PSI Journal 2016 by MPSA Undergraduate Research Journal

PSI vi

2016

This year's cover art brings the realm of psychology back to its roots, while reminding us of how far the field has come. The divide of the hemispheres represents the long-standing yet inaccurate traditional realm of right-brain vs. left-brain functioning. The decorative trail of blossoms juxtaposed with the mechanics on the opposing side represent the nature vs. nurture components of this astounding organ. While the gears symbolizes our learning of the intricacies of the brain, the lock and key mechanisms remind us of the many secrets it holds that we are still working to uncover. With the research showcased in this issue, we hope to shed light on some of these hidden mysteries. 2

2016

PSI McGill Undergraduate Psychology Journal

Issue VI

March 2016 ISSN 1929-2414

2016

Foreword

Dear Reader, On behalf of the faculty of the Department of Psychology of McGill University, I am pleased to salute the editorial staff and students who are participating in the 6th edition of the McGill Psychology Studentsâ&#x20AC;&#x2122; Association Journal. I want to particularly highlight the efforts of Saloni Singh, editor and chief whose tireless efforts made this edition possible.

This edition surpasses previous editions in all respects. The fifteen articles reflect the increasing levels of participation of undergraduate psychology students at McGill in the research enterprise. While our students have been carrying out research for many years, they are now able to publish their results. Writing up one's research and gaining experience with the publication process is an important research skill; I'm pleased that it can begin at the undergraduate level. Many of the current authors will go on to distinguished research careers and I'm sure they will treasure their first publication.

I'm particularly impressed with the breadth and quality of research reported in this edition. The current articles deal with topics as diverse as sexual arousal, pain, weight loss, pupillometry and per-

sonal autonomy. Many of the initial findings reported in this edition will provide important data for future research programs and grants.

Irving Binik Professor and Journal Academic Advisor Department of Psychology McGill University

2016

Acknowledgements This journal would not have been possible without the effort and commitment of everyone involved. In particular, we would like to thank:

The Arts Undergraduate Society, for providing us with the funding that has allowed us to print this journal Professor Irving Binik, for his invaluable advice about various aspects of the journal The executive team of the McGill Psychology Studentâ&#x20AC;&#x2122;s Association, for supporting PSI at every step of the way

2016

Journal Team Journal Coordinator

Saloni Singh

Managing Editor

Maria Leis

Editorial Board

Aditi Bali Anis Farid Caroline Van den Eynde Cleo Bertrand

Emma Stewart Enya Sclapari Jennifer Burns Lauren Manoukian Michelle Azzi Yujin Kang

Layout Editor

Jonathan Doherty

Cover Artist

Myriam Lecousy

2016

Table of Contents

The Role of Specificity in Implementation of Intention Planning for Weight Loss

9 23

Success Farah Islam

Investigating the Leader-Member Exchange Recipe for Job Satisfaction: Is the Active ingredient Autonomy Support? Marie-Catherine Mignault

Relationship Satisfaction and Perceived Partner Support as Predictors of Motivation for Treatment in Women with Eating Disorders Ariane Sophie Marion Jetten

47 64 80 95

The Effects of Epistemic Need on Engagement in Dysfunctional Norms Holly Engstrom

Variability in Communal Behavior as a Mediator of the Effect of Attachment

Anxiety on Relationship Satisfaction Bayley Taple

Examining the Underlying Mechanisms and Psychological Factors Implicated in Dynamic Measures of Pain Tricia Gower

Social Reward Leads to Value-Driven Shifts of Attention Kathleen Stewart

2016

106

An Investigation of the Relationship between Neural Network Activation and Sexual Concordance in Men and Women Jennifer Lee

124

Male Pedophilia: Disease of the Brain or Strong Sexual Desire towards Children? Pauline Vitte

134 152

The Relationship between Gender, Income, and Sleep in School-Aged Children Anastasiya Voloshyn

Reaching for the top: Pressures Towards Perfection-Striving in a University Setting AndrĂŠ St-Jacques

Is There an Anxiety Gene?: A Review of the Serotonergic System and its Implica-

169

tions for Neuroticism Andrea Boza, Michael Haichin, Ariane Marion Jetten Antonia Trendafilova, and Emma Whitehall

184

Pupillometry as a Vehicle to Elucidate Misdirection: Paying Attention to Magic Jane Zhang

202 213

Comparing and Contrasting Housing Interventions for Persons with SMI Natalie Winicov

Role Models and Self-Regulation Serena Mennitto

2016

The Role of Specificity in Implementation of Intention Planning for Weight Loss Success

Farah Islam Supervisor: Dr. Bärbel Knäuper

Abstract The purpose of the current study is to investigate the effects of implementation intentions (IIs) for physical activity on weight loss in an overweight/obese population (BMI range of 28 to 45 kg/m , waist circumference ≥ 88 for women, ≥ 102 for men) partaking in the 2

McGill CHIP Healthy Weight Program, a lifestyle behaviour change program. We hypothesize that the higher the level of specificity of the IIs (i.e., degree of II detail), the more effective the II will be (i.e., lead to greater weight loss), Furthermore, we predict that both the specificity of the cues and the response matter for the effectiveness of II on weight loss. A total of 420 IIs from 34 participants who have completed the entire program (22 sessions) were used for analyses. Results found that there is no relationship between level of specificity of II and effective weight loss. Furthermore, there seems to be no effect of either components of II (i.e. the “if” and the “then” component) on achieving weight loss.

Keywords: implementation intentions, specificity, physical activity, weight loss

2016 Introduction It is estimated that currently over half of Ca-

1993; 1999). Essentially, II link anticipated critical situations to goal directed responses (i.e.

nadians (54%) are overweight or obese (BMI of 28 “Whenever situation X arises, then I will do Y!”) to 45 kg/m , waist circumference ≥ 88 for women, and have been shown to successfully promote the 2

≥ 102 for men) (Statistics Canada, 2015). Over-

initiation and attainment of goals (Gallo &

weight and obesity have become a leading public Gollwitzer, 2007; Gollwitzer, 1999). II allow indihealth concern in Canada because they are asso- viduals to translate their goals into actions beciated with an increased risk of various health

cause a mental link is created between the spe-

problems, including type 2 diabetes, hyperten-

cific cue situation (the “if” part) and the intended

sion, coronary artery disease and stroke, respira-

goal-directed response behaviour (the “then”

tory effects, cancers, and liver and gallbladder

part). For instance, if one is trying to develop

disease (Kopelman, 2007). Although many peo-

healthier eating habits, then one might create an

ple are trying to lose weight, most usually resort

II such as: “If I am watching television after din-

to quick-fix weight loss programs, which are

ner, then I will eat an apple instead of chips!”

based on a very-low calorie diet. Although such

Here, the critical situation entails the “If I am

approaches can lead to success in the short-term, watching television after dinner” part, while the goal-directed behaviour is limiting the future seindividuals quickly revert back to their original weight once the diet is over (Shai & Stampfer,

lection of choices to “then I will eat an apple in-

2008). A major factor accounting for this phe-

stead of chips” (Gollwitzer, 1999). By forming

nomenon is that although it is relatively easy for

these II, the mental representation of the “cue”

an individual to form goals targeted towards a

situation becomes highly activated, allowing for

healthier lifestyle and even achieve the first few

easy detection, recall, as well as immediate and

steps, it is much more difficult to uphold the new efficient responding of the individual, without exerting conscious and cognitive effort (Gallo & behaviours and overcome barriers in the longterm. Therefore, a pressing question is how indi-

Gollwitzer, 2007; Gollwitzer & Schaal, 1998).

viduals can achieve weight loss and maintain

Thus, the individual can switch from exercising

their healthier lifestyle in the long-term.

their conscious and goal-directed behaviours to

The concept of implementation intentions (II) was first introduced by Gollwitzer in 1993 as an effective self-regulatory tool (Gollwitzer, 1993; 1999). II are concrete action plans that specify, in an if-then format, when, where, and how one will act in order to achieve a specific goal (Gollwitzer,

being automatically controlled by the selected situational cues (e.g. reaching for an apple in-

stead of a bag of chips when watching television becomes a habit) (Gallo & Gollwitzer, 2007; Gollwitzer & Schaal, 1998). Research on II has been gaining further pop10

2016 vention in a group setting.

were asked to form complete and precise II for

While growing research evidence shows that either preparatory or target behaviours concernII are effective, there is still considerable hetero-

ing buying condoms (where, where, and how

geneity in the size of effects across studies

would they purchase them), using them (how

(Hagger & Luszczynska, 2014). We propose that

they will use them and initiate condom use) and

the effectiveness of II in initiating and maintain-

discussing them (what they would say and at

ing behavioural changes long-term can be further what moment?) (De Vet et al., 2011a). Particiimproved if it is better understood how their

pants in this study were once again strongly en-

wording is related to their effectiveness. A study

couraged to write down the aforementioned de-

by De Vet, Oenema, and Brug (2011b) found that tails, but not instructed to use an if-then format. forming II of maximal specificity is crucial for be- The analyses for specificity in this study were haviour change, which in this particular case was conducted by creating a dichotomous variable increasing physical activity. In this study, re-

that reflected whether or not a sufficiently precise

spondents were provided the opportunity to

and complete target behaviour II had been

form up to three II that would lead to increased

formed (“0” if imprecise or incomplete, or “1” if

physical activity. Despite the fact that several

II is sufficiently specific and complete) (De Vet et

studies show the necessity of forming II using an al., 2011a). An example of a high specificity II for if-then format to achieve the most effect (Gallo et a preparatory behaviour concerning buying conal., 2009; Thürmer, McCrea, & Gollwitzer, 2013),

doms is: “I buy condoms from a vending ma-

respondents in this study were only asked to

chine when I am at the pub this Saturday” be-

write down the following: what physical activity

cause it explains both how or where and when

they will do, on what day(s) of the week, when

the respondent will be purchasing condoms (De

they plan to do it, where they will do it, and for

Vet et al., 2011a).

how long they will perform the activity. Researchers then examined the specificity of the II

Results found that only 6.8% of respondents in the preparatory behaviour condition formed

by awarding participants one point for specifying complete and precise II compared to 17.6% of rein precise terms each of the components for a

spondents in the target behaviour condition, sug-

maximum score of five points per II. Results

gesting a difficulty in forming high quality II for

showed that participants who formed more spe-

these women. However, those women who were

cific II (such as “On Tuesday after work, I will go able to form higher quality II as indicated by the running” compared to “On a weekday evening I

coding measures, were more committed to these

will do sports”) were more physically active two

plans and perceived these plans as more useful,

weeks later.

which in turn predicted increased preparatory

Similar effects were found in another study by De Vet et al. (2011a), where young women

actions such as carrying condoms in their wallet before going to a party, or purchasing condoms 11

2016 ularity in the past decade. Hagger and Luszczyn- weight-loss success in a group setting, we inteska (2014) assessed that while there were only 63 grated II within a highly successful lifestyle interarticles pertaining to the topic in 2003, this num-

vention, namely the Diabetes Prevention Pro-

ber quickly rose to 849 articles by the year of

gram (DPP). The DPP was developed at the Uni-

2012. Instructing individuals to form II has been

versity of Pittsburgh Medical Centre around 15

shown to successfully facilitate numerous types

years ago and has been shown in large-scale

of behaviours in a variety of domains, such as

studies to reduce the progression of pre-diabetes

enhancing academic goals (e.g., reliably compos- to diabetes by a large percentage (Diabetes Pre-

ing a curriculum vitae or completing an arithme- vention Program Research Group, 2002a). The tic task on time) and increasing the use of public

intervention focused on behavioural lifestyle

transport in students (Gallo & Gollwitzer, 2007).

change mainly in the areas of eating and physical

Furthermore, the increasing literature pertaining

activity. The two major goals were to achieve and

to II formation has also found interest in the field maintain 7% weight loss from their initial weight of health promoting behaviors.

and to participate in a minimum of 150 minutes

Forming II in service of goal intentions has

of physical activity per week for each participant.

been shown to be important for reducing nega-

For those who received the lifestyle intervention,

tive health behaviors such as diminishing smok-

the incidence of type 2 diabetes decreased by

ing habits, decreasing alcohol consumption, and

58%, whereas for those who received the phar-

successfully decreasing the proportion of energy

macological treatment (metformin), the incidence

derived from saturated fat intake (Sheeran & Or- was decreased by only 31% (Diabetes Prevention bell; Osch, Lechner, Reubsaet, & Vries, 2010;

Program Research Group, 2002a). The limitations

Armitage, 2009; Luszczynska, Scholz, & Sutton,

of the feasibility of this costly one-on-one inter-

2007). Furthermore, II have also been shown to

vention led to the adaption of the DPP to a group

be effective in promoting healthy behaviors, in-

setting, namely the Group Lifestyle Balance pro-

cluding increased attendance for cervical screen-

gram (GLB) (Greenwood et al., 2014). Although

ing (Sheeran & Orbell), promoting condom use,

the group version is cheaper and easier to deliv-

increased physical activity (De Vet et al., 2011),

er, a meta-analyses of twenty-eight GLB studies

and significantly improved contraceptive adher-

show an average weight loss of 4% body weight

ence in teenagers (with the latter reducing emer-

(Ali, Echouffo-Tcheugui, & Williamson, 2012),

gency consultation by 15% after the intervention)

which is less effective compared to the average

(Martin et al., 2011).

7% weight loss found in the DPP (Diabetes Pre-

In the present study, we seek to extend the

vention Program Research Group, 2002b). There-

research on II to promote healthy diet behaviours fore, the McGill CHIP Healthy Weight Program and weight loss in a comprehensive behavioural (HWP) integrates II into the GLB with the objecweight loss program. In order to achieve optimal tive of achieving higher effectiveness of the inter12

2016 before going on vacation as opposed to the wom- effective the II will be as measured by weight en who did not form high quality II (De Vet et al., loss. Second, we hypothesize both the specificity 2011a). Osch, Lechner, Reubsaet, and Vries (2010) had the objective to measure the impact of speci-

of the cues and the specificity of the response matter for the effectiveness of the II. That is, we predict that the more specific the cues in their II,

ficity in II on smoking abstinence. Participants in the more weight the individual will lose, and the a smoking cessation contest were asked to formu- more specific the response in their II, the more late three detailed coping plans specifying, in an

if-then format, when, where, and how they planned to remain abstinent in three situations

weight they will lose.

Although the current available research has not yet directly examined whether the specificity

where they found it most difficult to refrain from of the cues and the response both matter for the smoking (Osch et al., 2010). Coders then rated

effectiveness of II, this has been indirectly exam-

specificity quality of the II on a 3-point scale. Non ined in a few studies. For instance, in a study by -specific plans, such as “If I have the urge to

Verhoeven et al., (2014) participants were divid-

smoke, then I will go and do something else”

ed into a control group, cue-monitoring diary

were coded as “0,” medium specific plans, such

group where the participants were asked to re-

as “If I have the urge to smoke, then I will try to

flect upon the critical cue situations that led to

relax” were coded as “1,” and highly specific

their unhealthy snacking, or another experi-

plans, such as “If I have the urge to smoke, then I mental group where the participants were asked will drink a cup of coffee” were scored as

to create an if-then plan to reduce their snacking

“2,” (Osch et al., 2010). Results showed that alt-

behaviors. Results showed that those who had

hough there was no significant difference be-

kept a cue-monitoring diary had a significantly

tween those that formulated medium and highly lower snacking frequency and a slightly lower

specific plans, respondents who created II plans

(marginally significant) caloric from unhealthy

with higher levels of specificity showed signifi-

snacking than those who had kept a control dia-

cantly greater abstinence rates for smoking be-

ry. While both cue-monitoring and forming II led

haviours compared to those with low specificity

participants to gain more insight into their per-

planning.

sonally relevant cues that led them to consume

In the present study, we aim to contribute to

unhealthy snacks, creating II was not found to

the existing literature in this field in two ways.

reduce unhealthy snacking behaviors. While a

First, we seek to investigate how the level of

limitation of this study is that they cannot ad-

specificity of formulated II by the participants in

dress long-term behavior change maintenance,

the McGill CHIP Healthy Weight Program is re-

results suggest that in the short term, cue moni-

lated to weight loss success. We predict that the

toring significantly suffices to decrease unhealthy

higher the level of specificity of the II, the more

snacking habits without additional benefits from 13

2016 planning (Verhoeven et al., 2014).

and 24 months into the program, and weight-

To our knowledge, no research has been con- related risk factors (Knäuper et al., 2014). ducted to date with regards to examining the

The aim of the current study is to analyze the

effects of the specificity of the goal-directed re-

quality of the II that participants in the Healthy

sponse portion of II (the “then” part). Therefore,

Weight Program formed. The presented analyses

although we cannot clearly hypothesize the di-

build upon a preliminary analysis conducted by

rection of such effects, we will be investigating

Sasson (2014), during which the participants had

whether or not the specificity of the “then” part

only completed the first 12 sessions of the pro-

has an effect on the overall success-potential of II. gram. The data for the current analyses includes 34 individuals in the experimental condition who Methods Trial Design

have successfully completed all 22 sessions of the one-year program (participants in the control group did not form II plans).

The McGill CHIP Healthy Weight Program is a randomized control trial (RCT) that compares two versions of the group in the Diabetes Preven-

Participants The current study sample includes a total of

tion Program, namely the Group Lifestyle Bal-

34 overweight or obese participants (BMI of 28 to

ance program (GLB), in a parallel group design

45 kg/m2, waist circumference ≥ 88 for women, ≥

(Knäuper et al., 2014). The study aims to increase 102 for men) who exercise less than 200 minutes the effectiveness of the GLB by implementing ev- per week. 85.3% of participants are females, idence-based habit formation techniques, namely while 14.7% are males. The mean age of the parII and mental imagery (Knäuper et al., 2014). A

ticipants is M = 50.1 years o ld (SD = 12.01), and

total of 154 participants have been randomly as-

70.6% are Caucasian. Table 1 shows the demographic

signed into the experimental or control condition. characteristics of the sample. Participants in the enriched condition received the exact same intervention as those in the control condition, with the only exception being the

Intervention Procedure At every session

(Knäauper et al., 2014),

if-then plans with guidance from a group life-

specific behaviours were highlighted (daily

style coach incorporated into the intervention of

weighing, portion control, increasing physical

the experimental condition. The primary out-

activity steps) by the lifestyle coach and were

come was the difference in percent body weight

discussed with participants. The enriched con-

loss between the two conditions at 3 months, 12

dition of the Healthy Weight Program would

months, and 24 months intro the trial. Secondary then, according to their goals and problem areoutcomes measured included physical activity

as, receive instruction from their lifestyle coach

(150 minutes per week) at 3 months, 12 months,

on how to effectively formulate II to target these 14

2016 problem areas using structured handouts called

scribed in their II, the more weight they will

“if-then plan summary sheet” (see Appendix

lose.

A). For instance, if a session highlighted the im-

The coding scheme for specificity used in

portance of daily water intake and this was a

the present paper was generated when conduct-

particular area of difficulty for a certain partici-

ing the preliminary analyses of the project

pant, the lifestyle coach would then work with

(Sasson, Chamandy, Xu, Ivanova, & Knäuper,

the individual on creating an efficient II with the

2014). Several rounds of revision were conduct-

goal of targeting and facilitating this behaviour

ed by coders in order to ensure inter-rater relia-

and eventually making it a habit. Another ex-

bility of over 85%. In the final round of codings,

ample includes the importance of daily weigh-

95% inter-rater agreement for specificity of cues

ing, which is often an area of difficulty for many

and 100% agreement for responses were

participants. Coaches work with each individu-

achieved (Sasson, 2014). The relevant coding

al to form an II suited to their particular sched-

guidelines can be found in Appendix B.

ule and during which they will successfully be

In the coding guidelines, specificity was dis-

able to integrate weighing into their daily hab-

tinguished between low specificity and high

its. Once the II has been formed and established,

specificity. Low specificity was defined as: a

the lifestyle coach then guides the participant to

“cue/response [that] can be more specifically de-

work towards optimal specificity of the cue (if-

scribed and questions are left to be answered”

part) and response (then-part) of the II (Sasson,

and was coded with a “1” (Sasson et al., 2014).

2014). Until the next group session, the individ-

Examples include responses such as: “… then I

ual will continue to receive feedback from the

will eat something else” or “… then I will try new

lifestyle coach by telephone or e-mail and

types of exercise” (Sasson, 2014), both of which

would revise their II accordingly to ensure max-

fail to provide a sufficient level of detail in ex-

imal effectiveness.

plaining their response and could include further information (e.g. What is the participant eating

Coding Procedure (Specificity) The aim of the current study was to deter-

instead? What is the new type of exercise the participant will try out?). High specificity, in con-

mine how the specificity of the II affects the

trast, was defined as: a “cue/response [that] can-

overall weight loss outcomes of the participants.

not be more specifically described and all ques-

We predict that the higher the level of specifici-

tions are answered” and was coded with a

ty of the II, the more effective the II will be as

“2” (Sasson et al., 2014). Examples of this include

measured by weight loss. Second, we also pre-

the following: “If I am eating Doritos”, or “…

dict that the more specific the cue is described in

then I will have an apple instead” (Sasson, 2014).

their II, the more weight the individual will

In the aforementioned examples, the participant

lose, and the more specific the response is de-

clearly states the cue/response with a level of de15

2016 tail that cannot be explained with any further de- pants. Thus, each participant had formed an avtail or information. Here, we know exactly what

erage of 12.35 II throughout the 22 sessions of the

the participant is doing (e.g., eating Doritos) and

program. Furthermore, using a code of 1 for indi-

what they plan to do instead (e.g., eat an apple),

cating low specificity and a code of 2 for high

achieving a code of “2”.

specificity, the mean proportion of high specificity scores was 85% for cues (SD = 14.98), and

Results The aim of the present study was to investi-

65.96% for responses (SD = 21.30), indicating that while participants created mostly high specificity cues,

gate how the level of specificity of the II is related but generated fewer highly specific responses. Table 3 to weight loss. We hypothesized that the higher

shows the proportion of high specificity II created by

the level of specificity of the II, the more effective participants. the II will be and the more weight the participant will have lost. Furthermore, we also predicted

To test the first hypothesis that the higher the level of specificity of the II, the greater the weight

that both the specificity of the cues and the speci- loss the participant will achieve, we ran correlaficity of the response matter for the effectiveness

tions between the average percent of high speci-

of the II on the weight loss outcome. Correlations ficity II plans and the total percent of weight lost between total percent of high versus low specific- after session 22. Results show that there is no sigity II and weight loss percept at session 22 were

nificant relationship between specificity of II and

used to evaluate the above hypotheses.

percent of weight lost at completion of the pro-

The primary outcome for this study was total gram, r = .004, p = .985. percent of overall weight lost after completing all

Our second prediction was to explore wheth-

22 sessions of the McGill CHIP HWP. In order to

er the specificity of the cues and the specificity of

test these, we used the participants’ initial weight the response differ in individual effectiveness of

at session 1, subtracted this by their weight

II on the weight loss outcomes. In order to test

achieved at session 22 and converted it into a per- this, we performed two separate correlations to centage. The average percent of total weight lost

investigate the relationship between a) the per-

for all 24 participants after session 22 was 6.39%

cent of highly specific II cues and the total weight

(SD= 5.38). A total of 10 participants were excluded

loss outcome, and b) the percent of highly spe-

from the analyses because we could not obtain their

cific II responses and the total weight loss out-

weight data for session 22, thus we could not calculate come. Analyses show that there is no relationship total percent of weight loss. Table 2 describes the aver- between the highly specific cues and total percent age weight of participants at session 1 and session

of weight lost, r = .021, p = .921, or between high-

22.

ly specific responses and total percent of weight Overall, a total of 420 physical activity-

related “if then” plans were coded for 34 partici-

lost r = -.010, p = .964. Table 4 presents the correlations between proportion of highly specific 16

2016 cues / responses and weight loss.

tistical power. However, we only had available data

Our findings suggest that there is no relation- from 24 experimental participants who have completed ship between the mean proportion of overall

the program, which greatly limits the potential of

specificity of II that were created by participants

achieving conventional levels of statistical signifi-

and their total level of weight loss achieved. Fur- cance. thermore, the results indicate that the individual

Second, it is important to note that the core of

components of II (e.g. the cue and the response)

the McGill CHIP HWP is being delivered during

do not make a difference in total weight loss

the first 12 sessions of the program, and that it is

attained either.

during this period where the majority of II are formed. Therefore, it is possible that examining

Discussion The objective of the current study was to explore the effects of characteristics of II on weight

the limited number of participants who have completed the entire program (as opposed to only 12 sessions examined by Sasson (2014)) would

loss in participants of the McGill CHIP HWP. We not lead us to obtain such a greater level of inforhypothesized that a higher level of specificity

mation regarding the influence of II on their

would lead to greater weight loss among partici-

weight loss.

pants, specifically that higher specificities of the

Although our results did not find either the

components of the II plan (e.g. the cue, and the

“if” (cue) nor the “then” (action) component of II

response) would each result in higher weight

to have an influence on long-term behavior

loss. The results of our analyses did not support

change, Verhoeven et al. (2014) did find that par-

either of our predictions. In particular, the level

ticipants who were instructed to monitor their

of specificity of the II did not predict weight loss

cues had successfully decreased their unhealthy

among participants and the specificity of the in-

snacking behaviors as opposed to those who did

dividual components of the II (cues, responses)

not monitor their cues. Although their study can-

was not related to participants’ total weight loss

not speak to long-term behavior changes because

outcomes at session 22. Based on this study’s pre- participants were monitored for only one week, liminary findings (the target sample size has not

their research implies a potential key role in plac-

yet been achieved), it seems that the level of spec- ing a greater focus on the “cue” component in II ificity of the II has no effect on weight loss.

planning. We predict that with our eventual sam-

There are several factors that could have hin- ple size of N = 128, monitoring the cues by using dered our hypothesis to be supported by the cur- “if-then” plans will have similar effects on rently available data. First, power analyses con-

weight, specifically weight loss and maintenance.

ducted prior to the trial showed that a total of N

Another limitation of our study is that our

= 128 participants (including both control and experi- coding guidelines permit us to only distinguish mental participants) will be needed for sufficient sta-

between high and low specificity, restricting ex17

2016 amination of the effects of medium specificity II.

ty habits. Although there are several limitations

It is possible that while the little detail found in

to consider in interpreting the findings we have

low specificity planning may not be sufficient

presented, future studies should aim to replicate

enough to establish new behaviors, over-

such analyses with a larger sample in longitudi-

specification may be counter beneficial by limit-

nal interventions and with coding guidelines that

ing the frequency of opportunities to carry out

are better suited for the type of “if-then” plans

the desired behavior (Sasson, 2014; Van Osch et

under consideration (e.g., food-related or physi-

al., 2010). For instance, a plan aimed to increase

cal activity “if-then” plans). Coding for three lev-

weekly time spent exercising can be described as els of specificity to test for the inverted U hypothfollows: “If it is the evening, then I will go to the gym” (low specificity), “If it is Tuesday evening,

esis should also be considered. In conclusion, the preliminary analyses pre-

then I will go to the gym” (medium specificity) or sented in this study suggest that level of specifici“If it is Tuesday evening, then I will go to the

ty of II has no effect on weight loss. However, fu-

gym and do 30 minutes of high intensity weight

ture research should take into account the afore-

training” (high specificity). While the first exam-

mentioned suggestions and investigate further

ple may not be detailed enough to promote the

for potential significance.

desired behavior, one may actually be restricting oneself from performing the desired behavior by References placing so many restrictions. Thus, there could be Adriaanse, M. A., Vinkers, C. D., De Ridder, D. an inverted “U” shaped pattern of behavioral engagement where optimal success lies in medium specificity planning (Sasson, 2014). Lastly, we must also consider that the coding

guidelines used for this study were established with a strong emphasis on II concerning eating behaviors. Given that the current paper includes physical-activity related plans only, the coding guidelines could have been revised to be better suited to capture the distinct details of these particular plans as opposed to eating habits. Conclusion and Future Research Directions The analyses conducted in this paper provide a preliminary basis for better understanding the role of II in developing long-term physical activi-

T., Hox, J. J., & De Wit, J. B. (2011). Do implementation intentions help to eat a healthy diet? A systematic review and meta-analysis of the empirical evidence. Appetite, 56(1),183-193. Ali, M. K., Echouffo-Tcheugui, J. B., & Williamson, D. F. (2012). How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program? He alth Aff airs, 31(1), 67-75. Armitage, C. J. (2004). Evidence that implementation intentions reduce dietary fat intake: a randomized trial. Health Psycho lo gy, 23(3), 319. Armitage, C. J. (2009). Effectiveness of experimenter-provided and selfgenerated implementation intentions to reduce alcohol consumption in a sample of the general population: a randomized exploratory trial. Health Psycho lo gy, 28(5), 545. De Vet, E., Gebhardt, W. A., Sinnige, J., Van Puffelen, A., Van Lettow, B., & de Wit, J. B. (2011a). Implementation intentions for buying, carrying, discussing and 18

2016 using condoms: The role of the quality of plans. Health Education Research, 26(3), 443-455. De Vet, E., Oenema, A., & Brug, J. (2011b). More or better: Do the number and specificity of implementation intentions matter in increasing physical activity? Psychology of Sport and Exercise, 12(4), 471-477. Diabetes Prevention Program (DPP) Research Group. (2002a). The Diabetes Prevention Program (DPP) description of lifestyle intervention. Diabetes care , 25(12), 2165-2171. Diabetes Prevention Program Research Group (Ed.). (2002b). Reduction In The Incidence Of Type 2 Diabetes With Life style Intervention Or Metformin. New England Journal of Medicine, 393-403. Gallo, I. S., & Gollwitzer, P. M. (2007). Implementation intentions: A look back at fifteen years of progress. Psico them a, 19(1), 37-42. Gallo, I. S., Keil, A., McCulloch, K. C., Rockstroh, B., & Gollwitzer, P. M. (2009). Strategic automation of emotion regulation. Jo urnal o f p erso nality and social psychology, 96(1), 11-31. Gollwitzer, P. M. (1999). Implementation intentions: strong effects of simple plans. Am erican Psycho lo gist, 54(7), 493-503. Gollwitzer, P. M., & Schaal, B. (1998). Metacognition in action: The importance of implementation intentions. Perso nality and So cial Psychology Review, 2(2), 124-136. Greenwood, D. A., Kramer, M. K., Hankins, A. I., Parise, C. A., Fox, A., & Buss, K. A. (2014). Adapting the group lifestyle balance program for weight management within large healthcare system diabetes education program. The Diabetes Educator, 40(3), 299-307. Hagger, M. S., & Luszczynska, A. (2014). Implementation intention and action planning interventions in health con texts: State of the research and proposals for the way forward. Ap p lied Psychology: Health and Well-Being, 6(1), 1-47. Knäuper, B., Ivanova, E., Xu, Z., Chamandy, M.,

Lowensteyn, I., Joseph, L., & Grover, S. (2014). Increasing the effectiveness of the Diabetes Prevention Program through if-then plans: study protocol for the randomized controlled trial of the McGill CHIP Healthy Weight Program. BMC p ublic health, 14(1), 1-8. Kopelman, P. (2007). Health risks associated with overweight and obesity. Obesity reviews, 8(s1), 13-17. Luszczynska, A., Scholz, U., & Sutton, S. (2007). Planning to change diet: A controlled trial of an implementation intentions training intervention to reduce saturated fat intake among patients after myocardial infarction. Journal of Psychosomatic Research, 63 (5), 491-497. Martin, J., Slade, P., Sheeran, P., Wright, A., & Dibble, T. (2011). ‘If-then’ planning in one-to-one behaviour change counselling is effective in promoting contraceptive adherence in teenagers. Journal of Family Planning and Reproductive Health Care, 37(2), 85-88. Osch, L. V., Lechner, L., Reubsaet, A., & Vries, H. D. (2010). From theory to practice: An explorative study into the instrumentality and specificity of implementation intentions. Psycho lo gy and Health, 25(3), 351-364. Sasson, M. (2014). The eff ect o f sp ecificity and nature of if-then plans on weight loss (unpublished undergraduate thesis). McGill University, Montreal. Sasson, M., Chamandy, M., Xu, Z., Ivanova, E., & Knäuper., B. (2015). Co d ing instructions: Specificity coding (unpublished coding guidelines), McGill University, Montreal. Shai, I., & Stampfer, M. J. (2008). Weight-loss diets—can you keep it off? The American Journal of Clinical Nutrition, 88(5), 1185-1186. Sheeran, P., & Orbell, S. (2000). Using implementation intentions to increase attendance for cervical cancer screening. Health Psycho logy, 19(3), 283–289. Statistics Canada. (2015). Body mass index, overweight or obese, self-reported, adult, by age group and sex (percent). Retrieved from 19

2016 http://www.statcan.gc.ca/tablestableaux/sumsom/l01/cst01/health81beng.htm Thürmer, J. L., McCrea, S. M., & Gollwitzer, P. M. (2013). Regulating self defensiveness: If–then plans prevent claiming and creating performance handicaps. Mo tivatio n and Em o tio n, 37 (4), 712-725. Verhoeven, A. A., Adriaanse, M. A., de Vet, E., Fennis, B. M., & de Ridder, D.T. (2014). Identifying the ‘if’for ‘if-then’plans: Combining implementation intentions with cue-monitoring targeting unhealthy snacking behaviour. Psychology & Health, 29(12), 1476-1492. Verplanken, B., & Faes, S. (1999). Good intentions, bad habits, and effects of forming implementation intentions on healthy eating. Euro p ean Jo urnal o f Social Psychology, 29(5-6), 591-604.

2016 Appendix

2016

Investigating the Leader-Member Exchange Recipe for Job Satisfaction: Is the Active ingredient Autonomy Support?

Marie-Catherine Mignault Supervisor: Dr. Richard Koestner

Abstract The present study aimed to examine job satisfaction through the lens of the leader-member exchange (LMX) theory. The investigation focused on whether autonomy support – a style of interaction whereby a leader deeply values a member’s perspective – represents an underlying mechanism

that links a high-quality leader-member exchange to job satisfaction. We recruited 215 employees (44 males) from a non-profit health organization. Employees were asked to indicate their level of perceived autonomy support and job satisfaction, in addition to rate their individual relationships with their employer. We found that autonomy support fully mediated the relationship between leadermember exchange quality and job satisfaction. However, gender appeared to moderate these effects such that leader-member exchange quality had an influence on the job satisfaction of women, but not of men.

2016 Introduction You take a deep breath. Then, you proceed to drop a heavy cardboard box on your brand new desk. You examine the space; perhaps lift your gaze to lock eyes with new faces. Possibly, a hint of nervousness is in the air: To whom do you answer? How will your immediate supervisor be? Surely, a part of you wishes to get along with him or her. However, so many factors are involved in a manager-employee relationship, thus you cannot be sure. Researchers have tried to shed light on the complexity of this type of relationship and have formulated an array of theories. Two chief theories stand out, as they appear to share fundamental principles. We begin by reviewing the leadermember exchange theory, which stresses the importance of healthy interactions between managers and employees. We then proceed to examine self-determination theory, which highlights how essential it is to treat individuals not as pawns, but as proactive organisms, thus supporting the individuals’ autonomy rather than seeking to control them. Subsequently, we proceed to explore whether autonomy support represents the mechanism underlying the link between a highquality leader-member exchange and high job satisfaction. The Leader-Member Exchange Theory. How can one predict whether a mutually enriching manager-employee relationship is likely to emerge? The current literature on the leadermember exchange theory (LMX) has shown that a leader-member dyad starts off at a transactional stage. This “stranger” stage is characterized by “cash and carry” economic exchanges that are purely contractual, during which the leader gives orders and compensates the member for the services rendered (Graen & Uhl-Bien, 1995). However, a testing phase, the “acquaintance” stage, may take place if either party in the dyad makes a re-

lationship offer by increasing the frequency of non-contractual social exchanges. If the other member accepts the offer by reciprocating the exchanges, the relationship will grow into a “mature partnership” (Graen & Uhl-Bien, 1995). Liden et al. (1993) have found evidence suggesting that this process generally unfolds very quickly. For example, on the Monday of your first week, you ask your supervisor: “How long am I allowed to go on break for?” On the following Monday, you ask your supervisor “how was your weekend?” and the supervisor reciprocates the question. As the second week comes to an end, the manager solicits your advice: “Should we tackle this case this way, or that way?” This new partnership will allow the “hired hand” to become a “trusted assistant,” and the relationship will reach the transformational stage, at which point the individuals can count on each other for loyalty and support (Graen & Uhl-Bien, 1995). What benefits are to be reaped from this strangers-to-partners transformation? In a metaanalysis, Dulebohn et al. (2011) suggested that a high-quality relationship between an employee and his or her supervisor is associated with, among other factors, greater job satisfaction, increased organizational citizenship behaviour, lower turnover intentions, and lower actual turnover rates. Which factors are involved in predicting whether a relationship offer will be made? According to Henderson et al. (2009), managers who have a tendency to adopt a transformational rather than transactional leadership style, such that they are inclined to foster a mutual reciprocal influence rather than a unidirectional downward influence, tend to form bonds of higher quality with their subordinates. Given the opportunity to influence their supervisor’s opinion, the subordinates may recognize that their perspectives are valued, which in turn could motivate them to invest more in the relationship. 24

2016 While the picture is becoming clearer in terms of the processes involved in the development of a mature partnership, a gap in the literature remains: we have yet to discover the mechanism underlying the link between a high quality leader-member exchange and positive outcomes, such as job satisfaction. Avolio (2009, p. 433) indeed suggests that efforts have mainly focused on the description of the construct at the expense of a search for the key factors involved in producing the positive effects: “LMX scales seem to have been developed on ad hoc, evolutionary basis, without the presentation of any clear logic or theory justifying the changes which were made”. Thus it leaves one to wonder: What elements present in the mature partnership are responsible for fostering greater job satisfaction? Could a line of research stemming from the SelfDetermination theory possibly bridge the gap between a high quality leader-member exchange and greater job satisfaction? The Self-Determination Theory. “Organismic integration” is the term used by Deci and Ryan (2000) to describe the phenomenon whereby human beings naturally strive to increase in coherence and in complexity throughout their lifetime. At the intrapersonal level, people seek to continually refine their interests and values, while creating harmony amongst their various inclinations. At the interpersonal level, a similar process can be observed, whereby people work to incorporate themselves within the social matrix (Ryan, 1995). This integrative process does not happen automatically. There are certain nutrients that are essential for the priming of integrative tendencies and the flourishing of human potential. Those nutrients come in the form of three psychological needs: the need for competence, the need for autonomy, and the need for relatedness (Ryan & Deci, 2000). The need for competence is fulfilled as one experiences a sense of efficacy in interacting with a given environment (White, 1959). Sat-

isfaction of the need for relatedness occurs when one experiences love and care from significant others (Baumeister & Leary, 1995). The need for autonomy is satisfied when the individual selfendorses and performs an activity volitionally (Ryan & Deci, 2006). Psychological need satisfaction influences the type of motivation that one is likely to experience (Ryan & Deci, 2000). Rather than focusing on the quantity of motivation an individual has, selfdetermination theory suggests that it is the quality of the motivation that accounts for different behavioural and emotional outcomes. Accordingly, quality of motivation falls on a descriptive continuum from controlled to autonomous regulation of behaviour (Deci & Ryan, 2000; Ryan, 1995). An individual is said to be autonomously motivated when the actions performed reflect personal interests and values. In contrast, controlled motivation is reflected in actions that one feels compelled to perform by external or internal pressures (Koestner et al., 2008). Autonomous motivation is associated with a host of positive outcomes, whereas controlled motivation is unrelated to outcomes (see Koestner et al., 2008 for meta-analysis). In fact, intrinsic motivation, at the very autonomous end of the motivation spectrum, has been shown to generate greater vitality, better conceptual learning, and greater creativity (Deci 1995; Deci & Ryan, 2008; Vansteenkiste, Niemiec & Soenens, 2010). Even though we start out in life with a great amount of intrinsic motivation, we are not immune to controlling reward contingencies and critical evaluations (Deci, 1995). Such conditions, which undermine our sense of autonomy, seem to effortlessly chip away at our natural enjoyment of the activity associated with the contingencies (Deci, 1995). Therefore, by the time we reach adulthood, our instinctive tendency to “imbue everything with life” seems to have gradually slipped away (Deci, 1995, p. 79). Although children are not given the opportunity to choose the context in which they are 25

2016 raised, adults have the power to change things. For example, we can select friends, romantic partners, and mentors who support our autonomy. Autonomy supportive agents tend to value the members’ perspectives, to nurture their inner resources, to encourage them to take initiative, and to minimize the controlling language, such as rewards, threats, punishments, competition, and praise (Deci, 1995). This style of interaction promotes numerous positive effects such as greater job satisfaction (Deci et al., 1989). In the workplace, could the receipt of autonomy support from one’s manager be associated with the development of a mature partnership? As Henderson et al. (2009) suggest, transformational leadership tends to influence the formation of higher quality bonds between leaders and members. Interestingly, in building a mature partnership, it seems that the transformational leader adheres to core features of autonomy support: By choosing mutual reciprocal influence over unidirectional downward influence, the leader appears to truly value the member's perspective and to minimize control. Therefore, we could hypothesize that autonomy support is indeed a construct associated with high quality LMX. In fact, due to its positive association with job satisfaction, autonomy support might represent the element in the leader-member relationship that accounts for greater job satisfaction in the member. Hypotheses The following hypotheses were investigated. First, we expected to observe positive correlations between LMX quality and job satisfaction, between LMX quality and perceived autonomy support, as well as between perceived autonomy support and job satisfaction. Second, we expected perceived autonomy support to mediate the relationship between leader-member exchange quality and job satisfaction (see Figure 1). Another hypothesis, which emerged upon analyzing the data, was included in order to verify the implication

of gender as a possible moderator of the relationship between LMX quality and job satisfaction. To date, no study on LMX has reported a gender difference in the outcomes related to leader member exchange quality. Methods Participants and Procedure 215 participants were recruited from a nonprofit health organization. Our two inclusion criteria required for companies to be structured in a hierarchical way and to be composed of over one hundred employees. Surveys were sent via email to a list of employees provided by the organization. Upon completion of the survey, participants were offered a $10 gift certificate to Amazon.ca. The survey was administered in late January. It included measures assessing (1) the quality of the relationship between the subordinate and his/ her supervisor, (2) the subordinate’s perception of the manager’s autonomy support, and (3) job satisfaction. The survey incorporated also other measures irrelevant to the present thesis. Measures Perceived Autonomy Support. The Work Climate questionnaire (Baard et al., 2004) was adopted to evaluate the workers’ perception of their managers’ level of autonomy support. The items related to employees’ experiences with their most immediate supervisor, inviting them to reflect on how they felt about their encounters with that superior (e.g. “I feel understood by my supervisor” and “ My supervisor answers my questions fully and carefully”). The workers were asked to rank their strength of agreement with the fifteen statements on a seven-point Likert scale, ranging from “Disagree Strongly” to “Agree Strongly”. Fourteen items were phrased positively and one item was reversed. Leader-Member exchange. From the twelve 26

2016 original items of the Multidimensional Measure of Leader-Member Exchange (Liden & Maslyn, 1998), eight items were included into our survey. Four dimensions of the employee-supervisor relationship were assessed: professional respect (e.g., “I admire my manager’s professional skills”), loyalty (e.g., “My supervisor would defend me to others in the organization if I made an honest mistake”), affect (e.g., “My manager is a lot of fun to work with”), and contribution (e.g., “I do not mind working my hardest for my manager”). However, since professional respect and contribution seemed to tap constructs other than the specific relationship between the leader and the member, such as leader effectiveness and extra-role behaviour respectively, these two subscales were excluded in our analyses. The items were rated on a seven-point Likert scale from “Strongly disagree” to “Strongly agree”. Job Satisfaction. The Job Satisfaction Composite Measure (Maurer & Chapman, 2013) included three questions. The first question measured job satisfaction with a yes or no answer: “All things considered, are you satisfied with your current job?” The second question required the employee to rank job satisfaction on a sevenpoint scale ranging from “Very Dissatisfied” to “Very Satisfied”. The third question asked the employee to put down a percentage for how happy, neutral, and unhappy they are with their current job. Scores on these 3 items were summed to form a composite score of job satisfaction. Results Preliminary Analyses Descriptive statistics for the key variables are provided in Table 1. It can be observed that participants generally reported moderately high levels of autonomy support and leader-member exchange quality, as well as average job satisfaction.

Main results Correlations among LMX, autonomy support, and job satisfaction. Table 2 indicates the strength of the relationships among the variables present in our hypothetical model (see Figure 2). Pearson correlations were performed on each pair of variables. All appear to be significant and positive. Thus, leader-member exchange quality is associated with autonomy support (r=0.70, p<0.01), as well as with greater job satisfaction (r=0.22, p<0.01). Additionally, autonomy support is related to job satisfaction (r=0.33, p<0.01). Mediation by autonomy support. In order to test our prediction that the relationship between LMX and job satisfaction is mediated by autonomy support, we conducted a mediational analysis. A Preacher and Hayes’ bootstrap procedure was used to test for direct and indirect effects of leader-member exchange on job satisfaction. Specifically, we wondered if the association between leader-member exchange quality and participants’ job satisfaction could be accounted for by their perceived autonomy support. The total effect was significant, β = .29 (SE = .07). The indirect pathway was found to be significant, β = .16 (SE = .07). After accounting for the indirect pathway through autonomy support, the direct pathway was found to be insignificant, β = .14 (SE = .09). This suggests a full mediation by perceived autonomy support, meaning that the effect of leader-member exchange quality on participants’ job satisfaction is dependent on the presence of perceived autonomy support (see Figure 3). Moderation by gender. A two-way ANOVA was performed, looking at the mean job satisfaction as a dependent variable for the following factors: LMX quality and gender. We created low LMX and high LMX groups by splitting LMX quality scores at the median. We obtained a main effect for the association between LMX quality and job satisfaction F(3,220)=6.38, p<0.000. Moreover, a significant interaction between gender and 27

2016 LMX was observed, F(1,219)=4.27, p<0.05. The interaction indicated that LMX quality had no impact on the job satisfaction of males, but had a significant impact on the job satisfaction of females (see Figure 4). Discussion This study sought to shed light on the relationship between leader-member exchange quality and job satisfaction. Specifically, we wanted to examine whether the association between higher LMX quality and greater job satisfaction could be explained by the provision of autonomy support by managers. We thought it was important to clarify this relationship because principles from the LMX theory are used in the workplace to increase the effectiveness and satisfaction of workers. Therefore, by positing a mechanism in the relationship that may facilitate the experience of greater job satisfaction, we expected the essential aspects of the exchange to emerge, thus enhancing the practicality of the theory. We suspected the implication of autonomy support in the association between LMX quality and job satisfaction for the following reasons. Leaders who engage in mature partnerships, signifying high quality LMX, value mutual reciprocal influence (Henderson et al. 2009), which involves taking the member’s perspective into consideration. Additionally, the tendency of those leaders to avoid unidirectional downward influence suggests that they are more prone to minimizing controlling language. Firstly, we demonstrated a strong positive association between leader-member exchange and autonomy support. This suggested that members who experience a higher quality relationship with their managers, i.e., a mature partnership, are also more likely to perceive their manager as autonomy supportive. Moreover, both LMX and autonomy support were associated with job satisfaction. By replicating previous findings, these associations indicated that ele-

ments from the two constructs might be important in fostering greater job satisfaction (Dulebohn et al., 2011; Deci et al., 1989). Nonetheless, the effects of leader-member exchange and autonomy support on job satisfaction did not appear to be independent of one another. We were able to show that autonomy support fully mediates the relationship between LMX and job satisfaction. Thus, it appears that having a mature partnership with one’s leader facilitates the experience of autonomy, which in turn leads to greater job satisfaction. Interestingly, a gender interaction effect revealed that LMX quality affected the job satisfaction of the female members, but not of the male members. To our knowledge, this interaction had not yet been reported in the LMX literature. One of the practical implications of this finding could be that, in a context in which a female employee experiences below-average job satisfaction, increasing the quality of their leader-member exchange, for instance, by allowing the employee to switch from one unit to another, may lead to improvements in job satisfaction. For men, however, it is unlikely that this effect would be obtained. Of course, directionality of this relationship would have to be confirmed by future investigation prior to application. It is possible that women who are not satisfied with their job perceive their relationship with their managers as lower in quality. In this investigation, we suggested that “contribution” and “professional respect” were aspects that tapped member proactivity and leader effectiveness rather than the core of the relationship between the leader and the member. Thus, we chose to solely examine the “loyalty” and “affect” components of LMX. Yet, it is possible that our choice to remove the “contribution” and “professional respect” components may have affected this gender effect. Perhaps these components impact male job satisfaction, while the “loyalty” and “affect” components of the relationship with the leader are more important for 28

2016 women’s job satisfaction. Future research should examine whether gender remains a moderator of the relationship between LMX and job satisfaction using the full construct (the four sub-scales) of LMX. Moreover, two items from each subscale were included into our survey, whereas the original LMX measure contained three items per subscale. Including all items could help in conveying a better sense of the quality of the leader-member exchange. The present study was exposed to certain limitations. First, we relied on the subordinates’ reports to assess the quality of their relationships with their supervisors, as well as their supervisors’ autonomy supportive behaviour. With reports on LMX quality from both parties, we could have looked at the degree of discrepancy between the two reports to assess whether reciprocity in the relationship influenced job satisfaction. Similarly, supervisors’ reports of their own autonomy supportive behaviour could have been used to corroborate employees’ perceptions. Additionally, grouping the employees under their respective managers would have enabled us to observe the variation among employees’ reports for one manager. Second, the female to male ratio was very high: 79.53%:20.47%. This ratio reflected the population from which the sample was drawn (nonprofit organizations). Indeed, the Canadian nonprofit sector salary and benefits study conducted in 2013 showed that in non-profit settings, the ratio of female to male employees is 81% to 19%. While eliminating the possibility that our difference was attributable to selection bias, the probability of obtaining a large male sample size is thus reduced, making the conclusions about gender differences harder to draw. Perhaps the same survey could be conducted in the private sector, where the gender ratio is more balanced, to see whether we would obtain a similar moderating effect of gender on the relationship between LMX and job satisfaction. Also, until investigated in other sectors, it is unclear whether the results ob-

tained in this study can generalize to the workplace as a whole. A third limitation to our findings is that the measures needed to justify our modification of the LMX scale were not collected in the present study. A correlational analysis could be performed to assess the discriminant validity of the LMX subscales in relation to other constructs, such as member proactivity and leader effectiveness. Future research should investigate in greater depth the gender differences in outcomes related to LMX quality. Indeed, a host of studies observe how levels of testosterone may differentially impact the importance that individuals assign to interpersonal relationships (Wallen, 2005). For males, it appears that the presence or absence of relationships, rather than the quality, affects their outcomes (Case et al., 1992). In contrast, it appears that women show sensitivity to the quality of their relationships (Jacobson et al., 1993). Therefore, it would seem relevant to assess gender differences in the workplace, specifically looking at the association between LMX and other outcomes, such as subjective well-being and proactivity. Furthermore, Wayne et al. observed in 1994 that subordinates in same-sex dyads perceived a better LMX quality compared with those in opposite-sex dyads. It would be interesting to see if, in the context of same-sex dyads, men experience greater job satisfaction, and conversely, if the effect on job satisfaction disappears for women in the context of opposite-sex dyads. Moreover, organizational research on leadership should continue to incorporate findings from the self-determination theory to eventually arrive at a clearer, richer and more parsimonious model of the ideal leadership recipe for job satisfaction. The results of this investigation demonstrated that having a mature partnership with one’s leader facilitates the experience of autonomy, which in turn leads to greater job satisfaction, but only for women. Fewer women than men reach leadership positions in the workplace, most re29

2016 maining all their lives in positions in which they are told what to do. However, they are sensitive to being controlled, and to the quality of the relationship they build with their leader. Our findings provide a path for future research interested in testing the causality of this model. Ultimately, we could design an intervention empowering women in the lower ranks of non-profit organizations to adjust their own job satisfaction. For example, making the switch from one unit to a more flexible one could potentially allow them to select an environment in which they have the opportunity to build autonomy supportive, mature partnerships. The women in our sample reported average job satisfaction. There is room for improvement, and as meta-analyses by Bowling et al. (2010) have suggested, that improvement could have significant repercussions on the quality of those women's lives. References Avolio, B., Walumbwa, F., & Weber, T. J. (2009). Leadership: Current Theories Research, and Future Directions. Annual Re view o f Psycho lo gy, 60, 421-449. Baard, P. P., Deci, E. L., & Ryan, R. M. (2004). Intrinsic need satisfaction: A Motivational Basis of Performance and Wellbeing in Two Work settings. Jo urnal o f Applied Psychology, 34(10), 2045-2068. Baumeister, R. F. & Leary, M. R. (1995). The Need to Belong: Desire for Interpersonal Attachment as a Fundamental Human Motivation. Psycho lo gical Bulletin, 117(3), 497-529. Case, R. B., Moss, A. J., Case N., McDermott, M., Eberly, S. (1992). Living Alone After Myocardial Infection: Impact on Prognosis. JAMA, 267(4), 515-519. Deci, E. L., Koestner, R., & Ryan, R. M. (1989). A Meta-Analytic Review of Experiments Examining the Effects of Extrinsic Rewards on Intrinsic Motivation. Psycho lo gical Bulletin, 125(6), 627-668. Deci, E. L. (1995). Why We Do What We Do . London: PenguinBooks. Deci, E. L., & Ryan, R. M. (2000). The “What” and “Why” of Goal Pursuits: Human Needs and the SelfDetermination of Behavior. Psycho lo gical Inquiry: An International Journal for the Advancement of

Psychological Theory, 11(4), 227-268. Deci, E. L., & Ryan, R. M. (2008). Self-Determination Theory: A Macrotheory of Human Motivation, Development, and Health. Canad ian Psycho lo gy, 49(3), 182-185. Dulebohn, J. H., Bommer, W. H., Liden, R. C., Brouer, R. L., & Ferris, G. R. (2011). A Meta-Analysis of Antecedents and Consequences of Leader-Member Exchange: Integrating the Past with an Eye toward the Future. Jo urnal o f Managem ent. Retrieved December 5, 2014, from http://jom.sagepub.com/ content/early/2011/07/19/0149206311415280 Graen, G. B., & Uhl-Bien, M. (1995). Relationship-Based Approach to Leadership: Development of LeaderMember Exchange (LMX) Theory of Leadership over 25 Years: Applying a Multi-Level Multi-Domain Perspective. Lead ership Quarterly, 6(2), 219-247. Henderson, D. J., Liden, R. C., Glibkowski, B. C., & Chaudhry A. (2009). LMX Differentiation: A Multilevel Review and Examination of its Antecedents and Outcomes. The Lead ership Quarterly, 20, 517-534. Jacobson, N. S., Fruzzetti, A. E., Dobson, K., Whisman, M., Hops, H. (1993). Jo urnal of Consulting and Clinical Psychology, 61(3), 516-519. Koestner, R., Otis, N., Powers, T. A., Pelletier, L., Gagnon, H. (2008). Autonomous Motivation, Controlled Motivation, and Goal Progress. Jo urnal o f Personality, 76(5), 1201-1230. Liden, R. C., Wayne, S. J., & Stilwell, D. (1993). A Longitudinal Study on the Early Development of Leader-Member exchanges. Jo urnal o f Ap p lied Psychology, 78(4), 662-674. Liden, R. C., Maslyn, J. M. (1998). Multidimensionality of Leader-Member Exchange: An Empirical Assessment through Scale Development. Jo urnal of Management, 24(1), 43-72. Maurer, T. J., Chapman, E. F. (2013). Ten Years of Career Success in Relation to Individual and Situational Variables from the Employee Development Literature. Jo urnal o f Vo catio nal Behavio r, 83(3), 450-465. Ryan, R. M. (1995). Psychological Needs and the Facilitation of Integrative Processes. Jo urnal o f Personality, 63(3), 397-427. Ryan, R. M., & Deci, E. L. (2000). Self-Determination Theory and the Facilitation of Intrinsic Motivation, Social Development, and Well-Being. Am erican Psychologist, 55(1), 68-78. Ryan, R. M. & Deci, E. L. (2006). Self-Regulation and the Problem of Human Autonomy: Does Psychology 30

2016 Need Choice, Self-Determination, and Will? Journal of Personality, 74(6), 1557-1586. Vansteenkiste, M., Niemiec C. P., & Soenens, B. (2010). The Development of the Five Mini-Theories of SelfDetermination Theory: a Historical Overview, Emerging Trends, and Future Directions. Advances in Motivation and Achievement, 16(A), 105-165. Wallen, K. (2005). Hormonal Influences on Sexually Differentiated Behavior in Nonhuman Primates. Frontiers in Neuroendocrinology, 26, 7-26. Wayne, S. J., Liden, R. C., Sparrowe, R. T. (1994). Developing Leaderâ&#x20AC;&#x201C;Member Exchanges: The Influence of Gender and Ingratiation. The American Behavioral Scientist, 37, 687â&#x20AC;&#x201C;714. White, R. W. (1959). Motivation Reconsidered: The Concept of Competence. Psychological Review, 66(5), 297-333.

2016 Appendix

2016

Relationship Satisfaction and Perceived Partner Support as Predictors of Motivation for Treatment in Women with Eating Disorders

Ariane Sophie Marion Jetten Supervisors: Howard Steiger, Ph. D, and Sabina Sarin, Ph. D

Abstract Autonomous motivation – freely choosing – has been shown to predict better treatment outcomes for eating disorders. Autonomy support – acknowledging patients’ perspective and providing options – has also been shown to increase patient autonomous motivation for treatment. Autonomy support from romantic partners has not yet been examined as a predictor of motivation for eating disorders treatment. This study assessed whether romantic relationship satisfaction, which covaries with eating disordered symptoms severity, and autonomy support from romantic partners, influenced patients’ levels of autonomous and controlled motivation for treatment. 36 patients (6 with anorexia nervosa, 30 with bulimia nervosa) were recruited from Douglas’ Eating Disorders Program. Patients completed questionnaires assessing autonomous (intrinsic) and controlled (extrinsic) motivation for treatment, romantic relationship satisfaction, and perceived autonomy support from their romantic partners. Results indicated that satisfying

relationships and greater perceived autonomy support were significantly associated with higher levels of controlled motivation for treatment, and not with autonomous motivation. Our findings are inconsistent with past research and suggest that those in supportive and satisfying relationships may be more likely to pursue eating disorders treatment on behalf of their partners rather than for their own sake.

2016 Introduction

linked with serious health problems including low bone mass and osteoporosis, leading to inExtreme body weight prevalence has increased risks of bone fracture (Mehler, Cleary, & creased in the past years in the United States as Gaudiani, 2011), hypothermia, hypotension, and shown by the doubling rates of obesity between bradycardia (Mitchell & Crow, 2006). 1980 and 2002 (Ogden, Carroll, Kit, & Flegal, 2014) and by eating disorders prevalence rates of Conversely, bulimia nervosa is defined in the about 6% (Hudson, Hiripi, Pope, & Kessler, DSM-V by binging and compensatory behav2007). Although the prevalence for eating disor- iours. Bulimics will overeat within a certain time ders may look small, it represents patients that frame, and then recurrently compensate by vomoften never get better. Indeed, the treatment attri- iting, using laxatives, fasting or over-exercising. tion rate is around 40% (Stein, Wing, Lewis, & Bulimia is characterised by a sense of lack of conRaghunathan, 2011). Finding appropriate care is trol over oneâ&#x20AC;&#x2122;s eating behaviour, and by the unthus of prime importance. Many factors, such as duly influence of oneâ&#x20AC;&#x2122;s shape and weight in selfbiological predispositions, internalization of the evaluation (American Psychiatric Association, thin ideal, and interpersonal/relationship distress 2013). Unlike anorexics, the body mass index have been shown to contribute to the onset and (BMI) of bulimics typically is within the normal maintenance of anorexia and bulimia (Jacobi, range (American Psychiatric Association, 2013). Hayward, de Zwaan, Kraemer, & Agras, 2004; Cognitive-behavioural therapy has been shown Pinheiro, 2009; Striegel-Moore & Bulik, 2007). to be an effective treatment in about 30% to 50% The goal of this research is to assess whether per- of cases with the other half of bulimic patients ceived autonomy support (described shortly) showing mediocre or no improvement (Fairburn from a romantic partner and relationship satisfac- & Harrison, 2003; Wilson, 2005). Bulimia has tion felt by a patient can have an impact on pa- been linked with electrolyte abnormalities intient motivation for treatment. volving a lack of potassium, chloride, and sodium, which may lead to cardiac arrhythmias Anorexia nervosa is characterised by the (Mitchell & Crow, 2006). DSM-V as the significant restraint of oneâ&#x20AC;&#x2122;s caloric intake leading to low body weight as measured Numerous factors have been implicated in by the body mass index (Thomas, Roberto, & the development and maintenance of eating disBrownell, 2009), a fear of gaining weight or be- orders, including genetic predispositions, anxiety coming fat (Yager & Andersen, 2005), and a dis- and depression, obsessive or borderline personalturbed body image (Attia & Walsh, 2007; Yager & ity traits, and maladaptive coping skills Andersen, 2005). Anorexia is associated with (American Psychiatric Association, 2013; Hubert some of the highest mortality rates of all mental Lacey, Coker, & Birtchnell, 1986; Walsh, 2013). illnesses (Harris & Barraclough, 1998), resulting Another risk factor that has been found to be imfrom medical complications, suicide, and the lack portant in both the development and mainteof effective treatments (Bodell & Keel, 2010). In- nance of eating disorders is interpersonal sensideed, while family therapy has been shown to be tivity or distress. Women with eating disorders effective with adolescents, no specific pharmaco- have been found to be more sensitive to rejection, logical or psychotherapeutic treatment has more attuned to the judgement or reactions of shown consistent, effective results with adults others, and have more conflictual relationships. (Bodell & Keel, 2010). Anorexia nervosa has been Consequently they experience more distress and 34

2016 less interpersonal relationship satisfaction (Hartmann, Zeeck, & Barrett, 2010; StriegelMoore, Silberstein, & Rodin, 1993), especially in their relationships with men (Thelen, Kanakis, Farmer, & Pruitt, 1993). In addition, interpersonal stress has also been found to be a major predictor of binge-purge behaviour (American Psychiatric Association, 2013; Steiger & Israël, 1999). Despite the importance of interpersonal factors in the onset and maintenance of eating disorders, very little research has specifically examined the romantic relationships of women with eating disorders. Contrary to what one might think, considering their poor interpersonal relationships, at least 15% of women with eating disorders are in romantic relationships (Bulik, Sullivan, Fear, Pickering, & Dawn, 1999; Côté, Bégin, Aimé, & Ratté, 2011). These women tend to report lower relationship satisfaction and more distress (Bulik, Baucom, Kirby, & Pisetsky, 2011; Van den Broucke & Vandereycken, 1988). Couples in which one partner has an eating disorder also tend to show less adaptive communication patterns than healthy couples (Van den Broucke, Vandereycken, & Vertommen, 1994). This additional relationship-related stress may in turn impede recovery from an eating disorder. Conversely, those in positive relationships may experience better treatment outcomes. In fact, relationship satisfaction has been associated with less severe eating disorder symptoms (Côté et al., 2011). In addition, some research has demonstrated that women who have recovered from anorexia are more likely to report satisfying romantic relationships than those who did not recover, and recovered anorexics tend to identify their partners’ support as the major factor and driving force in their recovery (Bulik et al., 2011; Keski-Rahkonen et al., 2014) Overall, past work indicates an important link between relationship satisfaction and severity of eating disordered symptoms. What is not

clear are the factors that make a relationship satisfying. One element that may be important to consider is the kind of support patients receive from their partners, as support that is perceived as controlling or directive may have a very different effect than what has been labelled ‘autonomy support’ (Ryan & Deci, 2000). Autonomy support – providing options, taking the other’s perspective and providing a rationale – has been linked with increased autonomous motivation (i.e. freely choosing to pursue something) for treatment across many health settings (Ng et al., 2012). According to Richard Ryan and Edward Deci (2000), authors of self-determination theory, autonomous motivation occurs when someone pursues an activity or behaves in a certain way because they want to, not because they feel they have to. When one feels autonomous and selfdetermined, the likelihood of achieving one’s goals are higher because of a higher inner drive to do so (Deci & Ryan, 2000). Controlled or extrinsic motivation, on the other hand, describes situations when people engage in behaviours only because of external incentives. There are four types of controlled motivation, ranging from the closest to the furthest away from being autonomous motivation. Those further away from autonomous motivation include external and introjected motivations. In essence, the two differ in the way they exert pressure on an individual. The first is more temporary; once the pressure is removed the individual is no longer motivated. The latter is internalized in an erroneous manner, which leads to long term effects and more inner conflicts (Ryan & Deci, 2000). Another type of motivation coined by Deci and Ryan is identified motivation, which occurs when someone values something without necessarily fully adhering to or endorsing it. Finally, integrated motivation occurs when people understand the rationale for engaging in a behaviour (e.g. going into treatment) and have come to 35

2016 endorse it themselves (Ryan & Deci, 2000). Integrated motivation ultimately leads to more autonomous motivation. According to selfdetermination theory, autonomy support is associated with increased autonomous motivation, whereas controlled or directed support is associated with poorer performance and lower wellbeing. This relationship has been demonstrated both in experimental and field study settings (Deci & Ryan, 2000). Studies reviewed by Deci and Ryan (2000) show that children who perceive their parents as autonomy supportive have higher levels of autonomous motivation (Grolnick, Ryan, & Deci, 1991). This finding is also true for adolescents regarding their teachers (How, Whipp, Dimmock, & Jackson, 2013). Finally, this result has been replicated in adult populations treated for a medical condition: those who feel autonomy supported by their medical practitioner display higher levels of autonomous motivation for treatment (Williams, McGregor, Zeldman, Freedman, & Deci, 2004). In the same study, important others have also been found to have an additional impact, apart from that of medical staff, on patients’ perceived autonomy support (Williams et al., 2006). Furthermore, in other studies, autonomy support from partners has been found to be associated with more intrinsic and identified (controlled) forms of motivation over three months in college students. This support was also associated with goal progress and improved relationship satisfaction among college romantic dyads (Koestner, Powers, Carbonneau, Milyavskaya, & Chua, 2012). To date, however, no research has examined the role of partner support in fostering autonomous motivation in eating disordered populations. Increased autonomous motivation has been associated with better treatment outcomes and long term results in health programs, whereas higher levels of controlled motivation has been associated with lower levels of compliance with

treatment and poorer outcomes (Ng et al., 2012). Less work has examined autonomous and controlled motivation levels in anorexic or bulimic patients and the factors that influence these motivation levels. In one recent study, Mansour and colleagues (2012) found that higher pre-treatment levels of autonomous motivation predicted better treatment outcomes in patients with bulimia spectrum disorders. Moreover, Van der KaapDeeder and colleagues (2014) found that environments providing choice and acknowledging the eating disordered patient’s perspective fostered higher levels of autonomous motivation in these patients. They additionally found that relative increases in self-endorsed motivation predicted increases in body mass index (BMI) in anorexic patients; thus indicating the potential importance of fostering autonomous motivation for treatment in eating disordered patients.

In sum, while researchers have found that relationship satisfaction is associated with eating disordered symptoms (Bulik et al., 1999; Côté et al., 2011), no research has examined whether pretreatment levels of relationship satisfaction predict autonomous motivation for treatment. In addition, while some preliminary research shows that autonomy supportive environments, particularly as provided by intimate partners (Koestner et al., 2012), foster better goal progress and relationship satisfaction, this has not been examined in an eating disorder population. Hypotheses We wanted to assess whether relationship status is linked to autonomous motivation for treatment; and if it was, whether it was mediated by the quality of the relationship. (1) We predicted that perceived autonomy support from partners would be positively related to both relationship satisfaction and autonomous motivation for treatment in patients who are in relationships. (2) We hypothesized that perceived autonomy support from partners in interaction with their levels 36

2016 of relationship satisfaction would explain more of the variance in autonomous motivation than would perceived autonomy support from other sources. (3) Lastly, we predicted that relationship satisfaction, perceived autonomy support from a romantic partner and autonomous motivation would be positively linked to eating disordered symptom severity. Eating disorder diagnoses were examined as moderators of these relationships in order to identify whether these effects differ for individuals with anorexia versus bulimia. Methods Participants Women are more likely to have an eating disorder than men (Götestam, Eriksen, Heggestad, & Nielsen, 1998; Hoek et al., 1995; KeskiRahkonen et al., 2009; Lucas, Beard, O'Fallon, & Kurland, 1991; Marques et al., 2011; Swanson, Crow, Le Grange, Swendsen, & Merikangas, 2011), hence this research study focused exclusively on women. Participants were female patients who were 18 years of age or older and self-referred to the outpatient clinic treatment of the Eating Disorder Program at the Douglas Mental Health University Institute. Participants included those that were single or in relationships for a minimum of 6 months. Participants met DSM-V criteria for anorexia nervosa, bulimia nervosa, or other specified eating or feeding disorder (OSFED) fitting under the bulimia or anorexia spectrum. Diagnoses were derived from interviews with expert clinicians with experience working with eating disorders. Participants with comorbid mood, anxiety and personality disordered symptoms were included in the study, however those with conditions (e.g., psychosis, bipolar, severe substance dependence) that might impede their capacity to respond to questionnaires were excluded.

Measures Social and Personal Questionnaire. This questionnaire assesses general demographic information including, among others age, gender, relationship status and duration if applicable. This demographic information helped determine who was eligible for the relationships group and their overall personal situation. Eating Disorder Examination Questionnaire (EDEQ; Fairburn & Beglin, 1994). The EDE-Q was developed as a 52-item self-report version of the eating disorder examination (EDE), a wellestablished investigator-based interview (Cooper & Fairburn, 1987). The EDE-Q is comprised of four components assessing major concerns of eating disordered patients: eating, shape issues, weight issues, and restraint. Responses are provided on a 7-point Likert scale ranging from “no days” to “every day” when considering the past four weeks (Fairburn & Beglin, 1994). It has been shown to have excellent internal consistency (Cronbach’s α = .88 to .93) (Luce & Crowther, 1999). Autonomous and Controlled Motivations for Treatment Questionnaire (ACMTQ; Zuroff et al. 2007). The ACMTQ is a 12-item questionnaire adapted by Zuroff and colleagues (2007) from Williams, Freedman, and Deci’s Treatment Self-Regulation Questionnaire (TSRQ) (1998). The initial modification Zuroff and colleagues (2007) performed was made to assess participants’ motivation for depression treatment rather than for physical health treatment, as was measured by the TSRQ. The ACMTQ (Zuroff et al., 2007) was further modified by Mansour and colleagues (2012) to give it to eating disordered populations. The word “depression” was replaced by “eating disorder”. The ACMTQ (Zuroff et al., 2007) assesses the extent of autonomous compared to controlled motivation for treatment. It is comprised of two subscales to measure both motivation types. Questions are to be answered with a 37

2016 Likert scale from 1 (strongly disagree) to 7 (strongly agree). The ACMTQ has demonstrated acceptable internal consistency in eating disordered populations (Cronbach’s α = .78) (Mansour et al., 2012). Revised Dyadic Adjustment Scale (RDAS; Busby et al. 1995). The RDAS is a 14-item selfreport scale assessing relationship satisfaction on three dimensions: (a) consensus in values, decision making, and affection; (b) satisfaction with the relationship; (c) cohesion of interests and common activities within the couple (Busby, Crane, Larson, & Christensen, 1995). Items are rated on a 6-point Likert scale describing the frequency of occurrence of an event (e.g. quarrels), or agreement with one’s partner on a particular item (e.g. always agree to always disagree on religious beliefs). The RDAS has been found to have excellent reliability (Cronbach α = .90) and good validity (Busby et al., 1995; Crane, Middleton, & Bean, 2000)

participate, they were contacted by trained research personnel who provided further details about the study and obtained written consent (see appendix A). Those who did not meet inclusion criteria, or whose therapist judged them as incapable of participating after they had given consent (e.g. because of sudden and endangering weight loss) were excluded. Clinical information about participants collected for inclusion criteria and throughout the course of the study were only reviewed by trained staff at the Douglas Mental Health University Institute. Participants were then scheduled to fill out a questionnaire battery comprised of the Social and Personal Questionnaire, Eating Disorder Examination Questionnaire (EDE-Q), Autonomous and Controlled Motivations for Treatment Questionnaire (ACMTQ), Revised Dyadic Adjustment Scale (RDAS) and Health Care Climate Questionnaire (HCCQ). Results

Health-Care Climate Questionnaire (HCCQ; Zuroff et al. 2007). The HCCQ is a 7-item questionnaire, adapted by Zuroff and colleagues (2007) from Williams, Grow, Freedman, Ryan, and Deci (1996), to assess psychiatric patients’ perception of the autonomy support they receive from their individual therapist. Responses are rated on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). In the current study, the word “individual therapist” was replaced by “romantic partner” to assess the participants’ perception of the autonomy support they received from their partners regarding their treatment (for full modified questionnaire, see appendix B). This questionnaire has good reliability (Cronbach α = .88) (Zuroff et al., 2007).

Participants were between the ages of 18 and 62 (Mean = 32.61, SD = 11.19). Most of the sample identified as Caucasian, Quebecoise or Canadian (27%), while the rest did not answer the question (66.7%) or were of another ethnic background (5.6%). Of the 37 initial participants, one was excluded because she had been in a relationship for only two months. Of the remaining 36 participants, 20 were single and 16 were in a relationship. Of the 16 in relationships, 9 reported being satisfied. Finally, information on psychoactive medication use was provided by 33 of the 36 participants, 11 of whom reported taking one or more of the following psychoactive drugs for their eating disordered or comorbid symptoms at the beginning of treatment: citalopram (n = 4), Procedure escitalopram (n = 2), aririprazole (n = 2), quetiapine (n = 2), clonazepam (n = 2), risperidone (n = Participants were recruited from the Douglas 1), venlafaxine (n = 1), lorazepram (n = 1), trazaEating Disorder Program. Individual or group done (n = 1), oxazepan (n = 1), and lithium (n = 1). therapists contacted the patients and explained to them the purpose of the study. If they wished to Independent samples t-tests revealed no sig38

2016 nificant group differences between anorexics and bulimics on any of the variables of interest (e.g. perceived partner support, relationship satisfaction autonomous or controlled motivation for treatment), with the exception of BMI (mean BMI of patients with anorexia = 15.34 (SD = 1.51); mean BMI of patients with bulimia = 24.48 (SD = 5.99), t(31) = -6.99, p < 0.001), with anorexics reporting lower BMI. Given the lack of difference between anorexics and bulimics on the variables of interest, all remaining analyses were conducted on the sample as a whole. Relationship satisfaction and motivation In order to examine whether those who were in satisfying relationships differed from those who were single or in unsatisfying relationships, we conducted a one-way ANOVA comparing levels of motivation for treatment. Results indicated that mean levels of autonomous motivation were higher on average for those in satisfying relationships (mean = 6.16) than those who were single (mean = 5.77) or in unsatisfying relationships (mean = 5.57), but these differences did not achieve statistical significance (F(2, 33) = 0.403, ns). On the other hand, results revealed an unexpected trend for group differences in controlled motivation on the basis of relationship quality (F (2, 33) = 3.019, p = 0.063). Tukey’s HSD post hoc tests revealed that those who were satisfied with their relationships had higher levels of controlled motivation than those unsatisfied with their relationships (p = 0.06). Means and standard deviations for all variables are presented in Table 1.

(11) = 0.817, p = 0.001). A follow up independent samples t-test comparing those who were satisfied versus unsatisfied in their relationships indicated that those satisfied with their relationships perceived their partner as more autonomy supportive than those who were not satisfied (t(11) = 4.906, p < 0.001). Moreover, perceived autonomy support from a partner was also significantly associated with controlled rather than autonomous motivation for treatment. Indeed, linear regression analyses indicated that perceived autonomy support from a romantic partner significantly predicted higher levels of controlled motivation for treatment (β = 0.57, t(12) = 2.301, p < 0.05) and accounted for 32% of the variance in controlled motivation (see Table 2). Furthermore, the association between autonomy support from a romantic partner and autonomous motivation was nonsignificant (β = 0.21, t(12) = 0.713, ns). Finally, linear regressions indicated that for those unsatisfied with their relationships, perceived autonomy support from their family was significantly associated with greater autonomous motivation (β = 2.145, t(4) = 3.276, p = 0.047) and accounted for 78.6% of the variance in motivation levels (see Table 2).

Hierarchical regression analyses were also performed to identify whether relationship satisfaction accounted for the significant relationship between partner support and controlled motivation. Neither perceived partner autonomy support nor relationship satisfaction were significant predictors of controlled motivation after accounting for the other (F (2, 10) = 2.612, ns) due to the Partner Autonomy support and motivation for high collinearity between the two variables. treatment Autonomy support from partners, friends and In order to examine the hypothesised rela- family tionship between perceived partner autonomy To examine whether autonomy support from support and autonomous motivation for treata romantic partner would predict motivation levment, we conducted correlation and linear reels above and beyond autonomy support from gression analyses. Results indicated that autonoother sources, such as friends and family, we permy support from romantic partners was signififormed hierarchical multiple regression analyses. cantly correlated with relationship satisfaction (r 39

2016 When autonomy support from friends and family, as well as relationship satisfaction were controlled for, autonomy support from a romantic partner was not significantly associated with autonomous motivation for treatment (F (4, 5) = 2.404, ns) or with controlled motivation (F (4, 5) = 0.58, ns). The coefficient for autonomy support from a romantic partner, however, showed a small trend, β = 1.318, t(9) = 2.101, p = 0.09. Relationship satisfaction and perceived partner autonomy support as a predictor of eating disordered symptoms To assess whether romantic relationship satisfaction and perceived autonomy support from a romantic partner were associated with eating disordered symptoms, after controlling for one another, we performed linear regressions. No significant associations were found between romantic relationship satisfaction and perceived partner autonomy support and the EDE-Q subscales of restraint or eating concerns. However, relationship satisfaction and perceived autonomy support from a romantic partner, as a composite variable, was significantly associated with lower scores on the ‘fear of gaining weight’ subscale of the EDE-Q (F(2, 10) = 4.425, p = 0.042) (see Table 2). An independent samples t-test indicated that those who were satisfied in their relationships did not significantly differ from those who were unsatisfied in their mean scores on the ‘fear of gaining weight’(t(14) = 0.77, ns). In addition, a one-way ANOVA was conducted to assess whether there were any group differences between those single, satisfied or unsatisfied with their relationship on eating disordered symptoms. Results indicated a trend only for the restraint subscale of the EDE-Q, whereby those who were satisfied in their relationships restrained less than those who were single (F (2, 33) = 2.592, p = 0.09). Finally, an independent samples t-test revealed there was a significant difference between eating disordered symptoms of participants who

lived with their romantic partner (15 out of the 16 in a relationship) and those who were single. In fact, those who lived with their partners had a significantly lower EDE-Q total score, indicating less severe eating disordered symptoms than single participants (t(32) = 1.528, p = 0.004). Discussion In line with the hypotheses, participants who perceived their romantic partners to be more autonomy supportive were more satisfied in their relationships. However, contrary to predictions, being in a satisfying relationship predicted higher levels of controlled motivation, rather than autonomous motivation. This differs from what Koestner and colleagues (2012) found in college populations, where relationship satisfaction predicted higher levels of autonomous motivation for goal progress. In another study, Bussolotti and colleagues (2002) also reported that women who lived with their partners had more severe symptoms of eating disorders, but displayed more motivation for treatment. However, it is not clear from this study whether patient motivation was autonomous or controlled, and romantic relationship satisfaction was not assessed. In the present study, participants who were satisfied in their relationship were also more likely to have increased motivation, but this motivation was extrinsic. Perceived autonomy support from romantic partners was also predictive of higher levels of controlled motivation for treatment, which is not surprising considering its high collinearity with relationship satisfaction. Our finding that perceived autonomy support from a romantic partner and relationship satisfaction are associated with initially higher levels of controlled motivation for treatment seems to suggest that patients who are satisfied with their relationship are coming for treatment more for their partners than for themselves. However, controlled motivation can change into more self-determined motivation over time. 40

2016 Indeed, self-determination theory purports that controlled forms of motivation, such as extrinsic or identified motivation, may ultimately evolve into more self-regulated, closer to intrinsic forms, such as integrated motivation, or even autonomous motivation. This can happen when autonomy support is provided by friends, family, a therapist or a romantic partner, along with structure and interpersonal involvement (Deci & Ryan, 2000). However, this process takes time and given the cross-sectional nature of this study, we were unable to explore whether the higher levels of controlled motivation translated into higher autonomous motivation. This remains a question for future research studies to explore. On the other hand, controlled motivation for treatment has also been associated with improved treatment outcome within the context of eating disorders. Indeed, Thaler and colleagues (2014) reported that, for patients with BMIs of 18.5 and lower, mandatory weight gains of 500 grams per week made patients gain more weight than when the weight gain was only recommended. Additional pressure to gain weight in the mandatory condition was achieved by excluding patients who did not gain enough weight three weeks in a row, suggesting a non-readiness to fully adhere to the treatment program. Patients in the mandatory weight gain condition also showed the same reduction in comorbid symptoms as those in the recommended condition, thus indicating that the benefits of a controlling context were without apparent negative consequences (Thaler et al., 2014). This controlling setting may be helpful especially for patients who have very low body weights. However, again, long-term outcomes were not assessed in the latter study, and so it is unclear whether those in the mandatory condition maintained their treatment gains to the same extent as those in the recommended weight gain condition. In addition, in contrast to the hypotheses, we also found no significant improvement in either autonomous or controlled motivation for treat-

ment when we examined perceived support from a romantic partner on top of that received by friends and family. Given the importance of romantic partners in patients’ lives, we had expected that partner support would be of greater influence in patient levels of autonomous motivation for treatment than either friends or family, but this was not the case. This is in line with some previous work indicating that “the most important others” in one’s life account for most of one’s goal progress and that second and third “most important” people do not add upon the first’s impact (Ruehlman & Wolchik, 1988). While we had expected our patients to consider their partners to be “the most important other” in their life, it is possible that this was not the case. Another factor that may account for our lack of significant results is that our sample is significantly different from that of the previously mentioned study, which used a college population. Women with eating disorders do experience more relationship distress (Bulik et al., 2011; Thelen et al., 1993; Van den Broucke & Vandereycken, 1988) and have more insecure attachment styles (Ward, Ramsay, & Treasure, 2000), which might dampen the influence their partners have on their autonomous motivation. Indeed, Deci and Ryan (2000) have hypothesized within the context of selfdetermination theory that “intrinsic motivation will be more likely to flourish in contexts characterized by a sense of secure relatedness (p.235)” (Deci & Ryan, 2000). When looking at perceived autonomy support from others as a predictor for autonomous motivation, we found that perceived autonomy support from family was significantly associated with autonomous motivation for those not satisfied with their relationship. This suggests that even if family therapy is not used to treat adult populations, patients’ perception of the autonomy support they receive from their families is important for their own autonomous motivation for treatment, particularly if they are unsatisfied in their romantic relationship. Considering that re41

2016 lationship satisfaction and perceived autonomy support are highly intertwined, those unsatisfied in their relationships may be more likely to feel their partners are not autonomy supportive of them and may hence rely more on other sources, such as their family, which in turn be more likely to increase their levels of autonomous motivation. Considering the distressing romantic relationships eating disorders women may experience (Bulik et al., 2011; Van den Broucke & Vandereycken, 1988), they might also trust their families more than their partners and as such create a more fertile ground for intrinsic motivation for treatment to develop (Deci & Ryan, 2000). Finally, for all those in a relationship, perceived autonomy support from a romantic partner did not predict severity of pretreatment levels of eating disordered symptoms, except for the subscale of fear of weight gain, even after controlling for relationship satisfaction.With a greater sample size, we may have found significant differences on other eating disorder symptom subscales. In addition, relationship status was also significantly associated with the EDE-Q restraint subscale such that those who were in satisfying relationships showed less restraint than single participants. This is consistent with previous literature indicating that more satisfying relationships are associated with less severe eating disordered symptoms (Côté et al., 2011). Moreover, in our sample, those who lived with their romantic partners displayed less severe eating disordered symptoms than those who were single. This finding contrasts with Bussolotti and colleagues (2002) who reported that women who lived with their partners had more severe eating disordered symptoms, but is in line with other work suggesting that women living with their partners have more motivation for treatment (Bussolotti et al., 2002), although we found this link to be significant only for those satisfied with their relationships. Being in a relationship, especially a satisfying one, and living with one’s partner may indeed be protective factors against

more severe eating disordered symptoms. Limitations This study has several limitations. First and foremost, we had a small sample size. We had only 6 anorexics and 30 bulimics, which prevented us from being able to examine differences on the basis of eating disorder status. We also did not have the power to examine whether results were moderated by age, relationship duration, psychoactive medications, partner cohabitation, or other factors we may have overlooked. In fact, we had only 20 participants who were single, 7 who were unsatisfied and 9 who were satisfied with their romantic relationships. So, there may have been group differences that were obscured by our insufficient power. Future studies should gather more participants and assure a sufficient number of patients both with anorexia and bulimia diagnoses who would also be in relationships. The current study was cross sectional, which limited us from examining the evolution of motivation, eating disordered and comorbid symptoms, and the potential impact of romantic breakups over the course of treatment. We were also unable to examine whether treatment outcome is influenced by romantic partner autonomy support, relationship satisfaction and autonomous motivation. Further studies should also include a readiness measure to assess whether only those who are “ready” can benefit from their partners’ autonomy support. Such findings may hint at the importance of including the partner in the treatment process, either in terms of couple therapy or support groups for the partners. Considering romantic partners are known to feel powerless in face of eating disorders (Huke & Slade, 2006), such support groups may help them become more involved in their relationships and more helpful to their partners. Some researchers have already attempted to bring romantic partners into therapy for eating disorders (Bulik et al., 2011). 42

2016 anorexia nervosa: efficacy, safety, and adherence. Motivational interviews should also be conPsychology Research and Behavior Management, 3, sidered for both patients and partners at the be91-108. ginning of treatment as they may have a positive Bulik, C. M., Baucom, D. H., Kirby, J. S., & Pisetsky, E. impact on both, improving readiness to change in (2011). Uniting Couples (in the treatment of) patients and reducing the psychological distress Anorexia Nervosa (UCAN). Internatio nal Jo urnal of Eating Disorders, 44(1), 19-28. of carers (Macdonald, Hibbs, Corfield, & TreasBulik, C. M., Sullivan, P., Fear, J., Pickering, A., & Dawn, A. ure, 2012). If these two conditions are met (1999). Fertility and reproduction in women with (readiness from patients and relief from psychoanorexia nervosa: A controlled study. Jo urnal o f logical distress of the partners), the partners Clinical Psychiatry, 2, 130-135. might be better able to provide autonomy sup- Busby, D. M., Crane, D. R., Larson, J. H., & Christensen, C. (1995). A revision of the dyadic adjustment scale port, and the patients may be more responsive to for use with distressed and non-distressed couples: it, which in turn might ultimately lead to greater construct hierarchy and multidimensional scales. autonomous motivation for their treatment. Journal of marital and family therapy., 21(3), 289-308. Bussolotti, D., Fernández-Aranda, F., Solano, R., JiménezMurcia, S., Turón, V., & Vallejo, J. (2002). Marital status and eating disorders: an analysis of its relevance. Jo urnal o f p sycho so m atic research, 53(6), 1139-1145. Cooper, Z., & Fairburn, C. (1987). The eating disorder examination: A semi-structured interview for the assessment of the specific psychopathology of eating disorders. Internatio nal Jo urnal o f Eating Disorders, 6(1), 1-8. Côté, M., Bégin, C., Aimé, A., & Ratté, C. (2011). Deepening the understanding of the relationship between couple issues and the severity of the eating symptoms in a clinical sample. Revue Francophone de Clinique Comportementale et Cognitive, 16(1), 12-26. Crane, D. R., Middleton, K., & Bean, R. (2000). Establishing criterion scores for the kansas marital satisfaction scale and the revised dyadic adjustment scale. The American Journal of Family Therapy, 28(1), 53-60. Deci, E. L., & Ryan, R. M. (2000). The "What" and "Why" of Goal Pursuits: Human Needs and the SelfDetermination of Behavior. Psycho lo gical Inquiry, 11(4), 227-268. Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: interview or self-report questionnaire? International Journal of Eating Disorders, 16(4), 363-370. Fairburn, C. G., & Harrison, P. J. (2003). Eating disorders. The Lancet, 361(9355), 407-416. References Götestam, K. G., Eriksen, L., Heggestad, T., & Nielsen, American Psychiatric Association. (2013). Diagno stic and S. R. (1998). Prevalence of eating disorders in statistical manual of mental disorders: DSM-5. Norwegian general hospitals 1990-1994: Washington, D.C. Admissions per year and seasonality. EAT Attia, E., & Walsh, B. T. (2007). Anorexia nervosa. The International Journal of Eating Disorders, 23(1), 57-64. American journal of psychiatry, 164(12), 1805-1810. Grolnick, W. S., Ryan, R. M., & Deci, E. L. (1991). Inner Bodell, L. P., & Keel, P. K. (2010). Current treatment for

Conclusion This study showed the importance of romantic partners in the patients’ motivation for their eating disorders treatment. Indeed, satisfying relationships in which patients feel autonomously supported by their partners seem to increase patients’ controlled motivation for treatment, insofar as patients may be motivated to seek treatment for the sake of their partners. Improving relationships and fostering greater autonomous support could potentially increase motivation for treatment, which may lead to greater symptom improvement or simply more balanced eating behaviour. Over time, a more healthy and selfdetermined relationship may lead to positive, autonomously motivated outcomes for patients suffering from eating disorders. Romantic relationships should be given greater attention within the context of eating disorders as romantic partners may be particularly important sources of influence in patient motivation and readiness (Bussolotti et al., 2002) for treatment.

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2016 Appendix

2016

The Effects of Epistemic Need on Engagement in Dysfunctional Norms

Holly Engstrom

Abstract Within some groups, the prevalence of specific dysfunctional behaviours (e.g. binge-drinking) is sufficiently high that these behaviours may be considered normative. One frequently overlooked motivating factor in the literature on dysfunctional norms is epistemic need (degree to which an individual seeks knowledge). The present study manipulated a potentially harmful group norm (pushing 25% longer beyond the limit of a baseline pain tolerance measure) to be construed as either functional or dysfunctional. Next, we measured epistemic needs via self-concept clarity (SCC) to examine whether individuals with higher epistemic needs (low SCC) were more likely to enact a dysfunctional norm than individuals with lower epistemic needs (high SCC). Results indicate that there was a marginally significant interaction effect between SCC and norm construal, in that participants with high epistemic needs were less likely to self-regulate in the functional condition, while participants with lower epistemic needs were more likely to do so.

2016 Introduction

group (Bachman et al., 1991; Wallace et al.,

Social groups differ from one another on

2003), as are alcohol-related fatalities (Young

a variety of bases, oftentimes the most notice-

& Joe, 2009). In Venezuelan Native American

able of which is what kind of behaviour their

populations, 94.2% of men exhibit dangerous

members exhibit in contrast to behaviour ex-

drinking patterns, 80.8% of whom have had

hibited

groups

“sufficient consequences from their drinking

(Pepitone, 1976). In 1936, Sherif first de-

to be classified as ‘harmful drinkers’” (Seale,

scribed these jointly negotiated templates or

Seale, Alvarado, Vogel, & Terry, 2002). Dys-

rules for social behaviour as norms. It has

functional norms, in the form of violence and

since been argued that norms evolve to pro-

delinquency, are also present to a dangerous

mote socially desirable, functional behaviour

degree within gangs. As demonstrated by

(Allison, 1992; D. Campbell, 1975), implying

Thornberry, Krohn et al. (1993), it is not the

that norms that are harmful to group mem-

case that gangs attract members who are al-

bers or maladaptive for the group at large do

ready more violent, but rather that member-

not exist. However, this suggestion is contra-

ship in gangs causes members to become

dicted by observations from the real world

more likely to commit crimes, especially seri-

and the ethnographic record. In some cases,

ous offences, and to do so frequently. There

groups of people have been observed to en-

are a number of other well-documented cases

gage in activities that are maladaptive, un-

of dysfunctional norms, such as the nightly

healthy, and risky: in a word, dysfunctional.

tavern drinking among low-income long-

Importantly, these behaviours are sometimes

shoremen

so pervasive that they are, by definition, nor-

(Mars, 1987) and the high consumption of

mative. Given that there is often some kind

unhealthy foods in the Southern African

of social sanction for diverging or defecting

American community of the United States

from the norm (Cialdini & Trost, 1998), the

(Oyserman, Fryberg, & Yoder, 2007). The

presence of a dysfunctional norm can be a

high prevalence of maladaptive behaviours

strong influence on group members to en-

in these communities demonstrates that this

gage in maladaptive behaviour.

is a collective problem rather than an indi-

members

other

Newfoundland’s

harbours

The presence of dysfunctional norms is

vidual one, rendering the problem difficult to

evinced in a number of communities. For ex-

combat due to social pressures to engage in

ample, among Aboriginal people in the Unit-

the dysfunctional norm.

ed States, rates of alcohol use, smoking, and

These dysfunctional norms pose enor-

drug use are much higher than in any other

mous problems to both the well-being of in48

2016 dividual group members as well as the group

Longitudinal Health Survey (RHS), 2002/03: Re-

at large. For example, as a result of the high

sults for Adults, Youth and Children Living in

prevalence of alcohol consumption in Abo-

First Nations Communities 2005). As a conse-

riginal communities, death due to alcohol use

quence of awareness of the enormously nega-

is 43.7 per 100,000 in the Aboriginal popula-

tive outcomes of these maladaptive behav-

tion (which is almost double the rate of the

iours, there is a significant amount of re-

general population), and Aboriginal youth

search dedicated to understanding, prevent-

face two to six times greater risk for every

ing, and controlling them.

alcohol-related problem than do other Amer-

Much of the previous literature exploring

ican youths (Chansonneuve, 2007). Moreo-

these behaviours tends to disregard the col-

ver, these harmful effects are not limited to

lective aspect of the behaviour in favour of

the individual who engages in them. Severe

focusing on the individual. Some of these re-

adverse effects are experienced by children of

search approaches include focusing on how

parents with drug or alcohol addiction, as

personality traits predict maladaptive behav-

they are three times more likely to be physi-

iour (Conrod, Castellanos-Ryan, & Mackie,

cally or sexually assaulted and four times

2011; Hair & Hampson, 2006), looking at the

more likely to be neglected and are also more

impact of stressful life events on the inci-

likely to suffer low self-esteem, depression,

dence of problematic behaviour (Moos, Fin-

suicide, truancy, and addictions later in life

ney, & Cronkite, 1990; Myers, McLaughlin,

(Chansonneuve 2007). Furthermore, drug use

Wang, Blanco, & Stein, 2014), and investigat-

has been linked to problems in Aboriginal

ing the relationship between cognitive pro-

populations such as high rates of alcohol-

cesses such as coping strategies and dysfunc-

related violence, accidents, unemployment,

tional behaviour (Wilson, 1978; Windle &

family problems, and risky sexual behaviour

Windle, 1996). As these behaviours have

(National Native Alcohol and Drug Abuse Pro-

such a significant impact on both the individ-

gram: General Review, 1998). Most Aboriginal

ual and those around them, they are treated

people in these communities recognize these

very seriously by society. Unfortunately, of-

behaviours as dysfunctional: in Manitoba,

ten the strategies employed are based solely

73% of all Aboriginal people believe that al-

on individual interventions such as therapy

cohol is a problem in their community

and rehabilitation programs, many of which

(National Native Alcohol and Drug Abuse Pro-

draw upon the types of research described

gram: General Review, 1998). Furthermore,

above (Beck, Wright, Newman, & Liese, 2011;

63.9% of Aboriginal people believe that no

DiClemente, Fairhurst, & Piotrowski, 1995;

progress is being made on substance and al-

Rogers & Dymond, 1954).

cohol abuse problems (First Nations Regional

Yet, individual-based intervention strate49

2016 gies are often ineffective in the case of dys-

haviours. If these norms are the basis on

functional norms. For example, despite the

which this group can be distinguished from

fact that millions of dollars have been invest-

another, they are likely to become part of this

ed by governments and Aboriginal institu-

group’s identity (Oyserman et al., 2007). This

tions to combat substance abuse, levels of

may lead to specific challenges in eradicating

substance abuse have in fact risen among Ab-

the behaviour, which are ignored by individ-

original people (Taylor & Sablonniere, 2014).

ual approaches. If this is the case, it may be

One reason for their lack of efficacy may be

particularly difficult to eradicate this behav-

that such programs are often designed to in-

iour.

tervene at the individual level rather than the

In recent literature there have been some

collective level. As Taylor and Sablonniere

attempts to justify why individuals may

(2014) explain, programs such as Alcoholics

choose to engage in dysfunctional group

Anonymous rely on the ability of individuals

norms based on an investigation of group

to come to the conclusion that they have a

identity. Most of these approaches focus on

problem with substance abuse which is

belongingness and inclusion. According to

affecting their lives. When the social frame of

self-presentation theory, individuals are mo-

reference is others who also consume alcohol

tivated to behave in certain ways in order to

at a high rate, it becomes much more difficult

be evaluated positively by others in their

to recognize that a problem exists, since

group (although they may not actually be-

many others seem to behave in similar ways.

lieve

Furthermore, if these behaviours are integral

(Tedeschi, 2013). For example, Rutland, Cam-

to a group’s identity, there may be social

eron et al. found that children who had not

pressure to engage in them. Both of these fac-

internalized the norm of tolerance for out-

tors are ignored by these individualistic ap-

groups still suppressed their prejudice in

proaches. Indeed, a number of recent publi-

public situations (2005). Alternately, accord-

cations on substance abuse among Aborigi-

ing to Oyserman’s identity-based motivation

nal populations have outlined the need for a

model (2007), group members feel a greater

collective,

approach

sense of inclusion in the group by engaging

(Chansonneuve, 2007; Marlatt et al., 2003). It

in a behaviour that is “identity infused”.

is possible that group norms that are harmful

These behaviours are not simply choices

to group members may confer benefits in

made in the moment, but rather are choices

terms of their distinctiveness, or ability to

that are congruent with the rest of their

distinguish one group from another on the

group – in other words, normative. This be-

basis of this behaviour, because very few oth-

haviour may have positive or negative health

er groups are likely to engage in harmful be-

effects. For example, sushi, pasta, curry, and

culturally

sensitive

these

behaviours

positive)

2016 hamburgers are associated with different na-

1959). As Gerard and Mathewson demon-

tional, ethnic, and racial groups. Eating the

strated, people who suffer physical pain to-

food from one’s own group facilitates greater

gether feel a heightened sense of belonging

feelings of inclusion in one’s group. The

to their group (1966). This mechanism has

choice of one food over another may be in-

been implicated in causing individuals initi-

nocuous (e.g. choosing rice or pasta) or may

ated into gangs with painful beatings to val-

have serious health impacts (e.g. choosing

ue gang membership more highly (Vigil,

potato chips over fruit). Groups that engage

1996). Dysfunctional norms may follow a

in behaviours like unhealthy food consump-

similar mechanism by causing individuals to

tion or alcohol abuse generally do not view

continually experience harm in order to feel

this behaviour as positive. However, accord-

connected to their group; because of cogni-

ing to social identity theory, individuals are

tive dissonance, membership in this group is

motivated to create for themselves through

perceived as valuable and an individual’s

social groups an identity that is both positive

sense of belonging to this group is height-

(i.e. will be perceived positively by others)

ened. Furthermore, as Rawn and Vohs argue,

and distinctive (i.e. can be identified as part

individuals are willing to use self-control to

of a group which is different from other

undergo personal harm by enacting danger-

groups) (Tajfel, 2010). The reason why indi-

ous or risky behaviours such as drug abuse,

viduals would choose to enact dysfunctional

sadism (including murder), and attempting

group norms is thus a mystery.

to become HIV-positive to gain social re-

Researchers have proposed some potential explanations for this mystery, most of

wards (such as a greater sense of inclusion in the group) (2011).

which center around an individual’s sense of

However, there may be another, more

belongingness to and inclusion in the

overlooked factor causing individuals to sub-

group. For one, when an individual enacts a

scribe to dysfunctional group norms. In

self-harmful behaviour in order to feel more

Sherif’s famous autokinetic line experiments,

connected to his or her group (for example,

when presented with an ambiguous stimu-

painful initiations into fraternities), cognitive

lus, subjects’ estimates of the length of the

dissonance occurs, making that individual

line tended to conform to the “estimates”

feel that because a high-cost behaviour was

given by confederates. When later asked in

enacted for the purpose of group member-

private to estimate the line length, they still

ship, group membership must be highly val-

guessed lengths similar to those presented

uable. This causes that individual to like that

earlier by confederates (Sherif, 1936), sug-

group more and therefore want to be even

gesting that they had conformed to the esti-

more related to that group (Aronson & Mills,

mates given by confederates not simply be51

2016 cause they wanted to fit in and be liked

self-esteem, chronic self-analysis, and a rumi-

(because in private these pressures presuma-

native form of self-focused attention (J.

bly do not exist), but also because the confed-

Campbell et al., 1996), illustrating desire for

erates provided an informational influence

information about the self – high epistemic

(that is, because the stimulus was ambigu-

need. In contrast, high SCC is positively cor-

ous, subjects used the confederates as a

related with self-esteem and sense of purpose

source of information). A replication of this

in life (Baumgardner, 1990). Furthermore,

study using fMRI techniques found that

high SCC predicts the use of active coping

when succumbing to this informational influ-

styles (e.g. taking action to solve a problem)

ence of confederates, subjects still used parts

rather than passive styles (e.g. denial) (Smith,

of the brain associated with decision-making

Wethington, & Zhan, 1996), proactive prob-

rather than, for example, concerns about self-

lem solving in social situations (Bechtoldt, De

presentation (Berns et al., 2005). This finding

Dreu, Nijstad, & Zapf, 2010), holding an

supports Sherif’s hypothesis that this is in

opinion that is different from the majority

fact an informational influence being exerted

(Rios Morrison & Wheeler, 2010), and open

upon participants.

communication with parents in adolescence

When individuals lack information, they

(Van Dijk et al., 2014)). It seems that in gen-

look to others around them for guidance. Yet,

eral having a clear self-concept predicts posi-

individuals differ in terms of their epistemic

tive

needs (that is, the degree to which they seek

(Schwartz, Côté, & Arnett, 2005). Hence,

knowledge and information in any given sit-

those with more epistemic needs (low SCC)

uation). Furthermore, it is possible that some

would probably be far more likely to con-

individuals also exhibit greater epistemic

form to group norms, since the behaviour of

needs across situations. Self-concept clarity

those around them provides an informational

(SCC), the “extent to which self-beliefs are

influence as to how they should behave.

clearly and confidently defined, internally

However, those with low epistemic needs

consistent, and stable” (J. Campbell, 1990; J.

(high SCC) are probably less likely to con-

Campbell et al., 1996), can be used as a proxy

form to dysfunctional norms as enacting

to measure epistemic need, particularly in

these norms comes at a personal cost that is

the context of conformation to norms. It is

not outweighed for these individuals by the

likely that an individual with an unclear con-

satisfaction of epistemic needs.

outcomes

agentic

behaviour

ception of the self is also high in epistemic

Lack of self-concept clarity may be a par-

needs given that he or she lacks information

ticularly important but overlooked aspect of

about the self, which generally guides our

motivation for certain groups who struggle

behaviour. Low SCC is correlated with low

with lack of clarity at the collective level. 52

2016 Many

the

groups

discussed

earlier

The target behaviour for participants was

(including Aboriginal populations in North

to engage in a dysfunctional norm by experi-

America and Australia as well as African

encing excessive, unnecessary pain which

Americans in the United States) have had

was perceived by that individual as mala-

their collective identity fragmented by colo-

daptive. In the experiment, we created a ficti-

nialism and active attempts at assimilation

tious group norm using the cold pressor test

(such as residential schools in Canada that

that we then construed as either functional or

did not permit Native children to speak their

dysfunctional. Participants were told that the

own language). Usborne and Taylor (2010)

norm for their group was to leave their hands

demonstrated that among a sample of Cana-

in the cold water for 25% longer than their

dian First Nations people, deficits in cultural

baseline pain tolerance score in seconds dur-

(collective) identity clarity were associated

ing a subsequent trial of the same test. In one

with deficits in SCC. Lack of SCC as a result

condition, group members were told that this

of lack of cultural clarity could therefore help

behaviour was advantageous and adaptive

to explain the high rates of engagement in

because it indicated progressive pain toler-

dysfunctional norms in many disadvantaged

ance (where pain tolerance increases on each

communities. Given that many disadvan-

trial)

taged communities have had their identities

(functional norm). In the second condition,

infringed upon by the majority group, they

participants were told that the group norm

may have lower cultural clarity and therefore

was in fact maladaptive because progressive

lower SCC, causing more engagement in dys-

pain tolerance has detrimental health effects

functional norms.

(dysfunctional norm). It has been shown in

which

confers

health

benefits

The current study therefore aims to in-

previous studies that participants have a

vestigate the role of an individualâ&#x20AC;&#x2122;s epistemic

heightened tendency to conform to norms if

needs, as measured by SCC, in their adher-

they are told that this is a norm for their

ence to dysfunctional norms. We hypothesize

group, regardless of whether it actually is or

that individuals with high epistemic needs

not, as long as they are under a condition of

(low SCC) will be more likely to engage in

threat to their group identity (Jonas et al.,

dysfunctional norms whereas individuals

2008). To create a baseline importance for the

with low epistemic needs (high SCC) will be

group norm, we first primed subjects to think

less likely to do so. On the other hand, we do

about their group identity by reading about a

not hypothesize that there will be a signifi-

threat to their group. Adding threat as part of

cant difference between those with high vs.

the experimental conditions also has the ben-

low epistemic needs in the functional norm

efit of in some sense recreating the power dy-

condition.

namics experienced by many groups who 53

2016 commonly enact dysfunctional norms in that

their baseline pain tolerance score in seconds.

they are generally low status, threatened

The cold pressor apparatus is similar to

groups. As such, we created an intergroup

that presented by Turk, Meichenbaum, and

situation to better mimic the experience of

Genest (1983), consisting of an approximately

disadvantaged groups outside the laboratory

49-liter camping cooler filled with approxi-

to increase the applicability of our results for

mately 45 liters of water in which a cooling

disadvantaged groups and to set the ground-

device (Dexell, EK45 model) and a circulation

work for an environment in which norms

pump

would feel relevant.

Pump, Model 4100-C) were placed to keep

(Fisher

Scientific

Isotemp

Water

the water uniformly at 5째 Celsius. The clock Methods

used to time the participants was placed on

A total of 74 students participated in the

top of the cold pressor so that participants

experiment. However, nineteen were exclud-

were able to view their time. Participants first

ed from our analyses because they were ei-

sanitized their hands and placed them in a

ther: not Francophone, not McGill University

bucket of room temperature water to practice

students, or behavioural outliers on the cold-

the technique and to clean their hands. They

pressor task (they exceeded our safety limit

were then told to place their hands in the

of 180 seconds on their baseline trial). In to-

cold pressor apparatus and to remove them

tal, data from 55 students (12 men, 43 wom-

when they could no longer handle the pain

en, mean age = 20.11, SD = 2.157) were ana-

caused by the cold temperatures. Any partici-

lyzed. Participants were recruited online and

pants who left their hands in the water for

by phone and told that they would be partici-

over 180 seconds were instructed to remove

pating in a study designed to test second-

them to prevent any damage from the cold

language processing in ego-depleted states.

water. The amount of time participants left

Individuals were screened from participation

their hands in the cold pressor was recorded

if they had any neurological or cardiovascu-

as their baseline score.

lar conditions, or if they smoked more than

Participants then returned to the lab and

five cigarettes per day, as these have been

completed a pre-experimental questionnaire

linked to adverse effects when doing the cold

on computers. This questionnaire included a

pressor test (von Baeyer, Piira, Chambers,

number of different scales, the focus of which

Trapanotto, & Zeltzer, 2005). Participants

for this paper was the SCC scale. The SCC

were tested in groups of two to five. After

scale used is a shortened version of the scale

consenting to the experiment, participants

proposed by J. Campbell which has been

were taken one at a time to a different room

shown to be internally reliable, temporally

to perform the cold pressor test, to determine

consistent, and externally valid (1990). It asks 54

2016 participants to evaluate their agreement with

The full text of the functionality manipula-

statements using a 7-point Likert scale, and

tion can be found in Appendix C. Partici-

includes items such as “I seldom experience

pants were asked to type “I agree” to indicate

conflict between the different aspects of my

their consent to perform the cold pressor task

personality” and “Sometimes I think I know

a second time (and to verify that they had

other people better than I know myself”.

actually read the information regarding the

Items 2, 5, 7, and 10 from J. Campbell’s origi-

norm). They were then taken to the cold

nal scale were removed for the sake of brevi-

pressor room to perform the task once more,

ty, meaning that the final scale used in this

and given the same instructions as on the

experiment had a total of 8 items. This scale

first trial. The number of seconds they per-

can be found in full in Appendix A.

sisted on during their second trial was rec-

To induce a feeling of threat to the participants, during the pre-experimental question-

orded and the difference between their second and first trial was calculated.

naire they were asked to read a document

Finally, participants returned to the lab

from McGill University which proposed

once more and were asked to complete a post

changes to McGill’s language policy such

-experimental

that students would no longer be permitted

experimental questionnaire included three

to submit work in French. Participants were

items regarding the amount of self-regulation

asked to write a short paragraph on their

exerted by participants. Self-regulation is de-

opinion regarding the proposed changes as a

fined as one’s ability to control impulses and

manipulation check. The full text of the

abstain from instant gratification (Hagger,

threat manipulation can be found in Appen-

Wood, Stiff, & Chatzisarantis, 2010) and was

dix B. They were then informed that in order

measured to determine the extent to which

to reach the state of ego-depletion required

participants tried to overcome the pain of the

for the second phase of the experiment they

cold pressor task. Harrison’s activity effort

would be performing the cold pressor task

scale, which was designed to measure the

for a second time. Both groups of participants

“frequency of exerted effort beyond pain,

were told that it was a norm for their group

discomfort, and fatigue in women aging with

to persist 25% longer than their baseline on

paralytic polio” (2009), was used to measure

the

self-regulation. This scale has been shown to

second

trial.

Participants

the

internally

questionnaire.

consistent

The

and

post-

“dysfunctional” category were told that hav-

reliable

ing this progressive pain tolerance is detri-

(Harrison, 2009). Items 3, 4, 6, 7, and 8 were

mental to one’s health, while participants in

removed from the scale because they target-

the “functional” category were told that pro-

ed fatigue or were otherwise not relevant to

gressive pain tolerance has health benefits.

the current study, leaving a total of three re55

2016 maining items. Participants were asked to

normative behaviour. This was done to ex-

rate their agreement on a 7-point Likert scale

plore the hypothesis that participants with

with the following: “I pushed myself to keep

low SCC would be more likely to engage in

going when experiencing increasing discom-

dysfunctional norms than participants with

fort”; “I stopped performing the task when I

high SCC, but that there would be no differ-

felt discomfort” (reverse scored); and “I kept

ence in the functional condition. Multiple lin-

going when I needed a break”. Participants

ear regressions were therefore used to ex-

were then debriefed as to the true nature of

plore the effect of functionality and SCC on

the experiment and compensated $10 or 1%

engagement in the behaviour. The categorical

extra course credit.

condition variable was recoded into two dummy variables to allow comparison of

Results

conditions to each other. These dummy variables were entered into the first step of the

Preliminary Analyses

analysis along with mean-centered SCC

Scale reliability analyses revealed that

scores. The dummy variables were then each

the items from the SCC scale and the self-

multiplied with the mean-centered SCC

regulation scale were above the acceptable

scores to compute interaction terms that were

level of reliability in our sample, (Cronbach’s

entered into the second step of the analyses.

alpha = .85 and .74, respectively.) Participants

A marginally significant interaction was

scored, on average, near the midpoint of the

probed by testing the differences between the

SCC scale, MSCC = 4.151, SD = 1.278 and

regression lines at one standard deviation

slightly above the midpoint of the self-

above and below the mean of SCC.

regulation scale, Mself-regulation =4.809, SD =

The regression procedure was first ap-

1.496. During the cold pressor task partici-

plied to the time difference between trials.

pants tended to leave their hands in the wa-

The model overall was not significant F(2, 52)

ter longer than prescribed by the norm we set

= 0.348, p = 0.791. Furthermore, there was no sig-

for them of 25% longer on the second trial,

nificant main effect of functionality or SCC,

although this was fairly variable, Mcold pressor %

and there was no significant effect of their

= 40.310%, SD = 41.604, Mcold pressor time = 14.252

interaction. The regression procedure was

seconds, SD = 20.642.

then applied to self-regulation scores. In the first step of the regression analysis exploring

Main analysis

self-regulation as a function of SCC and func-

For the main analysis, SCC was included

tionality, there was no main effect of condi-

as a potential moderator of the relationship

tion or identification; however, the addition

between functionality and engagement in the

of the SCC by functionality interaction mar56

2016 ginally improved the model fit, F(2, 52) =

trend demonstrated in figure 1 suggests that

0.008, p = 0.992, R2 = 0.000, ΔR2 = 0.058, ΔF =

contrary to our hypothesis, participants with

3.13, p = 0.379, f2 =.062. There was no signifi-

high or low SCC did not differ significantly

cant main effect of functionality or SCC

in self-regulation in the dysfunctional condi-

(please see table 1), but there was a marginal-

tion, but in the functional condition those

ly significant interaction effect of functionali-

with high SCC self-regulated more while

ty X SCC (β = 0.25, t = 1.77, p = 0.083). Thus,

those with low SCC self-regulated less.

these results indicate that SCC interacts with

functionality of norm to impact level of self-

Discussion

regulation. Furthermore, power analysis us-

The results of this experiment revealed

ing G*Power (Faul, Erdfelder, Buckner &

that participants with high and low SCC self-

Lang, 2009) revealed the achieved power of

regulated equally in the dysfunctional condi-

the interaction effect of SCC and functionali-

tion, but a marginally significant effect of the

ty of norm on self-regulation in the present

interaction term suggests that those in the

study to be low (power = .46, assuming

functional condition with high SCC self-

f2=.062, α=.05, N=55). If the effect size found

regulated more than they did in the dysfunc-

in the present study is a reflection of the pop-

tional condition while those with low SCC

ulation, a sample of 125 would be required to

self-regulated less. In other words, those with

achieve a power of .80 (as recommended by

low SCC tried harder to engage in the norm

Cohen, 2013). The standardized coefficients

and were more willing to suffer pain to do so

for each of the variables are plotted in Table

when the norm was dysfunctional than when

1. Figure 1 plots this interaction effect.

it was functional, whereas those with high

Next, we conducted a simple slopes anal-

SCC exhibited the opposite pattern. Howev-

ysis to test the difference between regression

er, a marginally significant effect of the inter-

lines at one standard deviation above and

action and non-significant simple slopes

below the mean of SCC. Among those with

analysis indicate that the current results can

high SCC, those in the functional condition

only go as far to present preliminary findings

did not significantly self-regulate more or

regarding the impact of SCC on the willing-

less than those in the dysfunctional condi-

ness to engage in functional or dysfunctional

tion, t(54) = 1.257, p = 0.214. Similarly, among

group norms. Moreover, this difference in

those with low SCC, those in the functional

self-regulation did not translate to a signifi-

condition did not significantly self-regulate

cant difference in the behaviour observed

more or less than those in the dysfunctional

(the time difference between trials).

condition, t(54) = -1.306, p = 0.197. Although

The disparity between participants’ self-

our slopes did not achieve significance, the

reported amount of self-regulation and their 57

2016 actual behaviour on the cold-pressor task

of engaging in the norm, which one would

could be explained in a number of ways. It is

expect to be low if the individual was not

possible that most participants felt obligated

benefitting otherwise from their engagement

to adhere to the given norm for the purpose

in the norm (i.e. if they were told that it was

of the experiment, especially given that par-

functional).

ticipants on average left their hands in the

Our results did not support our hypothe-

water about 40% longer on the second trial

sis that individuals with low SCC would en-

regardless of condition (even though we in-

gage in dysfunctional norms more than indi-

formed participants that the norm is only a

viduals with high SCC, and as such it is diffi-

25% increase). As well, it is possible that even

cult to interpret them with any confidence.

without being told such behaviour is norma-

The finding that those with low SCC self-

tive, individuals would attempt to last longer

regulate more to engage in this behaviour

on the second trial in an effort to â&#x20AC;&#x153;beatâ&#x20AC;? their

when told that it is harmful to their health

previous score, or simply that they would be

than when told it is beneficial to their health

more accustomed to the task on the second

is unexpected. One possible explanation as to

trial and last longer as a consequence. It is

why those with low SCC self-regulated less

also possible that self-regulation scores were

in the functional condition than those with

more affected than actual time because for

high SCC is that perhaps those with low SCC

some participants it may have been more

would have self-regulated less overall on any

difficult to perform a cold pressor test the

task, as previous studies have found that low

second time, meaning that perhaps these par-

SCC is correlated with low conscientiousness

ticipants were physically unable to achieve

(J. Campbell et al., 1996). However, the addi-

the norm or the score they desired despite

tional clarity conferred by a dysfunctional

exerting more effort to do so (Hagger et al.,

norm due to its distinctiveness may provide

2010). As we did not include a control condi-

individuals with low SCC motivation to en-

tion in this experiment, we are not able to tell

gage more in this norm, raising their level of

whether the fact that most people adhered to

self-regulation to that of those with high

the norm is due to our experimental manipu-

SCC. However, because we did not include a

lation prompting them to do so because the

control condition to evaluate the amount of

behaviour is normative or due to other fac-

self-regulation that individuals exhibited out-

tors. However, the data regarding self-

side of a context of group norms, this possi-

regulation is still interesting to interpret, es-

ble explanation cannot be supported by this

pecially because questions were designed to

experiment. Future studies should investi-

determine the amount of suffering a partici-

gate the relationship between self-regulation

pant was willing to undergo for the purpose

and SCC to determine whether this is the 58

2016 case.

Although this study did not support our

It is also possible that self-esteem plays a

hypothesis that the disparity between indi-

role in the relationship between SCC and en-

viduals with high and low SCC would

gagement in functional or dysfunctional

emerge in the dysfunctional norm condition,

norms. High SCC is strongly positively corre-

it does support the general trend in the litera-

lated with high self-esteem (J. Campbell et

ture indicating that low SCC is accompanied

al., 1996). Perhaps those with high self-

by a host of detrimental effects to the individ-

esteem value their well-being more highly

ual. It seems that individuals with low SCC

and therefore are more motivated to engage

are less willing to self-regulate towards func-

in functional norms than in dysfunctional

tional behaviours than they are towards dys-

norms, or perhaps those with high self-

functional behaviours. This may be one rea-

esteem have such high self-esteem because

son why dysfunctional norms are often

they view themselves as willing to self-

found in marginalized communities whose

regulate only when this is beneficial for them.

identities have been infringed upon by ma-

As self-regulation is measured by self-report,

jority groups (for example, through colonial-

it is subject to individual biases about which

ism). As Usborne and Taylor (2010) describe,

items they are willing to endorse. While this

having a clear cultural identity is strongly

is a limitation of the measurement, it also

correlated with having high SCC. Thus in

provides insight into the subjective feelings

communities where cultural identity is less

of individuals regarding their behaviour. It

clear, individuals are likely to have lower

seems that those with high SCC (and there-

SCC, which seems to cause individuals to self

fore probably high self-esteem) are only will-

-regulate less towards functional behaviours

ing to endorse items such as â&#x20AC;&#x153;I kept going

and more towards dysfunctional behaviours.

when I needed a breakâ&#x20AC;? when they perceive

Although the results of this study are only

the behaviour as beneficial to them, possibly

marginally significant, this trend could help

because there is a relationship between self-

to explain the continuing marginalization of

esteem and engagement in functional behav-

these communities. This mechanism may be

iours. It is not possible to determine whether

contributing further to their low status by

this is the case from our data because we did

causing these group members to self-regulate

not measure self-esteem. Future studies

towards fewer functional behaviours than

should investigate the relationship between

dysfunctional behaviours. Field studies in-

SCC, self-esteem, and engagement in func-

vestigating whether individuals with low

tional and dysfunctional norms, perhaps by

SCC actually engage in fewer functional be-

controlling for self-esteem in a similar study

haviours and more dysfunctional behaviours

to ours.

would be instrumental in further studying 59

2016 this mechanism and determining its impact

research that could be conducted to further

on real communities.

investigate this relationship, as it may have

Furthermore, these results indicate that

substantial implications for the well-being of

the development of intervention strategies to

individuals with low SCC and for the well-

increase SCC could have a substantial effect

being of groups with low collective clarity as

on the status of these communities, as well as

well.

the well-being of low-SCC individuals. There is very little research on the stability of the

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2016 Appendix

2016

Variability in Communal Behavior as a Mediator of the Effect of Attachment Anxiety on Relationship Satisfaction

Bayley Taple Supervisors: Dr. D. S. Moskowitz, and Dr. Gentiana Sadikaj

Abstract Attachment anxiety is characterized by ambivalence between wanting to be close to others, yet also fearing rejection by these others. This ambivalence should be reflected in higher variability in communal behavior (agreeable-quarrelsome). We hypothesized that variability in communal behavior would mediate the association between attachment anxiety and relationship satisfaction. We used an event-contingent recording methodology with 93 cohabiting couples. Variability was operationalized as the intraindividual (within-person) standard deviation of communal behavior in daily interactions with a romantic partner. Findings were partly consistent with expected results. For women, attachment anxiety was positively related to variability in communal behavior. In both genders, higher variability in communal behavior was related to lower relationship satisfaction. Among

women, the indirect effect of attachment anxiety on relationship satisfaction via variability in communal behavior was significant. Findings suggest that attachment anxiety influences romantic satisfaction to the extent that it leads to higher variability in communal behavior among women.

Keywords: attachment anxiety, intraindividual behavioral variability, flux, communal behavior

2016 Introduction The attachment system influences interpersonal relationships throughout one’s lifespan (Bowlby, 1969/1982, 1973; Mikulincer & Shaver, 2005). Individual differences in attachment can be characterized along two dimensions: attachment anxiety and attachment avoidance. Previous studies have examined the processes by which a person’s attachment orientation influences the person’s interpersonal relationships. The relational ambivalence experienced by individuals high on attachment anxiety about their close relationships (Bartz & Lydon, 2006, 2008; Mikulincer, Shaver, Bar-On, & Ein-Dor, 2010) is hypothesized to be one such process explaining the influence of attachment anxiety on interpersonal relationships. Relational ambivalence arises because of the conflict between the desire for closeness and fear of rejection by a close other (Bartz & Lydon, 2006, 2008; Mikulincer et al., 2010). This conflict may be manifested in inconsistent communal behavior, which negatively impacts relationship quality (Bartz & Lydon, 2006, 2008). The present study examines whether a person’s behavior, as reflected in intraindividual variability in communal behavior, mediates the association between attachment anxiety and satisfaction in romantic relationships. Adult Attachment Theory Bowlby (1969/1982, 1973) postulated that a person’s attachment orientation develops in childhood in response to the type of care received from a principal attachment figure and remains relatively stable throughout the person’s lifespan. Mikulincer and Shaver (2005) defined attachment orientation as “the systematic pattern of relational expectations, emotions, and behaviors that results from internalization of a particular history of attachment experiences” (p. 150). Attachment avoidance is characterized as the degree to which an individual seeks independence and distance

in relationships; higher attachment avoidance occurs among individuals whose previous experience has led the individual to distrust others (Givertz, Woszidlo, Segrin, & Knutson, 2013; Karantzas, Feeney, Goncalves, & McCabe, 2014; Mikulincer & Shaver, 2003, 2005). Attachment anxiety reflects the degree to which the person seeks reassurance of closeness in relationships; higher attachment anxiety is associated with fear of abandonment brought about by prior experience (Givertz et al., 2013; Karantzas et al., 2014; Mikulincer & Shaver, 2003, 2005; Sadikaj, Moskowitz, & Zuroff, 2011). As reviewed by Mikulincer and Shaver (2005), anxiously attached individuals employ hyperactivating strategies involving persistent vigilance for potential threats to one's relationship. On the other hand, avoidant individuals use deactivating strategies such as striving for independence and denying closeness. Lower scores on both dimensions indicate a more secure attachment orientation (Mikulincer & Shaver, 2003, 2005). A securely attached individual has confidence in the availability of attachment figures and thus, becomes a stable and autonomous person (Bowlby, 1973). Mediators of the Effect of Attachment on Relationship Satisfaction Several studies have demonstrated a direct effect of attachment on relationship quality, such that higher attachment anxiety and avoidance are associated with lower relationship satisfaction, for both the individual and their romantic partner (Mikulincer & Shaver, 2005). Research has also focused on identifying variables that mediate the association between attachment and relationship satisfaction (Dandurand, Bouaziz, & Lafontaine, 2013; Givertz et al., 2013; Karantzas et al., 2014; Lavy, Mikulincer, & Shaver, 2013; Mikulincer & Shaver, 2005; Sadikaj, Moskowitz, & Zuroff, 2015a). Several mediators have been posited and examined. Dandurand and col65

2016 leagues (2013) investigated the association between attachment orientation, relationship commitment goals, and relationship satisfaction. Commitment goals were measured with the Approach and Avoidance Commitment (AAC) scale. Approach commitment goals focus on positive relationship aspects and acknowledge negative aspects as external to the relationship, whereas avoidance commitment goals have a negative focus internal to the relationship. They found that attachment avoidance and attachment anxiety were negatively associated with relationship satisfaction. Unexpectedly, the association between attachment avoidance and lower relationship satisfaction was mediated by fewer approach commitment goals. However, the findings from Dandurand et al. (2013) can be viewed as consistent with the greater use of deactivating strategies, which consistently disengage individuals with higher attachment avoidance from their relationships. Sadikaj and colleagues (2015a) used an eventcontingent recording (ECR) procedure over 20 days to examine felt security as a mediator of the association between attachment orientation and relationship satisfaction in cohabiting couples. The researchers defined felt security “as a person’s subjective experience of trusting a romantic partner to be available and responsive to meet the person’s needs” (p. 3). Felt security was measured at the event level which indicated how secure individuals felt in specific interactions with the partner during the 20-day ECR procedure. Higher attachment avoidance was associated with lower felt security, and lower felt security was associated with lower relationship satisfaction. These indirect associations were found within-partner (i.e., for the individual) concurrently and cross-partner (i.e., for their partner) over time. Surprisingly, they did not find a link between attachment anxiety, felt security, and relationship satisfaction (Sadikaj et al., 2015a). In a study examining attachment orientation and relationship quality, Givertz et al. (2013) re-

ported that attachment avoidance and attachment anxiety were negatively associated with relationship quality because of lower felt security and interpersonal trust. Karantzas and colleagues (2014) found associations between attachment orientations and relationship satisfaction, which were mediated by partner support and trust. Attachment anxiety was negatively associated with both partner support and trust; attachment avoidance was negatively associated with trust (Karantzas et al., 2014). In sum, attachment anxiety and attachment avoidance are negatively associated with relationship satisfaction, and this negative association appears to be mediated by a variety of factors. Although these previous studies have reported a negative association between higher attachment insecurity and relationship satisfaction, other researchers have found contradictory evidence that the indirect effect of attachment orientation on relationship satisfaction was positive rather than negative. In a dyadic diary study Lavy et al. (2013) examined the association between attachment orientation and intrusiveness and how intrusiveness was associated with relationship satisfaction. The results indicated that an individual’s attachment anxiety and their romantic partner’s attachment avoidance were associated with greater intrusiveness by the individual. Unexpectedly, intrusiveness was associated with greater relationship satisfaction the day after the intrusive behavior (Lavy et al., 2013). The researchers explained that intrusive behavior might have raised problems that needed to be discussed and solving these problems increased relationship satisfaction (Lavy et al., 2013). Overall, these studies indicate that a variety of mediators appear to influence the link between attachment anxiety and relationship satisfaction. The present research explores variability in communal behavior as one such mediator.

2016 Attachment Anxiety and Variability in Communal Behavior Higher attachment anxiety has been associated with higher ambivalence in interpersonal relationships (Bartz & Lydon, 2006, 2008; McClure, Bartz, & Lydon, 2013; Mikulincer et al., 2010). Relational ambivalence is a conflict between affiliation, wanting to be close to others, self protection and fearing rejection by these others. It has been studied in the context of the endorsement of communal norms (Bartz & Lydon, 2006, 2008; McClure et al., 2013) and relationship goals (Mikulincer et al., 2010). Communal norms govern displays of unconditional giving behavior and are usually enacted in close relationships, such as with friends, family, and romantic partners (Bartz & Lydon, 2006). Presumably, if an individual endorses communal norms, they engage in more agreeable behavior on average across situations. However, if norms are endorsed inconsistently, communal behavior will be inconsistent too. In a study examining attachment and adherence to communal norms, Bartz and Lydon (2008) reported that individuals with higher attachment anxiety were inconsistent and ambivalent in their use of a communal script in close relationships. Moreover, the extent to which individuals adhered to a communal script was negatively related to the risk of rejection and the ambivalence between approach and avoidant behavior, both characteristics of attachment anxiety. Furthermore, this ambivalence was related to relationship dissatisfaction (Bartz & Lydon, 2008). Attachment avoidance was not associated with approach-avoidant conflict, but was related to aversion to closeness (Bartz & Lydon, 2008). McClure and colleagues (2013) explored the concept of relational ambivalence in the context of social dilemma games: the prisonerâ&#x20AC;&#x2122;s dilemma (PD), where the best payoff occurs when one does not cooperate, and the assurance game (AG), where the best payoff results from cooperation. The results indicated that attachment anxiety was associated with inconsistent behavioral

strategies, which was operationalized as a longer latency to decide on a strategy, especially in AG. The authors hypothesized that the association between attachment anxiety and inconsistent strategies was due to interpersonal factors such as trust and self-protection (McClure et al., 2013). The relational ambivalence associated with high attachment anxiety could be associated with low trust and high self-protection tendencies, and consequently inconsistent behavioral strategies. Mikulincer and colleagues (2010) found that individuals with greater attachment anxiety were ambivalent between approach and avoidance relationship goals, meaning that they felt conflicted between their desire to show closeness and their fear of rejection. The association between relational ambivalence and attachment anxiety was demonstrated using both an approach-avoidance task and self-report measures. In addition, the experimenters activated either approach or avoidance relationship goals; such activation increased the ambivalence between the activated goal and the opposite goal among anxiously attached individuals (Mikulincer et al., 2010). The researchers noted that ambivalence was related to conflict between closeness and rejection rather than independence, distance, and loneliness (Mikulincer et al., 2010). Closeness seeking behaviors map onto the communal dimension of circumplex models of interpersonal behavior (Leary, 1957; Moskowitz & Fournier, 2015; Roberts, 2007; Wiggins, 1991). Seeking closeness can be viewed as agreeable behavior, but if an individual is overcome by fear of rejection they may behave in a quarrelsome manner. Although attachment avoidant individuals expressed an explicit desire for autonomy and independence, they were found to show an implicit ambivalence toward distance with others (Mikulincer et al., 2010). In summary, the literature suggests that individuals with higher attachment anxiety are ambivalent toward the endorsement of communal norms, and between approach and avoidant be67

2016 havior. Therefore, attachment anxiety is expected to be associated with greater variability in communal behavior because these individuals would be torn between their desire to show closeness and their fear of rejection. Attachment avoidance was not related to ambivalence, and thus is not expected to be associated with variability in communal behavior. Research has not yet explored variability in communal behavior as a mediator of the association between attachment anxiety and relationship satisfaction. Intra-individual Variability in Interpersonal Behavior Interpersonal behavior can be conceptualized along two independent dimensions using the Interpersonal Circumplex Model: agency (submissiveness-dominance), and communion (quarrelsomeness-agreeableness) (Moskowitz, 1994; Wiggins, 1991). Moskowitz and Zuroff (2004) proposed several ways of characterizing intraindividual behavioral variability for this model. Intraindividual (within-person) variability or flux in interpersonal behavior is defined as fluctuations in a person’s behavior across situations (Fournier, Moskowitz, & Zuroff, 2008; Moskowitz & Zuroff, 2004). It is calculated as the standard deviation from an individual’s mean score on one of the behavioral dimensions (e.g. communal behavior) across situations. Flux in an interpersonal behavior has been conceptualized as a stable personality construct (Moskowitz & Zuroff, 2004). Behavioral variability within the Interpersonal Circumplex reflects poor personal adjustment and is related to negative interpersonal outcomes (Moskowitz & Fournier, 2015). For example, Sadikaj, Rappaport, Moskowitz, Zuroff, Koestner, and Powers (2015c) used an event-contingent recording (ECR) procedure over 20 days to study interpersonal spin, a representation of behavioral variability across interpersonal behavioral dimensions. They found that higher spin was negatively associated with relationship satisfaction for individuals and their partners.

Flux in communal behavior is specifically expected to be negatively associated with relationship satisfaction for the individual and their partner. High flux may lead to unpredictability of an individual’s behavior and change how others perceive that person. High behavioral fluctuations over time may be reflected in other people’s inconsistent descriptions of the individual’s personality (Moskowitz & Fournier, 2015). Inconsistency in personality may be linked to negative relationship outcomes, because partners would not have stable expectations of the behaviors to expect from the individual, which may change how partners react (Moskowitz & Fournier, 2015). If the partner’s reaction to the individual’s unpredictability is negative, the individual’s relationship satisfaction may suffer. Considering that intraindividual behavioral variability has consequences for relationship quality (Côté, Moskowitz & Zuroff, 2012; Sadikaj et al., 2015c), flux is expected to be a mediator of the association between attachment anxiety and relationship satisfaction. The Present Research Previous research has found links between attachment orientation, specifically attachment anxiety, and relationship satisfaction. The literature has also demonstrated links between attachment anxiety and ambivalence of engaging in communal behavior. The present study is novel in that it will examine intraindividual variability in communal behavior, measured as flux, as a mediator of the association between attachment anxiety and relationship satisfaction. Hypotheses In accordance with several previous studies, it is expected that attachment anxiety will be negatively associated with relationship satisfaction. Based on previous research indicating that attachment anxiety is associated with ambivalence toward communal norms (Bartz & Lydon 2006, 2008) and ambivalence between approach 68

2016 and avoidant behavior (Mikulincer et al., 2010), it is hypothesized that attachment anxiety will be positively associated with flux in communal behavior. Based on Moskowitz and Fournier (2015), flux in communal behavior is expected to be negatively associated with relationship satisfaction for the individual and their partner. Furthermore, flux in communal behavior will mediate the association between attachment anxiety and relationship satisfaction, both for the individual and their partner. Attachment anxiety will result in greater variability in communal behavior, which will lead to poorer relationship satisfaction (see Figure 1). Method Participants The sample included 93 heterosexual couples cohabitating for a minimum of six months. Potential participants were excluded from the study if they had children and if they did not have at least part-time employment. Participants were recruited locally through various media, such as newspaper ads and postings on Craigslist.ca. The sample was heterogeneous in several factors including age, education, ethnicity, first language, relationship length, and cohabitation length. Sample characteristics are presented in Table 1. Procedure Participants were administered a package of questionnaires during the first meeting conducted in the lab. They completed measures of attachment orientation, personality, and demographics. Next, participants completed the eventcontingent recording (ECR) procedure. Participants were instructed to record their interpersonal interactions for a period of 20 days. They were given a maximum of ten forms to use per day. On the forms they recorded interactions lasting at least five minutes with different interaction partners (e.g., friends, coworkers), but were asked to make sure at least two to three of the interactions

per day were with their romantic partner. Participants were instructed to complete the ECR forms in private and mail forms the following day to ensure accuracy and compliance. Relationship satisfaction was measured following the ECR procedure. Participants were compensated $160 upon completion of the ECR procedure. Measures Experiences in close relationships – revised (Fraley, Waller, & Brennan, 2000). The Experiences in Close Relationships – Revised questionnaire is a self-report measure about attachment orientation. It is comprised of two 18-item subscales: attachment anxiety and attachment avoidance. Each item was rated on a 7-point Likert scale ranging from 1 (stro ngly d isagree ) to 7 (stro ngly agree). Example items for measuring attachment anxiety included: “I often worry that my partner will not want to stay with me” and “When I show my feelings for romantic partners, I'm afraid they will not feel the same about me.” Example items for measuring attachment avoidance included: “I prefer not to be too close to romantic partners” and “I prefer not to show a partner how I feel deep down.” Higher scores on each subscale indicated greater attachment anxiety and attachment avoidance. Both subscales of Experiences in Close Relationships – Revised have high internal consistency, Cronbach coefficient alpha for avoidance = 0.92, and for anxiety = 0.89. Attachment anxiety and attachment avoidance were correlated both within-partner and cross-partner (see Table 2). Relationship satisfaction (Spanier, 1976). Relationship satisfaction was measured with the satisfaction subscale of the Dyadic Adjustment Scale (DAS), a self-report questionnaire comprised of ten items. The DAS measures relationship stability and satisfaction. The satisfaction subscale included items such as, “How often do you discuss or have considered divorce, separation, or terminating your relationship?” and “In general, how often do you think things between 69

2016 you and your partner are going well?” The DAS has high content, criterion, and construct validity, as well as high reliability. The satisfaction subscale has high internal consistency, Cronbach coefficient alpha = 0.94. Relationship satisfaction was correlated cross-partner (see Table 2). Event-contingent recording (ECR). The ECR is a self-report procedure. For each interaction participants reported: the time of the interaction, where the interaction took place, the type of interaction, their interpersonal behavior, and their perception of their partner’s behavior; perception of the partner was not used in the present study. The 20-day ECR procedure has been shown to be reliable and valid (Moskowitz, Russell, Sadikaj, & Sutton, 2009). The number of situations reported (M = 55.79, SD = 18.51, Range = 10 - 127) was independent of relationship satisfaction, relationship length, cohabitation length, and attachment anxiety and attachment avoidance. Interpersonal behavior. Behaviors indicated on the ECR form were measured with the Social Behavioral Inventory (SBI; Moskowitz, 1994), based on the Interpersonal Circumplex Model (Wiggins, 1991). Communal behavior is a dimension of behavior ranging from quarrelsome (i.e., distancing from another or severing social ties) to agreeable (i.e., reinforcing social ties) behavior (Moskowitz, 1994). Participants were instructed to endorse behaviors in which they had engaged, such as “I confronted the other(s) about something I did not like” (quarrelsome behavior) and “I expressed affection with words or gestures” (agreeable behavior). To ensure that participants did not develop a response set, four versions of the ECR form were rotated daily. Internal consistency for items measuring quarrelsomeness is high (α = 0.84) and moderate for agreeableness (α = 0.53), which is expected given that they are broad behavioral categories (Moskowitz, 1994). The scales are stable, coefficient alpha = 0.95 for both quarrelsome and agreeable behaviors (Moskowitz, 1994). The scale has construct validity: agreeableness is negative-

ly correlated with quarrelsomeness (Moskowitz, 1994). Calculation of communal behavior scores at the event-level. Behavioral scores representing each end of the communal dimension (agreeable and quarrelsome behavior) were constructed for each event. Frequencies (0 to 3) of agreeable and quarrelsome behavior were calculated. We then calculated scale scores as the mean frequencies of each behavioral pole. Lastly, we constructed ipsatized scores for each behavioral pole by subtracting the mean frequency of all behaviors from the scale scores. Event-level communal behavior was calculated by subtracting quarrelsome behavior from agreeable behavior. Calculation of mean communal behavior across situations. Mean communal behavior was computed as event-level communal behavior aggregated across all interactions. Calculation of flux scores for communal behavior. Flux in communal behavior was calculated as the standard deviation from an individual’s mean communal behavior across situations. Results Descriptive Statistics Descriptive statistical analyses were performed using Mplus (Version 7.2; Muthen & Muthen, 1998–2014). Sample descriptive statistics are presented in Table 2. Gender differences were examined using the rescaled -2 log likelihood difference test (Satorra & Bentler, 2010). Men had higher mean levels of communal behavior (difference = 0.06, z = 3.59, p < 0.05) and higher attachment avoidance than women (difference = 0.19, z = 2.02, p < 0.05). There were no gender differences in variability in communal behavior (difference = -0.01, z = -0.85, p > 0.05), attachment anxiety (difference = -0.00, z = -0.01, p > 0.05), or relationship satisfaction (difference = 0.02, z = 0.48, p > 0.05). Within-partner and cross-partner correlations were estimated and are presented in Table 70

2016 2. Men and women’s relationship satisfaction was highly correlated. Only one gender difference was found in the within-partner correlations: the correlation between flux in communal behavior and mean levels of communal behavior was negative and significant in men but not in women. Attachment anxiety and avoidance were negatively associated with relationship satisfaction among both men and women. Additionally, the relationship between flux in communal behavior and relationship satisfaction was negative and significant for men and women. Flux in communal behavior was positively associated with attachment anxiety but was not associated with attachment avoidance in either gender. No gender difference was found in the crosspartner correlation between flux in communal behavior and mean levels of communal behavior. Mean communal behavior was negatively related to flux in communal behavior across partners. Cross-partner correlations indicated that attachment anxiety and avoidance were negatively associated with relationship satisfaction. The crosspartner correlations between attachment anxiety and avoidance and flux in communal behavior were not significant in either gender. Furthermore, men’s flux in communal behavior was more strongly negatively related to women’s relationship satisfaction than women’s flux in communal behavior was related to men’s relationship satisfaction. Analytical Strategy A meditational analysis was performed (Baron & Kenny, 1986; Shrout & Bolger, 2002). The Actor-Partner Interdependence Model in latent modeling framework was used to account for non-independence in the dyadic data (Kenny, Kashy, & Cook, 2006). Relationship satisfaction was the dependent variable. Attachment anxiety and attachment avoidance were the independent variables. Flux in communal behavior was the mediator variable (see Figure 1). The effects of attachment anxiety and attachment avoidance on

flux and relationship satisfaction, and of flux on relationship satisfaction were examined both within-partner and across-partners. Mean communal behavior was added as a covariate when examining the effect of attachment on flux and of flux on relationship satisfaction. The model was examined simultaneously for women and men’s data. To test for gender differences, the rescaled -2 log likelihood difference test was used. The significance of the withinpartner and cross-partner indirect effects of attachment on relationship satisfaction via flux in communal behavior was examined using the bias -corrected bootstrapping method for computing confidence intervals (MacKinnon, Lockwood, & Williams, 2004) based on 50,000 bootstrap iterations. An indirect effect was considered significant at α = 0.05 if its 95% confidence interval (CI) did not include zero. Direct and Indirect Effects of Attachment Anxiety on Relationship Satisfaction via Flux in Communal Behavior Results of the fitted model are presented in Table 3 and Figure 2. The model’s overall fit indices were good: χ² = 14.85, df = 15, p = 0.46; CFI/ TLI = 1.00/1.00; RMSEA = 0.00; SRMR = 0.05. Within-partner effects. Attachment and relationship satisfaction: Direct effects. No direct effect of attachment anxiety on relationship satisfaction among men and women was found. Rather, there was an indirect effect of attachment anxiety on relationship satisfaction via flux in communal behavior among women; this finding is subsequently discussed further. Additionally, findings revealed that attachment avoidance was negatively associated with relationship satisfaction for both men (b = 0.18) and women (b = -0.18). Attachment and flux in communal behavior. Consistent with the hypotheses, attachment anxiety was found to be positively associated with flux in communal behavior among women, b = 71

2016 0.02. This association was not significant in men. Associations between attachment avoidance and flux in communal behavior were not significant. Flux in communal behavior and relationship satisfaction. In accordance with expectations, women’s flux in communal behavior was negatively associated with relationship satisfaction, b = -1.85. This association was not statistically different between genders. Attachment, flux in communal behavior, and relationship satisfaction: Indirect effects. The hypotheses were partially supported in that attachment anxiety lead to flux in communal behavior, and flux in communal behavior was negatively associated with relationship satisfaction among women, b = -0.04, 95% CI = -0.08 to -0.01. The indirect effect from attachment anxiety to relationship satisfaction via flux in communal behavior was not significant among men. As expected, there were no indirect effects from attachment avoidance to relationship satisfaction via flux in communal behavior for either gender. Cross-partner effects. Attachment and relationship satisfaction: Direct effects. In accordance with hypotheses, the effect from women’s attachment anxiety to men’s relationship satisfaction was negative and significant, b = -0.16. The effect from men’s attachment anxiety to women’s relationship satisfaction was not significant. There were no direct associations between attachment avoidance and relationship satisfaction among either gender. Attachment and flux in communal behavior. The effects from attachment anxiety and attachment avoidance to flux in communal behavior were not significant. Flux in communal behavior and relationship satisfaction. The results indicated that men’s flux in communal behavior was negatively associated with relationship satisfaction in women, b = -2.16. The effect from women’s flux in communal behavior to men’s relationship satisfaction was not significant.

Attachment, flux in communal behavior, and relationship satisfaction: Indirect effects. There were no indirect effects found for partners of either gender; in other words, there were no associations between attachment anxiety or attachment avoidance and relationship satisfaction via flux in communal behavior. Discussion We examined whether variability in communal behavior explained in part the effect of attachment anxiety on satisfaction with a romantic relationship. Variability, or flux across events, was operationalized as intraindividual standard deviation of communal behavior in daily interactions with a romantic partner. Based on attachment theory and previous literature, we conceptualized high variability in communal behavior as a behavioral manifestation of the ambivalence that characterizes high attachment anxiety. Individuals with high attachment anxiety are ambivalent between wanting to be close to others, yet fearing rejection by these others (Mikulincer & Shaver, 2003, 2005). Specifically, individuals high on attachment anxiety may display love and affection (i.e., agreeable behavior) toward their romantic partner, but subsequently feel an intense fear of rejection, and to remedy their emotional state they may act in a quarrelsome manner. Their engagement in quarrelsomeness is a possible reaction to their perceived threat of rejection and the resulting negative affect. We suggested that this behavioral manifestation of ambivalence, variability in communal behavior, would partly explain the link between attachment anxiety and relationship satisfaction. Findings were partially consistent with expected results. Attachment anxiety was positively associated with flux in communal behavior among women. Flux in communal behavior was negatively related to relationship satisfaction within-partner in both genders. Additionally, men’s flux in communal behavior was negatively associated with their partner’s relationship satis72

2016 faction. Moreover, among women we found an indirect effect of attachment anxiety on relationship satisfaction via flux in communal behavior. The indirect effect suggested that higher attachment anxiety was related to lower romantic satisfaction to the extent that such anxiety leads to higher variability in communal behavior among women. This indirect effect was not supported among men. Collectively, these findings emphasize the distinct importance of attachment anxiety and variability in communal behavior as influencing relationship satisfaction among romantic couples. This research begins to address the important question of what drives flux or variability in communal behavior? As discussed earlier, attachment theory and previous research support the idea that attachment anxiety is associated with ambivalence (Mikulincer et al., 2010). This ambivalence should be reflected in frequent and large fluctuations between quarrelsome behavior, due to the fear of abandonment, and agreeable behavior, due to the desire to be close to others. Another possible mechanism that drives variability in behavior is an individualâ&#x20AC;&#x2122;s behavioral control (how one regulates their behavior). If an individual is unable to regulate their behavior they will likely behave in an erratic manner characterized by behavioral fluctuations (i.e. behavioral variability; Sadikaj, Moskowitz, & Zuroff, 2015b). Mikulincer and Shaver (2003) reported that attachment anxiety is related to poor selfregulation skills. Likewise, emotion regulation may play a role in variability in behavior as well; if an individual has difficulty regulating their emotions, they will likely have more negative affect, which may lead to more quarrelsome behavior. Furthermore, if their emotions are not regulated, they will be more erratic, or variable, which should induce greater variability in their communal behavior (Sadikaj et al., 2015b). More research needs to be conducted to fully understand the mechanisms that prompt these fluctuations in communal behavior.

In accordance with our hypotheses and consistent with previous literature, the mediated effect from attachment to relationship satisfaction via variability in communal behavior was specific to attachment anxiety and was independent of attachment avoidance. Attachment avoidance has been associated with an aversion to closeness (Bartz & Lydon, 2006, 2008; McClure et al., 2013; Mikulincer et al., 2010); this aversion would more likely be reflected in mean level of quarrelsome behavior rather than variability on the communal dimension of behavior. Furthermore, Mikulincer et al. (2010) reported that attachment avoidance was not associated with ambivalence. Individuals higher on attachment avoidance may be firm about their motivations in close relationships (i.e. distancing themselves from others), which could lead to rigid behavioral patterns; thus, we did not expect to see an association between variability in communal behavior and high attachment avoidance. Our findings support these expectations. Attachment avoidance was negatively associated with relationship satisfaction, but this association was independent of variability in communal behavior. In contrast, attachment anxiety was related to greater variability in communal behavior, which is likely due to its characteristic relational ambivalence. The current findings provide further support for the negative association between insecure attachment, both high attachment anxiety and high attachment avoidance, and relationship satisfaction (for reviews, see Hadden, Smith, & Webster, 2014; Mikulincer, Florian, Cowan, & Cowan, 2002). It is important to note that, as expected, the indirect effect among women wiped out the direct within-partner effect from attachment anxiety to relationship satisfaction. In other words, variability in communal behavior explained the link between attachment anxiety and relationship satisfaction, hence the association did not hold when variability in communal behavior was removed from the analysis. Results partially supported previous research findings 73

2016 (Collins & Read, 1990; Kirkpatrick & Davis, 1994; Simpson, 1990) concerning the direct effect of attachment orientation on relationship satisfaction, such that women’s higher attachment anxiety was negatively associated with men’s relationship satisfaction. Collins and Read (1990) found that women’s attachment anxiety was negatively associated with relationship evaluations both for women and their male partners. These withinpartner and cross-partner effects were not present among men. Additionally, Kirkpatrick and Davis (1994) found that attachment anxiety among women was negatively related to relationship satisfaction in both genders. Kirkpatrick and Davis (1994) suggested that this moderation of the attachment effects by gender might emerge because of gender roles. Women with higher attachment anxiety may behave in a possessive manner, which their male partner may interpret as threatening to their autonomy, in turn leading to lower relationship quality (Kirkpatrick & Davis, 1994). This finding supports the direct effect we found, such that higher attachment anxiety in women was negatively associated with relationship satisfaction among men. Gender emerged as a moderator of the mediated effect, such that attachment anxiety was associated with relationship satisfaction via variability in communal behavior among women, but not men. Previous research has found that gender was also a moderator of the direct effect from attachment anxiety to relationship satisfaction (discussed above; Collins & Read, 1990; Kirkpatrick & Davis, 1994). However, Hadden and colleagues (2014) noted that although several studies have found gender differences, research has yet to investigate the mechanism of this effect. Studies thus far have primarily examined gender as a moderator of the direct effect from attachment anxiety to relationship satisfaction; these findings are an appropriate guide for future research. Further studies should examine the process by which gender moderates the effect of attachment anxiety on relationship satisfaction

via variability in communal behavior. Limitations and Future Research This study has several strengths, one of which is the use of the ECR procedure to measure variability in communal behavior was beneficial. This procedure allowed us to capture within -person variability indices of behavior reported as reported both by the individual and their partner (Moskowitz et al., 2009). Additionally, the use of a heterogeneous community sample lends confidence to the generalizability of our findings. Importantly, statistical analyses examined both within-partner and cross-partner paths simultaneously in the same model, accounting for nonindependence characteristic of a dyadic sample (Kenny et al., 2006; Sadikaj et al., 2015a). Despite these strengths this study also has some limitations. Our sample was restricted to heterosexual couples, which limits the generalizability of the findings. Although we do not expect that recruiting a sample beyond heterosexual couples would influence our findings, in future research it would be informative to recruit couples that identify with other sexual orientations. As discussed previously, gender was found to be a moderator of the mediated effect. Therefore, gender should be examined in future studies in order for researchers to make a firm conclusion as to why this gender difference exists. Relationship satisfaction was not measured prior to the ECR methodology. This is somewhat problematic because a proportion of flux in communal behavior, which may have been due to preexisting relationship issues, was not accounted for. Stated differently, if relationship quality is poor, the partners may encounter more quarrelsome situations than average, and their variability in communal behavior may in part be due to these occurrences. In future research, we should measure relationship satisfaction at the first meeting to have a baseline measure of couples’ relationship quality. Furthermore, we would be able to examine the contribution of variability in 74

2016 communal behavior to relationship satisfaction above and beyond existing relationship quality. Although the ECR methodology is reliable and valid, we cannot employ it to make causal claims about the nature of the associations examined. In future research, we may want to study variability in communal behavior with an experimental paradigm. An experimental manipulation and/or laboratory observation could be used as an alternative to the ECR methodology. For example, couples could come into the lab and be presented with hypothetical scenarios and describe behavioral strategies in which they would engage (e.g., Grover, Nangle, & Zeff, 2005). Experimenters could code the behaviors exhibited by participants as either quarrelsome or agreeable. The experimental design would be longitudinal to obtain measures of behavior on several occasions. Then variability in communal behavior would be extrapolated from the behaviors described. If experimental results supported the meditational model of this paper, they would strengthen the confidence in a causal link from attachment anxiety to relationship satisfaction via variability in communal behavior. In future research, it may also be interesting to examine flux in behavior including the agentic dimension in the analyses as well as the communal dimension. This would permit the examination of whether variability in dominant and submissive behavior plays a role in relationship satisfaction.

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2016 Appendix

2016

Examining the Underlying Mechanisms and Psychological Factors Implicated in Dynamic Measures of Pain

Tricia Gower Supervisors: Dr. Michael Sullivan, and Junie Carrière

Abstract This study examined the relation between temporal summation of pain (TS) and repetition-induced summation of pain (RISP). The study also examined whether pain-related psychological factors

were differentially associated with TS and RISP. The study sample consisted of 83 healthy participants (34 men and 49 females). On the first day of testing, participants were guided through a series of exercises to produce ‘delayed onset muscle soreness’ (DOMS). On the second day of testing, participants were exposed to repeated noxious stimulation (pinpricks, lifting) to generate indices of TS and RISP. Results revealed that the indices of TS and RISP were not significantly correlated. Depressive symptoms were significantly correlated with TS, but not with RISP. Pain catastrophizing and anxiety were not significantly correlated with TS or RISP. These findings suggest that the mechanisms underlying TS are distinct from those underlying RISP.

Keywords: chronic pain, dynamic measures of pain, pain-related disability, temporal summation, repetition induced summation of pain, anxiety, depression, catastrophizing

2016 Introduction Pain is a global health issue that has implications for the functioning of both the individual and society (Dagenais, Caro & Haldeman, 2008; Tang & Crane, 2006). In Canada, chronic pain is reported by 18.9% of the adult population, and half of individuals with chronic pain report suffering for over 10 years (Schopflocher, Taenser & Jovey, 2011). Chronic pain has been shown to contribute to a range of adverse social, physical, and mental health outcomes, including heightened disability, unemployment, suicide, anxiety and depressive disorders (Tang et al., 2006; Gureje, Von Korff, Simon & Gater, 1998; Nanos Research 2007). Chronic pain differs from acute pain along a number of dimensions. Acute pain has a sudden onset, often in response to some form of noxious stimulation. It has been suggested that the pain experienced can be construed as a protective alarm that alerts the individual to the possibility of tissue damage (Lipton, 1991). Chronic pain is defined as lasting beyond 6 months (Rucker, 2001). Given that chronic pain is by definition enduring and difficult to cure, many aspects of a personâ&#x20AC;&#x2122;s lifestyle may suffer, such as loss of interpersonal control, status, independence, and financial stability (Loeser, 2005). The transition from acute pain to chronic pain involves a complex interplay of mechanisms. Chronic pain may result from a myriad of possible physical, cognitive, emotional, religious, cultural, and contextual factors (Sullivan, 2008; Rippentrop, Altmaier, Chen, Found, Keffala, 2005), which all contribute to the difficulty of understanding its underlying properties. An important area of research involves the identification of factors that make some individuals more vulnerable to the onset of chronic pain and pain-related disability

(Loeser, 2005). Dynamic Measures of Pain Dynamic measures of pain, which examine pain over time, can be used in experimental settings to determine the underlying mechanisms and psychological factors involved in chronic pain. One widely known dynamic measure of pain is Temporal Summation (TS). TS is a physiological phenomenon that can be experimentally induced in order to study the relationship between repetitive noxious stimulation and experienced pain intensity. TS is said to occur when experienced pain severity increases despite a constant amount of pressure, thermal, or electrical stimulation (Sullivan et al, 2009; Rhudy et al, 2010). The occurrence of TS requires stimulus contact of approximately one second, presented repetitively in intervals of approximately three seconds (Staud, Craggs, Robinson, Perlstein & Price, 2007). The study of TS will help to further elucidate aspects of chronic pain and disability. TS may occur due to repetitive stimulation of C-fibers, which is posited to cause the temporary hyperexcitability of second-order neurons in the spinal cord (Sullivan et al, 2009; Rhudy et al, 2011). These ascending systems are most likely also modulated by descending pain-inhibitory systems that originate from the central nervous system (Sullivan et al, 2009). Examination of this complex interaction of mechanisms can clarify the relationship between TS and chronic pain. Individuals with chronic pain exhibit higher rates of mechanical temporal summation, in comparison to healthy individuals (George, Wittmer, Fillingim & Robinson, 2006). TS has also been shown to influence self-reports of disability in individuals with chronic pain (George et al, 2006). These studies suggest the utility of 81

2016 TS for the examination of chronic pain and disability. Another phenomenon, known as repetition-induced summation of pain (RISP), allows the study of movement-related aspects of pain. RISP occurs when repeated physical activity leads to increases in pain, despite a lack of increase in physical demand (Sullivan et al, 2009). In studies examining RISP, approximately 20% of chronic pain patients demonstrate a significant increase in pain severity, despite the constant intensity of physical demand (Sullivan, Larivière & Simmonds, 2010). When musculoskeletal pain is simulated in healthy participants through a series of physical exercises prior to testing, the proportion of healthy individuals demonstrating higher RISP index is similar to the approximate 20% from previous studies with chronic pain patients (Mankovsky-Arnold et al, 2013). These studies suggest that certain individuals are at increased risk for greater pain severity following repeated physical activity, such as those with persistent pain conditions (Lambin et al., 2011; Vierck et al, 2001). It is possible to measure RISP using Delayed-Onset Muscle Soreness (DOMS) - an experimental manipulation that mimics the effects of musculoskeletal pain in healthy participants. The presence of musculoskeletal pain is necessary for physical activity to be experienced as a noxious stimulus. For this reason, DOMS must be induced prior to the RISP task in order for pain to occur in healthy participants (Mankovsky-Arnold et al, 2013). DOMS consists of sets of exercises that are repeated until a point of volitional fatigue is reached (Udermann, Mayer, Graves & Ploutz-Snyder, 2002). This procedure causes minor disruptions in muscle fibers, which leads to burning and aching pain sensations via inflammation and ischemia (Byrne, Eston & Edwards, 2001; Vecchiet, Vecchiet, Bello-

mo & Giamberardino, 1999). The muscle soreness is known to peak 24-48 hours after the session of physical exercises (Cheung, Hume & Maxwell, 2003). It has also been suggested that performing fewer sets with higher weights is more efficient at inducing DOMS (Udermann et al, 2002). The current study used DOMS to simulate a temporary “chronic condition” in healthy participants. The study of the underlying mechanisms involved in RISP can help to identify the riskfactors that make an individual more susceptible to an increased RISP index. Previous studies have suggested that the stimulation of muscle nociceptors during repeated muscle contractions may be caused by the release of bradykinin, or by ischemia in the muscles (Sullivan et al, 2009). The excitation of muscle nociceptors then causes muscle pain and soreness (Sullivan et al, 2009). Given that RISP has been studied only recently, further explanation should be explored. It is possible that the processes underlying RISP are similar to those of TS, as both phenomena study dynamic pain experiences. Further research using RISP will allow increased understanding of its underlying mechanisms, subsequently clarifying the factors that have a role in chronic pain. Psychological Factors Psychological factors have been shown to influence the relationship between pain severity and pain-related disability. Research suggests that psychological factors may be more important predictors of pain-related disability than pain itself (Cook, Brawer & Vowles, 2006). In fact, psychosocial variables have been previously shown to account for 59% of the variance in disability associated with chronic pain (Turk & Okifuji, 2002). The relationship between experiences of pain and psychological factors suggests that in order to understand the underlying mechanisms of 82

2016 chronic pain, we must also understand the psychological factors involved. Pain catastrophizing is one commonly recognized psychological risk factor for heightened pain experience and disability (Sullivan, 2001). Pain catastrophizing is composed of three factors: rumination, magnification, and helplessness, which can occur in response to actual or anticipated pain (Sullivan, 2012). Catastrophizing involves a cycle of hypervigilance to pain symptoms, avoidance of pain-related activities, and then increased catastrophic thinking and pain symptoms (Sullivan, 2012). The downward spiral associated with catastrophizing plays a substantial role in pain-related disability, in terms of both physical and emotional functioning (Sullivan, Thibault, Andrikonyte, Butler, Catchlove & Lariviere, 2006). Catastrophizing is associated with an increased likelihood for developing chronic pain, and these risks are found independently of negative affect, depression, and other types of psychological distress (Edwards, Smith, Stonerock & Haythornthwaite, 2006; Turner, Jensen, Warms & Cardenas, 2002). Anxiety is an additional psychological factor that has implications in the experience of pain. Anxiety is a future-oriented affective state that leads to the anticipation of pain (Leeuw et al., 2007), but is more generally defined as excessive apprehension of internal or external stimuli (Gale & Oakley-Browne, 2004). Anxiety leads an individual to partake in preventative behaviors, such as avoidance, which can then further increase catastrophizing (Leeuw et al., 2007). Increased anxiety may lead to greater attention to pain symptoms and threatening information, which would then lead to increased arousal, and a subsequent augmentation of the painful experience (Turk & Okifuji, 2002; Buitenhuis & de Jong, 2011). Patients with chronic low back pain commonly exhibit anxious moods

(Krishnan et al, 1985), which suggests a relationship between anxiety and chronic pain. Negative mood is another psychological factor that has been associated with pain (Rush, Polatin & Gatchel, 2000; Linton et al, 2011; Richardson et al, 2009). High negative mood, in combination with low positive mood, has been associated with depressive symptoms (Watson, Clark & Carey, 1988). There is evidence that depressive symptoms are a risk factor for the onset and development of pain (Carroll, Cassidy & Cote, 2004). Patients with both pain and depressive symptoms have more pain complaints, pain intensity, and pain chronicity (Sullivan & Robinson, 2006). These various studies suggest that there is a strong relationship between psychological variables and persistent pain conditions, however more research is needed to investigate the relationship in further detail. Psychological factors that have been found to be associated with experiences of pain are likely to also influence temporal summation and repetition-induced summation of pain. Temporal summation may be heightened by psychological factors, such as catastrophizing and anxiety, due to their interference with descending pain-inhibitory systems (Sullivan et al, 2009). Brain areas responsible for the affective aspects of pain may also be sensitized by psychological factors, leading to increased TS (Sullivan et al, 2009). In temporal summation, catastrophizers exhibit greater increases in pain ratings across repetitive noxious stimuli (Rhudy et al, 2010). As catastrophizing is associated with higher depressive symptoms and increased anxiety during pain induction procedures (Richardson et al, 2009), it is conceivable that negative mood and anxiety similarly relate to TS and RISP.

2016 Current Study The primary objective of this study was to examine the association between TS and RISP, in order to determine whether these two phenomena share common variance. The second goal of the study was to examine whether TS and RISP are associated with psychological factors in similar ways, in order to further determine whether TS and RISP are underlined by the same mechanisms. As outlined previously, pain catastrophizing has consistently shown association with increased TS index (Sullivan et al, 2009; Rhudy et al, 2010), and has shown association with RISP index in a recent study (Sullivan et al., 2010). Since anxiety and depressive symptoms are associated with catastrophizing (Sullivan et al., 2009; Leeuw et al., 2007; McCracken et al., 1993; Richardson et al., 2009), it is possible that these psychological factors will also be associated with both TS and RISP in a consistent pattern, similar to that seen in catastrophizing. We expected that TS and RISP would be positively and significantly correlated, indicating that these two measures share common variance. We also expected that TS and RISP would be similarly associated with psychological variables, such as pain catastrophizing, negative mood, and anxiety, suggesting that TS and RISP are underlined by similar mechanisms. Finally, based on previous research, it was also expected that all psychological variables would be associated with each other. Method Participants The final study sample consisted of 83 participants between the ages of 18-50 years old. Advertisements were posted on the online McGill Classified website, and flyers were posted around the McGill campus. Individuals were excluded from participation in

the study if they had any cardiovascular, musculoskeletal, or neurological conditions. Individuals with any other health conditions that may have worsened after strenuous activity were also not chosen to participate. Lastly, individuals were excluded if they took part in regular physical activities more than once a week, or if they were involved in upper body training over the past 6 months. Screening was conducted during a telephone interview. Participants were also instructed to avoid taking pain medications prior to both testing sessions. Measures Pain Catastrophizing: The Pain Catastrophizing Scale was used to assess the extent to which a subject experiences rumination, magnification, and helplessness during a pain experience (Sullivan et al., 1995). On this scale, respondents were asked to rate 13 statements, on a scale of 0-4 (0=not at all, 4=all the time), regarding the extent to which a subject experiences various catastrophic thoughts while experiencing pain. Statements include “I become afraid that the pain will get worse” and “I keep thinking about how much it hurts”. The total score was obtained by summing responses, yielding a possible total score between 0-52. The PCS has been shown to have high temporal stability and high internal consistency (coefficient α = .87) (Sullivan et al, 1995). Negative Mood: The short form of the State Mood Measure was used to assess negative mood. In this study, negative mood was used as a proxy for the possibility of depressive symptoms. On this scale, respondents were asked to answer 12 items with descriptive adjectives, such as “discouraged”, “sad” and “hopeless”. Participants could rate the degree to which they feel each item according to an 11-point scale (0=not at all, 10=extremely). The total score was obtained 84

2016 by summing responses, with the three positive items reverse-coded. This scale has been shown to be a valid and reliable measure of the positive and negative dimensions of mood (Watson, Clark & Tellegen, 1988). Anxiety: The State-Trait Anxiety Inventory (STAI) consists of two questionnaires, each with 20 items. The State scale was used to assess momentary anxiety symptoms. The Trait scale was used to assess chronic anxiety symptoms. On these scales, respondents were asked to rate each statement by a fourpoint scale (1=not at all and 4=very much so). For the purpose of this study, we used the total score, which is obtained by summing responses, and ranges from 20-80. The STAI has been shown to be a reliable and sensitive measure of anxiety (Marteau & Bekker, 1992). Perceived Exertion. The PerceivedExertion Scale (PES) was used to assess muscle fatigue experienced by participants during lifting exercises (DOMS). On this scale, respondents were asked to choose any number between 0-10 (0=no exertion, 10=maximum exertion), including decimals, in order to rate how strenuous the exercise felt to them. The PES has shown high criterion-related validity (Chen, Fan & Moe, 2010). Mean Activity-Related Pain: This 11point scale (0 = no pain, 10 = excruciating pain) was used to assess pain severity as participants lifted each of the 18 weighted canisters during the RISP task. The mean of activity-related pain was obtained by averaging pain ratings across lifts. The RISP index was computed by subtracting the mean activityrelated pain of the last 3 canister lifts from the mean activity-related pain provided for the first 3 canister lifts (Mankovsky-Arnold, Wideman, LariviĂ¨re, & Sullivan, 2013). Higher values on the RISP Index (2 or greater) reflect greater increases in pain across the successive lifts.

Temporal Summation Pain Severity: This 11-point scale (0 = no pain, 10 = excruciating pain) was used to assess pain severity after each pinprick tactile stimulation during the TS task. The TS index was obtained by subtracting the mean pain ratings in the last trial (10th) from the mean pain ratings in the first trial (Edwards & Fillingim, 2001). Procedure Day One: Upon arrival, participants were asked to complete a consent form. Measures were collected on weight, height, and elbow height. The State Mood Measure was completed. Participants then performed a series of four exercises in order to induce DOMS. The four exercises included a chest press, latseated row, shoulder abduction and shoulder flexion. Demonstrations were provided by the researchers before the participant completed each exercise. Each exercise consisted of sets of five repetitions, each lasting 10 seconds, unless the participant had reached maximum exertion prior to completion of all repetitions. Following each set of five repetitions the participant was given a one-minute break, and a two-minute break following each exercise. During the one-minute break, the participant was asked to give a rating between 0-10, according to the PerceivedExertion Scale. They were reminded that this scale has nothing to do with pain, and is instead a measure of how heavy and strenuous the exercise felt to them. A rating of 10 following a set indicated the participant had reached their maximum level of exertion, and no more sets for the given exercise would occur. Weight would be increased between each set in a given exercise depending on the PES ratings from the previous set. A final set of questionnaires was completed, including the State Mood Measure, the Pain Catastrophizing Scale, and the State-Trait Anxiety Inventory. The participant was then compen85

2016 sated 20 dollars. Day Two: Following a 24-48 hour interval, participants returned to the laboratory to complete the temporal summation (TS) and repetition-induced summation of pain (RISP) procedures. The order of TS and RISP was randomized. Prior to these tasks, the State Mood Measure was completed. The RISP task required participants to stand in front of a table with 18 cans on it, labeled A through R, with 6 cans per row and 3 cans per column. The height of the table was adjusted based on the elbow height that was measured on day one. Participants then lifted the cans in alphabetical order: going up each column, the can of the first row is lifted with the dominant arm at a 90 degree angle, then the can of the second row is lifted with the arm fully extended, then the can of the third row is lifted while the participant is slightly bent at the hips. This procedure was then repeated for column two, and so on. Arm positioning was demonstrated by the researcher prior to participant completion. Participants were asked to lift each can for a few seconds, a few centimeters off the ground, and then to give a pain rating between 0-10, with zero representing no pain and ten representing excruciating pain. Participants were then asked to lift can F, in the third row and second column, for as long as possible. The TS task was conducted using a Neuropen with 40g tips. Prior to stimulation, capsaicin cream was applied to a 3 cm area of the non-dominant volar forearm. Following application of the cream, a 15 minute waiting period occurred so that the cream could take effect. The task was explained to the participant before beginning stimulation. Then, 3 neuropen stimulations were applied at 30 second intervals, with a pain rating given by the participant after each stimulation. This design aimed to establish a baseline mechanical pain rating. Next, 10 neuropen stimula-

tions were applied at one second intervals, with a pain rating given at the first and tenth stimulation. A period of 45 seconds with no stimulation then occurs, with a pain rating every 15 seconds. This procedure then occurred on the dominant arm. The process is then repeated on the non-dominant and dominant arms, including the 10 neuropen stimulations and a 45 second waiting interval. Prior to the end of the experiment, the participant filled out the State Mood Measure, the Pain Catastrophizing Scale, and the State-Trait Anxiety Inventory. The participant was finally debriefed and compensated 20 dollars for their time. Approach to data analysis SPSS version 21.0 was used to conduct all data analyses. Means and SDs were computed on sample characteristics and questionnaire scores. Correlational analyses were used to assess the association between TS and RISP. Correlational analyses were also used to assess the relationship between pain catastrophizing and both TS and RISP, between negative mood and both TS and RISP, and between anxiety and both TS and RISP. Results Descriptive Sample characteristics and mean scores on measures of TS, RISP, pain catastrophizing, negative mood, and anxiety are presented in Table I. The total sample size consisted of 91 participants, however, following outlier labeling theory, 8 cases were determined as outliers and were therefore eliminated. The final sample consisted of 83 participants (34 M, 49 F). Participants were aged between 18 and 50 years old, with a mean age of 25.5 (SD = 7.5 years). The distribution of RISP scores is comparable to that which has been reported in previous research (See Figure I) (Sullivan, 86

2016 LariviĂ¨re, & Simmonds, 2010). There were significant gender differences on measures of pain catastrophizing, t = 66.62, p = .006, and on measures of anxiety, t = 65.77, p = .029. There were no gender differences on the other study variables. Correlational Analysis Correlational analyses did not reveal a significant association between TS and RISP indices, r = 0.113, p = 0.31 (see Figure II). Individuals with higher TS indices did not show similar trends with RISP indices, suggesting the mechanisms underlying these two measures might be different. There were no significant associations between pain catastrophizing and TS, r = 0.042, p = 0.703, and pain catastrophizing and RISP, r = 0.416, p = 0.901. There were no significant associations between anxiety and TS, r = 0.118, p = 0.295, and anxiety and RISP, r = 0.003, p = 0.982. There was a significant association between negative mood and TS, r = 0.273, p = 0.013, but not between negative mood and RISP, r = 0.100, p = 0.182. The pattern of associations between the psychological variables and indices of TS and RISP reinforce the possibility that the two indices are underlined by different mechanisms. There were significant associations between pain catastrophizing and negative mood, r= .345, p= .001, and between anxiety and negative mood, r= .255, p= .021. There was no significant association between pain catastrophizing and anxiety, r= .144, p= .199. Discussion The results from the present study contribute to the growing literature on the mechanisms underlying dynamic measures of pain. This study examined the potential shared variance between TS and RISP. It also investigated whether these two dynamic phenomena are underlined by similar psychological variables. We hypothesized that

TS and RISP would be correlated, suggesting that these two dynamic measures share common variance. We also hypothesized that pain catastrophizing, negative mood and anxiety would be associated with both TS and RISP, suggesting that TS and RISP are underlined by similar mechanisms. Lastly, based on the literature, we hypothesized the psychological factors would be correlated with each other. The results showed that TS and RISP indices were not correlated. There was also no significant correlation found between pain catastrophizing and both TS and RISP, negative mood and RISP, and between anxiety and both TS and RISP. Only negative mood and TS showed a significant correlation. A significant correlation was found between pain catastrophizing and negative mood, and between anxiety and negative mood. These results suggest that TS and RISP do not share common variance, and may not be underlined by similar mechanisms. The findings of this study showed that there was no significant association between TS and RISP. The absence of shared variance between TS and RISP suggests that these indices may have different underlying mechanisms. This finding could be substantiated by several possible explanations. First, TS and RISP may be measures of entirely different types of pain. This explanation is feasible given that previous studies have found there to be three distinct clusters of nociception, including thermal nociception, chemical nociception, and mechanical nociception (Mogil et al, 1999). The TS paradigm of the current study involves repetitive pressure stimulation, and therefore may engage mechanical nociception (Graven-Nielson et al, 2003). In contrast, the possible involvement of bradykinin, prostaglandins, and hydrogen ions during exogenous stimulation in RISP, suggests that this measure may involve chemical nociception (Graven-Nielson & Arendt87

2016 Nielson, 2003). If this explanation were to be found valid, it would suggest that TS and RISP both involve exogenous invocation of muscle pain, but through different underlying mechanisms. A study by Lambin and colleagues (2011) suggests that an absence of correlation between TS and RISP could also be due to the differences in their experimental procedures. In TS, the patient is relatively inactive, and passively receives experimenter-controlled stimulation. In RISP, stimulation is selfinitiated and self-paced. As a result, RISP may involve different central and peripheral processes. RISP may also be more ecologically relevant to participants. This explanation would suggest that TS and RISP differ in the psychological and physiological processes that they involve. The almost completely null correlation between TS and RISP suggests that the two indices involve different underlying mechanisms, and further research is necessary to explore potential explanations for this finding. The results of this study showed a significant association between negative mood and TS, however there was no significant association between negative mood and RISP. Based on past literature, we expected an association between negative mood and TS, and between negative mood and RISP. Depressed patients have been found to experience heightened pain intensity (Main & Watson, 1999), which would have been reflected in both TS and RISP indices, if both indices were to share underlying mechanisms. The differences in patterns of association between negative mood and TS and RISP suggest that the two indices are underlined by different mechanisms. A possible explanation for this finding reflects the hypothesis that TS is mechanical pain, whereas RISP is chemical pain. TS stimulates the skin and muscle, which then engages ascending systems of the spinal

cord and descending systems of the central nervous system (Graven-Nielson et al, 2003; Sullivan et al, 2009; Rhudy et al, 2011). In contrast, muscle pain experienced in RISP may be caused by the release of chemicals, such as bradykinin (Sullivan et al, 2009). The involvement of chemicals may cause the muscle pain to occur automatically, bypassing cognitive and psychological factors, such as depressive symptoms. The results of this study also did not find association between anxiety and TS, or between anxiety and RISP. Previous studies have shown that the consequences of anxiety, such as hypervigilance towards perceived symptoms, lead to an increase in pain (Buitenhuis et al, 2011). However, it is possible that anxiety causes increases in pain only for individuals with pre-existing pain. A study by Turk and colleagues (2002) showed that individuals with high anxiety experience cognitive disturbances as a result of their pain, but not in the absence of pain. The healthy individuals used in the current study did not have pre-existing chronic pain, and therefore the role that anxiety plays in pain severity may not have been made apparent in this sample. Future studies should address the association between anxiety and TS and RISP in individuals with chronic pain, in order to clarify the role that anxiety plays. This study found association between pain catastrophizing and negative mood, which is in accordance with previous literature. Several studies have found overlap in the variance among depressive symptoms and pain catastrophizing in patients with chronic pain, in both experimental and clinical pain research (Sullivan et al, 2009; Hassett, Cone, Patella & Sigal, 2000; Sullivan & Dâ&#x20AC;&#x2122;Eon, 1990). This study adds to the literature by experimentally replicating these results in healthy individuals. In accordance with previous studies, our 88

2016 results showed that anxiety and negative mood were significantly correlated. Depressive symptoms have been shown to be 9 times more likely to develop in patients with anxiety disorders, compared to individuals with no mental illness (McLaughlin, Khandker, Kruzikas & Tummala, 2006). Anxiety and depressive symptoms are frequently comorbid in individuals with chronic pain (Bair et al, 2008). Also, when anxiety and depressive symptoms are comorbid, there is increased risk of the occurrence of multiple chronic physical conditions (Scott et al, 2007). The association between anxiety and negative mood found in the current study suggests that the scales were used correctly, and that the scales accurately reflect the constructs of interest. There are important limitations to this study that must be considered during the interpretation of its findings. The methods used in the DOMS exercises may have also influenced the absence of association found between TS and RISP. The PerceivedExertion Scale may have been used differently among participants. Participants may have perceived their muscle fatigue differently, depending on other factors, such as cognitions and energy levels. It is also possible that participants gave inaccurate, high intensity ratings, knowing that this would end the exercises more quickly. As the induction of DOMS requires muscle fatigue to be reached in order for the onset of muscle soreness to occur (Nie et al., 2005), inaccurate ratings of the Perceived-Exertion Scale may have interfered with the RISP procedure. It is therefore possible that an association between RISP and TS was not found because RISP did not cause pain in a large portion of the participants, due to the insufficient DOMS induction. A larger sample size would have increased the number of participants that DOMS occurred for, thereby increasing the

accuracy of the RISP indices. Further research is needed to confirm the lack of association between TS and RISP found in the current study. In conclusion, our study investigated whether TS and RISP share common variance and common psychological variables, in order to determine whether these two phenomena are underlined by the same mechanisms. Based on our findings, TS and RISP showed no common variance. They were not significantly related in the same manner to psychological factors, including pain catastrophizing, anxiety, and negative mood. These findings suggest that TS and RISP do not share underlying mechanisms. Future studies should explore exactly how TS and RISP differ in their underlying mechanisms.

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2016 Appendix

2016

Social Reward Leads to Value-Driven Shifts of Attention

Kathleen Stewart Supervisors: Dr. Jelena Ristic

Abstract Attention can be captured by previously neutral stimuli that have been paired with a reward. Here we investigated whether imbuing arbitrary spatial associations with social reward can lead to the development of attentional orienting. Twenty undergraduate students participated in a two-day

study in which reaction times to respond to targets were measured before and after a learning task, in which participants received social reward for cue-target spatial pairings. In the subsequent test, conducted a day later, participants were faster to respond to previously rewarded spatial associations, indicating that they had implicitly learned the contingency between the rewarded cue and spatial location. In addition, social competence, as measured by the Autism Spectrum Quotient, was positively related to the amount of learning from social reward. These findings suggest social reward can lead to learning of spatial associations and that individual differences in social competence may moderate the robustness of this effect.

2016 Introduction Many types of stimuli in our environment capture and shift our attention as we go about our daily lives. Specifically, social information is able to powerfully shift our attention; for example, when talking to someone and their eyes shift towards an object, it is natural for us to shift our attention to what they are looking at. This is known as so cial attention, and it develops in infancy (Farroni, Massaccesi, Pividori, & Johnson, 2004; Scaife & Bruner, 1975). We use the gaze of others to learn important things about our environment, while deficits in social attention are one of the hallmarks associated with Autism Spectrum Disorders (Dawson et, al., 2004). These deficits often manifest as decreased ability to engage in communicative acts (Sigman, Mundy, Sherman, & Ungerer, 1986), difficulty understanding the viewpoint of others (e.g., theory of mind; Baron-Cohen, 2000), and language deficits, as children with autism fail to use gaze to infer the target of a novel word (Baron-Cohen, Baldwin, & Crowson, 1997). It is thus clear that attention to social information is critical for humans. In the lab, spatial orienting of attention is often studied using a Posner Cueing paradigm (Posner, 1980), where participants first fixate on a central stimulus before a cue such as a flashing box, an arrow, deviated eye gaze - appears, which will shift attention to a location in space (e.g. left or right). Then, a target demanding a response is presented and participantsâ&#x20AC;&#x2122; reaction times are measured. In this task, two types of trials are possible: (i) valid trials, where the target appears at the location indicated by the cue, and (ii) invalid trials, where the target appears at the location not indicated by the cue. Over the past few decades this paradigm has been used with various types of visual cues such

as flashing boxes and arrows, however it has also been used to study social attention (Friesen & Kingstone, 1998; Frischen, Bayliss, & Tipper, 2007). In the latter case, eyes gazing either left or right act as an attentional cue. Even when participants are informed that gaze direction is non-predictive of where the target will appear, people tend to automatically shift their attention in the direction of gaze, indicating that gaze information influences human attention. This leads us to the question of why we orient our attention to gaze direction, even when the information is not useful to the task at hand. One theory is that through development, we learn that where people look tells us important information about their desires, goals, and intentions, and so it becomes intrinsically rewarding to follow such gaze information (Moore & Corkum, 1994). Thus, it is possible that humans follow gaze automatically because we have linked that process with a social reward (e.g., engaging in conversation with others or initiating joint attention). In the current study we set to test the hypothesis that social orienting may be driven by social reward. Past research shows that attention is sensitive to prior reward history, such that previously rewarded stimuli tend to capture attention subsequently when the reward has been withheld. However, the focus of these studies has been only on monetary reward. For example, Hickey, Chelazzi and Theeuwes (2010) found that attention was captured by colour information even when irrelevant to the task at hand. Participants were asked to identify the orientation of a line inside a uniquely shaped target while ignoring other irrelevant distractor shapes; however, one of the distractors was a salient different colour (green). For each trial, 96

2016 participants were given either a high or low reward when they responded correctly. In the high reward condition, if the colour of the target remained the same across trials (for example, the target remained green), participants were much faster to respond, but if the target colour changed across trials (for example, switched from green to red), and a distractor became the previously rewarded colour (in this case green), participants were much slower to identify the line within the red shape. This indicates that attention was being captured by the colour of the previously-rewarded target, despite the colour now being irrelevant for that specific trial. Anderson, Laurent and Yantis (2011) have similarly found that non-salient, task-irrelevant stimuli captured attention when previously associated with a high monetary reward. They extended the findings of Hickey et, al., (2010), by showing that these effects could last up to twenty-one days after learning and that individual differences in working memory capacity predicted the strength of reward learning. Together these studies suggest that attention can be captured independently of our current goals and stimulus salience, highlighting the importance of our past experiences in changing attention, even when these associations are first learned with arbitrary coloured shapes. Here we extended this research by examining whether participants could learn specific cue colour-target location contingencies that would subsequently lead to shifts of attention instead of simply attentional capture towards a particular stimulus. To additionally examine the question of whether social attention may develop because of inherent social reward, we administered social instead of monetary reward. To investigate the effects of social reward, we rewarded participants when they correctly responded to targets appearing only on one side of a neutral

cue. Furthermore, similar to Anderson et al (2011), we investigated if individual differences in social competence, as measured by the Autism Spectrum Questionnaire ((AQ); Baron-Cohen, 2001), were linked to the amount of ‘social learning’ that resulted from reward administration. We hypothesized that social reward would lead to learning of particular spatial relations, even after the reward had been removed. We also hypothesized that we might see stronger effects of socially rewarded learning for those individuals with higher social competence. Methods Participants 20 McGill undergraduate students (17 females, mean age 20.7) participated in the study and were recruited through McGill’s participant pool. They were compensated with extra course credits for their participation. Each student participated in two sessions, spanning roughly three hours in total (2 hours the first day; 1 hour the second day). All participants gave written consent to participate in the study and were debriefed at the end of the second session. Apparatus and Stimuli The experiment ran on Mac Mini computers using MATLAB version 2009b. The stimuli were presented on 16” CRT monitor, and psychtoolbox 3.0 was used to display the experimental sequence. Participants were seated in a dimly lit room, roughly 57 cm from the monitor. The stimuli included a black fixation point (0.46° x 0.46° of visual angle), two bicoloured circles (1.81° x 1.81°; orange and yellow, or blue and green; see Figure 1), which served as cues, and a black “X” (0.69° x 0.69°) and “+” (0.84° x 0.84°), which served 97

2016 as response targets. The target was positioned 6.25° from central fixation, and appeared either to the left, right, above or below the circle. For each participant, one bicoloured circle was critical and the other was non-critical. The critical circle was associated with feedback during the learning phase of the task. For half of the participants the orange half of the critical circle was associated with positive reward during the learning phase and the yellow half of the critical circle was associated with negative reward, while for the other half of participants blue was associated with positive reward and green with negative reward. The non-critical circle was not imbued with positive reward or negative reward. Design and Procedure Participants completed the experiment in two experimental sessions, which included Baseline, Learning, and Test conditions. Baseline and Learning were run on the first day while the Test session was run on the second day. In all conditions, participants completed a computerized task. In this procedure, they were first presented with a central fixation point, followed by one of two bicoloured circle cues. After a variable delay, known as the stimulus onset asynchrony (SOA; 100, 300 or 700ms), a target appeared above, below, to the left, or to the right of the central cue. Participants responded to the target with a key press. The orientation of the cue circle was equiprobable, as was the location of the target, therefore the cue was always nonpredictive of where the target would appear. The targets were equally likely to be an “X” or a “+”. Baseline. The baseline condition was run to ensure that no prior associations between color and target position existed. As shown in Figure 2, in the baseline condition,

participants were presented with a fixation point in the center of the screen for 680 ms, followed by one of the two bi-coloured circles at fixation. The bi-coloured cues could be oriented either along the horizontal or vertical axis and the target appeared after a variable SOA on left, right, top or bottom location of the screen. No targets appeared in about 8% of the trials, which ensured that participants were responding only when the target was present. Participants were asked to simply detect the target by pressing the space bar with their preferred hand as quickly as possible. The target remained on the screen until a response was made or until 1500 ms had elapsed, at which point the trial timed out. Participants were informed that all combinations of cue and target types were equally likely, and were told to refrain from responding when no target appeared on screen. The task was divided into four blocks and contained 832 trials, which included 64 no-target trials. Learning. The second experimental condition involved the manipulation of social reward. To do so, the same experimental task was slightly modified to allow for the reward administration. First, right before this condition, participants were given a 20-minute break involving coffee, tea, juice or pop as well as a selection of cookies. They were brought into the lobby to converse with the experimenter. The conversation was not scripted, and flowed naturally, however, the experimenter did reference her thesis, and mentioned that the participants were really helping her by participating. The goal was to create a social connection with the participants during this time period. After the break, the participants returned to the testing room and completed the learning task. The task sequence in the Learning condition was similar to that used in the Baseline 98

2016 task, except that the participants were now asked to discriminate between the ‘X’ and ‘+’ targets by pressing one key if they saw an “X”, and another if they saw a “+”. The keyboard response keys (‘z’ and ‘/’) were labeled with an “X” and a “+”, while target-key response assignment was counterbalanced across participants. Participants were told that in this task they had the opportunity to win ‘points for the experimenter’ based on their accuracy and speed in identifying the targets and that these points would greatly benefit the experimenter and her project. They were also made aware that negative points might be awarded for incorrect responses (negative reward). At the start of each block a smiling picture of the experimenter on the instruction screen appeared. Then, participants started receiving a reward of +5 points when they correctly identified the target that matched the location of the positively rewarded half of the bi-coloured critical circle (valid trial). Five points were lost for incorrect identification of the target that matched the location of the negatively rewarded half of the critical circle (invalid trial). No points were accrued when participants responded correctly to targets that occurred on any other location or following the non-critical cue (neutral trial; see Figure 3). A feedback screen at the end of each block showed the number of points accumulated and the number of blocks left. Each participant completed a total of 768 trials, divided over four testing blocks. Test. On day 2, participants completed the Test condition, which was identical to the baseline task, and thus did not present any reward. At the end of the experiment, they filled out the AQ questionnaire. The AQ is a 50-item questionnaire, designed to test the number of autistic-like traits present in the typical population. Participants indicate the degree to which they agree with specific

statements using a 4-point likert scale. They receive a score of 1 for traits that align with autistic tendencies (out of a total score out of 50), whereby higher scores indicate more autistic-like traits and thus lower social competence. Results Trials in which participants anticipated the target (RT<100ms) or did not respond to the target (RT>1000ms) were excluded from the analyses. Trials in which participants pressed a key when no target was present, referred to as false alarms, were excluded. Error rates were overall low. Anticipatory responses occurred on less than 1.2% and 1.5% of trials in the Baseline and Test conditions while timeouts occurred on less than 0.6% and 0.3% of trials respectively. False alarms occurred on less than 1.5% of trials in the Baseline, and on less than 3.7% in the Test. All participants performed well on the learning task, with an average of 90% accuracy across participants. Two types of analyses were run. First repeated measures ANOVA contrasted mean correct RTs for baseline and test conditions as a function of reward (i.e., critical vs. noncritical cue). Then, a linear regression analysis was run to examine if the individual scores on the AQ predicted the magnitude of the attention orienting effect in the Test condition (i.e., the amount of ‘social learning’). ANOVAs Baseline. We first examined mean RTs using a repeated-measures ANOVA with cue type (to be ‘critical’, ‘noncritical’), cue validity (valid, invalid, neutral) and SOA (100ms, 300ms, 700ms) to determine whether (1) there were any attention effects prior to learning and (2) whether we could collapse the data across the two cue types, as neither cue differed in the baseline task. One interac99

2016 tion between SOA and cue validity [F(4,76) =4.2, p<0.05] revealed a type of reverse attention effect, whereby at the longest SOA the reaction times for the orientation that was to be positively rewarded in the next task (valid) were slower than the other two cue validity types (invalid and neutral; all other effects involving cue validity; Fs<3.2, ps>0.05). Thus if anything, this ‘reversed’ attention effect is in fact biasing our task away from exhibiting learning effects in the Test condition. As for our second question, we found no main effect or interactions involving cue type (all Fs<1.8 all ps>0.14). Therefore, we collapsed across the two cue types to create an average baseline measure for all subsequent analyses (all other Fs<3, all ps>0.05). Average baseline vs. non-critical cue. We next contrasted the RTs from the average Baseline with the RTs from the non-critical cue in the Test condition in order to ensure that no changes in cue validity occurred, as the noncritical cue was not associated with any manipulation. A repeated measures ANOVA with condition (average baseline, non-critical cue), SOA (100ms, 300ms, 700ms) and cue validity (valid, invalid, neutral) was run. As expected, there was a main effect of condition [F(1,19)=33.2,P<0.001], with participants having faster reaction times in response to the non-critical cue, which is likely due to practice effects from performing the same detection task on both day one and day two. A main effect of SOA was present as well [F(2,38)=31.3, p<0.001] due to the classic foreperiod effect (Bertelson, 1967), as participants were faster to respond at the 300ms and 700ms SOAs. A two way interaction between condition and SOA [F(2,38)=4.1, p<0.05] indicated flattened foreperiod in the non-critical cue condition, suggesting that the participants were not using the temporal information provided by the cue as efficiently

in this case. Finally a two-way interaction between SOA and cue validity [F(4,76)=2.9, p<0.05] indicated that no effects of cue validity were observed in the Test condition relative to the Baseline condition. This is depicted in Figure 4. No other effects or interactions were reliable (all Fs<2.5, ps>0.05). Average baseline vs. critical cue. Next we ran the same ANOVA which contrasted the Average baseline data with the critical cue data in the Test condition to investigate whether our social manipulation led to learning of the arbitrary cue-target pairings that were rewarded. First, there was a main effect of condition [F(1,19)=33.8, p<0.001] suggesting the faster reaction times to the critical cue are due to practice effects. Second, and as in the non-critical condition, there was also a main effect of SOA [F(2,38)=44.9, p<0.001] with faster reaction times at longer SOAs. There was no overall main effect of cue validity [F<1]; however, a three-way interaction between condition, SOA and cue validity [F (4,76)=2.9, p<0.05] indicated that participants were faster to respond to the positively rewarded cue-target location at SOA times of 300ms and 700ms in the Test condition (all other Fs<3, ps>0.05). These data are plotted in Figure 5. Since there was no significant speeding of the RTs for the invalid or negatively rewarded spatial pairings (t(19)<1, p>0.4, paired, two-tailed) and because we counterbalanced which bi-colour cue served as the critical cue across participants, it is clear that these shifts of attention were not due to low level features like the cue’s colour or reward salience. Instead the benefits of RT for the rewarded spatial pairings appear to reflect learning. Thus, the ANOVA results show that the participants exhibited orienting in the Test condition for rewarded spatial pairings only. 100

2016 Regression Analyses To examine if the magnitude of orienting in the Test condition varied with individual participant’s social competence, we also conducted simple linear regressions in which participant’s scores on the AQ (i.e., level of social competence) were entered as predictor variables of the overall magnitude of the orienting effect observed in the Test condition on Day 2. To do so, we first calculated the effect of positive reward learning by subtracting response times for the positively rewarded trials from the neutral trials at each SOA and then taking an average score across all SOAs. As shown in in Figure 6, the variability in AQ scores explained 23% of the variance in the magnitudes of the orienting effect towards the positively rewarded half of the critical circle [R2=0.23, F(1,19)=6.6, p<0.05]. Here, the AQ scores were negatively related to positive reward learning (β=-0.98, p<0.05), such that individuals low in social competence (i.e., those with a high AQ score) showed smaller orienting effects and hence less susceptibility to the effects of social reward. A similar analysis for negative reward (i.e., RTs for the negative reward –RT at neutral trials averaged across all SOA) indicated no relationship between the AQ and magnitude of orienting at Test [R2<1. F<1]. Thus, an individual level of social competence appears to predict the magnitude of learning of cue-target contingencies through positive social reward, but not through negative reward. Discussion In this study, we examined whether imbuing certain cue-target spatial contingencies with social reward could lead to the development of spatial orienting. We hypothesized that if social reward is as strong as other types of rewards (e.g. monetary), participants would learn the rewarded pairings, leading

to faster responses even after the reward had been removed. We further hypothesized that individual variability in social competence might modulate the amount of learning from the social reward. This is exactly what we found. The data indicated that the implicitly administered social reward manipulation led to learning the pairing between a rewarded colour and a target location. Furthermore, individual level of social competence was related to the magnitude of orienting after learning whereby individuals high in social competence showed larger learning for the socially rewarded pairings. These results have three main implications. First, they show that attention is influenced not just by monetary reward, and that rewarding spatial associations rather than singleton stimuli themselves may lead to the development of orienting effects. Most studies to date have looked at value-driven attentional capture using monetary reward, however we have shown that social reward can also affect attention. This result is in line with a recent study by Heerey (2014) in which participants were asked to select one of two faces over a series of trials. Feedback for selection was given in the form of polite and genuine smiles. Heerey found that participants were biased towards repeating actions that were reinforced with genuine smiles, which carry more social reinforcement, and that the ability to learn from the social reward was predicted by participants’ AQ scores. Similarly, Lin, Adolphs, & Rangel (2012) showed that participants learned to associate cartoons of slot machines with positive, negative and neutrally emotional faces, just as they did with positive, negative and neutral monetary earnings, further demonstrating the importance of social reward to humans. Our results extend these results and indicate that social reward may modulate learning of asso101

2016 ciations. It is thus possible that spontaneous gaze following in humans develops because engaging with other humans is socially rewarding. Our data indicated that social reward was a powerful motivator, even when the spatial contingencies were not present in the environment. And although learning took only approximately 30 minutes, the formed associations lasted for at least one day. Second, this research adds to the growing number of studies which have strayed from the idea that the control of human attention involves a simple dichotomy, in which attention is either guided voluntarily on the basis of our goals (such as focusing attention on a book one is reading; Yantis & Jonides, 1990), or involuntarily on the basis of salient environmental events capturing our attention (for example, quickly turning our attention in response to a loud sound; Posner, 1980). It has become increasingly clear that there may be other forms of attention, such as attention driven by the past selection history of the stimulus or reward (e.g., Ristic & Kingstone, 2012; Awh, Belopolsky, & Theuwees, 2012), neither of which can be explained by a voluntary/involuntary framework of attentional control. Our study supports this notion by demonstrating that reward-driven attentional orienting was neither voluntary, as there was no goal-driven reason for participants to orient to rewarded cue-target contingencies, nor involuntary, as participants were not orienting their attention in response to the perceptual or reward salience of the cue. It is important for the field of attention to assimilate this information into a new framework of spatial attention, one that leaves behind a dichotomous framework in favor of a more encompassing version, which includes types of attentional responses that do not fit neatly into either of the two classic categories of

spatial attention. Third, we demonstrated that the magnitude of attentional orienting due to social reward depended on individual differences in social competence. These findings suggest that not every person pays attention to stimuli in the same way, and that some people might learn reward contingencies more strongly than others. This dovetails with investigations into individual differences and spatial attention. For example, Bayliss & Tipper (2005) demonstrated that individuals with high social competence oriented strongly to objects that were attended to by others whereas those with low social competence oriented more to shapes. Further Bayliss and colleagues (Bayliss, di Pellegrino & Tipper, 2005) have also demonstrated gender differences in that females are more strongly cued by eye gaze direction than males. Understanding how individual variability in social competence within a typical population furnishes social attention is a fruitful avenue for future research. Finally, while our results clearly demonstrated that social reward leads to learning of spatial associations, it is clear that further research on this topic may be beneficial. For example, future studies should consider comparing the effects of social reward to the effects of monetary reward to examine differences in spatial learning from different types of reward. It would also be interesting to examine different types of reward, such as behaviorally relevant rewards that directly benefit the person, such as having to complete fewer trials of the task, which may act as a strong reward incentive. Other individual differences such as gender might impact learning from social reward as well. There are many exciting possibilities for furthering our knowledge about how motivation and reward influence our attention. 102

2016 References Anderson, B.A, Laurent, P.A., & Yantis, S. (2011). Valuedriven attentional capture. Pro ceed ings o f the National Academy of Sciences of the United States of America, 108(25), 10367-10371. doi: 10.1073/pnas.1104047108. Awh, E., Belopolsky, A. V., & Theeuwes, J. (2012). Topdown versus bottom-up attentional control: a failed theoretical dichotomy. Trend s in Co gnitive Science, 16(8),437-443. doi:10.1016/j.tics.2012.06.010 Baron-Cohen, S. (2000). The cognitive neuroscience of autism: Evolutionary approaches. In M. S. Gazzaniga (Ed.), The new co gnitive neuro sciences (pp. 1249–1257). Cambridge, MA: MIT Press. Baron-Cohen, S., Baldwin, D. A., & Crowson, M. (1997). Do children with autism use the speaker’s direction of gaze strategy to crack the code of language? Child Development, 68, 48–57. doi: 10.1037/0033-2909.133.4.694 Berridge, K. C., & Robinson, T. E. (1998). What is the role of dopamine in reward: hedonic impact, reward learning, or incentive salience? Brain Research Reviews, 28(3), 309-369. doi: 10.1016/S0165-0173(98)00019-8 Bertelson P. (1967). Time course of preparation. Quarte rly Journal of Experimental Psychology, 19, 272–279. doi:10.1080/14640746708400102 Dawson, G., Toth, K., Abbott, R., Osterling, J., Munson, J., Estes, A., & Liaw, J. (2004). Early social attention impairments in autism: social orienting, joint attention and attention to distress. Developmental Psychology, 40(2), 271-283. doi: /10.1037/0012-1649.40.2.271 Farroni, T., Massaccesi, S., Pividori, D., & Johnson, M. H. (2004). Gaze following in newborns. Infancy, 5, 39–60. doi: 10.1207/s15327078in0501_2 Friesen, C. K., & Kingstone, A. (1998). The eyes have it! Reflexive orienting is triggered by nonpredictive gaze. Psycho no m ic Bulletin & Review , 5, 490–495. doi:10.3758/BF03208827 Frischen, A., Bayliss, A. P., & Tipper, S. P. (2007). Gaze cueing of attention: visual attention, social cognition and individual differences. Psycho lo gical Bulletin, 133(4), 694-724. doi: 10.1037/0033-2909.133.4.694 Heerey, E. A. (2014). Learning from social rewards predicts individual differences in self-reported social ability. Jo urnal o f Exp erim ental Psycho lo gy: General, 143(1), 332-339. doi: 10.1037/a0031511 Hickey C, Chelazzi, L., & Theeuwes, J. (2010). Reward changes salience in human vision via the anterior cingulate. Jo urnal o f Neuroscience, 30(33),

11096-11103. doi: 10. 1523/ JNEUROSCI. 1026-10. 201 Lin, A., Adolphs, R., & Rangel. A. (2012). Social and monetary reward learning engage overlapping neural susbtrates. So cial Cognitive and Aff ective Neuroscience, 77(3), 274-281. doi: 10.1093/scan/nsr006 Moore, C., & Corkum, V. (1994). Social understanding at the end of the first year of life. Develo p m ental Review, 14, 349–372. doi: 10.1111/j.1467-7687.2005.00445.x Posner, M. I. (1980). Orienting of attention. Quarterly Journal of Experimental Psychology, 32(1), 3-25. doi: 10.1080/00335558008248231 Scaife, M., & Bruner, J. S. (1975). The capacity for joint visual attention in the infant. Nature, 253, 265–266. doi:10.1038/253265a0 Sigman, M., Mundy, P., Sherman, T., & Ungerer, J. (1986). Social inter actions of autistic, mentally retarded and normal children and their caregivers. Jo urnal of Child Psychology and Psychiatry, 27, 647–656. doi: 10.1111/j.1469-7610.1986.tb00189.x Yantis, S., & Jonides, J. (1990). Abrupt visual onsets and selective attention: voluntary versus automatic allocation. Jo urnal of Exp erim ental Psycho lo gy: Human Perception and Performance, 16(1), 121-134. Doi: 10.1037/0096-1523.16.1.121

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2016

An Investigation of the Relationship between Neural Network Activation and Sexual Concordance in Men and Women

Jennifer Lee, Mayte Parada, Marima Gerard, Isabelle Leduc-Cummings, and Dr. Irving Binik

Abstract The current study investigates differential brain activation as it relates to sexual concordance in men and women. Women typically show less concordance than men in response to visual sexual stimuli (VSS). A number of theories have been proposed to explain this discrepancy, however there is a lack of research assessing the brainâ&#x20AC;&#x2122;s response to sexually arousing stimuli, its role in the activation of the genital response, and the appraisal of the arousal response. We hypothesized that women would have lower concordance scores than men, that distinct neural network activation would be found between humour and erotic conditions, and that distinct patterns of neural network activation would be found in individuals with high or low concordance. In particular, we hypothesized that the increased activation of the hypothalamus and amygdala characteristic of the male sexual arousal response may be common to individuals with high concordance more generally. Ten participants (5 male, 5 females) watched two five-minute videos with either humorous or sexual content while continuously rating their subjective sexual arousal. Brain activation and physiological arousal was measured via fMRI and infrared thermal imaging. No significant differences in sexual concordance by gender were found. fMRI analysis revealed components unique to the erotic condition including the thalamus, brainstem, cingulate gyrus, hippocampus, left frontoparietal area, default mode network, and salience network. However, no significant differences in brain network activation were found between men and women or groups with high and low concordance. Further research with a larger sample size is needed to determine whether gender differences in concordance simply reflect methodological artefacts, and whether there are distinct patterns of neural network activation underlying differences in concordance.

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2016 Introduction Sexual concordance refers to the correlation between subjective and physiological sexual arousal. Women typically show lower sexual concordance than men in response to visual sexual stimuli (VSS), though it is difficult to make between-gender comparisons since different technologies are often used to assess physiological arousal in men and women (Suschinsky, 2012; Laan & Janssen, 2007; Chivers, 2010). The most commonly used instruments for measuring genital arousal include penile strain gauges for men and vaginal photoplethysmography for women (See Chivers, 2010; Hatch, 1979; Barlow, 1970). However, such tools are often intrusive and not directly comparable between men and women, leaving open the possibility that lower levels of concordance in females may reflect a methodological flaw or artefact rather than a difference by gender. Thermal imaging of the genitals (thermography) is a promising, non-intrusive tool that indirectly tracks changes in genital blood flow by way of infrared radiation, which is then expressed as a unit of temperature in degrees Celsius (Kukkonen, 2007; 2010). Although levels of concordance seem to improve in women when using thermography (average r = .26), a disconnect between subjective and genital arousal in women still exists compared to men (average r = .66) (Kukkonen, 2007; 2010). It has been shown that enhancing genital awareness may increase concordance in women (Brotto, Basson, & Luria, 2008), which leads us to believe there may be topdown neural network activation differences underlying concordance. Previous studies on the patterns of neural activation associated with sexual arousal typically measure bloodoxygen-level dependent signals using func-

tional magnetic resonance imaging (BOLD fMRI) coupled with visual sexual stimuli (VSS) (Karama, 2002; Mouras, 2003; Ferretti, 2005). Current fMRI research has implicated activation of the anterior cingulate, medial prefrontal, orbitofrontal, insular, occipitotemporal cortices, amygdala, and ventral striatum in both males and females in response to VSS (Mouras, 2003; Ferretti, 2005; Arnow, 2002), with greater activation in the hypothalamus and amygdala seen in males but not females (Karama, 2002; Hamann, 2004). However, no studies as of yet have attempted to study the neural correlates of sexual concordance in men and women or in people with high and low sexual concordance, regardless of gender. As men typically have greater concordance than women, and typically show greater neural activation in the hypothalamus and amygdala during VSS, the present study attempts to resolve whether greater neural activation of these areas is common to individuals with high concordance in general. As such, the aim of the present study was to investigate the relationship between brain activation and sexual concordance in response to visual sexual stimuli in sexually healthy men and women. We hypothesized that 1) measurement of genital and subjective arousal using genital thermal imaging would confirm a lower sexual concordance in a group of female participants compared to male participants; 2) fMRI concurrently with thermal imaging in response to visual sexual stimuli would reveal activation of a set of common and distinct neural networks in response to an erotic condition versus a humour condition; 3) there would be a positive correlation between brain activation of the visual network, brainstem, hypothalamus, and amygdala with initial rise in genital tem107

2016 perature during an erotic condition in men and women; 4) men would show greater brain activation compared to women in the erotic condition but not in the humour condition, particularly in networks encompassing the amygdala and hypothalamus; 5) participants with higher sexual concordance would show greater activation of the hypothalamus and amygdala compared to those with low sexual concordance, in the erotic condition but not in the humour condition Methods Participants Five men and five women were recruited from the university and community through online and posted advertisements. A detailed telephone screening interview was conducted to assess eligibility to participate in the study. Subjects were included if they were in good health, between the ages of 18-45, and reported no sexual arousal or desire problems. Participants completed a standardized sexual functioning questionnaire and scored within the inclusion criteria â&#x20AC;&#x201C; a score of >65 on the International Index of Erectile Functioning (IIEF) for males (Rosen, 1997), or a score of >26.5 on the Female Sexual Function Index (FSFI) for females (Wiegel, 2005). Female subjects were tested during the same phase of the menstrual cycle to avoid variability in main outcome measures due to variation in hormone levels. Exclusion criteria included pregnancy or breastfeeding, irregular menstrual periods, self-reported STI/STD, use of medications that may interfere with sexual arousal, non-heterosexual orientation, pain, medical or psychiatric illness, hormone therapy, any metal prostheses or devices, no prior sexual experience, or objections to watching sexually explicit material.

Procedure Participants were screened and completed a standardized sexual functioning questionnaire (see above). On the day of testing, participants undressed from the waist down and were given a hospital gown before being placed inside an fMRI scanner. A 9-minute anatomical scan was performed to locate brain regions in relation to a standard anatomical map. A functional MRI trial was then conducted, consisting of 5 minutes of humorous content and 5 minutes of erotic content. Participants were asked to continuously rate their subjective arousal throughout the films while a thermal imaging camera recorded temperature readings of their genital region. At the end of each film clip, they were also asked to rate both how much they liked the video and how much it made them want to experience sexual pleasure on a 10 point scale. These questions were displayed for 12 seconds each. The total length of the scan was 10 minutes and 48 seconds. After testing, subjects were debriefed and compensated with CAD$100. Equipment Projector-mirror system. A projector displayed the film stimulus on a screen facing the head-opening of the MRI machine. A mirrored head-attachment allowed participants to view the screen while lying horizontally during the MRI. The projector was connected to a laptop computer through a switch box, and was used to display the videos and rating scales. Headphones. Ear-bud headphones were provided to participants to allow for audio accompaniment to the visual film stimuli. Noise levels were tested beforehand using a random audio clip for each participant to ensure a comfortable volume that would not be stifled by the noises of the MRI machine. Button Box. A hand-held button box, 108

2016 connected to a laptop computer through a switch box, was used by the participant to initiate the stimulus video, record subjective arousal, and respond to subjective arousal questions as they appeared on the screen. The clicker featured a left and right button to adjust ratings on a visual scale, and an enter button to submit the chosen response to a given question. Intercom. A standard intercom was used for communication between the participant and the female investigator, who was in the adjoining room. Blinds were drawn to separate fMRI technicians from the participant allow complete privacy in the MRI machine. Stimulus Materials. The humour film clip consisted of an episode of Modern Family. The erotic film clip “Breakfast in Bed” provided by www.danejones.com ®, consisted of a variety of sexual activities between a man and woman, including kissing/foreplay, mutual oral sex, and vaginal intercourse. The films were presented privately to participants through the projector-mirror apparatus and earphones. The stimuli were played and controlled by Psychopy2 software (Peirce, 2007) on a PC in the controller room. Main Outcome Measures Continuous measures of genital arousal. A FLIR T450sc infrared camera measured temperature of the labia, clitoris, and thigh of females or the base, tip, and thigh of males, recording at intervals of 2.3 seconds. The sampling interval of the camera was set to eight frames per second, with a sensitivity of +/- 1°C. The camera is equipped with a Vanadioum Oxide detector producing thermal images of 320 x 240 Pixels. For males, the camera was placed several meters from their feet, elevated and angled approximately 30° downward. For females, the camera was angled at approximately 20°. The different camera placements for males and females reflect-

ed the optimal spots for clear images of their respective genital regions. After videos were recorded, FLIR ResearchIR Max software recorded temperatures at three regions of interest at intervals of 2.6 seconds in order to time -lock recordings with fMRI sampling rates for later analysis. Continuous measures of subjective sexual arousal. Throughout all film clips, a 10point scale was displayed at the bottom of the screen. Participants were instructed to rate their level of sexual arousal continuously throughout all clips with 0 representing no sexual arousal and 10 signifying the most sexually aroused a participant could feel. Participants moved the cursor indicating the selected number left or right using two buttons on the hand-held clicker, denoting decreases or increases in arousal. The subjective arousal ratings were extracted and recorded every 2.6 seconds. fMRI. A 3T Siemens Magnetom TrioTim syngo MR B17 (Siemens AG, Erlangen, Germany) was used for functional and structural imaging. The scanning session began with a high-resolution three-dimensional acquisition for anatomical localization (voxel size, 1.1 x 1.0 x 4.0 mm). Blood oxygen leveldependent (BOLD) fMRI data were acquired with the following parameters: coil elements: HEA, HEP, voxel size: 3.0 x 3.0 x 3.0 mm, matrix size: 64 x 64 pixels, TE: 30 ms, FOV: 192 mm, flip angle: 90 deg, slice thickness: 3.0 mm. 44 functional volumes consisting of 270 transaxial slices were acquired for each run with a TR of 2660 ms. An anatomical acquisition was first run to allow for the positioning of axial slices over the brain. A functional run was subsequently performed, lasting ten minutes in total, while blood-oxygen leveldependent signals were recorded at a frame rate of 2.6 seconds. Post-stimulus questions. After each five -minute film clip, participants were asked to 109

2016 rate how much they liked the video and how much it made them want to experience sexual pleasure on a 10-point scale. Statistical Analysis All non-fMRI statistical analyses were run on SPSS 20. Thermal data was recorded across erotic and humour conditions for men and women. Difference scores were computed by subtracting the initial temperature from the final temperature at the beginning and end of each condition. A 2-way repeated measures ANOVA was performed for women to determine whether region of interest (thigh, labia, and clitoris) or video (erotic or humour condition) had an effect on temperature difference scores. A similar ANOVA was performed for men, with regions of interest including the thigh, penile shaft, and tip. Subjective arousal was recorded across erotic and humour conditions and the average scores of male or female subjects at every time point were calculated to resolve general within-group trends (see Figure 2). The difference score of each individual’s subjective arousal ratings was calculated as the difference between the first and last recording of subjective arousal. An independent samples t-test was performed to test for differences in subjective arousal difference scores between the humour and erotic condition, and between men and women in the erotic condition. Concordance of subjective and genital arousal was calculated in two distinct ways. Within-subject concordance was determined by running Pearson product moment correlations on the subjective arousal ratings and genital temperatures of each subject (both base and tip were compared to SA in men and labia and clitoris in women). An independent samples t-test was then run to compare the mean Pearson r-values for withinsubject concordance of men and women.

Calculations of within-group concordance were performed by first finding the average genital temperature and subjective arousal for every point in time for all men or all women. A Pearson product moment correlation was then run on the averaged genital temperatures and subjective arousal for each group. Additional Pearson product moment correlations were run (grouped by men and women) to determine whether there was any relationship between increases in subjective arousal, temperature, individual concordance, and how highly the subject rated the video in the two post-stimulus questions. Temporal independent component analysis was run on the aggregate of all ten subjects using FSL 5.0.6. Cross correlations were run with FSL to determine the degree of correlation between 20 components found in both erotic and humour conditions. 11 of the 20 initially identified components were disregarded as “noise.” Pairs of erotic-humour components with Pearson values of over 0.4 were considered common to both conditions. fMRI videos were analyzed using FSL independent component analysis (ICA) (Bell and Sejnowski, 1995; Comon, 1994; Hyvarinen and Oja, 2000), which resolves spatially independent patterns of neural activity without a predetermined model. Spatial maps from the group-average analysis were used to generate subjectspecific versions of spatial maps and associated time series using dual regression (Beckmann, 2009; Smith, 2009). The groupaverage set of spatial maps was regressed for each subject into the subject’s 4D space-time dataset. This analysis resulted in a set of subject-specific time series. Next, time series were regressed into the same 4D dataset, resulting in a set of subject-specific spatial maps, one per group-level spatial map. We then tested for differences between the 5 men 110

2016 and 5 women using FSL’s rand o m ise permutation-testing tool. We similarly tested for differences between 5 high-concordance individuals and 4 low-concordance individuals. Individuals with concordance levels above .65 were considered high concordance. Temperature difference scores and % change of BOLD levels in each component were calculated for the erotic condition for each individual. % change of BOLD levels was determined by calculating the difference between the highest and lowest levels of activation for a given component, divided by the lowest value. For each component, Pearson correlations were run between individual temperature differences and % change in BOLD. Results Genital response In women, there was a significant effect of region of interest on temperature difference scores [F(2,8) = 4.714, p 2 = .044, ηp = .541)], with post-hoc LSD tests (p< .05) revealing that temperature difference scores in the thigh region (M= -.051, SD = .412) were significantly lower than that of the clitoris (M = .16, SD = .579). There was however no significant difference between the labia region (M = .054, SD = .602) and either the thigh or clitoris. No significant differences were found for the main effect of video condition. In men, there were significant effects of both video condition [F(1,4) = 23.291, p = .008, ηp2= .853] and region of interest [F(2,8) = 27.603, p=.000, ηp2= .873], as well as the interaction of region of interest and video condition [F(2,8) = 7.101, p = .045, ηp2 = .640]. Temperature difference scores in the erotic condition (M= 1.917, SD = 1.887) were higher than those of the humour condition (M = .182, SD = .748). Post-hoc LSD tests (p<.05) for the

erotic condition revealed that temperature difference scores were greater for both the shaft (M= 1.105, SD = 1.405) and tip (M = 2.100, SD = .852) than the thigh (M = -.056, SD = .411), but no significant differences existed between shaft and tip. No significant differences were found between regions of interest in the humour condition. Subjective arousal response Compared to the humour condition, both men and women reported higher levels of subjective arousal in response to the erotic condition. Subjective arousal in both men and women appeared to increase steadily for the first 104 seconds of the erotic condition and were relatively high throughout the duration of the film, while remaining close to 0 throughout the duration of the humour condition. The difference score of each individual’s subjective arousal ratings was calculated as the difference between the first and last recording of subjective arousal. There was a significant difference in difference scores for subjective arousal between humour and erotic conditions, in both men and women. In men, SA rating difference scores for the humour condition (M=.4, SD= .89) differed significantly from those in the sex condition (M=6.6, SD=1.67), t(8) = -7.307, p<.01. In women, SA rating difference scores for the humour condition (M = 0.0, SD = 0.0) differed significantly from those in the sex condition (M = 6.25, SD = 2.62), t(6)=-4.753, p<.01. No significant differences were found when comparing average subjective arousal ratings for the erotic condition across time in men (M = 4.90, SD= 1.63) and women (M=4.84, SD=2.32), nor when comparing average difference scores of subjective arousal ratings in men or women in the sex condition.

111

2016 Concordance of genital and subjective arousal response No significant differences were found between the averaged within-subject concordance scores of males and females, whether comparing base and labia or tip and clitoris (p>.05). Individual within-subject concordance scores are listed in Figure 3a. In terms of within-group concordance, average subjective arousal and penile base temperatures were highly correlated (r = .829, df = 114, p <.01) in the erotic condition for men, as were average subjective arousal and penile tip temperatures (r = .853, df = 114, p<.01). For the erotic condition in women, average subjective arousal and labia temperatures were highly correlated (r=.785, df=114, p<.01), as were average subjective arousal and clitoral temperatures (r=.838, df=114, p<.01) (see Figure 3b). Among men, subjective arousal difference scores (the difference between the last and first subjective arousal rating of the video) was strongly negatively correlated with both temperature difference score of the penile shaft (r = -.982, df = 3, p < .01) and % temperature difference of the penile shaft (r = .975, df = 3, p <.01), which indicates that the males with the highest increases in penile tip temperature had the lowest change in subjective arousal ratings. Moreover, individual concordance scores were negatively correlated with % difference in penile shaft temperature (r = -.928, df = 3, p<.05) as well as shaft temperature difference scores (r= -.901, df = 3, p<.05), suggesting males with the highest increases in genital temperature had the lowest concordance scores. No correlations between post-stimulus question responses and either subjective arousal or genital temperature differences were found in men. Among women, no significant withingroup correlations were found between temperature differences and either ratings of

subjective arousal, post-stimulus question ratings, or concordance level. However, average subjective arousal was significantly correlated with the degree to which they wanted to experience sexual pleasure after the video (r = .95, df = 2, p <.05). Moreover, subjective arousal difference scores were highly correlated with how much they related to how much they rated liking the video (r = .983, df = 2, p < .05). Lastly, ratings of the two questions were correlated with one another (r = .935, df = 3, p <.05), suggesting women who reported liking the video also tended to rate the video more highly for how much it made them want to experience sexual pleasure. Brain network activation Among the regions activated in both erotic and humour conditions were those corresponding to the visual network (occipital pole, lateral occipital regions, occipital fusiform gyrus), the right frontoparietal area, and sensorimotor areas. Components with no corresponding correlated component (Pearson values of < 0.4) between the erotic and humour conditions (i.e. components that were unique to one condition or the other) are shown in Figure 4. Among regions activated in the erotic condition and not the humour condition were the thalamus, brainstem, cingulate gyrus, hippocampus, left frontoparietal area, default mode network, and salience network (anterior insula, inferior frontal gyrus, superior frontal gyrus, anterior cingulate cortex, mid/post cingulate cortex, superior frontal gyrus, and medial frontal gyrus). Regions activated in the humour condition and not the erotic condition included the auditory network (inferior temporal areas), and the anterior visual cortex. Concordance of brain network activation and genital response No significant differences in brain net112

2016 work activation were found for either gender or concordance level. In men, strong correlations were found between individual temperature difference scores and % BOLD activation of three distinct components: the visual network (occipital pole, lateral occipital regions, occipital fusiform gyrus) (R2 =0.589), a component comprised of the thalamus, brainstem, cingulate gyrus, and hippocampus (R2 = 0.5273), and the default mode network (R2 = 0.587). In women, strong correlations in the erotic condition were only found between temperature difference scores and % change of BOLD levels in the thalamus, brainstem, cingulate gyrus, and hippocampus (R2 = 0.3537). Discussion In women, the video condition (sex or humour) did not have any significant effect on the difference scores of genital temperatures. As expected, male temperature difference scores in the erotic condition were higher than that of the humour condition for both the shaft and tip, but not the thigh. Subjective arousal was much higher in the erotic condition than humour condition for both groups. Subjective arousal scores for the erotic condition did not significantly differ between men and women. No significant differences were found in the within-subject concordance between men and women. Moreover, when genital temperature and subjective arousal were averaged among all men and women for every time point, both genders had high within-group concordance (r = .853 and .838 for male tip vs. subjective arousal and female clitoris vs. subjective arousal respectively). However, men with the highest increase in penile tip temperatures had the lowest change in subjective arousal ratings. Those same men also had the lowest concordance scores. No such relationship was found in women.

The women with the highest average continuous subjective arousal were likely to be the same women who rated the video highly when asked how much it made them want to experience sexual pleasure. Subjective arousal difference scores were also positively correlated with how much women rated liking the video. No such relationship existed for men. fMRI analysis revealed components unique to the erotic condition including the thalamus, brainstem, cingulate gyrus, hippocampus, left frontoparietal area, default mode network, and salience network (anterior insula, inferior frontal gyrus, superior frontal gyrus, anterior cingulate cortex, mid/post cingulate cortex, superior frontal gyrus, and medial frontal gyrus). However, dual regression did not reveal any significant differences in the networks activated in either women vs. men or people with high vs. low concordance. When comparing temperature difference scores and % change in BOLD levels for each component during the erotic video, it appeared that increased activation of the thalamus, brainstem, cingulate gyrus, and hippocampus were highly correlated with increases in genital temperatures in both men and women, with increases in visual network and default mode network specifically correlated with genital temperature increases in men but not women. Since there was no difference in average subjective arousal ratings for men and women in the erotic condition, it would appear that both groups felt similarly aroused by the stimulus. It is possible that the low number of participants in each group might account for this failure to replicate genital temperature increases in women in the erotic condition. Women generally do not show as drastic a genital temperature change as men in response to sexual stimuli (Kukkonen, 2007; 113

2016 Abrahamson, 1981); a higher number of participants might therefore be required to resolve the more subtle female temperature increases as significant in the erotic condition. Our results failed to resolve any gender differences in concordance. Despite the fact that female genital temperature increases were not significantly different in the humour vs. erotic condition, it would appear that the subtle changes in female genital temperature over the course of the erotic condition were enough to provide strong positive correlations when compared against subjective arousal in women, in most individuals and as an averaged group. While many studies have suggested that females show less concordance than men (Suschinsky 2012; Laan & Janssen, 2007; Chivers, 2010), our findings support the hypothesis that commonly reported lower levels of sexual concordance in women than men may be the result of methodological differences, which might be mitigated by use of genital thermography (Chivers, 2010). However, only 4 female subjectsâ&#x20AC;&#x2122; data was eligible for use (one subject forgot to rate subjective arousal during the trial), therefore it is possible that the low number of subjects sampled was not enough to observe the differences in concordance by gender that might exist in the population. Additional studies with larger sample sizes will need to be done to confirm this finding. Interestingly, the men with the highest temperature changes (both by % difference and by difference scores) were likely to report the lowest change in subjective arousal and the lowest concordance scores. We propose two possible explanations for this finding. It is possible that there is a distractor effect caused by the subjective arousal rating task, compromising oneâ&#x20AC;&#x2122;s ability to attend to the visual sexual stimulus and thus explaining why the men with the highest concord-

ance were those with the smallest genital response. A previous study in which males performed increasingly complex distractor tasks while listening to an erotic tape showed that increases in penile tumescence were negatively correlated with the complexity of the task (Geer & Fuhr, 1976). Our findings suggest there may be a trade-off between attending to sexually arousing features of the stimuli and providing accurate continuous subjective arousal responses, and that this effect may more prevalent in men than women. This proposed effect is highly consistent with previous studies showing that continuous SA reporting throughout the sexual stimulus seemed to result in lower genital responses in men, but not women (Wincze et al., 1980). Another possible explanation is a statistical one: the narrower the range of subjective arousal scores used (for instance, 0 to 5 as opposed to 0 to 10), the less closely oneâ&#x20AC;&#x2122;s ratings are able to statistically parallel increases in genital temperature, as one is employing fewer discrete scores to reflect a comparatively wider range of temperature increases. This possibility might partially account for why men who used a smaller range of the subjective arousal ratings (indicated by smaller difference scores) tended to also have comparatively worse concordance. Women with higher subjective arousal were more likely to provide higher responses to both post-stimulus questions in the erotic condition, whereas these patterns were not found in men. This would indicate that whether or not the subject liked the video was a better predictor of subjective arousal ratings in women than men. This finding is consistent with previous studies suggesting positive affect increases self-reported sexual arousal, and that women may be more sensitive to contextual aspects of visual sexual stimuli they find unpleasant (Laan & Janssen, 2007). Moreover, it has been proposed that 114

2016 autonomic processes play a more prominent role in arousal appraisal in men, in part due to their more conspicuous genital responses whereas women are typically reported to be more sensitive to meanings and context of visual sexual stimuli (Rupp & Wallen, 2008). Our findings corroborate reports that positive appraisal of sexual stimuli was positively correlated with subjective ratings of sexual arousal in women (Laan, 1994), further suggesting that â&#x20AC;&#x153;likingâ&#x20AC;? the video may be less important for the arousal response in men. The finding that distinct fMRI BOLD components were activated during the erotic condition and not the humour condition corroborates previous findings that VSS preferentially activates the thalamus, brainstem, cingulate gyrus, hippocampus, frontoparietal area, anterior insula, and frontal gyrus (Karama, 2002; Mouras, 2003; Ferretti, 2005; Arnow, 2002). The salience network -- the insula in particular -- has been implicated in interoceptive awareness and active monitoring of autonomic processes, as well as modulation of attention in response to salient cues (Menon & Uddin, 2010). Our findings of increased salience network activation may support the hypothesis that the task of rating oneâ&#x20AC;&#x2122;s subjective arousal requires awareness of physiological states and peripheral cues (Suschinsky & Lalumiere, 2012). Failure of dual regression to find differences of BOLD component activation by gender or by concordance level did not replicate previous reports of greater hypothalamic and amygdala activation in males compared to females (Karama, 2002; Harmann, 2004). Our findings fail to support the hypothesis that participants with higher sexual concordance show differential brain region activation of the hypothalamus and amygdala compared to those with lower sexual concordance. These results may be due to the lesser spatial resolution of independent component analy-

sis compared to region-based, model-driven fMRI analyses which specifically target the hypothalamus and amygdala. Furthermore, our statistical analyses were largely limited by the small group sizes for each gender that were available to us (n=5). Both men and women showed increases in activation of the thalamus, brainstem, cingulate gyrus, and hippocampus which highly corresponded to the onset of increases in genital temperature. The involvement of many of these regions has been implicated in previous studies on the neuroanatomical correlates of visually evoked sexual arousal, with activation of the anterior cingulate, insula, amygdala, hypothalamus, and frontoparietal areas having previously been correlated with penile erections (Stoleru, 1999; Ferretti, 2005). It is possible that these regions specifically play a role in the physiological arousal response. In contrast, the left frontoparietal area and salience network, which showed weak correlation with the genital response but high overall activation in the erotic condition, may be involved in either perception or higher-level cognitive processing of the VSS. Genital temperature changes were additionally correlated with activation of visual networks in men, but not women. This research strengthens previous findings suggesting that physiological arousal in men may be more closely related to perception of visual sexual stimuli, while the female arousal response might rely more heavily on nonvisual contextual factors and social backdrops (Rupp & Wallen, 2008). Future experiments. Our small sample size (5 men and 5 women) may not have been enough to resolve significant temperature difference scores between video conditions for women, but it is likely that adding more participants to future studies will yield results in the expected direction. Future studies with a larger sample size should be done to 115

2016 determine whether differences in concordance by gender can be consistently replicated using genital thermography, or whether such reported differences are largely the result of methodological differences in sampling genital arousal in men and women. It may be that thermography yields smaller concordance differences between men and women which must be resolved with a larger number of subjects. Additionally, studies employing modeldriven fMRI statistical analysis will need to be done to determine the neural locus for cognitive awareness of subjective arousal, if such a locus exists at all. A model-based rather than spatially independent componentbased approach might be better able to resolve differences in activation specific to the hypothalamus and amygdala, to determine if heightened activity in these regions associated with the male arousal response might also be common to individuals with greater concordance more generally. Lastly, more studies must be conducted on the possible negative effects of continuous subjective arousal responses on concordance and genital arousal, and why this distractor effect appears to affect the genital responses of men more so than women (Wincze et al., 1980). Distractor tasks of varying levels of complexity can be given to both men and women during a presentation of VSS to determine their effects on both genital response and concordance. If the act of continuous lever or scale-based subjective arousal reporting does in fact cause decreased concordance in men, future studies investigating sexual concordance may in fact yield more accurate results using discrete rather than continuous measures of subjective arousal (i.e., sampling retrospectively, after the VSS has been presented in its entirety).

Conclusion In conclusion, the present study did not resolve any sex differences in concordance, and there was no significant effect of erotic stimulus on female genital temperatures; both these findings may be the result of a limited number of participants and should be investigated further. The men with the smallest genital response typically had the largest subjective arousal response and the highest concordance, suggesting that continuously rating oneâ&#x20AC;&#x2122;s subjective arousal might detract from attention to the VSS itself to the effect of a smaller genital arousal response. fMRI analysis revealed a set of distinct neural networks activated during the erotic condition and not the humour condition â&#x20AC;&#x201C; among them, a network comprised of the thalamus, brainstem, cingulate gyrus, hippocampus, left frontoparietal area, the default mode network, and the salience network. High correlation of the genital arousal response and activation of the visual networks was found in men but not women, suggesting male genital arousal may be more closely linked to visual perception of sexual stimuli compared to women. Lastly, dual regression of independent components revealed no difference in network activation between men and women or between individuals with high or low concordance, but further studies might employ model-based analyses on activation of the hypothalamus and amygdala to attempt to resolve these differences. References Abramson, P. R., Perry, L. B., Seeley, T. T., Seeley, D. M., & Rothblatt, A. B. (1981). Thermographic measurement of sexual arousal: A discriminant validity analysis. Archives of sexual behavior, 10(2), 171-176. Arnow, B. A., Desmond, J. E., Banner, L. L., Glover, G. H., Solomon, A., Polan, M. L., ... & Atlas, S. W. (2002). Brain activation and sexual arousal in healthy, heterosexual males. Brain, 125(5), 1014-1023. Barlow, D. H., Becker, R., Leitenberg, H., & Agras, W. S. 116

2016 (1970). A mechanical strain gauge for recording penile circumference change. Journal of Applied Behavior Analysis, 3(1), 73-76. Beckmann, C. F., Mackay, C. E., Filippini, N., & Smith, S. M. (2009). Group comparison of resting-state FMRI data using multi-subject ICA and dual regression. Neuroimage, 47(Suppl 1), S148. Bell, A. J., & Sejnowski, T. J. (1995). An informationmaximization approach to blind separation and blind deconvolution. Neural computation, 7(6), 1129-1159. Chivers, M. L., Seto, M. C., Lalumiere, M. L., Laan, E., & Grimbos, T. (2010). Agreement of self-reported and genital measures of sexual arousal in men and women: A meta-analysis. Archives of sexual behavior, 39(1), 5-56. Comon, P. (1994). Independent component analysis, a new concept?. Signal processing, 36(3), 287-314. Ferretti, A., Caulo, M., Del Gratta, C., Di Matteo, R., Merla, A., Montorsi, F., ... & Romani, G. L. (2005). Dynamics of male sexual arousal: distinct components of brain activation revealed by fMRI. Neuroimage, 26(4), 1086-1096. Geer, J., & Fuhr, R. (1976). Cognitive factors in sexual arousal: The role of distraction. Journal of Consulting and Clinical Psychology, 44, 238–243. Hamann, S., Herman, R. A., Nolan, C. L., & Wallen, K. (2004). Men and women differ in amygdala response to visual sexual stimuli. Nature neuroscience, 7(4), 411-416. Hatch, J. P. (1979). Vaginal photoplethysmography: Methodological considerations. Archives of Sexual Behavior, 8(4), 357-374. Hyvärinen, A., & Oja, E. (2000). Independent component analysis: algorithms and applications. Neural networks, 13(4), 411-430. Kukkonen, T. M., Binik, Y. M., Amsel, R., & Carrier, S. (2007). Thermography as a Physiological Measure of Sexual Arousal in Both Men and Women. The journal of sexual medicine, 4(1), 93-105. Kukkonen, T. M., Binik, Y. M., Amsel, R., & Carrier, S. (2010). An evaluation of the validity of thermography as a physiological measure of sexual arousal in a non-university adult sample. Archives of Sexual Behavior, 39(4), 861-873. Laan, E. (1994). Determinants of sexual arousal in women. Unpublished doctoral dissertation, University of Amsterdam, Amsterdam, The Netherlands. Laan, E., & Janssen, E. (2007). How do men and women feel? Determinants of subjective experience of sexual arousal. The psychophysiology of sex, 278-290. Menon, V., & Uddin, L. Q. (2010). Saliency, switching,

attention and control: a network model of insula function. Brain Structure and Function, 214(5-6), 655-667. Mouras, H., Stoléru, S., Bittoun, J., Glutron, D., PélégriniIssac, M., Paradis, A. L., & Burnod, Y. (2003). Brain processing of visual sexual stimuli in healthy men: a functional magnetic resonance imaging study. Neuroimage, 20(2), 855-869. Peirce, JW (2007) PsychoPy - Psychophysics software in Python. J Neurosci Methods, 162(1-2):8-13 Rellini, A. H., McCall, K. M., Randall, P. K., & Meston, C. M. (2005). The relationship between women's subjective and physiological sexual arousal. Psycho p hysio lo gy, 42(1), 116-124. Rosen, R. C., Riley, A., Wagner, G., Osterloh, I. H., Kirkpatrick, J., & Mishra, A. (1997). The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology, 49(6), 822-830. Smith, S. M., Fox, P. T., Miller, K. L., Glahn, D. C., Fox, P. M., Mackay, C. E., ... & Beckmann, C. F. (2009). Correspondence of the brain's functional architecture during activation and rest. Proceedings of the National Academy of Sciences, 106(31), 13040-13045. Stoleru, S., Gregoire, M. C., Gerard, D., Decety, J., Lafarge, E., Cinotti, L., ... & Comar, D. (1999). Neuroanatomical correlates of visually evoked sexual arousal in human males. Archives of sexual behavior, 28(1), 1-21. Suschinsky, K. D., & Lalumière, M. L. (2012). Is sexual concordance related to awareness of physiological states?. Archives of sexual behavior, 41(1), 199-208. Suschinsky, K. D., Lalumière, M. L., & Chivers, M. L. (2009). Sex differences in patterns of genital sexual arousal: Measurement artifacts or true phenomena?. Archives of Sexual Behavior, 38(4), 559-573. Wiegel, M., Meston, C., & Rosen, R. (2005). The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. Journal of sex & marital therapy, 31(1), 1-20. Wincze, J. P., Venditti, E., Barlow, D. H., & Mavissakalian, M. (1980). The effects of a subjective monitoring task in the physiological measure of genital response to erotic stimulation. Archives o f Sexual Behavio r, 9, 533–545.

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2016

Male Pedophilia: Disease of the Brain or Strong Sexual Desire towards Children?

Pauline Vitte Supervisor: Dr. Noreen Bider

Abstract Pedophilia is a major concern in society. As such, the research aimed at determining the underlying causes and mechanisms of pedophilic behavior is extensive. Whereas most of the research points towards a neurobiological model of pedophilia, in which pedophilic fantasies are the result of under-

lying neurological dysfunction, more recent research has used new brain imaging technologies to study the pathways involved in sexual arousal in pedophilic individuals, and the results of these recent studies differ from one another. In fact, while some evidence points to an underlying illness of the brain, other results suggest that pedophilic individuals exhibit a real sexual attraction to children and not to adults, suggesting that their behavior is driven by altered sexual preference, and not neurological dysfunction. The present paper aims to discuss - and provide an explanation for - these differences in findings, and proposes that the substantially different methods used in each of these studies can account for the observed discrepancies. From this analysis, a comprehensive model of pedophilia will then be proposed.

124

2016 Introduction

tests, determined that PI display lower intel-

Pedophilia, defined as intense and per-

ligence scores, lower memory abilities, and

sistent sexual arousal, urges, or behaviors in-

higher rates of left-handedness, which have

volving a prepubescent child (DSM-IV: APA,

all been correlated to neurodevelopmental

1994), is a major social concern. In fact, it is

perturbations (Blanchard et al, 2002). Moreo-

estimated that approximately 1 in 12 children

ver, a study by Blanchard et al. (2003) reveals

has been sexually approached or abused by

that PI self-report more brain injuries occur-

an adult in the US (Fagan et al, 2002). Be-

ring before the age of 13 than controls. Other

cause of the important danger pedophilia

case report studies report that patients with

represents for children, governmental poli-

previously normal sexual behaviors, who lat-

cies have implemented mandatory reporting

er developed pedophilic attitudes, had tem-

of suspected child sexual abuse to authorities

poral and frontal brain lesions, as revealed

(Fagan et al, 2002). This lowers the risk that

by neuroimaging techniques (Miller et al,

children will be harmed, but also discourages

1986; Mendez et al, 2000).

distressed, non-abusive individuals with pe-

While all of this research suggests an ill-

dophilic urges to seek help to control their

ness-of-the-brain model for pedophilia, re-

fantasies, out of fear of being reported. Con-

cent studies using more powerful brain im-

sequently, the true prevalence of pedophilia

aging techniques, namely Magnetic Reso-

cannot be determined, and as very few non-

nance Imaging (MRI), to study brain struc-

abusive pedophilic individuals come for-

ture, or functional MRI (fMRI), to study brain

ward, most studies conducted in this field

function, have found evidence of abnormali-

recruit individuals from forensic facilities

ties in brain structures, as well as, by con-

who have abused children, and are thus

trast, evidence of sexual arousal brain activa-

criminal pedophiles. It is estimated, however, that

tion patterns equivalent

the majority of pedophilic individuals sex-

ly healthy subjects, but directed towards chil-

ually attracted to children, never do abuse.

dren. This suggests that pedophilia might be

Additionally, about 50% of child sexual abus-

the result of altered sexual attraction, rather

ers do not meet the clinical diagnostic criteria

than brain abnormalities. The proposed re-

for pedophilia (Seto, 2008).

search aims to shed light on this often-found

to those of sexual-

Most of the research aimed at determin-

difference in findings, and hypothesizes that

ing the etiology of pedophilia has found

methodological discrepancies - in particular

some evidence of neurological dysfunction in

the differential assessment of pedophilia in

pedophilic individuals (PI). In fact, Cantor et

subjects, the choice of the control group, and

al. (2004), using various neuropsychological 125

2016 the experimental paradigms - drive this di-

sexual arousal, as well as recognition of sex-

vergence in findings. Following this analysis,

ually relevant stimuli (Mouras et al, 2003).

an integrative model for pedophilia attempt-

The activation of each of these structures

ing to reconcile both models will be pro-

should be considered separately when study-

posed. In order to control for a maximum of

ing sexual attraction, as a dysfunction in one

variables, only studies that use MRI or fMRI,

area will have drastically different implica-

look at brain anatomy or functioning in areas

tions than a dysfunction in another area.

involved in sexual attraction, and study both

homosexual male or heterosexual male pe-

2- Methodological differences in the choice of

dophilic individuals, not limited to incest,

control groups and assessment of pedophilia

will be considered in this paper.

are related to differences in brain structure findings by MRI

1- Brain areas involved in sexual arousal

As previously mentioned, due to manda-

Firstly, the reader needs to recognize the

tory reporting policies (Fagan et al, 2002),

different roles of brain structures involved in

most of the research is done on pedophilic

sexual arousal in order to understand the im-

individuals who come from the criminal sys-

plications of the abnormalities found in the

tem and thus have abused children, most of

studies. The lim bic system is the part of the

them repeatedly. These men are therefore

brain that includes the amygdala, the hypo-

considered crim inal p ed o philes. It is worth

thalamus, the insula and the dorsal midbrain.

noting that approximately half of all child

It is involved in the autonomic part of sexual

sexual abusers do not meet the diagnostic cri-

arousal (Mouras et al, 2003; Ferreti et al,

teria for pedophilia (Seto, 2008), as they do

2005). It lights up in healthy heterosexual

not display repeated and persistent sexual

males in response to erotic visual stimulation

urges towards children. This is relevant be-

and co-occur with penile erection (Ferreti et

cause the sexual attraction to children in the

al, 2005). Fro nto striatal parts of the brain,

criminal pedophile sample is rarely assessed

such as the Orbito-Frontal Cortex (OFC), the

in these studies. In fact, in most studies, hav-

Prefrontal cortex (PFC) and the superior tem-

ing repeatedly abused a child is sufficient to

poral lobes, have been associated with the

be included in the pedophilic sample. Thus,

cognitive part of sexual arousal, the pro-

while it is true that men who have abused

cessing of sexual stimuli, and the regulation

children are much more likely to show re-

of socially inappropriate behavior (Ferreti et

sponses to children in phallometric testing

al, 2005; Burns et al, 2003; RedoutĂŠ et al,

(Blanchard et al, 2001), using child abuse as a

2000). Finally, the parietal areas of the brain

measure of pedophilia remains an imperfect

are related to attentional processes during

measure. Therefore, it is reasonable to as126

2016 sume that studies that assess pedophilia by

ment of pedophilia are used.

using phallometric responses to pictures of

Schiffer et al. (2007) compared, via MRI

children will find different results than stud-

analysis, the structural brain differences be-

ies that assess pedophilia by the previous

tween pedophilic individuals who had sex-

abuse of children. Similarly, studies that

ually offended children, and healthy male

attempt to control for the criminal compo-

controls from the community. His main find-

nent of child sexual abuse by using a non-

ing indicates lower Grey Matter Volume

sexual criminal control group will supposed-

(GMV), which is necessary for the processing

ly find brain differences that vary from those

of information in various brain structures, in

found in studies that compare brain activa-

the frontrostriatal parts of the brain of pe-

tion in criminal pedophiles vs healthy sub-

dophilic individuals. These structures are im-

jects from a community sample.

plicated in the regulation of social behavior,

This indeed seems to be the case. In this

and deficiencies in GMV in these areas imply

field of interest, it appears that only one

that PI have difficulty inhibiting their urges

study used a criminal control group when

and lack regulative mechanisms that would

studying structural brain differences between

prevent them from abusing children. Howev-

PI and non-pedophilic controls. This same

er, deficiencies in these areas may just be re-

study, by Cantor et al. (2008), used strict con-

lated to the criminal component of the PI in-

ditions for the inclusion of individuals in the

cluded in these samples, and not to pedophil-

pedophilic samples: the individuals either

ia itself, as the control group was non-

had to admit being pedophilic, show phal-

criminal. In fact, Cantor et al. (2008) have

lometric responses to children greater than

replicated this paradigm by comparing the

responses to adult sexual stimuli, or, in the

brain structure of PI to that of non-sexual

case in which individuals didn't show phal-

offenders. The authors underline the im-

lometric responses to any kind of stimuli,

portance of this comparison group: it con-

had offended at least one child under the age

trols for brain differences associated with

of 14, but had not offended against individu-

general criminality in pedophilic offenders as

als over 17 years old. This is a considerably

well for the stress related to incarceration.

more reliable measure of pedophilia than

When these two factors were controlled for,

measures relying only on offenses and self

the structural MRI revealed no differences in

reports, which is what most studies in this

the frontrostriatal system of PI and criminal

field of research have used thus far. This sec-

controls, suggesting that the findings of

tion compares the differences in findings re-

Schiffer et al. (2007) were related to the crimi-

garding structural brain abnormalities in PI,

nal component of pedophilia and not to the

when different control groups and assess-

sexual attraction to children. Moreover, the 127

2016 Cantor et al. (2008) assessment of pedophilia

founding variables, this paper will compare

is much more focused on attraction to chil-

the experimental paradigms of studies that

dren (i.e. responses on phallometric tests),

assess pedophilia by forensic analysis and for

and less on sexual offenses against children.

which the control groups consisted of sexual-

Consequently, their results indicate lower

ly healthy community individuals.

White Matter Volume (WMV), which is nec-

Studies investigating brain abnormalities

essary for the relaying of brain information

in PI vs. controls in the absence of sexual

and connectivity between structures, in the

stimuli paradigm are MRI studies. This kind

temporal and parietal lobes of PI. These areas

of research reports brain abnormalities in PI

are involved in identifying an environmental

individuals, arguing for the existence of an

stimuli as sexually relevant, and thus defi-

underlying neurological cause for their sexu-

ciencies in connectivity in these structures

al deviance. For example, Schiffer et al. (2007)

suggest that PI may identify a sexually rele-

found lower GMV in frontostriatal brain are-

vant stimulus differently than controls, argu-

as, reflecting their lack of ability to control

ing for an altered-sexual-preference model of

and repress their fantasies towards children.

pedophilia. Ultimately, we can see that the

Similarly, Schiltz et al. (2007) noted a smaller

way in which pedophilia is assessed and

right amygdala volume in PI relative to con-

whether or not the criminal component of

trol, by MRI analysis when they were ex-

child sexual abuse is controlled for at least

posed to no stimuli at all. Right amygdala

partially drive the differences in findings,

lesions are associated with enhanced libido

and argue for the existence of two different

(Braun et al, 2003), suggesting that pe-

models of pedophilia.

dophilic individuals are in general hypersexual. However, because these studies were

3- Methodological differences in the experi-

conducted in the absence of sexual stimuli,

mental paradigm are related to inconsistent

and every brain region is associated with a

evidence of brain abnormalities in pedophilic

wide variety of behaviors, not just sexual be-

individuals

havior, one cannot exclude the possibility

The

studies

previously

mentioned

that these brain abnormalities are unrelated

looked at structural brain differences be-

to their pedophilia. Instead, they could be

tween PI and controls. Another important

related to other personality traits, such as im-

field of research concerns functional brain

pulsivity, antisocial behavior, lack of social

differences, or brain activity patterns, associ-

skills, or even criminality. In fact, while the

ated with exposure to visual sexual stimuli.

studies conducted in the absence of sexual

Here again, the results present inconsisten-

stimuli point to an illness-of-the-brain model

cies. For the sake of control for other con-

of pedophilia, other studies looking at brain 128

2016 differences between PI and controls when

compared to controls when both groups were

they are presented with relevant or irrelevant

exposed to their sexually-relevant stimuli.

sexual stimuli tend to indicate that the brain

This suggests lower impulse control and low-

activation patterns in PI in response to child

er cognitive component of sexual arousal in

sexual stimuli are largely similar to those in

PI. Yet here again, the entire PI sample in this

sexually healthy controls in response to nor-

study had offended and the control group

mal adult sexual stimuli, hinting towards an

was non-criminal, thus the possibility re-

altered-sexual-attraction model of pedophil-

mains that this activation was correlated to

ia.

their criminal behavior, more than to their Schiffer et al. (2008) compared the brain

sexual behavior..

activation patterns of heterosexual PI to that

The comparison of results and implica-

of heterosexual controls (attracted to adult

tions of these two types of studies, one with-

women) when they were shown their respec-

out and one with presentation of a sexually-

tive sexually arousing stimuli (nude girls for

relevant stimulus, seem to indicate the possi-

PI and nude women for controls). Results

bility that forensic PI suffer from brain abnor-

showed that both groups displayed greater

malities, some of which are related to lack of

activation in response to their respective

control over their impulses and desires,

stimuli, and significantly less or no brain re-

while others are related to enhanced libido or

sponse to their non-relevant sexual stimuli,

hyper sexuality. However, these brain abnor-

indicating clear sexual target preference. The

malities do not seem to be directly related to

brain areas that were activated include path-

their deviant sexual preference, as studies

ways

processes

looking at brain activation (fMRI) show that

(occipito-temporal cortex), as well as multi-

the sexual arousal pathways function essen-

ple parts of the limbic system, such as the

tially the same way in PI when viewing nude

amygdala, the thalamus and the hippocam-

girls and in controls when viewing adult

pus, which are related to autonomic sexual

girls. Another study has shown that PI dis-

arousal and behaviors. Overall, this data

play significantly less limbic system activa-

shows that the brain activation patterns dur-

tion than controls, namely the amygdala, hy-

ing sexual arousal are essentially identical

pothalamus, insula and dorsal midbrain,

between PI and controls when viewing their

when viewing adult sexual stimuli (Walter et

sexually-relevant

al, 2003). This reflects the lack of sexual inter-

involved

attentional

stimuli,

which

argues

against the illness-of-the-brain model of pe-

est of pedophilic individuals in adults.

dophilia. However, it was once again found

Conclusion

that PI had lower OFC activation involved in

This paper has shown that the methodo-

decision making and inhibitory behavior

logical discrepancies across studies looking 129

2016 at brain structure and activation in pe-

sexual stimuli tend to find more brain differ-

dophilic individuals account at least partly

ences between PI and controls, and to hint

for the differences in results and interpreta-

towards a neurobiological-disease model of

tion. Studies that compare brain functioning

pedophilia.

of criminal PI to non-criminal subjects taken

However, the vast majority of the studies

from the community tend to find inter-group

in this field are conducted on individuals

differences in the frontal parts of the brain,

who have abused children and have been ar-

involved in inhibitory processes and regula-

rested. Some studies attempt to control for

tion of behavior, reflecting the impulsive and

the

criminal nature of sexual abuse. These stud-

(Cantor et al, 2008), but even so, it is reasona-

ies point towards the existence of a neurolog-

ble to assume that if these studies were re-

ical dysfunction underlying pedophilia. On

peated on pedophilic individuals who have

the other hand, studies that use non-sexual

never directly abused children, and sought

criminal offenders as a comparison group to

help or treatment in order to deal with their

control for the crim inal component of the pe-

fantasies, the findings would be different.

dophilic individuals tend to find less or no

These results would also be more informa-

differences in the frontal parts of the brain

tive of the brain mechanisms underlying pe-

and more differences in the parietal parts of

dophilic arousal itself, and not child abuse.

the brain involved in recognition of visual

Unfortunately, the mandatory reporting poli-

stimuli as sexually relevant (Cantor et al,

cies (Fagan et al, 2002) make it highly unlike-

2008). The pedophilic sample of the latter

ly that individuals with pedophilic fantasies

study was also formed of individuals with

will seek the help of a physician, out of fear

more sexual attraction towards children than

of being reported, and apprehension that

adult, as opposed to pedophilic samples

their condition will be revealed to their fami-

formed by choosing individuals who abused

lies. Nevertheless, studies that could manage

children in the past. This may also play a role

to include more non-offensive pedophiles

in the inconsistencies in findings, as the focus

would provide important insight on the pos-

is on sexual attraction, and not abuse.

sible underlying neural deficiencies of pedo-

criminal

component

pedophilia

Moreover, studies investigating brain

philia. In the meantime, we suggest that

function in response to sexual stimuli argue

studies investigating the brain mechanisms

for the existence of a true sexual attraction

towards children and a lack of sexual interest

measures and/or fMRI assessment of attrac-

in adults, hinting towards the sexual desire

tion towards children to select their pe-

model of pedophilia. Conversely, studies

dophilic individuals sample, while studies

looking at brain pathways in the absence of

investigating the brain mechanisms involved

pedophilic

arousal

use

phallometric

130

2016 in the sexual abuse of children use PI sam-

children, without the presence of brain ab-

ples from forensic facilities, as two very

normalities. This model is hypothetical, and

different brain pathways seem to underlie

should be tested by further studying the

the two conditions.

brain structure and activation pattern of non-

A comprehensive model for pedophilia.

criminal pedophiles. In fact, we expect that if

In conclusion, the methodological incon-

the experimental paradigms presented in this

sistencies present in studies of brain path-

paper were repeated with a non-criminal pe-

ways in pedophilia point towards two possi-

dophilic sample, no differences in the

ble models of pedophilia: a model of strong

frontrostriatal parts of the brain would be

sexual arousal to children leading to pe-

found between PI and controls. Moreover, PI

dophilic fantasies, and an illness-of-the-brain

would show similar brain activation pattern

model, where some brain abnormalities in

than controls in response to child sexual

inhibitory and regulative brain processes

stimuli, but not to adult sexual stimuli. The

lead to criminal pedophilia and to the abuse

only brain differences that would be perhaps

of children. Figure 1 represents a model

found between PI and sexually healthy con-

attempting to reconcile the evidence for both

trols would be that PI have a smaller amyg-

models of pedophilia, namely, the model by

dala volume, associated with hypersexuality

which pedophilia results from strong sexual

(Braun et al, 2003).

attraction to children, comparable to the desire control subjects have towards adult sexu-

References

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American Psychiatric Association. (2000). Diagno stic and statistical manual of mental disorders, fourth edition (DSM-IV). Washington, DC: Author. Blanchard, R., Christensen, B. K., Strong, S. M., Cantor, J. M., Kuban, M. E., Klassen, P., ... & Blak, T. (2002). Retrospective self-reports of childhood accidents causing unconsciousness in phallometrically diagnosed pedophiles. Archives o f Sexual Behavior 31(6), 511-526. doi: 10.1023 /A:1020659331965 Blanchard, R., Klassen, P., Dickey, R., Kuban, M. E., & Blak, T. (2001). Sensitivity and specificity of the phallometric test for pedophilia in nonadmitting sex offenders. Psycho lo gical Assessm ent, 13(1), 118-126. doi: 10.1037/1040-3590.13.1.118 Blanchard, R., Kuban, M. E., Klassen, P., Dickey, R., Christensen, B. K., Cantor, J. M., & Blak, T. (2003). Self-reported head injuries before and after age 13 in pedophilic and nonpedophilic men referred for clinical assessment. Archives o f sexual behavio r, 32 (6), 573-581. doi: 10.1023/A:1026093612434 Braun, C. M., Dumont, M., Duval, J., Hamel, I., & Godbout, L. (2003). Opposed left and right brain hemisphere

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131

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2016 Appendix

Figure 1: A comprehensive model of pedophilia, based on the evidence from studies presented in this paper It is crucial to separate reward from salience when studying value-driven reward. Once something starts to become rewarded, it becomes more salient due to it carrying important feedback information (Berridge and Robinson, 1998). To address this, we included a negative reward aspect in our study so that we could differentiate between reward and salience. One half of the critical cue is positively rewarded, and the other is negatively rewarded during the learning phase, so that each half of the circle will be equally salient. This allows us to differentiate whether or not any change in reaction times are due to positive or negative reward as opposed to salience.

133

2016

The Relationship between Gender, Income, and Sleep in School-Aged Children

Anastasiya Voloshyn Supervisors: Dr. Bärbel Knäuper, Dr. Reut Gruber, and Jamie Cassoff

Abstract Lower socioeconomic status (SES) has been shown to be associated with shorter sleep duration and a higher prevalence of sleep disturbances in children. Findings regarding the association between SES, gender, and sleep in children have been mixed. The aim of this study was to examine the rela-

tionship between income (as indicator of SES) and children’s sleep, and to look at gender as a moderator of this relationship. Parent reports of sleep duration, parasomnia symptoms, sleep disordered breathing symptoms, and the degree to which parents perceived their child’s sleep behaviours as problematic, were collected for 616 children aged 6-12 years. A positive association was found between income and sleep duration and a negative association was observed between income and sleep disordered breathing symptoms. Gender was found to moderate the relationship between income and sleep duration as well as the relationship between income and symptoms of sleep disordered breathing, such that girls’ sleep was more strongly affected by income in both cases. This study points to a greater impact of SES on the sleep of girls. These findings add to the growing literature on the relationship between SES and children’s health and have implications for future research and interventions. Further studies will need to investigate the mechanisms explaining the stronger association between SES and sleep for girls and future interventions aimed at this population might increase their effectiveness by taking into account this association.

Key words: income, sleep duration, sleep disturbances, school-aged children, gender

134

2016 Introduction

tend to be quite common in this age range, with

Sleep is an essential state that is instrumental prevalence rates varying from 10%-45%. It is imto survival and optimal everyday functioning. portant to detect and treat sleep disturbances in Sleep in children and the various factors that pro- childhood because they decrease the quality of mote or hinder it are receiving increasing atten- the children’s days and nights and lead to negation, as research reveals the harmful consequenc- tive consequences that have potential long-term es of poor sleep on children’s lives and develop- ramifications, which will be discussed next. ment. Consequences of Sleep Deprivation in SchoolSleep in School-Aged Children

Aged Children

The National Sleep Foundation recommends

In children, sleep is essential for optimal

that school-aged children (6-12 years) sleep for 9 everyday functioning and for physical and cognito 11 hours per day (Hirshkowitz et al., 2015), tive growth (Gruber et al., 2014). Sleep disturbwith the optimal amount of hours of sleep de- ances and sleep deprivation in children result in

creasing

progressively

the

child

ag- insufficient sleep, which in turn has negative con-

es. However, a decrease in the amount of sleep sequences on their cognitive, socio-emotional, that children get has been observed over the past behavioural, and physical functioning (Meijer, century in American, European, and Asian coun- 2008; Owens, 2008; Sadeh, 2007). These consetries (Matricciani, Olds, & Petkov, 2012). Optimal quences are due to the impact of insufficient sleep duration recommendations for children sleep on the functioning of brain areas such as have also decreased over the past century the prefrontal cortex, which is important in exec(Matricciani, Olds, Blunden, Rigney, & Williams, utive functioning, like planning or decision mak2012). Meanwhile, it is found that the actual sleep ing (Durmer & Dinges, 2005). duration has been an average of 37 minutes lower than the recommended sleep duration over the The Relationship between Children’s Sleep and past century (Matricciani, Olds, Blunden, et al., Socioeconomic Status 2012). Thereby, an increasing number of children

It is known that sleep in children is affected

are getting less than the optimal amount of sleep, by a multitude of factors, one of which is the sociwhich can have broad-ranging negative conse- oeconomic status (SES) of the child’s family. The

quences on their physical and mental health and socioeconomic status is defined as “the social growth.

standing or class of an individual or group” and

Additionally, children’s sleep might be sig- “is measured as a combination of education, innificantly affected by sleep disturbances, which come, and occupation” (American Psychological 135

2016 Association, 2015). Lower SES has been consist- Jaffe, & Doghramji, 2006). They include sleepently found to be associated with shorter sleep. walking, sleep talking, night terrors, and nocturChildren from lower SES families have later bed- nal enuresis, among others (Markov et al., 2006). times or earlier wake-up times compared to chil-

Factors influencing the relationship be-

dren from higher SES families (Biggs, Lushing- tween sleep and SES. Multiple factors have ton, Martin, van den Heuvel, & Kennedy, 2013; been proposed to explain the described relationMcLaughlincrabtree et al., 2005). Furthermore, as ships between SES, sleep duration, and sleep disan international trend towards decreasing sleep turbances.

duration in children is seen, the decline in sleep

Inappropriate sleep environments. Inappro-

duration over the years has been larger for lower- priate sleep environments are known to lead chilSES children (Dollman, Ridley, Olds, & Lowe, dren to sleep less and have more sleep disturb2007). The prevalence of sleep disturbances is al- ances. Due to the financial restraints of families so higher in lower SES children (Bagley, Kelly, from lower SES, many people live in small homes Buckhalt, & El-Sheikh, 2014; Buckhalt, 2011; El- that are poorly insulated, insufficiently ventilated Sheikh et al., 2013; Umlauf, Bolland, Bolland, and heated, and have uncomfortable bedding. Tomek, & Bolland, 2015). Most commonly, an in- This environment leads to suboptimal sleep concreased prevalence of problems with falling and ditions that disrupt sleep (Buckhalt, 2011; Wilson, staying asleep (insomnia), as well as problems Miller, Lumeng, & Chervin, 2014). with waking up in the morning is reported

Medical conditions. Because of a lack of ac-

(Bagley et al., 2014). An increased prevalence of cess to quality medical care and exposure to poor sleep disordered breathing is also reported in air quality and diets, children of low SES are lower SES children (Chervin et al., 2003; Redline more likely to be overweight or obese and have et al., 1999). Sleep disordered breathing encom- asthma (Ernst, Demissie, Joseph, Locher, & Beck-

passes all conditions in which the child suffers lake, 1995; Gnavi et al., 2000). This leads to an infrom abnormal breathing patterns during sleep creased prevalence of sleep disturbances, espethat may or may not result in waking (American cially sleep disordered breathing (Buckhalt, Academy of Sleep Medicine, 2005) such as ob- 2011). structive sleep apnea, central apnea syndrome,

Inconsistent schedules and lack of parental

and others (American Academy of Sleep Medi- supervision. The living environment of low SES cine, 2005). Two studies additionally reported a families is often chaotic (Evans, Gonnella, Marhigher prevalence of parasomnias in lower SES cynyszyn, Gentile, & Salpekar, 2005), which is (Ipsiroglu et al., 2001; Stein, Mendelsohn, Ober- believed to contribute to irregular sleep times in meyer, Amromin, & Benca, 2001). Parasomnias both children and parents (Buckhalt, 2011). This are undesirable behavioural, physiological, or chaos (family instability, and lack of time and enexperiential events accompanying sleep (Markov, ergy for parents to supervise their children) and 136

2016 lack of sleep hygiene behaviours in lower SES Wong et al., 2013). Umlauf et al. (2015) found that families was found to be associated with de- the everyday stress of living in impoverished creased nighttime sleep duration and an in- neighborhoods had a stronger effect on the sleep creased prevalence of sleep disturbances such as of lower SES girls as compared to lower SES insomnia

and

frequent

nighttime

wakings boys. While boys had a higher prevalence of

(Brown & Low, 2008; Buckhalt, 2011; Jones & sleep disturbances than girls, girls showed a Ball, 2014).

slower decline in symptoms of sleep disturbances

Exposure to daytime stressors, traumatic ex- throughout adolescence, an effect that was

periences, and the childrenâ&#x20AC;&#x2122;s ability to cope. shown to be due to the stressors present in low Another factor for the adverse effect of low SES SES neighborhoods and families (Umlauf et al. on childrenâ&#x20AC;&#x2122;s sleep that has received some sup- 2015). Umlauf et al. (2015) speculated that this is port is the influence of daytime stressors and because lower SES girls are more stress-reactive traumatic experiences to which children of low (i.e. have a lower threshold for the initiation of a SES are more likely to be routinely exposed stress response to a perceived stressor or threat). (Evans & English, 2002). An increased exposure Yet other studies find no effect of gender on the to daytime stressors and direct exposure to vio- relationship between SES and sleep (Bagley et al., lence have been shown to be associated with pre- 2014; El-Sheikh et al., 2013; El-Sheikh et al., 2010). sleep worries and feelings of hopelessness that Biggs et al. (2013) have reported an indication of reduce sleep duration and increase the preva- an interaction (older boys from the minor ethnicilence of sleep disturbances in children and ado- ty and low SES had the lowest sleep duration) lescents from low SES families (Bagley et al., although they were not able to test it statistically 2014; Umlauf et al., 2015).

due to low power when attempting to perform a

The relationship between SES, gender, and four-way ANOVA. In sum, the empirical evi-

sleep. The association between SES and sleep dence for the interaction between gender and SES may also differ by gender, but the empirical evi- on sleep duration and sleep disturbances is dence is mixed. Some studies show that lower mixed and warrants further investigation, as it is SES boys sleep less and have lower sleep quality important to understand the factors that make than girls (Bagley et al., 2014; Biggs et al., 2013; children prone to poorer sleep. Buckhalt, 2011; Sadeh, Raviv, & Gruber, 2000; Spilsbury et al., 2004). However, it is not clear The Current Study why this is the case (Biggs et al., 2013; El-Sheikh,

The current study aims to further investigate

Kelly, Buckhalt, & Benjamin Hinnant, 2010). A the relationship between SES, gender, and sleep few studies report the opposite pattern, with girls in children. Using parent-reported annual househaving a shorter sleep duration and more sleep hold income as an indicator of SES, we aim to undisturbances than boys (Umlauf et al., 2015; derstand the interaction of SES with gender and 137

2016 how it is associated with sleep duration and sleep larger project, the Brain-to-Society Child Cohort disturbances in school-aged children.

Obesity Study. This study is part of a 5-year pro-

In order to do so, we investigate five out- gram of a team of Canadian and Indian researchcomes related to children’s sleep, namely sleep ers, funded by the CIHR’s Institute of Human duration, the number of symptoms of parasomni- Development, Child and Youth Health and the as and sleep disordered breathing (two sleep dis- India Council of Medical Research (ICMR). Canaturbances common in school-aged children) as dian data were obtained from 616 children living evidenced by subscale scores in the Children’s in the Greater Montreal Metropolitan Area be-

Sleep Habits Questionnaire, as well as parents’ tween the months of March and August 2013. perception of their children’s sleep disturbance The participants were sampled by quota samsymptoms and parasomniac symptoms as a pling from a list of adult participants who were problem. The influence of income and gender willing to participate in surveys in compensation and their interaction on these outcomes are in- for money and who had indicated that they lived vestigated to test the following hypotheses:

with a child aged 6 to 12 years. This list was purchased from the sampling firm SM Research. A

Hypotheses

survey research center, which was hired to con-

1. Parent-reported income is associated with par- duct the survey, then proceeded to interview parent-reported sleep duration, such that lower in- ticipants by telephone. Among the contacted parcome is associated with shorter sleep duration. ticipants, those who were willing to participate The relationship is moderated by gender such and had a child aged 6 to 12 at home were selectthat it is stronger for girls than boys.

ed, up until a target sample size of 612 partici-

2. Parent-reported income is associated with par- pants was achieved. All data were collected ent-reported parasomnia and sleep-disordered through a telephone-based interview. The parent

breathing symptoms and the degree to which received a $10 compensation for his or her particparents consider their child’s sleep disturbance as ipation. a problem, such that lower income is associated with higher parasomnia and sleep disordered Measures breathing symptoms and parents considering

Demographic information. Parents were

these symptoms as more of a problem. The rela- asked to report on the child’s age, gender, and tionships are moderated by gender such that they the annual household income. Parents had to inare stronger for girls than boys.

dicate whether their income was “less than

Methods

$6,000”, “$6,000 to under $10,000”, “$10,000 to under $25,000”, “$25,000 to under $45,000”,

Participants and Procedure

“$45,000 to under $65,000”, “$65,000 to under

Data for this study were collected as part of a $95,000”, or “more than $95,000”. Their responses 138

2016 were

then

coded

into

integers

from

1 also reported in previous validation studies, indi-

(corresponding to an income of “less than cating that the items are valid (Owens et al., $6,000”) to 7 (corresponding to an income in the 2000). The current study uses parents’ reports of category of “more than $95,000”).

the frequency with which they observe sleep dis-

Sleep Duration. Parents answered the ques- turbance symptoms in their child in a “typical tion “What is your child’s usual amount of sleep week”, on a 3-point scale from “rarely” (0-1 time each day?” by indicating the amount of hours a week), through “sometimes” (2-4 times a and minutes (including nighttime sleep and day- week), to “usually” (5-7 times a week). The rat-

time naps) their child slept. Sleep

ings were transformed to an ordinal variable

Disturbances. Sleep disturbances with “rarely” assigned a value of 1 and “usually”

were assessed using 18 questions from the a value of 3, and a composite score of the severiChild’s Sleep Habits Questionnaire (CSHQ). The ty of symptoms was calculated by adding up the CSHQ is a validated survey tool for the screening ratings for all the symptoms of each subscale. If of sleep disturbances in children, based on parent the parent did not know whether the child prereports. It is composed of 45 items grouped into 8 sented a given symptom from a subscale, the subscales measuring bedtime resistance, sleep composite score on that subscale was not calcuonset delay, sleep duration, sleep anxiety, night lated in this case, and they were excluded from wakings, parasomnias, sleep-disordered breath- the analysis. Parents’ ratings of whether they being, and daytime sleepiness (Owens, Spirito, & lieve each symptom to be a problem (“yes” or McGuinn, 2000). Data obtained for the subscales “no”) are also used. The latter were transformed assessing

parasomnias

and

sleep-disordered to an ordinal variable, with “no” assigned a value

breathing were used for the current study. The of 0 and “yes” assigned a value of 1. A total score test-retest reliability of the two sub-scales is of perception of parasomnia symptoms as a prob-

deemed acceptable: r = .69 for the sleep disor- lem and sleep disordered breathing symptoms as dered breathing subscale and r = .62 for the para- a problem by parents was then calculated by somnias subscale (Owens et al., 2000). The report- adding up the coded parent ratings for each subed Cronbach’s alphas for the two subscales are: α scale separately. If the parents indicated that the = .51 (control sample) and α = .93 (clinical sam- symptom is not present or that they did not ple) for the sleep disordered breathing subscale, know whether it was a problem, their total score and α = .36 (control sample) and α = .56 (clinical for their perception of symptoms as problems sample) for the parasomnias subscale (Owens et was not calculated and they were excluded from al., 2000). Significant differences at the p < .001 the analyses. alpha level, using the Mann-Whitney U-test analysis, between the scores on the items of the two subscales of control and clinical samples were 139

2016 Results

der and income (Î˛ = .12, p = .002) were found to be significantly associated with sleep duration (R2

Descriptive

= .088, F(2, 583) = 28.22, p = .000). Table 2 presents

Sample size varied for each of the assessed the relevant information for this regression analoutcomes because not all 616 parents provided ysis. Figure 1 presents the relationship between complete answers for the variables of interest. income and sleep duration for both girls and Subsamples are described in the sections detail- boys. The figure shows that, as expected, sleep ing the results for each of the assessed out- duration increases with increasing income for

come. From the original sample of 616 children, boys and girls. As expected, the slope of sleep 30 were excluded due to parents not reporting, duration as a function of income is steeper for not wanting to report, or not knowing the house- girls than for boys, indicating that income influhold income. The remaining sample of 586 chil- ences sleep duration to a greater extent for girls dren comprised 288 boys and 298 girls in the age than boys. Boys had a shorter sleep duration than range of 6-12 years, with a mean of 9.07 years (SD girls across all income categories (t(614) = -2.15, p = 1.68). A mean sleep duration of 9.51 hours (SD = .031). = 0.99) was reported. The mean income of this sample was within the $65,000 to under $95,000 Relationship

between

Income, Gender,

and

income category, with a standard deviation of Symptoms of Parasomnias Âą1.33 income categories from the mean. The cor-

Complete data for the parasomnias subscale

relations between the predictor variables and the of the CSHQ were available for 566 children. The outcome measures are shown in Table 1.

mean age of this subsample was 9.07 years (SD = 1.68). The sample was comprised of 281 boys and

Relationship between Income, Gender, and Sleep 285 girls. A stepwise multiple regression was

Duration

performed to investigate the hypothesis that in-

A stepwise multiple regression (n = 586) was come is negatively associated with parasomnia performed to investigate the hypothesis that in- symptoms and that this relationship is moderatcome is positively associated with sleep duration ed by gender. Age was controlled for in the first and that the relationship is moderated by gender. step of the regression, and gender, income, and Age was controlled for in the first step of the re- the interaction between gender and income were gression, and gender, income, and the interaction entered as independent variables in the second between gender and income were entered as in- step. The score on the parasomnias subscale was dependent variables in the second step. The total the outcome variable, and the alpha level was set sleep duration (in minutes) was the outcome var- to p < .05. The model was not found to be signifiiable and the alpha level was set to p < .05. Age (Î˛ cant (F(1, 564) = 3.784, p = .052). = -.26, p = .000) and the interaction between gen140

2016 Relationship

between

Income, Gender,

and

Symptoms of Sleep Disordered Breathing

Complete data of parents’ perception of parasomnia symptoms as a problem were available

Complete data on the sleep disordered for 143 children. The mean age of this subsample breathing subscale were available for 583 chil- was 9.33 years (SD = 1.66) and it consisted of 74 dren. The mean age of this subsample was 9.07 boys and 69 girls. A stepwise multiple regression years (SD = 1.69) and it was comprised of 286 was performed to investigate the hypothesis that boys and 297 girls. A stepwise multiple regres- income is negatively associated with parents’ sion was performed to investigate the hypothesis perception of their child’s parasomnia symptoms

that income is negatively associated with sleep as a problem, and that this relationship is moderdisordered breathing symptoms and that gender ated by gender. Age was controlled for in the moderates this relationship. Age was controlled first step of the regression, and gender, income, for in the first step of the regression, and gender, and the interaction between gender and income income, and the interaction between gender and were entered as independent variables in the secincome were entered as independent variables in ond step. The score on the parasomnia subscale the second step. The interaction between gender was the outcome variable and the significance and income (β = -.12, p = .003) was found to be alpha level was set to p < 0.05. The model was not significantly associated with symptoms of sleep found to be significant (F(1, 141)= 0.302, p = .583). disordered breathing (R2 = .015, F(2, 580) = 4.41, p = .013). Table 3 presents the relevant information Relationship between Income, Gender, and Parfor the regression. Figure 2 presents the plot of ents’ Perception of Sleep Disordered Breathing sleep disordered breathing symptoms as depend- Symptoms as a Problem ent on income for girls and boys. It can be seen

Parents’ perception of sleep disordered

that as income increases, reported symptoms of breathing symptoms as a problem was available

sleep disordered breathing decrease for boys and for 176 children. The mean age of this sample girls. Furthermore, this decrease is more pro- was 9.18 years (SD = 1.68) and it consisted of 78 nounced for girls than for boys, such that sleep boys and 98 girls. A stepwise multiple regression disordered breathing symptoms of girls are more was performed to investigate the hypothesis that affected by income than those of boys. However, income is negatively associated with parents’ boys had more sleep disordered breathing symp- perception of their child’s sleep disordered toms than girls across all income categories (t breathing symptoms as a problem and that this (611) = 2.04, p < .042).

relationship is moderated by gender. Age was controlled for in the first step of the regression,

Relationship between Income, Gender, and Par- and gender, income, and the interaction between ents’ Perception of Parasomnia Symptoms as a gender and income were entered as independent Problem

variables in the second step. The score on the 141

2016 sleep disordered breathing subscale was the out- tween income, gender, and parents’ perception of come variable, and the alpha level was set to p < parasomnia

symptoms

sleep

disordered

0.05.The model was not found to be significant (F breathing symptoms. (1, 174) = 0.790, p = .375). The Relationship between Sleep Duration, SES, Discussion

and Gender

The aim of the current study was to investi-

Our results regarding the association be-

gate the relationship between income, as an indi- tween income and sleep duration are consistent

cator of SES, and gender on school-aged chil- with the literature, reporting that sleep duration dren’s sleep in a sample of Montreal children. is shorter the lower the SES (Biggs et al., 2013; ElParent-reported sleep duration, symptoms of Sheikh et al., 2013; Fredriksen, Rhodes, Reddy, & parasomnias and sleep disordered breathing, and Way, 2004). parents’ perception of sleep disturbance symp-

Moreover, our findings are also consistent

toms as problems were assessed as outcomes. We with most of the existing literature with regards found a negative association between income and to boys sleeping less than girls (Arman et al., sleep duration for boys and girls. This association 2011; Bagley et al., 2014; Buckhalt, 2011; Dollman was moderated by gender such that girls’ sleep et

al.,

2007;

McLaughlincrabtree

al.,

duration decreased more precipitously as income 2005). Only one study found shorter sleep duradecreased. Sleep duration was also found to de- tion in lower SES girls than in lower SES boys crease with age. However, boys slept significant- (Wong et al., 2013), while no reports of shorter ly less than girls across all income categories. A sleep duration in higher SES girls as compared significant negative relationship between income with higher SES boys exist. Wong et al.’s findings and symptoms of sleep disordered breathing was might be explained by our finding that the sleep

found for boys and girls, and this relationship duration of girls comes closer to that of boys with was again moderated by gender, such that the decreasing SES. As such, the moderation effect of prevalence of symptoms in girls increased more gender on the association between income and rapidly as income decreased than the prevalence sleep duration found in our study might have of symptoms in boys. Age was not found to be been strong enough in Wong et al.’s sample to related to sleep disordered breathing symptoms. lead to shorter sleep in girls. Again, boys were found to have a significantly

A novel finding of our study is the interac-

higher overall prevalence of sleep disordered tion between income and gender in predicting breathing symptoms throughout income catego- sleep duration and the fact that girls’ sleep duraries. No significant relationship was found be- tion decreases more rapidly with decreasing intween income, gender, and symptoms of para- come. This has not been investigated by any somnias. Finally, no relationship was found be- studies in the literature. This finding is consistent 142

2016 with Umlauf et al.â&#x20AC;&#x2122;s (2015) hypothesis that girls Polo, 2003). Testosterone has been found to be might be more susceptible to the effect of SES on apnea-promoting, as evidenced by an increase in sleep because they are more stress-reactive.

apnea and hypopnea symptoms in men undergoing testosterone replacement therapy (Schneider

The Relationship between Sleep Disordered et al., 1986) and an increased prevalence of sleep Breathing, SES, and Gender

disordered breathing in women with elevated

Our findings that the prevalence of sleep- levels of androgens (Dexter & Dovre, 1998). An disordered breathing is negatively associated increase in sleep disordered breathing as boys

with SES are consistent with the existing litera- enter adolescence has also been observed, supture on this topic (Chervin et al., 2003; Redline et porting the hypothesis that the condition is proal., 1999; Rona, Li, Gulliford, & Chinn, 1998). The moted by testosterone (Corbo et al., 2001). mechanism responsible for this association has

Our findings regarding age and the preva-

not yet been determined, but medical conditions lence of sleep disordered breathing symptoms (i.e. asthma and obesity) exacerbated or pro- are not consistent with the literature. While we voked by the poor quality environments of chil- have not found age to be significantly associated dren living in low SES have been proposed with sleep disordered breathing symptoms, the (Buckhalt, 2011). Interestingly, a study of chil- literature indicates that sleep disordered breathdren aged 2-12 years in China has found a higher ing tends to decrease with age (Goodwin et al., prevalence of sleep disordered breathing in chil- 2010; Zhang, Spickett, Rumchev, Lee, & Stick, dren living in the city zones than in the moun- 2004). Goodwin et al. (2010), for example, reporttainous region of Beijing, even though city fami- ed a remission rate of 60.3% for snoring and lies were of significantly higher SES than those 70.8% for sleep disordered breathing in their living in the mountainous region (Liu et al., sample of children ages 6-12 after a mean time of

2005). Such findings might indicate that air quali- 4.6 years. Our failure to support these findings ty and diet could be potential mediating factors might be due to the fact that we did not control of the relationship between income and sleep dis- for gender in our analyses. The possible increasordered breathing symptoms found in our study. ing prevalence of sleep disordered breathing in Furthermore, our findings of a higher preva- boys as they age (due to increasing levels of teslence of sleep disordered breathing symptoms in tosterone) might have overshadowed the deboys are also supported by the literature creasing prevalence of it in girls, given that our (Goodwin, Vasquez, Silva, & Quan, 2010; Liu et sample was almost equally divided among the al., 2005; Ng et al., 2005). Although the exact ex- two genders. planation for this increased prevalence is not

Our novel finding that gender interacts with

clear, it is believed that increased levels of testos- income in predicting sleep disordered breathing terone in boys might play a role (Saaresranta & raises interesting questions. One potential expla143

2016 nation for a stronger relationship between sleep tween SES and parasomnia did not identify the disordered breathing symptoms and SES in girls potential mechanism that might explain this asmight be the finding that rates of overweight and sociation. Although the cause of many parasomobesity in girls are more closely linked to SES nias is unknown, it is estimated that about 60% of than in boys (Mushtaq et al., 2011; Noh, Kim, Oh, cases present a family history of parasomnia, & Kwon, 2014), but future studies are needed to which might indicate genetic factors influencing understand this relationship.

the prevalence of these disturbances (Timothy,

Our findings regarding the interaction be- 2004). If this is the case, the possible genetic etiol-

tween income and gender and the association ogy of the disorder might be an explanation for with sleep duration and sleep disordered breath- the lack of association that we found between a ing in the current study echo previous findings social factor like SES and the prevalence of parareporting that the health and well-being of girls somnias. are more affected by SES than those of boys

Meanwhile, findings of parasomnia preva-

(Kling, Liebman, & Katz, 2007). After analyzing lence are mixed when it comes to gender effects: the data from the Moving to Opportunity study, some studies find parasomnias (e. g. nightmares) Kling et al. (2007) found that the well-being and to be more prevalent in girls (Ipsiroglu et al., health of girls is more strongly associated with 2001) while other studies find no difference beSES. Improving factors associated with SES (such tween the two genders (Goodwin et al., 2004; Li as housing and neighborhood) led to better et al., 2011), while yet other studies find higher health and well-being in girls, whereas in boys prevalences for most parasomnias in boys this effect was not as strong and, for some out- (Ghalebandi et al., 2011; Liu et al., 2005; Petit, comes, the relationship was negative (Kling et al., Touchette, Tremblay, Boivin, & Montplaisir, 2007).

2007). No studies have looked at interactions be-

tween SES and gender in affecting parasomnia The Relationship between Parasomnia, SES, and prevalence. Gender The findings of the current study are incon- The Relationship between Parent’s Perception of sistent with those of Ipsiroglu et al. (2001) and Sleep Disturbance Symptoms as a Problem, SES, Stein et al. (2001) who found a negative associa- and Gender tion between SES and parasomnia. However,

Our hypothesis that a negative relationship

they are consistent with results obtained by exists between income and parents’ perception of Ghalebandi et al. (2011), who found no associa- sleep disturbance symptoms as a problem, and tion between the prevalence of parasomnias and that it is moderated by gender was not supportSES in a sample of Iranian children. Furthermore, ed. We predicted that parent’s perception of the two studies that did find a relationship be- symptoms as a problem would be related to SES, 144

2016 because the lower the SES, the higher the severity of time and resources (which might have led to of symptoms, and therefore the more concerned inaccessibility to knowledge about the opportunithe parents would be about them. Because we ty to be part of research or an inability to comdid not find a relationship between income and municate with researchers), lower SES parents the prevalence of parasomnia symptoms, the might not have had the same opportunity to be finding that parents’ perception of these symp- part of the study as higher SES parents. Another toms as a problem was not associated with in- limitation of our sample is that it was composed come is not surprising. However, a strong rela- of children from an urban area only. This is likely

tionship was found, as described previously, be- to have an effect on our findings because stresstween sleep disordered breathing symptoms and ors and environmental conditions (air quality, income. An explanation for our insignificant re- diet, quality of the sleep environment) that affect sult regarding parents’ perception of symptoms sleep are likely to differ between urban and rural as a problem might be the fact that parents are settings. Our findings can thus not be generalized not likely to be aware of and report their child’s to sub-urban or rural settings. sleep problems, even when these would be con-

There are additional limitations when it

sidered as warranted of attention by screening comes to our measures. Our study is based on questionnaires. Stein et al. (2001) found that less parent-reported data of their child’s sleep. This than one half of parents discuss their child’s sleep might raise some validity concerns regarding the problems with their pediatrician during routine results. Parent-report regarding sleep duration care. These findings highlight the possible lack of might not be accurate. It has been shown that awareness regarding childhood sleep disturb- parents tend to overestimate their child’s sleep ances and their negative impact on children’s duration as compared to measurements of sleep everyday functioning and development.

duration with objective measures such as actigra-

phy or polysomnography (Hodge, Parnell, HoffLimitations and Future Directions

man, & Sweeney, 2012). The same can be said

Multiple limitations need to be mentioned about the parent-reported symptoms of sleep disregarding the current study. First, the distribu- turbances used in this study. Parents might not tion of incomes in our sample is not homogene- be aware of the exact frequency at which certain ous. It is highly skewed towards higher incomes. sleep behaviours occur during the night and This might have affected our results because low might have missed some difficult-to- observe beincome families are not adequately represented. haviours such as teeth grinding and restlessness This skewness in our sample might be due to the (some of the symptoms of parasomnias assessed fact that a convenience sample was used (i.e. par- by the CSHQ) or gasping and arrests in breathing ents who had agreed to be contacted for research (CSHQ symptoms of sleep disordered breathing). purposes with the survey company). Due to lack Most of the studies that look at the relationship 145

2016 between sleep and SES use similar measures. It differential effect of SES on sleep between genwould be interesting to see whether the current ders. findings can be replicated with more objective

Finally, as prompted by the results of the cur-

measures of sleep duration and sleep disturb- rent study, it is important to develop intervenances.

tions to help low SES families increase their chil-

The fact that we have used only one indicator dren’s sleep duration and sleep quality in order of SES, namely income, is also a limitation of our to prevent the negative impact of poor sleep on study. Indeed, research suggests that different behavioural, cognitive, emotional, and physical

indicators of SES (income, parental education, outcomes of children. Parent-education programs parental occupation) are differently associated to aimed at increasing the sleep duration of children children’s sleep (El-Sheikh et al., 2013). El-Sheikh living in low-income families have shown some et al. (2013) found that, even though overall all promise in this regard. For example, one such lower SES was associated with poorer sleep out- program has been shown to improve parents’ comes, different indicators of SES were associat- knowledge regarding children’s sleep (i.e. how to ed with different sleep outcomes. For example, promote optimal sleep in children), their selfparental perceived economic well-being was as- efficacy

implementing

sleep-promoting

sociated with sleep duration whereas maternal measures in their household (which is shown to education was associated with sleep efficiency (El be associated with greater likelihood of success-Sheikh et al., 2013). Furthermore, our study did ful implementation), and their attitudes regardnot look at the size of the family of the child, and ing their child’s sleep (Wilson, Miller, Bonuck, as such we do not know whether the families Lumeng, & Chervin, 2014). As a result, sleep dulacked the sufficient resources for the number of ration in the children whose parents received the people living in the household or not.

intervention increased by 30 minutes (as assessed

The current study raises multiple questions at the 1-month follow-up) (Wilson, Miller, Bothat need to be addressed in future investiga- nuck, et al., 2014). The long-term effects of such tions. For example, our study only looked at two interventions are however not known (Blunden, common sleep disturbances in school-aged chil- Chapman, & Rigney, 2011). If such interventions dren. Future research should look at other com- are implemented, it is important to consider the mon categories of sleep disturbances such as be- factors stemming from low SES that affect chilhavioural insomnias and circadian rhythm sleep dren’s sleep (poor sleeping environments, stressdisorders and investigate how they are related to induced sleep problems, medical conditions such SES and gender. One important future avenue as asthma and obesity, disorganized schedules would be to investigate the mechanisms that ex- and parental supervision, etc.). Because our findplain the relationship between children’s sleep ings indicate that income is more strongly related and SES, and what might be the cause of the to girls’ sleep than boys’ sleep, it might be im146

2016 2015 Arman, A. R., Ay, P., Fis, N. P., Ersu, R., Topuzoglu, A., factors associated with SES that affect sleep when Isik, U., & Berkem, M. (2011). Association of sleep duration with socio-economic status and intervening with girls than with boys. Targeting behavioural problems among schoolchildren. APA these factors might therefore lead to greater imActa Paediatrica, 100(3), 420-424. Bagley, E. J., Kelly, R. J., Buckhalt, J. A., & El-Sheikh, M. provement in sleep for girls than for boys. How(2014). What keeps low-SES children from sleeping ever, because low SES boys have the shortest well: the role of presleep worries and sleep environment. SLEEP Sleep Med icine . sleep duration and the highest prevalence of Biggs, S. N., Lushington, K., Martin, A. J., van den Heuvel, sleep disordered breathing, it is especially imC., & Kennedy, J. D. (2013). Gender, socioeconomic, and ethnic differences in sleep portant to prioritize interventions in this populapatterns in school-aged children. Sleep m ed icine, tion. As shown by the results of the current 14(12), 1304-1309. Blunden, S. L., Chapman, J., & Rigney, G. A. (2011). Are study, different sleep disturbances might also be sleep education programs successful? The case for differentially affected by SES. This implicates that improved and consistent research efforts. Sleep Medicine Reviews Sleep Medicine Reviews. the screening and treatment need to take into acBrown, E. D., & Low, C. M. (2008). Chaotic living count these differential effects in order to obtain conditions and sleep problems associated with children's responses to academic challenge. Jo urnal better results, especially in low SES children. of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43), 22(6), 920-923. References Buckhalt, J. A. (2011). Insufficient Sleep and the SocioecoAmerican Academy of Sleep Medicine. (2005). The nomic Status Achievement Gap. Child international classification of sleep disorders, revised: Development Perspectives, 5(1). Diagnostic and coding manual (4 ed.). Westchester: Chervin, R. D., Clarke, D. F., Huffman, J. L., Szymanski, E., American Academy of Sleep Medicine. Ruzicka, D. L., Miller, V., . . . Giordani, B. J. (2003). American Psychological Association. (2015). Socioeconomic School performance, race, and other correlates of status. Psycho lo gy to p ics. Retrieved 18 March, sleep-disordered breathing in children. Sleep 2015 medicine, 4(1), 21-27. Arman, A. R., Ay, P., Fis, N. P., Ersu, R., Topuzoglu, A., Corbo, G. M., Forastiere, F., Agabiti, N., Pistelli, R., Isik, U., & Berkem, M. (2011). Association of sleep Dell'Orco, V., Perucci, C. A., & Valente, S. (2001). duration with socio-economic status and Snoring in 9- to 15-year-old children: risk factors behavioural problems among schoolchildren. and clinical relevance. Ped iatrics, 108(5), 1149-1154. APA Acta Paediatrica, 100(3), 420-424. Dexter, D. D., & Dovre, E. J. (1998). Obstructive Sleep Bagley, E. J., Kelly, R. J., Buckhalt, J. A., & El-Sheikh, M. Apnea Due to Endogenous Testosterone (2014). What keeps low-SES children from sleeping Production in a Woman. Mayo Clinic Pro ceed ings, well: the role of presleep worries and sleep 73(3), 246-248. environment. SLEEP Sleep Med icine . doi: http://dx.doi.org/10.4065/73.3.246 Biggs, S. N., Lushington, K., Martin, A. J., van den Heuvel, C., & Kennedy, J. D. (2013). Gender, Dollman, J., Ridley, K., Olds, T., & Lowe, E. (2007). Trends socioeconomic, and ethnic differences in sleep in the duration of school-day sleep among 10- to 15 patterns in school-aged children. Sleep m ed icine, -year-old South Australians between 1985 and 14(12), 1304-1309. 2004. APA Acta Paediatrica, 96(7), 1011-1014. American Academy of Sleep Medicine. (2005). The Durmer, J. S., & Dinges, D. F. (2005). Neurocognitive international classification of sleep disorders, revised: consequences of sleep deprivation. Sem inars in Diagnostic and coding manual (4 ed.). Westchester: neurology, 25(1), 117-129. American Academy of Sleep Medicine. El-Sheikh, M., Bagley, E. J., Keiley, M., Elmore-Staton, L., American Psychological Association. (2015). Socioeconomic Chen, E., & Buckhalt, J. A. (2013). Economic status. Psycho lo gy to p ics. Retrieved 18 March,

portant to put special emphasis on targeting the

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Figure 1. Total Sleep Duration as a Function of Income for Boys and Girls

Figure 2. Sleep Disordered Breathing Symptoms as a Function of Income for Boys and Girls

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Reaching for the top: Pressures Towards Perfection-Striving in a University Setting

André St-Jacques Supervisors: Dr. Richard Koestner

Abstract Perfectionism is a multi-faceted personality characteristic. One type of perfectionism, known as other-oriented perfectionism (OOP), is an expectation of perfection from others, as opposed to an expectation of perfection for oneself. Previous research has found a relationship between having per-

fection-demanding friends and valuing extrinsic aspirations such as fame, over intrinsic aspirations such as social connection. The aim of this priming study was to assess the effect that a university’s emphasis on excellence may have on students’ perfectionism, affect and aspirations. Students were first asked to read and rate promotional material about their university. Participants randomized to the high OOP condition were given promotional statements that reflected a university culture of high OOP, while participants in the low OOP condition were given promotional material that reflected a university culture of both low OOP and support. Participants in the high OOP condition did not show significant differences in importance of aspirations. However, female participants subjected to the high OOP condition showed significantly higher self-criticism compared to the low OOP condition. In addition, identity exploration and commitment moderated the relationship between condition and post-manipulation self-reported perfectionism. In the high OOP condition, identity diffused individuals showed significantly more perfectionism-striving than identity achieved individuals

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2016 Introduction The transition to university can be difficult. New students must adjust to the demands of classes, life away from home and the pressures to succeed. In order to maintain high grades and meet the demands of their programs, students often feel the need to strive for academic perfection. In addition to self-imposed striving for perfection among students, universities often demand perfection of their students. For example, the official McGill University website emphasizes having the “brightest students”, “highest average entering grades” (“McGill at a Glance,” 2015) and a sense of pride in students “who have achieved a significantly higher gradepoint average than” their peers (Love, 2015). Previous research has demonstrated that having perfection-demanding friends and family is associated with pursuit of external markers of success such as material wealth, popularity and physical attractiveness (Hope, Koestner, Holding, & Harvey, 2015). In this study, we were interested in testing whether priming students with a perfectionismdemanding environment negatively affected students in a similar manner. Intrinsic and extrinsic aspirations Our principal reason for studying perfectionism is that this construct fits within the larger context of human motivation and selfdetermination theory. A vital aspect of human motivation involves the pursuit of aspirations (Deci & Flaste, 1995). Selfdetermination researchers Deci and Ryan (2008) understand aspirations as life goals: long-term pursuits that guide people’s activities. They contrast two opposing sets of aspirations: intrinsic and extrinsic. Intrinsic aspirations involve the pursuit of well-being and

need satisfaction. Close relationships, community engagement and personal development are three examples of intrinsic aspirations that have been studied in detail (Deci & Ryan, 2008; Kasser & Ryan, 1993; 1996). Extrinsic aspirations involve the pursuit of external indicators of worth. Material possessions, popularity and physical attractiveness are three relevant examples of extrinsic aspirations (Deci & Ryan, 2008; Kasser & Ryan, 1993; 1996). As Deci and Ryan explain, this tendency towards extrinsic aspirations (e.g., striving for wealth) can crowd out intrinsic aspirations (e.g., building close relationships) that might otherwise satisfy important psychological needs for relatedness, competence and autonomy (Ryan & Deci, 2000; Deci & Ryan, 2008). Highly valuing extrinsic aspirations is associated with a host of negative outcomes (Kasser & Ryan, 1996). Using a sample of college students, Kasser and Ryan (1993) demonstrated that striving for financial success, an extrinsic aspiration, was negatively associated with adjustment and well-being, and positively associated with behavioural disorders. By contrast, Hope, Milyavskaya, Holding and Koestner (2014) also looked at college students and showed that an increase in intrinsic aspirations over the course of an academic year predicted greater subjective well-being and psychological well-being. Several other studies have shown similar correlations between intrinsic aspirations and well-being (e.g., Vansteenkiste, Simons, Lens, Sheldon, & Deci, 2004; Ryan, Chirkov, Little, Sheldon, Timoshina, & Deci, 1999; Schmuck, Kasser, & Ryan, 2000). In sum, intrinsic aspirations are associated with positive outcomes, and extrinsic aspirations, with negative ones. What leads people to pursue extrinsic 153

2016 aspirations over more psychologically satisfying intrinsic aspirations? A relevant study by Sheldon and Krieger (2004) looked at students in their first year of law school. They found that over the course of the academic year, students showed increasing extrinsic values and decreasing intrinsic values. As expected, this change in extrinsic and intrinsic values was associated with a decrease in subjective well-being. A separate study conducted by Noels, Clément and Pelletier (1999) looked at teachers’ communicative style in a summer French course. When students perceived their learning environment to be more controlling, they showed lower scores on measures of intrinsic motivation and higher scores on measures of extrinsic motivation. Essentially, a person’s social context has a significant impact in determining their intrinsic or extrinsic aspiration profile. In particular, controlling environments, such as those involving a controlling parent or teacher, are associated with greater extrinsic goal pursuit (e.g., Williams, Hedberg, Cox, & Deci, 2000; Noels et al., 1999). Perfectionism Perfectionism is one internal pressure in particular that has been studied in the context of extrinsic aspirations. This personality trait involves holding high personal standards and being excessively critical of one’s mistakes (Frost, Marten, Lahart, & Rosenblate, 1990). Hewitt and Flett (1991) have described three separate subtypes of perfectionism: self-oriented perfectionism, socially prescribed perfectionism and, especially relevant to our study, other-oriented perfectionism (OOP). Self-oriented perfectionism, an internal control, involves setting excessively high standards for achievement of goals, as well as being highly self-critical when those standards are not met (Hewitt & Flett, 1991).

Interestingly, while certain aspects of perfectionism are maladaptive, other aspects can play an adaptive role (Enns, Cox, & Clara, 2002). The self-critical aspect of perfectionism in particular has been associated with depressive symptoms, neuroticism, negative perceptions of the self and a defensive interpersonal orientation (Enns & Cox, 1999; Dunkley, Blankstein, Zuroff, Lecce, & Hui, 2006). In contrast, Dunkley et al. (2006) found that the personal standards aspect of perfectionism was inversely correlated with neuroticism and reflected active striving for high standards and achievement, suggesting that personal standards may be an adaptive component of perfectionism. Consistent with this distinction, Stoeber and Eismann (2007) found that young musicians who had greater personal standards also showed greater intrinsic motivation, hours of weekly practice and achievement (grades and awards). In contrast, self-critical (negative reactions) perfectionism in these musicians was associated with extrinsic motivation, performance anxiety and emotional fatigue. Socially-prescribed perfectionism involves the perception that one’s environment demands perfection (Hewitt & Flett, 1991). Unlike self-oriented perfectionism, sociallyprescribed perfectionism is consistently associated with extrinsic motivation (Mills & Blankstein, 2000; Stoeber, Feast, & Hayward, 2009; Chang, 2014). In addition, Dunkley, Zuroff, and Blankstein (2006) showed that in a college student sample, socially-prescribed perfectionism was highly correlated with self -criticism. Other-oriented perfectionism (OOP) differs from self-oriented perfectionism and socially-prescribed perfectionism in that it is the expectation of perfection of others, rather than of oneself (Hewitt & Flett, 1991). Possibly due to its externalizing nature, OOP has been less studied than the two other forms of 154

2016 perfectionism identified by Hewitt and Flett (1991). Stoeber (2014) addressed this dearth in the literature by studying correlations between OOP and certain personality characteristics. He found that people high in OOP, those who demand perfection of others, were also high on measures of narcissism, Machiavellianism and psychopathy, commonly referred to as the ‘dark triad’. In addition, people high in OOP were less likely to pursue goals related to nurturance and intimacy, opting instead for dominance related goals. In pursuing this line of research, Hope et al. (2015) asked the following question: if your friends are extremely demanding of perfectionism, how does that affect your own aspirations? As expected, friends who were high in OOP tended to place greater importance on extrinsic aspirations, compared to those low in OOP. In addition, individuals who had friends high in OOP also placed more importance on showing extrinsic aspirations. Hope et al. (2015) explained that this may be due to internalizing of friends’ prioritization of extrinsic values and seeking approval from demanding friends by seeking external markers of success. Although perfectionism is usually thought of as a personal characteristic, Hope et al. (2015) demonstrated that friends’ OOP is associated with one’s own extrinsic aspiration pursuit. Identity status in relation to aspirations In the previously discussed study, Hope et al. (2015) did not assess the individual characteristics that play a protective role against social demands of perfectionism. The present study examines Erikson’s concept of identity status as one such factor. In the 1950s, Erik Erikson (1959) introduced a novel framework for thinking about human development. He postulated that, contrary to previously held beliefs, human psychosocial development continues throughout one’s

lifespan. He subdivided this development into eight distinct stages, each presenting a set of challenges to be resolved in order for an individual to grow and develop new competencies. The fifth stage, identity status, revolves around the notions of exploration and commitment (Erikson, 1959). Identity exploration is the process by which individuals discover themselves and their interests by engaging in various social, academic, relational and other pursuits. Identity commitment involves investing time and energy into a chosen and personally meaningful subset of those pursuits. Individuals who explore occupational, political, religious and other options, and then commit their time and effort to a subset of these options, develop a sense of who they are and where they fit in the world (Marcia, 2002). People who have both explored and committed are said to be identity achieved, while people who have done neither are said to be identity diffused. In addition, two in-between states exist. Individuals who have explored but haven’t yet committed are in identity moratorium, whereas individuals who have prematurely committed before exploring are in identity foreclosure. Identity achievement is an important predictor of subjective and psychological well-being, while identity diffusion is inversely correlated with both of these measures of well-being (Waterman, 2007). This fifth identity stage is especially relevant to the period of emerging adulthood (ages 18 -25), and therefore relevant to university students (Arnett, 2000) and our study. A few studies have begun to look at Erikson’s theory of psychosocial development in relation to self-determination theory’s concept of intrinsic and extrinsic aspirations (e.g., Sheldon & Kasser, 2001; Van Hiel & Vansteenkiste 2009), yet there remains much to be explored. Relevant to our study, Hope et al. (2014) demonstrated that an increase in 155

2016 intrinsic aspirations over the course of an academic year predicted increased identity resolution in college students, and this mediated the relationship between intrinsic aspirations and enhanced subjective well-being. However, previous research has not yet assessed whether the association between identity achievement and intrinsic aspirations is maintained despite external perfectionism-demanding pressures. In other words, does identity status play a protective role against the negative effects of OOP? Research looking at identity status and conformity has shown that identity diffused individuals are much more likely to be influenced by peer pressure than identity achieved individuals (Toder & Marcia, 1973; Adams, Ryan, Hoffman, Dobson, & Nielsen, 1984). We believe that the reason why identity achieved individuals are less influenceable is because their firm sense of identity protects them against external pressures. In this study, we tested this hypothesis by looking at identity status as a moderator of the effect of OOP on aspirations and of OOP on selforiented perfectionism. The present study In the present study, we aimed to elaborate on the findings of Hope et al. (2015) by looking at the effect that manipulating the environment’s demands of perfectionism (OOP) has on participants’ importance of extrinsic aspirations. We designed an experiment in which participants would be randomly assigned to one of two conditions, either a high perfection-demanding environment (high OOP) or a low perfectiondemanding environment (low OOP). By providing participants with information about their university that reflected a culture demanding perfectionism, we primed a high OOP environment to assess how that affected participants’ aspirations. For the low OOP

environment, we provided participants with information about their university that reflected a supportive culture that didn’t demand perfection. First, we hypothesized that students in the high OOP condition would report valuing extrinsic and lower measures of intrinsic aspirations following the manipulation more than a low OOP, high support group. Second, we hypothesized that participants subjected to the high OOP condition would show higher level of self-critical and personal standards perfectionism. Third, we hypothesized that identity status (achieved or diffused) would play a moderating role on who would be affected by the manipulation. In other words, we predicted that identity diffused individuals, but not identity achieved individuals, would show higher extrinsic aspirations and higher perfectionism following the manipulation. Methods Participants 144 students (110 female, 34 male) from McGill University in Montreal were recruited for a study on students’ values and personal goals. All participants were current undergraduates between their first and fifth year (M = 2.97, SD = 1.06), and fluent in English. The sample’s age ranged between 18 and 49 years old (M = 20.65, SD = 2.96). Participants were recruited through the McGill psychology subject pool website, the McGill classified website, and flyers posted in several campus buildings. They were compensated $10 or one course credit for 30 to 45 minutes of participation. Procedure In order to keep participants naïve to the purpose of the study, we informed participants that they would be completing two un156

2016 related studies, the first consisting of a paper and pencil based survey, and the second consisting of an online questionnaire. Students were told that the first study was being conducted in conjunction with the McGill Office of Admissions (fictitious name) in order to pilot and further develop new recruitment material. This first study was a prime and contained a series of 10 “promotional statements” about McGill (see Appendices A and B). Participants were randomly assigned to either a high other-oriented perfectionism (OOP) condition or a low OOP condition. Participants in the high OOP (other-oriented perfectionism) condition (n = 72) were given statements reflecting a culture that demands perfectionism (e.g. “McGill nurtures the best of its students to prepare them to be at top of their fields”), whereas participants in the low OOP condition (n = 72) were given statements reflecting a supportive culture (e.g. “McGill nurtures all students to prepare them for a life of learning”). Contrasting statements were written in parallel across conditions, reflecting similar structure and domains (e.g., community engagement, McGill athletics), but with diverse perfectiondemanding content. Both conditions also included three neutral statements that were the same across conditions (e.g., “Our 11 faculties and 11 professional schools offer more than 300 programs to some 39,000 graduate and undergraduate students”). In order to ensure that participants adequately read and assimilated the promotional statements, we asked them to rate each statement on a scale from 1 (very unattractive reason to attend McGill) to 5 (very attractive reason to attend McGill) and rank the three statements that they liked most (see Appendix C). Following completion of the deceptive McGill Admissions part of the study, participants were moved to desktop computers to complete the second part of the study, an online survey on

the platform Qualtrics. We informed participants that the “second study” was being conducted on behalf of the McGill Human Motivation Lab and would assess values and personal goals. The questionnaires and measures used in this online portion are outlined below. We then informed participants of the deception, explaining how the two studies were actually connected, and provided monetary or course credit compensation. The promotional statements and promotional statement rating material have been provided in the appendices. Measures Life Satisfaction. In line with previous research (Pavot, Diener, Colvin, & Sandvik, 1991), we employed the Satisfaction with Life Scale (SWLS) (Diener, Emmons, Larsen & Griffin, 1985) to measure life satisfaction. Participants were instructed to respond to each of the 5 statements by indicating the degree to which the statement reflected their satisfaction on a 7-point scale, from 1, no t at all true, to 7, very true. For example, one sample item was “In most ways my life is close to ideal.” Positive and negative affect. The Mood Report (Diener & Emmons, 1984), also used in previous research (Emmons, & Diener, 1986), was employed to measure positive and negative affect. The online questionnaire instructed participants to respond to 9 mood states, four positive and five negative, by indicating the extent to which they had felt that mood over the previous two weeks. “Joyful” was one sample item of a positive mood state, while “Unhappy” was one example of a negative mood state. Participants responded on a 7-point scale, from 1, not at all, to 7, extremely. A ‘positive affect’ variable was computed for each participant by taking the mean of the four positive emotions. A ‘negative affect’ variable was also computed 157

2016 for each participant by taking the mean of the five negative emotions. In addition, an ‘internalizing emotions’ variable was computed by taking the mean of participants’ responses across “Unhappy”, “Depressed” and “Worried/Anxious”. Aspirations. The Aspiration Index (AI) is a standard scale used to measure intrinsic and extrinsic aspirations (Sheldon & Kasser, 2008; Kasser & Ryan, 1996). For this study, an adapted and future-oriented version of the AI was used. Participants were asked to respond to a list of 18 aspirations that they may have for the future. On a scale of 1 to 7 from 1, least important, to 7, most important, participants were asked to rate how important each aspiration was for them. Each item on the scale corresponded to one of six types of aspirations: community contribution, close relationships, self-growth, financial success, physical attractiveness, and fame/popularity. One sample item for intrinsic aspirations (close relationships) was “I will feel that there are people who really love me, and whom I love,” while one sample item for extrinsic aspirations was “I will be financially successful.” Identity exploration and commitment. We used the Short-form Ego Identity Process Questionnaire (Zimmermann, Mantzouranis & Biermann, 2010) with two additional occupation-related items to measure identity exploration and commitment. This questionnaire has been validated (Balistreri, BuschRossnagel & Geisinger, 1995) and used (Zimmermann, Mahaim, Mantzouranis, Genoud, & Crocetti, 2012) in previous research. The online questionnaire asked participants to rate each of the 18 statements on a 6-point Likert scale from 1, stro ngly d isagree, to 6, strongly agree. For example, the statement “I am very confident about what kinds of friends are best for me” reflects identity commitment, while the statement “I have

considered different political views thoughtfully” reflects identity exploration. Self-oriented Perfectionism and Selfcriticism. We used a questionnaire consisting of five items from the self-oriented perfectionism (SOP) subscale of the multidimensional perfectionism scale (MPS) (Hewitt & Flett, 1989; 1990; 1991) and 12 items from the Depressive Experiences Questionnaire (DEQ) (Blatt, 1979; Blatt, D’Affliti, & Quinlan, 1976) to measure self-oriented perfectionism (SOP) and self-criticism (SC). Participants rated each item on a 7-point Likert scale from 1, not at all agree, to 7, totally agree. For example, the statement “One of my goals is to be perfect in everything I do” reflects self-oriented perfectionism, while the statement “I have a difficult time accepting weaknesses in myself” reflects self-criticism. This combination of subscales from the MPS and DEQ has been used in previous research to evaluate selfcriticism and self-oriented perfectionism of university students (Harvey et al., 2015; Powers, Koestner, Zuroff, Milyavskaya, & Gorin, 2011). Data analyses We conducted three analyses of variance with extrinsic and intrinsic aspirations, affect, subjective well-being, perfectionism and selfcriticism as the dependent variables. It was a 2 x 2 x 2 ANOVA with condition (high OOP/ low OOP), identity exploration level (high/ low) and identity commitment level (high/ low) as the between subject factors. Results

Manipulation checks To ensure that our manipulation had the desired effect on participants’ perceptions of their university’s OOP nature, we asked participants the following question: “Overall, how much do you think a high school senior 158

2016 who values excellence will be attracted by the provided promotional statements you read?” We then analyzed their responses using independent samples t-tests. There was a significant effect of condition on participants’ ratings in response to this question, p < .001, with participants in the high OOP condition responding with higher ratings to the question “Overall, how much do you think a high school senior who values excellence will be attracted by the provided promotional statements you read?” (M = 4.17, SD = 0.74), t(141) = 4.19, than participants in the low OOP condition (M = 3.63, SD = 0.81). Other manipulation check questions, such as “McGill University expects its students to excel at whatever they do”, and “It is important to McGill University that everything that I do is of topnotch quality”, did not produce significant differences between the high OOP and the low OOP conditions. Extrinsic and intrinsic aspirations To test our hypotheses, we conducted three analyses of variance with extrinsic aspirations, perfectionism and self-criticism as the dependent variables. These were 2 x 2 x 2 ANOVAs with condition (high OOP/low OOP), identity exploration level (high/low) and identity commitment level (high/low) as the between subject factors. Our first hypothesis was that students subjected to the high OOP condition would report higher measures of extrinsic and lower measures of intrinsic aspirations. However, neither the ANOVA of extrinsic aspirations nor the ANOVA of intrinsic aspirations revealed any main effects or interactions approaching significance (see Figures 1 and 2 in Appendix D for a table comparing the results described above).

Perfectionism, self-criticism and internalizing emotions Our second hypothesis was that the high OOP group would show greater perfectionism and self-criticism. The ANOVA of selfcriticism did not reveal any main effects or interactions with identity exploration and commitment that approached significance. However, we then repeated the ANOVA separately for men and women. The results showed that there was no significant effect for men, but that there was a significant main effect of self-criticism for women, F (1,108) = 4.29, p < .05. Women in the high OOP condition reported higher self-criticism (M = 4.33, SD = 1.13) relative to women in the low OOP condition (M = 3.84, SD = 1.37). In addition, we found marginally significant results showing that participants in the high OOP condition (M = 3.95, SD = 1.46), F (1,142) = 2.86, p = .09, showed higher measures of internalizing emotions (unhappy, worried/anxious and depressed) than participants in the low OOP condition (M = 3.56, SD = 1.26) (see Figure 3 in Appendix D for a table comparing the results described above). Identity status moderates perfection striving Our third hypothesis was that we would find an interaction between identity status and condition in predicting perfectionism. The ANOVA of perfectionism yielded no main effects or 2-way interactions approaching significance. However, a significant 3way interaction emerged, F (1,113) = 7.48, p < .01 (Table 1 in Appendix D shows the means and standard deviations for perfectionism by condition and identity status). Recall that we hypothesized that diffused (low exploration, low commitment) participants would show the greatest reaction to the condition whereas achieved participants (high exploration, high commitment) would show the least. The mean differences confirm this 159

2016 hypothesis. Diffused participants reported dramatically different levels of perfectionism in the two conditions. The mean difference between the two conditions for diffused participants was 1.14. By contrast, achieved participants showed a small difference in reports of perfectionism across the two conditions. The mean difference in perfectionism scores for achieved participants was 0.21. The foreclosed and moratorium participants showed moderate levels of reactivity to the high OOP condition. Interestingly, for those two identity statuses, the perfectionism condition actually resulted in lower ratings of perfectionism (see Figure 4 in Appendix D for a table comparing the results described above). Discussion In this study, we found that presenting participants with promotional statements about their university that primed a perfection-demanding (high OOP) culture neither elicited extrinsic aspiration pursuit, nor prevented intrinsic aspiration pursuit to a significant degree. The first hypothesis will be further discussed in the section regarding limitations of our study. Although we did not find effects on aspirations, women responded with significantly higher measures of self-criticism following the perfectionism manipulation. In addition, we found a significant interaction between condition, identity status and striving perfectionism. Interpretation of results Women self-criticism. Our second hypothesis proposed that participants in the high OOP condition would show greater selforiented perfectionism. Although our data did not support this hypothesis, we did find that the high OOP condition resulted in greater self-criticism (a maladaptive aspect of perfectionism) in women. We interpreted these results according to research that has

been conducted on stereotype threat. Stereotype threat is a situation that arises when people fear that they will confirm negative stereotypes about their social group (Steele & Aronson, 1995). This fear leads to lower performance on tasks in which there is a perceived threat of confirming the stereotype. One study looking at this effect found that when women were told that a math test would likely produce gender differences, they performed substantially worse than men on the test (Spencer, Steele, & Quinn, 1999). However, when participants were told that the test would not produce gender differences, results on the test between men and women were much closer. In discussing stereotype threat, Ryan and Ryan (2005) explain that worry is one factor that mediates decreased performance. Worry refers to cognitive reactions to the threat of confirming a stereotype. In particular, worry involves selfcriticism and concern about the consequences of failure. This explanation is relevant to our findings. The women in our study may have perceived a perfection-demanding environment as eliciting a negative female stereotype. It is possible that women in our study responded with increased self-criticism in reaction to the fear of confirming this negative stereotype. An alternate explanation for the significant differences between conditions in womenâ&#x20AC;&#x2122;s but not menâ&#x20AC;&#x2122;s self-criticism, is that men may have been protected from the effects of our manipulation. Research on autism reveals that men are four times more likely to show autism spectrum conditions than women (Scott, Baron-Cohen, Bolton, & Brayne, 2002). In addition, individuals with autism spectrum conditions show insensitivity to social reputation (Izuma, Matsumoto, Camerer, & Adolphs, 2011). It is possible that a few men in our study had an autism spectrum condition and were therefore insensi160

2016 tive to external social pressures towards perfectionism. Future research could assess markers of stereotype threat, as well as markers of autism spectrum conditions in order to understand the gender effects on selfcriticism found in our study. Eriksonian identity status as a protective factor. Our third hypothesis was that identity status (as measured with identity exploration and commitment) would act as a protective factor against the effects of a high OOP environment. We predicted that identity achieved individuals, who have explored different definitions of themselves and committed to a subset of these, would be mostly unaffected by the manipulation. We predicted that identity diffused individuals, who have neither explored nor committed, would show greater perfectionism and extrinsic aspirations following the manipulation. We hypothesized that this would be the case because identity diffused individuals tend to be more susceptible to pressures to conform (Toder & Marcia, 1973). Therefore, we predicted that these individuals would also be more susceptible to pressures to be perfectionistic. We did not find a significant interaction between identity status, condition and aspirations. However, we did find results confirming the hypothesized interaction between identity status, condition and striving perfectionism. Indeed, it was identity diffused individuals, but not identity achieved individuals, who showed the greatest difference in levels of self-oriented perfectionism between the two conditions. Identity diffused individuals in the high OOP condition reported more perfectionism than identity diffused individuals in the low OOP condition. What does this interaction mean and how is it relevant? We speculate that this protective effect of identity achievement is explained in part by an internal locus of selfdefinition. These and other identity status

findings have important implications for university life. Identity achieved individuals seemed to be less influenced by our manipulation, possibly due to a more internal locus of selfdefinition. As James Marcia (1973) explains, students who achieve an identity develop an internal, as opposed to external, locus of selfdefinition. This internal locus of selfdefinition, which involves defining and evaluating oneâ&#x20AC;&#x2122;s identity according to internal indicators of psychological need satisfaction (Marcia, 1964), implies that students are less vulnerable to the stress of evaluation and social expectations (Marcia, 1966). In contrast, an external locus of self-definition involves defining and evaluating oneâ&#x20AC;&#x2122;s identity according to external indicators of worth such as judgement from peers (Marcia, 1964). Identity achieved individuals have a less malleable sense of who they are and where they fit into the world (Marcia, 2002). In other words, participants in our study who were identity achieved likely did not feel the need to modify their levels of self-oriented perfectionism according to social expectations. Identity diffused individuals on the other hand showed greater perfectionism following exposure to a high OOP environment. These findings are consistent with research that has been conducted on identity status and conformity. Indeed, identity diffused individuals were found to be significantly more influenced by peer pressure to conform than identity achieved individuals (Adams, Ryan, Hoffman, Dobson, & Nielsen, 1984). Toder and Marcia (1973) had female undergraduates complete the Asch conformity task where participants are socially pressured to misinterpret the length of a line. Participants who were either identity achieved or foreclosed showed significantly less conformity than participants who were identity diffused or moratorium. Essentially, as repli161

2016 cated in our study, it appears that identity diffused individuals may be more external in their sense of self and feel the need to conform to social expectations of perfection. It is well-documented that in addition to the protective effects demonstrated in our study, identity achievement is associated with many other positive outcomes. An achieved identity is correlated with development of meaningful romantic relationships, psychological well-being, subjective wellbeing and is inversely correlated with the maladaptive (self-critical) aspect of perfectionism (Luyckx, Soenens, Goossens, Beckx, & Wouters, 2008; Hope et al., 2014). Given these positive outcomes, Hope et al. (2014) were interested in studying how university students go about developing their identity. In their longitudinal study, they found that increased prioritization of intrinsic aspirations over the course of an academic year predicted increased identity achievement by the end of that school year. In linking previous research to our experiment, this has important implications for student life: if students are given opportunities to pursue intrinsic aspirations at the beginning of their university career, this may positively influence identity achievement. In turn, developing an achieved identity could protect students against the negative effects of a highly perfection-demanding (high OOP) environment. We found that identity achieved individuals, who are more firm in their identity and in their base levels of perfectionism, are less influenced by social demands for perfection. As studied by Hope et al. (2014), the pursuit of intrinsic aspirations is involved in developing this achieved identity. Limitations and future directions The first hypothesis suggested that the extent to which students’ university was a perfection-demanding environment would

have an effect on students’ valuing of different aspirations, with a highly perfectiondemanding environment eliciting more extrinsic and less intrinsic aspirations. However, we did not find a significant effect of a high OOP environment on participants’ aspirations. In this section, I will first identify several aspects of our experiment, the sample, the manipulation and the control condition, that might explain our lack of significant results. Second, I will provide suggestions for future research. Third, I will discuss limitations to the generalizability of our study. Limitations of our sample. The representative sample that we chose for our study included students in all years of their undergraduate degrees at McGill University. Although the sample used allowed for greater generalization of findings, it also meant that participants came into the lab with preconceived notions about McGill University’s perfectionism profile. Consequently, several participants in the low OOP condition told us that items such as “McGill values and respects the pursuits all of its students” and “McGill nurtures all students to prepare them for a life of learning” were false and that it was misleading to convey this information within promotional documents. These students may have come into the experiment with a firm impression of McGill University as a high OOP environment, which would effectively cancel out the effects of the low OOP control condition. These strong opinions about McGill may have been reflected in answers to manipulation check items. The high OOP group responded with higher ratings to the question, “Overall, how much do you think a high school senior who values excellence will be attracted by the provided promotional statements you read?” However, participants in this high OOP condition did not respond 162

2016 with higher ratings to other manipulation check items such as “McGill University expects its students to excel at whatever they do”. In response to the question about the high school senior, participants were able to identify whether the statements they received reflected high or low demands of perfection. However, when asked more specifically about their own opinions about their university, participants likely responded based on their preconceived notions about McGill University’s demands of perfection, as opposed to responding based on the statements provided. Considering that participants likely had strong opinions about their university, our manipulation did not succeed in changing their opinions. Preconceived notions might explain our non-significant aspirations results and manipulation check results. In order to avoid this issue, future research might restrict the sample to first year students who may have a more malleable impression of McGill, and therefore be more sensitive to our manipulation. Limitations of our manipulation. The manipulation that we chose for this study placed an emphasis on the personal standards (striving) aspect of perfectionism. In the high OOP condition, participants read statements such as “McGill values and respects its candidates who demonstrate a commitment to the pursuit of excellence in academic work” and “McGill nurtures the best of its students to prepare them to be at top of their fields.” However, the manipulation did not place any emphasis on the ‘criticism’ aspect of perfectionism. Research suggests that personal standards (striving) perfectionism, especially when coupled with intrinsic motivation, is correlated with achievement and effort, and inversely correlated with neuroticism (Stoeber & Eismann 2007). Self-critical perfectionism, on the other hand, is consist-

ently correlated with a host of negative outcomes (Enns & Cox, 1999; Dunkley, Blankstein, Zuroff, Lecce, & Hui, 2006). Importantly, OOP involves high criticism of others (Hewitt & Flett, 1991). Our manipulation did not prime this ‘criticism’ aspect of OOP and therefore did not properly prime the OOP construct. In order to address this flaw, a future replication of our study might include several statements emphasizing criticism when high standards aren’t met. For example, in the high OOP condition, participants could read that “McGill pushes students to succeed by imposing GPA cut-offs required to stay in honours programs” or that “our students continue to rise to the challenge, as less than 10% get placed on academic probation.” Although such statements would not be as fitting within promotional material, participants could instead be told that they would be reviewing material given to freshman students during their first week at McGill. Limitations of our control condition. A major drawback of our low OOP condition was that it wasn’t a true control condition. The statements in this condition reflected two important aspects, low perfection and support. Statements such as “The Canadian Institutes of Health Research supports McGill students for their involvement in health research” might have interacted with participants’ already formed impressions of McGill to produce the perception of a perfectiondemanding environment. In other words, participants may have perceived the low OOP condition as perfection-demanding. In order to solve this dilemma of the control condition, a future study could use two control conditions. In order to create an opposing condition to the high OOP condition, the first control could be an acceptance condition, with an emphasis on acceptance of mistakes, failures and imperfections. The sec163

2016 ond control condition could forgo the concept of perfectionism entirely by having a different focus, such as diversity. One sample statement for a diversity control condition might be “Students from more than 20 countries around the world study as McGill University.” This would allow us to statistically compare the high OOP condition with both a low OOP condition and a control condition that is unrelated to the concept of perfectionism. Generalizability limitations. In addition to having possible preformed opinions (as discussed above), the sample chosen for this study was limited in its homogeneity. Our sample consisted of predominantly female undergraduate university students at one Canadian university. There are many differences between the socio-economic status, ethnic background and gender distribution between students attending McGill and students attending other Canadian universities. As a result, generalizability to all Canadian undergraduate students and to the general population is limited. Further investigation could assess students attending different universities and faculties. In future replications of our study, modifying our sample, manipulation and control conditions would allow us to more fully understand the effect of a perfectiondemanding environment on individuals’ aspirations. In addition, replications of our research must be conducted with different samples before we are able to generalize our findings to university students.

ronment), students did not show differences in their aspiration profile. However, female students in the high OOP environment showed greater self-criticism. Additionally, identity diffused participants showed greater perfectionism following the manipulation than identity achieved participants. We interpreted the self-criticism findings in female students as indicative of the ‘worry’ mediating component of the stereotype threat reaction. We interpreted the perfectionism findings in identity diffused individuals as indicative of their external locus of self-definition and their tendency to conform to social pressures. These and other findings are of interest because they relate to student life. Hope et al. (2014) demonstrated that an increase in intrinsic aspirations over the course of an academic year predicted increased identity resolution in college students, as well as subjective well-being. Our study showed that identity achievement acts as a protective factor against pressures to be perfect. Taken together, these findings suggest implications for university life: Supporting students in intrinsic goal pursuit helps them develop their identity, which in turn enables them to resist external pressures towards certain negative outcomes of perfectionism. In fact, when individuals do not feel controlled, they can reap the benefits of high expectations. Ultimately, people feel most engaged when demands are high and they have the support and ability to meet those high demands (Csikszentmihalyi, 1997; Ryan & Deci, 2000).

Conclusions and implications In summary, our study revealed negative effects of a heightened culture of perfectionism on women’s levels of self-criticism and identity diffused individuals’ levels of perfectionism. When primed with a high OOP environment (as opposed to a low OOP envi-

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2016 Appendix

Figures 1 and 2. Intrinsic and extrinsic aspirations by condition. No significant differences.

Figure 3. Significant main effect of condition on womenâ&#x20AC;&#x2122;s self-criticism.

Figure 4. Significant interaction of perfectionism by condition and identity status.

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2016

Is There an Anxiety Gene?: A Review of the Serotonergic System and its Implications for Neuroticism

Andrea Boza, Michael Haichin, Ariane Marion Jetten, Antonia Trendafilova, and Emma Whitehall

Abstract Neuroticism has been linked with polymorphisms of the serotonergic transporter gene (5-HTT) as possibly involved in the manifestation of affective psychopathologies. Cerebral concentrations of serotonin produced by the long (L) allele variant are much higher than the short (S) allele variant, yet the latter is more frequently linked to negative emotionality, due to evidence indicating a robust association with neuroticism and related mental disorders. A suggested mechanism explaining how the short allele affects personality development is the increased amygdala activation caused by adverse environmental stimuli, experienced by these subjects. This increased activation may act as a mediating factor in the phenotypic expression. However, the 5-HTT gene-linked polymorphic region (5-HTTLPR)-neuroticism relationship has not been shown to be linear. Currently, many studies examine how the trait is involved in the acquisition of internalizing disorders, particularly focusing

on depression and anxiety. No conclusive evidence has been amassed to date, as the research field is fairly limited in its methodology as a result of the complex interactions at hand. Keywords: serotonin transporter (5-HTT), neuroticism, 5-HTT gene-linked polymorphic region (HHTTLPR, short allele, anxiety, depression

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2016 Introduction Overview of the Serotonergic System In the early 19th century, a factor was discovered in blood after clotting, which constricted vascular smooth muscle in order to increase vascular tone. This substance was later isolated and identified as 5hydroxytryptamine (5-HT, also called serotonin) (Jonassen & Landro, 2014). Today, we know that 5-HT is also a neurotransmitter that contributes to many physiological functions such as motor activity, circadian and neuroendocrine rhythms including food intake, sleep and reproductive activity, as well as cognition and emotional states including mood (Heils et al., 1996; Lesch et al., 1996). 5-HT is produced in the brain by nine serotonergic clusters of neurons along the midline of the brain stem, projecting to nearly every area in the central nervous system, particularly the dorsal raphe nucleus. After being released by a serotonergic neuron and binding to a receptor in the synaptic space, 5HT is transported inside the cell because there are no enzymes present for its metabolism. The presynaptically located serotonin transporter, also known as SERT or 5-HTT, returns 5-HT to the cell so that it can be recycled into new vesicles or decomposed, a process primarily completed by monoamine oxidase A (MAO-A) in the mitochondria (Andrews, Barwhani, Lee, Fox & Thomson, 2015; Jonassen & Landro, 2014). Serotonin Transporter (5-HTT) and its Variants (See Figure 1 in Appendix) The 5-HTT is a sodium-dependent symporter located in the plasma membrane of the cell with its primary purpose being the efficient removal of 5-HT from extracellular areas (Jonassen & Landro, 2014). It is widely expressed both in the periphery, where it is

found in many organs to remove 5-HT from the bloodstream, and in the brain, where it is abundantly expressed in cortical and limbic areas involved in emotional aspects of behaviour (Andrews et al., 2015; Lesch et al., 1996). By regulating the duration and magnitude of serotonergic responses, the 5-HTT is central to the fine-tuning of 5-HT actions in the brain and periphery (Lesch et al., 1996). Abnormalities in 5-HTT functioning result in altered intensity and duration of 5-HT communication with presynaptic receptors, which in turn mediate inhibitory control of the 5-HT neuron itself, and with postsynaptic receptors (Jonassen & Landro, 2014). The human 5-HTT is encoded by a single gene (SLC6A4) composed of 14 exons spanning 40 kilobases (kb), and has been mapped to chromosome 17q11.1-q12. The sequence of the transcript encodes a protein of 630 amino acids, containing 12 transmembrane domains (Murphy & Moya, 2011; Nakamura, Ueno, Sano & Tanabe, 2000). Decreased 5-HTT gene function increases extracellular 5-HT levels and leads to reduced receptor binding to receptors 5-HT1A and 5-HT1B, but increased 5HT2A, 5-HT2C and 5-HT3 receptor mRNA levels and/or ligand binding (Jonassen & Landro, 2014). The SLC6A4 gene has been studied more than any other single candidate gene in the field of neurobiology. In 1996, Heils and colleagues reported a common polymorphism of a unique GC-rich repetitive sequence located in the proximal 5â&#x20AC;&#x2122; regulatory region of the gene, providing evidence for alleledependent differential 5-HTT promoter activity. This repetitive sequence, known as the 5HTT gene-linked polymorphic region (5HTTLPR), displays a complex secondary structure that can regulate the transcriptional activity of the nearby 5-HTT gene promoter, 170

2016 contains positive response elements, and silences transcriptional activity in nonserotonergic cells (Heils et al., 1996). The 5HTTLPR, located ~1 kb upstream of the transcription initiation site, is defined by a length variation of the repetitive sequence (deletion or insertion), with the short (S) and long (L) alleles consisting of 14 and 16 repetitive elements (44 base pair difference), respectively (Heils et al., 1996). Through the use of in vitro analyses, the study concluded that the basal transcriptional activity of the L variant was approximately threefold higher than that of the S variant, thus indicating that this is a functional polymorphism (Heils et al., 1996). A pioneering study conducted shortly after by Lesch and colleagues (1996) showed that human lymphoblast cells homozygous for the L variant (L/L) produced 1.4 to 1.7 times higher concentrations of 5-HTT mRNA, showed increased levels of serotonin uptake, and displayed greater 5-HTT inhibitor binding than cells with one or two copies of the short variant (S/L or S/S). By increasing 5-HT uptake and subsequently accelerating 5-HT clearance from the synaptic cleft, the L allele keeps extracellular levels of 5-HT lower than the S allele. Data from these earlier studies demonstrated that the S/S and L/S genotypes mRNA levels were similar while the L/L genotype differed, suggesting that the polymorphism has more of a dominant-recessive effect than a codominant-additive one (Lesch et al., 1996). In 2000, Nakamura and colleagues described at least 10 novel variants of the S and L alleles, distinguished by single nucleotide polymorphisms (SNPs), and found that the 5HTTLPR consists of a total of 14 alleles in Caucasian and Japanese populations. One of those SNPs (A to G) was found within the first of two extra repeats of the 5-HTTLPR L allele, designated long A (LA) and long G (LG). In 2006, it was demonstrated that only

LA is associated with high levels of 5-HTT mRNA transcription in vitro, while LG yielded lower mRNA levels similar to the S allele (Hu et al., 2006). These results indicated that the 5-HTTLPR be described as functionally triallelic (Hu et al., 2006). It should therefore be noted that up to 15% of individuals previously considered to be L carriers in all studies of the 5-HTTLPR, should instead be functionally classified with S carriers. This error rate of Âą15% might have influenced study results, leading to false positives or false negatives (Murphy et al; Malie & Vogt, 2013). Shortly thereafter, a study established that the LA/LA genotype is associated with greater 5-HTT density (Praschak-Rieder et al., 2007). Another functional SNP was detected and named rs25531 (Kraft, Slager, McGrath, & Hamilton, 2005). It was later determined that the base pair difference between L and S variants was 43 (not the previously reported 44) and that the rs25531 SNP refers to the same nucleotide within the S allele as the A/G subdivision within the L allele described by Hu et al. in 2006 (Wendland et al., 2006). The fact that this SNP can be found in the context of both S and L alleles means that rs25531 and the 5-HTTLPR should be treated as two independent loci with 4 possible alleles (SG, SA, LG, LA). Despite this finding, the literature from the past decade remains dominated by the triallelic model, although the most studied is the biallelic (insertion/deletion) polymorphism, as data on the other polymorphisms remains contradictory and poor (Jonassen & Landro, 2014). Recently, another promoter region variant named rs25532 was reported and showed an allele-dependent effect on 5-HTT expression of up to 7-fold, but has since not been extensively researched (Wendland et al., 2008).

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2016 Short and Long Alleles of the 5-HTT Gene and Neuroticism As previously mentioned, there are many variants of the serotonin transporter gene, which in turn have functional consequences on the serotonergic system (Lesch et al., 1996). For the purpose of this review, however, only those pertaining to neuroticism will be discussed. The research linking serotonin and neuroticism has focused mainly on the short and long alleles of the transporter gene (Golimbet et al., 2001; Savitz & Ramesar, 2004). Indeed, the alleles are thought to influence personality traits, especially those relating to one’s tendency to be anxious and experience negative emotions, namely neuroticism (Savitz & Ramesar, 2004). The directionality of this relationship – and its mere existence – has been debated by researchers. Some find no links at all (Golimbet et al., 2001; Middeldorp et al., 2007), while others are discovering positive relationships between 5-HTTLPR polymorphisms and neuroticism (Lesch et al., 1996). The different positions will be discussed and analyzed in the following sections. Evidence for Differing Directions of the Link Between Alleles and Neuroticism Savitz and Ramesar (2004) discuss arguments both in favor and against the hypothesized link between the shorter allele of the serotonin transporter gene and neuroticism. They mention Hariri et al.’s (2002) finding that carriers of the short allele, as compared to those homozygous for the long allele, showed increased activity in the amygdala, a brain area responsible for reacting to threats and processing negative emotions. This increased activity of the amygdala is, in turn, linked with more negative emotions when encountering new stimuli (Kagan, 1997). Thus, there is evidence supporting a link between the short allele and neuroticism. How-

ever, Savitz and Ramesar (2004) indicate that 18 out of the 36 surveyed studies were shown to be significant, six of which were in favor of a positive relationship between the long allele and the neurotic traits, rather than with the short allele. This effectively demonstrates the controversial body of evidence, as half of the studies analyzed were non-significant, while there were many critiques of those that were significant. In fact, only two sets of results remained significant after they were corrected for multiple testing, to prevent any false significance from occurring (Savitz & Ramesar, 2004). Moreover, it was pointed out that non-significant studies’ samples tended to include more females, while significant associations between neuroticism and the 5HTT gene were more commonly made based on predominantly male samples (Flory et al., 1999). However, there were also exceptions to this trend since women carriers of the short allele also displayed increased neurotic traits, while some male samples yielded no significant results at all (Melke et al., 2001; Retz et al., 2002). Overall, there seems to be little significant research - once results are corrected and sample biases are excluded demonstrating a link with either the long or short allele of the 5-HTTLPR polymorphism with neuroticism. A study by Golimbet et al. (2001) examined the allele makeup for the 5-HTT gene of healthy controls, patients with affective disorders, and healthy participants with relatives affected by psychoses (i.e., schizophrenia or affective psychosis). The researchers looking for links between the alleles and neuroticism found no association across samples between having either the dominant short or the homozygote long allele and neuroticism. They even found, contrary to others, that neuroticism was lower for carriers of the short/short (S/S) allele compared with those carrying the long/short (L/S) or long/long (L/ 172

2016 L) alleles in their samples (Golimbet et al., 2001). One could infer from this that those with the longer version of the allele may be disadvantaged by higher levels of trait neuroticism. This statement must not be overrated, however, as the result for this analysis was not statistically significant. Middeldorp et al. (2007) agrees with the previous research group, as they state their “results strongly suggest that there is no straightforward association between the 5HTTLPR and neuroticism, anxiety and depression” (p. 294). This group analyzed selfreports of twins and their families five times over a period of 10 years. They assessed neuroticism, anxiety, and depression, and found no relationship with the 5-HTTLPR short or long allele (Middeldorp et al., 2007). Moreover, Verschoor and Markus (2011) found a difference between short and long alleles in how carriers experienced the stress of an academic examination, although it was independent of neuroticism. Indeed, they compared S/S and L/L allele carriers on perceived stress and mood as affected by negative stress (the examination) and found those homozygous for the short allele were significantly more impacted by negative stress, regardless of trait neuroticism (Verschoor & Markus, 2011). This is especially interesting because even if the alleles did not correlate with neuroticism, S/S carriers have an increased risk of experiencing more stress than those carrying the L/L version. Lesch et al. (1996), on the other hand, found a significant association between the 5HTTLPR genotype and neuroticism as measured by the NEO-PI-R scale (Costa & McRae, 1992) assessing the Big 5 traits. Essentially, they indicated a relationship between the short allele and anxiety-related personality characteristics (i.e. neuroticism) (Lesch et al., 1996). The same author agreed that “the association reported […] represent only a small

portion of the genetic contribution to anxietyrelated personality traits” (Lesch et al., 1996, p. 1530), which have been shown to be 40 to 60% inheritable (Heath et al., 1994; Loehlin, 1989; Plomin et al., 1994). Factors Explaining the Variation in Results A meta-analysis conducted by Schinka et al. (2004) suggests that the type of scale used to measure neuroticism plays a major role in determining whether studies will reach significance. Indeed, the Harm Avoidance Scale (HA) developed by Cloninger (1987) and the NEO-PI-R (Costa & McCrae, 1992), which measures neuroticism as part of the Big Five traits, yielded significantly different results, with the latter producing larger effect size: 0.23 as compared to 0.04 for studies using the HA scale. The authors concluded that, although the association between the 5-HT short allele and anxiety traits is small, it is reliable (Schinka et al., 2004). Finally, a way to explain these largely inconsistent results would be to contend that the relationship between the polymorphism and neuroticism is not linear. Indeed, Sirota et al. (1999) showed that people at extreme ends of the neuroticism scale actually have a lower chance of being a short allele carrier than someone in the middle range, which may explain the findings by Golimbet et al. (2001) that people who had the highest neuroticism scores in their samples actually had the long allele. They state that the 5-HTTLPR had a modest main effect on neuroticism that is most apparent in the middle of the distribution, together with a quadratic component that becomes substantial at both high and low levels of the trait (Sirota et al., 1999, p.37). (See Figure 2 in Appendix). Mechanism of Personality Development Increased Amygdala Activation The aforementioned studies provide evidence toward the linkage between the poly173

2016 morphism of the serotonergic transporter (5HTT) and the degree of neuroticism of an individual, which has been classified as one of the Big Five personality traits. As previously explained, 5-HTT is located throughout the periphery, but is also present in the brain where it is abundantly expressed in cortical and limbic areas involved in emotional aspects of behaviour (Andrews et al., 2015; Lesch et al., 1996). Its location in the brain might play a crucial role in understanding how the availability of this neurotransmitter, due to differences in gene transcription and functioning, leads to variations in personality traits and consequently behaviour among individuals, specifically neuroticism (Mazzanti et al., 1998). Hariri and colleagues (2003) have coined the term “imaging genomics” to describe a field that uses functional neuroimaging to analyze the genotype-phenotype relationships. With the help of this technique, they have been able to show the increased activation of the amygdala in individuals possessing the short 5-HTTLPR allele, which may promote anxiety-related personality traits (Ebstein, 2006). This relationship has also been examined in animal studies. One particular experimental design showed that 5 -HTT knockout mice experience heightened anxious and depressive traits, are less persistent when faced with challenges, and show less exploratory behavior (Bengel et al., 1998; Jennings et al., 2006). In particular, this behavior appears to be mediated by increased dendritic branching in the amygdala and the limbic cortex, which are part of the so-called brain fear circuit (Wellman et al., 2007). In 2008, Uher and McGuffin showed in studies on rhesus monkeys that the presence of the gene’s short allele, in tandem with unfavorable early nurturing conditions, could be the mechanism leading to more prevalent neuroendocrine reactivity to stressful events, ex-

pressed as greater alcohol consumption and by a smaller available quantity of serotonin in the central nervous system. These initial studies on animals support the interaction between environment and genes, where the short allele, when cooccurring with increased exposure to adverse circumstances, may be affecting personality development. These animal studies have fuelled further research with human participants. The field of personality genetics first began in 1996 with the discovery of the link between the 5-HTTLPR and neuroticism/harm avoidance behavior. Several studies since have investigated the specific mechanisms that lead to the emergence of this personality trait. As previously expressed, findings with humans have proven unclear, and there have been erratic results using self-report measures of neuroticism (Ebstein et al., 2006). According to the NEO-PI-R personality inventory measure, neuroticism “includes traits such as anxiety, anger, hostility, depression, self-consciousness, impulsiveness and vulnerability” (Ebstein et al., 2006, p. 3). This is important, as many studies have focused specifically on examining one of these traits, rather than neuroticism as a whole (Ebstein et al., 2006). Moreover, Uher and McGuffin (2008) examined the geneenvironment (G-E) interaction effect on the onset of depression, and found supporting evidence for it in 15 human studies, in addition to animal studies, thus shedding light into factors affecting neuroticism. Gene-Environment Interactions in Determining Phenotype The aforementioned studies emphasize that gene effects are largely influenced by environmental factors, and cannot be assessed in isolation. In fact, measuring environmental effects is essential to improving genetic re174

2016 search accuracy (Uher & McGuffin, 2008). Caspi et al. (2003) support this claim by linking stressful life events such as childhood abuse, and the presence of the sho rter 5HTTLPR allele, to a higher likelihood of experiencing events as more stressful. Moreover, Jacobs and colleagues (2006) examined the 5-HTTLPR polymorphism and its effects on neuroticism. They also investigated how the allele can induce depression as a function of increasing number of stressful life events (SLE). They assessed depressive symptoms in their prospective cohort study using selfreport measures over 15 months in 374 ethnically homogeneous female twins presenting 5-HTTLPR allele variations. Their results showed how greater numbers of short alleles led to an increased depressogenic effect of neuroticism (Jacobs et al., 2006). Nonetheless, the results found in studies looking at polymorphism and its effects on neuroticism have been unclear, usually varying by gender, and often contradicting one another. An instance of such contradictory evidence is exemplified by a study conducted in England looking at the 5-HTTLPR and its effects on neuroticism and depression. The researchers found no significant effect linking any allele to either the trait or the illness, thus contradicting previous significant positive results such as those found by Jacobs et al. (2006) and Uher and McGuffin (2008) (Saffen et al., 2005). These opposing findings might actually help to explain the mechanisms involved in determining personality, shedding new light into the nature-nurture debate, and highlighting the combination of hormonal, environmental, and individual effects on personality development. Perhaps it is time to take a closer look at the interaction that such genetic variations can have in predisposing an individualâ&#x20AC;&#x2122;s personal experience towards certain situations, thus setting a pattern for the way

they will interact with the environment. The variance in 5-HTTLPR determines the amount of serotonin released in the body, which affects the way in which the individual interacts with common life situations and either positively or negatively reinforces the degree of neuroticism. Jacobs et al. (2006) argued that the short 5-HTTLPR allele moderates the association between depressive disorders and the tendency to experience the environment as stressful, and that it is key in coping and appraisal processes when experiencing environmental adversity (Jacobs et al., 2006). For these purposes, the role that serotonin plays in the body regulating cell proliferation, migration, and differentiation, particularly during developmental stages, might explain its organizational effects (Lesch & Mossner, 1998). Through the actions of the 5HT transporter (which regulates the duration of serotonergic transmission), serotonin affects the developed brain by moderating cognition, emotion, sleep, appetite, and pain, among others (Heils et al., 1996; Lesch et al., 1996). Moreover, the finding associated with the effect on personality by possessing a short allele has also been supported by other studies. For example, Hariri et al (2002) found that carriers of the short 5-HTTLPR allele have a higher degree of activation in the amygdala in response to fearful stimuli. Personality development is one example of genotype and environment interacting to ultimately produce a certain phenotype. A study by Caspi et al. (2003) was critical in highlighting the variability in vulnerability when individuals possessing different genetic 5-HTTLPR make-ups face adverse environments. This is also supported by the findings of Kendler et al. (1995) using quantitative population genetic studies, Canli et al. (2006) using neurophysiological investigations, and Barr et al. (2004) using experimental studies 175

2016 on animals. Results contradicting these findings are thought to be due to varying age compositing, unreliable environmental measurement, and use of samples (Uher & McGuffin, 2008). Future studies will have to resolve this by specifically placing importance in quantifying, classifying, and measuring environmental situations, which is the biggest challenge moving forward.

Applications to Mental Disease As was discussed earlier concerning directionality, Savitz & Ramesar (2004) were able to identify 12 studies that support the existence of a relationship between the short allele variation of the 5-HTTLPR and anxiety related personality traits. Their analysis also reverberated the link between affective disorders and personality traits - specifically neuroticism with a plethora of study examples. Miller (1991) identified high neuroticism, low extraversion and low conscientiousness as the “misery triad” which seems to lend individuals with this configuration “little capacity for well-being to start with” (p. 430). This, taken alongside McCrae & Costa’s (1990) evidence of the stability of human traits in terms of rank order over time, implies that certain individuals—likely those in possession of the short allele of the 5-HTTLPR—would be left considerably vulnerable to mental or personality disorders. Miller’s 1991 intensive analysis of Big 5 personality traits across a diverse group of treatment seekers provides vital normative comparisons for this discussion. Miller found that neuroticism was the highest average score across participants, a full standard deviation above normative and non-treatment seeking groups (see Figure 3 in Appendix), and was implicated in predicting the intensity and duration of the client’s distress. According to Miller (1991), the “patients in this sample who scored very high on

[neuroticism] were likely to meet the diagnostic criteria for relatively serious and potentially disabling disorders” (p. 421). Miller (1991) uses Borderline Personality Disorder as an example in his analysis, and McCrae & Costa (2002) later echoed this connection between the Big 5 trait of neuroticism and borderline personality disorder. Depression, characterized by low mood and loss of interest in pleasurable activities, is one of the most widespread mental disorders among adolescents and adults, and has become more common over the past few decades (Hollon et al., 2002). Although there is no guaranteed treatment for depression, a number of effective treatments have been validated through scientific research. Many treatment approaches, such as cognitivebehavioural therapy, support groups, and pharmacotherapy, are available to the depressed patient. There is ongoing research attempting to determine which type of therapy works best for individual clients. For the purposes of this analysis, it is interesting to note that the most common pharmaceutical treatment involves medications that affect the serotonergic system. Antidepressants typically affect the serotonin, norepinephrine, and dopamine systems. Specifically, Greist et al. (1995) found that selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, fluvoxamine, and sertraline show consistency in their effectiveness as antidepressants, as well as applications that extend into the treatment of obsessive-compulsive disorder (OCD). The fact that one of the most effective treatments for depression acts on the serotonin system validates this relationship between the 5-HTTLPR and the development of clinical depression. In a recent update, Uher and McGuffin (2010) proposed a critical analysis, which looks into potential reasons why, despite the replicated gene-environment interaction be176

2016 tween the 5-HTTLPR and the development of depression, a direct gene-illness relationship does not arise. The reason for their update was a meta-analysis that was released the same year, which claimed insufficient evidence to support a connection between the 5HTTLPR and the development of clinical depression. Following an exhaustive review of published work on the topic, Uher and McGuffin (2010) identified the method used to assess environmental adversity as significantly implicated in the results of studies’ analysis of the polymorphism between long and short alleles of the 5-HTTLPR. Although no specific causal conclusion was reached, the paper suggested using objective methods of stress assessment rather than retrospective self-report as the latter show more inconsistent results, likely indicating errors in accurate memory retrieval. They believe that self-report questionnaires both over-report adverse events by including trivial occurrences, and under-report severe events important for the onset of depression (Uher & McGuffin, 2010, p. 19). Gingnell et al. (2010) applied the link between neuroticism and the polymorphism of the 5-HTTLPR to another specific mental disorder - premenstrual dysphoric disorder (PMDD). The premenstrual dysphoric disorder (PMDD) is characterized by a “recurrent cluster of physical and negative mood symptoms during the luteal phase of the menstrual cycle” (Gingnell et al., 2010, p. 417). Although the focus of analysis pertaining to such disorders typically remains within the realm of endocrinology, Gingnell and colleagues (2010) identified personality, psychosocial, and genetic factors that make their study applicable to this discussion. Compared to healthy controls, patients with PMDD displayed higher levels of neuroticism in general. More specifically, within the PMDD population, there was a distinct difference

between patients with at least one copy of the short allele of the 5-HTTLPR and patients lacking this variation (i.e., homozygous for the long allele), with the latter group scoring lower on psychic trait anxiety and showing no lack of assertiveness (Gingnell et al., 2010). Psychopathologies - Underlying Neuroticism and the 5-HTT Variants Thus far, the academic literature has come to equivocal findings within and across experimental designs due to the complexity of interactions neuroticism and genes have with mental health. The unassertive correlational mixture of weak and moderate effects between neuroticism and the 5-HTTLPR make it difficult to further establish whether the phenotype possibly underlies a psychopathology (Gorwood, 2004; Middledorp et al., 2007). Firstly, inconclusive results are seen when when comparing studies’ results concerning the 5-HTT gene and related psychological disorders. This is because these studies ignore the biological make-up and focus uniquely on the behavioural aspect, specifically the neuroticism personality trait, and its interactions with the environment. In a study of two very large samples, Willis-Owen et al. (2005) dismissed the existence of a statistically noteworthy relationship between the 5HTTLPR variants and both the neurotic personality, and clinical depression. Nonetheless, more recently Uher and McGuffin (2008) also proposed that there is no directly emerging genotypic relationship with neuroticism underlying a particular illness. Opposition was found in an investigation by Mandelli et al. (2015) that intentionally overlooked the genotype of the participants and found an affiliation between high levels of neuroticism and a robust risk factor for acquiring an affective psychiatric condition, such as depression. The neuroticism levels were consid177

2016 erably implicated in the severity of the depressive condition and of the preoccupation with suicidal thoughts, even when the statistical models were set to control for the participants' stress-related events and social networks. The researchers explained their recurrent significant results in terms of the stressdiathesis hypothesis, such that diagnosed women responded in a maladaptive manner, predisposing them to major depressive disorder because of their intrinsically more neurotic personalities, which amplifies the negative valence of life's stressful events (Mandelli et al., 2015). It seems that it will take some time before the findings in the literature will be able to pinpoint the implication of serotonin transporter gene polymorphisms in a specific mental health dysfunction. Apart from this, there are several other suggested genes and variants potentially involved in neuroticism, which further increases uncertainty (Aleksandrova et al., 2012). Moreover, it is difficult to estimate how much of the variance in a single disorder is accounted for by a particular 5-HTT variant, knowing that most variants are associated with a wide range of highly comorbid internalizing disorders, spanning from situational phobia to generalized anxiety (Hettema et al., 2006; Ohara et al., 1998). In many studies, there are polymorphisms within the 5-HTT gene found outside the 5-HTTLPR, as well as other variants of genes involved in serotonergic and dopaminergic transmission, which contribute to the variance found in patients with anxiety disorders (Baca-Garcia et al., 2007; Ogilvie et al., 1996; Ohara et al., 1998). These variants have been correlated with heightened risk for developing obsessive-compulsive disorder, generalized anxiety, unipolar and bipolar disorders (Baca-Garcia et al., 2007; Ogilvie et al., 1996; Ohara et al., 1998). To date, neuroticism has not been linked

with certainty to an underlying affective psychiatric condition, but most researchers leave room for more conclusive evidence and believe in a small, but meaningful effect of the 5 -HTT gene variants (Baca-Garcia et al., 2007; Gorwood 2004; Griffith et al., 2010; Ohara et al., 1998). The evidence required to establish a more assertive relationship will come as researchers in the field begin to correct for the following experimental flaws. Limitations in Studying Neuroticism and Hormones Unfortunately, a few influential methodological threats are clouding the relationship between neuroticism and related psychopathologies, environmental adversity, and genes. Presently, the research field is in need of studies with very large sample sizes to yield enough statistical significance for interactions between candidate genes, the environment, and clinical diagnoses (Gorwood, 2004; Surtees et al., 2006). Similarly, there is a need for the use of standardized measures to provide valid and replicable findings since self-report measures are heavily biased, environmental adversity measures are difficult to quantify, and the protocols for genotyping are prone to errors (Griffith et al., 2010; Middeldorp et al., 2007; Surtees et al., 2006; Uher & McGuffin, 2008). To shed light on neuroticism trait-related disorders, it is necessary to understand and account for gender-specific illness associated variables, population stratification, and differences in clinical diagnoses (Ogilvie et al., 1996; Griffith et al., 2010; Ohara et al., 1998; Uher & McGuffin, 2008). After all, when it comes to the stratification of gender and/or ethnicity in prevalence rates for psychopathologies, women receive diagnoses of psychiatric disorders more frequently compared to men, with the exception of OCD (Afifi, M., 2007). 178

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Mandelli, L., Nearchou, F.A., Vaiopoulos, C., Stefanis, C.N., Vitoratou, S., ... Stefanis, N.C. (2015). Neuroticism, social network, stressful life events: Association with mood disorders, depressive symptoms and suicidal ideation in a community sample of women. Psychiatry Rese arch, 226, 38-44. Mazzanti, C., Lappalainen, J., Long, J., Bengel, D., Naukkarinen, H., Eggert, M., . . . Goldman, D. (1998). Role of the Serotonin Transporter Promoter Polymorphism in Anxiety-Related Traits. Archives of General Psychiatry, 55(10), 936-940. McCrae, R. R., Costa, P. T. (1990). Perso nality in ad ultho o d . New York: Guilford Press. Melke, J., Landén, M., Baghei, F., Rosmond, R., Holm, G., Björntorp, P., Westberg, L., ... Eriksson, E. (2001). Serotonin transporter gene polymorphisms are associated with anxiety-related personality traits in women. Am erican Jo urnal o f Med ical Genetics, 105 (5), 458-463. Miller, T. (1991). The Psychotherapeutic Utility of the FiveFactor Model of Personality: A Clinician's Experience. Jo urnal o f Perso nality Assessm e nt, 415-433. Middeldorp, C.M., de Geus, E.J.C., Beem, A.L., Lakenberg, N., Hottenga, J.-J., Slagboom, P.E., & Boomsma, D.I. (2007). Family based association analyses between the serotonin transporter gene polymorphism (5-HTTLPR) and neuroticism, anxiety and depression. Behavio ral Genetics, 37(2), 294-301. Murphy, D., Li, Q., Engel, S., Wichems, C., Andrews, A., Lesch, K., & Uhl, G. (2001). Genetic perspectives on the serotonin transporter. Brain Research Bulletin, 56, 487-494. Murphy, D., & Moya, P. (2011). Human serotonin transporter gene (SLC6A4) variants: Their contributions to understanding pharmacogenomic and other functional G×G and G×E differences in health and disease. Current Op inio n in Pharmacology, 3-10. Murphy, D., Maile, M., & Vogt, N. (2013). 5HTTLPR: White Knight or Dark Blight? ACS Chemical Neuroscience, 13-15. Nakamura, M., Ueno, S., Sano, A., & Tanabe, H. (2000). The human serotonin transporter gene linked polymorphism (5-HTTLPR) shows ten novel allelic variants. Mo lecular Psychiatry, 32-38. Ogilvie, A.D., Battersby, S., Bubb, V.J., Fink, G., Harmar, A.J., Goodwin, G.M., & Smith, C.A.D. (1996). Polymorphism in serotonin transporter gene associated with susceptibility to major depression. Lancet, 347(9003), 731-733. 180

2016 Ohara, K., Nagai, M., Suzuki, Y., Ochiai, M., & Ohara, K. (1998). Association between anxiety disorders and a functional polymorphism in the serotonin transporter gene. Psychiatry Rese arch, 81(2), 277-279. Plomin, R., Owen, M. J., & McGuffin, P. (1994). The Genetic Basis of Complex Human Behaviors. Science, 264 (5166), 1733-1739. Praschak-Rieder, N., Kennedy, J., Wilson, A., Hussey, D., Boovariwala, A., Willeit, M., ... Meyer, J. (2007). Novel 5-HTTLPR Allele Associates With Higher Serotonin Transporter Binding In Putamen: A [11C] DASB Positron Emission Tomography Study. Biological Psychiatry, 327-331. Retz, W., Thome, J., Blocher, D., Baader, M., & RoĚ&#x2C6;sler, M. (2002). Association of attention deficit hyperactivity disorder-related psychopathology and personality traits with the serotonin transporter promoter region polymorphism. Neuroscience Letters, 319(3), 133-136. Savitz, J.B, Ramesar, R.S. (2004). Genetic variants implicated in personality: A review of the more promising candidates. Am e rican Jo urnal o f Medical Genetics part B (Neuropsychiatric Genetics), 131B, 20-32. Schinka, J.A., Busch, R.M., Robichaux-Keene, N. (2004). A meta-analysis of the association between the serotonin transporter gene polymorphism (5-HTTLPR) and trait anxiety. Mo lecular Psychiatry, 9, 127-202. Sirota, L.A., Greenberg, B.D., Murphy, D.L., Hamer, D.H. (1999). Non-linear association between the serotonin transporter promoter polymorphism and neuroticism: A caution against using extreme samples to identify quantitative trait loci. Psychiatric Genetics, 9, 35-38. Surtees, P.G., Wainwright, N.W.J., Willis-Owen, S.A.G., Luben, R., Day, N.E., & Flint, J. (2006). Social adversity, the serotonin transporter (5-HTTLPR) polymorphism and major depressive disorder. Biological Psychiatry, 59(30), 224-229. Uher, R., & McGuffin, P. (2008). The moderation by the serotonin transporter gene of environmental adversity in the aetiology of mental illness: Review and methodological analysis. Molecular Psychiatry, 13, 131-146. Uher, R., & McGuffin, P. (2010). The moderation by the serotonin transporter gene of environmental adversity in the etiology of depression: 2009 update. Mo lecular Psychiatry, 18-22. Verschoor, E., Markus, C.R. (2011). Affective and neuroendocrine stress reactivity to an

academic examination: Influence of the 5-HTTLRP genotype and trait neuroticism. Bio lo gical Psychology, 87, 439-449. Wellman, C., Izquierdo, A., Garrett, J., Martin, K., Carroll, J., Millstein, R., . . . Holmes, A. (2007). Impaired Stress-Coping and Fear Extinction and Abnormal Corticolimbic Morphology in Serotonin Transporter Knock-Out Mice. Journal of Neuroscience, 27, 684-691. Wendland, J., Martin, B., Kruse, M., Lesch, K., & Murphy, D. (2006). Simultaneous genotyping of four functional loci of human SLC6A4, with a reappraisal of 5-HTTLPR and rs25531. Molecular Psychiatry, 224-226. Willis-Owen, S.A.G., Turri, M.G., Munafo, M.R., Surtees, P.G., Wainwright, N.W.J., â&#x20AC;Ś Flint, J. (2005). The serotonin transporter length polymorphism, neuroticism, and depression: a comprehensive assessment of association. Biolo gical Psychiatry, 58(6), 451-456.

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2016 Appendix

Figure 1: Human 5-HTT gene (SLC6A4) organization showing multiple functional variants. (Retrieved from Murphy, Malie & Vogt, 2013).

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Figure 2: Increased numbers of short allele repeats do not match the classic pattern of more short allele repeats co -occurring with high neuroticism at the extremes of the neuroticism dimension. There, both high and low observed neuroticism could be linked to similar number of short allele repeats. (Retrieved from Sirota, Greenberg, Murphy & Hamer, 1999).

Figure 3: The mean neuroticism score is a full standard deviation above normative and non -treatment seeking groups. (Retrieved from Miller, 1991).

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2016

Pupillometry as a Vehicle to Elucidate Misdirection: Paying Attention to Magic

Jane Zhang Supervisor: Dr. Amir Raz

Abstract Magicians have developed powerful ways to manipulate the subjective experience of their audiences. The techniques conjurors employ provide an opportunity to study the modulation of attention and awareness. The present study examines how, despite multiple exposures, misdi-

rectionâ&#x20AC;&#x201D;diverting attention away from hidden elementsâ&#x20AC;&#x201D;can yield a robust and sustainable effect. We studied 124 participants in four randomized versions of the experiment featuring short, muted video clips displaying a magician performing variations of the classic Monte both with and without misdirection. The Monte is a staple trick using three playing cards, a related pair and an oddball target, wherein the spectator needs to keep track of the location of the target. Analyzing accuracy, confidence ratings, and pupillary response revealed that in the presence of misdirection, participants reported inaccurate target positions. This was concurrent with increase in pupil size after feedback, regardless of the Monte version. Our findings suggest that misdirection relies on participants with rigid cognitive schemes and those unable to entertain alternative visual strategies despite their awareness of misdirection. Keywords: visual attention, misdirection, pupil dilation

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2016 Introduction Magicians exploit the inherent susceptibility of the attentional system to interruption and distraction (Lavie, 2005) to misdirect the audience (Lamont & Wiseman, 2005). Our conscious representation of the world is far less complete than our subjective experience would suggest (Rensink, 2000). By moving constantly, our eyes provide multiple views of the objects around us. As a result, we rapidly lose much of the visual information. In recent years, researchers have incorporated research on facets of magic performance into cognitive science (Raz, Olson, & Kuhn, 2015). These studies have examined the psychological mechanisms behind certain magic techniques and provide valuable insights into human cognition (Kuhn, Amlani, & Rensink, 2008; Macknik et al., 2008). Examining the modulation of attention bears both theoretical and practical benefits. Many everyday accidents result from distraction or inattention. These lapses of attention can be dangerous and lead to negative consequences. Inattentional blindnessâ&#x20AC;&#x201D;the failure to notice substantial events within the visual field while engaged in another attentional demanding taskâ&#x20AC;&#x201D;is present across numerous contexts (Mack & Rock, 1998). Furthermore, a deficiency in the control of attention, as found in patients with ADHD or OCD, can affect the ability of an individual to function in society. Therefore, developing new avenues of research into human perception and cognition could be important across many domains. Misdirection and Attention The present study provides an integrative venue for assessing the impact of misdirection, a dynamic visual stimulus, on modulating behavior, by proxy of attention. Magic

studies have mostly focused on misdirectionâ&#x20AC;&#x201D;the practice of diverting the attention of the spectator away from a secret action (Kuhn & Martinez, 2012). When subject to misdirection, observers may not perceive a trick directly in their field of vision if they are not actively attending to it, or do not understand the importance of the stimulus (Macknik et al., 2008). Misdirection draws attention without redirecting the gaze of the spectator. Therefore, this convenient tool may affect the neural circuits controlling covert (i.e., attention in the absence of eye movements) and overt (i.e., where people look) visual attention independently (Kuhn & Tatler, 2005). Both aspects of the visual attention system overlap (Corbetta et al., 1998) and, under normal circumstances, are closely related (Awh, Armstrong, & Moore, 2006). Previous studies of misdirection that did not indicate changes in gaze fixation have identified pupil size variation as a reflection of fluctuation in cognitive processing load. However, there is considerable evidence that covert attention can be deployed several saccades ahead of voluntary eye movements (Henderson & Hollingworth, 1999; Peterson, Kramer, & Irwin, 2004). These results suggest that the difference between participants who can and cannot detect misdirection may be primarily due to differences in the allocation of covert visual attention (Kuhn & Findlay, 2010; Kuhn & Tatler, 2005). However, this explanation may represent an oversimplification of the actual complex mechanisms involved in effective misdirection. Thus, a better understanding of overt and covert attention could provide insight into the psychological mechanisms by which magicians modulate attention.

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2016 Pupil Dilation and Attention Studies on misdirection have traditionally relied on eyetracking, but eye movements offer an incomplete picture of the mechanisms underlying misdirection. Ocular movements are a measure of overt attention, but the current literature suggests that misdirection is a result of the effective manipulation of covert attention. Researchers can instead use pupil dilation as an indirect index of attention. Two antagonistic smooth muscle groups control the opening through which light enters the eye. The sphincter constricts the pupil, and the dilator increases pupillary diameter, as seen in Figure 1. Pupil diameter offers a more direct and objective measure of processing load, especially given that it is regulated by the sympathetic nervous system, which is not under direct voluntary control (Loewenfeld, 1993). Pupil dilation can also give insight to cognitive processes taking place under the threshold of awareness (Bijleveld, Custers & Aarts, 2009). Hence, pupil size variations can reflect cognitive processes that are occurring even if the participants are unable to access that information. Using pupillometry to investigate automatic cognitive processing allows for the study of attention under high levels of ecological validity whilst retaining a high degree of experimental control. Methodological rigour is crucial in pupil dilation experiments as it is often difficult to isolate what is truly being measured using psycho-physiological methods (Seeber, 2013). Experiments, such as misdirection paradigms, most effectively incorporate pupillometry when they are tightly controlled, use isolated stimuli and have short periods of interest (Seeber, 2013). We wanted to isolate the pupil size variation related to fluctuations in cognitive processing load, which is responsible for about 0.5mm of the change in pupil size (Beatty & Lucero-Wagoner, 2000). The

literature linking changes in processing load, cognitive effort, and use of attentional resources with pupil dilation has been highly consistent (Beatty, 1982; Kahneman, 1973; Kahneman & Beatty, 1966; Laeng, Sirois, & Gredeb채ck, 2012). Apart from drugs, the pupil additionally reacts to three kinds of stimuli: luminosity, emotions and cognitive activity (Seeber, 2013). Since the pupil also responds to ambient illumination (Clarke, Zhang, & Gamlin, 2003), we took great care to prevent such confounds by holding illumination constant. In general, previous findings indicate that we can employ pupil dilation as an indirect continuous measure of cognitive load during attentional processing. The Current Study The current experiment used the threecard Monte illusion as a misdirection paradigm to examine the underlying facets of effective misdirection. We chose to use the three-card Monte due to its clear goal, instant feedback (participants immediately learn whether they were right or wrong), and versatility. The subjects had to follow a target card while a magician shuffled the card along with two other cards. The trick worked by making them believe that it was a fair game of visual acuity, but in reality it was a rigged game that relied on the use of a sleight-ofhand. Under normal circumstances, the target was easy to locate, but when a sleight-ofhand was present, the target card would not end up in its predictable position. The key misdirection used by the magician manipulated the attention of the subject away from the target card by surreptitiously switching the target with a dummy card. A high proportion of participants were unable to recognize that the magician had switched the target card. Instead, the routine was often perceived as a game of skill; subjects would mistakenly believe that their error was due to 186

2016 either an increase in shuffling speed by the magician or because they lost sight of the target. In a controlled environment, pupil variation coupled with the three-card Monte illusion may reveal additional cues as to how individuals perceive and respond to misdirection. The present study aimed to (1) further validate pupillary response as a measure of cognitive processing load and (2) examine the components of effective misdirection. Based on previous work, we suggested that effective misdirection could persist because participants do not alter their visual search strategy even after multiple exposures to misdirection. This is due to a lack of viable alternative strategies rather than a misallocation of attention. We predicted that naïve individuals (i.e. those unfamiliar with the concept and practice of misdirection) would experience a larger pupil dilation effect in the sleight-of-hand condition even after multiple exposures to the three-card Monte routine. Methods Participants 124 undergraduate students (116 women and 8 men) from the Department of Psychology at McGill University participated in this study in return for token extra credit. Ages ranged from 18 to 25 years (mean±SD=20±1.5 years). A screening filter used by the Department of Psychology granted permission only to those who met study restrictions: inclusion criteria consisted of normal or corrected-tonormal vision; exclusion criteria consisted of use of hard contact lenses (due to interference with the infrared camera used by the hardware) and any previous experience with magic. Of the 124 participants, only 60 (53 women and three men) met the strict calibration criteria we imposed for data analysis. In the final sample, ages ranged from 18 to 25

years (mean±SD=20±1.4 years). The Jewish General Hospital Research Ethics Committee (Montreal, Quebec, Canada) approved this research study. Apparatus We used a desktop-mounted EyeLink 1000 system with a 2000 Hz sampling rate (SR Research, Mississauga, ON, Canada), 35 mm monocular PENTAX lens, and a chinrest. The viewing configuration was set to a stabilized head, monocular (right eye) mode. We presented the video stimuli on a 22 inch widescreen Samsung SyncMaster 2233 HD monitor set 605 mm from the center of the screen (615 mm to top of screen, 625 mm to bottom of screen) to the eyes of the participants, as fixed in place by the chin-rest. The viewing window consisted of a 4:3 aspect ratio, 1024x768 pixel display area with display corners set 197.5 mm horizontally and 148 mm vertically from the center of the screen. Eye movements were calibrated with a 9point grid with inclusion criteria set to an average of 0.5 visual degree of error or less, and a maximum of one visual degree of error or less for any one fixation target in the calibration grid (Holmqvist et al., 2011). We controlled for illumination by using a single light source situated above the participants to cast an even, diffuse white light that would not be overpowering. The lamp utilized a 13-watt compact fluorescent light rated at color temperature of 4100-Kelvin cool white in appearance and 900 lumens in output. To keep the rest of the room dark, black curtains surrounded the testing station. All other light sources were turned off. Stimuli and Variables We created video recordings of four variations of a three-card Monte routine. Each version had the same target: the Queen of Hearts. For sharp contrast, the dummies con187

2016 sisted of a six of clubs and/or a six of spades. We named the four versions Flat, Bent, BentCorner, and Torn (Figure 2). Each threecard Monte version also had a Normal condition and a Sleight-of-hand condition (in which misdirection is applied and the target quietly switched with a dummy using sleight -of-hand). We labeled the misdirection variable Deception in the statistical analyses. We cropped the video stimuli to include only the torso and hands of the magician in order to limit the influence of social cues in magic perception (Kuhn, Tatler, & Cole, 2009). We strictly enforced visual congruence between the two conditions during the filming process such that the videos looked identical to a typical viewer. Procedure Participants were told in advance that they would be watching magic tricks and that their job was to track and locate the target card (the red queen of hearts versus two black dummy cards) after the shuffle. After calibration, all participants watched the same sequence of 3-card Monte videos presented in full 720x480 resolution: Habituation (3 trials), and then the experimental conditions Flat (2 trials), Bent (2 trials), BentCorner (2 trials), and Torn (2 trials). We presented each of the four versions in both the Normal condition and the Sleight-of-hand condition. There were an equal number of Normal and Sleight-of-Hand videos presented. Each participant completed 11 experimental trials (three from the Habituation portion and eight from the actual experiment portion). See Table 1 for details. We first habituated participants to the experimental paradigm by predicting the position of the target card in the Flat version, without misdirection, three times. The target ended up in each of the three possible positions once (left, center, right). This data was

not included in the analyses. We presented the four variations (Flat, Bent, BentCorner, and Torn) in random order. We presented each variation twice: once with Sleight-ofhand and once without. The order of presentation was counterbalanced. We decided to incorporate four variations because previous literature indicated that participants become less susceptible to misdirection when the same magic trick is repeated using the same method (Kuhn & Tatler, 2005; Kuhn & Findlay, 2010; Kuhn & Martinez, 2012). We split each video into two continuous parts. Participants watched the first half, called Trick (Figure 3), where the cards are first presented and shuffled. Following the shuffle, participants made their predictions and provided a confidence rating on a fivepoint Likert scale. The last frame of the video was paused and remained onscreen until participants finished making their predictions. Immediately afterwards, participants viewed the corresponding â&#x20AC;&#x153;revealâ&#x20AC;? video, which showed participants the true position of the target and allowed them to visually assess the accuracy of their prediction, i.e., the feedback. The eyetracking camera recorded all real-time gaze fixations and pupil dilations for the duration of the study. We collected three types of measurements to assess the durability of misdirection: Latency. Response latency is the time elapsed before the participants had to guess the location of the target card and the time that elapsed when they had to choose a confidence rating. Accuracy. (A) Correctness is the percentage of correct answers across all experimental trials. (B) ShouldHave is short for should have picked this one and is a measure of effective misdirection. While shuffling, the magician leads the target into the predetermined outcome position. If misdirection is 188

2016 present, then the target does not end up in its normal predetermined outcome position. ShouldHave compares the predetermined outcome position—regardless of the presence or absence of misdirection in the trial—and the actual answer of the participant. Thus, a participant should always choose the predetermined outcome position if misdirection fooled them. ShouldHave is the percentage of matching responses between the predetermined outcome position and the answer of the participant. (C) Confidence ratings of the participants’ predictions were made on a Likert-scale of 1 to 5 (1 = not very confident, 5 = very confident). Pupillometry.(A ) We compared change in the baseline maximum pupil size during the critical period when the trick ends to the maximum pupil size during the critical the period before the Reveal of the target card. The first critical period lasts from the end of the Trick when the magician finishes shuffling the cards to when the magician presents the cards on the table, and the second critical period lasts from the moment the magician flips the target and makes it fully visible until the video ends. We also compared the maximum pupil size during the critical period before the Reveal of the target with the maximum pupil size after the Reveal. The first critical period lasts from the beginning of the Reveal until the magician touches the first card to be flipped, and the second critical period lasts from the moment the magician flips the target and makes it fully visible until the video ends. (B) Pupillary response latency is the time elapsed from the start of the Reveal to maximum pupil dilation. The Reveal starts as soon as the magician flips the target and makes it fully visible, and ends when the video terminates (refer to Table 1).

Results We conducted three sets of related analyses to test the overall hypothesis that misdirection is durable. All statistical analyses used the IBM SPSS version of Statistics 20.0 (IBM Corporation, August 2011) for Windows 7. Latency Analysis The response latency analyses consisted of a dependent sample t-test to determine if the response latency would differ between the moment of deliberation when the participants had to guess the target card location and the period during which they had to choose a confidence rating. The hypothesis stated that if participants were unaware of misdirection, they would spend less time deliberating on which confidence rating to choose. Accuracy Analysis The accuracy analyses consisted of three separate dependent samples t-tests to determine the extent to which “Correctness”, “ShouldHave” and the average confidence rating proportions differ between Normal versus Sleight-of-hand conditions. I hypothesized that if misdirection is durable, then Correctness will be different between conditions, but ShouldHave will not. The average confidence rating for each trial condition should also not differ between the deception variables, as participants should not be able to differentiate between the Sleight-of-hand and the Normal conditions. Pupillometry Analysis The pupil response can occur as quickly as 200 ms after the presentation of the stimulus (Lowenstein & Loewenfeld, 1962), although dilation as a response to cognitive load is usually slower and begins with a delay of 300 to 500 ms (Beatty, 1982). The peak 189

2016 amplitude of pupil dilation (i.e., maximum pupil sizes) typically occurs approximately 900-1200 ms after the beginning of an experimental trial (Beatty, 1982). We measured the peak amplitude of pupil dilations during three periods per Monte routine: the critical period lasting about 4 seconds after the trick ends, the baseline critical period lasting about 4 seconds immediately before the reveal of the target card, and the comparison critical period lasting about 4 seconds right after the reveal. Thus, most peak amplitudes occurred within the recording interval. The first pupillometry analysis consisted of a repeated measures 2-Way ANOVA to determine whether pupil size changes would differ between viewings of Normal and Sleight-of-hand routines, as well as between the four Monte versions. A lack of difference in pupil variation before the reveal of the target card would show that the participants do not suspect the presence of deception. A second pupillometry analysis that consisted of a repeated measures 2-way ANOVA then compared maximum pupil size between the start and the end of the reveal of the target card. Presuming that only seeing the answer is more cognitively demanding than viewing the cards facedown, we subtracted the baseline maximum pupil size before the reveal of the target card from the maximum pupil size both before and after the reveal of the target card for each of the trials. A third pupillometry analysis consisted of a repeated measures 2-Way ANOVA to determine if the response latency, i.e., the time elapsed from the start of a critical period after the reveal to the peak pupil dilation, would differ between the conditions and their respective levels. If misdirection is durable, then pupil size contrasts and latency should both differ across conditions as participants evaluate the accuracy of their answers amongst the three possibilities.

Hypothesis Testing Outcomes Latency Analysis The results of the dependent samples ttest supported the hypothesis that if misdirection successfully fooled the participants there would be a difference between the reaction times in the two settings. The reaction time when choosing the confidence rating was much shorter (Mdifference = 1014.50, SEdifference = 95.71, 95% CI [826.58, 1202.43]) than when guessing the location of the target card. This difference was statistically significant, t(670) = 10.60, p < .001 (refer to Table 2 for descriptive statistics). Accuracy Analysis The results of the dependent samples ttest supported the hypothesis that if misdirection is durable, then Correctness will be different between conditions, but ShouldHave and the average confidence ratings will not (see Table 3 for descriptive statistics): The presence of Sleight-of-hand resulted in a marked decrease (Mdifference = .84, SEdifference = .02, 95% CI [.79, .89]) in the accuracy of participant answers. This difference of means was statistically significant: t(59) = 35.45, p < .001, 2-tailed. The presence of Sleight-of-hand resulted in a small increase (Mdifference = -.01, SEdifference = .02, 95% CI [-.05, .04]) in the ability of the magician to get participants to select the predetermined outcome position. This difference of means was not statistically significant: t(59) = -.38, p = .71, 2-tailed. The presence of Sleight-of-hand resulted in a small increase (Mdifference = -.30, SEdifference=.11, 95% CI [-.64, .05]) in the average confidence rating of the participants. This difference of means was not statistically significant: t(3) = -2.76, p = .07, 2-tailed (refer to Table 3). We calculated the average confidence rating for each trial condition (found in 190

2016 Table 4), and we assessed the confidence scores for a linear relationship over time (found in Figure 4). Pupillometry Analysis We followed the guidelines set forth by Girden (1992) for interpreting values of Epsilon for the results. We chose the GreenhouseGeiser correction for violations of sphericity due to its conservative nature and as a compromise between the more liberal HuynhFeldt correction and the even more conservative Lower-Bound correction. The results of the ANOVA supported the hypothesis that if misdirection is durable, then pupil size contrasts should differ across conditions, and latency should also differ across conditions as participants evaluate the accuracy of their answers (see Figure 5 for a visual representation of the difference in means). During the critical period between the end of the magic trick and the start of the reveal of the target card, the effect of the version of the three-card Monte on maximum pupil size was not statistically significant, F (2.68, 479.55) = 2.53, p = .06. The magnitude of pupil dilation between the end of the trick and the target reveal onset was similar across blocks. The Normal or Sleight-of-hand condition also did not exert a statistically significant main effect on the maximum pupil size, F(1, 179) = 0.95, p = .33. Interestingly, there was no interaction effect between the conditions Deception and Monte Version (refer to Table 5 for descriptive statistics). The maximum pupil dilation measured between the start of the reveal of the target card and the end of the reveal showed a significant main effect of Deception, F(1,179) = 17.40, p < 0.001. The difference between the pupil dilation was larger during the Sleight-ofHand condition (134.7 pixels) than for the Normal condition (96.7 pixels). The main effect of Monte version was not significant, F

(2.82, 504.34) = 2.51, p = 0.06. Despite these results, the pairwise contrasts between tasks was significant for the Torn Monte version (138.9 pixels) when compared with each of the Flat (109.1 pixels), the Bent (106.0 pixels), and the BentCorner (108.9 pixels) Montes. In addition, we noted a statistically significant interaction between Monte version and Deception, F(2.65, 473.74) = 3.19, p < 0.05. Thus, during the Torn Monte version, pupil dilation difference was especially bigger during the Sleight-of-hand (172.5 pixels) when compared to the Normal condition (105.3 pixels). Table 6 lists the relevant descriptive statistics. We found a statistically significant interaction effect between Monte Version and Deception for the response latency, F(2.57, 151.50) = 14.47, p < .001. The main effect of Monte version, (F(3, 177) = 8.11, p < .001), shows longer overall response latencies for Torn (6126 ms) than for Bent (5809 ms), Flat (5565 ms) and BentCorner (5054 ms). Deception also exerted a statistically significant effect on the response latency, (F(1, 59) = 48.04, p < .001), indicating that responses to Sleight-of-hand routines (6279 ms) were markedly longer than Normal routines (4998 ms). Refer to Table 7 for descriptive statistics.

Discussion A systematic scientific analysis of the cognitive mechanisms utilized in magic has only recently begun, although attempts to establish a relationship between magic and psychology are not new (Wiseman, 1996). Given this overall situation, further research using magic techniques as a vehicle to extract nuanced information about the mechanisms that underlie the behavioral basis of consciousness seems necessary (Macknik et al., 2008). Crucially, magical techniques performed in a controlled environment provide a robust set of cognitive and perceptual manipulations to aid the exploration of the neu191

2016 ral mechanisms and behavioral underpinnings of consciousness, attention, and visual perception. Our study follows the recent renewed interest in using magic techniques as a tool to naturally direct eye movements by using the 3-card Monte routine, a misdirection paradigm, to address the construction of top-down processes influencing attention. In search of the effects of misdirection on covert attention performance measures, we used the pupil response to examine the effects of expectation and attention on cognitive processing load during visual processing. The experimental results are consistent with previous findings and show that misdirection is durable after multiple uses; participants persist to perform poorly in the presence of misdirection even when they have access to instant feedback. Furthermore, pupil diameter reflects variations in processing requirements within tasks as well as between tasks. The present results confirm that participants are aware that misdirection fooled them, but even when they anticipate misdirection, they fail to develop other problem-solving techniques. The durability of misdirection may thus be due to a lack of alternative strategies rather than due to a misallocation of attention. Accuracy Our participants performed poorly and remained consistently wrong in the presence of misdirection. They showed an 84.17% reduction (p < .001) in the accuracy of their answers when a sleight-of-hand was present. Accuracy was 92.08% with a Normal shuffle, but dropped to 7.92% when we used a Sleight-of-hand. Furthermore, even after multiple exposures, participants chose the predetermined outcome position nearly every time. These results seem to indicate that participants kept reusing the same unsuccessful strategy even when they had access to

instant feedback telling them whether they answered correctly or not. The sleight-ofhand shuffles even resulted in a small increase of 0.8% in participants selecting the predetermined outcome position (91.67% for Normal shuffles versus 92.50% under misdirection). Additionally, participants averaged 4.11 on a five-point confidence scale under misdirection and 3.81 with a Normal shuffle. Despite their poor performance at detecting misdirection, participants showed a heightened sense of confidence. The reaction time data supported these results. The participants were either unaware of or uninterested by the deception, as they did not spend additional time to deliberate on the confidence rating following the guess of the target card location: the time spent deciding on the confidence rating (1234 ms) was much shorter than for the card choice (2249 ms). Overall, the presence of misdirection seems to have exerted little influence on the decisionmaking behavior of participants, whereas it exerted a strong influence on their accuracy. Cognitive Load Our results establish pupillary responses as a physiological marker of cognitive load by demonstrating that pupil size significantly enlarges only when comparing the trials before and after the reveal of the target card. Misdirection led to no difference in pupil size variation between the ending of the trick and before the reveal of the target card, for the four different 3-card Monte variations (Flat, Bent, BentCorner, and Torn) and for the presentation of the videos with and without deception. The lack of variation in reaction to the different Monte versions demonstrates that participants do not distinguish or are not interested in identifying the difference between the hypothesized complexities of the 3 -card Monte versions (with Torn having the easiest target card to follow, followed by 192

2016 BentCorner, Bent, and finally Flat). However, a larger difference in the maximum pupil size before and after the reveal of the target card was present across all trials: 134.7 pixels for the Sleight-of-hand condition compared to 96.7 pixels for the Normal condition (p < .001). In line with other researchers who have repeatedly shown that larger pupillary responses were positively correlated with the difficulty of the task (Hess & Polt, 1964; Hyönä, Tommola, & Alaja, 1995; Kahneman & Beatty 1966), our results seem to show that the more challenging Sleight-of-hand condition was associated with greater cognitive effort, as indicated by a larger pupil response, than the normal condition. Using the pupillary response as an indicator of processing load, the latency data generally replicated the differences obtained. A longer response latency should typically accompany a larger pupillary response. As such, responses (p < .001) in Sleight-of-hand feedback (6279 ms) were much longer than during Normal feedback (4998 ms). Our results are consistent with the long-standing association of the variation of cognitive effort with the variation of pupil dilation that the pupillometry literature has extensively documented (Laeng et al., 2012). The variation in the task difficulty level of the Normal and Sleight-of-hand conditions are likely to be partly attributable to differences in the nature of the two cognitive tasks. We need greater cognitive effort to make sense of the reveal if the target fails to show up in the predetermined outcome position. On one hand, we can assume that the Normal condition is a simple perception task— the participant does not need to make further sense of the results, as the target card will end up where it was expected. On the other hand, the Sleight-of-hand condition is likely a reasoning task, as the card will not end up where it “should” have been, because it in-

volves deceit. These results concur with the summary of the peak amplitudes of pupillary response in different cognitive tasks compiled by Beatty (1982), which indicated that a perception task induced lower levels of pupil dilation than a reasoning task. Our results highlight naïve individuals’ inability to either detect or perform well when they face misdirection although they seem aware of its presence. In addition, we found that pupil size variation differed between the four different 3card Monte routine variations for the Torn Monte only. The Torn Monte (138.9 pixels) led to a much larger dilation than for the Flat (109.1 pixels), Bent (106.0 pixels), and the BentCorner (108.9 pixels) routines. There was no significant difference in pupil dilation between the Flat, Bent, and BentCorner Montes. Further empirical support comes from the latency data. Longer response latency typically accompanied a larger pupil contrast: Torn (6126 ms), Bent (5809 ms), Flat (5565 ms) and BentCorner (5054 ms). Taking into account the fact that previous findings have continuously been able to show that pupillary response varies as a function of task difficulty (Hess & Polt, 1964; Hyönä, Tommola, & Alaja, 1995; Kahneman & Beatty 1966), one possible explanation is that the Torn Monte version was the only one that was visually different from the other Monte versions. Torn may have produced the largest pupillary response because a corner of the target was physically torn before the shuffle, hence it is easier to distinguish. In the eyes of naïve participants unfamiliar with magic tricks, the target card in the Torn condition would be substantially more visually salient since they did not know what to pay attention to in the other conditions. Hence, the hypothesized difference in the difficulty of the Monte versions might only apply to individuals familiar with magic tricks. 193

2016 The theoretical and practical implications of attentional processing make it important to have independent and reliable real-time measures of cognitive load. Kahneman (1973) proposed three criteria for any valid physiological indicator of processing load and the present study was able to provide evidence for the first two criteria: pupil diameter as reflecting variations in processing requirements within task as well as between tasks. Additionally, evidence for the third criteria— presence of individual differences in the ability to carry out a cognitive task—has been demonstrated previously (Ahern & Beatty, 1979; Antikainen & Niemi, 1983). Taken together, these findings establish the validity of pupil response as a measure of cognitive processing load. Effective Misdirection An alternative explanation for the difference in pupillary size addresses the role of expectation in guiding both covert attention and the eye. Attentional capacity is susceptible to top-down influences. Individuals often process events based on expectations rather than transcribe an objective recording of the physical reality. The magic trick—the 3-card Monte—served as a cognitive illusion and we presumed that making sense of the routine when it differed from expectation required a higher degree of cognitive processing than when the result met expectation. The key to selecting the correct location of the target card was first to recognize that the game was rigged and then to adapt the attentional strategy to detect the sleight-of-hand. Instead, participants often believed they had lost sight of the target because the card shuffling happened too fast. Effective misdirection may operate by making use of the preconceived notions the participants have about the illusion. Numerous studies have provided compelling evidence that expectation

affects perception at the neural level (Bunzeck, Wuestenberg, Lutz, Heinze, & Jancke, 2005) as well as the detection of unexpected stimulus (White & Davies, 2008). When people expect a certain result, they tend to block out other possibilities and exclude important changes in the scene (Rohenkohl, Gould, Pessoa, & Nobre, 2014), e.g., failing to notice a sleight-of-hand maneuver that switches the target card during the shuffle. Therefore, if participants believe the shuffle was too quick or that they had momentarily lost sight of the target then they would not try to alter their attentional strategy. To beat the game, they would have had to be more flexible in their visual search strategies by restructuring their understanding of how misdirection works. Participants had to realize that the shuffle may be rigged and then adapt their strategy, but prior expectations impeded their performance by making them persist in the use of a single unsuccessful solution. Through identifying pupil dilation as an indirect marker of cognitive load, the present results inform theories on the mental processes underlying misdirection and brings us one step closer to understanding how participants are processing magic tricks in real time. The presence of larger pupil dilations and longer latencies highlight naïve individuals’ inability to either detect or perform well when faced against misdirection, even though they are aware that they are doing something wrong. However, awareness of misdirection may not confer an advantage in countering its effects. From this perspective, our pupillometry findings fit into the idea that expectation influences how we attend to information and therefore what does or does not enter our conscious experience. The durability of misdirection likely exists as a cognitive illusion—that of a fair game of skill. As long as participants believe there is only one 194

2016 strategy to counter misdirection, wrong answers may reinforce their false belief that they should focus their attention on tracking the target. In return, their wrong attentional strategy would make them neglect other important aspects in the scene such as the hands of the magician. Therefore, the durability of misdirection may be mainly due to an inability to restructure the problem rather than due to a dysfunction of covert attention allocation. Caveats Several limitations apply to the current findings. First, the scope of our investigation provides limited information on the entire range of cognitive mechanisms at play during magic perception. Furthermore, convenience sample was composed mostly of female participants (95%) as the recruitment method we employed mainly recruited from the psychology department. Another potential limitation of our methodology is that the increase in pupil size and latency is unlikely to be entirely due to a greater cognitive load, and may be partly due to increased arousal (Seeber, 2013). Although we were able to control for variation in illumination, part of the change in pupil size could also have been a reflection of the stronger emotion of surprise that came with a violation of expectation elicited by errors, uncertainty, and competitive desire to get the right answer (Partala & Surakka, 2003; Stelmack & Mandelzys, 1975). Furthermore, our analyses drew on data from only 60 of the 124 participants. One reason for this large exclusion has to do with the strict calibration criteria for data analysis: we looked at both the average and the maximum visual degrees of error. Unlike previous investigations that excluded only 22.2% of participants due to poor data, we used no pre-processing or interpolation of the pupil dilation data (cf. Murphy, Robert-

son, Balsters, & Oâ&#x20AC;&#x2122;connell, 2011). Despite the exclusion of half the datasets, the size of the final cohort ensured that the observed effects were unlikely artifacts. The randomized presentation of the trials represent an important strength of the experiment. It eliminated a possible source of confounding due to any carry-over effect from training and counterbalanced the effects of multiple exposure to misdirection. Future studies should control for the limitations present in the current study. Conclusion This study examined effective misdirection using pupillary response to index cognitive processing load. A larger pupil size resulting from a violation of expectation occurred in the presence of misdirection, such as a sleight-of-hand, indicating that participants were aware that they made an error. The larger dilation seems to indicate that we process a magic trick whether or not misdirection is involved. We suggest that the expectations of the participants may be the reason behind the persistence of misdirection as they may lead the observer to focus on one unsuccessful strategy instead of trying alternative options. Therefore, the efficacy of misdirection may not be mainly attributable to the manipulation of covert attention but rather to a lack of flexible thinking. These findings enhance our understanding of how topdown processes affect pupillary response, and could have implications for how we recognize and process misdirection outside of conscious awareness. Expanding upon this study could be invaluable in elucidating the mechanisms underlying the control of attention.

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Comparing and Contrasting Housing Interventions for Persons with SMI

Natalie Winicov

Abstract The State of Homelessness in Canada 2014 Report estimates that over 235,000 Canadians will experience homelessness in a year, with anywhere from 20 to 40% of this population suffering from a severe mental illness (SMI). With the issue growing to the point of being a national crisis, policy makers are beginning to look at alternative methods in dealing with homelessness. This paper discusses the different housing interventions and their effectiveness in regards to recovery promotion, with the term “recovery” encompassing improvement in multiple areas. This review examines the three major housing intervention models for persons with severe mental illness and the interventions’ consistency with the recovery paradigm. The housing models discussed include: supervised housing, congregate housing, and Housing First. Additionally, emergency shelters and absolute homelessness are reviewed in order to provide a comparison from pre- to post-intervention. Aspects considered in assessing a housing model’s effectiveness are stigma reduction, autonomy promotion, cost, retention, engagement and social support. This is a structured review that drew information from personal communication with Dr. Whitley and published articles found through PubMed, the McGill library, PsycINFO, and PsycArticles. All of the housing interventions provided superior results in comparison to absolute homelessness and emergency shelters. With respect to retention and cost, data suggests that Housing First surpasses the other two models, reaching retention rates as high as 87% (New York Housing Study) and fewer per capita costs, hospitalizations and incarcerations. Still, research provides mixed results for all housing interventions and further follow-up research should be conducted as the issue of homelessness gains an increasing amount of the public’s attention.

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2016 Introduction In the last 30 years, Canada has experienced a dramatic reduction in rental housing, individual income and occupational benefits, forcing Canadians to spend an increasing proportion of their income on housing. In the last 20 years, government investment in affordable and social housing has drastically decreased, putting more Canadians at risk of becoming homeless and contributing to the advancement of homelessness as a national crisis. Homelessness is defined by the Canadian Homelessness Research Network (CHRN) as “…the situation of an individual or family without stable, permanent, appropriate housing, or the immediate prospect, means and ability of acquiring it.” The State of Homelessness in Canada 2014 report estimates that over 235,000 Canadians will experience homelessness within a year, and that anywhere from 20 to 40% of this population suffers from a severe mental illness (SMI) (Gaetz, Gulliver & Richter, 2014). Homeless individuals with an SMI are in a particularly vulnerable position; they must deal with psychiatric distress while fighting to survive on the streets. This demographic experiences a disproportionate amount of victimization, as well as substance abuse, stigma, incarcerations and lack of resources. With the issue growing to the point of being a national crisis, policy makers and practitioners are searching for alternative methods in dealing with homelessness. This paper discusses the different housing interventions and their effectiveness in regards to recovery promotion, with the term “recovery” encompassing improvement in multiple areas. Emergency Shelters Following the massive societal shift from

institutionalization to community services in the 1960’s, the use of emergency shelters increased significantly: it is estimated that in the span of a year, over 180,000 homeless individuals will stay in an emergency shelter (Gaetz, Gulliver & Richter, 2014). These establishments are now the most common form of respite from homelessness, serving as a stop-gap measure by providing basic needs such as shelter and meals, typically on a night-to-night basis. Grella (1994) appropriately describes the system as such: “rather than facilitating a transition to permanent and/or stable housing…the shelter provided temporary, and sometimes episodic, respite from homelessness.” The episodic nature of shelters is exemplified in a study which found that 43% of the men who used shelters stayed for a week or less (Ellen & O’Flaherty, 2010, p. 63). For people with SMI, shelters offer a better alternative to life in a hospital or on the streets but lack the necessary resources to support the autonomy and security that permanent housing can. Beyond lacking mental health resources, shelters are typically encumbered with violence, theft, bedbugs and illness, resulting in brief shelter stays that end in a return to street life. Shoe theft is particularly common and attenuating, and despite having a sobriety requirement, shelters can become centers from which drug sales operate, adding a new element of danger to the environment. Maslow’s hierarchy of needs places physiological needs and safety needs at the bottom, and the theory suggests that the most basic level of needs must be met before the individual can achieve less essential needs. When homeless individuals with a SMI have no access to the most basic requirements such as food or a secure place to sleep, it is quite audacious to expect them to focus 203

2016 on sobriety or mental health treatment. Autonomy is almost non-existent in most emergency shelters, where requirements often include sobriety, certain personal characteristics (gender, age), personal hygiene, adherence to curfew and wake up times, and participation in group chores. Residents typically have to line up in the late afternoon every day to secure their spot in the shelter, which poses a problem for someone who performs shift work and needs to work during this time. It is counterintuitive to encourage individuals to find work while requiring that he or she is available to stand in line during standard shift hours. These factors present a major obstacle from the very beginning, and actually perpetuate the chronicity of an individual’s homelessness, and seeing as the chronic homeless make up 8% of Canada’s shelter population but use 40% of its resources, this should be avoided at all costs. In other words, chronicity is expensive. Exceeding of the time limit or failing to maintain sobriety also warrants termination of shelter stay. One in five shelter clients, typically those with SMI, experience an imposed departure because they are deemed as disruptive or non-compliant by shelter co-residents and staff (Rothwell, 2015). Others find themselves so overwhelmed by the chaotic and unsafe environment of a shelter that they choose to return to the streets. Even when an individual is able to stay in a shelter for a period of time long enough to be considered ‘housing ready,’ there are scarce resources to achieve permanent housing.

Supervised Housing To address the need for more permanent housing options for homeless individuals with SMI, practitioners designed the supervised housing intervention with the intent of providing longer-term housing with more

intensive mental health treatment. This system takes the ‘treatment first’ approach, wherein in exchange for a bed and supportive services, the client must comply with program rules such as treatment compliance and total sobriety. Twenty-four-hour care is provided by live-in or on-call staff and the consumers assume the role of a patient (Nelson, Aubry, & Lafrance, 2007). The supervised housing model commonly takes the form of board-and-care homes or foster homes in congregated areas, with support services such as medication management and meals. These types of programs also enforce curfews, visitation regulations, mandatory policies to put aside savings, assigned roommates, and consequently result in a forfeit of privacy. Consumers have limited choice in most facets of their lives, and a study by California, Segal & Kotler (1993) suggests that the structure of supervised housing actually resulted in a decrease in independent social functioning and an increase in assisted social functioning. Solely based on episodes of homelessness and hospitalizations, studies suggest that compared to standard post discharge treatment from a psychiatric hospital (i.e. shelters, staying with friends) supervised housing leads to higher housing retention and fewer hospitalizations. Lipton, Nutt, & Sabatini (1988) found that after twelve months, 69% of their custodial-based experimental group were living in permanent housing and were homeless for a mean of 6% of nights after placement. In comparison, 30% of the control group were permanently housed after 12 months and spent a mean of 46% of nights homeless. In terms of hospitalizations, after 12 months, 8% of the experimental group were in the state hospital versus 22% of the control group. On the other hand, Browne & Courtney (2004) determined that compared to people living in their own home, boarding 204

2016 residents with schizophrenia were significantly more likely to be admitted to hospital despite displaying no differences in suicidality or delusions/hallucinations. This certainly has financial implications: there is a difference of approximately $500 per day between the cost of residential treatment and hospitalization (Lipton, Nutt, & Sabatini, 1988). All of this said, the primary focus of this paper is the housing intervention’s consistency with the recovery paradigm. Murphy (1976) found that in a side-by-side comparison of patients in a psychiatric hospital and custodial-housed clients, there were no differences in recovery outcomes, nor did they show improvements in either sociability or social functioning. A lack of support and opportunity may account for this, as Browne & Courtney’s (2004) study found that boarding house occupants (in this case, individuals with schizophrenia) exhibited more problematic scores on the “cognitive scale, the physical illness scale, supportive relationships scale, the suitability of the accommodation scale and the opportunity for useful and meaningful occupational and recreational activities scale.” Perhaps this is in part due to the isolated, micro-institutional nature of supervised living: Browne and Courtney (2004) reported that boarding situations typically offer less opportunity for social support than independent living, despite the presence of other residents, partly as a consequence of the stigma that accompanies the grouping of people who share a mental illness. According to Ridgway & Zipple (1990), regardless of the house’s setting, residents of supervised houses have reduced contact with the broader community and may avoid outside interactions in expectancy of social rejection. A study which surveyed mental health service consumers’ preferences for housing and support concluded that the majority preferred not to live with other mental health

consumers, demonstrating a desire to not be congregated on the basis of disability (Tanzman, 1993). Structure and routine, essential components of recovery, do not seem wholly feasible in the supervised housing structure. Dayto-day routines, such as cooking, cleaning and washing, are done under supervision and in shared spaces (communal bathroom facilities and group meals), and chores are assigned rather than chosen as part of one’s schedule. Because guests are rarely allowed into homes, the prospect of developing a romantic relationship, another important aspect of recovery, is very difficult. A client bringing a potential romantic partner to their supervised home for people with SMI could simply fuel a cycle of shame and isolation. Browne & Courtney’s (2004) finding that boarding house occupants had worse scores on ‘suitability of the accommodation scale’ can be partially attributed to the physically poor state of most supervised homes. As a result of an overwhelming resistance from middle and upper class areas towards having group homes “in their backyard,” the houses typically reside in low-income and dangerous areas. This makes physical safety a prominent concern among residents, which is particularly relevant in the case of consumers with SMI. For example, Hiday et. al (1999) found that the rate of violent criminal victimization was two and a half times greater for people with SMI compared to the general population. With this in mind, it is not surprising that in 21 of the 26 studies that Tanzman (1993) reviewed, group homes were one of the least popular options for living, being preferred by only 0-7 percent of consumers with a severe mental illness. Additionally, the live-in staff component of supervised housing was not preferred over oncall, off-site staff by groups surveyed in Tanzman’s (1993) review of studies. 205

2016 Although retention for supervised housing models is better than control interventions, it suffers at the hand of sobriety requirements that serve as a massive obstacle for an individual whose basic safety and stability needs have not been met. This applies even more to clients with severe mental illness; according to Padgett, Stanhope, Henwood, & Stefancic (2010) approximately 50– 70% of persons who are homeless and have a severe mental illness also abuse substances. Advocates of the sobriety requirement argue that not having this condition would enable residents to continue substance abuse, despite a lack of evidence for this. The New York Housing Study (NYHS) found no difference in substance abuse between Housing First participants (abstinence was not required) and treatment-first participants (Padgett, 2006). Supportive Housing In an attempt to improve housing retention rates and decrease the isolation that is common among persons with SMI, the supportive housing model was implemented. This design affords the opportunity to eventually become ‘housing ready’ with emphasis on housing placements and independent living, but still operates under the assumption that “only a small, high-functioning group” can live completely autonomously immediately upon institutional discharge (Siegel et.al, 2006). There is no consensus on the definition of supportive housing, but the model is more of a spectrum that includes varying degrees of support, case management and independence. Some supportive housing interventions take the form of halfway houses or group homes, with one- or two-bedroom apartments clustered in small buildings. Other models involve a linear continuum whereby a client can progress through steps based on compliance and treatment response, with

the initial step being emergency shelter and the final step being permanent housing. Regardless of the precise configuration, this model is more consumer-driven and autonomy-promoting than supervised housing, with less intensive support. Studies suggest that the supportive housing model offers greater housing stability and retention rates than supervised housing interventions. Wong et al (2008) found that compared to controls, supportive housing clients spent more days in stable housing and 65.5% maintained tenure during the study period. Prior to entering supportive housing, 44.7% of clients utilized shelters, and after being housed, only 3.1% reported utilization, which significantly reduces costs: the average shelter bed costs $13,000 per year (Ellen & O’Flaherty, 2010, p. 49). Even more robust financial savings were implicated in hospitalization reduction: among those who maintained tenure, 13.5% used inpatient services compared to 29.5% of those left. Additionally, 23% of ‘stayers’ used emergency services versus 42.9% of ‘leavers’ (Wong et.al, 2008). Still, costs of supportive housing are significantly higher than independent living. The construction and staffing of a full continuum of housing is expensive and time-consuming, and once established, costs between $6,00010,000 per person per year (Ellen & O’Flaherty, 2010, p. 49). Several studies such as McHugo et.al’s (2004) study, among others, implies that supportive housing tenants show high levels of treatment and medication compliance, and an increased trust with support staff due to constant contact with the patient. Staff is better equipped to identify warning signs among their clients because of the close relationship that intensive case management affords. Furthermore, because the housing agency and treatment team are linked, clients can bypass the stigma that landlords may 206

2016 hold towards those with SMI, and service care providers can make choices that are in the best interest of the client rather than the landlord. SMI consumers with difficult behavioral problems are more likely to be housed initially and less likely to lose their housing because of problems that, in openmarket housing, could lead to eviction (McHugo et.al, 2004). If a client suffers from a relapse or declines in functioning, he or she can return to a setting on the continuum that offers more intensive care. The structure of group living in the context of supportive housing has profound advantages and disadvantages. As with any form of congregate housing, to group together people with SMI is to run the risk of further alienating them from the community and heightening their awareness of having a SMI. A house of residents with shared disabilities often gains a negative reputation from the surrounding community; for example, one individual describes her perception of group living as such: “I would not go to (this single-room occupancy hotel). They’re all crazy.” (Luhrmann, 2007). This stigmatization causes pressure among housemates to accept more normative social roles and condemn any ‘messed up’ behavior that may ‘give away’ their mental illness to the community (Whitley & Campbell, 2014). Having to hide a severe mental illness is yet another added stress in a client’s already unstable and trying situation. Moreover, living in a group environment alongside others struggling with substance abuse increases the likelihood of triggers and subsequent relapse. This has particular significance according to Bebout (1999), who found that among people with SMI, recovery from substance abuse is the strongest predictor of housing stability. On the other hand, a group commitment to recovery may result in increased motivation to abstain from substances and facilitates a

mutual support shared by residents experiencing similar difficulties. The majority of supportive housing programs make housing contingent upon progress and compliance, and clients do not have control over whom they share their living space with. Models that involve progression through different levels of autonomy pose a unique set of problems: the transition between individual stages is often stressful, there is the constant threat of demotion or eviction, and in reality, recovery very rarely moves in a linear fashion. This model also neglects the fact that many individuals with SMI suffer from skill-transfer deficits, so applying learned skills to a new setting (from stage to stage) may be particularly difficult. Even the individuals that are able to reach ‘housing readiness’ find themselves cut off from their support team upon discharge and left solely responsible for finding and maintaining permanent housing. Unlike the ‘Housing First’ approach, the supportive housing treatment program is often timelimited and the discharge to independent living situations may result in the termination of social services. This is despite the fact that although individuals with severe mental illness may be considered ‘housing ready’ after some time, they are rarely without need of any services. While evidence is mixed, studies support the claim that supervised and supportive housing have better housing retention and hospitalization reduction outcomes than shelter care but fall short in promoting the autonomy and social support facets of recovery. Thus arises the conundrum of how to promote autonomy and social support without sacrificing housing retention and reduction in hospitalization. Housing First The Housing First model (HF) is a more 207

2016 recent intervention model (1992) which emphasizes immediate placement into permanent, affordable housing. Rent is typically 30% of the consumer’s income, and the consumer has the same rights as any apartment tenant would on a standard lease. Support and mental health treatment services are provided in the form of Assertive Community Treatment (ACT) teams and intensive case management, off-site but on-call 24 hours a day. Unlike previous housing models, HF operates on the principles of consumer choice, therefore housing is completely free of sobriety or treatment conditions. It takes a harm-reduction rather than an abstinence approach by having treatment staff engage in open and honest conversations with the consumer and teach practical strategies, taking into account the client’s readiness to change. The client defines their own treatment goals, and the staff serves as a facilitator rather than a caregiver. This paradigm shift in housing intervention is driven by the notion that housing is a basic human right, and should be available to people with an SMI and/or substance addiction without them having to prove that they are worthy of having a roof over their heads. But a fundamental question that arises from the proposal of HF is can individuals with SMI really live independently and actively recover? Studies suggest that yes, is it absolutely possible, and recovery in HF is equally if not more achievable in comparison to other housing models. The NYHS ruled that “a person’s mental health diagnosis is not related to his or her ability to obtain or to maintain independent housing” (Tsemberis et al., 2004, p. 654), and found that HF consumers had a retention rate of 87% over 4 years. Padgett’s (2006) study suggests that the HF model resulted in fewer psychiatric hospitalizations compared to traditional housing and less time spent homeless, con-

sistent with a multitude of studies reporting a dramatic increase in housing stability compared to supervised housing interventions. Figure 1 illustrates the superior housing tenure that HF achieves compared to linear residential treatment. These findings are not exclusive to Canada and the United States, either- in Amsterdam, 87.9% of the HF program users sustained their housing, 94% in Copenhagen, 92.9% in Glasgow and 79.4% service users in Lisbon (Lindovská, 2014). ACT is a crucial aspect of the Housing First model, and clients are typically required to meet with their program staff on a weekly or monthly basis. These meetings take place in the comfort of the consumer’s own home, where the staff and consumers can have open dialogue with the knowledge that any information given to their case manager cannot affect their residency - the staff is not the gatekeeper to housing. This is also to the benefit of the staff, as one ACT staff member explained: “we get to see people in their own environment, which is a lot easier clinically to assess people when they’re in their own surroundings” (Henwood, Stanhope, & Padgett, 2010). Emphasis is on consumer choice, so the consumer dictates which issues are addressed, ranging from medication management to employment seeking to help for a broken radiator. Compared to standard treatment, ACT yields more positive ratings of health and wellbeing as well as improved ability to meet one’s basic needs (Nelson, Aubry, & Lafrance, 2007). Coldwell & Bender (2007) found that compared with standard care users, ACT clients showed a 26% greater improvement in psychiatric symptom severity and experienced a 37% greater reduction in homelessness. Furthermore, if a consumer terminates their stay in the residence, treatment does not have to concurrently end, and the client can be followed by their staff for as long as they wish. 208

2016 Perhaps ACT and Housing First yield such positive results because of their focus on true recovery, including practical components such as employment, relationships, budgeting, and notably, autonomy. The HF model offers the highest level of autonomy among all the housing models, and engagement and retention prove to be far more effective when clients are able to actively participate in their own treatment decisions. Immediate housing placement affords “in vivo” learning, allowing clients to implement learned skills directly in the setting in which they live. The scattered-site nature of HF apartments places participants in normal environments, provides constant exposure to “normal” life and functioning individuals, and gives them the opportunity to participate in the community (Ridgway & Zipple, 1990). Scattered-site is also advantageous in reducing stigma towards individuals with SMI in comparison to congregated housing models. The design skirts the possibility of a single building becoming known as a “crazy house” and allows clients to observe and interact with people who do not have SMI, using these community members as role models for successful functioning. Critics of the HF model target its harm reduction approach, arguing that residents are enabled to continue substance use if their residency was not contingent upon abstinence (Wong et.al, 2008). Data does not support this claim; the NYHS study found that there was no difference in substance abuse between the Housing First participants and the treatment-first continuum participants (Padgett, 2006). On the contrary, Padgett et al (2009) found that Housing First participants were significantly more likely to have low/no substance use in a year than the Treatment First participants. Among the 31 TF consumers who reported drug use, 26 “went AWOL” from their program and 14

fully relapsed while comparatively, none of the eight HF participants who reported using substances unenrolled from the program. This is a demonstration of HF client engagement and openness with the staff because disclosure of drug use will not jeopardize their housing. Another critique of Housing First is its shortcoming in improving social support for its clients. In a study by Siegal et al (2006), HF participants reported significantly greater feelings of isolation compared to those in community residences. This is perhaps due to the scattered-site nature of HF and the accompanying pressure to blend in among neighbors without SMI. Still, the model increases opportunity for broader community integration, rather than socialization within microcosms of people with SMI. A number of studies suggest that HF outcomes in mental health and substance abuse are very similar to those in Treatment First interventions (Leff et.al, 2009). There are several explanations for this: because HF allows clients to go at their own pace and choose their own priorities, HF consumers may not be choosing to focus on their addiction or mental health at the tim e o f the study. Following up in several years will be important in identifying whether or not this plays a role in the results. Another possibility is that the HF population has equal or less optimal results because it includes the harder -to-reach clientele that is ineligible for TF programs due to more challenging issues. In light of the advantages and disadvantages of several intervention models along the housing continuum, it is clear that this is not an either/or situation. Just as there is a continuum of housing, there is also a continuum of functioning. Some patients prefer the 24hour, intensive care that supervised housing provides based on the severity of their mental illness, while others may prioritize their 209

2016 autonomy and feel comfortable living in private market housing. The need for emergency services will never disappear so the services cannot be completely eliminated, but policy focus should shift from stop gaps to more permanent solutions. In a meta-analysis of housing models for persons with MI, Leff et al (2009) demonstrate that all housing models resulted in significantly greater housing stability and fewer hospitalizations than non-model housing. HF had the greatest effect size for housing stability and satisfaction, but the impressive results that HF yields may be somewhat skewed by measurement. In studies on retention, the data reports whether or not an apartment/house is being rented out, rather than whether or not that person is living there. For the general population, this does not need to be seriously taken into consideration, but among HF users with SMI, many find it very challenging to live independently and lack the skills required to run a household. A potential solution is an intermediary point of intervention prior to independent living, in the form of recovery centers. Recovery centers include recovery-enhancing services and resources, often consumer-run, and offer life skills, social connections, recreational activities to a client who is not completely ready to live independently (Whitley, Strickler & Drake, 2011). These centers emphasize peer-support and the newer model of recovery rather than fostering client dependence social services. This type of approach reflects a trend where policy-makers “ask the experts” - a promising development towards housing interventions for persons with SMI that operate on the premise that recovery is entirely possible.

References Bebout, R. (1999). Housing Solutions, Alcoholism Treatment Quarterly, 17(1), 93-112. Browne, G., & Courtney, M. (2004). Measuring the impact of housing on people with schizophrenia. Nurs Health Sci Nursing and Health Sciences, 37-44. City, F. (1999). Gold Award: The Wellspring of the Clubhouse Model for Social and Vocational Adjustment of Persons With Serious Mental Illness. PS Psychiatric Services, 1473-1476 Coldwell, C., & Bender, W. (2007). The Effectiveness of Assertive Community Treatment for Homeless Populations With Severe Mental Illness: A MetaAnalysis. American Journal of Psychiatry AJP, 393-399. Cost of Homelessness in Canada - Lookout Society. (n.d.). Retrieved October 16, 2015. Culhane, D., Metraux, S., & Hadley, T. (2002). Public service reductions associated with placement of homeless persons with severe mental illness in supportive housing. Housing Policy Debate, 107-163. Ellen, I., O’Flaherty, B. (2010). How to house the homeless. New York: Russell Sage Foundation. Finding a Good Residential Option for someone with Severe Mental Illness. (n.d.). Retrieved October 1, 2015. Gaetz, S., Gulliver, T. & Richter, T. (2014). The State of Homelessness in Canada: 2014. Toronto: The Homeless Hub Press. Henwood, B., Stanhope, V., & Padgett, D. (2010). The Role of Housing: A Comparison of FrontLine Provider Views in Housing First and Traditional Programs. Administration and Policy in Mental Health and Mental Health Services Research Adm Policy Ment Health, 77-85. Hulchanski, J. (2009). Transitional Housing Models in Canada: Options and Outcomes. In Finding home policy options for addressing homelessness in Canada. Toronto, Ont.: Cities Centre Press. Hurtubise, R., Babin, P., & Grimard, C. (2009) Shelters for the Homeless: Learning from Research. In: Hulchanski, J. David; Campsie, Philippa; Chau, Shirley; Hwang, Stephen; Paradis, Emily (eds.) Finding Home: Policy Options for Addressing Homelessness in Canada (e-book), Chapter 1.2. Toronto: Cities Centre, University of Toronto. Lee, S., Wong, Y., & Rothbard, A. (2009). Factors Associated With Departure From Supported Independent Living Programs for Persons With Serious Mental Illness. Psychiatric Services. Leff, H., Chow, C., Pepin, R., Conley, J., Allen, I., & Seaman, C. (2009). Does One Size Fit All? What We 210

2016 Can and Can't Learn From a Meta-analysis of Housing Models for Persons With Mental Illness. PS Psychiatric Services, 473-482. Lindovská, E. (2014). Homelessness Coping Strategies from Housing Ready and Housing First Perspectives. European Journal of Homelessness, 8(1), 97-115. Lipton, F., Nutt, S., & Sabatini, A. (1988). Housing the Homeless Mentally Ill: A Longitudinal Study of a Treatment Approach. PS Psychiatric Services, 40-45. Luhrmann, T. (2007). “The Street Will Drive You Crazy”: Why Homeless Psychotic Women in the Institutional Circuit in the United States Often Say No to Offers of Help. American Journal of Psychiatry AJP, 15-20. Martinez, T., & Burt, M. (2006). Impact of Permanent Supportive Housing on the Use of Acute Care Health Services by Homeless Adults. Psychiatric Services, 992-999. McHugo, G., Bebout, R., Harris, M., Cleghorn, S., Herring, G., Xie, H., Drake, R. (2004). A Randomized Controlled Trial of Integrated Versus Parallel Housing Services for Homeless Adults With Severe Mental Illness. Schizophrenia Bulletin, 969-982. Murphy, H. (1976). The Influence of Foster-Home Care on Psychiatric Patients. Arch Gen Psychiatry Archives of General Psychiatry, 179-179. Nelson, G., Aubry, T., & Lafrance, A. (2007). A review of the literature on the effectiveness of housing and support, assertive community treatment, and intensive case management interventions for persons with mental illness who have been homeless. American Journal of Orthopsychiatry, 350-361. doi:10.1037/0002-9432.77.3.350 Nelson, G. (2010). Housing for People with Serious Mental Illness: Approaches, Evidence and Transformative Change. Journal of Sociology and Social Welfare, 37(4), 123-146. Padgett, D. (2006). Housing First Services for People Who Are Homeless With Co-Occurring Serious Mental Illness and Substance Abuse. Research on Social Work Practice, 74-83. Padgett, D., Henwood, B., Abrams, C., & Davis, A. (2008). Engagement and retention in services among formerly homeless adults with co-occurring mental illness and substance abuse: Voices from the margins. Psychiatric Rehabilitation Journal, 226-233. Padgett, D., Stanhope, V., Henwood, B., & Stefancic, A. (2010). Substance Use Outcomes Among Homeless Clients with Serious Mental Illness: Comparing Housing First with Treatment First Programs.

Community Ment Health J Community Mental Health Journal, 227-232. Ridgway, P., & Zipple, A. (1990). The paradigm shift in residential services: From the linear continuum to supported housing approaches. Psychosocial Rehabilitation Journal, 11-31. Rothwell, D. (2015, October 22). Using Data to Reduce Homelessness. Lecture presented at Kagedan Lecture on Social Work and Human Rights. Siegel, C., Samuels, J., Tang, D., Berg, I., Jones, K., & Hopper, K. (2006). Tenant Outcomes in Supported Housing and Community Residences in New York City. PSYCHIATRIC SERVICES, 982-991. Sylvestre, J., Nelson, G., Durbin, J., George, L., Aubry, T., & Ollenberg, M. (2010). Housing for people with serious mental illness: Challenges for system-level community development. Community Development, 35-45. Talbott, J. (2007). "The Street Will Drive You Crazy": Why Homeless Psychotic Women in the Institutional Circuit in the United States Often Say No to Offers of Help. Yearbook of Psychiatry and Applied Mental Health, 158-159. Tsemberis, S., & Eisenberg, R. (2000). Pathways to Housing: Supported Housing for StreetDwelling Homeless Individuals With Psychiatric Disabilities. PS Psychiatric Services, 487-493. Whitley, R., & Campbell, R. (2014). Stigma, agency and recovery amongst people with severe mental illness. Social Science & Medicine, 1-8. Whitley, R., Harris, M., & Drake, R. (2008). Safety and Security in Small-Scale Recovery Housing for People With Severe Mental Illness: An Inner-City Case Study. PSYCHIATRIC SERVICES, 165-169. Retrieved October 1, 2015, from ps.psychiatryonline.org Whitley, R., Strickler, D., & Drake, R. (2011). Recovery Centers for People with Severe Mental Illness: A Survey of Programs. Community Ment Health J Community Mental Health Journal, 547-556. Wong, Y., Poulin, S., Lee, S., Davis, M., & Hadley, T. (2008). Tracking residential outcomes of supported independent living programs for persons with serious mental illness. Evaluation and Program Planning, 416-426.

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2016 Appendix

Figure 1. Tsemberis & Eisenberg (2000)

212

2016

Role Models and Self-Regulation

Serena Mennitto Supervisor: Dr. Richard Koestner

Abstract A prospective longitudinal study was conducted to assess the impact of having a role model on personal goal achievement. In an initial questionnaire, 187 university students indicated three personal goals they would be pursuing over the school year, and whether they had a role model associated with each goal. Baseline measures of self-efficacy, autonomy and commitment were obtained. These variables, as well as goal achievement, were reassessed twice during the semester at one-month intervals. While neither self-efficacy nor goal achievement differed significantly between the role model and no role model groups, it was found that having a role model was associ-

ated with greater commitment and autonomy motivation. Students with a role model also felt that the pursuit of their goal was more energizing. These findings indicate that having a role model has implications for self-regulation.

213

2016 Introduction On the television show M*A*S*H, the

normative standard, such as getting a better grade than 90% of their class.

young company clerk Radar O’Reilly tries to

Taylor and Lobel (1989) have noted

learn how to interact with women by observ-

that when people have a goal to improve

ing and seeking advice from Hawkeye Pierce,

themselves in an area, they will compare

the unit’s chief surgeon and resident play-

themselves with people they consider success-

boy. On Go ssip Girl, a young freshman

ful. In general, people are not motivated by

named Jenny admires a sophomore, and tries

individuals they consider to be worse-off un-

to dress and behave similarly to them. Social

less they think they are vulnerable to failure

learning theory states that people can learn

or a negative outcome (Lockwood, Wong,

either from their own experiences or the ex-

McShane, & Dolderman, 2005). The extant lit-

periences of others through observation

erature has shown that students who chose to

(Bandura, 1977b). In the previous examples,

compare themselves to more successful peers

the characters are trying to learn how to be-

improve

have or achieve certain outcomes by observ-

(Blanton, Buunk, Gibbons, & Kuyper, 1999).

ing others. They are engaging in modeling,

Blanton et al. (1999) suggest that upward com-

which is “the process in which observers

parisons provide information about strategies

pattern their thoughts, beliefs and behaviours

that can be used to improve performance, or

after those displayed by one or more mod-

that they may help students become more mo-

els” (Schunk & Zimmerman, 2007). In order

tivated to obtain better grades. Another study

to gauge whether they are making progress

bolsters their hypothesis, demonstrating that

toward a goal or outcome, people engage in a

upward comparisons are more motivating

process of self-judgment. This process in-

than downward ones (Lockwood, Shaugh-

volves comparing a recent performance with

nessy, Fortune, & Tong, 2012). In addition,

a standard that can be absolute or normative.

Lockwood and Kunda (1997) argue that the

An absolute standard is a fixed level of per-

ideal role model or comparison target is older,

formance, while a normative standard is a

at a more advanced stage in their career, and

level of performance compared to the perfor-

has achieved what the observer would like to.

their

academic

performance

mance of others. If the standard is normative,

Role models have been linked to the con-

comparisons with peers become necessary

cept of self-efficacy, or the belief in one’s own

(Schunk, 1995). For example, if a person sets

ability to successfully engage in behaviour that is

a goal of improving their school perfor-

necessary for the fulfilment of a goal or outcome

mance, they can compare themselves to an

(Bandura, 1977a). Cheung and Yue (2003) found

absolute standard, such as a GPA of 4.0, or a

that a person’s perceived self-efficacy can be 214

2016 bolstered by having a â&#x20AC;&#x153;luminaryâ&#x20AC;? role model,

experiment with ophiodiophobics, but his re-

someone whose intellectual and moral quali-

search had a narrower focus. He chose to

ties have led to achievement and renown.

compare the efficacy of two different kinds of

They observed that adolescents who reported

modeling behaviours - coping and mastery

a high level of modeling after a luminary had

behaviours - on the reduction of avoidance

higher self-efficacy than those without a mod-

behavior in female undergraduates. He noted

el. Those without a model, in turn, had higher

that exposing subjects to coping models, who

self-efficacy than those who reported that they

initially demonstrate fear and gradually over-

showed a low level of modeling after a lumi-

come it, was more effective than exposing

nary (Cheung & Yue, 2003). Other research

them to mastery models, who overcome their

has shown that a personâ&#x20AC;&#x2122;s self-efficacy can al-

fear quickly (Meichenbaum, 1971).

so determine the effect that exposure to a role

Investigations about coping and mas-

model will have (Hoyt, 2013). In a study about

tery models were also conducted in order to

women and leadership role models, Hoyt ob-

determine whether they were differentially

served that women with high self-efficacy

effective in quelling anxiety. McMurray, Lu-

found the role models inspiring, while women

cas, Arbes-Duprey and Wright (1985) studied

with low-self efficacy were deflated by expo-

the effects of exposure to coping or mastery

sure to the role model. The women with lower

models in children experiencing anxiety about

self-efficacy did not think that the success ex-

going to the dentist. They noted that, while

emplified by the role model was personally

children in the mastery and coping conditions

attainable (Hoyt, 2013).

experienced lower anxiety than those in the

Earlier research on modeling involved

control condition, the difference between the

using modeling techniques to extinguish

coping and mastery conditions was not statis-

learned behaviours and cure phobias. One

tically significant (McMurray et al., 1985).

study compared different methods that could

The importance of coping and mastery

be used to cure ophidiophobia, or the fear of

models has further been explored with chil-

snakes (Bandura, Blanchard, & Ritter, 1969).

dren, albeit with a different focus: their school

The techniques chosen were symbolic desensi-

achievement. Schunk (1995) defines mastery

tization, symbolic modeling, and live model-

models as those who perform flawlessly from

ing with guided participation. While all of

the start, while coping models have trouble in

these techniques were successful to some de-

the beginning but gradually improve over

gree at extinguishing phobic behaviour, mod-

time. In an early study, Schunk and Hanson

eling with guided participation was found to

(1985) showed children in a math class videos

be the most powerful method (Bandura et al.,

of a peer or teacher completing division prob-

1969). Meichenbaum (1971) also conducted an

lems. The experimenters used the peer as a 215

2016 coping model and the teacher as a mastery

grams for at-risk students is to ensure that the

model. They discovered that those who had

models emphasize the cumulative nature of

watched a peer subsequently completed more

success, which is related to Schunk’s definition

math problems in class than those who had

of “coping model” (1995).

seen the video of the teacher. However, the latter performed better than the control group,

The Current Study

who had not been exposed to a model (Schunk

The current study used a prospective, longitu-

& Hanson, 1985). Schunk, Hanson and Cox

dinal design to examine the impact of having

(1987) later found that children perceived

a role model on the personal goal pursuits of

greater similarity between themselves and

university undergraduate students. Partici-

similarly-aged coping models than with mas-

pants were asked to list their three most im-

tery models. In addition, having one or more

portant goals at the beginning of the semester

coping models or many mastery models re-

and were followed up in the middle and end

sulted in higher self-efficacy and better perfor-

of the semester. Participants reported on their

mance in children compared to those with one

motivation, self-efficacy, and commitment for

mastery model (Schunk, Hanson, & Cox,

each of their goals in the baseline survey, and

1987).

they reported their progress in achieving Related programs exist

schools

goals in the follow-ups. Participants also indi-

where the goal is to expose students at risk for

cated for each goal whether or not they had a

leaving school prematurely to positive role

role model.

models. The evaluation of one such program, the

Hispanic

Mother-Daughter

We hypothesized that having a role

Program,

model would be related to higher levels of goal

geared toward female Mexican-American stu-

achievement and that this effect would be me-

dents, was unfavorable (Hernandez, 1995). The

diated by a higher level of self-efficacy. We also

intervention did not appear to have the de-

hypothesized that this effect would be stronger

sired effect, because the models insinuated

in participants with coping role models than in

that success is an all-or-nothing concept, aris-

their peers with mastery models.

ing from individual effort. The researcher also noted that the models never mentioned any

Methods

failures, mistakes or setbacks they had encoun-

Participants

tered in their career. While these models were

A sample of 198 (158 female) McGill

not conceptualized as mastery models per se,

University undergraduate students participat-

there is overlap between Hernandez’s descrip-

ed in an eight month-long study about goal

tion and that of Schunk (1995). Hernandez’s

setting and personality. They were recruited

recommendation for improvement of pro-

through online classified advertisements and 216

2016 setting and personality. They were recruited

ly 11 participants failing to complete the three

through online classified advertisements and

assessments used in this study; the data col-

posters displayed on campus. Participants’

lected from these participants was not used in

ages ranged from 17 to 47, with a mean of

any analyses.

20.89 (SD=3.198). Students received fifty dol-

Measures

lars in compensation for completing all assessments from September through April. For completing the first three assessments, partici-

pants received twenty dollars in December. Procedure

Personal goals In the baseline survey completed in

September, participants were asked to identify three personal goals they intended to pursue during the academic year. Specifically,

The study consisted of one initial 45-

participants were asked: “Personal goals are

minute long and five 15-minute long online

projects and concerns that people think

surveys sent to participants from September

about, plan for, carry out, and sometimes

2014 until April 2015. For the purposes of the

(though not always) complete or succeed at.

current analysis, only data collected in the

They may be more or less difficult to imple-

first three surveys sent in September, Novem-

ment; require only a few or a complex se-

ber and December were used. Students who

quence of steps; represent different areas of a

were interested in the study contacted re-

person’s life; and be more or less time con-

search assistants via email in September to ob-

suming, attractive, or urgent. Please think of

tain more information about the study. Poten-

three personal goals that you plan to carry

tial participants were excluded if they were

out this semester.” This measure of personal

not undergraduates at McGill University. If

goals has been used successfully in previous

they stated their interest in participating in the

studies (Koestner, Otis, Powers, Pelletier, &

study, they were emailed a link in September,

Gagnon, 2008; Milyavskaya, Ianakieva, Foxen

which contained a consent form and the first

-Craft, Colantuoni, & Koestner, 2012). Exam-

survey. In the first survey, participants indi-

ples of goals listed by participants include “I

cated three goals they intended to pursue

want to learn the piano”, “Lose 10 pounds”

throughout the academic year and whether

and “I want to get a 3.5 GPA.”

they had a role model associated with each goal. Follow-up surveys were emailed to par-

Role models

ticipants at approximately one-month inter-

After identifying their three personal

vals to assess goal progress, with reminders of

goals at baseline, participants were asked to

the three goals they had listed in the initial

indicate whether or not they had a role mod-

survey. The retention rate was 94.4%, with on-

el associated with their goal. The instructions 217

2016 read as follows: “Some people have a role

model's road to success was smooth, and they

model in mind when setting a goal; this model

encountered very few setbacks” and “The

could be someone who has succeeded at their

model succeeded at the goal quickly because

goal or who exemplifies the behavior required

they are naturally good at it or have a special

to achieve their goal. Do you have a role mod-

talent.” The correlation between these two

el associated with your goal?” If participants

items was 0.42. The mean on both items was

had a role model, they were asked to enter the

used to obtain an overall mastery score for the

role model’s initials. Participants were also

model associated with each goal.

asked if their role model was a friend, family

Goal achievement and progress

member, acquaintance, famous person, or other. If the participant answered “other”, they

Goal progress was measured in both No-

were prompted to enter their relationship to

vember and December. It was assessed by calcu-

the model in the box provided.

lating the mean of three items answered on a 7point Likert scale ranging from stro ngly d isagree

The

extent

which

participants

viewed their role models as coping and mastery models was measured in the third survey. The measures used to evaluate this were created specifically for this study. Participants were asked to rate their agreement with four statements on a 7-point Likert scale ranging from stro ngly d isagree (1) to stro ngly agree (7). The

statements

were

(1) to stro ngly agree (7). These items were “I have made a lot of progress toward this goal”, “I feel like I am on track with my goal plan” and “I feel that I have achieved this goal.” These items were used in previous studies with similar designs (Koestner et al., 2008; Milyavskaya et al., 2012). To assess total goal progress we calculated a mean across follow-ups.

derived from

Schunk, Hanson and Cox’s definition of coping and mastery role models (1987). Two of

Other goal variables Self-efficacy,

autonomous

motivation,

the items referred to coping models, while the

commitment and vitality were measured with the

two others referred to mastery models. The

same items previously used in other prospective

coping model items were “The model had to

longitudinal studies. (Koestner et al., 2008; Mi-

overcome the same fears and setbacks as I

lyavskaya, 2012).

have when trying to accomplish the goal” and “The model's performance has improved over time as a result of practice.” These items were correlated at 0.29. The mean of both items was used to calculate an overall coping score for the role model. The mastery items were “The

Self-efficacy for each goal was assessed at

baseline. Participants were asked “To what extent do you feel you have the skills and resources necessary to attain this goal?” This was measured using a 7-point Likert scale, where 1 means 218

2016 strongly disagree and 7 means strongly agree.

of first goals, 29.2% of second goals, and 25.4%

A brief 5-item scale was used to meas-

of third goals. Cross-tabulation procedures

ure participants’ autonomous motivation for

revealed that role models were significantly

each of their goals. Subjects were asked to rate

more common for health goals than for aca-

how much they were pursuing the goal for

demic, social or leisure goals. Specifically,

five reasons (eg.: “Because it represents who

46.5% of health goals were associated with a

you are and reflects what you value most in

role model, whereas only 24.4% of other types

life”). Two of the items were reverse-scored

of goals had a role model. Cross-tabulation

(eg.: “Because somebody else wants you to, or

procedures also looked at who served as the

because you’ll get something from somebody

role model. Participants’ friends were identi-

if you do”). Participants answered these ques-

fied as the most common role model (45%),

tions on a 7-point Likert scale ranging from

followed by their family members (27.2%), fa-

not at all for this reason (1) to m o stly fo r this

mous people (17.2%) and acquaintances

reason (7). Autonomous motivation was calculated

(10.7%). In the following analyses we focus on

as the mean of responses to these items.

the results for participants’ first goal, which is assumed to be the most important and acces-

Participants’ commitment to each of

sible goal.

their personal goals was also assessed in the first survey. Participants were asked “How

Table 1 presents the means and standard

committed do you feel toward this goal?” Par-

deviations for all of the key variables related to

ticipants rated their agreement with this item

the first goal in the study. Participants rated their

on a 7-point Likert scale ranging from stro ng-

role models as higher on coping than on mastery

ly disagree (1) to stro ngly agree (7).

t(119)=3.81, p<.001. Furthermore, participants re-

In December, goal vitality was measured for each goal using one item (“This goal makes me feel alive and vital”). Participants rated their agreement with the item on a 7point Likert scale from stro ngly d isagree (1) to strongly agree (7). Results

Preliminary Analyses

ported high levels of self-efficacy, autonomous motivation and commitment to their first goal. When they were followed up at the end of the first semester, participants reported only modest progress on their goal, but did feel that pursuing their goal was energizing. Primary Analyses

Table 2 presents the means and standard deviations for key variables in the study depend-

Approximately 28% of participants’

ing on whether the participant had a role model

goals were associated with a role model. Spe-

or not. Independent samples t-tests were per-

cifically, role models were reported for 30.1%

formed to compare the means of both groups. No 219

2016 significant differences were found between

amine the effects of having a role model on

groups on self-efficacy at baseline nor on goal

personal goal pursuit. We hypothesized that

achievement at the end of the semester. How-

participants who associated a role model

ever, participants who had a role model re-

with their goal would be more likely to

ported feeling more autonomous about their

achieve their goal, and that this effect would

goal than those without a role model at base-

be mediated by a higher level of self-efficacy.

line, t(194)=3.41, p<0.001. Similarly, partici-

Additionally, we hypothesized that this effect

pants with a role model also felt more com-

would be stronger for those with coping role

mitted toward achieving their goal at the be-

models than in their peers with mastery

ginning of the study, t(194)=2.18, p<0.05. At

models.

the end of the semester, students with a role

The results failed to support these hypoth-

model also reported that the pursuit of their

eses. T-tests revealed that there was no difference

goal was more energizing than their peers

between the role model and no role model

without a role model, t(183)=2.00, p<0.05.

groups on either goal achievement or selfefficacy. This result is not consistent with previ-

Supplemental Analyses

ous studies. For instance, Cheung and Yue (2003)

An analysis of variance revealed that

concluded that students who reported a high lev-

goals with a role model were significantly

el of modeling after a role model had higher self-

more likely to be achieved if the role model

efficacy than their fellow students without a

was a friend than any other kind of model, F

model (2003). These results were not replicated in

(3,52)= 3.66, p<0.05. Goal achievement by type

this study, perhaps because the vast majority of

of role model is presented in Table 3.

models listed by participants in the current study

Bivariate correlations were calculated

to quantify the relationship between coping

were not famous luminaries, but were their

friends.

and mastery role model scores and commit-

The data also does not support our second

ment, effort and goal achievement. These are

hypothesis; coping and mastery model scores

presented in Table 4. Neither coping nor mas-

were unrelated to either goal progress or self-

tery scores were related to commitment or

efficacy. This contradicts a previous study, where

goal progress. However, coping scores were

having a coping model was associated with

related to effort put toward the goal (r=0.273,

greater self-efficacy (Schunk et al., 1987). It is pos-

p<0.01) whereas mastery scores were not signifi-

sible that this discrepancy is due to methodologi-

cantly correlated with effort.

cal differences between the current study and that of Schunk, Hanson and Cox (1987). It is im-

Discussion The purpose of this study was to ex-

portant to note that in their study, the type of role model was manipulated by the experimenter 220

2016 such that subjects were assigned to a condi-

Thus, it is not possible to determine whether

tion where they were exposed once to either

people with high levels of autonomous moti-

a coping or mastery model (Schunk et al.,

vation and commitment are more likely to

1987). Alternatively, in the current study,

choose role models, or whether having a role

subjects chose their own models, and rated

model leads to higher levels of autonomous

the models on coping and mastery, which

motivation and commitment. It is also possi-

were treated as distinct continuous variables.

ble that both explanations are accurate. In ad-

This approach is more ecologically valid than

dition, at the end of the semester, participants

the one previously used.

with a role model reported feeling more ener-

The items used to measure coping and

gized by the pursuit of their goal. Finally, the

mastery were created specifically for this

extent to which participants identified their

study. Although the coping and mastery

model as a coping model was associated with

items were written to contradict each other,

greater efforts made toward achieving the

participants did not see their models as pure-

goal.

ly coping or mastery models. It is important

These findings are significant because au-

to note that coping and mastery scores were

tonomous motivation, commitment and vitality

negatively correlated, but the correlation was

have been related to goal achievement. It has

weak (r=-0.293, p<0.01). While the mastery

been found that a personâ&#x20AC;&#x2122;s sense of autonomy

items were significantly correlated (r=0.42,

predicts success at a personal goal (Sheldon &

p<0.01), the correlation between the two cop-

Elliot, 1998). Employeesâ&#x20AC;&#x2122; level of commitment to

ing items was non-significant, suggesting

a work-related goal was found to be positively

that the items do not measure what they

related to their success at the goal and the success

were intended to measure. Before being used

of their organization as a whole (Porter & Lat-

in future studies, these items should be re-

ham, 2013). Finally, Ryan and Frederick (1997)

vised.

have shown that vitality, or the feeling of being While our results disconfirmed our hy-

pothesis,

some

interesting

findings

energized, is a significant indicator of well-being

did

and is related to self-motivation in the context of

emerge, which indicate that having a role

goal pursuit. Future research could examine the

model has implications for self-regulation and

relations between having a role model and these

the pursuit of personal goals. At baseline, par-

goal-related variables more exhaustively.

ticipants with a role model reported higher

While it was not the primary goal of the

autonomous motivation and commitment rel-

study, we obtained information about what kinds

ative to other subjects without a model. It is

of role models are chosen by university under-

not possible to determine causation because

graduate students, as well as for what types of

this relation was found cross-sectionally.

goals they were chosen. Participants chose role 221

2016 models for approximately 28% of their goals.

limitations. First, while it was conducted us-

Role models were by far more common for

ing a large sample, the sample contained sole-

health-related goals (e.g. “Lose 5 pounds”,

“Go to the gym more often”) than for academ-

most of the sample was female and the mean

ic, leisure, work, interpersonal or personality

age was 20.89 years. Thus, the results cannot

goals. It is not clear why this is the case, but it

be generalized to other populations. It would

is possible that students are exposed to more

be interesting to see what kinds of goals and

potential role models in this domain than in

role models are chosen by people in other age

others. Another possible explanation is that

groups, as their interests and focuses are like-

the behaviours associated with health-related

ly different. Furthermore, while the study ran

goals are easier to model than the behaviours

from September 2014 to April 2015, it was

required to attain other types of goals. For ex-

subject to time constraints. Participants in the

ample, the behaviours required to attain a

study were asked to identify three goals they

health-related goal, like making healthier food

hoped to achieve throughout an academic

choices and doing exercise, may be easier to

year, but the data used in the current manu-

observe than the behaviours required for oth-

script spanned only half of that time. It is pos-

er categories of goals.

sible that participants did not have enough

undergraduate

students.

Additionally,

Participants’ friends were the most

time to achieve their goals in this period and

common type of role model, followed by fam-

that this could explain why we did not find a

ily members, famous people and acquaintanc-

difference between the role model and no role

es. This finding is significant because our re-

model groups on goal achievement.

sults suggest that people who choose a friend

The study was also limited by the fact that

as a role model are more likely to achieve

participants were only permitted to identify one

their goal than those who have another rela-

role model for each of their goals. When pursu-

tionship with their model. Perhaps this is be-

ing a goal, it is possible that people look up to

cause participants are more similar to their

more than one role model to inspire them, espe-

friends than to the other categories, and per-

cially if the goal is highly important and salient.

ceived similarity to a role model has been pre-

For example, it has been noted that being ex-

viously linked to self-efficacy and motivation

posed to multiple role models may facilitate be-

(Schunk, 1995). In future studies it would be

haviour change (Schunk et al., 1987). However, it

interesting to measure participants’ perceived

is likely that participants listed their most salient

similarity to their role model, and if this varia-

role model, thus the lack of multiple models was

ble differs based on their relationship with the

unlikely to play a significant role in our findings.

role model.

Also, participants may have changed their role

The present study is subject to several

model over the course of the study, while sub222

2016 -jects who initially did not have a role model

tion and analysis, as well as reading and cor-

may have chosen one later on. However, this

recting drafts. The author would also like to

issue may not be very important as role mod-

thank Dr. Richard Koestner for his supervi-

els were identified in less than a third of cases.

sion, advice and guidance throughout the year.

Concluding Remarks The current study explored the effects

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2016

Table 1 Means and Standard Deviations for Key Variables Mean

Standard Deviation

Mastery Rating for Role Model

4.19

1.35

Coping Rating for Role Model

4.91

1.18

Self-efficacy

5.40

1.24

Autonomous Motivation

5.14

1.19

Commitment

5.87

1.08

Time 3 Goal Achievement

3.15

1.86

Time 3 Vitality

4.91

1.62

Table 2 Goal Variables by Having a Role Model or Not

Time 1 Self-efficacy

Role Model Mean (SD) 5.39 (1.23)

No Role Model Mean (SD) 5.40 (1.25)

Time 1 Autonomy Motivation

5.57 (1.05)

4.95 (1.21)

Time 1 Commitment

6.14 (0.86)

5.77 (1.14)

Time 3 Goal Achievement

2.85 (1.68)

3.29 (1.92)

Time 3 Vitality

5.36 (1.35)

4.85 (1.70)

225

2016

Table 3 Goal Achievement by Role Model Type Role Model Type

Goal Achievement Mean (SD)

Friend

3.46 (1.67)

Family Member

2.64 (1.50)

Famous Person

2.75 (1.86)

Acquaintance

1.44 (0.73)

Table 4 Pearson Correlations for Time 3 D Coping Score

Mastery Score

Commitment

0.168

-0.056

Effort Goal Progress

0.273** 0.139

-0.16 -0.058

Coping Score

——

-0.29**

Mastery Score

-0.29**

——

**: Correlation is significant at the 0.01 level.

226

2016

227