effectiveness of occupational therapy intervention in

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IJOT : Vol. 45 : No. 3 September 2013 - December 201321

The Indian Journal of Occupational Therapy : Vol. 45 : No. 3 (September 2013 - December 2013)

To study the effectiveness of occupational therapy intervention inthe management of fear of public speaking in school going

children aged between 12-17 years Author : Nazia Ali (M.O.Th.)*; Co-Author : Ruchi Nagar (M.Sc. O.T.)**

ey Words:

Fear of Public Speaking,Relaxation, Desensitization

* Sr. Occupational Therapist,Akshay Pratisthan, New Delhi

** Assistant Professor, JamiaHamdard, New Delhi

Institution:Jamia Hamdard, New Delhi

Period Of Study :

2009-2010

Correspondence :Dr. Nazia Ali,

C-1264, Masjid Wali Gali, Tigri,New Delhi - 110062

Tel. No. :9818911486

E- Mail :[email protected]

Abstract

Objective:To find the efficacy of occupational therapy intervention for the school going children with fear ofpublic speaking.

Method: Thirty subjects with fear of public speaking were taken, which included both boys and girls. The

study designwas Pretest- Posttest, Experimental, Prospective and Single centre. Children having Fear ofpublic speaking was assessed using Hamilton Anxiety Rating Scale (HAMA) and Fear Thermometer (FT).

Results: It was found that there was significant (P


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Inclusion Criteria :

1. Subjects of age 12-17 years.

2. Regular school going children.

3. English medium public school.

Exclusion Criteria :

1. Subjects below 12 years & above 17 years.

2. Subjects with known history of any serious medical illness.

3. Diagnosed case of learning disability.

Variables :

• Independent variable: OT intervention

• Dependent variable : Fear of public speaking

Ooycome Measures or Scales Used

a. Hamilton Anxiety Rating Scale (HAMA). Tool for measuring

the severity of a patient’s anxiety. The HAMA probes 14 itemsand takes 15-20 minutes to complete the interview. Items arescored on a 5- point scale, raw data were given as:

0 = no anxiety.

1 = mild anxiety

2 = moderate anxiety

3 = severe anxiety

4 = very severe anxiety

HAM- A Score Level of anxiety

14 -17 mild

18 - 24 mild to moderate

25 and above moderate to severe

b. The Fear Thermometer (FT) is used which required subjectsto rate their anxiety level during their speech on a scale from 0

to 10 where 0 represented an absence of anxiety and 10represented maximal possible anxiety. FT scores were simplythe values assigned.

PROCEDURE:

Students were asked to fill HAMA scale. Subjects scoring morethan 14 on HAMA were selected for the study. Thus a total of 30 subjects were screened for the study. Subjects selected were

asked to rate fear levels on FT. Subjects were taken up for theOT intervention which included Relaxation and Desensitization.

Intervention had 15 individual treatment sessions, twice a week.

The first 10 sessions had Relaxation for 1 hour each and thenext 5 sessions had Desensitization for 45 minutes each whichincluded 15 minutes of discussion (relaxation training), 10

minutesfor constructing an anxiety hierarchy and 20 minutesfor Systematic pairing of visualized scenes with relaxation.

Intervention :

Treatment had 15 individual treatment sessions, twice a week.

Integrated Treatment (IT) Total Treatment Time

Relaxation 10 sessions (1 hour each)

Desensitization 5 sessions (45 minutes each)

Session 1 to 10

For Relaxation Schultz’s Autogenic Training (AT) was used.Children sat in comfortable armchairs and the following

exercises of relaxed breathing, relaxation of right hand, left hand,muscles of legs, and relaxation of abdomen and breast muscleswere provided in single sessions.

Children were asked to practice the same AT exercises at home,once a day.

After 7th session, the AT group was requested to 2-3 minutes of relaxation while in the classroom.

Session 11-15

Initiation session- 15 minutes discussion (relaxation training)

- 10 minutes constructing an anxiety hierarchy

- 20 minutes Systematic pairing of visualized scenes

with relaxation

Subjects were told to practice relaxation twice a day for 15minutes between sessions.

Subsequent sessions began with 15 minutes check on practice

and progress in relaxation during which relaxation was inducedand this was followed by desensitization.

Hierarchies ranged from 8 to 20 items arranged in order of arousing potency and each item was presented in imagination

to the subjects for 10 seconds followed by 30 seconds of relaxation before presenting the next item.

If the subjects did not signal anxiety after the second presentation

of an item, then the therapist presented the next item. If anxietywas signalled the item was repeated until an anxiety – freepresentation occurred.

After the intervention, the subjects were again asked to fill the

scales respectively.

Data Analysis and Result :

Microsoft excel 2003 data sheet was used to make master chart.

All statistical tests were performed using Statistical Package for Social Sciences (SPSS) version 15.Wilcoxon Signed Rank Testwas used to compare pre-treatment & post treatment scores among

the total sample. Mean and Standard Deviation of the pre-treatment & post treatment were also calculated as the samplesize was too small. Additionally, Mann- Whitney Test was used

to determine any significant difference in fear of public speakingbetween males and females and also with the age groups i.e.12-14 & 15-17 years. The statistical analysis, a P value equal toor less than .05 (P d” .05) was accepted as significant.


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Interpretation

Table-1 shows Comparative analysis for pre & post HAMA andFT. The data shows the pre & post mean values of HAMA andFT are (22.27, 11.57 & 6.37, 3.77) respectively. Result reveals

that there was significant ( p d” .05) difference between pre &

post intervention value for both.Table 2 shows that there was greater value of HAMA for femalesthan males before and after intervention .FT scores were higher

for females than males before intervention but post interventionmales had greater value than females. The result of test reveals

that there was no any significant (Pd”.05) difference between

male and female for pre and post HAMA (.097 & .882) and FT(.289 & .863) values.

Table 3 shows the data for HAMA & FT between Gr1 and Gr2.

The data shows that there was greater value of HAMA for gr1than

gr2 before and after intervention. FT scores were higher for Gr1than Gr2 before and after intervention. The result of test reveals

that there was no any significant (Pd”.05) difference betweenGr1 and Gr2 for pre and post HAMA (0.066 & .983) and FT(.374 & .757) values.

Table 1 : Summary of Comparison of pre & post HAMA and FT

VariablesPre Post

Z value P valueMean ± S.D Mean ± S.D

HAMA 22.27 ± 5.89 11.57 ± 3.75 -4.791 .000

FT 6.37 ± 1.27 3.77 ± 1.43 -4.901 .000

Table 2 : Comparison between male (N=13) and female (N=17) for HAMA and FT

Table 3 : Comparison between Gr1 (12-14 yrs.) and Gr2 (15-17 yrs.) for HAMA and FT

Variables

Mean ± S.D. U valueP-value

M F M F

Pre Post Pre Post Pre Post

Hama 20.38+5.39 23.70+5.99 11.31+3.50 11.76+4.02 71.00 107.00 .097 .882

Ft 6.08+1.19 6.58+1.32 3.85+1.40 3.70+1.49 86.00 106.50 .289 .863

Variables

Mean ± S.D. U value

Gr1P-value

Gr1 Gr2 Gr1 Gr2

Pre Post Pre Post Pre Post

Hama 23.79+5.92 19.63+5.04 11.73+4.09 11.27+3.22 62.00 104.00 .066 .983

Ft 6.52+1.30 6.09+1.22 3.78+1.27 3.72+1.73 84.50 97.50 .374 .757

Graph-1(a) Comparison of Pre and Post HAMAGraph-1(b) Comparison of Pre and Post FT


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Graph-3(b) Comparison between Gr1 and Gr2 for FT

Graph-2(a) Comparison between male and female for HAMA Graph-2(b) Comparison between male and female for FT

Graph-3(a) Comparison between Gr1 and Gr2 for HAMA

Discussion :This study has investigated to see the efficacy of OccupationalTherapy Intervention including relaxation training and systematicdesensitization in reducing fear of public speaking. In present

study the result was found that there was significant (Pd” .05)effect of O.T. intervention in reducing fear of public speaking,hence the experimental hypothesis is proved by rejecting the

null hypothesis.

In present study the fear of public speaking had reduced after O.T. intervention. Statistically significant difference was foundin HAMA and FT as outcome measure before and after the

relaxation training and systematic desensitization [table 1] and[Graph 1(a) & 1(b)]. Few studies11, 12, 13, 14 have similar findingswith the present study. Kondas O. (1967)13Found the similar

results using Fear Survey Schedule Scale. It was found that theresults with relaxation by means of Schultz method andsystematic desensitization are significant in children. This could

be attributed to the fact that fear of public speaking is a learnedfear in which punishment, feeling ashamed, criticism, decreasingprestige and similar effects work as negative reinforcing factors.

Fear of public speaking symptoms like tremor, excitement,muscle rigidity or a feeling of stomach spasm indicates thepresence of tension in this state. The result showed better results

in children with Schultz’s Method of relaxation.

Study by Turner,Biedel& Cooley-Quille (1995)14 investigatedthe behavioral treatment effects on social phobia’susing HAMA

clinical rating and various self-report measures(EPI, FQ& SPAI)reports that there was a significant decrease in fear in studentsbefore and after treatment.

In the present study, females had greater mean score valuesthan males before intervention, it shows females had greater fear than males [table 2]. The present finding is in agreement

with the finding of Salman et al (1997),2Ollendick et al (1985)15

and Ollendick and King (1994).16 Mean scores for HAMA andFT have reduced for both males and females post intervention,

this implies that the fear has reduced in both males and females

[Graph 2(a) & 2(b)]. However there was no significant differencein the decrease of fear between males and females. This implies

that both males and females had similar improvements i.e.decrease in fear.

In the present study, Group 1 had greater mean score valuesthan group 2 before intervention, it shows that group1 had greater

fear than group2 [table 3] and [Graph 3(a) & 3(b)]. The presentfinding resembles with the findings of Salman et al (1997)2 andOllendick and King (1994).16Ollendick and King reported young

adolescents have more fears than older adolescents whereasSalman et al (1997)2 said that there was an age related declinein fears. From the light of these findings it could be said that as

the child ages the level of fear decreases.


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This study was done to determine the effectiveness of

Occupational Therapy intervention including relaxation andsystematic desensitization to reduce fear. There was significantreduction in fear of public speaking using this standard treatment

protocol in school going children between 12 to 17 years. Therelaxation technique helps to control the tension, anxiety and

fear by systematic efforts.

The treatment (relaxation training and systematic desensitization)given in this study is a combination of the treatments used bySchooling &Emmelkamp ,1993;17 Mattick et al 198918 and

Kondas O. 196713.

Limitations :

• Sample size was relatively small; hence the results cannotbe generalized to masses.

• The range of age group of the sample was small (12-17

yrs.), hence the results cannot be generalized to other age

groups.• Small duration of the Protocol.

Future Recommendations :

• Large population should be studied.

• Age groups below 12 & above 17 yrs. can also be includedin the study.

• Experiment should be carried out on the person having some

different types of fears / phobias.

• Follow-up should be there every two years.

Conclusion :The experimental hypothesis of the study was accepted and null

hypothesis was discarded. The result of this study revealed thatOccupational Therapy intervention significantly reduces the fear of public speaking in school going children between the age

group 12 to 17 years.

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