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abstract: Anxiety is one of the most common psychiatric disorders among children yet characterized by lower use of mental health services. Preventive efforts have demonstrated promise in the ability to reduce anxiety symptoms. However, as evidence-based interventions move into real-world settings, there is a need to systematically examine potential implementation factors that may affect program outcomes. The current study investigates the relations between different aspects of implementation and their effect on outcomes of a school-based preventive intervention targeting anxiety symptoms. Specifically, the study examines: (1) the measurement of quality of delivery, (2) specific relations among implementation components, (3) relations between these facets and anxiety program outcomes. Implementation data were collected from nine school-based mental health staff and observer ratings. Program outcomes (pretest and immediate posttest) were measured from 59 participants and their parents (mostly mothers) in the intervention condition. Implementation components included adherence, quality of delivery, time spent, participant responsiveness, and perceived usefulness of program materials. Program outcomes included child-reported emotional expressivity, physiological hyperarousal, negative cognitions, social skills, self-efficacy, and child and parent reported levels of child anxiety. Study findings indicated that quality of delivery was best captured as two facets: skillful presentation and positive engagement. Adherence and quality of delivery were associated with greater participant responsiveness, although time spent was not. Significant relations were found between some implementation components and some program outcomes. Further efforts can be used to optimize the translation of evidence-based programs into real-world settings. / Dissertation/Thesis / Doctoral Dissertation Psychology 2017

This thesis presents the development and implementation of a proof-of-concept study testing music listening’s capacity to reduce subjective and physiological symptoms of anxiety in a situation analogous to an anxiety disorder. This interdisciplinary thesis draws on both clinical psychology and music psychology literature to present a conceptualisation for music listening in the treatment of anxiety disorders. In preparation for the proof-of-concept study, criteria for optimal stimuli were synthesised from the music psychology literature, two optimal stimuli were selected, and an anxiety induction protocol was developed to model the worry-based nature of an anxiety disorder. The two stimuli selected were ‘The Swan’, from Carnival of the Animals, by Camille Saint-Saëns, and a combination of ‘Dawn’ and ‘The Secret’, by Dario Marianelli, from the 2005 film Pride and Prejudice. In the anxiety induction protocol, participants were told that they would be asked to give a presentation in front of other participants and experimenters (whom they had not yet seen), and that this presentation would be assessed. While they awaited the presentation, participants were asked to do a mental visualisation exercise, which involved thinking about any previous public speaking experience that had made them feel nervous. Participants were given headphones with either music or white noise while they completed this exercise. The proof-of-concept study was conducted with a general population, with participants (n = 58) randomised to listen to either music or white noise during the anxiety induction protocol. Subjective anxiety (as per the short form of the state scale of the State Trait Anxiety Inventory, or STAI-SF) and physiological arousal (as per pulse rate and skin resistance) were measured. Physiological arousal measures were taken for one minute at baseline (time 1), for one minute when the participant had been introduced to the task and were reading through the mental visualisation exercise (time 2), and while the participants completed the mental visualisation exercise, and music or white noise was playing (time 3). Subjective anxiety scores were obtained immediately after each physiological time point. Results showed that subjective anxiety and physiological arousal rose significantly in response to the anxiety induction protocol, and that subjective anxiety and pulse rate decreased significantly in response to the music but remained the same for those who listened to white noise.

The negative impact of test anxiety has been well documented in the literature with empirical studies demonstrating the existence of a negative relationship between test anxiety and academic performance (Schwarzer, 1990; Seipp, 1991). In 1967, test anxiety was determined to be a problem for 10% of school aged children (Klondas). A decade later, studies suggested this rate was closer to 25 or 30% (Nottelmann & Hill, 1977). In a study of a Pittsburgh area school district, Beidel (1991) found clinically significant Test Anxiety Scale for Children (TASC) scores in 34% of students in a suburban school district that is predominantly white and has a middle to upper socioeconomic status, and 36% of students in an urban district comprised of mixed racial and socioeconomic groups. This data suggests that the prevalence of test anxiety has increased over time. Teachers are in a unique position to assist students in managing their anxiety through research based intervention and behavioral techniques. The results of this research will determine how much information is beneficial to the teacher in order for them to provide the best services for students who present with test anxiety. The role of the school psychologist will also be examined. / School of Education; / School Psychology / PhD; / Dissertation;

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