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1989 56: 185Canadian Journal of Occupational TherapyFranklin Stein and Janet Smith

Short-term Stress Management Programme with Acutely Depressed In-Patients  

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CJOT — Vol. 56 — No. 4

"#.440;44.*4-

Short-term Stress Management Programme with Acutely DerAressed In-Patients

Franklin Stein, Janet Smith

Key VVords: * Biofeedback, methods

• Depression

• Stress managernent training

Franklin Stein, OTR, Ph.D., FAOTA was Director, Occupational Therapy Programme, University of Wisconsin-Milwaukee, Milwaukee, WI, at the time of writing. He is presently Director, School of Medical Rehabilitation, Uni-versity of Manitoba, Winnipeg. Mani-toba, R3E OW3.

Janet Smith, OT(C) is Staff Occupa-tional Therapist at the Edmonton Gen-eral Hospital, Alberta.

Abstract

A shori-term stress management pro-gramme was carried out as a pilot study with seven acutely depressed in-patients. Various techniques in muscle relaxation and biofeedback were used in a six- session programme designed to decrease anxiety and to cope more effectively with stress. One occupational therapist served as a group facilitator and teacher of stress management techniques while a second occupational therapist served as the group recorder During the one and a half hour sessions specific tech-niques were practthed by the patients. These techniques included Benson's Relaxation Response, visual imagery, Jacobson's Progressive Relaxation, heart raW and finger temperature biofeedback and behavioural rehearsal. A Stress Management Que,stionnaire, developed by the first author, was used to help the patients become more aware of the symptoms of stress, stressors that "trigger"symptoms and everyday activ-ities that can be used to control stress. The State - Arzxiety Scale was admin-istered pre- and post-intervention to assess the reduction of anxiety. Results showed that there was a significant re-duction in anxiety at the .05 level using a correlated Nest. Qualitative cotnments from the patients at the end of the stress management programme indicated that the sessions had a positive effect in increasing their ability to relax and in learning to recognize individual stress reactions as well as new alternatives to coping with stress.

In the 17th century, Robert Burton (1632/1938), an Oxford scholar and recluse, wrote his classical work The Anatonzy of Melancholy. This work sum-marized the western world's view of the causes and treatment of depres-sion, and concluded with:

Melancholy is either a disposition or habit. In disposition, it is that transitory melancholy which goes and comes upon every small occa-sion of sorrow, need, sickness, trou-ble, fear, grief , passion or perturba-tion of the mind ... And from these melancholy dispositions, no men liv-ing is free. (p. 125) These remarkable insights of Burton

still ring true 350 years later. Depres-sion is a universal phenomena that is an integral characteristic of human thought and behaviour. It is estimated that be-tween one tenth and one quarter of the adult population of the United States will suffer from depression at least once during their lifetime (Munoz, 1987).

Severe depression is a significant pub-lic health problem throughout the world that has continually challenged the psy-chiatric community. Historically, treat-ment of severe depression has included both organic rernedies such as medi-cation; psychosurgery (e.g., lobotomy); electroconvulsive therapies; and psy-chosocial methods such as creative art therapies, spiritual counselling, psy-chotherapy and behavioural methods.

In general, depression can be char-acterized as a biopsychosocial disor-der that has at multifactorial etiology with severity of symptoms ranging from

October/Octobre 1989

185

CJOT — Vol. 56 — No. 4

mild, moderate to severe. The current edition of the DSM-IIIR (American Psychiatric Association [APA], 1987) includes the following symptoms as being characteristic of a major depres-sive syndrome: 1. depressed mood 2. markedly diminished interest or

pleasures in activities 3. significant weight loss or weight gain 4. disturbance in sleeping 5. motor disturbances 6. fatigue or loss of energy 7. feelings of worthlessness and exces-

sive or inappropriate guilt 8. diminished ability to think, concen-

trate or make decisions 9. recurrent thoughts of death and

suicide. The average age of initial onset is in

the later 20's with symptoms develop-ing over days to weeks. Prodromal or early clinical indicators of a depression include generalized anxiety, panic at-tacks, phobias or mild depressive symp-toms which may occur over a period of several months (APA, 1987, p. 220).

In classifying depressive disorders, theorists have made the distinction be-tween endogenous or psychotic de-pression and reactive or neurotic de-pression. Although this distinction is highly controversial, it has been sub-stantiated by factor analytic research evidence (Leber, Beckham, & Danker-Brown, 1985).

In understanding the etiology of de-pression, it is generally accepted that some people have a vulnerability to depression that could be due to genet-ics, damaging effects of earlier adver-sity, the lack of social supports or an interaction between these factors (Wing & Bebbington, 1985, p. 776).

Stress and Depression It has long been known by researchers

and clinicians that psychosocial stress contributes to many illnesses and disa-bilities including bronchial asthma, hy-pertension, headaches, rheumatoid ar-thritis, dermatitis and ulcerative colitis (Alexander, 1950). The theoretical mod-els and experimental data describing the effects of stress on the body were first described by Walter Cannon (1939) in his classical work, The Wisdotn of the Body. Selye (1956) later elaborated upon Cannon's work and described the general adaptation syndrome directly linking psychological factors with phys-iological responses. Since the initial

research by Cannon and Selye, scien-tists throughout the world have broad-ened the area of stress research, ex-amining neurochemical and physiolog-ical evidence implicating stress as a contributing factor in diverse illnesses, diseases and disabilities.

The latest frontier of stress research is in the area of psychoneuro-immu-nology and the interactions between brain, behaviour and the immune sys-tem (Glaser et al., 1987). The research presented is based on this link between stress, physiological reactions and de-pression (Dupue, 1979).

Billings and Moos (1985) raise the question: "Why do stressful life cir-cumstances lead to depression among some persons but not others?" (p. 941) To answer this question, they propose, "that the depression-related outcomes of stressful life circumstances are in-fluenced by individuals' personal and environmental resources as well as by their appraised and coping responses" (p. 941). In other words, they are pro-posing that individuals' reactions to stress are dependent upon their inner resources and support networks. Some people may on the one hand be stress resistant while others rnay be prone to stress. The ability to handle stress may also vary during one's life tiine. It is implied from this model that we may be able to teach individuals to learn how to cope more effectively with stress by providing (1) specific exercises and techniques that inoculate the individ-ual to stress, (2) treatment programmes to increase social skills and self-esteem and (3) ongoing support groups. Re-search evidence has demonstrated that depressed persons are less socially skilled than non-depressed individu-als (Lewinsohn, Antonuccio, Steinmetz, & Teri, 1984; Libet & Lewinsohn, 1973; Youngren & Lewinsohn, 1980). Clini-cal studies of the effectiveness of assertiveness training and social skills training in lessening depression have also shown positive results (Sanchez & Lewinsohn, 1980; Wells, Hersen, Bel-lack , & Himrnelhoch, 1979). In these studies, social skills training included role playing, modelling of skillful be-haviour by the therapist, feedback, pos-itive social reinforcement and coaching in eye contact, gestures, smiles and voice volume (Becker & Heimberg, 1985). Pearlin and Schooler (1978) found that a sense of environmental mastery, along with high self-esteem

lessen the effects of life stress and can protect one from becoming severely depressed. In addition, I3eck (1963, 1974) theorized that people vvho are filled vvith self-blame are vulnerable to depression. There are also data (Bill-ings & Moos, 1985; Wilcox, 1981) to support the concept that social sup-port is effective in lessening depres-sion among individuals experiencing stressful life events.

The underlying assumption guiding this research study is that if a depressed patient can cope more effectively with stress then the patient will be able to gain control over his illness.

Cognitive -Behavioural Therapies In recognizing the relationship be-

tween stress and psychogenic factors in depression, researchers and clini-cians have developed cognitive-beha-vioural therapies. In general, cognitive-behavioural therapies comprise vari-ous treatment techniques that attempt to change a patient's behaviour through structured learning (Dobson, 1988). For example, the patient is taught to con-trol anxiety, to increase the ability to problem solve, to learn how to relax, and to cope more effectively with stress. A psychoeducational approach with the mentally ill seeks to create a learn-ing environment to foster patient in-dependence (Crist, 1986). Using a psychoeducational approach, Lewin-sohn, Antonuccio, Steinmetz, and Teri (1984) developed a unique method for the treatment of depression, incorpo-rating cognitive-behavioural techniques. This method entitled "The Coping with Depression Course" is offered in 12 two-hour sessions conducted over eight weeks. Follow-up sessions are held one and six months post. The course is conducted using a group format with six to eight participants. Lectures and skill development experiences include relaxation , increasing pleasant activi-ties, changing negative cognitions and improving social skills. Outcome stud-ies of the Coping with Depression Course have been positive (Brown & Lewinsohn, 1984; Steinmetz, Lewin-sohn , & Antonuccio, 1983; Teri & Lewinsohn, 1981; Lewinsohn, 1987).

In the present study, the cognitive-behavioural and psycho-educational theoretical frameworks were integrated into a short-term stress management programme for acutely depressed in-patients. This approach, if proven

186

October/Octobre 1989

l(Female) 32 2(Male) 37 3(F) 31 4(F) 45

5(F) 35 6(F) 30 7(F) 39

High School University High School University

High School High School High School

Medical Secretary Veterinarian Secretary Teacher

Hairdresser Homemaker Nurses' Aid

Single Single Single Separated

Divorced Married Married

Depression (post-partum) Unipolar Depression Unipolar Depression Depression, Obsessive-compulsive Bipolar-Depressed State Unipolar Depression Unipolar Depression

4 6 6

19 23 25

10 3 6 2

35 32 21 38

CJOT — 56 -- No. 4

effective, could serve as a clinical model for occupational therapists working with acutely depressed patients. In testing this approach, the author pro-posed the following research questions: 1. Can acutely depressed in-hospital

patients be taught to reduce their anxiety through a short-term struc-tured stress management programme?

2. Specifically, is biofeedback-mediated relaxation therapy helpful in reduc-ing anxiety in depressed patients?

3. What are the typical symptoms, stressors and coping activities iden-tified by this sample of depressed patients?

Methodology

Measurement Instruments One of the two scales from the State-

Trait Anxiety Inventory (STAI) (Spiel-berger, 1983), was used to measure anxiety. The S-Anxiety Scale (used in the study) is made up of 20 items and assesses how people feel at the time of testing which is defined as a "Transitory emotional condition characterized by subjective feelings of tension and ap-prehension " Anastasi, 1982, p. 530). Test-retest reliability in normal col-lege students for the S-Anxiety Scale ranged from .16 to .54. "What such low correlations indicate is an interac-tion between persons and situational stress" (Anastasi, 1982, p. 530). In other words, the S-Anxiety Scale is a sensi-tive measure to use when examining short term intervention.

The Stress Management Question-naire (SMQ) (Stein, 1987; Stein & Nikolic, 1989) which normally takes 20 minutes to complete, consists of

three parts: symptoms, stressors and coping activities. The patient is re-quested to check yes or no to each of 158 items, and then to rank order the responses from 1 to 10 in each part, assigning the rank of 1 to the most severe symptom or stressor, or to the activity that most relieves stress.

The SMQ was developed (a copy of the SMQ is available from the first author) over a five-year period where more than 600 subjects completed the questionnaire. Individual items were selected originally from an open-ended questionnaire. Three experimental edi-tions were used as the basis of the current form. Concurrent or predic-tive validity have not been measured for the SMQ. Based on the prelimi-nary research in selecting items, the SMQ possesses a high degree of con-tent validity defined as "...essentially the systematic examination of the test content to determine whether it cov-ers a representative sample of the behaviour domain to be measured" (Anastasi, 1982, p. 131).

In a test-retest reliability of 34 college students (mean age of 27), the percen-tage of concurrence of responses (after two weeks) ranged from 85% to 89')/0.

Subjects

The patients for the pilot study came from a general hospital unit located in an urban metropolis in Western Can-ada. The screening criteria for patient inclusion was as follows: (a) primary diagnosis of depression, (b) age 20-45 years old, and of at least average intelligence.

Eight voluntary patients were referred

to the research study after obtaining administrative and ethics approval. Seven patients completed the study and one patient dropped out voluntar-ily. The descriptive characteristics of patients are shown in Table 1.

In general, the patient group can be described as a typical sample of de-pressed adults. They included six fe-males and one male, all received anti-depressive medication, had at least a high school education and were mostly single or separated. The average length of their illnesses was nine years, the average age of onset of depression was 27 years old and the average number of depressed episodes per individual was five.

Intervention The stress management group met

for six consecutive weekly sessions that lasted approximately an hour and a half. Cognitive-behavioural methods were integrated into the group proc-ess. The researcher lead the group and the co-leader recorded the sessions. Each session focused on stress man-agement techniques that could be used in everyday life. An outline of the stress management protocol is summarized in Table 2. The sessions consisted of lectures by the researcher on the na-ture of stress, practice sessions in stress management techniques, biofeedback, and relaxation methods, and a group discussion of how individual patients experience the symptoms of stress, the everyday stressors in their lives and the activities that are useful in controlling stress. A short description of the stress management techniques employed in the study are discussed below.

Table 1

Descriptive Characteristics of Patients

Age of Onset Number of Marital

of Depression Depressed Subject Age Education

Occupation

Status Diagnosis

Symptoms

Episodes

October/Octobre 1989 187

CJOT — Vol. 56 — No. 4

Table 2

Outline of Stress Management Protocol

Session Overall Purposes

Tests Administered

Techniques Introduced

Homework

Establish psycho- — Stress Management — Benson Relaxation Response — Practice relaxation educational environment

Questionnaire — Progressive Relaxation response

to discuss stress — State-Trait Anxiety

(isometric contraction and management techniques

Inventory relaxation)

2 Discuss the relationship — Visual Imagery — Keeps daily stress between stress and the — Back Massage diary onset of symptoms

3 Discuss everyday — Heart Rate and Finger — Practice relaxation stressors in environment

Temperature Biofeedback techniques

4 Discuss individual reactions and activities to manage stress

5

Identify pleasant activities to counteract stress

Summarize and evaluate experience and discuss how stress management can be incorporated into every day activities

— Behavioural Rehearsal of Stressful Situations

— Deep Breathing — Paradoxical Intention

— Stress Management Questionnaire

— State-Trait Anxiety Inventory

— Individual Evaluation

— Identify difference between tension and relaxation

— Practice progressive relaxation by associating negative thoughts with muscle tension and calm thoughts with muscle relaxation

— Follow-up individual compliance

Stress Management Techniques Employed in the Study

The Relaxation Response (Benson, 1979). This technique, based on medi-tation, contains four basic components necessary to elicit the relaxation re-sponse. "The components: a comfort-able position; a quiet environment; repetition of a prayer, word, sound or phrase; and adoption of a passive atti-tude when other thoughts come into consciousness" (p. 140).

Progressive Relaxation (Jacobson, 1938). Essentially this technique, that is widely used in stress management programmes, is based on the premise that relaxation is the opposite of ten-sion or anxiety. The subject is trained to systematically contract and relax groups of muscles, starting from the lower extremities.

Paradoxical Intention (Walker, 1975). This technique is based on the theory that individuals develop fears and tensions because of anticipatory anxiety. In using this technique, the individual is told to think of something he fears most or to create a negative emotion such as anxiety. By creating a negative feeling, the individual begins to cognitively control the symptom.

Visual Imagery (Korn & Johnson, 1983). The investigators in the current study used guided imagery as a tech-nique to help the patient create a pleas-ant experience by imagining a dream house. While the patients were in re-laxed positions, the therapist had the patients create mental images of each room in their dream house. The exer-cise took about ten minutes to com-plete. After the exercise, the patients were encouraged to share their images

of their dream houses with the group. Behavioural Rehearsal (Monti, Cor-

riveau, & Curran, 1982). "In essence behavioural rehearsal offers patients a unique opportunity to practice new skills, to receive constructive criticisms in area.s of potential improvement and to receive social praise for using these skills" (p. 191).

The Stress Management Question-naire and S-Anxiety Scale were admin-istered during the first and sixth ses-sion. A qualitative evaluation forrn filled out by the patients was also admin-istered during the final session. Pa-tients were encouraged to follow-up on the stress management techniques as homework assignments, to practice relaxation techniques and to keep a daily stress diary. (See Table 2.) In session five, paradoxical intention was used in which the patient was asked to

188 October/Octobre 1989

3

4

5

6

7

cognitively create an anxiety state or to feel a depressed emotion. The pa-tient was then asked to cognitively create a pleasant feeling. The exercise was paired with contracting the mus-cles of the face and upper extremities and creating muscle tension and then relaxing or letting go these muscles and creating a relaxed mood. The pa-tient practiced pairing tension with flexed muscles and relaxation with loose muscles.

Portable biofeedback equipment was used in enabling the patients to monitor finger temperature and heart rate. The patients were instructed to use the biofeedback equipment as physiological rneasures of their ability to produce a relaxed state. Biofeed-back was used to increase the patient's cognitive control of psychophysio-logical mechanisms in the autonomic nervous system (Olton & Noonberg, 1980).

CJOT - Vol. 56 - No. 4

Results

Table 3 summarizes the patients' re-sponses on the SMQ. For each pa-tient, the first five ranks are listed in regard to the symptoms of stress, stressors and activities to relieve stress. Since one of the major purposes of

the SMQ is to help the patient to be-come aware of the psychophysiologi-cal nature of stress, the individual re-sponses are of prime importance. For

Table 3

Results from Stress Management Questionnaire

Subject Symptoms

Stressors Activities to Relieve Stress

1 1. Defensive 2. Angry 3. Tense 4. Anxious 5. Sweaty palms

2 1. Neck/low back pain 2. Chest pains 3. Angry 4. Irritable 5. Keeping eye contact

1. Fatigue 2. Concentrating 3. Angry 4. Anxious 5. Tremors

1. Constipation 2. Dryness in mouth 3. Fatigue 4. Frequent urination 5. Headaches

1. Keeping eye contact 2. Tremors 3. Remembering 4. Nervous 5. Tense

1. Muscle tension 2. Anxious 3. Tremors 4. Reacting 5. Sarcasm

1. Concentrating 2. Headaches 3. Muslce Tension 4. Not ranked 5. Not ranked

1. Having no control over situation 2. Criticisrn 3. Arguments 4. Feeling too much pressure at school or work 5. Being evaluated for performance

1. Financial situations 2. Being late for an appointment 3. Having no control over a situation 4. Poor performance on a test 5. Failure to meet goals

1. Lack of self confidence 2. Problems in relationships 3. Pressure at work 4. Being in crowds 5. Trying to please people

1. Financial situations 2. Driving in traffic 3. Excessive noise 4. Being evaluated 5. Lack of confidence

1. Feeling too much pressure at school or at work 2. Finatncial situations 3. Feeling guilty for inadequate bahaviour 4. Meeting deadline 5. Studying for exam

1. Problems in relationships 2. Raising children alone 3. Financial situations 4. Not meeting goals 5. Gaining weight

1. Excessive noise 2. Being unprepared 3. Speaking in front of group 4. Not ranked 5. Not ranked

1. Being by myself 2. Watch TV 3. Avoid situation 4. Eating 5. Listening to music

1. Avoid situation 2. Relax (lie down) 3. Walking 4. Listen to music 5. Exercising

1. Avoid situation 2. Go shopping 3. Listen to music 4. Cleaning house 5. Analyze situations

1. Go to dinner 2. Cleaning house 3. Eating 4. Exercising 5. Being busy

1. Listen to music 2. Dancing 3. Crocheting 4. VVatch TV 5. VValking

1. Eating 2. Cleaning house 3. Take a drive in a car 4. Avoid situation 5 Baking

1. Exercise 2. Needlecraft 3. Not ranked 4. Not ranked 5. Not ranked

October/Octobre 1989 189

52 44 69 57 51 30 58

mean = 51.6

-23 -5 +9 -14 -3

-24 -6

2.122*

Table 5

Patients' Responses Identifying the Most Helpful Stress Management Technique

Stress Management Techniques Number of Responses

(out of 7) Percent

Relaxation Response Visualizing Dream House Telling or listening to funny story Tensing muscles by imagining a brick wall Writing an angry letter and destroying it Relaxing each muscle of the body Role playing a stressful situation Filling out the stress management questionnaire Relaxing by using heart rate monitor Relaxing by increasing finger temperature Daily diary of stress

7 5 5 4 4 3 3 2 2 2

CJOT — Vol. 56 — No. 4

75 2

49 3

60 4

71 5

54 6

54 7

64 mean = 61

example, Subject lfeels that having no control over a situation can cause her to become defensive, angry, tense or anxious. She finds that being by her-self, watching TV, or avoiding the situ-ation will relieve her stress. These re-sults have clinical significance although they do not atternpt to answer the ques-tion: Is the individual coping effectively with stress? The results demonstrate the wide variance in the vvay the de-pressed individual responds to stress. There are no generalized stress symp-toms or stressors that precipitate stress. For the investigators, the significance of the results is in the cognitive proc-ess of analyzing the nature of stress.

The process itself enables the individ-ual to gain insight in order to change behaviour.

Table 4 summarizes the results of the State-Anxiety Scale administered pre- and post experiment. Six of the seven patients had positive results, meaning that their anxiety scores de-creased. (See Table 4.)

As a qualitative measure of improve-ment, the investigator administered an evaluative survey during the post ses-sion. Six of the seven patients felt that the group experience on stress man-agement was helpful and one patient felt it was helpful sometimes.

One subject felt that the group could

100 71 71 57 57 43 43 29 29 29 14

be improved by adding more theory on the nature of stress. The relaxation response and visualizing a dream house were the two experiences that patients felt were the most helpful. (See Table 5.)

Discussion and Conclusion

The major purpose of this pilot study was to determine if a group of de-pressed patients can reduce their anx-iety through a short-term highly struc-tured stress management programme. The results demonstrated that six of the seven patients did reduce their anx-iety and the group as a whole showed significant improvement. Since there was no control group, the results may have been influenced by the Hawthorne Effect in that the improvement may be based on the attention from the inves-tigators. The generalized efficacy of a structured stress management pro-gramme with depressed patients is still problematic. However, the effectiveness of a stress management programme in reducing anxiety with depressed pa-tients in a clinical setting has been demonstrated. This was also positively reinforced by the patients' qualitative responses.

It is no surprise that a cognitive-behavioural approach is effective with depressed patients. During the last 20 years, clinical research on cognitive therapy has demonstrated its effective-ness (Sacco &13eck, 1985). Also previ-ous research has shown that cognitive therapy is as effective as pharmaco-therapy in reducing depression (Mur-phy, Simons, Wetzel, &. Lustman, 1984).

Since cognitive-behavioural therapy appears to be very effective with de-pressed patients, occupational thera-pists should seriously consider incor-porating components into a compre-hensive treatment approach for de-pressed patients. Johnston (1986), a senior occupational therapist at the UCLA Neuropsychiatric Institute in Los Angeles, California, explored the use of cognitive-behavioural techniques with depressed patients in a day treat-ment setting. She concluded that cog-nitive-behavioural techniques are ap-propriate areas in which occupational therapists can develop interest and ex-pertise. Johnston advocated that the role of the occupational therapist is to teach cognitive-behavioural techniques that involve interpersonal, problem solv-ing and self-management skills.

Table 4

Comparison of Pre - Post Test Differences on State Anxiety Scale for Depressed Patients

Subject Pre-test Score Post-test Score Difference

a = S-Anxiety Score for Working Adults = 36 S-Anxiety Score for Depressive Reactive Patients = 54.4 (Spielberger, 1983)

b = A minus sign(or negative difference) indicates a decrease in anxiety *Significant difference between pre- and post-test scores at .05 level, 6df

October/Octobre 1989 190

From this pilot study, we can con-clude that a stress management pro-gramme for acutely depressed in-patients was helpful in reducing anxi-ety. The major implications of this study for occupational therapists working with depressed patients are. 1. Stress management can be taught to

patients in a short-term structured group, incorporating cognitive-behavioural techniques and bio-feedback.

2. Depressed patients respond individ-ually to stressors and display unique symptoms.

3. Depressed patients can be taught to increase their repertoire of coping activities in dealing with stress.

4. Individual stress management pro-grammes can be devised using the individual data from the Stress Man-agement Questionnaire.

For the clinical investigator, further research questions remain, such as: 1. Do patients with exogenous depres-

sion respond better to stress rnan-agement than patients with endoge-nous depression?

2. How can stress management tech-niques be incorporated into the de-pressed patients everyday life?

3. What are the most effective stress management techniques for de-pressed patients, such as relaxation therapy, biofeedback and cognitive behavioural methods?

4. Does learning how to cope more effectively with stress prevent relapse in the individual who is vulnerable to depression?

5. Finally, it is suggested that this pilot study be replicated with a control group and larger sample, thereby increasing the internal validity and generalizability of results to the pop-ulation of depressed patients.

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Resume

Un programme de courte duree de controle du stre.ss a ete mene comme etude pilote aupres de sept clients hosp-italises pour depression aigue. Diffe-rentes techniques de relaxation muscu-laire et de retroaction biologique ont ete utili sees dans un programme en six seances concu pour diminuer l'anxiete et controler le stress de facon efficace. Un ergotherapeute agissait en tant que facilitateur de groupe et professeur des techniques de controle du stress pendant

qu'un deuxieme agissait comme rappor-telt,: Durant les seances d'une duree d'une heure et demie, les patients se sont exerces a des techniques specifi-ques. Ces techniques comportaient la reponse a la relaxation d'apres Benson, l'imagerie visuelle, la relaxation progres-sive de Jacobson, la mesure des batte-ments cardiaques et de la temperature digitale en rapport avec le processus de retroaction biologique et la repetition du comportement. Un questionnaire sur le controle du stress mis au point par le premier des deux auteurs a ete utilise pour aider les clients a mieux reperer les symptomes du stress, les eMments

declencheurs et les activites de tous les jours qui peuvent etre utilisees pour controler le stress. L'echelle du niveau d'anxiete (State Anxiety Scale) a ete utilisee avant et apres l'intervention pour evaluer la diminution de l'anxiete. Les resultats ont demontre, a l'aide du rapport de correlation, une diminution significative de l'anxiete. Les commen-taires de nature qualitative emis par les clients a la fin du programme orzt de-montre l'effet positif des seances sur l'augmentation de leur habilete a relaxer et a apprendre a reconnaitre les reac-tions individuelles de stress de meme que de nouvelles facons de le maitriser.

ALZHEIMER SOCIETY OF CANADA

The Alzheimer Society of Canada is pleased to announce the enhanced research programme targeting $600,000 for the 1989-1990 granting cycle. The Society has substantially increased its financial commitment to research and is offering a new programme with two focuses: biomedical research stream and caregiving research stream. VVithin each granting stream there will be three categories of research awards: Training Awards, both Doctoral and Post-Doctoral; Career Support; and Research Grants. Application forms, detailed specifics of eligibility requirements and selec-tion criteria are available from the address belovv.

The deadline for receipt of applications if November 15, 1989. For further information please contact:

Alzheimer Society of Canada, 1320 Yonge Street, Suite 302, Toronto, Ontario, M4Y 1X2

(426) 925-3552.

SOCIETE ALZHEIMER DU CANADA

C'est avec plaisir que la Societe Alzheimer du Canada annonce la mise en oeuvre d'un programme de recherche de 600 000 $ pour l'exercice 1989-90. La Societe a augmente sensiblement le financement affect& a la recherche et offre dorenavant un nouveau programme a deux volets; la recherche biomedicale et la recherche sur les soins de sante. Trois categories de bourse de recherche seront attribues pour chaque type de recherche: Bourse de formation, bourse de doctorat et bourse post-doctorat; Aide professionelle; et Bourse de recherche.

Les formules de demande et les criteres de selection sont disponsibles de la Societe. La date limite de reception des demandes est le 15 novembre 1989. Pour recevoir de plus amples renseignements, priere de conrimuniquer avec:

Societe Alzheimer du Canada, 1320, rue Yonge, Bureau 302, Toronto (Ontario), M4T 1X2

Tel (416) 925-3552.

W.F.O.T. CONGRESS APRIL 19909

MELBOURNE, AUSTRALIA

• OVERWHELMING RESPONSE TO CALL FOR PAPERS, 460 ABSTRACTS RECEIVED.

• Countries contributing abstracts include: Australia, Botsvvana, Canada, Denmark, England, Finland, Iceland, India, Ireland, Japan, Malaysia, Netherlands, New Zealand, Nigeria, Norway, Portugal, Sweden, Switzerland, Singapore, South Africa, USA and West Germany.

• Registrations have been received already. The first overseas regis-tration being from Hong Kong. Super Saver registration fee deadline 1st January 1990.

• Pre conference workshops filling fast. Book early to get the work-shop of your choice.

• Students world wide requesting information on billeting. Several schools have set about fund raising to ensure representation at the WFOT Congress in Melbourne.

Further Information from WFOT Secretariat:

1st Floor, 387 Malvern Road, South Yarra, VIC 3141. Phone: 03 824 0022. FAX: 03 240 0771.

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