Sweat Therapy: Effects on Group Therapeutic Factors and Feeling States
Although separated by oceans, continents and millennia, people have used group sweating for common purposes including physical and mental health, spirituality, and close interpersonal interaction. The use of a sauna offers the most practical means of group sweating for developing sweat therapy as a counseling technique as high quality saunas have been manufactured on a large scale for international use for several generations. Although there is a lack of a coherent, solid accumulation of knowledge concerning the psychological effects of sweating procedures, there have been some interesting findings regarding sweating and psychological well-being that have important implications for therapeutic and preventive mental health purposes. These findings include that sweating promotes positive effects on sleep (Putkonen & Elomma, 1976), mood and affect (Kuusinen & Markuu, 1972; Frankva and Franek 1990), and on hyperactivity, specifically for people with anorexia nervosa (Gutierrez, Vazquez, & Boakes, 2002). One of the most consistent descriptions is that sweating facilitates relaxation and stress relief (Colmant & Merta, 2000; Gutierrez, Vazquez, & Beumont, 2002; Sorri, 1988; and Sudakov, Sinitchkin, & Khasanov, 1988).
Stephen Colmant, Carrie Winterowd, Allen Eason, Chris Cashel, Sue Jacobs
Introduction
Sweating practices have been used throughout the world to help people gain more physical, mental and spiritual health. Examples of different forms of group sweating include the American Indian sweat lodge ceremony, the Finnish sauna, the Russian bania, the Jewish shvitz, the Islamic hammam, and the Japanese mushi-buro. References to group sweating have been cited as old Celtic and Teutonic practices, important in tribes of Africa, Melanasia, Australia, New Guinea, Polynesia, and was a central practice to the Greeks, Romans, and Aztecs (Vogel, 1970). Today, few modern health clubs are without a sauna or steam room. Bikram Yoga, which combines group sweating with yoga, is becoming increasingly popular and can be found available across the U.S. (McGrane, 2002).
Although separated by oceans, continents and millennia, people have used group sweating for common purposes including physical and mental health, spirituality, and close interpersonal interaction. The use of a sauna offers the most practical means of group sweating for developing sweat therapy as a counseling technique as high quality saunas have been manufactured on a large scale for international use for several generations. Although there is a lack of a coherent, solid accumulation of knowledge concerning the psychological effects of sweating procedures, there have been some interesting findings regarding sweating and psychological well-being that have important implications for therapeutic and preventive mental health purposes. These findings include that sweating promotes positive effects on sleep (Putkonen & Elomma, 1976), mood and affect (Kuusinen & Markuu, 1972; Frankva and Franek 1990), and on hyperactivity, specifically for people with anorexia nervosa (Gutierrez, Vazquez, & Boakes, 2002). One of the most consistent descriptions is that sweating facilitates relaxation and stress relief (Colmant & Merta, 2000; Gutierrez, Vazquez, & Beumont, 2002; Sorri, 1988; and Sudakov, Sinitchkin, & Khasanov, 1988).
Sweating practices cause several prominent acute physiological effects that have many health benefits and few risks. Hannuksela and Ellahham (2001) completed a meta-analysis using 271 studies completed in the last forty years to examine the physiological effects of sauna bathing. The acute physiological effects include an increase in skin and rectal temperature, sweating, skin blood flow, heart rate, cardiac output, cardiac stroke volume, and systolic blood pressure; and a decrease in diastolic blood pressure, and blood flow to internal organs and muscles. Sauna use activates the sympathetic nervous system, the rennin-angiotensin-aldosterone system, and the hypothalamus-pituitary-adrenal hormonal axis. Many hormonal changes have been identified as occurring during sauna use, however, these changes reportedly return to normal levels within a few hours and there are no permanent effects (Hannuksela & Ellahham).
Sauna bathing is beneficial for the prevention and treatment of some lung, heart, and skin problems (Hannuksela & Ellahham, 2001). In their investigation of sauna on lifestyle-related diseases, Biro, Masuda, Kihara, and Tei (2003) found that repeated sauna therapy improves vascular endothelial function and reduces body weight and suggest that sauna may prevent atherosclerosis. It promotes deeper sleep, pain relief, muscle relaxation, and has been helpful in treating insomnia, arthritis, and as an adjunct to cancer treatment (Berger & Rounds, 1998). However, sauna is contraindicated during high-risk pregnancies and for patients with unstable angina pectoris, recent myocardial infarction, severe aortic stenosis, decompensated heart failure, and cardiac arrhythmia (Hannuksela & Ellahham, 2001).
While a substantial amount of research on the physiological effects of sweating exists, research attempting to measure the psychological effects of sweating is rare, especially when it comes to randomized controlled studies (Colmant, 2005). The majority of this research has been descriptive and almost entirely focused on the Finnish Sauna. In one of the larger studies (N = 100), Frankva and Franek found that sweating resulted in improvements in mental satisfaction, energy, relaxation, frustration, and anxiety. Although there is a lack of a coherent, solid accumulation of knowledge concerning the psychological effects of sweating procedures, there have been some interesting findings regarding sweating and psychological well-being that have important implications for therapeutic and preventive mental health purposes. These findings include that sweating promotes positive effects on relaxation and stress relief (Colmant & Merta, 2000; Covalt, 1954; Frankova & Franek, 1990 ; Sorri, 1988; and Sudakov, Sinitchkin, & Khasanov, 1988), sleep (Kuusinen & Markuu, 1972), mood (Sudakov, Sinitchkin, & Khasanov, 1988), and is beneficial to women with anorexia by reducing hyperactivity, (Gutierrez, Vazquez, & Beumont, 2002).
Results from preliminary research with combining group counseling with group sweating have been positive, however, as is true with the great majority of the research on the psychological effects of sweating, there is a strong need for replication. To date, only one randomized controlled study has investigated the baseline effects of combining group sweating with group counseling on interpersonal and intrapersonal outcomes. Colmant, Eason, Winterowd, Jacobs, & Cashel investigated the effects of sweat therapy on group dynamics and affect (2005). Group sweating appeared to accelerate and intensify group counseling processes (2005). Overall, the investigators found that sweat group participants reported more therapeutic factors that had an impact on their group counseling experience, rated sessions as more beneficial, and interacted with stronger group cohesion than non-sweat participants. Therapeutic factors in sweat groups were greater in terms of overall frequency and in the quality of process variables compared to non-sweat groups by self-report and observational measures.
The present study attempts to replicate the Colmant et al. (in press) pilot study on the effects of sweat therapy on group therapeutic factors and feeling states with a larger sample (N = 85), better control including comparable session times between sweat and non-sweat groups, and a more effective measurement strategy by including more sensitive and comprehensive measures and a repeated measures design (pre – during –post – 2 hr post –next day post) with feeling state measures.
The primary purpose of this study was to examine the efficacy of sweat therapy as a group counseling technique by investigating the effects of sweat therapy on group therapeutic factors with a group of college students. The second purpose of this study was to explore the effects of sweat and non-sweat group counseling conditions on feeling states to investigate one aspect of how group sweating functions.
Methodology
The 85 participants were randomly assigned to one of two conditions: (a) Sweat group: Group counseling in a sauna; or, (b) Non-sweat group: Group counseling in a standard office setting. The twelve groups included; four coed sweat groups, one men’s sweat group and one women’s sweat group matched by four non-sweat coed groups, one men’s non-sweat group and one women’s non-sweat group.
The groups met weekly for six sessions. The groups were facilitated in the form of Yalom (1995) interpersonal process groups with a focus on the here-and-now and member-to-member interactions. The use of group sweating differed from what is traditionally considered a technique or structured exercise. For the sweat groups, the heat was used as a medium for interpersonal process. We did not use the sweating experience as a leader directed activity to guide individual members to respond in a particular way. The sweat groups were held at a YMCA or health club in the local community. The temperature in the sauna was 145 Fahrenheit. The non-sweat groups were held at a university counseling psychology clinic.
Measures used in this study included an informed consent form, an intake form, the Critical Incidents Questionnaire (CIQ), the Therapeutic Factor inventory (TFI), the Exercise Induced Feeling Inventory (EFI)and the Subjective Exercise Experiences Scale (SEES). The CIQ was administered at the end of each of the six sessions. The TFI was administered as a post-test at the end of the last session. There were five administrations of the EIFI and the SEES at the fourth session: just before the session began (pre-test), 45-minutes into the session (during), at the end of the session (post), two-hours after the session (2-hours post), and the next day (next day post).: PRE, DURING, POST, 2-HR POST, NEXT DAY POST.
Results and Discussion
Overall, the sweat therapy groups appeared to have greater therapeutic quality compared to the non-sweat groups as measured by direct and indirect assessment of participants’ perceptions of their experience and by practical variables. Sweat therapy group participants perceived a greater availability of therapeutic factors, reported sessions to be more useful, and had less absenteeism and group dropouts than non-sweat group counseling participants. See figures 1 – 5. Secondly, participants in these two conditions appeared to differ with regard to their feeling states of fatigue, revitalization, and physical exhaustion two-hours following the group intervention. In particular, sweat participants, on average, felt less fatigued, more revitalized, and less physically exhausted two hours following the group experience compared to non-sweat participants. See figures 6 – 8.
This study contributes to the evidence needed to determine whether group sweating should be added to standard psychological practice. People are primed to receive benefits from group sweating on multiple levels. The results of this study provide empirical support for the theory that sweat therapy enhances the quality of group process and is a useful medium for group work. This study also adds to our understanding of how group sweating operates by specifically implicating improved feeling states (less fatigue, less physical exhaustion & revitalization) lasting several hours. At this point, a priority for future research should be to explore the use of sweat therapy with specific group populations and issues. Trying to understand the full effects of group sweating, the underlying mechanisms and why this practice remains central to many cultural groups, promises critical insight into multiple psychological, biological and sociological areas of knowledge.
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