FELDENKRAIS AND ANXIET Y

The eects of a Feldenkrais Awareness Through Movement program on state anxiety

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Gregory S. Kolt, Janet C. McConville

Abstract The eects of a Feldenkrais1 Awareness Through Movement program and relaxation procedures were assessed on a volunteer sample of 54 undergraduate physiotherapy students over a 2-week period. Participants were randomly allocated into a Feldenkrais Method1 group, a relaxation group, or a no-treatment (control) group, and state anxiety was measured using the ComposedAnxious scale of the Prole of Mood States-Bipolar Form (Lorr & McNair 1982) on four occasions: prior to the rst intervention, prior to the fourth intervention, on completion of the fourth intervention, and one day after the fourth intervention. Analysis of variance showed that anxiety scores for all groups varied signicantly over time and, specically, that participants reported lower scores at the completion of the fourth intervention. Further, compared to the control group, females in the Feldenkrais1 and relaxation groups reported signicantly lower anxiety scores on completion of the fourth session (compared to immediately prior to the fourth session), and this reduction was maintained one day later. These ndings can be interpreted as preliminary evidence of the ecacy of the Feldenkrais Method1 and relaxation procedures in reducing anxiety. # 2000 Harcourt Publishers Ltd

Gregory S. Kolt PhD, BSc, BAppSc(Phty), GradDipEd, GradDipBehavHlthCare Professor and Associate Dean (Research), Faculty of Health Studies, Auckland University of Technology Janet C. McConville BAppSc(Phty), GradDipPhysio(Sports), MSc Feldenkrais Practitioner, Associate Lecturer, School of Physiotherapy, La Trobe University Correspondence to: Gregory Kolt Faculty of Health Studies, Auckland University of Technology, Private Bag 92006, Auckland 1020, New Zealand. Tel: +64 9 3079999 ext 7774; Fax: +64 9 3079877; E-mail: gregory.kolt@aut.ac.nz Received December 1999 Revised February 2000 Accepted February 2000
........................................... Journal of Bodywork and Movement Therapies (2000) 4(3), 216^220 # 2000 Harcourt Publishers Ltd

Introduction
The Feldenkrais Method1 is an increasingly popular treatment modality used by health professionals for a range of dysfunctions (Hopper et al. 1999; James et al. 1998; Wildman 1990). The aim of the Feldenkrais Method1 is to improve function by teaching individuals to move with ease and eciency. It has been suggested that the Method works by improving a persons awareness of
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his or her body and attending to one's kinaesthetic sense of movement (Apel 1992). By increasing the awareness and discrimination of sensory input, an individual could achieve improved dierentiation of body parts, thereby replacing habitual movement patterns with new movement options (Rywerant 1983). Further, Feldenkrais (1977) put forward the premise that improved neuromuscular function could have a positive inuence not only on the

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Feldenkrais and anxiety way one moves, but also how one thinks and feels. Despite the rise in popularity of the Feldenkrais Method1, a relatively limited body of empirical evidence for the Method's eciency has been published (e.g. Bearman & Shafarman 1999; Brown & Kegerreis 1991; Chinn et al. 1994; Gutman et al. 1977; Hopper et al. 1999; James et al. 1998; Kirkby 1994a; Ruth & Kegerreis 1992; Stephens et al. 1999). The majority of available research is in form of anecdotal evidence and case study reports (e.g. Lake 1985; Martin 1994; Strauch 1988). Several reports have indicated that physiological, psychological and kinesthetic changes can be achieved using the Feldenkrais Method1. Some of the reported physical eects include increased muscle length and exibility, improved posture and muscular relaxation (Hopper et al.1999; James et al. 1998). The empirical studies that have been carried out to assess the ecacy of the Method on physical attributes and functions have produced conicting ndings, which have often been complicated by problematic methodology (e.g. lack of control groups) and the diculties in investigating the Feldenkrais Method1 where dependent variables are aected by multiple psychological, physical, and autonomic inuences (Bate 1994). A smaller body of literature has addressed possible psychological and behavioural eects of the Feldenkrais Method1. It has been suggested that the Feldenkrais Method1 can reduce perceived exertion levels during movement (Brown & Kegerreis 1991; Chinn et al. 1994; Ruth & Kegerreis 1992), induce relaxation (Wanning 1993), elevate mood, enhance ability to learn, increase clarity of thought (Lake 1983) and reduce anxiety (Soloway 1996). Although it has been suggested that the improved neuromuscular function associated with the Feldenkrais Method1 could inuence how an individual thinks and feels (Feldenkrais 1977), no published empirical investigations have been found that have directly assessed anxiety in relation to the Method. For these reasons, the present work was carried out within an exploratory framework. The aim of this study was to investigate the eects of a Feldenkrais1 Awareness Through Movement program on state anxiety. For the purpose of this study, state anxiety was dened as an unpleasant emotional state which may exist at any given moment in time and at any particular level of intensity, the experience of which encompasses various psychological (e.g. nervousness, distress, worry) and somatic (e.g. autonomic nervous system phenomena) symptoms (Spielberger et al. 1983). Test instruments The test package administered at the start of the study consisted of a questionnaire to collect personal data (e.g. age, gender, previous experience with the Feldenkrais Method1 and relaxation training) and the Bipolar Form of the Prole of Mood States (POMS-BI, Lorr & McNair 1982). State anxiety was assessed using the `ComposedAnxious' scale of the POMS-BI. This scale consists of 12 adjectives or phrases (e.g. `untroubled', `tense'. `relaxed') which participants respond to with one of four response options (`much unlike this', `slightly unlike this', `slightly like this', `much like this') that described how they were feeling `right now'. The psychometric properties of the POMS-BI have been reported as acceptable (Lorr & McNair 1982). Procedure Participants, after completing the POMS-BI questionnaire, were randomly allocated to one of three treatment procedures: Feldenkrais1 training (n=17), relaxation training (n=20), and no training (control) (n=17). Subjects in the Feldenkrais Method1 group participated in four 45 min Awareness Through Movement (ATM) lessons via training audiocassettes (a commonly used method of ATM administration, Kolt et al. 1998) over a 2-week period: the sessions were held two times per week on separate days. The lessons used were `Activating the exors' (Wildman 1983a), `Activating the extensors' (Wildman 1983b), `Rolling onto the side' (Wildman 1983c) and `Lengthening the hamstrings and spine' (Wildman 1983d). Audiocassettes of the Wildman ATM lessons are available from Feldenkrais1 Resources, Box 2067, Berkeley, California, 94702, USA. Subjects in the relaxation group participated in four 45 min

Method
Participants The participants were 54 (19 male and 35 female) undergraduate physiotherapy students ranging in age from 17 to 38 years (mean age=22.0, SD=3.9). The male participants (mean age=21.8, SD=3.0) were not signicantly dierent in age from the female participants (mean age=22.2, SD=4.4). None of the participants had practical experience with the Feldenkrais Method1 prior to the commencement of this study. The participants were volunteers and no payment or other incentive was oered. All participants signed an informed consent form and the project was approved by the La Trobe University Faculty of Health Sciences Ethics Committee.
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Kolt and McConville relaxation sessions (also administrated by audiocassette, Kirkby 1994b). The program involved three aspects of relaxation: Benson's relaxation technique (Benson 1975), Jacobson's progressive relaxation (Jacobson 1964), and guided imagery (Zahourek 1988). See Box 1 for an example of the dialogue of the relaxation exercise. The relaxation sessions were held at the same time as the Feldenkrais1 sessions, but in a separate room. The participants in the control group were not required to perform any specic tasks over the 2-week intervention period. The POMS-BI was administered to all participants on four occasions: prior to lesson 1, prior to lesson 4, on completion of lesson 4 and one day after lesson 4. This study was part of a larger project on the eect of the Feldenkrais Method1 on cognitive mood states and hamstring muscle length (James et al. 1998). When males and females were analysed separately, the females showed a signicant interaction eect between treatment group and time of measurement, F (6, 96)=3.01, P=0.009. Post-hoc analyses showed that, compared to the control group, females in the Feldenkrais1 and relaxation groups reported signicantly lower anxiety scores on completion of the fourth lesson (compared to immediately prior to the fourth session), and this reduction was maintained one day later.

Results
A 364 factorial ANOVA with repeated measures on one factor (time) showed that the between groups main eect for treatment technique and the interaction between treatment group and time of measurement were not signicant for the POMS-BI ComposedAnxious scores. However, ComposedAnxious scores of the POMS-BI did vary signicantly over time F (3, 153)=14.62, p=0.001, with posthoc tests showing that all participants reported lower ComposedAnxious scores (i.e. participants in all groups were less anxious and more composed) at the completion of session four.

Discussion
The current study showed that, compared to female participants in the control group, female participants in the Feldenkrais group and relaxation group reported a reduction in anxiety levels over a single Feldenkrais1 ATM lesson.

Box 1 Example of relaxation exercises. (Adapted from Kirkby1994b) Jabobson's Progressive Relaxation Make yourself comfortable and, if you can, lie on the oor in a comfortable position. If not, sit in a chair. We will start now. I want you to be relaxed. We will commence with your hands. Try to leave the rest of your body relaxed. When I say the word `now' I want you to tense your hands. Make them very very tight. Tense your hands now. Tense them, tense, then, increase the tension, tighter, tighter, relax. Let the tensions ow out. Let the relaxation ow into those muscles. Focus your attention on the relaxation. Focus your attention on how those muscles feel. Now I want you to tense your arms up to your shoulders. Try to leave your hands and the rest of your body relaxed. When I say the word `now' I want you to tense your arms. Tense them now F F F [the exercise continues progressively to involve other regions of the body] Benson's Relaxation Sit quietly or lie quietly and think about your breathing. I want you to empty your head and concentrate only on your breathing. Put one hand upon your chest. You can feel your breathing. Without making yourself uncomfortable see if you can make your breathing a little shallower. See if you can breathe a little less deeply. Don't do this to where it's uncomfortable. Remain at a comfortable level of breathing. See if you can breathe a little slower, but not to where it is uncomfortable. Continue to breathe at a comfortable level. Now put your hands by your side again. Focus on your breathing. As you breathe out I want you to say to yourself silently the word ``relax''. As you breathe out say silently to yourself ``relax''. As you breathe out say to yourself ``relax'' F F F Sometimes it's very hard to concentrate on your breathing. Other thoughts intrude. To help you let these thoughts go I want you to focus on an image. An image that can move in time with your breathing. For example, some curtains that are blowing in and out of a window. As you breathe in the curtains blow in, and as you breathe out the curtains blow out F F F Focus on the image in time with your breathing. Focus your attention on the image, and as you breathe out say to yourself `relax' F F F [The exercise continues in this vein] Guided Imagery I want you to think of yourself standing in a eld. It's a very sunny day. The sun is shining down on you as you stand in the green grass, and a soft wind, a soft breeze, ows over you. It's very warm. You can feel the sun shining on you. The sun is shining through your clothes and you can feel it on your body. Close your eyes and turn your face towards the sun F F F On the other side of the river are trees, and the soft breeze ows through them. You can see the leaves moving, the branches softly swaying. As the leaves turn, their colour changes. There are some rocks in the river and the water swirls past them F F F You are feeling happy, you are feeling calm. I want you to focus on your breathing and as you breathe out say `relax' F F F After three more breaths open your eyes and lie quietly.

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Feldenkrais and anxiety Further, this dierence was maintained one day later. The ndings of the current study do not support those of Kirkby (1994a) who found (as part of a larger study) no signicant dierences in anxiety between the Feldenkrais1 and no training (control) interventions in females reporting severe premenstrual symptoms. The dierences in ndings could be due to the sample characteristics (the current study focused on a group of `normal' subjects, while Kirkby investigated women who had reported severe premenstrual symptoms) or the dierent instruments used to measure anxiety in the two studies. That the current study showed Feldenkrais1 and relaxation procedures to be equally eective (for female participants) in reducing anxiety, could be explained by the technique's providing temporary distraction from unpleasant cognitions and emotions (Morgan 1985). Despite the obvious lack of empirical research into the eects of the Feldenkrais Method1 to support this possible explanation, the distraction hypothesis has previously been used to explain reduced anxiety levels following participation in exercise (Bahrke & Morgan 1978; DeVaney et al. 1994; Fillingam & Blumenthal 1993). For example, Bahrke and Morgan suggested that reductions in anxiety associated with exercise were not due to exercise per se but rather due to the diversional aspects of the activity through serving as a distraction from the stressors of daily life. In the present study, however, that the anxiety reduction was maintained one day later, suggests that distraction alone does not fully account for the prolonged anxiety changes. The present ndings must be viewed in light of some possible limitations, These include dierences in the number of males and females in the sample that could possibly impact on the gender dierences in ndings, and that participants in the Feldenkrais and relaxation groups could have `expected' their interventions to result in anxiety changes, and hence, responded to the POMS-BI accordingly. Notwithstanding these possible limitations, the ndings of the present study provide a framework on which further investigations of the Feldenkrais Method1 can be based. One obvious direction for further research involves the investigation of the Feldenkrais Method1 on highly anxious populations and other `clinical' groups (e.g. people with chronic low back pain). In summary, the ndings can be interpreted as preliminary evidence of the ecacy of the Feldenkrais Method1 and relaxation procedures in reducing anxiety and should be considered by health care professionals when managing anxiety and related conditions.

Acknowledgements
The authors thank Kathy Hayes for her assistance in collecting the data for this project and gratefully acknowledge the cooperation of the participants in giving their time. This research was carried out while Gregory Kolt was working in the School of Physiotherapy, La Trobe University, Melbourne, Australia.

REFERENCES
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Bearman D, Shafarman S 1999 The Feldenkrais Method in the treatment of chronic pain: A study of ecacy and cost eectiveness. American Journal of Pain Management 9: 2227 Benson H 1975 The relaxation response. William Morrow and Company, New York Brown E, Kegerreis S 1991 Electromyographic activity of trunk musculature during a Feldenkrais Awareness Through Movement lesson. Isokinetics and Exercise Science 1: 216220 Chinn J, Trujillo D, Kegerreis, S., Worrell T 1994 Eect of a Feldenkrais intervention on symptomatic subjects performing a functional reach. Isokinetics and Exercise Science 4: 131136 DeVaney S, Hughey AW, Osborne WL 1994 Comparative eects of exercise reduction and relaxation training on mood states and type A scores in habitual aerobic exercises. Perceptual and Motor Skills 79: 16351644 Feldenkrais M 1977 Awareness through movement: health exercise for personal growth. Harper and Row, New York Fillingam RB, Blumenthal JA 1993 The use of aerobic exercise as a method of stress management. In: PM Lehrer, RL Woolfolk (eds), Principles and practice of stress management. The Guilford Press, New York Gutman GM, Herbert CP, Brown SR 1977 Feldenkrais versus conventional exercises for the elderly. Journal of Gerontology 32: 562572 Hopper C, Kolt GS, McConville JC 1999 The eects of Feldenkrais Awareness Through Movement on hamstring length, exibility, and perceived exertion. Journal of Bodywork and Movement Therapies 3: 238247 Jacobson E 1964 Anxiety and tension control: a physiologic approach. Pitman Medical Publishing Company, London James M, Kolt GS, McConville JC, Bate PJ 1998 The eects of a Feldenkrais program and relaxation procedures on hamstring length. Australian Journal of Physiotherapy 44: 4954 Kirby RJ 1994a Changes in premenstrual symptoms and irrational thinking following cognitive-behavioural coping skills training. Journal of Consulting and Clinical Psychology 62: 10261032 Kirkby RJ (Speaker) 1994b Relaxation (Audiocasette Recording). La Trobe University Media Production Unit, Melbourne, Australia Kolt GS, McConville JC, Bate PJ 1998 The eects of a Feldenkrais program and relaxation procedures on

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hamstring length (Authors' Response). Australian Journal of Physiotherapy 44: 143144 Lake B 1985 Acute back pain: treatment by the application of Feldenkrais principles. Australian Family Physician 14: 1175 1178 Lorr M, McNair DM 1982 Bipolar Prole of Mood States Manual. Educational and Industrial Testing Service, San Diego, CA Martin R 1994 The dicult groin: A Feldenkrais approach. Australian Physiotherapy Association Sports Physiotherapy Group Newsletter 3: 2022 Morgan WP 1985 Aective benecence of vigorous physical activity. Medicine and Science in Sports and Exercise 17: 94100 Ruth S, Kegerreis S 1992 Facilitating cervical exion using a Feldenkrais method: Awareness Through Movement. Journal of Orthopaedic & Sports Physical Therapy 16: 2529 Rywerant Y 1983 The Feldenkrais Method: teaching by handling. Keats Publishing, New York Soloway E 1996 Mary Jane. International Feldenkrais Federation Journal 3: 2225

Spielberger CD, Gorsuch R, Lushene PR, Vagg PR, Jacobs GA 1983 Manual for the State-Trait Anxiety Inventory: STAI (Form Y). Consulting Psychologists Press, Palo Alto, CA Stephens J, Call S, Evans K, Glass M, Gould C, Lowe J 1999 Responses to ten Feldenkrais Awareness Through Movement lessons by four women with multiple sclerosis: Improved quality of life. Physical Therapy Case Reports 2: 5869 Strauch R 1988 Functional integration and the feeling of sense. The Feldenkrais Journal 4: 3035 Wanning T 1993 Healing and the mind/body arts. Massage, acupuncture, Yoga, T'ai chi and Feldenkrais. Journal of the American Association of Occupational Health Nurses 41: 349351 Wildman F (Speaker) 1983a Activating the exors (Audiocassette Recording, Volume 1, Lesson 1, No. C3 2934 01396 2925). Feldenkrais Professional Tape Series, Berkeley, CA Wildman F (Speaker) 1983b Activating the extensors (Audiocassette Recording, Volume 1, Lesson 2, No. C3 2934 01396

2925). The Feldenkrais Professional Tape Series, Berkeley, CA Wildman F (Speaker) 1983c Rolling onto the side (Audiocassette Recording, Volume 1, Lesson 5, No. C3 2934 01429 2645). The Feldenkrais Professional Tape Series, Berkeley, CA Wildman F (Speaker) 1983d Lengthening the hamstrings and spine (Audiocassette Recording, Volume 1, Lesson 6, No. C3 2934 01429 2645). The Feldenkrais Professional Tape Series, Berkeley, CA Wildman F 1990 Learning the missing link in physiotherapy. A radical view of the Feldenkrais method. New Zealand Journal of Physiotherapy 18: 67 Zahourek RP 1988 Relaxation and imagery: Tools for therapeutic communication and intervention. W.B. Saunders, Philadelphia

RESOURCES
Audiocassettes of the Wildman ATM lessons are available from Feldenkrais Resources, Box 2067, Berkeley, California, 94702, USA.

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