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Copyright by
Michael Athans

1983

A HOLISTIC APPROACH TO STRESS MANAGEMENT:
A PILOT STUDY

BY

Michael J. Athans

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Counseling and Educational Psychology

1983

ABSTRACT

A HOLISTIC APPROACH TO STRESS MANAGEMENT:
A PILOT STUDY

BY

Michael J. Athans

This dissertation focused on the holistic variables of
nutrition, exercise and coping and defending as a treatment
for stress.

Thirty-five subjects of this study responded to newspaper
and radio public service notices in the greater Lansing area.
Subjects were pretested and were randomly assigned to one of
two groups. Group One received the five-week workshop based
on the holistic model. Group Two was held as a control group
and returned six weeks later when all subjects were post-
tested. Group Two then received the five-week treatment and
was posttested again. The same instructor, nurse, room,
time, and day of the week were maintained for consistency of
treatment.

The workshop (treatment) was focused on stress, its
relationship to heart disease, and to psychophysiology.

Type A personality was discussed, as well as nutritional,
coping, defending, and physical exercise patterns in
relation to stress. Subjects participated in a relaxation
technique and aerobic exercise. The workshop was didactic

and participatory, with small group discussion.

 

 

Michael J. Athans

The dependent variables used during testing periods
were the MMPI ego strength and emotional disorder scales,
the basic coping and psychogenic attitude scales from
Millon's Behavioral Health Inventory, Haan's coping and
defending scales, a checklist derived to measure dietary
intake and physical exercise patterns, and systolic and
diastolic blood pressure readings.

In the statistical analysis of data, multiple analysis
of covariance was performed on all dependent variables, with
sex and pretest covaried. An overall group effect was found
to exist, with subsequent univariate analysis revealing the
psychogenic attitude scale, Haan's defending scale and
dietary intakeanuiphysical exercise patterns accounting for
the overall group effect. The results of this study suggest
that ego strength and coping styles are less likely to increase
as a result of a five-week workshop, whereas subjects' defen-
siveness decreased. Blood pressure readings remained normal
for both groups during this period.

Limitations of this study and recommendations for
further research include a larger sample for increased cell
size, reducing the possibility of significant results due to
chance. Also, a longer period of time may be necessary for

physiological and personality variables for change.

 

DEDICATION

To Michael and Christine, my parents, who taught me

one of life's enduring qualities, commitment. Your support

and understanding is always with me.

iii

ACKNOWLEDGMENTS

I especially wish to thank Bill Hinds, my advisor and
chairperson, whose support and guidance provided the
environment for me to learn and grow as a student and
researcher.

Special thanks also to Douglas Miller, Bill Farquhar
and Rochelle Habeck, committee members, whose ideas and
criticisms proved valuable as objective readers.

I am grateful to Floyd Irvin, who guided me in the road
to discovery of myself. Your constant support and under-
standing during the most trying of times is appreciated.

I would also like to thank Ginni Davis-Cook for the
typing of this manuscript. You were timely and thoughtful

as I wrote drafts in Chicago and you typed in East Lansing.

iv

LIST OF TABLES . . .

TABLE OF CONTENTS

LIST OF CHARTS

Chapter

I.

II.

III.

IV.

THE PROBLEM . C O O O O O O D O O O O O O O

Introduction . . . . . . . . . . . . . . . .
Theory . . . . . . . . . . . . . . . . . . .
Need for the Study . . . . . . . . . . . . .
Purpose . . . . . . . . . . . . . . . . . .
Hypotheses . . . . . . . . . . . . . . . . .
Overview . . . . . . . . . . . . . . . . . .

REVIEW OF THE LITERATURE . . . . . . . . . .

Stress . . . . . . . . . . . . . . . . . . .
The Psychophysiology of Stress . . . . . .
Stress and Disease . . . . . . . . .

Heart Disease and the Type A Behavior Pattern
Nutrition and Disease . . . . . . . . . . .
Field Dependence and Independence . . . . .
Coping and Defending . . . . . . . . . . . .
Holistic Theory . . . . . . . . . . . . . .
Nutrition . . . . . . . . . . . . . . . .
Physical Exercise . . . . . . . . . . . .
Psychological Ceping and Defending . . . .

DESIGN OF THE STUDY . . . . . . . . . . . .

Sample and Population . . . . . . . . . . .
Procedures . . . . . . . . . . . . . . . . .
Hypotheses . . . . . . . . . . . . . . . . .
Instrumentation . . . . . . . . . . . . . .
Data Analysis . . . . . . . . . . . . . . .
Research Design . . . . . . . . . . . . . .

ANALYSIS OF DATA . . . . . . . . . . . . . .
SUMMARY, DISCUSSION, CONCLUSIONS . . . . . .
Summary . . . . . . . . . . . . . . . . . .
Discussion . . . .'. . . . . . . . . . . . .

Conclusions . . . . . . . . . . . . . . . .
Suggestions for Further Research . . . . . .

V

vii

viii

mlemU-DH H

11

11
12
17
19
24
27
31
41
42
45
47

49

49
51
55
58
68
68

7O
80
80
83

9O
91

APPENDICES . . . . . . . . . . . . . . . . . . . . .

A.

MMPI Emotional Disorder Scale . . . . . . . . .
MMPI Ego Strength Scale . . . . . . . . . . .
Millon Behavioral Health Inventory: Basic
Coping Scales . . . . . . . . . . . . . .
Millon Behavioral Health Inventory: Psychogenic
Attitude Scales . . . . . . . . . . . . . . .
Haan's Coping Scales . . . . . . . . . . . . .
Haan's Defending Scales . . . . . . . . . . . .
Stress Management Behavioral Checklist . . . .
Radio Announcement . . . . . . . . . . . . . .
Newspaper Announcement . . . . . . . . . . . .
Letter of Consent to Participate . . . . . . .
Treatment . . . . . . . . . . . . . . . . . . .

OF REFERENCES . . . . . . . . . . . . . . . . .

vi

94

94
96

100

119
131
171
211
218
219
220
221

250

LIST OF TABLES

Table Page
1 Major Symptoms in 300 Cases of Relative
Hypoglycemia . . . . . . . . . . . . . . . . . 26

2 Interrelationships Between Dietary Carbohydrate,
Biochemical Parameters of Energy Metabolism,

and Disease States . . . . . . . . . . . . . . 28
3 Interrelationships Between Biochemical

Parameters of Energy Metabolism and Disease

States I O O O O O O O O O C O O O O O O O O O 29
4 Age Demographics of Subjects . . . . . . . . . . 50
5 Sex Demographics of Subjects . . . . . . . . . . 50
6 Urban or Rural Environments of Subjects . . . . Sl
7 Occupational Data of Subjects . . . . . . . . . 51
8 Pearson Product-Moment Correlation Coefficients

on Pretests . . . . . . . . . . . . . . . . . 71
9 Dependent Variable Posttest Least Square Means

(Covaried) . . . . . . . . . . . . . . . . . . 74

10 Dependent Variable Pretest Means . . . . . . . . 75

vii

LIST OF CHARTS
Chart Page

1 Subdivisions of the Nervous System . . . . . . . . l4

viii

CHAPTER I

THE PROBLEM

Introduction

 

The effects of stress have become pervasive and univer-
sal, creating a national concern. People of all ages and
occupations use the term "burnout" to describe feelings of
physical and emotional depletion. Home situations and
personal lifestyles have also contributed to some people's
distress, perhaps as a result of a continuously changing,
highly technological society. While in 1900 most Americans
were farming in rural areas, 75 years later 75 percent had
'crowded into urban areasanuionly 4 percent of the remaining
25 percent were employed on farms. In response to this swift
urbanization and change in lifestyles, there has been a
tremendous rise in the number of self-help groups, seminars,
workshops, and books related to helping people understand
their environment and reduce the stress in their lives.

Physical stress symptoms range from short-lived
fatigue to chronic back pain, migraine headaches and ulcers.
Affective symptoms include hostility, aggression, irrita-
bility, depression and apathy. Psychosomatic components may
comprise or aggravate disorders. For example, Meyer and

Haggerty (1962) demonstrated that respiratory illness

1

2
became four times as severe if preceded by acute stress.
Doctors trained by the traditional medical model typically
pay little attention to personal dynamics such as attitudes,
coping and defending behaviors, and nutritional factors such
as the excessive intake of sugar, caffeine or meats. The
alleviation of immediate symptoms then, rather than the
prevention of illness and maintenance of health, has tended

to be the focus of traditional medicine.

In contrast, the holistic health model has proved useful
in preventing stress reactions and alleviating stress symp-
toms. Pelletier (1977) states:

Holistic medicine recognizes the inextricable inter-

action between the person and his psychosocial envi-

ronment. Mind and body function as an integrated

unit, and health exists when they are in harmony,

while illness results when stress and conflict disrupt

this process. (p. 11)

The holistic model then, holds that each individual is com-
prised of a mind, body and spirit interaction and that the
body is in a state of health when these elements function in
harmony. Disorders are created, not only by physical means,
but by the disruptive interaction of social factors, person-
ality variables, psychological stress and the inability to

find integrative solutions to this complex of variables. Fail-
ure to maintain the balance is likely to result in psychoso-
matic illness. For example, when a person cannot cope with
environmental stress, the body breaks down at its weakest

point as part of a disturbed adaptive process. The holistic

model suggests that this reaction is not inevitable and that

3
the individual has some control of biological and psycho-
logical functions, as well as the environment. Holistic
health differs from traditional medicine in that the latter
tends to pay less attention to the patient's psychosocial
environment and holistic medicine suggests that one can gain
control over it by carefully looking at all the factors

which may represent potential stressors.

Theory

From the time of Hippocrates it has been recognized that
psychological factors play a precipitating role in physical
illness. Ulcers, headaches, asthma and pain are but a few of
the ailments thought to be psychogenic in origin. Recent
research indicates that certain personality characteristics
are more inclined to produce a "stressed state" in the body,
thereby making it more prone to such ailments, including
coronary heart disease (Rosenman, Braud, Jenkins, Friedman,
Straus and Wurm, 1975).

Selye's (1956) General Adaptation Syndrome (GAS) is a
theory which illustrates the physiological mechanisms in
which prolonged stress produces pathology and damage to the
body. GAS consists of three states: alarm reaction, stage of
resistance.and state of exhaustion. In the GAS, pituitary-
adrenal cortical hormone secretions act as a system of defense
to ward off noxious stimuli. The alarm reaction is the body's
only acknowledgement of stress on the system. In the stage of
resistance, the body responds to the stress, increasing its

'resistance to the noxious agent. If these defenses are

4
maintained, disease may result from the adrenal cortical and
pituitary hormones, inflammation, and/or the lowering of
body resistance, creating an "exhausted" physical state.

Numerous studies have shown that how an individual
copes may reduce physiological arousal to stressful events
(Singer, 1974; Hinkle, 1974). Coping and defending strate-
gies, depending on their use, may serve to exacerbate or
alleviate the stressful condition. (Mmaexample is the use
of repression as a defense, prolonging stress and resulting
in increased anxiety or depression. Other mechanisms in the
coping and defending processes include denial, tolerance of
ambiguity, doubt, empathy, intellectualization, projection,
isolation and others.

Activity has been known to reduce stress by pro-
ducing a healthy, invigorated body (Blumenthal, Williams &
‘Williams, 1980). Increased activity and physical exercise
improve the tone and quality of muscle tissue and strengthen
the blood vessels, lungs and heart. Even low levels of
activity prove more beneficial than none at all. Miller,
Rubin, Clark, Crawford and Arthur (1970) found that airplane
pilots who were active in the landing of their aircraft had
less somatic complaints and less anxiety as compared to
:radar intercept officers who have a sedentary role in the
landing of aircraft.

Holistic medicine emphasizes maintaining a healthy body

by exploring one's coping and defending styles and by

5
observingtflmalevel of physical activity and food intake, as
this also contributes to how one feels physically. For
example, certain foods are easily digested and metabolized.
Other foods not only require a longer digestive process, but
also release chemicals which must be storedixxtflmabody, at
times reaching dangerous levels. One such chemical is tyro-
sine, the amino acid found in meat. Julien (1978) believes
that it is transformed into amino acids which stimulate the
sympathetic nervous system. Such stress on the system may
prove harmful over prolonged periods. Proteins, carbohydrates
and fats taken in will be reflected in energy levels, as well
as in the physical condition of the body. Pritikin (1979)
holds that Americans consume an excess of meats at the risk
of heart disease. He emphasizes a low fat diet, high in
complex carbohydrates to reduce potential for heart disease
and reduce lethargy, indicating that nutritional intake
plays an important part in whether or not the body feels

stressed.

The variables of nutrition, physical exercise, and c0p-
ing and defending styles as described above, then, are
holistic components which act together to determine an indiv-
idual's ability to adapt to and deal with stressful encounters

in everyday living.

6

Need for the Study

 

A review of the literature suggests that
although there are many well thought out theories and re-
search studies concerning the relationship between stress and
disease, researchers have tended to focus on how stress
affects one or another specific area of human functioning.
For example, Selye (1956), Levi (1974), and Singer (1974)
have emphasized how hormones respond to life
adjustments and their effects on the likelihood of disease.
Friedman and Rosenman (1974), Dimsdale and Moss (1980),
McCranie, Simpson and Stevens (1981) , Howard (1976) , and
others have focused on the relationship of Type A behavior
patterns to coronary heart disease. Lazarus (1966) has
examined how people perceive life events through the

appraisal of stimuli. Haan (1963) has looked at c0ping and
defending mechanisms, and Hinkle (1974) at how defending
relates to frequency of illness. Julien (1978) has studied
the intake of foods and how this may create stress

a n d Blumenthal, Williams, Kong, Schanberg and Thompson
(1980) have done the same regarding the role of physical
exercise.

There has been little research combining these related
theories and studies into an integrated investigation of
health. Pelletier (1977) has come closest to this by unify-
ing the theories of others into one "holistic" model. How-
ever, virtually no research has been undertaken to study
these holistic concepts in their mutual interaction as they

affect prevention and treatment.

Purpose

The purpose of the present study is to design a holistic
approach to stress management, which includes the variables
of nutrition, activityamuipsychological coping and defending
mechanisms. The holistic nature of the stress management
workshop is emphasized to provide participants of the study
with an understanding of how the mind and body work in unison

and facilitate coping with stress.

Hypotheses

 

The hypotheses of this study are dependent vari-
ables measuring the holistic concepts. The dependent
variables of coping and defending behaviors are measured
using scales from Norma Haan's COping Inventory, the Millon
Behavioral Health Inventory and scales from the Minnesota
Multiphasic Personality Inventory (MMPI). Nutritional
intake and physical exercise variables are measured using
a checklist. Physiological readings of blood
pressure are recorded as dependent variables.

The following are the research hypotheses which are
stated in null and research form in Chapter III, and for
which the results are stated in Chapter IV.

Hypothesis I: The treatment group will show a
decrease in posttest scores as
compared to the control group on the
dependent variable emotional disorder
(MMPI).

Hypothesis II: The treatment group will have an
increase in posttest scores as

compared to the control group on the
dependent variable ego strength (MMPI).

Hypothesis III:

Hypothesis IV:

Hypothesis V:

Hypothesis VI:

Hypothesis VII:

Hypothesis VIII:

Hypothesis IX:

Hypothesis X:

8

The treatment group will have a decrease
in posttest. scores as compared to the
control group on the dependent variable
basic coping scales (Millon Behavioral
Health Inventory).

The treatment group will have a decrease
in posttest. scores as compared to the
control group on the dependent variable
psychogenic attitude scales (Millon
Behavioral Health Inventory).

The treatment group will have an increase
iJ1 posttest. scores as compared to the
control group on the dependent variable
Haan's coping scales.

The treatment group will have a decrease
5J1 posttest. scores as compared to the
control group on the dependent variable
Haan's defense scales.

The treatment group will have a decrease
in posttest, scores as compared to the
control group on the dependent variable
systolic blood pressure.

The treatment group will have a decrease
5J1 posttest. scores as compared to the
control group on the dependent variable
diastolic blood pressure.

The treatment group will have improved
dietary intake in posttest scores as
compared to the control group on the
dependent variable nutrition (checklist).

The treatment group will exhibit increased
physical exercise in posttest. scores as
compared to the control group on the
dependent variable physical exercise
(checklist).

Overview

The second chapter is a review of the literature pertaining

to theory and research leading up to the present study. A basic

explanation of stress is from the work of Hans Selye, a pioneer

in physiological stress research. The psychophysiology of stress

9
will be discussed to explain the chain of events which takes
place from the actual perception of a stressor to its
ultimate behavioral manifestation. The pathology of athero-
sclerosis, myocardial infarction, and angina pectoris will
then be discussed, as these diseases are often manifestationS‘
of advanced forms of stress. Rosenman and Friedman's research
on coronary heart disease and Type A personality, and research
which supports this view are included. Also important in this
section is the role of nutrition and disease, as changes in
dietary intake are correlated to such disorders as hypogly-
cemia, anxiety, and coronary heart disease.

Coping and defending will be examined, as these behaviors
play an important role in the manifestation and maintenance
of stress. Contributions in this section include the research
of Pearlin and Schooler, Norma Haan and Richard Lazarus.

A review of pertinent literature indicates that little
empirical research has been conducted ontflmzholistic approach
to understanding stress. Thus, the last part of the literature
review will focus on coping, stress, and the management of
stress through holistic methods. The holistic variables of
nutrition, physical exercise, and coping mechanisms, which
include attitudes about life and work will be discussed. This
holistic approach is one method of understanding, treating,
and preventing stress.

The sample, population, research procedures, hypotheses,
instrumentation, analysis and the experimental design of this

study are described in Chapter III and Chapter IV is an

10
analysis of data. Chapter V includes a discussion of the

results, summary, and conclusions.

CHAPTER II

REVIEW OF THE LITERATURE

Stress

Selye (1974) defines stress as "the nonspecific response
of the body to any demand made upon it" (p. 14). What Selye
means is that itdoes not matter if a situation is pleasant
or unpleasant, what matters is how one responds to the situa-
tion, since evidence suggests that life events of either a
pleasant or unpleasant nature result in increased physio-
logical activity. For example, Levi (1964) has shown that
both amusing and aggression-provoking films result in in-
creased levels of adrenal medullary hormones. While stress
has been given "bad press" by a society which finds it all
too prevalent, Selye makes it clear that complete freedom
from stress could result in death.

Exposure of the body to stress may have beneficial
or damaging results. Responses to stress are manifested in
a variety of ways. When a part of the body is exposed to
stress, the result may be increased local resistance, such
as adaptation, inflammation or tissue breakdown, depending
on the body's interpretation of the need. In response,
corticoids will either combat or promote inflammation
and hormones will either produce acetylcholine or adrenalin

11

12
for the fight or flight response. Examples of the resis-
tance phase at the psychological and physiological levels
can be seen in the body's efforts to achieve a homeostatic
balance. These include eating when hungry, psychological
defense mechanisms, and neural-hormonal reactions to stress

on the body.

The Psychophysiology of Stress

 

Attitudes contribute to how we feel because they are
perceptions which are learned over time and include feelings
and beliefs about other persons, objects, events, and
activities (Tossi, 1977). Once the above stimuli are per-
ceived as stressful, the body then produces a neurophysio-
logical reaction which stresses the body and can cause
permanent harm if prolonged (Selye, 1974). An example is
frustration, which may turn stress into distress.

Selye's (1956) "General Adaptation Syndrome" (GAS)
explains three phases which are constantly reproduced when
demands are made on the body. The first phase is an alarm
reaction which results from dealing with a new or ambiguous
situation. ffluaphysiology of this reaction involves
increasing sympathetic-adrenomedullary activity by sending
epinephrine through the vascular system. The second phase
of this syndrome is the resistance state, in which the body

attempts to make a physiological adjustment. Adaptation

13
during the resistance phase takes place if one learns to
cope with the stimulus. Exhaustion is the final state of the
adaptation syndrome, occurring after prolonged exposure to a
stressor, when energy resources become depleted. Death is
the body's most dramatic response to prolonged stress.

To explain how these reactions come about, it is neces-
sary to know that the nervous system is broken down into a
central nervous system (CNS) and a peripheral nervous system.
The CNS consists of the brain and the spinal cord, the
peripheral system contains all the neural tissue outside the
CNS (see chart 1). The peripheral nervous system is further
described as having somatic and autonomic components, with
sympathetic and parasympathetic systems forming part of the
autonomic nerves and muscle tissue. Both the brain and the
autonomic system are important in that the brain perceives
stressful stimuli and regulates bodily functions, and the
autonomic system responds to these signals viscerally through
neural tissue.

The subcortical areas of the brain regulate normal body
functions and include the basic control center for the auto-
nomic nervous system, which is the system principally respon-
sible for maintaining a stressed state. This area includes
the cerebellum, the center regulating body movements; the
medulla oblongata, which regulates heartbeat, respiration,
and blood vessel diameters; and the pons, which regulates the

sleep cycle.

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15

The midbrain and cerebral hemispheres include the basal
ganglia, thalamus and hypothalamus, the latter which is a
primary activator of the autonomic nervous system, acting to
transform neurological stimuli into endocrine-producing
stress reactions. The hypothalamus is also connected with
the limbic system, and is known as the seat of emotion.
Chauchard (1962) and Gelhorn and Loufbourrow (1963) consider
the hypothalamus a critical organ in the regulation of
emotion.

Stress activates the autonomic nervous system and the
endocrine system through the limbic system, which determines
when the hypothalamus will be activated. This organ also
responds to perceived stress from the cortex, which is
responsible for the higher-order abstract functions of
language, memory, and reasoning.

The brain stem reticular formation is part of the CNS.
It extends up the rear of the medulla into the midbrain and
the hypothalamic part of the forebrain. The reticular forma-
tion, also known as the reticular activating System (RAS), is
discussed because it serves as a general arousal system,
activating the cortex to stimulate visceral arousal and muscle
tension (French, 1957). The end result, not produced by the
reticular system alone, is the changing of a psychological
stressor into a neurophysiological response where the
subjective experience of stress is also felt physically.

The autonomic nervous system controls gastrointestinal,

vascular, and reproductive functions. The sympathetic nervous

16
system, a part of the autonomic system, serves to control
involuntary muscles and constrict blood vessels. The para-
sympathetic system acts to extend smooth muscles, thereby
inducing relaxation. When a stressor is perceived by the
cortex the brain sends signals out so quickly that the auto-
nomic system is said to react "automatically," exciting or
inhibiting the sympathetic or parasympathetic systems through
muscle extension or contraction and blood vessel constriction
or dilation. When the sympathetic system constricts blood
vessels to accelerate heart rate, blood moves away from the
body's extremities to the head and trunk, resulting in the
feeling of cold hands and feet. Muscle tension is also
perceived under stress; even if not consciously recognized,
it can leave the body drained at the end of a day.

The sympathetic and parasympathetic systems of the auto-
nomic nervous system are receiving increased attention because
evidence indicates that it is possible to gain some control
over these systems. Meditation, biofeedback, and other
relaxation techniques are relatively recent methods of
reducing muscle tension and hormones in the body.

When a stressor is perceived it also excites the hypothala-
mus, which in turn produces a substance that stimulates the
pituitary. This gland is part of the endocrine system which
secretes the adrenocorticotropic (ACTH) hormone into the blood,
maintaining a stress reaction by stimulating the heart and brain
for the fight or flight response. Recent evidence indicates that

under long—term stress, ACTH induces the external cortical portion

17
of the adrenal gland to secrete corticoids which act to inhibit
inflammation and defend the body via immune reactions. Thy-
roxine is also produced during periods of long-term stress,
while adrenalin is activated by the adrenal gland to deal
with short-term stress, dilating the arteries of the heart, ‘
accelerating heart rate, and increasing blood circulation
(Selye, 1954; Pelletier, 1977; Jenkins, 1978).

Simpson, Olewine, Jenkins (1974) and others find that
under stress there is increased tendency for the clotting
elements of the blood to build up plaque and thicken the
arterial wall, narrowing that passageway. As blood vessels
narrow and clots form, there is greater likelihood that the
clots will occlude a coronary artery, resulting in angina
pectoris or myocardial infarction. Singer's (1974) research
also shows that intense day-to-day involvement is linked to

elevated blood pressure and increased endocrine response.

Stress and Disease

 

Some diseases in which stress plays a particularly
important role are high blood pressure, atherosclerosis,
myocardial infarction, angina pectoris, gastric ulcers, and
various mental disturbances. Atherosclerosis is a cardio-
vascular disease, the most prevalent disease of mankind. In
1978 there were two million deaths in the United States, of
which 52 percent were due to cardiovascular disease, mainly
the result of atherosclerosis. Myocardial infarction is a
dramatic form of heart disease in which 95 percent of the

victims suffer from atherosclerosis. One of the causes of

18
this condition is a lesion or obstruction in the arterial
wall,vflfixfileventually produces a heart attack. Where
occlusion is not evident, any sudden increases in myocardial
demands, including those produced by physical or emotional
stress, may lead to myocardial infarction.

The personality variables such as hard striving for
achievement which contribute to a stressful lifestyle, lack
of regular physical exercise and high intake of saturated
fats are said to be predisposing factors for heart disease.
Other predisposing epidemiological factors include: elevated
lipoprotein (this includes cholesterol), increased blood
pressure, cigarette smoking, and elevated blood sugar
(Robbins & Angell, 1976).

Evidence suggests that anxiety, depression and psycho-
somatic illnesses are also related to the develOpment of
coronary heart disease, particularly angina pectoris. The
attacks are thought to be caused by a sudden inbalance
between myocardial demands and the capacity of the coronary
arteries to fulfill those demands. Angina is defined as
chest pain precipitated by effort and alleviated by rest.
Ostfeld, Lebovits, Shekelle and Paul (1964) found that people
who developed angina complained of a variety of somatic
symptoms. Repression and denial were often used by these
patients in an attempt to resolve emotional conflicts and
dissatisfaction. In the above study, men who subsequently
developed angina pectoris, as compared to myocardial infarc-

tion patients and those without heart disease, scored

19
significantly higher on the MMPI Hypochondriasis and Hysteria
scales and lower on "dissatisfied emotionally" scale of the
16PF, two personality inventories which measure psychological
traits.

The role of anxiety in coronary heart disease was also
discussed by Medalie, Kahn, Neufeld, Riss, Goldbourt,
Perlstein and Oron (1973), who foundtflmn:subjects who scored
high in anxiety were twice as likely to develOp angina pectoris
as those who scored low on anxiety. The research of Medalie
et a1 supports Jenkin's (1971) statement that work overload
and chronic conflict situations may be precursors of coronary
heart disease. PeOple with problems related to family, work,
and finances were found to be more likely to develop angina

pectoris than those without such conflicts.

Starting in 1960, Rosenman,Friedman and their colleagues
followed 3,500 men for eight and a half years in a longitudi-
nal study known as the Western Collaborative Group Study
(WCGS). The men were examined medically, and the results
of the examination indicated that men of average height who
developed coronary heart disease were similar to healthy men,
but heavier in weight. In addition, men who reported moderate
to heavy work activity, or who undertook regular daily exer-
cise had lower rates of heart disease than those with
sedentary to light work and virtually no exercise. Cigarette
smoking was found to be a significant precursor of heart
disease among men 39 to 49 years old, but not for men in the

50 to 59 age bracket (Rosenman, Friedman, Straus, Wurm,

20

Kositchek, Hahn, and Werthessen, 1964). A history of
coronary heart disease in either parent was also associated
with a higher rate of coronary heart disease.

Biological factors found to be significantly related
to heart disease in the Rosenman study included systolic and
diastolic blood pressure, as well as serum concentrations of
cholesterol, triglycerides, lipalbumin, beta lipoproteins,
and the beta/alpha lipoprotein ratio. At both high and low
cholesterol levels, men with high beta/alpha ratios developed

more coronary heart disease than those with lower ratios.

Heart Disease and the Type A Behavior Pattern

 

The results of the Rosenman and Friedman study also
confirmed the Type A behavior pattern as a precursor of
chronic heart disease, independent of the standard risk
factors (Rosenman et al., 1975; 1964). Subjects in their
study were classified as either "Type A" or "Type B" person-
alities, following a structured interview. Type A person-
ality exhibits behavior characterized by hard driving, aggres-
sive striving for achievement, competitiveness, impatience,
restlessness, a continual state of alertness, and consistently
hurried activity (Jenkins, 1971). Type B personality lacks
these characteristics.

In the WCGS longitudinal study, those subjects judged
to be Type A at the onset of the study exhibited twice the
rate of coronary disease, were five times as likely to have

a second myocardial infarction, and had twice the rate of

21
fatal heart attacks as those who did not exhibit Type A
characteristics (Type B subjects). These differences
remained, even when serum lipids, blood pressure, smoking,
obesity and other biological factors were held constant
statistically. The risk was, in fact, approximately equal
to that produced by other chronic heart disease risk factors
such as elevated blood pressure, high cholesterol levels,
or cigarette smoking. Similar findings have subsequently
been reported by Kenigsberg, Zyzanski, Jenkins, and
Warwell (1974).

Other researchers have independently reported empirical
evidence from studies of coronary heart disease patients and
matched control groups, indicating that patients with coronary
disease strive more diligently for achievement, tend to be
perfectionists, are chronically tense and unable to relax,
are committed to expending more energy on a job or profession,
and are more active and energetic than corresponding compari-
son groups (Jenkins, 1971). This constellation of traits
approximates RosenmananuiFriedman's Type A behavior pattern,
which also includes aggressiveness and time urgency among its
essential aspects (Rosenman et al., 1964; Friedman, 1969).

Howard, Cunningham, and Rechnitzer (1976) conducted a
study similar to Rosenman and Friedman's, in which 236
managers from twelve different companies were examined for
prevalence of Type A behavior. This three-year longitudinal

study included a number of measures of health, job and career

22
issues, personality, changes in lifestyle and family
environment. Physiological measures included resting blood
pressure, serum, lipids, and an exercise stress test.
Approximately 60 percent of the managers were classified as
Type A‘s. The result showed that lower levels of education
were associated with a greater prevalence of Type A behavior.
Type A behavior also declined slightly with age, while Type B
behavior increased slightly with age. In the biochemical
analyses, Type A persons exhibited significantly higher
systolic and diastolic blood pressure and serum triglyceride
levels than Type B individuals.

Subjects were also asked to indicate their exercise
and smoking habits. Although a large percentage of Type A's
were found to be cigarette smokers, smoking was not found to
be significantly related to either behavior type. In contrast,
however, exercise habits were type-related; in every age group
except the eldest, a larger percentage of the Type B's were
exercisers. The above results tend to confirm the findings
of Rosenman and Friedman and indicate how the Type A behavior
pattern is related to a number of the risk factors in coronary
heart disease.

Jenkins (1978) went further to suggest that the Type A
behavior pattern is specifically associated with atherosclero-
tic diseases. Analysis of the Western Collaborative Group
Study shows that only those persons dying of coronary disease
and those dying of accidents clearly have a Type A mean
score on the Activity Survey, a measure of Type A personality.

Jenkins reports that men dying of malignancies, lung diseases,

 

23
and the like tend to be rather evenly distributed between
Type A and B, often closer to Type B.

Blumenthal, Williams, Kong, Shamberg and Thompson (1978)
found similar results in that the Type A behavior pattern
was not only associated with increased risk of specific
coronary heart disease events, but was even more prevalent
among patient groups with more severe coronary atherosclero-
sis. The findings further suggest that behavior patterns are
related to atherosclerotic processes in women as well as men.
Their 156 patients received a behavioral evaluation (using
the structured interview technique develOped by Rosenman and
Friedman), psychological testing, blood levels, and arterio-
grams. A medical history was taken prior to coronary angio-
graphy. The authors found Type A behavior patterns to be
related to indices of lipid metabolism previously associated
with increased risk for coronary heart disease. The Type B
patients had a mean serum cholesterol level of 211 mg, with
Type A having 248 mg. This difference was statistically
significant and remained so when means were adjusted for age
and sex. Type A behavior patterns were also related to a
positive history of hyperlipidemia. Blumenthal and his
associates did not find statistically significant differences
between Type A and Type B patients with respect to cigarette
smoking or blood pressure. However, the relationship between
behavior pattern and total coronary index remained signifi-
cant when age, sex, blood pressure, cholesterol, and

cigarette smoking were all simultaneously covaried.

 

 

 

24

The Rosenman and Friedman research, and the research
it stimulated, raise the question of eventual, personal
control over chronic heart disease. The findings have many
implications which could conceivably reduce the incidence of
heart disease and its annual cost. The evidence that Type A
behavior may even play a role in the atherosclerotic process
suggests that the pattern exerts its influence upon chronic
heart disease risk over time and highlights the importance
of identifying and modifying Type A behavior patterns early

in life.

Nutrition and Disease

 

There have been many changes in food consumption in the
United States in the last few years, with dramatic increases
in carbohydrate and sugar consumption and a reduction in the
use of protein. Malnutrition is a word that is no longer
associated with only underdeveloped countries:

The nature of the aberration is (1) an excess of

total calories, empty calories,total fat, saturated

fat, cholesterol, refined sugar, salt, and (2) an

inadequacy (relative and/or absolute) of essential
nutrients (vitamins, minerals, essential amino acids
and essential fatty acids) and bulk. This malnutri-
tion of a different type is actually widespread in

the economically developed countries--malnutrition

in the literal meaning of the word, bad nutrition.

(Katz, Stampler and Pick, 1958)

A change in the pattern of carbohydrate intake appears to be
the most obvious alteration in the world's dietary intake
during the twentieth century. This pattern essentially

involves a reduction in complex and an increase in simple

carbohydrate consumption (Albrink, 1965; Antar, Ohlson and

25
Hodges, 1964; Takahashi, 1962; Yudkin, 1964). Such eating
habits tend to reduce the intake of protein, vitamins, and
minerals since many of the simple carbohydrate foods are
relatively low in these nutrients.

In this regard, an association is thought to exist
between abnormal behavior and the metabolism of nutrients.
Specifically, carbohydrate metabolism is correlated to
disorders. One of these, hypoglycemia, is an excess of
sugar or glucose in the blood as a result of diet and has
been observed to mimic many psychiatric, somatic, and
neurological disorders. Correlations exist between hypo-
glycemia and anxiety, irritability, fatigue, mental confu-
sion, and uncontrollable emotional outbursts (Richter, 1959;
Williams, 1959; Salzer, 1966). (See Table 1). Depression
has been linked with dietary riboflavin or pantothenic acid
deficiencies (Eiduson, Geller, Yuwiler and Eiduson, 1964).

Diet deserves serious attention in the coronary proneness
profile because of its effects on nutritional, endocrinologic
and metabolic status. The dietary alterations suggested by
the Council on Foods and Nutrition are primarily concerned

with the regulation of dietary fat, especially the saturated

26
TABLE 1

MAJOR SYMPTOMS IN 300 CASES OF RELATIVE HYPOGLYCEMIA

 

 

Percentage of Patients

 

 

 

Symptoms Reporting Symptoms
Psychiatric
depression 60
insomnia 50
anxiety 50
irritability 45
crying spells 32
phobias 31
lack of concentration 30
forgetfulness or confusion 26
unsocial or antisocial behavior 22
restlessness 20
previous psychosis 12
suicidal 10
Somatic
exhaustion or fatigue 87
sweating 41
tachycardia 37
anorexia 32
‘ chronic indigestion or bloating 29
cold hands or feet 26
joint pains 23
obesity 19
abdominal spasm 16
Neurologic
headache 45
tremor (inward or external) 42
muscle pains and backache 38
numbness 29
blurred vision 24
muscular twitching or cramps 23
staggering 18
fainting or blackouts 14
convulsions 4

 

SOURCE: H. Salzer, Relative hypoglycemia as a cause of
neurOpsychiatric illness, Journal of National Medical Associa-
tion, 58, 1, 12-17, 1966.

 

27
fatty acids, with the ultimate purpose of preventing hyper-
lipemia and its consequence, coronary heart disease. Concern
with substantial increases in simple carbohydrates in
economically advanced countries in the twentieth century, and
a closer relationship between ischemic heart disease mortality
and sugar intake is more recently apparent. Significant blood
glucose changes follow the elimination of refined carbohy-
drates from the diet. There is a direct relationship between
glucose in the blood and systolic blood pressure; as glucose
levels increase,so does systolic pressure. The reverse is
also true. While these relationships (see Tables 2, 3) have
been well established, blood glucose levels will vary and
researchers have not yet determined what levels are physio-
logically acceptable to avoid coronary heart disease and
possible early death (Antar, 1964; Greaves, 1964; Yudkin,
1964; Ashton, 1965; BanyOpadhyay, 1964; Yudkin, 1966). The
data suggest the need for further research in the area of

dietary carbohydrates and coronary heart disease.

Field Dependence and Independence

Extensive research indicates that field dependent and
field independent individuals differ in aspects of social
behavior and physiological functioning. Field dependence
is the extent to which individuals utilize external frames
cf reference in organizing their perceptions. Field depen-
dent individuals exhibit a reduced sense of separate identity
from other peOple, reflected in such traits as preferring

more social interaction with others, being more attentive

28

TABLE 2

INTERRELATIONSHIPS BETWEEN DIETARY CARBOHYDRATE, BIOCHEMICAL
PARAMETERS OF ENERGY METABOLISM, AND DISEASE STATES

 

 

Diet

Metabolism

Disease State

 

High carbohydrate
intake

 

Increases serum tri-
glycerides, circula-
tion insulin and insu-
lin resistance

Enhances atherosclerosis
and the development of
diabetes mellitus

 

High refined carbo-

 

hydrate intake

Results in a deficiency
of specific carbohydrate
enzymes and a decrease
in glucose tolerance

 

Gives rise to diabetes
mellitus and athero-
sclerosis

 

Most of dietary
carbohydrate as
sucrose or glucose

Causes an increase in
serum triglycerides

A feature of: obesity,
diabetes mellitus, gout,
atherosclerosis

 

Most of dietary
carbohydrate as
starch

Produces a reduction
in serum triglycerides

 

100 gram glucose
tolerance supple-

ment of 60 grams
intravenously

Produces an excessive
serum insulin response

Obesity, hyperglyceri-
demia

 

100 gram oral or 25
gram intravenous
glucose tolerance
supplement

Yields evidence of a
close association
between impaired glu-
cose tolerance and
increased serum tri—
glycerides

Supports the possibility
that elevation of plasma
triglycerides is a mani-
festation of insulin re-
sistance and represents a
stage in the development
of maturity onset diabetes

 

SOURCE:

M. Albrink and P. Davidson, "Impaired glucose tolerance in

patients with hypertriglyceridemia," Journal of Laboratory and Clinical
Medicine, 6154, 573-584, April 1966.

29

TABLE 3

INTERRELATIONSHIPS BETWEEN BIOCHEMICAL PARAMETERS OF
ENERGY METABOLISM AND DISEASE STATES

 

 

Relationship

Occurrence

 

A positive association exists
between hypertriglyceridemia,
hyperuricemia, and impaired‘
glucose tolerance

 

A primary association between
hypertriglyceridemia and
impaired glucose tolerance

May explain the increased
frequency of diabetes in
diseases such as coronary
atherosclerosis, hyper-
tension, hyperlipemia and
gout (which have elevated
triglyceride levels as a
common feature)

 

Decreased carbohydrate toler-
ance, abnormal lipid patterns,
excessive insulin response to
glucose, and excessive synal-
bumin insulin antagonism

Exists in diabetes mellitus,
atherosclerosis, and ischemic
heart disease

 

Correction of elevated serum
triglyceride levels occurred

In maturity onset diabetes
that responds to tolbutamide

 

Impaired carbohydrate metabo-
lism or an impaired glucose
tolerance

Is evident in: pregnancy,
women taking ovulatory
suppressants

 

SOURCE:

M. Albrink and P. Davidson,

"Impaired glucose

tolerance in patients with hypertriglyceridemia," Journal of
Laboratory and Clinical Medicine, §Z;4, 573-584, April 1966.

 

 

30
to social cues, and being less concerned with achievement
striving than field independent persons.

A number of studies have found field dependent individu-
als to be more likely to have higher basal levels of galvanic
skin reponse (Silverman, Cohen, Shmauonian, & Greenberg, 1961),
higher levels of free fatty acids (McGough, Silverman, &
Boddonoff, 1971), and higher levels ofserum cholesterol
(Flemenbaum, 1978; Sousa-Poza, Rohrberg, Bellabarba & Ruest,
1976) in comparison to more independent persons. Several
investigators have interpreted these findings to indicate a
heightened state of autonomic arousal in field dependent
individuals as compared to their field independent counter-
parts (Flemembaum, 1978; McGough, Silverman, & Boddonoff,
1965; Pillsburgy, Meyerowitz, Salzman, & Satran, 1967; Silver-
man, McGough, & Boddonoff, 1967). These physiological find-
ings suggest that degree of field dependence/independence may
be an important personality dimension influencing Type A
individuals, as well as others.

Compared to field independent Type A individuals, field
dependent Type A's may be expected to experience greater auto-
nomic arousal in response to environmental stimuli. McCranie,
Simpson, and Stevens (1981) hypothesized that persons posses-
sing a field dependent cognitive style in combination with
Type A behavior would exhibit higher levels of serum choles-
terol and triglycerides than field independent Type A individu-
als. In a study of 82 medical students, these researchers'
results showed that field dependent Type A's had higher total

cholesterol and triglyceride levels than field independent

31
Type A's and either group of Type B subjects. They suggest that
field dependent Type A individuals become more physiologi-
cally aroused in response to environmental stimuli due to
self-involvement and awareness, leading to greater physio-
logic motivation in response to perceived environmental
challenges.» They further believe that these individuals
are more concerned with comparing and evaluating their
behavior and performance with that of others, thereby
producing chronic arousal in response to perceived inter-
personal challenges.

Field dependence/independence research confirms that
when social, environmental, and physiological factors impinge
upon individuals, they affect psychological states and are
perceived as stressful. Psychodynamically, the above research
may be interpreted to mean that a combination of Type A
behavior and a field dependent cognitive style reflects
chronic tension. Despite the fact that these individuals
describe themselves as having Type A traits, they also
exhibited a cognitive style associated with reduced orienta-
tion toward autonomous achievement striving and a greater
need for the external guidance, perhaps in an attempt to
deny or repress their underlying passive, dependent tenden-
cies. Such considerations become important in examining

coping and defending styles and their impact on stress.

Coping and Defending
A careful look at coping and defense mechanisms is needed

because people use coping and defending styles to perceive and

32
react to the world emotionally. This has been found to
affect their physical health, as evidenced by the psycho-
physiology literature.

Pearlin and Schooler (1978) gathered information about
coping responses and psychological attitudes through sched-
uled interviews with a sample of 2,300 subjects representa-
tive of the Chicago area census. The final sample had an
equal number of males and females, and an age group ranging
from 18 to 65 years of age was used in order to employ
subjects at various stages of their careers. The interviews
yielded three distinct types of information about (1) poten-
tial life strains such as conflicts and frustrations, (2)
coping responses employed to deal with stressors, and (3)
perceived emotional stresses. Using factor analysis, major
themes were identified from listed stressors, including
three involving marriage, three involving parenting, and
four involving occupations.

The researchers defined psychological resources as those
parts of personality that help individuals withstand threats
in their environment. Such psychological resources define
how people function. C0ping responses are different than
psychological resources in that they comprise what people do
to deal with environmental stressors. (In the study, the
authors identified three relevant c0ping responses. The
first, changing the stressful situation, is the most effec-
tive way of dealing with stressors, as it acts to eliminate

the cause of stress. Although such a response appears

 

33
obvious, it was used quite infrequently by study subjects,
either because the situation was not recognized as a problem
or because subjects lacked the ability or knowledge to change
environmental circumstances; some attempted to change their
situation by substituting one stressor for another.

A second coping response, in which coping does not
succeed in changing the situation, is altering the meaning
of the problem through rationalizing, selectively ignoring
or making the situation less important, and substituting
other rewards. The third type of c0ping function manages
stress attitudinally. Examples here are beliefs that "time
will change everything," "everything works out for the best,"
and similar reassurances.

Pearlin and Schooler found that occupationally, the
most effective way of coping involves the manipulation of
goals and values. People unable to control stress in their
occupations will devalue the importance of their work, with-
drawing psychologically from that environment. Such devalua-
tion and withdrawal differed from the techniques found to be
effective in the areas of marriage, parenting, and household
economics, where mastery and positive self-esteem were
important means of c0ping. In all areas, stress was found
to be the result of self-denigration more than any other
personality factor. Individuals' attitudes about their work
environment were also found to be important factors in

creating possible stress.

34

In order to determine which is more efficacious, person-
ality characteristics (including psychological resources such
as self-denigration, mastery, and self-esteem) or specific
behavioral responses to specific role situations, Pearlin and
Schooler put summary scores in a regression analysis. The
results indicated that occupational stress management is
more amenable to the psychological resources of the person
than to specific coping responses. The results also indicated
that while psychological characteristics are important in
dealing with environmental stressors at work, what one does
matters more in interpersonal relationships. The authors
suggest that future studies should look not only at what
peeple do for c0ping efficacy but the situations in which
they do it as well, for c0ping mechanisms vary in different
role situations.

Freud, as early as 1911, recognized that people respond
to threat by defending against it, in order to protect the
sphere of the ego. His theory on ego functioning and the
use of defenses has since been expanded upon by Anna Freud
(1936) and many others. Freud used the terms "conscious" and
"ego" interchangeably. The ego develOps as the organism
changes from primary process, which is the infant's need for
immediate gratification, to secondary process, where thought,
perception, memory, language, and delay are incorporated into
the structures of the young child through the normal process
of growth and development. The ego, in incorporating these

functions, acts to mediate the perception and comprehension

35
of external and internal stimuli. It responds to anxiety
and conflict by employing countercathartic energy to keep
these stressful stimuli out of consciousness through the use
of defenses. The ego, then, can be seen as a mediator of
the external world and its demands, and its internal frame
of reference. Defenses are used in this capacity to lessen
the discrepancy between these two realities (Blank & Blank,
1974).

Conflict, anxiety, and their defenses are often resolved
through repression but may reproduce the stress in the dis-
guised form of a symptom (Blank & Blank, 1974). Continued
use of defenses suggests a stressed state in the individual
with psychosomatic illness or conversion reactions, possible
long-term side effects.

Lazarus (1966), although not a psychoanalyst, incorpor-
ates the roles of the ego and perceived threat to the system
in his theory. He defines psychological stress as a result
of cagnitive appraisal of the threat, which must be antici-
pated or future-oriented, and result from the processes of
perception, learning, memory, judgment or inference, in which
data are assimilated to assume ideals and expectations.
Ambiguous stimuli require the processing of belief systems
about the organism and its environment. Personality variables
such as trait anxiety and self-esteem come into play here,
in that they affect the appraisal of the threat. The level
of anxiety experienced and one's self—esteem contribute to
the appraisal of threat. A person with high self-esteem who

is not experiencing anxiety will perceive stress as less

36
threatening to the system than a person with low self-esteem
who is experiencing anxiety.

Anticipation of stress is best explained by the Shannon,
Szmyd and Prigmore (1962) study, which showed that anticipa-
tion of dental procedures resulted in marked adrenal cortex
stress responses.

This finding further solidifies our concept that the

anticipation of oral surgery stimulates the adrenal

cortex. It was further evident that in groups of
patients scheduled for different oral surgical pro-
cedures, higher steroid concentrations were present

in those subjects scheduled for more complicated

operations. Since the pituitary—adrenal system is

generally stimulated under conditions in which the
integrity of the organism is threatened, it might be
expected that fear or anxiety most likely would be
associated with increased ACTH release and subsequent
increased secretion of adrenocortical hormones. The
increased pre-Operative steroid levels are thus held

to be the result of 'psychological stresses' incident

to the anticipation of undergoing oral surgery. (p. 3)

It is evident that once a stimulus has been perceived
as threatening, c0ping mechanisms act to deal with the stress.
COping is based on cognitive activity involving appraisal of
the conditions of threat which will result in the coping
response. Lazarus defines defense as a part of the c0ping
process in which individuals psychologically deceive them-
selves about the actual conditionscfifthreat. Defenses act to
distort the threatening experience so that it appears less
dangerous to the organism. Lazarus thus views c0ping and
defending as one process. Coping is not a threat, but an

appraisal of the situation. When necessary, the individual

responds defensively for experiences to appear less

threatening.

37

If a person does not perceive that danger exists, then
no stress reaction will be evident. Hinkle (1974) analyzed
the personality factors distinguishing peOple who were rare-
ly ill from those with frequent illnesses. He suggests that
those who remain healthy show a lack of concern for other
pe0ple and life goals, and lack of involvement in life
affairs.

The healthiest members of our samples often showed

little psychological reaction to events and situations

which caused profound reactions in other members of the
groups. The loss of a husband or wife or a failure to
attain apparently important goals produced no profound
attachment to people, goals or groups. . . [they]
behaved as if their own well being were one of their
primary concerns. An employed man or woman might

refuse a promotion because he, [or she] did not want

the increased responsibility, refuse a transfer

because it was too much trouble. . . . As family

members, such people might refuse to take the respon-

sibility for an aged or ill parent or sibling, giving

as an explanation a statement implying that it would be

"too much for me." (pp. 40-41)

These individuals appear to be using their defenses to protect
themselves from threatening life experiences. If no appraisal
ofstress is made, then coping and the physiological responses
to the threat will not occur. If the stress is appraised,
however, then c0ping strategies and physiological mechanisms
come into play.

Haan (1977) reinterprets and adds to the psychoanalytic
theory of the ego's efforts to modify conflict through its
defensive role. For example, psychoanalysts recognize the
adaptive defenses of sublimation and substitution as a
healthy means of gratifying primitive impulses. Haan defines

these healthy adaptations and others as c0ping. She views

coping mechanisms as consistent with healthy ego functioning.

38

whereas defenses are perceived as a threat to the ego. Haan
also differs from Lazarus in believing that c0ping and
defending are on a continuum and use similar mental processes.
She lists a variety of ego mechanisms with defensive and
c0ping modes (as well as a "fragmented" mode). The c0ping
modes include objectivity, intellectuality, logical analysis,
tolerance of ambiguity, empathy, regression in the service of
the ego, concentration, sublimation, substitution and suppres-
sion. The defensive mechanisms of the ego which serve to dis-
tort reality are isolation, intellectualization, rationaliza-
tion, doubt, projection, repression, denial, displacement,
reaction formation and regression. An example of the con-
tinuum may be represented by the coping mode of objectivity,
which enables one to separate ideas from feelings to achieve
objective evaluations, versus its defensive counterpart,
isolation. When isolation is used as a defense, the subject
is unable to integrate ideas and the affect does not appear
related to ideas. Similarly, intellectuality is the ability
to detach oneself in an affect-laden situation which requires
impartial analysis. This ceping mechanism's defensive counter-
part is intellectualization, which involves the use of words
and abstractions to retreat from affect. Coping, then,
involves purpose and choice and enhances appropriate expres-
sion of affect. Defenses are more rigid, distorting and
negating appropriate affective expression.

Haan groups psychological reactions to stress by whether

they are assimilated or accommodated by the ego. The

39

Piagetian technique of assimilation is employed when an
organism utilizes something from its environment and incor-
porates it. Accommodation results when the ego structure is
changed by the input. Assimilation responses are the result
of:

1. not anticipating the stressful event,

2. differential expectations,

3. ambiguous situations,

4. individuals believing they will be stressed,

5. a situation thought to be similar to one previously
not handled well,

6. an individual being in a depleted state when the
stress occurs,

7. lack of information necessary to process the
situation.

Accommodation is the result of:

1. inability to control the stress,

2. prolonged stress,

3. intense stress,

4. continual exposure to varied stresses,

5. little previous experience in dealing with stress.
These responses arise because peOple have different c0ping
responses as a result of varied childhood ego development,
differential interpretations of situations (cognitive
processing may trigger different associations or emotions),
and because some have more support systems than others. For
Haan, then, intervention should focus on coping mechanisms

and concommitant affect (Haan, 1977).

40

Empirical evidence supports the proposition that in-
creases in defensive behavior are related to threat and
stress reactions (Fenz & Epstein, 1962). Lazarus and others
(1962) showed that when denial and intellectualization were
used defensively, subjects showed lower levels of stress
response, including autonomic levels of arousal. These data
support the contention that the way in which a person
appraises and copes with an environmental stressor has an
important bearing on the emotional and adaptational outcome
and further indicate that defensive functioning is success-
ful in a variety of stressful situations. For example, a
seriously ill patient who denies or ignores a diagnosis and
is not willing to accept the possibility of death, may fare
better psychologically and physically than one who accepts
and succumbs (Gentry, Foster & Harvey, 1972). Carl Rogers
also has acknowledged that a closed, well-defended person
is likely to c0pe with stress better than his ideal of the
Open, sensitive person (see Bergin & Strupp, 1972, p. 316).

Hormonal secretions also appear to be related to the
success of c0ping mechanisms. Friedman, Mason and Hamburg
(1963) studied parents whose children had incurable cancer.
Two defensive subjects (one father and one mother) living
on the ward and two defensive subjects living at home were
compared to a group of parents whose children were hospi-
talized for cancer. The parents were observed and their
urine specimens taken frequently during the children's

hospitalization. Although there were noticeable increases

41
in threatening events, urinary excretion of hydrocortizone
remained remarkably stable during the period. Friedman et al.
suggest that levels of hormonal secretion seemed to be
dependent on the success of the parent's defensive (coping)
ability. Thus, hormonal stress reactions are not increased
when psychological defenses serve to protect the individual

from environmental stress.

Holistic Theory

 

Rogers (1960) discusses the rationale behind holistic
theory which holds illness to be a complex concept that
incorporates multiple physical and emotional stresses.

There is growing suspicion that many a focus of
pathology heretofore considered as the specific
consequence of a specific cause may not be so at
all. . . . Thus, we are led to the concept of
multiple causation of illness. This concept main-
tains that illness is rarely the result of the
impact of a single, discrete, disease-causing

agent (such as the tubercle bacillus) upon an
otherwise normal and healthy man. Rather, it holds
that most, if not all, illness is an expression of
a basic unbalance in man's physiological adaptation
to multiple physical and emotional stresses that are
initiated, for the most part, in the condition of
his external environment.

Thus, how individuals perceive and evaluate information from
their environment influences thought processes, diet, and
muscular activity. Attitudes also play a part because they
reflect an individual's feelings and beliefs about other
persons, objects, events and activities, and are developed
over time, as are diet, the use of physical exercise, and
the ability to relax (Girdano, 1979). Certain attitudes

influence life styles which may contribute to the development

42
of disease (Friedman & Rosenman, 1974). The holistic approach
to stress takes into account life styles and attitudes about
living, including attitudes about diet and physical exercise, as
well as methods of coping and attaining psychological well-
being. All of these contribute to perceptions of stress and

its management.

Nutrition

 

Nutrition is the relationship of foods to the health of
the human body, and prOper nutrition is defined as the intake
of an adequate balance of all the essential nutrients in order
to promote health. It has long been established that an
improperly balanced diet will lead to nutritional deficien-
cies, with resultant ailments. Fats, carbohydrates and
proteins, for example, are essential sources of energy.
Failure to ingest proper amounts of these nutrients will
result in stressanuipossible death. Good quality diets, then,
which are relatively high in protein and vitamin components
are in harmony with optimal health. The converse parallels
an increased incidence and severity of disease.

Today germs are not our principal enemy. Our chief

medical adversary is what I consider a disturbance

of the inner balance of the constituents of our

tissues, which are built from and maintained by

necessary chemicals in the air we breathe, the water

we drink and the food we eat. For a generation we

have worked on the concept that our cells are never

static and that in time must be replaced in varying

degrees by the nutrients obtained from food. More
specifically, our working hypothesis has been that

all disease is chemical and when we know enough,
chemically correctable. (Spies, 1958, p. 675)

43

Turning from the essential components of food necessary
to maintain health, there are others that represent a hazard
to healthy functioning. Caffeine is an ingredient found in
coffee, tea, cola and chocolate. The use of caffeine raises
nutritional concerns because of its pharmacological actions.
This popularly consumed drug stimulates the central nervous
system, heart, kidneys, lungs and arteries, as it is totally
absorbed into the blood stream and carried throughout the
body and brain. With 100 to 200 mg of caffeine (the equiva-
lent of one to two cups of coffee), the brain easily becomes
stimulated. The spinal cord is the next target for larger
doses. Although behavioral signs suggest increased mental
alertness due to an increase of blood pumped to the heart,
caffeine actually decreases blood flow to the brain by
constricting the cerebral blood vessels (Julien, 1978), with
the end result being more work for the heart, thereby creating
more stress. Evidence also indicates potentially deleterious
effects of caffeine stimulation at the fetal level of
development (Goldstein, Aaronow & Kalmen, 1968).

Nicotine is also a widely used psychoactive agent that
stimulates the central nervous system and cerebral cortex,
producing increased levels of anxiety. Nicotine, like
caffeine, acts to stimulate the brain but is actually a long
term depressant of the nervous system. Normal use of nico-
tine also increases heart rate and blood pressure, acting
to stimulate the heart, increase its work load and create

more stress. Other effects of smoking include strain on the

44

vascular system, the formation of blood clots, chronic
toxicity, and a positive correlation with lung cancer
(Julien, 1978).

The intake of meat may also have deleterious effects
on the body. It is controversial at this time whether exces-
sive consumption of meat, as a form of protein, serves to
overstimulate the sympathetic nervous system. The amino
acid found in meat, tyrosine, is transformed into Depa,
dopamine, and norepinephrine. Julien (1978) suggests that
neurons containing these transformed amino acids (mainly
norepinephrine) are associated with arousal reactions. He
believes that norepinephrine acts to trigger the sympathetic
nervous system, which releases epinephrine and creates
intense emotional experiences in the peripheral nervous
system. His theory suggests that excessive meat intake
creates an imbalance in the biological system, not unlike
those which occur during particularly stressful periods. For
example, Dimsdale and Moss (1980) studied plasma catecholamine
levels obtained during the initial moments of public speaking.
The researchers found that both norepinephrine and epinephrine
increased significantly at these times. The increase of
epinephrine was particularly striking, in effect serving
to keep the speaker in a ”stressed" state. These chemical
effects appear to be similar to those subsequent to excessive
meat consumption.‘

The effects of excessive sugar intake and resulting

hypoglycemia on the body have already been discussed as a

45
cause of high blood pressure and ischemic heart disease.

This simple carbohydrate and its increased consumption is
noteworthy because of its deleterious effects on the system.
The relationship of diet to disease is based on the
notion that health and sickness are the result of many inter-

acting factors. When a host succumbs to one or more of the
many environmental influences, low resistance or high suscep-
tibility to disease is likely. Diet can serve in various
ways to modify the host state so that nutrients may increase
resistance. Conversely, the lack of nutrients can serve to

decrease resistance and exaggerate susceptibility to disease.

Physical Exercise

A healthy body is the result of prOper nutrition com-
bined with a regular program of exercise. Exercise improves
the tone and quality of muscle tissue and stimulates the
processes of digestion, absorption, metabolism and elimina-
tion. It also strengthens blood vessels, lungs, and heart,
resulting in improved transfer of oxygen to the cells and
increased circulation to the blood and lymph systems.

Blumenthal et al. (1980) found evidence that a supervised
program of regular exercise can successfully modify the
physiological and psychological variables associated with
increased risk for coronary heart disease in a nonclinical
sample of healthy adults. Subjects enrolled in a ten-week
fitness program were judged to be free of overt cardiovascu-
lar disease, as determined by medical history, physical exam,

and electrocardiogram. The testing included physiological

46
measures of blood pressure, serum lipids, body weight,
plasminogen activator release in the blood, and treadmill
performance. Psychological measures included the Jenkins
Activity Surveytxadetermine Type A/B behavior patterns and
a survey developed from the Friedman and Rosenman interview
schedule. Testing was done in the two weeks prior to and in
the two weeks after a ten week program of physical condi-
tioning.

The conditioning program utilized by Blumenthal et al.
was 10 minutes of stretching exercises followed by 30 to 45
minutes of continuous walking/jogging (approximately three
miles) three times a week for 10 weeks. The subjects were
also encouraged to limit their dietary intake of total

calories, salt, cholesterol and saturated fats. A general
improvement in overall physical condition was documented by
significant increases in treadmill performance by the entire
group; significant reductions in blood pressure and weight
were observed, as well as significant increases in plasmino-
gen activator release and high density lipOproteins.

Clausen (1977) and Saltin, Bloomquist, Mitchell, Johnson,
Wildenthal and Chapman (1968) also documented the utility of
physical exercise in reducing blood pressure, blood lipids,
and resting heart rate, strengthening lungs and heart, and
reducing the risk of heart disease. Additionally, Blumenthal
and his colleagues were the first to provide evidence that
the Type A behavior pattern may be modified by participation

in a regular exercise program. These researchers demonstrated

47
a reduction of Type A behaviors in conjunction with their
fitness program. Although their findings are limited by
their failure to use a control group, they have provided
valuable evidence suggestive of a link between Type A behavior
patterns and the future occurrence of coronary heart disease
in healthy individuals.

The relationship between moderate forms of activity as
compared toaasedentary role has been studied by Miller et a1.
(1970) Who found more adrenal cortical stress responses in
pilots actively engaged in aircraft carrier landing practice
than in radar intercept officers who have more of a passive
role in the Operation. The radar intercept officers reported
more somatic complaints and anxiety; the more active pilots
evidenced greater physiological activity and fewer reports
of psychological distress. This finding of this study
indicates that active physical involvement may be seen as a

coping strategy to reduce perceived stress.

Psychological Coping and Defending

 

The concept of coping is used to refer to any response
to external life stressors that serves to prevent, avoid, or
control emotional distress. As an individualized defense
against threats in specific situations, c0ping involves
responses to both environmental and internal emotional
stressors by appraising the threat and responding to it
(Lazarus, 1966). Defenses serve to protect the ego against

unrest. Regression, repression, reaction formation, isolation

48
undoing, projection, introjection, turning against self,
intellectualization, sublimation, displacement and denial
are many of the popular defenses the psyche uses to protect
itself from perceived threat or emotional distress, at times
acting unconsciously (Haan, 1977).

Gentry, Foster and Harvey (1972) suggest that defensive
functioning may be adaptive, designed to deal with a stressful
situation. Hinkle's (1974) research indicates that this mode
of functioning may be less situational and more of an overall
personality characteristic. He compared the personality
variables of healthy people to those with frequent physical
illness. Those who remained healthy showed a lack of concern
for others, life goals, and involvement in life affairs.

Lazarus et al. (1962), Fenz and Epstein (1962) and others
have shown that defenses are inversely related to threat and
ultimately to the stress reaction on the body. Defenses,
then, serve to prevent the emotional correlates of vulnera-
bility, depression, and possible decompensation.

As part of a holistic model, then, it is necessary to
examine coping and defending styles, as they determine how
an individual will perceive and react to the environment.
Nutritional intake and physical exercise are often overlooked
as important determinants of stress, or, they are seen individu-
ally as a contributor to stress. The holistic model emphasizes
that coping and defending styles, nutritional intake and physical
exercise cannot be separated; it is their integration which makes
the person and determines how an individual responds to the

stresses of everyday life.

CHAPTER III

DESIGN OF THE STUDY

The population and sample, research procedures, hypothe-
ses, instrumentation necessary to collect the data, data
analysis, and experimental design will be discussed in this

chapter.

‘Sample and Population

 

Research subjects were people who telephoned in response
to radio, newspaper advertisements and public service
messages about a stress management workshOp offered free of
charge to the Greater Lansing Community.

At the time of the first phone contact subjects were
told that the workshop was part of a research project. They
were informed that they would be randomly assigned to one of
two groups at the first meeting; one group would meet over
the next five weeks, the second would begin five weeks later
for the same five-week treatment. Subjects were also told
that they would be tested on two or three occasions. All
respondents were then told a date, time, and place to meet
on the Michigan State University campus.'

A total of 38 phone contacts were made, with 36 subjects
present for the pretest session. One subject decided he could
not participate at that time and, thus, the final sample at

49

50
pretest was comprised of 35 subjects, 14 of whom were males
and 21 females. Ages ranged from 20 to 64, with a mean Of
38.6 years. Almost all subjects were employed and were well
established in their careers as executives for the state
government, Oldsmobile, or other large corporations. There
were also secretaries, teachers, students, cardiac rehabili-

tation patients and retirees (see Tables 4, 5, 6, and 7.)

TABLE 4

AGE DEMOGRAPHICS OF SUBJECTS

 

 

 

 

Age Group Number Of Subjects

20-29 8
30-39 14
40-49 2
50-59 9
60-69 2

Total 35

TABLE 5

SEX DEMOGRAPHICS OF SUBJECTS

 

 

 

Sex Number of Subjects
Females 21
Males 14

Total 35

 

51
TABLE 6

URBAN OR RURAL ENVIRONMENTS OF SUBJECTS

 

 

 

 

Environment Number of Subjects
Urban 30
Rural 5
Total 35
TABLE -7

OCCUPATIONAL DATA OF SUBJECTS

 

 

 

 

Occupation Number Of Subjects

State government 8
Business managers 4
Teachers 4
Secretaries 3
Students 5
Retirees 6

Total 35

Procedures

 

In the first meeting, all telephone respondents met at
the same time and place for the purposes of pretesting and
random assignment to groups. All subjects were pretested
with the same instruments, which are described in further
detail in this chapter. All testing instruments were paper-
and-pencil, except for blood pressure readings. ~At the con-
clusion Of the pretesting period, subjects were randomly
assigned to one of two groups. One group was asked to return

at the same time and place on a particular date six weeks

52
later. The treatment group then met in the same room for
the next five weeks, in which five three-hour sessions were
held on the same day of the week, time, and place. On the
sixth week, all subjects were posttested. For the next
five weeks, the second group then received the same treat-
ment under the same conditions, and were posttested again.

In order to hold testing procedures constant, the same
day of the week, time and room were maintained throughout
the workshop period. All testing instruments were the same
pre—and posttesting, and were administered in the same format.
The room used at all times was a classroom on the MSU campus
with a capacity for forty people. Seating consisted Of 40
desk-chairs. A blackboard and overhead projector were
available as an aid to the instructor.

The two workshOps were conducted by the same instructor
in order to maintain consistency Of treatment. For the same
reasons, the same nurse was maintained throughout the work-
shops and testing intervals. The nurse was told that there
would be two five-week stress management workshops and three
testing intervals, for which blood pressure readings would
be needed. She was paid an agreed-upon sum Of five dollars
per hour compensation. In order to have their blood pressure
taken, subjects were asked to quietly, one-by-one go to the
back of the room. Subjects sat in a chair, and after one
minute Of rest, the reading was taken from their right arm.
The nurse had a card on each subject, for which she recorded

the readings on a weekly basis.

53
The design described above is a Pretest/Posttest Control

Group Design with randomization:

Pretest/Posttest Control Group Design

R 01 X 02

R 01 02 X 03
Where:

R = Randomization

1 = Observation 1, or pretest (all subjects)

= Five-week treatment

0
X
02 Observation 2, or first posttest (all subjects)
0

3 Observation 3, or posttest after control group
received five-week treatment.

The independent variables in this study were those of
nutrition, physical exercise, and psychological coping and
defending mechanisms. A curriculum was devised from the
literature review of this dissertation, with articles to
supplement and support the information presented. Care was
taken to maintain the subjects' interest. Participation
from the subjects was encouraged and easily obtained.

In order to describe the contents Of the workshOp,

a summary is presentedl ”What is Stress?" was the focus
of the first week. Hans Selye's definition of stress was
discussed, along with the concept of ”wellness." Definitions
and illustrations Of atherosclerosis, arteriosclerosis,
myocardial infarction,and blood pressure were presented so

that participants might understand the relationship between

54
stress and heart disease. The psychophysiology of stress,
with a focus on the autonomic system was also presented with
the use of visual aids.

In the second week, small groups of approximately five
each were formed for participants to discuss when, where,
why, and with whom stress occurs in their lives. These
findings were then discussed as a large group. Internal and
external sources of stress were identified as an outcome of
this process. The Holmes and Rahe Social Adjustment Scale
was administered as an aid to the above. Time was available
for reactions to this scale.

In the third week, Type A personality and heart disease
was discussed, with reference made to Freidman and Rosenman's
research. Indicators for Type A personality and suggestions
for changing these behaviors were part of this session.
Psychological COping and defending were also discussed, with
a review of defensive and COping styles.

The fourth week was based on self-help techniques,
with a description of biofeedback, meditation, concentration,
and deep relaxation. All subjects participated in a forty-
minute relaxation procedure.

The importance of physical exercise and a well-balanced
diet were the topics for the fifth week. A consultant came
to both workshOp groups and showed subjects how to do aerobic
exercises, in which they participated. Practical nutritional
information was also discussed, such as the importance Of the

essential nutrients, the effects Of alcohol and caffeine on

55
the nervous system, habits revolving around the buying,
cooking and eating of food.
The conclusion of the workshop servedtflmapurpose of
integrating the information presented to support the holistic

approach to stress management.

- Hypotheses

 

The hypotheses of this study follow from the purpose of
the study. The dependent variables, measuring coping and
defending behaviors, are scales from Norma Haan's COping
Inventory, the Millon Behavioral Health Inventory and scales
from the Minnesota Multiphasic Personality Inventory. Nutri-
tional intake and physical exercise variables were measured
using a checklist. In addition, blood pressure readings were
recorded as a dependent physiological variable.

Null Hypothesis I: There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
emotional disorder (MMPI).

Alternate Hypothesis I: The treatment group will show
a decrease in posttest scores
as compared to the control
group on the dependent varia-
ble emotional disorder (MMPI).

Null Hypothesis II: There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable ego
strength (MMPI).

Alternate Hypothesis II: The treatment group will have
anincrease in posttest scores
as compared to the control
group on the dependent varia-
ble ego strength (MMPI).

56

Null Hypothesis III:

Alternate Hypothesis III:

Null Hypothesis IV:

Alternate Hypothesis IV:

Null Hypothesis V:

Alternate Hypothesis V:

Null Hypothesis VI:

Alternate Hypothesis VI:

There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
basic COping scales (Millon
Behavioral Health Inventory).

The treatment group will have
a decrease in posttest scores
as compared to the control
group on the dependent varia-
ble basic COping scales (Mil-
lon Behavioral Health Inven-
tory).

There is no difference in post-
test scores between the treat-
ment and control groups on the
dependent variable psychogenic
attitudes scales (Millon
Behavioral Health Inventory).

The treatment group will have
a decrease in posttest scores
as compared to the control
group on the dependent varia-
ble psychogenic attitude
scales (Millon Behavioral
Health Inventory).

There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
Haan's coping scales.

The treatment group will have
an increase in posttest scores
as compared to the control
group on the dependent varia-
ble Haan's coping scales.

There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
Haan's defensive scales.

The treatment group will have
a decrease in posttest scores
as compared to the control
group on the dependent varia-
ble Haan's defensive scales.

 

57

Null Hypothesis VII:

Alternate Hypothesis VII:

Null Hypothesis VIII:

Alternate Hypothesis VIII:

Null Hypothesis IX:

Alternate Hypothesis IX:

Null Hypothesis X:

Alternate Hypothesis X:

There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
systolic blood pressure.

The treatment group will have
a decrease in posttest scores
as compared to the control
group on the dependent varia-
ble systolic blood pressure.

There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
diastolic blood pressure.

The treatment group will have
a decrease in posttest scores
as compared to the control

group on the dependent varia-
ble diastolic blood pressure.

There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
nutrition (checklist).

The treatment group will have
improved dietary intake in
posttest scores as compared
to the control group on the
dependent variable nutrition
(checklist).

There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
physical exercise (checklist).

The treatment group will exhi-
bit increased physical exer-
cise in posttest scores as
compared to the control group
on the dependent variable
physical exercise (checklist).

58

Instrumentation

 

The holistic approach to stress management takes into
account variables thought to be significant in current stress
levels. Previous research has indicated that individual
aspects of functioning can be measured as possible
stress inducers. Many researchers, however, have not con-
trolled for other environmental and internal variables that
are also stress producing. For example, Pelletier (1977)
cites environmental and cultural influences that create stress
(Rosenman et al., 1979; Wolff, 1968). These include nation-
ality, eating habits, and place of residence. Recently,
nutritional factors have been suggested as stressors, with
supporting evidence from physiological research (Julien, 1978;
Jenkins, 1978). Julien discussed the chemical reactions
triggered through excessive consumption of meat and Jenkins
conducted research on the Type A personality and its associa-
tion with heart disease. Robbins and Angell (1976)—discuss
predisposing epidemiological factors such as elevated lippo-
proteins, increased blood pressure, cigarette smoking, and
elevated blood sugar. Clausen (1977) and Saltin, Bloomquist,
Mitchell, Johnson, Wildenthal and Chapman (1968) have docu-
mented the utility Of physical exercise in reducing blood
pressure, blood lipids, and resting heart rate. Lazarus (1966)
states that psychological stress results when one appraises
threat to the system, and the research of Shannon, Szmyd and
Prigmore (1962) showed how anticipation of stress resulted

in adrenal cortex stress responses. These scientists have

59

sought specific answers in their own fields, overlooking
other potentially important variables. This holistic study
will, therefore, combine the concepts of nutrition, psycho-
logical coping, physical exercise, and physiological responses.

A review oftflmaliterature suggests that comprehensive
understanding of coping measures and other stress indicators
is still in the infancy of its development. For this reason,
a variety of inventories are used in this study. The dependent
variables in this study include ten measures. The emotional
disorder scale and ego strength scale are derived from
research on the Minnesota Multiphasic Personality Inventory.
Haan has developed coping and defending scales consis-
tent with her theory and derived from the California
Psychological Inventory and the MMPI. Another inventory used
in measuring psychological coping is based on Theodore
Millon's theory and research, whose psychogenic attitude scales
are used in this study to determine the level of psychosocial
stressors, and basic coping scales provide information about
personality styles. Physiological measures include systolic
and diastolic blood pressure readings. Nutritional intake
and physical exercise patterns.are measured from the behavioral
checklist. All the subjects were tested at pretest, posttest I,
and the second group at posttest II phases of the study.

The instruments and their content, reliability, and
validity are as follows:

1. Behavioral Checklist--consisting Of items relating to

 

nutrition, psychological coping, and physical exercise. Food

60
group intake and physical exercise patterns were measured
from this checklist. The Cronbach Alpha interitem reliability
for the total checklist is .74. A pilot study was performed
prior to the use of the checklist on a similar sample.

2. Coping Scales--developed by Norma Haan. These COping

 

and defense scales are derived from the Minnesota Multiphasic
Personality Inventory (MMPI) and California Psychological
Inventory (CPI). They have a mean reliability of .70 based
on the Kuder-Richardson formula, and are validated with the
CPI and MMPI. COping tended to be positively correlated to
the standard scales and defense was negatively correlated

on the CPI. Haan refined the scales using a larger sample
and cross-validation data. Validity coefficients were lower,
but more consistent, ranging from .21 for denial to .57 for
intellectuality. The scales follow from Haan's theory and
research on ego develOpment. Haan believes that COping is

a normative mode to the extent that an individual can deal
with internal and environmental situations. If the person's
perceptions are beyond assimilatory or accommodatory capa-
bility, defenses are used to distort reality. The COping

scales and their defending counterparts are as follows:

Objectivipy--the ability to separate ideas from feelings

 

to achieve Objective evaluations.

Isolation--when the subject is unable to put ideas

 

together and affect does not appear related to ideas.

Intellectuality--using many words and abstractions to

 

retreat from the use of affect.

61
Intellectualization--the analysis of a problem in
purely intellectual terms in order to avoid or defend from
the related affect.

Logical Analysis--a systematic organization of personal

 

and environmental situations.

Rationalization--explaining and justifying behaviors.

 

Tolerance of Ambiguity--coping with cognitive and

 

affective stimuli and tolerating complex negative and positive
feelings toward others.

Eggpg--when one is unable to resolve ambiguity. The
subject doubts his own perceptions and judgments and is un-
able to make up his mind.

Empathy--when the subject is able to imagine how another
person thinks and feels.

Projection--Attributing an objectional tendency to

 

another person insteadcfifrecognizing it as part of oneself.

Regression in the service of the ego--using preconscious

 

functioning in a flexible way and in a form of play or humor.

Regression--resorting to demanding, dependent, non-age

 

appropriate behavior to avoid responsibility, aggression and
demands.

Concentration--the subject is able to set aside disturb-

 

ing feelings or thoughts in order to focus on the task at
hand.
Denial--denying facts and feelings that are painful.

Sublimation--finding alternative channels which are

 

socially acceptable to express more primitive affect.

62
Displacement--temporarily and unsuccessfully attempting
to control unacceptable feelings or impulses in their
original state, and altering their meaning for greater
internal or external tolerance.

Substitution--expressing tempered, domesticated feelings

 

with flexibility as a substitute to rigidity.

Reaction Formation--transforming impulses and affects

 

into their Opposites.

Suppression--controlling inapprOpriate feelings for the

 

right time, place, and person. Affect is expressed when
apprOpriate.

Repression--unconscious1y and purposely forgetting.

 

Haan's COping scales include objectivity, intellectuality,
logical analysis, tolerance of ambiguity, empathy, regression
in the service of the ego, concentration, sublimation, substi-
tution, and suppression. The defensive modes include isola-
tion, intellectualization, rationalization, doubt, projection
regression, denial, displacement, reaction formation, and
repression. The coping mechanisms represent normative modes
Of functioning, the defensive operations are used in response
to threat to the system.

3. Selected MMPI Scales--emotional disorder (Ed) and ego

 

strength (Es) scales. The emotional disorder scale is very
closely related to the Health Opinion Survey (HOS) formulated
by Dohrenwend and Dohrenwend (1969). The HOS focuses on
psychosomatic complications arising from emotional disorders
Of anxiety or depression. The Ed scale is most sensitive to

emotional distress, anxiety, guilt, and self-alienation.

63
This scale has moderately high positive correlations with
the MMPI faking scale (F) (.66) and negative correlations
with Lie (L) (-.23) and K (-.6l). It also correlates posi-
tively with depression, psychoasthenia, schizophrenia, and
other MMPI clinical scales.

The ego strength (Es) scale measures psychological
adaptation and emotional disturbances or psychiatric disor-
ders. Spiegel (1969) fOund the Es scale to be the single
best MMPI predictor separating psychological health in
nonpathological subjects from severe psychOpathology in
hospitalized psychometric cases.

Roessler et al. (1963) found that subjects who were
relatively free of serious psychOpathology, as identified by
a high Es scale, used less effort in the moment-tO-moment
control Of homeostatic processes and, as a result, these
psychologically healthy subjects were able to respond
promptly, apprOpriately, and effectively to new demands made
on adaptational defenses arising from environmental or immuno-
logical situations. Roessler (1966, 1967) also found that
subjects high in ego strength (as measured by the Es scale)
can tolerate greater intensities of cold, heat, and noise,
and are able to withstand higher levels of electric shock
without complaint. These subjects also manifested relatively
greater ranges of autonomic reaction to brief stressors.

4. The Millon Behavioral Health Inventory--this inventory
was developed to provide clinical information about psycho-

social attitudes and stressors, as well as physical problems.

64
The eight personality scales are called Basic Coping Styles
and are derived frombujjrnfs theory of personality (Millon,
1969). The Basic Coping Styles include the following scales:

Introspective Style: (32 items) High scorers are

 

emotionally flat, quiet, and untalkative, often appearing
unconcerned about their problems.

Inhibited Spyle: (43 items) High scorers tend to be

 

hesitant with others and are often shy and ill-at-ease.
These subjects tend to keep their problems to themselves but
they do seek understanding and attention.

COOperative Style: (33 items) High scorers tend to be

 

eager to establish themselves with others and will follow
advice closely. They may be inclined to deny the existence
Of problems.

Sociable Style: (40 items) High scorers tend to be

 

outgoing, talkative and charming. They may be changeable
in their likes and dislikes.

Confident Style: (33 items) High scorers act in a calm

 

and confident manner. They are likely to fear bodily ail-
ments and will follow a treatment plan that will ensure their
well-being.

Forceful Style: (33 items) High scorers tend to be

 

somewhat domineering, tough-minded, and somewhat distrustful.

Respectful Style: (42 items) High scorers are likely to

 

be responsible, conforming and COOperative. They hold their
feelings inside and appear well-controlled and serious-

minded. These patients usually follow therapeutic

65
recommendations, but there is a strong tendency to deny
symptoms. They do not like being sick since this signifies
weakness and inefficiency.

Sensitive Style: (48 items) High scorers tend to be

 

unpredictable and moody. These patients often seem dis-
pleased with their physical and psychological state. Mood
changes seem to occur for no apparent reason.

Six psychogenic attitude scales were developed to reflect
psycho-social stressors. The first two of these scales
pertain to relatively objective events which have been
experienced as either chronically or recently stressful. The
second two relate to attitudes that intensify the subjective
impact of past or future stressful events. The last two
scales attempt to gauge the status of two significant sources
Of potential stress, interpersonal relationships and bodily
functioning. The scales are as follows:

Chronic Tension: (29 items) High scorers on this scale

 

are disposed to suffer various psychosomatic and physical
(ailments. These peOple are constantly on the go, live under
self-imposed pressure, and have trouble relaxing. They are
most likely to exhibit the Type A behavior pattern (Friedman
& Rosenman, 1974).

Recent Stress: (20 items) High scorers on this scale

 

have an increased susceptibility to serious illness for the
year following test administration. Recent marked changes
in their lives predict a significantly higher incidence of

poor physical and psychological health than the population

66
at large (Andrew, 1970; Rahe and Arthur, 1968). This scale,
then, addresses subjects' perceptions of stress in the recent
past.

Premorbid Pessimism: (40 items) High scorers on this

 

scale are disposed to interpret life as a series of mis-
fortunes that are likely to intensify real physical and
psychological difficulties. Depression is ruled out by
noting characterological tendencies toward viewing the world
in a negative manner on the Future Despair Scale.

Future Despair: (38 items) High scorers do not look

 

forward to a productive future life. They view medical
difficulties as seriously distressing and potentially life
threatening.

Social Alienation: (33 items) This scale measures the

 

level of familial and friendship support, both real and
perceived. Cobb (1977) and Rabkin and Struening (1976) have
found that level Of support is a significant moderator in the
impact Of life stresses.

Somatic Anxiety: (34 items) High scorers tend to be

 

hypochondriacal and susceptible to minor illnesses, experi-
encing an unusual amount of fear concerning bodily functions.
Six psychogenic attitude scales were develOped to reflect
psychosocial stressors. Six additional scales called psycho-
somatic correlates were empirically derived to appraise other
emotional factors which complicate psychosomatic ailments or

predict psychological complications.

67

The Millon Inventory has been validated on three
dimensions: theoretical-substantive, internal-structure,
and external criterion. In addition, the test was cross-
validated for better generalizability. The median biserial
correlation for the items on the personality scales was .47.
The psychogenic attitude scales were develOped on theoretical-
substantive grounds. Lists were developed and rated by
clinicians, with items selected by more than 75 percent of
the raters included in the inventory. It was also validated
externally with the MMPI, CPI, Rotter's Locus of Control,
Beck's Depression Scale, the Life Events Survey, and the
Webber-Johansson Temperament Survey.

Test-retest reliability on the personality scale range
from .77 to .88, with a mean of .82. The psychogenic scale
is .85 and the empirical scale .80.

5. Blood Pressure Res.Ponses-‘systolic and diastolic readings
were taken by a trained practitioner at all testing intervals
and at each weekly workshop meeting. All readings were taken
on the right arm in a sitting position after one minute rest.
Systolic and diastolic blood pressure readings were found by
using a baumanometer merconical blood pressure device with

a cuff and stethoscope. Diastolic blood pressure is the
pressure on the vascular walls when the heart is at rest.
Cattell (1966) found diastolic blood pressure to be signifi-
cantly related to trait anxiety or constant stress. A higher
diastolic reading reflects greater stress on the vascular

walls. Systolic blood pressure refers to the pressure on

68
the vascular walls at the peak of the heart's thrust.
Systolic blood pressure is a measure Of situational stress
and is therefore more labile than diastolic (Turek, Van
Durkuy, Pelgrim, De Keyzer, Von Der Furh, and Voerman, 1977).
Blood pressure readings have been correlated with health,
with readings greater than 140/90 predictive of potential

heart and kidney damage (Wheatly, 1977).

Data Analysis

 

Due to the large number of dependent variables used in
this treatment, an attempt was made to collapse certain scales
into meaningful groups, thereby reducing the possibility of
reaching significance merely by chance. As the dependent
variables increase, so does the possibility of accidentally
achieving significance. Multivariate Analyses of Covariance
were used to determine significance levels without com-
pounding the alpha level, Or increasing the probability Of

rejecting the null hypothesis when it is actually true.

Research Design

 

The Pretest/Posttest Control Group Design was used in
this study. This is a true experimental design and meets
Campbell and Stanley's (1963) criteria for internal validity.
Equivalency of groups can be assumed through randomization
and a control group is used for comparison. All subjects

interested in this intervention received the treatment.

69

Pretest/Posttest Control Group Design

R 01 X 02

R 01. 02 X 03
Where:

R = Randomization

01 = Observation 1, or pretest (all subjects)

X = Five-week treatment

O2 = Observation 2, or first posttest (all subjects)
0

3 = Observation 3, or posttest after control group
received five-week treatment.

CHAPTER IV

ANALYSIS OF DATA

The data derived from the instruments in Chapter III
and a discussion of statistical procedures used to analyze
the data will comprise this chapter. Each hypothesis will be
restated, with a statement as to whether its null form was
supported or rejected.

Pearson product-moment correlations were performed on
all pretests in order to determine if, and to what extent,
relationships existed among the dependent variables. The
correlations revealed that there were relationships among the
dependent variables; however, the correlations were not large
enough to recommend the exclusion of dependent variables due
to common factor variance (see Table 8). One high correlation
(.793) was found, between diastolic and systolic blood pres-
sure, which was expected due to the physiological similarity.
Diastolic blood pressure measures the rate at which blood
flows through the vascular walls when the heart is at rest,
while systolic pressure measures the rate of blood flow while
the heart is at work. The diastolic reading is a measure of
chronic stress, systolic is more sensitive to situational
stress. Both measures were retained as dependent variables

in order to determine if subtle differences could be found.

70

71

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72

Multiple analysis of covariance (MANCOVA) was the method
of data analysis chosen for the statistical design described
iJI this study. This statistical. procedure, like all
regression analyses, expresses the statistical significance
of the relationship of the treatment group as compared to the
control. Multiple regression is especially useful when there
are varied cell sizes, or when other variables are included
for control purposes. Multiple analysis of covariance is a
more sophisticated multiple regression procedure which tests
the significance of the differences among means. Initial
mean differences between the experimental groups on a co-
variate, a variable correlated with the dependent variable,
are thus controlled. In this study, analysis of covariance
was used to ensure equivalency of groups at pretest time;
therefore pretests, and the additional variable of sex, were
covaried. Sex was not tested as a main effect because it
would reduce cell size to five observations in one particular
cell, thereby limiting statistical inferences.

The Hotelling-Lawley Trace and Pillai's Trace tests of
MANCOVA were tested for overall group effects on the following
posttest dependent variables: emotional‘disorder, ego strength,
basic coping scales, psychogenic attitude scales, Haan's coping
scales, Haan's defense scales, systolic blood pressure and
diastolic blood pressure, with pretest and sex serving as
covariates. This MANCOVA test indicated an overall group
effect [F(8,8) = 7.01, p<.006], meaning there was a statisti-

cally significant difference when the treatment group was

73
compared to the control on the dependent variable posttest scores,
with pretest and sex differences adjusted. Subsequent uni-
variate analyses were conducted on this group effect to
determine which particular variables accounted for the over-

all significance. The psychogenic attitude scales proved

significant [F(l,15) = 34.86, p<.0001], as well as Haan's
defense scales [F(5,15) = 11.65, p<.004]. (See Tables 9 and
10).

Hotelling-Lawley Trace and Pillai's Trace MANCOVA tests
were then applied to the checklist, with sex and pretest
means again covaried. A main effect for group resulted
[F(3,18) = 3.81, p<.03], again indicating a statistically
significant difference when the treatment group was compared
to the control on checklist posttest scores, with initial
differences on the pretest adjusted. Subsequent univariate
analyses indicated that three variables contributed to the
main effect: nutrition [F(l,20) = 8.77, p<.007]; psychologi-
cal coping [F(l,20) = 3.50, p<.072]; and physical exercise
[F(l,20) = 4.05, p<.057]. (See Tables 9 and 10 for least
square means).

For purposes Of clarity, each hypothesis is restated
below in its null and alternate form, with a subsequent state-
ment pertaining to whether the hypothesis was maintained or
rejected in the analyses of the data.

Null Hypothesis I: There is no difference in

posttest scores between the
treatment and control groups

on the dependent variable
emotional disorder (MMPI).

74

TABLE 9

DEPENDENT VARIABLE POSTTEST LEAST SQUARE MEANS (COVARIED)

 

 

Standard Error

 

Dependent Least Square Least Square
Variable Group Mean Mean

Ego Strength treatment 22.905 1.205

control 25.939 1.096
Emotional Disorder treatment 13.675 0.723

control 14.279 0.657
Basic Coping Scale treatment 414.264 12.671

control 426.274 11.523
Psychogenic treatment 322.061 10.895
Attitude Scale control 418.519 9.908
Haan's treatment 3.934 0.185
Defensive Scales control 4.881 0.168
Haan's Coping treatment 5.588 0.145
Scales control 5.402 0.132
Diastolic treatment 74.038 2.211
Blood Pressure control 78.539 2.011
Systolic treatment 115.800 3.095
Blood Pressure control 122.600 2.815
Nutrition treatment 24.204 0.773

control 27.542 0.712
Physical Exercise treatment 10.063 0.906

control 21.545 0.061
Psychological treatment 37.603 1.252
Coping control 40.904 1.150

 

TABLE 10

DEPENDENT VARIABLE PRETEST MEANS

 

 

 

Dependent Standard
Variable Group Mean Deviation

Ego Strength treatment 24.688 5.665

control 26.105 5.685
Emotional Disorder treatment 14.813 2.373

control 14.211 3.242
Basic Coping Scale treatment 412.866 26.779

control 406.684 67.181
Psychogenic treatment 404.600 111.331
Attitude Scale control 356.000 106.277
Haan's treatment 4.069 0.581
Defensive Scales control 4.199 0.509
Haan's Coping treatment 5.381 0.568
Scales control 5.519 0.608
Diastolic' treatment 76.133 9.731
Blood Pressure control 82.737 13.068
Systolic treatment 123.869 17.840
Blood Pressure control 123.316 19.209
Nutrition treatment 25.313 5.023

control 27.789 5.138
Physical Exercise treatment 20.375 3.243

control 20.526 4.647
Psychological treatment 39.313 4.362
Coping control 41.158 4.349

 

Alternate Hypothesis I:

F(1,15) = .31, p<o.5855

The treatment group will show
a decrease in posttest scores
as compared to the control

group on the dependent varia-
ble emotional disorder (MMPI).

The null hypothesis was not rejected.

Null Hypothesis II:

Alternate Hypothesis II:

F(1,15) = 2.82, p<0.1139

There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable ego
strength (MMPI).

The treatment group will have
an increase in posttest scores
as compared to the control
group on the dependent varia-
ble ego strength (MMPI).

The null hypothesis was not rejected.

Null Hypothesis III:

Alternate Hypothesis III:

F(1,15) = .40, p<0.5369

There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
basic coping scales (Millon
Behavioral Health Inventory).

The treatment group will have
a decrease in posttest scores
as compared to the control
group on the dependent varia-
ble basic coping scales (Mil-
lon Behavioral Health Inven-
tory).

The null hypothesis was not rejected.

Null Hypothesis IV:

There is no difference in post-
test scores between the treat-
ment and control groups on the
dependent variable psychogenic
attitudes scales (Millon
Behavioral Health Inventory).

77

Alternate Hypothesis IV:

F(1,15) = 34.86, p<0.0001
The null hypothesis was rejected

Null Hypothesis V:

Alternate Hypothesis V:

F(1,15) = .72, p<0.4088

The treatment group will have
a decrease in posttest scores
as compared to the control
group on the dependent varia-
ble psychogenic attitude
scales (Millon Behavioral
Health Inventory).

for its alternate.

There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
Haan's coping scales.

The treatment group will have
an increase in posttest scores
as compared to the control
group on the dependent varia-
ble Haan's coping scales.

The null hypothesis was not rejected.

Null Hypothesis VI:

Alternate Hypothesis VI:

F(1,15) = 11.65, p<0.0038
The null hypothesis was rejected

Null Hypothesis VII:

There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
Haan's defensive scales.

The treatment group will have
a decrease in posttest scores
as compared to the control
group on the dependent varia-
ble Haan's defensive scales.

for its alternate.

There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
systolic blood pressure.

78

Alternate Hypothesis VII: The treatment group will have
a decrease in posttest scores
as compared to the control
group on the dependent varia-
ble systolic blood pressure.

F(1,15) = 2.10, p40.1680
The null hypothesis was not rejected.

Null Hypothesis VIII: There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
diastolic blood pressure.

Alternate Hypothesis VIII: The treatment group will have
a decrease in posttest scores
as compared to the control
group on the dependent varia-
ble diastolic blood pressure.

F(1,15) = 1.11, p<0.3078
The null hypothesis was not rejected.

Null Hypothesis IX: There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
nutrition (checklist).

Alternate Hypothesis IX: The treatment group will have
improved dietary intake in
posttest scores as compared
to the control group on the
dependent variable nutrition
(checklist).

F(1,20) = 8.77, p<.007
The null hypothesis was rejected for its alternate.

Null Hypothesis X: There is no difference in
posttest scores between the
treatment and control groups
on the dependent variable
physical exercise (checklist).

Alternative Hypothesis X: The treatment group will
exhibit increased physical
exercise in posttest scores
as compared to the control
group on the dependent varia-
ble physical exercise (check-
list).

79
F(1,20) = 4.05, p/.057
The null hypothesis was rejected for its alternate.

In summary, multivariate analyses revealed an overall
group effect. Univariate testing indicated thattflmadependent
variables of psychogenic attitudes, Haan's defense scales,
and all three variables of the checklist (nutrition,
psychological coping, physical exercise) accounted for the
overall significant difference. Further explanation, in an
effort toward a comprehensive understanding of these results,

will be undertaken in Chapter V.

CHAPTER V

SUMMARY, DISCUSSION, CONCLUSIONS

This chapter will serve to bridge the gap between the
research cited in the literature and this present study.
Primarily, a discussion of the study results will aid in
better understanding the contributions of a holistic approach
to stress management. The nature of the treatment and the
instruments used to test the hypotheses will be explored
and their limitations noted. Finally, conclusions and

suggestions for future research will be offered.

Summary

In recent years, stress has become a household word to
describe difficulty coping in personalanuiprofessional
settings. Although technological advances have served to
improve our lifestyles through modern day time-saving con-
veniences and devices that give us fingertip access to the
world, the revolution has speeded up our lives and assaulted
our ears and nerves affecting every aspect of peoples' lives.
As a result, bodily stress may range from short-lived fatigue
to chronic back pain, migraine headache, and ulcers. Psycho-
somatic disorders and mental fatigue have also become common.

Researchers exploring how stress affects human function-
ing have most often focused on specific symptomatology or
particular types of stress producers. Selye (1956), Levi

(1974), and Singer (1974) have emphasized the role of
80

81
hormonal response to life adjustments and their effects on
the likelihood of disease. Julien (1978) has studied how
foods may add stress to the system and Blumenthal, Williams,
Kong, Schanberg and Thompson (1980) have done the same
regarding exercise. Additionally,-McCranie, Simpson and
Stevens (1981), Howard (1976) and others have conducted
extensive long-term research (n1 Type A behavior and its
relationship to coronary heart disease. Lazarus (1966) and
Haan (1963) have explored coping and defending styles, and
Hinkle (1974) explains how psychological defending relates to
the frequency of illness. The present study has attempted to
unify the theories and research cited above into a holistic
workshop,in which all parts of the body and psyche are assumed
to act in unison to maintain a healthy system. The workshop in
this study, then, includes the holistic concepts of nutrition,

physical exercise, and coping and defending styles as aids to

reducing stress. Ten hypotheses were derived as dependent

variables to measure these holistic concepts.

Thirtydfiye subjects of this study responded to radio and
newspaper public service notices in the greater Lansing area.
They were informed about the nature of the study and all
subjects were pretested using the instruments on which the
hypotheses are based, which were described in Chapter III of
this study. Subjects were also randomly assigned to one of
two groups. Group one received the five-week workshop based

on the holistic model. Group two was not treated at this

82
time, but six weeks later (time two), when all subjects were
posttested. Group two then received the five-week workshop
treatment and was posttested again. The same instructor,
room, time, and day of the week were maintained for consis-
tency of treatment. The workshop (treatment) was focused on
stress, its relationship to heart disease, and to psychophysi-
ology. Type A personality was discussed, as well as nutri-
tional, coping, defending, and physical exercise patterns in
relation to stress. The workshop was didactic and partici-
patory, with small group discussion.

In the statistical analysis of the data, PearSon product-
moment correlations were performed on all the pretests to
determine if relationships existed among variables. There
was no justification to exclude dependent variables. Multiple
analysis of covariance was performed on all dependent variables,
with sex and pretest covaried. An overall group effect was
found to exist when all the variables (excluding the checklist)
were analyzed [F(8,8) = 7.01, p<.006]. Subsequent univariate
analyses revealed the psychogenic attitudes scale [F(1,15) =
34.86, p<.001] and Haan's defense scale [F(5,15) = 11.65,
p<.004] accounted for the main effect. Additional analyses
were conducted on the checklist, with sex and pretest covaried.
A main effect for group resulted [F(3,18) = 3.81, p<.03], with
univariates indicating that three variables accounted for
most Of the variance: nutrition [F(1,20) = 8.77, p<.007],
psychological coping[F(l,20) = 3.60, p<.072], and physical

exercise [F(1,20) = 4.05, p<,057].

83

Discussion

 

This section will be used to discuss the overall results
of this study and how they relate to the research cited.

More specifically, why certain univariates contributed to the
overall group effect and why other dependent variables were
not significant, based on the theories and research cited in
Chapter IL,will be discussed. The limitations of this study
will also be explored.

In reviewing the results, the treatment group had a
significant difference in decreased posttest scores as com-
pared to the control group on the dependent variable Millon's
psychogenic attitude scales and Haan's defense scales. On
the checklist, the nutrition scale showed significantly
improved dietary intake and the physical exercise scale
revealed significant increases in physical exercise patterns.

Millon's psychogenic attitude scales measured personal
feelings and perceptions related to psychological stress,
often a precursor to psychosomatic complaints and illness.
Two of these scales, chronic tension and recent stress,
attempt to measure the effects of relatively objective events
which are stressful. Chronic tension tends to be a measure
of Type A behavior, and the recent stress scale a measure of
recent stress similar to the Holmes and Rahe (1967) Social
Readjustment Side. These two scales, then, encompass person-
ality traits and external factors which may create stress.
The premorbid pessimism and future despair scales tend to

identify how people relate to the stress they are experiencing,

84
with high scorers complaining about life in general and
exhibiting poor attitudes for coping with stress. Social
alienation and somatic anxiety, the last two scales, measure
interpersonal relationships and bodily functioning, with high
scorers prone to ailments and hypochrondriasis. The scales
which comprise the psychogenic attitude scale, then, take
external stress into consideration but focus primarily on
personality characteristics and attitudes about illness and
recovery. Following treatment, the experimental group in
this study attained significantly lower scores as compared
to the control on this variable, meaning that the treatment
group were less likely to report psychosomatic complaints,
had better dispositions toward recovery from illness,
exhibited fewer Type A characteristics, and experienced less
external stress, as compared to the controls. Subjects in
the experimental group learned about Type A behaviors, heart
disease, coping and defending styles, the psychophysiology
Of stress, and that people do, in fact, have some control
over their bodies through the autonomic system. These factors
appeared to have had a positive influence on how subjects
later felt and perceived stress, as compared to those in the
control group. Subjects in the control group exhibited
increased scores on the psychogenic attitude scale at post-
test time, indicating that during the waiting period, and
perhaps as a result of it, subjects continued to exhibit

poor attitudes for coping with stress.

85

The literature suggests that if attitudes, beliefs, and
feelings about other persons and events are perceived as
stressful, the body will produce a neurophysiological
reaction, maintaining a stressed state. The end result may
be chronic heart disease, as evidenced by Jenkins (1971), who
found that subjects experiencing work overload and chronic
conflict situations related to work and family were more
likely to develop angina pectoris than those without such
conflicts. Subjects in the workshop of this study exhibited
fewer Type A characteristics and experienced less external
stress as compared to the controls, suggesting less of a
likelihood for chronic heart disease.

The experimental group scored significantly lower than
the control group on Haan's defense scales, scales which
attempt to measure the classical defenses: isolation, intel-
lectualizations, rationalization, doubt, projection, regres-
sion, denial, displacement, reaction formation, and repression.
High scores on these scales indicate a well-defended person,
who feels vulnerable and mOre easily threatened than those
with lower scores. Subjects were randomized and all dependent
variables were covaried on the pretests, thus we.cannot say
that the control group was significantly more well-defended
than the experimental group by chance factors. Rather, we
must assume that the treatment itself affected defensiveness,
perhaps by informing subjects about coping and defending
styles, and by providing activities which encouraged parti-

cipation and, on one occasion, small group interaction.

86
Subjects in the control group exhibited increased defen-
siveness scores during the waiting period, suggesting that
this was a difficult period. This was also evidenced by
subjects' poor attitudes for coping with stress as indicated
on the psychogenic attitude scale.

The ego part of the personality acts to mediate percep-
tions of internal and external stimuli and defenses come into
play to respond to stressful situations to reduce the threat
and anxiety. Continued use of defenses suggests a stressed
state in the individual with psychosomatic illness a possible
long-term side effect. This workshop served to make subjects
more aware of potential stressors. Subjects were more likely
to appraise future-oriented stress as less threatening to the
psyche, and perhaps had less need to use defenses to protect
the ego. Lazarus' contention is that the individual uses
defenses to psychologically deceive themselves about the
active conditions of the threat; however, this appeared not
to be necessary as a result of the workshop. This workshop
served the purpose of making better appraisals of stress,
finding them less threatening.

Hinkle (1974), Gentry, Foster and Harvey (1972), and Fenz
and Epstein (1962) indicate that under extreme forms of stress,
such as a patient who is seriously ill, or parents of a child
dying of a terminal illness, defenses are used as a way of coping
with the trauma. They suggest that the seriously ill patient
who defends may fare better psychologically and physically.

At some point in time, then, there is an inverse relationship

87
as to the use of defenses to protect the sphere of the ego.
Although it is not known conclusively, the data and reports
from subjects in the present study indicate that subjects
did not experience such traumatic stressful situations where
defenses were used to such a large extent. The results of
this study could not confirm the findings of Hinkle, Gentry,
Foster and Harvey, and Fenz and Epstein, which suggests that
defenses are used for traumatic situations to protect the
individual from the threatening situation.

All three components of the checklist proved to be
significant when the treatment group was compared to the
control, indicating that treatment group subjects changed
their behavior and attitudes about nutritional intake and
physical exercise, and became psychologically more able to
cope with stress. It appears that the workshop served to
educate subjects about these behavior patterns, and perhaps
also reinforced personal commitments to change these aspects
of their lives, as evidenced by their response to the workshop
and the fact that some subjects were cardiac rehabilitation
patients on the road to recovery from a heart attack. These
subjects were eager to learn that personality variables which
contribute to a stressful life-style (Type A behavior), lack
of regular physical exercise and high intake of saturated
fats are predisposing toward heart disease (Robbins and
Angell, 1976).

Similarly, Rosenman and Friedman (1960) found that

members reported moderate to heavy work activity, or who

88
undertook regular daily exercise had lower rates of heart
disease than those with sedentary to light work. Blumenthal
et a1. (1980) found that a supervised program of regular
exercise can successfully modify the physiological and
psychological variables associated with increased risk for
chronic heart disease in a non-clinical sample of healthy
adults. In addition to the subject's personal motivation
acquired from this information, the checklist asked questions
such as, "How many six-ounce chocolate bars do you eat per
week?" Thus, an awareness may have developed from the pre-
test and through the workshop as to what attitudes and habits
were healthy to maintain.

Given these positive responses to the treatment, it
remains to be discussed why the treatment and control groups
were not found to be significantly different on the dependent
variables of ego strength, emotional disorder, Haan's coping
scales, Millon's basic coping scales, and diastolic and
systolic blood pressures, as suggested by the literature.

Subjects in the treatment group did not score signifi-
cantly higher on Haan's COping Scale or Ego Strength, or
score lower on the Emotional Disorder Scale. Ego strength,
like coping, appears to be consistent with healthy ego
functioning, the integrated part of personality. Psycho-
analysis tells us that deep-rooted personality structures
may be difficult to change in short periods of time, as ego
strength takes years to develop via the secondary processes

of thinking, language, delay, motility, memory, etc. But

89

even once the child has mastered these tasks and ego strength
is developed with the formation of the personality, years
later ego strength continues to develop as the adult person
is subjected to life's experiences. As a result, a construct
like ego strength and its coping counterpart may be less
subject to change, especially in the period of five weeks.
Although defenses are deep-rooted personality structures
like coping responses, these subjects had somewhat healthy
coping responses as evidenced by attending the workshop with
the purpose of alleviating stress. The participatory nature
of the workshop and the above combination of factors suggests
that perhaps defenses are more easily broken down than
coping mechanisms are established. Subjects learned that
repression and other defensive behavior may create a stressed
state with psychosomatic ailments resulting. They also
learned that under extreme forms Of stress, defenses serve
to protect the individual. As a result, they may have learned
to discriminate so that defenses are maintained in certain
extreme stressful situations where they are necessary, but
through the awareness created by the workshop, Lazarus'
information suggests they were able to make better cognitive
appraisal to threat, with the stress less threatening to the
system. Millon's Basic Coping Styles are personality
variables which may not be subject to changing easily for the
same reasons.

The data are consistent with the Pearlin and Schooler

(1978) research which indicates that in stressful

90
interpersonal relationships what one does to change the
stressful situation is most important. To that extent,
subjects in the present study participated in the workshop
and discussed their difficulties, with the end result, hope-
fully, a change in their behavior or attitude about the
stressful situation.

Cattell (1966) found diastolic blood pressure to be
significantly related to trait anxiety or constant stress,
whereas systolic blood pressure is thought to be more situa—
tional. In this study, systolic and diastolic blood pressure
were not significantly lowered, perhaps because a five-week
workshop is not enough time for these physiological changes
to take place. For example, nutritional and exercise habits
may be improved by lowering salt consumption and walking
instead of using an elevator, yet these behavioral changes
may take time to manifest themselves physiologically in blood
pressure readings. The Blumenthal study suggests these
physiological changes are possible in a ten-week period. It
should be noted, however, that blood pressure readings for
the treatment and control at pre- and posttest time were
within a normal range, suggesting that further reductions

would be difficult to ensure.

Conclusions

 

The purpose of this research was to design a holistic
approach to stress management where participants could learn

how diet, activity, and coping and defending can work in

91
unison to facilitate coping with stress. From the findings
derived from the data, there was an overall significant
differences between the treatment group as compared to the
control.

These findings suggest that defenses, Type A behavioral
patterns measured indirectly, attitudes and perceptions
about life-style, nutritional intake and exercise patterns
can be changed as the result of a five-week workshop. Coping
responses and the more deep-rooted personality components
such as ego strength appear less changeable as the result of
a five-week workshop. Similarly, the physiological measure
of blood pressure was not significantly different for the
treatment group during this time period.

This research is consistent with the holistic theory
that how individuals perceive and evaluate information from
their environment influences attitudes, diet, activity, and
coping and defending responses. The research also supports
the theory that a holistic workshop can have beneficial
results in treating individuals who feel the need to allevi-

ate stress in their lives.

Suggestions for Further Research
Limitations of this study and recommendations for
further research include a larger sample for increased cell
Size and a more powerful test. Statistically, this would have
enhanced the present findings. All pretests and sex served
as covariates, thereby reducing the power of the test. Also,

because of the small sample who were volunteers, and the

92
results of pretesting, caution must be taken in generalizing
to larger populations.

There were limitations to the test data, despite a survey
of several hundred scales. The coping and defending scales
were derived by Haan following an integrated theory, yet they
were tested on limited samples, making norms uncertain. The
scales are not yet published as clinical instruments, attes-
ting to their research nature. This study used the scales to
compare differences between the treatment and the control
group, rather than comparing the treatment to a normative
sample. Contrary to Haan's coping and defending scales, the
Millon Behavioral Health Inventory has a rich clinical base;
however, many of these norms are based on people who were
hospitalized. Millon claims the inventory can be used on any
population; however, it must be noted that the normative base
were medically hospitalized adults and the subjects in the
present study were compared to this normative sample.

The checklist was derived due to a lack of published
measures on nutrition and physical exercise habits. Although
it proved reliable, its validity is unknown. For the applica-
tions of this study, however, the checklist seemed to serve
a useful purpose.

Perhaps more physiological measures would prove useful,
such as the treadmill performance used in the Blumenthal
study, where a program of regular exercise successfully modi-
fied the physiological and psychological variables associated

with an increased risk for chronic heart disease. Blood

93
levels of cholesterol and triglycerides would also indicate
less stress as detected on the heart physiologically,
rather than an indication of less stress reported through
subjective attitudes and perceptions. A longer time frame,
such as the ten weeks in the Blumenthal study, would be

needed to derive the physiological results, however.

APPENDICES

APPENDIX A

MMPI EMOTIONAL DISORDER SCALE

94
Emotional Disorder Scale (Ed) MMPI

2. I have a good appetite.

29. I am bothered by acid stomach several
times a week.

41. I have had periods of days, weeks, or
months when I couldn't take care of
things because I couldn't "get going."

47. Once a week or oftener I feel suddenly
hot all over, without apparent cause.

76. Most of the time I feel blue.
88. I usually feel that life is worth while.

108. There seems to be a fullness in my head
or nose most of the time.

152. Most nights I go to sleep without
thoughts or ideas bothering me.

174. I have never had a fainting spell.
178. My memory seems to be all right.

186. I frequently notice my hand shakes when
I try to do something.

189. I feel weak all over much of the time.
190. I have very few headaches.

191. Sometimes, when embarrassed, I break out
in a sweat which annoys me greatly.

217. I frequently find myself worrying about
something.

230. I hardly ever notice my heart pounding
and I am seldom short of breath.

238. I have periods of such great restlessness
that I cannot sit long in a chair.

242. I believe I am no more nervous than most
others.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

95

Emotional Disorder Scale (continued)

257. I usually expect to succeed in things
I do.

305. Even when I am with people I feel lonely
much of the time.

 

 

APPENDIX B

MMPI EGO STRENGTH SCALE

14.

22.

32.

33.

34.
36.
43.
48.

51.

58.

62.

82.

94.

95.
100.

109.

96
Ego Strength Scale (Es) MMPI

I have a good appetite.
I have diarrhea once a month or more.

At times I have fits of laughing and
crying that I cannot control.

I find it hard to keep my mind on a task
or job.

I have had very peculiar and strange
experiences.

I have a cough most of the time.
I seldom worry about my health.
My sleep is fitful and disturbed.

When I am with people I am bothered by
hearing very queer things.

I am in just as good physical health as
most of my friends.

Everything is turning out just like the
prophets of the Bible said it would.

Parts of my body often have feelings like
burning, tingling, crawling, or like
"going to sleep."

I am easily downed in an argument.

I do many things which I regret afterwards
(I regret things more or more often
than others seem to).

I go to church almost every week.

I have met problems so full of possibili-
ties that I have been unable to make
up my mind about them.

Some people are so bossy that I feel like
doing the opposite of what they request,
even though I know they are right.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

132.

140.

153.

174.
181.

187.

189.
192.

208.
209.
217.

221.
231.
234.

236.
241.

244.

251.

97

Ego Strength Scale (continued)

I like collecting flowers or growing
house plants.

I like to cook.

During the past few years I have been well
most of the time.

I have never had a fainting spell.

When I get bored I like to stir up some
excitement.

My hands have not become clumsy or
awkward.

I feel weak all over much of the time.

I have had no difficulty in keeping my
balance in walking.

I like to flirt.
I believe my sins are unpardonable.

I frequently find myself worrying about
something.

I like science.
I like to talk about sex.

I get mad easily and then get over it
soon.

I brood a great deal.

I dream frequently about things that are
best kept to myself.

My way of doing things is apt to be mis-
understood by others.

I have had blank spells in which my
activities were interrupted and I did
not know what was going on around me.

253.

261.

270.

341.

344.

349.
355.
359.

367.
378.
380.

384.

389.
410.

420.

421.

430.

98

Ego Strength Scale (continued)

I can be friendly with people who do
things which I consider wrong.

If I were an artist I would like to draw
flowers.

When I leave home I do not worry about
whether the door is locked and the
windows closed.

At times I hear so well it bothers me.

Often I cross the street in order not to
meet someone I see.

I have strange and peculiar thoughts.

Sometimes I enjoy hurting persons I love.

Sometimes some unimportant thought will
run through my mind and bother me for
days.

I am not unusually self-conscious.

I am embarrassed by dirty stories.

I try to remember good stories to pass
them on to other people.

My worriesseem to disappear when I get
into a crowd of lively friends.

Whenever possible I avoid being in a crowd.

I would certainly enjoy beating a crook
at his own game.

I have had some very unusual religious
experiences.

One or more members of my family is very
nervous.

I am attracted by members of the
opposite sex.

 

458.

483.

488.
489.

494.

510.
513.

515.

525.
541.

544.

548.

554.

555.

559.

561.

99

Ego Strength Scale (continued)

The man who had most to do with me when I
was a child (such as my father, step-
father, etc.) was very strict with me.

Christ performed miracles such as changing
water into wine.

I pray several times every week.

I feel sympathetic towards people who tend
to hang on to their griefs and troubles.

I am afraid of finding myself in a closet
or small closed place.

Dirt frightens or disgusts me.

I think Lincoln was greater than
Washington.

In my home we have always had the ordinary
necessities (such as enough food,
clothing, etc.).

I am made nervous by certain animals.

My skin seems to be unusually sensitive
to touch. '

I feel tired a good deal of the time.

I never attend a sexy show if I can avoid
it.

If I were an artist I would like to draw
children.

I sometimes feel that I am about to go to
pieces.

I have Often been frightened in the middle
of the night.

I very much like horseback riding.

APPENDIX C

MILLON BEHAVIORAL HEALTH INVENTORY:
BASIC COPING SCALES

100

Millon Behavioral Health Inventory

Basic Coping Scales

Introspective Personality Style (32 items)

Item #

3.
10.

11.

14.
17.
19.
22.

25.

37.

45.

48.
49.
50.
51.
54.
60.
63.
64.
66.

67.

Test Item
When I was a young child, my parents felt very proud of me.
I almost never feel pressure in the work I do.

I get very frightened when I think of being all alone in the
world.

All my life I have to "blow up" every now and then.
A quiet hobby is more fun for me than a party.

I often say things that I regret having said.
People can influence me quite easily.

I don't mind that other people are not interested in my friend-
ship.

I make nasty remarks to people if they deserve it.

I do my best to get along with others by being pleadant and
agreeable.

I often get angry with people who do things slowly.

I don't depend much on other people for friendship.

I feel pretty upset about most things in my life.

It is very difficult for me to stop feelings from coming out.
I like to flirt a lot.

I am a dramatic and showy sort of person.

I often think about unhappy things that have happened to me.
I often do things for no reason other than it might be fun.

I guess I'm a complainer who expects the worst to happen.

It is not unusual to feel lonely and unwanted.

101

Introspective Personality Style

(Continued)
Item # Test Item

76. I like being in a crowd just to be with lots of people.

78. I guess I depend too much on others to be helpful to me.

81. I get frightened when I think I have a medical problem.

86. I often feel so angry that I want to throw and break things.
94. Many important things have happened in my life this past year.
100. I like to tell others about the things I have done well.

104. I wish the people around me would move faster and get more

things done.

106. I have very few close personal ties with others.

112. I haven't thought much about what I'll be doing a year from now.
143. I become very excited or upset once a week or more.

148. I have a strong need to feel like an important person.

149. My day is filled with pressures and responsibilities.

102

Millon Behavioral Health Inventory

Basic Coping Scales

Inhibited Personality Style (43 items)

Item #

9.

18.

28.

29.

33.

35.

36.

44.

45.

47.

50.

53.

55.

56.

57.

63.

67.

69.

75.

76.

77.

80.

Test Item
I am very pleased with all the things I have done up to now.
Most people wouldn't care much if I were very sick.
I often feel that Others do not want to be friendly to me.
If I became ill, I wouldn't have much help from my family.
So little of what I have done has been appreciated by others.
I've done most things in my life very well.
When I think about the past, I remember mostly the good things.
I look forward to the future with lots of hope.

I do my best to get along with Others by being pleasant and
agreeable.

I get upset when things I don't expect happen to me.

I feel pretty upset about most things in my life.

I can stand a lot of pain.

In time of trouble there are several friends that I can depend on.
Most people can be trusted to be kind and thoughtful.

Even if I were very sick, I'd keep fighting and never give up.
I often think about unhappy things that have happened to me.
It is not unusual to feel lonely and unwanted.

Lots of people would care about me if I became very sick.

I seem to fit in right away with any group of people I meet.

I like being in a crowd just to be with lots of people.

Most of my problems just go on and on.

I have always felt some kind of problem between me and the
opposite sex.

103

Inhibited Personality Style

(Continued)

Item # Test Item

83. I would have lots of visitors if I were in the hospital.

85. I would never let a serious sickness stop me from working toward
the future.

91. I very Often think I am not wanted by others in a group.

92. Even shen things seem to be going well, I expect that they'll
soon get worse.

93. I would rather be direct with people than avoid telling them
something they don't like.

98. Evern since I was a child I have been losing touch with the
real world.

99. I cannot depend on my family when I need them.

105. I often feel that there is nothing I can do to make my life
easier.

106. I have very few close personal ties with others.

111. I have faith that human nature is good.

116. My work makes me tense almost all the time.

119. If I were young again, I would do things very differently.

122. Rather that demand things, people can get what they want by
being gentle and thoughtful.

124. I can see more sides of a problem better than others can.

127. For me, the future looks like it will be full of trouble and
problems.

129. I have never felt much life in me.

131. I often doubt whether people are really interested in what I am

saying to them.

104

Inhibited Personality Style

(Continued)

Item # Test Item

133. I don't know what I want out of life.

138. There has recently been an important change in my job.
142. I'd be a pretty lonely person if I ever were hospitalized.

146. I get so touchy that I can't talk about certain things.

1105

Millon Behavioral Health Inventory

Basic Coping Scales

Cooperative Personality Style (33 items)

Item #

6.

11.

22.

25.

30.
37.

45.

48.
49.
56.
60.
61.
62.
70.

74.

76.
78.
82.

93.

Test Item
I like to be the one in authority to take charge of things.

I get very frigthened when I think of being all alone in the
world.

People can influence me quite easily.

I don't mind that other people are not interested in my friend-
ship.

In many ways I feel very superior to most people.
I make nasty remarks to people if they deserve it.

I do my best to get along with others by being pleasant and
agreeable.

I often get angry with people who do things slowly.

I don't depend much on other people for friendship.
Most peOple can be trusted to be kind and thoughtful.
I am a dramatic and showy sort of person.

I can't stand people who are late for appointments.

I do my best to stop anyone from trying to boss me.

I would much rather follow someone than.be the leader.

I find it hard to feel sorry for people who are always worried
about things.

I like being in a crowd just to be with lots of people.
I guess I depend too much on others to be helpful to me.
Punishment never stopped me from doing whatever I wanted.

I would rather be direct with people than avoid telling them
something they don't like.

106

Cooperative Personality Style

(Continued)

Item # Test Item

102. I usually let other people have their own way.

104. I wish the people around me would move faster and get more
things done.

106. I have very few close personal ties with others.

109. I have a strong desire to win any game I play with others.

111. I have faith that human nature is good.

114. When someone hurts me, I try to forget it.

118. In this world you either push or get shoved.

126. I am more worried about finishing things that I start than most
people.

128. I do my best not to hurt people's feelings.

136. I am very uneasy when I have to tell people what to do.

139. I like to follow instructions and do what others expect of me.

141. I am a quiet and cooperative person.

144. I always try to do what is proper.

148. I have a strong need to feel like an important person.

107

Millon Behavioral Health Inventory

Basic Coping Scales

Sociable Personality Style (40 items)

Item #

15.

17.

25.

28.
33.
38.
41.

43.

45.

47.
49.
50.
54.
58.
60.
63.
64.
67.
70.

75.

— Test Item

This year I was successful as something that was very important
to me. -

A quiet hobby is more fun for me than a party.

I don't mind that other people are not interested in my
friendship.

I often feel that others do not want to be friendly to me.

So little of what I have done has been appreciated by others.
I have had more than my share of troubles in the past year.

I almost never worry about my health.

There are always a number of reasons why most problems can't
be solved.

I do my best to get along with others by being pleasant and
agreeable. -

I get upset when things I don't expect happen to me.

I don't depend much on other people for friendship.

I feel pretty upset about things in my life.

I like to flirt a lot.

I sometimes feel I am in this world all alone.

I am a dramatic and showy sort of person.

I often think about unhappy things that have happened to me.
I often do things for no reason other than it might be fun.
It is not unusual to feel lonely and unwanted.

I would much rather follow someone than be the leader.

I seem to fit in right away with any group of people I meet.

108

Sociable Personality Style

(Continued)

Item # Test Item

76. I like being in a crowd just to be with lots of people.

77. Most of my problems just go on and on.

83. I would have lots of visitors if I were in the hospital.

91. I very often think I am not wanted by others in a group.

94. Many important things have happened in my life this past year.

100. I like to tell others about the things I have done well.

102. I usually let other people have their own way.

105. I often feel that there is nothing I can do to make my life
easier.

106. I have very few close personal ties with others.

108. If I thought I were getting sick, I would quickly call a doctor.

112. I haven't thought much about what I'll be doing a year from now.

118. In this world you either push or get shoved.

119. If I were young again, I would do things very differently.

121. I've had a lot of shocks and disappointments this past year.

127. For me, the future looks like it will be full of trouble and
problems.

131. I often doubt whether people are really interested in what I am
saying to them.

136. I am very uneasy when I have to tell people what to do.

141. I am a quiet and cooperative person.

144. I always try to do what is proper.

146. I get so touchy that I can't talk about certain things.

109

Millon Behavioral Health Inventory

Basic Coping Scales

Confident Personality Style (33 items)

Item #

1.

6.

7.

9.

15.

16.

22.

28.

30.

33.

35.

53.

58.

62.

67.

70.

74.

75.

78.

82.

83.

Test Item
I have always been able to overcome the problems I've had.
I like to be the one in authority to take charge of things.
If I were very sick, I'm sure that everything would work out well.
I am very pleased with all the things I have done up to now.

This year I was successful at something that was very important
to me.

I am in better health than most of my friends.

People can influence me quite easily.

I often feel that others do not want to be friendly to me.
In many ways I feel very superior to most people.

So little of what I have done has been appreciated by others.
I've done most things in my life very well.

I can stand a lot of pain.

I sometimes feel I am in this world all alone.

I do my best to stop anyone from trying to boss me.

It is not unusual to feel lonely and unwanted.

I would much rather follow someone than to be the leader.

I find it hard to feel sorry for people who are always worried
about things.

I seem to fit in right away with any group of people I meet.
I guess I depend too much on others to be helpful to me.
Punishment never stopped me from doing whatever I wanted.

I get frightened when I think I have a medical problem.

.110

Confident Personality Style

(Continued)
Item # Test Item
88. I really hate to have my work pile up.
91. I very often think I am not wanted by others in a group.
93. I would rather be direct with people than avoid telling them
something they don't like.
100. I like to tell others about the things I have done well.
102. I usually let other people have their own way.
119. If I were young again, I would do things very differently.
124. I can see more sides of a problem better than others can.
126. I am more worried about finishing things that I start than most
people.
131. I often doubt whether people are really interested in what I am
saying to them.
136. I am very uneasy when I have to tell people what to do.
148. I have a strong need to feel like an important person.
150. I like to arrange things down to the last detail.

111

Millon Behavioral Health Inventory

Basie Coping Scales

Forceful Personality Style (33 items)

Item #

6.

12.

22.

30.

37.

48.

54.

56.

60.

61.

62.

70.

72.

74.

78.

82.

84.

87.

93.

Test Item
I like to be the one in authority to take charge of things.

I am ready to attack anyone who tries to say terrible things
about me.

People can influence me quite easily.

In many ways I feel very superior to most people.

I make nasty remarks to people if they deserve it.

I often get angry with people who do things slowly.

I like to flirt a lot.

Most people can be trusted to be kind and thoughtful.
I am a dramatic and showy sort of person.

I can't stand people who are late for appointments.

I do my best to stop anyone from trying to boss me.

I would much rather follow someone than be the leader.

To.get ahead in this world I'm willing to push people who get
in my way.

I find it hard to feel sorry for people who are always worried
about things.

I guess I depend too much on others to be helpful to me.
Punishment never stopped me from doing whatever I wanted.

Amoung the most important things a person can have are a strong
will and the drive to get ahead.

I dislike going to doctors, and do so only after trying every-
thing myself.

I would rather be direct with people than avoid telling them
something they don't like.

112

-2-

Forceful Personality Style

(Continued)

Item # Test Item

102. I usually let other people have their own way.

104. I wish the people around me would move faster and get more
things done.

109. I have a strong desire to win any game I play with others.

111. I have faith that human nature is good.

114. When someone hurts me, I try to forget it.

118. In this world you either push or get shoved.

122. Rather than demand things, people can get what they want by
being gentle and thoughtful.

126. I am more worried about finishing things that I start than most
people.

128. I do my best not to hurt people's feelings.

136. I am very uneasy when I have to tell people what to do.

139. I like to follow instructions and do what others expect of me.

141. I am a quiet and cooperative person.

148. I have a strong need to feel like an important person.

150. I like to arrange things down to the last detail.

113

Millon Behavioral Health Inventory

Basic Coping Scales

Respectful Personality Style (42 items)

Item # Test Item
1. I have always been able to overcome the problems I've had.
2. Lately, life has been going along as usual, with no special

things happening.

8. I always take the medicine a doctor tells me to even if I don't
think is is working.

9. I am very pleased with all the things I have done up to now.

10. I almost never feel pressure in the work I do.

14. All my life I have to "blow up" every now and then.

17. A quiet hobby is more fun for me than a party.

21. I have a lot of faith that doctors can cure any sickness.

32. No matter what, seeing a doctor can make me feel better.

34. Keeping to a time schedule is not important to me.

35. I've done most things in my life very well.

37. I make nasty remarks to people if they deserve it.

38. I have had more than my share troubles in the past year.

39. It is good to have a regular way of doing things to avoid mis-
takes.

41. I almost never worry about my health.

45. I do my best to get along with others by being pleasant and
agreeable.

47. I get upset when things I don't expect happen to me.

54. I like to flirt a lot.

56. Most people can be trusted to be kind and thoughtful.

114

Respectful Personality Style

(Continued)
Item # Test Item
57. Even if I were very sick, I'd keep fighting and never give up.
60. I am a dramatic and showy sort of person.
64. I often do things for no reason other than it might be fun.
73. Doctors have always been helpful to me.
82. Punishment never stopped me from doing whatever I wanted.
84.- Among the most important things a person can have are a strong
will and the drive to get ahead.
85. I would never let a serious sickness stOp me from working toward
the future.
86. I often feel so angry that I want to throw and break things.
88. I really hate to have my work pile up.
89. I find it hard to take my mind off my work even when I'm supposed
to be relaxing.
93. I would rather be direct with people than avoid telling them
something they don't like.
95. What this country really needs are more serious and devoted
citizens.
106. I have very few close personal ties with others.
108. If I thought I were getting sick, I would quickly call a doctor.
112. I haven't thought much about what I'll be doing a year from now.
114. When someone hurts me, I try to forget it.
120. It is very important that children learn to obey their elders.
126. I am more worried about finishing things that I start than most

133.

people.

I don't know what I want out of life.

1153

Respectful Personality Style

(Continued)

Item # Test Item

139. I like to follow instructions and do what others expect of me.
141. I am a quiet and cooperative person.

144. I always try to do what is proper.

150. I like to arrange things down to the last detail.

116
Millon Behavioral Health Inventory

Basic COping Scales

Sensitive Personality Style (48 items)

Item #

10.

11.

12.

13.

14.

19.

24.

31.

33.

35.

37.

43.

47.

48.

50.

51.

Test Item
I have always been able to overcome the problems I've had.
When I was a young child, my parents felt very proud of me.
I am very pleased with all the things I have done up to now.
I almost never feel pressure in the work I do.

I get very frightened when I think of being all alone in the
world.

I am ready to attack anyone who tries to say terrible things
about me.

I have a feeling that things in my life just go from bad to
worse.

All my life I have to "blow up" every now and then.
I often say things that I regret having said.
Even in difficult times, I always try to be cheerful.

If I ever got a serious illness, I think it would be the end
of me.

So little of what I have done has been appreciated by others.
I've done most things in my life very well.
I make nasty remarks to people if they deserve it.

There are always a number of reasons why most problems can't be
solved.

I get upset when things I don't expect happen to me.
I often get angry with people who do things slowly.
I feel pretty upset abOut most things in my life.

It is very difficult for me to stop feelings from coming out.

1117

Sensitive Personality Style

(Continued)
Item # Test Item
58. I sometimes feel I am in this world all alone.
59. I feel that the doctors I have seen are not interested in my
problems.
63. I often think about unhappy things that have happened to me.
64. I often do things for no reason other than it might be fun.
66. I guess I'm a complainer who expects the worst to happen.
67. It is not unusual to feel lonely and unwanted.
68. I worry a lot about my health.
71. If I had a very serious sickness, I think I would fall apart
mentally.
77. Most of my problems just go on and on.
86. I often feel so angry that I want to throw and break things.
88. I really hate to have my work pile up.
92. Even when things seem to be going well, I expect that they'll
soon get worse.
103. I usually won't take any medicines, even if a doctor tells me to.
104. I wish the people around me would move faster and get more
things done.
105. I often feel that there is nothing I can do to make my life
easier.
107. This past year has been one of the most difficult ones in my life.
111. I have faith that human nature is good.
114. Hospitals are frightening and lonely places to be in.
116. My work makes me tense almost all the time.

118

Sensitive Personality Style

(Continued)

Item # Test Item

118. In this world you either push or get shoved.

126. I am more worried about finishing things that I start than
most people.

131. I often doubt whether people are really interested in what I
am saying to them.

133. I don't know what I want out of life.

134. Life has never gone well for me.

135. I've been touchy or tearful about everything most of my life.

141. I am a quiet and cooperative person.

143. I become very excited or upset once a week or more.

146. I get so touchy that I can't talk about certain things.

149. My day is filled with pressures and responsibilities.

APPENDIX D

MILLON BEHAVIORAL HEALTH INVENTORY:
PSYCHOGENIC ATTITUDE SCALES

119

Millon Behavioral Health Inventory

Psychogenic Attitude Scales

Chronic Tension (29 items)

seal

6.
10.
14.
19.
23.
24.
34.

43.

47.
48.
58.
61.
62.
66.
86.
88.

89.

104.

109.

116.

Test-Item
I like to be the one in authority to take charge of things.
I almost never feel pressure in the work I do.
All my life I have to "blow up" every now and then.
I often say things that I regret having said.
I often find time to take it easy and do nothing.
Even in difficult times, I always try to be cheerful.

Keeping to a time schedule is not important to me.

There are always a number of reasons why most problems can't
be solved.

I get upset when things I don't expect happen to me.

I often get angry with people who do things slowly.

I sometimes feel I am in this world all alone.

I can't stand people who are late for appointments.

I do my best to stop anyone from trying to boss me.

I guess I'm a complainer who expects the worst to happen.

I often feel so angry that [want to throw and break things.
I really hate to have my work pile up.

I find it hard to take my mind off my work even when I'm supposed
to be relaxing.

I wish the people around me would move faster and get more
things done.

I have a strong desire to win any game I play with others.

My work makes me tense almost all the time.

120

Chronic Tension

(Continued)

Item # Test Item

118. In this world you either push or get shoved.

126. I am more worried about finishing things that I start than

most people.

132. It is very easy for me to relax and slow down.

137. I am too rushed and busy to take the vacations I should.
143. I become very excited or upset once a week or more.

146. I get so touchy that I can't talk about certain things.
148. I have a strong need to feel like an important person.
149. My day is filled with pressures and responsibilities.

150. I like to arrange things down to the last detail.

12.1
Millon Behavioral Health Inventory

Psychogenic Attitude Scales

Recent Stress (20 items)

Item #

2.

14.

15.

26.

38.

40.

52.

58.

59.

65.

77.

79.

92.

94.

107.

121.

137.

138.

143.

146.

Test Item

Lately, life has been going along as usual, with no special
things happening.

All my life I have to "blow up" every now and then.

This year I was successful at something that was very important
to me.

I've had serious money problems this past year.

I have has more than my share of troubles in the past year.
Many people have been spying into my private life for years.
My family has had really bad problems in the past year.

I sometimes feel I am in this world all alone.

I feel that the doctors I have seen are not interested in my
problems.

During the past year, someone close to me has been very ill.
Most of my problems just go on and on.
I moved during the past year.

Even when things seem to be going well, I expect that they'll
soon get worse.

Many important things have happened in my life this past year.

This past year has been one of the most difficult ones in my
life.

I've has a lot of shocks and disappointments this past year.
I am too rushed and busy to take the vacations I should.
There has recently been an important change in my job.

I become very excited or upset once a week or more.

I get so touchy that I can't talk about certain things.

.122

Millon Behavioral Health Inventory

Psychogenic Attitude Scales

Premorbid Pessimism (40 items)

Item #

1.

9.

13.

15.

18.

24.

26.

27.

28.

31.

33.

36.

38.

43.

50.

52.

58.

63.

66.

Test Item
I have always been able to overcome the problems I've had.
I am very pleased with all the things I have done up to now.

I have a feeling that things in my life just go from bad to
worse.

This year I was successful at something that was very important
to me.

Most people wouldn't care much if I were very sick.

Even in difficult times, I always try to be cheerful.

I've had serious money problems this past year.

I almost always have medical problems.

I often feel that others do not want to be friendly to me.

If I ever got a serious illness, I think it would be the end
of me.

80 little of what I have done has been appreciated by others.
When I think about the past, I remember mostly the good things.
I have had more than my share of troubles in the past year.

There are always a number of reasons why most problems can't
be solved.

I feel pretty upset about most things in my life.

Mu family has had really bad problems in the past year.

I sometimes feel I am in this world all alone.

I often think about unhappy things that have heppened to me.

I guess I'm a complainer who expects the worst to happen.

123

Premorbid Pessimism

(Continued)
Item # Test Item
67. It is not unusual to feel lonely and unwanted.
68. I worry a lot about my health.
69. Lots of people would care about me if I became very sick.
71. If I had a very serious sickness, I thing I would fall apart
mentally.
77. Most of my problems just go on and on.
91. I very often think I am not wanted by others in a group.
92. Even when things seem to be going well, I expect that they'll
soon get worse.
105. I often feel that there is nothing I can do to make my life
easier.
107. This past year has been one of the most difficult ones in my
life.
119. If I were young again, I would do things very differently.
121. I've had a lot of shocks and disappointments this past year.
126. I am more worried about finishing things that I start than
most people.
127. For me, the future looks like it will be full of trouble and
problems.
129. I have never felt much life in me.
131. I often doubt whether people are really interested in what I
am saying to them.
134. Life has never gone well for me.
135. I've been touchy or tearful about everything most of my life.

124

Premorbid Pessimism

(Continued)

Item # Test Item

140. I often think that I have a serious illness.

142. I'd be a pretty lonely person if I ever were hospitalized.
143. I become very excited or upset once a week or more.

146. I get so touchy that I can't talk about certain things.

1255

Millon Behavioral Health Inventory

Psychogenic Attitude Scales

Future Despair (38 items)

Item #

7.

13.

15.

20.

31.

41.

43.

44.

50.

51.

57.

63.

66.

67.

69.

71.

75.

77.

Test Item

If I were very sick, I'm sure that everything would work
out well.

I have a feeling that things in my life just go from bad to
worse.

This year I was successful at something that was very important
to me.

I have lots of plans of what I'd like to be doing ten years
from now.

If I ever got a serious illness, I think it would be the end
for me.

I almost never worry about my health.

There are always a number of reasons why most problems can't
be solved.

I look forward to the future with lots of hope.

I feel pretty upset about most things in my life.

It is very difficult for me to stop feelings from coming out.
Even if I were very sick, I'd keep fighting and never give up.
I often think about unhappy things that have happened to me.

I guess I'm a complainer who expects the worst to happen.

It is not unusual to feel lonely and unwanted.

Lots of people would care about me if I became very sick.

If I had a very serious sickness, I think I would fall apart
mentally.

I seem to fit in right away with any group of people I meet.

Most of my problems just go on and on.

.126

Future Despair

(Continued)

Item # Test Item

81. I get frightened when I think I have a medical problem.

83. I would have lots of visitors if I were in the hospital.

85. I would never let a serious sickness stop me from working
toward the future.

92. Even when things seem to be going well, I expect that they'll
soon get worse.

101. I'd rather be dead than have a very serious sickness.

105. I often feel that there is nothing I can do to make my life
easier.

106. I have very few close personal ties with others.

112. I haven't thought much about what I'll be doing a year from now.

115. Hospitals are frightening and lonely places to be in.

118. In this world you either push or get shoved.

119. If I were young again, I would do things very differently.

123. I get very upset when I feel pain in any part of my body.

127. For me, the future looks like it will be full Of trouble and
problems.

129. I have never felt much life in me.

133. I don't know what I want out of life.

134. Life has never gone well for me.

140. I often think that I have a serious illness.

142. I'd be a pretty lonely person if I ever were hospitalized.

145. I don't think I would want to go on living if my body was
marked up a lot in a serious operation.

146. I get so touchy that I can't talk about certain things.

12'7

Millon Behavioral Health Inventory

Psychogenic Attitude Scales

Somatic Anxiety (34 items)

Item #

4.

11.

13.

16.

27.

32.

38.

41.

42.

43.

47.

50.

51.

53.

63.

66.

68.

71.

77.

Test Item
I have almost never been sick.

I get very frightened when I think of being all alone in the
world.

I have a feeling that things in my life just go from bad to
worse.

I am in better health than most of my friends.

I almost always have medical problems.

No matter what, seeing a doctor can make me feel better.

I have had more than my share of troubles in the past year.
I almost never worry about my health.

If I thought I had a serious sickness, I would quickly talk it
over my family.

There are always a number of reasons why most problems can't
be solved.

I get upset when things I don't expect happen to me.

I feel pretty upset about most things in my life.

It is very difficult for me to stop feelings from coming out.
I can stand a lot of pain.

I often think about unhappy things that have happened to me.
I guess I'm a complainer who expects the worst to happen.

I worry a lot about my health.

If I had a very serious sickness, I think I would fall apart
mentally.

Most of my problems just go on and on.

128

Somatic Anxiety

(Continued)

Item # Test Item

81. I get frightened when I think I have a medical problem.

89. I find it hard to take my mind off my work even then I'm
supposed to be relaxing.

92. Even when things seem to be going well, I expect that they'll
soon get worse.

97. T.V. programs about illness make me very upset.

108. If I thought I were getting sick, I would quickly call a doctor.

112. I haven't thought much about what I'll be doing a year from now.

115. Hospitals are frightening and lonely places to be in.

121. I've had a lot of shocks and disappointments this past year.

123. I get very upset when I feel pain in any part of my body.

127. For me, the future looks like it will be full of trouble and
problems.

129. I have never felt much life in me.

134. Life has never gone well for me.

135. I've been touchy or tearful about everything most of my life.

140. I often think that I have a serious illness.

143. I become very excited or upset once a week or more.

129

Millon Behavioral Health Inventory

Psychogenic Attitude Scales

Social Alienation (33 items)

Item #

5.
9.
18.

25.

28.
29.
33.
36.

42.

44.
49.
50.
55.
56.
58.
67.
69.
75.

80.

83.

Test Item
I have friends who will listen to any problems I have.
I am very pleased with all the things I have done up to now.
Most people wouldn't care much if I were very sick.

I don't mind that other people are not interested in my
friendship.

I often feel that others do not want to be friendly to me.

If I became ill, I wouldn't have much help from my family.

80 little of what I have done has been appreciated by others.
When I think about the past, I remember mostly the good things.

If I thought I had a serious sickness, I would quickly talk it
over with my family.

I look forward to the future with lots of hope.

I don't depend much on other people for friendship.

I feel pretty upset about most things in my life.

In time of trouble there are several friends that I can depend on.
Most people can be trusted to be kind and thoughtful.

I sometimes feel I am in this world all alone.

It is not unusual to feel lonely and unwanted.

Lots of people would care about me if I became very sick.

I seem to fit in right away with any group of people I meet.

I have always felt some kind of problem between me and the
opposite sex.

I would have lots of visitors if I were in the hospital.

130

Social Alienation

(Continued)

Item # Test Item

91. I very often think I am not wanted by others in a group.

98. Ever since I was a child I have been losing touch with the
real world.

99. I cannot depend on my family when I need them.

106. I have very few close personal ties with others.

110. Nobody really cares about my state of health.

113. All my life I have had the feeling that I have done something
terribly wrong or evil.

122. Rather than demand things, people can get what they want by
being gently and thoughtful.

125. If I were getting sick, I wouldn't waste my time telling anyone
in my family.

131. I often doubt whether people are really interested in what I am
saying to them.

133. I don't know what I want out of life.

135. I've been touchy or tearful about everything most of my life.

142. I'd be a pretty lonely person if I ever were hospitalized.

146. I get so touchy that I can't talk about certain things.

APPENDIX E

HAAN'S COPING SCALES

Item #

18.

41.

45.

55.

73.

74.

76.

116.

121.

125.

133.

140.

143.

154.

170.

197.

200.

211.

1.31
Haan's Coping Scales (CPI):

Objectivity (Male)

Test Item

When in a group of people I usually do what the others want rather
than make suggestions.

A person who doesn't vote is not a good citizen.

For most questions there is just one right answer, once a person
is able to get all the facts.

As a child I used to be able to go to my parents with my problems.
Some of my family have quick tempers.

Maybe some minority groups do get rough treatment, but it's no
business of mine.

It is very hard for me to tell anyone about myself.
I often feel as if the world was just passing me by.

It is annoying to listen to a lecturer who cannot seem to make up
his mind as to what he really believes.

I was a slow learner in school

There is something wrong with a person who can't take orders
without getting angry or resentful.

I feel as good now as I ever have.

I enjoy hearing lectures on world affairs.

I like to be with a crowd who play jokes on one another.

I like tall women.

I often act on the spur of the moment without stopping to think.
Once in a while I laugh at a dirty joke.

In a group of people I would not be embarrassed to be called upon
to start a discussion or give an opinion about something I know well.

I have frequently found myself, when alone, pondering such abstract
problems as freewill, evil, etc.

Objectivity (Male)

(Continued)

Item # Test Item

215. I would like to write a technical book.

227. It is hard for me to find anything to talk about when I meet
a new person. '

234. We ought to pay our elected officials better than we do.

238. Sometimes I just can't seem to get going.

257. I often feel as though I have done something wrong or wicked.

292. I used to like it very much when one of my papers was read to
the class in school.

295. I would be willing to give money myself in order to right a wrong,
even though I was not mixed up in it in the first place.

299. I don't seem to care what happens to me.

303. We should cut down on our use of oil, if necessary, so that there
will be plenty left for the people fifty or a hundred years from
now.

373. My table manners are not quite as good at home as when I am out
in company.

375. There are certain people who I dislike so much that I am inwardly
pleased when they are catching it for something they have done.

382. Success is a matter of will power.

401. Most young people get too much education.

407. I have had no difficulty in starting or holding my bowel movement.

417. Any job is all right with me, so long as it pays well.

436. I never cared much for school.

445. I would fight if someone tried to take my rights away.

Item #
18.

41.

45.
55.

73.

76.

116.

121.

125.

140.
143.
147.
154.
170.
197.

200.

211.

215.
234.

238.

1133
Haan's Coping Scales (CPI):

Objectivity (Female)

Test Item
A person who doesn't vote is not a good citizen.

For most questions there is just one right answer, once a person
is able to get all the facts.

As a child I used to be able to go to my parents with my problems.
Some of my family have quick tempers.

Maybe some minority groups do get rough treatment, but it's no
business of mine.

I often feel as if the world was just passing my by.

It is annoying to listen to a lecturer who cannot seem to make up
his mind as to what he really believes.

I was a slow learner in school

There is something wrong with a person who can't take orders
without getting angry or resentful.

I enjoy hearing lectures on world affairs.

I like to be with a crowd who play jokes on one another.

I certainly feel useless at times.

I like tall women.

I often act on the spur of the moment without stopping to think.
Once in a while I laugh at a dirty joke.

In a group of people I would not be embarrassed to be called upon
to start a discussion or give an opinion about something I know well.

I have frequently found myself, when alone, pondering such abstract
problems as freewill, evil, etc.

I would like to write a technical book.
We ought to pay our elected officials better than we do.

Sometimes I just can't seem to get going.

134

Objectivity (Female)

(Continued)

Item # Test Item

292. I used to like it very much when one of my papers was read to
the class in school.

295. I would be willing to give money myself in order to right a wrong,
even though I was not mixed up in it in the first place.

303. We should cut down on our use of oil, if necessary, so that there
will be plenty left for the people fifty or a hundred years from now.

313. I hardly ever feel pain in the back of the neck.

315. People should not have to pay taxes for the schools if they do
not have children.

375. There are certain people whom I dislike so much that I am inwardly
pleased when they are catching it for something they have done.

401. Most young people get too much education.

407. I have had no difficulty in starting or holding my bowel movement.

417. Any job is all right with me, so long as it pays well.

436. I never cared much for school.

445. I would fight if someone tried to take my rights away.

Item#
17.
31.

41.

45.
46.
55.

73.

85.

103.

116.

141.
144.
160.
172.
179.

200.

211.

215.

230.

135

Haan's Coping Scales (CPI):

Intellectuality (Male)

Test Item
I would like to be a journalist.
I doubt whether I would make a good leader.

For most questions there is just one right answer, once a person
is able to get all the facts.

As a child I used to be able to go to my parents with my problems.
I think I would like the work of a school teacher.
Some of my family have quick tempers.

Maybe some minority groups do get rough treatment, but it's no
business of mine.

I don't like to undertake any project unless I have a pretty good
idea as to how it will turn out.

I like to listen to symphony orchestra concerts on the radio.

It is annoying to listen to a lecturer who cannot seem to make up
his mind as to what he really believes.

Parents are much too easy on their children nowadays.

I am somewhat afraid of the dark.

I would like to hear a great singer in an opera.

I do not have a great fear of snakes.

When I work on a committee I like to take charge of things.

In a group of people I would not be embarrassed to be called upon
to start a discussion or give an opinion about something I know well.

I have frequently found myself, when alone, pondering such abstract
problems as freewill, evil, etc.

I would like to write a technical book.

I would rather be a steady and dependable worker than a brilliant
but unstable one.

136

Intellectuality (Male)

(Continued)

Item # Test Item

238. Sometimes I just can't seem to get going.

239. I like to talk before groups of people.

241. The man who provides temptation by leaving valuable property
unprotected is about as much to blame for its theft as the one
who steals it.

255. Only a fool would try to change our American way of life.

258. In school I found it very hard to talk before the class.

263. Lawbreakers are almost always caught and punished.

303. We should cut down on our use of oil, if necessary, so that there
will be plenty left for the people fifty or a hundred years from now.

320. I would be willing to describe myself as a pretty "strong" personality.

340. Our thinking would be a lot better off if we would just forget about
words like "probably," "approximately," and "perhaps."

357. For most questions there is just one right answer, once a person
is able to get all the facts.

371. I would rather be a steady and dependable worker than a brillant but
unstable one.

403. I have a natural talent for influencing people.

407. I have had no difficulty in starting or holding my bowel movement.

418. I am embarrassed with people I do not know well.

436. I never cared much for school.

452. I dislike to have to talk in front of a group of people.

Item #

17.

41.

45.

46.

55.

57.

60.

73.

103.

116.

141.

144.

160.

172.

179.

200.

211.

215.

230.

1137
Haan's Coping Scales (CPI):

Intellectuality (Female)

Test Item
I would like to be a journalist.

For most questions there is just one right answer, once a person
is able to get all the facts.

As a child I used to be able to go to my parents with my problems.
I think I would like the work of a school teacher.
Some of my family have quick tempers.

I have sometimes stayed away from another person because I feared
doing or saying something that I might regret afrerwards.

I have often met people who were supposed to be experts who were
no better than I.

Maybe some minority groups do get rough treatment, but it's no
business of mine.

I like to listen to symphony orchestra concerts on the radio.

It is annoying to listen to a lecturer who cannot seem to make up
his mind as to what he really believes.

Parents are much too easy on their children nowadays.

I am somewhat afraid of the dark.

I would like to hear a great singer in an opera.

I do not have a great fear of snakes.

When I work on a committee I like to take charge of things.

In a group of people I would not be embarrassed to be called upon
to start a discussion or give an opinion about something I know well.

I have frequently found myself, when alone, pondering such abstract
problems as freewill, evil, etc.

I would like to write a technical book.

I would rather be a steady and dependable worker than a brilliant
but unstable one.

138

Intellectuality (Female)

(Continued)

Item # Test Item

238. Sometimes I just can't seem to get going.

239. I like to talk before groups of people.

241. The man who provides temptation by leaving valuable property un-
protected is about as much to blame for its theft as the one who
steals it.

242. I am a good mixer.

255. Only a fool would try to change our American way of life.

258. In school I found it very hard to talk before the class.

263. Lawbreakers are almost always caught and punished.

303. We should cut down on our use of oil, if necessary, so that there
will be plenty left for the people fifty or a hundred years from now.

320. I would be willing to describe myself as a pretty "strong" personality.

340. Our thinking would be a lot better off if we would just forget about
words like "probably," approximately," and "perhaps."

357. For most questions there is just one right answer, once a person is
able to get all the facts.

371. I would rather be a steady and dependable worker than a brilliant
but unstable one.

403. I have a natural talent for influencing people.

407. I have had no difficulty in starting or holding my bowel movement.

436. I never cared much for school.

452. I dislike to have to talk in front of a group of people.

Item #

22.

38.

41.

45.
46.
55.

73.

89.

112.

116.

121.
135.
140.
143.
160.
165.
170.
179.

204.

139
Haan's Coping Scales (CPI):

Logical Analysis (Male)

Test Item

When a person "pads" his income tax report so as to get out of some
of his taxes, it is just as bad as stealing money from the government.

It is hard for me to start a conversation with strangers.

For most questions there is just one right answer, once a person
is able to get all the facts.

As a child I used to be able to go to my parents with my problems.
I think I would like the work of a school teacher.
Some of my family have quick tempers.

Maybe some minority groups do get rough treatment, but it's no
business of mine.

Once a week or ofterner I feel suddenly hot all over, without
apparent cause.

I set a high standard for myself and I feel others should do the
same.

It is annoying to listen to a lecturer who cannot seem to make up
his mind as to what he really believes.

I was a slow learner in school.

I wake up fresh and rested most mornings.

I enjoy hearing lectures on world affairs.

I like to be with a crowd who play jokes on one another.

I would like to hear a great singer in an opera.

I do not mind taking orders and being told what to do.

I often act on the spur of the moment without stopping to think.
When I work on a committee I like to take charge of things.

I like to plan a home study schedule and then follow it.

140

Logical Analysis (Male)

(Continued)

Item # Test Item

211. I have frequently found myself, when alone, pondering such abstract
problems as freewill, evil, etc.

215. I would like to write a technical book.

225. People pretend to care more about one another than they really do.

227. It is hard for me to find anything to talk about when I meet a
new person.

238. Sometimes I just can't seem to get going.

241. The man who provides temptation by leaving valuable property un-
protected is about as much to blame for its theft as the one who
steals it.

253. When prices are high you can't blame a person for getting all he
can while the getting is good.

255. Only a fool would try to change our American way of life.

326. It is annoying to listen to a lecturer who cannot seem to make up
his mind as to what he really believes.

340. Our thinking would be a lot better off if we would just forget about
words like "probably," "approximately," and "perhaps."-

357. For most questions there is just one right answer, once a person is
able to get all the facts.

378. I doubt if anyone is really happy.

407. I have had no difficulty in starting or holding my bowel movement.

418. I am embarrassed with people I do not know well.

Item #

41.

45.
46.
55.

57.

73.

89.

112.

116.

121.
135.
140.
143.
160.
165.
179.
204.
209.

211.

14l
Haan's Coping Scales (CPI):

Logical Analysis (Female)

Test Item

For most questions there is just one right answer, once a person
is able to get all the facts.

As a child I used to be able to go to my parents with my problems.
I think I would like the work of a school teacher.
Some of my family have quick tempers.

I have sometimes stayed away from another person because I feared
doing or saying something that I might regret afterwards.

Maybe some minority groups do get rough treatment, but it's no
business of mine.

Once a week or oftener I feel suddenly hot all over, without
apparent cause.

I set a high standard for myself and I feel others should do the
same.

It is annoying to listen to a lecturer who cannot seem to make up
his mind as to what he really believes.

I was a slow learner in school.

I wake up fresh and rested most mornings.

I enjoy hearing lectures on world affairs.

I like to be with a crowd who play jokes on one another.

I would like to hear a great singer in an opera.

I do not mind taking orders and being told what to do.

When I work on a committee I like to take charge of things.
I like to plan a home study schedule and then follow it.
Most people are honest chiefly through fear of being caught.

I have frequently found myself, when alone, pondering such abstract
problems as freewill, evil, etc.

2142

Logical Analysis (Female)

(Continued)

Item # Test Item

215. I would like to write a technical book.

225. People pretend to care more about one another than they really do.

226. Most people worry too much about sex.

238. Sometimes I just can't seem to get going.

241. The man who provides temptation by leaving valuable property un-
protected is about as much to blame for its theft as the one who
steals it.

253. When prices are high you can't blame a person for getting all he
can while the getting is good.

255. Only a fool would try to change our American way of life.

326. It is annoying to listen to a lecturer who cannot seem to make up
his mind as to what he really believes.

340. Our thinking would be a lot better off if we would just forget words
like "probably," "approximately," and "perhaps."

357. For most questions there is just one right answer, once a person
is able to get all the facts.

378. I doubt if anyone is really happy.

407. I have had no difficulty in starting or holding my bowel movement.

418. I am embarrassed with people I do not know well.

Item

14.
17.
45.
46.
62.

73.

121.
123.

134.

141.
152.

176.

185.

211.

213.

230.

234.

#

1.43

Haan's Coping Scales (CPI):

Tolerance of Ambiguity (Male)

Test Item

Our thinking would be a lot better off if we would just forget
about words like "probably," "approximately," and "perhaps."

I always follow the rule: business before pleasure.

I would like to be'a journalist.

As a child I used to be able to go to my parents with my problems.
I think I would like the work of a school teacher.

I think Lincoln was greater than Washington.

Maybe some minority groups do get rough treatment, but it's no
business of mine.

I was a slow learner in school.
I think I am stricter about right and wrong than most people.

It makes me uncomfortable to put on a stunt at a party even when
others are doing the same sort of thing.

Parents are much too easy on their children nowadays.
I read at least ten books a year.

I commonly wonder what hidden reason another person may have for
doing something nice for me.

I often do whatever makes me feel cheerful here and now, even at
the cost of some distant goal.

I have frequently found myself, when alone, pondering such abstract
problems as freewill, evil, etc.

It makes me angry when I hear of someone who has been wrongly pre-
vented from voting.

I would rather be a steady and dependable worker than a brilliant
but unstable one.

We ought to pay our elected officials better than we do.

144-

Tolerance of Ambiguity (Male)

(Continued)

Item # Test Item

243. I am often bothered by useless thoughts which keep running
through my mind.

255. Only a fool would try to change our American way of life.

292. I used to like it very much when one of my papers was read to the
class in school.

295. I would be willing to give money myself in order to right a wrong,
even though I was not mixed up in it in the first place.

296. I would like to be an actor on the stage or in the movies.

303. We should cut down on our use of oil, if necessary, so that there
will be plenty left for the people fifty or a hundred years from now.

305. I often wish people would be more definite about things.

335. There are times when I act like a coward.

340. Our thinking would be a lot better off if we would just forget about
words like "probably," "approximately," and "perhaps."

361. I like to have a place for everything and everything in its place.

370. Disobedience to any government is never justified.

371. I would rather be a steady and dependable worker than a brilliant
but unstable one.

378. I doubt if anyone is really happy.

387. I don't like things to be uncertain and unpredictable.

391. I am quite a fast reader.

397. Once I have my mind made up I seldom change it.

399. At times I have been so entertained by the cleverness of a crook
that I have hoped he would get by with it.

400. I think I am stricter about right and wrong than most people._

404. I am in favor of a very strict enforcement of all laws, no matter
what the consequences.

463. It is hard for me just to sit still and relax.

Item #

17.

25.

45.

46.

62.

73.

121.

123.

134.

141.

152.

176.

185.

211.

213.

230.

243.

255.

264.

145
Haan's Coping Scales (CPI):

Tolerance of Ambiguity (Female)

M
I would like to be a journalist.
Clever, sarcastic people make me feel very uncomfortable.
As a child I used to be able to go to my parents with my problems.
I think I would like the work of a school teacher.
I think Lincoln was greater than Washington.

Maybe some minority groups do get rough treatment, but it's no
business of mine.

I was a slow learner in school.
I think I am stricter about right and wrong than most people.

It makes me uncomfortable to put on a stunt at a party even when
others are doing the same sort of thing.

Parents are much too easy on their children nowadays.
I read at least ten books a year.

I commonly wonder what hidden reason another person may have for
doing something nice for me.

I often do whatever makes me feel cheerful here and now, even at
the cost of some distant goal.

I have frequently found myself, when alone, pondering such abstract
problems as freewill, evil, etc.

It makes me angry when I hear of someone who has been wrongly
prevented from voting.

I would rather be a steady and dependable worker than a brilliant
but unstable one.

I am often bothered by useless thoughts which keep running through
my mind.

Only a fool would try to change our American way of life.

I would be very unhappy if I was not successful at something I had
seriously started to do.

146

Tolerance of Ambiguity (Female)

(Continued)

Item # Test Item

295. I would be willing to give money myself in order to right a wrong,
even though I was not mixed up in it in the first place.

296. I would like to be an actor on the stage or in the movies.

303. We should cut down on our use of oil, if necessary, so that there
will be plenty left for the people fifty or a hundred years from now.

340. Our thinking would be a lot better off if we would just forget about
words like "probably," "approximately," and "perhaps."

361. I like to have a place for everything and everything in its place.

370. Disobedience to any government is never justified.

371. I would rather be a steady and dependable worker than a brilliant
but unstable one.

380. I am known as a hard and steady worker.

387. I don't like things to be uncertain and unpredictable.

397. Once I.have my mind made up I seldom change it.

399. At times I have been so entertained by the cleverness of a crook
that I have hoped he would get by with it.

400. I think I am stricter about right and wrong than most people.

404. I am in favor of a very strick enforcement of all laws, no matter

what the consequences.

Item #

1.
18.
28.
30.

32.

45.

49.

87.

110.

123.
141.
156.
168.

171.

180.

185.

202.
210.

213.

217.

147
Haan's Coping Scales (CPI):

Empathy (Male)

Test Item
I enjoy social gatherings just to be with people.
A person who doen't vote is not a good citizen.
I think I would like the work of a dress designer.
I gossip a little at times.

I tend to be on my guard with people who are somewhat more
friendly than I had expected.

As a child I used to be able to go to my parents with my problems.

When someone does me a wrong I feel I should pay him back if I
can, just for the principle of the thing.

I like adventure stories better than romantic stories.

The thought of being in an automobile accident is very frightening
to me.

I think I am stricter about right and wrong than most people.
Parents are much tto easy on their children nowadays.

I hardly ever get exicted or thrilled.

My home life was always happy.

I think I could do better than most of the present politicians if
I were in office.

My parents have generally let me make my own decisions.

I often do whatever makes me feel cheerful here and now, even at
the cost of some distant goal.

If given the chance I would make a good leader of people.
I very much like hunting.

It makes me angry when I hear of someone who has been wrongly
prevented from voting.

I think I would like the work of a librarian.

1423

Empathy (Male)

(Continued)

£29211: M

218. I love to go to dances.

221. People have a real duty to take care of their aged parents, even if
it means making some pretty big sacrifices.

239. I like to talk before groups of people.

244. If I were a reporter I would like very much to report news of
the theater.

249. I like mechanics magazines.

253. When prices are high you can't blame a person for getting all he

(a can while the getting is good.

292. I used to like it very much when one of my papers was read to
the class in school.

303. We should cut down on our use of oil, if necessary, so that there will
be plenty left for the people fifty or a hundred years from now.

307. If I am driving a car, I try to keep others from passing me.

334. I get nervous when I have to ask someone for a job.

368. I have had no difficulty starting or holding my urine.

385. It is pretty easy for people to win arguments with me.

397. Once I have my mind made up I seldom change it.

404. I am in favor of a very strict enforcement of all laws, no matter
what the consequences.

433. It is more important that a father be kind than that he be successful.

Item #

18.

28.

30.

32.

37.

45.

49.

87.

110.

123.

141.

156.

168.

171.

185.

202.

210.

213.

217.

.149
Haan's Coping Scales (CPI):

Empathy (Female)

Test Item
A person who doesn't vote is not a good citizen.
I think I would like the work of a dress designer.
I gossip a little at times.

I tend to be on my guard with people who are somewhat more friendly
than I had expected.

I have very few fears compared to my friends.
As a child I used to be able to go to my parents with my problems.

When someone does me a wrong I feel I should pay him back if I can,
just for the principle of the thing.

I like adventure stories better than romantic stories.

The thought of being in an automobile accident is very frightening
to me.

I think I am stricter about right and wrong than most people.
Parents are much too easy on their children nowadays.

I hardly ever get excited or thrilled.

My home life was always happy.

I think I could do better than most of the present politicians
if I were in office.

I often do whatever makes me feel chreeful here and now, even at
the cost of some distant goal.

If given the chance I would make a good leader of people.
I very much like hunting.

It makes me angry when I hear of someone who has been wrongly pre-
vented from voting.

I think I would like the work of a librarian.

150

Empathy (Female)

(Continued)
Item # Test Item
239. I like to talk before groups of people.
244. If I were a reporter I would like very much to report news
of the theater.
249. I like mechanics magazines.
292. I used to like it very much when one of my papers was read to
the class in school.
303. We should cut down on our use of oil, if necessary, so that there will
be plenty left for the people fifty or a hundred years from now.
307. If I am driving a car, I try to keep others from passing me.
380. I am known as a hard and steady worker.
397. Once I have my mind made up I seldom change it.
404. I have had no difficulty in starting or holding my bowel movement.
433. It is more important that a father be kind than that he be

successful.

Item #

28.
29.
45.
55.
62.
71.

86.

88.
114.
141.
149.
174.

211.

213.

229.

230.

231.

243.

250.

1551

Haan's Coping Scales (CPI):

Regression in Service of Ego (Male)

Test Item
A person needs to "show off" a little now and then.
I think I would like the work of a dress designer.
I am often said to be hotheaded.
As a child I used to be able to go to my parents with my problems.
Some of my family have quick tempers.
I think Lincoln was greater than Washington.
I get excited very easily.

Most of the arguments or quarrels I get into are over matters
of principle.

I do not like to see people carelessly dressed.

At times I feel like picking a fist fight with someone.

Parents are much too easy on their children nowadays.

I consider a matter from every standpoint before I make a decision.
I never make judgments about people until I am sure of the facts.

I have frequently found myself, when alone, pondering such
abstract problems as freewill, evil, etc.

It makes me angry when I hear of someone who has been wrongly
prevented from voting.

I much prefer symmetry to asymmetry.

I would rather be a steady and dependable worker than a brilliant
but unstable one.

I am apt to show off in some way if I get the chance.

I am often bothered by useless thoughts which keep running
through my mind.

I must admit I find it very hard to work under strict rules and
regulations.

.152

Regression in Service of Ego

(Female)

Item #
255.

262.

306.
311.
316.
335.
347.

375.

378.
397.

399.

403.

423.

451.

(Continued)

Wee
Only a fool would try to change our American way of life.

There have been a few times when I have been very mean to another
person.

I have nightmares every few nights.

I cannot do anything well.

My parents wanted me to "make good" in the world.

There are times when I act like a coward.

I never make judgments about people until I am sure of the facts.

There are certain people whom I dislike so much that I am inwardly
pleased when they are catching it for something they have done.

I doubt if anyone is really happy.
Once I have my mind made up I seldom change it.

At times I have been so entertained by the cleverness of a crook
that I have hoped he would get by with it.

I always see to it that my work is carefully planned and organized.

If people had not had it in for me I would have been much more
successful.

I set a high standard for myself and I feel others should do
the same. ‘

W
28.
29.
42.
44.
45.
62.

86.

88.
114.
124.
141.

149.’

174.
180.

211.

213.

230.

231.

243.

1513
Haan's Coping Scales (CPI):

Regression in Service of Ego (Female)

Test Item
A person needs to "show off" a little now and then.
I think I would like the work of a dress designer.
I am often said to be hotheaded.
I sometimes pretend to know more than I really do.
Sometimes I feel like smashing things.
As a child I used to be able to go to my parents with my problems.
I think Lincoln was greater than Washington.

Most of the arguments or quarrels I get into are over matters
of principle.

I do not like to see people carelessly dressed.

At times I feel like picking a fist fight with someone.

I am likely not to speak to people until they speak to me.
Parents are much too easy on their children nowadays.

I consider a matter from every standpoint before I make a de-
cision.

I never make judgments about people until I am sure of the facts.
My parents have generally let me make my own decisions.

I have frequently found myself, when alone, pondering such ab-
stract problems as freewill, evil, etc.

It makes me angry when I hear of someone who has been wrongly
prevented from voting.

I would rather be a steady and deperdable worker than a brilliant
but unstable one.

I am apt to show off in some way if I get the chance.

I am often bothered by useless thoughts which keep running
through my mind.

I154

Regression in Service of Ego

(Female)

Item #

250.

255.

262.

306.
311.
316.
335.
347.

354.

375.

378.
397.

399.

408.

451.

(Continued)

Test Item

I must admit I find it very hard to work under strict rules
and regulations.

Only a fool would try to change our American way of life.

There have been a few times when I have been very mean to another
person.

I have nightmares every few nights.

I cannot do anything well.

My parents wanted me to "make good" in the world.

There are times when I act like a coward.

I never make judgments about people until I am sure of the facts.

A strong person will be able to make up his mind even on the
most difficult questions.

There are certain people whom I dislike so much that I am inwardly
pleased when they are catching it for something they have done.

I doubt if anyone is really happy.
Once I have my mind made up I seldom change it.

At times I have been so entertained by the cleverness of a crook
that I have hoped he would get by with it.

I always see to it that my work is carefully planned and
organized.

I set a high standard for myself and I feel others should do
the same.

Item#

53.

54.

70.

92.
129.
135.
139.
143.
179.
197.
225.
238.
245.
252.
256.
270.
279.
290.

292.

339.
359.

369.

.155
Haan's Coping Scales (CPI):

Concentration (Male)

Test Item
I think I would enjoy having authority over other people.
I find it hard to keep my mind on a task or job.
Sometimes I cross the street just to aviod meeting someone.
People often expect too much of me.
I think I would like to drive a racing car.
I wake up fresh and rested most mornings.
It is all right to get around the law if you don't actually break it.
I like to be with a crowd who play jokes on one another.
When I work on a committee I like to take charge of things.
Once in a while I laugh at a dirty joke.
People pretend to care more about one another than they really do.
Sometimes I just can't seem to get going.
Most of the time I feel happy.
I sometimes feel that I am a burden to others.
I want to be an important person in the community.
I often lose my temper.
I often get disgusted with myself.
I have never been in trouble because of my sex behavior.

I used to like it very much when one of my papers was read to the
class in school.

I have been in trouble one or more times because of my sex behavior.
I think I am usually a leader in my group.

I seem to do things that I regret more often than other people do.

156

Concentration (Male)

(Continued)

Itgmfi Test Item

378. I doubt if anyone is really happy.

383. I usually have to stop and think before I act even in trifling matters.
407. I have had no difficulty in starting or holding my bowel movement.

418. I am embarrassed with people I do not know well.

422. I feel like giving up quickly when things go wrong.

431. As a youngster in school I used to give the teachers lots of trouble.
438. I would have been more successful if people had given me a fair chance.
445. I would fight if someone tried to take my rights away.

449. Almost every day something happens to frighten me.

465. I must admit that I am a high-strung person.

472. I feel that I would be a much better person if I could gain more

understanding of myself.

Item#
53.
71.
92.

94.

129.
135.
139.
143.
160.
179.
197.
225.
238.
245.
252.
256.
270.
279.
290.

292.

339.

15'?
Haan's Coping Scales (CPI):

Concentration (Female)

Test Item
I think I would enjoy having authority over other people.
I get excited very easily.
People often expect too much of me.

With things going as they are, it's pretty hard to keep up hope
of amounting to something.

I think I would like to drive a racing car.

I wake up fresh and rested most mornings.

It is all right to get around the law if you don't actually break it.
I like to be with a crowd who play jokes on one another.

I would like to hear a great singer in an opera.

When I work on a committee I like to take charge of things.

Once in a while I laugh at a dirty joke.

People pretend to care more about one another than they really do.
Sometimes I just can't seem to get going.

Most of the time I feel happy.

I sometimes feel that I am a burden to others.

I want to be an important person in the community.

I often lose my temper.

I often get disgusted with myself.

I have never been in trouble because of my sex behavior.

I used to like it very much when one of my papers was read to
the class in school.

I have been in trouble one or more times because of my sex behavior.

158

Concentration (Female)

(Continued)

Item # Test Item

359. I think I am usually a leader in my group.

369. I seem to do things that I regret more often than other people do.

383. I usually have to stop and think before I act even in trifling
matters.

407. I have had no difficulty in starting or holding my bowel movement.

418. I am embarrassed with people I do not know well.

422. I feel like giving up quickly when things go wrong.

431. As a youngster in school I used to give the teachers lots of trouble.

438. I would have been more successful if people had given me a fair
chance.

445. I would fight if someone tried to take my rights away.

449. Almost every day something happens to frighten me.

453. I wouk under a great deal of tension.

465. I must admit that I am a high-strung person.

472.

I feel that I would be a much better person if I could gain more
understanding of myself. ‘

Item #

23.

27.

61.
67.

73.

76.

86.

130.

144.

152.

160.

166.

172.
187.
197.
240.

273.

280.

299.

159
Haan's Coping Scales (CPI):

Sublimation (Male)

Test Item
In most ways the poor man is better off than the rich man.

It makes me feel like a failure when I hear of the success of
someone I know well.

I liked school.
I feel sure that there is only one true religion.

Maybe some minority groups do get rough treatment, but it's no
business of mine.

I often feel as if the world was just passing me by.

Most of the arguments or quarrels I get into are over matters
of principle.

Sometimes without any reason or even when things are going wrong
I feel excitedly happy, "on top of the world."

I am somewhat afraid of the dark.
I read at least ten books a year.
I would like to hear a great singer in an opera.

In school I always looked far ahead in planning what courses to
take.

I do not have a great fear of snakes.

I am inclined to take things hard.

Once in a while I laugh at a dirty joke.
I would like to be a nurse.

I am bothered by people outside, on streetcars, in stores, etc.,
watching me.

I enjoy many different kinds of play and recreation.

I don't seem to care what happens to me.

160

Sublimation (Male)

(Continued)

Item # Test Item

301. I am afraid to be alone in the dark.

322. I do not like to loan my things to people who are careless in the
way they take care of them.

344. I am made nervous by certain animals.

349. If a person is clever enough to cheat someone out of a large sum
of money, he ought to be allowed to keep it.

368. I have had no difficulty starting or holding my urine.

378. I doubt if anyone is really happy.

380. I am known as a hard and steady worker.

390. I have not lived the right kind of life.

399. At times I have been so entertained by the cleverness of a crook
that I have hoped he would get by with it.

404. I am in favor of a very strict enforcement of all laws, no matter
what the consequences.

416. I don't think I'm quite as happy as others seem to be.

418. I am embarrassed with people I do not know well.

436. I never cared much for school.

445. I would fight if someone tried to take my rights away.

449. Almost every day something happens to frighten me.

466. I am a very ticklish person.

Item #

27.

67.

73.

76.

86.

110.

130.

144.

152.

160.

166.

172.
187.
197.
209.

273.

280.

299.

301.

161

Haan's Coping Scales (CPI):

Sublimation (Female)

Test Item

It makes me feel like a failure when I hear of the success of
someone I know well.

I feel sure that there is only one true religion.

Maybe some minority groups do get rough treatment, but it's no
business of mine.

I often feel as if the world was just passing me by.

Most of the arguments or quarrels I get into are over matters
of principle.

The thought of being in an automobile accident is very frighten-
ing to me.

Sometimes without any reason or even when things are going wrong
I feel excitedly happy, "on top of the world."

I am somewhat afraid of the dark.
I read at least ten books a year.
I would like to hear a great singer in an opera.

In school I always looked far ahead in planning what courses
to take.

I do not have a great fear of snakes.

I am inclined to take things hard.

Once in a while I laugh at a dirty joke.

Most people are honest chiefly through fear of being caught.

I am bothered by people outside, on streetcars, in stores, etc.,
watching me.

I enjoy many different kinds of play and recreation.
I don't seem to care what heppens to me.

I am afraid to be alone in the dark.

162

Sublimation (Female)

(Continued)

Item # Test Item

322. I do not like to loan my things to people who are careless in
the way they take care of them.

344. I am made nervous by certain animals.

349. If a person is clever enough to cheat someone out of a large sum
of money, he ought to be allowed to keep it.

368. I have had no difficulty starting or holding my urine.

378. I doubt if anyone is really happy.

380. I am known as a hard and steady worker.

389. I get pretty discouraged with the law when a smart lawyer gets
a criminal free.

390. I have not lived the right kind of life.

399. At times I have been so entertained by the cleverness of a crook
that I have hoped he would get by with it.

416. I don't think I'm quite happy as others seem to be.

418. I am embarrassed with people I do not know well.

436. I never cared much for school.

445. I would fight if someone tried to take my right away.

449. Almost every day something happens to frighten me.

466. I am a very ticklish person.

Item #
19.
55.

60.

61.

94.

119.

133.
165.
173.
174.
223.
225.
231.
232.
256.
258.
270.
301.
310.

340.

163
Haan's Coping Scales (CPI):

Substitution (Male)

Test Item
I think I would like the work of a building contractor.
Some of my family have quick tempers.

I have often met people who were supposed to be experts who were
no better than I.

I liked school.

With things going as they are, it's pretty hard to keep up hope
of amounting to something.

Planning one's activities in advance is very likely to take most
of the fun out of life.

I feel as good now as I ever have.

I do not mind taking orders and being told what to do.

My way of doing things is apt to be misunderstood by others.

I never make judgments about people until I am sure of the facts.
I keep out of trouble at all costs.

People pretend to care more about one another than they really do.
I am apt to show off in some way if I get the chance.

Sometimes I feel that I am about to go to pieces.

I want to be an important person in the community.

In school I found it very hard to talk before the class.

I often lose my temper.

I am afraid to be alone in the dark.

I would rather have people dislike me than look down on me.

Our thinking would be a lot better off if we would just forget
about words like "probably," "approximately," and "perhaps."

I164

Substitution (Male)

(Continued)

Item # Test Item

347. I never make judgments about people until I am sure of the facts.

379. I would rather not have very much responsibility for other people.

397. Once I have my mind made up I seldom change it.

401. Most young people get too much education.

404. I am in favor of a very strick enforcement of all laws, no matter
what the consequences.

411. I am bothered by acid stomach several times a week.

416. I don't think I'm quite as happy as others seem to be.

430. The things some of my family have done have frightened me.

447. If I saw some children hurting another child, I am sure I would
try to make them stop.

477. I get tired more easily than other people seem to.

479. I sweat very easily even on cool days.

Item #
19.
55.

60.

61.

94.

119.

133.
165.
173.
174.
225.
228.
231.
232.
256.
258.
270.
284.
301.
310.

331.

1655
Haan's Coping Scales (CPI):

Substitution (Female)

Test Item
I think I would like the work of a building contractor.
Some of my family have quick tempers.

I have often met people who were supposed to be experts who
were no better than I.

I liked school.

With things going as they are, it's pretty hard to keep up hope
of amounting to something.

Planning one's activities in advance is very likely to take
most of the fun out of life.

I feel as good now as I ever have.

I do not mind taking orders and being told what to do.

My way of doing things is apt to be misunderstood by others.

I never make judgments about people until I am sure of the facts.
People pretend to care more about one another than they really do.
I like to read about history.

I am apt to show off in some way if I get the chance.
Sometimes I feel that I am about to go to pieces.

I want to be an important person in the community.

In school I found it very hard‘to talk before the class.

I often lose my temper.

It is hard for me to act natural when I am with new people.
I am afraid to be alone in the dark.

I would rather have people dislike me than look down on me.

I often start things I never finish.

166

Substitution (Female)

(Continued)

Item # Test Item

340. Our thinking would be a lot better off if we would just forget
about words like "probably," "approximately," and "perhaps."

344. I am made nervous by certain animals.

347. I never make judgments about people until I am sure of the facts.

379. I would rather not have very much responsibility for other
people.

397. Once I have my mind made up I seldom change it.

401. Most young people get too much education.

404. I am in favor of a very strict enforcement of all laws, no matter
what the consequences.

416. I don't think I'm quite as happy as others seem to be.

430. The things some of my family have done have frightened me.

477. I get tired more easily than other people seem to.

479. I sweat very easily even on cool days.

70.

76.

94.

96.
143.
154.
160.
161.
168.

175.

176.

198.

206.

214.

225.

239.

253.

167

Haan's Coping Scales (CPI):

Suppression (Male)

Test Item
I looked up to my father as an ideal man.
A person needs to "show off" a little now and then.
Sometimes I cross the street just to avoid meeting someone.
I often feel as if the world was just passing me by.

With things going as they are, it's pretty hard to keep up hope
of amounting to something.

I take a rather serious attitude toward ethical and moral issues.
I like to be with a crowd who play jokes on one another.

I like tall women.

I would like to hear a great singer in an opera.

I am sometimes cross and grouchy without any good reason.

My home life was always happy.

I have had blank spells in which my activities were interrupted
and I did not know what was going on around me.

I commonly wonder what hidden reason another person may have for
doing something nice for me.

Before I do something I try to consider how my friends will react
to it.

I have often found people jealous of my good ideas, just because
they had not thought of them first.

In school I was sometimes sent to the principal for cutting up.
People pretend to care more about one another than they really do.
I like to talk before groups of people.

When prices are high you can't blame a person for getting all he
can while the getting is good.

168

Suppression (Male)

(Continued)

Item # Test Item

267. I am a better talker than a listener.

270. I often lose my temper.

311. I cannot do anything well.

316. My parents wanted me to "make good" in the world.

337. Much of the time my head seems to hurt all over.

341. My people treat me more like a child than a grown-up.

369. I seem to do things that I regret more often than other peole do.

390. I have not lived the right kind of life.

393. I have used alcohol excessively.

407. I have had no difficulty in starting or holding my bowel move-
ment.

416. I don't think I'm quite as happy as others seem to be.

431. As a youngster in school I used to give the teachers lots of
trouble.

436. I never cared much for school.

449. Almost every day something happens to frighten me.

453. I work under a great deal of tension.

463. It is hard for me just to sit still and relax.

465. I must admit that I am a high-strung person.

Item #

3.

4.

18.

32.

76.

94.

96.

143.

154.

160.

176.

198.

206.

214.

225.

243.

253.

267.

270.

169
Haan's Coping Scales (CPI):

Suppression (Female)

Test Item
I looked up to my father as an ideal man.
A person needs to "show off" a little now and then.
A person who doesn't vote is not a good citizen.

I tend to be on my guard with people who are somewhat more
friendly than I had expected.

I often feel as if the world was just passing me by.

With things going as they are, it's pretty hard to keep up hope
of amounting to something.

I take a rather serious attitude toward ethical and moral issues.
I like to be with a crowd who play jokes on one another.

I like tall women.

I would like to hear a great singer in an Opera.

I commonly wonder what hidden reason another person may have for
doing something nice for me.

Before I do something I try to consider how my friends will
react to it.

I have often found people jealous of my good ideas, just because
they had not thought of them first.

In school I was sometimes sent to the principal for cutting up.
People pretend to care more about one another than they really do.

I am often bothered by useless thoughts which keep running through
my mind.

When prices are high you can't blame a person for getting all he
can while the getting is good.

I am a better talker than a listener.

I often lose my temper.

170

Suppression (Female)

(Continued)

Item # Test Item

311. I cannot do anything well.

316. My parents wanted me to "make good" in the world.

337. Much of the time my head seems to hurt all over.

341. My people treat me more like a child than a grown-up.

351. Some of my family have habits that bother and annoy me very much.

369. I seem to do things that I regret more often than other people
do.

390. I have not lived the right kind of life.

393. I have used alcohol excessively.

407. I have had no difficulty in starting or holding my bowel
movement.

416. I don't think I'm quite as happy as others seem to be.

431. As a youngster in school I used to give the teachers lost of
trouble.

436. I never cared much for school.

449. Almost every day something happens to frighten me.

453. I work under a great deal of tension.

463. It is hard for me just to sit still and relax.

465. I must admit that I am a high-strung person.

APPENDIX F

HAAN'S DEFENDING SCALES

Item #

19.
42.

69.

80.

86.

102.

106.

109.

120.

128.

143.

201.

213.

232.

253.

257.

258.

290.

316.

322.

1.71

Haan's Defending Scales (CPI):

Isolation (Male)

Test Item
I think I would like the work of a building contractor.
I sometimes pretend to know more than I really do.

I would disapprove of anyone's drinking to the point of
intoxication at a party.

There have been times when I have been very angry.

Most of the arguments or quarrels I get into are over matters
of principle.

I like to be the center of attention.
The average person is not able to appreciate art and music very well.
I get pretty discouraged sometimes.

I do not always tell the truth.

It takes a lot of argument to convince most people of the truth.
I like to be with a crowd who play jokes on one another.

I have no patience with people who believe there is only one
true religion.

It makes me angry when I hear of someone who has been wrongly
prevented from voting.

Sometimes I feel that I am about to go to pieces.

When prices are high you can't blame a person for getting all he
can while the getting is good.

I often feel as though I have done something wrong or wicked.
In school I found it very hard to talk before the class.

I have never been in trouble because of my sex behavior.

My parents wanted me to "make good" in the world.

I do not like to loan my things to people who are careless in
the way they take care of them.

172

Isolation (Male)

(Continued)

Item # Test Item

330. Everything tastes the same.

368. I have had no difficulty starting or holding my urine.

393. I have used alcohol excessively.

397. Once I have my mind made up I seldom change it.

403. I have a natural talent for influencing people.

404. I am in favor of a very strict enforcement of all laws, no
matter what the consequences.

412. I like to give orders and get things moving.

416. I don't think I'm quite as happy as others seem to be.

418. I am embarrassed with people I do not know well.

455. There seems to be a lump in my throat much of the time.

466. I am a very ticklish person.

Item #

19.
42.

60.

69.

80.

86.

102.

106.

109.

120.

143.

201.

213.

232.

253.

257.

258.

260.

290.

314.

1373
Haan's Defending Scales (CPI):

Isolation (Female)

Test Item
I think I would like the work of a building contractor.
I sometimes pretend to know more than I really do.

I have often met people who were supposed to be experts who
were no better than I.

I would disapprove of anyone's drinking to the point of
intoxication at a party.

There have been times when I have been very angry.

Most of the arguments or quarrels I get into are over matters
of principal.

I like to be the center of attention.

The average person is not able to appreciate art and music very well.
I get pretty discouraged sometimes.
I do not always tell the truth.

I like to be with a crowd who play jokes on one another.

I have no patience with people who believe there is only one
true religion.

It makes me angry when I hear of someone who has been wrongly
prevented from voting.

Sometimes I feel that I am about to go to pieces.

When prices are high you can't blame a person for getting all he
can while the getting is good.

I often feel as though I have done something wrong or wicked.
In school I found it very hard to talk before the class.

I always try to do at least a little better than what is expected
of me.

I have never been in trouble because of my sex behavior.

I must admit I try to see what others think before I take a stand.

174

Isolation (Female)

(Continued)

Item # Test Item

316. My parents wanted me to "make good" in the world.

322. I do not like to loan my things to people who are careless in the
way they take care of them.

368. I have had no difficulty starting or holding my urine.

393. I have used alcohol excessively.

397. Once I have my mind made up I seldom change it.

403. I have a natural talent for influencing people.

404. I am in favor of a very strict enforcement of all laws, no matter
what the consequences.

412. I like to give orders and get things moving.

416. I don't think I'm quite as happy as others seem to be.

418. I am embarrassed with people I do not know well.

463. It is hard for me just to sit still and relax.

466. I am a very ticklish person.

Item #

7.

25.
31.
46.
65.
102.

116.

172.

179.

186.

200.

215.

230.

234.
239.

241.

255.
263.

266.

175
Haan's Defending Scales (CPI):

Intellectualization (Male)

Test Item

When in a group of people I usually do what the others want rather
than make suggestions.

Clever, sarcastic people make me feel very uncomfortable.

I doubt whether I would make a good leader.

I think I would like the work of a school teacher.

I think I would like the work of a clerk in a large department store.
I like to be the center of attention.

It is annoying to listen to a lecturer who cannot seem to make up
his mind as to what he really believes.

I do not have a great fear of snakes.
When I work on a committee I like to take charge of things.
I usually don't like to talk much unless I am with people I know well.

In a group of people I would not be embarrassed to be called upon to
start a discussion or give an opinion about something I know well.

I would like to write a technical book.

I would rather be a steady and dependable worker than a brilliant
but unstable one.

We ought to pay our elected officials better than we do.

I like to talk before groups of people.

The man who provides temptation by leaving valuable property un-
protected is about as much to blame for its theft as the one who
steals it.

Only a fool would try to change our American way of life.

Lawbreakers are almost always caught and punished.

I think most people would lie to get ahead.

17(5

Intellectualization (Male)

(Continued)

Item # Test Item

278. If I get too much change in a store, I always give it back.

293. Every now and then I get into a bad mood, and no one can do anything
to please me.

302. I have often gone against my parents' wishes.

333. Education is more important than most people think.

340. Our thinking would be a lot better off if we would just forget
about words like "probably," approximately," and "perhaps."

355. I have strong political opinions.

367. My home life was always very pleasant.

371. I would rather be a steady and dependable worker than a brilliant
but unstable one.

376. I enjoy planning things, and deciding what each person should do.

385. It is pretty easy for people to win arguments with me.

387. I don't like things to be uncertain and unpredictable.

403. I have a natural talent for influencing people.

420. I used to steal sometimes when I was a youngster.

443. I'm not the type to be a political leader.

448. People seem naturally to turn to me when decisions have to be made.

466. I am a very ticklish person.

Item #

25.
31.
37.
46.
65.
102.

116.

133.
159.
172.
179.

186.

200.

215.

230.

234.

239.

241.

17'?

Haan's Defending Scales (CPI):

Intellectualization (Female)

Test Item

When in a group of people I usually do what the others want rather
than make suggestions. -

Clever, sarcastic people make me feel very uncomfortable.
I doubt whether I would make a good leader.

I have very few fears compared to my friends.

I think I would like the work of a school teacher.

I think I would like the work of a clerk in a large department store.
I like to be the center of attention.

It is annoying to listen to a lecturer who cannot seem to make up
his mind as to what he really believes.

I feel as good now as I ever have.

I feel nervous if I have to meet a lot of people.

I do not have a great fear of snakes.

When I work on a committee I like to take charge of things.

I usually don't like to talk much unless I am with people I know
very well.

In a group of people I would not be embarrassed to be called upon
to start a discussion or give an opinion about something I know well.

I would like to write a technical book.

I would rather be a steady and dependable worker than a brilliant
but unstable one.

We ought to pay our elected officials better than we do.
I like to talk before groups of people.
The man who provided temptation by leaving valuable property un-

protected is about as much to blame for its theft as the one who
steals it.

178

Intellectualization (Female)

(Continued)

Item # Test Item

255. Only a fool would try to change our American way of life.

263. Lawbreakers are almost always caught and punished.

293. Every now and then I get into a bad mood, and no one can do
anything to please me.

333. Education is more important than most people think.

340. Our thinking would be a lot better off if we would just forget about
words like "probably," approximately," and "perhaps."

355. I have strong political opinions.

367. My home life was always very pleasant.

371. I would rather be a steady and dependable worker than a brilliant
but unstable one.

376. I enjoy planning things, and deciding what each person should do.

385. It is pretty easy for people to win arguments with me.

387. I don't like things to be uncertain and unpredictable.

403. I have a natural talent for influencing people.

420. I used to steal sometimes when I was a youngster.

443. I'm not the type to be a political leader.

448. People seem naturally to turn to me when decisions have to be made.

466. I am a very ticklish person.

Item #
13.

16.

27.

37.
54.
55.
70.
79.

94.

102.
121.

125.

144.
165.
168.
169.
197.
252.

253.

258.

179
Haan's Defending Scales (COPI):

Rationalization (Male)

Test Item
I am very slow in making up my mind.

There's no use in doing things for people; you only find that you
get it in the neck in the long run.

It makes me feel like a failure when I hear of the success of
someone I know.

I have very few fears compared to my friends.

I find it hard to keep my mind on a task or job.

Some of my family have quick tempers.

Sometimes I cross the street just to avoid meeting someone.
I am afraid of deep water.

With things going as they are, it's pretty hard to keep up hope
of amounting to something.

I like to be the center of attention.
I was a slow learner in school.

There is something wrong with a person who can't take orders
without getting angry or resentful.

I am somewhat afraid of the dark.

I do not mind taking orders and being told what to do.
My home life was always happy.

Teachers often expect too much work from the students.
Once in a while I laugh at a dirty joke.

I sometimes feel that I am a burden to others.

When prices are high you can't blame a person for getting all he
can while the getting is good.

In school I found it very hard to talk before the class.

180

Rationalization (Male)

(Continued)

Item # Test Item

307. If I am driving a car, I try to keep others from passing me.

322. I do not like to loan my things to people who are careless in the
way they take care of them.

329. It is hard for me to sympathize with someone who is always doubting
and unsure about things.

337. Much of the time my head seems to hurt all over.

341. My people treat me more like a child than a grown—up.

356. I seldom worry about my health.

367. My home life was always very pleasant.

372. I have reason for feeling jealous of one or more members of
my family.

411. I am bothered by acid stomach several times a week.

417. Any job is all right with me, so long as it pays well.

429. Even the idea of giving a talk in public makes me afraid.

430. The things some of my family have done have frightened me.

463. It is hard for me just to sit still and relax.

477. I get tired more easily than other people seem to.

Item #

11.

16.

27.

37.

55.

79.

94.

102.

121.

125.

137.

144.

165.

168.

169.

197.

225.

252.

253.

258.

181

Haan's Defending Scales (CPI):

Rationalization (Female)

Test Item

People can pretty easily change me even though I thought that
my mind was already made up on a subject.

There's no use in doing things for people; you only find that you
get it in the neck in the long run.

It makes me feel like a failure when I hear of the success of
someone I know well.

I have very few fears compared to my friends.
Some of my family have quick tempers.
I am afraid of deep water.

With things going as they are, it's pretty hard to keep up hope
of amounting to something.

I like to be the center of attention.
I was a slow learner in school.

There is something wrong withaaperson who can't take orders without
getting angry or resentful.

I wish I were not bothered by thoughts about sex.

I am somewhat afraid of the dark.

I do not mind taking orders and being told what to do.

My home life was always happy.

Teachers often expect too much work from the students.

Once in a while I laugh at a dirty joke.

People pretend to care more about one another than they really do.
I sometimes feel that I am a burden to others.

When prices are high you can't blame a person for getting all he
can while the getting is good.

In school I found it very hard to talk before the class.

1i32

Rationalization (Female)

(Continued)

Item # Test Item

307. If I am driving a car, I try to keep others from passing me.

322. Ido not like to loan my things to people who are careless in the
way they take care of them.

329. It is hard for me to sympathize with someone who is always doubting
and unsure about things.

337. Much of the time my head seems to hurt all over.

341. My people treat me more like a child than a grown-up.

356. I seldom worry about my health.

367. My home life was always very pleasant.

372. I have reason for feeling jealous of one or more members of
my family.

411. I am bothered by acid stomach several times a week.

417. Any job is all right with me, so long as it pays well.

429. Even the idea of giving a talk in public makes me afraid.

430. The things some of my family have done have frightened me.

463. It is hard for me just to sit still and relax.

477. I get tired more easily than other people seem to.

Item #

13.
37.
38.
40.
54.
76.

94.

111.

129.
144.
161.
177.
202.

227.

245.

264.

279.

284.

305.

335.

1533

Haan's Defending Scales (CPI):

Doubt (Male)

Test Item
I am very slow in making up my mind.
I have very few fears compared to my friends.
It is hard for me to start a conversation with strangers.
I get very nervous if I think that someone is watching me.
I find it hard to keep my mind on a task or job.
I often feel as if the world was just passing me by.

With things going as they are, it's pretty hard to keep up hope
of amounting to something.

When in a group of people I have trouble thinking of the right
things to talk about.

I think I would like to drive a racing car.

I am somewhat afraid of the dark.

I am sometimes cross and grouchy without any good reason.
I am certainly lacking in self-confidence.

If given the chance I would make a good leader of people.

It is hard for me to find anything to talk about when I meet a
new person.

Most of the time I feel happy.

I would be very unhappy if I was not successful at something I
had seriously started to do.

I often get disgusted with myself.
It is hard for me to act natural when I am with new people.
I often wish people would be more definite about things.

There are times when I act like a coward.

184

Doubt (Male)

(Continued)

Item # Test Item

341. My people treat me more like a child than a grown-up.

344. I am made nervous by certain animals.

351. Some of my family have habits that bother and annoy me very much.
368. I have had no difficulty starting or holding my urine.

369. I seem to do things that I regret more often than other people do.
416. I don't think I'm quite as happy as others seem to be.

419. It often seems that my life has no meaning.

422. I feel like giving up quickly when things go wrong.

429. Even the idea of giving a talk in public makes me afraid.

449. Almost every day something happens to frighten me.

452. I dislike to have to talk in front of a group of people.

456. I have more trouble concentrating than others seem to have.

467. At times I think I am no good at all.

lee-Li
13.
37.
38.
40.
54.
66.
76.

94.

97.

111.

129.
144.
177.
192.
202.

227.

239.
245.
252.
279.
284.

335.

185
Haan's Defending Scales (CPI):

Doubt (Female)

M
I am very slow in making up my mind.
I have very few fears compared to my friends.
It is hard for me to start a conversation with strangers.
I get very nervous if I think that someone is watching me.
I find it hard to keep my mind on a task or job.
Sometimes I feel like swearing.
I often feel as if the world was just passing me by.

With things going as they are, it's pretty hard to keep up hope
of amounting to something.

I would like the job of a foreign correspondent for a newspaper.

When in a group of people I have trouble thinking of the right
things to talk about.

I think I would like to drive a racing car.
I am somewhat afraid of the dark.

I am certainly lacking in self-confidence.
When I meet a stranger I often think that he is better than I am.
If given the chance I would make a good leader of people.

It is hard for me to find anything to talk about when I meet
a new person.

I like to talk before groups of people.

Most of the time I feel happy.

I sometimes feel that I am a burden to others.

I often get disgusted with myself.

It is hard for me to act natural when I am with new people.

There are times when I act like a coward.

186

Doubt (Female)

Item #

341.
344.
351.
367.
368.
369.

373.

383.
416.
419.
422.
429.
449.
452.
456.

467.

Test Item
My people treat me more like a child than,a grown-up.
I am made nervous by certain animals.
Some of my family have habits that bother-and annoy me very much.
My home life was always very pleasant.
I have had no difficulty starting or holding my urine.

I seem to do things that I regret more often than other people do.

My table manners are not quite as good at home as when I am out
in company.

I usually have to stop and think before I act even in trifling matters.
I don't think I'm quite as happy as others seem to be.

It often seems that my life has no meaning.

I feel like giving up quickly when things go wrong.

Even the idea of giving a talk in public makes me afraid.

Almost every day something happens to frighten me.

I dislike to have to talk in front of a group of people.

I have more trouble concentrating than other seem to have.

At times I think I am no good at all.

Item #

41.

59.

62.

63.

67.

76.

83.

90.

98.

121.

125.

133.

143.

153.

168.

173.

186.

197.

212.

220.

.187

Haan's Defending Scales (CPI):

Projection (Male)

Test Item

For most questions there is just one right answer, once a person
is able to get all the facts.

The trouble with many people is that they don't take things seriously
enough.

I'think Lincoln was greater then Washington.

It is a good thing to be frank.

I feel sure that there is only one true religion.

I often feel as if the world was just passing my by.

I usually feel nervous and ill at ease at a formal dance or party.

As long as a person votes every four years, he has done his duty
at a citizen.

People today have forgotten how to feel properly ashamed of them-
selves.

I was a slow learner in school.

There is something wrong with a person who can't take orders without
getting angry or resentful.

I feel as good now as I ever have.

I like to be with a crowd who play jokes on one another.

If I am not feeling well I am somewhat cross and grouchy.

My home life was always happy.

My way of doing things is apt to be misunderstood by others.

I usually don't like to talk much unless I am with people I know
very well.

Once in a while I laugh at a dirty joke.
I have never been in trouble with the law.

I feel uneasy indoors.

188

Projection (Male)

474.

(Continued)

lgfgLf Test Item

257. I often feel as though I have done something wrong or wicked.

258. In school I found it very hard to talk before the class.

259. I usually feel that life is worthwhile.

270. I often lose my temper.

282. A large number of people are guilty of bad sexual conduct.

355. I have strong political opinions.

362. I have never seen a vision.

368. I have had no difficulty starting or holding my urine.

404. I am in favor of a very strict enforcement of all laws, no matter
what the consequences.

405. People often talk about me behind my back.

418. I am embarrassed with people I do not know well.

436. I never cared much for school.

I sometimes tease animals.

Item #

41.

58.

59.

63.
67.
76.

90.

98.

125.

133.
7143.
153.
168.
173.
182.
197.
212.
220.

258.

1853

Haan's Defending Scales (CPI):

Projection (Female)

Test Item

For most questions there is just one right answer, once a person
is able to get all the facts.

I get very tense and anxious when I think other people are
disapproving of me.

The trouble with many people is that they don't take things
seriously enough.

It is always a good thing to be frank.
I feel sure that there is only one true religion.
I often feel as if the world was just passing me by.

As long as a person votes every four years, he has done his
duty as a citizen.

People today have forgotten how to feel properly ashamed of
themselves.

There is something wrong with a person who can't take orders with-
out getting angry or resentful.

I feel as good now as I ever have.

I like to be with a crowd who play jokes on one another.

If I am not feeling well I am somewhat cross and grouchy.
My home life was always happy.

My way of doing things is apt to be misunderstood by others.
I would rather go without something than ask for a favor.
Once in a while I laugh at a dirty joke.

I have never been in trouble with the law.

I feel uneasy indoors.

In school I found it very hard to talk before the class.

1190

Projection (Female)
(Continued)

Item # Test Item

259. I usually feel that life is worthwhile.

270. -I often lose my temper.
355. I have strong political opinions.
362. I have never seen a vision.

368. I have had no difficulty starting or holding my urine.
405. People often talk about me behind my back.
436. I never cared much for school.

474. I sometimes tease animals.

Item #

13.

24.

44.

47.

54.

71.

76.

81.

83.

91.

121.

143.

149.

150.

168.

197.

212.

221.

238.

245.

19].
Haan's Defending Scales (CPI):

Regression (Male)

Test Item

Our thinking would be a lot better off if we would just forget
about words like "probably," "approximately," and "perhaps."

I am very slow in making up my mind.

I always like to keep my things neat and tidy and in good order.
Somefimes I feel like smashing things.

Women should not be allowed to drink in cocktail bars.

I find it hard to keep my mind on a task or job.

I get exicted very easily.

I often feel as if the world was just passing me by.

I must admit I often try to get my own way regardless of what
others may want.

I usually feel nervous and ill at ease at a formal dance or party.
Sometimes I think of things too bad to talk about.

I was a slow learner in school.

I like to be with a crowd who play jokes on one another.

I consider a matter from every standpoint before I make a decision.
Criticism or scolding makes me very uncomfortable.
My home life was always happy.

Once in a while I laugh at a dirty joke.

I have never been in trouble with the law.

People have a real duty to take care of their aged parents, even
if it means making some pretty big sacrifices.

Sometimes I just can't seem to get going.

Most of the time I feel happy.

192

Regression (Male)

(Continued)

Item # Test Item

246. I like to plan out my activities in advance.

252. I sometimes feel that I am a burden to others.

257. I often feel as though I have done something wrong or wicked.

262. There have been a few times when I have been very mean to
another person.

267. I am a better talker than a listener.

341. My people treat me more like a child than a grown-up.

368. I have had no difficulty starting or holding my urine.

369. I seem to do things that I regret more often than other people
do.

380. I am known as a hard and steady worker.

416. I don't think I'm quite as happy as others seem to be.

419. It often seems that my life has no meaning.

429. Even the idea of giving a talk in public makes me afraid.

451. I set a high standard for myself and I feel others should do
the same.

467. At times I think I am no good at all.

Item #

13.

24.

35.

37.

44.

47.

71.

76.

81.

91.

121.

143.

149.

168.

187.

197.

212.

221.

238.

245.

.193

Haan's Defending Scales (CPI):

Regression (Female)

Test Item

Our thinking would be a lot better off if we would just forget
about words like "probably," "approximately," and "perhaps."

I am very slow in making up my mind.

I always like to keep my things neat and tidy and in good order.
I become quite irritated when I see someone spit on the sidewalk.
I have very few fears compared to my friends.

Sometimes I feel like smashing things.

Women should not be allowed to drink in cocktail bars.

I get excited very easily.

I often feel as if the world was just passing me by.

I must admit I often try to get my own way regardless of what
others may want.

Sometimes I think of things too bad to talk about.

I was a slow learner in school.

I like to be with a crowd who play jokes on one another.
I consider a matter from every standpoint before I make a decision.
My home life was always happy.

I am inclined to take things hard.

Once in a while I laugh at a dirty joke.

I have never been in trouble with the law.

People have a real duty to take care of their aged parents, even
if it means making some pretty big sacrifices.

Sometimes I just can't seem to get going.

Most of the time I feel happy.

194

Regression (Female)

(Continued)

Item # Test Item

246. I like to plan out my activities in advance.

252. I sometimes feel that I am a burden to others.

257. I often feel as though I have done something wrong or wicked.

262. There have been a few times when I have been very mean to another
person.

373. I am bothered by people outside, on streetcars, in stores, etc.,
watching me.

341. My people treat me more like a child than a grown-up.

361. I like to have a place for everything and everything in its
place.

367. My home life was always very pleasant.

368. I have had no difficulty starting or holding my urine.

369. i seem to do things that I regret more often than other people

0.

380. I am known as a hard and steady worker.

416. I don't think I'm quite as happy as others seem to be.

419. It often seems that my life has no meaning.

429. Even the idea of giving a talk in public makes me afraid.

451. I set a high standard for myself and I feel others should do
the same.

467. At times I think I am no good at all.

Item #

18.

32.

36.

41.

45.
54.
70.
121.
128.

131.

143.
152.
180.

186.

229.

230.

243.

245.

195
Haan's Defending Scales (CPI):

Denial (Male)

Test Item
I looked up to my father as an ideal man.
I liked "Alice in Wonderland" by Lewis Carroll.
A person who doesn't vote is not a good citizen.

I tend to be on my guard with people who are somewhat more friendly
than I had expected.

When I was going to school I played hooky quite often.

For most questions there is just one right answer, once a person
is able to get all the facts.

As a child I used to be able to go to my parents with my problems.
I find it hard to keep my mind on a task or job.

Sometimes I cross the street just to aviod meeting someone.

I was a slow learner in school.

It takes a lot of argument to convince most people of the truth.

One of my aims in life is to accomplish something that would
make my mother proud of me.

I like to be with a crowd who play jokes on one another.
I read at least ten books a year.
My parents have generally let me make my own decisions.

I usually don't like to talk much unless I am with people
I know well.

I much prefer symmetry to asymmetry.

I would rather be a steady and dependable worker than a brilliant
but unstable one.

I am often bothered by useless thoughts which keep running
through my mind.

Most of the time I feel happy.

196

Denial (Male)

(Continued)

Item # Test Item

253. When prices are high you can't blame a person for getting all he
can while the getting is good.

263. Lawbreakers are almost always caught and punished. -

285. I refused to play some games because I am not good at them.

289. There have been times when I have worried a lot about something
that was not really important.

309. I have been afraid of things or peeple that I knew could not hurt me.

312. Any man who is able and willing to work hard has a good chance
of succeeding.

327. I find it easy to "drop" or "break with" a friend.

357. For most questions there is just one right aswer, once a person
is able to get all the facts.

373. My table manners are not quite as good at home as when I am out in
company.

375. There are certain people whom I dislike so much that I am inwardly
pleased when they are catching it for something they have done.

378. I doubt if anyone is really happy.

404. I am in favor of a very strict enforcement of all laws, no matter
what the consequences.

444. My parents never really understood me.

467. At times I think I am no good at all.

Item

18.

32.

36.

41.

45.

54.

70.

86.

88.

114.

121.

128.

131.

143.
152.
229.

230.

243.

197

Haan's Defending Scales (CPI):

Denial (Female)

Test Item
I looked up to my father as an ideal man.
I liked "Alice in Wonderland" by Lewis Carroll.
A person who doesn't vote is not a good citizen.

I tend to be on my guard with people who are somewhat more friendly
than I had expected.

When I was going to school I played hooky quite often.

For most questions there is just one right answer, once a person
is able to get all the facts.

As a child I used to be able to go to my parents with my problems.
I find it hard to keep my mind on a task or job.
Sometimes I cross the street just to avoid meeting someone.

Most of the arguments or quarrels I get into are over matter of
principle.

I do not like to see people carelessly dressed.

At times I feel like picking a fist fight with someone.

I was a slow learner in school.

It takes a lot of argument to convince most people of the truth.

One of my aims in life is to accomplish something that would make
my mother proud of me.

I like to be with a crowd who play jokes on one another.
I read at least ten books a year.
I much prefer symmetry to asymmetry.

I would rather be a steady and dependable worker than a brilliant
but unstable one.

I am often bothered by useless thoughts which keep running through
my mind.

1.98

Denial (Female)

(Continued)

Item # Test Item

245. Most of the time I feel happy.

253. When prices are high you can't blame a person for getting all he
can while the getting is good.

263. Lawbreakers are almost always caught and punished.

285. I refuse to play some games because I am not good at them.

289. There have been times when I have worried a lot about something
that was not really important.

309. I have been afrid of things or people that I knew could not
hurt me.

312. Any man who is able and willing to work hard has a good chance of
succeeding.

327. I find it easy to "drop" or "break with" a friend.

357. For most questions there is just one right answer, once a person
is able to get all the facts.

373. My table manners are not quite as good at home as when I am out
in company .

375. There are certain people whom I dislike so much that I am inwardly
pleased when they are catching it for something they have done.

378. I doubt if anyone is really happy.

380. I am known as a hard and steady worker.

395. It is very important to me to have enough friends and social life.

404. I am in favor of a very strict enforcement of all laws, no matter
what the consequences.

444. My parents never really understood me.

456. I have more trouble concentrating than others seem to have.

Item #

37.
54.
_7o.
71.
76.
77.

81.

94.

102.
121.
149.
153.
161.
214.
224.
232.

243.

247.

248.

199

Haan's Defending Scales (CPI):

Displacement (Male)

Test Item

Our thinking would be a lot better off if we would just forget
about words like "probably," "approximately," and "perhaps."

I have very few fears compared to my friends.

I find it hard to keep my mind on a task or job.

Sometimes I cross the street just to avoid meeting someone.
I get excited very easily.

I often feel as if the world was just passing me by.

When I get bored I like to stir up some excitement.

I must admit I often try to get my own way regardless of what
others may want.

With things going as they are, it's pretty hard to keep up hope
of amounting to something.

I like to be the center of attention.

I was a slow learner in school.

I consider a matter from every standpoint before I make a decision.
If I am not feeling well I am somewhat cross and grouchy.

I am somteimes cross and grouchy without any good reason.

In school I was sometimes sent to the principal for cutting up.

I usually expect to succeed in things I do.

Sometimes I feel that I am about to go to pieces.

I am often bothered by useless thoughts which keep running
through my mind.

When a man is with a woman he is usually thinking about
things related to her sex.

I must admit that I have a bad temper, once I get angry.

200

Displacement (Male)

(Continued)

Item # Test Item

252. I sometimes feel that I am a burden to others.

257. I often feel as though I have done something wrong or wicked.

258. In school I found it very hard to talk before the class.

262. There have been a few times when I have been very mean to another
person.

340. Our thinking would be a lot better off if we would just forget
about the words like "probably," "approximately," and "perhaps."

369. i seem to do things that I regret more often than other people

0.

407. I have had no difficulty in starting or holding my bowel move-
ment.

413. I get all the sympathy I should.

416. I don't think I'm quite as happy as others seem to be.

417. Any job is all right with me, so long as it pays well.

419. It often seems that my life has no meaning.

436. I never cared much for school.

450. I get sort of annoyed with writers who go out of their way to
use strange and unusual words.

456. I have more trouble concentrating than others seem to have.

463. It is hard for me just to sit still and relax.

471. I sometimes feel that I do not deserve as good a life as I have.

Item #

25.

32.

71.
76.
77.

81.

94.

121.

149.

153.
161.
214.
224.
232.

247.

248.
252.

257 O

201:
Haan's Defending Scales (CPI):

Displacement (Female)

Test Item

Our thinking would be a lot better off if we would just forget
about words like "probably," "approximately," and "perhaps."

Clever, sarcastic people make me feel very uncomfortable.

I tend to be on my guard with people who are somewhat more
friendly than I hav expected.

I get excited very easily.
I often feel as if the world was just passing me by.
When I get bored I like to stir up some excitement.

I must admit I often try to get my own way regardless of what
others may want.

With things going as they are, it's pretty hard to keep up hope
of amounting to something.

I was a slow learner in school.

I consider a matter from every stanpoint before I make a
decision.

If I am not feeling well I am somewhat cross and grouchy.

I am sometimes cross and grouchy without any good reason.

In school I was sometimes sent to the principal for cutting up.
I usually expect to succeed in things I do.

Sometimes I feel that I am about to go to pieces.

When a man is with a woman he is usually thinking about things
related to her sex.

I must admit that I have a bad temper, once I get angry.
I sometimes feel that I am a burden to others.

I often feel as though I have done something wrong or wicked.

202

Displacement (Female)

(Continued)

Item # Test Item

258. In school I found it very hard to talk before the class.

262. .There have been a few times when I have been very mean to
another person.

340. Our thinking would be a lot better off if we would just forget
about words like "probably," "approximately," and "perhaps."

369. I seem to do things that I regret more often than other people
do.

407. I have had no difficulty in starting or holding my bowel move-
ment.

416. I don't think I'm quite as happy as others seem to be.

419. It often seems that my life has no meaning.

436. I never cared much for school.

456. I have more trouble concentrating than others seem to have.

463. It is hard for me just to sit still and relax.

471. I sometimes feel that I do not deserve as good a life as I have.

Item #

11.

18.

19.

75.

87.

88.

92.

100.

113.

121.

123.

128.

141.

152.

160.

186.

210.

211.

217.

2013
Haan's Defending Scales (CPI):

Reaction Formation (Male)

Test Item
I enjoy social gatherings just to be with people.

People can pretty easily change me even though I thought that my
mind was_already made up on a subject.

A person who doesn't vote is not a good citizen.
I think I would like the work of a building contractor.

We ought to worry about our own country and let the rest of the
world take care of itself.

I like adventure stories better than romantic stories.
I do not like to see people carelessly dressed.

People often expect too much of me.

I prefer a shower to a bathtub.

School teachers complain a lot about their pay, but it seems to
me that they get as much as they deserve.

I was a slow learner in school.

I think I am stricter about right and wrong than most people.

It takes a lot of argument to convince most peOple of the truth.
Parents are much too easy on their children nowadays.

I read at least ten books a year.

I would like to hear a great singer in an opera.

I usually don't like to talk much unless I am with people I
know very well.

I very much like hunting.

I have frequently found myself, when alone, pondering such ab-
stract problems as freewill, evil, etc.

I think I would like the work of a librarian.

204

Reaction Formation (Male)

(Continued)

Item # Test Item

219. Most people inwardly dislike putting themselves out to help
other people. -

244. If I were a reporter I would like very much to report news of
the theater.

249. I like mechanics magazines.

258. In school I found it very hard to talk before the class.

264. I would be very unhappy if I was not successful at something I
had seriously started to do.

269. I like science.

293. Every now and then I get into a bad mood, and no one can do
anything to please me.

389. I get pretty discouraged with the law when a smart lawyer gets a
criminal free.

395. It is very important to me to have enough friends and social life.

400. I think I am stricter about right and wrong than most people.

404. I am in favor of a very strict enforcement of all laws, no
matter the consequences.

418. I am embarrassed with people I do not know well.

443. I'm not the type to be a political leader.

Item #

11.

18.
19.
37.

75.

87.
88.
92.
100.

113.

121.
123.
141.
152.
160.
161.
163.

186.

210.

205
Haan's Defending Scales (CPI):

Reaction Formation (Female)

Test Item
I enjoy social gatherings just to be with people.

People can pretty easily change me even though I thought that
my mind was already made up on a subject.

A person who doesn't vote is not a good citizen.
I think I would like the work of a building contractor..
I have very few fears compared to my friends.

We ought to worry about our own country and let the rest of the
world take care of itself.

I like adventure stories better than romantic stories.
I do not like to see people carelessly dressed.

People often expect too much of me.

I prefer a shower to a bathtub.

School teachers complain a lot about their pay, but it seems to
me that they get as much as they deserve.

I was a slow learner in school.

I think I am stricter about right and wrong than most people.
Parents are much too easy on their children nowadays.

I read at least ten books a year.

I would like to hear a great singer in an opera.

I am sometimes cross and grouchy without any good reason.

I like parties and socials.

I usually don't like to talk much unless I am with people I
know very well.

I very much like hunting.

206

Reaction Formation (Female)

(Continued)

Item # Test Item

211. I have frequently found myself, when alone, pondering such ab-
stract problems as freewill, evil, etc.

217. I think I would like the work of a librarian.

244. If I were a reporter I would like very much to report news of
the theater.

249. I like mechanics magazines.

258. In school I found it very hard to talk before the class.

264. I would be very unhappy if I was not successful as something I
had seriously started to do.

269. I like science.

293. Every now and then I get into a bad mood, and no one can do any-
thing to please me.

322. I do not like to loan my things to people who are careless in
the way they take care of them.

389. I get pretty discouraged with the law when a smart lawyer gets
a criminal free.

395. It is very important to me to have enough friends and social life.

400. I think I am stricter about right and wrong than most people.

404. I am in favor of a very strict enforcement of all laws, no matter
what the consequences.

443. I'm not the type to be a political leader.

480. I must admit it would bother me to put a worm on a fish hook.

Item #

4.

5.

17.
18.
25.
28.

41.

45.

73.

76.

86.

88.

89.

97.
121.
124.
152.

159.

1207
Haan's Defending Scales (CPI):

Repression (Male)

Test Item
A person needs to "show off" a little now and then.

Our thinking would be a lot better off if we would just forget
about words like "probably," "approximately," and "perhaps."

When in a group of people I usually do what the others want
rather then make suggestions.

I would like to be a journalist.

A person who doesn't vote is not a good citizen.

Clever, sarcastic people make me feel very uncomfortable.
I think I would like the work of a dress designer.

For most questions there is just one right answer, once a person
is able to get all the facts.

As a child I used to be able to go to my parents with my problems.

Maybe some minority groups do get rough treatment, but it's no
problem of mind.

I often feel as if the world was just passing me by.

Most of the arguments or quarrels I get into are over matters
of principle.

I do not like to see people carelessly dressed.

Once a week or oftener I feel suddenly hot all over, without
apparent cause.

I would like the job of a foreign correspondent for a newspaper.
I was a slow learner in school.

I am likely not to speak to people until they speak to me.

I read at least ten books a year.

I feel nervous if I have to meet a lot of people.

Repression (Male)

(Continued)

Item # Test Item

187. 1 am inclined to take things hard.

210. I very much like hunting.

211. I have frequently found myself, when alone, pondering such ab-
stract problems as freewill, evil, etc.

213. It makes me angry when I hear of someone who has been wrongly
prevented from voting.

229. I much prefer symmetry to asymmetry.

242. I am a good mixer.

244. If I were a reporter I would like very much to report news of
the theater.

292. I used to like it very much when one of my papers was read to
the class in school.

295. I would be willing to give money myself in order to right a wrong,
even though I was not mixed up in it in the first place.

305. . I often wish people would be more definite about things.

320. I would be willing to describe myself as a pretty "strong"
personality.

361. I like to have a place for everything and everything in its place.

399. At times I have been so entertained by the cleverness of a crook
that I have hoped he would get by with it.

429. Even the idea of giving a talk in public makes me afraid.

Item #

17.
18.
25.
28.

41.

45.

73.

76.

86.

88.

97.
121.
124.
152.
187.
209.

210.

209
Haan's Defending Scales (CPI):

Repression (Female)

Test Item
A person needs to "show off" a little now and then.

Our thinking would be a lot better off if we would just forget
about words like "probably," "approximately," and "perhaps."

When in a group of people I usually do what the others want rather
than make suggestions.

I would like to be a journalist.

A person who doesn't vote is not a good citizen.

Clever, sarcastic people make me feel very uncomfortable.
I think I would like the work of a dress designer.

For most questions there is just one right answer, once a person
is able to get all the facts.

As a child I used to be able to go to my parents with my problems.

Maybe some minority groups do get rough treatment, but it's no
business of mind.

I often feel as if the world was just passing me by.

Most of the arguments or quarrels I get into are over matters
of principle.

I do not like to see people carelessly dressed.

I would like the job of a foreign correspondent for a newspaper.
I was a slow learner in school.

I am likely not to speak to people until they speak to me.

I read at least ten books a year.

I am inclined to take things hard.

Most people are honest chiefly through fear of being caught.

I very much like hunting.

.210

Repression (Female)

(Continued)

Item # Test Item

211. I have frequently found myself, when alone, pondering such ab-
stract problems as freewill, evil, etc.

213. It makes me angry when I hear of someone who has been wrongly pre-
vented from voting.

244. If I were a reporter I would like very much to report news of
the theater.

284. It is hard for me to act natural when I am with new people.

292. I used to like it very much when one of my papers was read to
the class in school.

295. I would be willing to give money myself in order to right a wrong,
even though I was not mixed up in it in the first place.

320. I would be willing to describe myself as a pretty "strong"
personality.

361. I like to have a place for everything and everything in its place.

399. At times I have been so entertained by the cleverness of a crook
that I have hoped he would get by with it.

429. Even the idea of giving a talk in public makes me afraid.

459. My sleep is fitful and disturbed.

APPENDIX G

STRESS MANAGEMENT BEHAVIORAL CHECKLIST

2 11

STRESS MANAGEMENT BEHAVIORAL CHECKLIST

Name Date

 

Age Sex Height Weight

 

 

Muscular Frame: Large Medium Small

Recommended body build and weight (see chart)

 

Do you live in an urban or rural environment?

 

In the past five weeks:
Number of days missed at work due to physical illness
Number of days missed at work due to "mental health"

Number of confrontations with people in work setting

Pulse rate active

resting

 

Blood pressure _____ / _____

l.

2.

10.

ll.

2 12

NUTRITION

Circle the response which most applies to you:

I thoroughly chew my food before swallowing:
a) always b) usually 0) rarely d) never

I take time for leisurely, relaxing meals:
a) always b) usually c) rarely d) never

I avoid foods which are high in fats and carbohydrates:
a) always b) usually c) rarely ' d) never

I avoid processed foods whenever possible:
a) always b) usually 0) rarely d) never

I add salt to my food:
a) never b) rarely c) usually d) always

I try to nutritionally balance my meals and/or supplement them
with vitamins when necessary:

a) always b) usually 0) rarely d) never

I eat an average of cakes, pastries, or other high energy
foods (not including chocolate bars) per day:

a) 0-1 b) 2-3 0) 4-5 d) 6+

I drink an average of 12 ounce cola beverages per day:

a) 0-1 b) 2-3 o) 4-5 d) 6+ .

I use an average of tablespoons of refined sugar per day:
a) 0-1 b) 2-3 c) 4-5 d) 6+

I drink an average of cups of coffee or tea (not including
herbal teas) per day:

a) 0-1 b) 2-3 0) 4-5 d) 6+

I eat an average of one ounce chocolate bars per week:
a) 0-1 b) 2-3 0) 4-5 d) 6+

(2)

213

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12. I smoke an average of cigarettes per day:
a) 0-10 b) 11-20 c) 21-30 d) 31-40+
13. I eat meat (beef, pork, hamburger, etc., but not including
poultry times per week:
a) 0-3 b) 4-7 c) 8-11 d) 12-16+
I4. I eat at fast food chains an average of times per week:
a) 0-1 b) 2-3 o) 4-5 d) 6+
15. I drink an average of alcoholic beverages (liquor, wine,
beer) per week:
a) 0-1 b) 2-3 c) 4-5 d) 6+
16. Drugs or medication other than caffeine or alcohol per week
(include dose where possible):
a) aspirin
b) amphetamines (pep pills, diet pills)
c) tranquilizers (sleeping or nerve pills, eg:
"Miltown",'Librium", "Seconal")
d) pain pills (codeine, "Demerol", etc.)
e) antihistamines or allergy pills
f) marijuana or other non-classified
17. Write the number of servings that you eat from each of the
. food groups on an average day:
Food Group i of Servings:-
Breakfast: fruits and vegetables
meats and cheese
breads and cereals
dairy products
Lunch: fruits and vegetables
meats and cheese
breads and cereals
dairy products
Dinner: fruits and vegetables
meats and cheese
breads and cereals
. dairy products
Snacks: fruits and vegetables

 

meats and cheese
breads and cereals
dairy products

(3)

 

 

 

1

h 0

10.

ll.

12.

13.

 

214
PSYCHOLOGICAL
I am bored:
a) never b) rarely c) usually
I understand my feelings:
a) always b) usually c) rarely

. I share my feelings with others:

a) always b) usually c) rarely

I feel fatigued:
a) never b) rarely c) usually

I feel like I have control over my life:
a) always b) usually c) rarely

. I worry (am preoccupied):

a) never b) rarely c) usually

I am easily annoyed by little things:
a) never b) rarely 0) usually

I perceive myself as being in a crisis situation:

a) never b) rarely c) usually

d)

d)

d)

d)

,d)

d)

d)

Basically, I feel like I enjoy myself and the world:

a) always b) usually 0) rarely

I enjoy my work:
a) always b) usually 0) rarely

I get along well with my boss:
a) always b) usually c) rarely

I get along well with my colleagues:
a) always b) usually c) rarely

I feel rushed:
a) never b) rarely c) usually

(4)

d)

d)

d)

d)

always

never

never

always

never

always

always

always

never

never

never

never

always

14. I find it easy to relax when I have time on my hands:
a) always b) usually c) rarely d) never
15. When I have a problem I talk about it with a friend or colleague:
a) always b) usually c) rarely d) never
16. I find sufficient time to finish my work:
a) always b) usually c) rarely d) never
17. I am anxious when I don't have anything to keep me busy:
a) never b) rarely 0) usually d) always
18. When under pressure I tend to loose my temper:
a) never b) rarely c) usually d) always
PHYSICAL
I. I have trouble falling and/or staying asleep times per week:
a) 0—1 b) 2-3 c) 4—5 d) 6+
2. I have a nervous stomach times per week:
a) 0-1 b) 2-3 c) 4—5 d) 6+
3. I experience constipation or diarrhia times per week:
a) 0-1 b) 2-3 c) 4—5 d) 6+
4. I experience headaches or muscle tension times per week:
a) 0-1 b) 2-3 c) 4-5 d) 6+
5. I get cold hands and/or feet times per week:
a) 0-1 p b) 2-3 c) 4-5 d) 6+
6. I bite my nails or grit my teeth about times per week:
a) 0-1 b) 2-3 o) 4-5 d) 6+
7. I get cold symptoms an average of times per week:
a) 0-1 b) 2-3 0) 4-5 d) 6+
8. I am short of breath about times per week:

215

a) 0-1 b) 2-3 c) 4-5 d) 6+

(5)

216

9. I experience muscle tension headaches times per week:
a) 0-1 b) 2-3 G) 4-5 d) 6+
10. I suffer from skin problems:
a) never b) rarely 0) usually d) always

11.

I climb the stairs rather than ride the elevator:

a)

always b) usually c) rarely d) never

If possible I would rather walk than ride:

a)

always b) usually c) rarely d) never

How many hours per day do you engage in:

a)

b)
o)
d)
e)
f)
s)
h)
i)
j)

k)

l)
m)

n)

relaxation exercises (examples include meditating,
deep breathing, yoga, totally quiet relaxation,
biofeedback, autogenic training, etc.)

 

sleeping

 

sitting

 

driving

 

reading

 

eating

 

talking

 

listening

 

watching television or movies

 

active moderate physical work ( eg:
washing the car, housework, employment)

walking:
slowly
moderately
very quickly

 

 

 

 

jogging or running

 

recreation or competitive sports (tennis,
racketball, swimming, football, etc.)

 

exercises, calisthetics, aerobics
other

 

 

 

(6)

217

DESIRABLE HEIGHT AND WEIGHT CHART*

MEN

Height
(with 1" shoes)

Small Medium Large
Ft In. Frame Frame Frame
5 2 112-120 118-129 126-141
5 3 115-123 121-133 129-144
5 4 118-126 124-136 132-148
5 5 121-129 127-139 135-152
5 6 124-133 130-143 138-156
5 7 128-137 134-147 142-161
5 8 132-141 138-152 147-166
5 9 136-145 142-156 151-170
5 10 140-150 146-160 155-174
5 11 144-154 150-165 159-179
6 0 148-158 154-170 164-184
6 1 152-162 158-175 168-189
6 2 156-167 162-180 173-194
6 3 160-171 167-185 178-199
6 4 164-175 172-190 184-204

WOMEN

Height
(with 2" shoes)

Small Medium Large
Ft In. Frame Frame Frame
4 10 92-98 96-107 104-119
4 11 94-101 98-110 106-122
5 0 96-104 101-113 109-125
5 1 99-107 104-116 112-128
5 2 102-110 107-119 115-131
5 3 105-113 110-122 118-134
5 4 108-116 113-126 121-138
5 5 111-119 116-130 125-142
5 6 114-123 120-135 129-146
5 7 118-127 124-139 133-150
5 8 122-131 128-143 137-154
5 9 126-135 132-147 141-158
5 10 130-140 136-151 145-163
5 11 134-144 140-155 149-168
6 0 138-148 144-159 153-173

* Weight in pounds according to frame, in indoor clothing.
For nude weight, deduct 2 to 4 pounds.

APPENDIX H

RADIO ANNOUNCEMENT

218

212 East Point Lane, E-7
East Lansing, MI 48823

March 6, 1981

Ms. Diane Hutchens

Public Service Director
WKAR Radio

310 Auditorium

Michigan State University
East Lansing, MI 48824

Dear Ms. Hutchens:

I am a graduate student in the Department of Counseling and
Educational Psychology at Michigan State.

I will be providing free stress management workshops to the
East Lansing and MSU community during spring term, 1981 as part
of my dissertation research.

Please include the following public service message on your
station from.March 15 to April 1:
Stress management workshops will be offered to
people in the WKAR listening area. The workshop
is free of charge. Call Michael Athans at 332-6299
for more details.

I would appreciate repeating the announcement as often as
possible. Thank you for your cooperation. If you have any questions,
please feel free to contact me at the above number.

Sincerely,

Michael J. Athans

APPENDIX I

NEWSPAPER ANNOUNCEMENT

219

NEWSPAPER ANNOUNCEMENT

 

Stress management workshops emphasizing a holistic
approach will be offered free of charge to people in the
Greater Lansing community. Contact Michael Athans at

332-6299 for details.

APPENDIX J

LETTER OF CONSENT TO PARTICIPATE

220

STRESS MANAGEMENT WORKSHOP

I understand the nature of this workshop and
would like to participate in it. I realize that no
beneficial effects are guaranteed. As part of this
workshop I will take paper and pencil inventories
and will allow for periodic blood pressure readings:
I understand this information is for research
purposes only and is wholly confidential. Should I
decide at any time to no longer participate in this

study I may do so.

 

 

Name Date

APPENDIX K

TREATMENT

II.

III.

IV.

221

OUTLINE OF WORKSHOP PRESENTATION

What is Stress?

A.
B.
C.
D.

According to Traditional Medicine
The Concept of "Wellness"

Hans Selye's Definition

Stress and Heart Disease

1. Arteriosclerosis

2. Atherosclerosis

3. Myocardial Infarction

4. Blood Pressure

The Psychophysiology of Stress

What are Some Potential Stressors?

A.

IDISmall Group Interaction, Discuss:
1. When does stress occur?

2. Where?

3. Why?

4. With whom?

5. How did you feel about it?

6. What can be done to change it?

Administer the Holmes and Rahe Social Adjustment Scale,
then discuss internal and external sources of stress

Type A Personality and Heart Disease

Psychological Coping and Defending

A.
B.
C.
D.
E.

The Expression of Emotions as an Outlet
The Defenses

Lazarus on Stress, Coping and Defending
Defense Mechanisms

Coping Mechanisms

VI.

VII.

VIII.

IX.

F.
G.

222

Hinkle on Stress and Coping
The Pearlin and Schooler Study

Self-Help Techniques

A.
B.
C.
D.

Biofeedback
Concentration
Deep Relaxation
Meditation

The Importance of Physical Exercise

Nutrition

A.
B.
C.
D.
E.
F.
G.
H.
I.
J.

The Importance of a Well-balanced Diet
Proteins

Carbohydrates

Fats

Fiber

Cholesterol and Lippoprotein Levels
Eating Habits

A Well-balanced Diet

(The Effects of Alcohol on the Nervous System

The Effects of Caffeine

Summary and Conclusion of the Holistic Approach to

Stress Management

223
I. What is Stress?

Traditional medicine has its foundations in illness.
Symptoms are seen as physical and require alleviation through
surgery, medication and other physical remedies, with nutrition
and psychology not part of the medical model.

Wellness, on the other hand, is a way of life. It is a
life-style you design in order to achieve your highest
potential for well-being. Wellness is more than just the
absence of illness--it is a holistic concept, incorporating
the*whole person. To maximize well-being, one's physical,
emotional, spiritual, and cognitive domains must interact to
create mind-body oneness. For wellness, then, you must:

1. Know what your needs are and how to satisfy them.

2. Express your emotions to communicate what you are
experiencing to others.

3. Be "attuned" to your body's signals emotionally and
physically.

 

4. Keep your body functioning properly to avoid deficits
in particular domains, as this will drain the entire
body. Thus, proper nutrition, physical exercise, in-
tellectual stimulation and the expression of emotions
are necessary to keep the body in harmony. Time to
think and meditate is important.

Hans Selye, a well-known physiologist states that stress
is both positive and negative on the human system. Stress is
any demand made upon the body, with complete freedom from
stress just as detrimental to the body as too much stress.

The physiological consequences of stress on the body may
result in high blood pressure, arteriosclerosis, myocardial
infarction, atherosclerosis, gastric ulcers, mental illness
and other diseases.

Arteriosclerosis is a thickening and hardening of the
arterial walls. It is caused by a gradual deposit of calcium
on the interior of the arteries.

 

Atherosclerosis is an advanced type of hardening and is
due to the buildup of cholesterol or fatty deposits in the
arterial walls. This disease usually affects the aorta,
heart, brain, arteries and other blood vessels. The etiology
of this most prevalent disorder of mankind is still unknown
but is found to be most common in affluent areas of the
world, and it becomes more prevelant with age. Robbins and
Angell (1976) believe the high prevalence of atherosclerosis
found in the United States, England, Australia, New Zealand,
and the Scandinavian countries compared to the low figures

 

224

in Central and South America and the economically poor
populations in Africa and India is due to environmental
rather than genetic differences. Not all members of
affluent areas of the world and increasing age develop
atherosclerosis. In fact, the authors state that within the
same town, people 80 years old have less extensive athero-
sclerosis than those 30 years old. Important predisposing
factors for atherosclerosis include:

1. elevated serum lipoproteins
2. increasing blood pressure

3. cigarette smoking

4. elevated blood sugar levels.

Two or more of these risk factors create a larger risk than
any one factor; however, the presence of all four risk factors
increasestfluaprobability of developing coronary heart dis-
ease thirteen times of the control population (Kannel, 1974).

The above predisposing factors appear to be beyond our
control in that three of the four are physical and internal,
leaving only cigarette smoking as a risk over which we have
direct control. In fact, however, lipoproteins, increased
blood sugar levels and increasing blood pressure are very
much a function of our diet and lifestyles, which we tend to
perceive as uncontrollable.

Recent evidence suggests that Type A personality life
styles, lack of regular physical exercise, poor diet, stress,
(hypertension and smoking) are also predisposing toward heart
disease. The research on obesity is conflicting at this
point. High intake of saturated fats has also been known to
be predisposing toward heart disease; however, there is some
controversy over saturated versus unsaturated fat intake.

Myocardial infarction is also a form of heart disease
in which 95 percent of the cases suffer from atherosclerosis.
One of the causes of this condition is a lesion or obstruction
in the.zterial wall, eventually producing a heart attack. If
there is no occlusion, sudden increases produced by physical
or emotional stress may lead to myocardial infarction.

Bloodgpressure is the force a heart uses to push blood
through the arteries. When the heart contracts, the pressure
of the blood increases-~this is systolic blood pressure.
Whentfluaheart relaxes between beats, the pressure levels off--
This is diastolic pressure. Salt intake, phsyical and
emotional stress are particularly critical to blood pressure.

 

 

225

All Y '..‘ "

DEVELOPMENT OF ATHEROSCLEROSIS
i

 

 

 

Blood Passageway

  

Arterial Wall

 

Advanced Stage

Normal Artery Beginning Stage -

 

226
II. The Psychophysiology of Stress
A. The Nervous System
1. Central Nervous System (CNS)
A. Brain

1. Forebrain
a. Telencephalon (endbrain)
l. Neocortex
2. Basal Ganglia
3. Limbic System

2. Midbrain

3. Hindbrain
a. Cerebellum
b. Pons
c. Medulla Oblongata

B. Spinal Cord
2. Peripheral Nervous System
A. Somatic

B. Autonomic
l. Sympathetic '
2. Parasympathetic

227

The Central Nervous System is composed of the brain and
spinal cord. This includes the "grey matter" and the sensory
areas (the cranial nerves) that help us interpret stimuli
from our environment. Odors, for example, go through our
nose and are interpreted bytfluabrain, and are then categor-
ized into familiar or unfamiliar. This process occurs for
taste, touch, and hearing as well.

 

The Brain Stem Reticular Formation is part of the CNS.
The reticular formation extends all the way to the rear of
the medulla up into the midbrain and the hypothalamus part
of the forebrain. The reticular formation system is important
because it is believed to function in governing the activity
of the brain through increasing arousal and alertness.

 

The Peripheral Nervous System contains all the neural
tissue outside the CNS. This includes the autonomic system
(sympathetic and parasympathetic) and the somatic system.

 

When we talk about stress, it is the autonomic nervous
system which is important, along with the reticular acti-
vating system. The autonomic system contains cells and
fibers which innervate the internal organs, glands, and
smooth muscles. The Sympathetic and Parasympathetic Systems
act in opposition to each other. The sympathetic nerves are
associated with energy expenditure and emergency reactions.
These smooth muscles contract to chemicals, constricting
voluntary muscles and activating the endocrine system. The
Parasympathetic System of smooth muscles is associated with
rest, digestion, and energy conservation. The Sympathetic
and Parasympathetic parts of the Autonomic Nervous System
are important because when a stressor is perceived by the
cortex, the Autonomic system reacts "automatically" by
constricting or dilating the sympathetic and parasympathetic
systems.

 

Also in response to stress, glands in the endocrine
system are stimulated by hormones which maintain the stress
reaction. These glands include the hypothalamus, pituitary,
thyroid, adrenals and gonads. Thyroxine and adrenalin
maintain the stress reaction by dilating the arteries of the
heart, accelerating heart rate, and increasing blood
circulation. Because extra blood is needed for the heart,
blood flow is minimized to the hands and feet, leaving blood
in the trunk and head, where it is most needed. The result
is cold hands and feet, and sweat production induced by the
sympathetic systems.

It is the muscle tension that one feels when stressed.
Although the tension may not be felt directly, it leaves the
body drained at the end of a day. Over a period of time
this will have degenerative effects.

228

The Autonomic System is important to us because it is
one of the few parts of the body over which we have direct
control. Meditation, biofeedback, and other self-help
techniques are methods of directly reducing muscle tension
and hormones released in the body. This workshop will focus
on these techniques along with proper nutrition, physical
exercise, and an understanding of the coping and defense
styles we use.

229

III. What are Some Potential Stressors?

A.

In small group interaction, discuss:

1. When does stress occur?

2. Where?

3. Why?

4. With whom?

5. How did you feel about it?

6. What can be done to change it?

7. Are you more stressful at home or at work?

8. How do you typically resolve these situations?
Are they recurring?

9. Is the stress perceived as internal or external?

Administer the Holmes and Rahe Social Adjustment
Scale.

1. Review external factors--how much control of them
do we have?

2. What about internal stress--how much control do
we have?

3. Introduce coping and defending styles in refer-
ence to the expression of emotions.

‘ r flu"?

 

230

THE HOLMES AND RAHE SOCIAL READJUSTMENT RATING SCALE

EVENT VALUE
Death of a spouse 100
Divorce 73
Marital separation 65
Jail term 63
Death of a close family member 63
Personal injury or illness 53
Marriage 50
Fired from work 47
Marital reconciliation 45
Retirement 45
Change in family member's health 44
Pregnancy - 40
Sex difficulties 39
Addition to family 39
Business readjustment ' 39
Change in financial status 38
Death of a close friend 37
Change to a different line of work 36
Change in number of marital arguments 35
Mortgage or loan over $10,000 31
Foreclosure of mortgage or loan 30
Change in work responsibilities 29
Son or daughter leaving home 29
Trouble with in-laws 29
Outstanding personal achievement 28
Spouse begins or stops work 26
Starting or finishing school 26
Change in living conditions 25
Revision of personal habits 24
Trouble with boss 23
Change in work hours, conditions 20
Change in residence 20
Change in schools 20
Change in recreational habits 19
Change in church activities 19
Change in social activities 18
Mortgage or loan under $10,000 17
Change in sleeping habits 16
Change in # of family gatherings 15
Change in eating habits 15
Vacation 13
Christmas season 12

Minor violation of the law 11

231
IV. Type "A" Personality

The term "Type A Personality" was coined by Friedman and
Rosenman in a study of heart disease. Type A Personality
behavioral patterns are precursers to chronic heart disease.
They include such personality attributes as hard driving,
aggressive striving fixrachievement, competitiveness, impa-
tience, restlessness, a continual state of alertness and
consistently hurried activity. In this study, those subjects
rated through structured interviews to be Type A at the
onset of the study had twice the rate of coronary heart
disease, were five times as likely to have a second
myocardial infarction and had twice the rate of fatal heart
attacks as compared to Type B (absence of Type A behavioral
patterns). This amount of risk is approximately equal to
that produced by elevated blood pressure, cholesterol, or
cigarette smoking.

Signs of the Type A personality include:

1. thinking of or doing more than two things at once;

2. scheduling more activities into less time;

3. failure to notice or be interested in your
environment or things of beauty;

4. hurrying the speech of others;

5. becoming irritated when forced to wait in line or
when driving behind a car you think is moving too
slowly;

6. believing if you want something done well, you have
to do it yourself;

7. having difficulty sitting and doing nothing;

8. playing nearly every game to win, even when playing
with children; ~

9. measuring success by numbers (quantity vs. quality).

Suggestions for changing Type A behavior begin with an
observation of behaviors with the related feelings. See
"Suggestions for Changing Type A Behavior."

10.

11.

12.

13.

14.

232
SUGGESTIONS FOR CHANGING TYPE A BEHAVIOR*

Recognize "hurry sickness." If recognized you will be
better prepared to alter it.

Endurance. Remember changing a habit takes time.

Each morning, noon and mid-afternoon remind yourself that
life is always an "unfinishedness."

Begin in your vocational hours to listen quietly to the
conversation of others. Expose yourself to slow down
maneuvers and tactics.

Quit trying to think of more than one thing at a time.

If you see someone else doing a job slower than you know
you can do it, don't interfere with him unless you are
positive he can't do the job at all.

Never forget when confronted by a task to ask yourself
the following:

a. Will this matter have importance five years from now?
b. Must I do this rightrxnvor do I have enough time to
think about the best way to accomplish it?

Make it a habit to ask yourself before you begin to speak:

a. Do I really have anything important to say?
b. Does anyone want to hear it?
c. Is this the time to say it?

Tell yourself at least once a day that no enterprise ever
failed because it was executed too slowly, too well.
(Remember, haste makes waste.)

Shy away from deadlines at definite times if possible
(Nightly arrival at home should be elastic).

Carry reading materials with you so if you have to wait
(at the airport, barber shop, etc.) you won't fret.

Remember to protect you own allotment of time; no one else
will.

Resist from projecting your own sense of time urgency upon
those with whom you come in contact.

Purposely, with a companion, frequent restaurants and
theaters where there will be a period of waiting,
concentrate on conversation instead of impatience at
having to wait.

 

 

 

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

233

When you are following a car whose speed seems too slow,
penalize yourself by not passing it even when you are
able to do so.

Attempt to read books that demand not only your entire
attention, but also a certain amount of patience.

Learn to interrupt long session of any activity that you
know or suspect may induce tension and stress. Take a
break before continuing. This will break the interior
tension.

Begin to speak your thanks or appreciation to others when
they have performed services for you.

Begin to smile at as many persons as often as you can.
Concentrate on making your own character one of worth.

Drill yourself in improving your speech, expanding your
vocabulary. Learn more words, expand your mind and
thinking processes.

Drill yourself in the art of holding opinions loosely.
Don't become angry when others vary.

Refrain from saying "I told you so." It tends to arouse
hostility in other people.

Continue to seek some'floneliness" for yourself. Use it
to acquire the things worth being.‘

Find time to consolidate a few friendships into firm and
spiritually rewarding intimacies. Remember living
things provide joy. -

Allocate time for reading, pursuing interests, visiting
museums, galleries and theaters. Take time to recall
the past.

Finally, persist in drilling yourself in these exercises.
Remember success is the ability to survive failure.
Forming new habits takes time.

*Adapted from "Type A Behavior and Your Heart" by

Meijer Friedman, M.D. and Ray H. Rosenman, M.D.

 

234

 

V. Psychological Coping and Defending

A. The Expression of Emotions as an Outlet

Perceive - feel

 

LNE'E‘ a ., OUTPUT: -
V’
Senses Talk (communication
Sight \~/’ skills)‘
smell Sensory . . .
touch Awarenes Exhibit BehaViors
tight control of
taste .
hear emotions
appropriate control
Food loose control
Water Sweat
Oxygen Eliminate

 

 

Input consists of all thatvmemay possibly take into our
body. This, of course, includes food, water, and oxygen, but
we also take much in via the senses, by hearing, seeing,
touching, and tasting the environment. Our perceptions are
a cognitive awareness, i.e., that which we do to better
understand our environment. This perceiving is transformed
chemically to induce our feeling states.

The output part of the total system includes talking,
sweatingannieliminating, but also use of affect in behavioral
modes after processing in the cognitive domain. Our percep-
tual awareness determinestflmelevel of affect which can be
expressed in the environment. For many, this means being
hyperactive or withdrawn, anxious or depressed. It is our
defensive posture which determines the expression of

235

emotionsanuiultimately how much psychological stress is
maintained in the body, thereby creating physiological
tension which may be released inappropriately by a
sudden blast of anger.

A great deal of energy is expended in attempting to
control emotions. Too much control is defensive behavior,
keeping us on guard and requiring constant attention emo-
tionallyanxiphysically. Spending energy to negate or deny
emotional feelings is draining and stressful, the end
result possibly being a number of physical and emotional
symptoms including ulcers, asthma, obesity, headaches,
depression, heart disease, and possibly cancer. When
emotions are suppressed cognitively the body has no choice
but to find outlets for their expression through physical
symptoms.

Too little control over emotions also expends energy
through temper tantrums and acting out. These emotions
can be expressed more efficiently and appropriately, with
less stress on the system. Communication is important,
then, in expressing one's feelings, as psychological games
require more energy to maintain neurotic lifestyles. An
example of this is Passive-Aggressive type behaviors.

B. The Defenses

Freud, as early as 1911, recognized that people
responded to threat by defending against it, in order to
protect the sphere of the ego. His theory on ego functioning
and the use of defenses has since been expanded upon by
Anna Freud (1936) and many others. Freud used the term
"conscious" and "ego" interchangably. The ego develops as
the organism changes from primary process, which is the
infant's need for immediate gratification, to secondary
process, where thought,perception, memory, language and
delay are incorporated into the structures of the young
child through the normal process of growth and maturation.
The ego, in incorporating these functions, acts to mediate
the perception and comprehension of external and internal
stimuli. It respondstx>anxiety and conflict by employing
countercathetic energy to keep these stressful stimuli out
of consciousness through the use of defenses. The ego, then,
can be seen as a mediator of the external world and its
demands, and its internal frame of reference. Defenses
are used in this capacity to lessen the discrepancy between
these two realities.

Conflict, anxiety, and their defenses are often
resolved through repression, but may reproduce the stress
in the disguised form of a symptom. Continued use of de-
fenses suggests a stressed state in the individual with
psychosomatic illness or conversion reactions possible
long-term side effects.

236
C. Lazarus on Stress, Coping and Defending

Psychological stress is the result of cognitive appraisal
of threat to the system. The threat must be anticipated or
future oriented as a result of the processes of perception,
learning, memory, judgment and thought. The appraisal is
thus more than just a perception—-it includes an inference
from the environment.

 

 

Coping is a response to the above threat. It is defined
as any response to external life stressors that seems to
prevent, avoid, or control emotional distress. This is what
poeple g9 with stress.

 

Defending is a part of the coping process in which the
individual psychologically deceives himself about the
condition of the threat. Defenses act to distort the
threatening experience so they are less dangerous to the
individual.

 

237

D. Psychological Defense Mechanisms

Acting Out-—Directly expressing an unconscious wish or
impulse to avoid being conscious of the feeling involved.
It is impulsive to avoid the tension involved.

 

Controlling--Excessively attempting to manage or regulate
events in the environment to minimize anxiety.

 

Denial--Seeing or hearing a reality but refusing to accept it.

Distortion--Grossly reshaping external reality to suit inner
needs.

 

Dissociation--Temporary but drastic modification of personal
identity to avoid emotional distress.

 

Hypochondriasis--Complaints about body pain and somatic
symptoms which are exaggerated or nonexistent.

 

Intrgjection--Internalizing the characteristics of someone
withtflmagoaI of establishing closeness and constant presence
of the person.

 

Intellectualization--Control of affect and impulses by
thinking of them instead of experiencing them, to control
anxiety.

 

Isolation--Separating affect from content, thereby repressing
the affect.

 

Passive-Aggressive Behavior--Indirectly and passively being
aggressive toward someone.

 

Projection--Placing your own attitudes and feelings on
someone else.

 

Rationalization--Justifying attitudes, beliefs, or behavior
that may otherwise be unacceptable by an incorrect application
of justifying reasons or the invention of a convincing fallacy.

 

Reaction Formation--Management of unacceptable impulses by
permitting expression of the impulse in antithetical form.

 

Repression--Making an idea or feeling which was once
conscious awareness into unconsciousness so it is not remembered.

 

Regression--Returning to an earlier stage of development to
avoid the anxiety of a present stage.

 

238
E. Mature Defenses--Coping Styles

Altruism--Vicarious but constructive and instinctually
gratifying service to others.

 

Anticipation--Planning for future inner discomfort.

 

Concentration--Ability to think and retain information about
an event or feeling for a period of time.

 

Empathy--Acceptance and understanding aboutrxnvanother
person feels.

Humor--Expressing feelings without personal discomfort and
Without unpleasant effect on others. Humor allows one to
bear and yet focus on what is too terrible to be borne.

Logical Analysis--Common sense deductions about behaviors
and events.

 

Tolerance of Ambiguity--The ability to deal with complex or
uncertain situations that do not easily yield to understanding
or control.

 

Sublimation--Gratifying a socially objectional impulse by
retaining the goal but transferring the event to one more
socially valued.

 

Substitution--A mature action of substituting or changing one
behavior or event for another.

 

Suppression--A conscious or semiconcious decision to postpone
attention to a conscious impulse or conflict.

 

239
F. Hinkle (1974)

Hinkle analyzed the personality factors distinguishing
people who were rarely ill from those with frequent illness.
He suggests that those who remain healthy show a lack of
concern for other people and life goals, and lack of
involvement in life affairs. These individuals appear to be
using their defenses to protect themselves from threatening
life experiences.

Empirical evidence supports the proposition that
increases in defensive behavior are inversely related to
threat and stress reactions (Fenz and Epstein, 1962).
Lazarus and others (1962) showed that when denial and in-
tellectualization were used defensively, subjects showed
lower levels of stress response, including autonomic levels
of arousal. This data supports the contention that the way
a person appraises and copes with an environmental stressor
has an important bearing on the emotional and adaptational
outcome and further indicates that defensive functioning
is successful in a variety of stressful situations. For
example, a seriously ill patient who denies or ignores a
diagnosis and is not willing to accept the possibility of
death, may fare better psychologically and physically than
one who accepts and succumbs (Gentry, Foster and Harvey,
1972). Friedman et al. suggest that levels of hormonal
secretion seemed totmzdependent on the success of the
defensive coping activity.

This data, along with psychoanalytic theory, suggests
that during periods of acute trauma on the psyche, people
protect themselves from the threat by using their defenses.
Although this response may help alleviate the immediate
trauma, continued defended responses to life's situations
will result in emotional and physical depletion, with the
end result possible psychosomatic illness such as headaches,
ulcers, heart disease, or hysterical conversion reactions.
Thus, in the long run, acknowledging life's stresses and
dealing with them through appropriate coping responses
outweighs the short-term defensive maneuvers.

240

G. The Pearlin and Schooler (1978) Study on Coping:

The authors

gathered information about coping responses

and psychological attitudes through scheduled interviews with

a sample of 2300

representative of the Chicago area census.

People were asked about conflicts and frustrations, what coping
responses they employed to deal with the stressors, and what

emotional stress

 

 

 

 

 

they felt. Themes were broken down into

Ehese major areas: three had to do with marriage, three

involved parenting, and four involved occupations.

 

The

 

 

authors identified three coping responses as being relevant:

1. Changing

the stressful situation acts to eliminate

 

the cause of stress.

This response was used infrequently,

perhaps because the situation was not recognized as a problem,
or because people lacked the ability or knowledge to change
environmental circumstances.

2. A coping
the situation is
rationalization,
it, etc.

 

3. Managing
things," "Things

The authors
effective way of
People unable to

 

response which does not succeed in changing
altering the meaning of the problem by
or substitution of other rewards, ignoring

"Time will change
etc.

stress attitudinally.
will work out for the best,"

 

found that occupationally the most
coping was to manipulate goals and values.
control stress in occupations will

devalue the importance of their work, with the end result
being psychological withdrawal.

In marriage

 

esteem were important means of coping.

important.

and parenting, mastery and positive self-
What one does is

 

Handouts for this section:

 

A.

B.

"Can your Emotions Kill You?" Psychology Today,
Nov 77, G. Engel.

Coping and defending mechanisms.

241

(Note: Subjects participated in a
VI. Self-Help Techniques 45-minute relaxation technique.)

A. Biofeedback is western technology's way of measuring the
autonomic changes in the body. Eastern philosophies and ways
of life have for years used meditation as a way to relax and
center themselves. Biofeedback is a way of measuring these
changes which take place by measuring EEG-—brain wave
activity and muscle tension in the forehead, temperature
fluctuations, etc. Biofeedback is a feedback loop, which
means that once the brain waves, muscle tension, or
temperature are transmitted visually or auditorily , we have
some control over the system, thereby producing a feedback
loop.

 

B. Concentration--similar to a form of meditation, where one
develops concentration on a thought or word, thereby allowing
other anxieties to approach consciousness during this focusing
technique.

 

C. Deep Relaxation--often visualization: "imagine a blue cloud
slowly moving through each part of your body." Focus on each
muscle group, tensing and relaxing.

 

D. Meditation--in a recent study, subjects were matched with
themselves on several variables. x was rest, X meditation
(TM). Results: within 5-10 minute; of the onsef of medita-
tion, oxygen consumption decreased 17%; CO elimination, 12%;
cardiac output decrease 25%; EEG increased in slow alpha waves
by 9 cps; skin resistance increased 500%.

 

The changes in heart rate, blood pressure, and skin
resistance all suggest that there are specific changes within
the functioning of the autonomic nervous system. The EEG
patterns seen during meditation distinguish sleep from
dreaming. This is a different state of consciousness in
which one is alert by relaxed.

How to meditate:

 

l. a comfortable sitting position with straight spine
is recommended;

2. pick two quiet times per day, for 20 minutes each;

3. focus your attention on one object, word, idea, etc.--
the word "one" or "om" is easy to remember. Continue
to repeat the word--you will at times lose its focus,
then regain it, as other stressful events come to the
surface of consciousness. '

Results of the above techniques:

1. calming the body, with a sense of serenity;

. heightened awareness;

. better health-~physical and emotional;

less of a need for alcohol, drugs, etc.;

lowered blood pressure, brain will show an increase
in alpha waves.

who)»

242
VII. The Importance of Physical Exercise
All exercise serves to:

Control blood circulation

Prevent heart disease

Keep your bones from weakening

Maintain your weight at a proper level

Burn off fat

Suppress appetite

Reduce anxiety and depression

Increase general fitness

Lengthen blood clotting time, preventing spontaneous
blood clotting

Lower blood pressure

Make arteries more elastic

Increase oxygen in blood

Enable heart to pump blood with less effort

Foster less physical and emotional tiredness

Physical exercise should stress the cardio-vascular system
4-5 times per week, for not less than 15 minutes. Stretching
exercises for 5 minutes prior are important to tone muscles
(see list of stretches). It is also important to cool down
afterward. If you still find yourself short of breath 10
minutes after your exercise, it is too strenuous.

Aerobics are a group of exercises that increase the heart
and breath rates for a sustained period of time, greatly
increasing the flow of oxygen and blood to all parts of the
body. Examples of aerobics include: bicycling, running,
jogging, swimming, jumping rope, walking quickly, etc. Golf,
downhill skiing, gardening and housework are not strenuous
enough to stress the heart and cardio-vascular system.

Note: Subjects participated in 45 minutes of aerobics by
a trained instructor.

 

Handouts for this section:

 

A. "Everyday Stretches to Free Body and Mind," Medical
Self-Care, Fall 1980. J. Palidone.

 

B. "Bicycling, Cholesterol and Your Heart," Health and
Fitness, March 1980. E. Gaston.

1.
2.

4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

243

STRETCHES

Neck stretch

Groin stretch

Back stretch (on toes)

Head to knee stretch

Forward split

Hop on toes

Standing stretch (upper body--side)
Standing stretch (legs and hips)
Crossed legs stretch

Chest stretch

Jumping jacks

Quadriceps stretch

Sit backs and leg lifts

244
VIII . Nutrition

Sources of nutrition include protein, carbohydrates (simple
and complex), fat, fiber, water and minerals.

A. Protein is important in providing body-building amino

acids, which provide a role in growth, metabolism, and
maintenance of body tissue. Protein can be derived from grains,
roots, vegetables and fruits in their unrefined form, as well
as meat, fish, eggs, milk. Dr. Pritikin feels that most
Americans get too much protein and do not properly balance
their amino acid content.

B. Fats constitute almost half the total caloric diet for most
Americans. It is found in butter, margarine, shortening,
cooking and salad oils, peanuts, dairy products, eggs, meats,
nuts, seeds. Advantages: coats nerve endings, provides us
with shiny hair and skin. Disadvantages: fats cause three
kinds of damage--l) suffocates tissues’by depriving them of
oxygen, 2) raises the level of cholesterol and uric acid in
tissues, contributing to atherosclerosis and gout, 3) impedes
carbohydrate metabolism and fosters diabetes. All fats
(animal, vegetable, saturatedanuiunsaturated) form a fatty film
around the red blood cellsanuiplatelets, causing them to stick
together. This clumping means that 5-20 percent of your blood
circulation shuts down.

 

 

Too much fat is in foods which are fried in butter or margarine.
Butter is constantly added to food to enhance flavor. On a diet
of grains, vegetables, and fruits, you would still take in 5-

10 percent of your total calories in fat.

Animal fats are the fatty acids. This is saturated fat, and
raises the cholesterol level in the blood. THere is no
cholesterol in grains, fruits and vegetables.

Vegetable fats are mostly unsaturated fatty acids. There are
unsaturated fats in corn, safflower, soybeans, etc.

 

Butter/margarine: Hydrogen bonds are added to make margarine
solid at room temperature, thereby making it unsaturated or
hydronated. Emulsifiers, stabilizers, bleaching agents, and
preservatives are also added. Butter has few if any additives
but is saturated. The caloric intake is the same--100 calories
per tablespoon.

 

C. Carbohydrates: 1. Simple carbohydrates are refined. These
include sugar, unbleached white flour, and alcohol. Sugar is
added to many foods--vitamins, canned and frozen vegetables,
fruits, yogurt, bread and canned soups, etc. Sugar has no
nutritional value, as it is highly refined. Most Americans
eat about 2 pounds of sugar per week, which is one-quarter of
their total calories. Three-fourths of the sugar we eat comes
from frozen processed foods, with only one-quarter eaten as

 

245

table sugar. Evidence shows strong correlations between diets
high in refined carbohydrates and several American health
problems--dental disease, obesity, blood sugar problems and
heart disease. Less than 10 percent of your diet should consist
of simple carbohydrates. 2. Complex carbohydrates occur
naturally in grains, fruits and vegetables. They are important
for feeding the brain.

D. Fiber comes from the structural and stabilizing part of
plants. Fiber is particularly important intflmaprocess of
elimination and also seems to help prevent rectal colon
cancers. The typical American diet does not get enough fiber.
Fiber can be found in complex carbohydrates, especially when
eaten raw or slightly steamed. Also found in wheat bran

(there isn't enough in bread).

Measures of Fatty Deposits in the Blood

 

A. Cholesterol: This is a sterol, which is like a fat in that
it does not dissolve easily in water or blood plasma. All
cells manufacture and contain cholesterol. It helps make the
acids for digestion and steroid hormones such as progesterone
and adrenal gyucocorticoids. When too much cholesterol gets
into the blood, it settles into the arterial walls, hardening
and narrowing them.

 

Atherosclerosis begins with a fatty yellow streak on the inner
lining of the arteries, with growing deposits of fibrous
material rich in fatty cholesterol (arterial plaque). With
plaque build-up, the flow of‘the blood slows down. The vessel
will close up and the artery will die as an end result. When
part of the heart begins to die from want of food and oxygen,

a myocardial infarction occurs. A stroke occurs when a sec-
tion of the brain is similarly starved. Cholesterol foods are
prime factors in coronary heart disease in that they contribute
to high blood cholesterol levels. A change in diet will change
these levels. Foods rich in cholesterol are from animal sources.
There is no cholesterol in grains, fruits and vegetables.

 

 

Most Americans eat about 800 ml. cholesterol per day. Pritikin
advocates only 100 ml. Foods to avoid for cholesterol include:
shrimp, caviar, organ meats, eggs. Pritikin recommends lean
meats, poultry and fish limited to 1% pounds per week. His
diet is 10 percent protein, 10 percent fat, and 80 percent
complex carbohydrates.

 

Blood cholesterol levels should be 100 plus your age, according
to Dr. Pritikin. Ameicans tend to range from 150 to 330, yet
this is abnormally high considering other cultures and the
health hazards associated with high cholesterol. Any level
over 165 can be atherogenic--it will encourage the growth of
plaque in the arteries.

246

B. Lipoproteins: Lippoproteins carry cholesterol through the
blood. High density lippoproteins act to clear out redundant
cholesterol from the body's tissues and return it to the

liver for excretion. People are born with an equal amount of
high and ltmr density lippoproteins. Low density lippoproteins
invade the arterial wall and initiate plaque formation.

 

C. Triglycerides: A compound containing three fatty acids.
It is formed from carbohydrates and is stored in fat cells.
When broken down, triglycerides release free fatty acids into
the blood.

 

Highest Nutritional Values

 

I. Choose fresh foods first, then frozen. Even frozen foods
lose nutritional value while waiting to be thawed or initially
frozen. Also, important enzymes are lost in the freeze.

Canned foods should be used minimally due to added sugar, salt,
preservatives and other chemicals used for processing and
storing.

2. Breads/cereals should be chosen from whole grains. These
contain important B vitamins, protein and fiber. Refined
flour has few if any nutrients. "Enriched" means that vitamins
are sprayed on, after the hull is removed. The hull has the
most nutrients to begin with, including fiber. "Whole wheat,"
"rye," etc. is whole grain.

 

3. The more foods are prepared and processed, the more nutri-
ents are lost and the more additives are used in their
preparation.

4. Read labels. They list ingredients starting with the
largest amount first. Think of a soft drink as carbonated
water, sugar, artificial flavors and colors, caffeine, stannous
chloride, and high in calories. Look at the amount of protein,
carbohydrates and fats.

 

5. Natural sweetener means sugar.

A Well-Balanced Diet

 

Eat two kinds<ifwhole grains daily, e.g. wheat, oats, barley,
brown rice, or buckwheat.

Eat some raw vegetables daily, e.g. green or yellow vegetables.
Next best to raw, steam lightly.

Haveaafresh fruit daily, including at least one citrus fruit.
Low fat, low cholesterol animal protein should be used.

Pritikin suggests a total of 6 ounces per week, and not more
than 1% pounds.

 

247

Avoid oil fats, sugar, honey, sweeteners, and processed foods.

Eating Habits

 

Do you eat leisurely? sitting down? Educate yourself on foods
and nutritional values? Get a balance of many foods?

Low-fat natural cheeses: -

 

1% lowfat cottage cheese Edam

Farmers cheese Pre Monde -
Ricotta, if skim Jarlsburg

Mozarella Parmesan

Lean meats:

 

Veal Sirloin beef
Leg of lamb Liver

Low-fat fish

 

Cod Halibut
Ocean perch Red Snapper
Flounder Sea Bass
Haddock Sole

The Effects of Alcohol

 

Alcohol causes the blood platelets to stick together reducing
red blood cell oxygen carrying capacity and blood supply to
the heart.

It affects brain cells and functioning.

Liver becomes filled with fats.

Depresses your immune system.

The Effects of Caffeine

 

Caffeine stimulates the CNS and brain. It produces rapid
heart beats, insomnia, high free-fatty acids in the blood,
increases gastric secretion, and causes high blood pressure.
Coffee has 90 to 120 mg caffein per 5 ounces, cola about 40,
a chocolate bar 25. A seven-year-old boy weighing 60 pounds
drinking three cokes per day is drinking the equivalent of

a l75-pound man drinking eight cups of coffee.

Note: Subjects were asked to bring three food products from
their pantry, and labels were read and discussed.

248

Handouts for this section:

A. key nutrients

B. "How to Read Label Claims, Nutrition Action, Oct 81,
S. Turner and G. Moyer.

C.'Caffeine: What it Does3 Consumer Reports, Oct 81.
D. Ratings of breakfast cereals, Consumer Reports.

E. Several of Claiborne's low-salt gourmet recipes from
the New York Times.

249
STRESS MANAGEMENT WORKSHOP

Recommended Reading

 

The articles and handouts have been specifically chosen
to correspond with the workshop and its holistic nature.
Below are additional readings for the curious or intensive
reader. All books are paperbacks and are available in local
bookstores.

Albrecht, Karl. (Forword by Hans Selye). Stress and the
Manager: Making it Work for You. New Jersey: Prentice-
Hall, Inc. 1979.

 

Anderson, Bob. Stretchigg. Westminster, MD: Shelter
Publications (Random House), 1980.

 

Everroad, Jim. 5 Minute Total Shape-Up Program. Los Angeles:
Price, Stern, Sloan Publishers, 1980.

 

Friedman, M. and Rosenman, R. Type A Behavior and Your
Heart. New York: Alfred A. Knopf, 1974.

Forbes, Rosalind. Life Stress. Garden City, New York:
Doubleday and Co., Inc., 1979.

 

Girdano, Daniel and Everly, George. Controlling Stress and
Tension: A Holistic Approach. New Jersey: Prentice-
Hall, Inc., 1979.

 

Nutrition Search, Inc. Nutrition Almanac. New York: McGraw-
Hill Book Co., 1980.

 

Pelletier, Kenneth. Mind as Healer, Mind as Slayer. New
York: Dell Publishing Co., Inc., 1977.

Pritikin, Nathan. The Pritikin Program for Diet and Exercise.
New York: Bantam Books, 1980.

Selye, Hans. Stress Without Distress. New York: Signet
Books, 1974.

 

Spino, Dyveke. New Age Training for Fitness and Health.
New York: Grove Press, 1979.

 

LIST OF REFERENCES

 

Albrink, M. Diet and cardiovascular disease. Journal of American
Dietetic Association, 1965, fig, 20-25.

 

Albrink, M., & Davidson, P. Impaired glucose tolerance in patients
with hyptertriglyceridemia. Journal of Laboratory and
Clinical Medicine, April 1966, 2144)! 573-584.

 

Andrew, J. Recovery from surgery, with and without preparatory
instruction, for three coping styles. Journal of Personality
and Social Psychology, 1970, 15(3), 223-226.

Antar, M., Ohlson, M., & Hodges, R. Changes in retail market food
supplies in the United States in the last seventy years in
relation to the incidence of coronary heart disease, with
special reference to dietary carbohydrates and essential fatty
acids. American Journal of ClinicalgNutrition, 1964, 11(3),
169-178.

Ashton, W. Atheroma, glucose, lipid, and insulin. Lancet, August
14, 1965, 1(7704), 347-348.

Ashton, W. Dietary fat intake and dietary sugar. Lancet, 1961,
7167, 3-9.

Bandyopadhyay, A., & Banerjee, 8. Plasma lipids in cardiovascular
disorders. American Journal of Medical Science, 1964, 248(2),
203-205.

Bergin, A. 8 Strupp. H. Changing frontiers in the science of
psychotherapy. Chicago: Aldine,’l972.

Blank, R., & Blank, G. Ego psychology theory and practice. New
York: Columbia University Press, 1974.

Blumenthal, J., Williams, R., Kong, Y., Schamberg, S., & Thompson,
L. Type A behavior patterns and coronary atherosclerosis.
Circulation, 1978, §§, 634-639.

 

Blumenthal, J., Williams, R., Williams, R., Jr., & Wallace, A.
Effects of exercise on the Type A (coronary prone) behavior
pattern. Psychosomatic Medicine, 1980, 13, 289-296.

Campbell, D. & Stanley, J. §xperimeppal and quasi-experimenta1
designs for research. Chicago: Rand/McNaIly College Pub-
lishing, 1963.

250

251

Cattell, R. Anxiety and motivation: Theory and crucial experi-
ments. In C. Spielberger (ed.), Anxiety and behavior. New
York: Academic Press, 1966.

 

Chauchard, P. The brain. Translated by David Norlen. New York:
Grove Press, 1962.

 

Clausen, J. Effect of physical training on cardiovascular adjust-
ments to exercise in men. Physiological Review, 1977, 57,
779-816. '-

 

Dahlstrom, W., Welsh, G., & Dahlstrom, L. An MMPI handbook, vol.
II: Reseapgh applications. Minneapolis: University of
Minnesota Press, 1975.

 

 

Dimsdale, J., Hackett, T., Black, P., & Hutter, A. Emotional
correlates of Type A behavior pattern. Psychosomatic Medicine,
1978, 52(7), 580-583.

Dimsdale, J., & Moss, J. Short-term catecholamine response to
psychological stress. Psyphosomatic Medicine, 1980, ig(5),
493-497.

Dohrenwend, B., & Dohrenwend, B. Social status and psychological
disorder: A causal inquiry. New York: Wiley, 1969.

 

Eiduson, S., Geller, E., Yuwiler, A., & Eiduson, 8. Biochemistry
and behavior. Princeton: D. Van Nostrand, 1964.

 

Fenz, W. & Epstein, 8. Measurement of approach-avoidance conflict
along a stimulus dimension by a thematic apperception test.
Journal of Personality, 1962, 3Q, 613-632.

Flemenbaum, A., & Anderson, R. Field dependence and blood choles-
terol: An expansion. Perceptual Motor Skills, 1978, ii, 867-
874.

Flemenbaum, A., & Flemenbaum, E. Field dependence, blood uric acid
and cholesterol. Perceptual Motor Skills, 1975, 11, 135-141.

Freud, A. The ego and the mechanisms of defense. New York: Inter-
national Universities, 1936.

Friedman, M. Pathogenesis of coronary artery disease. New York:
McGraw Hill, 1969.

Friedman, M. Type A behavior: Its possible relationship to patho-
genetic processes responsible for chronic heart disease. In
Dembroski et al. (eds.), Coronary prone behavior. New York:
Springer-Verlag, 1978, 137:140.

252

Friedman, M, & Rosenman, R. Type A Behavior and your heart.
New York: Alfred A. Knopf, 1974.

 

Friedman, W., Mason, J., & Hamburg, D. Urinary 17-hydroxy
corticorteroid levels in parents of children with neoplastic
disease: A study of chronic pyschological stress. Psycho-
somatic Medicine, 1963, 25, 365-376.

French, J. The reticular foundation. Scientific American. May
1957, 2-8.

 

Gellhorn, E. & Loufbourrow, G. Emotions and emotional disorders.
New York: Harper and Row, 1963.

 

Gentry, W., Foster, 8., 8 Harvey, T. Denial as a determinant of
anxiety and perceived health status in the coronary care unit
Psychosomatic Medicine, 1972, 31, 39-44.

Girdano, D. & Everly, G. Controllin stressyand tension: A Holis-
tic approach. Englewood Cliffs, N.J.: Prentice Ha , .

 

Goldstein, A., Aaronow, L. & Kalmen, S. Principles of drug addic-
tion. New York: Harper and Row, 1968.

Glass, David. Behgvior patterngy stress, and coronary disease.
Hillsdale, N.J.: Lawrence Erlbaum, 1977.

Haan, N. Coping and defending. New York: Academic Press, Inc.,
1977.

Haan, N. Coping and defense mechanisms related to personality
inventories. Journal of Consulting Psychology, 1965, g3,
373-378.

Haan, N. PrOposed model of ego functioning: Coping and defense
mechanisms in relationship to IQ change. Psychological
Monographs, 1953, 11, 23.

 

Hinkle, L. The effect of exposure to culture change, social change,
and changes in interpersonal relationships on health. In B.
Dohrenwend and B. Dohrenwend (eds.), Stressful life events:
Their nature and effect. New York: Wiley, 1974.

Howard J., Cunningham, D. & Rechnitzer, P. Health patterns
associated with Type A behavior: A managerial population.
Journal of Human Stress, March 1976, 1, 24-31.

Jenkins, C. Psychological and social precursors of coronary dis-
ease. New England Journal of Medicine, 1971, 284, 244-245.

Jenkins, C. Recent evidence supporting psychologic and social risk
factors for coronary disease. New England Journal of Fadicine
1976, 294, 1033-1038.

253

Jenkins, T. W. Functional mammalism neuroanatomy. Philadelphia:
Lee and Febiger, 1978.

Julien, R. M. Ayprimer of drug addiction. San Francisco: W. H.
Freeman and Company, 1978.

Kaplan, N. Stress, the sympathetic nervous system and hyperten-
sion. Journal of Human Stress, 1978, 1(3), 29-34.

 

Katz, L., Stampler, J., &,Pick, R. Nutrition and atherosclerosis.
Philadelphia: Lee and Febiger, 1958.

Kenigsberg, D., Zyzanski, S., Jenkins, C., Warwell, W., &
Lizciordello, A. The coronary-prone behavior patterns in
hospitalized patients with and without coronary heart disease.
Psychosomatic Medicine, 1974, 1Q, 344-351.

 

Kerlinger, F. Foundations 9f behavioral research. New York: Holt,
Rinehart and Winston, Inc., 1973.

 

Lacey, J., Kagan, J., Larry, B., & Moss, H. The visceral level:
Situational determinants and behavioral correlates of auto-
nomic response patterns. In P. H. Knopp (ed.), Expression
9f the emotion in man. New York: International Universities
Press, 1963.

Lazarus, R. A strategy for research on psychological and social
factors in hypertension. Journal of Human Stress, 1978 1(3),
35-40.

Lazarus,R. ‘Psychological stress and the COping problem. New York:
McGraw-Hill, 1966.

Lazarus, R., and others. A laboratory study of psychological stress
produced by a motion picture film. Psychological Monographs,
1962, 12 (34, whole no. 553).

Levi, L. StressigSources, ganagement, and prevention. New York:
Liverfight Publishing Corp., 1974.

Levi, L. The urinary output of adrenalin and noradrenalin during
pleasant and unpleasant emotional states. Psychosomatic
Medicine, 1964, 11, 80-85.

Lovallo, W. The role of stress in the development of heart disease:
Theory and research. Biological Psyphology Bulletin, 1979,
§(3), 70-95.

Manuck, S., Croft, S., a Gold, K. Coronary-prone behavior and
cardiovascular response. Psychophysiology, 1978, 12(5), 403-
411.

254

Manuck, 8., Harvey, A., & Lechleiter, S. Effects of coping on
blood pressure responses to threat of adversive stimuli.
Psychqphysiology, 1978, 15(6), 544-549.

Medalie, T., Kahn, H., Neufeld, H., Riss, E., Goldbourt, V.,
Perlstein, T., & Oron, D. Myocardial infarction over a five-
year period: I. Prevalence, incidence and mortality experience.
Journal of Chronic Disease, 1973, 1Q, 63-84.

McCranie, E., Simpson, M., & Stevens, J. Type A behavior, field
dependence and serum lipids. Psychosomatic Medicine, 1981,
5342), 107-116.

 

McGough, W., Silverman, A., & Boddonoff, J. Patterns of fat
mobilization in field-dependent and field-independent subjects.
Psychosomatic Medicine, 1965,‘11, 245-256.

Meyer, R. & Haggerty, R. Streptococcol infections in families:
Factors altering individual susceptibility. Pediatrics, 1962,
12, 539-549. .

Miller, R., Rubin, R., Clark, 8., Crawford, W. & Arthur, R. The
stress of aircraft carrier landings: I. Corticorteroid re-
sponses in naval aviators. Psychosomatic Medicine, 1970, 11
581-588.

Millon, T. Modern psychopathology. Philadelphia: Saunders, 1969.

Ostfeld, A., Lebovits, 8., Shekelle, R., & Paul, P. A prospective
study of the relationship between personality and coronary
heart disease. Journal of Chronic Diseeses, 1964, 11, 265-
276.

 

Pearlin, L. & Schooler, C. The structure of coping. Journal of
Health and Social Behavior, 1978, 12, 2-21.

Pelletier, K. Mind as healer, mind as slayer. New York: Dell
Publishing, 1977.

Pillsbury, J., Meyerowitz, S., Salzman, L., & Satran, R. Electro-
encephalographic correlates of perceptive style: Field
orientation. Psychosomatic Medicine, 1967, 12, 441-449.

Pritikin, N. ThglPritikin program for diet and exercise. New York:
Grosset afidfiDunlap, 1979.

Rabkin, J. & Struening, E. Life events, stress and illness.
Science, 1976, 194, 1013-1020.

Rahe, R. & Arthur R. Life change patterns surrounding illness
experience. Journal of Psychosomatic Research, 1968, 11,
341-345.

Richter, D. Biochemical aspects of anoxic and hypoglycemic states.
In J. Cummings and M. Kremer (eds.), Biochemical aspects of
neurological disorders. Oxford: Blackwell Scientific Publi-
cations, 1959.

 

Robbins, S.,& Angell, M. Basic pathology. Philadelphia: W. B.
Saunders, 1976.

 

Roessler, R., Alexander, A., & Greenfield, N. Ego strength and
physiological responsivity: I. The relationship of the Barron
Es scale to skin resistance, finger blood volume, heart rate,
and muscle potential responses to sound. Archives of General
Psyehiatry, 1953, 3, 142-154.

Roessler, R., Burch, N., & Childers, H. Personality and arousal
correlates of specific galvanic skin responses. Psychophysi-_

Roessler, R., Burch, N., and Mefferd, R. Personality correlates
of catecholamine excretion under stress. Journal of Psycho-
somatic Research, 1967, 11, 181-185.

 

Rogers, E. Human ecology and health. New York: The MacMillan
Co., 1960.

Rosenman, R., Braud, R., Jenkins, D., Friedman, M., Straus, R., &
Wurm, M. Coronary heart disease--the Western Collaboration
Group study: Final follow-up experience of 88 years. Journal
of the American Medical Association, 1975, 11, 872-877.

Saltin, E., Bloomquist, G., Mitchell, J., Johnson, R., Wildenthol,
R., & Chapman, C. Response to exercise after bedrest and after
training. Circulation, 1968, 1g, 1-78.

Salzer, H. Relative hypoglycemia as a cause of neuropsychiatric
illness. Journal of National Medical Association, 1966, 51(1),
12-17 0

Selye, H. Stress without distress. Philadelphia and New York:
J. P. Lippincott, 1974.

 

Selye, H. The stress of life. New York: McGraw-Hill, 1956.

Shannon, D., Szmyd, L. & Prigmore, J. Stress in dental patients.
School of Aerospace Medicine Reports, Brooker Air Force Base,
Texas, 1962, No. G2-59, 6.

Silverman, A., Cohen, S" Shmauonian, B. & Greenberg, G. Psycho-
physiological investigations in sensory deprivation.
Psychosomatic Medicine, 1961, 11, 48-62.

256

Silverman, A., & McGough, W. Perceptual relationships to periph-
eral venous tone. Journal of Psychosomatic Research, 1971,
15, 199-205. “

 

Silverman, A., McGough, W., & Bogdonoff, M. Perceptual correlates
of the physiological response to insulin. Psychosomatic
Medicine, 1967, 12, 252-264.

Simpson, M., Olewine, D., & Jenkins, C. Exercise-induced cateco-
1amines and platelet aggregation in the coronary-prone
behavior pattern. Psychosomatic Medicine, 1974, 1:, 476-487.

 

Singer, M. Engagement-involvement: A central phenomenon in
psychophysiological research. Psychosomatic Medicine, 1974.
36’ 1-17.

Sousa-Poza, J., Rohrberg, R.i Eellaberba, D., & Ruest, P. Physio-
logical concomitants (1 3 Uptake) of field dependence.
Psyehosomatic Medicine, 1976, gg, 19-26.

Spiegel, D. SPI discriminators among four psychological health-
sickness levels. Journal of Consulting and Clinical Psychol-
ogy, 1969, 1;, 750-756 (a).

Spiegel, D. SPI and MMPI predictors of psychopathology. Journal
of Pro'ective Techniques and Personality Assessment, 1969, 11,
265- 3 (b).

Spies, T. Some recent advances in nutrition. Journal of American
Medical Association, 1958, 167(2), 675-690.

Takahashi, E. An epidemiological approach to the relation between
diet and cerebrovascular lesions and arteriosclerotic heart
disease. Tohoku Journal of Experimental Medicine, 1962, 11(3),
239-257.

Tossi, M. Organization stress as a moderator of the relationship
between influence and role response. Academy of Management
Journal, 1977, 11, 7-20.

Turek, J., Van Derkuy, A., Pelbrimm, C., DeKeyzer, F., Van Der Fuhr,
S., & Voerman, J. Blood pressure response to a new standard-
ized stress test. Netherlands Journal of Medicine, 1977, 19,
104-106.

Wheatley, D. Stress and the heart. New York: Raven Press, 1977.

Williams, D. Clinical aspects of anoxic and hypoglycemic states.
In J. Cummings and M. Kremer (eds.), Biochemical aspects of
neurological disorders. Oxford: Blackwell Scientific Pfibli-
cations, 1959.

 

 

257

Wolff, H. Stress and disease. Rev. and ed. by Stewart Wolf and
Helen Goodell. Springfield, IL: Charles C. Thomas, 1968.

 

Yudkin, J. Dietary aspect of atherosclerosis. Angiolegyj 1966,
11(2), 127-133.

Yudkin, J. Patterns and trends in carbohydrate consumption and
their relation to disease. Procedures of Nutritional Sgience,
1964, 11(2), 149-162.