Breath and Voice 1

RUNNING HEAD: Breath and Voice

Breath and Voice: The Effects of Breathing Awareness and Giving of Testimony on Black and
White Battered Womens Feelings of Depression and Self-Efficacy*

Susan H. Franzblau, PhD, Sonia Echevarria, Michelle Smith, &
Thomas E. Van Cantfort, PhD
Fayetteville State University
Fayetteville, North Carolina









*This study was supported by Grant Number P20 MD001089 from the National Center of
Minority Health and Health Disparities, National Institutes of Health. Its contents are solely the
responsibility of the authors and do not necessarily represent the official views of National
Institutes of Health.

Please send correspondence to Susan H. Franzblau, PhD, Fayetteville State University, 1200
Murchison Road, Fayetteville, North Carolina 28301 (910 672-1574) sfranzblau@uncfsu.edu
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ABSTRACT
In an experiment exploring the effects of testimony and meditative breathing techniques on
depression and self-efficacy, 40 Black and White women, self-identified as abused within the
last two years by an intimate partner, either gave testimony of their abuse to a same race listener,
participated in breathing/relaxation exercises, participated in a combined testimony/breathing
condition, or functioned as waiting controls. Results indicate that breathing and combined
testimony/breathing significantly reduced depression scores and increased feelings of self-
efficacy. There were no differences by race, education, number of children under age 5 in their
custody, or whether or not their abuser was a member of the military. Implications of these
findings for counseling abused women are discussed.
















Keywords: abuse, Black, White, women, mindfulness, yoga, testimony, narrative therapy,
pranayama, breathing, depression, self-efficacy.
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Breath and Voice: The Effects of Breathing Awareness and Giving of Testimony on Black and
White Battered Womens Feelings of Depression and Self-Efficacy
Changing the structural relationships to power, including discrimination and
disempowerment based on ones gender, race/ethnicity, and social class is the first requirement
for building a healthy society (Franzblau & Moore, 2001). It is well-understood that the abuse of
women is one of this countrys most serious public health problems due to extreme power
imbalances between women and men and the social trap that emanates from the expectation that
women engage in strong emotional bonding in their romantic relationships (Dutton, 1988). For
most women, the greatest risk of physical, emotional, and sexual violation will come from a man
they have known and trusted, often an intimate partner (Warshaw, in Dan, 1994, p. 201).
Battered women represent 35% of women seeking care for any reason in emergency
departments (McLeer & Anwar, 1989), and 23% of those who seek routine prenatal care (Helton,
Anderson, & McFarlane, 1987). Seventy-five percent of women who are first identified as
battered in a medical setting will go on to suffer repeated abuse (Star, Flitcraft, & Frazier, 1979).
Lets look at North Carolina as an example of this epidemic. The National Coalition
against Domestic Violence has documented 197 domestic violence murders committed over a
three-year period from 2002 through October 8, 2004. In 2003 alone, The North Carolina
Council for Women/Domestic Violence Commission reported that in all counties in the state,
90,341 crisis calls were received on their hotline. Hospital services were provided for 1,377
battered people, and counseling services for 54,718, the majority of whom were women (39,316)
as compared to men (5,579). Poor women of color are more likely to suffer from abuse and the
effects of domestic violence, given the triple victimization of race, gender, and social class.
Added to this, problems of child custody, length of time victims experience abuse, and the type
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of domestic relationship involved can further exacerbate the effects of abuse. This epidemic is a
multifaceted challenge to those who counsel abused women.
Abuse, Depression and Self-Efficacy. Bandura (1997) has shown that there is a strong
inverse relationship between feelings of self-efficacy and depression. As depression increases,
feelings of confidence to change ones situation decrease. Women are twice as likely to
experience depression as are men. This difference may be due to womens experience of greater
poverty, differing social roles and gender discrimination, as well as more negative life events,
including violence and abuse (Hegarty, Gunn, Chondros, & Small, 2004). When a woman
experiences abuse, the lack of support and loss of self-confidence (self-efficacy) can result in
feelings of hopelessness and depression. Some consequences of depression are easier to
recognize by the sufferer, including low mood and lack of concentration, others may be harder to
recognize because the main effects of depression reduce the persons ability to interact with
loved ones and other family members...These effects can includelack of energy, and
preoccupation with negative themes and ideas (Segal, Williams, & Teasdale, 2002, p. 10). The
inability to influence events and social conditions that significantly affect ones life can give rise
to feelings of futility and despondency (Bandura, 1997, p. 153). People become sad and
depressed by their inability to achieve outcomes that are highly valued (Bandura, 1997) and
because of the common co-occurrence of privations and threats, both apprehension and despair
often accompany perceived inefficacy to alter miserable life circumstances (Bandura, 1997, p.
153). A meta-analysis of the prevalence of mental health problems among women abused by an
intimate partner, found that compared with women who had not been abused, approximately half
of the abused women had clinical depression (Godling, 1999). Those who are depressed are
vulnerable to ruminative thoughts and need to develop skills to counteract these invasive
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thoughts, given that rumination about dejecting life events and the womens despondent state
tends to amplify and prolong depressive reactions (Bandura, 1997).
Abused women, in their terror, often restrict their behavior to actions deemed acceptable
to the perpetrator. As a result, these actions limit participation in public life and undermine self-
confidence (Heise, Pitanguy, & Germain, 1994). Dan (1994) suggests that blaming the woman
for her abuse, not showing genuine concern for the abused womens experience, or failure to
recognize the impact of battering on the abused womans life and psyche can cause the battered
women to further withdraw and avoid seeking the help she needs. Low self-efficacy can stem
from a continuation of abuse and others lack of recognition of that abuse. Low self-efficacy
also stems from the lack of ideological and institutional support so needed by those who are the
most oppressed. The feelings of powerlessness and lack of self-efficacy among abused women
crosses a number of domains (Franzblau & Moore, 2001).
Socializing Efficacy. Whether or not one feels confident that they can change the
conditions of their lives initially depends upon ideological support: Women need to feel
confident that their gender, race, and social class will not interfere with their ability to leave their
abusive relationship and find housing, a job, and affordable health care. Second, economic
support is critical for the women to have the means to hire an attorney, move away from the
abuser, and provide independent support for their children. Third, an education enables women
to develop job skills that would allow them to gain economic independence. Fourth, women
must have confidence that they have the legal support to keep their batterer away from them and
their children, as well as maintain custodial rights to their children.
Finally, for those women who have few financial, institutional and ideological resources
to combat abuse, nonjudgmental emotional social support is critical. Nonjudgmental emotional
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and social support, allow women to believe that they can control the outcome of their situation.
If they are not given nonjudgmental emotional and social support, abused women could continue
to isolate themselves from significant others in their lives, including friends and family members,
thus increasing their depression and lowering feelings of self-efficacy.
Although the focus of domestic violence research has been to treat abused women as
victims, there is little published literature addressing how abused women understand the causes
of abuse, how their opinions may differ from those with little or no experience with such
violence, and how the implications of such differences might be for interventions and prevention.
The insights that abused women could offer, given their past or ongoing experience with abuse,
are often overlooked in traditional research (Nabi & Horner, 2001). By recasting abused women
as authorities on domestic violence, we enable these women to express their unique insights into
the depth and breadth of abusive experiences, as well as in potential solutions to abuse (Nabi &
Horner, 2001). Therapists could also learn from this approach.
The Value of Testimony.
In truth, no person has privileged access to the naming of anothers reality. The only
thing we can hope for is our ability to interpret the experiences of others, keeping in mind that
others experiences are seen through their own lens, contextualized in their lived experience.
The most we can do as researchers and counselors is to identify, and bring into our
consciousness, our own experience of the experience of others, as expressed by them. This is
why empathy is so important to the understanding of the experiences of others, and so critical to
any environment deemed to be therapeutic. Empathy is defined here as our ability to connect
other persons understandings of their experiences with our understanding of the experience of
the other. When a person authors their experience (verbally describes the experience in her own
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words without coercion), we can better understand, through collaborative qualitative analysis of
the persons testimony, the meaning they give to their experience (Epston, & White, 1992).
Narrative Therapy. For many victims of violence, giving testimony can be viewed as a
form of therapy. In fact, narrative therapy is a growing body of practices and ideas, whose
primary focus is giving precedence to peoples stories and voices (Freedman &Combs, 1996). In
narrative therapy, the therapeutic relationship is seen as facilitative. During narrative therapy,
the client becomes an active collaborator in the therapeutic process, which helps them move
away from self-recrimination, blame, and judgment (Monk, 1997). Narrative acts of self-making
are guided by unspoken, implicit cultural models of what selfhood should be, might be, and
should not be. Self-making is the principle way a person establishes his/her uniqueness,
allowing the person to distinguish herself from others (Bruner, 2004), and is culturally embedded
(Cushman, 1991). The narrative approach to counseling enables clients to begin their journey of
co-exploration in order to find hidden talents and abilities that may help them overcome life
problems (Monk, 1997). The persons telling of her story offers a landscape or context within
which a persons problems can be understood by both the therapist and the client.
In all cultures, telling stories is a process of sharing history with ones family, the
community, and larger culture. Although these relationships are often not directly attended to
and verbalized, they certainly constitute a part of the dialogue between individuals and, as such,
are part of the social processes through which stories are shaped (Richert, 2003). For abused
women, the listener can be defined as a therapist, attorney, judge and/or jury, and people who
work within the therapeutic and criminal justice communities. Heightened sensitivity to contexts
such as culture, gender, race, and class, add to the ability of the listener to understand, empathize,
and offer help in meaningful ways (Lieb & Kanofsky, 2003). Richert (2003) suggests that
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therapists take care to locate her/his questions in the context of the therapists experience as well
as the clients experience, as a way of acknowledging the co-created nature of meaning and of
privileging the clients knowledge.
No reality exists, independent of human meaning. However, meanings are not generated
by individual minds alone, but by social interaction. Interaction is central to this process of
meaning making because the performative nature of language generates the very state of affairs
being described (Richert, 2003). Rogler (1999) suggests that a participant or client will inform
the listener of proper means of interpreting his or her actions. Thus, if a researcher or counselor
actually listens to what the clients say, assumptions of homogeneity fall by the
waysideNorms can and should be sensitized to each respondents experience (Rogler, 1999,
p. 431).
Significantly, the cultural story of psychotherapy privileges the therapists knowledge
and sets up a power differential between the client and therapist. Telling others about oneself
is, then, no simple matter. It depends on what we think they ought to be like-or what selves in
general ought to be like (Bruner, 2004, p. 4, emphasis his). Within narrative therapy, the
listener is required to create a safe and nonjudgmental environment for the client. Therapists
approach the clients story with openness by locating his or her questions within the context of
the clients experience (Richert, 2003).
The value of testimonial or phenomenological studies of victims of violence cannot be
underestimated in terms of our understanding of victims experiences and how that would inform
our ability to help them. For example, in a study of 164 people who recounted situations in
which their feelings had been hurt, Leary and his colleagues (Leary, Springer, Negel, Ansrell, &
Evans, 1998) found that hurt feelings were characterized by undifferentiated negative affect,
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which affect is often accompanied by emotions such as anxiety and hostility. Analyses of the
subjective experiences of these victims revealed that these hurtful episodes typically had
negative repercussions for the relationships between perpetrators and victims. In a pre post study
of Sudanese refugees living in a Ugandan refugee settlement who were diagnosed as suffering
from PTSD, only 29% of those who gave testimony about their abuse, compared to 79% of those
who just went through supportive counseling, and 80% of those who went through psycho
education, were found to still fulfill PTSD criteria after one year. The lessening of PTSD among
those who gave testimony of their abuse occurred despite the fact that they continued to live in
dangerous conditions (Neuner, Schauer, Klaschik, Karunakara, & Elbert, 2004).
The testimony method has also been used for a group of 20 traumatized 23-62 year old
refugees from genocide in Bosnia-Herzegovina (Weine, Kulenovic, Pavkovic, & Gibbons,
1998). All participants received an average of 6 sessions of testimony psychotherapy and then
were given standardized instruments for measuring PTSD in a pre-post test design and at 2 and 6
months follow-up. The post-treatment assessments demonstrated significant decreases in the rate
of PTSD diagnosis, symptom severity, the severity of re-experiencing, avoidance, and depressive
symptoms. The researchers found significant increases in scores on the Global Assessment of
functioning Scale (GAFS). At 2 and 6 months follow-up, refugees showed significant decreases
in all symptoms and an increase in the GAFS. This pilot study provides preliminary evidence
that giving testimonies as a form of psychotherapy may lead to improvements in depressive
symptoms, PTSD, and improvement of functioning in survivors of state-sponsored violence.
Research in this area reveals interesting content, not often available through strict
nomothetic methods. For example, Thomas (2003) used a community sample of 19 middle-class
men who audio taped their anger narratives. Thomas found that anger experiences were
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described by the men as intense physical arousal felt within the body. Nomothetic methods
might measure physical arousal as a correlate to the mens telling of their story but could not tell
us the meaning that men gave to this physical arousal.
In a study of battered women using a three session interview methodology, Buchbinder &
Eisikovitz (2003) found that shame was found to be prevalent in battered womens
phenomenological biographies. The researchers argue that shame traps the battered women,
having a pervasive influence on the self, relationships with others, and emotional experiences,
and becomes an obstacle in leaving the violence (p. 4). Buchbinder & Eisikovitz suggest that
any form of intervention depends on this understanding of the womens feelings of shame.
The above studies reveal that telling ones story of abuse and victimization is a necessary
first step, although not sufficient, for reduction in feelings of depression, relief from anxiety, and
increases in feelings of self-efficacy. A World Bank study (Heise, Pitanguy, & Germain, 1994)
found that women who are unable or unwilling to seek help from the police or other
government authorities may nonetheless admit abuse when questioned gently and in private by a
supportive[person]Contrary to expectations, women are willing to admit abuse when
questioned directly and non-judgmentallyIn fact, asking itself can be an important
intervention (p. 34). According to Dr. Ana Flavia dOliveira (1993), some women have been
waiting their whole lives for someone to ask.
In a study of narrative story-telling, comparing listening techniques, researchers Bavelas,
Coates, & J ohnson (2000) found that the way listeners listened had an effect on the content of the
narratives. In a study of sixty-three unacquainted dyads, one person in each dyad told his or her
own close-call story. Distracted listening using generic responses (e.g. mmm!) resulted in stories
that were less illustrated. Specific responses such as wincing or exclaiming which were
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connected to what the narrator was saying at the moment seemed to help the narrators
performance. This finding suggests that moment-by-moment collaboration is important to face-
to-face storytelling.
Intimate violence silences and isolates its victims. The insights that abused women could
offer, given their past and ongoing experience of domestic violence, are often overlooked.
Giving testimony of their abuse stops the silence and allows women to inform those who have
the authority to help. Further, by recasting abused women as authorities on domestic violence,
women are given back their voice, enabling them to express their unique insights into the
occurrence of abuse and its potential solutions (Nabi & Horner, 2001).
Working with Breath, Pranayama, and Consciousness-Based Therapies.
The effects of intimate abuse on women, their bodies, minds, consciousness, and spirit
(including their will to live and resilience) can be vast and devastating. Abused women may
suffer from depression, low self-efficacy, post traumatic stress, anxiety, and low self-esteem.
Physically, they may suffer lowered and compromised immune systems, miscarriages, broken
bones, and bruised organs. All of these experiences affect and are affected by their breathing.
The use of breath to focus on the present and enable the person to observe their negative
thoughts without being caught up in them, has been explored most recently through the concept
of mindfulness (Kabat-Zinn, 1990, 1994).
Mindfulness Based Cognitive Therapy. Until very recently, mindfulness has been a
relatively unfamiliar concept in much of traditional Western health care (Kabat-Zinn, 1982).
The concept of mindfulness has its origins in Hatha Yoga: which includes doing yoga poses
(asanas), engaging in pranayama (breath control), and the practice of sitting meditation: Asanas,
pranayama, and sitting meditation are intricately related to one another. Mindfulness, according
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to Kabat-Zinn (1994) simply means paying attention in a particular way on purpose in the
present moment, and without judgment. Theoretically, mindfulness does not eliminate negative
thoughts and emotions; however, with mindfulness practice one is less caught up in these
negative thoughts and emotions (Cohen-Katz, Wiley, Capuno, Baker, & Shapiro, 2004).
[M]indfulness based stress reduction therapy has amazing therapeutic effects in which
the patient is able to see that thoughts are just thoughts and they are not you or reality, that
the simple act of recognizing thoughts as thoughts can free one from the distorted reality often
created which then allows for more clear-sightedness and a greater sense of manageability in life
(Kabat-Zinn, 1990, 69-70)

Segal, Williams, & Teasdale (2002) suggest that, as a result of repeatedly identifying
negative thoughts as they arise and standing back from them to evaluate the accuracy of their
content, patients often make a more general shift in their perception of negative thoughts and
feelings.
Mindfulness-Based Cognitive Therapy is a skills-training program designed to teach
people to become more aware of and to relate differently to their thoughts, feelings, and bodily
sensations. Thoughts and feelings are encouraged to be seen as passing events in the mind rather
than seeing them as part of the self, identifying with them, or treating them as accurate
reflections of reality. The eight week program, as designed by Kabat-Zinn (1982), teaches skills
that allow people to disengage from habitual dysfunctional routines of thought, particularly those
thoughts that are ruminative and depressionrelated. The program involves yoga poses (asanas),
sitting meditation, and diaphragmatic breathing (pranayama).
When one is mindful, the mind responds afresh to the unique pattern of
experience in each moment instead of reacting mindlessly to fragments of a total
experience with old, relatively stereotyped, habitual patterns of mind. (Teasdale, Segal,
Williams, Ridgeway, Soulsby & Lau, 2000, p. 618)

The few Mindfulness-Based Cognitive Therapy experiments (using random assignment
and control groups) completed within the last ten years have revealed some very interesting and
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positive results. In one such study, depression was lowered in patients studied in Bangor, North
Wales and their over generalized autobiographical memories were significantly reduced
(Williams, Teasdale, Segal, & Soulsby (2000). In a study of how mindful meditation could
reduce stress in patients with moderate to severe psoriasis who were undergoing phototherapy,
those who received mindful meditation reached a halfway relief point or a clearing point
significantly more rapidly than those in the control group. It also increased the rate of resolution
of psoriatic lesions in patients with psoriasis (Kabat-Zinn, Wheeler, Light, Skillings, Scharf,
Cropley, Hosmer, & Bernard (1998). In a study by Teasdale, Segal, Williams, Ridgeway,
Soulsby & Lau (2000), patients in remission or recovery from major depression, who received
Mindfulness-Based Cognitive Therapy (MBCT), had less hazard of relapse, when compared to
controls. In fact, participants with three or more previous episodes of depression almost halved
their relapse/recurrence rates over the follow-up period, again as compared to controls.
Yogic Understandings of Breath. In the yogic tradition, prana is substituted for breath.
According to yogic teachings, Prana is vital energy which connects the psyche/mind and
soma/body. It is vital because it is the very essence of life (Rama, Ballentine, & Hymes, 2004).
Without prana we are said to have expired. How does prana affect these various systems of
the body, mind, and spirit?
Although Western science has determined that breathing is controlled by the autonomic
nervous system, yoga teaches us that even though breath is controlled by the autonomic nervous
system, we are able, with practice, to place the breath under conscious control. This is the work
of pranayama: The means to self-inquiry, self-realization, and self-transformation (Rosen,
2002). Breath, as understood through ancient Vedic knowledge, leads us to understanding of the
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self, changing of the self, and the revelation that we are part of and breathing with the breath of
the universe.
These ancient guides to breath suggest physical and psychological benefits as well.
Breath improves digestion and speeds elimination of wastes from the body, centers and focuses
the mind as a distraction from hunger and thirst, opens the sinus cavities so that more oxygen
enters the body, combines with blood in the lungs to create oxygenated blood, which then travels
throughout the body. Breath has powerful effects on diseases of the upper respiratory tract,
including allergies and clogged sinuses. Breath, through the elongation of the exhalation,
reduces blood pressure and concomitant anxiety (Rama, Ballentine, & Hymes, 2004). Muscles
involved in respiration include the diaphragm, intercostals, abdominal, and accessory muscles.
Seventy-five percent of air movement during quiet inhalation is accounted for by the work of the
diaphragm. The intercostals, abdominal and other muscles, including sternoleidomastoid and
other neck muscles are engaged in the other 25% of air movement during quiet inhalation
(Caruana-Montaldo, Gleeson, & Zwillich, 2000).
A number of small studies, often with a limited number of participants, some done in
India and some in the United States, have revealed some preliminary evidence for the effect of
yogic breathing exercises on mood and stress of a diversity of people (e.g. Rama, Ballentine, &
Hymes, 1998; Weber, 1996). Weber conducted a study at South Nassau Communities Hospital
in Oceanside, New York (1996) and found that clinically diagnosed patients benefit from
meditative breathing, guided imagery and soft music. Thirty-six patients with major depression,
bipolar disorder and schizophrenia experienced a significant drop in their anxiety levels after
three sessions a week of these relaxation techniques. These techniques relied on breath as an
anchor, teaching the participants that deepening their use of breathing can steady them. Weber
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suggests that these breathing techniques also had the effect of opening these patients up to new
experiences.
In a longitudinal study of applied relaxation techniques as applied to generalized anxiety
disorder, Borkovec & Costello (1993) trained fifty-five participants to use slow-paced meditation
with diaphragm breathing and monitored their reactions. Results indicated that applied
relaxation had a major impact on BDI-II depression scores and Hamilton Anxiety Rating Scale
Scores. Kim & Kim (2005) examined the effects of a particular relaxation breathing exercise
they designed on anxiety and depression in stem cell transplant patients. They developed a 30
minute tape demonstrating exercises to be practiced while they were lying in bed. These
exercises consisted of concentrating on the lower abdomen, placing their ankles on their knees,
bending both knees, relaxing the body and mind, stroking down their hair and face, rotating their
ankles, and stretching their legs and arms in bed. Compared to the control group, the relaxation
breathing exercise (RBE) groups depression, as measured by the BDI-II, decreased
significantly.
According to the philosophy of pranayama within the context of Hatha Yoga, (Iyengar,
2003) the act of breathing takes place in the present, thus the focus on breath helps the person put
the past and future aside and concentrate on now, rather than later. Further, awareness of breath
takes the place of ruminative thinking, allowing the person to substitute negative thoughts with
the simple and deliberate act of breathing (Segal, Williams, & Teasdale, 2002). These breathing
and relaxation techniques could have an important place within the clinical/counseling
community because these techniques have been shown to have positive effects on the mitigation
of anxiety, panic attacks, as well as chronic pain (Kabat-Zinn, Lipsworth, Burner, & Sellers,
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1986; Kabat-Zinn, Massion, Kristeller, Peterson, Fletcher, Pbert, Lenderking, & Santorelli,
1992).
Investigating Pranayama. According to researchers and practitioners of pranayama (See
for example Iyengar, 2003; Rosen, 2002; Rama, Ballentine, & Hymes, 2004), pranayama
involves the lengthening, directing, regulating and movement of the breath, which includes
limiting, restraining, and retaining breath. The origins of pranayama are not well-known but
may go all the way back to the writing of the Vedas, or Sanskrit books of knowledge coming out
of India about four thousand years ago (Rosen, 2002). Prana in Sanskrit means to bring forth life
(pra-to bring forth; na-to live). Yama (or ayama) means stretch, extend, stop, lengthen in space
or time but is often translated in English to mean control (Rosen, 2002). Iyengar (2003) states
that [d]uring normal inhalation, an average person takes in about 500 cubic centimeters of air;
during deep inhalation the intake of air is about six times as greatThe practices of pranayama
increase the students (sadhakas) lung capacity and allows the lungs to achieve optimum
ventilation (p. 15).
A variety of breaths are used for a diversity of objectives. For example, during savasana
(corpse pose/relaxation), the breath is slow, steady, and quiet, allowing the body, mind, and brain
to move towards the center of the self, allowing one to recuperate. The person, according to
Iyengar, reaches a state of clarity, where consciousness, rather than ruminating thoughts, is in
full command (p. 251). Placing the breath has the effect of showing the sadhaka that breath is
under their control and can move from place to place within the body, for the purpose of
stimulation or relaxation.
The following study used a variety of pranayama techniques, including training the
women to work with extensions and reductions of inhalations and exhalations, to place the
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breath, to understand the movement of the diaphragm, to learn to lift and open the chest in order
to free the breath in the upper lungs, to use breath with sound as an enhanced relaxation
technique, and, finally, to use the breath to recuperate by maintaining a state of focused stillness
in body, senses and mind. Yoga poses were incorporated into the breathwork for the purpose of
enhancing the pranayama technique (See Appendix A).
METHODOLOGY
The following experiment, funded under grant P20 MD002089-01 from the National
Institutes of Health, NCMHD, and Department of Health and Human Services, investigated how
the giving of emotional/social support by training battered women in yogic breathing techniques
and encouraging them to give testimony of their abuse affected their feelings of self-efficacy and
depression. The experiment was conceived as a 2(testimony) by 2 (breathing) repeated measures
design. The researchers hypothesized that telling ones story of abuse will influence scores on
the BDI-II (Beck, 1996) and the Franzblau Self-Efficacy Scale (FSES) (Franzblau, 1997) (See
Appendix A). They also hypothesized that learning yogic breathing techniques will influence
scores on the BD-II and FSES. Researchers assumed that the scores on the BDI-II and FSES
would reflect the inverse relationship between self-efficacy and depression (Bandura, 1997). It
was expected that the significance of this inverse relationship would lend support for the inter-
instrument reliability of the BDI-II and FSES.
It was further hypothesized that the battered womans race, whether or not the abuser was
a member of the military, the womens level of education, and the number of children under the
age of 5 living in the abused womens custody would affect both levels of depression and
feelings of self-efficacy.

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Participants.
Forty women who self-identified as either Black (n=20) or White (n=20) and also self-
identified as verbally, emotionally, physically, and/or sexually abused by a man with whom they
have been intimate within the last two years, were invited to participate. The participants were
found through advertisements and snowballing techniques. Announcements of the experiment
were carried in the local newspaper, through placement of flyers on the inside of bathroom stall
doors in the court house, the local state university and community college, and in various bars
and other locations. Within race, the participants were randomly assigned to one of four
conditions: testimony, breathing, testimony/breathing, or waiting control. They were also
matched with a trained listener of the same race. Each participant received $100.00(1/3 the first
day, 1/3 the third day, and 1/3 the last day)
Listeners.
Women research assistants (two counseling masters students and one senior
undergraduate psychology major) were trained to actively listen to the participants, asking
questions only to encourage the participants to talk about and elaborate on their experiences (e.g.
could you talk more about that; could you explain what you mean). The research assistants were
also trained to exhibit conscious involvement in the participants story through eye contact and
body language. All testimonies were taped for later transcription. One of the graduate students
was trained by the primary investigator, who is a Registered Yoga Teacher, to teach the
breathing protocol (See Appendix B).
Procedure.
Experimental Conditions:
1. Testimony (two 45 minute sessions over two consecutive days)
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2. Breathing (two 45 minute sessions over two consecutive days)
3. Combined testimony/breathing (two 45 minute sessions, beginning
with testimony, over two consecutive days)
4. Waiting controls (waiting controls were to receive one of the two
treatment conditions after the experiment ended, if they wished to
continue their participation)
The experiment took four consecutive days to complete. Testimonies were taken in a
small room in a discrete location on the third floor of the campus library; breathing techniques
were taught in a yoga studio located close to the university. On the first day, participants took a
modified version of the FSES and the BDI-II, and were asked to fill out a demographic sheet and
informed consent. All participants took the FSES and BDI-II again on the fourth day, and were
debriefed. If at any time during the four days they requested legal or psychological help, a sheet
of paper with resource information was given to them. The sessions were recorded on a Marantz
PMD-670 compact flash recorder with 2GB CF card for later transcription and content analyses
of the narratives.
RESULTS
Overall, African American women in this sample were bettered educated than Whites.
Nevertheless, only three women (1 African American and 2 White women) had graduate school
experience. A Chi Square analysis showed no significant difference in level of education by
race. Most participants completed high school and had some college education. No other
demographic information differentiated the participants.
The Becks Depression Inventory II (BDI-II) (Beck, 1996) was used to measure the level
of depression for each participant both before and after treatment conditions. The BDI-II clinical
Breath and Voice 21
scores range from minimal to severe: minimal (0-13), mild (14-19), moderate (20-28), and severe
(29-63). In the Testimony condition and Testimony/Breathing condition, the pre BDI-II scores
were severe ( X =31.2 & 30.7 respectively). The post BDI-II scores for Testimony changed
from severe to moderate ( X =21.7); and for Testimony/Breathing, changed from severe to mild
( X =17.2). For the Breathing condition, the pre BDI-II scores were mild ( X =10.4) with post
scores improving to minimal ( X =4.6). Waiting controls, who took the BDI-II three days apart,
scored moderate in both pre and post conditions ( X =23.2 pre & 22.2 post). Inter and intra
instrument reliability was tested using a Persons r. Then analyses of variance and covariance
were computed. Post hoc comparisons were made for both the analyses of variance and
covariance.
The FSES was computed to produce a positive self-efficacy and negative self-efficacy
score. The scale consisted of five bifurcated factors: anxiety/relieved; in control/out of control;
unafraid/afraid; secure/insecure; confident/non-confident. Participants were required to indicate
the level of intensity for each factor: extremely (coded as 3), moderately (coded as 2), and
somewhat (coded as 1). Both positive and negative factors were added up and the difference
between positive and negative scores was computed. The resulting score was then analyzed
using analysis of variance. Individual factors were also analyzed comparing pre and post scores.
Pearson r correlation matrix reveals the relationship between the pre BDI-II and post
BDI-II scores. The analysis yielded a correlation of r =.719 (p =.001). Fifty-two (52%) percent
of the variability in the Post BDI-II is accounted for by the pre BDI-II score.
A test of the relationship between the pre FSES positive score and the pre FSES negative
score yielded a correlation of r =.796 (p =.001). This correlation indicates that as the pre FSES
positive score increased the pre FSES negative score decreased. Sixty-three (63%) percent of the
Breath and Voice 22
variability in the pre FSES positive score is accounted for by the pre FSES negative score. These
findings confirm the intra-instrument reliability of both the BDI-II and the FSES.
A test of the relationship between the pre BDI-II and the pre FSES positive score yielded
a correlation of r =-.701 (p =.001). Forty-three (43%) percent of the variability in the pre FSES
score is accounted for by the pre BDI-II score. This finding indicates an inverse relationship
between these two instruments, confirming one of the hypotheses. As the pre FSES positive
score increased, the pre BDI-II negative scores increased. The relationship between the pre BDI-
II and the pre FSES negative score yielded a correlation of r =-.641 (p =.001), with forty-one
(41%) percent of the variability in the pre FSES negative score accounted for by the pre BDI-II.
This finding indicates an inverse relationship between these two measures (See Correlation
Matrix Table 1).
These findings support the inter-instrument reliability of the BDI-II and FSES, and reveal
a strong inverse relationship between self-efficacy and depression. As Bandura (1997) has
suggested, the inability to control current or future events influences mood. Raising an
individuals feelings of self-efficaciousness promotes empowerment and facilitates a decrease in
depression.
[Place Table 1 here]
BDI-II. An analysis of variance, comparing treatment conditions to difference scores on
the BDI-II, resulted in an F-ratio of 4.123 (df =3, 36; p =.013). The treatment conditions
accounted for 23% of the variability in the scores. This finding demonstrates that treatment
overall, had a significant effect on the BDI-II scores (See Table 2).
[Place Table 2 here]
Breath and Voice 23
A Tukey Post Hoc analysis revealed that the most significant difference in depression lies
between the Testimony/Breathing condition and the Waiting Control (Mean Difference of 8.4, p
=.008) (See Table 3).
[Place Table 3 here]
The means of the difference in the pre and post BDI-II scores for each treatment
condition were computed. The means are as follows: Testimony 9.50, Breathing 7.40,
Testimony/Breathing 13.5, and Waiting Control 1.10. These scores represent an average
reduction of depression levels across all treatment conditions. Again, the largest difference is
between Testimony/Breathing and Waiting Control (See figure 1)
[Place Figure 1 here]
Depression scores improved across all treatment conditions. In the Testimony condition
70% of the participants had improvement in their depression scores; and the Breathing condition
50% of the participants had improvement. It should be noted that 50% of the participants
randomly assigned to the breathing treatment group had initial scores in the minimally depressed
range (0-13), which left no room for improvement. However, 100% of the participants who
could improve their scores did. Seventy percent of the participants in the Testimony/Breathing
condition also showed an improvement. Only 20% of the participants in the Waiting Controls
showed improvement. These findings indicate that all treatment groups improved their
depression scores, compared to controls (See figure 2). A Chi Square analysis was conducted
after removing those participants with minimal depression scores, which reduced the sample size
by 9 (40 to 31), of which 55% came from the Breathing group. One was lost from the
Testimony/Breathing group and three from the Waiting Controls. That left eight cells in the Chi
Square matrix; expected values require at least 5 per cell, which would require 40 participants.
Breath and Voice 24
Thus, 31 remaining participants would not meet the expected condition for a Chi Square
analysis. Nevertheless, a Pearson Chi Square analysis revealed a value of 7.734 (df =3; p =
.052).
[Place Figure 2 here]
A between subjects Analysis of Covariance revealed an F ratio of 3.164 (df =3, 35; p =
.037). Treatment accounted for 21% of the variability in the post BDI-II scores. This finding
indicates that, overall, treatment conditions had a significant effect on the post BDI-II scores
(See Table 4).
[Place Table 4 here]
A Post Hoc comparison between treatment conditions revealed a significant difference
between the Breathing group and Waiting Controls ( X =8.261, p =.031). A Post Hoc
comparison between the Testimony and Breathing group was also significant ( X =10.224, p =
.009). There was no other statistically significant difference between groups (See Table 5).
[Place Table 5 here]
A race (2) X treatment conditions (4) between subjects analysis of covariance was
computed, revealing a main effect of treatment (F =2.947, p =.048). There was no main effect
for race and no interaction between race and treatment. Negative FSES scores decreased as a
result of treatment, which accounted for 22% of the variability in the post FSES score (See Table
6).
[Place Table 6 here]
Although analyses revealed no main effect of race on FSES scores and no interaction, it
is interesting to note the difference between Black and White abused womens post negative
FSES (See figure 3). White womens mean post FSES negative score was 1.2 points less than
Breath and Voice 25
Black womens mean post FSES negative score. This difference in self-efficacy could be
accounted for by cultural differences in social support networks, coping styles, social class,
and/or types/intensity of abuse. Further research using a larger sample size and more specific
demographic information might reveal whether this difference can be sustained.
[Place Figure 3 here]
A one-way Analysis of Variance, comparing pre and post difference scores on each of the
five factors in the FSES was computed. The five factors are: 1) In/Out of Control; 2)
Secure/Insecure; 3) Confident/Not Confident; 4) Afraid/Unafraid; and 5) Anxious/Relieved. For
the factor In/Out of Control analysis revealed an F ratio of 3.541 (df =3, 35) p=.024 and for
Confident/Not Confident an F ratio of 4.023 (df =3, 35) p =.015. For the factor
Secure/Insecure, analysis revealed an F ratio of 3.308 (df =3, 35) p =.031. A Tukey HSD post
hoc comparison revealed that all of the significant differences were between
Testimony/Breathing and Waiting Controls (mean differences were: In/Out of Control =
2.85556; Confident/Not Confident =2.90; Secure/Insecure =2.78889 (see figures 4 - 6), (p =
.05)).
[Place Figures 4, 5 & 6 here]
DISCUSSION
Statistical analyses of the effects of the four experimental conditions on depression and
self-efficacy confirmed a number of hypotheses. An inverse relationship between depression
and self-efficacy was confirmed. The breathing condition significantly affected abused womens
levels of depression and self-efficacy; and the combination of giving testimony and breathing
affected their levels of depression and negative self-efficacy. There were significant differences
between the waiting control group and testimony/breathing conditions on feelings of self
Breath and Voice 26
efficacy, particularly for the factors In Control/Out of Control, Secure/Insecure, and
Confident/Not Confident. A number of hypotheses were not confirmed. For example, there
were no racial differences, no differences in education, and no influence of children under the
age of five on depression and self-efficacy.
Critique. Although the abused women participants were randomly assigned to the four
conditions, it was not possible for participants to be blind to the conditions to which they were
assigned. Therefore, women who took the BDI-II in the testimony condition initially scored in
the severe range. After giving their testimony, their BDI-II scores fell from clinically severe to
moderate. Women who took the BDI-II prior to the breathing condition, however, scored in the
mild range. After the breathing exercises, their BDI-II score fell from mild to minimal.
Interestingly, women who took the BDI-II prior to the combination testimony/breathing initially
scored in the severe range and after their combined condition, scored in the mild range. Waiting
controls scored in the moderate range in both the pre and post conditions. What accounted for
the differences in pre BDI-II scores? It may be that the BDI-II, rather than measuring some
internal and consistent trait categorized as depression, actually reflects their present state
combined with context within which they were taking the test, and the expectations arising from
awareness of this context. Given that the women were not blind to the conditions to which they
were assigned, those in the testimony condition may have been affected by the expectation that
they were giving testimonies about their abuse, possibly causing them to feel more depressed
initially. Women in the breathing condition could have been affected by the expectation that
they were going to relax, possibly causing them to feel less depressed initially. Women entering
the combined condition were initially affected by having to give their testimonies first; however,
because they learned breathing/relaxation last, their depression scores moved from severe to
Breath and Voice 27
mild, reflecting how relaxed they were the day after the breathing session. This result is very
revealing, indicating that context, rather than an example of an internal validity problem, should
be an important consideration in helping abused women move towards psychological and
emotional health (See Rogler, 1999, for a more extensive examination of the role of culture and
context in mental health assessment).
CONCLUSION
Historically, abused womens right to tell the story of their abuse has been drowned out
by the authoritarian voices of government officials, police, family, religious institutions and even
friends. Our understanding of intimate abuse is limited by who gets to tell these womens story,
and depends on who is listening, and whether or not the women are believed. For most of the
women in this study, giving their recorded testimony was their first chance to hear themselves
talk about the horrific details of their experiences. The women were finally able to release the
emotional burdens that had been buried within, in a non-threatening and nonjudgmental
environment. The environment created in this study gave the women a chance to voice their
concerns and their fears, without being reprimanded, interrogated, ignored, and most
importantly, further violated by the listener. Dan (1994) suggests that blaming women for their
abuse, not showing genuine concern for the abused womans experience, or failure to recognize
the impact of battering on her life and psyche can lead to further withdrawal and avoidance of
the help-seeking that she needs. The narrative approach to counseling enables clients to begin
their journey of co-exploration of the hidden talents and abilities that may help them overcome
life problems (Monk, 1997). In order for women to begin to feel self-efficacious, they need
basic social and emotional support involved in active and nurturing listening followed by
mindful exercises in breathing and relaxation (See Franzblau & Moore, 2001, for a discussion of
Breath and Voice 28
socializing efficacy). By recasting abused women as authorities on domestic violence, they are
enabled to express their unique insights into the occurrence of abuse and its potential solutions
(Nabi & Horner, 2001).
This study shows that for battered women, both self-efficacy and depression are
influenced by minimal conditions in their environment, beginning with whether or not they are
being listened to and whether or not they have learned a method to control their stress by
controlling their breathing. When one combines telling ones story of abuse with yogic
breathing exercises, feelings of depression and lack of confidence, control, and insecurity are
greatly reduced. These two factors, in combination, seem to provide some symptomatic relief
for abused women, and appear to be a necessary first step toward abused womens healthy self-
regard.
The significant effects on depressive symptoms in the breathing group indicate the
dramatic effects that breathwork and meditative techniques have on stressful life events. The
breathing treatment produced an environment in which the women could feel safe and peaceful,
an environment in which the participant could be free of judgment and oppression. They are
encouraged to not criticize themselves during the process, focusing not on their mistakes, but on
feeling comfortable and in control, with all attention given to the breath and movements of the
body. These techniques, when taken out of the laboratory, would allow abused women to focus
and observe patterns in their lives that could help them successfully navigate through future
stressful events (Beitel, Ferrer & Cecero, 2005).
Breath and Voice 29
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Appendix A


Franzblau Self-Efficacy Scale (1997, modified 2005)

For each of the following feelings, please indicate by marking an X, for which point on the scale
applies to you:

Anxious or Relieved

Extremely.moderately.somewhat Extremely.moderately.somewhat

In Control Out of Control


Extremely.moderately.somewhat Extremely.moderately.somewhat

Secure Insecure


Extremely.moderately.somewhat Extremely.moderately.somewhat

Unafraid Afraid

Extremely.moderately.somewhat Extremely.moderately.somewhat

Confident Not Confident

Extremely.moderately.somewhat Extremely.moderately.somewhat


Breath and Voice 37
Appendix B

BREATHING TECHNIQUES CONDITION

SITTING IN EASY YOGA POSE (Learning How to Breath and Sitting in an Easy Cross
Legged Position)
1. Easy Yoga Pose. Cross legs in easy yoga pose, sitting on as many blankets as necessary to
bring knees below hips.
2. Bring your awareness to your breath and observe it flowing in and out of your nose as you
Inhale and Exhale.
3. Place on hand on abdomen and other on heart. Exhale by pulling abdomen inward, back
toward spine.
To Inhale, release the inward abdominal pull and allow belly to swell gently forward into
your hand. Try to keep the hand on heart from moving.
(Do not press belly forward, keeping it strain-free)
4. Place palms on side of chest, level with bottom of breastbone. Fingertips are barely
touching the chest. Exhale deeply. Then Inhale deeply and expand chest, trying to
move fingertips away from the midline of chest. Make chest round. Notice how chest
expands in all directions - sideways, forward and backward, and upward. As you Exhale,
gently squeeze rib cage inward with hands.
5. Place palms on side ribs and as you Inhale feel the ribs expand into your hands. As you
Exhale feel the side ribs contract toward the center of your body.
6. Inhale. Then Exhale fully. This empties the lugs and creates room for a deep Inhalation.
7. To Inhale, relax the abdomen and allow the belly to gently swell forward a little. Do not do
anything. Dont press belly outward. Simply release the inward pull of abdomen. Air will
Breath and Voice 38
come in effortlessly.
8. Then aim the breath upward into chest and expand chest, rounding it; and slide your
shoulder blades down your back. Do not shrug your shoulders upward. Keep them down
and relaxed.
9. To Exhale, allow ribs to relax, and release the air slowly and gently pull your belly in.
10. Now make theInhalations and Exhalations even and fluid as if your breath was like water
flowing in and out.
LYING IN CROCODILE POSE (Feeling the Breath on Your Stomach).
Lie on your stomach with your arms stretched out before you and the palms touching.
Rest your forehead on the ground. Inhale and Exhale, bringing your awareness to your
breath and the rise and fall of your stomach. As you Inhale, notice that your stomach
expands pushing your spine off the ground. As you Exhale, notice that your stomach
contracts pressing your spine and chest towards the ground. Breathe here for 10 full
breaths.
SITTING IN EASY YOGA POSE (Expanding the Exhalations)
1. Come back to Easy Yoga Pose. And continue the easy breathing.
2. Inhale for four beats. Now Exhale for four beats. Concentrate on the breath in your belly
and move the breath up toward your chest. When you Exhale, feel the breath sliding down
your back, bring your shoulders down and your shoulder blades together down with the
Exhalation.
3. Inhale for two beats and Exhale for three beats.
4. Inhale for two beats and Exhale for four beats.
5. Inhale for three beats and Exhale for five beats.
Breath and Voice 39
6. Inhale for three beats and Exhale for six beats.
EASY YOGA POSE SQUARE BREATHING (Learning how to expand the spaces between
the Breath)
1. Inhale for four beats
2. Hold the breath for two beats
3. Exhale for two beats
4. Hold the breath for two beats
5. Repeat the sequence but hold the breath for three beats
6. Repeat the sequence but hold the breath for four beats
SUPPORTED BRIDGE POSE (Learning how to Lift and Open the Chest Cavity and Free
the Breath in the Upper Lungs)
1. Lie down on your back with your knees bent and your feet flat on the floor directly under
your knees.
2. As you Inhale, let the breath travel up your chest from your belly. As you Exhale, let the
breath travel down your back to your tailbone.
3. Lift your arms directly toward the ceiling and stretch one arm at a time, expanding the
muscles away from your spine.
4. Lift up your hips and place the block directly under your sacrum and rest your sacrum on the
block.
(You should feel totally comfortable resting on the block).
5. Stretch out your arms, lining your arms up with your shoulders, palms up and fingers slightly
curled up.
6. Roll the ball of the humorous (the upper arm) toward the back plane and flatten your upper
Breath and Voice 40
back and shoulder blades to the floor.
7. Close your eyes and breathe evenly, using four beats for the Inhalation and four beats for the
Exhalation.
8. Take twenty full breaths here.
9. Lift your hips and remove the block. Then come down on your back, one vertebra at a time.
10. Tuck your pelvis forward so that your lower back is resting on the ground.
11. Bring your knees up to your chest and wrap your hands around you shins, and then draw your
forehead toward your knees.
12. Then roll over to one side and come up to your hands and knees.
CHILDS POSE (Learning how to Breath in a Relaxing Pose)
1. Sit back on your heels.
2. Press your buttocks into your heels and extend your spine forward.
3. Extend your arms in front of you, resting them on the floor.
4. Rest your forehead on the floor or on a block, if your head does not reach the floor
5. Take long Inhalations (4 beats).
6. Exhales are longer (6 beats).
7. Engage Bee Breath (Inhale and then, with your mouth closed, Exhale, humming deep in
your throat until there is no breath left. Continue with your Inhalations and Exhalations
this way.
SAVASANA (Corpse Pose) (Those suffering from hypertension, high blood pressure, heart
disease, emphysema, a cold or throat congestion, or restlessness should place pillows under
head) (Those suffering from sciatica pain or lower back pain should place a bolster under
the knees)
Breath and Voice 41
EXPLANATION: Relaxation means recuperation. It is not simply lying on ones back with
a vacant mind and gazing, nor does it end in snoring. It is the most refreshing and rewarding
pose. The body, breath, mind and brain move toward the equalization of mind, body, and breath.
It is a state of stillness where the body, senses, and mind are controlled by you.
1. First achieve stillness of the body: Remove all restricting garments, belts, glasses, contact
lenses, etc.
2. Sit with your knees bent and feet together and flat on a blanket spread out on the mat.
3. Draw an imaginary line down the center of your body from your legs all the way up to the
crown of your head.
4. Gradually lower your vertebra, vertebra by vertebra along that imaginary center line until
your back is totally flat on the floor.
5. Lift your hips slightly and lift your sacroiliac region, and with your hands, move the flesh
and skin from the back of the waist down toward your buttocks.
6. Lift your arms straight up to the ceiling and stretch one arm at a time, feeling the muscles and
skin move away from the center of your spine to the sides and spill like liquid butter on to the
floor.
7. Adjust your head so that it is at the center, with your neck long and your chin slightly tucked
toward your collarbone. Stretch out your neck, so that it is resting comfortably on the floor
and that your head is resting comfortably without your neck being pinched.
8. J oin your heels and knees, the center of your coccyx, and your spinal column and the base of
the skull, so that they all rest on this imaginary straight line down the center of your body.
9. Place the inner point of each shoulder blade to the floor. Roll the skin of the top of the chest
from the collar bones toward the shoulder blades, so that your back rests perfectly on the
Breath and Voice 42
blanket.
10. Take your spine from the center of your spine to your lumbar vertebra and rest them
evenly on either side so that the ribs are spread out uniformly. Rest on the center of your
sacrum so that your buttocks relax evenly.
11. Keep your feet together and stretch out the out edges of your heels. Then let your feet
fall outwards. Your big toes should feel weightless. Do not force your little toes to touch the
floor.
12. Keep your hands away from your body, forming an angle of about 15 degrees at the armpits.
Bend your arms at the elbows, touching your shoulder tops with your fingers. Extend the
back portion of your upper arms and take the elbows as far as you can towards your feet.
Then lower your forearms and extend your hands from your wrists to the knuckles of your
fingers, with your palms facing up and your fingers curling up like the petals of a blossom.
Keep your fingers passive and relaxed.
13. The feeling of lying on the floor should be as though your body is sinking into mother earth.
COVER THEM WITH BLANKET. IF THEY NEED PILLOW OR SOMETHING
UNDER THEIR KNEES, THIS IS THE TIME TO DO IT.
14. Remove tension from the back of the body from the truck to neck, arms, and legs. Next relax
the front of the body from your upper thighs to your throat. Then relax from the neck to the
crown of your head.
15. Experience lightness in your armpits, your groin, diaphragm, lungs, spinal muscles, and
abdomen.
16. Gently move your upper eye lids toward the inner corners of the eyes. Relax the skin above
them and create space between your eyebrows.
Breath and Voice 43
17. Keep the root of your tongue passive as in sleep and resting on your lower palate. Keep
the corners of your lips relaxed by stretching them sideways.
18. Pay attention to your skin on your temples, cheekbones, and lower jaw and relax the skin,
feeling as if the skin is melting like butter from the center of your face to the sides.
19. Breath evenly through both nostrils, Inhaling normally but Exhaling softly, deeply and
longer than the Inhalation. Feel as if your breath is oozing from the pores of the skin on your
chest.
20. Stay with an awareness of your breath and let the thoughts you have move in and out of
your mind but let them go. Simply observe them.
SAY THE FOLLOWING IN A SOFT, MELODIC VOICE
Like the darting movements of a fish in the water are the movements of the mind and intellect.
When the water is unruffled, the image reflected in your mind is unbroken and still. When the
wavers of your mind and intellect are stilled, the self arises undisturbed to the surface of the
water, free of desires. At this stage of rest, the mind is free from fluctuations, and it dissolves and
merges into your self, like a river emptying into the sea.
COMING BACK TO EASY YOGA POSE
1. Slowly bring your consciousness back to your breath and notice that your breath is
breathing you. Feel the contentment and peace of your body and mind.
2. Bring your knees up to your chest and slowly roll over to the right side, curling up into
fetal position. Breathe slowly and deeply in this position.
3. Slowly, keeping your back rounded, come to Easy Yoga Pose. Make sure you are sitting
on blankets if you need to.
4. Inhale for four beats up the front of your body, beginning at your belly and moving
Breath and Voice 44
toward your collar bones. Then Exhale for four beats down the back of your body, drawing your
shoulders down with your breath. Breathe this way for about 10 breaths.


Breath and Voice 45
Table 1

Correlation Matrix

** Correlation is significant at the 0.01 level (2-tailed).

Post Beck
Depression
Pre SE
Positive
Post SE
Positive
Pre SE
Negative
Post SE
Negative
Pre Beck
Depression
Pearson Correlation
.719(**) -.701(**) -.547(**) -.641(**) -.532(**)
Sig. (2-tailed)
.000 .000 .000 .000 .000
N
40 40 40 40 40
Post Beck
Depression
Pearson Correlation
-.419(**) -.625(**) -.389(*) -.727(**)
Sig. (2-tailed)
.007 .000 .013 .000
N
40 40 40 40
Pre SE Positive Pearson Correlation
.520(**) .796(**) .357(*)
Sig. (2-tailed)
.001 .000 .024
N
40 40 40
Post SE Positive Pearson Correlation
.289 .738(**)
Sig. (2-tailed)
.070 .000
N
40 40
Pre SE Negative Pearson Correlation
.251
Sig. (2-tailed)
.118
N
40
Breath and Voice 46
Table 2

One-way Analysis of Variance on the Difference Scores
Between the Pre & Post BDI-II by Treatment

Source
Type III Sum
of Squares df Mean Square F Sig.
Partial Eta
Squared
Corrected Model
804.075(a) 3 268.025 4.123 .013 .256
Intercept
2480.625 1 2480.625 38.159 .000 .515
treatment
804.075 3 268.025 4.123 .013 .256
Error
2340.300 36 65.008
Total
5625.000 40
Corrected Total
3144.375 39

Breath and Voice 47
Table 3

Multiple Comparisons

Dependent Variable: Difference Score on Beck's Depression Scale
Tukey HSD
95% Confidence Interval
(I) Condition (J ) Condition
Mean
Difference
(I-J ) Std. Error Sig.
Lower Bound Upper Bound
Breathing 2.10 3.606 .937 -7.61 11.81
Talk/Breathing
-4.00 3.606 .686 -13.71 5.71
Talk
Waiting Controls
8.40 3.606 .110 -1.31 18.11
Breathing Talk
-2.10 3.606 .937 -11.81 7.61
Talk/Breathing
-6.10 3.606 .343 -15.81 3.61
Waiting Controls 6.30 3.606 .315 -3.41 16.01
Talk/Breathing Talk
4.00 3.606 .686 -5.71 13.71
Breathing
6.10 3.606 .343 -3.61 15.81
Waiting Controls
12.40(*) 3.606 .008 2.69 22.11
Waiting Controls Talk
-8.40 3.606 .110 -18.11 1.31
Breathing -6.30 3.606 .315 -16.01 3.41
Talk/Breathing
-12.40(*) 3.606 .008 -22.11 -2.69
Based on observed means.
* The mean difference is significant at the .05 level.
Breath and Voice 48
Figure 1

Mean Difference Scores (Posttest Pretest) Depression Score by Treatment Conditions
Talk Breathing Talk/Breathing Waiting Controls
Condition
0
2
4
6
8
10
12
14
E
s
t
i
m
a
t
e
d

M
a
r
g
i
n
a
l

M
e
a
n
s
Estimated Marginal Means of Difference Score on Beck's
Depression Scale
Breath and Voice 49
Figure 2
Number of Participants with Improved Scores on the Post BDI-II
Talk Breathing Talk/Breathing Waiting Controls
Condition
0
2
4
6
8
C
o
u
n
t
Improvement
No Improvement
Improvement
Bar Chart

Breath and Voice 50
Table 4

Analysis of Covariance
With the Pretest as the Covariate

Source
Type III Sum
of Squares df Mean Square F Sig.
Partial Eta
Squared
Corrected Model
3500.818(a) 4 875.205 14.272 .000 .620
Intercept
21.888 1 21.888 .357 .554 .010
prebdii
1963.918 1 1963.918 32.026 .000 .478
treatment
582.005 3 194.002 3.164 .037 .213
Error
2146.282 35 61.322
Total
16340.000 40
Corrected Total
5647.100 39

Breath and Voice 51
Table 5

Pairwise Comparisons

95% Confidence Interval for
Difference(a)
(I) Condition (J ) Condition
Mean
Difference
(I-J ) Std. Error Sig.(a)
Lower Bound Upper Bound
Breathing 2.157 4.242 .614 -6.454 10.768
Talk/Breathing
4.120 3.503 .247 -2.991 11.230
Talk
Waiting Controls
-6.104 3.732 .111 -13.681 1.473
Breathing Talk
-2.157 4.242 .614 -10.768 6.454
Talk/Breathing
1.963 4.204 .643 -6.572 10.498
Waiting Controls -8.261(*) 3.671 .031 -15.715 -.807
Talk/Breathing Talk
-4.120 3.503 .247 -11.230 2.991
Breathing
-1.963 4.204 .643 -10.498 6.572
Waiting Controls
-10.224(*) 3.710 .009 -17.755 -2.693
Waiting Controls Talk
6.104 3.732 .111 -1.473 13.681
Breathing 8.261(*) 3.671 .031 .807 15.715
Talk/Breathing
10.224(*) 3.710 .009 2.693 17.755
Based on estimated marginal means
* The mean difference is significant at the .05 level.
a Adjustment for multiple comparisons: Least Significant Difference (equivalent to no adjustments).

Breath and Voice 52
Table 6

A 2-Way ANCOVA
Race by Treatment Condition for Post Self Efficacy Negatives
With the Pre Self Efficacy Negatives as the Covariate

Source
Type III Sum
of Squares df Mean Square F Sig.
Partial Eta
Squared
Corrected Model
90.602(a) 8 11.325 1.982 .083 .338
Intercept
13.953 1 13.953 2.441 .128 .073
presen
20.027 1 20.027 3.504 .071 .102
race
9.909 1 9.909 1.734 .198 .053
treatment
50.521 3 16.840 2.947 .048 .222
race * treatment
13.790 3 4.597 .804 .501 .072
Error
177.173 31 5.715
Total
457.000 40
Corrected Total
267.775 39

Breath and Voice 53
Figure 3


Euro-American African American
Race
-1.6
-1.8
-2
-2.2
-2.4
-2.6
-2.8
E
s
t
i
m
a
t
e
d

M
a
r
g
i
n
a
l

M
e
a
n
s
Estimated Marginal Means of Post SE Negitive

Breath and Voice 54

Figure 4
-2
-1
0
1
2
Talk Breath T/B WC
In control/Out of control


Positive numbers are In Control Negative Numbers are Out of Control
Breath and Voice 55
Figure 5
-1
-0.5
0
0.5
1
1.5
2
Talk Breath T/B WC
Confident/Not Confident

Positive Numbers are Confident Negative Numbers are Not Confident
Breath and Voice 56

Figure 6


0
0.5
1
1.5
2
2.5
3
Talk Breath T/B WC
Secure/Insecure









Positive numbers are Secure Negative numbers are Insecure