Sweat therapy
Abstract
The purpose of this study was to explore the use of group sweating as an experiential group work activity. Four boys with disruptive behavior disorders residing at a group home participated in twelve sweat therapy sessions. Measures of self-esteem, group home treatment progress, participant perceptions of therapeutic factors, and the results of a termination questionnaire are given. These results, their implications, and recommendations for future research are discussed.
Key Terms
Group Sweating is social interaction while experiencing psychophysiological reactions to heat exposure. Examples include the American Indian sweat lodge, the Finnish sauna, the Russian bania, and the Turkish hamman.
Sweat Therapy is the combination of group sweating with psychotherapy or counseling.
Sweat Therapy
The two most frequently observed diagnoses among adolescent psychiatric inpatients are conduct disorder and oppositional-defiant disorder (Horne & Sayger, 1990; Garrett & Marler, 1989; Perry, 1989; Weisz & Weiss, 1993). Often these youth present with concomitant symptoms of depression, attention-deficit with hyperactivity, and substance abuse (American Psychiatric Association, 1994). An estimated 6 to 16 percent of boys and 2 and 9 percent of girls under the age of 18 years have conduct disorder. Oppositional defiant disorder is found between 16 and 22 percent of school-age children (Kaplan, Sadock, & Grebb, 1994). The question of effective treatments for youth with conduct disorder or oppositional-defiant disorder has long been a controversial one among mental health professionals (Garrett & Marler, 1989; Gilliam, 1993; Johnson, Rasbury, & Siegel, 1986; White, 1989) partly because of the particularly challenging externalizing symptoms presented by this population (Kazdin, 1997; Offord & Bennett, 1994). These symptoms include aggression against others, destruction of property, temper tantrums, and noncompliance, to name but a few. Kaplan, Sadock, and Grebb (1994) state that no treatment is considered curative for youth with conduct disorder and they recommend that multimodality treatment programs that use all the available family and community resources are likely to bring about the best results.
In recent years, experiential group work activities have gained impressive popularity in working with youth with disruptive behavior disorders and have been found beneficial by many (Behar & Stephens, 1978; Crisp & Aunger, 1998; Kjol & Weber, 1993; Reddrop, 1997, Sachs & Miller, 1992; Tippet, 1993; Webb, 1993). Benefits frequently reported include improvements in participant’s self-esteem and interpersonal behavior (Blanchard, 1993). One of the most common forms of experiential group work activities found in mental health settings is the “ropes course” (Gilliam, 1993; Weider, 1990).
The authors’ experience investigating the American Indian sweat lodge ceremony as group therapy with Navajo youth with disruptive behavior disorders inspired this study. The authors found that the sweat lodge ceremony was highly compatible to modern group work. In addition, the practice of group sweating appears to have good potential as an experiential group work activity in working with non-American Indian youth as it provides a challenging experience while promoting therapeutic factors beneficial to group psychotherapy (Colmant & Merta, 1999).
The sweat lodge ceremony is nearly universal among American Indian tribes from coast to coast and in Alaska, across Canada and in Mexico today. Evidence of American Indians using the sweat lodge ceremony dates back as early as 400 B.C. (Quattrin & Cremin, 1988). Traditionally, the American Indians used the sweat lodge for many purposes including basic bathing, socialization, evening warmth, celebration, a cleansing of the body and mind, and preparation for war, hunting, marriage, or passage into adulthood (Quinn & Smith, 1992). Many modern American Indian treatment programs use the sweat lodge ceremony. Hall (1986), who surveyed 39 native alcohol treatment programs at random, found that half of the programs offered sweat lodge ceremonies on site or provided access to them. Navajo social service and health department agencies currently use the sweat lodge routinely for the treatment of a wide array of problems, from physical ailments to problems of adolescent delinquency and substance abuse (Colmant & Merta, 1999).
An important function of the sweat lodge ceremony is providing group counseling (Colmant & Merta, 1999). Several writers in the field have drawn similarities between modern group work and the sweat lodge ceremony (Lake, 1987; Mails, 1991; Quinn & Smith, 1992; Ross & Ross, 1992; Walkingstick-Garrett & Osborne, 1995). Colmant and Merta (1999) found that 9 of Yalom’s (1995) 11 therapeutic factors of group therapy appeared to be readily apparent in the ceremony. These factors included instillation of hope, universality, imparting of information, altruism, development of socializing techniques, imitative behavior, group cohesiveness, catharsis, and existential factors. Other therapeutic features identified as prominent in the ceremony were that the ceremony was used much like an experiential group activity, promoted moral-cognitive development, and fortified cultural identity (Colmant & Merta, 1999).
Many non-American Indian groups have also made use of the sweat lodge ceremony and it is becoming increasingly popular in mainstream culture. In their paper advocating the potentials of sweat lodges for adventure education programs, Quinn and Smith (1992) described a number of groups sponsored by various growth and educational movements of the 1980’s that used the American Indian sweat lodge experience. They explain that “sweats” were used for improving group cohesiveness and interpersonal bonding (1992). Several popular movie stars report regularly using the sweat lodge and a 1997 Newsweek article lists “de-stressing at Native American sweat lodges” as a trendy thing to do (Hamilton,1997, p. 59). A recent search on the Internet found 3659 web pages using the term “sweat lodge”. Information offered includes everything imaginable, from the history and legends of the sweat lodge to how one can participate in a ceremony or buy their own portable sweat lodge that advertises to be designed in the Native American tradition by using recycled earth friendly materials.
The problem with using the sweat lodge ceremony with non-Indians is that the sweat lodge ceremony is a sacred ritual to American Indians. In the authors’ experience, American Indian representatives require that sweat lodges be built and ceremonies be facilitated by only American Indian people qualified to do so. Many American Indian representatives strongly object to non-American Indian groups proposing to use the sweat lodge ceremony. It is such a central part of the religious beliefs of American Indians that, according to Hirschfelder and Molin (1992), “it is inconceivable that an Indian could practice his religious life in the traditional Indian way without having access to a sweat lodge” (p. 287).
Colmant and Merta (1999) recommend that what has better potential for widespread use with non-Indians, is to combine the sweating process with psychotherapy while leaving aside all other sacred ritualistic aspects of the ceremony. They go on to explain that with non-Indians, a sweat therapy session could take place in a sauna or sauna-like structure rather than a sweat lodge. Modern group work formats could be adjusted to be integrated with the sweating process to accommodate select populations (Colmant & Merta, 1999). Group sweating, while helping people relax and de-stress, also requires mental and physical fortitude. As in experiential group work, sweat lodge participants are presented with a challenging experience (enduring the intense heat in the sweat lodge) which the leader relates to their treatment. Sweat lodge leaders often reflect on the similarities between enduring the heat in the sweat lodge and enduring the daily frustrations that provoke participants identified problems. This aspect of the sweat lodge ceremony seemed specifically useful in reducing problem behaviors with youth with disruptive behavior disorders as it seemed to help strengthen frustration tolerance (Colmant & Merta, 1999).
Group sweating in many different forms has been practiced throughout the world for thousands of years. In addition to the American Indian sweat lodge, examples include the Finnish sauna, the Russian bania, and the Turkish hamman. References of group sweating have been cited as old Celtic and Teutonic practice, important in tribes of Africa, Melanasia, New Guinea, and Polynesia, and even practiced by the Aztecs (Vogel, 1970). Sweat baths were as ubiquitous to ancient Greece and Rome as movie theaters and gas stations are now (Aaland, 1997). Group sweating reached its grandest scale in ancient Rome with gigantic structures such as the Diocletian bath which had a capacity for 6,000 people. Throughout history physicians endorsed the medicinal value of the sweat bath in its various forms. The oldest known medical document, the Ayurveda, appeared in Sanskirt in 568 BC and considered sweating so important to health that it prescribed the sweat bath and thirteen other methods of inducing sweat (Aaland, 1997). Today, few modern health clubs are without a sauna or steam room.
“Sweat bathing” is the more common term used to classify different forms of activities using sweating (Aaland, 1997; Vogel, 1970). While, to bathe, is one reason many people participate in sweating activities, there are several other prominent biopsychosocial effects. In the authors’ opinion, the term “group sweating” does better to include the main elements of people sweating together which seem to be social interaction while experiencing psychophysiological reactions to heat exposure.
Sweating has three primary functions: it rids the body of wastes, regulates body temperature, and helps keep the skin clean and pliant. During a 15-minute sauna, about one liter of sweat is excreted, depending on the individual. The excretion of harmful wastes such as urea and uric acid that takes place during a 15-minute sauna would normally take the kidneys 24 hours to perform (Aaland, 1997). Some researchers claim that the rapid flexing of the heart and blood vessels in the heat of a sauna is a healthy exercise that puts little more strain on the heart than strolling on level ground (Aaland, 1997). Heat stress also causes a complex neuroendocrine response (Jezova, Jurankova, Mosnara, Kriska, & Skultetyova, 1996, cite Vigas, Kvetnansky, Jurcovicova, Jezova, & Tatar, 1984; Jezova, Vigas, Tatar, Jurcovicova, & Palat, 1985; Kauppinen & Vuori, 1986; Vigas, Martino, Bukovska, & Langer, 1988; Wittert, Livesey, Ricards, Donald, & Espiner, 1992; Jezova, Kvetnansky, & Vigas, 1994). Jezova, Jurankova, Mosnara, Kriska, and Skultetyova (1996) found that heat exposure with the use of a sauna caused a rise in cortisol levels in men and a rise in cortisol and ACTH levels in women. The splashing of water on super heated rocks in a sauna produces an abundance of negative ions (Aaland, 1997). The discovery of negative ions in saunas a few years ago became headline news in Finland. If the air is charged with too few negative ions and too many positives, we become anxious, fatigued, and tense (Aaland, 1997). Recent research has identified the blockage of positive ion build up and negative ion retention as important in the treatment of numerous psychiatric disorders (Bohus, Foerstner, Kiefer, & Gebicke, 1996; Taya & Watanabe, 1998; Watanabe, 1998). In addition, a main motive for people sweating together is socialization. Social interaction is a main objective for people using the American Indian sweat lodge ceremony (Lake, 1987; Colmant & Merta, 1999; Mails, 1991; Quinn & Smith, 1992; Ross & Ross, 1992; Walkingstick-Garrett & Osborne, 1995), the Finnish sauna (Norden & Prinz, 1986), the Russian bania, and the Turkish hamman (Aaland, 1997).
The purpose of this study was to explore sweat therapy as an experiential group work activity with non-American Indian youth with disruptive behavior disorders. In this study sweat therapy included the combination of group sweating with group counseling. Specifically investigated was the effects on self-esteem, progress in the group home throughout the treatment period, participant perceptions of therapeutic factors, and participants’ overall perceptions of the sweat therapy sessions. The identification of therapeutic factors in the authors’ 1999 investigation of the sweat lodge ceremony was the result of the authors’ experience participating in the ceremony and interviewing participants rather than the use of a more objective method of soliciting participant perceptions. To better identify which therapeutic factors may be most prominent, Colmant and Merta (1999) recommended using a more objective method such as the one pioneered by Bloch, Reibstein, Crouch, Holroyd, and Themen (1979). In this system, critical incidents reported by group members are classified into therapeutic factors.
This article is organized as follows: a method section which includes a description of the participants and treatment setting, a description of dependent measures and questionnaires employed, and a description of the sweat therapy treatment used, a results section, and a discussion section which summarizes the results, discusses their implications, and offers recommendations for future research.
Method
Participants
Families and Youth Inc. Boy’s Group Home located in Las Cruces, New Mexico comprised the group members. The group home maintains up to eight boys ranging in age from thirteen to eighteen. The boys are usually referred to the group home by social workers or probation officers as either a transitionary step down from a more intensive placement such as a detention center or residential treatment center or as a preventive measure to keep them from requiring such a placement. In terms of the Diagnostic and Statistic Manual of Mental Disorders Fourth Edition (American Psychiatric Association, 1994) the boys most commonly receive a diagnosis of one or more of the disruptive behavior disorders: conduct disorder, oppositional defiant disorder, or attention deficit hyperactivity disorder. Their IQ scores fall in the normal range. Abuse and neglect usually characterize the boy’s home lives. The length of stay at the group home ranges anywhere from a few months to several years. Although licensed as a residential treatment center, the group home provides more of a home-like setting. Treatment provided includes 24-hour supervision, a behavior management system, individual, family, and group therapy. The boys attend either public school or alternative school programs offered in the community. The study began with six boys of Anglo and/or Hispanic descent. The mean age was 15. Two boys did not complete the study due to their being discharged from the group home program before the end of the study. Another two boys who were admitted to the group home toward the end of the study participated in the last three sessions.
Measures
The measures employed in this study included the following:
1. The Coopersmith Self-Esteem Inventories (SEI) (Coopersmith, 1989);
2. The FYI Boy’s Group Home Level System;
3. A Weekly Group Response Form;
4. A Termination Questionnaire.
Self-Esteem
Self-esteem was measured by having the boy’s complete the Coopersmith Self-Esteem Inventories (SEI) School Form (Coopersmith, 1989). This self-report questionnaire consists of 58 items: fifty self-esteem items and eight items that constitute the Lie Scale. The self-esteem items yield a total score and separate scores for four subscales: General Self, Social Self-Peers, Home-Parents, and School-Academic. The subscales allow for variances in perceptions of self-esteem in different areas of experience. This study reports the total scores. Construct validity was confirmed by Kokenes (1974, 1978) and reviewed favorably by Peterson and Austin (1985). The test-retest reliability of this instrument is .80 (Bedian, Geagud, & Zmud, 1977) and .88 (Coopersmith, 1967).
The FYI Boy’s Group Home Level System
Group home treatment progress was measured using the FYI Boy’s Group Home level system. Every week each boy is assigned a level ranging from 1 - 4. The higher the level, the more privileges the youth is eligible for. The completion of personal goals, chores, and the presence or absence of exhibiting serious problem behaviors (fighting, property destruction, noncompliance, drug use, etc.) determined the youth’s level.
Weekly Group Response Form
Using a likert scale from 1 -5, the group response form first asked participants to rate how useful they found the session. Secondly, participant perceptions of therapeutic factors were identified by employing Bloch, Reibstein, Crouch, Holroyd, and Themen’s (1979) system. This involved having participants respond to the following question: “What event (incident, interaction) from this group session was most helpful to you?” “Describe what happened, the feelings you experienced, and how the event was helpful to you.” Participant statements were classified into 12 therapeutic factors: instillation of hope, universality, imparting of information, altruism, development of socializing techniques, imitative behavior, group cohesiveness, catharsis, existential factors, interpersonal learning, the corrective recapitulation of the primary family group, and experiential group work. Experiential group work was identified as a therapeutic factor for statements indicating psychological benefits received from enduring the heat. The authors classified the statements. Their percentage of agreement was 88%. The last question on the group response form asked for recommendations for changing the particular group session being considered or future ones.
Overall Perceptions of the 12 Sweat Therapy Sessions
Group participant’s overall perceptions of the twelve weeks of sweat therapy sessions were collected using a Termination Questionnaire developed by the authors. This questionnaire contained nine items and was administered orally. The first question again employed the Bloch et. al. (1979) system for identifying participant perceptions of therapeutic factors as used on the group response form. Participants were also asked to rate the overall value of participating in the sweat therapy group, rate the value of having to endure the heat, rate the value of interacting with male counselors and other boys, rate the value of discussing the first round topic: overall weekly summary, the second round topic: weekly progress in the program, the third round topic: family concerns and discharge plans, and the fourth round topic: open discussion. Lastly, participants were asked to rank order the four kinds of topics discussed.
Data Collection Procedures
The boys completed the Coopersmith Self-Esteem Inventories (SEI) both before the 12 week treatment course and after. Group home staff administered the SEI. Administration time was thirty minutes. The group home staff determined the boys levels each week as part of their weekly staff meeting. The boys completed the weekly group response form after each sweat therapy session. The first author administered the termination questionnaire orally at the completion of the treatment course.
Treatment
The sessions were held in a sauna at a local health club. To obtain the use of a sauna the authors sent letters to two health clubs and informed the club owners about Families and Youth, Inc., the group home, and a description of the research project. We first asked that the health clubs donate the use of their saunas in exchange for a tax deduction. The owner of one health club expressed an interest in working out an agreement but did not view a tax deduction as beneficial. Our agreement was the use of the sauna for two hours for twelve consecutive Sundays when the club was usually closed in exchange for a fee of $5.00 per person plus a $5.00 group fee for towels per session. It was important to the club owner to be provided with a copy of Families and Youth, Inc. professional liability insurance and to be assured that any harm caused by our treatment procedures was not the responsibility of the health club.
Once a week for twelve weeks the boys participated in a sweat therapy session. The temperature of the sauna was 130 Farenhieght. The particular sauna used was a wet sauna so it was also very humid. Sessions began including four, five minute intervals in the sauna with three, three minute breaks. Gradually, the group worked up to completing five, ten minute intervals in the sauna. The intervals in the sauna were referred to as rounds. The counselors encouraged the boys to take breaks whenever they felt it necessary, however, after the first few sessions a member taking a break during a round was rare. Each round focused on a particular topic. Generally, in the first round the boys were asked to give an overall summary of how their week went. The second round focused on progress in the program for that week by discussing level system status. The third round focused on family concerns and discharge plans. In the fourth round the counselors facilitated an open discussion. In addition, the group aided each boy in developing a personal goal related to treatment. For example, one boy who had frequent conflicts with peers due to his irritating them with his constant hyperactive and impulsive behavior, developed a goal of improving his interactions with others by listening better, not arguing, and behaving in a more mature manner.
Results
Self-Esteem using the Coopersmith Self-Esteem Inventories
The mean scores for the SEI have generally been in the range of from 70 to 80 with a standard deviation of from 11 to 13 (Coopersmith, 1989). Table 1 shows the pre-test total score and post-test total score for each boy. As shown, all of the scores were within the average range. Three of the four boys showed an increase in self-esteem scores at the end of the twelve sessions. One boy’s improvement closely approached one standard deviation above the mean. For the boy who showed a two point decrease, it is important to note that his lie scale score decreased 57% at post-test. This suggests that he became more open and less defensive in his responses.
Group Home Treatment Progress using a Level System
On average, the boys progress on the level system through the twelve week period showed gradual improvement through weeks one through four, peaked within weeks five through eight, then leveled off and began to come down slightly within the last few weeks. Figure 1 shows the average level the boys were on for each four week period. All of the boys showed a trend similar to the one shown in figure 1. None of the boys averaged lower than level 2 or higher than 3.75 for any of the four week periods shown. The problem behaviors most often associated with the dropping of a boy’s level were the failure to complete chores and acting defiant toward staff.
Perceptions of Therapeutic Factors using a Weekly Group Response Form
In terms of usefulness, the boys’ average rating of the sweat therapy sessions was a 4 on a scale of 1-5, 1 indicating that they strongly disagree that the session was very useful and 5 indicating that they strongly agree that the session was very useful. The boys who did not complete the full twelve weeks of sessions also rated the sessions as very useful. Their average rating of the usefulness of the sessions was also a 4. Of the 32 group forms contributed by group participants, 10 could not be classified for therapeutic factors. An analysis of the remaining 22 group forms revealed that the group participants identified the following factors as helpful most often: experiential group work (tie), catharsis (tie), and universality. In the early sessions (1-6) catharsis and universality received the highest rankings. In the late sessions (7-12) experiential group work and catharsis received the highest rankings. The psychological benefits most often reported as received from enduring the heat were to relax and relieve stress. Frequent recommendations to improve sessions included that participants be able to lift weights before sessions, to increase the frequency and duration of sessions, and to incorporate music.
Overall Perceptions of the Sweat Therapy Sessions using a Termination Questionnaire
When asked to identify the event, activity, or person’s comments during the 12 weeks that was most helpful the boys stated the following:
Boy #1
“The sweating. It made my mind stronger. I didn’t think I could do it but I did it. Also, I got things off my chest.” The authors judged this response to reflect the benefits of experiential group work and catharsis.
Boy #2
“Talking with Rod (second author) and observing how he interacted with the other boys. He was a good role model. The most important message he gave me was to lighten up and be myself.” The emphasis on modeling in this statement resonates of imitative behavior.
Boy #3
“The day I ended up storming out of the group. Afterwards I was calm and not as tense. Through that session I learned that a lot of times when I’m trying to make things better, I’m actually making it worse by annoying others.” The experience of catharsis and insight described here in which this boy alludes to being the result of receiving negative feedback from others reflects the benefits of interpersonal learning.
Boy #4
“To regularly review the topics of discussion in the first three rounds.” Boy #4 recommended that sessions would be better if there were more rounds or if the rounds were longer. Although this boy might have been touching on several therapeutic factors, there is not enough information in this response to classify it.
On a scale of 1-5, 1 being poor and 5 being excellent, the boys’ average rating of the overall value of participating in the sweat therapy group was a 4.3. The average rating of the value of having to endure the heat in the sweat therapy group was a 4.8. When asked to explain how enduring the heat was helpful, the boys stated the following:
Boy #1
“It made my mind stronger. I didn’t think I could do it but I did it.”
Boy #2
“It was challenging. It made me feel as if I had accomplished something worthwhile.”
Boy #3
“It helped me to be able to control myself when things are bothering me. Lets say I’m angry about something. Well, I can make myself not get upset.”
Boy #4
“The heat relaxed my body and muscles. I felt a lot of stress come out of me and then I felt good when I came out.”
The average rating of the value of interacting with male counselors and other boys in the sweat therapy group was a 4.3. When asked to explain the boys stated the following:
Boy #1
“Talking to the counselors was more helpful. The boys talk about less serious stuff.”
Boy #2
“Interacting with the male counselors was more helpful because they were better listeners (than the other boys) and interacted in a more mature manner.”
Boy #3
“Helped us relieve stress by getting things off our chest. If group home staff came we would have been much more closed.”
Boy #4
“Interacting with the counselors was more helpful. I could talk more serious to the counselors and they were more respectful.”
The average rating of the value of discussing the first round topic: “overall weekly summary” in the sweat therapy group was a 5. The average rating of discussing the second round topic: “weekly progress in the program” was a 4. The average rating of discussing the third round topic: “family concerns and discharge plans” was a 3.8. The average rating of the fourth round topic: “open discussion” was a 4.5. When asked to rank order the four kinds of topics discussed, “overall weekly summary” was liked best. “Open discussion” came in second. “Weekly progress in the program” and “family concerns/discharge plans” were tied for third place.
Discussion
This study serves as an initial inquiry into the use of combining group sweating with group counseling. In this study four boys with disruptive behavior disorders residing at a group home participated in twelve sweat therapy sessions. Specifically investigated was the effects on self-esteem, progress in the group home throughout the treatment period, participant perceptions of therapeutic factors, and participants’ overall perceptions of the sweat therapy sessions. The absence of a control group and the small number of participants limit the strength of conclusions that can be made from this study.
In summary, the participants in this study viewed the sweat therapy sessions as a positive experience and reported that the sessions were useful to them to share personal concerns and receive assistance with problem solving. Three of the four boys showed improvement in measures of self-esteem at the end of the treatment course. Treatment progress in the group home remained stable throughout the sweat therapy treatment period. The boys identified experiential group work, catharsis, universality, imitative behavior, and interpersonal learning as being prominent therapeutic factors within the sessions. The boys viewed enduring the heat very positively as they made statements indicating that doing so left them with a feeling of accomplishment and improved their frustration tolerance. They also reported that the sweating process helped them relax and relieve stress. The counseling format that the boys reported to be most useful was to ask them to discuss a summary of their week and the facilitation of an open discussion.
A noteworthy difference between sweat therapy and experiential activities such as ropes is that in ropes, processing mainly takes place after the challenging activity and in the sweat therapy sessions, processing took place during the challenging activity. In ropes, therapist facilitated processing typically takes place initially with goal-setting and presentation of activities, immediately after an activity in the form of debriefing, and at the end of the session to provide consolidation of learning, evaluation of the group, and closure (Blanchard, 1993). In the sweat therapy sessions, therapist facilitated processing took place while the participants faced the challenging activity of enduring the heat. This provided the opportunity for the therapist and other group members to better enter into an individual’s psychology while they struggled. This opportunity can be especially advantageous when working with youth who often minimize, deny, or have poor insight. For example, a question stated in the present tense such as, “What are you thinking about right now?” often produces more elaborate information than one asked in the past tense. Few rigorous physical activities are conducive to therapist facilitated processing while an individual is engaged in the activity due to the individual’s attention being required to safely perform the necessary movements.
Group processing while enduring the heat of the sauna may also have a desensitization effect. In the sauna the boys became flooded with psychophysiological reactions which they often respond to with problem behaviors. The boys’ physiological reaction to the heat of the sauna was likely similar to the state they were in when acting-out: their body temperature rose, their heart rate increased, and they were sweating. They were also likely to have been engaging in negative self-talk with thoughts like, “I can’t stand it anymore!”. It seems meaningful that sweat therapy encourages participants to be more insightful, problem solve, and be more prosocial while in a physiologically escalated state. In addition to adolescents with disruptive behavior disorders, this aspect of sweat therapy could prove very useful in working with other populations such as, domestic violence batterers and those with anxiety disorders.
An advantage to group sweating being a strenuous physical activity that does not require movement is that many people often excluded from participating in activities like ropes, rock climbing, or backpacking because of ambulatory problems could participate in sweat therapy. Heart problems and acute respiratory diseases are of the few conditions that might make intense sweating medically contraindicated.
Group sweating is a relatively safe and healthy form of exercise used throughout the world for thousands of years for the promotion of physical and mental health. The results of this initial inquiry indicate that combining group sweating with group counseling appears useful as an experiential group work activity. In addition, sweat therapy seems to offer some advantages over other commonly used experiential group work activities such as, by offering more opportunity for therapist facilitated processing while engaged in a physically challenging activity and by accommodating a wider range of physical ability. Other variables that should be investigated include the effects of differences in temperature and humidity. In addition to the use of control groups and a larger number of participants, future studies should also consider comparing other forms of experiential group work activities to sweat therapy such as ropes courses.
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