Table Of ContentUNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES
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APPROVAL SHEET
Title ofDissertation: "TheEffects ofProgressive Relaxation and Music on Attention, Relaxation~
and Stress Responses: AnInvestigation ofthe Cognitive-BehavioralModel ofRelaxation"
Name ofCandidate: LT PeterScheufele
DoctorofPhilosophy Degree
28 January 1999
DissertationandAbstract Approved:
erome Singer, Ph.D.
epartmentofMedical & Clinical Psychology
~Ommittee Chairpe~--l-
,- __
Date
~ ~
~cy
Sbro 0, Ph.D.
DepartmentofMedical & Clinical Psychology
Committee Member
97
~
;23
Edmund Howe, M.D., J.D. Date
DepartmentofPsychiatry
Committee Member
*
Printed on Recycled Paper
The author hereby certifies that the use of any copyrighted material in the thesis
manuscript entitled:
"The Effects of Progressive Relaxation and Music on Attention,
Relaxation, and Stress Responses: An Investigation of the Cognitive-Behavioral
Model of Relaxation.
n
beyond brief excerpts is with the permission of the copyright owner, and will save
and hold harmless the Uniformed Services University of the Health Sciences
from any damage which may arise from such copyright violations.
Peter M. Scheufele
Department of Medical and Clinical Psychology
Uniformed Services University of the Health Sciences
ii
ABSTRACT
Title: The Effects of Progressive Relaxation and Music on Attention,
Relaxation, and Stress Responses: An Investigation of the
Cognitive-Behavioral Model of Relaxation.
Author: Peter M. Scheufele, Doctorof Philosophy, 1999
Directed by: Neil E. Grunberg, Ph.D.
Professor
Department of Medical and Clinical Psychology
Stress management interventions have been shown to be effective
adjuncts forthe management of medical disorders, and for the prevention and
management of occupational stress. Despite their usefulness, it is not
completely understood how behavioral stress management techniques exert
their effects. Benson (1975) proposed that all relaxation techniques elicit a
general "relaxation response." Davidson and Schwartz (1976) suggested that
stress management techniques have specific effects. A compromise position
suggests that the specific effects of relaxation techniques are superimposed
upon a general relaxation response (Lehrer & Woolfolk, 1993). The cognitive
behavioral model of relaxation suggests that relaxation is achieved through
hierarchical cognitive and behavioral factors (Smith, 1988), but has not been
adequately evaluated experimentally (Lehrer & Woolfolk, 1993).
The present experiment examined relaxation within a framework of the
cognitive-behavioral model. Sixty-seven normal volunteers were exposed to a
iii
stress manipulation and"then to one of two relaxation (Progressive Muscle
Relaxation, Music) orcontrol conditions (Attention Control, Silence).
Measurements of attention, relaxation, and stress responses were obtained
during each phase of the experiment. All four groups exhibited similar
performance on behavioral measures of attention that suggested a reduction in
physiological arousal folloWing their relaxation orcontrol condition, as well as
decreased heart rate. Progressive Relaxation resulted in the greatest effects on
behavioral and self-report measures of relaxation. The Music condition resulted
in the lowest biological measures of stress (I.e., heart rate and cortisol
responses).
Results from the present experiment suggest that relaxation techniques
involve both attending to a simple stimulus and a reduction in arousal, consistent
with previous work. In addition, the results were consistent with the position that
specific effects of relaxation techniques are superimposed upon a general
relaxation response. Progressive Relaxation protocols may exert theireffects by
providing cognitive cues to patients to label their reduced arousal as relaxation.
Moreover, relaxing music may be useful forthe prevention of stress-related
symptoms and conditions.
iv
The Effects of Progressive Relaxation and Music on Attention, Relaxation, and
Stress Responses: An Investigation of the Cognitive-Behavioral Model of
Relaxation
by
Peter M. Scheufele
Doctoral Dissertation submitted to the FaCUlty of the
Department of Medical and Clinical Psychology
Graduate Program ofthe Uniformed Services University
of the Health Sciences in partial fulfillment
of the requirements forthe degree of
Doctor of Philosophy, 1999
v
ACKNOWLEDGMENTS
A numberof individuals deserve special mention for theirassistance with
the present work. I would like to thankthe frnlowing people: Natalie Rosen and
Sandra Silbergeld, for assisting with subject payment and advertising requests;
Jim Saris for audio-taping and video equipment; Ann Thomas of Georgetown
University Medical Centerfor being the voice of relaxation; Shannon Gupta and
Fred Lamourfor data entry assistance; Elena Fichera and Jay Stone for being
flexible in sharing laboratoryspaces; Matthew Rahman, Ph.D., for helping with
the computer data; Stephanie Nesporfor assistance with the cortisol assay, and
Wendy Law, Ph.D., for suggesting the attention control and lettercancellation
tasks, and for helpful advice throughout graduate school.
I also would like to thank my dissertation committee fortheirtime and
effort in offering thoughtful feedback to my proposal, revised proposal, and
completed manuscript: Jerome E. Singer, Ph.D. for suggestions regarding
analyses and power; Edmund G. Howe, M.D., J.D., for comments about ethical
and human use issues and reminding me that individual differences matter, and
Tracy Sbrocco, Ph.D., for being my clinical advisorthroughout graduate school.
In addition, I would like to thank CAPT J. Thomas from the Department o~
Radiology for his support in my continued development as a naval officer, and
Michael Feuerstein, Ph.D., for his support of my clinical training.
Finally, I would like to thank my major advisor, Neil E. Grunberg, Ph.D., for
being a "mentor" in every sense ofthe word, for having faith that I could make it
to this point, and for inspiring me with his energy and dedication to reach higher
vi
than Ithought was possible. And to Martha. who knew I could make it. and
makes this journeyso much more.
vii
TABLE OF CONTENTS
Approval sheet .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Copyright statement ii
Abstract iii
Title page v
Acknowledgments vi
Table of Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
List of Tables xiii
List of Figures xvi
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Stress 4
Stress Management: Clinical Overview 9
Stress Management: Key Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 12
Progressive Relaxation 15
Music Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Explanations for Relaxation .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Floor Effect 23
Lack of Effect 23
Relaxation-Induced Anxiety 23
Combinations of Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Attention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Self-focused Attention 31
Summary 33
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
viii
Major Hypotheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Methods 41
Subjects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Experimental Design . . . . . . . . . . . . . . . . . . . . . . 41
Telephone Screening and Subject Assignment 42
Human Subjects Protection . 43
Procedure 44
Stress Manipulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . 46
Progressive Relaxation Condition . . . . . . . . . . . . . . . . . . . . . . . . 47
Music Condition 48
Attention Control Condition .. . . . . . . 49
Silence Condition 51
Final Stress Measurement Period . . . . . . . . . . . . . . . . . . . . . . . . 52
Depen~entVariables 54
Self-Report Measures 54
Behavioral Measures 59
Psychophysiological Measures 63
Biochemical Measure 63
Psychophysical Measure 64
Independent Variable _ 66
Experimental Condition _. . . . . . . . . . . . . . . . . . . . . 66
Statistical Analysis Plan _. . . . . . . . . . . . . . . . . . . . . 67
Sample Characteristics _. . . . . . . . . . . . . . . . . . . . . 67
Behavioral Measures of Attention 68
ix
Self-Report Measures of Attention 69
Behavior Measure of Relaxation . . . . . . . . . . . . . . . . . . . . . . . . . 69
Self-Report Measures of Relaxation 69
Self-Report Measures Indexing Stress 69
Psychophysiological Measures Indexing Stress 70
Biochemical Measure Indexing Stress 70
Psychophysical Measure Indexing Stress 70
Results 72
Sample Characteristics 72
Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Speech Anxiety 72
Positive and Negative Affect . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Perceived Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Psychological Distress 73
Time of Day 73
Music Preference 73
Behavioral Measures of Attention 74
Letter Cancellation Task (DVT) 74
Performance Assessment Battery (PAB) Task 1 76
PAB Task 2 (Serial Addition-Subtraction) 78
PAB Task 3 (Six-Letter Search) 80
Self-Report Measures of Attention 82
Visual Analog Scale (VAS) Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Focus of Attention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
x
