.mnnuwumuﬁ;

.4
.x A I u
. $3,.
5.3.? .s
9
r

1!.“ LM

{:2

5.5190.

‘s,:
mu.

m 4.
u... :5.‘.

71.:

\.. a:

4.3 1.5....
.2 a.
t . . rxr {rte}

. z

. .
:5: \t is.
:2 sax:

A: ...,.C

a
: 52‘ , v.
33:92.}:
5 t

it.- w-

 

.Ssl... .1: Y‘ I .
rah?- ...‘1.$.I DL
.v\)1....n :29:

‘ALMVHMHF

11,

:35: In.

I r £253.”.
.. 155.9.

:r .

.23.?!) r:

.vvx a:
I

.{X a .33»,
1:. 1i...»

1....hvuhl
r I; ‘34....»
.(i x r

‘ _
.. x. 511.31:
ri} 5.3.1... JP
(33??)

"if...
Q ‘F¢.\-vv«
3.1.. .

.-

.. 1.33:3 Ila
:17}!!! .3... 7‘
$1.. I}:

. 3

5|
um"...
.I.. 2".le l .l

1.11?!
o)

.m‘l‘
my.

if.» 7y .
P 1.9 {3-741

.‘33; .v: .

y“ u-
>10"?

'i

‘ ... . T ..
. .. n . .«y. .‘Dllv-buiv
1:... :Y ., .13....31 .Nyrilu II
15:91.3: .1 .

“lllllll‘Wlllﬂl'

2000

 

LIBRARY
Michigan State
University

 

 

 

This is to certify that the

dissertation entitled

AN ANALYSIS OF THE THERAPEUTIC PROCESS OF DOSA THERAPY

presented by

Noriko Kubota

has been accepted towards fulﬁllment
of the requirements for

Ph. D. degreeiqSQCJ'aLSLlen’ ce

 

AMA

Major professor

 

Date w

PLACE iN RETURN BOX to remove this checkout from your record.
TO AVOID FINES return on or before date due.
MAY BE RECALLED with earlier due date if requested.

 

DATE DUE DATE DUE DATE DUE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11/00 cJCIRCIDatomes-p, 14

AN ANALYSIS OF THE THERAPEUTIC PROCESS OF DOSA THERAPY

Noriko Kubota

A DISSERTATION

Submitted to
Michigan State University
in partial fulﬁllment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

School of Social Work
College of Social Science

2000

ABSTRACT

AN ANALYSIS OF THERAPEUTIC PROCESS OF DOSA THERAPY

By

Noriko Kubota

This dissertation aimed to examine the effectiveness and the therapeutic process
of Dosa therapy, a body-oriented psychotherapy which was developed in Japan, as an
intervention tool for social work practice in order to facilitate individuals psycho-social
well-being. Dosa means motor action in Japanese. Dosa therapy uses voluntary
movement to bring about changes in a person’s behavior and psychological ﬁmctioning.
Clinical studies have reported supportive results to work with individuals with
schizophrenia, obsessive-compulsive disorder, anxiety disorder, hyperventilation,
psychosomatic disorder, and depression. These clinical studies were small-scale studies
and almost exclusively employed a case study method.

This dissertation study was undertaken in an effort to further research about Dosa
therapy. Speciﬁcally, Dosa therapy was used with American individuals with anxiety
problems to examine the effectiveness with individuals other than Japanese. Systematic
observations were conducted by using single subject methodology to examine the effect
of Dosa therapy on the participants’ behavior, anxiety level, experiencing, self-efﬁcacy,
and locus of control. In addition, the underlying mechanism by which Dosa therapy

operates was explored by using a task analysis approach.

Five female graduate students who had an anxiety problem participated in this
clinical study. The intervention with the relaxation Dosa exercise for the upper body
(kukan-hineri) was implemented for seven or eight sessions after the three or four
baseline sessions.

It was found that, as a group, albeit small, the participants’ experiencing level
became signiﬁcantly deeper, that the participants’ anxiety decreased signiﬁcantly and
their behavior changed in an expected direction, that the participants became signiﬁcantly
self-efﬁcacious and their locus of control became more internal. When examined
individually, all participants showed changes in their experiencing level of functioning,
however, the effect on their behavior, anxiety level, self-efﬁcacy and locus of control
were clear with four participants. Since the Dosa exercise was the only element which
was added in the intervention phase, these results indicate that Dosa therapy appeared to
have an effect on the changes in the participants’ experiencing, behavior, cognitive, and
affective functioning. Analysis with a task analysis approach revealed the process that a
Dosa task was resolved and based on this performance process, the internal operations
which produced overt performance were inferred. Based on this analysis, it was surmised
that through Dosa exercise, the participants obtained a functional Dosa operational
system, where they felt that they could move their body voluntarily and internalized a
functional, realistic body image. This change in perception of themselves as well as the
relaxed state of mind might have led them to perceive the situation and the events
differently and generated the changes in behavior and psychological functioning. Further

research is needed to replicate these results.

€0pyright by
NORIKO KUBOTA
2000

ACKNOWLEDGEMENTS

My dissertation journey has come to an end. It has been a long, sometimes
overwhelming process. I sometimes found myself completely lost in an unpredictable
process and was paralyzed by thinking weather or not this work really was deserving of a
degree. I started to put ideas together for this ﬁnal project of my studies in the doctoral
program during the winter of 1999, had my proposal meeting last June and ﬁnalized the
proposal in the summer. After receiving approval from the University Committee on
Research Involving Human Subjects in early September, recruitment for the participants
in the study was started. I worked with the individuals who participated in this study
during the fall semester. In the winter of 2000, I started to process and analyze the data.
By the time I started to write it up, the snow was gone and the ﬂowers were in bloom. My
anxiety level was high at the time of defense of my dissertation, but I survived it. I
worked hard and carefully in each step I went through.

Throughout this whole process, the members of my dissertation committee, four
unique, brilliant scholars, were behind me, guided and supported me. I deeply appreciate
the guidance from Dr. Rena Harold as the chairperson of my dissertation committee. She
was open to accept my idea of conducting a clinical study on an intervention technique
which was developed in Japan that she had never heard of before. She has been ﬂexible
and precise when providing feedback. I was always amazed by the insightful and
intelligent comments she gave me on my drafts. She was so caring and provided me a
safe environment and at the same time she believed in me and prompted me when I

became paralyzed in the middle of the process, which helped me make up my mind and

do my job. I trusted her words and just did what I had to do. She is a role model that I
emulate as a teacher and a scholar. Dr. Victor Whiteman helped me so much during the
data processing and analysis. He listened to the preliminary ﬁndings and gave me
productive feedback. Dr. Martha Ewing has been supportive throughout the process and
gave stimulating comments on my ﬁndings. I felt that she is always interested in her
students’ growth as a person and a professional. Dr. Don Hamachek guided me in a
slightly different way, by challenging me and my ideas. To be honest, I was scared at
ﬁrst. However, I want to thank him for the way he taught me because his challenges
really made me think and work hard to clarify some important points in my study.

I owe thanks to Drs. Ellen Whipple and Lucy Mercier. They kindly allowed me to
visit their class to recruit the volunteers for this study. I owe special thanks to Professor
Jo Ann McFall. She supervised me during the therapy period and helped me make
arrangements for the space to conduct the interviews. I felt that I had her as a ﬁfth
member of my dissertation committee. I appreciate the support for my study ﬁom Dr.
Gary Anderson, the director of school of social work. He allowed me to use the ofﬁces of
school of social work to conduct the interviews for my study and provided the parking
permits for the participants.

I want to thank the participants in my study. They were brave enough to work
with me as a therapist. They taught me many things and helped me grow as a clinician. I
really enjoyed working with them.

I received excellent professional assistance from Dr. Randall Fotiu, a statistician
at the computer center, Dr. Connie Page, a professor at the Department of Statistics, and

Mr. Linyuan Li, a graduate consultant at the Department of Statistics. Dr. Fotui was kind

vi

enough to actually sit with me at a computer lab and to show me how to run a statistical
test to analyze my data. Dr. Page and Mr. Li provided their expertise to ﬁnd a suitable
statistical analysis for my less than conventional research design. Without their
professional assistance, I may be still wandering around on campus with the raw data in
my hand. They are wonderful resources on campus. I would like to thank Professor
Kiyosho Ohno, at Otsuma University in Tokyo, for the comments he gave me on the
interpretation of the results. He listened to my ideas and gave me excellent feedback
when I called him early morning or late at night. I also appreciate Dr. Marjorie Klein, at
University of Wisconsin, for the suggestion she game on the data analysis. I only knew
her through her research. However, when I sent an E-mail asking for her suggestion
regarding my data analysis, she immediately responded to my question and provided me
a helpful opinion.

Several other individuals helped me. Linda Lane, a fellow doctoral student,
worked with me on the data processing. She and I went through an eight-week training
and worked as independent raters for one of the measurements used in this study. I truly
enjoyed working with her and she listened patiently and understandingly to what I had to
say when I felt overwhelmed by the amount of work to be done. Peg Whalen, a fellow
doctoral student, helped me draw professional graphs to present the results. Judy
Berglund, a fellow doctoral student, proofread the drafts and corrected the editorial
mistakes. I have to confess it was not easy to write a dissertation in a foreign language.
Larry Graber, a doctoral student at University of Southern California, read my proposal
and gave me helpful feedback. As a clinician who is interested in body-oriented

psychotherapies, he provided insightful opinion during the therapy.

vii

Finally, but not the least, I appreciate my family and friends who gave me
unlimited support and encouragement during this long, stressful process. My parents
probably have no idea what I have been through, however, they always trusted me and
supported my decision. I want to thank Dr. and Mrs. Tom and Jane Johnson. They took
me under their wing when I came to the United States and provided me a wonderful,
family-like environment. The beautiful nature around their home and their animals helped
me maintain my sanity.

Now I have come to the end of my study. I am ready to go out in the real world, to

have new experiences and to develop both personally and professionally.

viii

TABLE OF CONTENTS

LIST OF TABLES ........................................................................................... xii
LIST OF FIGURES ........................................................................................ xiv
CHAPTER 1
INTRODUCTION ............................................................................................ 1
Experience: Common Therapeutic Factor ............................................ 2
Role of Body in Psychotherapy ............................................................ 5
CHAPTER 2
REVIEW OF THE LITERATURE .................................................................. 8
Historical Background of Dosa therapy ................................................ 8
Dosa Training ...................................................................................... 14
Model of Dosa Process ....................................................................... 16
Evolution of Dosa Training ................................................................ l9
Dosa Therapy ...................................................................................... 24
Task Achieving Approach ...................................................... 25
Therapeutic Factor .................................................................. 29
Empirical Studies on Dosa Therapy ................................................... 32
Experimental Studies .............................................................. 32
Clinical Studies ....................................................................... 36
Hypotheses and Research Questions .................................................. 42
CHAPTER 3
METHODOLOGY ......................................................................................... 44
Overview ............................................................................................. 44
Single-Subject-Design ............................................................ 45
Task Analysis Approach ......................................................... 47
Recruitment of Participants ................................................................. 51
Participants .......................................................................................... 53
Design ................................................................................................. 57
Intervention ......................................................................................... 58

ix

Instrumentation ................................................................................... 59
Questionnaire for Anxiety Problem and

Background Information ......................................................... 59
Clinical Anxiety Scale ............................................................ 6O
Behavior Record Form ............................................................ 60
Experiencing Scale .................................................................. 60
Self-Efﬁcacy Scale .................................................................. 61
Belief in Personal Control Scale ............................................. 62
Therapy Session Record Form ................................................ 63
Questionnaire for Somatic Awareness .................................... 64
Questionnaire for Relaxation Strategies ................................. 64
Session Evaluation Questionnaire ........................................... 65
Questionnaire for Therapy Experience ................................... 65
Procedures ........................................................................................... 66
CHAPTER 4
RESULTS ....................................................................................................... 69
Preliminary Analysis ........................................................................... 69
Reliability of the measurements .............................................. 69
Segment Identiﬁcation for EXP .............................................. 70
Test of Autocorrelation ........................................................... 71
Therapeutic Effect on Variables ......................................................... 73
Anxiety .................................................................................... 73
Behavior .................................................................................. 78
Experiencing ........................................................................... 84
Self-Efﬁcacy ........................................................................... 91
Internal Control ....................................................................... 93
Therapeutic Effect on Each Participant .............................................. 95
Participant 3 ............................................................................ 95
Participant 6 ............................................................................ 97
Participant 7 ............................................................................ 99
Participant 8 .......................................................................... 101
Participant 9 .......................................................................... 103
Therapeutic Process .......................................................................... 106
Description of the Task and the Task Environment .............. 106
Rational Analysis .................................................................. 107
Empirical Analysis ................................................................ 108
CHATER 5
DISCUSSION ............................................................................................... 120
Major Findings .................................................................................. 120
Therapeutic Effect ................................................................. 120
Therapeutic Process .............................................................. 128

Limitations of This Study ................................................................. 130

Delimitation .......................................................................... 1 30
Limitation of Single Subject Design ..................................... 132
Placebo Effect ....................................................................... 135
Attrition ................................................................................. 137
Baseline ................................................................................. 143
Measurement ......................................................................... 144
Implications of This Study ................................................................ 146
Cross-Cultural Relevance ..................................................... 146
Implication for Theories of Social Work .............................. 148
Implication for Social Work Practice and
Program Development .......................................................... 149
Implication for Social Work Research .................................. 151
Directions for Future Research ......................................................... 153
APPENDICES
A. Handout for Participant Recruitment ........................................... 158
B. Consent Form for the Screening Interview .................................. 160
C. Consent Form for the Three-week Baseline Group ..................... 163
D. Consent Form for the Four-week Baseline Group ....................... 166
E. Questionnaire for Anxiety Problem and
Background Information .............................................................. 169
F. Clinical Anxiety Scale .................................................................. 172
G. Behavior Record Form ................................................................. 174
H. Experiencing Scale ....................................................................... 176
I. Self-Efﬁcacy Scale ........................................................................ 178
J. Belief in Personal Control Scale ................................................... 180
K. Therapy Session Record Form ..................................................... 182
L. Questionnaire for Somatic Awareness ......................................... 184
M. Questionnaire for Relaxation Strategy ........................................ 186
N. Session Evaluation Questionnaire ................................................ 188
O. Questionnaire for Therapy Experience ........................................ 190
REFRENCES ................................................................................................ 192

xi

10.

LIST OF TABLES

Participants’ Anxiety Problem, Anxiety Score,
Disturbance Level and Extent of Participation ................................... 54

Lag l Autocorrelations of the Baseline Phase

on the Anxiety Scale (CAS), the Self-Efﬁcacy Scale (SES),

the Locus of Control Scale (PBCS), the Experiencing Scale (EXP),
and the Behavior Observation ............................................................. 72

Lag 1 Autocorrelations of the Intervention Phase

on the Anxiety Scale (CAS), the Self-Efﬁcacy Scale (SES),

the Locus of Control Scale (PBCS), the Experiencing Scale (EXP),
and the Behavior Observation ............................................................. 72

Contrasts of Anxiety Score between the Baseline and
Intervention Phase ............................................................................... 74

Mean Anxiety Scores in the Baseline and Intervention Phase,
Effect Size, and T Values .................................................................... 75

Means of Target Behaviors in the Baseline and Intervention Phases .79

Contrasts of Modal Experiencing Level between the Baseline
and Intervention Phase ........................................................................ 85

Means of Modal Experiencing Level in the Baseline and
Intervention Phases and T values ......................................................... 86

Contrasts of Peak Experiencing Level between the Baseline
and Intervention Phase ........................................................................ 87

Means of Peak Experiencing Level in the Baseline and
Intervention Phases and T values ......................................................... 88

xii

11.

12.

13.

14.

15.

Means of Number of Somatic Sensations, its Noticeability and
Hedonic Valence ................................................................................. 89

Contrasts of Self-Efficacy Score between the Baseline
and Intervention Phases ...................................................................... 92

Mean Self-Efﬁcacy Scores in the Baseline and
Intervention Phases, Effect Size, and T Values .................................. 93

Mean PBCS Scores in the Baseline and Intervention Phases,
Effect Size, and T Values .................................................................... 94

Behavioral Indices of Each Step of Dosa Performance Process ....... 109

xiii

10.

11.

LIST OF FIGURES

Diagrammatic description of Dosa Process ........................................ 14

Model of Dosa Process to describe the relationship between

psychological, neurological, and musculoskeletal systems ................ 17
Timeline of the study .......................................................................... 58
Schedule of instrument administration ............................................... 68
Anxiety Scores for Group 1 (Participants 3, 7, 8) ............................... 76
Anxiety Scores for Group 2 (Participants 6, 9) ................................... 77
Target Behaviors for Group 1 (Participants 3, 7, 8) ........................... 81
Target Behaviors for Group 2 (Participants 6, 9) ............................... 82
Rational Performance Model Based on Idealized Client .................. 108
Revised Performance Model ............................................................. 1 18
Preliminary Operations Model .......................................................... 1 l9

xiv

CHAPTER 1

INTRODUCTION

Social work has adopted the person-in-environment theory as one of its core
theoretical frameworks. This theory has as its goal understanding individuals within their
environment and the social systems that inﬂuence their behavior and are, at the same
time, reciprocally inﬂuenced by them (Pinkus, Haring, Lieberman, Mishne, & Pollock,
1977; Richmond, 1922). In practice, social workers aim to enhance and maintain the
psychosocial functioning of the client system. In doing so, social work endorses the
dignity of the individual and self-determination as core values of social work practice
(Compton & Galaway, 1994).

As intervention techniques to achieve the aforementioned goal, social workers
utilize various approaches that address interpersonal interactions, intrapsychic dynamics,
and life-support and management issues (Brandell, 1997; NASW, 1989). Psychotherapy
is one form of intervention frequently used in micro-level social work practice
(Wakeﬁeld, 1988). Shaffer (1947) stated that psychotherapy is a learning process through
which an individual acquires an ability to speak to him/herself to control his/her behavior.
Frank (1974) argued that the primary function of psychotherapy is to restore the client’s
sense of mastery. The common theme of their statements can be restated that the goal of
psychotherapy is to maximize an individual’s welfare by enhancing and maintaining
his/her agency and autonomy in the context of the social environment (Garﬁeld &

Bergin, 1986). In this respect, I believe that psychotherapy is compatible with social work

goals and values and is a useful and legitimate intervention tool for social work practice.

The evaluation of the effectiveness of practice is a major way that clinicians
enhance their knowledge and hone their skills (Hartman, 1994). Practice evaluation is
also important for every professional to build a sound, accountable practice foundation
(Bloom, Fisher, & Orme, 1995; Barlow, Hayes, & Nelson, 1984; Videka-Sherman &
Reid, 1988). Based on this understanding, this dissertation study aimed to investigate the
effectiveness of Dosa therapy, a form of body-oriented psychotherapy, as a tool of social
work practice. I hope this study shortens the distance between clinical work and research

and provides a way to incorporate an evaluative means into practice of Dosa therapy.

Experience: Co_mmon themutic factor

Researchers/clinicians of different psychotherapeutic orientations have
emphasized the client’s experience in the therapeutic interaction as a common factor for
psychotherapeutic change (Arkowitz & Hannah, 1989; Gendlin, 1979; Goldfried, 1980).
Gendlin (1979) deﬁnes experiencing as an inner referent and argues that access to the
inner referent facilitates the psychotherapeutic process. In other words, successful therapy
brings a person closer to his/her ongoing, bodily, felt ﬂow of experiencing, makes
him/her more aware of his/her experiencing, and makes them act and think based on this
direct datum (inner referent) (Klein, Mathieu, Gendlin, & Kiesler, 1969). Goldfried
(1979, 1980) pointed out that therapists need to know something about an experiential
referent to understand the meaning of the client’s word or narrative and argued that
providing new, corrective experiences is a common strategy among psychoanalytic,

behavioral, and humanistic psychotherapies.

Researchers of client-centered therapy originally focused on clients’ experiences
in the therapy sessions (Gendline, 1962; Rogers, 1959). Rogers (1959) addressed
experience and deﬁned it as everything that is going on in a person at any given moment
which is potentially available to awareness. Experience, as a verb, can be deﬁned to
receive in the organism the impact of the sensory or physiological events that are
happening at the moment. In other words, it is a process of symbolization with some
degree of accuracy, of those sensory or visceral events at the conscious level. Thus, the
internal, phenomenological quality is the primary feature of this concept. Rogers was
interested in clients’ experiences in order to clarify the phenomenon of incongruence
which he deﬁned to be a discrepancy between awareness and experience because he
hypothesized that incongruence is one origin of psychological problems or disturbances.

Along with the theoretical development, the Experiencing scale (EXP) was
constructed to operationalize the concept and to conduct empirical studies (Klein,
Mathieu, Gendlin, & Kiesler, 1969). The ﬁrst study concerned with the changes in
expressed experiencing was conducted by Gendlin, Jenny, and Shlien (1960). They
looked for an association between outcome and the patient’s manner of experiencing.
They found that successﬁil clients moved from remotely talking about feelings to more
directly expressing them. These individuals also became more able to see the relationship
with the therapist as an important new experience and came to see a parallel between
present experiences of the relationship with the therapist and problems experienced in
other contexts. These ﬁndings supported the hypothesis of experiential involvement and

shifts as prominent factors in the successful outcome of psychotherapy.

Several more studies were conducted by using EXP to investigate the relationship
between the client’s experiencing level and outcome and other therapy variables (Karon
& O’Grady, 1969; Karon & VandenBos, 1970; Kiesler, 1969; Kiesler, Klein, & Mathieu,
1965; Rogers, Gendlin, Kiesler, & Truax, 1967; Ryan, 1966). In general, these studies
showed that the experiencing level is consistently related to the type of the client’s
disturbance and to outcome. For example, Kiesler, Klein, and Mathieu (1965) compared
the EXP level between schizophrenic, neurotic, and normal subjects and found that
neurotic subjects had a higher EXP level than either schizophrenic or normal subjects.
They surmised that the experiencing level of the neurotic subjects were higher than those
of the schizophrenics and the normal subjects because they were less disturbed than the
schizophrenics and more motivated for therapy than the normal subjects. Kiesler (1969)
found that more successful patients show higher EXP levels compared with less
successful patients. EXP is also associated with initial client factors such as motivation
for therapy or readiness to perform skills relevant to therapy, and with the quality of the
therapist’s performance. For example, Rogers et al. (1967) found that the EXP level was
associated with absence of depression at the beginning of therapy, with high verbal
ability, and with high verbal productivity and expressiveness. It was also revealed that the
EXP level was related to the therapist’s accurate empathy which was rated by
independent judges. Karon and VandenBos (1970) found that EXP level was related to
therapist warmth.

As for the changes of the experiencing level over the course of treatment, the
results were more complex. However, general trends revealed the following. Rogers,

Gendlin, Kiesler, and Truax (1967) looked at the difference in the EXP trends between

the more successful and less successful schizophrenics. The results showed that the EXP
level stayed higher with more successful patients, whereas the EXP level was constantly
low with less successful patients. It was also found that more successful patients had
smoother trends with less backsliding and more consistently maintained their initial
levels. The results of Ryan’s study (1966) revealed that the general trend for the more
successful therapy group was up and that for the less successful group was down.
Therefore, the experiencing level over the course of treatment is also associated with

therapy outcome.

Role of Body in Psychothegpy

In order to access the experiential level of functioning, therapists of some
modalities of humanistic psychotherapy incorporate techniques that address the client’s
bodily awareness or somatic sensations in therapy. For example, Gendlin (1986)
developed a technique called “focusing” in order to focus on internal experiencing.
Kepner (1987) incorporated body-oriented techniques in his practice of Gestalt therapy in
order to enhance self-awareness.

A focus on the body in psychotherapy can be found earlier than those interests of
researchers/clinicians in humanistic/experiential psychotherapies. Wilhelm Reich, M.D.,
(1897-1957) was a pioneer in the western culture who focused on the body in
understanding a person’s problem and actively used body movement in an attempt to
solve psychological problems. As a student of Freud, he focused on libido as essential to
human functioning and this focus evolved into a notion of orgone energy which he

thought to be an actual body energy. He conceptualized neurosis as the physical blockage

of the ﬂow of orgone energy in the body. He saw a parallel between such rigidities in the
body and rigidities in mind, reﬂected in ﬁxed ways of thinking about one’s self and one’s
world, accompanied by other forms of thought disturbances. Reich focused not just on
what people said, but also on how they said it and what their body did when they spoke.
He thought these defensive body-mind patterns, which he called ‘armour’, were created
based on childhood experiences (Reich, 1972). In order to release those rigidities, Reich
developed techniques to work with the body by focusing on posture, muscular tension
and breathwork (West, 1994). His therapy was known as Reichan Therapy and his
students developed their own form of body-oriented psychotherapy based on Reich’s
original ideas. These include Bioenergetics (Lowen, 1976), Core Energetics (Pierrakos,
1987), and Biosynthesis (Bodera, 1986).

The body is also addressed in various forms of relaxation strategies or
interventions to facilitate self-control ability in cognitive-behavioral therapy. For
example, relaxation techniques such as progressive relaxation (Jacobson, 1974),
biofeedback (Schwarts, 1973), autogenic training (Schultz & Luthe, 1959), and
meditation (Shapiro, 1980) emphasize the utility of relaxation responses as an alternative
to anxiety reactions (Kazdin, 1984). Wolpe (1976) developed systematic desensitization
and incorporated relaxation techniques to reduce anxiety. Goldfried (1971) used Wolpe’s
systematic desensitization not just to regulate the physiological arousal of anxiety but
also to develop a coping strategy for anxiety and called this therapy, coping skills
training. In these therapies, the physiological aspect of relaxation responses is mainly

focused and considered a counter-response to anxiety.

In sum, the body has been addressed in various forms of psychotherapy, although
the degree of focus on the body, the theory about the role the body plays in the etiology
of problems, how the body is used in bringing about change, and the conceptualization of
the underlying mechanism, varies depending on the basic assumptions or theory of each
form of psychotherapy. However, there is one common thread which is that the body and
mind function in synergy by interacting with each other.

A body-oriented psychotherapy was developed in Japan, separate from the above
trends and inﬂuences. This therapy is called Dosa Therapy (Naruse, 1973, 1992) and has
been applied in various clinical settings to help individuals cope with their problems.
Case studies have been conducted to examine its effectiveness with various client
populations in Japan and supportive results have been reported (F ujioka, 1987;
Hoshikawa, 1992; Kubota, 1991; Ogawa, 1992; Shimizu, 1992; Tsuru, 1982).

This dissertation study centers on the investigation of the therapeutic process of
Dosa therapy. Speciﬁcally, a cross-cultural examination was conducted by using Dosa
therapy with Americans to examine if it works with individuals who are not Japanese. A
systematic observation was conducted by using a single subject design to evaluate
effectiveness of Dosa therapy as an intervention technique in clinical practice. In
addition, the therapeutic process was analyzed by using a task analysis approach to
investigate the underlying mechanism of change by which Dosa therapy operates. Based
on these ﬁndings, an aspect of the body-mind connection which is facilitated through

Dosa therapy has been explored.

CHAPTER 2

REVIEW OF THE LITERATURE

Historical Background of Dos_a_ therapy

Dosa therapy is a form of body-oriented psychotherapy developed in Japan. Dosa
means motor action in Japanese and utilizes voluntary movements as a means to bring
about changes in psychological functioning and behavior. This method was originally
developed as a psychological rehabilitation program for people with cereme palsy (CP)
and was called Dosa training (Naruse, 1973, 1985, 1992; Ohno, 1978). Motor difficulties
of people with CP are considered to be caused by the damage to motor areas in the brain.
Conventional rehabilitation programs aim to inhibit abnormal muscle tone and facilitate
normal movement patterns based on neurological understanding (Bellenir, 1997;
Russman & Romness, 1998). A research team in Japan, consisting of psychologists,
addressed the difficulty that individuals with CP have ﬁom psychological and behavioral
points of view and investigated psychological factors that play a role directly in the motor
control process. As a result, they developed a rehabilitation program to remedy the motor
difficulties of people with CP and framed this program as a type of psychological
rehabilitation.

Naruse and his colleagues (1973) conducted a series of studies to investigate the
nature of motor difficulties of people with CP, especially rigid body tension which is a
core impediment to their voluntary movements. They started with in-depth observations
of the motor control patterns of these individuals to perform a simple motor task. When

they had people with CP pick up a glass full of water from a table and drink water ﬁom

it, the requisite body movements for the task such as stretching an arm toward the glass,
grasping it, and bending the elbow toward the mouth, did not occur immediately. Instead
of stretching an arm toward the glass, they started to stiffen their shoulder or whole arm
before actually stretching their arm. Once they managed to stretch their arm, they
overextended it. The movement was reﬂex-like and lacked ﬁne regulation. When they
tried to grasp the glass, the same process was observed. That is, the irrelevant movements
such as bending a wrist or extending the palm occurred before the grasping movement in
the palm was initiated. Once the intended movement occurred, grasping was very strong
as if breaking a glass. The harder they tried to perform the intended movement, the stiffer
their body became. Moreover, once their body became stiff, they could not release the
tension immediately after the task was over. Regarding the experiences while trying to
perform the task, people with CP described that they felt as if their arms and shoulders
moved by themselves. This account suggested that even if it was they who moved their
body, they did not feel those movements as their own. In other words, people with CP do
not have a sense of voluntary control while moving their body (Naruse, 1973).

The researchers summarized their observation as follows: (1) when people with
CP intend to move their body, they tend to tense their body more excessively than
necessary, (2) once they become tense, it is not easy for them to release it, and (3) they do
not have a sense of voluntary control in this process.

Naruse (1973) used an Electromyograph (EMG) to observe objectively the muscle
tone of people with CP performing a motor task. He had healthy individuals and people
with CP press and release a button with their index ﬁnger following the instruction and

recorded the electrical potential of the corresponding muscles. With the healthy subjects,

their EMG showed activity immediately after the instruction to press the button and the
activity disappeared immediately aﬁer the instruction to release it. On the contrary, with
the CP subjects, there was a delay of EMG activity after the instruction of pressing a
button. Once their EMG showed activity, the amplitude was much bigger and less stable
than the ones of their healthy counterparts. Moreover, it took time to disappear after the
instruction to release the button. When instructed to repeat this task, the healthy subjects
showed a regular pattern of heightened and lowered EMG, whereas the EMG of people
with CP showed irregular patterns. Their EMG did not disappear completely after each
trial, maintained active to a certain level, and eventually, there was no difference in the
EMG between the pushing and releasing movement. This EMG pattern clearly showed
the process that the tension was not released completely after each movement and that the
residual tension was accumulated. Therefore, the physiological index supported the
behavioral observation of motor movements of people with CP.

From this observation, it was assumed that the excessive tension in the body
prevented individuals with CP from getting clear sensory information from those parts of
their body. It was surmised that this lack of body awareness might make it difficult to
maintain the balanced tension and relaxation which is necessary for a controlled
movement and as a result interfere with a successive, coordinated movement (Ohno,
1978)

Ohno (1978) examined the development of motor control in children with CP to
investigate how their motor difﬁculties became salient over the course of development.
He interviewed the mothers of children with CP and collected pictures of those children

from an early age, when available. He found that as infants, those children’s limbs and

bodies were generally hypotonic rather than hypertonic and they did not move well.
When those children started to walk and learn motor movements as toddlers and in early
childhood, a tensed movement pattern started to emerge when performing a certain
movement. As they became more active in late childhood, some body parts tended to
become stiffer in a speciﬁc movement and their movements became more unbalanced. In
adolescence, their movements became more rigid and the unbalanced posture became
salient. Based on this data, he speculated that as children with CP grew, their ﬂexibility
of body movement decreased and a tension-relaxation unbalance in their movements
appeared. Those patterns became habitual and a speciﬁc unbalanced body posture
developed. Therefore, rigid tension patterns which cause their motor difﬁculty are
acquired over the course of their development.

Based on these observations, the researchers hypothesized that in the development
of voluntary movement, people with CP learned how to tense their body in performing a
voluntary movement but failed to learn how to relax their body, or it was difficult for
them to learn how to relax their tension due to the impairment of the brain. Thus, the
excessive body tension prevents them from learning ﬁne motor regulation.

The researchers then proposed to view the difficulty in motor movement of people.
with CP on the behavioral level, not just as a result of physiological impairment. By
viewing tension in the body of people with CP as tension behavior, the researchers started
to explore the ways to help people with CP relax the rigid body tension. They also argued
that psychological factors that are directly involved in the motor control process need to
be addressed besides motivation or personality traits which are addressed traditionally in

psychological studies to understand and help people with CP (Ohno, 1978).

Tsuji (1966) used hypnosis to help people with CP relax their body tension and
observed their responses. She found that those people could relax their body tension
under hypnosis and their EMG showed lowered muscle tone. This result was replicated
by other researchers (Kimura & Kobayashi, 1968; Kobayashi, 1966; Naruse, 1967; Ohno,
H., 1967, 1968; Ohno, K., 1968). It was found that people with CP could move relaxed
body parts fairly well under hypnosis. Moreover, relaxation under hypnosis maintained
for a while, although the tension in their bodies returned gradually as time passed. These
clinical experiments suggested that peOple with CP can learn how to relax their rigid
body tension and to move their body and that a psychological technique is useful for this
purpose (Ohno, 1978).

Ftuther examination of relaxation behavior under hypnosis revealed that some
body parts of people with CP did not start to move just by relaxing tension in those parts.
They needed to practice to move those parts after relaxation. And there were some parts
which they could not move no matter how hard they tried. Therefore, it became clear that
while some parts of their body started to move once tension was released, for some parts
correct movements needed to be learned after relaxation, and still there were some parts
which they could not move even aﬁer the practice. The ﬁrst two conditions indicated that
people with CP did not learn the correct movements or learned the incorrect movements
due to the tension. The last condition may be an indication that those parts were affected
by the impairment on the brain. Therefore, it was suggested that difﬁculties in motor
movement of people with CP may be acquired mostly through insufﬁcient learning due to
the physiological impairment and that it is possible for those people to learn the correct

movements under a certain condition (Ohno, 1978).

Based on these ﬁndings, it was hypothesized that the motor difficulties of people
with CP may not be explained completely as caused by the impairment of the brain
(Naruse, 1973, 1992; Ohno, 1978). In other words, their motor difﬁculty may be
understood as a problem of motor control on the behavioral level, which is caused by the
impairment. From this psychological, behavioral point of view, the difﬁculties of those
people are acquired due to their insufﬁcient ability to learn how to relax excessive tension
in their body and to move their body due to the rigid body tension. In other words, the
damage on the brain affects the process of learning how to regulate the movements.

Focusing on the behavioral level, the researchers deﬁned the difﬁculty of people
with CP as the difﬁculty in voluntary motor movement or motor control. That is, they
cannot move their own body in the way they intend. This understanding prompted the
researchers to develop a psychological rehabilitation program, Dosa training, which
focused on helping these people learn to relax their excessive bodily tension and to move
their body with an adequate level of tension (Naruse, 1973; Ohno, 1978).

Based on the understanding of the motor difficulties of people with CP, Naruse
(1973) proposed the concept of Dosa as a process of human voluntary motor movement
in general and intended to depict the motor control process on a behavioral level. He
theorized that the Dosa process is a psychological, self-regulatory process which is
controlled by a person’s higher mental operation and subsumes physiological systems.
The Dosa process is described with three components: intention, effort/striving, and
physical movement (see Figure 1). When we perform any voluntary movement, we ﬁrst
intend to perform a speciﬁc movement and make a plan to do so (Intention). Based on the

plan, we exert efforts to move relevant parts of our body (Striving) to actualize the

13

 

intended movement (Physical movement). When our effort is adequate, an intended
movement results. In this process, a person operates his/her body based on sensory
feedback. In this respect, the Dosa process is an active self-operational process rather
than a merely automatic, physiological process.

Naruse, thus, differentiated the Dosa process from physical movement; the former
focuses on psychological operation during motor regulation, while the latter addresses
neurological and musculoskeletal mechanisms, the hardware of voluntary movement. He
also emphasized the Dosa process as a dynamic interplay between various control
systems which include mental activities concerning motor control, neurological systems,

and musculoskeletal systems.

 

 

 

 

Intention + Striving .5 Physical movement

 

 

 

 

 

 

 

 

Fiw l. Diagrammatic description of Dosa Process

Dosa Training

The original purpose of Dosa training was to help a person with CP learn to move
their body voluntarily and thus improve self-control of motor movements (Ohno, 1978).
Internalizing the operation of initiating and carrying out a speciﬁc movement is a main
focus of the exercises, rather than an actual movement. The therapist assists the client to

practice a target movement by guiding the client’s body with his/her hand. At the same

14

time, he/she provides verbal feedback regarding the movement the client is performing
and/or clues and encouragement while practicing it.

The exercises to practice a speciﬁc movement have been developed. They are
categorized into three types (Naruse, 1973, 1985; Ohno, 1978): (1) relaxation Dosa
exercises, (2) simple Dosa exercises, and (3) integrated Dosa exercises. Relaxation
exercises aim to help a person learn how to relax a speciﬁc part of the body which is
tense or becomes tense in a movement. These exercises consist of (1) relaxation exercises
around the shoulder, neck and arm, (2) relaxation exercises around the lower back and
groin and (3) relaxation exercises around the knee and ankle. For example, an exercise
that moves both shoulders backward while pulling shoulder blades together in a sitting
position is one of the relaxation exercises around the shoulders.

Simple Dosa exercises are designed to practice a single joint movement within the
possible range of motion without a movement in irrelevant parts of the body. The
exercises are grouped into (1) simple Dosa exercises for the neck, shoulders, and upper
limbs, (2) simple Dosa exercise for the groin and lower limbs, and (3) simple Dosa
exercise for the mouth, lips, and tongue. For example, bending or extending an arm
without tension in the shoulder, wrist or hand is designed to practice a smooth arm
movement.

Integrated Dosa exercises are aimed at controlling more complex body
movements in which movements of the whole body are involved. This exercise includes
maintaining a balanced sitting or standing posture, coordinated walking, writing, and
speaking. For example, an exercise to move weight from one leg to the other in a

standing posture is a part of the exercises for coordinated walking.

Model of Dog Process

Naruse (1992) proposed a more detailed model of the Dosa process which
incorporates multiple levels of htunan ftmctioning (see Figure 2). This process includes
the psychological system, neurological system, and physical system as subsystems.
Feedforward processes which are depicted with lines with a right-pointing arrow proceed
from the psychological system to the physical system through the neurological system.
This process is initiated by a person’s intention to make a movement for a certain
purpose. Then a person plans how to move his/her body to meet the intention and strives
to perform an actual physical movement. In other words, in order to perform an intended
movement, a person activates the motor cortex, the neurological system, and the
musculoskeletal system to actualize a speciﬁc movement. A movement which results
through this process is fed back to a person as shown with lines with a left-pointing
arrow. It is also monitored visually regarding how much the resultant movement agrees
with the intention and the plan.

From a physiological point of view, it is explained that a motor movement is
generated by the neurological activities in the motor cortex. However, Naruse believes
that the neurological activities are activated by a person’s psychological activities such as
intention and planning. In this respect, a voluntary motor movement is a psychological
phenomenon as well (Naruse, 1985).

When a person intends to move his/her body and plans how to actualize a given
motor movement, he/she pays close attention to the relevant body parts and operates the
musculoskeletal system to perform the intended movement. This operation is a

feedforward process. In this striving process, psychological operation and physiological

l6

functioning, such as neural and musculoskeletal systems, intersect and work
cooperatively. To perform the intended movement, a person closely monitors his/her
motor movement and makes necessary corrections based on incoming sensory
information. In this respect, the feedback process is also operating. This process also
requires psychological, neurological, and kinesthetic levels of information processing. If
an intended movement results, the task is achieved. If an actual movement is different
from a planned one, a change needs to be made. This is done by modifying operational

strategies based on the sensory feedback.

 

 

 

*Visual Observation r
—>Planning1 l—DPattem Movementri |> Motor Regulation ‘1
Intention ! ;Striving Motor . :Musculo- Joint : Physical

Cortex-g i skeletal Movements; Movements
""""""""""" -S¥$l¢m.-._.-.-.-.-.-.-.-.;
Hatchin Proprioceptive Motor Identiﬁcation 44
Activities
Visual Recognition «

 

 

 

 

Figm 2. Model of Dosa process to describe the relationship between psychological,
neurological, and musculoskeletal systems.

In this respect, the Dosa process is an integrated self-operational process, in which
a person functions proactively in the process. In other words, a person engages in
constant, active information processing by integrating feedback information into a

feedforward operation.

However, we are not always aware of this voluntary, self-regulatory process while
moving our body. For example, when we perform daily activities or well-leamed
behaviors, we tend to focus on a behavioral result and are less aware of the process of
what we are doing to actualize the movement. Therefore, we tend to consider that our
body moves automatically once we think to perform a speciﬁc movement. This is
because the movement has been performed so many times and we do not need to be
aware of each step in order to perform it. However, if we pay attention to the process, we
can become aware of the effort process we used to perform a speciﬁc movement.
Hypnotic responses are another example of a voluntary movement where we lack a sense
of our own movement. When given a suggestion such as, “your arm will move up”, we
feel as if our arm has started to rise by itself, sometimes we even feel that we cannot stop
the movement. This is a nature of suggestion responses. Even if we are moving our arm,
we feel as if it moves automatically. Therefore, the manner of awareness of the motor
control process, that is, how we perceive the movement, can be inﬂuenced by those
factors such as previous learning and the situational demands.

On the contrary, when we learn a new physical skill, such as skiing or playing a
piano, the self-regulatory process of moving our body becomes a focus of our attention
and we are clearly aware of what we are doing to perform a necessary movement.
Therefore, as long as it is a voluntary movement of a living human being, a person’s
psychological operation is involved in the process, however, the level or manner of
awareness of this control process can be inﬂuenced by a person’s internal and/or

environmental factors.

Regarding the place of the Dosa regulation system in relation to the whole human
regulation system, Ohno (1978) considers that the Dosa regulation system and the
psychological regulation system exist under a higher, integrated self-regulation system;
the former involves motor control and the latter, psychological functioning in general.
These two systems are basically independent but operate in synergy to regulate human

behavior.

Evolution of Dosa training

Following the development of the Dosa process, exercises of Dosa training were
used to treat individuals with several different conditions. Konno (1977) applied Dosa
training in order to treat the behavioral problems of a boy with Attention-
Deﬁcit/Hyperactivity Disorder (AD/HD). He aimed to facilitate the child’s attention
focusing and behavior regulation abilities through Dosa training. Besides characteristic
behavioral problems such as difficulty in concentration and impulsivity, children with
AD/HD generally show difﬁculty in motor coordination and tend to tense their entire
body in moving a speciﬁc part of their body, which suggests a lack of differentiation of
body parts. Konno hypothesized that if he could teach this boy how to relax himself, he
might learn how to focus his attention and control his disruptive behaviors. As an
exercise, Konno used one of the relaxation Dosa exercises of an arm which is to move an
arm slowly ﬁ'om side to head in lying on the ﬂoor. When the child tightened his arm
and/or shoulder, the therapist stopped the movement and helped him relax the tension in a

particular part.

19

A supportive result was obtained. By the third session, the child lay down by
himself to start the practice. By the ﬁfth session, the tension in his arm and shoulder
while moving the arm lessened and when it happened, the child relaxed his shoulder and
elbow, saying “slowly” to himself. Along with this progress in the therapy session,
changes in his behavior at home and in the kindergarten were observed. Hyperactive
behaviors lessened and he started to play at one place longer than before. He started to
listen to the teacher’s instruction at the kindergarten and his impulsive, disruptive
behavior also lessened. Then he came to pay more attention to other children’s play and
subsequently started to attend other children’s play. Konno concluded that the Dosa
exercise helped this boy learn self-control. In sum, his hyperactive behaviors lessened
and he came to pay more attention to his environment. This attentional change provided
opporttmities to learn social, interpersonal behaviors.

Konno (197 8) treated ﬁve children with AD/HD with Dosa training and examined
the behavioral change in detail that he observed during the treatment. He used the same
relaxation Dosa exercise as in the previous study. He found that behavioral change of
these children showed a fairly common pattern. At ﬁrst, they showed such behaviors as
relaxing tension intentionally before talking and decreasing impulsive, hyperactive
behaviors. These behaviors suggest that the children were learning self-control. Then
they started to pay more attention to other children’s play, imitate them and partly attend
to their play. Along with those behavioral changes, their speech improved with increased
vocabulary. He posited that the children learned an ability to self-control through Dosa

training. The children became calmer and paid more focused attention to their

20

environment. This change in the quality of attention prepared those children to be ready
to learn social behaviors.

Konno’s studies showed the effectiveness of Dosa training as an intervention
technique to change the emotional and behavioral problems which are typical among
children with AD/HD. The following replication studies started to examine the
effectiveness of Dosa training to facilitate the development and/or adj ustrnent of children
with other types of disability.

Konno, Tanaka, and Ohki (1979) used Dosa training with an autistic child. This
seven-year old boy avoided contacts with people and an eye-to-eye gaze. He engaged in a
repetitive behavior of circling by himself at one place and his vocabulary was limited.
With the intervention of Dosa training, avoidance of social interactions lessened: he
started to come close to his mother and hold hands with other children. The repetitive,
stereotypic behavior decreased. Eventually, he started to interact with other children by
attending to their play.

Tanaka (1982) and Ninomiya and Koshio (1982) used Dosa training with a child
with mental retardation. A case study reported by Tanaka (1982) was of a 4 year-old boy
with severe mental retardation. This boy did not respond to external stimuli such as big
sounds or calling his name nor show any interest in things and people around him. He did
not show any emotional responses to external stimuli or personal contacts. He could sit
up by himself but could not change posture. Mother complained that she did not feel like
she was taking care of a human being because of the lack of responsiveness from her son.
Tanaka used the relaxation Dosa exercise of an arm which was used in Konno’s Study

(1977, 1978). The primary focus of this exercise for this child was to induce his response

21

to the movement in his arm because he did not show any responses behaviorally and/or
emotionally during the practice and let the therapist move his arm. Once he started to
respond to the practice behaviorally such as tightening his shoulder or bending his elbow,
then the therapist applied the procedure to help him relax the tension.

As the practice progressed, the boy started to show emotional attachment to his
mother by extending his hands to her and those emotional responses increased. He started
to show an interest in things around him and started to crawl to reach a toy. He started to
respond to his name and turned and looked at that person who called his name. This case
suggested that Dosa training could facilitate a person’s mental functioning and enable
him/her to respond more actively. It was also suggested that not just relaxation but also
the tension responses, that is the process of responding to one’s body during the Dosa
practice, may be an important, therapeutic experience which leads to a change in
psychological functioning (Ohno, Tanaka, Miyake, & Kobayashi, 1982 ).

A case study reported by Ninomiya and Koshio (1982) was of a 16-year-old boy
who was severely mentally retarded. This boy’s developmental level was four months old
measured by a developmental test for infants. He could walk by himself, however, the
posture was very disﬁgured: His shoulders were lifted, his back became round and his
knees were bent. All daily activities required assistance. He frequently sat aimlessly on
the ﬂoor and engaged in self—stimulating behaviors such as licking his hands and rubbing
his hands together. He did not pay attention to a toy which was positioned in front of his
eyes nor did he respond to his name. He did not show any affective responses toward
people. The treatment with a relaxation Dosa exercise of an arm was conducted over one

year.

22

This boy showed a strong resistance to the physical touch by the therapists.
Therefore, to accept the therapists and the Dosa exercise was a primary goal in the initial
stage of the treatment. Once it was reached, the therapists assisted this boy to release
tension in his arm and/or shoulder while moving his arm. As the exercise progressed, the
following behaviors were observed. He started to show an interest in a toy which was
positioned in ﬁ'ont of his eyes and extended his arm to reach it. He played with a ball in
front of him and watched it while rolling. He also started to lean on the therapist and
smiled at him. These behavioral changes indicated that as he learned a controlled
movement in his arm through Dosa training, his mental functioning became more active.

Based on this clinical observation, Ninomiya and Koshio speculated that learning
to relax the tension in his body helped the boy to develop his active problem solving
ability and then facilitated this boy’s mental functioning. They argued that a task of Dosa
practice is direct and simple, therefore, it would be easy for people with mental
retardation to follow, individuals who might otherwise easily get distracted and confused
with a complex task.

Tanaka (1985) used Dosa training with a child with Down’s Syndrome. The client
was a three-year old girl who did not understand language nor acquired communicative
speech. She did not respond to the stimuli ﬁ'om outside nor show any interests in other
people. She moved forward in a sitting position. She could stand but, her standing posture
was unstable and she could not maintain it for a long time. Tanaka used a relaxation
exercise around the lower back, groin, and ankles to improve balanced standing. As the
practice of the Dosa exercise progressed, this girl’s motor movements improved. She

could stand by herself for a few minutes, balancing herself, and she started walking with

23

assistance. Along with those improvements in motor control, she started to hold an eye-
to-eye gaze with her mother and smiled at her. She became more interested in things and
started to reach things around her. This case also suggested that Dosa training not only
improved her motor control ability, but promoted more active, adaptive behaviors.

These clinical studies suggested the possibility that the improvement of motor
control ability may inﬂuence a person’s psychological functioning and behavioral
regulation. Based on this assumption, the clinicians started to use the exercises of Dosa
training in therapy to work with individuals with various psychological problems and
examined its effectiveness as a psychotherapeutic technique. A term, Dosa therapy, was
coined for a type of psychotherapy which utilizes the Dosa exercises in order to bring
about a change in the client’s psycholgoical problem (Naruse, 1992).

Case studies have been conducted to evaluate Dosa training’s effectiveness with
individuals with various problems. Clients who have been treated successfully with Dosa
therapy include individuals with schizophrenia (Tsuru, 1982), anxiety disorder (F ujioka,
1987), obsessive-compulsive disorder (Kubota, 1991 ), hyperventilation (Hoshikawa,
1992), psychosomatic disorder (Ogawa, 1992), and depression (Shimizu, 1992). Dosa
therapy also has been applied effectively to athletes to help them enhance their physical
performance (Hoshino, 1982, 1992; Yarnanaka, 1992) and older adults to help them

maintain and improve their physical and mental ﬁrnctioning (Araragi, 1992).

Dosa Therapy
Naruse (1985, 1992) developed a theory of Dosa therapy based on his clinical

experiences over thirty years and/or empirical studies by other researcher/clinicians. In

24

this section, a theory of Dosa therapy by Naruse will be described followed by a review

of the empirical research.

Task Achieving Approach

In Dosa therapy, the client and the therapist meet once a week. A session of Dosa
therapy lasts approximately one hour and consists of two parts: half of the session is
spent in discussion about the client’s condition since the previous session and the other
half of the session includes the Dosa exercise. The focus of the discussion is on the
client’s behavioral, cognitive, affective, and experiential states regarding the issue which
brought the client to therapy. This information becomes a basis for the therapist and the
client to examine how the client’s perception and/or responses to his/her issue have
changed outside of the therapy session.

During the Dosa exercise, the client practices moving a speciﬁc part of his/her
body in a more regulated way. The focus of the practice is placed on the way the client
exerts effort in performing the movement, speciﬁcally, the manner of self-operation to
perform a given movement, rather than performance itself, which is a consequence of a
certain self-operation.

The process is assumed to proceed as follows (N aruse, 1985, 1992). The therapist
proposes a speciﬁc motor movement for the client to practice. This movement is called a
Dosa task and becomes a task or problem for the client to solve. A Dosa task is usually
transmitted from the therapist to the client verbally and non-verbally. It is given verbally
by instructing the client in a speciﬁc body movement. It is also proposed non-verbally by

gently, and slowly, guiding the client’s body in a speciﬁc direction to show concretely

25

what the therapist meant and to assist the client’s movement. In order to begin practicing
the task, the client ﬁrst needs to accept a given Dosa task and at least understand it
cognitively.

The client then plans to perform a given movement and starts to operate his/her
body in order to perform the Dosa task with the therapist’s assistance. At some point in
this beginning period, the client needs to understand the Dosa task on a physical level. In
other words, the client needs to feel physically what the required movement is and feel
sensations which happen in the relevant parts of the body. Once the client understands the
Dosa task cognitively and physically, then the strategy for performing the Dosa task will
become a center of attention for the client. The client closely monitors the performance
and pays attention to the sensory feedback while performing the movement. When the
strategy to carry out a movement is appropriate, the intended movement occurs. When
the operational strategies are inappropriate or insufﬁcient, resultant movement is different
from the intended one. In such a case, the client needs to correct strategies using the
sensory feedback as a clue. In this respect, the client acts proactively to pursue the
process and achieve the goal, paying close attention to his/her own internal operation
process as well as the sensory feedback. For this reason, Naruse (1992) referred to Dosa
therapy as a task achieving approach.

During the Dosa exercise, the therapist and the client communicate mainly on a
physical level between the client’s body and the therapist’s hand. The therapist also asks
about the client’s sensorimotor awareness, thoughts and feelings while moving his/her

body. This conversation is included based on the assumption that the attempts at

26

verbalizing internal sensations and/or operations will facilitate the client’s focus on
his/her experiencing process (Kubota, 1991).

The decision about which exercises to be used as a Dosa task for a speciﬁc client
is based on the client’s condition and the client and the therapist’s therapeutic
relationship. However, the relaxation Dosa exercises and the integrated Dosa exercises
are included frequently as a Dosa task (N aruse, 1985). Relaxation Dosa exercises,
especially those which aim to relax muscles around the neck, shoulders, and upper-body,
are used frequently. This is because most clients show tension in their upper body when
they enter therapy and an adequate level of relaxation is considered to be a necessary
base for a controlled motor movement (Naruse, 1985). In order to relax a speciﬁc part of
the body, a person needs to (l) differentiate a tensed part from a relaxed part, (2) feel the
degree of tension, (3) pay close attention to the relevant parts and feel those parts in
relation to the whole body, and (4) exert adequate effort to relax and modify the strategy
if necessary. This operation requires continuous information processing between the
psychological and kinesthetic levels of functioning. In this respect, the relaxation
exercises of Dosa therapy help a person’s psychological operation move toward self-
relaxation (Naruse, 1985).

The integrated Dosa exercise for balancing an up-right position is also ﬁequently
adopted as a Dosa task. Clinical observation of Dosa therapy with severely disabled
children suggested this practice might provide an experience which develops a sense of
self in the world (N aruse, 1992). When those children who could not sit by themselves,
sat or stood on their own feet with assistance, it was frequently observed that they looked

up and then around almost as if that was the ﬁrst time they encountered the world out

27

there and tried to acknowledge the space surrounding them. After the appearance of such
behaviors, they started to become interested in things and people and behave more
actively. When those children came to sit by themselves with more stability, they started
to extend their arms in attempt to reach an object around them which indicated that they
differentiated themselves from the objective world around them. Based on these
observations, it is assumed that balancing a person’s own body in three dimensional
space in relation to gravity helps a person develop a sense of self and a feeling of
existence in the world; a foundation of him/herself in relation to the psycho-social
environment.

Jacobson (1964, 1974) developed progressive relaxation to facilitate mental
conn‘ol by means of control over the musculoskeletal system and later renamed it a self-
operation control. The practices to learn to relax a speciﬁc part of the body were
described, which proceeds from paying attention to a certain part, noting a tension and
gradually relaxing a target muscle/muscle group. On the practical level, a commonality
can be seen in the procedures between Dosa therapy and progressive relaxation.
However, Jacobson (1964) described relaxation as “requiring no effort” (p.72), and a
tension as work. This may be true physiologically. However, from the viewpoint of Dosa
therapy, on the psychological level, relaxation requires a certain mental operation (effort)
which was described above. In this respect, progressive relaxation and Dosa therapy may
share commonalities in the goal and the procedures, however a difference can be seen in

the conceptualization of the process.

28

Therapeutic F actor

Naruse (1988) believed every person lives by exercising agency and referred to
the center of a person’s agency as the self. He deﬁned the self as a phenomenological
experience with a feeling of “I”. The self utilizes his/her potential within a limit of bio-
psycho-social constraint and actualizes his/her own potentials as much as possible. The
psychological existence of a person’s body, which a person is aware of as his/her own
body and can operate intentionally, is deﬁned as “self body”. The self operates self body
and utilizes it as a tool in interacting with its environment.

Naruse (1988, 1992) hypothesized that Dosa therapy utilizes a person’s
experiential functioning to bring about covert, psychological changes, which then leads to
overt, behavioral changes. For this reason, he referred to Dosa therapy as an experiential
method. Naruse (1988) believed that mobilizing experiential functioning is one of the
common therapeutic factors of psychotherapy. He deﬁned the experiencing as a
subjective, active feeling when a person is engaging with the environment and includes
both feedforward and feedback information during this self-activity process. It is a total,
here and now feeling of which a person is aware while operating on something (Naruse,
1988). Experiencing includes a conscious feeling as well as unconscious and
subconscious functioning or tacit knowledge of which a person is implicitly aware
regarding self-activity (Naruse, 1992).

Naruse (1992) differentiated the manner of experiencing from the content of
experiencing and deﬁned the latter as what a person is experiencing, while the former as
how a person is experiencing the content matter. He argued that the content of

experiencing has been addressed as a target in most modalities of psychotherapy which

29

have been developed by western clinicians/researchers, however, that the manner of
experiencing is more important than the content and, thus, should be directly addressed in
therapy.

Naruse (1992) considered that the manner of experiencing includes affective,
emotional responses such as being sad, happy, or angry and feelings which arise when a
person regulates his/her behavior such as uneasy, relaxed, upset, accepted, and satisﬁed.
It also includes feelings about self such as a feeling of self-identity and a feeling of
evolving, feelings regarding one’s body such as a feeling of owning a body and a feeling
of dissociating from the body, and feelings regarding the relationship with the
environment such as a feeling of ﬁt and a feeling of being understood by others. He
assumed that the manners of experiencing which are functional and enable individuals to
lead an adaptive, healthy life include those which accompany a feeling of being whole
rather than fragmented, being alive rather than vague and unclear, being active rather
than dormant or stagnated, and being stable rather than unstable.

In addressing the manner of experiencing, it is desirable that the person focuses
on him/herself as a target of observation ﬁom which experiencing is generated. When a
person views him/herself, the abstract self-concepts such as personality, behavioral
tendencies, values, and abilities may not be adequate as targets of observation. These
personal attributes tend to elicit a cognitive, evaluative judgement and generate an
affective response, which is negative most of the time for people who are in therapy.
Thus, Naruse felt that focusing on the abstract aspect of the self is not useful for therapy.
Those aspects of the self which are concrete and direct in nature and do not elicit

evaluative, affective reactions are more appropriate targets of observation. For example,

30

the body sensations and feelings and those changes that a person becomes aware of when
sitting in a chair or when a person moves his/her body, can be appropriate targets of
observation in addressing a person’s manner of experiencing.

Naruse (1992) explained that the Dosa process sensitively reﬂects a person’s
manner of experiencing in a small, subtle motor movement and/or tension. Naruse argued
that Dosa therapy can address directly the manner of experiencing rather than
understanding and interpreting the content of experiencing. He assumed that a person’s
problem is caused by an inappropriate manner of experiencing, and, therefore, the goal of
Dosa therapy is to change that manner of experiencing to a more ftmctional one. The
practice of a Dosa task could help a person modify his/her manner of experiencing to a
new, more functional one. In other words, the Dosa task can be a tool to provide a person
with an opportunity to learn a new manner of experiencing. It is assruned that this new
manner of experiencing can lead to a change in a person’s manner of experiencing in
their daily living, such as the way of perceiving, feeling, and thinking about things and
their attitudes toward themselves and their own life (N aruse, 1992). Furthermore, it is
assumed that a feeling of self-operation during the motor control, that is, a feeling of
agency in actively exerting effort to move a speciﬁc body part, is enhanced through Dosa
therapy and will have ramiﬁcations in other areas of the person’s existence.

Hmnanistic psychotherapy, which includes experiential and phenomenological
therapies, also stresses addressing a person’s experiential functioning (Gendlin, 1979,
1992; Greenberg, Safran, & Rice, 1989). In particular, Gendlin’s (1979, 1992)
experiential psychotherapy focuses on the experiential felt sense which is deﬁned as a

bodily feeling that contains meaning about a person’s interrelation with his/her world.

31

Naruse (1988, 1992) did not discuss his theory of experiencing and Dosa therapy in
relation to humanistic psychotherapy, however, it appears that his theory shares some
views with humanistic psychotherapy. Both humanistic psychotherapy and Dosa therapy
address a therapy process by conceptualizing it as a dynamic process (Naruse, 1992;
Rogers, 1958). They also assume self as an agency of human functioning which contains
potential for change and growth (Naruse, 1985; Rowan, 1992). However, in Dosa
therapy, the manner of experiencing is addressed by means of body movement. In other
words, the practice of motor control is expected to inﬂuence the client’s manner of
experiencing in general, without directly focusing on his/her experiences regarding the

problem. This aspect is a characteristic of Dosa therapy.

Empirical Studies on Dosa therapy

Experimental Studies

Konno and Ohno (198 7) conducted an experiment to identify factors which
facilitate the relaxation process through Dosa training. They administered a relaxation
Dosa exercise to ﬁfty-eight, healthy, female college students and had them complete a
20-item questionnaire after the practice about their experiences regarding the relaxation
exercise. A factor analysis of the results identiﬁed three factors. One of the factors
(Factor I) was related to psychological acceptance of the experimental situation and/or
relaxation assistance. A second factor (Factor 11) was related to differentiated and
integrated body awareness. And the last factor (Factor III) was related to the feeling of
generalized relaxation. The individuals who reported that they focused on their body

sensations dming the practice were classiﬁed into the “concentrated” group and those

32

who did not focus on their body sensations during the practice were classiﬁed as the
“non-concentrated” group. Their scores on the three factors were compared. It was found
that the concentrated group scored signiﬁcantly higher on Factors I and 11 than the non-
concentrated group. This result suggested that those subj ects who paid attention to the
relaxation process or the body sensations while relaxing their body tended to accept the
relaxation assistance more easily and have more differentiated and integrated body
awareness than the subjects who did not focus on their body sensations during the
practice. They concluded that a person’s active involvement in the relaxation process is
indispensable for self-relaxation with Dosa therapy.

Konno (1993) examined the effect of body tension and the awareness of it, on a
person’s experience of relaxation. Sixty-ﬁve college students were divided into three
groups based on body tension and their awareness of it. The awareness group consisted of
individuals who had muscular tension around their neck, shoulder and low back and were
limited in moving those parts due to the tension and were aware of those tensions. The
non-awareness group included individuals who had muscle tension around their neck,
shoulder and low back but were not aware of it. The no—tension group included
individuals who did not have muscle tension in the upper body. The subjects had a
relaxation exercise around the upper-body and answered a questionnaire regarding their
feelings and body sensations aﬁer the relaxation. The results showed that the awareness
and the no-tension groups reported more decrease in the uncomfortable body sensations
than the non-awareness group. Individuals in these two groups also reported more
stability in standing, lightness of body, and good mood. On the contrary, the non-

awareness group reported more vague/non-speciﬁc relaxed feelings such as feeling light-

33

headed and difﬁculty in concentration, and uncomfortable body sensations such as heavy
or languid feeling or a feeling that their body was not his/her own. These results showed
that individuals who were aware of their body tension experienced relaxation more
positively, whereas individuals who lacked awareness of their body tension responded
negatively to relaxation with a feeling of light—headedness or difﬁculty in concentration.
It was suggested that awareness of body tension inﬂuences how a person responds to the
changes in his/her body. More speciﬁcally, when a person perceived a change in body
sensation as a meaningful experience, he/she could utilize this experience in ﬁnding a
chre to solve his/her problem.

Konno (1989) examined the changes in the acuity of tactile sensation as a result of
the relaxation exercise of Dosa therapy. He administered a relaxation Dosa exercise to
twenty female college students and measured the acuity of tactile sensations of their
shoulders by means of two-point limen, also known as the two-point threshold, which is
the traditional measure of spatial acuity, before and after the relaxation exercise. The
results showed that the two-point limen decreased signiﬁcantly after the relaxation. There
was no signiﬁcant difference in the two-point limen between right and leﬁ shoulder.

The subjects were then divided into two groups, high or low in acceptance of
relaxation, based on the scores on the questionnaire about relaxation experiences. Those
who scored high on items related to differentiated and integrated awareness of relaxation
were considered as high in acceptance of relaxation and were classiﬁed as the high
acceptance group. Those who scored low on those items were placed in the low
acceptance group. The comparison of the changes in two-point limen between these two

groups revealed that the two-point limen of the high acceptance group was signiﬁcantly

34

lowered aﬁer relaxation, whereas there was no difference in two-point limen before and
after the relaxation with the low acceptance group. These results indicated that relaxation
through Dosa therapy increased the subjects’ acuity of tactile sensation. It also suggested
that acceptance of relaxation plays an important role in awareness of changes in body
sensations.

Konno (1997) also examined the effect of relaxation and postural training on
visual and auditory perception. Eighteen college students were randomly assigned to the
experimental and control groups. The experimental group had a relaxation Dosa exercise
of shoulders and postural training and took visual acuity, visual ﬁeld, and hearing acuity
tests before and after the relaxation exercise. The control group took the same test before
and after the thirty-minute conversation with the experimenter. Individuals in the
experimental group reported positive changes in body perception and external perception
aﬁer the relaxation. More speciﬁcally, those individuals felt more grounded in standing,
felt that their body became more active, felt more relaxed, and had a feeling of fullness in
their abdomen. They also reported that they saw the external world more vividly,
experienced a broader visual ﬁeld, and had a more lively impression about the external
world. The results of the tests showed the visual acuity, visual ﬁeld, and hearing acuity of
the experimental group signiﬁcantly increased over those of the control group. It was
suggested that the relaxation experience through Dosa therapy may enhance the external
perception by improving the visual and auditory acuity.

In sum, these studies conducted by Konno, suggest that awareness of one’s body
inﬂuences how a person perceives and accepts relaxation experiences. Furthermore, it

appears that relaxation experiences improve a person’s perception.

35

Clinica; Studies

Clinical studies which aimed to examine the effectiveness of Dosa therapy have
also been conducted. Most of them are small-scale case studies. In this section, those
clinical studies will be reviewed.

Tsuru (1982) applied Dosa therapy to ﬁve patients with schizophrenia in an in-
patient setting. The patients were all female with ages ranging from 31 to 43. They
showed symptoms which are typical of a person with schizophrenia such as auditory
hallucination, delusion, ﬂat affect, and mutism. They had treatment with a relaxation
Dosa exercise around the upper body once a week for 14 sessions. Rigid muscle tension
was observed for all of them around their neck, shoulders, torso and lower back. The aim
of the relaxation exercises was to help the women learn how to relax the rigid muscle
tensions in their body. As they relaxed those tensions with the therapist’s assistance, they
became aware of the tension in their body and learned how to relax it by themselves more
smoothly. Along with the progress of self-relaxation, changes in their symptomatic
behaviors were observed in the therapy session at ﬁrst and later in other situations. The
patients started to relate to the therapist more actively during the exercise. They also
started to interact with nurses and other patients. Their impulsive behavior resulting ﬁ'om
delusions, decreased. Over all, they became more active and interactive. Tsuru speculated
on the relationship between in-therapy experiences and behavioral change as follows. In
order to relax body tension, the patients had to resolve anxiety to release a familiar body
pattern and change themselves. This experience, she suggested, facilitated their self

activity and helped them respond more openly and actively in the daily situations.

36

F ujioka (1987) reported the results of Dosa therapy with a man with conversion
disorder. F uj ioka examined the therapeutic process of Dosa therapy based on this case.
The client was experiencing difficulties such as a lightheadedness, loss of balance and
difﬁculty in walking in social situations. Dosa therapy, with a relaxation Dosa exercise of
the upper body, was conducted with this client for thirteen sessions. In the beginning of
the relaxation exercise, the client could relax a rigid tension around his shoulder only
slightly. However, he did not feel that he was relaxing it. As the practice progressed, his
awareness changed ﬁ'om believing that his body relaxed by itself to believing that he was
relaxing that tension. Along with this progress in the Dosa practice, changes in his
behaviors were observed. The symptoms started to happen less and he was able to stand
for about one hour at a ceremony. He became less worried that his symptom would
appear and his overall tightness in interpersonal situations lessened. He also started to
feel more conﬁdent about himself.

Fujioka analyzed the therapy process as follows. The ﬁrst ﬁve sessions were
considered an opening phase where the client encountered his body by focusing on the
sensations in his body. The next two sessions were an expansion phase where the client
learned self-relaxation but was not aware that he was relaxing himself. Then followed the
self body operation phase where the client came to feel that he was relaxing a rigid
tension himself. The process ended with the closing phase where the client worked
thoroughly with the strategies of relaxation. Fujioka argued that the goal of Dosa therapy
is to help the client facilitate activity of his/her self, gain a lively and active sense of

his/her body, emotion, and existence, and monitor this internal self-functioning.

37

Kubota (1991) applied Dosa therapy to a woman with obsessive-compulsive
disorder and examined the therapy process in terms of self activity which was facilitated
through Dosa therapy. It was found that as the client became more aware of subtle
sensorimotor information from her body and learned to move her body more voluntarily,
her irrational thoughts changed into more rational ones and she started to act based on a
more realistic judgement of the situation. It was suggested that Dosa therapy facilitated a
form of self-activity in such a way that this client perceived her body as an object of
attention and operated it more actively and realistically. It was also speculated that a
manner of self-activity became more active and realistic through the Dosa exercise and
this change in manner of self-activity led her to respond based on a more realistic
judgment without being obsessed with her irrational thoughts.

Watanabe (1995) used Dosa therapy to treat nine nurses with burnout syndrome.
A self—concept scale and a burnout scale were administered before and after the
intervention. The intervention with a relaxation Dosa exercise around the torso was
conducted for twelve sessions. It was found that at the end of the intervention, the overall
burnout score decreased and that the self-concept regarding the body changed in a
positive direction. It was suggested that awareness of the body through self-relaxation led
to a change in self-concept which is directly related to the body and an improvement in
mood, such as reduction of depression and exhaustion, which are symptoms of burnout.

A case of hyperventilation which was treated with Dosa therapy was reported by
Hoshikawa (1992). The client was a sixteen-year—old, high school girl. She experienced
an attack at school and/or in a train almost everyday and sometimes the attack

accompanied stiffness in her extremities. The therapy was conducted for ﬁve sessions

38

and a relaxation exercise around shoulders was used. The symptom disappeared after the
ﬁrst session and this condition was maintained for the rest of the time. From this case,
Hishikawa speculated that this girl perceived her symptom as something which happened
automatically and was out of her control. Through Dosa exercise, she practiced
controlling her body movements and facilitated awareness of her body. This experience
led to a disappearance of the symptom. The successive practice of self relaxation might
have contributed to her remaining symptom-free.

Ogawa (1992) treated a man with a psychosomatic problem. The client was a
middle-aged man who suffered from dizziness, excessive tension in his shoulders and
pain in the back. These symptoms started after a job transfer due to stress. He ﬁrst saw an
internist, an orthopedist, and a dentist, however, no physical problem was found. A
relaxation Dosa exercise around the upper body was used to help him become aware of
tension in his body and learn to relax it. Through Dosa exercise, the client became aware
of tension in his neck, shoulder, and back and came to relax them by himself. Along with
the progress in therapy, his physical symptoms started to decrease and he became aware
of the relationship between stress and physical tension. He then found a new way of
coping with his stress. It was indicated that Dosa exercise helped the client become aware
of tension in his body and relax it voluntarily. This experience led the client to become
aware of the relationship between his physical symptoms and psychological state and he
started to adopt a new coping strategy for his stress.

Shimizu (1992) reported a case of depression which was treated with Dosa
therapy. The client was a middle-aged man who suffered from depressed mood and

agitation and reported a suicidal ideation. The session with Dosa therapy was interspersed

39

nine times in conventional counseling sessions. By the thirteenth session, his depressed
mood was improved and he started to act more actively and respond more ﬂexibly in
interpersonal situations. Shimizu speculated that through Dosa exercise, the client noticed
a new movement and sensation in his body. Based on these new experiences, the client
came to perceive himself differently and behave based on a realistic judgment.

Tsuru (1991) also applied Dosa therapy to a man with depression and examined a
therapeutic factor of Dosa therapy from the therapy process. The client became depressed
and withdrawn aﬁer experiencing an interpersonal conﬂict. He also had a feeling of
restlessness when thinking about that traumatic incident and sometimes that feeling
occupied him for the rest of the day. In therapy, he practiced relaxation Dosa exercises
around the neck, shoulder, and torso. Through the practice of relaxing tension in his
body, he became aware of subtle sensations in his body and started to feel that he was
relaxing the tensions in his body and felt his body more real as his own. He eventually
learned to relax smoothly and felt that his body was more relaxed and this became a basis
of his mental functioning. Along with these experiences through Dosa exercises, he
started to observe his behavior more objectively, his anxiety in interpersonal situations
lessened, and he became more active in his work, and reported a strategy to stop negative
thinking when it occurred and showed signs of self-control over his thoughts. Through
this case, Tsuru speculated that a person gained a more real and lively sense of their own
body through Dosa practice and this experience led to the changes in behaviors. It was
assumed that bringing about a change in one’s own sense of self body is a major

therapeutic factor of Dosa therapy.

40

These clinical studies, though small in scale, provide beginning evidence that
Dosa therapy has been effective in helping individuals with various psychological
problems. As for the research method, most of them used a case study method except for
Watanabe’s study (1995) which adopted a pre test-post test design with one group.
Therefore, the evidence, while systematically noted, is somewhat anecdotal in nature and
threats to internal validity exist. Analyses of the underlying mechanism of therapeutic
change were conducted qualitatively. More speciﬁcally, a researcher (1) described the
process of Dosa task performance in the session and the process of the client’s behavioral
change outside the therapy, (2) juxtaposed the in-session event and the out—of-therapy
change to see their relationship, (3) found a pattern in which a speciﬁc in-session event
precedes an out-of-therapy change, and (4) made an inference about the underlying
mechanism which might relate the in-session event to the change in behavior outside the
therapy. For example, through analysis of the therapeutic process of a client with
obsessive-compulsive disorder, Kubota (1991) described a parallel pattern between the
Dosa practice and an out-of-session change. When the client came to relax her body more
voluntarily and acknowledged that she was doing so intentionally, the client could divert
her attention from her obsessive ideas to relevant things at that moment. From this
pattern, it was inferred that the client’s self functioning became more active and reality-
based through the Dosa practice and that this manner of self functioning enabled her to
gain more control over her obsession in her daily living based on more realistic

judgements.

41

Hypptheses and Research Questions

This dissertation study was undertaken in an effort to move research about Dosa
therapy to another level. By using rigorous, single subject methodology, systematic
observations were conducted to examine the effectiveness of Dosa therapy for individuals
with anxiety problems. In addition, the underlying mechanism by which Dosa therapy
operates was explored by using a task analysis approach which is a method of process
study. The research questions and speciﬁc hypotheses of this dissertation study are as
follows.

First, does Dosa therapy facilitate a person’s experiencing process? It was
hypothesized that the participants’ manner of experiencing would change in the direction
of becoming more internally oriented, integrated, reality-based, and active after the Dosa
therapy intervention. Speciﬁcally, the participants’ experiencing would reach a higher
level on the Experiencing scale (see Appendix H). The awareness of somatic sensations
during the Dosa practice would increase in quantity and quality, as measured by the
Questionnaire for Somatic Awareness (see Appendix L).

Second, does Dosa therapy change a person’s manner of self-functioning to a
more adjusted manner? This question was examined on cognitive, affective, and
behavioral levels. On the cognitive level, it was hypothesized that the participants would
become more autonomous and that there would be an increase in their agency after the
treatment. Speciﬁcally, a participant’s locus of control would become more internal on
the Belief in Personal Control Scale (see Appendix J) and a participant’s self-efﬁcacy
level would become higher on the self-efﬁcacy scale (see Appendix I). On the behavioral

level, it was hypothesized that the frequency or duration of undesirable behavior

42

regarding the participant’s anxiety problem would decrease or desirable behavior would
increase as recorded by the Behavior Record Form (see Appendix G). On the affective
level, it was hypothesized that the participant’s anxiety level would decrease and result in
lower scores on the Clinical Anxiety Scale (see Appendix F).

Lastly, a question was asked about what was happening in the Dosa therapy
session which generated the aforementioned change. This question was answered by
analyzing the therapy process qualitatively and developing the models which describe the
process of how the Dosa task was performed. By using a task analysis approach, the
performance model was developed to describe the process of how the Dosa task was
achieved. From this model, the operations model was developed to describe a
participant’s possible mental operations which generated the observable performances. In
so doing, an underlying mechanism of Dosa therapy which connects experiences in body

with changes in psychological functioning, was explored.

43

CHAPTER 3

METHODOLOGY

Overview

This dissertation study utilized single subject methodology as the research design,
which involves an intensive, systematic observation of each subject over time (Bloom,
Fischer, & Orme, 1995; Gingerich, 1988). This design is less common in contemporary
research, where most studies focus on a group of individuals, aggregate the data, and
compare means to determine effects or differences. However, single subject design is
particularly well suited for the evaluation of clinical practice with individual clients and
the effectiveness of an intervention as was undertaken for this dissertation (Bloom,
Fischer, & Orme, 1995; Kazdin, 1982).

In order to investigate the change process which operates in Dosa therapy, a task
analysis approach was adopted as a data analysis method (Reid, 1988; Rice & Greenberg,
1984). This analysis method engages in a continuous, moment-by-moment analysis of the
psychotherapeutic process. This method of data analysis is also less common but adds to
an important element to the conventional outcome research of psychotherapy which
compares conditions before and after the intervention to see any effect of the therapy.
This section starts with the descriptions of single subject design and task analysis

approach.

Single Sulﬁect Des_ig

Single subject research designs which involve an intensive observation of the
individual are also referred to as ideographic strategies, whereas group-comparison
designs which compare the average of groups are referred to as monothetic strategies.
The relative values of single subject versus group design methodologies have generated
arguments and the conclusion has not been reached as yet (McGuigan, 1990).

A major criticism of the between-group designs for applied research is that
conclusions are drawn based on group means and these values may not be informative in
understanding an individual’s behavior. Under some conditions, the group means may
not be indicative of individual behavior and could be misleading (McGuigan, 1990). In
those cases, focus on a single subject allows the researcher to know more about the
individual’s behavior under a speciﬁc condition, which is particularly important in
clinical practice.

The case study method has been used to study the individual client in an applied
research ﬁeld. This method allows a researcher to study a single case in a naturalistic and
uncontrolled setting and provides unique, rich information about a speciﬁc individual.
However, these very speciﬁc characteristics are also weaknesses of this research method.
That is, the case study method lacks controlled conditions and carefully administered
objective measures of behaviors (Kazdin, 1998).

Single subject design has been developed as a more intensive observation method
of individual persons than a traditional case study method and advocated as a method of
applied research to immediately and directly evaluate the effect of practice (Barlow &

Hersen 1984; Bloom, Fischer, & Orme, 1995; Kazdin, 1982; York, 1998). Single subject

45

design involves systematic observations of a speciﬁed problem or objective of the client
and measures the problem/objective repeatedly over time. In this respect, single subject
design is also referred to as a repeated measures design.

The process starts with specifying a target or targets of intervention, proceeds to
monitoring the intervention process, and ends with evaluating the outcome. When
specifying the target(s), a concrete, observable behavior which represents the client’s
problem is selected and operations or measurement procedures of the target behavior are
speciﬁed. Single subject design typically consists of two types of phases; a baseline phase
(A) and an intervention phase (B). During a baseline phase, the information regarding the
target behavior is collected through systematic observation and/or report. However, no
target-focused intervention is implemented. During an intervention phase, one or more
target-focused intervention(s) are implemented and change in the target behavior(s) is
measured.

In order to draw a conclusion about whether the intervention had an impact on the
target behavior, a practitioner/researcher looks for persistent concomitant variation
between the intervention and the predicted change in the target. That is, when change in
the target behavior occurs after the intervention is introduced and only when these two
events persistently covary, then this condition provides the practitioner/researcher a basis
on which to draw the conclusion that the intervention may be a cause of change of the
target (Barlow & Hersen, 1984). Therefore, the target behavior is compared between the
baseline and the intervention phase on the same person. In this respect, each subject

serves as its own control.

46

Generality of the ﬁndings from a study with the single subject design is made
based on similarities between a particular subject treated in the study and a person in
question. That is, if a study shows that a given intervention is successful with an
individual with a particular problem and certain personal characteristics, then the
clinician can be relatively conﬁdent to say that a person with the same problem and the
similar personal characteristics might respond well to that particular intervention. This
process is called logical generalization (Edgington, 1966) and this has provided a
rationale for applied researchers to generalize the results ﬁom a single case (Barlow &
Hersen, 1984; Dukes, 1965; Shontz, 1965).

An advantage of single subject design compared to a group design concerns the
reduction of error variance (McGuigan, 1990). This repeated-treatment design eliminates
individual differences by employing the same participant as his/her own control. Thus,
this design makes it possible to reduce error variance in the study, where error variance is

a measure of the variance for which we cannot account.

Task Analysis Approach

Psychotherapy research can be classiﬁed as outcome research or process research.
Outcome research addresses the presence and magnitude of changes that are brought
about through the therapy, whereas process research focuses on the interaction between
the client and the therapist in the therapy session (Lambert & Hill, 1994). Outcome
research, which typically adopts a group comparison design and sees the difference(s) in
a client’s behavior before and after the therapy, has been criticized for its limitation

around understanding therapeutic factors (Barlow, 1981). Speciﬁcally, Barlow (1981)

47

argued that conventional outcome research failed to answer important questions for
clinical practice, that is, why a speciﬁc treatment works and for whom it works and for
whom it does not. The use of a single subject design, as discussed above, alleviates some
of these problems. However, to augment this situation, process research has been
proposed as a way to investigate the psychotherapy change process on a moment-by-
moment basis (Rice & Greenberg, 1984; Safran, Greenberg, & Rice, 1988). A task
analysis approach was introduced as a method of process research by Greenberg (1975),
Rice and Saperia (1984), and Safran, Greenberg, and Rice (1988) to investigate the
process of therapeutic interaction and to connect in-session change with outside-therapy
change.

Task analysis has been used since the 19403 in Industrial Psychology and the ﬁeld
of education to study human problem-solving processes. Newell and Simon (1972)
developed a general model of the human problem-solving process in speciﬁc task
environments by analyzing individual verbal protocols and inspecting qualitative
similarities and differences between various protocols. This general approach is referred
to as the task-analysis approach. In this approach, the researcher starts with developing a
model of the process by which a speciﬁc task is accomplished. The initial model is
developed based on a theory and rational analysis of human information processing in a
speciﬁc problem-solving situation. Then the researcher inspects individual protocols,
compares them with the initial model, and revises the model to bring it in line with the
real phenomenon. This procedure involves the progressive development of a heuristic

model of human performance and information processing activities. This model is to be

48

tested and reﬁned in an interactive fashion on the basis of its ability to model an
individual’s speciﬁc problem-solving performance.

Greenberg (1975, 1984) and Rice and Greenberg (1984) introduced this approach
to the psychotherapy research ﬁeld by reasoning that psychotherapeutic intervention is
considered to be a task environment where the client attempts to perform a particular
cognitive-affective task. With this approach, they attempted to identify the client’s inner
operations that are essential for the successful resolution of a speciﬁc therapeutic task.
The process of building a model of client inner operation while resolving a therapeutic
task, involves three stages. First, a researcher selects and describes the task and task
environment. Second, a model of therapeutic process for a speciﬁc change task in the
session is constructed based on theoretical, rational analysis and the researcher’s clinical
experiences. Lastly, the developed model is examined empirically based on intensive
examination of several individual cases and will be revised based on the empirical data.
Hypothesis testing to verify the model has been conducted by differential efficacy studies
and/or comparing successful cases to unsuccessful ones on the outcome (Greenberg,
1984).

In constructing a model of change mechanisms, Rice and Greenberg (1984)
proposed two levels of abstraction in an attempt to understand what the client needs to do
in therapy to achieve change. The ﬁrst level is referred to as client process, which
concerns the manifest client performance in the session. The second level is referred to as
client operation, which concerns the client’s internal mental operations and is inferred
from the former, performance process. Rice and Greenberg expect that the level of client

operations will become a transferable level of understanding across different orientations

49

of psychotherapy. The goal of the task analysis is to identify and understand the client’s
internal operation that enables the client to resolve successfully a class of therapeutic
tasks (Rice & Saperia, 1984).

For example, Greenberg (1984) developed a performance model and an
operations model of conﬂict resolution in Gestalt therapy through the empty chair work.
In the performance model, he described the conﬂict resolution dialogue between the two
chairs which starts with a split between them, then moves to criticism of one chair and
affective reactions and a new experience of the other chair and is eventually followed by
a negotiation and/or an integration between the two parts. The operations model, which
was inferred from the performance model, starts with identiﬁcation of the most alive
sense of criticism in one chair and formation of reaction in the other chair and ends with
dissolution of differences and integration of both perspectives.

In order to conduct a process study, it is important to examine whether a speciﬁc
task in the session has a therapeutic effect which is worth studying in depth. When it is
found that the task is therapeutically meaningful, then process analysis can be pursued to
examine therapeutic factors (Greenberg, 1984).

In Dosa therapy, performing a speciﬁc movement is a primary focus in the
therapy session (Naruse, 1992). This movement is called a Dosa task and is proposed by
the therapist to the client and is accepted by the client. If the client can perform a given
movement, the Dosa task is achieved. However, most of the time, the client encounters
difﬁculty performing it in a controlled manner, that is, tensing and relaxing speciﬁc parts
of the body simultaneously. When the client notices such difﬁculty, a problem-solving

situation arises where the client and the therapist work together to resolve this situation.

50

A problem is solved when a client manages to make a movement with the therapist’s
assistance. A Dosa task involves primarily a sensorimotor process, however, it also
includes a psychological process. The therapist provides a safe environment and
assistance for the client to successfully solve the task. The client practices the movement
until he/she can perform it voluntarily. Therefore, for a Dosa task, a problem and a goal
are deﬁned clearly and the start and the end of the process are also clearly demarcated
and noticeable both for the client and the therapist. For this reason, a task analysis
approach was selected to analyze the Dosa therapy process. A performance model of the
Dosa task process addresses the Dosa performance process. An operation model focuses
on inner operations during the Dosa task performance. These two models were used to
speculate about an underlying mechanism of the Dosa process and an aspect of a body-

mind interaction during Dosa therapy.

Recruitment of Participants

The participants of this study were recruited from among female graduate
students who had an anxiety problem. An anxiety problem was deﬁned in this study as an
issue or problem which worried an individual and made her feel anxious. Recruitment
proceeded as follows. The investigator visited four social work classes for students in the
master’s program with permission of the instructors. In the class, the investigator
distributed a handout (see Appendix A), explained the purpose of the study and the length
of commitment and asked for their participation. Nine students volunteered to participate

from approximately eighty students in the four classes.

51

Then an individual screening session was held with the nine volunteers,
individually. In the screening session, the investigator again explained the purpose of this
study, the philosophy of Dosa therapy, and the nature and duration of involvement in this
study. When the volunteer agreed to proceed to the interview to talk about her anxiety
problem, she was asked to sign the consent form (see Appendix B) and reminded that
participation was voluntary, that she could discontinue at any point, and that her identity
would be kept anonymous. The questionnaire regarding anxiety problems and
background information (see Appendix E) was administered to collect information about
the issue the volunteers wanted to work on and some brief demographic information. The
clinical anxiety scale (see Appendix F) was administered to measure the volunteer’s
anxiety level. Based on the information given on the questionnaire, the investigator
conducted an interview to set a goal/obj ective of the therapy and to identify a behavior
which represented the volunteers’ anxiety problems in order to monitor the progress of
the therapy.

The criteria of inclusion and exclusion for this study were set as follows.
Individuals whose main problem was anxiety were to be included. Those who had other
psychiatric problems combined with anxiety or those who had been diagnosed or
appeared to be classiﬁable as having other psychiatric problems than anxiety were to be
excluded from the study. In order to determine whether an individual rrright be
classiﬁable as having psychiatric problems, the DSM-IV was used to evaluate their

symptoms (American Psychiatric Association, 1994).

52

Participgts

All nine volunteers met the criteria of inclusion and were included in this study.
Table 1 shows the participants’ anxiety problem, the anxiety score on the clinical anxiety
scale, and the disturbance level on the questionnaire for anxiety problem, which was
answered on a lO-point scale, 1 meaning no trouble at all and 10, very disturbed.

As seen in Table l, the main anxiety problems the participants addressed were
diverse. The anxiety scores on the clinical anxiety scale (Hudson, 1992; Westhuis &
Thyer, 1989), described later in this section, ranged from 8 to 47. The clinical anxiety
scale has a clinical cutting score, which is 30 (i 5). Therefore, the score of participant 5
indicates that she has an anxiety problem. The scores of Participant 1, 4, and 6 fell in an
area where it indicates possible presence of anxiety. The scores of Participant 2, 3, 7, 8,
and 9 indicate that their anxiety levels were within normal range. Their disturbance levels
on the questionnaire regarding anxiety problems and background information, which
were self-rated, ranged from 6 to 9, suggesting they were quite disturbed by the issue.

Among these participants, four of them terminated their participation in the
middle of the study and ﬁve of them completed their participation. Participant 1
terminated her participation aﬁer the ﬁrst interview because of a time conﬂict.
Participants 2 and 5 terminated their participation after the second interview of the
intervention phase. Participant 2 acknowledged that talking about her issue invoked the
same dreadful feeling which she experienced as an issue in her daily life and made her
feel uncomfortable. For this reason, she decided to end her participation. Participant 5
had scoliosis for which she was having treatment. Before the therapy started, she said that

relaxation exercise might help her condition. When it actually started, she began

53

r0
1111

am

Pa

P2

Pa

worrying that the Dosa exercise might have a negative effect on her body condition. The

investigator made sure that no unusual condition had occurred in her body at that point

and supported her desire to terminate her participation. Participant 4 terminated her

 

 

Table 1
Participants’ Anxiety Problem, Anxiety Score, Disturbance Level and Extent of
Participation
Participant Anxiety Problem Anxiety Disturbance Extent of
Score Level Participation
Participant 1 Taking care of l-year- 32 6 Terminated
old daughter after the 1st
baseline session
Participant 2 Anxiety when having no 17 7-8 Terminated
control of a situation after the 2Ml
intervention
Participant 3 Difficulty of 13 8 Completed
concentration on study treatment
Participant 4 Balancing work, study, 30 8 Terminated
and private life after the 4th
intervention
Participant 5 Balancing study and 47 9 Terminated
family demands after the 2"d
intervention
Participant 6 Feeling of isolation and 26 8 Completed
not ﬁtting in treatment
Participant 7 Procrastination l6 8 Completed
treatment
Participant 8 Feeling toward 8 8 Completed
boyfriend treatment
Participant 9 Anxious feeling 18 6-8 Completed
treatment

 

54

participation after the fourth session of the intervention phase because her schedule
changed and she could not ﬁnd time to continue her participation.

The participants who stayed in the study are described in detail below:

Participant 3 was a ﬁfty-year—old woman. She came back to school after working
for more than twenty years. She felt overwhelmed by the amount of work she needed to
do for the classes and had difﬁculty focusing when she actually sat down to study. She
hoped to become more relaxed and to concentrate on her study. The actual amount of
study time recorded in hours was selected as the behavior to monitor.

Participant 6 was a forty-three-year-old woman. She felt that she has not ﬁt in
since she was a young girl. She questioned the norm most of the time and liked to
challenge things, aiming for a high standard. She criticized that the majority of people
simply went along with the norm. For this reason, she always felt isolated. Intellectually,
she knew that everyone need not think the way she did, however, she was still disturbed
by thinking of this situation. Her goal of the therapy was to decrease a feeling of
frustration or stress and to let go of it. Since stress and frustration built up during the day,
she had difficulty falling asleep at night. As a behavior to monitor, she decided to focus
on this behavior and rate the difﬁculty falling asleep on a scale ﬁom 0 to 10, 0 meaning
not difﬁcult at all and 10, very difficult. She was to rate her sleep behavior each morning.

Participant 7 was a twenty-three-year-old woman. She was dissatisﬁed with the
way she did school work. Through her undergraduate years, she almost exclusively
waited until the last minute to study for the tests. Although she did ﬁne on them, she
always felt that she should have been studying more. As a graduate student, she found

herself becoming too anxious to sit and write a paper because she felt it difficult. For this

55

reason she avoided doing it. At the same time, she felt that it was not fun to sit and study
and interacting with ﬁiends was more ﬁrn. As a goal of therapy, she wanted to become
less anxious in doing schoolwork and do the work without procrastinating. As a behavior
to monitor, she decided to count her daily study time in hours.

Participant 8 was a twenty-three-year—old woman. She had a boyfriend from
undergraduate school. Recently, her boyﬁiend started to talk about engagement.
However, she was ambivalent about her feelings toward him. At times she felt he was the
one and other times she was not sure about her feelings. Therefore, she felt elated with
the idea of engagement at one moment and at the next moment, she felt anxious about it.
Her goal for this therapy was to become clear about her feelings and making a decision
conﬁdently. As a behavior to monitor, she decided to rate her level of assurance of her
feelings toward her boyfriend on a scale from 0 to 10, 0 meaning not sure at all and 10,
completely sure about my feelings toward boyfriend.

Participant 9 was a forty-three-year-old woman. She complained that she had
been feeling anxious and felt restless lately. She did not know what was causing her
troubling feelings, but thought the stress of schoolwork might be one of the causes. She
wanted to slow down inside and feel less anxious. She noticed that she tended to become
curt with her husband, when she became anxious. She also kicked things or cried.
Therefore as a behavior to monitor her anxiety level, the aforementioned behaviors to

ventilate her anxiety were focused on and she counted the occurrence of those behaviors.

56

Desigp

A multiple-baseline single subj ect design was employed for this study (Bloom,
Fischer, & Orme, 1995). Multiple baseline design is one of the variations of the single
subject design. It adopts several baselines established simultaneously prior to the
administration of the treatment(s). Speciﬁcally, for this study, two baselines were
installed. One baseline lasted for three weeks and the other baseline, for four weeks.
Therefore, the participants in the ﬁrst group had three-weeks of baseline and from the
fourth week they started therapy. The participants in the second group had four-weeks of
the baseline phase and their intervention started from the ﬁfth week. This time lag gives
the second group a longer baseline and, thus, enables the investigator to obtain more
stable baseline data.

If a desired change in the target observation occurs with both groups only after the
intervention begins, then this change pattern becomes the basis for inferring causality.
That is, the intervention is the likely cause related to the observed sequential changes in
the target problem with both groups. Therefore, there is no need to withdraw the
treatment to see the effect once it has been applied and thus this design enables the
researcher/practitioner to resolve the ethical problem of withdrawing a beneﬁcial
treatment to a participant, which other single-subjecbdesigns require. This is a major
advantage of this design (McGuigan, 1990).

The participants were randomly assigned into either of the two baselines.
Participants 3, 7, and 8 were assigned to the ﬁrst group. They had a three-week baseline
(A) and ﬁ'om the fourth week, the intervention (B) started. Their intervention lasted for

eight weeks. Participants 6 and 9 were assigned to the second group. They had a four-

57

week baseline (A) and started the intervention (B) from the ﬁfth week. They had seven
intervention sessions. All of them had one follow—up session (F -UP) approximately six

weeks after the last intervention session. Figure 3 shows the time line of the study.

Week 1 2 3 4 5 6 7 8 9 10 ll F-Up
Participant 3 A- --- --- B- --- --- --- m m ---- ---- .......
Participant 7 A- --- --- B- --- m m m m ---- ---- .......
Participant 8 A- --- --- B- --- m m m m ---- ---- .......
Participant 6 A- --- --- --- B- m m m --- ---- ---- -------
Participant 9 A- --- --- --- B- --- m m m ---- ---- .......

Figge 3. Timeline of the study.

Intervention

The intervention with Dosa therapy started after the three or four-week baseline
phase. The participant and the investigator/therapist met for one hour, once a week. The
ﬁrst half of the session was spent for the scale administration and the discussion of the
condition of the participant’s anxiety problem during the previous week and the next half
of the session was spent on the practice of a Dosa exercise.

A relaxation Dosa exercise of the upper-body (Kukan-hineri) was selected as a
Dosa task for all participants. The practice proceeded as follows.

The participant lay on the ﬂoor on her side. The therapist slowly moved the
participant’s upper shoulder backward toward the ﬂoor, while blocking the lower

shoulder and lower-back so that the participant relaxes the upper-body while rotating it.

58

The therapist stopped where the participant’s movement stopped, in other words, where
tension arose and the participant could not relax further. The therapist waited at the point
while adding some pressure against the tension. When the participant relaxed that part,
the therapist followed her body movement. After relaxation happened a few times, the
therapist helped the participant return her body to the starting position. This movement
was repeated two times for both sides.

After the relaxation exercise, the participant was asked to stand up and balance
her body in an upright position. The participant was asked to put her weight on her right
foot, then left foot, then toward toes, then heels, and ﬁnally to ﬁnd a position where she
felt most stable. While balancing her body, the participant was asked to pay attention to
the sensations in parts of her body in relation to the whole body and the feelings which

accompany these slow, subtle body movements.

Instrumentation
Eleven instruments were either created or selected to collect and measure data

during the baseline and intervention periods. Each is described below.

@estionngire for Anxiety Problem Jand Backgrouryl Information. The
questionnaire regarding the anxiety problem and background information was designed to
collect information on the participant’s anxiety problem and background information (see

Appendix E). This scale was used at the screening interview.

59

Clinical Ampiety Scale (CAS). The clinical anxiety scale (Hudson, 1992;
Westhuis & Thyer, 1989) was selected to measure the participants’ anxiety level (see
Appendix F). This scale was used to measure the amount, degree, or severity of clinical
anxiety reported. The CAS has 25 items and is useful for measuring general anxiety. A
coefficient alpha of this scale is .94 and the standard error of measurement (SEM) is 4.2,
suggesting a minimal amount of measurement error. The test-retest correlations range
from .64 to .74. The CAS discriminates signiﬁcantly between groups known to be
suffering from anxiety and lower anxiety control groups, suggesting having good known-
group validity. The CAS has a clinical cutting score of 30, which provides a rough
diagnostic indicator. It is advised that a score which falls within plus or minus 5 of the
cutting score is treated as an area which indicates possible presence or absence of an

anxiety problem.

B_eh_avior Record F orm. The behavior record form was created by this investigator
to monitor the participants’ target behavior which represents their anxiety problem (see
Appendix G). This form was used to record the ﬁ‘equency of occurrence or duration of a
target behavior based on the discussion of the participants’ anxiety problem. The
discussion of identifying a target behavior and establishing a recording plan (when and
how to record a target behavior) began at the screening session and was ﬁnalized at the

ﬁrst session of the baseline phase. This form was recorded weekly.

Exmp'encing Scale (EXP). The experiencing scale (Klein et al., 1969) was

selected to measure the participants’ experiencing level (see Appendix H). This scale was

60

used to measure the participants’ level of experiencing. The level of experiencing was
categorized into 7 levels. Level One is the lowest level of experiencing in which the
subject focuses on external events and describes them in a detached way, thus personal
involvement is absent. Level Seven is the highest level of experiencing in which the
subject shows awareness of immediately present feelings and internal processes.

The experiencing level is to be judged independently by multiple raters ﬁ'om a
ﬁve to eight-minute excerpt from the therapy session. Ratings are summarized into two
scores: a modal rating which characterizes the overall or average experiencing level of
the unit and a peak rating which is a point where the highest level is reached.

Interrater reliabilities, after training with the EXP manual, for undergraduate
raters, range from .75 to .97 for modal rating and from .88 to .94 for peak rating, for
professional raters, from .88 to .99 for modal rating and from .90 to .93 for peak rating.
Interrater reliabilities for the single-subject studies range from .79 to .83 (Klein, Mathieu-
Coughlan, & Kiesler, 1986).

For this study, two social work graduate students worked as raters. They went
through an eight-week training required in the training manual before rating segments
from this study (Klein et al., 1969). A six-minute segment was selected from a tape-
recording of the session. The procedure taken to identify the segment for rating will be
described in the results section. When the ratings did not agree between the two raters,

the two raters had a discussion until an agreement was reached.

Self-Efﬁcacy Scale (SESL The self-efﬁcacy scale was created by this researcher

to measure the participants’ self-efficacy level (see Appendix I). This scale was used to

61

measure the strength of the participants’ expectancy of effectively handling her anxiety
problem or a situation related to the anxiety. The participant was asked to answer how
certain she was about handling her issue/anxiety situation effectively on an ll-point
scale, 0 = completely uncertain and 10 = completely certain (Bandura, 1977; Bandura,

Jeffery, & Gajdos, 1975).

Belief in Personal Control Scale (BPCS). The belief in personal control scale
(Berrenberg, 1987) was selected to measure the level of participants’ internal control (see
Appendix J). This scale was used to measure the participant’s perception of her personal
control. The BPCS was developed to measure three dimensions of personal control:
general external control (Fl) assesses the extent to which an individual believes his/her
outcomes are self-produced (intemality) or produced by fate or powerful others
(extemality). The exaggerated control dimension (F2) measures an extreme and
unrealistic belief in personal control. The God-mediated dimension (F3) measures the
belief that God can be enlisted in the achievement of outcomes and distinguishes
individuals who believe they have no control over their outcomes from those who believe
they control outcomes through God. In this study, only the general external control
dimension (Fl) was used.

The alphas of the BPCS are .85 (F1), .88 (F2), and .97 (F3), suggesting good
internal consistency. Four-week test-retest correlations are .81(F1), .85 (F2), and .93 (F3),
suggesting good stability. The BPCS correlates in the expected directions with several

other measures including the Intemal-External Locus of Control, the Taylor Manifest

62

Anxiety Scale, the Feelings of Inadequacy Scale, and the Mania and Depression Scales,

suggesting excellent construct validity (Fisher & Corcoran, 1994).

_TT_Lcr_apv Session Rpcord Form. The therapy session record form was created to
record interaction between the therapist and the participant during the Dosa practice (see
Appendix K). Information on three dimensions was recorded sequentially on this form:
(1) the therapist’s procedure and observation regarding the participant’s Dosa task
performance, (2) the participant’s kinesthetic/sensorimotor sensations, and (3) the
participant’s thoughts and feelings during the Dosa task performance. The investigator
ﬁlled in a form after each therapy session based on a videotape recording.

Speciﬁcally, the therapist’s procedure was described on the following points: in
which direction the therapist moved the participant’s body, with how much strength,
feedback on the participant’s performance, questions regarding the participant’s response.
The participant’s Dosa task performance was described by the therapist with regard to the
following points: the range of relaxation, the location of the tension, duration of the
tension, accompanying movements in that body part and/or other body parts and facial
expression. The range of relaxation refers to how much the shoulder moves following
relaxation. The location of the tension refers to where the participant’s shoulder stops due
to the tension. In order to describe the range of relaxation and location of the tension, the
possible range of the movement was divided into 4 points. In this case, the angle which a
shoulder line and the ﬂoor make ranges from 0 to 90 degrees. The starting point where
the shoulder line and the ﬂoor make 90 degrees is Point 1. Where the upper shoulder

touches the ﬂoor and the angle between a shoulder line and the ﬂoor is 0 degree is Point

63

4. The point where a shoulder line and the ﬂoor make 60 degrees is Point 2. And the
point where a shoulder line and the ﬂoor make 30 degrees is Point 3. A mid-point was
used, such as, 1.5, 2.5, or 3.5, to describe an approximate position between two points.
Duration of tension refers to how long the movement stops due to the tension, in other
words, how long it takes to relax that tension. This information was measured in seconds.

The participant’s kinesthetic sensation was recorded regarding what sensations
she noticed, on which body parts, and at what point in relation to the Dosa performance.
The participant’s thoughts and feelings included what she thought and how she felt

during the Dosa performance.

Qpestionnaire for Somatic Awareness (QSA). The questionnaire for somatic
awareness was designed to monitor the participants’ somatic awareness during the Dosa
exercise (see Appendix L). This questionnaire was used to measure the participants’
quantity and quality of somatic awareness during the Dosa exercise based on the
measurement used in a study on sensory awareness during an aerobic exercise (Ciofﬁ,
1991). The participants were asked to list the sensations they noticed during the Dosa
practice. On each reported sensation, the participants were asked to rate the noticeability
on a lO-point scale which ranges from 1 = barely, 5 = moderately, to 10 = extremely, and
its hedonic valence on a 40-point scale which ranges from —20 = extremely unpleasant,

0 = neither unpleasant or pleasant, to +20 = extremely pleasant.

Qpestionnaire for Relaxation Strategies (QRS ). The questionnaire for relaxation

strategies was designed to monitor the participants’ experiences regarding relaxation (see

Appendix M). This questionnaire was used to collect information regarding the

participants’ strategies for relaxation and was administered after the Dosa practice.

Session Evaluation Questionnaire (SEQ). The session evaluation questionnaire
(Stiles, 1980; Stiles & Snow, 1984; Stiles, Shapiro, & Firth-Cozens, 1990) was selected
to measure the participants’ evaluation of each therapy session (see Appendix N). This
scale was used to measure dimensions of the impact of the therapy sessions based on
previous studies (Stiles, 1980; Stiles & Snow, 1984; Stiles, Shapiro, & Firth-Cozens,
1990). This scale consists of 16 bipolar adjective scales in a semantic differential format.
The participants were asked to answer on a 7-point scale regarding the session itself and
their own feelings immediately following the session. The ﬁrst part of the questionnaire
addresses the participants’ session evaluation and measures two independent dimensions:
Depth and Smoothness. The mean rating on those scales such as worthless-valuable,
shallow-deep, empty-full, and ordinary-special yields the Depth index. The Smoothness
index is the mean rating on difﬁcult-easy, unpleasant-pleasant, rough-smooth, and
dangerous-safe. The second part of the questionnaire focuses on the participants’ post-
session mood and measures Positivity and Arousal dimensions. The Positivity index is
the mean rating on sad-happy, afraid-conﬁdent, uncertain-deﬁnite, and angry-pleased.
The Arousal index is the mean rating on quiet-aroused, slow-fast, still-active, and calm-

excited. Higher scores indicate greater magnitude of impact for each dimension.

Questionnaire for Therapy Exgrience (QTE ). The questionnaire for therapy

experience was designed by this researcher to see the participants’ overall experiences of

65

Dosa therapy (see Appendix 0). This questionnaire was used to obtain the participants’
overall evaluation of this therapy. It contained open-ended questions regarding the
participants’ experience of Dosa therapy. The questions included changes experienced,
points/aspects for which Dosa therapy and/or the therapist facilitated the participant’s
change, the participant’s satisfaction with the results of therapy, and remaining problems
and/or new ones (Strupp, Wallach, & Wogan, 1964). The questionnaire also included the
question regarding the level of disturbance of the problem/issue at the end of the therapy.

This questionnaire was administered at the last therapy session.

Procedures

At the ﬁrst session of the baseline phase, the investigator explained the structure
and the timeline of the therapy to the participants and written consent was obtained when
they assured their commitment for this clinical study (see Appendices C and D). During
the baseline phase, the participant and the investigator met for a half hour at each session.
The participants were asked to answer the CAS, SES, and BPCS, and then the participant
and the investigator talked about the condition of their issue/problem during the previous
week based on the recording on the behavior record form. The interview was audiotape-
recorded with the participant’s permission, for the rating of the participant’s experiencing
level.

During the intervention phase, the participant and the investigator met for one
hour. The ﬁrst half of the session was spent as in the baseline phase, the scale
administration and the discussion about the status of the participant’s anxiety

problem/issue. The second half of the session was spent on the Dosa exercise. The

practice of the Dosa task was videotaped, again with consent of the participant. This was
later viewed by the investigator/therapist and used to record the participant’s Dosa
performance on the therapy session record form. After the Dosa practice, the participants
answered the Session Evaluation Questionnaire (SEQ) and the Questionnaire of
Relaxation Strategies (QRS) and were then asked about their somatic awareness by using
the Questionnaire for Somatic Awareness (QSA). At the end of the last intervention
session, the questionnaire about the therapy experience (QTE) was administered. The
participants were asked to keep a record of the target behavior on the behavior record
form for one additional week after the ﬁnal session, then, to complete the clinical anxiety
scale, the self-efﬁcacy scale, and the belief in personal control scale, and to mail them to
the investigator.

Approximately two weeks before the scheduled follow-up session, the behavior
record form was mailed to the participants with a letter to remind them of the follow-up
meeting. The participants were asked to start recording their target behavior a week prior
to the follow-up session and bring it to the session.

The follow-up session (F-UP) was held approximately six weeks after the last
therapy session. The follow-up session was conducted with the same structure as the
interview conducted during the baseline phase. The participant and the investigator met
for a half hour. The participant answered questionnaires including the clinical anxiety
scale, the self-efficacy scale, and the belief of personal control scale. An interview
regarding the status of the participant’s anxiety problem was conducted based on the
recording on the target behavior. Table 2 shows when the instruments were administered

to collect the information.

67

Instruments ﬂaw Intervention F olIow-up
Elam My Q81

Clinical anxiety scale
Self-efficacy scale
Belief in personal control scale
Experiencing scale
Behavior Record
Therapy Record

><><><><><
><><><><><

Session evaluation questionnaire

Questionnaire for somatic awareness

><><><><><><><><><

Questionnaire for relaxation strategy

Questionnaire for therapy experiences X

Figure 4. Schedule of instrument administration.

68

CHAPTER 4

RESULTS

Preliminm Analyses

Before proceeding with the analyses to exarrrine the effect and therapeutic process

of Dosa therapy, the following preliminary analyses were conducted.

Milky of the Measaremepta

The reliability coefﬁcients (alpha) of the anxiety scale (CAS) and the locus of
control scale (PBCS) for this study were computed. The coefﬁcient alpha for the CAS
was .87. The previous study reported a coefﬁcient alpha of .94 (Westhuis & Thyer,
1989). Therefore, the value of this study was slightly lower than the one in the previous
study, but still quite high. The coefﬁcient alpha for the PBCS in this study was.89. In the
previous study, a coefﬁcient alpha was reported as .85 (Fisher & Corcoran, 1994).

Therefore, the value of this study was slightly higher than the one reported in the

previous study.

Since two individuals worked as raters for the experiencing scale (EXP), the inter-
l‘ater reliability coefﬁcient was computed. Following the training manual, Ebel’s
intl‘aclass method was used to compute an estimate of the reliability of the means of the
Indge’s ratings (m) (Guilford, 1954). The inter-rater reliability of this study was .97 and

.83 for the modal and peak ratings, respectively. The inter-rater reliabilities which were

69

reported previously from the single-subject studies ranged from .79 to .83. Therefore, the

inter-rater reliabilities of this study are at least comparable to those values.

Segment Identiﬁcation for EXP

For the experiencing rating, it was decided to select a six-minute segment from

 

each interview following the training manual protocol (Klein, et al., 1969). In order to
select the location of a segment for the rating, a pilot study was conducted. Three
participants were selected randomly from all participants. From each participant, two
interviews were selected. In total, six interviews were selected for this pilot study. A
thirty-minute interview was divided into three segments; a ﬁrst ten-minute, a second ten-
minute, and a last ten-minute. The client’s experiencing level for each segment was rated
by using a running rating method, in which the rater rates each client’s speech in turn (M.
Klein, personal communication, February 10, 2000). Then the ratings were summarized
into a modal and peak rating of each segment and compared between three segments. For
the modal ratings, the means for the ﬁrst, second, and third segment were 2.00, 1.83, and
2. 1 6, respectively. The difference between the segments was not signiﬁcant,
E (2, 5) = 1.00, p > .05, and the level of association was small (112 = .17). For the peak
ratings, the means for the ﬁrst, second, and third segment were 3.00, 3.17, and 3.33,
respectively. Once again, the difference between the segments was not signiﬁcant,
E (2, 5) = .57, p > .05, and the level of association was small (1]2 = .22).

These results indicated that there was no difference in the level of experiencing
betWeen the ﬁrst, second and third part of the interview. Since the interview usually

started with talking about the concrete incidents during the previous week and proceeded

70

to the discussion about the feelings and thoughts relating to the incidents, it was decided
that a six-minute segment would be selected from the last third segment. Speciﬁcally, the
portion from the 22“ to 28th minute was selected proportionally from each interview for

the experiencing rating.

Test of Autocorrelan'on

Autocorrelation is a type of correlation which indicates the degree of serial
dependency between the adjacent observations within a series of observations made over
time. A lag 1 autocorrelation indicates the extent to which the values of a variable are
dependent on the immediately preceding ones. One of the assumptions underlying many
statistical tests as applied to the analysis of single subject designs is the assumption that
the observations are independent. When the observations are dependent, it violates the
assumption of independence between observations and this can result in Type I or Type II
errors (Bloom, Fisher, & Orme, 1995). In single subject design, the observations are
made continuously over time and the data from a study using single subject design are
especially susceptible to autocorrelation. For this reason, a lag 1 autocorrelation on each
measure was computed to see the level of correlation between the values and the
immediately preceding ones. Tables 2 and 3 show a lag l autocorrelation on each
measure during the baseline and intervention phase, respectively.

As shown in Table 2, none of the autocorrelations of the baseline phase were
signiﬁcant. The autocorrelations during the intervention phase for the behavior
observation of participant 6, the locus of control of participant 7, and the self-efﬁcacy of

participant 8 were statistically signiﬁcant (see Table 3). These data were transformed

71

using the ﬁrst difference transformation, which is one of the data transformation methods
to correct for autocorrelation. The autocorrelations with the transformed data were
computed (Bloom, Fisher, & Orme, 1995). They were -. 16 for the behavior observation
of participant 6, -.29 for the PBCS of participant 7, and -.19 for the SES of participant 8.
Lag 1 autocorrelations for those transformed data were not signiﬁcant. Therefore, when
the statistical analysis which assumes the independence of the observation was

conducted, the transformed data were used.

Table 2

Lag 1 Autocorrelations of the Baseline phase on the Anxiety Scale (CAS), the Self-
Efticacy Scale (SES), the Locus of Control Scale (PBCS), the Experiencing Scale (EXP),
and the Behavior Observation

 

 

 

Participants CAS SES PBCS EXP EXP BEHAVIOR
Mode Peak

Participant 3 -.25 -.66 .25 -- -- -.09
Participant 6 .29 .37 -.07 -.30 -.47 -.02
Participant 7 .24 -.27 -.23 -- -- .00
Participant 8 .20 -.35 -.53 -- .25 -.64
Participant 9 -. 1 7 -.42 -.30 -- -.42 -.60

Table 3

Lag 1 Autocorrelations of the Intervention Phase on the Anxiety Scale (CAS), the Self-
Eﬁicacy Scale (SES), the Locus of Control Scale (PBCS), the Experiencing Scale (EXP),
and the Behavior Observation

 

 

 

Participants CAS SES PBCS EXP EXP BEHAVIOR
Mode Peak

Participant 3 .36 -.02 -.43 -- -.46 .60

Participant 6 .29 .50 .31 -.27 -.27 .61 *

Participant 7 -.14 -.O9 .59“ -.12 -.02 -.16

Participant 8 .00 .59* -.O7 -.50 -.40 .00

Participant 9 -.02 .04 .1 l -.27 -.45 -.27

* p<.05

72

Therapeutic Effect on Variables

 

The analyses to examine the effect of the intervention with Dosa therapy was
conducted by comparing the baseline and intervention phase on each variable measured
by the scales. Participant 9 could not ﬁnd time on the week when the other participants
had their ﬁrst baseline interview and started her participation from the second week.
Therefore, her baseline observations were short one observation point from the other
participants in the second group. Participant 3 failed to return the scales and the behavior
recording after the last intervention. Therefore, the observation points of the intervention
phase for Participant 3 were seven, rather than eight. The results will be described on
each variable cross-sectionally in this section. In the following section, they will be

reviewed on each participant individually in relation to the hypotheses.

Anni!

The analysis to examine the effect of the intervention was conducted as a group
ﬁrst and then for each individual. The group means of the anxiety score for the baseline
and intervention periods were 16.76 and 9.26, respectively. The difference in the anxiety
score between the two periods was signiﬁcant, t (4) = 4.22, p < .05. An analysis of
variance for repeated measures was also conducted to examine the difference between the
baseline and intervention phase. The contrasts were computed to examine the difference
between the baseline and one or some combination of the intervention observations. The
results are shown in Table 4. Again, the difference in the anxiety score between the
baseline and intervention was signiﬁcant, F (1, 15.8) = 4.71, p <.05. These results

indicate that the participants’ anxiety scores decreased signiﬁcantly during the

73

intervention phase. Thus, these results are supportive for the second hypothesis about the
effect of the intervention with Dosa therapy on the participants’ affective level of
functioning. As seen in Table 4, the difference between the average anxiety score of
baseline period and the anxiety score of a single intervention session became signiﬁcant
from the seventh week. This result indicates that the change was revealed from the third

week after the intervention started, although a smaller effect is seen at weeks 9 (p = .06)

 

 

and 11 (p = .14).
Table 4

Contrasts of Anxiety Score between the Baseline and Intervention Phase
Weeks Num DF Den DF P value Pr>F
Baseline vs 5“'3 week 1 42.4 0.03 0.87
Baseline vs 6‘“ week 1 36.5 2.51 0.12
Baseline vs 7th week 1 30.0 5.16 0.03
Baseline vs 8'11 week 1 24.0 4.42 0.05
Baseline vs 9th week 1 21.9 4.10 0.06
Baseline vs 10th week 1 18.7 4.64 0.04
Baseline vs 11th week 1 17.0 2.37 0.14
Baseline vs 5.8th weeks 1 23.6 3.34 0.08
Baseline vs 6-9th weeks 1 19.4 5.44 0.03
Baseline vs 7-10‘11 weeks 1 16.2 6.03 0.02
Baseline vs 8-11th weeks 1 13.9 4.96 0.04
Baseline vs Intervention 1 15.8 4.71 0.05

 

Table 5 shows the mean anxiety scores of the participants in the baseline and
intervention phases, the effect size which indicates the magnitude of the difference
between the two periods, and the results of the t-tests. The average anxiety scores

decreased for all participants. The effect size ranges ﬁ'om -1.13 to -1.79. This difference

74

indicates that the participant’s anxiety score decreased approximately 40% (ranging from

37.1 % to 46%) during the intervention phase compared to the average score in the

baseline phase. Although the change in the anxiety score reached a statistical signiﬁcance

level only for Participant 7, t (10) = 2.34, p < .05, the change for other participants was

fairly large, shown by the effect size.

 

 

 

 

Table 5
Mean Anxiety Scores in the Baseline and Intervention Phases, Effect Size, and T values
Participant Baseline Intervention Effect Size T value
Participant 3
M 11.88 1.71 -1.79 (-46%) 2.02
SD 10.00 1.25
Participant 6
M 17.40 10.14 -1.26 (-39.6%) 2.15
_S_I_) 2.30 7.20
Participant 7
M 26.50 14.25 -1 .43 (-42%) 2.34*
S_D 5.20 9.65
Participant 8 '
_M_ 8.00 6.00 -1.15 (-37.5%) 1.89
S_D 1.82 1.69
Participant 9
M 20.00 14.21 -1.13 (-37.l%) 1.80
_S_ 2.83 5.96
*p <.05.

The anxiety scores of each session for the participants were plotted in a chart (see

Figures 5 and 6). The intervention started from the fourth week for Group 1 (Participants

3, 7, and 8). The anxiety score of Participant 3 started to decrease the last week of the

observation period and maintained that level or lower during the intervention period (see

Participant 3 Anxiety

 

 

l4 rill-Ill

manganese

9.3m 23m D0225. Emmi—U

F-Up

12

Weeks

Participant 7 Anxiety

 

in L! r L! ? lit

0 5 0 5 5 0 5
4 3 3 2 m I. I 0

9.8m 0.8m been: .835

F-Up

12

10

Weeks

Participant 8 Anxiety

 

a a a ..... a . .... ... .
83m 0.3m .3853. .3236

F-Up

12

10

Weeks

Figure 5. Anxiety Scores for Group 1 (Participants 3, 7, 8)

76

Participant 6 Anxiety

bl llIiLIl . ill!

 

050505050

4332211

28m 28m 3252 .836

 

4

 

12 F-Up

11

10

Weeks

Participant 9 Anxiety

 

 

II III Li 1— k if

0 50 5 0 5 0 5 0
4 33 2 2 I I

23» 0.8» 30.52 325.0

l2 F-Up

10

Weeks

Figge 6. Anxiety Scores for Group 2 (Participants 6, 9)

77

Figure 5). The anxiety scores of Participant 7 were decreasing during the observation
period. When the intervention started, the score increased once and started to decrease
from the following week. Her anxiety score increased on the eleventh week, which
coincided with the ﬁnal exam week (see Figure 5). The anxiety score of Participant 8
started to decrease three weeks following the beginning of intervention (see Figure 5).
Therefore, for this group, the causal effect of Dosa therapy on the participants’ anxiety
level was clear for Participant 8. The causal effect of the intervention on the anxiety level
was somewhat ambiguous for Participants 3 and 7.

For Group 2 (Participants 6 and 9), the intervention started from the ﬁfth week.
As seen in Figure 6, the anxiety scores of Participant 6 and 9 were high during the
baseline period and they maintained that level while the intervention started with the
former group; there was a trend of increasing anxiety level for both of them. More
importantly with regard to the purpose of multiple baseline design, their anxiety level
maintained that level and was not affected when the intervention started with Group 1.
Their anxiety scores started to decrease one week after the beginning of intervention.
Therefore, the causal effect of the intervention on the participants’ anxiety level was clear
for this group. In total, three participants’ anxiety score started to decrease after the
intervention started. This result, although not very strong, indicates the intervention with

Dosa therapy inﬂuenced the participant’s anxiety level.

Behavior

Table 6 shows the means of the target behavior during the baseline and

intervention phases for the participants. The target behavior of each session for the

78

participants was plotted in a chart (see Figures 7 and 8). Since the target behavior of each
participant was different and the unit of each behavior was not comparable, a group

analysis was not conducted.

 

 

Table 6

Means of Target Behaviors in the Baseline and Intervention Phases
Participant Baseline Intervention
(Target Behavior)

Participant 3 M 4.67 14.86
(study hours) S_D 5.11 6.92
Participant 6 M 5.13 2.90
(difﬁculty of falling asleep) S_D 1.07 1.04
Participant 7 M 7.17 5.86a
(study hours) SD 4.07 2.59
Participant 8 M 9.37 9.68
(assuredness of her feelings) S_D .47 .45
Participant 9 M 5.33 .43
(acting-out behavior) SD 3.06 .54

 

Note. 1”The mean was computed without the last observation.

The issue Participant 3 addressed was her anxiety and overwhelming feeling
caused by schoolwork. She counted her study hours to see if her anxiety would decrease
and allow her to focus on her studies. As shown in table 6, her study hours increased
dming the intervention period compared to the period of the baseline. As seen in Figure
7, her study time decreased during the baseline period. After the beginning of
intervention, her study time started to increase and steadily increased after a decrease on
the second week. A regression line was computed to examine the trend during the

intervention period. A standardized slope (B) was .74. It did not reach a statistical

79

signiﬁcance level, E (1, 5) = 6.10, p =.057. However, the change was in the expected
direction. This indicates that her study hours appeared to have increased during the
intervention period.

Participant 7 monitored her study hours to see the change in her anxiety aroused
by procrastinating schoolwork. As shown in Table 6, the average study hours during the
intervention period decreased compared to the one during the baseline period. However,
the difference in study hours between the two periods was not signiﬁcant, 1 (8) = .626,

p = .55. Figure 7 shows the study hours during the baseline and intervention phases. Her
study hours during the baseline decreased. Once the intervention started, her study hours
started to increase until the second session before the last. She did not study at all after
the last session. The last session was held after the ﬁnal exam week, therefore, this
environmental factor can explain the fact that she did not study at all after the last
session. A regression line was computed to examine the trend during the intervention
period, excluding the last observation. The standardized slope (B) was .88 and was
signiﬁcant, F (l, 5) = 16.75, p <.01. This result indicates that during the intervention
period her study hours increased signiﬁcantly.

Participant 8 monitored the assuredness of her feelings toward her boyﬁiend. This
behavior was rated on an ll-point scale, 0 meaning not sure at all and 10, very
sure/almost certain. As shown in Table 6, the average of the rating increased during the
intervention period. Figure 3 shows the ratings during the baseline and intervention
periods. The ratings during the baseline period ﬂuctuated and were not stable. After the
beginning of intervention, the ratings became higher and stable, except for a drop on the

7th week. Seven observations out of eight in the intervention period fell above the average

80

Participant 3 Behavior

5
m 1 m

953.— .33

 

 

 

 

F-Up

12

10

Weeks

Participant 7 Behavior

2

9:5: .355

a

0

F-Up

 

Weeks

Participant 8 Behavior

II rilrlllrllllrl...r‘.
0 9 8 7 6 5 4 3 2 1. O
1

§=v8=8< as metal

 

it

F-Up

12

10

Weeks

Figure 7. Target Behaviors for Group 1 (Participants 3, 7, 8)

81

Participant 6 Behavior

. '""I'l'-"|"l|'|||'||"'t

.. IILIlIl » ‘ihllr »ilL. IIILl. _r. lk|t

09876543210

1

32mm wﬁzé .3 b.3056 .Lo mused

12 F-Up

ll

10

Weeks

Participant 9 Behavior

"""""""""""""""""""

_L.._ _L

I i I} .likii. F l|rll|i 1.. ll. llllrll|ri. .l

9 oo 7 6 5 4. 3 2 .I 0
Lo_>mcom Solwcso<

12 F-Up

ll

10

Weeks

Figare 8. Target Behaviors for Group 2 (Participants 6, 9)

82

of the baseline period. Therefore, the data achieved statistical signiﬁcance based on a
binomial test (York, 1998). This result indicates that she became signiﬁcantly more sure
of her feelings during the intervention period. Actually, she made a decision during the
7th week and got engaged to her boyﬁiend.

Participant 6 focused on the difficulty of falling asleep at night as a behavior to
monitor the change in her anxiety level. Because she felt that she did not ﬁt in and got
ﬁ'ustrated, those feelings accumulated during the day and interfered with her sleep at
night. She rated the difﬁculty of falling asleep on a scale from 0 to 10, 0 meaning not
difficult at all and 10, very difﬁcult. As shown in Table 6, the average rating during the
intervention period became lower than during the baseline period. Figure 8 shows the
ratings of the baseline and intervention periods. The rating started to decrease after the
beginning of intervention almost steadily. A regression line was computed to examine the
trend during the intervention period. The standardized slope ([3) was -.88 and was
signiﬁcant, F (l, 5) = 16.50, p <.01. This result indicates that it became signiﬁcantly less
difficult for Participant 6 to fall asleep during the intervention period.

Participant 9 focused on her acting-out behaviors as a target behavior to monitor
her anxiety level, because she noticed that she tended to ventilate her anxiety by acting in
a somewhat aggressive way. As shown in Table 6, the number of acting-out behaviors
decreased during the intervention period. Figure 8 shows the acting-out behaviors during
the baseline and intervention periods. The number of acting-out behaviors ﬂuctuated
during the baseline period. After the beginning of intervention, the number of acting-out
behaviors decreased and stayed on the lower level. All observations during the

intervention period fell below the average of the baseline period. Therefore, the

83

difference in acting-out behaviors between the baseline and intervention periods achieved
statistical signiﬁcance based on a binomial test (York, 1998). This result indicates that
Participant 9 acted out her anxiety less during the intervention period.

As Participants 3, 7, and 8 were assigned to Group 1, their intervention started
from the fourth week. The study hours for Participants 3 and 7 decreased during the
baseline and started to increase ﬁ'om the following week after the intervention began (see
Figure 7). As for Participant 8, the ratings of her feeling ﬂuctuated during the baseline
just as she described in the beginning and started to become more stable and higher from
the four weeks after the intervention started. As for Participants 6 and 9, whose
intervention started from one week after Group 1, their behaviors also started to change
after the intervention began (see Figure 8). Therefore, these results clearly indicate that
the intervention with Dosa therapy inﬂuenced the change in the participants’ behavior.
Thus, the results support the hypothesis about the effect of the intervention on the

participants’ behavioral level of functioning.

Expgriencing

The participants’ experiencing level was measured on the experiencing scale
(EXP). It was also monitored as the participants’ somatic sensations during the Dosa
exercise in terms of the number, its noticeability and hedonic valence. The results on
these measures will be examined separately.

Exgriencing Level. The difference in the EXP scores between the baseline and
intervention periods were examined as a group ﬁrst, followed by individual analyses. As

for the modal experiencing score, the group means of the baseline and intervention

84

periods were 2.04 and 2.80, respectively. The difference in the modal experiencing
between two periods was signiﬁcant, 1 (4) = -3.26, p <.05; E (1, 19.7) = 6.76, p <.05. The
contrasts of analysis of variance for repeated measures are shown in Table 7. The results
indicate that the modal experiencing score became signiﬁcantly higher during the
intervention period than the baseline period. Thus this result was supportive for the ﬁrst

hypothesis about the effect of the intervention on the participants’ experiencing level.

 

 

Table 7

Contrasts of Modal Experiencing Level between the Baseline and Intervention Phase
Weeks Num DF Den DF F value Pr > F
Baseline vs 5ih week 1 39.2 2.14 .15
Baseline vs 6th week 1 38.8 2.95 .09
Baseline vs 7th week 1 39.3 7.10 .01
Baseline vs 8th week 1 39.2 0.01 .92
Baseline vs 9th week 1 39.2 2.19 .14
Baseline vs 10“1 week 1 39.2 2.19 .14
Baseline vs 5-8th weeks 1 21.4 5.50 .02
Baseline vs 6-9th weeks 1 17.4 5.58 .03
Baseline vs 7-10th weeks 1 17.8 5.12 .03
Baseline vs Intervention 1 19.7 6.76 .02

 

Table 8 shows the mean modal experiencing scores of each participant during the
baseline and intervention phase. The modal experiencing level increased during the
intervention phase for all participants except for Participant 3, whose level did not
change. The difference in the modal experiencing level for Participant 8 was statistically

signiﬁcant, t (6) = -2.65, p <05.

85

Table 8

Means of Modal Experiencing Level in the Baseline and Intervention Phases and T

 

 

 

 

values
Participant Baseline Intervention T value
Participant 3
M 2.00 2.00 --
SD .00 .00
Participant 6
M 2.20 3.60 -1.40
S_D .45 2.19
Participant 7
M 2.00 2.57 -1.33
S_D .00 1.13
Participant 8
M 2.00 3.00 -2.65*
S_D .00 1.00
Participant 9
M 2.00 2.83 -l .40
S_D .00 1.17
*p <.05

As for the peak experiencing level, the group means of the baseline and

intervention phases were 3.23 and 4.27, respectively. The difference in the level between

the two phases was statistically signiﬁcant, 1 (5) = -4.69, p <.01; E (1, 15.2) = 11.29,

p <.01. Table 9 shows the contrasts of analysis of variance for repeated measures. These

results indicate that the peak experiencing level signiﬁcantly increased during the

intervention period compared to the baseline period. Thus, again, the results are

supportive for the ﬁrst hypothesis about the effect of the intervention on the participants’

experiencing level.

86

Table 9
Contrasts of Peak Experiencing Level between the Baseline and Intervention Phase

 

 

Weeks Num DF Den DF F value Pr > F
Baseline vs 5Eh week 1 38.7 3.72 .06
Baseline vs 6‘“ week 1 32.8 5.61 .02
Baseline vs 7th week 1 28.3 13.12 .001
Baseline vs 8th week 1 26.1 0.12 .73
Baseline vs 9th week 1 25.0 12.83 .001
Baseline vs 10th week 1 24.5 4.81 .03
Baseline vs 5-8'h weeks 1 18.2 7.56 .01
Baseline vs 6.9th weeks 1 15.2 10.52 .01
Baseline vs 7-10th weeks 1 13.7 10.02 .01
Baseline vs Intervention 1 15.2 1 1.29 .004

 

Table 10 shows the means of peak experiencing level for the participants. The
peak experiencing level of all participants increased during the intervention period. The
peak experience level of Participants 6 and 7 reached statistical signiﬁcance,

_t_ (5.89) = -3.29, p <05 and t (9) = -5.91, p<.000, respectively. The peak experiencing
level of Participants 8 and 9 was not statistically signiﬁcant, 1 (9) = -2.05, p = .07 and
1(8) = -1.70, p = .12, respectively. However, the change was in the expected direction.
These results suggest that the peak experiencing level increased for almost all
participants. Theoretically and clinically, the transition from level 3 to 4 on the scale is
one of the key events. This transition indicates that the ability to refer inwardly and
acknowledge that experience, emerged in the client (Mathieu-Coughlan & Klein, 1984).
Therefore, the change in the peak experiencing level of these participants has clinical

signiﬁcance.

87

Table 10
Means of Peak Experiencing Level in the Baseline and Intervention Phases and T values

 

 

 

 

Participant Baseline Intervention T value

Participant 3
M 3.00 3.43 -1.16
E .00 .98

Participant 6
M 3.40 5.20 -3.29*
_S_Q .55 1.10

Participant 7
M 3.00 4.14 -5.91***
M) .00 .38

Participant 8
M 3.50 4.43 -2.05
SD .58 .79

Participant 9
M 3.25 4.17 -1.70
S_D .50 .98

*p <.05. *"p <.01.

Somatic Awareness. Somatic awareness during the Dosa exercise was monitored
on the questionnaire for somatic awareness (QSA) in three dimensions; the munber of
somatic sensations reported, its noticeability, and the hedonic valence. To examine the
change in these dimensions over the process of therapy, the average of the ﬁrst two
sessions and the last two sessions were computed as the score of the early period and the
late period. Table 11 shows the number of somatic sensations reported and its
noticeability and the hedonic valence for the participants.

As for the direction of the change in each dimension, the investigator did not
clearly state it in the hypothesis section. However, it was assumed that the number of
somatic sensations reported during the Dosa practice, its noticeability and the hedonic

valence would increase as the Dosa practice progresses.

88

Table 11
Means of Number of Somatic Sensations, its Noticeability and Hedonic Valence

 

 

Participant Number of Noticeability Hedonic Valence
Sensations
Participant 3
Early 3.0 7.35 2.65
Late 3.0 4.65 -4.65
Participant 6
Early 3.5 8.36 -13.00
Late 2.0 8.50 20.00
Participant 7
Early 3.0 7.50 -4.15
Late 2.5 8.75 -7.10
Participant 8
Early 4.5 8.05 -2.6
Late 4.5 4.18 -1.13
Participant 9
Early 3.5 9.05 14.00
Late 2.0 10.00 10.00

 

The group means of the number of sensations reported during the Dosa exercise
in the early and the late intervention periods were 3.5 and 2.8, respectively. However, the
difference was not statistically signiﬁcant, 1 (4) = 2.06, p = .11. This suggests that the
participants tended to report less somatic sensations at the late period than the early
period of intervention. As shown in Table 11, Participants 6, 7, and 9 reported less
somatic sensations during the late period of intervention, however, the difference was
small. Therefore, the result revealed an opposite direction to the investigator’s
assumption.

The noticeability of somatic sensations was measured on a 10-point scale; 1
meaning barely noticeable, 10, extremely noticeable. The group means of the early and

the late periods were 8.07 and 7.21, respectively. The difference between the two periods

89

was not statistically signiﬁcant, 1 (4) = .83, p >.05. As shown in Table 11, the
noticeability of the somatic sensation became higher for Participants 6, 7, and 9, in the
late period of intervention than the early period, whereas it became lower for Participants
3 and 8. Therefore, there is no trend which is common for all participants. The
investigator’s assumption on the noticeability of somatic sensations was not supported.

The hedonic valence of somatic sensation was measured on a 40-point scale,
-20 meaning extremely unpleasant, +20, extremely pleasant. The group means of the
hedonic valence for the early and late intervention periods were -.62 and 3.43,
respectively. The difference between the two periods was not signiﬁcant, 1 (4) = -.55, p
>.05. As shown in Table l 1, each participant showed an idiosyncratic change regarding
the hedonic valence of the somatic sensation. Participant 3 experienced the somatic
sensation as more pleasant at the early period and more unpleasant in the late period. For
Participant 6, the somatic sensation was unpleasant in the early period and became more
pleasant around the end of the intervention. For Participant 7, the somatic sensation was
unpleasant and it became more unpleasant toward the end of the intervention. For
Participant 8, the somatic sensation was unpleasant and it became less unpleasant toward
to end of the intervention. Participant 9 experienced the somatic sensation as pleasant
throughout the intervention, although, it became slightly less pleasant toward the end of
the intervention. Therefore, again, there was no common trend among the participants.
The results did not support the investigator’s assumption on this dimension. These results
regarding somatic awareness will be further discussed in the following chapter.

In sum, the effect of the intervention with Dosa therapy on the participants’

experiencing was not observed on the somatic awareness dimensions. Thus, these results

90

do not support the ﬁrst hypothesis about the effect of the intervention on the participants’

experiencing.

Self-Efficacy

Self-efﬁcacy was measured on the self-efficacy scale. The group means of the
self-efﬁcacy score in the baseline and intervention phase were 6.70 and 8.14,
respectively. The difference in the self-efﬁcacy score between the two periods was
signiﬁcant, 1 (4) = -4.18, p <.01; E (1, 15.3) = 8.18, p <.01. This result indicates that the
participants’ self-efﬁcacy increased signiﬁcantly during the intervention phase. Thus, this
result is supportive for the second hypothesis about the effect of the intervention on the
participants’ cognitive level. The contrasts of analysis of variance for repeated measures
are shown in Table 12. The contrast between the average score of the baseline period and
a single intervention session became signiﬁcant from the seventh week. This result
suggests that the difference in self-efﬁcacy started to emerge from the third intervention
session.

Table 13 shows the participants’ mean self-efﬁcacy score, the effect size and the
T values. The self-efficacy scores of all participants increased during the intervention
period ﬁ'om the baseline period. The effect size, which indicates the magnitude of
change, ranged from .40 to 3.32. This suggests there was an increase in the self-efﬁcacy
score in the intervention period, ranging from 15.5% to greater than 100%, over the
average score in the baseline period. The difference in the self-efﬁcacy score reached
statistical signiﬁcance for Participants 6 and 9, t (10) = -5.68, p = .000 and t (9) = -2.79,

p = .02, respectively. The difference in the self-efficacy score for Participant 3 was not

91

signiﬁcant, however, the effect size was fairly large. The difference in the self-efficacy
score was not signiﬁcant and the effect size was small for Participant 8 when the
transformed data was used due to the autocorrelation. However, the difference in the

actual score was comparable to the one for Participant 6.

 

 

Table 12

Contrasts of Self-Efﬁcacy Score between the Baseline and Intervention Phases
Weeks Num DF Den DF F value Pr > F
Baseline vs 5Wweek 1 41.9 0.69 .4
Baseline vs 6th week 1 35.3 2.86 .10
Baseline vs 7th week 1 29.3 4.90 .03
Baseline vs 8th week 1 25.3 6.04 .02
Baseline vs 9“1 week 1 22.9 5.91 .02
Baseline vs 10th week 1 21.5 7.32 .01
Baseline vs 11‘" week 1 20.6 4.50 .04
Baseline vs 5-8th weeks 1 20.9 5.31 .03
Baseline vs 6.9th weeks 1 17.3 7.33 .01
Baseline vs 7-10‘“ weeks 1 14.9 8.89 .01
Baseline vs 8-11th weeks 1 13.4 8.62 .01
Baseline vs Intervention 1 15.3 8.18 .01

 

92

Table 13
Mean Self-Efﬁcacy Scores in the Baseline and Intervention Phases, Effect Size, and T
values

 

 

 

Participant Baseline Intervention Effect Size T value

Participant 3
M 7.88 8.57 1.17 (+37.9%) -1.69
_S_D .85 .53

Participant 6
M 5.60 8.00 3.32 (+<100%) -5.68***
S_D .55 .82

Participant 7
M 6.75 7.63 .78 (+28%) -1 .27
SD 1.50 .92

Participant 8
__ 7.50 9.63 .40 (+15.5%) - .36
S_D 1.29 .52

Participant 9
M 5.75 6.86 1.75 (+45.9%) -2.79"‘
S_ .50 .69

 

*p < .05. "*p < 000.
Note. Transformed data were used for Participant 8 to compute the effect size and for T-
test.

Locu_s of Control

Locus of control was measured on the personal belief in control scale (PBCS).
The average PBCS score in the baseline and intervention phases were 73.31 and 78.97,
respectively. The difference in the PBCS score was not statistically signiﬁcant,
t(4) = -2.20, p = .09; _F_‘ (1, 18.4) = 2.73, p = .1. However, the change was in the expected
direction. This result suggests that the participants’ locus of control became somewhat
more internal in the intervention period. However, this result is not supportive for the
second hypothesis about the effect of the intervention on the participants’ cognitive level.

Table 14 shows the means of PBCS scores in the baseline and intervention

periods for the participants, the effect size and T values. As shown in Table 14, the means

93

of the PBCS scores in the intervention period increased for all participants. The effect

size ranged from .20 to 2.64. This indicates that there was an increase in the PBCS score

in the intervention period, ranging from 8% to approximately 50%, over the average

score in the baseline period. The difference in the scores between the baseline and

intervention phases was signiﬁcant for Participants 3 and 6, t (9) = -2.63, p = .02 and

t (10) = -4.50, p = .001, respectively. The difference in the scores was not statistically

signiﬁcant for participant 9, t (3.09) = -2.01, p = .14. However, the effect size which

indicates the magnitude of the change was comparable to the one for Participant 3.

 

 

 

Table 14
Mean PBCS Scores in the Baseline and Intervention Phases, Effect Size, and T values
Participant Baseline Intervention Effect Size T value
Participant 3
M 78.75 83.43 1.57 (+44%) -2.63*
S_D 3.30 2.57
Participant 6
M 77.40 83.86 2.64 (+49.6%) -4.50**
E 2.19 2.61
Participant 7
M 66.00 67.5 .20 (+ 8%) - .19
M), 3.16 2.14
Participant 8
M 79.75 80.38 .29 (+11%) - .36
SD 3.40 1.30
Participant 9
M 64.63 79.71 1.71 (+45.6%) -2.01
S_ 14.89 2.43

 

*p < .05. "p < .01.
Note. Transformed data were used for Participant 7 to compute the effect size and for T-

test.

94

Therapautic Effect on Each Participapt

In this section, the aforementioned results will be reviewed for each participant
individually and the effect of the intervention with Dosa therapy on each participant will

be examined.

Participant 3

Participant 3 was overwhelmed by the amount of study required from the graduate
courses she was taking and became too anxious to focus on her studies. In the screening
interview, she described a plan to prepare the environment which might help her
concentrate on her study. The plan included making a study schedule to designate time
for study, and removing herself from outside activities. By the end of the baseline period,
she quit the outside activities in which she had been involved and transferred
responsibilities to other members. After the beginning of the intervention, she reported
that she started to feel that things were under control and charted out the study schedule
for the rest of the semester. She also reported that she was feeling a time pressure to do
the schoolwork and meet the due date for each assignment but that this was different
from what she felt before and did not feel so bad. On the third session after the beginning
of intervention, she reported that she became more focused on her studies. Her study
hours started to increase after the beginning of intervention. Her anxiety level started to
decrease at the end of baseline period and stayed on the lower level.

On the questionnaire for therapy experience (QTE) which was administered at the

end of the last session, her disturbance level was 4 on a lO-point scale (1 meaning no

95

trouble at all, 10, very disturbed). She was at level 8 at the beginning of the therapy. She
stated that her issue was resolved and she was very satisﬁed with this result.

At the follow-up session which was held approximately six weeks after the last
session, her anxiety level maintained the level of the last session and her study hours
stayed higher than the average of the intervention period.

As for the ﬁrst hypothesis about the effect on her experiencing, the average modal
and peak experiencing level during the intervention period were not signiﬁcantly higher
than the ones during the baseline period (see Tables 8 and 10). However, the peak
experiencing level during the intervention period reached level 4 in two sessions and 5 in
one session, whereas it remained at level 3 throughout the baseline period. The peak
experiencing level, on average, was not higher signiﬁcantly. However, her experiencing
level reached a higher level in some sessions. This may lend support for the hypothesis
indicating her experiencing reached a higher level during the intervention period.

Regarding somatic awareness during the Dosa exercise, the number of sensations
she reported during the ﬁrst two sessions and the last two sessions was the same. The
noticeability of the sensations decreased in the last two sessions and its hedonic valence
moved from pleasant in the ﬁrst two sessions to unpleasant in the last two sessions. These
results do not suggest that she became more aware of somatic sensations as the Dosa
exercise progressed. Therefore, the hypothesis about the effect of the intervention on her
experiencing was not supported on the somatic awareness measure.

As for the second hypothesis about the effect of Dosa therapy on the behavioral,
cognitive, and affective level of functioning, her study time increased and the trend was

clear. This indicates that the intervention had an effect on the behavioral level of

96

functioning. Her anxiety level was lower in the intervention period than the baseline
period. However, the change started at the last baseline session. Therefore, the causal
effect of the intervention was ambiguous on the affective level. Her self-efﬁcacy became
higher in the intervention period. Although the change was not statistically signiﬁcant,
the effect size did indicate that her self-efﬁcacy score became 37.9 % higher over the
average in the baseline period. Her locus of control became more internal in the
intervention period and the difference in the PBCS scores between the baseline and
intervention periods was statistically signiﬁcant. Therefore, the intervention had an effect

on the cognitive level of functioning.

Participant 6

The issue Participant 6 focused on was her feeling that she did not ﬁt in. This
feeling made her feel isolated and sometimes frustrated because she felt no one
understood her. She often challenged the status quo to try to improve a situation. This
tended to cause an interpersonal conﬂict. Those incidents usually built up stress in her
and made her feel upset and anxious. Because of this, it was difﬁcult for her to shut them
out of her mind at night and fall asleep. As a target behavior, she recorded her case in
falling asleep to monitor her anxiety level.

Her anxiety level started to decrease one week after the beginning of the
intervention and her sleep behavior started to improve right after the intervention started.
On the third session after the intervention started, she reported that she became aware of

inner sensations and when she felt anxiety building, for example while working on a

paper With the due date approaching, she took a short break and it helped her slow down.

97

She reported that she came to view that her tendency to think things more deeply made
her feel different and isolated and that there might be some people who think the same
way she does. On the ﬁfth intervention session, she became tense the night before a class
presentation and could not fall asleep. She tried relaxation and while concentrating only
on her breathing and muscle sensation, she noticed that the disturbing thoughts
disappeared and she could fall asleep. At the last session, she stated that she still has a
feeling that she did not ﬁt in, but it does not disturb her any more nor does it cause
anxiety. That is because she now realizes that people are allowed to have a different
opinion. She further stated that she can control just herself and she will not let others’
opinion continue to affect her.

On the questionnaire about therapy experiences which was administered at
termination, her disturbance level was 2; it was 8 at the beginning of therapy. She rated
that her issue was resolved and she was very satisﬁed with this result. At the follow-up
session, it was found that both her anxiety level and behavior remained consistent with
those reached at the end of the therapy.

As for the ﬁrst hypothesis about the effect of Dosa therapy on her experiencing,
the experiencing level increased for both modal and peak levels during the intervention
period. The increase in the peak rating was statistically signiﬁcant. This result lends
support for the hypothesis. Regarding the somatic awareness during the Dosa exercise,
the number of sensations she noticed decreased slightly in the last two sessions,
compared to the ﬁrst two sessions. The noticeability of those sensations slightly increased
in the last two sessions. The hedonic valence became extremely pleasant in the last two

sessions, which were negative in the ﬁrst two sessions (see Table l 1). These results

98

suggest she came to perceive the somatic sensations more positively as the therapy
progressed.

As for the second hypothesis about the effect of Dosa therapy on the behavioral,
cognitive, and affective levels of functioning, her sleep behavior improved during the
intervention period and the trend of the change during the intervention reached statistical
signiﬁcance. This result supports the hypothesis about the effect on the behavioral level.
Her anxiety score decreased during the intervention period and the effect size indicated
that her anxiety score decreased 39.6% during the intervention period over the average of
the baseline period, although it was not statistically signiﬁcant. This result is a direction
that supports the hypothesis about the effect on the affective level. Both her self-efﬁcacy
and internal control increased during the intervention period. Both changes were also
statistically signiﬁcant. Therefore, these results were supportive for the hypothesis about

the effect on the cognitive level.

Participgt 7

The issue Participant 7 focused on was her anxiety caused by procrastinating
when doing her schoolwork. When an assignment appeared very difﬁcult for her, she
avoided starting it. As a result, putting off the work made her very anxious. During the
baseline phase she continued to put off writing a paper and ﬁnished doing it in one day
on the day before it was due and felt intense anxiety. This also made her feel very
disappointed with herself. During the intervention, she continued failing to make an early
start although she continued planning it. On the fourth session, she started to write a

paper a few days before the due date and ﬁnished it within a decent time on the day

99

before it was due. This experience made her feel conﬁdent and good about herself.
However, this was the only occasion when she succeeded. The paper was an assignment
from the class which she enjoyed. Based on this experience she noticed that degree to
which she cared about the class affected how much effort she put in for an assignment.

The disturbance level at the end of the therapy was 8 on a lO-point scale; it was
also 8 at the beginning of the therapy. She rated that her issue was slightly improved and
she was somewhat satisﬁed with this result, on the questionnaire for therapy experience.

At the follow-up session, which was held six weeks after the last session, her
anxiety level became higher than the average of the intervention period. Her study hours
were more than the level at the end of the therapy.

As for the ﬁrst hypothesis about the effect on the experiencing, the modal and
peak experiencing level increased during the intervention period and the peak
experiencing level was signiﬁcantly higher than the baseline period. This result partially
supports the hypothesis. Regarding the somatic awareness during the Dosa exercise (see
Table 11), the number of sensations she reported in the last two sessions slightly
decreased. The noticeability of the sensations increased in the last two sessions compared
to the ﬁrst two sessions. The hedonic valence of the sensations became more unpleasant
in the last two sessions. These results indicate that as the Dosa exercise progressed, she
began to notice the somatic sensations more clearly and slightly unpleasantly.

As for the second hypothesis about the effect on her behavioral, affective, and
cognitive level of functioning, her study time increased during the intervention phase and
the trend was statistically signiﬁcant. However, the average study time was lower during

the intervention period than the baseline period. Therefore, the therapeutic effect on her

100

study behavior was ambiguous. Her anxiety lowered signiﬁcantly during the intervention
period than in the baseline period. However, her anxiety scores started to decrease during
the baseline period (see Figure 5). Therefore, again, the therapeutic effect on her anxiety
level was not conclusive. Her self-efficacy became higher and her locus of control
became more internal during the intervention period. However, they did not reach
statistical signiﬁcance. Therefore, the therapy did not have an effect on her cognitive

level.

Participant 8

The issue Participant 8 addressed was her feelings toward her boyfriend. She was
not sure about her feelings and her feelings ﬂuctuated ﬁ'om one extreme to the other. At
one time she felt that he was the person she was meant to be with and the next moment
she was not sure about that. This condition made her feel anxious and she could not make
a decision regarding the engagement. For this reason, she wanted to become certain about
her feelings and make a decision conﬁdently. She monitored her feelings toward her
boyfriend as a target behavior.

During the baseline period, her feelings ﬂuctuated and the ratings of her feelings
ranged from 6 to 10 on a scale from 0 to 10. This condition veriﬁed her account. After the
beginning of intervention, she started to feel right and more deﬁnite about her feeling
toward her boyﬁiend. She made a decision to marry her boyﬁiend on the third week after
the beginning of intervention and told her decision to her parents on the following week.
She was worried about her parents’ feelings about her boyfriend and this affected her

feelings of insecurity about him. In spite of her concern, her parents were very happy for

101

her. The scales reﬂected her internal condition sensitively: the behavior rating dropped
and the anxiety score increased the week she made the decision about the engagement.
After that week, the behavior ratings became higher and more stable. The anxiety scores
became lower and maintained the lower level for the rest of the intervention period. At
the end of the therapy, her disturbance level became 1, no trouble at all, which was 8 at
the beginning of the therapy. She rated that her issue was resolved and she was very
satisﬁed with this result.

At follow-up, the rating of her feelings maintained the level which was reached at
the end of the therapy. Her anxiety level was higher than it was at the end of the therapy.
However, it was still below the average of the baseline period.

As for the effect of the therapy on her experiencing, both modal and peak
experiencing levels became higher during the intervention period: the change in the
modal rating was statistically signiﬁcant and the change in the peak rating was fairly
large, although it did not reach statistical signiﬁcance (see Tables 8 and 10). Therefore,
these results partially support the hypothesis. Regarding the somatic awareness during the
Dosa exercise, the number of sensations she noticed did not change between the early and
the late part of the intervention. The noticeability of those sensations became less clear in
the last two sessions. The hedonic valence of those sensations became less unpleasant in
the last two sessions. These results indicate that she came to notice somatic sensations
less clearly and less unpleasantly around the end of the intervention.

As for the effect of the therapy on the behavioral, cognitive, and affective level of
functioning, the ratings of her feeling toward her boyﬁiend became higher in the

intervention than the baseline period and this change reached statistical signiﬁcance.

102

During the intervention period she made a decision to become engaged. This indicates the
therapy also made a difference which had clinical signiﬁcance. Therefore, the
intervention had an effect of her behavioral level. Her anxiety score became lower in the
intervention period than the baseline phase. This difference did not reach statistical
signiﬁcance, however the reduction of her anxiety score during the intervention period
was 37.5% and fairly large. Therefore, this ﬁnding is in the direction of the hypothesis
about the effect of the intervention on her affective level. Her self-efﬁcacy scores became
higher in the intervention period than the baseline period. Although the change was not
statistically signiﬁcant after the data were transformed to remove the autocorrelation, the
difference in the actual scores was large and clear (see Table 13). Her locus of control
score became higher in the intervention period than the baseline period. But the
difference was small. Therefore, these results lend partial support for the hypothesis

about the effect of the intervention on her cognitive level.

Participant 9

The issue Participant 9 focused on was her anxiety caused by the stress from
schoolwork. Her disturbance level from this issue ranged from 6 to 8, reporting it
ﬂuctuated from day to day. She tended to act out when she felt anxious and stressed out.
Therefore, she counted her acting-out behaviors such as becoming curt with her husband,
crying, and kicking things, to monitor her anxiety level.

After the beginning of the intervention she started to feel that her tension level
went down. She felt she became more tuned into her body and tried relaxation when she

felt tense during the week. She started to notice that when she became anxious, she could

103

not frmction well and became less productive. She also noticed that she is a social person
and enjoyed interacting with family and friends. However, due to the fact that
schoolwork consumed her time, she did not spend enough time with her family and
ﬁiends. She assumed that this might be one of the factors about which she felt so
stressed. She said about this situation, “It is my decision if I let anxiety take over my life
and become miserable or I take over and do something about it.” Thus, she took time for
her family and socialized with her friends and enjoyed it. She experienced a few incidents
which were stressful and made her feel very upset. One time she locked herself out of her
car at a gas station on her way to meet with her ﬁiend to work on an assignment together
and the other time, she got lost on her way to get her assignment paper which was due on
the following day. However, both times she handled the situation without acting out. She
became aware of an internal sign that anxiety was building up. When she noticed it she
found it easier to handle it if she talked about it. She stated that if she talked about it, it
allowed her to put some distance between the stressful event and herself and that helped
her not get caught up with her feelings. At the end of the therapy her disturbance level
became 1, no trouble at all. She rated that her issue was resolved and she was very
satisﬁed with the result.

At the follow-up session which was held six weeks after the last session, her
anxiety level was lower than the level of the last session and she did not have any acting-
out behaviors.

As for the hypothesis about the effect of therapy on the experiencing, both the
modal and peak experiencing levels became higher in the intervention period than the

baseline period. Although the change in the peak experiencing level did not reach

104

statistical signiﬁcance, the change was fairly large. This result lends a partial support for
the hypothesis. Regarding the somatic awareness during the Dosa exercise, the number of
sensations she noticed slightly decreased in the last two sessions. The noticeability of
those sensations became slightly higher in the last two sessions than the ﬁrst two
sessions. The hedonic valence became slightly less pleasant in the last two sessions.
These results indicate that as the Dosa exercise progressed, she tended to notice slightly
less somatic sensations and she noticed them slightly more clearly and less pleasantly.
As for the hypothesis about the effect of the therapy on the behavioral, affective,
and cognitive level of frmctioning, her acting-out behaviors decreased during the
intervention period. The difference in her behavior between the baseline and intervention
periods reached statistical signiﬁcance. Her anxiety level also deceased during the
intervention period. Although the difference in the anxiety score between the baseline
and intervention periods did not reach statistical signiﬁcance, the reduction of her anxiety
scores during the intervention period was 37.1% over the average of the baseline period
and fairly large. Her self-efﬁcacy became higher during the intervention period and the
difference in the self-efﬁcacy scores between the baseline and intervention periods was
statistically signiﬁcant. Her locus of control became more internal in the intervention
period. Again, although the difference between the baseline and intervention periods did
not reach statistical signiﬁcance, the increase of the scores during the intervention period
was 45.6% over the average of the baseline period and fairly large. In sum, the
intervention seems to have had some effects on the behavioral, affective, and cognitive

level. These results are in the direction that was hypothesized.

105

Therapeutic Process

Since the results described above indicate that the intervention with Dosa therapy
had a therapeutic effect on the participants’ self-functioning, an analysis of the
therapeutic process of Dosa therapy was conducted by using a task analysis approach.
The following three steps were taken to identify the participant’s inner operations which
enabled them to resolve a task of Dosa therapy. First, the task and the task environment
of Dosa therapy were described. Second, a rational performance model, which is to be
made based on theory, rational analysis and the researcher’s clinical experiences, was
constructed. Lastly, the rational model was tested empirically with the data from the
participants and revised based on the empirical data. Based on the revised performance
model, the operations model which describes the participants’ mental operations during

the Dosa task process was constructed.

Description of the Task and the Task Environment

The Dosa task used in this study was to relax the participants’ upper body while
rotating it. The participants needed to relax relevant parts of their body to rotate their
upper body toward the ﬂoor. The participants’ task was started when the therapist
proposed the Dosa exercise and they decided to do it. When the participants came to a
point where they could not move the body further, this point became another task
situation. The participants’ task at this point was to pay attention to the body sensation
and try to ﬁnd a way to relax the speciﬁc part of the body which became stiff and

prevented the movement.

106

When a task situation arises and the client focuses on this task, the therapist
knows this because the movement of the client’s upper body stops. The therapist’s
assistance, which is termed the task environment in a task analysis approach, included the
following (Konno & Ohno, 1987; Kubota, 1991): (l) The therapist pushes the client’s
body slightly harder toward the direction to which the client’s body is supposed to move
in order to clarify the body sensation. (2) The therapist encourages the client to feel the
body sensations and to keep doing it for a while to see if the sensations change. And (3)

the therapist suggests the client try and ﬁnd a strategy of how to resolve the difﬁculty.

Rational Analysis

Based on the review of the literature and the investigator’s clinical experiences,
the idealized performance model of relaxation Dosa process was identiﬁed (Naruse,
1985; Konno & Ohno, 1987; Watanabe, 1995). The eight steps were identiﬁed and
illustrated as in Figure 9.

First, the client accepts the Dosa exercise which the therapist proposes and starts
the practice. Second, the client reaches a point where she cannot relax her body. At this
point, the client somehow relaxes the body and notices the movement in the body which
occurs as a result of relaxation. Third, the client becomes aware of the tension in some
parts of the body which prevents the movement. Fourth, the client becomes aware of the
sensation which follows relaxation. F ifth, the client knows the relaxation physically and
starts paying attention to the effort process of how to relax. Sixth, the client tries some

strategies to relax tension in her body. Seventh, the client ﬁnds a strategy or a clue which

107

is useful to relax the body. Lastly, the client learns the self-relaxation skill and can relax

in the way she intends.

 

LStart the relaxation Dosa exerciszl
V

 

 

 

Become aware of the body movement as a result of relaxation
V

Become aware of the tension sensation

V

Come to know the relaxation physically based on
relaxation sensation

V

 

 

 

 

 

 

 

 

 

 

 

| Start to focus on the effort process for self-relaxatioﬁ
V

 

 

 

 

Try some strategies for self-relaxation
V
Identify the useful strategy for self-relaxatiohl

v
IAttain self-relaxation]

 

 

 

 

 

 

Fim 9. Rational Performance Model Based on Idealized Client.

Empirical Analysis

Before beginning the examination of each participant’s Dosa performance
process, the behavioral indices based on which the investigator judged the occurrence of

each step was described. They are shown in Table 15.

108

Table 15
Behavioral Indices of Each Step of Dosa Performance Process

 

Step 1: Start the relaxation Dosa exercise
The participant follows the therapist’s instruction to start the practice.

Step 2: Become aware of the body movement after or while relaxing
The participant reports that her body is moving. However, she does not report a
speciﬁc body sensation regarding tension and/or relaxation.
The participant agrees with therapist’s feedback that her body is moving.

Step 3: Become aware of the sensation of body tension
The participant reports a body sensation when her body stops moving due to a
body tension.

Step 4: Come to know the relaxation (goal of a Dosa task) based on body sensation
The participant reports a body sensation while or after she relaxed the tension.

Step 5: Start to focus on the effort process for self-relaxation
The participant reports what she tries to do to relax her body the ﬁrst time after
step 4 is observed.

Step 6: Trial of some strategies for self-relaxation
The participant reports what she is doing to relax her body tension.
The participant reports how easy or difficult it is to relax body tension.

Step 7: Identiﬁcation of a useful strategy for self-relaxation
The participant reports that she identiﬁes a clue of what to do to relax body
tension.

Step 8: Attainment of self-relaxation
The participant reports she can relax body tension voluntarily by using a strategy
she found.

 

The participants’ Dosa performance which was recorded on the therapy session
record form was examined in terms of the steps described above in Table 15. The
participants’ perception of the therapy session and post-therapy mood was measured on

the session evaluation questionnaire. The participants’ perception of the session was

109

measured in terms of the depth and smoothness dimensions and their post-therapy mood
was measured in terms of the positivity and arousal dimensions. Those dimensions were
measured on a 7-point scale and yield the score of each dimension, the higher the score,
the higher the dimension. The investigator hoped to see that the participants would
perceive the session with Dosa therapy as deep and smooth. As for the post-therapy
mood, the investigator assumed that the participants would feel positive and alert after the
session. The Dosa performance process which each participant went through is described

below with their perception of the session and post-therapy mood.

Particimat 3. At the ﬁrst intervention session, Participant 3 lay down on her side
on the mat and moved her body toward the ﬂoor following the therapist’s instruction
(Step 1). Her shoulder stopped twice due to the tension between point 1.5 and 2, where
the angle made with the shoulder line and the ﬂoor is between 75 and 60 degrees. She
relaxed the tension after three and 9 seconds, respectively. However, for both times she
did not notice movement of her body or any changes in the body sensation. When she
relaxed the tension which occurred at point 2, she reported that she felt a little difference
after the therapist asked her if she felt any difference in her body (Step 2). At the second
trial, she started reporting more body sensations. When her shoulder stopped at point 2,
she reported that she was feeling a twist and stiffness in her shoulder (Step 3). When she
relaxed the tension at point 3, where the angle made with the shoulder line and the ﬂoor
becomes 30 degrees, she felt her shoulder was relaxing (Step 4).

At the third session, the tension between Points 2 and 3 were resolved and her

shoulder moved to Point 3 without interruption. When she relaxed the tension at Point 3,

110

she reported lightness in her body. When her body stopped at Point 3.5, she reported
tightness in waist and shoulder. It took ﬁfty-three seconds to relax the tension. When the
therapist asked what she did to relax that tension, she reported that she was just trying to
relax it (Step 5). At the end of the exercise, Participant 3 reported that she could feel a
relaxation sensation more clearly.

At the fourth session, Participant 3 noticed that the tightness in her waist at Point
3 became less than she felt in the previous session. After relaxing it, she reported that the
tightness moved up a little and she was feeling it in her upper back. When the therapist
asked what she did when the sensation moved up, she reported that she relaxed her waist
and shoulders and that she was getting a sense of how she could let it go. When she was
relaxing the other side, she reported that this side was easier to relax than the previous
side (Step 6).

At the sixth session, Participant 3 relaxed the tension at Point 3.5 and reported
that she came to feel a subtle change in her body when the tension started to loosen
(step7). At the seventh session, after she relaxed the tension at Point 3.5, she stated that
she relaxed it by focusing her mind on being relaxed (Step 8).

Regarding Participant 3 ’s perception of the session with Dosa therapy, the
average depth score and smoothness score were both 6.94. The average positivity score
and arousal score were 6.78 and 5.91 respectively. These results indicate that Participant
3 perceived the session with Dosa therapy very deep and smooth and she felt positive and

more alert after the session.

11]

Participant 6. At the ﬁrst session, Participant 6 did not raise any question when
the therapist explained what to do and took a position by lying on the side to start the
Dosa practice (Step 1). Her shoulder stopped ﬁrst when it moved to Point 2 and the
tension was relaxed after three seconds. When the therapist asked if she noticed any
difference, she did not respond. When her shoulder stopped again after moving a little
further, she relaxed it after four seconds. She agreed this time when the therapist asked
her if she felt any movement in her body (Step 2). When her shoulder moved to Point 3,
she reported that she was feeling her back was stretching (Step 3). It took ten seconds to
relax that tension. Then she changed the side to relax the other side. When her shoulder
stopped at Point 3, she reported the tension in the muscles and when she relaxed, she
reported the relaxing sensation in the muscles and the tensed sensation moved up. When
she relaxed it, she reported it had disappeared (Step 4).

At the second session, she noticed a pulling sensation when her shoulder stopped
at Point 2.5 and the tension moved to the upper part after she relaxed. When she relaxed
tension in that part, she reported she tried to let it go (Step 5). At the third session, she
reported she visualized that the muscle was going to relax as a strategy for relaxation. At
the fourth session, she reported she concentrated on the stretching muscle while trying to
relax that part. At the ﬁfth session, she reported that she was doing very well and relaxed
her shoulder to Point 3.5. These accounts indicate that she was trying some strategies by
monitoring if they worked or not (Step 6).

At the sixth session, she reported that she slowed down the breathing and that
helped her relax (Step 7). At the seventh session, she relaxed tension at Point 3.5 and

reported that she relaxed the tension by monitoring her breathing (Step 8).

112

Regarding Participant 6’s perception of the session with Dosa therapy, the
average depth score and smoothness score were 6.46 and 6.25 respectively. The average
positivity score and arousal score were 6.29 and 2.18 respectively. These results indicate
that Participant 6 perceived the session with Dosa therapy very deep and smooth and she

felt positive and less alert after the session.

Participant 7. Participant 7 lay down on her side and took a position to begin the
practice after the therapist explained the exercise (Step 1). When her shoulder stopped at
Point 2 due to the tension, she reported that she was feeling tightness inside of her
shoulder blade (Step 3). She relaxed it in 8 seconds, but she did not feel that her body
relaxed. Her shoulder stopped again at around Point 2.5 and she pointed to her upper
shoulder and reported she was feeling a lot of tension in that area. She managed to relax
it. However, again she did not feel any change in her body sensation. At the second trial,
she relaxed tension at Point 2 in ten seconds and reported that her shoulder was moving
down (Step 2). With the other side, her shoulder stopped at Point 2. She relaxed tension
in twenty seconds and reported that the pain in her neck lessened.

At the second session, her shoulder stopped at Point 2.5 and she reported strain in
her shoulder blade. When it relaxed, she reported that she felt the muscle relax (Step 4).
When her shoulder relaxed at Point 3, again she noticed it and reported she felt warmth in
her shoulder blade. At the second trial, she stated that she concentrated on the area where
she felt tension and tried to relax it (Step 5) and felt sure that she did something to relax
although she could not explain what she did. At the third session, she reported that she

just let it go and her shoulder fell, after she relaxed the tension at Point 3 and felt relaxed.

113

With the other side, her shoulder stopped at Point 2.5, moving less than the other side did,
she reported that it feels like this side is harder to relax than the other side. She reported
that she tried to slow down her breathing and focused on the area where she felt tension
in order to relax (Step 6). At the fourth session, her shoulder did not stop until Point 3.
When it stopped, she relaxed faster than before. After she relaxed the tension, she
reported that she felt that she was getting more control over her body. At this session, she
reported that she concentrated on the tensed area and slowed down her breathing while
imagining that area was going to relax. At the ﬁfth session, she reported that she felt the
muscle loosening before she could ﬁrlly relax the tension. At the sixth session, she
relaxed the tension at Point 3.5 in ﬁfteen seconds and reported that she concentrated on
her arm and shoulder and let it go. She also stated that she tried not to control it, rather
just let the muscle relax. However, she still had to think about it to make it happen (Step
7). At the seventh session, her shoulder moved straight to Point 3.5 and stopped. She felt
a pulling sensation in her shoulder blade and relaxed it in seven seconds. She reported it
became easier to relax and she hardly had to think about it (Step 8).

Regarding Participant 7’s perception of the session with Dosa therapy, the
average depth score and smoothness score were 6 and 6.28 respectively. The average
positivity score and arousal score were 5.69 and 1.8 respectively. These results indicate
that Participant 7 perceived the session as deep and smooth and felt fairly positive and

less alert after the session.

Participant 8. Participant 8 also started the practice without any difficulty, lying

on her side on the mat and letting the therapist help to move her shoulder toward the ﬂoor

114

(Step 1). Her shoulder stopped at Point 3 where tension occurred. She relaxed it in
thirteen seconds. When her shoulder moved again and the therapist asked if she noticed
any sensation, she admitted it by nodding her head. When her shoulder relaxed again, she
reported that her shoulder moved (Step 2). When her shoulder stopped after moving a
little further, she reported she was feeling her back and side stretching (Step 3). At the
second session, she reported strain in various parts of her body such as the ﬁ'ont shoulder,
lower side, and lower back, when her shoulder stopped. When relaxed, she reported her
body moved. However, she did not notice any body sensations accompanying relaxation
besides movement. At the third session, she noticed her side became loose after
relaxation (Step 4). When her shoulder stopped at Point 3, she reported strain, but it was
less than the previous week, she said. At the second trial of the other side, she relaxed
faster when the tension occurred and reported that she thought about relaxing that part
(Step 5). After the practice, she reported she felt more relaxed this session than the
previous sessions.

At the fourth session, her shoulder moved all the way to Point 3.5 without
stopping. When it stopped, she could not relax it right away. When she relaxed, she
reported that she felt frustrated because she was not sure if she was doing it properly
(Step 6). At the seventh session, when she relaxed tension at Point 3.5, she reported she
took a deep breath and concentrated on relaxing the body (Step 7). At the eighth session,
she reported while relaxing the tension at Point 3.5 that the tension became faint and the
relaxation was going well (Step 8).

Regarding Participant 8’s perception of the session with Dosa therapy, the

average depth score and smoothness score were 5.91 and 6.44 respectively. The average

115

positivity score and arousal score were 6.13 and 2.78 respectively. These results indicate
that this participant perceived the session with Dosa therapy as fairly deep and smooth

and felt positive and less alert after the session.

Participant 9. Participant 9 also did not have any difﬁculty nor show any
hesitation when the therapist asked her to lie down on her side to start the Dosa practice
(Step 1). Her shoulder moved to Point 2 and stopped ﬁrst time. She relaxed it after two
seconds. When the therapist asked if she noticed the movement, she nodded her head
(Step 2). When she relaxed the tension at Point 3, she reported that she felt release (Step
4). At the second session, her shoulder stopped at Point 3, while trying to relax, she
reported that she was feeling stifﬁress in her shoulder (Step 3). It took her seventeen
seconds to relax the tension. With the other side, her shoulder stopped at Point 2. She
reported a pulling sensation in her side and stated that she had to focus on her body and
shut out other thoughts to relax that part of her body (Step 5). At the third session, when
she relaxed the tension at Point 3, she reported that in order to relax the tension, she also
had to relax other parts. When she started the other side, she reported immediately that
this side was tighter and harder to relax than the other side. At the ﬁfth session, she
reported that she focused on the tension while relaxing her body (Step 6). At the sixth
session, she reported that concentrating on the tension and trying to regulate her breathing
helped her relax the tension at Point 3 (Step 7). At the seventh session, she relaxed
tension at Point 3.5 smoothly and reported that she was just letting go and it went

naturally (Step 8).

116

Regarding her perception of the session with Dosa therapy, the average depth
score and smoothness score were 6.96 and 6.71 , respectively. Regarding her post-therapy
mood, the average positivity score and arousal score were 6.5 and 3, respectively. These
results indicate that Participant 9 perceived the session as very deep and smooth and she
felt very positive and she was less alert after the Dosa therapy session.

In sum, Participants 3, 6, and 8 followed all the steps of the rational model.
Participant 7 noticed tension before she became aware of the movement of her body
while relaxing. Therefore, Step 3 appeared before Step 2. The rest of the process
followed as described in the rational model. Participant 9 became aware of the movement
of her body while relaxing and then became aware of a relaxing sensation before she
noticed the tensed sensation. Therefore, for Participant 9, Step 4 appeared before Step 3.
After this, the process proceeded as the rational model described.

Based on these empirical data, the rational model was revised. Since it was found
that Step 2 to Step 4 do not follow the order which was expected in the rational model,
these steps were combined into a single step and a new step was named as “Become
aware of body sensations which arises before, during and after the relaxation”. This
includes moving sensations, tension and relaxation sensations. The revised performance

model based on the actual data from the participants is shown in Figure 10.

117

 

|Start the practice of the relaxation Dosa exercisa
V

 

 

Become aware of body sensations which arise
before, during and after relaxation

V
Start to focus on her own effort process for relaxation]
V

[Try some strategies for relaxation]
V

 

 

 

 

 

 

 

 

 

[Identify a useful strategy for self-relaxation]
V

Attain self-relaxation

 

 

 

 

 

Figge 10. Revised Performance Model.

Based on the revised performance model, an operation model was constructed by
inferring the possible internal mental operations which are involved in generating the
observable performances. A prelirrrinary operations model is shown in Figure 11. The
participants started the practice of the Dosa task by accepting the Dosa task and the
therapist’s assistance. Next, the participants focused their attention on their body and the
body sensations which arose accompanying the relaxation. Then, they became aware of
the body sensations during the relaxation. They came to understand the Dosa task
physically and started to focus on the effort process to generate the movement by paying
attention to the part which needs to be more relaxed. Then the participants connected the
strategy to the resultant movement after relaxation, evaluated how it matched with the

planned movement, and revised the strategy based on the evaluation. This helped them

118

identify the operational strategy which enabled them to relax the speciﬁc part and

allowed them to regulate the operational process while monitoring the movement.

 

[Accept the Dosa task]
V

 

 

Focus on the speciﬁc body parts and the body sensationg
V

Understand the Dosa task physically
Focus on the striving process to relax

W
v

 

 

 

 

Connect the striving process to the resultant movementl
Evaluate the extent to which the resultant movement
agrees with the planned movement
Revise the strategy based on the discrepancy
between the planned and resultant movement

V

Identify a useful operational strategy
to perform the planned movement

V

 

 

 

 

 

 

 

 

egulate the identiﬁed operational strategy
while monitoring the resultant movement

 

 

 

Figure 11. Preliminary Operations Model

119

CHAPTER 5

DISCUSSION

In this study, the effectiveness of Dosa therapy in treating individuals with
anxiety problem was examined. In addition, the therapeutic process of Dosa therapy was
analyzed to better understand the underlying mechanisms which operate during Dosa
therapy. In this section, the ﬁndings from the study are reviewed, the limitations of the
study are examined, and the implications of the study for social work theory, research,

practice, and social policy are discussed.

Major F indinga

Themutic Effect

Five female graduate students who had an anxiety problem were treated with
Dosa therapy. The effect of the intervention with Dosa therapy was examined with regard
to the change in their experiencing, affective, behavioral, and cognitive functioning. As a
group, the participants’ experiencing level deepened in the intervention period for both
the modal and peak experiencing level. The average peak experiencing level of the
intervention period was 4.27. Level four experiencing indicates that a person attends
inwardly and describes his/her feelings or experiences of the events, rather than the
events themselves. Therefore, as hypothesized, the result suggests that the intervention
with Dosa therapy helped the participants attend to their feelings and experiences.

The average anxiety scores of the participants decreased during the intervention

period, indicating that the intervention with Dosa therapy had an inﬂuence in reducing

120

the participants’ anxiety. With regard to the causal inference of the intervention, the
anxiety scores began to decrease after the intervention started with three of the
participants, Participants 6, 8, and 9. Therefore, the result suggests, although not
conclusively, that it was the intervention that inﬂuenced the change in the participants’
anxiety level. Thus, as hypothesized, the intervention with Dosa therapy may have had an
effect on the participants’ affective level of functioning.

Regarding the participants’ target behavior, an expected change in their behavior
was observed in the expected direction for all participants. Moreover, these changes
occurred after the intervention began. Therefore, it again indicates that Dosa therapy was
effective in generating a change in behavior and supported the hypothesis about the effect
of Dosa therapy on the participants’ behavioral level of functioning. However, a
behavioral change for Participant 7 was interpreted as ambiguous. This is discussed in
detail later. The participants’ self-efﬁcacy increased and their locus of control became
more internal, although the change in locus of control did not reach statistical
signiﬁcance. These results indicate that Dosa therapy affected the participants’ cognitive
functioning, enhancing their self-efficacy and bringing their locus of control toward the
internal direction. In fact, the participants started to do something to cope with their
anxiety problem such as organizing their daily schedule, taking a time-out, and relaxing
away their tension when it occurred. This suggests that they took control over their lives
and actively exercised a coping strategy. Thus, again, the result was somewhat supportive
of the hypothesis about the effect of Dosa therapy on the participants’ cognitive level of

functioning.

121

When the change in the participants’ behavioral and affective levels was
examined more closely, it was seen that the change in their behavior followed the
implementation of the intervention for all participants, whereas the effect of the
intervention on their anxiety level was clear for three participants. In other words, the
participants’ behavior responded more sensitively to the intervention. This discrepancy of
responses between the two levels of functioning could be caused by the difference of the
reaction time of behavioral and affective levels of functioning. In other words, the
affective level takes more time to respond to the intervention than the behavioral level.
This may appear because of the sensitivity of the measurement, or it may reﬂect the
nature of the relationship between the behavior and affective level of functioning, that is,
the behavioral change occurs ﬁrst and is followed by the change in the affective level.
This will be an interesting question to pursue in future research.

The participants showed expected changes in all or some of their levels of
functioning. When examining the results individually, however, more complex and
interesting pictures were revealed.

As for Particiwt 3, who focused on her feeling of being overwhelmed by her
schoolwork and could not focus on her studies, her study hours increased. Her locus of
control became more internal in the intervention period. Her experiencing level did not
deepen during the intervention phase on average. However, there were a few sessions in
which her peak experiencing level reached higher than the level of the baseline period.
Her anxiety level decreased during the intervention. However, the change in the anxiety
score started at the last observation of the baseline period. For this reason, the causal

effect of the intervention was inconclusive. Therefore, the effect of the intervention was

122

observed on her behavior and cognitive functioning. But, the effect on her experiencing
and affective functioning was not clear.

Her feeling of being overwhelmed and her difficulty in concentration were likely
caused by the transition she was going through. She worked for more than twenty years
and then came back to school. It is assumed that she might have experienced some
changes in her life such as in her role, daily schedule, and workload. These changes
might have made her feel overwhelmed. When she came to the screening interview, she
already had a plan to handle this situation and described it to the investigator. This
suggested that she was a task-oriented person and well motivated to cope with the
situation she was facing. Her feeling of being overwhelmed might have been a result of
her enthusiasm which was not organized or directed yet.

As planned, she transferred the responsibility to other members in the outside
activities in which she was involved and made a weekly schedule to allocate time for
study during the baseline period. This might have inﬂuenced the decrease in her anxiety
level during the baseline period. Her tendency to be task-oriented may explain the result
that her experiencing level stayed in the lower level. Although she talked about her
feelings regarding the event, most of the time she focused on each event she was facing
and discussed concretely how to handle them. Therefore, on average, her experiencing
level stayed in a lower stage.

She found the Dosa exercise relaxing and energizing at the same time. This
appears contradictory. However, from the investigator’s past experiences, a client may

feel relaxed and alert at the same time. It is assumed that this experience may have helped

123

her keep focused and get her work done, since she was already motivated and eager to do
the necessary work.

Participant 6 addressed the feeling that she did not ﬁt in, which made her feel
anxious, isolated, and sometimes ﬁ'ustrated. During the intervention period, her anxiety
decreased and her sleep behavior improved. She came to feel more self efﬁcacious and
her locus of control became more internal. Her peak experiencing level also increased
and the average peak experiencing level during the intervention period was 5.2. In level 5
experiencing, a person explores his/her issue and makes a tentative hypothesis regarding
the cause of the problem in order to resolve it. Therefore, the effect of the intervention
was observed on her experiencing, behavioral, affective, and cognitive levels.

By the end of the intervention, she came to acknowledge the difference in
opinions she observed between others and herself, and did not get disturbed by this
situation. It appeared that she committed herself fully to a project, whatever it is, once she
decided to do it. She took the same stance for her graduate study and took it very
seriously. Therefore, it was assumed that she was motivated for the change when she
decided to participate in this study. The problem she focused on bad a long history. For
this reason, it appeared difﬁcult to deal with her issue in this type of short-term therapy.
In spite of the investigator’s concern, the changes in her various levels of functioning
were observed. It is assumed that the fact that the improvement of her condition was
measured with a concrete behavior and that she was motivated, facilitated the changes
observed through the intervention.

Participa_nt 7 focused on her habit to procrastinate the completion of her

homework, which made her anxious, and worked to change this study habit. Her peak

124

experiencing level became higher during the intervention. Her study hours increased
during the intervention period. However, the average study hours during the intervention
period were less than during the baseline period. Therefore, the change in her study
behavior was not clear. Examined more closely, her study hours during the baseline
period continuously decreased. The fact that she had to report her study hours affected
her study behavior and she spent more time studying for the ﬁrst two weeks than she did
usually. Her study behavior in the ﬁrst two weeks might have been inﬂuenced by the self-
observation and an overrepresentation of what it usually was.

Her anxiety lowered during the intervention period. However, her anxiety scores
started to decrease during the baseline period. Therefore, again, the effect of the
intervention on her affective level was ambiguous. The change in her self-efficacy and
locus of control were small. Therefore, there was no therapeutic effect observed on her
cognitive functioning. In sum, the effect of Dosa therapy was observed on her
experiencing. However, the effect on her behavior and affective functioning was not
clear. The effect on her cognitive functioning was not observed.

Her goal of therapy was to start working on her class assignments early and not to
procrastinate. Her reason for doing this was because she became a graduate student and
she thought that this was what graduate students “should” do. She reported that she felt
guilty not for herself but for the therapist when she did not spend as many hours for her
study as she planned. This account may illustrate that she was motivated extrinsically by
the outside standard or another person’s evaluation rather than intrinsically by her own
interest. However, she started to work early on one assignment from the class she really

enjoyed and cared about. This incident suggests that her study behavior was obviously

125

inﬂuenced by her interest in the class. Therefore her goal for therapy might have needed
to be explored more thoroughly with regard to what she was really interested in having
happen.

Particigapt 8 focused on her feelings toward her boyfriend. She was not sure if he
was the right man to marry and this made her feel anxious. Her feelings ﬂuctuated from
one extreme to the other and she could not make a decision conﬁdently regarding the
engagement. Her experiencing level became higher during the intervention period and
she talked more about her feelings regarding this issue. The ratings of her feelings toward
her boyfriend became higher and she became more sure of her feelings. Actually, she
made a decision to marry her boyfriend and got engaged during the intervention period.
In this respect, a clinically signiﬁcant change in her behavior occurred during the
intervention period. She became less anxious during the intervention period. Her self-
efﬁcacy score increased during the intervention period. However, due to the
autocorrelation, the data were transformed and the difference was not large enough to
reach statistical signiﬁcance with the transformed data. In sum, the effect of the
intervention was observed on the behavioral, affective, and experiencing levels. The
effect on her cognitive level was not clear. It is assumed that Dosa practice helped
Participant 8 became more tuned in to her internal experiences. This experience made her
more aware of her feelings toward her boyfriend and more conﬁdent to make a decision
regarding the engagement.

Participant 9 focused on her anxiety caused possibly by her fear of not being able
to do her schoolwork well. During the intervention period, her peak experiencing level

became higher. She became less anxious and her acting-out behaviors decreased. Her

126

self-efﬁcacy became higher and her locus of control became more internal during the
intervention period. Therefore, the effect of the intervention was observed on the
experiencing, affective, behavioral, and cognitive levels.

Participant 9 decided to come back to school when her children became college-
age. Therefore, she was a non-traditional student. She ﬁnished her undergraduate degree
and continued to the master’s program to become a social worker. She had been under
stress ﬁ'om the schoolwork for the past several years, but she continued striving. In this
respect, the issue she focused on had lasted for the past several years. It is speculated that
Dosa therapy helped her tune in to what is really important to her and re-prioritize things
which she needed to take care of. As a result, she decided to take more time for her
family and friends and became less anxious about schoolwork. Participant 9 reported that
she used meditation in the past. This experience may have helped her focus on her inner
feelings, which Dosa therapy aims to do.

In sum, the effect of intervention with Dosa therapy was observed with four
participants out of ﬁve who completed the therapy. This result suggests that the
intervention with Dosa therapy is effective to treat individuals with anxiety problems
(Kazdin, 1982). The fact that the Dosa exercise was the only element which was added in
the intervention phase suggests that Dosa therapy produced the effects observed with
these participants. This result also gives a basis for generalization of this study, because
the positive result from one individual was replicated with three other individuals (Bloom

et al., 1995).

127

Therapeutic Proce§_s_

The therapeutic process of Dosa therapy was examined by using a task analysis
approach. Combining the rational, theoretical understanding with an empirical
examination of the actual Dosa task process from ﬁve participants, a performance model
of Dosa therapy was constructed to describe the observable task performance process of
Dosa therapy. Based on this performance model, the possible inner operations involved in
generating the observable performance were inferred and the internal operations model
was constructed.

The performance process began with starting the practice of the Dosa exercise.
Then the participants became aware of the body sensations which occurred during the
relaxation process. They included moving sensations of the body, tension and relaxed
sensations. By noticing the body sensations which were brought on during the relaxation,
the participants came to understand the Dosa task physically. Then the strategies of how
to relax their body became their primary focus. They tried some strategies to relax
tension in the body. After some trial and error, they identiﬁed a useful strategy and
eventually attained self-relaxation.

Based on the above performance process, the internal operations process was
inferred. It was assumed to proceed as follows. In order to start the practice, the
participants needed to accept the Dosa task. Then the participants focused their attention
on their body and the body sensations. This operation, which attended internally, enabled
the participants to identify the body sensations during the relaxation practice. After this,
the participants understood the Dosa task physically and started attending to the

operational process to relax speciﬁc parts of the body. This operation seemed to be a

128

prerequisite to engage them in an effort to start relaxing. The participants, then, engaged
in self-observation to connect what they did with what kind of movement occurred,
evaluated if the movement agreed with the planned movement, and when it did not,
changed the operation to decrease the discrepancy. Then the participants identiﬁed a
useful operation to perform the planned movement and eventually carried out the
operation, while monitoring the resultant movement in order to attain self-relaxation.

This operations model describes the internal process which was assumed that the
participants went through to attain self-relaxation. From this process, it is speculated that
the participants developed a functional Dosa operational system, where they felt that they
could move their body more voluntarily and developed a more functional, realistic body
image (K. Ohno, personal communication, June 14, 2000). It is assumed that this change
in perception of themselves as well as the relaxed state of mind which was brought about
by the Dosa exercise might have led them to perceive the situation and the events
differently and generated the changes in behavior and in affective and cognitive
functioning.

Studies on intentional behaviors and behavior control processes revealed that
human behaviors are much more automatic than we think. In other words, the ability to
exercise conscious, intentional control over our behavior is actually quite limited (Bargh
& Chartrand, 1999; Kirsh & Lynn, 1999; Libet, 1985). Libet (1985) reported a series of
studies in which the readiness potentials (RPS) that precede motor actions were recorded
using electrodes placed on the subject’s scalp. It was revealed that awareness of the
intention to initiate the response did not occur until after the onset of the RPs. This result

suggested that voluntary movements can be initiated by unconscious cerebral processes

129

before conscious intention appears. Libet surmised that conscious control may operate to
select and modulate the volitional process, instead of initiating it. Kirsh and Lynn (1999)
argued that intentions prime behavior for automatic activation and also guide ongoing
behavior. Therefore, development of a frmctional Dosa operational system through Dosa
therapy may provide an opporttmity to balance controlled and automatic processing in a
person’s functioning. As for a strategy for relaxation, Participant 7 described her
experience such that she tried not to control her body movements and thought about the
relaxation in order for it to happen. Other participants also reported that they thought
about relaxing and then were able to produce that response. As their reports indicate,
voluntary motor control process is intentional as well as automatic. Experientially, they
might have needed to relinquish existing, conscious control to some extent in order to let
an automatic processing be canied out in order to relax. This experience might have led
the participants to become aware of and acknowledge a process which is out of their
conscious, volitional control. This experience may make a person suspend judgment
based on an existing ﬂame of reference and prime a new response set, which may lead to

a new behavior.

Limitations of This Study

Delimitation

In this study, the effect of the intervention with Dosa therapy was examined with

individuals with anxiety problems. Therefore, the target problem of this study was an

anxiety problem. As a criteria of inclusion and exclusion, it was decided, prior to the

130

recruitment of the participants, that individuals whose main problem was anxiety would
be included and those whose anxiety problem was combined with other psychiatric
problems would be excluded. In this respect, the results of this study might apply to the
individuals whose main issue is anxiety, without being combined with other psychiatric
problems.

The participants in this study were recruited from among female graduate students
with an anxiety problem in order to maintain the participants’ characteristics as being as
homogeneous as possible because of the small sample size. Therefore, the positive effects
of Dosa therapy on an anxiety problem may be limited, until further study to female
clients. The effect of Dosa therapy could be different with men with an anxiety problem.
It is assumed that a gender difference in somatic awareness and openness to somatic
information may exist. In other words, women and men might perceive and respond to
the somatic sensations differently. Therefore, examining the effect of Dosa therapy with
male subjects and comparing the gender difference in the effect of Dosa therapy will be
another interesting question for ﬁxture study.

In this study, the participants were recruited from among graduate students. The
investigator visited four social work classes for students in the master’s program and
advertised this therapy opportunity. It was made clear that they would receive therapy
free of charge in return of their participation. They did not receive other incentives such
as course credit or monetary compensation. Therefore, they were volunteers who were
interested in getting treatment. In other words, they were motivated to receive treatment
and achieve therapeutic change. In this respect, it is assumed that their motives were

close to what clients might demonstrate who usually appear for therapy.

13]

However, they might not have sought treatment without the investigator’s
solicitation. They might have been motivated ﬁ'om a slightly different reason. That is,
they might have been interested in, besides their own well-being, contributing to the
investigation or learning a new therapeutic technique. Therefore, this motivation factor
may have enhanced their expectancy to change. Thus, therapeutic change may be more
readily achieved than in the actual clinical situation. This characteristic of the participants

may affect the generality of this study to a clinical situation (Kazdin, 1998).

Limitation of Single Subject Des_igp

Single subject designs are highly suited to evaluate a particular treatment and to
answer research questions regarding if a particular intervention as a whole has therapeutic
effects on the client’s performances (Kazdin, 1982). However, when it comes to the more
subtle questions of outcome, single subject designs raise ambiguities. These questions
include what aspects of the treatment are more facilitative for therapeutic change, which
treatment is more effective, and for whom is a particular treatment more effective, what
kind of client characteristics interact with the effect of treatment, or what outside events
might inﬂuence treatment outcomes which are sometimes referred to as threats to internal
validity (Bloom et al, 1995). However, attempts have been made to overcome these
weaknesses. For example, to compare the effectiveness of different treatments, an
alternative treatment could be implemented at different points in time. In other words, a
clinician could implement one treatment, withdraw it and implement the other treatment.

However, the order with which the treatment is implemented may inﬂuence the results

132

and raise the ambiguity of the result (Kazdin, 1982), and it may also raise ethical
concerns if a treatment that is producing results is withdrawn.

Single subject designs are especially weak when addressing questions regarding
the characteristics of the client that may interact with the treatment effect (Kazdin, 1982).
Since single subject design focuses on a few individuals, when a few subjects respond
differently, there is no systematic way of determining whether the intervention was more
or less effective as a function of the treatment itself or the particular characteristics of the
subjects. Factorial designs with a between-group design are more effective in addressing
this type of question. Clients are grouped according to variables such as age, diagnosis,
socioeconomic status, severity of problem, or other dimensions which appear to be
relevant to the effect, and the results are examined as to the effectiveness of treatment
interacting with the speciﬁc types of clients.

In the present study, one participant did not respond as well as the other four
participants. However, the data do not allow the investigator to identify the speciﬁc
factors which inﬂuenced this differential effect of Dosa therapy among the participants.
Therefore, this is a limitation of this study due to the research design. However, this
limitation could be overcome in a subsequent study through systematic replications of a
single-case examination using Dosa therapy with certain types of subjects. If a certain
type of subject responds better or more poorly to Dosa therapy than others and there is an
obvious relationship between subject characteristics and response to treatment, a
consistent pattern of data among different types of subjects may emerge. By
accumulating the data, the investigator may be able to tell eventually what type of client

responds well or poorly to Dosa therapy.

133

Generality of the ﬁndings from single subject design has been a major source of
controversy (Barlow & Hersen, 1984). Bloom et a1. (1994) described that generality
appears to be “one of the most important limitations of single-system designs” (p. 318)
because a participant in a single subject design is susceptible to a problem of sampling
representativeness. In other wards, the investigator is not sure if the subject in the study is
indeed representative of the client population with the speciﬁc problem under
investigation. Within single-case demonstrations with one or a few subjects, by
deﬁnition, there is no immediate possibility to assess generality across subjects. In this
respect, between-group research has a better possibility of providing information on the
generality of the results than single subject research does (Kazdin, 1982). However, the
mere fact of using large numbers of subjects in research, which between-group research
usually does, does not automatically ensure the generality of the ﬁndings (Sidman, 1960).
Because the results are usually evaluated on the basis of average group performance and
the individual data are seldom examined regarding intervention effects among individuals
in the experimental group, the ﬁndings by the group analysis alone do not provide the
information regarding how many individuals in the experimental group were affected or
affected in a meaningful way. Thus, ambiguity about the generality of ﬁndings from
between-group research remains. On the contrary, if single-subj ect research demonstrated
dramatic effects of a particular intervention on a single subject, like reinforcement-based
techniques which have been effective across an extremely wide range of populations,
settings, and target problems (Kazdin, 1978), the ﬁnding is likely to be more
generalizable across individuals than the ﬁnding based on the relatively weaker criterion

of statistical signiﬁcance. In fact, there is always a possibility that a statistically

134

signiﬁcant difference was obtained clue to chance in any between-group investigation
(Kazdin, 1982). Therefore, the relative generality of ﬁndings ﬁ'om one research approach
over another is a complex issue and requires further consideration. In the meantime, it
may be better to judge the generality of the ﬁndings from single subject research

conservatively to avoid an overstatement.

Placebo Effect

Psychotherapy’s effect in relation to the placebo effect remains controversial
(Lambert, Shapiro, & Bergin, 1986). It has been recognized that the factors such as
suggestion and the patient’s faith in a treatment have a powerﬁrl effect in the healing
process. In medicine, the substance which is pharmacologically inert, but produces a
positive effect for which it is applied is called a “placebo”. Placebos are used to
differentiate the effects of an active chemical agent from a psychological agent such as
the power of suggestion and the patient’s expectancies for change. The notion of placebo
effect has been transferred directly to the area of psychotherapy research to account for
the changes resulting from such psychological effects as participation in the therapy and
the expectations for improvement which were generated from such participation. These
general characteristics might be responsible for change rather than other active
ingredients which a speciﬁc psychotherapy intends to produce. However, in
psychotherapy, both the effects of treatments and placebos depend on psychological
mechanisms and the factors that account for change have not been well understood. In
fact, in psychotherapy, mobilizing the client’s expectancy for change partially contributes

to the positive outcome of the treatment (Frank, 1973). Therefore, there is no clear basis

135

for identifying those factors such as participation in the therapy and the client’s
expectation for change as inert (Lambert et al., 1986). A client’s expectancies for
improvement and discussion about his/her problem may be active therapeutic factors that
inﬂuence psychological processes leading to change.

It has been noted by researchers that the purpose of the brain is to anticipate the
future (Dennett, 1991; Hyland, 1985; Jacob, 1982; Kirsh, 1990). In this respect,
enhancement of expectancy involves the most basic functioning of the brain. Therefore,
expectancy effects may not be something which the researcher should control, rather it
may be an element which should be maximized for a positive therapeutic impact (Kirsh
& Lynn, 1999).

Garﬁeld (1991) pointed out the fact that the comparative outcome studies of
psychotherapy have reported relatively few differences in terms of outcome and
emphasized that it is important to acknowledge a major role played by common factors
which operate across different forms of psychotherapy. However, he also acknowledged
the speciﬁc factors which can play a signiﬁcant role in the therapy for particular types of
problems. Lambert et a1. (1986) also argued that those factors which are common to most
therapies such as expectation for improvement, understanding of the problem, and
therapist’s warmth and attention are central to psychological treatments and play an
active role in client improvement and thus, they should not be viewed as theoretically
inert or trivial.

For this reason, such factors as the client’s expectancies generated by treatment,
participation in therapy, and other ingredients common across different therapeutic

techniques, are referred to as nonspeciﬁc treatment factors or common factors (Kazdin,

136

1998; Lambert, et al., 1986). The difference among various modalities of psychotherapy
may be in the way of maximizing the common factors or the level of functioning a
speciﬁc therapy focuses on in order to enhance the common factors.

In the present study, a multiple baseline design across subjects of the single
subject design was used as a research design by applying the same intervention with
different subjects starting at a different time. This speciﬁc design allows the investigator
to compare the change within the subjects by using a subject as his/her own control. The
time lag of introducing the intervention to multiple clients gives the investigator a
stronger basis from which to draw a causal conclusion. In fact, the positive effects of the
intervention with Dosa therapy were observed with four participants. However, the
results do not allow the investigator to differentiate clearly the therapeutic ingredients
speciﬁc to Dosa therapy from the common factors. In this respect, this is a limitation of
this study. However, this does not mean that the effect of this therapy was superﬁcial or
temporal nor are the ﬁndings of this study insigniﬁcant and thus, should be disregarded.
Rather, it means that it failed to ﬁnd incremental effects of Dosa therapy, that is, the
effects beyond those attributable to common factors (Lambert et at., 1986). One way to
answer this question in the future will be to adopt a control group and compare the effect

on outcome measures between the experimental and control groups.

Attrition
Four participants terminated their participation prematurely. One of them,
Participant 1, terminated her participation after the ﬁrst baseline interview because of a

time conﬂict. Three of them, Participants 2, 4, and 5, completed the baseline period and

137

after the intervention began, they decided to discontinue their participation. The
participants who dropped out of the study may be systematically different ﬁom other
participants who stayed in the study. If this is the case, it is difficult to draw a valid
inference about treatment. It could also affect the generality of the results (Kazdin, 1994).
Therefore, this investigator addresses this issue here. The characteristics of these three
participants are examined ﬁrst. Then the possible factor(s) which might have contributed
to their premature termination is explored individually.

These three participants were not signiﬁcantly different from other participants
who completed the treatment with such demographic characteristics as age, ethnic
background, and marital status. In addition, their subjective disturbance level, which was
self-rated at the screening session, did not differ from other participants. However, the
initial anxiety scores of two of them, Participants 4 and 5, were higher than the scores of
other participants who completed the study. In fact, their anxiety scores were above 30
and fell in the clinical anxiety area. Their high anxiety level might have precluded them
from attending to the subtle small sensations in their body during the Dosa practice which
Dosa therapy requires. If so, Dosa therapy may be suitable to work with individuals
whose anxiety level is not as high. However, this is an inference which is drawn from
only two subjects. Therefore, ﬁrrther study needs to be conducted to make a conclusive
statement.

Participant 2 addressed her anxiety which arises when she is not in control of a
situation. As examples, she listed that she experienced fear when she ﬂew and was
feeling anxious when letting others make plans and/or arrangements. The incidents she

recorded as problem behaviors included that she felt frustrated when her friend kept

138

talking on the telephone and did not let her end the conversation and her co-worker
misunderstood what she said and kept mentioning it after she explained what she really
meant. In those incidences, she quickly became very frustrated and angry, “she blew up”
in her words. The therapist noticed from the second baseline interview that Participant 2
became less talkative, although she continued her participation. Participant 2 became
frustrated with the investigator when the investigator probed the process of how she
became angry in relation to her thoughts, feelings, and behaviors. This incident may
suggest that she is more goal-oriented and less interested in the process. This proclivity
might have made her conclude quickly that the process-oriented conversation was
irrelevant or less important or that she was not being understood and thus needed to be
questioned, and made her frustrated, perhaps in a similar manner that she experienced in
the scenario she described with her co-worker.

After the Dosa practice at the second intervention session, she refused to answer
the post-therapy questionnaires. To the investigator’s inquiry, she explained that she felt
uncomfortable talking about her issue because doing so brought up the same negative
feeling as when it occurred. When the therapist suggested termination as an option
because she might not be ready to deal with her issue at this point, the investigator may
not be the person who can work with her effectively, or this treatment method may not be
suitable for her, she smiled for the ﬁrst time in that session. Her response appeared a sign
of relief to the investigator. During the Dosa practice, Participant 2 asked if she was
supposed to feel relaxed. After the exercise, she also reported that she usually felt pain in
her neck pointing to the bottom of her neck, which was presumably caused by her

stiffening her shoulder. However, she was not aware of doing so to make it feel that way.

139

These accounts suggest that it was difficult for her to focus on her experiencing, which is
a process. Participant 2 might have beneﬁted more from a cognitive-behavioral therapy
rather than an experiential therapy.

Participant 4 focused on her anxiety and overwhelming feeling caused by her
packed schedule. She was working full-time, enrolled as a full-time student, plus doing
ﬁeld instruction for sixteen hours a week. Physically there was not time for socializing
with her ﬁiends and family. She used to enjoy the kick boxing class at an athletic club to
which she belonged and that was a way to relieve stress from work. However, her packed
schedule did not allow her to continue the class. The average anxiety score during the
baseline period was 31.25 and the one during the intervention period was 25.33. This
may have been a sign of decreasing anxiety level. However, the target behavior, the
number of times she was worried about study and assignments, did not change much: the
average times of worrying during the baseline period was 13.71 a day, whereas the one
during the intervention period was 13.29. As for the Dosa practice, she did not notice
relaxed sensations during the practice. Instead, she felt relaxed after the practice. She
reported that it was difficult for her to relax with Dosa therapy compared to kick boxing.
On the session evaluation questionnaire which was administered after the Dosa practice,
the average smoothness score was 4.81 and the average positivity score was 4.06 on a 7 -
point scale. These results indicate that she perceived the therapy session less smooth
compared to those participants who completed the study and she did not feel as positive
after the practice as did other participants.

Her high anxiety level might have made her engage in an intense, strenuous

workout, such as kick boxing, to release her anxiety and stress. As a result, she became

140

used to the type of physical sensations which accompany strenuous workout. On the
contrary, during the Dosa exercise, she was asked to pay attention to subtle physical
sensations. Dosa exercise required her to pay attention to the sensations which are very
different from what she was used to. Therefore, it might have been difﬁcult for her to feel
relaxation sensations during the Dosa exercise (L. Graber, personal communication,
October 26, 1999).

Participant 5 focused on her feeling overwhelmed, caused by working as a full-
time student and taking care of her husband who has a chronic disease and her children.
Since she had to juggle all the roles she was playing, she noticed she tended to hurry her
children and become less patient with them. Her goal for this therapy was to become
calmer and feel less stress. She also had scoliosis. Since Dosa therapy involves body
movement, the investigator became alerted to her physical condition and asked how she
felt about doing the Dosa exercise at the beginning of the therapy and again, at the
beginning of the intervention period. Participant 5 said that a relaxation exercise may be
good for her back problem and showed willingness for the practice.

Her anxiety scores were high and fell in the clinical area. They did not decrease
after the intervention began. During the Dosa practice, she felt the relaxation after her
body relaxed. On the session evaluation questionnaire administered at the ﬁrst
intervention session, she rated 1 on the dangerous-safe item, indicating that she felt the
session was extremely dangerous. The investigator was very concerned about her
response because no other participants responded on that scale the way she did. The
investigator raised this issue in the following session and Participant 5 explained that she

was afraid that the Dosa exercise may have a negative effect on her body. When the

141

investigator asked if Participant 5 experienced any negative conditions after the ﬁrst
exercise, she denied it and did not object to do the Dosa practice in that session. During
the practice in the second session, she asked if she was supposed to feel stretching or
relaxation. On the session evaluation questionnaire after this session, she rated 4 on the
dangerous-safe scale, indicating that she felt this session was neither dangerous nor safe.
Before the next session, she called the investigator and told her of her decision to
discontinue her participation. She gave as a reason that she was afraid that Dosa therapy
may cause some damage to her body. The therapist made sure that she did not have any
negative condition after the two therapy sessions and supported her decision.

From this process, it is assumed that Participant 5’s physical condition, scoliosis,
made her feel negative sensations when she focused on body sensations. Even if she felt
relaxed sensations, it may not be enough to change her perception. A client’s openness to
therapy is considered as one of the factors which contributes to the positive outcome of
the experiential psychotherapy (Greenberg, Elliot, & Lietaer, 1994). In this respect, her
accounts suggest that she was hesitant to experience what was happening in her body or
even may have been dissociated from what was actually happening in her body. Ciofﬁ
(1991) suggested that the subject’s cognition inﬂuences how he/she perceives the somatic
sensations. Therefore, her preexisting physical condition might have set a negative ﬂame
of reference when she attended to her body sensations during the Dosa practice and led
her to conclude that Dosa practice may lead to a negative effect on her body.

As discussed above, the participants of this study were volunteers who were
solicited by the advertisement of a free therapy. If they did not know this opportunity,

they might not have sought therapy actively. Moreover, the only thing they would lose by

142

discontinuing the participation of this therapy was an opportunity of free therapy. These

facts might have also affected the attrition rate of this study.

M9.

Single subject designs involve two phases; baseline and intervention phases. The
evaluation of the intervention effect is conducted by comparing these two phases and
examining how clear the changes are across phases. Therefore, obtaining a stable baseline
is important. Stability refers to the absence of trend and relatively small variability in
performance/scores on a measurement (Kazdin, 1982). When a baseline level has no
trend or a trend in the direction opposite ﬁom that predicted by the intervention,
inferences about intervention effects which are to be drawn based on the difference
between the baseline and intervention periods is greatly facilitated. On the contrary, when
there is a trend which is in the same direction as predicted as a result of the intervention
and the observations during the baseline phase ﬂuctuate, stronger intervention effects are
required to infer that there is a systematic difference between the baseline and
intervention phases.

The number of observations during the baseline in this study were three or four
points for the behavior measure and four or ﬁve points for other measures. It is relatively
small with regard to the number of observations. For example, the baseline of the anxiety
measure of Participant 7 showed a trend which is in the same direction as predicted as a
result of the intervention. Therefore, it made it difﬁcult for the investigator to conclude
that the effect resulted from the intervention. The baseline of the behavior observation of

Participant 7 was also problematic. With regard to the direction of the change, it was

143

desirable: The trend during the baseline was in the opposite direction ﬁ'om what was
predicted from the intervention and the trend during the intervention period was in the
direction which was predicted by the intervention. However, the average scores were
higher during the baseline than the intervention period, which was contradictory to the
prediction. Therefore, the result did not allow the investigator to draw a conclusion about
the effect of the intervention on Participant 7’s behavior. If the baseline was extended,
more stable observation could be obtained and perhaps it would illustrate more clearly
the pre-intervention condition. This could have allowed the investigator to draw a more

conﬁdent inference about the effect of the intervention.

Measurement

In order to measure the participants’ anxiety level, the clinical anxiety scale
(Hudson, 1992; Westhuis & Thyer, 1989) was used. This scale measures the amount of
the participants’ clinical anxiety. It was selected because it is useful for measuring
general anxiety and has fairly high reliability. However, it was found that there are
individual differences regarding individuals’ tendency to appraise situations as
threatening and to respond to those situations with anxiety behaviors (Spielberger, 1966).
This reﬂects individual’s trait anxiety which is deﬁned as an individual’s proneness to
anxiety. On the contrary, state anxiety refers to a transient feeling of anxiety at a given
moment in time. Therefore, a person with high trait anxiety has a higher tendency than a
low trait anxious person to experience anxiety. The state anxiety reactions of high trait
anxious individuals exceed those of low trait anxious counterparts. The drop-outs might

have been systematically different on their trait anxiety from those who stayed in the

144

study. However, the CAS does not provide the information regarding this aspect. If a
scale which measures this dimension was used, the data might have provided more
information regarding the participants’ anxiety.

To measure the participants’ somatic awareness during Dosa practice, the
questionnaire for somatic awareness was designed based on a previous study (Cioffi,
1991). The participants’ somatic awareness was measured regarding three dimensions;
the number of sensations noticed by the participant, its degree of noticeability, and
subjective unpleasantness. Comparing the average of the ﬁrst two sessions and the last
two sessions, no signiﬁcant difference was observed on all three dimensions. However,
the ntunber of somatic sensations decreased in the last two sessions, which is an opposite
direction to the assumed change.

These inconclusive results may be partly attributable to the way in which the
participants’ somatic awareness was measured. The participants’ somatic sensations were
recorded after the practice based on their memory. Watching the video-recording, the
investigator noticed that during the practice, the participants reported more sensations
than they did after the practice. Therefore, the report may not reﬂect their actual
experiences during the practice.

For this reason, the information on the number of sensations noticed during the
Dosa practice may not be accurate. Moreover, the noticeability of the sensations was
supposed to measure how clearly the participants notice the somatic sensations. It was
assumed that as the practice of the Dosa exercise progresses, the participants come to

notice fainter sensations more clearly. However, this dimension could have been

145

confounded with the strength of the sensation. More consideration is required regarding
how to measure this dimension accurately.

The number of sensations during the practice, their noticeability, and hedonic
valence were averaged including both tension sensations and relaxation sensations. If the
sensations had been separated in terms of tension or relaxation, it might have given a
different result. Therefore, this issue may need to be dealt with more careﬁrlly in future

study.

Implications of This Study

Grog-Cultural Relemg

Dosa therapy was developed in Japan and has been used as a psychotherapeutic
technique with Japanese clients. Dosa training has been used as a rehabilitation technique
with Iranian individuals with Cerebral Palsy and found effective to remedy motor
difficulties with those individuals. For example, Dadkhah (1998a) used Dosa training
with Iranian children with cerebral palsy and reported the effects on body consciousness.
In this study, seven Iranian children with cerebral palsy, ages 8 to 14, had rehabilitation
treatment for their motor difficulties using Dosa training. Their levels of private and
public body consciousness were measured by a translated version of Body Consciousness
Questionnaire (Miller et al., 1981) before and after the training. The results indicated that
there was a signiﬁcant improvement in the children’s body consciousness and that the
improvement in private body consciousness is larger than that of public body
consciousness. Dadkhah (1998b) also used Dosa training for disabled sportsmen with

cerebral palsy and reported that their sports performance was improved.

146

In the present study, the investigator used Dosa therapy with American women.
This is the ﬁrst attempt to use Dosa therapy as a psychotherapeutic technique with
individuals who belong to the western culture. The results of the present study suggest
the psychotherapeutic efficacy of Dosa therapy to American individuals.

It appears that the Dosa process or motor control process is less affected by the
culture to which an individual belongs than are cognitive or affective processes. In fact,
the investigator did not ﬁnd any noticeable differences with regard to the participants’
responses during the Dosa practice from those of Japanese clients with whom the
investigator worked in the past. Therefore, Dosa therapy, which focuses on a person’s
Dosa process, may be less inﬂuenced by the person’s cultural background.

Dosa therapy is task-focused and encourages an individual’s autonomy. These
underlying values are compatible with American values. This aspect might have
facilitated the participants’ acceptance of Dosa therapy as a treatment method.

Besides the intervention techniques used in the present study, the therapist and the
participants did not share the same cultural background. This usually adds a complexity
in the helping relationship (Kadushin, 1990). The therapist acknowledged this difference
clearly from the outset of the relationship and asked the participants not to hesitate to ask
to repeat what the therapist said whenever they did not understand it. This statement
might have shown the therapist’s honesty and openness to acknowledge the difference.
This might have facilitated a functional therapeutic relationship. The primary focus
during the Dosa exercise is on the Dosa process, which mainly involves the body
sensations. Those sensations such as tightness, stiffness, lightness or loosening sensations

are concrete and easy to empathetically understand even if the therapist comes from a

147

different culture than the participants. Therefore, this aspect also contributed to
establishing a good therapeutic relationship which then facilitated the therapeutic process

of Dosa therapy.

Ir_npﬂ'_cation for Theories of Social Work

Systems theory is one of the inﬂuential theories in social work in understanding
human behavior. Systems theory holds a dynamic concept of transaction between various
levels of human functioning and is considered to have a potential for an integrative view
of the person-in-environment (Germain, 1994). The Dosa process is considered to be an
interplay between psychological, neurological, and musculoskeletal systems. In this
respect, the view of human functioning in Dosa therapy is compatible with systems
theory.

In the present study, an underlying mechanism through which Dosa therapy
operates was explored. From the results, it was speculated that obtaining a ﬁmctional
motor control system or Dosa system may have an inﬂuence on the person’s cognitive,
affective functioning, and behavior. This view of mind-body connection is different from
the commonly held mind-body connection which operates through the autonomic nervous
system. In the latter view, the physiological process of the body is addressed and it is
considered that the psychological and the physiological processes are parallel and have
reciprocal effects on each other. This view still holds mind/body dualism which has a
deep root in Western philosophy since Descartes made a clear distinction between “the
mind” and “the body” (Smith, 1985). On the contrary, in Dosa therapy, the

phenomenological, subjective aspect of the body is addressed and the body process is

148

considered to be an aspect of the self functioning. Therefore, this view is more holistic.
This is the uniqueness of Dosa therapy. Thus, the investigator believes that this view will

facilitate seeing a person as a whole and human functioning more holistically.

Mation for Socéial Work_Practice apd Program Development

Anxiety problems are one of the common conditions social workers encounter in
a mental health setting. In fact, it was found that approximately twenty-ﬁve percent of the
general population is affected by the anxiety disorders (Kessler et al., 1994). There are
several intervention techniques which are considered to be helpful to work with
individuals with anxiety problems. They include a psychodynamic approach, cognitive
therapies, systematic desensitization, and pharmacotherapy (Wicks & Parsons, 1984). In
the present study, individuals with anxiety problems were treated with Dosa therapy.
Four of ﬁve participants who completed the treatment showed changes in their behavior
and psychological functioning. Therefore, this result suggests that Dosa therapy is
effective as an anxiety treatment as well.

In the present study, the intervention was implemented for seven or eight sessions.
The length of therapy is fairly short. The intervention in this study can be classiﬁed as a
brief therapy or time-limited therapy. Brief therapy or short-term therapy is a trend in
recent psychotherapeutic practice (Bergin & Gardielf, 1994). A study indicated that about
half of the patients who underwent psychotherapy showed signiﬁcant improvement by
the eighth session and that most cases obtain optimal results within about 26 sessions,
and that the more difﬁth cases can be signiﬁcantly helped within a year (Howard,

Kopta, Krause, & Orlinsky, 1986). Once, brief therapy was viewed as superﬁcial.

149

However, it has been indicated empirically that a good deal of change can be stimulated
in a shorter time than previously thought (Bergin & Garﬁeld, 1994). This study suggests
that the effect of Dosa therapy begins to emerge at around the third session and by the
seventh or eight session the changes in various levels of functioning are secured at least
for that time period. Therefore, Dosa therapy can be added to a list of treatment options
for brief therapy.

Previously, it was found that mental health services were distributed unequally
among the population and that the underprivileged members of the society were excluded
from the beneﬁt (Garﬁeld & Bergin, 1994). It was assumed that one of the factors which
contributed to this unequal distribution of mental health services was the fact that the
traditional psychotherapy lasted longer. Some individuals could not afford therapy if
therapy continued for more than one year. The emergence of brief therapies was one of
the responses to this situation. Therefore, adding Dosa therapy as an option of Brief
therapy will increase opportunities for the underprivileged in getting their mental health
needs met.

Moreover, in most modalities of psychotherapy, the primary exchange between
the therapist and the client occurs verbally. This means that the client has to have an
ability to express themselves verbally. This fact has also limited the population who can
beneﬁt from talk therapy. Play therapy and behavior therapy widened the population
which psychotherapy can reach. In Dosa therapy, the therapist and the client
communicate on the Dosa level, which is a motor control process and primarily non-

verbal. Therefore, Dosa therapy may be a possibility for individuals who do not beneﬁt

150

from talk therapy. This may include infants, individuals with developmental disabilities,
and individuals whose experiencing is dissociated from their cognitive process.

When establishing a mental health program in the community, adding Dosa
therapy as a treatment option in the program will improve the efficacy of the program by
reaching the individuals who otherwise are excluded Item the conventional therapy due
to ﬁnancial limitations, their ease with verbal communication, or due to a challenge in

their ability.

Ir_npll:ation for Social WorkLResear_Lh

The present study used single subject methodology as a research design to
examine the effectiveness of Dosa therapy. Individuals with anxiety problems were
recruited from among graduate students and the treatment with Dosa therapy was
conducted. In this respect, this study is applied research. Single subject design is a
method to systematically observe changes brought about by the intervention in a single
client system. This method has been advocated in social work as a method to evaluate
social work practice (Bloom et al., 1995; Gingerich, 1988). It has been expected that the
empirical evaluation of social work practice facilitates integration of research and
practice, secures issues of accountability and establishes a scientiﬁc knowledge base for
social work practice (Gingerich, 1988). Gingerich (1988) differentiated research from
practice evaluation. However, to this investigator, it seems to be rather a conceptual
demarcation. Practice evaluation is a kind of research in an applied ﬁeld to examine what
works, how it works, and with whom. In this dissertation study, various measurements

were used because the investigator was interested in understanding the effect of the

151

intervention on the various levels of human functioning and obtaining knowledge about
what is happening during the intervention with Dosa therapy. When conducting an
evaluation in an actual practice setting, some modiﬁcations may need to be made with
regard to the number of measurements used, the recording plan of the target behavior, or
the duration of the baseline phase. However, these issues are inﬂuenced by what research
questions the practitioner is asking, not by whether the practitioner intends to evaluate
his/her practice or conduct research. Bloom et al. (1995) described nicely that the process
of conducting single subject designs can be paralleled with the practice process. This
investigator believes that this study gives support for the use of single subject designs in
conducting a practice evaluation in social work practice and obtaining empirical
knowledge for clinical practice. Single subject designs have some general and
methodological limitations (Kazdin, 1982). However, there is no perfect research design.
Each research design is a different way to ask a research question (Anastas &
MacDonald, 1994; Kazdin, 1982; Tyson, 1992; Videka-Sherman & Reid, 1988).
Therefore, this investigator believes the single subject design is a valid, useful research
methodology, especially suited to an applied research ﬁeld.

Single subject designs have been strongly associated with evaluation of the
intervention with behavioral and cognitive-behavioral orientations. This may be due to
the historical fact that this method was developed through research on operant
conditioning (Kazdin, 1994). However, single subject designs should not be restricted to
these areas and can be used as a general treatment evaluation. In fact, there have been a
few attempts to apply this design to evaluate other types of interventions such as

psychoanalysis and paradoxical intervention (F onagy & Moran, 1990; Kolko & Milan,

152

1983). In this study, single subject design was used to evaluate Dosa therapy which is an
experientially oriented therapy. Therefore, this investigator believes that this study also
attests to a broader utility of single subject designs.

The present study used a task analysis approach to examine an underlying
mechanism which operates during the treatment with Dosa therapy. A task analysis
approach was developed as a means of process research. Although it was expected to
augment efforts of outcome research to develop effective practice models, research that
adopted this approach was limited in social work (Reid, 1988). This study attests to the
utility of a task analysis approach as a means to investigate the therapeutic process.
Originally a task analysis approach was used to examine the process of a cognitive,
affective task (Greenberg, 1984). In this study, this approach was used to investigate the
process of the Dosa task which involves motor control processes. Therefore, this study
suggested the possibility of using a task analysis approach with a task other than one that

is cognitive or affective.

Directicﬂ for Future Ras_e_a£h

In the present study, the effectiveness of Dosa therapy was examined with
individuals with anxiety problems. The questions which ask if Dosa therapy works for
individuals with anxiety problems were examined by using the single subject design. The
results provided support for the positive effect of Dosa therapy. As discussed as a
limitation of this study, the research design used in this study does not allow the

investigator to separate out factors which are speciﬁc to Dosa therapy from common

153

factors. In order to further the understanding of the effectiveness of Dosa therapy, this is
another question to be answered.

Another possible direction will be systematic replication of this study. By
changing conditions such as client characteristics, settings, or target problems, the
investigator can tell to what extent Dosa therapy is effective. As discussed earlier, by
accmnulating the data ﬁom systematic replication, the investigator may be able to tell if
Dosa therapy is effective, for whom, or with what type of problem.

The clinical anxiety scale (Hudson, 1992; Westhuis & Thyer, 1989), discussed
above, is useful for measuring general anxiety. However, this scale does not provide the
information regarding the key components of anxiety, which are behavioral, cognitive,
and somatic/physiological. If a scale was used which measures these all components of
anxiety, the data would provide the information regarding which component is more
inﬂuenced by the intervention with Dosa therapy. In other words, it may be possible to
expect, eventually, what type of anxiety would respond more to the intervention with
Dosa therapy. This will be an interesting question to explore in the future.

In the present study, the therapeutic process of Dosa therapy was analyzed by
using a task analysis approach. The Dosa process was focused on for analysis. A
performance model, which described how the Dosa task was carried out, was developed
and the internal operations model was inferred from the performance model. This is only
a beginning to understand how the Dosa process inﬂuences a person’s psychological
functioning. The process of how a person perceives their experiences of Dosa control
may be a variable which provides the information to link the experience in Dosa control

to change in psychological functioning. By analyzing the person’s perception during the

154

Dosa practice, the effect of Dosa control on psychological functioning will be further

understood.

155

APPENDICES

156

PPENDD( A

ADVATISEMENT OF PARTICIPANT RECRUITMENT

157

 

sw s
A“ M “meat,

The investigator plans to conduct a clinical study on the
effectlveness o a psychotherapy called Dosa therapy. Dosa
therapy was developed 1n Japan and has not been used 111 the
U. S. 11 Japanese, Dosa means motor actlon. Thls is a
body-orlented therapy and uses bodily movement to brlng
about a change in psycholo lcal functlonlng. Dosa therapy
has been use w1th1nd1v1dua s with varrous problems and has
been found to_be effective for lssues and roblems which
lnclude anxret ,_d1ff1culties ln_ pub 1c 8 eak_lng,
obesessrve-compu srve problems, tensron, and d1 1cultles in
interpersonal relatlonshlps.

In this study, Dosa therapy will be used with female
Amerlcanstu ents to examine the effectlveness of Dosa
therapy w1th a non-Japanese populatlon. Female American
studentswho have worries regardmg classes, relat1_onshlps,
andoutslde res onsrbllitles, or anxrety about a speC1ﬁc thlng
or srtuatlon are elng recrulted.

The student investigator, Noriko Kubota, who is workin
on her Ph.D. IS a certl led cllnlcal psycholo 1st 1n Japan wrt
a Master's ofSocral Work degree from the n1~terd States. She
wrll admlnlster Dosa therap 1nd1v1duall free of char e.
Therapy S_essrons wlll behe once a wee for one hour or
eight sessrons. Sessrons wrll be held at Baker Hall. She w111 be
superv1sed by an expenenced socral work clln1c1an.

 

Individuals who are interested inthis free therap
opportunity or who want further lnforrnatlon about thls stu y
ma contact Noriko Kubota at 517-655-6015 between 8am
an 9pm or by e-amll at kubotano@pllot.msu.edu.

 

158

APPENDIX B

CONSENT FORM FOR SCREENING INTERVIEW

159

Consent Form

This study is designed to investigate the effectiveness of a type of body-oriented
psychotherapy. This psychotherapy is called Dosa Therapy and was developed in Japan.
Dosa means motor action in Japanese and uses bodywork to bring about changes in a
person’s psychological functioning. Dosa therapy has been used successfully for
individuals with anxiety problems, obsessive-compulsive problems, excessive tension,
and difﬁculties in interpersonal relationships and in public speaking. In this study, the
researcher will examine the effectiveness of Dosa therapy for American students who
have an anxiety-related issue/concem.

The purpose of this screening session is (1) for you to receive more information
about Dosa therapy and the investigator/therapist, so that you will have sufficient
information to decide whether you want to participate in this study, and (2) for the
investigator/therapist to obtain detailed information regarding the issue you want to work
on. This screening session will last approximately one hour; you will be asked to answer
the questionnaires which take approximately 10 minutes and provide information about
the issue you want to solve. Based on the information obtained today, the investigator
will decide whether you will be a good candidate for this study and report the results to
you within a week.

If you decide to participate in this study, we will start the individual sessions
immediately. Your participation in this study will last approximately four months; this
timefrarne includes therapy sessions and an observation period before the therapy begins.
The observation phase will take 3 or 4 weeks prior to therapy. We will meet for half an
hour once a week. You will be asked to answer the questionnaires and to provide
information regarding your anxiety status. The questionnaires will take approximately ten
minutes. This information will be used to establish a baseline so that change due to
therapy will be measurable. The number of therapy sessions will be seven or eight,
ending our sessions on the ﬁnal week of the semester. We will meet for one hour once a
week. The ﬁrst half of the hour will be spent in discussion and completion of
questionnaires. The second half of the hour will be spent for the Dosa exercise to induce
change in your issue. The follow-up session will be held once after winter break to
complete those questionnaires that you originally ﬁlled out.

All interviews will be tape-recorded and all therapy sessions will be videotaped.
They will be used to obtain information about the therapy process. They will not be
shared with anyone. However, if the therapist is concerned about any part of the
therapeutic process, the audio or visual tape may be shared with the social work
supervisor of this project. All audio and visual tapes will be destroyed at the completion
of the study.

Your participation is voluntary. You may choose not to participate at all, may

refuse to participate in certain procedures or answer certain questions, or may discontinue
your participation at any time without penalty.

160

All results will be treated with strict conﬁdence and you will remain anonymous
in any report of research ﬁndings. Within these restrictions, aggregated group results may
be made available to you at your request.

The therapist will work hard to provide an effective therapeutic experience,
however, beneﬁcial effects through Dosa therapy are not guaranteed. MSU students can
receive counseling services free of charge at the MSU Counseling Center, 207 Student
Services Building, 355-8270.

Any questions or concerns about this study may be directed to Noriko Kubota
(516-655-6015, kubotano@pilot.msu.edu) or Dr. Rena Harold (432-3733). Any questions
about participants’ rights as human subjects of research may be directed to the
chairperson of the University Committee on Research Involving Human Subjects
(UCRIHS): David E. Wright (355-2180).

Please indicate your voluntary agreement to participate by signing below.

Consent

I understand that I am freely participating in this study by Noriko Kubota under advice of
Jo Ann McFall and Dr. Rena Harold, School of Social Work. I understand that I am free
to decline to answer any question during the session. Furthermore, I understand that my
responses will be held in strict conﬁdence and my responses will not be singled out or
reported in any way that may be identiﬁable.

Signed: Date:

161

APPENDIX C

CONSENT FORM FOR THE THREE-WEEK BASELINE GROUP

162

Consent Form

This study is designed to investigate the effectiveness of a type of body-oriented
psychotherapy. This psychotherapy is called Dosa Therapy and was developed in Japan.
Dosa means motor action in Japanese. This therapy uses bodywork to bring about
changes in a person’s psychological functioning. Dosa therapy has been used successfully
for individuals with anxiety problems, obsessive-compulsive problems, excessive
tension, and difficulties in interpersonal relationships and in public speaking. In this
study, the researcher will examine the effectiveness of Dosa therapy for American
students who have an anxiety-related issue and concern.

Your participation in this study will last approximately four months including
three preliminary sessions, eight therapy sessions and one follow-up session. During the
preliminary sessions, you and the therapist/investigator will meet for half an hour once a
week for three weeks. You will be asked to answer questionnaires and to provide
information regarding your issue/concem. The questionnaires take approximately ten
minutes to complete. This information will be used to establish a baseline so that change
due to therapy will be measurable. The number of therapy sessions will be eight. You and
the therapist/investigator will meet for one hour once a week for 8 weeks. In therapy
sessions, the ﬁrst half of the session will be spent for interview and the second half will
be spent for relaxation exercise. The follow-up session will be held one month after
therapy ends. In the follow-up sessions, you and the therapist/investigator will meet for
half an hour and you will be asked to answer the questionnaires to see how well the
therapy results will have maintained. Your total involvement will be 15 weeks.

All interviews will be tape-recorded and all therapy sessions will be videotaped.
They will be used to obtain information about the therapy process. They will not be
shared with anyone. However, if the therapist is concerned about any part of the
therapeutic process, the audio or visual tape may be shared with the social work
supervisor of this project. All audio and visual tapes will be destroyed at the completion
of the study.

Your participation is voluntary. You may choose not to participate at all, may
refuse to participate in certain procedures or answer certain questions, or may discontinue
your participation at any time without penalty.

All results will be treated with strict conﬁdence and you will remain anonymous
in any report of research ﬁndings. Within these restrictions, aggregated group results may
be made available to you at your request.

The therapist will work hard to provide an effective therapeutic experience,
however, beneﬁcial effects through Dosa therapy are not guaranteed. MSU students can
receive counseling services free of charge at the MSU Counseling Center, 207 Student
Services Building, 355-8270.

Any questions or concerns about this study may be directed to Noriko Kubota
(516-655-6015, kubotano@pilot.msu.edu) or Dr. Rena Harold (432-3733). Any questions

163

about participants’ rights as human subjects of research may be directed to the
chairperson of the University Committee on Research Involving Human Subjects
(UCRIHS): David E. Wright (355-2180).

Please indicate your voluntary agreement to participate by signing below.

Consent
I understand that I am ﬁ'eely participating in this study by Noriko Kubota under the
supervision of Jo Ann McFall and Dr. Rena Harold, School of Social Work. I understand
that I am free to decline to answer any question during the session. Furthermore, I

understand that my responses will be held in strict conﬁdence and my responses will not
be singled out or reported in any way that may be identiﬁable.

Signed: Date:

164

APPENDIX D

CONSENT FORM FOR THE FROUR-WEEK BASELINE GROUP

165

Consent Form

This study is designed to investigate the effectiveness of a type of body-oriented
psychotherapy. This psychotherapy is called Dosa Therapy and was developed in Japan.
Dosa means motor action in Japanese. This therapy uses bodywork to bring about
changes in a person’s psychological functioning. Dosa therapy has been used successfully
for individuals with anxiety problems, obsessive-compulsive problems, excessive
tension, and difﬁculties in interpersonal relationships and in public speaking. In this
study, the researcher will examine the effectiveness of Dosa therapy for American
students who have an anxiety-related issue and concern.

Your participation in this study will last approximately four months including
four preliminary sessions, seven therapy sessions and one follow-up session. During the
preliminary sessions, you and the therapist/investigator will meet for half an hour once a
week for four weeks. You will be asked to answer questionnaires and to provide
information regarding your issue/concem. The questionnaires take approximately ten
minutes to complete. This information will be used to establish a baseline so that change
due to therapy will be measurable. The number of therapy sessions will be seven. You
and the therapist/investigator will meet for one hour once a week for 7 weeks. In therapy
sessions, the ﬁrst half of the session will be spent for interview and the second half will
be spent for relaxation exercise. The follow-up session will be held one month after
therapy ends. In the follow-up session, you and the therapist/investigator will meet for
half an hour and you will be asked to answer the questionnaires to see how well the
therapy results will have maintained. Your total involvement will be 15 weeks.

All interviews will be tape-recorded and all therapy sessions will be videotaped.
They will be used to obtain information about the therapy process. They will not be
shared with anyone. However, if the therapist is concerned about any part of the
therapeutic process, the audio or visual tape may be shared with the social work
supervisor of this project. All audio and visual tapes will be destroyed at the completion
of the study.

Your participation is voluntary. You may choose not to participate at all, may
refuse to participate in certain procedures or answer certain questions, or may discontinue
your participation at any time without penalty.

All results will be treated with strict conﬁdence and you will remain anonymous
in any report of research ﬁndings. Within these restrictions, aggregated group results may
be made available to you at your request.

The therapist will work hard to provide an effective therapeutic experience,
however, beneﬁcial effects through Dosa therapy are not guaranteed. MSU students can
receive counseling services free of charge at the MSU Counseling Center, 207 Student
Services Building, 355-8270.

Any questions or concerns about this study may be directed to Noriko Kubota
(516-655-6015, kubotano@pilot.msu.edu) or Dr. Rena Harold (432-3733). Any questions

166

about participants’ rights as human subjects of research may be directed to the
chairperson of the University Committee on Research Involving Human Subjects
(UCRIHS): David E. Wright (355-2180).

Please indicate your voluntary agreement to participate by signing below.

Consent

I understand that I am freely participating in this study by Noriko Kubota under the
supervision of Jo Ann McFall and Dr. Rena Harold, School of Social Work. I understand
that I am ﬂee to decline to answer any question during the session. Furthermore, I
understand that my responses will be held in strict conﬁdence and my responses will not
be singled out or reported in any way that may be identiﬁable.

Signed: Date:

167

APPENDIX E

QUESIONNAIRE FOR ANXIETY PROBLEM AND

BACKGROUND INFORMATION

168

Questionnaire for Anxiety Problem and Background Information

1. Anxiety Problem
(1) The issue or problem you want to work on with me in Dosa therapy

On a scale ﬁom l tolO, with 1 meaning no trouble at all and 10 meaning you are very
disturbed by this issue/problem, where would you put yourself today?

1 2 3 4 5 6 7 8 9 10
No trouble at all Very disturbed

(2) Have you ever had therapy before for this problem or any other concern?
Yes[ ] No[ ]

If yes,
a. What was the issue at the time you sought therapy?

b. What type of therapy did you have?

c. How long or how many sessions did the therapy last?

d. What was the result of your last therapy experience?
Your issue was

Solved Improved Slightly improved Not changed Worsened
c. How much were you satisﬁed with that result?
Very satisﬁed Somewhat Slightly Not at all

(3) What made you interested in participating in this study?

169

2. Background Information
Name:
Address:
Telephone Number:
E-mail Address:
Are you currently pregnant? Yes[ ] No[ ]
Do you plan to get pregnant in a few months? Yes[ ] No[ ]
Have you ever been diagnosed with a psychiatric disorder/condition?
Yes[ ] No[ ]
If yes,
Diagnosis

Medication

170

APPENDD( F

CLINICAL ANXIEY SCALE

171

Date:

Clinical Anxiety Scale
(Hudson, 1992; Westhuis & Thyer, 1989)

Name:

This questionnaire is designed to measure how much anxiety you are currently feeling. It
is not a test, so there are no right or wrong answers. Answer each item as carefully and as
accurately as you can by placing a number beside each one as follows.

1 = Rarely or none of the time
2 = A little of the time

3 = Some of the time

4 = A good part ofthe time

5 = Most or all of the time

) I feel calm.

) I feel tense.

) I feel suddenly scared for no reason.

) I feel nervous.

) I use tranquilizers or antidepressants to cope with my anxiety.
) I feel conﬁdent about the future.

) I am free from senseless or unpleasant thoughts.

) I feel afraid to go out of my house alone.

) I feel relaxed and in control of myself.

) I have spells of terror or panic.

) I feel afraid in open spaces or in the streets.

) I feel aﬁaid I will faint in public.

) I am comfortable traveling on buses, subways or trains.

) I feel nervousness or shakiness inside.

) I feel comfortable in crowds, such as shopping or at a movie.
) I feel comfortable when I am left alone.

) I feel aﬁaid without good reason.

) Due to my fears, I unreasonably avoid certain animals, objects or situations.
) 1 get upset easily or feel panicky unexpectedly.

) My hands, arms or legs shake or tremble.

) Due to my fears, I avoid social situations, whenever possible.
) I experience sudden attacks of panic which catch me by surprise.
) I feel generally anxious.

) I am bothered by dizzy spells.

) Due to my fears, I avoid being alone, whenever possible.

172

APPENDIX G

BEHAVIOR RECORD FORM

173

Behavior Record Form

 

 

Behavior to be Observed:
Date Number of Times/length of Time Additional Comments
Behavior Occurred

 

 

 

 

 

 

 

 

 

 

 

174

 

APPENDIX H

EXPERIENCING SCALE

175

Short Form of Experiencing Scale
(Klein, M., Mathieu, P., Kiesler, D., & Gendlin, D. 1969)

 

 

Stage Content Treatment

1 External events; refusal to participate. Impersonal, detached

2 External events; behavioral or intellectual self- Interested, personal, self-
description participation.

3 Personal reactions to external events; limited Reactive, emotionally
self-descriptions; Behavioral descriptions of involved.
feelings.

4 Descriptions of feelings and personal Self—descriptive;
experiences associative.

5 Problems or propositions about feelings and Exploratory, elaborative
personal experiences hypothetical

6 Synthesis of readily accessible feelings and Feelings vividly expressed,
experiences to resolve personally signiﬁcant integrative, conclusive or
issues affirmative

7 Full, easy presentation of experiencing; all Expansive, illuminating,
elements conﬁdently integrated conﬁdent, buoyant.

 

Note. Treatment in the table refers to the manner of expression.

176

APPENDIX I

SELF -EF FICACY SCALE

177

Self-Efﬁcacy Scale
(Bandura, 1977; Bandura & Jeffery, & Gajdos, 1975)

How certain you are that you can handle your concern/issue effectively now?

10 Completely certain
I know several good ways of handling my concern/issue.
I am sure that I can carry out at least one of the above options to handle
my concern/issue.
I am completely sure that I can handle my concern/issue before it gets out

of hand.

9

8

7

6

5 Maybe / Maybe not
I have some idea what can be done to handle my concern/issue.
I am not sure if I can carry out one of the options successfully.
It depends on some unforeseen factors that I am not aware of.

4

3

2

1

0 Completely uncertain

I have no idea what helps to cope with my concern/issue.
I am not sure that I am able to do anything to handle my concern/issue.
My concern gets out of hand easily.

178

APPENDIX J

BELIEF IN PERSONAL CONTROL SCALE

179

This questionnaire consists of items describing possible perceptions you may have of
yourself, others, and life in general. Please respond to each of the statements below by

Belief in Personal Control Scale
(Berrenberg, 1987)

indicating the extent to which that statement described your beliefs. For each statement
circle the number that best describes your feelings.

M-kb-IN"

5:5xoeoxra

13
14
15
16
17
18

19

1 = Always true

2 = Often true

3 = Sometimes true
4 = Rarely

5 = Never true

Getting what you want is a matter of knowing the right people.
My behavior is dictated by the demands of society.

I ﬁnd that luck plays a bigger role in my life than my ability.
My success is a matter of luck.

Getting what you want is a matter of being in the right place at
the right time.

I feel that other people have more control over my life than I do.
There is little that I can do to change my destiny.

I am not the master of my own fate.

Most things in my life I just can’t control.

Other people hinder my ability to direct my life.

What happens to me is a matter of good or bad fortune.

Fate can be blamed for my failures.

I am the victim of circumstances beyond my control.

I can control my own thoughts.

I am at the mercy of my physical impulses.

In this life, what happens to me is determined by my fate.

I am the victim of social forces.

The unconscious mind, over which I have no control, directs my
life.

I am not really in control of the outcomes in my life.

180

Hﬂﬂﬂﬂ

g—a—ahay—au—ap—ap-ap—np—au—a—ag—ua—a

ﬂ

NNNNN

NNNNNNNNNNNNN

N

wwuuw

wwwwwuwwwwwww

b.)

h-h-k-k-h

Ah-ﬁ-k-kA-h-hhh-h-hh

.5

MMMMM

UIMMUIMMMMMMMMM

LII

APPENDIX K

THERAPY SESSION RECORD FORM

181

Therapy Session Record Form

 

Participant:

Session: Date:

Therapist’s Procedure Subject’s Dosa Subject’s kiensthetic
Performance/Responses sensation, thoughts, feelings
(Therapist’s observation) (Subject’s feedback)

 

 

 

 

 

182

 

APPENDIX L

QUESTIONNAIRE FOR SOMATIC AWARENESS

183

Questionnaire for Somatic Awareness
(Ciofﬁ, 1991)

Please write the body sensations you noticed as many as possible while practicing Dosa
task.

1. sensation ( ) body part ( )
How clearly did you notice this sensation?
l 2 3 4 5 6 7 8 9 10
Barely Moderately Extremely
How did you feel this sensation?

-20 -10 0 +10 +20
Extremely Neither unpleasant Extremely
unpleasant or pleasant pleasant

2. sensation ( ) body part ( )
How clearly did you notice this sensation?
l 2 3 4 5 6 7 8 9 10
Barely Moderately Extremely
How did you feel this sensation?

-20 -10 0 +1 0 +20
Extremely Neither unpleasant Extremely
unpleasant or pleasant pleasant

3. sensation ( ) body part ( )
How clearly did you notice this sensation?
1 2 3 4 5 6 7 8 9 10
Barely Moderately Extremely
How did you feel this sensation?

-20 -10 0 +10 +20
Extremely Neither unpleasant Extremely
unpleasant or pleasant pleasant

4. sensation ( ) body part ( )
How clearly did you notice this sensation?
l 2 3 4 5 6 7 8 9 10
Barely Moderately Extremely
How did you feel this sensation?

-20 -10 0 +10 +20
Extremely Neither unpleasant Extremely
unpleasant or pleasant pleasant

184

APPENDIX M

QUESTIONNAIRE FOR RELXATION STRATEGY

185

1.

Questionnaire for Relaxation Strategy

Did you notice tension during today’s practice? Yes [ ] No [ ]
If yes, what kind of sensation was it?

In which body part did you feel it?

How did you feel about it?

Did you notice relaxation during today’s practice? Yes [ ] No [ ]
If yes, what kind of sensation was it?

In which body part did you feel it?

When during the process did you notice that relaxation?
[ ] after it happened
[ ] while it’s happening
[ ] before it happened

How did you feel about it?

Did that relaxation happen automatically without your doing anything or did you do
anything to make that relaxation happen?

[ ] it happened automatically.

[ ] I did something to make it happen.

If you did something, please describe what you did to make relaxation happen.

Did you have any sensations or feelings in your body beforehand when relaxation
starts? Yes[ ]No[]
If yes, how was it like?

Which body part?

186

APPENDIX N

SESSION EVALUATION QUESTIONNAIRE

187

Session Evaluation Questionnaire

(Stiles, 1980; Stiles, Shapiro, & Firth-Cozens, 1990)

Please place an “X” on each line to show how you feel about this session.

1. This session was (1) difficult easy.

2. Right now I feel

1 ----2----3 ----4----5----6----7

(2) worthless valuable.
1 ----2---3 ----4----5----6----7

(3) shallow deep.
l----2----3----4----5----6---7

(4) unpleasant pleasant.
l----2----3----4----5----6----7

(5) empty full.
l----2---3----4----5----6----7

(6) ordinary special.
l----2----3----4----5----6----7

(7) rough smooth.
l---2---3---4----5----6---7

(8) dangerous safe.
1 ---2---3 ---4----5----6---7

(1) sad happy-
1----2---—3----4----5----6----7

(2) afraid conﬁdent.
l----2----3----4----5----6----7

(3) uncertain deﬁnite.
l ---2---3 ---4----5----6---7

(4) quiet aroused.
l---2---3---—4----5----6----7

(5) slow fast.
1---2----3----4----5----6----7

(6) still active.
1 ----2----3 ----4----5 ----6----7

(7) angry pleased.
1----2----3----4----5----6----7

(8) calm excited.
I ----2---3 ----4----5----6----7

188

APPENDIX 0

QUESTIONNAIRE FOR THERAPY EXPERIENCE

189

Questionnaire for Therapy Experience

1. What change(s) did you notice during this therapy experience with Dosa therapy?

2. What aspect(s) of Dosa therapy do you think was helpful to you in bringing about the
above change?

3. What aspect(s) of the therapist’s assistance/attitude do you think was helpful to you in
bringing about the above change?

4. On a scale from 1 tolO, with one meaning no trouble at all and 10 meaning you are
very disturbed by that issue/problem, where would you put yoruself today?

1 2 3 4 5 6 7 8 9 10
No trouble at all Very disturbed

5. How do you describe the result of this therapy experience with Dosa therapy?
Your issue is

Solved Improved Slightly improved Not changed Worsened
6.How much are you satisﬁed with this result?

Very satisﬁed Somewhat Slightly Not at all

7. Do you have any remaining issue(s) and/or new ones? Yes[ ] No[ ]
If Yes, please describe below.

8. Do you know where you can go for additional help or support for these issues or others
that may arise? Yes[ ] No[ ]

If No, would you like a referral for additional help? Yes[ ] No[ ]

190

REFERENCES

191

REFERENCES

American Psychiatric Association. (1994). Diagpostic and statistical manual of
merytal disorders (4'h ed.). Washington, DC: American Psychiatric Association.

Anastas, J. & MacDonald, M. (Eds) (1994). Research desigp for social work and
the human service; New York: Lexington Books.

Araragi, K. (1992). Koreisha-rinsho ni okeru Dosa-ho. [Dosa therapy for the
clinical practice with the elderly.] In G. Naruse (Ed), Kenko to smrts no Rin_s_ho-Do&
13 (pp.98-11 1). Tokyo: Shibundo.

Arkowitz, H. & Hannah, T. (1989). Cognitive, behavioral, and psychodynamic
therapies: Converging or diverging pathways to change? In A. Freeman, K. Simon, L.

Beutler, & H. Arkowitz (Eds), Comprehensive ﬂabwk of cogm'tive thwy (pp. 143-
167). New York: Plenum Press.

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavior change.
Psychological Review, 84, 191-215.

Bandura, A., Jeffrey, R W., & Gajdos, E. (1975). Generalizing change through
participant modeling with self-directed mastery. Behavior Research and Therapy, 13,
141-152.

Bargh, J. & Chartrand, T. (1999). The unbearable automaticity of being.
American Psycholpgiat. 54(7), 462-479.

Barlow, D. H. (1981). On the relation of clinical research to clinical practice:
Current issues, new directions. Journal of Consulting and Clinical Psychology, 49, 142-
155.

Barlow, D. & Hersen, M. (1984). Sin e case ex rimental desi : Strate 'es for
study_11_1' g behavior change (2"‘I ed.). Boston: Allyn and Bacon.

Barlow. D. H., Hayes, S. C., & Nelson, R. O. (1984). The scientist practitioner:
Research and accountability in clinical and educational settings. New York: Pergarnon

Press.

Bellenir, K. (Ed.) (1997). Congenital disorders sourcebook. Detroit:
Omnigraphics.

192

Bergin, A. E. & Garﬁled, S. L. (1994). Overview, trends, and future issues. In S.

L. Garﬁled & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change (4‘h
ed., pp. 821-830). Hew York: John Wiley & Sons.

Berrenberg, J. (1987). The belief in personal control scale: A measure of God-
mediated and exaggerated control. Journal of Personaliiy Assessmeni, 51, 194-206.

Bloom, M., Fischer, J ., & Orme, J. (1995). Evaluating practice: Guidelinss for th_e
accountable professiong (2nd ed.) Boston: Allyn and Bacon.

Boadella, D. (1986). Lifestreams. London: Routledge.

Brandell, J. R. (Ed.)(1997). Theogy and practice in clinical social work. New
York: The Free Press.

Cioﬂi, D. (1991). Sensory awareness versus sensory impression: Affect and
attention interact to produce somatic meaning. Cogm'tion and Emotiog 5(4), 275-294.

Compton, B. & Galaway, B. (1994). Social work processes (5th ed.). Paciﬁc
Grove, CA: Brooks/Cole.

Dadkhah, A. (1998a). Body consciouness in dohsa-hou, a Japanese
psychorehabilitative program. Perceptual and Motor Skills, 86, 411-417.

Dadkhah, A. (1998b). The effect of dohsa-hou on body consciousness in disabled
sportsmen. Japanese Psychological research, 40(3), 134-143.

Dennett, D. (1991). Consciousness explained. Boston: Little, Brown.
Dukes, W. (1965). N=1, Psychological Bulletm 64(1), 74-79.

Edgington, E. (1966). Statistical inference and non random samples.
Psychological Bulletin, 66(6), 485-487.

Fisher, J. & Corcoran, K. (1994). Measurements for clinical practice: A
sourcebook Vol. 2_._ (2nd ed.). New York: The Free Press.

F onagy, P. & Moran, G. (1990). Studies on the efﬁcacy of child psychoanalysis.
Journal of Consulting and Clinical Psychology, 58(6), 684-695.

Frank, J. D. (1973). Persuasionjand healing (2“d ed.). Baltimore: Johns Hopkins
University Press.

Frank, J. D. (1974). Psychotherapy: The restoration of morale. American J oumal
of Psychiaﬂ, 131(3), 271-274.

193

 

Fujioka, T. (1987). Dosa-Ryohou no chiryou katei ni kansuru ichi kosatsu [On the

therapeutic process of Dosa therapy]. Journal of Japanese Clinical Psychology, 5(1), 14-
25.

Garﬁeld, S. L. (1991). Common and speciﬁc factors in psychotherapy. Journal of
Integrptive gnd Eclectic Psychotherapy, 10(1), 5-13.

Garﬁeld, S. L. & Bergin, A. E. (1994). Introduction and historical overview. In A.
E. Bergin & S. Garﬁeld (Eds.), _ILandbooJk of psychotherapy and behpvior change (4th
ed., pp. 3-18). New York: John Wiley & Sons.

Garﬁeld, S. L. & Bergin, A. E. (1986). Introduction and historical overview. In S.

Garﬁeld & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change (3.ml
ed., pp. 3-22). New York: John Wiley & Sons.

Gendlin, E. (1962). Experiencing and the creation of meaning: A philosophical
and psychological approach to the subiective. New York: The Free Press of Glencoe.

Gendlin, E. 31979). Experiential psychotherapy. In R. Corsini (Ed), Current
psychotherapies (2n ed., pp. 340-373). IL: F .E. Peacock Publishers.

Gendlin, E. (1986). Let your body inteppret your dreams. Wilmette: Chiron.

Gendlin, E. (1992). The wider role of bodily sense in thought and language. In M.
Sheets-Johnstone (Ed), Givingthe body its due (pp. 192-207). New York: State
University of New York Press.

Gendlin, E., Jenny, R., & Shlien, J. (1960). Counselor ratings of process and
outcome in client-centered therapy. Journal of Clinical Psychology, 16, 210-213.

Germain, C. (1994). Human behavior and the social environment. In F. Reamer
(Ed.), The foundations of social workitnowledgs (pp. 88-121). New York: Columbia
University Press.

Gingerich, (1988). Rethinking single-case evaluation. In L. Videka-Sherman &
W. Reid (Eds.), Advances in clinical social work research (pp.11-24). Silver Spring, MD:
NASW Press.

Goldfried, M. (1971). Systematic desensitization as training in self-control.
Journal of Consulting and Clinics] Psychology, 37, 228-234.

Goldfried, M. (1979). Anxiety reduction through cognitive-behavioral

intervention. In P. C. Kendall & S. D. Hollon (Eds.), @grﬁive—behpvioral intervention_s_:
Theory. researclhand procedures (pp. 117-152). New York: Academic Press.

194

Goldfried, M. (1980). Toward the delineation of therapeutic change principles.
Americap Psychologist, 35(11), 991-999.

Greenberg, L. (197 5). A task analyp'c approach to the study of psvch_otherap_eutic
events. Unpublished doctoral dissertation, York University, Canada.

Greenberg, L. (1984). A task analysis of intrapersonal conﬂict resolution. In L.
Rice & L. Greenberg (Eds.), Patterns of change (pp. 67-123). New York: Guilford Press.

Greenberg, L., Elliott, R., & Lietaer, G. (1994). Research on experiential
psychotherapies. In A. Bergin & S. Garﬁeld (Eds.), Handbook of psychothegpy and
behavior change (pp. 509-539). New York: John Wiley & Sons.

Greenberg, L., Safran, J. & Rice, L. (1989). Experiential therapy: Its relation to
cognitive therapy. In A. Freeman, K. Simon, L. Beutler, & H. Arkowitz (Eds.),
Comprehensive handbook of cognitive therapy (pp. 169-187). New York: Plenum Press.

Hartman, A. (1994). Social work practice. In F. Reamer (Ed), The foundations of
sociglyworlﬁcnowledgs (pp.13-50). New York: Columbia University Press.

Hoshikawa, T. (1992). Kakokyu-syokogun heno tekiyo [Application of Dosa
therapy to a case with hyperventilation syndrome]. In G. Naruse (Ed), Rinsho-Dosahou
no riron to cmi'yo (pp.179-187). Tokyo: Shibundo.

Hoshino, K. (1982). Dosa kunren no sports heno oyo. [An application of Dosa
triaing to sports]. In G. Naruse (Ed), Shinti rehabilitation no tenkai: Seishin no hattatsu
Mseiks heno 1% (pp. 183-191) [The evolution of psychological
rehabilitation: The intervention for mental development and activation]. Fukuoka, Japan:
Institute for Psychological Rehabilitation.

Hoshino, K. (l992).Kata-tsukuri, kata-kuzushi, kata-nanoshi [form-creation,
form-destruction, and form-recreation]. In G. Naruse (Ed), Kenko to sp_o_rts no Rinsho-
Dosa-ho (pp. 1 72-1 81). Tokyo: Shibundo.

Howard, K., Kopta, S., Krause, M., & Orlinsky, D. (1986). The dose-effect
relationship in psychotherapy. American Psychologisi, 41, 159-164.

Hudson, W. (1992). The WALMYR assessment scales scoring manual. Tempe,
AZ: WALMYR.

Hyland, M. (1985). Do person variables exist in different ways? American
Psychologistn 40, 1003-1010.

Jacob, F. (1982). The possible and the actual. Seattle, WA: University of
Washington Press.

195

Jacobson, E. (1964). Anxietygnd tensfion control. Philadelphia: J. B. Lippincott
Company.

Jacobson, E. (1974). Progmssive relaxation. Chicago: University of Chicago
Press.

Kadushin, A. (1990). The socipl woererview: A guide for human service
professionals (3rd ed). New York: Columbia University Press.

Karon, B. & O’Grady, P. (1969). Intellectual test changes. Psychothegpy, 6, 88-
96.

Karon, B. & VandenBos, G. (1970). Experience, medication, and the
effectiveness of psychotherapy with schizophrenics. British Journal of Psychiatry, 116.
427-428.

Kazdin, A. (1978). The application of operant techniques in treatment,
rehabilitation, and education. In S. Garﬁeld & A. Bergin (Eds.), Handbook of
psychotherapy and behavior change (2“‘1 ed, pp. 549-5 89) New York: John Wiley &
sons.

Kazdin, A. (1982). Single-case research desigp: Methods for clinical and supplied
settings. New York: Oxford University Press.

Kazdin, A. (1984). Behavior modiﬁcap'on in applied settings (3rd ed).
Homewood, IL: The Dorsey Press.

Kazdin, A. (1994). Methodology, design, and evaluation in psychotherapy
research. In A. Bergin & S. Garﬁeld (Eds.), Handbook of psychotherapy and behavior
change (pp. 19-71). New York: John Wiley & Sons.

Kazdin, A. (1998). Research desigp in clinical psychology (3rd ed). Boston: Allyn
and Bacon.

Kepner, J. (1987). Body process: A Gestalt approach to working with the body in
psychotherapy. New York: Gardner Press.

Kessler, R., McGonagle, K., Zhao, 8., Nelson, C., Hughes, M., Eshelrnan, S.,
Wittchen, H., & Kendler, K. (1994). Lifetime and 12-month prevalence of DSM-HI-R
psychiatric disorders in the United States. Archives of General Psychiagy, 51, 8-19.

Kiesler, D. (1969). Reﬁnement of the exmriencing scale as a counseling tool.
Report to US Department of Health, Education and Welfare, Office of Education, Bureau

of Research.

196

Kiesler, D., Klein, M., & Mathieu, P. (1965). Sampling from the recorded therapy
interview: The problem of segment location. Journal of Consulting Psychology, 29, 337-
344.

Kimura, S. & Kobayashi, S. (1968). Saiminho niyosu moseimahisha no koudou
henyo nitsuite. [Behavior change of people with cerebral palsy by hypnosis]. Journal of
Clinical Psychology,_§, 4.

Kirsh, I. (1990). Chang'pg exgtations: A key to effective psychotherapy. Paciﬁc
Grove, CA: Brooks/Cole.

Kirsh, I. & Lynn, S. (1999). Automaticity in clinical psychology. American
P_8ychologist, 54(7), 504-515.

Kline, M., Mathieu-Coughlan, P., Kiesler, D. (1986). In L. Greenberg & W.
Pinsof (Eds.), The psychotherapeutic process: A research handbook (pp. 21-71). New
York: Guilford Press.

Kline, M., Mathieu, P., Kiesler, D., & Gendlin, E. (1969). The exmriencing scale
manual. University of Wisconsin Press.

Kobayashi, S. (1966). Noseinahiji no rehabilitation. [Rehabilitation for children
with cerebral palsy] (pp.281-290). In G. Naruse (Ed), Kyouilcu Saimingm. [Educational
hypnosis]. Tokyo: Seishin Shobo.

Kolko, D. & Milan, M. (1983). Reframing and paradoxical instruction to
overcome “resistance” in the treatment of delinquent youths: A multiple baseline
analysis. Joumal of Consultingand Clinical Psychology, 51(5), 655-660.

Konno, Y (1977). Tadoji no kodo-henyo niokeru udeage-dosa-control-ho no
kokoromi [An application of Dosa-control-therapy to children with hyperactivity
problem]. Proceedings of the 41st Annual Meeting of the Japanese Societyof Psychology,
1098-1099.

Konno, Y. (1978). T_adoii no kodo-henyo niokeru udeage-dosa-control-ho no
l_<ooromi: Kodo henyo ni okeru shikan kunren no koka ni tsuite. [An application of Dosa-
control-therapy to children with hyperactivity problem: The effect of relaxation training
on behavioral change]. (Rep. Vol. 24, 187-196). Tokyo, Japan: Tokyo Education
University, Department of Education.

 

Konno, Y. (1989). Changes of body sensation through muscular relaxation: Using
the method of measuring tactile two-point limen. The Japanese Journal of Pachology,
@(4), 229-215.

Konno, Y. (1993). Awareness of chronic muscular tension and mind-body
experiences. Joumﬂf Behavior Therapy, 19(2), 1-10.

197

Konno, Y. (1997). The effects of relaxation and postural training on external
perception: Improvement of visual acuity, visual ﬁeld, and fearing acuity. Japanese
Psychological Research, 39(2), 119-123.

Konno, Y, Tanaka, H., & Ohki, M. (1979). Tadoji no kodohenyo ni okeru udeake
dosa control kunrenho no koka ni tsuite. [The effect of udeage-dosa control training on
behavior change for children with hyperactivity]. Bulletin of Consultation and School

Psychology, 18, 29-48.

Konno, Y., Ohno, K. (1987). A factor analytic study of the acceptance of
relaxation through Dohsa training. The Japanese Joum_al of Psychology, 58(1), 57-61.

Kubota, N. (1991). The psychotherapeutic treatment for an obsessive-compulsive
neurotic client by Motor Action Training. Journal of Jamese Clinical Psychology, 9(2),
17-28.

Lambert, M. & Hill, C. (1994). Assessing psychotherapy outcomes and processes.

In A. Bergin & S. Garﬁeld (Eds.), Handbook of psychotherapy and behavior change (4th
ed, pp. 72-113). New York: John Wiley and Sons.

Lambert, M., Shapiro, D., & Bergin, A. (1986). The effectiveness of
psychotherapy. In S. Garﬁeld & A. Bergin (Eds.), Handbook of psychotherapy and
behavior change (pp. 157-212). New York: John Wiley & Sons.

Libet, B. (1985). Unconscious cerebral initiative and the role of conscious will in
voluntary action. The behavioral and Brain Sciences 8 529-566.

 

Lowen, A. (1976). Bioenergetics. London: Conventure.

McGuigan, F. (1990). Exg'mental psychology: Methods of research (5'11 ed.)
Mew Jersey: Prentice Hall.

Miller, L. Murphy, R., & Buss, A. (1981). Consciousness of body: Private and
public. Journﬁ of Personality apt} Social Psychology, 41, 397-406.

Naruse, G. (1967). Noseimahisya no shinrigakuteki-rehabilitation: Shikankodo ni
tsuite. [Psychological rehabilitation for people with cerebral palsy: On relaxation
behaviors]. (11(2), 33-46). Japan: Kyusyu University.

Naruse, G. (1973). Shinri-rehabilitation [Psychological rehabilitation]. Tokyo:
Seishin-Shobo.

Naruse, G. (1984). Shogaiji notameno Dosa-ho [Dosa therapy for children with
disability]. Tokyo: Tokyo Shoseki.

198

 

 

Naruse, G. (1985). Dosa-kumen no riron [Theory of Dosa therapy]. Tokyo:
Seishin-shobo.

Naruse, G. (1988). Jiko-Control-ho [Self-control technique]. Tokyo: Seishin-
shobo.

Naruse, G. (1992). Sinririnsho niokeru kadaitasseitekihoho to taﬁenchiryoron
[Task achieving methods and experiential theory in psychotherapy]. (Research Report
Vol. 28, 1-24). Fukuoka, Japan: Kyushu Women’s University.

 

National Association of Social Workers. (1989). NASW standards for the practice
of clinical sochal work. Washington, DC: NASW Press.

Newell, A. & Simon, H. (1972). Human problem solving, New York: Prentice-
Hall.

Ninomiya, A. & Koshio, M. (1982). Judo, saijudo seishin chitaiji no shinri
rehabilitation: Dosa kunren ni yoru gaikai tono kosyokodo no kaihatsu no kokoromi. In
G. Naruse (Ed), Shinti rehabilitation no tenkai: Seishin no hattatsu to kasseika heno
hatarakikake. (pp. 143-150) [The evolution of psychological rehabilitation: The
intervention for mental development and activation]. Fukuoka, Japan: Institute for
Psychological Rehabilitation.

Ogawa, Y. (1992). Shinshinsho-sha [A case of psychosomatic problem]. In G.
Naruse (Ed), Rinshodosaho no riron to cm 0 (pp.202-213). Tokyo: Shibundo.

Ohno, H. (1967). Kindenzriho niyoru s_hinteki kincho to shikan nikansuru
jikkenteki kep_kﬂ. [An experiment on the effect of psychological tension and relaxation
by an Electromyograph]. Unpublished master’s thesis. Japan: Kyusyu University.

Ohno, H. (1968). Samin shikan to shikan kunren. [Hypnotic relaxation and
relaxation training]. In G. Naruse (Ed), Saimin smppsium: Vol. 1. Shinrigakuteki
rehabilitation (pp.32—41). [Hypnosis symposium Vol. 1: Psychological rehabilitation].
Tokyo: Seishin shobo.

Ohno, K. (1968). Saiminyudo to kunrenjo no mondaiten. [Hypnotic induction and
the problems during the training]. In G. Naruse (Ed), Saimin syr_nppsium: Vol. 1.
Shinrigakuteki rehabilitation (pp. 7-23). [Hypnosis symposium Vol. 1: Psychological
rehabilitation]. Tokyo: Seishin shobo.

Ohno, K. (1978). Noseimahiji to Dosa fujiyuu [Children with cerebral palsy and
difﬁculty in motor control]. In K. Ohno & S. Murata. (Eds.), Noseimahiji no yogo-
kunren: Dosa kunren no jissai (pp.9-35). [Care and training for children with cerebral
palsy: Practice of Dosa training]. Tokyo: Keiotsushin.

199

Ohno, K., Tanaka, H., Miyake, M., & Kobayashi, S. (1982). Udeage dosa control
kunren ho ni taisuru hanhokeika no bunkei nitsuite. [An analysis of responses to udeage-
dosa control method]. Bulletin of Consultation ag School Psychology, 20, 15-24.

Pierrakos, J. (1987). Core Energetics: Developing the cagcity to love and heal.
Mendocino, CA: Life Rhythm Publications.

Pinkus, H., Haring, J ., Lieberman, F., Mishne, J ., & Pollock, J. (1977). Education
for the practice of clinical social work at the master’s level: A position paper. Clinical
Social Work Journal, 5(4), 253-268.

Reich, W. (1972). Character analysis. New York: F arrar, Straus, & Giroux.

Reid, W. (1988). Change-process research: A new paradigm? In L. Videka-
Sherman, & W. Reid (Eds), Advances in clinical social work research (pp.130-148).
Silver Spring, MD: NASW Press.

Rice, L. & Greenberg, L. (1984). Patterns of change. New York: Guilford Press

Rice, L. & Saperia, E. P. (1984). Task analysis of the resolution of problematic
reactions. In L. Rice & L. Greenberg (Eds.), Patterns of change (pp.29-66). New York:
Guilford Press

Richmond, M. (1922). What is social casework? New York: Russell Sage.

Rogers, C. (195 8). A process conception of psychotherapy. American
Psychologig, 13, 142-149.

Rogers, C. (1959). A theory of therapy, personality, and interpersonal
relationships, as developed in the client-centered framework. In S. Koch (Ed),
Psychology: A study of a science Volume 3 (pp. 184-256). New York: McGraw-Hill
Book Company.

Rogers, C., Gendlin, E., Kiesler, D., & Traux, C. (1967). The thwutic

relationship and its impact: A study of psychotherapy with schizophrenics. Madison,
Wisc.: University of Wisconsin Press.

 

Rowan, J. (1992). Humanistic psychotherapy: What is humanistic psychotherapy?
British Journal of Psyghothemy,_9(l), 74-83.

Russman, B. & Romness, M. (1998). Neurorehabilitation for the childe with
cerebral palsy. In G. Miller & G. Clarg (Eds), The cerebral palsies: Causes,
conseauences, and management (pp.32 1 -3 32). Boston: Butterworth-Heinemann.

Ryan, R. (1966). The role of the exp_ep'encing variable in the psychotlrs_rapautic
process. Doctoral dissertation, University of Illinois. No. 66-7805.

 

200

Safran, J ., Greenberg, L., & Rice, L. (1988). Integrating psychotherapy research
and practice: Modeling the change process. Psychotherapy, 25, 1-17.

Schultz, J. & Luthe, W. (1959). Autogenic training: A psychophysiologic
approach in psychotherapy. New York: Gnme & Stratton.

Schwartz, G. (1973). Biofeedback as therapy: Some theoretical and practical
issues. American Psychologist. 28. 666-673.

Shaffer, L. (1947). The problem of psychotherapy. American Psychologist, 47(2),
459-467.

Shapiro, D. (1980). Meditation: Self-reggation and altered states of
consciousness. New York: Aldine Publishing.

Shimizu, R. (1992). Shinkeishosei-utsubyosya be [An application for a depressed
patient with anxiety disorder]. In G. Naruse (Ed), R_in__shodos_alao no riron to chiryo
(pp.223-233). Tokyo: Shibundo.

Shontz, F. (1965). Research methods in mnaliiy. New York: Appleton-
Century-Crofts.

Sidman, M. (1960). Tactics of scientiﬁc research. New York: Basic Books.
Smith, E. (1985). The body in psychotherapy. Jefferson, NC: McFarland.
Spielberger, C. (1966). Anxiegy and behavior. New York: Basic Books.

Stiles, W. (1980). Measm'ement of the impact of psychotherapy sessions. Journal
of consulting and Clinical Psychology, 48(2), 176-185.

Stiles, W. & Snow, J. (1984). Dimensions of psychotherapy session impact across
sessions and across clients. British Journal of Clinical Psychology, 23, 59-63.

Stiles, W., Shapiro, D., & Firth-Cozens. (1990). Correlations of session
evaluations with treatment outcome. British Journal of Clinical Psychology, 29, 13-21.

Strupp, H., Wallach, M., & Wogan, M. (1964). Psychotherapy experience in
retrospect: Questionnaire survey of former patients and their therapists. Psychological

Monogpaphs: General and Applig 78(11, Whole No. 588).

Tanaka, H. (1982). Judo seishinhattatsu chitai ji ni okeru dosa kadai no imi ni
tsuite. [The role of Dosa task for children with severe mental retardation]. In G. Naruse
(Ed), Shinti rehabilitation no tenkai: Seishin no hattatsu to kasseika heno hatarakikake.
(pp. 129-142) [The evolution of psychological rehabilitation: The intervention for mental
development and activation]. Fukuoka, Japan: Institute for Psychological Rehabilitation.

201

Tanaka, S. (1985). Dawnsho-ji no dosa kunren. [Dosa training for children with
Down’s Syndrome]. In G. Naruse (Ed), Shogaiii no tameno dosam (pp. 159-170).
[Dosa method for children with disability]. Tokyo: Tokyo Shoseki.

Tsuji, K. (1966). Kinundo ni oyobosu shinteki kincho to shikan no kouka:
Shutoshite nosei-syonimahi no sairnin kouka ni tsuite. [The effect of psychological
tension and relaxation on muscle movements: The hypnotic effect on children with
cerebral palsy]. Unpublished graduation thesis, Kyusyu University, Japan.

Tsuru, M. (1982). Seishinbunretsubyosha no Dosa-kaizen to shakaiteki
kodohenso [Change in Dosa process and in social behavior of schizophrenic patients]. In
G. Naruse (Ed), Sinri-rehabﬂation no tenkai. Fukuoka, Japan: Sinri-rehabilitation
kenkyujo.

Tsuru, M. (1991). On a change of a sense of self body and of a manner of
experiencing in the “Dohsa” therapy: Through a case with depression and tension of an

interpersonal situation. Journal of Japanese Clinical Psychology, 9(1), 5-17.

Tyson, K. (1992). A new approach to relevant scientiﬁc research for practitioners:
The heuristic paradigm. Social Work, 37, 541-556.

Videka-Sherman, L. & W. Reid, W. (Eds) (1988). Advances in clinical social
work research (pp.130-148). Silver Spring, MD: NASW Press.

Wakeﬁeld, J. (1988). Psychotherapy, distributive justice, and social work:
Psychotherapy and pursuit of justice. Social Service Rsview. 62(3), 353-382.

Watanabe, K. (1995). Dosa-hon niyoru kangofu no moetsukijotai no teigen
nikansuru kento [Evaluation of the effects of “Dohsa” Therapy for alleviation of
burnout]. Japanese Journal of Clinical Psychology, 13(2), 133-144.

West, W. (1994). Post-Reichian therapy. In D. Jones. (Ed), Innovative therapy: A
handbook (pp. 13 1-145). Philadelphia: Open University Press.

Westhuis, D. & Thyer, B. (1989). Development and validation of the clinical
anxiety scale: A rapid assessment instrument for empirical practice. Educational and

Psychological Measuremeni, 49(1), 153-163.

Wicks R. & Parsons, R. (1984). Counseling strategies and intervention techniques
for the human services (2“d ed). New York: Longrnan.

Yamanaka, H. (1992). Sports niokeru Dosa-ho no ichizuke [Place of Dosa thearpy

in sports]. In G. Naruse (Ed), Kenko to sports no Ring-Dom (pp. 151-171). Tokyo:
Shibundo.

202

York, R. (1998). Conducting social work research: An experimental approach.
Boston: Ally and Bacon.

203

nrcnrcnn star: UNIV. LIBRARIES
lllW]llllllllllllllllllllmllllllIlllllllllllllnlllll"
31293020488577