than is
working with a professional clinician, research on the use of media as a therapeutic adjunct, or
Media Assistance, may help to serve individuals in an efficacious manner.
To explore the clinical viability of Media Assistance, I employed a prepost experimental
research design to investigate the potential differences between three different methods of
delivering a guided relaxation to a population of adolescents. The purpose of this study was to
investigate the differences in effectiveness between a Video-Guided Relaxation Program, VGRP;
an Audio-Guided Relaxation Program, AGRP; and a Live, in vivo, Guided Relaxation Program,
LGRP, on the self-reported levels of stress among a sample of high school students. All three
treatment conditions lasted 10 minutes in duration and employed the same guided relaxation
transcript (Appendix E) that I prerecorded or read live.
Upon meeting the criteria for participation in the study, participants completed a
preassessment research packet made up of a demographic questionnaire (Appendix B) and a
brief assessment of frequently reported symptoms of stress (SSSI-S; Appendix C; Piiparinen &
Smith, 2003, 2004), which established a baseline stress state upon which to compare the effects
of the treatments. Next, I utilized the seven separate classes to serve as separate treatment groups
to receive the first of the three treatment conditions. Each group received the remaining two
treatment conditions over the course of the next 3 days. All participants received all three
treatment conditions by the end of the 4 days. After each exposure to treatment, participants
again completed the stress symptoms scale as well as a scale designed specifically for the present
study to measure the participants’ reactions to the experiential exercise (REES; see Appendix D).
This study was designed mainly to answer one specific research question: “Is there a
relationship between the means of delivering guided relaxation to adolescents and the amount of

8
stress that they report?” If a relationship was found, then a follow-up question explored in this
study was “What is the magnitude of the relationship between the method of delivering guided
relaxation to the amount of stress adolescents report?” Secondary research questions examined
the extent to which reactions to the treatments influenced their effects and what demographic
variables, if any, correlated with the influence of the treatment conditions on the reported levels
of stress.

9
Chapter 2: Literature Review
Psychological Stress
Psychological stress is defined as “a particular relationship between the person and the
environment that is appraised by the person as relevant to the individual’s well-being and in
which the person’s resources are taxed or exceeded” in a foundational study (Lazarus &
Folkman, 1984, p. 152). The term stress, first used in the psychological sense by Harvard
physiologist Walter B. Cannon, identifies the physiological fight or flight (i.e., stress) response
as evidenced by the biochemical changes that take place within the body during times of
difficulty by generating the quick bursts of energy needed to fight or flee the threat of danger
(1914).
The term stress was brought into prominent use in psychology by Hans Selye who found
that any threat of danger, be it real or imagined, can elicit a cascading physiological effect
throughout the individual’s entire body (Selye, 1950). His early research revealed a universal
reaction to stress, broken into three stages, termed the General Adaptation Syndrome (GAS;
Selye, 1956). Recent studies have supported and elaborated upon this paradigm (Lazarus, 2007;
Uchino, Smith, Holt-Lunstad, Campo, & Reblin, 2007). The GAS defines the first stage, termed
Alarm, as the body’s stress (i.e., fight or flight) response to the perceived presence of danger,
triggers the production of adrenaline and cortisol along the hypothalamic-pituitary-adrenal axis
of the autonomic nervous system (Tsigos & Chrousos, 2002). If the stressor persists, stage two,
termed Resistance, occurs when the body attempts to regain homeostasis in spite of the stressor.
Because the body cannot resist the stressor indefinitely, stage three, termed Exhaustion, occurs as
the body’s resources are gradually depleted and autonomic nervous system symptoms appear,
such as increased sweating, heart rate, respiration, muscle tension, metabolism, and blood

10
pressure (Segerstrom & Miller, 2004; Selye, 1950). Additional physiological symptoms
associated with stress include a contracted anus, dilated pupils, sharpened vision and hearing, a
feeling of butterflies in the stomach, or cold hands and feet resulting from the redirection of
blood flowing away from the digestive system and extremities and into the larger muscles of
body facilitating motility (Selye, 1950; Taché & Selye, 1985).
Whereas the biochemical changes associated with stress at one time provided ancestral
humans with the quick bursts of energy that they needed to fight or flee a threat of danger
(Cannon, 1914), modern humans must learn how to manage stress in a manner that is more
appropriate to societal customs. Failure to appropriately manage the symptoms of psychological
stress and its consequent biochemical and physiological changes has been shown to lead to a
wide array of social and health problems. Some short-term effects of unmanaged stress include
the exhibition of aggression (Hampel & Petermann, 2005), anxiety, depression (Segrin, 1999),
suicidal ideation, and hopelessness (Dixon, Rumford, Heppner, & Lips, 1992). Some long-term
effects include substance abuse (Macleod et al., 2004; Sadava & Pak, 1993) and various
behavioral problems (Compas, Connor-Smith, Saltzman, Thomsen, & Wadsworth., 2001;
Compas, Orosan, & Grant, 1993; McNamara, 2000).
Although the direct association between unmanaged stress and physical illness has
remained somewhat modest in strength (Barr, Boyce, & Zeltzer, 1996), the excessive presence of
stress hormones has been shown to be coincident with various maladies of the vital systems of
the body. The autonomic nervous system may be affected causing headaches (Wittrock &
Forkaer, 2001), sleep disturbances (Farnill & Robertson, 1990), irritable bowel syndrome
(Blanchard & Turner, 2000), and high blood pressure (Schwartz, Pickering, & Landsbergis,
1996). The endocrine and immune systems can be affected causing chronic fatigue (Chalder,

11
Cleare, & Wessely, 2000), rheumatoid arthritis (Zautra & Smith, 2001), lupus (Peralta-Ramírez,
Jiménez-Alonso, Godoy-García, & Perez-García, & the Group Lupus Virgen de las Nieves,
2004), and asthma (Rietveld, Beest, & Everaerd, 1999), as well as a susceptibility to infection (S.
Cohen, 2002), illness (J. Cohen, Tyrrell, & Smith, 1991), and the common cold (Stone,
Bovbjerg, Neale, & Napoli, 1992).
Stress in adolescence. Although stress is a condition that one must learn to manage
throughout one’s lifespan, it may not emerge as a critical condition until one reaches adolescence
(Wagner, Abela, & Brozina, 2006). This is partly due to the physical and hormonal changes that
occur in a maturing body between ages of 10 and 20, but it may also pertain to the many
cognitive, social, and emotional changes that emerge during this period as well. In this unique
phase of life, as the individual is transformed from a child into an adult, a great many
possibilities for learning and maturation emerge, but it can also be a period in which personal
resources and social limits are routinely tested and frequently exceeded.
Consequently, psychological stress is considered to be a natural part of adolescent
development by many researchers (Hutchinson, Baldwin, & Oh, 2006; Kraag, Zeegers, Kok,
Hosman, & Abu-Saad, 2006; Washburn-Ormachea, Hillman, & Sawilowsky, 2004). Whereas
studies demonstrate that adolescents are most particularly affected by those stressors that arise
out of ongoing and daily routines over which they perceive they have little or no control, such as
school assignments, quarrels within peer relationships, family responsibilities, and other stressors
(Frydenberg & Lewis, 2004; Hurrelmann & Raithel, 2005; Hutchinson et al., 2006), such
challenges may be exacerbated by the incidence of traumatic life events, such as accidents,
illnesses, parental divorce, child abuse, or the loss of a loved one (Nastasi et al., 2007).
Teenagers whose present living environment is chaotic, whose upbringing taxes their resources,

12
or who presently suffer from a serious emotional or behavioral problem, are more likely to have
difficulty coping with stress during adolescence and later in life (J. Compas, 1987; Hampel &
Petermann, 2006; Windle, 1992).
It is important to note that stress has emerged as a significant issue within the adolescent
population in recent years. The literature reveals that the rate of adolescent suicides (Gibbons,
Hur, Bhaumik, & Mann, 2006) as well as adolescents’ need for antipsychotic and antidepressant
medications (dosReis et al., 2005) have both increased markedly in the last decade. Although it
would be erroneous to posit a correlation between these findings and the increased rate of
adolescent use of visual media as noted in Chapter 1 (Comstock & Scharrer, 2006), such findings
suggest the need for a close investigation into how stress is impacting this particular segment of
the population.
Stress in adolescent development. As adolescents develop and explore new roles and
behaviors, they must learn new ways of managing the stress they face lest they fall prone to
dangerous or risky behaviors as an escape from the discomfort engendered by stressful
encounters (i.e., use of drugs or promiscuous sex; Compas et al., 2001; Macleod et al., 2004).
Stress in adolescence may be considered closely tied with adolescent development. Two
developmental changes are undergone in adolescence according to prominent psychological
theory: (a) the cognitive developmental stage of formal operations is achieved (Piaget, 1972),
and (b) the psychosocial developmental stage of self-identity is forged (Erikson, 1950, 1968).
Both of these theories of adolescent development are discussed below regarding their relevance
to the present study, followed by some discussion of identity development particularly and how
media may influence it.

13
According to cognitive developmental theorist, Jean Piaget, adolescence is the phase of
life when abstract reasoning, or what he called formal operational thinking, begins to appear
(Piaget, 1972). The stage of formal operations enables individuals to extend their thoughts
beyond the here-and-now and to begin to make predictions and create plausible ideals based on
hypotheses using logic and reason. While this stage enables individuals to engage thoughtfully
and meaningfully in the larger social issues of society (e.g., pollution or racism), this capacity
also makes the individual susceptible to the anxiety, worries, and stressors that such awareness
may bring and the existential threats they potentially impose (Piaget, 1972). Thus, the ability to
recognize and manage the uncomfortable feelings and emotions that such cognitions may bring
helps to lay the cognitive foundation that the adolescent will need to establish the appropriate
thinking and stress management habits the individual will need to draw upon later as an adult.
With regard to the present study, formal operations may predispose teens to the stress that
accompanies exposure to certain forms of media, but it may also help teens to learn how to
recognize and manage stress before it becomes detrimental (Harrison, 2006).
According to psychosocial developmental theorist, Erik Erikson, adolescence can be
conceptualized as the period of life in which the emerging self, or ego, must establish an identity
as separate from but interconnected with the wider social context or consequently suffer from
role confusion (Erikson, 1950, 1968). In Erikson’s view, psychosocial development may be seen
from the point of view of the conflicts, inner and outer, which the vital personality
weathers, re-emerging from each crisis with an increased sense of inner unity, with an
increase in the capacity “to do well” according to his [sic] own standards and the
standards of those who are significant to him. (Erikson, 1968, pp. 91-92)
Thus, the adolescent self is psychologically characterized as a tester of social limits, an explorer
of roles and behaviors, and a pursuant of existential quandaries such as “Who am I?” and “Why
am I here?” Adolescence can be viewed as a period of moratorium, as a temporary postponement

14
of societal commitments, such that a differentiated self-identity can be established (Erikson,
1968).
In the past 20 years, researchers have expanded on Erikson’s fifth (i.e., adolescent) stage
of development. Among them, James Marcia has examined the role of identity formation from
the two aspects of crisis and commitment (Marcia, 1966, 1980). According to Marcia’s
perspective, adolescent identity can be conceptualized as being one of four identity statuses that
he describes according to the presence or absence of crisis (i.e., defined as making one’s own
decisions) and commitment (i.e., defined as investing personally in an ideology). These four
identity statuses are (a) identity diffusion (i.e., the absence of both crisis and commitment), (b)
identity foreclosure (i.e., the presence of commitment in the absence of crisis), (c) moratorium
(i.e., the presence of crisis in the absence of commitment), and (d) identity achieved (i.e., the
presence of both crisis and commitment; Marcia, 1980). According to this theory, these identity
statuses can be ordered into two subcategories such that identity diffused and identity foreclosed
can be considered to be lower and less sophisticated, whereas moratorium and identity achieved
can be considered to be higher and more sophisticated (Marcia, 1980).
This theory supports the assertion that stress can be considered an integral part of
adolescent development insofar as adolescents must forge a new identity by differentiating
themselves from the beliefs, values, and goals that are passed on to them by their parents and
society and committing to an identity based upon their own existential exploration. This
exploration can become a stressful period of confusion and doubt, but the avoidance of this vital
piece of development may result in psychological stagnation and a proneness to pathology
(Marcia, 1980). The establishment of a stable adult identity, then, may be considered a

15
consequence of the adolescent’s capacity to recognize and manage the stress generated in the
course of existential exploration (Johnson, Buboltz, & Seeman, 2003; Makros & McCabe, 2001).
It is worth noting that adolescent exploration may occasionally be sought through the use
of visual media (Bickham et al., 2003; Lohaus et al., 2005). However, studies have suggested
that the content of the media to which many adolescents gravitate tends to portray messages and
behaviors that promote unattainable standards and expectations (Csikszentmihályi & Schneider,
2000; Signorielli & Kahlenberg, 2001). Such portrayals may contribute to the stress they feel,
rather than offering some relief from it. Some research of commercial television suggests that
market researchers aim to influence and monetize the moods and behaviors of the adolescent
demographic specifically (Comstock & Scharrer, 2006; Desmond & Carveth, 2007; Nelson &
McLeod, 2005). This type of directive influence may not be conducive to their general health
and well-being, but may instead encourage maladaptive behaviors such as aggressiveness
(Anderson et al., 2003; Darwish, 2002), disordered eating (e.g., Alperin, 2005; Tiggemann,
2005), sexual promiscuity (L’Engle, Brown, & Kenneavy, 2006; Tolman, Kim, Schooler, &
Sarsoli, 2007), substance abuse (e.g., Primack, Gold, Land & Fine, 2006; Stacy, Zogg, Unger, &
Dent, 2004), and other risky behaviors (e.g., Buwalda, 2004). It is for this reason that alternative
forms of media content, such as those associated with Media Assistance, are explored in the
present study, and serve as the basis for investigation.
Stress Management
Traditionally, at least four different kinds of approaches have been clinically employed as
a form of stress management: (a) guided relaxation training, (b) social problem solving, (c) social
adjustment and emotional self-control, and (d) a combination of each of these approaches (Kraag
et al., 2006). Given the one-way (i.e., prerecorded) communication that is implicit in the Media

16
Assistance method of treatment, guided relaxation served as the best approach to stress
management for exploration in the present study. Before discussing guided relaxation as an
approach to stress management, the way in which relaxation itself influences the mind and body
and impacts stress warrants further discussion.
Relaxation response. As noted above, cardiologist Herbert Benson (1977) demonstrated
that an individual can use one’s mind to change physiology for the better, thus improving one’s
health and emotional outlook on life. In a seminal paper published by Benson and his colleagues
(Benson, Beary, & Carol, 1974), the relaxation response (RR) was demonstrated to initiate an
integrated set of physiological changes that directly counteract the fight or flight (i.e., stress)
response thereby triggering the body’s natural restorative process. According to Benson, a person
can shut off or tune out the physiological danger signals associated with stress by initiating the
RR (e.g., by taking deep diaphragmatic breaths, actively relaxing their muscles, slowly repeating
calming words or phrases, or passively ignoring distracting thoughts or feelings). After 3
minutes, the stress response burns out as the cerebral cortex stops sending emergency signals to
the hypothalamus, which in turn ceases to send panic messages to the nervous system such that
heart and breathing rate, muscle tension, metabolism, and blood pressure all return to their
normal levels (Benson, Beary & Carol, 1974). Whereas the stress response is characterized by
sympathetic activation stimulating the body to react to potential threats, the RR is characterized
by parasympathetic activation that enables the body to maintain a generalized state of
homeostasis (Jacobs et al., 1996).
Additional studies from the 1970s showed that triggering the RR decreases oxygen
consumption, and lowers heart rate, arterial blood pressure, and the rate of respiration (Wallace
& Benson, 1972). In the 1980s, the regular and extensive elicitation of the RR for 4-6 weeks of

17
daily practice was associated with more enduring physiological changes such as a generally
reduced responsiveness to the stress hormone, norepinephrine, an increased resiliency to stress,
and the reduced need for medication (Benson, Arns, & Hoffman, 1981; Lehmann, Goodale, &
Benson, 1986).
In more recent studies, the regular triggering of the relaxation response has been shown
to help individuals manage many of the symptoms associated with anxiety, addiction, and stress,
and generally improve their mental and physical functioning (Deckro et al., 2002; Scheufele,
2000). Among middle school populations, students whose classes were taught by teachers trained
in the relaxation response curriculum exhibited higher academic performance, as measured by
GPA (p = .0001), better work habits (p = .0001), and a greater degree of cooperativeness (p =
.0001) than those students whose teachers were not trained in the RR curriculum (Benson,
Wilcher et al., 2000). Another recent study showed that daily practice of the RR has been linked
with significant improvements in symptoms associated with irritable bowel syndrome (Keefer &
Blanchard, 2001).
Popular techniques for triggering the relaxation response (RR) include massage,
progressive muscle relaxation (PMR), yoga stretching, diaphragmatic breathing, imagery,
meditation, or some combination of these (Smith, Amutio, Anderson, & Aria, 1996). Benson
(1977) proposed four underlying elements that should be present during the relaxation,
regardless of the technique being used, in order to effectively elicit the RR: (a) the presence of an
object on which to focus, such as a candle, a mantra, one’s breath, a television; (b) a quiet
environment; (c) a comfortable position; and (d) a positive attitude. These elements, coupled
with three cognitive skills proposed by Smith (1990), will ensure the influence of the technique
on cognitive and somatic arousal. These cognitive skills are (a) focusing, described as the ability

18
to identify, differentiate, maintain attention on, and return attention to simple stimuli for an
extended period; (b) passivity, described as the ability to stop unnecessary goal-directed and
analytic activity; and (c) receptivity, described as the ability to tolerate and accept experiences
that may be uncertain, unfamiliar, or paradoxical. These underlying elements and cognitive skills
are implicitly beneficial, but aid the efficacy of the particular relaxation technique when
practiced over time (Smith, 1990, p. 65).
Guided Relaxation
While the skills associated with triggering the relaxation response (RR) are accessible to
almost everyone, guided and deliberate practice relaxing is usually needed for the individual to
learn to recognize and manage the indicators of psychological stress (Jacobson, 1925, 1934,
1970). Even a single exposure to the guided practice of relaxation has been demonstrated in early
studies to have ameliorative effects on mental and physical conditions (Benson, Beary et al.,
1974; Benson, 1977; Benson, Arns, & Hoffman, 1981; Benson, 1983).
In a systematic review of the literature exploring various relaxation techniques in the
treatment of pain from 1996 to 2005 (Kwekkeboom & Gretarsdottir, 2006), the randomized trials
of relaxation interventions were analyzed in an effort to draw conclusions as to the efficacy of
various relaxation interventions (e.g., progressive muscle relaxation, jaw relaxation, rhythmic
breathing, and other relaxation exercises). The authors concluded that most of the 15 studies that
were reviewed demonstrated weaknesses in methodology, limiting the ability to draw
conclusions as to the efficacy of the interventions. Among these weaknesses, the authors noted
that many of the studies failed to address individual differences among participants as to their
responsiveness to particular relaxation techniques. The present investigation addresses one such

19
weakness by examining how the method by which guided relaxation is delivered influences its
potential efficacy with stress.
Audio-guided relaxation. The research cited above demonstrates the relative efficacy of
live or in-person guided relaxation programs. Yet, it is not always feasible, practically or
financially, for individuals to employ the services of trained professionals in order to make use of
a relaxation program, particularly if one intends to gain the more enduring and lasting benefits
that come from a daily practice routine. As such, audio tapes may be used to guide individuals
into the RR in lieu of in-person instruction. When practicing with a tape rather than with a live
trainer, some disadvantages arise, such as the inability to tailor the program to the individual’s
own unique style or challenges. The benefit of having ready access to a tape that can be used at
any time may outweigh some of these potential drawbacks.
Most of the early research into the use of audio tapes for guided relaxation met with an
underwhelming response in the literature. In a systematic meta-analysis of the early research
exploring audiotaped relaxation, Paul and Trimble (1970) stated, “None of the available
literature provides evidence that recorded relaxation instructions . . . produce effects comparable
with those obtained by ‘live’ treatment procedures,” (pp. 299-300). When these early studies of
audiotaped relaxation programs were shown to be at all beneficial, it tended to be when the audio
programs were used in combination with live training (Zeisset, 1968). As such, Paul and Trimble
(1970) concluded that the lack of efficiency of audiotaped procedures was due to the “lack of
response contingent feedback in the recorded mode,” (p. 300). In other words, the responsiveness
of a live trainer to the individual differences of individual participants was lost in the
employment of recorded training.

20
Given the datedness of Paul and Trimble’s (1970) meta-analysis of the literature, it is the
position of the researcher that responsiveness to audiotaped instructions has possibly increased
since that time, as demonstrated by Smyth et al. (1999). In this research, the effects of the use of
an audiotaped guided relaxation on the symptoms associated with asthma (i.e., self-report and
expiratory flow), stress, and general well-being were examined with a group of middle-aged
asthmatics (n = 20). Their results showed that listening to the relaxation tape generated responses
in the direction of the hypothesis and achieved statistical significance in the measures of reported
asthma symptoms (p < 0.1) and expiratory flow (p < 0.05). [This p-value is reported in the
primary source article by Smyth et al. (1999). Because the social sciences report statistical
significance at p < 0.05 or lower, it is presumed that the authors’ reporting of significance with a
p < 0.1 does not broaden the definition of what constitutes a significant finding, but is more
likely the result of a misprint of “p < 0.01” in the original article. At the time of this writing, the
authors of the study did not respond to e-mailed requests for confirmation of this assumption.]
Listening to the relaxation tape did appear to decrease negative mood (p < 0.05) and stressor
reports (p < 0.01) in the treatment group, but the effects were unrelated to positive mood (p =
0.001). Although the researchers maintained some reservations regarding the small sample size
and the potential threats to internal validity posed by the Hawthorne, or placebo, effect or the
tendency for scores to regress towards the mean, these findings remain suggestive that guided
relaxation audio tapes can serve as a brief, low-risk, and relatively inexpensive form of
supplemental treatment for stress.
In another recent study published in 2007, Cropley et al. examined the effects of a 10-
minute guided relaxation tape on the desire to smoke and several symptoms associated with
tobacco withdrawal, such as tension, irritability, and restlessness, with a group of smokers of at

21
least 10 daily cigarettes for at least 3 years (n = 30). Participants were asked to rate the strength
of their desire to smoke and to rate the intensity of their withdrawal symptoms before a guided
relaxation, immediately following the relaxation tape, and at three 5-minute intervals following
the intervention. The research tentatively demonstrated that the desire to smoke decreased
immediately following the relaxation and for at least 5 minutes following the relaxation as
compared to the control group that did not receive guided relaxation (p = 0.05). Although the
authors recognized that the effects of the intervention were “modest and requires [sic]
replication” (p. 992), the effects that were measured were in the predicted direction of the present
hypothesis, namely that even a brief 10-minute guided relaxation audiotape can impact
participants’ scores on self-reported measures.
Video-guided relaxation. As mentioned in the previous chapter, psychological research
into the effects of visual media has been in the literature for as long as the medium has been in
existence. Since its inception, many studies have been published suggesting that visual media
(specifically, video) can influence behavior, either as the result of social modeling (Bandura,
Ross, & Ross, 1963) or as a result of how it influences the various neurological processes in the
brain (Kelly, Grinband, & Hirsch, 2007) or both.
The majority of studies that examine the effects of visual media, such as television,
movies, and videogames, on adolescents tend to focus primarily on how violent content tends to
lead to the exhibition of violent or aggressive behaviors (Anderson & Dill, 2000; Ferguson,
2007; Palys, 1986). While it is difficult to refute the direct effects of media on adolescents
revealed in these laboratory studies, the view that violent media invariably leads to violent
behaviors has been challenged by a small group of researchers who have posited a theory that the
effect of visual media is not necessarily as direct as is presumed by these studies. These

22
researchers posit the Media Practice Model that holds that the effect of visual media is more
dialectical and interactive with the viewer’s own unique experiences, motivations, and
expectations and may relate to the user’s sense of identity, the user’s reason for selecting the
media, the context or situation in which that media is viewed, and the viewer’s interpretation of
that media (Brown, 2006; Brown & Walsh-Childers, 2002; Levy & Windahl, 1985; Rubin, 2002;
Steele & Brown, 1995).
Given this theoretical basis, the effect that a particular piece of visual media has with an
adolescent may have more to do with the purpose or intention behind watching the video than is
usually presumed by the direct effects model. This interactive quality of the Media Practice
Model serves as a theoretical support for the therapeutic use of video herein proposed. Previous
exploration into the use of video with a therapeutic intention has demonstrated some promising
results. In one study in particular, a process of using video imagery called photic stimulation—
flashes of light from a video screen—was shown to induce relaxation in individuals who watched
it as the frequency of the flashes was progressively slowed over time (Landeck, 2004). Landeck
suggested that photic stimulation could be used as an alternative approach to inducing relaxation
in a clinical setting with reluctant or anxious clients.
Only a few studies were found in the literature to explore the potential therapeutic value
of video. Among them, the earliest known study was published nearly 20 years ago and
examined how videos of quiescent animals could be used to moderate the stress response in an
elderly population (DeSchriver & Riddick, 1990). DeSchriver and Riddick investigated whether
the stress-ameliorating effects of animal companionship (Allen, Blascovich, & Mendes, 2002;
Friedmann, Thomas, & Eddy, 2000) are comparable to watching videos of animals, which could
avert the potential allergies or phobias that could be triggered by the use of live animals in a

23
clinical setting. To this end, the researchers evaluated the muscle tension and cardiovascular
responses using pulse rate and skin temperature in a relatively small sample (n = 27) of elders
(with a mean age of 75 years) who were randomly assigned to two experimental conditions (e.g.,
viewing an aquarium or a video tape of an aquarium with the sound of water trickling over
rocks) and a control condition (a placebo video tape of television color bars and static). Members
of all three groups perceived their treatments as relaxing, and results appeared to move in the
expected direction, but the results did not achieve statistical significance overall. However,
qualitative evaluations elicited the overall sentiment from the participants that gazing at the fish
was an enjoyable and beneficial activity. Almost universally, participants stated that the videos
allowed them to feel “totally relaxed” and helped them to temporarily “forget about [their]
problems while watching” the videos (DeSchriver & Riddick, 1990, p. 47). Subjective reports
such as these, which are suggestive of results in the direction of the present study’s hypothesis,
raise the possibility that the lack of empirical support offered by this study is not a matter of the
videos being ineffectual, but rather the failure of the instrumentation utilized to measure the
effect.
In another more recent and compelling study of the therapeutic use of video, Wells
(2005) extended the findings of DeSchriver’s and Riddick’s work (1990) beyond videos of fish
to also include videos of other animals as well. In this study, Wells evaluated the heart rate and
blood pressure of a larger sample (n = 100) of younger university students (with a mean age of
19.71), who were randomly assigned to three experimental conditions (i.e., videos of fish, birds,
or primates) and two controls (videos of humans or a blank screen). She found that the videos
universally encouraged relaxation, with participants in all three experimental conditions
exhibiting significantly (p < 0.001) lower levels of heart rate and blood pressure than those

24
individuals exposed to the control videos. She concluded that “videotapes of certain animals can
reduce cardiovascular responses to psychological stress and may help to buffer viewers from
anxiety, at least in the short term” (in abstract). Overall, the results from Wells’ (2005) study
suggest that the presence of animals in video form can have a stress-ameliorating effect on
cardiovascular dynamics similar to that of live animals. However, this study investigated the
effects of the video only in the short-term, and thus, long-term implications cannot be drawn. It
is possible that participants may become habituated by repeated viewings of the video such that
its stress-reducing impact may be weakened.
It may be noted that Wells’ (2005) study is the first study of its kind to present
videotapes of animals without any type of auditory stimulation (p. 213). While certain types of
auditory cues (e.g., classical or new age music) have been demonstrated to reduce stress (Chafin,
Roy, Gerin, & Christenfeld, 2004; Krout, 2007; Pelletier, 2004; Smith & Joyce, 2004), the
results from Wells’ study show that visual stimulation by itself can buffer people against some of
the symptoms of stress. This finding gives support to the lack of auditory stimulation, in the
treatment conditions explored by the present study.
Audio- and video-guided relaxation. As noted in the previous chapter, only one study was
found to have been published in the last 2 decades exploring the comparative efficacy of audio
and video methods of facilitating relaxation (Byrnes, 1996). In this study, Byrnes measured the
ongoing levels of stress experienced by 33 adult subjects and 21 college students (n = 54) as they
were subjected to one of three experimental conditions. Subjects were randomly assigned to
either listen to a piece of classical music, view an underwater film of tropical sea life, or listen to
the same piece of classical music while viewing the same underwater film of tropical sea life.
Participants were also asked to complete a brief questionnaire pertaining to profession and

25
relaxation preferences, and they were asked to rate their current level of stress on a 7-point Likert
scale both before and after the intervention. Then, during the intervention itself, participants
utilized a device designed to assess their overall tension on a continuum in real time (known as
the Continuous Response Digital Interface or CRDI) by which participants turned a dial to
denote their current level of tension during the exposure to the intervention. The data gathered by
the CRDI was subjected to a post hoc t test analysis against the perceived stress levels as
reported by the pretreatment and posttreatment questionnaires.
Byrnes’ (1996) results demonstrated that there was a significant difference between the
pretreatment and posttreatment stress responses for the combined audio-video condition (p =
0.002), but not for the audio or video conditions separately (p = 0.154). Although the results for
all three conditions did not achieve statistical significance, Byrnes stated that participants in all
three conditions reported an overall decrease of tension and stress over the course of the
intervention and, upon completion, reported that they enjoyed their participation. Such positive
results offer promise to the employment of VGRP in the reduction of stress and facilitation of
relaxation, albeit they are inconclusive at this time. Byrnes’ treatment lasted approximately 2
minutes and 50 seconds, which is a relatively brief intervention that would not be expected to
generate as robust an effect as it seemed to based on the participants’ subjective experience of
stress. Moreover, one cannot discount the possible placebo effect of the use of the CRDI
instrumentation as well as of the video tape itself. However, Byrnes’ study suggests the
possibility of eliciting a similarly effective result from Media Assistance programs as was found
by the present study.

26
Chapter 3: Method
Research Design
At the end of Chapter 1, the basic research design of this study was briefly discussed. In
this chapter, I explore this subject more deeply. Given that live (in vivo) guided relaxation has
already been shown to help individuals manage stress (Cropley et al., 2007), as discussed
previously in Chapter 2, the primary aim of this study was to explore whether Media Assistance
might be a comparable adjunct to the clinical treatment of stress. The investigation of Media-
Assisted forms of treatment provided useful findings in terms of determining their potential role
in the range of clinical treatments.
In this research, I explored how three different methods of delivering guided relaxation—
video, audio, and live—influence various symptoms associated with stress. As is described in
more detail below, the video-guided relaxation program, or VGRP, is composed of nature
imagery that was used with permission from a commercially available DVD (see Appendix G).
The visual imagery is accompanied by a prerecorded audio track of the guided relaxation
transcript recited in a calm and soothing intonation (see Appendix E). The audio-guided
relaxation program, or AGRP, was composed of the same audio track used in the VGRP in the
absence of the visual nature imagery. The live, or in vivo, guided relaxation program, or LGRP,
was composed of the researcher reciting the guided relaxation transcript (see Appendix E) in a
calm and soothing intonation, in person with the participants. No music was employed with any
of these methods as this could potentially confound the primary focus of whether visual imagery
helps or hinders the stress-ameliorating efficacy of guided relaxation.

27
The purpose of this research was to answer the following questions:
1. “Is there a relationship between the method used to deliver guided relaxation to
adolescents and the amount of stress they report after receiving the treatment?” and
2. “What is the magnitude of the relationship between the method of delivering guided
relaxation and the amount and subtypes of stress levels that are reported?” Secondary research
questions were:
1. “Which demographic variables, if any, correlate with the influence of the guided
relaxation programs on reported levels of stress?” and
2. “To what extents do the participants’ reactions to the treatment conditions correlate
with reported levels of stress after exposure to treatment?”
In an effort to answer these questions, I utilized quantitative methods that had been
employed to view data objectively and to understand the relationship between variables in a
uniform fashion (Braud & Anderson, 1998). To establish and maintain a high quality of
standards, quantitative measures, such as questionnaires and surveys that have a high degree of
reliability and validity, were used. Quantitative methods are one of the most accepted forms of
data collection in the field of psychology today and are presumed to be the most congruent with
the scientific method (Creswell, 1994).
In this study, I employed a prepost experimental research design to serve an exploratory
function as to how three methods of delivering guided relaxation influence reports on a
psychological measure of stress. Specifically, I compared the effects that a Video-Guided
Relaxation Program (VGRP), an Audio-Guided Relaxation Program (AGRP), and a Live (in
vivo) Guided Relaxation Program (LGRP) had on the self-reported levels of stress among a
group of 77 Northern California high school students.

28
Upon acceptance into the study, all participants completed a pretreatment research packet
composed of a Demographic Questionnaire (Appendix B) and an assessment of frequently
reported stress symptoms, as measured by the Smith Stress Symptoms Inventory-State version
(SSSI-S, see Appendix C; Piiparinen & Smith, 2003, 2004) to establish demographics and the
baseline measures of participants’ present state of stress prior to the treatment. The third
instrument utilized in the present study, the Reactions to an Experiential Exercise Scale (REES,
see Appendix D), was employed after each treatment condition. A more detailed discussion of
these instruments is provided later in this chapter.
Upon completion of the pretreatment research packet, participants received the first of the
three treatment conditions (e.g., VGRP, AGRP, or LGRP), depending on the class to which they
were assigned. Each class received a different treatment condition for each of the 4 days of data
gathering. In other words, all seven classes received all three treatment conditions during the 4-
day period, albeit in a different order. This counterbalancing design was used to maintain the
distinction between the effects of order with that of the treatment itself. Participants completed
the two psychological assessments, the REES and the SSSI-S, after each exposure to a treatment
condition.
Participants
A convenience sample of 91 adolescents was recruited from a local high school in
Northern California to participate in the study in order to obtain sufficient statistical data that
could be made generalizable to the population at large and to account for the possibility of
attrition. Participation was solicited through contact with the school’s teachers with the
understanding that students’ participation throughout the study was entirely voluntary, although
teachers were encouraged to offer class participation credit for involvement in the study. All

29
participants and at least one of each participant’s parents were required to sign an informed
consent form (Appendix A) and were told about the nature of the study prior to filling out the
pretreatment questionnaires. Participants and at least one parent were informed that participation
in the study was entirely voluntary and that participants might choose at any time to discontinue
participation for any reason.
The required criteria for inclusion in the study were as follows: (a) willingness to
participate, (b) ability to speak and read English fluently as attested by their teacher, (c) signed
and parentally cosigned informed consent forms, and (d) full-time enrollment in mainstream,
rather than special-education, classes at a local high school. Students from special education
classes were excluded so as to ensure that all participants in this study had the appropriate level
of intelligence and the minimal fluency in English that was required to maintain the scientific
validity of the assessments.
Participants were selected from a diverse sampling across all grade levels from within a
“Focus on Success” class, the purpose of which was to offer students skills and techniques that
fostered good study habits. Although a diverse sample was difficult to achieve within a single
high school, diversity of participants was sought within the confines of the above-stated criteria.
Out of the 91 participants recruited, 77 returned the parentally cosigned informed consent forms
and were thus given the Demographic Questionnaire (Appendix B) and the Smith Stress
Symptoms Inventory-States version (Appendix C; Piiparinen & Smith, 2003, 2004) to establish
the baseline measures of stress.
After all of the data were collected, 21 of the 77 participants needed to be eliminated for
the reason that invalid data was suspected. These 21 participants’ responses to both the baseline
measures and to the three repeated measures of SSSI-S reflected the overall impression that none

30
of the items on the stress scale applied to them at all. (A thorough discussion of the rigorous
manner by which the participants’ “disengagement” from the study was conceptualized will be
provided later in this chapter.)
A preliminary correlational analysis between this disengaged segment of the sample and
the rest of the participants showed that this group of disengaged participants was more likely to
be male (r = .32, p < .004) and to report lower grades (e.g., Ds and Fs; r = -.23, p < .05) than the
group whose scores were included in the primary analysis. Although suggesting that males with
low grades would typically disengage from studies such as this one, this study did not have
enough individuals in the sample to allow this finding to serve a predictive function. The other
participants’ inclusion in the study was not related to any of the other demographic variables
including ethnicity, socioeconomic status, grade, primary language, or media preferences.
Although a moderate amount of selection bias—or a distortion of data arising from the
way in which the data is collected—is to be expected in any self-reported measure, this amount
of disengagement within the study was higher than expected. It is possible that doing research in
a classroom setting created a conflation between participation in the study with other in-class
assignments. Those students who disengaged from the study might have been disposed to tuning
out in-class assignments, in an effort to be “cool,” hostile, or otherwise resistant to in-class
authority. If so, their responses would not have accurately reflected the effects of the
interventions on how people perceived their emotional responses—which was the primary focus
of the study—and so therefore a decision was made to remove these participants’ scores from the
primary sample in order to maintain the validity of the study.
This scenario raises some interesting questions pertaining to the way in which
interventions such as the ones explored in this research might be brought into the classroom

31
setting and used with individuals who fit this particular demographic profile. The interventions
themselves might have, in fact, been quite effective with such participants, but their general
disengagement from participation in the study might have evoked what could be considered to be
due to the study’s methodology or due to a problem of instrumentation for this particular
subgroup of the population. A more thorough exploration of these methodological findings and
the limitations they imposed on the present research are discussed in more detail in Chapter 5.
The demographics for the remaining 56 participants are shown in Table 1. This sample of
participants was evenly split between the two genders, with an average age of 15 years (M =
15.2, SD = 1.1), primarily English-speaking, in 9th and 10th grade, and who reported getting
mostly Bs or Cs academically. They reported being mainly Caucasian or Latino/Hispanic,
followed by Bimultiracial, Asian, African American or another unlisted ethnicity. A majority of
the students reported that they did not know their socioeconomic status, but those that did know
predominantly reported a high SES (e.g., more than $100 thousand per year), with some lower-
income exceptions.
Instruments
In this study, participants completed three questionnaires. The first questionnaire was
designed to gather general demographic information from the participants and to gather specific
information pertinent to the present topic of inquiry (Appendix B). The second questionnaire, the
Smith Stress Symptoms Inventory-States version (SSSI-S, see Appendix C; Piiparinen & Smith,
2003, 2004) was designed to measure frequently reported stress symptoms, such as
Worry/Negative Emotions, Striated Muscle Tension, Attention Deficit, Autonomic
Arousal/Anxiety, Depression, and Interpersonal Conflict/Anger. The third questionnaire, the
Reactions to an Experiential Exercises Scale (REES, see Appendix D), was an instrument

32
Table 1
Demographic Variables
N %
Gender
Male 28 50%
Female 28 50%
Age
14 20 36%
15 12 21%
16 16 29%
17 7 13%
18 1 2%
Grade
9 26 46%
10 21 38%
11 2 4%
12 7 13%
Language
English 41 73%
Other 13 23%
No Response 2 4%

33
Table 1 (continued)
N %
Ethnicity
Caucasian 23 41%
Latin / Hispanic 13 23%
Bimultiracial 7 13%
Asian 6 11%
African American 4 7%
Other 3 5%
No Response 1 2%
Grade Point Average
As 4 7%
Bs 34 61%
Cs 16 29%
Ds 1 2%
Fs 0 0%
No Response 1 2%

34
Table 1 (continued)
N %
Socioeconomic Status
More Than $100 Thousand 10 18%
Between $75 & $100 Thousand 3 5%
Less Than $25 Thousand 2 4%
Don’t Know 30 54%
No Response 1 2%
designed especially for the purposes of this study and measured participants’ reactions (in terms
of their Enjoyment, Engagement, and Interest in Repeating the exercise) to each of the three
treatment conditions. All of these instruments will be discussed in greater detail below.
Demographic questionnaire. All participants completed a demographic questionnaire.
This questionnaire (see Appendix B) consisted of 10 multiple choice items that elicited
participants’ demographic information, such as their age, grade, sex, ethnicity, academic
performance, and socioeconomic status. Additional questionnaire items were included in an
attempt to explore participants’ media preferences in general, while relaxing, average time spent
daily using said media, and the extent of any prior experience with relaxation techniques that the
participants may have had. It was hoped that the data generated by these items would enable me
to explore whether a participant’s predilections toward and uses of media would influence the
participant’s compliance to the Media Assistance methods being studied as well as the
participant’s response to them. Although follow-up research would be needed to focus on this

35
relationship more directly, such exploratory data could help to provide the basis for such studies
examining how elements of the Media Practice Model (discussed in Chapter 1) might relate to
the potential efficacy of Media Assistance as an adjunctive form of clinical treatment. Items
about media preference were coded as binary variables for each type of media listed with type of
media reported = 1 and not reported = 0.
Reactions to an Experiential Exercise Scale (REES). The Reactions to an Experiential
Exercise Scale (REES; Appendix D) is an 18-item, 6-point Likert-type scale designed expressly
for the purposes of the present study. I developed it to measure the extent to which individuals
felt Engagement during, Enjoyment of, and an Interest in Repeating the given experiential
exercise. Respondents to this questionnaire were asked to indicate the extent to which a
statement fit with how the respondent felt “in reaction to the exercise” along a 6-point Likert
scale (with 1 indicating “Strongly Disagree” and 6 indicating “Strongly Agree”). The statements
used in the REES were used to assess three subscale reaction categories: engagement,
enjoyment, and interest in repeating the exercise. The REES is written at a junior high school
reading level, is easy to administer with groups or individuals, and takes about 5 to 7 minutes to
complete.
For the purposes of the present study, a 19th item was added to the REES to elicit the
extent to which participants elected to close their eyes during the exercise, as measured across a
6-point Likert-type scale, with 1 indicating “Strongly Disagree” and 6 indicating “Strongly
Agree.” The purpose of including this additional item was to evaluate the potential confound
imposed by the possibility of participants closing their eyes during the exercise. As some
research has shown (Craig et al., 2000; Putman, 2000), closed eyes increases alpha brainwaves,
which are 8-12 cycles per second, and which in turn increase relaxation, reduce stress, and

36
reduce the beta brainwaves, which are 13-25 cycles per second, and thus reducing wakefulness.
Moreover, this item may have helped to elicit data concerning the relative efficacy of the
imagery used in the VGRP on the reported levels of stress among participants in this condition
who reported that they kept their eyes open during the treatment. For this study, the measure of
whether participants closed their eyes during the treatment conditions was reverse-coded and
then recoded as a dichotomous variable with closed eyes reported as 1 and eyes opened to any
extent reported as 2.
For the final implementation of the REES after the third treatment condition was
completed, an open-ended question was added to elicit participants’ preference and experience
with each of the three conditions. Participants were asked to describe the treatment that they
liked the best and why, in as much detail as they wanted. This item was intended to elicit
subjective information about which aspects of the three conditions aided or hindered the
participants’ relaxation and overall reaction. It was hoped that this qualitative information would
help to deepen the interpretation offered by the quantitative data of the questionnaires and
possibly guide the direction of future studies.
To determine the reliability of the REES, the instrument was piloted in a total of seven
separate graduate-level psychology classes in Northern California in which students underwent
brief experiential exercises lasting approximately 10 minutes in duration (n = 75, M age = 29.3
years old, SD = 6.4 years) with 48 females, 15 males, and 13 participants with undisclosed age
and gender. The specific classes to pilot the REES participated in various creative expression
exercises that related to their personal goals for the academic semester. The Cronbach’s alpha
coefficient for internal reliability was calculated for the entirety of the REES at .92 (for
subscales, Enjoyment = .83, Engagement = .85, and Interest in Repeating = .86). For females,

37
alpha was .92 for the REES overall, with Enjoyment = .84, Engagement = .85, and Interest in
Repeating = .86. For males, alpha was .85 for the REES overall, with Enjoyment = .72,
Engagement = .83, and Interest in Repeating = .88.
For the present study, the Cronbach’s alpha coefficient for internal reliability for the
REES was calculated for each of the three treatment conditions. The participants of the present
study (n = 56) were all treated to the three treatment conditions in seven separate classes in
varying orders over the course of 4 consecutive days. Cronbach’s alpha for each of the three
subscales for each of the three treatment conditions ranged from .71 to .93, meeting the minimal
criterion of alpha = .50 (J. Cohen, 1987).
The overall reactions to each of the interventions tended to be correlated with one another
so that participants who enjoyed the live condition also tended to enjoy the audio and video
conditions, with similar findings revealed for their feeling of engagement with the interventions
and their interest in repeating the interventions. Cronbach’s alpha for Enjoyment for the
combined live, audio, and video conditions was .81, for Engagement was .71, and for Interest in
Repeating was .84. As a result, a decision was made to average ratings of Enjoyment,
Engagement, and Interest in Repeating across conditions, to give one score each for each
respondent in each of the three subscales.
Smith Stress Symptoms Inventory-State (SSSI-S). The Smith Stress Symptoms Inventory-
State version (SSSI-S) is a 34-item 4-point Likert-type scale measuring the degree to which
individuals currently feel a range of frequently reported stress symptoms (see Appendix C;
Piiparinen & Smith, 2003, 2004). Respondents to this questionnaire were asked to indicate the
extent to which a statement described how they felt “right now” along a 4-point Likert scale,
with a 1 indicating “Doesn’t fit me at all” and a 4 indicating “Fits me very well.” The SSSI-S

38
was based on the Smith Stress Symptoms Scale (1990) and the Stress Costs Inventory (Smith,
1993) and was designed to reflect content areas typically measured by cognitive anxiety
inventories. It measures five symptom categories identified through a thorough factor analysis of
stress (Smith, Rausch, & Kettmann, 2004): (a) Worry/Negative Emotion, (b) Attention Deficit,
(c) Striated Muscle Tension, (d) Autonomic Arousal/Anxiety, and (e) Interpersonal
Conflict/Anger. Each of these symptom categories is well established in the stress literature as
reflecting part of naturally-occurring stress responses. The SSSI-S is not a measure of
psychopathology inasmuch as its items and categories were obtained from and tested on
nondiagnosed college students and no clinical samples were used in its development. As a result,
the symptoms assessed by the SSSI-S are to be considered normal mood states, or naturally-
occurring stress symptoms, and not comprehensive enough to suggest a psychopathological
diagnosis. The SSSI-S is written at a junior high school reading level and is easy to administer
with individuals or groups in about 5 to 7 minutes.
Each subscale of the SSSI-S is made up of a sample of questionnaire items, the scores of
which are averaged together to calculate the reported level for that particular symptom’s
subscale. For example, the Striated Muscle Tension subscale is made up of item number 17 (“My
shoulders, neck, or back are tense.”), item number 20 (“My muscles feel tight, tense, or clenched
up.”), item number 23 (“I have backaches”), and item number 32 (“I have headaches.”). Taken
together, these items can offer a good picture of the participant’s current level of muscle tension;
however, this score may be distorted by the incidence of a passing headache or temporary injury.
Similarly, the other symptom subscales are based on items that may be prone to transient
changes. So, overall, the SSSI-S should not be used to serve a diagnostic function. Rather, the

39
scale offers an assessment of the participant’s moment-to-moment incidence of naturally-
occurring stress symptoms to serve as an area requiring further evaluation.
Although Smith created the SSSI-S with a subscale for Depression, I decided to remove
this subscale from the analyses for this study because the two items associated with this subscale
(item number 11, “I feel distressed,” and item number 13, “I am depressed”) were both included
among the items comprising the Worry/Negative Emotion subscale making it somewhat
redundant. Additionally, the Depression items subscale might have been somewhat
underreported by adolescents who might report depressive mood states in a more active language
such as those associated with the Interpersonal Conflict/Anger subscale (e.g., item number 16, “I
feel cynical or hostile,” and item number 35, “I feel irritated or angry,”), as opposed to the
passive language associated with the Depression subscale.
In terms of psychometrics, the SSSI-S has a Cronbach’s alpha coefficient ranging from
0.86 to 0.79 (Smith, 1990, p. 199), suggesting that it has high internal reliability. However, no
studies have yet been performed to evaluate its concurrent validity—that is, its validity as
compared with other similar scales of stress or anxiety. Nevertheless, the results of many studies
have demonstrated that the SSSI-S has substantial construct validity. An instrument’s construct
validity refers to the extent to which it measures all of the unobservable facets of the social
construct that it purports to measure. In the case of the SSSI-S, the scale’s construct validity is
evaluated by its measurement of the six stress symptom categories noted above as a function of
recognized patterns of response to a stressful situation.
An example of the SSSI-S’s construct validity is evident in two complementary studies
performed by Piiparinen and Smith (2003, 2004) who investigated the influence of the terrorist
attacks in New York City on September 11, 2001 (9/11). Archival data of the SSSI-S

40
administered to a sample of Chicago-area college students 5 months prior to 9/11 (n = 320, M
age = 25.7, SD = 8.6) was compared with data gathered 1 to 5 weeks after 9/11 with a similar,
albeit a separate, group of Chicago-area college students (n = 149, M age = 22.0, SD = 6.1). The
two groups did not differ by gender distribution, but the pre-9/11 group was slightly older.
Analyses of variance showed that men and women displayed the same pattern of stress
symptoms.
Multiple analyses of variance, with age included as a covariate, indicated that the post-
9/11 respondents scored higher than pre-9/11 respondents on the attention deficit scale (F[1, 467]
= 7.6, p = 0.006), indicating that college students displayed higher scores on stress-related
attention deficit after the attacks of 9/11 than a comparable group of college students did before
the attacks. The attention deficit scale, as implemented by the SSSI-S, measures cognitive
responses to stress, including memory loss, loss of concentration, feeling disorganized, feeling
confused, and becoming easily distracted. Interestingly, no other significant differences were
found between the two groups in any of the other six categories of stress symptoms. Moderately
strong correlations between attention deficit, autonomic arousal/anxiety (r = .66, p < .0005),
worry (r = .69, p < .0005), and anger (r = .60, p < .0005) and moderate correlations with muscle
tension (r = .45, p < .0005) and depression (r = .57, p < .0005) were found, supporting the
suggestion that the attention deficit measured was related to stress.
In other words, the pattern of these college students’ stress-related attention deficit
resembled the kind of dissociative symptoms and denial that are associated with the initial phases
of posttraumatic stress disorder (Piiparinen & Smith, 2003). As Lazarus and Folkman (1984)
suggested, dissociation and denial serve as ways of distancing oneself from the disruptive and
negative feelings following a traumatic event in response to which nothing concrete can be

41
accomplished. As Piiparinen and Smith (2003) pointed out, this pattern of distancing oneself
from negative affect is consistent with the findings shown in studies of posttraumatic stress
reactions of persons living in terrorized communities. The comparability of these findings
demonstrates the SSSI-S’s adequate construct validity as a stress scale and presents the SSSI-S
as an effective measure of the social construct of stress, including its cognitive, physical, and
emotional ancillaries as delineated by the instrument’s six categorical subscales.
This scale was selected because it is the only available nonpathological self-report
measure that elicits the participant’s moment-to-moment transient state symptoms of stress
across a variant of cognitive, physical, and emotional subscales. Short of using
psychophysiological measures, such as electroencephalograms, electrocardiograms, or galvanic
skin response measures (which can be difficult to employ for the purposes of a brief intervention
in a classroom setting), a state-based self-report questionnaire served as the best and most
feasible method for eliciting individuals’ moment-to-moment awareness of their present states of
mind. Further, all of the other self-report measures of stress I found were either assessments for
clinical pathology, such as the State-Trait Anxiety Inventory, or served as measures of the static
disposition or trait of stress rather than the momentary state of stress, such as the Perceived
Stress Scale. These measures were deemed inappropriate because the intention of the study was
to examine the immediate impact of a brief intervention on participants’ transient stress states in
a nonclinical setting. Although the SSSI-S assesses state of mind, which is, by definition,
transient and subject to low test-retest reliabilities, the SSSI-S serves as a one-of-a-kind self-
report measure inasmuch as it enables the individual to evaluate the individual’s own present
experience of stress in the present moment. This moment-to-moment awareness is critical for the
development of meditative attention (Smith, 2005). As such, a measure like the SSSI-S requires

42
respondents to attend to their current state of mind, thereby enhancing the meditative attention
that is indicative of the present study’s approach to relaxation (Smith, 2001).
For the present study, the Cronbach’s alpha coefficient for internal reliability for the
SSSI-S was calculated for each of the three treatment conditions. The participants of the present
study were all treated to the three treatment conditions in seven separate classes in varying orders
over the course of 4 consecutive days. Cronbach’s alpha for each of the six subscales for the
baseline scores and each of the three treatment conditions range from .56 to .92, meeting the
minimum criterion of .50.
Procedure
Teachers in a Northern California high school were contacted through a mutual associate,
and permission to conduct research in their seven “Focus on Success” study-habits classes was
requested. A written description of the study was provided to introduce the study in greater
depth. Upon receipt of permission to conduct research at the high school, I visited each of the
classes designated for prospective participation in order to introduce myself and the study to the
students and the teachers, to answer any questions that the students or teachers might have had,
as well as to provide information pertinent to the topic of the study and informed consent forms
to all interested persons. The study was introduced by informing potential participants that
research had determined that most people find relaxation exercises to be beneficial and
enjoyable. Although it is understood that such information may have biased participants’
responses and generated placebo effects, such information was given to all participants so that
any placebo effects were distributed uniformly across all treatment conditions and made
irrelevant to the focus of the present study, specifically, the comparative efficacy of the three
treatments, not whether the treatments themselves were effective at reducing reported levels of

43
stress (see Appendix H for a transcript of what was disclosed to participants just prior to each
treatment). Providing such information is considered to be part of the participants’ informed
consent and part of what is likely to occur when introducing similar relaxation exercises in actual
clinical practice. A brief explanation of stress, its causes, and its effects was offered, followed by
a brief description of relaxation, its causes, its effects, and the benefits of reducing stress. Lastly,
a general description of what was entailed in participation in the study was given.
All interested participants were asked to take an informed consent form, sign it, have it
signed by at least one parent, and then return it to a designated collection folder at the school
maintained by a teacher. Prior to distributing the informed consent forms, the forms were
verbally explained to the students in the classes with regard to the nature of the study and what
was required of them if they chose to participate. Additional copies of the informed consent
forms were provided to the teachers to distribute to prospective participants upon request. The
students had 4 weeks to contact the researcher with any questions and to return the signed and
cosigned informed consent forms. The teachers’ assistance was enlisted to remind the students of
the deadline and to distribute additional copies of the informed consent forms should they be
needed.
Once enough qualified participants submitted their informed consent forms, each
student’s name was written on a master list with a three-digit numeric code corresponding to the
random number assigned to each of the pretreatment research packets that were distributed to the
participants at the commencement of the study. This numeric code became the participant’s
identification number throughout the course of the study.
The instructions for both of the pretreatment questionnaires were explained to the
participants by the researcher with the reminder that all of the information provided by them

44
would be kept strictly confidential. The students were asked to answer all of the questions as
honestly and accurately as they could. The students had a total of 10 minutes to complete the
pretreatment research packet. The first questionnaire is the demographic questionnaire that
assesses basic information about the participant such as age, gender, academic performance,
socioeconomic status, preferred methods of relaxation, and electronic media preferences (see
Appendix B). The second questionnaire is the Smith Stress Symptoms Inventory-State version
(SSSI-S; Piiparinen & Smith, 2003, 2004), a 34-item 4-point Likert-type questionnaire designed
to measure the degree to which individuals feel that statements pertaining to stress symptoms fit
how they are feeling right now. The students were instructed to return the completed research
packets to the researcher upon completion. These were then placed in a locked file box and
stored in a secure location to which the researcher had sole access in order to maintain
participants’ confidentiality.
Each of the seven classes received each of the three treatment conditions—LGRP,
AGRP, or VGRP—once per day over the course of four days. The order in which the classes
received the treatments followed a counterbalancing method, also known as the Latin Squares
method, which helped to minimize the threats posed by the order of the treatment methods or
other outside influences that might have impacted the results of the study (e.g., natural disasters
or the death of a classmate), while increasing the statistical significance achieved by a within
groups analysis of the data. (For an illustration of the order in which the seven classes received
the three treatment methods over the course of the 4 days of the study, see Table 2.)
It would have been more convenient for the statistical rigor of the study if all seven
classes had rotated through the schedule uniformly, so that their respective treatment conditions
would not be influenced by the relative time of day over the course of the study; however, not all

45
Table 2
Guided Relaxation Treatment Schedule for All Seven Classes
Period Day 1 Day 2 Day 3 Day 4
1 Class 5: Audio Class 4: Video Class 3: Live Class 2: Audio
2 Class 1: Video Class 5: Live Class 4: Audio Class 3: Video
3 Class 2: Live Class 1: Audio Class 5: Video Class 4: Audio
4 Class 3: Audio Class 2: Video Class 1: Live No Treatment
5 Class 6: Audio Class 7: Live Class 7: Audio Class 7: Audio
6 No Treatment Class 6: Video No Treatment Class 6: Audio
of the classes rotated through the schedule. As Table 2 shows, periods 5 and 6 (i.e., the afternoon
periods) were split between Class 6 and Class 7. Such realities of the school’s class schedule
made the implementation of a uniform treatment schedule challenging within the school setting.
Preliminary statistical analyses comparing the morning classes and the afternoon classes
showed some significant differences between the two groups, which will be discussed in greater
detail in the following chapter. These differences may be accounted for by the fact that by the
afternoon students may have experienced increased stress as a function of classroom activities or
peer interactions throughout the day. However, these differences might also be accounted for by
reasons other than the time-of-day, including the relatively smaller sizes of the afternoon classes
(n = 11) as compared to the morning classes (n = 45), or bias as a function of class assignment.
A thorough discussion of the details for each of the three treatment conditions is
described in detail below. Upon completion of each treatment, participants were asked to
complete a posttreatment questionnaire, consisting of the SSSI-S and a version of the REES
which includes an open-ended question (see item 20 in Appendix D) to elicit the participants’

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