ABSTRACT
This study centered on influence of psychotherapy and
gender on depression. 60 participants were used in the study (30 males and 30
females). 15 of the males and 15 of the females were administered only positive
self-talk and 15 participants of the female, and 15 of the males were
administered exercise and positive self-talk. 30 participant of the male and 30
participant of the female were administered only exercise. The participants
where drawn from student of Nnamdi Azikiwe University, Awka. Beck Depression Inventory
and self rating depression scale of Williams (1965) which was later
re-validated by Obiorah (1995) were used in the study. 3-way ANOVA were also
used in the study to test three hypotheses. The first hypothesis stated that
there will be a significant difference on the effect of exercise in combination
with positive self-talk on depression than exercise alone.
The second hypothesis stated that there will be a
significant difference between males and females on the influence of
psychotherapy on depression.
The third hypothesis states that there will be a
significant difference on those administered high exercise than those
administered low exercise on reducing of depression. The researcher concludes
that there is no significant difference on the effect of exercise in
combination with positive self talk on depression than exercise alone. The
researcher also concludes that those administered high exercise will have a
significant increase in reducing depression than those administered low
exercise. The implication and recommendation where made for further study.
CHAPTER ONE
1.0 INTRODUCTION
This study will be centered
on influenced of psychotherapy and gender on depression. But the type of
psychotherapy that was used in this study was positive self-talk and exercise.
Self-talk can be defined as what people say to themselves with particular
emphasis on the words used to express thoughts and beliefs about oneself and
the world to oneself. Positive self-talk are those words people say to themselves
for encouragement.
Exercise can be defined as an
activity or a task that trains the body or the mind. We have two types of
exercise namely Isotomic and Isometric exercise. Isotomic exercise involves
moving a muscles through long distance against low resistance as in running.
While Isometric exercise involves moving a muscles through a short distance
against a high resistance as in body budding, wrestling, boxing and press up
etc.
We also have Aerobic
exercise. Aerobic exercise are those exercise that help to increase
cardiovascular fitness by improving the body’s use of oxygen and allowing the
heart to work less strenuously. Aerobic exercise include running, cycling,
swimming and dancing.
Depression is a mood disorder
that is characterized by emotional, physiological/behavioural and cognitive
symptoms.
Emotional
Symptoms
2.
Depressed mood
3.
Anhedonia (lost of interest or
pleasure in usual activity)
4.
Irritability (particularly in
children and adolescents)
Physiological and
behavioural symptoms
1.
Sleep disturbances (hypersomnia or
insomnia)
2.
Appetite disturbances
3.
psychomotor retardation or
agitation)
4.
Catatonia (unsual behaviours
ranging from complete lack of movement to excited agitation)
5.
fatigue and loss of energy
Cognitive
Symptoms
1.
Poor concentration and attention
2.
Indecisiveness
3.
Sense of worthlessness or guilt
4.
Poor self-esteem
5.
Hopelessness
6.
Suicidal thoughts
7.
Delusion and hallucinations with
depressing themes.
For some time now, it has
been common knowledge that exercise is good for one’s physical health. It has
only been in recent years, however, that it has become commonplace to read in
magazines and health newsletters that exercise can also be of value in
promoting sound mental health. Although this optimistic appraisal has attracted
a great deal of attention, the scientific community has been much more
cautious in offering such a blanket endorsement. Consider the tentative
conclusions from the Surgeon General’s report on Physical Activity and Health (PCPEFS
Research Digest, 1996) that “physical activity appears to relieve symptoms
of depression and anxiety and improve mood” and that “regular physical activity
may reduce the risk of developing depression, although further research is
needed on this topic”.
The use of carefully chosen
words, such as “appears to” and “may” illustrate the caution that people in the
scientific community have when it comes to claiming mental health benefits
derived from exercise. Part of the problem in interpreting the scientific literature
is that there are over 100 scientific studies dealing with exercise and
depression or exercise and anxiety and not all of these studies show
statistically significant benefits with exercise training. The paucity of
clinical trial studies and the fact that a “mixed bag” of significant and
non-significant findings exists makes it difficult for Scientifics to give a
strong endorsement for the positive influence of exercise on mental health.
There is no doubt that the mental health area variables associated with sound
mental health. However, until these clinical trial studies materialize, there
is still much that can be done to strengthen statements made about exercise and
mental health.
What evidence would prompt
some Scientifics to “stick their neck out” in favour of more definitive
statements? One reason for greater optimism is the recent appearance of
quantitative reviews (i.e. meta-analyses) of the
literature on a number of summaries of results across studies. By including all
published and unpublished studies and combining their results, statistical
power is increased. Another advantage of using this type of review process is
that a clearly defined sequence of steps is followed and included in the final
report so that anyone can replicate the studies. Two additional advantages that
meta-analysis has over other types of reviews include:
(a)
The use of a quantification
technique that gives an objective estimate of the magnitude of the exercise
treatment effect; and
(b)
Its ability to examine potential
moderating variables to determine if they influence exercise – mental health
relationships. Given these advantages, this paper will focus primarily on
results derived from large-scale meta-analysis reviews.
ANXIETY REDUCTION
FOLLOWING EXERCISE
It is estimated that in the
United States approximately 7.3% of the adult population has an anxiety
disorder that necessitates some form of treatment (Regier 1988). In addition,
stress-related emotions, such as anxiety, are common among healthy individuals
(Cohen, Tyrell, & Smith, 1991). The current interest in prevention has heightened interest in
exercise as an alternative or adjunct to traditional interventions such as
psychotherapy or drug therapies.
Anxiety is associated with
the emergence of a negative form of cognitive appraisal typified by worry,
self-doubt, and apprehension. According to Lazarus and Cohen (1977), it usually
arises in the face of demands that tax or exceed the resources of the system of
… demands to which there are no readily available or automatic adaptive
responses” (p. 109). Anxiety is a cognitive phenomenon and is usually measured
by questionnaire instruments. These questionnaires are sometimes accompanied by
physiological measures that are associated with heightened arousal/anxiety
(e.g. heart rate, blood pressure, skin conductance, muscle tension). A common
distinction in this literature is between state and trait questionnaire
measures of anxiety. Trait anxiety is the general predisposition to respond
across many situations with high levels of anxiety. State anxiety, on the other
hand, is much more specific and refers to the person’s anxiety at a particular
moment. Although “trait” and “state” aspects of anxiety are conceptually
distinct, the available operational measures show a considerable amount of
overlap among these subcomponents of anxiety (Smith, 1989).
For meta-analytic reviews of
this topic, the inclusion has been criterion which has been included in the
review. Studies with experiment-imposed psychosocial stressors during the post
exercise period have not been included since this would confound the effects of
exercise with the effects of stressor (e.g., Stoop color-word test, active physical performance).
The meta-analysis by Schlicht (1994), however, included some stress-reactivity
studies and therefore was not interpretable.
Landers and Petruzzello
(1994) examined the results of 27 narrative reviews that had been conducted
between 1960 and 1991 and found that in 81% of them the authors had concluded
that physical activity/fitness was related to anxiety reduction and depression
following exercise and there was little or no conflicting data presented in
these reviews. For the other 19%, the authors had concluded that most of the
findings were supportive of exercise being related to a reduction in anxiety,
but there were some divergent results. None of these narrative reviews
concluded that there was no relationship.
There have been six
meta-analyses examining the relationship between exercise and anxiety reduction
(Calfas & Taylor, 1994; Kugler, Seelback, & Kruskemper, 1994; Landers
& Petruzzello, 1994; Long & van Stavel, 1995; McDonald & Hodgdon,
1991; Petruzzellor, Landers, Hatfield, Kubitz, & Salazar, 1991). These
meta-analyses ranged from 159 studies (Landers & Petruzzello, 1994;
Petruzzello et al., 1991) to five studies (Calfas & Taylor, 1994) reviewed.
All six of these effects ranged from “small” to “moderate” in size and were
consistent for trait, state, and psychophysiological measures of anxiety. The
vast majority of the narrative reviews and all of the meta-analytic reviews
support the conclusion that across studies published between 1960 and 1995
there is a small to moderate relationship showing
that both acute and chronic employed (i.e., state, trait or
psychophysiological), the intensity or the duration of the exercise, the type
of exercise paradigm (i.e. acute or chronic), and the scientific quality of the
studies. Another meta-analysis (Kelley & Tran, 1995) of 35 clinical trial
studies involving 1,076 subjects has confirmed the psychophysiological findings
in showing small (-4/03), but statistically significant, post exercise
reductions for both systolic and diastolic blood pressure among normal
normotensive adults.
In addition to these general
effects, some of these meta-analyses (Landers & Petruzzello, 1994;
Petruzzello et al., 1991) that examined more studies and therefore had more
findings to consider were able to identify several variables that moderated the
relationship between exercise and anxiety reduction. Compared to the overall
conclusion noted above, this is based on database. More research, therefore, is
warranted to examine further the conclusions derived are based on a much
smaller variables. The meta-analyses show that the larger effects of exercise
on anxiety reduction are shown here:
a.
The exercise is “aerobic” (e.g.,
running, swimming, cycling) as opposed to nonaerobic (e.g. handball,
strength-flexibility training),
b.
The length of the aerobic training
program is at least 10 weeks and preferably greater than 15 weeks, and
c.
Subjects have initially lower
levels of fitness or higher levels of anxiety. The “higher levels of anxiety”
includes coronary (Kugler 1994) and panic disorder patients (Meyer, Broocks,
Hillmer
– Vogel, Bandelow, & Ruther, 1997).
In addition, there is limited
evidence which suggests that the anxiety reduction is not an artifact “due more
to the cessation of a potentially threatening activity than to the exercise
itself” (Petruzzello, 1995, p. 109), and the time course for postexercise
anxiety reduction is somewhere between four to six hours before anxiety returns
to pre-exercise levels (Landers & Petruzello, 1994). It also appears that
although exercise differs from no treatment control groups, it is usually not
shown to differ from other known anxiety-reducing treatments (e.g., relaxation
training). The finding that exercise can produce an anxiety reduction similar
in magnitude to other commonly employed anxiety treatments is noteworthy since
exercise can be considered at least as good as these techniques, but in
addition, it has many other physical benefits.
EXERCISE AND
DEPRESSION
Depression is a prevalent
problem in today’s society. Clinical depression affects 2-5% of Americans each
year (Kessler et al., 1994) and it is estimated that patients suffering from
clinical depression make up 6-8% of general medical practices (Katon &
Schulberg, 1992). Depression is also costly to the health care system in that depressed
individuals annually spend 1.5 times more on health care than nondepressed
individuals, and those being treated with antidepressants spend three times
more on outpatient pharmacy costs than those not on drug therapy (Simon,
VonKorff, & Barlow, 1995). These costs have led to increased governmental
pressure to reduce health care costs in America. If available and effective,
alternative low-cost therapies that do not have negative side effects need to
be incorporated into treatment plants. Exercise has been proposed as an
alternative or adjunct to more traditional approaches for treating depression
(Hales & Travis, 1987; Martinsen, 1987.
The research on exercise and
depression has a long history of investigators (Franz & Hamilton, 1905;
Vaux, 1926) suggesting a relationship between exercise and decreased
depression. Since the early 1900s, there have been over 100 studies examining
this relationship, and many narrative reviews on this topic have also been
conducted. During the 1990s there have been at least five meta-analytic reviews
(Craft, 1997; Calfas & taylor, 1994; Kugler et al., 1994; McDonald &
Hodgdon, as many as 80 (North et al., 1990). Across these five meta-analytic
reviews, the results consistently show that both acute and chronic exercise are
related to a significant reduction in depression. These effects are generally
“moderate” in magnitude (i.e. depressed, or mentally ill. The findings indicate
that the antidepressant effect of exercise begins as nondepressed, clinically
exercise and persists beyond the end of the exercise program (Craft,
1997; North et al., 1990). These effects are also consistent across age,
gender, exercise group size, and type of depression inventory.
Exercise was shown to produce
larger antidepressant effects when:
a.
The exercise training program was
longer than nine weeks and involved more sessions (Craft, 1997; North et a;.,
1990);
b.
Exercise was of longer duration,
higher intensity, and performed a greater number of days per week (Craft,
1997); and
c.
Subjects were classified as
medical rehabilitation patients (North et al., 1991) and, number on
questionnaire instruments, were classified as moderately/severely depressed
compared to mildy/moderately depressed (Craft, 1997). The latter effect is
limited since only one study used individuals who were classified as severely
depressed and only two studies used individuals who were classified as
moderately to severely depressed. Although limited at this time, this finding
calls into question the conclusions of several narrative reviews (Gleser &
Mendelberg, 1990; Martinsen, 1987), which indicate that exercise has
antidepressant effects only for those who are initially
mild to moderately depressed.
The meta-analyses are
inconsistent when comparing exercise to the more traditional treatment for
depression, such as psychotherapy and behavioural interventions (e.g.,
relaxation, meditation), and this may be
related to the types of subjects employed. In examining all types of subjects,
North et al. (1990) found that exercise decreased depression more than
relaxation training or engaging in enjoyable activities, but did not produce
effects that were different from psychotherapy. Craft (1997), using only
clinically depressed subjects, found that exercise produced the same effects as
psychotherapy, behavioral interventions, and social contact. Exercise used in
combination with individual psychotherapy or exercise together with drug
therapy produced the larges effects; however, these effects were not
significantly different from the effect produced by exercise alone (Craft,
1997).
That exercise is very
effective as more traditional therapist is encouraging, especially considering
the time and cost involved with treatments like psychotherapy. Exercise may be
a positive adjunct for the treatment of depression since obesity can also cured
through exercise which behavioral interventions do not. Thus, since exercise is
cost effective, has positive health benefits, and is effective in alleviating
depression, it is a viable adjunct or alternative to many of the more
traditional therapies future research also needs to examine the possibility of
systematically lowering antidepressant medication dosages while concurrently
supplementing treatment with exercise.
OTHER
VARIABLES ASSOCIATED WITH MENTAL HEALTH Positive mood: The
Surgeon General’s Report also mentions the possibility of exercise
improving mood. Unfortunately the area of increased positive mood as a result
of acute and chronic exercise has only recently been investigated and therefore
there are no meta-analytic reviews in this area. Many investigators are
currently examining this subject and many of the preliminary results have been
encouraging. It remains to be seen if the additive effects of these studies will
result in conclusions that are as encouraging as the relationship between
exercise and the alleviation of negative mood states like anxiety and
depression.
Self-esteem: Related to the
area of positive mood states in the area of physical activity and self-esteem.
Although narrative reviews exist in the area of physical activity and
enhancement of self-esteem, there are currently four meta-analytic reviews on
this topic (Calfas &
Taylor, 1994; Gruber 1986;
McDonald & Hodgdon, 1991; Spence, Poon, & Dyck, 1997). The number of
studies in these meta-analyses ranged from 10 studies (Calfas & Taylor,
1994) to 51 studies (Spence et al., 1997). All four of the reviews found that
physical activity/exercise brought about small, but statistically significant, increases
in physical self-concept or self-esteem. These effects generalized across
gender and age groups. In comparing self-esteem scores in children, Gruber
(986) found that aerobic fitness produce much larger effects on self-esteem
scores than other types of physical education class activities (e.g., learning
sports skills or perceptual-motor skills).
Gruber 91986) also found that the effect of physical activity was larger for
handicapped compared to non-handicapped children.
Restful sleep: Another area
associated with positive mental health is the relationship between
exercise and restful sleep. Two meta-analyses have been conducted on this topic
(Kubitz, landers, Petruzzello, & Han, 1996; O’Connor & Youngstedt,
(1995). The studies reviewed have primarily examined sleep duration and total
sleep time as well as measures derived from electroencephalographic
(EEG) activity while subjects are in various stages of sleep. Operationally, sleep researchers have
predicted that sleep duration, total sleep time, and the amount of high
amplitude, slow wave EEG activity would be higher in physically fit individuals
than those who are unfit ( chronic effect) and higher on nights following
exercise (i.e. acute effect). This prediction is based on the “compensator’
position, which posits that ‘fatiguing daytime activity (e.g. exercise) would
probably result in a compensatory increase in the need for and depth of
nighttime sleep, thereby facilitating recuperative, restorative and/or energy
conservation processes” (Kubtiz et al., p. 278).
The sleep meta-analyses by
O’Connor and Youngstedt (1995) and Kubitz et al. (1996) show support for this
prediction. Both reviews show that exercise significantly increases total sleep
time and aerobic exercise decreases rapid eye movement (REM) sleep. REM sleep
is a paradoxical form in that it is a deep sleep, but it is not as restful as slow wave
sleep (i.e, stages 3 and 4 sleep). Kubtiz et al. (1996) found that acute and
chronic exercise was related to an increase in slow wave sleep and total sleep
time, but was also related to a decrease in sleep onset latency and REM sleep.
These findings support the compensatory position in that trained subjects and
those engaging in an acute bout of exercise went to sleep more quickly, slept
longer, and had a more restful sleep than untrained subjects or subjects who
did not exercise. There were moderating variables influencing these results.
Exercise had the biggest impact on sleep when:
a.
The individuals were female, low
fit, or older,
b.
The exercise was longer in
duration; and
c.
The exercise was completed earlier
in the day (Kubitz et al., 1996).
To determine “where” and
“how” positive self-talk fits into the scheme of intrapersonal communication,
and communication as a whole, some definitions must be derived. The reality of
emotional choice - - that intrapersonal communication (IAPC), imaging, and
visualization (Weaver and Cottrell, 1987). Positive self-talk is part of IAPC,
but the part cannot be equal to the whole.
Having concluded that
positive self-talk and IAPC are separate but related, what is IAPC? Shedletsky
(1989) places it into the traditional model of communication, but all
elements of “sender” “receiver”, and “transmitter” are carried out within
individual people. Pearson and Nelson 9185) expand that definition as follows:
Intrapersonal communication
is not restricted to “talking to ourselves”; it also includes such activities
as internal problem solving, resolution of internal conflict, planning for the
future, emotional catharsis, evaluation of ourselves and others.
Fletcher (1989) adds the
physiological dimension to IAPC. Fletcher defines, “Intrapersonal communication
… is the process interior to the individual by which reality evolves and is man
tined.” It is a process which involves other parts of the body including the
nervous system, organs, muscles, hormones, and neurotransmitters. IAPC, as well
as the internal thoughts and language associated with it, serve as another
“control” system in the body, on much the same level as the body’s other
system. This is the beginning of the mind-body, or psychophysiological,
connection.
Medical professionals are
beginning to take note of mind-body interrelationships in their treatment of
patient. The basis of this is the recognition of the functions of inner speech.
These functions are to:
v
Coordinate other connective
sensory and motor functions within the brain
v
To integrate and link the
individual to the social order
v
To regulate human behaviour
through spoken language
v
To provide for human mentation as
reflected in mental processes and activities (Korba, 1989).
Positive
self-talk is a health behaviour that has potentially far-reaching effects.
Although it will most likely be used by those who have a high internal locus of
control and place a high value on health, it can also help relatively healthy
people in health “maintenance” programs. Self-talk is categorized as being
positive or negative. As its label implies, positive self-talk has good implications
for people’s mental and physical well-being. However, the negative is not all
bad. The key to using self-talk is to strive for an appropriate balance (which
is a tenet of holistic medicine itself) between the two.
The use of positive self-talk
has been linked to the reduction of stress, in turn, can effect other positive
health changes. Positive self-talk, like thoughts, is not neutral because it
triggers behavior in either a positive or negative direction. Both thoughts and
positive self-talk are based on beliefs – which ‘can exist with or without
evidence that they are accurate” (Grainger, 1989) --- which are formed early in
life. Beliefs shaped our positive self-talk, which in turn affects our
self-esteem.
However, negative thinking as
the “thinking of choice,” may not be so bad, because it heightens people’s
sensitivity to the situation they are facing. They are likely to think more
clearly. Grainger says, “Negative thinking, then, is the most productive, the
most useful, and the healthiest thinking to adopt “when risk is high”.
Instead of categorizing
negative self-talk as “negative,” it might be better to call it “logical and
accurate” self-talk. Braiker (1989) emphasizes the “responsible” use of
self-talk. She warms against confusing positive inner
dialogue with positive thinking, happy affirmations, or self-delusions.
Logical, accurate self-talk recognizes personal short-comings, but also
modifies them to help people define a plan of correction.
DEVELOPING A
POSITIVE MENTAL ATTITUDE
A positive mental attitude as
a basis for self-talk does not require self-dilution. The development of
optimistic thought patterns requires essentially three things; recognizing
self-talk for what it is, dealing with negative messages, and harnessing the
positive for the greater good of individual person. By using inner speech,
people can influence their health states, but the benefits potentially react
beyond that. To make self-talk positive, people must change what goes into
their subconscious. All this hinges on recognition of inner messages.
Levine (1991) expands on the
idea of noticing through patterns. Regardless of the thought type (positive or
negative), she suggests people reflect upon the antecedents to and the feelings
about the particular thought. When people determine which thoughts improve
their sense of well-being, they can make those thoughts occur more frequently.
Again, this does not imply
that people who practice positive self-talk will be a group of “happy campers”.
Negative inner speech can and does play a constructive role in helping people
create better realties for themselves. As was previously state, negative
thoughts can trigger warning signals
in high risk situations. The object is to deal with the underlying message, and
then move to correct the situation. Negative self-talk, like its label implies,
has a downside as well.
McGonicle (1995) categorizes
“harmful” negativity as being “awfulisitc” (everything is catastrophic),
“absolutistic” (using “must.” “always,” “never’), or should-have self-talk (‘I
‘should have’ done this”).
These also are found on what
Braiker lists as “cognitive trap”. Other elements include: all-or-nothing
thinking; discounting the positive; emotional reasoning; and personalization
and blame. Levine suggest examining “seed thoughts”, sometimes mindlessly –
sued clichés, for negative elements - - either emotion or health related. For
example, thinking “I’m a nervous wreck,” “I’m eaten up with anger,” “that
disease runs in my family,’ and “Only the good die young” can undermine any
positive thinking people try to achieve. Therefore, individuals must replace
these thoughts with something more constructive.
In a society where people
(especially females) are taught to downplay their good points, developing
positive self-talk might be difficult at first. It necessitates a
‘reality-check.” Most of the time, people are a lot “better”
(performance/health-wise) than they previously concluded. Keeping a journal,
using your name as you talk of yourself, and releasing pent-up feelings are
some of the ways
1.1 STATEMENT
OF PROBLEM
Recently, people are
realizing that chemotherapy (drug treatment) may not really be the treatment of
choice for psychological problems. As a result of this, most people are now
looking forward for treatment techniques that does not involve taking of drugs. Psychotherapy, through
non-psychopharmacological means, may not give individuals the type of control
that they crave for. Hence, individual may resist some form of psychotherapy
that puts them directly under the control of the psychotherapy. Such clients
prefer therapies that will enable them carryout the treatments themselves after
the initial training. Exercising and positive self talk gives them the type of
control that they desire. Therefore, the present study seeks to determine
whether exercising and talking positively to self will reduce feeling of
depression among persons.
1.2 RESEARCH
QUESTIONS
The
research questions of this study are as follows:
1.
Will there be any significant
difference on effect of exercise in combination with positive self-talk on
depression than exercise alone.
2.
Will there be any significant
difference between males and females on the influence of psychotherapy on
depression.
3.
Will there be any significant
difference on those administered high exercise than those administered low
exercise on reducing of depression.
1.3 PURPOSE
OF THE STUDY
The results of this study
confirm what has been acknowledged among people but with limited empirical
confirmation that exercise has some mental health benefits. The study will also
show find out whether talking positively to self will help to reduce a lot of negative
thoughts that people hold and that acts as poison to their minds and body.
Furthermore, the study will
also know whether non-psychopharmacological treatment techniques can help to
reduce depression.
1.4 RELEVANCE
OF THE STUDY
This study will be useful to
those in the medical and clinical psychology settings and even private persons.
This may contribute in better understanding and treatment of depression in our
society. Also, it will make people to understand that exercise is not only
beneficial to muscle training and weight controls but also to control the
psychological state for holistic mental health.
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