CONTENTSijcp.co.in/downloads/ijcp/2008fb.pdf · 2020. 2. 27. · CONTENTS Instructions to Authors i-vi Editorial 90-92 Original Articles Normative Data on Seguin Form Board Test:

CONTENTS

Instructions to Authors i-vi

Editorial 90-92

Original Articles

Normative Data on Seguin Form Board Test: Basavarajappa, D. Venkatesan, 93-97and M. Vidya

Personality, Emotional Intelligence, and Alexithymia Correlate with Academic 98-107Achievement in Technology Students: Kamlesh Singh

Life and Need Satisfaction among Patients with First Episode Psychoses: Indrajeet 108-114Banerjee,Gobinda Majhi, Shantna, K. , Amool. R. Singh, A. N. Verma and S. Choudhury

Effects of Burden on Negative Emotional States in Spouses of 115-119Chronic Schizophrenic Patients: S. Kumar, Km. A. Jain, S. Mohanty and Uma RaniPersonality, Stressful Life Events, Meaning in Life and Reasons for Living 120-126Atanu Kumar Dogr a, Saugata Basu, Sanjukta Das , Anindita Chaudhuri

Expectation and Availability of Social Support in Cancer and Diabetic Women 127-137Patients : P. Awasthi, and R. C. Mishra

Alcohol Related Beliefs among College Students: Mahima Sukhwal and L. N. Suman 138-146

Assessment of Antisocial Behavior in Opium Dependents: Mahdieh Rahmanian 147-155

Overview

The Neuroscience of Well-being : S. P. K. J ena 156-162

Therapy

Application of EMDR in the Treatment of Major Depressive Disorder: A Case 163-172Study: Usha Verma Srivastava and A. Mukhopadhyay

Behavioural Intervention of Compulsive Behaviours in Autism: A Case Study 173-177M. Thomas Kishore

Book Review 178-179

A.K. Srivastava, Ph. D., KanpurA. T. Beck, Ph. D., U. S. A.Adarsh Kohli, Ph. D., ChandigarhAkbar Husain, Ph. D., MalayasiaAkshya Kumar, Ph. D., ImphalAlka Nizamie, Ph. D., RanchiAmool. R. Singh, Ph. D., RanchiB. P. Mishra, Ph. D., LudhianaB. L. Dubey, Ph. D., ChandigarhC. R. Mukundan, Ph. D., BangloreD. Dhanpal, Ph. D., CoimbatoreD. Sahoo, Ph. D., BhubaneswarD. K. Kenswar, Ph. D., RanchiD. Pershad, Ph. D., ChandigarhDalip R. Patel, Ph. D., U.S.A.Dharitri Ramaprashad, Ph. D., BangaloreDwarka Pershad, Ph. D., ChandigarhF. M. Sahoo, BhubaneswarG. G. Prabhu, Ph. D., MysoreGeetika Tankha, Ph. D. , JaipurHoney Vahali Oberoi, Ph. D., DelhiJamuna Rajan, Ph. D., BangaloreN. K. Chadha , Ph. D., DelhiK. Geerish, Ph. D., ThiruvanantapuramK. B. Kumar, Ph. D., ManipalK. Dutt, Ph. D., LucknowK. P. Sreedhar, Ph. D., ThiruvanantapuramK. Rangaswami, Ph. D., SecunderabdKalpana Srivastava, Ph. D., PuneKiran Rao, Ph. D., BangaloreL. Sam S. Manickam, Ph. D., MysoreL. N. Suman, Ph. D., Bangalore

M. K. Mondal, Ph. D., DelhiMalavika Kapur, Ph. D., BangaloreMallika Banerjee, Ph. D., KolkataManju Mehta, Ph. D., New DelhiManoj Sharma, Ph. D., BangaloreManoranjan Sahay, Ph. D., DelhiMasroor Jahan, Ph. D., RanchiN. R. Mrinal, Ph. D., NagpurNamita Khanna, Ph. D., AustraliaP. K. Chattopadhyay, Ph. D., KolkataP. K. Chakraborty , Ph. D., RanchiP. T. Sasi, Ph. D., TrissurR. G. Sharma, Ph. D., VaranasiR. Kumar, Ph. D., AgraRitu N. Sharma, Ph. D., ChandigarhS. Dash, Ph. D., CanadaS. Haque, M. D., RanchiS. C. Gupta, Ph. D., LucknowS. E. Hussain, Ph. D., MuzaffarpurS. K.Verma, Ph. D., ChandigarhS. R. Khan, Ph. D., JammuS. S. Nathawat, Ph. D., JaipurShobini L. Rao, Ph. D., BangaloreSubodh K. Sinha, Ph. D., RanchiSuprakash Choudhury, Ph. D., RanchiSurya Gupta, Ph. D., GurgaonT. B. Singh, Ph. D., New DelhiT. R. Shukla, Ph. D., LucknowV. D. Sinha, Ph. D., RanchiVibha Sharma, Ph. D., DelhiY. S. Vagrecha, Ph. D., SagarV. D. Mishra, Ph. D., Ghazipur

INDIAN JOURNAL OF CLINICAL PSYCHOLOGY__________________________________________________________________Volume 35 September 2008 No. 2

Editor: S. P. K. Jena, Ph. D.

Editorial Board

http://www.novapdf.com


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PresidentT. B. Singh, Ph. D.Institute of Human Behaviour and AlliedSciences, Delhi

Immdeiate Past PresidentS. S. Nathawat, Ph. D., Jaipur

SecretaryL.S.S Manickam, Ph.D.JSS Medical College Hospital, Mysore

Joint SecretaryNaveen Grover, Ph. D.Institut of Human Behaviour and AlliedSciences, Delhi

Immediate Past-SecretaryK.Gireesh, Ph. [email protected]

Council Members: All IndiaLata Hemchand, [email protected], D. Sharma, Ph. D., [email protected]

Council Members: East ZoneKaptan Singh Senegar, Ph. D., Ranchisenegar_dr.ks_ [email protected] Kumar Roy, M. Phil, [email protected]

President-ElectMalavika Kapur, Ph. D.A-3, Burnton Rustumji Apartments 21Brunton Road, Bangalore

TreasurerGauri Shankar Kaloiya, Ph. D.HIRD, Nilokheri, Karnal, Haryana

S. P. K. Jena, Ph. D. (Convenor)University of Delhi, South Campus,New Delhi

L. S. S. Manickam Ph.D (Ex-Officio)JSS Medical College Hospital, Mysore

Manju Mehta , Ph. D.All India Institute of Medical SciencesNew Delhi

Journal Committee

S. Venkatesan , Ph. D. (Co-convenor)All India Institute of Speech & HearingMysore

Honey Oberoi Vahali, Ph. D. ,University ofDelhi, Delhi

J. Mohapatra, M.Phil. (M & S. P)S. C. B. Medical College, Cuttack

Executive Council

.

Council Members: West ZoneKlpana Srivastava, Ph.D., Punee-mail: [email protected]. C. George, Ph.D., Miraje-mail: [email protected]

Council Members: North ZoneShalini Anant, Ph. D., Delhie-mail: [email protected] Kumar Dhalwal, Ph.D., Dehra Dune-mail: surender [email protected]

Council Members: South ZonePoornima Bhola, Ph. D., Bangaloree-mail: [email protected] Mohan, Ph. D., [email protected]

President’s Nominee:K. B. Kumar, Ph. D., [email protected] Verma, Ph. [email protected]

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Instruction for Authors

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Instruction to Authors



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reference section, list all authors’ names when thereare six or fewer; when there are seven or more, listthe first six and add et al. Particular care be taken forpunctuation and the spelling of authors names, thespelling in the text and the year should be consistentwith that in the references. Reference, which has notbeen cited in the text, should not be included in thelist of references. They should be alphabeticallyarranged and must not be numbered.

a. Article from a journalSingh, R. S. & Oberhummer, I. (1980) Behaviourtherapy within a setting of karma yoga. Journal ofBehaviour Therapy and Experimental Psychiatry, 11,135-141.b. Article from a journal supplementOrengo, C.A., Bray, J. E., Hubbard, T., LoConte L.,& Sillitoe, I (1999). Analysis and assessment ofcognitive impairment in head injured. Neurology,Neurosurgery & Psychiatry Suppl. 3, 149-170.c. In press articleKharitonov, S. A., Barnes, P. J., Behavioural and socialadjustment. European Respiratory Journal, in press.d. Article from conference proceedingsJones, X. (1996). Prevalence of Mental & Behaviouraldisorder. In Proceedings of the FirstNationalConference of World Psychiatry Association27-30 June; Baltimore. Edited by Smith, Y.Stoneham:Butterworth-Heinemann; pp.16-27.e. Book chapter, or article in a bookKerkhof, A. J. F. M., & Nathawat, S.S. (1989).Suicidal behavior and attitudes towards suicide amongstudents in India and the Netherlands: A cross culturalcomparison. In R.F.W. Diekstra, R. Maris, S. Platt,A. Schmidtke & G. Sonneck (Eds.) Suicide and itsprevent ion: The rol e of atti tud e and int uiti on , pp. 1 44-159, London: E. J.Brill.f. Whole issue of journalPonder, B., Johnston, S., Chodosh, L. (Eds.) (2006).Innovative oncology. In Breast Cancer Research, 10,1-72.g. Whole conference proceedingsSmith, Y. (Ed) (1996). Proceedings of the FirstNational Conference of World Psychiatry Association,27-30 June 2007; Baltimore. Stoneham: Butterworth-Heinemann.h. Complete bookMargulis, L. (2005) Cognitive Sciences, New Haven:Yale University Press.

i. Monograph or book in a seriesHunninghake, G.W., Gadek, J. E.(1995).The alveolarm a c ro p h a g e. In Cu ltured Huma n Cells and Ti ssues.Edited by Harris TJR. New York: Academic Press.54-56. [Stoner G (Series Editor): Methods andPerspectives in Cell Biology, Vol 1.]j. Book with institutional authorAdvisory Committee on Genetic Modification. (1999).Annual Report. London.k. Ph. D. thesisKohavi, R. (1995). Psychosocial function in diabetics,Ph.D. thesis. All India Institute of Medical Sciences,Psychiatry Department, New Delhi.l. Link / URLMorse, S.S. (1995). Factors in the emergence ofinfectious diseases. Emerg Infect Dis [serial on theInternet]Jan-Mar [cited 1996 Jun 5];1(1). Availablefrom: URL: http://www.cdc.gov/ncidod/EID/eid.htm.m. The author should ensure that all the referencescited in the text are persent in list of references andthat there is no extra references in this list.

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Table 1. Reaction time (in seconds) of schizophrenicsand normal subjects for different types of sensorystimulation.C ond it i ons S chi zo. (n=30 Normal (n=30) t Mean SD Mean SD

Vi sua l 1.7 0. 94 0. 7 0. 01 0 .45 **

A ud i t or y 3.0 0. 02 2. 6 0. 96 0.11*

p < . 01 *, p < . 001 **

Ins tru ction t o Authors

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Instruction to Authors




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1, 3 Department of P. G. Studiesin Psychology, University of Mysore, Mysore-570006, e-mail: br@psychology,uni-mysore.co.in. Department of Clinical Psychology, All India Institute of Speech and Hearing, Mysore-570006, e-mail: psycon. [email protected]. Correspondence: First author

Normative Data on Seguin Form Board Test1Basavarajappa, 2D. Venkatesan, and 3M. Vidya

Prior to Itard’s (1932) pioneering work,attempts were made to assess the intellectual(non-verbal) abilities of children who could notor would not speak more directly. Seguin (1856)developed a simple but a unique testing methodusing form boards for assessment of intellectualabilities in children through non-verbal means.The instrument and its many derivatives havebecome widely used and are well knownuniversally as Seguin Form Board (SFB) (Du Bois,1970). Stanford-Binet Intelligence Scale includesa Seguin-like form board, a merger of efforts byBinet, Simon and Seguin -the three pioneers inthe field of intelligence test development. Sinceearly 1900s, non-verbal intelligence testing hasdeveloped methods for assessing cognitivefunctioning of children who could not or wouldnot speak. The SFB was basically constructed asteaching aid under ‘Physiological Method’ forchildren with mental retardation (Seguin, 1866).Later, it was used to assess general intelligenceof children in pre-primary and primary schoolyears (Spearman, 1927); or for measuring visualdiscrimination and matching, eye-handcoordination and cognitive-perceptual abilities

in children (David & Virginia, 1972). Wallin (1916)regards the SFB as a most useful device to testform perception, movement and intelligence-thatis, psycho-motor development. Form Board testswere also used for measurement of ability tomanipulate concrete material in contrast to verbal/abstract ability. Wallin (1916) observed that theperformance (speed) on form board increaseswith chronological and mental age-more rapidlyin early years. He suggested that tests are oflittle value diagnostically unless periodicallyfortified with reliable age norms. According toDavid and Virginia (1972), analysis of SFB testhas shown that vector loadings for the test todiffer among age levels, indicating that the testmay be measuring different abilities at differentage levels.

There have been efforts to develop Indiannorms for SFB from time to time. In a survey onMumbai school children (N= 378) within a limitedage range (6-8 years), the speed of performancewas found to be slower than their Westerncounterparts (Ramachandran, Deshpande, Apte,., Shukla, and Shah, (1968). Around the sametime, Bharatraj (1971) improved on the sample

Indian Journal of Clinical Psychology Copyright , 2008, Indian Association of2009, Vol. 35, No.2, 93-97 Cli nical Psychologists (ISSN 0303-2582)

The present study is an attempt to revalidate and develop normative data on anon-verbal test of intelligence-Seguin Form Board (SFB). The SFB was administeredon a sample of 720 children including 361 boys and 359 girls between age group of 36-120 months (Mean Age: 89.19 months; SD: 20.82) drawn from rural and urban areasand belonging to different social economic status groups. Results indicate that SFBcontinues to remain a valid and reliable speed test of intelligence at lower age levels ofchildren. However, there is need to evolve separate norms on SFB for different agegroups, socio-economic status levels, and area of residence (rural and urban) respectively.An attempt is also made in this study to demonstrate a modified procedure of testperformance as relatively more appropriate, superior and effective for estimation ofmental ages/IQ of children on this test.

Keywords: Seguin Form Board, normative data, Indian norms, chronological age,mental age, modified administration

mailto:[email protected].



Basavarajappa et al./ Normative Data on Seguin Form Board Test

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size and age range of tested children to discoverthat the Mysore kids were much faster on theform board. Verma, Pershad and Randhawa (1979)presented a preliminary report of different speedsin performance between upper and lower classsample of school children between 4-8 years fromChandigarh. The norms on SFB by children fromDelhi schools given by Goel and Bhargava (1990)are almost identical to Mysore. A gender andgrade level based norms was reported for boysand girls between LKG to class VII on a sampleof 669 children between 3 ½ to 13 years fromGovernment and non government schools inPatna, Bihar (Venkatesan, 1998). Nonetheless,norm development and test re-validationexercises remain a continual activity to preventobsolescence and faulty comparisons ofcontemporary children against standards ofpreceding generation (Flynn, 1984; 1985). Theprocedure conventionally used for administrationin this test involves giving three trials. Speed ofperformance is emphasized. In a recent and relatedstudy, a modified procedure of test administrationfor SFB was attempted on a sample of 720children. Results indicated that an optimum ofthree trials is insufficient to determine the mentalage equivalence of children on this test. Theoptimum speed of performance on SFB appearsto occur around sixth trial. The study reiteratedthe value and use of calculation of a ‘decrementscore and quotient’ (Venkatesan, Basavarajappa& Divya, 2007). The present study is an attemptto revalidate SFB norms based on variableshitherto unexplored fully-such as, age, genderand area of residence (rural/urban) respectively.

The aim of this study was to revalidate anddevelop fresh comparative norms on mental agesagainst shortest time taken for a modifiedprocedure of test administration for completingthe SFB in a studied sample of children in relationto their chronological age, gender and area ofresidence.

Method

The study was carried out on a sample of720 children between chronological age range of36-120 months (Mean 89.19; SD 20.82). Thesample included 361 boys (Mean Age: 89.13; SD:20.73) and 359 girls (Mean Age: 89.24; SD: 20.94).Within the sample, there was equal number ofchildren from rural and urban areas (N: 360). Theeducational status of the sample ranged fromkindergarten to standard seven. A rural area, asoperationally defined in this study, includedgeographical locations that were administrativelygoverned by a ‘panchayat’ and not by a‘municipal corporation’. The socio economicstatus of the sample ranged between One (N=238), Two (N= 307), Three (N=139) and Four (N=36) respectively. A revised version of the NIMHSocio Economic Status (SES) Scale (NIMH, 1999)was employed in this study. This scale offersnumerical points of different ranges forcomputation of a SES score/level for an individualby taking into account details like parentaloccupation and education, annual family income,combined properties as well as per capital incomeof the family. Higher points on the scale indicatebetter SES levels.

The procedure for data collection involveduse of cross sectional individualized testingprocedure for each child included as sample inthis study. The only alteration in procedure oftest administration followed in this study was toallow each child as many repeat trials on SFBuntil s/he showed a plateau of identical readingsof time taken for at least three consecutive trials.For example, if a child continued to improve histimings on the Board even after three trials, s/hewas allowed to perform the next trial/s. Theadministration was continued till the child showedsame timings for three successive trials, i.e., tillplateau was observed.

Results and Discussion

The raw data generated from this study wasin the form of time taken in seconds and thenumber of trials used by each child to reach aplateau of identical performance on the SFB for



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Basavarajappa a et al./ Normative Data of Seguin Form Board Test

three successive trials. The results of the studybased on the performance of the children areanalyzed and discussed in relation to thefollowing variables:

The trial wise results on SFB indicate agradual decrease in mean time taken for the firstsix trials (Table 1) beginning trial one (Mean: 40.27;SD: 17.36) through trial two (Mean: 35.05; SD:15.78) to trial three (Mean: 32.18; SD: 14.64) up totrial six (Mean: 29.57; SD: 13.71) (p: <0.001). Thisdecreasing trend stops thereafter indicating thatan optimum of the best performance has beenreached. These findings reiterate the argumentof an earlier investigation (Venkatesan,Basavarajappa and Divya, 2007) in favor of anoptimum of six rather than three trials on the boardas necessary before deciding on the shortest of

the trials for as basis for calculation of mentalages/intelligence quotients in children assessedon this test of intelligence. These findings aresimilar to observations made by Wallin (1916)that the speed of performance on form boardimproves with increasing chronological andmental ages of children. It is also seen that thedecrements in time taken by children forperformance on the board is smooth andcontinuous from age levels 36-47 months and 96-107 months respectively. Thereafter, the timingof performance goes up for the children between108-120 months; thereby supporting the viewthat the SFB is more suitable indicator of mentalages for younger rather than older age groups ofchildren.

Trials/Age I II III IV V VI VII VIII IX X

36-47 months. Means 62.45 56.33 52.37 50.72 49.43 49.18 48.52 49.34 49.71 47.50(N=10) SD 14.29 13.29 12.51 12.55 12.03 12.20 12.18 11.92 11.20 08.7848-59 months. Means 43.58 38.63 36.51 35.34 34.84 34.47 34.48 34.75 34.94 43.25(N=66) SD 11.58 11.10 09.58 09.26 09.22 09.24 09.29 08.90 09.82 10.3160-71 months. Means 45.48 38.89 34.93 32.46 31.61 31.15 30.76 31.61 38.21 30.00(N=116) SD 17.22 14.82 13.31 12.21 11.68 11.29 11.65 13.06 15.80 -72-83 months. Means 35.23 30.12 27.44 26.46 25.80 25.41 25.44 24.83 26.50 -(N=117) SD 10.33 09.20 08.76 08.05 07.99 08.04 08.10 08.04 07.75 -84-95 months. Means 30.31 25.22 23.04 21.73 21.20 20.94 20.30 20.87 23.50 27.00(N=116) SD 10.28 8.06 07.69 06.95 06.54 06.52 05.73 05.52 05.61 2.8396-107months. Means 24.16 20.95 19.15 18.51 18.08 17.79 18.76 23.40 - -(N=128) SD 6.24 05.26 04.59 04.32 04.44 04.35 05.18 09.40 - -108120months.Means 40.21 35.03 32.18 30.88 30.17 29.83 31.37 34.08 39.80 41.69(N=167) SD 17.36 15.78 14.64 14.11 13.73 13.71 13.81 14.58 14.66 11.15Total Means 40.27 35.05 32.18 30.88 30.17 29.57 31.37 34.08 39.80 41.69(N=720) SD 17.36 15.78 14.64 14.11 13.73 13.71 13.81 14.58 14.66 11.15F value 147.05 165.30 174.71 184.76 187.28 189.23 130.63 130.64 14.86 1.53Probability <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.292df 5,714 5,714 5,714 5,714 5,714 5,714 5,592 5,307 5,88 5,7

Socio Economic Status

The analysis of performance by the childrenon the SFB reveals that, irrespective of SocioEconomic Status, there is decrease in the timetaken by the subjects till about the sixth trialfollowing a plateau thereafter.The data indicatesthat children from higher SES perform on an

average faster or take lesser time to perform onthe SFB across any number of trials than childrenof the same age group in the lower SES levels (p:< 0.001). These findings are similar to reports byDavid and Virginia (1972) on small differences inspeed of SFB performance based on SES.

Table-1. Distribution of Seguin Form Board norms based on age /trials



Basavarajappa et al./ Normative Data on Seguin Form Board Test

96

Trials/ I II III IV V VI VII VIII IX XSESSES I(N=238) Means 35.61 30.92 28.41 27.24 26.29 26.23 27.63 30.98 36.42 37.00

SD 15.52 13.93 12.97 12.51 11.81 11.83 12.16 13.59 13.80 04.24SES II(N=307) Means 38.98 33.65 30.93 29.61 28.84 28.51 29.91 31.78 37.33 43.71

SD 16.70 14.78 13.59 13.01 12.074 12.66 11.81 13.77 13.69 11.46SES III(N=139) Means 47.59 41.96 38.39 37.05 36.48 36.04 37.44 40.87 45.85 40.50

SD 18.59 17.46 16.31 15.83 15.68 15.62 15.61 15.09 16.25 14.25SES IV(N=36) Means 52.89 47.17 43.89 41.89 40.69 40.86 41.21 46.63 49.50 -

SD 14.97 14.75 14.14 13.47 12.82 12.88 11.21 10.97 11.46 -Total(N=720) Means 40.27 35.05 32.18 30.88 30.17 29.57 31.37 34.08 39.80 41.69

SD 17.36 15.78 14.64 14.11 13.73 13.71 13.81 14.58 14.66 11.15F-value 22.48 24.37 24.13 24.44 25.56 26.18 20.96 12.10 33.40 114.17Probability <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.080 <0.846df 3,72 3,72 3,72 3,72 3,72 3,72 3,59 3,31 3,90 3,9

TrialsBoys/Girls I II III IV V VI VII VIII IX X

Boys (N=361) Means 42.56 36.91 33.92 32.43 31.74 31.36 32.75 35.92 41.25 42.22SD 17.64 16.09 15.06 14.47 14.15 14.08 14.08 14.64 13.31 9.47

Girls (N=359) Means 37.84 33.14 30.44 29.32 28.58 28.36 29.92 32.02 37.34 33.75SD 16.75 15.26 14.02 13.58 13.13 13.18 13.39 14.29 16.60 11.70

t-value 3.69 3.23 3.21 2.97 3.11 2.89 2.52 2.38 1.26 1.86Probability <0.001 <0.001 <0.001 <0.003 <0.002 <0.004 <0.012 <0.018 <0.213 <0.086df 7,18 7,18 7,18 7,18 7,18 7,18 5,96 3,11 9,2 1,1

Trials/Urban/Rural l II III IV V VI VII VIII IX X

Urban(N=360) Means 36.56 31.66 29.14 27.93 27.27 26.88 27.86 30.25 37.52 42.29

SD 16.54 14.47 13.28 12.66 11.97 11.93 12.10 13.23 14.14 11.06Rural Means 43.86 38.40 35.23 33.83 33.06 32.77 35.01 39.06 42.08 41.00(N=360) SD 17.41 16.33 15.31 14.87 14.75 14.72 14.54 14.80 14.96 12.28t-value 5.77 5.86 5.70 5.73 5.79 5.90 6.55 5.55 1.77 0.20Probability <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.008 <0.864df 7,18 7,18 7,18 7,18 7,18 7,18 5,96 3,11 9,2 1,1

Table- 2. Distribution of Seguin Form Board norms based on SES

Table- 3. Distribution of SFB Norms based on Area of Residence (Urban and Rural)

Area of Residence

The results indicate that area of residence(either rural or urban) is also an influential factorin the speed of performance of children on SFBacross all trials as well as age levels respectively.The rural children are on an average definitelyslower than their urban counterparts for the sameage (p: < 0.001).

Gender

An analysis of performance on the SFBbased on gender variable indicates that girls showfaster and better performance than boys of sameage levels in all the trials (p < 0.001). Similarobservations were reported by David and Virginia(1972). Girls took on an average four seconds

Table 4. Distribution of SFB Norms based on Gender (Boys and Girls)



97

less to complete the board and the obtained t-values are significant up to sixth trial.

In sum, SFB continues to remain a valid andreliable speed test of intelligence at lower agelevels. Other things being equal, there are intertr ial decrements in the rates or speed ofperformance by children across gender (boys/girls), SES levels and area of residence (rural/urban) thereby substantiating the developmentand use of separate norm comparisons on SFBbefore making a final impression or decision onthe intellectual status of a given child..

References

Bharatraj, J. (1971). AIISH Norms on Seguin FormBoard with Indian children. The Journal of AllIndia Institute of Speech and Hearing. 2, 117-127.

David, R..L., & Virginia, C. S. (1972). Seguin FormBoard; Technical Report 20. DisadvantagedChildren and their first School Experiences.EST-Head Start longitudinal study. Technical ReportSeries ED081833.

DuBois, P. H. (1970). A history of psychologicaltesting.. Boston: Allyn and Bacon.

Flynn, J. R. (1984). The mean IQ of Americans:Massive gains 1932 to 1978. PsychologicalBulletin, 95, 29-51.

Flynn, J. R. (1985). Wechsler Intelligence Tests: Dowe really have a criterion of mental retardation?American Journal of Mental Deficiency, 90, 236-244

Goel, S. K., & Bhargava, M. (1990). Hand Book forSeguin Form Board . Agra: NationalPsychological Corporation.

Itard, J. M. G. (1932). The Wild Boy of Aveyron. NewYork, The Century Co.

NIMH. (1999). The NIMH Socio Economic StatusScale for case history taking. Secunderabad:National Institute for the MentallyHandicapped.

Ramachandran, K. V., Deshpande, V. A., Apte, S. V.,Shukla, M. N., & Shah, M. R. (1968). A Surveyof school children in Mumbai city with specialreference to their physical efficiency, mental andnutritional status. Mumbai: Asia PublishingHouse.

Seguin, E. (1856). Origin of the treatment and trainingof Idiots. American Journal of Education, 2,145-152.

Seguin, E. (1866). Idiocy and its treatment by thephysiological method. New York: William Wood.

Spearman, C. E. (1927). The abilities of man: Theirnature and measurement. New York: Macmillan.

Venkatesan, S. (1998). Revalidation of Seguin FormBoard Test for Indian Children. Indian Journalof Applied Psychology. 35, 1 & 2. 38-42.

Venkatesan, S., Basavarajappa, & Divya, M. (2007).Seguin Form Board Test: Field try-out on amodified procedure of test administration. IndianJournal of Applied Psychology. 44, 1-5.

Verma, S. K., Pershad, D., & Randhawa, A. (1979).The preliminary report on a performance test ofintelligence on 4-8 years old children. IndianJournal of Clinical Psychology. 6, 2. 125-130.

Wallin, A. J. E. (1916). Age norms of psychomotorcapacity. Journal of Educational Psychology, 7,117-24.

Basavarajappa a et al./ Normative Data of Seguin Form Board Test



The interest in studying quality of life inpersons with severely mentally ill started asconcern with the role played by them in thesociety after the advancement in drug treatmentin recent times. Life satisfaction referscharacteristics and objective life conditions, aswell as perceptions of life circumstances in a verityof domains, often referred to as well being or lifesatisfaction. Much of the sociology of mentalillness has focused on social factors related tothe symptoms of illness or distress andreciprocally the effects of symptoms on socialwell being. Those experiencing mental disordersmanifest the adverse consequences of the illnesseffect on their interpersonal and economic wellbeing. (Weissman & Paykel, 1974)

Psychiatric symptoms are likely to be someof the most important factors related to lifesatisfaction. Studies suggest that illness causes

Life and Need Satisfaction among P atients with FirstEpisode Psychoses

1 Indr ajeet Baner jee, 2Gobinda Majhi, 3Shant na, K. . , 4Amool R. Singh 5A. N .Verma , 6 S. Choudhur y

Purpose of the present study were to assess the levels of life satisfaction and socialneed satisfaction among recently recovered inpatients who had first episode of psychoticillness and compare their reported life and social need satisfaction. The study includedtotal 60 indoor patients, 30 with first episode of mania with psychotic symptoms and30 with schizophrenia under treatment for the first time. Both groups were assessedth rough Br ief P sych iatr ic R ating Scale, Lif e Satisf action Scale an d Sociogenic needSatisfaction Scale. The results revealed that they had poor life and sociogenic need satisfaction. Most ofthe subjects in both the groups felt moderate level of life satisfaction and moderate tolow level of subjective social need satisfaction. However, they did not differsignificantly on either life satisfaction or any domains of sociogenic need satisfaction.The study also suggests that a subjective well-being is not associated with illnessvariables Rather, irrespective of clinical conditions of the individuals with psychiatricillness. This has implications for planning better psychosocial interventions strategies,patient management and relapse prevention.

Keywords: life satisfaction, need satisfaction, first episode psychosis

deficits in social well being, further resulting insocial withdrawal and rejection. This mayeventually lead to subjective feeling of poor lifesatisfaction. It is predicted that there is reciprocalrelationship between illness symptoms, and lifesatisfaction. A plethora of studies suggest thatclinical symptoms are associated with poorsubjective quality of life in various psychotic andmood disorders. In some studies it is reportedthat severity of depression seems to be thestrongly associated with well-being andsubjective life satisfaction (Kessing et al, 2006;Zhang et al, 2006; Goldberg & Harrow 2005; Simet al, 2004; Reine et al, 2003; Fitzgerald et al, 2001;Salokangas et al, 2006). As depressive symptomsimprove the sense of subjective well-being startsprevailing. In bipolar disorders, manic andhypomanic symptoms have also been found tobe associated with poor sense of well-being and

1,2,3,5Department of Psychiatric Social Work, 4Department of Clinical Psychology, 6Department of Psychiatry Ranchi Institute of Neuro Psychiatry and Allied Sciences, Kanke, Ranchi

Indian Journal of Clinical Psychology Copyright , 2008, Indian Association of2008, Vol. 35, No.2, 108-114 Cli nical Psychologists (ISSN 0303-2582)



life satisfaction (Vojta et al 2001). When normalcontrols, subjects with prodromal symptom andfirst episode schizophrenia were compared it wasobserved that poor subjective quality of life wasassociated with severity of symptoms (Bechdolfet al 2005).

Social support, social relationship andvarious psychosocial factors are associated withPerceived Quality of Life. Subjective QOL hasbeen found to be associated with social support.This was found invariably among those who arein clinically stable phase or recovering from asevere episode of mental illness (Michalak et al2006). Ritsner et al ( 2000); Warner et al (1998)and Spirdonow et al (l998) assessed the qualityof life among psychiatric patients on variouspsychological, clinical and sociodemographicvariables and found that psychosocial factorsare more associated with subjective QOL ratherthan psychopathologic symptoms in variousclinical group. Gaite et al (2002) and Bengtsson-Tops & Hansson(2001) reported that in additionto severity of symptoms, family support andfriendship appear to be predictor of subjectiveand objective quality of life in schizophrenia.Hansson et al (2003) studied the relationshipbetween needs and subjective quality of life inschizophrenic patients and found that unmetneeds are strongly associated in this populationand most important unmet need was socialrelationship. In another study Hansson et al (2002)found that perceived better quality of life wasassociated with favorable perception ofindependence, social network and privacy inschizophrenia. Whereas Ritsner et al (2003)reported that improved subjective quality of lifeof schizophrenia patients is associated withclinical symptoms as well as subjective self-efficacy and self esteem.

Keeping in view of the above, the presentstudy was conducted to examine the level of lifeand social need satisfaction among recentlyrecovered indoor patients with first episode ofpsychotic illness in clinically stable phase.

Method

Subjects

Two groups of subjects participated in the presentstudy: 30 with mania having psychotic symptomsand 30 with schizophrenia. All were males in theage r an ge of 20 to 40 year s . Th e aver age agefor mania with psychotic symptoms and patientsof schizophrenia was 31.40 and 28.67 yearsrespectively. Majority of patients were marriedand educated up to class 12th standard. Most ofthem were Hindu by religion. Both the groupswere matched on sociodemographic variables.Except age of patients and duration of illness,there was no statistically significant differencein marital status, education, occupation, income,family type, residence and religion for bothgroups.

Tools

Brief Psychiatric Rating Scale (BPRS) (Overall&Gorham, 1991) was used to exclude thepatients with severe symptoms. There are 18items in the scale. Rating varies from 1 to 7, 1-3indicates non pathological intensity of asymptom and 4-7 indicates pathological severityof symptom. Those scored more than 3 on anyBPRS sub items were excluded from the study.

Life satisfaction was assessed through LifeSatisfaction Scale (LSS) (Alam & Srivastva,2001). This is a structured schedule consistingof 60 items, distributed across 6 different domainsof life satisfaction such as: health, personal,economic, marital, social and job. The obtainedtotal score on the scale provides the index of lifesatisfaction

Sociogenic Need Satisfaction Scale (SNS)(Chauhan et al, 1986) i.e SNS was used in orderto assess need satisfaction. The scale measuresmagnitude of satisfaction of sociogenic needs ina general framework. It relates to need-satisfaction provided to the individual by asociety. The scale consisting of 40 items provides

Banerjee et al./ Life and need satisfaction



measures of sociogenic need-satisfaction relatedto positive and negative need- dimensions.

ProcedureThis was a cross-sectional study designed

primarily to examine subjective life andsociogenic need satisfaction among patients withfirst episode psychosis. Purposive sampling wasused for selection of subjects in the present study.For collecting sociodemographic information, asemi structured data schedule was used. Thesubjects were identified through DiagnosticCriteria for Research (ICD 10-DCR, WHO, 1993).

In order to exclude the patients with severesymptoms, the subjects were screened throughBP RS. Su bsequen tl y, th ey wer e a ssess ed onLife Satisfaction and Sociogenic Need SatisfactionScales as well. All assessments were conductedin one-to-one setting.

Results

The obtained data were analyzed usingStatistical Package for Social Sciences (SPSS)version 11.0.

Life Satisfactions

For sociodemographic variables t-test and 2 tests were conducted. To see the level andthe group difference in life satisfaction anddomains of sociogenic need satisfaction Chi-square test was used. Table 1 provides acomparison of the sample on Life Satisfactionscore. Those with first episode mania (withpsychotic symptoms) and persons who werediagnosed with schizophrenia for the first time,have had similar experience of life satisfaction. In

both the groups 73.3% subjects reported anaverage level of life satisfaction. The differencewas not significant (Table 1).

Sociogenic Needs Satisfaction

No significant difference was found invarious domains of sociogenic need satisfaction.Most of the patients in both group reportedmoderate to low level of either positive or negativedimension of sociogenic need satisfaction (Table2). This remains same when we compared theoverall positive and negative dimensions ofsociogenic need satisfaction in both group.However 80% persons with schizophreniareported high to average level of sublimation incomparison to 66.7% of first episode mania withpsychotic symptoms, the difference was notstatistically significant.

Discussion

The findings revealed that despite havingvery mild symptoms and no previous history ofany severe illness, about two third of the patients

Table 1. Comparison of the samples on Life satisfaction total score

Life Satisfaction Mania with P.S n=30

Schizophrenia n=30 Chi- square p

High 5 (16.7) 4 (13.3) Average 2 (73.3) 22 (73.3)

Low 3 (10.0) 4 (13.3) .254 .881

**p=0.05 in both groups reported moderate level of life

satisfaction and low to moderate level ofsociogenic need satisfaction. Secondly both thegroup did not differ significantly in overall lifesatisfaction or any domains of sociogenic needsatisfaction. There are very few reports onsatisfaction with life in well functioning personshaving first time psychosis. Studies in this regardwhich compared between the groups withpsychosis are not consistent, some of themreported that persons with mood disorders andschizophrenia experience equal level ofsatisfaction with life whereas some reported




Table 2. Comparison of the sample in Sociogenic Needs Satisfaction domains

Sociogenic Needs Satisfaction domains

Mania with PS

n=30

Schizophrenia n=30

Chi- square p

High 6 (20.0) 9 (30.0) Average 13 (43.3) 11 (36.7)

Acceptance

Low 11 (36.7) 10 (33.3) .814 .666

High 7 (23.3) 11(36.7) Average 16 (53.3) 13 (43.3) Cooperation

Low 7 (23.3) 6 (20.0) 1.276

.528

High 7 (23.3) 8 (26.7) Average 16 (53.3) 12 (40.0) Identification

Low 7 (23.3) 10 (33.3) 1.168 .558

High 0 (0) 0 (0) Average 26 (86.7) 23 (76.7)

Dominance

Low 4 (13.3) 7 (23.3) 1.002 .317

High 7 (23.3) 9 (30.0) Average 12 (40.0) 13 (43.3)

Rejection

Low 11 (36.7) 8 (26.7) .764 .683

High 10 (33.3) 9 (30.0) Average 10 (33.3) 11 (36.7)

Isolation

Low 10 (33.3) 10 (33.3) .100 .951

High 8 (26.7) 10 (33.3) Average 14 (46.7) 12 (40.0) Differentiation

Low 8 (26.7) 8 (26.7) .376 .829

High 5 (16.7) 13 (43.3) Average 15 (50.0) 11 (36.7) Sublimation

Low 10 (33.3) 6 (20.0) 5.171 .075

High 5 (16.7) 7 (23.3) Average 16 (53.3) 15 (50.0)

Overall Positive

dimension Low 9 (30.0) 8 (26.7 .424

.809

High 8 (26.7) 10 (33.3) Average 13 (43.3) 11 (36.7) Overall Negative

Dimension Low 9 (30.0) 9 (30.0) .389 .823

Note: Figures in parentheses indicate percentage. **p=0.05 significant differences in various domains ofsubjective quality of life. The results presentedhere are consistent with data of previous researchby Bamiso et al (2007), who r epor ted th at patientswith psychotic disorders are less satisfied withall asp ects of t h eir lives and found th a t th e deg r -ee of s at isfacti on wi th var i ou s asp ects of l ife in p a t i e n t s w i t h a f f e c t i v e d i s o r d e r s a n dschizophrenia were reported to be poor by both

the group. There are studies which report highlevel of satisfaction with life among psychiatricpatients. Olusina and Ohaeri (2003) studied therecently recovered psychiatric patients on theirfeeling of well being, their satisfaction in differentdomains of living experience, and the correlatesof subjective QOL. Patients with schizophreniaand major affective disorder reported a high levelof over all s en se of well bein g an d satis fact ion




with self and further at least two third of thesubject were categorized as having average QOL.Koivumaa et al (1996) studied the associationbetween life satisfaction and treatment factorsamong patients with schizophrenia, majordepression and anxiety disorder. Life satisfactionwas low regardless of other factors in all groupsan d wh en gr oups wer e compa r ed, s ch izoph r en iarecorded better life satisfaction than patients withoth er disorders. Roh land et al (2000) r epor ted thatpatien ts with schizoph renia usually rate their lifesatisfaction higher than persons with otherpsychiatric disor ders. In a follow-up study Ritsn eret al (2003) also found that subjects with improvedconditions in schizophrenia, schizo-affective andmood disorder, in comparison to schizophrenia,schizo-affective and mood disorder, patient reportmore dissatisfaction with life. Atkinson et al(19 97),con fi m ed t h e sa me r esult in theirstu dy,h owever h e question ed th e validity of self- r epor tmeasures of life satisfaction, particularly for usewith those suffering from affective disorder,sin ce scor es may be i n flu en ced by a ffect ivebias and poor insight.

The social needs assessed in present studyare satisfaction of individual in social situationan d r ole exp ectat ion s felt by t h e su bject. Abouttwo third of subject reported low to moderatelevel of positive need satisfaction and at leastone third of subjects reported high level ofnegative need satisfaction, which indicate poorto average level of subjective feeling of socialadjustment. Michalk et al (2005) conducted ar eceive of lit er at ur e i n bip olardisor der s to see th equality of life, well-being and other social variancereported in various studies and found thatmajority of studies indicated that quality of lifemarkedly impaired in patients with bipolardisorders even when they are considered to beclinically euthymic. The findings of Sierra et al(2005) are similar to the findings of the index studywhere he compared the bipolar patients withnormal controls and found that patient’s groupobtained statistically significant lower scores onall sub-scales of subjective well-being and most

importantly patients experienced this even in thestable phase of the disorder.

The study revealed that poor subjective lifeand need satisfaction among the patients of boththe categories. This results in poor sense of socialwellbeing. The study suggests obvious clinicalimplications for improving QOL of patientshospitalized with severe mental disorders. Furtherwe must focus not only on reduction ofsymptomatology and enhancing levels offunctioning, but also on the patients subjectivewell being and sociogenic needs. Rehabilitation,intervention to prevent further episode shouldbe directed to eventually promote subjective QOLin due course of time. Increased awarenessamong mental health professionals about suchapproach may lead to better understanding ofthese concepts and possibly improvedtheoretical framework for designingpsychological management strategies for thepatients reporting for treatment on initial stage.We suggest future research toward furtherunderstanding of the relationship of subjectivewell-being and mental illness.

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India is one of the few countries in the worldwhere women and men have nearly the same lifeexpectancy at birth. The fact that the typicalfemale advantage in life expectancy is not evidentin India suggests that there are systematicproblems with women’s health. Indian womenhave high mortality rates, particularly duringchildhood and reproductive years. They havelow level of education and low participation inlabor force. They live under the control of theirparents or their husbands, or their sons indifferent phases of life and enjoy less ofautonomy (Chatterjee, 1990; Desai, 1994; TheWorld Bank, 1996). These factors tend to havenegative consequences for the health of Indianwomen.

A frequently reported reason for poor healthof Indian women is the discriminatory practicesagainst girls and women. The most alarmingevidence for this is provided by the large numberof “missing women” (the females who apparentlydied in the past). About a decade ago the World

Expectation and Availability of Social Support inCancer and Diabetic Women Patients

1P. Awasthi, and 2R. C. MishraDuring chronic illness women patients pass through significant life changes. Lack ofpsychosocial and emotional support during illness interferes with their psychologicalfunctioning. In the present study the nature of expected and obtained social supportby women suffering from cervix cancer (n=100) and diabetes (n=100) was analyzed.With respect to the delivery of support, the findings showed that diabetic womenreceived greater amount of emotional, informational, social and practical supports thanwomen suffering from cervix cancer. While educated women received greater emotional,informational, and social support than uneducated women, urban women receivedpractical support more than rural women. The findings indicated that both cancer anddiabetic patients had almost similar level of expectations for emotional, informational,social companionship and practical supports, however, some differences in theexpectation of supports were evident due to educational and residential background ofwomen. The implications of these findings for women patients are discussed.

Keywords: Cervix cancer, diabetes, social support, received support, network structure,support quality

Bank (1996) estimated a deficit of 35 millionfemales who should be part of the population,but are not there mainly due to higher femalethan male mortality rate for every age group upto the age 30 ( Registrar General, 1996). The mostextreme manifestation of this problem is the sex-selective abortion. Use of medical technology todetermine the sex of a fetus is on rise in India,and over 90 percent of the fetuses that are abortedare female (The World Bank, 1996).

Studies also indicate that women experiencediscrimination in the allocation of householdresources including food, access to healthservices and breast-feeding (InternationalInstitute of Population Sciences, 1995). Duringillness boys are more likely to be taken for medicalcare than girls (Bhalla, 1995; Jejeebhoy, Shireen& Rao, 1998). Studies also indicate that between1-4 years more girls than boys die due to factorsrelated to living conditions and negligence suchas accidents, injuries, fever, and digestivedisorders (Government of India, 1995). It is

Indian Journal of Clinical Psychology Copyright, 2008, Indian Association of2008, Vol. 35, No.2, 127-137 Cli nical Psychologists (ISSN 0303-2582)

1, 2Department of Psychology, Faculty of Social Sciences, Banaras Hindu University, Varanasi, UttarPradesh, India.Correspondence: First author: [email protected],

mailto:[email protected],



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Awasth i et al ./Availabilit y of social su pport in cancer and diabet ic w omen patients

expected that in the first half of the 21st centurymaintenance of the women’s health would be abig challenge in developed as well as developingcountries.

In view of these projected dangers issuesrelated to women’s health have become mattersof great concern. Between 2003 and 2005, theWomen’s Global Network for ReproductiveRights (WGNRR) based in the Netherlands hascoordinated a campaign (called the “Women’sAccess to Health Campaign”) in collaborationwith the People’s Health Movement (PHM). Thecampaign has highlighted the failure of Alma AtaDeclaration of “Health for All by the Year 2000”.It has also reformulated the Declaration as“Health for All in the 21st Century” with thetarget reset to 2020. As a result of these campaignshealth is now viewed not only as an individualand social concern, but also as a national concernof prime importance.

During the last decade the challenges posedby chronic diseases have drawn careful attention.Among them cancer is identified as one of theten leading causes of death in India (NationalCancer Registry Programme, 2000). It is group ofdiseases that can occur in all living cells of thebody. Epidemiological studies show that 70-90%of all cancers are environmental. It is estimatedthat there are nearly 2 - 2.5 million cancer cases atany given point of time. Over 700 thousand newcases and 300 thousand deaths occur annuallydue to cancer. Nearly 1500 thousand patientsrequire facilities for diagnosis, treatment andfollow-up at a given time. Data from population-based registries under National Cancer RegistryProgramme indicate that the leading sites ofcancer are oral cavity, lungs, esophagus andstomach amongst men, and cervix, breast andoral cavity among women. Oral and lung cancersin males and cervix and breast cancers in femalesaccount for over 50 per cent of all cancer deathsin India.

Diabetes mellitus is another common chronicillness that threatens human population. It ischaracterized by defects in the body’s ability toproduce or use insulin. Diabetic women are not

only at higher risk for Peripheral Vascular Disease(PVD) than normal women, but they also have agreater risk for coronary artery disease andhypertension (Cerhan, et al, 1998; Elias, et al,1995), cardiovascular diseases (Colsher, et al,1991) and stroke (McCall, et al, 1992).

During the phases of chronic illnesspatients, particularly women, undergo significantlife changes (Doherty, 2004). These phases areoften associated with feelings of vulnerability,anxiety, insecurity and crisis (Knobf, 2000). Thetransition to survival from cancer and diabeteshas been described as a chaotic experience inwhich women try to balance the elation ofsurviving a life-threatening illness with thedemands of persistent physical symptoms, alteredlife meaning, uncertainty, and fears of recurrenceand sudden death (Granet, 2001; Kattlove &Winn, 2003). During the critical phase of illnesssocial support is a key factor in life contentmentand desire to live.

Studies have demonstrated facilitatoryeffects of social support on the psychologicaland physical well-being of individuals sufferingfrom chronic illnesses such as cancer (Helgeson& Cohen, 1996), coronary heart disease (Uchino,Cacioppo, & Kiecolt-Glaser, 1996) and diabetes(Cheng & Boey, 2000). These studies bring outthe potential of social relationships to promoteand maintain physical and mental health, and tobuffer or ameliorate the deleterious effects ofpsychosocial stress on health. Cobb (1976)defines social support as information that leadsan individual to feel cared for, loved, esteemedand a member of the network of mutualobligations. Kahn and Autonucci (1980) considersocial support as the expression of liking,admiration, respect, love, agreement andaffirmation as well as the provision of direct aidand assistance. Thus, social support representsa multi-dimensional construct that involves thesocial relationship of people, and an indicationthat one is esteemed and cared for.

Measurable aspects of social relations arecommonly divided into three major dimensions:network structure; social support; and support



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quality (Antonucci, 1994; Lynch, 1998). “Networkstructure” refers to the individuals who make upa given person’s social network. A description ofnetwork structure contains information such asthe number of people with whom the patient hasongoing social relationships, the relationship ofthese individuals to the patients, and theirfrequency of contact with and proximity to thepatient. “Social support” comprises bothemotional support (e.g., talking through a problemwith someone) and instrumental aid (e.g.,providing care or financial help during illness).This construct is typically assessed by askingpatients if they have received or given suchsupport in the past, or they may be asked if theybelieve that such support would be available tothem (or provided by them) should a need arisesin the future. “Support quality” refers to anindividual’s subjective evaluation of his/herrelationships in terms of adequacy, amount ofreciprocity, or the degree to which interactionswith network members are perceived as negative.

Viewed in this perspective, social supportrefers to a wide variety of phenomena thatcharacterize the social environment, or the peoplewho surround individuals in their network. Itincludes the supportive ways in which differentpeople behave in one’s social environment. Adistinction is made between structural andfunctional aspects of social support. The formerdeals the existence of social relationships,interconnections and the relations amongnetwork members (e.g., the number of friends aperson has, frequency of interaction with friends).The latter refers to the resources that peoplewithin an individual’s social network provide.These include emotional support, instrumentalsupport and informational support. Emotionalsupport refers to having people available to listen,care, sympathize, provide reassurance, and makeone feel valued, loved and cared for. Instrumentalsupport (also referred to as tangible support)involves people providing concrete assistancesuch as help with household chores, lendingmoney, or running errands. Informational support

involves the provision of information or guidance(Helgeson, 2003).

Studies indicate that social support mayinfluence health through (a) suppression ofnegative affect (b) enhanced immune systemfunctioning, and (c) promotion of healthfullifestyles (Cohen, 1988). Glasgow, Strycker,Toobert, and Eakin (2000) have developed asocial-ecological approach to chronic diseasemanagement, which incorporates some aspectsof social support received from typical sources(e.g., family members, friends and acquaintances)and also the support from the broader community(e.g., neighborhoods, workplace and communityorganizations).

Studies indicate that social relationships mayhave either a positive or a negative effect onhealth. Seeman (1996) points out that theimplication of relationships for health dependson the degree to which support is perceived as“positive and supportive” or “negative and non-supportive” by the respondent. While positiveaspects of support are widely studied, Rook(1994) argues for the study of negative aspectsof support in order to obtain a complete pictureof the association between social relationshipsand health.

In research a direct and a buffering effect ofsocial support on mental and physical health hasbeen documented (Berkman, 1985; Cohen & Syme1985). Hypothesized mechanisms for a directeffect are physiological processes operatingthrough the immune neuroendocrine andcardiovascular systems (Seeman, 1996). Bufferingeffect is noted when social support reduces thenegative impact of life stressors on an individual.Berkman (1985) describes pathways throughwhich social support may have an indirect effecton health; these include access to better medicalcare availability of aid, and social pressure toengage in positive health behaviors.

Studies reveal that people with socialsupport adjust better psychologically to stressfulevents, recover more quickly from already-diagnosed illness, and reduce their risk ofmortality from specific diseases (Coyne &




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Downey, 1991; House, Landis, & Umberson, 1988;Sarason, Sarason & Pierce, 1990). Much of theevidence shows that social support is positivelyrelated to psychological well-being (Cohen &Syme, 1985; Kasl & Cooper, 1987; Kumari &Sharma, 1990; Leiter, 1991; Sandler & Barrera,1984; Schwarzer & Leppin, 1991). Mishra, (1997,2001) found family and social network as the mostdominant support systems for health care in therural communities.

The present study attempts to (a) examinethe nature and the extent of social support womensuffering from cancer and diabetes receive fromtheir social network, (b) assess the extent of socialsupport women patients expect to receive, and(c) examine the discrepancy between the actualand expected support of the women patients. Thestudy is exploratory; hence no hypotheses havebeen advanced.

Method

Sample

The sample comprised women patientssuffering from cervix cancer (n=100) and diabetes(n=100). The samples were selected taking intoconsideration whether they were educated oruneducated, and whether they came from rural orurban settings.

Design

A 2 x 2 x 2 factorial design was employed byselecting educated, uneducated, urban and ruralwomen patients of cancer and diabetic from somemedical centres and hospitals of Varanasi. Theage group of women was 30-65 years. The socialand demographic features of the two groups werealmost homogeneous.

Measure

A social support measure (Arora & Kumar(1998) was given to participants. This measurefocuses on support providers and the nature ofsupport expectation and its delivery. Emotional,informational, social companionship and practicalsupports are assessed. An index for overall

support can be obtained by adding up the scoreson the whole measure.

The measure consists of 38 items. Emotionalsupport dimension consists of 15 items, socialand informational support dimensions consist of6 items each, and practical support dimensionconsists of 11 items. Four types of responsesare sought for each statement: (a) who givesyou this support, (b) from whom do you expectthis kind of support, (c) how much support doyou expect, and (d) how much support do youget? For question ‘C’ and ‘D’, a 7-point scale isused (not at all =0, very much=6). This paperdeals only responses of women patients obtainedunder (c) and (d) categories.

Homogeneity index for the actual supportwas found to range from 0.80 to 0.93. For theexpected support the range was from 0.84 to 0.92.Discrimination indices for items of both measureswere significant at .01 level. Alpha coefficientsfor Actual and Expected Social Support were 0.98and 0.96 respectively.

Results

Social Support Expected

The mean scores of the groups on thismeasure are given in Table 1. The scores aregenerally higher for emotional and practicalsupport than for informational and socialcompanionship support.

ANOVA (Table 2) revealed significant maineffects of education on emotional, informational,social companion, practical and overall supportmeasures; the educated group scored higher thanthe uneducated group on all measures. The maineffect of residence was significant for practicalsupport only with the urban group scoring higherthan the rural group. The main effect of diseasewas not significant.

On the other hand, Disease x Educationeffect on practical and overall support measuresrevealed a significant difference between cancerand diabetic group only in the case of educatedwomen. Education x Residence effect oninformational and practical support indicated a



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significant rural-urban difference only for theeducated group. Disease x Residence effect onsocial companionship support revealed asignificant difference between cancer and diabeticgroups only in the rural sample. The multipleinteractions of disease, education and residenceon practical support suggested that for botheducated and uneducated groups, differencesbetween cancer and diabetic groups weresignificant only for participants from ruralbackground.

Social Support Received

The mean scores of the groups on thismeasure are provided in Table 3. Scores aregenerally higher for emotional and practicalsupport than for informational and socialcompanionship support. Variation in scores isalso evident according to residence andeducation.

ANOVA (Table 4) revealed a significant maineffect of disease for emotional, informational,social, practical and overall support. The meanscores of diabetic group were higher than thoseof the cancer group. The main effect of education

Table 1. Mean scores of Social Supports expected by Groups

Types of Social Support

Disease Groups

Educated Groups

Uneducated Groups

a. Emotional Urban Rural Urban Rural Cancer Mean 74.84 66.48 59.56 68.20 S.D. 16.94 16.26 18.77 17.13 Diabetes Mean 78.04 76.08 64.32 62.44 S.D. 15.26 15.79 17.42 12.70 b. Informational Cancer Mean 32.32 27.40 23.52 26.60 S.D. 7.55 5.98 7.86 6.94 Diabetes Mean 34.52 31.64 26.04 23.40 S.D. 7.32 6.40 8.06 6.44 c. Social

Companionship

Cancer Mean 29.88 28.52 26.52 30.32 S.D. 5.42 7.40 7.77 9.02 Diabetes Mean 32.92 28.76 29.48 24.44 S.D. 7.83 7.64 8.47 9.06 d. Practical Cancer Mean 63.68 50.36 49.12 54.52 S.D. 11.63 11.37 13.46 14.22 Diabetes Mean 65.20 63.00 53.36 47.96 S.D. 9.24 8.44 14.01 11.74 e. Total Support Cancer Mean 199.84 172.76 160.72 179.64 S.D. 34.92 37.52 40.08 41.55 Diabetes Mean 210.76 199.44 174.44 157.84 S.D. 33.11 34.58 45.48 36.02




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Uchino, B. N., Cacioppo, J. T., & Kiecolt-Glaser, J.

Table 2. ANOVA outcomes on the Expected Social support Sources of Variations

df Emotional Informational Social – Companion

Practical Total

Disease (D) 1 1.96 2.05 .01 3.17 1.97 Education(E) 1 19.15 ** 42.93** 4.44* 31.48** 27.57** Residence(R) 1 .24 3.35 2.33 5.45* 2.95 D x E 1 1.96 3.14 1.96 6.15* 4.74* E x R 1 3.10 4.20 .93 5.45* 3.76 D x R 1 .31 .83 6.93** .00 .88 D x E x R 1 3.86 3.73 1.86 10.88** 5.97* Error 168

Table 3. Mean Scores of Social Supports received by Groups Types of Social Support Disease Groups

Educated Groups Uneducated

Groups a. Emotional Urban Rural Urban Rural Cancer Mean 63.88 58.00 51.76 52.00 S.D. 19.99 18.44 16.93 17.80 Diabetes Mean 69.72 66.20 56.36 55.72 S.D. 16.26 16.62 16.95 13.68 b. Informational Cancer Mean 25.52 21.76 17.76 21.60 S.D. 9.71 6.99 8.52 6.81 Diabetes Mean 29.36 26.20 20.64 18.48 S.D. 7.86 7.53 8.08 5.60 c. Social Companionship Cancer Mean 26.08 24.20 19.28 24.64 S.D. 6.11 7.22 10.31 9.42 Diabetes Mean 30.28 26.28 25.84 21.88 S.D. 8.27 8.16 9.76 8.29 d. Practical Cancer Mean 54.72 43.68 41.00 43.16 S.D. 11.00 12.74 15.26 14.70 Diabetes Mean 59.12 56.92 49.56 43.12 S.D. 9.69 11.52 14.38 11.45 e. Total Support Cancer Mean 170.20 147.64 129.68 143.24 S.D. 43.58 42.88 50.82 47.28 Diabetes Mean 188.48 175.52 152.40 141.32 S.D. 35.25 40.56 42.90 34.90



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Table 4. ANOVA outcomes on the Social Supports received

Sources of Variations

df Emotional Informational

Social -Companion

Practical Total

Disease (D) 1 5.47 * 3.49 * 4.23 * 14.01 ** 8.04 ** Education(E) 1 19.26 ** 32.11 ** 9.62 ** 28.94** 23.81** Residence(R) 1 1.05 1.48 .83 6.28* 1.95 D x E 1 .35 3.92 .25 1.70 1.15 E x R 1 .88 4.00 2.20 1.64 2.59 D x R 1 .02 1.57 5.45* .00 .40 D x E x R 1 .11 2.25 2.15 6.22 * 2.10 Error 168 *p .05, **p .01

Table 5. Mean Discrepancy Scores of Groups on Social Supports Types of Social Support Disease

Groups Educated Groups

Uneducated Groups

a. Emotional Urban Rural Urban Rural Cancer Mean -10.96 -8.52 -9.80 -15.40 S.D. 6.49 6.13 4.78 9.10 Diabetes Mean -8.32 -9.88 -11.08 -6.72 S.D. 5.29 7.81 6.16 4.54 b. Informational Cancer Mean -6.72 -5.64 -5.76 -5.00 S.D. 3.70 3.86 3.72 4.10 Diabetes Mean -5.16 -5.44 -5.40 -4.92 S.D. 3.81 3.43 3.51 3.46 c. Social Companionship Cancer Mean -4.00 -4.32 -5.64 -5.68 S.D. 2.31 4.67 4.42 5.00 Diabetes Mean -2.72 -2.52 -3.64 -2.56 S.D. 3.01 2.49 3.33 2.48 d. Practical Cancer Mean -6.48 -6.16 -7.72 -11.72 S.D. 5.64 4.92 4.46 9.71 Diabetes Mean -6.08 -6.08 -5.92 -5.24 S.D. 5.02 4.93 3.86 4.51 e. Total Support Cancer Mean -26.00 -25.12 -28.92 -37.84 S.D. 19.16 15.25 12.55 20.22 Diabetes Mean -22.28 -23.92 -26.04 -20.48 S.D. 12.69 13.90 13.82 13.01




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Table 6. ANOVA outcomes on the Social Supports (Discrepancy between received and expected support) Sources of Variations

df Emotional Informa- tional

Social Companion

Practical Total

Disease (D) 1 5.48* 1.07 16.10** 7.73** 8.51* Education(E) 1 2.06 .78 3.75 3.39 3.42 Residence(R) 1 .00 .92 .20 .90 .22 D x E 1 2.72 .38 .99 6.13* 3.15 E x R 1 .32 .04 .32 1.33 .09 D x R 1 2.58 .59 .64 1.91 1.92 D x E x R 1 14.18** .25 .08 2.52 3.88 Error 168 *p .05, **p .01

was also significant on all measures (educatedscored higher than uneducated). The main effectof residence was significant only for practicalsupport; (urban scored higher than the ruralgroup). The interaction of education andresidence on informational support indicated thaturban-rural difference was significant only in thecase of educated women. The interaction ofdisease and residence on social companionshipsupport revealed a significant difference betweencancer and diabetic patients in the urban sample.The multiple interaction of disease, education andresidence on practical support suggested thatfor the educated group, difference betweencancer and diabetic patients was significant inthe case of those from rural background. For theeducated group differences between cancer anddiabetic patients were significant only in the caseof those from an urban background.

Discrepancy between Received and ExpectedSupport

The mean discrepancy scores (actual minusexpected) of groups on this measure are given inTable 5. It may be noted that all means arenegative suggesting that women in generalexpected more than what they got as support.The scores are generally higher for emotional andpractical support than for informational and socialcompanionship supports.

ANOVA (Table 6) revealed the main effect ofdisease to be significant for emotional, social,practical and overall support; the mean scores ofcancer group were higher than those of thediabetic group. The main effects of educationand residence were not significant. Theinteraction of disease and education on emotionalsupport indicated that the difference betweencancer and diabetic group was significant onlyin the case of uneducated women. On the otherhand, the multiple interaction of disease,education and residence on emotional supportpointed to a complex nature of relationshipaccording to different levels of the factors.

Discussion\

The findings of the study revealed that theof patients of cancer and diabetes receivedemotional, informational, social companionshipand practical supports from their social network,however, diabetic patients received greatersupport than cancer patients. Education andresidential background were also significantlylinked to the availability of some of thesesupports.

Research in general indicates that perceivedavailability of social support has a positive effecton physical and psychological well-being(Cohen, Gottlieb & Underwood, 2000). For an



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individual social support means availability ofemotional, informational, and instrumental socialresources (Cohen & Wills, 1985; Kessler, 1992).

Supportive social relationships have beenconceptualized as operating in three possibleways to alleviate the problem of stress. Firstly,social support can enhance health by fulfillingmany of the human needs such as affection,approval, social contact and security. Secondly,support can reduce interpersonal tensions andenhance positive effects in the environment.Thirdly, support can buffer an individual’sexposure to stress resulting from anticipation orexperience of the chronicity of disease.

Our findings revealed that all patientsgenerally expected emotional and practicalsupport more than informational or socialcompanionship support. However, diabeticpatients expected greater emotional and practicalsupport than cancer patients. These differentialexpectations of women suffering from cancer anddiabetes concerning social supports can beexplained in terms of the anticipatedconsequences of their illness. Diabetic patientsare often advised by consulting doctors to staystress free and observe medication and dietaryprescriptions as rituals. These require not onlythe company of others, but also their activesupport in variety of ways. For cancer patients,who often think of a shorter life span, socialnetwork and dietary concern recede to thebackground, with the rumination on theirpersonal and familial problems acquiring a centralplace in their psyche. Many even considermedication unnecessary and often terminate itpartly or completely. Faced with the uncertaintyof life, less expectations for emotional or practicalsupports on the part of cancer patients is not tobe surprised at.

A noteworthy feature of our findings is thediscrepancy between the amount of expected andactually received supports. The level ofexpectation was always higher than the level ofsupport actually received. Both the cancer anddiabetic patients showed greater discrepancy onemotional and practical supports than on

informational and social companionship supports.This is understandable in view of the fact thatthe majority of women who participated in thepresent study were married and hailed from atraditional middle class background. In this groupwomen play a central role in managing householdand caring for other family members. Theiremotional bonding with family members andfriends develops greater expectation foremotional and practical supports from themduring the course of illness. It may also be notedthat in many Indian families the family income(e.g., through agriculture or family business) isshared, and the husbands are not free to use itthe way they want. This situation may lead togreater expectation for both emotional andpractical supports.

The overall findings suggested that thediscrepancy between the expected and receivedemotional support was greater among cancer thandiabetic patients. The reason may be that diabeticpatients can live their life as good as any oneelse except for some dietary controls and little ofmedication, whereas cancer patients suffer frommental trauma, physical disabilities, extreme pain,rigorous medication and severe side effects oftreatment. These consequences of the diseaseand attendant risks to life might result in greaterexplanation of cancer patients from others ascompared to that of diabetic patients.

In view of the extent to which the sense ofsecurity derived from support is important inenhancing well-being of patients; the findingsdo not present us with favorable picture of cancerand diabetic patients. They bring out the needfor sensitizing support providers to enhance theprobability of support deliveries to expected levelof patients. They also suggest the need foreffective interaction of patients with supportproviders in order to develop more realisticexpectations regarding support.

Studies indicate that the problems of womenpatients are largely rooted in their psychosocialenvironment, and the changes in life situations.The existing health delivery system fails tointervene into these contexts. Satisfaction with




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social support, secure attachment with others,and use of active coping processes are importantfactors associated with the experience of positivepsychological states during chronic illnesses.Health service providers may keep thesepsychological factors in mind while dealing withpatients suffering from chronic health problems.These factors have the potential to inform usabout the ways in which the quality of life ofpatients across diverse populations can beimproved. More studies of women patients arerequired to address their health related problemsin general, and chronic-disease related problemsin particular.

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1,2 Department of Mental Health and Social Psychology, NIMHANS, Hosur Road, Bangalore- 560029. Reprint requests: Second author

Alcohol Related Beliefs among College Students1Mahima Sukhwal and 2L. N. Suman

Indian Journal of Clinical Psychology Copyright, 2008, Indian Association of2008, Vol. 35, No.2, 138-146 Clin ical Psychologists (ISSN 0303-2582)

World-wide, one half of the total adultpopulation (2 billion people) uses alcohol(Anderson, 2006). Krohn and Brandon (2000)reported student drinking to be the number onehealth problem on college and universitycampuses across the world. In Bangalore, Paul(1999) studied the prevalence of risk for alcoholuse in college students, and found that 40% ofthe sample reported drinking and 15% werefrequent drinkers.

In a study on health-related cognitions toheavy drinking in college students, Dantzer,Wardle, Fuller, Pampalone, and Steptoe (2006)showed that beliefs in the health benefits oflimiting alcohol consumption were negativelycorrelated with intake, and likelihood of drinkingheavily was substantially greater in individualswho had weak health beliefs. In a more extensivestudy, Simons and Gaher (2004) examinedprospective relations between attitudes toward

The present study aimed at examining alcohol-related beliefs among collegestudents. The sample comprised of 236 college students – 120 female studentsand 116 male students. The age range of the sample was between 18 to 21years. The tools used in the study were Personal Information Data Sheet, Scalefor Assessment of Attitudes toward Drinking and Alcoholism (SAADA),Alcohol Expectancy Questionnaire – Adult Form (AEQ), and The Positive andNegative Affect Schedule (PANAS). Assessments were carried out in groupsessions in the college premises. Data were analyzed using parametric statisticaltechniques such as t-test and Pearson’s product moment correlation. Resultsrevealed that family structure, alcohol use in family and alcohol use amongfriends significantly influenced the alcohol related cognitions of collegestudents. Attitudes toward alcohol and alcohol related expectancies weresignificantly associated with each other. Negative affect was correlated withhigher positive expectancy. The implications for primary prevention for collegestudents are discussed.

Key words: Alcohol related beliefs, attitudes toward alcohol, alcoholexpectancies, drinking beliefs.

alcohol use and drug-free experience, and alcoholconsumption and problems in undergraduatestudents. The results showed that attitudestowards alcohol use were less associated withalcohol problems among participants with morepositive attitudes toward drug-free experience.Hence, these studies demonstrated thesignificance of attitude towards alcohol as relatedto alcohol consumption.

Read, Wood, Lejuez, Palfai, and Slack (2004)examined gender differences in alcoholexpectancies among college drinkers. Expectancyaccessibility and endorsement were modestlycorrelated, with higher alcohol consumption andfemale gender linked to greater accessibility andendorsement of social enhancementexpectancies. Gender moderated the relationbetween consumption and sociability expectancyaccessibility. Among men, heavier drinking wasassociated with more rapid activation of



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expectancies. Generally, associations amongpositive and negative reinforcement expectanciesand alcohol use across measurement approacheswere found. The authors also observed somevariability in expectancy-use relations as afunction of gender. Alcohol consumption wasfound to be associated with accessibility of twodomains of positive expectancies: socialenhancement and tension reductionexpectancies. In the context of expectancies,Young, Connor, Ricciardelli, and Saunders (2006)employed AEQ, along with the drinkingexpectancy profile (consisting of the drinkingexpectancy questionnaire (DEQ) and the drinkingrefusal self-efficacy questionnaire) to predictseverity of alcohol dependence, frequency ofdrinking, and the quantity of alcohol consumedper occasion. Positive alcohol expectancy factorsaccounted for significant variance in all threedrinking indices. Negative expectancy did notadd incremental variance to the prediction ofdrinking behaviour in this sample. The findingsalso support the use of the AEQ as a soundmeasure of positive expectancy.

Method

The aim of the study was to examine alcohol-related beliefs among college students. Theobjectives were to examine the following in thestudy sample: (1) Attitudes toward alcohol use,(2) Alcohol related expectancies, (3) Affect, (4)To examine gender differences in the abovevariables, (5) To examine the relationships amongall the above variables

Sample

The sample consisted of 236 collegestudents (116 boys and 120 girls). Undergraduatestudents 18 to 21 years of age studying in Englishmedium colleges were included. Studentsstudying in professional courses, in part-timejobs, those of Foreign Nationality and thosestudying in hostels were excluded.

Tools

Personal Information Data Sheet: Part 1 ofthis data sheet was used to obtain socio-demographic information about the subjects.This includes the subject’s name, age, sex,education, and details of family members. Part 2was used to obtain information about exposureto alcohol use. It includes family history ofalcohol use and alcohol use by friends.

Scale for Assessment of Attitudes towardDrinking and Alcoholism (SAADA) (Basu,Malhotra & Varma, 1998): It is a 29-item self-report scale for assessment of attitudes towarddrinking and alcoholism (SAADA). It has fourfactors named “Acceptance”, “Rejection”,“Avoidance” and “Social Dimension”. The test-retest reliability ranges from 0.64 to 0.96.Cronbach’s alpha coefficients were high tomoderate for all the factors as well as for thewhole scale. Other tests of internal consistencyincluded item-item and item-total correlations ineach factor. Generally high positive correlationswere found in both the cases (item-item and item-total).

Alcohol-Expectancy Questionnaire (AdultForm) (AEQ) (Brown, Goldman, Inn & Anderson,1980). It is a 120 item questionnaires. It is anempirically derived research instrument designedto assess positive effects attributed to moderatealcohol consumption. Six kinds of positiveexpectancies are assessed: positive globalchanges in experience; sexual enhancement;social and physical pleasures; assertiveness;relaxation or tension reduction; and arousal orinterpersonal power. Adequate internalconsistency measures were attained for 5 of the6 expectancies. Due to the limited number of itemssatisfying the statistical criteria for inclusion, thearousal/aggression expectancy has a coefficientalpha of 0.27. Given its discriminative utility inprevious research, this expectancy was includedfor research purposes. Content validity, criterionvalidity and construct validity have been foundto be satisfactory.



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Positive and Negative Affect Schedule(PANAS) (Watson, Clark & Tellegen, 1988): Thisinstrument includes ten items and was developedto measure the two primary dimensions of mood– positive and negative affect. The alphareliabilities are all acceptably high, ranging from0.86 to 0.90 for positive affect (PA) and from 0.84to 0.87for negative affect (NA). The test-retestreliability of PA was found to be 0.79, whereas forNA it was found to be 0.81. Both PANAS scalesare very highly correlated with theircorresponding regression-based factor scores ineach solution, with convergent correlationsranging from 0.89 to 0.95, whereas the discriminantcorrelations are quite low, ranging fro -02 to -0.18.

Procedure

Students meeting the inclusion andexclusion criteria from selected undergraduatecolleges in the city of Bangalore were contacted.Written informed consent was obtained and theabove mentioned questionnaires wereadministered. The sample comprised of 24subjects: 14 males and 10 females. The total timetaken was about one hour and forty minutes.

Results

The sample of the present study consistedof 236 subjects, including 116 males and 120females. The age of the participants ranged from18 to 21 years. Most subjects belonged to nuclearfamilies and most had fathers who were graduates(e.g., B. Com, B.E., etc.). Most of them had motherswho were only school educated. Significantlymore number of female subjects belonged toHindu religion, whereas more male subjects wereChristians. The protocols were scored, and themeans and standard deviations of the test scoresfor the different groups were calculated. t-testswere applied for analyzing gender differences,and Pearson product moment correlation wasused to examine the direction and degree ofassociation among all the variables.

The results on SAADA indicate that there isno significant difference between the two groups(male and female) on attitude towards drinkingand alcoholism. No significant difference emergedon any of the factors – Acceptance, Rejection,Avoidance, and Social Dimension (Table 1).

No significant difference emerged betweenmales and females on any of the six alcoholexpectancies measured on AEQ. However,significant difference emerged on the total AEQscores between male and female participants(Table 2).

AEQ total scores have been found to bepositively correlated with attitudes of Rejectionand Avoidance, and negatively correlated withAcceptance. Acceptance of alcoholism anddrinking has been found to be associated withhigher expectancies of Sexual Enhancement,Social and Physical Pleasures, Assertiveness, andRelaxation or Tension Reduction; and negativelycorrelated with expectancy of Positive GlobalChanges in Experience. Rejection of alcoholismand drinking has been found to be positivelycorrelated with expectancies of Positive GlobalChanges in Experience, Social and PhysicalPleasures, Assertiveness, and Relaxation andTension Reduction. Avoidance of alcohol is alsopositively correlated with the expectancy of Socialand Physical pleasures from alcohol. A positivecorrelation has been found between SocialDimension on SAADA and expectancies of Socialand Physical Pleasures.

On both the primary dimensions of mood –positive and negative affect on PANAS, nosignificant difference was found between thescores of male and female participants. Forpositive affect between males and females(Males: M 3.348, SD 9.087; Females: M 32.63, SD7.885, t 0.768, p 443) nor there was any significantdifference in negative affect (Males: M 25.41, SD7.62; Females: M 25.18, SD 8.005, t 0.226, p.821)(Table 3). The results show a positivecorrelation between expectancy of Positive GlobalChanges in Experience and Negative Affect. Theresults also show a positive correlation between

Sukhwal et al ./ Alcohol related beliefs



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Table 1. Mean, standard deviation and t-values on SAADA

Table 2. Mean, standard deviation and t-values on AEQ

*p< 0.05 Table 3. Mean, standard deviation and t-values on PANAS

Males Females Types of Affect M SD M SD

t p

Positive affect 3.348 9.08 32.63 7.88 0.76 .443 Negative affect 25.41 7.62 25.18 8.00 0.22 .821

Negative Affect and expectancy of Sexual

Enhancement on AEQ (Table 4). As far as alcohol use in families is

concerned, 45% of the male subjects had one or more of the family members consuming alcohol. 55% subjects came from families where no alcohol use was present. On factor I of SAADA, i.e., Acceptance, students from families with no alcohol use had a higher mean. On the other hand, the students from families with alcohol use in their families had a

higher mean on Rejection. On the Social Dimension, the students belonging to families with alcohol use present had a higher mean. This group is also higher on the overall score for expectancies than the male students with no alcohol use in their families (Table 5).

Forty seven percent of female subjects belonged to families with alcohol use, whereas 53% belonged to families with no alcohol use. Female students with no alcohol use in their

Males Females Factors

M SD M SD t p

Acceptance 26.75 8.77 27.82 6.28 -1.07 .283 Rejection 29.8 7.89 29.89 8.25 -0.04 .965 Avoidance 13.37 3.78 12.97 3.91 0.80 .422 Social dimension 14.95 3.53 15.80 3.70 -1.80 .072

TOTAL 83.64 13.436 86.53 11.62 -1.77 .078

Males Females Factors

M SD M SD t p

Sexual enhancement 8.30 3.23 7.79 2.45 1.36 .173

Social & physical pleasures 13.09 3.34 12.58 3.25 1.19 .235 Assertiveness 14.88 4.90 14.50 4.10 0.64 .519 Relaxation or tension reduction 12.91 4.37 13.15 3.74 -0.46 .644

Arousal or Interpersonal power 7.28 1.99 7.48 1.51 -0.82 .409

TOTAL 173.91 31.33 163.64 27.01 2.59 .010*

Sukhwal et al./ Alcohol related beliefs



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Sukhwal et al./ Alcohol related beliefs Table 4. Alcohol use in family: Males

Present Absent Variables M SD M SD t p

SAADA Total 85.73 10.594 81.94 15.236 -1.521 .131 I 24.21 5.696 28.81 10.230 2.897 .005** II 31.60 8.120 28.42 7.466 -2.190 .031* III 13.96 3.667 12.89 3.847 -1.523 .131 IV 15.96 3.360 14.13 3.480 -2.870 .005** AEQ Total 182.02 30.467 166.69 30.577 -2.556 .012* I 39.67 12.328 34.23 12.779 -2.316 .022* II 9.02 2.853 7.72 3.425 -2.189 .031* III 14.00 2.751 12.34 3.618 -2.723 .007* IV 15.98 4.430 13.98 5.113 -2.219 .028* V 14.06 4.022 11.97 4.461 -2.620 .010* VI 7.69 1.925 6.95 2.003 -2.011 .047* PA 34.50 7.843 32.66 9.969 -1.088 .279 NA 25.50 7.045 25.34 8.113 -.109 .913

* p< 0.05, ** p< 0.01 Table 5. Alcohol use in family: Females

* p< 0.05, ** p< 0.01 families can be seen to be lower on Acceptance of alcohol, and higher on Rejection and Avoidance of alcohol. Except on the factor of sexual enhancement, female students with

alcohol use in their families present have higher expectancies than their counterparts with no alcohol use present in the family. No significant difference was seen in the


SAADA Total 89.61 12.948 83.84 9.643 -2.786 .006** I 24.88 5.292 30.39 5.975 5.319 .001** II 33.57 8.659 26.67 6.380 -5.009 .001** III 14.54 3.885 11.59 3.417 -4.414 .001** IV 16.45 3.935 15.23 3.426 -1.804 .074

AEQ Total 175.40 22.071 153.25 26.866 -4.750 .001** I 37.32 9.863 33.63 8.287 -2.231 .028* II 8.11 2.535 7.52 2.377 -1.318 .190 III 13.91 2.752 11.41 3.221 -4.545 .001** IV 15.41 4.216 13.70 3.853 -2.318 .022* V 14.39 3.334 12.06 3.766 -3.566 .001** VI 7.79 1.345 7.20 1.615 -2.129 .035* PA 32.61 8.377 32.66 7.494 .034 .973 NA 25.95 7.749 24.52 8.225 -.977 .331



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Sukhawal et al./ Alcohol related beliefs

Table 6. Alcohol use among friends: Males


SAADA Total 83.84 13.857 81.73 8.638 -.494 .622

I 26.48 8.847 29.36 7.953 1.039 .301 II 30.39 7.916 24.64 5.626 -2.345 .021* III 13.35 3.790 13.55 3.959 .160 .873 IV 15.03 3.438 14.18 4.468 -.755 .452

AEQ Total 174.56 30.696 165.00 40.988 -.778 .438 I 37.39 12.418 29.82 15.098 -1.885 .062 II 8.53 3.073 6.09 4.011 -2.434 .016* III 13.33 3.248 10.73 3.524 -2.512 .013* IV 15.16 4.658 12.18 6.462 -1.942 .055 V 13.18 4.260 10.27 4.819 -2.128 .035* VI 7.33 1.930 6.82 2.601 -.814 .418 PA 33.97 8.334 28.82 14.169 -1.807 .073 NA 25.37 7.710 25.82 7.026 .184 .854

* p< 0.05 Table 7. Alcohol use among friends: Females


SAADA Total 88.68 12.536 83.31 9.322 -2.535 .013*

I 25.57 5.533 31.19 5.862 5.321 .001** II 32.60 8.587 25.83 5.755 -4.784 .001** III 14.11 3.981 11.25 3.139 -4.185 .001** IV 16.40 3.641 14.90 3.657 -2.217 .029*

AEQ Total 170.06 25.263 153.93 26.933 -3.235 .002** I 36.07 9.890 34.27 8.052 -1.049 .296 II 7.74 2.518 7.88 2.393 .302 .763 III 13.28 3.242 11.52 2.996 -2.996 .003** IV 14.74 4.396 14.15 3.626 -.771 .442 V 14.03 3.658 11.83 3.509 -3.272 .001** VI 7.43 1.481 7.54 1.584 .392 .696 PA 32.26 8.698 33.19 6.525 .627 .532 NA 25.79 7.940 24.27 8.100 -1.020 .310

* p< 0.05, ** p< 0.01 expectancy of Sexual Enhancement between female students belonging to families with alcohol use or no alcohol use. However, the

total score on expectancies is higher among female students with alcohol use in their families (Table 6).









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Based on paper presented at National Conference on Psychological Well being Assessment and Issues , February, 5-7, 2007 , Bhubaneshwar. 1Department of Applied Psychology, University of Delhi, Benito Juarez Road, New Delhi-110 021, e-mail: puspak208 @rediff mail.com.

The Neuroscience of Well-being1S. P. K. Jena

The concept of well-being defies a precise definition due to its conceptual relativity. Ithas attracted attention of the neuroscientists studying the cognitive and health-sustaining processes as much as the philosophers investgating the nature ofcon ci ou s n es s . C lin ical o bs er vat ion s dr aw n f r om m u t ipl e s ou r ces h ave adde d n ewdimensions to our understanding of self and well being. Here, an attempt has beenmade to examine the concept through three neurobehavioural dimensions namely: (1)somatosensory experience, (2) neural representation of self and (3) neuropsychologicalcorrelates of the healing process. Well-being is explained in the light of three fundamentaltemporal elements of the cognitive map: the past largely governed by the memoryfunctions of the temporal lobe, the present , by the somatosensory (‘here-and-now’)functions of the parietal and occipital lobes and the future, governed by the integrativeand planning functions predominantly monitored by the frontal lobe. The concepts ofattachment, self and healing process (resilience) in psychotherapy are examined in thelight of their concomit ant neu ral events . In spite of the inh erent limitat ions posed bythe r edu ct ion is m , t he neu r os cien ce view of w ell-being is con s idered as an us efu lcons tr uct t o under st an d the self, well being and h ealt h sutaining processes.

Keywords: Self, well being, somatosensory experience, maya, meta-cognition, mokshya

Well-being has been an issue of concern forall, perhaps since the twilight of humancivilization. This has been a converging groundfor researchers across disciplines. The concept‘self’ and ‘well-being’ are intertwined. Althoughthe concept of health and healthy personalityrevolves around the concept of well-being, it isdifficult to find an easy way to determine thepredictors and relate them in an unquivocalmanner. However, operationally we maypresumume that the sense of well-being is a beliefabout onself, which is derived from a criticalperception of the sense of harmony between bodyand mind — a feeling state that combines bestof the two worlds of experience: one physicaland another mental,-- one concrete andobservable and another, abstract andphenomeonological .

The quest for self entails manyepistemological questions, for instance: Is the‘self’ represented in the brain substrates? Hence,can it be mapped? How do we experience the

Indian Journal of Clinical Psychology Copyright , 2009, Indian Association of2008, Vol. 35, No.2, 156-162 Clin ical Psychologists (ISSN 0303-2582 )

ph ysical wor l d vis a vi s th e ‘s elf ’ . Are theredifferent neural substrates that give differentsegments of experience of self ? . Then how arethey integrated ? Although there is no easyanswer to these questions, an attempt is made tohighlight some of the current perspectives ofneuroscience.

The Somato-sensory Experience

The fundamental design of the sensorysystem is such that it provides a total and‘meaningful’ experience of the world around andwithin us. However, the perceptions are not justthe replica of the actual somato-sensoryexperience but messages that are transmitted as‘codes’ and interpreted by the brain. Ourexperiences are different from what we actuallysense through our sensory apparatus, therefore,believed to be largely ‘deceptive’ and illusory,as the meaning that we derive from them arecoloured by still another set of experience. It is

mailto:[email protected].



Jena/ The neuroscience of wellbeing

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like a conditioned animal’s reponse to the foot-steps of its master, mistaking it as cue for dis-pensing food or an amputed soldier experiencingsensations in the amputed limb that does not ex-ist, in real life people live with many conditionedhopes and anxieties of the future, drawing experi-ences from their past. Immediate gratification thatpeople derive from the objects become the sourceof pain or displeasure for them when they losethem-- fail to recover them from the flowing streamof time. In tead of real obejcts, their images be-come abstract source of constrol. thus, symbusand images take over the functions of living andnon-living objects. some experiences of pleasureand pain are so intense that as if the time standsstill for such experiences. People fail to move awayfrom them. behaviourists term the phenomenonas ‘stimulus controls’, psychoanalysts see themas ‘fixations’ and Indian philosophers, as maya-- the illusion. .

Search for meaning has been a crucialcomponent in experiencing the world. In the sameway water has the basic property of flowingdownward , adding meaning to the sensoryexperiences of life is the dynamic andfundamental property of mind. Our sensory,perceptual and central processes are orchestratedto make our existence meaningful. Human mindthat is roughly represented by the brain,operatesby making interpretations of numerous neuralevents. In fact, this, act of making sense of things,people and events is more than the concensualvalidation of the experience from the real world.Higher the complexity of the perceptual eventhigher is the chance of variation in interpreta-tion. The abstract painting of the artist, or pro-jective tests used by the psychologist in person-ality assessment are some of the finest examples.Mountcastle (1975) made an imaginative state-ment explaining this illusive human experience interms of neural events: “Each of us believes him-self to live directly within the world that sur-rounds him, to sense its objects and events pre-cisely, to live in real and current time. I assert thatthese are perceptual illusions, for each of us con-fronts the world from brain linked to ‘what is out

there’ by a few million fragile sensory nerve fi-bers. These are our only information channels,our lifelines to reality. These sensory nerve fi-bers are not high fidelity recorders; for they ac-centuate certain stimulus features, neglect oth-ers. The central neuron is a story-teller with re-gard to the afferent nerve fibers; and he is nevercompletely trustworthy, allowing distortions ofquality and measure, within a strained but iso-morphic spatial relation between ‘outside’ and‘inside’. Sensation is an abstraction, not a repli-cation of the real world”.

People live with the experiences of their past,infatuations of the present and hopes of thefuture. The sense of wellbeing relates to all ofthese temporal events. The actions of the recentor remote past, the immediate ‘here-and-now’somato-sensory experience and planning for thefuture influence our well-being. Functioning ofbody and the mind. In a simplistic terms, humanbehaviour is influenced by the events thathappen on this timeline. Disruption of theconnectivity due to psychological disturbances,or physical trauma paves the way to illness bydefocusing the individual from health sustainingbehaviour.

The above diagram attempts to map thefunctional elements of time in major psychologicalfunctions of different lobes.There is an inticrate and dynamic relationship

Figure 1 . Mapping the time : Symbolicrepresentation of time in the human brain.

The Future: (Planning functions)

The Present:(Somatosensori functions)

The Past:(Memory functions)

Frontal lobe Parietal lobe

Temporal lobeOccipital lobe



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between these three elements of ‘cognitive map’.Actions and experiences that are not in tune withthe psychobiological response tendencies (i.e.personality dispositions) or incongruent with thesociocultural practices, cause klesha (distress).It affects the sense of happiness. In this senseantecedents of the past and expectancies of thefuture regulate present behaviour. These are the‘bottom-up’ processes which determine well-being of the individual. However, the ‘top-down’processes such as individual’s capacity forvisualization of the future and effectivemanipulation of attentive process for bothsimultaneous and successive events of life also,regulate the sense of well-being. The Buddhisticconcept of well-being is intertwined with theconcept of nirvana which is attained throughone’s voluntary exposure to painful experienceof life. The sensory experiences of the present isundermined in expectancy of the of the eternalpleasure of the future. The concept of mokshyaof Hindu religious scriptures is seen as theconsequence of good deeds that is instrumentalin breaking the eternal cycle of birth and death.In many ways, the idea of mokshya and nirvanaare close and compatible to each other.

The past that is constituted of consequencesof the previous actions, the immediate retrievablepast, the ancestral past carried for generations,symbolized as memory functions, are primarilylocated in temporal lobe. The presentencompasses the ‘here-and-now’ nature ofsomatic and sensory (somato-sensory) functionsof the parietal and occipital lobes. The future issymbolized in planning function, which isprimarily located in the frontal lobes. Associationsand synchronization of these three temporalevents determine our present state of well-being.

The psychoevolution of the human brain,has been made possible not only by respondingto the changing nature of challenges posed bythe environment but also due to the habituationand disappearance (extinction) of ineffectiveresponses. Old responses when fail to generatedesirable consequences, new problem-solvingskills and pleasure-seeking behaviour emerge and

best ones of them dominates the responserepertoire. Thus, future planning for substitutingold with the new and effective responses holdthe key to well-being. Hopes and expectanciesof the future become more important than eventsof the past or present.

Neuropsychology of Self

Perception of self comes not only from thesensory systems but also from the corticalrepresentations of body senses, memory of thepast and planning, hopes and expectations ofthe future. Awareness of the self in relation toone’s surroundings such as time, space andperson is considered as ‘orientation to self’. Itdepends on the continuity of awareness andtranslation of immediate experience into memoriesof sufficient duration to maintain awareness ofthe ongoing history. Sentience is the term, whichis used to refer to subjective experience,phenomenal awareness, raw feelings, and first-person tense “I am” (Gazzaninga, Ivy & Mangun,2002). The normal body schema depicts “theperipheral, schematically conscious, structured,plastically bordered spatial perception of one’sown body, constructed from previous and current(especially somesthetic) sensory information”(Fredericks, 1969b). Disorientation to time andspace occurs in a large variety of CNS disordersincluding Alzheimer-type dementia, or damageto the reticular activating system. One of themost curious disorders, manifested as loss ofknowledge about ones’s own body and bodilyconditions, is generally known asasomatognosia. There are different varieties ofasomatognosias. Anosognosia is one in whichunawareness and denial of illness. A secondvariety is anosodiaphoria, a condition in which,the patient becomes indifference to his/her illness. A fourth variety is inability to localize or namebody parts called autotopagnosia. Asymboliafor pain is another condition in which there maybe absence of normal reaction to pain. Even ifthere is severe injury to the body parts one maynot be able to perceive it at all. Unilateral




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anosognosias and anosodiaphorias, resultingfrom lesion in the posterior parietal region in theright hemisphere most commonly involves rightside of the body. Whereas autotopagnosias occurdue to legion of the left parietal cortex.( Kolb, &Whishaw, 1990). These pathologies of perceptionof self indicate the role of cortex and sub-corticalstructures like limbic system in perception of‘self’. When loss of perception of self is disrupteddue to these brain pathologies one also losessome semse of ‘well-being as well.

Sense of well-being incorporates threeelements: the experience of the physical reality(including the bodily states,) or perception aboutoneself as a fully functioning individual and asense unique integration of this complexexperience.

Well-being : A Creative Process

Health is not just a state of mind or bodyalone but a creative response (Jena, 2005), so isthe sense of well-being that emerges from it. Wearand tears of the body and mind are constantlyamended and modified through out the life span.It is a dynamic process. Its connotation variesacross, time, space and social context. Loss ofcreativity paves the way for disease and death.Well-being is largely defined in terms of one’sself- perception in the context of the physical,social and cultural realities. This element ofrelativity defies a scientific definition.

The pathways from sensory receptors to thebrain are never direct. There are hundreds ofsynaptic gaps that modify information by the timeit reaches the cortex. Further there are cross modalconnections between different sensory systemsrepresented in the cortex. For conventional stimulithe responses are quick and performed withmachine-like precision, such as an eye-blink or aknee jerk. Even voluntary responses such asmaking a signature may attain high level offunctional autonomy due to practice, leading tomodified cerebral organization. Involvement ofhigher cortical processes is minimized. Incubationperiod for processing of information about

complex stimuli that are either meaningless,unconventional or require conscious control isrelatively long. As one excels in this process theresponses become more and more autonomous,the organism tends to spend less and less amountof time on them. It provides more time at hisdisposal to engage in acquisition of new andmeaningful responses.

Higher Order Conditioning and Meta-cognition

Every organism is a learning being. It is thekey mediating process, which is involved inacquisition of new responses. Attainment of thestate of well-being may be seen as consequenceof series of learning experience. The entire lifespan of the individual is a long processconditioning irrespective of the goals peopleselect for themselves. The conscious effort toattain well-being is not free from this. At the initialstage the repertoire of behaviour is much moreelaborate than what happens later for attainingthe state of well-being. In Indian philosophicalliterature, this is termed as sadhana -theconscious effort for attaining well-being and thestate of attainment as siddhi. Higher orderconditioning, transforms real objects into abstractcues, images, symbols and thoughts. Chantingof mantras, visualizing image of the ‘God’ orperforming religious rituals serve this critical cuefunction to induce a state of relaxation. Withtraining, these cues and symbols come to attainthe same capacity like that of the actual objectsto induce relaxation. Physical realities becomeabstract. People do create and recreatepsychophysical states of their own.

However, they differ in their capacity to beconditioned by the external stimuli and also byautosuggestions. The later has more importantrole than the former as it facilitates bettergeneralization. The personality traits such asintroversion and extraversion are oftenassociated with conditionability. Thesuggestibility tests for hypnosis indicate the levelof suggestibility. These provide windows tounderstand the learning process. However,



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conditioning itself does not speak about theprocess of well-being. The metacognitiveprocesses play a significant and supplementaryrole in ‘reading’ the consequences and evaluatingthem. The inner speech “how have I done?” playsa decisive role in retaining or dropping a health-sustaining behaviour. A diabetic’s refusal ofsugar-r ich food or stressed individual’scontinuation of his exercises are the examples.

The Healing Process

Certain religious practices like, prayer,meditation, yogic postures (asanas) like svasansand yoganidra are some of the culturally valuedattention-based methods to induce quickdissociative states. Meditation helps people tolearn how to focus attention, Schwartz explainedhow a treatment protocol developed on the basisof mindfulness meditation helped in treatment ofobsessive-compulsive disorder (OCD) (Schwartz,& Bagley, 2002). According to him, attentioncreates mental force. It makes changes in the inthe structural organization of the brain andallocation of resources (e.g blood flow) to thebrain, therefore, it improves the neuroplasticity.In a broader sense, plasticity “is built into thefabric of brain and mind at multiple levels, fromthe molecular to cognitive” (Black, 2000, p.119).

Recently, these self-induced procedures ofdissociation have been studied empirically. Kahn(2005) classified meditation into two distinctgroups: one, based on focus of attention andanother, on relaxed acceptance. The former has aspecific focus (e.g kundalini meditation),whereas the later, allows the thought process tocome and go (e.g yoga nidra). Both kinds ofmeditation lead to different brain responsesactivating different brain areas (e.g. Lazar et al.2000; Lou et al. 1999, Newberg et al. 2001). Thefunctional brain imaging (fMRI) study conductedon subjects practicing in kundalini meditationthat required them to focus attention on theirbreathing. It activated the areas involved inattention and arousal such as the lateral parietalregions and the anterior cingulate and amygdala

(Lazar, et al., 2000). Newberg and his associates(2001) also found increased activity in theprefrontal cortex when subjects focused theirattention on visualized images and maintained it.Whereas, practice of relaxation type meditationthat involves loss of conscious control overthought process, showed different kind of brainresponse.

PET scan results showed that specific brainareas were activated for specific meditativecontents. For example, when meditation wasfocused on the weight of the limbs, supplementarymotor areas were activated. Meditation focusedon joy and happiness particularly activated theleft hemisphere (Davidson, & Irwin, 1999). Onthe other hand, when subjects were engaged invisual imagery, the occipital and parietal cortexeswere activated. Similar observations were madewhen subjects were required to focus attentionon breathing (Lazar, et al. 2000). These studiesindicate that the focus of meditation itselfdetermines the area of activation of the brainstructures.

In still another experiment Austin (2003)explored the neural correlates of meditativeexperience of losing one’s sense of self or ego,the feeling he described as “no physical orpsychic self but only a kind of anonymous mirrorwas witnessing the scene”. During thismeditative state several changes were observed,including changes in thalamus that allowed toblock external sensory input, which in turnallowed a deeper internal awareness. Corticalreorganization is necessary for facilitating healingprocess and recovery from neural damage. It is aconstantly ongoing process, that reflects the“dynamic balance” within the system (Kaas, 2000,p.232). Learning to focus attention on one’s ownthought required for self-regulation, produceelectrochemical effects that are critical to repair,neuronal growth and development of axonalconnections (Zhou, & Black, 2000). Fuster wrote,“Experience begin to play its structural network-building role early in ontogeny, and that rolepersists throughout life”. (Fuster, 2003, p.39).Thus, the forgotten links of culture, religion and




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science need to be empirically re-examined fromthe perspective of neuroscience.

People seek other’s help, advice, or care,when they either fail to rely on themselves orwhen the self-regulatory mechanism fails toprevent a disorder. It provides an opportunityfor re-programming the psychobiological system.This issue has attained immense significance inour current understanding of psychotherapy asa healing process. The psychobiologicalprocesses initiated by the suggestions of thetherapist as guru and the nature has not beenstudied adequately in the healing process sinceempirical study of the process is a Herculean task.However, the experimental studies conducted byPlatanov and other Russian researchers in 1950s(e.g Platanov, 1959) revealed that verbalsuggestions creates through the rapport zone aconcentrated focus of excitation specially aimedat reinforcing the restorative function of thecerebral cortex. This function is evoked by atemporary exclusion of its other functionsincluding the coupling and analyzing functions.Detachment (nirasakta), self-isolation(atmanibritti) and withdrawal of senses from theobjects (pratyahara) are some of the time-testedpreparatory methods. Many adopt these methodsas life styles in order to make themselvesamenable for behavioural change.

Conclusion

The sense of well-being is key to happiness.It is a critical response, perhaps awareness of thesum total of ‘positive’ signals that one receivesfrom the bodily states . Its disturbance ormisperception is manifested in the form ofunhappiness, disease, even death. Study ofwellness would hopefully be a convergingground for all human sciences. Although aneuroscience perspective may appear somehowreductionistic, it has opened up new windows ofunderstanding. As happiness has been the mainconcern of the human race, research on well-beingshould logically incorporate the folk traditionsof healing practices, the processes involved in

therapeutic change and the current innovationsin neuroscience of self and its awareness.

References

Austin, J. H. (2003) Your self, your brain and zen.Cerebrum, 5, 47-64.

Black, I. B. (2000) Introduction” to Section II.Plasticity, In M. S. Gazzaniga et al. (Eds.) Thenew cognitive neurosciences, 2nd ed. MIT Press :Cambridge and London.

Davidson, R. J. & Irwin, W. (1999) The functionalneuroanatomy of emotion and affective style.Trends in Cognitive Sciences, 3, 1, 11-21.

Fredericks, J. A. M. (1969b) Disorders of bodyschema. In Vinken. P. J., & Bruyn, G. W. (Ed.)Handbook of clinical neurology. Vol. 4 ,North_Holland Publishing Company:Amsterdam, pp. 207-240.

Fuster, J. M. (2003) Cortex and mind: Unifyingcognition. Oxford University Press: New York.

Jena, S. P. K. (2005) Sociobiology of health, In A. K.Dalal & S. Roy (Eds.) Social Dimensions ofHealth, Rawat Publications, Jaipur.

Kaas, J. H. (2000) The reorganization of sensory andmotor maps after injury in adult mammals, In M.S. Gazzaniga, et al. (Eds.) The new cognitiveneurosciences, 2nd ed. MIT Press : Cambridgeand London. pp.223-236.

Kahn, D. (2005) From chaos to self-organization: Thebrain, dreaming and religious experience. In K.Bulkeley (Ed.) Soul, psyche, brain: New directionsin the study of religion and body-mind science.Palgrave McMillan: New York.

Kolb, B. & Whishaw, I. Q. (1990) Fundamentals ofhuman neuropsychology, W. H. Freeman & Co.New York.

Lazar, S. W., Bush, G., Gollub, R., Friechione, G. L.,Khalsa, G. and Benson, H. (2000) functionalbrain-mapping of the relaxation response andmeditation. Neuro Report, 11, 1581-1585.

Lou, H. C., Kjaer, T. W., Friberg, L., Wildschiodtz,G., Holm, S. & Nowak, M. (1999) A 15O-H2 PETstudy of meditation and the resting state of normalconsciousness. Human Brain Mapping, 7, 98-105.

Mountcastle, V. B. (1975) The view from within:Pathways to the study of perception, JohnHopkins Medical Journal, 136, 109-131.

Newberg, A., Alavi, A., Baime, M., Pourdehnad, M.,Santanna, J. & d’ Aquili, E. (2001) The



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measurement of regional cerebral blood flowduring the complex cognitive task of meditation:A preliminary SPECT study. PsychiatryResearch: Neuroimaging Section, 106, 113-122.

Platavov, K. I. (1959) The word as a physiologicalfactor, Foreign Language Publishing House,Moscow. Schwartz, J. M. & Begley, S. (2002)

The mind and the brain: Neuroplasticity andpower of mental force. Regan Books, HarperCollins: New York.

Zhou, R. & Black, I. B. (2000) Development of neuralmap: Molecular mechanisms. In M. S. Gazzanigaet al. (Eds.) The new cognitive neurosciences, 2nd

ed. MIT Press : Cambridge and London.




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1 NIMH Regional Centre, B. T Road, Kolkata 700 090, email: [email protected]

Behavioural Intervention of Compulsive Behaviours inAutism: A Case Study

M. Thomas Kishore

Autism is syndrome primarily characterized by qualitative impairments in social skills,communication and restricted interests and repetitive behaviours. Sometimes therepetitive behaviours seen in this disorder overlap with obsessive and compulsivedisorders. Behaviour modification techniques based on the principle of operantconditioning are known to be effective in case of stereotypic behaviours but there is noclear data whether the same is effective in case of compulsive behaviours in Autism. Inthis context the present study was designed to treat compulsive behaviours in a boywith autism through applied behavioural analysis.

Key Words: Autism, compulsive behaviours, behavioural intervention.

Autism is a pervasive developmentaldisorder characterized by qualitative impairmentsin social skills, verbal and nonverbalcommunication restricted and repetitive interestsor behaviours (American Psychiatr icAssociation, 1994). It is commonly associatedwith mental retardation and other behavioural andpsychiatric disorders (American Academy ofChild and Adolescent Psychiatry, 1999; Kim etal., 2002). Particularly, obsessive behaviours aremore striking as they are, at times, carried to suchextent that it appears as if obsessions are mainor the only motivation. These behaviours seemto appear during the adolescence. If theobsessive behaviours are not continuallymonitored and managed, it will come to dominateand place handicapping limitations in the lives ofpersons with autism (Wing, 1990) or mentalretardation. The first step in this direction will beto differentiate between certain repetitivebehaviours characteristic of autism andobsessive-compulsive behaviours, as it will helpthe therapist to chose appropriate interventionsand estimate the prognosis (Martin et al., 2000;Perry & Condillac, 2003). Given that self-awareness and communication skills are deficientin autism, differentiating between repetitivebehaviours and compulsive behaviours is

Indian Journal of Clinical Psychology Copyright , 2008, Indian Association of2008, Vol. 35, No.2, 173-177 Cl inical Psychologists (ISSN 0303-2582)

difficult unless the individual is able to clearlyexplain the subjective experiences. Perhaps, thiscould be a reason why there is little reliableinformation regarding the assessment ormanagement of compulsive behaviours in autism(Brown, 1990). Applied behavioural analysis wasfound to be effective in the management ofautism (Perry & Condillac, 2003) nevertheless itsefficacy could not be generalized to obsessiverituals due to lack of consistent data. In thiscontext the present case study was designed withthe objective of studying the efficacy of appliedbehavioural analysis in the management ofcompulsive behaviours in autism.

Case history

Master AB was 17 years when he wasbrought to the present study centre by his parentswith the presenting complaints of repetitive andmea n in gl ess beh aviour s , n on -comp lian ce, poorattention span, abnormal posture and handmovements. Personal history revealed thatprenatal period was apparently uneventful; hewas born of full term and caesarean delivery.Other birth details were normal. Hisdevelopmental milestones were delayed in generalwith marked deficits in language development,




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Kishore/ Behavioural intervention in autism

social reciprocation, imaginative and social play.He was admitted to normal school at five years ofage but discontinued after four years primarilydue to behavioural problems. Most of the timehe would sit alone gesturing, poking self withfingers or flapping fingers. In addition to thesebehaviours, he started showing certain repetitivebehaviours three years prior to the date ofconsultation at the present study centre like,throwing keys through the window, drinking atleast one liter water from the bottle at once,touching the padlocks, excess washing andkeeping things in particular order. He was earlieron several medications including antipsychoticdrugs, stimulants and anxiolytics besides regularspecial education training for seven years.Although there were no significant gains, parentsreported that they continued with the medicationas the child would become restless andaggressive whenever the drugs were withdrawnor reduced.

Initial assessment revealed that he wasindependent in all self-help activities exceptbuttoning, washing after toileting. He could followsimple instructions. He could communicate intwo-word phrases but would not initiate ormaintain conversation. Echolalia was quiteprominent. He could read few sight words andcount numbers meaningfully up to 15. Hisdevelopmental quotient was 54 and socialquotient was 51 on Developmental Screening Test(Bharat Raj, 1977) and Vineland Social MaturityScale (Bahrat Raj, 1992), respectively. His IQ onBinet-Kamat Test of Intelligence (Kamat, 1967)was found to be 50. The Childhood AutismRating Scale (CARS) (Schopler et al., 1988) scorewas 36. Based on the developmental history,behavioural observation and test findings adiagnosis of mild mental retardation, autism andobsessive and compulsive disorder-predominantly compulsions were made (WorldHealth Organization, 1992).

Behaviour analysis and formulationFive domains were identified for intervention:

(1) compulsive behaviours, (2) motor and verbal

stereotypes, (3) cognitive deficits, (4) social and(5) language skills. However, this paper outlinesonly the management of the compulsivebehaviours. Based on the parental report andbehavioural observation the following targetbehaviours were taken: Throwing keys, touchingthe padlocks, drinking water from a bottle at onceand throwing water from buckets. Problembehaviours were recorded for two consecutiveweeks by frequency recording technique andanalyzed as per the ABC Paradigm (Yule, 1980;Peshawaria, & Venkatesan, 1992). ABC model wasused in this study for its simplicity and validity(Zirpoli & Mello, 1993; Peshawaria & Venkatesan,1992) besides it was easy to make the parents theco-therapists to gain insights into the problembehaviours.

Functional analysis indicates that all thetarget behaviours were contingent upon an urgeto do them; the boy’s verbatim for severalsubsequent non-leading questions is translatedinto English and summarized as follows: “I feelurged to do this. Otherwise, I do not feel good. Ifeel restless”. Although the duration ofpreoccupation with these thoughts and theirrelationship to the compulsive acts could not beestablished due to generalized cognitive deficitsassociated with the present clinical condition.Analysis of antecedents indicates that none ofthe target behaviours have any association withspecific place, time and person. Theconsequences are that these acts reduce anxietyand the boy would feel better. The parents wouldallow him to continue with it as externalsuppression of the act makes him aggressive.Precisely speaking, the compulsive behaviourwas negatively reinforced. Negativereinforcement is condition or situation in which astimulus is removed or avoided by a behaviour.Hence, it increases the probability that thebehaviour will recur (Repp, 1983). Applied tothis case, the boy was compulsively indulging intarget behaviours because they led to reductionin anxiety or feelings of discomfort.

Behavioural intervention



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Before starting the intervention, medicationwas gradually tapered and put on need-basedmedication by the consultant Psychiatrist.Intervention was based in general on operantlearning principles. The parents were involvedas co-therapists.

(a) Identifying reinforcers: Duringintervention, the parents were explained boutthe antecedents, consequences and their effectson the problems behaviours, and limits were setfor each excess behaviour. The parents were torecord the problem behaviours at home. Theywere helped to prepare a reinforcement menu,identifying several activity and material rewardsbased on their personal experience and placingthem in order of their preference. From the menu,music emerged as a strongest reinforcer .

(b) Scheduling of activities: In consultationwith the parents, a schedule of meaningfulactivities, such as adaptive behaviours wasprepared for the child. Activities also comprisedof target behaviours such as keeping the key

Table 1: Showing improvement in target behaviours.

Target responses

Note: The numbers in each row indicate average frequency of behavioural problems per day during thepreceding week. After the Session IV, each session was conducted after every fifteen days.

SessionsBaseline I II III IV V VI VII VIII

1 Throwing keys from window 10 9 7 5 0 0 0 0 0

2 Touching padlocks/keys 10 7 3 2 2 1 1 0 0

3 Drinking water at once 10 7 3 2 2 1 0 0 0

4 Throwing water from buckets 5 5 2 3 2 2 2 0 0

bunch in appropriate place, dusting of pad locks,locking the door/cupboards whenever required,storing water and watering plants which weredesirable and also alternative to the targetbehaviours. The schedule also consisted of self-help behaviours, social, communication andacademic activities which were of immediatefunctional relevance. Based on Premack Principle

the activities were ordered in such way that highprobability behaviours followed the lowprobability desirable behaviour (Alberto &Troutman, 1990).

(c) Differential Reinforcement of AlternativeBehaviours: This technique involves contingentreinforcement of those adaptive behaviours thatare alternative to the target behaviours (Alberto& Troutman, 1990; Zirpoli & Mello, 1993;Peshawaria & Venkatesan, 1992). For example,the boy was reinforced contingent upon theperformance of desirable behaviours mentionedin the activity schedule. Social rewards were usedimmediately after occurrence of alternativebehaviours, and when a pre-set mark of numberof alternative behaviours was met he was givenan activity reward.

d) Exposure and response prevention:Initially, depending on the therapeutic settingparents and therapists exposed the boy to thematerial that trigger compulsive behaviours andprevent responses with combination of verbalclues and mild physical restraint involving

stopping him by holding his elbow. Graduallythe parents switched on to verbal and gesturalclues, and finally no clues.

The intervention was implemented withparents as co-therapists. Each session wasconducted for one hour at every weekly intervalup to one month, and fortnightly for another twomonths. During each session programme was




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reviewed and future goals were set.

Discussion

Autism is a syndrome primarily characterizedby qualitative impairments in social skills andcommunication, and restricted and repetitiveinterests or behaviours. The repetitive behavioursof autism sometimes overlap with compulsivebehaviours therefore clinicians should givecareful consideration to identify each disorderseparately, as they may have bearing onidentifying intervention and prognosis (Perry &Condillac, 2003). The present case study wasdesigned with the objective of studying theefficacy of applied behavioural analysis in themanagement of compulsive behaviours in autism.

Results of the intervention indicated thatapplied behavioural analysis was useful inmanaging compulsive behaviours in autism (Perry& Condillac, 2003). The empirical data of thepresent case-study suggest that significantchanges could be noted in compulsivebehaviours at least by a month. Observations byparents also confirmed steady improvement inother problem behaviours and significant gainsin overall adaptive behaviours. It is apt to notethat the behavioural intervention package usedin this study was not specific to compulsivedisorders but comprised of careful analysis ofantecedents and consequences, and generaltechniques based on principles of operantconditioning. Carefully done behaviourmodification would also facilitate generalizationof learning to new situations. The results alsoindicated that it is possible to differentiatebetween the repetitive behaviours andcompulsive behaviours provided that theindividual has required cognitive andcommunication abilities to narratepsychopathology. Nevertheless, it may not beeasy to fulfill all criteria of an obsessive-compulsive disorder specified in the traditionaldiagnostic systems (World Health Organization,1992; American Psychiatric Association, 1994).

In conclusion, compulsive behaviours could

be managed with applied behavioural analysisand the key to it is functional analysis of thetarget behaviours. And, family members can beinvolved effectively in the behaviour modificationprogramme for autism.

References

Alberto, P.A., & Troutman, A. C. (1990). Appliedbehavior analysis for teachers. New York: MerrillPublishing Co.

American Academy of Child and AdolescentPsychiatry. (1999). Practice parameters for theassessment and treatment of children, adolescents,and adults with autism and other pervasivedevelopmental disorders. Journal of the AmericanAcademy of Child and Adolescent Psychiatry, 38(12 suppl.), 32-54.

American Psychiatric Association. (1994). Diagnosticand Statistical Manual of MentalDisorders (4thed.). Washington, DC: American PsychiatricAssociation.

Bharatraj, J. (1977). Developmental Screening Test.Mysore: Swayam Sidha Prakashanam.

Bharatraj, J. (1994). Vineland Social Maturity Scale.Enlarged version. New Delhi: Mansayan.

Brown, W. (1990). The early years. In: K Ellis (Ed.),Autism: Professional perspectives and practice(pp 25-49). London: Chapman & Hall.

Kamat, V. V. (1967). Measuring intelligence of Indianchildren. London: Oxford University Press.

Kim, J., Szatmari, P., Bryson, S., Streiner, D. L., &Wilson, F. J. (2000). The prevalence of anxietyand mood problems among children with autismand Asperger’s Syndrome. Autism, 4, 117-32.

Martin, A., Patzer, D. K., & Volkmar, F. R. (2000).Diagnostic issues in Asperger Syndrome. In A.Klin, F. R. Volkmar, & S. S. Sparrow (Eds.).Asperger Syndrome (pp 210-230). New York:Guilford.

Perry, A. & Condillac, R. (2003). Evidence-BasedPractices for Children and Adolescents withAutism Spectrum Disorders: Review of theLiterature and Practice Guide. Children’s MentalHealth, Ontario.

Peshawaria, R. & Venkatesan, S. (1992). Behaviouralapproach in teaching mentally retarded children:A manual for teachers. Secunderabad: NationalInstitute for the Mentally Handicapped.

Repp, A. C. (1983). Teaching the mentally retarded.



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Englewood Cliff, New Jersey: Prentice Hall Inc.Schopler, E., Reichler, R. J., Renner., B. R. (1988).

Childhood Autism Rating Scale. Los Angeles:Western Psychological Services.

Wing, L. (1990). What is autism? In: K Ellis (Ed.).Autism: Professional perspectives and practice(pp 1-24). London: Chapman & Hall.

World Health Organization (1992). The ICD-10classification of mental and behavioural

disorders: Clinical Descriptions and DiagnosticGuidelines. World Health Organization, Geneva.

Yule, W. (1980). Identifying Problems: Functionalanalysis and observation and recordingtechniques. In: Yule, W. & Carr, J. (Ed.) Behaviourmodification for people with mental handicaps,2nd edn., ( pp. 8-27), Croom Helm: London.

Zirpoli, T. J. & Mello, K. J. (1993). Behaviormanagement: application for teachers andparents. New York: Merrill.




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Clinical psychologists are often involved inthe psychological evaluation of their client forthe purpose of diagnosis and treatment. Besidesobservation and interview they often use numberof objective psychometric test for the purpose.The information gathered from various sourcesneeds to be understood, integrated andinterpreted in the light of the changingclassification systems of Psychiatric disorder likeDSM-IV-R / TR and ICD-10. This book fulfillssome of the long-standing needs of manyclinicians in this direction.

As the title of the book suggests it provides anintegrated discussion of common symptoms,personality styles, test patterns, treatment optionsand relates these with various major diagnosticcategories that clinicians use every day (disordersclassified under axis-I and axis-II like... Substanceuse; Schizophrenia; Affective; Anxiety;Somatoform and pain; Dissociative and pain;Sexual; Personality; Impulse control and eating;Central Nervous System Impairment, ADHD, andMental Retardation are included). This bookprovides an excellent a base for interpreting someof the Psychological test result from DSM-IVperspectives. This book deals with diagnosticissues and concepts based on recent informationon commonly used psychological tests likeMMPI-2, 16PF, High School PersonalityQuestionnaire, WAIS-R, Millon ClinicalMultiaxial Inventory (MCMI), Rorschach, TAT,and Drawing tests. According to the authorsthese tests are selected because of theirpopularity, availability of large amount ofnormative data, familiarity, and most commonlyused and researched objective psychologicaltests. Useful (multimodal assessment &treatment) information for the clinicians ispresented in 18 chapters.

Chapters (1-11) are organized methodically andsequentially for each disorder with a number ofrelated syndromes grouped together under anappropriate chapter heading. Each chapter isdivided into several sections like (a) an overviewof the information relevant to specific diagnosticdisorder being discussed and presented; (b) thena section is generally followed by DSM-IV criteriaspecific to that disorder (for some disorders bothare presented together for lack of sufficientmaterial or information); (c) the next subsectionpresents the MMPI-2 code types and scalepatterns specific to that disorder along withpossible variations of the disorder; (d) in the nextsubsection the same principle like- c is adoptedwhile presenting the 16PF correlates of thedisorder (many specific secondary scales arederived from MMPI-2 &16PF, results of the samefor the diagnosis of a pattern or type of disorderar e given when they specifically & clear ly apply);(e) next subsection contains relevant informationgathered from other psychological tests likeMCMI, WAIS-R, projective and drawing tests.And finally chapter integrates common behaviorpattern/features (DSM-IV descriptors), test data,and the preferred treatment options- a multimodaltreatment is the preferred approach. Chapter- 16on malingering is prepared more or less in thesame pattern.Chapter 12 and 13 consists of an updated clinicalcorrelates of MMPI-2 and 16PF.Chapter 14 dealswith issues in predicting various patterns ofbehavior that directly involve dangerous to selfand others. Information and issues related toPsychopharmacology, forensic-legal matters andissues of competency, criminal responsibility andcivil commitment are presented Chapter 15, and17 respectively. Chapter 18 deals withprofessional case preparation. Through out the

Book Review

The Clinician’s Handbook. Integrated Diagnostics, Assessment, and Intervention in Adult andAdolescent Psychopathology, Fourth Edition. 1996. Authors; Robert G. Meyer and Sarah E. Deitsch.Allyn & Becon, Boston. 543 pages.

Indian Journal of Clinical Psychology Copyright, 2008, Indian Association of2008, Vol. 35, No.2, 00-00 Clinical Psychologists (ISSN 0303-2582)



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book multimodal diagnosis and treatment isemphasized for each disorder.After Chapter 18, the book provides useful classicand recommended source books for wide varietyof disorders (Meyer titled it as bibliotherapy) asAppendix-A. Appendix-B provides screeningdevice (Meyer In for mation Battery ) a paper-pen ciltest which the author used for over 18 years.Appendix-C provides short and long relaxationtechniques for stress management, and finallyAppendix-D lists major relevant legal cases toclinicians on issues like consent and control inintervention, privileged communication, personalinjury, child custody, juvenile proceedings,professional issues, suicide and so on.This book is useful even to those clinicians whouse the psychological test rarely in their practice,as the test responses linked to various functionalaspects of each disorder and treatment options.

Further, besides clinical psychologists the bookis useful for many professionals involved inmental health profession. This book can be usedas text book or as supplement to a standardsource book for post graduate psychologycourse at university or training centers incounseling and clinical psychology.

Acknowledgement: I thank Dr. Kevin R. RowellProfessor of psychology & Counseling,University of Central Arkansas for providing thebook recently.

BasavarajappaUniversity of Mysore, Manasa Gangotri,Mysore. [email protected] ,[email protected],in

Basavarajappa/ Book review

mailto:ajappa@gmail.

mailto:[email protected],in



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