The eects of a Feldenkrais1 Awareness Through Movement program on state anxiety

7/29/2019 The e ects of a Feldenkrais1 Awareness Through Movement program on state anxiety

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The eects of a Feldenkrais1

Awareness Through Movementprogram on state anxiety

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gregory S. Kolt, Janet C. McConville

Abstract The eects of a Feldenkrais1 Awareness Through Movement program and

relaxation procedures were assessed on a volunteer sample of 54 undergraduate

physiotherapy students over a 2-week period. Participants were randomly allocated

into a Feldenkrais Method1 group, a relaxation group, or a no-treatment (control)

group, and state anxiety was measured using the ComposedAnxious scale of the

Prole of Mood States-Bipolar Form (Lorr & McNair 1982) on four occasions: prior

to the rst intervention, prior to the fourth intervention, on completion of the fourth

intervention, and one day after the fourth intervention. Analysis of variance showed

that anxiety scores for all groups varied signicantly over time and, specically, that

participants reported lower scores at the completion of the fourth intervention.

Further, compared to the control group, females in the Feldenkrais1 and relaxation

groups reported signicantly lower anxiety scores on completion of the fourth session

(compared to immediately prior to the fourth session), and this reduction was

maintained one day later. These ndings can be interpreted as preliminary evidence of

the ecacy of the Feldenkrais Method1 and relaxation procedures in reducing

anxiety. # 2000 Harcourt Publishers Ltd

Introduction

The Feldenkrais Method1 is an

increasingly popular treatmentmodality used by health

professionals for a range of

dysfunctions (Hopper et al. 1999;

James et al. 1998; Wildman 1990).

The aim of the Feldenkrais

Method1 is to improve function by

teaching individuals to move with

ease and eciency. It has been

suggested that the Method works by

improving a persons awareness of

his or her body and attending to

one's kinaesthetic sense of

movement (Apel 1992). By

increasing the awareness anddiscrimination of sensory input, an

individual could achieve improved

dierentiation of body parts,

thereby replacing habitual

movement patterns with new

movement options (Rywerant 1983).

Further, Feldenkrais (1977) put

forward the premise that improved

neuromuscular function could have

a positive inuence not only on the

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Journal of Bodywork and Movement Therapies (2000)

4(3), 216^220

# 2000 Harcourt Publishers L td

Gregory S. Kolt PhD, BSc,BAppSc(Phty),

GradDipEd,GradDipBehavHlthCare

Professor and Associate Dean (Research), Faculty

of Health Studies, Auckland University of

Technology

Janet C. McConville BAppSc(Phty),

GradDipPhysio(Sports),MSc

Feldenkrais Practitioner, Associate Lecturer, School

of Physiotherapy, La Trobe University

Correspondence to: Gregory Kolt

Faculty of Health Studies, Auckland University ofTechnology, Private Bag 92006, Auckland 1020,

New Zealand.

Tel: +64 9 3079999 ext 7774; Fax: +64 9 3079877;

E-mail: [email protected]

Received December 1999

Revised February 2000

Accepted February 2000

F E L D E N K R A I S A N D A N X I E T Y

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J O U R N A L O F B O D Y W O R K A N D M O V E M E N T T H E R A P I E S J ULY 2 0 0 0


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way one moves, but also how one

thinks and feels.Despite the rise in popularity

of the Feldenkrais Method1, a

relatively limited body of

empirical evidence for the Method's

eciency has been published (e.g.Bearman & Shafarman 1999;

Brown & Kegerreis 1991; Chinn

et al. 1994; Gutman et al. 1977;

Hopper et al. 1999; James et al.

1998; Kirkby 1994a; Ruth &

Kegerreis 1992; Stephens et al.

1999). The majority of available

research is in form of anecdotal

evidence and case study reports

(e.g. Lake 1985; Martin 1994;

Strauch 1988).

Several reports have indicatedthat physiological, psychological

and kinesthetic changes can be

achieved using the Feldenkrais

Method1. Some of the reported

physical eects include increased

muscle length and exibility,

improved posture and muscular

relaxation (Hopper et al.1999; James

et al. 1998). The empirical studies

that have been carried out to assess

the ecacy of the Method on

physical attributes and functions

have produced conicting ndings,which have often been complicated

by problematic methodology (e.g.

lack of control groups) and the

diculties in investigating the

Feldenkrais Method1 where

dependent variables are aected by

multiple psychological, physical, and

autonomic inuences (Bate 1994).

A smaller body of literature has

addressed possible psychological

and behavioural eects of the

Feldenkrais Method

1

. It has beensuggested that the Feldenkrais

Method1 can reduce perceived

exertion levels during movement

(Brown & Kegerreis 1991; Chinn et

al. 1994; Ruth & Kegerreis 1992),

induce relaxation (Wanning 1993),

elevate mood, enhance ability to

learn, increase clarity of thought

(Lake 1983) and reduce anxiety

(Soloway 1996).

Although it has been suggested

that the improved neuromuscular

function associated with the

Feldenkrais Method1 could

inuence how an individual thinks

and feels (Feldenkrais 1977), no

published empirical investigationshave been found that have directly

assessed anxiety in relation to the

Method. For these reasons, the

present work was carried out within

an exploratory framework.

The aim of this study was to

investigate the eects of a

Feldenkrais1 Awareness Through

Movement program on state

anxiety. For the purpose of this

study, state anxiety was dened as

an unpleasant emotional state whichmay exist at any given moment in

time and at any particular level of

intensity, the experience of which

encompasses various psychological

(e.g. nervousness, distress, worry)

and somatic (e.g. autonomic

nervous system phenomena)

symptoms (Spielberger et al.

1983).

Method

Participants

The participants were 54 (19 male

and 35 female) undergraduate

physiotherapy students ranging in

age from 17 to 38 years (mean

age=22.0, SD=3.9). The male

participants (mean age=21.8,

SD=3.0) were not signicantly

dierent in age from the female

participants (mean age=22.2,

SD=4.4). None of the participantshad practical experience with the

Feldenkrais Method1 prior to the

commencement of this study.

The participants were volunteers

and no payment or other incentive

was oered. All participants signed

an informed consent form and the

project was approved by the La

Trobe University Faculty of Health

Sciences Ethics Committee.

Test instruments

The test package administered at the

start of the study consisted of a

questionnaire to collect personal

data (e.g. age, gender, previous

experience with the Feldenkrais

Method1 and relaxation training)

and the Bipolar Form of the Prole

of Mood States (POMS-BI, Lorr &

McNair 1982). State anxiety was

assessed using the `Composed-

Anxious' scale of the POMS-BI.

This scale consists of 12 adjectives or

phrases (e.g. ùntroubled', `tense'.

`relaxed') which participants

respond to with one of four response

options (`much unlike this', `slightly

unlike this', `slightly like this', `much

like this') that described how theywere feeling `right now'. The

psychometric properties of the

POMS-BI have been reported as

acceptable (Lorr & McNair 1982).

Procedure

Participants, after completing the

POMS-BI questionnaire, were

randomly allocated to one of three

treatment procedures: Feldenkrais1

training (n=17), relaxation training

(n=20), and no training (control)(n=17). Subjects in the Feldenkrais

Method1 group participated in four

45 min Awareness Through

Movement (ATM) lessons via

training audiocassettes (a commonly

used method of ATM

administration, Kolt et al. 1998)

over a 2-week period: the sessions

were held two times per week on

separate days. The lessons used were

Àctivating the exors' (Wildman

1983a), Àctivating the extensors'(Wildman 1983b), `Rolling onto the

side' (Wildman 1983c) and

`Lengthening the hamstrings and

spine' (Wildman 1983d).

Audiocassettes of the Wildman

ATM lessons are available from

Feldenkrais1 Resources, Box 2067,

Berkeley, California, 94702, USA.

Subjects in the relaxation group

participated in four 45 min

Feldenkrais andanxiety

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relaxation sessions (also

administrated by audiocassette,

Kirkby 1994b). The program

involved three aspects of relaxation:

Benson's relaxation technique

(Benson 1975), Jacobson's

progressive relaxation (Jacobson1964), and guided imagery

(Zahourek 1988). See Box 1 for an

example of the dialogue of the

relaxation exercise. The relaxation

sessions were held at the same time

as the Feldenkrais1 sessions, but in

a separate room. The participants in

the control group were not required

to perform any specic tasks over

the 2-week intervention period.

The POMS-BI was administered

to all participants on four occasions:prior to lesson 1, prior to lesson 4,

on completion of lesson 4 and one

day after lesson 4.

This study was part of a larger

project on the eect of the

Feldenkrais Method1 on cognitive

mood states and hamstring muscle

length (James et al. 1998).

Results

A 364 factorial ANOVA withrepeated measures on one factor

(time) showed that the between

groups main eect for treatment

technique and the interaction

between treatment group and

time of measurement were not

signicant for the POMS-BI

ComposedAnxious scores.

However, ComposedAnxious

scores of the POMS-BI did vary

signicantly over time F (3,

153)=14.62, p=0.001, with post-hoc tests showing that all

participants reported lower

ComposedAnxious scores (i.e.

participants in all groups were less

anxious and more composed) at the

completion of session four.

When males and females were

analysed separately, the females

showed a signicant interaction eect

between treatment group and time of

measurement, F (6, 96)=3.01,

P=0.009. Post-hoc analyses showed

that, compared to the control group,females in the Feldenkrais1 and

relaxation groups reported

signicantly lower anxiety scores on

completion of the fourth lesson

(compared to immediately prior to

the fourth session), and this

reduction was maintained one day

later.

Discussion

The current study showed that,compared to female participants

in the control group, female

participants in the Feldenkrais

group and relaxation group reported

a reduction in anxiety levels over a

single Feldenkrais1 ATM lesson.

Box1 Example of relaxationexercises. (Adapted from Kirkby1994b)

Jabobson's Progressive Relaxation Make yourself comfortable and, if you can, lie on the oor in a comfortable position. If not, sit in a

chair. We will start now. I want you to be relaxed. We will commence with your hands. Try to leave the rest of your body relaxed. When I say

the word `now' I want you to tense your hands. Make them very very tight. Tense your hands now. Tense them, tense, then, increase the

tension, tighter, tighter, relax. Let the tensions ow out. Let the relaxation ow into those muscles. Focus your attention on the relaxation.

Focus your attention on how those muscles feel. Now I want you to tense your arms up to your shoulders. Try to leave your hands and the

rest of your body relaxed. When I say the word `now' I want you to tense your arms. Tense them now F F F [the exercise continues progressively

to involve other regions of the body]

Benson's Relaxation Sit quietly or lie quietly and think about your breathing. I want you to empty your head and concentrate only on your

breathing. Put one hand upon your chest. You can feel your breathing. Without making yourself uncomfortable see if you can make your

breathing a little shallower. See if you can breathe a little less deeply. Don't do this to where it's uncomfortable. Remain at a comfortable level

of breathing. See if you can breathe a little slower, but not to where it is uncomfortable. Continue to breathe at a comfortable level. Now put

your hands by your side again. Focus on your breathing. As you breathe out I want you to say to yourself silently the word ``relax''. As you

breathe out say silently to yourself ``relax''. As you breathe out say to yourself ``relax'' F F F Sometimes it's very hard to concentrate on your

breathing. Other thoughts intrude. To help you let these thoughts go I want you to focus on an image. An image that can move in time with

your breathing. For example, some curtains that are blowing in and out of a window. As you breathe in the curtains blow in, and as you

breathe out the curtains blow out F F F Focus on the image in time with your breathing. Focus your attention on the image, and as you breathe

out say to yourself `relax' F F F [The exercise continues in this vein]

Guided Imagery I want you to think of yourself standing in a eld. It's a very sunny day. The sun is shining down on you as you stand in

the green grass, and a soft wind, a soft breeze, ows over you. It's very warm. You can feel the sun shining on you. The sun is shining through

your clothes and you can feel it on your body. Close your eyes and turn your face towards the sun F F F On the other side of the river are trees,

and the soft breeze ows through them. You can see the leaves moving, the branches softly swaying. As the leaves turn, their colour changes.

There are some rocks in the river and the water swirls past them F F F You are feeling happy, you are feeling calm. I want you to focus on your

breathing and as you breathe out say `relax' F F F After three more breaths open your eyes and lie quietly.

Kolt andMcConville

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Further, this dierence was

maintained one day later.

The ndings of the current study

do not support those of Kirkby

(1994a) who found (as part of a

larger study) no signicant

dierences in anxiety between theFeldenkrais1 and no training

(control) interventions in females

reporting severe premenstrual

symptoms. The dierences in

ndings could be due to the sample

characteristics (the current study

focused on a group of `normal'

subjects, while Kirkby investigated

women who had reported severe

premenstrual symptoms) or the

dierent instruments used to

measure anxiety in the two studies.That the current study showed

Feldenkrais1 and relaxation

procedures to be equally eective

(for female participants) in reducing

anxiety, could be explained by the

technique's providing temporary

distraction from unpleasant

cognitions and emotions (Morgan

1985). Despite the obvious lack of

empirical research into the eects of

the Feldenkrais Method1 to

support this possible explanation,

the distraction hypothesis haspreviously been used to explain

reduced anxiety levels following

participation in exercise (Bahrke &

Morgan 1978; DeVaney et al. 1994;

Fillingam & Blumenthal 1993). For

example, Bahrke and Morgan

suggested that reductions in anxiety

associated with exercise were not

due to exercise per se but rather due

to the diversional aspects of the

activity through serving as a

distraction from the stressors ofdaily life. In the present study,

however, that the anxiety reduction

was maintained one day later,

suggests that distraction alone does

not fully account for the prolonged

anxiety changes.

The present ndings must be

viewed in light of some possible

limitations, These include

dierences in the number of males

and females in the sample that could

possibly impact on the gender

dierences in ndings, and that

participants in the Feldenkrais and

relaxation groups could have

`expected' their interventions to

result in anxiety changes, and hence,responded to the POMS-BI

accordingly.

Notwithstanding these possible

limitations, the ndings of the

present study provide a framework

on which further investigations of

the Feldenkrais Method1 can be

based. One obvious direction for

further research involves the

investigation of the Feldenkrais

Method1 on highly anxious

populations and other `clinical'groups (e.g. people with chronic low

back pain). In summary, the ndings

can be interpreted as preliminary

evidence of the ecacy of the

Feldenkrais Method1 and

relaxation procedures in reducing

anxiety and should be considered by

health care professionals when

managing anxiety and related

conditions.

Acknowledgements

The authors thank Kathy Hayes for her

assistance in collecting the data for this

project and gratefully acknowledge the

cooperation of the participants in giving

their time. This research was carried out

while Gregory Kolt was working in the

School of Physiotherapy, La Trobe

University, Melbourne, Australia.

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RESOURCES

Audiocassettes of the Wildman ATM lessons

are available from Feldenkrais

Resources, Box 2067, Berkeley,

California, 94702, USA.

Kolt andMcConville

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The eects of a Feldenkrais1 Awareness Through Movement program on state anxiety