Utility of relaxation training with children in school settings: a plea for realistic goal setting and evaluation

Anxiety, Depression and Self-Esteem in Secondary School Children

With the introduction of a new curriculum and increased targets for schools, children are facing increased pressure to succeed in examinations at increasingly earlier ages. It is therefore necessary to emphasize the need for greater awareness of the distress that may be experienced by young children and adolescents as a result and implement provision for early interventions. The aim of this study was to investigate changes occurring in anxiety, affect, depression and self-esteem in secondary school children as they approached important school examinations and to examine variations between schools of differing design and status. There were a total of 520 participants, from four different schools in two school years (year 9, age 13-14 and year 11, age 15-16). Participants completed self-report questionnaires at two time points—firstly during regular term time and the second in the week immediately prior to the examinations. Gender differences were found in the majority of measures with females displaying greater levels of anxiety and negative affect immediately before the examinations, whereas males reported higher positive affect and self-esteem and lower depression and anxiety, even within the week prior to the examinations. Differences between the schools were also found. However, there were no significant differences between the two school years and the two times of testing. A number of trends were identified in relation to both gender differences and the influence of the type of school attended. Females, particularly those attending independent or grammar schools, reported a greater negative mood overall and before the examinations. It is suggested that there is a need for a school-based provision aimed at pro-actively increasing pupils self-esteem and to develop skills for dealing with stressful situations—particularly important examinations.

The effects of a stress management intervention in elementary school children

OBJECTIVE

This preliminary study tests the effectiveness of an elementary school-based stress management technique on anxiety symptoms and heart rate variability (HRV) in children.

METHODS

In this controlled prospective longitudinal study, children in third-grade classroom participated in a teacher-led daily 10-minute stress management intervention for 4 months. The control class teacher read from a children's book for 10 minutes daily. A standardized anxiety scale and HRV (using computer biofeedback program) were measured before the 4-month intervention, immediately after, and 1 year later.

RESULTS

The intervention class showed significant improvement from baseline to the immediate postintervention period in total anxiety (N = 14, F = 12.95, p = .002), with 1-year follow-up scores maintaining improvement (N = 13, F = 5.88, p = .025). The intervention class had small improvement in HRV using the biofeedback program in the immediate postintervention period, with significant improvement at 1-year follow-up (N = 13, F = 10.61, p = .005). The control class showed no improvements. Qualitatively, children reported that the intervention was helpful during stressful times at school and at home, even after the study period.

CONCLUSION

An elementary school-based short daily stress management intervention can decrease symptoms of anxiety, and improve HRV, a measure of relaxation. Ultimately, these children found this skill continued to help them cope better with everyday stressors.

Test-anxious Children and Adolescents: Psychopathology, Cognition, and Psychophysiological Reactivity

Test anxiety in children has long been recognised to be a significant and challenging educational problem. Recent advances in diagnostic interviewing, cognitive assessment, and physiological recording have facilitated a considerable amount of research on test-anxious youth. This research has yielded important clinical insights about test-anxious children and adolescents of interest to teachers and psychologists. We describe and evaluate the findings of these investigations. Finally, we discuss the implications of the research findings for intervention in school settings. Cognitive-behavioural strategies are tentatively recommended for the treatment of test-anxious children and adolescents.

Preliminary study: Psychological effects of muscle relaxation on Juvenile delinquents

The purpose of this study is to test our hypothesis that muscle relaxation is effective on the psychological well-being of juvenile delinquents. Subjects were 16 juvenile delinquents who had entered a reform school. Subjects were divided into two groups. The muscle relaxation group received muscle relaxation therapy once a week for a total of 4 times. The control group spent an ordinary daily life in the reformatory. Psychological questionnaires used were the Rosenzweig Picture Frustration Study (P-F study), the Psychological Stress Response Scale (PSRS), and the Eysenck Personality Questionnaire (EPQ). There was a significant Group Time interaction of the Group Conformity Rating (GCR) of the P-F study (F [1,14] =10.1, P=0.007). There were no significant interactions in the other psychological subscales. Thus, muscle relaxation therapy may improve frustration tolerance among juvenile delinquents.

Effectiveness of autogenic relaxation training on children and adolescents with behavioral and emotional problems

OBJECTIVE

To investigate the effectiveness of autogenic relaxation training in a mildly disturbed outpatient population of children and adolescents with mostly internalizing symptoms, and/or some aggressive, impulsive, or attention deficit symptoms.

METHOD

Fifty children and adolescents from southern Germany (mean age 10.2 years; range 6-15 years; mostly intact middle class family background) participated in a group intervention program. Fifteen patients were randomly assigned to a waiting-list control group. Behavior symptoms (Child Behavior Checklist), psychosomatic complaints (Giessen Complaint List), and level of stress were assessed before and after the intervention or after the waiting phase. Individual goal attainment was evaluated at the end of the intervention and in a 3-month follow-up.

RESULTS

The parent report on CBCL reflected reduced symptoms compared with control. The child report indicated reduced stress and psychosomatic complaints both in the intervention and control group, and no significant group x time interaction effects occurred on these scales. Effect sizes of 0.49 in the CBCL and 0.36 in the complaint list indicated clinically relevant effects of the intervention compared with the control group. At the end of the intervention, 56% of the children and 55% of the parents reported partial goal attainment, 38% of the children and 30% of the parents reported complete goal attainment; 71% of the parents confirmed partial goal attainment 3 months postintervention.

CONCLUSIONS

Autogenic relaxation training is an effective broadband method for children and adolescents.

Treatment of temporomandibular disorders among adolescents: a comparison between occlusal appliance, relaxation training, and brief information

In a randomized trial the effects of occlusal appliance and relaxation therapy, each combined with brief information, were compared with brief information only, in adolescents with temporomandibular disorder (TMD) pain. One-hundred-and-twenty-two adolescents (93 F and 29 M aged 12-18 years) were randomly assigned to one of the following 3 groups: brief information + occlusal appliance (BI + OA), brief information + relaxation therapy (BI + RT), or brief information (BI). Included were subjects reporting pain once a week or more often, in addition to receiving a diagnosis of TMD according to the Research Diagnostic Criteria (RDC/TMD). They were evaluated before and after treatment and at a 6-month follow-up by means of self-reports and clinical assessment. The result revealed a significantly higher reduction in frequency of pain, in pain intensity (visual analog scale [VAS]), and in a composite pain index (intensity x frequency) for patients treated with BI + OA compared with those treated with BI alone. In the BI + OA group, 60% of the patients attained a clinically significant improvement (at least 50% or more) on the pain index, a significantly higher proportion compared to that obtained in the other 2 treatment groups. Analgesic consumption was also significantly more reduced in the BI + OA group compared to the BI group. However, no significant differences were found between the treatment groups in jaw opening or in muscle and TMJ tenderness scores. Occlusal appliance was found to be superior to both relaxation therapy and brief information regarding pain reduction and can therefore be recommended when treating adolescents with TMD pain.

Relaxation training as a holistic nursing intervention

For centuries cultures have incorporated strategies that recognize the power of engaging the mind in the process of healing. In this century, relaxation training (RT) is a skill that has been repeatedly validated by nursing, medical and psychology researchers as a complementary intervention that is effective for a wide range of clinical situations. Relaxation can be employed by nurses and patients to offset the negative effects of stress, illness, and surgery while promoting healing and self efficacy. The nurse's knowledge of RT is essential to a holistic nursing approach that supports an innovative model of caring for nursing practice.