Cogn#ive Therapy and Research, Vol. 5, No. 2, 1981, pp.

211-215

Cognitive and Relaxation Coping Skills in Stress Inoculation

Jerry L. Deffenbacher 1
Colorado State University

Rudolf M. Hahnioser
Scottsdale, Arizona

Stress inoculation (Meichenbaum, 1972) is as effective as, if not more effective than, interventions such as desensitization (Jaremko, 1979). Stress inoculation contains training in two different types of coping skills: (a) self-instructional training aimed at replacing task-irrelevant thoughts with task-oriented self-instruction (cognitive), and (b) a coping form of desensitization (relaxation). The critical treatment components, however, remain unclear. Does its effectiveness derive primarily from training in cognitive self-instruction, from the development of relaxation coping skills, or do the elements interact synergistically to create a treatment more powerful than either component alone? The present study addressed these questions through a parametric analysis of stress inoculation. Test-anxious subjects received one of four conditions: (a) cognitive coping skills (CCS), (b) relaxation coping skills (RCS), (c) combination of cognitive and relaxation coping skills (C + RCS), or (d) waitlist control (WLC). The 47 (31 female and 16 male) psychology students who scored in the upper 25% on the debilitating (D) scale of the Achievement Anxiety Test (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, Department of Psychology, Colorado State University, Fort Collins, Colorado, 80523, to whom all 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 assigned to(a) C C S ( N = 13), (b) R C S ( N = 10), (c) C + R C S (N = 13), or (d) WLC (N = 11). One subject from C + RCS did not complete treatment and was excluded from the study. Instruments measured several distinct aspects of test anxiety. Debilitating trait test anxiety, how much anxiety interferes with tests generally, and facilitating trait test anxiety, how much anxiety facilitates test performance generally, were measured respectively by the 10- and 9-item D and F scales from the AAT. State test anxiety, the momentary affective experience under evaluative stress, was measured by the 10-item worryemotionality scale (Liebert & Morris, 1967), which yields worry (cognitive concern and distraction) and emotionality (self-perceived physiological arousal) scores, as well as a summative index of state test anxiety. Test performance was evaluated by the Digit Symbol Test (Brown, 1969), the Wonderlic Personnel Test (Wonderlic, 1970), and classroom exam scores in one class. Subjects completed all anxiety and performance measures 1 week prior to treatment and 1 week after treatment. The AAT was additionally administered at a 5-week posttreatment follow-up. The worry-emotionality scale was administered just prior to both the analogue and classroom exams, and the analogue test was preceded by instructions stressing the time-limited, intelligence-testing nature of the exam. Treatments consisted of four 50-minute sessions over a 2-week period and were administered in groups of 5-7 by the second author. Since a single therapist was used, therapist bias could not be controlled and was assessed by having subjects complete a 3-item rating scale at the end of each session. Items included (a) counselor interest in group members, (b) clearness of communication, and (c) degree of expressed expectation of 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 inoculation. Test anxiety was described in terms of worry or the tendency to emit irrational, task-irrelevant self-verbalizations during tests, diverting attention from the task and lowering performance. The first two sessions focused on identifying and changing these dysfunctional self-instructional patterns. In the last two sessions subjects developed a set of written selfinstructions that corrected their specific self-defeating cognitive patterns and then practiced these sets while taking standardized tests. Homework involved review and rehearsal of the sets twice per day, especially before exams. RCS described test anxiety in terms of emotionality, the tendency for heightened autonomic arousal to interfere with performance. The first two sessions focused upon training in applied relaxation coping

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skills, becoming aware of arousal, and using it as cue to apply relaxation coping skills. In the last two sessions subjects developed relaxation self-instructional sets and applied them in the same testing conditions as in CCS. Homework involved review and rehearsal of relaxation sets twice per day, especially before exams. C + R C S subjects received both treatment regimens. Test anxiety was explained in terms of both worry and emotionality, and self-instructional sets necessarily included both cognitive and relaxation coping skills. Standardized tests were taken while employing these combined self-instructional sets, and homework involved rehearsal and employment of them. WLC subjects were told they had been selected randomly to have their treatment delayed until the beginning of the next term. Ratings of therapist behavior were averaged across sessions because of little variability within sessions. All Ms were uniformly high (6 or greater) and revealed no differences among active treatments on any of the therapist behaviors (counselor interest, clearness of communication, and expectations of success, Fs(3,42) = 1.17, 2.65, and 1.13, n.s.), suggesting that differences among treatment groups were attributable to treatments rather than to therapist bias, at least measured by these variables. One-way ANOVAs and tests for homogeneity of variance on premeasures revealed no significant between-groups differences, suggesting that prior to treatment groups were equivalent on measures of test anxiety and performance. Therefore, data were analyzed by analysis of covariance using the prescore as the covariate (Table I) with post hoc comparisons among adjusted means done by Newman-Keuls multiple-range tests. Results from the analogue testing demonstrated significant betweengroups differences for worry, emotionality, and states test anxiety, but not for performance. Active treatment groups were less worried (p's < .05), emotional (p's< .01), and state test anxious (p's< .01) than controls and did not differ significantly from one another on these measures. The classroom examination paralleled analogue testing; active treatment groups were less worried (p's< .05), emotional (p's< .01), and state anxious (p's< .01) than controls and did not differ significantly among themselves. Performance in both situations did not differ for treated and untreated subjects, though within-group changes suggested significant practice effects for all groups. Significant posttreatment and follow-up differences were found for both debilitating and facilitating trait test anxieties. Immediately posttreatment, active treatment groups reported significantly less debilitating test anxiety (AAT D) than controls (p's< .05). At follow-up, treated subjects continued to report significantly less debilitating test anxiety than controls (p's < .01), but the C + RCS group now reported significantly

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less debilitating test anxiety than either of the two other active treatment groups (p's< .05). Just after treatment, the C + RCS group reported significantly greater facilitating test anxiety than other groups (p's < .05). At follow-up, the C + R C S group continued to report more facilitating test anxiety than WLC or RCS groups (p's< .05), and the CCS group experienced significantly more facilitating test anxiety than controls(p < .05). While the design did not rule out the possible influence of nonspecific, attentional factors, the results demonstrated that relaxation and cognitive components of stress inoculation alone or in combination effectively lowered test anxiety. Treated subjects showed significant reductions in general test anxiety (AAT D) and in specific stress reactions (worry, emotionality, and state anxiety) in both an evaluative analogue and actual classroom tests. Follow-up revealed that treatment effects were maintained. However, while cognitive and relaxation components alone were effective, their combination appeared somewhat superior. For example, at follow-up C + RCS led to significantly more debilitating test anxiety reduction than either CCS or RCS. Posttreatment results also showed that only the C + RCS group significantly increased facilitating test anxiety, and follow-up revealed that this superiority was maintained relative to RCS. Less formal data additionally support the superiority of C + RCS. Of the eight posttreatment anxiety measures showing change, the C + RCS group produced the greatest change on five and was nearly identical to CCS on a sixth. Change on the Digit Symbol and Wonderlic also was greatest for the C + RCS group. Thus, both formal and informal comparisons suggest that treatment combining cognitive and relaxation coping skills was somewhat superior to either component alone.

REFERENCES
Alpert, R., & Haber, R. N. Anxiety in academic achievement situations. Journal of Abnormal and Social Psychology, 1960, 61, 206-215. Brown, M. A set of eight parallel forms of the digit symbol test. Unpublished set of tests, University of Waterloo, Waterloo, Ontario, Canada, 1969. Jaremko, M. E. A component analysis of stress inoculation training. Cognitive Therapy and Research, 1979, 3, 34-48. Liebert, R. M., & Morris, L. W. Cognitive and emotional components of test anxiety: A distinction and some initial data. Psychological Reports, 1967, 20, 975-978. Meichenbaum, D. H. Cognitive modification of test anxious college students. Journal of Consulting and Clinical Psychology, 1972, 39, 370-380. Wonderlic, E. F. Wonderlic Personnel Test Manual Northfield, Illinois: Wonderlic, 1970.