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 an
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
1. Sadness
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 metaanalysis (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 metaanalyses (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 metaanalytic 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 nonhandicapped children.
Restful sleep: Another area associated with positive mental health
is the relationship between exercise and restful sleep. Two metaanalyses 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:
? Coordinate other connective sensory and motor functions
within the brain
? To integrate and link the individual to the social order
? To regulate human behaviour through spoken language
? To provide for human mentation as reflected in mental
processes and activities (Korba, 1989).
Positive self-talk is a health behaviour that has potentially farreaching 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
Levine recommends becoming aware of and constructively using
thoughts.
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 nonpsychopharmacological 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 nonpsychopharmacological 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