Romanian Journal of Experimental

Applied Psychology

Volume 5, Issue 3
August 2014

www.rjeap.ro

Romanian Society of Experimental Applied Psychology

2014
 ROMANIAN JOURNAL OF EXPERIMENTAL Ricardo Garcia, University of La Coruña, Spain
APPLIED PSYCHOLOGY Frederick Anseel, Ghent University, Belgium
Gernot Schuhfried, Vienna Test System,
EDITORIAL BOARD Austria
Markus Sommer, University of Vienna, Austria
Editor in chief Gerald Schuhfried, Vienna Test System,
Mihai Aniţei - founding member Austria
University of Bucharest, Romania Rhiannon Luyster, Harvard University, USA
Marco Vetter, University of Vienna, Austria,
Executive Editor Head of Research Schuhfried GmbH
Mihaela Chraif - founding member Adrian Tudor Brate, "Lucian Blaga" University
University of Bucharest, Romania of Sibiu, Romania
Mioara Cristea, Laboratory of Mobility and
Members Behaviour Psychology - IFSTTAR, France
Cazan Ana Maria Daniela Dumitru, "Titu Maiorescu" University,
Cicei Catalina Bucharest, Romania
Craciun Barbara Alin Gavreliuc, West University of Timişoara,
Gatej Emil Razvan Romania
Gyorgy Manuela Cezar Giosan, Columbia-University, USA
Popa Radu Florinda Golu, Bucharest University, Romania
Sarbescu Paul Grigore Havarneanu, Researcher, IFSTTAR,
Stan Maria Magdalena Mobility and Behavior Psychology Lab, France
Truta Camelia Ion Juvină, Carnegie Mellon University, USA
Vochita Alexandru Rodica Marcela Luca, „Transilvania“ University,
Braşov, Romania
Proof Readers Elena Lupu, „Petroleum and gas” University,
Burtaverde Vlad Ploiesti, Romania
Caius Ciprian Tudor Ana Maria Marhan “Constantin Radulescu-
Craciun Andra Motru“ Institute of Philosophy and Psychology,
Mihaila Teodor Bucharest, Romania
Laurențiu Mitrofan, Bucharest University, RO
SCIENTIFIC BOARD Valeria Negovan Zbaganu, Bucharest
University Adrian Opre, "Babes-Bolyai"
Academician Alexandru Surdu, „Constantin University, Cluj-Napoca, Romania
Rădulescu-Motru“ Institute of Philosophy and Camelia Popa, “Constantin Radulescu-Motru“
Psychology, Bucharest, Romania Institute of Philosophy and Psychology,
Academician Constantin Ionescu-Târgovişte, Bucharest, Romania
„Carol Davilla“ University of Medicine, Doina Saucan, “Constantin Radulescu-Motru“
Bucharest, Romania Institute of Philosophy and Psychology,
Charles Nelson, Harvard University, USA Bucharest, Romania
Charles Zeanah, Tulane University, USA Constantin Ticu, "Alexandru Ioan Cuza"
Nathan Fox, Maryland University, USA University, Iasi, Romania
Peter Mitchell - University of Nottingham Elena Vladislav, Bucharest University, Romania
Malaysia Campus - editor of the British Journal Cristian Vasile, „Petroleum and gas” University,
of Psychology - Malaysia Ploiesti, Romania
Mathias Müller, Leipzig University, Germany Victor Velter, Ministry of Education, Romania
Marilyn Campbell MAPS - Queensland
University of Technology, Australia

2
 TABLE OF CONTENTS

1. Mihai Aniței - EDITORIAL - Personality - the biological perspectives

5-7

2. Bodea Haţegan Carolina, Talaş Dorina - Issues in bilingualism in the context

of autism spectrum disorders. Case study report
8 - 20

3. Geanina Cucu-Ciuhan, Nicoleta Răban-Motounu - Experiential learning of

basic psychotherapy skills: a case study in a Romanian university
21 - 35

4. Madalina Petrescu - Reducing autoperceived stress and optimizing the

academic motivation in personal development groups- sample study
36 - 47

5. Dora Codreanu, Angela Boglut, Miheala Chraif - Correlative study

regarding the pain perception and emotions at young students at psychology
48 - 59

6. Angela Boglut, Mihai Robu - Relationship between emotions and perceived

stress at workplace
60 - 69

7. Gianina-Ioana Postăvaru - Life disruptions following breast cancer

70 – 85

8. Steliana Rizeanu - Pathological gambling and impulsivity

86 – 94

9. Steliana Rizeanu – BOOK REVIEW - “A cognitive-behavioural therapy

programme for problem gambling”
95 – 97

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 ROMANIAN JOURNAL OF
EXPERIMENTAL APPLIED PSYCHOLOGY

VOL. 5, ISSUE 3 – www.rjeap.ro

EDITORIAL: PERSONALITY - THE BIOLOGICAL

PERSPECTIVES

MIHAI ANIȚEI, PHD.

University of Bucharest, Faculty of Psychology and Educational Sciences,
Department of Doctoral School

Since ancient times, the Greek philosophers attempted to explain human

personality. They believed that the human behavior types are caused by the fluids
in the human body. Philosophers believed that excess blood determines sanguine
temperament, excess black bile causes melancholic temperament, excess yellow
bile determines hot temper while excess phlegm leads to a phlegmatic
temperament. Of course this is a purely theoretical approach, this perspective never
having been empirically tested (Canli, 2006). Temperament refers to a person's
characteristic emotional nature, including sensitivity to emotional stimulating,
specific reaction speed, prevailing mood condition, and all peculiarities of
fluctuation and intensity of dispositional state, all of which are considered to be
dependent on the person's physical structure and hereditary determined "(Allport,
1937, as cited in Ryckman, 2008).
Ivan Pavlov, one of the greatest psychologists, a physiologist at base,
investigated stimulus-response type simple classical conditioning. Pavlov identified
three properties (strength, mobility, balance) that determine the structure of the
central nervous system (Ryckman, 2008). Strength reflects the energetic capacity
of the neuron, being genetically determined, mobility refers to the dynamics of
fundamental mental processes, the need to shift from a mental process to another,
and balance is the ratio of excitation and inhibition.
After studying canine behavior, Pavlov developed four temperament types
which are specific to humans as well: 1) weak type characterized by anxiety,
inhibition, low tolerance to stress; 2) highly-unbalanced type characterized by
excitability, hyperactivity and irritability; 3) strong-balanced-inert type
characterized by steadiness, calm, high tolerance to stress and frustration; 4)
strong-balanced-mobile type characterized by liveliness, motivation, energy
oriented outwards (Ryckman, 2008).
Another psychophysiological mechanisms perspective is that of Enrst
Kretschmer who, by studying psychiatric patients, determined that these disorders
arerelated to physical constitution. Thus, he concluded that there are three main
types: 1) picnic - bulky abdomen, overweight, stretched skin, horizontal
constitution, 2) asthenic- flat rib cage, small, round head, long, sharp nose,
feminine features on men and masculine features on women; 3) athletic- well-
developed, muscular, broad shoulders, balanced physical constitution (Ashton,
2013). William Sheldon continued the study of these types calling them
somatosensory types using different names for each type. Picnic type is called
endomorph, the term ectomorph is used for the asthenic type and mesomorphs
describes the athletic type (Ashton, 2013).
Robert Cloninger developed a model that tests the neurotransmitters influence
on personality traits. More broadly, the neurotransmitters are biochemical
substances that are involved in communication between nerve cells called neurons
(Ashton, 2013). Considering how neurons communicate, we can say that neurons
are the basis of thoughts, emotions and human behavior and the substances in the
body can influence human behavior (Ashton, 2013). The major neurotransmitters
are found in the central nervous system and in the bone marrow and they are
serotonin, dopamine and norephinephrine. (Ashton, 2013). Dopamine helps
neurons transmit impulses about the existence of things that people consider to be
good or are seen as rewards. Individuals characterized by high levels of dopamine
are those who seek excitability, excitement, everything new. This dimension of
personality has features like extravagance, opulence, lack of organization,
excitability, impulsiveness. In contrast, there are people who do not seek
excitement or fun (Larsen & Buss, 2008). The second neurotransmitter is serotonin,
a neurotransmitter that inhibits signal transmission on punishment, with the
purpose to stop the neurons from sending impulses when there are stimuli that
represent punishment. Serotonin is related to states like anxiety, tension or pain
(Larsen & Buss, 2008). The third neurotransmitter is norepinephrine.
Norepinephrine is known as having a role in inhibiting responses to conditioned
stimuli, the stimuli that have been associated with rewards. Norepinephrine has a
strong relationship with behaviors that generate pleasure (Larsen & Buss, 2008).
Another important model is that of Jeffrey Gray, in which he argued that the
brain has different regions, and certain functions involving interactions between
multiple brain regions and personality traits influence human behavior (Canli ,
2006). The two systems described by Jeffrey Gray are The Behavioral Activation
System and The Behavioral Inhibition System. The Behavioral Activation System
is composed of brain regions that are responsible for receiving signals from the
nervous system side which indicates a situation in which reward may be
experienced (Canli, 2006). The Behavioral Activation System is related to
Cloninger's model in terms of dopamine. Gray argued that the behavioral activation
system is different for each person, being more or less sensitive to stimuli showing
reward. The behavioral inhibition system is composed of brain regions that are
responsible with the reception of signals from the nervous system, which indicates
the existence of situations in which punishment or suffering are experienced (Canli,
2006). This system serves to stop behaviors that denote avoidance of punishment
and suffering. Another biological model of personality is that of Hans Eysenck. He
developed three major personality factors (Extraversion, Neuroticism and

6
Psychoticism) and claimed that human behavior is based on the variation of the
central nervous system excitability (Burger, 2007; Ryckman, 2008).
Another view of the biological model is the alternative model with five
factors of personality of Marvin Zuckerman in which he tried to observe the
biological perspective of a number of personality factors using factor analysis.
Thus, he developed factors such as: activity, sociability, impulsivity thrill-seeking,
aggressiveness and neuroticism-anxiety. According to Zuckerman each personality
trait is determined by a unique combination of neurotransmitters between brain
structures (Larsen & Buss, 2008).

REFERENCES

Ashton, M.C., (2013). Individual Differences and Personality, second edition.London:

Elsevier.
Burger, J.M., (2007). Personality, 7th edition. Belmont: Thomson Wadsworth.
Canli, T., (2006). Biology of Personality and Individual Differences. New York:
Guilford Press
Larsen, R.J., & Buss,D.M., (2008). Personality Psychology. Domains of Knowledge
about human nature ,3th edition. New York: McGraw Hill.
Ryckman, R.M., (2008). Theories of personality. Belmont: Thomson Wadsworth.

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 ROMANIAN JOURNAL OF
EXPERIMENTAL APPLIED PSYCHOLOGY

VOL. 5, ISSUE 3 – www.rjeap.ro

ISSUES IN BILINGUALISM IN THE CONTEXT OF AUTISM

SPECTRUM DISORDERS. CASE STUDY REPORT

BODEA HAŢEGAN CAROLINA a, TALAŞ DORINA b

a, b
Babeş-Bolyai University, Cluj-Napoca, Faculty of Psychology and Education
Sciences, Department of Special Psycho-Pedagogy

Abstract
The impact of bilingualism on language development in the context of autism
spectrum disorders (ASD) represents the main focus of this article. In order to investigate
this aspect the researchers used the single case study qualitative method. The selection
criteria were: the presence of ASD, bilingual exposure and language developmental age
less than 2 years. The fallowing instruments were used to collect data: semi-structured
interview and Communication Matrix translated in Romanian language. The results
underline the fact that communication development in a case of ASD with bilingual
exposure is reinforced by the two languages specific features, this adding cultural,
linguistic and cognitive value to child`s speech and language development.

Cuvinte cheie: tulburări din spectru autist, bilingvism, scala Communication

Matrix, tulburări de limbaj, abilităţi de comunicare

Keywords: autism spectrum disorders, bilingualism, Communication Matrix,

language disorders, communication skills

1. THEORETHICAL FRAMEWORK

1.1. Bilingualism

Bilingualism`s implications in structuring language were widely studied from

a psychological, psycho-pedagogical, linguistic and psycholinguistic point of view.
Thus, Bodea Haţegan (2009, 2010, 2011) underlines through a study focus on
investigating bilingualism and its implication on structuring language at
morphological and lexical level that bilingualism influences in a significant manner
children with different kind of disabilities language skills (the study focuses on
three different categories of children with disability: hearing impaired children,
children with learning difficulties and children with cognitive disability). The study

*
Autor corespondent:
Bodea Haţegan Carolina
Email: carolina.bodea.hategan@gmail.com
was conducted on Romanian native speakers having as second language different
foreign languages. At morphological level the study underlines bilingualism
implication on different important morphemic aspects such as: article, gender,
number, diathesis, time, mode, pronoun, comparison degrees of the adjective,
compound prepositions, derivative morphemes, supra-segmental morphemes,
animate/inanimate category. This indicates that bilingualism prevents the
acquisition of certain morphologic abilities. These abilities, however, represent
fundamental elements of the morphologic competence in the Romanian language,
according to the value of the t test (p<..01). These results are also sustained by
Paradis, Crago, Genesee, Rice (2008) research, they underlining that bilingual
(French-English) children with language impairments have difficulties in handling
several morph-syntactical aspects. However these grammatical aspects „may not be
an impediment to learning two languages, at least in the domain of grammatical
morphology” underline the authors, conclusion (Paradis, Crago, Genesee, Rice,
2008, p. 1).
Regarding the lexical level the above mention study also emphasizes a
significant different between the bilingual children and the non-bilingual children
participating in the research. Thus, this result confirmed the stated hypothesis
difficulties related to the simultaneous learning of two languages that can cause
difficulties in structuring lexical abilities, emphasizing the negative impact of
bilingualism on the structuring of the lexical level of the language. These results
are comparable with those that can be found in the specialized literature (Pearson;
Fernandez; Oller, 1993).

1.2. BILINGUALISM AND AUTISM SPECTRUM DISORDERS (ASD)

The impact of bilingual exposure on language development of children with

autism spectrum disorders is very little studied. Thus, there are studies underlining
that bilingual exposure is connected with additional delays on language
development, when speaking about children with autism (Kremer-Sadlik, 2005).
This aspect raises a lot of concerns in the bilingual families with an autistic
children, thus most of the parents tend to have one single language option.
Regarding this aspect Yu (2013) reported that bilingual families in Chinese-English
tend to choose to speak English with their ASD children. Yu (2013) developed a
research on 10 bilingual Chinese-English immigrants trying to underline the nature
of the language practice, the constraints of the language practice and the impact on
children development. The results of this research underline parents` fears about
bilingualism to intensify additional delays in children language development.
Despite these fears most of the parents (mothers especially) tend to often choose
one of the two spoken language based on different criteria such as:
communicational needs (taking into consideration that all of the participants in the
study were immigrants, they understood that they children need to be prepared to
establish communication relations not only within family boundaries, but within a
9
larger community where English is the dominant spoken language),
communicational environment (where the communication act takes place, in front
of whom), children`s response (mothers tend to be guided by children`s responses
having into consideration that they are an important member of the therapeutically
team), mothers personal beliefs regarding the impact of bilingualism on language
development (several mothers did not considered that bilingual exposure might
have a negative impact on child`s development).
Hambly, Fombonne (2012) investigated the impact of bilingual exposure on a
larger group of autistic participants (n-75). They assessed children`s language and
social development by focusing on the fallowing abilities: initiating of pointing,
response to pointing, attention to voice, vocabulary level, social interactions,
language acquisitions (first words, first phrase). They concluded that there were no
significant differences between the participants in the research, thus, they
concluded that „bilingually – exposed children with ASD did not experience
additional delays in language development” (Hambly, Fombonne, 2012, p. 1342).
Petersen, Marinova-Todd & Mirenda (2012) developed a research comparing 14
monolingual (English) and 14 bilingual children (English –Chinese). They reported
even better lexical abilities in the case of bilingual exposure, underlining that ASD
can be bilingual exposed without negative implications on their language
development.
These findings are consonant with that reported in the case of the typically
developed children (Bialystok, 2001; Attariba, Heredia, 2008) or in the case of
children with language impairments (Crutchley, Conti-Ramsden, Bottinig,, 1997;
Gutierrez-Clellen, Simon-Cereijido, Wagner, 2008; Paradis, Crago, Genesee, Rice,
2003).
American Speech-Language Hearing Association (ASHA 2004, 2005, 2011)
is also mentioned in Yu (2013) research as promoting the importance of mother
tongue language due to the cultural heritage even if ASHA do recognize the fact
that many speech and language therapists use to advise immigrant parents to speak
with their children the official language of the country they live in. Thus, in these
cases mother tongue language is not spoken anymore in these families. From this
point of view the focus on bilingualism and its implication on different
developmental aspects is required by the worldwide social climate, the emigration
phenomenon, this having a significant impact on the education of children,
especially when they face different disabilities or difficulties.

2. OBJECTIVES AND HYPOTHESES

2.1. OBJECTIVES

10
 Drawing a communication profile by using Communication Matrix in the
context of a bilingual child with autism spectrum disorders.
 Underlining the way bilingualism influence communication development in the
case of a child with autism spectrum disorders.

2.2. HYPOTHESES

 Maternal language ensures higher acquisitions regarding communication

development in the case of autism spectrum disorders.
 Bilingual exposure can negatively influence language development in the case
of autism spectrum disorders.

3. METHOD

3.1. PARTICIPANT

In order to reach the above mentioned objective, this research is designed

based on a single case study. The participant in the research is C.A., a 4.9 years old
girl diagnosed with autism spectrum disorder. The parents are Romanians, but they
lived and worked in Spain when C.A. was born. The maternal language was
Romanian.
C.A. was diagnosed with autism spectrum disorder when she was 3.2 years
old and she started ABA (Applied Behavior Analysis) therapy in Spanish. From
birth to that time the parents spoke Romanian and Spanish at home. When she
started the therapy, the therapists recommended the family to speak only Spanish at
home with the child. When she was 4.5 years old her parents decided to come back
to Romania. All the family members started to speak Romanian languages.
According to the mother’s report, C.I. was able to understand simple commands in
Romanian language after two weeks of living in Romania, and “she acts like she
feels very comfortable in the new context”. Also, the mother said “she used to say
the same things using the word in Spain and the word in Romanian” giving us two
simple example: “pâine”-“pan” (bread), “agua”-“apa” (water).
In present C.A. is enrolled in a private center that provides one-to-one therapy
services for children diagnosed with autism spectrum disorder in Romania. The
therapy follows ABA’s principles. The therapy sessions include gross motor
activities (bike, hammock and trampoline), fine motor activities (coloring, puzzles,
beads, clips, piano) academic activities (books, computer) and games with different
toys (dolls, cars). C.A. attends the center daily for 6-7 hours. All the therapists
speak Romanian and the parents started to speak only Romanian at home.

11
 3.2. INSTRUMENTS

The semi-structured interview was the main instrument used for collecting
data. This type of interview has a more flexible structure, it being the most
appropriate method for collecting data regarding parents` attitude and direct
experiences. This interview had three major parts: a. the first part contained
questions regarding child`s anamnesis from birth till now (questions about
pregnancy, birth, motor and linguistic acquisitions, medical problems, family
medical history); b. the second part focused on aspects regarding language
development; c. the third part focus on aspects regarding the bilingual exposure.
Data collected based on the semi-structured interview were completed using
Communication Matrix Scale. The Communication Matrix is an instrument that
assesses the first stages of communication occurring in the first two years of life, in
typically developing children. The parent answer some questions regarding the
reason the child communicate and the behaviors the child uses to communicate.
These communicative behaviors are organized in seven levels: Level I Pre-
Intentional Behavior, Level II. Intentional Behavior, Level III. Unconventional
Pre-symbolic Communication, Level IV. Conventional Pre-symbolic
Communication, Level V. Concrete Symbols, Level VI. Abstract Symbols, and
Level VII. Language (Rowland, 2011, 2010).
There are two versions for Communication Matrix: a version for specialists
and a version for parents. The Communication Matrix version for specialists was
used in this study. The Communication Matrix is available in six languages:
English, Spanish, Chinese, Russian, Korean, Vietnamese and Romanian. In this
research Romanian version was used in order to collect data from the parent and
the therapists, regarding C.A. `s communicative behaviors, and the English online
version in order to generate the Communication Matrix Profile.

3.3. PROCEDURE

Data were collected in the semi interview with the father and the mother. The
researchers also had two 60 minutes session of direct interaction with C.A. The
receptive and expressive language was evaluated during these sessions; C.A.
answered to some simple questions, followed simple commands and played
different games. The participant was observed during a therapy session.
Communication Matrix Profile was generated by collecting data from the speech
therapist and two other therapists who worked with C.A. in the past 3 months.

4. RESULTS
Father does not report any abnormalities during pregnancy and birth. Motor
development milestones were achieved at appropriate times. According to father’s
12
report C.A. did not present any babbling during the first year of life. The only
vocalizes she was able to say were „câţi [cɨtsi] (how many in English); ca [ka] (as
in English)”. In Romanian the word „câţi” has two specific Romanian phonemes
„â” - a centered, closed, unrounded, vowel and „ţ”-a mixture between „t” and „s”,
it is an affricate consonant, beginning with an explosion as in „t” and ending in s
friction as in „s”, it is a voiceless sound, produced without the participation of the
vocal cords, it is an oral sound, articulated behind the upper alveolar board. While
pronouncing the final phoneme is shortened, it barely hearing, thus from an
articulator point of view this word is as simple pronounced as the other word „ca”
[ka].
C.A. presents a special interest for letters. There are some sounds very
annoying for her: real motorcycle starting sounds and concrete breaker sound. It is
well known the fact that autistic children have many auditory processing disorders.
In this case this auditory processing disorders manifest as a hearing sensibility
when listening the above mentioned sounds no matter their intensity.
According to the records from Spain, when C.A. was 4.5 years old, she was
able to pronounce several words in Spanish, words presented in Table 1.

Table 1. C.A’s verbal words in Spanish at 4.5 years old

Words Requests Persons Rewards
Spanish English Spanish English Spanish English Spanish English
piña mama chupa
pineapple agua [´aɣwa] Water mother lollipop
[´piɲa] [´mama] [´ʧupa]
ocho pompa abuela zumo
eye Pomp grandmother juice
[´oʧo] [´pompa] [a´βwela] [´θumo]
Caliopia
gomi [´gomi] jelly chupa [´ʧupa] Lollipop Caliopia pan [pan] bread
[ka´ljopja
pompa gomi
pomp gomi [´gomi] Jelly jelly
[´pompa] [´gomi]
guapa „zumo” chuches
lovely Juice sweets
[´gwapa ] [´θumo] [´ʧuʧes].
hueso puzzle-
bone Puzzle
[´weso] [´puθθle]
si muñeca –
if Wrist
[si] [mu´ɲeka]
serpiente
bota [´bota] boot snake
[seɾ´pjente]
martillo
uva [´uβa] grape Hammer
[maɾ´tiʎo].
vaca
cow
[´baka]
chupa [´ʧupa] lollipop
cinco [´θiŋko
five
]
agua [´aɣwa] water
zumo
juice
[´θumo]
Caliopia
Caliopia
[ka´ljopja]
Manuela
Manuela
[ma´nwela]

13
 The words pronounced in Romanian language are presented in Table 2. The
words are phonetically written in both languages and translated in English in order
to be able to make comparisons.

Table 2. C.A.’s verbal words in Romanian at 4.9 years old

WORDS REQUESTS PERSONS REWARDS
Romanian English Romanian English Romanian English Romanian English
ac[ak] needle gata [gata] finish mama mother ciupa lollipop
[mama] [čiupa]
mama [mama] mother afară [afarə] out tata [tata] father afară [afarə] out
tata father ciupa lollipop Clau [Clau`] Clau suc juice
[tata] [čiupa] [suc]
pana [pana] feather bunica grandmother
[bunika]
cubu [cubu`] cube
pomu [pomu`] tree
ochi [ochi`] eye
mâna [mɨna] hand
cot [kot] elbow
becu [beku`] light
bulb
pui [pui] chicken
ou [ou] egg
banana banana
[banana]
apă [apə] water
ciupa [čiupa] lollipop
cană [kanə] cup
papuci shoes
[papuči]
da yes
[da]
nu no
[nu]

C.A. answers to her name, identifies and discriminates her body parts in
Spanish and Romanian language. During the last 3 months C.A. lived in Romania,
she gained new concepts. Even if the spoken language has changed, the new
communication abilities are achieved, she is able to answer Yes/No questions using
the correspondent adverbs ”Da (Yes)/Nu (No)”, to verbalize “Gata (It is enough)”
when she finishes her work, to identify some objects and pictures in a book. One of
the most important concepts C.A. achieved was to verbalize when she needs to use
the toilet. The isolated phonemes she is able to pronounced are: A, E, I, O, U, B, P,
D, T, G, M, N, and F.
During the direct interaction sessions C.A. answered some short questions
“What is your name? How old are you? What is your mother’s name? What is your
father’s name?” At the beginning of each activity C.A. choose a reinforcing item.
The most frequent reinforcing item C.A. chose was the candy. C.A. was able to

14
follow simple commands: “Open the book.”, “Turn the page.” and “Put the blocks
on the shelf.”
The data collected from the parent and from the other specialists was used to
elaborate the Communication Matrix Profile presented in Figure 1. Table 3
presents C.A. `s mispronounced words.

Figure 1. Communication Matrix Profile for C.A.

Table 3. C.A. `s mispronounced words

Romanian word English correspondent word C.A. pronunciation
lup [lup] wolf upu [upu`] – the word is
pronounced omitting the liquid
consonant “l”
jeleu [jeleu] jelly dedeu [dedeu`]-the word is
pronounced replacing “j” and “l”
with “d”.
cal [cal] horse caiu [caiu`]-the word is pronounce
with replacing “l” with “i”

5. DISCUSSIONS

The words C.A. is able to pronounce in Romanian and Spanish language

follow the same pattern; most of them are simple nouns, expressed in monosyllabic
15
and disyllabic words. C.A. tends to transform the monosyllabic word in a disyllabic
one in order to longer the pronunciation by adding “u” vowel in the end of the
word. This happens in Romanian language where “u” vowel added in the end of
the monosyllabic word transforms the words in disyllabic words, it being a linking
vowel between the root of the word and the definite article morpheme. This
transformation is common in spoken language. In C.A. case the monosyllabic
words transformed in disyllabic ones are: “pomu” (in English tree), “cubu” (in
English cube), “becu” (in English light bulb). This transformation also happens in
other three cases where C.A. pronounces the words with other pronunciation
disorders, as it is presented in Table 3.
Analyzing the words used by C.A. from the semantic point of view there is
also a high correspondence between the Spanish pronounced words and the
Romanian ones, this underlining that language development is reinforced by the
bilingual exposure. For example, it was even easier for her to learn the body parts
in Romanian, because they sound similar in Spanish. (ex. “ocho”-“ochi”). Even the
presence of the linking vowel “u” in Romanian can be explained through the
Romanian-Spanish mixture from the rhythmic point of view. Romanian language is
not as rhythmic as Spanish, if in Spanish the stress is placed in the last part of the
words (on final syllables), in Romanian it is mainly place on the first syllables from
the word. When prolonging the words the child has the possibility to use secondary
stress in Romanian words, on the last syllables from the pronounced words
(Dascǎlu-Jinga, 2001).
The usage of the linking vowel “u”, even if it results from the phonetic
mixture of the two spoken languages is of great help for the child. From the speech
and language therapy practice it helps the child improve pronunciation and get to a
superior level on communication skills (to more phonetically complex words-
disyllabic words, three or even more syllables words).
From a functional point of view the words C.A. uses are concrete words, able
to help her signal her basic needs. All the listed pronounced are context- specific
from a semantic point of view, C.A. being able to require things, to express
intentions, needs and to make herself understood by parents and therapists, in a
high degree.
Regarding Communication Matrix profile the first three levels of the language
acquisition (I. Pre-Intentional Behavior, II. Intentional Behavior, III.
Unconventional Pre-symbolic Communication) are mastered. Nine cells in the
Conventional Communication level are also mastered, she demonstrates the
emerging of two cells in the fourth level (yellow color/light colored), the
conventional communication level, she uses some conventional gestures and
sounds with the intent of affecting caregiver’s behavior. There are three cells with
some offers things or share, uses polite social forms and asks questions in this level
that need to start working on. Mastering these levels places C.A.’s language
development between 12-24 months. Her language delay is of approximately 3
years.

16
 Despite the fact that generating the Communication Matrix Profile the
therapist has the chance to establish child`s language development stage, the profile
presents the exact level of communication the child has mastered and the
communication abilities the child is emerging, thus it is very useful to elaborate the
objectives for the intervention plan. In this case the objectives will focus on how to
offer/share different things, how to request more of an action, to use polite social
forms, to ask questions, to ask for help. A list of syllables and short words
containing vowels and consonants C.A. is able to pronounce will be given to all the
specialists and the parents. Because C.A. loves music and she has great abilities to
imitate movements and words, having into consideration her auditory processing
sensibility, the therapist will teach her new songs accompanied by movements. The
researcher recommended the specialist to keep track of the vocabulary words C.A.
can verbalize.
No matter what language the child uses, Romanian or Spanish, the first levels
of communication are the same, thus underlining that Communication Matrix
levels are suitable for studying cases of bilingual exposure as they are not
dependent on historical languages, they addressing language in a more general way
(if we take into consideration Coşeriu`s perspectives on language levels, 1999).
This case proves the fact that communication abilities follow the same pattern, a
child with autism is able to develop communication skills in two different
languages, without being negatively influenced by this mixed linguistic exposure.
The bilingualism issues in families with a child diagnosed with autism
spectrum disorder creates many controversies. Is it important or necessary to
promote maternal languages in families with children with autism spectrum
disorders in the first years of life or should we promote bilingual exposure as a
linguistic and cognitive stimulation mean? These questions are of an extreme
importance as they arise in parents` mind all the time and therapists are supposed to
offer evidence-based solutions. These solutions are more likely to be identified
within the child`s and family`s specific, they being deeply connected with each
intrinsic dynamic situation. In order to able to answer the above questions and to
offer a perspective in this case, mothers` opinion was asked about her child
bilingual exposure.
Regarding this, findings confirm the conclusions of some recent researchers
Hambly, Fombonne (2012), Petersen, Marinova-Todd & Mirenda (2012), the
mother does not believe the Spanish language had a negative influence toward
C.A.’s communication languages. Once her family came back into Romania, she
considers that C.A. is more comfortable to communicate using maternal language,
taking into consideration the new environment, even from linguistic point of view.
The mother does not regret they used only Spanish language during the time they
started the therapy in Spanish, everybody tried to make things easier for C.A. “we
thought it is a normal continuing to use the same language the therapists used
because all the requests and all the communication began in the therapy”.
Mother also underlines the fact that the bilingual exposure was absolutely
necessary considering the fact that the family used to live in a foreign country and
17
that she felt important for the child to preserve their cultural identity. Thus, she
stresses that in their situation the bilingual exposure solution was the best linguistic
solution she could find for the child.
Based on mothers` opinions regarding bilingual exposure, the fallowing
conclusions can be drown: bilingual exposure is a necessity in certain situations;
this mixed linguistic option is mainly a family personal decision; this decision has
influence on child`s development, but not in a negative way.

6. CONCLUSIONS

Communication Matrix proved to be a valuable assessing instrument based on

which the researchers could structure the interviews in a bilingual situation.
Language and communication development in the case of a bilingual exposure
needs to be approached not just in terms of idiomatic competence or discursive
competence, but also in terms of elocutionary competence, a more general
competence situated according to Coseriu`s linguistic approach at a universal
linguistic level (Coseriu, 1999). Thus, it is very important to use a universal, more
general tool to evaluate and to track progress for the child’s communication
abilities in this case of Romanian–Spanish bilingualism. Communication Matrix is
also a valuable and useful assessing tool from the perspective of the developmental
disorders it addresses. Among the developmental disorders ASD are common ones
and they require a very specific approach both from the assessment and therapeutic
perspective. Based on this, after using it during the assessing stage,
Communication Matrix can also be used in the next months to establish the
progress the child will make and to set new therapeutic objectives. New research is
needed in the bilingualism field in the context of autism spectrum disorder to
increase the reliability of this data.

Received at: 19.05.2014, Accepted for publication on:30.05.2014

ACKNOWLEDGMENT

We sincerely thank this family for taking part in this study.

18
REFERENCES

Attariba, J., Heredia, R.R. (2008). An Introduction to Bilingualism, Principles and

Processes, USA: CRC Press.
Bialystok, E. (2001). Bilingualism in Development. UK: Cambridge University Press.
Bodea Haţegan, C. (2011). Abordări structuralist-integrate în terapia tulburărilor de
limbaj şi comunicare (Structural-integrated approaches in speech and language therapy),
Cluj-Napoca: Cluj Universiy Press.
Bodea Haţegan, C. (2009). Modalităţi de evaluare şi stimulare a competenţei
morfologice (Means for assessing morphologic competences). Unpublished Doctoral
Thesis, Cluj-Napoca.
Bodea Haţegan, C. (2010). Bilingualism-its implications in structuring morphological
and lexical abilities in Romanian language. Studia Psychologia-Paedagogia, 2, 13-23.
Coseriu, E. (1999). Introducere în psiholingvistică. Cluj Napoca: Echinocţiu Press.
Crutchley, A., Conti-Ramsden, & G.; Bottinig, N. (1997). Bilingual children with
specific language impairment and standardized assessments: Preliminary findings form a
study of children in language units. The International Journal of Bilingualism, 1, 117-134.
Dascǎlu-Jinga, L. (2001). Melodia vorbirii în limba românǎ. Bucureşti: Univers
Enciclopedic Press.
Gutiérrez-Clellen, V.F.; Simon-Cereijido, G., & Wagner, C. (2008). Bilingual children
with language impairment: A comparison with monolinguals and second language learners.
Applied Psycholinguistics, 29, 3-19, DOI:10.1017/S0142716408080016.
Hambly, C., & Fombonne, E. (2012). The Impact of Bilingual Environments on
Language Development in Children with Autism Spectrum Disorders. Journal of Autism
and Developmental Disorders, 42, 1342-1352, DOI: 10.1007/s10803-011-1365-z.
Kremer-Sadlik, T. (2005). To Be or Not to Be Bilingual: Autistic Children from
Multilingual Families. In ed. James Cohen, Kara T. McAlister, Kellie Rolstad, and Jeff
MacSwan, Proceedings of the 4th International Symposium on Bilingualism, 1225-1234,
Somerville, MA: Cascadilla Press.
Paradis, J., Crago, M., Genesee, F.,& Rice, M. (2003). Bilingual children with specific
language impairment: How do they compare with their monolingual peers?. Journal of
Speech, Language and Hearing Research, 46, 1-15.
Pearson, B. Z.; Fernandez, M. C., & Oller, D.K. (1993). Lexical development in
bilingual infants and toddlers: Comparison to monolingual norms, Language Learning, 43,
93-120.
Petersen, J. M., Marinova-Todd, S. H., & Mirenda, P. (2011). Brief Report: An
Exploratory Study of Lexical Skills in Bilingual Children with Autism Spectrum Disorders.
Journal of Autism and Developmental Disorders, 42, 1499-1503, DOI: 10.1007/s10803-
011-1366-y.
Rowland, C., & Fried-Oken, M. (2010). Communication Matrix: A clinical and research
assessment tool targeting children with severe communication disorders. Journal of
Pediatric Rehabilitation Medicine: An Interdisciplinary Approach, 3, 319–329. DOI:
10.3233/prm-2010-0144.
Rowland, C. (2011). Using the Communication Matrix to Assess Expressive Skills in
Early Communicators. Communication Disorders Quarterly, 32, 190-201.
Yu, B. (2013). Issues in Bilingualism and Heritage language Maintenance: Perspectives
of Minority-Language Mothers of Children with Autism Spectrum Disorders. American
19
Journal of Speech-Langauge Pathology, 22, 10-24, DOI: 10.1044/1058-0360(2012/10-
0078).

REZUMAT

Autorii articolului încearcă să delimiteze prin acest material modul în care contextul
bilingv, expunerea concomitentă la două sisteme lingvistice diferite, influenţează
structurarea abilităţilor de comunicare, în contextul prezenţei unei tulburări din spectru
autist. Metoda de abordare este una calitativă, prin intermediul studiului de caz, date fiind
constrângerile diagnostice şi de expunere simultană la două limbi, necesitatea prezenţei
bilingvismului. Datele culese cu ajutorul observaţiei sistematice, a interviului semi-
structurat şi a scalei Communication Matrix evidenţiază faptul că, în cazul asupra căruia
se focalizează demersul investigativ, cazul unui copil cu tulburări din spectru atutist, expus
simultan atât la sistemul lingvistic românesc, cât şi la cel spaniol, prezenţa bilingvismului
facilitează dezvoltarea abilităţilor sale de comunicare. Datele acestui articol trebuie privite
ca sistem de bune practici, deciziile la nivelul altor cazuri, cu privire la expunerea
bilingvă, recomandându-se a se face în funcţie de specificul şi particularităţile cazurilor
ţintite.

20
 ROMANIAN JOURNAL OF
EXPERIMENTAL APPLIED PSYCHOLOGY

VOL. 5, ISSUE 3 – www.rjeap.ro

EXPERIENTIAL LEARNING OF BASIC PSYCHOTHERAPY

SKILLS: A CASE STUDY IN A ROMANIAN UNIVERSITY

GEANINA CUCU-CIUHAN a, NICOLETA RĂBAN-MOTOUNUa

a
University of Pitesti,
Department of Psychology and Communication Sciences

Abstract
The paper presents the results of a one semester training program for third year
undergraduate psychology students that had the purpose to enhance their basic
psychotherapeutic skills (empathy, congruence, and non-conditional acceptance of the
client). The research is a pre-post-test quasi-experimental design on undergraduate
psychology students (N=59) aged 18 to 44. Aspects regarding professional competencies
were assessed using the NEO Personality Inventory – Revised, the Profile of Emotional
Distress, and the Proactive Coping Scale. To test for changes in their dimensions between
the two experimental moments, the paired sample t-test was used. Statistical data analysis
revealed significant improvements (p<0.05; small to medium size effects) in terms of
openness, positive emotions, proactive coping skills, and changes on some facets of NEO
PI-R Neuroticism dimension.

Cuvinte cheie: învățare experiențială, psuhoterapie, abilități, formare.

Keywords: experiential learning, psychotherapy, skills, training.

1. INTRODUCTION/THEORETHICAL FRAMEWORK

Different countries or psychotherapeutic schools have different training

programs for those wanting to become psychotherapists. In line with each school’s
orientation, the program focuses on specific skills and information, but the basis is
set during initial psychotherapy courses in faculty years. The impact the therapeutic
relationship has on the psychotherapy outcomes makes a strong argument in favor

*
Autor corespondent: Ceanina Cucu-Ciuhan, geaninaciuhan@gmail.com
of concentrating not only on theoretical knowledge, but also on skills development.
Relationship skills are useful for psychologists in general, because they establish
the framework for obtaining authentic information no matter the setting.
In two recent meta-analyses, Ackerman and Hilsenroth (2001, 2003)
considered twenty-five studies on therapist characteristics associated with strong
therapeutic alliance and other fourteen on characteristics associated with poor
alliance. They found that the strong therapeutic alliance is associated with
flexibility, honesty, respectfulness, trustworthiness, confidence, interest, alertness,
friendliness, warmth, and openness. In contrast, poor alliance is associated with
rigidity, uncertainty, tendency to exploit, criticalness, distance, tenseness,
aloofness, and distractedness. The relationship between personality traits and
therapeutic alliance is important especially early in psychotherapy career, when the
psychotherapist doesn’t master effective alliance skills and hasn’t enough
experience (Chapman, Talbot, Tatman, Britton, 2009). The Five Factor model
seems to be a useful tool to investigate the problem. Chapman, Talbot, Tatman, and
Britton (2009) in a sample of trainees (master and doctoral students) found lower
than average Neuroticism levels, and higher than average levels for the other four
factors (Extraversion, Agreeableness, Conscientiousness, and Openness).
In relationship to the Openness factor, especially the Openness to Values
facet, a special skill was identified: cross-cultural empathy (Dyche, & Zayas,
2001). Psychologists need it because they have to work with people with different
cultural backgrounds, in a world where moving from one culture to another is a
common fact. Cross-cultural empathy has been defined “as a general skill or
attitude that bridges the cultural gap between therapist and client, one that seeks to
help therapists integrate an attitude of openness with the necessary knowledge and
skill to work successfully across cultures” (Dyche, & Zayas, 2001, p.246). They
consider that an attitude of openness that allows the trainees participation in the
course helps develop a collaborative working style, an important component of
cross-cultural empathy.
Experiential programs are considered a helpful tool in optimizing the
students’ decision concerning psychotherapy training in a specific school
(Schapira, 2010). Information from books, articles, internet or tutors is not enough
to reach to a correct decision, because it is interpreted based on personal
experience, which is limited at the beginning, and there is a strong possibility to
misunderstand what being psychotherapist in a specific orientation means. If such
an experiential program is to be used for the students to have a more realistic
picture of a specific psychotherapy orientation, we can also assume that it has a
contribution to the initial development of some important skills. Godek and Murray
(2008) confirmed by means of two experiments that, when people are oriented to
the future, they tend to use rational processing, and when they turn to the past, they
tend to use experiential processing. The starting point was the adaptation they

22
made to the Epstein’s (1991) characteristics for both types of processing. They
described the experiential system as holistic, automatic, affective, more rapid, and
action oriented, encoding reality in concrete images, metaphors and narratives. On
the other side, rational processing is analytic, intentional, logical, but also slower,
encoding reality in abstract symbols, words and numbers, generating behaviour
mediated by conscious appraisal of events. They didn’t, though, elucidated the
mechanisms that link the time orientation to a certain processing type, experiential
or rational. They mentioned the hypothesis from a previous study, conducted by
Schul and Mayo (2003), who believed that the future orientation determines self-
detachment. Marks, Hine, Blore and Philips (2007) came with an instrument to
assess the dominant processing type, showing that rational scores were associated
with openness to experience, conscientiousness and open minded thinking, and
experientialism correlated positively with emotional expressivity in adolescents
with ages between 13.1 and 18.8 years. Previously, Pacini and Epstein (1999)
found that experiential processing was associated with conscientiousness and
openness to experience on an adult sample.
Experiential learning helps students focus on the personal way of solving
specific tasks over and over again so that they learn how to stimulate growth in
others, and also they benefit from the experience themselves. Mergenthaler (2008),
starting from the interactions between client and psychotherapist, proposed a
dynamic in four steps clients use when faced with a problematic situation:
relaxation, experience, connection, and reflection, in what he called the theory of
“resonating minds”. A person goes through the whole cycle to solve a life problem
in a different period of time, from minutes to months. The stages are differentiated
according to the level of emotion and abstraction: relaxation is characterized by
lower emotional and abstraction levels; experience by a higher emotional level,
either positive or negative, and still a lower abstraction level; connection implies a
lot of emotion and higher abstraction; and, finally, reflection comes with low
emotional level and high abstraction. Mergenthaler’s model transcends the
dichotomy between rational and emotional processing, showing that it is their
interplay that characterizes human development, with emotions guiding the
appropriate cognitive processing: negative emotions allow recalling autobiographic
material deepening processing in the present, and positive emotions stimulate
insight.
Experiential learning is based on the synergistic effects emerging from
interactions between five polarities: apprehension and comprehension, reflection
and action, epistemological discourse and ontological recourse, individuality and
relational ability, status and solidarity. A particular form of experiential learning,
conversational learning, is efficient in training managers. It was defined as “a
process whereby learners construct new meaning and transform their collective
experiences into knowledge through their conversation” (Baker, Jensen, & Kolb,

23
2005, p.412), while experiential learning is creating knowledge through
transformation of experience. Using perceptions and theoretical knowledge alone is
not as helpful as combining them with internal reflection upon them in a process of
extending them and self-knowledge (Kolb, 1984).
Good (2009) tried to find the core of Semrad’s talent, considered to be among
the most influential teachers of psychotherapy training in his generation. Semrad’s
approach, by sitting with the clients and helping them acknowledge and bear their
emotions, allowed them to overcome mental disorder even without medical
treatment. This way, even the diagnostic seemed unimportant for the client’s
evolution. His attitude in action was far more convincing than his published papers,
and it was considered that a paper could not express the central meaning of his
lessons.

2. OBJECTIVE AND HYPOTHESES

2.1. OBJECTIVE

The theoretic aim of our study was to assess the psychological effects of an
experiential learning program for psychotherapy. The applicative objectives were:
to demonstrate that the skills that the psychology graduate should have in order to
be successful in a postgraduate psychotherapy program, which are related with his
capacity to create a therapeutic relationship with the client, can be developed by
experiential learning.

2.2. HYPOTHESES

The general hypothesis is: After termination of the experiential learning

program for psychotherapy the students will have an increased emotional stability,
openness to experience of different kinds, and proactive coping skills.
The specific hypotheses were:
o The experiential learning program determines a significant growth of the
students’ emotional stability.
o The experiential learning program determines a significant growth of the
students’ openness to experience.
o The experiential learning program determines a significant improvement of
the students’ proactive coping skills.

24
 3. METHOD

3.1. PARTICIPANTS/SUBJECTS

The initial sample included all the 82 third year undergraduate psychology
students of our specialization, divided into five groups of 13 to15 students. From
this sample, 25 students didn’t meet the criteria for being included in the final
statistical analysis: to attend all the sessions, to participate at the scheduled initial
and final assessments, and to give complete answers on all questionnaires’ items.
The final sample included 59 students, 52 females (88.5%), and 7 males (11.9%)
with ages between 21 and 44 (m=23.49, sd=4.61), all Romanian, from different
parts of the country.
They received initial explanations about the experiential learning program and
most of them were enthusiastic about participating.

3.2. INSTRUMENTS/APPARATUS/STIMULI/MATERIALS

Revised NEO Personality Inventory (NEO PI-R, Costa & McCrae, 1991) is a
concise measure of the five major dimensions of personality and their most
important facets. Together, the five dimension scales (N – Neuroticism, E –
Extraversion, O – Openness, A – Agreeableness, and C - Conscientiousness) and
the 30 facets scales allow a comprehensive assessment of personality. NEO PI-R, S
Version, contains 240 items with five answering options and rated on a scale with
five points. The questionnaire was adapted for Romanian population by Iliescu,
Minulescu, Nedelcea, Ispas (2009), with Cronbach’s alpha between .55 and .71 for
the facets, and between .77 and .91 for the big factors, and test-retest reliability
between .75 and .83, very close to those of the original form, and of adaptations to
other cultures.
Profile of Emotional Distress (PDE, David, 2005) is an instrument created to
assess the subjective dimension of functional and dysfunctional negative emotions
(worry/fear or anxiety, and sadness or depression). The scale contains 26 items
formulated as adjectives describing these emotions. The respondent is asked to rate
the adjectives on a five points scale according to their frequency during the last two
weeks. Scores are computed for functional worry/fear, dysfunctional anxiety,
functional sadness, dysfunctional depression, functional emotions, dysfunctional
emotions, and total distress. The internal consistency was between .75 and .94 for
the subscales and the entire scale on the Romanian population. It has significant
positive correlations with Beck Depression Inventory, Dysfunctional Attitudes
Scale, ABS2, State Trait Anxiety Inventory, and Unconditional Self-Acceptance
Questionnaire, and it is recommended for research use.

25
 Proactive Coping Scale (PCS, Greenglass, Schwarzer, & Taubert, 1999b), in
contrast with classical points of view regarding coping which relate it to past
events, focuses on future threats and challenges which are mostly certain. It means
developing resources in order to minimize the effect of stressful future events, and
a strong belief in personal potential to face them (Schwarzer, & Knoll, 2003).
These resources refer to psychological strengths, but also developing the social
network, or accumulating wealth. It is considered to have its origins not in the state
anxiety, but at the level of the trait anxiety (or the tendency to experience worry). It
involves having a vision, giving life a meaning, orienting towards a goal: the
individual takes charge of his own life, at least in part, which also means
developing personal resources. The PCS was created by Greenglass, Schwarzer and
Taubert (1999a) as part of the Proactive Coping Inventory. PCS is the only scale of
this inventory dedicated exclusively to proactive coping. The scale has an internal
consistency alpha of .86 on Romanian population (comparable with that of the
English form). It has also a positive correlation with perceived self-efficacy and a
negative correlation with job burnout. The instrument has 14 items, each of them
with four answer variants (form not at all true to completely true). Some items
have reversed scoring. The total score is obtained by summing the scores for every
item.

3.3. PROCEDURE

The students were tested at the beginning (pre-test: T1) and at the end (post-
test: T2) of the semester with all three instruments. The experiential learning
program was ten weeks long, plus the first and the last week, when the assessments
were realized. The students received credits for their involvement in the seminar’s
activity and for completing the instruments.
It was explained to them that the personal difficulties that came up during the
program should remain confidential. The confidentiality aspects were discussed
before the beginning of the program, and the students agreed upon it. Although,
they were allowed to share with others information about theory and examples in a
general manner, with no details regarding the identification data of the person who
was the basis of the example.
The experiential learning program combined experiential with rational
processing. First, we were focused on each student’s experience during the
psychotherapeutic technique, and then on the ways he or she could use it in the
future for specific purposes. A special attention was paid to experiential learning
because, as mentioned before, the psychotherapist is more capable to attain a
stronger therapeutic alliance as he or she becomes more experienced, that is if he or
she values and integrates past experience with the present client.

26
 The program was administered once a week for two hours (as part of the
“Child and Adolescent Psychotherapy” course) and every other week for another
two hours (as part of the “Orientations in Psychotherapy” course), in addition to the
weekly two hours lectures on philosophic foundations, principles, applications, and
techniques for each course. It was conducted by teachers who were also specialists
and trainers in experiential psychotherapy, with MDs in Psychotherapy and
Psychological Assessment, and PhDs in Psychotherapy. The seminars were
conducted in groups of 13 to15 students, according to their prior formal class
organization, so the participants in the same group were familiar to each other. The
program was a combination of theory and practical examples. The concepts that
underline the basic psychotherapeutic skills were first presented during the weekly
lectures and they were afterwards experimented during seminars. The experiential
learning referred to involving the students in the different psychotherapeutic
techniques so that they get to a personal sense of the way each technique works,
which its applications and effects are, and they learn to trust in some of the
techniques. These techniques, in the same order, were:
 techniques of active listening;
 free associations, dream analysis and dramatization;
 negative thoughts and dysfunctional beliefs identification, counter-
argumentation, experiments to test them, advantages and disadvantages
inventory, building and using self-evaluation scales to assess the emotional
state;
 metaphor and creative techniques (body metaphor; drawing with a special
theme: the family, developing strategies to overcome difficulties, discovering
new meanings and strategies for the personal difficulties by creative means in a
small group; plasticine modelling; using metaphor expressed at all levels as
ways of uncovering unconscious, latent solutions to daily chores and
challenges);
 gestalt techniques (especially empty chair work, needs and affective
awareness);
 symbolic play;
 relaxation training;
 body focalization and scanning;
 imagery;
 story-telling;
 music-therapy;
 dramatization and role playing - the privileged technique especially the for
the Child and Adolescent Psychotherapy seminar - involving the
“psychotherapist”, “the child with a disorder”, and his or her “family”.

27
 For each session we followed a general structure: (1) psychotherapeutic
technique application involving each student (they used the technique with
themselves individually, in small groups or in the whole group); (2) individual
discussion upon the previous personal involvement in the technique in the whole
group (each student resumed his experience); (3) the teacher guided the group
discussion so that the students discover from their own experience the general
dynamic of the technique, the psychological mechanisms it implicated, the
therapeutic goal it could be used for, its detailed steps, its place in the whole
psychotherapeutic plan (design), the proper moment of its use in the therapeutic
process; (4) final conclusions regarding the theoretical implications and the
psychological theory underlying specific interventions.

3.4. EXPERIMENTAL DESIGN

The research was conducted as a pretest posttest quasi-experiment. We chose

this type of design without a control group because the program we tested was part
of the undergraduate teaching program. Also, the students were evaluated at the
end of the semester and a significant difference in the learning program might have
influenced their final grades.

4. RESULTS

A comparative analysis of the students that were included in the final

statistical analysis and those that weren’t was conducted based on scores obtained
at the initial assessment (T1). T test for independent samples revealed that the
participants that didn’t answer all our requirements had higher scores on N1,
Anxiety (t=-2.823, p=.007), and N3, Depression (t=-2.821, p=.028), and lower
scores on C2, Order (t=3.022, p=.004), and C5, Self-Discipline (t=2.694, p=.010).
Descriptive statistics for the assessment instruments of the remaining 59
students are presented in Table 1 and Table 2. SPSS 15 was used for the statistical
analysis.

28
 Table 1: Paired sample t Test for scores on Profile of Emotional Distress scales (T1 pretest, T2 pot-test), the
signification level, means, and standard deviation of the corresponding distributions

Scale Moment Mean Standard t Test for p

deviation paired
samples
Functional Sadness T1 11.1525 3.8588 2.207 .031
T2 10.1695 3.6773
Dysfunctional Sadness/Depression T1 10.8983 3.8716 -.375 .709
T2 11.0847 4.4848
Functional Fear T1 15.4915 4.3485 .797 .429
T2 14.9322 5.6808
Dysfunctional Fear/Anxiety T1 9.8983 3.5071 -.203 .840
T2 9.9831 3.7208
Functional negative emotions T1 26.6441 7.1457 1.514 .136
T2 25.1017 8.4358

Dysfunctional negative emotions T1 20.7966 6.7869 -.418 .678

T2 21.1525 7.9974
Our first hypothesis was that the experiential learning program determines a
significant growth of the students’ emotional stability. Paired samples t-test was
used to determine if there were significant differences between the initial and final
assessments for PDE scales, and for NEO PI-R Neuroticism factor and its facets.
The results are presented in Table 1 for PDE and Table 2 for NEO PI-R. The only
significant difference was found for functional sadness, which decreased during the
program. It is important to notice, though, that both initial and final assessments
revealed average or below average mean scores on all these scales. In addition, the
E6 facet of the Extraversion factor, Positive Emotions, significantly increased from
a mean of 20.05, at pre-test, to a mean of 21.09 at post-test, the experiential
program having a small size effect, Cohen’s d = 0.222.

Table 2: Means and Standard Deviations of distributions of scores on NEO PI-R factors and their facets

Factor Initial Assessment Final Assessment

Facet Mean Standard Mean Standard
Deviation Deviation
Neuroticism 89.63 25.70 91.08 19.62
Anxiety 16.95 4.30 17.00 5.06
Angry Hostility 13.61 4.66 14.25 4.67
Depression 13.29 5.21 14.19 5.16
Self-Consciousness 15.88 4.03 16.47 4.78
Impulsiveness 14.80 4.23 14.42 4.30
Vulnerability 12.68 4.16 12.85 4.59
Extraversion 113.00 15.43 111.37 17.51
Warmth 16.95 4.30 17.00 5.06
Gregariousness 19.34 3.83 19.47 4.53
Assertiveness 15.69 4.00 15.47 3.51
Activity 18.10 3.23 18.47 3.42
Excitement Seeking 17.10 4.65 16.32 4.67

29
 Positive Emotions 20.05 5.24 21.08 2.89
Openness 106.14 17.09 110.64 16.14
Fantasy 16.20 4.14 16.59 4.12
Aesthetics 19.10 5.53 20.64 5.38
Feelings 18.95 5.11 21.22 3.62
Actions 15.69 3.44 15.17 3.19
Ideas 16.33 4.67 17.85 5.53
Values 18.34 2.89 19.32 2.93
Agreeableness 113.53 21.68 111.80 14.00
Trust 18.59 4.91 18.76 4.86
Straightforwardness 19.73 4.88 19.71 5.16
Altruism 20.47 3.40 20.36 3.00
Compliance 16.59 4.38 16.71 4.16
Modesty 15.51 4.32 16.10 4.47
Tender-mindedness 20.08 3.61 20.15 2.99
Conscientiousness 116.93 15.55 116.00 17.80
Competence 19.95 3.49 19.95 3.69
Order 20.02 3.40 19.56 4.07
Dutifulness 21.08 3.05 21.10 3.52
Achievement Striving 18.29 2.99 18.31 3.42
Self-Discipline 19.59 3.22 19.37 3.69
Deliberation 18.00 4.82 17.71 5.11

The second hypothesis was that the experiential learning program determines
a significant growth of the students’ openness to experience, as it is assessed by the
Openness factor of NEO PI-R and its facets. The paired samples t test was used to
compare the O factor of NEO PI R or its facets pre-test and post-test. A significant
increase of the total Openness factor resulted, from a mean of 89.63 to a mean of
91.09 (t=-2.49, p=.016). The facets with a significant growth were: O2 - Openness
to Aesthetics (from a mean of 19.10 to a mean of 20.64, t=-2.25, p=.018), O3 -
Openness to Feelings (from a mean of 18.95 to a mean of 21.22, t=-3.14, p=.003),
and O6 - Openness to Values (from a mean of 18.34 to a mean of 19.32, t=-2.26,
p=.028). The size effect, Cohen’s d, was 0.270 for the Openness factor, indicating a
small effect; for Openness to Aesthetics (O2) it was 0.330, also a small effect; for
Openness to Feelings (O3) it was 0.53, a medium effect, and for Openness to
Values (O6) it was 0.34, a small effect.
The last hypothesis was that the experiential learning program determines a
significant improvement of the students’ proactive coping skills. To verify if the
collected data confirmed it, the paired samples t test was used. We compared the
PCS scores pretest and posttest. For the third hypothesis, the score for PCS
significantly increased from a mean of 40.49 to a mean of 43.47 (t=-7.70, p=.001),
with a high size effect.

30
 5. CONCLUSIONS

The data didn’t confirm our first hypothesis, which assumed that the students
would be more emotionally stable after their involvement in the experiential
learning program, with the exception of functional sadness. The absence of any
significant variation with the exception mentioned before (functional sadness) has
several explanations. The teacher-student relationship can’t be considered entirely
psychotherapeutic, but a teaching one, although student centred. The personal
difficulties presented by the students were not deep enough attended, because
personal development wasn’t the main purpose of the program and the group work
ensured limited confidentiality. We have to mention also other factors out of our
possibility to control in this research: the mean level of functional or dysfunctional
emotions was in the lower part of the mean interval for the Romanian population,
and the final testing was realized before the exam session and the final exam, so a
certain level of anxiety, especially functional fear, seems normal.
An alternative explanation is possible if we take into consideration the
increase in the Positive Emotions facet. Adding this information to the results
related with this hypothesis we may think that the program helped the students
become more conscious of their emotions, both positive and negative. This is a
very important resource for a psychotherapist, because it helps him properly
manage transfer issues in the psychotherapeutic relationship, and avoid
countertransference. The assessment instruments we used were self-evaluation
questionnaires, so that the insignificant variances in the negative emotions don’t
necessarily mean that the participants didn’t experience fewer negative emotions if
they became more conscious of their emotions. Adding all the results we are
inclined to think that the students became more aware at emotional level, no matter
if the emotions are either positive or negative, a considerable gain for their future
profession.
Data confirmed our second hypothesis: The experiential learning program
determines a significant growth of the students’ openness to experience. The results
were in concordance with the experiential teaching. The experiential orientation, as
part of the humanistic psychotherapies, has as a main long term goal to enhance
client’s openness to experience, both external and internal (Rogers, 1954). The
internal experience in its unity is reflected in the emotional state of the individual,
experience which guides the establishment of the meaning of the specific
experiences (Perls, 1965). The student’s personal involvement in the therapeutic
techniques, the student centred teaching relationship favoured the resolution of
some personal difficulties, and the student’s connection between the theory and
global internal motivational states (personal meanings, needs, goals, interests). This
was reflected in the students’ increased scores after participating in the program on

31
E6 (Positive Emotions), but also on O6 (Openness to Values). The experiential
learning led to an increased openness to values, which indicates more flexible
attitudes, unifying emotional, cognitive and behavioural changes. These can be
important resources when facing life challenges.
Our third hypothesis was also confirmed by the data: The experiential
learning program determines a significant improvement of the students’ proactive
coping skills. This means that the students involved in the study significantly
improved their proactive coping skills. They found the way in converting their
anxiety in an important resource to face potentially stressful events. The techniques
they worked with modelled internal mechanisms which made them feel more
prepared for life, more resourceful. These mechanisms also involved finding a
meaning in the problems they encounter. Their confidence is an important factor
when establishing the psychotherapeutic relationship, because, when it is
accompanied by the psychotherapist’s congruence, it encourages the client to trust
the psychotherapeutic process.
The differences between the excluded students and those included in the final
analysis need to be considered. Our initial data showed that the students who didn’t
meet the inclusion criteria were more anxious, more depressed, they had a weaker
self-discipline and poorer sense of order. This can be interpreted as a necessity to
first assess such traits in students soliciting training in psychotherapy in order to
identify the ones with such problems. Special programs including counselling,
personal analysis and optimization, could help them integrate better. These initial
programs should address their problems generating negative affect like fear and
depression at a deeper level. This way the students will benefit more from an
experiential learning program. If they choose not to attend this additional sessions
at least they could use the information to find means to avoid losing the investment
they make in training (personal effort, time and, why not, financial costs). It is
important to mention that we base our conclusions on data collected with NEO PI-
R, so they don’t refer to psychopathology.

5.1. Limitations of the Present Study

One important limitation of our study is that it hasn’t a control condition

but we have already explained our reasons for choosing to do so. Qualitative
research dedicated to students’ feedback can give a glimpse of their internal
mechanisms leading to the observed effects. Another limitation is that we didn't
investigate if the teachers’ training in experiential psychotherapy had any influence
on the results, although it’s reasonable to assume so.

5.2. Directions for Future Research

32
 A future study including a control condition is needed. Nevertheless, we
consider our work as an example to encourage other psychotherapy trainers,
teachers or supervisors, to assess the effects of their work with students in order to
find improvements, by focusing on specific skills. One other special concern refers
to assessing unintended effects of training programs concerning larger aspects of
personality from both trainer’s and trainees’ perspectives. This type of
investigation would allow comparison among different psychotherapeutic schools
or orientations.

5.3. Conclusions

In our research we tried to combine classical bibliographical resources, like

books by Rogers, and Perls, with new studies regarding the psychotherapeutic
efficiency and its factors, in an effort of reaching to the core of the
psychotherapeutic experience, no matter where it happens, and of initiating the
students in it.

33
REFERENCES
Akermann, S.J., & Hilsenroth, M. J. (2001). A review of trainee characteristics and
techniques negatively impacting the therapeutic alliance. Psychotherapy, 38(2), 171-184.
doi: 10.1037/0033-3204.38.2.171
Akermann, S.J., & Hilsenroth, M. J. (2003). A review of trainee characteristics and
techniques positively impacting the therapeutic alliance. Clinical Psychology Review, 23
(1), 1-33. doi: 10.1016/S0272-7358(02)00146-0
Baker, A.C., Jensen, P.J., & Kolb, D.A. (2005). Conversation as Experiential Learning.
Management Learning, 36, 411-429. doi: 10.1177/1350507605058130
Chapman, B.P., Talbot, N., Tatman, A.W., Britton, P.C. (2009). Personality traits and
the Working Alliance in Psychotherapy Trainees: An Organizing Role for the Five Factor
Model? Journal of Social and Clinical Psychology, 28(5), 577-593. doi:
10.1521/jscp.2009.28.5.577
Costa, P.T., & McCrae, R.R. (2009). NEO PI-R. Manual tehnic şi interpretativ (NEO
PI-R. Technical and Interpretative Manual). Cluj-Napoca: Sinapsis.
David, D. (2005). Profilul Distresuslui Emoţional (Profile of Emotional Distress). Cluj-
Napoca: Cognitrom.
Dyche, L., & Zayas, L.H. (2001). Cross-cultural empathy and training the contemporary
psychotherapist. Clinical Social Work Journal. 29(3), 245-258. doi:
10.1023/A:1010407728614
Epstein, S. (1991). Cognitive-experiential self-theory: An integrative theory of
personality. In R. Curtis (Ed.), The relational self: Convergences in psychoanalysis and
social psychology (pp. 111–137). New York: Guilford Press.
Godek, J. & Murray, K.B. (2008). Willingness to pay for advice: The role of rational
and experiential processing. Organizational Behavior and Human Decision Process,
106:77-87. doi:10.1016/jobhdp.2007.10.002. www.sciencedirect.com
Good, M. (2009). Elvin V. Semrad (1909-1976): Experiencing the Heart and Core of
Psychotherapy Training. American Journal of Psychotherapy, 63(2), 183-205.
Greenglass, E., Scwarzer, R., Jakubiec, D., Fiksenbaum, L., & Taubert, S. (1999a, July
12-14). The Proactive Coping Inventory (PCI): A Multidimensional Research Instrument.
The 20th International Conference of the Stress and Anxiety Research Society (STAR),
Cracow, Poland.
Greenglass, E.R., Schwarzer, R., Taubert, S. (1999b). The Proactive Coping Inventory
(PCI): A multidimensional research instrument. [On-line publication]. Retrieved from:
http://userpage.fu-berlin.de/~health/greenpci.html
Kolb, D.A. (1984). Experiential Learning: Experience as the Source of Learning and
Development. Englewood Cliffs, NJ: Prentice Hall
Marks, A.D.G., Hine, D.W., Blore, R.L., & Philips, W.J (2007). Assessing individual
differences in adolescents’ preference for rational and experiential cognition. Personality
and Individual Differences, 44:42-52. doi:10.1016/j.paid.2007.07.006
Mergenthaler, E. (2008), Resonating minds: A school-independent theoretical
conception and its empirical application to psychotherapeutic processes. Psychotherapy:
Theory, Research and Practice, 18(2):109-126. doi: 10.1080/10503300701883741

34
 Pacini, R. & Epstein, S. (1999). The relation of rational and experiential information
processing styles to personality, basic beliefs, and the ratio-bias phenomenon. Journal of
Personality and Social Psychology, 76(6), 972-987. doi: 10.1037/0022-3514.76.6.972
Perls, F. (1965). Gestalt Therapy: Excitement and Growth in the Human Personality.
New York: Delta Books
Rogers, C.R. (1951). Client - Centered Psychotherapy: its current, practice,
implications and theory. Boston: Houghton Mifflin Company.
Schapira, S.K. (2000). Choosing a Counselling or Psychotherapy Training. London:
Routledge.
Schul, Y., & Mayo, R. (2003). Searching for certainty in an uncertain world: The
difficulty of giving up the experiential for the rational mode of thinking. Journal of
Behavioral Decision Making, 16(2), 93–106. doi 10.1002/bdm.434
Schwarzer, R., & Knoll, N., (2003). Positive Coping: Mastering Demands and
Searching for Meaning. In S.J. Lopez, & C.R. Snyder, (Eds.), Positive psychological
assessment: A handbook of models and measures. (pp. 339-409). American Psychological
Association.

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 ROMANIAN JOURNAL OF
EXPERIMENTAL APPLIED PSYCHOLOGY

VOL. 5, ISSUE 3 – www.rjeap.ro

REDUCING AUTOPERCEIVED STRESS AND OPTIMIZING

THE ACADEMIC MOTIVATION IN PERSONAL
DEVELOPMENT GROUPS- SAMPLE STUDY

MADALINA PETRESCU 1
SNSPA, Department Of Psychology, Romania

Abstract
The present study is focused on reducing the autopercieved stress and anxiety level
in academic environment and also optimizing the intrinsic and extrinsic motivation of the
undergraduate students at the psychology participating during 6 group development
session. The method: The participants were a number 35 undergraduate students at
psychology, age between 19 and 27 years old (M=21.6; S.D.=2.11), 28 female and 7 male,
from rural and urban areas. The instruments were: the questionnaire of academic intrinsic
and extrinsic motivation (Chraif & Petrescu, 2014) adapted from intrinsic and extrinsic
motivation in high-school (Dogoter, 2013); the academic autoperceived stress and anxiety
questionnaire (Petrescu, 2014) adapted from the organizational autoperceived stress and
anxiety questionnaire (Parker & DeCotiis, 1983).The results highlights that three
hypotheses has been confirmed (p<0.01). Hence the 6 session of group development
reduced the autoperceived stress level and anxiety and increased the extrinsic motivation
for the undergraduate students at psychology.

Keywords: autoperceived stress, intrinsic motivation, extrinsic motivation, personal

development, play role.

1. INTRODUCTION
Beck (1979) defines cognitive therapy as "a structured, active, directive,
time-limited, based on a coherent theoretical conception ... focused on issues ...
and " here and now " approach... encouraging the development of self help skils
"(Beck et al., 1979, pg. 5-6).
1
Corresponding author:
Madalina Petrescu
e-mail: petrescumdalina@gmail.com
 Beck et al. (1979) principles of cognitive therapy are:
 collaborative relationship "working alliance" between client and therapist;
 structuring meetings;
 focus on problems and on present;
 empirical investigation - formulating hypotheses and testing them;
 Guided discovery - the client is encouraged to find alternatives, with little
 persuasion from the therapist and questioning is conducted by the Socratic
model;
 inductive methods - the client learns to look upon their thoughts and beliefs as
assumptions whose validity is open to testing;
 educational emphasis on work and practice skills developed in the natural
environment of the client.

Reducing stress is known in the literature as coping methods. These methods

of coping are adaptive methods of the individual to stressors (Stranks, 2005). After
Stranks (2005) there are a number of job adaptation methods: gather as much
information about stress; identify a systematic approach on stress; deal with
feelings; develop behavioral skills; establish and maintain a strong network of
emotional and social support; develop a lifestyle that improves the effects of
stress; focus on the positive and spiritual development; plan and successfully
execute changes in life. Stranks (2005) as well as several authors in the literature
(Teasdale & Connely, Weinberg, Sutherland & Cooper, 2010, Cooper & Dewe,
2004) have cataloged a series of global strategy:

• Relaxation methods: emphasis is placed on deep breathing techniques such

as yoga or other known methods. Such techniques include the control of muscles,
muscle relaxation. It is recommended that these techniques take place in a quiet
place.
• Sports: these refer to sports such as swimming, athletics, football, tennis or
any physical activity that requires intense body movements.
• Drugs: This adaptation strategy is the least used and not recommended for
adaptation to stress as coping is based on medication and not on cognitive and
physiological adaptation.

Taylor (1953) showed that anxiety reduction happens when an individual is

exposed to a number of situations that trigger this condition. These exercises aim
to decrease anxiety, increase motivation and performance (Taylor, 1953).
Although there is evidence that anxiety can be lowered with medication (Moreira
et. Al., 2008, Neufeld et. Al., 2011, Steiner et. Al., 1998), psychologists have

37
developed a number of techniques that can reduce individual anxiety without drug
therapy by means of cognitive behavior therapy (Laidlaw et. al., 2003, Taylor
1953). Generally, motivation is a series of internal states which induces particular
behaviors in a certain direction to a person. In literature there are several known
theories of motivation, such as Maslow's theory of needs, goal-setting theory or
Herzberg's two-factor theory (Spector, 2008).
One of the most common theories of motivation comprises intrinsic
motivation that are internal components of individual and extrinsic motivation that
keeps the external components of the individual (Spector, 2008). Durham &
Bartol (2009) show that salary (pay) is the best motivator for an employee, and
intrinsic motivation is effective if the employee wants to fulfill a personal goal.

2. OBJECTIVES AND HYPOTHESES

2.1. OBJECTIVES

 To highlight auto perceived level of stress reduction;

 To evidence optimization of intrinsic motivation;
 To evidence optimization of extrinsic motivation.

2.2. HYPOTHESES

 The participation to a number of 6 group development sessions reduce

statistically significant the auto perceived academic stress for the
undergraduate students at psychology;
 The participation to a number of 6 group development sessions reduce
statistically significant the level of anxiety regarding academic
involvement for the undergraduate students at psychology;
 The participation to a number of 6 group development sessions increase
statistically significant the level of intrinsic motivation in academic life
for the undergraduate students at psychology;
 The participation to a number of 6 group development sessions increase
statistically significant the level of extrinsic motivation for the
undergraduate students at psychology;

38
 3. METHOD

3.1. PARTICIPANTS

The participants were a number 35 undergraduate students at psychology,

Titu Maiorescu University, age between 19 and 27 years old (M=21.6; S.D.=2.11),
28 female and 7 male, from rural and urban areas (table 1).

Table 1 Descriptive statistics for variables age and gender

Mean Median Mode Std. Deviation Minim Maxim

age 21.60 21.00 20a 2.117 19 27

gender 1.20 1.00 1 .406 1 2

Figure 1 Histogram for variable age

In figure 1 can be seen the frequencies distribution for variable age of the
participants.

3.2. INSTRUMENTS

• Questionnaire for measuring intrinsic and extrinsic motivation adapted for

the academic environment after Dogoter (2013). This questionnaire has 8 items
that measure self-perceived pain on a Likert scale from 1 (not at all) to 10 (very
high). The dimensions are intrinsic motivation (α = 0.763) and extrinsic
motivation dimension (α = 0.721).

39
 • Questionnaire for measuring self-perceived stress in the academic
environment (Petrescu & Chraif, 2014) adapted from occupational stress
questionnaire developed by Parker and DeCotiis (1983). The dimensions are self-
perceived stress (α = 0.758) and college anxiety level (α = 0.736). Each item is
scored on a scale from 1-5, where 1 = strongly disagree, 2 = slightly disagree, 3 =
neither agree nor disagree, 4 = slightly agree, 5 = strongly agree. 1 is fairly close
to a low stress area and a score of 5 indicates a high level of stress at work.

3.3. PROCEDURE

The 35 participants were divided into three personal development groups.

The instruments were applied in the first group development session and after 6
weeks. The development group sessions were scheduled every week and the
participants exercised cognitive behavioural techniques as program for reducing
perceived stress in academic environment, perceived anxiety in academic
environment, optimizing the level of intrinsic and extrinsic motivation. Also,
during group development sessions, the participants played role plays focused on
reducing anxiety and perceived stress as “project development”, “we listen, you
present the project”, “questions for project lecturer”.

3.4. EXPERIMENTAL DESIGN

In figure 1 and figure 2 can be seen the experimental designed the factorial
design for testing the hypotheses.

Evaluation of stres Evaluation of stress

and intrinsic, extrinsic and intrinsic,extrinsic
motivation evaluation: Participating at 6 motivation evaluation:
35 participants in group 35 participants in
group development, development, group development,
first session. sessions. the end of th 6th
session.

Figure 2. Experimental design of testing the hypotheses.

In figure 2 can be observed the experimental design for testing the

hypotheses regarding reducing the autoperceived stress level, anxiety, intrinsic
and extrinsic motivation during 6 personal development gropus.

40
 As factorial plan, the independent variable can be seen in figure 3.

Level 1 Level 2
No group development sessions After 6 group development participation
participation

Figure 3. Representing the independent variable „gruop development strategies and technicues in
reducing autopercied stress, anxiety, intrinsic and extrinsic motivation”.

The dependent variables are: Intrinsic motivation 1, extrinsic motivation 1,

Perceived anxiety 1, Perceived stress 1, intrinsic motivation 2, and extrinsic
motivation 2, and Perceived anxiety 2, Perceived stress 2.

4. RESULTS

In table 2 can be seen the descriptive statistics for the dependent variables
measured before the participation to the 6 personal development sessions
(Momentum 1) and after participation at 6 personal development sessions
(Momentum 2).

Table 2 Descriptive Statistics

N Mean Std. Deviation Minimum Maximum

The results before the group development sessions: first application

Intrinsic motivation 1 35 36.29 8.611 14 51

Extrinsic motivation 1 35 18.91 10.314 7 47
Perceived anxiety 1 35 16.2000 6.40221 4.00 27.00
Perceived stress 1 35 21.8857 6.75962 7.00 31.00

The results after the group development 6 sessions: second application

Intrinsic motivation 2 35 38.8571 6.82186 27.00 52.00

Extrinsic motivation 2 35 28.5143 10.72208 12.00 50.00
Perceived anxiety 2 35 13.0000 4.75271 4.00 21.00
Perceived stress 2 35 17.5429 5.10100 7.00 27.00

In tables 3, 4 and 5 can be seen the values and significations for the Kolmogorov-
Smirnov Test applied for the dependent variables: Intrinsic motivation 1, Extrinsic
motivation 1, Perceived anxiety 1, Perceived stress 1, Intrinsic motivation 2, Extrinsic
motivation 2, Perceived anxiety 2, Perceived stress 2.

41
 Table 3 One-Sample Kolmogorov-Smirnov Test
Intrinsic Extrinsic Perceived
motivation 1 motivation 1 anxiety 1
N 35 35 35
Normal Parametersa,b Mean 36.29 18.91 16.2000
Std. 8.611 10.314 6.40221
Deviation
Most Extreme Differences Absolute .073 .226 .140
Positive .073 .226 .067
Negative -.065 -.124 -.140
Kolmogorov-Smirnov Z .433 1.337 .828
Asymp. Sig. (2-tailed) .992 .056 .499
a. Test distribution is Normal.
b. Calculated from data.

In table 3 can be seen that the data distributions for the variables Intrinsic
motivation 1, Extrinsic motivation 1, Perceived anxiety 1. The data are normal
distributed (p>0.05).

Table 4 One-Sample Kolmogorov-Smirnov Test

Perceiv Intrinsic Extrinsic
ed stress 1 motivation 2 motivation 2
N 35 35 35
Normal Parametersa,b Mean 21.8857 38.8571 28.5143
Std. Deviation 6.75962 6.82186 10.72208
Most Extreme Differences Absolute .164 .109 .128
Positive .089 .075 .128
Negative -.164 -.109 -.100
Kolmogorov-Smirnov Z .970 .645 .759
Asymp. Sig. (2-tailed) .304 .800 .612
a. Test distribution is Normal.
b. Calculated from data.

In table 4 can be observed and analyzed the data distribution for the
dependent variables: Perceived stress1, intrinsic motivation 2, Extrinsic
motivation 2. The data are normal distributed (p>0.05).

Table 5 One-Sample Kolmogorov-Smirnov Test

Perceived Perceived
anxiety 2 stress 2
N 35 35
Normal Parametersa,b Mean 13.0000 17.5429
Std. Deviation 4.75271 5.10100
Most Extreme Differences Absolute .100 .114
Positive .100 .090
Negative -.082 -.114
Kolmogorov-Smirnov Z .592 .672
Asymp. Sig. (2-tailed) .875 .757
a. Test distribution is Normal.
b. Calculated from data.

42
 In table 5 can be observed and analyzed the data distribution for the
dependent variables: Perceived anxiety 2, perceived stress 2. The data are normal
distributed (p>0.05).

Table 6 Paired Samples Statistics

Std. Error
Mean N Std. Deviation Mean
Pai anxietateperceputa1 16.2000 35 6.40221 1.08217
r1 anxietateperceputa2 13.0000 35 4.75271 .80335
Pai stresperceput 21.8857 35 6.75962 1.14258
r2 stresperceput2 17.5429 35 5.10100 .86223
Pai motivatie intrinseca 36.29 35 8.611 1.456
r3 mintrinseca2 38.8571 35 6.82186 1.15311
Pai motivatie extrinseca 18.91 35 10.314 1.743
r4 mextrinseca2 28.5143 35 10.72208 1.81236

In table 6 can be seen the descriptive statistics for the dependent variables:
Intrinsic motivation 1, extrinsic motivation 1, Perceived anxiety 1, Perceived
stress 1, intrinsic motivation 2, and extrinsic motivation 2, and Perceived anxiety
2, Perceived stress 2.
In order to test the hypotheses and taking in consideration the normal
distribution of the dependent variables, the t-test for pairs has been applied (tables
7, 8 and 9).

Table 7 Paired Samples Test

Paired Differences
Mean Std. Deviation Std. Error Mean
anxietateperceputa1 -
Pair 1 3.20000 2.25962 .38195
anxietateperceputa2
Pair 2 stresperceput - stresperceput2 4.34286 4.51757 .76361
motivatie intrinseca -
Pair 3 -2.57143 10.41008 1.75962
mintrinseca2
motivatie extrinseca -
Pair 4 -9.60000 13.05914 2.20740
mextrinseca2

Table 8 Paired Samples Test

Paired Differences
95% Confidence Interval of the Difference
Lower Upper t df
Pair 1 anxietateperceputa1 -2.42379 3.97621 8.378 34
anxietateperceputa2
Pair 2 stresperceput -2.79102 5.89470 5.687 34
stresperceput2
Pair 3 motivatie intrinseca --6.14742 1.00456 -1.461 34
mintrinseca2
Pair 4 motivatie extrinseca --14.08597 -5.11403 -4.349 34
mextrinseca2

43
Table 9 Paired Samples Test
Sig. (2-tailed)
Pair 1 anxietateperceputa1 - anxietateperceputa2 .000
Pair 2 stresperceput - stresperceput2 .000
Pair 3 motivatie intrinseca - mintrinseca2 .153
Pair 4 motivatie extrinseca - mextrinseca2 .000

The results in table 9 confirm the following three research hypotheses

(p<0.01):
 The participation to a number of 6 group development sessions
reduce statistically significant the auto perceived academic stress for
the undergraduate students at psychology;
 The participation to a number of 6 group development sessions
reduce statistically significant the level of anxiety regarding
academic involvement for the undergraduate students at psychology;
 The participation to a number of 6 group development sessions
increase statistically significant the level of extrinsic motivation for
the undergraduate students at psychology;

The hypothesis “The participation to a number of 6 group development

sessions increase statistically significant the level of intrinsic motivation in
academic life for the undergraduate students at psychology” has not been
confirmed (p>0.05).

5. CONCLUSION

Participating in personal development groups plays an important role in

controlling emotions and cognition, controllimg anxiety, increasing self-esteem
and reducing stress (Holdevici, 2010a; Holdevici, 2010b; Holdevici 2011, Beck,
1979; Cottraux, 2003). The fact that three research hypotheses were confirmed
further substantiates and emphasizes that personal development groups that use
technical strategy and cognitive behavioral therapy have success with customers.
Thus, anxiety towards the academic level was significantly reduced following the
techniques and strategies used such as role play, interaction, dialogue, etc.
Moreover stress self-perception intensity was reduced following participation and
involvement in the 6 personal development sessions. The fact that intrinsic
motivation did not increase after participation in the 6 meetings of personal
development is not an impediment because in Table 6 it can be seen that
participants in staff development sessions have a group mean of 36.29 on intrinsic
motivation, where the maximum score is 50.
The group is characterized by a high level of intrinsic motivation and an
increase to38.8571 after the 6 sessions of personal development which, while not

44
statistically significant, can be said that it is quite large. Moreover, participation in
6 sessions of personal development resulted in a statistically significant increase in
intrinsic motivation by increasing interest in the profession of psychologist and the
interest in solving the problems of prospective customers and not the interest in
earning a good salary.

REFERENCES

Beck, A.T.,Rush, A.J.,Shaw, B.F., & Emery, G. (1979). Cognitive therapy of

Depression. New York: Guilford Press.
Cooper, C.L., & Dewe, P., (2004). Stress: A brief history. Oxford: Wiley Blackwell.
Cottraux, J.(2003), Terapiile cognitive. Bucuresti:Polirom.
Dogoter, V. (2013). Diferenta de gen privind autoperceptia motivaţiei extrinseci,
intrinseci şi emoţiilor pozitive şi negative la tinerii liceeni din Bucuresti, lucrare de licenţă
nepublicată, biblioteca FPSE, Universitatea din Bucureşti.
Durham,C.C., & Bariol,K.M., (2009). Pay for Performance in E. Locke, (ed.),
Handbook of Principles of Organizational Behavior. West Sussex: Wiley
Holdevici, I. (2010a). Tratat de psihoterapie cognitive-comportamentală. Bucuresti:
Trei,
Holdevici, I. (2010b). Psihoterapia - Un tratament fara medicamente. Bucuresti:
Universitară.
Holdevici, I. (2011). Psihoterapii de scurtă durată, Bucuresti: Trei,.
Laidlaw, E., Thompson,L.W., Gallagher-Thompson,D., & Dick-Siskin, L., (2003).
Cognitive Behaviour Therapy with older people. West Sussex: John Wiley & Sons.
Moreira, F.A., Kaiser, N., Monory, K., & Lutz, B., (2008). Reduced anxiety-like
behaviour induced by genetic and pharmacological inhibition of the endocannabinoid-
degrading enzyme fatty acid amide hydrolase (FAAH) is mediated by CB1 receptors.
Neuropharmacology, 54, 141-150.
Neufeld, K.M., Kang, N., Bienenstock, J., &, Foster, J.A., (2011). Reduced anxiety-
like behavior and central neurochemical change in germ-free mice.
Neurogastroenterology& Motility, 23(3),255-119.
Spector, P., (2008). Industrial and Organizational Behavior, 5th Edition, New Jersey:
Wiley.
Steiner, H., Fuchs, S., & Accili, D., (1998). D 3 Dopamine Receptor-Deficient Mouse:
Evidence for Reduced Anxiety. Psychology & Behavior, 63(1),137-141.
Taylor, J.E., (1953). A personality scale of manifest anxiety. The Journal of abnormal
and social psychology, 48(2), 285-290.
Teasdale, E.L., & Connely, S.C., (2011). Innovations in Stress and Health in S.
Cartwright & C.L. Cooper (eds.), Innovations in Stress and Health. London: Palgrave
MacMillan.
Weinberg,A., Sutherland, V.J., & Cooper, C.L., (2010). Organizational Stress
Management: A strategic approach. London: Palgram MacMillan.

45
REZUMAT
Prezentul studiu este orientat pe evidenţierea reducerii autopercepţiei streului şi a
nivelului de anxietate şi creşterea motivaţiei intrinseci şi extrinseci relaţionate cu
activităţile şi responsabilităţile din mediul academic la psihologie.Metoda: Participanţii
sunt un număr de 35 de studenţi, Universitatea Titu Maiorescu, secţia de psihologie cu
vârsta între 19mşi 27 de ani (M=21.6; S.D.=2.11), 28 femei şi 7 bărbaţi din mediul rural
şi urban. Instrumente:chestionar de evaluare a mativaţiei intrinseci şi extrinseci (Chraif &
Petrescu, 2014), adaptat după chestionarul de evaluare a motiavaţiei intrinseci şi
extrinseci în liceu (Dogoter, 2013); chestionar de autoperceţie a stresului şi anxietăţii la
studenţi (Petrescu, 2014) adaptat după chestionarul de autopercepţiei a stresului şi
nivelului anxietăţii în organizaţii (Parker și DeCotiis, 1983). Rezultatele au confirmat trei
dintre ipotezele cercetării (p<0.01)evidenţiind faptul că cele 6 sesiuni de dezvoltare
personală la care au participat cei 35 de studenţî au dus la reducerea semnificativă
statistic a stresului şi nivelului anxietăţii în legătură cu activităţii de indeplinit la
facultate, relaţîonarea cu colegii etc şi creşterea interesului pentu moţîavaţia extrinsecă
ce face parte din viaţa noastră şi ne asigură existenţa.

Appendix 1

Chestionarul pentru Stres academic adaptat (Petrescu şi Chraif, 2014)

În cele ce urmează veți găsi o serie de afirmații cu privire la dumneavoastră. Citiți

cu atenție fiecare afirmație și alegeți pe o scală de la 1 la 5 (1 = dezacord puternic,
5 = acord puternic) cât de mult vă caracterizează fiecare afirmație.
Dezacord puternic

Acord puternic

1 Activitatile si temele pentru acasa ma împiedică sa imi petrec suficient timp 1 2 3 4 5

cu familia
2 Petrec atât timp de mult timp la facultate/ în bibliotecă/ sala 1 2 3 4 5
seminar/laborator încât nu mai reacționez la lucrurile evidente
3 Efectuând lucrarile practice şi proiectele aici, am foarte puțin timp pentru 1 2 3 4 5
alte activități
4 De multe ori am sentimentul că sunt căsătorit/ă cu facultatea 1 2 3 4 5
5 Am prea mult de invaţat și prea puțin timp pentru a finaliza proiectele, 1 2 3 4 5
activităţile
6 Câteodată mă îngrozesc când sună telefonul acasă deoarece ar putea să fie 1 2 3 4 5
un telefon de la colegii de grupă/serie/facultate
7 Mă simt de parcă niciodată nu am o zi liberă 1 2 3 4 5
8 Prea mulţi colegi din facultate se epuizează din cauza cerințelor la 1 2 3 4 5
seminarii/laboratoare
9 Mă simt anxios sau nervos din cauza apropierii sesiunii 1 2 3 4 5

46
10 Activităţile de student presupune mai multe decât ar trebui a 1 2 3 4 5
11 Sunt multe momente în care viaţa de student pur și simplu mă înnebunește 1 2 3 4 5
12 Câteodată când mă gândesc la proiectele de efectuat simt o apăsare pe piet 1 2 3 4 5
13 Mă cuprinde un sentiment de vinovăție atunci când lipsesc de la ore: 1 2 3 4 5
seminarii, laboratoare, cursuri

Anexa 2
Chestionar motivatie intrinseca si extrinseca (Chraif & Petrescu, 2014)
adaptat dupa Dogoter (2013) în mediul academic pe studenti ciclul licenta.
Chestionarul are 5 itemi destinati măsurarii motivatiei extrinseci si 5 itemi
destinati motivatiei intrinseci. Scala este de la 1-minimum la 10-maximum.
Se calculeaza scorul total motivatie intrinsecă prin insumarea intemilor pt
motivatia intrinseca.
Se calculeaza scorul total motivatie intrinsecă prin insumarea intemilor pt
motivatia intrinseca.

Appendix 2
Chestionat pentru evaluarea motivatiei intrinseci si extrinseci iin mediul
academic, la studenţi (Chraif & Petrescu, 2014),
Dezacord
puternic

puternic
Acord

In general duc un proiect la bun sfarsit pentru a ma simti implinit/a 1 2 3 4 5 6 7 8 9 10

in general duc la bun sfarsit un proiect pentru a-i satisface pe altii 1 2 3 4 5 6 7 8 9 10
cand am ales facultatea am pus accent pe implinirea visului meu 1 2 3 4 5 6 7 8 9 10
personal i
cand am ales facultatea am pus accent pe castigul unui salariu 1 2 3 4 5 6 7 8 9 10
motivant dupa absolvirea facultăţii
Am ales specializarea de psiholog pentru ca eu consider acest 1 2 3 4 5 6 7 8 9 10
domeniu interesant
am ales specializarea de psiholog pentru ca ma intereseaza castigul 1 2 3 4 5 6 7 8 9 10
material dupa absolvire
In facultate invat pentru propria satisfactie 1 2 3 4 5 6 7 8 9 10
In facultate invat ca sa iau bursa/sa fiu la fara taxa/buget 1 2 3 4 5 6 7 8 9 10
Cand termin o activitate cel mai important este sa obtin rezultatul 1 2 3 4 5 6 7 8 9 10
dorit
cand termin o activitate cel mai important este sa fiu remunerat 1 2 3 4 5 6 7 8 9 10
material/recompensat

47
 ROMANIAN JOURNAL OF
EXPERIMENTAL APPLIED PSYCHOLOGY

VOL. 5, ISSUE 3 – www.rjeap.ro

CORRELATIVE STUDY REGARDING THE PAIN

PERCEPTION AND EMOTIONS AT YOUNG STUDENTS
AT PSYCHOLOGY

DORA CODREANU a, ANGELA BOGLUT b, cMIHEALA CHRAIF

a
University of Bucharest, Department of Psychology
b
Timisoara University,
c
University of Bucharest,Department of Psychology

Abstract

The present study investigates, on one hand, the existence of possible statistically
significant correlations between “pain perceived towards the dentist visit” and negative
and positive emotions. Pain is a subjective sensation which is usually accompanied by
other (mostly unpleasant) sensations and has been an aspect of both medical and
psychological interest. This fact is due to the difficulty of obtaining objective measures
regarding pain as the medical personnel bases their treatment of pain on the patient's
statements. Our study included the participation of psychology students and intended to
study pain in correlation to general positive emotions, trait and state emotions.

Keywords: pain, negative, positive emotions, study

1. INTRODUCTION

According to IASP (International Association for the Study of Pain) pain is

defined as an unpleasant sensory and emotional sensation, determined or related to

*
Autor corespondent:
Angela Blogut
Email: psiho.angela@gmail.com
concrete or potential tissue lesions or described in terms which refer to such lesions
(Turner et. al.,1994)
As it refers to a sensation, therefore a psychological interpretation, pain is
reported to the previous experience of an individual. An already known and
understood sensation may not be described as pain by an individual and pain by
another who experiences it for the first time and doesn't know it's significance and
who feels fear toward it (Caraceni, 2004)
In analyzing fear we must mention a few general characteristics.
- Pain is a strictly individual experience. In evaluating pain, the medical
doctor cannot obtain an objective information but he exclusively trusts the
descriptions offered by the person who suffered or suffers from the pain (Reinders,
et. al., 2002)
The pain always has an affective component which is usually a negative one,
of suffering, discomfort, fear but sometimes it includes satisfaction (Reinders, et.
al., 2002)
- Pain is not a pure sensation but is described by other sensations such as
pressure, torsion, pressure, burn or stings (Reinders, et. al., 2002)
- Pain brings information related to possible lesions, whether potential or
existent (Reinders, et. al., 2002)
The pain threshold of a stimuli is lower than the intensity which produces
lesion, as pain has a protective role, or preventing serious lesions. Pain, therefore
informs about the intensity of a stimuli and so is theoretically proportional to the
intensity of the produced stimuli; on the other hand, imaginary pain or lesion may
interfere (Rainville, et. al., 2005).
The experience of pain is one of the basic experiences that a person can have
and has had in life. However, pain can be interpreted differently depending on
biological, cultural, psychological and social factors (Lyons & Chamberlain, 2005).
Spector & Fox (2002) as cited in Fox & Spector (2006) defined emotions as
an adaptive response to life events, while a psycho-evolutionary approach suggests
that emotions are the result of an individual's assessment of an event (beneficial or
harmful, good or bad) or stimulus. Of course, the assessment has a cognitive,
subjective side, it changes and includes the emotional experience of the individual
and is essential to the survival of humans and other animals (Fox & Spector, 2006).
The experience of negative emotions prepares a person for action, for
physiological arousal and high attention. Often strong negative emotional states
lead to impulsive actions, so many specialists see negative emotions as parts of
counterproductive behavior (Fox & Spector, 2006).
On the other hand, positive emotions lead to positive experiences and this in
turn leads to positive thoughts that specialists call moral. Moral helps us see things
in a positive way, be happy and have results in that which we engage in (Bowles &
Cooper, 2009). Positive and negative emotions have been studied extensively in

49
organizational (Bowles & Cooper, 2009; Maellaro & Whittington, 2009, Brandes
& Das, 2006, Spector, 2009) and clinical psychology. It has been proved that
alcohol addicts tend to have more negative emotions than positive emotions
(Cooper et. al., 1995). Defining emotions has been somewhat strange and very hard
to classify for specialists. Emotions are response trends to a series of events that
take place in the short term. Usually, an emotion occurs when an individual
evaluates an event as personal (Friedrickson, 2001).

2. OBJECTIVES AND HYPOTHESES

2.1. OBJECTIVES

 Our primary objective is to investigate gender differences in perceiving

pain among Psychology students.
 Our second objective sights possible correlations between positive
emotions, negative emotions and perceiving pain while visiting the dentist.

2.2. HYPOTHESES

 There are statistically significant differences regarding gender on self-

perceived pain correlated to the doctor among female subjects compared to
male subjects
 There are statistically significant correlations between positive emotions
and pain perception during medical visits.
 There are statistically significant correlations between pain perception
during medical visits and negative emotions.

3. METHOD

3.1. PARTICIPANTS

The present study has included the participation of a number of 65 students of

the Faculty of Psychology and Educational Sciences, University of Bucharest, aged
between 19 and 26 years old (M=21,80; S.D.=4,14) (table 2), 35 female and 30
male, both residents of the rural and urban environment (as shown in table 1).

50
Table 1 gender
Frequency Percent Valid Percent Cumulative Percent
Valid male 30 46.2 46.2 46.2
female 35 53.8 53.8 100.0
Total 65 100.0 100.0

Table 2 Descriptive Statistics

N Mean Std. Deviation
age 65 21.80 4.147
Valid N (listwise) 65

3.2. INSTRUMENTS

In order to test our proposed hypothesis, we decided to use the following

instruments:
- Questionnaire of assessing pain during medical visits (Codreanu, 2013).
This questionnaire has a number of 8 items which evaluate self-perceived pain on a
Likert 1 (not perceived) to 5 (highly perceived).
- Questionnaire of assessing state and trait emotions (MEST-Ro, Pitariu,
Levine, Muşat, & Ispas, 2006) – this questionnaire assesses the intensity of
emotions experienced by people; in our study, we have utilized an adapted version
of this instrument as the original was dedicated to asssessing the intensity of
emotions experienced by workplace employees. Therefore, the items have been
adaptated in order to fit the environment of the chosen subjects, namely
Psychology students. The instrument keeps the five positive emotions and five
negative emotions of the STEM questionnaire (State - Trait Emotion Measurement)
as elaborated by Levine and Xu (2005): joy, anxiety, pride, sadness, vigilance,
anger, affection, envy, content, guilt and shame.

3.3. PROCEDURE

Data has been obtained collectively with groups of psychology students. They
have signed an informed consent certificate and have received the instructions of
applying the questionnaires. Applying the instruments lasted between 15 and 20
minutes.

51
 3.4. EXPERIMENTAL DESIGN

The independent variable consists in the subject's gender: female or male.

The dependent variables consist of: pain perception (total score) and also the
eight items of the questionnaire, each describing pain perception within a given
situation: state positive emotions, general positive emotions, state negative
emotions and general negative emotions. Such emotions include: joy, anxiety,
pride, sadness, vigilance, anger, affection, envy, content, guilt and shame.

4. RESULTS


Testing the data normality in the case of the following variables: pain
total, pain, state positive emotions, general positive emotions, general
negative emotions.
In order to test the data distribution we have applied the normality
Kolmogorov – Smirnov statistical test.

Table 3 One-Sample Kolmogorov-Smirnov Testc

Totalpain-doctor Positive emotions General positive traits

N 30 30 30
Normal Parametersa,b Mean 12.1000 30.80 32.37
Std. Deviation 2.45441 8.984 10.227
Most Extreme Differences Absolute .216 .175 .120
Positive .216 .175 .120
Negative -.129 -.155 -.092
Kolmogorov-Smirnov Z 1.184 .961 .658
Asymp. Sig. (2-tailed) .121 .314 .779
a. Test distribution is Normal.
b. Calculated from data.

c. gender = male

Table 3 shows the following variables data: total pain, positive state emotions
and trait positive emotions to be normally distributed (p>0, 05) in the case of male
participants.

52
Table 4 One-Sample Kolmogorov-Smirnov Testc

General negative
Negative emotions traits
N 30 30
Normal Parametersa,b Mean 18.43 14.50
Std. Deviation 6.268 6.479
Most Extreme Differences Absolute .127 .169
Positive .127 .169
Negative -.115 -.125
Kolmogorov-Smirnov Z .695 .924
Asymp. Sig. (2-tailed) .719 .361
a. Test distribution is Normal.
b. Calculated from data.
c. gender = male

Table 4 shows that the data of the following variables: negative state emotions and
negative trait emotions are normally distributed (p>0, 05) in the case of male
participants.

Table 5 One-Sample Kolmogorov-Smirnov Testc

Positive general
Totalpain-doctor Positive emotions traits
N 35 35 35
Normal Parametersa,b Mean 18.0857 31.91 33.00
Std. Deviation 4.39499 9.754 9.075
Most Extreme Differences Absolute .092 .091 .127
Positive .081 .075 .127
Negative -.092 -.091 -.122
Kolmogorov-Smirnov Z .546 .538 .754
Asymp. Sig. (2-tailed) .927 .934 .620
a. Test distribution is Normal.
b. Calculated from data.
c. genul = feminin

In table 5 we may notice that the data related to the following variables,
namely total pain, state positive emotions and trait positive emotions are normally
distributed (p>0, 05) in the case of female participants.

53
Table 6 One-Sample Kolmogorov-Smirnov Testc
Negative emotions General negative traits
N 35 35
Normal Parametersa,b Mean 17.20 14.40
Std. Deviation 4.425 5.392
Most Extreme Differences Absolute .150 .130
Positive .150 .130
Negative -.091 -.090
Kolmogorov-Smirnov Z .886 .767
Asymp. Sig. (2-tailed) .412 .599
a. Test distribution is Normal.
b. Calculated from data.
c. gender = female

Table 6 shows that the following variable data: negative state emotions and
trait negative emotions are normally distributed (p>0, 05) among the female
participants.

1. Testing hypothesis regarding correlations between dependent variables

Table 7 Matrix of correlations between the following variables: total pain, state positive emotions and general
positive traits (male)
General positive
totalpaindoctor Positive emotions traits
totalpaindoctor Pearson Correlation 1 .115 .019
Sig. (2-tailed) .545 .920
N 30 30 30
Positive emotions Pearson Correlation .115 1 .943**
Sig. (2-tailed) .545 .000
N 30 30 30
General positive traits Pearson Correlation .019 .943** 1
Sig. (2-tailed) .920 .000
N 30 30 30
Negative emotions Pearson Correlation .378* .028 -.232
Sig. (2-tailed) .039 .884 .217
N 30 30 30
trasaturi generale negative Pearson Correlation .292 -.509** -.665**
Sig. (2-tailed) .118 .004 .000
N 30 30 30
*. Correlation is significant at the 0.05 level (2-tailed).
**. Correlation is significant at the 0.01 level (2-tailed).
a. gender = male

54
Table 8 Correlation matrix of: total pain, negative state emotions and general negative traits (male)
General negative
Negative emotions traits
totalpaindoctor Pearson Correlation .378* .292
Sig. (2-tailed) .039 .118
N 30 30
Positive emotions Pearson Correlation .028 -.509**
Sig. (2-tailed) .884 .004
N 30 30
Positive general trait Pearson Correlation -.232 -.665**
Sig. (2-tailed) .217 .000
N 30 30
Negative emotions Pearson Correlation 1 .720**
Sig. (2-tailed) .000
N 30 30
General negative trait Pearson Correlation .720** 1
Sig. (2-tailed) .000
N 30 30
*. Correlation is significant at the 0.05 level (2-tailed).
**. Correlation is significant at the 0.01 level (2-tailed).
a. gender = male

In tables 7 and 8 we may notice positive and statistically significant

correlations for male subjects between the following variables: total pain and
negative state emotions (r=0,378; p<0.05),positive state emotions and positive trait
emotions (r=0,943; p<0.01). A negative and statistically significant correlation has
been found between positive state emotions and negative trait emotions (r=-0,509;
p<0.01).
By following tables 7 and 8 we may assert that the following hypothesis
“There is a statistically significant correlation between self perceived total pain
towards medical visits and state negative emotions”. Other hypothesis regarding
regarding variable correlations have not been confirmed (p>0.05).

55
Table 9 Correlation matrix of the following variables: total pain, state positive emotions and general positive traits
(female)
General positive
totalpaindoctor Positive emotions traits
totalpaindoctor Pearson Correlation 1 .169 .145
Sig. (2-tailed) .332 .407
N 35 35 35
Positive emotions Pearson Correlation .169 1 .950**
Sig. (2-tailed) .332 .000
N 35 35 35
General positive traits Pearson Correlation .145 .950** 1
Sig. (2-tailed) .407 .000
N 35 35 35
Negative emotions Pearson Correlation -.093 -.049 -.109
Sig. (2-tailed) .594 .778 .533
N 35 35 35
General negative traits Pearson Correlation -.183 -.428* -.497**
Sig. (2-tailed) .293 .010 .002
N 35 35 35
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).
a. gender = female

Table 10 Correlation matrix of the following variables: total pain, state negative emotions and general negative
traits (female)
General negative
Negative emotions traits
totalpaindoctor Pearson Correlation -.093 -.183
Sig. (2-tailed) .594 .293
N 35 35
Positive emotions Pearson Correlation -.049 -.428*
Sig. (2-tailed) .778 .010
N 35 35
General positive traits Pearson Correlation -.109 -.497**
Sig. (2-tailed) .533 .002
N 35 35
Negative emotions Pearson Correlation 1 .574**
Sig. (2-tailed) .000
N 35 35
Negative general traits Pearson Correlation .574** 1
Sig. (2-tailed) .000
N 35 35
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).
a. gender = female

In tables 9 and 10 we may notice positive and statistically significant

correlations for female subjects between the following variables: total pain and
general negative trait emotions (r=0,574; p<0.01), emotions regarding positive
state and positive trait emotions (r=0,95; p<0.01). There are also negative and
statistically significant correlations between trait positive emotions and trait
negative emotions (r=-0,497; p<0.01).

56
 By following tables 9 and 10 we notice that within the female subjects the
hypothesis that “there is a statistically significant correlation between self
perceived total pain towards medical visits and negative trait emotions” is
confirmed. Other hypothesis have not been confirmed in the case of female
subjects (p>0.05).
Testing statistical hypothesis regarding mean differences according to
gender for the following variables: total pain, positive state emotions, general
positive emotions, state negative emotions, general positive emotions.
Considering that the data distribution is normal and the subject samples
divided by gender contain minimum of 30 participants, we were able to apply the t-
student test for independent groups.

Table 11 Independent Samples Test and statistical significance

t-test for Equality of Means
t df Sig. (2-tailed)
totalpaindoctor Equal variances assumed -6.622 63 .000
Equal variances not assumed -6.899 54.746 .000
Positive emotions Equal variances assumed -.476 63 .636
Equal variances not assumed -.479 62.652 .634
General positive traits Equal variances assumed -.265 63 .792
Equal variances not assumed -.262 58.591 .794
Negative emotions Equal variances assumed .926 63 .358
Equal variances not assumed .902 51.109 .371
General negative traits Equal variances assumed .068 63 .946
Equal variances not assumed .067 56.626 .947

Table 11 shows the t student test value and statistical significance for
each analyzed variable (total pain, positive state emotions, general positive
emotions, negative state emotions, general positive emotions), according to
gender.
Therefore, the hypothesis stating that “There are statistically significant
differences according to gender on self-perceived pain towards medical
visits among female subjects compared to male subjects” is confirmed
(p<0.01).
In additions, female subjects perceived pain towards medical visits
stronger than male subjects (female group mean 18,08>12,10 male mean
group).

57
 5. CONCLUSIONS

The present study proposed to add information regarding pain, an important

medical and psychological aspect within healthcare. Our results have shown a
significant difference in the occurrence of pain during medical visits (namely,
dental visits) and positive and negative emotions and also between the levels of
pain experienced by females compared to males. Based on our results we support
the idea of applying continuous studies regarding pain in order to come to more
and more objective measure possibilities. Pain is essential as an indicator of
potential threat but on a larger intensity, it has the potential of affecting the
subject's well being and it can also has a response within the emotional and mental
balance.

Received at: 20.06.2014, Accepted for publication on: 29.06.2014

REFERENCES

Bowles, D., & Cooper, C.L., (2009). Introduction in D.Bowles, & C.L., Cooper (eds.) ,
Employee Morale. Driving Performance in Challenging Times.London: Palgrave
MacMillan.
Brandes, P., & Das,D., (2006). Locating behavioral cynicism at work: construct issues
and performance implications in P.L., Perrewe, & D.C., Ganster. Research in occupational
stress and well being. Oxford: Elsevier.
Caraceni,A., Martini, C., Zecca, E.,& Portenoy, R.K., (2004). Breakthrough pain
characteristics and syndromes in patients with cancer pain. An international survey.
Pallative Medicine, 18, 177-183.
Codreanu, D. (2013). Diferente de gen privind autoperceptia emoţiilor şi
durerii la studenţii de la psihologie, Teză de licenţă nepublicată, FPSE,
Universitatea din Bucureşti
Cooper, L.M., Frone, M.R., Russell, M., & Mudar, P., (1995). Drinking to regulate
positive and negative emotions: A motivational model of alcohol use. Journal of
Personality and Social Psychology, 69(5),990-1005.
Friedrickson, B.L., (2001). The role of positive emotions in positive psychology: the
broaden and build theory of positive emotions. Am Psychol., 56(3), 218-266.
Lyons, A.C., & Chamberlain, K.,(2005). Health Psychology.A critical introduction.
New York: Cambridge University Press.
Levine, E. L. & Xu, X. (2005). Development and Validation of the State-Trait Emotion
Measure (STEM). Paper presented at the 20th Annual Conference of the Society for
Industrial and Organizational Psychology, Los Angeles, US.
Maellaro,R., & Whittington, J.L., (2009). Management Development for Well-Being
and Survival: Developing the Whole Person in C.L., Cooper, J.C., Campbell & M.J.,

58
Schabracq, International Handbook of Work and Health Psychology, 3th edition. West
Sussex : John Wiley & sons.
Pitariu, H.D., Levine, E.L., Musat, S., & Ispas, D., (2006). Validarea chestionarului de
masurare a emotiilor ca stare si trasatura (Mest-ro) la baschetbaliste.Psihologia Resurselor
Umane, 4(2), 16-27.
Rainville, P., Bao, Q.V.H., & Chretien, P., (2005). Pain-relaed emotions modular
experimental pain perception and automatic responses. Pain, 118, 306-318.
Reinders, M.F., Geertzen, J.H.B., & Dijkstra, P.U., (2002). Complex Regional Pain
Syndrome Type I: Use of the International Association for the study of pain diagnostic
criteria defined in 1994. The Clinical Journal of Pain, 18, 207-215.
Spector, P.E., (2009). The role of job control in employee health and well-being in C.L.,
Cooper, J.C., Campbell & M.J., Schabracq, International Handbook of Work and Health
Psychology, 3th edition. West Sussex : John Wiley & sons.
Turner, J.A., Deyo, R.A., Loeser, J.D., von Korff, M., & Fordyce, W.E., (1994). The
importance of placebo effects in pain treatment and research. JAMA, 271(20), 1609-1614.

REZUMAT

Prezentul studiu investighează pe de-o parte posibile corelaţii semnificative statistic

între variabila „durere percepută faţă de medicul stomatolog” şi emoţîile pozitive şi
negative. Durerea este o senzație subiectivă care este de obicei însoțită de alte senzații
neplăcute (mai ales) fiind un aspect de interes medical dar și psihologic. Acest fapt se
datorează dificultăților de obține măsurători obiective în ceea ce privește durerea pentru
personalul medical atunci când administrează un tratament, iar pacienții declară durere.
Studiul nostru a inclus participarea studenților la psihologie și intenționează să studieze
durerea în corelație cu emoții pozitive generale, trăsături și emoții.

Cuvinte cheie:durere, negative, emoții pozitive, studiu

59
 ROMANIAN JOURNAL OF
EXPERIMENTAL APPLIED PSYCHOLOGY

VOL. 5, ISSUE 3 – www.rjeap.ro

RELATIONSHIP BETWEEN EMOTIONS AND PERCEIVED

STRESS AT WORKPLACE

ANGELA BOGLUT a, MIHAI ROBU b

a
Timisoara University, Department of Psychology
b
University of Bucharest, Department of Psychology

Abstract

Stress is seen as a source of tension, a negative condition that affects an individual

biologically due to external factors. Emotions are seen as affective states that an individual
experiences every day, these emotions being influenced by events in the environment. The
present study investigates the relationship between emotions and perceived stress at work,
this relationship being very important in organizational psychology. From the perspective
of many organizational psychologists, it is very difficult to measure emotions because of the
many factors involved. Participants in the study are workers aged between 18 and 55 years
from different organizations. They completed the questionnaires at work. As expected
results show that negative emotions have a negative relationship with physical health and
behavior at work. As future directions, this study should be conducted in much larger
scalse so that results can be globalized.

Keywords: perceived stress, emotions, negative, study

1. INTRODUCTION

To give a complete definition of the concept of stress, we need to know what

the word stress means. Thus, starting from the English Dictionary, the word
"stress" is derived from the Old English "stresse", the medieval "estresse" and
vulgar Latin "strictia" which had the sense of suffering, hardship of life (Bamber,

*
Autor corespondent:
Angele Blogut
Email: psiho.angela@gmail.com
2006). Researchers make a broad and specific differentiation of what stress is,
taking it as a good thing, stress being a response, a warning of the dangers that are
around us. Stress as a source of tension, is a factor biologically affecting an
individual due to external factors in the environment (Ogden, 2007). Researchers
made the difference between acute stress, which is a response to certain factors
such as a major exam, public speaking, etc. and chronic stress, which is a response
to the environment, such as work or family problems (Mark & Smith, 2008).
Stress as a general term refers to two distinct concepts, called stressors
(characteristics of the environment or thoughts that cause the individual to have
adverse reactions) or tension (the individuals’ reactions to stress) (Cohen, Kamarck
and Mermelstein, 1983;; Beehr & O 'Hara, 1987; Knapp, 1988 cited Bamber, 2006;
Dewe, O' Driscoll & Cooper, 2010).
Folkman & Lazarus (1984), after the cognitive revolution which took place in
this field, have focused on the research of stress, both in the workplace and in
general. Thus, they developed a new definition of stress that changed the
perception of how stress occurs and how to intervene against it. Stress from the
perspective of Lazarus and Folkman (1984) is a cognitive mediation of the product
provided by the individual and the interaction with the environment.
This approach has been called "transactional stress theory."
Warr (1987) as cited in Mark & Smith (2008) suggests that occupational stress is
very much influenced by the characteristics of the workplace and affects the
physical and mental health of the employee. Michigan occupational stress model
was developed by French and Kahn in 1962 (Mark & Smith, 2008), and refers to
job stressors and how they affect employee performance. From the perspective of
Buunk et. al. (1998) as cited in Mark and Smith (2008) this theoretical perspective
has no practical background, not being proven that this model influences the
performance and health at work.
Lazarus & Cohen (1977) as cited in Lazarus & Folkman (1984) share
negative stimuli in three categories: major changes after the cataclysmic events that
affect a large number of people, major changes affecting one or more persons, and
daily negative events. Events considered cataclysmic affects a number of people
that are linked (relatives, friends) being an event that cannot be controlled by the
individual. An example would be the death of a loved one or a relative, a threat to
life by failing to treat a disease (cancer), a divorce or an important exam in the life
of the individual (Lazarus and Folkman, 1984) .
Our daily life is punctuated by much less dramatic stressful experiences
arising from our roles in life. Lazarus & Folkman (2004) have focused more on
daily issues that affect us. People face everyday and everywhere problems like the
neighbor's dog, problems with the house, husband /wife, minor accidents, smoking,
or other small incidents. Although everyday complications are much less dramatic

61
than the changes in life such as divorce or death, they may be more harmful to
health (Lazarus and Folkman, 1984).
Of course, there are many studies that studied the relationship between
emotions and stress at work (Elliott et. Al., 1994; Fogarthy et al., 1999, Spector et
al., 2000; Marsland, 2001; Zautra, 2003 Feldman et. al., 2004), the two being
important concepts for each specialist in the area of organizational psychology.
From the point of view of occupational stress, Kompier (2003) as cited in Kompier
& Taris (2005) distinguishes seven theoretical approaches in the area of stress,
general wellbeing, satisfaction at work and job design: job characteristics the
Michigan occupational stress model, job demands control model, addressing socio-
technical approach to action theoretical model, the effort reward imbalance model
and the vitamins model.
People who experience stressful feelings detrimental to pleasant emotions
tend to have lower morale, affecting well being in general (Hart & Cooper).
Spector et. al. (2000) say that emotions at work are very important to be measured,
but also must take into account factors that cannot be controlled when measuring
emotions and subjectivity of subjects is not negligible. These obstacles make it
difficult to measure emotions. Negative emotions are defined as negative affective
states that influence the individual, experiencing feelings like anxiety, depression
or anger (Spector et al., 2000).

2. 2. OBJECTIVES AND HYPOTHESIS

2.1. OBJECTIVES

The main purpose of the present study is to investigate the existent relation
between positive and negative emotions and self perceived stres but also
organisational behavior existent in restaurant in Romania.

2.2. HYPOTHESES

General hypotheses:
 There is a statistically significant correlation between variables such
as organizational climate and positive state emotions in the studied
restaurant.
 There is a statistically significant correlation between the variables of
organizational climate and general positive emotions in the restaurant
included in the study.

62
  There is a statistically significant correlation between variables of
organizational climate and negative state emotions in the restaurant
we have included in the present study.
 There is a statistically correlation between variables of organizational
climate and negative general emotions in the studied restaurant.
 There are statistically significant correlations between organizational
climate variables in the studied organization.

3. METHOD

3.1. PARTICIPANTS

The study has included the participation of employees of an organization with

restaurant activity profile, namely oriental dishes served în Bucharest. The studied
sample has included 26 participants out of which 18 were female and 8 male. As
for the age, the employees were aged between 18 and 53 years old (M= 36.42;
A.S.= 4.12).

Table 1 Frequency distribution and percentage for the gender variable

Frequency Percent Valid Percent Cumulative Percent
Valid male 8 30.8 30.8 30.8
female 18 69.2 69.2 100.0
Total 26 100.0 100.0

3.2. INSTRUMENTS

- Questionnaire of assessing organizational climate adapted from Pitariu

(2008 apud Budean & Pitariu, 2008).
- This section of the questionnaire includes 7 dimensions: work satisfaction,
physical health, workplace behavior, stressful factors, methods and coping
techniques, behavioral control.
- The questionnaire of state and trait emotions assessment (MEST-Ro, Pitariu,
Levine, Muşat, & Ispas, 2006) – it is an instrument which measures the intensity of
emotions experienced by people, in our case, employees that the work place. The
questionnaire keeps the five positive emotions and the five negative emotions of
the STEM questionnaire State- Trait Emotion Measurement), elaborated by Levine
and Xu (2005): joy, anxiety, pride, sadness, vigilance, anger, affection, envy,
content, guilt and shame.

63
 3.3. PROCEDURE

The data has been collectively collected in groups of 4 – 5 employees during

the work break. All participants have signed the informed consent certificate and
have received the instructions of questionnaire application. The application has
lasted between 25 to 35 minutes.

3.4. EXPERIMENTAL DESIGN

Dependent variables: content, work behavior, physical health, general

behavior, events interpretation, sources of workplace tenstion, coping with stress,
managing work situations and positive state emotions, general positive emotions,
negative state emotions and general negative emotions in the studied restaurant.

4. RESULTS

Table 2 Correlation matrix of the variables: organizational climate and general positive emotions, negative state
emotions and general negative emotions part A
6
Tension 5 management
Work Physical General event sources stress of work
content behavior health behavior interpretation at work coping situations
Correlation
1.000 .640** .693** .616** .713** .666** .767** .635**
content Coefficient
Sig. (2-tailed) . .000 .000 .001 .000 .000 .000 .000
Correlation
Work .640** 1.000 .910** .735** .698** .798** .784** .779**
Coefficient
behavior
Sig. (2-tailed) .000 . .000 .000 .000 .000 .000 .000
Correlation
Physical .693** .910** 1.000 .727** .717** .782** .787** .731**
Coefficient
health
Sig. (2-tailed) .000 .000 . .000 .000 .000 .000 .000
Correlation
.616** .735** .727** 1.000 .864** .712** .616** .720**
Spearman's rho

A General Coefficient
behavior Sig. (2-tailed) .001 .000 .000 . .000 .000 .001 .000
N 26 26 26 26 26 26 26 26
Correlation
B events .713** .698** .717** .864** 1.000 .783** .706** .728**
Coefficient
interpretation
Sig. (2-tailed) .000 .000 .000 .000 . .000 .000 .000
Sources of Correlation
.666** .798** .782** .712** .783** 1.000 .694** .787**
tension at the Coefficient
workplace Sig. (2-tailed) .000 .000 .000 .000 .000 . .000 .000
Correlation
5 coping with .767** .784** .787** .616** .706** .694** 1.000 .821**
Coefficient
stress
Sig. (2-tailed) .000 .000 .000 .001 .000 .000 . .000
6 managing Correlation
.635** .779** .731** .720** .728** .787** .821** 1.000
workplace Coefficient
situations Sig. (2-tailed) .000 .000 .000 .000 .000 .000 .000 .

64
 Correlation
Positive .373 -.196 -.131 .052 .260 .254 .097 .091
Coefficient
emotions
Sig. (2-tailed) .060 .338 .522 .801 .200 .211 .637 .659
state total
N 26 26 26 26 26 26 26 26
Total general Correlation -.177 -.482* -.549** -.227 -.244 -.204 -.340 -.291
positive Coefficient
emotions Sig. (2-tailed) .387 .013 .004 .264 .229 .318 .089 .150
N 26 26 26 26 26 26 26 26
Total state Correlation .134 .457* .384 .114 .039 .229 .171 .111
negative Coefficient
emotions Sig. (2-tailed) .515 .019 .052 .578 .849 .261 .403 .589
N 26 26 26 26 26 26 26 26
total general Correlation .119 .444* .359 .256 .192 .357 .188 .296
negative Coefficient
emotions Sig. (2-tailed) .563 .023 .072 .208 .347 .073 .359 .143
N 26 26 26 26 26 26 26 26
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).

As we may notice in table 2, there are statistically significant correlations

between the following variables: content and work behavior (r=0,640; p<0.01),
content and physical health (r=0,693; p<0.01), content and general behavior
(r=0,616; p<0.01), content and event interpretation (r=0,713; p<0.01), content and
sources of tension at the workplace (r=0,666; p<0.01), content and stress coping
(r=0,767; p<0.01), ) content and managing work situations (r=0,635; p<0.01), work
behavior and physical health (r=0,910; p<0.01), work behavior and general
behavior (r=0,735; p<0.01), ) work behavior and events interpretation (r=0,698;
p<0.01), work behavior and work sources of tension (r=0,798; p<0.01), work
behavior and stress coping (r=0,784; p<0.01), work behavior and managing work
situations (r=0,779; p<0.01), work behavior and total state negative emotions
(r=0,444; p<0.01), physical health and general behavior (r=0,727, p<0.01),
physical health and sources of tension at work (r=0,782, p<0.01), physical health
and stress coping (r=0,787, p<0.01), physical health and managing work situations
(r=0,731, p<0.01), general behavior and events interpretation (r=0,864, p<0.01),
general behavior and workplace tension (r=0,612, p<0.01), general behavior and
coping to stress (r=0,706, p<0.01), general behavior and managing work situations
(r=0,728, p<0.01), events interpretation and coping with stress (r=0,706, p<0.01),
events interpretation and coping with stress (r=0,728, p<0.01), sources of tension
and dealing with stress (r=0,694, p<0.01); sources of tension and managing work
place situations (r=0,787, p<0.01), stress coping and situation management (r=
0.821; p<0.01).

65
 Table 3 Matrix of correlations between organizational climate change and general positive states, negative state
emotions and general negative emotions part B
Total general positive Total negative General negative
emotions state emotions
Correlation
-.177 .134 .119
Coefficient
content
Sig. (2-tailed) .387 .515 .563
N 26 26 26
Correlation
-.482* .457* .444*
Coefficient
Work behavior
Sig. (2-tailed) .013 .019 .023
N 26 26 26
Correlation
-.549** .384 .359
Coefficient
Physical health
Sig. (2-tailed) .004 .052 .072
N 26 26 26
Correlation
-.227 .114 .256
Coefficient
General behavior
Sig. (2-tailed) .264 .578 .208
N 26 26 26
Correlation
-.244 .039 .192
Coefficient
B events interpretations
Sig. (2-tailed) .229 .849 .347
N 26 26 26
Correlation
-.204 .229 .357
Sources of tension at the Coefficient
Spearman's rho

workplace Sig. (2-tailed) .318 .261 .073

N 26 26 26
Correlation
-.340 .171 .188
Coefficient
5 coping with stress
Sig. (2-tailed) .089 .403 .359
N 26 26 26
Correlation
-.291 .111 .296
Coefficient
6 managing work situations
Sig. (2-tailed) .150 .589 .143
N 26 26 26
Correlation
.514** -.483* -.286
Coefficient
Total state emotions
Sig. (2-tailed) .007 .012 .156
N 26 26 26
Correlation
1.000 -.475* -.548**
General total positive Coefficient
emotions Sig. (2-tailed) . .014 .004
N 26 26 26
Correlation
-.475* 1.000 .789**
Coefficient
emotii negative stare total
Sig. (2-tailed) .014 . .000
N 26 26 26
Correlation
-.548** .789** 1.000
Coefficient
emotii negative genral
Sig. (2-tailed) .004 .000 .
N 26 26 26
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).

66
 In table 2 and 3 we may notice negative statistically significant between the
following variables: total general positive emotions and workplace behavior (r=-
0,428, p<0.05), general positive emotions total and physical health (r=-0,549,
p<0.01), negative state emotions total and workplace behavior (r=-0,457, p<0.05).

5. CONCLUSIONS

Based on the evaluation of emotions within a restaurant our of which 5

positive emotions (joy, pride, vigilance, affection, content) and 5 negative emotions
(anxiety, sadness, anger, envy, guilt and shame) by using the STEM scale elaborate
by Levine and Xu (2005) and physical health and also the dimensions of
organizational climate, content, work behavior, physical health, general behavior,
events interpretation, workplace tensions sources, stress coping and managing
workplace situations we have come to confirm the work hypothesis we have
initially proposed.
By summing up the scores obtained for positive emotions, respectively the
negative ones two scales have been created: the positive emotions scale and the
negative emotions scale. In order to measure them a Likert scale of 10 levels has
been created, in which level 1 indicates the fact that the manager has not felt the
respective emotion during the latest work days and 10 shows the fact that he or she
has strongly experienced the emotion during the latest days of work.
Considering the bi-variate correlations shown in tables 21 and 22, a part of the
proposed research hypothesis have been confirmed (there are statistically
significant correlations between the following variables: content and work behavior
(r=0,640; p<0.01), content and physical health (r=0,693; p<0.01), content and
general behavior (r=0,616; p<0.01), content and events interpretation (r=0,713;
p<0.01), content and stress coping (r=0,767; p<0.01), content and managing
workplace situations (r=0,635; p<0.01), workplace behavior and general behavior
(r=0,735; p<0.01), workplace behavior and events interpretation (r=0,698; p<0.01),
etc). In addition, out of the total of participants, 61,5% have recently experienced
extremely low shame and guilt levels, 3,8% very low 1 and 7,7% very low, 30,8%
have experienced extremely high general content, 15,4% high 1 and only 3,8%
have shown low levels, 23,1% have reported extremely high recent content while
15,4% low 2 and only 3,8% extremely low, 57,7% extremely low general envy,
15,4% very low 1 and only 3,8% have reported high levels of envy. Considering
both the organizational climate diagnosis and the hypotheses testing we are able to
assert that at the Karama restaurant, the employees benefit from a beneficial
organizational climate in regards to physical, mental health and pro-organizational
behavior.

67
 5.1. Future directions

The variables we have included in the study (content, workplace behavior,

physical health, general behavior, events interpretation, sources of workplace
tension, coping with stress, managing workplace situations) are very important
within the organizational level and therefore a more profound study of the
correlation between them, of the relations regarding other aspects of organizational
nature, could represent consistent subjects of future research studies including
Romanian population.
We may consider using larger groups, samples to show more clearly and more
objectively the obtained results and extending applying them to different domains
of activity.

Received at: 28.06.2014, Accepted for publication on:10.07.2014

REFERENCES

Bamber, M.R., (2006). CBT for Occupational Stressin Health Professionals. Introducing
a schema-focused approach. East Sussex: Routledge..
Budean, A., Pitariu, H.D. (2008). Cultura organizationala. Realitati si perspective in
Romania. In E. Avram si C. Cooper (coord.) Tendinte actuale in Psihologia
Organizational-Manageriala (pp. 197-218) Iasi: Polirom.
Dewe, P.J.,. O’Driscoll, & Cooper, L.C., (2010) .Theories of Psychological Stress at
Work în R.J., Gatchel & I.Z., Schultz (eds.), Handbook of Occupational Health and
Wellness, Handbook in Health, Work and Disability, New York: Springer.
Elliott, T.R., Chartrand, J.M., & Harkins,S.W., (1994). Negative Affectivity, emotional
distress, and the cognitive appraisal of occupational stress. Journal of Vocational Behavior,
45, 185-201.
Feldman, P.J., Cohen, S., Hamrick, N., & Lepore, S.J.,(2004). Psychological Stress,
appraisal, emotion and cardiovascular response in a public speaking task. Psychology and
Health, 19(3), 353-368.
Fogarthy, G.J., Machin, M.A., Albion, M.J., Sutherland, L.F., Lallor, G.I., & Revit, S.,
(1999). Predict Occupational Strain and Job Satisfaction: The role of Stress, Coping,
Personality and Affectivity Variables. Journal of Vocational Behavior, 54, 429-452.
Hart, P.M., & Cooper, C.L., (2001). Occupational stress: Toward a more integrated
Framework in N., Anderson, D.S., Ones, H.K. Sinangil & C. Viswesvaran (eds.),
Handbook of Industrial, Work and Organizational Psychology, second
edition.London:Sage.

68
 Kompier, M.A.J., & Taris, T.W., (2005). Psychosocial risk factors and work-related
stress: nuisances, nuances and novelties? În A.S.G., Antoniu, L.C., Cooper (eds.) Research
Companion to Organizational Health Psychology. Cheltenham: Edward Elgar.
Lazarus, R.S., & Folkman, S., (1984). Stress, Appraisal, and Coping. New York:
Springer.
Levine, E. L. & Xu, X. (2005). Development and Validation of the State-Trait Emotion
Measure (STEM). Paper presented at the 20th Annual Conference of the Society for
Industrial and Organizational Psychology, Los Angeles, US.
Mark, G.M.,& Smith, A.P., (2008). Stress models: A review and suggested new
direction în Houdmont, J. and Leka, S. eds. Occupational Health
Psychology. Nottingham: Nottingham University Press, pp. 111-144.
Marsland, A.L., Cohen, S., Rabin,B.S., & Manuck, S.B., (2001). Association Between
Stress, Trait Negative Affect, Acute Immune Reactivity, and Antibody Response to
Hepatitis B Injectation in Healthy Young, Health Psychology, 20(1), 4-11.
Ogden, J., (2007). Health Psychology, 4 th edition. New York: McGrall-Hill Education.
Pitariu, H.D., Levine, E.L., Musat, S., & Ispas, D., (2006). Validarea chestionarului de
masurare a emotiilor ca stare si trasatura (Mest-ro) la baschetbaliste.Psihologia Resurselor
Umane, 4(2), 16-27.
Spector, P.E., Zapf, D., Chen, P.Y., & Frese, M., (2000). Why negative affectivity
should not be controlled in job stress research: don’t throw out the baby with the bath
water. Journal of Organizational Behavior, 21, 79-95.
Zautra, A.J., (2003). Emotions, Stress and Health. New York: Oxford University Press.

REZUMAT

Stresul autoperceput este vazut ca o sursa de tensiune, o stare negative, care

afecteaza biologic individul datorita factorilor externi. Studiul present investigheaza relatia
dintre emotiile si stresul perceput la locul de munca, aceasta relatie fiind foarte importanta
in psihologia organizationala. Din perspectiva mai multor psihologi organizationali,
emotiile sunt greu de masurat din cauza multitudinilor de factori care intervin.
Participantii studiului sunt persoane care muncesc cu varsta intre 18 si 55 de ani din
diferite organizatii, completand chestionarele la locul de munca. Asa cum era de asteptat
rezultate arata faptul ca emotiile negative au o relatie negativa cu sanatatea fizica si
comportamentul la locul de munca.

Cuvinte cheie: stres autoperceput, emotii, negative, studiu

69
 ROMANIAN JOURNAL OF
EXPERIMENTAL APPLIED PSYCHOLOGY

VOL. 5, ISSUE 3 – www.rjeap.ro

LIFE DISRUPTIONS FOLLOWING BREAST CANCER

GIANINA-IOANA POSTĂVARU 2
Loughborough University, UK & Alexandru Ioan Cuza University of Iasi,
Romania

Abstract
Thirty six breast cancer survivors (17 Romanian and 19 English) with a mean age of 58 years took part in
in-depth interviews relating to life disruptions following the diagnosis. Data were analysed using thematic
analysis. The resultant themes reflected illness continuum challenges such as the breast loss, clothings and use
of cosmetic purchases, sexuality, fear of recurrence, devaluation, lack of medical information and stigmatisation.
The trajectory of breast cancer survivorship is a mobile process and there is a variety of needs and challenges
defined by the nature of psychological adaptation to the new social status as survivor which should be
encompassed in intervention development.

Cuvinte cheie: cancer mamar, supraviețuire, calitativ, cercetare participativă

Keywords: breast cancer; survivorship; qualitative; participatory research

1. INTRODUCTION

Although over 300 studies on breast cancer and quality of life were published
in 2008 (DiSipio et al., 2010), there are women subgroups in Europe, among
which Romanian breast cancer survivors, about which little or no information is
known. While previous research provides insights into short- and long-term
psychological, medical and social side effects of treatment and illness itself, it
seems that there is a lack of evidence to vindicate whether the conventional stories
relating to breast cancer, which have promoted ad nauseam positive images of
survivorship, reflect survivors’ genuine identity. Often, during anti-cancer

2
Corresponding author:
Gianina-Ioana Postăvaru
e-mail: G.Postavaru@lboro.ac.uk
campaigns mastectomy scars have been hidden, while cosmetic companies invited
women to adopt an image of wholeness and femininity. Attempts to analyze the
cultural illustrations of breast cancer have been reported over time, but studies
have disregarded how ‘the new survivor identity shapes the disease experiences of
women with breast cancer’ (Kaiser, 2008). Literature has shown that breast cancer
might remain a permanent disease for some women, whereas to others it might
give the sense of a victory over a battle. Therefore, the purpose of this piece of
work was to describe how breast cancer survivors in Romania and UK framed
their survival-related predicaments on both micro- and meso levels.

2. THEORETICAL BACKGROUND

Macmillan Cancer Support in the UK in 2012 defined the term survivor as

‘anyone who is living with or after cancer’. Other definitions suggested that
survivorship was the absence of any signs or symptoms of recurrence, or analyzed
the concept in terms of surviving an acute or severe illness (Peck, 2008). More
recently, survivorship was defined as the recovery from a life-threatening
experience. Oncologists, exempli gratia, have counted survival as the time of
diagnosis for the purposes of calculating statistics. According to different scholars,
acute survivorship has been defined as the period of active treatment. Extended
survivorship has been represented by the post-treatment remission period, and
potentially occasional treatment. Finally, permanent survival does not result at a
single moment, but progresses from an extensive period of free-survival (Grinyer,
2009). These alternative definitions created space for many people to adopt the
title of survivor. Following the literature to date, in this piece of work short-term
survival was defined as a period of up to five years post diagnosis, while long-
term survival referred to a period succeeding the first five years of diagnosis.
Consequently, survivorship is a continuous process of adaptation to the
diagnosis, when new life strategies are learnt and challenges are faced. While
some neoplastic women might become depressed, others might ‘make a good
psychological adaptation to their illness’ (Hughes, 1987). Some women may
struggle with the lack of medical information relating to their diagnosis (Demir et
al., 2008). For a distinct subset of survivors, cancer is a disabling event (Alfano et
al., 2006; Bloom et al., 2007) due to physical, mental or emotional problems. Fear
of recurrence has been ranked as the highest concern of breast cancer survivors
(Alfano et al., 2006), while sexual functioning has been one of the primary areas
that require research sensitiveness, given the implications of menopausal
symptoms and difficulties related to relationships, body image and self-acceptance
(Avis et al., 2005). Although a series of reports have looked at the economical
factors affecting the health status of Romanian cancer women, their subjective

71
complex experiences are not understood. Overall, death rates from all forms of
cancer have decreased in most European countries since 1995, but central
European countries, among which Romania, were an exception to this declining
pattern. Although limited funding and organization have been mentioned in
relation to cancer survivorship research in Europe (Rowland et al., 2013), data
suggested that in recent decades, due to improvements in early detection and
treatment, five year survival rates have increased to 50% or more in adults with a
history of cancer in many European countries.
No data were available about mammography screening in 2000 in Romania.
The differences in terms of participation in screening programmes for women
aged 50-69 between Romania (8%) and the UK (73%) in 2010 were conspicuous.
Moreover, Romania registered the lowest rate of mammography screening
attendance among European member countries after the Slovak Republic.
Romania registered the lowest level of health expenditure in Europe in the past
years, and by comparison, it was half as UK’s. The subsequent medical staff
deficit (about 40.000 doctors and nurses), waiting list policy, the lack of the
cheapest medicines on the market and the growing prices of drugs, limited access
to treatment and medical services and patient discrimination based on income
created the scene for poor public health outcomes (FABC, 2012) and unmet needs
of cancer survivors. On the contrary, in the UK a critical improvement in the field
was represented by modernization strategies, extended roles for medical staff
networking between hospitals to address the needs of populations in rural areas
and the establishment of academic research positions related to cancer
survivorship.
Limited research has examined the contribution of prostheses and breast
reconstruction on women’s life satisfaction. Overall, studies have not examined
the social legacy of mastectomy and little is known about how social inequality
and discrimination are experienced by survivors. Furthermore, whether the public
discourse of survivorship implemented on organizational level (by making images
of women’s illness visible via ribbons and pink color) has encouraged breast
cancer survivors embrace it was an open question to explore in this article.

3. MAIN OBJECTIVE

The analyses were conducted in the context of a wider project examining

breast cancer survivors in Romania and the UK, and aimed to support the
reflection on some experiences that revolved around cancer survivorship during
the data collection.

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 4. METHOD

4.1. GUIDING RESEARCH APPROACH

The study of intimate aspects of survivorship enters the territory of what has
been framed as sensitive research. An essential aim through the research process
was to empower participants and to disintegrate the tension between private and
public accounts of breast cancer survivorship. The collection and analysis of data
were informed by a participatory research approach. The experience of breast
cancer is multidimensional and women's responses to the loss of a breast are
unique and grounded by many agents. Questions about sexuality, self-perception,
diverse forms of burden and intimacy are often left unasked because of
embarrassment or humiliation. The aim was to give a voice to those who belonged
to a culture of silence, where concerns were seldom disclosed, and where women
were less likely able to get information on their own reality (Postavaru, 2014). The
philosophy of the current analysis was that participants’ involvement and research
contexts were sources of knowledge creation.

4.2. STUDY PARTICIPANTS

This was a multi-site study with 36 participants, out of which 17 were

Romanian and 19 were English. Using a purposive sampling technique, research
participants were predominantly white middle-aged breast cancer women.
Participants were mainly from urban area of residence and were receiving medical
treatment in medical units or attending diverse support organizations. According
to other studies, such samples represent women most likely to identify themselves
with the survivor culture. Before completing the survey, potential participants
were informed that main inclusion criteria referred to the absence of psychiatric
conditions and active medication which could result in serious psychological side-
effects, and literacy. Six Romanian women and one in the UK experienced cancer
recurrence. Three participants in Romania and one in the UK reported secondary
cancers (breast, bone and pulmonary cancer) and the Hodgkin’s disease at the
moment of data collection. Women did not differ by age, marital status, education,
illness stages and period since being diagnosed. The mean age was 58 years at the
moment of data collection. 31% of Romanian and 33.3% of UK participants were
long-term survivors. Ethics approval was granted by partner organizations and
Loughborough University. Separate ethical packets were created for participants
in each country. As part of the protocol, the research process involved some
therapeutic pay-off. Requests for counseling were predominantly registered from
inpatients, and issues raised were mainly related to the need of information

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concerning treatment side-effects, emotional burden associated with treatment and
the relationship with the intimate partner.

4.3. DATA COLLECTION APPROACH

Invitations to several organisations in Romania and the UK and an

informational flyer were sent in order to assist the process of data collection.
Women who requested information were contacted and given a brief description
of the study, opportunities to ask questions, and were screened for study inclusion
criteria. Communication between the lead researcher and the institutional
representatives took place by phone, email, and, when possible, visits to different
support groups were paid. The use of partnered interviews was one way to
challenge the traditional clinical research, by attempting to minimize the
likelihood of emotional threat and show respect to the research participants
experiencing inequalities and vulnerability at different levels of existence. The
method suggested that research participants represented an authoritative source of
knowledge. This implied a political overtone of the research by promoting
empowerment through active participation and by providing women the space to
define their own problems and suggest changes. Therefore, the information was
not simply collected from the research participants. Rather, it was ‘coproduced
intersubjectively in a manner that preserves the existential nature of the
information’ (Liamputtong, 2012).

4.4. DATA COLLECTION PROCEDURE

Interviews were conducted face to face, where possible. When participants

expressed the wish to fill in the forms at home, a two-week period was allowed for
the research packet to be returned to the lead researcher. Questions were translated
and adapted for the Romanian and the UK contexts. The duration of a face to face
interview was about one hour and a half. Interview questions primarily acted as a
guide for the researcher, focusing on self-reflected experiences relating to the
illness. They touched topics as breast and illness representation (including the self,
community and authorities), communication with medical staff, challenges and the
use of cosmetic purchases. Exempli gratia, participants were asked to describe
how the breast surgery changed their lives, what were the most distressing
consequences of the illness, what changes occurred in their lives after diagnosis,
and if they felt less valued as breast cancer survivors. The aim was to elicit
participants’ modes of thinking about issues surrounding the questions, and to
provide them with latitude over what they felt comfortable to disclose. If the
respondents went off on a tangent or shared information that they found to be
relevant, the researcher explored the topics further.

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 4.5. DATA ANALYSIS PROCEDURE

Experimental design if necessary. Thematic analysis was used to analyze the

text data collected within the interviews and to classify them into an efficient
number of themes that represented similar meanings. This method was generally
used with a study design whose aim was to describe a phenomenon for which the
literature was limited. Therefore, preconceived categories were avoided. The
categories were allowed to flow from the data. Data were generally coded into two
broad categories, as (1) accounts of the personal experience with the diagnosis and
the treatment and (2) accounts of experiences lived on organizational level. Then,
working subcategories and themes were extracted. All data that emerged from the
open-ended questions were stored in a document. Text data were in print and
electronic formats. Analysis started with reading all data repeatedly to achieve
immersion and obtain a sense of the whole. Then data were read word by word to
derive preliminary themes. Some themes were combined during the analytical
process, whereas others were divided into subcategories. The researcher sought to
generate results that were grounded in data and entailed ‘a constant moving
backwards and forwards between data and emerging theoretical notions’ (Bryman,
1989). As the purpose of the research was exploratory, the thematic grouping was
simply described.

5. RESULTS
Three themes described experiences lived on personal level (the meaning of
breast, implications of mastectomy and the use of cosmetic purchases) and other
three gave an account of experiences on organizational level (the status of cancer
survivorship, political dimension of survivorship and communication with
doctors).

5.1. Theme one: The emotional and social meaning of the breast

As depicted in the interviews, a woman’s breast represents emotionally and

symbolically her womanhood, sexuality, aesthetic appearance, feeding of her
infant and feelings of love and motherhood. For women sexuality includes ideas
of body image, femininity, and desirability. Sexuality has emotional, intellectual
and sociocultural components, as two survivors in the UK explained:

Breast means a biological part of the woman body, having functional and
aesthetic roles. (M., 45 years)
Breasts are important to feel feminine and sexually attractive. (H., 49 years)

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 As another survivor mentioned, the breast is entitled a crucial implication in
the social construction of feminine roles; it is a symbol of woman’s identity and of
the visual self, which define the intimacy, the connection with the outside world
and the manner a certain culture constructs social representations about the illness
and the person. Moreover, it serves as a tool people use to create their own
judgements and to give aesthetic verdicts.
Breast is part of my body that indicates who I am. It gives me shape and
displays my clothes correctly to make me who I am. It is the first thing people see
and begin to make a judgement about me; right or wrong; it is the visual me. (L.,
45 years, UK)

5.2. Theme two: The legacy of breast cancer survivorship nowadays

Survival from cancer encompasses moments of uncertainty and fear, and

potentially, premises for mental illness (depression), as the accounts of five
Romanian participants revealed.

I was drained of everything. I was not able to think. I was seeing everything in
black. (R., 56 years)
I was shocked; I was thinking at what was the worst, at my life that could end at
any time without enjoying it too much and at the things I have not managed to do.
(E., 57 years)
I live my life in fear of what may happen at any time. (E., 57 years)
I became depressive and this has influenced all my life. (O., 63 years)
I cannot compare the diagnosis with anything else; I have never been through
something like this. It is something hard and painful. Symptoms after
chemotherapy (vomiting, nausea and dizziness) were taken with difficulty. (A., 55
years)

This came in line with the criticism of the positive breast cancer image and
the plenty of childlike products and ribbons marketed in public campaigns. Two
survivors in the UK found fault with the usage of pink colour.

Turquoise always loved that colour, calming and peaceful! Definitely not breast
cancer pink, never forget someone giving me a breast cancer pink ribbon to wear
in the early days-made me feel sick and also to me it was like saying- “look I have
breast cancer, look at me!” (N., 65 years)
Yellow, because it is the colour of the sun, when the sun shines people are usually
happy and it makes me feel good. (L., 62 years)

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 Moreover, efforts have been put together, on an organizational level, to
encourage the destigmatisation of illness, as reflected in the following four
extracts.

Nowadays, cancer does not mean death at all; with a little luck, trust, fight, the
right treatment and a lot of support from the family and people close to you, you
can battle the illness and keep it under control. (M., 58 years, RO)
People should have confidence that cancer does not necessarily mean death. (L.,
60 years, RO)
It is not the end of the world, just a few years of having treatment. You are never
the same but you are alive. (J., 54 years, UK)
They need moral support, to be treated with understanding; they (peers) need to
show them that they care; they need to advocate for people with cancer. People
with cancer need to receive material support and quality care. (U., 56 years, RO)

5.3. Theme three: Political resistance and disregard

Another theme that evolved from the data was the expansion of identity
politics to illness. Breast cancer women’s identity has been mirrored and shaped
on political levels, creating space for distrust, ignorance and alienation. In
Romania, as a couple of accounts suggested, breast cancer survivors were most
likely to be approached as an invisible and dysfunctional subculture (with specific
needs and life standards) and as a threat to the financial security of public
institutions.

Cancer survivors are regarded by authorities as people who do not even matter at
issue. Ordinary people look at them with pity. (M., 62 years)
Authorities regard us with indifference; ordinary people regard us with interest
and admiration; some of them regard us with indifference and others with respect
and concern. (L., 47 years)
We are regarded by them (politicians) as handicapped persons. (A., 44 years)
Authorities always think that we might ask money from them. (O., 56 years)
Authorities want us to disappear, to not use the public money at all. (U., 39 years)
Authorities treat us with indifference and false compassion. (T., 49 years)

5.4. Theme four: Implications of mastectomy

Advances in treatment of breast cancer have not avoided approaching the

implications of breast surgery. Breast cancer survivors can have a range of
responses after mastectomy, such as acceptance, diminished self-valuation,
physical and psychological trauma. Mastectomy can take a serious emotional cost
on a woman and even affect the way she (re)constructs her feminine identity. As

77
none of the Romanian survivors in the study afforded to undergo breast
reconstruction, it was critically important to examine the impact of breast surgery.
Five survivors in Romania disclosed that they felt physically and psychologically
disabled.

It was a kind of suffering that could not be explained in words. It was a mutilation.
(D., 45 years)
It was a mutilation, a kind of aggression you cannot describe in words. (J., 56
years)
It was a physical and psychological mutilation. (S., 47 years)
It was an amputation, a handicap. (P., 44 years)
It was body damage. (N., 49 years)

For another woman, the psychological effects of mastectomy involved a

long-term healing process: It is a trauma that I try to overcome. (I., 62 years)
The loss of the breast was experienced by one participant as an attack to the
body image and worrying about aesthetic features. The following extract indicates
that mastectomy gave one the belief that the being was flawed; shame manifested
as a core feeling of not being valuable and lovable. As can be noticed in the
account, emotions associated with mastectomy decreased self-esteem and
organized a new and disintegrated image of the self: Yes of course less valued,
looking like a freak having lost a breast. I was losing part of me. I did not feel like
whole person. I felt ashamed at having lost a breast. (F., 44 years, UK)
For another participant the support received from the family was a buffer
against the traumatizing consequences of the surgery: I was lucky that I did not
perceive it as a handicap; my family and those close to me did not perceive it as
something odd. (H., 45 years, RO)

5.5. Theme five: Prostheses, breast reconstruction and clothing

Data showed that none of the Romanian survivors that took part in the study
could afford breast reconstruction. Some women in the present research could not
afford buying prostheses or did not have information about related opportunities.
One survivor described that finding a proper bra was a ‘nightmare’ and that the
breast loss affected her sexuality, attractiveness and activities. Moreover,
prosthesis was an essential resource for her to re-establish her social plausibility
and the sense of personal well-being and quality of life.

Clothes and bra shopping: sometimes difficult to get the clothing you want
because of the cut of neckline. The nightmare of getting proper bra fitting and
suitable bra to hold prosthesis; unable to wear <pretty nightwear> without bra;

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less swimming due to prosthesis wear and tear and not being able to afford
swimming prosthesis. Getting a new prosthesis off NHS when change in body
weight without the ninth degree (very annoying when you think how many
prostheses you could have for the price of reconstruction!). Finally, as time goes
on, there is the increasing concern of return or life expectancy after breast cancer.
Otherwise, life continues pretty much as before. (U., 55 years, UK)

From another paragraph one learns that the body acceptance after
mastectomy can take a long time. The intensity of the grieving started to fade after
years. Deformity goes beyond the issue of desirability and touches much more
fundamental concerns, such as identity and social representation and acceptance of
the self.

Having had a total mastectomy four years ago I am in a good place with body
image. But it took nearly three years to get there. I couldn’t have breast
reconstruction at that time and wouldn’t have been able to have reconstruction for
at least eighteen months. I hated my dysmorphic body and was angry. They hadn’t
done a double mastectomy. I had good sized breasts so have always had to wear a
bra and prosthesis unable not to as my remaining stuck out like a Dalek’s antenna
and so obvious! Wouldn’t answer the door or receive visitor if in pyjamas! I am
now able to cope with change in body image and glad I didn’t have double
mastectomy. Life is okay. (N., 52 years, UK)

A different picture we get from a survivor who followed breast

reconstruction. She expressed her positive emotions related to the activities she
was able to do. Her breast reconstruction brought her femininity back. Obviously,
breast reconstruction was associated with greater satisfaction with clothing style
and the escape from wearing prosthesis. It preserved her body image and self-
perception of attractiveness: I enjoy buying clothes, going swimming and feeling
attractive. (J., 43 years, UK)

Probably the most common reason for choosing reconstruction is to not wear
external prostheses, as another woman retold. If women go for breast
reconstruction, there is the premise that they are not satisfied with their external
prostheses: I had reconstruction four years after surgery. I had very physical
teaching job and often lost my prosthesis. I was often asked about reconstruction
so the best way to know was to have it done. (I., 51 years, UK)
The correction of the external deficit does not necessarily repair the internal
one. Emotions might vary from visible embarrassment, which acts as a permanent
reminder, to struggle: They say that cancer is a disease of the soul. Although you
manage to treat the physical, mind remains affected. You manage to resist

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treatment only if you have a strong psyche. Paradoxically, cancer patients are
good people at heart. (P., 54 years)

The benefits from wearing prostheses are described by three survivors in the
UK. These women commonly specified that prostheses reshaped their bodies,
made them look more attractive and increased awareness relating to their self-
image.

Yes, I wore several kinds of prosthesis, soft, various shapes and stick-on. I cut a
sponge and stitched it into my swimming costume. I also stitched a sponge into an
all-in-one to put on after swimming. This I think meant that I was self-conscious
about my shape. (U., 43 years)
I wear prosthesis to even up my shape. I love clothes and this way I feel I look
better. (T., 47)
I have worn prosthesis because I still wish to retain the shape of my breast and to
look good and still feel like a woman. (P.45 years)

5.6. Theme six: Difficulties relating to doctor-survivor communication

Not only had the mistrust in the health care team, but also the lack of
confidence in their knowledge shaped the survivorship experience of two
participants in the study. From the data it seems that women resisted, questioned
or challenged medical authority.

I feel that you are not told of the different types of treatment that are used in
different parts of the country so that you have a choice. (H., 52 years, UK)
My life is black. There is no real support once your treatment is finished. There
are no professionals who have the time to listen to you. The oncology team does
not even have sound knowledge of the drugs they prescribe. Why do they not make
a record of the side effects you are having? How can percentages be accurate?
(K., 49 years, UK)

Another woman described that she refused to return to the medical unit, as
she felt disempowered and treated with lack of dignity. Her lamentation is an
attempt to take back her singularity and to re-establish new authorship over her
life. It seems that the experience of consulting a doctor and the information
provided might be questionable; this kind of encounter might undermine trust in
the medical expertise.

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I don’t have to return anymore to this clinic unless I have a concern, but when I
did I would be so stressed, cannot forgive them for misinformation and feeling like
a statistic rather than a human being. (J., 43 years, UK)

As patients wish to vanquish the illness that alters their lives, they may also
wish to regain control of their life narratives, which they have yielded up to
‘objective’ medical authority, as seen in the following two extracts.

When I was told that I needed further surgery the surgeon said I could have
immediate reconstruction, but he would not recommend it for me. Now, I do not
want to give any more time to surgery. (L., 55 years, UK)
I have not had breast reconstruction. I do not want more operations or to put my
family through me going into hospital again. (S., 53 years, UK)

6. DISCUSSION

Overall findings have suggested that the majority of breast cancer women in
this study, both in Romania and the UK, experienced a couple of challenges that
affected their lives. A smaller number of women mentioned that the illness
enabled them to understand the importance of having a positive self-image.
Findings indicated concerns surrounding inadequate and insufficient care provided
in medical settings and a need for more ‘humanized’ medical practice. It was
revealed that there was a paucity of knowledge relating to certain experiences and
needs of survivors in Romania and even in the UK that affected their quality of
life within transitory steps of survivorship.
Almost nothing has been known about survivors who refuse or do not have
the opportunity to follow reconstruction. This research lends support to the
exploration of how survivors articulate the social and emotional meaning of breast
loss and the benefits from wearing breast prostheses. Problems arising from
wearing prostheses and how women deal with clothing after mastectomy are
sensitive topics which scarcely have been scientifically approached. From the
data it seems that these aspects influenced women’s lives more than has been
believed at first glance. It was also indicated that women encountered difficulties
in wearing prostheses and that their options for clothing were constrained.
Moreover, women in Romania felt exposed to stigmatisation and vulnerability on
both personal and organizational levels. This finding aligns with the conclusions
one author suggested, in that ‘not only do cancer survivors feel isolated in their
pain, but their very identities – indelibly inscribed by the cancer experience – are
pushed to the margins of the social fabric in which selfhood is embedded’
(McKenzie et al., 2004).

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 The emotional legacy associated with wearing prostheses or breast
reconstruction, fear of recurrence, perceived devaluation and stigmatization
inclines one to question the authenticity of public images of survivorship shared
over years. Accounts of women in the UK, who could afford breast
reconstruction, from a feminist perspective, changed the natural process of
recovery and the content of narrations. Those who reconstructed their breasts or
wore prostheses promoted an intact image of the body. Survivors who used
cosmetic purchases were expected and socially encouraged to integrate the image
of perfect healthy bodies, and repudiate their physical imperfections. It seems that
cultural approval of the diagnosis has been lacking. Breast cancer has been one of
the illnesses whose cultural emphasis has been sharply contested. As the published
literature showed, it has been associated for many years with stigmatization and
discrimination, which made women suffer the disease in silence. The repudiation
of patients’ voices and the promotion of cultural models that did not allow women
to tell their stories jeopardized survivors’ identities.
This is one limitation of the public discourse of breast cancer survivorship
identified in the analysis as it did not create space for some Romanian women to
embrace it. The dark side of breast cancer was retold in some extracts, which
made visible some hidden emotions as hopelessness, anger and grief.
There appeared to be a gap in provision between doctors’ practices and
survivor’s needs. When patients complain of being treated like numbers they
grieve that their singularity is not valued. This finding is in line with what other
scholar suggested, ‘that they have been reduced to that level at which they repeat
other human bodies’ (Charon, 2006).
This study provides evidence that there is a tension between how women
experienced survivorship on both organizational and political levels. While they
were perceived as unnoticed in society by authorities, women were simultaneously
encouraged to declare their status via pink clothes and ribbons. The proclamation
of a perfect shape of the body following treatment via clothing, reconstruction and
prostheses was seen as meddlesome by some survivors. The accounts embrace a
public mission which at some point becomes political. On the one hand, narrations
inform about the disruptions of the illness. On the other hand, they question the
place of the diagnosis into the public agenda. Therefore, to what extent breast
cancer women have embraced the dominant survivor identity, which promotes
perfect bodies, positive emotions, self-confidence and hope for recovery has
remained an open question.
The way these challenges are managed can have an ongoing impact on the
way in which breast cancer survivorship is viewed. The accounts employed in this
analysis represented a delicate state of existence between life and death and they
were dialogical in nature. Therefore, accurate appreciation of the signification of
breast loss and of the endeavours one makes to overcome the loss is critical. Most

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of the accounts in this study speak for the identification of real needs of breast
cancer survivors and of appropriate care services to provide at transitory moments
of survivorship. The accent needs to be placed on identifying hidden and
unspoken experiences with the illness, by promoting active participation in
research and by designing intervention for and with its potential receivers.
There are some connate limitations in this study. The study was implemented
within support groups, patient organizations and medical units, which implied that
the experiences with cancer may have reflected at some points the culture of the
groups. There will always be some intimate chapters of life which remain private,
hidden and undisclosed. Participants’ recall of their experiences may be blurred by
the passage of time. Breast cancer discriminates, as its incidence is higher within
certain ethnic and socioeconomic groups than within others. Therefore, the
participants in the current study were generally white women of the middle-and
upper-middle classes who had the literacy and motivation to participate, and the
opportunity to get involved in research projects. Furthermore, they were
predominantly emotionally and physically stable enough in order to encourage,
through their shared stories, women with a similar diagnosis.

7. CONCLUSION

The emphasis on this research was aimed to be seen as an effort to reflect

more accurately the shared challenges relating to breast cancer, to ensure the
commitment to participants’ perspectives and more than a survivors’
recapitulation of past experiences with the diagnosis. The culture of illness was
seen from the experience of the ill. The implications of the themes in this analysis
engendered trajectories and patterns towards survivorship, in which the meanings
women ascribed to their own experiences needed to be placed in the contexts of
the cultural values and practices in each country. The emphasis was also on the
need to understand how cancer survivorship was patterned on societal and
individual levels.
Hopefully this analysis has contributed towards some knowledge necessary
to develop services that could meet the needs expressed in this paper.
Undoubtedly, services need to be better structured to facilitate access and provide
unique modes of delivery. These services need to be provided in sites other than
tertiary medical centres (e.g. community-based clinics). ‘There is a need for better
understanding and effective approaches that smoothly reintegrate the cancer
survivor into society’ (Grinyer, 2009). Therefore, the emotional costs of cancer
survivorship should have entered the medical intervention agenda.

ACKNOWLEDGMENT
The author thanks all the survivors who took part in this study.

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 FUNDING INFORMATION
This work was partly supported by Grant POSDRU/CPP 107/DMI 1.5/S/78342

DISCLOSURES
No conflict of interest to disclose.

REFERENCES

Alfano, C.M. & Rowland J. (2006). Recovery issues in cancer survivorship: a new
challenge for supportive care. Cancer Journal, 12, 432–443.
Avis, N. E. et al., (2005). Assessing Quality of Life in Adult Cancer Survivors
(QLACS). Quality of Life Research, 14(4), 1007–1023. doi:10.1007/s11136-004-2147-2
Bloom, J., R., Peterson, D., M. & Kang, S., H. (2007). Multi-dimensional quality of
life among long-term (5+ years) adult cancer survivors. Psycho-Oncology; 16(8), 691–
706.
Bryman, A.(1989). Research Methods and Organization Studies. New York: Routledge
Charon, R. (2006). Narrative Medicine : Honoring the Stories. New York: Oxford
University Press. doi: ISBN 139780195166750
Demir, F., Donmez, Y. C., Ozsaker, E. & Diramali, A. (2008). Patients’ lived
experiences of excisional breast biopsy: a phenomenological study. Journal of Clinical
Nursing. 17(6), 744–51. doi:10.1111/j.1365-2702.2007.02116.x
DiSipio, T. et al., (2010). Does quality of life among breast cancer survivors one year
after diagnosis differ depending on urban and non-urban residence? A comparative study.
Health and Quality of Life Outcomes. 8, 3. doi:10.1186/1477-7525-8-3
FABC. (2012) Press Release. Bucharest.
Grinyer, A. (2009). Life after Cancer in Adolescence and Young Adulthood. New
York: Routledge.
Hughes, J. (1987). (p. 156). Cancer and Emotion. Psychological preludes and reactions
to cancer John Wiley Sons Ltd.
Kaiser, K. (2008). The meaning of the survivor identity for women with breast cancer.
Social Science & Medicine. 67(1),79–87. doi:10.1016/j.socscimed.2008.03.036
Liamputtong, P. (2007). (p. 246). Researching the Vulnerable- A guide to sensitive
research methods. London: SAGE Publications Ltd.
McKenzie, H., Crouch, M. (2004). Discordant Feelings in the Lifeworld of Cancer
Survivors. Journal of the Social Study of Health, Illness and Medicine. 8(2), 139–157
Peck, S. Survivorship: A Concept Analysis. Nursing Forum. 2008; 43(2), 91–102.
Postavaru, G. (2014). A participatory research approach: Designing research with
vulnerable women, in SAGE Cases in Methodology. Sage Publications, ISBN 978-1-4462-
7305-0
Rowland, J. H. et al., (2013). Cancer survivorship research in Europe and the United
States: where have we been, where are we going, and what can we learn from each other?
Cancer. 119 Suppl,2094–108.doi:10.1002/cncr.280

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 REZUMAT

Treizeci și șase de supraviețuitoare ale cancerului mamar (17 din România și 19 din
UK), cu media vârstei de 58 de ani, au luat parte la o serie de interviuri aprofundate cu
privire la provocările existențiale în urma diagnosticului. Datele au fost analizate
utilizând analiza tematică. Temele extrase au reflectat o serie de provocări pe un
continuum al bolii, cum ar fi cele legate de pierderea sânului, alegerea vestimentației,
folosirea achizițiilor cosmetice, sexualitate, teama de recidivă, devalorizare, lipsa unor
informații medicale și stigmatizare. Traiectoria către supraviețuirea de cancerul mamar
este un proces mobil, însoțit de o diversitate de nevoi și provocări definite de natura
adaptării psihologice la noul statut social de supraviețuitor al neoplaziei și se cere
imperios a fi integrată in programele de intervenție psihosocială.

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 ROMANIAN JOURNAL OF
EXPERIMENTAL APPLIED PSYCHOLOGY

VOL. 5, ISSUE 3 – www.rjeap.ro

PATHOLOGICAL GAMBLING AND IMPULSIVITY

STELIANA RIZEANU
Hyperion University of Bucharest,
Department of Psychology

Abstract
Pathological gambling is a psychological disorder that usually begins as an
enjoyable activity, but in time, some gamblers become addicted to gambling, they lose their
jobs, their family and feel depressed and anxious. Pathological gambling differs from the
recreational or social gambling of most adults, who view it as a form of entertainment and
wager only small amounts. This behaviour affects the gambler's family and friends and the
most obvious consequence of gambling problems is a poor private economy. The
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 2000) the official
publication of the American Psychiatric Association, classified pathological gambling in
the section on disorders of impulse control and defines this disorder as ”a persistent and
recurrent maladaptive gambling behaviour that is not better accounted for by a manic
episode”. This research supports the existence of a positive correlation between
pathological gambling and impulsivity among pathological gamblers presenting for
treatment. A group of 90 patients diagnosed with pathological gambling which joined this
research filled in the SOGS- South Oaks Gambling Screen and the Barratt Impulsivity
Scale. The results were compared to those obtained by a control group. The clinical group
shown higher level of impulsivity scores measured with Barratt impulsivity scale compared
to the control group.

Cuvinte cheie: joc de şansă patologic, impulsivitate, comportament.

Keywords: pathological gambling, impulsivity, behaviour.

*
Autor corespondent:
Steliana Rizeanu
Email: stelianarizeanu@yahoo.com
 1. INTRODUCTION/THEORETHICAL FRAMEWORK

The present explication of pathological gambling in DSM-IV characterizes

pathological gambling in quite exact terms; offers the starting point for measures
that are reliable, replicable, and sensitive to regional and local variation;
distinguishes gambling from other such disorders; and suggests the utility of
applying concrete clinical treatments.
Clinical evidence suggests that pathological gamblers engage in destructive
behaviours: they commit crimes, they run up large debts, they damage relationships
with family and friends, and they kill themselves (Korn, & Schaffer, 2004).
A greater understanding of this problem through scientific research is critical
(Hills, Hill, Mamone & Dickerson, 2001).

2. OBJECTIVE AND HYPOTHESES

2.1. OBJECTIVE

The objective of this paper is to identify and measure the level of impulsivity,
which is a personality trait of most pathological gamblers.
Existing literature on pathological gambling uses many terms to describe
impulsive behaviours from a variety of important perspectives, including
"sensation-seeking," "behavioural disinhibition," and "risk-taking" (Raylu & Oei,
2010). In a study comparing a group of pathological gamblers in treatment to
controls from the community, Specker, Carlson, Edmonston and Johnson (1996)
established that a higher percentage of pathological gamblers had at least one other
such disorder (35 versus 3 percent).

2.2. HYPOTHESES

Our hypotheses is that participants from clinical group, diagnosed with

pathological gambling disorders, have in the same time a high level of impulsivity
level.

3. METHOD
3.1. PARTICIPANTS/SUBJECTS

The study has been conducted on a total number of 180 participants, split into
two groups: the clinical group and the control group.
The clinical group consists of 90 participants, 22 women and 68 men, aged
between 25 and 54 years old, with an age mean of 33.6 and a standard deviation

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(SD =8.484). All the participants are pathological gamblers who, in conformity to
the SOGS assessment, have a specific pathological gambling behavior, with a
mean of 13.07 and a standard deviation (SD = 2.743), their answers situating in the
interval 9-19. The subjects have undergone psychological counseling after signing
up for a special treatment program called “Responsible gambling”.
The control group consists of 90 participants working in a call-center with a
sale profile. In this sample, the age criterion has been respected and the assessment
has been done in group. The battery test has been filled in by 60 women and 30
men, aged between 25 and 54 years old, with an age mean of 29.4 and with a
standard deviation (SD = 5.326).

3.2. INSTRUMENTS

In this study we used a semi-structured interview designed to obtain

demographic information and gambling history, the South Oaks gambling Screen
in order to identify the pathological gamblers and the Impulsivity scale (BIS-10) to
evaluate impulsivity.
South Oaks Gambling Screen (SOGS), developed by Lesieur and Blume
(1987) is the most utilized instrument for the general screening of gambling
disorders; it is easy to administer and score and the results are highly correlated to
DSM-IV-TR (2000) diagnostic criteria.
The Impulsivity Scale (BIS-10, Barratt, 1985) has a number of 30 items
through which impulsivity is evaluated. The high scores indicate a high level of
impulsivity of the individual, the mean calculated on a sample of 812 participants
being 62.7 with a standard deviation of 14.745.

3.3. PROCEDURE

The raw scores have been statistically processed using the SPSS program,
version 14.0. Descriptive statistical indicators like: mean, median, mode and
standard deviation, have been used, as well as shape distribution indicators
(skewness and kurtosis). The statistical processing also consists of correlational
analysis and significance analysis, using the T-student test.

4. RESULTS

In the clinical sample, all the 90 participants have given valid answers and
there were no difficulties in gathering the data.

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 Regarding their education level, 43.7% of the participants have an average
level of education and 56.3% have finished high-school.
The analysis of the pathological gambling behavior has been investigated
regarding the socio-economic level of the participants, as well. So, 20.3% have a
low socio-economic level, 36.5% have an average socio-economic level and 43.2%
have a high socio-economic level.

Chart 1. The distribution of the participants regarding their socio-economic level (clinical
sample)

In the control sample, the distribution of the participants regarding their

education level (N=90) has shown that 20.4% of the respondents have graduated
high-school and 79.6% have a high/superior education level. The distribution of the
participants by their socio-economic level indicates that 23.5% have a low income,
58.3% have an average income and 18.2% have a high income.

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Chart 2. The distribution of the participants regarding their socio-economic level (control
sample)

The clinical group:

After filling in the SOGS Questionnaire (Lesieur & Blume, 1987), the
participants from the clinical sample have scored a mean of 13.07 and a standard
deviation (SD=2.743) and their answers situate in the score interval 9-19, which
indicates the pathological character of the gambling.

Table 1. Statistical indicators for the clinical sample when the participants self-evaluated
themselves using SOGS

N =90 Clinical group

Mean 13,07
Median 12,00
Mode 12,00
Standard deviation 2,743
Skewness 0,554
Kurtosis -0,573
Minimum 9
Maximum 19

In histogram 1, the asymmetry coefficient – skewness (which refers to the

slope of the frequency distribution curve) is 0.554. This value indicates a small
positive asymmetry towards left of the frequency distribution curve.

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Histogram 1 SOGS

The arch coefficient – kurtosis (-0.573) indicates a platykurtic distribution,

so it confirms the observation that the scores are moderately grouped around the
central value.
For the Impulsivity Scale (BIS-10, Barratt, 1985), the mean of the scores is
70.19, a value that is situated in the segment of high manifestation of the
impulsivity pattern in the interviewed subjects.
The scores have varied between 8 points, the minimum score (which indicates
low impulsivity) and 122 points, the maximum score (which indicates high
impulsivity).
The calculated standard deviation was 34.423, indicating a variance
coefficient of approximately 39%, which suggests a high dispersion of the data
around the central value.

Table 2. Statistical indicators for the Impulsivity Scale – clinical group

N =90 Clinical group
Mean 70,19
Median 73,00
Mode 25,00
Standard deviation 34,423
Skewness -0,183
Kurtosis -1,279
Minimum 8
Maximum 122

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 The asymmetry coefficient – skewness – for the clinical sample is -0.183. So,
the distribution is negatively asymmetric and it determines a quasi-symmetrical
curve with a slight inclination/lean towards right, which means that the respondents
have the tendency of scoring high and average on this impulsivity scale, rather than
scoring low, which would situate them on the left end of the distribution. The arch
coefficient kurtosis (-1.279) indicates a flat distribution, in which the scores are
scattered around the central tendency.

Histogram 2 BIS-10

The control group

The participants from the control sample who filled in the SOGS
Questionnaire, do not fit into the pathological score interval, the mean being 3.28
and the standard deviation (SD=1.002). Their responses varied between the
minimum score of 0 and the maximum score of 4, which indicates the fact that they
lack the preoccupation for gambling.

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Table 3. Statistical indicators for the control sample when the participants self-evaluated
themselves using SOGS
N =90 Control group
Mean 3,28
Median 2,00
Mode 1,00
Standard deviation 1,002
Skewness 0,323
Kurtosis -0,274
Minimum 0
Maximum 4

For the Impulsivity Scale (BIS-10, Barratt, 1985), the mean of the scores is
32.27, with a standard deviation of 8.562.
The scores have varied between 0 points, the minimum score and 33 points,
the maximum score, which shows that the impulsivity level in these subjects is a
non-pathological one.

Table 4. Statistical indicators for the Impulsivity Scale – control group

N =90 Control group
Mean 32,27
Median 30,50
Mode 11,00
Standard deviation 8,562
Skewness -0,619
Kurtosis 0,488
Minimum 0
Maximum 33

The Barratt scores of clinical sample were positively correlated with the
pathological gambling as indicated by the scores of South Oak Gambling Screen –
SOGS; a correlation between impulsivity and gambling symptoms was found
(r=0,517, p<0,000).

5. CONCLUSIONS

The research hypothesis, which stipulates that the impulsivity level, on a

sample of 90 participants, is higher in the clinical sample (diagnosed pathological
gamblers) than in the control sample, is accepted.

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 After analyzing the data, the general conclusion is that diagnosed pathological
gamblers have a high level of impulsivity, which, most of the times, represents a
risk factor in maintaining this pathology and in the occurrence of relapse.
In the future, prevention plans and treatment interventions should aim to
increase the gambler’s contact with non-gambling peers and non-gambling
activities (Rizeanu, 2013).
Research is needed that allows us to better understand the link between the
level of impulsivity and subsequent changes in gambling disorders (Rizeanu,
2012).

REFERENCES

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental

Disorders. Washington, DC: Author.
Barratt, E. S. (1985). Impulsiveness subtraits: Arousal and information processing. In
J.T. Spencer & C.E. Izard (Eds.) Motivation, emotion and personality (pp137-146). North
Holland: Elsevier Science.
Hills, A., Hill, S., Mamone, N., & Dickerson, M. (2001). Induced mood and persistence
at gaming. Addiction, 96(11), 1629–1638.
Korn, D.A., & Schaffer, H. J. (2004). Massachusetts Department of Practice Health’
Practice Guidelines for Treating Gambling-Related.
Lesieur, H. R., & Blume, S. B. (1987). The South Oaks Gambling Gambling Screen
(SOGS):A new instrument for the identification of pathological gamblers. American
Journal of Psychiatry, 144, 1184–1188.
Raylu, N., Oei, T.P. (2010). A cognitive behavioural therapy programme for problem
gambling. East Sussex: Routledge.
Rizeanu S. (2013). Pathological gambling and depression. Procedia - Social and
Behavioral Sciences – Elsevier. Vol 78/2013, p 501-505.
Rizeanu S. (2012). Proposal for a Cognitive Model to the Treatment of Pathological
Gambling. Procedia - Social and Behavioral Sciences - Elsevier. Vol 33, 2012, pp 742–
746.
Specker, S.M., Carlson, G.A., Edmonson, K.M., Johnson, P.E. (1996). Psychopathology
in pathological gamblers seeking treatment. Journal of Gambling Studies,12/1996, p 67–81.

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 ROMANIAN JOURNAL OF
EXPERIMENTAL APPLIED PSYCHOLOGY

VOL. 5, ISSUE 3 – www.rjeap.ro

BOOK REVIEW - A COGNITIVE-BEHAVIOURAL THERAPY

PROGRAMME FOR PROBLEM GAMBLING
STELIANA RIZEANU
Hyperion University, Department of Psychology

This book is a practical guide which supplies detailed information to help

the therapist worldwide and the gamblers understand gambling behaviours.
The cognitive behaviour therapy programme provided in this manual
reflects the findings of a comprehensive literature review of the treatment of
problem gambling.
A cognitive-behavioural therapy programme for problem gambling is
written for professional health workers with some training and knowledge of
cognitive-behavioural therapy.
This practical guide has fifteen chapters which contains ten core and three
election sessions and includes handouts and exercises that can be downloaded and
provide helpful guidance for addiction counsellors. In this book the authors use a
cognitive-behavioural approach and provide a session by session guide for
overcoming problem gambling.
The first chapter is an “Overview” with three main points: the programme
contents and goal, the structure of the programme and sessions and guidelines on
using the treatment programme. There are four parts to the programme: the first
one’s aim is to assess the client’s problems and needs; the second’s phase aim is to
provide the client with basic strategies to help stabilize compulsive gambling; the
third teaches the client a range of coping skills and the last teaches strategies to
maintain therapeutic gains and minimize relapse in the future.
The second chapter, “Introduction” offer us a review of the problem
gambling treatment literature which aim to provide the factors associated with the
development and maintenance of problem gambling, a summary of the currents
treatments for problem gambling, the evidence for the efficacy of CBT for problem
gambling and the rationale and evidence of the effectiveness of the CBT
programme contained in the book.
 Chapter 3 “Session one: Assessment” provides the session content and
goals: discuss aim and rationale of the session; conduct an assessment; devise a
case formulation and treatment plan; provide treatment rationale and plan;
introduce home exercises.
Chapter 4 “Session two: Psycho-education and self-management strategies
to stabilize gambling” has two parts: the first has the aim to educate the client
about the problem gambling and the aim of the second part is to teach the client
self-management skills to stabilize his gambling and to discuss about strategies to
cope with urges to gamble.
Chapter 5: ”Session three: Cognitive-restructuring I - identifying” aims to
identify the gambling specific thinking errors using cognitive-behavioural
strategies; there are two categories errors among problem gamblers: gambling
specific errors and other thinking errors. The gambling specific errors can be
divided into three categories: illusion of control of gambling, predictive control and
interpretative biases.
Chapter 6 “Session four: Cognitive restructuring II - challenging gambling
specific thinking errors” starts with the psycho-education of the client and aims to
generate rational self-statements, such as: gambling outcomes are more determined
by luck than skill; gambling outcomes are not related to previous outcome; gaming
machines are set in such a way that they pay less than the stake.
Chapter 7 “Session five: Cognitive restructuring III - identifying and
challenging other/general thinking errors” has the aim to replace these errors with
more realistic and rational thoughts. The general thinking errors include the
following: all or nothing thinking; overgeneralization; mental filter; jumping to
conclusions; should statements; magnification or minimization; emotional
reasoning; labelling and personalization.
Chapter 8 “Session six: relaxation and imagination exposure” introduces the
client to some relaxation exercises and imagination exposure techniques based on
the technique of systematic desensitization developed by Wolpe.
The ninth chapter, “Session seven: Problem solving and goal setting skill
trainings” aims to teach the client the usefulness of problem solving as well as the
steps involved in a problem solving approach.
Chapter 10 “Session eight: Management of negative emotions” help the
client understand the role negative emotions may play in the maintenance of
gambling problems, assist the client to explore his negative emotions and teaches
him strategies of coping with negative emotions. The negative emotions that are
common among problem gamblers are: anxiety, guilt, anger and depression.
Chapter 11 “Session nine: Relapse prevention and maintenance of
therapeutic gains I – balanced lifestyle” discuss about the importance of a balanced
lifestyle in minimizing lapses and aims to explore the client’s own lifestyle and
help him to change his life.

96
 Chapter 12 “Session ten: Relapse prevention and maintenance of therapeutic
gains II – coping with high-risk situations” provides the possible high-risk
situations that could lead to lapse and the strategies to avoid them.
The last three chapters present the three elective sessions of the programme:
assertiveness and skills training; getting out of debt and teaching significant others
strategies to cope with the gambler’s behaviours.
A cognitive-behavioural therapy programme for problem gambling is
designed for psychologists working in addiction area and highlights the efficacy of
cognitive-behavioural therapy in the treatment of pathological gambling.

97