Ror 2016 37 issue 1

Volume 37 / 2016

Rorschachiana

Editor-in-Chief Sadegh Nashat Advisory Editor Anne Andronikof Associate Editors Hiroshi Kuroda Gregory J. Meyer Fernando Silberstein Justine McCarthy Woods Book Review Editor Marianne Nygren

Journal of the International Society for the Rorschach

Special Issue: Neuroscience and the Rorschach

Editorial Inkblots and Neurons Correlating Typical Cognitive Performance With Brain Structure and Function Emiliano Muzio Private Practice, Helsinki, Finland

The idea that the Rorschach can be used to study brain–behavior relationships dates back to Hermann Rorschach’s seminal work, in which a quarter of the clinical cases presented were neurological (Rorschach, 1921). At the time, the distinction between “organic” and “nonorganic” mental disorders had not been clearly drawn. Psychiatric facilities, such as the one Rorschach practiced and gathered his data in, typically diagnosed and treated a wide range of both mental and neurological disorders, including epilepsy, mental retardation, brain tumors, traumatic brain injuries, dementia, and other conditions.

Following Rorschach’s death in 1922, the suggestion that the Rorschach could be used as a neuropsychological tool was more explicitly articulated by Piotrowski (1936), one of the great pioneers of the Rorschach, who developed a list of ten empirically-based “organic signs.” These signs are, to this day, considered a useful tool for identifying patients with neurocognitive disorders, and for describing some of the neuropsychological characteristics commonly observed in such patients. Piotrowski observed that patients suffering from organic disorders of the brain typically: (1) give a lower number of responses on the Rorschach, (2) need more time to produce responses, (3) give less responses with human movement, (4) tend to name colors, instead of using them as determinants in their responses, (5) give less responses that fit the formal characteristics of the blots, (6) give a lower number of popular responses (responses occurring at least in every third protocol administered), (7) give numerous perseverative responses, (8) have trouble correcting responses they perceive to be of poor quality or inadequate (“impotence”), (9) express perplexity throughout the task and tend to repeatedly seek reassurance from the examiner, and (10) tend to use repetitive “pet-expressions” throughout the task (e.g., “This is a work of art … This is a beautiful work of art … This is a nice piece of work”, etc.). Piotrowski’s idea was that it is the accumulation of these signs in a Rorschach protocol which increases the probability of © 2016 Hogrefe Publishing

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an organic disorder of the brain. Subsequent empirical studies have confirmed the diagnostic validity and clinical utility of these signs when five or more are present in a protocol (e.g., Chaudhury, John, Bhatoe, & Rohatgi, 1999; Mattlar, Knuts, & Alanen, 1986).

In 1999, 417 published studies using the Rorschach for the study of a broad range of neurological populations were reviewed. Approximately 45% of these studies were published in the 1940s and 1950s and concerned, for example, patients with epilepsy, Parkinson’s disease, mental retardation, head injury (notably during World War II), and patients having undergone therapeutic lobotomy (Caputo, 1999). From the 1960s, however, with the advent of specific neuropsychological methods and neuroimaging techniques came the increasing criticism of the use of the Rorschach within a neuropsychological framework. This was in part due to the confusing multiplicity of systems of administration, coding, and interpretation available for the Rorschach at that time.

With the development of Exner’s Rorschach Comprehensive System (RCS) and it’s perceptual-cognitive problem-solving paradigm in the 1970s and 1980s, as well as it’s growing empirical database and popularity among clinicians and researchers worldwide (Exner, 2003), a renewed interest in the method from a neuropsychological perspective was seen in the 1990s (Acklin & Wu-Holt, 1996; Zillmer & Perry, 1996). This historical development made it possible to conceptualize the Rorschach, not only as a method of personality assessment, but as a method capable of bridging the artificial gap that still exists between neuropsychology and personality psychology (Muzio, 2004). The more recent Rorschach Performance Assessment System (R-PAS) also follows this trend with its interpretive emphasis on perceptual-cognitive aspects of the response process and on the Rorschach as a performance-based method. For example, R-PAS has put increased emphasis on the importance of taking into account the overall level of perceptual-cognitive processing complexity when interpreting individual variables (Meyer, Viglione, Mihura, Erard, & Erdberg, 2011).

Like commonly used neurocognitive measures, the Rorschach is based on the person’s performance in a standardized problem-solving task. However, it differs from traditional neurocognitive tests in a key respect. While neurocognitive tests are best described as tests of maximal cognitive performance (i.e., tests that measure how well the person does when asked to do his/her best on a task with explicit requirements), the Rorschach is best conceived as a test of typical cognitive performance (i.e., a test that measures what the person typically does in more open-ended situations). This difference is related to the difference between having the ability to do something and the disposition to do so. For example, a person might be intelligent and cognitively sophisticated (maximal performance), yet not be disposed to put these abilities to good use (e.g., towards academic, Rorschachiana (2016), 37(1), 1–6

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occupational, or social/relational achievements), because of emotional or personality issues (typical performance). Although real life circumstances and performance measures are best conceived as being on a continuum between these two conditions, the maximal-typical dichotomy is a useful heuristic for thinking about the match between different types of performance tasks and real world contexts. This distinction, first introduced by Cronbach (1990), was later referred to in the literature in relation to questions of construct validity and case validity in assessment (Teglasi, Nebbergall, & Newman, 2012).

The RCS has been used in a number of studies on neurological populations. This has allowed researchers to accumulate information on both the validity of Rorschach variables and the characteristics of typical performance in these populations. For example, the RCS has been used to study the psychological characteristics of patients with closed head injury (Exner, Colligan, Boll, Stischer, & Hillman, 1996; Sinacori, 2000), Asperger’s disorder (e.g., Holaday, Moak, & Shipley, 2001), attention deficit/hyperactivity disorder (e.g., Cotugno, 1995), dementia (Muzio & Luperto, 1999), dementia of the Alzheimer’s type (Muzio, Andronikof, David, & Di Menza, 2001; Perry, Potterat, Auslander, Kaplan, & Jeste, 1996), or patients with polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (Ilonen, Hakola, Vanhanen, & Tiihonen, 2012).

More recently, a number of studies correlating Rorschach performance to structural (e.g., voxel-based morphometry) and functional neuroimaging (e.g., functional magnetic resonance imaging of the brain: fMRI) or electroencephalography (EEG) findings have been conducted, shedding light on the relationships between typical cognitive performance and personality on the one hand and brain structure and function on the other. These have explored, for example, the relationships between perceptual accuracy and the structure and function of key areas of the limbic system, such as the amygdala, using structural and functional neuroimaging (Asari et al., 2010a, 2010b). Other such studies have explored the relationship between the human movement response – related to cognitive sophistication, creativity and empathy – and mirroring activity in the brain, using EEG (Porcelli, Giromini, Parolin, Pineda, & Viglione, 2013).

In this special section, five articles representing current and international neuroscientific research both on and with the Rorschach are presented. The first two studies present further evidence of the numerous correlations which exist between performance on the Rorschach and performance on neurocognitive tests. In the first study, conducted in the United States, a number of variables of the RCS and R-PAS are shown to correlate with neurocognitive variables in children (Meyer, 2016). In the second study, conducted in Finland, the Coping Deficit Index (CDI) of the RCS is shown to correlate with a number of neurocognitive variables in two samples of subjects with severe psychiatric disorders and a sample © 2016 Hogrefe Publishing

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of healthy adults. In this same study, a correlation is found between two components of the CDI – human movement and the weighted sum of color responses (EA and WSumC) – and relative temporal grey matter volume of the brain (Ilonen, Salokangas, & Turku Study Group, 2016).

The third study, conducted in Japan, examines brain hemodynamics using fMRI when responding to chromatic versus achromatic cards of the Rorschach (Ishibashi et al., 2016). This study largely confirms the neuropsychological underpinnings of the Rorschach response process as previously described in the literature (Acklin & Wu-Holt, 1996).

The last two studies present new neuroscientific research designs which should allow researchers to investigate the neurological substrates of Rorschach performance while avoiding costly or methodologically problematic brain imaging techniques in the future. The first one, conducted in Italy, is a pilot study which looks at how neurological priming can be used to study the neurological correlates of the Rorschach (Giromini, Viglione, Brusadelli, Zennaro, Di Girolamo, & Porcelli, 2016). This study uses varying degrees of neurological priming of the Mirror Neuron System (MNS) to examine its impact on the production of responses of human movement (M). The second study, also conducted in Italy, presents a critical review of the Rorschach literature using fMRI and a new technique for examining the neurological correlates of personality functioning through the Rorschach using resting state fMRI (Cristofanelli, Pignolo, Ferro, Ando’, & Zennaro, 2016).

Given the Rorschach’s impressive empirical research database in the field of both personality assessment and neuropsychological assessment, it can now be considered a useful tool for both personality assessment and neuropsychological assessment. Awareness of the neurological and neurocognitive correlates of Rorschach variables enables psychologists working in personality assessment to better integrate this knowledge into their assessment practice, thus broadening their understanding of a wide range of psychological phenomena and behavior.

It can also be of great use to neuropsychologists interested in conducting more comprehensive forms of neuropsychological assessment; that is, neuropsychological assessment that includes not only measures of maximal cognitive performance and self-report, but also evidence-based measures of typical cognitive performance and personality functioning.

References Acklin, M. W., & Wu-Holt, P. (1996). Contributions of cognitive science to the Rorschach technique: Cognitive and neuropsychological correlates of the response process. Journal of Personality Assessment, 67(1), 169–178.

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Asari, T., Konishi, S., Jimura, K., Chikazoe, J., Nakamura, N., & Miyashita, Y. (2010a).

Amygdalar enlargement associated with unique perception. Cortex: A Journal Devoted to the Study of the Nervous System and Behavior, 46(1), 94–99.

Asari, T., Konishi, S., Jimura, K., Chikazoe, J., Nakamura, N., & Miyashita, Y. (2010b).

Amygdalar modulation of frontotemporal connectivity during the inkblot test. Psychiatry Research: Neuroimaging, 182(2), 103–110.

Caputo, J. S. (1999, July). The Rorschach as a neuropsychological instrument: Historical precedents and future use. Paper presented at the XVI International Congress of Rorschach and Projective Methods, Amsterdam, The Netherlands.

Chaudhury, S., John, T. R., Bhatoe, H. S., & Rohatgi, S. (1999). Evaluation of Piotrowski’s organic signs of head injury. Journal of Projective Psychology and Mental Health, 6(1), 53–57.

Cotugno, A. J. (1995). Personality attributes of attention deficit hyperactivity disorder (ADHD) using the Rorschach Inkblot Test. Journal of Clinical Psychology, 51(4), 554–562.

Cristofanelli, S., Pignolo, C., Ferro, L., Ando’, A., & Zennaro, A. (2016). Rorschach nomological network and resting-state large scale brain networks: Introducing a new research design. Rorschachiana, 37(1), 74–92.

Cronbach, L. J. (1990). Essentials of psychological testing. New York, NY: Harper and Row. Exner, J. E. (2003). The Rorschach: A Comprehensive System (4th ed.). New York, NY: Wiley.

Exner, J. E., Colligan, S. C., Boll, T. J., Stischer, B., & Hillman, L. (1996). Rorschach findings concerning closed head injury patients. Assessment, 3(3), 317–326.

Giromini, L., Viglione, D. J., Brusadelli, E., Zennaro, A., Di Girolamo, M., & Porcelli, P. (2016).

The effects of neurological priming on the Rorschach: A pilot experiment on the human movement response. Rorschachiana, 37(1), 58–73.

Holaday, M., Moak, J., & Shipley, M. A. (2001). Rorschach protocols from children and adolescents with Asperger’s disorder. Journal of Personality Assessment, 76(3), 482–495.

Ilonen, T., Hakola, P., Vanhanen, M., & Tiihonen, J. (2012). Rorschach assessment of personality functioning in patients with polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy. Acta Neuropsychiatrica, 24(4), 236–244.

Ilonen, T., & Salokangas, R. K. R., Turku Study Group (2016). The Rorschach Coping Deficit Index as an indicator of neurocognitive dysfunction. Rorschachiana, 37(1), 28–40.

Ishibashi, M., Uchiumi, C., Jung, M., Aizawa, N., Makita, K., & Nakamura, Y. (2016).

Differences in brain hemodynamics in response to achromatic and chromatic cards of the Rorschach: A fMRI study. Rorschachiana, 37(1), 41–57.

Mattlar, C.-E., Knuts, L.-R., & Alanen, E. (1986). The Piotrowski sign system: Its association with age and intelligence and the structure of the Piotrowski signs. British Journal of Projective Psychology and Personality Study, 31(1), 3–15.

Meyer, G. J. (2016). Neuropsychological factors and Rorschach performance in children.

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Meyer, G. J., Viglione, D. J., Mihura, J. L., Erard, R. E., & Erdberg, P. (2011). Rorschach Performance Assessment System: Administration Coding, Interpretation, and Technical Manual. Toledo, OH: Rorschach Performance Assessment System.

Muzio, E. (2004). Le Rorschach Système Intégré en neuropsychologie: Articulation du cognitif et de l’affectif [The Rorschach Comprehensive System in neuropsychology: Integrating cognition and affect]. Psychologie Française, 49(1), 33–49.

Muzio, E., Andronikof, A., David, J.-P., & Di Menza, C. (2001). L’intérêt du test du Rorschach (Système Intégré) dans l’évaluation psychométrique en gériatrie: Exemple de la démence de type Alzheimer [The use of the Rorschach test (Comprehensive System) in

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psychometric assessment in geriatrics: Example of dementia of the Alzheimer type]. La Revue de Gériatire, 26(2), 121–130.

Muzio, E., & Luperto, L. (1999). Démence et fonctionnement de la personnalité à travers le Rorschach chez un groupe de femmes âgées hospitalisées [Dementia and personality functioning through the Rorschach in a group of hospitalized elderly women]. European Review of Applied Psychology / Revue Européenne de Psychologie Appliquée, 49(3), 227–236.

Perry, W., Potterat, E., Auslander, L., Kaplan, E., & Jeste, D. (1996). A neuropsychological approach to the Rorschach in patients with dementia of the Alzheimer type. Assessment, 3(3), 351–363.

Piotrowski, Z. (1936). On the Rorschach method and its application in organic disturbances of the central nervous system. Rorschach Research Exchange, 1, 23–39.

Porcelli, P., Giromini, L., Parolin, L., Pineda, J. A., & Viglione, D. J. (2013). Mirroring activity in the brain and movement determinant in the Rorschach test. Journal of Personality Assessment, 95(5), 444–456.

Rorschach, H. (1921/1976). Psychodiagnostic (5ème éd.) [Psychodiagnostic (5th ed.)]. Paris, France: Presses Universitaires de France.

Sinacori, D. R. (2000). Depression in a brain injured sample: An investigation of indicators on the Rorschach and MMPI-2. Dissertation Abstracts International, 60(8-B), 4251.

Teglasi, H., Nebbergall, A. J., & Newman, D. (2012). Construct validity and case validity in assessment. Psychological Assessment, 24(2), 464–475.

Zillmer, E. A., & Perry, W. (1996). Cognitive-neuropsychological abilities and related psychological disturbance: A factor model of neuropsychological, Rorschach, and MMPI indices. Assessment, 3(3), 209–224.

Emiliano Muzio Eteläinen Hesperiankatu 12 B 35 00100 Helsinki Finland Tel. +358 456717283 E-mail emiliano@muzio.net

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Original Article Special Issue: Neuroscience and the Rorschach

Neuropsychological Factors and Rorschach Performance in Children Gregory J. Meyer University of Toledo, OH, USA Abstract: This study uses an archival data set to correlate Rorschach scores with measures of cognitive functioning in youth, and extends the literature in three ways. First, although Wechsler-based scales of intellectual ability are criteria in the primary sample, correlates with specialized measures of neuropsychological functioning are provided in smaller subsamples, with a focus on tests of perceptual accuracy and perceptual synthesis. Second, absolute levels of cognitive ability are examined, rather than age-adjusted scores, in order to match with the non-age adjusted Rorschach scores. Third, the results expand the relevant research literature on Comprehensive System scores and provide novel data for scores in the Rorschach Performance Assessment System. Findings showed an expected pattern of correlations for Rorschach scores of organizational activity, synthesized responses, perceptual accuracy, conceptual complexity, and complex perceptual representations. The Rorschach scores most correlated with neuropsychological perceptual synthesis skills were those related to perceptual accuracy and those requiring complex perceptual representations, although Rorschach scores tended to be more strongly associated with verbal abilities than with perceptual organizational skills. These data provide further evidence for the validity of selected Rorschach scores and contribute to an understanding of the cognitive characteristics linked to various types of Rorschach responses.

Keywords: Rorschach, neuropsychology, Wechsler, intelligence, children

This article describes the association between a number of Rorschach scores and performance on tests of cognitive ability. There has been a long tradition of exploring the relationship between Rorschach scores and measures of intellectual ability, cognitive functioning, and psychological development (e.g., Acklin & Fechner-Bates, 1989; Allison & Blatt, 1964; Brooks, 1979; Charek, Meyer, & Mihura, 2015; Gallucci, 1989; Goldfried, Stricker, & Weiner, 1971; Greenberg & Cardwell, 1978; Gross, Newton, & Brooks, 1990; Ilonen et al., 2000; Marsden, 1970; Meyer, Erdberg, & Shaffer, 2007; Meyer, Giromini, Viglione, Reese, & Mihura, 2015; Mihura, Meyer, Dumitrascu, & Bombel, 2013; O’Neill, O’Neill, & Quinlan, 1976; Ridley, 1987; Ridley & Bayton, 1983; Smith, Bistis, Zahka, & Blais, 2007; Stanfill, Viglione, & Resende, 2013; Wagner, Young, & Wagner, 1992; Wenar & Curtis, 1991; Wood, Krishnamurthy, & Archer, 2003; Zillmer & Perry, 1996). Although results are not uniform, these studies generally have been consistent in demonstrating that measures of psychological sophistication, including general intelligence and youth © 2016 Hogrefe Publishing

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age, are positively associated with Rorschach scores indicative of cognitive synthesis, conventionality of perception, articulation of the determinants of one’s perceptions, and embellishing perceptions with activity, particularly human activity (see Mihura et al., 2013, and Stanfill et al., 2013, for reviews). Some studies have demonstrated that the synthesized Whole response (W-Sy) is the variable that is most strongly correlated with measures of intellectual ability or cognitive resources (e.g., Acklin & Fechner-Bates; Allison & Blatt; Charek et al., 2015).

This study builds on the existing research by using an archival database to examine the extent to which selected Rorschach variables are correlated with measures of cognitive ability. It adds to the existing literature in three ways. First, in addition to providing associations with intelligence measures, Rorschach scores are correlated with other standardized neuropsychological measures of cognitive and perceptual functioning. Specifically, correlates are examined with the Benton Judgment of Line Orientation Test (JLO; Benton, Varney, & Hamsher, 1978), the Developmental Test of Visual-Motor Integration (VMI; Beery & Buktenica, 1982), the Bender Visual Motor Gestalt Test (Bender, 1938; Hutt, 1985), and the ReyOsterrieth Complex Figure (ROCF; Strauss, Sherman, & Spreen, 2006). These are perceptual motor tests that, in the order listed, require increasing levels of perceptual organization and synthesis for successful completion of the task. Although considered less central, this study also provides correlates with the Trail Making Test (Reitan & Wolfson, 1985), which requires visual-spatial scanning and visual processing, particularly for Trails A. A second contribution from this study is to explore how absolute levels of cognitive ability in youth correspond to Rorschach performance. The hypothesis is that with children and adolescents it is the attainment of specific levels of cognitive abilities that will be more strongly associated with Rorschach performance than indices of relative standing among same-age peers, as is found with deviation-based IQ scores. Rorschach variables are reported as raw score measures of one’s absolute level of performance and they are not age-adjusted; as such they should have stronger associations with neuropsychological test raw scores that measure absolute levels of cognitive ability. It appears that only one previous Rorschach study examined the correlates of this kind of “mental age” for cognitive functioning rather than deviation-based IQ scores. O’Neill et al. (1976) found that mental age was more strongly associated than chronological age with complexity of representations, synthetic integration, and perceptual accuracy. Studying children provides an ideal opportunity to explore differences between deviationbased intellectual abilities (i.e., IQ) and absolute levels of ability. Children have rapidly changing cognitive abilities, yet the same tasks, such as the Wechsler Intelligence Scale for Children-Revised (WISC-R; Wechsler, 1981), can be administered to them across a wide age range.

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The third contribution from this study comes from its use of a relatively large sample of clinically referred children who were originally assessed using the Comprehensive System (CS; Exner, 1993) and an array of other neurocognitive measures. The scores selected for analysis include CS variables and scores found in the Rorschach Performance Assessment System (R-PAS; Meyer, Viglione, Mihura, Erard, & Erdberg, 2011) that can be derived from them. This study thus adds to the small existing literature on the correlates of CS scores with cognitive ability in children and adolescents (Brooks, 1979; Gallucci, 1989; Smith et al., 2007; Wood et al., 2003), and provides some initial data on selected R-PAS variables.

Brooks (1979) used the WISC-R to assess 88 outpatient children aged 6 to 17 years who were referred for behavioral or learning problems. With IQ classified in six bands, she observed largely nonsignificant mean differences across a set of CS scores that included number of responses (R), frequency of organizational effort (Zf), use of the whole inkblot (W), use of common detail locations (D), proportion of percepts with ordinary form quality (CS X+%, R-PAS FQo%), percepts with human activity or movement (M), whole or partial human representations (H+Hd), proportion of animal content (A%), proportion of responses to the last three chromatic cards (CS Afr, R-PAS 8910%), and the sum of human movement and the weighted use of color (CS EA, R-PAS MC). In a smaller subgroup, the number of responses where more than one type of determinant was coded (Blend) also did not differ by IQ. The only significant differences found were for the sum of animal movement and inanimate movement (FM+m) and the sum of shading and achromatic color determinants (YTVC’), such that both variables increased with increasing IQ. Gallucci (1989) contrasted 41 gifted children aged 11 or 12 years who were enrolled in a summer program for children with IQ scores above 135 to a control group of 27 children aged 11 or 12 years drawn from local schools with average IQ scores. Unlike Brooks, he found the high IQ children had higher scores on R, Zf, and M. Gallucci did not study W, D, H+Hd, A%, Afr or 8910%, EA or MC, Blend, FM+m, or YTVC’. However, he did examine vague synthetic responses (CS DQv/+, R-PAS Sy Vg) and the difference between expected and observed organizational activity (Zd), finding both scores to be higher in the high IQ group. Gallucci anticipated these gifted children would be more creative and have more “nonentrenched” thinking and perception. As such, he anticipated that they would have higher scores on indices of distorted perception (CS X-%, R-PAS FQ-%), lower scores on conventional perceptions (X+% or FQo%) and the most popular percepts (Popular), and higher scores on indices of illogical concepts or implausible relationships, as reflected in an elevated weighted sum of six cognitive codes (CS WSum6, R-PAS WSumCog). Gallucci found support for each of these © 2016 Hogrefe Publishing

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suppositions, though only four of the six individual cognitive codes were significantly different across groups.

Wood et al. (2003) examined 117 adolescents aged 13 to 18 years who were referred for clinical assessment in an inpatient or outpatient setting. They were examined with Wechsler IQ measures that included the WISC-R, its third edition (the WISC-III), or the Wechsler Adult Intelligence Scale-Revised (WAIS-R). They examined many of the same variables as Brooks (1979) and Gallucci (1989), finding that IQ was positively associated with DQ+ or Sy, Zf, M, and Blend%, as well as the sum of all human content (SumH), and inversely correlated with the proportion of responses determined only by a form determinant (F%). Like Brooks, Wood et al. did not find W or R to be associated with IQ. Wood et al. also found that perceptual accuracy variables were related to IQ, though in the direction opposite of Gallucci, such that X+% was positively correlated with IQ and X-% negatively correlated with IQ. The latter is more consistent with the non-CS literature, suggesting that Gallucci’s sample may be atypical in the direction of its effect sizes for these variables. Using a slightly smaller subset of participants, Wood et al. also examined Verbal IQ (n = 99) and Performance IQ (n = 98). In general, the determinant-based and cognitive synthesis scores were somewhat more highly correlated with VIQ than PIQ, though coefficients were about equal in size for the perceptual accuracy variables.

Smith et al. (2007) used a sample of 27 children and adolescents aged 6 to 18 years to examine associations between 14 CS scores and performance on the ROCF after controlling for general IQ and age (for four scores). For the ROCF, the authors examined accuracy on direct copy, accuracy on delayed recall 30 minutes later, and an organizational score based on the completeness of five primary elements in the figure. They found no variables were correlated with delayed recall accuracy. However, direct copy accuracy was positively correlated with D and unusual detail (Dd) location use, non-synthetic ordinary developmental quality (DQo), and the proportion of nondistorted responses to the common location areas (WDA%). Direct copy accuracy also was negatively correlated with Zd, DQv/+, X-% or FQ-%, and the Perceptual Thinking Index (PTI). Organizational quality was only predicted by the number of responses incorporating the background white space on the inkblot cards (CS S, R-PAS AnyS). This study is somewhat challenging to interpret, given that IQ was partialed out of the ROCF variance.

The relevant literature using CS scores in relation to cognitive ability measures is thus contradictory and incomplete, such that additional data could inform understanding of the association between cognitive ability and Rorschach responding. The Rorschach variables selected for this study included both CS and R-PAS scores related to organizational activity, synthesized responses, perceptual accuracy, conceptual complexity, and complex perceptual representations.

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Before considering the data, however, it is worthwhile to differentiate cognitive ability measures from Rorschach responding. All of these measures rely on examiner-coded behaviors that are exhibited while performing a task; that is, they are all performance tasks. However, performance tasks of intelligence, academic achievement, and neuropsychological processing are designed as maximal performance measures of cognitive ability (or impairment). Maximal performance measures provide test-takers with clear guidelines about what is considered “good performance,” explicit instructions for how to achieve good or accurate performance, and quiet, nondistracting testing conditions that foster maximal performance output. In contrast, the Rorschach is a task of typical performance.

Typical performance measures evaluate what a person most often does when left to his or her own devices across situations. They do not have clear guidelines with respect to what qualifies as “good performance,” they permit a wide range of allowable responses, and they impose minimal demands on the respondent to perform in a particular way. Cronbach first coined these terms to describe types of assessment measures, and he noted that maximal performance measures assess what a person “can do,” while typical performance measures assess was a person “will do” (e.g., Cronbach, 1990). Thus, even though responses to the Rorschach task can be evaluated for their degree of cognitive sophistication, synthetic operations, and general complexity, these indicators are obtained from behaviors that are spontaneously offered under conditions in which task demands are minimal.

And making activities or tasks complicated when they need not be is not necessarily adaptive or sophisticated. Thus, markers of complexity on the Rorschach may be influenced by or even driven by factors other than cognitive capacity, including emotional dysregulation on the high end or affectively defensive simplification on the low end (Meyer, 1997b).

Methods Participants Participants were selected from an archival database of children referred to the Pediatric Neuropsychology Laboratory at the University of Chicago Hospitals during the years 1987 to 1992 to rule out the possibility of neurological contributions to behavior, learning, or emotional difficulties. The sample was obtained by reviewing the archival files of approximately 600 children seen by this service over that five year period. Initially, 143 cases were selected that were in the age range from 6 to 16 years, had WISC-R scores available, and had a scorable Rorschach protocol. As described in the Procedures below, for a presentation © 2016 Hogrefe Publishing

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given in 1993 (Meyer et al., 1993) this initial sample was reduced to 70 protocols that had a valid administration of the Rorschach. However, the sample was then augmented by 30 additional protocols over the following year, resulting in a final sample of 100 children and adolescents. Their mean age was 11.52 (SD = 2.50) and 60% were female. Average Full Scale IQ was 93.66 with a SD = 18.52 and a range from 48 to 141.

Not all participants had data on all of the criterion variables: 98 had summary values for raw IQ scores, 81 had VMI raw scores, 67 had Trails scores, 28 had JLO and ROCF scores, and 25 had Bender scores. For comparing raw scores to standard scores, 77 had WISC-R deviation IQ scores and 60 had VMI standard scores. Most of the children were assessed with three (n = 32) or four (n = 38) of these measures, though a number had five (n = 17) or all six (n = 5) tests. However, a small proportion were assessed with just two of the criterion measures (n = 8).

The largest proportion of children were assessed with the WISC-R, VMI, and Trails.

Measures For ease of presentation, the R-PAS name for a variable will be used if it differs from the CS name. The variables examined consisted of R, W, W%, Zf, Zd, Synthesis (Sy; which combines DQ+ and DQv/+ from the CS), W with Sy (W-Sy), F% (as a psychometrically superior alternative to the traditional CS Lambda score; see Meyer, Viglione, & Exner, 2001), Blend, instances when one side of the inkblot is described as a symmetrical reflection of the other (r), instances when the form is articulated as contributing to a dimensional perspective (FD), instances when the shading features are articulated as contributing to a dimensional perspective (V), the sum of all dimensional perspectives (VFD), the sum of human movement and the weighted sum of color (MC; equivalent to EA in the CS), FQ-% (equivalent to X-% in the CS), distorted perceptions to the commonly used locations (WD-%; nearly the inverse of XA% in the CS), FQo% (equivalent to X+% in the CS), Popular, two of the Rorschach’s primary factors (Meyer, 1992), and the Complexity composite score (Meyer et al., 2011) along with its component scores: Location, Space and Object Quality Complexity (LSO); Content Complexity (Cont); and Determinant Complexity (Det). The fourth component of Complexity is R, which was included already.

FD, V, and r responses were examined because a child must have relatively sophisticated visual-spatial operations in order to perceive these kinds of response components, as well as advanced verbal-expressive abilities in order to articulate these kinds of perceptions to the examiner. The two Rorschach factors examined are complexity markers referred to as Factor 1 and Factor 2a in Meyer (1992).

Factor 1 was initially termed “R and Determinant Articulation,” though Rorschachiana (2016), 37(1), 7–27

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subsequently it was referred to as the Response Engagement dimension (Meyer, 1997b; Meyer, Riethmiller, Brooks, Benoit, & Handler, 2000). It is derived by the following equation applied to the z scores for each variable listed: .3(R) + .4(FY) + .3(FC’) + .3(m) + .3(S) + .3(FC) + .25(FM) + .2(FV) – .25(Lambda). Factor 2a was termed “Cognitive-Emotional Engagement Unaffected by R,” and it is derived by the following equation using z scores: .35(Color-Shading-Blend) + .3(W) + .25(Zd) + .25(CF+C) + .25(FC’) – .6(Lambda) – .2(D). It was anticipated that Factor 1 would be correlated with verbal abilities, given the varied determinants that are included on this factor, and that Factor 2a would be significantly correlated with measures of both verbal and perceptual skills.

Participants were assessed with the WISC-R, typically using all 12 of its subtests, though Mazes was used less frequently than the other subtests in this dataset.

Summary scores on the raw score metric were obtained by converting each subtest to z scores and then computing the average z score. Although z scores are measures of relative standing, in these analyses they are computed independent of age and they provide a mechanism for computing a summary score across subtests that differ notably in their raw score distributions. The summary scores based on these raw score measures included Verbal Comprehension (VC; mean of Information, Similarities, Vocabulary, and Comprehension), Perceptual Organization (PO; mean of Picture Completion, Picture Arrangement, Block Design, and Object Assembly), Freedom from Distractibility (FFD; mean of Arithmetic, Digit Span, and Coding), and Full Scale IQ (FSIQ; mean of all subtests). Not all participants had age-based standard scores for these composites, so the sample size was reduced when examining the differential size of validity coefficients for raw score composites versus age-based IQ standard scores.

The JLO (Benton et al., 1978) is a motor-free test of visual-spatial perception that requires the judgment of the angular relationships between lines. It was scored by counting the total number of correct responses, where both stimulus lines are identified correctly (30 possible points), and by counting “near misses,” which are instances when one or both stimulus lines are erroneously identified as being in their immediately adjacent position (for example, a line in the #8 position is indicated as falling in the #7 or #9 position).

The VMI (Beery & Buktenica, 1982) provides a series of images for copying that progress from a simple line to more complex geometric shapes. The summary scores included the raw count of the number correct, as well as age-based standard scores. The Bender (Bender, 1938; Hutt, 1985) consists of nine figures shown on individual cards that must be copied onto a single piece of blank paper. The summary score indicated the number of errors made.

The Rey-Osterrieth Complex Figure is a design reproduction task that was scored according to a modification of the Kirk and Kelly (1986) scoring system. © 2016 Hogrefe Publishing

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Utilizing this system, two aspects of the direct copy drawings with the stimulus visible were coded: (1) the number of stimulus lines present (maximum = 71) and (2) the accuracy of the drawing as judged by the proper alignment of elements within the drawing (maximum = 52). Three raters (Frank Zelko, Sharon Murphy, and Deanne Orput) coded 33 ROCF protocols with excellent reliability; correlations between the scores of Zelko and either Murphy or Orput were .96 and .98 for lines present and accuracy, respectively.

The Trail Making Test (Reitan & Wolfson, 1985) includes two components, both of which require an individual to draw lines sequentially connecting 25 circles. On Trails A, the circles contain numbers that must be connected in order as quickly as possible. Trails B is similar except the participant has to repeatedly alternate between a number and a letter in sequence, going from 1 to A, A to 2, 2 to B, B to 3, and so on. The score for each component is the time required to completion.

Procedures Rorschach coding was conducted by six investigators (Gregory Meyer, Sharon Murphy, Theresa [Kiolbasa] Campbell, Mary Daly, Deanne Orput, and Jan Remer-Osborn). These investigators, all of whom had received training with the Comprehensive System (Exner, 1986, 1991), began with a series of trial protocols.

Each coder first practiced blind coding with a series of protocols that had also been coded by Rorschach Workshops. Coding discrepancies were discussed and resolved as a group until a satisfactory level of reliability was obtained to begin coding the research protocols. Subsequently, each of the initial 143 protocols was blindly and independently coded by two of the authors. All coding differences were then resolved by one of two final arbitrators (Meyer or Campbell). Subsequently, two of the coders (Meyer and Campbell) independently evaluated the quality of the administration and clarification for each Rorschach protocol. Even though all protocols could be scored, if both judges believed that an administration was conducted poorly (e.g., minimal inquiry, clearly not verbatim record, missing location sheet, and insufficient notation on the written record for clear identification of location) the protocol was excluded from further analysis. This resulted in 33 protocols being dropped from the study. Next, the recommendation of Exner (1988) to exclude all protocols with fewer than 14 responses was followed, which resulted in the elimination of 40 additional protocols. The sample at this point consisted of 70 participants (Meyer et al., 1993). Subsequently, 30 additional protocols were added that had at least 14 responses and met criteria for administration quality.

Prior to data analysis, distributions for all variables were examined to screen for potential manual data entry errors and to identify potentially problematic skew, Rorschachiana (2016), 37(1), 7–27

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defined as values greater than |2.0|, which is indicative of a moderate departure from normality (Curran, West, & Finch, 1996). Among the criterion variables, Trails B was positively skewed (2.44) and Trails A nearly so (1.79), so both were square root transformed, which brought skew below 1.20. The number of lines present on the ROCF was initially strongly negatively skewed (–2.75) and it was transformed by raising it to the third power (Behrens, 1997), which helped but did not fully eliminate the skew –2.28). Among Rorschach variables, skew was elevated in R (2.01), r (3.23), and V (2.65), so square root transformations were applied. Doing so fixed the problem with R (1.59) and V (1.70), but the distribution for r (2.08) was too limited to be fully corrected.

Two types of reliability data were available for this dataset. Electronic records were available that contained the original coding for 67 of the protocols. The scores from these protocols were compared to the final scores after the protocols had been independently recoded by two of the researchers and had all disagreements resolved. These coefficients are genuine field reliability coefficients (Meyer, 1997a; McGrath et al., 2005), attesting to the reliability of an instrument as it is used in clinical practice. In addition, electronic records were available for some of the independent recoding that had been undertaken for this study. There were a total of 32 protocols with at least one recoded record present and 28 of these protocols had coding available from both of the independent recoders. The scores from the 28 protocols recoded twice were compared to each other. For both sets of analyses, protocol level scores were compared using intraclass correlations following a two-way random effects model assessing absolute agreement for a single rater (McGraw & Wong, 1996).

Results and Discussion Interrater reliability was evaluated using interpretive guidelines recommended by Cicchetti (1994). According to these guidelines, Table 1 shows that protocol level reliability was “good” (.60 to .74) to “excellent” (≥ .75) in both sets of analyses for all variables, except for FD which had a coefficient of .59 in the field reliability dataset, placing it at the upper end of the “fair” range (.40 to .59). These results are consistent with other findings in the literature showing good to excellent reliability for most variables (Meyer et al., 2002; Viglione, Blume-Marcovici, Miller, Giromini, & Meyer, 2012).

Table 2 provides the correlations between both sets of variables, with Rorschach scores in the rows and cognitive criterion measures in the columns. The columns are ordered by sample size, as indicated in the third row, with the largest and most © 2016 Hogrefe Publishing

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Table 1. Protocol level interrater reliability for Rorschach scores comparing both the original coding for clinical purposes to the final resolved coding for research (n = 67) and the coding of two independent coders for research (n = 28) using a two-way random effects model intraclass correlation coefficient for the absolute agreement of a single rater [ICC(A,1)] ICC(A,1) Original vs. Final

Research: 1 vs. 2

n=

67

28

Ra

.99

.99

W

.97

.96

W%

.96

.92

Zf

.98

.97

Zd

.84

.81

Sy

.69

.84

W-Sy

.68

.78

F%

.92

.87

Blend

.94

.85

ra

.96

.94

FD

.59

.60

Va

.84

.79

VFD

.62

.68

MC

.93

.87

FQ-%

.79

.66

WD-%

.76

.70

FQo%

.79

.64

Popular

.77

.81

Factor 1

.83

.94

Factor 2a

.94

.92

Complexity

.96

.97

LSO

.89

.93

Cont

.90

.96

Det

.97

.92

a

Note. Variable was transformed to reduce skew.

trustworthy results on the left followed by increasingly smaller, underpowered, and less precise findings to the right. Most of the criterion variables are scored in a direction such that better skills and performance are indicated by higher scores; however, the opposite is the case for Trails A and B, JLO Near Misses, and Bender Gestalt Errors.

In a general sense these tables demonstrate that many Rorschach variables are strongly correlated with one’s level of cognitive development or sophistication in Rorschachiana (2016), 37(1), 7–27

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Table 2. Correlations of selected Rorschach scores with raw score measures of intelligence and neuropsychological functioning WISC-R

Beery VMI

Trails Aa

VC

PO

FFD

FSIQ

N=

98

98

98

98

81

67

Ra

.08

.15

.00

.09

–.04

–.01

Ba

JLO

ROCF LPa

Acc

BG

#Cor

Near

Err

67

28

28

28

28

25

–.07

–.24

.13

–.16

–.04

–.32

W

.30

.25

.20

.28

.27

–.45

–.20

.27

–.47

.46

.20

–.35

W%

.19

.12

.15

.17

.25

–.31

–.07

.37

–.49

.33

.11

–.16

Zf

.36

.37

.25

.37

.32

–.49

–.28

.21

–.42

.51

.40

–.31

Zd

.10

–.06

–.04

.00

–.09

.15

.17

.07

–.13

–.25

–.38

–.09

Sy

.37

.32

.21

.34

.11

–.29

–.10

.05

–.27

.25

.11

–.21

W-Sy

.36

.23

.16

.29

.10

–.21

.01

.22

–.41

.01

–.24

–.22

–.24

–.07

–.10

–.15

.02

.04

–.16

–.25

.42

–.37

–.08

.28

.32

.18

.17

.25

.00

–.17

–.03

–.02

–.20

.28

.05

–.22

F% Blend ra

.25

.26

.22

.27

.37

–.19

–.08

.15

–.10

.13

.04

–.20

FD

.39

.35

.30

.39

.22

–.36

–.20

.03

–.10

.38

.26

–.35

Va

.30

.17

.25

.26

.17

–.11

–.05

.21

–.27

.30

.25

–.28

VFD

.44

.34

.36

.42

.25

–.34

–.20

.16

–.24

.42

.31

–.41

MC

.26

.13

.09

.18

–.09

–.12

–.03

.00

–.24

.29

–.06

–.19

FQ-%

–.29

–.29

–.29

–.31

–.24

.27

.33

–.02

–.05

–.39

–.39

.25

WD-%

–.20

–.22

–.21

–.22

–.21

.22

.27

.13

–.24

–.39

–.45

.10

FQo%

.19

.28

.23

.26

.31

–.18

–.18

.00

.13

.19

.23

–.14

Popular

.07

.23

.11

.16

.11

–.13

–.17

.00

.05

.38

.54

–.17

Factor 1

.27

.20

.11

.22

.01

–.17

–.03

.01

–.23

.15

.06

–.46

Factor 2a

.36

.13

.15

.24

.06

–.17

.04

.26

–.50

.38

–.01

–.41

Complexity

.28

.24

.10

.24

–.01

–.16

–.03

–.16

–.10

.16

.04

–.28 –.27

LSO

.25

.29

.10

.25

.06

–.14

–.07

–.13

–.08

–.05

–.01

Cont

.19

.16

.02

.15

–.08

–.14

.00

–.34

.07

.24

.07

–.13

Det

.32

.19

.15

.25

–.03

–.15

–.02

.08

–.33

.25

.05

–.39

Note. Bolded coefficients are statistically significant at p < .05. JLO = Judgment of Line Orientation, ROCF = Rey-Osterrieth Complex Figure, BG = Bender Gestalt, VC = Verbal Comprehension, PO = Perceptual Organization, FFD = Freedom from Distractibility, FSIQ = Full Scale IQ, VMI = Visual Motor Integration, #Cor = Number Correct, Near = Near Miss, LP = Lines Present, Acc = Accuracy, Err = Errors, LSO = Location-Space-Object Quality Complexity, Cont = Content Complexity, Det = Determinant Complexity. a Variable was transformed to reduce skew.

verbal and perceptual abilities. Specifically, although R in this sample is not associated with raw cognitive ability, organized perceptions (W, W%, Zf) or perceptions requiring synthetic operations and the meaningful integration of inkblot components (Sy, W-Sy) clearly are. There is strong convergent validity for these © 2016 Hogrefe Publishing

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Rorschach measures across the range of verbal and perceptual criterion measures.

A notable exception to this pattern occurs with Zd. Theoretically, Zd should be positively correlated with measures of visual-perceptual information processing or attentiveness to visual details. However, Zd is unrelated to any cognitive skills assessed by the WISC-R, VMI, Trails, JLO, or Bender and it is inversely related to accuracy on the ROCF. The latter suggests that attentiveness to visual detail and the accurate integration of component elements of a visual field, as is found with ROCF accuracy, are associated with an under-incorporative style on Zd rather than with an over-incorporative style. This is contrary to expectation. However, it is consistent with the general negative findings for Zd in the research literature (Mihura et al., 2013). The ROCF correlations rely on a small n, but the data do not support the use of the Zd score and suggest that the efficacy of the weights and expected values that are used to compute final scores on this variable should be recomputed and validated before this variable is used in practice.

The Rorschach scores that are most associated with and possibly dependent on neuropsychological perceptual synthesis skills are those related to perceptual accuracy (FQ-%, WD-%, FQo%, and Popular) and two of the three codes that require communication about sophisticated perception or perceptual-integration (i.e., reflections and dimensionality). That Rorschach perceptual accuracy scores are associated with developed visual-spatial skills is not surprising. However, it appears that production of both the most conventional and the most distorted Rorschach perceptions is dependent on the kinds of sophisticated perceptual synthesis skills that are assessed by the ROCF and to a lesser extent by PO on the WISC-R. It is interesting that dimensional responses (FD and VFD) are so highly correlated with verbal and perceptual abilities. This suggests that the production of a dimensional response depends not only on certain cognitive capacities, but perhaps also upon a process of developmental maturation, which is reflected in higher raw scores on the criterion measures, that allows for perspective taking.

F% (inversely), Blend, the two factors, and Complexity and its components are generally correlated with raw verbal intelligence scores and somewhat inconsistently with raw scores on the JLO, ROCF, and Bender. The correlations with verbal intelligence are generally in the range of |.25| to |.30|, indicating there is still a substantial degree of independence between these types of measures. This relative independence would be consistent with the view that the Rorschach variables are also sensitive to emotionally driven complexity, which can be a taxing burden at times, as opposed to simply unencumbered cognitive complexity. However, the data also indicate that complex, sensitive awareness to subtle aspects of the environment, as embodied in these Rorschach markers of complexity, is dependent on intellectual capacities, and the relative absence of this Rorschach based Rorschachiana (2016), 37(1), 7â&#x20AC;&#x201C;27

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complexity leaves children prone to the forms of visual neglect found with the JLO and Bender.

Overall, Table 2 demonstrates that the Rorschach scores considered here are associated somewhat more strongly and consistently with verbal abilities than they are with perceptual organizational abilities. Thus, the verbal mediation of responses, the articulation of the determinants of one’s perceptions, and the description of meaningfully related components within the inkblots are all elements of the Rorschach process that are clearly dependent on the development of skills in verbal articulation and verbal concept formation. These verbal skills obviously interact with nonverbal skills, and there are few of these Rorschach scores that are associated with verbal abilities but not perceptual abilities.

Nonetheless, when considering the correlates of the most basic test of visual perception – the Judgment of Line Orientation – the data suggest that overall accuracy on this measure is not significantly correlated with any of the Rorschach variables examined here. Instead, it is the subtly wrong, nearly correct responses on this task that are associated with a number of the Rorschach variables. This suggests that the Rorschach variables considered here are less tied to skills in simple or basic visual perception and more related to complex skills in visual perception and synthesis as found on the VMI, ROCF, Bender, and JLO near misses.

Table 3 provides data comparing criterion variables consisting of raw scores of cognitive ability versus age-adjusted standard scores of cognitive ability for a subset of the Rorschach variables examined in Table 2. These analyses use just the subset of cases that had both raw scores and age-based standard scores computed.

For the WISC-R, 77 of the 98 initial cases had standard score data for VC, PO, and FSIQ. However, only 64 cases had standard score data for FFD, so it was omitted from the analyses. For the VMI, 60 of the original 81 cases had age-based standard scores calculated. The Rorschach variables included in Table 3 were those showing stronger associations with these cognitive criterion measures in Table 2.

Bolded coefficients in Table 3, like in Table 2, indicate statistically significant associations. Underlined pairs of coefficients on a row within the test-based columns indicate instances when the raw score coefficient was significantly different than the standard score coefficient, using procedures for comparing overlapping correlated correlations (Meng, Rosenthal, & Rubin, 1992). One thing to note from Table 3 is that the validity coefficients for raw scores are uniformly higher than those in Table 2. It is not clear what accounts for this, though the cases that are in Table 2 and not in Table 3 were primarily the 30 cases added last to the database.

With respect to the comparison between raw scores and age-adjusted standard scores, although the differences often are not dramatic, there are six instances © 2016 Hogrefe Publishing

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Table 3. Comparing the association of selected Rorschach scores with raw scores versus ageadjusted standard scores of cognitive ability WISC-R VC

PO

FSIQ

VMI

Raw

SS

Raw

SS

Raw

SS

Raw

SS

n=

77

77

77

77

77

77

60

60

W

.36

.34

.28

.28

.33

.34

.29

.28

W%

.23

.24

.12

.13

.19

.20

.24

.20

Zf

.44

.32

.45

.39

.47

.39

.41

.29

Sy

.42

.39

.35

.31

.38

.40

.18

.12

W-Sy

.42

.42

.26

.22

.33

.38

.14

.15

–.34

–.30

–.16

–.14

–.24

–.23

–.06

.08

Blend

.38

.36

.25

.21

.32

.34

.08

.02

ra

.29

.12

.34

.27

.34

.18

.45

.30

FD

.50

.34

.45

.35

.50

.40

.35

.17

Va

.36

.23

.18

.11

.31

.21

.18

.10

F%

VFD

.56

.37

.43

.32

.54

.41

.34

.17

MC

.33

.36

.18

.20

.24

.31

–.05

–.06 –.22

FQ-%

–.27

–.25

–.26

–.26

–.28

–.28

–.21

FQo%

.17

.10

.26

.21

.23

.15

.30

.28

Popular

.04

–.04

.23

.16

.14

.05

.10

.05

Factor 1

.34

.31

.30

.27

.32

.32

.06

–.02

Factor 2a

.46

.46

.21

.19

.33

.35

.12

.00

Complexity

.34

.34

.31

.31

.31

.37

.05

.01

LSO

.27

.24

.32

.30

.29

.31

.09

.06

Cont

.27

.32

.25

.29

.23

.34

.00

.00

Det

.42

.40

.28

.26

.35

.37

.05

–.03

|Mean|

.34

.29

.28

.25

.32

.30

.17

.11

Note. Bolded coefficients are statistically significant at p < .05; pairs of coefficients that are underlined are significantly different from each other at p < .05. VC = Verbal Comprehension, PO = Perceptual Organization, FSIQ = Full Scale IQ, VMI = Visual Motor Integration, Raw = raw scores, SS = Standard Scores, LSO = Location-Space-Object Quality Complexity, Cont = Content Complexity, Det = Determinant Complexity. a Variable was transformed to reduce skew.

when the raw scores were more highly correlated with Rorschach data than the standard scores. There were no instances when the standard scores were more highly correlated with Rorschach variables than the raw scores. There were also eight instances when the raw score criterion variable produced a statistically significant correlation but the standard score did not; there were no instances of the Rorschachiana (2016), 37(1), 7–27

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reverse. Thus, absolute levels of cognitive maturation and sophistication are more strongly associated with Rorschach variables than age-adjusted standard scores indicative of a child’s abilities relative to peers of the same age.

Although these findings are informative, this study is limited by several factors.

First, it makes use of archival data that were collected and scored about 25 years ago. Second, the primary criterion measure, the WISC-R, has been revised three times since then, although versions of the same subtests remain in the later iterations. Third, sample sizes were particularly small for the JLO, ROCF, and Bender (ns from 25 to 28). Fourth, although we used R-PAS scores that were included in the CS or that could be generated from CS data, the protocols were not collected or coded using R-PAS guidelines.

Conclusion Overall, despite the limitations just noted, these data provide further evidence for the validity of the Rorschach and contribute to an understanding of the cognitive characteristics that are associated with or even required for the production of various types of Rorschach responses. Although the Rorschach clearly is a task that invites complex perceptual abilities, it is also a task that requires the verbal mediation and translation of perceptual impressions. In particular, the articulation of the various shading, coloring, and movement features in a perception, as well as the description of meaningfully related components within the inkblots, are tied to strong verbal and conceptual skills. Examiners in applied settings should thus anticipate that individuals with limited cognitive resources will tend to have less complex Rorschach protocols, while individuals presenting with neuropsychological impairments, such as verbal or nonverbal learning disabilities, will likely show manifestations of these cognitive impairments in the organization, richness, and accuracy of their Rorschach percepts.

Acknowledgments I am very grateful to Sharon G. Murphy, Theresa (Kiolbasa) Campbell, Mary Daly, Deanne Orput, Frank A. J. Zelko, Jan Remer-Osborn, and Neil Pliskin who collaborated with me to generate this data set. I am also thankful to Sadegh Nashat and Mónica Guinzbourg for their help with translation.

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Hutt, M. (1985). The Hutt adaptation of the Bender-Gestalt Test: Rapid screening and intensive diagnosis. New York, NY: Grune & Stratton.

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Meyer, G. J., Viglione, D. J., & Exner, J. E. Jr. (2001). Superiority of Form% over Lambda for research on the Rorschach Comprehensive System. Journal of Personality Assessment, 76, 68–75. doi: 10.1207/S15327752JPA7601_4 Meyer, G. J., Viglione, D. J., Mihura, J. L., Erard, R. E., & Erdberg, P. (2011). Rorschach Performance Assessment System: Administration, coding, interpretation, and technical manual. Toledo, OH: Rorschach Performance Assessment System.

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Journal of Personality Assessment, 94, 607–612. doi: 10.1080/00223891.2012.684118 Wagner, E. E., Young, G. R., & Wagner, C. F. (1992). Rorschach blends, IQ, and the effect of R. Journal of Personality Assessment, 59, 185–188. doi: 10.1207/s15327752jpa5901_15 Wechsler, D. (1981). Manual for the Wechsler Adult Intelligence Scale-Revised. New York, NY: Psychological Corporation.

Wenar, C., & Curtis, K. M. (1991). The validity of the Rorschach for assessing cognitive and affective changes. Journal of Personality Assessment, 57, 291–308. doi: 10.1207/ s15327752jpa5702_8 Wood, J. M., Krishnamurthy, R., & Archer, R. P. (2003). Three factors of the Comprehensive System for the Rorschach and their relationship to Wechsler IQ scores in an adolescent sample. Assessment, 10, 259–265. doi: 10.1177/1073191103255493 Zillmer, E. A., & Perry, W. (1996). Cognitive-neuropsychological abilities and related psychological disturbance: A factor model of neuropsychological, Rorschach, and MMPI indices. Assessment, 3, 209–224. doi: 10.1177/1073191196003003003 Received December 15, 2015 Revision received February 4, 2016 Accepted February 10, 2016 Published online June 10, 2016

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Gregory J. Meyer Department of Psychology UH 1065 Mail Stop 948 University of Toledo 2925 W. Bancroft Street Toledo, OH 43606 USA Tel. +1 419-530-4312 Fax +1 419-530-8479 E-mail Gregory.Meyer@UToledo.edu

Summary This study uses an archival data set to correlate Rorschach scores with measures of cognitive functioning in youth (age M = 11.52, SD = 2.50; 60% female), extending the literature in three ways.

First, although Wechsler-based scales of intellectual ability are criteria in the primary sample (n = 98), correlates with specialized measures of neuropsychological functioning are provided in smaller subsamples, with a focus on tests of perceptual accuracy and perceptual synthesis. These measures include the Judgment of Line Orientation Test (n = 28), Developmental Test of VisualMotor Integration (n = 81), Bender Visual Motor Gestalt Test (n = 25), Rey-Osterrieth Complex Figure (n = 28), and Trail Making Test (n = 67). Second, absolute levels of cognitive ability are examined, rather than age-adjusted scores, in order to match with the non-age adjusted Rorschach scores. Third, the results expand the relevant research literature on Comprehensive System (CS; Exner, 2003) scores and provide novel data for scores in the Rorschach Performance Assessment System (R-PAS; Meyer, Viglione, Mihura, Erard, & Erdberg, 2011). The Rorschach variables examined consisted of the number of responses (R) whole locations (W), W%, organizational frequency and efficiency (Zf, Zd), Synthesis (Sy), W with Sy (W-Sy), pure Form (F%), Blend, Reflections (r), Form Dimension (FD), Shading Dimension or Vista (V), all dimensional perspectives (V+FD), Human Movement and Weighted Sum of Color (MC), Form Quality Minus (FQ-%), distorted perceptions to the commonly used locations (WD-%), Form Quality Ordinary (FQo%), Popular, two of the Rorschach’s primary factors (Meyer, 1992), and the Complexity composite score (Meyer et al., 2011) along with its component scores: Location, Space and Object Quality Complexity (LSO); Content Complexity (Cont); and Determinant Complexity (Det). Findings generally showed an expected pattern of correlations for Rorschach scores of organizational activity, synthesized responses, perceptual accuracy, conceptual complexity, and complex perceptual representations.

However, the Zd variable showed no evidence of validity. The Rorschach scores most correlated with neuropsychological perceptual synthesis skills were those related to perceptual accuracy and those requiring complex perceptual representations, although Rorschach scores tended to be more strongly associated with verbal abilities than with perceptual organizational skills. These data provide further evidence for the validity of selected Rorschach scores and contribute to an understanding of the cognitive characteristics linked to various types of Rorschach responses.

Résumé Cette étude utilise des données d’archive pour corréler les scores obtenus au test du Rorschach à des mesures de tests du fonctionnement cognitif chez des adolescents (moyenne âge=11.52 ; Et : 2.50 ; 60% filles), afin d’enrichir la littérature de trois façons. Tout d’abord, bien que les échelles © 2016 Hogrefe Publishing

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du Wechsler d’évaluation de l’intelligence ont été considérées dans un premier échantillon (n=98), des corrélations avec des mesures neuropsychologiques plus spécifiques ont été calculées sur des sous-échantillons, en focalisant notamment sur des tests de précision perceptuelle et la capacité à synthétiser. Ces mesures ont été obtenues aux tests de Judgment of Line Orientation (m=28), Developmental Test of Visual-Motor Integration (n=81), Bender Visual Motor Gestalt Test (n=25), Rey-Osterrieth Complex Figure (n=28), et Trail Making (n=67).

Deuxièmement, des niveaux absolus des aptitudes cognitives ont été examinés et non des scores ajustés par rapport à l’âge, afin d’harmoniser avec les scores du Rorschach qui ne sont pas spécifiques à l’âge.

Troisièmement, les résultats s’ajoutent aux données existantes dans la littérature sur le Système Intégré (CS ; Exner, 2003) et fournissent de nouvelles données pour le Rorschach Performance Assessment System (R-PAS ; Meyer, Viglione, Mihura, Erard, & Erdberg, 2011).

Les variables du Rorschach suivant ont été examinées : nombre de réponses (R), réponses globales (W, W%), la fréquence et l’efficience organisationnelle (Zf, Zd), la capacité à synthétiser (Sy), forme pure (F%), mélanges (Blends), réflexions (r), forme dimension (FD), estompages ou vista (V), toutes les perspectives dimensionnelles (FD+V), kinesthésies humaines et la somme pondérés des couleurs (MC), qualité formelle négative (FQ-%), déformations perceptuelles dans les localisations globales et grands détails (WD-%), bonne qualité formelle (FQo%), banalités (P), deux des facteurs primaires au Rorschach (Meyer, 1992), le score composite de complexité (Meyer et al., 2011) avec les scores qui le composent : localisation, blanc, complexité de la qualité de l’objet (LSO) : complexité du contenu (Cont) ; et enfin la complexité du déterminant (Det). Les résultats montrent un pattern attendu de corrélations pour les scores au Rorschach de l’activité organisationnelle, capacité à synthétiser, précision perceptuelle, complexité conceptuelle, et complexité des perceptions de représentation. Toutefois, aucune preuve de validité du Zd n’a été démontrée.

Les scores au Rorschach qui corrèlent le mieux avec des aptitudes de synthèse perceptuelle sont ceux de la précision perceptuelle et ceux qui requièrent une complexité perceptuelle des représentations, malgré le fait que les scores au Rorschach ont normalement tendance à plus corréler avec les aptitudes verbales que perceptuelles. Ces données fournissent des preuves de la validité de certains scores au Rorschach et contribuent à la compréhension des caractéristiques cognitives liées aux différentes réponses au test du Rorschach.

Resumen Este trabajo utiliza un conjunto de datos de archivo de casos para correlacionar puntuaciones Rorschach con medidas de funcionamiento cognitivo en jóvenes (edad M = 11,52, SD = 2,50; 60% mujeres) ampliando la literatura existente en el tema en tres direcciones. Primero, aunque las escalas de evaluación de habilidades cognitivas basadas sobre Wechsler son los criterios de la primera muestra (N = 90), correlaciona con medidas especializadas del funcionamiento neuropsicológico que son provistas por submuestras mas pequeñas centradas en tests de exactitud y síntesis perceptual. Estas medidas incluyen el juicio del Test de la Orientación Lineal (n = 28), del Test del Desarrollo de la Integración Viso - Motora (N = 81), del Test Gestáltico Viso – Motor de Bender (n = 25), la Figura Compleja de Rey - Osterrieth (n = 28), y el Test Trail Making (N = 67). Segundo, son examinados los niveles absolutos de capacidad cognitiva, más que por el ajuste de puntajes en función de la edad, a fin de que se correspondan con puntajes Rorschach no ajustados por la edad.

Tercero, los resultados amplían la relevante literatura de investigación existente sobre los puntajes del Sistema Comprehensivo (CS; Exner, 2003) y proveen información novedosa para los puntajes en el Rorschach Performance Assessment System (R-PAS; Meyer, Viglione, Mihura, Erard, & Erdberg, 2011). Las variables Rorschach examinadas consistieron en: el numero de respuestas

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(R), localizaciones globales (W), W%, frecuencia y eficacia organizacional (Zf, Zd), Síntesis (Sy), Globales con síntesis (W-Sy), Forma pura (F%), Complejas, Reflejos (r), Forma Dimensión (FD), Dimensión sombreada o Vista (V), todas las dimensiones de perspectiva (V+FD), Movimiento Humano y Suma Ponderada de Color (MC), Calidad Formal Menos (FQ-%), distorsiones perceptuales en las localizaciones habitualmente usadas (WD-%), Calidad Formal Ordinaria (FQo%), Populares, dos de los factores primarios del Rorschach (Meyer, 1992), y el puntaje compuesto de Complejidad (Meyer et al., 2011) junto con los puntajes que lo componen: Localización, Espacio y Complejidad de la calidad del Objeto (LSO), Complejidad de Contenido (Cont.), y Complejidad de Determinantes (Det). En general, los resultados mostraron un esperable patrón de correlaciones para los puntajes Rorschach de actividad organizativa, respuesta de síntesis, exactitud perceptual, complejidad conceptual y representaciones perceptuales complejas. Sin embargo, la variable Zd no mostró evidencia de validez. Los puntajes Rorschach que más correlacionaron con las tareas de síntesis neuropsicológica perceptual fueron aquellos relacionados con la exactitud perceptual y aquellos que requirieron representaciones perceptuales complejas, aunque los puntajes Rorschach tendieron a estar más fuertemente asociados con capacidades verbales más que con las habilidades de organización perceptual. Estos datos aportan evidencia para la validez de la selección de los puntajes Rorschach y contribuyen a una mejor comprensión de las características cognitivas vinculadas con varios tipos de respuestas Rorschach.

要約 本研究は保管されている一連のデータを用いてロールシャッハ諸変数と若者（平均年齢11.52歳、 SD=2.50、女性）の認知機能の測度との関連を検討したものであり、3つの方法で文献を検証してい る。最初に、ウェクスラーにもとづく知的能力の尺度が最初の標本（n=98）の基準とされたのである が、神経生理学的機能を特別に測定する尺度との関係性が、知覚的正確さや知覚的統合の検査に焦 点づけられて、より小さな下位標本に適用されている。これらの測度の中には、Judgment of Line Orientation Test(n=28)や、視覚運動統合の発達検査（n=81）、ベンダー視覚運動ゲシュタルトテスト （n=25）、Rey-Osterrieth Complex Figure（n=28）、Trail Making Test（n=67）が含まれてい る。次に、年齢で調整されたスコアではなく、認知的能力の絶対レベルが、年齢により調整されていな いロールシャッハのスコアと適合させるために施行された。第三に、この結果を関連する包括システム （CS：Exner,2003）のスコアについての研究文献に展開させ、Rorschach Performance Assessment System（R-PAS;Meyer,Viglione,Mihura,Erad,&Drdberg,2011）のスコアにも新しいデータを提供する。 検討されたロールシャッハのスコアは総反応数（R）、全体反応（W）、W%、組織化活動の頻度と効 率（Zf,Zd）、統合反応（Sy）、統合のあるW、純粋形態反応（F%）、ブレンド反応、反射反応 (r)、形態立体反応（FD）、立体あるいは拡散（V）、すべての立体反応（V+FD）、人間運動反 応と重みづけられた色彩反応（MC）、形態水準マイナス（FQ-%）、通常使よくわれる領域におけるゆ がんだ知覚（WD-%）、形態水準普通反応（FQo%）、平凡反応、ロールシャッハ一次要因 （Meyer,1992）の２つ、複雑性スコア（Meyerら,2011）の構成要素すべて：位置空白対象の複雑 性（LSO）：内容の複雑性（Cont）：決定因子の複雑性（Det）、である。本研究の結果は次第 に、組織化活動や統合反応、知覚の正確さ、概念的な複雑性、複雑な知覚表象のロールシャッハ反 応のパターンを示し、予測した。しかしながらZdは妥当な証拠を示さなかった。もっとも神経生理学的な知覚 統合技術と関連しているロールシャッハのスコアは知覚的正確さに関連しており、複雑な知覚表象を要求して いるものであった。しかしながら、ロールシャッハのスコアは知覚組織化の技量よりは言語能力とより強く関連 している傾向にあった。これらのデータは選択されたロールシャッハのスコアの妥当性を提供し、様々なタイプ のロールシャッハ反応と関連している認知的特性の理解に貢献する。

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Original Article Special Issue: Neuroscience and the Rorschach

The Rorschach Coping Deficit Index as an Indicator of Neurocognitive Dysfunction Tuula Ilonen, Raimo K. R. Salokangas, and Turku Study Group Department of Psychiatry, University of Turku, Finland Abstract: Despite a conceptual link between the Rorschach Coping Deficit Index (CDI) and a loss of cognitive and functional capacity, no published study has explored whether or how the CDI relates to these characteristics as measured by other neuropsychological test instruments. We examined the relationship between the CDI and neurocognitive abilities of language skills, perceptual organization, memory, and executive functioning separately in adolescent psychiatric inpatients (n = 267), as well as in adults with first episode schizophrenia or severe affective disorder (n = 117), and healthy adults (n = 94). We found a significant link between the CDI and limited cognitive capacity. Impaired comprehension predicted the elevated CDI in adolescents whereas perseveration tendency and impaired delayed memory in adult patients and impaired memory functions in healthy people predicted the elevated CDI. The CDI seems to include neurocognitive aspects, and may reflect persistent deterioration associated with neurocognitive dysfunction.

Keywords: cognitive function, comprehensive system, Coping Deficit Index, Rorschach

The Coping Deficit Index (CDI) is an empirically derived set of variables generated as a by-product of the Depression Index. An elevated CDI (CDI ≥ 4) indicates a persistent personality style causing difficulties in social adjustment and is associated with maladaptive development (Exner & Weiner, 1995). A significant relationship has been found between the CDI and criteria assessing interpersonal and/or emotional deficits (Mihura, Meyer, Dumitrascu, & Bombel, 2013).

One study investigating the relationship between the CDI and depression failed to demonstrate that withdrawal and social skills in children and adolescents had any significant relationship between the CDI and these symptoms and features, as assessed by parents or people who know the child or adolescent well (Stredny & Ball, 2005).

According to Exner’s original data, an elevated CDI was found in 6–24% of nonpatient children, 3–10% of nonpatient adults, 20–25% of schizophrenia patients, about 50% of personality disorder patients, and 74% of alcohol and drug abusers (Exner, 2003). An elevated CDI was found in 53–60% of neurological populations (Exner, Colligan, Boll, Stischer, & Hillman, 1996; Sinacori, 2000). Generally percentages were high in patients showing social ineptness and more coping Rorschachiana (2016), 37(1), 28–40 DOI: 10.1027/1192-5604/a000075

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limitations and deficiencies. Later research has shown an even higher proportion of elevated CDI in nonpatients. According to international reference data 36% of nonpatient adults had a CDI ≥ 4 (Meyer, Erdberg, & Shaffer, 2007). Up to 55% of nonpatient preadolescents and adolescents in Italy had a CDI ≥ 4 (Lis, Salcuni, & Parolin, 2007).

When we look more closely at the variables included in the CDI, they are interpreted as reflecting limited coping resources and poor control capacity (EA < 6 or AdjD < 0), difficulties in anticipating positive or more assertive forms of interactions among others (COP < 2 and AG < 2), limited capacity to process and comply with emotional experience (WSumC < 2.5 or Afr < .46), behaviorally nonindependent and passive interactions with others or disinterest in others (p > a + 1 or pure H < 2), and, finally, limited capacity to form close attachments to others, minimal social interaction, or unusual dependency orientation (T < 1 or Isolate / R > .24 or Fd > 0). The CDI has been linked to social competence because most of the variables seem to relate to interpersonal needs or deficits. People with a CDI ≥ 4 are described as being limited in coping abilities and being helpless when contending with the demands of daily living. They have difficulties maintaining satisfying social relationships because of their deficits in social skills.

In a clinical setting, many patients show an elevated CDI, indicating coping difficulties, but at the same time some limitations in basic cognitive capacity. Cognitive dysfunction is a well-established feature of schizophrenia, bipolar disorder, and psychotic depression (Bora, Yücel, & Pantelis, 2010). Cognitive deficits have been identified also in patients suffering from depression (Rock, Roiser, Riedel, & Blackwell, 2014). It is reasonable to suppose that coping adequately with ordinary aspects of daily life and social demands requires resources and cognitive capacity.

To date, there is limited data concerning the CDI and possible neurocognitive correlates. In fact, how the CDI relates to general measures of cognitive ability such as intelligence, memory, or executive function is unknown. In an attempt to fill this gap we investigated the relationship between the CDI and neurocognitive abilities of language skills, perceptual organization, memory, and executive functioning separately in three cross-sectional samples including adolescent inpatients, adult inpatients, and adult healthy people.

Method Subjects This paper comprises three different cross-sectional samples from Turku study projects. Descriptive characteristics of the three samples are presented in Table 1. © 2016 Hogrefe Publishing

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Table 1. Descriptive characteristics for age, education, and essential test variables

Age Education IQ

Adolescent inpatients N = 276

Adult inpatients N = 117

Healthy people N = 94

Mean (SD)

Mean (SD)

Mean (SD)

15.6 (1.6)

34.4 (11.4)

28.7 (8.5)

9.5 (1.5)

12.4 (2.6)

13.8 (2.1)

100.7 (12.4)

100.0 (15.3)

117.6 (8.4)

Number of Rorschach responses, R

21.7 (7.4)

20.6 (9.0)

24.4 (9.2)

Lambda

1.06 (1.1)

0.9 (1.4)

0.7 (0.6)

CDI

3.0 (1.2)

2.9 (1.3)

2.3 (1.3)

CDI ≥ 4

40.2%

35.0%

15.9%

Intake data and methods have been reported in detail previously (Ilonen et al., 1999; Ilonen, Heinimaa, Korkeila, Svirskis, & Salokangas, 2010). The first sample consists of 276 (99 male and 177 female) adolescent psychiatric inpatients with a variety of psychiatric diagnoses from schizophrenia spectrum disorders to adjustment disorders, with 24% being diagnosed as psychotic. The second sample consists of 117 (56 male and 61 female) inpatients with first-episode schizophrenia spectrum disorder (n = 27) and severe affective disorder (n = 90), with 58% being diagnosed as psychotic. In addition, 58 patients from the second sample (27 male and 31 female) participated in a magnetic resonance imaging (MRI) study. Their average age was 35.8 years (SD = 12.1), and their average full-scale IQ was 101.59 (SD = 14.0). All patients who were included were diagnosed with the DSM-IV (American Psychiatric Association, 1994), and a final diagnosis was formulated as a consensus best-estimate diagnosis by experienced psychiatrists.

The third sample comprised a control group of 94 (70 male and 24 female) healthy voluntary persons. Controls were excluded if they showed any evidence of psychiatric or neurological disease history, substance abuse, or were taking any concurrent medication. All participants gave written informed consent for the study.

Measures All participants were administered the Wechsler Intelligence Scale for Children (WISC-III; Wechsler, 1999) or, when aged over 16, the Wechsler Adult Intelligence Scale-Revised (WAIS-R; Wechsler, 1992) to obtain information on general intelligence and neuropsychological domains of language skills, perceptual Rorschachiana (2016), 37(1), 28–40

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organization, working memory, and psychomotor speed. The Wechsler Memory Scale-Revised (WMS-R) (Wechsler, 1987) was used to assess immediate and delayed memory and learning in adult samples. A total of 64 adolescents were administered immediate and delayed Logical Memory subscales. The Wisconsin Card Sorting Test (WCST; Heaton, Chelune, Talley, Kay, & Curtiss, 1993) was used to assess components of executive functioning in both adult samples. A total of 162 adolescents performed the test. The Rorschach was administered and scored according to the standard procedure of the Comprehensive System (Exner, 2001). All subjects produced 14 or more responses and, therefore, the protocols are considered to be of sufficient length to be regarded as interpretatively useful (Exner, 2003). In addition, both the number of Rorschach responses (R) and Lambda (L) were of an average range. Using the formulas of Meyer (1999), interrater reliability analyses were conducted for the total CDI score. The kappa coefficient obtained was 0.93, revealing excellent interrater reliability.

Structural data on the brain were acquired with a Magnetom 63SP 1.5 T scanner (Siemens, Erlangen, Germany) at Turku University Hospital. The conventional spin-echo sequence (TE 90 ms, TR 3120) was used and, on average, 25 slices with 5 mm slice thickness. We examined relative measures of grey matter, white matter, and cerebrospinal fluid volumes to control for variations in head size.

Statistical Analysis Statistical analyses were performed with SPSS 21 software. The CDI was normally distributed in all samples and therefore we used it as a continuous variable on which higher values are less preferable than lower ones. In the adolescent sample, all variables were normally distributed, except for perseverative responses and errors of the WCST, where the distributions were positively skewed. In the adult patient sample, all variables were normally distributed, except for verbal and visual learning and visual reproduction, where the distributions were negatively skewed, and errors, perseverative responses, and perseverative errors of the WCST, where the distributions were positively skewed. In the healthy adult sample all variables were normally distributed, except for delayed verbal learning, delayed visual reproduction, and percentage of conceptual level responses of the WCST, where the distributions were negatively skewed, while the distributions of errors, perseverative responses, and perseverative errors were positively skewed.

Thus, we applied parametric tests for normally distributed variables and nonparametric tests for variables with skewed distributions. Because correlations do not reveal the causality we calculated linear regression analyses using the selected cognitive variables as the independent measures and the CDI as a

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dependent measure. P values of less than 0.05 were interpreted as statistically significant.

Results Table 2 presents the correlations of the CDI with test scores of WISC/WAIS, WMS, and WCST. In adult samples significant correlations were found on all assessed domains with specific emphasis on verbal skills, verbal memory and learning, and executive function. The CDI was strongly negatively correlated with verbal intellectual ability and verbal memory, and positively correlated with impairment of executive function. In the adolescent sample significant correlations of the CDI were found with language skills and logical memory, but not with executive function.

To test the hypothesis of a conceptual link between the CDI and a loss of cognitive capacity, we then conducted a linear stepwise regression analysis using the CDI as a dependent variable and the scores of the WISC/WAIS, WMS, and WCST as independent variables. In the adolescent sample, comprehension accounted for 13% of the variance in the CDI (F = 9.13, p = .004, R2 = 0.13), which was the only statistically significant predictor (β = –.384, p = .004). In the adult inpatient sample, perseverative responses accounted for 10% of the variance in the CDI (F = 14.06, p < .001, R2 = 0.10, β = .330, p < .001). Delayed memory explained an additional 4% of the variance (F = 10.68, p < .001, R2 = 0.14, β = –.239, p = .01). In the healthy people sample verbal memory accounted for 13% of the variance in the CDI (F = 14.52, p < .001, R2 = .13, β = –.369, p < .001).

Delayed visual reproduction explained an additional 5% of the variance (F = 11.39, p < .001, R2 = 0.18, β = –.269, p < .01).

The most important single CDI variables that correlated positively (p < .05) with performance on neurocognitive measures were EA (= M + WSumC, a combined ideational/affective index of available resources), H (the perception of whole and realistic humans), active (a) and passive (p) movement responses, and COP (co-operative movement responses indicating positive interpersonal interactions).

AdjD (capacity for control and stress tolerance), AG (aggressive movement responses), T (a tactile impression), Afr (affective ratio), Isolation Index and Fd (food responses) did not have correlations with neurocognitive variables.

A subsample of the adult inpatients (n = 58) participated in the MRI study. CDI subvariables EA (rs = .30, p < .05) and WSumC (rs = .29, p < .05), as well as delayed verbal learning (rs = .29, p < .05), correlated with the relative temporal grey matter volume of the brain.

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Table 2. Correlations between CDI and cognitive variables in adolescent inpatients, adult inpatients, and healthy adult Adolescent inpatients (n = 276)

Adult inpatients (n = 117)

Healthy people (n = 94)

Language skills – Information

–.14*

–.30**

–.26*

– Vocabulary

–.21**

–.26**

–.31**

– Similarities

–.23**

–.29**

–.30**

– Comprehension

–.16**

–.19*

–.25*

–.03

–.19*

–.24*

–.30**

na

Attention and working memory – Digit Span – Visual Memory Span

na

Perceptual organization – Picture Completion

–.04

–.07

–.12

– Picture Arrangement

–.07

–.19*

–.21*

– Block Design

–.04

–.19*

–.19

– Object Assembly

–.05

–.26**

–.22*

Psychomotor speed – Digit Symbol

–.04

–.32**

–.13

Full-scale IQ (WISC-III / WAIS-R)

–.15*

–.30**

–.30**

Verbal IQ

–.18*

–.30**

–.36**

Performance IQ

–.07

–.19*

–.13

– Immediate Logical Memory

–.22

–.25**

–.36**

– Delayed Logical Memory

–.28*

–.24*

–.29**

– Immediate Verbal Learning

na

–.17

–.31**

– Delayed Verbal Learning

na

–.25**

–.17

– Immediate Visual Learning

na

–.21*

na

– Delayed Visual Learning

na

–.27**

na

– Immediate Visual Reproduction

na

–.21*

–.35**

– Delayed Visual Reproduction

na

–.20*

–.37**

Verbal Memory Quotient (WMS-R)

na

–.26**

–.37**

Visual Memory Quotient

na

–.19*

na

General Memory Quotient

na

–.32**

na

Attention/Concentration Quotient

na

–.26**

na

Delayed Memory Quotient

na

–.33**

na

Memory and learning

(Continued on next page)

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Table 2. (Continued) Adolescent inpatients (n = 276)

Adult inpatients (n = 117)

Healthy people (n = 94)

Executive function (WCST) – Percent errors

.01

.30**

.20*

– Percent perseverative responses

.06

.35**

.21*

– Percent perseverative errors – Percent Conceptual

.05

.35**

.21*

–.02

–.30**

–.24*

Note.*Correlation is significant at the 0.05 level (2 tailed); **Correlation is significant at the 0.01 level (2 tailed); na = no assessment.

Discussion In this study we focused on the CDI and neurocognitive tests. We studied the relationship between the CDI and neurocognitive abilities of language skills, perceptual organization, memory, and executive functioning separately in three crosssectional samples comprising adolescent inpatients, adult inpatients, and healthy adult. Although there seems to be a conceptual link between the CDI indicating coping abilities and general cognitive ability, to date, published research evidence is lacking. As expected, we found significant negative correlations between the CDI and mainly verbal intellectual ability and verbal memory in all samples. This means that the higher the CDI score, the lower the scores on tests measuring verbal intellectual ability and verbal memory, and conversely, the lower the CDI score, the better the performance on neurocognitive tests. In addition, an elevated CDI correlated with impaired executive function in both adult samples. Executive functions are defined as cognitive abilities necessary for complex goal-directed behavior and adaptation to a range of environmental changes and demands (Loring, 1999). It is well known that persons with disturbed brain function have high levels of perseveration on the WCST, indicating conceptual inflexibility.

These difficulties make it impossible for many such persons to solve problems, function socially, and maintain satisfactory interpersonal relationships.

An elevated CDI is thought to be related to developmental difficulties appearing early in childhood, but can disappear following a substantial period of development (Weiner, 2003). Forty percent of the adolescent inpatients and 35% of the adult inpatients achieved a CDI ≥ 4. An elevated CDI was also found in some healthy persons (16% having a CDI ≥ 4). This is more than the normative data of Exner (2003) shows, but less than the internationally based reference data (Meyer et al., 2007). Our findings are in line with the view that the CDI indicates persistent impairment in coping capacity that may result from developmental Rorschachiana (2016), 37(1), 28–40

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arrest or a loss of functional capacity (Weiner, 2003). An important finding was the link between coping difficulties as assessed by the CDI and poor verbal memory function, even in healthy persons. Impaired memory as a neuropsychological dysfunction has an important effect on a person’s adaptive capacities. There is reason to suppose that these healthy persons have already had markers of poor memory since childhood and, as a result, some deficits in coping capacities.

Poor comprehension accounted best for coping deficits in adolescent patients.

Comprehension needs common-sense judgment and practical reasoning and also reflects the person’s social knowledgeability and judgment (Lezak, 1995). Verbal reasoning and judgment are needed to handle complex real-life situations.

Furthermore, neurocognitive problems during childhood and adolescence are related to poorer social functioning in adulthood.

Perseverative responses accounted best for coping deficits in adult patients with first episode schizophrenia and severe affective disorders, signifying substantial limitations in cognitive flexibility and adaptive capacities. Perseveration is a recognized sign of disturbed brain function. Thus, our finding may reflect a possible organic dysfunction in some patients hindering the normal achievement of coping skills. Delayed memory contributed a little bit to the total amount of variance. It is a consistent finding confirming the view of possible organic dysfunction in persons with a CDI ≥ 4. Although the CDI did not significantly correlate with MRI volumes, two of its subvariables, EA (an index of resources available for planning and implementing deliberate strategies of coping with problem solving situations) and WSumC (the capacity to use affect in problem solving), as well as delayed verbal memory, correlated positively with relative temporal grey matter volume. The grey matter serves to process information in the brain, and various learning and memory problems have been associated with decreased grey matter volume.

Impairment of memory and learning is thought to reflect temporal hippocampal pathology (Lezak, 1995).

The CDI includes eleven variables that are arranged according to a combination of different values on five empirically based criteria. The first four seem to contain variables such as EA, COP, WSumC, and H, which were related to neurocognitive capacity. Therefore, sufficient resources for solving problematic situations in daily living and an ability to perceive whole and realistic humans in positive interpersonal interactions are based on basic neurocognitive capacity. The fifth criterion contains variables indicating interpersonal needs or deficits. They did not correlate with neurocognitive variables.

The strength of this study is seen in the three relatively large samples of both adolescent and adult inpatients and healthy adult nonpatients. A high Lambda, suggesting a constricted approach to the test, may address the question of coping resources, but in our study Lambda was found to be in the average range. When © 2016 Hogrefe Publishing

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Lambda and/or education were used as covariates, the results did not transform.

One limitation may be that only a part of the adolescents underwent memory and executive function testing.

We provide empirical support for the interpretation and utilization of the CDI in clinical practice. The CDI as a general measure of capacities for coping with the demands of daily living includes an important neurocognitive aspect. An elevated CDI may contain variables that are related to cognitive difficulties indicating chronic impairment in coping capacity. Persons with impairments in the neurocognitive key domains, such as memory and/or executive function underlying maladaptive development and coping difficulties as assessed by the CDI, often have problems formulating plans to deal with future events and solving even practical problems associated with life in the community. The notion of targeting treatment to social skills training has been thought to improve deficits in coping capacity. We have to ask, however, whether this is enough. Cognitive impairment could interfere with the ability to benefit from interventions based on learning, such as social skills training. Of course persons with an elevated CDI based on variables which do not relate to basic cognitive capacity are likely to benefit from treatment focused on social skills training. Further research is needed to examine in more detail the validity of the CDI as a measure of neuropsychological dysfunction.

References American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (DSM-IV). Washington, DC: APA. Bora, E., Yücel, M., & Pantelis, C. (2010). Cognitive impairment in schizophrenia and affective psychoses: Implications for DSM-V criteria and beyond. Schizophrenia Bulletin, 36, 36–42.

Exner, J. E. (2001). A Rorschach workbook for the comprehensive system (5th ed.). Asheville, NC: Rorschach Workshops.

Exner, J. E. (2003). The Rorschach: A comprehensive system (4th ed.). New York, NY: Wiley.

Exner, J. E., Colligan, S. C., Boll, T. J, Stischer, B., & Hillman, L. (1996). Rorschach findings concerning closed head injury patients. Assessment, 3(3), 317–326.

Exner, J. E., & Weiner, I. B. (1995). The Rorschach: A comprehensive system: Vol. 3.

Assessment of children and adolescents (2nd ed.). New York, NY: Wiley.

Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtiss, G. (1993). Wisconsin Card Sorting Manual: Revised and expanded. Odessa, FL: Psychological Assessment Resources.

Ilonen, T., Taiminen, T., Karlsson, H., Lauerma, H., Leinonen, K-M., Wallenius, E., Tuimala, P., & Salokangas, R. K. R. (1999). Diagnostic efficiency of the Rorschach schizophrenia and depression indices in identifying first-episode schizophrenia and severe depression. Psychiatry Research, 87, 183–192.

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Ilonen, T., Heinimaa, M., Korkeila, J., Svirskis, T., & Salokangas, R. K. R. (2010). Differentiating adolescents at clinical high risk for psychosis from psychotic and non-psychotic patients with the Rorschach. Psychiatry Research, 179(2), 151–156.

Lezak, M. D. (1995). Neuropsychological assessment (3rd ed.). Oxford, UK: Oxford University Press.

Lis, A., Salcuni, S., & Parolin, L. (2007). Rorschach comprehensive system data for a sample of 116 preadolescent and 117 adolescent nonpatients from Italy. Journal of the Personality Assessment, 89(S1), 91–96.

Loring D. W. (Ed.). (1999). INS Dictionary of Neuropsychology. New York, NY: Oxford University Press.

Meyer, G. J. (1999). Simple procedures to estimate chance agreement and kappa for interrater reliability of response segments using the Rorschach Comprehensive System.

Journal of Personality Assessment, 72, 230–255.

Meyer, G. J., Erdberg, P., & Shaffer, T. W. (2007). Toward international normative reference data for the comprehensive system. Journal of the Personality Assessment, 89(S1), 201–216.

Mihura, J. L., Meyer, G. J., Dumitrascu, N., & Bombel, G. (2013). The validity of individual Rorschach variables: Systematic reviews and meta-analyses of the comprehensive system. Psychological Bulletin, 139(3), 548–605.

Rock, P. L., Roiser, J. P., Riedel, W. J., & Blackwell, A. D. (2014). Cognitive impairment in depression: A systematic review and meta-analysis. Psychological Medicine, 44, 2029–2040.

Sinacori, D. R. (2000). Depression in a brain injured sample: An investigation of indicators on the Rorschach and MMPI-2. Dissertation Abstracts International, 60(8B), 4251.

Stredny, R. V., & Ball, J. D. (2005). The utility of the Rorschach Coping Deficit Index as a measure of depression and social skills deficits in children and adolescents. Assessment, 12(3), 295–302.

Wechsler, D. (1992). Wechsler Adult Intelligence Scale – Revised Manual [Finnish translation. Psykologien Kustannus Oy, Helsinki]. Cleveland, OH: The Psychological Corporation.

Wechsler, D. (1999). Wechsler Intelligence Scale for Children (WISC-III) [Finnish translation.

Psykologien Kustannus Oy, Helsinki]. Sidcup, UK: The Psychological Corporation.

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Received February 10, 2015 Revision received December 1, 2015 Accepted January 12, 2016 Published online June 10, 2016 Tuula Ilonen Department of Psychiatry University of Turku Kunnallissairaalantie 20, rak.9 20700 Turku Finland Tel. +358 2 266 2526 E-mail tuuilo@utu.fi © 2016 Hogrefe Publishing

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Summary The Rorschach Coping Deficit Index (CDI) has been linked to social competence. Most of the variables included in this index seem to relate to interpersonal needs or deficits. In clinical practice we have found that many patients with a CDI ≥ 4 also perform poorly in certain neurocognitive domains. One gap in the clinical validity literature is that it is unknown how the performance on the CDI relates to measures of cognitive ability. In this study, we investigated the relationship between the CDI and neurocognitive abilities of language skills, perceptual organization, memory, and executive functioning separately in three cross-sectional samples comprising adolescent inpatients (n = 267), adult inpatients (n = 117), and healthy adults (n = 94). We found a significant relationship between coping deficits as assessed by the CDI and poor performance on neurocognitive tests.

Poor comprehension accounted best for coping deficits in adolescent patients. Perseverative responses and delayed memory accounted best for coping deficits in adult patients, signifying substantial limitations in cognitive flexibility and adaptive capacities. In healthy persons, impaired verbal memory predicted coping deficits. In conclusion, the CDI as a general measure of capacities for coping with the demands of daily life includes an important neurocognitive aspect. When we examined the single variables included in the CDI, we found that four of the five criteria consist of variables such as EA, COP, WSumC, active and passive movement responses and H, which were significantly related to cognitive performance. The CDI may easily increase with variables that are related to cognitive functions. The notion of targeting treatment to social skills training has been thought to improve deficits in coping capacity. Cognitive impairment could, however, interfere with the ability to benefit from interventions based on learning, such as social skills training. Further research is needed to examine in more detail the validity of the CDI as a measure of neuropsychological dysfunction.

Yhteenveto Rorschachiin sisältyvä Coping Deficit Index (CDI) on yhdistetty sosiaaliseen kyvykkyyteen, sillä useimmat indeksiin sisällytetyt muuttujat näyttävät liittyvän vuorovaikutuksellisiin tarpeisiin tai häiriöihin. Kliinisessä työssä olemme havainneet korkean CDI arvon (CDI ≥ 4) omaavien potilaiden suoriutuvan heikosti monilla neurokognitiivisilla alueilla. Koska kirjallisuus on tältä osin puutteellinen, halusimme tutkia, onko CDI yhteydessä peruskognitiivisiin toimintoihin, kuten kielellisiin kykyihin, havainnon organisaatioon, muistiin ja toiminnan ohjaukseen. Poikkileikkaustutkimus koski kolmea erillistä otosta: nuorisopsykiatriset potilaat (n = 267), aikuispsykiatriset potilaat (n = 117) ja aikuiset terveet henkilöt (n = 94). Havaitsimme CDI:llä arvioitujen hallintakeinojen häiriöiden olevan merkittävässä yhteydessä heikkoon suoriutumiseen neurokognitiivisissa testeissä. Nuorisopsykiatrisilla potilailla kielellisen käsityskyvyn puutteet selittivät parhaiten hallintakeinojen häiriöitä. Aikuispsykiatrisilla potilailla perseveraatio ja viivästetyn muistin vaikeudet selittivät hallintakeinojen häiriöitä heijastellen merkittäviä kognitiivisen joustavuuden puutteita ja sopeutumisvaikeuksia näillä potilailla. Aikuisilla terveillä henkilöillä häiriöt kuulonvaraisen muistin alueella selittivät hallintakeinojen häiriöitä. Näin CDI sisältää myös merkittävän neurokognitiivisen puolen. Yksittäisistä CDI:iin sisällytetyistä muuttujista EA, COP, WSumC, aktiiviset ja passiiviset liikevastaukset ja H olivat yhteydessä kognitiiviseen suoriutumiseen. CDI nousee helposti kognitioon liittyvien muuttujien seurauksena. Hoidon kohdistaminen sosiaalisten kykyjen harjoittamiseen on ajateltu kohentavan hallintakeinoja. Kognitiivinen häiriö saattaa kuitenkin vaikeuttaa hyötymistä oppimiseen pohjaavista interventioista. Jatkossa tarvitaan vielä yksityiskohtaisempaa tutkimusta CDI:n validiteetista neuropsykologisen häiriön mittarina.

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Résumé L’indice d’incompétence sociale (CDI = Coping Deficit Index) du Rorschach a été mis en relation avec les compétences sociales. La plupart des variables inclues dans cet indice semblent liées aux besoins ou déficits interpersonnels. En pratique clinique, nous avons constaté que de nombreux patients ayant un CDI ≥ 4 sont peu performants dans certains domaines neurocognitifs. Une des lacunes dans la littérature clinique pertinente est que la manière dont les performances en rapport avec le CDI sont en relation avec des mesures d’aptitudes cognitives reste inconnue. Dans cette étude, nous avons examiné le lien entre le CDI et les capacités neurocognitives languagières, d’organisation perceptuelle, de mémoire et de fonctionnement exécutif séparément dans des échantillons transversaux comprenant des patients adolescents (n = 267), des patients adultes (117) et des personnes adultes en bonne santé (94). Nous avons constaté une relation significative entre l’incompétence sociale évaluée par le CDI et une faible performance aux tests neurocognitifs. Les déficits de compréhension ont le mieux rendu compte de cette relation parmi les patients adolescents. Les réponses persévératives et les déficits de mémoire différée ont le mieux rendu compte de cette relation parmi les patients adultes, suggérant des déficits importants dans les domaines de flexibilité cognitive et des capacités d’adaptation. Parmi les personnes en bonne santé, les déficits de mémoire verbale ont le mieux rendu compte de cette relation. En conclusion, le CDI, en tant que mesure générale des capacités de répondre aux exigences de la vie quotidienne, comprend un aspect neurocognitif important. Lorsque nous avons examiné les variables individuelles comprises dans le CDI, nous avons constaté que quatre critères sur cinq, à savoir des variables comme EA, COP, WSumC, les réponses de mouvement actif ou passif et H, étaient en relation étroite avec les performances cognitives. Le CDI peut facilement s’ élever en rapport avec des variables liées aux fonctions cognitives. La notion d’un traitement centré sur l’apprentissage d’aptitudes sociales a été proposée pour remédier à l’incompétence sociale représentée par le CDI. Dans certains cas, les déficits cognitifs pourraient toutefois faire obstacle à la capacité du sujet à bénéficier d’interventions reposant sur l’apprentissage, telles que l’apprentissage d’aptitudes sociales. Des études plus approfondies sont nécessaires pour mettre en évidence de manière plus détaillée la validité du CDI en tant que mesure de dysfonctionnement neuropsychologique.

Resumen El Índice de Inhabilidad Social de Rorschach (CDI, por su sigla en inglés) se ha relacionado con la competencia social. La mayor parte de las variables que se incluyen en el índice parecen relacionarse con las necesidades o déficits interpersonales. En la práctica clínica hemos observado que muchos pacientes con un CDI ≥ 4 también tienen un desempeño pobre en algunos dominios neurocognitivos. Un hecho que supone una laguna en la literatura sobre validez clínica es que no se sabe cómo se relaciona el desempeño en el CDI con los indicadores de la capacidad cognitiva básica. En el presente estudio, hemos investigado la relación que existe entre el CDI y las capacidades neurocognitivas de la habilidad para el lenguaje, la organización perceptual, la memoria y el funcionamiento ejecutivo, por separado en tres muestras transversales que constan de pacientes hospitalizados adolescentes (n = 267), pacientes hospitalizados adultos (117) y personas adultas sanas (94). Hallamos una relación significativa entre la inhabilidad social según la evalúa el CDI y un desempeño pobre en las pruebas neurocognitivas. En pacientes adolescentes, la falta de capacidad de afrontamiento o inhabilidad social se vio expresada en la mala comprensión. En pacientes adultos, las respuestas perseverantes y la memoria retardada encontraron justificación en la inhabilidad social, lo cual implica importantes limitaciones en la flexibilidad cognitiva y las capacidades de adaptación. En personas sanas, los problemas en la memoria verbal anticiparon la inhabilidad

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social. En conclusión, el CDI como una medición general de las habilidades para afrontar las exigencias de la vida diaria incluye un aspecto neurocognitivo importante. Al analizar la variables del CDI individualmente, hallamos que cuatro de los cinco criterios estaban compuestos de variables que se encontraban altamente relacionadas con el desempeño cognitivo, como EA, COP, WSumC, respuestas de movimiento activas y pasivas, y H. El CDI podría aumentar fácilmente con variables relacionadas con la cognición. Se ha creído que apuntar el tratamiento a las habilidades sociales mejora el déficit en la capacidad de afrontamiento. Sin embargo, la disfunción cognitiva podría interferir con la capacidad para beneficiarse de las intervenciones basadas en el aprendizaje, como el entrenamiento de las habilidades sociales. Es necesario continuar investigando para poder examinar con más detalle la validez del CDI como un indicador de disfunción neuropsicológica.

要約 ロールシャッハ法の対処不全指標（CDI）は社会的な能力と結び付けられてきた。この指標に含まれる 変数の多くは、対人関係上の要求あるいは欠乏に関係しているようである。臨床実践においてわれわれは CDIが4より大きい多くの患者が、ある認知神経科学的な領域において貧しい成果を示すことを見出してき た。臨床的な妥当性の文献における一つの隔たりは、CDIにおける出来ばえがどのように認知能力と関連 しているかについて知られていないことである。本研究では、我々はCDIと、言語能力や知覚統合、記 憶、実行機能といった認知神経科学的な能力との関連性を、青年期の入院患者（n=267）、大人の 入院患者（n=117）、健康な大人（n=94）からなる横断的なデータにおいて研究している。われわれは CDIによって査定される対処不全と認知神経科学的な検査における低い成績の間の有意な関連性を見出 している。青年期の入院患者の対処不全を貧しい理解力がよく説明していた。固執反応と抑圧は大人の患 者の対処不全をよく説明しており、認知の柔軟性や適応能力の実質的な限界を表していた。健常者で は、障害を受けた言語的記憶は対処不全を予想する。結論として、CDIは日常生活の要求に対する対 処能力を全般的に測るものとしてある重要な認知神経科学的な側面を含んでいる。われわれがCDIに含 まれている一つの変数について吟味した時、5つの基準のうちの4つがEA、COP、WSumC、積極的‐消 極的運動反応、Hで構成されていることに気がつくであろう。そしてこれらは、認知的能力に有意に関 連しているものである。CDIは容易に認知機能に関連する変数を追加することができるであろう。社会技 能訓練を対象にする治療では、対処能力の欠乏を改善することを考えてきた。しかしながら、認知的な障 害は、社会技能訓練といったような学習に基づく介入をからの利益（恩恵）を得る能力を妨害する。 CDIが認知神経科学的機能障害の測度として妥当であるかどうかをより詳細に吟味するためにはさらなる 研究が必要である。

Rorschachiana (2016), 37(1), 28–40

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Original Article Special Issue: Neuroscience and the Rorschach

Differences in Brain Hemodynamics in Response to Achromatic and Chromatic Cards of the Rorschach A fMRI Study Masahiro Ishibashi1, Chigusa Uchiumi2, Minyoung Jung3, Naoki Aizawa4, Kiyoshi Makita5, Yugo Nakamura6, and Daisuke N. Saito7,8 1

Department of Arts and Sciences, Osaka Kyoiku University, Japan

2

Institute of Socio-Arts and Sciences, Tokushima University, Japan

3

Department of Child Development, University of Fukui, Japan

4

Graduate School of Human Development and Environment, Kobe University, Japan

5

Faculty of Psychological and Physical Science, Aichi Gakuin University, Japan

6

National Mental Support Center for School Crisis, Osaka Kyoiku University, Japan

7

Research Center for Child Mental Development, University of Fukui, Japan Biomedical Imaging Research Center, University of Fukui, Japan

8

Abstract: In order to investigate the effects of color stimuli of the Rorschach inkblot method (RIM), the cerebral activity of 40 participants with no history of neurological or psychiatric illness was scanned while they engaged in the Rorschach task. A scanned image of the ten RIM inkblots was projected onto a screen in the MRI scanner. Cerebral activation in response to five achromatic color cards and five chromatic cards were compared. As a result, a significant increase in brain activity was observed in bilateral visual areas V2 and V3, parietooccipital junctions, pulvinars, right superior temporal gyrus, and left premotor cortex for achromatic color cards (p < .001). For the cards with chromatic color, significant increase in brain activity was observed in left visual area V4 and left orbitofrontal cortex (p < .001).

Furthermore, a conjoint analysis revealed various regions were activated in responding to the RIM. The neuropsychological underpinnings of the response process, as described by Acklin and Wu-Holt (1996), were largely confirmed.

Keywords: achromatic and chromatic colors, brain hemodynamics, functional magnetic resonance imaging (fMRI), Rorschach

The Rorschach Inkblot Method (RIM), developed by the Swiss psychiatrist Hermann Rorschach in 1921, consists of 10 inkblot plates. These plates include five achromatic color cards and five chromatic color cards. Responses in which Š 2016 Hogrefe Publishing

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clients verbalize or imply the use of chromatic color stimuli are coded as chromatic color responses.

Based on his research, Rorschach (1921/1951) considered color responses to be “the representative of affectivity” (p. 76). He described that the “absolute number of color responses is a good measure of affective lability” (p. 98). At a later date, Schachtel (1966/2009) pointed out that emotional experiences and color perception on the RIM share characteristics of passivity, immediacy, and directness, although “color responses are not identical to color perception” (p. 163). Furthermore, in the Comprehensive System (CS; Exner, 2003), different codes for color responses and their proportions are used (FC; CF + C) as an index of affective modulation.

Numerous psychometric studies and clinical observations have been conducted to examine the effects of color stimuli and the characteristics of chromatic color responses, but there are some inconsistencies between studies. For example, Malone and colleagues (Malone et al., 2013) indicated a significant correlation between scales measuring emotional regulation and integration and the number of color responses (CF and C) in clinical groups. On the other hand, Stevens and colleagues (Stevens, Edwards, Hunter, & Bridgman, 1993) showed that, although the sample size was small, there was no significant correlation between indices such as FC; CF + C in the CS and emotional indices obtained from their experimental procedure in college students. However, in a recent meta-analysis of the validity literature, indices relating to color responses (e.g., Weighted Sum of Color and Form-Color Ratio) were listed as variables with good validity (Mihura, Meyer, Dumitrascu, & Bombel, 2013).

An increasing number of studies have focused on examining the characteristics of the RIM from a neuropsychological perspective. Belyi (1983) showed that patients with tumors in the right hemisphere produced more CF + C and a lower F+% than those with tumors in the left hemisphere. More recently, the correlation between the RIM and the laterality of the Thematic Apperception Test (Hiraishi, Haida, Matsumoto, Hayakawa, Inomata, & Matsumoto, 2012) and the association between brain activity and thought disorders, or syntax structures, indicated by the RIM (Kircher et al., 2001; Kircher, Tomasina, Brammer, & McGuire, 2005) have been investigated. Jimura and colleagues (Jimura, Konishi, Asari, & Miyashita, 2009) found a positive correlation between the SumC’ of the RIM performed in a regular setting and medial frontal lobe activity when negative feedback was given. Also, Acklin and Wu-Holt (1996) discussed functional localization of brain activity during the RIM response process (Exner, 2003), from encoding the stimulus field to articulation of the selected responses. However, this general perceptual process involved in the RIM has been insufficiently studied.

Furthermore, the question remains as to whether the presence of chromatic color Rorschachiana (2016), 37(1), 41–57

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stimuli can produce differences in perceptual processes in response to the inkblots, and, if so, what is the nature of these differences?

The goal of the present study was to confirm the response process involved in the RIM as described by Acklin and Wu-Holt (1996). We measured brain hemodynamics of healthy participants using fMRI (Cohen & Bookheimer, 1994; Kim & Ugurbil, 1997) while they engaged in the RIM, and examined response characteristics by comparing brain activation patterns between achromatic and chromatic cards.

Method Participants Forty volunteers (20 men, 20 women; age M = 24.7 years, SD = 4.8) were recruited from an inter-university community by advertisement. We verified each subject had no history of neurological or psychiatric illness by a self-report questionnaire and an interview. All participants reported being right-handed and the Edinburgh Handedness Inventory (Oldfield, 1971) supported their reports (Laterality Quotient: M = .85, SD = .14, minimum = .27, maximum = 1.00). They also reported they were unfamiliar with the Rorschach inkblot stimuli.

Ethical Consideration The protocol was approved by the ethical committee of Osaka Kyoiku University (Osaka, Japan), and the experiments were undertaken in compliance with national legislation and the Code of Ethical Principles for Medical Research Involving Human Subjects of the World Medical Association (the Declaration of Helsinki). All participants gave their written informed consent to participate in the study.

Magnetic Resonance Imaging A time-course series of 88 volumes was acquired using T2*-weighted, gradient echo, echo planar imaging (EPI) sequences with a 3.0 Tesla MR imager (Discovery MR750; General Electric Medical Systems, Milwaukee, WI, USA) and a 32 channel head coil. Each volume consisted of 40 slices, each 3.0 mm thick, with a 0.5 mm gap to cover the entire cerebral and cerebellar cortex. Oblique scanning was used to exclude the eyeballs from the images. The time interval between two successive acquisitions of the same slice (TR: Repetition time) was 3000 ms with a flip angle (FA) of 90 degrees and 25 ms echo time (TE). The field of view (FOV) was Š 2016 Hogrefe Publishing

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192 mm and the in-plane matrix size was 64 × 64 pixels. For anatomical reference, T1-weighted FSPGR [TR = 6.38 ms, TE = 1.996 ms, FA = 11 degrees, FOV = 256 mm, matrix size = 256 × 256 mm, slice thickness = 1 mm, a total of 172 trans axial images] was obtained for each subject.

Experimental Design and Task Procedure The ten inkblot plates of the Rorschach were scanned and used as stimuli. We also produced a series of figures drawn only by the outline of the 10 inkblots for the line task. The visual stimuli were projected using a MRI compatible liquid crystal display (LCD) projector (SV-6011, AVOTEC, FL, USA) connected to a personal computer, which generated visual stimuli using Presentation (Neurobehavioral Systems, CA, USA) onto a half transparent screen, and were presented at a visual angle of 14.7° × 18.3°.

During the fMRI experiment, participants performed a total of four 4 min 24 sec sessions. The experimental session consisted of 10 blocks for each of the two conditions (RIM and line task blocks) and two rest blocks. During the RIM task block, participants were asked to keep thinking what the inkblots might be and make as many responses as possible throughout the trial, and were asked to press the button when they came up with a response. During a line task block, instead, participants were asked to press the button when a part of the outline of a figure turned gray (about three times per a trial, on average; intended to counterbalance the number of button presses on the RIM task). This task block involved detecting the luminance change of a part of the outline (about 1 degree of visual angle), requiring participants to attend to figure shape and figure outlines. Moreover, the line task was designed to subtract the effect of the motions of button press from the RIM task. For each block, Cards I to X were presented in the standard order and in the upright position. Then, all the cards were presented in the inverted position (see Figure 1). We did not ask participants to respond to each task verbally in this study in order to control the influence of verbalization on brain hemodynamic change.

After completing the scanning session, participants were asked to write down as many responses as they remembered for each Rorschach card. We did not conduct the inquiry in the present study.

Imaging Data Processing The first 4 volumes of each fMRI session were discarded because of unsteady magnetization, and the remaining 84 volumes per session were used for analysis.

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Figure 1. Experimental task and design. Five RIM task blocks and five line task blocks, each lasting 21 s, were presented alternately in one fMRI session. During a RIM task block, participants were asked to press the button when they came up with an answer about what the RIM figures looks like. During a line task block, participants were asked to press the button when a part of the outline of a figure turned gray. Inkblots were presented from Card I to Card X in order in the upright position, then repeated in the inverted position. Note that the pictures here were created for illustrative purposes alone.

Image and statistical analyses were performed using Statistical Parametric Mapping (SPM8; Wellcome Department of Cognitive Neurology, London, UK) implemented in Matlab R2010a (Mathworks, Sherborn, MA) (Friston, Ashburner et al., 1995; Friston, Holmes et al., 1995).

Head motion was corrected with the realignment program of SPM8. There was no trend of head motion correlated with the task. Following realignment, the volumes were normalized to the Montreal Neurological Institute (MNI) space (Evans, Kamber, Collins, & MacDonald, 1994) using a transformation matrix obtained from the normalization process of the first EPI image of each individual subject to the EPI template. Finally, the normalized fMRI data were spatially smoothed with a Gaussian kernel of 8 mm (full-width at half-maximum) in the x, y, and z axes.

Statistical Analysis Statistical analyses were conducted at two levels. First, the individual task-related activation was evaluated. Second, the summary data for each individual were incorporated into a second-level analysis using a random-effect model (Friston, Holmes, & Worsley, 1999) to make inferences at a population level. The signal time course for each subject was modeled with a general linear model (Friston, Holmes et al., 1995). The design matrix for the single-subject analyses contained two task-related regressors (achromatic and chromatic cards). Regressors that

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were of no interest, such as the session effect and high-pass filtering (128 s), were also included to eliminate the low-frequency trend. The weighted sum of the parameters estimated in the individual analysis consisted of ‘‘contrast’’ images, which were used for the group analyses (Friston et al., 1999). The contrast images obtained by individual analysis represented the normalized increment of the fMRI signal for each subject. Significant signal changes for each contrast were assessed by means of t statistics on a voxel-by-voxel basis. The threshold for the SPM{t} of group analyses was set at p < .001 (uncorrected for multiple comparisons) for height and p < .05 for cluster size (corrected for multiple comparisons) (Friston, Holmes, Poline, Price, & Frith, 1996).

For each inkblot response, brain activity during the line task was subtracted from that of the RIM task. In addition, to reveal the effects of color stimuli on the RIM, we compared brain activity for five achromatic (I, IV, V, VI and VII) and five chromatic cards (II, III, VIII, IX, and X) for each voxel. A paired t test was conducted to investigate differences between these two types of cards.

Results Number of Responses The average number of times the participants pressed the button (R) in response to the 10 RIM inkblots was 69.88 ± 16.81, maximum = 114, median = 67, and minimum = 38. The average R for the five achromatic cards was 33.63 ± 8.91, and for the five chromatic cards 36.25 ± 8.74, resulting in significantly more R for the chromatic cards (t(39) = 3.553, p = .001, d = .562). Cards with relatively more R produced were X, I, and III; and those with relatively less R were IV, VII and VIII (see Table 1). Using the obtained R, the value corresponding to Afr (Exner, 2003) was calculated as .455, and (VIII+IX+X)% (Kataguchi, 1988) yielded 31.1.

Comparisons of Brain Activation Between Achromatic and Chromatic Cards Significant increases in brain activity were observed in the bilateral medial occipital gyrus (BA; Brodmann area 18, 19), the bilateral pulvinar, the left middle frontal gyrus (BA 6), and the right superior lateral gyrus (BA 22) for the achromatic cards.

On the other hand, brain activities significantly increased in the left lingual gyrus (BA 18) and the left orbitofrontal area (BA 11) for responses to the chromatic cards (Table 2; Figure 2 and Figure 3).

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Table 1. Mean and SD of number of responses (R) for each card of the RIM Card

Mean

SD

I

8.05

2.39

IV

6.08

2.18

V

6.23

1.93

VI

7.08

1.95

VII

6.20

1.96

All achromatic cards

33.63

8.91

II

6.83

2.18

III

7.80

2.56

VIII

6.43

1.62

IX

7.08

1.87

X

8.13

2.42

36.25

8.74

All chromatic cards

Table 2. Regions with significant differences between achromatic and chromatic color response Region

BA

Laterality

MNI Coodinates (mm) x

y

t

d

1.40

z

Achromatic > chromatic Middle occipital gyrus

18

R

24

–94

16

8.86***

Precuneus

7

R

16

–78

48

4.00***

0.63

Middle occipital gyrus

18

L

–12

–102

8

6.60***

1.04

Precuneus

7

L

–22

–78

38

4.12***

0.65

R

14

–26

1

6.08***

0.96

R

34

–38

–8

4.29***

0.68

L

–10

–26

18

4.64***

0.73

Pulvinar Parahippocampal gyrus

37

Pulvinar Middle frontal gyrus

6

L

–24

–4

40

4.72***

0.75

Superior temporal gyrus

22

R

46

–18

–4

4.72***

0.75 1.16

Chromatic > achromatic Lingual gyrus

18

L

–26

–104

–8

7.33***

Middle frontal gyrus

11

L

–24

30

–16

4.66***

0.74

Middle orbital gyrus

10

L

–32

50

–6

4.49***

0.71

Notes. BA, Brodmann area; L, left; R, right. The threshold for the SPM{t} of group analyses was set at p < .001 (uncorrected for multiple comparisons) for height, and cluster p < .05 (corrected for multiple comparisons). *** p < .001, uncorrected. Effect size for paired t test (d) was calculated as t / square root of N (Toyoda, 2009).

Regions Significantly Activated in Both Sets of Cards: A Conjoint Analysis To test whether there were common areas that were significantly activated in both contrasts for chromatic and achromatic RIM cards (compared to the line task), © 2016 Hogrefe Publishing

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Figure 2. Maximum intensity projection (MIP) images of the brain regions with significantly increased activity when the achromatic cards are shown.

Figure 3. MIP images of the brain regions with significantly increased activity when the chromatic cards are shown.

a conjunction analysis was calculated. Results showed significant activation in the following regions (see Table 3): the bilateral superior and middle occipital gyri (BA 17 and 18), the fusiform gyri (BA 19), the inferior parietal lobules (BA 40), and the inferior temporal gyri (BA 20 in left and BA 37 in right). A significant increase in activation was also observed bilaterally in the hippocampus and parahippocampal gyri (BA 36 in left and BA35 in right). Moreover, significant activation was shown in the left amygdala, the bilateral anterior cingulate cortices (ACC, BA 32), the orbitofrontal cortices (OFC, BA 47), and the dorsal and ventral lateral prefrontal cortices (BA 9, 45).

Discussion Regions Significantly Activated in Response to Achromatic Cards In response to achromatic cards, significant activation was observed in the large area of the bilateral medial occipital gyri (BA 18, 19). These areas are also called prestriate visual cortex and include secondary visual areas (V2) and visual area V3.

V2 is known to be responsible for perceiving subjective contour (Peterhans & von der Heydt, 2003), and one study has suggested that the lateral area of the occipital Rorschachiana (2016), 37(1), 41â&#x20AC;&#x201C;57

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Table 3. Regions commonly activated in achromatic and chromatic cards, calculated by a conjoint analysis Legions

BA

Laterality

Middle occipital gyrus

17

L

Middle occipital gyrus

18

R

7

L

Superior pariatal lobule

MNI coodinates (mm)

t

d

16.77***

2.65

x

y

z

–14

–98

–8

28

–88

–8

16.96***

2.68

–24

–60

44

17.15***

2.71

7

R

26

–64

46

13.74***

2.17

Inferior parietal lobule

40

L

–46

–42

50

12.39***

1.96

Inferior parietal lobule

40

R

38

–42

44

9.18***

1.45

Fusiform gyrus

19

L

–36

–68

–12

18.06***

2.86

Superior pariatal lobule

Fusiform gyrus

19

R

40

–68

–14

19.48***

3.08

Inferior temporal gyrus

20

L

–52

–40

–18

8.24***

1.30

Inferior temporal gyrus

37

R

48

–42

–20

9.41***

1.49

Hippocampus

L

–28

–22

–10

7.14***

1.13

Hippocampus

R

26

–20

–12

6.85***

1.08

Parahippocampal gyrus

36

L

–28

–28

–26

6.16***

0.97

Parahippocampal gyrus

35

R

26

–32

–20

5.12***

0.81

L

–28

–6

–20

3.50***

0.55

Anterior cingulate gyrus

32

L

–6

32

30

7.07***

1.12

Anterior cingulate gyrus

32

R

8

26

32

6.86***

1.08

Orbitofrontal cortex

47

L

–38

28

–18

7.95***

1.26

Orbitofrontal cortex

47

R

36

28

–14

4.69***

0.74

Amygdala

Dorsolateral prefrontal cortex

9

L

–46

8

26

15.99***

2.53

Dorsolateral prefrontal cortex

9

R

46

14

28

11.30***

1.79

Ventrolateral preftontal cortex

45

L

–50

36

10

8.10***

1.28

Ventrolateral preftontal cortex

45

R

56

40

8

9.62***

1.52

Note. BA: Brodmann area, L: left, R: right. The threshold for the SPM{t} of group analyses was set at p < .001 (uncorrected for multiple comparisons) for height, and cluster p < .05 (corrected for multiple comparisons). *** p < .001, uncorrected. Effect size for paired t test (d) was calculated as t / square root of N (Toyoda, 2009).

lobe is related to processing contour of a shape (Humphrey et al., 1997). Tsuji (1997) pointed out, citing Schachtel (1966/2009), that form recognition requires more activity and indirectness compared to color recognition, which is characterized by passivity and directness. Attention to the contour of a form response might be more focused in response to achromatic cards.

Significantly increased activation was also observed for the achromatic cards in the bilateral pulvinars. Studies have indicated that the pulvinar mediates maintaining visual attention (Fischer & Whitney, 2012) and making decisions about the © 2016 Hogrefe Publishing

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precision of integrated visual information (Komura, Nikkuni, Hirashima, Uetake, & Miyamoto, 2013). Moreover, significant increase in right superior temporal gyrus (BA22) activation was also observed in response to achromatic cards.

This region shows significant increase in activation when selective attention is paid to shapes (Corbetta, Miezin, Dobmeyer, Shulman, & Peterson, 1990).

These results also suggest that participants directed more attention to shapes when responding to achromatic cards.

The bilateral precunei (parieto-occipital junction, POJ; BA7) were also activated significantly in responding to achromatic cards. POJ is related to scene processing (Sato et al., 1999) or mental rotation (Mourao-Miranda, Ecker, Sato, & Brammer, 2009). In addition, various functions such as visuo-spatial imagery, episodic memory retrieva,l and self-processing might activate the POJ (see Cavanna & Trimble, 2006, for a review). The right hippocampal gyrus (BA 37) was also activated. This area involves memory retrieval (Greicius, Krasnow, Boyett-Anderson, Eliez, Schatzberg, Reiss, & Menon, 2003), and is related to processing visual information regarding both formal and spatial characteristics (Sato, 2000).

Regions Significantly Activated in Response to Chromatic Cards In response to chromatic cards, a significant increase in left linguial gyrus (visual area V4, BA18) activity was observed. A study suggests that V4 is closely related to color perception and its consistency (Mullen, Dumoulin, McMahon, de Zubicaray, & Hess, 2007). Chromatic color stimuli could promote significant V4 activation during the responses to chromatic cards.

Significant activation was also shown in the left orbitofrontal cortex (OFC). The OFC is considered to be a region of processing rewards, and is widely involved in emotion regulation, attention and executive functions (see Ono & Tabuchi, 1993, for a review). The lateral OFC is specifically related to paying selective attention to specific information (Corbetta, Miezin, Dobmeyer, Shulman, & Petersen, 1991) or to regulating task-irrelevant emotional information (Vuilleumier, Armony, Driver, & Dolan, 2001). For the RIM task, form is the fundamental factor for a response (Tsuji, 1997), and chromatic color stimuli may interfere with the task in some cases (Shapiro, 1960). One study showed that high impulsivity on the NEO-PI-R was related to an increase in CF and C, as high impulsivity might interfere with the capacity to produce a relevant response (Yasuda, 2012). Significant increase in OFC activation when responding to chromatic cards implies that chromatic color stimuli might interfere with focusing on form processing as “noise,” and that OFC might be activated to regulate the influence of such stimuli.

Another discussion about the significant increase in OFC activation in response to chromatic cards might be considered. Chromatic color stimuli could be a cue to Rorschachiana (2016), 37(1), 41–57

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a RIM response, in a setting where the instruction was to give as many responses as possible. Greater OFC activation could have emerged because the stimuli were operated as a reward. However, regions involved in processing rewards and emotional control such as the amygdala, the ACC, and the DLPFC did not show significant activation in response to chromatic cards. Significant increase in R and V4 activation suggests that subjects perceived chromatic color stimuli, and that such stimuli increased the number of responses produced.

Regions Significantly Activated in Both Card Groups Results from a conjoint analysis revealed that various regions are related to responding to the RIM. These regions could be grouped into three clusters. First, regions which involve processing visual information were significantly activated, including the visual cortices, the dorsal and ventral visual streams, and the fusiform gyri. The lateral occipital gyrus is related to processing the outline of an object, and the fusiform gyrus and parahippocampal gyrus involve the processing of texture (Koyama & Kawamura, 2007). Second, regions involving various functions of memory were significantly activated, such as the hippocampus and the parahippocampal gyri. Both episodic and semantic memory appear to be involved in the RIM task. These regions are critical for episodic memory (Tulving & Markowitsch, 1998). Regarding semantic memory, it has been hypothesized that repeated parts of episodic memories might be fixed as semantic memories (Yamadori, 2003). Third, regions including the ACC, the OFC, the LPFC, and the amygdala are involved in emotional control during a cognitive task (Salzman & Fusi, 2010). Further investigation is required to better understand why the OFC showed significant activation on chromatic cards.

This study experimentally investigated brain hemodynamics during the RIM task, and confirmed that the results are generally consistent with the RIM response process as described by Exner (2003) and by Acklin and Wu-Holt (1996). We also found differences in brain activation between achromatic and chromatic cards. In accordance with Hermann Rorschach, who named his test a “form interpretation test” (Rorschach, 1921/1951), we confirmed that several cerebral regions involving the perceptual processing of form were activated in response to the RIM. Furthermore, regions involving emotional expression and processing also showed significant activation throughout the task. This seems to suggest that the RIM is not merely a “form interpretation test,” but also a task which involves emotional processing, as proposed by Muzio (2004) in his review.

However, our study presents several limitations. First, Rorschach data were not collected in a standard setting. Subjects were instructed to produce as many responses as possible in a trial, which resulted in a substantial increase in R. © 2016 Hogrefe Publishing

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The size of the projected images of RIM stimuli might also have affected the responses, as the images were smaller than their standard size. Above all, we did not collect verbal responses directly, which limited our capacity to investigate the relation between brain activity as measured by fMRI and various RIM scores, especially scores such as Form Quality and Form-Color Ratio. Second, the validity of the empirical design of the analysis comparing the data between five achromatic and five chromatic cards could have been taken into account. Chromatic cards could have been divided into two black-and-red cards and three cards with various colors. We could also have compared the activation to each of the achromatic cards.

Kataguchi (1988) suggested the “A-B-C series,” a set of parallel cards including an achromatic series (all chromatic colors of blots were converted to grayscale), a black series (all blots were colored black without shading) and a contour series (only outlines of the blots were presented). These series are available to explore the influence or meaning of chromatic color and shading in the RIM response process.

Numerous studies have shed light on the neurological correlates of various mental health problems, such as depression or posttraumatic stress disorder. Muzio (2004) discussed the potential of the RIM as an instrument capable of transcending trends in neuropsychology and personality psychology. We believe that further investigation of the neurological correlates of the RIM and other projective methods should lead us to confirm their validity as psychological assessment tools with neuropsychological underpinnings.

Acknowledgments The main results of this paper were originally presented at XXI International Congress of Rorschach and Projective Methods in Istanbul, Turkey (July, 2014). This study was conducted with a grant from JSPS KAKENHI (23530897).

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Yamadori, A. (2003). Hito no kioku kinou ni okeru kaiba kaibakboukai no yakuwari [Roles of hippocampus and hippocampal gyrus for human memory functions]. No To Hattatsu, 35, 105â&#x20AC;&#x201C;112.

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Received March 9, 2015 Revision received December 22, 2015 Accepted January 13, 2016 Published online June 10, 2016 Masahiro Ishibashi Department of Arts and Sciences Osaka Kyoiku University 4-698-1 Asahigaoka Kashiwara, Osaka 582-8582 Japan Fax +81 72 978-3625 E-mail isibasim@cc.osaka-kyoiku.ac.jp

Summary The color responses in the Rorschach inkblot method (RIM) has been interpreted in relation to emotion; however, how color stimuli are processed during the response process is as yet unclear.

The present study was conducted to obtain basic information about brain activities during the RIM task by measuring the brain activities and comparing them to the responses made to the chromatic and achromatic color cards. Forty right-handed adults (20 females and 20 males) without a history of neurological or psychiatric problems participated in the study. Scanned figures were prepared of the 10 RIM inkblot plates (in upright and inverted positions) and the cards comprised of only the contour of the inkblot for the concurrent stimuli, and these cards were projected onto the screen in the MRI scanner (GE MR750) for 21 s each. The participants were required to think about what they saw in the inkblots as much as possible during the card presentation and to press the button when they came up with a response. For the cards with only black contour, the color of a small part of contour changed gray during the presentation and the subjects were asked to press the button when they noticed when the color changed. The data obtained in the concurrent task was subtracted from the data obtained in the RIM task and the responses in chromatic and achromatic cards were compared for each voxel. As a result, for achromatic color cards, significant increases in cerebral activity were observed in the bilateral visual areas V2 and V3, parietoccipital juncions, pulvinars, right superior temporal gyrus, and left premotor cortex (p < .001). For the chromatic color cards, significant increases were observed in the left visual area V4 and orbitofrontal cortex (p < .001). A conjoint analysis to seek commonly activated regions between the two conditions revealed that various regions associated with visual, memory, and emotion regulation were significantly activated during the RIM task. The response process described by Acklin and Wu-Holt (1996) was largely confirmed. Limitations and future challenges were also discussed.

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要約 ロールシャッハ法（Rorschach Inkblot Method; RIM）における色彩反応は情動性との関連を中心に解 釈されてきたが，反応の過程において色彩刺激がどのように処理されているかはわかっていないところが多 い。本研究ではRIM実施時の脳活動を測定し無彩色図版と彩色図版との比較をおこない，RIMにおける 色彩刺激の特徴を検討することで，RIM実施時の脳活動に関する基礎的資料を得ることを目的とした。 研究協力者として，精神科既往歴のない右利きの成人40名（男性20名，女性20名）が参加した。10 枚のRIM図版（正位置，逆位置）のスキャン画像と，並行課題の刺激としてRIM図版の輪郭だけをとり だした図版を準備し，MRI装置(GE MR750)内のスクリーンにプロジェクターで投影した（それぞれ21 秒）。RIM図版提示時は，インクブロットが何に見えるかできるだけ多く考え，思いついたらボタンを押下 するよう求めた。輪郭だけの図版は，提示時間内にランダムに輪郭の一部の色を変え，変わったらボタン を押下するよう求めた。RIM課題実施時のデータから平行課題のデータを引き，voxelごとに彩色図版と 無彩色図版との間の差を比較した。結果として，無彩色図版においては両側２次および３次視覚野，両 側視床枕，右側上側頭回，左側運動前野での有意な活動の上昇が観察された。一方で彩色図版 においては左の４次視覚野と眼窩前頭野での有意な活動の上昇が示された（いずれもp<.001）。また conjoint分析より，両図版において共通に活動の上昇を見せる領域として，視覚情報の処理に関する領 域，記憶に関する領域，そして感情の統制に関する領域などが示された。これはAcklin & Wu-Holt (1996)が考察したRIMの反応過程に関与する諸領域と多くの一致を示した。今後の課題についても考察を おこなった。

Résumé Les réponses chromatiques dans la Méthode à tache d’encre de Rorschach (RIM) ont été interprétées par rapport à l’émotion. Néanmoins, on ne sait toujours pas comment les stimuli de couleur sont traités lors du processus de réponse. Le but de la présente étude était d’obtenir des informations de base sur les activités du cerveau lors de l’emploi de la RIM en mesurant les activités du cerveau et en les comparant aux réponses obtenues pour les cartes chromatiques et achromatiques. Quarante adultes droitiers (20 femmes et 20 hommes) sans antécédents de problèmes neurologiques ou psychiatriques ont participé à l’étude. Les chiffres numérisés des 10 planches de tache d’encre de RIM (dans les positions droite et inversée) et les cartes comportant uniquement le contour de la tache d’encre pour les stimuli concomitants ont été préparés, et chacune de ces cartes a été projetée sur un écran dans le scanner IRM (GE MR750) pendant 21 secondes. Il a été demandé aux participants de penser autant que possible à ce qu’ils voyaient dans les taches d’encre lors de la présentation des cartes, et d’appuyer sur le bouton quand ils y pensaient. Pour les cartes ayant uniquement un contour noir, la couleur d’une petite partie du contour est devenue grise pendant la présentation et il a été demandé aux participants d’appuyer sur le bouton dès qu’ils remarqueraient ce changement de couleur. Les données obtenues dans la tache concomitante ont été déduites des données obtenues dans la tache RIM et les réponses dans les cartes chromatiques et achromatiques ont été comparées pour chaque voxel. On a alors constaté que pour les cartes achromatiques, des augmentations significatives de l’activité cérébrale dans les aires visuelles bilatérales V2 et V3, les jonctions pariéto-occipitales, les pulvinars, le gyrus temporal supérieur droit, le cortex prémoteur gauche (p < .001). Les cartes chromatiques, des augmentations significatives ont été observés dans l’aire visuelle gauche V4 et dans le cortex orbitofrontal (p < .001). Une analyse conjointe destiné à identifier des régions généralement actives entre deux états a révélé que diverses régions ont été considérablement activées lors de l’emploi de RIM impliquant une régulation visuelle, mémorielle et émotionnelle. Le processus de réponse décrit par Acklin et Wu-Holt (1996) a été largement confirmé. Les limites et défis à venir ont également été abordés.

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Resumen Las respuestas al color en el método de manchas de tinta de Rorschach (RIM) han sido interpretadas con relación a la emoción; sin embargo, cómo se procesan los estímulos de color durante el proceso de respuesta aún es incierto. El presente estudio se realizó para obtener información básica sobre las actividades que ocurren en el cerebro mientras se realiza la tarea RIM, esta información se obtiene mediante la medición de las actividades cerebrales y se la compara con las respuestas dadas a las tarjetas cromáticas y acromáticas. Cuarenta adultos diestros (20 mujeres y 20 hombres) sin antecedentes de problemas neurológicos o psiquiátricos participaron en el estudio. Se prepararon figuras escaneadas de las 10 láminas de manchas de tinta del método RIM (en posición vertical y posición invertida) y se prepararon tarjetas que incluían solamente el contorno de la mancha de tinta para los estímulos concurrentes, y estas tarjetas se proyectaron en la pantalla en el escáner de resonancia magnética (GE MR750), cada una durante 21 de segundos. Se pidió a los participantes que piensen sobre qué veían en las manchas de tinta tanto como les sea posible durante la presentación de la tarjeta y que pulsen el botón cuando piensen sobre ello. En el caso de las tarjetas con solamente un contorno negro, el color de una pequeña parte del contorno cambió a gris durante la presentación y se pidió a los sujetos participantes que pulsen el botón cuando se den cuenta del cambio de color. Los datos obtenidos en la tarea concurrente se restaron de los datos obtenidos en la tarea RIM y las respuestas obtenidas para las tarjetas cromáticas y acromáticas se compararon según cada vóxel. Como resultado, en el caso de las tarjetas acromáticas, se observaron aumentos significativos en la actividad cerebral en las áreas visuales bilaterales V2 y V3, articulaciones parieto-occipitales, núcleos pulvinares, el giro temporal superior derecho, y la corteza pre-motora izquierda (p < 0,001). En el caso de las tarjetas cromáticas, se observaron aumentos significativos en el área visual izquierda V4 y la corteza orbito-frontal (p < 0,001). Un análisis conjunto para buscar regiones comúnmente activadas entre las dos condiciones reveló que varias regiones se activaron de manera significativa durante la tarea RIM, que son regiones que involucran la regulación visual, de la memoria y de las emociones. El proceso de respuesta descrito por Acklin y Wu-Holt (1996) se confirmó en gran medida. También se examinaron limitaciones y futuros desafíos.

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Original Article Special Issue: Neuroscience and the Rorschach

The Effects of Neurological Priming on the Rorschach A Pilot Experiment on the Human Movement Response Luciano Giromini1, Donald J. Viglione2, Emanuela Brusadelli3, Alessandro Zennaro1, Marzia Di Girolamo1, and Piero Porcelli4 1

Department of Psychology, University of Turin, Italy

2

California School of Professional Psychology, Alliant International University, San Diego, USA

3

Department of Psychology, University of Milano-Bicocca, Italy

4

Psychosomatic Unit, IRCCS De Bellis Hospital, Castellana Grotte, Italy Abstract: This article introduces a new scientific paradigm that might allow the investigation of the neurological correlates of the Rorschach test without using expensive and time consuming tools such as the fMRI or the EEG. Based on the literature on the Mozart effect, we anticipated that preactivation of a given brain network before exposure to the Rorschach cards would associate with the increased production of responses (or determinants) presumed to be associated with that same network. To pilot test this hypothesis, we focused on the postulated link between human movement (M) responses and mirror neuron system (MNS) activity, and investigated whether preactivation of the MNS would associate with the increased production of M responses. Specifically, 30 students were administered a subset of Rorschach cards immediately after watching three short videos aimed at activating the MNS at three different levels (no/low/high activation). Although no statistically significant differences among the three conditions were found, a linear trend in the expected direction (p = .107), with medium effect size (η2 = .087) was observed. In addition to providing information on the M response, this article introduces a new scientific paradigm to investigate the neurological correlates of the Rorschach.

Keywords: neurological priming, Rorschach, human movement, mirror neurons

In the last few decades, it has been proposed that the preactivation of certain areas of the cortex might prime behaviors and competences that are related to such neural areas. One of the most famous examples of this phenomenon – also called “neurological priming” – is probably the Mozart effect, which was discussed for the first time in a 1993 issue of Nature. In the study, Rauscher, Shaw, and Ky (1993) observed that brief exposure to Mozart’s “Sonata for Two Pianos in D Major, K.448” led to higher short-term enhancement of spatial intelligence scores Rorschachiana (2016), 37(1), 58–73 DOI: 10.1027/1192-5604/a000077

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as compared to exposure to silence or a relaxation tape. These initial findings were later replicated or extended by the same authors (e.g., Rauscher & Shaw, 1998; Rauscher, Shaw, & Ky, 1995) and other researchers (e.g., Aoun, Jones, Shaw, & Bodner 2005; Ho, Mason & Spence, 2007; Rauscher, Robinson, & Jens, 1998).

According to Rauscher, Shaw, and Ky (1993), the higher spatial performance after exposure to Mozart’s sonata might be the result of the music priming the brain for spatial activity. Indeed, both musical (Bever & Chiarello, 1974), spatial (De Renzi, 1982; Desrocher, Smith, & Taylor, 1995; Kimura, 1969), and attentional (Liederman, 1986; Mesulam, 1981) processing are thought to be associated with right hemisphere activation (Leng & Shaw, 1991). Thus, listening to Mozart’s music might activate brain areas that are also involved in spatial processing, and this, in turn, might prime spatial cognition such that spatial performance is improved.

Although there is some controversy (e.g., Newman et al., 1995; Steele, Ball, & Runk, 1997; Stough, Kerkin, Bates, & Mangan, 1994), such a neurological explanation for the Mozart priming effect is supported by several studies. First, listening to Mozart’s music not only improves spatial performance but also affects brain functioning, as indicated by electroencephalography (EEG) recordings (Jausovec & Habe, 2005). In addition, not only spatial abilities but also visuo-spatial attention – another function of the right hemisphere – improves after listening to Mozart (Ho et al., 2007). Moreover, Rideout, Dougherty, and Wernert (1998) found that a similar effect to the Mozart effect could also be observed by using Yanni’s “Acroyali/Standing in Motion,” a musical composition deemed to be similar to the Mozart piece used in the first study. Furthermore, the Mozart effect occurs in nonmusicians, who process melodic information exclusively in the right hemisphere, but not in musicians, who process melodic information in both hemispheres (Aheadi, Dixon, & Glover, 2010). Other evidence also supports this view (Chokron, Bartolomeo, Colliot, & Auclair, 2002; Coupard & Kapoula, 2005; Kittler & Turkewitz, 1999; Mildner, 2002).

The phenomenon of neurological priming finds a theoretical foundation in the trion model of the cortical column (Leng & Shaw, 1991; McGrann, Shaw, Silverman, & Pearson, 1991; Shaw, Silverman & Pearson, 1985, 1988; Silverman, Shaw, & Pearson, 1986), which is a mathematical representation of Mountcastle’s (1978) columnar model of the cerebral cortex. Roughly speaking, the main idea of the model is that small units of neurons have different levels of firing activity, and different clusters of these units can produce complex spatial-temporal firing patterns. As a result, a change in a few units or clusters can affect broader patterns of spatial-temporal firing. In line with this model, similar units or clusters of neurons might fire, for example, when either listening to music or doing activities requiring spatial ability (Leng & Shaw, 1991). Accordingly, listening to music might © 2016 Hogrefe Publishing

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affect and prime multiple patterns of spatial-temporal firing, including those that are related to the execution of tasks requiring spatial ability, i.e., hearing Mozart’s music might “warm-up” neurons prior to completing a spatial task, thus improving the performance (Rauscher, Shaw, & Ky, 1993).

The idea that preactivating specific cerebral regions might prime functions related to such regions also comes from many other research areas. For example, Reuter-Lorenz, Kinsbourne, and Moscovitch (1990) have shown that activating the left hemisphere by requiring the completion of a verbal task leads to an improvement in other tasks processed by the left hemisphere, such as processing times or efficiency for the information presented. As another example, Brunel, Lesourd, Labeye, and Versace (2010), investigating the sensory priming effects in semantic categorization, have recently suggested that a facilitatory effect could be explained in terms of preactivation of auditory areas. As a further example, Sterr (2006), working on the response-priming paradigm (Neumann & Klotz, 1994; Vorberg, Mattler, Heinecke, Schmidt, & Schwarzbach, 2003), has proposed that performance differences between response and no-response priming conditions may be due to different preactivations of motor regions evoked by the prime stimuli. Many other examples could also be found, especially in research areas dealing with visuo-motor priming and action imitation abilities (e.g., Gillmeister, Catmur, Brass, & Heyes, 2008; Vogt, Taylor, & Hopkins, 2003).

Neurological Priming and the Rorschach In recent years there has been increasing interest in the neurological correlates of the Rorschach (Rorschach, 1921), and some fMRI (e.g., Asari et al., 2010a; 2010b) as well as EEG (e.g., Giromini, Porcelli, Viglione, Parolin, & Pineda, 2010; Pineda, Giromini, Porcelli, Parolin, & Viglione, 2011; Porcelli, Giromini, Parolin, Pineda, & Viglione, 2013) studies on this topic have been conducted. However, both EEG and fMRI methodologies require technical neurophysiological knowledge and skills, as well as equipment and monetary resources that may not be available to many Rorschach investigators. Thus, to date the research on the Rorschach has not yet taken full advantage of the recent advances in neuroimaging techniques (see also Meyer, Viglione, & Giromini, 2014).

To advance research on the neurological correlates of the Rorschach, this article introduces a new methodological approach that makes use of the phenomenon of neurological priming. Specifically, we anticipated that preactivation of a given brain network would associate with the increased production of Rorschach responses presumed to be associated with that same network. Because of our Rorschachiana (2016), 37(1), 58–73

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experience with the topic, we focused on the link between the activity of the mirror neuron system (MNS; di Pellegrino, Fadiga, Fogassi, Gallese, & Rizzolatti, 1992; Gallese, Fadiga, Fogassi, & Rizzolatti, 1996; Rizzolatti, Fadiga, Gallese, & Fogassi, 1996) and the human movement (M) response to the Rorschach (Exner, 2003; Meyer, Viglione, Mihura, Erard, & Erdberg, 2011).

M Responses and MNS In the Rorschach, the M code is typically scored when the respondent perceives a response object engaged in a human movement, with the described movement reflecting a human activity (e.g., “two people dancing”). Because the Rorschach inkblots do not move, the movement is not a characteristic of the stimulus, but rather something that the respondent adds to it. Accordingly, it is deemed that M responses reveal important information about the personality and functioning of the respondents (Exner, 2003; Malmgren, 2000; Meyer et al., 2011; Rorschach, 1921). Rorschach (1921), in particular, firmly believed that the M response reflects an identification mechanism, so that Ms would be central to the interpretation of the test. In line with this view – albeit with some theoretical differences – almost all other Rorschach authorities have conceived M as one of the best sources of information about the respondent’s inner life, human representations, personality dynamics, and functioning (e.g., Beck, 1944; Mayman, 1977; Piotrowski, 1977; Rapaport, Gill, & Schafer, 1946). Thus, it is not surprising that both the Comprehensive System (CS; Exner, 2003) and the Rorschach Performance Assessment System (R-PAS; Meyer et al., 2011) have retained the M code.

Because M presumably depends on an identification mechanism, and likely reveals important information about the individual’s ability to identify with and understand another person, a few years ago Giromini et al. (2010) hypothesized that M responses would occur with MNS activity. Indeed, the MNS is supposed to be directly responsible for embodied simulation (Gallese, 2003) – a mechanism through which viewing movement performed by another person automatically activates in the observer the internal representations of the body states associated with such movement, as if the observer was performing rather than just observing that same movement (Freedberg & Gallese, 2007). Furthermore, the MNS is considered the neural basis for unique human skills such as empathy and theory of mind (Gallese, 2003; Rizzolatti & Craighero, 2004). Thus, both the response process presumably behind the production of M (i.e., an identification/embodied simulation mechanism) and its interpretation (i.e., M is indicative of high social cognition skills) suggest that the MNS may be involved in the production of M responses.

Support for the link between the M response and the MNS comes from three published articles based on two independent EEG studies. In a first study, © 2016 Hogrefe Publishing

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Giromini et al. (2010) administered a subset of Rorschach cards to a small student sample while recording their EEG. By using the 8–13 Hz EEG frequency suppression over the sensorimotor cortex as an index of MNS activity (for a review, see Pineda, 2005), the authors found the postulated association with M, observing a statistical significance of p = .004 and a medium effect size of η2 = 0.06. One year later, these findings were replicated with a larger sample size using the entire set of Rorschach cards (Pineda et al., 2011). Of note, increasing the sample size and fixing a number of methodological issues produced a larger effect size of η2 = 0.17.

Lastly, Porcelli et al. (2013) recently re-analyzed the data discussed by Pineda et al. (2011) to test some clinically important distinctions (e.g., M with ordinary form quality vs. M with unusual or distorted form quality), and their results further confirmed that the MNS may be the neural network responsible for the production of M responses.

Method The current study tested whether preactivation of the MNS is associated with increased production of M responses. On the one hand, this investigation aimed at providing additional information about the link between MNS and M. On the other hand, we also aimed at introducing a new scientific and experimental paradigm to investigate the neurological correlates of the Rorschach. Given that this new approach does not require any particular resources or technical skills (e.g., it does not need an EEG or fMRI equipment), we anticipate that it might be used by many Rorschach researchers, in various circumstances, to investigate the neurological correlates of various Rorschach responses. Given the small sample size and other technical limitations, however, this study is to be intended only as a pilot study.

Thirty students were administered a subset of three Rorschach cards immediately after watching three short videos aimed at activating the MNS at three different levels. It was anticipated that if the M response was linked to MNS activity, then the participants would produce more M responses when exposed to the videos that elicit higher activation of the MNS, as a result of neurological priming.

Participants The sample was composed of 30 students of the University of Milano-Bicocca, ranging in age from 18 to 25 years (M = 22.6; SD = 4.3). Sixty percent (n = 18) of them were female. All were Italian citizens and spoke Italian. Although they Rorschachiana (2016), 37(1), 58–73

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were college-level psychology students, nobody attended any Rorschach classes before volunteering for the experiment. All received class credit for their participation.

Priming Stimuli & Rorschach Presentation The stimuli consisted of three videos and three Rorschach cards. The videos were taken from Oberman, Pineda, and Ramachandran (2007), and were used with the aim of activating the MNS of the participants at different levels. Video A (baseline, no activation) consisted of a full-screen television static (mean luminance 3.7 cd/m2); Video B (low MNS activation) showed three individuals tossing a ball up in the air to themselves; Video C (high MNS activation) showed the same three individuals tossing a ball to each other and occasionally throwing the ball off the screen toward the viewer. Thus, with the MNS activation increasing from Video A to B to C (Oberman et al., 2007), we anticipated that the production of M responses would follow the same pattern, with the greatest number of M responses in Condition C, that is after exposure to video C. The three Rorschach cards (cards II, III, and VII) with the greatest M response frequency (Exner & Erdberg, 2005) were selected so as to avoid problems with repeating the videos while maximizing effect size and statistical power. Each of the three cards was presented three times: once after exposure to Video A, once after exposure to Video B, and once after exposure to Video C. Participants were required to give a different response to each card in each condition for a total of nine responses. The entire presentation, i.e., both the order of the cards and the order of the videos, was randomized.

Procedure After giving written consent for participation, each participant was individually taken into a quiet room to begin the experiment. The videos and Rorschach cards were then presented on a computer monitor. First, the participant viewed one of the videos for 10 s with the prior instruction to watch it. Then a Rorschach card appeared, with the participant being asked to tell the experimenter what the inkblot might be, which is the standard instruction. Though only one response was allowed, no time limit was given for responding. Listening to the participant verbalize the response, the experimenter (the third author) transcribed it verbatim.

Subsequently, this same procedure was repeated twice for a total of three times.

Afterwards, the experimenter inquired the responses in line with both CS and R-PAS methods. She was blind to the purposes of the study, and, at the time

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the study was conducted, she had already used the Rorschach for clinical and research purposes for about ten years.

Data Preparation All responses were promptly coded for the presence vs. absence of M. Prior to analyzing the data, interrater reliability for the coding of M was examined. Specifically, an experienced Rorschach user (the first author) who had been using the Rorschach for research purposes for many years, and who was blind to the codes of the experimenter who collected the data and to the three conditions, independently recoded all responses of all records for the presence vs. absence of M. At the response-level, Cohen’s Kappa was 0.96; at the protocol-level, intraclasscorrelation coefficient was also 0.96. These findings are comparable to previous studies on the interrater reliability of the Rorschach (Viglione, Blume-Marcovici, Miller, Giromini, & Meyer, 2012; Meyer, 2004; Viglione & Taylor, 2003) and confirm the excellent interrater reliability of the M response.

Results To test the hypothesis that higher preactivation of the MNS would lead to greater production of M responses, a repeated-measures within-subject ANOVA was calculated with M as the dependent variable and the three conditions (i.e., after exposure to Video A, after exposure to Video B, and after exposure to Video C) as the three levels of the within-subject factor. The hypothesis itself was tested by examining the linear trend with the expectation that the number of M increases from Condition A to Condition B to Condition C. This linear trend indicating M as progressively more frequent from Condition A to B to C was not significant but could be understood as approaching significance when a nonconservative threshold (α = 0.10) is considered, F (1, 29) = 2.767, p = 0.107, η2 = 0.087 (see Figure 1). Also, the partial eta squared value fell in the medium range of suggested benchmarks (small = 0.01; medium = 0.06; large = 0.14) (Kittler, Menard, & Phillips, 2007).

Discussion This pilot study aimed at exploiting the neurological priming phenomenon to investigate the association between M responses and MNS activity. It was hypothesized that if the association between M and MNS activity held true, then a Rorschachiana (2016), 37(1), 58–73

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Figure 1. Mean number of M responses after exposure to Videos A, B, and C. Mean number of M responses produced after exposure to Video A (baseline), B (low MNS pre-activation), and C (high-MNS pre-activation). Error bars represent the standard error of the mean.

preactivation of the MNS prior to exposure to the Rorschach stimuli would increase the production of M responses because of a neurological priming effect.

Thus, three videos believed to activate the MNS at different levels were utilized, and the participants were administered a few Rorschach cards three times, each time after exposure to one of the videos. According to our hypotheses, it was expected that the mean number of M responses produced by the respondents in each condition (i.e., after exposure to each of the videos) would be linearly related to the level of MNS activation formerly elicited by the video.

The results did not fully confirm our main hypotheses, in that no significant differences among the three conditions were found. However, within our small sample, the highest mean frequency of M responses was observed for Condition C, i.e., for responses produced after exposure to the video associated with the highest MNS activation (see Figure 1, Condition C). Also, when a nonconservative threshold of α = .10 was considered, a marginally significant linear trend in the expected direction was observed. Furthermore, the effect size of this linear trend was medium and in the expected direction.

On the one hand, it should be noted that some alternative explanations, unrelated to the MNS theory, are possible. For example, the putative relationship between M and the video condition could be due to a psychological priming effect unrelated to neural mirroring activation. On the other hand, however, this explanation is unlikely, because of the evidence of the close relationship between M © 2016 Hogrefe Publishing

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responses and mirror neurons activity found in our previous investigations (Giromini et al., 2010; Pineda et al., 2011; Porcelli et al., 2013).

Some methodological issues may have reduced the power of our analyses. First, the same three videos were presented to all participants many times during the experiment. Therefore, it is possible that habituation occurred, thus reducing the priming effect of the videos. Second, not to make the administration too long, only three Rorschach stimuli were selected. As a result, for each condition the number of M responses that could theoretically be produced ranged from zero to three. Such a low variability may have reduced the possibility to measure precisely the effects of neurological priming. Third, the same three Rorschach cards were administered three times to each participant, which might have reduced the effective power of the analyses. In this regard, however, it is important to note that the frequency with which examinees produce M responses varies from one card to another (Exner & Erdberg, 2005). Thus, using different Rorschach cards for different priming conditions would make it difficult to distinguish between the effects of MNS priming and the effects of the Rorschach stimuli on the propensity to see human movement in the ambiguous inkblots.

All in all, given the medium effect size observed, and the marginally significant trend found (p ≈ 0.10), there is reason to believe that with larger sample sizes and some technical adjustments to the research design, a more notable effect would be observed. Thus, future research might consider using a greater number of videos (e.g., 9 videos for each condition) and/or more stimuli, perhaps also including non-Rorschach stimuli. Additionally, the length of the videos might be manipulated, so as to find an optimal duration of the videos, and to ensure that neurological priming occurs with no habituation effects. Furthermore, in future research, the Rorschach stimuli might be presented in a more ecologically valid way, rather than using the screen of a laptop. Along the same lines, future research might try to establish a baseline frequency of M responses “naturally” given by each of the participants prior to the experiment, to further discriminate the effects of the neurological priming procedure. Many other adjustments might also be considered.

Regardless of its limitations, this pilot study provides some suggestions for a nontraditional methodological approach for investigating neurological correlates of the Rorschach without using expensive and time-consuming tools such as fMRI or EEG. Indeed, we anticipate that our new method might be used for various purposes, with many Rorschach variables, and to test a variety of hypotheses. For example, one might want to use the phenomenon of neurological priming to investigate the link between color responses – deemed to be associated with affective/ emotional resources – and brain networks involved in the processing of emotions, such as the limbic system. In this example, one might, for instance, seek to investigate whether short videos proven to activate the limbic system would increase Rorschachiana (2016), 37(1), 58–73

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(or not) the number of color responses to the colored Rorschach cards. Many other applications are also possible. A pre-requisite for this method to be used, however, is that its technical parameters – such as the length of the videos, the number of repetitions, etc. – be carefully investigated in future experimental studies. Its applicability, in other words, awaits further research.

Acknowledgments This article is based on part of an unpublished doctoral dissertation by Luciano Giromini on social, cognitive, and clinical psychology at the University of Milano-Bicocca.

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Received February 25, 2015 Revision received December 12, 2015 Accepted January 12, 2016 Published online June 10, 2016 Luciano Giromini Department of Psychology University of Turin Italy Tel. +39 011 670 3060 E-mail luciano.giromini@unito.it

Summary It has been proposed that the Rorschach human movement (M) response may be associated with activity of the mirror neuron system (MNS), a neurological network responsible for imitation learning, action understanding, and, possibly, empathy. To date, however, this hypothesis has only been explored by two studies measuring EEG markers of MNS activity simultaneous to Rorschach cards presentation. The current study adopted a different approach and tested whether preactivation of the MNS would be associated with increased production of M responses. Thirty students were administered a subset of Rorschach cards immediately after watching three short videos aimed at activating the MNS at three different levels. Video A (no MNS activation) consisted of a fullscreen television static; Video B (low MNS activation) showed three individuals tossing a ball up in the air to themselves; Video C (high MNS activation) showed the same three individuals tossing a ball to each other and occasionally throwing the ball off the screen toward the viewer. Each of the selected Rorschach cards was administered three times, i.e., once following each of the videos. First, one of the videos was presented on a computer screen for 10 seconds. Next, a Rorschach card was administered and the participant’s response transcribed verbatim. Afterward, another video was shown, followed by another Rorschach card, and so forth until the end of the Rorschachiana (2016), 37(1), 58–73

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experiment. We anticipated that the mean number of M would be highest in Condition C and lowest in Condition A, consistent with the idea that pre-activation of the MNS associates with increased production of M responses. To test this hypothesis, a repeated-measures within-subject ANOVA was calculated with M as the dependent variable and the three conditions (A, B, and C) as the three levels of the within-subject factor. The hypothesis itself was tested by examining the linear trend with the expectation that the number of M increase from Condition A to Condition B to Condition C. This linear trend indicating M as progressively more frequent from Condition A to B to C was not significant but could be understood as approaching significance when a nonconservative threshold (α = 0.10) is considered. Also, the partial eta squared value fell in the medium range of suggested benchmarks. In addition to providing information on the M response, this article introduces a new scientific paradigm to investigate the neurological correlates of the Rorschach.

Riassunto È stato ipotizzato che la risposta Movimento Umano (M) al Rorschach potrebbe essere associata all’attività del sistema dei neuroni specchio (MNS), un network neuronale responsabile dell’apprendimento per imitazione, della comprensione delle azioni e, probabilmente, dell’empatia. Ad oggi, comunque, questa ipotesi è stata esplorata solamente da due studi, i quali hanno usato l’EEG per valutare l’attivazione del MNS durante la presentazione delle tavole Rorschach. Il presente studio propone un approccio differente e valuta se la pre-attivazione del sistema dei neuroni specchio possa essere associata ad un incremento della produzione di risposte M. A trenta studenti è stata quindi somministrata una parte del test di Rorschach, immediatamente dopo aver guardato tre brevi video finalizzati all’attivazione del MNS a intensità variabile: il video A (nessuna attivazione del MNS) mostrava uno schermo vuoto; il video B (bassa attivazione) mostrava tre persone che si lanciavano una pallina; il video C (elevata attivazione) mostrava le stesse tre persone che si lanciavano una pallina e che occasionalmente lanciavano la pallina anche contro lo schermo, verso lo spettatore. Ciascuna delle tavole è stata somministrata tre volte, ovvero una volta dopo ciascun video. All’inizio, ogni video veniva mostrato sullo schermo di un computer per 10 secondi. Successivamente, compariva una tavola Rorschach e la risposta dei partecipanti veniva trascritta parola per parola. Dopodiché, un altro video veniva mostrato, seguito da un’altra tavola Rorschach, e così via fino alla fine dell’esperimento. La nostra ipotesi era che la media di risposte M sarebbe stata più alta nella condizione C e più bassa nella condizione A, coerentemente con l’idea che una preattivazione del MNS si associ ad un incremento della produzione di risposte M. Per verificare questa ipotesi, è stata calcolata una ANOVA a misure ripetute, con M come variabile dipendente e le tre condizioni (A,B,C) come i tre livelli del fattore. L’ipotesi in sé è stata testata esaminando il trend lineare dell’ANOVA, in linea con l’aspettativa che il numero di M sarebbe progressivamente aumentato dalla condizione A, alla B, e alla C. Questo andamento lineare, sebbene non sia risultato statisticamente significativo, potrebbe essere inteso come vicino ad un valore significativo se si considera una soglia non conservativa (α = 0.10). Inoltre, il valore della partial η2 può essere considerato come “medio”, secondo i valori di riferimento comunemente adottati. Oltre a fornire informazioni sulla risposta M, questo articolo introduce un nuovo paradigma scientifico per studiare i correlati neurali del Rorschach.

Résumé On a supposé que la réponse de mouvement humain (M) au Rorschach peut être associée à l’activité du système de neurones miroirs (MNS), un réseau neuronal responsable de l’apprentissage © 2016 Hogrefe Publishing

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par imitation, de la compréhension des actions et, probablement, de l’empathie. Toutefois, à ce jour, cette hypothèse a été seulement explorée par deux études, lesquelles ont utilisé le EEG pour évaluer l’activation du MNS pendant la présentation des planches du Rorschach. Cette étude adopte une approche différente et mesure si la pré-activation du système de neurones miroirs serait associée à une augmentation de la production de réponses M. Une partie du test du Rorschach a été administré à trente étudiants, immédiatement après avoir vu trois brèves vidéos visant a activer le MNS à trois niveaux différents: la vidéo A (aucune activation du MNS) était composée d’un écran de télévision statique; la vidéo B (activation basse) exhibait trois personnes lançant une balle en l’air; la vidéo C (activation élevée) exhibait les mêmes personnes lançant une balle entre eux et, occasionnellement, lançant la balle hors écran, vers le spectateur. Chacune des planches sélectionnées a été administrée trois fois, c’est-à-dire une fois après chacune des vidéos. Au début, chaque vidéo a été présentée sur l’écran d’un ordinateur pendant 10 secondes. Ensuite, une planche du Rorschach a été administrée, et la réponse des participants était transcrite mot à mot. Enfin, une autre vidéo a été présentée, suivie d’une autre planche du Rorschach, et ainsi de suite jusqu’à la fin de l’expérience. Nous avons supposé que la moyenne des réponses M serait plus élevée dans la condition C et plus basse dans la condition A, en accord avec l’idée qu’une pré-activation du MNS est associée à une augmentation de la production de réponses M. Pour vérifier cette hypothèse, une ANOVA à mesures répétées a été calculée, avec M comme variable dépendante, et les trois conditions (A, B, C) comme les trois niveaux du facteur. L’hypothèse elle-même a été testée en examinant la tendance linéaire, avec l’attente que le nombre de M serait progressivement augmenté de la condition A à la condition B, et de la condition B à la condition C. Cette tendance linéaire, qui indique M comme progressivement plus fréquent de la condition A à la B à la C, n’était pas significative, mais pourrait être considérée comme proche d’une valeur significative au seuil α = 0.10. De plus, la valeur du partiel η2 était dans la tranche moyenne, selon les valeurs de référence standard. En plus de fournir des informations sur la réponse M, cet article introduit un nouveau paradigme scientifique pour l’étude des corrélats neurologiques du Rorschach.

Resumen Se ha hipotizado que la respuesta del movimiento humano Rorschach (M) podría asociarse con la actividad del sistema de neuronas espejo (MNS), una red neuronal responsable del aprendizaje de imitación, comprensión de acciones y, posiblemente, empatía. Hasta hoy, de todas formas, esta hipótesis ha sido explorada sólo por dos estudios que medían los marcadores de la actividad del MNS simultánea a la presentación de las cartas de Rorschach. El actual estudio ha adoptado una estrategia diferente y ha probado la posibilidad de que la preactivación del MNS pudiera asociarse con una mayor produción de respuestas M. Se suministró un subconjunto del Rorschach a 30 estudiantes inmediatamente después de que hubiesen visto tres vídeos cortos con el objetivo de activar el MNS a tres niveles diferentes. Video A (no activación de MNS) consistió en una televisión estática con pantalla completa (full-screen television static); Video B (baja activación de MNS) mostraba tres individuos que se tiraban una pelota uno al otro y ocasionalmente tiraban la pelota fuera de la pantalla hacia el espectador. Cada una de las cartas del Rorschach seleccionadas se suministró tres veces, i.e. cada una siguiendo cada uno de los vídeos. Primero, uno de los vídeos se presentaba sobre la pantalla de un ordenador durante 10 segundos. Enseguida se suministraba una de las cartas de Rorschach y se transcribía textualmente la respuesta del participante.

Luego, se mostraba otro vídeo seguido de otra carta de Rorschach y así hasta el final del experimento. Hemos supuesto que la media de respuestas M tenía que ser mayor en la condición C y más baja en la condición A, congruente con la idea de que la preactivación del MNs se asocia

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a una mayor producción de respuestas M. Para ensayar esta hipótesis se calcularon ANOVAS en medidas repetidas intra-sujeto con M como variable dependiente y las tres condiciones (A, B y C) como los tres niveles del factor intra-sujeto. La hipótesis misma fue ensayada examinando la tendencia lineal con la previsión de que el número de M aumentase de la condición A a la condición B y a la condición C. Esta tendencia lineal que evidencia cómo M es progresivamente más frecuente que la condición A a la condición B y a la condición C no fue significativo pero se pudo considerar significativo cuando se considera un umbral no conservativo (α=010). también el valor de la parcial η2 puede caer en la gama media de los implicados puntos de referenciaa. Además de aportar información sobre la respuesta M, este artículo introduce un nuevo paradigma científico para investigar las correlaciones neuronales del Rorschach.

要約 ロールシャッハの人間運動反応（M）はミラーニューロンシステム（MNS）の活動性、模倣学習や行為 の理解、そしておそらく感情移入に反応する神経学的ネットワークと関連しているのではないかと提唱されてい る。しかしながら、今日まで、この仮説はたった２つの研究でのみ探求されており、それらの研究ではロ ールシャッハ図版の提示と同時に生じるMNSの活動性を測るEEGのマーカーを測定している。本研究は異 なった接近法を採用しており、MNSのpre-activationがM反応の生成の増加につながるであろうかどうかを 吟味する。30名の学生に、3種類の異なったレベルでMNSを活性化する目的を持った短いビデオを見たの ち、ロールシャッハの一部が施行された。ビデオA（MNSが活性化しない条件）はテレビに全画面表示さ れた静止画から構成されている；ビデオB（MNS低活性化）では3人の人物がボールを自分自身に向 けて空中にトスしている様子を示している；ビデオC（MNS高活性化）ではビデオBと同じ3人がお互いにボ ールをトスしあっており、時折ボールがスクリーンから観察者の方に投げられる。選択されたロールシャッハ図 版は3回、すなわち、それぞれのビデオに続いて一度ずつ、施行される。最初はビデオのうちの一つがコ ンピュータ画面に10秒間提示される。次に、一枚のロールシャッハ図版が提示され、参加者の反応が逐 語的に記録される。その後で、別のビデオが示され、別のロールシャッハ図版が提示され、そして実験 の最後まですすめられる。われわれは、MNSのpre-activationはM反応の生成の増加に関連していると考 えて、Mの平均値は条件Cが最も大きく、条件Aが最も小さいと予想した。この仮説を検証するために、M を独立変数として、3つの条件（A,B,C）を被験者の中の3つのレベルの違いとして、繰り返しありの被験者 要因の分散分析が行われた。この仮説自体は、条件A、B、Cの順でMの数が増えてゆくという線形傾 向を吟味することで検証できる。このMが条件A、B、Cの順に頻度が徐々に大きくなるという線形傾向は 有意ではなかったが、保守的ではない閾値（α=0.10）を考慮した場合に、有意に近いであろうと考える ことができる。また、偏イータ二乗値は推奨されるベンチマークの中間あたりにあたった。M反応を生成す る情報に加えて、ロールシャッハ法の神経学的関係性を調べる新しい科学的パラダイムを本論文は紹介し ている。

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Original Article Special Issue: Neuroscience and the Rorschach

Rorschach Nomological Network and Resting-State Large Scale Brain Networks Introducing a New Research Design Stefania Cristofanelli1, Claudia Pignolo2, Laura Ferro1, Agata Ando’2, and Alessandro Zennaro2 1

Department of Social and Human Science, University of Aosta, Italy

2

Department of Psychology, University of Turin, Italy Abstract: Despite advances in neuroscience, the field of personality assessment has not yet taken full advantage of the progress in neuroimaging techniques. Functional Magnetic Resonance Imaging (fMRI) is one of the most widely used neuroimaging techniques and allows the detection of brain processes and their anatomically detailed correspondences. In the last fifteen years, few studies have developed research designs using the Rorschach test in fMRI settings, analyzing the relationship between Rorschach variables and brain neural circuits. Although their findings were promising, some methodological issues related to fMRI research design have been outlined. Recently, personality neuroscience is emerging as a new field of research that attempts to deepen and refine neurobiological and psychological theories of personality using fMRI in resting state conditions. Recent studies report that resting state networks show a direct relationship with psychological traits. The aim of the present article is to propose a new research design that employs resting-state functional connectivity analyses to explore the brain’s functional architecture in relation to psychological constructs of Rorschach variables related to perceptual styles and personality traits.

Keywords: fMRI, nomological networks, resting state, Rorschach

The nomological network (Cronbach & Meehl, 1955) is a system of laws that relate theoretical constructs to observable data, observable data to each other, and theoretical constructs to each other. This network is necessary for providing a conceptualization of psychological constructs and for highlighting that only a network of meaningful associations between theoretical constructs and observable data may determine the validity of a single variable. For the Rorschach, construct validity concerns the parallel between the construct of interest as measured by Rorschach variables and behaviors and processes involved in the production of coded responses (Bornstein, 2012; Mihura, Meyer, Dimitrascu, & Bombel, 2013). For example, according to the Rorschach literature, human movement (M) responses are a measure of the respondent’s mental abilities, such as empathy, planning, Rorschachiana (2016), 37(1), 74–92 DOI: 10.1027/1192-5604/a000078

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and imagination, because of the implied ability to identify with a human being (Exner, 2003; Exner & Erdberg, 2005; Meyer, Viglione, Mihura, Erard, & Erdberg, 2011; Mihura et al., 2013). Thus, construct validation of M responses should be sustained by the relationship between this Rorschach variable and the construct of empathy. Given the weak relationship between most Rorschach scores and introspective self-reports, recent studies have linked Rorschach variables to findings from the field of cognitive neuroscience. By conducting an EEG study, Giromini, Porcelli, Viglione, Parolin, and Pineda (2010) have shown that EEG mu suppression, a proxy biomarker for mirror neuron activation, occurred concomitantly with the participants attributing human movement to the Rorschach stimuli. Using repetitive transcranial magnetic stimulation (rTMS), a recent study (Ando’ et al., 2015) has shown that temporary disruption of activity in the left inferior frontal gyrus, which is thought to include a large amount of mirror neurons, yielded a statistically significant reduction in the attribution of human movement to the Rorschach cards. These studies demonstrate that neuroimaging and brain stimulation techniques may be employed to investigate construct validity of Rorschach variables.

Functional Magnetic Resonance Imaging (fMRI) is one of the most widely used neuroimaging techniques (Hamilton, Chen, Thomason, Schwartz, & Gotlib, 2011; de Ruiter, Veltman, Phaf, & van Dyck, 2007; Seminowicz et al., 2004; Walter, Berger, & Schnell, 2009). This technique relies on blood flow and blood oxygenation changes (i.e., Blood-Oxygen-Level Dependent [BOLD] signals) occurring in the brain over time, which are closely related to neural activity. Thus, fMRI techniques allow the detection of brain processes and their anatomically detailed correspondences. fMRI studies have been conducted in different experimental fields and, more recently, they have been used to investigate neural correlates of personality structure, measured by psychological tests, within more complex clinical contexts.

The aim of the present paper was to explore and review the literature related to the Rorschach and fMRI in order to introduce a new research design to investigate the construct validity of the Rorschach. The increasing use of neuroimaging techniques, in particular fMRI, has introduced a revolution in terms of research design, since the activation of specific brain areas can be mapped while subjects are performing cognitive tasks (Van Horn & Ishai, 2007). Thus, neuroimaging techniques may be used in a multidisciplinary perspective and may contribute to the study of the neurophysiological substrates of psychological variables associated with the Rorschach. We reviewed the most important findings related to studies in which the Rorschach was administered in a fMRI setting and focused on different issues emerging from the methodology used by the authors.

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Rorschach and fMRI Studies In the last fifteen years, two research groups have developed research designs using the Rorschach in fMRI settings. Kircher and colleagues (Kircher, Brammer, Williams, & McGuire, 2000; Kircher, Liddle, Brammer, Williams, Murray, & McGuire, 2001; Kircher, Liddle, Brammer, Williams, Murray, & McGuire, 2002; Kircher, Brammer, & McGuire, 2005) presented seven Rorschach cards on a screen during fMRI scanning to elicit fluent speech in patients with schizophrenia and in healthy participants. They correlated different components of fluent speech production (e.g., thought-disordered speech, lexical retrieval and articulation, syntax processing) to BOLD signal changes and, thus, investigated the neural correlates of the process of language generation. The authors demonstrated that patients with schizophrenia showed different patterns of brain activation and produced a lesser rate of complex sentences and more thought-disordered speech compared to healthy participants. Despite the fact that the studies mentioned above represent an innovative use of the Rorschach in fMRI settings, the authors did not examine the relationship between Rorschach variables and patterns of brain activation.

More recently, Asari and colleagues (2008, 2010a, 2010b) investigated the interaction between emotion- and perception-related neural circuits during the administration of the Rorschach. The Japanese research group hypothesized that unique responses on the Rorschach were generated by the interference of emotions during perceptive and projective processing (Exner, 2003). Sixty-eight healthy subjects were exposed to the Rorschach during fMRI scanning and were instructed to say what the inkblot looked like. The authors then classified the Rorschach responses as “frequent,” “infrequent,” or “unique” (Form Quality minus, or FQ-), based on the frequency rate of each response in a matched control group. According to Exner, they adopted a frequency criterion of 2% to classify “frequent” (above the criterion) and “infrequent” (below the criterion) responses, whereas “unique” responses were those that did not occur in the control group.

The studies reported by Asari et al. are closely linked together, with each study being based on the findings of the previous one.

The first study (Asari et al., 2008) focused on the neural substrates that underlie unique responses on the Rorschach. Results revealed that unique responses were associated with the activation of the right temporal pole, which is anatomically proximal to limbic structures (e.g., the amygdala). In a recent review (Olson, Plotzker, & Ezzyat, 2007), the temporal pole has been considered as a paralimbic region and is related to the social and emotional processing of sensory stimuli, to the storage of perception–emotion linkages, and to personal semantic memory.

Given the link found by the authors between unique (FQ-) responses, temporal Rorschachiana (2016), 37(1), 74–92

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pole functions, and the anatomically proximal amygdala, Asari and colleagues hypothesized that unique perception on the Rorschach may be produced by the integration of emotional and perceptual processes.

In the second study (Asari et al., 2010a), based on the anatomical proximity of the amygdala to the temporal lobe and in accordance with the literature, they tested the hypothesis that amygdala volume was related to the production of unique responses on the Rorschach. They found a positive correlation between the unique response ratio (URR; i.e., the number of unique responses divided by the total number of responses), c volume, and other components of the limbic system (e.g., cingulate gyri, which is involved in emotional processing). Thus, results seemed to indicate that emotion-related neural circuits (in particular the limbic system) might underlie the frequent production of unique perception and FQ- responses to the inkblot stimuli. In the third and last study (Asari et al., 2010b), and based on previous results, Asari et al. investigated whether the amygdala was involved in the modulation of the cortical network while participants were involved in the task of finding suitable representations to the inkblot stimuli.

The Rorschach variable WSumC (i.e., the weighted sum of responses determined by color) was used as a score for emotional sensitivity. A positive correlation between the URR and WSumC was found, indicating that emotion may play a role in the perception of unique and uncommon percepts on the Rorschach. Moreover, results revealed a significant modulatory effect of the amygdala on the temporopolar region, confirming the interference of emotion on perception during the Rorschach task.

Despite the fact that the abovementioned findings were promising, some methodological issues related to fMRI research design deserve mentioning. The main limitation of using fMRI techniques has to do with the numerous artefacts generated, which can lead to errors in analyzing the results. Firstly, significant scanner noise may undermine the ecological validity of the performance of the subject.

For example, subjects may not be able to hear themselves speak clearly. However, Kircher et al. (2005) reported that all participants were able to hear themselves speak in spite of the noise. Secondly, the principal issue related to overt speech responses during fMRI scan concerns artefacts associated with head motion and air volume changes in the sinus cavities and in the pharynx during phonation.

The head-motion correction during fluent speech has recently become a real matter of debate because it has been shown that inadequate correction for these artefacts can result in spurious correlations in many fMRI analyses (Lee & Therriault, 2013). Thus, researchers need to quantify and control for head movements to manage this methodological issue. Thirdly, the method of defining the neural regions of interest (ROI) has been reported by Asari et al (2010b) as a methodological concern. The ROI is a subset of an image or a dataset of cerebral regions Š 2016 Hogrefe Publishing

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identified to test a particular hypothesis. Previous neuroimaging studies investigating personality that have used an a priori selection of ROI (Adelstein et al., 2011; Canli, Amin, Haas, Omura, & Constable, 2004; DeYoung, 2010; Eisenberger, Lieberman, & Satpute, 2005; Kumari et al., 2007; Wright et al., 2006) identified this condition as a methodological limitation considering the complexity of the construct investigated: personality traits. Given that personality traits are associated with extended distributed networks of regions, rather than being localized in a few specific regions, dynamic interactions of large-scale networks, including low-level sensory and high-order cognitive brain regions, form the basis of complex thought and behavior (Adelstein et al., 2011). Thus, the inclusion of largescale data-driven methods is necessary to investigate the neural correlates of personality traits more comprehensively (Kunisato et al., 2011). Lastly, the administration of the Rorschach is no longer standardized. The plates are presented on a screen and, because subjects are not allowed to move, they cannot hold and rotate the cards. Moreover, the inquiry is not conducted, so analyses are based solely on spontaneous responses. Asari et al. (2008, 2010a, 2010b) tried to bypass these limitations by providing participants with a MRI-compatible button press, so that they were able to rotate the image while in the scanner. Furthermore, the authors conducted post-experimental interviews outside the scanner to inquire as to where the percepts were seen.

Introducing a New Research Design Recently, personality neuroscience is emerging as a new field of research that attempts to link biological variables to existing stable patterns of emotion, cognition, motivation, and behavior (Canli, 2008; DeYoung, 2010, DeYoug & Gray, 2009). The aim of personality neuroscience is to deepen and refine neurobiological and psychological theories of personality using techniques such as fMRI in resting state conditions (Ciuciu, Varoquaux, Abry, Sadaghiani, & Kleinschmidt, 2012; Lei, Yang, & Wu, 2015). Personality neuroscience “entails the examination of how variability among individuals on cognitive, emotional, motivational, or behavioral dimensions (e.g., extraversion, intelligence, empathic ability) is related to neural variables” (Mar, Spreng, & DeYoung, 2013, p. 674). However, personality constructs underlying numerous personality tests, and the Rorschach in particular, are explained by a pattern of various underlying factors that mostly vary together.

Early research conducted on the detection of cognitive and somatosensory brain processes (de Ruiter et al. 2007; Hamilton et al. 2011; Seminowicz et al., 2004; Walter et al., 2009) have mainly investigated aspects of functional segregation.

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However, a change in perspective has been introduced, so that recent literature has focused on the study of functional integration and patterns of brain connectivity, instead of investigating aspects of functional segregation and isolating regions functionally specialized in performing specific tasks. Moreover, given that several studies of cerebral metabolism (Raichle & Gusnard, 2002; Raichle et al., 2001) revealed a low energy increment of cerebral task activity (about 0.5–1.0%) compared to resting state conditions (about 60–80%), the examination of resting state neural activity has been introduced. In order to outline a new research design allowing us to better understand the psychological functions underlying Rorschach variables, we examined the concept of cerebral intrinsic activity, resting-state, and large scale resting state brain networks (rs-lsbn).

Resting-state neuroimaging is based on the identification of low-frequency spontaneous fluctuations in broad cerebral areas while the subject does not perform a specific task. A large part of the daily activities of the mind are internal and performed without external stimuli (Buckner & Vincent, 2007). During this particular state of consciousness, the subject is monitoring information such as feelings and body position, free association of thoughts that relate to past experience, inner speech, mental images, emotions, working memory, and planning for future events (Bar, 2009; Carhart-Harris & Friston, 2010; Raichle, 2010; Shulman, Hyder, & Rothman, 2009). The brain at rest, then, engages in intrinsic activity, defined in the literature as the default mode network (DMN), baseline state, and conscious resting-state (Raichle & Snyder, 2007). The DMN consists of spontaneous and simultaneous neuronal oscillations of anatomically segregated areas of the brain that are more metabolically active at rest when a person is not focused on external demand. Thus, the DMN turns off during goal-oriented activity and the task positive network (TPN) is activated.

In addition to the DMN, the literature has highlighted the presence of important rs-lsbn with visual, motor, linguistic and attentive functions at rest (Raichle et al., 2001). Several of the most recent resting-state networks studies have in fact reported inter-individual differences in functional intrinsic connectivity related to psychological traits, such as social competence (Di Martino et al. 2009), risktaking (Cox et al., 2010), aggression (Hoptman et al., 2009), and cognitive efficiency (Andrews-Hanna et al., 2007). Although there is still a lack of complete agreement with regard to what could be a unique measure of rs-lsbn and the data are continuously updated, 10–11 principal networks have been identified (Rosazza & Minati, 2011): DMN, sensorimotor component, executive control component, visual components, auditory component, temporo-parietal component, and lateralized fronto-parietal components.

Currently, resting-state fMRI has been extensively used in neuroscience because of its advantages (He, 2011; Lei et al., 2015; Lei, Zao, & Chen, 2013; Smith et al., © 2016 Hogrefe Publishing

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2009). The most important requisite of resting-state spontaneous oscillations is their high test-retest reliability, indicating that rs patterns are stable across time (DeYoung et al., 2010; Van Dijk et al., 2009; Zuo et al., 2010). Moreover, this technique allows the detection of a wide range of brain regions correlated with psychological traits simultaneously (Lei et al. 2015). Crucial to introducing our innovative research design is the finding that most of the major brain networks that are involved in a task are also detectable in the brain at rest, and that these patterns are impressively similar to the networks activated by a wide spectrum of cognitive-behavioral tasks (Laird et al., 2011; Smith et al., 2009). Moreover, models of functional connectivity during rest summarize coactivation patterns that reflect individual history and experience (Sporns, 2013). Recent experiences, as well as consolidated abilities, may leave a “memory trace” within brain function and spontaneous fluctuations may be involved in the process of memory consolidation.

Recent studies in personality neuroscience hypothesized that rs-lsbn may have a direct relationship with psychological traits (Adelstein et al., 2011; Canli, 2004; DeYoung et al., 2010; Lei et al., 2013). In a very recent study, resting-state neuroimaging was employed as a powerful tool to analyze the brain structure and the neuronal correlates of the Big-Five constructs and extraversion-introversion traits (Lei et al., 2015). Researchers found a significant relationship between the DMN and Extraversion. Moreover, Adelstein and colleagues (2011) found that personality domains measured by the NEO-PI-R (Costa & McCrae, 1992) correctly predicted resting-state functional connectivity (RSFC) between hypothesized patterns of regions. In particular, Neuroticism predicted RSFC involved in selfreferential processing, emotional regulation, and fearful anticipation; Extraversion predicted RSFC involved in social attention, face recognition, motivation and reward; Openess to Experience predicted RSFC implicated in working memory and creativity; Agreeableness predicted RSFC involved in social and emotional attention; Conscientiousness predicted RSFC implicated in planning and futureoriented episodic judgment. Generally, personality neuroscience studies confirmed the utility of examining the synchronous cerebral connectivity at rest to identify neural markers of complex traits, such as personality traits.

On the basis of the aforementioned neuroimaging evidence, we have highlighted that rs-lsbns appear to be linked to psychological functioning and to specific personality features. Based on these findings, we propose a new research design that employs RSFC analyses to explore the brain’s functional architecture in relation to psychological constructs of Rorschach variables related to perceptual styles and personality traits. In this research design, each fMRI scan should be a measure taken in rest condition and participants should be instructed to rest with their eyes open in passive fixation. The administration of the Rorschach would be Rorschachiana (2016), 37(1), 74–92

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assessed outside the fMRI scanner, ensuring a more ecological setting, and the cerebral intrinsic activity would be analyzed without a task condition. Therefore, this new research design would allow bypassing most of the critical issues related to the administration of the Rorschach during fMRI scans. Moreover, investigating resting states would allow researchers to avoid artefacts related to phonation, fluent speech, and movements of the head.

At this point, our attention should be directed to formulating hypotheses about Rorschach variables (Exner, 2003). As we discussed above, resting state patterns are stable over time and recent research has related these patterns to personality traits. Thus, the first group of hypotheses concerns the relationship between the RSFC analyses identified by Adelstein and colleagues (2011) and Rorschach variables considered to identify trait characteristics. The intrinsic connectivity between regions involved in the evaluation of self and others, as well as in socially directed thought, such as determining or inferring the purpose of others actions (dorsomedial prefrontal cortex of the DMN), may be predicted by Rorschach variables from the Self Perception and Interpersonal Perception clusters. Moreover, Affect cluster variables (particularly WSumC) may predict the intrinsic connectivity between regions involved in the processing of positive emotions (orbitofrontal cortex, insula, and amygdala areas; Lei et al., 2015), as well as the processing of reward and motivation (DeYoung et al., 2010). We also hypothesize a negative correlation between a high lambda style and regions involved in cognitive flexibility (anterior cingulate cortex and dorsolateral prefrontal cortex; DeYoung et al., 2009; Jung et al., 2010). Particularly, variables of Interpersonal Perception and the Coping Deficit Index (CDI) may predict connectivity with regions involved in altruism and social information processing (cortex and posterior temporal cortex; Kober et al., 2008). Finally, we hypothesize that the Controls cluster may predict the activity of regions involved in planning and self-discipline (lateral prefrontal cortex and medial temporal lobe; DeYoung & Gray 2009; DeYoung et al., 2010).

Further hypotheses may arise from the recent resting state literature related to specific diagnostic groups. For example, the DMN has been investigated in patients with schizophrenia. Broyd et al. (2009) reported that weak regulations of competition between the DMN and the task-positive network in patients with schizophrenia reflected over-mentalizing and excessive vigilance to the external environment. Therefore, a suitable hypothesis would be that of a relationship between excessive competitions between networks and the Hypervigilance Index (HVI). Moreover, increased connectivity between the DMN and other resting state networks is associated with attention deficits related to the intrusive role of hallucinations and delusional experiences. This last finding may contribute to the hypothesis of a relationship between increased connectivity and the Š 2016 Hogrefe Publishing

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Perceptual-Thinking Index (PTI). The DMN has also been associated with depression and anxiety (Broyd et al., 2009). It is involved in free mental processes and in cognitively passive tasks. Its activation correlates with the human ability to roam with the mind, to think about past experiences, or to imagine the future (Rosazza & Minati, 2011). DMN connectivity is related to ruminative and self-referential thinking, and patients with depressive mood disorders show increased functional connectivity in affective regions (e.g., the thalamus) that may interfere with cognitive processing (Greicius, Supekar, Menon, & Dougherty, 2009). Consistently, Sheline et al. (2010) found that people with a diagnosis of depression presented deficiency in the suppression of the DMN (particularly the medial prefrontal cortex) and that they experienced long periods of intense negative rumination. These findings suggest a relationship between increased functional connectivity or deficit in the suppression of the DMN and Vista (V) responses, as well as a higher score on the Depression Index (DEPI).

Using fMRI techniques to investigate construct validity in the psychological and clinical domains is a recent field of research developed over the past 20 years. The research design presented here seems to us of particular interest for future studies in the field of resting-state fMRI, which has not yet been sufficiently explored in relation to psychological testing in general, and to the Rorschach test in particular.

The aim of this new research design is to identify the latent structures that shape the resting-state lsbn and that simultaneously predict Rorschach variables. This research design would ensure methodological rigor of the standardized administration of the Rorschach in a more “natural” setting, and may avoid technical artefacts related to the sources of noise involved in fMRI. To our knowledge, the Rorschach and fMRI literature has not yet explored the relationship between neural correlates detected during the recording of intrinsic activity at rest and Rorschach variables. Thus, correlating resting-state networks to Rorschach variables may contribute to the growing literature on the validity of the Rorschach and may provide a biological foundation for some Rorschach variables.

Conclusion How can neuroimaging techniques be concretely of use with respect to issues so far articulated? Is it possible to contribute to the Rorschach nomological network through the analysis of resting-state large-scale brain networks? Cognitive psychology has long adopted neuroimaging techniques to study brain functioning at the level of simple phenomena, such as memory, language, or sensorimotor tasks, but exploring more complex phenomena, such as psychopathology and Rorschachiana (2016), 37(1), 74–92

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personality, is more challenging. Neuroscience and clinical psychology have often traveled in parallel, avoiding possible points of contact but are often moving in the same direction. Indeed, on closer inspection, this fracture was in part a consequence of Freud’s “failed attempt” to substantiate his theory through the use of neuroscience, hampered by a lack of appropriate tools (Northoff, 2012a, 2012b).

From this point of view, it is likely that Freud would today be very interested in neuroscience and that he would finally have available tools to investigate the psyche in more sophisticated ways. On the other hand, Pulver (2003) draws attention to the importance of having realistic expectations with regard to the potentiality of neuroscience. Faced with a technology enabling the observation of the brain in vivo and providing us with images of its functioning, we risk falling into the opposite error of that mentioned above, considering that neuroimaging is to mental health what radiography is to a bone fracture. In this case, beyond the initial blind enthusiasm for the potential of neuroimaging (McCabe & Castel, 2008), the risk would be a subsequent total distrust. So what is the correct position?

Rather than talking about a correct position, we could talk about a beneficial location.

It seems, in fact, that these two paths will cross at a point beyond which, in order to make progress together, they will need each other. Clinical approaches formulate theories to explain psychological phenomena; neuroscience shows the brain functions that underlie these processes and human behavior by providing access to information that would otherwise not be available. Fonagy and Target (2003), speaking of clinical and research approaches, consider that we should not see a evolutionary relationship between conceptual research (which generates hypotheses) and empirical research (which evaluates assumptions), but rather a complementary one. One could consider these two positions as being in a state of reciprocal tension: each induces the other to clarify itself. From those premises it is our opinion, therefore, that the progressive development of neuroimaging techniques, both with respect to the accuracy and to the enlargement of the objectives of investigation, can effectively contribute to the development of knowledge in psychopathology and psychodiagnosis. This could help put both the Rorschach and the dialogue between neuroscience and clinical practice, as well as the relationship between mind and brain, in a new light.

In conclusion, in the present review we aimed to investigate how neuroimaging and brain stimulation techniques may contribute to the development of knowledge about the psychological functions underlying Rorschach variables. The innovative research design that we have proposed and discussed may significantly contribute to the nomological network of the Rorschach. However, some limitations are worth noting. First, within the field of neuroscience, it is still not clear which are the specific psychological functions involved in resting state networks © 2016 Hogrefe Publishing

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(Read et al., 2010). Second, given that Rorschach variables tap both implicit and explicit psychological processes, the constructs related to Rorschach variables are not easy to define. As Mihura and colleagues (2012) stated in their recent metaanalysis of Rorschach variables: Appropriate criteria in the nomological network for Rorschach variables need to be specified to parallel the performance-based coding of inkblot-delimited attribution and behaviors […] The coding of these response behaviors produces valid constructs but also constructs that are uniquely shaped (and limited) by the task. (Mihura et al., 2012, p. 32) Acknowledgments We thank Philip Erdberg for his comments on an earlier draft of this article.

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Reliable intrinsic connectivity networks: Test-retest evaluation using ICA and dual regression approach. Neuroimage, 49(3), 2163–2177. doi: 10.1016/j.neuroimage. 2009.10.080 Received March 8, 2015 Revision received December 23, 2015 Accepted January 12, 2016 Published online June 10, 2016 Stefania Cristofanelli Department of Social and Human Science University of Aosta Strada Cappuccini 2A 11100 Aosta Italy E-mail s.cristofanelli@univda.it

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Summary Neuroscience and clinical psychology have often traveled in parallel, avoiding possible points of contact but often moving in the same direction, at least because they are anchored to each other by having a common object of study: the human mind and its manifestations. Recently, neuroimaging techniques have completely revolutionized the way we conceive the study of the brain, allowing us to switch from an anatomical-segregation position to a more functional integration view of brain mechanisms, based on networks between various cerebral areas not necessarily anatomically close to each other. The aim of this article was to explore and review the neuroimaging fMRI literature on the Rorschach in order to contribute to the knowledge base on psychological and personality traits that form the basis of the Rorschach. Therefore, we point out the principal methodological issues related to free flow speech responses during scanning and artefacts associated with head motion and changes in the sinus cavities and the pharynx during phonation. The conscious resting state in humans is supported by an extensive network of associative parietal areas that can be further hierarchically organized in a network of fronto-parietal working memory, driven in part by emotions, and working under the supervision of prefrontal executive networks. At rest, in addition to the default mode network (DMN), the literature reports the presence of other important networks with visual, motor, linguistic, and attentive functions. Indeed, these networks seem to be linked to the psychological functioning of individuals. Crucially, most of the networks detectable in the brain involved in a task are also identifiable in the brain at rest. Thus, we introduce a resting state fMRI research design to compare the diagnostic meaning of some Rorschach variables and the structure and functions of resting-state state brain networks (rs-lsbn). Specifically, we aimed to relate Rorschach variables to rs-lsbn by using fMRI to analyze cerebral intrinsic activity. With this research design, the administration of the Rorschach test (The Comprehensive System, Exner, 1993) would take place outside the fMRI. This condition would allow the bypassing of important methodological limitations, such as the presence of fMRI artefacts during fluent speech, the non-ecological setting for Rorschach administration, and, finally, the low temporal resolution due to the nature of the BOLD signal detected during scanning.

Sintesi Neuroscienze e psicologia clinica hanno spesso viaggiato parallelamente, evitando il più possibile punti di contatto ma muovendosi tuttavia molto spesso nella stessa direzione, se non altro perché ancorate l’una all’altra dal fatto di avere un comune oggetto di studio: la mente umana e le sue manifestazioni. Attualmente le tecniche di neuroimaging hanno completamente rivoluzionato il modo di concepire lo studio del cervello, consentendo di passare da una posizione di segregazione anatomica ad una visione del cervello e dei suoi meccanismi di connettività funzionale più ampia, basata cioè sui network di aree cerebrali non necessariamente anatomicamente contigue. L’obiettivo di questo articolo è di esplorare e percorrere nell’ambito della letteratura sul neuroimaging una revisione degli studi condotti con l’utilizzo dell’fMRI e il test di Rorschach, al fine di contribuire allo sviluppo delle conoscenze relative al funzionamento mentale e di personalità che stanno alla base del test. Abbiamo dunque sottolineato le principali criticità ed i problemi metodologici relativi all’analisi del fluire libero dell’eloquio durante una scansione fMRI e agli artefatti associati al movimento del capo e alla fonazione. L’esistenza di stati consci di resting state negli individui è supportata in letteratura dall’individuazione di un’estesa rete associativa di aree parietali gerarchicamente organizzata in una rete fronto-parietale di working memory, guidata in parte dalle componenti emotive, sotto la supervisione di una rete prefrontale esecutiva. In condizioni di rest, oltre

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al DMN, la letteratura evidenzia la presenza di altri importanti network con funzioni visive, motorie, linguistiche ed attentive che risultano essere collegati con il funzionamento psicologico. Il dato più interessante consiste nel fatto che la maggior parte dei network che sono rilevabili nel cervello durante l’esecuzione di un compito possono essere identificati nel cervello anche in condizioni di rest. Abbiamo dunque proposto un nuovo disegno di ricerca in cui alcune variabili Rorschach possono essere messe in relazione con i resting-state state brain networks (rs-lsbn), identificati attraverso l’uso della fMRI per analizzare l’attività cerebrale intrinseca. Questo disegno di ricerca prevede che la somministrazione del test di Rorschach sia condotta all’esterno dello scanner, consentendo in questo modo pertanto di evitare le limitazioni metodologiche relative agli artefatti implicati nell’analisi del fluent speech durante la somministrazione del test in macchina, le caratteristiche scarsamente ecologiche di tale setting di assessment ed infine la bassa risoluzione temporale da attribuire alla natura intrinseca del segnale BOLD durante la rilevazione del fluire libero dell’eloquio.

Résumé La neuroscience et la psychologie clinique ont souvent voyagé en parallèle, évitant les points de contact possibles, mais se déplaçant souvent dans une même direction, étant liées l’une à l’autre par un objet d’étude commun: l’esprit humain et ses manifestations. Les techniques de neuro-imagerie ont complètement révolutionné la façon dont nous concevons l’étude du cerveau et nous permettent de commuter entre une position de ségrégation anatomique et une vue plus fonctionnelle des mécanismes cérébraux, basée sur les réseaux entre aires cérébrales diverses.

L’objectif de cet article est d’effectuer une revue de la littérature sur la neuro-imagerie et les études cliniques réalisées avec l’imagerie par résonance magnétique fonctionnelle (IRMf), afin de contribuer au développement de la connaissance relative au fonctionnement mental et de personnalité basé sur le test du Rorschach. Nous avons donc souligné les principales difficultés et les problèmes méthodologiques relatifs à l’analyse du flux libre de l’élocution pendant l’examen d’IRMf, ainsi qu’aux artéfacts associés au mouvement de la tête et à la phonation pendant cet examen. L’existence d’états conscients de repos (“resting state”) chez les individus est abordé dans la littérature par la découverte d’un vaste réseau associatif des zones pariétales organisées hiérarchiquement dans un réseau fronto-pariétal de la mémoire de travail, dirigé en partie par des composantes émotionnelles, et sous la supervision d’un réseau exécutif préfrontal. Pendant les conditions de repos, en plus du réseau du mode par défaut (RMD), la littérature signale la présence d’autres réseaux importants avec fonctions visuelles, mnésiques, linguistiques et d’attention qui sont liées au fonctionnement psychologique. L’élément le plus intéressant est le fait que la plupart des réseaux qui sont détectables dans le cerveau pendant l’exécution d’une tâche peuvent être identifiés dans le cerveau également dans des conditions de repos. Nous avons donc proposé une nouvelle méthodologie de recherche dans laquelle les variables Rorschach peuvent être mises en relation avec les réseaux détectables en condition de repos, identifiés en utilisant l’IRMf pour analyser l’activité cérébrale intrinsèque. Cette méthodologie de recherche prévoit que l’administration du Rorschach soit effectuée à l’extérieur de l’appareil IRMf, permettant ainsi d’éviter les problèmes méthodologiques relatifs aux artefacts liés à l’administration du test dans le scanner, aux caractéristiques peu écologiques de ce contexte d’évaluation, et enfin à la basse résolution temporelle du signal BOLD pendant des tâches de fluence verbale et d’élocution libre.

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Resumen Neurociencia y psicologia clinica a menudo han viajado en paralelo, evitando lo mas posible puntos de contacto pero al mismo tiempo moviendose en la misma direccion, eso porque estan conectadas por el mismo objeto de estudio: la mente humana y sus manifestaciones. Actualmente las tecnicas de neuroimaging ha revolucionado totalmente la forma en que se concibe el estudio del cerebro, permitiendo el pasaje desde una posicion de segregacion anatomica hasta una vision del cerebro y de sus mecanismos de connexion funzionales mas ancha. El objetivo de este papel es el de explorar y actuar una revision de la literatura sobre el neuroimaging y los estudios del fMRI y del test de Rorschach, para contribuir al avanzamento del conoscimento del funcionamiento mental y de personalidad que rapresentan la base del test. Entonces hemos estresado las principales criticidad y los problemas metodologicos del analisis del libre flujo del discurso durante una sesion de fMRI y los artefactos conectados al movimento de la cabeza y a la fonacion. La existencia de estrado consientes de resting state en las personas està apoyada el la lecteratura por la individuaccion de una larga red de asociasion de las areas parietal organizada jerárquicamente en una red fronto-parietal de working memory, conducida en parte por las componentes emotivas, bajo la supervision de una red prefrontal esecutiva. En condiciones de rest, mas que al DMN, la literatura maestra la presenzia de otros importantes networks con funciones visivas, motorias, linguisticas y de atencion que estan conectados con el funzionamento psicologico. El dado mas interesante es el hecho que la majoria de los networks que se pueden detectar en el cerebro durante la ejecucion de una tarea puden ser identificados en el cerebro tambien en condiccion de rest. Entonces hemos propuesto un nuevo debujo de busqueta en que algunas variables Rorschach pueden ser puestas en relation con los networks detectados en condicciones de rest (rs-lsbn), identificados a travez de la analisis de la acrtividad cerebrales intrinseca. Este debujo de busqueta implica que la administracion del test de Rorschach sea hecha fuera de lo scanner, permitiendo aci de evitar las limitaciones metodologicas cerca los artefactos implicados el la analisis del fluent speech en la administracion del test en la machina, las caracteristicas poco ecologicas de este setting de assessment y ademas la baja resolucion temporal que se pueden atribuir a la natura de la senal BOLD durante la rilavacion del flujo libre del discurso.

要約 神経科学と臨床心理学はしばしば平行線の経緯をたどっており、少なくとも共通する研究の目的（人間の心 とそれを明らかにすること）を有していることでお互い固定しあっているので、同じ方向に進んでいるのである が、接触点を回避している。近年、神経画像処理の技術が、われわれが脳の研究方法について考える 方法について完全な革命を起こし、多様な知的領域の間のネットワークにもとづいて、お互いに解剖学的に 近接している必要はないが、われわれが解剖学的-分離からより脳のメカニズムの機能的統合の観点に切り 替えることを可能にした。この論文の目的は、ロールシャッハ法の基礎を形作っている心理学的特性や性格 特性の知識の発展に貢献するために、ロールシャッハ法についてのfMRIの神経画像処理の文献を調査 し、整理することである。それゆえ、われわれは図版を走査している間の自由な流れの話で反応することに 関連している方法論的な問題や、発声の際の頭の動きや洞腔内や咽頭内における変化に関連している偽 所見の問題を指摘している。人間の意識的に休んでいる状態では、頭頂連語野における広範なネットワ ークにサポートされており、頭頂連合野は前頭頂部のワーキングメモリーのネットワークにおいてはるかに階層 的に組織化されており、部分的に情緒に動かされ、前頭葉にある実行系ネットワークのもとで作用してい る。安静時には、デフォルトモードネットワーク（DMN）に加えて、文献によると視覚、運動、言語、注 視の機能についての他の重要なネットワークの存在が報告されている。実際、これらのネットワークは個人の 心理学的な機能と連結してようである。非常に重要なことに、課題をおこなっている脳において検出すること が可能である大部分のネットワークはまた安静時の脳において同定することができる。それゆえ、われわれ © 2016 Hogrefe Publishing

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は安静時fMRI研究デザインを、いくつかのロールシャッハ変数の診断的意味や安静時の脳のネットワーク （rs-lsbn）の構造や機能と比較するために紹介する。明確に言うとすれば、われわれはロールシャッハの 変数とfMRIをもちいたrs-lsbnと関連付けて脳に固有の活動を分析することを目的にしている。研究デザイン について言うと、ロールシャッハ法（CS、Exner,1993）の施行がfMRIとは別に行われた。この条件は、 ロールシャッハ施行の間の流ちょうな発話や非生態学的なセッテングの間のfMRIといった人工物の存在のよ うな方法論的問題、そして、最終的には走査している間のBOLDシグナル性質による低い時間分解能を回 避することを許容するであろう。

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© 2016 Hogrefe Publishing