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Dissertation on a new causal theory of stress

The Schematrix Conflict Theory of
Stress & Coping
Sarah L. Macdonald
Submitted in part assessment for Bsc Honours Psychology
At: Northampton ni!ersity" Northampton
Date: April #$$%
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This study was carried out in totality by myself and is the responsibility of myelf alone.
Signed S.L.Macdonald
Scientists should aim to develop theories which are simple, true and have a high
degree of explanatory power (arl !opper" The Logic of Scientific Disco#ery"
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Thirty years of stress and coping research has produced little in the way of fundamental"
testable theory" as declared in publications by ma)or stress research groups. This study
proposes" describes and tests a new causal theory" of stress based on an expansion of the
traditional concept of schemata. The theory postulates the existence of a matrix of
schemata (The Schematrix' made up of all manner of types of psychological structure and
co#ering all aspects of mental (and physical' functioning. The theory hypothesises that
stress occurs when the schematrix conflicts with so called *real life+. That is to say what is
expected is confounded by actuality. ,llustrations are gi#en of the way the theory might
wor- in explaining current obser#ations. There is discussion around ways of testing the
theory including difficulties and ideas for o#ercoming these problems. These ideas are
de#eloped into protocols and tested with results intriguingly suggesti#e of the #alidity of
the theory. .uture possibilities for research are explored and extended discussion
underta-en around the implications of the theory for understanding mental illness as well
as normal functioning" therapy enhancement and other applications in the wor-place and
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( would li)e to than) a number of people for their help and ad!ice while compiling this study"
*he tutors and lecturers ( would especially li)e to than) +of Northampton ni!ersity, are:
Dr -raham .itchell +my dissertation super!isor, for his support and ad!ice/ Dr 0e!in
Buchanan and Dr 1ose 2apede!ila for suggestions on *hematic Analysis"
(f nothing else/ ( ha!e immensely en3oyed this attempt to push bac) frontiers" 4ith anyone else
as tutor ( don5t thin) ( would ha!e had the courage to ma)e the attempt"
*han) you/
Sarah .acdonald
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Page unfinished
*itle Page ---------------------------------------------------------------------------------- Page 1
Abstract ------------------------------------------------------------------------------------ Page #-&
Ac)nowledgements --------------------------------------------------------------------- Page '
2ontents ----------------------------------------------------------------------------------- Page 6-7
8ist of tables ------------------------------------------------------------------------------ Page 9-:
2HAP*;1 <N;
(ntroduction ------------------------------------------------ Page 1$-1#
Definition of )ey words ---------------------------------- Page 1&
Aim = <b3ecti!es = Hypothesis --------------------------- Page 1'
2HAP*;1 *4<
>uantitati!e research --------------------------------------- Page 16-1:
>ualitati!e research ----------------------------------------- Page #$-#1
*heories of stress-------------------------------------------- Page #1-#%
Stress at 4or)----------------------------------------------- Page #7-#9
.edical 2onse?uences------------------------------------- Page #:-&&
Schema theory ---------------------------------------------- Page &&-&6
Psychometric instruments--------------------------------- Page &%-&:
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<ptimism and stress--------------------------------------- Page '$
2HAP*;1 *H1;;
.ethodology: -------------------------------------------------------------------------- Page '1-'7
Aims ------------------------------------------------------------------------------------- Page '1
>ualitati!e !ersus ?uantitati!e ------------------------------------------------------- Page '1-'#
>uestionnaire ---------------------------------------------- Page '#-'&
;thical consideration ------------------------------------- Page ''
Population = study group -------------------------------- Page ''-'6
Pilot study ------------------------------------------------- Page '6
.aterials --------------------------------------------------- Page '%
2arrying out the study ----------------------------------- Page '%-'7
2HAP*;1 @<1
1esults ------------------------------------------------------ Page '9-%%
2HAP*;1 @(A;
Discussion: --------------------------------------------------- Page
Discussion of methodology ----------------------------- Page
Discussion of results ------------------------------------- Page
Discussion of sources of error -------------------------- Page
1ecommendations for further study ------------------- Page
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2onclusion --------------------------------------------------
1eferences ----------------------------------------------------
Bibliography -------------------------------------------------
AppendiB A ---------------------------------------------------
AppendiB B ---------------------------------------------------------
AppendiB 2 ---------------------------------------------------------
AppendiB D ---------------------------------------------------------
AppendiB ; ---------------------------------------------------------
AppendiB @ ---------------------------------------------------------
AppendiB - ---------------------------------------------------------
8(S* <@ *AB8;S AND D(A-1A.S
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Definitions of ey Terms
Stress 4 the dictionary definition is *A mentally or emotionally disrupti!e or upsetting condition
occurring in response to ad!erse eBternal influences and capable of affecting physical
health/ usually characteriCed by increased heart rate/ a rise in blood pressure/ muscular
tension/ irritability/ and depression5 +Heritage Dictionary of the ;nglish 8anguage

Howe!er/ there has been much disagreement and uncertainty in the research literature o!er a
definition" <!er #$ years ago 0asl +1:79
, listed a range of definitions from the highly
specific to the eBtremely general/ encompassing both stimulus and response" DeB/
Beehr E 1oberts +1::#
, eBamined 61 articles in siB ma3or 3ournals and found multiple
definitions of stress/ and 2oB +1::&
, suggests that stress can be defined as Fa
psychological state which is part of and reflects a wider process of interaction between
indi!iduals and their en!ironment5" 8aCarus and @ol)man/ +1:9' p1#, suggest stress
cannot be considered a single !ariable but a Frubric of many !ariables and processes5"
Studying an element which has hitherto escaped clear definition is eBtremely problematic"
Participants in this study puCCled on many occasions as to whether their Ffrustration5 or
FanBiety5 or Firritation5 ?ualified as stress" *his decision was always left to their discretion in
the absence of a clear definition"
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1esearch into coping started as part of psychoanalysis whereby @reud defined it as a Fdefence
mechanism5 which too) a !ariety of forms such as repression/ sublimation/ pro3ection
or rationalisation +Brown/ 1:%'
," *he dictionary definition is to Fcontend with
difficulties and act to o!ercome them5 +Heritage Dictionary of the ;nglish 8anguage/
#$$$," As for stress there is little consensus among modern researchers of the
FA pattern imposed on compleB reality or eBperience to assist in eBplaining it/ mediate
perception/ or guide response5 +Heritage Dictionary of the ;nglish 8anguage/ #$$$," *annen E
4allat +1:97
, describe a schema as a Fpre-eBisting cogniti!e structure5"
*he theory re?uires that the concept of Fschemas5 be eBpanded into the concept of a schema
matriB or FschematriB5 consisting of associated/ interloc)ing/ o!erlapping and connected schema
Schematrix conflict
4hen one schema is opposing another schema" @or eBample/ the schema for disli)e of a
particular class of food conflicts with the schema that to refuse to eat a prepared meal is Fnot
done5" *he theory says this leads to stress"
2ngram +to be completed,
Somatic mar-er (to be completed,
!aradigm +to be completed,
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Chapter 0ne
Lac- of theoretical basis in stress & coping research
4hen researching the topic of stress for my dissertation/ despite the crucial nature of the topic
and the large numbers of papers/ it was apparent that !ery little is )nown or understood about
stress" *here ha!e been well o!er #$$/$$$ research papers published on stress and coping since
1:7% to date +Pubmed #$$%
, which represents an enormous research effort o!er the past &$
years to increase )nowledge on the sub3ect" Howe!er/ leading researchers in the field admit to
the lac) of progress and the poor ?uality of the research" 2oyne E 1acioppo +#$$$, refer to
?uantitati!e stress research as Fin crisis5/ as it has Ffailed to yield any substanti!e findings5 and
is Ffruitless and potentially misleading5/ *hey also e!aluated applied research aimed at practical
solutions to stress-related problems" 4hile research supports some ad!anced therapies for
stress-related problems/ such as cogniti!e beha!ioural therapy +2B*,+ Bisson and Andrew/ #$$6
G -ranath

et al/ #$$%
,/ according to 2oyne E 1acioppo +#$$$,/ this has lead to impro!ed
understanding/ unco!ered mechanisms or established any strong theoretical bases" *ennen et al
+#$$$, described the gap in stress between theories=ideas and research as being Fan abyss5/ and
point out/ that the pioneer in the field/ 1ichard 8aCarus/ accepted the failure of ?uantitati!e
research in progressing a fundamental undertanding of stress" 8aCarus appealed for more
?ualitati!e research designs in the hope of bridging the gap +8aCarus E @ol)man 1:9',/
howe!er/ they continue to be !ery rare" <ther ma3or contributors to the field tal) about Ftwo
decades of concentrated research ha!e yielded little of clinical or theoretical !alue5 +Somerfield
E .c2rae/ #$$$," Serious methodological and conceptual flaws ha!e resulted in a flood of
papers which are HdisappointingH 1::7/ p1&1,/ Htentati!eH +Ieidner E Sa)lofs)e/ 1::%/
p6#$,/ HmodestH +2osta/ Somerfield/ E .c2rae/ 1::%/ p'',/ HsterileH +Snyder/ 1:::/ p&#%,/
HstagnatedH +Pearlin/ 1::1/ p#76,/ and Htri!ialH +8aCarus/ 1:::/ p166," 8eonard Newman +#$$1,
continues the tirade/ pointing out that pre!ious identifications of coping with stress as a defence
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mechanism +2ramer/ #$$$, are Fconceptually and empirically problematic5" Dones and Bright
attribute the lac) of focus and producti!ity in stress research to Fa shortage of ade?uate models
and theories to guide research and practice5 +Dones and Bright/ #$$'
Current Stress Models and Theories
*here are se!eral models for the stressed state" *he physiological model relates to the Ffight or
flight5 response and in!ol!es a biochemical cascade in!olcing adrenocorticotrophic hormone
+A2*H,/ adrenaline/ cortisone and hydrocortisol" <Bytocin is in!ol!ed in some specific
responses in women/ although it is uncertain in what way/ although it may in!ol!e oestrogen
Presumably the physical manifestations of stress all manifest themsel!es through this
biochemistry but the wide !ariety of stress responses arises from psychological processes"
<ccupational stress is probably the most thoroughly studied area within general stress research"
Among !ariables thought to influence the occupational stress process social support +House/
1:91,/ locus of control +Spector/ 1:9#/ Par)es/ 1:9:, and control +Spector/ 1:9%," Howe!er/ it
would seem that these factors act by influencing well-being/ perhaps/ by buffering stress"
;Bperimental psychologists ha!e also identified a factor described as Fpredictability5 as being
important to the stress process +.iller/ 1:9$
/ 1:91
,/ but this has recei!ed little attention in
the literature"
arase-+s )ob demand8control model.
<ne of the most widely researched models of 3ob control and occupational stress is an
interactonist model )nown as the F3ob demands-control model5+0araase)/ 1:7:," 4hen the
psychological demands of a 3ob are high and control o!er the 3ob is low/ the model predicts
health status and well-being are lowered" Howe!er/ when demands and control are high/ the
indi!idual will eBperience an increased moti!ation to perform" Although 0arase) +1:7:/ 1:9:/
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1::$, and Bromet et al +1:99, present e!idence in fa!our of the model/ other studies ha!e not
done so +Payne E @letcher/ 1:9&/ Spector 1:97/ .c8aney and Hurrell/ 1:99/ Sauter/ 1:9:/
4arr/ 1::$a, and an eBprimental study also failed to pro!ide any e!idence for the model
+Perrewe E -anster/ 1:9:," 8andsbergis5 +1:99, study produced some/ though ambiguous
e!idence/ and there animal studies which seem to offer support +4eiss/ 1:7#,""
Transactional Models of Stress.
*he most common type of stress theory currently are termed Ftransactional5+eg" 2oB/ 1:79/
Schuler/ 1:9#/ ;dwards/ 1::#," *hese models en!isage stress as a process in!ol!ing continual
transaction between the eBternal pressures and internal demands +2oB E .ac0ay/ 1:91," *he
theory allows that the indi!idual !aries in withstanding these forces and percei!ing the
pressures and deciding whether and to what eBtent they ha!e importance +.c-rath/ 1:7%/
Beehr E Bhagat/ 1:96," *his model is all cogniti!e-based but still highly compleB and suggests
internal and eBternal aspects be studies togethter
Social support and the buffering hypothesis.
Social support is the reciprocal care ta)en by indi!iduals for each other +4illiams E House/
1:96," *here are two hypotheses that are categorised within social support +Henderson/ 1:9',"
*he first suggests that social support direct affects well-being - that is your stress is lower
because you are feeling happier/ while the second/ buffering hypothesis/ is similar eBcept that
the effect is not directly on well-being but acts as a Fwindbrea)5 between the stressor and the
indi!idual ameliorating the stressors damage"
(n an eBtensi!e re!iew/ 2ohen E 4ills +1:96, found e!idence for these hypotheses" Howe!er/
wor) place research studies ha!e found little support of buffering/ although some studies find
some e!idence +8a1occo et al/ 1:9$/ 0irmeyer E Dougherty/ 1:99/ Buun) et al/ 1:9:, and
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others none +eg" -anster et al/ 1:9%/ Dooley et al/ 1:97/ 0aufman E Beehr/ 1:9:," *he
buffering hypothesis is similar in concept to 0arase)5s 3ob-demands-control model" Both 3ob-
demands-control and buffering models indicate that some !ariable +wor)er control or social
support, interacts with stressors such that the damaging effect of stressors upon well-being is
lessened" Both social support and wor)er control are therefore hypothesiCed to pro!ide
resources by which the nature of the en!ironment can be changed/ thus lessening the impact of
stressors" *herefore/ social support/ in some circumstances/ may pro!ide a means of controlling
the wor) en!ironment" Neither theory/ howe!er/ encompasses the influence of cogniti!e
Predictability/ control and stress"
Predictability may be considered to be pre!ious a!ailability of information about an e!ent"
Although you cannot ha!e control without predictability +if you ha!e no forewarning of
something you cannot be in control with respect to it,/ being able to predict a stressors reduces
its effects/ both beha!ioural and physiological +.iller/ 1:9$/ 1:91," Howe!er/ A!erill et al
+1:7:, demonstrated that people prefer to try and a!oid the stressor if at all possible" Studies in
organisations support the idea that predictability is associated with contentment" 4arr5s
F!itamin model5 +1:97, proposes that an orgnanisation which operates in a clearly !isible way
impro!ed staff well-being"
Percei!ed control and its relation to actual control"
*he facet model of wor) stress +Beehr E Newman/ 1:79
," Beehr and Newman +1:79,
identifies more than 16$ !ariables in!ol!ed in stress/ gi!ing recognition to the compleBity of the
problem" Based largely on occupational stress/ this model in!ol!es changes occurring o!er
time/ feedbac) to the indi!idual/ which then results in personality and other changes"
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2oB and .ac)ay +1:7%, suggested that stress is due to a dynamic transaction between the
indi!idual and the en!ironment +see @igure 11"6," (mportant to this model is the indi!idualJs
cogniti!e assessment of the percei!ed demands made on him or her/ and that indi!idualJs
percei!ed capability to deal with those demands" Stress is the result of the percei!ed demand
outweighing the percei!ed capability"
Theories of Coping
Any theory of stress needs to include coping in its eBplanations" *hree le!els ha!e been
described/ coping styles that reflect the broad !iew + monitoring-blunting +.iller and .angan/
G .iller et al 1::%
" !igilance-a!oidance/ approach-a!oidance,/ strategies that reflect an
intermediate le!el +e"g"/ confrontation/ see)ing social support/ planned problem sol!ing,G and
coping acts or beha!iours that reflect specific/ situation-determined/ responses that are
idiosyncratic for the indi!iudal+;ndler E Par)er/ 1::$
G 0rohne/ 1::%G SchwarCer E
SchwarCer/ 1::%,"
4hen confronted with traumatic life e!ents/ an indi!idual will resort to a wide range of
strategies to cope with/ reduce or remo!e the resulting stress" .ost of the recent de!elopments
in the field of coping with stress and trauma can be traced to the wor) of 8aCarus and
colleagues +e"g" 8aCarus/ 1::&G 8aCarus E @ol)man/ 1:9'," *hey see coping made of two
phases: Fprimary appraisal5/ which is a cogniti!e assessment of the stressful e!ent and its
potential for damage/ and Fsecondary appraisal5/ which refers to a cogniti!e assessment of what
to do abnout it" <ther +e"g"/ Billings E .oos/ 1:91G Pearlin E Schooler/ 1:79, researchers !iew
coping as made of two separate classes/ one emotion-focused/ trying to cope at the le!el of
emotionality/ and the other problem-focused coping/ trying to address the stress trigger" .ore
recent efforts at modelling coping include the addition of a third Fdimension5 +a!oidance-
orientated copingG Par)er E ;ndler/ 1::#,/ as well as other two-dimensional configurations
+e"g"/ approach !s" a!oidance/ engagement !s" disengagement coping, +0rohne/ 1::%G Par)er E
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;ndler/ 1::%G *obin/ Holroyd/ 1eynolds/ E 4igal/ 1:9:," <!erall coping is thought to be
compleB/ multidimensional/ and Fsensiti!e to the en!ironment/ the personality and a!ailable
resources5 +@ol)man E .os)owitC/ #$$', @ol)man E .os)owitC +#$$', also state/ howe!er/
that despite significant efforts that research Fseems only to ha!e scratched the surface5 of how
coping affects people and they also draw attention to methodological problems" Aaillant +#$$$,
describes three classes of coping/ Fsee)ing help5/ Fconscious cognition5 and Fin!oluntary mental
mechanisms5" (n fact there is still significant contro!ersy about whether and to what eBtent
coping mechanisms are conscious or unconscious"
.ost recently 8aCarus and colleagues ha!e turned increasingly to coping in relation to emotion"
He ma)es the case for studying discrete emotions in the conteBt of four processes that represent
the central features of a theoretical system: appraising/ coping/ Kow of actions and reactions/
and relational meaning with coping the )ey feature of the emotion process/ +8aCarus/ #$$%
Stress and ,llness
(n the absence of a comprehensi!e theory of stress on which to base/ there has/ apparenetly/
been little in the way of fundamental )nowledge outcomes arising from research" Howe!er/
some more practical ?uestions ha!e been diligently studied/ in particular that relating to whether
stress produces illness" (t would seem from the large number of papers that there is a definite
connection between stress and medical conditions" Stress and depression ha!e shown
correlations/ although the nature of that connection is uncertain +Hammen/ #$$6," Stress has
also been associated with a wide !ariety of other medical conditions/ including cardio!ascular
disease/ H(A/ colds and psychiatric problems li)e P*SD/ anBiety +Schneiderman/ #$$6

, and
bipolar disorders +Pay)el/ #$$&," 8arge numbers of papers co!er presumed stressful situations
such as coping with cancer +Len

et al #$$%
G 4ong

et al/ #$$%
G Smith et al/ #$$6
/ 1eiche/
Nunes E .orimoto/ #$$'
,/ trauma +Budur/ @alcone E @ranco/ #$$%
G 0a3antie E Phillips/
,/ gut problems +Buret / #$$%
,/ allergies +4right/ #$$6
, and a !ast number of other
conditions and situations +*hoits/ 1::6
," Stress and the immune system has spawned a new
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discipline/ that of psychoneuroimunology" Although it is not pro!en that stress negati!ely
affects the immune system/ there are many suggesti!e papers 8us) and 8ash/ #$$6
G Ben-
;liyahu/ #$$&
G 1obins et al /#$$%
Stress and 3ender
(t might seem li)ely that gender would ha!e some impact on stress and coping and se!eral
papers find 3ust that" -a!ranidou and 1osner/ +#$$&
, found that men eBperience traumatic
e!ents more often than women/ women and men differ in the type of traumatic eBperiences they
eBperience/ and women more often de!elop P*SD after the eBperience of a traumatic e!ent"
;Bplanations they eBamine are methodology used/ the higher pre!alence of childhood seBual
abuse and rape in women/ the different coping styles of women and men/ or the more limited
socio-economic resources of women" <ther studies find small effects that women suffer more
stress than men and their coping style is more emotion-focused +Pilar .atud/ #$$'
," *roisi
suggests two e!olutionary theories are rele!ant in gender differences with respect to
susceptibility to social stress/ seBual selection theory and life history theory +*roisi/ #$$1
@elsten +1::9, found no gender differences in stress/ coping or depression among a population
of students" <n the physiological side/ 0udiel)aa/ and 0irschbaumb/ +#$$6
, loo)ed at gender
differences in the hypothalamusMpituitaryMadrenal aBis hormone/ cortisol under eBtreme stress"
*hey found the o!erall picture indicated that adult men respond to psychological stress with
greater increases in cortisol compared to women" *hey hypothesised that the greater stress
reacti!ity obser!ed in men might be causally associated with an ele!ated ris) for diseases
associated with high le!els of cortisol such as cardio!ascular disease and diabetes and may help
eBplain the higher pre!alence for these diseases in males" Howe!er/ the lower cortisol response
obser!ed in women may be related to a hyporeacti!ity of the HPA aBis/ which is associated with
an increased ris) for autoimmune diseases/ a condition much more pre!alent in women" (n
coping also it is still not clear whether there are gender differences +Porter and Stone/ 1::6
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Se!eral countries/ such as Sweden and Norway/ ha!e seen a dramatic increase in absenteeism
during the last 1$ years/ particularly among women/ due to health problems +8undberg/ #$$6
*hese includee burnout/ depression/ muscular pain/ headache/ gastrointestinal problems/ and so
on" .ost of these disorders ha!e been regarded as stress related/ and described as Fmedically
uneBplained symptoms5" Although it is tempting to blame this on the more rapid pace of modern
life/ increased wor)load/ and continuous ad3ustment to change/ ;ri)sen et al" +#$$'
,/ found
that sub3ecti!e health complaints are not restricted to modern ci!iliCation but are also fre?uent
among indi!iduals li!ing under primiti!e conditions"
A paper which demonstrates what women already )now to be ob!ious/ loo)s at the trait of
dominance and finds that men ha!e blood pressure rises when con!ersing with una?uainted/
more dominant person +either gender, whereas women do not show this trait at all +Newton/
*here is also an abundance of indi!idual papers which are re!ealing on a small scale about
some important aspects of stress/ for eBample/ Allen et al +1::1, show that the presence of a
dog/ e!en when you don5t touch it/ is better at moderating stress than ha!ing a non-3udgemental
supporti!e friend/ especially in women
(t has been remar)ed that there is Fa shortage of ade?uate models and theories to guide research
and practice5 in psychological stress +Dones and Bright/ #$$'
Dones and Bright +#$$', contemplate the possibility that there might ha!e to be an array of
Fmicro and meta theories5 to co!er as broad an area as stress" Somerfield +1::7
, suggests it
may only be possible to produce theories rele!ant to specific situations"
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*aylor et al +#$$$, made and substantiated the fascinating suggestion that there are
fundamentally different mechanisms operating/ relating to stress and coping in men and women"
1ather than the traditional idea that the origin of coping is the Ffight and flight5 response they
postulate that in women it is a F*end-and-Befriend5 mechanism" Arising from women5s
nurturing e!olutionary role/ this seems intuiti!ely possible and their arguments are plausible"
-eary E @linn +#$$#, eBpands *aylor5s notion to include paternal acti!ities in men"
*aylor5s response to this/ howe!er/ is dismissi!e +*aylor et al #$$#," Since then there seem to
ha!e been no follow up studies on this"
8ife orientation test
*he 8ife <rientation *est +8<*, is a 1$-item measure of generalised dispositional optimism
that was de!eloped by Scheier and 2ar!er in 1:96 and re!ised in 1::' +8<*-1, to focus on
respondentsJ eBpectations for the future +Scheier/ 2ar!er et al" 1::'," Scores range from $ to #'
with high scores indicating greater optimism" ;!idence suggests that optimism is associated
with lesser amounts of distress during times of difficulty/ and hence is beneficial for physical
and psychological well-being" *his may be mediated by the manner of coping with stress"
Although the 8<* has been widely used/ it has some problems" (ts original items did not all
focus as eBplicitly on eBpectations for the future as theory dictated" (n part to remedy this
deficiency/ we ha!e since de!eloped a modest re!ision of the 8<*/ called 8<*-1 +Scheier et al
," According to Aautier

et al +#$$&
, the re!ised test 8<*-1 unnecessarily bisects the
trait into optimism and pessimism/ but Na)ano

, found the #-factor model useful with
Dapanese students" 8<* was found to correlate partially with ?uality of life in the elderly

Howe!er/ it has been found lac)ing in robustness/ that is it can be fa)ed +*errill et al/ #$$#
A global measure of percei!ed stress/ *he Percei!ed Stress Scale +2ohen/ 0amarc)/ E
.ermelstein/ 1:9&
, measures the degree to which oneJs life situations and circumstances are
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percei!ed as stressful" *his measure calls for the indi!idual to self-appraise le!el of stress/ so
the Percei!ed Stress Scale +PSS, accounts for indi!idual differences in the assessment of
en!ironmental demands" *he PSS is a 1'-item instrument which as)s participants to respond to
a series of statements designed to e!aluate the degree of stress eBperienced" (t has been used to
show the heritability of percei!ed stress +@ederen)o/ #$$%
, as a measure of global stress
during cancer treatment +
-olden-0reutC et al/ #$$', in which it showed significant factor
stability" (t has been used as a measure of stress diseases li)e in chronic fatigue syndrome
+0elly et al/ 1:::
/ chronic )idney disease +<dden et al/ #$$%,
/ and spinal cord in3ury
1intala et al/ #$$6, to name but a few/ as well as a measure of the efficacy of stress
management techni?ues +
Ietter?!ist et al/ #$$&,"
Aspinwall and *aylor loo)ed at 8<S and PSS in o!er %$$ American college students as well as
a large number of other factors +1::#
, and Segerstrom +1::9,
loo)ed at mood/ coping and
immune changes with respect to stress in 6$ law students" Both found in!erse correlation
between percei!ed stress and optimism" <ne paper directly attempted correlation of 8<S/ PSS
with respect to gender/ and while they found 8<S and PSS correlations there was no significant
difference between genders +SitC and Poche/ #$$#
C03/,T,92 SC,2/C2 (/D SC:2M( T:20;<
The paper begins with a re#iew of the use of the schema concept in the #arious
subdisciplines of cogniti#e science. (n historical perspecti#e is employed= the re#iew
begins with authors who were important in laying the foundations for cogniti#e science"
and mo#es to a consideration of contemporary wor-ers. a' !hilosophy Cogniti#e science
may be #iewed as an enterprise that is concerned with the ways in which the structures of
the mind allow representations of the world" and the ways in which they process such
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representations. The >uestion of the mind?s representation of the world has long been
posed by philosophy" and philosophy may therefore be considered the founding
subdiscipline of cogniti#e science (3ardner" $%@&'. 0ne of the greatest philosophers"
ant" employed the concept of the schema precisely in order to discuss the possibility of
-nowledge. ant attempted to go beyond the impasse between the empiricists" who
argued that -nowledge has its origins in the external world" and the rationalists" who
argued that -nowledge is a product of the mind. :e argued that schemas interdigitate
between properties of the mind (the a priori categories' and raw sensory data (of a
posteriori experience'. AThis representation of a uni#ersal procedure of the imagination in
pro#iding an image for a concept" , entitle the schema of the conceptA (>uoted in
3ardner" $%@&'. ,n more contemporary terms" mental schemas are acti#ated by the
external world" and simultaneously pro#ide an interpretation of it. b' /euroscience
Cogniti#e science ac-nowledges that structures of the mind ha#e a biological basis" and
neuroscience is therefore an important subdiscipline of cogniti#e science. .urthermore"
the neurologists :ead and :olmes ($%$$' were among the first to use the concept of the
schema. These wor-ers were interested in the spatial perceptions of patients of their
bodies" and referred to the basis of these as the postural schema. The postural schema
integrated sensations which were triggered by postural change. ,n lesions of the parietal
lobe the schema may be destroyed" with the possible outcome that patients ignore part of
their body" treating it as if it were not their own. Con#ersely" an amputee may ha#e an
intact brain schema" and therefore experience mo#ements in the missing phantom limb.
Today the more widely used term is the body schema (.rederi-s" $%B%'" and
contemporary neuroscience has ad#anced to the point where it can begin to consider the
biological underpinnings of more complex schemas such as cogniti#e and affecti#e
schemas (LeDoux" $%@%'. c' De#elopmental !sychology (lthough de#elopmental
psychology is not usually considered one of the subdisciplines of cogniti#e science" !iaget
is one of the most important figures in the prehistory of cogniti#e science. The notion of
the schema was central in !iaget?s wor-. (ccording to !iaget" the initial schemas of the
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child comprise biologically based sensorimotor reflexes which coordinate the child?s
interactions with the en#ironment. 3radually these biological schemas allow adaptation
to the en#ironment by two complementary processes. 9ia assimilation the schema grasps
some no#el aspect of the en#ironnment" so modifying itself to cope with the en#ironment
better. 9ia accomodation the schema is differentiated and elaborated so as to be
consistent with the en#ironment. 1ith time" the schemas are transformed to the point
where the organism reaches a new stage of de#elopment. !iaget succeeds in pro#iding a
detailed description of these transformations from the point of sensorimotor schemas to
the operations of formal thought (!iaget" $%&5'. d' Cogniti#e !sychology The concept of
the schema in contemporary cogniti#e science is perhaps most directly traceable to the
wor- of the Critish cogniti#e psychologist Cartlett ($%65'. Cartlett" a onetime student of
:ead" was interested in memory" and in particular in the notion that the context of an
experience had crucial effects on what was retained and how well this was recalled.
2bbinghaus had pioneered the experimental study of memory using nonsense syllables"
but this approach did not seem ade>uate to Cartlett?s concerns. ( con#ersation with
/orbert 1einer" one of the founding figures in cogniti#e science" ga#e Cartlett an
experimental methodology for de#eloping his ideas. 1einer?s idea was to use the
;ussian Scandal parlor game in which a story is passed around the room" and then the
original and final #ersions compared. Cartlett found that sub)ects showed consistent
patterns of error in the recall of narrati#es. Thus" for example" an (merican ,ndian
narrati#e would regularly be re#ised by sub)ects until it came to resemble a 1estern tale.
Cartlett de#eloped the construct of the schema to explain this" describing a schema as a
component of memory which is formed from encounters with the en#ironment" and which
organiDes information in specific ways. Such schemas aid the recall of a typical (1estern'
narrati#e" but systematically distort the recall of an unusual ((merican ,ndian' narrati#e.
Cartlett ($%65' wrote" A;emembering is not the re8excitation of innumerable fixed"
lifeless" and fragmentary traces. ,t is an imaginati#e reconstruction" or construction"
built out of the relation of our attitude towards a whole acti#e mass of past
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experience....,t is thus hardly e#er really exact" e#en in the most rudimentary cases of
rote recapitulation" and it is not at all important that it should be so. The attitude is
literally an effect of the organism?s capacity to turn round up upon its own AschemataA
and is directly a function of consciousness.A :e defined a schema as Aan acti#e
organiDation of past reactions or of past experiences which must always be supposed to
be operating in any well8adapted organic repsonse. 1hene#er there is any order or
regularity of beha#ior" a particular response is possible only because it is related to other
similar responses which ha#e been serially organiDed" yet which operate not singly as
indi#idual members coming one after another" but as a unitary mass.A ( #ariety of
definitions of schemas ha#e been offered subse>uently. Thorndy-e and :ayes8;oth
($%E%' describe three uni#ersal assumptions made by different authorsF that a schema is
an organiDation of conceptually related elements representing a prototypical abstraction
of a complex concept= that a schema gradually de#elops from past experience= and that a
schema guides the organiDation of new information. ( schema comprises an architectural
element (its structure' and a propositional element (its content'. Cogniti#e schemas are
in#ol#ed in cogniti#e operations (e.g. encoding" retrie#al'" in which cogniti#e e#ents (e.g.
thoughts" images' are produced and processed. Schemas are highly interdependent and
hierarchically organised" they may in#ol#e #erbal or non#erbal8elements" and they may
be more or less open to awareness (Crai- and Loc-hart" $%E5= ,ngram and endall"
$%@B'. Schema theory has pro#en #aluable in accounting for a #ariety of psychological
phenomena. Schema theory has been used in contemporary studies of memory (Schacter"
$%@%'" concept representation (Smith" $%@%'" problem sol#ing (9anLehn" $%@%'"
mo#ement (Gordan and ;osenbaum" $%@%' and language ((rbib et al" $%@E'. Schemas
ha#e been found to facilitate recognition and recall" to influence speed of information
processing and problem sol#ing and allow for the chun-ing of information into more
meaningful units to enable inference about missing data" and to pro#ide a basis for
prediction and decision ma-ing. ,t is thought that schemas engender bias by relying on
confirmatory e#idence at the expense of disconfirming e#idence" but that this process
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maintains schemas (;umelhart" $%@7= Meichenbaum and 3ilmore" $%@7= 1infrey and
3oldfried" $%@B'. ( #ariety of other constructs ha#e been used by cogniti#e scientists and
their forerunners to describe mental structures. Many bear a good deal of family
resemblance to the idea of schemas. /otable examples include (belson and Shan-?s
($%@$' AscriptsA" Candura?s ($%E@' Aself8systemsA" elly?s ($%&&' Apersonal constructsA"
Miller" 3alanter and !ribram?s ($%BH' AplansA" and Mins-y?s ($%E&' AframesA. The
notion of the connectionist networ-" currently extremely popular in the field of artifical
intelligence" has been argued to represent a microle#el description of the schema concept
(Cen Iee#" $%@@'.
C2T122/ C03/,T,92 (/D CL,/,C(L SC,2/C2
This re#iew of the schema construct in cogniti#e science demonstrates that schema theory
has been widely employed by cogniti#e scientists. :owe#er" it may be ob)ected that the
#ery di#ersity of the use of schema theory points to the problematic nature of the schema
concept. Different cogniti#e scientists operationaliDe and measure schemas in different
ways. Similarly the #ersatility of the concept may reflect only a lac- of theoretical rigor.
0n the other hand the concept of schemas has general heuristic #alue insofar as it allows
different cogniti#e scientists to theoriDe about mental structures from the perspecti#e of
their particular subdiscipline. The schema construct allows different cogniti#e scientists
to begin to build an integrati#e framewor- that addresses such >uestions as how the
structures of the mind enable representation" how they are based in biology" how they
de#elop and change" and how they account for a #ariety of psychological phenomena.
Certainly there is room in schema research for impro#ement in both empirical
measurement and theoretical rigor (.is-e and Lin#ille" $%@H= 1illiams et al" $%@@'.
/e#ertheless" the de#elopment of the schema concept as a broad heuristic is important
insofar as it represents a mo#e in cogniti#e science away from a molecular and bottom8up
approach (concentrating on the elementary units of processing and on the influence of
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the details of a tas- on performance'" and toward a molar and top8down approach
(highlighting the large8scale properties of processing and the influence of strategies and
contexts on performance'. Similarly schema theory represents a mo#e away from the
laboratory and artificial 2bbinghausian methodologies to a concern with the
in#estigation of day8to8day human acti#ity. These shifts in cogniti#e science are reflected
in increasing interest in using schema theory to in#estigate such phenomena as self and
other representation" and the representation of emotion. Schema theory has been applied
to concepts of the self by a number of wor-ers (Mar-us" $%EE= ;ogers" $%@$'. This
research follows the line of earlier wor- on schemas. Thus" self schemas are #iewed as
generaliDations about the self that de#elop out of past experience and that organiDe the
processing of self8related information in the social en#ironment. This in turn results in
#arious forms of bias" but allows the maintenance of a consistent self8concept (3reenwald"
$%@H'. Similarly a number of authors (Cantor and Mischel" $%EE= .is-e" $%@$= Taylor and
Croc-er" $%@5' ha#e described e#aluati#e schemas for assessing others. ,n this -ind of
research" schemas ha#e been used as to explain such phenomena as stereotypes and the
reactions they elicit. .inally" schema theory has begun to grapple with the problem of
emotion. 2arly authors suggested that affect and cognition are seperate but interacti#e
systems. (ffect was argued to be either postcogniti#e (/eisser" $%EB= Mandler" $%E&' or
precogniti#e (Ia)onc" $%@H'. 0n the other hand" Le#enthal ($%@5' and 3reenberg and
Safran ($%@7' ha#e offered schema models which attempt to synthesiDe affect and
cognition. Le#enthal ($%@5'" for example" writes that emotions A....can be regarded as a
form of meaning. They ha#e significance for the person experiencing and expressing
them. Their meaning has two aspectsF they ?say? something about our organismic
state...and they ?say? something about the en#ironmentA. ,n this line of thin-ing" schemas
ha#e both an ideational and an affecti#e component. (ll these areas re>uire further
empirical and theoretical de#elopment (:iggins and Cargh" $%@E= lein and ihlstrom"
$%@B'. (s cogniti#e scientists begin to research these sub)ects" their interests begin to
approximate those of clinicians. Let us mo#e" then" to clinical theory and practice.
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CL,/,C(L SC,2/C2 (/D SC:2M( T:20;<
,t has been demonstrated that cogniti#e scientists use schema theory to address a number
of salient issues about mental structures. .irst" structures of the mind enable
representation. Second" these structures are based in biology. Third" structures de#elop
and change. .ourth" such structures may account for a #ariety of psychological
phenomena" including beha#ior" cognition" and emotion. 1ith this range of issues in
mind" it is not difficult to see how schema theory may be useful in the clinic.
!sychopathology may in#ol#e" for example" conflict (where underlying schemas are
somehow distorted' or deficit (where underlying schemas are absent or underde#eloped'.
!sychopathologists are interested" then" in disturbed representations" in particular in
disturbances in representations of self" other" and the interaction of self and other. ,nsofar
as these disturbances ha#e a biological underpinning" this too is of interest. The
de#elopmental transformations which lead to such disturbances are of course of great
importance. Models of psychopathology attempt to describe the psychic structures that
lead to abnormal beha#ior" cognition" and emotion. Similarly" psychotherapy may
in#ol#e" for example" transference (where the therapist is seen through pre8existing
schemas'" resistance (where pre8existing schemas undermine change' and interpretation
(where a meta8cogniti#e process of disengagement from and reflection on the patient?s
schemas occurs'. !sychotherapists are interested" then" in changes in representations of
self and other" and in the way in which psychotherapy leads to such changes. ,nsofar as
psychopharmacological inter#entions help promote such changes in representations"
therapists will be interested in how this occurs. Models of psychotherapy attempt to
describe the psychic structures that account for #arious phenomena in psychotherapy
that in#ol#e beha#ior" cognition" and emotion. 1hile these concerns are common to
different psychopathologists and psychotherapists" many concepts other than that of
schemas are" of course" employed to explain psychopathology and psychotherapy. , want
to show that although such concepts may be useful" they may also be open to
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transformation into" or subsumption under" schema theory. ,t may be ob)ected that this
merely constitutes the translation of different terms into schema language. :owe#er" ,
want to argue that schema theory allows different clinical schools to include rigorous
components of their orientation and to discard less rigorous aspects" and so enables
ad#ances in these schools. .urthermore" schema theory fosters integration by allowing
central themes to be tac-led in con#ergent ways. These arguments are made in the
following sections in terms of two di#ergent approaches in modern clinical wor-" the
cogniti#e8beha#ioral and the psychoanalytic. Schema theory may be seen as increasingly
important in each school. ,t will be suggested that schema theory enables important
ad#ances within each school" and that it allows important clinical themes to be considered
in an integrati#e way.
C03/,T,928C2:(9,0;(L T:2;(!< (/D SC:2M(S
The initial beha#ioral model of psychopathology and psychotherapy was that of 1atson.
The exemplar discussed by 1atson and his students (1atson and ;ayner" $%5H' was the
induction and elimination of a fear of white rats in an ele#en month old boy" (lbert C."
with techni>ues of conditioning and deconditioning. ( criti>ue of this discussion is
beyond the scope of this paper" but it may be noted that such wor- does not readily allow
a focus on some of the concerns that psychopathologists and psychotherapists ha#e been
listed as ha#ing. Mental structures are pointedly ignored" constitutional factors are
downplayed" de#elopmental processes are limited to those of conditioning" and while
beha#ioral e#ents such as phobias and learning are tac-led" other complex phenomena in
psychopathology and psychotherapy such as personality disorder" or resistance and
transferance" are ignored. ,t is not surprising" then" that there has been a shift in clinical
beha#iorism to more cogniti#e models. 1hile the early cogniti#e8beha#iorists" such as
2llis ($%B5'" incorporated cognitions into their theory" there was still a reluctance to focus
on the structures of the mind. (bnormal cognitions resulted from cogniti#e distortions"
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and the structures that produced cogniti#e distortions were glossed o#er. There was a
corresponding neglect of the de#elopment of cogniti#e distortions. ,t may be again be
argued that this #iew has difficulty in accounting for complex -inds of psychopathology
and for complex phenomena in psychotherapy. :owe#er" later cogniti#e8beha#iorists
ha#e become increasingly interested in structures of the mind. Cec-" for example"
introduced the schema concept in the context of depression (Cec-" $%B7" $%BE'" and more
recently he and his colleagues ($%%H' ha#e elaborated the notion of schemas in order to
extend cogniti#e therapy to the personality disorders. 0ther authors in the cogniti#e8
beha#ioral tradition ha#e also employed the notion of schemas ((rn-off" $%@H= Tur- and
Speer" $%@6= 3oldfried and ;obins" $%@6= 3reenberg and Safran" $%@7= <oung" $%%H'" but
Cec-?s is the most extensi#e contribution. Cec- and his co8wor-ers suggest that different
types of schemas ha#e different functions. ,n their #iew cogniti#e schemas are concerned
with abstraction" interpretation and recall" affecti#e schemas are responsible for the
generation of feelings" moti#ational schemas deal with wishes and desires" instrumental
schemas prepare for action" and control schemas are in#ol#ed with self8monitoring and
self8regulation. There are also subsystems of schemas. Thus cogniti#e schemas include
schemas concerned with self8e#aluation and e#aluation of others" schemas concerned
with memory and recall" and schemas concerned with expectancies and predictions. They
argue that such schemas can be #iewed as operating in logical linear progression. (
dangerous stimulus acti#ates a Adanger schemaA" which in turn acti#ates affecti#e "
moti#ational" action" and control schemas. This framewor- is used to discuss
de#elopment and change. Schemas de#elop as a result of both constitutional and
en#ironmental factors. ( particular schema may de#elop in response to de#elopmental
experiences" or as a result of identification with family members. Certain patterns may
be deri#ed from or compensate for such schemas. Therapists use cogniti#e" affecti#e and
beha#ioral strategies to change cogniti#e" affecti#e" and beha#ioral schemas. Change
comprises a continuum from restructuring of schemas to more subtle modifications. This
framewor- is also used to discuss different -inds of psychopathology. Dysfunctional
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thoughts" feelings" and beha#iors are due to schemas that produce consistently biased
)udgements. The schemas of personality disorders resemble those of the symptom
disorders" but they are in#ol#ed in the e#eryday processing of information" and are
operati#e on a more continuous basis. .inally this model is used to discuss complex
aspects of psychotherapy. Schemas regarding change" self" and others may impede
therapy. Schemas regarding the therapist may be labelled transferance cognitions.
!S<C:0(/(L<T,C T:2;(!< (/D SC:2M(S
Classical psychoanalytic theory posits that psychopathology can be understood in terms
of an energetics model. .reud argued that the forces of the unconscious are expressed"
repressed" and transformed" resulting in e#eryday beha#iors and in psychopathology.
During de#elopment these forces manifest in different configurations" and de#elopmental
e#ents may therefore affect later dynamics in specific ways. !sychoanalysis leads to
insight into such dynamics" and allows for their wor-ing through. Modern analysts ha#e
increasingly re)ected this model" which is drawn from nineteenth century science. Many
ha#e attempted to de8emphasiDe the dri#e component of psychoanalytic theory" and to
focus on its relational aspects= on the self" the ob)ect" and their interaction (Mitchell"
$%@@'. 0n this model" the past is important insofar as pre#ious relationships determine
the nature of future ones. Symptoms are explicable" for example" in terms of relational
deficits. Therapy occurs within the context of an empathic relationship" and so allows for
growth. .urthermore" in considering new models to replace the energetic one" a number
of psychoanalysts ha#e drawn on schema theory (2agle" $%@B= Slap and Say-in $%@6=
1achtel" $%@5'. !erhaps the most extensi#e contribution" howe#er" is that of :orowitD
($%@@" in press'. :orowitD ($%@@' suggests that e#ery indi#idual has a repertoire of
multiple schemas of self and other. Self schemas include ways to gain pleasure or a#oid
displeasure (moti#ational schemas'" positioning in relation to the world (role schemas'"
and ways of helping a person decide which of two moti#es to choose (#alue schemas'.
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Superordinate schemas that articulate self to other schemas in ways that organiDe a script
of wishes" fears" and li-ely reactions are called role relationship models. Schemas are
applied simultaneously along multiple parallel channels. Shifts in schema acti#ity are
accompanied by shifts in state of mind" and control processes pre#ent the emergence of
certain states of mind in defensi#e fashion. This model is again used to account for
de#elopment and change. Self8schemas de#elop from a basis of genetic and en#ironmental
interaction. ;ole relationship models de#elop in the context of interpersonal beha#ioral
patterns. Common issues are those of lo#e and care" power and control" and sexuality and
status. The framewor- is also used to discuss different -inds of psychopathology.
Changes in the en#ironment may lead to a poor fit between external reality and
preexisting role8relationship models. 2motional response to stress is due in part to the
discord between the new situation and enduring schemas. ,n some people schemas and
patterns of control of schemas are inappropriate and insistent. These constitute
personality problems. .inally this model is used to account for the phenomena of
psychotherapy. ,n therapy the schemas of the patient become manifest in the role8
relationship models between clinician and patient. The therapeutic alliance allows the
patient to de#elop insight into such schemas" and during a process of wor-ing through to
gradually replace or modify them.
(/ ,/T23;(T,92 (!!;0(C: 1hile schema theory may be increasingly important
in both cogniti#e8beha#ioral and psychodynamic wor-" Cec- and :orowitD approach
clinical theory and practice from widely di#ergent positions. This is reflected in their
assumptions about schemas. Cec-?s #iew of schemas as triggered in a linear fashion is
consistent with the focus of cogniti#e therapy on the automatic cognitions that precede
emotion. :orowitD?s di#ision of schemas into moti#ational" role and #alue schemas" on
the other hand" reflects the .reudian concern with the id" ego" and superego structures.
.urthermore" differences in theoretical assumptions lead to di#ergent methods for
measuring schemas. /e#ertheless" as in the case of schema theory in cogniti#e science"
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the schema concept may ha#e a broad heuristic #alue in the clinic insofar as it allows
different clinicians to approach common concerns about mental structures" their
de#elopment" and their importance in understanding psychopathology and
psychotherapy. The wor- of Cec- and :orowitD on schemas con#erges on these sub)ects.
This section attempts to illustrate the heuristic #alue of schema theory in the clinic. ,t is
argued first that the cogniti#e8beha#iorist and psychoanalytic models each ha#e distinct
ad#antages and disad#antages" and that schema theory has potential for incorporating
the ad#antages and eschewing the disad#antages of these schools. ,t is then suggested that
schema theory allows a number of important clinical themes to be considered in an
integrati#e way. 0ne ad#antage of beha#iorism lies in is its emphasis on a systematic and
empirical approach. The model presented here is consistent with the idea that it is
possible to study psychopathology and psychotherapy in a systematic way" and to
pro#ide empirical descriptions of psychological phenomena. Clinicians ha#e begun to
de#ote attention to the rigorous assessment of schemas (Landau and 3oldfried" $%@$=
;udy and MerluDDi" $%@7= Segal" $%@@'" and such methodologies are important in
research on the nature of psychopathology and on the efficacy of psychotherapy.
.urthermore" while it may be argued that the ad#ance of clinical theory will always be
intimately tied to clinical practice" schema theory allows for the incorporation of more
general experimental techni>ues and findings. 0n the other hand" the cogniti#e8
beha#ioral tradition has increasingly chosen to theoriDe about the mental structures that
early beha#iorists wanted to ignore. 2arly cogniti#e8 beha#iorists noted abnormal
cognitions" but continued to de8emphasiDe the structures responsible for these cognitions"
their de#elopment" and their manifestation in the clinic in the form of resistance and
transferance. .inally" modern cogniti#e8 beha#ioral therapists such as 3uidano and
Liotti ($%@6' ha#e de#oted a good deal of attention to psychological structures" to their
de#elopment" and to their importance in psychopathology and psychotherapy. ,t is at this
point that cogniti#e8beha#ioral theory begins to employ a schema model. ,n contrast to
beha#iorism" psychoanalysis tac-les mental structures without hesitation. ,n many ways"
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.reud may be considered a cogniti#ist who focused on mental structures" their growth
and change" and their conse>uences for beha#ior and for the clinical situation. 0n the
other hand" .reud ne#er really escaped his natural science bac-ground. The theory of
dri#e permeates all his wor-s. 1hile the dri#e model constitutes a good model for such
phenomena as mo#ement and momentum" it fails to pro#ide an ade>uate account of the
subtle meanderings and manipulations of the mind. Dri#e and force are too cumbersome
for meaning and cognition. .urther" .reud?s notion of dri#es is one which concei#es of
the child?s unconscious as identical to that of the adult" and his notion of memory traces
is in terms of a passi#e perceptual apparatus= his usual penetrating focus on de#elopment
and transformation blurrs at this crucial point. .inally" the inherently conflicted notion
of an energy that is psychic exemplifies .reud?s failure to resol#e the relation between
psyche and soma. Modern analysts ha#e retained aspects of dri#e theory" but ha#e shifted
their emphasis to the construction of the self" of the other" and of the space between them
(Mitchell" $%@@'. This #iew re)ects dri#es (as energetic or psychological concepts'" without
going to the opposite extreme of denying that psychoanalysis is a science concerned with
models. ,t is at this point that psychodynamic theory begins to adopt a schema model.
3i#en the -inds of approximations outlined here" it is not surprising to find an o#erlap of
#arious techni>ues in clinical practice. Modern cogniti#e therapists wor- with dreams
and spontaneous images (<oung" $%%H'" while psychoanalysts ha#e become increasingly
open to the adoption of cogniti#e8beha#ioral techni>ues (1achtel" $%EE'. .urther" the
possibility of increasing theoretical integration emerges. Cy way of example let us use
schema theory to consider some central focuses of psychotherapy 8 the unconscious"
dri#es and defenses" symptoms and therapeutic change. ,nsofar as schemas are not
-nown to the person" they are unconscious. The importance of unconscious processes has
become increasingly apparent in cogniti#e science (ihlstrom" $%@@'. ,t is clear that the
processes that ta-e place out of awareness are not only extremely important" but can be
scientifically described. 1hile empirical clinical research on the relation between schemas
and the unconscious is limited (She#rin" $%@@'" schema theory may be theoretically useful
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in the clinic. Consider" for example" a female #ictim of incest" who describes difficulties in
relationships with men" but who is largely unaware of how these relationships reflect
earlier familial patterns. ,t is possible to conceptualiDe this patient as ha#ing particular
schemas about herself" about men" and about her interactions with men= schemas of
which she may be or less aware. Thus this patient may ha#e schemas in which atttention
is gi#en her by men only when she is seducti#e" and in which all men are untrustworthy.
The patient may consciously deny the presence of such schemas but ne#ertheless her
thoughts" feelings and actions may entail their existence. Thus a clinical formulation is
constructed which posits particular unconscious schemas" and which is employed to
account for consciously reported psychological phenomena. This schema #iew of the
unconscious discards the classical analytic metaphor of the unfettered beast lur-ing in
the mind" as well as the modern analytic metaphor of the damaged baby at the core of
the patient. ,t also departs from the beha#iorist a#oidance of the unconscious. The
schema #iew" howe#er" maintains the classic analytic ideas of psychic determinism and of
the existence of unconscious processes" and also conforms to the attempts of modern
analysts and beha#ioral8cogniti#e therapists to describe how the past repeats itself
unwittingly in the present. ,nsofar as schemas direct beha#iors" cognitions" and emotions
in a particular way" they result in repetiti#e patterns of beha#ior" thought" and feeling.
:owe#er" schemas de#elop in adaptation to life" and can therefore be seen not only as
constricti#e (defensi#e' but also as creati#e (strategic'. Thus in the patient discussed
earlier the schema in which all men are #iewed as untrustworthy" may ha#e pro#ed
helpful at home" but may ha#e lead to inappropriate affect in later relationships. (nalysts
may ob)ect to this -ind of thin-ing for it appears to downplay the libidinal and
aggressi#e phenomena which are highlighted in analytic defense theory. Certainly
schema theory has only begun to theoriDe affect" sexuality and aggression (:orowitD"
$%@@'. /e#ertheless" the idea that schemas ha#e defensi#e and strategic aspects discards
the classical notion of energetic forces being defended against by the ego" and downplays
the modern analytic emphasis on psychic deficit as accounting for the repetiti#e patterns
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of the present. :owe#er" this #iew can perhaps incorporate the classic analytic concern
with affect" as well as the modern analytic and cogniti#e8beha#ioral emphasis on the
adapti#e or strategic aspects of fixed patterns of beha#ior" thought" and feeling. ,nsofar
as the beha#iors" cognitions" and emotions directed by schemas are abnormal" they
constitute symptoms. !sychotic symptoms may" for example" point to the absence or lac-
of de#elopment of certain symptoms (!erris" $%%H'. Character symptoms may indicate
the presence of maladapti#e schemas (<oung" $%%H'. Dissociati#e symptoms may point to
a lac- of integration between schemas (:ilgard" $%EE'. Schemas in the patient mentioned
earlier may" for example" result in personality features such as being o#erly seducti#e" or
being >uic- to anger. .urther wor- needs to be done on the way in which schema theory
acccounts for the range of clinical symptoms. ,t is clear" howe#er" that a schema theory of
symptoms contrasts with the classical analytic notion of symptoms as dynamic
compromise formations" the modern analytic emphasis on symptoms as the result of
relational deficits" the beha#iorist concept of symptoms as stimulus8response mediated"
and the early cogniti#ist description of symptoms as emerging from cogniti#e distortions.
Schema theory does" howe#er" follow psychoanalytic and cogniti#e8beha#ioral theory
insofar as they emphasiDe the mental structures responsible for symptoms. 1hat about
therapeutic changeJ (ccording to schema theory" therapy in#ol#es an affecti#e and
cogniti#e process in which a #ariety of techni>ues are used to engage and explore
schemas. Subse>uent e#ents depend on the nature of the pre8existing schemas. Some
schemas may be non8linguistic in nature" and these may then be gi#en a #oice. 0ther
schemas may be out of awareness" and these may then be ac-nowledged. The patient may
be encouraged not to use a particular schema or to de#elop compensatory schemas
(,ngram and :ollon" $%@B'. (lternati#ely schema change can be fostered" either of more
superficial schemas or of deeper ones" using emoti#e" cogniti#e and beha#ioral methods
(<oung" $%%H'. ,n the patient we ha#e discussed" the operation of schemas of seduction
and mistrust within the therapeutic relationship" and the way in which they lead to
particular thoughts and feelings may be brought into awareness" and the patient may be
- && -
- &' -
encouraged to practice new ways of relating to others. This -ind of theoriDing contrasts
with the classic analytic model of cure as the result of dynamic catharsis" the modern
analytic model of cure as the result of empathic reparenting" and the cogniti#e8beha#ioral
models of reinforcement or relearning. Schema theory ne#ertheless maintains the
.reudian emphasis on insight" the modern analytic emphasis on empathy" and the
cogniti#e notion of the remodelling of mental structures. ,n similar #ein" transferance
in#ol#es not so much a distorted neurotic repetition" nor a genuine holding en#ironment"
but rather an entry into and reshaping of the patterns of the patient. The cumulati#e
effect of these s-etches of the clinical application of schemas hopefully indicates the
integrati#e potential of this construct. /e#ertheless much wor- remains to be done. 2ach
of these clinical s-etches re>uires theoretical expansion. Theoretical wor- at the o#erlap
of cogniti#e and clinical science" such as the use of schemas to understand self and affect"
also re>uires further de#elopment (1illiams et al" $%@@'. .urthermore" such theory must
be complemented by empirical research. ,f schemas are to be accepted as real mental
structures which explain mental and clinical phenomena" then their accurate definition"
and documentation become paramount. The operationaliDation and measurement of
deep constructs is" howe#er" difficult (Segal" $%@@'. Schemas are measured only indirectly"
for example" by pencil8and8paper methodologies (Coyne and 3otlib" $%@B'. .urthermore"
different cogniti#e scientists and clinicians ha#e defined schemas in somewhat different
ways" with each wor-er attaching his or her theoretical framewor- to the construct.
1hile schemas ha#e a degree of constancy" they may also be dynamic and multifaceted"
so exacerbating the difficulties of the empiricist. ,n sum" both theoretical inno#ation and
detailed clinical obser#ation will be necessary in order to ad#ance an ade>uate account of
schemas in the clinic.
SKMM(;< , ha#e shown that schema theory is used by a #ariety of cogniti#e theorists
and clinicians. , ha#e suggested that schema theory allows a focus on mental structures"
their biological basis" their de#elopment and change" and the way in which they direct
- &' -
- &6 -
psychological e#ents. These focuses are important not only in cogniti#e science" but also
in the clinic. Schema theory therefore allows cogniti#e scientists and clinicians to conduct
a con#ergent discourse. .urthermore" schema theory may be useful in allowing different
clinicians to employ a unified framewor-. , ha#e also indicated that a great deal of wor-
in both the cogniti#e and clinical sciences remains to be done. !roblems in the
operationaliDation and measurement of schemas remain to be sol#ed" and a #ariety of
theoretical areas need to be de#eloped further. /e#ertheless" the use of schema theory in
the clinic opens up cogniti#e science to a whole series of phenomena. The clinic confronts
schema theory with a #ariety of psychological structures (cogniti#e and affecti#e'"
processes (top8down or molecular and bottom8up or molar'" and forms of representation
(fantasies" dreams" hypnotic recollections" hallucinations" delusions'. Such a
confrontation benefits cogniti#e science insofar as it shifts its focus away from the
laboratory and toward man in all his complexity. Con#ersely" by loo-ing at cogniti#e
science" clinicians may begin to incorporate empirical and experimental methodologies.
Cogniti#e theory may pro#ide a unified model of the mind to underpin an unified clinical
approach. :opefully this paper will encourage the dialogue between the cogniti#e and
clinical sciences" and will encourage empirical and theoretical research on schemas.
- &6 -
- &% -
Dissertation topic
@ollowing *aylor5s *end-and-Befriend *heory/ the original intention was to pursue the
influence of gender in stress and coping" (ntuiti!ely it would seem li)ely to be in!ol!ed/ but
in!ol!ement of genderMdifferences in stress E coping would seem to ha!e been somewhat
neglected in research" *here are eBceptions to this of course" Han)in E Abramson +#$$1, ha!e
loo)ed at gender and depression and attempt to eBplain why more women than men suffer from
depression and why it should start around age 1&" *heir theory is based on women being more
!ulnerable in transactions 1:(T T;(/S(CT,0/SJJ which cause depression which
increase !ulnerability" 4ilson/ Pritchard E 1e!alee

+#$$6, found gender differences in coping
strategies but with no connection to any particular theory" *roisi +#$$1, loo)s at gender
differences in vulnerability to social stress with respect to seBual selection theory and life
history theory" -a!ranidou E 1osner +#$$&, loo)ed at gender and Post-*raumatic Stress
Disorder +P*SD," *hey found that men ha!e more traumatic e!ents/ women ha!e more P*SD5s/
howe!er the traumas are different and the coping styles are different" <!erall/ gender
differences are not apparent"
*his is supported by the British Household Panel Sur!ey of 1$/$$$ participants +Buc) et al
," sing the -eneral Health >uestionnaire +Duncan-Dones/ 1:7:
, no significant
differences were found between genders" (lthough there are studies where stri-ing affecti#e
gender differences ha#e been obser#edJJJJJ these do not seem to ha!e been conducted with
any particular hypothesis in mind" *herefore/ the original rationale for my research was to focus
on gender differences using as far as possible a process approach 1:(T ,S ( !;0C2SS
(!!;0(C:JJ and with a !iew to eBploring *aylor5s F*end and Befriend5 hypothesis in the
hope of potential important steps forward"
- &% -
- &7 -
Howe!er/ in trying to ma)e this theory open to testing/ and reading around the literature/ it
became apparent that it was possible to formulate a general theory of stress which
seemingly fits all the re?uirements according to ;ulberg/ 4ee)ley and Bhagat5s
criteria +1:99
, of clarity/ internal consistency/ falsifiability/ eBternal consistency/
comprehensi!eness/ parsimonious +concise, and original"

(t is with trepidation ( submit this new theory and my attempts to test it"
The Schematrix Conflict Theory of Stress
,S T:,S 0K; T:20;<JJ
*he theory states that
1" Psychological stress occurs when psychological perception of so-called Freal-life5
occurrences are in conflict with the psychological perception arising from deeply held/
pre!iously established psychological schemas"
#" Schemas are a much broader concept than currently accepted" (n fact they form a broad
matriB of structures made of schemata of many differing fla!ours: - breadths/ strengths/
scope and type"
&" 2oping in!ol!es the ad3ustment of the schema matriB +schematriB, to reduce the disparity"
;Bamples are pre3udices/ tastes/ opinions/ courses of action etc etc" C0/.KS2DJJJJ 1:< ,S
T:,S :2;2JJ
Stress occurs when life e!ents challenges one or more of these preformed framewor)s"
*hese framewor)s are the same or similar to the FSomatic mar)ers5 described by Damasio" He
demonstrates their eBistence by ingenious eBperiments in!ol!ing playing cards and shows that
they are pre-eBisting templates which inform our decisions/ so that decisions can be made more
- &7 -
- &9 -
?uic)ly" *hey are also intimately in!ol!ed with our emotions/ in that people with brain damage
leading to reduced emotions +a la -age, cannot access these"
+.ore to go in here,
- &9 -
- &: -
*he aim of the study is to eBplain/ propose and defend a hypothesis for the causation of stress/
to identify testable aspects of the hypothesis and test them"
1:< D0 12 :(92 0CG2CT,92 ,/ JJJ
1" 2arry out a detailed search of the stress and coping literature
# @ormulate a hypothesis meeting the ;ulberg/ 4ee)ley and Bhagat5s +1:99, criteria for
theories of stress"
& De!elop a strategy for testing elements of the theory
' <btain suitable/ willing participants for the study
6 Analyse ?uantitati!e data using SPSS
%" Analyse ?ualitati!e data using *hematic Analysis

(;2/+T 12 SK!!0S2D T0 ST(T2 T:2 :<!0T:2S,S" /0T T:2 /KLL
:<!0T:2S,SJJ C(/+T ;2M2MC2;JJJJ
*est 1" *he null hypothesis is that there will be no correlations between Dependant Aariables/
+percei!ed stress scale and the life orientation scale, and (ndependent Aariables +gender/
age grouping/ pet ownership/ occupation/ amount of free-time/ hobby type,
*est #" *he Null Hypothesis is that decisi!eness as a measure of schema will not correlate with
uneBpected e!ent stress"
S:0KLD/+T 12 !KT S0M2T:,/3 ,/ :2;2 (C0KT T:2 ,/T2;9,21S" 0K;
- &: -
- '$ -
Chapter 6
*he aim of the empirical part of this paper was to test the hypotheses"
Mualitati#e 9ersus Muantitati#e
8eading researchers in the field/ as mentioned in the introduction/ ha!e criticised the body of
stress research for an o!er-reliance on psychometric instruments S:0KLD/+T 12
KS2 MK(/T,T(T,92 :2;2JJ/ and an insufficiency of ?ualitati!e methods" *o
ta)e heed of these recommendations both approaches ha!e been employed in this
(n!estigating a new approach re?uires not only choice of a suitable method/ but also a
connection with pre!ious methods to act as a baseline from one set of results to
another" *herefore traditional instruments were used in this study with !ariables
traditionally li)ely to influence stress/ against which to compare new types of
measurement designed to test the new theory" 2<N@S(N-NNNN
Semi-structured inter!iews were also employed as being a more producti!e method when
assessing the sub3ect from a new angle" >uestionnaires can only produce answers to
the ?uestions put" 4hereas in semi-structured inter!iew/ the topic of life stresses could
be triggered and a free-flowing con!ersation allowed so that the participants own
words/ own perceptions and reflections can be captured for thematic analysis later/
producing a telling collection of ?uotes and statements along rele!ant themes"
- '$ -
- '1 -
*he disad!antage of structured inter!iew method is that the in!estigation and data analysis can
be !ery time consuming/ and the results do not lend themsel!es to statistical analysis/
so hypothesis can not be pro!ed or dispro!ed"
>uantitati!e in!estigation lends itself to statistical analysis/ and can be used to pro!e or
dispro!e a theory" Howe!er/ because the ?uestions as)ed are closed/ patients are not
able to introduce new areas into the study" *he only information gi!en is what is as)ed
*he chosen method of in!estigation in this study was closed ?uestions in a ?uestionnaire
+?uantitati!e analysis," *his method would allow hypothesis to be pro!en/ or not/ and
would allow a comparison to be carried out between two groups of patients 10KLD
C2 ( 300D ,D2( T0 M2/T,0/ T:,S 2(;L,2;" (S T:,S ,S .,;ST
12+92 ;2(LL< T(L2D (C0KT ,/T2;9,21N.JJJ
- '1 -
- '# -
!ilot Study
As a composite ?uestionnaire was used during this study/ made up of three separate
?uestionnaires all using different scoring methods/ a small pilot was run to loo) for ade?uacy of
the briefing and instructions" (t was also useful to loo) for ease of use or any other factors
interfering with the intended testing" *his in!ol!ed as)ing two !olunteers to run through the
process as if they were being tested and gi!ing feedbac)" As a result of this some of the
?uestions were modified as being contradictory/ and a few remo!ed altogether as the o!erall test
was too long" *he briefing document was also modified as it was important that participants
were not aware of what was under test/ and also were not aggra!ated by not )nowing"
(lso a pilot inter#iew was employed to get the most out of the inter#iewees.
Method $ 8 !sychometrics
D2S,3/ NN. (!!;0(C:" ,9+S (/D D9+S
!(;T,S,!(/TSN. :01 T:2< 12;2 S2L2CT2D (/D (/<T:,/3 2LS2 T:(T
1(S ;2L29(/T (/D :01 , 30T S(M!L2..!;0C2DK;2 KS2DN
(!!(;(TKSLM(T2;,(LSN description of the e?uipment or materials you used and the
functions which they ser!ed/ (f you de!ised a ?uestionnaire or de!eloped a piece of apparatus
then you need to tell the reader how you did this and pro!ide sufficient information about it so
that they could understand it" (f the ?uestionnaire or apparatus has been described in pre!ious
wor) then you should refer the reader to the more detailed published description elsewhere and
pro!ide a more general description in the report which enables the reader to understand what
you did without ha!ing to loo) up the original reference"
!;0C2DK;2N. chronological account of the research process as eBperienced by the
participants" informed consent was obtained and how participants were debriefed as well as the
way in which the data were collected"
- '# -
- '& -
*he first study uses a correlated between-sub3ects design to in!estigate connections between the
measured !ariables of life orientation/ percei!ed stress/ and decisi!eness/ and the factors of
gender/ occupation/ leisure time/ pet ownership/ hobby types/ age grouping/ and uneBpected
e!ent response in %' participants"
*he study aimed to test for any correlations between gender/ occupation type/ free-time/ pet
ownership/ hobby types/ age grouping/ and uneBpected e!ent response with measures of
percei!ed stress and optimism"
*here were se!en independent !ariablesG gender/ occupation/ free-time +6 groupings,/ pet-
ownership/ hobby type/ age +four groups,/ and uneBpected e!ent response" *here were three
dependant !ariables/ perception of stress +PSS,/ life orientation +optimism, +8<S,/ and
decisi!eness +D2,"
*he ?uestionnaires were identical for all participants and the order of the ?uestions did not !ary"
Participants were selected from an opportunity sample on the basis of a re?uirement to achie!e
a balance of gender and occupation in the sample"
2orrelations between PSS/ 8<S and D2 were tested pair wiseNNN sing PearsonJs 1an)/ as
*abachni) and @idell +#$$1
, suggest is essential for .AN<AA1 !alidity" Differences between
PSS/ 8<S and D2 between all other subgroups were tested using uni!ariate AN<AAs" *he
sample siCe for indi!idual sub-groupings was thought too small for multiway AN<AA"
Ne!ertheless/ combination correlations between the 7 independent !ariables and the &
dependant !ariables were tested using the -eneral 8inear .odel/ multi!ariate analysis with the
following groupings +table N, as the computer processing power was insufficient for
simultaneous analysis of all !ariables"
Aariable -roup 1 -roup # -roup & -roup '
gender/ 3ob/ age
gp" uneBpected
e!ent response
free-time/ pet-
hobby type
e!ent response/
occupation type/
pet ownership/
hobby types/ age
8<S/ PSS/ D2 8<S/ PSS/ D2 8<S/ PSS/ D2 8<S/ PSS/ D2
*able O -roupings of (ndependant and Dependant Aariables for SPSS analysis"
Performing multiple AN<AA tests ris)s committing a type 1 error falsely re3ecting a null
hypothesis" Howe!er in an attempt to !alidate the use of multi!ariate AN<AA/ testing showed
- '& -
- '' -
BoB5s . test contradicted the null hypothesis that the obser!ed co!ariance matrices of the
dependant !ariables are e?ual across groups/ and also 8e!ene5s test showed that the error
!ariance of the DA was not e?ual across groups" *his warned against reliability of .AN<AA
but the !iolations of conditions in this case were modest/ therefore the .AN<AA could be
considered !alid +Brace/ 0emp/ and Sneglar/ #$$&
p #'1",
(n this case it was important to eBplore .AN<AA as this method uses a combination of DAs in
correlation with the (As" *he study was using three putati!e facets of stress as DAs which might
ha!e had unforseeable interconnectedness that only a combinatorial method would re!eal/ and
that separate one-way AN<AA would not detect"
Participants were all residents of the Northampton area" *here were &# students tested +1% male/
1% female, and &# permanent office employees +1% male/ 1% female," No selection was
performed on any other !ariable"
*he student participants were all engaged on degree courses at uni!ersity/ the professionals
were all permanent employees" Selection was by !olunteering on receipt of email in!itation"
8ieP""NNNN it was an opportunity sample wasn5t itNN
*he ?uestionnaire gi!en combined three separate ?uestionnaires/ these were the life orientation
scale +8<S, +Iullow/ 1::1
, +the percei!ed stress scale +PSS, +2ohen/ 0amarc) and
.ermelstein/ 1:9&
, and a specially constructed decisi!eness ?uestionnaire +D2," *his
?uestionnaire +see AppendiB, consisted of 1% ?uestions re?uiring a decision to be made on a
wide !ariety of topical sub3ects/ but not re?uiring any special interests or eBperiences" (t was
designed so the time ta)en for a response is timed/ and is a measure of how ?uic)ly the
participant can decide what to answer in a number of situations they are li)ely not to ha!e
considered before"
- '' -
- '6 -
*he specific structure of the ?uestionnaire was:-
A Basic data on gender and age - recorded
B Sur!ey 1 M 8ife <rientation Scale M scored as instructions
2 Sur!ey # - Percei!ed Stress Scale M scored as instructions
D Sur!ey & M decisi!eness scale M timed in seconds"
*he 8ife <rientation Scale is a measure of dispositional optimism !alidated against reports of
physical health related symptoms +
Scheier and 2ar!er/ 1:96," (t ta)es the form of 1#
statements against which the participant has fi!e le!els of agreement from strongly positi!e to
strongly negati!e/ and a central neutral position" *hese were then scored asNN
Percei!ed stress was tested using the Percei!ed Stress Scale +2ohen/ 1:9&, which measures the
degree to which situations in oneJs life are felt stressful" (t consists of 1' ?uestions re?uiring the
participants to estimate the fre?uency of possibly stressful e!ents occurring within a one-month
time frame" A score of < +ne!er, to ' +!ery often, was obtained for each item" @or items 1/ #/ &/
9/ 11 and 1# answers were scored where $ Q $/ ' Q '/ but ?uestions '/ 6/ %/ 7/:/ 1$ and 1& were
scored in the re!erse direction as they were positi!ely worded where $ Q '/ ' Q $"
<f the four additional ?uestions/ the first re?uired a yes=no for the presence of pets within the
household" *he second was to describe in one word a preferred past time" *he third was a
re?uirement to estimate the amount of hours of personal free-time per wee) in ranges of $ M 6/ %
-1$/ 11 M 16 and 1% M #$" *he last ?uestion as)ed for a simple yes=no answer in response to the
?uestion of whether an uneBpected e!ent had occurred in the past year considered to be !ery
- '6 -
- '% -
Table $ 3roupings of charcteristics from extra >uestions for S!SS purposes
:obbies .ree time hours per
Knexpected e#ents O
/ame Score ;ange Score ;esponse Score ;esponse Score
music 1

$ to 6 1
1 yes 1

6 to 1$ # Not at all # no #

1$ to 16 & Not sure &


16 or more '



sport #R

friends #R
R Q sociable pastimeG

solitary pastime
*he testing occurred o!er a period of se!eral wee)s according to each participant5s a!ailability
and at their con!enience" ;ach participant was gi!en the briefing document and ?uestionnaire to
complete whilst alone and in a ?uiet en!ironment" No time limit was imposed" *he completed
?uestionnaire was to be replaced in an en!elope pro!ided and returned to the researcher"
(t was eBplained that participation was !oluntary and that they could withdraw at any time"
*hey were as)ed to complete the ?uestionnaires as honestly as possible" After completing the
?uestionnaires they were debriefed by eBplaining pre!ious research findings/ and the aims and
hypotheses of the present study and were as)ed if they had any ?uestions" (f they had they were

- '% -
- '7 -
2thical Considerations
*o ensure the in!estigation conformed to the BPS ethical guidelines +see AppendiB % for ;thics
form, participants were told that participation was !oluntary and they could withdraw at any
time" All indi!iduals approached were willing to gi!e informed consent" Participants were told
before they completed the ?uestionnaire that it would as) ?uestions about their stress le!els and
opinions about life situations" No deception was used other than the concealment of the o!erall
purpose of the study" *he ?uestionnaires were anonymous and coded" After completing the
?uestionnaires participants were !erbally debriefed to ensure all ?uestions or concerns were
addressed/ they were told that the study aimed to test the relationship between stress/ optimism
and the other factors measured and that past research on the sub3ect is inconclusi!e"
- '7 -
- '9 -
Method !(;T 5
Semi8structured inter#iews
Aolunteers from the group completing the ?uestionnaires were in!ited/ and four responded/ to
ta)e part in the inter!iew part of the study" *hey in!itation was worded: S4ould any
indi!iduals completing the ?uestionnaires be willing to ta)e part in further analysisNT *his was
to in!ol!e responding to three general ?uestions F*ell me about stress in the wor)place5/ F*ell
me about stress in the family5 and F*ell me about stress in your personal life5 by tal)ing freely
about your own life" *hey were told it was eBpected to ta)e about &$ minutes in all/ that their
words would be taped and transcribed into teBt and analysed by loo)ing at recurring themes"
<nly four people !olunteered and they were all inter!iewed" *hey were gi!en briefing prior to
the inter!iew and debriefing afterwards +See AppendiB for papers,
A head-set microphone attached to a P2 was used for recording the inter!iews and the 4indows
recording programme FAudacity 1"& Beta5" *ranscription into teBt was done manually of the
entire inter!iew"
;ach transcript was read se!eral times" *he following themes were sought and identified in the
1" elements of not being able to be genuine or Foneself5
#" elements of eBpectations - especially those unfulfilled
&" use of the words should or ought
'" any )ind of 3udgement
6" anything eBpressing something not being right
%" anything where a preference is eBpressed for something other than what actually

- '9 -
- ': -
Chapter .our
S(< !,L0T 1(S SKC2SS.KL
!;09,D2 o#er#iew of the statistical procedures used to analyse the data
12 S:0KLD KS2 M0ST ,M!0;T(/T ;2SKLTS .,;ST
(LS0 Clarify the meaning 0. 3;(!:SLT(CL2S in text.
Method $ 4 !sychometric tests.
;ach participant was gi!en a JscoreJ for each section of the ?uestionnaire/ and also gi!en an
o!erall total score" *he scores were calculated from the answers gi!en on the ?uestionnaires
according to the instructions +see AppendiB,
*here were no correlations between the dependant !ariables according to Pearson5s r +see
AppendiB O," *his is essential for multi!ariate analysis as correlation between dependant
!ariables could lead to compleB interpretation +*abachni) and @idell/ #$$1,"
.ulti!ariate AN<AA as per groups 1/ #/ & E ' +See table O, showed no statistically significant
correlations using Pillai5s *race as the most robust statistic/ eBcept for the following:-
(A DA Sig
<ccupation type decision-ma)ing $"$: 7"%%9
Stress-related surprise e!ent decision-ma)ing $"$$ #6"%6&
Table P 1esults of multi!ariate AN<AA showing significance when !erified by uni!ariate AN<AA"
Cant ha#e )ust Dero+s as answerJJJ
(ndi!idual uni!ariate AN<AAs were used to follow up on suggested significances from the
multi!ariate analyses/ rather than Discriminate Analysis/ as there were !ery few" @ollowing
uni!ariate AN<AA no other significant correlations emerged"
*he results indicate the following:-
1" *hat professional5s ta)e statistically significantly longer to ma)e decisions than
#" *hat participant5s who had endured stress from the uneBpectedness of an e!ent showed
statistically significant shorter decision-ma)ing times"
&" *hat the elements suspected to be associated with stress +as measured by PSS, e"g" pet
ownership/ amount of free time/ occupation/ gender and age show no correlation with
percei!ed stress indi!idually or in combination" *hey also show no correlation with
optimism +8<S,"

- ': -
- 6$ -
-raphical representation of results
student professional

@ig O Scatterplot of DA decisi!eness against occupation

:orrible graphN
yes no

@ig O Scatterplot of DA decisi!eness !ersus stress-inducing uneBpectedness

- 6$ -
- 61 -
10 20 30 40
male f emale
10 20 30 40
@ig & Histogram of DA PSS !ersus gender
1hat does count meanJJJ /eed to do graphs again" titles need to be better
- 61 -
- 6# -
;esults of Thematic (nalysis of Semi8structured ,nter#iews
,nter#iew $N..
1" ;lements of not being able to be genuine or Foneself5
#" ;lements of eBpectations - especially those unfulfilled
&" se of the words should or ought
'" Any )ind of 3udgement
6" Anything eBpressing something not being right
%" Anything where a preference is eBpressed for something other than what actually
- 6# -
- 6& -
,nter#iew 5N
1" ;lements of not being able to be genuine or Foneself5
#" ;lements of eBpectations - especially those unfulfilled
&" se of the words should or ought
'" Any )ind of 3udgement
6" Anything eBpressing something not being right
%" Anything where a preference is eBpressed for something other than what actually
- 6& -
- 6' -
,nter#iew 6N
7" ;lements of not being able to be genuine or Foneself5
9" ;lements of eBpectations - especially those unfulfilled
:" se of the words should or ought
1$" Any )ind of 3udgement
11" Anything eBpressing something not being right
1#" Anything where a preference is eBpressed for something other than what actually
- 6' -
- 66 -
,nter#iew 7N
1&" ;lements of not being able to be genuine or Foneself5
1'" ;lements of eBpectations - especially those unfulfilled
16" se of the words should or ought
1%" Any )ind of 3udgement
17" Anything eBpressing something not being right
19" Anything where a preference is eBpressed for something other than what actually
- 66 -
- 6% -
,n many ways it is the re#erse of the introduction.
the discussion is a discussion of the results
;estatement of the main research >uestion and to pro#ide a summary
of the rele#ant results
include an attempt to relate your findings to pre!ious research in the
area and place the results in a theoretical conteBt
Draw attention to differences between your results and those of other
Lou should consider ?uestions raised by the results of your research
or ?uestions which ha!e not been answered by your study
;nd the discussion by bringing the reader bac) to a general point

- 6% -
- 67 -

Allen/ 0"." Blasco!ich/ D" *oma)a/ D" and 0elsey/ D"." +1::1, Presence of Human @riends
and Pet Dogs as .oderators of Autonomic 1esponses to Stress in 4omen" Dournal of
Personality and Social Psychology Aol" %1/ No" '/ 69#-69:
2osta/ P" *"/ Dr"/ Somerfield/ ." 1"/ E .c2rae/ 1" 1" +1::%," Personality and coping: A
reconceptualiCation" (n ." Ieidner E N" ." ;ndler +;ds",/ Handboo) of coping +pp" ''-%1,"
New Lor): 4iley"
2oyne/ D"2" E 1acioppo/ ."4" +#$$$, Ne!er the twain shall meetN 2losing the gap
between coping research and clinical inter!ention research" American Psychologist 66+%,/
2ramer P" " +#$$$, Defense mechanisms in psychology today" @urther processes for
adaptation"Am PsycholJun;55+%,:%&7-'%"
@ol)man/ S" E .os)owitC/ D"*" +#$$$, Positi!e Affect and the <ther Side of 2oping
American Psychologist 66+%,/ %'7-%6'"
@ol)man/ S" E .os)owitC/ D"*" +#$$6, 2oping: Pitfalls E Promise" Ann" 1e!" Psychol" 66:
-eary/ D"2"/ @linn/ ."A" +#$$$," SeB differences in beha!ioral and hormonal response to
social threat: commentary on *aylor et al" Psychol 1e!" <ctG1$:+',:7'6-6$
Hammen/ 2" +#$$6, Stress E Depression Ann"1e!" 2lin" Psychol" 1: #:&-&1:"
Han)in/ B"8" E Abramson/ 8"L" +#$$1, De!elopment of -ender Differences in Depression:
An ;laborated 2ogniti!e Aulnerbility-*ransactional Stress *heory Psych" Bull 1#7+%,77&-
8aCarus 1" S" +1:::," Stress and emotion: A new synthesis" New Lor): Springer"
8aCarus/ 1"S" E @ol)man/ S" +1:9', Stress/ appraisal E coping" New Lor)/ Springer
.ar)s/ D" +1::7," ;ditorial" Dournal of Health Psychology/ #/ 1&1"
.aslow/ AH" E .ittelman/ B" +1:'1, Principles of Abnormal Psycholog"y New Lor)/
- 67 -
- 69 -
Newman/ 8"S" +#$$1, 2oping E Defense: No clear distinction American Psychologist6%+:,
Pay)el/ ;"S" +#$$&, 8ife e!ents and affecti!e disorders" Acta" Psychiatrica" Scandina!ica"
1$9 +Suppl '$9, %1-%%"
Pearlin/ 8" (" +1::1," *he study of coping: An o!er!iew of problems and directions" (n D"
;c)enrode +;d",/ *he social conteBt of coping +pp"#%1-#7%," New Lor): Plenum Press"
Pub.ed +National 8ibrary of .edicine,
Schneiderman/ N"/ (ronson/ -" E Siegal/ S"D" +#$$6, Stress E health: psychological/
beh!ioral E biological determinants" Ann"1e!" 2lin" Psychol 1:%$7-#9"
Snyder/ 2" 1" +1:::," 2oping: 4here are you goingN (n 2" 1" Snyder +;d",/ 2oping: *he
psychology of what wor)s +pp" &#'-&&&," New Lor): <Bford ni!ersity Press"
Somerfield/ ."1" E .c2rae/ 1"1" +#$$$, American Psychologist 66+%,/ %#$-%#6"
*aylor/ S";"/ 0lein/ 8"2"/ 8ewis/ B"P"/ -ruenewald/ *"8"/ -urung/ 1"A"/ pdegraff/ D"A"
+#$$$, Biobeha!ioral responses to stress in females: tend-and-befriend/ not fight-or-
flight"Psychol 1e!" DulG1$7+&,:'11-#:"
*aylor/ S";"/ 0lein/ 8"2"/ 8ewis/ B"P"/ -ruenewald/ *"8"/ -urung/ 1"A"/ pdegraff/ D"A"
+#$$#," SeB differences in beha!ioral and hormonal response to social threat : 1eply to
-eary E @linn +#$$#," Psychol 1e!" DulG1$7+&,:'11-#:"
*ennen/ H"/ Afflec)/ -" Armeli/ S" E carney/ ."A" +#$$$, A Daily Process Approach to
2oping American Psychologist 66+%,/ %#%-%&%"
*roisi/ A" +#$$1, -ender differences in !ulnerability to social stress:A Darwinian
perspecti!e" Phys" Beha!" 7&:''&-'':"
Aaillant/ -";" +#$$$, Adapti!e .ental .echanisms American Psychologist66:1 9:-:9"
4H< Burden of Disease/ #$$1
4ilson/ -"S"/ Pritchard/ .";"/ 1e!alee/ B" +#$$6, (ndi!idual differences in adolescent
health symptoms: the effects of gender and coping" D Adolesc" DunG#9 +&,:&%:-7:"
- 69 -
- 6: -
Ieidner/ ."/ E Sa)lofs)e/ D" +1::%," Adapti!e and maladapti!e coping" (n ." Ieidner E N"
S" ;ndler +;ds",/ Handboo) of coping +pp" 6$6-6&1,"New Lor): 4iley"
- 6: -
HeritageV Dictionary of the ;nglish 8anguage/ @ourth ;dition 2opyright W #$$$ by Houghton .ifflin 2ompany"
0asl" S"A" +1:79, ;pidemiological contributions to the study of wor) stress" (n 2"8" 2ooper and 1"8" Payne +;ds, Stress at
4or)" 2hichester: 4iley and sons
DeB/ S"."/ Beehr/ *"A" E 1oberts/ 2"0" +1::#, *he meaning of occupational stress to sur!ey respondents" Dournal of
Applied Psychology 77/ %#&-#9
2oB/ *" +1::&, Stress research and stress management: putting theory to wor)" +Health And Safety ;Becuti!e 2ontract
1esearch 1eport No %1" HS;/ 0"
Brown/ D"A"2" +1:%', @reud and the post-@reudians" HarmondsworthG Penguin
*annen/ D"/ E 4allat/ 2" +1:97, (nteracti!e frames and )nowledge schemas in interaction" Social Psychology >uareterly/
6$/ #$6-#1%"
Pubmed .edical Science database of "S" National 8ibrary of .edicine/ 9%$$ 1oc)!ille Pi)e/ Bethesda/ .D #$9:'
Bisson D/ Andrew ." Psychological treatment of post-traumatic stress disorder +P*SD,"2ochrane Database Syst 1e!" #$$6
Apr 19G+#,"
: -ranath D/ (ng!arsson S/ !on *hiele / 8undberg " +#$$%, Stress management: a randomiCed study of cogniti!e
beha!ioural therapy and yoga"2ogn Beha! *her"G&6+1,:&-1$"
Dones/@" and Bright/ D"+#$$', Stress: .yth/ *heory and 1esearch" Prentice Hall" P #61"
*aylor/S";"/ -onCaga/ -"2"/ 0lein/8"2" d/ Hu/ P"/ -reendale/ -"A"/ Seeman/ *"A" +#$$%, 1elation of <Bytocin to
Psychological Stress 1esponses and Hypothalamic-Pituitary-Adrenocortical ABis Acti!ity in <lder 4omen Psychosom
.ed" .ar-AprG%9+#,:#&9-'6
.iller/ S"." 4hen is a little information a dangerous thing N 2oping with stressful life e!ents by monitoring !ersus
blunting" (n S"8e!ine and H"rsin +;ds",/ 2oping and Heal=h" New Lor): Plenum Press/ 1:9$"
.iller/ S"." Predictability and human stress: towards a clarification of e!idence and theory" (n 8"Ber)owitC +;d",/
Ad!ances in ;Bperimental Social Psychology/ Ao1"1'" New Lor)/ Praeger/ 1:91"
Beehr/ *"A" E Newman/ D";"+1:79, Dob stress/ employee health and organisational effecti!enessG a facet analysis/ model
and literature re!iew" Personnel Psychology &1/ %%6-%::"
.iller S./ .angan 2;" +1:9&, (nteracting effects of information and coping style in adapting to gynecologic stress:
should the doctor tell allND Pers Soc Psychol" DulG'6+1,:##&-&%"
.iller S./ 1odoletC ./ .angan 2;/ Schroeder 2./ Sedlace) *A" +1::%, Applications of the monitoring process model
to coping with se!ere long-term medical threats"Health Psychol" .ayG16+&,:#1%-#6
;ndler/ N" S"/ E Par)er/ D" D" +1::$," .ultidimensional assessment of coping: A critical e!aluation" Dournal of Personality
and Social Psychology/ 69/ 9''-96'
8aCarus 1S" +#$$%, ;motions and interpersonal relationships: toward a person-centered conceptualiCation of emotions
and coping"D Pers" @ebG7'+1,::-'%"
Len DL/ 0o 2H/ Len 2@/ Lang .D/ 4u 2L/ Duan 2H/ Hou .@" +#$$%, >uality of life/ depression/ and stress in breast
cancer women outpatients recei!ing acti!e therapy in *aiwan" Psychiatry 2lin Neurosci" AprG%$+#,:1'7-6&"
4ong ./ 8ooney ;/ .ichaels D/ Palesh </ 0oopman 2" +#$$%, A preliminary study of peritraumatic dissociation/ social
support/ and coping in relation to posttraumatic stress symptoms for a parentJs cancer"
Psychooncology" X;pubY .ar #$"
Smith D;/ 1ichardson D/ Hoffman 2/ Pil)ington 0" +#$$6, .indfulness-Based Stress 1eduction as supporti!e therapy in
cancer care: systematic re!iew" D Ad! Nurs" No!G6#+&,:&16-#7"
1eiche ;./ Nunes S</ .orimoto H0" +#$$', Stress/ depression/ the immune system/ and cancer"
Lancet Oncol. OctG6+1$,:%17-#6
Budur 0/ @alcone */ @ranco 0" +#$$%, Diagnosing and managing posttraumatic stress disorder"
2le!e 2lin D .ed" @ebG7&+#,:1#1-#/ 1#6-%/ 1#9-:"
0a3antie ;/ Phillips D(" +#$$%, *he effects of seB and hormonal status on the physiological response to acute psychosocial
stress" Psychoneuroendocrinology"@ebG&1+#,:161-79"
Buret A-" +#$$%, How stress induces intestinal hypersensiti!ity"
Am D Pathol" DanG1%9+1,:&-6" 1e!iew
4right 1D" +#$$6, Stress and atopic disorders" D Allergy 2lin (mmunol" DecG11%+%,:1&$1-%
*hoits/ P"A" +1::6, Stress/ coping and social support processes" Dournal of Health and Social Beha!ior/ &6/ ;Btra issue" '$
years of .edical Sociology 6& M 7:"
8us) B/ 8ash AA" +#$$6, *he stress response/ psychoneuroimmunology/ and stress among (2 patients"Dimens 2rit 2are
Nurs" Dan-@ebG#'+1,:#6-&1"
Ben-;liyahu S" +#$$&, *he promotion of tumor metastasis by surgery and stress: immunological basis and implications
for psychoneuroimmunology" Brain Beha! (mmun" @ebG17 Suppl 1:S#7-&%"
1obins D8/ .c2ain N8/ -ray DP/ ;lswic) 10 Dr/ 4alter D./ .cDade ;" +#$$%, 1esearch on psychoneuroimmunology:
tai chi as a stress management approach for indi!iduals with H(A disease"
Appl Nurs 1es" @ebG1:+1,:#-:"
-a!ranidou/ ."and 1osner/ +#$$&,1"*he 4ea)er SeBN-ender And Post-*raumatic Stress Disorder
Depression And AnBiety 17:1&$M1&:
Pilar .atud/ ." +#$$', -ender differences in stress and coping styles Personality and (ndi!idual Differences &7 1'$1M
*roisi A" +#$$1, -ender differences in !ulnerability to social stress: a Darwinian perspecti!e"
Physiol Beha!" DunG7&+&,:''&-:
0udiel)aa/B"."/ and 0irschbaumb/ 0" +#$$6, SeB differences in HPA aBis responses to stress:
Biological Psychology %: 11&M1&#
Porter/ 8"/ E Stone/ A" +1::6," Are there really gender differences in copingN A reconsideration of pre!ious data and
results from a daily study" Dournal of Social and 2linical Psychology/ 1'/ 19'-#$#"
8undberg/ " +#$$6, Stress hormones in health and illness: *he roles of wor) and gender
Psychoneuroendocrinology &$/ 1$17M1$#1
;ri)sen/ H"1"/ Hellesnes/ B"/ Staff/ P"/ rsin/ H"/ +#$$'," Are sub3ecti!e health complaints a result of modern ci!ilisationN
(nt" D" Beha!" .ed" 11/ 1##M1#6"
Newton/ *"8"/ 4atters/ 2"A"/ Philhower 28/ 4eigel 1A" +#$$6, (nt D Psychophysiol" SepG67+&,:#1:-#9"
2ardio!ascular reacti!ity during dyadic social interaction: the roles of gender and dominance"
Dones/@" and Bright/ D"+#$$', Stress: .yth/ *heory and 1esearch" Prentice Hall" P #61"
Somerfield/ ."1" +1::7, *he utility of systems models of stress and coping for applied research" Dournal of
Health Psychology #/ 1&&-161"
Scheier/ ." @"/ 2ar!er/ 2" S"/ E Bridges/ ." 4" +1::'," Distinguishing optimism from neuroticism +and trait anBiety/ self-
mastery/ and self-esteem,: A re-e!aluation of the 8ife <rientation *est" Dournal of
Personality and Social Psychology/ %7/ 1$%&-1$79"
Aautier/S"/ 1aufaste/ ;" and 2ariou/ ." +#$$&, Dimensionality of the 1e!ised 8ife <rientation
*est and the status of filler items (nternational Dournal <f Psychology/ / &9 +%,/ &:$M'$$
Na)ano 0"Psychol 1ep"+#$$', Psychometric properties of the 8ife <rientation *est-1e!ised in samples of Dapanese
students"DunG:'+& Pt 1,:9':-66"
Bain -H 8emmon H *eunisse/ S " Starr D . @oB H 2 Deary ( D"4halley 8 D +#$$&, >uality of 8ife in healthy old age:
relationships with childhood (>/ minor psychological symptoms and optimism Soc Psychiatry Psychiatr ;pidemiol &9:
*errill D1/ @riedman D-/ -ottschal) 8A/ Haaga DA +#$$#, 2onstruct !alidity of the 8ife <rientation *est"D Pers Assess"
DecG7:+&,:66$-%&"2ounseling 2enter/ *owson ni!ersity/ SA""
2ohen S/ 0amarc) */ .ermelstein 1" A global measure of percei!ed stress"D Health Soc Beha!" 1:9& DecG#'+',:&96-:%"
@ederen)o (S/ SchlotC 4/ 0irschbaum 2/ Bartels ./ Hellhammer DH/ 4ust S" +#$$%, *he heritability of percei!ed
stress"Psychol .ed" .arG&%+&,:&76-96"
-olden-0reutC D./ Browne .4/ @rierson -./ Andersen B8" +#$$', Assessing stress in cancer patients: a second-order
factor analysis model for the Percei!ed Stress Scale"Assessment" SepG11+&,:#1%-#&"
0elly 0S/ Soderlund 0/ Albert 2/ .c-arrahan A-" Social support and chronic fatigue syndrome"
Health 2ommun" 1:::G11+1,:#1-&'"
<dden .2/ 4hooley .A/ Shlipa) .-" +#$$%, Depression/ stress/ and ?uality of life in persons with chronic )idney
disease: the Heart and Soul Study"Nephron 2lin Pract"G1$&+1,:c1-7"
1intala DH/ 1obinson-4helen S/ .atamoros 1" Sub3ecti!e stress in male !eterans with spinal cord in3ury"D 1ehabil 1es
De!" #$$6 .ay-DunG'#+&,:#:1-&$'"
Ietter?!ist 0/ .aanmies D/ Strom 8/ Andersson -" 1andomiCed controlled trial of internet-based stress
management"2ogn Beha! *her" #$$&G&#+&,:161-%$
Aspinwall/ 8"-"/ E *aylor/ S";" +1::#," .odeling cogniti!e adaptation: a
longitudinal in!estigation of the impact of indi!idual differences and coping on college ad3ustment and performance"
Dournal of Personality and Social Psychology/ %&/ :9:-1$$&"
Segerstrom/ S"2"/ *aylor/ S";"/ 0emeny/ .";"/ E @ahey/ D"8" +1::9," <ptimism is associated with mood/ coping/ and
immune change in response to stress" Dournal of Personality and Social Psychology/ 7'/ 1%'%-1%66"
SitC/ ; H" and Poche/ N"+#$$#, -ender Differences (n *he 1elationship Between <ptimism And Percei!ed Stress
Buc)/ N"/ -ershuny/D"/ 1ose/ D" and scott/D"+eds", +1::', 2hanging households : the British Household Panel
Sur!ey 1::$-1::#/ 2olchester: ;S12 1esearch 2entre on .icro-Social 2hange/ ni!ersity of ;sseB"
Duncan-Dones P" +1:7:,Aalidity and uses of the -H>"Br D Psychiatry" <ctG1&6:&9#
;ulberg/ 4ee)ley and Bhagat5s +1:99, .odels of Stress in <rganiCational 1esearch: A .etatheoretical
Perspecti!e Human 1elations"G '1: &&1-&6$
*abachni)/ B"-" and @idell/ 8"S" +#$$1, sing multi!iariate statistics" Harper 2ollins
Brace/ N"/ 0emp/ 1" and Sneglar/ 1" +#$$&, SPSS for Psychologists: a guide to data analysis using SPSS for windows"
Palgra!e .acmillan
Iullow/H"." +1::1, ;Bplanations and eBpectations:understanding the Fdoing5 side of optimism" Psychological
;n?uiry #/1 '6- ':
2ohen S/ 0amarc) */ .ermelstein 1" +1:9&, A global measure of percei!ed stress" D Health Soc Beha!" DecG#'+',:&96-
Scheier .@/ 2ar!er 2S" <ptimism/ coping/ and health: assessment and implications of generaliCed outcome
eBpectancies" Health Psychol" 1:96G'+&,:#1:-'7"