CHAPTER III: METHODOLOGY
Design of the study
The present study is an experimental study with two group comparison design
with pre and post assessment. Experimental group was subjected to intervention, whereas
for the control group no intervention was given.
Sample
Subjects (Boys and Girls students in 10th, 11th, and 12th grade) for the present
research were selected from different high schools of Iran. Initially 400 students
(Boys=193 and Girls=207) were screened based on the inclusion and exclusion criteria.
Out of 400 students, 130 students (63 Boys and 67 Girls) fulfilled the cut off score
criteria used for the study. Cut off score criteria based on research tools for selecting
subjects for intervention on academic stress was the score of 15 and above (15 to 30);
for depression was 20 and above (20 to 54) and for self-efficacy was 28 and below (1 to
28). For the main study out of 130 students (who met cut off score criteria) 5 Boys and
5Girls each from 10th, 11th, and 12th grade were randomly assigned to experimental group
(15 Boys and 15 Girls) and control group (15 Boys and 15 Girls). Experimental group
was subjected to intervention.
Inclusion criteria
1. Student should be between 15 and 17 years of age.
2. Student should be studying in government schools.
3. The students should be regularly attending the school.
4. Both boys and girls.
Exclusion criteria
1. Students below 15 and above 17 years age.
2. Students who exposed to similar intervention earlier
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Sampling flowchart
Screening subjects based on inclusion/exclusion criteria
N=400
Boys N=193
Girls N=207
th
10 grade N= 60
10th grade N= 67
11th grade N= 65
11th grade N= 70
12th grade N=68
12th grade N=70
Number of subjects
available based on cut off
Boys=63, Girls=67
Selected 5 boys and 5 Girls each from 10th, 11th and 12th grade for
experimental and control group
Control
Experimental
N= 30; boys=15, Girls=15
N= 30, Boys=15, Girls=15
No Intervention
Intervention
Post-assessment
Two weeks after the
Analysis
interventions
Post-assessment
Contemporary with
intervention group
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Research Tools and their description
Semi-structured interview schedule (appendix A). This was developed by the researcher
for the present study to collect socio—demographic details.
Scale for Assessing Academic Stress (SAAS) - Appendix-B
Scale for assessing academic stress developed by Sinha, Sharma and Mahendra
(2001) was used. This scale consist a 30-item self-report measure. Subject has to answer
each items for the presence or absence of academic stress symptoms. The test was
standardized on a random sample of 400 (Male 200, Female 200) school student. SAAS
measures five independent factors of academic stress indicating expression of academic
stress through different channels: cognitive (items 1-7), affective (items 8-13), physical
(14-18), social and interpersonal (19-23), and motivational (24-30). All the items under
each factor have fairly high loading ranging from 0.60 to 0.85.
Scoring: The subject has to choose yes answer for the presence of academic stress or no
answer for the absence of academic stress, scored as (1- the presence of symptoms) and
(0-the absence of symptoms) for each item as applies to him/her.
Norms: After analysis of the test scores, the mean score was 11.3 with standard deviation
of 3.68.
Reliability: The test- re-test reliability of SAAS over the period of one moth is 0.88 and
split-half reliability is 0.75 indicating adequate reliability of the scale. Internal
consistency of the scale is also adequate being in a range of 0.30 and 0.81. In the present
research high academic stress means 1 standard deviation above the mean (11.3+3.68=
15).
Iranian norm: For Iranian population SAAS was established on 286 high school girls
and boys students (Azizi, 2010). The total mean score for SAAS was 11.08 followed by
standard deviation of 3.88; the reliability of the scale with split half was 0.81; with testretest was 0.84, and with Cronbach’s Alpha was 0.87. Since norms established on Indian
and Iranian population was similar, mean of 11.0 with SD of 3.88 was used in the present
study as norm. In the present research high academic stress means 1 standard
deviation above the mean (11.08+3.88≈ 15).
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Children’s Depression Inventory (CDI) – Appendix-C
The children’s depression inventory (CDI, Kovacs, 1992) is appropriate for
children and adolescents aged between 7 and 17 years. CDI assess and quantifies a range
of depressive symptoms, including disturbed mood, problems in hedonic capacity and
regulative functions ,low self evaluation, hopelessness ,difficulties in interpersonal .
Scoring: The CDI consists 27 self report items and each items has three alternative
choice (a, b, and c). Subject has to choose one of the alternative choices. The total score
can ranges from 0 to 54. Besides of the total score, the CDI yields scores for five factors
or subscales: negative mood, interpersonal problems, and ineffectiveness, anhedonia,
and negative self esteem. Among these questions 14 of them are scored directly and 13
are reverse. Reverse items are: 2- 5-7-8-9-10-11-13-15-16-18-21-25 and the rests are
direct.
Direct scoring: In direct items zero (0) score alternate choice answered as a; one (1) for
alternate choice answered as b; and two (2) for alternate choice answered as c.
Reverse scoring: In reverse items zero (0) score alternate choice answered as c; one (1)
for alternate choice answered as b; and two (2) for alternate choice answered as a.
Norms: The scores between 0 - 8 refer that the person is healthy, the scores between 9 19 refer that the person is prone to depression. The general screening purpose, cut-point
recommended by Kovacs (1992) is 20, and Finch, Saylor, and Edwards (1985) reported a
mean score of 9.01 (SD=6.97) for girls, and 10.33 (SD=7.59) for boys. A score of 20 on
the CDI is at the 90th percentile and is often the cut-off used to determine that someone
is experiencing a clinically significant level of depression (Craighead, Craighead,
Smucker, & Ilardi, 1998). In the present study the scores of 20 and above (20 to 54)
was used as a norm for selecting the subjects.
Reliability: The CDI has been shown to have good reliability. The internal consistency
through Coronbach’s Alpha for total CDI was ranging from (0.71 to 0.94), negative
mood (α=0.62); Interpersonal problems (α= 0.59); Ineffectiveness (α= 0.63); Anhedonia
(α= 0.66); and Negative self esteem (α= 0.68) (Kovacs, 1992).
Validity: Studies of the discriminant validity of the CDI have produced mixed results.
Saylor, Finch, Spirito, & Bennett (1984) did not find significant differences between the
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CDI scores of depressed and non-depressed children and adolescents. Timbremont,
Braet, & Dreesen (2004), however, found that the CDI discriminated between depressive
disorders and other psychiatric diagnoses well and in their study over 84% of participants
were accurately identified as depressed or not depressed using their CDI scores.
Norms for Iran population: For Iranian population Rajabi (2004) administered CDI on
399 guidance and high school girl and boys student. The reliability of the scale with testretest was 0.89; Cronbach’s Alpha was 0.88; split-half was 0.83. Further, the coefficient
of correlation between CDI and the short-form CDI in total sample was 0.36, in the girls
was 0.55 and in the boys was 0.22.
General Self Efficacy Scale (GSES) - Appendix-D
The general self efficacy scale (GSE; Schwarzer& Jerusalem, 1995) assesses a
general sense of perceived self efficacy with the aim in mind to predict coping with daily
hassles as well as adaptation after experiencing all kinds of stressful life events. The
scale is designed for the age of 12 years and above.
Scoring: The GSE consists 10 self report items and each item includes of four choices and
scored as (1-not at all true; 2-hardly true; 3-moderately true; 4-exactly true). Sum up the
responses to all 10 items to yield the final composite score ranges from 10 to 40. The
scores below 28 are considered as low self-efficacy.
Reliability: in samples from 23 nations, Cronbach’s alpha ranged from 0.76 to 0.90, with
the majority in the high .80s.
Validity: Criterion related validity is documented in numerous correlation studies where
positive coefficients were found with favorable emotions, dispositional optimism, and
work satisfaction. Negative coefficients were found with depression, anxiety, stress,
burnout and health complaints.
In the present study test-retest reliability was established using 30 boy and 30 girl
high school students over the four weak. The Pearson coefficient of correlation was
equal to 0.86. In this study the scores of 28 and below was used as a norm for selecting
the subjects.
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Procedure
The present study has been carried out in three following phases.
Phase I:
1. Principals of the High Schools were contacted to obtain permission and explained the
nature of research. They were requested to give permission and cooperate to collect data
for the research. The process of research was explained to them. They were assured of
keeping the data confidential.
After obtaining permission researcher established rapport with students and
parents for cooperation in the research.
Obtaining informed consent from student parents (Appendix E)
Screening: For the purpose of the present study, initially 400 high school students (207
girls and 193 boys) were administered the research tools. Out of 400 students, 130 of
them fulfilled research criteria (high in academic stress and depression, and low in selfefficacy and academic performance). From 130 students, 63 of them were Boys (10th
grade N= 19; 11th grade N= 21; and 12th grade N= 23) and 67 of them were Girls (10th
grade N= 23; 11th grade N= 20; and 12th grade N= 24).
Details of the Boys and Girls who fulfilled research criteria is given below.
Table 3.1
Showing the numbers of Boys and Girls in each group (10th , 11th , 12th ) in experimental (n=30)
and control (n=30)
Groups
Experimental
Gender
10th grade
Grades
th
11 grade
12
th
Total
grade
Control
Total
boys
girls
boys
girls
5
5
5
5
20
5
5
5
5
20
5
5
5
5
20
15
15
15
15
30
30
123
60
STUDENTS’ DEMOGRAPHIC DATA
Table 3.2
Showing Mean and standard deviation of subject’s age
Groups
Experimental
boys
Gender
grade
Control
girls
boys
girls
M
SD
M
SD
M
SD
M
SD
15.8
1.30
15.4
0.55
15.2
0.84
15.6
0.55
11th grade
15.8
0.84
16.0
0.71
15.7
1.0
15.8
1.3
12rd grade
16.0
0.70
16.0
0.83
15.8
0.84
16.0
0.84
Total
15.9
0.95
15.8
0.70
15.6
0.89
15.8
0.88
10th grade
Table 3.2 shows that the mean age of subjects in experimental group are (15.9 in
boys) and (15.8 in girls); and in control group are (15.6 in boys) and (15.8 for girls).
Table 3.3
Showing Literacy level of the boy’s parents
Literacy levels
primary
secondary
Diploma* and above
Percentage
Percentage
Percentage
Father
4.00 (27%)
5.00 (33%)
6.00 (40%)
Mother
7.00 (47%)
5.00 (33%)
3.00 (20%)
Father
7.00 (47%)
4.00 (27%)
4.00 (27%)
Mother
7.00 (53%)
6.00 (47%)
2.00 (13%)
Group
Experimental
Control
Note: The numbers in the bracket refer to percentage
*In Iran after 12th grade students enter into the next stage of education which is called
Diploma (this will be equal to 10+2 course in India).
Table 3-3 shows that the literacy level of 40 percent of the boy’s fathers in
experimental group was diploma and above, and 47 percent of the boy’s mother literacy
level was primary school. In control group the literacy level of the most of boy’s fathers
(47%) was primary and 47% of the student’s mothers were secondary school.
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Table 3.4
Showing Literacy level of the girl’s parents
Literacy levels
primary
secondary
Diploma and above
Percentage
Percentage
Percentage
Father
7.00 (47%)
4.00 (27%)
4.00 (27%)
Mother
6.00 (40%)
6.00 (40%)
3.00 (20%)
Father
7.00 (47%)
4.00 (27%)
4.00 (27%)
Mother
5.00 (33%)
8.00 (53%)
2.00 (13%)
Group
Experimental
Control
Note: The numbers in the bracket refer to percentage
Table 3-4 shows that the literacy level of 47 percent of the girl’s fathers in
experimental group was primary school, and 40 percent of the girl’s mother’s literacy
level was also primary school. In control group the literacy level of the most of girl’s
fathers (47%) was primary and 53% of the girl’s mothers were secondary school.
Phase II: Selection of samples for research purpose based on the research criteria. That
is high score on academic stress, high score on depression, low score on self-efficacy and
low in academic performance. 130 students met the cut off score criteria (Boys=63 and
Girls= 67). Out of 130 students 60 of them have been grouped into experimental (15 girls
and 15 boys) and control (15 girls and 15 boys) group using simple random sampling
technique. (There are 5 Boys and 5 Girls each drawn from 10th, 11 th, and 12th grades)
(Table, 3-1).
Cut off score criteria based on research tools for selecting subjects for
intervention on academic stress was the score of 15 and above (15 to 30); for depression
was 20 and above (20 to 54) and for self-efficacy was 28 and below (1 to 28).
Experimental group subjects were subjected to intervention and control group subjects
did not receive any intervention.
Phase III: Intervention
Intervention package
The Intervention package consisted of the following modules as described below.
The 30 subjects of the experimental group were selected for this stage of study
which included 13 sessions (each session approximately 1 hour per each week) of CBT.
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Some of the sessions were carried out in groups (e.g. Warm up or ice breaking, and Final
session). All the intervention sessions were conducted in the counseling center of the
school to maintain uniformity. Out of 13 sessions, 11 sessions were conducted
individually and two sessions were conducted in group separately for Boys and Girls.
Table 3.5
Showing the details of intervention carried out with each subjects
Number of
Times
sessions
Type of
of
Name of Interventions
(separately for
intervention
Sessions
boys and girls)
(hours)
Group
Warm up or ice
2
(separately for
2
breaking Breathing
exercise
boys and girls)
Identifying the current
Individual
1
1
problems
Self-observation
Individual
1
1
Positive thinking
training and stress
inoculation
Cognitive restructuring
Problem solving
training
Assertive imaginary
Time management and
study skills training
Final session
No of
subjects
30 (15+15)
30 (15+15)
30 (15+15)
Individual
2
1
1
1
2
2
Individual
Individual
Individual
Individual
Group(separately
for boys and
girls)
2
30 (15+15)
1
30 (15+15)
1
30 (15+15)
1
30 (15+15)
2
30 (15+15)
2
30 (15+15)
Module 1: Warm up or Ice breaking
Rationale:
The first session of intervention was done in group. Any group therapy session
begins with ice breaking and warm up session. It is necessary for any group therapy to
get familiarize with other members of the group.
Session one is the first opportunity for group members to meet each other with
the group leaders (researcher) and familiarize with each other. Because the therapist has
a lot of information to cover in this session in terms of presenting information, it is
important that therapist aim for a balance between presenting information and allowing
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space for group interaction and discussion. Promoting group discussion can take place
with the introductions.
It was helpful for group members to introduce themselves and say a little bit
about themselves.
In the present study there are 30 stressed students (15 boys and 15 girls). Two
groups of 15 boys and girls were formed randomly. In the first session all the 30
participates met together. As first step of ice breaking session 16 groups consisting of 2
students each separately for boy and girl were formed. 8 groups with 2 students each is
formed separately for boys and girls. When 7 groups is created (N=14) one student left
out from the group and could not find his/her partner. The researcher acted as his partner
and introduced him/her to the group and vice versa. Each member of the group instead
introducing him/herself, introduced his/her partner as a friend regarding his/her details
two pleasant and unpleasant events; two best like and two least like thing, hobbies and
habits.
Aim/goal
To create group cohesiveness to bring the sense of we-ness among the stressed
and depressed students. Following the introductions, the researcher provided the
structure of the group which including the group format (13 sessions, 60 minutes per
session) and session format (e.g., homework review).
Strategies covered in session:
1- Group members (group members share personal experiences of what brought
them to group).
2- Explain structure and session format of group, and review group norms.
3- Explain what to expect from treatment (clarify expectations).
4- To explain and make each participant understand the group rules such as:
a) Confidentiality: Maintenance of confidentiality of information of each
member.
b) Homework: Group members were educated about the importance of
homework (such as maintaining stress diary-appendix-F)
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c) Missing appointments: Information about how to compensate for the missed
session (i.e. attending another group session conducted by same therapist for
similar problem.
5- Present information on the nature of stress and depression, and self-efficacy
6- Introduce the CBT approach to stress and depression, and self-efficacy.
During this session breathing training was taught and subjects were asked to
practice it at home and at school. Deep breathing is one of the best ways to lower stress
in the body. This is because when the student breathes deeply it sends a message to
his/her brain to calm down and relax. The brain then sends this message to his/her
body. Those things that happen when students are stressed, such as increased heart rate
and fast breathing, all decrease as they breathe deeply to relax (Murray& Pizzorno,
2006).
Strategies covered in session: in this session students asked to practice the following
strategies of breathing.
1. Sit up straight. Exhale.
2. Inhale and at the same time relaxes the belly muscles. Feel as though the belly is
filling with air.
3. After filling the belly, keep inhaling. Fill up the middle of your chest. Feel your chest
and rib cage expand.
4. Hold the breath in for a moment, and then begin to exhale as slowly possible.
5. As the air is slowly let out, relax your chest and rib cage. Begin to pull your belly in
to force out the remaining breath.
6. Close your eyes, and concentrate on your breathing.
7. Relax your face and mind.
8. Let everything go.
9. Practice about 5 minutes.
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Module 2: identifying the current problems
Rationale:
It has been shown that identifying the current problems of subject will help to
achieve reasonable results. Finding out the current problems not only clarifies things, but
also enables the subjects to experience CBT as collaborative, and helps therapist to
understand the adolescent’s perspective and priorities (Kroll, Harrington, & Gowers,
1996).
Objective:
Identifying the student’s academic related problems (e.g. difficulty in Maths,
Algebra, Geometry, etc. and also problem with teachers, parents, and peers).
Components:
1. Assessment of current problem of subjects through unstructured interview.
2. Identifying the precipitating and maintaining factors.
3. Identification of type of stress based on stress diary and the associated feelings.
Module 3: Self-observation
Self-observation by the subjects about their thoughts, feelings, emotions,
attitudes, and beliefs based on the diary / home assignment and attempt is made by the
researcher to address the same. The stress diary worksheet was reviewed at the beginning
of each session. Negative automatic thoughts (NATs) were identified.
Rationale:
Self-observation is a useful technique when the subjects are trying to create a new
habit or break old and unhealthy habits. It is useful because:
1. It gives an opportunity to be aware of their problems, stress, feelings, and etc.
2. It helps to create a structure. Subject’s academic difficulties and progress becomes
more concrete when observed by visible and external measures.
3. Second benefit is that the mere act of recording behaviors changes the occurrence of
the behavior in the desired direction.
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4. Self-observation forms the base line for active intervention to change behaviors
because the individual’s measure of progress can form the basis for programs of
reward or punishment.
Objective:
Encouragement of subjects to be aware of their beliefs, thoughts, emotions,
feelings, etc; and pay attention to these, make accurate discriminations among them (that
is between negative and positive) and be aware of the importance of relationships
between the events, beliefs and behaviors.
Components: self-monitoring/self-control
Self-observation was accomplished in the following ways:
1. Determination of the events that have led to unpleasant emotions along with
feelings.
2. Determination of the types of emotions in that situation and rating of the same on
a scale of 1 to 100 %.
3. Determination of the negative automatic thoughts (NATs) of the present emotion
and his/her opinion about these NATs.
4. Subject’s reasonable explanation for these NATs and how they rate it?
5.
Reassessment of their opinions about these NATs and how they rate it.
6. Self-monitoring is a useful technique for modifying NATs.
Module four and five: positive thinking training and stress inoculation
After identifying negative thoughts (based on stress diary), subjects are trained to
inculcate positive thinking through CBT methods (stress inoculation). Further, attempt
was made to identify the cognitive distortions and associated general irrational thinking
like “all or none thinking”, “overgeneralization”, “selective abstraction”, “catastrophic”,
and “emotional reasoning”.
Rationale:
Positive thinking helps subjects to overcome stress, as optimistic students would
handle situations in a positive manner. Positive thinking encourages them to let go of
things that they usually get frustrated and worried about. It further, helps in realizing and
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understanding that negative emotions lead to nowhere. Positive thinkers develop the
ability of seeing the solutions, not just problems. Positive thinking equips subjects with
methods and technique to do the things in a better way. It encourages them to look at the
positive side of life. It makes persons believe that everything will be fine; hence causing
individual’s thinking to be more relaxed.
Objective:
Encourage the students to identify and stop their negative thoughts and replace
them with positive thoughts by learning the positive ways of thinking.
Components:
The first stage of stress inoculation is educational, and involves didactic training
about the nature of stressful reactions. In this stage students asked to write down any
distress experienced e.g. worry about the academic problems with time/date and a brief
description of the situation, then the specific thoughts and images (cognition), feelings
(bodily sensations or emotions), and actions (things said or done).
The second stage of stress inoculation involves the presentation of a number of
behavioral and cognitive coping skills, including positive self-statements (e.g. if I try a
little more, I will get good result in maths), and self-reinforcement (e.g. I can do it, or I
have done it, so I can go over my all problems).
In the final stage of stress inoculation, the student exposed to a variety of stressors in
order to rehearse his or her newly acquired coping skills.
Some practical instructions for positive thinking were presented during to the session:
1. Ignore what others might say or think about you, if they discover that you are
changing in the way you want (e.g. I must live for myself, so I behave in the ways that I
like without viewing how people think regarding it).
2. Always visualize only favorable and beneficial situations. Use positive words in your
inner dialogues or when talking with others (e.g. today I will have a good day in the
school with my classmates). Smile a little more, as this helps to think positively.
Disregard any feelings of laziness or a desire to quit. If you preserve, you will transform
the way your mind thinks.
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3. Once a negative thought enters your mind, you have to be aware of it and endeavor to
replace it with a constructive one. The negative thought will try again to enter your mind,
and then you have to replace it again with a positive one. It is as if there are two pictures
in front of you, and you choose to look at one of them and disregard the other.
Persistence will eventually teach your mind to think positively and ignore negative
thoughts (e.g. if you think that entering to the next stage of education or college is
difficult, you can manage your mind as, if I try hard, I will go to the next stage of
education or college).
4. In case you feel any inner resistance when replacing negative thoughts with positive
ones, do not give up, but keep looking only at the beneficial, good, and happy thoughts
in your mind (e.g. even if I entered the college, I cannot pass it easily, you can say
yourself that since I succeed in the last stage, I can cope with this stage too).
5. It does not matter what your circumstances are at the present moment. Think
positively, expect only favorable results, situations and circumstances will change
accordingly. It may take some time for the changes to take place, but eventually they do
(e.g. I know that I don’t have a single room for studying in my father’s house, but if I
focus on the study I will get good marks).
6. Another method is the repetition of affirmations. It is a method which resembles
creative visualization, and which can be used in conjunction with it (e.g. I believe my
abilities to overcome each situation that I am faced).
Module six: Cognitive restructuring
Rationale:
Cognitive restructuring or the disputing of irrational beliefs (IBs) may help
subjects who are convinced that (1) their negative emotional–behavioral functions is
partly the result of their irrational, unrealistic, and illogical thinking; (2) they can
constructively change their IBs to rational beliefs (RBs) and will then function
significantly better; (3) their irrational thinking includes strong emotional and behavioral
components; (4) if they persist both emotionally (strongly) and behaviorally (actively)
acting against their irrational beliefs, they will automatically and unconsciously create an
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effective new philosophy that will tend to make them less disturbed and keep them from
seriously disturbing themselves in the future (O’Donohue & Fisher, 2009).
Objective
Identify the negative beliefs and make an effort to dispute the negative beliefs
(For example, negative beliefs that involve predictions about the future or statements
about the self). In this session, the aim of intervention was focused on the student’s
depression and self-efficacy.
Components
Subjects were taught and trained in the ABCDE model of Ellis and Dryden,
(1987) to conceptualize how events can impact beliefs and leads to its consequences. In
this model, "A" stands for Activating Event or Adversity. "B" refers to one's Irrational
Belief about the event of “A”. That belief then leads to "C" the emotional and behavioral
Consequences. "D" stands for dispute of irrational beliefs. E stands for New
Effect/Education or the new more effective emotions and behaviors that result from more
reasonable thinking about the original event.
Subjects were made to understand the logic of Cognitive Behavior Therapy
(CBT), and explained to them with example that events alone do not lead to their
disturbed reactions, but that they contribute to these consequences through negative
thoughts, beliefs and predictions.
Subjects demonstrated with example (diary maintaining stress) that when they
disturb they will have strong negative thoughts that largely consist of absolutistic (I will
continue my study if I get high score in all subjects, otherwise it will be useless), shoulds
(e.g. I should be the best in Algebra), predictions (I will never enter in college), and other
ideas.
Educated subjects how to think, feel, and act against their negative thoughts with
cognitive and behavioral techniques (e.g. positive thinking), which interrelate.
Examples from diary of the students were taken to demonstrate how to
specifically dispute their negative thoughts: realistically and empirically, logically, and
juristically or pragmatically. Particularly shown to them how to change their rigid,
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absolutistic demands on themselves, other people, and were taught how to develop
flexible, and workable preferences.
Subjects are shown that when they actively and persistently dispute negative
thoughts with behavioral evidence they can create new thought that is based on
experiential evidence and that will include strong rational coping statements that can
help them to get and stay better (O’Donohue & Fisher, 2009).
In this session researcher helped subjects to identify irrational beliefs (from diary
maintaining the stress). Then, students trained about “disputing irrational thinking”. In
this session, students were shown how negative externalized beliefs may lead to personal
beliefs (e.g. everybody knows that algebra is a difficult subject and students cannot pass
it easily, so, the student may be internalize that belief and believes that he/she is not able
to cope of it). In this session challenging negative thoughts homework was given to the
subject (Appendix-G).
Module seven: Problem solving training
Rationale:
Basic ingredient in CBT is to improve the problem-solving abilities of the
subjects. Problem-solving is a self-directed cognitive-behavioral process by which a
person attempts to identify or discover effective or adaptive solutions for specific
problems encountered in everyday living. This training has been used in the management
of problems such as stress, depression, relationship problems, etc. (Dobson, 2001).
Objective:
Help the students to deal with external factors which may cause stress leading to
depression, low self-efficacy and poor academic performance.
Components:
A typical problem-solving training format might include the following skills
(Appendix-H).
1. Problem definition: identify the problem in your life. Ask yourself a question such as
“slow down, what is the problem”.
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2. Generating alternatives: Think of a variety of ideas and write down all things that
you could do. Ask yourself, “What are my choices”. Choose the solution that you
think is the best.
3. Evaluating emotional and behavioral consequences (decision making)
Once a list of alternative options has been generated, the individual is taught to
systematically evaluate the potential for each solution to meet the defined goals (e.g.
“what would happen with this choice”? “How might I feel”? And, now, “how do I carry
out the best choice”?)
4. Planning to use the selected solution.
This step involves monitoring and evaluating the consequences of the actual
outcome after a solution plan is carried out (Donohue & Fisher, 2009). (e.g. “how did
that choice work”? “Should I make another choice next time”? (Dobson, 2001).
For example a subject may use problem solving as follow:
1. I do not understand maths.
2.
(a) Try hard to understand the logic of maths, (b) avoid subjects which involve, (c)
discontinue schooling, (d) join other classmates who have same problem, (e) make a
new friend who is good at maths. Explain to him the difficulty he encounter in
understanding maths and the feeling attached with it, (f) take extra tuition to learn
maths.
3.
If I select the first four choices their consequences would not be good, but the last
two alternatives may lead to better results (evaluation).
4. Ok, I have decided to enhance my maths ability and explain to them about their
views and select the best positive alternative.
Module eight: Assertive imaginary
Rationale:
Nonassertive students built up a lot of resentment in school and home. Non
assertiveness in everyday relationships produces more resentment and alienation in the
long run than being assertive. In contrast, assertive responses not only preserve their self135
respect but also facilitate good communications, which is essential for mutual satisfying
relationships.
Objective:
Help the students to express their rights, thoughts and feelings in a direct way
without violating the rights of others. Helps in overcoming inferiority feeling, boost, selfimages, enhances succeed feelings.
Components:
First stage: identify your level of assertiveness. Some of activities, feelings and behavior
are to be known as the level of assertiveness in individual. For example how comfortable
do you feel about activities such as:
Refusing requests of others.
Expressing your negative feeling like annoyance, anger or displeasure to others.
Expressing positive feelings, giving and receiving compliments.
In initiating and maintaining conversation with others.
Stand up for your right with the people around you at school and home.
Second stage: draw up a hierarchy of difficulties and priority. Prepare a list to identify
problem area and the level of difficulty in handling the situation. Then you should
identify the short term and long term goals.
Third stage: start systematic assertive training skills. These training can be several in
numbers as per the demands of the situation.
Repetitive emphasis on your desired point: learn skill of calm repetition. What you want
to say over again and again without manipulating the verbal side. Avoid argumentative
bating and irrelevant logic while achieving your desired points.
Accept clarity and be your own judge: never acknowledge manipulative criticism by
others calmly as the acceptance may strengthen your critics that something is doubtful or
true. Be your own judge for what you do. This will allow you to receive criticism
comfortably without becoming anxious or defensive.
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Assertion of negative things in your behavior: hostile and constructive criticisms of your
errors and faults or negative qualities by others should be accepted sympathetically but
without apology.
Negative inquiry: promote criticism if it is helpful to give you more information or
exhaust it if it is totally manipulative. This way of negative inquiry will allow your
critics to be assertive and less dependent on manipulative game. Others will be
encouraged to express their honest negative feelings rather than manipulative.
Use non-verbal communication: to be assertive establish a good eye contacts, stand or
sits comfortably, talk in an assertive statement , cooperation and emphasis should be
used, such as I feel; I think; I want; show assertiveness, let us, we would; show
cooperation, and what do you think, what do you feel and etc.
Avoid inappropriate anger and hostility: the action of pointing finger, glaring eyes, and
an angry or loud voice show aggression of individual. Indirectly aggressive behavior
uses the language of non-assertive behavior either by body posture or by words.
Forth stage: start rehearsal the appropriate behavior. Set a realistic goal to be achieved,
as without this it will not be possible to change your behavior into assertive behavior.
Built up success gradually, step by step, learning to be more assertive in minor problem
area to more difficult situations.
Fifth stage: transfer of learned behavior. The worth of the training is if learned behavior
is properly transferred at its needed place that is either home or school. Keep a daily
record of what happened and how you behaved. It is then possible to evaluate the
progress (Khokhar, 2003).
Module nine: Time management and study skills training
Students have taught how to manage their time (time management training) and
how to study effectively (study skills training).
Time management training
Rationale:
Generally most of students do not know how to manage their time effectively.
The value of time management is not control of time per se, but the way person can use
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time to improve their life (Mackenzie, 1990). Time management leads to success by
reducing stress, maintaining balance, increasing productivity and also setting and trying
to reach goals. From this broadened perspective, students can see that the real value of
time management is that it enhances their lives in all dimensions (Alay & Kocak, 2002).
Objective:
To teach and train students about the best use of time that is under their disposal.
To keep a time program for the students so that they learn what are the best ways
to utilize their time.
Components:
Managing of time well is an important element of success — especially for the
students.
1. Make a To-Do List Every Day: Put things that are most important at the top and do
them first. And don't forget to reward yourself for your accomplishments e.g. assignment
and homework.
2. Use Spare Minutes Wisely: When you’re commuting on the bus or taxi, use the time to
get some reading done.
3. It is Okay to Say No: If your friend asks you to go to a movie on a Thursday night and
you have an exam the next morning, realize that it's okay to say no. Keep your short- and
long-term priorities in mind.
4. Find the Right Time: You'll work more efficiently if you figure out when you do your
best work. For example, if your brain handles maths better in the afternoon, don't wait to
do it until late at night.
5. Review Your Notes Every Day: Reviewing helps you reinforce what you've learned, so
you need less time to study before a test.
6. Get a Good Night's Sleep: Your brain needs rest to perform at its peak. Lack of sleep
makes the day seem longer and your tasks seem more difficult.
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7. Communicate Your Schedule to Others: If phone calls or text messages are proving to
be a distraction, tell your friends that you are only available at certain times of day and
not to expect a response at other times.
8. Become a Taskmaster: Give yourself a time budget and plan your activities
accordingly. Figure out how much free time you have each week before you add any
commitments.
9. Don't Waste Time Agonizing: Instead of agonizing and procrastinating, just do it.
Wasting an entire evening worrying about something that you're supposed to be doing is
not productive, and can increase your stress.
10. Determine Your Priorities: You can’t do everything at once. Establish the
importance of each item. Then set realistic goals that are attainable.
Study skills training
Rationale:
Study skills training is have interconnected with time management. If the
students do not have good time management skills, they will not study enough. If they
don’t have good study skills, they will waste their time. Once they learn how to study
effectively, they will find that they have more time left to pursue extracurricular
activities; not only they will have extra time, but also they will be stress free since they
won’t be worrying about the things they have to do (panel, 2002).
Objective:
Help the students to learn good study habits.
In this session students are trained in the PQ4R program of study skills (formulated
by Thomas and Robinson, 1972). This strategy will improve the student's reading
comprehension. PQ4R is an acronym for Preview, Question, Read, Reflect, Recite, and
Review. Here are the steps:
1. Preview: Look through the pages of your reading passage and read the headings of the
chapter and any section dividing the chapter. Read the first and last paragraph in each
section. View the illustrations in each section. Read the captions under the pictures and
take a few minutes to look at charts, graphs, or maps.
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2. Question: Think about the information you learned in the Preview. Ask yourself
questions about it. Think about what you already know about ideas you saw during your
Preview. What do you think are main points that will be raised in the chapter? What do
you expect to learn from reading this material?
3. Read: Read the passage. If there are ideas seem important, make a note of them on
paper. If the book belongs to you, consider making notes in the margins and highlight
important parts in the book. If you just can't imagine writing in your book, make notes on
paper.
4. Reflect: Take time to reflect on what you have read. How are the passages or chapters
inter-related? How does the information fit into things you have already learned? What
new information did you learn? Did the passage include the information you expected it
to cover? Was there information that surprised you?
5. Recite: Think about the material. Discuss it with someone else or write down the main
points you learned. Generally, writing information down by hand will improve memory
of the material. If writing is a problem for you, consider brief notes or discuss the
material with other students. It is important to summarize the material in writing using
your own words. Explain it aloud to someone else or recite your notes aloud to yourself.
Consider using a graphic organizer to increase your understanding of how concepts in
the reading relate to each other.
6. Review: Consider the main points of the material. Were your questions answered? Do
you feel that the writer's points are fully understood? (Kihlstrom, 2011).
Session 10: The final session, involved summing up the previous sessions. Advice was
given regarding the steps to be taken to prevent further difficulties and planning how to
overcome such difficulties. Eliciting the feedback from students, discussed about the
goals achieved. In this session students were explained about everyday use of the
techniques learnt in order to prevent the relapse of stress and depression symptoms.
Session was terminated by thinking the students, parents and school administration. This
session was carried out in group.
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Phase III: Post assessment
After two weeks of the therapy, post-test was done individually. Once again,
academic stress, depression, and self-efficacy questionnaires were administered on both
experimental and control groups.
Ethical issues
1. Written informed consent was obtained from each subject participating in the study
(Appendix-I).
2. Confidentiality was assured and maintained.
3. Participants were explained about the nature of the study and participation in the study
is voluntary and they have the right to discontinue at any time.
4. Participants who did not meet the study criteria (cut off score criteria used in the
present study) were offered necessary help such as psycho-education, breathing
exercise and counseling done on voluntary basis.
Statistical Methods
In the present study to analyze the data, statistical methods such as descriptive
statistical methods (e.g. graphs, mean and standard deviation) and inferential statistical
techniques (e.g. coefficient of correlations to analysis of demographic data, independent
t-test to compare of the pre-post mean scores between experimental and control group;
repeated measure analysis of variance to assess the effects of CBT, and effect size
calculation in order to determine the portion of independent variables in explanation of
variance of dependent variables or to determine the magnitude change occurred due to
the applied interventions) were used. Also, data was analyzed with the statistical package
of software system -16 for windows.
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