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Just Breathe and Relax

Permanent Link: http://ncf.sobek.ufl.edu/NCFE004701/00001

Material Information

Title: Just Breathe and Relax Alternative Therapies for Symptoms of Stress Disorders
Physical Description: Book
Language: English
Creator: Arias, Carlos
Publisher: New College of Florida
Place of Publication: Sarasota, Fla.
Creation Date: 2013
Publication Date: 2013

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Genre: bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

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Abstract: Prolonged and unwarranted levels of stress can lead to several psychological and health issues including the possibility of a severe anxiety disorder. The symptoms of stress disorders are often times treated with medication whose efficacy has been brought into question. Myriad stress therapies have been proposed as alternatives to typical treatment and amongst them meditation has shown the most promise. The current experiment attempts to further elaborate on stress research by comparing an eclectic meditation group with a control and exercise group on several stress measures over a three week period. Measures included everyday burnout scores (Maslach Burnout Inventory), inventory of stressful events (Holmes and Rahe Stress Scale), and cardiovascular response (blood pressure and heart rate reactivity). Although the results did not support the use of meditation as an alternative therapy, they have important implications for future research which are elaborated and discussed.
Statement of Responsibility: by Carlos Arias
Thesis: Thesis (B.A.) -- New College of Florida, 2013
Electronic Access: RESTRICTED TO NCF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE
Bibliography: Includes bibliographical references.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The New College of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Local: Faculty Sponsor: Bauer, Gordon

Record Information

Source Institution: New College of Florida
Holding Location: New College of Florida
Rights Management: Applicable rights reserved.
Classification: local - S.T. 2013 A6
System ID: NCFE004701:00001

Permanent Link: http://ncf.sobek.ufl.edu/NCFE004701/00001

Material Information

Title: Just Breathe and Relax Alternative Therapies for Symptoms of Stress Disorders
Physical Description: Book
Language: English
Creator: Arias, Carlos
Publisher: New College of Florida
Place of Publication: Sarasota, Fla.
Creation Date: 2013
Publication Date: 2013

Subjects

Genre: bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: Prolonged and unwarranted levels of stress can lead to several psychological and health issues including the possibility of a severe anxiety disorder. The symptoms of stress disorders are often times treated with medication whose efficacy has been brought into question. Myriad stress therapies have been proposed as alternatives to typical treatment and amongst them meditation has shown the most promise. The current experiment attempts to further elaborate on stress research by comparing an eclectic meditation group with a control and exercise group on several stress measures over a three week period. Measures included everyday burnout scores (Maslach Burnout Inventory), inventory of stressful events (Holmes and Rahe Stress Scale), and cardiovascular response (blood pressure and heart rate reactivity). Although the results did not support the use of meditation as an alternative therapy, they have important implications for future research which are elaborated and discussed.
Statement of Responsibility: by Carlos Arias
Thesis: Thesis (B.A.) -- New College of Florida, 2013
Electronic Access: RESTRICTED TO NCF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE
Bibliography: Includes bibliographical references.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The New College of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Local: Faculty Sponsor: Bauer, Gordon

Record Information

Source Institution: New College of Florida
Holding Location: New College of Florida
Rights Management: Applicable rights reserved.
Classification: local - S.T. 2013 A6
System ID: NCFE004701:00001


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JUST BREATHE AND RELAX Just Breathe and Relax: Alternative Therapies for Symptoms of Stress Disorders BY CARLOS ARIAS A Thesis Submitted to the Division of Social Sciences New College of Florida in partial fulfillment of the requirements for the degree Bachelor of Arts Under the sponsorship of Professor Gordon Bauer Sarasota, FL May, 2012

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JUST BREATHE AND RELAX ii Acknowledgements First and foremost, I would like to thank all the New College professors that I have had the pleasure of knowing. Not a day went by at New College where I did notlearn something new and miraculous about the world around us; however, I would like toparticularly mention a few professors that deserve more than just acknowledgement. Thank you, Heidi Harley, for teaching me that the hardest questions are still worth askingand that humans and thermostats have a lot in common. Thank you, Alfred Beulig, for teaching me what the human brain is truly capable of both on a chalkboard and in my own mind. Thank you, Leo Demski, for showing me it takes more than courage toaccomplish the job. Thank you, Steven Graham, for showing me how far the right state of mind can take you. And last but certainly not least, thank you, Gordon Bauer, for beingmore than just a teacher or a guide; you have given me the tools to prove to myself that I can accomplish anything I want in life with the right passion and dedication for my work. I would not have been able to accomplish the hardest work of my life without the courageI found in your words and personality. Thank you, eternally. I would also like to thank my all peers for contributing to the wonderful years I have had at New College, but would like to note a few. Thank you, Judith Lobo, for teaching me that what I was looking for was right in front of me the entire time. Thank you, Jon Wright, for never letting me work hard without playing hard. Thank you, Jennie Caskey, for giving me strength when I needed it most. And thank you, William Byatt no words. I'd also like to thank my family, the Hostel, Those Guys, and the Family. I love you all

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JUST BREATHE AND RELAX Table of Contents Acknowledgements ....................................................................................... .. Table of Contents ........................................................................................... .. Abstract .......................................................................................................... .. Introduction .................................................................................................... Method ........................................................................................................... ..Results ............................................................................................................ ..Discussion ...................................................................................................... ..References ...................................................................................................... ..Appendices ..................................................................................................... .. iiiiv222526 3236 iii

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JUST BREATHE AND RELAX iv JUST BREATHE AND RELAX Carlos Arias New College of Florida, 2012 ABSTRACT Prolonged and unwarranted levels of stress can lead to several psychological and health issues including the possibility of a severe anxiety disorder. The symptoms of stress disorders are often times treated with medication whose efficacy has been brought into question. Myriad stress therapies have been proposed as alternatives to typical treatment and amongst them meditation has shown the most promise. The current experiment attempts to further elaborate on stress research by comparing an eclectic meditation group with a control and exercise group on several stress measures over a three week period. Measures included everyday burnout scores (Maslach Burnout Inventory), inventory of stressful events (Holmes and Rahe Stress Scale), and cardiovascular response (blood pressure and heart rate reactivity). Although the resultsdid not support the use of meditation as an alternative therapy, they have important implications for future research which are elaborated and discussed. Professor Gordon Bauer Division of Social Sciences

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JUST BREATHE AND RELAX 1 Just Breathe and Relax: Alternative Therapies for Symptoms of Stress Disorders The most prevalent type of disorders in the United States are anxiety disorders with 18.1% of the adult population having at least a 12-month prevalence and 22.8% ofthese cases being classified as severe (Kessler, Chiu, Demler, & Walters, 2005). These disorders can be exhausting and can range from slight generalized anxiety to severe traumatic stress. Anxiety is characterized by stress but the two concepts are intrinsically different. Stress is an appropriate psychophysiological response to a potentially threatening stimulus while anxiety is a feeling of apprehension and fear that is often accompanied by the stress response. Long-term exposure to a consistent stressor or theoverwhelming stress from multiple stressors can lead to anxiety. Sometimes the body isoverwhelmed by anxiety and consistently elicits a stress response with or without adistinct stressor. If this anxiety ever becomes exhausting it can lead to an anxietydisorder. Treatment of anxiety disorders tends to focus on two goals: remission andcoping. The current research focuses on the treatment of the stress symptoms of anxietydisorders and so discusses different supplemental treatments that have been used (orcould be used) as therapy for coping with stress. Before going any further it is important to have a complete understanding of what stress actually is. Several models have been created to help describe what stress is and together they provide multiple perspectives on this fascinating adaptation. Stress has been defined in many different ways and the reason for this has to do with the variability of what we often call stress. Stress could be seen simply as the feeling or condition of being

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JUST BREATHE AND RELAX 2 exposed to a demanding stimulus when one does not have the resources to take on the problem at hand; however, this definition does not properly describe what occurs during short-term stressful events that may require no solving. To truly understand what stress is, one needs to comprehend the different ways in which stress has been described. First it is important to make a distinction between short-term stress and long-term stress. Acute stress can be related more to the startle response than to long-term stress. It is the reaction the body has to what seems like an immediate dangerthe fight-or-ightresponse of the sympathetic nervous system. During this reaction the body undergoes a systemic preparation for survival: increased heart and respiratory rate, inhibition of digestion, constriction of blood vessels in parts of the body, dilation of blood vessels for the muscles, inhibition of salivation, and relaxation of the bladder to name just a few. These physiological reactions are accomplished by actions in the hypothalamic-pituitary-adrenal axis which release catecholamine hormones into the body. Both short and long-term stress begins in the same way perception of a stressor which triggers the fight-or-ight response. If the stressor is reappraised as safe then thebody begins parasympathetic actions in order to return to homeostasis. But if the stressor persists as a threat then the individual would have to begin coping behaviors in order to deal with the stress. The General Adaptation Syndrome (GAS) is a model for long-term stress. There are three stages to the GAS: alarm, resistance, and exhaustion (Selye, 1936). In acute stress there is only the alarm phasethe phase in which the stressor is realized and the body responds through sympathetic nervous system action. But in long-term stress the alarm phase is followed by the resistance phase in which the individual

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JUST BREATHE AND RELAX 3 attempts to adapt to the constant stressor. The body only has a certain number of resources, however, and so cannot keep up resistance indenitely. Exhaustion, the thirdphase, is characterized by the depletion of bodily resources and the inability to maintainregular function. Long-term exhaustion leads to myriad health issues commonly associated with long-term stress. Contrary to common opinion, not all stress is bad stress. Selye (1975) subdivided stress into both eustress and distress. Stress leads to a bodily response that prepares one against a threat by enhancing focus and attention as well as prioritizing bodily resources for rigorous physical exertion. In the case of strength training or studying for an exam, stress can help the individual enhance his or her ability to function on the particular problem which is causing the stress. This is easily distinguishable from distress in which the body's response does little or nothing to help the situation and instead keeps the body in a fairly useless alarmed state. Distress all too often leads to exhaustion and long-termhealth issues related to stress. When the problem of distress lingers for too long, the body uses up most of its resources and the individual is left with a constant and overwhelming sense of exhaustion. One of the most important attributes of stress is the necessity of appraisal. Lazarus (1966) believed that cognitive appraisal of the situation is what allows an individual to perceive the threat which is producing stress. To Lazarus, there are two levels of appraisal: primary appraisal and secondary appraisal. The primary appraisal involves judging whether the situation is truly a threat while the secondary appraisal involvesjudging the kinds of resources the individual has to cope with the problem and the

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JUST BREATHE AND RELAX 4 negative emotions that have arisen because of the problem. Secondary appraisal can therefore the primary appraisal since a problem is not much of a problem if the solution is readily available. It is important to note that the body reacts to perceived stressors at a speed much faster than cognitive appraisal. For example, if the loud roar of a lion is heard the body gets alarmed and begins to react based on this rudimentary primary appraisal. But once the cognitive processes catch up and a complete appraisal is possible, the individual can better judge whether or not the stressor is a real threat. If the lion's roar came from a large hungry predator nearby then the body will enter the resistance phase in which it will try to solve the problem and possibly lead to long-term stress. Whereas, if the lion's roar came from a television set then the stressor is no longer perceived as a real threat and the body begins actions to return to homeostasis after the short-terrn acute stress response. Although stress has so far been described as a generalized reaction to a stressful stimulus, it seems evident that physiological and emotional stress responses vary greatly depending on the type of stressor and the way in which the threat is appraised. This idea has led researchers to formulate the integrated specificity model (Kemeny, 2003). The hypothesis behind the model is that stressors cause fairly distinct behavioral and cognitive responses which are shaped by the unique demands of the stressor. The model diverges from Selye's GAS model in that it treats stressors as diverse events that can an individual on multiple levels depending on the type of stressor. Selye was correct in believing that there was a generalized adaptative response to stressful events; certain psychophysiological reactions occur for all types of induced stress, including

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JUST BREATHE AND RELAX 5 hypothalamic activity, autonomic system action, and immunological responses. But, as research on appraisal has shown, this does not mean that all stressful events impact the individual in the same way. Factors such as the perception of social threat and emotional states can change the way the event impacts the body as a whole; therefore, it seems likely that the stress response is more complex than previously thought and should take into account the various sources of stress and their subtle physiological differences. Empirical research on physiological responses to varied types of stressful events would shed much light on the integrated specificity hypothesis. In an attempt to categorize stressors in an integrated specificity model, Denson, Spanovic, and Miller (2009) performed a meta-analysis of 66 experiments which measured cortisol and immune changes during an emotion or stress inducing task. The manipulations in these experiments were categorized into five groups: cognitive appraisal, basic emotions, rumination and worry, social threats, and global mood status. The researchers hypothesized different cortisol depending on the need for extended energy and over 170 hypotheses on immune responses based on the stressors possible demands on different parts of both the natural and specific immune system. For example, it was hypothesized that rumination and worry would increase cortisol levels and suppress the innate but not the adaptive immune system. Their results showed significant differences between groups on cortisol levels as was hypothesized. In terms of immune response, nine of the predictions made were supported by the results. Although at first glance this seems to provide much evidence for the integrated specificity model, nine significant results out of over 170 analyses would be expected

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JUST BREATHE AND RELAX 6 simply by chance (due to the standard value for difference in statistics). In addition, the analysis only included published articles and therefore does not take into account studies that, although still important data points, did not find remarkable enough results to end up published. But this does not mean that there is no hope for the model. Future research should mimic the methodology of the meta-analysis with a few key differences. For one, the researchers in this meta-analysis should take into account the autonomic nervous system (ANS) reactions in addition to cortisol and immune responses. ANS activity has already been found to be highly variable in appraisal research and so would be a important physiological dimension of the integrated specificity response (J amieson, Nock, & Mendes, 2011). Furthermore, measuring the plasma concentrations of certain hormones (such as AVP) may provide more diverse findings. To complete the picture of what stress is, one needs to understand the neurobiological mechanisms at play. Within the body, the most important interactions during a stressful event are between the hypothalamus, pituitary gland, and adrenal gland. Together these interactions form what is known as the HPA axis. The hypothalamus receives neurological input from various sources including the cerebral cortex, limbic system, and visceral organs. When the hypothalamus receives feedback that suggests that something in the body is deviating from homeostasis, the stress response begins. The hypothalamus then releases two major hormones: arginine vasopressin (AVP) and corticotropin-releasing factor (CRH) (Daruna, 2004). Both of these hormones are released from the paraventricular nucleus (PVN) of the hypothalamus into vesicles that ultimately transport the hormones into the pituitary

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JUST BREATHE AND RELAX 7 gland. AVP is then released into the rest of the brain and body through the posterior pituitary gland. In the body, AVP has an antidiuretic effect on the kidneys and a slight vasoconstrictive effect on the cardiovascular system. However, within the brain AVP has been linked with memory formation and water absorption. CRH is transported from the PVN into the anterior pituitary which triggers the gland to release adrenocorticotropic hormone (ACTH). Once the ACTH reaches the adrenal gland, it stimulates the release of steroid hormones, namely cortisol, into the body (Daruna, 2004). Cortisol is the hormone most often related to stress and anxiety. Its main function is to prepare the body for rapid energy exhaustion during a stressful event. It accomplishes this task by increasing blood sugar as well as helping metabolize proteins, fats, and carbohydrates while suppressing the actions of the immune system. This shift in priority of the body's energy is effective for a proper response but can be very damaging in the long-term. Excessive and consistent stress is characteristic of anxiety. Continued exhaustion of the body's resources through cortisol can lead to serious negative effects on the hippocampus and immune system; therefore, the stress that accompanies anxiety disorders can have lasting and severe immunological and memory related consequences (Daruna, 2004). The prevalence and severity of certain stress and anxiety disorders make it evident that efficient treatment for these disorders is important. But treatment of anxiety requires a personalized therapy (or therapies) to tackle the individual issues of clients. In addition to the common treatments for stress disorders, therapists have a variety of alternative therapies at their disposal to help people deal with the symptoms of their anxiety

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JUST BREATHE AND RELAX 8 disorders. Typical therapies For most stress related disorders the main treatment is Cognitive Behavioral Therapy (CBT) often paired with medication (Mayo, 2010). CBT is an eclectic talk therapy that combines the approaches of both behavioral therapy and cognitive therapy. It has been shown to be very effective in the treatment of a wide range of disorders including anxiety disorders and mood disorders. The aim of CBT is to tackle the source of the problem using talk therapy techniques like Socratic questioning and cognitive restructuring that promote goal-oriented thinking, systematic behavioral self-analysis, and the thinking. Unlike more palliative treatments, CBT aims for the complete remission of the disorder. The alternative therapies put forth in this review are not meant to replace CBT but are meant to replace the medication treatment that usually accompanies CBT. Medication, as well as the alternative therapies put forth, acts best as supportive treatment to lessen the severity of stress symptoms as opposed to cure-focused treatments like CBT. There are many different kinds of medication that are used for anxiety disorders. The most notable types of these medications are antidepressants (such as duloxetine, and bupropion) and benzodiazepines (like clonazepam, diazepam, and alprazolam) (Mayo, 2010). Antidepressants are usually used for the treatment of depression because of their on serotonin and consequential effect on mood. This positive effect on mood has shown to help alleviate the negative symptoms of anxiety as well. For mild anxiety symptoms, one would typically be prescribed a moderately safe antidepressant

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JUST BREATHE AND RELAX 9 such as an SSRI. Although fairly safe relative to other antidepressants, even SSRI's have a long list of possible side-effects which range from physical symptoms like headaches and nausea to sexual dysfunctions and increased likelihood for suicide. In addition to normal side-effects, one major effect of most medications is the formation of a dependency and, consequently, withdrawal symptoms. Antidepressants and other anxiety medications tend to have withdrawal symptoms such as increased irritability, fatigue, and general anxiety. Despite all the negative consequences, antidepressants are still some of the most commonly prescribed in the country. Given this, one would expect that this class of drugs must be quite efficient. Foumier et al. (2010) performed a meta-analysis of randomized and placebocontrolled studies which tested the efficacy of antidepressants on depression using the Hamilton Depression Rating Scale (HDRS). The HDRS is one of the most commonly used measures of depression severity in clinical research. It comprises 17 questions on the frequency and magnitude of depressive symtoms (such as depressive mood, insomnia, and anxiety) which provide a score between zero and 54. Scores below seven are considered normal, scores between seven and 17 would indicate mild depression, 18 to 24 would be moderate depression, and over 24 would be severe depression. The analysis of 718 participants from a total of six studies showed that the efficacy of the medication over placebo was largely dependent on the severity of the baseline depression. For patients with HDRS scores below 23, there was no significant difference between the medication and the placebo. The threshold of statistical significance was only reached in those patients whose baseline HDRS score was 25 or over. These results provide

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JUST BREATHE AND RELAX l0 evidence for the use of antidepressants in the treatment of severe depression but not for mild to moderate depression. In addition, it seems that their ability to enhance mood may be similarly overstated and so may be their efficacy as treatment for symptoms of stress disorders. Despite this truth, antidepressants are often used as supplemental treatment for all levels of depression and anxiety. Medication is undeniably an efficient, supporting treatment for certain types of disorders (Granger et al., 2009); however, the many problems with medication make it clear that equally efficient, alternative therapies should be adopted into mainstream usage. Medication not only comes with negative side-effects and a possible chemical dependency but also comes with a monetary cost. The benefits of medication are also fairly chronologically limited when compared with other forms of treatment in that medication does not provide patients with permanent cognitive tools that could be used to prevent and treat future stress related issues. At the same time alternative therapies have their own issues, the biggest of which is the general lack of proper research with structured methodologies. The best way to properly juxtapose alternative therapies for stress disorders with medication is to describe the strengths and of specific kinds of treatments. Alternative Therapies Although there is a wealth of various alternative therapies for stress related disorders, there are also many common characteristics they all share. Often alternative therapies are designed to treat an array of disorders or a symptom (such as stress or low self-esteem) shared across different disorders. This is very similar to typical uses of

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JUST BREATHE AND RELAX ll medication in that both medication and alternative therapies do not aim to solve theproblem directly but instead provide a framework of support for a main treatment that canfocus on the individual's issues. Music Therapy Music therapy is a prototypical alternative therapy in that it is has been used to treat a variety of psychopathologies, is best used when supporting a main form oftreatment, and generally lacks a structured treatment methodology. The reason musictherapy has lacked structure has to do with the fact that music therapy is essentially anumbrella term for many different methodologies that have rarely been properly compared and contrasted in a research setting. Christian Gold et al. (2007) carried out a study involving the specific analysis of 75 children and adolescents with various kinds of psychopathology undergoing music therapy. What these researchers did that distinguishes their experiment from other musictherapy studies is that they attempted to find the specific attributes that form part of music therapy and were more or less efficient. Fifteen music therapists were used to conduct five specific types of treatment methods which generally fall under the umbrellaof music therapy: unstructured improvisation, playing precomposed songs (or other formsof structured music play), listening to music, verbal music analytical discussion, andother creative activities (games, dancing, puppet play, etc.) which did not necessarily involve music but were often used in conjunction with other forms of music therapy. Allparticipants included in the study were offered music therapy and randomly assigned to one of the treatment styles. The 75 participants attended weekly music therapy sessions

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JUST BREATHE AND RELAX 12 for as long as they desired (some for many years). The experimenters gave pretests before treatment and compared them with postests given after treatment was nished or untilthey had completed 25 sessions whichever came first. Therapeutic efficacy was measured in differing ways, based on the participant's diagnosis. For most participants this was measured using standardized scales Although, overall, the music therapy had significantly positive therapeutic value, one of the major findings was that other forms of activity (games, dancing, puppet play,etc.) did not facilitate the therapy. In fact, when other forms of activity were used as partof the therapy there was significantly less improvement when compared to therapy which involved a more music focused therapy with less involvement of other activities. Otherfindings showed that participants required a unique form of treatment based on personal characteristics. Verbal discourse, for example, was more efficient for older participantsand the use of songs decreased in efficacy for 3-14 year olds but increased for 15-19 yearolds. These results suggest the idea that, although music therapy is an effective therapy, ultimately the treatment will only be effective if it is properly adapted to the individual's needs. Adventure Therapy Unlike music therapy, adventure therapy (also called wildemess therapy) has not been well researched but what little research there is supports the efficacy of adventuretherapy as a support treatment and as a preventative treatment for many kinds of depression and self-esteem issues. Adventure therapy has rarely been studied for its useas a stress reduction technique specifically; however, many of the ways in which it has

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JUST BREATHE AND RELAX 13 been implemented echo other treatment methodologies that do focus on stress and anxiety. Adventure therapy is a form of psychotherapy which involves putting individuals in a novel and usually wilderness-like environment along with adventure therapists and other clients. These therapeutic journeys are usually accompanied by group orientedactivities and problem solving exercises. The idea of adventure therapy is to bring the individual to a new and safe place where the typical problems of life are replaced by activities involving survival and group bonding exercises. Many of the techniques used in treating depression also efficiently help with stress. Norton (2008) investigated the effect of wilderness therapy on the levels of depression and psychosocial development of 21 teenagers (age 13-17). The wilderness therapy was conducted by Outward Bound, a non-profit outdoor education organization. The program's name was Intercept and is intended for at-risk youth with issues like anger management, poor school performance, low motivation, and drug experimentation. One-hundred fifteen adolescents were a part of the program and, although all were contacted, only 21 agreed to be a part of the study for the full duration. Two quantitative measures were used before and after treatment: the Reynolds Adolescent Depression Scale-2 and the Measures of Psychosocial Development. In addition to these scales, the researcher also obtained qualitative assessments in the formof posttherapy phone interviews and forms to be completed by the child's guardian which included questions on topics like general medical history, mental health history, substance abuse, and family conict. Both the qualitative and quantitative measures supported the researcher's hypothesis, showing a significant measurable decrease in the prevalence of

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JUST BREATHE AND RELAX l4 depression and an increase in the levels of psychosocial health. These ndings suggest that adventure therapy is a good treatment for depression and depressive symptoms of various disorders. This study does have one major problem: there was no control group. Sadly, it tends to be rare for research related to adventure therapy to include a proper control group. In addition, the participants were all from a specific age group. Although the fact that all the subjects in this study were teenagers limits the generalizablility of the results, group cohesion is an important part of adventure therapy and having peers that can relate to one another not only aids in facilitating therapeutic outcomes but is not limited to a single age group. When implemented, adventure therapy tends to focus around a specific kind of group and more often than not involves group therapy sessions. In the case of Scheinfeld, Rochlen and Buser's (2011) study, 11 middle-aged men were taken on an adventure therapy retreat. The adventure therapy took the form of a four day hiking retreat. Duringthe retreat the men and researchers spent their time exercising (hiking 4-6 miles a day), cooking together, and participating in intermittent 2-3 hour group therapy sessions. As part of the retreat, participants were asked to complete a personal interview in order to better gauge the impact of the adventure therapy. An overwhelming majority of the participants responded that the adventure therapy provided a new perspective for theirissues and allowed them to distance themselves from their livesand therefore theirproblemslong enough to clear their minds. Although the responses do seem to support the idea that adventure therapy is an effective means of treatment, there are quite a few major issues with the methodology of

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JUST BREATHE AND RELAX 15 this study. A few of the major aws included lack of a control group, a small sample size, and unspecified focus of treatment (the participants were seeking therapy for varying problems which included marriage, anger, depression, and self-esteem issues). And although the researchers did use a coding system to collect responses in as much a quantitative fashion as possible, the evidence would have been better supported if the researchers tested the participants before and after treatment using standardized self-report scales. Unfortunately, this study is like most of the research in this field in thisfashionlacking quantitative methodological rigor and has only a generalized focus of therapy. Although adventure therapy does show promise as a supplemental antianxiety treatment, much more properly controlled research must be done before the therapy hasthe empirical support it needs to be properly considered. It does, however, serve the purpose of illustrating an interesting characteristic of a lot of these alternative therapies; the best possible therapy for a patient tends to depend heavily on the context of the patient and their disorder. Adventure therapy has been shown to be effective forpromoting group cohesion, motivation, and self-esteem which may in turn aid withgeneral anxiety. In addition, it provides a medium to facilitate exercise which, as described later, is itself an effective alternative therapy. Alternative Medications In addition to the various non-pharmacological alternative therapies for stress disorders, there are also alternative medications that show promise as possible treatments; including homeopathic alternatives and more controversial regulated alternatives. One of

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JUST BREATHE AND RELAX 16 the more well known herbal treatments is St. John's wort. This supplement is available over the counter and is often sold as an herbal alternative to antidepressants. Research into the mechanism behind St. John's wort points to various different active compounds (Butterweck, 2003). Of these, hypericin, hyperforin and different avonoids are mostoften associated with the antidepressant qualities of the drug. The plant extract is known to inhibit synaptic reuptake of serotonin which mimics the actions of SSRI's as well as the reuptake of dopamine and noradrenaline. This HPA axis activity has been supported through behavioral studies of rats in which those with in vivo St. John's wort had significant reduction in immobility and the negative effects of unavoidable stress (Butterweck et al., 2002). Research has supported the efficacy of St. John's wort as treatment for mild depression. Kasper et al. (2008) performed two double-blind, randomized and placebo-controlled studies on the efficacy of St. John's wort as an antidepressant in a human sample. The researchers used the Hamilton Rating Scale for Depression (HAMD) to gauge depression. Out of the 1200 patients in the original baseline reading, 217 with mild depression were eligible to participate in the long-term study (HAMD score 520). Experimental group participants were given either 600, 900, or 1200 mg of the plant extract every day while the control group received a daily placebo. After 6 weeks participants were reevaluated using the HAMD, and the results showed a significant dropin depression scores in all three dosages relative to the placebo group. No differences were found between the three dosage groups. These results, along with what we know about the mechanism of St. John's wort,

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JUST BREATHE AND RELAX 17 support the use of this extract as a treatment for mild depressive symptoms. Little to no research has been done on the use of St. John's wort as specifically an antianxiety medication in human subjects; however, given that antidepressants tend to be used as treatments for anxiety symptoms and that the extract has a large HPA axis inuence, there is enough evidence to support the usage of St. John's wort as a supplemental treatment for stress disorders. In addition to medicinal alternatives for mild anxiety symptoms, there are also possible treatments for more severe stress disorders; one of the most controversial of which is methylenedioxymethamphetamine (MDMA). MDMA is best known for its association with the street drug ecstasy, but new research into its use as a PTSD treatment has helped change the way we look at this drug. What makes MDMA unique as an antidepressant medication is that the inuence of most antidepressants appears subtlyover weeks of daily treatment while MDMA has been shown to be effective after a few long sessions of psychotherapy paired with the drug. This disparity is a testament to thepowerful effects of MDMA and therefore brings to question the safety of this treatment. The problem is that, until recently, there existed little to no proper research on the drug, its usage as a supplement to therapy, or the long-term side-effects of clinical doses. However, thanks to modern researchers, light has begun to be shed on the effects of this often misunderstood chemical. In a recent groundbreaking study, Mithoefer et al. (2011) tested the efficacy of MDMA combined with psychotherapy on twenty participants with chronic posttraumatic stress disorder (PTSD). Of the twenty participants, twelve were given the active drug and

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JUST BREATHE AND RELAX 18 eight were given a placebo. There was one non-drug preparatory therapy session, twoexperimental eight-hour psychotherapy sessions, and follow-up non-drug sessions for all twenty participants. The subjects were tested using a clinician-administered PTSD scale at several points throughout the study: baseline, four days after the first experimental session, four days after the second session, and two months after the last session. During the experiment, the researchers made sure to monitor blood pressure, body temperature, and neurocognitive triggers. For all three measurements after the baseline measure, the researchers found a significant decrease from baseline in PTSD scale scores in the experimental condition relative to the control. Not only did the results support their hypothesis that MDMApaired with psychotherapy can be an efficient treatment for PTSD, but they found absolutely no adverse effects on blood pressure, body temperature, or neurocognition due to the drug. One of the most redeeming qualities of this study was that it was quite empirically sound; it was double-blind, randomized, and placebo-controlled. The results show that there is a need for future studies to replicate Mithoefer and colleagues experiment with the same level of empirical rigor but should include a comparativecondition in which participants are given psychotherapy paired with a commonantidepressant. Exercise Although it may sound like an all too simple solution, exercise alone has been shown to be incredibly efficient at reducing stress symptoms. Exercise not only promotes health in the individual, but also provides the body with endorphins (which can enhance

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JUST BREATHE AND RELAX l9 mood) and even puts people in meditative states. Gerber and Puhse (2009) performed ameta-analysis of the research surrounding the use of exercise as a buffer for stress.Included studies had to meet important empirical criteria (such as having a good control) and involved comparing frequency of exercise to levels of stress. Their results showed that an overwhelming number of studies had shown at least partly supportive data. What has not been researched enough is the use of an exercise based therapy as an adjunct to typical psychotherapy. Like other alternative therapies, shows much promise as an alternative to medication and a stress preventative. Meditation Of all alternative therapies, meditation has shown the most promise as a treatment for the symptoms of stress disorders. But before discussing research on meditation, it is vital to understand that it can be done in a variety of different ways with different goals in mind. Meditation can be classified in many ways but the meditation styles most often mentioned in research are concentration, observational and transcendental. Concentrationmeditation refers to meditation whose aim is to maintain attention on one particular task by alleviating the mind of excess thoughts and distractions. This is the kind of meditation one thinks of when they are told to focus their mind on a single particular thought; some typical examples include breathing exercises, tai chi, and some forms of yoga but any activity which requires precise and complete concentration can be consideredconcentration meditation. In this style, the goal is to clear superuous thoughts by maintaining attention on a single idea. Meanwhile, observational oriented meditation

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JUST BREATHE AND RELAX 20 involves an increased awareness of the current external and internal environment. Mindfulness meditation, which is the act of bringing complete attention to the present experience, is the most widely studied form of observational meditation. Transcendental meditation (TM), on the other hand, is not only the most studied meditation form of all but a meta-analysis of different relaxation techniques has shown that TM is better than other forms of meditation at reducing anxiety (Eppley, Abrams, & Shear, 1989). TM is characterized by the idea of effortless mental transcending. Transcending refers to achange in awareness which reects a change in mental state. This mental state can be readily achieved by even novice meditators and is often described as a state of mind freefrom thought. Although these three categories provide a good picture of what meditationis, in reality meditation can be practiced in a multitude of ways including inuences which overlap all of these categories. Although there are variations in efficacy, the one thing that every form of meditation has in common is the inuence on stress management. Lee et al. (2007) studied the effectiveness of a meditation-based stress management program on 41 individuals with an anxiety disorder. Participants were randomly assigned to receive eight weeks of either the meditation program or an anxiety disorder education program.Measurements were taken four times during the experimentat baseline and every twoweeks after for eight weeks. Five different scales of anxiety were used: the HamiltonAnxiety Rating Scale, the Hamilton Depression Rating Scale, the State-Trait Anxiety Inventory, the Beck Depression Inventory and the Symptom Checklist-90 Revised. Although there were no significant improvements of depression scores, the meditation

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JUST BREATHE AND RELAX 21 group did signicantly better than the control group on all measures of anxiety. Theresults of this study are not unlike most studies. Meditation on the whole has been shown to have antianxiety effects again and again. What is interesting is that the same technique can be applied to a lot of different disorders. Although much research has been done on meditation in general, few studies explore the efficacy of certain meditation styles. The current experiment continues the research on meditation by comparing an eclectic group of meditators to acontrol group on several measures of stress. Within the meditation group were participants from three different courses: a Su meditation course, a secular meditation course, and a ow-oriented object manipulation course. Object manipulation, although not strictly meditation, involves focusing your mind on a particular task as one does in the concentration style of meditation. This experimental group was compared with two control groups: a regular control and an exercise group. All three of these groups werecomposed of students from either a small liberal arts college or a private art college in southwest Florida. Stress was measured through change in both burnout levels and physiological stress reactivity. Burnout levels refer to the number of problems related to lifemanagement difficulty and was measured using the Maslach Burnout Inventory (MBI). Burnout is frequently tested in stress studies because it describes the amount of inuence stress has had on normal life events. Generally, burnout is used in relation to a particularstressful inuence such as career burnout. The MBI used in the current study asked questions regarding workload and peer relations but participants were asked to generalize

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JUST BREATHE AND RELAX 22 these questions to everyday workload and social interactions in order to gauge the impact of stress on everyday life-management. Meanwhile, physiological stress reactivity refers to the ability to return to biological homeostasis after an immediate stressful event. Inthis study, reactivity was measured using blood pressure and heart rate. It was hypothesized that, despite little to no change in the magnitude of stressful events, burnoutlevels would decrease for the experimental and exercise groups but not the regular control group. It was further hypothesized that physiological stress reactivity would increase for the experimental group but neither control groups. This latter hypothesis is based on the ideas that cognitive appraisal facilitates a more appropriate reaction toward a nonthreatening stressor and that meditation in general helps one gain a better sense ofcognitive appraisal. Method Participants There were a total of 23 participants in the experiment; due to participant mortality, four subjects were not used for repeated measures analysis. Of the 19 left, 11 were female and eight were male. The mean age was 21 and ranged from 19 to 22.Participants were mostly college students from either a small liberal arts college or a private art college in southwest Florida. Recruitment of experimental group participants was done through the discretion of the class instructors. The control groups were recruited by word-of-mouth outside of the fitness center at one of the schools. All groups

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JUST BREATHE AND RELAX 23 Participants in the experimental group were students in one of three meditation courses: a Su meditation course, a secular meditation course, and a poi spinning class. All three classes met for one hour once a week. Ultimately 12 out of the 19 participantswere in the experimental group. Both the religious (Sufi) and secular meditation courses were similar in that they included an eclectic mix of meditative styles. In the Su course, for example, activitiesranged from sitting meditation to chanting to poetry reading and discussion. These two classes can be said to include elements from observational, concentration, and transcendental meditation but with a general focus on observational meditation. The object manipulation course (poi spinning), on the other hand, is almost exclusively a form of concentration meditation. During the course, students were taughtabout a particular type of movement meditation which involves the manipulation of propscalled poi. The props themselves are simply a pair of weighted balls at the end of chains meant to be spun in varying aesthetic and rhythmic patterns. Poi spinning can best bereferred to as a performance art and is often times called a ow art because of itsrelationship with the positive psychology concept of the state of mind called ow. Like other forms of concentration meditation (tai chi for example), the point is not to clear the mind but to focus entirely on the task at hand.Materials A total of two measures were used self-report questionnaire and a physiological measure. Included in the questionnaire were two scales. One of the scales was the Holmes and Rahe Stress Scale (HRSS) which measures the collective magnitude of

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JUST BREATHE AND RELAX 24 stressful events in an individual's life for the past 12 months (Holmes and Rahe, 1967). The other scale in the questionnaire was the Maslach Burnout Inventory (l\/IBI) which measures one's level of burnout from everyday stressors. Both the HRSS and MBI have been consistently tested for their validity (Scully, Tosi, & Banning, 2000; Schutte et al., 2000). In addition to the two stress scales, participants were asked for their name, contactinformation, sex, age, and level of meditation experience. Physiological reactivity to stress was gauged by comparing different cardiovasular measurements. Systolic and diastolic blood pressure along with heart rate (in bpm) were taken using a small portable pressure cuff.Procedure First, participants were asked to complete the short questionnaire. Once completed, participants were taken to a separate room for physiological stress testing. Heart rate was taken during this period as a baseline measure. Measurements were takenthroughout the stress-inducing task and for one minute afterward for a total of three measurement events per session: (1) baseline, (2) during stress task, and (3) after the task. These three values were compared in order to gauge reactivity for both physiological measures. Heart rate reactivity, for example, was recorded as a ratio of the return in heartrate after the stress task relative to the change in heart rate from baseline during the task. The physiological change from baseline during the stress-task was recorded to ensure the validity of the stress-inducing task. The stress-inducing task in the current study was adapted from the second portion of the Trier Social Stress Test (TS ST). The TSST has become a widely accepted method

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JUST BREATHE AND RELAX 25 of inducing stress in studies over the past 14 years (Kudielka, Hellhammer, & Kirschbaum, 2007). The first part of the TSST was not included in this study for several reasons including lack of time. The second part of the TSST is much simpler and shorter;participants were asked to continuously subtract a small prime number from a large one.In the current study this procedure was adapted with the addition of an acoustic stimulus. Exactly ten seconds after subtracting 13 continously from 2083 (remained consistent), a loud sound (the Windows XP error sound) would emit from speakers hooked up to the computer in front of the researcher. If the participant responded strongly to the sound the researcher merely replied with I'm sorry if that startled you. Please continue the arithmetic task. After one minute of the stress-inducing task, the participant was asked to relax for one more minute for the last physiological measure. Care was taken to time events evenly for all participants. Results The results showed a marked (but not quite significant) decrease in mean burnout scores from baseline to post-treatment for the meditation and control group but not the exercise group. For more detailed descriptive results on burnout scores, please see Table 1. The exercise group was removed from inferential statistics due to small sample size. Results from repeated measures ANOVAs on the Holmes and Rahe Stress Scale scores (stress events scale) showed no significant difference across all groups over time F(1, 15) = .356, p = .706; however, paired t-tests showed a significant increase in all cardiovascular responses during the first session and significant increases in diastolic pressure and heart rate during the second session (see Table 2).

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JUST BREATHE AND RELAX 26 Post-treatment burnout scores were analyzed using both a repeated measures ANCOVA (co-varying for stress events scores) and a hierarchical multiple regression analysis (partitioning stressful event scores and baseline burnout measurements). Results from both the ANCOVA, F(1, 15) = 1.249, p = .281, and the linear analysis, F(1, 15) = 1.78, p = 0.20, showed no significant group differences. Cardiovascular increase and reactivity were similarly analyzed using a repeated measures ANOVA and a hierarchical multiple regression correlation. Participants whose cardiovascular response did not show an increase were removed from the ANOVA reactivity analysis. Results from the AN OVA showed no significant group differences for cardiovascular increase or reactivity for all three measures (see Table 3). Results from the regression analysis showed significant effects for all cardiovascular measurements (bothincrease and reactivity for all three measures) but most of these effects were not predicted by group (see Table 4). The only exception was heart rate increase which was significantly predicted by condition; control group participants increased their heart rate, M = 13.23, SD = 10.35, significantly more than the (eclectic) meditation group participants, M : 7.23, SD = 5.48 when partitioning for stressful event scores and baseline heart rate. Discussion The results of the experiment showed little support for the use of meditation as therapy for stress. Burnout scores were not significantly reduced by the experimental group. Physiological reactivity also did not show any significant differences. Thesefindings suggest that, if exercise or meditation provide benefits to general stress, the

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JUST BREATHE AND RELAX 27 mechanism by which they do so may not relate to cardiovascular responses to stress and may not alleviate everyday burnout. In terms of exercise, this conclusion is slightly counter-intuitive. Exercise tends to involve much cardiovascular stress and so exposes people to consistent eustress without anxiety. One would expect that this exposure should prepare the body to respond to a non-threatening stressor in a similar manner. Although this may still be true for more long-term exercisers, there are also the benefits to stress levels that could have more to do with the psychological and social implications of exercise. For one, exercise tends to have a major positive on self-esteem and often times can be a social activity as in team sports. These psychosocial effects can have prominent indirect on self-perception of everyday stressors even for novice exercisers. Exercise is also, in part, a focused meditative activity; therefore, it could be that both typical concentration meditation and exercise share a common psychological mechanism that helps provide the individual with a mental environment better-suited for coping. The current experiment did not find evidence for the beneficial effects of exercise on stress levels although past research has (Gerber & Puhse, 2009). These results may support the idea that only long-term exercise has significant effects on stress levels; however, in order to make this claim future research must use similar methodology but a much larger exercise group. In terms of meditation, initial analyses showed that meditation classes did not have significant effects on levels of everyday burnout or physiological responses to

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JUST BREATHE AND RELAX 28 stress. Like the results of the exercise group, these may be better explained by the inexperience of the students. This idea would suggest that there is some cognitive mechanism (or mechanisms) which meditation can help cultivate over a long period of time. One is tempted to assume that, if there was a slowly cultivated mechanism, it would be the act (and skill) of meditation itself during a stressful situation. Research has shown that performing 20 minutes of meditation before a stressful task (but not after) reduces the negative effects of stress for completely inexperienced meditators (Mohan, Sharma, & Bijlani, 2011). Although this might explain some of the effects found in lesscontrolled studies, the current researcher controlled for this possibility by explicitly asking participants not to meditate during the experiment and by having participants use the time before the stress task to complete the survey. This means that if there is a benefit specifically from long-term meditation, it must be some biological difference between experienced and novice meditators that is not the act of meditation itself but rather something that prepares the individual for a stressful event which meditation develops over time. A more probable candidate is the meditative aspect of in-the-moment awareness or, to describe it as Lazarus would, appraisal of the immediate environment. Recent research on appraisal may shed some light on the importance of reappraisal on the physiological response to a stressful event and may one day provide a partial explanation of the power of meditation. Jamieson, Nock and Mendes (2011) studied the effects of reappraisal on cardiovascular stress responses. After a baseline cardiovascular measure, the 49

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JUST BREATHE AND RELAX 29 participants were randomly placed into one of three groups: a reappraisal group, an ignore-cues group, and a control group. In the reappraisal group, participants were educated on the functional and adaptive nature of stress. More specifically, they were told the evolutionary significance of stress and that arousal can aid performance on a stressful task. The ignore-cues group were instead told that the best way to increase performance and decrease nervousness during a stressful task was to reorient their attention to ignore the source of stress. The control group simply performed a nondemanding task. All three groups were then administered the complete Trier Social Stress Test (TS ST) while the experimenters continued cardiovascular measurements. Their results noted significantly better cardiovascular reactivity and output in the reappraisal condition compared with both of the other groups. These findings support the idea that reappraisal might be a key cognitive tool for reducing the physiological effects of stress and may even be a prime factor of what makes CBT effective. However, to say that there is a clear connection between appraisal and meditation may still be a bit presumptious. Future work in the field of stress and meditation research should head in two directions: exploring the connection between appraisal and meditation as well as expanding on the current experiment. Research into the biological differences between meditators and nonmeditators has yielded interesting results; some of which may help draw a bridge between appraisal and long-term practice of meditation. fMRI studies have shown differences in brain activation but this provides a limited understanding of the more subtle mechanisms behind meditation. More interesting is the impact of meditation on AVP levels. O'Halloran (1985) found that experienced meditators had significantly higher plasma

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JUST BREATHE AND RELAX 30 AVP concentrations during a state of decreased arousal. This hormone has also been repeatedly shown to be associated with memory formation (Pan et al, 2010; Aarde & J entsch, 2006; Dietrich & Allen, 1997). High AVP levels may be the biological manifestation of good attentional control and therefore may play a role in both concentration meditation and appraisal of stressful cues. Future empirical work into the neurobiology of meditation should broaden their measures to include plasma concentrations of hormones often related to concentration such as AVP. Research seeking to explore the effectiveness of meditation as an alternative treatment for symptoms of stress disorders should repeat the current study with key methodological differences. To fine tune our understanding of meditation, experimental groups should include students from various types of meditation. In addition, dependent measures should be expanded to include salivary cortisol or alpha-amylase measurements throughout the sessions. The ideal experiment would have four experimental groups (observation, concentration, transcendental and eclectic meditation courses), two control groups (exercise and regular control), and three dependent measures (cardiovascular reactivity, everyday burnout, and salivary cortisol). The stress-induced event could also be extended to include the full TS ST, although this may not be necessary since even the simple methodology of the current experiment yielded a significant physiological response. Future research should also take care to include a large enough sample size to properly represent the population. Results from a study on that scale could provide a much better defined understanding of which techniques have the most therapeutic value.

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JUST BREATHE AND RELAX 32 References Aarde, S. M., & J entsch, J. (2006). Haploinsufficiency of the arginine-Vasopressin gene is associated with poor spatial working memory performance in rats. Hormones And Behavior, 49(4), 501-508. Butterweck V, B"ockers T, Koite B, et al. (2002). Long-term effects of St J ohns wort and hypericin on monoamine levels in rat hypothalamus and hippocampus. Brain Res; 930: 21-9. Butterweck, V. (2003). Mechanism of action of St John's wort in depression: What is known?. CNS Drugs, 17(8), 539-562. Daruna, J H. (2004). Introduction to Psychoneuroimmunology. Burlington, MA: Elsevier Academic Press. Denson, T. F., Spanovic, M., & Miller, N. (2009). Cognitive appraisals and emotions predict cortisol and immune responses: A meta-analysis of acute laboratory social stressors and emotion inductions. Psychological Bulletin, 135(6), 823-853. Dietrich, A., & Allen, J D. (1997). Vasopressin and memory: I. The Vasopressin analogue AVP[sub]49[/sub] enhances working memory as well as reference memory inthe radial arm maze. Behavioural Brain Research, 87(2), 195-200. Eppley, K. R., Abrams, A. I. and Shear, J (1989), Differential effects of relaxation techniques on trait anxiety: A meta-analysis. Journal of Clinical Psychology, 45: 957-974. Fournier, J C., DeRubeis, R. J ., Hollon, S. D., Dimidjian, S., Amsterdam, J D., Shelton, R. C., & Fawcett, J (2010). Antidepressant drug effects and depression severity:

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JUST BREATHE AND RELAX 33 A patient-level meta-analysis. JAAL4: Journal Of The American Medical Association, 303(1), 47-53. Gerber, M., & Piihse, U. (2009). Do exercise and tness protect against stress-induced health complaints? A review of the literature. Scandinavian Journal Of Public Health, 37(8), 801-819. Gold, C., Wigram, T., & Voracek, M. (2007, December). Predictors of change in music therapy with children and adolescents: The role of therapeutic techniques. Psychology and Psychotherapy: Theory, Research and Practice, 80(4), 577-589. Granger, D. A., Hibel, L. C., Fortunato, C. K., & Kapelewski, C. H. (2009). Medication effects on salivary cortisol: Tactics and strategy to minimize impact in behavioraland developmental science. Psychoneuroendocrinology, 34(10), 1437-1448. Holmes, T. H., & Rahe, R. H. (1967). The Social Readjustment Rating Scale. Journal Of Psychosomatic Research, 11(2), 213-218. Jamieson, J. P., Nock, M. K., & Mendes, W. (2011). Mind over matter: Reappraising arousal improves cardiovascular and cognitive responses to stress. Journal Of Experimental Psychology: General. Kasper, S. S., Gastpar, M. M., M1"1ller,W. E., Volz, H. P., Dienel, A. A., Kieser, M. M., & Moller, H. J. (2008). Efficacy of St. John's wort extract WS 5570 in acute treatment of mild depression: A reanalysis of data from controlled clinical trials. European Archives Of Psychiatry Ana Clinical Neuroscience, 258(1), 59-63. Kemeny M. E. (2003). The psychobiology of stress. Current Directions in Psychological Science, 12, 124-129.

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JUST BREATHE AND RELAX 34 Kessler, R.C., Chiu, W.T., Demler, 0., & Walters, E.E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-I V disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, Jun; 62(6):617-27. Kudielka, B. M., Hellhammer, D. H., & Kirschbaum, C. (2007). Ten Years of Research with the Trier Social Stress Test--Revisited. In E. Harmon-J ones, P. Winkielman, E. Harmon-J ones, P. Winkielman (Eds.) Social neuroscience: Integrating biological and psychological explanations of social behavior (pp. 56-83). New York, NY US: Guilford Press. Lazarus, R. S. (1966). Psychological stress and the coping process. New York, NY US: McGraw-Hill. Lee, S., Ahn, S., Lee, Y., Choi, T., Yook, K., & Suh, S. (2007). Effectiveness of a meditation-based stress management program as an adjunct to pharmacotherapy in patients with anxiety disorder. Journal of Psychosomatic Research, 62(2), 189195. Mayo Clinic Staff. (2010). Anxiety. Retrived April 3, 2012, from http://www.mayoclinic.com/health/anxiety/DS01187 Mithoefer, M. C., Wagner, M. T., Mithoefer, A. T., Jerome, L., & Doblin, R. (2011). The safety and efficacy of ::3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: The first randomized controlled pilot study. Journal Of Psychopharmacology, 25(4), 439-452. Mohan, A., Sharma, R., & Bijlani, R. L. (2011). Effect of meditation on stress-induced

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JUST BREATHE AND RELAX 35 changes in cognitive functions. The Journal Of Alternative Complementary Medicine, 17(3), 207-212. Norton, C. (2008). Understanding the impact of wilderness therapy on adolescent depression and psychosocial development. Illinois Child Welfare, 4(1), 166-178. O'Halloran, J. (1985). Hormonal control in a state of decreased activation: Potentiation of arginine vasopressin secretion. Physiology & Behavior, 35(4), 591-595. Pan, Y., Chen, X., Wu, M., Ma, C., & Qi, J. (2010). Arginine vasopressin prevents against impairment of spatial learning and memory in rats. Hormones And Behavior Selye, H. H. (1936). A syndrome produced by diverse nocuous agents. Nature, 138. Selye, H. (1975). Confusion and controversy in the stress field. Journal Of Human Stress, 1(2), 37-44. Scheinfeld, D. E., Rochlen, A. B., & Buser, S. J. (2011). Adventure therapy: A supplementary group therapy approach for men. Psychology ofMen & Masculinity. Schutte, N., Toppinen, S., Kalimo, R. and Schaufeli, W. (2000), The factorial validity of the Maslach Burnout Inventory-General Survey (1\/IBI-GS) across occupational groups and nations. Journal of Occupational and Organizational Psychology, 73: 53-66. Scully, J. A., Tosi, H., & Banning, K. (2000). Life event checklists: Revisiting the Social Readjustment Rating Scale after 30 years. Educational And Psychological Measurement, 60(6), 864-876.

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JUST BREATHE AND RELAX 35 Medicine, 17(3), 207-212. Norton, C. (2008). Understanding the impact of wilderness therapy on adolescent depression and psychosocial development. Illinois Child Welfare, 4(1), 166-178. O'Halloran, J. (1985). Hormonal control in a state of decreased activation: Potentiation of arginine vasopressin secretion. Physiology & Behavior, 35(4), 591-595. Pan, Y., Chen, X., Wu, M., Ma, C., & Qi, J. (2010). Arginine vasopressin prevents against aB2535-induced impairment of spatial learning and memory in rats. Hormones And Behavior. Selye, H. H. (1936). A syndrome produced by diverse nocuous agents. Nature, 138.Selye, H. (1975). Confusion and controversy in the stress eld. Journal Of Human Stress, 1(2), 37-44. Scheinfeld, D. E., Rochlen, A. B., & Buser, S. J. (2011). Adventure therapy: A supplementary group therapy approach for men. Psychology ofMen & Masculinity. Schutte, N., Toppinen, S., Kalimo, R. and Schaufeli, W. (2000), The factorial validity of the Maslach Burnout Inventory-General Survey (MBI-GS) across occupational groups and nations. Journal of Occupational and Organizational Psychology, 73: 53-66. Scully, J. A., Tosi, H., & Banning, K. (2000). Life event checklists: Revisiting the Social Readjustment Rating Scale after 30 years. Educational Ana Psychological Measurement, 60(6), 864-876.

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JUST BREATHE AND RELAX Figure 1 Post-treatment Systolic Measurements Systolic Blood Pressure 1501C|l3 SD CuntrolExercise Group Error Bars: +I 1SE Mediation M aas _u ram 9 nt Time iaseline During Past 36

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JUST BREATHE AND RELAX Figure 2 Post-treatment Diastolic Measurements Diastolic Blood Pressure 130 EDEU40ED CoritrolExercise Group Error Bars: +:'1SE Nieditetian Measurement Time Baselinealluring Post 37

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JUST BREATHE AND RELAX Figure 3 Post-treatment Heart Rate Measurements I201:10-A an C! SE] Heart Rate (bpm) 4020 Coritrol Exercise Group Error Bars: +:ISE Medrtatian Measurement Time Baseline 38

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JUST BREATHE AND RELAX Table 1 Burnout Scores MeditationExercise Control Total Mean 47.44 43.67 47.43 46.84 Baseline SD 20.65 15.31 23.82 Post-treatment Mean 46.22

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JUST BREATHE AND RELAX Table 2 40 Comparison of baseline and during phases of cardiovascular measurements using twotailed paired t-tests Systolic 3 .04 Diastolic 4.19Heart Rate 3 .46 Baseline <.0l <.0l <.0l Post-treatment I 2 0.88 0.393.43 <.0l 3.46 <.Ol

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JUST BREATHE AND RELAX 41 Table 3 Results of repeated measures ANO VA on cardiovascular responses between groups over time Increase Reactivity N E 12 _1\_/ E 12 Systolic 16 0.49 0.62 8 1.71 0.32 Diastolic 16 2.21 0.14 10 2.16 0.18 Heart rate 16 1.31 0.3 11 0.22 0.65

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JUST BREATHE AND RELAX 42 Table 4 Results of hierarchical multiple regression correlation on post-treatment cardiovascular I"Sp0IlSS Systolic DiastolicHeart rate Increase Inc predicted by Reactivity React predicted group b rou E E Q Beta t Q E _E Q Beta t Q 0.89 16.2 <.01 0.11 0.82 0.43 0.87 12.1 <.01 0.18 1.24 0.240.88 14.1 <.01 0.24 1.58 0.14 0.9 16.2 <.01 0.13 0.92 0.38 0.9 17.1 <.01 0.3 2.19 0.05 0.93 25.9 <.01 0.1 0.84 0.42


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