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University Microrilnns International 300 N /HFB HOAD, ANN ARBOR, Ml 3B100 1K BFDFORD ROW, LONDON WC1R ■IflJ, ( NOLAND 791597!. FORMAN, MICHAEL ALAN SPECIFICITY OF IRRATIONAL ATTITUDE PATTERNS IN PSYCHOPHYS10LOG1CAL DISORDERS: A DESCRIPTIVE STUDY. THE OHIO STATE UNIVERSITY, PH.D., 1979 University M icrofilm s International •TOO N / 1 I H H O A O . A N N A H U O H . Ml '1HKM. @ Copyright hy Michael Alan Forman 1979 SPECIFICITY OF IRRATIONAL ATTITUDE PATTERNS IN PSYCHOPHYSIOLOGICAL DISORDERS: A DESCRIPTIVE STUDY DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Michael Alan Forman, A.B., M.S. The Ohio State University 1979 Approved By Reading Committee: Donald J. Tosi Herman J. Peters Peter H. Gwynne adviser Department of Counselor Edfucation ACKNOWLEDGEMENTS Create ideas with humility knowing that behind the idea he calls his own are thoughts and efforts of many men. -- W. A. Peterson I wish to express my indebtedness to all the physicians and their associates who cooperated in this venture, while special thanks are extended to Dr. David R. Rudy, Director of the Riverside Family Practice Center, whose generous assistance in this research endeavor was appreciated. I am grateful for the support of my academic advisor, Dr. Donald J. Tosi, whose wit and guidance has inspired me to believe in myself and to persevere in the face of difficulties. Special thanks goes out to Keith Widaman for hio invaluable statistical consultation; to my friend and colleague, Dr. Dennis Eshbaugh, for his encouragement and enumerable clarifying comments; to Judy Boggs who spent many long hours typing this manuscript. I would also like to thank the many cooperative patients suffering from psychosomatic disorders. Without their participation and interest, the study would not have been possible and I hope this investigation will be helpful to them. I am grateful to all those who have helped, but my deepest appreciation goes to my family for their investment in me. To my parents, Bernard and Lois Forman; grandparents, Henry and Birdie Faye Raff; to my parents-in-laws, William and Dea Brandon and Maurice and Magda Waldman; and of course my wife, Debi, whose patience and love helped to make it all worthwhile. iii VITA August 16, 1952. Born - Chicago, Illinois 1972 .............. Medical Researcher, Pox River Hospital, Chicago, Illinois 1973-1974.......... Psychiatric Team Worker, London Memorial Hospital, Chicago, Illinois 1974 .............. A.B., Psychology, Indiana University, Bloomington 1975 .............. Counselor, University Middle School, Practicum, Indiana University, Bloomington 1975 .............. M.S., Counseling and Guidance, Indiana University, Bloomington 1975 ........ Program Consultant, Council for Retarded Citizens, Columbus, Ohio 1975-197 9 .......... Psychological Intern, Dr. Henry Samuels, Riverside Psychological Services, Columbus, Ohio 1976-197 9 .......... Psychological Intern, Community Agency for Labor and Management, Columbus, Ohio FIELDS OF STUDY Major Field: Counselor Education Studies in Counselor Education. Professor Donald J. Tosi Studies in Counselor Education. Professor Herman J. Peters Studies in Psychiatry. Professor Peter H. Gwynne, iv Vita - continued Studies in Developmental Psychology. Professor Henry Leland Studies in Clinical/Counseling Psychology. Professor Harold J. Pepinsky v TABLE OP CONTENTS Page ACKNOWLEDGEMENTS................................. ii VITA. ................................... iv LIST OP TABLES................................... viii LIST OF FIGURES................................. x Chapter I. Introduction ............................. 1 Need For The Study..................... 4 Purpose Of The Study................... 8 Hypotheses...................... 8 Limitations Of The Study.............. 9 Definitions Of Terms................ 11 II. Review Of The Literature................. 14 Historical Remarks: The Mind-Body Problem. .............. 14 Psychogenesis ...... ............ 20 Cardiovascular System - Migraine Headache .......o...... 29 Classification. ......... 29 Pathophysiology.............. 32 Personality Attributes.......... 34 Musculoskeletal System - Psychogenic Low Back Pain. .......... 46 Classification and Pathophysiology.............. 46 Personality Attributes.......... 50 Gastrointestinal System - Duodenal Ulcer............................... 66 Classification and Pathophysiology.............. 66 Personality Attributes.......... 69 vi. Page III. M e t h o d .................................... 82 Selection Of The Instrument.......... 82 Selection Of The Sample ........ 85 Procedure . .............. 89 Statistical Analysis. ................ 91 Research D e s i g n .................... 92 Summary ................ 93 IV. Analysis Of The D a t a ..................... 95 Factor Analysis ..................... 95 Analysis Of Variance.......... 100 V. Summary, Conclusions And Recommendations . 117 Summary 117 Discussion And Implications ...... 121 Recommendations ............ ..... 126 APPENDIXES A. Summary Of Conversation Held With The Patients........................... 135 B. Cover Letter/Consent Form................. 137 C. Personal Data Questionnaire. ............. 138 D. Common Beliefs Survey III. ......... 140 E. Common Beliefs Survey III: Parcel And Factor Membership Of Items. .... 144 LIST OF REFERENCES............................... 149 -ii LIST OP TABLES Table Page 1. Relations Between Stimuli, Persons, and Responses, Described in Different Languages.......................... 22 2. Sample Characteristics .......... 87 3. Univariate F-Tests of Groups Main Effect for CBS III Factors ..... ... 101 4. Mean Scores for Ss Performance on Factor V of the CBS III. ......... 102 5. Univariate F-Tests for the Combined Psychosomatic Groups Versus the Medical Control Group on Six Dependent Factors . 103 6. Results of Duncans New Multiple Range Test on all Ordered Pairs of Means for Factor I I I .................. 105 7. Results of Duncans New Multiple Range Test on all Ordered Pairs of Means for Factor V .............. 105 8. Univariate F-Tests of Groups Main Effects for Age and Socioeconomic Status . 107 9. Mean Age For Groups................ 107 10. Mean Socioeconomic Status for Groups . 107 11. Results of Duncans New Multiple Range Test on all Ordered Pairs of Means for Age............ 108 12. Results of Duncans New Multiple Range Test on all Ordered Pairs of Means for Socioeconomic Status ................ 109 viii Table Page 13. Correlation Matrix For 18 Parceled Variables. ........ .............. 111 14. Varimax Loadings of 18 Item-Parcels on 6 Factors .................... , . 114 15. Promax Loadings of 18 Item-Parcels on 6 Factors .................... , . 115 16. Interfactor Correlation Matrix ...... 116 ix LIST OF FIGURES Page Figure 1 Scree Test For Factors............ 97 x CHAPTER I INTRODUCTION "It is more important to know what sort of person has a disease than to know what sort of disease a person has." Hippocrates apparent overstatement is actually quite profound. Once again, the patient as a human being with worries, fears, hopes, despairs, as an individual whole and not merely the bearer of organs - of a diseased liver or stomach - is becoming the legitimate object of medical interest (Alexander, 1950). From a historical perspective, this renewed psychological interest is nothing more than a revival of old philisophic views in a new and scientific form. Psychosomatic medicine once again has been emerging in the past few decades from the dichotomous fallacies based on Cartesian dualism between the mind and the body into a fertile