7/27/2019 33026180.pdf

1/13

THE EF FE CT OF A SELF-MONTTORED RELAXATIONBREATHING EXERCISE ON MALE AD OLESCENTAGGRESSIVE BEHAVIOR' -. T rud i G aines an d Le ash a M .Barry

ABSTRACTThis study sought to contribute to the identification of effective interventionsin the a rea of male adolescent aggressive behavior. Existing research includesboth group- and single-case studies implementing treatments which typicallyinclude an anger-management component and its attendant relaxation andstress-reduction techniques. The design of this study was single-subject withmultiple baselines across 6 subjects on 2 behavioral measures. The settingwas a residential juvenile justice program for male adolescents, and the treat-me nt w as a relaxation b reath ing exercise. The res ults of th e study were mixed,with improvement on both behavioral measu res in 2 of the 6 p articipan ts.

Aggression is a focus of therapeutic interventions with adolescentsalrea dy involved in the legal system and w ho may well be on their w ayto establishing intractable behavior patterns. These patterns may becarried into adulthood and likely result in criminal activity and incar-ceration w ith recidivism reported as high as 50% (Snyder & Sickmund,1999). While not all adolescents -with aggression problems will followthis developmental pa th, almost all incarcerated adu lts bring a h istoryof delinquency and aggression with them into their troubled existence(Kazdin, Siegel, & Bass, 1992).The World Health Organization hasreported violence as being a global hea lth problem, and so, to interv eneeffectively in an early stage of this problem's development holds im-portant social merit (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002).According to Gloldstein, Glick, and Gibbs (1998), the definition ofaggression derives from social learning theory and, therefore, consti-tutes learned behavior that stems from the interaction of the individ-ual with the en vironm ent. The developm ent of violent conduct asrepo rted by Nietzel, H ase m an, and Lynam (1999) occurs wh en biologi-cal, environmental, psychological, and social factors blend in certain

Lea sha M. Barry, Division of Teacher Edu cation, U niversity of W est Florida.Requests for reprints should be sent to Trudi Gaines, Division of TeacherEdu cation, U niversity of W est Florida, Building 85 , Room 176, 11000 U niver-sity Parkway, Pensacola, Florida, 32514. E-mail: tgaines@uwf.edu

7/27/2019 33026180.pdf

2/13

pattems. These definitions and origins notwithstanding, the point atwhich the individual responds to the stimulus, either in a deliberateor automatic fashion, contains elements that can be ameliorated re-gardless ofthe aforementioned factors and origins.Researchers have focused on aggressive behavior among adolescentsin various environments to include education (Frey, Hirschstein, &Guzzo, 2000; Deffenbacher, Lynch, Oetting, & Kemper, 1996), correc-tions (Steiner, Garcia, & Matthews, 1997; Swenson & Kennedy, 1995),and mental health treatment settings (Margolin, Youga, & Ballou,2002; Snyder, 1999). The autho rs of this study sought to contribute toefforts which identify effective prevention measures that educators andother professionals who work with adolescents can incorporate into avariety of settings, which are cost effective, and which entail th e leastdisruption to normal daily activities and routines.Anger management interventions typically include relaxation exer-cises for stress and anxiety reduction, and these exercises often focuson the breath (Fraser, 1996). When adolescents learned about thephysiology of anger and how to use the techniques that promote relax-ation and self-regulation, teachers, parents and the adolescents them-selves reported improvement in their behavior (Kellner, 1999). Therecommendations made by Rutherford, Quinn, and Mathur, 1996) de-scribed an approach to aggression and problem behaviors that includedthe various components of social skills training, cooperative learning,anger management, and self-control strategies. The anger manage-ment component emphasized the teaching of specific relaxation andstress-reduction breathing exercises, which included deep breathingand deep muscle relaxation. Other relaxation techniques that havebeen shown to be useful in arousal reduction are progressive musclerelaxation , meditation, yoga, guided imagery, and biofeedback.

Relaxation exercises and techniques are frequently included whenbehavioral problems are the focus of interventions because of theirassociation with physiological arousal reduction that can have a nega-tive influence on behavior (Novaco, 1975). The physiological arousalassociated with aggression includes an increase in heart rate, muscletension, and breathing ra te {Kellner & Tuttin, 1995). With an increasein this physiological arousal comes an increase in angry thoughts, evenmore so when combined with alcohol and or drugs, and results in aninhibition of internal control (Hollin, 2003). The ability to reduce thearousal response through increased self-regulation is a necessary in-gredient in the prevention of an aggressive response. When adolescentswere instructed in relaxation coping skills, they were able to calm

7/27/2019 33026180.pdf

3/13

through and to proactively cope with their angry feelings (DefFen-bacher et al., 1996). According to the Margolin et al. (2002) study oninale adolescent violence and aggression, these youth consistently re-ported angry thoughts as a trigger for the physical arousal that re-sulted in aggressive acts. These youth identified the instruction theyhad received in ameliorating the arousal by using relaxation tech-niques as an integral component in their ability to resist the subse-quent, impulsive, aggressive behaviors.As previously noted, intervention programs in the area of aggressionand anger management typically consist of a combination of compo-nents. Determining which of the components is efficacious is problem-atic because of the confounding effect of one element with another.Research on tbe efficacy of such individual elements has been recom-mended (Feindler & Ecton, 1986). For instance, Deffenbacher andStark's (1992) study showed that relaxation coping skills were as effec-tive in the treatment of anger as a combination of such skills withcognitive coping skills.In the present study, we sought to extend this previous research byassessing the effects of an isolated relaxation breath ing exercise (RBE)applied to adolescent males in a juvenile justice residential program.Our study employed an RBE in an attempt to (a) increase impulsecontrol as indicated by measuring thefrequencyof use of curse words,(b) decrease the frequency of inappropriate behaviors as defined andmeasured by the juvenile justice behavior managem ent system in placeat the facility, and (c) introduce self-monitoring of use of curse words,behavior, and use of the RBE. The purpose of this study w as to deter-mine the effect of an isolated RBE on both inappropriate behavior andlanguage use in adolescents when practiced as an independent, single-component intervention.

M E T H O D- ^ParticipantsSix residents ("Sam," "Tom," "Jack," "Bill," "John" and "Joe") at aregional juvenile justice residential program participated based ontheir being recommended by the program superintenden t as requiringassistance with anger management and impulse control and on theirhaving already been at the program for at least one month. At thisfacility, adolescent males satisfy court-ordered legal consequences forcriminal behavior of a generally non-violent nature.

7/27/2019 33026180.pdf

4/13

history of counseling or therapy for any mental health problems andwas not taking any psychotropic medications.Tom was 15 years old with a history of legal problems related to theftand drug possession. He reported having participated in counseling fordrug-related issues and having a diagnosis of attention deficit hyperac-

tivity disorder (ADHD). He was prescribed Ritilin, Prozac, and Wellbu-trin in the past and was taking Prozac at the time of the study.Bill was 17 years old at the time of the study and reported havinga history of stealing and drug trafficking for which he became involvedwith the legal system. He reported daily marijuana use until recentlyand that he was ordered to a residential program because he did notcomply with attendance at court-ordered counseling.Joe was 18 years old and reported a history of daily m arijuana use .He had participated in substance abuse counseling recently but noother counseling interventions. He denied being prescribed any psy-chotropic medications.Jack was 17 years old and reported daily marijuana use since theage of 12. He did not attend school for approximately 2 years because offamily instab ility w ith respect to place of residence. His legal problemsrevolved around trafficking in stolen goods and in methamphetam ines,which he denied using. He reported having participated in anger man-agement classes but not having paid any attention. He denied takingany psychotropic medications or having any other mental healthproblems.John was 15 years old and reported having dropped out of schoolin the sixth grade, being truant and not caught, and having smokedmarijuana since the age of 7 or 8. He also reported having used otherstreet drugs and alcohol as they became available to him. He reportedhaving been diagnosed with a learning disability and as never havingbeen prescribed any psychotropic medications. A review of the fac ilit /sfiles corroborated the information provided by the participants.Informed consent was obtained in w riting from each of the six parti-cipants. Paren tal consent was not required, as the Florida Departmentof Juvenile Jus tice is considered to act in loco parentis by way of theirapproval for conducting the study.

DesignThe design of this study was single subject with multiple baselinesacross six participants on two behavioral measures. The design desig-nation was ABAB, which allowed the researchers to compare responsesto the RBE across participants and to observe any changes in the

7/27/2019 33026180.pdf

5/13

two treatment phases allowed for more opportunity to observe anybenefit th at may have resulted from the treatment and increased theinternal validity o fthe study. The initial treatmen t pbase had a dura-tion of 14 days, and the withdrawal phase lasted for 2 days.ProcedureDependent variables. All residents at tbis facility received dailyscores for behavior from 0% to 100%, with the higher score reflectingless aggression. Specifically, direct care staff observed residentsthroughout the day and marked "checks" on a daily log for variousinappropriate behaviors, such as using curse words, being off task , andverbalizing or acting out hostility toward another resident or staff.This study looked at two measures for each participant: the daily be-havior score and the number of daily checks received for inappropriatelanguage (curse words). The second measure, inappropriate language,indicates a specific type of lack of impulse control that often functionsas a precursor to escalating aggressive behavior (Kellner, 1999). Thesetwo measures were obtained for each participant from daily programrecords throughout the course of the study.Direct-care staff, who recorded the daily checks from which totalscores were tabulated, were trained by the director ofthe program'sbehavioral component. Throughout the course of any given period atthe facility, two or more direct-care staff were present. There were alsotimes, as when accompanying a resident from one building to the next,when only one staff member was with a participant. These procedureswere part of the regular program protocol and allowed for continuousdata collection by trained observers who were present and collectingthis data within the naturally occurring environment of the facility.To minimize impact, the researcher visited the program only weeklyduring the course of the study after RBE was introduced, to monitorparticipant compliance and to determine firsthand if any participantwas experiencing problems, had any questions, or was no longer w illingto continue in the study.Self-monitoring data. Each participant was given an individualizedschedule and daily checklist to self-monitor compliance and provide anindicator of fidelity of implementation and to cross reference with thetwo behavioral indicators measured by program staff at the facility.The checklist consisted of an entry for each of the times of day thatthe RBE was used and for any additional time as used. The checklistswere completed for each day by each of the participants.Agreement ofbehavioral data. Participants provided feedback on thedaily behavior scores and use of inappropriate language reported hy

7/27/2019 33026180.pdf

6/13

staff. Agreement between staff and participant judgm ent was used asan indicator of reliability of the measures used in the study.Fidelity of implem entation. Fidelity of implementation was also indi-cated by participant's self-report of the use of the RBE documented intheir self-monitoring data sheets.Independent variable. The researcher instructed each participant inthe practice of the RBE as described below and told participants onwhich day they should begin, stop, and begin again according to thephase of the project. The RBE followed a pattem of inhaling for thecount of four, holding that breath for a count of seven, and exhalingfor a count of eight, repeating the cycle five times (Weil, 1998). Partic i-pants did the RBE at three points during the day: upon arising, atmidday, and before going to sleep. Also, participants used it at anypoint during the day when experiencing heightened feelings of angeror imminent lo'ss of control over an impulsive response or outburstof aggression.

RESULTSThe results of the study were mixed, as seen in Figures 1 and 2,with three residents' data reported in each figure. Of the six partici-pants, only Joe demonstrated improvement of both measures during

the second treatment phase, with relatively high daily behavior scoresthroughout the phases. His checks for bad language increased duringthe first half of the first treatment phase; however, this did not seemto seriously impact his daily behavior score.Sam, Tom, and Jack did not improve noticeably on the daily behaviorscore measure, although their scores did not worsen. Tom and Samdid dem onstrate improvement in their checks for bad language duringthe second treatment phase. Bill's daily behavior score for the secondtreatment phase reflects a slight improvement over the first threephases, although his checks for bad language were relatively highthroughout. John's daily behavior scores showed improvement for thefirst twelve days of the first treatment phase with a correspondingdecrease in daily checks for bad language. During the second trea tm entphase, however, gains were lost.Agreement of behavioral data. Participant self-monitoring of theirdaily behavior scores and use of curse words indicated that they agreedwith the program staffs assessment of their behavior. During weeklyinterviews conducted by the researcher with the participants, theywere asked to explain incidents that resulted in low scores, and in no

7/27/2019 33026180.pdf

7/13

0 1 3 5 T S I I 13 IS 17 IB 21 23 25 27 3B 31 33 35 37

3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39JACK DAY

1 3 5 7 fi 11 13 15 17 19 21 23 25 27 29 31 33 35

Figure 1. Daily bdia vio r scores (75-100) and daily num ber oflanguage checks (0-5) for Sam, Tom, and Jack during baseline,treatment, withdrawal, and reintroduction of treatment phases.

7/27/2019 33026180.pdf

8/13

1 3 5 7 9 11 13 15 17 19 21 23 25 Z7 29 31 33 35 37 39M YJOHN

1 3 5 7 8 11 13 15 17 19 21 23 25 27 29 31 33 35 37 38

! fg?um 80g 750 A A i

1111! K' * /\ ^ A/\/l y V V11< '1

i 1\ 1V . J - .

. J .1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 38

r- DAY

2 Daily behavior scores (75-100) and daily number oflanguage checks (0-5) for Bill, John, and Joe during baseline,treatment, withdrawal and reintroduction of treatm ent phases.

7/27/2019 33026180.pdf

9/13

Fidelity of implementation. To assess the fidelity of implementation,participant self-monitoring sheets were reviewed on a weekly basis.Participants completed the self-monitoring sheets with 100% compH-ance. Data reviewed from the self-monitoring sheets indicated that insome instances, participants forgot to use the RBE and appropriatelyrecorded it. Overall, participants reported compliance in use of theRBE for 100% of opportunities (3 times per day over 14 days).Anecdotal evidence. Tom reported that, on the days during the firsttreatm ent phase when he received rather low scores, he was having aparticularly difficult time getting along with another resident, stating"I just lost it." We discussed the possibility of repeating the RBE moreoften during the day, as was part of the initial instructions, and Tomstated that it was simply difficult to remember to do so at first. Jackreported a similar reason when asked about the three drops in hisdaily behavior score. Conflict with other residents was th e cause mostoften mentioned by participants for problems with their behavior. Aseach of the partic ipan ts were asked individually about their own expe-rience of doing the RBE, the response that it was found to be helpfulwas most often provided. Joe stated th at i t "helps me to focus."

DISCUSSIONWe employed a relaxation breathing exercise (RBE) in an attemptto reduce anxiety while increasing impulse control and self-monitoring.In all, our results were mixed with benefits demonstrated for a fewpartic ipants in some phases. Overall, benefits of RBE as implementedhere were fairly inconsistent. Anecdota data, however, was quite posi-tive with individual participants reporting that they found the exerciseuseful. Although our findings were inconsistent across participants,benefits for some were evident in the brief time that R3E was intro-

duced. To intervene successfully and consistently with participantsfirom this particular population of adolescent males, those involved inresidential juvenile justices programs, specifically, may require alarger or more intensive dose of treatment.It is important to note tha t RBE was not introduced to these partici-pants without potential additional influences on their behavior. Addi-tional factors that may have influenced results included additionalsocial reinforcement for participating, and prompting through the taskof self-monitoring the use of the RBE. Participants' compliance withthe treatment relied on daily self-report using a provided behavioral

7/27/2019 33026180.pdf

10/13

instructions and with his individual schedule for the RBE. Self-reportof compliance may have provided a prompt to the participants to useth e strate gy . In addition, the resea rche r visited th e program once everyweek, spending several minutes with each participant individually,which m ay have reinforced compliance. Th ree ofth e prog ram staff alsoregularly reinforced the importance of compliance with the partici-pan t s .

Limitations of the study were ohserver reliability as indicated hyparticipant self-report with respect to compliance with treatment anddependent measures. We employed participant self-report as both anatt em pt a t self-monitoring an d as an indicator ofthe reliability of staff-recorded behaviors on a daily basis. Future research efforts shouldatte m pt to increase reliabil ity of m easu rem ent by having two indepen-dent observers record hehavioral outcome measures in addition to par-ticipant self-report to check for self-monitoring, as was used here.A nother l imitation w as due to the context ofthe project. The len gthof t im e av ailable for the study w as l im ited hy intern al adm inistrativechanges at the facility. Therefore, our timeline was rushed. RBE asoutlined hy Weil (1998) may be more effective when practiced withanother technique such as hreath meditation. Further, RBE may bemore effective when implemented on a consistent basis for a longerperiod of time, allowing for practice and rehearsal. Finally, RBE may

be more effective if applied more intensely. Recommendations for fu-tur e study include attem pting a more struc tured environm ent in whichto practice the RBE, to combine this technique with another one, toextend the length of treatment t ime, and to increase the intensity ofthe intervention. Further, a complete component analysis of commonanger management programs is l ikely warranted.The goal of decreasing aggression in male adolescents who are al-ready involved in the juvenile justice program is a common threadamong such progrEims. Typically, intervenions include an anger man-agem ent component which, in tu m , includes relaxation techniques an dexercises (Knapczk, 1992; Snyder, 1999). We sought to take one fre-quen t e lement of anger ma nagem ent , tha t is , an RBE, and at tem pt toisolate its efficacy across several participants. Despite the mixed re-sults reported, we do encourage future research in this area as somehenefit w as dem onstrated within the l imited t ime frame in which RBEwas applied.

' ' RE FE RE NCE S

7/27/2019 33026180.pdf

11/13

Deffenbacher, J. L., & St ark , R. S. (1992). Relax ation and cogn itive-relaxationtreatments of general anger. Journal of Counseling Psychology, 39,158-167.Feindler, E. L., & Ecton, R. B. (1986). Adolescent anger control: Cognitive-behavioral techniques. New York: Pei^amo n.Fraser, M. W. (1996). Aggressive behavior in childhood and early adolescence:An ecological-developmental perspective on youth violence. Social Work,42, 347-362.Frey , K. S., Hirs chs tein, M . K., & Guzzo, B. A. (2000). Second Step : P rev en tingaggression by promoting social competence. Journal of Emotional & Be-havioral Disorders, 8(2), 102-112.Go ldstein, A. P., Glick, B., & Gibbs, J. C. (1998). Aggression replacement train-ing (Rev. ed.). Cham paign, IL: Research Press.HoUin, C. R. (2003). Aggression replacement training: Putting theory and re-search to work. Reclaiming Children and Youth, 22(3), 132-136.Kaz din, A. E., Siegel, T. C , & Bas s, D. (1992). Cogn itive problem-solving skiUstraining and parent management training in the treatment of antisocialbehavior in children. Journal of Consulting and Clinical Psychology,60, 733-747.Ke llner, M. H. (1999). The effects of an ge r m anagem en t groups in a day schoolfor emotionally disturbed adolescents. Adolescence, 34, 645-652.Kellner, M. H., & T ut tin , J. (1995). A school-based anger management programfor deveiopm entally and em otionally disabled high school stud en ts. Ado-lescence, 30, 813-825.Knapc2yk, D. R. (1992). Effects of developing alternative responses on theaggressive b ehavior of adolescents. Behavioral Disorders, 17, 247-263.Krug, E. G., Dahlberg, L. L., Mercy, J. A., Zwi, A. B., & Lozano, R. (Eds.).(2002). World report on violence and health. Geneva: W orld Heedth Orga-nization.Margolin, A., Youga, J., & Ballou, M. (2002). Voices of violence: A study ofmale adolescent aggression. Journal of Hum anistic Counseling, Educa-tion, and Development, 41, 215-232.Nietzel, M. T., H asem ann , D. M., & Lynam , D. R. (1999). Behav ioral p erspec-tive on violent behavior. In V. B. Van H asselt & M. Hersen (Eds.),Hand-book of psychological approaches w ith violent offenders: Contemporarystrategies and issues (pp. 39-6 6). New York: Kluwer Academ ic/Plenum .Novaco, R. W. (1975). Anger control: The development and evaluation of anexperimental treatment. Lexington, MA: D. C. H eath .Rutherford, R. B. Jr., Q uinn, M. M., & M athu r, S. A. (1996). Effective strategiesfor teaching appropriate behaviors to children w ith emo tional disorder/behavioral disorders. Reston, VA: Council for Children with BehavioralDisorders. (ERIC D ocument Reproduction S ervice No. ED 391 304).Snyder, K. W. (1999). Anger management for adolescents: Efficacy of briefgroup therapy. Journal of the American Academy of Child and Adoles-cent, 38, 1409-1420.Snyder, S. N., & Sickmund, M. (1999). Juvenile justice: A century of change.(Juvenile Justice Clearinghouse Publication No. NCJ 178995). Rockville,MD: Office of Juvenile Justice and Delinquency Prevention.Steiner, H., Garcia, I. G., & Matth ew s, Z. (1997). Posttra um atic s tress disorderin incarcerated juvenile delinqu ents. Journal of the American Academ y

7/27/2019 33026180.pdf

12/13

Swenson, C . C , & Kenn edy, W. A. (1995). Perceived control and tre at m en toutcome with chronic adolescent offenders. Adolescence, 30, 565'-579.W eil, A. (1998). Health and healing. Shelburne, VT: Chapters.

' 1*'1

7/27/2019 33026180.pdf

13/13