The construct of control in mind-body medicine: implications for healthcare.

Research suggests that one of the principal reasons patients are attracted to alternative medicine is that they find many of these therapies more congruent with their philosophical orientation toward health. Many mind-body approaches, which are some of the most frequently used classifications of complementary and alternative therapies, grow out of research demonstrating the important role of psychological factors in treating and preventing illness. This article reviews research on one such factor--control--and its importance in health. Studies demonstrating the following are highlighted: (1) illness frequently results in feelings of loss of control; (2) gaining a sense of control can help patients to cope with illness; (3) whereas control may influence physiological function and health outcomes, the amount of active control we can exercise over physical functioning and health is limited; and (4) it is important to match control strategies to patient control styles and preferences. The implications of mind-body studies are also discussed.

Sense of control and adjustment to breast cancer: the importance of balancing control coping styles.

The relationship of modes of control and desire for control to psychosocial adjustment in women with breast cancer was examined. Fifty-eight women with stage I or stage II breast cancer were surveyed shortly after their diagnosis and again 4 and 8 months later. The authors hypothesized that a control profile in which individuals use a positive yielding (i.e., accepting) mode of control in conjunction with an assertive mode results in better adjustment than relying exclusively or primarily on an assertive mode. Results lend preliminary support to this hypothesis. At 8-month follow-up, those women who had a high desire for control and were low in positive yielding control showed the poorest adjustment, whereas those high in desire and the positive yielding mode showed the best psychosocial adjustment. The findings suggest that balanced use of active and yielding control efforts may lead to optimal psychosocial adjustment and quality of life in the face of life-threatening illnesses.

The application of computerized content analysis of speech to the diagnostic process in a psychiatric outpatient clinic.

Twenty-five new psychiatric outpatient were clinically evaluated and were routinely administered a brief psychological screening battery which included measures of symptoms, personality, and cognitive function. Included in this assessment procedure were the Gottschalk-Gleser Content Analysis Scales on which scores were derived from five-minute speech samples by means of an artificial intelligence-based computer program. Intercorrelations of these content analysis measures with scores obtained from the MMPI-2, SCL90, and other measures confirmed previously published construct validation findings. The use of this computerized content analysis procedure for initial, rapid diagnostic neuropsychiatric appraisal is supported by this research.

Controlling ourselves, controlling our world. Psychology's role in understanding positive and negative consequences of seeking and gaining control.

This article begins by examining psychology's contributions to understanding the positive consequences of control for individual mental and physical health. Person-environment control mismatches and the negative personal, interpersonal, and societal consequences of seeking and having control are then discussed. As corrections to mismatches and negative consequences, three methods of analyses are provided. First, definitional and conceptual precision is offered, including a more careful matching of control-related interventions to multidimensional, individual-specific control profiles. Second, therapeutic assessment and interventions are placed within a biopsychosocial model of control. Finally, philosophy of science and paradigmatic issues underlying control theories are highlighted, particularly as they affect psychology's role in examining values toward which control efforts should be directed. These topics are important for people's personal and collective well-being.

Aging and sense of control.

Three groups representing different phases of the developmental lifecycle--12 senior citizens, 67 young adults, and 14 healthy middle-aged normal adults--were assessed using a multidimensional control inventory. Senior citizens had a healthy over-all sense of control comparable to those of the other two groups and a significantly lower (healthier) negative sense of control. They also were significantly more likely to endorse acceptance as a way of addressing areas of concern and to complement self as a source of control with a sense of control coming from others (including God, belief in a higher power).

Assessing the relationship between a multidimensional psychological "control profile" and cardiovascular risk.

This article begins by citing apparently conflicting sets of literature regarding the association between control and cardiovascular risk. Each set of findings is based on a unidimensional understanding of control. To gain more precise information, a multidimensional control inventory, the Shapiro Control Inventory (SCI), was given to twenty individuals at the time of their yearly physical. Results showed that low perceived control on the domain specific control scale was associated with higher cardiovascular risk. Further, several findings between specific risk parameters--smoking, calories from fat, blood pressure, and cholesterol level (HDL)--were significantly associated with different dimensions of the control profile. Case study data from the two individuals at highest risk suggest that different control profiles may be associated with cardiovascular risk. Guidelines and suggestions for future research are offered.

A control profile of adult children of alcoholics: a preliminary investigation.

In order to more precisely investigate the nature of control and self-control issues for adult children of alcoholics (ACA), a group of ACAs was compared to a group of sex and age matched healthy normals and a sex matched group of college students on the Shapiro Control Inventory (SCI). The SCI provides a profile that is both general domain (positive sense of control, desire/efforts for control, agency of control, and mode of control) and domain specific (body, mind, interpersonal, self, career, environment). Analysis of variance and subsequent planned comparisons on the SCI showed significant differences between the ACA and the two comparison groups in general domain sense of control, in three of the four general domain mode quadrants, and in the domain specific areas of body, mind, interpersonal, and career. Individual areas where ACA subjects felt most out of control were weight, significant other, and family of origin; 89.5% felt concern with self-concept, stress, and relationship with significant other. Although a small subset of ACAs had a strikingly high "in control" profile, most did not. Finally, the sense of control profile of ACAs is compared with two clinical populations--borderline and depression--and is shown to fall midway between the clinical and normative groups. Guidelines and suggestions for further research are offered.

A psychological "sense-of-control" profile of patients with anorexia nervosa and bulimia nervosa.

To investigate control and self-control issues for patients with eating disorders, 10 individuals diagnosed with anorexia nervosa or bulimia nervosa were compared to two sex-matched groups of 9 and 50 adults on the Shapiro Control Inventory. Analysis of variance and subsequent planned comparisons showed significant differences indicative of pathology between the eating-disordered group and one or both comparison groups on the general domain sense of control scale and the positive sense of control scale. Three of the four mode scales and the domain-specific sense of control scale were also in the expected direction. Several clinically relevant individual items also supported this trend. The discussion notes the clinical importance of refining how control is measured for eating-disordered populations.

Measuring the psychological construct of control. Discriminant, divergent, and incremental validity of the Shapiro Control Inventory and Rotter's and Wallstons' Locus of Control Scales.

The psychological construct of control is increasingly thought to be an important variable in psychosomatic medicine, but there are limitations with how it has been measured by previous instruments. The current study details four limitations of previous instruments as a rationale for developing a new multi-faceted, multi-dimensional instrument to measure control, the Shapiro Control Inventory (SCI). Discriminant, divergent, and incremental validity of the SCI is compared with the Rotter's Internal/External Locus of Control Scale and Wallstons' Multidimensional Health Locus of Control Scales on five groups, one normal and four clinical groups (depression, generalized anxiety disorder, borderline personality, and panic disorder). Analysis of variance showed significant differences among populations on each of the nine SCI scales. The majority of these results were highly significant, whereas for Rotter's scale the results were barely significant, and for Wallstons' three scales, not at all significant. Correlations of the SCI scales with Rotter's and Wallstons' scales were small to moderate, but in no case explained more than 15% of the variance. The SCI also provided incremental validity over Rotter's and Wallstons' scales both for sensitivity (clinical versus normal) and specificity (between clinical groups). The discussion section provides suggestions for future research.

Adverse effects of meditation: a preliminary investigation of long-term meditators.

Adverse effects of meditation were assessed in twenty-seven long term meditators (average 4.27 years) both retrospectively (time one) and prospectively at one month (time two) and six months (time three) following a meditation retreat. At both time one and time three subjects reported significantly more positive effects than negative from meditation. However, of the twenty-seven subjects, seventeen (62.9%) reported at least one adverse effect, and two (7.4%) suffered profound adverse effects. When subjects at time one were divided into three groups based on length of practice (16.7 months; 47.1 months; 105 months) there were no significant differences in adverse effects. How the data should be interpreted, and their implications both for the clinical and psychotherapeutic use of meditation as a relaxation/self-control strategy, and as a technique for facilitating personal and spiritual growth, are discussed. Limitations of the study and suggestions for future research are also offered.

Changes in mode of control and self-control for post myocardial infarction patients evidencing Type A behavior: the effects of a cognitive/behavioral intervention and/or cardiac counseling.

A control model of psychological health was utilized to assess the effects of a cognitive/behavioral intervention and/or cardiac counseling with post myocardial infarction patients evidencing Type A behavior. A previously developed four quadrant control inventory measuring perceived mode of control and perceived self-control was given to groups in two sections of the Recurrent Coronary Prevention Project. The experimental group (coronary counseling plus cognitive/behavioral intervention) was tested after one year (E1) and two years (E2) of treatment. The cardiac counseling group was assessed only after two years (C2). As hypothesized, the cognitive/behavioral treatment section at E2 had a significantly higher overall satisfaction level and congruence between real and ideal self on each of the four quadrants than at E1, and than the cardiac counseling only (C2). Further, on each of the four quadrants, E2 had a psychologically healthier mode of control profile than the cardiac counseling only (C2); and a healthier profile on both the positive assertive and positive yielding mode of control than at E1. Finally, E2's self-control score was significantly higher than C2's. Comments on future directions in measuring perceived control, and on the relationship of control and Type A behavior are offered.

A sense of control, health, and illness: exploring the mind-body relationship and the socio-cultural/spiritual context: reflections on Bali.

Research has shown that there is a much more intimate and complex relationship between the "mind" and "body" than heretofore acknowledged within the predominant Western scientific paradigm; and that a "sense of control" may be one of the more important variables mediating that relationship. Furthermore, even when this "mind-body" relationship is studied, it is often done so in a reductionist way--at a psychophysiological level within the individual, thereby ignoring the socio-cultural context within which it is embedded. To address these issues, this article examines the mind-body relationship within the socio-cultural/spiritual context of Bali. Specifically examined are: (1) the culture's underlying assumptions about the mind-body-spirit connection across developmental and life cycle issues (including physical illness, and death); (2) the importance of maintaining a sense of control, harmony, and balance, within oneself, one's community, and the cosmos; and (3) the implications of those views for a control-based model of positive health. The article concludes with: (1) a discussion of why control seems to be such an important "construct" in human evolution; (2) an examination of the costs and benefits of different methods of maintaining a sense of control and orientation; and (3) and a call for efforts toward a unifying theory of human control.

"Self-control" concerns for men and women: refinement and extension of a construct.

This study develops and refines aspects of the construct of self-control according to a four-quadrant model: Assertive-positive, assertive-negative, yielding-positive, and yielding-negative. Twenty-six men and 78 women evaluated areas of their life in terms of the perceived degree to which they utilized these various dimensions of control. Results indicated that, depending on the specific area of clinical concern (e.g., interpersonal relationships, professional pursuits, emotional expression, health), there were significant differences in the kinds of self-control strategies that Ss tended to employ. From a clinical perspective, while Ss in this sample exercised a high degree of assertive-positive control in their professional lives, in the interpersonal and affective spheres they perceived themselves to be more out of control and exercising more negative-assertive control.

Self-control: refinement of a construct.

Previous efforts, on a theoretical/model building level, refined the construct "self-control" into four quadrants: (1) positive assertive (active control), (2) positive yielding (letting-go control), (3) negative assertive (over-control), and (4) negative yielding (too little control). To test the discreteness of the four quadrants, 706 individuals, the majority in health and healing professions, from nine cities across the United States, responded to prompt words designed to assess each quadrant. A factor analysis provided partial concurrent validation, and the results revealed information about the semantic structure of self-control, as well as personal characteristics associated with self-control. Further, mean tabulations showed not only cultural bias (i.e., high self-control was associated almost exclusively with Quadrant 1, but also sex role bias (i.e., low self-control for a man was most often associated with Quadrant 3, negative assertiveness, and for a woman was most often associated with Quadrant 4 negative yielding). Clinical implications of these findings in terms of developing a self-control assessment inventory for matching self-control strategy to an individual with a particular clinical problem are discussed, and guidelines and suggestions for further research are offered.

A content analysis of views of self-control: relation to positive and negative valence, and implications for a working definition.

It has been argued that one important variable that hampers research on self-control strategies is the absence of a working definition of self-control. Part of the difficulty involves the ambiguous and self-reflexive nature of the term itself, and part of the difficulty involves tautological imprecision equating the construct and definition of self-control with the effects of a self-control strategy. In order to begin to bring order to what has heretofore been a linguistic morass, an effort was made to assess individuals' views of self-control and then to perform a content analysis of the different aspects and dimensions actually embedded within these views. This study offered partial confirmation for six previously identified dimensions: choice, responsibility, awareness, discipline, skill, and goal. These dimensions provide us with a beginning phenomenological framework for assessing how individuals view self-control, and thereby help refine the position endorsed by Mahoney and Arnkoff (1979) that "self-control is a social label which is differentially applied to some behavior patterns." Further, individuals were requested to list positive and negative aspects of self-control, in order to assess whether, as Mahoney and Arnkoff suggest, self-control is necessarily applied to behavior perceived as (a) being socially appropriate or desirable and (b) originating from noble ideals. The study found that there were both positively and negatively valenced aspects thought to be associated with self-control, and that the mention of a certain dimension of self-control (discipline) was found to be significantly correlated with a specific negatively valenced view (rigidity). The study concludes with implications for developing a working definition of self-control, and with guidelines and suggestions for future research.