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The Indian Journal of Occupational Therapy : Vol. 45 : No.

3 (September 2013 - December 2013)

To study the effectiveness of occupational therapy intervention in


the management of fear of public speaking in school going
children aged between 12-17 years
Author : Nazia Ali (M.O.Th.)*; Co-Author : Ruchi Nagar (M.Sc. O.T.)**
Key Words:
Fear of Public Speaking,
Relaxation, Desensitization

Abstract
Objective:To find the efficacy of occupational therapy intervention for the school going children with fear of
public speaking.
Method: Thirty subjects with fear of public speaking were taken, which included both boys and girls. The
study designwas Pretest- Posttest, Experimental, Prospective and Single centre. Children having Fear of
public speaking was assessed using Hamilton Anxiety Rating Scale (HAMA) and Fear Thermometer (FT).
Results: It was found that there was significant (P<=.05) effect of O.T. intervention in reducing fear of public
speaking.It was found that females had greater fear than males and also group 1(12-14yrs) had greater fear
than group 2(15-17yrs).
Conclusion:Our result showed that occupational therapy intervention significantly reduces the fear of public
speaking in school going children between the age group 12 to 17 years.

Introduction
Glossophobia or speech anxiety is the fear of public speaking. The word Glossophobia comes
from the Greek glossa, meaning tongue, and phobos, fear or dread. The fear of public speaking
is called Glossophobia (or, informally, stage fright). It is believed to be the single most common
phobia affecting as much as 75% of the population.1
Childhood fears are very common and it is well known that the objects of these childhood
fearsare tied to specific developmental phases.2It is quite a common problem and relatively
intense3Literature showed that over 85% of the children reported thattheir fears interfered with
their daily activities and prevented them from doing things theywould like to do.4
The fear of public speaking can be socially debilitating, and is often cited as a primary reason
why someone is unable to advance in his or her career. Different therapeutic approaches have
been developed to help people overcome or deal with such fears as public speaking.5

** Assistant Professor, Jamia


Hamdard, New Delhi

In the past, the researchers have studied the effects of relaxation and desensitization
separately.6,7,8,9,10 The intervention program in this study consists of relaxation training and
systematic desensitization both given together. Thus the need was felt to conduct a study to
find the effectiveness of Occupational Therapy treatment (including relaxation and desensitization)
in children to reduce fear of public speaking.

Institution:
Jamia Hamdard, New Delhi

Aim : To find the efficacy of occupational therapy intervention for the subjects with fear of
public speaking.

Period Of Study :
2009-2010

Experimental Hypothesis : Occupational therapy intervention helps in reducing fear of public


Speaking in Indian school going students.

Correspondence :
Dr. Nazia Ali,
C-1264, Masjid Wali Gali, Tigri,
New Delhi - 110062

Null Hypothesis : There will be no effect of Occupational Therapy Intervention in reducing fear
of publicSpeaking in Indian School going students.

Tel. No. :
9818911486

Thirty subjects with fear of public speaking were taken, which Consisted of both boys &
girls.

E- Mail :
alinazia786@gmail.com

Study Design :Pre-test- Post-test, Experimental, Prospective, Single centre.

* Sr. Occupational Therapist,


Akshay Pratisthan, New Delhi

IJOT : Vol. 45 : No. 3

Methodology :

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September 2013 - December 2013

Inclusion Criteria :

Integrated Treatment (IT)

1. Subjects of age 12-17 years.

Relaxation

10 sessions (1 hour each)

2. Regular school going children.

Desensitization

5 sessions (45 minutes each)

3. English medium public school.

Session 1 to 10

Exclusion Criteria :

For Relaxation Schultzs Autogenic Training (AT) was used.


Children sat in comfortable armchairs and the following
exercises of relaxed breathing, relaxation of right hand, left hand,
muscles of legs, and relaxation of abdomen and breast muscles
were provided in single sessions.

1. Subjects below 12 years & above 17 years.


2. Subjects with known history of any serious medical illness.
3. Diagnosed case of learning disability.

Children were asked to practice the same AT exercises at home,


once a day.

Variables :
Independent variable:

Total Treatment Time

OT intervention

After 7th session, the AT group was requested to 2-3 minutes of


relaxation while in the classroom.

Dependent variable : Fear of public speaking


Ooycome Measures or Scales Used

Session 11-15

a. Hamilton Anxiety Rating Scale (HAMA). Tool for measuring


the severity of a patients anxiety. The HAMA probes 14 items
and takes 15-20 minutes to complete the interview. Items are
scored on a 5- point scale, raw data were given as:

Initiation session

0 = no anxiety.
1 = mild anxiety

- 15 minutes

discussion (relaxation training)

- 10 minutes

constructing an anxiety hierarchy

- 20 minutes

Systematic pairing of visualized scenes


with relaxation

Subjects were told to practice relaxation twice a day for 15


minutes between sessions.

2 = moderate anxiety
3 = severe anxiety

Subsequent sessions began with 15 minutes check on practice


and progress in relaxation during which relaxation was induced
and this was followed by desensitization.

4 = very severe anxiety


HAM- A Score

Level of anxiety

14 -17

mild

18 - 24

mild to moderate

25 and above

moderate to severe

Hierarchies ranged from 8 to 20 items arranged in order of


arousing potency and each item was presented in imagination
to the subjects for 10 seconds followed by 30 seconds of
relaxation before presenting the next item.
If the subjects did not signal anxiety after the second presentation
of an item, then the therapist presented the next item. If anxiety
was signalled the item was repeated until an anxiety free
presentation occurred.

b. The Fear Thermometer (FT) is used which required subjects


to rate their anxiety level during their speech on a scale from 0
to 10 where 0 represented an absence of anxiety and 10
represented maximal possible anxiety. FT scores were simply
the values assigned.

After the intervention, the subjects were again asked to fill the
scales respectively.

PROCEDURE:

Data Analysis and Result :

Students were asked to fill HAMA scale. Subjects scoring more


than 14 on HAMA were selected for the study. Thus a total of
30 subjects were screened for the study. Subjects selected were
asked to rate fear levels on FT. Subjects were taken up for the
OT intervention which included Relaxation and Desensitization.

Microsoft excel 2003 data sheet was used to make master chart.
All statistical tests were performed using Statistical Package for
Social Sciences (SPSS) version 15.Wilcoxon Signed Rank Test
was used to compare pre-treatment & post treatment scores among
the total sample. Mean and Standard Deviation of the pretreatment & post treatment were also calculated as the sample
size was too small. Additionally, Mann- Whitney Test was used
to determine any significant difference in fear of public speaking
between males and females and also with the age groups i.e.
12-14 & 15-17 years. The statistical analysis, a P value equal to
or less than .05 (Pd .05) was accepted as significant.

Intervention had 15 individual treatment sessions, twice a week.


The first 10 sessions had Relaxation for 1 hour each and the
next 5 sessions had Desensitization for 45 minutes each which
included 15 minutes of discussion (relaxation training), 10
minutesfor constructing an anxiety hierarchy and 20 minutes
for Systematic pairing of visualized scenes with relaxation.
Intervention :
Treatment had 15 individual treatment sessions, twice a week.

IJOT : Vol. 45 : No. 3

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September 2013 - December 2013

Interpretation

that there was no any significant (Pd.05) difference between


male and female for pre and post HAMA (.097 & .882) and FT
(.289 & .863) values.

Table-1 shows Comparative analysis for pre & post HAMA and
FT. The data shows the pre & post mean values of HAMA and
FT are (22.27, 11.57 & 6.37, 3.77) respectively. Result reveals
that there was significant (p d .05) difference between pre &
post intervention value for both.

Table 3 shows the data for HAMA & FT between Gr1 and Gr2.
The data shows that there was greater value of HAMA for gr1than
gr2 before and after intervention. FT scores were higher for Gr1
than Gr2 before and after intervention. The result of test reveals
that there was no any significant (Pd.05) difference between
Gr1 and Gr2 for pre and post HAMA (0.066 & .983) and FT
(.374 & .757) values.

Table 2 shows that there was greater value of HAMA for females
than males before and after intervention .FT scores were higher
for females than males before intervention but post intervention
males had greater value than females. The result of test reveals

Table 1 : Summary of Comparison of pre & post HAMA and FT


Pre

Post

Mean S.D

Mean S.D

HAMA

22.27 5.89

FT

6.37 1.27

Variables

Z value

P value

11.57 3.75

-4.791

.000

3.77 1.43

-4.901

.000

Table 2 : Comparison between male (N=13) and female (N=17) for HAMA and FT

Variables
Hama
Ft

Mean S.D.
F
M

Pre
20.38+5.39 23.70+5.99
6.08+1.19
6.58+1.32

U value

P-value

Post
11.31+3.50 11.76+4.02
3.85+1.40
3.70+1.49

Pre
71.00
86.00

Post
107.00
106.50

Pre
.097
.289

Post
.882
.863

Table 3 : Comparison between Gr1 (12-14 yrs.) and Gr2 (15-17 yrs.) for HAMA and FT
Variables
Hama
Ft

Gr1

Mean S.D.
Gr2
Gr1

Pre
23.79+5.92 19.63+5.04
6.52+1.30
6.09+1.22

Post
11.73+4.09 11.27+3.22
3.78+1.27
3.72+1.73

P-value
Pre
.066
.374

Post
.983
.757

Graph-1(b) Comparison of Pre and Post FT

Graph-1(a) Comparison of Pre and Post HAMA

IJOT : Vol. 45 : No. 3

Gr2

U value
Gr1
Pre
Post
62.00
104.00
84.50
97.50

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Graph-2(a) Comparison between male and female for HAMA

Graph-2(b) Comparison between male and female for FT

Graph-3(a) Comparison between Gr1 and Gr2 for HAMA

Graph-3(b) Comparison between Gr1 and Gr2 for FT


Study by Turner,Biedel& Cooley-Quille (1995)14 investigated
the behavioral treatment effects on social phobiasusing HAMA
clinical rating and various self-report measures(EPI, FQ& SPAI)
reports that there was a significant decrease in fear in students
before and after treatment.

Discussion :
This study has investigated to see the efficacy of Occupational
Therapy Intervention including relaxation training and systematic
desensitization in reducing fear of public speaking. In present
study the result was found that there was significant (Pd .05)
effect of O.T. intervention in reducing fear of public speaking,
hence the experimental hypothesis is proved by rejecting the
null hypothesis.

In the present study, females had greater mean score values


than males before intervention, it shows females had greater
fear than males [table 2]. The present finding is in agreement
with the finding of Salman et al (1997),2Ollendick et al (1985)15
and Ollendick and King (1994).16 Mean scores for HAMA and
FT have reduced for both males and females post intervention,
this implies that the fear has reduced in both males and females
[Graph 2(a) & 2(b)]. However there was no significant difference
in the decrease of fear between males and females. This implies
that both males and females had similar improvements i.e.
decrease in fear.

In present study the fear of public speaking had reduced after


O.T. intervention. Statistically significant difference was found
in HAMA and FT as outcome measure before and after the
relaxation training and systematic desensitization [table 1] and
[Graph 1(a) & 1(b)]. Few studies11, 12, 13, 14 have similar findings
with the present study. Kondas O. (1967)13Found the similar
results using Fear Survey Schedule Scale. It was found that the
results with relaxation by means of Schultz method and
systematic desensitization are significant in children. This could
be attributed to the fact that fear of public speaking is a learned
fear in which punishment, feeling ashamed, criticism, decreasing
prestige and similar effects work as negative reinforcing factors.
Fear of public speaking symptoms like tremor, excitement,
muscle rigidity or a feeling of stomach spasm indicates the
presence of tension in this state. The result showed better results
in children with Schultzs Method of relaxation.

IJOT : Vol. 45 : No. 3

In the present study, Group 1 had greater mean score values


than group 2 before intervention, it shows that group1 had greater
fear than group2 [table 3] and [Graph 3(a) & 3(b)]. The present
finding resembles with the findings of Salman et al (1997)2 and
Ollendick and King (1994).16Ollendick and King reported young
adolescents have more fears than older adolescents whereas
Salman et al (1997)2 said that there was an age related decline
in fears. From the light of these findings it could be said that as
the child ages the level of fear decreases.

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September 2013 - December 2013

This study was done to determine the effectiveness of


Occupational Therapy intervention including relaxation and
systematic desensitization to reduce fear. There was significant
reduction in fear of public speaking using this standard treatment
protocol in school going children between 12 to 17 years. The
relaxation technique helps to control the tension, anxiety and
fear by systematic efforts.
The treatment (relaxation training and systematic desensitization)
given in this study is a combination of the treatments used by
Schooling &Emmelkamp ,1993;17 Mattick et al 198918 and
Kondas O. 196713.

3.

Muris et al. The role of parental fearfulness and modeling in childrens


fear. Behav. Res. Ther. (1996); 34: 265-268.

4.

Hofmann G.S, Ehlers A. and Roth T.W. Conditioning theory: a model


for the etiology of public speaking anxiety? Behav. Res. Ther. (1995);
33: 567-571.

5.

Cunningham V , Lefkoe M. &Sechrest L. Eliminating fears: An


Intervention that permanently eliminates the fear of public speaking.
Clinical Psychology & Psychotherapy.(2006); 13:183-193.

6.

Marshall W.L, Presse L. and Andrenes W.R. A self administered


program for public speaking anxiety. Behave. Res. & Therapy. (1976);
14: 33-39.

7.

Taylor S. The hierarchic structure of fears. Behav. Res. & Therapy.


(1998);36: 205-214.

8.

Amir N, Weber G, Beard C. & Taylor C.T. The effect of a single


Session Attention Modification Program on Response to a Publicspeaking Challenge in Socially Anxious Individuals Journal of Abnormal
Psychology. (2008); 117:860-868.

9.

Muris P, Sterneman P, Merckelbach H. and Meesters C. The role of


parental fearfulness and modeling in childrens fear. Behav. Res. Ther.
(1996); 34: 265-268.

10.

Woy J.R. and Efran J.S. Systematic desensitization and expectancy in


the treatment of speaking anxiety. Behav. Res. & therapy. (1972); 10:
43-49.

Limitations :

Sample size was relatively small; hence the results cannot


be generalized to masses.

The range of age group of the sample was small (12-17


yrs.), hence the results cannot be generalized to other age
groups.

Small duration of the Protocol.

Future Recommendations :

Large population should be studied.

11.

Rachman S. Studies in desensitization-I. The separate effect of relaxation


and desensitization. Behav. Res. & therapy. (1965); 3: 245-251.

Age groups below 12 & above 17 yrs. can also be included


in the study.

12.

Lang P.J. Experimental studies of fear reduction. J. Clini. Psychol. (1966);


45:1618-1619.

Experiment should be carried out on the person having some


different types of fears / phobias.

13.

Kondas O. Reduction of Examination Anxiety and Stage- Fright By


Group desensitization and Relaxation. Behav. Res & Therapy. (1967);
5: 275-281.

Follow-up should be there every two years.

14.

Turner S.M, Beidel D.C. and Cooley Quille M.R. Two- Year follow-up
of Social phobics treated with social effectiveness. Therapy. Behav.
Res. Ther. (1995); 33: 553-555.

15.

Ollendick et al. Fears in children and adolescents: normative data.


Behav. Res. Ther. (1985); 23: 465-467

16.

Ollendick T.H. and King N.J. Fears and their level of interference in
adolescents. Behav. Res. Ther. (1994); 32: 635-638.

17.

Scholing A. and Emmelkamp P.M.G. Exposure with and without


cognitive therapy for generalized social phobia Effects of Individual
and Group Treatment. Beh. Res. Ther. (1993); 31: 667-681.

18.

Mattick R.P, Peters L. & Clarke L.D. Exposure and cognitive restructuring
for social phobia: a controlled study. Behavior Therapy. (1989); 20:323.

Conclusion :
The experimental hypothesis of the study was accepted and null
hypothesis was discarded. The result of this study revealed that
Occupational Therapy intervention significantly reduces the fear
of public speaking in school going children between the age
group 12 to 17 years.

References :
1.

Rothwell, J. Dan. In the company of others: An Introduction to


communication. New York; MC Graw Hill, 2004

2.

Elbedour S, Shulman S. &Kedem P. Childdrens fears: Cultural and


developmental perspectives. Behav. Res. &Ther. (1997); 35: 491-496.

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September 2013 - December 2013