Effectiveness Of Jacobson'S Progressive Muscle Relaxation (Jpmr) Technique On Social Anxiety Among High School Adolescents In A Selected School Of Udupi District, Karnataka State

Introduction :

Adolescence is a transitional stage of physical and mental human development that occurs between childhood and adulthood. This transition involves biological, social and psychological changes which are shaped by the social environment in which they live. The social environment provides the opportunity, barriers, role models and support for individual's development and health. Systems within the social environment include family, peers, schools, community and the large society and these all contribute to an adolescent's development and health. The future of our country depends on the mental health and strength of our young people. (Wilson & Hockenberry, 2007)

Period of adolescence can be stressful for children and parents. Children are dealing with the challenges of going through puberty, meeting changing expectations and coping with new feelings. Most of the children meet these challenges successfully and grow into healthy adults while others have a harder time coping with all these problems. (Aggarwal, Prabhu & Anand, 2007)

Mental, emotional and behavioral disorders among children, youth and young adults create an enormous burden for their families and nation. They threaten the future health and well being of young people. A review of three longitudinal studies concluded that close to 40 percent of young people had at least one psychiatric disorder by the time they are 16 years. Anxiety disorders are among the most common mental, emotional, and behavioral problems to occur during childhood and adolescence. About 13 of every 100 adolescents between the age of 9 to 17 years experience some kind of anxiety disorder (Sanderson, Tilse, Nicholson, Oldenburg & Graves, 2007).

An exploratory study was conducted to find out the frequency, demographic and phenomenological characteristics of social anxiety disorder (SAD), family related factors, academic impairments and comorbidity of depression among adolescents in Ahmadabad. The result showed that 54 (12.8%) adolescents had SAD (Mehtalia and Vankar, 2004). In recent years, it has been increasingly acknowledged that anxiety disorders are highly prevalent in the general adult population. Recent worldwide estimates for the 1-year lifetime prevalence of any anxiety disorders is 10.6% (Somers, Goldner, Waraich & Hsu, 2006).

Physical activity is an important means of reducing stress levels and preventing some of its damaging effects on the body. Exercise uses up the adrenaline and other hormones which the body produces under stress and relaxes the muscles. It will help to strengthen the heart and improve blood circulation (Townsend, 2005). An exploratory study was conducted to find out the effectiveness of meditation and progressive relaxation as treatments for symptoms of stress. Subjects were recruited from advertisements in local newspapers and received five sessions of training. All subjects self-monitored, stress symptoms throughout the study and had their behavior rated weekly by a spouse/roommate. The progressive relaxation and meditation treatments resulted in a significant reduction of stress symptomatology over time (Woolfolk, Lehrer, McCann & Rooney, 1982). Research suggests that physical activity can lead to a change in body chemistry which can affect the way people feel as well as their physical condition.

Different types of relaxation techniques can also help to raise self-esteem and reduce anxiety and depression. It is necessary to identify the students with social anxiety and teach Jacobson's Progressive Muscle Relaxation technique which will help them to overcome the anxiety and improve the self –esteem.

Objectives :

Objectives of the study were to:

1. identify the students with social anxiety

2. find out the association between social anxiety and selected demographic varaibles such as age, gender, type o family and birth order of the students

3. find out the relationship between social anxiety and its assiciated factors

4. determine the effectiveness of Jacobson's progressive muscle relaxation on social anxiety in terms of reduction in post test anxiety score

Materials and Methods :

Procedure :

The researcher met the participants in the school and the Headmistress introduced the researcher to them and purpose of the study was explained. The questionnaires were distributed to all the 8 th and 9 th standard students who were present on the day of data collection. There were 193 students present on the day of data collection. The students with moderate to severe social anxiety were identified from the data on social anxiety. There were 52 students with moderate and five students with severe social anxiety.

The Jacobson's Progressive Muscle Relaxation Technique was initiated after one week as the students were busy with their academic schedule. On first day only 51 students were present and they were divided into three groups (fifteen, eighteen and eighteen). The researcher arranged a convenient place for conducting the JPMR technique and the morning time was chosen to practice the technique. The instruction regarding the performance of the relaxation was given to the subjects and it was

demonstrated to them which took around 45 minutes. Subjects practiced the Jacobson's Progressive Relaxation under the supervision of the researcher for ten days and only 40 students attended all the ten sessions. The post test was given on the 10^th day immediately after the JPMR.

Data analysis :

Descriptive statistics was used to identify the sample characteristics. Categorical data was compared using Chi square test. Paired t test was used to find out the significance difference between the mean pretest and mean post test scores. Relationship between social anxiety and associated factors of social anxiety were analyzed by Spearman rank correlation.

Results :

Description of the sample characteristics

Out of 193 subjects, majority (59.1%) of the children were in the age group of 14-15 years. The boys constituted 66.8% of the sample and the girls were only 33.2%. With regard to the birth order there was equal distribution to first and second born i.e. 83(43%), 11(5.7%) were third born, 2 (1%) were fourth born and 14 (7.3%) were only child in the family. Data on type of family show that 173 (89.6%) were from nuclear family, 17 (8.8%) were from joint and only 3(1.6%) were from extended family.

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Fig. 1

Pie diagram showing the frequency and percentage of students with social anxiety

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Table 1

Chi square value computed between social anxiety and selected demographic variables (n= 193)

Variables	No SA	Mild	Moderate Severe		2 X value	df	p value
Age in years
12-13	4	49	25	1	15.297	3	*0.001
14-15	28	55	27	4
Gender Male	20	76	30	3	4.397	3	0.212
Female Birth Order	12	28	22	2
Single	3	7	3	1	11.700	9	0.180
First	17	50	15	1
Second Third and	11	41	29	2
above	1	6	5	1
	Below		Above
median  38			median 38
Type of family Nuclear	91		82
Extended	10		10		0.049	1	0.825

X² (3)= 7.81 p <0.05, X² ₍₉₎ = 16.92  p>0.05, X²(1)= 3.84, p>0.05

* Significant at 0.05 level

Table 2

Correlation coefficient computed between social anxiety and associated factors (n = 193)

Factors	r value	p value
Parental strictness	0.507	0.001*
Parental conflicts	0.175	0.015*
Peer rejection   Social anxiety	0.497	0.001*
Teachers strictness	0.199	0.005*
Troubled with appearance	0.456	0.001*
? Discrimination among siblings	0.176	0.018*

*Significant at 0.05 level df ₍₁₉₂₎ = 0.195

? n =179. Only 179 students had siblings

Discussion :

The goal of the study was to identify the students with social anxiety and evaluate the effectiveness of Jacobson's Progressive Muscle Relaxation in reducing the social anxiety. The findings of the present study showed that out of the 193 samples, majority of the children i.e.

104 (54%) experienced mild social anxiety. Moderate social anxiety was experienced by 52(27%) children, 5(3%) children experienced severe social anxiety. Thirty two (16%) children did not experience any social anxiety. These findings supports the exploratory study conducted in Ahmadabad to find out the frequency, demographic and phenomenological characteristics of social anxiety disorder (SAD), family related factors, academic impairments and comorbidity of depression among adolescents. Four twenty one adolescents in a high school were screened for SAD and depression and associated factors with academic impairments using Social anxiety

Inventory Scale, Brief Patient Health Questionnaire and questionnaire on factors associated with social anxiety disorder. The result showed that 54(12.8%) adolescents had SAD (Mehtalia and Vankar, 2004).

Present study revealed a significant positive correlation between social anxiety and associated factors such as parental strictness, parental conflicts, teacher's strictness, peer rejection, troubled with appearance and discrimination among siblings. These findings support the proposition of parental acceptance-rejection theory (Rohner et al, 2007). Adolescent's perception of a warm and accepting quality in the relationship with their parents is remarkably important to maintain their healthy psychological adjustment because their security and other emotional and psychological states are dependent on it (Rohner et al, 2007).The findings of the present study also support the study conducted by Mehtalia & Vankar (2004) in Ahmadabad. The result showed that 54(12.8%) adolescents had social anxiety disorder. The most common manifestations were avoiding giving speeches, performing or giving talk in front of audience, being centre of attention and speaking up at a meeting. Most of these manifestations of social anxiety disorder were equally found among boys and girls. Social anxiety disorder was also associated with difficulty in coping with studies, concern about weight, having fewer friends, lack of intimacy with parents and being treated differently form siblings.

In the present study it was observed that the mean post test anxiety score was significantly lower than the mean post test score which was significant at 0.05 level. This finding supports an evaluative study conducted to determine the effects of single session of meditation and progressive muscle relaxation on stress reduction. The progressive muscle relaxation group had the greatest decline in somatic anxiety (Wachelka & Katz,1999).

Few limitations noted for the present study were the study was limited to only one school and non probability sampling technique was used to select the samples. So the study can not be generalized to a larger population. Self construction of the tools such as social anxiety scale for adolescents, tool to assess the associated factors of social anxiety and non establishment of construct validity may contribute to errors in the findings.

Conclusion :

Despite limitations, results from this study suggest that Jacobson's Progressive Muscle Relaxation Technique is effective in reducing the social anxiety. Replication of this study, using a more powerful design and large sample size is a needed next step. Nursing, in 21^st century, looks forward for more independent roles in health care system. These kind of interventional therapies have manifold effects on human life and health. This study finding has contributed to strengthen this aspiration of nursing profession to reach a greater height of independence on education and service.