GUIDED IMAGERY TRAINING AS TREATMENT FOR ALCOHOLISM BY WILLIAM GORDON HUGHES A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 1982 Copyright 1982 by William Gordon Hughes ACKNOWLEDGEMENTS The author would like to express his sincere appreciation to Dr. Gary Seiler for his assistance and direction throughout the development and completion of this dissertation. The author also thanks the other members of his committee, Dr. Ben Barger and Paul W. Fitzgerald, for their assistance. TABLE OF CONTENTS ACKNOWLEDGEMENTS iii LIST OF TABLES vi ABSTRACT vii CHAPTER INTRODUCTION I Background information 2 Need for Study 12 Rationale 13 Research Hypotheses 14 Definition of Terms 16 Organization of the Study 22 CHAPTER II REVIEW OF THE LITERATURE 23 Anxiety in the Alcoholic 23 Stress and Drinking 24 State and Trait Anxiety 25 Low Self-Esteem 25 Overview of Imagery 27 Concept of Successful Treatment 33 Rationale for Imagery as Treatment 35 CHAPTER III METHODOLOGY 40 Research Design 41 Research Hypotheses 45 Selection of Subjects 46 Instrumentation 48 Procedure 53 Statistical Analysis 61 Limitation of the Study 63 CHAPTER IV FINDINGS 65 CHAPTER V DISCUSSION 77 Implications 78 Recommendations 80 APPENDIX A DRINKING QUESTIONNAIRE 82 APPENDIX B OUTLINE: IMAGERY TRAINING SESSION FOR THERAPISTS 83 APPENDIX C DIAGRAM OF TREATMENT GROUPS 85 APPENDIX D RELAXATION TECHNIQUES 87 APPENDIX E INTERVIEW OUTLINE: IDENTIFYING CHARACTERISTICS FOR IMAGERY SESSION 91 REFERENCES 92 PROFILE 112 LIST OF TABLES Table Page 1. ATTRITION OF SUBJECTS 66 2. ANOVA SUMMARY TABLE FOR TREATMENT AND STATE ANXIETY DIFFERENCES 69 3. ANOVA SUMMARY TABLE FOR TREATMENT AND STATE ANXIETY DIFFERENCES LIMITED TO CONTINUOUS EPISODIC ALCOHOLICS 71 4. ANOVA SUMMARY TABLE FOR TREATMENT AND TRAIT ANXIETY DIFFERENCES 72 5. ANOVA SUMMARY TABLE FOR TREATMENT AND TRAIT ANXIETY DIFFERENCES - LIMITED TO FIRST STAGE ALCOHOLICS 73 6. ANOVA SUMMARY TABLE FOR TREATMENT AND TRAIT ANXIETY DIFFERENCES - LIMITED TO CONTINUOUS/EPISODIC ALCOHOLICS 74 7. ANOVA SUMMARY TABLE FOR TREATMENT AND STATE ANXIETY DIFFERENCES - LIMITED TO FIRST STAGE ALCOHOLICS 75 Abstract of Dissertation Presented to the Graduate Council of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy GUIDED IMAGERY TRAINING AS TREATMENT FOR ALCOHOLISM By William Gordon Hughes August, 1982 Chairman: Dr. Gary Seiler Major Department: Department of Counselor Education This study was designed to test the efficacy of Guided Imagery Training and specifically Progressive Relaxation/Guided Imagery Training as a treatment for alcoholics. The study is a quasi-experimental research study using a randomized control group pretest-posttest factorial design. A 2 x A factorial design of two classifications of alcoholics and four treatment groups was used. Using the Diagnostic and Statistical Manual III, alcoholics were classified either First Stage or Continuous/Episodic alcoholics. The four treatment groups were control, Progressive/Relaxation Training, Guided Imagery Training, and Progressive Relaxation/Guided Imagery Training. Pretests and posttests were administered to 120 outpatient clients in three treatment centers in Florida. Criterion measures were the Tennessee Self-Concept Scale, Speil- berger's State-Trait Anxiety Inventory, and a Drinking Questionnaire, developed by the investigator. Treat- ment period was five one hour sessions. Control Group was actually five sessions based on the Reality Therapy approach. The three experimental groups were divided evenly, one half session Reality Therapy, one-half experimental session. Guided Imagery Training emphasized subject participation. Subject selected situations he wanted to cope with more effectively; situations were the focus of imagery session; subject verbalized as he visualized the situation; and subject reinforced visualized coping behavior by describing positive emotions regarding coping behavior. Emphasis was on coping. Treatments produced no change in self-esteem or actual drinking behavior. Progressive Relaxation/ Guided Imagery Training significantly reduced state and trait anxiety more than Control Group and Progressive Relaxation Training. Guided Imagery Training significantly reduced state and trait anxiety more than the Control Group. Guided Imagery was determined to be a signifi- cant part of Progressive Relaxation/Guided Imagery Training. A comparison was made of Guided Imagery Training, in this study, to that in past research. Recommendations were made that treatment be extended to have impact on self-esteem and drinking behavior. CHAPTER I INTRODUCTION This study addresses the problem of successful alcoholism treatment. In addressing this problem it becomes necessary to understand the basic tenets of alcoholism. Chapter presents background research I regarding social influence on alcoholism, along with research on the disease concept, psychological theories, and addictive cycle of alcoholism. Chapter II presents a literature review regarding two personality characteristics of alcoholics, anx- iety and low self-esteem. This prospectus suggests guided imagery can be a successful treatment for al- coholism. An overview of imagery and a rationale for imagery as treatment are presented. In treating alcoholics, a fundamental problem has been identified, the inability to cope (Blane, 1968; Chafetz, 1959; Chafetz, Blane, and Hill, 1970; Silber, 1959, 1967, 1970, 1974). Two factors influencing this inability are low self-esteem and hiqh anxiety level (Berg, 1971; Gary and Guthrie, 1972; Gross and Carpenter, 1971; Masserman, 1976; McLachlon, 1976; Browne, 1976). Chapter III outlines the research design, instru- mentation, research procedure, and statistical analysis. 1