Beangste en nie-beangste eerstejaardamestudente : 'n klinies-psigologiese verkenning
Du Plessis, Wynand Frederick
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At present the problem of anxiety seems to be less prominent than during previous decades, which had specifically been characterized as the "era of anxiety". The increased consumption of narcotics, the vast number of publications regarding anxiety as well as the necessity of change in the South African society - implying change in traditional security-providing structures and thus causing uncertainty - underline the fact that the problem of anxiety can in fact not be seen as being less prominent on a national or international level. Where, on the one hand, the period of youth provides special challenges to young people, it also represents potential for the experience of anxiety, since it implies developmental tasks, which may lead to conflict and with further intensification, to the experience of anxiety. Against this background the present study was primarily an endeavour to investigate possible differences between a population of anxious and a random sample of non-anxious female first-year students Secondly the study involved an applied therapeutic investigation to evaluate the efficiency of an anxiety-reduction program carried out on a sample of anxious students and a stimulation programme with a sample of non-anxious subjects, both by means of audio-psycho-phono= logical training. Firstly the prominence of the phenomenon of anxiety as it manifests itself in the fields of theology, philosophy, literature and psychology, was outlined briefly. Next, various definitions of anxiety were discussed. It was concluded that at present a universally acceptable definition of anxiety could not be provided, due to its multi-dimensional nature. Then the etymology of anxiety was explored It transpired that the concept of anxiety was fundamentally rooted in aspects pertaining to conflict-threat-potential and renewal. 6.2 SURVEY OF THE LITERA 6.2 SURVEY OF THE LITERATURE (CHAPTER I) Subsequently anxiety was discussed in terms of related phenomena, such as fear, depression, guilt, tension and stress, meaningfulness, development of personality and faith. As an outcrop of the discus= sion the neurophysiology and the biochemistry of anxiety were also briefly scanned. From this it became clear that anxiety is a corn= plex combination of different emotions and that its manifestation and adapt at ion both on the neurophysiological and biochemical level, cannot be conceived in simple terms. Anxiety was found to be cha= racterized by both ergotro~hic-sympathetic adrenocortical activity, and trophotropic-parasympathetic adrenomedullary activity. Should both these antagonistic systems discharge simultaneously, it should be seen as indicative of a breakdown of their normal reciprocal relations. The latter situation could create the possibility for an increased proneness to maladaptive behaviour . Next the problem of anxiety was analyzed in terms of recent thera= peutic approaches. In the survey of the main approaches the psyo choanalyt ic, behavioral ,existent ial-humanist ic and audio-psychophonological approaches were included, the latter, due to the fact of being relatively new and thus unknown. Each approach was discussed in terms of its theoretical and therapeutic methods and was evaluated in terms of its underlying view of man. Regarding the psychoanalytic approach a short survey of the classical psychoanalytical approach was given; subsequently the more recent, still relevant views of anxiety as presented by Rank, Horney, Sullivan and From were outlined. The discussion was then focussed on the separation anxiety theory and therapy of Mann, whose approach might be regarded as a contemporary psychoanalytic-oriented approach to the problem of anxiety. The behavioral approach was discussed in terms of the main assumptions regarding the etiology of anxiety. The following therapeutic approaches from a behavioral view were then discussed: relaxation methods and systematic desensitization, assertiveness training, cognitive approaches and self-control techniques. The evaluation on principal grounds emphasized the value of an active, symptom-direc= ted approach, but also cautioned t h a t the philosophical view un= d e r l y i n g t h e behavioral approaches did not permit optimal u t i l i = zation of the p o t e n t i a l of anxiety. Next the existential-humanis= t i c approach was discussed, with reference t o three main points of departure regarding anxiety, viz. anxiety a s a consequence of the human condition, anxiety as a t h r e a t t o core values of the individual and anxiety a s t h e experience of meaninglessness. Subsequent= l y , t h e t h e r a p e u t i c approaches h a i l i n g from t h e s e p o i n t s of departure were discussed, viz. those of Bugental, May and Frankl. Evalua= tion of the above-mentioned approaches emphasized t h e c o n s t r u c t i v e p o t e n t i a l of these approaches, but a l s o indicated t h a t the existen= tial-humanistic approach, when viewed from a Christian perspective, is hampered by its s e c u l a r view of man, p a r t i c u l a r l y regarding ther a p e u t i c p r a c t i c e . In connection with audio-psycho-phonology (APP) an o u t l i n e was given of the causes of anxiety (including causes of a p r e n a t a l l e v e l ) . The r o l e of auditory perception i n r e l a t i o n t o the problem of anxiety was also emphasized. Next, an o u t l i n e of audio-psycho-phonological t r a i n i n g as it i s applied t o the problem of anxiety was discussed. The three phases c o n s t i t u t i n g t h e process viz. the phase of f i l t e r e d sounds, the phase of sound b i r t h and the phase of audio-vocal t r a i - ning were discussed. In view of the unf a r n i l i a r i t y of t h i s approach, p o s s i b l e p o i n t s of convergence between APP and e x i s t i n g approaches were d e l i n e a t e d . I n t h e e v a l u a t i o n of t h i s approach, i t s Christian view of man was outlined. However, it was a l s o pointed out t h a t extensive research was needed i n order t o place many speculative aspects on a sounder s c i e n t i f i c basis. In conclusion it was s t a t e d t h a t the d i f f e r e n t approaches manifested important points of conver= gence i n co-existence with many divergent t r e n d s . 6.3 METHOD OF STUDY (CHAPTER 11) In t h i s chapter a survey was given of the procedure with reference t o the psychometric i n v e s t i g a t i o n . Selection of s u b j e c t s : the population Erom which t h e s u b j e c t s were drawn consisted of female f i r s t year students studying f o r a de= gree. A t o t a l of 424 students from various f a c u l t i e s were asses= sed by means of two standardized anxiety s c a l e s , eg. the IPATanxiety s c a l e and the Reactions t o Everyday S i t u a t i o n s (RES). From t h e s e s u b j e c t s , a population of anxious subjects and a ran= dom sample of non-anxious subjects were i d e n t i f i e d . The anxious subjects each achieved a sten score of 7 or higher on both anxiety s c a l e s . The non-anxious subjects were randomly drawn from an i d e n t i f i e d group of 76, who had a l l achieved a sten score of 4 o r lower, on both anxiety s c a l e s . Psychometric assessment: t h i s process was c a r r i e d out i n three phases: Phase one concurred with the mass evaluation involving a l l f i r s t year students. Amongst other psychological t e s t s , the subjects completed the Personal, Home, Social and Formal Rela= t i o n s Questionnaire as well as a biographical questionnaire. Since t h e r e s u l t s of these two questionnaires were incorporated i n the present s t u d y , the occasion of the mass evaluation could be viewed as representing the i n i t i a l phase of assessment. The second phase c o n s t i t u t e d t h e e v a l u a t i o n of the 424 s u b j e c t s , by means of the two anxiety q u e s t i o n n a i r e s , which led t o the identi= f i c a t i o n of the anxious and the non-anxious group, both consis= t i n g of 40 subjects. The t h i r d phase consisted of the individual assessment of the t o t a l of 80 s u b j e c t s . After contact had been established with each of these s u b j e c t s , they were met indivi= dually, and af t e r a collaboration r e l a t i o n s h i p had been e s t a b l i s - hed the following b a t t e r y of psychological t e s t s was completed: t h e Tree Test o f Bolander, the shortened version of the Beck de= pression inventory, the STAI-anxiety s c a l e , the Purpose i n Life Test (PIL), i t s complementary s c a l e , the Search-for-Nof tic-Goals- Test (SONG), the S.A.-Wechsler-intelligence t e s t f o r a d u l t s and the Personal Orientation Inventory (POI). A measure of academic performance, based on average performance during the mid-year examination was a l s o acquired f o r each s u b j e c t . Since the instruments u t i l i z e d c o n s t i t u t e d mainly q u e s t i o n n a i r e s , and a l t e r a t i o n of responses could have occurred due t o the f a c t of s o c i a l d e s i r a b i l i t y , s p e c i a l e f f o r t s were made to e s t a b l i s h a working r e l a t i o n s h i p based on t r u s t . C o n f i d e n t i a l i t y was a l s o emphasized as well as the willingness t o discuss the r e s u l t s once they had been obtained. Many subjects seemingly welcomed the opportunity f 6 r s e l f - d i s c l o s u r e and an emotional c a t h a r s i s r e s u l t e d i n the majority of c a s e s . After the completion of the individual assessment of both groups, the r e s u l t s were computed by means of s t a t i s t i c a l techniques. The following techniques were incorporated: the chi-square goodness-of-fit-test f o r in= dependent groups, the z-test f o r determining t h e s i g n i f i c a n c e of differences f o r l a r g e groups, a p r o f i l e analysis f o r independent groups and the Wilcoxon paired ranks sign t e s t f o r small de= pendent groups (the l a t t e r being u t i l i z e d t o compute the r e s u l t s of the applied therapeutic programmes (See 6.6). 6.4 RESULTS PROVIDED BY THE PSYCHOMETRIC INVESTIGATION (CHAPTER 1111 Thetestresultswerereported separately as regards each of the tes= t i n g instruments, i n the order i n which they had been performed. 6.5 DISCUSSION OF THE RESULTS OF THE PSYCHOMETRIC INVESTIGATION (CHAPTER IV) The findings of t h e i n v e s t i g a t i o n could be summarized in terms of the following dimensions: f i r s t l y global s i m i l a r i t i e s among c e r t a i n as= pects of the two groups emerged. In terms of biographical v a r i a b l e s t h e groups were found t o be almost completely s i m i l a r , s i n c e only t h r e e of the 25 biographical variables produced s i g n i f i c a n t d i f f e = rences. According to t h e r e s u l t s on the Tree Test, the groups showed no difference i n terms of the occurrence of traumatic i n c i d e n t s , such as i l l n e s s o r the loss of loved ones. I n t e l l e c t u a l l y the groups al= so functioned on a comparable l e v e l . The l a t t e r finding might be r e l a t e d t o the f a c t t h a t the groups also did nog d i f f e r i n terms of academic perf onnance. A second, more important dimension, was t h a t the r e s u l t s r e f l e c t e d s i g n i f i c a n t differences in favour of the non-anxious group. From the biographical questionnaire it emerged t h a t the anxious group produced s i g n i f i c a n t l y fewer leaders in the area of s p o r t , t h a t they were s i g n i f i c a n t l y more doubtful about t h e i r academic choices ( f i e l d of study) and t h a t they manifested a s i g n i f i c a n t l y lower l e v e l of academic a s p i r a t ion than the non-anxious group. These few signi= f i c a n t differences on the biographical questionnaire suggested t h a t differences between the groups did e x i s t - the magnitude and meaning of which could be deduced from t h e r e s t of the r e s u l t s . In terms of adjustment the anxious group a l s o manifested s i g n i f i c a n t l y g r e a t e r indices of problematic adjustment regarding personal, home, s o c i a l and formal r e l a t i o n s . S i g n i f i c a n t i n d i c a t i o n s of low self-esteem, more nervousness, poorer self-control and l e s s self-confidence as well as a bigger pre-occupation with physical well-being was charac= t e r i s t i c of the anxious group on t h e l e v e l of personal adjustment. The above-mentioned i n d i c a t i o n s of problematic adjustment were confirmed f u r t h e r by the s i g n i f i c a n t l y lower level of s e l f - a c t u a l i z a = t i o n achieved by the anxious group. In terms of the l a t t e r the anxious group was found t o be struggling s i g n i f i c a n t l y more t o achieve time competence, and they were s i g n i f i c a n t l y l e s s inclined towards u t i l i z i n g t h e i r p o t e n t i a l f o r self-support. Furthermore, they were functioning s i g n i f i c a n t l y poorer on a l l four combined sub-scales of the POI: valuing, s e l f - p e r c e p t i o n , i n t e r p e r s o n a l s e n s i t i v i t y and awareness. In terms of these r e s u l t s the e x p e r i e n t i a l world of the anxious group appeared t o be more c o n s t r i c t e d , and l e s s l i f e - g i v i n g than t h a t of the non-anxious group. The f a c t t h a t the anxious group appeared not t o be optimally involved i n t h e i r e x p e r i e n t i a l world, as a r e s u l t of the above-mentioned r e s u l t s , might also explain t h e i r inadequate sense of meaningfulness as well as t h e i r moderate l e v e l of depression. This condition might be r e l a t e d t o t h e f i n d i n g s about t h e i r s i g n i f i c a n t stronger tendency towards defence. A t h i r d dimension revealed the vulnerability of the anxious group in view of the developmental tasks as related to t h e i r developmental level, viz. the youthful phase (18-22 years). In the f i r s t place, it appeared that the members of the anxious group, as a result of t h e i r low self-images, inadequate sense of meaningfulness and mode= rate depression, were not a s f r e e l y able to participate in the actua= l i z a t i o n of t h e i r i d e n t i t i e s as were the members of the non-anxious group. This s t a t e of a f f a i r s suggested the danger of alienation in= stead of identity formation, should the high level of anxiety not de= crease. Vulnerability i n terms of the second developmental task, viz. t h e delineation of certain l i f e values and goals, appeared from t h e finding that the anxious group f e l t t h e i r behaviour to be s i g n i f i c a n t l y less compatible with the norms of society. In t h i s regard, the r e s u l t s of the self-actualization questionnaire mani= f e s t e d f u r t h e r confirmation, since it t y p i f i e d t h e anxious group as s i g n i f i c a n t l y l e s s inclined t o t h e i r own preferences, dislikes and needs. From these findings it was concluded that value realization as part of personality development could not take place optimally. Diminution of living thus appeared as a sign of danger, should the high anxiety skate not decrease. As regards the choice of and preparation f o r a career, as a t h i r d developmental task, the vul= nerability of the anxious group was revealed in t h e i r being signif i c a n t l y more doubtful about t h e i r choice of study course than the non-anxious group. This aspect was further underlined by t h e i r s i g n i f i c a n t l y lower level of academic aspiration - a fact which might be related to the f a c t t h a t 10% of the anxious group had terminated t h e i r studies during the f i r s t five months of t h e i r academic career, whilst no drop-outs occured among the non-anxious group. The most prominent facet of vulnerability stemmed from t h e struggle of the anxious group with the fourth developmental task, viz. the experience of interpersonal r e l a t i o n s . Interpersonal d i f f i c u l t i e s varied from s i g n i f i c a n t l y more problems of adjustment regarding home relations to adjustment in terms of social and formal relations. Additional results in t h i s regard were that the anxious group found it d i f f i c u l t t o i n i t i a t e warm, meaningful relationships, manifested s i g n i f i c a n t l y s t r o n g e r i n t r o v e r s i v e tendencies as well as a sign;= f i c a n t l y weaker need t o r e l a t e t o members of t h e opposite sex. They were a l s o s i g n i f i c a n t l y more limited i n t h e i r capacity f o r s e l f - expression. Thus the i s o l a t i n g e f f e c t of anxiety was concretely s p e l l e d out i n the r e s u l t s . Should the high l e v e l of anxiety n o t be lowered, it might lead t o a l i e n a t i o n from the s o c i a l environment, accordingly prevent the supposed development from g e n i t a l i t y t o sexual mutuality and possibly cause the r e l a t i o n s h i p s of the anxious subjects with t h e i r parents t o become f i x a t e d i n the sphere of de= pendence. A fourth dimension revolved around a need f o r and s u f f i c i e n t potent i a l f o r an anxiety reduction programme. This need c r y s t a l l i z e d from the following evidence: the s u b j e c t s ' behaviour during the phase of individual assessment, t h e i r high scores on the Seeking-of- ~ o G t i c - ~ o a l s - ~ e stth, e i r s i g n i f i c a n t l y higher scores on the desira= b i l i t y subscale of the PHSF Questionnaire, which indicated a willing= ness t o respond honestly and, u l t i m a t e l y t h e f a c t t h a t 25% of t h i s group eventually completed an anxiety reduct ion programme. The sub= j e c t s ' p o t e n t i a l f o r therapy emerged, amongst other things, from the following: the presence of high anxiety which, in existential-humanistic terms, could be i n t e r p r e t e d as a p o t e n t i a l growth stimulus, a s well as the r e l a t i v e l y favourable home backgrounds of the s u b j e c t s . In conclusion it was cautioned t h a t the anxious group could not be "written off", since the spheres in which they experienced t h e i r most i n t e n s e anxiety might well represent those areas i n which they might be bound t o undergo the most s i g n i f i c a n t personality expansion, depending on the way i n which they deal with t h e i r experiences of anxiety. 6.6 AN APPLIED INVESTIGATION WITH REGARD TO A SAMPLE OF ANXIOUS AND A SAMPLE OF NON-ANXIOUS FEMALE FIRST'YEAR STUDENTS BY MEANS OF AUDIO-PSYCHO-PHONOLOGICALT RAINING (CHAPTER V) The second part of the empirical i n v e s t i g a t i o n consisted of two therapeutic programmes, viz. and anxiety-reduction programme with a sample of anxious s u b j e c t s and a stimulation programme with a sample of non-anxious s u b j e c t s , both by means of APP t r a i n i n g . The f i r s t programme was motivated from the l i m i t a t i o n s of the previous inves= t i g a t i o n s by means of t h i s approach, as well as from the s p e c i a l need, f e l d amongst members of the anxious groups f o r such a programme. The stimulation programme was i n i t i a t e d purely on experimental grounds Both programmes consisted of 60 half-hour sessions of l i s t e n i n g t o f i l t e r e d music by means of the electronic-ear-apparatus, and both were controlled by means of r e g u l a r t h e r a p e u t i c interviews. Ten s u b j e c t s completed the anxiety-reduction programme and the r e t e s t i n g . In comparison t o a control group of 12 s u b j e c t s , t h e following re= s u l t s were achieved: the anxiety level of the experimental group had decreased s i g n i f i c a n t l y , whereas a s i g n i f i c a n t change did not occur i n the control group; the sense of meaningfulness increased s i g n i f i c a n t l y i n t h e experimental group, yet decreased in the con= t r o l group; i n both groups scores on the SA-Wechsler-intelligence t e s t showed a s i g n i f i c a n t increase in both performance and t o t a l i n t e l l i g e n c e scores, but only the experimental group achieved a s ig= n i f i c a n t increase in scores on t h e v e r b a l IQ. On a measure of s e l f - a c t u a l i z a t i o n (the POI) the experimental group manifested a s i g n i f i z c a n t i n c r e a s e . Finally i n t e r e s t i n g q u a l i t a t i v e changes emerged from the t h r e e drawings of some members of the experimental group. Regarding t h e s t i m u l a t i o n programme with a sample of non-anxious s u b j e c t s , fourteen female f i r s t - y e a r s t u d e n t s completed the programme. Retesting showed the following r e s u l t s : a s i g n i f i c a n t reduction of s t a t e anxiety, a s i g n i f i c a n t increase i n scores on the SA-Wechsler- 1 i n t e l l i g e n c e t e s t , a s i g n i f i c a n t increase i n the l e v e l of self-ac= t u a l i z a t i o n and some notable changes on the Tree Test. P r a c t i c a l i - ties prevented the possibility of checking the results of the nonanxious experimental group with a control group. Research related and person-centred considerations subsequently led to a follow-up study as it would enable the present experimenter to evaluate the real significance of the presumably favourable results reported above. The period between the inital testing and the fol= lowing-up evaluation was 14,3 months. From the results it became evident that the anxious experimental group (N = 10) had maintained its significant reduction of anxiety. The anxious control group (N = 9) also showed a significant reduction in anxiety. A signifi= cant increase in the level of self-actualization occured in the anxious experimental group, but not in the anxious control group. Additional data supporting the findings were evidenced by a special follow-up questionnaire. The follow-up evaluation with the non-anxious experimental group (N = 13) provided the following results: a significant global in= crease in the level of self-actualization, while the non-anxious control group (N = 11) evidenced no significant increase in their level of self-actualization. The follow-up questionnaire again do= cumented further supporting evidence. The significance of the two applied investigations was summarized in terms of the following statements: The results indicated the value of audio-psycho-phonological training in the therapeutic approach to anxious female, firstyear students. The results also indicated that seemingly well-adjusted nonanxious female first-year students could be stimulated to achieve a significant increase in the level of self-actualization as measured by the POI, by means of audio-psycho-phonological trai= ning . As a means of evaluating APP training and as a point of departure for the development of more relevant instruments, the selection of psychological t e s t s functioned r e l a t i v e l y e f f e c t i v e l y . The procedures underlying both therapeutic programmes emphasized c e r t a i n d e f i c i e n c i e s and also underscored the need f o r f u r t h e r research. Conducting the therapeutic progranmes c o n s t i t u t e d a very s p e c i a l growth experience f o r the experimenter. Recommendations concerning both anxious and non-anxious students were made i n terms of the following: Procedures f o r t h e i d e n t i f i c a t i o n of anxious female f i r s t - y e a r students by means of the mass evaluation i n which a l l f i r s t - y e a r s t u d e n t s p a r t i c i p a t e , as well as measures t o provided a form of multi-modal treatment by means of APP t r a i n i n g , i n order t o prevent unnecessary loss of student p o t e n t i a l ; and investiga= t i o n s with male f i r s t - y e a r students i n order t o e v a l u a t e t h e dup= l i c a b i l i t y OF the present findings. - Recommendations regarding non-anxious students included: stimulation of developmental p o t e n t i a l i n students with a v a r i e t y of student dilemmas without s p e c i f i c c l i n i c a l symptoms; and the stimulation of p o t e n t i a l t o communicate i n students being preP pared f o r person-centred c a r e e r s , eg. nursing, psychology, theo= logy and s o c i a l work, as well as students i n p a r t i c u l a r l i f e si= tuations such as engaged couples and student leaders. F i n a l l y recommendations were made with regards t o the planning of APP programmes per se .
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