Awareness Integration: A Non-Invasive Recovery Methodology in Reducing College Students’ Anxiety, Depression, and Stress
Foojan ZEINE – Personal Growth Institute, Inc. Irvine, CA California, United States
Nicole JAFARI – Department of Human Development California State University, Long Beach United States
Mohammad FOROUZESH – College of Health and Human Services, California State University, Long Beach United States
ABSTRACT
The purpose of this study is to further understand and mitigate stress and anxiety among college students in addition to finding new evidence based approach to address the source of these stressors. College students, predominantly freshmen are subject to stress and stressors (D’Zurilla & Sheedy, 1991), which is due to the transitional college life (Towbes & Cohen, 1996). Students feel the pressure of acquiring a job, establishing a career, and finding a potential life partner. The interaction between all these stressors results in anxiety and tension (Romano, 1992). Awareness Integration (AI) Model (Zeine, 2014) is an effective psychological methodology that utilizes non-invasive and effective techniques to help individuals suffering from multiple stressors overcome anxiety and depression. To test the AI Model, a study was set up at California State University using convenient sampling of subjects recruited on a voluntary basis to participate over the course of 16 weeks during 2015 Fall Semester. A majority of those involved were working on their undergraduate degree and the rest were in a graduate program. More than half of the participants were females between the age ranges of 18 – 24 living on the west coast. Lastly, ethnicity had a strong turnout amongst Caucasian (n =25), Hispanic (n = 51), and Asians (n = 22); nearly half of the subjects appeared to live below the poverty line making less than $25,000 annually. The researchers’ hypothesis is that students’ mindfulness of sources of stress, and utilization of emotional releasing techniques will reduce anxiety and depression, increase their coping mechanism, improve their academic performance, and the quality of their relationships both in and the outside of the campus life. The final results showed significant reduction in the areas of anxiety, depression, and stress among the participants, who completed the modules within the period of the semester.
INTRODUCTION
Emerging adults of 18-25 years, such as college students go through developmental stages unique to their abilities, new found autonomy, and social expectations. This period of development differs from adolescence and young adulthood as it tackles cultural identity as well as experiencing independence and role exploration (Arnett, 2000). College life is one of transition and great deal of change, which leads to students, particularly freshmen to experience stress and negative pressures from external factors (D’Zurilla & Sheedy, 1991). Among the scholars, the interest in how people cope with stress has grown dramatically over the past decade (Moos & Moss, 1986). The starting point for much of this research is the conceptual analysis of stress and coping offered by Lazarus in 1966, who argued that stress consists of three processes. Primary appraisal is the process of perceiving a threat to oneself. Secondary appraisal is the process of bringing to mind a potential response to the threat. Coping is the process of executing that response. Although the interest in such analysis has gained popularity, there is still a need for an efficient psychometric measurement. Other studies have shown that individual’s negative self-efficacy beliefs could impact choice and task engagement leading to stress and consequently creating anxiety and depression. These beliefs could also limit the degree of determination in task accomplishment (Schunk, 1981; Schunk & Hanson, 1985; Schunk, Hanson, & Cox, 1987). Efficacy beliefs also influence the amount of stress and anxiety individuals experience as they engage in an activity (Pajares & Miller, 1994). As a consequence, selfefficacy beliefs exercise a powerful influence on the level of accomplishment that individuals experience due to the transitional college life. Feeling competent and able to choose the right tasks and successfully completing them is correlated to self efficacy (Towbes & Cohen, 1996). Awareness Integration (AI) is a new model in the field of psychotherapy, which synthesizes numerous concepts from cognitive, behavioral, emotional, and body-mind theories. AI Model aims to enhance self- awareness, increase self-esteem, release past traumas and psychological blocks, reduce symptoms of anxiety and depression, and promote a clear, realistic, and positive attitude in order to learn and implement new skills for an effective, productive, and functional life. The Awareness Integration Model also uses multiple psychological models to integrates them into an effective method of therapy for all sorts of behaviors, such as addiction, depression, and substance This model allows for release and then integration through flexibly structured questions and expansive interventions that connect core beliefs, emotions, locations in the body where emotions are stored and relevant/original memories. Due to previous studies confirming college students’ level of anxiety and stress, and to test the viability of AI on college students, a research study was conducted at California State University, Long Beach (CSULB). This study was made possible by a CSULB research grant to develop evidence based data on the applicability and effectiveness of TOJET: The Turkish Online Journal of Educational Technology – November 2017, Special Issue for the AI Model on college students and correlation to reducing depression and anxiety. An Institutional Review Board application was also generated and approved by CSULB IRB committee to safeguard the participants’ well being and rights throughout the procedure. The AI study offered a multi-factorial research exploration; (1) Understand anxiety, depression and stress among college students, (2) Test a new evidence based approach to address the source of these stressors, and (3) To examine a multi-modality, non-invasive self helps psychological model on enhancing self- awareness, releasing past traumas and/or psychological blocks, promoting clarity and positive attitude to learn, and implementing new skills for an effective, productive, and successful Life.
THE MECHANISM OF AWARENESS INTEGRATION PROCESS
Awareness Integration Model is a Multi-Modality Psychological Model that enhances Self-Awareness, releases past traumas and/or psychological blocks, promotes clarity and positive attitude to learn, implements new skills for an effective, productive, and successful Life. This model synthesizes components of already established psychological theories and approaches such as Cognitive Behavioral therapy, Emotion Focused Therapy, Existential Psychotherapy, Person-centered approaches, Attachment theories, Eye Movement Desensitization and Reprocessing (EMDR), Hypnosis, and Mind-Body theories.
The Awareness Integration model operates based on 9 principles that have been researched for many years through different theories.
1) Reality of the observer is subjective based on the state of being beliefs, meanings, emotions, and behaviors.
2) The potential to learn skills to have a functional and successful life is available for a human being.
3) Skills are learned through physical and psychological development in combination with the mirroring of parents and environment.
4) Perception of the information and experience allows meaning to be assigned, and categorization and generalization of the assigned meanings about the self and the world allows a personal identify to be realized.
5) Experiences are stored in memory cognitively, emotionally and somatically. A traumatic experience is compartmentalizing and waits integration to be healed and reintegrated.
6) When the unintegrated belief-emotion-body state is healed and released and integrated, neutral and positive attitude are surfaced.
7) Through the completion of this process, the creation of an intended and conscious choice regarding values, thoughts, feelings, actions and results.
8) Skills can be learned and sustained in a neutral environment toward a desired and intentional result.
9) Conscious and clear vision of a desired result with tangible goal setting, effective planning and efficient action raises TOJET: The Turkish Online Journal of Educational Technology – November 2017, Special Issue for IETC 2017
The goal of this model is to foster awareness and to integrate all split parts of the self from the past into the present, create a vision for the future, create solid goals and action plans with an external feedback loop to ensure a sustainable successful and fulfilled life. The primary method of AI involves identifying one’s negative and/or irrational core beliefs, the formulas one has created to operate within one’s life, and the identities they have created, sustained and operated. AI will allow for the release of emotional and somatic charges that remain from unintegrated experiences and memories and the dismantling of negative core beliefs. This process assures the integration of the self which will allow skill building and creation of a chosen and intended future to be attainable without the past sabotaging the future. In this research students were directed through the use of a structured set of questions for awareness, and mind-body technique for integration, laid out through six phases. Each phase has its own set of questions and an intent specific to that phase. Clients will be directed through all six phases and explore their relation with different areas of their lives including their school, careers, finances, relationships, families, childhood, themselves, death, God and spirituality, and other significant areas especially related to the student.
Phase I – Phase One is designed to induce awareness of the student’s perceptions, emotion, and behaviors in relation to their external environment and how those constructs impact their lives. Every one’s identity gets created within relationships. As a child one is born into a marriage, a family, and a culture which immediately feeds the child what is right or wrong.
A human being forms the questions in this phase include:
What do you think of (people or concepts in an area of life)? How do you feel about (people or concepts in an area of life)? How do you behave towards (people or concepts in an area of life)? How does the way you think, feel, and behave towards (people or concepts in an area of life) affect your and other’s life?
Phase II – This phase encompasses three functions:
A) To create awareness of the student’s projections of others’ opinions and feelings about them
B) To enhance the student’s ability to observe others’ behavior towards them and to observe the meanings the student attributes to that behavior
C) To identify ways in which these constructs impact the student’s life.
Questions in this phase include: How do you assume people think about you? How do you assume people feel about you? How do you assume or observe people behave toward you? How do your assumptions affect your and other’s life?
Phase III – Phase Three aims to foster awareness of student’s beliefs, emotions, and behavior about the self in relation to each area of life and considering the identity that interacts towards and responds to various areas of life.
Questions in this phase include: As you see yourself among people, looking at them while they’re looking at you, what do you think about yourself? How do you feel about yourself? How do you behave towards yourself?
Phase IV – In Phase Four, the student is guided when necessary, in simultaneously experiencing the connection between thoughts, formulas, and schemas with emotions and the body areas that maintain and reflect intense emotions. This process becomes necessary when the student finds a negative core belief about the self or the world which holds a heavy emotional charge. In this phase the core belief is linked to the emotion which is stored in the body and the associated memory that initiated the belief and then allow the release of negative core beliefs, hidden intentions, shadows, and emotions locked in the body. This process also allows one to gain awareness of the ability to be with, tolerate, and manage emotions effectively.
Questions in this phase include: When you say [negative core belief] how do you feel about yourself? How do you feel when you say this to yourself? Where is the feeling in your body? What is the intensity on a scale from 1 to 10? Then the student is guided to focus on their body in the location that the emotion is residing, and then to allow the emotion to take the student to the first time he/she experienced this kind of emotion and decided the negative belief system. The student then allows an integration between the adult side of the self which is present now and the past/ young part of the self which is still compartmentalized.
Phase V – In Phase Five, the student explores the client’s chosen values. A commitment to think, feel, and behave via the intention to actualize a chosen value system brings forth a chosen attitude and a chosen identity to live by. From this new commitment, short and long term goals are identified and scheduled, and tangible action plans are set toward a desired outcome. In this phase, the therapist will identify which skills the client has already acquired and which skills need improvement.
Phase VI – In Phase Six the student creates a collage of the goals and values as a feedback loop to remind and put in place the context of the values and mission statement that the student has chosen until then goals have been created. Audio feedback loop and or choosing a symbol to use is also helpful if the student does not like to use a collage. The process of AI is to foster self-awareness from past to present and to integrate the various parts of the ‘Self’ that have been shattered and separated as a result of psychological trauma. AI offers step by step guidance on how to recognize the broken pieces of one’s self, but also to find a way to reunite and reattach all the parts, so that it can once again function effectively and productively. Through this intricate process, the participant recognizes and identifies all the unconstructive thoughts and destructive mental strategies that reside at the core value system of the individual, all the while, help find a way to replace the undesirable thoughts with a positive and more productive principles (Zeine, 2014).
PURPOSE OF THE STUDY
The study is based on a descriptive, micro-genetic model to measure the applicability and effectivity of AI Model on college students aiming to reduce the level of anxiety, stress, and depression. The AI model had been previously studied on two separate occasions with positive results: (a) individuals suffering from depression, and (b) subjects who had gone through divorce or had recently been separated. The first study on individuals was successfully concluded and published in 2014 in the “International Journal of Emergency Mental Health and Human Resilience” indicated a 27.5% decrease in depression, 37% decrease in anxiety, 15% increased self-esteem, and 13% increase in self-efficacy after taking part in AI therapy workshop. A second study on the AI Module published in 2017, in the Mental Health in Family Medicine (2017) yielded 76% decrease in depression, a 60% decrease in anxiety, a 43% increase in self-esteem, and 20% increase in selfefficacy, would be a worthwhile tool to utilize for this population, which as mentioned above, depression, anxiety, and low self-esteem have been a by-product of their divorce. Previous studies having shown successful outcome for AI Model in reducing depression and anxiety, prompted the researchers to test this technique on college students, who suffer from stress due to continually being exposed to deadlines and hectic study schedule leading to depression and anxiety.
METHODOLOGY
This is a descriptive study and the subjects were recruited from the Health Science and the Human Development Departments. As planned, participants were asked to volunteer and sign a consent form if participating. The study also involved recruitment, two hours of training, personal online support, a pretest and posttest survey. Recruitment was the first phase of this project including collection of consent forms. Prior to the study, the university IRB application was submitted for approval. A training session was given, where students were asked to complete a set of psychometric standardized questionnaire on anxiety, stress, and self-efficacy.
The process was followed by each individual filling out a demographics survey and the pretest. The pretest was based on a modification of three different psychometric inventory assessment measuring levels of anxiety, depression, and stress. The Rosenberg self-esteem scale (RSES; Rosenberg, 1965; Blascovich & Tomaka, 1993), The Beck Depression Inventory BDI-II (Beck, Ward, Mendelson, Mock & Erbaugh, 1961) and The Beck Anxiety Inventory (Beck, 1988; Beck & Steer, 1993) were used to create the pretest and post-test for this study.
Sample Population and Demographic Subjects were recruited at California State University of Long Beach, from two Health Science and two Human Development upper division classes. The study, a micro-genetic research methodology technique, of a short term data collection duration, took over the course of 16 weeks during 2015 Fall Semester. A majority of those involved were working on their undergraduate degree (n = 117) and the rest were in a graduate program (n =4). The average age ranged between 18 – 24 years (82.2%) with a large sum living on the west coast (92.2%). Lastly, ethnicity had a strong turnout amongst Hispanics with 51 participants (39.5%), 25 Caucasian (19.4%), and 22 Asians (17.1%); nearly half of the subjects appeared to live below the poverty line making less than $25,000 annually (M = 2.39, SD = 2.025).
DATA ANALYSIS
The pretest and posttest were based on The Rosenberg self-esteem scale (RSES; Rosenberg, 1965; Blascovich & Tomaka, 1993), The Beck Depression Inventory BDI-II (Beck, Ward, Mendelson, Mock & Erbaugh, 1961) and The Beck Anxiety Inventory (Beck, 1988; Beck & Steer, 1993) assessing specific and measurable criteria in the following categories: * Questions 1-4 to measure Depression * Questions 5-7 to measure Anxiety * Questions 8-10 to measure Self-esteem
Once the data were collected, using SPSS software, the research assistants computed the overall results based on participants’ response given to each of the fifteen AI Modules selected for this study. The outcome of SPSS analysis yielded in both empirical and descriptive results, which were used in further analysis. Using an excel worksheet, the empirical data was then used to compute the decrease in depression and anxiety. Using the statistical standard mean formula; (X1+X2+X3+….+ Xn/n) X100 to reflect overall percentages. Accordingly, the standard deviation for each question in each category was calculated to show proof of concept and to ensure a strong confidence level. Based on these calculations, the results showed that there was 68% Overall decrease in Depression and 21.72% Overall decrease in Anxiety as a result of AI psychological model.
EXTRANEOUS VARIABLES
In the course of this research study, the variables of AI Psychological Model and impact on students’ degree of depression and stress were measured. However, it is noteworthy to mention other outlier variables may be instrumental in the degree of AI efficiency. It may be possible that each student’s temperament, personality, characteristics, and response to adversity should be taken into consideration in the next research study. Also, as the descriptive results showed, gender was shown to be different in response to distress; therefore, the degree of AI success may be dependent on gender orientation. Another element to consider is the timing of pretest and posttest as the time of taking the psychometric may result in different outcome. Other multifactorial elements to be considered as extraneous variables are: Demographic Ethnicity Socio-Economic Status Academic performance It is imperative that extraneous variables to be analyzed and studied to rule out other factors influencing the results.
UNANTICIPATED RESULTS
Participants were mostly from Liberal Arts college, who are predominately females. Based on Ptacek, Smith, and Dodge (1994) study, there is gender differences in coping mechanism of stress even if the stressors and or appraisals of the stress factors are the same. In the AI study, females significantly chose being less able to relax when compared to males. Also, females were significantly more likely to feel that they were having difficulty breathing when compared to males. Males were also significantly more likely to feel capable of doing things when compared to females and felt more capable of handling unforeseen issues when compared to females.
LITERATURE REVIEW
Due to the transitional college life (Towbes & Cohen, 1996) students particularly freshmen are subject to stress and stressors (D’Zurilla & Sheedy, 1991), Students feel the pressure of acquiring a job, establishing a career, and finding a potential life partner. The interaction between all these stressors results in anxiety and tension (Romano, 1992). Previous research has yielded over 600 articles discussing the importance of addressing the stress of education in medical field, only 24 studies reported intervention programs, and only six of those used rigorous scientific method. Results revealed that medical trainees participating in stress- management programs demonstrated improved immunologic functioning, decreases in depression and anxiety, increased spirituality and empathy, enhanced knowledge of alternative therapies for future referrals, improved knowledge of the effects of stress, greater use of positive coping skills, and the ability to resolve role conflicts. Despite these promising results, the studies had many limitations.
DISCUSSION
Depression affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year. Over 80% of the people that have symptoms of clinical depression are not receiving any specific treatment for their depression. The number of patients diagnosed with depression has increased by approximately 20% per year. In the last 12 months, about one-third of U.S. college students have shown difficulty functioning due to depression, and almost half said they felt overwhelming anxiety in the last year, according to the 2013 National College Health Assessment, which examined data from 125,000 students from more than 150 colleges and universities. The anticipated outcome is to better understand and to alleviate stress and anxiety among college students. This is a very important issue among college students across US campuses. More than 30 percent of students who seek services for mental health issues report that they have seriously considered attempting suicide at some point in their lives, up from about 24 percent in 2010, says Pennsylvania State University psychologist Ben Locke, PhD, who directs the Center for Collegiate Mental Health (CCMH), an organization that gathers college mental health data from more than 263 college and university counseling or mental health centers. The anticipated outcome and goals of this research proposal is to investigate an effective and accelerated method of treating depression, stress related and emotional problems.
A study by Misra, McKean, West & Russo (2000) examined the perceptions of academic stress among male and female college students, and compared the perception of 249 students and 67 faculty members from a mid-western University. Results indicated the existence of stress among college students; however, it also showed a skewed perception of the level of stress among students and the undermining perception by faculty of their stressors.
In another study investigating the sources and levels of stress in relations control and selfesteem in university students showed that 77.6% and 10.4% of the students fall into the moderate and serious stress categories, respectively, and that there were significant differences between females and males’ students in both academic and life stress, with female students more stressed than males. This result also encompassed the correlation between control and academic stress meaning students with high self esteem are less stressed than are those with low (Abouserie, 1994).
A separate study consisting of 157 females and 86 males indicated that life satisfaction is positively correlated to less stress both male and female college students with high life satisfaction had more demanding life styles than individuals with low life satisfaction, but they did not suffer greater personal stress. The significant role of fulfilling inter-personal relationships in overall life satisfaction was also evident (Bailey& Miller 1998). Struthers, Perry, & Menec, 2000) Burleson and Goldsmith’s (1998) study of 258 participants 258 suggested that verbalizations of positive emotion words in conjunction with reappraisals partially mediated the influence of person-centered comfort on emotional improvement Burleson, B. R., & Goldsmith, D. J. (1998). Furthermore, realizing that a coping mechanism is available when needed will cause the individual to reappraise a threat as less threatening.
Other studies such as structural equation analysis by ( relationship between college students’ academic stress and course grade was influenced by problemshowed that the focused coping and motivation but not emotion-focused coping. Factor analyses of data obtained from 965 graduate and undergraduate students yielded a well- differentiated 11-factor solution of internally consistent and stable scores. The 57- item instrument distinguished between students with high and low stress and was unrelated to students’ perceptions of their physical health (Blankstein, Flett, & Koledin, 1991).
As another example, if a coping response is less effective than expected, you may reappraise the level of threat or reappraise what coping response is appropriate (Carver, Scheier, & Weintraub, 1989). In similar fashion, contemporary motivation theories focus on the cognitive and affective processes that instigate, direct, and sustain human action. Researchers investigate the operation of such processes as goals, expectations, attributions, values, and emotions (Pintrich & Schunk, 1996). Educational research has yielded inconsistent results on the relation of self-efficacy to persistence. A positive relation may be found in the early stages of learning when greater persistence leads to better performance. As skills develop students should require less time to complete a task, which means that self- efficacy will relate negatively to persistence. With development, children are better able to determine how much persistence may be necessary to succeed. Thus, self-efficacy may predict persistence better at the higher grades. This issue needs to be explored during academic learning. (Schunk, 1995) Studies have shown that positive attitude is correlated with effective strategies and problem solving and reinterpretation of problems. At the same time, the avoidance technique has been correlated to feelings of hopelessness and negative self worth. Furthermore, maintaining a positive attitude has been correlated with psychological well being. An overall feeling of well being is instrumental in strategizing a problem solving technique that in achieving healthy psychological state in all dimensions (Lazarus & Folkman,1984).
All research points at the high level of stress among college students and the shortage of quality programs and or psychological models to address these stressors. It has been shown that stress could negatively impact academic performance and quality of life. Therefore, it is imperative that students are given the tools needed to have a positive college experience and gain access to good quality programs to help ease their stressors and teach them self defense mechanism combating stress.
STUDY LIMITATIONS AND RECOMMENDATONS
STUDY LIMITATIONS AND RECOMMENDATONS
AI psychological model was tested on students in the College of Liberal arts, which is predominately female yielding an imbalance in participants’ gender and consequently impacting the results. Therefore, AI Model should be tested on college students in other colleges such as science and computer or film. In addition, the following considerations should be incorporated into future research: Rigorous study design, including randomization and control (comparison) groups, measurement of moderator variables to determine which intervention works best for whom, Specificity of outcome measures, and Follow-up assessment, including effectiveness of future patient care.
UNANTICIPATED RESULT
Study reveled significant differences on how male and females responded to self appraisal questions. Participants in the AI study were mostly from Liberal Arts college, who are predominately females, whom significantly chose moderately less able to relax when compared to males’ participants’ response on the same relation. Also, females were significantly more likely to feel that they were having difficulty breathing when compared to males. Males were significantly more likely to feel capable of doing things when compared to females, who felt more capable of handling unforeseen issues when compared to females. These differences raise questions such as what are the gender differences in coping mechanism in stressful situation? How does each gender perceive self esteem, self worth, and self perception?
CONCLUSION
The AI experimentation teaches self analysis techniques and self help method for an individual to realize, recognize, address, and take on stressors in life. It also teaches participants how to develop emotional and cognitive mindfulness to better help label and combat such stressors. The overall results in this study show that students develop mindfulness of sources of stress, and learn utilization of emotional releasing techniques to reduce anxiety and depression. The AI treatment also increased their coping mechanism, improved their academic performance, and the quality of their relationships both in and the outside of the campus life. The final results showed significant reduction in the areas of anxiety, depression, and stress among the participants, who completed the modules within the period of the semester. As discussed, studies predominately show the correlation between positive attitude, effective strategies, and problem solving. An overall feeling of well being is instrumental in strategizing a problem solving technique that in achieving healthy psychological state in all dimensions. Self efficacy
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