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Teacher-led Relaxation Response Curriculum in
an Urban High School: Impact on Student
Behavioral Health and Classroom Environment
H. Kent Wilson, PhD; Matthew Scult, BS; Marilyn Wilcher, BA; Rana Chudnofsky, MEd; Laura Malloy, LICSW;
Emily Drewel, BA; Eric Riklin, BA; Southey Saul, BA; Gregory L. Fricchione, MD; Herbert Benson, MD;
John W. Denninger, MD, PhD
Context • Recent data suggest that severe stress during the
adolescent period is becoming a problem of epidemic
proportions. Elicitation of the relaxation response (RR)
has been shown to be effective in treating anxiety, reducing
stress, and increasing positive health behaviors.
Objective • The research team’s objective was to assess the
impact of an RR-based curriculum, led by teachers, on the
psychological status and health management behaviors of
high-school students and to determine whether a train-thetrainer model would be feasible in a high-school setting.
Design • The research team designed a pilot study.
Setting • The setting was a Horace Mann charter school
within Boston’s public school system.
Participants • Participants were teachers and students at
the charter school.
Intervention • The team taught teachers a curriculum
that included (1) relaxation strategies, such as breathing
and imagery; (2) psychoeducation regarding mind-body
pathways; and (3) positive psychology. Teachers
implemented this curriculum with students.
Outcome Measures • The research team assessed changes
in student outcomes (eg, stress, anxiety, and stress
management behaviors) using preintervention/
postintervention surveys, including the Perceived Stress
Scale (PSS), the State-Trait Anxiety Inventory-Form Y
(STAI-Y), the stress management subscale of the
H. Kent Wilson, PhD, is an assistant in psychology in the
Learning and Emotional Assessment Program at
Massachusetts General Hospital (MGH) and an instructor at
Harvard Medical School (HMS) in Boston, Massachusetts.
The following researchers are based out of the BensonHenry Institute (BHI) for Mind Body Medicine at MGH:
Matthew Scult, BS, is a clinical research coordinator; Marilyn
Wilcher, BA, is the senior director; Rana Chudnofsky, MEd, is
the director of yoga programs and director of the Education
Initiative (EI); Laura Malloy, LICSW, is the director of yoga
programs and codirector of the EI; Emily Drewel, BA, is a
clinical research coordinator; Eric Riklin, BA, is a clinical
research coordinator; and Southey Saul, BA, is a former
ADVANCES, SPRING 2015, VOL. 29, NO. 2
Health-promoting Lifestyle Profile II (HPLP-II), the
Rosenberg Self-Esteem Scale (RSES), the Locus of Control
(LOC) questionnaire, and the Life Orientation Test-Revised
(LOTR). Classroom observations using the Classroom
Assessment Scoring System (CLASS)-Secondary were also
completed to assess changes in classroom environment.
Results • Using a Bonferroni correction (P < .007), the study
found that students experienced a significant reduction
(P < .001) in measures of state-level anxiety on the STAI
from pre- to postintervention. The study also found an
increase in the use of stress management behaviors at that
point. Using a Bonferroni correction (P < .007), the study
found that students had significantly less perceived stress
(P < .001), less state anxiety (P < .001) and trait anxiety
(P < . 001), and increased use of positive stress management
behaviors (P < .004) at the follow-up assessment in the fall
of the following year. Using a Bonferroni correction
(P < .002), the study found a significant increase in overall
classroom productivity (eg, increased time spent on
activities and instruction from pre- to postintervention).
Conclusions • This study showed that teachers can lead
an RR curriculum with fidelity and suggests that such a
curriculum has positive benefits on student emotional and
behavioral health and on classroom functioning. (Adv
Mind Body Med. 2015;29(2):6-14.)
intern and volunteer (currently a clinical doctoral student at
the University of Rhode Island); Gregory L. Fricchione, MD,
is the director of BHI, the associate chief of psychiatry and
the director of the Division of Psychiatry and Medicine at
MGH and a professor of psychiatry at HMS. Herbert
Benson, MD, is director emeritus for BHI and a professor of
medicine at HMS. John W. Denninger, MD, PhD, is director of
research at BHI, an associate in psychiatry at MGH, and an
instructor at HMS.
Corresponding author: H. Kent Wilson, PhD
E-mail address: firstname.lastname@example.org
Wilson—Implementation of Teacher-led RR Curriculum
Sources of Adolescent Stress Adolescence is a time characterized by a unique set of stressors. Evidence shows that the development of coping and self-regulation skills can buffer the effects of stress by promoting student ability to control physiological stress responses and by promoting attention.16. SPRING 2015. the burden and types of stress grow profoundly. and the results are indicative of increased risk for cardiovascular disease later in life. evidence regarding the nature and effects of stress in children and adolescents suggests that chronic uncontrolled stress may have significant. found that adolescents consistently reported that their stress levels were much higher than what they believed to be healthy. founded in 1989. Controlled studies conducted by the EI have demonstrated that RR-based interventions can be effective in ADVANCES. conducted by the American Psychological Association (APA). stress is increasingly implicated as a major contributing factor to the achievement gap between those students and students of a higher socioeconomic status. during both the school year and the summer months. meditation.com.2 higher blood pressures. and health domains seem indeed to be cause for concern. including violence10 and substance abuse. and guided imagery. students from families with a low socioeconomic status encounter environmental stressors such as substandard housing. Effects of Adolescent Stress The ubiquity of chronic stress during the adolescent period is a matter of concern because it puts teens at risk for a range of physical and psychological complications. behavioral.15 and found to have an impact on health and well-being. The Benson-Henry Institute Education Initiative (BHI EI).27 as well as with dropout rates and negative social outcomes. bringing accessible relaxation skills to teachers and students.29 Consequently. In particular.9 Uncontrolled stress and maladaptive coping tendencies have been associated with a range of negative health behaviors in students. RR practice is intended to build resiliency to stress and to counteract some of the deleterious physical and psychological effects of chronic exposure to the stress response. most adolescents report a belief that stress does not have a major impact on their physical or mental health. yoga. thought.28 Evidence shows that youth who are exposed to multiple poverty-related stressors demonstrate lower competencies on domains of social-emotional skill and self-regulation. the RR is characterized by decreases in all those measures.13 as teens work to navigate changing social situations and to attain developmentally appropriate autonomy. which acts both as a structured environment and as an environment in which students are exposed to many salient stressors.8 with academic concerns presenting a primary source of stress for many students16. VOL. or muscular activity.8 One recent study measured students across the 4 years of high school and found that students exhibiting high stress at both the beginning and end of high school performed significantly worse on cumulative academic achievement than did their peers who exhibited high stress at only 1 or none of the measurement periods. increased residential turnover. Adolescents with chronic stress have been found to have weaker immune systems. sound. has become a target of such educational interventions.4 Long-term effects of chronic stress that are met with maladaptive coping mechanisms also increase the risk for emotional and psychiatric challenges.20 Wilson—Implementation of Teacher-led RR Curriculum For students from low-income and urban backgrounds. An increase in interpersonal stressors in that period has been demonstrated14. Recent figures suggest that severe stress during the adolescent period is becoming a problem of epidemic proportions.19. academic. and behavioral control. including diaphragmatic breathing.30-33 The school setting. 2 7 .1 More alarming. and (2) a passive return to the repetition when everyday thoughts intrude. stress has become an issue of increasing public health concern.17 Academic performance appears to have a bidirectional association with stress.12. Stress and anxiety have been shown to be associated with lower overall academic achievement. The cornerstone of the BHI EI training is the elicitation of the relaxation response (RR). Whereas that response is characterized by neuroendocrine signaling and physiological changes. poverty.22 that put them at an increased risk for social-emotional.com I n recent decades. Use ISSN#1470-3556. long-term effects on both physical and mental health. prayer. and academic problems.37 The RR can be elicited by a range of techniques and practices.This article is protected by copyright. In addition to the general adolescent stressors discussed earlier. please visit copyright. has been a leader in the research on and development of school-based programs. 29. particularly.3 and higher amounts of inflammation. high population density. increased attention has been given to developing effective stress management interventions to help students recognize and cope with stress in healthy ways. such as increases in heart and breathing rates and in inflammatory responses. focusing primarily on academic outcomes. concentration. School-based Interventions Despite the wealth of reports describing the negative outcomes associated with chronic stress during adolescence.18 and. To share or copy this article.23-25 Such environmental stressors are associated with higher rates of internalizing and externalizing disorders26. Several studies have demonstrated a significant increase in stress during this life phase. for those planning to pursue higher education. visit advancesjournal. including depression5-7 and other internalizing symptoms.11 The implications of adolescent stress patterns on the long-term personal. phrase. and high crime rates21. a physiological state that is directly opposite to that of the stress response.34-36 Elicitation of the RR involves 2 components: (1) the repetition of a word.1 Recently. Recent evidence has illuminated the effects of stress in the immediate term as well. A 2014 “Stress in America” survey. NO. school year ratings of stress were found to be much higher than the reported average for adults. To subscribe.
both immediately and at 1 year after the intervention as compared with preintervention. 11 were Caucasian. the research team also evaluated results through standardized observations—a rating of the classroom environment as indexed by emotional support.83 ± 1.38 In another study. on one in which the RR curriculum was delivered by teachers in middle-school classrooms.82 ± 12. Eleven teachers consented to participate in the study. an organization tasked by the European Commission to extend and disseminate mental health programs. and 28 self-identified as Hispanic. the Locus of Control (LOC) questionnaire. the StateTrait Anxiety Inventory-Form Y (STAI-Y). after 1 semester. It was hypothesized that students would have an increase in psychological functioning and that an increase in the positivity of the classroom climate would be observed. students in the group following the RR-based curriculum reported significant increases in self-esteem.41 The current study aimed to build on the previously cited EI RR studies38. 4 were Asian. This course included sessions on (1) stress physiology. (2) RR physiology. with a mean of 15. The second phase included a refresher class immediately prior to implementation. students reported reductions in psychological symptoms. Student ages ranged from 13 to 19 years. the Rosenberg Self-Esteem Scale (RSES). To subscribe. 51 were African American. 6 teachers selected by the school Wilson—Implementation of Teacher-led RR Curriculum . 2 28 staff members.59 years of education. optimism. and instructional support. visit advancesjournal. At the time of the current study. METHODS Participants Participants were recruited from a Horace Mann charter school within Boston’s public school system.60. Two trainers from the BHI EI led the trainings for teachers. 6 hours in total during the fall and early winter of the school year. Trainers. Students. NO. In a randomized. Teachers. visualization.68 ± 2. Procedures As part of a wellness initiative within the participating school. To share or copy this article. Because the current study was the first time that a teacher-led RR intervention was introduced to a high-school setting. Twenty-five students did not report their races. inviting them to allow their children to participate in the study. and perceived stress as compared with waitlisted controls. Letters were sent to the parents of all highschool students at the school.26. the stress management subscale of the Health-promoting Lifestyle Profile II (HPLP-II).40 Those previous studies have shown promising results.42 The current study sought to determine whether a train-the-trainer model would be feasible and effective in a high-school setting. crossover study conducted by researchers at BHI. by teachers and staff members. parental informed consent and student assent were obtained from 102 students (58% female). EI interventionists provided to high school sophomores either an RR-based curriculum or health education. state anxiety. classroom organization. in particular. 6 were Caucasian. and the Life Orientation Test-Revised (LOT-R)—to assess perceived stress. The trainers first taught the teachers how to use the techniques in their own lives and then showed them how to bring the techniques into the classroom. Of students enrolled. EI interventionists delivered an RR-based treatment that was integrated into the physical education curriculum of highschool students and found that the intervention group showed significantly greater improvements in levels of perceived stress and state anxiety and in health-promoting behaviors after the intervention as compared with a waitlisted control group. 1 was American Indian. and 10 reported more than 1 race. Finally. Four were African American. selfesteem. with ages ranging from 24 to 60 years and with a mean of 39. and support personnel—received a 3-week professional development course on the RR curriculum. however. use of positive health behaviors. Teachers had a mean of 18. interventions must be delivered within a school’s existing framework. the high school had 214 students and 8 ADVANCES. the trainers either provided support in modeling delivery of the intervention or observed the classroom and provided feedback at the end of a class to facilitate training. and yoga. 31% Hispanic. highlighted the fact that interventions delivered by teachers are more realistic for long-term dissemination than are those delivered by specialist staff. at which time research staff answered questions and obtained informed consent.com.com academic contexts. 4% Asian. A recent report by the DataPrev Project.39 and. and 1 was Hispanic.42 The research team at BHI found that middleschool students who were enrolled in 3 or more classes with a teacher who was trained in the RR had significantly higher grade point averages and demonstrated better work habits and classroom cooperation than did those with fewer RR exposures. All staff at the school underwent training. please visit copyright. mindfulness. anxiety.This article is protected by copyright. Both were master’s-level educators with approximately 28 years of experience working with children and 6 to 7 years of working as trainers at the EI. Use ISSN#1470-3556. In those sessions. administrators. 29. Participants were also recruited at a Parent Night. the interventionists led college students in six 90-minute RR trainings. The current study investigated the psychological effects and health management behaviors of high-school students who underwent a teacher-led intervention. (3) techniques to elicit the RR—diaphragmatic breathing. after only 6 weeks. Once all students completed the pretest questionnaires in February.39 In a third study. The percentages were reflective of the school as a whole. In February. all staff—teachers. participating students completed questionnaires—the Perceived Stress Scale (PSS). and (4) principles from positive psychology and cognitive reframing. and LOC. The student population was 60% African American. and 3% Caucasian. Of the approximately 220 students at the school. VOL. SPRING 2015. For the programs to be implemented on a larger scale. weekly classroom support was provided and adapted to the needs of individual teachers.
49 Pearson correlations for the STAI-State. and significantly associated with all 3 versions of the PSS scale and with the Posttraumatic Stress-Arousal Symptom Scale (PTS-AS). scores range from 20 to 80.com administration incorporated the RR curriculum into their classrooms. were used to demonstrate positive psychology. approximately an 88% fidelity to intervention. and again in the fall of the subsequent school year in late October and early November. and Anxiety Sensitivity Index50 were strongly significant (r > 0. VOL. please visit copyright. the physiology of the RR. The teachers were supported with in-class modeling by the 2 trainers as described earlier. The research team calculated the percentage for that follow-up without those students being included in the analysis. The mean score for adults on this scale is approximately 14. 29. visit advancesjournal. they implemented a brief RR practice with their students every day of the week. due to delays related to obtaining the school district’s approval for the study as well as to complications with scheduling logistics.53 It produces a ADVANCES. For both the pretest and posttest observations. Wilson—Implementation of Teacher-led RR Curriculum Retention Of the 11 teachers who consented to participate in the study. The average score for each scale was calculated across the 4 cycles to obtain the overall score for each measurement period. 73 (86%) completed the short-term follow-up.This article is protected by copyright. The STAI-Y is a 40-item scale measuring state (S) and trait (T) anxiety. with higher scores indicating more perceived stress.48 Anxiety.01. such as writing in a gratitude journal or “news and goods” focusing on positive events (eg. The HPLP-II is a 52-item scale measuring the frequency of 6 domains of health-promoting behaviors. and role playing was used to demonstrate that concept. SPRING 2015. Students completed the Perceived Stress Scale (PSS) at all 4 time points.51 Cronbach’s α for the STAI-State and STAI-Trait were . fewer than 4 cycles per time point were obtained for 3 of the teachers due to complicating circumstances. The curriculum included lessons on the physiology of stress.45. the retention for the follow-up was then 64%. respectively. Scores range from 0 to 40. a higher score indicates more anxiety. The PSS is a 10-item scale measuring a global perception of stress during the month prior to the month of the test.com. 10 had classroom observations completed prior to and following the intervention. Finally. Use ISSN#1470-3556.01.47 Cronbach’s α for the PSS is . identifying and sharing something good that happened that day). however. 77 (91%) completed the posttest. Given that the follow-up at the end of the year was completed so close to the postintervention assessment. To subscribe. the follow-up completed in the fall of the following school year was included in the analyses. The trainers also helped the teachers develop their own materials and observed classroom teaching of the curriculum to ensure fidelity to the study. exercises. The original study’s design had proposed that students receive the intervention early in the school year. 2 9 . the intervention was not completed until later in the school year.44 Previous studies with adolescents using this scale have had mean scores that range from approximately 18 to 26. confirming appropriate construct and convergent validity. such as a class period starting 15 minutes late or a teacher going on maternity leave. STAI-Trait. 6 weeks later in mid-June. P < . Of the observations that were completed by the trainers. In addition to obtaining data from self-reported questionnaires. Cognitive restructuring that focused on recognizing and reframing automatic negative thinking was also a component of the curriculum. NO. For each subscale. The PSS scale is moderately correlated with the Impact of Event Scale (IES). particularly imagery that focused on success in performance of test taking. the research team decided that the evaluation did not provide a meaningful follow-up measure. The T-Anxiety subscale consists of 20 statements that assess how respondents generally feel. classroom observations were conducted using the Classroom Assessment Scoring System (CLASS)Secondary.001) as a measure of construct validity among panic disorder patients. and imagery. In addition. The stress management questions assess the degree to which the respondent engages in various stress management behaviors. Of those 85 who completed the pretest. 85 ultimately chose to participate and completed the pretest. Students completed the stress management subscale of the Health-promoting Lifestyle Profile II (HPLP-II) at all 4 time points. which indicates good internal reliability.46 The scale has shown sufficient internal and test-retest reliability and is correlated in a way that is expected for a range of self-report and behavioral criteria. four 20-minute cycles were usually completed.82. Of the 102 students who were consenting participants in the study. Instead. The S-Anxiety subscale consists of 20 statements that evaluate how respondents currently feel. P < . Students completed follow-up questionnaires after the intervention was completed in their classrooms in early May. The selected teachers provided at least 30 minutes per week of RR instruction in the classroom for 6 to 8 weeks.86.91. yoga.43 For each of the participating teachers. and it was not included in the data analyses. observations were conducted prior to and after the teacher delivered the intervention to the students. depending on class schedules.40 and . P < . To share or copy this article. Seven students who had participated had graduated at the end of the year of the intervention and were unavailable to complete the follow-up in the following year. and 50 (59%) completed the follow-up in the fall of the following year. Outcome Measures Perceived Stress. and techniques for inducing the RR. The mean score for high-school students for both subscales is approximately 40. Teachers were selected by the administration to ensure that all students received exposure to the curriculum.52 Stress Management. such as diaphragmatic breathing. Students completed the State-Trait Anxiety Inventory-Form Y (STAI-Y) at all 4 time points. among 29 male undergraduate students in a socially stressful setting. 15 of 17 lessons were rated as following the curriculum plan.
Using a Bonferroni correction to account for multiple comparisons (P < . Postintervention Surveys Paired sample t tests were used to compare survey data gathered immediately postintervention with the baseline data. LOT-R.and postintervention measures of state-level anxiety on the STAI (P < . The agreement between the 2 measurements. See Table 2 for P values and means for each measure. The team ran a Bonferroni correction to correct for multiple comparisons.60. respectively. (2) a classroom’s organization (ie. The RSES is a 10-item measure of global selfesteem consisting of statements related to overall feelings of self-worth or self-acceptance.68. and 28 months were . the mean score of approximately 41 on the STAI-S was fairly similar to the mean score of approximately 39 for high-school students. (3) the teacher’s instructional support (ie. suggesting high test-retest reliability. Normative data relevant to this population for the RSES.88. significant differences were found between students’ pre.58 Locus of Control. The data collectors then rated the environments. with a higher score indicating greater levels of optimism. students did report lower levels of perceived stress and of trait-level anxiety after the intervention than they did prior to it.61 Test-retest intervals at 4 months.59 The LOC scale has high reliability. Scores range from 0 to 30. focusing on student-teacher interactions and behavior. The validity of the instrument has been supported in various populations. or LOC when comparing preintervention and postintervention scores. To subscribe. Data collectors used a standardized manual describing all codes and were trained through use of master-coded tapes. See Table 1 for descriptive statistics for the students’ report.78. their ratings had at least an 80% agreement with the master-code videotapes) within 1 scale point for global ratings. Three of the 4 data collectors were not involved in the current study beyond completing the observations. optimism. 10 of the 80 total observation cycles were double coded. 24 months.57 The α reliability for the RSES is . including adolescents and community-residing adults. within 1 scale point across the 11 scales. Students completed the Rosenberg SelfEsteem Scale (RSES) at all 4 time points to obtain a measure of self-esteem. Both convergent and discriminant validity were demonstrated. and support for a student’s autonomy). with a mean score of approximately 47.56 The RSES demonstrates concurrent. . was 86%. The CLASS-Secondary is an observational tool that uses trained observers to rate secondary classroom environments.001). Data collectors were research coordinators employed by BHI. In addition.79. please visit copyright.56. a teacher’s sensitivity. A low score indicates internal control while a high score indicates external control. Wilson—Implementation of Teacher-led RR Curriculum . as measured by Cronbach’s α. the quality of feedback and the degree to which lessons promoted analysis). evidence of a positive or a negative 10 ADVANCES. Scores range from 0 to 24. During the 20-minute observation cycles. Students completed the Locus of Control (LOC) questionnaire at all 4 time points. Paired sample t tests were used to conduct pre-post tests and to compare preintervention data with data at the follow-up in the fall of the year following the intervention. The LOC is a 13-item questionnaire measuring generalized expectancies for internal versus external control of reinforcement.80. 2 emotional climate. The Classroom Assessment Scoring System (CLASS)-Secondary was used to assess the classroom environments prior to and after the intervention.003). According to the measure’s procedures. productivity.This article is protected by copyright. Scores range from 0 to 13. from . Observed Classroom Environment. students reported at the posttest that they were using significantly more stress management techniques than they had reported prior to the intervention (P = .70 to . RESULTS Preintervention Surveys At baseline.53-55 Self-esteem. 12 months. visit advancesjournal. The α reliability coefficient for the total instrument is . and HPLP-II were not available for comparisons with those of the study’s participants.007). Students reported lower anxiety postintervention. predictive. NO. and construct validity using known groups. To check inter-rater reliability during the study. with a large effect size. SPRING 2015. With regard to anxiety. using 7-point scales. With respect to the original sample used by the test’s developers. data collectors recorded observations about the classroom environments. Ratings of classroom quality included the following indicators: (1) the classroom’s emotional climate (ie. Although not significant after corrections for multiple comparisons. No significant differences were found between students’ reports of self-esteem. was . students reported greater levels of perceived stress than the adult norm. and use of materials for instruction).com subscale score ranging from 1 to 4. VOL. which was within the range of scores found in other studies of adolescents discussed earlier. . and (4) students’ engagement. all data collectors passed a reliability test (ie. Participants did report higher trait-level anxiety. internal consistency for the LOT-R. 29. and sound discriminant validity. Mean scores on the PSS were approximately 19. Higher scores indicate more frequent health-promoting behaviors. with a higher score indicating higher self-esteem. Use ISSN#1470-3556. than the normative sample’s mean score of approximately 40 for high-school students.60 Optimism.com. The LOT-R is a 10-item questionnaire measuring individual differences in generalized optimism versus pessimism. which indicates good test-retest reliability.94. and . the presence of misbehavior in the classroom and/or how behavior is managed. with a small-to-medium effect size. To share or copy this article. Students completed the Life Orientation Test-Revised (LOT-R) at all 4 time points. Statistical Analysis The research team conducted descriptive statistics to examine baseline profiles.
State-Trait Anxiety Inventory Form-State. students reported significantly less perceived stress (P < .11 ± 4. LOC. less state anxiety (P < . SPRING 2015. LOC. State-Trait Anxiety Inventory Form-Trait. Locus of Control.46 Follow-up Mean 16. STAI-State.70 ± 9. Locus of Control.712 . visit advancesjournal. VOL. a Table 3.11 17. Rosenberg Self-Esteem Scale. the data in Table 3 shows changes from the pretest means shown in Tables 1 and 2. To share or copy this article.001) and trait anxiety Wilson—Implementation of Teacher-led RR Curriculum (P < . Student Psychological Assessment: Baseline Data Survey Variables PSS STAI-State STAI-Trait HPLP-II: Stress Management RSES LOC LOT-R Preintervention Mean ± SD 19. n/a. Once again. Rosenberg Self-Esteem Scale. a Follow-up Surveys Paired sample t tests were used to compare survey data that was gathered in the fall of the subsequent school year with preintervention data.71 ± 4.001a <. HPLP-II: Stress Management. 29. LOT-R.25 12. composites were calculated from the ratings gathered at ADVANCES. Life Orientation Test-Revised.146 . Life Orientation Test-Revised. P values with significance after the Bonferroni correction (<. Student Psychological Assessment: Comparison of Preintervention and Follow-up Data Survey Variables PSS STAI-State STAI-Trait HPLP-II: Stress Management RSES LOC LOT-R Preintervention Mean 19.58 0.07 ± 3.70 41.84 HPLP-II: Stress 16.com.34 1.82 25. Rosenberg Self-Esteem Scale.38 .007) between the baseline assessment and the follow-up assessment.001a .309 n/a n/a 0.65 36.60 ± 5.01 P Values <.31 ± 5. STAI-State. Perceived Stress Scale. Health-promoting Lifestyle Profile II subscale for stress management. STAI-Trait. LOT-R. Using a Bonferroni correction to account for multiple comparisons.28 Abbreviations: PSS.04 Survey Preintervention Postintervention Variables Mean Mean PSS 19. Medium effect sizes were seen for all of the variables. State-Trait Anxiety Inventory Form-State.004). 2 11 . Perceived Stress Scale. several statistically significant differences were identified (P < . students reported increased optimism at the follow-up. please visit copyright. To subscribe. and increased use of positive stress management behaviors (P = .84 12. with the exception of a small-to-medium effect size for the change in stress management behaviors.30 0.015 <. Locus of Control.57 12.60 23.90 44.31 41.023 .60 21.31 22. HPLP-II: Stress Management.003a Cohen’s d 0. Life Orientation Test-Revised.07 LOT-R 23.09 23.64 23.45 Abbreviations: PSS.001a .80 21.30 STAI-State 41.This article is protected by copyright.05 0.001a <.004a .71 18.25 44. Perceived Stress Scale.49 18.41 16. LOC.07 12. LOT-R.18 0. STAI-Trait. State-Trait Anxiety Inventory Form-Trait. HPLP-II: Stress Management. Classroom Observations Following guidelines from the CLASS manual.47 0.15 38. no significant differences existed between self-esteem and LOC between to the preintervention and the follow-up data. STAI-Trait. State-Trait Anxiety Inventory Form-State. RSES.50 Management RSES 21.001).67 STAI-Trait 44.25 30. Health-promoting Lifestyle Profile II subscale for stress management.44 21. At the follow-up assessment. Health-promoting Lifestyle Profile II subscale for stress management. State-Trait Anxiety Inventory FormTrait.57 0. Use ISSN#1470-3556.com Table 2.001). RSES. STAI-State.45 16.25 ± 8. P values with significance after the Bonferroni correction (<. Student Psychological Assessments: Comparison of Preintervention and Postintervention Data Table 1. thus. not applicable.38 0. RSES. Comparisons were made only for students who contributed data at both time points.00 LOC 12.010 Cohen’s d 0.12 n/a n/a Abbreviations: PSS.11 0. NO. P Values .007).007). Although not significant after the Bonferroni correction.67 41.
with a large effect size. Classroom observations did not yield results that were consistent with the hypothesis that improvements in the emotional climate of the classroom would occur.565 . it is also possible that those areas of identity and personality (ie. students who participated in the study and received instruction in elicitation of the RR. and health behaviors. teachers’ and students’ reduced stress).and Postintervention CLASS Dimensions Positive Climate Negative Climate Teacher Sensitivity Regard for Adolescent Perspectives Behavior Management Productivity Instructional Learning Formats Content Understanding Analysis and Problem Solving Quality of Feedback Student Engagement Preintervention Mean 5. The downstream effects of the interventions (eg. Further longitudinal studies are needed to understand better if and how stress and resiliency programs can influence identity and personality factors and to account also for moderators.73 4.02 0. significant changes in those areas were found 1 year after baseline data was gathered and approximately 7 to 8 months after the intervention was administered in the classroom setting. only 1 dimension’s ratings. Consistent with the current research team’s hypotheses. Changes in selfesteem have been found in a previous RR intervention.70 P Values . 29. Although changes were identified in stress. 2 large-scale implementation of such an intervention is possible. which was contrary to the current research team’s expectations. visit advancesjournal. it may be that they were secondary outcomes that were influenced by other moderating influences in the prior studies. implementing an RR-based intervention may produce positive changes in Wilson—Implementation of Teacher-led RR Curriculum .38 and given that the current intervention included activities that promoted positive psychology and resiliency. optimism. but the finding of increased productivity needs to be probed further.039 . optimism.65 0.002).68 4. the current study has provided further evidence that 12 ADVANCES.90 4.125 . and self-esteem) were simply not direct outcomes of the current intervention as designed.66 4.05.62 5.29 0.13 0. productivity.This article is protected by copyright.91 0. together with information about cognitive strategies.00 5.23 5.74 4. Classroom Assessment Scoring System.20 0. with a large effect size.924 . Use ISSN#1470-3556. An interaction may exist between students’ and teachers’ stress and productivity. such as academic success and family and peer relationships. Paired sample t tests were used to examine changes in ratings for those dimensions (Table 4). Consistent with work done by Benson et al42 in 2000. These long-term changes and notable significant changes in trait-level anxiety suggest that the RR intervention may have led students to internalize skills in stress and emotional regulation beyond the practices that occurred in the classroom.79 4. To share or copy this article. After the intervention. VOL.com.653 . but the significance did not survive the correction for multiple comparisons. The increase in the teachers’ quality of feedback to students was significant at P < . It may be that the selected measures were not sensitive enough to detect changes. Most notably.20 1.30 Abbreviation: CLASS.06 4.04 0. NO. please visit copyright. Results from classroom observations in the current study identified positive changes in classroom productivity.06 2. Using a Bonferroni correction (P < . the research team had hypothesized that changes to optimism and LOC would occur. less anxiety. and greater use of positive stress management and health behaviors after completing the intervention.com Table 4. SPRING 2015.03 4. must also be further explored.398 .002) when comparing data gathered preintervention and immediately postintervention. To subscribe.and long-term changes in adolescents’ psychological and behavioral functioning. Instead.65 5. or self-esteem.942 . because teachers in the study were able to implement the intervention with fidelity. with mostly medium effect sizes.195 Cohen’s d 0.35 4.19 0.375 . were significantly different (P = . reported less perceived stress.43 2.002a .47 0.90 4. anxiety. DISCUSSION The current study provides evidence that an RR intervention can be applied in educational settings and suggests that such an intervention can contribute to desirable short. ratings of overall time spent on instructional activities in the classroom increased significantly. a P value with significance after the Bonferroni correction (<.38 4.36 0. Classroom Observations Using the CLASS: Comparing Ratings Pre.95 Postintervention Mean 5.627 .38 1.002). which may contribute to changes in classroom or instructional dynamics. changes were not found in students’ LOC.02 4. LOC. individual observations at pretest and posttest for each of the 11 dimensions.
The research team ultimately proceeded with the current intervention without a control because the participating school provided an excellent opportunity to assess the feasibility of having a school-wide intervention that was delivered by the school’s staff.30(3):393-416. 1998. Of the 85 students who completed the pretest. retention from pretest to the follow-up at the beginning of the following school year was 64%. Mazanov J. First. Ann Behav Med. 2007. Psychosom Med. 2014. which is why the current research team introduced classroom observations into the study. Finally. Telzer EH. completed questionnaires). 5. Three of the 4 data collectors were not involved in the study beyond completing classroom observations. (2) observations of the classroom environment and students’ behaviors. were those who found some benefit from the program. Data collection for the classroom observations also was a potential source of bias. February 11. visit advancesjournal. 2 13 .org/news/press/releases/2014/02/teen-stress. Nevertheless. it is possible that students who continued to participate (ie. The current study had several limitations that should be mentioned. A second possible source of bias in the data involved attrition. To subscribe. but retention was also limited by factors commonly seen in school-based studies (ie. generalization of findings must be limited to urban high schools with a predominantly ethnic and minority population. were used in an attempt to monitor this bias. 2014. Actually. graduating students or changes to enrollment). Brady SS. 2010. practice.apa.com this loop that can have implications for academic success and behavioral functioning. Critical periods may exist in which skills learned in interventions are better internalized. Although the mentioned limitations are important to acknowledge. teachers’ education and educational policy can be better informed to address the growing need for teaching self-regulatory skills in the classroom. Finally. which were blinded to the data collector. and test scores. the current study found indications of long-term changes in behavior. in addition to assessing psychological functioning. McNeely C. Matthews KA.com. has important implications for practice. Despite its limitations. 3. (3) quantifiable outcomes. further understanding of the processes that are involved is needed. 2009. 77 completed the immediate posttest (91% retention). Bower J. and ongoing follow-up with students and teachers is needed to determine whether these interventions are sustained in the classroom and to what degree students continue to use the skills that were taught in their everyday lives. and curriculum development. Psychological antecedents of depressive symptoms: an evaluation using daily experiences methodology.62 and developing interventions and curricula that can address the interaction between the teachers’ and the students’ stress is important. Cole SW. American Psychological Association survey shows teen stress rivals that of adults [press release]. Stader SR. VOL.31(1):80-88. such as grades. Fuligni AJ. REFERENCES 1. 4. it must be noted that without a control group. Baltimore. the attrition rate from pretest to posttest was small. Further investigation with a randomized controlled study design is needed to confirm that the RR curriculum is directly linked to such benefits. J Abnorm Psychol. SPRING 2015. and selfregulatory behavior. but 1 was responsible for coordinating the study. The Teen Years Explained: A Guide to Healthy Adolescent Development. the study has provided results that have implications for future research. together with classroom productivity. Indeed. J Adolesc. Indeed. Kiang L. Washington. attendance. 2. randomized. and implementing this type of intervention with students of varying age groups will be important.This article is protected by copyright. Inter-rater reliability checks. First. DC: American Psychological Association. Byrne DG.71(3):329-333. 6. and policy. Use ISSN#1470-3556. Further. It also allowed for the calculation of the effect sizes necessary for power analyses when future projects with randomized controls are implemented. it is important to understand better the downstream effects that interventions such as the current one can have on classroom functioning. reliance primarily on self-report data also limited how well specific constructs could be measured. Accessed August 5. ADVANCES. Greater attrition occurred for the follow-up in the fall of the following school year (approximately 8-9 mo after the pretest). MD: Johns Hopkins University. it was not possible to account for biases that timing or setting may have introduced into the results. with data collectors who are blinded to the study’s goals and procedures. academic performance.107(1):17-26. attendance and dropout rates.aspx. the ability to detect significant Wilson—Implementation of Teacher-led RR Curriculum changes in the classroom environments was also limited due to a small sample size. Generalization and causal implications are particularly limited given the absence of a randomized control group. Davenport SC. Hokanson JE. 2006. however. a teacher or parent) about a student’s functioning. when taking graduation into account. and behavioral problems. A future study that integrates the following measures will be important: (1) self-report data. Only 50 students (59%) completed that follow-up. To share or copy this article. controlled studies of interventions such as the current one must be conducted to provide more rigorous evidence that the changes found by the outcome measures were attributable to the RR curriculum. and (4) reports from a third party (eg. The data collectors who completed the observations were employed by the program running the study and could have been invested in its outcome. By better understanding the many processes involved. Profiles of adolescent stress: the development of the adolescent stress questionnaire (ASQ). http://www. The indication that a teacher-led RR curriculum can produce significant changes in adolescent stress. Nonetheless. evidence exists that a teacher’s emotional regulation has an impact on classroom functioning. educational policy. NO. 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