Accelerated Anxiety Reduction:  
Rationale, Components, and Outcomes

by

Richard Driscoll, Ph.D.*

Westside Psychology
Knoxville, Tennessee

*Send correspondence to: Richard Driscoll, Ph.D., Westside Psychology,

301 S. Gallaher View Rd, Suite 102, Knoxville, TN 37919;

or email to: drD at amtaa dot org

The two recorded protocols used here are available on request to interested researchers.

Richard Driscoll, Ph.D.

865 690-0962 x104

fax 865 690-0995

email: drD at amtaa dot org

Abstract

The rationale and procedure are presented for a brief desensitization training strengthened by physical exertion and positive adaptive images. The procedure counters physiological over-arousal through strenuous muscle stretch–tense, deep breath, and release sequences; encourages positive expectations; and uses positive images to replace negative cognitions and to introduce adaptive alternatives.

PsycINFO: 3350; 3580

Combining Physical Exertion
and Positive Images:
Anxiety Reduction Rationale, Protocol, and Outcomes

Anxiety-reduction protocols produce consistent benefits but often require several hours or more of intervention. The Ergene (2003) meta-analysis of test-anxiety reduction protocols finds that interventions taking between three and a half and eight hours produced the better results, while those taking an hour or less were much less effective. The current inquiry explores the use of physical exertion and positive adaptive image components to expedite the anxiety-reduction process.

Components of Anxiety

Anxiety is understood to involve a combination of physiological over-arousal (termed emotionality) and worrisome cognitions (Liebert & Morris, 1967; Spielberger, 1980), which often result in performance impairments. In testing situations, worry and physiological arousal operate together (Harris & Johnson, 1983; Smith et al., 1990; Sapp, 1994). Physiological arousal produces troublesome cognitions (e.g., "I'm failing," "How stupid of me!"), while these same troublesome cognitions in turn increase physiological arousal. Performance failure is a consequence, although poor performance then contributes to additional anxiety.

Strong physiological and cognitive components are combined here to control these anxiety components. While various anxious students may do well with one or two intervention components (Hiebert, 2000), a composite approach might be expected to benefit a broader range of individuals (Sapp, 1996).

Components

Exposure is central in desensitization and extinction approaches. Exposure may be especially therapeutic when the fear response is overcome or, more importantly, when the experience ends in a clear sense of relief and safety. We might expect that the more pronounced the sense of relief, the stronger the anxiety-reduction benefit. Components which can suppress anxiety quickly and are not themselves compromised by anxiety could anchor a more robust desensitization procedure.

Exertion

Those who have played active sports know that no matter how anxious you are before a game, the anxiety subsides once you are up and running. In an early confirmation, anxiety has been found to be significantly lower after strenuous physical activity (Morgan, 1973). Physiological arousal prepares one for physical activity, and the activity itself is the natural usage of that arousal.

Physical activity has been used in desensitization for many years in lieu of relaxation, and as a component of an aggressive response to build confidence. Running has been used in the successful treatment of phobias, including difficult-to-treat hospitalized agoraphobics (Orwin, 1973).

As physical activity is not ordinarily inhibited by high anxiety, it can act as a unidirectional counter to physiological stress and can continue to counter stress even in high anxiety conditions. The continuing action under high anxiety conditions should make highly threatening exposure scenes more manageable, thus allowing a steeper exposure hierarchy and more rapid extinction.

Given the early promise of physical activity, it is perhaps surprising that it has not found its way into mainstream practice. Unfortunately, most forms of physical activity appear to be too awkward and too odd to fit properly in an ordinary psychotherapy office. Aerobic exercise programs are found to benefit a variety of anxiety and mood disorders, including panic disorder (Salmon, 2001), but are ordinarily classified as health and fitness programs rather than as therapy programs.

Positives

Jogging + Positive Images

An early component analysis suggests that exertion and positive images can be combined to promote especially rapid benefits (Driscoll, 1976). Sixty-four test-anxious students imagined six preparation and exam scenes, each twice, with a pause between the scenes, for a total of nine minutes of conditioning. In a 2 x 2 design, 16 also jogged in place through the sequences; 16 imagined positive images during the pauses; and 16 both jogged and imagined the positives.

Refinements

Stretching & Tensing

Physical stretching is an active component in traditional Eastern relaxation and health practices such as Yoga, Tai Chi, and Qi Gong. It appears again in the Pilates exercises, as a popular way to relieve stress. Stretching also focuses attention, and can help redirect attention away from anxious concerns and reinstate feelings of well-being. It has been suggested as an adjunct to deep breathing to relieve stress (Wilkinson, Buboltz and Seemann, 2001)

The next pair of sequences focuses on the back and waist muscles. "Arch your back, gently, slide your waist a couple of inches to the right, stretch your right arm down, tighten your arms, make them as stiff as you can, and take a deep breath in…" Then, we reverse sides: "Arch your back, gently, and slide your waist a couple of inches to the right…."

The next pair focuses on the waist and legs. "Push your right leg out a couple of inches, stretching your hips, and tighten both of your legs, and take in a deep breath, and tighten your stomach muscles, and hold it a moment…" And again, we reverse sides.

The exact sequencing of stretches can vary according to the preferences of the therapist and the needs of the clients. It is important that clients stretch and tighten not just single isolated areas but as many major muscle groups as possible in each sequence, for maximum exertion.

Deep Breaths

Shallow breathing is a symptom of panic attacks, accompanies other high anxiety conditions as well, and lowers proper respiratory functioning (Hendricks, 1995). Having clients take deep breaths counters the shallow breathing associated with high anxiety. Instructions have clients hold their breath for approximately 8–10 seconds.

Introduce Positive Expectations

As clients relax, we can provide instructions that suggest benefits and invite clients to accept the suggestions rather than question them.

Composite Anxiety Suppressor

The principal sequence thus has clients stretch and tense, take deep breaths of air, release and relax, feel successful, and expect further benefits. Additionally, in the later sequences, we suggest: "Letting go now of all worry and concern," or "Letting go now of all stress and tension." or "Letting go now of all anxieties and fears."

The sequence appears to reduce tension quickly. Five to six minutes of stretch-tense-air-relax-suggestions sequences were provided in multiple anxiety-reduction seminars, and most participants reported being at least as calm after the brief sequences as they had been during previous, lengthier relaxation experiences.

Individuals experiencing extreme anxiety or panic are often sensitive to signs of physiological arousal such as increased heart rate and shortness of breath, and jogging or other strenuous exercise can intensify these signs. The present stretch–tense sequence appears to consume physiological tension without triggering these anxiety signals. It also refocuses attention on the activity and away from the somatic symptoms.

In anxiety-reduction interventions, clients report that the stretch–tense, air and release sequences reduce their anxiety and reinstate a sense of peace and confidence, even after highly stressful exposure scenes. Thus, the sequences appear to serve their intended function.

Positive Adaptive Images.

The positive suggestions and images used here are mental adaptations to the intimidating situations. Interest in school subjects contributes strongly to school performance, so an interested attitude is a plausible antidote to a fearful attitude. A shield is understood to protect from attack, so an imaginary shield might reasonably protect from a verbal and emotional attack. The adaptive images are meant to promote counterconditioning, which is the elimination of an unwanted response such as anxiety through the introduction of an incompatible response.

Test-Anxiety Reduction

To apply the protocol to test anxiety reduction:

The main positive here is the sense of interest, which is captured from a favorite activity, re-experienced, and then woven into the learning and testing scenes. In an ordinary state, it would be far-fetched to propose that a highly test-anxious student could take pleasure in anything remotely connected with a test. Yet with the special training state produced here, students can and do imagine enjoying learning, organizing, and then showing their mastery on tests. Once they can imagine interest, they are more apt to experience interest in real situations.

Shielding Against Hostility

Many clients are readily stressed and intimidated by anger, accusation, criticism, and manipulation. Personnel management courses propose that it takes up to five compliments to make up for one insult, suggesting that the average individual is surprisingly thin-skinned and readily unsettled by antagonism.

The following steps are to reduce stress amid antagonism:

In an ordinary state, it would be far-fetched to propose that sensitive individuals could feel safe amid hostile accusations. Yet, with the special sequencing here, individuals can and do imagine feeling safe while facing images of anger, criticism, and manipulation.

Overview

Table 1

Subjects and Benefits from Five Samples

Discussion

The five studies tend to be similar in several features. Four of the samples addressed test anxiety, while one addressed stress in hostile situations. Four protocols used the stretch–tense and release sequence, while one used jogging as the exertion component. Three samples involved two 30–35 minute sessions; the fifth grade sample involved five such sessions; and the jogging sample had two sessions totaling 40–50 minutes. Four of the interventions relied on a recorded protocol, while the jogging procedure was administered by assistants. Three samples had tightly randomized controls, one had approximately randomized controls, and the pilot sample relied on normative controls. Four samples involved positives that were adaptations to the threatening situation, while the jogging sample involved positive images unrelated to the anxiety condition.

Methodological shortcomings should be noted: In the absence of matched controls in the pilot, the Intervention gains were compared against the average controls from the other four samples. While not ideal, the

control gains appear similar enough among studies so that the average should be a reasonable estimate.

In the probation sample, two students being tutored but failing to progress were chosen for the Intervention group. While completely random assignment is the reasonable standard, it seems improbable that two students failing to progress would have show unusual anxiety-reduction benefits without intervention. Thus, their inclusion as Intervention subjects should not have provided an appreciable advantage to that group.

Taken together, the five samples suggest that the relatively brief exertion + positives protocols produce reasonably strong anxiety-reduction benefits across various student samples.

By curtailing anxiety rapidly, the stretch–tense, deep breath, release and suggestion sequences appear to produce strongly positive experiences after exposure scenes. In classical conditioning, the experience immediately after a stimulus becomes associated with the stimulus itself. In anxiety counterconditioning, the rationale can expressed metaphorically as "All's well that ends well." The exposure scenes here end well indeed, with substantial good feelings that convey all is well and counter expectations of impending doom.

The rapid transition from stressful exposure to positive feelings is thought to allow the exposure hierarchy to progress more rapidly, expediting the conditioning: The interventions are briefer than many standard protocols, taking only two 30–40 minute sessions with college students.

It remains to be seen whether further research by other investigators will confirm the strength of these outcomes. If the current results withstand replication, the protocol should produce standard or perhaps even improved benefits for performance anxieties, with briefer interventions and the advantages of administration via recorded instructions. Further research is needed to verify the strength of the benefits and to assess applications to various other anxiety conditions.

References

revised June 24, 2006