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II (HHS 1111/11/1111111111111111 1111/1/11 " 3 1293 10457 4227 1 L337». 331' Bgmwlnw ftme 1 Univerfity 1'\ This is to certify that the thesis entitled ADAPTIVE REGRESSION, IMAGERY, AND VOLUNTARY CONTROL OF WHITE BLOOD CELL ACTIVITY presented by Sarah B. Whiteher has been accepted towards fulfillment of the requirements for M.A.’ degree in We W»— Major professor Date June 9, 1982 0-7639 MS U is an Affirmative Action/Equal Opportunity Institution MSU LIBRARIES _._c_. RETURNING MATERIALS: Place in book drop to remove this checkout from your record. FINES will be charged if book is returned after the date stamped below. ADAPTIVE REGRESSION, IMAGERY, AND VOLUNTARY CONTROL OF WHITE BLOOD CELL ACTIVITY by Sarah B. Hhitcher A MASTERS THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS De par tmen t o 1‘ Psychology 1982 ABSTRACT ADAPTIVE REGRESSION, IMAGERY, AND VOLUNTARY CONTROL OF WHITE BLOOD CELL ACTIVITY BY Sarah B. Hhitcher This study was designed to investigate the validity of the "bioinformational theory of emotional imagery" developed by Lang (1979) which proposes that images are "propositional structures" with both cognitive and somatic components. The Rorschach Inkblot Test was used to assess the ability of subjects to adaptively regress. as this ability is thought to be associated with a capacity for generating emotional imagery. It was hypothesized that subjects who produce emotional images would be more likely to be able to control the activity of their neutrophils (a kind of white blood cells) as the somatic component of the imagery propositional structure would be activated by the imagery. The results indicated that while subjects were consistently able to control their neutrophils, there was little relationship between the vividness of imagery and amount of neutrOphil change. However, adaptive regression did appear to be moderately related to the ability to control neutrophil activity. Possible explanations flor this finding are discussed. ACKNOWLEDGEMENTS I would like to thank my committee members, Al Rabin (Chairperson). John Schneider. and Ralph Levine. for their guidance in this research. I would also like to thank C. Wayne Smith flor his patient work analyzing the blood samples in his laboratory. and flor his inspiring influence as a serious scientist. Other sincere thanks go to Bill Bukowski and Kenneth Bertram flor their help in with statistical and computer difficulties. Finally. I would like to thank Gail Hill flor her guidance in operating the Hewlett—Packard computer. LIST OF TABLES. . . . LIST OF FIGURES . . . LIST OF APPENDICES. . Chapter I. II. III. IV. INTRODUCTION. . Background. . . TABLE OF CONTENTS Imagery in healing and diagnosis. An instrument predicting cancer progress. Physiological correlates of imagery . . . The brain and the immune system . IMAGERY AND NEUTROPHIL FUNCTION STUDIES A preliminary study . . Study 1 . . . . Study 2 . . . . THE PRESENT STUDY . Individual differences in imagery Statement of the problem. Hypotheses. . . METHOD. Subjects. . . . vividness Page vi vii 12 13 18 2a 32 33 no u 1 42 L12 Psychological measures and procedure. . . . . The Rorschach Inkblot Test. . . . . . . . . [1] Tolerance for unrealistic experience. Klein's criteria. . . . . . . . . Criteria in the present study . . Scoring . . . . . . . . . . . . . Operationalization of hypotheses. [2] Primary process content . . . . Holt's content variables. . . . . Scoring . . . . . . . . . . . . . Operationalization of hypotheses. [3] Emphasis on articulated form. . Scoring . . . . . . . . . . . . . Operationalization of hypotheses. [A] Number of responses . . . . . . Scoring . . . . . . . . . . . . . Operationalization of hypotheses. Rorschach procedure . . . . . . . . . Final Rorschach scores. . . . . . . . Imagery measures and procedure. . . . Imagery interview . . . . . . . . . scoring 0 O O O O O O O O O O O O O NeutrOphil function measures and procedure. Cellular functions. . . [1] Shape change. . . [2] Adhesiveness. . . I3] Chemotaxis. . . Blood function scores . . . . . . . General procedure . . . . . . . . . . Stmy 1 O I O O O O O O I O O O O O StUdy 2 O O O 0 O O O O O O O O O 0 v 0 RESULTS 0 O O O O O O O O O O O O O O 0 Descriptive statistics. . . . . . . . . Preliminary correlational analyses. . . Cluster analyses. . . . . . . . . . . . Cluster 1: Adaptive regression. . . . Cluster 2: Blood function . . . . . . Final Correlations. . . . . . . . . . summer y 0 O O O O I O O O 0 O O O O 0 VI. DISCUSSION. . . . . . . . . . . . . . . General discussion. . . . . . . . . . . Future research VII. SUMMARY REFERENCES . APPENDICES . O O O 0 iv 77 79 83 89 TABLE 10 11 LIST OF TABLES Changes in white blood cells in a preliminary study, with two types of imagery plus a jogging condition. . Baseline levels of neutrophil function. . . . . . . . Neutrophil function befOre and after a 25 minute relaxation-imagery session. . . . . . . . . . . . . . Correlations between imagery ratings and changes in blood function during imagery (Study 1). . . . . . Correlations between imagery dimensions and blood function difference scores in Study 2 . . . . . . . . Descriptive statistics for Rorschach interval scale variables. IMAGERY ratings and blood function difference scores . . . . . . . . . . . . . . . . . . Frequencies for dichotomous Rorschach variables: F, and TOLERANCE O O O O O O O O O O O O I O O O O 0 Preliminary correlations among variables. . . . . . . Communalities and alphas for Cluster 1: Adaptive regre831on (AR) 0 O O O O O O O O O O O O 0 I O 0 O O Communalities and alphas for Cluster 2: Blood funCtion (BF) 0 O O O O O O O I O O O O I O O O . O O 0 Final correlations.among clusters and items . . . . . 14 20 21 25 29 61 62 64 67 69 72 FIGURE I II III IV VI VII VIII IX LIST OF FIGURES White blood count changes with two different types of’imagery, plus a jogging condition . . . . . . . . Changes in adherance of neutrophils with two different types of imagery plus a jogging condition. Changes in stimulated adherance (responsiveness) with two different types of imagery plus a jogging condition. 0 O O O O O I O O O C O O O O O O C O O 0 Pre and post white blood count means for control and imagery conditions in Study 1. . . . . . . . . . . . Adherance means (unstimulated): Percentage of neutrophils adhering for control and nmagery conditions in Study 1. . . . . . . . . . . . . . . . Pre and post white blood count means for control and imagery conditions in Study 2. . . . . . . . . . Adherance means (unstnmulated) Percentage of neutrophils adhering for control and nmagery condition: StUdy 2 O O O O O O I O O O O O O O O O 0 Pre and post white blood count means for control and imagery conditions in Study 1 and 2. . . . . . . Adherence means (unstimulated): Percentage of neutrophils adhering for control and imagery condition in Study 1 and 2 . . . . . . . . . . . . . Results by individual: Percentage of neutrophils adhering for control and imagery condition (Study 1) O O O O O O I O O O I O O O O O O O C O 0 Results by individual: White blood count for control and imagery condition (Study 1). . . . . . . . . . . vi 15 16 17 22 23 27 28 30 31 3Q 35 LIST OF APPENDICES APPENDIX A Specific imagery instructions for Study 1. . . . . 90 B Specific imagery instructions for Study 2. . . . . 93 C Primary process content categories . . . . . . . . 96 vii CHAPTER I INTRODUCTION Throughout the history of Western medicine, imagery has been used as a means of diagnosing and treating disease (MacMahon & Hastrup, 1980). This practice continues to the present day, despite the tem- porary discrediting of such techniques during the height of mechanis- tic theory in medicine. The difference between contemporary and past uses of imagery rests in the body of knowledge accumulated through scientific research which now guides its application to health prob- lems, both physical and mental. Recent contributors to this body of knowledge are John Schneider and his associates (C. Wayne Smith. M.D., and Christie Minning, M.A.) who have been investigating the effects of imagery on neutrophil function (neutrophils are a type of white blood cell involved in immune response to bacterial infection). In a series of pilot studies (unpublished) they observed consistent changes from baseline in several parameters of neutrophil behavior (as measured by laboratory tests on blood samples). changes which were consistent with the imagery content. Subjects' neutrophils became more active when images direct- ed towards activating them were used in a relaxation imagery exercise. The mechanisns by which imagery affects neutrophil processes are unknown. The purpose of this investigation is to study individual differences in voluntary control of neutrophils, in hopes of under- standing principles which may underly the phenomenon. Identification of personality dimensions associated with individual differences.may help to clarify the interaction between intrapsychic structure and physiological response to imagery. It is hypothesized that imagery vividness is an important determinant of neutrophil response. and that individuals capable of adaptive regression produce more vivid imagery. These hypotheses have implications for the validity of a theoretical model of imagery developed by Lang (1979) in which he discusses his concept of the image as a "propositional network" containing both sym- bolic stimulus and somatic response components. Background Imagery in healing and dagnosis Prior to Aristotle, genesis and remission of disease was thought to be indivisible fom imaginal activity; "Images of objects of desire or aversion aroused emotions which in turn set up humeral imbalances, disturbing digestion and other vital functions culminating in various forms of pathology ." (MacMahon & Hastrup, 1980, p. 205) When Descarte redefined the mind as "immaterial substance". imagination logically ceased to play a role in disease. "Images, along with emotions were placed among the 'contents' of the mind and thereby rendered causally ineffective in affecting somatic processes. Mechanistic physiopathology emerged as a substitute for the fermer holistic approach in medicine." (MacMahon & Hastrup, 1980, P. 206) Irrespective of dominant philosophical beliefs, not all ailments could be successfully diagnosed and treated according to mechanistic models. Physicians such as Hartley (1705-1757). Tuke (1827-1895) and physicians such as Hartley (1705-1757). Tuke (1827-1895) and Rush (l7u6-1813) persisted in their use of imagination in therapy and theory because of its usefulness. For example. Hartley believed that "involuntary" functions could be affected by imagination: "We seem to have a semivoluntary power to alter the motion of the heart Dmmediately by introducing strong ideas..." (Hartley. 1966, p. 2H8) William James also had an interest in imagery. His concept of ideo- motor action, "gave a theoretical basis to the connection between imagination and arousal" (MacMahon & Hastrup, 1980, p. 209). During the 1930's, Shultz developed a comprehensive series of imagery-relaxation exercises to be used in adjuctive medical treat- ment. In these exercises, called "autogenic therapy" (Luthe. 1969). the patient is advised to relax and "attain mental contact" with vital organs. Visualizations include spontaneous colors. objects. con— cepts. feelings and questions. There are also specific visualizations ”to treat virtually every category of diseases: ulcers. gallbladders. colitis, heart condition, obesity, diabetes. ad infinitum" (thterberg & Lawlis, 1978. p. 12). An even more recent application of imagery to healing can be found in the Simontons' (Simonton, Simonton & Sparks; 1978) work with cancer patients. These patients (who are conjointly undergoing conventional medical treatment) are taught to image their white blood cells and medical therapy combatting their cancer and winning the fight Guided imagery is one component of a comprehensive psychothera- peutic program which includes griefwork, goal setting. suggested sup- plemental reading, regular physical exercise, group therapy, indivi- dual counselling, and relaxation training. Simonton (Simonton et a1, 1978) used this program with a group of 180 stage IV cancer patients, who. statistically, had a predicted median life expectancy of 21 months. With the psychothera— peutic treatment. the median survival time was 31 months. There are major flaws in this study, most notably the highly select quality of the sample. These were patients who were motivated to come especially to the Simonton clinic for treatment and who were open to non-conven- tional therapy procedures. However, the results do suggest that psychologically oriented adjunct therapy might be useful to cancer patients, and that more systenatic research in this area is needed. Simonton, Simonton & Creighton (1978) observed a relationship between the content of the imagery used by cancer patients and disease progression. In the imagery training, patients are encouraged to develop their own images to represent their immune system and medical treatment overcoming their cancer. Simonton (Simonton et. al., 1978) maintains that the individualistic content of the imagery used by each patient reveals "extremely important information about patient beliefs" (p. 127). For example, one man visualized his white blood cells as eggs in an incubator, his cancer as a big black rat. and his chemotherapy as "little white pills". "Once in a while the rat eats one of the pills...[and] he's sick for awhile, but then he always gets better and he bites me all the harder." (Simonton et. al., 1978. p. 127) This man's disease progressed quite rapidly. Another patient who attained a remission imaged his white blood cells as "...A vast army of white knights on white horses who would line up, their lances gleaming in the sunlight, and charge through the landscape killing cancer cells, which were small. slow-moving creatures." (Simonton et. al.. 1978. p.129) An instrument predicting cancer progress Achterberg and Lawlis (1978). intrigued by the Simontons' observations. set out to systematically study the relationship between imagery content and disease progress. They developed an instrument. the IMAGE-CA (Achterberg & Lawlis. 1978). to assess patients' imagery on a number of dimensions thought to be important predictors of cancer progression. The theoretical rationale behind the IMAGE-CA is as follows; ”Just as the body exhibits symptoms which are not the disease itself. but unique manifestations of the interaction of the disease and the total body. the psyche does likewise. In the case of the latter. however. symbols become the synthetic representations of the more concrete cognitive processing. The analogy between symbol and symptom can be carried into application. in that the understanding of both symptomatic and symbolic events lead to the diagnosis of a patient's physical functioning and psychological attributes." (Achterberg & Lawlis. 1978. p.94) The symbolism refered to here is the symbolism of imagery. Achterberg and Lawlis (1978). after extensive communication with the Simontons about their clinical observations regarding the imagery-disease progress parallel. derived 1n dimensions for clas- sifying imagery "effectiveness". These are 1) Vividness of cancer cells (How vivid do they seem to be?) 2) Activity of cancer cells (How active are the images?) 3) Strength of cancer cells (Do the cells seem strong?) a) Vividness of white blood cells 5) Activity of white blood cells 6) Numerosity of white blood cells (How'many are there?) 7) Size of white blood cells (Large or small?) 8) Strength of white blood cells 10) Effectiveness of treatment (How effective is the treatment in overcoming the cancer in the imagery?) 11) Symbolism of treatment (How symbolic. as opposed to literal. are the images used?) 12) Overall strength of imagery (How strong and vivid are the images and symbols used?) 13) Regularity of imagery (Is it done at least twice a day?) 1n) Relationship to disease management (Does the patient cooperate with all aspects of therapy?) (Achterberg & Lawlis. 1978. Pp. 1u1-1uu) Based on a structured interview. experienced clinicians rate each of these dimensions on a 5 point scale. In addition. there is a rating fOr clinical Judgement. i.e.. the Judgement of the clinician regarding overall "effectiveness" of the flmagery. Two studies were conducted to assess the scale's reliability and validity. one using disease status as a criterion and the other. the functionability of the patients. The IMAGE-CA showed excellent reliability (inter-rater reliabilities ranged from .73 to .95). and predicted disease course better than blood chemestry. (Achterberg. Lawlis. Simonton & Simonton. 1977). In fact. the researchers were dismayed to find that patients scoring below a particular cut-poff point on the scale had very little chance of survival. Physiological Correlates of Imagery The Achterberg and Lawlis (1978) studies point to a definite link between imagery and cancer progress. The question of whether the imagery is a reflection of the cancer patients' physiological state. or whether there is some cause and effect relationship remains. Jacobson (1930) was one of the first investigators to systemati- cally study physiological correlates of imagery. He recorded ocular movements in subjects visualizing such things as the Eiffel Tower. this morning's newspaper etc.. and consistently found more activity during imagery than relaxation. Furthermore. the patterns of ocular activity corresponded to patterns found when subjects viewed pictures of the same objects. Imagery has been used in systematic desentization therapy precisely because of its ability to evoke autonomic arousal. According to desensitization theory. anxiety is defined as a conditioned pattern of autonomic response (Wolpe. 1966). which is weakened whenever the conditioned stimuli are presented and the response does not occur. Imaging threatening stimuli repeatedly in a relaxed state eventually extinguishes the response (Van Egeren. Feather. & Hein. 1971). Lang. Helamed & Hart (1970) studied physiological reactivity to fear imagery in relation to therapy outcome. They found-that subjects who responded well had faster heart rates during fearful scenes than during scenes which did not produce fear. These subjects reported unusually fearful scenes when their heart rates were highest. and that heart rate decreased with fewer reports of fearful scenes. "This covariation between verbal report and cardiac activity was not found for those who failed to show improvement with treatment." (Lang. 1977. p.863) Lang (1979) maintains that systematic desensitization therapy . is effective because a mental image is not a "picture" in the mind. but a "...conceptual network. controlling specific somatovisceral patterns and constituting a prototype for overt behavioral expressionl" (p. 495) In other words. images. like other kinds of information. are stored in the brain in conceptual networks. Conceptual networks of images differ from other informational networks in that they have both cognitive schemas and built-in prototypes of somatic responses to these schemas. In a test of this "bioinformational" model. Lang (1979) and his co—workers systematically varied the propositional organization of instructions designed to evoke emotional imagery. They found that subjects given instructions to image both the threatening stimulus and its autonomic response concomitants produced more arousal than subjects directed to image the stimulus or the response alone. The relationship between imagery and disease progress is very different from the connection between desensitization imagery and autonomic arousal. However. using "bioinformational terms". it may be that the body on some level "knows" the physiological situation; things are getting better or they are getting worse. This information may be associated in memory with certain images or symbols with posi- tive or negative components. Positive mental images may exert a gene- ral and beneficial effect on the body by evoking physiological asso- ciations with pleasureable or positive experiences. Furthermore. since images (and by implication patterns of somatic activity) are an integral part of the mind's entire informational network. including semantic memory. it may be speculated that the specific content of the image could react to or produce specific somatic states. The brain and the immune system On the physiological level. are there mechanisms by which usagery might affect somatic processes? Most studies linking psychological factors to immune response have focused on stress or bereavement as independent variables (Rogers. Dubey & Reich. 1979). Stress appears to be a significant risk factor in the development of infectious disease (Day. 1951). autoimmune diseases (Engel. 1955). and even cancer (Bahnson. 1969. LeShan & Worthington. 1966). Depressed lymphocyte function has been found to be associated with depression (Bartrop. et. al. 1977). and the relationship between the bereavement accompanying loss and increased susceptability to all kinds of illness is well known (Dohrenwend & Dohrenwend. 1974). In addition immune system functions can be affected by condition- ing procedures and even hypnosis. Ader and Cohen (1975: see also Rogers. Reich. Strom & Carpenter. 1976) were able to behaviorally con- dition immunosupression in rats. Black. Humphrey & Niven (1963). used direct hypnotic suggestion to inhibit the Mantoux reaction (tuberculin skin test). Interestingly. subjects were able to produce this result in whichever arm the experimenter suggested. while the other arm (which had been treated as well) remained unaffected. Hypersensi- tivity reactions have also been reduced via hypnosis (Rogers et. al.. 1979). According to Amkraut and Solomon (1979). there are multiple pathways by which psychological states might affect the immune system. 10 "The organisn is continuously exposed to insults which may give rise to ... diseases but...the mechanisms of resistance develOped both during evolution and during the life of the individual are generally adequate to prevent the occurence of severe disease. Thus. the mammalian organism is considered to be a system in which a continuous balance between pathogenic events and defense mechanisns is present... Emotional factors. by causing small changes. alter the state of immune balance and convert imapparent or mild illness to manifest or severe illness." (p. 546) The most widely held hypothesis regarding the psyche-immune system relationship is that of neuroendocrine mediation. Both leucocytes and neutrophils have receptors sensitive to a variety of hormones. including adrenalin. insulin. histamine. acetylchoine and beta-adrenergic catecholamines (Rogers et. al. 1979). In addition. the thymus. which is responsible for several elements of effective immune response is dependent on a normal neuroendocrine environment (Amkraut & Solomon. 1975). These are mechanisms by which stress and other global emotional states (including positive ones) can affect the immune balance. It is more difficult to understand how hypnosis can suppress the Mantoux reaction in one arm and not the other. and why specific flmagery con- tent seems to correspond to specific somatic patterns. patterns not explainable by positive or negative affective states. Again. using informational terms. the human organism can be viewed as consisting of multiple information systems. Cells pass information to each other. messenger RNA passes information intra- cellularly. and the neuroendocrine system communicates both with the central nervous system and with the immune system. It is possible that higher order mental processes might communicate specific infor- 11 mation to the immune system and vice versa. although tracing the path- way would be extraordinarily difficult. CHAPTER II IMAGERY AND NEUTROPHIL FUNCTION STUDIES While studying chemotaxis (response to chemicals given off by bacteria) in neutrophils. C. Wayne Smith (Smith. Hollers. Bing Patrick. 1975). observed that subjects who reported having a recent stressful experience showed deficits in neutrophil functions related to effective immune response. He communicated this observation to John Schneider who was familliar with the Achterberg and Lawlis (1978) studies. They subsequently decided to engage in some preliminary investigations of the effects of imagery on neutrophils. using healthy subjects. The neutrophil. a type of white blood cell. is a central compon- ent of the body's defense against bacterial infection. In order for neutrophils to carry out their defensive role. they must be capable of changing shape from their resting Spherical form to a bipolar config— uration (having a definite "head" and "tail" region) which crawls by means of pseudopods. In addition. the cellular membrane must take on an adhesive quality that allows the cell to migrate along the walls of blood vessels to the site of infection. This adhesiveness is also important for passing between the endothelial cells into the surround- ing tissue. where the neutrophils engulf foreign agents. Utimately. effectiveness of an immune response involving neutrophils is dependent on the number available for migration and also upon the cells' respon- siveness to chemotactic factors ("signals" from invading organisms). 12 13 Laboratory measures are available to reliably assess Neutrophil count (white blood count (WBC). the capacity of neutrophils to change shape (shape change (SC). to adhere (adherance (AD) and to respond to chemotaxic factors (chemotactic factor (CF). These measures were used as the dependent variables in the studies of imagery and neutrophil function described below. A prelminary study In an initial pilot study. one subject participated in three experimental conditions. In condition 1. the subject ran for 20 min- utes (a regular activity). Condition 2 consisted of a 20 minute self-induced relaxation-imagery session with a focus on increasing the adherance and responsiveness of the neutrophils. In condition 3. a relaxation imagery—hyperventilation exercise was used. The subject imaged stressful circumstances in order to bring about a decrease in adherance and responsiveness. and an increase in count (the pattern of neutrophil behavior associated with stress). Hyperventilation was used in conjunction with the imagery. as the subject thought that since hyperventilation often accompanys anxiety states. it would facilitate imagery of stressful circumstances. In condition 1. blood measures were taken before and after the 20 minute jogging session. In conditions 2 and 3. measures were taken before and after imagery and again. 29 hours later. As the results in Table 1 indicate. there were striking differ- ences in the overall white blood cell count.in adherance. and in res- ponsiveness (adherance stimulated by a chemotactic factor). The most 14 TABLE 1* Changes in white blood cells in a preliminary study. with two types of imagery plus a jogging condition (N=1) Condition WBC Adherance [D] Stim. Adherance I Pre 5900 161$ 81% Post 6900 [A] 63$ 86% II Pre 5800 63$ 89% Post “300 [B] 91% 100% 24 Hr. 9800 851 100$ III Pre 6000 51: 35; Post 100 32$ 78% 29 Hr. 8300 [C] 22% 511 Condition I: Running for 20 minutes (pre and post measures) Condition II: Imagery : Increase WBC. AD. SC (pre. post and 29 Hr. measures) Condition III: Stress imagery/hyperventillation (pre. post and 29 Hr. Measures) [A] [B] [C] [D] Increase WBC due to increase in Lymphocytes. Decrease WBC due to decrease in Neutrophils. Lymphocytes unchanged. Increase WBC due to increase in Neutrophils. Lymphocytes unchanged. Refers to the proportion of neutrophils remaining attached to a serum coated surface. * Tables 1-4 are taken from Schneider. Smith. Minning & Whitcher (Unpublished). CELLS 8900-1 1 8000-1 7600-1 7200-1 PER 6800-1 HL 6900-1 6000-1 5600-1 5200-1 9800-1 0000—: 9000-1 FIGURE I“ Changes in white blood count in a preliminary study (N=1) III I J—II I I I I I I PRE POST 2“ Hrs CONDITION Condition I: Jogging Condition II: Imagery of increased neutrophil activity Condition III:Stress Imagery and hyperventilation ' Figures I-IX are taken from Schneider. Smith. Minning & Whitcher. (unpublished). 16 FIGURE II Changes in adherance of neutrophils in a preliminary study (N=1) 1001-1 1 1 90S-1 CELLS 1 AD- 801-1 II HER- 1 ING 701-1 1 60$-1 I I I SOS-1 I #01-1 1 30$-1 1 205-1 1 III- 10S-1 1 05-1 1 1 1 PRE POST 29 Hrs. CONDITION Condition I: Jogging Condition II: Imagery of increased neutrophil activity Condition III:Stressful Imagery and hyperventilation FIGURE III Changes in stnnulated adherance in a preliminary study (N=1) 100 -1 ———-II 1 1 1 I 90 -1 CELLS 1 RES- 1 POND- 1 I INC 80 -1 1 1 1 70 -1 1 1 1 60 -1 1 1 1 50 -1 Iglfii 1 1 1 PRE POST ZuHrs. CONDITION Condition I: Jogging Condition II: Imagery of increased activity Condition III:Stressful Imagery/hyperventilation 18 interesting finding is the radically different patterns for conditions 2 and 3. (See figures I through III) It appears that image content has a differential effect on basic neutrophil fUnctions. although this finding is confounded by the use of hyperventillation in condition 3 and not in condition 2. Study 1 Encouraged by these results. Minning (unpublished doctoral dissertation). with the help of Schneider and Smith. designed a larger study to assess the effectOf one imagery condi- tion (condition 2) on neutrophil behavior in a sample of 16 healthy subjects. After first having two blood samples taken 20 minutes apart as a control measure, subjects participated in three group training sessions. 1 The first meeting was an educational session in which Smith discussed the components of neutrophil response to infection. He showed slides depicting the cells in various stages of activation to give subjects a visual impression that might be used in the imagery exercise. The remaining two sessions were devoted to training the subjects in the relaxation-imagery technique designed to increase neutrophil adherance and responsiveness. In the second session. the Achterberg and Lawlis (1978) studies were presented. both to give the subjects an idea of the dimensions important in "effective" imagery (i.e.. vividness. symbolism). and to engender positive expectancies. Then Minning led the group in a a guided imagery exercise in which subjects were asked to visualize 19 their neutrophils becoming more numerous and active, changing shape. becoming more adhesive. and passing through the blood vessel wall. (See Appendix A for a verbatim transcript of the guided imagery instructions.) This exercise was repeated in the third session. The experimental session was conducted individually after the training was complete. Blood measures were taken before and after the exercise. Subjects were debriefed regarding their imagery experience using a structured. open-ended interview similar to the procedure used With the IMAGE-CA (Achterberg and Lawlis. 1978). This interview was designed to elicit information enabling ratings (on a scale of 1 to 5) to be made on the presence and intensity of several imagery dimensions. These dimensions are as follows: 1) Vividness of imagery 2) Whether the cells had been imaged changing their shape 3) Adhesiveness of the cells 0) Whether the cells had been imaged leaving the bloodstream 5) Strength of the cells 6) Whether the cells had been imaged using symbols or concrete representations. and the degree of abstraction of the symbols 7) The overall feeling of the experience— positive or negative 8) Clinical judgement regarding imagery "effectiveness" Results of Study 1 are illustrated in Tables 2 & 3. Both adhe- siveness and count dropped dramatically (shape change remained con- stant). however the change in adhesiveness was in a direction contrary to expectation. (See Figures IV & V) The imagery instructions were to image the neutrophils becoming more numerous and increasing in adhe- siveness. The count was expected to drop because of the suggestion to see the cells passing through the blood vessel wall. where they would be unavailable to venepuncture. The adhesiveness was expected to rise 20 TABLE 2 Baseline levels of neutrophil function (N=32)' Sample 1 Sample 2 Mean Range Mean Range Total Count 7900 5900-9900 7200 5300-9100 (Cells per ml) Neutrophil count 3900 3100-9700 3800 3050-5750 (Cells per ml) Adherance A) 91 37-99 38 39-92 (Percent adhering) Adherance B) 39 36-92 38 35-91 (Percent adhering) Chemotactic A) C) 90 99-98 91 89-93 (Percent responding) Chemotactic B) C) 78 71-85 79 79-69 (Percent responding) A) isolated neutrophils B) cells in whole blood * To deve10p a large pool of control data. the experimenter took two blood samples thirty minutes apart from 32 individuals. The 16 subjects who participated in Study 1 were among these indivi- duals. P Value 08 ns 03 21 TABLE 3 Neutrophil function before and after a 25 minute relaxation—imagery session (N=16) Before After F Val. P. Val. Mean Range Mean Range Total white blood count 8200 6700-9700 6900 5100-7700 29.53 (.0001 (WBC-Cells per ml) Adherance (AD-percent 95 92-98 28 29-32 5.63 (.05 cells adhering Chano tactic (Shape Change) 91 86-96 92 86-98 .02 ns (SC-1 responding) 22 FIGURE IV Pre & Post white blood count means for control and imagery conditions in Study 1 (N=16) : : ' : PRE POST PRE POST Control Imagery PERIOD OF SAMPLE CELLS AD- HER- ING 23 FIGURE V Adherance Means (Unstimulated) Percentage of neutrophils adhering for control and imagery condition 100 90 80 7O 6O 50 9O 3O 20 10 Study 1 (N=16) I PRE POST PRE Control PERIOD OF SAMPLE I POST Imagery 24 according to the instructions. In retrospect. it was hypothesized that the more adhesive cells may have adhered to the vessel wall or passed through. leaving only the less adhesive cells in the blood stream. Other findings of interest are the correlations between several imagery dimensions and blood function change scores (See Table 9). Study 2 Study 2 was designed in part to replicate the results of Study 1. in part to test the hypothesis that adherance had increased because more responsive cells were not available to venepuncture. and in part to test the hypotheses of the current study. 12 additional subjects were recruited and trained according to the same procedure (with minor variations to be discussed in the Methods section of this paper). The guided imagery instructions differed in that subjects were asked to image their cells changing shape and becoming more active. numerous and adhesive. but not sticking to the blood vessel wall and not passing through. There was also an additional suggestion to image the cells of the blood vessel endotheliun as not responsive to the neutro- phils adhering or passing through. To increase the sample size. subjects from Study 1 were contacted and asked to participate in another training and experimental session. In the training session. results of Study 1 were discussed and the experimenter led them in the new imagery exercise. Fourteen of Study 1's original 16 subjects participated in Study 2. 25 TABLE 9 Correlations between imagery ratings and changes in blood function during imagery (N=16) Blood 1 function 1 difference 1 Vivid- Shape Adher- Count Stren— Feel— Sym Clinical scores 1 ness change ance change gth ling bolis Judgemnt I ; Imagery 1 / WBC 1 .29 .12 .08 .36 .21 .20 .58" .29 I I Imagery 1 AD-UflStim. I 019 -007 -026 -023 031 -020 011 -011 I I Imagery 1 Ad-Stim 1 -.19 -.97* -.59** -.23 -.25 -.59** -.18 -.50* 1 Imagery 1 SC-Unstim 1 .18 .32 .02 .33 .00 .30 .22 .27 1 Imagery 1 SC-Stim I -010 .00 .10 029 -025 021 .2“ e13 p<.10 'p<.05 *‘p<.01 26 Figures VI & VII show the results of Study 2. Subjects again showed remarkable capacity to influence their neutrophils. Further— more. the direction of change suggests that in Study 1. the cells that had more adhesive were not available. In Study 2. adherance increased significantly (p < .05) and while there was a slight increase in count. the difference was insignificant. Again. although the imag- ery results were not as strong as in Study 1. in Study 2. several imagery dimensions were significantly correlated with neutrophil change (see Table 5). The importance of these data is strengthened by the finding that the same subjects who produced a drop in neutrophil adhesiveness sub- sequently produced an increase with the new imagery instructions (see Figures VIII & IX). This finding suggests that the imagery. rather than the relaxation or other more general factors (such as expectancy or affective states) is responsible for the observed changes in neu- trophils. It also supports the notion that neutrophils somehow "understand" image symbols. 27 FIGURE VI Pre A Post white blood count means for control and nmagery conditions in Study 2 (N=26) Control Imagery PERIOD OF SAMPLE 28 FIGURE VII Adherance Means (Unstimulated) Percentage of neutrophils adhering for control and imagery condition Study 2 (N=26) 100 -1 1 1 90 -1 1 / 1 80 -1 MEAN 1 S 1 CELLS 70 -1 ADHER- 1 INC 1 60 -1 1 1 50 -1 1 1 90 -1 : \ 1 3o -1 1 1 20 -1 1 1 10 -1 1 1 1 Control Imagery PERIOD OF SAMPLE 29 TABLE 5 Correlations between imagery dimensions and blood function difference scores in Study 2 (N=26) l 1 White blood Adherance Stimulated Shape 1 count adherance change 1 Vividness 1 -.05 -.02 .31 -.39* 1 Shape 1 .11 .08 -.09 -.35* Change 1 Adherance 1 .09 -.10 .13 -.92* 1 Strength 1 -.33 .15 .38' -.18 I Feeling 1 -.16 .09 .37” -.58** 1 Symbolism 1 -.02 .05 .20 -.35* Clinical 1 judgement 1 -.22 .10 .38' -.99* H 1 WHITE BLOOD COUNT 0000- 9000— 8000- 7000- 6000- 5000- 9000- 30 FIGURE VIII Pre & Post white blood count means for control and imagery conditions in Study 1 5 2 Study 1e Study 2 ...—.... .. .. Control Imagery PERIOD OF SAMPLE 31 FIGURE IX Adherance Means (Unstimulated) Percentage of neutrOphils adhering for control and imagery condition Study 1 & 2 100 -1 . 1 Study 1 g 1 Study 2 ...... 90 -1 I I I 80 -1 MEAN 1 S 1 CELLS 70 -1 ADHER- 1 ING 1 60 -1 1 1 ,’ 50 -: ,z’ 1 ,r" . / u ,r 90 -1 :::::::‘—___—_~‘_“‘ .I’ : ..... ~ 1 30 -1 1 1 20 -1 1 1 10 -1 1 1 1 1 Control Imagery PERIOD OF SAMPLE CHAPTER III THE PRESENT STUDY In Study 1. several imagery dimensions were significantly correlated with blood function difference scores. Subjects who changed their neutrophils the most produced imagery that was more symbolic and more detailed (they included images of the cells changing shape. becoming more adhesive. and leaving the blood stream). They also imaged their cells as being strong and reported more positive feeling about the experience than other subjects. Thus. there apears to be something about the imagery itself that predicts neutrophil change. Lang (1979) suggests that the success of desensitization therapy depends "at least on vividness and perhaps on the affective intensity" of the generated images. and that imagery vividness is determined by the completeness of the "evoked propositional structure". "Subjects reporting vivid images can generally describe them in exquisite detail. providing a large catalog of discimin- able stimulus elements." (Lang. 1979. p. 872) Although the vividness dimension alone was only mildly correlated with blood function differences. the clinical judgement dimension reflects vividness in a more complete sense. When making a clinical judgement of imagery "effectiveness". one asks. "To what extent did the imagery include all components of the instructions?". and "How symbolic is the imagery?" . "How intense and positive is the affect behind the imagery?". Thus. the results indicate that subjects who were able to control their neutrophils generated imagery with the two components that. according to Lang (1979) are important in effective imagery; 32 33 vividness and affective intensity. Individual differences in imggery vividness As illustrated in Figures X A XI. there were substantial indi- vidual differences in ability to voluntarily change neutrophil beha- vior. The purpose of this study is to look at personality dimensions underlying these individual differences. Individual differences in imagery vividness may be especially important in this ability. Lang (1979) states that differences in responsiveness to desensi- tization therapy may vary. particularly in the pathological popula- tions with whom it is often used. "It has been suggested that [this] population may be one of the least responsive to language mediated emotional cues." (Lang. 1978. p. 508) "This group is less capable...of processing emotional experience ‘off line' [and] specifically needs to work with fear stimuli in vivo." (Lang 1977. p. 878) Lang also suggests that "the ability to become absorbed in a representation of reality ‘as if' it were an objective experience" is a requirement for vivid imagery and thus for successful therapy (Lang. 1977. p. 878). Many other researchers have studied the association between imagery vividness and personality factors. Among them are Lindaur (1977) who found a relationship between imagery vividness and a high appreciation of aesthetic experience. Hargreaves A Bolton (1972) found that vivid mental imagery is associated with creativity as measured by divergent thinking tasks. Palmer and Field (1968) found 34 FIGURE X Results by Individual (N=16) Percentage of neutrophils adhering for control and imagery condition 100 — 95- 90 - 85 - 80 - 75 - MEAN i CELLS 70 - ADHERING 65 - 60 - 55 - 50 - 95 - 90 - 35 30 - 25 - 20 - 15 - 1O - I Control Imagery PERIOD OF SAMPLE FIGURE XI Results by Individual: White blood count for control and imagery conditions in Study 1 (N=16) Control Imagery PERIOD OF SAMPLE 36 vivid imagery to be correlated with hypnotizability. Also relevant is the literature on generation of imagery under sensory deprivation and isolation conditions. Goldberger A Holt (1961) found that some subjects were able to adapt to sensory deprivation through generation of imagery with "controlled primary process content". These individuals also tended to be artistic and sensitive. Cemberari's studies (as reported in Freedman A Marks (1965) of adaptive responses to isolation led to the identification of a syndrome which included "production and tolerance for all regressive phenomena along with higher frequency of spontaneous imagery or ‘hallucination'". (Freedman A Marks. 1965. p. 96-97) Freedman and Marks (1965) found that vivid visual imagery pro- duced by photic stimulation was associated with a characteristic they called "willingness to suspend one's generalized reality orientation". The notion of "generalized reality orientation" is taken from Shor's (1959) theoretical discussion of hypnosis. Broadly defined. it refers to "the conventionalized schemata which are the basic fabric of the waking mind". and is conceptually similar to secondary process. Under hypnosis and similar conditions. this orientation fades and "Derivation distinctions between wishes. onself. other. imagination and reality fade with it. as do many inhibitions conscious fears and defenses; and primary process material... can flow more easily into awareness. And if they [the distinctions] do [fade]. a new kind of orientation is created which shares some of the qualities of the dream." (Shor. 1959. p. 597) Freedman A Marks (1965) also found that the Rorschach color-sum ratio was positively correlated with photic stimulation imagery. Therefore. 37 "On the assumption that emotion is a primary process function. this result... supports the theoretical relationship between the suspension of the generalized reality orientation and regression in service of the ego." (Freedman A Marks. p. 103) Further. they assert that "The syndrome of abilities or traits identified in the present experiment is concerned with an extremely basic aspect of personality function. the question of what a person can accept as reality. As such this syndrome may have relevance to a wide variety of situations which are conducive to unreal experiences." (p. 111) This study is especially interesting as vivid imagery requires. in Lang's words. "the ability to become absorbed in a representaion of reality". Also. the correlation between photic stimulation imagery and the Rorschach color sum score parallels his assertion regarding the importance of an affective component in effective imagery. Klein. Gardner and Schlesinger (1962) investigated subjects' responses to a variety of unreal experiences (such as apparent movement. distortion of the visual field with anseikonic lenses. and the Rorschach test) and found that a characteristic they call "tolerance for unrealistic experiences" accounted for individual differences. In taking the Rorschach. the individual who is "tolerant of unrealistic experience" "comfbrtably accepts the task as an opportunity for projection. He may even view the blot as something to be played with... He is initially insecure but before long warms up to the task and gets free enough to play associatively with the card... [He] never loses all concern with reality but can joke about it. (Klein et. al.. 1962.p. 98-99) Schachtel's (1959) modification of Kris' (1952) notion of "regression in service of the ego" was found by Fitzgerald (1966) to be associated with 38 "a relative lack of repression in the face of conceptual com- plexity...[and] the ability to shift from more to less regu- lated thinking with facility." (p. 661) The above descriptions of people who successfully adapt to sensory deprivation and isolation conditions. who can suspend their generalized reality orientation. tolerate unrealistic experience. become absorbed in a representation of reality. and be open to experience. all have a great deal in common. The analytic theory behind the notion of regression in service of the ego (Kris. 1952) provides a way to conceptualize the basic personality dynamics characterizing individuals with these qualities. individuals who are. by implication. likely to generate vivid mental imagery. Schafer (1958) in a discussion of Kris' (1952) original formulation defines regression in service of the ego as "... The ego's permitting relatively free play to primary process in order to accomplish its adaptive tasks. The ego detours through regression toward adaptation. It is warranted to speak here of regression in so far as primary process or its close derivatives. normally warded off. are allowed a place in conscious experience: and it is warranted to speak of the process being in service of the ego in so far as regression serves ego interests (such as being creative or empathic), is relatively easily reversible. and is amenable to productive working over by the ego in terms of its adaptive pursuits. (p. 125) - The ability to allow primary process material to enter conscious- ness without being overwhelmed requires a "flexibility of repression" (Kris. 1952) that is only possible when an individual's ego structure is secure. Economically speaking. regression in service of the ego requires abundant intrapsychic energy for the shifting of cathexis "from preconsciousness to consciousness" (Kris. 1952) that allows pri- mary process contents to emerge. When the ego is weak, a hypercathexis 39 of energy in defense mechanisms occurs. leaving insufficient energy available for these shifts. According to Schafer.some of the personality factors facilitating adaptive regression are. "A well developed set of affect signals [so that] when the regressive process threatenes to get out of hand... apropriate signals will trigger the search for defensive disguise of content or reversal of the entire process. Confidence in these signals make it safe to regress." "A second condition is a secure sense of self. and. more broadly. a well established ego identity... Where this security is weak or absent. one must rigidly maintain self-boundaries and organization and a self definition of a particular sort for fear of having nothing otherwise." "[Another]...factor is relative moderateness. rather than archaic severity. of superego pressures. and. in close correlation with this. relative flexibility rather than rigidity... of defense and controls." (p.95) Thus. the individual capable of adaptive regression is a flexible individual with a strong ego and well developed affect. The fact that researchers have linked these qualities to the ability to generate vivid mental imagery is not surprising. The pre- conscious is the realm of symbolism and intense affect. When an indi- vidual can suspend the "hypercathexis between preconsciousness and consciousness" (Kris. 1952) the primary process is free to elaborate the framework structure of imagery with rich symbolism and to evoke emotional arousal. The result is vivid and emotional imagery. no Statement of thegproblem There is an historical precedent for viewing imagery as inte- grally associated with somatic processes. John Schneider and his co-workers were able to confirm this association using scientific pro- cedures. While the results did not correspond exactly to the imagery suggestions. the same group of subjects produced two different pat- terns of neutrophil behavior using two sets of imagery instructions. When subjects imaged their neutrophils becoming more adhesive and leaving the blood stream. both count and adhesiveness dropped. When they imaged their cells becoming adhesive and not leaving the blood stream. adhesiveness increased and count remained unchanged. Because the difference in imagery instructions was a matter of semantics. it seems likely that images may indeed be. as Lang (1978) suggests. like other information. propositional networks with built-in somatic components. Variations in the amount of information (vividness) in an image. along with variations in affective intensity (which may be a function of vividness). make a difference in patterns of somatic activity. Lang (1977. 1978) manipulated the propositional structure of imagery instructions and found that affective arousal was closely linked to instructional completeness. Another way to investigate the validity of his model is to distinguish a group of individuals likely to produce vivid and complete mental imagery because of their charac- teristic personality structure. and see if they are more capable of voluntarily controlling neutrophil behavior. Ln Hypotheses The current study investigates the relationships among imagery vividness. personality. and voluntary control of neutrophil behavior (for the purpose of this study. it will be assumed that emotional imagery is vivid imagery). The hypotheses to be tested are as follows: 1. Individuals most capable of regression in service of the ego will generate the most vivid imagery. 2. Individuals most capable of regression in service of the ego will have the greatest control over neutrophil fUnction. CHAPTER IV METHOD Subjects This study utilized the subjects who participated in Study 2. thirteen of whom also took part in Study 1. The total number was 25. There were twelve medical students. seven students in psychology, and six subjects engaged in other occupations (one undergraduate. two local businessmen. one pastor. and one social services director. and one university professor). Ages ranged from 18 to 92. The sex distribution was 19 males and 11 females. Most of the subjects were recruited through two year-long grad— uate seminars taught by John Schneider and his associates on Medical Psychology and Loss A Grief. A sign-up sheet was passed around during class. Dr. Schneider was personally aquainted with many of the sub- jects who signed up. and a priori excluded those individuals known to have major health problems. and those he thought had a pessimistic attitude toward the possibility of affecting neutrophils through imag- ery. Therefore. these subjects were in no way representative of the community at large. They were highly motivated. above average in intellegence. relatively successful. and unorthodox in their beliefs. Psycholggical measures andgprocedure The Rorschach Inkblot Test. The Rorschach Inkblot Test was used to measure the ability to adaptively regress. Several measures that are theoretically asso- ciated with adaptive regression were utilized. These measures were 1) 42 93 "tolerance for unrealistic experience" (Klein. 1962). 2) Holt's (1960) primary process content scores. 3) "emphasis on articulated Form" (Shafer. 1959). and 9) the number of responses (Rapaport Gill A Shafer. 1968). In the following section. the relevance of these vari- ables to adaptive regression and their operationalization will be dis- cussed. [1] Tolerance for unrealistic experience (TOLERANCE) As mentioned in the preceeding section. notion of "tolerance for unrealistic experience" discussed by Klein et. al. (1962) is very sim- ilar to Kris' (1952) concept of regression in service of the ego. For an individual to be comfortable with the blurring of intrapsychic boundaries that regression imples. he or she must be able to "play" with reality. To test his hypothesis that tolerance for unrealistic experience would be related to perceptual experience. Klein divided subjects into tolerant (T+) and intolerant (T-) categories. based on their attitudes toward taking the Rorschach. These attitudes were thought to better reflect a subject's capacity for "playing" with reality than the formal scores. Klein's procedure for catagorizing subjects was adopted as one measure reflecting a capacity for adaptive regression. This procedure is as follows: 99 Klein's Rorschach criteria for judging tolerance and intolerance for unrealistic experiences The rating criteria were developed on the premise that the T+ and T- extremes are more readily discernible in a subject's attitude toward his responses than in the standard ‘signs' by which Rorschach protocols are usually scored. Evidences of concern with realism and reasonableness of Re sEn se 3 The main difference between T+ and T- is the freedom the subject permits himself of tampering with the ‘reality' of the card. Differences in this respect are revealed in a number of ways. The T+ person comfortably accepts the task as an opportunity for projection. He may even view the blot as something to be played with. If he does not necessarily enjoy the task. he at least does not find it uncomfortable. A T+ protocol is notably free of critical comments and expressions of dissatisfaction with the task. The T+ subject can toy with alternative conceptions for a given area; he may elaborate responses from small hints provided by the blots. In formulating meanings for the blots. he may draw either upon the train of his associations. or on specificable physical areas: he does not feel compelled to anchor responses only to meanings that are clearly confirmable by physical features of an area nor only to physical details that provoke least doubt about the meanings they suggest. The T- person, on the other hand. sets limits to the ideational freedom he permits himself in confronting the open-ended instruction. This shows itself not so much in unproductivity or few responses as in a tendency to subject his responses to a critical eye (e.g.. ‘A bat. but not a very good one'). He prefers certainty. the confirmable meaning: the less certain is allowed expression only grudgingly. warily. and with circumspection. His protocols are dotted with qualifiers as if ‘to keep the record straight' (e.g.. ‘It looks a little bit like...'). He is concerned over an imaginary picture that does NOT fit a meaning: he tends generally to be caught up in the formal qualities of the blot rather than in the associative byways of the meanings that happen to come to mind. 95 The T- orientation may disclose itself less in these specific ways than in a general discomfort with the task itself. indicated by the subject's manner of response. e.g. he may quibble; he may repeatedly ask questions about how he is to respond; he may complain about the vagueness of what is expected of him. This discomfort may take the form of projected meanings (e.g.. a person or animal may be ‘grotesque' or a form ‘vague'). Variety of determinants T+ qualities may be revealed through a variety of other determinants than form alone. such as shading. colour. etc.. all. for the most part. integrated with the fOrm attributes of the blots. References to colour. for example. should disclose this easy blend. In contrast. the T- attitude may be implemented either by a total unresponsiveness to colour or by sporadic. unmodulated reactions to it. (Klein etc 310, p. ua-ug) Criteria for scoringgT+ and T- in the present studyyg In the present study. raters utilized several major dimensions of Klein's criteria as discussed above. Subjects who seemed to be at ease with the Rorschach testing. and who seemed to enjoy the testing situation (as evidenced by such comments as "Oh! what a cute little bearI") were rated as T+. A variety of determinants. especially movement responses were also taken as indicating T+ qualities. Subjects who tended to qualify their responses (with comments like "This could be a bug if it had antennae.") were rated as T-. as were subjects who seemed to need reassurance that their responses were adequate ("Is that the sort of thing you want to know?") Subjects who produced records with few responses and few deteriminants other than form wer also scored T-. Admittedly. there was a fair amount of subjectivity in these ratings; many records had both T+ 96 and T- characteristics. Nevertheless. reliability of the measure was adequate (.89). Scoring. In the current study. subjects classified as tolerant (T+) by two independent raters received a 1. and those classifed as in- tolerant (T-) received a 2. As mentioned above. inter-rater relibility was .89. Operationalization of hypotheses. It is hypothesized that individuals classified as T+ will have more vivid imagery (as evidenced in higher imagery ratings). and greater changes in blood function (increased neutrophil shape change. adhesiveness and responsiveness). [2] Primary process content (PRIPRO) Freud originally made the distinction between primary and secon- dary process to emphasize his assumption that dreams and hysterical symptoms. rather than being nonsense. are products of a primitive thinking mode which develops prior to logical thought (Holt A Havel. 1960). When adaptive regression occurs. this primary process thinking mode is reactivated and can be used for creative purposes. Holt A Havel (1960) point out that rather than being dichotomous. primary and secondary process "define the extremes of-a logical con- tinuum" (p. 265). All thinking is "compelled by drives". along with the "requiredness of external reality and the logical structure of ideas" (Holt A Havel. 1960). Holt (1960) developed his manual for scoring primary process manifestations to measure how close thought products (appearing on the Rorschach) are to the primary process pole. and to assess the equilibrium of the individual when such thoughts are 97 produced. There are three major components to Holt's system; 1) content variables. which assess drive domination in the content of test res- ponses. 2) fOrmal variables. which deal with deviations in response structure. and 3) control and defense variables. which assess a sub- ject's reaction to the emergence of primary process material (Holt A Havel. 1960). The content variables alone were used in the current study. There was some theoretical justification for doing so. Holt's control and defense variables measure the effectiveness of an individual's defenses. For the purposes of this study it was assumed that most. if not all. of the subjects in the current study had effective defenses. by virtue of their occupations. It was con- sidered unlikely that a medical student. for example. would produce an abundance of primary process without adequate ego controls. Thus. the content scores probably reflect the ability of subjects in this study to adaptively regress. rather than their propensity to maladaptively regress. The formal variables. like the content variables. measure the degree to which a thought product is affected by drives. only they focus on evidence for primary process in the formal structure of test responses. Subjects who were able to "get in touch with" their pri- mary process probably produced primary process content as well as evi- dence of primary process in response structure. Holt's procedure for deriving content scores was used as a second measure of adaptive regression. The rationale for. and definitions of. these scores are as follows (Please see Appendix C for a complete 98 list of Holt's primary process content scores): Holt's Content variables "We have made the assumption that all thought and perception are organized to some extent by drives as well as by the given requiredness of external reality and the logical structure of ideas. We thus ask. not whether a thought process involves drives or not. but the extent and the manner in which drives are involved in cognition. Other things being equal. the less neutralized (and the more instinctivized) is the energy of the drive. the closer does thought come to the primary-process pole. The problem of scoring Rorschach content for primary process becomes then a question of establishing criteria by which the degree of neutralization of the motivating drive energy may be identified. We ask first. whether any relevance to an instinct derivative can be seen in a given response. Since taking the test is not a situation in which there can be any realistic striving for direct gratification of a basic drive. we assume that any drive imagery that occurs is not a part of goal-oriented behavior but rather evidence that the drive is organizing the response in a relatively "primary" way. If reference to a drive is apparent in the content. we estimate its closeness to the original instinct- as manifested in the directness or "primitivity" of its aim- and then the extent to which the drive itself dominates cognitive processes. as against being subordinated or controlled by them. Both ideas and affects may indicate drive tension. The system makes provision for scoring each. and thus has two major divisions: ideational drive-representations. and affective drive-representations. Since the Rorschach is designed. however. to ellicit ideas rather than effect. by far the greater number of the content categories are devoted to the former. This heading. in turn. has three major subdivisions: drives with libidinal aims; drives with aggressive aims; and thematic indications of guilt and anxiety. The latter covers responses which we assume are reactions to instinctual threat. even when their libidinal or aggressive nature cannot be discerned. Each of these subdivisions has two main sections. noted as "Level 1" and "Level 2". These represent two levels of closeness to the primary process pole. as defined by several criteria. One of these has to do with a 99 "primitive-civilized" dimension: the more the type of drive expression described or implied is socialized and discussion of it is appropriate to communication between strangers in a professional situation. ths more the thinking concerned has to be secondary; we then score Level 2. Conversely. the more direct. intense. or blatant the drive expression the closer it is to the primary process; the score given is Level 1. In a sense. we have here a control distinction ...A second criterion has to do with the degree to which the response focuses on the drive-relevant organ. When a certain part of anatomy is seen in isolation. this is scored on the lower level if one or more of the following effects would result: 1. Placing such a part of the anatomy in the context of perception of a whole body (or a whole face) implies a more socially acceptable type of content. in the sense that it is. for example. more permissible in polite society to discuss a woman's figure than to speak specifically of her breasts. 2. Going from the part to the whole implies a change in the percept itself. such as the implications of the presence of clothing. There is no such implication as far as a penis is concerned; whether it is specified as being part of a complete man. or seen by itself. clothes would not be present. whereas if breasts are seen as part of a total figure. there is an implication that the woman is clothed unless it is specifically stated that she is not. 3. Finally. it must be considered to what extent a particular body detail fOrms a "good gestalt" in itself- to what extent is it natural to see it as a unit in isolation? Lewis Carroll had this in mind and made deliberate use of it in the passage where Alice saw the smile without the Cheshire cat." (Holt A Havel. 1960. p.271-272) 50 Scoring. Scoring procedures were according to the section for content variables in Holt's Manual with one exception. Holt uses the distinc- tion between Level 1 and Level 2 only in the scores for control and defense. He counts each occurrence of primary process content as one point. regardless of level. Since the control and defense scores were not used. it was decided that the Level 1 scores would count as two points. and Level 2 scores as one point. It was thought that this procedure would yield more infbrmation adaptive regression than the simple scores for occurence of primary process manifestations. Level 1 and Level 2 scores were summed to yield a total "Pripro" score for each subject. Inter-rater reliability was .95. Operationalization of hypotheses. It is hypothesized that subjects with higher primary process (PRIPRO) scores (summing level 1 responses (2 points) and level two responses (one point) will have higher imagery ratings (their imagery will be more vivid). and will show evidence of control of neutrophil function (their neutrophils will change shape. and become more adhesive and responsive) than subjects who have lower primary process (PRIPRO) scores. [3] Emphasis on articulated form (F%) This measure taken from Shafer's (1959) book on psychoanalytic interpretation of the Rorschach. is the extended F1 on the Rorschach. The extended F1 is the percent of total responses having form as the primary determinant. According to Shafer. the extended F1 is the best indicator of an individual's capacity for self-control. The imposi- 51 tion of form on Rorschach stimuli involves an "active and responsible" engaging of these stimuli to "make good use of their potentialities“. "This active approach to the test situation and the availability of energy for carrying it through ordinarily indicates some strength in the patient's psychological status...[it] is a necessary. even if not sufficient. indication of well-maintained adaptive and defensive efforts." (Shafer. 1959. p.176) It might be said that self-control should be negatively related to the capacity for adaptive regression; a defensive structure that enables self-control requires a large investment of psychic energy which makes the shifts from primary to secondary process (and vice versa) difficult. However. there is a certain sense in which good defenses and a strong ego structure are necessary for adaptive regression. Defenses are needed to flexibly enter into and terminate primary process thinking. Furthermore. one might add that well-defended individuals are likely to engage in adaptive regression. as adaptive regression is a process that fosters development of effective defenses. It must be kept in mind that effective defenses are not rigid defenses. and the extended FT also can indicate an exces- sive emphasis on control. When more than 90% of Rorschach emphasize form. "defensive operations are likely to be too rigid and severe. 52 adaptiveness limited. and feeling and fantasy stifled." (Schafer. 1959. p. 177) Therefore there is an optimal range for the extended F1. which according to schafer is between 80 and 90 percent. Individuals who fall within this range were considered capable of adaptive regression. Scoring. In the current study. the extended FS was the total number of responses having form as the primary determinant (F, M. FY. FT. FV. and FC. and blends where form is primary) divided by the total number of responses (R). Subjects whose score fell outside the optimal range. 80-901. in either direction. will receive a 0. those within the range received a 1. Inter-rater relibility was .95 Operationalization of hypotheses. It is hypothesized that indivduals whose extended F1 is between 80 and 90% will have more vivid mental imagery (higher imagery ratings). and will show greater change in neutrophil count. adhesiveness. shape and responsiveness. than individuals who have an extended F1 greater than 90% or less than 80%. [9] Number of responses (R) Finally. the number of responses was used as a fourth measure of adaptive regression. Theoretically. individuals who are capable of producing a large number of responses on the Rorschach show an ideational fluency that is negatively related to defensiveness and positively related to creativity. According to Rapaport et. al 53 (1968). "The number of responses. R. reflects the quantitative productivity of the subject. This productivity depends upon the flexibility of the perceptual process and the wealth and pliancy of the associative process." (p. 298) It is this flexibilty of perception and wealth of associative process that one would expect to find in the individual capable of adaptive regression. Scoring. Beck's (1962) standard method of scoring for the number of responses was utilized. Inter—rater relibility was .97. Operationalization of hypotheses. It is hypothesized the subjects who show a large number of responses will produce more vivid imagery (higher imagery ratings) and greater changes in their neutrophils (increased adhesiveness. shape change and responsiveness). Rorschachgprocedure The Rorschach was administered to subjects according to the procedure outlined by Beck (1962). All testing sessiOns were tape recorded and transcribed verbatim. Two independent scorers. blind to the results of subjects' blood function difference scores and imagery ratings. scored the records using the Beck (1960) system. These scorers then rated the records for tolerance for unrealistic experience (T) and primary process content (Pripro). and then calculate the extended F1 and number of responses (R). 59 Final Rorschach scores. Since inter-rater reliabilities were good; (as mentioned earlier these were .89 for TOLERANCE. .95 for Primary Process [PRIPRO]. .95 for Articulated form [F5]. and .97 for number of responses [R]). final scores were computed for each sub- ject by taking the mean of the two ratings for PRIPRO and R. Only one Because the two scorer's ratings were not significantly different. one rating for TOLERANCE was used. The final F5 score was com- puted by taking the mean of the two ratings for Articulated form and dividing that by the final score for R. before determining whether a subject's score fell inside or outside the optimal range. hence whe- ther they received a score of 0 or 1. Imaggry measures and procedure Imagegyinterview. An open-ended interview was conducted with subjects to assess the vividness of their imagery. The same data as was collected for Study 2 was used. The questions asked for this interview were as follows. 1) What did your white blood cells look like? 2) Did you see them changing shape? 3) Did you see them getting sticky? 9) How strong did they seem to be? 5) How was the experience for you? How did you feel? 6) Was there anything else about the experience that you haven't told me that you think might be important? All interviews were tape recorded and rated by three experienced clinicians using a 5 point scale on the following dimensions: 55 1) Vividness of the imagery 2) Extent to which a change in shape was emphasized. 3) Extent to which a change in adhesiveness was emphasized. 9) Strength of the neutrophils. 5) Overall feeling: Whether the experience was positive (5) or negative (1) 6) Degree of symbolism used in the imagery. 7) Clinical judgement of imagery effectiveness: Whether the raters felt that the imagery was the kind that is likely to produce neutrophil changes. 8) Clinical judgement of the adhearance dimension: Whether the cells actually became adhesive. as judged from the imagery 9) Clinical judgement of the shape change dimension. 10) Clinical judgement of the availability of cells: whether or not the cells would remain available to venipuncture (5: available. 1: not available) 11) Extent to which the picture suggested vivid imagery. Scoring. Scores for these dimensions ranged from 1 to 5. An additional imagery summary score was computed by first. summing each raters' scores for all dimensions for each subject. and then taking the mean of the ratings. Inter—rater reliability was .93. Neutrophil function measures and_procedure Blood samples were obtained by venepuncture. Ten ml was antico- agulated with heparin. 2 ml was anticoagulated with EDTA and 3 ml was allowed to clot in a glass tube. A portion of the serum was stored at -70 degrees for possible future use. A total white cell count and differential was performed according to standard procedure. A previ- ously published procedure (Smith. Hollers. Patrick. A Hassett. 1979) was utilized for Neutrophil isolation. 56 Cellular functions: 1] Shape change. One measure of chemotactic response is the ability of cells to assume a bipolar configuration upon exposure to a chemotactic factor (CF) Two techniques were be used. One was recently developed by David Jadwin. an osteopathic medical student. This technique utilizes whole anticoagulated blood. The (CF (e.g.. f-Met-Phe) is added to the sample to a final concentration of 10 - 10 M. The sample is allowed to sit at room temperature for 30 min. and then the blood smears are made on a LARC spinner. The percentage of cells with a bipolar configuration is then determined by scoring 100 cells per slide. The second technique utilizes purified neutrophils and has been published (Smith et. al. 1979) 2] Adhesiveness. The ability of cells to stick to protein coated surfaces was determined by two techniques. One involves passing heparized blood over a glass bead column (Smith A Hollers. 1980). The concentration of leukocytes was determined before and after passage over the beads. The effect of CF was determined by adding CF to the blood sample 5 minutes before testing adhesiveness. The second technique has been published (Smith et. al. 1979). We determined the adherance of isolated neutrophils and the effects of CF stimulation. 3] Chemotaxis. The spontaneous migration and chemotactic responsiveness of isolated neutrophils was determined utilizing a modification of the Boyden Technique (Smith et. al. 1979). The number of cells migrating into micropore filters was estimated using an Optimax image analyzer. Subjects were fully informed in advance of the nature and purpose of the experiment. Subjects were excluded if they had any chronic pro- cess which might be affected by the experimental condition (e.g.. migraine headaches). Participation was delayed because of infections within the past weeks. active allergies. or certain drug use within three days of the experiment (aspirin. alcohol. marijunana. LSD. etc). All subjects had two control blood samples taken at 20 minute inter- 57 vals at the same time of day (between 8:00 and 9:00 AM) as the exper- imental blood sample would be taken. Control samples were obtained prior to any instruction or training. All subjects had a blood sample taken immediately prior to (PRE) and immediately after (POST) the experimental condition. Blood function scores. Four blood function scores were used in statistical analysis of data obtained in the current study. These scores were calculated by taking the difference between PRE and POST imagery measures of neutro- phil count (WBC). unstimulated adherance (AD). stimulated adherance (STIM-AD). and unstimulated shape change (SC). Generalyprocedure The current study used the subjects of both Study 1 and Study 2. Because the training procedures differed. the procedures will be des- cribed by study. Study 1 In Study 1. initial screening took place in Smith's laboratory. where two blood samples were taken 20 minutes apart to establish a baseline and to test for neutrophil reactivity to venepuncture (some individuals' neutrophils are activated simply as a result of having blood drawn). Subjects then participated in the three group training sessions. 58 and one individual experimental session. The three group sessions proceeded as outlined previously. The only thing that was not men- tioned is that subjects drew pictures of their neutrophils as they had visualized them after the practice imagery exercises. rated themselves on the following imagery dimensions: 1) vividness. 2) numerousness 3) shape change 9) whether they had been imaged leaving the blood stream. 5) adhesiveness. 6) strength. and 7) symbolicness. This was done in order to reinforce the notion that all these dimensions contributed to effective imagery and should be included in the experimental imagery session. The subjects who had participated in the above training procedures were contacted again and asked to participate in a further study. 19 subjects consented. They met with Schneider. Smith and myself. and the results of Study 1 were discussed. along with the rationale for the current study. Subsequently this experimenter led them in a prac- tice imagery exercise in which they were instructed to image their cells becoming more active. adhesive. etc.. but not leaving the blood vessel and not adhering to the walls. The sound of ocean waves was played in the background as a noise screen. The experimental session was conducted in a private office with a reclining chair. Smith took an initial blood sample befbre the shades were drawn and the subject was fully relaxed. The sound of waves was again played in the background. The experimenter read the same imagery instructions that had been used in the practice session. (See appendix B for a verbatim transcript) The second blood sample was taken with the subject relaxed in the chair. after 59 the 25 minute imagery session. Subjects were asked to draw a picture of their neutrophils and were then interviewed. Subjects were tested with the Rorschach prior to the experimental session. Study 2 16 additional subjects were screened in Smith's lab for Study 2. Of these subjects. 5 did not continue (one dropped out due to a busy schedule. two were under substantial stress and so were excluded to prevent a confounding of results. and Smith was unable to obtain blood samples from the other two). Subjects attended three group training sessions that were very similar to the sessions attended by Study 1 subjects with the follow- ing exceptions. First. John Schneider. rather than Minning conducted the two imagery training sessions. He also led the practice imagery exercises. Secondly. subjects were not asked to draw pictures and self-rate them. Instead. Schneider discussed their imagery and exper- iences with them as a group. The individual experimental session was conducted as before except a tape of Schneider reading the imagery instructions was used instead of having an experimenter read them. The tape had the sound of waves in the background. Subjects wore headphones when listening to the tape. After the post blood sample. subjects were asked to draw a picture of the neutrophils as they had been visualized and were interviewed about their imagery. As in Study 1, subjects were tested with the Rorschach prior to the experimental session. CHAPTER V RESULTS Descriptive statistics Table 6 shows the means. standard deviations. and minimum and maximum values for the variables primary process content (PRIPRO). number of responses (R). imagery vividness (IMAGERY). and the blood function difference scores; white blood cell count (WBC). unstimulated adherance (AD). stimulated adherance (STIM-AD) and shape change (SC). along with the number of subjects for whom values were available. Table 7 shows the frequencies of values for the two dichotomous varia- bles. tolerance for unrealistic experience (TOLERANCE) and articulated form (F1). A series of one-way analyses of variance revealed no sig— nificant sex differences in any of the variables. Therefore. all an- alyses were performed grouping the two sexes together. Preliminary correlational analyses All variables were correlated using Statistical Packagegfor the Social Sciences (SPSS) (Nie. Hall. Jenkins. Steinberger A Bent. 1975). yielding the matrix in Table 8. Of particular interest in this matrix are 1) the correlation between the number of responses (R) and changes in white blood cell count (WBC) (r=.35. p<.09). and 2) the correlation between primary process content (PRIPRO) and changes in unstimulated adherance (AD) (r=.33. p<.05). These correlations. although small. 60 61 TABLE 6 Descriptive statistics for interval scale Rorschach variables (R A PRIPRO). IMAGERY ratings. and blood function difference scores (WBC. AD. STIM-AD. SC) Variable 1 Mean Standard Range N of Cases Name 1 deviation 5' R 1 32.6 8.0 19 - 99 26 PRIPRO 1 19.2 9.9 3 - 38 26 E IMAGERY 1 30.0 8.6 13.5 - 93.5 26 1 WBC 1 320.0 519.1 -900 - 1300.0 29 AD 1 -28.9 11.7 -98 - -6 25 STIM—AD 1 -26.0 11.7 -51 - -8 25 SC 1 5.7 15.2 -15 - 91 16 62 TABLE 7 Frequencies for dichotomous Rorschach variables: F1 and TOLERANCE 1 Variable name 1 Value Frequency I ; F1 1 0 18 1 1 8 1 TOLERANCE 1 0 12 1 1 19 63 support Hypothesis 2; that individuals capable of adaptive regression are most able to control their neutrophil function. Due to the small sample size. the corelations include considerable sampling error var- iance; with more subjects. one might well expect to see more stable relationships. Correlations between PRIPRO and R and the other blood function variables (WBC. AD, STIM-AD. and SC) were also quite small. but in the expected direction. Interestingly. the Rorschach variable F1 showed a significant negative correlation with STIM-AD (r=-.39. p<.05). and was negatively correlated with AD and SC as well. although not significantly so. It may be that F1 is tapping some variable orthogonal to adaptive regres- sion but which still predicts the ability (or inability) to control blood function. Alternatively. the significant correlation between F1 and STIM-AD might have occured by chance. To test the post-hoe hypothesis that F1 is measuring defensive- ness rather than adaptive regression. the variable was re-computed so that an extended F1 above .85 was scored 0 and an extended F1 below .85 was scored 1. The hypothesis was that individuals with an F1 over .85 would be too defensive to be able to adaptively regress. Confirming this hypothesis was a correlation of .91 between F1 as computed. and STIM-AD (p< .02). This is in contrast with the negative correlation between F1 (as computed with Schafer's criteria) and shape change. The data do not support Hypothesis 1; that individuals most cap- able of adaptive regression show the most vivid imagery. None of the Rorschach variables were correlated with IMAGERY to any substantial Preliminary correlations among variables 69 TABLE 8 1 R PRIPRO F1 TOLER- IMAG— WBC AD STIM- SC 1 ANCE ERY AD I g : PRIPRO 1 .99" 1 1 F1 1-.20 .25 1 TOLER- 1 ANCE 1 .18 .17 .11 I I IMAG- 1 ER! I .00 .1“ -013 020 I ; "BC I .35. 026 028 002 -007 I I 1 AD I 019 033' -028 -008 005 -032 I I STIM- 1 AD I 005 016 ‘03“ ‘007 026 ‘058... 05”.. 1 1 SC I 013 018 -030 .19 ‘euu. .07 0‘43. -015 1 ' p<.05 '9 p<.01 "' p<.OO1 65 degree. However. there was a significant negative correlation between IMAGERY and SC (r=-.99. p<.05). indicating that. if the correlation is not a statistical artifact. the more vivid the imagery an individual uses. the less their cells are likely to change shape. It is likely that this correlation occured by chance. as SC had a small sample size (n=16). and as it did not correlate in a coherent manner with the other blood function variables. These correlations were .07 with WBC. .93 with AD and -.15 with STIM-AD. and indicate that SC was not a particularly useful measure for the purposes of this study. Similarly. TOLERANCE proved to be a poor predictor: it showed consistently low correlations with the other Rorschach variables (.11 to .17) suggesting that it not a good measure of adaptive regression as was hoped. The highest correlation between TOLERANCE and another variable was with IMAGERY, r:.20. Nor did it correlate with the blood function variables. In general. the correlational analyses yielded only weak support for Hypothesis 2. and essentially no support for Hypothesis 1. Cluster Analyses Due to several problems with the correlational analyses. the decision was made to perform a cluster analysis. These problems were first. significant correlations by occur by chance alone when running a large number. leading to a type 1 error; secondly. there was a large amount of random variance in the correlations due to sampling error and to the unreliability of the instruments. and no way of esti- mating the extent of this random variance; and finally, simple corre- 66 lational analysis only allows a very rough assessment of which varia- bles might be measuring similar or different phenomena. Cluster analysis helped to ameliorate these problems. By group- ing variables into unidimensional clusters. an estimation could be made of the reliability of the items in these clusters. and thus of the true correlations between clusters. Furthermore cluster analysis helped to pinpoint the variables predicting a parallel fashion. and those orthogonal to each other. Cluster 1: Adaptive Reggession . Cluster analysis was performed using PACKAGE. a program developed by J.Hunter (unpublished). First. a confirmatory factor analysis was performed to determine which. if any. variables showed substantial covariance. This was done by calcu- lating standard score coefficient alpha for groups of theoretically related variables. Initially. the Rorschach variables R. PRIPRO. TOLERANCE. and F1 were placed in one group. yielding an alpha of .95. and indicating that the variables in this cluster were not related to each other in any coherent way. Further examination of the communalities (a communalitiy is an estimate of the amount of variance of each item in a cluster has in . common with the cluster as a whole) revealed that the relibility was low because F1 was quite unrelated to the other variables. Therefore the alpha was calculated for the three other Rorschach variables. yielding a value of .59. Examination of the communalities in this cluster indicated that TOLERANCE was contributing little to the cluster's reliability. and so R and PRIPRO were combined into the final cluster. henceforth called Adaptive Regression. or AR. The 67 TABLE 9 Communalities and alphas for Cluster 1: Adaptive Regression (AR) (Communalities in the diagonal) [A] All Rorschach variables: Alpha=.95 1 R Pripro F1 TOLERANCE I 1 1 R 1 .12 1 1 PRIPRO 1 .99 .95 E F; I -020 026 01 1 TOLER- 1 ANCE 1 .18 .17 .12 .12 1 [B] R. PRIPRO and TOLERANCE: Alpha: .59 1 R PRIPRO TOLERANCE a 1 1 R 1 .98 1 1 PRIPRO1 .99 .97 I I TOLER-1 ANCE .18 .17 .7 68 alpha for this cluster was an acceptable .66. (See Table 9 for com- munalities and standard score coefficient alphas for the formation of Cluster 1: AR.) The fact that TOLERANCE and F1 could not reliably be included in a cluster with PRIPRO and R was not surprising. given the results of the correlational analysis which indicated that TOLERANCE was weak predictor of the Rorschach variables. and that F1 was related to the blood function variables in a direction opposite to PRIPRO and R. Cluster 2: Blood function (BF). In the formation of the blood functioni cluster. the first step was to estimate the alpha for a cluster con- taining AD. STIM-AD. and SC. WBC was not included in this cluster because it is known to be causally related to AD and STIM-AD. When white blood cell count decreases. adherance will increase (and vice versa). This happens because when the cells increase in adherance. they adhere to the blood vessel walls and are not available to vene- puncture. When they are not adhesive. they are suspended in the blood. and are available. The high negative correlation between WBC and AD (r=-.58. p<.OO1) illustrates this relationship. Excluding WBC. the alpha for the blood function cluster was 53. However. the communalities showed that SC was not related to the other cluster members. STIM-AD also showed a low communality. however. when the two adherance variables AD and STIM-AD were combined into a clus- ter. the alpha rose to .71. (See Table 10 for communalities and standard score coefficient alphas for formation of the BF cluster. 69 TABLE 10 Communalities and alphas for Cluster 2: Blood Function (BF) (Communalities in the diagonal) [A] Comunalities for AD. STIM-AD. and SC: Alpha: .53 1 AD STIM-AD sc I AD 1 1.68 I I STIM-1 AD 1 .55 .8 1 1 SC I 0‘93 -015 O3 70 Final correlations. The rationale behind forming the two clusters. AR and BF. was to derive reliable measure of adaptive regression and blood function in order to assess whether or not there is a robust relationship between the them. (In computing correlations between clusters. it is important to keep in mind that the correlations are adjusted for attenuation. and thus are larger than raw correlations. The adjustment for attenuation is made using the cluster's coefficient alpha and is thought to reflect the true correlation between theore- tical factors.) The final correlation between Cluster 1 (Adaptive regression) and Cluster 2 (blood function) was .35. significant at the p<.09 1evel.again supporting Hypothesis 2 (See Table 11). Furthermore. the correlation between AR and WBC was a solid .93 (p<.01). Interestingly. the correlation between F1 and BF was signi- ficant and negative (r=-.92. p<.01). This again suggests that this variable reflects a psychological process negatively associated with the ability to control neutrophil function. but which is different from adaptive regression. Other evidence for the orthogonal relation- ship between F1 and adaptive regression are the correlations between F1 and PRIPRO. and between F1 and R. which go in opposite directions; .26 and -.20 respectively. Summary. To summarize. the cluster analysis yields evidence for the validity of Hypothesis 2. that the ability to adaptively regress is related to the ability to control blood function. Again. there is 00~support for Hypothesis 1. that individuals who produce more vivid innagery are more capable of adaptive regression. Nor is there any 71 evidence that imagery vividness is associated with the ability to con- trol blood function. 72 TABLE 11 Final correlations among clusters and items (adjusted for attenuation) 1 R PRIPRO F1 TOLER- IMAG- WBC AD STIM- SC CLUSTER 1 ANCE ERY AD 1(AR) 1 1 1 CLUST- 1 ER 1 1 .71**' .71*** .9 .25 .11 .93** .37' .15 .22 1.00 (AR) 1 1 1 CLUST- 1 .17 .33“ —.92** -.11 .21 -.60*** .75'*' .75**' .18 .35” ER 2 1 (BF) 1 ' p<.05 '* p<.01 '9' p<.001 CHAPTER IV DISCUSSION General discussion This study was designed to investigate some of the relationships among personality factors. imagery. and voluntary control of neutrophil functioning. The observed correspondence between the content of imagery instructions and changes in neutrophil behavior was of particular interest. as it implies that there is some kind of informational system spanning the mind-body gap. or alternatively. that the gap is a fiction. Lang's (1978) "bioinformational" model of’imagery provides a means of conceptualizing this phenomenon. If images are propositional structures with both semantic and somatic components. it is possible that specific imagery instructions.might produce physiological effects corresponding to the instructions. However. the mechanisms by which this might occur must remain in the realm of speculation. Lang's research indicates that detailed imagery instructions which include suggestions for somatic arousal are more effective in desensitization therapy. Furthermore. he proposes that individuals who produce vivid mental imagery will respond best to such therapy. In the current study. it was hypothesized that the ability to regress in service of the ego would be associated with both vivid mental imagery and a capacity for voluntary control of neutrophil function. with the implication that it is the vividness of the imagery that produces the physiological effect. Vividness was Operationally defined as high ratings on a number of imagery dimensions: subjects 73 79 who included shape change. increases in adhesiveness and count. who used symbolic images. and who reported positive affect were termed vivid imagers. It was presumed that individuals capable of adaptive regression would recieve high nmagery ratings and would produce more changes in neutrophil activity. as their imagery would be more "complete" in Lang's sense. Unfortunately. the results of the study suggest that vivid imagery is not particularly associated with either adaptive regression or voluntary control of neutrophil function. ,There are several ways to account for this finding. First. it is conceivable that the imagery rating procedure does not adquately measure the variables that Lang maintains are most important in imagery; affective intensity and completeness. Images of neutrophils that were rated high on dimensions thought to be associated with "effective" imagery are not necessarily "complete" images. Without an imagery instrunent explicitly designed to measure affective intensity and completeness. it is not really possible to assess the validity of Lang's bioinformational model. Even if such a test of Lang's theory were to be devised. the theory might well prove to be invalid. Imagery does not necessarily have to have a semantic component to be effective. Different emotions might evoke different patterns of neutrophil response. regardless of the imagery instructions. The experimenter's expectation might well be sufficient to evoke emotional response and physiological change. 75 Furthermore. the procedure of looking at individual differences in the capacity for adaptive regression is a rather indirect means of assessing the relationship between imagery and voluntary control of blood function. It would be far better to simply give a group of subjects an instrunent designed to assess the completeness. affective intensity. and vividness of the imagery they habitually produce. and then look at the extent to which they can control their neutrophils. It is also possible that the imagery rating procedure is biased toward visual imagery. The questions were not devised to get subjects to talk about kinesthetic or auditory images. and those subjects who used this type of imagery might have recieved low ratings, contributing to measurement error. There is research (Lindaur. 1977) indicating that there are many different kinds of’imagery. and an individual who is a a good imager in one mode. is not necessarily good in another. Another explanation for the lack of significant correlation between IMAGERY and the Rorschach and blood function variables is the fact that a tape recording was used to deliver imagery instructions. In Study 1. the subjects were given instructions by an expernmenter. and in Study 1. several imagery dimensions were found to be significantly correlated ‘with blood fUnction difference scores (see p. 29). Furthermore. these subjects produced on the whole. greater changes in blood function than the subjects in the present study. Perhaps ‘the use of the tape recorder caused the subjects to produce 76 less vivid imagery. Finally. one must consider the variable. adaptive regression. and how it is measured in the present study. Perhaps individuals who have high PRIPRO scores and high R scores are able to engage in just one aspect of adaptive regression. the regressive phase. and are less able to engage in the integrative phase that would be fmportant in producing imagery. Production of vivid mental imagery may require a focused utilization of primary process material: simply to be able to let primary process take over may not be sufficient. In order to assess this explanation for the lack of correlations between IMAGERY. adaptive regression and blood function. it would be necessary to devise some instrument measuring the ability to integrate and elaborate primary process experience. The results of this study do indicate that psychological processes are reflected in physiological activity; this should come as no surprise unless one is a strict proponent of Cartesian notions. The capacity for adaptive regression has been intensively investigated and has been shown to be associated with a variety of factors. from problem solving ability to ego strength. It is quite reasonable that it should be moderately correlated with the ability to control neutrophil activity. However. again. it is difficult to pinpoint mechanisns underlying the relationship without getting lost in idle speculation. Probably the most conservative interpretation of the 77 data from the current study would be to say that individuals who can adaptively regress tend to be more open to suggestions delivered in the hmagery instructions. It is not the imagery content in itself. but the suggestions delivered by the experi- menter. that cause the individual to affect his or her neutrophils. The literature indicates that hypnosis can be used to produce a very specific somatic effect (inhibition of the Mantoux reaction. in the one arm and not the other. c.f. Black et. al.. 1963). The imagery instruction procedure is highly similar to a basic hypnotic induction. It is not necessary (or parsimonious) to hypothesize a complex linkeage between imagery content. adaptive regression and blood function changes. unless one adheres to the philosophical assumption that mind is separate from body. and that mechanisms are necessary to link the two. If one assumes that there is only one indivisible entity. differences in suggestiblity. due to varying inclinations to adaptively regress. could account for this study's results. Future research The question of why different imagery instructions can produce significantly different patterns of physiological activity remains to be answered. The results of this study suggest that future research should proceed in two diverging directions. First. as mentioned earlier. the capacity of subjects to produce vivid and complete mental imagery should be directly measured and the results correlated with blood function changes. In this way. 78 the usefulness of Lang's bioinformational model might be assessed. as well as the usefulness of contructs which intervene between body and mind. Secondly. the hypothesis that hypnotic suggestibility is a more important factor than imagery content in producing neutrophil change should be tested. By administering a hypnotic susceptibility scale to subjects and correlating the results with blood function changes. one might discover that variables such as the expectation of the experimenter. or the degree of the experimenter's rapport with the subject. are more crucial variables than imagery in voluntary control of autonomic functions. CHAPTER VII SUMMARY This study investigates the inter-relations among imagery. adaptive regression. and voluntary control of neutrophil function. Previous studies (Smith. et. al.. unpublished) have shown that individuals can affect the count. adhesiveness. shape and responsiveness of their neutrophils. and that this ability appears to be related to the kind of imagery they use. Subjects whose imagery is rated as vivid. detailed and symbolic. and who report that they enjoy the imagery experience. are better able to control their neutrophils. The literature suggests that the ability to generate vivid mental imagery is associated with a particular personality structure: such individuals have the cognitive flexibility and ego strength to regress in service of the ego. They can make rapid shifts in levels of psychic functioning. allowing drives and needs from the unconscious to embellish their imagery with affect and symbolism. In the current study. it was hypothesized that individuals capable of adaptive regression would produce more vivid mental imagery (Hypothesis 1). As the vividness of imagery used by subjects appears to be positively associated with the amount of change they produce in neutrophil functioning. it was further hypothesized that individuals capable of adaptive regression would have more control over their neutrophils (Hypothesis 2). 79 80 Lang's bioinformational model was discussed as a possible framework for understanding how the semantic content of images is associated both with the vividness of the images and the extent of somatic arousal evoked by them. This was proposed as one means of understanding how individuals who adaptively regress might be better able to control their neutrophils than individuals who cannot do so. Suon individuals would produce more vivid imagery. which would evoke greater physiologic response. and thus affect neutrophils to a greater degree. 28 subjects underwent training in imagery and relaxation and then participated in individual experimental sessions in which they listened to instructions directing them to increase the adhesiveness of their neutrophils. to see them changing shape. and to see them becoming more responsive to stnmulation by bacterial agents. Laboratory tests were run on blood samples taken before and after the experimental session to determine 1] cell count. 2] adhesiveness of the cells. 3] shape configuration. and 9] responsiveness to a chemotactic factor (a chemical similar to the chemical given off by a bacteria which is recognized by a white blood cell. and which instigates its response). For purposes of data analysis. the difference between pre and post imagery values for each neutrophil function was calculated. Subjects were interviewed regarding their imagery experience after the experimental session. and these 81 interviews were rated on a number of dimensions designed to yield an overall measure of imagery vividness. such as the extent to which the subject reported vivid images. the complete- ness of the images used (did they contain images of the cells changing shape as well as becoming adhesive and responsive). the feeling tone of the imagery (positive or negative) etc. Each dimension was rated on a scale of 1 to 5. and the results summed to yield an overall imagery rating for each subject. The Rorschach.Inkblot test was administed to each subject before the experimental session. Four different.measures.of adaptive regression were derived from the Rorschach protocols; 1] tolerance for unrealistic experience (TOLERANCE). using criteria similar to those used by Klein in his (1962) investigation of responses to unreal experiences. 2] primary process content. (PRIPRO) using R. R. Holt's (1960) scoring system. 3] presence or absence of an extended F1 (F1) of between 80 and 90 percent (the extended F1 is the nunber of responses on the Rorschach having form as the primary determinant. including F.M.FC.FY.FT.FV and blends). and 9] the number of responses (R). Data analysis revealed a small but significant relationship between a cluster containing two Rorschach variables (R and PRIPRO). and a cluster containing a composite of two measures of Iaeutrophil adhesiveness (AD and STIM—AD) (r=.35. p<.05). In addition. t:here was a significant relationship between the Rorschach cluster and changes in neutrophil count (WBC) (r=.93. p<.01). Contrary to expectation. the Rorschach variable F1 was found 82 to be negatively and significantly associated with changes in blood function (r=.92. p<.01). indicating that perhaps the F1 variable was measuring defensiveness rather than adaptive regression. Post-hoe analyses partially confirmed this hypothesis. The Rorschach variable TOLERANCE was not found to be related to any other variable in the study. The vividness of imagery as measured in the current study was not correlated with the measures of blood function nor with measures of adaptive regression. Thus. Hypothesis 2 was confirmed. while Hypothesis 1 was not. Possible interpretations of the findings are discussed. as are the shortcomings of the measures used and of the approach in general. Directions for future research are suggested. REFERENCES Achterberg. J.. A Lawlis. G.F.. The Imagery g£_Cancer. Institute for Personality and Ability Testing. 1978. Amkraut. A.. A Solomon, G.F.. From the symbolic stimulus to the pathophysiologic response: Immune mechanisms. International Journal 32 Psychiatry ig_Medicine. 1975.(9). 591-563. Bahnson. C.B. (editor) Second conference on the psychophysiological aspects of cancer. Annals of the New York Academy 22 Science. 1969. 169. 307-639. BartrOp. R.W.. Lazarus. L.. Luckhurst. E.. et. al. 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Your mind can help create susceptibility to illness but it can also contribute to health. Your white blood cells are a part of your body's natural defense sys- tem for controlling and defeating infectious processes such as virus- es. We know that white blooo cells have as a purpose getting rid of anything they see as not being a part of the self. They remember very well and can combat old forms of illness. White blood cells profit from being exercised and used. We are attempting to study the extent to which you can iniluence these cells. particularly the shape and movement of your white blood cells simply by visualizing them becoming more flexible and sticky. and being able to leave the blood stream and to go to the parts where they may be needed. During the next few min- utes. you will have an opportunity to exercise your white blood cells. All you have to do is just relax and listen. Don't worry about the time because I will let you know when the time is up. The entire pro- cess will take about 20 minutes. Just relax and listen to the instructions. First of all I would like for you to be sitting in a way you can be very relaxed and comfor table. I'll give you a few seconds to 90 91 situate yourself in the chair so that your arms and legs can be relaxed and comfortable. and so that your back and your head are supported. Lean in the chair as far back as is comfortable for you (pause). Now, I would like for you to pick a spot on the wall or ceiling. comfortably look at it then kind of let your eyes go soft. Take a deep breath. hold it. and then push it all out. Resume normal breathing. and just notice your breath. As I count downwards from 10. continue to stare at the spot until your eyes become very heavy. Ten. nine. eight, seven. six. five. four. three. two one. Now gently close your eyes and just concentrate on my voice. Breathe in slowly and deeply. Breathe in warmth and heaviness and comfort. Breathe out any tension. As you breathe in say to yourself under your breath "I am". and as you breathe out. say to yourself. "relaxed". "I am ... relaxed". "I am relaxed" (pause). Let any kind of thoughts that come into your head just kind of pass through and by. or any noises that you might hear just kind of note them and let them pass through (pause). Let your body begin to quiet down. As you quiet down perhaps you can hear and feel your pulse. perhaps in your throat or in some other part of your body. Feel your blood pulsing. carrying warmth A relaxation throughout your body. Feel the kind of strength and power in your blood carrying soothing warmth and relaxation (pause). Imagine your white blood cells and feel yourself becoming a part of them. Imagine them moving around in your blood strean. See if you can image your white blood cells becoming more flexible. pliant. changing shape and form. getting longer. Imagine them being able to get more sticky and adhere to various parts of the 92 vessel wall and to each other. getting stickier and stickier so they can attach to the blood vessel wall (pause)). Imagine the sticky cells beginning to squeeze through the blood vessel wall (pause). Imagine them going to places in the body where there is garbage collected - old cells kind of useless. or weak and confused. Imagine your white blood cells. perhaps as garbage collectors of some sort. picking up the garbage in your body and taking it away. dumping it outside of your body somewhere. Continue to imagine your white blood cells becoming more flexible and sticky and moving from the blood stream. When your're ready. at your own pace. slowly let the muscles of your eyelids lighten up. Let the muscles of your body kind of come back to life and get light. and wiggle your toes and your fingers. In a few minutes Wayne will come in to take another blood sample. Just stay relaxed and seated until after the blood sample is taken. Then I will ask you a few questions about what you have been imagining. Just let yourself relax and feel good about yourself. APPENDIX B Specific imagepy instructions for Stugy 2 This is an exercise that will help you relax and learn more about how your mind can contribute to your health. You are familiar with your neutr0phils already. and you know how they are a part of the body's natural defense system. They get rid of anything that is not yourself. You also know that they profit from being exercised and used. Through exercise. they are more able to come to your aid when you need them. We are studying the extent your neutrophils will change shape. and become more adhesive as a result of your visualization. During the next few minutes. you will have an opportunity to let them get some exercise. All YOU have to do is relax and listen to the instructions. Don't worry about the tnne because I will let you know when the time is up. The entire process will take about 20 minutes. Just listen to the instructions and enjoy the relaxation experience. First of all. try to sit in a way that you can be very relaxed and comfortable. I'm going to give you a minute to situate yourself in the chair so that your arms. and your back and your legs can be very relaxed and comfortable. and so that your head is supported. Take some time to get relaxed. Now I would like you to pick a spot on the wall or ceiling. comfortably look at it. and let your eyes go soft. Now start letting a feeling of warmth and heaviness begin to fill your body. Take a deep breath. hold it. then push it all out. Now just breathe normally and notice your breath. As I count downward from 10. continue to let 93 94 the feeling of comfort and relaxation fill your body. 10. 9 you are feeling more and more relaxed. 8 7 your whole body is starting to feel very comfortable. 6 5 9 let the feeling of warmth and relaxation sooth you. 3 2 1 now rest gently and just listen to the instructions. Breathe in slowly and deeply. Breathe in warmth and relaxation and comfort. Breathe out any tension. And as you breathe in say to yourself- I am. And as you breathe out. to yourself. relaxed. I am... relaxed. I am... relaxed. If any thoughts come into your head. just let them go their way. like clouds on a summer's day. If there are any noises. just note them and let them pass through. Let your body quiet down and when you feel relaxed and still. perhaps you can begin to feel your pulse- perhaps in your throat. or perhaps in some other part of you body. Feel your blood pulsing. bringing warmth and relaxation through your body. flowing slowly. Feel the strength and power of your blood. Now begin to imagine your neutrophils floating in your blood stream. Feel yourself becoming part of them. Imagine them moving along. floating happily. See if you can imagine your neutrophils becoming more flexible. pliant. changing shape and form. getting longer. Imagine them getting stickier and having all sorts of tentacles. Imagine them changing shape and getting stickier. but not sticking to the blood vessel wall. They do not pass through because there is no reason to do so. This is just an exercise A fun game that they like to play. Imagine that the cells of the blood vessel walls are not at all responsive. They are asking the neutrophils not to stick or pass through. Instead they encourage 95 them to stay in the vessel and exercise. practice up for when they are really needed somewhere in the body. Continue to imagine as many neutrophils as you can. becoming flexible. changing their shape. Imagine them becoming very sticky and having many tentacles. See the cells of the blood vessel wall encouraging them to stay inside and practice. They are not receptive to the neutrophils sticking to them or passing through. Instead. the neutrophils are just floating around in the blood vessel. exercising. changing shape and form. becoming stickier. practicing up for when they are called on to fight disease. When you are ready. at your own pace. slowly let the muscles of your eyelids lighten up. Let the muscles of your body come back to life and get light. Wiggle your toes and your fingers and you can open your eyes and become aware of the room around you. APPENDIX C Primary process content categpries L. Libidinal L10 Oral. Level 1 L10-Ag Oral-aggressive.Level 1 L10-Ag Oral-agressive. Level 1 L1A Anal. Level 1 L18 Sexual. Level 1 L1E-V Exhibitionistic-voyeuristic. Level 1 L1H Homosexual. Level 1 L1M Miscellaneous libidinal. Level 1 L20 Oral. Level 2 L20-Ag Oral Aggressive, Level 2 L2A Anal. Level 2 L28 Sexual. Level 2 L2E-V Exhibitionistic-voyeuristic. Level 2 L2H Homosexual. Level 2 L2M Miscellaneous libidinal. Level 2 Ag. Aggressive Ag1S Sadistic Aggression. Level 1 Ag10b Masochistic (Object) Aggression. Level 1 Ag1R Results of Aggression. Level 1 Ag2S Subject agression. Level 2 Ag20b Object aggression. Level 2 Ag2R Results of aggression. Level 2 96 "‘11111111111111ES