Abstract. Introduction. Methodology : Author : Nazia Ali (M.O.Th.)*; Co-Author : Ruchi Nagar (M.Sc. O.T.)**

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1 The Indian Journal of Occupational Therapy : Vol. 45 : No. 3 () To study the effectiveness of occupational therapy intervention in the management of fear of public speaking in school going children aged between years Author : Nazia Ali (M.O.Th.)*; Co-Author : Ruchi Nagar (M.Sc. O.T.)** Key Words: Fear of Public Speaking, Relaxation, Desensitization Abstract Objective:To find the efficacy of occupational therapy intervention for the school going children with fear of public speaking. Method: Thirty subjects with fear of public speaking were taken, which included both boys and girls. The study designwas Pretest- Posttest, Experimental, Prospective and Single centre. Children having Fear of public speaking was assessed using Hamilton Anxiety Rating Scale (HAMA) and Fear Thermometer (FT). Results: It was found that there was significant (P<=.05) effect of O.T. intervention in reducing fear of public speaking.it was found that females had greater fear than males and also group 1(12-14yrs) had greater fear than group 2(15-17yrs). Conclusion:Our result showed that occupational therapy intervention significantly reduces the fear of public speaking in school going children between the age group 12 to 17 years. Introduction Glossophobia or speech anxiety is the fear of public speaking. The word Glossophobia comes from the Greek glossa, meaning tongue, and phobos, fear or dread. The fear of public speaking is called Glossophobia (or, informally, stage fright). It is believed to be the single most common phobia affecting as much as 75% of the population. 1 Childhood fears are very common and it is well known that the objects of these childhood fearsare tied to specific developmental phases. 2 It is quite a common problem and relatively intense 3 Literature showed that over 85% of the children reported thattheir fears interfered with their daily activities and prevented them from doing things theywould like to do. 4 The fear of public speaking can be socially debilitating, and is often cited as a primary reason why someone is unable to advance in his or her career. Different therapeutic approaches have been developed to help people overcome or deal with such fears as public speaking. 5 * Sr. Occupational Therapist, Akshay Pratisthan, New Delhi ** Assistant Professor, Jamia Hamdard, New Delhi Institution: Jamia Hamdard, New Delhi Period Of Study : Correspondence : Dr. Nazia Ali, C-1264, Masjid Wali Gali, Tigri, New Delhi Tel. No. : E- Mail : [email protected] In the past, the researchers have studied the effects of relaxation and desensitization separately. 6,7,8,9,10 The intervention program in this study consists of relaxation training and systematic desensitization both given together. Thus the need was felt to conduct a study to find the effectiveness of Occupational Therapy treatment (including relaxation and desensitization) in children to reduce fear of public speaking. Aim : To find the efficacy of occupational therapy intervention for the subjects with fear of public speaking. Experimental Hypothesis : Occupational therapy intervention helps in reducing fear of public Speaking in Indian school going students. Null Hypothesis : There will be no effect of Occupational Therapy Intervention in reducing fear of publicspeaking in Indian School going students. Methodology : Thirty subjects with fear of public speaking were taken, which Consisted of both boys & girls. Study Design :Pre-test- Post-test, Experimental, Prospective, Single centre. IJOT : Vol. 45 : No. 3 21

2 Inclusion Criteria : 1. Subjects of age years. 2. Regular school going children. 3. English medium public school. Exclusion Criteria : 1. Subjects below 12 years & above 17 years. 2. Subjects with known history of any serious medical illness. 3. Diagnosed case of learning disability. Variables : Independent variable: OT intervention Dependent variable : Fear of public speaking Ooycome Measures or Scales Used a. Hamilton Anxiety Rating Scale (HAMA). Tool for measuring the severity of a patient s anxiety. The HAMA probes 14 items and takes minutes to complete the interview. Items are scored on a 5- point scale, raw data were given as: 0 = no anxiety. 1 = mild anxiety 2 = moderate anxiety 3 = severe anxiety 4 = very severe anxiety HAM- A Score Level of anxiety mild mild to moderate 25 and above moderate to severe b. The Fear Thermometer (FT) is used which required subjects to rate their anxiety level during their speech on a scale from 0 to 10 where 0 represented an absence of anxiety and 10 represented maximal possible anxiety. FT scores were simply the values assigned. PROCEDURE: Students were asked to fill HAMA scale. Subjects scoring more than 14 on HAMA were selected for the study. Thus a total of 30 subjects were screened for the study. Subjects selected were asked to rate fear levels on FT. Subjects were taken up for the OT intervention which included Relaxation and Desensitization. Intervention had 15 individual treatment sessions, twice a week. The first 10 sessions had Relaxation for 1 hour each and the next 5 sessions had Desensitization for 45 minutes each which included 15 minutes of discussion (relaxation training), 10 minutesfor constructing an anxiety hierarchy and 20 minutes for Systematic pairing of visualized scenes with relaxation. Intervention : Treatment had 15 individual treatment sessions, twice a week. Integrated Treatment (IT) Total Treatment Time Relaxation 10 sessions (1 hour each) Desensitization 5 sessions (45 minutes each) Session 1 to 10 For Relaxation Schultz s Autogenic Training (AT) was used. Children sat in comfortable armchairs and the following exercises of relaxed breathing, relaxation of right hand, left hand, muscles of legs, and relaxation of abdomen and breast muscles were provided in single sessions. Children were asked to practice the same AT exercises at home, once a day. After 7 th session, the AT group was requested to 2-3 minutes of relaxation while in the classroom. Session Initiation session - 15 minutes discussion (relaxation training) - 10 minutes constructing an anxiety hierarchy - 20 minutes Systematic pairing of visualized scenes with relaxation Subjects were told to practice relaxation twice a day for 15 minutes between sessions. Subsequent sessions began with 15 minutes check on practice and progress in relaxation during which relaxation was induced and this was followed by desensitization. Hierarchies ranged from 8 to 20 items arranged in order of arousing potency and each item was presented in imagination to the subjects for 10 seconds followed by 30 seconds of relaxation before presenting the next item. If the subjects did not signal anxiety after the second presentation of an item, then the therapist presented the next item. If anxiety was signalled the item was repeated until an anxiety free presentation occurred. After the intervention, the subjects were again asked to fill the scales respectively. Data Analysis and Result : Microsoft excel 2003 data sheet was used to make master chart. All statistical tests were performed using Statistical Package for Social Sciences (SPSS) version 15.Wilcoxon Signed Rank Test was used to compare pre-treatment & post treatment scores among the total sample. Mean and Standard Deviation of the pretreatment & post treatment were also calculated as the sample size was too small. Additionally, Mann- Whitney Test was used to determine any significant difference in fear of public speaking between males and females and also with the age groups i.e & years. The statistical analysis, a P value equal to or less than.05 (Pd.05) was accepted as significant. IJOT : Vol. 45 : No. 3 22

3 Interpretation Table-1 shows Comparative analysis for pre & post HAMA and FT. The data shows the pre & post mean values of HAMA and FT are (22.27, & 6.37, 3.77) respectively. Result reveals that there was significant (p d.05) difference between pre & post intervention value for both. Table 2 shows that there was greater value of HAMA for females than males before and after intervention.ft scores were higher for females than males before intervention but post intervention males had greater value than females. The result of test reveals Table 1 : Summary of Comparison of pre & post HAMA and FT that there was no any significant (Pd.05) difference between male and female for pre and post HAMA (.097 &.882) and FT (.289 &.863) values. Table 3 shows the data for HAMA & FT between Gr1 and Gr2. The data shows that there was greater value of HAMA for gr1than gr2 before and after intervention. FT scores were higher for Gr1 than Gr2 before and after intervention. The result of test reveals that there was no any significant (Pd.05) difference between Gr1 and Gr2 for pre and post HAMA (0.066 &.983) and FT (.374 &.757) values. Variables Pre Mean ± S.D Post Mean ± S.D Z value P value HAMA ± ± FT 6.37 ± ± Table 2 : Comparison between male (N=13) and female (N=17) for HAMA and FT Mean ± S.D. U value P-value Variables M F M F Pre Post Pre Post Pre Post Hama Ft Table 3 : Comparison between Gr1 (12-14 yrs.) and Gr2 (15-17 yrs.) for HAMA and FT Mean ± S.D. U value Variables Gr1 Gr2 Gr1 Gr2 Gr1 P-value Pre Post Pre Post Pre Post Hama Ft Graph-1(a) Comparison of Pre and Post HAMA Graph-1(b) Comparison of Pre and Post FT IJOT : Vol. 45 : No. 3 23

4 Graph-2(a) Comparison between male and female for HAMA Graph-2(b) Comparison between male and female for FT Graph-3(a) Comparison between Gr1 and Gr2 for HAMA Discussion : This study has investigated to see the efficacy of Occupational Therapy Intervention including relaxation training and systematic desensitization in reducing fear of public speaking. In present study the result was found that there was significant (Pd.05) effect of O.T. intervention in reducing fear of public speaking, hence the experimental hypothesis is proved by rejecting the null hypothesis. In present study the fear of public speaking had reduced after O.T. intervention. Statistically significant difference was found in HAMA and FT as outcome measure before and after the relaxation training and systematic desensitization [table 1] and [Graph 1(a) & 1(b)]. Few studies 11, 12, 13, 14 have similar findings with the present study. Kondas O. (1967) 13 Found the similar results using Fear Survey Schedule Scale. It was found that the results with relaxation by means of Schultz method and systematic desensitization are significant in children. This could be attributed to the fact that fear of public speaking is a learned fear in which punishment, feeling ashamed, criticism, decreasing prestige and similar effects work as negative reinforcing factors. Fear of public speaking symptoms like tremor, excitement, muscle rigidity or a feeling of stomach spasm indicates the presence of tension in this state. The result showed better results in children with Schultz s Method of relaxation. Graph-3(b) Comparison between Gr1 and Gr2 for FT Study by Turner,Biedel& Cooley-Quille (1995) 14 investigated the behavioral treatment effects on social phobia susing HAMA clinical rating and various self-report measures(epi, FQ& SPAI) reports that there was a significant decrease in fear in students before and after treatment. In the present study, females had greater mean score values than males before intervention, it shows females had greater fear than males [table 2]. The present finding is in agreement with the finding of Salman et al (1997), 2 Ollendick et al (1985) 15 and Ollendick and King (1994). 16 Mean scores for HAMA and FT have reduced for both males and females post intervention, this implies that the fear has reduced in both males and females [Graph 2(a) & 2(b)]. However there was no significant difference in the decrease of fear between males and females. This implies that both males and females had similar improvements i.e. decrease in fear. In the present study, Group 1 had greater mean score values than group 2 before intervention, it shows that group1 had greater fear than group2 [table 3] and [Graph 3(a) & 3(b)]. The present finding resembles with the findings of Salman et al (1997) 2 and Ollendick and King (1994). 16 Ollendick and King reported young adolescents have more fears than older adolescents whereas Salman et al (1997) 2 said that there was an age related decline in fears. From the light of these findings it could be said that as the child ages the level of fear decreases. IJOT : Vol. 45 : No. 3 24

5 This study was done to determine the effectiveness of Occupational Therapy intervention including relaxation and systematic desensitization to reduce fear. There was significant reduction in fear of public speaking using this standard treatment protocol in school going children between 12 to 17 years. The relaxation technique helps to control the tension, anxiety and fear by systematic efforts. The treatment (relaxation training and systematic desensitization) given in this study is a combination of the treatments used by Schooling &Emmelkamp,1993; 17 Mattick et al and Kondas O Limitations : Sample size was relatively small; hence the results cannot be generalized to masses. The range of age group of the sample was small (12-17 yrs.), hence the results cannot be generalized to other age groups. Small duration of the Protocol. Future Recommendations : Large population should be studied. Age groups below 12 & above 17 yrs. can also be included in the study. Experiment should be carried out on the person having some different types of fears / phobias. Follow-up should be there every two years. Conclusion : The experimental hypothesis of the study was accepted and null hypothesis was discarded. The result of this study revealed that Occupational Therapy intervention significantly reduces the fear of public speaking in school going children between the age group 12 to 17 years. References : 1. Rothwell, J. Dan. In the company of others: An Introduction to communication. New York; MC Graw Hill, Elbedour S, Shulman S. &Kedem P. Childdren s fears: Cultural and developmental perspectives. Behav. Res. &Ther. (1997); 35: Muris et al. The role of parental fearfulness and modeling in children s fear. Behav. Res. Ther. (1996); 34: Hofmann G.S, Ehlers A. and Roth T.W. Conditioning theory: a model for the etiology of public speaking anxiety? Behav. Res. Ther. (1995); 33: Cunningham V, Lefkoe M. &Sechrest L. Eliminating fears: An Intervention that permanently eliminates the fear of public speaking. Clinical Psychology & Psychotherapy.(2006); 13: Marshall W.L, Presse L. and Andrenes W.R. A self administered program for public speaking anxiety. Behave. Res. & Therapy. (1976); 14: Taylor S. The hierarchic structure of fears. Behav. Res. & Therapy. (1998);36: Amir N, Weber G, Beard C. & Taylor C.T. The effect of a single Session Attention Modification Program on Response to a Publicspeaking Challenge in Socially Anxious Individuals Journal of Abnormal Psychology. (2008); 117: Muris P, Sterneman P, Merckelbach H. and Meesters C. The role of parental fearfulness and modeling in childrens fear. Behav. Res. Ther. (1996); 34: Woy J.R. and Efran J.S. Systematic desensitization and expectancy in the treatment of speaking anxiety. Behav. Res. & therapy. (1972); 10: Rachman S. Studies in desensitization-i. The separate effect of relaxation and desensitization. Behav. Res. & therapy. (1965); 3: Lang P.J. Experimental studies of fear reduction. J. Clini. Psychol. (1966); 45: Kondas O. Reduction of Examination Anxiety and Stage- Fright By Group desensitization and Relaxation. Behav. Res & Therapy. (1967); 5: Turner S.M, Beidel D.C. and Cooley Quille M.R. Two- Year follow-up of Social phobic s treated with social effectiveness. Therapy. Behav. Res. Ther. (1995); 33: Ollendick et al. Fears in children and adolescents: normative data. Behav. Res. Ther. (1985); 23: Ollendick T.H. and King N.J. Fears and their level of interference in adolescents. Behav. Res. Ther. (1994); 32: Scholing A. and Emmelkamp P.M.G. Exposure with and without cognitive therapy for generalized social phobia Effects of Individual and Group Treatment. Beh. Res. Ther. (1993); 31: Mattick R.P, Peters L. & Clarke L.D. Exposure and cognitive restructuring for social phobia: a controlled study. Behavior Therapy. (1989); 20:3-23. IJOT : Vol. 45 : No. 3 25