Sweating Might Be Good for the Mind

TORONTO, Aug. 18 (UPI) -- Having a bad day with your co-workers? Feeling the blahs? Maybe you need to sweat out your problems -- with friends or colleagues.

Since ancient times, people have climbed into saunas, sweat lodges or related facilities to endure high heat. Now researchers at Oklahoma State University suggest sweat therapy might be an effective way to improve mental well-being.

"The heat of a sauna or sweat lodge is a dynamic force," researcher Stephen Colmant, a doctoral candidate at the university in Stillwater, told United Press International. "Group sweating has had a central place in societies throughout the world for thousands of years in helping people gain more physical, mental and spiritual health."

Ancient Romans built gigantic structures such as the Diocletian bath, which could accommodate 6,000 people at a time, Colmant said. Archeologists have found Mayan sweat houses dating circa 900 BC.

Evidence of communal sweat lodge ceremonies dates to 400 BC among Native Americans. There are references to group sweating in old Celtic and Teutonic groups, and the practice of group sweating is found associated with the Jewish shvitz and the Islamic hammam. Turkish baths and Russian bania also number among cultural sweat houses and tribes in Africa, Melanesia, Australia, New Guinea and Polynesia also partake in group sweating.

Reporting at the annual meeting of the American Psychological Association, Colmant said he and his colleagues examined the way 24 participants recruited from a college undergraduate class responded to counseling along with group sweat therapy in a sauna that reached 145 degrees Fahrenheit. They compared the subjects with students who received counseling only.

Overall, Colmant said, the participants who underwent sweat therapy reported more relaxation, stress relief and a feeling of accomplishment from sweating it out. Although the number of participants was small, he said the sweating group found the counseling more beneficial than those who just received counseling. The sweaters also characterized their group interactions better than the counseling-only group.

"Near the end of their 40-minute sauna sessions, there was a lot of group interaction in the sweat therapy groups," Colmant said. He suggested the shared ability to endure the heat somehow opened the participants' desire to interact with others who had gone through a similar ordeal. The participants filled out several questionnaires and psychological tests to assess their mental state.

The students attended eight weekly sessions of either sweat therapy or traditional counseling. Those who went into the sauna spent 10 minutes in the heat, then five minutes outside. Overall, each weekly session included four 10-minute periods in the chambers.

Although the participants -- 12 men and 12 women -- were permitted to leave the chamber if they felt ill, Colmant said no one sought relief from the heat prematurely.

"It is difficult to draw any generalities from such a small pilot study," said Maria Newton, assistant professor of exercise and sport science at the University of Utah in Salt Lake City.

"However, this is an interesting study," Newton, a sports psychologist, told UPI. "It does suggest that there is an impact on a person's mental well-being that occurs with physiological changes. Not many studies have looked at this," she added.

"The health benefits of group sweating appear to be a main reason for its popularity," Colmant said, adding researchers have cited healthier-looking skin, deeper sleep, pain relief, muscle relaxation, and arthritis relief as physical benefits of sweating practices.

Colmant said he hoped his preliminary research would prompt more extensive studies of sweat therapy's impact on the psychological needs of individuals.

Copyright 2003 by United Press International.
All rights reserved.

Sweat Therapy Heals Traditionally

Sweat Therapy Heals Traditionally
By Stephen Colmant

Driving between Gallup and Shiprock on Highway 666 into the Navajo reservation, I was full of anticipation. I just graduated with my master’s degree in counseling and was ready to apply my psychotherapy skills at my new job at a treatment center for Navajo boys. After a few months at the job, my excitement turned to frustration and self-doubt as I found my Western therapy techniques ineffective. I was doing more limit-setting and crowd control than psychotherapy. Then, a Navajo traditional healer took me to a sweat lodge ceremony.

After the leader ordered that the door flap be dropped, plunging the group into darkness, he said that the purpose of the first round was to pray or meditate for resolving a personal problem or bettering oneself in general. He then poured a special mixture of water and herbs over the heated rocks. Hissing blasts of hot steam filled the darkened lodge and I experienced my first real world lesson in psychotherapy – Navajo style. Following that initiation, I incorporated the sweat lodge ceremony as a weekly practice at the treatment center and the positive affect on the boys was dramatic.

After I left the Rez, I missed the sweat ceremonies. I also thought my clientele at that time -- youth coming out of detention centers and psychiatric hospitals -- could benefit from the ritual. So, I made a deal with a local gym owner to use his sauna and created my own sweat therapy sessions. Now, I’m a second-year, doctoral student and leader of a team at Oklahoma State University Counseling Psychology Department researching sweat therapy.

Sweating as a physical and mental cleansing ceremony is an ancient practice. Most Westerners are familiar with the physical benefits of a sauna such as improved cardio functioning, purifying the body of toxins and keeping the skin healthy. Few understand that there are also psychological benefits. The American Indian sweat lodge, Finnish sauna, Russian bania, Jewish shvitz and Turkish hamman are international forms of sweat therapy. One would be hard pressed to find a culture or era in which group sweating was not a common practice.

Michael Winkelman, an anthropologist from the University of Arizona, asserts that the universality of basic experiences related to shamanism, like group sweating, illustrates that these practices are not strictly cultural but have psychobiological features. The practices are significant in that they promote socialization, elicit altered states of consciousness and have contributed to the evolution of society and consciousness.

People often report that a good sweat session helps them relax and de-stress. Research is showing that the effects on sleep, availability of negative ions and neuroendocrine response produced by sauna affect not only stress management but also psychiatric disorders. A fundamental way our brains function is through the attraction and repulsion of negative and positive ions. The splashing of superheated rocks in a sauna or sweat lodge produces an abundance of negative ions, which promote feelings of refreshment and well-being as well as improved work efficiency. If air is charged with few negative ions and too many positives, humans become anxious, fatigued and tense. The blockage of positive ion build-up and retention of negative ions have long been identified as important in the treatment of numerous psychiatric disorders.

Studies by M.I Hannukesela and S. Ellahham, published in The American Journal of Medicine [110,118-126], indicate that saunas activate the sympathetic nervous system, the rennin-angiotensin-aldosteronesystem and the hypothalamus-pituitary-adrenal hormonal axis. This causes releases of hormones including adrenocorticotropic, aldosterone, angiotensin II, argininevasopressin, atrial natriuretic peptide, beta-endorphin, cortisol, epinephrine, glucose, growth hormone, norepenephrine, prolactin, renin activity, thyroid and thyroid-stimulating. These increases return to normal within a few hours and have no permanent effects.

Sweat lodges also improve sleep. In research comparing sleep-EEGs, post-sauna sleep was deeper producing 72 percent more deltawave sleep than in control recordings.

Anger management is facilitated by sweat therapy. It has been shown to cause desensitization to states associated with aggression and anxiety. For people with anxiety or anger behavior, over-reacting to one’s physiological response to provoking stimuli is a key part of the problem. The heat of a sauna or sweat lodge is a dynamic force. For the first 10 minutes, the average participant will likely experience the heat as pleasurable but this will gradually change to an effort of endurance as time passes. When the experience changes to an effort of endurance, those with problems of frustration tolerance will be especially challenged. Similarities between anxiety/anger provoking situations and sauna are that body temperature rises, heart rate is increased, sweating is induced and negative self-talk begins. Learning to cope with the sweat induced state seems to help with control in anger situations. One aspect of sauna use that makes it a good match with counseling is that the activity allows a therapy session to be conducted while participants face the challenge of enduring the heat. Being an intense physical activity that does not require movement, sauna may be especially useful to those with physical disabilities. However, it is physically dangerous for those with acute heart and respiratory problems to take part in sweat therapies.

Studies have long shown that the psychological effects of sweat ceremonies are particularly conducive to the goals of group therapy. The process seems to promote interpersonal bonding and personal disclosure. People are less defensive and open up more in a sauna than in a standard office setting.

A sweat session is a traditional way to mark the beginning or completion of a personal journey such as starting a new health regimen or other personal commitments to change. Basic instructions on how to use a sauna are usually posted in most fitness centers. Shower-up, have plenty of water on hand and do about four, 10- to 15-minute intervals in the sauna with about a five-minute break between each sweat session. Develop your own ceremony by adding music, aromatherapy, meditation or prayer. Sit back and relax, get into the heat and go off into your altered state of consciousness seeking the ancient wisdom of your ancestors in the primordial womb of the sweat lodge.

Stephen Colmant, MA, LPC is a second year doctoral student in counseling psychology and licensed counselor at Oklahoma State University. He has several publications and national presentations on using sweat therapy as a counseling technique.



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SWEAT CEREMONIES
American Indian sweat lodge ceremonies are sacred gatherings. No matter how authentic the session, for non-Indians to conduct such ceremonies and charge a fee is tantamount to someone dressing up like the Pope and charging admission to a church service. The following are some respectful options to go sweat.

Breitenbush Hot Springs
Oregon
503-854-3314
Nestled in the Oregon Cascade Mountains, Breitenbush has monthly sweat lodge ceremonies. Following tradition, there is no charge but participants are asked to bring gifts or contribute to cover the costs of wood and caring for the leaders.

Seven Circles
Richmond, Calif.
510-236-3512; www.sevencircles.org
Fred Wahpepah, a Kickapoo and Sac-and-Fox elder, is providing an opportunity for people to participate in traditional ceremonies such as the sweat lodges and sacred pipe, without charge.

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.





References
Aaland, M. (1997). Sauna and Health. In Sweat [On-Line]. Available: www.cyberbohemia.com
Bedian, A. G., Geagud, R. J., and Zmud, R. W. (1977). Test-retest reliability and internal consistency of the short form of Coopersmith’s Self-Esteem Inventory. Psychological Reports, 40 1041-1042.
Behar, L., & Stephens, D. (1978). Wilderness camping: An evaluation of a residential treatment program for emotionally disturbed children. American Journal of Orthopsychiatry, 48, 644-653.
Blanchard, C. W. (1993). Effects of ropes course therapy on interpersonal behavior and self-esteem of adolescent psychiatric inpatients. Unpublished doctoral dissertation, New Mexico State University, Las Cruces.
Bloch, S., Reibstein, J., Crouch, E., Holroyd, P., & Themen, J. (1979). A method for the study of therapeutic factors in group psychotherapy. British Journal of Psychiatry, 134, 257-263.

Bohus, M., Foerstner, U., Kiefer, C., & Gebicke, P. (1996). Increased sensitivity of the inositol-phospholipid system in neutrophils from patients with acute major depressive episodes. Psychiatry Research, 65, 1, 45-51.
Colmant, S. A. and Merta, R. J. (1999). Using the sweat lodge ceremony as group therapy for Navajo youth. The Journal for Specialists in Group Work 24, (1) 55-73.
Coopersmith, S. (1967). The Antecedents of Self-Esteem. Palo Alto, CA: Consulting Psychologists Press, Inc.
Coopersmith, S. (1989). Self-Esteem Inventories. Palo Alto, CA: Consulting Psychologists Press, Inc.
Diagnostic and Statistical Manual IV (1994). American Psychiatric Association. Washington, D.C: American Psychiatric Association.
Garrett, C. J., & Marler, B. K. (1989). Conduct-disordered children and adolescents. In R. D. Lyman, S. Prentice-Dunn, & S. Gabel (Eds.) Residential and inpatient treatment of children and adolescents (pp. 289-304). New York: Plenum Press.
Gass, M. A. (1993). Adventure Therapy: Therapeutic applications of adventure programming. Dubuque, Iowa: Kendal/ Hunt.
Gilliam, N. (1993). What happens when ropes courses move from the woods to psychiatric treatment facilities? In M. A. Gass(Ed.), Adventure therapy: Therapeutic applications of adventure programming (pp. 209-216). Dubuque, IA: Kendall-Hunt.

Hall, R. L. (1986). Alcohol treatment in American Indian populations: an indigenous healing treatment modality compared with traditional approaches. Alcohol and Culture, 19, 171-175.
Hamilton, K. (1997, July 21). Blowing smoke. Newsweek, 54- 60.
Hirschfelder, A. and Paulette, M. (1992). The Encyclopedia of Native American Religions. New York, NY: Facts On File.
Horne, A. M., & Sayger, T. V. (1990). Treating conduct and oppositional defiant disorders in children. New York: Pergamon Press.
Jezova, D., Jurankova, E., Mosnarova, A., & Kriska. (1996). Neuroendocrine response during stress with relation to gender differences. Acta-Neurobiolagiae-Experimentalis,56, 3, 779-785.
Johnson, J. H., Rasbury, W. C. , & Siegel, L. J. (1986). Approaches to child treatment: Introduction to theory, research, and practice. New York: Pergamon.
Kaplan, H., Sadock, B., & Grebb, J. (1994). Synopsis of psychiatry. Baltimore, Maryland. Williams & Wilkins.
Kazdin, A. E. (1997). Practitioner review: Psychological treatments for conduct disorder in children. Journal of Child Psychology and Psychiatry, 38, 161-178.

Kjol, R., & Weber, J. (1993). The 4th fire: Adventure-based counseling with juvenile sex offenders. In Gass, A.M. (1993). Adventure Therapy: Therapeutic applications of adventure programming (pp. 23-157). Dubuque, Iowa: Kendal/Hunt.
Kokenes, B. (1974). Grade level differences in factors of self-esteem. Developmental Psychology, 10, 954-958.
Kokenes, B. (1978). A factor analytic study of the Coopersmith Self-Esteem Inventory. Adolescence, 13, 149-155.
Lake, R. G. (1987). The sweat lodge: An ancient medicine for modern sickness. Mesa, AZ: Self Discovery Magazine 6-22.
Mails, T. (1991). Fool’s Crow: Wisdom and power. Tulsa: Council Oak Books.
Norden, G., & Prinz, M. (1986). “Sauna Culture” in Austria: Toward a sociology of the sauna and its users. Journal-fur- Sozialforschung, 26, 2, 160-178.
Offord, D. R. & Bennett, K. J. (1994). Conduct disorder: Long-term outcomes and intervention effectiveness. Journal of the American Acadamy of Child and Adolescent Psychiatry, 33 1069-1078.
Perry, R. (1989). The medical inpatient model. In R. D. Lyman, S. Prentice-Dunn, & S. Gabel (Eds.), Residential and inpatient treatment of children and adolescents (pp. 61-79). New York: Plenum Press.

Peterson, C. and Austin, J. T. (1985). Review of Coopersmith Self-Esteem Inventories. In Mitchel, J. V. (Ed.). (1985). The Ninth Mental Measurements Yearbook (Vol.1). Lincoln, NE: The University of Nebraska Press.
Quatrin, D. W. and Cremin, W. M. (1988). A possible sweatlodge at the Schilling site (20KZ56), Kalamazoo county, Michigan. Midcontinental Journal of Archeology, 13, (1) 29-39.
Quinn, W. J., & Smith, T. E. (1992). The sweat lodge ceremony in challenge/adventure programming. Proceedings of the International Conference of the Association for Experiential Education 20th, Banff, Alberta, Canada.
Rohnke, K. (1984). Silver bullets:A guide to initiative problems, adventure games, stunts and trust activities. Hamilton, MA: Project Adventure.
Ross, J., & Ross, J. (1992). Keep the circle strong: Native health promotion. Journal of Speech and Language Pathology and Audiology, 16, 291-302.
Taya, K., & Watanabe, Y. (1998). Neuro-regulational therapy for neuropsychiatric diseases using Ca-super(++) antagonists. Human Psychopharmacology Clinical and Experimental, 13, 6, 389-405.

Tippet, S. (1993). Therapeutic wilderness programming for borderline adolescents. In Gass, A. M. (1993). Adventure Therapy: Therapeutic applications of adventure programming (pp. 23-157). Dubuque, Iowa: Kendal/Hunt.
Vogel, V. (1970). American Indian Medicine. University of Oklahoma Press.
Walkingstick-Garrett, M., & Osborne, L. (1995). The Native American sweat lodge as metaphor for group work. The Journal for Specialists in Group Work, 20, 33-39.
Watanabe, Y. (1998). Central type CA-super(2+) channel modulaters as targets for the novel treatment of psychiatric diseases. Human Psychopharmacology Clinical and Experimental, 13, 8, 539-542.
Webb, B. J. (1993). The use of a three-day therapeutic wilderness adjunct by the Colorado Outward Bound School with survivors of violence. In by Gass, A.M. (1993). Adventure Therapy: Therapeutic applications of adventure programming (pp. 23-157). Dubuque, Iowa: Kendal/Hunt.
Weider, R. (1990). Experiential therapy: An adventure in self-discovery enters the psychiatric hospital. In J. C. Miles, & S. Priest (Eds.), Adventure Education (pp. 35-44). State College, PA: Venture.
Weisz, J., & Weiss, B. (1993). Effects of psychotherapy with children and adolescents. Newbury Park, CA: Sage.

White, J. L. (1989). The troubled adolescent. New York: Pergamon.
Yalom, I. D. (1995). The theory and practice of group psychotherapy. New York, N.Y: Basic Books.

Using the Sweat Lodge Ceremony as Group Therapy for Navajo Youth

Abstract
The sweat lodge ceremony can be seen as a culturally relevant approach to group therapy in working with Navajo youth. This paper describes the sweat lodge ceremony used at a residential treatment center located on the Navajo Nation and compares the ceremony to modern group work by identifying Yalom’s (1995) eleven therapeutic factors of group therapy within the ceremony. Other psychotherapeutic features of the ceremony are also discussed. In addition, considerations for widespread use of the ceremony with Native Americans and non-Native Americans are given as well as recommendations for future research.


Coming together through group sweating to enhance well-being is a fundamental social practice that transcends both culture and time. Group sweating and other ancient wisdom practices have strong healing potentials that are typically unrecognized by modern counseling and psychology. Universal practices complementary to modern psychology have the potential to transform conventional therapeutic interventions into more meaningful and effective approaches. What other traditional forms of healing have psychotherapeutic features and have potential to be combined with modern counseling and psychotherapy? Please comment.

Sweat Therapy Treatment Manual

Carrie Winterowd, Stephen Colmant, and Allen Eason

Oklahoma State University

Significant portions of this manual have been modified from an original manual developed by Robert Morgan, Ph.D., with his permission for Sweat therapy.

SWEAT THERAPY TREATMENT MANUAL

This treatment manual is intended to provide you with a guide for conducting a interpersonal (process-oriented) approach to group psychotherapy with sweat (i.e., in a sauna condition) for college students. This manual is intended to function as a guide to this particular group treatment approach with sweat.

The group treatment approach presented in this manual is based on the interpersonal, process-oriented approach to group psychotherapy as presented by Irvin Yalom (1995) in his classic text on group psychotherapy.

This treatment manual is presented in a fashion that is analogous to the treatment approach. As the interpersonal process-oriented approach is the basis for this treatment, it will be described in detail in Part I of this manual. The sweat treatment strategies will be described in Part II of this treatment manual. This manual was written in a clear and reader friendly format, thus scientific references will be implemented only as specifically warranted. Please note that the interpersonal process-oriented approach as described in this manual refers to the approach described by Yalom. We will not cite him for each statement or explanation, but you should be aware that this is his intellectual work (unless otherwise cited), not ours.

PART I

Interpersonal Process-Oriented Approach

As stated previously, this classic approach to group psychotherapy was initially developed by Yalom in 1970. Yalom’s theory will be described briefly, yet in sufficient detail to allow you to implement this approach. The interpersonal process-oriented approach to group work as described here refers to an exploration of group members’ interpersonal relationships with each other as well as their relationship to you (the facilitator). This exploration occurs within the group and remains the focus of the group, therefore the process of this approach is centered in the “here and now” (i.e., the present) and focuses on interpersonal relationships.

In describing this treatment approach, Yalom (1995) has indicated several key components which you must be aware of and attempt to implement to adequately facilitate this interpersonal process-oriented approach to group therapy. These components include: the eleven therapeutic factors of group work, culture building and norm shaping, and maintenance of a “here-and-now” focus. In addition, stages of group therapy and group dynamics will be discussed briefly. These components are described briefly here, and will be presented in greater detail in the first two of the four training sessions.

The students who participate in this study will be referred through this manual as “clients” or “group members.” The facilitators of the groups will be referred through this manual as “facilitators.” The interpersonal process-oriented groups with or without sweat will be referred throughout this manual as “groups” or “group therapy.”

Therapeutic Factors:

Yalom (1995) has empirically identified eleven therapeutic factors based on the “intricate interplay of human experience” (pg. 1) and that opens the path way to therapeutic change. These eleven factors are: (1) Instillation of Hope, (2) Universality, (3) Imparting Information, (4) Altruism, (5) The Corrective Recapitulation of the Primary Family Group, (6) Development of Socializing Techniques, (7) Imitative Behavior, (8) Interpersonal Learning, (9) Group Cohesiveness, (10) Catharsis, and (11) Existential Factors. The following is a description and therapeutic explanation of each of the eleven therapeutic factors.

Instillation of Hope: Hope is crucial to the therapy process. Group members (and facilitators) need to achieve and maintain hope that change is possible. Hope is required to not only keep clients in therapy, but “faith in a treatment mode can in itself be therapeutically effective” (pg. 4). As the group facilitator, you must be able to communicate how this group approach will help group members. In addition, you should attempt to capitalize on their hope in the efficacy of this treatment approach whenever possible (e.g., early group sessions, reinforce positive expectations, educate when faced with negative preconceptions, and direct attention to improvements displayed during the course of the group).

Universality: Clients may enter group therapy with the preconceived idea that they are alone with their problems and that others do not share similar difficulties. While this is true to some extent, the disconfirmation of their uniqueness may be a powerful sense of relief. That is, clients learn that they are universally similar to one another. It is assumed that as clients begin to share and learn about each others’ similarities, they will become more trusting and open with each other. Your role is to aid in the development of group universality by pointing out similarities among group members. When clients present with problems or goals that are similar it is important that you indicate the universal nature of their issues. This may be most easily achieved during the first group session. As clients begin to discuss their lives, you will help the group identify commonalties in their life histories, issues, and goals.

Imparting Information: This therapeutic factor includes both didactic instruction (e.g., psycho-education) and direct advise (by the facilitator as well as group members). In general, clients in interpersonal process-oriented groups do not highly value didactic instruction or advice giving, and Yalom discourages such practices. As the facilitator, you may chose to use psychoeducation or offer suggestions to some group members to facilitate their growth and improvements. However, it is recommended that you not overuse these interventions. Group members will also give advice to one another, especially in early stages of the group. While group members typically do not find the advice of other group members as highly beneficial, advice giving serves a purpose. The process, rather than the content is important as it implies and conveys mutual interest and caring. This is an important facet of group therapy and clients may benefit from acknowledging that they are interested in and care about one another.

Altruism: In group therapy, clients receive through giving. Clients may particularly benefit from this factor as it may be one of the few times that they give rather than take. Clients may believe that they are a burden to others and the experience that they can be helpful or of importance to others may be refreshing and may boost self-esteem. Clients in group therapy may be helpful to one another via providing support, reassurances, suggestions, insight, and sharing of problems. Not infrequently, clients in group therapy will accept observations from other clients long before they accept your observations. You may be perceived as a professional who is not from the real world, who can not really understand them. Other clients are real and understand their plight, thus, are more credible sources of information. Typically, clients question the utility of group therapy asking questions such as “How can the blind lead the blind?” This resistance may be best explored through the therapeutic factor of altruism. In effect, a client who says other clients are in the same position as him/herself and cannot possibly be of help to him/her, is in effect saying “these clients are like myself, and I have nothing of value to offer them.” You can assist these clients in exploring their negative self-evaluation by helping them identify ways that they can be of assistance to the group. Others may vicariously benefit from this process exploration. In addition, it may prove beneficial to reflect the support you notice in group sessions.

The Corrective Recapitulation of the Primary Family Group: Group dynamics occur that closely resemble familial dynamics. Many aspects of families are re-experienced in groups: authority/parental figures, peer siblings, strong emotions, deep intimacy, and hostile and competitive feelings. Responses to other clients in the group will be similar to reactions to family members. Of therapeutic importance, however, is not that early family experiences or conflicts are merely relived, rather that they are relived correctly. Your task is to find common ties between past and current feelings, thoughts, and behaviors, and to explore and challenge rigid interpersonal behaviors. You should assist clients in identifying behaviors that are heavily influenced by early family experiences, and encourage them to experiment with new interpersonal behaviors in the group. The group should be a safe haven for them to try on new behaviors. Thus, when clients can work out problems with you and the other members, they are actually working through unfinished business from previous relationships.

Development of Socializing Techniques: Groups provide an instant laboratory for the observation and development of social skills. The development of socializing skills in an interpersonal process-oriented group is a secondary gain as social skills training is usually not a focus of these groups; however, clients may learn from others’ feedback about their social behaviors. This may provide clients with a unique opportunity of receiving direct feedback regarding their interpersonal skills. It appears intuitively plausible that this feedback could only help clients in their interpersonal relationships within and outside of the group. Yalom (1995) emphasizes the potential benefits of this therapeutic factor when he states “senior members...are attuned to process; they have learned how to be helpfully responsive to others; they have acquired methods of conflict resolution; they are less likely to be judgmental and more capable of experiencing and expressing accurate empathy.” Your task here is to aid clients in developing more functional social skills via modeling (i.e., demonstrating the behavior yourself directly or indirectly) and/or feedback.

Imitative Behavior: We have all at one time or another imitated behaviors of others. Group therapy is no different as clients will model their own behavior based on your behaviors and/or the group members’ behaviors. Clients in this group will likely “try on” bits and pieces of other people in group and then keep those behaviors that “fit” and discard qualities that are ill-fitting. Yalom (1995) articulates this point very succinctly when he writes about this process of trying on and discarding others qualities or characteristics as beneficial because finding out who we are not is important for finding out who we are.

Interpersonal Learning: Interpersonal learning is by far the most abstract and difficult to explain of all of Yalom’s therapeutic factors. Interpersonal learning includes processes that are similar to individual therapy such as insight, working through transference, and the corrective emotional experience. To understand interpersonal learning as identified by Yalom, you must first be familiar with his view of the importance of interpersonal relationships, the corrective emotional experience, and the group as social microcosm.

Interpersonal relationships are important because we develop a sense of who we are based on the perceptions and reflections of others. In general, most clients try to live life based on their own values and standards and in a way that others can be proud of them. With regard to interpersonal relationships, individuals have a tendency to distort perceptions of others (Yalom refers to these distorted perceptions as “parataxic distortions”). These distortions occur in response to facilitators as well as group members. For example, a chronically angry and resentful client may perceive others as harsh and rejecting. If this projection can be identified and discussed in group, than s/he may be in a unique position to obtain consensual validation (i.e., obtain feedback from the group with regard to his/her self-evaluation).

It is assumed that the group will rekindle previous emotional experiences but that the client will be allowed to experience a “corrective emotional experience”. That is, client growth may develop through self-disclosure of emotionally laden material and group feedback allows for reality testing. Five components appear of utmost importance with regard to the “corrective emotional experience”: (1) clients will take risks of expressing strong emotional reactions; (2) the group must support the clients’ risk; (3) group process is examined; (4) inappropriate feelings and behaviors or avoided interpersonal behaviors are recognized; and (5) more honest and deeper interactions are facilitated. Again, it should be noted that the emotional expression is not sufficient to promote change and that a cognitive component (i.e., reflecting on the experience and finding meaning in it) is essential for change to occur. You will need to assist the group by framing and/or making sense of the emotions exhibited in the group.

One of the primary benefits from interactive groups is that they facilitate a social microcosm of the group members. In other words, group members begin to interact with one another as they do with others outside the group. In many ways, the group will represent their day-to-day world. With the passage of time, group members will be themselves during group interactions. As a result, they will eventually display their own problems or pathologies. You do not need to ask about their problems or pathologies, because they will display it for you and for everyone else to see. One of your most significant tasks will be to identify and subject to therapy those maladaptive interpersonal behaviors of individual group members and help them learn new ways of relating. Prior to turning the social microcosm to a therapeutic advantage, you must first identify group members’ recurrent maladaptive patterns. Group members will elicit feelings from one another, and you need to consider these feelings as data. If these are not the feelings that the client desires to elicit, then a problem has been identified. Note that one response of another group member is insufficient data and you must seek confirmatory data (from other group members as well). Consensual validation (feedback about one’s self-evaluation) from the group must be obtained to truly aid in the identification of maladaptive interpersonal styles in each group member. Some of the complaints frequently voiced by clients is that the group and it’s interactions are not representative of the real world—that the group is artificial and contrived. It should be pointed out that while the group members meet only once a week, they are in a position to explore with great depth the life experiences and interpersonal functioning’s of one another. To develop the kind of trust and honest necessary to work together cannot possibly be considered artificial. There is nothing artificial about a client expressing anger with you or another client. In fact, in many ways, group experiences can be more real than their everyday life.

Lastly, the therapeutic factor of interpersonal learning must include a discussion of insight. Insight is the discovery of something of importance about oneself, and may occur on at least four different levels.

1. Clients may develop an objective impression of their interpersonal style. They may learn how others view them.

2. Clients may develop an understanding of their interactional patterns.

3. Clients may develop an understanding of the motivations behind their interactional patterns. They may learn why they interact the way they do. For example, clients may learn that they behave in certain ways to avoid perceived catastrophes (e.g., if I express my anger I will end up in a fight; if I cry I will be perceived by others as weak).

4. Clients may develop an understanding of how they became the way they are.

Group Cohesiveness: Group cohesiveness in its most basic form refers to the attractiveness of a group for its members. Defined more behaviorally, group cohesiveness refers to members feelings of warmth and comfort in the group, feelings of belonging, valuing the group, and feelings of being valued, unconditionally accepted and supported by the other group members. Group cohesiveness appears to be a necessary component of group therapy, as well as any other group, should be able to develop this therapeutic factor. Group cohesiveness is not a stagnant process, rather, the cohesiveness of any group fluctuates with the circumstances of the group; however, some level of group cohesiveness must be maintained or members are likely to leave the group.

Lastly, it is critical to the process of group therapy that you do not misinterpret group cohesiveness as comfort. Cohesive groups should be better able to develop and express anger and conflict. Hostility must be acknowledged and expressed to avoid covert hostility, which would significantly hinder the effectiveness of the group. Hostility in group therapy must be processed and it is imperative that the conflicting group members establish a means of working together. Clients may have a tendency to avoid open expression of anger and hostility, however, as the group facilitator you need to help the group identify and explore conflict via the open expression of anger. Be aware and prepare for the initial expression of anger to be directed at you. If the group members cannot trust you with their anger, how can they trust the other clients. This issue will be discussed in greater detail under the heading of “stages of group therapy”, but suffice it to say for now, that you should observe client challenges or confrontations at some point in the early group development. For example, you may be confronted about your lack of direction or your lack of care and concern. If you do not deal with this open expression of anger in a healthy and positive way (e.g., allow members to share their disappointment, anger, etc. without judgement), you will inadvertently establish a group norm discouraging the open expression of intense feelings.

Catharsis: Catharsis is the process of emotional experience and generally refers to expressing and discharging previously repressed emotions. It is generally accepted by most theorists and clinicians that catharsis is not sufficient to promote psychological change. As the facilitator, one of your tasks is to help the client get beyond the ventilation of feelings and attempt to add meaning or significance to the cathartic experience. You must facilitate the dual process of expressing feelings and then reflecting back on the process (this process is known as the self-reflective loop and is discussed in greater detail below). For example, you might ask a group member what it was like to share those feelings in the group just now. Catharsis is critical to group therapy, without which the group would be a sterile intellectual discussion of ideas and thoughts, yet it is insufficient to promote change and must be supplemented by other therapeutic factors. In addition, this therapeutic factor allows clients (possibly for the first time in their lives) to learn and be able to say what is bothering them. With regard to catharsis with clients, please note that expression of affect is a relative experience. What one perceives as intense may not be the same as what others perceive as intense. Thus, if a relatively constricted client expresses an affective response, consider the experience from that client’s experiential world.

Existential Factors: The existential factors refers to the search for purpose and meaning in life, and consists of five points:

(1) “Recognizing that life is at times unfair and unjust”

(2) “Recognizing that ultimately there is no escape from some of life’s pain or from death”

(3) “Recognizing that no mater how close I get to other people, I must still face life alone”

(4) “Facing the basic issues of my life and death, and thus living my life more honestly and being less caught up in trivialities”

(5) “Learning that I must take ultimate responsibility for the way I live my life no matter how much guidance and support I get from others” (p. 88).

In a general sense these five existential factors emphasize awareness of death, freedom, isolation, the purpose of life and the struggle with existence. This therapeutic factor is not grounded in techniques or strategies, instead, it is an attitude or a way of viewing the world. Your task is to aid the client in exploring his/her role in the world and way of living.

Integrating the Therapeutic Factors

As you read about the eleven therapeutic factors you probably developed a sense of those therapeutic factors that carry more weight with regard to the change process. Yalom would not disagree with you. For example, instillation of hope in and of itself does not facilitate change, however, it helps keep members in the group to allow other therapeutic factors to facilitate change. In addition, the therapeutic factors should not be considered individually, but collectively. Each factor contributes and is critical to the process of change. If you think of the change process in a circular fashion with change at the top of the loop and each factor leading in a circular fashion to change, you can see that if any one factor is removed, the loop is broken. Thus, each factor is not necessarily a condition of change, rather a mechanism in the process of change. One of your goals for your group should be to facilitate the process of change by integrating the therapeutic factors as described above.

Culture Building and Norm Shaping:

One of your tasks as the group facilitator is to develop a group that works as a “therapeutic social system” (pg. 109). That is, you are not the agent of change, the group is. It should be the group members who facilitate change for one another via the therapeutic factors, thus it is your task to establish a group culture that maximizes the effective therapeutic interactions. Your task is to maximize the strengths of the group to facilitate an interactional group.

In building a therapeutic culture, group norms will evolve. Some of the norms of the group will be explicit (e.g., identified group rules as described below), while most will be implicit. You influence the type of norms that evolve. In fact, you cannot help but influence the development of group norms. You need to be conscious of your influence on group norms and attempt to establish norms that facilitate interactional group therapy. In developing group norms you will assume two basic roles: technical expert and model-setting participant.

As the technical expert, you do not need to rely on group exercises or gimmicks to develop therapeutic norms. Rather, you can rely on your knowledge and experience to actively facilitate the group norms. You already possess the necessary techniques for the development of the desired norms. You simply need to be conscious of how you effect group norms and plan your strategy appropriately. Yalom (1995) gives the following examples which I believe adequately describe your task here:

“the leader must attempt to create an interactional network in which the members freely interact rather than directing all their comments to or through the facilitator. To this end, facilitators may implicitly instruct members in their pregroup interviews or in the first group sessions: they may, repeatedly during the meetings, ask for all members’ reactions to another member or toward a group issue; they may wonder why conversation is invariably directed toward the facilitator; they may refuse to answer questions or may even close their eyes when addressed; they may ask the group to engage in exercises that teach clients to interact-for example, asking each member of the group, in turn, to give his or her impressions of every other member; or facilitators may , in a much less obtrusive manner, shape behavior by rewarding members who address one another-facilitators may nod or smile at them, address them warmly, or shift their posture into a more receptive position” (pg. 113).

As the model-setting participant, you shape group norms by example. You should attempt to model four basic functions: (1) honest and open communication, (2) appropriate restraint, (3) appropriate self-disclose (i.e., as the facilitator, do not self-disclose too early in the group and avoid promiscuous self-disclosure), and (4) transparency (i.e., do not hide behind your role as group facilitator). To function as a model you must “join” the group. You will be expected to share with the group. You will not need to share identifying information (a process that can prove dangerous with this population), however, you should be willing to share your own interpersonal difficulties with the group. For example, if you find yourself in constant conflict with a particular client you can model trust and openness by exposing this conflict to the process of the group. You will model honest and open communication and transparency, but to do this you must be comfortable with yourself and allow yourself to come out from behind your role as facilitator. In effect, you become a group member who is subjected to interpersonal difficulties just like every one else in the world. Finally, you should positively reinforce similar client behavior. Do not punish those who are less trusting and share only minimally. You should reinforce them for what they have shared, you can process their difficulty in opening up more to the group, you can engage in risk assessment of opening up, and you can encourage clients to share more, but do not act in a punitive manner to the amount or your perceived tardiness of their sharing. To do so, will inadvertently reinforce negative feelings of sharing. Clients will learn that sharing only leads to greater expectations of what one must share, and everyone will be afraid to be more open with the group.

Here-And-Now Focus

As stated previously, the here-and-now refers to the focus on the interpersonal relationships within the group and occurs in the present. The focus on the here-and-now is of paramount importance in Yalom’s theory and is a concept that you will need to be familiar and comfortable with to facilitate an interpersonal process-oriented group. For this reason, I contribute more detail to this concept than any other concepts in this theory. To implement a here-and-now focus you need to know that this process occurs at two levels: first is an experiential level and second is an “illumination of process” level.

In the experiential level, group members will experience feelings in the here-and-now. Some of these feelings will be strong and will be in reaction to other group members, the facilitator, and the group at large. The focus of this portion of the group will be on these feelings. Identifying and sharing with the group these feelings will be one of your primary goals for each of the individual members. The events in meetings must take precedence over any other events (e.g., outside the group). That is not to say that other events in the clients life are not to be discussed, however, the group focus must remain on intergroup behaviors. The here-and-now focus will remain incomplete without the second level, the illumination of process. That is, you must facilitate “process commentary” (i.e., explaining what you observed/heard happening in the group) on the events that occur in the here-and-now. Experiencing is insufficient to facilitate change; experiencing must by accompanied by interpersonal learning which occurs through process commentary (e.g., reflection on the experience and sharing it in group). Thus, you have two tasks: 1) facilitate a here-and-now focus and then 2) lead the group in an exploration of the here-and-now experiences (e.g., thoughts, feelings, behaviors, interactions). In effect, the group will perform a “self-reflective loop”. The group will live in the here-and-now, and then reflect back on the thoughts, feelings, behaviors, and/or interactions that occurred.

For purposes of this group, process will refer to the interpersonal relationships between group members. Process is not the same as content. Content refers to the explicit meaning of statements, whereas process refers to underlying meanings. To understand the process you need to consider the reason, from an interpersonal perspective, that clients make statements when they do, how they do, and to whom they do. In other words, why is a client saying what s/he is saying, how s/he is saying it, and to whom s/he is saying it. This is the group process and it is this process commentary that separates experiential group therapy from other social interactions.

Some techniques may aid you in activating a here-and-now focus; however, you are strongly encouraged not to rely on these techniques in a prescriptive format, rather to understand the purpose and intent behind the techniques. In so doing, you will then be in a position to initiate your own techniques that are consistent with your own individual style. First, it may help you to think in the here-and-now. Your focus should be on attempting to bring each group session, each event into the here-and-now. Ask yourself a question such as, “How can I get this discussion into the here-and-now?” This will help keep you in a here-and-now focus. This should be done as early as the first group session. For instance, after group introductions and initial discussion, you may interrupt the group with a process comment. Yalom provides the following narrated example “We’ve done a great deal here today so far. Each of you has shared...But I have a hunch that something else is going on, and that is that you’re sizing one another up, each arriving at some impressions of the other, each wondering how you’ll fit in with the others. I wonder now if we could spend some time discussing what each of us has come up with thus far.” As you can see from this example, you can directly influence a here-and-now focus. You will attempt to adjust the focus from the external, abstract, and impersonal, to the internal, specific, and personal. Encourage the use of first person (“I”) rather than third person (“You”). Identify when group members are talking to you and encourage group communication. Other examples of moving the focus to a here-and-now focus will be presented in the training sessions.

Another strategy is to provide feedback on how to ask and give feedback to and from other group members. It may be necessary for clients to occasionally check out their beliefs with the group. Help clients avoid group questions such as “Do you like me?” in favor of more effective questions such as “What is it about me that you like most and least?” This type of activity promotes process commentary and includes the following sequence:

1. A description of behavior. Clients learn to see themselves as others see them.

2. Here is the impact of your behavior on others. Clients learn how their behavior makes others feel.

3. Here is the impact of your behavior on others attitudes toward you. Clients learn how others feel about them as a result of their behavior.

4. Here is the impact of your behavior on your attitude toward yourself. Clients learn how their behavior influences their own attitude about themselves.

When initially inquiring about intergroup relations, you will receive resistance from the group. Clients will say something to the effect that they like all of the group members the same. It may be important for you to accept these defenses initially, but stay with the task, continue to probe and explore, and do not hesitate to model interpersonal communications. For example, after a long silence you may initiate “process commentary” by asking for the thoughts of the group members that were “unsaid”. You can then model this behavior by sharing your own thoughts that occurred during the silence.

At times it may occur to you that things are going “unsaid” as the group is nearing the end. You may have the members imagine that the group has just ended and they are leaving. Ask them what disappointments they would have about that session. Also, do not hesitate to wonder about how group discussions relate to the group session (e.g., if they are discussing the frustration of clients in the facility, wonder aloud if that is how they are feeling in the group). Your wondering may or may not be accurate, but either way, you facilitate a here-and-now focus.

Once you have established a here-and-now focus, you must then use this process therapeutically (i.e., process illumination). The illumination of process consists of four stages: (1) client recognition of their behavior, (2) client understanding of the effects of this behavior, (3) determine their satisfaction with their behavior, and (4) change in behavior. To facilitate these stages you must first be able to recognize process. This is a skill that generally occurs with experience, and you may or may not have had opportunities to develop this skill. Some specific examples will be provided to aid you, as needed, in the recognition of process.

Establishing a process orientation within the group is as difficult and maybe moreso than establishing a here-and-now focus; however, another one of your tasks will be to facilitate an environment that accepts a process orientation. In so doing you are encouraged to attempt to facilitate client learning via their own route. That is you may have to hold onto some process commentary until you are able to find a method that allows the client to obtain their own insight. This will carry much more weight than any brilliant interpretation that you as a facilitator can offer. This is not an easy task, and as the time frame for this group is relatively short (especially by Yalom’s standards) you are encouraged to weigh the time limits against the clinical utility of making an interpretation.

When you chose to illuminate on the group process, you are advised to consider how you can aid the client in hearing your process commentary. Some basic concepts are suggested here. First and most obvious, clients may hear your interpretations more clearly if they are framed in a supportive manner. Second, avoid the temptation to label or classify (e.g., antisocial, narcissistic, uncaring). A statement first describing some positive aspect of their group behavior followed by an observation and interpretation of the ineffective or aversive group behavior may be more easily heard by the client. Third, be observant of “moments of truth”. That is, their are times when in an instant of openness an client discloses some truth that will provide you with therapeutic leverage at a later point in the group. For example, a client may state that they would like to develop more intimate relationships with others. By remembering this statement you may be in a position to use his/her stated desire in making a process commentary to how his/her intergroup behavior effects relationships with others in the group.

If any of this information is unclear, I will reiterate many of these points during the first two training sessions. In addition, videotapes produced by Yalom will accurately display the use and impact of the here-and-now focus.

Stages of Group Psychotherapy

Yalom (1995) identifies three stages of group therapy that all groups must obtain in order to become a functional therapeutic group. These stages include the initial stage, the conflict, dominance and rebellion stage, and thirdly, the development of cohesiveness. These stages are not clearly defined as to when or how a particular group will progress through each stage, but as the facilitator you should be able to recognize and process with the group, the stages as they occur.

The initial stage (also referred to by Yalom as the “in or out” stage) is characterized by four basic phases. First, there must be an orientation to the group. You can facilitate this phase by discussing the purpose of the group, expectations of group members, and structure of the group. Second, it is normal for group members to be hesitant about group participation and self-disclosure. Trust has not yet formed and the clients will continue to seek approval from the group rather than openly discuss their life struggles. Thirdly, the group will experience a “search for meaning” phase. The clients will attempt to make sense of the group, ask and explore how the group will help them, they will question how much they really want to share, and they will attempt to find a role within the group. Finally, there will be a dependency phase. Here the clients will look for structure, typically from you. They will seek you out for direction, approval, acceptance, and you will see many of the group statements directed to you. You can exert great influence at this point and must remember that you are attempting to establish therapeutic norms as described previously.

The second stage of group therapy is the conflict, dominance and rebellion stage (which Yalom also refers to as the “top-bottom” stage). Here the group shifts focus from approval and acceptance to conflict, dominance, and power. A group hierarchy will likely emerge as clients jostle for position within the group. In this stage, the clients are becoming more real and you will begin to see who the group members really are. Controlling and dominant clients will attempt to assume control in the group, while more passive clients will allow the group to be directed by others. The clients are allowed to be a little more real because in this stage they are becoming more comfortable with one another. The first sign that the second stage is occurring is the emergence of conflict. This conflict will typically not present itself in a hostile or aggressive fashion. Rather, subtle disagreements will become evident. This is the group’s method of “testing the waters” for the acceptance of conflict. As stated previously, group conflict will invariably be directed to you first. If they can not express conflict with you the facilitator, how can they trust to express conflict with one another, and a group without conflict will be like a marriage without conflict--boring, distant, detached, and unreal. You must be prepared to accept conflict, no matter how great or small the challenge, because the group’s challenge of you is essential to the life of the group. As such, you must not only permit but encourage confrontation (e.g., reinforce challenges) directed at you. Rest assured, the group will save you and eventually switch the focus of the challenges from you to one another.

Group cohesiveness is the third and final stage of group therapy identified by Yalom. He has also referred to this stage as a “close-far” stage. This stage is characterized by an increase in trust, self-disclosure, and group cohesion. The focus typically shifts from a conflictual process to one of intimacy. This stage permits the emergence of the real person and secrets are commonly shared. The group develops the cohesion necessary for intimate work to occur. Group cohesion is a relative term. Clients may develop a strong sense of cohesion that is not easily recognized by facilitators experienced with groups that have achieved more intimate levels. You should caution against harboring high expectations, yet allow yourself to develop a sense for and some expectations for intimacy to occur within the group. You should acknowledge with the group their movement towards intimacy and closeness and reinforce behaviors that initiate this process.

Some Notes about Group Dynamics

You already have a good sense about group dynamics, both from experience and from reading the previous sections of this manual. In this section, I want to clarify or describe some of the important group dynamics identified by Yalom (1995) that you should be aware of but that were not identified above. These dynamics include: group maintenance, group resistance, and problem clients.

Group maintenance will be one of your primary tasks once the group has begun. You must identify and deter any threats to group cohesiveness. Frequent tardiness, subgrouping, and scapegoating are examples of processes that can negatively impact group cohesiveness. You need to monitor the cohesiveness of the group and it may be necessary at times to delay work on an individual’s problems for the betterment of the group. For example, if a new client enters the group and is unacknowledged while another group member immediately engages in a dialogue of his problems, you should consider stopping this member and processing with the group the new members presence and the groups lack of acknowledgment to him. Again, you should attempt to confront this behavior in a nonpunitive manner. For example, you may ask the speaking client how s/he thinks the new client is feeling in the group at that point.

Group resistance is common in any group therapy. You may frequently observe group members becoming resistant (generally defined as pain avoidance) to you, to other group members, or to the group at large. When this occurs, your task is to help the client see through their resistance to be able to hear the message they are receiving. It is only then that they can accurately confirm or disconfirm a message. For example, it is likely at some point in your group that a group member will make an observation or interpretation to another group member who in turn becomes defensive and resistant to this message. You may encourage the client to listen to the message by acknowledging his/her ability to defend against or counter the message, but point out that in so doing, s/he is unable to accurately hear the message and is unable to discern which parts of the message are actually true for him/her.

Problem clients exist in all groups, and your client group will be no different. Common problem patient presentations include: the monopolist (talks a great deal in group), the silent patient (talks rarely), the boring patient (detailed stories that stay at a surface level), and most common for your group, the characterologically difficult client (personality problems/disorders). These group members will test your clients as well as your abilities to facilitate a therapeutic group; however, you may be helped in knowing that these are examples of interpersonal problems. You may at times be unsuccessful in your attempts to confront or challenge this behavior, but you may find success in providing your insights (or interpretations) on how the behavior affects their interpersonal relationships. Furthermore, you will be especially effective if you can aid the client in identifying how the effects of his behavior actually contradict what he desires in interpersonal relationships.

Summary of an Interpersonal Process-Oriented Approach to Group Therapy

This approach to group psychotherapy with clients will incorporate Yalom’s (1995) interpersonal process-oriented theory. The foundation of this treatment will consist of eleven therapeutic factors: instillation of hope, universality, imparting information, altruism, the corrective recapitulation of the primary family group, development of socializing techniques, imitative behavior, interpersonal learning, group cohesiveness, catharsis, and existential factors. These factors do not facilitate change independently, rather should be implemented collectively into the treatment process. One of your tasks is to facilitate a culture and develop norms that are conducive to interpersonal exploration. This interpersonal exploration should occur in the here-and-now, as group members will react with emotion to the group members, the facilitator, and the group as a whole; however, this is not sufficient for change. You must facilitate a self-reflective loop where group members share their feelings and then reflect back on this experience with the group. Lastly, you should be aware of the group stages your group members may progress through including: the initial stage (characterized by group orientation, hesitant participation, a “search for meaning”, and dependency); the conflict, dominance and rebellion stage (characterized by a focus shift to issues of conflict, dominance, and power); and the group cohesiveness stage (characterized by increased trust, self-disclosure, and group cohesion).

By now you should have a sense of your task when facilitating an interpersonal process-oriented approach to group counseling. It is hoped that Part I of this manual has prepared you for facilitating a therapeutic environment that is rich in opportunity for interpersonal understanding and growth. The avenue to this end lies in the therapeutic factors and the here-and-now process as described previously. As you move into Part II of this manual you are advised to maintain your present awareness of the interpersonal process-oriented approach.

PART II

Sweat Approach

Preparation
Each participant and facilitator will need the following:
 1 Quart of water.
 Two Towels
 Minimum attire is a bathing suit.
 The facilitator should have a digital watch with a timer and alarm as is on an athletic watch. A Timex Ironman watch is excellent.

Structure of Sweating Sessions

After members are seated and the door is closed, the facilitator will start his/her watch timer. The group will begin spending four, ten-minute intervals in the sauna. In this manual, the intervals spent in the sauna will be referred to as “Rounds”. After each round, the facilitator will direct the participants to leave the sauna to take a five-minute break in the room directly across from the sauna. The facilitator should encourage everyone to drink plenty of water. Remaining standing between rounds may be helpful for anyone experiencing light-headedness. When the five-minute break is up, the facilitator will direct the participants to re-enter the sauna for the next round. Each subsequent session, along with the group’s consent, the facilitator will raise the amount of time during the rounds by one minute, not to exceed 15 minutes. For example, Session 1 will be four ten-minute rounds, Session 2 will be four eleven-minute rounds, and so forth. It is important that all group members be encouraged to take breaks from the sauna whenever they feel it necessary. Other information regarding signs and symptoms of people having problems due to heat exposure are in the following section on Heat Disorders.

One of your roles as a group facilitator is to ensure the physical and emotional safety. If the facilitator is concerned about the emotional (e.g., undue group pressure or ridicule; being verbally abused) or physical (e.g., people touching each other inappropriately; not respecting physical space and boundaries) well-being of group members as a result of group dynamics or group conflicts, then the facilitator should intervene to interrupt these group dynamics and discuss them. Below is a list of other physical safety concerns that the group facilitator must attend to:

I. HEAT DISORDERS
If a group member is suspected of suffering either a heat related or other injury the counselor will attend to that person and will instruct another group member to inform health club staff of the problem.

A. HEAT STROKE occurs when the body's system of temperature regulation fails and body temperature rises to critical levels. This condition is caused by a combination of highly variable factors, and its occurrence is difficult to predict. Heat stroke is a medical emergency. The primary signs and symptoms of heat stroke are confusion; irrational behavior; loss of consciousness; convulsions; a lack of sweating (usually); hot, dry skin; and an abnormally high body temperature, e.g., a rectal temperature of 41°C (105.8°F). If body temperature is too high, it causes death. The elevated metabolic temperatures which contribute to heat stroke, are also highly variable and difficult to predict.

If a group member shows signs of possible heat stroke, professional medical treatment should be obtained immediately. The person should be escorted out of the sauna. The person’s skin should be wetted and air movement around the person should be increased to improve evaporative cooling until professional methods of cooling are initiated and the seriousness of the condition can be assessed. Fluids should be replaced as soon as possible. The medical outcome of an episode of heat stroke depends on the victim's physical fitness and the timing and effectiveness of first aid treatment.

No person suspected of being ill from heat stroke should be sent home or left unattended unless a physician has specifically approved such an order.

B. HEAT EXHAUSTION. The signs and symptoms of heat exhaustion are headache, nausea, vertigo, weakness, thirst, and giddiness. Fortunately, this condition responds readily to prompt treatment. Heat exhaustion should not be dismissed lightly, however, for several reasons. One is that the fainting associated with heat exhaustion can be dangerous so the victim should not be left unattended; moreover, the victim may be injured when he or she faints. Also, the signs and symptoms seen in heat exhaustion are similar to those of heat stroke, a medical emergency.

People suffering from heat exhaustion should be removed from the hot environment and given fluid replacement. They should also be encouraged to get adequate rest.

C. HEAT COLLAPSE ("Fainting"). In heat collapse, the brain does not receive enough oxygen because blood pools in the extremities. As a result, the exposed individual may lose consciousness. This reaction is similar to that of heat exhaustion and does not affect the body's heat balance. However, the onset of heat collapse is rapid and unpredictable.

D. HEAT RASHES are the most common problem in hot work environments. Prickly heat is manifested as red papules and usually appears in areas where the clothing is restrictive. As sweating increases, these papules give rise to a prickling sensation. Prickly heat occurs in skin that is persistently wetted by unevaporated sweat, and heat rash papules may become infected if they are not treated. In most cases, heat rashes will disappear when the affected individual returns to a cool environment.

PART III

Group Intervention Plan

Intake Interview:

1. Establish rapport
2. Discuss limits of confidentiality (obtain signature on confidentiality form)
3. Provide an overview of the program
• focus on interpersonal relationships
• describe the purpose and procedure of the assessment phases
• discuss group rules/norms
4. Obtain informed consent and have client sign consent form
5. Obtain background information via your normal
clinical interview style

Session 1:
1. Administer pretest measures.
1. Discuss group rules including confidentiality (including your limits to confidentiality)
2. Facilitate group introductions
3. Begin implementing the therapeutic factors (e.g., universality, instillation of hope)
4. Begin to facilitate a here-now-focus

Sessions 2, 4, and 5:
1. Administer 2 questionnaires (Curative Factor Scale and Group Response Form) at the end of each session before members leave.

Session 3:
1. Affect scales will be administered five (5) times. The scales are the PANAS, SEES, and EIFI. They are stapled together and highlighted for administration times: PRE, DURING, POST, 2HR-POST, and NEXT-DAY-POST. Administer PRE before beginning session.

2. Administer DURING on a clipboard five minutes into the third round.

3. Administer POST and 2 questionnaires (Curative Factor Scale and Group Response Form) at the end of session after exiting sauna before members leave.

4. 2HR-POST and NEXT-DAY-POST will be given to group members to take home and fill out on their own. Instruct members to complete 2 HR-POST two hours after end of session. Instruct members to complete NEXT-DAY-POST at 10 AM the following day.

Session 6:

1. Begin the group.

2. Provide the opportunity for some closure and feedback about the experience in group (e.g., What was this group experience like for you?).

3. Administer 2 questionnaires (Curative Factor Scale and Group Response Form) at the end of session before members leave.

Session 7:

1. Administer post-test measures. Group counseling will not be held. Thank everyone for their participation.

Sweat Therapy in Men's Health Magazine

Men’s Health is the world’s largest men’s magazine and has a circulation of 1.67 million. The current issue offers a special section on stress including eight articles and 34 pages. In the article titled, “100 Ways to Beat Stress”, interventions to cope with stress from recent research conducted in universities throughout the world are listed and described. In between interventions using exercise and music, our study on sweat therapy is listed as #10 and reads: “In an Oklahoma State University study, those who combined sauna use with group counseling had greater stress relief, feelings of relaxation, and sense of accomplishment compared with those who only had their heads shrunk.” Click on Top 20 Ways to Reclaim Your Life

Clinical Research on the Psychological Effects of Sweating: 1954 to 2004

Research attempting to measure the psychological effects of sweating is rare, especially when it comes to randomized controlled studies. Searching the following data bases (PsychInfo, Eric, Medline), there were no research investigations on the psychological effects of sweating procedures prior to the 1970s. And since the 1970s, the investigations undertaken have been a hodgepodge of different topics rather than a coherent, solid accumulation of knowledge concerning the psychological effects of sweating procedures. Since there is such a wide variability in the literature on the psychological effects of sweating procedures, this review presents a summary in chronological order.

The scientific study of sweating procedures has been almost entirely focused on the Finnish sauna as opposed to other forms, such as the American Indian sweat lodge, Russian bania, Turkish hammam, etc.

In 1954, Dr. Covalt, a physician, wrote “Sauna Baths – A Preliminary Report”. In it, he reported an absence of the sauna in medical literature. His literature review conducted through the Library of Congress resulted in ten reports: Six from Germany; three from Switzerland; and, one from Sweden (Covalt, 1954). These reports, spanning from 1938 to 1950, investigated the physiological effects of sauna bathing. Covalt, calling for a replication of European findings in the United States, conducted a study with five healthy women taking weekly saunas for twelve weeks. In addition to reporting the results of basic measures of body weight, blood pressure, and body temperature, Covalt reported that the sauna caused the women to experience a sense of well-being.

The next study on the psychological effects of sweating does not appear until 1972. Kuusinen and Markuu investigated the immediate aftereffects of the Finnish sauna on psychomotor performance and mood with 20 males. The results indicated that the effects of sauna bathing on performance that required rapid and adequate psychomotor adjustment did not differ from those of merely washing oneself. Slight differential effects on mood were discovered with decreases in anxiety and hostility (Kuusinen & Markuu, 1972).

In another 1970s experiment, this time with five young healthy males, the participants were exposed to a 90º C sauna as three ten-minute sessions separated by rest periods at room temperature in between (Putkonen & Elomma, 1976). During the subsequent night their EEGs were recorded and the recordings compared to their sleep-EEGs taken without a preceding sauna bath. The results were that the post-sauna sleep was deeper; during the first third of the recording period, or the first two hours, there was 72% more delta wave sleep than in the control recordings (1976).

No experimental studies were found to have occurred in the 1980s. Sorri (1988) wrote a psychoanalytic view of sauna bathing and described it as follows (p.236):
Sauna bathing is a pleasant and relaxing experience that combines psychic, physical and social pleasures. A person’s inner feelings about sauna bathing, its essential components are mainly unconscious. The sauna bath reduces the aggressive behavior and enables bathers to forget the commonplace pressures of everyday life. The sauna evokes memories of childhood development, awakening feelings of maternal warmth and paternal power in the bather. The sauna is a positive mental health resource, even though its effects are transitory.

Frankva and Franek (1990) found significant positive effects of sauna baths on immediate mental states for both men and women (N = 100). These effects included improvements in mental satisfaction, energy, relaxation, frustration, and anxiety. Limitations of this study included that all the participants were regular sauna users (1 year minimum) and the absence of a comparison group.

In 2000, Colmant and Merta completed the first investigation into combining group counseling with group sweating with four adolescent boys with disruptive behavior disorders. They suggested that one way in which intense heat exposure is complimentary to the counseling process is that “sweat therapy” offers physiological and psychological stress whereby the patient is provided psychosocial support to learn better coping (2000). The heat during sweat therapy was described as a dynamic force. They explained that, for the first ten minutes the average participant will likely experience the heat as pleasurable but this gradually changes to an effort of endurance as time passes. When the experience changes to an effort of endurance, those with problems of frustration tolerance are especially challenged (Colmant, 2003). Similarities between anxiety/anger provoking situations and sauna are that body temperature rises, heart rate is increased, sweating is induced, and negative self-talk begins, thus, people with problems of aggression or anxiety who have difficulty remaining calm and/or prosocial when in a physiologically escalated state may especially benefit from sweat therapy. Recent research supports that those with higher neurotic personality traits have greater difficulty coping with heat stress (LeBlanc, Ducharme, Pasto, & Tompson, 2003).

LeBlanc, Ducharme, Pasto, and Tompson (2003) investigated the relationship of personality traits to people’s responses to warm and cold environments with 20 young healthy adults. The personality measure used was the Big Five Personality Inventory (BFPI). Higher scores on each of the five scales are related to higher self-reported levels of extraversion, agreeableness, conscientiousness, neuroticism and openness. For both the cold and the hot environments, the researchers found that people who scored high for neuroticism (tendency to be anxious, fearful, sensitive, and self-critical) had both a higher discomfort rate and a lower autonomic nervous system (ANS) response. In other words, when in the cold environment (10º C) they reported it to be highly uncomfortable and shivered less than normals. In the hot environment (40º C), they found it highly uncomfortable and sweated less.

Since 1997, Dr. Emilio Gutierrez, a clinical psychologist at the University of Santiago in Spain, has been investigating the use of heat treatment for people with anorexia nervosa (AN). Three types of heat treatment that Dr. Gutierrez and his colleagues are investigating include continuous exposure to a warm environment, wearing a thermal vest, and sauna. Heat treatment was developed with the specific aim of helping patients to control strenuous exercising and other manifestations of hyperactivity. Excessive activity is a recurrent characteristic observed in people with AN since the first modern descriptions of the illness (Gutierrez et al. 2002).

The main instigation for the development of heat-treatment for hyperactivity was an extrapolation from animal research where the effect of ambient temperature (AT) on the behavior of rats exposed to restricted feeding schedules has been investigated. This research describes decrease in feeding behavior and the "self-starvation" observed in rats when the animals are simultaneously exposed to a restricted feeding schedule and given free access to an activity wheel (Routtenberg & Kuznesof, 1967). Because of the numerous parallels with behavioral features of AN patients (such as hyperactivity, hypothermia, self-starvation, and weight loss), this animal model has been proposed as a potentially useful analogy of AN (Epling & Pierce, 1996). In this research, it is suggested that hyperactivity in rats (wheel running) serves a compensatory function in support of thermoregulatory homeostasis, impaired by loss of weight brought about by the interaction between restrictive food schedule and physical activity (Sherwin, 1998). However, the interaction between restricted feeding and activity in the rats is heavily dependent on ambient temperature. Just running the experiment 6 °C above standard temperature is sufficient to inhibit excessive running in the rats. Accordingly, they do not lose weight, do not self-starve, and survive the experiment (Lambert, 1993). In warmer temperatures, Rats improve their meal efficiency and gain weight in spite of the experimental conditions of restricted feeding and free access to the running wheel (Morrow et al. 1997).

Gutierrez et al. (2002) also found sauna use suspiciously not listed in the medical literature as a weight loss strategy used in AN. They explain that the absence of sauna use in AN is unusual because it is very effective at causing rapid fluid loss like other commonly used weight loss methods in AN such as diuretic and purgative abuse. These researchers speculate that sauna use may prevent people from developing the full-blown syndrome and may accelerate their recovery. The researchers describe their successful clinical experience and case study using a sauna with AN. They report that as activity receded, the patients did not report anxiety, depression, or other unpleasant experiences, but on the contrary they repeatedly emphasized the calming and relaxing effect of heat. These psychological changes were followed by a progressive normalization of eating. Furthermore, those changes were maintained during follow-up after the discontinuation of sauna use (2002). However, Gutierrez et al. have not yet produced a randomized controlled study using sauna for patients with AN. In an interview with Dr. Emilio Gutierrez in July 2004, he made the following comments (Colmant, 2004):

Colmant: Can you say more about your plans for a study using a sauna with people with AN? One of the things I am curious about is if you are planning a randomized controlled study using a sauna?
Dr. Gutierrez: Of course, this is the study I am most interested to perform. However, I can’t give you a definite answer at the moment. Actually, I am in Vancouver to check out this possibility. I know that there would be a lot of difficulties to perform the ‘first’ study with sauna and AN patients. The ethics committee could pose a lot of difficulties. Four years ago, I managed to send Prof. Peter Beumont in Sydney, an infrared sauna. This was a very expensive enterprise and the sauna is still there. Regretfully, after the death of Prof. Peter Beumont, I think that this sauna cabin will never be used. It is easier to do trials with new drugs, no matter how ineffective they happened to be, or how feeble the theoretical foundation could be. A problem with the sauna is that, in comparison with drugs, it seems half mysterious, half esoteric. Probably, we will need to move slowly and accumulate more direct and indirect evidence about the beneficial, preventative, protective effect of heat, and their risks too. An important clue in this respect will be what Anu Vähäsoini will find in her study in Finland about the current practice of sauna use by real AN patients. The whole idea about the role of heat in the treatment of AN will then be more ample than just performing a one-shot study (sauna, or whatever other device). Probably our next step after the first randomized trial with thermal vests here in Vancouver, will be a dose-response study with this strategy of heat application.

One of the most consistent descriptions of the effects of sauna is that it causes feelings of relaxation and stress relief (Colmant & Merta, 2000; Gutierrez, Vazquez, & Beumont, 2002; Sorri, 1988; and Sudakov, Sinitchkin, & Khasanov, 1988). Specific descriptions concerning the use of intense sweating in counseling include that intense heat exposure creates an altered state of consciousness for the participant, creates a challenging activity in which to improve coping, and requires no movement and therefore lends itself well to process facilitation.

Some writers have described the sweating experience as creating an altered state of consciousness (ASC) for the participant. An ASC is defined as a transient state characterized by time distortion, disinhibition from social constraints, altered sense of self, or a change in focused attention. Typical examples of activities thought to cause an ASC include dreaming, endurance running, meditation, daydreaming, hypnosis, and various drug-induced states (Dietrich, 2003). Michael Winkelman, an anthropologist from the University of Arizona, describes group sweating as a shamanic practice used worldwide to promote ASCs (2000). Barbara Kerr, Ph.D. is a professor of counseling psychology at Arizona State University and recipient of the American Psychological Association Presidential Citation. She is a leader in the fields of Gender and Giftedness, Spiritual Intelligence, Creativity, and Counseling Gifted Students. In her most recent book, Letters to a Medicine Man: The shaping of spiritual intelligence, she wrote extensively about her experience using the American Indian sweat lodge (2002). In an interview in February, 2004 Dr. Kerr made the following comments about the role of the heat in the sweat lodge in psychological healing:

Eason: What is the role of the heat in the sweat lodge in psychological healing, from your perspective?
Dr. Kerr: It's just a vehicle. I think that the heat moves people into an altered state much more rapidly than other techniques. It raises arousal level and when people are in high state of arousal, when they are a bit frightened and uncomfortable they tend to be more open to interpretations that will help resolve that arousal. They can attribute their resolution of the arousal to that interpretation, so that in the sweat lodge, within 5 minutes, people are sweating and hot and kind of scared and in that state, they are looking - remember it is dark, so in that state of almost no stimulation except the heat and the closeness, they are looking for a way of resolving their anxiety and fear. Often, the particular prayers and interpretations that are made give the person a way out, a way out of that state of fear and arousal, so that if something as simple as telling a story of Atomi and the 49 warriors, there is an interpretation-at the end of the story- it says: and so we realize that Atomi's warriors of fear and doubt are merely illusions. This statement of fear and doubt are illusions if it is timed exactly right, the person has a euphoria sometimes, a catharsis where they recognize not only the fear of the sweat lodge, the fear of the heat and darkness. Somehow it generalizes to their other fears and they recognize their fears are illusionary in their lives.
Eason: Fear becomes a very powerful emotion.
Dr. Kerr: In a way we turn fear back on itself, we turn Atomi's warriors and get them into retreat by showing the illusionary nature of fear. We also show we have control. We have power to control our fear. People learn that the singing and drumming also helps that and they learn a number of ways of managing their fear. In therapy of course, there are procedures like Gestalt techniques that are very confrontive that do the same thing. They raise arousal level to the point the people are just casting around looking for some way for resolving this horrible state that they are in, in fear. And when an interpretation comes around they will often grab at it.
Eason: You mentioned singing and dancing, are they other ways, that you are aware of that you think have the same power that heat, singing and dancing have?
Dr. Kerr: Yes. I think any kind of rigors that we expose ourselves to, again within a safe environment, that essentially make our brain chemicals and our body more ready for change. That is why fasting tends to put people in very receptive states, fasting, various kinds of deprivation and rigors such as running, dancing, these kinds of things. Of course, the dancing is changing heart rate and that sort of thing. So, some rigors sort of just prepare us to be more receptive and some rigors that we encounter just flip the consciousness. One thing I am very interested in looking at is the flip from sympathetic to parasympathetic, there seems to be some sort of move from sympathetic to parasympathetic response that seems to be a very fertile and fruitful time for change to occur.

Conceptualizing the sweating experience as an altered state of consciousness, however, creates additional assumptions and many complexities in terms measurement. The existence of ASCs is still considered controversial and research with ASCs is typically conducted with complex neurological instruments that are costly and require highly specialized training such as in electrophysiological and neuroimaging. Conceptualizing the sweating experience simply as a form of exercise is more parsimonious, makes sense and seems to have better practicality.

In a study with 24 college students exploring the effects of sweat therapy on group dynamics and affect, the researchers attempted to measure the effects of the sweating experience using the Critical Incidents Questionnaire (CIQ) and the Positive and Negative Affect Scale (PANAS) (Colmant, Eason, Winterowd, Jacobs, & Cashel, in press). For both the men and women’s sweat groups, statements classified as Experiential Features on the CIQ indicated that the sweating process promoted relaxation, a relief from stress, and/or a feeling of accomplishment. In fact, the sweating process was noted by participants as one of the most important aspects of their experience as the sweating process was the second most frequently identified factor by women after Acceptance/Cohesion and ranked third for men after Acceptance and Interpersonal Action. Relaxation, stress relief, and/or a feeling of accomplishment were not reported as benefits by any of the non-sweat participants on the CIQ.

These findings, however, were not supported by the results with the PANAS. Participants completed the PANAS at the end of each session. The PANAS measures positive and negative feelings and emotions. It consists of ten positive adjectives and ten negative adjectives. Positive Affect (PA) reflects the extent to which a person feels enthusiastic, active, and alert. In contrast, Negative Affect (NA) is a general dimension of subjective distress and unpleasurable engagement that, “subsumes a variety of aversive mood states,” (Watson et al., p. 1063). Participants are asked to rate the adjectives based on how they feel using a five-point Likert scale (1 = Very Slightly or Not At All, 5 = Extremely). The PANAS is scored by totaling one score for the ten positive adjectives and one score for the ten negative adjectives.

No differences were found between sweat and non-sweat groups in the experience of affect. Timing of administration of the PANAS may have been problematic. In this study, participants were tested immediately after each session and were compared for affect measured after the second session to affect measured after the seventh session. Since measures were not taken before each session, acute changes in affect were not ascertained. Colmant et al. (in press) recommended that it will be important for future researchers to measure subjects’ response at multiple times: before-sweat, during-sweat, and post-sweat. From clinical experience with sweat therapy, people often report feeling their best about an hour after the experience, report sleeping better, and experiencing noticeable positive effects into the following day. In addition, the PANAS may not be sufficiently sensitive to effects of the sweating experience on affect. The domains of the PANAS have been criticized as too restrictive and containing items irrelevant to intense physical activity (McAuley & Courneya, 1994; Gauvin & Rejeski, 1993). Measures of acute exercise-induced changes in affect may be more sensitive to the sweating experience.

McAuley and Courneya (1994) and Gauvin and Rejeski (1993) argue that existing measures of mood and affect such as the POMS and the PANAS do not do well to measure the stimulus properties of the subjective experiences unique to physical activity. McAuley and Courneya argue that the PANAS is problematic from both a conceptual and theoretical perspective as a result of it being a single-item affect scale that presumes that affect is simply bipolar and unidimensional (1994). From their research, the stimulus properties of physical activity include Revitalization, Tranquility, Positive Engagement, and Physical Exhaustion (Gauvin & Rejeski, 1993) and Positive Well-Being, Psychological Distress, and Fatigue (McAuley & Courneya, 1994). The Exercise Induced Feeling Inventory (EIFI) measures Revitalization, Tranquility, Positive Engagement, and Physical Exhaustion (Gauvin & Rejeski, 1993). The Subjective Exercise Experiences Scale (SEES) measures Positive Well-Being, Psychological Distress, and Fatigue (McAuley & Courneya, 1994). Both the EIFI and the SEES were designed to (a) be employed during activity if necessary, (b) be capable of being used in multiple administrations, and (c) be sufficiently sensitive to experiences unique to physical activity (Gauvin, L. & Spence, 1998).

Thinking about intense heat exposure through use of a sauna, steam room, or sweat lodge as a form of exercise provides a useful analogy. The definition of “Exercise”, according to the American Heritage Dictionary, includes “activity that requires physical or mental exertion, especially when performed to develop or maintain fitness” (1976, p. 459). The sweating experience produces profound physiological changes and perceptions of physical symptoms. Both exercise and sauna cause the stimulation of the sympathetic nervous system and the activation of the hypothalamus-pituitary-adrenal hormonal axis and both cause an increase in noradrenaline (E. Guiterrez, personal communication, July13, 2004). However, there does seem to be some notable differences between exercise and the effects of sweating procedures. Unlike in typical exercise activities, sauna causes an increase in β-endorphins and does not increase the concentration of adrenaline in the blood stream (E. Guiterrrez, personal communication, July13, 2004). Sauna also causes muscle relaxation, whereas, typical exercise activities require muscle tension and the movement of large muscle groups.

In recent years, there has been a growing recognition of the role of physical activity in the maintenance and promotion of mental health, psychological well-being, and health-related quality of life (Gauvin & Spence, 1998). Gauvin and Spence explain that, in this regard, a focal point for researchers has been to study the outcomes of acute bouts of physical activity on transient psychological states (1998). They report that, “the literature shows that acute vigorous physical activity results in decreased state anxiety and depression and improved feelings of energy, calmness, and hedonic tone,” (Gauvin & Spence, 1998, p. 325). Furthermore, other researchers have demonstrated that single bouts of physical activity can dampen the reactivity associated with psychosocial stressors that may contribute to the etiology of cardiovascular disease (Blumenthal et al. 1991).

A unique feature of sweating compared to other forms of exercise is that it does not require movement. The fact that sweating does not require movement makes it especially conducive to being combined with counseling and psychotherapy. A noteworthy difference between sweat therapy and experiential activities used in adventure therapy such as ropes is that in ropes, processing mainly takes place after the challenging activity and in the sweat therapy sessions, processing takes 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 sweat therapy sessions, therapist facilitated processing takes place while the participants face the challenging activity of enduring the heat. This provides the opportunity for the therapist and other group members to better enter into an individual’s psychology while they struggle. This opportunity can be especially advantageous when working with people 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. Another 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 can participate in sweat therapy. Heart problems and acute respiratory diseases are of the few conditions that might make intense sweating medically contraindicated.

Research currently underway at Oklahoma State University attempts to replicate the Colmant et al. (in press) 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 (Therapeutic Factors Inventory, Exercise Induced Feeling Inventory, & Subjective Exercise Experiences Scale) and a repeated measures design (pre – during –post – 2 hr post –next day post) with feeling state measures. The purpose of this study is to investigate the effects of sweat therapy on group therapeutic factors and feeling states with a group of college students. The feeling states investigated will include Revitalization, Tranquility, Positive Engagement, Physical Exhaustion, Positive Well-Being, Psychological Distress, and Fatigue.

In summary, the previous literature on the psychological effects of sweating procedures is sketchy and includes a wide variety of topics. There is a lack of randomized controlled studies and many of the studies were conducted with a small number of participants and lacked adequate comparison groups. However, there have been some interesting findings that have important implications for therapeutic and preventive mental health purposes. These findings include that sweating promotes positive effects on sleep, mood and affect, and on hyperactivity, specifically for people with anorexia nervosa. One of the most consistent descriptions is that sweating facilitates relaxation and stress relief. Preliminary research with sweat therapy finds the process of group sweating to be complimentary to group counseling. There is a strong need for replication of studies to better solidify these findings. Utilizing measures of acute exercise-induced changes in affect offers a pragmatic approach at this point in the development of investigating the psychological effects of sweating procedures.

REFERENCES

American Heritage Dictionary. (1976). Boston, MA: Houghton Mifflin Company.

Blanchard, C. W. (1993). Effects of ropes course therapy on interpersonal behavior and
self-esteem of adolescent psychiatric inpatients. Unpublished doctoral
dissertation, New Mexico State University, Las Cruces.

Blumenthal, J. A., Emery, C. F., Madden, D.J., Coleman, R.E., Riddle, M.W., Schiebolk,
S., Cobb, F.R., Sullivan, M.J., and Higginbotham, M.D. (1991). Effects of
exercise training on cardiorespiritory function in men and women >60 years of
age. American Journal of Cardiology, 67, (3), 633-639.

Colmant, S. A. and Merta, R. J. (1999). Using the sweat lodge ceremony as group
therapy for Navajo youth. The Journal for Specialists in Group Work 24, (1)
55-73.

Colmant, S. A. and Merta, R. J. (2000). Sweat therapy. The Journal of Experiential
Education 23, (1) 31-38.

Colmant, S.A. (2003). Sweat Therapy Heals Traditionally. Sweat Magazine, 12, (8), 15-
8.

Colmant, S.A., Eason, E.A., Winterowd, C.L., Jacobs, S.C., and Cashel, C. (In Press).
Investigating the Effects of Sweat therapy on Group Dynamics and Affect. Journal for Specialists in Group Work.

Colmant, S. A. (2004). Heat treatment in Anorexia Nervosa: Interview with Emilio
Gutierrez. In Interviews with Leaders in the Field [On-Line]. Available: www.PsychSymposium.com

Covalt, N. K. (1954). Sauna Baths: A preliminary report. American Journal of Physical
Medicine, 33, p. 216-223.

Dietrich, A. (2003). Functional neuroanatomy of altered states of consciousness: The
transient hypofrontality hypothesis. Conciousness and Cognition, 12, 231-
256. Dittman, M. (2004). Alternative health care gains steam. Monitor on
Psychology, 35 (6), p. 42-45.

Epling, W. F., and Pierce. W. D. (1996). Activity anorexia: Theory, research, and
treatment. Mahwah, NJ: Erlbaum.

Eason, E. A. (2004). Interview with Barbara Kerr. In Interviews with Leaders in the Field
[On-Line]. Available: www.PsychSymposium.com

Frankova, E. and Franek, A. (1990). Relaxace v saunove lazni. Ceskoslovenska
Psychologie 34, (3) 229-241.

Gauvin, L. and Rejeski, J.W. (1993). The Exercise-Induced Feeling Inventory:
Development and initial evaluation. Journal of Sport and Exercise Psychology
15, 403-423.

Gauvin, L. and Spence, J.C. Measurement of Exercise Induced Changes in Feeling States,
Affect, Mood, and Emotions. (1998). In Advances in Sport and Exercise
Psychology Measurement. Morgantown, WV. Fitness Information Technology,
Inc.

Gilbert, N. and Prinz, M. (1986). “Sauna Culture” in Austria: Toward a sociology of the
sauna and its users. Journal fur Sozialforschung, 26 (2) 160-178.

Gutierrez, E., Vazquez, R., and Boakes, R. A. (2002). Activity-based anorexia: Ambient
temperature has been a neglected factor. Psychonomic Bulletin & Review, 9, (2),
239-249.

Kerr, B. & McAlister, J. (2001). Letters to the Medicine Man: The Shaping of Spiritual
Intelligence. Cresskill, NJ: Hampton Press.

Kuusinen, J. and Markuu, H. (1972). Immediate aftereffects of the Finnish sauna on
Psychomotor performance and mood. Journal of Applied Psychology, 56 (4) 336- 340.

LeBlanc, J. Ducharme, M.B., Pasto, L. and Thompson, M. (2003). Response to thermal
stress and personality. Physiology and Behavior, 80, (1) 69-74.

Lambert, K. G. (1993). The activity-stress paradigm: Possible mechanisms and
applications. Journal of General Psychology, 120, 21-32.

Lox, C. L. and Rudolph, D. L. (1994). The Subjective Exercises Experiences Scale
(SEES): Factorial Validity and Effects of Acute Exercise. Journal of Social
Behavior and Personality, 9, 837-844.

McAuley, E. and Courneya, K.S. (1994). The Subjective Exercise Experiences Scale
(SEES): Development and preliminary evaluation. Journal of Sport and Exercise
Psychology 16, 163-177.

Morrow, N. S., Schall, M., Grijalva, C. V., Geiselman, P. J., Garrick, T., Nuccion, S., and Novin, D. (1997). Body temperature and wheel running predict survival times in rats exposed to activity-stress. Physiology & Behavior, 62, 815-825.

Putkonen, E., (1976). Sauna and physiological sleep: Increased slow-wave sleep after heat exposure. In Kauppin, K. and Vuori I. (1985). In Man in the sauna. Annals of
Clinical Research, 18, 173-185.

Routtenberg, A. and Kuznesfof, A. (1967). Self-starvation of rats living in activity wheels
on a restricted feeding schedule. Journal of Comparative & Physiological
Psychology, 64, 414-421.

Sorri, P. (1988). The sauna and sauna bathing habits – A
psychoanalytic point of view. Annals of Clinical Research 20, 236-239.

Sudakov, K. V. Sinitchken, V. V. and Khasanov, A. A. (1988). Systemic responses in man exposed to different heating and cooling treatment in a sauna. The Pavlovian Journal of Biological Science, 23, (3), 89-94.

Watson D., Clark, L.A. and Tellegen, A. (1988). Development and validation of brief
measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54 1063-1070.

Sweat Therapy Dissertation

Stephen’s doctoral dissertation was completed in December 2005.

THE EFFECTS OF SWEAT THERAPY ON GROUP THERAPEUTIC FACTORS AND FEELING STATES

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. Eighty-five (85) university students 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 groups met weekly for six sessions. Measures used 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).

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. 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. 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 lasting several hours. Implications for future research are discussed. Obtain Dissertation

A Multipurpose Mental Health Resource

We have used and considered several types of facilities for the use of sweat therapy - the combination of intense heat exposure with counseling/psychotherapy. These structures have included the sweat lodge, sauna, steam room, etc.

An important consideration in using any specific form of group sweating is to respect the cultural/religious traditions associated with different structures. This is especially important in the case of the Native American sweat lodge.

Another important consideration is practicality. Working as part of an agency which provides counseling/psychotherapy often demands that sessions begin and start on time and occur rain or shine. Counseling agencies are also more likely to be found in an urban setting rather than a rural one.

We recommend that a Finnish-style sauna offers the most practical means of group sweating for developing sweat therapy as a counseling technique. High quality saunas have been manufactured on a large scale for international use for several generations. They can be built for indoor or outdoor use or to fit almost any-sized room. The convenience of operating on electricity allows for ease of scheduling.

One problem in using the sauna for group work is that they are almost always designed in an “L” shape rather than a circle. Use of a sauna with circular seating would lend itself better to group processing. We had the above floor plan drawn up for us by Finnleo also known as Saunatec. To accommodate eleven people, the dimensions of this sauna are 9’ x 12’ x 7’. This sauna sells for about $30,000 (US). We are currently researching potential funding sources to support our dream sauna for sweat therapy.

Having a sauna on agency premises would provide a multipurpose mental health resource. The primary purpose would be to make use of intense heat exposure to help accelerate and intensify counseling process. Sessions can be formatted for specific population needs. The secular nature of this sauna allows for facilitator creativity. Some counselors may choose to incorporate rituals/practices based on the cultural background of themselves and their client(s) with smudging, meditation, prayer, storytelling, or other spiritual practice. The use of music has been incorporated with group sweating by multiple cultural groups. Marine-quality stereos and speakers like the one shown in the advertisement below sold by Poly-Planar advertise to be practically impervious to heat and water exposure and perfect for sauna use. Our work on developing Sweat Therapy Audio opens the door to several possibilities to create experiences complementary to the goals of counseling using audio recordings that incorporate meditation, music, and sweating while participants are encouraged to confront personal challenges. Recordings can be designed for specific populations and issues. And last but certainly not least, let’s not forget about taking care of the caretaker. Having a sauna on agency premises would provide an excellent way for staff to relax, distress, and get rejuvenated.

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.



REFERENCES

Colmant, S. A. and Merta, R. J. (1999). Using the sweat lodge ceremony as group
therapy for Navajo youth. The Journal for Specialists in Group Work 24, (1)
55-73.

Colmant, S. A. and Merta, R. J. (2000). Sweat therapy. The Journal of Experiential
Education 23, (1) 31-38.

Colmant, S and Eason, E. The Cultural Validity of Complimentary and Alternative Medicine Practices. Society of Counseling Psychology, Division 17 of the APA, October 2004 Newsletter.

Colmant, S.A., Eason, E.A., Winterowd, C.L., Jacobs, S.C., and Cashel, C. (In Press). Investigating the Effects of Sweat therapy on Group Dynamics and Affect. Journal for Specialists in Group Work.

Colmant, S. A. (2004). Heat treatment in Anorexia Nervosa: Interview with Emilio
Gutierrez. In Interviews with Leaders in the Field [On-Line]. Available: www.PsychSymposium.com

Connelly, J. (1986). Premature termination in group psychotherapy: Pretherapy and early
therapy predictors. International Journal of Group Psychotherapy, 36, (2), 145-
152.

Frankova, E. and Franek, A. (1990). Relaxace v saunove lazni. Ceskoslovenska
Psychologie 34, (3) 229-241.

Gauvin, L. and Rejeski, J.W. (1993). The Exercise-Induced Feeling Inventory:
Development and initial evaluation. Journal of Sport and Exercise Psychology
15, 403-423.

Gauvin, L. and Spence, J.C. Measurement of Exercise Induced Changes in Feeling States,
Affect, Mood, and Emotions. (1998). In Advances in Sport and Exercise
Psychology Measurement. Morgantown, WV. Fitness Information Technology,
Inc.

Kuusinen, J. and Markuu, H. (1972). Immediate aftereffects of the Finnish sauna on
Psychomotor performance and mood. Journal of Applied Psychology, 56 (4) 336- 340.

McAuley, E. and Courneya, K.S. (1994). The Subjective Exercise Experiences Scale
(SEES): Development and preliminary evaluation. Journal of Sport and Exercise
Psychology 16, 163-177.

McGrane, K. Have Yoga Mat Will Travel. New York Times January 31, 2002.

Mills, K. L. and MacNair-Semands, R. R. (2003). Validity test of the Therapeutic Factors
Inventory Scale: A correlational study of three instruments. Unpublished manuscript.

Putkonen, E., (1976). Sauna and physiological sleep: Increased slow-wave sleep after heat exposure. In Kauppin, K. and Vuori I. (1985). In Man in the sauna. Annals of
Clinical Research, 18, 173-185.

Vogel, V. (1970). American Indian Medicine. University of Oklahoma Press.

Yalom, I. D. (1995). The theory and practice of group psychotherapy. New York, N.Y:
Basic Books.

Clinical Implications of Thermal Therapy in Lifestyle-Related Diseases

Systemic thermal therapy, such as taking a warm-water bath and sauna, induces systemic vasodilation. It was found that repeated sauna therapy (60°C for 15 min) improved hemodynamic parameters, clinical symptoms, cardiac function, and vascular endothelial function in patients with congestive heart failure. Vascular endothelial function is impaired in subjects with lifestyle-related diseases, such as hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking. Sauna therapy also improved endothelial dysfunction in these subjects, suggesting a preventive role for atherosclerosis. In animal experiments, sauna therapy increases mRNA and protein levels of endothelial nitric oxide synthase (eNOS) in aortas. In normal-weight patients with appetite loss, repeated sauna therapy increased plasmaghrelin concentrations and daily caloric intake and improved feeding behavior. In obese patients, the body weight and body fat significantly decreased after 2 weeks of sauna therapy without increase of plasma ghrelin concentrations. On the basis of these data, sauna therapy may be a promising therapy for patients with lifestyle-related diseases. READ FULL ARTICLE

Sweat Away Depression

Masuda, Nakazato, Kihara, Minagoe, Tei. (2005). Repeated Thermal Therapy Diminishes Appetite Loss and Subjective Complaints in Mildly Depressed Patients. Psychosomatic Medicine 67:643-647.

Abstract

Objective:

We observed that repeated thermal therapy improved appetite loss and general well-being in patients with chronic heart failure. The purpose of this study is to clarify the effects of repeated thermal therapy in mildly depressed patients with appetite loss and subjective complaints.

Methods:

Twenty-eight mildly depressed inpatients with general fatigue, appetite loss, and somatic and mental complaints were randomly assigned to thermal therapy group (n = 14) or nonthermal therapy group (n = 14). Patients in the thermal therapy group were treated with 60°C far-infrared ray dry sauna for 15 minutes and were then kept at bed rest with a blanket for 30 minutes once a day, 5 days a week for a total of 20 sessions in 4 weeks.

Results:

Four weeks after admission, somatic complaints, hunger, and relaxation scores significantly improved and mental complaints slightly improved (p = .054) in the thermal therapy group compared with the nonthermal therapy group. Furthermore, the plasma ghrelin concentrations and daily caloric intake in the thermal therapy group significantly increased compared with the nonthermal therapy group.

Conclusions:

These findings suggest that repeated thermal therapy may be useful for mildly depressed patients with appetite loss and subjective complaints.

To obtain this article

http://www.psychosomaticmedicine.org/cgi/content/abstract/67/4/643

Using the Sweat Lodge Ceremony to treat Veterans with PTSD

Solace of heat

Traditional Native Amercan sweat ceremonies at a veterans' medical center in Salt Lake City offer patients an alternative path to healing

By Jessica Ravitz
The Salt Lake Tribune
Salt Lake Tribune
Article Last Updated:11/13/2006 04:37:07 PM MST

Editor's note: Reporter Jessica Ravitz participated in a sweat ceremony at Veterans Administration Medical Center in Salt Lake City and shares a view from the inside. The names of veterans receiving substance abuse treatment have been changed in the story to protect their identities.

Native American men often returned home from battle haunted. The violent images of actions including their own left their spirits wounded. To mend that which had been broken, many tribes welcomed the warriors with the warmest of embraces. A sweat ceremony, a purification ritual, helped bring the men peace and make them whole.

Fast forward hundreds of years to Vietnam flashbacks, IEDs in Iraq, foreign deployments that last for months, even years, on end. Today psychologists regularly invoke the term "post-traumatic stress disorder." Combine combat trauma with perhaps a history of sexual, physical or emotional abuse, divorce, unemployment or even homelessness, and it's no wonder substance abuse programs at Veterans Administration hospitals see a steady flow of patients.

Shame and guilt, after all, can drive the most well-meaning of individuals to self-destruct.

Salt Lake City's VA Medical Center is tapping into an age-old tradition to help these troubled veterans, inviting them, voluntarily, to sweat, regardless of their backgrounds.

"Oftentimes vets who have been in combat, their spirit is still overseas," says Arnold Thomas, the spiritual leader who conducts the twice-monthly and year-round ceremonies in the VA hospital's sweat lodge. We want to bring "his spirit back into his body and welcome him home again."

Tucked behind Building 4 on the sprawling VA hospital campus, beyond the metal gate featuring a medicine wheel and the word Purtkwahgahm (Ute Indian for "healing ground") sits the sweat lodge, established more than four years ago.

A handful of veterans, including alumni and others currently in the North Star substance abuse program, help prepare for the ceremony. They chop kindling, for several hours, to fuel the fire that'll heat more than 30 lava stones. Several men, including one Native American in a T-shirt featuring an eagle and the phrases, "Pure American" and "Live Free," stand by ready to assist in building the fire, setting up the altar and doling out prayers.

James, an Anglo veteran in recovery after a 30-year addiction to cocaine, says the treatment program and the sweat ceremonies have saved him.

"It's a spiritual cleansing," he says about the sweat, which lasts about four hours. "It purges my body of toxins. When I'm done, I feel high."

Sweat practices vary by tribe, among those that observe the ceremony, but today's consists of four rounds. With the use of rattles, drums, herbs thrown on the hot stones, chants and traditional song, the spiritual leader and participants pray for others, not themselves. The first round is for the unborn and infants, the second young people, the third adults and the fourth the elderly and those who have "gone before us," Thomas explains.

"Our ceremonial rites are about giving... We're taught not to pray for ourselves," says the spiritual leader, who also invites participants to include prayers of gratitude and healing.

The actual sweat lodge, a small dome-like structure, is modeled in the Plains Indian tradition, framed in willow branches tied to replicate a buffalo's body (a long veterbrae and rib cage). It's heavily draped with thick military-green woolen blankets and a canvas tarp, all meant to hold in the heat and moisture while keeping the inside pitch black. The lodge symbolizes the womb of Mother Earth, and ceremony participants emerge from the experience reborn.

Thomas crawls through the sweat lodge door, or flap, which faces east. He's making final preparations, clearing out the pit inside, blessing it with tobacco and feeling his way as he sets up the altar that stands between the lodge and fire.

The Shoshone-Paiute, now of Salt Lake City but once of the Duck Valley Indian Reservation of Idaho and Nevada, has his own traumatic story. After his father committed suicide, Thomas - a former star athlete in high school - steeped himself in drugs and alcohol. At 18, he lodged a 30-30 hunting rifle beneath his chin and fired, trying to kill himself. Instead he blew off almost half his face and survived, leaving himself permanently blind and unable to speak for several years.

Eventually Thomas, 36, turned to tribal traditions to learn about forgiveness and deal with his pain, anger and guilt. He found healing and balance, relying on elders who taught him to help others. Along the way he earned a master's degree in social work from the University of Utah and now works with Volunteers of America. When he isn't at his day job, providing spiritual guidance or leading ceremonies at the VA hospital or Salt Lake's Indian Walk-In Center - he used to lead sweats at the state prison, too - he travels North America as a motivational speaker.

On this day, a group of men and one woman stand beneath an overcast sky as the ceremonial fire roars. Dan, an Anglo first-timer snug in his West Coast Choppers sweatshirt, looks for last-minute tips.

"I heard if it gets too hot, I should meditate, right?" he says.

"Be in your prayers, because then you're in your spirit. And your spirit doesn't know heat, fatigue or thirst," advises Rod Betonney, a Navajo who's worked in the drug and alcohol field for 20 years and is an addiction therapist at Eagle's Nest, the residential component of the VA's treatment program.

Betonney has laid the groundwork, giving participants a general understanding of the sweat, before the spiritual leader takes over.

From wooden boxes and ornate wrapped bags, Thomas pulls out the materials to create the altar, muttering prayers in Shoshone. A staff, the wood-burnings completed by a Vietnam veteran from Michigan, stands in the altar, a small mound of earth. Arranged around it are items including a buffalo skull, elk hide and cocoon rattles, a drum, a fan made of eagle feathers, a set of antlers and a can of tobacco.

Participants circle the fire, sprinkling tobacco and their own prayers on the flames. A tin can holding burning embers and cedar is carried around, the smoke directed toward each person with the waving of feathers. The plumes of smoke carry prayers skyward and bless the sweat before it begins.

The men strip down to shorts or swimming trunks. Women are asked to wear a long skirt and short-sleeved T-shirt. While some tribes prefer single-sex sweats, others allow co-ed participation. The VA, a federal program, must be open - both to genders and belief systems. If a participant wishes to pray to Jesus or recite verses of Quran while sweating, that's just fine.

"Pray to whatever it is you believe in," Betonney says.

With Thomas seated in the lodge, the group of about a dozen slowly enter. On their hands and knees, the participants - about half Native American, the others Anglo - greet the spiritual leader with: "Permission to enter." He welcomes each person, one by one, as they add the words, "All my relations," and crawl in a clockwise circle to take their positions. The space is no more than 5 feet high and about 12 feet in diameter, and on some occasions, holds up to 25 people. In the center is the pit where hot stones will be placed. A bucket of water is on hand, not to drink, but to pour on the rocks and fill the lodge with steam.

No one can say just how hot it'll get. Answers, from people who've been to a sweat before, range from "damn hot" to "very frickin' hot." But the point is to separate from the physical, detach and lose oneself in prayer. James speaks of having hallucinations, seeing "fairy shadows" and images of a "veil blowing in the wind." If the heat becomes unbearable, some suggest putting your head on Mother Earth.

"She'll take care of you," they say.

The stones, said to represent ancestors or teachers, are brought in one by one by the "fire man," a participant who keeps the fire going and brings fresh hot stones into the lodge before each round. "When they're real hot" the man, who's both Navajo and Hopi, says later, "you can see their faces."

"They speak to you," Betonney adds, "through the steam."

The fire, Thomas says, "symbolizes the same fire that's in you ... that spirit that's burning in you."

The darkness inside is the kind where you can't see your hand in front of your face. Sometimes, when cedar, sage or sweet grass is sprinkled on the stones, which might glow if they're hot enough, you can see the orange of the burn. The sweet smells fill the crowded space, as do the rhythmic beatings of the drum and shakings of rattles, the Shoshone songs and chants. Participants pray, some silently, some in whispers, others in moans or cries. They pray for their loved ones - from the past, present and future - and pray for the people they speak of and share stories of between rounds.

One veteran, who's disconnected from his own children, asks everyone to "pray for fatherless chldren and childrenless fathers." Simon, an Arapoho, speaks of an uncle who just killed himself and a cousin who died in a car wreck. Betonney requests prayers for friends who are struggling with addiction. Many of the men, including Thomas, speak of soldiers and veterans who need peaceful lives and states of mind.

When the flap opens, after each round, the released steam carries the groups' prayers. The cool air that enters is said to be the breath of the creator.

Participants are encouraged to stay for all four rounds, to "complete the circle," but doing this isn't easy. Dan, the first-timer, begins a mad scramble toward the exit after the first round. "I've got to get out of here," he cries. "I'm sorry, but I can't do it."

Thomas reaches out to the sound and talks Dan down as the others look on. He asks Dan, who's fought in three wars, to bow his head to Mother Earth. Dan is blessed with special prayers. Eagle feathers and cedar smoke are waved around his drenched body. And in the end, this veteran breathes easier, finds a sense of calm and retreats to his spot in the lodge. "This is really something," he says later. "I'm never going to forget it."

Later, after the second round, Simon - his face to the ground - moans: "I'm going to be sick." He crawls from the lodge and wretches, repeatedly, outside. Thomas and several assistants join him for blessings by the spiritual fire. They pray for his healing and strength. Having just been in treatment for a few days, the poisons are still deep inside and need to come out. Purged, Simon crawls back inside to join the group.

Between rounds, participants sprawl on the floor. Some lie flat on their backs, knees up; others are in the fetal position or face down. Still others look around, sharing nods of encouragement and gentle smiles. With towels, they wipe away sweat as it pours from their skin, soaking their clothes and hair.

About a third to half of the 15 veterans enrolled in the Eagle's Nest residential treatment program do the sweat at any one time, Betonney says. The other participants are alumni, those receiving outpatient services, or - at today's sweat - Native American veterans getting treatment in the Volunteers of America detoxification program. Many share stories of gratitude. A Navajo vet, who was once living on the streets, says reconnecting with his spiritual side allowed him to move in the right direction.

"You can take yourself to this place [spiritually] any time and any place you want," Betonney likes to remind participants.

The sweat ends as dusk begins to fall. The group, in their dripping clothes, gathers outside and shares deep embraces. James, clean for 115 days, walks out smiling, likening the high, the experience, to doing "an eight-ball of cocaine."

But this is a high of another sort. The sweat lodge experience is one that this veteran, and the others who pray for him, hope will help build him up, bring him peace and make him whole again.

JESSICA RAVITZ can be reached at jravitz@sltrib.com or 801-257-8776. Send comments to the religion editor at religioneditor@sltrib.com.

ARTIST INVITES PUBLIC TO GET NAKED FOR SAUNA EXHIBITION AT CATALYST ARTS BELFAST

Is art good for you? Of course it is - especially when it’s by Joanna Karolini. The Polish-Danish artist has erected a fully-functioning Finnish sauna in the Catalyst Arts Centre in Belfast and is inviting the public to strip off and reap the physical and social benefits of her work.

The show, titled The Bath is Hot, is running until March 9 2007. As well as the sauna, video footage, photographs and objects all illustrate the cultural background of saunas and bathing facilities in various countries.

“I want to use the space to encourage viewers to come to the gallery to pursue leisure and health,” said Karolini, “and the sauna to be a catalyst for social exchange, discussions and a warm platform where other events can take place.”
The sauna can be booked for either mixed or single-sex evening sessions or a family session on Saturday afternoons. A naked mixed session is also available on Tuesday nights.
Karolini reports a very positive response from the public, and the gallery has already received several bookings for the nude session. Day visitors can view the exhibition and walk into the sauna when cold.

The artist says her work is about reminding people of the often forgotten links between art, leisure, health, and social interaction. Karolini notes that Roman baths were not only a place to get clean, but also a social haven where lectures and readings could be heard.

She states that health has been separated from art-culture in this country describing gyms as often, “cold” and “functional” where people unsociably put their headphones in to pound the treadmill.

Museum Exhibition link: http://www.catalystarts.org.uk/exhibitions/2007/karjoa/karjoa.html#slide2

Sweat Therapy: Considering Cultural Appropriation and Cultural Integration

In the United States, many people are familiar with the American Indian sweat lodge ceremony and respect the practice as a sacred religious ceremony. Few know the background of the sauna and steam room in their local gym, where it came from or how it got there. Often, when discussing the potential for using sweat practices to promote well-being, the concern of cultural appropriation from American Indian cultures is raised. Cultural appropriation is the adoption of some specific elements of one culture by a different cultural group. The term is often used to mean the theft of icons, rituals, and behavior from one culture or subculture by another, generally by a dominant culture from a minority culture.

Many non-American Indian groups have 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 as de-stressing at Native American sweat lodges have been a trendy thing to do. An Internet search in 1999 found 3659 web pages using the term “sweat lodge”. In July, 2004 there were 55,400 and in January, 2007 there were 1,100,000. 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”.

Indeed, the sweat lodge ceremony could be the poster child for cultural appropriation. 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 our 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). Considering the ideas of cultural theft and exploitation is long overdue.

On the other side of the continuum, when it comes to sweat practices, the threat of “cultural appropriation” can be so daunting to some that they are unwilling to consider the use of group sweating at all without having an actual medicine man to build a lodge and conduct a ceremony. At a recent conference, I met a facilitator of an experiential wilderness program. She thought that the youth she worked with could benefit from sweating but feared there was no way she could incorporate the activity without a Native American traditional healer. American Indians are not the only people who have built sweat baths of branches, blankets, and earth. Sweat practices are not unique to any one culture, have existed throughout the world for thousands of years and continue to be developed. Culture is not static. The integration of cultures occurs constantly and is a natural consequence of human interaction, particularly over time. The question, “Should new and better sweat procedures be developed?” is irrelevant. New sweat procedures integrating ancient traditions with new technologies are regularly developed. A better question is: “How should new and creative sweat procedures be developed?”

Looking at the ancient forms of sweat practices, there are common adjunctive practices that people have found complementary to sweating. Some of these practices include meditation, music, aromatherapy, and close interpersonal interaction. We encourage people to be creative with their sweat procedure and experiment with different practices to create their own rituals.

Human beings are hardwired to use rituals and symbols just as we are to develop language. Rituals and symbols are used to honor our values. They are often the grease for the wheels to get the process moving to a deeper level more quickly. When used within a group, rituals and symbols can help to focus interaction and promote a sense of social solidarity and group identity. For example, a group the first author works with on the Cherokee reservation has a strong value of respect for self-disclosure and for the entire group to listen when one person is talking. We have an agreed ritual to take turns summarizing how our week went. We use an eagle feather to symbolize this ritual. For the Cherokee, the eagle symbolizes peace. The eagle feather is treated with great care. It must never touch the ground and is kept in a cedar box when not in use. When we bring out the eagle feather, the entire group is quickly focused on this process. No words are necessary to explain it and we are all of one mind during that time – respect for one another and attention to each others concerns.

When developing one’s own sweat procedure and rituals, it is important to consider the idea of Cultural Appropriation. Most people would find it exploitive for a non-Indian to start calling himself “Medicine Man” and charging people money to participate in ceremonies he knows little about. But what about burning sage on the rocks or praying in your sweat? Is this cultural appropriation? Is there any practice that didn’t originate somewhere else first? There are often no clear answers on the subject of cultural appropriation.

We offer two general guidelines to avoid negative aspects of cultural appropriation. First, learn as much as you can about any of the rituals/practices that you plan to use. Where did the practice come from? How did it develop? What other groups use it? What are some of the meanings attributed to it? Secondly, consider the differences between common practices versus culturally specific practices. The Navajo Mountain song is a culturally specific practice. Music is a common practice to all cultures. Integrating practices that are common rather than culturally specific help keep one out of the realm of cultural appropriation. We also challenge people to explore cultural specific practices that are consistent with their own background.

Common Practices to Consider Integrating

Intensify your sweat practice by adding another dimension to it with meditation, music, smudging/incense, and close interpersonal interaction. These activities are common adjunctive practices used in many ancient forms of sweat practices and integrate well with sweating.

Meditation

Meditation naturally emerges while sweating. The intense heat promotes introspection and deep relaxation while the participant cultivates an attitude of calmness and self-regulation. This can grow to include the development of other mental qualities such as concentration, love, or wisdom. As is true with any discipline, to become skilled in meditation takes time and practice. Yet anyone can meditate. Here are some thoughts and reflections to consider for a sauna meditation:

Sitting erect but not rigid, lean against the back of the sauna, placing your hands comfortably in your lap. Let your body and mind rest and relax and get into the heat.

When you feel comfortable with it, allow your eyes to gently close. Tune in to the feeling of the breath moving in and out of your body, allowing yourself to breathe mostly through your mouth as the hot air stings the nostrils. Focus on the sensation of the hot air moving in and out of your mouth.

Let your body relax and as you sweat, think about the stress leaving your body. Negative energy leaves your body as you sweat. As the sweat leaves the pores of your skin so does anger, frustration, and tension. Relax and enjoy the heat.

Just become as comfortable as possible. The intense heat of the sauna is gentle at first, providing a very warm, relaxing feeling.

Some people sweat immediately and others take longer. Notice how your body reacts to the heat. As the sweat begins coming to the surface of your skin. Notice the feeling of your body.

Feeling relaxed and calm, the intensity of the heat grows. You may begin to struggle slightly as the heat works its way through your body. As the heat intensifies, so does the amount of stress and anxiety that is released.

Each time that you find your mind wandering off, simply bring it back to your breathing.

For further work on meditation:

Personal instructors can be helpful and meditation groups are now widespread.

Those wanting to further their learning meditation might also consider these books:

• Tart, C. (2001). Mind Science. Novato, CA: Wisdom Editions.

• Bodian, S. (1999). Meditation for dummies. Foster City, CA: IDG Books Worldwide.
Some excellent guided meditation audio recordings:

• Mindfulness Meditation Practice CDs and Tapes with Jon Kabat-Zinn – Series 2 Link:http://www.mindfulnesstapes.com/index.html

• Guided Meditations: For Calmness, Awareness, and Love by Bodhipaksa. Link: http://www.wildmind.org/

Music

Music having therapeutic benefits has long been known. Music’s ability to calm, stimulate the imagination, and to promote healing is documented in the Bible and in other ancient sources. Often cited is that the Biblical David played the harp for King Saul to help absolve his moods of despondency. Shamans and healers of many cultures have used music in their rituals and healing practices from ancient times.

Music therapy is included in many departments of integrative medicine, offering mind-body techniques designed to introduce positive thoughts, familiar images, pleasant associations, peaceful mood, and enjoyable feelings. The effects of music may be profound relaxation, a peak experience of joy, or a depth of understanding or insight. From research with music therapy, we know that music is associated with a decrease in depression, improved mood, and a reduction in pain, stress and anxiety. Music therapy has also been shown to improve various aspects of social interaction.

Exactly how music operates to cause the above effects is unknown. So, be careful of products claiming to elicit certain emotional states by targeting brainwaves with particular sound frequencies. Our understanding of how music works is not quite that far along yet. Popular theories of how music may operate physiologically include that (1) sound or music may stimulate involuntary centers in the central nervous system, causing physiological reactions that later are involved in conscious thought; (2) music may be transmitted first to higher levels of the brain, where sounds become involved with emotion and abstract thought before affecting physiology; or, (3) both the first and second mechanisms work in concert.

Musical preference has been identified as one of the most important factors mediating the beneficial effects of music. Music has a very personal and intimate meaning for each individual and may have either a calming or a stimulating effect. Researchers have found that such factors as the environment, health state, degree of alertness or fatigue, degree of familiarity with music used, and previous musical experience could have an influence on the effects of music. Most music therapy studies have focused on reducing anxiety. Characteristics of the type of music found to reduce anxiety include simple repetitive rhythm, predictable dynamics, low pitch, slow tempo, consonance of harmony, no percussion instruments, string composition, and recognized instrumental and vocal timbre. Others found that slow, quiet, non-vocal music lowered physiological responses associated with stress, whereas faster music generally heightened the physiological responses.

A great way to incorporate music into your sweat routine is if you own your own sauna. There are several manufacturers of marine-quality stereos and speakers that advertise to be practically impervious to heat and water exposure and perfect for sauna use. One manufacturer is Poly-Planar (see www.polyplanar.com). If you don’t own your own sauna, you can bring music into your sweat session with the use of a hand-held personal audio player with headphones. We have used several types of personal audio players including digital music players inside saunas and have not experienced any problems with the sauna conditions causing damage to the music players. One reason for this might be that the heat exposure is relatively brief (about 15-minutes before taking a break). However, if you are still worried about possibly damaging your audio player, you can insulate your audio player simply by wrapping a towel around it. Your other option is to buy a CD player just for sauna use for as little as $10 (US) so if it does happen to get damaged, it is not the end of the world.

Smudging/Incense

The releasing of fragrant smoke from plant or animal sources often with the use of essential oils as part of a ritual has been used worldwide for thousands of years and can be found today in rituals used in every major religion. The Greek historian Herodotus reported its use among the Assyrians and Babylonians, while on Egyptian monumental tablets kings are represented swinging censers. In Jewish rituals it entered very extensively, being used especially in connection with the Eucharistic offerings of oil, fruits, and wine, or sacrifices. By the command of God, Moses built an altar of incense, on which the sweetest spices and gums were burned. It has been popularly used for thousands of years within India as an integral part of Hindu deity worship. Chinese and Japanese society used incense as a time keeping device in the form of incense clocks. It holds an important purpose in Buddhism and in the Catholic Church.

Traditionally, incense and smudging are used for cleansing, purification, protection of physical and spiritual bodies, banishment of negative energies and creation of sacred space. Many believe that incense or smudging releases the energy and fragrance of the herbs and botanicals so they can heal and promote well-being. Today, aromatherapy – the therapeutic use of essential oils and plants - is a multimillion dollar business. Aromatherapy products include diffusers, lamps, pottery, candles, pendants, earrings, shampoos, skin creams, lotions, and bath salts, and shower gels. Proponents claim that aromatherapy can stimulate the immune system, improve concentration, relieve pain, muscle aches, and act as an aphrodisiac. Some claim that aromatherapy can be used for a multitude of purposes from athlete’s foot to enlightenment and everything in between. The clinical research, however, on the therapeutic use of aromatherapy does not support such claims.

What is not in doubt is that smell is a powerful sense. The olfactory system, the apparatus responsible for our sense of smell, has a pathway in the brain closely associated with the limbic system. The limbic system contains the amygdala and the hippocampus parts of the brain which are closely associated with emotion and memory respectively. The sense of smell is especially powerful in triggering memory. So if you want to use a symbol as part of a ritual that gets everyone’s attention, the sense of smell is hard to beat.

Try experimenting with different herbs. Sage, cedar, and mountain tobacco are often used in sweat lodge ceremonies. Eucalyptus is also worth trying. Burning herbs in a sweat lodge is done conveniently by sprinkling some over the hot rocks inside the lodge. Be careful not to use too much making it hurtful to breathe. It doesn’t take much to create a pleasant aroma. Inside a sauna, smudging or incense can be better achieved using a smudge pot or firebowl – simply a ceramic or clay bowl used for burning herbs. Some mix essential oils with water and pour the mixture over the hot rocks.

Close Interpersonal Interaction

Friendships and intimate relationships enhance the quality and length of one’s life. Isolation, alienation, and separation from others generally are associated with all manner of poor health conditions and greater susceptibility to premature death, while social support remains one of the strongest identified predictors of positive mental health over the lifespan.

Sweating accelerates and intensifies group interaction. Close interpersonal interaction is a main purpose of the different forms of sweating used around the world. For many Native Americans, once a sweat lodge ceremony is concluded, the participants consider one another as brothers. In other words, friends who sweat together, stay together. The focus of our research with sweating has been on how the experience affects how people interact with one another. As opposed to non-sweat conditions, we found that sweating caused a greater attraction to the group and its members, and that people were more willing to open up and self-disclose (Colmant, Eason, Winterowd, Jacobs, & Cashel, 2005; Colmant, 2005).

One of the best ways to sweat is to share the experience with close friends or family members. And it’s also a great way to make new friends. You can gradually build a sweat group over time. If you are using a sauna at your local gym, and you perform your sweat session at the same time each week, you’ll find that you start seeing the same people there. Before you know it, your own sweat crew will begin to form. Invite friends to come to the sauna with you. If you have your own sauna or sweat lodge, start to collect sweat goers by inviting people to join in and again, before you know it, you will have a cohesive group of sweaters. People will bring food for afterwards and the experience becomes an event.

Examples of such groups are everywhere. One example is the Iowa Pond Sauna Tribe. John Reeves, a salesman of Fairfield, Iowa built a sauna over a pond near his home in the Summer of 2003. Two of his friends helped him. See above picture. They do a sweat session every Sunday from 6:00 to 8:00 PM. Eight to fourteen people typically attend. The participants come from a wide range of backgrounds and often from all over the country and the world – a veterinarian, high school and college students, construction workers, cooks, teachers, massage therapists, spiritualists, and wild land firefighters. They use a wood burning stove and the sauna is usually ready in about thirty minutes. A five-gallon bucket of well water is carried in that sometimes has essential oil mixed in, such as eucalyptus, lemon oil, or orange oil. People cool off by sitting outside, swimming in the pond, rolling in the snow, or by using a garden hose. A potluck meal is held afterwards. So if you are ever in Southeast Iowa on a Sunday, stop by the Iowa Pond Sauna for a good sweat session and the company of some “neo-primitive extreme-heat worshippers” but make sure you call in advance to reserve a spot as the event has become quite popular.

Future Research

A current priority for our future research is to use sweat therapy with different populations and issues. We are currently pursuing grant funding to support investigating the use of sweat therapy as part of a substance abuse intensive outpatient program. A Finnish-style sauna offers a practical means of group sweating for developing sweat therapy as a counseling technique. High quality saunas have been manufactured on a large scale for international use for several generations. They can be built for indoor or outdoor use or to fit almost any-sized room. The convenience of operating on electricity allows for ease of scheduling.

One problem in using the sauna for group work is that they are almost always designed in an “L” shape rather than a circle. Use of a sauna with circular seating would lend itself better to group processing. We had the above floor plan drawn up for us by Finnleo also known as Saunatec. To accommodate eleven people, the dimensions of this sauna are 9’ x 12’ x 7’. This sauna sells for about $15,000 (US).

Having a sauna on agency premises would provide a multipurpose mental health resource. The primary purpose would be to make use of intense heat exposure to help accelerate and intensify counseling process. Sessions can be formatted for specific population needs. The secular nature of this sauna allows for facilitator creativity. Some counselors may choose to incorporate rituals/practices based on the cultural background of themselves and their client(s) with smudging, meditation, prayer, storytelling, or other spiritual practice. The use of music has been incorporated with group sweating by multiple cultural groups. Marine-quality stereos and speakers advertise to be practically impervious to heat and water exposure and perfect for sauna use. Our work on developing Sweat Therapy Audio opens the door to several possibilities to create experiences complementary to the goals of counseling using audio recordings that incorporate meditation, music, and sweating while participants are encouraged to confront personal challenges. Recordings can be designed for specific populations and issues. And last but certainly not least, let’s not forget about taking care of the caretaker. Having a sauna on agency premises would provide an excellent way for staff to relax, distress, and get rejuvenated.

References

Colmant, S. A., Eason, E. A., Winterowd, C. L., Jacobs, S. C., & Cashel, C. (2005). Investigating the Effects of Sweat therapy on Group Dynamics and Affect.Journal for Specialists in Group Work, 30(5), 329-341.

Colmant, S.A. (2005). The Effects of Sweat Therapy on Group Therapeutic Factors and Feeling States. Unpublished doctoral dissertation, Oklahoma state University, Stillwater, OK.

Hirschfelder, A. and Paulette, M. (1992). The Encyclopedia of Native American Religions. New York, NY: Facts On File.

Quinn, W. J., & Smith, T. E. (1992). The sweat lodge ceremony in challenge/adventure programming. Proceedings of the International Conference of the Association for Experiential Education 20th, Banff, Alberta, Canada.

Introducing: The Sweat Therapy Sauna

The world’s first Sweat Therapy Sauna was completed today! Click on pictures to enlarge view.

“What the hell is a Sweat Therapy Sauna,” you ask? The Sweat Therapy Sauna was designed specifically for group work. The design was influenced by the Finnish Sauna, the American Indian Sweat Lodge, and modern technology.

Like a common sauna, it was built with conventional wood-framed construction with insulation between vertical studs, the interior lined with cedar walls and benches. It is heated with an electric heater. Like an American Indian sweat lodge, the Sweat Therapy Sauna allows people to sit in a circle to promote group cohesion. The heating element is placed in the center. It is windowless to control lighting to promote intimacy and introspection and contains a stereo system to make use of the therapeutic benefits of music.

The dimensions of the Sweat Therapy Sauna are 10’ x 10’ x 7’ and can accommodate about 12 people. The 15 KW electric heater is a stainless steel floor model purchased from Finlandia Sauna. Four recessed ceiling lights operate on a dimmer switch. The stereo is a waterproof marine audio system that includes an amplifier, MP3 connector, and four speakers purchased from Poly-Planar. A shower is installed on the outside of the right front wall.

This project was a long time in the planning. I completed my doctoral dissertation in 2005 - THE EFFECTS OF SWEAT THERAPY ON GROUP THERAPEUTIC FACTORS AND FEELING STATES. The primary purpose of the 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 85 college students. Overall, I found that participants in sweat groups had superior group cohesion and interpersonal interaction than participants in non-sweat groups (groups held in a standard office setting). It was clear that the sweat experience accelerated and intensified group dynamics. It seemed to me that the differences between the sweat and non-sweat groups would have been even greater if participants in the sweat groups were able to sit in a circle (a fundamental technique in any group work). One of the study’s limitations I identified was that -

“the seating arrangements in the saunas used were set in an “L” shape rather than a circle. Use of a sauna with circular seating would lend itself better to group processing.”

Soon after I completed my dissertation, I began looking into obtaining a circular sauna and quickly found that . . .there was no such thing. Saunas are either built with one wall of seating or with two walls of seating in an “L” shape. At the very most, there are designs for 3-sided seating in a “U” shape. My requests for a customized circular design from pre-cut and pre-fabricated sauna manufacturers resulted in estimates way out of my price range. It looked like the only way my Sweat Therapy Sauna was going to become a reality was if I got a big fat research grant and obtaining one would not be easy. The idea was shelved as part of a 5-year plan. The Sweat Therapy Sauna would not have become a reality without the help of Kevin Trautman.

Kevin Trautman, owner of Trautman Woodworks located in the Sylva area of North Carolina is a contractor. His daughter and mine are friends and both just completed the 4th grade. Soon after I told Kevin of my dreams and woes, he quickly told me to cheer up and said that he and I could build the Sweat Therapy Sauna ourselves for a fraction of the price of the estimates I was given. I told Kevin that I have absolutely zero mechanical ability but he was unconcerned. Together we launched off into this project with Kevin as the technical expert and master craftsman and me as the visionary/laborer.

I would have been satisfied with a sauna that looked like a box just as long as my criteria were satisfied – (1) Circular Seating, (2) Kick-Ass Heating Element in the Center, (3) Stereo, and (4) Control of Lighting. Kevin heard what I wanted but demanded that it look sharp.

Kevin’s work must be described as no less than artistry. He made sure to meet my specifications and went above and beyond. From start to finish, the three principles that guide his work are Durability, Practicality, and Beauty. He continually came up with creative ideas to improve on my project and was a pleasure to work with.

Here is Kevin’s contact information:

Kevin Trautman
TRAUTMAN WOODWORKS
Serving Jackson, Macon and
Surrounding Counties
Home: (828)631-9169
Cell: (828)226-2349
Trautman2@verizon.net

If you are interested in coming out to my home in Bryson City, NC to try a sweat session, send me an email and I will give you a couple of dates to choose from. I would also be happy to host an exclusive sweat session for your group. You can contact Stephen at COLMANT@GMAIL.COM. Yvette is available to host women-only sessions. You can contact Yvette at YCOLMANT@GMAIL.COM

Sweat Therapy Theory

Our Sweat Therapy Theoretical Model explains the mechanism for how sweat practices work to cause therapeutic effects. Our model begins with examination of cultural priming. Beyond a cultural predisposition toward the activity, four main factors are hypothesized to account for the psychotherapeutic benefits: (1) Exercise, (2) Self-Regulation, (3) Interpersonal Factors, and (4) Metaphorical Contextual Elements. These factors interact in a reciprocal manner to produce positive effects upon the body, mind, and spirit.

Sweat rituals have been used throughout the world, throughout time.

The medical benefits of sweat rituals include improved cardiac and endothelial function, the reduction of hypertension, pain relief, are helpful with arthritis, used as an adjunct to cancer treatment, and reduce body weight and body fat. The psychological effects include improved coping with stress, improved mood and affect, promotes deeper sleep, and reduces hyperactivity. In terms of spirituality, sweating causes an altered state of consciousness, promotes intuition, and improves ones ability to grapple with existential concerns.

Our Sweat Therapy Theoretical Model explains the mechanism for how sweat practices work to cause therapeutic effects. Our model first begins with examination of cultural priming. Beyond a cultural predisposition toward the activity, four main factors are hypothesized to account for the psychotherapeutic benefits: (1) Exercise, (2) Self-Regulation, (3) Interpersonal Factors, and (4) Metaphorical Contextual Elements. These factors interact in a reciprocal manner to produce positive effects upon the body, mind, and spirit.

CULTURAL PRIMING

The practice of group sweating has been present throughout the world for thousands of years and is central to community life among many cultural groups. Different forms of indigenous sweat practices can be found across many geographically and culturally distinct regions of the world: (1) American Indian Sweat Lodge; (2) Finnish Sauna; (3) Greek Sweat Bath; (4) Irish Sweat House; (5) Japanese Mushi-Buro and Korean Jim Jil Bang; (6) Jewish Shvitz; (7) Islamic Hammam; (8) Mayan Sweat House; (9) Mexican and Central American Temescal and Inipi; (10) Roman Balnea and Thermae; (11) Russian Bania; and (12) Scythian Sweatbath; and (13) South African Sifutu. Many of these sweat practices have been present for more than 2,000 years with the Mayan Sweat House dated 900 BC as the earliest documented sweat structure. Before ever entering a sauna or sweat lodge, many participants already have beliefs and expectations about the experience. They are predisposed to the activity based upon its passing from one generation to another. Since sweat rituals have existed for thousands of years throughout the world, people will be attracted to it and are primed to receive benefits from it that are consistent with their cultural background. The more prominent the practice exists in the individual’s background, the stronger the priming.

EXERCISE

From clinical experience, sweating induces commonly observed effects of exercise on mental health, such as reducing anxiety, depression, and stress and improving body image, self-esteem, and sense of well being. The sweating experience produces profound physiological changes and perceptions of physical symptoms. Sauna is similar to exercise as it causes the stimulation of the sympathetic nervous system, activation of the hypothalamus-pituitary-adrenal hormonal axis, and an increase in noradrenaline. However, sauna is different from exercise in a few important ways. Unlike in typical forms of exercise, sauna causes an increase in B-endorphins and does not increase the concentration of adrenaline in the blood stream. Sauna also contrasts with the majority of exercise activities because it does not require muscle tension, the movement of large muscle groups, and attentional capacities to be focused on muscle coordination. Sauna is a unique form of exercise as it causes muscle relaxation and allows focal attention to be focused on another activity, such as group content and process. The state of arousal that accompanies being in exercise mode stimulates learning involved in the other three factors.

SELF REGULATION

Heat exposure in an enclosed area goes beyond being a form of exercise by creating an altered state of consciousness characterized by a dynamic balance between alertness and relaxation. At first, the heat is soothing and as the body begins to respond to the heat through sweating, the body’s muscles experience a release of tension, promoting a deeper state of relaxation. However, rather than slipping into a state of relaxation resembling rest or sleep, further heat exposure keeps the mind and body active through the process of sweating. As the heat becomes more intense, the participant is challenged to keep the mind relaxed, requiring meditative attentiveness. Walsh and Shapiro (2006, p. 3-4) defined meditation as the “family of self-regulation practices that focus on training attention and awareness in order to bring mental processes under greater voluntary control and thereby foster general mental well-being and development and/or specific capacities such as calm, clarity, and concentration.” One can allow negative thoughts and feelings related to the heat become the focus of their experience. Alternatively, one can focus on thoughts and feelings that help one to adapt, cope, and thrive when faced with adversity. Learning to endure the heat requires a form of meditation and leaves the person feeling a sense of accomplishment. This meditative attentiveness and sense of positive adaptation influence the depth of appreciation for metaphors and encourage problem solving.

METAPHORICAL CONTEXTUAL ELEMENTS

The contextual elements involved in group sweating include taking breaks, dimmed lighting, wearing sparse or no clothing, drinking large quantities of water, and the use of fire as a symbol. These contextual elements serve to maximize the therapeutic properties of heat exposure and are common to the many forms of group sweating used throughout the world. The psychological effects of sweat therapy may be partially accounted for by the metaphorical meaning stemming from the contextual elements of group sweating. The symbolism of fire can be understood across languages and cultures as the basis of heat and light, of warmth and illumination. A safe therapeutic atmosphere is represented by the gentle womb-like warmth of the enclosed sauna, which encourages relaxation and openness versus anxiety and defensiveness. Whereas many current social norms encourage us to keep distance from one another, especially when sweating, the sauna symbolizes closeness and promotes genuineness. Sitting together in a sauna symbolically promotes a safe and open therapeutic atmosphere, which may be considered the building blocks of effective group therapy. In addition to safety and openness, change is critical to any therapeutic endeavor. Mind-body purification occurs as a natural consequence of intense sweating; toxins are sweated out through the pores of the skin, bringing clarity to the mind and homeostasis to the body. The intense physical experience pushes us to become more introspective and appreciate personal, symbolic reactions to the heat. Intense heat comes to represent life’s greatest challenges while enduring the heat is a symbol of human will and resiliency. In addressing life’s challenges, taking breaks and drinking water are symbols of self-care and rejuvenation. The shared experience of sweating and enduring the heat promotes group members’ common humanness and a sense of existential togetherness. Through the symbolism of the shared, enclosed womb-like purification, group members come to accept and learn from one another. The experiential, symbolic process of group sweating appears to stimulate and reinforce the critical group therapeutic factors of cohesion and interpersonal learning.

INTERPERSONAL FACTORS

Socialization is a main purpose of the many forms of sweat rituals used throughout the world. Sweat practices have long been a place for the interpersonal exchange of trials and tribulations. Exercise, metaphor, and self-regulation seem to intensify group dynamics. At the same time, group interaction provides an opportunity for participants to process the experience. From clinical experience with sweat therapy, group members perceive the sweating experience as a moderate challenge to which they respond by seeking social support and engaging in thinking that promotes self-esteem (e.g.: “Although I’m uncomfortably hot, I am staying in the sauna because doing so will make me better in some way.”). The sweat condition prompts altruism which quickly translates into cohesion. Group members work together as a unit to get through the heat by offering towels and water to one another and showing frequent concern for one another's ability to handle the heat. These seemingly simple expressions of sharing and concern for one another become part of the group norms and transcend into people showing greater care and concern for one another when discussing deeper topics. Self-Disclosure, Interpersonal Learning, and Group Cohesion were the most prominent group therapeutic factors identified for the sweat groups in the 2005 sweat therapy pilot study (Colmant et al., 2005). Sweating and interpersonal interaction are natural catalysts for one another.

The Russian Banya

The banya is a firmly established part of Russian culture. "Every year on New Year's Eve, my friends and I go to the banya." So starts that familiar cinematographic favorite of the New Year season, Irony of Fate. The banya is a recognizable point of cultural reference, everyone knows what it is and what it involves. They are typically the setting for male bonding and/or forging of business deals. In the dark criminal beginnings of New Russia they were the choice meeting places for corrupt officials and Mafiosi. Although these murky dealings are now seen as things of the past, many do argue that a good number of important decisions in Russia take place in the steamy shadows of exclusive banyas. Something which excludes women from the real business of power broking.

Bath houses have existed in some shape or form for thousands of years. The Roman baths are still famous, and in northern China the bath houses are the only way to get through the winter.

Russia of course has its own bath house tradition, also with a long standing history. There are long hard winters here and the Russians require some steamy relief from the penetrating cold. Foreign journalists too.

The banya is a firmly established part of Russian culture. "Every year on New Year's Eve, my friends and I go to the banya." So starts that familiar cinematographic favorite of the New Year season, Irony of Fate. The banya is a recognizable point of cultural reference, everyone knows what it is and what it involves. They are typically the setting for male bonding and/or forging of business deals. In the dark criminal beginnings of New Russia they were the choice meeting places for corrupt officials and Mafiosi. Although these murky dealings are now seen as things of the past, many do argue that a good number of important decisions in Russia take place in the steamy shadows of exclusive banyas. Something which excludes women from the real business of power broking.

Women do frequently use the banya, but the image of burly Russians wearing nothing but felt hats and beating one another with twigs is more iconic in the male form than the female. Marius Koch is a young German professional, resident in Moscow, and a devotee of the banya. "I go to the sauna a lot in Germany, but it's not the same without the hats and the sticks. That's really the major difference between saunas in the two countries," he says. "I do actually go more often in Germany, on a weekly basis in fact, but there it is really for utilitarian purposes. Here it is more of a social event."

It is the social aspect that is at the heart of the banya experience. As good for your health and for beating the cold as it may be, what accounts for its widespread popularity is the opportunity to relax with friends in hot, sticky surroundings and just have fun and relax. As one Russian banya goer said, "A good banya depends not on its condition or its price, but first of all upon the people with whom you go. People are the heart and soul of the banya."

So Where to go?

Top of everyone's list is the Sanduny Banya. With its collonades and elegant 19th century interior it is worth a look. It has a range of spa treatments and a good restaurant, and has been a steamy feature of the Moscow landscape since it opened. It has always provided a luxurious retreat from the icy streets and today no less so than before. The men's section consists of three "classes" and the women's of two. For two hours in the public banya you can expect to pay from 800-1,000 rubles. You are strongly recommended to fork out for the top class option and to sample some of their kitchen's Adjaria Khachapuri.

If you want to become one with the people then there are cheaper options, and the most popular of them is the Krasnopresneskie banya at 1905. At 500 rubles it attracts a less elevated clientele than the Sanduny and a hotter sauna, the overall look is practical and gritty. Workman-like tiles and plain wooden planks adorn the walls and floors, and people recline with glasses of beer and unpretentious scowls. As one British visitor said, "many have a slight Mafioso vibe, though it's hard to be sure when they're naked."

These are the two that most frequently come up in conversation and many expats are familiar with them. Slightly off the beaten track is the Seleznevskie banya on Seleznevskie Ulitsa. For some reason it is not so well known, yet deserves a mention chiefly for the overpowering blast of its sauna and the icy, icy bite of its plunge pool in winter - seemingly supplied with melted snow. A proper assault upon the senses, your 600 rubles would be well spent here although you should really bring your own towel and tapochki (slippers) to avoid the extortionate rental rates of 250 and 50 rubles respectively.

So all very well for the public banyas. These large scale affairs echo the Roman institution, much more in keeping with the ancient Slavic tradition is the small-scale private banya that is ideally situated beside a snow festooned dacha, but is much more commonly found in Moscow on http://www.clubsaun.ru/.

Two that are worth trying are the Yegipetsckaya Sauna at Aviamotornoy, which offers dream-like surroundings and copious quantities of shashlik and beer for very reasonable prices, a room can be hired for between 1,700-3,000 rubles (bear in mind that you can fit lots of people in). First encountered by The Moscow News as the venue for a birthday party, the setting was ideal and is recommended to anyone who wants to expunge the ravages of age. The sauna could have been hotter though.

The Russkaya Banya at Novoslobodskaya is also worth a visit, as it does offer a properly hot sauna and properly cold plunge pool. The management are very welcoming and a large room costs 1,200 rubles, again this can be split by you and your friends.

So, get out that podzhopnik (cushion) and start exercising that venik swinging arm. The pleasures of the Russian banya are definitely best enjoyed in groups, and the nervous especially are advised to bring along some moral support for this elaborate and exhaustive hang-over cure.

By Tom Washington

Finns reign in Sauna World Championships

The world championships in sauna sitting have been held in Heinola, 138 kilometres (86 miles) north of Helsinki since 1999.

This year 164 competitors from 23 countries including Canada, China and Germany participated in the contest.

Bjarne Hermansson who won the male championship stayed in a sauna heated to 110 decrees Celsius (230 Fahrenheit) for 18 minutes and 15 seconds.

HEINOLA, Finland (AFP) — Finland held onto its reign in 2008 Sauna World Championships by sitting in a piping hot sauna for longer than competitors from Belarus and Belgium.

Bjarne Hermansson who won the male championship stayed in a sauna heated to 110 decrees Celsius (230 Fahrenheit) for 18 minutes and 15 seconds.

"It feels wonderful, it is a dream come true," said Hermansson, his red hot skin covered with sweat.

Hermansson, who has attended the competition every year, said he had trained for it by going to a really hot sauna for more than 30 years.

But he admitted reaching his dream had not been easy. "It was slightly more pain than pleasure," he said.

The toughest woman was Leila Kulin who could take the heat for five minutes and 21 seconds, but Belarussian Natalya Tryfanava was a close competitor and only lost by one second.

"The secret to my success was Finnish persistence," Kulin told reporters just a few seconds after she stepped out of the sauna as the champion.

The world championships in sauna sitting have been held in Heinola, 138 kilometres (86 miles) north of Helsinki since 1999.

This year 164 competitors from 23 countries including Canada, China and Germany participated in the contest.

Finns love sauna. The Nordic country of 5.3 million people has around three million saunas and on Saturdays almost everyone goes to a sauna to unwind.

But the traditional Finnish sauna is far from the extreme hot competition sauna.

"This is a wrong way to go to sauna, this is not about relaxing, this is competition," Ossi Arvela, the head of the competition, told AFP.

He said the idea for the competition came after a group of men had frightened other customers in a Heinola swimming hall by organising their own competition in sauna and throwing so much water on the stove it became piping hot.

Research: Sweat Ritual Reduces State and Trait Anxiety and Improves Mood

A recent study (2008) conducted by researchers in Japan found that a sweat ritual reduced both state and trait anxiety.

Anxiety is a physiological and psychological state characterized by cognitive, somatic, emotional, and behavioral components. These components combine to create the painful feelings that we typically recognize as uneasiness, apprehension, or worry. Anxiety is a normal reaction to stress. It may help a person to deal with a difficult situation, for example at work or at school, by prompting one to cope with it. When anxiety becomes excessive, it may fall under the classification of an anxiety disorder.

Anxiety can be either a short term "state" or a long term "trait." Trait anxiety reflects a stable tendency to respond with state anxiety in the anticipation of threatening situations. It is closely related to the personality trait of neuroticism.

Here’s the study:

Shinya H., Yosikazu N., Eiji, K., Masahiro I., Yosuke S., Tatsuya N., Chiyoe M., Katsutaro N., Toshiyuki O. (2008). Effects of charcoal kiln saunas (Jjimjilbang) on psychological states. Complementary Therapies in Clinical Practice 14, 143–148.

Summary

This uncontrolled intervention study explored the effects of sauna bathing utilizing residual heat from charcoal kilns (charcoal kiln saunas) on psychological states. Forty-five volunteers (24 males and 21 females; mean age 51.9 years (S.D. 15.7)) visiting a bamboo charcoal kiln in Japan participated in the study. They completed a shortened version of the Profile of Mood States (POMS) and State–Trait Anxiety Inventory (STAI) before and after charcoal kiln sauna bathing in order to determine mood and anxiety states. Six factors relating to mood were measured using the POMS: Tension–Anxiety, Depression–Dejection, Anger–Hostility, Vigor, Fatigue, and Confusion. The two anxiety concepts of state anxiety and trait anxiety were also measured. Changes in psychological states before and after sauna bathing were then determined. All mood scales and both manifest anxiety measures were improved after sauna bathing. Charcoal kiln sauna bathing appears to improve mood and decrease anxiety. It is a limitation of this study that this was a descriptive prospective and an uncontrolled intervention study. Further investigation of the improvement of trait anxiety is required.

Conclusion

The effects of sauna bathing utilizing the residual heat from charcoal kilns on psychological states was investigated using the POMS shortened version and STAI. All the six factors of mood (Tension–Anxiety, Depression–Dejection, Anger–Hostility, Vigor, Fatigue, and Confusion) showed a significant improvement after sauna bathing on the POMS shortened version, and state anxiety and trait anxiety also showed significant improvement after sauna bathing on the STAI. As a result, charcoal kiln sauna bathing shows promise as an effective complementary and alternative medicine practice for the improvement of mood and reduction of anxiety.

Sweat Therapy has strong potential to be useful in working with people with anxiety disorders including PTSD.

The links below describe the use of the Sweat Lodge Ceremony for Veterans with PTSD in Veteran’s Administration, Medical Center programs in Arizona and Utah.

Arizona

http://www.usatoday.com/news/nation/2005-12-10-medicine-man_x.htm

Utah

http://psychsymposium.com/monthlist_html?year=2006&month=11

The Claim: Sitting in a Sauna Can Relieve Cold Symptoms

February 3, 2009

By ANAHAD O’CONNOR
THE FACTS

Scientists recently confirmed the age-old notion that hot liquids can relieve some cold and flu symptoms. But what about a dose of heat on a much larger scale — say, in a sauna?

With temperatures of 176 Fahrenheit or greater, saunas have been recommended for arthritis, asthma and chronic fatigue, among other things, since they were used by nomads in Finland centuries ago. Some reputed benefits have not been examined, but there is evidence that saunas may speed recovery from colds and reduce their occurrence.

Some researchers suspect sauna heat reduces symptoms because it improves drainage, while others speculate that the high temperatures help weaken cold and flu viruses. Why this might prevent sickness in the first place, however, is unclear. But research suggests an effect.

In one study by Austrian researchers, for example, a group of 50 adults were split into two groups and tracked for six months. One group was instructed to use saunas regularly; the other group abstained. At the end of the study the sauna group had contracted fewer colds.

“This was found particularly during the last three months of the study period, when the incidence was roughly halved compared to controls,” the scientists wrote.

Other studies have found similar results. But doctors caution that saunas can be hazardous to those with heart or circulatory problems.

THE BOTTOM LINE

There is evidence sauna use might reduce or prevent cold symptoms.

scitimes@nytimes.com

5th Critical Multicultural & Diversity Conference 2009

Stephen and Allen were invited to present at the 5th Critical Multicultural & Diversity Conference 8/4-8/5/09 at the University of Toronto. The conference title is “Integrating Traditional Healing Practices into Counselling Psychology & Psychotherapy.” For more information on this conference see: http://www.oise.utoronto.ca/cdcp/

Here is the presentation description:

Section 4: Traditional Healing and its Contemporary Formulations

Sweat Lodge as a Healing Ritual; Ayurveda; Naturopathy; TCM; Morita and Nikan Therapy; Network chiropractics; I-Ching; Yoga; Mindfulness meditation; Shiatsu; Reiki; Touch and Energy healing; Qigong; …

WORKSHOP

Sweat Therapy: Integrating sweat rituals into counseling and psychotherapy.

Stephen Colmant, Ph.D. and Allen Eason, Ph.D.

Sweat rituals have been used as traditional medicine throughout the world for thousands of years to promote well-being. Examples include the Native American sweat lodge ceremony, the Finnish sauna, the Russian bania, the Islammic hammam and Korean jim jil bang to name a few. This workshop will discuss the potentials of sweat practices to enrich educational and therapeutic programming. Dr. Colmant and Dr. Eason have completed several research studies on sweat therapy with at-risk youth and university students. They will review the research on the physiological, spiritual and psychological effects of sweating and present a theoretical model on the mechanisms for how sweat rituals operate to deliver therapeutic effects. Just as there are many forms of sweat practices, there are many means of incorporating counseling and group work with sweating. The facilitators hope to encourage people to be creative in incorporating sweat therapy into their work setting while being respectful of culturally specific practices.

Stephen Colmant, Ph.D. completed his doctorate through the Counseling Psychology Program at Oklahoma State University in 2005 and is a licensed psychologist with the Eastern Band of Cherokee Indians, Health and Medical Division, in Cherokee, NC, USA.

Allen Eason, Ph.D. completed his doctorate through the Counseling Psychology Program at Oklahoma State University in 2008 and is an Assistant Professor in American Ethnic Studies at Kansas State University in Manhattan, KS, USA.

* UPDATE - Due to budget constraints restricting travel funds, Stephen and Allen will not be able to present at this conference.

Exploring the Psychology of Ritual, Mythology, and Ordeal within the Sweat Lodge Ceremony

Gary Stewart of Murdoch University in Western Australia completed a study using grounded theory methodology to investigate the psychological effects of sweat lodges. Below is an excerpt from his unpublished thesis (2006, p 32.):

The most commonly reported theme was that of spiritual connection and how the Sweat Lodge encounter enabled participants the feeling of connectedness and spiritual unity.

This spiritual connection was frequently said to add meaning and purpose to the participant’s life. Often the data suggested that those interviewed had gained a sense of direction and purpose in their lives as a result of being involved with Sweat Lodge ceremonies.

The theme of feeling at home in the world and the universe and the sense of existential purpose, is possibly the most important theme that emerged from the data. The data indicates that the physical environment of the Sweat Lodge combined with the ritual component generate non-ordinary states of consciousness. The data also reveals that the facilitator teaches participants through the mythology of the Sweat Lodge and through different themes, while the attendees are in an altered state of consciousness.

This, as indicated by the data, has a powerful psychological effect on the participants, which is seen as profoundly positive and life changing.

Sweat Therapy Theory and Efficacy

In print this month in The Journal of Experiential Education.

The purpose of this article is to examine the potential application of sweat rituals to group counseling, adventure therapy, and other forms of group work by describing a theoretical model for how sweat rituals work and presenting the results of a randomized comparative outcome study on the efficacy of sweat therapy. The theoretical model proposes five factors that reciprocally interact to produce the positive effects of sweat rituals: cultural priming, exercise, self-regulation, metaphorical and contextual elements, and interpersonal factors. To investigate efficacy, 85 university students were randomly assigned to either a sweat condition (group counseling in a sauna), or a non-sweat condition (group counseling in a standard office setting) for six weekly sessions. Measures included the Critical Incidents Questionnaire, Therapeutic Factor Inventory, Exercise Induced Feeling Inventory, and the Subjective Exercise Experiences Scale. Results indicated that participants in the sweat condition perceived a greater availability of therapeutic factors, especially for group cohesion and interpersonal learning, and had better attendance, less attrition, and reported sessions to be more useful. Implications for future research and practice are discussed.

Keywords: Sweat Therapy, Group Counseling, , Indigenous Sweat Practices

E. Allen Eason is a Counseling Psychologist and Assistant Professor of American Ethnic Studies at Kansas State University, Manhattan, Kansas, USA. E-mail: easonea@gmail.com

Stephen A. Colmant is a Licensed Psychologist for the Eastern Band of Cherokee Indians, Health and Medical Division, Cherokee, North Carolina, USA. E-mail: colmant@gmail.com

Carrie L. Winterowd is an Associate Professor in the School of Applied Health and Educational Psychology at Oklahoma State University, Stillwater, Oklahoma, USA. E-mail: carrie.winterowd@okstate.edu

The Arizona Sweat Lodge Tragedy & the Facts on Sweat Rituals

The sweat lodge tragedy in Sedona, AZ has left three people dead and has generated many questions by those unfamiliar with sweat rituals. This tragedy has also created a dark cloud of suspicion over people making use of sweat rituals.

Sweat rituals have had a central place in societies throughout the world for thousands of years. Examples include the American Indian Sweat lodge, Finnish Sauna, Islamic Hammam, Russian Bania, and Korean Jim Jil Bang to name a few. Like Carl Jung’s Concept of the Archetype, sweat practices continue to re-emerge in different forms. The activity gives the participant an intense physical and psychological experience, the power of which can and will continue to be harnessed for a multitude of purposes. Some have used the practice of sweating to heal illness, socialization, for exercise, to promote spirituality, or as an aid in meditation. Others have used sweat practices as a sexual aphrodisiac, to promote prostitution or as a manipulative tool to promote the agenda of cult-like organizations.

Sweat rituals are known to be beneficial in the prevention and treatment of lung, heart, and skin problems. Additionally, research has shown that sweating promotes deeper sleep, pain relief, muscle relaxation, stress relief and has been helpful in treating insomnia, arthritis, and as an adjunct to cancer treatment. Some interesting findings recently coming out of Japan are that sweat rituals help to reduce depression, anxiety and even body fat.

Sweat rituals are contraindicated during high-risk pregnancies and for people with unstable angina pectoris, recent myocardial infarction, severe aortic stenosis, decompensated heart failure, and cardiac arrhythmia. Hands down the most researched form of sweat ritual is the Finnish Sauna. There has not been as much work on studying the Native American sweat lodge ceremony, so scientists often have to extrapolate findings on the sauna to other forms of sweat rituals. There are two million saunas in Finland among a population of five million. Researchers investigating sauna related deaths in Finland concluded that death in the sauna is a rare event. The rate of death occurring while in a sauna was less than 2 per 100,000 inhabitants. Out of 393 cases of death in a 12 year period, two-thirds were male and half were 50-69 years old, whereas most females were over 70 years of age. The majority of deaths were attributed to various cardiovascular diseases. Ischemic heart disease was the underlying cause of death in 63% of the natural deaths, and in 23% of these, autopsy findings also showed acute myocardial infarction. 50% of all cases had alcohol in their blood.

Intense heat exposure can be therapeutic and it can be deadly. Like a powerful drug, it is the way in which it is used that makes the difference. The context, preparation, helpful aids, temperature, rest periods, and recuperation time are all important. That does not mean that there is just one way or even “a best way” to do it. Although there are many different ways to enjoy a sweat ritual, some important guidelines should be considered.

Consider your amount of food intake before going to sweat. Sweating is a form of exercise. You wouldn’t decide to go for a run right after Thanksgiving dinner and the same should be true for sweating. It is often recommended that one fast for an hour or two before sweating. On the other hand, if you wait too long to eat you can feel faint or weak. A good general rule is to not eat heavy before you sweat and to moderate your pre-sweat meal to how you would before engaging in any intense exercise.

The recommended temperature is 176 to 194º F (80-90º C). Jewelry should be removed as it can feel burning to the skin. Plastic covered sport watches are usually fine and helpful for marking time. The things you will need are two towels and a quart of water. One towel is for bringing in with you into the sweat. This towel can be used for sitting on or other personal hygiene. The second towel is for drying off afterwards. The recommended time inside a sauna is anywhere from 10 to 15 minutes. Take a five-minute break and then repeat. Two to four rounds should do it. During the break drink plenty of water. Allow yourself to lie down and take a longer break to recuperate after your last round. Fifteen minutes should be plenty of time for your body to recuperate and for sweating to stop.

In my fifteen years of avid use of sweat lodges and saunas including lengthy research projects, I have never experienced a participant suffer a heat disorder. Nevertheless, it is important to be aware of the signs and symptoms and how to provide first-aid. Heat disorders include heat collapse, heat exhaustion and heat stroke. The symptoms of heat disorders include headache, nausea, vertigo, weakness, thirst, confusion, irrational behavior, loss of consciousness, convulsions, a lack of sweating, and an abnormally high body temperature. General recommendations for first aid of heat disorders include removing the person from the hot environment, wetting the person’s skin and increasing air movement around the person to improve evaporative cooling until professional methods of cooling are initiated and the seriousness of the condition can be assessed. Fluids should be replaced as soon as possible. No person suspected of being ill from heat stroke should be sent home or left unattended unless a physician has specifically approved such an order. Professional medical treatment should be obtained immediately in the case of heat stroke.

Used responsibly, sweat rituals offer numerous benefits to body, mind and spirit and few risks. My work in developing Sweat Therapy in counseling psychology has focused on using this powerful technique to promote health, psychological healing, and human growth. My research team and I at Oklahoma State University found that sweat rituals can be an excellent medium for group counseling. The experience helps groups bond and participants self-disclose quicker – key ingredients to a productive group. As the facts are revealed about the Sedona sweat lodge tragedy, I suspect we will ultimately learn less about the dangers of sweating and more about the dangers of narcissism.

Incorporating Sweat Therapy in Fitness Centers and Spas

For most Americans their access to a sweat practice such as a sauna or steam room is at their local fitness center, YMCA, or spa. There are currently about 30,000 fitness centers and 18,000 spas in the U.S. and their numbers are growing at a robust rate. It is a mistake to think that people attend these facilities only to promote physical health rather than overall well-being. In fact, fitness centers and spas might be one of the most effective sites for prevention intervention of physical and mental disorders. Typically, only minimal attention is paid to the use of saunas and steam rooms in these facilities like making sure they are turned on and clean. Some health spas make sweat practices a main feature of their services and take advantage of cultural priming and metaphorical contextual elements by offering more traditional forms of sweat practices. Examples include the Royal Palace in Brooklyn, NY and the Chicago Sweat Lodge. There is tremendous opportunity to amplify the positive effects of sweat practices on well-being by making the most of the five theoretical factors for how sweat practices work. Some of the ways of achieving this is through the incorporation of meditation, music, aromatherapy, and group work. Examples include creating special sweat groups based on membership or issues. A spa or fitness center could offer special services such as combining sweat with massage or exfoliation or special times for a women’s-only sweat group, a support group for coping with stress, seniors’ sweat, or a sweat-meditation group. Groups will gradually develop their own rituals and can be encouraged to do so by making available aromatherapy, music choice, or other metaphorical contextual elements.

The Mind, Body and Spiritual Benefits of Sweating

People have used sweat rituals around the world for thousands of years to gain greater physical, mental, and spiritual well-being. Examples include the Finnish Sauna, the American Indian Sweat Lodge, the Russian Banya, the Jewish Shvitz, and the Islamic hammam to name a few. Like Carl Jung’s Concept of the Archetype, sweat practices continue to re-emerge in different forms. The intense physical and psychological experience can and will continue to be harnessed for a multitude of purposes. Some have used the practice of sweating to heal illness, socialization, for exercise, to promote spirituality, or as an aid in meditation. Others have used sweat practices as a sexual aphrodisiac, to promote prostitution or as a manipulative tool to promote cult-like agendas. The work of my research team at Oklahoma State University in developing Sweat Therapy in counseling psychology focused on using this powerful technique to promote health, psychological healing, and human growth.

Sweat rituals are much more than just intense heat exposure. Intense heat exposure unchecked can result in heat disorders like heat stroke, heat exhaustion, heat collapse and death. Sweat rituals developed over centuries through human intelligence, creativity, and wisdom to optimize the experience to promote health. Like many holistic practices, sweat rituals are multidimensional. In addition to cultural priming, the theoretical model developed by myself and Allen Eason, Ph.D. of Kansas State University, focuses on four factors that contribute to the therapeutic effects of sweat rituals.

Exercise

The first factor is exercise. Sweat rituals give people an intense cardiovascular workout. The main differences between sweat rituals and typical forms of exercise, is that sweat rituals do not include the adrenaline surge and cause muscle relaxation. The fact that they do not require movement opens them up to people with ambulatory problems. The heart gets a good workout during a sauna and results in improved endothelial functioning. Cardiac output is increased by 60% to 70%. This is a function of increased heart rate which increases to about twice the resting rate, a 40% decrease in peripheral resistance of the vessels, and a decrease in diastolic and mean arterial pressures, with practically no change in systolic pressure. Sweat rituals are known to be beneficial in the prevention and treatment of lung, heart, and skin problems. Additionally, research has shown that sweating promotes deeper sleep, pain relief, muscle relaxation, stress relief and has been helpful in treating insomnia and arthritis. Some interesting findings recently coming out of Japan are that sweat rituals help to reduce depression, anxiety and even body fat. Sweat rituals are contraindicated during high-risk pregnancies and for people with unstable angina pectoris, recent myocardial infarction, severe aortic stenosis, decompensated heart failure, and cardiac arrhythmia.

Self-Regulation

The second factor is self-regulation. Self-Regulation is the activity of setting, working toward and achieving goals related to one’s personal desires. Sweating is an intense physical experience. It pushes the person to naturally bring thinking inwards to become more introspective as they appreciate their personal reactions to the heat. That means personal concerns come more quickly to the surface. The effects of heat on muscle relaxation help the person get into a deep state of relaxation.

Introspection and deep relaxation characterize the altered state of consciousness one gains while sweating. From introspection, personal goals develop. Personal issues are amplified through the low-to-moderate stress of the sweat experience which pushes the person to get down to it and get to the heart of the matter. Which personal issues are more pressing becomes clearer and problem solving becomes more efficient. Greater self-disclosure was a main finding of our research in which sweat therapy groups were compared to groups in a standard office setting.

Metaphorical Contextual Elements

Metaphorical Contextual Elements comprise the next therapeutic feature. The contextual elements promote biopsychosocial benefits through metaphor and the expression of ritual. Rituals are vehicles to spirituality and promote our sense of meaning, purpose and connectedness. Traditionally, the longest standing forms of sweat practices have each incorporated sweating for rites of initiation and transformation including birth, puberty, weddings, and death. There is a complex interaction of physiological effects, symbols and metaphors involved in sweat rituals that make it an ideal vehicle for rites of initiation and transformation.

Whether studying the traditional use of the American Indian sweat lodge or Finnish Sauna folklore, a common metaphor used is a return to the womb. The archetype of the womb is one of connectedness, interconnectedness, unity, community and protection. The womb provides a protective membrane that creates and sustains life. The gentle womb-like warmth of the typically small enclosures used for sweat practices promotes a sense of safety, relaxation and openness versus anxiety and defensiveness.

As time passes the heat feels more intense and the experience provides an ordeal that one submits to. Change is symbolically represented by basic elements (earth, air, fire, water) changing forms. Fire burns wood turning to smoke. Rocks glow red with heat. Water thrown on super-heated rocks changes to steam and intense heat. One withstands the heat as proof of fitness and commitment. The experience is a lesson in humility as the intensity grows. Just at the point of feeling wiped out, the person emerges from the sweat. . . they begin to recuperate and drink wholesome life-giving water. Then comes the feeling of strength and rejuvenation. The invigorating ritual brings the participant to life again. Through submission and ordeal one becomes wiser and learns a lesson in humility by experiencing a rite of death and rebirth that marks the passage to a higher level of maturity.

Interpersonal Factors

The fourth therapeutic feature is Interpersonal Factors. Our research compared therapeutic factors for groups in sweat and non-sweat conditions. We used multiple ways of assessing therapeutic factors such as having participants write about their group experience, the use of questionnaires, audio recordings, as well as attendance and dropout rates. The results were that the sweat therapy groups had greater therapeutic quality compared to the non-sweat groups. 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.

One condition promoted by sweating that accelerates interpersonal interaction is Genuineness. To be genuine is to be aware of one’s own feelings rather than presenting an outward facade of one attitude while actually holding another attitude at a deeper or unconscious level. Being genuine also involves the willingness to be and to express, in one's words and one's behavior, the various thoughts and feelings which exist within one's self.

People seem to GET REAL a lot quicker in a sauna than they do in an office setting. When you’re sitting in a sauna you’re relaxed and less defensive. You’re sitting with others, half-naked, and sweating profusely. The façade starts to melt away. As described earlier, there’s a push toward becoming more introspective as one monitors their reactions to the heat. This causes people to examine what else is going on within them. These conditions promote people becoming more willing to self-disclose and say what’s on their mind. Individuals in a group getting more REAL with themselves and one another, makes for a cohesive group.

There is no one way or even a “best way” to incorporate a sweat ritual into your life. For most Americans, their access to a sweat practice such as a sauna or steam room is at their local fitness center, YMCA, or spa. Adding a high-end feature to your house such as a sauna is one of the best ways to upgrade your home resale value as well as your lifestyle. Examples of cohesive groups using sweat rituals are everywhere and not just among traditional ethnic groups. I encourage people to make the most of the sweat ritual experience by incorporating music, meditation, aromatherapy and even throwing sauna parties. Used responsibly, sweat rituals have few risks and offer numerous benefits to body, mind and spirit.

References

Eason, E. A., Colmant, S. A., and Winterowd, C.L. (2009). Sweat Therapy Theory, Practice, and Efficacy. Journal of Experiential Education, Volume 32, 2 pp 121-136.