The Effect of Stress Inoculation Training on Anxiety and Performance

Transcription

1 Jounal of Occupational Health sychology 99, Vol., No. 2, 7- Copyight 99 by the Educational ublishing Foundation 7-99/9/$3. The Effect of Stess Inoculation Taining on Anxiety and efomance Tei Saundes and James E. Disell Floida Maxima Copoation Joan Hall Johnston and Eduado Salas U.S. Naval Ai Wafae Cente Taining Systems Division Stess inoculation taining is an intevention that has shown consideable pomise; howeve, many questions aise egading the application of this clinically based appoach to moe applied woplace settings. A meta-analysis was conducted to detemine the oveall effectiveness of stess inoculation taining and to identify conditions that may modeate the effectiveness of this appoach. The analysis was based on a total of 37 studies with 7 sepaate hypothesis tests, epesenting the behavio of,37 paticipants. Results indicated that stess inoculation taining was an effective means fo educing pefomance anxiety, educing state anxiety, and enhancing pefomance unde stess. Futhemoe, the examination of modeatos such as the expeience of the taine, the type of setting in which taining was implemented, and the type of tainee population evealed no significant limitations on the application of stess inoculation taining to applied taining envionments. The impact of stess on the individual has become a pimay concen in industy (Spettell & Liebet, 9), the militay (Disell & Olmstead, 99), aviation (ince, Bowes, & Salas, 99), spots (Jones & Hady, 99), and othe applied settings in which effective pefomance unde stess is equied. Accodingly, the development of effective inteventions fo stess eduction has taen on inceased impotance in the taining community (see Disell & Salas, 99; Ivancevich, Matteson, Feedman, & hillips, 99). Stess inoculation taining is a cognitive-behavioal appoach to stess management that has been implemented in a wide vaiety of settings. In discussing opeato eo in eal-wold settings such as nuclea powe accidents and aicaft emegencies, Spettell and Liebet (9) noted the high stess posed by these tas envionments and stated that "well-established psychological taining techniques [such as] stess inoculation may help to avoid o neutalize these theats" (p. ). Howeve, Newman and Beeh (979) have noted that the most Tei Saundes and James E. Disell, Floida Maxima Copoation, Winte a, Floida; Joan Hall Johnston and Eduado Salas, U.S. Naval Ai Wafae Cente Taining Systems Division, Olando, Floida. Suppot fo this eseach was povided by the Office of Basic Reseach, U.S. Amy Reseach Institute, Alexandia, VA. We than Bian Mullen fo his valuable collaboation. The views expessed heein ae those of the authos and do not eflect the opinion, policy, o views of the U.S. Depatment of Defense. Coespondence concening this aticle should be addessed to James E. Disell, Floida Maxima Copoation, 7 East Lyman Avenue, Winte a, Floida glaing deficiency of stess intevention pogams is the lac of igoous evaluation, and that much of the eseach evidence is compised of case studies, nonempiical epots, and studies lacing appopiate contols. Wexley and Latham (99) ageed: In posing the question of what we can conclude about the effect of stess management pogams, they answe that poof of the effectiveness of these pogams is difficult to obtain. Theefoe, although evidence suggests the efficacy of stess inoculation taining (see Meichenbaum, 993), the oveall effectiveness of this appoach has not been clealy established. Futhemoe, stess inoculation taining was developed pimaily as a clinical intevention, and most studies etain a clinical emphasis. That is, in most studies, a pesceened, highly anxious population was chosen fo taining intevention, most inteventions emphasize one-on-one individualized teatment, and most have been implemented in a laboatoy setting with a highly silled doctoal-level taine. In contast, in a typical applied taining envionment, tainees ae dawn fom a nomal population, taining taes place on a goup basis, and taining is implemented in a less contolled field setting with a less expeienced taine. Theefoe, thee is some question whethe stess inoculation taining may pove as effective unde conditions chaacteistic of the applied taining setting. This study pesents a meta-analysis of the liteatue on stess inoculation taining. The pupose of this study is to integate the liteatue on stess inoculation taining, povide a summay of the oveall effective- 7

2 STRESS INOCULATION TRAINING 7 ness of this appoach, and specify the conditions unde which stess inoculation taining is most effective. Stess Inoculation Taining We use the tem stess to descibe a pocess by which cetain envionmental demands (i.e., pefoming in font of othes, taing an examination, industial noises) evoe an appaisal pocess in which peceived demand exceeds esouces, and that esults in undesiable physiological, psychological, behavioal, o social outcomes (Disell & Salas, 99). Evidence indicates that stess is a costly healthelated issue, in tems of individual pefomance and well-being as well as oganizational poductivity (Ilgen, 99). Accodingly, a geat deal of eseach has been conducted to examine inteventions to educe the negative outcomes of stess on the individual. Stess inoculation taining was oiginally developed as a clinical teatment pogam to teach clients to cope with physical pain, ange, and phobic eactions (see Meichenbaum, 9, 993; Meichenbaum & Deffenbache, 9). Howeve, stess inoculation taining has subsequently been used as a compehensive stess taining intevention and has been implemented fo a vaiety of applications, such as speech anxiety (Altmaie, Leay, Halpen, & Selles, 9), occupational stess (Shap & Foman, 9), coping with advese medical pocedues (Jay & Elliott, 99), and enhancing pefomance unde stess (Bloom & Hautaluoma, 99). As the tem inoculation implies, stess inoculation taining is designed to impat sills to enhance esistance to stess. By taining effective coping sills befoe stess exposue, the objective of stess inoculation taining is to pepae the individual to espond moe favoably to negative stess events. The stess inoculation taining appoach is defined by a thee-stage taining intevention. The fist phase of taining is a conceptualization o educational phase. The goal of this initial phase of taining is to help the individual bette undestand the natue of stess and stess effects. The second phase of stess inoculation taining focuses on sill acquisition and eheasal. The pimay objective of this stage of taining is to develop and pactice a epetoie of coping sills to educe anxiety and enhance the capability to espond effectively in the stessful situation. The final phase of stess inoculation taining, application and followthough, involves the application of coping sills in conditions that inceasingly appoximate the citeion envionment. To enhance the tansfe of taining, tainees may engage in guided imagey o ole-play that allows them to apply coping sills in a gaduated manne acoss inceasing levels of stess. Although specific stess inoculation taining inteventions diffe accoding to the type of stess that is tageted by the taining (e.g., speech anxiety, test anxiety, etc.) and the specific coping sills pactice emphasized (e.g., ole-playing, imagey), the common thead among stess inoculation inteventions is that they shae these thee pimay taining components. The tipatite stess inoculation taining intevention is shown as the independent vaiable in the model povided in Figue. As illustated in Figue, we ae inteested in examining the effects of stess inoculation taining on two pimay outcomes: educing anxiety and enhancing pefomance. To examine these elations, we pusued two pimay analytic goals. The fist goal of this meta-analysis was to establish the oveall significance and magnitude of effect of stess inoculation taining: Is stess inoculation taining effective? Although some studies have concluded that stess inoculation taining is an effective stess intevention (Deffenbache & Hahnlose, 9; Registe, Becham, May, & Gustafson, 99; Sweeney & Koan, 92), othe esults have been moe equivocal (Bosmajian, 9; Russle, 9; Smith & Nye, 99). It is difficult if not impossible to establish the oveall effectiveness of this appoach fom a naative eview of the liteatue. In eviewing 2 yeas of stess inoculation eseach, Meichenbaum (993) noted that eseach is needed on the "usefulness of stess inoculation taining... elative to appopiate contol teatments. The field needs moe documented evidence that stess inoculation taining is indeed effective" (p. 39). Theefoe, in Figue, we epesent the lin between stess inoculation taining and pefomance and between stess inoculation taining and anxiety by a question ma. By integating the esults of studies that have examined the effectiveness of stess inoculation taining on these outcome measues, we can povide a pecise estimate of the typical study outcome within this eseach domain. Thus, the fist objective of this analysis was to establish the oveall magnitude of effect of stess inoculation taining. A second goal of this study was to examine factos that may incease o decease the effectiveness of stess inoculation taining. Janis (93) concluded that "stess inoculation taining often wos but sometimes does not. Obviously, the time has come to

3 72 UNDERS, DRISKELL, JOHNSTON, AND LAS hase : Conceptualization and Education hase 2: Sill Acquisition and Reheasal hase 3: Application and Follow-though Stess Inoculation Taining Figue. Model of the effects of stess inoculation taining on anxiety and pefomance. move on to a moe sophisticated phase of eseach, to investigate systematically the conditions unde which stess inoculation is effective" (p. 77). Of paticula inteest, stess inoculation taining was developed pimaily as a clinical intevention, and etains a stong emphasis on individualized taining and the intensive involvement of a silled facilitato (see Meichenbaum & Deffenbache, 9). Theefoe, thee is some question whethe the stess inoculation taining appoach is applicable to a moe applied taining envionment in which taining is moe liely to be administeed on a shot-tem, goup basis by a nondoctoal-level taine. Theefoe, the second goal of this study was to examine the extent to which the effectiveness of stess inoculation taining vaies as a function of cetain theoetically elevant and pactically impotant modeatos. As shown in Figue, we examine six factos that may modeate the effectiveness of stess inoculation taining: the type of tainee population, the numbe of taining sessions, the taining setting, the type of sills pactice used, the size of the tainee goup, and the expeience level of the taine. By examining the extent to which these factos modeate the effectiveness of stess inoculation taining, we can addess seveal questions of consideable pactical inteest. Fo example, is intensive, long-tem taining equied to poduce positive esults? Can taining be implemented effectively in goup settings? Is taining as effective in the field as in the expeimental laboatoy? Can taining be implemented effectively by less expeienced taines? These modeatos ae descibed in the following section. Type of opulation Effects of Modeatos In some studies, paticipants wee pesceened and a high-anxious population was chosen fo taining intevention (e.g., Adams, 9). Othe studies used an unsceened o nomal anxiety level tainee population (e.g., Jay & Elliott, 99). Some eseach suggests that high-anxiety individuals ae moe liely to be chaacteized by geate woy and self-doubt, self-depecation, and peoccupation with intefeing thoughts and feelings (Meichenbaum & Butle, 9; Deffenbache, 9). Stess inoculation taining pactitiones have placed geat emphasis on modifying cognitive pocesses, o the manne in which anxious individuals maintain negative beliefs (Meichenbaum & Deffenbache, 9). Theefoe, thee is some question whethe the stess inoculation taining appoach may be as effective fo a "nomal" population that, by definition, is not as self-absobed by these thoughts and uminations. Indeed, Femouw and Zitte (97) epoted a nonsignificant tend indicating that stess inoculation taining was moe effective fo those with high anxiety. To detemine whethe the type of tainee population modeates the effectiveness of stess inoculation taining, we examined sepaately those studies in which stess

4 STRESS INOCULATION TRAINING 73 inoculation taining was conducted with a highanxious population and those studies using a nomal anxiety population. Numbe of Taining Sessions Repoted studies of stess inoculation taining ange fom a single session administation (Altmaie & Happ, 9; ayne & Manning, 99) to as many as o moe sessions (Lustman & Sowa, 93; Tableman, Macinia, Johnson, & Rodges, 92). Stess inoculation taining pactitiones ague that, in the clinical setting, the numbe of sessions of taining pesented should be based on the individual needs of the client (Meichenbaum, 9). Howeve, fo taining applications, it is valuable to have a moe standadized estimate of the amount of taining equied: Fo example, ae shot-tem (one o two sessions) inteventions effective, o is moe intensive taining equied fo effective stess eduction? Futhemoe, if a elatively lage numbe of sessions ae equied fo successful taining, this may limit the applicability of this appoach in applied woplace settings. To examine whethe the effectiveness of stess inoculation taining is elated to the numbe of taining sessions, we coded each study accoding to the numbe of taining sessions administeed. Taining Setting Studies examining the effectiveness of stess inoculation taining have been conducted in both laboatoy and field settings. In a typical laboatoy study, taining is conducted in a univesity expeimental laboatoy (Adams, 9; Blacmoe, 93). Othe studies ae conducted in field settings such as schools (Shap & Foman, 9; Zeidne, Klingman, & apo, 9), hospitals (Kendall et al, 979), and community centes (Tableman et al., 92). In examining the utility of stess inoculation taining fo applied taining envionments, it is elevant to as whethe effects may be limited to contolled laboatoy settings, o whethe positive taining effects extend to field settings. Type of Sills actice Duing the second phase of stess inoculation taining, stess management sills ae acquied and pacticed. In some studies, paticipants used mental pactice (imagey) to ehease sills, and in othe studies, paticipants used actual behavioal pactice of sills (ole-playing). In a typical study utilizing imagey pactice, paticipants ae diected to imagine the stesso situation and pactice using the newly leaned coping sills (cf., Registe et al., 99). In studies utilizing behavioal pactice, paticipants may ole-play coping with the stesso situation while integating the sills leaned (cf. Foley, Bedell, LaRocca, Scheinbeg, & Reznioff, 97). Meichenbaum and Cameon (93) stated that both mental eheasal (imagey) and behavioal pactice (oleplaying) ae effective means of eheasing sills. Howeve, in a eview of the effects of mental pactice on pefomance, Disell, Coppe, and Moan (99) found that mental pactice was an effective taining appoach, although less effective than actual physical pactice. To addess the question of what type of sills pactice is most beneficial, we conducted sepaate analyses of the effectiveness of stess inoculation taining inteventions utilizing imagey vesus behavioal sills pactice. Goup Size Emphasis is often placed on the individualized natue of stess inoculation taining and on the intensive one-on-one elationship between the theapist and the client (Meichenbaum, 9; Meichenbaum & Deffenbache, 9). Howeve, in pactice, stess inoculation taining has been implemented on an individual basis (e.g., Jay & Elliott, 99) as well as in goup settings of vaying size (e.g., Foman, 9; Mace & Caoll, 9). Howeve, the extent to which the size of the teatment goup detemines the effectiveness of stess inoculation taining is unnown. Many applied taining settings do not allow the luxuy of one-on-one taining. Theefoe, it is of consideable pactical value to examine whethe the effectiveness of stess inoculation taining is limited by the size of the goup. Expeience of the Taine Stess inoculation taining poponents claim that taining can be conducted effectively both by expeienced taines and by less expeienced individuals (see Meichenbaum, 9). In most eseach studies, stess inoculation taining is implemented by highly tained, doctoal-level pofessionals. Howeve, Wexley and Latham (99) noted that in many oganizations, taines will not necessaily be the most expeienced employees. To examine whethe the effectiveness of stess inoculation taining is dependent on the expeience level of the taine, each hypothesis test was coded fo the expeience level of the peson conducting the taining.

5 7 UNDERS, DRISKELL, JOHNSTON, AND LAS ocedue In accodance with the pocedues specified in Coope (92), Mullen (99), and Mullen and Rosenthal (9), we conducted an exhaustive seach of the liteatue to locate elevant studies using the "ancesty" appoach, the "descendancy" appoach, the "invisible college" appoach, and "ey wod" seaches (i.e., stess inoculation, stess taining) of computeized databases such as sychological Abstacts (sycinfo), Dissetation Abstacts Intenational, and National Technical Infomation Sevice (NTIS). We also manually seached the efeence lists of elevant studies, eview aticles (e.g., Meichenbaum, 993) and boos, and seached though majo psychological jounals and association poceedings. It is citical in pefoming a esponsible meta-analysis to tae exteme cae in deiving the specific hypotheses to be tested, defining both the independent vaiable and dependent vaiables to be examined. The independent vaiable in this meta-analysis was stess inoculation taining. We defined stess inoculation taining opeationally as a taining intevention designed to educe stess effects and incopoating the thee phases of conceptualization and education, sill acquisition and eheasal, and application and followthough. In a ecent eview of stess inoculation eseach, Meichenbaum (993) efeenced moe than 2 studies that addessed the application of stess inoculation taining. Howeve, Meichenbaum noted that he cast a wide net in this naative eview, and that this set of studies included case studies, single case clinical inteventions, and nonempiical aticles, as well as contolled expeimental eseach. In some cases, stess inoculation taining was but one component of a boade-based intevention, and othe studies used divese cognitive-behavioal inteventions aligned with stess inoculation taining. We note the above to illustate that the citeia fo including studies in the cuent meta-analytic eview was moe tightly focused. Fist, to be included in this meta-analysis, a study must be clealy descibed as implementing a stess inoculation taining-based intevention o must clealy delineate the application of the thee-phase intevention as defined in the stess inoculation taining appoach. Thee ae any numbe of taining studies that implement some geneal tipatite intevention (i.e., initial oientation, taining, and follow-up) that could be boadly intepeted as a stess inoculation appoach. Theefoe, to avoid mixing dispaate studies, we limited ou definition of stess inoculation taining to those studies that wee descibed as incopoating a stess inoculation appoach o that explicitly implemented the thee phases of the stess inoculation taining appoach. Second, studies in which the stess inoculation intevention was one component of a boade-based o composite intevention ae not legitimate tests of the effects of stess inoculation taining and wee excluded. Futhe, to be included in the cuent analysis, a study must epot (o allow the etieval of) a test of the effectiveness of stess inoculation taining elative to a no-teatment contol goup. Thee wee two pimay types of dependent measues of inteest: anxiety and pefomance. In eviewing the eseach liteatue, it became evident that studies epoted conceptually diffeent opeationalizations of anxiety. Fo example, some studies epoted the effects of stess inoculation taining on a measue of state anxiety (such as the state anxiety scale of the State-Tait Anxiety Inventoy; Spielbege, Gosuch, & Lushene, 97), wheeas othes epoted the effects of stess inoculation taining on some specific measue of pefomance anxiety (such as speech anxiety o math anxiety). Theefoe, we conducted sepaate analyses of the effect of stess inoculation taining on these sepaate outcome measues. To be included in the stess inoculation taining-state anxiety analysis, a study had to epot a test of the effect of stess inoculation taining on some measue of state o tansitoy anxiety, such as the state anxiety scale of the State-Tait Anxiety Inventoy (Spielbege et al., 97). To be included in the stess inoculation tainingpefomance anxiety analysis, a study had to epot a test of the effect of stess inoculation taining on some specific measue of pefomance anxiety (these include measues of anxiety specific to the pefomance tageted in taining, such as speech anxiety o test anxiety). To be included in the stess inoculation taining-pefomance analysis, a study had to epot a test of the effect of stess inoculation taining on actual pefomance. In summay, we conducted thee sepaate analyses to test thee sepaate hypotheses: the effects of stess inoculation taining on state anxiety; the effects of stess inoculation taining on pefomance anxiety; and the effects of stess inoculation taining on pefomance. In addition to the basic statistical infomation (statistical test of the hypothesis, coesponding degees of feedom, sample size, and diection of effect), each data point was coded fo the pedictos descibed ealie: the type of tainee population, the numbe of taining sessions, the taining setting, the type of sills pactice used, the size of the tainee goup, and the expeience level of the taine. A total of 37 studies with 7 sepaate hypothesis tests, epesenting the behavio of,37 paticipants, wee included (see Table ). Examination of the chaacteistics of the studies in Table eveals that most wee published elatively ecently (with publication dates anging fom 977 to 99) and include both jounal aticles (2) and dissetations (7). Studies that did not meet the citeion fo inclusion in the database and wee omitted included those in which the equied statistical infomation was not etievable (e.g., Hytten, Jensen, & Sauli, 99; Meichenbaum, 972), studies in which thee was no contol goup (e.g., Schule, Gilne, Austin, & Davenpot, 92), and studies in which stess inoculation taining was combined with some othe type of teatment (e.g., Salovey & Haa, 99). In the analyses epoted below, hypothesis tests wee subjected to standad meta-analytic pocedues using the Rosenthal and Rubin meta-analytic appoach (see Mullen, 99; Rosenthal, 99). The pimay effect size estimate used in the Rosenthal and Rubin technique is the coelation coefficient. The pimay level statistics deived fom each hypothesis test ae tansfomed into common metics, fo effect size and i fo significance level. All meta-analytic computations ae caied out on Fishe's Z tansfomation of. The combination of effect sizes and combination of significance levels gauge the combined stength and pobability (espectively) of the effect of stess inoculation taining on the specific outcome measue. Focused compaisons of effect sizes ae used to detemine whethe effects vay in a pedictable way as a function of theoetically elevant pedictos. Fomulae and computational pocedues fo these meta-analytic techniques ae pesented in Mullen (99) and Rosenthal (99).

6 STRESS INOCULATION TRAINING 7 Table Studies Included in the Stess Inoculation Taining Meta-Analysis Study Type of stesso Adams (9) Geneal psychological distess (univesity students) Altmaie & Happ Solving complex (9) poblems (anagams) Altmaie et al. (9) Speech anxiety Blacmoe (93) Test anxiety Bloom & Hautaluoma Compute anxiety (99) Bosmaj ian (9) Dental pocedues Cadoc et al. (97) Speech anxiety De Boe ( 9) Geneal psychological distess (univesity students) Deffenbache & Test anxiety Hahnlose(9) Deiis (92) Finge & Galassi (977) Foley et al. (97) Foman (9) Foman (92) Jay & Elliott ( 99) Kendall et al. (979) Kubia (97) Lustman & Sowa (93) Mace & Caoll (9) Mason (9) Scuba diving Test anxiety sychological distess (multiple scleosis patients) Teache stess Teache stess Medical pocedues (paent's stess fom child's pocedue) Medical pocedue (cadiac catheization) Geneal psychological distess (adolescents) Teache stess Rappelling off a oof Test anxiety Neumann (9) Social anxiety ayne & Manning Teache stess (99) uitt(9) Test anxiety Registe et al. (99) Test anxiety Robets (9) sychological distess (caegives of Alzheime's patients) Statistic ((32) = 2.9 F(l, 2) = 2.3 f(23) '() '(3) K3) f(3) '(27) '() F(l, ) '(3) '(3) '() '() '() '() '() '() '(3) '(3) '(23) '(22) '(2) K2) (22) K23) F(\, 3) F(l, 3) F(l, 22) F(l,) '() =.3 '() =.32 F(l, ) =. F(l, ) =.73 '(3) = 3. F(l, 2) F(l,2) F(l, ) '(3) '(3) F(l,) F(l, 23) F(l, 23) '(7) = 3. = 3.9 = =.29 =. =. =.33 =.99 =.92 =.2 = 3.2 =.3 =.2 =.7 =.3 =.7 =. =.29 =.3 =.2 =.92 =.3 =.7 =. =.37 =.3 =. =.2 = 2.9 =.9 = 3. = 2.23 = 3.3 =.23 = = 7.79 =.33 HY N " O EX NUM RA GR SET (table continues)

7 7 UNDERS, DRISKELL, JOHNSTON, AND LAS Table (continued) Study Russle (9) Schneide (99) Settle (99) Shap & Foeman (9) Smith (99) Smith &Nye (99) Sweeney & Hoan (92) Tableman et al. (92) Ulissi (9) Weinbege (9) Ysaguie (99) Zeidne et al. (9) Type of stesso sychological distess (nusing students) Math anxiety Vocational stess (caee decision maing) Teache stess Test anxiety Test anxiety efomance anxiety (musical pefomance) Geneal psychological distess (lowe income individuals on public assistance) Induced stess (woshop accident film) sychological distess (AIDS patients) Teache stess Test anxiety Statistic F(l,2) F(l, 2) F(l, 3) F(l, 3) '() F(\, ) F(l, ) F(l, 33) F(l, 33) '() t() f() «) K) K) K) () '() f() '(72) = -.7 = -.2 =.9 = 27.2 = 3.9 = = 9.27 =. =.3 =.2 = 3.2 =. = 2.27 =. =. =. = = = 3.39 = 3. <(2) = 2. F(l,) =.9 F(l,) =.32 F(l,) =.2 (2) =.9 F(l,2) =.3 HY N " O EX Note. HY = the type of hypothesis test; = efomance anxiety test; = State anxiety test; = efomance test; O = type of population: = high anxious, = nomal anxiety; EX = expeience of the taine: = doctoal level o above, = below doctoal level; NUM = numbe of pactice sessions; RA = type of coping sills pactice: = imagey, = behavioal; GR = goup size; SET = setting: = field, = laboatoy. Dashes indicate data not available. "ositive effect sizes indicate a positive effect of stess inoculation taining. NUM RA GR SET Geneal Effects Results Table 2 pesents the esults of the combinations of significance levels and effect sizes fo the hypothesis tests included in the meta-analytic database, weighting each study by its sample size. The esults eveal that the oveall effect of stess inoculation taining on educing pefomance anxiety was of stong magnitude, =.9, and significant, z =.929, p <.. A substantial fail-safe numbe (p =.) =, indicates that it would tae moe than, additional undiscoveed studies aveaging no effect of stess inoculation taining to educe the obtained elationship to the. level; thus this finding is quite toleant of futue null esults. The oveall effect of stess inoculation taining on educing state anxiety was of modeate magnitude, =.373, and significant, z =.93, p <.. The fail-safe numbe obtained (p =.) was 3,. The effect of stess inoculation taining on enhancing pefomance was of modeate magnitude, =.29, and significant, z =.2, p <.. The fail-safe numbe obtained (p =.) was 7. Thus, stess inoculation taining was shown to be effective in educing pefomance anxiety, educing state anxiety, and enhancing pefomance unde stess. It should be noted that thee wee no studies in this database that epoted eliability coefficients fo the pefomance measues used, so adjustments fo attenuation wee not attempted. To the extent that measuement eo exists in the pefomance measues, estimates of the effect of stess inoculation

8 STRESS INOCULATION TRAINING 77 Table 2 Combinations of Levels and Effect Sizes: Effect of Stess Inoculation Taining on efomance Anxiety, State Anxiety, and efomance Measue Zpishe z **p<.. efomance anxiety ** State anxiety ** efomance ** taining may be consevative. Futhemoe, note that in Table, some aticles contibute multiple effect sizes (e.g., Sweeney & Hoan, 92, contibute thee hypothesis tests to the pefomance anxiety analysis). In the analyses, each hypothesis test was teated as an independent obsevationan assumption of independence that is false. Fo example, each of the thee hypothesis tests dawn fom Sweeney and Hoan (92) was deived fom the same population at the same time. Note that teating nonindependent esults as independent has no effect on the mean coelation o Fishe's Z indices of effect size (it simply weights each study accoding to the numbe of diffeent effect sizes it geneates). This type of violation, howeve inflates the significance levels of the combined pobability tests, and appopiate caution should be applied in intepeting combined pobability and chi-squae values. An altenative pocedue fo handling the poblem of multiple esults would be to attempt to select the "best" hypothesis test fom a study, although this appoach is somewhat abitay and capicious. A thid altenative is to pool the esults within each study into a single hypothesis test, although this appoach has the disadvantage of sacificing valuable infomation egading diffeences between tests when the effects ae collapsed togethe. To examine whethe the assumption of independence endes a distoted summay of this eseach domain, we conducted a supplemental meta-analysis in which multiple hypothesis tests fom a single study population wee combined into a single hypothesis test. Fo the pefomance anxiety database, this esulted in a total of distinct, independent hypothesis tests. The esults of this supplemental meta-analysis (mean effect size =.9, z =.9, p <.) ae functionally equivalent to the esults of the meta-analysis of the oiginal database ( =.9, z =.93, p <.). Fo the state anxiety database, the esults of the supplemental analysis (29 hypothesis tests) ae =.39, z =.3, p <.. Fo the pefomance database, the esults of the supplemental analysis (7 hypothesis tests) ae =.33, z =.33, p <.. These esults indicate that whethe multiple hypothesis tests ae teated as independent o pooled, the oveall conclusions emain intact. Type of opulation Sepaate analyses of the effects of stess inoculation taining wee conducted fo those studies using a high-anxiety population vesus those using a nomalanxiety population (see Table 3). The effect of stess inoculation taining on educing pefomance anxiety fo high-anxious tainees was of modeate-to-stong magnitude, =.9, and significant, z = 3.773, p <.. Fo tainees dawn fom a nomal-anxiety population, the effect of stess inoculation taining was of stong magnitude, =.72, and significant, z =.79, p <.. A focused compaison of effect sizes indicates that the tendency fo stess inoculation taining to exhibit stonge effects fo nomal-anxiety than fo high-anxiety pesons was significant, z =.73,/7<.. The effect of stess inoculation taining on educing state anxiety fo high-anxious tainees was modeate in magnitude, = All, and significant, z., p <.. Fo nomal-anxiety tainees, the effect of stess inoculation taining was of small magnitude, =.29, and significant, z =.73, p <.. A focused compaison of effect sizes indicates that this diffeence was not significant, z =., p >.. Table 3 Combinations of Levels and Effect Sizes and Focused Compaison: High-Anxiety Vesus Nomal-Anxiety Tainees efomance State efom- Tainee Measue anxiety anxiety ance High anxiety Nomal anxiety Focused compaison Wishe z ZfishEt Z *p <.. **p <.. z ** **.73* 3..7.** ** ** **.3

9 7 UNDERS, DRISKELL, JOHNSTON, AND LAS The effect of stess inoculation taining on impoving pefomance fo high-anxious tainees was of modeate magnitude, =.32, and significant, z =.3, p <.. The enhancement of pefomance fo nomal-anxiety tainees was of small magnitude, =.237, and significant, z = 3., p <.. The diffeence in magnitude between these effect sizes was not significant, z =.3,/j >.. In summay, stess inoculation taining was shown to be on effective stess intevention fo both high-anxious and nomal-anxiety populations. The data futhe indicate that the oveall positive impact of stess inoculation taining on educing pefomance anxiety was significantly stonge fo nomalanxiety tainees than fo high-anxiety tainees. Thee was no significant elationship between the type of tainee and the effect of stess inoculation taining on educing state anxiety o enhancing pefomance. Numbe of Taining Sessions Thee was a significant positive elationship between the numbe of pactice sessions and the magnitude of effect of stess inoculation taining on educing pefomance anxiety, =.32, z = 2.2, p <.. Thus, as the numbe of taining sessions incease, the beneficial effect of stess inoculation taining on educing pefomance anxiety inceases. Moeove, by using the egession fomula, Zpjshe =.7 -I- (.9 * sessions), we can deive an estimate of the magnitude of effect of taining liely to be obtained based on a given numbe of taining sessions. This analysis eveals that the mean effect of stess inoculation taining on pefomance anxiety epoted in Table 2 (Z F j shc =.2) can be obtained with a length of taining of appoximately six to seven sessions. Futhemoe, this analysis indicates that a single taining session is liely to be beneficial in educing pefomance anxiety to a small-to-modeate degee (Z Rsh e = -29). Thee was also a significant positive elationship between the numbe of pactice sessions and the magnitude of effect of stess inoculation taining on educing state anxiety, =., z = 2.2, p <.. Using the egession fomula, Z Fishe = (.39 * sessions), we can estimate that the mean effect of stess inoculation taining on state anxiety epoted in Table 2 (Z Fishc =.392) can be obtained with a length of taining of appoximately fou to five sessions. Again, a single taining session is liely to be beneficial in educing state anxiety to a small-tomodeate degee (Z Fishe =.27). The magnitude of effect of stess inoculation taining on pefomance was not pedicted by the numbe of taining sessions, = -.7, z =.,p >.. In summay, the beneficial effect of stess inoculation taining on educing pefomance anxiety and educing state anxiety inceases with inceasing taining sessions. Howeve, the data suggest that even a minimal taining intevention of one session is liely to poduce positive effects. The oveall positive effect of stess inoculation taining on enhancing pefomance was not modeated by the numbe of taining sessions. Taining Setting Table eveals that the eduction in pefomance anxiety endeed by stess inoculation taining in field settings was of stong magnitude, =., and significant, z = 9.2, p <.. In laboatoy settings, the effect of stess inoculation taining was also of stong magnitude, =.3, and significant, z = 3.7, p <.. The diffeence in magnitude between these two effect sizes was not significant, z =.2, p>.. The eduction of state anxiety in field settings was of modeate magnitude, =.37, and significant, z = 9.39, p <.. In laboatoy settings, the effect of stess inoculation taining was also of modeate magnitude, =.33, and significant, z =.2, p <.. This diffeence was not significant, z =.99, p >.. The enhancement of pefomance fom stess inoculation taining in laboatoy settings was of small magnitude, =., and significant, z =., p <.. Thee wee not enough hypothesis tests in the field settings cell ( = ) to ende a meaningful compaison. Table Combinations of Levels and Sizes and Focused Compaison: Field Vesus Laboatoy Settings Setting Field Laboatoiy Focused compaison **p<.oql. Measue Wishe Z ^Fishe Z z efomance anxiety ** **.2 State anxiety ** **.9% Effect efomance.23.9.**...**.7**

10 STRESS INOCULATION TRAINING 79 In bief, the esults of this analysis indicate that the effects of stess inoculation taining on educing pefomance anxiety and state anxiety ae as stong in the field as in the expeimental laboatoy. Type of actice Sepaate analyses wee conducted of the effectiveness of stess inoculation taining inteventions utilizing imagey vesus behavioal sills pactice (see Table ). Studies using imagey sills pactice yielded a stong, =.3, and significant, z = 2.7, p <., effect on educing pefomance anxiety. The effect fo those studies using behavioal pactice was of small magnitude,.27, and significant, z 2., p <.. This tendency fo imagey pactice to ende lage effects than behavioal pactice on educing pefomance anxiety was significant, z = 3.37,p<.. As a means of educing state anxiety, the effect of stess inoculation taining inteventions utilizing imagey pactice was of modeate magnitude, =., and significant, z =.37, p <.. The effect fo those studies using behavioal pactice was also of modeate magnitude, =.39, and significant, z.39, p <.. A focused compaison evealed no significant diffeence between imagey and behavioal pactice in educing state anxiety, z =.9, p >.. The enhancement of pefomance fom stess inoculation taining inteventions using imagey pactice was of small magnitude, =.7, and significant, z = 2.3, p <.. The effect fo those studies using behavioal pactice was of modeate-tostong magnitude, =.7, and significant, z = Table Combinations of Levels and Effect Sizes and Focused Compaison: Imagey Vesus Behavioal Sills actice actice Imagey Behavioal Focused compaison Measue *p <.. **p <.. %she z Znsbe Z z efomance anxiety ** * 3.37** State anxiety ** **.9 efomance * **.7**.2, p <.. The tendency fo behavioal pactice to ende lage effects than imagey pactice fo impoving pefomance was significant, z =.7, p<.. Thus, fo educing pefomance anxiety, stess inoculation taining incopoating imagey pactice was moe effective. Howeve, the behavioal pactice of coping sills was moe effective fo enhancing pefomance. Goup Size As the size of the taining goup inceases, stess inoculation taining becomes less effective in educing state anxiety, = -.3, z =.9, p <.. Using the egession fomula, Z F i S h e = -9 + (.9 * size), we estimate that the oveall mean effect of stess inoculation taining on educing state anxiety epoted in Table 2 (Z Fishe =.392) is obtained with a goup size of appoximately - tainees. Fo compaison, with a easonably lage tainee goup size of pesons, stess inoculation taining is still shown to ende a modeate impact on educing state anxiety (Z Fishe =.3). In a simila manne, as the size of the taining goup inceases, stess inoculation taining becomes less effective in enhancing pefomance, =.9, z = 3.9, p <.. Using the egession fomula, Z^e = -9 + (-. * size), we estimate that the oveall mean effect of stess inoculation taining on impoving pefomance epoted in Table 2 (Zpishe = -3) is obtained with a goup size of appoximately -9 tainees. Again, although the positive impact of stess inoculation taining becomes stonge as the goup size deceases, stess inoculation taining is shown to be effective in a tainee goup of easonable (-9 pesons) size. Howeve, this patten is evesed fo pefomance anxiety: Stess inoculation taining becomes moe effective at educing pefomance anxiety as the size of the goup inceases, =.32, z =.9, p <.. Using the egession fomula, Z Fishe =.3 + (.2 * size), we estimate that the oveall mean effect of stess inoculation taining on educing pefomance anxiety epoted in Table 2 (Z F i S he = -2) is obtained with a goup size of appoximately 7- tainees. Theefoe, stess inoculation taining is shown to be effective in educing pefomance anxiety in a goup setting of modeate size, although it becomes moe effective as the size of the goup inceases.

11 UNDERS, DRISKELL, JOHNSTON, AND LAS Expeience of the Taine Table epots sepaate analyses conducted fo studies in which taining was conducted by an expeienced taine (doctoal level and above) and those in which taining was conducted by a less expeienced taine (below doctoal level). The effect of stess inoculation taining on educing pefomance anxiety fo those studies in which expeienced taines wee used was of modeate magnitude, =., and significant, z =.7, p <.. Fo less expeienced taines, the effect was of stong magnitude, =.9, and significant, z = 3.9, p <.. This tendency fo less expeienced taines to yield stonge effects than those moe expeienced was significant, z = 232,p <.. This patten is upheld fo state anxiety and fo pefomance. The effect of stess inoculation taining on educing state anxiety fo those studies in which expeienced taines wee used was of modeate magnitude, =.2, and significant, z = 7., p <.. Fo less expeienced taines, the effect was somewhat stonge, =., and significant, z =.37, p <.. Again, the tendency fo less expeienced taines to yield stonge effects than those moe expeienced was significant, z = 3.99, p <.. The effect of stess inoculation taining on enhancing pefomance fo those studies in which expeienced taines wee used was of modeate magnitude, =.222, and significant, z = 3.92, p <.. Fo less expeienced taines, the effect was somewhat stonge, =.37, and significant, z = 3.7,p <.. Again, this diffeence was significant, z = 2.37, p<.. In summay, stess inoculation taining was shown Table Combinations of Levels and Effect Sizes and Focused Compaison: Expeienced Vesus Less Expeienced Taines Taine Expeienced Less expeienced Focused compaison Measue Zfishe Z ^Fishe Z *p<.. **p<.. z efomance anxiety.72..7** ** 2.32* State anxiety ** ** 3.99** efomance ** * 2.37* to have a significant impact on educing pefomance anxiety v educing state anxiety, and enhancing pefomance whethe taining was conducted by a moe expeienced o a less expeienced taine. Moeove, the data futhe indicate that less expeienced taines wee moe effective than moe expeienced taines. Discussion In a ecent eview of the geneal efficacy of psychological teatments, Lipsey and Wilson (993) concluded the following: "The pope agenda fo the next geneation of teatment effectiveness eseach, fo both pimay and meta-analytic studies, is investigation of which teatment vaiants ae most effective, the mediating causal pocesses though which they wo, and the chaacteistics of ecipients, povides, and settings that most influence thei esults" (p. 2). In this study, we have integated and summaized the eseach liteatue on stess inoculation taining, detemined the oveall impact of this appoach, and specified the conditions unde which it is effective. The fist goal of this meta-analysis was to establish the efficacy (o lac theeof) of stess inoculation taining. Results of this analysis povide stong suppot fo the effectiveness of stess inoculation taining as a stess taining intevention. Stess inoculation taining was shown to be an effective appoach fo educing pefomance anxiety, educing state anxiety, and enhancing pefomance unde stess. These geneal effects ae summaized in Figue 2. How do we povide a context fo evaluating the effect sizes obtained? Using Cohen's (977) benchmas fo effect sizes, the oveall effect sizes obtained ae all medium to lage in magnitude. Moe boadly, we may compae the oveall magnitude of effect of stess inoculation taining on pefomance ( =.29) with that obtained fom compaable meta-analyses of othe taining appoaches. Recent eseach indicates that the oveall mean effect of mental pactice on pefomance is =.2 (Disell et al., 99), and the oveall mean effect of oveleaning on pefomance is =.29 (Disell, Willis, & Coppe, 992). Thus, stess inoculation taining exets a positive effect on enhancing pefomance compaable to o stonge than these othe well-established taining inteventions. Futhemoe, the patten of the oveall esults obtained is infomative: Stess inoculation taining shows the stongest effect on educing pefomance anxiety, a somewhat smalle effect on educing state anxiety, and again a somewhat smalle effect on

12 STRESS INOCULATION TRAINING hase li Conceptualization and Education hase 2: Sill Acquisition and Reheasal hase 3: Application and Follow-though Stess Inoculation Taining -.S» Anxiety State Anxiety efomance Figue 2. Oveall effects. impoving pefomance. Recall that measues of pefomance anxiety included test anxiety, speech anxiety, and othe measues of anxiety specific to the sill being addessed in taining; state anxiety included measues of state o situational anxiety; and pefomance measues eflected actual impovement in pefomance. Thus, it is easonable to expect that stess inoculation taining may have a moe diect impact on pefomance anxiety specific to the tas at hand, a less diect impact on a elatively moe distal measue of state anxiety, and a weae effect on actual pefomance. Again, it should be emphasized that stess inoculation taining esulted in modeate-tostong impovements on all thee outcome measues. A second goal of this meta-analysis was to examine the extent to which the effectiveness of stess inoculation taining vaied as a function of elevant modeatos. The esults of these analyses identify the conditions unde which stess inoculation taining is effective and povide pactical guidelines fo taining implementation. The esults of this analysis indicate that stess inoculation taining is effective egadless of whethe those tained ae dawn fom a highanxiety and nomal-anxiety population. We had noted ealie the concen that because the stess inoculation taining appoach places a stong emphasis on modifying intefeing cognitions, it may be less effective fo a nomal tainee population that is liely to be less peoccupied with negative thoughts and beliefs than a high-anxiety goup. The data show this concen to be unwaanted. Oveall, the data indicate that the effectiveness of stess inoculation taining is not limited by the type of tainee population, and that the positive benefits of taining extend to nomal anxiety as well as high-anxiety populations. The data also eveal that the beneficial effects of stess inoculation taining incease as the numbe of taining sessions incease, both in tems of educing pefomance anxiety and educing state anxiety. Howeve, a question of moe pactical impot is not only "Does the amount of taining impact taining effectiveness?" but "How much taining is equied to poduce a positive effect?" One way to addess this question is to estimate the amount of taining equied to yield the mean effect size endeed by the studies in this database. This analysis indicated that the mean effect of stess inoculation taining on pefomance anxiety was obtained with a length of taining of appoximately six to seven sessions, and that the mean effect of stess inoculation taining on state anxiety was obtained with a length of taining of appoximately fou to five sessions. Futhemoe, the data indicate that, fo both pefomance anxiety and state anxiety, a single session of taining was sufficient to poduce a small-to-modeate impovement. Stess inoculation taining pactitiones caution that the amount of taining equied should be detemined by the specifics of the situationa pudent admonition. Howeve, the esults of this analysis eveal that stess inoculation taining is a elatively obust intevention. Of special inteest to those in applied taining envionments in which time and esouces ae often limited, stess inoculation taining can be implemented successfully without an inodinate amount of taining sessions. It is inteesting to note that the numbe of taining sessions did not pedict the effect of taining on pefomance. In othe wods, although stess inoculation taining had an oveall positive impact on enhancing pefomance, geate benefits did not accue fom moe taining sessions. One possible eason fo this esult stems fom the obsevation that the majoity of studies in this database emphasize the application of stess inoculation taining fo anxiety eduction; that is, the pimay oientation of stess inoculation taining is to develop coping sills fo

13 2 UNDERS, DRISKELL, JOHNSTON, AND LAS educing anxiety (see Meichenbaum & Deffenbache, 9). One indication of this is the fact that we wee able to uncove hypothesis tests of the effect of stess inoculation taining on state anxiety and only tests of the effect of stess inoculation taining on pefomance. The point is that most studies of stess inoculation taining place a geate emphasis on anxiety eduction pe se, and elatively less emphasis on enhancing tas pefomance. Accodingly, given that most taining activities in these studies ae oiented towad educing anxiety, it is not supising that the oveall effect of taining on pefomance is positive, but that moe taining does not lead to a geate enhancement of pefomance. In othe wods, educing anxiety may be a necessay but not sufficient pocedue fo impoving pefomance unde stess. Of paticula inteest to those inteested in enhancing pefomance in moe applied settings, the fact that stess inoculation taining is shown to lead to an oveall impovement in pefomance is encouaging. It suggests that stess inoculation taining inteventions that ae designed to focus moe diectly on enhancing pefomance unde stess may yield even moe positive esults. The analysis of the type of setting in which taining too place (laboatoy vs. field settings) evealed that stess inoculation taining is not a "hothouse" phenomenon. That is, the positive effects of stess inoculation taining ae not laboatoy bound but ae shown to be as stong in the field as in the expeimental laboatoy. The size of the taining goup was shown to be a significant modeato of taining effectiveness. As the size of the taining goup inceases, stess inoculation taining becomes less effective in educing state anxiety and less effective in enhancing pefomance. This phenomenon is not supising; the tendency fo lage goups to decease membes' satisfaction and motivation, and cause goup membes to feel moe anonymous and "lost in the cowd," has been well documented (see Mullen, 99). Yet, fo pactical puposes, it is valuable to note that wheeas the positive effects of stess inoculation taining on educing state anxiety and enhancing pefomance lessen with inceasing goup size, the data futhe indicate that stess inoculation taining emains effective with goups of modeate (i.e., - pesons) size. Howeve, the elationship between goup size and taining effectiveness is evesed fo pefomance anxiety: The impact of stess inoculation taining on educing pefomance anxiety inceased with inceasing goup size. Thus, the pesence of a geate numbe of othes in a taining goup tended to cause tainees to feel less pefomance anxiety. The data futhe indicate that stess inoculation taining is effective whethe taining is conducted by a moe expeienced o a less expeienced taine. In fact, less expeienced taines ae shown to be somewhat moe effective than moe expeienced taines. Howeve, in intepeting this somewhat anomalous esult, we note that most studies wee conducted unde academic auspices: Those studies coded as doctoal level o above wee most often conducted by doctoal-level faculty o a doctoal student. Those studies coded as below doctoal level wee typically conducted by a maste's student unde the diect supevision of doctoal-level faculty. Thus, within the studies in this database, the distinction between expeienced (doctoal level and above) and less expeienced taines (below doctoal level) is not substantial. The impotant message that these data eveal is that stess inoculation taining can be successfully implemented by expeienced taines and those that ae somewhat less expeienced. To paaphase an old saying: "It doesn't tae a h.d. to do it." These esults suggest the applicability of this appoach to applied settings in which doctoal-level psychologists may not be available. In summay, the esults of the analysis of modeato vaiables suggest no obvious limitations on the application of stess inoculation taining to nomal taining envionments. Results indicate that stess inoculation taining is effective fo nomal populations of tainees as well as highly anxious populations, taining can be implemented effectively in goups of modeate size and with a elatively modest numbe of taining sessions, the effects of taining ae as obust in field settings as in the laboatoy, and taining can be implemented by less expeienced as well as doctoal-level taines. Theefoe, although stess inoculation taining has been most commonly used as a clinical appoach, the esults of this analysis suppot the futhe application of this appoach in applied settings. How do we account fo the positive effects of stess inoculation taining? Stess inoculation taining is not a specific taining technique but is an integated appoach to educing stess effects. It includes thee distinct phases of taining: (a) an initial conceptualization o educational phase, (b) sills acquisition and pactice, and (c) application and follow-though. It is liely that each phase of taining contibutes to oveall taining effectiveness. One objective of the initial phase of taining is to povide infomation on the natue of the stess envionment and individual

14 STRESS INOCULATION TRAINING 3 eactions to stess. Reseach suggests that pepaatoy infomation may enable the individual to fom accuate expectations egading the stess envionment and stess eactions, incease a sense of pedictability and contol, and decease the distaction involved in attending to novel events and sensations in the stesso envionment. In a ecent study, Inzana, Disell, Salas, and Johnston (in pess) povided individuals with pepaatoy infomation befoe pefoming a stessful tas. The pepaatoy infomation descibed the stessos that would be encounteed in the tas situation, povided infomation on how these stessos might mae the paticipants feel, and povided infomation on how these stessos might affect pefomance. Results indicated that those who wee given pepaatoy infomation befoe tas pefomance made fewe eos unde stess, wee less liely to feel stessed, and wee moe confident in thei ability to pefom the tas. Duing the second phase of stess inoculation taining, tainees acquie and pactice stess management sills to educe anxiety and enhance the capability to espond effectively in the stess envionment. The type of sills taining implemented vaies accoding to the specific taining equiements, but it may often include cognitive contol o cognitive estuctuing techniques that tain the individual to egulate negative emotions and distacting thoughts (self-oiented cognitions), and elaxation taining to enhance physiological contol (i.e., awaeness and contol of muscle tension and beathing). Typically, these sills ae eheased though behavioal oleplaying o though the use of mental imagey. As demonstated in this analysis, both ae effective modes of pactice. The final phase of taining povides the oppotunity to execise tas sills in a setting that appoximates the eal-wold stesso envionment. Keinan, Fiedland, and Saig-Nao (99) have demonstated the effectiveness of gaduated taining, in which tainees ae exposed to inceasing levels of stess in a gaduated manne. Keinan and Fiedland (99) note that allowing sills pactice in a gaduated manne acoss inceasing levels of stessos (fom modeate stess execises to highe stess execises) satisfies thee impotant equiements: It allows the individual to become moe familia with elevant stessos without being ovewhelmed, it enhances a sense of individual contol and builds confidence, and gadual exposue to stessos is less liely to intefee with the acquisition and pactice of tas sills than would exposue to intense stess. Thee ae, of couse, limitations to ou analysis and to the implications that can be dawn fom it. This analysis allowed us to test seveal hypotheses egading modeatos of the effect of stess inoculation taining. These modeatos (such as the type of tainee population o goup size) wee chosen because they wee theoetically inteesting (i.e., past eseach suggested thei elationship to stess inoculation taining) and because the available empiical liteatue allowed thei examination (i.e., the infomation pesented in the studies allowed this vaiable to be coded o ated). Howeve, thee ae othe potentially infomative factos that we wee not able to examine. One inteesting question is whethe the sepaate components o phases of stess inoculation contibute diffeentially to taining effectiveness. Attempts to unavel what specific phases of stess inoculation taining ae most effective have not been conclusive (see Meichenbaum, 993). Futhemoe, thee has not been enough pimay level eseach conducted on the elative efficacy of the sepaate components of stess inoculation taining to allow a systematic analysis in a meta-analytic famewo. The question of what components of stess inoculation taining ae most effective unde what conditions deseves futhe study. Anothe modeato that we wee unable to examine is the extent to which gaduated pactice enhances taining. Gaduated pactice is descibed as a ey component of the sill pactice and application phase (see Meichenbaum, 993). Howeve, thee wee so few studies in this database that actually implemented gaduated pactice that we wee not able to examine the impact of this pocedue. Thus, in this manne, a meta-analysis may often seve to point out what eseaches do not now. The fact that we ae not able to examine the impact of gaduated pactice at the meta-analytic level suggests an aea equiing futhe eseach. Second, the studies included in this database wee limited to those that examined the use of stess inoculation taining as a stess taining intevention, and thus excluded studies of the effectiveness of stess inoculation taining fo pain toleance (ude, 9), ange eduction (Moon & Eisle, 93), o fo contolling hypetension (Amigo, Buceta, Becona, & Bueno, 99). Thee ae sepaate bodies of liteatue that deal with these cognate aeas. The esults of the cuent analysis ae limited to the effects of stess inoculation taining as an appoach fo educing anxiety and enhancing pefomance unde stess. Thid, thee ae methodological limitations of this analysis. Thee wee no studies in this database that epoted eliability coefficients fo the pefomance

15 UNDERS, DRISKELL, JOHNSTON, AND LAS measues used, so adjustments fo attenuation wee not attempted. In some liteatues in which sound eliability estimates ae available, these adjustments can pove to be quite infomative. The obseved effect size fo stess inoculation taining obtained in this analysis would be an undeestimate if in fact the pefomance estimates wee not pefectly eliable. The failue of the souce infomation to epot eliabilities fo pefomance measues is not unique to this paticula meta-analysis but epesents a common limitation of the eseach liteatue. Thee has been a gowing ecent emphasis, both fom within the pofession as well as fom outside funding agencies, on identifying efficacious psychological teatmentshow well specific teatments wo and unde what conditions they ae most effective. Results of this analysis indicate that the stess inoculation taining appoach is an effective method to educe anxiety and enhance pefomance in stessful envionments. Most of the studies included in this analysis wee conducted elatively ecently, indicating a consideable amount of cuent eseach activity in this aea. The esults of this analysis clealy encouage futhe application and eseach activity. Refeences Adams, J. (9). The stability of tait anxiety and state anxiety eactions in esponse to coping sills taining (Doctoal dissetation, Kent State Univesity, 9). Dissetation Abstacts Intenational, 2/B, 79. Altmaie, E. M., & Happ, D. A. (9). Coping sills taining's immunization effects against leaned helplessness. Jounal of Social and Clinical sychology, 3, -9. Altmaie, E. M., Leay, M. R., Halpen, S., & Selles, J. E. (9). Effects of stess inoculation and paticipant modeling on confidence and anxiety: Testing pedictions of self-efficacy theoy. Jounal of Social and Clinical sychology, 3, -. Amigo, I., Buceta, J. M., Becona, E., & Bueno, A. M. (99). Cognitive behavioual teatment fo essential hypetension: A contolled study. Stess Medicine, 7, 3-. Blacmoe, S. H. (93). A compaison of taining in stess inoculation, effective test taing techniques and study sills as teatments fo test anxiety (Doctoal dissetation, Texas A&M Univesity, 93). Dissetation Abstacts Intenational, /9A, 273. Bloom, A. J., & Hautaluoma, J. E. (99). Anxiety management taining as a stategy fo enhancing compute use pefomance. Computes in Human Behavio,, Bosmajian, C.. (9). A compaison of stess inoculation taining and stess education in the teatment of stess associated with dental pocedues (Doctoal dissetation, Viginia olytechnic Institute and State Univesity, 9). Dissetation Abstacts Intenational, 2/B,. Cohen, J. (977). Statistical powe analysis fo the behavioal sciences. New Yo: Academic ess. Coope, H. M. (92). Scientific guidelines fo conducting integative eseach eviews. Review of Educational Reseach, 2, Cadoc, C., Cotle, S., & Jason, L. A. (97). imay pevention: Immunization of childen fo speech anxiety. Cognitive Theapy and Reseach, 2, De Boe, J. B. (9). Component analysis of stess inoculation fo stess management (Doctoal dissetation, Univesity of South Daota, 9). Dissetation Abstacts Intenational, 7/2B, 7. Deffenbache, J. L. (9). Cognitive and physiological components of test anxiety in eal-life exams. Cognitive Theapy and Reseach,, 3-. Deffenbache, J. L., & Hahnlose, R. M. (9). Cognitive and elaxation coping sills in stess inoculation. Cognitive Theapy and Reseach,, 2-2. Deiis, J. G. (92). Stess inoculation taining: Effects on anxiety, self-efficacy, and pefomance in dives (Doctoal dissetation, Temple Univesity, 92). Dissetation Abstacts Intenational, /B, 33. Disell, J. E., Coppe, C., & Moan, A. (99). Does mental pactice enhance pefomance? Jounal of Applied sychology, 79, ^92. Disell, J. E., & Olmstead, B. (99). sychology and the militay: Reseach applications and tends. Ameican sychologist,, 3-. Disell, J. E., & Salas, E. (99). Goup decision maing unde stess. Jounal of Applied sychology, 7, Disell, J. E., & Salas, E. (Eds.). (99). Stess and human pefomance. Hillsdale, NJ: Elbaum. Disell, J. E., Willis, R., & Coppe, C. (992). Effect of oveleaming on etention. Jounal of Applied sychology, 77, -22. Finge, R., & Galassi, J.. (977). Effects of modifying cognitive vesus emotionality esponses in the teatment of test anxiety. Jounal of Consulting and Clinical sychology,, Foley, F. W., Bedell, J. R., LaRocca, N. G., Scheinbeg, L. C., & Reznioff, M. (97). Efficacy of stessinoculation taining in coping with multiple scleosis. Jounal of Consulting and Clinical sychology,, Foman, S. G. (9). Stess management taining: Evaluation of effects on school psychological sevices. Jounal of School sychology, 9, Foman, S. G. (92). Stess management fo teaches: A cognitive-behavioal pogam. Jounal of School sychology, 2, -7. Femouw, W. J., & Zitte, R. E. (97). A compaison of sills taining and cognitive estuctuing-elaxation fo the teatment of speech anxiety. Behavio Theapy, 9, -29. Hytten, K., Jensen, A., & Sauli, G. (99). 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