Original Article
SAT-based Self-image Improvement Intervention to Ameliorate Anxiety in ChineseCollege Students
Wen-Yan, Hu１）＊, Tsunetsugu, Munakata１）, Sayuri, Hashimoto１）, Wen-Jie, Yang２）, Ying, Feng3)*1） Department of Human Care Science, Graduate School of Comprehensive Human Science,

University of Tsukuba, Tennoudai, Tsukuba, Japan 305-8577
2） Mental Health Counseling Center, Yunnan University, Kunming 650091
3) School of Politics ＆Administration, Hainan University, Haikou 570228
E-mail addresses：hwy81＠hotmail.co.jp (W. H.); munakata21@yahoo.co.jp (T. M.)* Study on involvement in Enhancing College students Social ability by using SAT method—taking Hainan
University for example, Sponsored by 2009 Hainan education and science Eleventh Five-Year planning project■ Abstract
Objective: In this preliminary study, we examined the effectiveness of a 6 hours
self-image promotion intervention program on improving perceived emotional support
variables, self-image variables as well as on ameliorating anxiety. Participants andMethods: Participants were university students. We recruited 48 students andrandomly assigned them to one experimental group (n=24) and two control groups(n=24). Four participants of the control group 1 ceased participation prior tocompleting the post-intervention survey; thus, the final sample size of 44 (24experimental, 20 control) yielded a participation rate of 91%. Among them, 36% weremale, and 64% were female and ranging in age from 18 to 22 years (Mean=20±.98).
The self-image promotion intervention included 2 three-hour parts: Temperamentcoaching and SAT imagery therapy. Control groups were trained by communication
skill and stress management. Measures of perceived emotional support variables,
self-image variables and state anxiety were administered at pre-, post- and 5 monthfollow-up of the intervention to all these three groups. Trait anxiety was only
administered at pre- and 5 month follow-up of the intervention. Results: Analysis
indicated that relative to the control groups, experimental group had greater
improvement on the perceived emotional support and self-image (i.e., self-affirmationand problem solving) at post- and follow-up than per-intervention. In addition, theexperimental group had lower post- and follow-up scores on trait and state anxiety.
Discussion and Conclusions: The current study makes clear that the positive
self-image is very important for students to maintain low anxiety status. In order tocontrol anxiety disorder self-image change is needed firstly. Additionally, the indepthInternational Journal of Structured Association Technique No.4

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understanding of self and self-care behaviors for stress temperament is necessary.
The findings indicate that the self-image promotion program might be useful for
enabling college students to manage anxiety successfully.
Keywords: anxiety, self-image, parental image, positive expectation, self-carebehavior
1. Introduction
Anxiety disorder is becoming one of the most common psychological disorders inschool aged children and adolescents with high prevalence rate and many of themremaining unidentified and untreated 1). A 17,415 college freshmen survey showed thatfrom 2005 to 2008, Chinese college freshmen s mental health problem such as
anxiety and depression symptoms significantly increased year by year 2). Furthermore,a study pointed that such psychological problems are becoming the main reasons forhigh rate of withdraw from school, suicide and murder cases for Chinese students 3). In
addition, studies have proved that anxious individuals tend to choose a negative
perception and interpretation on things over other possible ones, and anxiety trait
may enhance the interpretation and/or processing of the cues conveying negative
emotion 4-6). Given the high prevalence rate and associated adverse effects, the needto prevent the development of anxiety disorders is paramount 1).
Worldwide, there are an increasing number of school-based and classroom-based
intervention studies to treatment or prevention students mental health or physicalproblems 7). The school system has been identified as an ideal avenue for thepromotion of prevention and early intervention programs for anxiety 8). Schools are
viewed as having unparalleled contact with youth and provide an opportunity to reachchildren and adolescents who have previously been unidentified and untreated 9).
Alison L. N. et al. reviewed 20 individual school-based prevention and earlyintervention programs for anxiety and suggested that both indicated and universal
approaches produce positive results with small to moderate reductions in anxiety at
post-test and follow-up. However, most of those programs lost follow-up datacollected and almost of them take long intervention time range from 8 to 14 sections(one section is about 1.5h ) or even lasting for 1 year 1). Additionally, in another review
study, the authors pointed that none of the reviewed programs included among its
goals improving adolescents ability to enjoy life, to laugh at themselves and the world,
or to develop emotionally or spiritually, all of which are important components ofmental health and nor did they make much systematic use of young people s own
goals 7). Therefore a short anxiety treatment and prevention school based program

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that are easy to operate and designed based on focusing on supporting students makeself-growth should be considered.
People s anxiety level is related to how they expect things. Those people who tend
to feel anxiety is because of they have negative expectations to the future. In another
word, people would feel easy and relax if they could have a positive expectation tothings. So, what are the determining factors for expectation manner? Munakata
suggested that the way that people anticipate things is determined by self-image 10).
Negative self-image always cause people cognize and anticipate things from anegative perspective and people who have positive self-image tent to have good andpositive expectations about future.
Traditionally, the Cognitive Behavioral Therapy (CBT), stress management
intervention, communication, relaxation and problem solving skills training have beenused for treating and preventing anxiety symptom through improving participants
self-image such as self-esteem and self-efficacy 11-19). However, the effectiveness of
those methods was not consistent. This maybe because of the CBT relies heavily on
the compliance of the clients, and it focuses on client s problem directly but not
resolve the root causes 20, 21). In other words, CBT focus on solving problem
more than supporting self-growth and clients might have the risk of suffering
mental health troubles again when other problems happened. There is another problem
should be noticed. Emotions have more influence on determine human being s
behavior than thought. This is might be one of explanations that why people usuallyknow it is not good, want to make some changes but fail to change finally. Thus we
suppose that the characteristic of CBT which try to change people s behavior
through changing their thought and believe might be one of the reasons of theinconsistent effectiveness.
Social skills might easy to be carried out and show great effectiveness for managing
anxiety for people with positive and strong self-image. However, for those who havenegative self-image, the effectiveness might be limited since social skill training itself
could not make improvement of self-image. Thus, even people mastered the skills, but
it would be very difficult for some of them to put skills into action because of lacking
positive expectation, feel powerlessness and lack of confidence.
Ueda et al. s study pointed that the sense of self-denial, trait anxiety among
university students were related to their parents aversive expression 22). Young s
study also pointed that the negative parental images endorsed by individuals as adults,
are the origins of their maladaptive self-images or schemas and these images are inturn responsible for adult emotional distress and disturbances in interpersonalfunctioning 23). John et al. s study supported the predictive relationship between

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images of parents, self-image and emotional well-being 24). Munakata explained themechanism that how parental image determines self-image. He pointed that it s
because people who have negative parental image tend to give up being themselves(i.e., repress their true feelings; emotionally and interpersonal dependent on others)
and develop others-rewarded oriented lifestyle without realizing it 25). According to
Munakata (2010) 25), others-reward oriented behavior forms and related withaversive parental image. It means individual get dopamine secreted and obtainpleasure motivated by sufficing for human being s want to be loved desire ,pursuing social achievement, view social success as a primary goal and what s more,
the judgment and standard of the outcome is controlled and determined by others.
Such kind of behaviors will ceaselessly cause one feel anxiety, feel stress, cause
negative self-image forming and result in psycho-somatic symptoms. In conversely,
self-rewarded seeking behavior forms related with positive parental image. Itmeans individuals get dopamine secreted and obtain pleasure motivated by sufficing
for human being s want to love oneself desire
want to love others desire . For
example, only pursue living positively, getting hopes, self-satisfaction, enjoyable, andappreciate others can help people maintain real well-being in such a stressful society.
Because such kind of behavior is related to build positive self-image, the judgment
and standard of the outcome can be controlled and determined by oneself, thoserewards resource belongs to oneself.
Based on these previous research results, and with considering the problems of theexisting social skill training and CBT intervention programs, one technique we usedhere is SAT imagery therapy that developed by Munakata, aimed to improveparticipants self-image through the change of their parental image script firstly in animagery work.
In recent years, self-care has developed as an important health care concept 26).
Self-care behavior based on one s own gene temperaments is also related to build
positive self-image and maintain well-being 27). According to Munakata s temperament
theory, temperament is the genetic character about our desire and emotional reaction,
which in turn define our behaviors. It contains two parts, one is personality
temperament and another is stress temperament which defines the strength of oursensitiveness and reaction, and has been divided into persistence, neuroticism andnovelty-seeking temperament 27). Genetic temperament, nucleus of one s nature
consisting of hereditary factors and biological factors related to neurotransmitter,does not change throughout one s lifetime. Among them all, those who have either
persistence temperament
observed in perfectionists orneuroticism
temperament represented by pessimism and tendency to be opinionated incline toInternational Journal of Structured Association Technique No.4

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become powerless, hopeless, fearful, solitary and stressful. Therefore, the self-carebehavior becomes extremely essential for those people to manage stress andmaintain well-being. However, other researches pointed that the issue of personal
identity for the purpose of better understanding of the self, another main feature ofmanaging the self, has received little attention when consider how to improvestudent s competence 28).
Therefore, in the current intervention program, stress gene temperament coaching
was contained to improve participants self-image through deeply understanding
themselves, improvement their interpretation style toward to themselves andsignificant others and let participants know what kind of self-care behaviors should bedone to care their stress gene temperament weak points. In order to compare theeffectiveness of the current intervention program we set two control groups whichwere trained by communication skill and stress management coaching.
The aim of this study is to use a randomized controlled design and validated outcome
measures to examine the effectiveness of self-image promotion intervention programon enhancing college students positive self-image, and on improving participants
anxiety status. Our hypotheses are as the following: 1) social skill training couldn t
make self-image improvement; 2) by looking parental substitute representation,
self-image could be improved; 3) with the improvement of self-image, the anxiety level
would decrease.
2. Methods
2.1 Subjects
Participants were university students recruited to take part in a self-image
promotion program for improving anxiety status through improving self-image by doing
self-care behavior and changing behavior from others-reward oriented pattern toself-reward oriented pattern. We recruited 48 students and randomly assigned themto experimental (n=24) and two control groups (n=24). Before they completed a
pre-intervention survey, we informed all participants of the informed all participants of
the natural and purpose of the study, and they voluntarily provided informed consent.
Four participants (control group 1) ceased participation prior to completing thepost-intervention survey; thus, the final sample size of 44 (24 experimental, 20
control) yielded a participation rate of 91%. The majority of students were second year
(n=29, 66%), and then the first year (n=13, 29.5%)，only 2 come from the third year
(4.5%). Among them, 36% were male, and 64% were female and ranging in age from 18 to
22 years (Mean=20±.98). Persistence temperament score range from 1 to 5 points(Mean=3.91 ± 1.27), neuroticism temperament score range from 0 to 5 points

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(Mean=3.36±1.36).
2.2 Procedure and Setting
Students volunteered by e-mail or telephone in response to flyers which wereposted around campus. We informed potential participants that they would be
randomly assigned to 1 of 2 groups: ① the experimental group (EG) involved
completing a pre-intervention survey, attending a one day intervention (2 parts, 3hours each) and completing a post-, one month and five month follow-up surveys; and② the control group involved completing pre-, post-, one month and five monthfollow-up surveys on the same days as the experimental group. In addition, the control
group was randomly divided into two groups: control group one (CG1) attending a one
day communication skill coaching course (2 parts, 3 hours each) and control group two(CG2) attending a one day university stress management coaching (4 parts, 1.5 hourseach). We give each one of the participants a ball pen and a notebook to encouragethem fulfill the checklist seriously.
Self-image promotion intervention
The self-image promotion intervention included 2 three-hour parts: ①Temperamentcoaching and ② SAT imagery work.
The first part is temperament coaching help participants change their interpretationstyle to themselves and others image by making them deep understanding thecharacteristics of self s and others genetic temperaments, and support them toknow what behaviors they should do to care of the weak point of their temperaments.
In this part participants were coached with genetic temperament knowledge andself-care behaviors about stress temperament, such as taking deep breath to calm
down, or letting inner voice say that s all right for several times to decrease theexpanded demand level. A human relationship improvement skill based on
temperament knowledge and self-care behavior also been trained.
Part 2 is SAT imagery work, with the aim of creating a positive self-image, andchanging students behaviors from others-reward oriented to self-reward oriented
pattern through changing their parental image to a positive one. SAT (structured
association technique) imagery work is a series of techniques that based on
structured questions, through makes use of intuition and association to support
people finding problem solution method or change behaviors 29). It is the Third
Generation Cognitive Behavioral Therapy which is characterized by focusing on
emotional change first. Munakata pointed that parental substitute representation is avery effective, simple and practicable method to help people control emotions25). SAT
imagery work is a development of traditional CBT and offsetting its weakness whichtries to change people s behavior begin with thought change. In the current study, weInternational Journal of Structured Association Technique No.4

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support participants change and control their emotion by finding out and using parents
substitute representation. Through the imagery work, they would feel unconditional
love from parents, with the fulfillment of want to be loved desire their parental
image would change to a positive one naturally. After changing their parental image,
participants could change their behavior to self-rewarded oriented behavior which inturn both contribute to the fulfillment of want to love oneself desire and want tolove others desire , and contribute to self-image changing to a positive one.
Communication skill coaching
Communication skill coaching also included 2 three-hour parts: ① Communication
skill lecture and ② Practice in pairs.
At the part one, participants were taught with listening skill, assertion skill andnegotiation skill with the aim of support students well-being from building
empowerment interpersonal relationship. In order to strengthen the effect, at part two,
participants practice ask for helping game, refuse game, encourage game, and positive
feedback game by using these skills learned at part one.
Stress management coaching
It was with the aim of improving students well-being through learning how tomanage change and difficult situations more effectively. It also included 4 parts: ①
Stress management; ②Autonomy; ③ Emotional management; and ④ Case analysis
by watching DVD.
2.3 Measures
The questionnaire consisted three parts: ① attributes (age, gender, academic level,stress temperament types); ② anxiety status; and ③ self-image variables. In thepresent research, the Japanese version scales were first translated into Chinese andthen back-translated into Japanese by two bilingually fluent researchers. Highconvergence between the two versions was obtained.

Anxiety status
State-Trait Anxiety Inventory (STAI)
Spielberger et al. s (1983) 30) well-known STAI was designed to assess two types ofanxiety, one's mood in the moment (state anxiety), and in general (trait anxiety). It
contains two 20-item scales. For the state anxiety scale, response choices were from
(1) Strongly agree to (4) Strongly disagree . On the other hand, for trait anxiety
scale, response choices were from (1) not at all to (4) very often . Agreement topositive and disagreement to negative items scored 1 with a total score range from 20
to 80, respectively. We coded all items so that higher scores indicated higher levels ofanxiety. In the current study the internal consistency of the Chinese version was 0.91
and 0.89, respectively. In the current study, we estimated the state anxiety at each

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time, but for the trait anxiety, we only estimated it at pre- and 5 month follow-up.

Perceived emotional support
Two instruments―Perceived Emotional Support from Family (ESFFA) and Perceived
Emotional Support from Peers (ESFP) scales (Munakata, 1996)31) were used toestimate the subjective experience. Each scale had 10 items. Sample items in ESFP
scale were: Do you have any friend who supports your behavior . Any friend was
replaced with Family members in ESFFA scale. The Cronbach s alpha in thecurrent study was 0.70 for ESFFA and 0.66 for ESFP, respectively.

Self-image variables
Self-affirmation
The converse score of 10-item self-denial scale (Munakata2001)32) was used toestimate perceived positive feelings of self-affirmation. The scale has 1 positive item
( I do like myself ) and 9 negative items (e.g. I want to die ; I don t know why I
was born ; I am dirty ). In this study, the items were reverse scored: responses thatapproximated positive to self-denial were scored 0 ( I always think so ), 1
( sometimes I think so ), and 2 ( I don t think so ); responses that approximatedpositive to self-denial were scored 2 ( I always think so ), 2 ( sometimes I thinkso ), and 0 ( I don t think so ). The total scores range from 0 to 20. Higher scoresindicate a high level of positive feelings of self-affirmation. Cronbach s alpha for the
scale was 0.65 in this study.

Problem solving behavioral trait
10-item problem solving behavioral trait scale (Munakata, 2001)32) was used tomeasure individual s behavioral trait that try to deal with the tasks and problems
positively, effectively and realistically. The scale comprises of items such as I
always confirm the fact prior to make judgment and I always make plan and think
about steps to take about what to do . Response choices were scored 2 ( I
always do so ), 1 ( I do so ), or 0 ( I don t do so ), with total scores range
from 0 to 20 and higher scores indicate high realistic problem solving behavioral trait.
Lower score was suggested the tendency to repeat the same kind of failures orpostpone to solve problems rather than facing the reality of fact. Cronbach s alphafor the scale was 0.75 in this study.

Self-expression behavioral trait
In this study we used the converse score of 10-item self-repression scale(Munakata, 1996)31) to measure self-expression behavior trait. The original scalemeasures the expectations of being acceptable from others by repressing one s true
feelings to satisfy people around. An example of a typical item such as I tend to
suppress my feeling I usually can t express what I really think easily . Originally,

International Journal of Structured Association Technique No.48

responses that approximated to self-repression were scored 2 ( I always do so ),1 ( I do so ), or 0 ( I don t do so ). In the current study, responds werereverse scored 0 ( I always do so ), 1 ( I do so ), or 2 ( I don t do so )with total scores range from 0 to 20 and higher scores indicate a high level ofself-expression behavior trait. Cronbach s alpha for the scale was 0.62 in this study.

Emotional autonomy behavior trait
The converse score of Japanese version of Hirschfeld, Gough, and Barrett (1977) 33)
interpersonal dependency scale was used to estimate interpersonal independency
behavioral trait. The original scale was used for personality assessment (Franche &Dobson, 1992) 34) and validity and reliability was examined. It is an 18-item scalemeasures one s tendency to socially depend on others and has both dependence
and independence domains. Independence items include I always rely on my own
efforts and I don t care about what the other people say . Dependence domainquestions include I m worried when I lose others favor and I d rather likebecome a follower than a leader . In this study the items were reverse scored: thedependence items were scored as 0 ( That s very true ), 0 ( That s true ),1 ( That s generally true ), and 1 ( That s not so ); those independence items
were scored as 1 ( That s very true ), 1 ( That s true ), 1 ( That s
generally true ) and 0 ( That s not so ). The total scores range from 0 to 18 andhigher scores indicate high emotional autonomy behavioral trait. Cronbach s alpha forthe scale was 0.66 in this study.
2.4 Ethical Considerations
Before starting the study procedures, the ethical permission was first obtained fromthe Ethical Committee of Graduate School of Comprehensive Human Sciences,
University of Tsukuba. The permission number is No.21-175. Before the test wasadministered, each student signed an informed consent agreement. A brief descriptionof the study was given to the participants, along with assurance that all answers would
remain completely anonymous.
2.5 Data Analysis
SPSS Version 17.0 statistical software was utilized for the statistic analysis of thisstudy. Means, standard deviations and reliability coefficients were conducted forexperimental group, for all variables pre-, post- and 5month follow up of theintervention. We also conducted Mann-Whitney tests to determine whether there
were any systematic differences between the groups at the baseline prior to theintervention. For each group, we conducted the Friedman test to examine whether
there is significant change within group and if it was significant, we conducted
Wilcoxon signed-ranks test continually to compare the changes of the data collectedInternational Journal of Structured Association Technique No.4

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at pre-, post- and 5month follow-up of the intervention. A p-value<0.05 wasconsidered significant (Post hoc test with Bon ferroni correction).
3. Results

3.1 Baseline
The median age of all participants was 20 with no difference between the groups.
63.6% was female and 36.4% was male. All the demographic variables of this study
population are depicted in Table 1. By using Mann-Whitney tests the demographics ofage, gender, stress temperament (persistence and neuroticism temperament) have nosignificant difference among study groups (p>0.05). However, for the outcome
variables, with regards to perceived emotional support from family there was asignificant difference between experimental group (EG) and control group two (CG2)(p=0.049), and between control group one (CG1) and control group two (CG2)(p=0.005). With regards to problem solving, there was a difference between control
group one (CG1) and control group two (CG2) (p=0.057), however it was notstatistically significant. With regards to self-expression, there was a significant
difference between between control group one (CG1) and control group two (CG2)(p=0.039). These differences would be considered which will validity affect the final
result.
Table 1. Demographic variables and outcome variables of the participants at pre-intervention
VariableEG

CG 1

p Value

CG 2

Demographics
Age (Median±SD)20.08±1.10

20.13±0.64

19.75±0.96

n.s.

10/14

2/6

4/8

n.s.

Persistence temperament

3.96±1.26

3.75±1.48

3.92±1.24

n.s.

Neuroticism temperament

3.54±1.17

3.00±1.51

3.25±1.65

n.s.

8.58±1.47

9.38±0.74

7.08±2.27

Gender (male/female)

Outcome variables
Perceived emotional support from family

EG vs CG2 p=.038*
CG1 vs CG2 p=.005**

Perceived emotional support from peers

8.54±1.91

9.50±0.53

9.00±1.20

n.s.

Self-affirmation

15.67±2.33

15.63±2.77

14.25±2.95

n.s.

Problem solving

8.79±3.85

9.00±1.60

7.50±1.73

CG1 vs CG2 p=.057†

Self-expression

9.87±3.23

8.25±1.83

10.42±2.53

CG1 vs CG2 p=.039*

Emotional autonomy

12.79±3.3412.50±2.26

12.83±2.75

n.s.

State anxiety

39.62±10.60

37.12±7.40

38.25±8.30

n.s.

Trait anxiety

41.67±11.00

46.25±8.4945.83±12.20

n.s.

Note. *** p<.001; ** p<.01; *p<.05; n.s. no significant

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3.2 Changes after intervention
Table 2 showed all of the outcome variables changes for three groups from pre- tofollow-up of the intervention. For experimental group, except the self expression scale(Friedman test, x2 =4.22, p=0.121) and emotional autonomy scale (Friedman test, x2=4.76, p=0.092), all the other scales showed significant changes after intervention(Table 2). Comparison with the baseline, Wilcoxon signed-ranks test showed that theperceived emotional support from family significantly increased at post-intervention(p=0.004) and 5 month follow-up (p=0.028), the perceived emotional support frompeers significantly increased at post-intervention (p=0.003) and 5 month follow-up(p=0.046), the self conceit significantly increased at post-intervention (p=0.000) and 5
month follow-up (p=0.006), the problem solving behavior significantly increased at
post-intervention (p=0.007) and 5 month follow-up (p=0.018). The trait anxiety
significantly decreased at 5 month follow-up (p=0.034), and the state anxiety
significantly decreased at post-intervention (p=0.000) and 5 month follow-up(p=0.044).
On the other hand, in control group 1 all of the scales did not show any statisticalsignificant changes between at baseline, post-intervention and 5 month later. All mostthe same, in control group 2, except the self-affirmation scale (Friedman test, x2=10.44, p=0.015), all the other scales did not showed significant changes after
intervention. The post hoc test of self-affirmation significantly increased at
post-intervention (p=0.022) and at 5 month follow up (p=0.045). Although theperceived emotional support from family showed statistical significant at Friedman
test (Friedman test, x2 =10.73, p=0.013), however, it lost significant at the post hoc
test post-intervention vs. pre-intervention (p=0.078) and at 5 month follow up(p=0.062).
Table 2. Outcome variables changes for three groups from pre- to follow-up of the intervention
Scale

Group

Pre-

Friedman

Post-

5 month-Wilcoxon signed-ranks test

test (P Value)

PESFFAPESFPP Value (vs. Pre-intervention)
25%

median75%

25%

median75%

25%

median75%

Post-

5 month-EG.001 **

8.00

9.00

10.00

10.00

10.00

10.00

9.00

10.00

10.00

.008 **

.032*

CG1

.077 †.

9.00

9.50

10.00

9.00

10.00

10.00

10.00

10.00

10.00

——

——

CG2

.013 *

4.50

8.00

8.75

8.00

8.00

9.00

7.25

9.00

10.00

.078 †.062 †

EG.008 **

8.00

9.00

10.00

10.00

10.00

10.00

9.00

10.00

10.00

.006 **.050 †

CG1.112n.s.

9.00

9.50

10.00

10.00

10.00

10.00

10.00

10.00

10.00

——

——

CG2

.706 n.s.

8.00

9.50

10.00

8.25

10.00

10.00

9.00

9.50

10.00

——

——

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EG

.000 ***

14.00

16.00

17.75

17.25

18.50

19.00

16.25

18.00

19.00

.000 ***.008 **

Self-

CG1

.172 n.s.

12.75

17.00

17.00

17.00

18.00

19.00

17.00

17.00

18.00

——

——

affirmation

CG2.015 *

13.25

15.50

16.00

13.25

16.00

17.75

12.50

17.00

18.75

.022*

.045*

EG

.033 *

5.25

9.00

12.00

7.50

10.00

15.00

8.00

9.00

13.75

.014*

.028 *

Problem

CG1.361 n.s.

8.00

9.50

12.75

9.25

12.00

13.75

11.00

11.00

12.75

——

——

solving

CG2.096 †

4.50

7.50

8.00

4.25

5.50

8.50

6.25

8.50

10.00

——

——

EG

.121 n.s.

8.25

10.00

12.00

9.00

11.00

12.75

10.00

11.00

13.00

——

——

Self-

CG1

.266 n.s.

7.00

7.50

10.00

7.25

10.00

12.00

7.75

10.00

10.00

——

——

expression

CG2.697 n.s.

8.00

11.00

12.00

9.25

10.00

12.75

8.50

11.50

12.75

——

——

EG

.092 †

10.00

13.00

16.00

13.00

14.00

16.00

14.00

14.50

16.00

——

——

Emotional

CG1.090 †

10.50

12.50

14.00

13.00

14.00

15.75

12.25

13.50

15.00

——

——

autonomy

CG2.110 n.s.

10.25

13.00

15.50

10.25

13.00

15.00

11.25

14.50

16.00

——

——

EG

.000 ***

31.50

36.50

48.00

23.25

26.00

34.75

25.00

31.50

43.25

.000 ***.050 †

State

CG1.090 †

29.75

35.00

40.50

22.25

25.00

28.50

22.25

29.50

41.75

——

——

anxiety

CG2.086 †

28.25

36.00

44.75

32.50

42.50

44.75

31.25

36.50

42.25

——

——

EG

.049 *

33.00

41.00

48.75

——

——

——

29.00

36.00

42.00

——

.034 *

Trait

CG1.157 n.s.

40.25

46.00

53.50

——

——

——

39.25

43.00

48.00

——

——

anxietyCG2

1.00 n.s.

34.50

51.00

55.75

——

——

——

39.25

48.00

53.50

——

——

Note. Perceived emotional support from family (PESFFA), Perceived emotional support from peers (PESFP).
*** p<.001; ** p<.01; *p<.05; n.s. no significant
Wilcoxon signed-ranks test was conducted continually only when Friedman test showed statistic significant.

4. Discussion
In this preliminary study, we examined the effectiveness of a 6 hours self-image
promotion intervention program on improving self-image and anxiety status. Findings
indicated that experimental group had greater improvement on the perceived
emotional support and self-image (i.e., self-affirmation and problem solving) at postand follow-up than per-intervention. In addition, the experimental group had lower
post- and follow-up scores on trait and state anxiety. Oppositely, the social skill
training seemed failed to change self-image and failed to make improvement ofanxiety status. The reasons that caused different results between the experimentalgroup and control groups might be determined by that whether the method focused on
supporting self-growth, and whether the method could make improving of self-image.
A strength of current intervention is that different with traditional CBT and social
skill training programs, it emphasized the importance role of parental substituterepresentation and self-care behavior about stress temperament in both improving

International Journal of Structured Association Technique No.4

12

self-image and managing anxiety. The effectiveness of current intervention supports
the previous research results 22, 25, 35, 36). People have negative parental image
perception when they have high standard of expectation to their parents. However,through the SAT imagery work, participants could awareness the existing of theirunborn siblings who might be their sisters or brothers. They can get energy andemotional support from the unborn siblings, and through this imagery work the
expectation standard to their parents would decrease at the same time. Then theirparental image script would improve naturally and leads fulfillment of three love
desires . When participants feel secure they can take self-reward oriented behavior
which could result in improving perceived emotional support ability, forming positive
self-image and positive expectation.
Students also improved their interpretation style of self and others image script bytemperament coaching, make them deep understanding self and others, and knowwhat they should do to care of their temperament. With improving of perceived
emotional support and self-image, students could recognize and interpret things in apositive manner (i.e., others emotion, support, and even see a stress thing as achallenge), have positive expectation, and establish secure attachments with others,
which in turn contribute to maintain low anxiety status.
Above all, the current study makes clear that the positive self-image is very
important for students to control anxiety symptoms. In order to development positive
self-image, deep understanding of self and self-care behaviors about stress
temperament is needed. Such as students who have anxious temperament shouldtake a deep breath let themselves cool down when they become emotional, and thosestudents who have persistence temperament should let inner voice say It s ok,that s all right when they demand a perfect thing. In order to development a positive
self-image, parental image must be considered to satisfy student s to be loved
desire . For example, to establish positive parental image by using a parental
substitute representation or unborn sibling s substitute representation (theymight be photographs with happy face, or Buddha picture or animated character) anddo some efforts such as make the substitute representation portable, or set it to adesktop picture, with such high frequency of stimulation, the positive parental image
would be fixed in the mind, replacing the negative one. Along with the parental imagechanging, students
love desire are satisfied, their perceived emotional support
ability improved and finally these efforts would contribute to self-reward oriented
behavior and individuals would develop positive self-image naturally while such
behaviors continued.
Only the stress management training group (CG2) showed effectiveness on

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13

improving the self-affirmation, however, neither the perceived emotional support
variables nor anxiety status showed any changes in both the two control groups.
Different with the previous researches results 1, 8, 9), in the current study, it seems thattraining by social skills alone seems impossible to help students who with negative
self-image to improve their anxiety status without self-image change. We suggest thatunless students develop a positive self-image first, they cannot perform those skills intheir daily life, because of the lack of positive expectation, lack of self-confidence andpowerlessness.
There are several limitations should be considered when interpret the current results.
One is come from the program itself. Among the outcome variables, however, nosignificant change was observed in the self-affirmation and self-expression. Additional
approaches seemed necessary. Second is the relatively small size of the sample,
especially the small size of the control groups, which may have been a contributing
factor in no significant results. Thirdly, we did not randomly select participants fromthe population which has implications for the generalizability of the results. The fourthis come from the questionnaires. Most of the scales were translated from Japanese to
Chinese, although a back-translated was performed, but we did not make muchmodification to make the items more suitable for Chinese expression style, moreeasier understanding for Chinese college students which may be the reason thatcaused the low Cronbanch s alpha coefficient and affect the current results. Fifth isthe ceiling effect which might affect the validity of the result, participants in control
groups had a high score on perceived emotional support from peers at the baseline.
■ Authors Contributions
Hu Wen-Yan suggested the idea of this study and facilitated the study procedures;she contributed to the conception, the design and the methodology; she conductedintervention training for the experimental group and the first control group, performed
the statistical, interpreted the results and the discussion, and drafted the manuscript.
Munakata and Hasimoto were involved in the study design and methodology revised
the result. Munakata has made substantial contribution to interpretation of data,revise and improvement the final manuscript. Yang Wen-Jie and Feng Ying have been
involved in the study design, getting permission for doing this study from Yunnan
University, provided the training for the second control group and collecting
references.
■ Acknowledgements
We grateful to the participants of the study, who showed great interesting in theInternational Journal of Structured Association Technique No.4

14

current program and cooperated to complete survey questionnaires for 4 times withserious attitude which in turn encourage we greatly. We also grateful thanks to all thestaff of Mental Health Counseling Center Yunnan University for their continuous
support of recruiting participant s, printing text, providing room and other materials
and questionnaires collection. Without their help the current intervention study
wouldn t be accomplished smoothly. At last, we d like to extend our grateful thanks
to our families for their unconditional emotional support.
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