Psychological Reports, 1975, 37,859-870. @ Psychological Reports 1975
SOME EFFECTS OF LESION LEVEL, A N D EMOTIONAL CUES ON AFFECTIVE EXPRESSION I N SPINAL CORD PATIENTS THEODORE M. JASNOS Elmcrest Psychiatric Institute Portland, Conn.
AND
KARL L. HAKMILLER' Universiry of Connecticu;
Summary.-The effect of peripheral change on emotional expression was examined in 24 males with functionally complete uansections of the spinal cord. The higher the level of lesion, the greater was the assumed restriction of afferent return from manipulated peripheral change. Consistent with expectations based on Schachter and Singer's (1962) theory of emotion, less intense feelings of arousal were expressed by subjects with higher (cervical) lesions than by subjects with lower (thoracic and lumbar) lesions. Also, expressed arousal to high and low emotion-relevant situations was similar among subjects with cervical lesions but differentiated those with lower lesions. Possible artifactual effects of several individual differences on expressed emotion were examined. None were significantly related to either lesion level or rated arousal.
In 1884, James equated emotion with the feeling of bodily changes following the perception of an exciting fact. While James identified the perception of visceral changes as the emotion, Lange (1885) emphasized the role of changes in the vasomotor system. Both theorists, however, shared a common emphasis on the importance of peripheral responses in emotion. Cannon's (1927) attack on the James and Lange formulations was, in part, based on early evidence that anatomical restriction of afferent feedback from the periphery did not appear to alter affective behavior. Sherrington (1900) reported unimpaired emotional response in a sample of sympathectomized dogs. Cannon, et al. (1927) observed a sympathectomized cat exhibit rage when presented with a barking dog. In addition, Dana (1921) observed apparently normal emotionality in one patient with a functionally complete wansection of the spinal cord at the cervical level. Two more recent studies have also examined affective experience in human accident victims with transections at varying levels of the spinal cord. McKelligott (1959) collected sevexal measures of individual differences from a sample of spinal-cord patients and found differences suggesting a decrement in reported 'Thanks are due to the individuals and hospitals who provided subjects and research space. Included ate Katherine C. Ill, M.D., New Britain Memorial Hospital; Thomas Hines, M.D., and Wllliam Baird, Gaylord Hospiral; Endte K. Brunner, M.D., Rutland Heights Hospital; Benjamin Woll, M.D., Lemuel Sharmck Hospital; Murry M. Freed, M.D., University Hospital. This study was funded by the University of Connecticut Research Foundation, Grant No. 5.171-000-06-0215-35-136, Karl L. Hakmiller, principal investigator. Requests for reprints should be directed to H h i l l e r , Department of Psychology, University of Connecticut, Storrs, Connecticut 06268.
860
T. M. JASNOS
&
K. L. HAKMILLER
affect as lesion level increased toward the cervical region. In a scudy by Hohmann (1966), patients were asked to compare their emotional experiences before and after injury. H e observed that the incidence of reported decreases in affect associated with anger, fear, and sexual excitement was directly related to the level of spinal cord lesion. The higher the lesion, the greater the reported decrease in affective experience since the injury. Hohmann's daca are relevant to the modified peripheral theory of emotion published by Schachter and Singer ( 1962 ). According to this theory, affective behavior may be viewed as a joint function of awareness of physiological arousal and cognitive interpretation of thac arousal. Perceived changes in physiological arousal are assumed to demand interpretation at the cognitive level. Available situational information is thought to be utilized in a cognitive attempt to explain or label the cause of the physiological arousal. If the apparent cause of the arousal is one which the individual has learned to label "emotion-inducing," then a report of an emotion will follow. Thus, both a state of physiological arousal and cognitions suggestive of affect are thought to be necessary conditions for the occurrence of emotional experiences. If persons differ in the extent to which they are aware of peripheral physiological arousal, this theory would predict differences in their experience and report of affective reactions. As lesion level increases toward the cervical region, it would be expected that the extent of awareness of peripheral arousal would decrease. Hence, as Hohrnann's results suggest, higher lesions would be associated with a decrease in experienced emotions. In the present scudy, it was hypothesized that: ( a ) The amount of expressed affect will decrease as the level of lesion increases, and ( b ) subjects with lower level lesions will be more responsive to differences in the affective content of the stimulus situation than those with higher level lesions. A boundary condition must be met to provide a fair test of these hypotheses. This condition, in terms of Schachter and Singer's (1962) theory, is that the tasks must elicit peripheral changes sufficient to instigate self-evaluative tendencies. Data are presented which indicate thac this condition was established by the experimental task.
METHOD Szrbjectr The subjects were 24 male accident victims who had suffered severe damage to the spinal cord resulting in complete motor and sensory paralysis. The criteria for contacting a patient for participation in the study were: ( a ) clinical evidence of functionally complete motor and sensory paralysis at a level corresponding to the patient's injury, ( b ) no evidence of cerebral impairment or inability to follow instructions, and ( c ) good over-all physical condition. Prior to participation the subjects were informed of the gzneral procedure, assured that the daca would
861
SPINAL LESION AND EMOTION
be held in confidence, and offered five dollars for their participation. Of those contacted, only four patients declined to participate in the study. The subjects were classified in three categories on the basis of lesion level: cervical, thoracic and lumbar. Because of the scarcity of patients with lumbar injuries, four patients with spinal cord transections at T12 (lowest thoracic vertebra) were included in the lumbar group. The distribution of lesion levels in each condition and additional subject information is presented in Table 1. A $paratas The subjects were either seen in a room provided by the participating hospital or at their current residence (Table 1). In either case, the room selected TABLE 1 BY ANALYSIS GROUP SUBJECT INFORMATION CLASSIFIED Lesion level
Sire of tesung'
Age
C6 C6 C6 C6 C5 C5 C7 C5
H H H H H H H H
43 26
7-11 T9 TS TI1 T7 T1 T9 T7
R
54 49 27 58 30 25 23 40
Months since injury
Drugst
Memory score$
-
+ + + + +
94.5 72.5 104.0 92.5 112.5 96.0 129.0 91.0
-
90.5 95.5 64.0 81.5 73.0 124.5 108.0 98.0
Cervical
17 44 39 26 18 21
326 96 5 10 266 87 23 65 Thoracic
R H H R R R H
61 44 36 4 25 50 23
4
+ + + + +
Lumbar
T12 T12 T12 L1 L1 L1 T12 L1
24 78 128.0 49 25 105.5 23 61 110.0 H 18 4 111.0 H 23 13 87.0 R 27 43 103.0 R 22 21 106.5 R 47 32 99.0 'R signifies residence, H signifies hospital. t + indicates that the subject was using medication with potentially sedative effects. $Based on the digit span and paired-associate sections of the Wechsler Memorg S a l e . R R H
-
862
T. M. JASNOS
&
K. L. HAKMILLER
afforded the subjecc privacy. A rear-view projection screen and carousel slide projector was positioned either on the floor next to the subject's bed or chair, or on a table. A tape recorder and portable clinical cardiograph were placed outside of the subject's line of vision to the screen. Afrer the preliminary description of the procedure the experimenter attached the cardiograph electrodes and explained the function of this apparatus while doing so. The subjecc was then given a detailed description of the procedure. These instructions were followed by a practice trial and corrective comments before proceeding to the eight-trial experimental task. The subject was told that the task involved mentally imagining himself to be in a particular situation and then describing his feelings. H e was asked to visualize himself in the situation depicted on each of several slides under circumstances to be described by the experimenter. Both the content of the photographic slides and verbal statements read by the experimenter shortly after the appearance of each slide were to be used as sources of information for this visualization. Planned variations in the slides and verbal statements provided the means of manipulating the affective content of the task trials although, of course, this was not mentioned to the subjects. The experimenter read the verbal statements immediately following the onset of each stimulus slide. Each statement required about 13 seconds to read. Approximately 20 sec. after the onset of the stimulus slide the experimenter asked: "What are some of your thoughts and feelings?" The time interval following was variable depending on the length of the subject's response. Probes were interjected to encourage a more lengthy response or to focus a subject's report on his thoughts and feelings. The first probe was: "Is there anything else?" If the subject's response became non-descriptive of his feelings, a more directive probe was used: "What are some of your feelings?" These reports were tape recorded for later coding. The subject then verbally rated the attractiveness of the slide just seen. A blank interval of about 20 sec. preceded the onset of the next slide trial. This procedure was repeated for the eight slide trials. Heart rate was recorded continuously throughout. Following the eight trials a variety of supplementary data were collected. These included a forced choice test for recall of certain features of the stimulus stides and verbal statements, a mood adjective checklist adapted from Radloff and Helmreich ( 1968), and a portion of the Wechsler Memory Scale. The subject was also asked to think back to and describe what he considered to be his most intense experience of anger, irritation, or fear since his injury. These descriptions were also tape recorded for later analysis.
SPlNAL LESION AND EMOTION
Slide Content The content of four of the slides consisted of views of a single female who had either been visibly injured or who could be described as having a hidden injury. The content of the other four slides was of either clothed or nude females. Two colored slides of nude women, previously assigned high ratings on arousal dimensions by intact judges, were selected as high arousal slides. Two colored slides which depicted clothed women who were conservatively dressed in knit sweaters were used as low arousal slides. Data from the injury slides will not be presented in this report since no significant effects appeared (Jasnos, 1970). Two high emotion-relevant cue statements asked the subject to imagine that he was alone with the woman on the slide and indicated that she was sexually available. In the two low emotion-relevant cue statements, another male was supposedly showing the subject the picture in a magazine while among a group of friends.
Design Level of spinal cord lesion defined the between-subject factor. There were eight subjects in each of the three conditions (cervical, thoracic, and lumbar). Each subject was exposed to all four factorial combinations of slide content and situational cue. The presentation order of these four treatments was counterbalanced in a Latin square. Since the number of available patients was insufficient to counterbalance completely the order of the nude and injury blocks, the injury slide block always preceded the nude slide block. RESULTS Heart Rate During Verbal T a ~ k The electrocardiograph recordings were scored in beats per five second interval. The mean number of beats per 5-sec. interval for a given response period was used as the data for analysis. To provide evidence a b u t the necessary boundary condition that the verbal task effectively elicited peripheral heart-rate change, comparisons were made between the average heart rate observed in the inter-trial interval prior to slide onset (first heart-rate response period) and the verbalization period in which the subject described his thoughts and feelings (second heart-rate response period). The heart-rate averages for each subject were summed over the stimulus potency and situational cue variation. These data were then analyzed with 3 X 2 analysis of variance with repeated measures on the second factor. The three spinalcord-lesion groups defined the first factor and heart-rate response period the second factor. As expected, the main effect of response period on heart rate was significant
864
T. M. JASNOS
&
K. L. HAKMILLER
( F = 63.09, p < ,001). Examination of the data showed that heart rate consistently increased from the preslide period to the ~ostslideverbalization period. The average increase in heart rate across all conditions was 5.4 beats per minute, with an average heart rate during the verbal response ~ e r i o dof 94 beats per minute. These data were fully consistent with the methodological requirement that peripheral activity changes occur during the second response period. AS expected, there were no significant differences attributable to lesion level or to an interaction of lesion level and response period. W e may assume, then, that at the periphery all subjects were aroused to an equivalent degree by some aspect of the task as required for a test of the hypotheses. Ratings of Expressed Affect The tape recorded feeling descriptions for each trial were typed on file cards and the coded condition designations concealed. The subjects' descriptions were then rated by 13 undergraduate psychology majors at Holy Cross College. The judges were uninformed as to the hypothesis and design of the study. These judges were instructed to assign ratings which "best describe the most intense level of emotion indicated by the protocol." Five category arousal and discomfort scales were employed for these ratings. Each interval was labeled with illustrative adjectives. The order in which these protocols were rated was random and differed for each judge. In addition, the order in which successive judges rated the protocols on arousal and discomfort was alternated. Pearson product-moment correlations were computed for all possible pairs of 13 judges. An average interjudge correlation of .712, indicating a high level of agreement among the judges, was obtained on the arousal dimension. The average interjudge correlation on the discomfort dimension was .520, perhaps indicating somewhat greater difficulty in rating the protocols on this dimension. The ratings of the 13 judges were summed to obtain an arousal score for each protocol. These scores were analyzed using a 3 X 2 X 2 analysis of variance with repeated measures on the last two factors. Lesion-level group was the between-subjects factor while the last two factors were defined by the slide content and situational cue variations. The analysis of the arousal ratings (Table 2 ) gave a significant main effect of lesion level ( p < .05). These differences were as expected under the first hypothesis. The cervical group expressed least intense arousal, followed by the thoracic and the lumbar group (which expressed the most intense arousal). In addition, there was a significant interaction of Lesion-level X Slide Content ( p < .05) as predicted by the second hypothesis. Moreover, an analysis of this interaction showed that the simple main effect of slide content shown to patients with thoracic and lumbar lesions was significant ( p < .01) while the simple main effect of slide content for those lesioned at the cervical level was
SPINAL LESION AND EMOTION TABLE 2
REPEATED-MEASLTES ANALYSIS OF VARIANCE: AROUSAL RATINGS df
Source
-
Between Subjeccs Level ( A ) Error Within Subjeccs Contenc ( B ) A x B Error Cue ( C )
2 21
583.51 130.25
P
F
MS
-
---
--
4.48
SOME EFFECTS OF LESION LEVEL, A N D EMOTIONAL CUES ON AFFECTIVE EXPRESSION I N SPINAL CORD PATIENTS THEODORE M. JASNOS Elmcrest Psychiatric Institute Portland, Conn.
AND
KARL L. HAKMILLER' Universiry of Connecticu;
Summary.-The effect of peripheral change on emotional expression was examined in 24 males with functionally complete uansections of the spinal cord. The higher the level of lesion, the greater was the assumed restriction of afferent return from manipulated peripheral change. Consistent with expectations based on Schachter and Singer's (1962) theory of emotion, less intense feelings of arousal were expressed by subjects with higher (cervical) lesions than by subjects with lower (thoracic and lumbar) lesions. Also, expressed arousal to high and low emotion-relevant situations was similar among subjects with cervical lesions but differentiated those with lower lesions. Possible artifactual effects of several individual differences on expressed emotion were examined. None were significantly related to either lesion level or rated arousal.
In 1884, James equated emotion with the feeling of bodily changes following the perception of an exciting fact. While James identified the perception of visceral changes as the emotion, Lange (1885) emphasized the role of changes in the vasomotor system. Both theorists, however, shared a common emphasis on the importance of peripheral responses in emotion. Cannon's (1927) attack on the James and Lange formulations was, in part, based on early evidence that anatomical restriction of afferent feedback from the periphery did not appear to alter affective behavior. Sherrington (1900) reported unimpaired emotional response in a sample of sympathectomized dogs. Cannon, et al. (1927) observed a sympathectomized cat exhibit rage when presented with a barking dog. In addition, Dana (1921) observed apparently normal emotionality in one patient with a functionally complete wansection of the spinal cord at the cervical level. Two more recent studies have also examined affective experience in human accident victims with transections at varying levels of the spinal cord. McKelligott (1959) collected sevexal measures of individual differences from a sample of spinal-cord patients and found differences suggesting a decrement in reported 'Thanks are due to the individuals and hospitals who provided subjects and research space. Included ate Katherine C. Ill, M.D., New Britain Memorial Hospital; Thomas Hines, M.D., and Wllliam Baird, Gaylord Hospiral; Endte K. Brunner, M.D., Rutland Heights Hospital; Benjamin Woll, M.D., Lemuel Sharmck Hospital; Murry M. Freed, M.D., University Hospital. This study was funded by the University of Connecticut Research Foundation, Grant No. 5.171-000-06-0215-35-136, Karl L. Hakmiller, principal investigator. Requests for reprints should be directed to H h i l l e r , Department of Psychology, University of Connecticut, Storrs, Connecticut 06268.
860
T. M. JASNOS
&
K. L. HAKMILLER
affect as lesion level increased toward the cervical region. In a scudy by Hohmann (1966), patients were asked to compare their emotional experiences before and after injury. H e observed that the incidence of reported decreases in affect associated with anger, fear, and sexual excitement was directly related to the level of spinal cord lesion. The higher the lesion, the greater the reported decrease in affective experience since the injury. Hohmann's daca are relevant to the modified peripheral theory of emotion published by Schachter and Singer ( 1962 ). According to this theory, affective behavior may be viewed as a joint function of awareness of physiological arousal and cognitive interpretation of thac arousal. Perceived changes in physiological arousal are assumed to demand interpretation at the cognitive level. Available situational information is thought to be utilized in a cognitive attempt to explain or label the cause of the physiological arousal. If the apparent cause of the arousal is one which the individual has learned to label "emotion-inducing," then a report of an emotion will follow. Thus, both a state of physiological arousal and cognitions suggestive of affect are thought to be necessary conditions for the occurrence of emotional experiences. If persons differ in the extent to which they are aware of peripheral physiological arousal, this theory would predict differences in their experience and report of affective reactions. As lesion level increases toward the cervical region, it would be expected that the extent of awareness of peripheral arousal would decrease. Hence, as Hohrnann's results suggest, higher lesions would be associated with a decrease in experienced emotions. In the present scudy, it was hypothesized that: ( a ) The amount of expressed affect will decrease as the level of lesion increases, and ( b ) subjects with lower level lesions will be more responsive to differences in the affective content of the stimulus situation than those with higher level lesions. A boundary condition must be met to provide a fair test of these hypotheses. This condition, in terms of Schachter and Singer's (1962) theory, is that the tasks must elicit peripheral changes sufficient to instigate self-evaluative tendencies. Data are presented which indicate thac this condition was established by the experimental task.
METHOD Szrbjectr The subjects were 24 male accident victims who had suffered severe damage to the spinal cord resulting in complete motor and sensory paralysis. The criteria for contacting a patient for participation in the study were: ( a ) clinical evidence of functionally complete motor and sensory paralysis at a level corresponding to the patient's injury, ( b ) no evidence of cerebral impairment or inability to follow instructions, and ( c ) good over-all physical condition. Prior to participation the subjects were informed of the gzneral procedure, assured that the daca would
861
SPINAL LESION AND EMOTION
be held in confidence, and offered five dollars for their participation. Of those contacted, only four patients declined to participate in the study. The subjects were classified in three categories on the basis of lesion level: cervical, thoracic and lumbar. Because of the scarcity of patients with lumbar injuries, four patients with spinal cord transections at T12 (lowest thoracic vertebra) were included in the lumbar group. The distribution of lesion levels in each condition and additional subject information is presented in Table 1. A $paratas The subjects were either seen in a room provided by the participating hospital or at their current residence (Table 1). In either case, the room selected TABLE 1 BY ANALYSIS GROUP SUBJECT INFORMATION CLASSIFIED Lesion level
Sire of tesung'
Age
C6 C6 C6 C6 C5 C5 C7 C5
H H H H H H H H
43 26
7-11 T9 TS TI1 T7 T1 T9 T7
R
54 49 27 58 30 25 23 40
Months since injury
Drugst
Memory score$
-
+ + + + +
94.5 72.5 104.0 92.5 112.5 96.0 129.0 91.0
-
90.5 95.5 64.0 81.5 73.0 124.5 108.0 98.0
Cervical
17 44 39 26 18 21
326 96 5 10 266 87 23 65 Thoracic
R H H R R R H
61 44 36 4 25 50 23
4
+ + + + +
Lumbar
T12 T12 T12 L1 L1 L1 T12 L1
24 78 128.0 49 25 105.5 23 61 110.0 H 18 4 111.0 H 23 13 87.0 R 27 43 103.0 R 22 21 106.5 R 47 32 99.0 'R signifies residence, H signifies hospital. t + indicates that the subject was using medication with potentially sedative effects. $Based on the digit span and paired-associate sections of the Wechsler Memorg S a l e . R R H
-
862
T. M. JASNOS
&
K. L. HAKMILLER
afforded the subjecc privacy. A rear-view projection screen and carousel slide projector was positioned either on the floor next to the subject's bed or chair, or on a table. A tape recorder and portable clinical cardiograph were placed outside of the subject's line of vision to the screen. Afrer the preliminary description of the procedure the experimenter attached the cardiograph electrodes and explained the function of this apparatus while doing so. The subjecc was then given a detailed description of the procedure. These instructions were followed by a practice trial and corrective comments before proceeding to the eight-trial experimental task. The subject was told that the task involved mentally imagining himself to be in a particular situation and then describing his feelings. H e was asked to visualize himself in the situation depicted on each of several slides under circumstances to be described by the experimenter. Both the content of the photographic slides and verbal statements read by the experimenter shortly after the appearance of each slide were to be used as sources of information for this visualization. Planned variations in the slides and verbal statements provided the means of manipulating the affective content of the task trials although, of course, this was not mentioned to the subjects. The experimenter read the verbal statements immediately following the onset of each stimulus slide. Each statement required about 13 seconds to read. Approximately 20 sec. after the onset of the stimulus slide the experimenter asked: "What are some of your thoughts and feelings?" The time interval following was variable depending on the length of the subject's response. Probes were interjected to encourage a more lengthy response or to focus a subject's report on his thoughts and feelings. The first probe was: "Is there anything else?" If the subject's response became non-descriptive of his feelings, a more directive probe was used: "What are some of your feelings?" These reports were tape recorded for later coding. The subject then verbally rated the attractiveness of the slide just seen. A blank interval of about 20 sec. preceded the onset of the next slide trial. This procedure was repeated for the eight slide trials. Heart rate was recorded continuously throughout. Following the eight trials a variety of supplementary data were collected. These included a forced choice test for recall of certain features of the stimulus stides and verbal statements, a mood adjective checklist adapted from Radloff and Helmreich ( 1968), and a portion of the Wechsler Memory Scale. The subject was also asked to think back to and describe what he considered to be his most intense experience of anger, irritation, or fear since his injury. These descriptions were also tape recorded for later analysis.
SPlNAL LESION AND EMOTION
Slide Content The content of four of the slides consisted of views of a single female who had either been visibly injured or who could be described as having a hidden injury. The content of the other four slides was of either clothed or nude females. Two colored slides of nude women, previously assigned high ratings on arousal dimensions by intact judges, were selected as high arousal slides. Two colored slides which depicted clothed women who were conservatively dressed in knit sweaters were used as low arousal slides. Data from the injury slides will not be presented in this report since no significant effects appeared (Jasnos, 1970). Two high emotion-relevant cue statements asked the subject to imagine that he was alone with the woman on the slide and indicated that she was sexually available. In the two low emotion-relevant cue statements, another male was supposedly showing the subject the picture in a magazine while among a group of friends.
Design Level of spinal cord lesion defined the between-subject factor. There were eight subjects in each of the three conditions (cervical, thoracic, and lumbar). Each subject was exposed to all four factorial combinations of slide content and situational cue. The presentation order of these four treatments was counterbalanced in a Latin square. Since the number of available patients was insufficient to counterbalance completely the order of the nude and injury blocks, the injury slide block always preceded the nude slide block. RESULTS Heart Rate During Verbal T a ~ k The electrocardiograph recordings were scored in beats per five second interval. The mean number of beats per 5-sec. interval for a given response period was used as the data for analysis. To provide evidence a b u t the necessary boundary condition that the verbal task effectively elicited peripheral heart-rate change, comparisons were made between the average heart rate observed in the inter-trial interval prior to slide onset (first heart-rate response period) and the verbalization period in which the subject described his thoughts and feelings (second heart-rate response period). The heart-rate averages for each subject were summed over the stimulus potency and situational cue variation. These data were then analyzed with 3 X 2 analysis of variance with repeated measures on the second factor. The three spinalcord-lesion groups defined the first factor and heart-rate response period the second factor. As expected, the main effect of response period on heart rate was significant
864
T. M. JASNOS
&
K. L. HAKMILLER
( F = 63.09, p < ,001). Examination of the data showed that heart rate consistently increased from the preslide period to the ~ostslideverbalization period. The average increase in heart rate across all conditions was 5.4 beats per minute, with an average heart rate during the verbal response ~ e r i o dof 94 beats per minute. These data were fully consistent with the methodological requirement that peripheral activity changes occur during the second response period. AS expected, there were no significant differences attributable to lesion level or to an interaction of lesion level and response period. W e may assume, then, that at the periphery all subjects were aroused to an equivalent degree by some aspect of the task as required for a test of the hypotheses. Ratings of Expressed Affect The tape recorded feeling descriptions for each trial were typed on file cards and the coded condition designations concealed. The subjects' descriptions were then rated by 13 undergraduate psychology majors at Holy Cross College. The judges were uninformed as to the hypothesis and design of the study. These judges were instructed to assign ratings which "best describe the most intense level of emotion indicated by the protocol." Five category arousal and discomfort scales were employed for these ratings. Each interval was labeled with illustrative adjectives. The order in which these protocols were rated was random and differed for each judge. In addition, the order in which successive judges rated the protocols on arousal and discomfort was alternated. Pearson product-moment correlations were computed for all possible pairs of 13 judges. An average interjudge correlation of .712, indicating a high level of agreement among the judges, was obtained on the arousal dimension. The average interjudge correlation on the discomfort dimension was .520, perhaps indicating somewhat greater difficulty in rating the protocols on this dimension. The ratings of the 13 judges were summed to obtain an arousal score for each protocol. These scores were analyzed using a 3 X 2 X 2 analysis of variance with repeated measures on the last two factors. Lesion-level group was the between-subjects factor while the last two factors were defined by the slide content and situational cue variations. The analysis of the arousal ratings (Table 2 ) gave a significant main effect of lesion level ( p < .05). These differences were as expected under the first hypothesis. The cervical group expressed least intense arousal, followed by the thoracic and the lumbar group (which expressed the most intense arousal). In addition, there was a significant interaction of Lesion-level X Slide Content ( p < .05) as predicted by the second hypothesis. Moreover, an analysis of this interaction showed that the simple main effect of slide content shown to patients with thoracic and lumbar lesions was significant ( p < .01) while the simple main effect of slide content for those lesioned at the cervical level was
SPINAL LESION AND EMOTION TABLE 2
REPEATED-MEASLTES ANALYSIS OF VARIANCE: AROUSAL RATINGS df
Source
-
Between Subjeccs Level ( A ) Error Within Subjeccs Contenc ( B ) A x B Error Cue ( C )
2 21
583.51 130.25
P
F
MS
-
---
--
4.48
