breath and voice

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RUNNING HEAD: Breath and Voice

Breath and Voice: The Effects of Breathing Awareness and Giving of Testimony on Black and

White Battered Womens Feelings of Depression and Self-Efficacy*

Susan H. Franzblau, PhD, Sonia Echevarria, Michelle Smith, &

Thomas E. Van Cantfort, PhD

Fayetteville State University

Fayetteville, North Carolina

*This study was supported by Grant Number P20 MD001089 from the National Center ofMinority Health and Health Disparities, National Institutes of Health. Its contents are solely theresponsibility of the authors and do not necessarily represent the official views of NationalInstitutes of Health.

Please send correspondence to Susan H. Franzblau, PhD, Fayetteville State University, 1200Murchison Road, Fayetteville, North Carolina 28301 (910 672-1574) [email protected]
mailto:[email protected]:[email protected]


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ABSTRACT

In an experiment exploring the effects of testimony and meditative breathing techniques ondepression and self-efficacy, 40 Black and White women, self-identified as abused within thelast two years by an intimate partner, either gave testimony of their abuse to a same race listener,

participated in breathing/relaxation exercises, participated in a combined testimony/breathingcondition, or functioned as waiting controls. Results indicate that breathing and combinedtestimony/breathing significantly reduced depression scores and increased feelings of self-efficacy. There were no differences by race, education, number of children under age 5 in theircustody, or whether or not their abuser was a member of the military. Implications of thesefindings for counseling abused women are discussed.

Keywords: abuse, Black, White, women, mindfulness, yoga, testimony, narrative therapy,pranayama, breathing, depression, self-efficacy.


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Breath and Voice: The Effects of Breathing Awareness and Giving of Testimony on Black andWhite Battered Womens Feelings of Depression and Self-Efficacy

Changing the structural relationships to power, including discrimination and

disempowerment based on ones gender, race/ethnicity, and social class is the first requirement

for building a healthy society (Franzblau & Moore, 2001). It is well-understood that the abuse of

women is one of this countrys most serious public health problems due to extreme power

imbalances between women and men and the social trap that emanates from the expectation that

women engage in strong emotional bonding in their romantic relationships (Dutton, 1988). For

most women, the greatest risk of physical, emotional, and sexual violation will come from a man

they have known and trusted, often an intimate partner (Warshaw, in Dan, 1994, p. 201).

Battered women represent 35% of women seeking care for any reason in emergency

departments (McLeer & Anwar, 1989), and 23% of those who seek routine prenatal care (Helton,

Anderson, & McFarlane, 1987). Seventy-five percent of women who are first identified as

battered in a medical setting will go on to suffer repeated abuse (Star, Flitcraft, & Frazier, 1979).

Lets look at North Carolina as an example of this epidemic. The National Coalition

against Domestic Violence has documented 197 domestic violence murders committed over a

three-year period from 2002 through October 8, 2004. In 2003 alone, The North Carolina

Council for Women/Domestic Violence Commission reported that in all counties in the state,

90,341 crisis calls were received on their hotline. Hospital services were provided for 1,377

battered people, and counseling services for 54,718, the majority of whom were women (39,316)

as compared to men (5,579). Poor women of color are more likely to suffer from abuse and the

effects of domestic violence, given the triple victimization of race, gender, and social class.

Added to this, problems of child custody, length of time victims experience abuse, and the type


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of domestic relationship involved can further exacerbate the effects of abuse. This epidemic is a

multifaceted challenge to those who counsel abused women.

Abuse, Depression and Self-Efficacy. Bandura (1997) has shown that there is a strong

inverse relationship between feelings of self-efficacy and depression. As depression increases,

feelings of confidence to change ones situation decrease. Women are twice as likely to

experience depression as are men. This difference may be due to womens experience of greater

poverty, differing social roles and gender discrimination, as well as more negative life events,

including violence and abuse (Hegarty, Gunn, Chondros, & Small, 2004). When a woman

experiences abuse, the lack of support and loss of self-confidence (self-efficacy) can result in

feelings of hopelessness and depression. Some consequences of depression are easier to

recognize by the sufferer, including low mood and lack of concentration, others may be harder to

recognize because the main effects of depression reduce the persons ability to interact with

loved ones and other family members...These effects can includelack of energy, and

preoccupation with negative themes and ideas (Segal, Williams, & Teasdale, 2002, p. 10). The

inability to influence events and social conditions that significantly affect ones life can give rise

to feelings of futility and despondency (Bandura, 1997, p. 153). People become sad and

depressed by their inability to achieve outcomes that are highly valued (Bandura, 1997) and

because of the common co-occurrence of privations and threats, both apprehension and despair

often accompany perceived inefficacy to alter miserable life circumstances (Bandura, 1997, p.

153). A meta-analysis of the prevalence of mental health problems among women abused by an

intimate partner, found that compared with women who had not been abused, approximately half

of the abused women had clinical depression (Godling, 1999). Those who are depressed are

vulnerable to ruminative thoughts and need to develop skills to counteract these invasive


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thoughts, given that rumination about dejecting life events and the womens despondent state

tends to amplify and prolong depressive reactions (Bandura, 1997).

Abused women, in their terror, often restrict their behavior to actions deemed acceptable

to the perpetrator. As a result, these actions limit participation in public life and undermine self-

confidence (Heise, Pitanguy, & Germain, 1994). Dan (1994) suggests that blaming the woman

for her abuse, not showing genuine concern for the abused womens experience, or failure to

recognize the impact of battering on the abused womans life and psyche can cause the battered

women to further withdraw and avoid seeking the help she needs. Low self-efficacy can stem

from a continuation of abuse and others lack of recognition of that abuse. Low self-efficacy

also stems from the lack of ideological and institutional support so needed by those who are the

most oppressed. The feelings of powerlessness and lack of self-efficacy among abused women

crosses a number of domains (Franzblau & Moore, 2001).

Socializing Efficacy. Whether or not one feels confident that they can change the

conditions of their lives initially depends upon ideological support: Women need to feel

confident that their gender, race, and social class will not interfere with their ability to leave their

abusive relationship and find housing, a job, and affordable health care. Second, economic

support is critical for the women to have the means to hire an attorney, move away from the

abuser, and provide independent support for their children. Third, an education enables women

to develop job skills that would allow them to gain economic independence. Fourth, women

must have confidence that they have the legal support to keep their batterer away from them and

their children, as well as maintain custodial rights to their children.

Finally, for those women who have few financial, institutional and ideological resources

to combat abuse, nonjudgmental emotional social support is critical. Nonjudgmental emotional


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and social support, allow women to believe that they can control the outcome of their situation.

If they are not given nonjudgmental emotional and social support, abused women could continue

to isolate themselves from significant others in their lives, including friends and family members,

thus increasing their depression and lowering feelings of self-efficacy.

Although the focus of domestic violence research has been to treat abused women as

victims, there is little published literature addressing how abused women understand the causes

of abuse, how their opinions may differ from those with little or no experience with such

violence, and how the implications of such differences might be for interventions and prevention.

The insights that abused women could offer, given their past or ongoing experience with abuse,

are often overlooked in traditional research (Nabi & Horner, 2001). By recasting abused women

as authorities on domestic violence, we enable these women to express their unique insights into

the depth and breadth of abusive experiences, as well as in potential solutions to abuse (Nabi &

Horner, 2001). Therapists could also learn from this approach.

The Value of Testimony.

In truth, no person has privileged access to the naming of anothers reality. The only

thing we can hope for is our ability to interpret the experiences of others, keeping in mind that

others experiences are seen through their own lens, contextualized in their lived experience.

The most we can do as researchers and counselors is to identify, and bring into our

consciousness, our own experience of the experience of others, as expressed by them. This is

why empathy is so important to the understanding of the experiences of others, and so critical to

any environment deemed to be therapeutic. Empathy is defined here as our ability to connect

other persons understandings of their experiences with our understanding of the experience of

the other. When a person authors their experience (verbally describes the experience in her own


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words without coercion), we can better understand, through collaborative qualitative analysis of

the persons testimony, the meaning they give to their experience (Epston, & White, 1992).

Narrative Therapy. For many victims of violence, giving testimony can be viewed as a

form of therapy. In fact, narrative therapy is a growing body of practices and ideas, whose

primary focus is giving precedence to peoples stories and voices (Freedman &Combs, 1996). In

narrative therapy, the therapeutic relationship is seen as facilitative. During narrative therapy,

the client becomes an active collaborator in the therapeutic process, which helps them move

away from self-recrimination, blame, and judgment (Monk, 1997). Narrative acts of self-making

are guided by unspoken, implicit cultural models of what selfhood should be, might be, and

should not be. Self-making is the principle way a person establishes his/her uniqueness,

allowing the person to distinguish herself from others (Bruner, 2004), and is culturally embedded

(Cushman, 1991). The narrative approach to counseling enables clients to begin their journey of

co-exploration in order to find hidden talents and abilities that may help them overcome life

problems (Monk, 1997). The persons telling of her story offers a landscape or context within

which a persons problems can be understood by both the therapist and the client.

In all cultures, telling stories is a process of sharing history with ones family, the

community, and larger culture. Although these relationships are often not directly attended to

and verbalized, they certainly constitute a part of the dialogue between individuals and, as such,

are part of the social processes through which stories are shaped (Richert, 2003). For abused

women, the listener can be defined as a therapist, attorney, judge and/or jury, and people who

work within the therapeutic and criminal justice communities. Heightened sensitivity to contexts

such as culture, gender, race, and class, add to the ability of the listener to understand, empathize,

and offer help in meaningful ways (Lieb & Kanofsky, 2003). Richert (2003) suggests that


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therapists take care to locate her/his questions in the context of the therapists experience as well

as the clients experience, as a way of acknowledging the co-created nature of meaning and of

privileging the clients knowledge.

No reality exists, independent of human meaning. However, meanings are not generated

by individual minds alone, but by social interaction. Interaction is central to this process of

meaning making because the performative nature of language generates the very state of affairs

being described (Richert, 2003). Rogler (1999) suggests that a participant or client will inform

the listener of proper means of interpreting his or her actions. Thus, if a researcher or counselor

actually listens to what the clients say, assumptions of homogeneity fall by the

waysideNorms can and should be sensitized to each respondents experience (Rogler, 1999,

p. 431).

Significantly, the cultural story of psychotherapy privileges the therapists knowledge

and sets up a power differential between the client and therapist. Telling others about oneself

is, then, no simple matter. It depends on what wethink theyought to be like-or what selves in

general ought to be like (Bruner, 2004, p. 4, emphasis his). Within narrative therapy, the

listener is required to create a safe and nonjudgmental environment for the client. Therapists

approach the clients story with openness by locating his or her questions within the context of

the clients experience (Richert, 2003).

The value of testimonial or phenomenological studies of victims of violence cannot be

underestimated in terms of our understanding of victims experiences and how that would inform

our ability to help them. For example, in a study of 164 people who recounted situations in

which their feelings had been hurt, Leary and his colleagues (Leary, Springer, Negel, Ansrell, &

Evans, 1998) found that hurt feelings were characterized by undifferentiated negative affect,


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which affect is often accompanied by emotions such as anxiety and hostility. Analyses of the

subjective experiences of these victims revealed that these hurtful episodes typically had

negative repercussions for the relationships between perpetrators and victims. In a pre post study

of Sudanese refugees living in a Ugandan refugee settlement who were diagnosed as suffering

from PTSD, only 29% of those who gave testimony about their abuse, compared to 79% of those

who just went through supportive counseling, and 80% of those who went through psycho

education, were found to still fulfill PTSD criteria after one year. The lessening of PTSD among

those who gave testimony of their abuse occurred despite the fact that they continued to live in

dangerous conditions (Neuner, Schauer, Klaschik, Karunakara, & Elbert, 2004).

The testimony method has also been used for a group of 20 traumatized 23-62 year old

refugees from genocide in Bosnia-Herzegovina (Weine, Kulenovic, Pavkovic, & Gibbons,

1998). All participants received an average of 6 sessions of testimony psychotherapy and then

were given standardized instruments for measuring PTSD in a pre-post test design and at 2 and 6

months follow-up. The post-treatment assessments demonstrated significant decreases in the rate

of PTSD diagnosis, symptom severity, the severity of re-experiencing, avoidance, and depressive

symptoms. The researchers found significant increases in scores on the Global Assessment of

functioning Scale (GAFS). At 2 and 6 months follow-up, refugees showed significant decreases

in all symptoms and an increase in the GAFS. This pilot study provides preliminary evidence

that giving testimonies as a form of psychotherapy may lead to improvements in depressive

symptoms, PTSD, and improvement of functioning in survivors of state-sponsored violence.

Research in this area reveals interesting content, not often available through strict

nomothetic methods. For example, Thomas (2003) used a community sample of 19 middle-class

men who audio taped their anger narratives. Thomas found that anger experiences were


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described by the men as intense physical arousal felt within the body. Nomothetic methods

might measure physical arousal as a correlate to the mens telling of their story but could not tell

us the meaning that men gave to this physical arousal.

In a study of battered women using a three session interview methodology, Buchbinder &

Eisikovitz (2003) found that shame was found to be prevalent in battered womens

phenomenological biographies. The researchers argue that shame traps the battered women,

having a pervasive influence on the self, relationships with others, and emotional experiences,

and becomes an obstacle in leaving the violence (p. 4). Buchbinder & Eisikovitz suggest that

any form of intervention depends on this understanding of the womens feelings of shame.

The above studies reveal that telling ones story of abuse and victimization is a necessary

first step, although not sufficient, for reduction in feelings of depression, relief from anxiety, and

increases in feelings of self-efficacy. A World Bank study (Heise, Pitanguy, & Germain, 1994)

found that women who are unable or unwilling to seek help from the police or other

government authorities may nonetheless admit abuse when questioned gently and in private by a

supportive[person]Contrary to expectations, women are willing to admit abuse when

questioned directly and non-judgmentallyIn fact, asking itself can be an important

intervention (p. 34). According to Dr. Ana Flavia dOliveira (1993), some women have been

waiting their whole lives for someone to ask.

In a study of narrative story-telling, comparing listening techniques, researchers Bavelas,

Coates, & Johnson (2000) found that the way listeners listened had an effect on the content of the

narratives. In a study of sixty-three unacquainted dyads, one person in each dyad told his or her

own close-call story. Distracted listening using generic responses (e.g. mmm!) resulted in stories

that were less illustrated. Specific responses such as wincing or exclaiming which were


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connected to what the narrator was saying at the moment seemed to help the narrators

performance. This finding suggests that moment-by-moment collaboration is important to face-

to-face storytelling.

Intimate violence silences and isolates its victims. The insights that abused women could

offer, given their past and ongoing experience of domestic violence, are often overlooked.

Giving testimony of their abuse stops the silence and allows women to inform those who have

the authority to help. Further, by recasting abused women as authorities on domestic violence,

women are given back their voice, enabling them to express their unique insights into the

occurrence of abuse and its potential solutions (Nabi & Horner, 2001).

Working with Breath, Pranayama, and Consciousness-Based Therapies.

The effects of intimate abuse on women, their bodies, minds, consciousness, and spirit

(including their will to live and resilience) can be vast and devastating. Abused women may

suffer from depression, low self-efficacy, post traumatic stress, anxiety, and low self-esteem.

Physically, they may suffer lowered and compromised immune systems, miscarriages, broken

bones, and bruised organs. All of these experiences affect and are affected by their breathing.

The use of breath to focus on the present and enable the person to observe their negative

thoughts without being caught up in them, has been explored most recently through the concept

of mindfulness (Kabat-Zinn, 1990, 1994).

Mindfulness Based Cognitive Therapy. Until very recently, mindfulness has been a

relatively unfamiliar concept in much of traditional Western health care (Kabat-Zinn, 1982).

The concept of mindfulness has its origins in Hatha Yoga: which includes doing yoga poses

(asanas), engaging in pranayama (breath control), and the practice of sitting meditation: Asanas,

pranayama, and sitting meditation are intricately related to one another. Mindfulness, according


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to Kabat-Zinn (1994) simply means paying attention in a particular way on purpose in the

present moment, and without judgment. Theoretically, mindfulness does not eliminate negative

thoughts and emotions; however, with mindfulness practice one is less caught up in these

negative thoughts and emotions (Cohen-Katz, Wiley, Capuno, Baker, & Shapiro, 2004).

[M]indfulness based stress reduction therapy has amazing therapeutic effects in whichthe patient is able to see that thoughts are just thoughts and they are not you or reality, thatthe simple act of recognizing thoughts as thoughts can free one from the distorted reality oftencreated which then allows for more clear-sightedness and a greater sense of manageability in life(Kabat-Zinn, 1990, 69-70)

Segal, Williams, & Teasdale (2002) suggest that, as a result of repeatedly identifying

negative thoughts as they arise and standing back from them to evaluate the accuracy of their

content, patients often make a more general shift in their perception of negative thoughts and

feelings.

Mindfulness-Based Cognitive Therapy is a skills-training program designed to teach

people to become more aware of and to relate differently to their thoughts, feelings, and bodily

sensations. Thoughts and feelings are encouraged to be seen as passing events in the mind rather

than seeing them as part of the self, identifying with them, or treating them as accurate

reflections of reality. The eight week program, as designed by Kabat-Zinn (1982), teaches skills

that allow people to disengage from habitual dysfunctional routines of thought, particularly those

thoughts that are ruminative and depressionrelated. The program involves yoga poses (asanas),

sitting meditation, and diaphragmatic breathing (pranayama).

When one is mindful, the mind responds afresh to the unique pattern ofexperience in each moment instead of reacting mindlessly to fragments of a totalexperience with old, relatively stereotyped, habitual patterns of mind. (Teasdale, Segal,Williams, Ridgeway, Soulsby & Lau, 2000, p. 618)

The few Mindfulness-Based Cognitive Therapy experiments (using random assignment

and control groups) completed within the last ten years have revealed some very interesting and


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positive results. In one such study, depression was lowered in patients studied in Bangor, North

Wales and their over generalized autobiographical memories were significantly reduced

(Williams, Teasdale, Segal, & Soulsby (2000). In a study of how mindful meditation could

reduce stress in patients with moderate to severe psoriasis who were undergoing phototherapy,

those who received mindful meditation reached a halfway relief point or a clearing point

significantly more rapidly than those in the control group. It also increased the rate of resolution

of psoriatic lesions in patients with psoriasis (Kabat-Zinn, Wheeler, Light, Skillings, Scharf,

Cropley, Hosmer, & Bernard (1998). In a study by Teasdale, Segal, Williams, Ridgeway,

Soulsby & Lau (2000), patients in remission or recovery from major depression, who received

Mindfulness-Based Cognitive Therapy (MBCT), had less hazard of relapse, when compared to

controls. In fact, participants with three or more previous episodes of depression almost halved

their relapse/recurrence rates over the follow-up period, again as compared to controls.

Yogic Understandings of Breath. In the yogic tradition, prana is substituted for breath.

According to yogic teachings, Prana is vital energy which connects the psyche/mind and

soma/body. It is vital because it is the very essence of life (Rama, Ballentine, & Hymes, 2004).

Without prana we are said to have expired. How does prana affect these various systems of

the body, mind, and spirit?

Although Western science has determined that breathing is controlled by the autonomic

nervous system, yoga teaches us that even though breath is controlled by the autonomic nervous

system, we are able, with practice, to place the breath under conscious control. This is the work

of pranayama: The means to self-inquiry, self-realization, and self-transformation (Rosen,

2002). Breath, as understood through ancient Vedic knowledge, leads us to understanding of the


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self, changing of the self, and the revelation that we are part of and breathing with the breath of

the universe.

These ancient guides to breath suggest physical and psychological benefits as well.

Breath improves digestion and speeds elimination of wastes from the body, centers and focuses

the mind as a distraction from hunger and thirst, opens the sinus cavities so that more oxygen

enters the body, combines with blood in the lungs to create oxygenated blood, which then travels

throughout the body. Breath has powerful effects on diseases of the upper respiratory tract,

including allergies and clogged sinuses. Breath, through the elongation of the exhalation,

reduces blood pressure and concomitant anxiety (Rama, Ballentine, & Hymes, 2004). Muscles

involved in respiration include the diaphragm, intercostals, abdominal, and accessory muscles.

Seventy-five percent of air movement during quiet inhalation is accounted for by the work of the

diaphragm. The intercostals, abdominal and other muscles, including sternoleidomastoid and

other neck muscles are engaged in the other 25% of air movement during quiet inhalation

(Caruana-Montaldo, Gleeson, & Zwillich, 2000).

A number of small studies, often with a limited number of participants, some done in

India and some in the United States, have revealed some preliminary evidence for the effect of

yogic breathing exercises on mood and stress of a diversity of people (e.g. Rama, Ballentine, &

Hymes, 1998; Weber, 1996). Weber conducted a study at South Nassau Communities Hospital

in Oceanside, New York (1996) and found that clinically diagnosed patients benefit from

meditative breathing, guided imagery and soft music. Thirty-six patients with major depression,

bipolar disorder and schizophrenia experienced a significant drop in their anxiety levels after

three sessions a week of these relaxation techniques. These techniques relied on breath as an

anchor, teaching the participants that deepening their use of breathing can steady them. Weber


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suggests that these breathing techniques also had the effect of opening these patients up to new

experiences.

In a longitudinal study of applied relaxation techniques as applied to generalized anxiety

disorder, Borkovec & Costello (1993) trained fifty-five participants to use slow-paced meditation

with diaphragm breathing and monitored their reactions. Results indicated that applied

relaxation had a major impact on BDI-II depression scores and Hamilton Anxiety Rating Scale

Scores. Kim & Kim (2005) examined the effects of a particular relaxation breathing exercise

they designed on anxiety and depression in stem cell transplant patients. They developed a 30

minute tape demonstrating exercises to be practiced while they were lying in bed. These

exercises consisted of concentrating on the lower abdomen, placing their ankles on their knees,

bending both knees, relaxing the body and mind, stroking down their hair and face, rotating their

ankles, and stretching their legs and arms in bed. Compared to the control group, the relaxation

breathing exercise (RBE) groups depression, as measured by the BDI-II, decreased

significantly.

According to the philosophy of pranayama within the context of Hatha Yoga, (Iyengar,

2003) the act of breathing takes place in the present, thus the focus on breath helps the person put

the past and future aside and concentrate on now, rather than later. Further, awareness of breath

takes the place of ruminative thinking, allowing the person to substitute negative thoughts with

the simple and deliberate act of breathing (Segal, Williams, & Teasdale, 2002). These breathing

and relaxation techniques could have an important place within the clinical/counseling

community because these techniques have been shown to have positive effects on the mitigation

of anxiety, panic attacks, as well as chronic pain (Kabat-Zinn, Lipsworth, Burner, & Sellers,


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1986; Kabat-Zinn, Massion, Kristeller, Peterson, Fletcher, Pbert, Lenderking, & Santorelli,

1992).

Investigating Pranayama. According to researchers and practitioners of pranayama (See

for example Iyengar, 2003; Rosen, 2002; Rama, Ballentine, & Hymes, 2004), pranayama

involves the lengthening, directing, regulating and movement of the breath, which includes

limiting, restraining, and retaining breath. The origins of pranayama are not well-known but

may go all the way back to the writing of the Vedas, or Sanskrit books of knowledge coming out

of India about four thousand years ago (Rosen, 2002). Prana in Sanskrit means to bring forth life

(pra-to bring forth; na-to live). Yama (or ayama) means stretch, extend, stop, lengthen in space

or time but is often translated in English to mean control (Rosen, 2002). Iyengar (2003) states

that [d]uring normal inhalation, an average person takes in about 500 cubic centimeters of air;

during deep inhalation the intake of air is about six times as greatThe practices of pranayama

increase the students (sadhakas) lung capacity and allows the lungs to achieve optimum

ventilation (p. 15).

A variety of breaths are used for a diversity of objectives. For example, during savasana

(corpse pose/relaxation), the breath is slow, steady, and quiet, allowing the body, mind, and brain

to move towards the center of the self, allowing one to recuperate. The person, according to

Iyengar, reaches a state of clarity, where consciousness, rather than ruminating thoughts, is in

full command (p. 251). Placing the breath has the effect of showing the sadhaka that breath is

under their control and can move from place to place within the body, for the purpose of

stimulation or relaxation.

The following study used a variety of pranayama techniques, including training the

women to work with extensions and reductions of inhalations and exhalations, to place the


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breath, to understand the movement of the diaphragm, to learn to lift and open the chest in order

to free the breath in the upper lungs, to use breath with sound as an enhanced relaxation

technique, and, finally, to use the breath to recuperate by maintaining a state of focused stillness

in body, senses and mind. Yoga poses were incorporated into the breathwork for the purpose of

enhancing the pranayama technique (See Appendix A).

METHODOLOGY

The following experiment, funded under grant P20 MD002089-01 from the National

Institutes of Health, NCMHD, and Department of Health and Human Services, investigated how

the giving of emotional/social support by training battered women in yogic breathing techniques

and encouraging them to give testimony of their abuse affected their feelings of self-efficacy and

depression. The experiment was conceived as a 2(testimony) by 2 (breathing) repeated measures

design. The researchers hypothesized that telling ones story of abuse will influence scores on

the BDI-II (Beck, 1996) and the Franzblau Self-Efficacy Scale (FSES) (Franzblau, 1997) (See

Appendix A). They also hypothesized that learning yogic breathing techniques will influence

scores on the BD-II and FSES. Researchers assumed that the scores on the BDI-II and FSES

would reflect the inverse relationship between self-efficacy and depression (Bandura, 1997). It

was expected that the significance of this inverse relationship would lend support for the inter-

instrument reliability of the BDI-II and FSES.

It was further hypothesized that the battered womans race, whether or not the abuser was

a member of the military, the womens level of education, and the number of children under the

age of 5 living in the abused womens custody would affect both levels of depression and

feelings of self-efficacy.


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Participants.

Forty women who self-identified as either Black (n=20) or White (n=20) and also self-

identified as verbally, emotionally, physically, and/or sexually abused by a man with whom they

have been intimate within the last two years, were invited to participate. The participants were

found through advertisements and snowballing techniques. Announcements of the experiment

were carried in the local newspaper, through placement of flyers on the inside of bathroom stall

doors in the court house, the local state university and community college, and in various bars

and other locations. Within race, the participants were randomly assigned to one of four

conditions: testimony, breathing, testimony/breathing, or waiting control. They were also

matched with a trained listener of the same race. Each participant received $100.00(1/3 the first

day, 1/3 the third day, and 1/3 the last day)

Listeners.

Women research assistants (two counseling masters students and one senior

undergraduate psychology major) were trained to actively listen to the participants, asking

questions only to encourage the participants to talk about and elaborate on their experiences (e.g.

could you talk more about that; could you explain what you mean). The research assistants were

also trained to exhibit conscious involvement in the participants story through eye contact and

body language. All testimonies were taped for later transcription. One of the graduate students

was trained by the primary investigator, who is a Registered Yoga Teacher, to teach the

breathing protocol (See Appendix B).

Procedure.

Experimental Conditions:

1. Testimony (two 45 minute sessions over two consecutive days)


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2. Breathing (two 45 minute sessions over two consecutive days)

3. Combined testimony/breathing (two 45 minute sessions, beginning

with testimony, over two consecutive days)

4. Waiting controls (waiting controls were to receive one of the two

treatment conditions after the experiment ended, if they wished to

continue their participation)

The experiment took four consecutive days to complete. Testimonies were taken in a

small room in a discrete location on the third floor of the campus library; breathing techniques

were taught in a yoga studio located close to the university. On the first day, participants took a

modified version of the FSES and the BDI-II, and were asked to fill out a demographic sheet and

informed consent. All participants took the FSES and BDI-II again on the fourth day, and were

debriefed. If at any time during the four days they requested legal or psychological help, a sheet

of paper with resource information was given to them. The sessions were recorded on a Marantz

PMD-670 compact flash recorder with 2GB CF card for later transcription and content analyses

of the narratives.

RESULTS

Overall, African American women in this sample were bettered educated than Whites.

Nevertheless, only three women (1 African American and 2 White women) had graduate school

experience. A Chi Square analysis showed no significant difference in level of education by

race. Most participants completed high school and had some college education. No other

demographic information differentiated the participants.

The Becks Depression Inventory II (BDI-II) (Beck, 1996) was used to measure the level

of depression for each participant both before and after treatment conditions. The BDI-II clinical


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scores range from minimal to severe: minimal (0-13), mild (14-19), moderate (20-28), and severe

(29-63). In the Testimony condition and Testimony/Breathing condition, the pre BDI-II scores

were severe (X= 31.2 & 30.7 respectively). The post BDI-II scores for Testimony changed

from severe to moderate (X= 21.7); and for Testimony/Breathing, changed from severe to mild

(X= 17.2). For the Breathing condition, the pre BDI-II scores were mild (X= 10.4) with post

scores improving to minimal (X= 4.6). Waiting controls, who took the BDI-II three days apart,

scored moderate in both pre and post conditions (X= 23.2 pre & 22.2 post). Inter and intra

instrument reliability was tested using a Persons r. Then analyses of variance and covariance

were computed. Post hoc comparisons were made for both the analyses of variance and

covariance.

The FSES was computed to produce a positive self-efficacy and negative self-efficacy

score. The scale consisted of five bifurcated factors: anxiety/relieved; in control/out of control;

unafraid/afraid; secure/insecure; confident/non-confident. Participants were required to indicate

the level of intensity for each factor: extremely (coded as 3), moderately (coded as 2), and

somewhat (coded as 1). Both positive and negative factors were added up and the difference

between positive and negative scores was computed. The resulting score was then analyzed

using analysis of variance. Individual factors were also analyzed comparing pre and post scores.

Pearson r correlation matrix reveals the relationship between the pre BDI-II and post

BDI-II scores. The analysis yielded a correlation of r = .719 (p = .001). Fifty-two (52%) percent

of the variability in the Post BDI-II is accounted for by the pre BDI-II score.

A test of the relationship between the pre FSES positive score and the pre FSES negative

score yielded a correlation of r = .796 (p= .001). This correlation indicates that as the pre FSES

positive score increased the pre FSES negative score decreased. Sixty-three (63%) percent of the


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variability in the pre FSES positive score is accounted for by the pre FSES negative score. These

findings confirm the intra-instrument reliability of both the BDI-II and the FSES.

A test of the relationship between the pre BDI-II and the pre FSES positive score yielded

a correlation of r = -.701 (p= .001). Forty-three (43%) percent of the variability in the pre FSES

score is accounted for by the pre BDI-II score. This finding indicates an inverse relationship

between these two instruments, confirming one of the hypotheses. As the pre FSES positive

score increased, the pre BDI-II negative scores increased. The relationship between the pre BDI-

II and the pre FSES negative score yielded a correlation of r = -.641 (p=.001), with forty-one

(41%) percent of the variability in the pre FSES negative score accounted for by the pre BDI-II.

This finding indicates an inverse relationship between these two measures (See Correlation

Matrix Table 1).

These findings support the inter-instrument reliability of the BDI-II and FSES, and reveal

a strong inverse relationship between self-efficacy and depression. As Bandura (1997) has

suggested, the inability to control current or future events influences mood. Raising an

individuals feelings of self-efficaciousness promotes empowerment and facilitates a decrease in

depression.

[Place Table 1 here]

BDI-II. An analysis of variance, comparing treatment conditions to difference scores on

the BDI-II, resulted in an F-ratio of 4.123 (df = 3, 36;p= .013). The treatment conditions

accounted for 23% of the variability in the scores. This finding demonstrates that treatment

overall, had a significant effect on the BDI-II scores (See Table 2).



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A Tukey Post Hoc analysis revealed that the most significant difference in depression lies

between the Testimony/Breathing condition and the Waiting Control (Mean Difference of 8.4,p

= .008) (See Table 3).


The means of the difference in the pre and post BDI-II scores for each treatment

condition were computed. The means are as follows: Testimony 9.50, Breathing 7.40,

Testimony/Breathing 13.5, and Waiting Control 1.10. These scores represent an average

reduction of depression levels across all treatment conditions. Again, the largest difference is

between Testimony/Breathing and Waiting Control (See figure 1)

[Place Figure 1 here]

Depression scores improved across all treatment conditions. In the Testimony condition

70% of the participants had improvement in their depression scores; and the Breathing condition

50% of the participants had improvement. It should be noted that 50% of the participants

randomly assigned to the breathing treatment group had initial scores in the minimally depressed

range (0-13), which left no room for improvement. However, 100% of the participants who

could improve their scores did. Seventy percent of the participants in the Testimony/Breathing

condition also showed an improvement. Only 20% of the participants in the Waiting Controls

showed improvement. These findings indicate that all treatment groups improved their

depression scores, compared to controls (See figure 2). A Chi Square analysis was conducted

after removing those participants with minimal depression scores, which reduced the sample size

by 9 (40 to 31), of which 55% came from the Breathing group. One was lost from the

Testimony/Breathing group and three from the Waiting Controls. That left eight cells in the Chi

Square matrix; expected values require at least 5 per cell, which would require 40 participants.


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Breath and Voice 24

Thus, 31 remaining participants would not meet the expected condition for a Chi Square

analysis. Nevertheless, a Pearson Chi Square analysis revealed a value of 7.734 (df = 3;p=

.052).


A between subjects Analysis of Covariance revealed an F ratio of 3.164 (df = 3, 35;p=

.037). Treatment accounted for 21% of the variability in the post BDI-II scores. This finding

indicates that, overall, treatment conditions had a significant effect on the post BDI-II scores

(See Table 4).


A Post Hoc comparison between treatment conditions revealed a significant difference

between the Breathing group and Waiting Controls (X= 8.261,p= .031). A Post Hoc

comparison between the Testimony and Breathing group was also significant (X= 10.224,p=

.009). There was no other statistically significant difference between groups (See Table 5).


A race (2) X treatment conditions (4) between subjects analysis of covariance was

computed, revealing a main effect of treatment (F = 2.947,p= .048). There was no main effect

for race and no interaction between race and treatment. Negative FSES scores decreased as a

result of treatment, which accounted for 22% of the variability in the post FSES score (See Table

6).


Although analyses revealed no main effect of race on FSES scores and no interaction, it

is interesting to note the difference between Black and White abused womens post negative

FSES (See figure 3). White womens mean post FSES negative score was 1.2 points less than


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Breath and Voice 25

Black womens mean post FSES negative score. This difference in self-efficacy could be

accounted for by cultural differences in social support networks, coping styles, social class,

and/or types/intensity of abuse. Further research using a larger sample size and more specific

demographic information might reveal whether this difference can be sustained.


A one-way Analysis of Variance, comparing pre and post difference scores on each of the

five factors in the FSES was computed. The five factors are: 1) In/Out of Control; 2)

Secure/Insecure; 3) Confident/Not Confident; 4) Afraid/Unafraid; and 5) Anxious/Relieved. For

the factor In/Out of Control analysis revealed an F ratio of 3.541 (df =3, 35) p=.024 and for

Confident/Not Confident an F ratio of 4.023 (df = 3, 35)p= .015. For the factor

Secure/Insecure, analysis revealed an F ratio of 3.308 (df = 3, 35)p= .031. A Tukey HSD post

hoc comparison revealed that all of the significant differences were between

Testimony/Breathing and Waiting Controls (mean differences were: In/Out of Control =

2.85556; Confident/Not Confident = 2.90; Secure/Insecure = 2.78889 (see figures 4 - 6), (p =

.05)).

[Place Figures 4, 5 & 6 here]

DISCUSSION

Statistical analyses of the effects of the four experimental conditions on depression and

self-efficacy confirmed a number of hypotheses. An inverse relationship between depression

and self-efficacy was confirmed. The breathing condition significantly affected abused womens

levels of depression and self-efficacy; and the combination of giving testimony and breathing

affected their levels of depression and negative self-efficacy. There were significant differences

between the waiting control group and testimony/breathing conditions on feelings of self


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efficacy, particularly for the factors In Control/Out of Control, Secure/Insecure, and

Confident/Not Confident. A number of hypotheses were not confirmed. For example, there

were no racial differences, no differences in education, and no influence of children under the

age of five on depression and self-efficacy.

Critique. Although the abused women participants were randomly assigned to the four

conditions, it was not possible for participants to be blind to the conditions to which they were

assigned. Therefore, women who took the BDI-II in the testimony condition initially scored in

the severe range. After giving their testimony, their BDI-II scores fell from clinically severe to

moderate. Women who took the BDI-II prior to the breathing condition, however, scored in the

mild range. After the breathing exercises, their BDI-II score fell from mild to minimal.

Interestingly, women who took the BDI-II prior to the combination testimony/breathing initially

scored in the severe range and after their combined condition, scored in the mild range. Waiting

controls scored in the moderate range in both the pre and post conditions. What accounted for

the differences in pre BDI-II scores? It may be that the BDI-II, rather than measuring some

internal and consistent trait categorized as depression, actually reflects their present state

combined with context within which they were taking the test, and the expectations arising from

awareness of this context. Given that the women were not blind to the conditions to which they

were assigned, those in the testimony condition may have been affected by the expectation that

they were giving testimonies about their abuse, possibly causing them to feel more depressed

initially. Women in the breathing condition could have been affected by the expectation that

they were going to relax, possibly causing them to feel less depressed initially. Women entering

the combined condition were initially affected by having to give their testimonies first; however,

because they learned breathing/relaxation last, their depression scores moved from severe to


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mild, reflecting how relaxed they were the day after the breathing session. This result is very

revealing, indicating that context, rather than an example of an internal validity problem, should

be an important consideration in helping abused women move towards psychological and

emotional health (See Rogler, 1999, for a more extensive examination of the role of culture and

context in mental health assessment).

CONCLUSION

Historically, abused womens right to tell the story of their abuse has been drowned out

by the authoritarian voices of government officials, police, family, religious institutions and even

friends. Our understanding of intimate abuse is limited by who gets to tell these womens story,

and depends on who is listening, and whether or not the women are believed. For most of the

women in this study, giving their recorded testimony was their first chance to hear themselves

talk about the horrific details of their experiences. The women were finally able to release the

emotional burdens that had been buried within, in a non-threatening and nonjudgmental

environment. The environment created in this study gave the women a chance to voice their

concerns and their fears, without being reprimanded, interrogated, ignored, and most

importantly, further violated by the listener. Dan (1994) suggests that blaming women for their

abuse, not showing genuine concern for the abused womans experience, or failure to recognize

the impact of battering on her life and psyche can lead to further withdrawal and avoidance of

the help-seeking that she needs. The narrative approach to counseling enables clients to begin

their journey of co-exploration of the hidden talents and abilities that may help them overcome

life problems (Monk, 1997). In order for women to begin to feel self-efficacious, they need

basic social and emotional support involved in active and nurturing listening followed by

mindful exercises in breathing and relaxation (See Franzblau & Moore, 2001, for a discussion of


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socializing efficacy). By recasting abused women as authorities on domestic violence, they are

enabled to express their unique insights into the occurrence of abuse and its potential solutions

(Nabi & Horner, 2001).

This study shows that for battered women, both self-efficacy and depression are

influenced by minimal conditions in their environment, beginning with whether or not they are

being listened to and whether or not they have learned a method to control their stress by

controlling their breathing. When one combines telling ones story of abuse with yogic

breathing exercises, feelings of depression and lack of confidence, control, and insecurity are

greatly reduced. These two factors, in combination, seem to provide some symptomatic relief

for abused women, and appear to be a necessary first step toward abused womens healthy self-

regard.

The significant effects on depressive symptoms in the breathing group indicate the

dramatic effects that breathwork and meditative techniques have on stressful life events. The

breathing treatment produced an environment in which the women could feel safe and peaceful,

an environment in which the participant could be free of judgment and oppression. They are

encouraged to not criticize themselves during the process, focusing not on their mistakes, but on

feeling comfortable and in control, with all attention given to the breath and movements of the

body. These techniques, when taken out of the laboratory, would allow abused women to focus

and observe patterns in their lives that could help them successfully navigate through future

stressful events (Beitel, Ferrer & Cecero, 2005).


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Appendix A

Franzblau Self-Efficacy Scale (1997, modified 2005)

For each of the following feelings, please indicate by marking an X, for which point on the scaleapplies to you:

Anxious or Relieved

Extremely.moderately.somewhat Extremely.moderately.somewhat

In Control Out of Control


Secure Insecure


Unafraid Afraid


Confident Not Confident



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Appendix B

BREATHING TECHNIQUES CONDITION

SITTING IN EASY YOGA POSE (Learning How to Breath and Sitting in an Easy Cross

Legged Position)

1. Easy Yoga Pose. Cross legs in easy yoga pose, sitting on as many blankets as necessary to

bring knees below hips.

2. Bring your awareness to your breath and observe it flowing in and out of your nose as you

Inhale and Exhale.

3. Place on hand on abdomen and other on heart. Exhaleby pulling abdomen inward, back

toward spine.

To Inhale, release the inward abdominal pull and allow belly to swell gently forward into

your hand. Try to keep the hand on heart from moving.

(Do not press belly forward, keeping it strain-free)

4. Place palms on side of chest, level with bottom of breastbone. Fingertips are barely

touching the chest. Exhale deeply. Then Inhale deeply and expand chest, trying to

move fingertips away from the midline of chest. Make chest round. Notice how chest

expands in all directions - sideways, forward and backward, and upward. As you Exhale,

gently squeeze rib cage inward with hands.

5. Place palms on side ribs and as you Inhalefeel the ribs expand into your hands. As you

Exhalefeel the side ribs contract toward the center of your body.

6. Inhale. Then Exhalefully. This empties the lugs and creates room for a deep Inhalation.

7. To Inhale, relax the abdomen and allow the belly to gently swell forward a little. Do not do

anything. Dont press belly outward. Simply release the inward pull of abdomen. Air will


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come in effortlessly.

8. Then aim the breath upward into chest and expand chest, rounding it; and slide your

shoulder blades down your back. Do not shrug your shoulders upward. Keep them down

and relaxed.

9. To Exhale, allow ribs to relax, and release the air slowly and gently pull your belly in.

10. Now make theInhalations and Exhalations even and fluid as if your breath was like water

flowing in and out.

LYING IN CROCODILE POSE (Feeling the Breath on Your Stomach).

Lie on your stomach with your arms stretched out before you and the palms touching.

Rest your forehead on the ground. Inhale and Exhale, bringing your awareness to your

breath and the rise and fall of your stomach. As you Inhale, notice that your stomach

expands pushing your spine off the ground. As youExhale, notice that your stomach

contracts pressing your spine and chest towards the ground. Breathe here for 10 full

breaths.

SITTING IN EASY YOGA POSE(Expanding the Exhalations)

1. Come back to Easy Yoga Pose. And continue the easy breathing.

2. Inhale for four beats. Now Exhalefor four beats. Concentrate on the breath in your belly

and move the breath up toward your chest. When you Exhale, feel the breath sliding down

your back, bring your shoulders down and your shoulder blades together down with the

Exhalation.

3. Inhale for two beats and Exhalefor three beats.

4. Inhalefor two beats andExhale for four beats.

5. Inhalefor three beats and Exhalefor five beats.


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6. Inhalefor three beats and Exhalefor six beats.

EASY YOGA POSE SQUARE BREATHING(Learning how to expand the spaces between

the Breath)

1. Inhale for four beats

2. Hold the breath for two beats

3. Exhale for two beats

4. Hold the breath for two beats

5. Repeat the sequence but hold the breath for three beats

6. Repeat the sequence but hold the breath for four beats

SUPPORTED BRIDGE POSE (Learning how to Lift and Open the Chest Cavity and Free

the Breath in the Upper Lungs)

1. Lie down on your back with your knees bent and your feet flat on the floor directly under

your knees.

2. As you Inhale, let the breath travel up your chest from your belly. As you Exhale, let the

breath travel down your back to your tailbone.

3. Lift your arms directly toward the ceiling and stretch one arm at a time, expanding the

muscles away from your spine.

4. Lift up your hips and place the block directly under your sacrum and rest your sacrum on the

block.

(You should feel totally comfortable resting on the block).

5. Stretch out your arms, lining your arms up with your shoulders, palms up and fingers slightly

curled up.

6. Roll the ball of the humorous (the upper arm) toward the back plane and flatten your upper


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back and shoulder blades to the floor.

7. Close your eyes and breathe evenly, using four beats for the Inhalation and four beats for the

Exhalation.

8. Take twenty full breaths here.

9. Lift your hips and remove the block. Then come down on your back, one vertebra at a time.

10. Tuck your pelvis forward so that your lower back is resting on the ground.

11. Bring your knees up to your chest and wrap your hands around you shins, and then draw your

forehead toward your knees.

12. Then roll over to one side and come up to your hands and knees.

CHILDS POSE (Learning how to Breath in a Relaxing Pose)

1. Sit back on your heels.

2. Press your buttocks into your heels and extend your spine forward.

3. Extend your arms in front of you, resting them on the floor.

4. Rest your forehead on the floor or on a block, if your head does not reach the floor

5. Take long Inhalations (4 beats).

6. Exhales are longer (6 beats).

7. Engage Bee Breath (Inhaleand then, with your mouth closed, Exhale, humming deep in

your throat until there is no breath left. Continue with your Inhalations and Exhalations

this way.

SAVASANA (Corpse Pose) (Those suffering from hypertension, high blood pressure, heart

disease, emphysema, a cold or throat congestion, or restlessness should place pillows under

head) (Those suffering from sciatica pain or lower back pain should place a bolster under

the knees)


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Breath and Voice 41

EXPLANATION: Relaxation means recuperation. It is not simply lying on ones back with

a vacant mind and gazing, nor does it end in snoring. It is the most refreshing and rewarding

pose. The body, breath, mind and brain move toward the equalization of mind, body, and breath.

It is a state of stillness where the body, senses, and mind are controlled by you.

1. First achieve stillness of the body: Remove all restricting garments, belts, glasses, contact

lenses, etc.

2. Sit with your knees bent and feet together and flat on a blanket spread out on the mat.

3. Draw an imaginary line down the center of your body from your legs all the way up to the

crown of your head.

4. Gradually lower your vertebra, vertebra by vertebra along that imaginary center line until

your back is totally flat on the floor.

5. Lift your hips slightly and lift your sacroiliac region, and with your hands, move the flesh

and skin from the back of the waist down toward your buttocks.

6. Lift your arms straight up to the ceiling and stretch one arm at a time, feeling the muscles and

skin move away from the center of your spine to the sides and spill like liquid butter on to the

floor.

7. Adjust your head so that it is at the center, with your neck long and your chin slightly tucked

toward your collarbone. Stretch out your neck, so that it is resting comfortably on the floor

and that your head is resting comfortably without your neck being pinched.

8. Join your heels and knees, the center of your coccyx, and your spinal column and the base of

the skull, so that they all rest on this imaginary straight line down the center of your body.

9. Place the inner point of each shoulder blade to the floor. Roll the skin of the top of the chest

from the collar bones toward the shoulder blades, so that your back rests perfectly on the


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Breath and Voice 42

blanket.

10. Take your spine from the center of your spine to your lumbar vertebra and rest them

evenly on either side so that the ribs are spread out uniformly. Rest on the center of your

sacrum so that your buttocks relax evenly.

11. Keep your feet together and stretch out the out edges of your heels. Then let your feet

fall outwards. Your big toes should feel weightless. Do not force your little toes to touch the

floor.

12. Keep your hands away from your body, forming an angle of about 15 degrees at the armpits.

Bend your arms at the elbows, touching your shoulder tops with your fingers. Extend the

back portion of your upper arms and take the elbows as far as you can towards your feet.

Then lower your forearms and extend your hands from your wrists to the knuckles of your

fingers, with your palms facing up and your fingers curling up like the petals of a blossom.

Keep your fingers passive and relaxed.

13. The feeling of lying on the floor should be as though your body is sinking into mother earth.

COVER THEM WITH BLANKET. IF THEY NEED PILLOW OR SOMETHING

UNDER THEIR KNEES, THIS IS THE TIME TO DO IT.

14. Remove tension from the back of the body from the truck to neck, arms, and legs. Next relax

the front of the body from your upper thighs to your throat. Then relax from the neck to the

crown of your head.

15. Experience lightness in your armpits, your groin, diaphragm, lungs, spinal muscles, and

abdomen.

16. Gently move your upper eye lids toward the inner corners of the eyes. Relax the skin above

them and create space between your eyebrows.


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Breath and Voice 43

17. Keep the root of your tongue passive as in sleep and resting on your lower palate. Keep

the corners of your lips relaxed by stretching them sideways.

18. Pay attention to your skin on your temples, cheekbones, and lower jaw and relax the skin,

feeling as if the skin is melting like butter from the center of your face to the sides.

19. Breath evenly through both nostrils,Inhaling normally but Exhalingsoftly, deeply and

longer than the Inhalation. Feel as if your breath is oozing from the pores of the skin on your

chest.

20. Stay with an awareness of your breath and let the thoughts you have move in and out of

your mind but let them go. Simply observe them.

SAY THE FOLLOWING IN A SOFT, MELODIC VOICE

Like the darting movements of a fish in the water are the movements of the mind and intellect.

When the water is unruffled, the image reflected in your mind is unbroken and still. When the

wavers of your mind and intellect are stilled, the self arises undisturbed to the surface of the

water, free of desires. At this stage of rest, the mind is free from fluctuations, and it dissolves and

merges into your self, like a river emptying into the sea.

COMING BACK TO EASY YOGA POSE

1. Slowly bring your consciousness back to your breath and notice that your breath is

breathing you. Feel the contentment and peace of your body and mind.

2. Bring your knees up to your chest and slowly roll over to the right side, curling up into

fetal position. Breathe slowly and deeply in this position.

3. Slowly, keeping your back rounded, come to Easy Yoga Pose. Make sure you are sitting

on blankets if you need to.

4. Inhalefor four beats up the front of your body, beginning at your belly and moving


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Breath and Voice 44

toward your collar bones. Then Exhale for four beats down the back of your body, drawing your

shoulders down with your breath. Breathe this way for about 10 breaths.


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Table 1

Correlation Matrix

** Correlation is significant at the 0.01 level (2-tailed).

Post Beck

Depression

Pre SE

Positive

Post SE

Positive

Pre SE

Negative

Post S

NegatPre BeckDepression

Pearson Correlation.719(**) -.701(**) -.547(**) -.641(**) -.532

Sig. (2-tailed) .000 .000 .000 .000 .

N 40 40 40 40

Post BeckDepression

Pearson Correlation-.419(**) -.625(**) -.389(*) -.727

Sig. (2-tailed) .007 .000 .013 .

N 40 40 40

Pre SE Positive Pearson Correlation .520(**) .796(**) .35

Sig. (2-tailed) .001 .000 .

N 40 40

Post SE Positive Pearson Correlation .289 .738

Sig. (2-tailed) .070 .

N 40

Pre SE Negative Pearson Correlation .

Sig. (2-tailed) .

N


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Breath and Voice 46

Table 2

One-way Analysis of Variance on the Difference Scores

Between the Pre & Post BDI-II by Treatment

SourceType III Sumof Squares df Mean Square F Sig.

Partial EtaSquared

Corrected Model 804.075(a) 3 268.025 4.123 .013 .256

Intercept 2480.625 1 2480.625 38.159 .000 .515

treatment 804.075 3 268.025 4.123 .013 .256

Error 2340.300 36 65.008

Total 5625.000 40

Corrected Total 3144.375 39


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Table 3

Multiple Comparisons

Dependent Variable: Difference Score on Beck's Depression Scale

Tukey HSD

95% Confidence Interval

(I) Condition (J) Condition

MeanDifference

(I-J) Std. Error Sig. Lower Bound Upper Bound

Breathing 2.10 3.606 .937 -7.61 11.81Talk/Breathing -4.00 3.606 .686 -13.71 5.71

Talk

Waiting Controls 8.40 3.606 .110 -1.31 18.11

Breathing Talk -2.10 3.606 .937 -11.81 7.61

Talk/Breathing -6.10 3.606 .343 -15.81 3.61

Waiting Controls 6.30 3.606 .315 -3.41 16.01Talk/Breathing Talk 4.00 3.606 .686 -5.71 13.71

Breathing 6.10 3.606 .343 -3.61 15.81Waiting Controls 12.40(*) 3.606 .008 2.69 22.11

Waiting Controls Talk -8.40 3.606 .110 -18.11 1.31

Breathing -6.30 3.606 .315 -16.01 3.41Talk/Breathing -12.40(*) 3.606 .008 -22.11 -2.69

Based on observed means.* The mean difference is significant at the .05 level.


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Breath and Voice 48

Figure 1

Mean Difference Scores (Posttest Pretest) Depression Score by Treatment Conditions

Tal k Breathing Talk/Breathing Wai ting Contro ls

Condition

0

2

4

6

8

10

12

14

Estim

atedMarginalMeans

Estimated Marginal Means of Difference Score on Beck's

Depression Scale


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Breath and Voice 49

Figure 2Number of Participants with Improved Scores on the Post BDI-II

Talk Breathing Talk/Breathing Waiting Controls

Condition

0

2

4

6

8

Count

Improvement

No Improvement

Improvement

Bar Chart


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Breath and Voice 50

Table 4

Analysis of Covari anceWith the Pretest as the Covariate

Source

Type III Sum

of Squares df Mean Square F Sig.

Partial Eta

SquaredCorrected Model 3500.818(a) 4 875.205 14.272 .000 .620

Intercept 21.888 1 21.888 .357 .554 .010

prebdii 1963.918 1 1963.918 32.026 .000 .478

treatment 582.005 3 194.002 3.164 .037 .213

Error 2146.282 35 61.322

Total 16340.000 40



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Table 5

Pairwise Comparisons

95% Confidence Interval forDifference(a)

(I) Condition (J) Condition

MeanDifference

(I-J) Std. Error Sig.(a) Lower Bound Upper Bound

Breathing 2.157 4.242 .614 -6.454 10.768Talk/Breathing 4.120 3.503 .247 -2.991 11.230

Talk

Waiting Controls -6.104 3.732 .111 -13.681 1.473

Breathing Talk -2.157 4.242 .614 -10.768 6.454

Talk/Breathing 1.963 4.204 .643 -6.572 10.498

Waiting Controls -8.261(*) 3.671 .031 -15.715 -.807Talk/Breathing Talk -4.120 3.503 .247 -11.230 2.991

Breathing -1.963 4.204 .643 -10.498 6.572

Waiting Controls -10.224(*) 3.710 .009 -17.755 -2.693

Waiting Controls Talk 6.104 3.732 .111 -1.473 13.681

Breathing 8.261(*) 3.671 .031 .807 15.715Talk/Breathing 10.224(*) 3.710 .009 2.693 17.755

Based on estimated marginal means* The mean difference is significant at the .05 level.a Adjustment for multiple comparisons: Least Significant Difference (equivalent to no adjustments).


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Table 6

A 2-Way ANCOVARace by Treatment Condition for Post Self Efficacy Negatives

With the Pre Self Efficacy Negatives as the Covariate

SourceType III Sumof Squares df Mean Square F Sig.

Partial EtaSquared

Corrected Model 90.602(a) 8 11.325 1.982 .083 .338

Intercept 13.953 1 13.953 2.441 .128 .073

presen 20.027 1 20.027 3.504 .071 .102

race 9.909 1 9.909 1.734 .198 .053

treatment 50.521 3 16.840 2.947 .048 .222

race * treatment 13.790 3 4.597 .804 .501 .072

Error 177.173 31 5.715

Total 457.000 40



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Breath and Voice 53

Figure 3

Euro-AmericanAfrican American

Race

-1.6

-1.8

-2

-2.2

-2.4

-2.6

-2.8

EstimatedMa

rginalMeans

Estimated Marginal Means of Post SE Negitive


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Breath and Voice 54

Figure 4

-2

-1

0

1

2

Talk Breath T/B WC

In control/Out of control

Positive numbers are In Control Negative Numbers are Out of Control


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Breath and Voice 55

Figure 5

-1

-0.5

0

0.5

1

1.5

2

Talk Breath T/B WC

Confident/Not Confident

Positive Numbers are Confident Negative Numbers are Not Confident


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Breath and Voice 56

Figure 6

0

0.5

1

1.5

2

2.5

3

Talk Breath T/B WC

Secure/Insecure

Positive numbers are Secure Negative numbers are Insecure

breath and voice

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