Cognitive and Relaxation Coping Skills in Stress

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Cog n#ive Therapy and Research, Vol. 5, No. 2, 1981, pp . 211 -21 5

Cogn itive and Relax ation C oping Skills in StressInoculat ionJ e rr y L . D e f f e n b a c h e r 1Colorado State UniversityR u d o l f M . H a h n i o s e rScottsdale, Arizona

Stress inoculation (Meichenbaum, 1972) is as effective as, if not moreeffective than, interventions such as desensitization (Jaremko, 1979).Stress inoculation contains training in two different types of copingskills: (a) self-instructional training aimed at replacing task-irrelevantthoughts with task-oriented self-instruction (cognitive), and (b) a copingform of desensitization (relaxation). The critical treatment components,however, remain unclear. Does its effectiveness derive primarily fromtraining in cognitive self-instruction, from the development of relaxa-tion coping skills, or do the elements interact synergistically to createa treatment more powerful than either component alone? The presentstudy addressed these questions through a parametric analysis of stressinoculation. Test-anxious subjects received one of four conditions: (a)cognitive coping skills (CCS), (b) relaxation coping skills (RCS), (c) com-bination of cognitive and relaxation coping skills (C + RCS), or (d) wait-list control (WLC).The 47 (31 female and 16 male) psychology students who scored inthe upper 25% on the debilitating (D) scale of the Achievement AnxietyTest (AAT; Alpert & Haber, 1960) volunteered for group treatment ;on completion of pretreatment assessment they were stratified on level

~An extended report of this article may be obtained from Jerry L. Deffenbacher, Depart-ment of Psychology, Colorado State University, Fort Collins, Colorado, 80523, to whomall correspondence should be addressed.211

0147-5916/81/0600-021!$03.00/0 1981 Plenum Publishing Corporation


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of test anxiety and, within constraints of scheduling, randomly assignedto (a ) C CS (N = 13), (b) RCS (N = 10), (c) C+ RC S (N = 13), or (d)WLC (N = 11). One subject from C + RCS did not complete treatmentand was excluded from the study.Instruments measured several distinct aspects of test anxiety. Debi l i -ta t ing tra i t tes t anxie ty , how much anxiety interferes with tests generally,and fac i l i ta t ing t ra i t t e s t anx ie ty , how much anxiety facilitates test per-formance generally, were measured respectively by the 10- and 9-itemD and F scales from the AAT. S ta te t e s t anx ie ty , the momentary affectiveexperience under evaluative stress, was measured by the 10-item worry-emotionality scale (Liebert & Morris, 1967), which yields worry (cog-nitive concern and distraction) and emotionality (self-perceived phy-siological arousal) scores, as well as a summative index of state test anxiety.T e s t p e r f o r m a n c e was evaluated by the Digit Symbol Test (Brown, 1969),the Wonderlic Personnel Test (Wonderlic, 1970), and classroom examscores in one class. Subjects completed all anxiety and performancemeasures 1 week prior to t reatment and 1 week after treatment . The AATwas additionally administered at a 5-week posttreatment follow-up.The worry-emotionality scale was administered just prior to both theanalogue and classroom exams, and the analogue test was preceded byinstructions stressing the time-limited, intelligence-testing nature of theexam.Treatments consisted of four 50-minute sessions over a 2-weekperiod and were administered in groups of 5-7 by the second author. Sincea single therapist was used, therapist bias could not be controlled andwas assessed by having subjects complete a 3-item rating scale at the endof each session. Items included (a) counselor interest in group members,(b) clearness of communication, and (c) degree of expressed expectationof program effectiveness and were rated on a 1-7 scale (1 = very low,7 = very high degree).

CCS was modeled after the cognitive component of stress inocula-tion. Test anxiety was described in terms of worry or the tendency toemit irrational, task-irrelevant self-verbalizations during tests, divertingattention from the task and lowering performance. The f irst two sessionsfocused on identifying and changing these dysfunctional self-instructionalpatterns. In the last two sessions subjects developed a set of written self-instructions that corrected their specific self-defeating cognitive patternsand then practiced these sets while taking standardized tests. Homeworkinvolved review and rehearsal of the sets twice per day, especially beforeexams. RCS described test anxiety in terms of emotionality, the tendencyfor heightened autonomic arousal to interfere with performance. Thefirst two sessions focused upon training in applied relaxation coping


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Cognitive and Relaxation Co ping Skills in Stress Inoculation 213skills, becoming aware of arousal, and using it as cue to apply relax-ation coping skills. In the last two sessions subjects developed relaxationself-instructional sets and applied them in the same testing conditionsas in CCS. Homework involved review and rehearsal of relaxation setstwice per day, especially before exams. C+RCS subjects received bothtreatment regimens. Test anxiety was explained in terms of both worryand emotionality, and self-instructional sets necessarily included bothcognitive and relaxation coping skills. Standardized tests were takenwhile employing these combined self-instructional sets, and homeworkinvolved rehearsal and employment of them. WLC subjects were toldthey had been selected randomly to have their treatment delayed untilthe beginning of the next term.

Ratings of therapist behavior were averaged across sessions becauseof little variability within sessions. All Ms were uniformly high (6 or greater)and revealed no differences among active treatments on any of the therapistbehaviors (counselor interest, clearness of communication, and expec-tations of success, Fs(3,42) = 1.17, 2.65, and 1.13, n.s.), suggesting thatdifferences among treatment groups were attributable to treatments ratherthan to therapist bias, at least measured by these variables.

One-way ANOVAs and tests for homogeneity of variance on pre-measures revealed no significant between-groups differences, suggestingthat prior to treatment groups were equivalent on measures of test anxietyand performance. Therefore, data were analyzed by analysis of covarianceusing the prescore as the covariate (Table I) with post hoc comparisonsamong adjusted means done by Newman-Keuls multiple-range tests.

Results from the analogue testing demonstrated significant between-groups differences for worry, emotionality, and states test anxiety, butnot for performance. Active treatment groups were less worried (p's < .05),emotional (p's< .01), and state test anxious (p's< .01) than controlsand did not differ significantly from one another on these measures. Theclassroom examination paralleled analogue testing; active treatmentgroups were less worried (p' s< .05), emotional (p 's < .01), and stateanxious (p' s< .01) than controls and did not differ significantly amongthemselves. Performance in both situations did not differ for treatedand untreated subjects, though within-group changes suggested sig-nificant practice effects for all groups.

Significant posttreatment and follow-up differences were found forboth debilitating and facilitating trait test anxieties. Immediately post-treatment, active treatment groups reported significantly less debilitatingtest anxiety (AAT D) than controls (p's< .05). At follow-up, treatedsubjects continued to report significantly less debilitating test anxietythan controls (p's < .01), but the C + RCS group now reported significantly


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Cognitive and Relaxation Cop ing Skills in Stress Ino culation 215less debilitating test anxiety than either of the two other active treatmentgroups (p' s< .05). Just after treatment , the C + RCS group reported sig-nificantly greater facilitating test anxiety than other groups (p's < .05).At follow-up, the C+RCS group continued to report more facilitatingtest anxiety than WLC or RCS groups (p' s< .05), and the CCS groupexperienced significantly more facilitating test anxiety than controls(p< .05).

While the design did not rule out the possible influence of non-specific, attentional factors, the results demonstrated that relaxation andcognitive components of stress inoculation alone or in combination ef-fectively lowered test anxiety. Treated subjects showed significant reduc-tions in general test anxiety (AAT D) and in specific stress reactions(worry, emotionality, and state anxiety) in both an evaluative analogueand actual classroom tests. Follow-up revealed that treatment effectswere maintained. However, while cognitive and relaxation componentsalone were effective, their combination appeared somewhat superior.For example, at follow-up C + RCS led to significantly more debilitatingtest anxiety reduction than either CCS or RCS. Posttreatment resultsalso showed that only the C + RCS group significantly increased facilitat-ing test anxiety, and follow-up revealed that this superiority was maintainedrelative to RCS. Less formal data additionally support the superiorityof C + RCS. Of the eight pos ttreatment anxiety measures showing change,the C + RCS group produced the greatest change on five and was nearlyidentical to CCS on a sixth. Change on the Digit Symbol and Wonderlicalso was greatest for the C + RCS group. Thus, both formal and informalcomparisons suggest that treatment combining cognitive and relaxationcoping skills was somewhat superior to either component alone.

REFERENCES

Alpert , R . , & Ha ber , R. N. A nxiety in academic achiev ement s i tuat ions. Journal of Ab-normal and Social Psychology, 1960, 61, 206-215.Brown, M. A set o f eight parallel forms of the digit symbol test. Unpublished set of tests ,Univers i ty of Water loo , Water loo , Ontar io , C anada , 1969.Ja remk o, M . E . A com ponen t ana lys is o f s t ress inocula t ion t ra in ing . Cognitive Therapyand Research, 1979, 3, 34-48.Liebert , R. M., & Morris , L. W. Cognit ive and emotional components of test anxiety: Adist inct ion and some ini t ia l data . Psychological Reports, 1967, 20, 975-978.Meichenbaum, D. H. Cognit ive modif icat ion of test anxious col lege students . Journal ofConsulting and Clinical Psychology, 1972, 39, 370-380.Wonderl ic , E. F. Wonderlic Personnel Test Manual Northfield, I l l inois: Wonderl ic , 1970.

Cognitive and Relaxation Coping Skills in Stress

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