ACKNOWLEDGEMENTS

The author would like to thank all the people who were helpful to her during the conduct of this investigation. Special thanks must go to the chairman and the members of my doctoral committee whose support and encouragement meant so much.

In addition, thanks must go to all the consul­ tants who provided information, materials and assistance during the study. Without all the tools and bibliographic help, this study could not have been begun.

But, most of all, my thanks must go to my family. Without my husband, Gayle, or my twin daughters, Samantha and Celia, I would have given up many times. Their love and support, and their ability to survive in a less­ than-neat house on convenience foods for two years, have kept me sane .

PATRICIA KAY AVANT

iii TABLE OF CONTENTS

Acknowledgements . iii Table of Contents. iv List of Tables vi CHAPTER

I STATEMENT OF THE PROBLEM 1

II RESUME OF PRESENT KNOWLEDGE • . 6 Attachment . . . 6 Anxiety . • . 20 Kirlian Photography . . 30 Theoretical Framework . . . 39

III METHODOLOGY 44 Overview . . • . . . . 44 Consultation Committee .•. 44 General Aims of the Study • 45 Sample ...... 48 Methods of Data Collection 49 Measurement Tools . . 50

IV ANALYSIS OF DATA. 58 Study Setting 58 Study Population. 59 Statistical Methods Used . • . . . . . • 61 Additional Findings 69 Methodological Problems . • ...... • 71 Sununary . . • ...... 73 v CONCLUSIONS, IMPLICATIONS, AND RECOMMENDATIONS • . . . • • • . . . . . • 75 Conclusions and Implications For Nursing Practice . • . 75 Attachment and Anxiety • . • . . . 75 Kirlian Photography . . . • . . . . 77 Indications for Further Research. ·. . . • 78 s urnrnary • • • • • • . • • • • • • • • 79

iv TABLE OF CONTENTS (continued) Page

BIBLIOGRAPHY ...... • . • . . . • 82

APPENDICES A DEMOGRAPHIC DATA SHEET 97

B MATERNAL ATTACHMENT ASSESSMENT TOOL 99

C TAYLOR MANIFEST ANXIETY SCALE 106 D KIRLIAN PHOTOGRAPHY 114 E STATISTICAL FORMULAS USED 117 F PERMISSION FOR THE STUDY 119

v LIST OF TABLES

1 CORRELATION.MATRIX, DAY ONE 65

2 CORRELATION MATRIX, DAY THREE 66

vi CHAPTER I

STATEMENT OF THE PROBLEM

Is there a relationship between maternal

attachment and maternal anxiety? If so, can Kirlian

photography be used to identify one or both of these

phenomena?

Several studies by Dr. Marshall Klaus and Dr.

John Kennell on maternal-infant bonding have indicated

that mothers who have had early contact with their new­ born infants behave more affectionately toward their infants than do mothers whose contact with their new­ borns occurs later after delivery. They suggested that there was a critical time period during the early post­ partum hours when bonding could occur with ease if mother and infant were kept together. In reviewing their studies, it seemed to this writer that more was involved than just a critical time period. Personal clinical experience indicated that some mothers behave more affectionately toward their infants than other mothers, whether or not they were kept together during a certain period after delivery.

1 2

Could the observed difference in the levels of

mother-infant attachment be attributed to something other

than simple togetherness? Perhaps some mothers and in-

fants were more compatible with each other, more in

harmony with each other, from the beginning. Perhaps

extremely_anxious mothers have difficulty forming

attachments. If nurses could determine which mothers and

infants were having difficulty adapting to each other,

nurses could possibly help these mothers learn about

their infants and how best to meet their infants' needs.

If nurses could help resolve early mother-infant inter-

action problems, damage to the mother, the infant, and

the mother-infant relationship might be prevented. Nurses

need to know when inadequate mother-infant attachment is

likely to occur in order to know when to intervene.

In addition, what of the mothers and infants who must remain separated for long periods after the infant's birth? Recent studies have indicated that cases of bat- tering, failure to thrive, and other forms of abuse are disproportionately large among premature infants.l

1M. Klein and L. Stern, "Low Birth Weight and the Battered Child Syndrome," American Journal of Diseases of Children 122 (1971): 15. 3

Klaus and Kennell have reported that families of pre-

mature infants were ·more likely to experience divorce,

child abandonment, or estrangement than when there had

been extensive early contact between the infant and his parents. 2

Several authors have commented on an apparent

relationship between anxiety and guilt and mothering

behaviors in premature infants. Prugh found that mothers

of premature infants often expressed anxiety about their

infants' well-being and guilt at producing a less-than­

perfect child.3 Kaplan and Mason viewed the birth of a

premature infant as a stressful time for the mother, or

a time of crisis. 4 Mason then predicted the quality of

mother-infant relationships from information gathered by

interviews with mothers of premature infants. Good mother-infant outcomes were associated with fairly high

2Marshall Klaus and John Kennell, Maternal­ Infant Bonding (St. Louis: The C. V. Mosby Co., 1976), p. 113. 3nane Prugh, "Emotional Problems of the Pre­ rna ture Infant's Parents, 11 Nursing Outlook 1 (August 1953): 461-464.

11 4n. M. Kaplan and E. A. Mason 1 Maternal Reac- tions to Premature Birth Viewed as an Acute Emotional 11 Disorder 1 American Journal of Orthopsychiatry 30 (July 1960: 539-552. 4

levels of anxiety, active information-seeking, and strong

maternal feelings. Poor outcomes· were associated with

low levels of anxiety and activity and little evidence of

maternal feeling. 5 Barnard reported, .however, that a

low level of anxiety about the child might be caused by overwhelming concerns with other problems. In a study which asked mothers of premature infants for their pri- mary concerns at one month postpartum, 65 percent of the responses related to the child or parenting. However, of the 35 percent whose answers did not relate to the child or parenting, there were other circumstances of financial or family problems which appeared to be preventing the mother from interacting with her baby. 6

In spite of the preliminary evidence concerning anxiety and maternal behavior in mothers of premature infants, little has been done in a systematic way to examine this relationship in mothers of full-term infants.

5E. A. Mason, "A Method of Predicting Crisis Outcome for Mothers of Premature Babies," Public Health Report 78 ( 1963): 1031-1035. 6Klaus and Kennell, Maternal-Infant Bonding, p. 10 3. 5

If anxiety does play a role in maternal attachment, is it in the same direction indicated in Mason's study? If so, what implications does this have for nursing care of postpartum women? Nurses will need to be able to accur­ ately assess anxiety levels as well as maternal attach­ ment behaviors in order to plan appropriate nursing inter~ ventions for the mothers and babies in their care. CHAPTER II

/ RESUME OF PRESENT KNOWLEDGE

Attachment

A review of the literature revealed a wealth of

information on maternal-infant attachment. However, most

studies focused on the infant's attachment to his mother.

,;t/. Klaus and Kennell are the predominant figures in research

,· on maternal attachment behavior y7 Based on long-range {.> studies over five years, they concluded that mothers

who were more attached to their infants early in the post-

partum period behaved in significantly more affectionate

ways toward those children as long as five years later. 7

Peter de Chateau, in Sweden, duplicated Klaus and

Kennell's study and obtained the·· same results. 8 In con-

trast, Harry L. Harlow's studies of infant monkeys raised

?Klaus and Kennell, Maternal-Infant Bonding, p. 59. 8peter de Chateau, "The Influence· of Early Con­ tact on Maternal and Infant Behavior in Primiparae," Birth and the Family ·Journal 3 {No. 4, 1976): 149-155.

6 7

with surrogate cloth mothers have shown that the infants

who have become mothers themselves are "helpless, hope-:

less, heartless mothers devoid, or almost devoid, of any rna ternal feeling ... 9

Mary S. Ainesworth, .in discussing infant attach-

ment behavior, listed three maternal behaviors which she

found highly correlated with strong infant attachments.

These were a positive attitude toward breast feeding, the

amount of care given to the infant, and the mother•s

excellence as an informant regarding her infant•s

behavior . 10

Robert Sears has postulated three stages of

attachment. The first is the primary attachment, or that

which occurs between the infant and his mother-as-o.bject.

The second stage occurs in young adulthood, when attach­

ment occurs to the pe·rson who will potentially become the

spouse. The third stage occurs when·a child is born to

9Harry L. Harlow, "The Heterosexual Affectional System in Monkeys, 11 Interpersonal Dynamics: Essays and Readings on Human Interactions, .ed. Warren D. Bennis, et al. {Homewood, Illinois: Dorsey Press, 1964), p. 69.

!OMary D. Saulter Ainesworth, Infancy in Uganda {Baltimore: Johns Hopkins Press, 1967), p. 400. 8 the couple. Sears calls this attachment one of parent to child-as-object. 11 Robert Cairns has suggested that maternal stimulation of the infant, maternal-infant interaction, and infant orientation behavior all play a significant part in the formulation of attachme~ts. 12

Gewirtz discussed several additions to this list, including visual tracking, touching, .clinging, crying, smiling, vocalizing, and separation anxiety. 13 In addi- tion, he discussed at length the inter-relatedness of environmental conditioning by both the mother and her infant on each other as a key feature in attachment formation. 14

llRobert R. Sears, "Attachment, Dependency, and Frustration," Attachment and Dependency, ed. Jacob Gewirtz (New York: John Wiley & Sons, 1972), p. 19.

12Robert B. Cairns, "Attachment and Dependency: A Psychobiological and Social-Learning Synthesis, 11 Attachment and Dependency, pp. 36-37.

l3Jacob Gewirtz, "On the Selection and Use of Attachment and Dependent Indices," Attachment and Dependency, pp. 181-l82.

14Gewirtz, "Me chan isms of Social Learning, " Handbook of Socialization Theory and Research, .ed. David A. Goslin (Chicago: Rand McNally & Co., 1969), pp. 102-103. 9

Yarrow postulated three steps in the formation

of dyadic attachments. These are: 1) selective

responsiveness to one person, manifested by overt pre-

ferential behavior such as smiling, .vocalizing, and

reaching; 2) behavior indicating certain specific ex-

pectations of the object of attachment; and 3) separa­ tion anxiety.15

John Bowlby, who has done seminal work on the

attachment process, stated that some of the components needed for attachment to occur are visual and auditory stimuli, orientation or movement towards desired person or object, touching, smiling, and social interaction.16

Bowlby also described four phases of attachment.

These were: 1) orientation and signals to draw the desired object toward the attaching person, .2) increased differential responsiveness to the desired person or ob- ject by auditory and visual stimuli and increased focus on the desired person or object, .3) maintenance of prox-

15Leon J. Yarrow, ."Attachment and Dependency: A Developmental Perspective," in Attachment and Dependency, ed. Jacob Gewirtz (New York: John Wiley & Sons, 1972), pp. 84-90.

16John Bowlby, Attachment and Loss, vol. 1 (New York: Basic Books, .Inc., 1969), pp. 271-297. 10

imity to the desired person or object, and 4) formation

of a goal-corrected partnership.17

Bowlby has also proposed a theory of attachment,

and, although he focused primarily on the infant, certain

aspects provide insights into maternal attachment as well.

The aspects of his theory which seem germaineto the pre-

sent analysis are: 1) attachment behavior is directed

toward one or a few specific individuals, 2) attachment

endures through a large portion of the life cycle, 3)

intense emotions arise during the formation of attachment,

4) preference for the familiar and fear of the strange

play a major role in attachment formation, 5) organiza-

tion of attachment behavior begins simply but evolves

into a fairly complex behavioral system, 6) parental

caretaking provides mutual proximity which induces a

sense of security, and 7) the most likely function of

attachment behavior is protection of the young.18

Klaus and Kennell, during their research efforts, modified Bowlby's theory and applied it to the formation

17rbid., .PP· 266-267.

l8Bowlby, "Attachment Theory, Separation Anxiety, and Mourning," American Handbook of Psychiatry, 2nd. ed., vol. 6 (New York: Basic Books, Inc., 1975), pp. 294-295. 11

of maternal attachments. They postulated seven princi­

ples which their studies suggested were crucial to the

formation of maternal attachment: 1) There is a sensi-

tive period in the first hours after delivery when attach­

ment behaviors are most easily aroused if mother and

infant have close contact with each other, 2) there

appears to be species-specific responses to the infant

in the human parents when first given their infant, 3)

the process of attachment occurs optimally to only one

infant at a time, 4) the infant must respond to the

mother by some signal such as body or eye movement, 5)

people who witness the birth process become strongly

attached to the infant, 6) it is difficult for some

adults to attach to one person while mourning the loss

or threatened loss of that same, or another, _person; and

·f7) anxiety about the well-being of a baby with a

temporary disorder may result in long-lasting concerns

on the part of the mother which may adversely affect the

child's development. 19 Clark and Affonso discussed the need for recipro-

cal interaction between mother and infant as a means of

19Klaus and Kennell, Maternal-Infant Bonding, p. 14. 12

fostering attachment. They suggested that maternal

attachment begins when the mother forms an idea of what

her child will be like while he is still in utero. They·

called this her "dream child." If the real child does

not turn out to be like the "dream child," the mother may

feel as if the baby is a stranger. She may even mourn

the "death" of the dream child which delays attachment

to the real one. 20 This idea is potentially related to

Klaus and Kennell's theory that a mother who is mourning one person cannot attach to another.

Anderson, in reporting a series of studies by nurse-midwifery students at the University of Illinois, characterized the mutual caregiving needs of mothers and infants immediately after delivery as the need for gener- alized peristalsis. She described a program labeled

"SMYLI (Self-regulatory Mother-Young Longitudinal

Interaction)" in which mother and infant were never separated after delivery, and breastfeeding was begun in the delivery room. The SMYLI program focused on the postpartum segment in which mother and infant were kept

<\ '' 20Ann L. Clark and Dyanne D. Affonso, "Infant. Behavior and Maternal Attachment: Two Sides of the Co'in~·" American Journal of Maternal Child Nursing 1 (March- ··. · April, 1976): 94-99. 13

together and where the dyad mutually interacted, grew

tired, and rested. Visual interaction and "en face"

positioning were prominent. Anderson found no problems

with increased mucus, increased chilling, or crying

while using the SMYLI technique. 21

Clark and Affonso also discussed the mother's

need for signals from the infant which would tell her if

she is satisfying her infant. They stressed the impor-

tance of this reciprocal sensory relationship in the

formation of attachments. 22

In a study of twenty-four mothers, Cannon exam-

ined the concept of maternal touch as described by Rubin

and also by Klaus and Kenne11. 23 Her findings indicated

that eighteen of th~ twenty-four mothers studied pro­ gressed through the orderly sequence of touching as

21Gene Cranston·Anderson, "The Mother and Her Newborn: Mutual Caregivers," JOGN Nursing 6 (September- October, 1977): 50-57. 22clark· and Affonso, "Infant Behavior," pp. 97-98. 23Rose Broeckel Cannon, "The Development of Maternal Touch During Early Mother-Infant Interaction," JOGN Nursing 6 (March-April 1977) : 28-33. 14

described by Rubin and Klaus: fingertips on infant's

extremities, fingertips on trunk, hand and palm touching

infant, complete enfolding with arms. "En face" posi-

tion and verbalization occurred in a large percentage of

the sample mothers. "En face" occurred in 92 percent of

the one-minute periods of study. Verbalizations occurred

in 58 percent of the one-minute periods. A final result

was that the mothers of undressed infants reached stages

two and four of maternal touch in a significantly shorter

time than mothers of dressed infants.24

In a cross-cultural study of the maternal

sensitive period, Hales et al. found that the time of

first maternal contact with the infant significantly

affected maternal affectionate behavior although it had

no effect on proximity-maintaining behavior or maternal

caretaking behaviors. Further results indicated that

time of first contact significantly influenced the amount

of maternal "en face 11 behavior. Early contact also

significantly increased the amount of looking, talking,

smiling, kissing, and fondling. Hales concluded that the

11 24 11 En face : Mother • s face parallel to infant • s face in same vertical plane of rotation, with mother's eyes directed toward infant's eyes. 15

limits of the maternal sensitive period for development

of strong attachments is probably less than twelve hours

after birth. 25

Poindron and Signoret studied anosmic ewes and

concluded that the establishment of a maternal bond in

ewes during a critical period postpartum was based on

olfactory cues. 26 And, in a study of cats with their

kittens, Haskins found that kitten vocalizations alone

reliably elicited approach and investigation from the

mother cats. The mother cats also vocalized more fre- quently in the presence of kitten vocalizations for at 27 least thirty days after the kitten's births. Results of another study of critical periods by

J. A. Ambrose indicated that reciprocal interaction was critical to developing attachments. He suggested a

25n. J. Hales, B. Lozoff, R. Sosa, and J. H. Kennell, 11 Defining the Limits of the Maternal Sensitive Period," (Cleveland, Ohio: mimeographed, 1977).

26p. Poindron and J. P. Signoret, 11 Study of Maternal Behavior in Sheep: Mechanisms Involved in Mother-Young Recognition, 11 Animal Behavior Abstract 5 (November 1977): 219.

27Ron Haskins, ~'Effect of Kitten Vocalizations on Maternal Behavior," Journal of Comparative and Physiological Psychology 91 (August 1977): 830-838. 16

pattern in which the infant's smile or cry initiated

action by the mother, _usually accompanied by her vocali-

zations. The sound of the mother and the tactile stimu-

lation given the infant released the following response

in the infant and initiated eye-to-eye contact. The

eye-to-eye contact stimulated further interaction. 28

Three other authors arrived at much the same conclusions regarding the need for interaction. In

Rheingold's study of infant's exploratory behavior, she reported that visual and auditory stimulation of the in­ fant could control the infant's touching of a bal1. 29

In another study she concluded that rocking, patting, feeding, bathing, holding, and looking at the face of the baby seemed to be sources of gratification for the parent and may be self-reinforcing actions. 30

28J. A. Ambrose, "The Concept of a Critical Period for the Development of Social Responsiveness, •• in Determinants of Infant Behavior II, ed. Brian Foss (New York: John Wiley & Sons, Inc., 1963), PP·. 201-226.

29Harriet L •. Rheingold, "Controlling the In­ fant's Exploratory Behavior, " in Determinants of Infant Behavior II, pp. 177-178. 30Rheingold, "The Social and Socializing In­ fant," in Handbook of Socialization Theory and Research, ed. David A. Goslin (Chicago: Rand McNally and Co.,

1969) 1 P• 785. 17

Wolff's studi.es on the early development of smiling

indicated that eye-to-eye contact, vocalization, and

touch facilitated the development of the smiling res-

ponse in infants. He stated that these three sensory

inputs were very important in developing social inter­

change between the infant and his parents. 31 Corter

concluded, after observing mother-infant interactions,

that proximity-seeking behaviors were the basis of

attachment formation. He classified these proximity-

seeking behaviors as visual contact, vocalizations,

clinging, and touching. 32 Carr et al. substantiated

the importance of visual contact between mother and infant for at least two years.33

In a study of 134 mother-infant pairs, Osofsky examined the relationship between neonatal characteris- tics and mother-infant interaction. Observations were made during feeding sessions and at stimulation sessions.

31peter Wolff, "Observations on the Early Devel­ opment of Smiling," in Determinants of Infant Behavior II, pp. 113-138. 32carl Corter, "Infant Attachments," in New Perspectives in Child Development, ed. Brian Foss (Baltimore: Penguin Books, Ltd., 1974), pp. 164-183.

33suzanne Carr, James M. Dobbs, Jr., and Timo­ thy s. Carr, "Mother-Infant Attachment: The Importance of the Mother's Visual Field," Child Development 46 (June 1975): 331-338. 18

Results indicated that more alert and responsive infants

had more responsive and sensitive mothers. Specifically,

maternal attentiveness and sensitivity related to eye

contact and auditory and tactile responsivity. ~sofsky

concluded that both mother and infant contributed to

attachment, and that consistencies in infant and mater-

nal styles were evident from the very beginning of the infant's life.34

Blehar et al. studied twenty-six mother-infant

pairs over a period of fifty-one weeks to determine the

value of face-to-face interaction. Their findings indi-

cated that "securely" attached infants were more respon-

sive and encouraging of interaction. Infants identified

as "anxiously" attached were more unresponsive and negative in early "en face" encounters, and their mothers were more likely to be impassive or abrupt. 35 Finally, two studies of positioning of infants may shed some light on the phenomenon of attachment

34Joy D. Osofsky, "Neonatal Characteristics and Mother-Infant Interactions in Two Observational Situa­ tions," Child Development 47 (December 1976): 1138-1147. 35Mary c. Blehar, Alicia Lieberman, and M. D. Saulter Ainesworth, "Early Face-to-Face Interaction and Its Relation to Later Infant-Mother Attachment," Child Development 48 (March 1977): 182-194. 19

formation. Sawin et al., in investigating the use of

the Datamyte Model 900 hand-held event recorder, studied

the relationship between race and holding behaviors of mothers. Analysis revealed that black mothers were more likely to adjust their infant's position following the infant's negative vocalization such as fretting or fuss­ ing than were Mexican-American or Anglo mothers.36

Richards and Finger, in an analysis of 268 photographs of Western, Eastern, and American Indian women and men holding infants, found a significant tendency of all women to hold babies on the left side of the body near the precordial region. The tendency was not significant among the men, however. 37

36nouglas Sawin, Judith Langlois, and Edward Leitner, .. What Do You Do After You Say Hello? Observ­ ing, Cadi ng, and Analyzing Par en t-Infan t Interactions, " Behavior Research Methods and Instrumentation 9 (October 1977): 425-428. 37Joel L. Richards and Stanley Finger, "Mother­ Child Holding Patterns: A Cross-Cultural Photographic Survey," Child Development 46 (December 1975): 1001- 1004. 20

Anxiety

The term "anxiety" is a conceptual category

covering many aspects of a complex phenomenon. It has

been viewed as a physiological state, a psychological

trait, a secondary drive, .a primary drive, and several

others, depending on which school of psychology is being

reported~ The original discussion of anxiety was that

of Sigmund Freud. Freud defined anxiety as an affective

state with three general components: a feeling of

unpleasure [sic], efferent or discharge phenomena, and

the perception of the first two components. He believed that a general inc~ease in excitation underlay anxiety.38

He spoke of anxiety as a response to a situation per­

ceived as danger. 39 Anxiety, according to Freud, could

be traced to a feeling of loss of a loved or longed-for person and was an expression of helplessness in the. ab- sence of that person. He felt that the original anxiety state was· probably the birth process for the infant. 40

38sigmund Freud, The Problem of Anxiety (New York: The Psychoanalytic Quarterly Press and W. W. Norton & Co., Inc., .1936), pp. 69-70.

39Ibid., p. 72.

4oibid., PP. 75-76. 21

Neo-Freudians such as Karen Horney and Harry

Stack' Sullivan have discussed anxiety. Horney believed

anxiety to be a primary state related to disturbances

of interpersonal relations, initially those between a

child and his parents or significant adults.41 Sullivan

saw anxiety as exclusively a function of one person•s

interpersonal relations with another person. If a

11 significant other .. condemned or was likely to condemn one•s actions or manner of achieving satisfaction of needs, then anxiety arose. He spoke of anxiety occur- ring on a continuum from mild, .. everyday .. anxiety to ' severe, incapacitating anxiety.42

Theories of anxiety have also been postulated by physiologists who believed that 1) emotion was grounded in physical phenomena; 2) anxiety was an effect, the cause of which was to be found in some stimulus in the environment; and 3) the foundation of this cause- --~ '' ~ . . .'~ effect relationship was the mediating influence of the

41Karen Horney, Our Inner Conflicts: A Con­ structive Theory of Neurosis (New York: W. W. Norton & Co., Inc., 1945), p. 41. 42Harry Stack Sullivan, The Inter-Personal Theory of Psychiatry (New York: W. W. Norton & Co., Inc., 1953), p. 152. 22

physiologic processes of the body. 4 3 Some evidence

pointed to the thalamus, hypothalamus, the limbic system, and possibly the reticular activating system as playing a role in the arousal state known as a·nxiety. 44 Martin, in particular, gave an extensive list of physiologic phenomena associated with anxiety. These were increased heart rate, increased systolic blood pressure, increased cardiac output, increased respiratory rate, frontalis muscle tension, increased forehead temperature, increased palmar conductance, increased central nervous system activity, elevated blood sugar levels, decreased peri- pheral resistance, decreased diastolic blood pressure, decreased hand temperature, and decreased salivation. 45

Learning theorists and existentialists have also discussed anxiety. Learning theorists have characteris- tically viewed anxiety as a secondary drive which is a

43william F. Fischer, Theories of Anxiety (New York: Harper and Row, Publishers, 1970), p. 52.

44rbid., pp. 54-55.

45a. Martin, "The Assessment of Anxiety by Physiological Behavioral Measures," Psychological Bulletin 58 ( 1961): 234-255. 23

learned response, 46 or a condit1oncd fear.47 £xisten-

tialist:; have characteristically viewed anxiety as being

caught between two or more mutually exclu:1ive desires

and standing paralyzed by the inability to choosc.48

An example of the existentialist view would be one in

which a young woman finds herself unable to choose

between her own desire to be mothered and her dcniro to

mother her infant. /'

Epstein proposed three types of bnslc anxiety.

1~ere were primary ovcrstimulation, cognitive incongrui-

ty, and response unavailability. Primary ovcrstimulation was the most fundamental type and was reflected in the fact that living organisms have an "upper limit of tol­ erance for energy input." 49 Cognitive incongruity was that state where there was incongruence, a mismatch, between an expected cognitive model and reality.SO

46Fischer~ Theories of Anxiety, p. 65.

47Ibid. I P· 79.

4Sibid., p. 87.

49seymour Epstein, "The Nature of Anxiety With Emphasis Upon Its Relationship to Expectancy 1" Anxiety: current Trends in Theory and Research. vol. 2, ed. Charles D. Spielberger (New York: Academic Press, 1972)1 p. 30 3.

50Ibid. I p. 34. 24

This incongruence contributed to response unavailability

1n. _w h'1c~ h arouse d ten d enc~es . could not be expressed. 51

This, in turn, .led to frustration and feelings of help-

lessness as well as a high state of diffuse physiologic

and psychologic arousal.

~ Epstein studied skin conductance and heart rate

in three groups of subjects receiving noxious stimuli.

One group was told the stimulus would be much worse than

it was, .one was told that the stimulus was not as bad as

it actually was, and the third group was given an accur- ate description of the stimulus. The high-threat group had the highest levels of arousal and the greatest reac- tions to impact, implying that worrying beforehand does not always make one better able to cope with anxiety­ producing phenomena.~2 A second study supported the view that habituation to anxiety-producing stimuli was produced by establishing the expectation of its occur­ rence over time.53

Slrbid., p. 35

52rbid., pp. 321-23

53rbid., p. 327 25

·rn·a. third study Epstein examined how uncer-

tainty about,-:the· occurrence of a threatening event would

influence arousal before the event and also when the

event .. actually occurred. Three groups were given 5 per­

cent, SO .. percent, and 95 percent expectancy probabili-

ties·· for a shock .occurring on the drawing of a card.

The ·,s percent expectancy group had the highest level of

arousal,· contradicting the hypothesis that the group wi.th. maximal uncertainty {50 percent} would produce higher .anticipatory arousal. Epstein suggested that the·

5 pe.rcent group were presented with a cognitive incon- gruity in.which they could not resign themselves to getting a shock or dismiss the idea that they would get one.54 / Hamilton, in a study of postpartum psychiatric problems, found that stress of childbearing and anxiety were ·frequent precipitators of postpartum psychiatric disorders. ·He stated that anxiety was the prominent feature in most forms of postpartum illness. 55 His

54rbid., p. 333.

55Jam~s Alexander Hamilton, Postpartum Psychi­ atric Problems (St. Louis: c.v. Mosby Co., _1962}, .P· 88. 26

studies ~·indicate.d four distinct periods in the develop­

ment. of·postpartum psychiatric illness. The.latent

period began on the third day after delivery and peaked

on the sixth day after initial recovery from the physi­

cal stress. of childbirth per se. The prodromal symptoms

included restlessness, insomnia, .exhaustion, .depression,

irritability, headache, .and mood changes. The late pro-

drornal symptoms 'included suspiciousness, confusion, in-

coherence; irrational statements, excessive concerns over-trivialities, and refusal of food. The final phase was overt illness. 56 Klein et al., in a study of twenty-seven preg- nant primaparas, found that patients who had high anxiety prior ,,to pregnancy also had high anxiety during pregnancy but that· the ini.tial anxiety decreased as pregnancy advanced. Regrettably, she did not include any follow-up on the ·patients' postpartum anxiety states. 57

Meleis.and Swendsen tested the effect of role supplemen~atipn, as a preventive nursing intervention, on f0:~ilies who.were expecting their first child.

56rbid~~ pp. 16-18. 57Henriette R. Klein, Howard W. Potter, and Ruth B. Dyk, Anxiety in Pregnancy and Childbirth (New York: Paul B. Holber, Inc., 1950), P· 69. 27

Although ·participation in the role supplementation pro-

gram failed to increase cominunication skills, .role-taking

skills, .or role perception congruence, the program did

reduce post-delivery anxiety levels in the experimental

group. v·One incidental finding of the ·study was that

postpartum anxiety levels increased in all subjects even

though the experimental groups• scores were lower than the other two groups' scores.58

Peplau noted a relationship between shame and

guilt and anxiety. She stated that when a discrepancy

existed between a person's self-concept and his actions

or performances in a situation, .he felt guilty and

inadequate. This guilt led to anxiety. She suggested

that mild anxiety was useful in solving problems. Also,

she postulated,

• . • needs create tension and tension creates energy that is transformed into some form of behavior.59 ••• The transformation of energy derived from tension or anxiety is an ongoing human tendency; it is a way in which the human organism moves and changes, .and grows, .or defends itsel£.60

58Afaf Ibrahim Me leis, .and Leslee A-. Swendsen, · "Role Supplementation: An Empirical Test of a Nursing Intervention, 11 Nursing Research ·27 (January-February 1978}: 11-18. 59Hildegard Peplau, Interpersonal Relations in Nursing (New York: G. P. Putnam's Sons, 1952), p. 80.

60ibid., p. 132. 28

She proposed three ways in which ·pers,ons respond to

anxiety: 1) change the goal to one more compatible with

success, .2) give up the goal and disassociate the feel-

ings associated with it, .or 3) develop fixed or stereo­

typed responses. 61 Goal achievement apparently either

reduced the anxiety or precluded the need to develop

anxiety at all.

John Bowlby discussed two distinct types of

anxiety associated with affectional bonds: separation

anxiety and anxious attachment. Separation anxiety occurs whenever attachment behavior is thwarted or seems likely to be thwarted. For example, .separation anxiety occurs when a mother-child pair are separated and cannot find one another.62 Anxious attachment was described as overdependency and attributed to one of twq causes.

The first was repeated separations, .threats of abandon- ment, changes of mother figures, .unfavorable comparisons with others, .and threats of loss or withdrawal of love.

61 Ibid • I .P • 9 2 . 62John Bowlby, "Psychopathology of Anxiety: The Role of Affectional Bonds,". in Studies of Anxiety, ed. M. H. Lader (Ashford, Kent, England: Headley Bros.,

Ltd., 1969) I p. 84. 29

The second cause was a reversal of parent-child roles

in which an anxiously attached mother demanded that the

child act as a caretaker to her.63 This sounds much

like Kempe's description of the potentially abusing mother. 64

Erik Erikson has discussed the formation of basic trust versus mistrust as the critical learning which must occur in very young infants. He suggested that learning to trust provided the infant with a rudi- mentary sense of ego identity. With this developing sense of ego identity he is willing to allow his mother /' out of his si¢ "without undue anxiety because she has become an inner certainty as well as an outer predic­ tability." 65

63Bowlby, "Attachment Theory," p. 299.

64c. Henry Kempe, "Pediatric Implications of the Battered Baby Syndrome," Archives of Diseases of Children 46 (February 1971): 28-37. 65Erik H. Erikson, Childhood and Society, 2nd ed. (New York: w. w. Norton & Co., Inc., 1963), p. 24 7. 30

Kirlian Photography

Kir lian photography, .named initially for its

Russian inventors, has been variously called radiation

field photography, corona discharge photography, and

high-voltage radiation photography. The Kirlians des-

cribed the process as .. photographing by means of high-

frequency current contact photography and the use of

high-frequency capacitor-electron-proton-optics to

convert non-electrical phenomena of living and non­

living objects into electrical ones.u66

The photographic process.was described by Gary

Poock to Edward Edelson of Smithsonian Magazine as

supplying high-voltage, low-amperage power to ~n elec-

trode under photographic film which created a large

electrostatic field. The electrons on the film thus had

a high potential. The finger placed directly on the

film had a low potential causing electrons to flow from

the film to the finger, creating a photoionization

66semyon Kirlian and Valentina Kirlian, 11 Photo­ graphy by Means of High-Frequency Currents, ... trans. in The Kirlian Aura: Photographing the Galaxies of Life, ed. Stanley Krippner and Daniel Rubin (Garden City, New York: Anchor Books, 1974), p. 50. 31 effect that sent photons cascading down into the film to create the peculiar image.67

Pehek et al. , .in studying the. process which they call corona discharge photography, described corona dis- charge as "a luminous, low-current gaseous discharge occurring in the atmosphere at electric field strengths below the. threshold for spark breakdown probably the most significant source of energy capable of creat­ ing an image.n68 In their study several inanimate objects, finger tips, film types, and voltages were used.

Results indicated that: 1) streamer formation tended to increase after washing with alcohol or acetone; 2) the corona of a finger, when a mylar sheet was inserted between finger and film, was always full and without gaps; 3) streamer formation was reduced in inanimate objects wetted with water; 4) palmar sweat indices co­ varied negatively with galvanic skin response (GSR).

When sweat count was high and GSR value was low, the density of the photographic image was low and often

67Edward Edelson, 11 Aura Phenomenon Puzzles Experts," Smithsonian (April 1977): 110-111. 68John o. Pehek, Harry Kyler, and David Faust, "Image Modulation in Corona Discharge Photography, .. Science 194 (October 15, 1976): 263. 32

there were no streamers at all; 5) hydration of a finger

in water reduced streamer flow. Thus, these authors

felt that moisture Qll the skin and moisture in the skin

accounted for a large percentage of the corona phenomena

although they stated they could not differentiate between

the two. Since water in the skin may be strongly influ-

enced by physiologic variables, the authors did not pos­

tulate that water was the only source of the phenomena.69

Moss et al., in several ongoing research pro-

jects, reported that with inorganic objects the coronas

never changed. Yet, with living organisms the coronas

changed in both internal and external characteristics

depending on the internal state of the organism. In a

series of human interaction studies, Moss has shown that

if two persons were photographed together and asked to think of specific things such as aggression, attraction to each other, or intense dislike of the other, that characteristic patterns emerged for each feeling?O

Murstein and Hadjolian, in a study of fingertip aura and interpersonal attraction, .found that female

69rbid., p. 269.

70Thelma Moss, .John Hubacher, .and Frances Saba, 11 Visual Evidence of Bioenergetic Interactions Between People? 11 a paper presented to The American Psychological Association, New York, May 1974, p. 8. 33

photographers elicited greater auras from male subjects

than from female subjects. A second finding demonstrated

that seductive behavior by the photographer of either

sex elicited lower aura scores in subjects of the oppo-

site sex. A third finding was that opposite-sex pairs

of subjects manifested greater auras than same-sex pairs

of either sex. A final conclusion was that mutually

liking couples had greater aura scores than mutually

disliking couples. 7 1

Krieger has reported that Kirlian photographs

of her hands at rest and simulating therapeutic touch

showed an enlarged corona during the therapeutic state.

She suggested that perhaps this larger corona was demon­

strating energy transference.72 Krippner and Rubin suggested that Kirlian photography may be a useful tool in systems research.

Using Von Bertalanffy's general systems theory, they suggested that since the Kirlian process responded to

71aernard I. Murstein and Serge E. Hadjolian, "Fingertip Aura and Interpersonal Attraction," Journal of Personality Assessment 41 (July 1977): 255-265.

72nolores Krieger, "Therapeutic Touch," Nursing Times 72 (April 15, 1976): 574. 34

changes in the state of the system, .it might prove to be a· useful diagnostic device in medicine.73

Krippner and Drucker synthesized Lewin's field theory and Presman's theory of the biological activity

of electromagnetic fields as a means of communication in

an attempt to explain what is seen in the Kirlian photo­

graphs. Lewin suggested that behavior was a function of

an individual's life space and that the boundary between

the life space and the outer world w~s permeable. Pres­

man suggested that the biological activity of electro- magnetic fields was a means of obtaining information within and among organisms and about changes in environ­ ment.74 Krippner explained:

Thus the fields observed in Kirlian photography can be explained on the basis of information theory as representations of processes by which an organism obtains information about its physical environment, by which the organism engages in informational exchange within its own system, and by which infor­ mation may be exchanged among organisms.75

73stanley Krippner and Daniel Rubin, eds-., The Kirlian Aura: Photographing the Galaxies of Life (Garden City, New York: Anchor Books, .1974),pp. 19-20.

74stanley Krippner and Sally Ann Drucker, "Field Theory and Kirlian Photography: An Old ~ap for a New Territory," The Kirlian Aura: Photograp~J.ng th~ Galaxies of Life, ed. Stanley Krippner and DanJ.el RubJ.n (Garden City, New York: Anchor Books, 1974), pp. 87-88.

75rbid., p. 89. 35

Tiller has done extensive, highly controlled studies similar to those of Pehek. The first three studieswere done by Tiller and Boyers on the production of colors in the Kirlian photographs. The first. study. determined that the colors were the result of the direc- tion from which ultraviolet light entered the film, that is, from the front as was the normal case, or from the back or side due to an air gap between the metal elec­ trode and the back side of the film.76 A second study supported the original findings in that the authors could duplicate colors at will by the length and direc­ tion of ~xposure. 77 A third study varied the finger- film-electrode spacing, and again the colors were shown to be the result of air gaps and direction of exposu~e. 78

The next studies dealt with the light source and streamer effects. The light source consistently proved to be ultraviolet or blue. A second finding was that the surface chemistry and moisture of the living

1 7 6o. G ·•. Boyers and w. A. Tiller, The Colors in Kirlian Photography Fact or Artifact'? (Stanford, .Cali­ fornia: Department of Materials Science and Engineering, Stanford~ pniv. [n.d.]), pp. 1-3.

77rbid., p. 4.

78Ibid., pp. 5-6. 36

electrode influenced the pattern of corona discharge.

It was also shown that the length of light-generating

streamer was linearly proportionate to the applied

voltage. 79 A final finding was that when a subject

changed his mental state every two minutes while main-

taining constant finger pressure on the film, his emis-

sian pattern changed even though rigorous controls had

been used.ao

After designing a new apparatus which controlled

more variables and provided for constant fingerpad pres-

sure, another study was done to determine the effects of

pulse width and number of pulses on the photograph. It

was found that: 1) increasing the pulse width and num-

ber only increased the brightness of the image, 2) the

pattern or image was highly repeatable, 3) as the finger-

pad-to-electrode spacing decreased, .the image or pattern

increased, and 4) it was not possible to detect physio-

logical changes in the subjects using a lOOKH power

79william Tiller, "Unveiling the Mysteries of Kirlian Photography," published in the Proceedings of the A.R.E. Medical Symposium on New Horizons in Healing, Phoenix, Arizona, January 1974, pp. 7-9.

sorbid. , p. 17. 37

81 supply. Another study was done using a higher voltage

and taking into account the ·changes in skin impedence

during the psychogalvanic reflex.· Results indicated

that ••the lower the driving frequency of the system, the

lower the required source voltage for gap discharge and

the easier it is for the subject to influence the gap

discharge by changes in physiologic state ... 82

In a monograph Tiller 11 tidied up the pictureu 8 3 by suggesting some rational experimental expectations about non-physical energies as 11 (a) energies of a non- electromagnetic, .nonsonic, and nongravi tational variety as we know them, (b) energies that do not directly stim- ulate our five physical senses as we know them, and (c) energies.that do not propagate in the four-dimensional space-time continuum as we know it ... 84 He suggested

81william Tiller, Kirlian Photography: Its Scientific Foundations and Future Potentials (Stanford, California: Department of Materials Science and Engineer­ ing, Stanford University, 1975}, pp. 44-45.

82Ibid, pp. 49-50.

8 3Ibid. , p. 51 .

84Ibid. 38 that Kirlian photography, .carefully controlled, might be a means to measure this "non-physical" energy. He further suggested that galvanic skin response might measure the same kinds of phenomena as Kirlian photo­ graphy. 85 He suggested that, .bY utilizing Kirlian photography, it should be possible to

• . • (a) develop an early warning system of grow­ ing pathology in living systems, {b) develop a reliable monitoring system for revealing the phy­ sical, emotional, and mental tone of human beings, {c) develop systems for determining the peak condi­ tions of participants in critical team activities, {d) develop a fatigue device useful for industrial operations, {e) develop what could be called a 'thermometer' for psychiatrists who are. sorely in need of an objective standard, and (f) develop monitoring devices that reliably register cause­ effect relationships associated with non-physical energies, etc •••. 86 Kirlian photography ••. promises to be very useful as a physiologic state monitor and is of sufficient complexity that a variety of unanticipated benefits may be forth­ coming.87

85rbid., pp. 51-52.

86rbid., p. 6 2.

87rbid., p. 63. 39

Theoretical Framework

An analysis of the concept of attachment led

to the development of a set of criteria which make up

the theoretical framework of the study. Concept analy- sis revealed that attachment consists of several inter~ related criteria: sensory data or input, basic trust, reciprocal interaction, energy exchange, role expecta- tions, and affect.

Support for this framework can be specified.

Klaus and Kennell's theory of attachment supports the criteria of sensory data, reciprocal interactions, and affect. 88 In a schematic presentation Klaus and Kennell list the multiple interactions which occur ·simultaneous- ly between a mother and her infant during feeding. They state that mother and infant are

.•. intimately involved with [one] another on a number of sensory levels. Their behaviors comple­ ment each other and serve to lock the pair together. The infant elicits behaviors from the mother which in turn are satisfying to him, and vice versa, the mother elicits behaviors in the infant which in turn are rewarding to her.89

88Klaus and Kennell, Maternal-Infant Bo·nding, p. 67.

89:i:bid. 40

The criteria of basic trust and role expecta-

tions are supported by Erikson as well as the criteria

of reciprocal interaction.90 He states that:

The firm establishment of enduring patterns for the solution of the nuclear conflict of basic trust versus basic mistrust in mere existence is the first task of the ego, and thus first of all a task for maternal care • • . Mothers create a sense of trust in their children by that kind of administration which in its quality combines sensitive care of the baby's individual needs and a firm sense of person­ al trustworthiness within the trusted framework of their culture's life style. This forms the basis in the child for a sense of • identity • which will later combine a sense of being 'all right, • of being oneself, and of becoming what other people trust one will become.91

The criteria of energy exchange is supported in

von Bertalanffy•s general systems theory. Bertalanffy

proposes that the organism is an .. open system in a [quasi-]

steady state, maintained constant in its mass relations

in a continuous change of component material and ener-

gies, in which material continually enters from, and

leaves into, the outside environment ... 9 2 Using von

Bertalanffy•s theory as a basis, Martha Rogers has

90Erikson, Childhood and Society, pp. 247-249.

9 1 Ibid • I .P • 2 4 9 • 92Ludwig von Bertalanffy, General Systems Theory (New York: George Braziler, 1968), p. 121. 41 developed a systems approach to nursing. Three of her principles of homeodynamics are germaine to this dis- cussion. The principle of reciprocy states that "recip­ rocy is a function of the mutual interaction between the human field and the environmental field."93 The princi- ple of resonancy states that "change in pattern and organization of the human field and the environmental field is propagated by waves . • . • Between man and environment there is a rhythmic flow of energy waves."94

The principle of synchrony states that "change in the human field depends only upon the state of the human field and the simultaneous state of the environmental field at any given point in space-time."95

Tiller and Moss also have postulated human energy fields which may exchange energy with one another.

Tiller reports an English study that concluded that

Kirlian fingerpad halos were associated with interperson­ al attraction, in that the halos grew brighter and wider

93Martha Rogers, An Introduction to the Theo­ retical Basis of Nursing (Philadelphia: F.A. Davis Co. 1970), pp. 96-97. 94rbid., p. 98.

95rbid., pp. 101-102. 42 when the persons being photographed liked each other.96

In a series of interaction studies and studies with healers, Moss identified the same phenomena and also stated that when persons who were ·photographed together did not like each other, the Kirlian halos diminished and pulled away from each other. In the healing study the halos of the healer were brighter and very wide dur- ing healing but diminished and were smaller than the baseline after healing, while the patient's halo increased and became brighter after the healing. Moss suggests that this is visual evidence of energy exchange.97 The criteria of role expectation is supported both by Klaus and Kennell and by Peplau. Klaus and

Kennell report that after quickening occurs in pregnancy, a woman usually develops fantasies about what her child will be like, attributing some personality characteris- tics to him. 98 She may then either be pleased or disappointed when the real child is born. She has

96Tiller, Kirlian Photography: Its Scientific Foundations and Future Potentials, P· 30. 97Thelma Moss, .Johri Hubacher, and Frances Saba, "Visual Evidence of Bioenergetic Interactions Between People?" a paper presented at The American Psychological Association, New York, 1974, PP· 4-8. 98Klaus and Kennell, Maternal-Infant Bonding, p. 4 2. 43

developed expectations about him. Peplau discussed the

expectations an infant has of his mother and suggests

that he expects his mother, .or her surrogate, .to satis-

fy his needs and to relieve his discomforts by answering his cries.99

The criteria of affect is supported by Klaus

and Kennell, Peplau, Erikson, and Moss. All have sug-

gested that positive affective states enhance inter-

personal relationships while negative affective states,

such as fear, anger, or anxiety, are detrimental to the

development of interpersonal relationships.

The criteria to be utilized from the framework

for this study are sensory input, reciprocal interaction,

and affect.

99peplau, Interpersonal Relations in Nursing, pp. 169-171. CHAPTER III

METHODOLOGY

Overview

The relationship between maternal attachment

and anxiety in primigravidas was examined using three

measurement tools. The first tool, developed by Klaus

and Kennell, measured maternal attachment behaviors by

observation of a mother-infant feeding period. The

second tool was the Taylor Manifest Anxiety Scale, a

measure of state anxiety. The third tool, Kirlian

photography, was used because it is a potentially useful

indicator of the subject•s physiologic state.

Consultation Committee

The consultation committee chosen for the study, all of whom were from the Texas Woman•s University, were:

From the College of Nursing, Anne M. Gudmundsen, R.N.,

Ph.D., Associate Dean for Graduate Studies; Barbara Car­ per, R.N., Ed.;D.; Betty Rudnick, .R.N., Ed.D., .Dean ad interim; Don Nicholas, .Ph.D., .Media Specialist; and from the College of Education·, Johri McFarland, .Ed.D., Dean.

44 45

Other consultants included Dr. William Tiller of Stanford University, .Dr. Thelma Moss of u .c .L.A.,

Dr. John Hubacher of U.C.L.A., .Serge Hadjolian of

Connecticut College, and Dr. David Faust of Drexel

University, for assistance with Kirlian photography.

Further assistance in statistical analysis was obtained from Dr. Clifford S. Knape of the Veterans Administration

Center, Waco, Texas. Dr. Janet Taylor Spence of the

University of Texas at Austin, and Drs. John Kennell and

Marshall Klaus of Case Western Reserve University were most helpful in providing both research tools and biblio- graphic assistance.

General Aims of the Study

This study was designed to determine 1) if there is a relationship between maternal attachment and maternal anxiety; and 2) if such a relationship does indeed exist, can that relationship be measured by

Kirlian photography. The null hypotheses tested were: H 1 There is no statistically significant relation­ 0 ship between maternal attachment scores and anxiety level scores· of primiparous postpartum women. 46

There is no statistically significant change in attachment scores or anxiety level scores. during postpartum hospitalization.

There is no statistically significant rela­ tionship between maternal attachment scores and rankings of Kirlian photographs.

There is no statistically significant rela­ tionship between anxiety level scores and rankings of Kirlian photographs.

Primary variables were the scores of maternal attachment as measured by Klaus and Kennell's behavior scale, the anxiety scores as measured by the Taylor

Manifest Anxiety scale, and ranking of Kirlian photo- graphs.

For the purposes of this study the following operational definitions were used:

1. Maternal attachment - an affectional tie that is formed between a mother and her child which endures through time and is manifested by specific maternal behaviors as measured by Klaus and Ke~nell's attachment behavior scale

2. Anxiety - a state characterized by subjective, consciously perceived feelings of apprehension and tension associated with arousal of the autonomic nervous system as measured by the Taylor Manifest Anxiety Scale

3. Kirlian photography - electrophotography in which one sees an image of the.structure of the surface of the object photographed plus a surrounding halo caused by a high-frequency corona discharge 47

Basic assumptions made in this study were:

1. Kirlian photography may be a useful monitor of physiologic stateslOO

2. The measurement tools measure the specified phenomena

3. Attachment and anxiety are variables which must be measured indirectly

Limitations of the study were:

1. Only healthy primigravidas with no complications and normal vaginal deliveries were admitted to the study

2. No mothers whose infants were sick or whose Apgar scores were below eight at five minutes after birth were admitted to the study

3. No mothers were allowed to smoke for at least thirty minutes prior to testing

4. No mothers who were being treated for any known underlying disorders were admitted to the study

5. No mothers who were receiving nicotinic acid were admitted to the study

6. No attempt was made to consider preparations for discharge from the hospital as an influ­ encing factor in anxiety

lOOTiller, Kirlian Photography: Its Scientific Foundations and Future Potentials, P· 63. 48

Sample

A sample of thirty-five healthy primigravidas who met the requirements previously mentioned agreed to participate in this study. The obstetric service of a

350-bed general hospital in Central Texas was the site for the study. Each mother was tested twice--once on the first postpartum day, and once on the third post­ partum day--for maternal attachment and anxiety levels, and to obtain Kirlian photographs. The first postpartum day was defined as from twenty-five to forty-eight hours after delivery. The third postpartum day was defined as from seventy-three to ninety-seven hours after delivery. Four subjects were subsequently dropped from the sample due to early discharge from the hospital.

One subject withdrew from the study after her mother convinced her that having the Kirlian photograph made would allow the investigator to "capture her soul." Not included in the sample were three mothers who refused to participate. One said she had a learning disability which made reading difficult. The other two did not give a reason for refusal and were not asked for one. Two who refused were black; one was white. 49

Methods of Data Collection

The protocol used is delineated below. The

procedure was the same for Day One and Day·Three. On

the first day postpartum the mother was approached, the

purposes of the study were explained, .and the mother was

asked to participate. A written consent form explaining

the procedures to be used was provided for the mother's

signature. All demographic data needed were then obtain­

ed. The mother could withdraw from the study at any

time. Thirty minutes prior to the feeding to be ob­

served, the investigator obtained a baseline Kirlian

photograph of the mother's right index finger. After

the baseline measurement had been obtained, the mother was asked to complete the Taylor Manifest Anxiety Scale. When the infant was brought to the mother, the investigator observed the feeding for fifteen minutes to obtain maternal attachment scores. After the feeding observation period was completed, another Kirlian photo­ graph was taken of the mother's fingerpad while the infant was still in the room. When all data were collec­ ted, the mother was thanked and an offer was made to answer any additional questions. 50

Measurement Tools

The observations for the maternal attachment score were from the time the infant entered the room and for fifteen minutes thereafter. The instrument was designed so that observations were made for twenty seconds out of each minute, and then recorded during the remaining forty seconds. Therefore, the total possible score for any behavior was fifteen.

The tool used to measure maternal attachment, developed by Klaus and Kennell, has been validated in the United States and in Sweden and Guatemala. They report inter-observer reliability of 90 percent for the observations in the United States. The tool is included in Appendix B. It yielded four scores: an overall attachment score, an affectionate behavior score, a proximity-maintaining score, and a caregiving score. The method of scoring was that used by Hales et al.101 One point was given for each of the behaviors observed during each of the twenty-second observation periods. The total attachment score was determined by

l01Hales et al., "Defining the Limits of the Maternal Sensitive Period," (mimeographed), P· 4. 51 adding all sub-scores for the total fifteen-minute period, to the score for complete attention on baby, minus distractability of mother's attention. The affec­

tionate behavior scores were derived by adding the points obtained from the following behaviors: "en face,". looking at baby, talking to baby, fondling, kissing and smiling at baby. Proximity-maintaining scores were derived by adding all points obtained for holding the infant, holding infant close, and encompassing the in­ fant. A total caretaking score was determined from the sum of nursing, burping, and covering scores. A copy of the scoring sheet can be found in Appendix B. The Taylor Manifest Anxiety Scale, used to measure anxiety, consisted of ninety true-false items to be marked by the mother. It is well validated and con­ sidered to be a reliable test instrument. A copy can be found in Appendix c. Taylor's standard scoring tech­ nique was used. A copy of the scoring instrument can be found in Appendix c. The third tool was Kirlian photography. Kirlian photography is a device for obtaining visual evidence of an organisms's electrical corona discharges. According to Tiller and Pehek et al. the technique is useful for measuring moisture in and on the skin and also for 52

measuring physiologic states. Since the tool has only

been available in this country for less than ten years,

it has not been fully validated, .and, therefore, .cannot be considered completely reliable.

The Kirlian apparatus employed was designed

and built by Dr. John Hubacher of the Neuropsychiatric

Institute, University of California at Los Angeles. The voltage at the electrode plate puts out about 10,000 volts, but the current (amperage) is extremely low, about .01 microamperes or 1/100 of a millionth of an ampere. The frequency is infinitely variable, but was set at the lowest reading {about 3,000 cycles per second, or 3,000hz.) after a pilot study indicated that the.best photographs were obtained at that setting. The exposure time is also variable, but pretesting indicated that the best photographs were obtained when the timer was set at .05 second. The machine was then preset at these readings and remained constant thereafter. A schematic diagram of the apparatus can be found in Appendix D. The power supply was connected to a 1/16-inch thick, 5" x 6" copper plate, which became electrostatic when the power was turned on. The copper plate was encased in a 7~" x 7~" x ~~~ plexiglass sheath with an opening on top. This opening was covered with two 53

dialectric sheets which were taped to the copper plate,

leaving a slightly depressed area in the top of the

plate into which the film was placed.

The film used was Kodak Tri-X Orthochromatic

4 11 x 5" sheet film. This film was less expensive and

easier to use than many other available types, and, in

addition, was very light sensitive which allows lower

exposure times to obtain good electrophotographs. All

film developing was done by the investigator in a

standardized manner using standard darkroom techniques

and chemicals. In using the Kirlian device, the following

steps were taken: First,the subject's right index finger

was washed with an alcohol swab, allowed to dry, and

dipped into a light talcum powder to control excess

moisture. Next, the electrode plate and film holder

were placed within a standard photographic black bag.

The film was then removed from the film holder and

placed on top of the electrode plate. Then, the subject was assisted to place her right hand in the bag and her

right index finger was positioned vertically on the film.

After the film was exposed, the subject's hand was removed from the bag until the next picture was taken. 54

To prevent mixups in patients' photographs, each film holder was carefully labeled, _using a small self-adhesive label, .with the mother's code number and the number of the picture (either "1" for Day One, or

.. 3" for Day Three) . When the films were developed and hung to dry, the label was removed from the film holder and affixed to the clothespin holding the developed film. When the film was dry, the label was removed from the clothespin and attached to the lower right corner of the film.

Since the meaning of Kirlian electrophotographs is not immediately self-evident, these were rated by a panel of four judges to prevent experimenter bias. The judges, all master's level nurse educators, were instruc- ted to use a rather complex Kirlian photograph ranking system originally developed by Hadjolian. In essence, brightness and size of corona are the centrally impor- 102 tant character1st1cs. · o f K'1r 1' 1an p h o t ograph s.

Hadjolian, in a study of interpersonal attraction, .de­ vised a seven-point rating scale based on intensity and size of corona, and "freedom from anxiety" (defined as the presence of fingerprints within the picture)·

102Tiller, Kirlian Photography, P· 26. 55

Intensity was defined by the brightness and color of the

corona. Size was determined by the length of the spikes

on the corona. If fingerprints were present, one point

was deducted from the score. A score of seven had

spikes longer than one-eighth of an inch and were pre­

dominantly white, bright, and clear. A score of six

was identical to those scored as seven except the spikes

were less than one-eighth of an inch. A score of five

was given when the spikes were at least greater than

one-sixteenth of an inch in size and were often blue in

color. They were clearly visible but less intense than

those rated six or seven. A score of four had spikes less than one­

sixteenth of an inch long with barely visible spikes and

were usually blue and.only faintly visible. A score of

three had a barely visible corona with no spikes, were

only slightly blue, and very dim. A score of two was

given where there was no corona at all, and a score of

one was given to brownish smudges that were fingerprints

instead of coronas. Hadjolian reported interobserver reliability scores of .96 and .996 for eight judges and 170 subjects' scores. Although Hadjolian found no differences in the effects of finger pressure on the size of corona, in 56

contrast to some previous studies·, subjects in the

present study were asked to hold their fingertips on the

film vertically, as an added precaution. This modifica­

tion was suggested by Hubacher who has found that this

technique eliminates the ~ffect of finger pressure on the corona size.l03

Three modifications were made in Hadjolian's

rating scale. The first modification was to change all

color description from "white" to "black" since raters were using the negatives of the film rather than prints

as in Hadjolian's study. The second modification was the addition of a score of "eight." The spikes of the Kirlian photographs produced in this investigation were often more than one-eighth of an inch long, but the coronas were not dense or there were gaps in the spikes. These were rated as "seven" and the photographs which had spikes one-eighth of an inch or longer without gaps and whose coronas were dense were rated as "eight." Two addi~ tions to descriptions were also added. For the score of

103John Hubacher. Personal communication, December 13, 1977. 57

"five .. the words .. coronas may have gaps" were added.

For the score of "four 11 the additional description "may have spikes but no corona•• was added.

Friedman•s two-way analysis of variance was used as a measure of inter-rater reliability which yielded a xr2 of 1.4367. This corresponded to a reliability of slightly better than .98.104 A copy of the scoring system is included in Appendix D.

The data were analyzed using a Novus National

Semiconductor Calculator Model 6030. Statistical tests used were Chi-square, two-by-two tables for an initial look at the data, Point Biserial Correlations, Pearson•s

Product-Moment Correlations, and Friedman•s Two-Way

Analysis of Variance. Results of the analysis will be presented in Chapter IV.

104Fred N .· Kerlinger, Foundations of Behavioral Research (2nd edition), PP· 290-292. CHAPTER IV

ANALYSIS OF DATA

Study Setting

All data were collected in late Spring 1978 in a 350-bed general community hospital in Central Texas.

The obstetrics service has approximately 250 deliveries per month. Normal obstetrics routine consists of delivery followed by one hour of postpartum recovery in a Recovery

Room, after which the mother is then transferred to the postpartum unit. The infant is removed from the delivery room shortly after delivery, shown to the father if.he was not present at the delivery, and placed in the obser­ vation nursery under a heat panel. The mother sees the baby through the window of the nursery when she leaves the Recovery Room. The next time she sees the baby is approximately six hours later, or whenever the next feed­ ing period occurs after the baby has regained normal·body temperature. She then has the baby for feedings every four hours during the day for approximately forty minutes.

58 59

Study Population

The sample for this study was made up of thirty,

healthy, married primigravidas who delivered well infants.

Only women who had normal vaginal deliveries were ad­ mitted to the study.

The sample consisted of twenty-four Anglo women,

three black women, and three women with Spanish surnames.

An attempt was made to increase the numbers of ethnic

persons of color in the sample, but none met all the cri~

teria. Several of the mothers spoke no English, and

several others were unmarried.

There were twenty-one male infants and nine

female infants among the sample mothers. The total

population of female infants born at the hospital during

the time of data collection was very small, .thus limiting

the numbers of female infants among the sample mothers.

Ages of the mothers ranged from fifteen to

twenty-nine years. The mean age was twenty-two years, with a standard deviation of three and eight-tenths years.

Twenty-one mothers were delivered under local anesthesia alone. Nine mothers had general anesthesia during delivery. 60

Thirteen of the mothers had participated in

childbirth education classes. Of these, eleven had their

husbands with them in the delivery room. Seventeen

mothers had not participated in childbirth education

classes. None of their husbands were present in the

delivery room, as it is against hospital policy to allow

husbands into the delivery areas without previous atten­

dance at childbirth education classes.

Educational levels for both husband and wife

were assessed. The number of years in school ranged from

nine to eighteen for the women in this study. Mean num­

ber of years in school was twelve and one-half. The num­

ber of years in school for the husbands ranged from nine

to eighteen. Mean number of years in school was thirteen

and three-tenths. There were five women in the sample who smoked.

None of these women who smoked had attended childbirth

education classes. No difference was found in these women's Kirlian photographs when compared to the rest of

the sample. These women were specifically asked ~.to smoke for at least thirty minutes prior to the time the

first Kirlian photographs were made. This was done to control for the effects nicotine may have on skin conductance. 61

Finally, .twelve of the women breastfed their

infants while eighteen of the women bottlefed. There were

no significant differences in the ages or educational

levels of the women who breastfed when compared to those who bottlefed.

Statistical Methods· Used

Four null hypotheses were proposed for study.

Each hypothesis will be presented along with the data analysis pertaining specifically to that hypothesis.

Additional findings will be presented at the conclusion of the chapter. Statistical tests used for analysis were: Chi­ square, Point Biserial Correlation with a t-test of significance, and Pearson's Product-Moment Correlation.

A list of statistical formulae used can be found in

Appendix E. Chi-square (x2) is basically a test to com­ pare observed frequencies with expected frequencies, specifically when one or more variables are categorized into frequencies. x2 was used in this study for an ini­ tial look at the data. It proved to be helpful at indi­ cating variables which were interrelated and, therefore, could be tested for correlation. 62

The Point Biserial Correlation (rpbis> is used

when one variable is continuous and one variable is dis-

crete or dichotomous. It was used to test relationships

between Kirlian photograph rankings (discrete) and Mani-

fest Anxiety scores (continuous) as well as between

Kirlian rankings and Maternal Attachment scores (contin-

uous). Point Biserial correlations were tested for sig-

nificance using a t-test at twenty-eight degrees of

freedom. The Pearson Product Moment correlation (r) is

used when two variables are continuous and rectilinear,

such as the Manifest Anxiety scale and the Maternal

Attachment Scale. No test for significance is necessary

for the Pearson's r since Fischer provides a table of 105 levels of significance for Pearson's r.

Hypothesis One

The first null hypothesis proposed was:

There is no statistically significant relationship between maternal attachment scores and manifest anxiety scores of primiparous postpartum women.

105Ronald A. Fischer, Statistical Methods for Research workers, 12 ed. {New York: Hafner Publishing Company, Inc., 1954) Table VA. 63

There was one overall attachment score and three

subscores for each day of observation. The range of

overall scores for Day One was 84 to 144, with a mean

of 117.633, and a standard deviation of 14.805. For

Day Three the range was 99 to 144, with a mean of 119.633,

and a standard deviation of 12.130.

Affectionate Behavior scores ranged from 32 to

76 on Day One, with a mean of 58.166, and a standard

deviation of 10.821. Affectionate behavior scores on

Day Three ranged from 43 to 79, with a mean of 59.233,

and a standard deviation of 10.180.

Proximity Maintaining scores ranged from 21 to

45, with a mean of 34.6 and a standard deviation of

6.020 on Day One. Day Three scores ranged from 21 to 44, with a mean of 34.7 and a standard deviation of 5.742.

Caretaking scores for Day One ranged from 7 to

16, with a mean of 12.733 and a standard deviation of

2.227. Scores for Day Three ranged from 11 to 17, with a mean of 14 and a standard deviation of 1.575.

Manifest Anxiety scores for Day One ranged from 6 to 36. The mean score was 18.90, .and the standard deviation was 7.906. Day Three scores ranged from 3 to

37, with a mean of 17.833 and a standard deviation of

9.006. 64

x2 analysis of attachment and anxiety scores yielded a score of x2 = 1.714 for Day One which approach­ es significance. A Point Biserial Correlation was then

computed for Anxiety with Attachment as the dichotomous variable. This analysis yielded a score of rpbis = .3644 and a t = 2.0708 which is significant at the p = .05

level of significance.

A Pearson Product Moment Correlation was then taken and yielded an r = -.43925 which is significant at the p = .02 level of significance. A second Pearson's r was taken for Day Three and yielded an r = -.3722 which is significant at the p = .05 level of significance. With the above levels of significance, the null hypothesis can be rejected. Attachment and anxiety co­ vary negatively. Therefore, it can be said that for this sample of women, low anxiety scores are correlated with high attachment scores, or, .as attachment scores rise, anxiety scores fall. Anxiety scores were also correlated with affec- tionate behavior scores for Day One, but not for Day

Three. Day One correlation coefficient was r = -.4396 which is significant at the p = .02 level of signifi­ cance. The data do not provide many clues as to why the correlation did not appear on Day Three. Perhaps 65

this score represents a Type II error, or perhaps the

relationship is present only on Day One. Perhaps the

affectionate behaviors may be good predictors of low

attachment and high anxiety levels on Day One, and

thence useful to nurses in that instance.

Table 1 presents the full correlation matrix

for Day One with the variables and their r scores.

Those relationships which proved significant are marked by an asterisk.

TABLE 1

CORRELATION MATRIX, DAY ONE

MA OA AB PM CT

MA X -.439256 * -. 439650* -.263117 .110050

OA X X .909090 ** .531750 ** -.002162

AB X X X .227570 -.023840

PM X X X X -.237080

CT X X X X X

MA (Manifest Anxiety) * p = . 02 OA (Overall Attachment) ** p = .01 AB (Affectionate Behavior) PM {Proximity Maintaining) CT {Caretaking) 66

The high correlations of affectionate behavior, proximity- maintaining, and caretaking to overall attachment is, .in part, due to the fact that they are subscores of overall attachment.

As can be seen in Table 1, .overall attachment was also correlated with affectionate behaviors and proximity maintaining. This high correlation is at least in part due to the fact that affectionate behaviors and proximity maintaining are subscores of overall attachment. These correlations held for Day Three as well. (See Table 2.)

TABLE 2

CORRELATION MATRIX, DAY THREE

MA OA AB PM CT

MA X -.372219* -.251060 -.282340 .078603

OA X X .867507** .411236* -.265200

AB X X X .051194 -.449292***

PM X X X X -.041920

CT X X X X X

* p = .05 ** p = .01 *** p = .02 67

Caretaking behaviors were not highly correlated with

overall attachment or any of the related subscores ex­

cept for affectionate behaviors on Day Three. The only

explanation for this change indicated by the data is

that caretaking scores increased significantly on Day

Three which increased the relationship in the two variables.

Hypothesis Two

Hypothesis Two stated:

There is no statistically significant change in attachment scores or anxiety level scores during postpartum hospitalization.

A t-ratio for correlated data was used to test the differ- ences in means of the variables from Day One to Day

Three. There were no significant differences in the means of any of the variables except caretaking. The mean for this variable on Day One was 12.7333, with a standard deviation of 2.22733. The mean on Day Three was 14, with a standard deviation of l.S7S6. The differ­ ence in means (t = -2.6499871, p = .OS) was significant at the p = .OS level of significance. This indicates that the number of caretaking activities increased sig- nificantly from Day One to Day Three. From these data 68

the null hypothesis must be accepted for all variables except caretaking.

Hypothesis Three

Hypothesis Three stated:

There is rio statistically significant relationship between maternal attachment scores and rankings of Kirlian photographs.

x2 analysis for maternal attachment scores and Kirlian rankings approached significance (x2 = 2.3295,

p = .20) on Day Three when the mother was with the baby

after feeding. However, the Point Biserial Correlations

were not significant for either Day One or Day Three,

with the baby or without it. Therefore, the null hypo-

thesis is accepted. There is no apparent relationship

between attachment scores and Kirlian rankings.

Hypothesis Four

Hypothesis Four stated:

There is no statistically significant relationship between manifest anxiety scores and rankings of Kirlian photographs.

x2 analysis indicated a relationship approach­ ing significance (x2 = 2.00956, p = .20) between Kirlian rankings and anxiety scores for mothers on Day Three 69

without the baby. Subsequent Point Biserial Correlation

supported the relationship (t = 2.6728033, .P = .02).

This is a fairly high correlation for this relatively

new measurement with a measure which has been well

validated. To this investigator's knowledge, a validated

measure of anxiety has never before been highly corre­

lated with a Kirlian photographic measure. Since the

relationship is validated only for one day and without

the baby, further study is clearly indicated. The null hypothesis can neither be accepted nor rejected since

the relationship occurs significantly on Day Three and not on Day One.

Additional Findings

Although no formal hypotheses were drawn, several additional relationships were investigated. The investigator asked whether there might be differences-in attachment scores or anxiety levels for: 1) mothers who were awake at delivery and mothers who were not; 2) mothers of boys and mothers of girls; 3) mothers who were younger and mothers who were older; and 4) mothers who were black or brown and mothers who were white. 70

There were no differences found between the scores of mothers who were awake and mothers who were asleep for either attachment or anxiety. There were no differences between the scores of mothers of male infants and mothers of female infants. This may have been par­ tially due to the small number of female infants in the sample. The same problem arose with the small number of black and brown mothers in the sample. There were no differences in the means found for attachment or anxiety.

There was a significant difference in the means of the youngest mothers (n = 5, range 15 - 18 years) and the oldest mothers (n = 5, range 27 - 29). A t-test for the difference between means of correlated samples indi­ cated a significant difference in the mean scores for both attachment and anxiety. The t for Day One Attach­ ment was -4.8583, with a p = .01. The t for Day One Anxiety was 3.4035, .with a p = .01. The t-tests for Day Three were not as conclusive, however. The t for attachment on Day Three was only -2.2776, which only approaches significance at p = .10. The t for anxiety on Day Three was only .7773, a value which is clearly not significant. The only conclusion which can be drawn from these data is that, at least for Day One in this sample, younger mothers had significantly higher anxiety 71

scores and significantly lower attachment scores than

the older mothers.

Methodological Problems

Several methodological problems arose during the course of the study. The most major problem con­ cerned the Kirlian device used. Although it continued to function well, the wire leading to the electrode was only soldered to the copper plate, leaving it unstable in the sense~_that it was difficult to keep it from twisting. For fear that the wire would be damaged if broken, the investigator's husband devised a wooden

11 Splint 11 or "handle" which was glued to the bottom of the plastic sheath or casing of the electrode. The wire was then taped firmly to the "handle" and was thus prevented from twisting or breaking. The ,.second methodological problem was actually cleared up before the research project began. During the pilot study one of the condensers in the Kirlian device went out. An expert in medical electronics was consulted, and the condenser replaced. This investiga­ tor feels that a small circuit breaker mounted on the side of the device which would trip before any fuses or 72

condensers could blow out would be a useful modification to the equipment.

A third methodological problem concerned

humidity control in the hospital rooms. The investigator

was assured by the engineer at the hospital that humid­

ity was maintained at about 40 percent in the patients'

rooms. There were no gauges on the walls, however, ex­

cept for thermostatic temperature controls. Therefore,

no real assurance can be given that humidity remained

constant when the Kirlian photographs were taken.

The fourth methodological problem had to do

with the necessity for the investigator to sit in the

room with the mother and baby. Her presence may have

had some anxiety-producing or inhibiting effects on the

mother's behavior with her infant. A better technique would have been to place the mother and infant in a

room with an observation mirror. Since there are no such rooms in the hospital used, this was not feasible.

It would reduce any biasing, however, from the observer being in the room. The last problem was more a frustration than an actual problem. The mothers were instructed to hold their fingertips vertically on the film in an effort to control for finger pressure. Many mothers, although they 73

were positioned properly by the investigator, would move

their fingers so that the whole ·fingerpad was on the

film. This necessitated additional time in the black

bag because the finger had to be repositioned. The

photograph was never taken until the finger was vertical.

Sununary

Analysis of the data indicated that null

Hypothesis One was rejected. There was a significant

negative correlation between manifest anxiety and mater­

nal attachment behaviors in the sample studied.

Null Hypothesis Two was accepted for all vari­

ables except caretaking. The caretaking behaviors

increased significantly from Day One to Day Three.

Null Hypothesis Three was accepted. There was

no real evidence of correlation between maternal attach­ ment scores and rankings of Kirlian photographs.

Null Hypothesis Four was neither accepted nor rejected. There was no relationship between anxiety scores and rankings of Kirlian photographs on Day One. However, there was a strong (p = .02) correlation between anxiety scores and Kirlian rankings on Day

Three when the mother did not have the baby present. 74

The correlation was not significant when the baby was with its mother, however.

Based on data analysis presented in this chap­ ter, one hypothesis can be reformulated and some impli­ cations for nursing practice and several recommendations for further research will be offered in Chapter V. CHAPTER V

CONCLUSIONS, IMPLICATIONS, AND RECOMMENDATIONS

Conclusions and Implicatiotis For N~rsing Practi·ce

Attachment and Anxiety

Any conclusions based on data from a sample

of thirty must be discussed only in terms of the popula-

tion in Central Texas from which it was drawn. No

broad empirical generalizations can be made from such a

limited sample. However, trends from this sample can

serve as appropriate leads in future research.

Analysis of the data from this study revealed

that maternal attachment and anxiety covaried negatively.

That is, as anxiety levels rose, attachment scores fell.

This could be very important to nursing practice. If nurses can recognize anxious mothers and plan appropri~ ate interventions, perhaps maternal attachment can be enhanced. On the other hand, if nurses plan nursing interventions to enhance maternal attachment, perhaps anxiety ~evels could be lowered. The mean anxiety scores

75 76

for both Day One and Day Three were higher than the

standard 50th percentile for the Manifest Anxiety Scale,

which supports the findings of Meleis and Swendsen that

postpartum mothers have high anxiety levels. Therefore,

it seems appropriate to suggest that nursing care for

normal primiparas ought to be planned to help reduce

anxiety levels and foster attachment behaviors. Perhaps

new mothers ought to be taught relaxation techniques for

the period after delivery as well as during delivery

itself. Another intervention might be focused around

teaching the mother how to respond to her infant's cues

and showing her how she can tell by the baby's behavior

whether her response was appropriate. Since the anxiety scores were also correlated

with affectionate behaviors, perhaps a good way to start

teaching the mother about her infant is to teach her how

to behave affectionately to her infant. Many new mothers

are understandably awkward and unsure of themselves.

This is especially true for women reared in an environ­ ment where there are no younger siblings, .no pregnant women, and no grandmothers. In such a mobile society as ours, with small, nuclear families, frequently many miles

from relatives, a young woman may give birth without pre­ viously having held or interacted with a single infant! 77

It thus becomes the basic fnnction of the nurse to ac­ quaint the ·mother with the appropriate skills necessary for providing her infant with a secure, trustworthy environment. Whether or not the mother actually feels affection for her infant, .she needs to know how to pro­ vide affectionate behaviors so that the infant can sur- vive emotionc;tlly to form his own attachments •

.Th~s type of intervention seems to be particu­ larly important for very young mothers since, in this study, mothers eighteen years old and younger had sig- nificantly higher anxiety levels and lower attachment scores than did mothers who were over twenty-seven years old.

Kirlian Photography

Analysis of the data from this study did not demonstrate any relationship between maternal attachment and the rankings of Kirlian photographs. There was a significant relationship between anxiety and the rankings of Kirlian photographs for Day Three when the mother did not have the· baby with her. There was no relationship exhibited for Day One at all or for Day Three when the baby was with the mother. 78

These ambiguous results lead this investigator to propose a new hypothesis:

There is a relationship between the scores on the Taylor Manifest Anxiety scale and rankings of Kirlian photographs in well individuals.

If further investigation should support this hypothesis,

Kirlian photography may prove to be a quick and inexpen- sive method for objectively diagnosing anxiety in hospitalized patients.

Indications for Further Research

As in many exploratory studies, the current research raised more questions than it answered. Listed below are some of the questions which seem to this inves- tigator to need further study.

Questions Related to Attachment and Anxiety

1. Can the study be replicated with similar results?

2. Would changing sample size, location of setting, or ethnic distribution of the sample alter the relationship between maternal attachment scores and anxiety levels? 3. Would the same relationship between attachment and anxiety exist in multigravidas?

4. Would the same relationship exist between . attachment and anxiety if the mothers were allow­ ed extended early contact with their infants as described by Klaus and Kennell? 79

5. Would the same relationship between attachment behaviors and anxiety be found if the fathers of newborn infants were studied?

Questions Relating to Kirlian Photography

1. Would the relationship between anxiety and the Kirlian rankings occur if the study were repli­ cated using a different sample size, a different population of primigravidas, or a different method of taking the photographs?

2. Would the relationship between Kirlian rankings and anxiety remain if the persons in the sample were multigravidas or fathers?

3. Would the relationship between anxiety and Kirlian rankings remain if another Kirlian device were used?

4. Can Kirlian photography be used to measure inter­ personal attraction or interaction of a family constellation of mother, father, and newborn infant'?

5. Would the relationship of Kirlian rankings to anxiety be replicable using mothers from another culture? 6. Is there a relationship between Kirlian rankings and Manifest Anxiety in normal, healthy indivi­ duals who are not currently involved in child­ birth or pregnancy?

Sununary

This was a report of an exploratory study of the relationship between maternal attachment and anxiety in thirty, healthy primigravidas who delivered well infants vaginally. Four null hypotheses were tested: 80

There is no statistically significant relation­ ship between maternal attachment scores and manifest anxiety scores of primiparous post­ partum women.

There is no statistically significant change in attachment scores or anxiety level scores during postpartum hospitalization.

H 3 There is no statistically significant relation­ 0 ship between maternal attachment socres and rankings of Kirlian photographs.

There is no statistically significant relation­ ship between manifest anxiety scores and rankings of Kirlian photographs.

Analysis of the data revealed a strong negative

correlation between maternal attachment scores and mani-

fest anxiety scores for both Day One and Day Three post-

partum. Therefore, null Hypothesis One was rejected.

For this sample the conclusion can be drawn that maternal

attachment scores rose as anxiety scores fell.

Null Hypothesis Two was accepted for all scores except the subscore for caretaking behaviors. The scores for caretaking increased significantly from Day

One to Day Three. Null Hypothesis Three was accepted. The data analysis revealed no relationship between maternal attachment scores and rankings of Kirlian photographs.

Further study using interaction photographs of the family constellation would be useful. 81

Null Hypothesis Four was not accepted nor rejected. Analysis revealed no correlation between anxiety scores and rankings of Kirlian photographs for

Day One. However, on Day Three when the mother did not have the baby with her, there was a significant relation­ ship between the anxiety scores and the Kirlian rank­ ings. Further study is needed to clarify this ambiguous result.

The report concludes with the implications of the study for nursing practice and recommendations for additional research. 82

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Mitchell, Edgar D. Psychic Exploration: A Challenge for Science. New York: G. P. Putnam's Sons, 1974.

Moss, Thelma and Johnson, Kendall. "Bioplasma·or cor~na Discharge?" In The Kirlian Aura: Photo­ graphing the Galaxies of Life. Edited by Stan­ ley Krippner and Daniel Rubin. Garden City, N.Y.: Anchor Books, 1974. 87

Murstein, Bernard I., ed. Theories of Attraction and Love. New York: Springer Publishing Company, Inc~, 1971.

O'Regan, Brendan. ..The Emergence of Paraphysics: n:eoretical Foundations... In Psychic Explora­ tlon: A Challenge for Science. Edited by Edgar Mitchell. New York: G. P.· Putnam's Sons, 1974.

Ostrander, Sheila, and Schroeder, Lynn. Psychic Dis­ coveries Behind the Iron Curtain. New York: Bantam Books, 1970.

Peplau, Hildegard E. Interpersonal Relations in Nursing. New York: G. P. Putnam's Sons, 1952.

Puthoff, Harold, and Targ, Russell. "Psychic Research and Modern Physics ... In Psychic Exploration: A Challenge for Scie~ce. Edited by Edgar Mitchell. New York: G. P. Putnam's Sons, 1974.

Rheingold, Harriet L. "Controlling the Infant's Explor­ atory Behavior ... In Determinants of Infant Behavior II. Edited by Brian Foss. New York: John Wiley & Sons, Inc., 1963.

11 The Social and Socializing Infant." In Handbook of Socialization Theory and Research. Edited by David A. Goslin. Chicago: Rand McNally and Company, 1969.

Schaffer, H. R. "Some Issues for Research in the Study of Attachment Behavior." In Determinants of Infant Behavior II. Edited by Brian Foss. New York: John Wiley & Sons, Inc., .1963.

Scott, J. p. ''Attachment and Separation in Dog and Man: Theoretical Propositions. •• In The Origins of Human Social Relations. Edited by H. R. Scha.ffer. New York: Academic Press, 1971. 88

,;_/ / Sears, Robert R. "Attachment, Dependency, and Frustra­ tion. 11 In Attachment and Dependency. Edited by Jacob Gewirtz. New York: John Wiley & Sons, 1972.

Spielberger, Charles D., ed. Anxiety arid Behavior. New York: Academic Press, .1966. ____ , ed. Anxietv: Current Trends in: Theo·ry and Research, vol. 1. New York: Academic Press, 1972. ____ , ed. Anxiety: Current Trends in Theory and Research, vol. 2. New York: Academic Press, \_.l . .._h 1972. ~ }{1 rtJ ' Stevens, A. G. "A tta chmen t Behavior, Separation Anxiety, and Stranger Anxiety in Polymatrically Reared Infants ... In The Origins of Human Social Rela­ tions. Edited by H. R. Schaffer. New York: Academic Press, 1971. Sullivan, Harry Stack. The Interpersonal Theory of Psychiatry. New York: W. w. Norton & Company, Inc., 1953.

Tiller, William A. 11 Devices for Moni taring Nonphysical Energies." In Psychic Exploration: A Challenge for Science. Edited by Edgar Mitchell. New York: G. P. Putnam's Sons, 1974. "Some Energy Field Observations of Man and Nature ... In '!'he Kirlian Aura: Photoqraphir:a the Galaxies of Life. Edited by Stanley Kr1ppner and Daniel Rubin. Garden City, N.Y.: Anchor Books, 1974. Kirlian Photography: Its Scientific Founda­ tions and Future Potentials. Stanford, .Calif.: Department of Materials Science and Engineering of Stanford University, [1975]. 89

Toth, Max. ..Historical Notes Relating to Kirlian Photo­ graphy. 11 In The Kirlian Aura: Photographing the Galaxies of Life. Edited by Stanley Krippner and Daniel Rubin. Garden City, N.Y.: Anchor Books, 1974.

Walker, Edith. ..Concerns, Conflicts, .and Confidence of Postpartum Mothers ... In Current Concepts in Clinical Nursing, vol. 4. Edited by Edith Anderson et al. St. Louis: C. V. Mosby Co., 1973. Wolff, Peter. "Observations on the Early Development of Smiling ... In Determinants of Infant Behavior II. Edited by Brian Foss. New York: John Wiley & Sons, Inc., 1963. / ~~arrow, Leon J. 11 Attachment and Dependency: A Develop­ men tal Perspective. 11 In Attachment and Dependency. Edited by Jacob Gewirtz. New York: John Wiley & Sons, 1972. 90

Articles

.. About New York: Psychic Snapshots. 11 New York Times, 2 June 1976, sec. 1.

Adarnenko, Viktor G. "Electrodynamics of Living systems, 11 Journal of Paraphysics 4 (No. 4, 1970).

Affonso, Dyanne. 11 The Newborn's Potential for Inter­ action, 11 JOGN Nursing 5 (November-December 1976).

Anderson, Gene Cranston. "The Mother and Her Newborn: Mutual Caregivers," JOGN Nursing 6 (September­ October 1977): 50-57.

Baird, Sally F. "Crisis Intervention Theory in Maternal-Infant Nursing," JOGN Nursing 5 (January-February 1976).

Blehar, Mary C., Lieberman, Alicia, and Ainesworth, M. D. Saulter. "Early Face-to-Face Interaction. and Its Relation to Later Infant-Mother Attach­ ment," Child Development 48 (March 1977): 182-194.

Bower, T. G. R. "The Object in the World of the Infant, 11 Scientific American 225 (October 1971} •

Brown, Marie Scott, and Hurlock, Joan T. "Mothering the Mother," American Journal of Nursing 77 (March 1977) . Cahill, Ann s. "Dual-Purpose Tool for Assessing Mater­ nal Needs and Nursing Care, " JOGN Nursing 4 (January-February 1975) .

Cannon, Rose Broeckel. "The Development of Maternal Touch During Early Mother-Infant Interaction," JOGN Nursing 6 (March-April 1977).

Carr, Suzanne, Dabbs, James M. , Jr., and Carr, Timothy S. "Mother-Infant Attachment: The Importance of the Mother's Visual Field, 11 Child Development 46 {June 1975). 91 l ~!, \:"\ Clark, Ann L., and Affonso, _Dyanne. 11 Infant Behavior and Maternal Attachment: Two Sides to the Coin, 11 American Journal of Maternal Child Nursing 1 (March-April 1976) •

Clark, Ann ~ • .. Recognizing Discord Between Mother and Ch~ld and Changing It to Harmony, .. Ame·rican Journal of Mate·rnal Child Nursing 1 (March­ April 1976).

de Chateau, Peter. 11 The Influence of Early Contact on Maternal and Infant Behavior in Primaparae," Birth and the Family Journal 3 (No. 4, 1976) .

Eckes, Sandra. 11 The Significance of Increased Early Con­ tact Between Mother and Newborn Infant, 11 JOGN Nursing 3 (July-August 1974). ----

Edelson, Edward. 11 Aura Phenomenon Puzzles Experts, 11 Smithsonian (April 1977).

Eidson, William W., and Faust, David L. 11 Corona Discharge Photography: Developing a New Scientific Tool, .. Drexel University News (Spring 1977).

Fanaroff, Avroy, and Merka tz, Irwin R. "Modern Obstetri­ cal Management of the Low Birth Weight Infant, .. Clinics in Perinatoloqy 4 (September 1977) .

Fantz, R. L., Ordy, J. M., and Udelf, M. s. "Maturation of Pattern Vision in Infants During the First Six Months, .. Journal of Comparative Physiologic Psychology 55 (December 1962) • Freeman, M. J. .. The Development of a Test for the Mea~ surement of Anxiety: A Study of Its Reliability and Validity, 11 Psychological Monographs: Gen­ eral and Applied 67 (No. 3, Whole No. 353, 1953).

Haskins, Ron. 11 Effect of Kitten Vocalizatic;>ns on Mater­ nal Behavior, .. Journal of· Campara t1 ve and Physiological Psychology 91 (August 1977) ·

Hrobssky, Diane M. 11 Transition to Parenthood:. A Balancing of Needs, .. The Nursing Clin1cs of North America, 12 (September 1977) • 92

Hurd, Jeanne Marie. "Assessing Maternal Attachment:

First Step Toward the Prevention of Child Abuse, 11 JOGN Nursing 4 (July-August 1975) •

Kaplan, D. M., and Mason, E. A. "Maternal Reactions to Premature Birth Viewed as an Acute Emotional Disorder," American Journal of Orthopsychiatry, 30 (July 1960).

Kempe, C. Henry. "Pediatric Implications of the Battered Baby Syndrome," Archives of Diseases of Children 46 (February 1971) •

Kennell, John H., and Klaus, M. H. "Care of the Mother of the High-Risk Infant," Clinical Obstetrics and Gynecology 14 (September 1971) •

Kennell, John H., and Rolnick, Alice R. "Discussing Problems in Newborn Babies With Their Parents," Pediatrics 26 (November 1960). Klaus, M. H.; Jerauld, Richard; Kregar, Nancy C.; McAlpine, Willie; Steffa, Meredith; and Kennell, John H. "Maternal Attachment, 11 New England Journal of Medicine 286 (March 2, 1972).

>/ Klaus, M.H., and Kennell, John H. "Mothers Separated From Their Newborn Infants," Pediatric Clinics of North America 17 (November 1970).

Klein, I~., and stern, L. "Low Birth Weight and the Battered Child Syndrome," American Journal of Diseases of Children 122 (1971) . Krieger, Dolores. "Therapeutic Touch,'' Nursing Times 72 (April 15, 1976). Lamb, Michael E. "A Defense of the Concept of Attachment," Human Development 17 (September-October 1974).

Levine, Nancy H. "A conceptual Model for Obstetric Nursing," JOGN Nursing 5 (March-April 1976) · · 1 y ''Mother- Maccoby, Eleanor E., and Feldman, S. Sh1r e.· . Attachment and stranger-Reactions 1n the Th1rd .f " Monographs of Society for Research Year o f Ll. e, . · t f in Child Development. Chicago: Un1vers1 Y o Chicago Press 37 (March 1972) · 93

Martin, B. "The Assessment of Anxiety by Physiological Behavioral Measures, .. Psychological Bulletin 58 (1961).

Mason, E. A. "A Method of Predicting Crisis outcome for Mothers of Premature Babies," Public Health Report 78 (1963) •

11 Me leis, Afaf Ibrahim, and Swendsen 1 .Lesl.ee A. Role Supplementation: An Empirical Test of a Nursing Intervention, .. Nursing Research 27 (January­ February 1978).

Moss, Thelma, and Johnson, Kendall. 11 Is There an Energy Body? 11 Osteopathic Physician 39 (October 1972).

"What About Kirlian Photography?" Psychic Magazine (July 1972) •

Murstein, Bernard I. 1 and Hadjolianl Serge E. "Finger­ tip Aura and Interpersonal Attraction, .. Journal of Personality Assessment 41 (July 1977).

Osofsky, Joy D. "Neonatal Characteristics and Mother­ Infant Interactions in Two Observational Situa­ tions," Child Development 47 (December 1976).

Pehek, John o., Kyler, Harry J., and Faust, David L • "Image Modulation in Corona Discharge Photogra­ phy," Science 194 (October 15, 1976). Poindron, p., and Signoret, J. p. "Study of Mate:nal Behavior in Sheep: Mechanisms Involved ~n Mother-Young Recognition, 11 Animal Behavior Abstracts 5 (November 1977) • Prugh, Dave. "Emotional Problems of the Premature Infant's Parents," Nursing Outlook 2 (August 1953) • Richards, Joel, and Finger, Stanley· "Mother-Child . Holding Patterns: A cross Cultural Photograph~c Survey," Child Development 46 (December 1975) • 94

Sawin, Douglas, Langlois, Judith, and Leitner, Edward "What Do You Do After You Say Hello'? Observfng Coding, and Analyzing Parent-Infant Interac- ' tions, " Behavior Research Methods and Instru mentation 9 (October 1977} .

Scott, Keith E., and Masi, Wendy s. "Use of the Datamyte in Analyzing Duration of Infant Visual Behaviors," Behavior Research Methods and Instrumentation 9 (October 1977}.

Snellgrove, Brian. "Kir 1ian Photography: A1 terna ti ve Medicine," Nursing Times 72 (April 15, 1976}.

Taylor, Janet A. "A Personality Scale of Manifest Anxiety, 11 Journal of Abnormal and Social Psy..:.. cbology 48 (April 1953) • Wilkins, William E., Hj elle, Larry A., and Thompson, Michael. "Anxiety and Actualization: A Reconceptualization, 11 Journal of Clinical Psychology 3 (October 1977} .

Unpublished Papers, Mimeographed Hales, D. J.; Lozoff, B.; Sosa, R.; and Kennell, J: I:I • "Defining the Limits of the Maternal Sens~t~ve Period" (mimeographed} January, 1977. Htibacher, John. Neuropsychiatric Institute, U.C.L.A. to l Kay Avant, Venice, Ca., 29 January 1978, Persona Files of Kay Avant, Waco, Texas. Hubacher, John; Gray, Jack; Moss, Thelma; and Saba., Frances. "A Laboratory Study of Unprthodoxd . · b tract for Secon Healing " prepubl~cat~on a s International Psychotronics Conference, Monaco, 1975 (mimeographed} · t' a Kh "Photo­ Kirlian, Semyon D., and Kirlian, Va~en ~n M a~s of High- V·sual Observat~on y e . d g raph y an d ~ 1 of scientif1c an Frequency Currents," JQurna_ h 0 f Aoplied PhotographY 6 (1961 ) (mimeograp trans. from Russian} • 95

Kirlian, Valentina Kh., and Kirlian semyon D "Cha t for Enth us7as· t s, " The· World' ·of Wonderful• DisP er charges (m~meograph trans. from Ru · ·d d b ss~an pro- v~ e y Dr. Thelma Moss).

Kyler, Ha~ry J., F~ust, David, and Beyer, Richard. Cor~na ~~sc~arge Photography: A Possible Appl~cat~on ~n Psychophysiology, ... paper pre­ sented to Eastern Psychological Association 48th Annual Meeting, Boston, April 13-16 1g77 (mimeographed) . '

Moss, Thelma, Hubacher, John, and Saba, Frances. "Visual Evidence of Bioenergetic Interactions Between People?" Paper presented at American Psycho­ logical Association, New York, May 1974 (mimeographed) . Moss, Thelma; Hubacher, John; Saba, Frances; and Johnson, Kendall. "Kirlian Photography: An Electrical Artifact?" paper presented at American Psycho­ logical Association, New Orleans, August 1974 (mimeographed) . . Moss, Thelma; Johnson, Kendall; Barshay, Marshall; Hubacher, John; and Gray, Jack. "Photographic Evidence of Healing Energy on Plants and People, .. paper presented at Dimensions of Healing Sym­ posium, University Extension, University of California at Los Angeles, 1973 (mimeographed) . lw1oss, Thelma, Johnson, Kendall, and Chang, Alice· "Effects of Alcoholic Consumption in People as Observed Through Electrical Field Photography," U.C.L.A., 1973 (mimeographed).

Moss, Thelma; Johnson, Kendall; Hubacher, John i and It, ". Gray, Jack I . "Now You See It ; Now You Don New York, 1973 (mimeographed)· Moss, Thelma; Johnson, Kendall; Gray, Jack; Hubacher' John; MacDonald, Roger; and Saba, Frances~ "Bioenergetics and Radiation Photography, paper presented at International Conference in Psychotronics, Prague, 1973 (mimeographed)· 96

Moss, Thelma, and Johnson, Kendall. "Electrons, Energy Flow, and Acupuncture," paper presented at National Institute of Mental Health, u. s. Conference on Acupuncture, Bethesda, Md., 1973 (mimeographed) .

Tiller, William A. "Unveiling the Mysteries of Kirlian Photography, 11 published in Proceedings of the A.R.E. Medical Symposium on New Horizons in Healing, Phoenix, Arizona, January 1974. APPENDIX A

DEMOGRAPHIC DATA SHEET 98

DEMOGRAPHIC DATA SHEET

NAME: AGE:

ROOM U:

CODE #:

PARA. ____ GRAVIDA ______

TYPE OF DELIVERY:

ANESTHESIA:

SEDATION: lo50THER St-~OKES?

MOniER TAKING NICOTINIC ACID?

ANY UNDERLYING DISORDERS?

HUSBAND PRESENT AT DELIVERY?

PRENATAL CLASSES?

EDUCATIONAL LEVEL: WI FE:

HUSBAND:

SEX OF INFANT:

INFANT STATUS: APGAR: APPENDIX B

MATERNAL ATTACHMENT ASSESSMENT TOOL 100

MATERNAL ATTACHMENT ASSESSMENT TOOL

Maternal-Infant Observation

Observation ground rules. 1. Observers should scrub when babies are on the floor.

2. Only one observer will be present in a room to watch one mother at a time. 3. Observer should enter the mother's room at least fifteen minutes before the baby is brought in.

4. The observer should attempt to become "part of the woodwork .. by not talking to the mother unless abso­ lutely necessary. Mothers can be told initially that the observer would like to watch quietly for fifteen minutes, then would be happy to talk to the mother and answer any questions. 5. The observer should try to stay in one place once seated. However, if the mother turns her back to the observer by rolling on her side, the observer should quietly change position so she can see. This should not be done more than once during the period. 6. The observer, using a timer, will watch the ~other for twenty seconds, then check all the behav1o:s on the schedule that occurred during the observat1on period. A forty-second period will_be used.to make the recordings. The observations w~ll cont~nue for fifteen minutes. 7· Observations will begin when the baby is brought in to the room. 101

MATERNAL ATTACHMENT ASSESSMENT TOOL

Definitions

State of infant

Quiet. Infant making no sounds or movements of arms, legs, or head. Eyes usually closed. Infant may be sucking. Active. Infant moving arms, legs, or head, or vocalizing or looking around in wide-eyed alert state (states 3 or 4). Crying. Infant in state 5 or 6, crying hard or fussing continuously. Single or infrequent vocalization not included as crying.

Mother nurses

Mother has infant at breast. Includes times when mother coaxes infant to suck, even if infant seems asleep.

Hother bottle feeds

Mother gives infant bottle lt>ther burps

Bother attempts to burp baby·

Bother uncovers or undresses baby infant•s skin. Definite moves by mother to expose . un Hay include removing blanket or

Bother holdinq infant . --or resting on her 1-'IOther has i nf ant 1 n her arms, ing in bed with one torso. :lot to inc 1 udc mother 5 1 Y an around infant lying next to her. 102

MATERNAL ATTACHMENT ASSESSMENT TOOL

Close contact

At least half the infant's body touching rnother•s trunk.

Baby on knees

r~other sitting with legs propped up and infant leaning on knees, or mother sitting up with infant lying on her knees.

Mother looks at infant

Mother's eyes on infant. May be a glance or a prolonged gaze.

En Face Mother's face parallel to infant•s in the same verti­ cal plane of rotation with mother•s eyes directed toward infant's eyes.

Encompasses Mother's upper arm, lower arm, and hand in contact with infant's body

Bother talks to infant Mother vocalizes to infant, including clucks, whisper~, and other noises. A-T-L · AnY extra touching Extra lovemaking or play behav1or · . of infant or infant • s clothes by mother • s fJ.nf~rs'0 excluding wiping baby's mouth ~ith cloth or er behaviors associated with feed1ng. l~other kisses infant Mother's lips brush infant's skin. 10 3

MATERNAL ATTACHMENT ASSESSMENT TOOL

Mother smiles at infant or in response to infant

Definite widening of mouth, heightening of eyebrows by mother with positive affect shown on face. Smile directed at observer not included.

Hother talks to adult

~ther talks to any adult, including observer.

Mother wa tchi nq T.V. Television on, mother's eyes directed at it.

Others present Adults besides mother present in room. May include roommate, nurse.

ft>ther lying down

l~other reclining in bed.

Hother leaning on e !bow l~ther reclining on side in bed with upper body supported by c lbow.

Mother sitting up though mother may be Upper body raised from bed, leaning back on support.

l')()ther occup1cd ·~ i th brca:; t milk from breast, touching Hother r..anually ,,xpclling putting cream on and explor i r.q brcas t ._., i th. f inge~s' breast or putt1nq on nursl.ng pa · ~t.ion '------Timonato ------Oxio ' TIME 1 2 ) 4 5 6 7 8 g 10 11 12 13 14 1.5 16 17 18 1.9 20 21 22 2] ~ i ,,. mr 1..n.f ~m '! lU;tfOfV'S r-~~1\."-1 ~~~Jt ~~·~1-:"h'~ !a:" ~;t ..1:o of In!U.K't•.'-1 .lt ti.'"':'C5 Ca:1)lcte .\tt. en Infant ...... t-\Jth•r l•;t~1 ~n 0 ~b t.i'c r 1c • .1.nir.q on e l.tx.Jw ~ Po':.h:!r sitting up ~bt!'t.!r r.ur~s oottlefeois burps un.:::u..·ers , urdresses t-bther tolds Infant close rontact encc:mpussing Infant on knees !obtier looks at Infant En face 1-btter talks to infant, sin;Js, c:xx>S A~L accessory touch/love kisses Infant smiles at Infant lwbtrer occupied with breast talks to adult - watcl)S!s t.v. ~rs present - 105

MATERNAL ATTACHMENT ASSESSMENT TOOL

Scoring Sheet

I. Affectionate Behavior A. Mother looks at infant enface B. Mother talks to infant, sings, coos C. Accessory Touch/Love Kisses infant Smiles at infant

Sub-score (A+B+C)

II. Proximity Maintaining Behavior

A. Holding infant B. Holding infant close C. Encompassing

Sub-score (A+B+C)

III .Caretaking Behavior

A. Mother nurses B. Mother bottlefeeds C. Mother burps infant D. Mother uncovers, undresses

sub-score (A+B+C+D)

IV. Mother • s Attention A. Total attention on infant B. Distracted at times - C. Easily distracted

sub-score (A-B-C) - Total Attachment ( I+II+III+IV) - 1\PPENDIX C

Tl\YLOR r·1.AHIFEST ANXIETY SCALE 107

BIOGRAPHIC INVENTORY

Do not write on this booklet in any way. Your answers to the inventory are to be recorded only on the separate answer sheet.

Print your nam~, the date, the date of your birth, age, sex, etc., 1.n the blanks provided on the Answer Sheet. Use only the special pencil provided for this test. After you have completed filling in the blanks, finish reading these instructions.

The statements in this booklet represent experi­ ences, ways of doing things, or beliefs or preferences that are true of some people, but are not true of others. Read each statement and decide whether or not it is true with respect to yourself. If it is true or mostly true, blacken the answer space in column T on the Answer Sheet in the row numbered the same as the statement you are answering. If the statement is not usually true or is not true at all, blacken the space in column .E. in the nlliOOered row. Answer the statement as carefully and honestly as you can. There are no correct or wrong . answers. We are interested in the way you work and J.n the things you be 1 i eve. Remember: Mark the answer space in column T if the statement is true or mostly true; mark the answer space in column F if the statement is false or mostly false. Be sure the space you blacken is in the row nwooered the same as the item you are answering. Mark each i tern as you come to it; be sure to mark . on:~ and only one, answer space for each i tern. Here l.S example: I would like to be an artist.T if If you would like to be an artist, that is, the statement 1· s true far as you are concerned, you as If the statement would mark the answer space under T· is false, you would mark the space under F • ask them now. If you have any questions, P 1 ease

DO NOT MARK ON THIS BOOKLET. 108

1. I am often sick to my stomach.

2. I think a great many people exaggerate their mis­ fortunes in order to gain the sympathy and help of others.

3. I do not tire quickly.

4. I have had very few quarrels with members of my family.

5. I am about as nervous as other people.

6. I would ra thcr win than lose in a game.

7. I have very few headaches.

8. I worry over money and business.

9. I work under a gr(~at deal of strain.

10. I think nearly anyone would tell a lie to keep out of trouble. 11. I cannot keep my mind on one thing·

12. I do not like everyone I know· ( .. the runs"} once a month or more 13. I have diarrhea 14. I am against qiving moneY to beggars.

15. I frequently notice my hand shakes when I try to do something. I meet new people. When 16 • I find it hard to make talk

17 • I blush as of ten as others· 18 0 off unt; 1 tomorrow what I • nee in a whi lc I put ..... ought to do today. 19 · I have night.r..arcs every few nights.

20 • People often disappoint me. 21 · bl troubles· • I worry qui tc a bit over poss~ e 109

22. Itmakes r.1e impatient to have people ask my advice or otherwise interrupt me when I am working on something important.

23. I practically never blush.

24. I like to know some important people because it makes me feel important.

25. I am often afraid that I am going to blush.

26. It takes a lot of argwnent to convince most people of the truth.

27. My hands and feet are usually warm enough.

28. I often find myscl f worrying about something.

29. I sweat very cas i l y even on cool days.

30. Hy table manners are not quite as good at home as when I am out in company. sweat which break out in a 31. When embarrassed I often is very annoying. I have under- aside a task that 32. I find it hard to set time. taken, even for a short 33. 1 do not often notice my heart pounding and I am seldom short of breath. 34. lt makes me uncomfortable to put on a stunt at a party even when others are doing the same sort of thing. 35. I feel hungry almost all the time. lf 36 • I could get into a movie without payiz:tg and be sure 1 was not seen I would probablY do Lt.

37. Often my bowels don't move for several days at a time. 38 · At tir.~es I feel like s.,.;earin9· 39 h trouble· · I ha·;e a grca t dca 1 of s tomac 110

40. At times I am full of energy.

41. At tilltes I lose sleep over worry.

42. I do not read every editorial in the newspaper every day.

43. ~!y sleep is res tlcss and disturbed.

44. Criticism or !Jcolding hurts me terribly.

45. I often dream about things I don • t like to tell other people.

46. I have often felt t:hat I faced so many difficulties I could not overcome them.

47. I am cas i 1 y embarrassed.

48. Sometimes when I am not feeling well I am cross.

49. My fee 1 i nq:; arc hurt cas ier than most people·

50. I often think "I wish I were a child again."

52. I wish I could be as happy as others ·

52. Often I can • t. undPr~-; tand why I have been so cross and grouchy .

53. I am usually calm and not easily upset.

54. I am vcr:y confident of myself.

55· I cry cas 11 y .

56. I ccrta1nly f,.~cl u1._;clc~.;s at times. ne almost 57. I f ce 1 anxiou:; auout t· .··,omething or someo all of the tir.:~. things· se. At tt~~cs I feel 1 1 kc ::.;m.:lshing

59. I tlr.i happy r-·.o:; l of th(! time. joke. 60. at a dirty Once in ,) -...·hi lt~ I laugh 111

61. It makes me nervous to have to wait.

62. At periods my mind seems to work more slowly than usual.

63. At times I am so restless that I cannot sit on a chair for very long.

64. Most people will use somewhat unfair means to gain profit or an advantage rather than to lose.

65. Sometimes I become so excited that I find it hard to get to sleep .

66. I do not always tell the truth.

67. At times I have been worried beyond reason about something that really did not matter.

68. I have often met people who were supposed to be experts who were no better than I.

69. I do not have as many fears as my friends·

70. What others think of me does not bother me.

71. I have been afraid of things or people that I knew could not hurt me.

72. I get angry sometimes. task or job. 73. I find it hard to keep my mind on a than I do now. 74. I have never felt better in my life most people. 75. I am more self-conscious than things. I stand on 76. I like to let people know where takes things hard. 77. I am the kind of person who

78. I gossip a little at times·

79 · I am a very nervous person· 8 have trouble thinking 0 · When in a group of people I of the right things to talk about· 112

81. Life is often a strain for me.

82. I get mad easily and get over it soon.

83. At times I think I am no good at all.

84. Once in a while I think of things too bad to talk about. 85. I am not at all confident of myself.

86. I have periods in which I feel unusually cheerful without any special reason.

87. At times I feel that I am going to crack up.

88. At times my thouqhts have raced ahead faster than I could speak. them.

89. I don't like to face a difficulty or make an impor­ tant decision. 90. Sometimes at. elections I vote for men about whom I know very 1 it tl c. 113

BIOGRAPHICAL INVENTORY KEYS

9 0 I t em AK L ( 19 6 l )

A Scale: Possible Score 50 21, 25, 28, 29, 1 11, 13, 15, 19, T responses: 1 1 8, 9 49, 11, ]5, 37, 39, 411 4 31 45, 46, 4 7' 71, 73, s 1, ss, 56, 57, 61, 6 31 6 5, 671 8 71 89 751 771 79, 811 8 3, 851 .591 69 2 31 271 33, 53, 54, F responses: ·~I s, 7 1 17,

T responses: 4 32,-34, 20, 22, 26, 28, 7 10, 141 16, F responucs: •~ I 81 621 64, 50, 521 56, 58, 38, 40, 44, 46, 80, 82, 86, 88 68, 701 7 41 76,

L Scale: Possible score 1.5 48 60 F responses: ;,, 12. 18, 24, 30, 36, 38, 42, • •

66, 72, 78, 84, 90 APPENDIX D

K I HLIA!,1 PHOTOGRAPHY 115

SCHEMATIC DRAWING OF KIRLIAN DEVICE

,, I) ()

··-·. - .:- ~. ---··· l1· >> ' l-..1 i :~ I,:.,..~. ,1 ... .~· 0 . L"' ...... ' ~ 115

SCHE~~TIC DRAWING OF KIRLIAN DEVICE

·.,. I \ ,. 'I f) " (.) ...... ' ~ ··. -~ .. ···N· ,, •• •• ·r-l ~~-,, ... ~ ,-,.._, ---~-·--·...... ____. I"' I ·- - :z. ~ & ,j: ·. .••-- r·~ ·-;..·"' Ill .....-+-~----·~. $ ;,'a ~ ~ ' -JV\r- .1\iv-

~0 ~-T ... b, ~ .. 0 •., •) • '-ri \! 0 ' !. ~ ~ .. '· --·~~- =-~ .. --.--.. ,.. ______...... ---··· ______, ..... / ...J

' ~·~ '.·.~ ~ ~~ ~'\\ ', ·.. ~~ " ,. . .

--~ ..,.. .. \,· 116

SCORING TECHNIQUE FOR RATING KIRLIAN PHOTOGRAPHS

SCORE DESCRIPTION OF CORONA

8 Spikes are longer than one-eighth of an inch and corona is clear, black, and dense

7 Same as 8. Corona not as dense, spikes have gaps.

6 Same as score of 8, except spikes are less than one-eighth of an inch in length. Coronas are complete.

5 Spikes are at least greater than one-sixteenth of an inch in length and corona is clearly visible, but less dense than those of 7 or 8. Corona may have gaps.

4 Spikes arc less than one-sixteenth of an inch in length and only faintly visible. Corona is still visible, but is less dense than 5 or corona may be absent, but spikes are still present. Corona is pale and 3 No spikes are visible. very dim. No corona is visible. 2 No spikes arc visible. some finger whorls may be 1 Smudges are visible. visible. If these finger whorls show up in any other t h actual rating prints, deduct one point from e of that print. APPENDIX E

ST,\TISTICJ\L FORMULAS USED 118

STATISTICAL FORMULAS USED

1) Chi-Square test 2 x2 = N (ad - be)

klmn

2) Point Biser ia 1 Cor relation

rpb -·

rpb 1--"N-2 t :::

l 2 1 - rpb

3) t-test for differences in means

t :::

correlation 4) Pearson Product-Moment NtXY - ( i: X) ( i: Y) r = 2 (LY)2 2 ) (I NEX -

of variance 5) Friedman's TWo-Way Analysis 2 xr = ----~~------12 l

PEt~ HISS ION FOR THE STUDY 120 TEXAS WOHAN'S UNIVERSITY

Human Research Committee t~al'!\e o! Investigator: Patricia Kay Coalson Avant Center: Denton

Address: 7601 Tallahassee Rd. Date: 4-27-78

~aco. Texas 76710

Your rstudy en tit 1 cd Maternal Attachment and Anxiety: An Exploratory Study has been reviewed by 1\ commi ttce of the Human Research Review Committee and it 4pp~4rn to r.-.~·ct our requirements in regard to protection of the individual'!' ri9htn. Ploanc be rcni nctod thcl t hoth the University and the Department of nealth, rducntion nnd Wclf.1rc regulations require that written eonsonta ~unt hto o..,t.,inccl fror:1 all human subjects in your studies.

Theao fomn rurst h{" l:,..pt on f i lP. by you.

f"urtht-m()rc, r.houlc! your project change, another review by the Cor.r.'litl~r ir. r~fluircd, ,,ccorcHnq to DHEW regulations.

Sincerely, C.k. ~ Chairman, Human Research Review Committee at Denton

cc: Cudu•tt Off lee 121 •l'EXAB \\TOMAN'S UNIVERSITY

May 10, 1978

Hn. Plltricl" K-.'1)' Av.tnt 7601 TallAhutsc-t" \laco, Tu1111 76710

Dear Hra. Avnnt:

Thank you very cuc-h !or n«-nd1ng \Jr1t ten authorization of clearance.

1 have plaC'~d thr cl.-nrnnrcr "1th tlw prospectus of your study and bnt note-d thAt Hn~d AJ1pruvnl hnn 00\J been given the prospectus.

1 loo)r. forvArd to nrnlnF: the rrnulto of your study.

Sincerely yours, /{:}L~~.· ~ p~dges Dean of the Graduate School

PB:ab

C't: nr. Annr C:ur4lr1r!lciPrn 'iunln& Center CrA~uatt- Of!Sct" 122 TEXAS ~OMAN'S UNIVERSITY

(Fora A·· \Jrltten pr~sentfttion to subject)

~~~!!~SubJect f£I Research ~Investigation:

(The follovlng ln!orcatlon ia to be rend to or read by the subject):

1. 1 hcrt!b)' author lze Kay Avant (N~e of peroon(s} who will perform procedure(s) or investigation(s)

to ;>f:rfor:: the- !oll<11o1lnK procedurc(s) or investt~Ation(s): (~scrt~c ln deta1l) . This stud)' is designed to investigate whether or not there is any relauoruhip betwe-en how a new roother and her baby get acquainted with one another ard the mthcr's level of anxiety or nervousness. If ·you choose to perticip.:ate in the !'tud)', there will be three different measures used: The first De.:asure is n qucstionn.nire with ninety true-false questions in it about how )"'U are fe-e 1 ing tod.ny. 'nle sc-cond mcnsure is collected by the investigator and is made during ~first f1fteen ~inutcs of the baby's feeding time. The investigator will sit quietl)' in A ch.dr ncnr )'OUr bed nnd watch you and the baby while he/she eats.

Tho third me.nsure is n "picture" of the end- of your right index finger. . It will be m.'\de b)' the inve~a ign tor, using a device called a "Kirlian apparatus·" ~ vill dc::cn!>trnte this to )"'U nnd show you a sample of what the pictures look like if )"t)U vhh. 1\.'0 pictures will be made: the first before the baby comes to bco fed, And the se-cond nftcr the baby is fed but before he/she leaves your roan. All ~c of these rnc-.n!'ures will be collected today and again day after tomorrow.

•tcd in Parngrnph l has been explained 2. The.> vrocrdllfl' ('f ln·.·r•tl;t•tlon ll .. to ~· by K,'l\' ,\VC ) l ntlons described in ). ( •) un(!f'rJt anl! '!.hAl the rr C'ccrhJrctl or I nvcRt g. k r discomforts: 9 0 tar•~~:ra~h l in·:rtl".·r thr !ollc.,..tin~ posRi.ble rts

(tapoc r H:r 1 n b·t "' 1) r t 1.. when the .Kirlian 1) I T.l.1)' ft"'Cl a very ~light tingling sensation on my mger P . fhotor:rarh i~ taken. that 1 am not';embarrassed as a 2) I undcr~t4"lnd th.'l t Mrs. Avant "·ill assure re~ult of particip.1tion in this study. 12 3 TEXAS WOMAN'S UNIVERSITY

(1-"onu 1\ Continunti.ua) l.(b) 1 understand tl1at the proccdurcs nnd investigations described in P;n·:~grnph 1 h;tVI' the following potential benefits to myself and/or 0thC'r:~: 1) Identification of faulty maternal-infant interaction while mother-infant pair are hospitalized where nursing intervention can be provided. 2) Identification of the role which anxiety may play in fostering/hindering the TOOther-infant interaction process. 3) l~tential for early identification of mother-infant pairs at high risk for child abuse and/or failure to thrive.

'•. An L'f(£~r to ;m~wC'r nll of my questions regarding the study has been :nadc.. lf altt·rnntivl' pr<.lcedures are more Advantageous to me, they h:~vC' !>t•f'n l'xpl:iim•

Ihttt•

(lf the subject is" minor, or othcrwi9l: unnble to sign, complete the fol t uwin~):

Suh'wct ls a m luor ( agv ___ ), or is unAb I e to sign because:

Sign:ttures (om• required)

F :~Lher Date

MothPr --·------DntL~

l:uurdlt~~l------·---·------::IJ-n7t-._.------124 1 1l:X.AS WO!-!,\N ":' UNIVERSITY

COLT.EGE liF NUR!aNG

-··------· ---·(inotit-;,t ion---;:;-.; ag(mcy)-·------

-- ·--· ------(student) ------

enrolled 1n a progra.m of nursing lnading to e Doctor of PhiloarJphy di!grt!c at Tc}:as Woman 1 a Un1vera:1.ty, the privilegP.. nr lt~ facillti~o in ~rder to atudy the following problem:

A copy o( the proposal :i.a ar.taC'hed.

l - ) _) •. ?~ -·-"·· .... - . ---·---·-·----.. ------.

1~111 out and si~1 three cotdes tn be distributed aa follows: Original Student First cnpy ARency SE-'cond copy T.W.Il. Cullego of Nurt-ltng

17