Final submission gladstone dissertation final draft embedded 1

A5( M$57,$/ A576 $1E))(&7,9( 6(/) &$5(35$&7,&( )25M(17$/ H($/7+ P52)(66,21$/6? A dissertation presented to the faculty of ANTIOCH UNIVERSITY SANTA BARBARA In partial fulfillment of the requirement For the degree of DOCTOR OF PSYCHOLOGY in CLINICAL PSYCHOLOGY By Jake Gladstone, PsyD April 2018 ARE MARTIAL ARTS AN EFFECTIVE SELF- CARE PRACTICE FOR MENTAL HEALTH PROFESSIONALS? This dissertation, by Jacob Gladstone, has been approved by the committee members signed below who recommend that it be accepted by the faculty of Antioch University Santa Barbara in partial fulfillment of requirements for the degree of Doctor of Psychology in Clinical Psychology. Dissertation Committee: _________________________________ Dr. Brett Kia-Keating, Ed. Dan Schwartz, Ph.

Second Faculty __________________________________ Dr. Randy Wood, Ph. External Expert ŝŝ Copyright 2018 By Jacob Gladstone, Psy. Candidate ŝŝŝ Abstract The field of mental health presents a wide range of occupational challenges including but not limited to ethical issues, cultural competency and effective caseload management.

In addition, mental health professionals who provide psychotherapy face a variety of challenging cases which include complicated interpersonal problems and stories of trauma. Due to the demands of their work, mental health professionals are exposed to traumatic experiences that may have a negative impact on their emotional, physical, and cognitive functioning (Portnoy, 2011). The challenges which mental health professionals face highlight the importance of effective self-care practices to reduce occupational stress. There us a body of research suggesting that the various aspects of martial arts martial arts, including the meditative practices as well as the physical exercise, can reduce stress and increase self-efficacy among martial arts practitioners (Birdee, et al., 2009; Bourdreau & Koznak, 1984; Boullosa, et al., 2015; Hakan, Kassab & Lothes, 2013; Hashizume et al.

To date, however, there is no specific research examining whether martial arts could serve as an effective self-care practice for mental health professionals. It is important to discuss both the benefits and disadvantages of practicing a martial art for self-care. This is a qualitative, phenomenological study designed to explore the lived experiences of mental health professionals who practice martial arts, in order to evaluate whether as an effective self-care practice for them. This Dissertation is available in Open Access at AURA: Antioch University Repository and Archive, http://aura.edu and OhioLink ETD Center, http://www.edu/etd ŝǀ Table of Contents Abstract.

iv Chapter I: Introduction. 1 Chapter II: Literature Review. 6 Benefits of physical exercise. 16 Overview of martial arts.

20 Review of the Literature on the effects of martial arts pUDFWLFH««««««««««« Martial arts practiced by the pDUWLFLSDQWV«««««««««««««««««««« Karate. 26 Brazilian Jiu Jitsu. 29 Chapter III: Research Methods. 32 Inclusion and exclusion criteria.

34 Internal and external validity. 37 Chapter IV: Results. 39 Martial Arts as a self-care practice«««««««««««««««««««««« Challenges of martial arts training. 49 Martial arts and clinical practice.

59 Implications for future research. 62 Appendix A: Informed Consent. 68 Appendix B: Interview Protocol. 69 ǀŝ Chapter I: Introduction Mental health professionals face a vast array of demands in the workplace.

Not only must they manage the typical responsibilities of employment including organization of tasks, effective communication, and maintaining current training certifications, they are also required to manage the emotional burdens that are inevitable in their respective field. For the purposes of this dissertation,ƚheODEHO³mental health professional´ represents Clinical Psychologists, Licensed Marriage and Family Therapists, Licensed Clinical Social Workers͕ and Psychology-interns and practicum trainees (Psy.) who provide therapeutic services. For these individuals, the stressful and often traumatic cases they see do not simply vanish once they clock out. Given the nature of their work, mental health professionals are vulnerable to stressors that challenge them emotionally, physically, spiritually, and can impact their cognitive resources and psychological well-being (Portnoy, 2011).

When conscious efforts are not made to manage work-related stress for mental health practitioners, research has found that such practitioners are highly vulnerable to experiencing distress that has a negative impact on their daily functioning. The term commonly used to describe the negative impact of work-UHODWHGVWUHVVLVµRFFXSDWLRQDOEXUQRXW¶7KLVWHUP encompasses a wide variety of symptoms that can potentially cause significant distress. Occupational burnout can lead to depression, anxiety, compassion fatigue, distraction and decreased self-awareness, and the risk of such consequences may increase with a lack of social- support (Carter, 2013). Over the course of their career, many mental health professionals will be tasked with treating individuals who present a wide variety of traumatic experiences.

Mental health ϭ  professionals who face such challenging cases are at risk of experiencing some level of secondary trauma as a result. Secondary trauma is a term that describes the emotional distress experienced by an individual who hears about the firsthand traumatic experience of another person (Baum, 2016). The symptoms of secondary trauma mimic the symptoms of post- traumatic stress disorder (PTSD). It is commonly accepted that mental health professionals can expect to experience a significant amount of emotional activation given the often painful and distressing material their clients share with, and sometime direct toward them.

Psychotherapists are often exposed to stories of trauma, complex and highly negatively charged interpersonal interactions, tragic stories, and complicated ethical issues and mandated reporting questions. A psychotherapist must absorb much painful affect and still be able to approach delicate issues with equanimity and competence if they are able to develop and implement treatment plans to target maladaptive behaviors and reduce the severity of the clientV¶VXIIHULQJ. Much research indicates that to provide effective psychotherapy, mental health professionals should engage in effective self-care practices to alleviate the occupational stress that they experience (Portnoy, 2011; Figley, 2002). Under Principal II: Responsible Caring of the Canadian Code of Ethics of Psychotherapy; 3ULQFLSDO,,VWDWHVWKDWSV\FKRORJLVWV³(QJDJHLQVHOI-care activities that help to avoid conditions that could result in impaired judgment and interfere with their ability to benefit and QRWKDUPRWKHUV´ 3RSH 9DVTXH] TKH$PHULFDQ3V\FKRORJLFDO$VVRFLDWLRQ¶V*HQHUDO 3ULQFLSOHV3ULQFLSDO$%HQHILFHQFHDQG1RQPDOHILFHQFHVWDWHVWKDW³3V\FKRORJLVWVVWULYHWREH aware of the possible effect of their own physical and mental health on their ability to help those ZLWKZKRPWKH\ZRUN´ 3RSH 9DVTXH] 7KHVH statements reflect the mental health SURIHVVLRQDOV¶HWKLFDOGXW\WRDFWLYHO\HQJDJHLQDFWLYLWLHVWKDWPD\UHGXFHWKHULVNRI Ϯ  occupational burnout, sHFRQGDU\WUDXPDRURWKHUULVNIDFWRUVWKDWPD\LPSDLUDFOLQLFLDQ¶VDELOLW\ to effectively care for their clients.

Numerous studies have been published which support a variety of martial arts styles in reducing stress. For example, researchers have demonstrated a positive association between Tai Chi training and stress reduction (Birdee, et al. Researchers have also argued that martial arts, notably Aikido, can be effective in stress reduction, emotional regulation and improving memory (Hakan, Kassab & Lothes, 2013). This dissertation attempts to answer the following question: Are martial arts an effective form of self-care for mental health professionals? For the purposes of this dissertation, the term martial arts encompasses a variety of styles including but not limited Karate, Brazilian Jiu Jitsu and Aikido.

This investigation first explores the literature to: 1) address mental health SURIHVVLRQDOV¶VXVFHSWibility to occupational burnout; and 2) explores the efficacy of martial arts as a self-care strategy. Two primary elements of martial arts are believed to be related to self- care including physical exercise and mindfulness. After discussing exercise and mindfulness based strategies involved in martial arts training, relevant martial arts styles are discussed to determine any benefits unique to a specific style. For this phenomenological dissertation, the theoretical perspective is based on the Humanistic model (Giorgi, 2009).

It is assumed that mental health professionals are aware of the psychological and emotional impacts of working in their respective fields. The Humanistic model assumes that: 1) Individuals have the innate desire to reduce stress and reach their full potential,  &RQVWUXFWLQJRQH¶VRZQLGHQWLW\DQGUHDFKLQJRQH¶VIXOOSRWHQWLDOPD\UHTXLUHVRFLDO support that martial arts may naturally provide in the dojo-setting. ϯ  Operational definitions 1) Occupational stress: Symptoms include weariness, decreased frustration tolerance, decreased empathy for clients (Portnoy, 2011), or any additional negative symptoms that the participants associate with their occupation. 2) Mental health professionals: Licensed Marriage and Family Therapists (LMFT) and LMFT interns, Licensed Clinical Social Workers (LCSW) and LCSW interns, School Psychologists, Clinical Psychologists, and PsyD trainees and interns.

3) Self-care effect sizes: How significant, if at all, is martial arts as a self-care activity? 4) Martial arts training: Including description of style, frequency and intensity of training. 5) Mindfulness: The process of bringing one's attention to the present moment. The hypothesis in the context of this dissertation is: Martial arts are an effective form of self-care for mental health professionals. It is common among martial arts enthusiasts to assume that training promotes well-being including self-confidence, physical health, emotional regulation, and improved cognitive functioning ;Boudreau, Koznak, 1984).

While many people may agree that martial arts offer a wide range of benefits, the statement does not take into consideration certain factors that may diminish the benefits of practicing martial arts. Some individuals may endure notable distress from their martial arts training. Stressors may include difficulty understanding techniques, physical injuries, negative interactions with peers, rigid instructors, or financial strain at martial arts studios with high tuition costs. ϰ  Given that this is a qualitative study, much of the data obtained was subjective and personal bias may be a factor to consider.

Additionally, it was essential to address and control for confounding variables so that the impact of martial arts training can be teased apart from the benefits the participants may have received from any other self-care practices. Also, selecting martial artists who fit the criteria as an LMFT, LCSW, School Psychologist, Psychological trainees, interns, or Licensed Clinical Psychologist was a daunting task. The selection criterion for participants also pertained to the delimitations of this study. The scope of research is limited to participants who practice martial arts and are able to reflect on how their professional performance and overall well-being has been impacted by their martial arts training.

The significance of this study is determined by the results. Generally speaking, the data supports martial arts as an effective self-care practice for mental health professionals. This is a significant finding because martial arts are growing as an extra-curricular activity, arguably due to its glorification through the entertainment industry and as a means of physical fitness. One can see the promotion of martial arts through action movies which typically have a high volume of hand to hand combat-scenes, and combat sports like mixed martial arts (MMA).

Although the health benefits have been reported across the data sets of this dissertation, problems due to martial arts training were also revealed in the results including increased psychological stress, interpersonal conflict and physical injury. ϱ  Chapter II: Literature Review Burnout is a term commonly used to describe a state of physical, mental and emotional exhaustion DWWULEXWHGWRRQH¶VRFFXSDWLRQ (Mayo Clinic, 2015). Burnout attributed to occupational demands FDQQHJDWLYHO\LPSDFWRQH¶VSURIHVVLRQDOH[SHULHQFH. The term burnout may include job dissatisfaction, fatigue, and absent mindedness at work (Gupta, Paterson, Lysaght, & Von Zweck, 2012).

For those who serve populations in significant distress, appropriate forms of self-care have been found to be essential in inoculating people from burnout. For example, therapists who work with individuals with trauma may be susceptible to occupational burnout as well as secondary trauma or compassion fatigue (Baird & Jenkins, 2002). Secondary trauma is a term used to describe an emotional reaction therapists may experience as a result of exposure or repeated exposures in therapy to trauma survivors¶ descriptions of their experiences (Baird, & Jenkins, 2002). Psychotherapists who work with traumatized or significantly mentally ill populations must cope with both the general demands of work as well as the intensely emotional and sometimes tragic stories they hear from their patients.

Whether serving populations with problems that are moderate or severe, mental health professionals are often required to absorb and process significant amounts of information empathetically while maintaining composure and emotional stability. This is often a difficult task, as the need to metabolize much painful affect makes mental health professionals highly susceptible to experiencing significant levels of work-related stress. Therefore, it is essential for mental health practitioners to find effective strategies to process the stress they experience to lessen their risk of burnout. In a study examining the effects of secondary trauma on psychotherapists, 188 participants who regularly treated trauma survivors completed questionnaires to evaluate their ϲ  psychological well-being (Mac Ian & Pearlman, 1995).