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Student Research, student work

The Effect of Emotional Support Animals on the Mood and Stress Response of a Person with PTSD

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A research article by Jessalyn Smith

*Trigger Warning: this article contains content related to domestic violence*

Abstract

An Emotional Support Animal serves to alleviate the effects of an emotional disability.  For someone suffering from post-traumatic stress disorder, the presence of such a companion can lead to a reduction of symptoms and a greater feeling of security.  As more people are prescribed Emotional Support Animals, it is important to test how these therapeutic tools could most effectively be utilized.  In this case study, I tested my mood and stress response before and after playing, walking, and cuddling with my emotional support animal and recorded my thoughts in a journal for each activity.  My moods, physical symptoms of stress, and thought processes were then analyzed to monitor the improvement across each category.  While all activities showed benefits to my mood, playing with the ESA showed the greatest improvement.  Additionally, there were no physical responses to stress noted after the playing sessions.  However, the changes in my writing characteristics and observations were consistent across all forms of activity.  Based on the data collected, active interactions with an ESA provided the most useful form of self-therapy for the subject.

The Effect of Emotional Support Animals on the Mood and Stress Response of a Person with Post-Traumatic Stress Disorder

According to the National Institute of Mental Health, post-traumatic stress disorder (PTSD) develops after a “shocking, scary, or dangerous event” and can lead to flashbacks, difficulties sleeping, avoidance of triggers, and memory issues among several other debilitating symptoms (Post-Traumatic Stress Disorder, n.d.).  The Vietnam War is widely associated with the first identification of PTSD as a mental disorder, and the term “post-traumatic stress disorder” was published by the American Psychiatric Association in 1980 (Crocq, M. A., & Crocq, L., 2000).  However, this was not the first instance of PTSD as it likely went unidentified in trauma survivors long before its formal identification.  Although psychologists started studying the disorder as “shell shock” in combat veterans, the term has since changed and expanded to include victims of abuse, assault, neglect, and other traumatic experiences. 

Therapy can be useful in managing symptoms and addressing their underlying causes.  There is an abundance of mental health providers that specialize in their own unique styles of therapy along with physicians that can provide medications to help address the symptoms.  However, patients respond differently to the various methods of treatment available.  What might work well for one person can have absolutely no effect on another.

            Emotional support animals (ESAs), also referred to as “assistance animals,” provide a new method for treating patients with PTSD.  ESAs are not considered service animals, and there are no training or species requirements to qualify as an ESA under the Fair Housing Act.  Any animal, from a professionally-trained Labrador Retriever to a hamster from the local pet store, can be categorized as an assistance animal with the correct documentation from a qualified mental health professional. Because the treatment method is relatively new, there is no landmark study that has conclusively determined the effects of having an ESA. However, there are a few common themes seen across research papers on the subject.  The animals provided “emotional work” by alleviating feelings of worry and loneliness in addition to providing comfort, “practical work” by promoting physical activity and distracting from symptoms, and “emotional nourishment” by enabling social interaction (Brooks, et al., 2018).  A preliminary study of  an animal-assisted intervention program applied this technique to the treatment of children exposed to domestic violence, many of them exhibiting symptoms of PTSD and other clinical disorders before treatment.  During the program, the participant would perform structured activities with the animal, such as playing, grooming, or feeding, in conjunction with cognitive-behavioral therapy.  Even though there was no significant improvement in aggressive or unruly behavior that is associated with the externalization of symptoms, the researchers observed an overall decrease the symptoms of PTSD, as well as a decrease in the internalization of such symptoms in the form of anxiety or depression (Muela, et al.,  2019).  The benefit to the children’s’ emotional well-being demonstrated by this study shows the potential of assistance animals and the need for further research.

            Even though most studies report that participants experience mental health benefits, it is unclear whether the type of activity done with the ESA changes the level of improvement.  In order to optimize treatment plans, it is important to know what strategies would optimize the available time.  The categories compared for the purposes of this experiment were playing, walking, and cuddling.  This case study seeks to observe the effect of the activity performed with an ESA on the mood and low-level stress response of the participant. 

Materials and Methods

I monitored my own mood and responses over the course of the case study.  A therapist diagnosed me with PTSD within the past year due to my experience with domestic violence. Based on his recommendation, I was seeking treatment through talk-therapy and was prescribed selective serotonin reuptake inhibitors by a psychiatrist, which I continued to take over the course of this study.  The emotional support animal used was a 50-pound cattle dog/ kelpie mix, Theo, which I adopted approximately three weeks before the study.  Theo is a very calm, six-year-old dog who primarily spends his days napping on the couch or running outside.  He loves physical affection and treats but does not seem to be interested in dog toys of any kind.

A baseline assessment was conducted at the beginning of each activity.  The assessment consisted of a short journal entry of my thoughts and mood before and after being exposed to a photo and text conversation that typically triggers a minor emotional response due to traumatic associations; the photos were not graphic and were known to not cause an overwhelming response.  At the top of the page, I recorded a rating of my mood on a scale of one to ten.  The scale had no specific meanings associated with the values and was based on an intuitive response.  My writing primarily focused on physical sensations, such as chest pain and changes in breathing, as well as my thoughts and what I focused on during that time.

I categorized the activities into cuddling, walking, and running/playing.  The last category is combined because of the Theo’s lack of interest in dog toys and typical play activities.  Instead, we would play a game similar to tag where he would chase me as I ran.  The timing of each session varied due to Theo’s needs and tolerance of different activities.  Once we completed the activity, I exposed myself to the same image as the beginning of the session and scrolled through an old text conversation that was consistent for each session throughout the study.  I recorded my response in the same format as the initial journal entry.  Different photo stimulus was used for each trial, and a series of similar images was used so that declines in responsiveness would not be attributed to overexposure.

At the end of the study, I compiled the journal entries and analyzed the results, comparing my mood ratings and the physical nature of my stress responses as well as identifying key words and phrases.

Results

            My mood improved after each activity performed.  On average, playing showed the highest increase in my mood ratings, averaging an increase of 1.5.  Walking showed the next greatest improvement, averaging at 0.75, and cuddling closely followed with an average increase of 0.5.  These numbers do not provide any specific revelations about how the characteristics of my mood changed, but they do offer a comparative scale.  Both activities performed outdoors ranked higher than the activity performed indoors, possibly due to the benefits of being outside combined with the effects of my ESA.  Even though cuddling seems to only offer a small increase in mood, it offered a more meditative experience where I was able to reflect upon past trauma and remain calm.  The outdoor activities acted more as a distraction, not allowing me to dwell on old memories for too long before being pulled away to focus on Theo.

            I noted feeling physical symptoms of stress before every session, but the response was less severe after cuddling.  The common symptoms I noticed were changes in my breathing pattern, a pressure at the top of my chest, and an ache in my left forearm.  This set of responses was known to occur before the study and was not unique to this set of stressful situations.  After cuddling, I reported noticing a “hitch in my breath” when opening the messages app that quickly subsided and my breathing returned to normal.  However, before that specific cuddling session, I had noted a pressure in my chest and a subsiding pressure in my arm.  Before the final cuddling session, I felt pressure in my chest and arm, changes in breathing, as well as a “rising feeling of panic.”  However, afterwards, the extremity of the physical response was limited to a “slight change in breathing and chest sensation,” which was a significant improvement from the previous entry.  Additionally, I felt less of a physical response to typing or writing the abuser’s name after cuddling, which I typically refrain from writing unless absolutely necessary.  Even when I still noticed a response to the stimuli, the physical indicators suggest that the stress was less severe after cuddling.

Walking provided a greater reduction in physical stress responses than cuddling, and there were no noticeable stress-induced sensations after playing. After one walking session, I did report a localized ache in the outer portion of my left wrist, which is similar to a common stress indicator, but it did not cover the inside part of my forearm where the related response would usually occur.  This was the only recorded instance of a physical response after performing an outdoor activity with Theo.  In all my other entries for walking and playing, there were combinations of the various physical sensations before the activity,  but none were reported after.  Similar to cuddling, there was also a decreased response to writing the abuser’s name.  Since I usually use the monitored aches and abnormal sensations to determine my level of stress, the intervention of an ESA demonstrated significant improvement in the severity of my reaction to low-level triggers.

            Another beneficial change that occurred across all activities was a shift in what I focused on in the stimuli. When I opened the last text conversation with the abuser before each activity, I primarily focused on his insults and vulgar profanity.  My eyes were drawn to reading what was being said, and I almost felt like I was being verbally attacked all over again.  In contrast, I focused more on my responses to his statements after each activity, regardless of which category the activity fell into.  I was no longer feeling vulnerable; instead, I felt justified in my assertions and irritated at his attempts at manipulation.  When I wrote about his messages in my journal entries after the sessions, my responses demonstrated a greater sense of annoyance or apathy compared to the stress I felt beforehand. 

            After the activity, regardless of which category it fell into, my journal entries showed a greater attention to the background of the pictures as well as a few less serious descriptions of the abuser’s appearance.  Even though I noticed a few objects in the background when I initially looked at the photos, I was more observant and able to determine the context of the photo, such as a Halloween or dojo party.  In the original entries, I would glance at the images, but paid little attention to why certain objects or people were there and mostly focused on how they juxtaposed the abuser’s face.  Often, this contrast would make him appear “like a cardboard cutout” that felt like it was “staring at me” and did not fit in with the other lively subjects in the photos.  While I continued to harshly comment the photos after my activities with Theo, I also wrote some comments that were a little more absurd and less stressed.  In response to his yellow sweatshirt, I wrote “Banana or lemon. Rotten on the inside.”  This statement made me want to continue writing a journal in a more poetic style to help vent some of my frustration and turn it into a less serious form of art.  The most notably cheerful statement came after I spent time playing with Theo.  I audibly laughed and wrote “he kind of looks like a worm.”  This observation still brings a bit of amusement, even though I have to picture the image again.  After the activities, my improved mood seemed to provide a buffer against the uncomfortable images and decrease the emotional toll of the associations.

            My time spent with Theo also showed signs of mental improvement that were not directly related to mood or stress response.  One trial was omitted from the mood average because of the large deviation from the regularly performed activities, but it did provide important insights to how Theo has improved my emotional well-being.  During the first play session, I was approached by a photographer associated with the University of California, Los Angeles (UCLA) who was interested in taking photos of Theo and me.  Even though I would normally be self-conscious about my appearance after quickly throwing my hair up in a messy bun and running around on the grass, I happily agreed to be photographed.  This unusual occurrence significantly boosted my mood and the presence of Theo encouraged me to do something that I would have once considered to be far outside of my comfort zone.

Discussion and Conclusions

            Playing with my ESA provided the greatest improvement in mood and the fewest physical signs of stress response after the activity.  These results suggest that more active interactions with an ESA would provide the greatest benefits to an individual.  However, since play activities were performed outside, it is important to expand future studies to analyze how the environment impacted the results by testing the activity in different location.  Either way, this method provides a therapeutic benefit that an individual can achieve with their ESA.

            There are also some notable benefits to cuddling with an ESA, despite the activity showing the least significant improvement in mood.  While walking and playing provided a distraction from intrusive thoughts and stressors, cuddling allowed my mind to wander and think about traumatic memories without the typical feeling of being overwhelmed.  In this case, it may be useful to combine the act of touching or cuddling an emotional support animal with some form of talk-based therapy with a licensed mental health professional.  In this controlled setting, it may help the patient address the underlying issues without becoming overwhelmed by an emotional response that would normally come from having a conversation about one’s traumatic experiences.  This potential benefit might not be as effective when performing more active activities where the individual is more distracted than meditative.

            Because I tested myself, the results may have been influenced by what I expected to happen or what I observed after first few sessions.  For this reason, it is important to have a larger group of subjects and to perform a double-blind experiment, where the experimenters are unaware of which journal entry they are analyzing, and the subjects do not know what the expected results are.  Some other potential factors that influenced the results were the different environments and levels of social interaction.  Even though the walk and playing took place in the same outdoor space, the cuddling sessions were performed inside, which may have influenced the results.  The different amounts of social interaction that occurred when outside may have also affected the results, which would have been amplified by the effects of quarantine.   In order to improve upon this case study,  these external factors should be accounted for and standardized.

            Further research is needed to understand the effects of different species of ESAs and the personalities of the assistance animal and its owner.  Since this study only included one animal, it is unclear whether the benefits would be consistent across different species.  Would the hamster from the pet store provide the same benefits as thee professionally-trained Labrador Retriever?  It is also important to test how the personality of the animal and how it corresponds with the owner’s personality and preferences since animals differ greatly in their levels of playfulness and affection.  While I am highly fond of animals, especially dogs, this is not the case for all people.  The compatibility of the animal and the owner could potentially impact the therapeutic benefits.

References

Brooks, H. L., Rushton, K., Lovell, K., Bee, P., Walker, L., Grant, L., & Rogers, A. (2018). The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence. BMC Psychiatry, 18(1). doi: 10.1186/s12888-018-1613-2

Crocq, M. A., & Crocq, L. (2000). From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology. Dialogues in clinical neuroscience, 2(1), 47–55.

Muela, A., Azpiroz, J., Calzada, N., Soroa, G., & Aritzeta, A. (2019). Leaving A Mark, An Animal-Assisted Intervention Programme for Children Who Have Been Exposed to Gender-Based Violence: A Pilot Study. International journal of environmental research and public health, 16(21), 4084. https://doi.org/10.3390/ijerph16214084

Post-Traumatic Stress Disorder. (n.d.). Retrieved from http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

Student Research, student work

Journaling Promotes Empathy When Centered on Emotional-Awareness

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A research paper by Jacy Black

Abstract

            Empathy is understood as an affective and cognitive human skill that incorporates understanding the feelings of others and a personal emotional reactions to those feelings. The positive relationship between empathy and self-reflection has been explored in scientific literature but the nature of this relationship remains ambiguous. With the understanding that empathy is a beneficial skill that can be improved, this work serves to explore self-reflection in journaling as a method of improving empathy. The experiment was conducted as a between-subjects design where participants were randomly assigned to emotional-awareness journaling or daily activity journaling conditions. The Empathy Quotient (EQ) for Adults and the Social Stories Questionnaire (SSQ) for Adults were utilized to measure the participants’ empathy levels before and after the experimental manipulation. It was hypothesized that participants in the emotional-awareness journaling condition would demonstrate significant empathy score increase across both tests and that the daily activity journaling condition would show no significant score change on these measures. In the emotional-awareness condition, most participants showed an increase in EQ and SSQ scores while SSQ scores stayed fairly consistent among participants in the daily activity journaling condition. The results of this study suggest emotional-awareness journaling can be a beneficial activity to promoting empathy. 

Introduction

Psychological mindedness (PM) is understood as an awareness and comprehension of mental processes such as thoughts, emotions, and behaviors, of which empathy and self-reflection are essential parts (Beitel, Ferrer, & Cecero, 2005, pp. 740-747). One aspect of empathy, and therefore psychological mindedness, is perspective-taking, or the “transposing of oneself into the thinking, feeling, and acting of another,” (Dymond, 1950, p. 343). A literature review conducted by Gerace, Day, Casey, & Mohr (2017) evaluated the relationship between self-reflection and perspective-taking according to previous research. Gerace et al. (2017) advocate the importance of accurate self-knowledge in self-reflection, thus impacting the empathetic skill of perspective-taking (pp. 4-24). This is further supported by experimental study results that demonstrate a positive relationship between personal insight and empathy (Dymond, 1950). However, despite supporting the relationship between self-reflection and empathy, Gerace et al. (2017) recognize the ambiguity in studies exploring this relationship and the need for further research into these two skills.

As self-reflection impacts perspective-taking, it stands to reason that activities designed to improve self-reflection and accurate self-knowledge can foster the development of empathy. Likewise, as empathy is widely recognized as a beneficial skill, exploring potential methods of improving empathy is a worthwhile endeavor. Journaling is one such method that can promote the development of empathy. It is our personal understanding that journaling can be an important introspective practice to improve emotional awareness and self-knowledge when utilized for this purpose. It was through this personal interest and experience that we began our study. Additionally, under the presumption that journaling proves to be effective in promoting empathy, this is a relatively inexpensive activity that can be easily and widely implemented.

Previous research suggests the practice of journaling may be beneficial in improving empathy, however journaling was not the main subject of previous studies and not all results were empirically based. Doctoral research conducted by Patton (2019) explored journaling, among other methods, to promote learning and empathy within the classroom. The results of her thesis concluded that journaling fostered empathy with regards to perspective-taking but not other explored measures, attributing the results to students’ ability to utilize journaling to process their own emotions while learning about the emotions of others (Patton, 2017, pp. 117-118). Another experiment explored journaling as a method to encourage self-reflection and awareness in students from a client-centered Occupational Therapy program (Jamieson et al., 2006). While it was assumed that journaling was beneficial, the assessment lacked an empirical evaluation. This prevented any determination of whether journaling significantly impacted the training experience and student empathy (Jamieson et al., 2006, pp. 79-82). Research focused solely on the practice of journaling, and how it should be utilized, is required to measure its impact on empathy more directly.

This study explores the relationship of journaling on empathy. We anticipate that the impact of journaling on empathy scores will be mediated by the way in which journaling is utilized. It is hypothesized that an increase in empathy scores, determined by the Emotion Quotient (EQ) for Adults and the Social Stories Questionnaire (SSQ) for Adults, will be significant when journaling content is centered around emotional-awareness, as opposed to no significant change in empathy scores when journaling consists of reiterating daily activities. This hypothesis is based upon the principle that reflection upon one’s emotions is important in fostering empathy.

Method

The experiment was conducted as a between-subjects design focused on the effects of journaling utilization on empathy scores. Undergraduate participants were randomly assigned to one of two journaling utilization conditions, tested on scores of empathy, and engaged in journaling for the duration of one week. Afterwards, they were again tested on empathy and the pretest and posttest scores were compared for significance.

Participants. Eight undergraduate students were recruited from the University of California, Los Angeles for a week long study (M=3 , F=5, Mage= 20.43, age range: 19-22). All participants are undergraduate colleagues of the researchers. One participant’s data was excluded from data analysis as they requested to leave the study. Refer to Table I for participant information according to group.

 nMean age
Group 1 (Control)420.67
Group 2 (Experimental)320.25
Table I. Summary of Participant Information.

Design. The experiment was conducted as a between-subjects design where participants were randomly assigned to one of two experimental conditions. The independent variable, journaling utilization, existed in two conditions: daily activity journaling (Group 1) and emotional-awareness journaling (Group 2). Empathy, the dependent variable, was operationalized according to the Empathy Quotient (EQ) Test for Adults and the Short Stories Questionnaire (SSQ) for Adults, two different measures of empathy (Appendix A). All participants took the EQ and SSQ tests and submitted the questionnaires for scoring. This pretest provided baseline empathy scores to compare later posttest empathy scores to, allowing for an analysis of empathy change following the experimental manipulations. Both conditions were then instructed to journal nightly before going to sleep for the duration of one week. Participants in Group 1 were instructed to utilize their journal to recall daily activities and served as the control group. Group 2 participants were instructed to journal regarding their emotional states throughout the day and served as the experimental group. A list of different emotions and associated signs and behaviors were also provided to Group 2 participants (Appendix B). They were encouraged to refer to the chart to precisely identify and label their different emotional states when journaling each night to promote deeper emotional-awareness and reflection. All participants were instructed to journal for the same amount of time each night (10 minutes) and for the duration of one week to control for potential confounding variables. At the end of the last day of journaling, both groups retested on the EQ and SSQ tests and submitted them for scoring. The pretest and posttest scores were then compared and analyzed across conditions for significant trends.

Results and Discussion

It was anticipated that the journaling utilization would mediate the impact of journaling upon empathy scores. We hypothesized that the increase in empathy scores would be significant for the emotional-awareness condition (Group 2) compared to no significant change for the daily activities condition (Group 1). Across the emotional-awareness condition, the resultant data was consistent with the original hypotheses. Group 2 participants improved by an average of 2.35 points for the EQ test (approximately 3.00% improvement) and 1.0 point for the SSQ test (approximately 5.0% improvement). These were considered to be a marginally significant and significant results, respectively, observed for almost all participants in Group 2. For the daily activity journaling condition, SSQ scores were fairly consistent with an average increase of .33 point (approximately 1.65% improvement). This change was deemed nonsignificant, and corroborated previous expectations. However, the EQ scores for the daily activity journaling showed an unexpected decrease; on average, participants in the daily journaling condition showed a decrease of 6.17 points from the pretest to the posttest (approximately 7.71% decrease). This was an unexpected result demonstrated across over half of participants in the control condition. SSQ and EQ scores are summarized in Table II.

             SSQMean Scores                      EQMean Scores
          PretestPosttest              PretestPosttest
Group 1 (Control)             8.008.33             54.6748.50
Group 2 (Experimental)           12.7513.75              48.7551.10
Table II. SSQ and EQ Pretest and Posttest Means.

The increase in empathy scores observed for participants in the emotional-awareness condition was consistent with our hypothesis. While this result could be attributed to the retest effect (also referred to as the practice effect) as the exact same SSQ and EQ tests items were administered twice, the effects would have been universally applied to both conditions. As the only marginal or significant increases of EQ and SSQ scores were observed for Group 2, the score improvement is more likely due to the effects of practicing emotional-awareness journaling than to previous exposure to the test questions.

Across nearly half of the participants, average scores on the EQ tests (44-50) and low scores on the SSQ test (5-8) were paired together for a participant, which is not typical for the empathy tests. The inconsistent results are unexpected, as these items typically have high concurrent validity. However, the SSQ and EQ differ on the number and nature of items presented, which may pose an explanation for this occurrence. The EQ relies upon self-report of how strongly a participant identifies with a list of 40 provided statements (Appendix A). The SSQ consists of ten different stories and corresponding responses, of which participants are asked to identify any responses could be perceived as upsetting. Additionally, whereas the EQ is an American test, the SSQ was created by the University of Cambridge in the U.K. As the majority of study participants were American undergraduates, it is likely that British phrases in the SSQ impacted comprehension and led to lower test scores. The combination of the different methods of assessing empathy and the language differences across the test likely contribute to the low concurrent validity observed.

            The substantial decrease in EQ scores for the daily activity journaling was unexpected and consistent across most Group 2 participants. It is unlikely that the act of daily activity journaling was a major cause of the decrease in EQ empathy scores. Rather, this was likely caused by a careless task approach on the self-report, as traditionally EQ scores show high test-retest reliability over the course of 12 months ( “The Empathy Quotient (EQ) for Adults”, n.d.).

Conclusion

Previous studies indicate journaling promotes the improvement of empathy skills. This research was supported by the results from this study, as the emotional-awareness journaling condition showed an increase in scores across both the EQ and SSQ tests. The empathy score increase deemed marginally significant or significant were only found for the emotional-awareness condition and not for daily activity journaling. This implicates the importance of self-reflection in promoting empathy, as empathy scores only increased when participants were instructed to foster emotional-awareness by utilizing their journaling sessions to recognize and label their emotions. This study suggests it is not the act of journaling itself that is significant, but the way in which it is utilized to promote self-reflection that has an impact upon empathy.

The resulting trends demonstrated that journaling focused on emotional-awareness was a likely contributor to the observed increase in empathy scores across the EQ and SSQ tests. However, further research directed specifically at the practice of journaling is needed to further support previous research findings and assert whether journaling is a major cause of empathy improvement. Additionally, the degree to which empathy scores can improve through journaling remains unexamined. The small sample size and the limited duration of the experiment posed limitations that should be considered and improved upon for future study, as a larger participant pool and a longer period of journaling could lead to more substantive results. Likewise, further study is necessary to determine which manner of journaling is most beneficial for the improvement of empathy.

Works Cited

Beitel, M., Ferrer, E., & Cecero, J. J. (2005). Psychological mindedness and awareness of self and others. Journal of Clinical Psychology,61(6), 739-750. doi:10.1002/jclp.20095

Davis H. (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology,44(1), 113-126. doi:10.1037/0022-3514.44.1.113

Dymond F. (1950). Personality and empathy. Journal of Consulting Psychology,14(5), 343-350. doi:10.1037/h0061674

Gerace, A., Day, A., Casey, S., & Mohr, P. (2017). ‘I think, you think’: Understanding the importance of self-reflection to the taking of another person’s perspective. Journal of Relationships Research,8. doi:10.1017/jrr.2017.8

Jamieson, Krupa, T., O’riordan, A., O’connor, D., Paterson, M., Ball, C., & Wilcox, S. (2006). Developing empathy as a foundation of Client-Centred Practice: Evaluation of a university Curriculum Initiative. Canadian Journal of Occupational Therapy,73(2), 76-85. doi:10.2182/cjot.05.0008

Patton T. (2019). Engaging Methods to Teach Empathy: A Successful Journey to Transformation(Doctoral dissertation, Union University School of Education, 2019) (pp. 1-160). ProQuest LLC.

The Empathy Quotient (EQ) for Adults. (n.d.). Retrieved April 25, 2020, from http://disabilitymeasures.org/EQ-Adult/

Appendix A

Sample Items from the Empathy Quotient (EQ) Test for Adults

THE CAMBRIDGE BEHAVIOUR SCALE

Please fill in this information and then read the instructions below.

Name:……………………………………………………………………

Today’s date:……………………………

How to fill out the questionnaire

Below are a list of statements. Please read each statement very carefully and rate how strongly you agree or disagree with it by circling your answer. There are no right or wrong answers, or trick questions.

1.I can easily tell if someone else wants to enter a conversation.strongly agreeslightly agreeslightly disagreestrongly disagree    
2.I find it difficult to explain to others things that I understand easily, when they don’t understand it first time.strongly agreeslightly agreeslightly disagreestrongly disagree      
3.I really enjoy caring for other people.strongly agreeslightly agreeslightly disagreestrongly disagree    
4.I find it hard to know what to do in a social situation.strongly agreeslightly agreeslightly disagreestrongly disagree    
5.People often tell me that I went too far in driving my point home in a discussion.strongly agreeslightly agreeslightly disagreestrongly disagree    
6.It doesn’t bother me too much if I am late meeting a friend.strongly agreeslightly agreeslightly disagreestrongly disagree    
7.Friendships and relationships are just too difficult, so I tend not to bother with them.strongly agreeslightly agreeslightly disagreestrongly disagree    
8.I often find it difficult to judge if something is rude or polite.strongly agreeslightly agreeslightly disagreestrongly disagree    
9.In a conversation, I tend to focus on my own thoughts rather than on what my listener might be thinking.strongly agreeslightly agreeslightly disagreestrongly disagree  
10.When I was a child, I enjoyed cutting up worms to see what would happen.strongly agreeslightly agreeslightly disagreestrongly disagree    

Appendix B

Student Research, student work

Focus Sessions and Periodic Breaks: A Personal Exploration of the Pomodoro Technique

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–By a student who would like to remain anonymous (June 2020)

Abstract

Personalizing one’s study habits and developing time management skills is an essential part of academic success. According to previous studies, an effective study habit is one that promotes focused learning and academic achievement, while an ineffective study habit is one that inhibits learning and academic progress. One time management technique, the Pomodoro Technique, has gained popularity over the years as a productivity booster and procrastination reducer. Alternating between 25-minute focus sessions and 5-minute breaks, the Pomodoro Technique has the potential to be an effective study habit by facilitating intentional learning and improving efficiency. To test whether this technique could improve my studying, I conducted a two-week, personal study. For one week, I observed and characterized my regular study habits using a journal. For the second week, I implemented the Pomodoro Technique and timed my study sessions using the phone application “Focus Keeper.” After comparing the average time studied per day, the average time per study session, the average number of phone interruptions, and perceived effectiveness of study sessions between the two weeks, I experienced an 8.95% decrease in daily study time, a 46% decrease in distractions, and a significant increase in motivation and focus with the Pomodoro Technique. From these results, I concluded that the Pomodoro Technique was an effective study habit that I could implement into my busy schedule.

Introduction

Whether in grade school or university, students of all ages have struggled with developing effective study habits and time management techniques. To aid in student learning, previous studies have proposed various frameworks to measure and evaluate study habits (Rabia et al., 2017; Burns & Dobson, 1984). One definition by Alzahrani et al. (2018) suggests that a good study habit is systematic andefficient, allowing students to plan, execute, and achieve learning objectives consistently and thoughtfully. Other scientists argue that a good study habit is measured by improved academic achievement, such as higher test scores and grade point averages (Jafari & Khatony, 2019; Purdie & Hattie, 1999). Still others—for example, Mustafa et al. (2010)—believe that a good study habit encourages flow, a state of uninterrupted engagement, focus, and effort on an academic task or topic. Although many of these studies identify characteristics of effective studying, few studies recommend specific study habits since these habits vary student to student based on learning styles, academic resources, and motivations (Idika, 2017). To improve my own study habits, I conducted a personal study to assess whether the Pomodoro technique could lead to more effective studying.

In the late 1980s, Francesco Cirillo developed the Pomodoro Technique as a university student struggling with a busy schedule, low productivity, and a lack of motivation (“Pomodoro® Press Center,” n.d.). Wanting to accomplish more in less time, Cirillo challenged himself to study effectively within the time allotted on a tomato-shaped kitchen timer (Cirillo, 2018). This pomodoro, or tomato in Italian, eventually became the logo for his business consulting firm and time management system. Comprising of six steps, the Pomodoro Technique breaks down larger projects into smaller tasks. The individual (1) chooses a task to complete, (2) sets a timer for 25 minutes, (3) works on the designated task for the allotted time without distraction, (4) stops working once the timer rings, (5) breaks for 5-minutes, and (6) repeats these steps three more times before taking a longer 20-minute break (Cirillo, 2018). One 25-minute focus interval is defined as a “Pomodoro,” and completing all six steps, or four Pomodoro’s, is known as a “Pomodoro Cycle” (Cirillo, 2018).

For the last two decades, the Pomodoro Technique has gained popularity in technology companies (Abrahamsson et al., 2008; Ruensuk, 2016) and business magazines, such as Forbes, The Guardian, and Harvard Business Review (“Pomodoro® in the News,” n.d.). Recently, the Pomodoro Technique has also reached mainstream audiences and students through self-help blogs and productivity articles that herald it as an effective time management system and study habit (Jubbal, 2016; Productivity tip: the Pomodoro technique, 2019; Boogaard, 2020). Although some observational studies have analyzed the Pomodoro Technique’s effectiveness (Feng, n.d.; Ahmed et al., 2014), to the best of my knowledge, few experiments verify its effectiveness for students. Despite this paucity of evidence, the Pomodoro Technique’s systematic, goal-oriented approach and intense, distraction-free focus intervals satisfy many of the aforementioned criteria for a good study habit. Additionally, studies have shown that short, intentional mental breaks during long intervals of work can improve performance and prevent fatigue or procrastination (Ariga & Lleras, 2011; Strongman & Burt, 2000). Thus, the Pomodoro Technique’s alternating system of intense work and mindful breaks has the potential to facilitate effective studying.

I am a current full-time, undergraduate student at the University of California, Los Angeles taking 20 units in Spring 2020. As a premed struggling with balancing extracurriculars, homework, and classes, I have had a growing interest in productivity and study tips that maximize my time. A few months ago, a medical student (whose channel I was following) posted a video explaining the Pomodoro Technique and its simple set-up. Curious to try this study habit, I designed this two-week study to examine whether I could use the Pomodoro technique as an effective study habit. During the first week, I evaluated my regular study habits as a control. During the second week, I implemented the Pomodoro Technique and used a phone application to time my study sessions. Over both the control and experimental weeks, I collected quantitative data (e.g. time spent studying each day, start and stop times, and the number of distractions) as well as qualitative data (e.g. journal entries about my mood and focus).

To compare my regular study habits to the Pomodoro Technique, I analyzed differences in average daily minutes of study, average minutes per study sessions, number of tasks completed each day, and perceived effectiveness of study sessions between the two weeks. Based on the data I gathered, I concluded that adding periodic breaks and focusing on one task at a time with the Pomodoro Technique resulted in fewer distractions and more effective studying.

Methods

For the first phase of the study, I characterized my regular study habits as a control. During this week, I tracked how long I studied each day, the number of distractions (namely, phone interruptions) per study session, and the start and stop times of my study sessions. Since I was not prone to open unrelated tabs or applications on my computer, I instead recorded the number of times I reached for my phone during a study session. I defined a study session as a prolonged period of studying with a maximum of 15 minutes of break time. Additionally, I recorded each task that I planned, the number of tasks I completed, and a short description of my mood or focus each day.

For the second phase of the study, I implemented the six-step Pomodoro Technique and used the iPhone application “Focus Keeper” to time my 25-minute focus sessions and 5-minute breaks. Like the control period, I noted the time studied each day, the number of distractions per session, the start and stop times of my study sessions, the number of tasks completed, and a short description of my mood or focus. I also recorded the number of Pomodoro’s I completed each day.

            Due to variations in daily workload and the time needed to familiarize myself with the new study habit, I decided to collect data on the Pomodoro Technique for a week. Once the control and experimental periods passed, I inputted the data into Excel to calculate the mean of the following variables: time studied per day, time per study session, number of distractions per day, and the number of tasks completed each day. I then calculated the percent change of these variables by subtracting the experimental statistic from the control statistic and dividing the result by the control statistic. This allowed me to compare the relative differences between the experimental and control statistics. If a variable had a percent change of more than 5% or less than -5%, the difference between the control and experimental week was considered significant.Additionally, I calculated the standard errors of the average time studied per day and the average time per study session to compare the variability, or spread, of the control and experimental data.

Results

Regular Study Habits – Based on my journal entries, my regular study habits were consistent day to day. Since mornings and afternoons were dedicated to lectures and meetings, most of my studying occurred in the evening. Before beginning my study sessions, I prioritized my tasks based on deadline. Once I began a task, I tended to complete it in one sitting with minimal breaks. When I did pause, it was to use the restroom or eat.

Each day, I studied an average of 314.13±25.83 minutes that I divided into three to four study sessions. These study sessions lasted about 88.83±10.90 minutes each. Additionally, I averaged 6.50 phone interruptions and completed 4 major tasks per day.

On days I woke up early (Mondays, Wednesdays, and Fridays), I recorded more instances of fatigue and sleepiness. On these same days, I completed more tasks than when I was well-rested or energetic. This was most likely because I had more hours in the day to study.

The Pomodoro Technique – Since data from the first two days were significantly less than my daily averages later in the week, I discarded these outliers. Based on my journal entries, I initially struggled with dividing tasks into neat 25-minute blocks and finding a suitable phone timer that could record my study sessions as I completed them.

I averaged a total of 286.00±64.77 minutes studied, or 9.40 Pomodoro’s, per day. Study sessions, or periods of consecutive Pomodoro’s, lasted about 90.00±61.13 minutes. Throughout the week, I averaged 3.50 phone interruptions and completed about 4 major tasks each day.

Although general levels of fatigue and sleepiness did not differ from the control week, I felt more focused during my experimental study sessions than usual. I was less distracted by daydreaming, worries about deadlines, and lack of motivation to initiate and finish tasks.

            Percent Change – After implementing the Pomodoro Technique, my daily time spent studying decreased by 8.95%, and the number of distractions each day decreased by 46.00%. I did not observe significant changes in the average time per session or the average tasks completed each day between the control and experimental data.

Discussion and Conclusion

Based on the 8.95% decrease in average daily study time and my reflections on perceived focus during study sessions, the Pomodoro Technique significantly increased my focus during study sessions. The number of completed tasks each day did not change significantly; however, I was able to reduce the overall time spent completing them. My efficiency and concentration improved while studying because I was more intentional about dividing work into manageable 25-minute spurts. Instead of wasting time motivating myself to start a task or procrastinating, the Pomodoro Technique held me accountable with a strict timer.

Additionally, the Pomodoro’s did not allow for distractions while studying, as evidenced by the 46.00% decrease in phone interruptions. The short, 5-minute breaks were more than enough time to decompress and reply to notifications. This promise of rest time reduced the temptation to check my phone during the 25-minute focus sessions.

One surprising finding in the experimental data was the rather large standard errors for the average time spent studying each day and the average time per study session—64.77 minutes and 61.13 minutes respectively. Although the experimental averages for these two variables were significantly different from the control averages, the standard errors indicated a larger variability in the experimental data. Some possible explanations for this discrepancy include inadequate time to adapt to the Pomodoro Technique, early completion of tasks before the timer rang (resulted in shorter Pomodoro’s), or more variation in assignments and tasks that week. The standard errors would likely decrease with an additional week of data collection.

Other limitations of this study included a small sample size of one, possible bias in the self-reported data, and restricted measures of effectiveness. Although this study measured efficiency, intentionality, and focus, further research can be done to understand the Pomodoro Technique’s effect on learning, memory, and other factors that contribute to effective studying. Additionally, future experiments can better quantify the Pomodoro Technique’s correlation with focus (e.g. tests of concentration or quantifications of brain activity), implement more extreme versions of the Pomodoro Technique (e.g. locking students out of browsers or enforcing longer focus sessions), or test alternative study habits, productivity systems, and apps.

Through this experiment, I concluded that the Pomodoro Technique was a simple yet powerful study habit that promoted intentionality, discipline, and focus. Although it was not always feasible to divide my tasks into 25-minute blocks or 2-hour Pomodoro Cycles (group projects and assigned readings were especially harder to complete), I learned two skills, allotting specific times for tasks and taking mindful breaks, that can improve my efficiency and concentration for future study sessions. This study is not representative of the general population and may not suit most university students; however, examining and experimenting with systems like the Pomodoro Technique is a worthwhile exercise in understanding and improving one’s study habits.

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